What Is the Difference Between EMDR Therapy and Cognitive-Behavioral Therapy? The most effective programs for treating psychological disorders use a variety of therapies. Two of the most widely accepted methods focusing on mental health disorders and substance abuse are eye movement desensitization and reprocessing (EMDR) and cognitive-behavioral therapy (CBT). But what are their differences, and can they complement each other despite these?
The differences between EMDR therapy and cognitive-behavioral therapy lie in how they extract patient information, how they administer treatment, and how long they last. EMDR relies on bilateral stimulation via eye movement to “rewire” the brain, while CBT uses behavior and thought modification.
Let’s see how each therapy can benefit different cases and if they can work together seamlessly.
What Is EMDR?
EMDR is a therapy used to treat emotional and mental health conditions, including anxiety, addiction, phobia, chronic pain, and post-traumatic stress disorder (PTSD).
Therapists instruct patients to follow the therapists’ fingers or hands with their eyes as they move from left to right and back and forth. This process is called bilateral stimulation (BLS), which activates the left and right sides of the brain. While the eye movements are taking place, therapists encourage patients to safely recall a “target memory,” an event that upsets them the most that may be the root cause of their medical condition.
Bilateral stimulation through eye movement diverts patient focus toward the fingers and away from the discomfort of memory recall. The objective of BLS is to encourage the patients’ brains to “reprocess” distressing thoughts, images, and memories so that when patients recall them, they are no longer upset by them.
This “disassociation” — separating memories from pain — teaches the brain to associate them instead with less upsetting feelings. In this way, the brain can heal.
How Does EMDR Work?
The human brain breaks down a life event into feelings, thoughts, and images and stores them in a network. EMDR founder Dr. Francine Shapiro considered this when she created EMDR. She based the therapy on the Accelerated Information Processing model, which theorizes that improperly stored and incompletely processed memories cause many mental disorders.
When we undergo trauma, the experience interferes with our brain’s information processing capability so that it stores only the first part of our thoughts, images, and emotions associated with the event. The remaining unprocessed information causes abnormal reactions in the brain that lead to mental health problems. That’s why BLS (zapping the brain’s two sides) is necessary to jolt the brain back to its “normal self.”
Benefits of EMDR
Many studies prove EMDR therapy helps patients suffering from trauma resulting from crime, accident, abuse, war, terrorism, natural disaster, and mass-casualty events (like community homicide).
It also has a positive effect on:
- Associated grief
- Invasive imagery (night terrors, flashbacks)
- PTSD triggers and symptoms
What Is CBT?
CBT is a psychotherapeutic treatment that teaches patients to identify, challenge, and replace destructive habits, thoughts, or behavior that cause (and worsen) anxiety, depression, and emotional difficulty with objective, realistic ones. CBT’s tenet revolves around core beliefs summed up in three categories: the self, others, and the future.
How Does CBT Work?
CBT teaches patients specific skills. It is different from other psychotherapy approaches because it focuses on how patients’ cognitions (thus, the name), behaviors, and feelings are linked to and affect each other. This connection allows cognitive therapists to intervene at various points in the process.
CBT focuses on minimizing problematic behavior connected to mental health disorders. CBT patients learn to anticipate risky situations and apply coping strategies to prevent relapse.
- Mental distraction
- Relaxation techniques
Exercises and Assignments
The behavior portion of CBT therapy involves giving patients tasks to challenge their irrational beliefs, plus homework. Assignments include keeping a diary of thoughts and, for socially anxious patients, going to a party. The objective is for patients to identify unhelpful beliefs and prove these wrong. The skills taught in the sessions require practice but will sustain patients throughout their lives.
Clinical Applications of CBT
CBT manages many emotional and mental health conditions, such as:
- Psychological reactions to violence or abuse
- Eating disorders (bulimia, anorexia nervosa)
- Emotional difficulties (panic, anxiety)
- Mental health disorders (phobia, sleep disorder, bipolar disorder, schizophrenia, depression, obsessive-compulsive disorder)
- Relationship challenges, including familial or marital conflicts
- Self-esteem challenges
- Addiction (most forms, including substance abuse)
- Stressful life challenges, including diagnoses of terminal illnesses, divorce, or bereavement
- Trauma, including PTSD
In certain cases, CBT works best combined with other treatments, such as an antidepressant or anti-anxiety medication added to cognitive therapy for anxiety or depression.
Approval From the Authorities
Controlled research has proven that CBT and EMDR are equally effective in treating PTSD. These organizations have approved both therapies for trauma treatment:
- American Psychiatric Association
- US Department of Defense
- US Department of Veterans Affairs
- International Society for Traumatic Stress Studies
- World Health Organization (WHO)
- Substance Abuse and Mental Health Services
However, research into EMDR therapy is still ongoing. The Trauma Recovery/EMDR Humanitarian Assistance Programs (HAP) publishes a regularly updated research study database on their website.
Differences Between EMDR and CBT
The World Health Organization guidelines on the differences between research-supported trauma treatments detail the differences between EMDR and trauma-focused CBT (TF-CBT). Unlike trauma-focused CBT, EMDR does not involve:
- Direct belief challenge
- Detailed descriptions of the traumatic event
- Extended exposure
Also, unlike TF-CBT, which involves in- and out-sessions, everything that takes place in EMDR sessions is done under the watchful eye of the therapist. Additionally, Shapiro discovered that seven out of 10 randomized controlled trials (RCTs) have proven that EMDR has quicker results and is superior to TF-CBT in some instances.
MedCircle reports that when Dr. Shapiro discovered the relationship between eye movements and traumatic memory, she conducted controlled studies to learn more. The results of these explorations demonstrated that EMDR significantly minimized the emotional distress linked to traumatic memories and maximized confidence in positive beliefs.
More research continued to follow. As they usually do with new technology, researchers compared EMDR to other established therapies, including CBT and exposure therapy — the standard of care for PTSD. Meta-analyses (comprehensive reviews of research) have consistently shown EMDR to be as effective — if not superior — to CBT and exposure therapy.
This webinar featuring EMDR creator Dr. Francine Shapiro can help you learn more about how EMDR works with unprocessed memories:
EMDR’s Similarities in Methodology With CBT
According to the American Psychological Association, EMDR’s similarities with CBT lie in their techniques:
- EMDR has also been applied successfully to treat other mental health issues.
Apart from phobias, chronic pain, anxiety, and depression, EMDR addresses the same mental health issues CBT treats, such as personality disorders, bipolar disorder, body dysmorphia, psychosis, and schizophrenia.
- EMDR is similar to CBT in its goal. EMDR’s objective is to gain a fresh perspective of traumatic memories by exploring the thoughts, images, emotions, and physical sensations connected to them, then change these so they won’t be as upsetting. CBT modifies how trauma patients feel and act by changing the thinking and behavior patterns responsible for negative emotions.
- EMDR also teaches coping strategies. EMDR does this in phases two and eight. In phase two, therapists teach patients stress-relief techniques and review how they use these skills between sessions. In phase eight, therapists and patients scrutinize progress and discuss potential future events that may need different responses, skills, or coping strategies.
- EMDR also reprocesses information. EMDR connects positive emotions and new skills to the target traumatic memory, teaching the brain to store fresh information properly. EMDR teaches patients to disconnect damaging emotions from traumatic memories to cope with them.
- EMDR patients also keep logs the way CBT clients keep journals. EMDR’s phase seven encourages closure. Patients achieve this by keeping logs of emotions or memories. Journaling is a form of expression of what a suffering individual is feeling inside. It can be quite cathartic.
- EMDR and CBT have shorter durations compared to others. Dr. Shapiro’s studies revealed that EMDR relieves some PTSD symptoms after three 90-minute sessions. Those with severe symptoms need more. EMDR also requires fewer treatment hours, making it more efficient than exposure therapy, which entails extensive treatment. CBT treatment is often short-term (6 to 20 sessions). Patients participate in session and out.
Studies on the Effectiveness of Both Therapies
Researchers published many studies on the effectiveness of EMDR and CBT. Scholars performed meta-analyses of those studies to summarize accumulated findings, which include these few examples:
- Cochrane Database of Systematic Reviews, 2013. Seventy studies revealed EMDR to be more effective at treating PTSD than standard treatments, like support therapy, non-directive counseling, and non-trauma-focused CBT. One of these is Bisson and Andrew’s Psychological treatment of post-traumatic stress disorder.
- Clinical Psychology and Psychotherapy, 1998. Sixty-one clinical trials on PTSD treatment proved that EMDR and CBT were equally the most effective PTSD treatments.
- Journal of Clinical Psychiatry, 2013. One hundred twelve studies indicated that CBT, EMDR, and exposure therapy effectively treat PTSD, and therapists can add various medications to the treatments.
- Study on juveniles, 2012. Five clinical trials with children and adolescents undergoing EMDR therapy revealed that preliminary studies had promising results, but research on adolescents with PTSD is limited.
- Shapiro’s Post Analysis
She found 24 random clinical trials supporting EMDR therapy for emotion-based trauma and seven studies acknowledging EMDR to be more effective than trauma-focused CBT. She also reported that 12 eye movement studies quickly and drastically reduced patients’ experience of negative emotions and troublesome images post-therapy.
Clinical Studies Comparing EMDR and CBT
- Treatment with EMDR. According to Drug Rehab, EMDR therapy alleviates distress associated with traumatic memories, which are often the cause of substance use disorders. Addiction-focused EMDR accomplishes this by reprocessing disturbing memories to minimize impulses to smoke, use drugs, drink alcohol, gamble, or engage in other compulsive behaviors.
- Treatment with CBT. CBT is appropriate for treating addiction because many people turn to nicotine, drugs, alcohol, or irrational behavior due to mental health issues or extreme stress.
CBT is built on the premise that the brain’s defective information processing leading to inaccurate and abnormal thoughts can cause negative emotions and destructive behavior, like substance abuse. Therapists identify and evaluate patients’ negative thoughts and help them develop realistic ones to create healthier behaviors.
PTSD arises in those who experience or witness a tragic, traumatic, or horrific event. The manifestations come in the form of numbness, bothersome thoughts, and scary memories of their experience.
The definition of PTSD has since expanded to include people with less severe but equally distressing experiences, such as unpleasant run-ins with family, friends, and colleagues. Traumatic or not, unprocessed memories are usually the cause of PTSD symptoms.
Although the organizations above have already approved both EMDR and CBT for treating PTSD, Shapiro still embarked on studies to compare EMDR’s effectiveness in trauma-related disorders with CBT’s efficacy. Her study revealed that EMDR offers equivalent effects to CBT but delivers these more quickly— with fewer sessions and no homework. Process analyses also indicated less distress for EMDR patients.
EMDR Versus Desensitization Versus Exposure Therapy in PTSD
When a group of researchers published the first EMDR study in 1989, another group also published the first three CBT studies on PTSD treatment. One used desensitization with civilian participants, and two tested flooding (exposure therapy) with veterans. All CBT studies achieved moderate effects after 6 to 14 sessions.
In contrast, the EMDR study showed marked desensitization of a traumatic memory in just one session. Two meta-analyses confirmed the similarity between EMDR and CBT in PTSD treatment. One meta-analysis also tested efficiency and concluded that EMDR was more effective than CBT because the EMDR studies used fewer sessions to achieve the same results.
A phobia is extreme, irrational anxiety, fear, or aversion to an object or situation, leading to the sufferer avoiding the stimulus or enduring it with great distress. It differs from common fears in that it adversely affects daily functioning.
Triscari et al.’s study, “Two Treatments for Fear of Flying Compared — Cognitive Behavioral Therapy Combined with Systematic Desensitization or Eye Movement Desensitization and Reprocessing,” was the first use of EMDR with CBT in treating the fear of flying. It tested a CBT-EMDR combination treatment and compared it with CBT-and-systematic desensitization (SD) fusion therapy to minimize the fear of flying.
The researchers concluded that both psychotherapeutic techniques (CBT and EMDR) posted significant improvements to the participants’ phobias. Questionnaire scores and participation in post-treatment flights proved this. EMDR posted similar results to SD.
Even though both investigated therapies showed clinical and statistical effectiveness in post-treatments similar to the CBT-SD combo, the researchers concluded that more in-depth investigation is required.
Marsden et al.’s study, “A randomized controlled trial comparing EMDR and CBT for obsessive-compulsive disorder (OCD),” compared EMDR to CBT in treating OCD based on response prevention and exposure. The researchers found that both therapies had comparable rates and clinical outcomes.
Child trauma greatly increases an individual’s potential to develop PTSD, either right after the trauma or much later in adulthood. Psychotherapeutic interventions like EMDR and CBT reduce the probability of developing PTSD.
- Juvenile Trauma with EMDR. To prevent or minimize the onset of PTSD symptoms, EMDR therapists use the eye movement method with patient memory recall to deal with the trauma.
- Juvenile Trauma with CBT. To achieve the same goal as above, CBT challenges the patients’ negative, distorted thinking linked to the trauma to help them develop positive thoughts and behaviors.
The clinical trial CBT-Eb Plus EMDR Versus CBT-Eb in Patients With Eating Disorders investigated a combination of enhanced CBT (CBT-E) and EMDR to treat eating disorders. The researchers discovered CBT-E alone to be an effective treatment for most participants, but 30% of them found remission difficult. The experts concluded that a combination of CBT-E and EMDR would help in the case of remission.
Panic Disorder and Anxiety
Research proves that both EMDR and CBT are effective in treating panic disorder. However, EMDR reduces symptoms faster than CBT, and its effects last longer.
- Anxiety with EMDR. An advanced version of EMDR reduces panic attacks and anxiety. Several studies showed that the eye movements used during EMDR minimize the intensity of patient apprehension.
- Anxiety with CBT. Cognitive therapists teach patients to apply new strategies to deal with anxiety. Strategies like role-playing and self-observation help them develop alternative viewpoints to lessen anxiety levels.
Self-esteem means confidence in one’s abilities or self-worth. People with healthy self-esteem do not need the positive opinions of others to feel good about themselves. They accept the way they are. People with low-self esteem don’t feel they are good enough. They are easily affected by people’s opinions and frequently bow to societal pressure.
Study on Adults
Griffioen et al.’s study, “The Effect of EMDR and CBT on Low Self-esteem in a General Psychiatric Population — A Randomized Controlled Trial,” reports that both EMDR and CBT are potentially effective treatments for patients suffering from low self-esteem and other psychiatric disorders.
Patients scored higher on the self-esteem measuring device called the Rosenberg Self-esteem Scale after treatments from both therapies. They also reported a considerable decrease in social anxiety, more social interactions, and fewer psychiatric symptoms. All the effects of the treatment lasted three months at follow-up.
Sixty percent of the participants who underwent ten therapy sessions reported marked improvement in self-esteem. There were no obvious differences between the effects of EMDR and CBT.
The Griffioen Study Had Several Strengths
It is one of the first randomized controlled trials (RCTs) primarily focused on the effectiveness of EMDR therapy for low self-esteem in adults. It is also one of the first RCTs examining the efficacy of CBT in treating low self-esteem.
In contrast to previous studies examining EMDR’s effect on low self-esteem — Wanders et al., 2008 (see below) and Staring et al., 2016 — the Griffioen study didn’t have participants with PTSD. This led the researchers to think that EMDR therapy was more effective in changing self-esteem than treating trauma-related symptoms.
With regard to the self-esteem treatment, the Griffioen study was one of the first to include a diverse group of participants with varying psychiatric disorders. The results suggest that EMDR and CBT are effective for treating low self-esteem in this challenging demographic. This study also had a follow-up to measure the treatment results over time, concluding that both EMDR and CBT’s treatment effects were maintained.
Study on Juveniles
The results of the Griffioen study were consistent with Wanders et al.’s 2008 study, “EMDR Versus CBT for Children With Self-Esteem and Behavioral Problems — A Randomized Controlled Trial.” Researchers found similar effects in adolescents. EMDR therapy and CBT proved equally effective in reducing low self-esteem.
The Wanders study involved 26 children with a mean age of 10.4 years who had behavioral problems. Researchers randomly assigned them to undergo four sessions of either EMDR or CBT before their usual treatment in outpatient and inpatient clinics.
To assess the treatment’s effectiveness, parents and mentors completed various behavioral measures and self-report instruments. The children finished self-assessment instruments before therapy, right after therapy, and at the follow-up after six months.
EMDR and CBT had notable positive effects on self-esteem and behavioral problems. Although the differences between EMDR and CBT treatment effectiveness were minimal, the children who originally received EMDR showed considerably larger changes in target behaviors than the kids in the CBT group.
The results support the use of EMDR in producing markedly positive and sustained effects on children’s self-esteem and related conditions.
- Low Self-Esteem with EMDR. People usually develop negative emotions and core beliefs that lead to low self-esteem because of past experiences. EMDR helps reprogram emotional memories that reinforce the core belief that they are not good enough. Processing these memories in an EMDR session allows patients to re-evaluate these experiences, positively influencing their self-esteem.
- Low Self-Esteem with CBT. Cognitive therapists teach patients practical skills to identify negative emotions and destructive thoughts and replace these with positive ones. CBT sessions encourage patients to face problems and overcome challenges. Their self-esteem will grow when they become successful using these techniques.
- Cancer with EMDR. EMDR therapy is effective in treating cancer-related trauma and stress. It also helps reduce cancer patients’ depression and anxiety levels. Research shows that the discussion of a cancer diagnosis during EMDR treatment sessions considerably reduced anxiety, depression, and PTSD symptoms.
- Cancer with CBT. CBT’s psychotherapeutic approach focuses on how thinking affects the way patients feel. They can use this premise to reduce the pain and negative emotions that come with different cancer cases.
The cognitive therapist begins therapy by gathering important facts about the cancer patient’s diagnosis and what worries them about it. These may be concerns over cancer treatments like chemotherapy and how it may cause them to lose their hair. The therapist then explores the issue by asking the patient to identify negative thoughts and their possible effects on cancer treatment.
The therapist then suggests a new way of thinking to encourage the patient to explore different perspectives to help them deal with all aspects of their illness.
EMDR and CBT Join Forces
EMDR and CBT can be combined to increase the effectiveness of treatments. EMDR targets the negative feelings, thoughts, and images linked to stored memories of a traumatic experience, often leading to mental health issues. To solve these challenges, it reprocesses negative information related to past, present, or future experiences.
EMDR helps patients overcome trauma by desensitizing them to disturbing thoughts and emotions by using the eye movement method to stimulate both sides of the brain as they recall upsetting events.
Adding CBT to EMDR treatments incorporates healthy ways of thinking into patients’ daily lives. EMDR provides insights to eliminate past irrational beliefs to prevent patients’ brains from repeatedly playing them out. CBT can help replace these negative thoughts and emotions with healthy ones to resolve mental health issues.
The EMDR Debate Continues
This review reveals that experts don’t agree among themselves about EMDR processes, why these work, and how to measure their efficiency. EMDR has appeared on the scene much later than CBT, which doesn’t attract the same amount of skepticism. Some researchers are calling for an integrative model to capture EMDR’s many effects. The late Dr. Shapiro’s successors are continuing her work in this regard.
Not only is it excruciating to recall past trauma, but it also takes time and effort to overcome the damaging thoughts and behaviors associated with them. Fortunately, we now have many choices in therapies for dealing with these challenges, leading with EMDR and CBT.
Both are considered safe and effective approaches to treating trauma and mental health disorders — as long as experienced therapists lead the treatments. The established CBT can be the anchor therapy, with EMDR as a complementary treatment.
Ultimately, we have to decide which therapy is right for us. But let’s check with our primary care physicians first.