Do EMDR's Eye Movements Matter? Two Meta-Analyses Disagree
Quick Answer
Whether EMDR's eye movements add anything is still contested. The National Center for PTSD states that "There is controversy about the mechanism of action in EMDR or whether bilaterial stimulation is needed," and Christopher Lee and Pim Cuijpers's 2013 meta-analysis found a moderate added effect for eye movements.
EMDR's standing rests on the full protocol. The International Society for Traumatic Stress Studies' 2019 guidelines rated EMDR "strongly recommended" for PTSD in children, adolescents and adults, a rating given to the therapy as a whole.
Whether the eye movements are EMDR's active ingredient is an open research question. The National Center for PTSD, which reviews PTSD treatment research for the U.S. Department of Veterans Affairs, states that there is controversy about EMDR's mechanism of action and about whether bilateral stimulation is needed at all. Psychiatrist and trauma researcher Bessel van der Kolk, one of EMDR's best-known advocates, holds that it is. Speaking on The Diary of a CEO podcast in 2024, he said that moving the eyes while recalling trauma activates brain pathways that help a person register the event as past.
The National Center for PTSD counts 38 randomized controlled trials of EMDR in its PTSD Trials Standard Data Repository. A randomized controlled trial assigns participants to treatments by chance, so differences in results are less likely to reflect who was chosen for each group. The Center notes that trials from the 1990s were less methodologically rigorous and produced conflicting results on how quickly EMDR worked and how well, while more rigorous recent studies support its efficacy as a full protocol. Early evidence on the eye-movement question was gathered largely in those older, weaker designs.
The first pooled test of the eye movements came from Paul Davidson and Kevin Parker, whose 2001 meta-analysis in the Journal of Consulting and Clinical Psychology combined 34 studies of EMDR. They found no incremental effect of the eye movements when EMDR was compared with the same procedure without them, and wrote that the evidence "suggests that the eye movements integral to the treatment, and to its name, are unnecessary." Christopher Lee and Pim Cuijpers later argued that methodological problems in those component studies may have hidden a real effect, and re-ran the question in their 2013 meta-analysis, which found one.
Van der Kolk adds a caution of his own: in his words, early childhood trauma is "much more sort of stubborn and resistant" to EMDR. His comment came in a podcast interview and concerns early childhood trauma specifically, so it is an expert's clinical impression rather than a trial result.
When you meet a prospective EMDR therapist, you can ask which form of bilateral stimulation they use and what evidence shaped that choice.
Do the eye movements in EMDR add anything on their own? The research has not settled it. Eye Movement Desensitization and Reprocessing (EMDR) is a structured trauma therapy in which a client briefly holds a distressing memory in mind while following a therapist's hand, a light, or another back-and-forth signal. That signal is called bilateral stimulation, meaning rhythmic left-right input through the eyes, touch or sound. It gives the therapy its name. Dismantling studies, which remove one piece of a treatment to see whether results change, have tested that component for more than two decades.
I am a licensed professional counselor-supervisor and certified school counselor, and I have practiced as a counselor since 2010, including work with trauma. According to the National Center for PTSD, EMDR has the highest recommendation in the VA/DoD PTSD guideline and in guidelines from the International Society for Traumatic Stress Studies, the UK's NICE and Australia's National Health and Medical Research Council, while the American Psychological Association gave it a conditional rating. Gemma Wilson, Derek Farrell, Ian Barron, Jonathan Hutchins, Dean Whybrow and Matthew Kiernan, in a 2018 systematic review of EMDR for PTSD, noted that much current EMDR evidence "relies on small sample sizes and provides limited follow-up data."
The open question concerns whether the eye movements add benefit beyond the other phases of EMDR, which include preparation, memory processing and reevaluation.
Why does the eye-movement question matter if you are choosing EMDR now?
Research on whether EMDR's eye movements add anything beyond the rest of the protocol remains split, which affects how you weigh the therapy's best-known feature against its other phases.
Before starting EMDR, you can ask a prospective therapist about the full treatment plan, including:
- Ask how much time the therapist spends on preparation and coping skills before any memory work begins.
- Ask which form of side-to-side stimulation they offer, such as eye movements, tapping, tones or a lightbar.
- Ask how you will track progress together, and when you will review it.
- Ask what your sessions will cost under your own insurance benefits.
The National Center for PTSD, part of the U.S. Department of Veterans Affairs, describes EMDR as "one of the most studied treatments" for PTSD, and its 2026 trial repository lists 38 randomized controlled trials of EMDR. The same center states openly that there is controversy about EMDR's mechanism of action and about whether bilateral stimulation is needed at all. Bilateral stimulation is input that alternates between the left and right sides, most often your eyes following the therapist's hand back and forth. According to the center, the therapist leads the client through sets of 20 to 40 back-and-forth movements during the desensitization phase, and proposed functions include lowering physiological arousal and making a memory less vivid and less emotional.
The EMDR Institute, which trains therapists in the approach, cites the 2013 meta-analysis by Christopher Lee and Pim Cuijpers on its efficacy page as support for the eye movement component.
Testing whether one component matters requires a study that delivers the full treatment with and without that component and compares the results.
According to the center, EMDR is typically delivered in weekly individual sessions of up to 90 minutes over about 3 months. In our practice, we tell clients that weekly sessions for 12 weeks is a standard length of time for therapy to make significant progress on a treatment plan. Timelines vary with the complexity of the trauma and the counseling approach, and clients with complex trauma may take longer.
Because a course of EMDR is a real commitment of time and money, it is reasonable to ask a therapist which parts of the protocol they consider essential and why.
Our therapists take most major insurances, but your independent benefits determine your specific payment per session. Our licensed professional counselor associates can take your insurance too. You can call us at 469-238-2686 and we can tell you about your specific plan, and if we cannot accommodate you, we refer you to community partners that take your insurance. If worry or panic is part of what brings you in, our page on anxiety therapy in Frisco describes other therapeutic approaches that can sit alongside trauma work.
What happens to EMDR's results when the eye movements are taken out?
In a 2016 randomized trial led by Martin Sack and published in Psychotherapy and Psychosomatics, 139 adults with PTSD received one of three versions of EMDR that differed only in what their eyes did during recall, and only one version used eye movements. PTSD symptoms fell significantly in all three over an average of 4.6 sessions.
In this design, called a dismantling study, the core work with the trauma memory stays in place while one ingredient is removed or swapped to see whether results change.
| Group in the 2016 trial | What participants did during recall | PTSD symptoms |
|---|---|---|
| Eye movements | Followed back-and-forth eye movements | Fell significantly |
| Fixed visual attention | Held their attention on a fixed visual point | Fell significantly |
| Exposure alone | Recalled the memory with no added visual task | Fell significantly, less than in the other two groups |
Symptoms were measured with the Clinician-Administered PTSD Scale by an assessor who did not know each participant's group. The two groups that kept their eyes on the therapist's hand, moving or still, improved significantly more than the group that recalled the memory with no visual focus, and the eye-movement and fixed-gaze groups did not differ from each other. Sack and colleagues concluded that "exposure in combination with an explicit external focus of attention leads to larger PTSD symptom reduction than exposure alone" and that "eye movements have no advantage compared to visually fixating on a nonmoving hand."
The National Center for PTSD, part of the U.S. Department of Veterans Affairs, reviews four randomized trials of EMDR with military or Veteran participants, all published before 2000. EMDR improved PTSD symptoms about as much as several comparison conditions, including EMDR without eye movement. Only one of the four delivered a full course of treatment; the others ran one to three sessions.
Christopher Lee and Pim Cuijpers reached a different result in a 2013 meta-analysis that pooled 26 studies with 849 participants in the Journal of Behavior Therapy and Experimental Psychiatry: 15 clinical trials and 11 laboratory experiments. Eye movements added a measurable effect in both groups of studies, and the effect was larger in the laboratory. Their abstract notes that an earlier meta-analysis had found no significant effect for the eye movement component, and attributes that to methodological problems in the studies it pooled.
The laboratory studies were analogue tasks in which nonclinical participants recalled distressing memories. In those tasks, eye movements did the most to reduce how vivid and emotionally intense the memories felt. Lee and Cuijpers proposed that eye movements tax working memory, lowering a memory's emotional salience during recall. The National Center for PTSD treats the analysis as support for eye movements reducing subjective distress, and adds that it "included studies beyond PTSD that used primarily self-report measures."
In clinical practice, the ingredient under test often involves no eye movement at all. The National Center for PTSD lists the ways a therapist may deliver bilateral stimulation, in sets of 20 to 40 back-and-forth movements: following the therapist's hand with the eyes, a lightbar, tactile tappers or buzzers, self-tapping, tones through headphones, and apps or websites. The same page says, "There is controversy about the mechanism of action in EMDR," and notes that whether bilateral stimulation is needed at all is still debated.
A research team led by Jinhee Baek reported in Nature in 2019 that in mice, bilateral stimulation led to "a clear and persistent decrease in fear behavior" compared with control conditions, as summarized by Gianluca Castelnuovo, Isabel Fernandez and Benedikt Amann, the editors of a Frontiers in Psychology research collection. A study in mice can point to a possible brain pathway. It cannot show what eye movements add for a person working through trauma with a therapist.
Across these studies, the clearest effect of eye movements appears during recall, in how intense a memory feels in the moment. EMDR therapists track that in-session change: Jessica Burgess, a psychologist whose primary client group is veterans, describes continuing bilateral stimulation until distress falls to "a one or a two out of 10." When researchers follow PTSD symptoms across a full course of treatment, the added effect of eye movements is moderate in the pooled treatment studies and, in the 2016 trial, absent once eye movements were compared with a fixed gaze. Improvement appeared in every group that worked repeatedly with the trauma memory. On current evidence, EMDR's results are better credited to the full structured protocol than to the eye movements alone.
Questions to bring to an EMDR therapist
- Ask which forms of bilateral stimulation the therapist uses, such as eye movements, a lightbar, tappers or tones, and whether you can try another form if following a moving hand is uncomfortable for you.
- Ask how much of each session will involve working directly with the trauma memory and how the therapist will pace that work. All three groups in the 2016 trial shared that element, and all three improved.
- Ask whether your PTSD symptoms will be tracked across treatment with a standard questionnaire such as the PCL-5, alongside the 0 to 10 distress ratings used within sessions.
- When you read that eye movements are proven, check whether the study involved people in PTSD treatment or volunteers in a laboratory memory task, and whether it measured distress during recall or symptoms after treatment.
How we checked this
We read the published abstracts of the Sack trial and the Lee and Cuijpers meta-analysis, not the full journal articles. We first found both studies through an April 26, 2026 essay on the Substack newsletter at drnicole.substack.com, written by a licensed clinical psychologist who publishes under the name Dr. Nicole. Her summary of the Sack trial's conclusion differs from the authors' own abstract, so we quote the abstract. The EMDR Institute, which promotes EMDR, reports the same effect sizes as Lee and Cuijpers. The editors of the Frontiers collection publish EMDR research. None of the figures here come from our practice. We offer EMDR, so we have a stake in how it is described. Still unknown: whether some clients, such as those who find direct recall hardest, gain more from bilateral stimulation than others. None of our sources tested that.
- National Center for PTSD, EMDR for PTSD professional overview, August 4, 2026.
- Martin Sack and colleagues, three-arm dismantling trial, Psychotherapy and Psychosomatics, 85(6), 2016, abstract.
- Christopher Lee and Pim Cuijpers, meta-analysis of eye movements in emotional memory processing, Journal of Behavior Therapy and Experimental Psychiatry, 44(2), 2013, abstract.
- drnicole.substack.com, essay comparing EMDR and exposure therapy, April 26, 2026.
- EMDR Institute, EMDR efficacy summary page, February 15, 2015.
- Castelnuovo G., Fernandez I. and Amann B.L., Frontiers in Psychology editorial on EMDR research, September 27, 2019.
- Jessica Burgess, psychologist, Wombat: Psychology and Telehealth webinar on EMDR, February 28, 2024, at 4:25 and 5:54.
Where does the EMDR evidence pull in different directions?
Guideline bodies endorse EMDR as a whole while the reviews beneath them rest on small samples, so we offer a free consultation to talk that uncertainty through before you commit.
A 2019 editorial in Frontiers in Psychology by Gianluca Castelnuovo, Isabel Fernandez and Benedikt Amann reported that the World Health Organization recognized EMDR in 2013 as a first-choice treatment for PTSD, and that the International Society for Traumatic Stress Studies rated it "strongly recommended" for children, adolescents and adults in its 2019 guidelines. The same editorial noted that the American Psychological Association's 2019 guideline gave EMDR only a "conditional" recommendation for adult PTSD, which caused controversy. After a published comment, the APA updated its guideline with the view that future reviews would probably move EMDR from conditional to strong.
For a client, this means the strength of the recommendation you hear can depend on which guideline a therapist follows.
The editors also described EMDR's theory. The Adaptive Information Processing model holds that much psychological distress comes from memories of disturbing experiences that were encoded poorly or never fully processed. In this model, bilateral stimulation is what helps those memories finish processing.
Support for that idea has come from an animal study. In a mouse study led by Jinhee Baek, bilateral stimulation produced "a clear and persistent decrease in fear behavior" compared with control conditions. It also increased activity in two brain regions that dampened excitability in the amygdala, the brain's threat detector. The editors called the work groundbreaking. They also wrote that further robust randomized controlled trials, and research on EMDR's specific mechanisms in humans, were still necessary.
Findings in mice have not yet been confirmed in people receiving EMDR, which is the gap the editors pointed to.
The human reviews carry their own limits. In a 2018 systematic review in Frontiers in Psychology, Gemma Wilson and colleagues at Northumbria University found that EMDR improved PTSD diagnosis, reduced PTSD symptoms and reduced other trauma-related symptoms. Their search produced two meta-analyses and four randomized controlled trials that met their quality standards, including one meta-analysis of 26 studies with 1,133 participants. The authors also noted a limitation: "much current evidence relies on small sample sizes and provides limited follow-up data."
When you meet a prospective EMDR therapist, you can ask which of these guidelines they follow and how they explain the conditional rating. You can also ask how they would adjust the plan if eye movements feel uncomfortable or overwhelming for you.
We offer free consultations so clients can decide whether we are a good therapeutic match, and that conversation is a good place to ask how a therapist thinks about this uncertainty. You can read how we structure care on our page about EMDR therapy in Frisco, including the preparation work that comes before any memory processing.
What can you trust about EMDR while the eye-movement question stays open?
EMDR's eight phases, from history taking to reevaluation, stay the same whichever form of bilateral stimulation a therapist uses, and only one of the eight involves that stimulation.
EMDR is a structured therapeutic approach with eight phases: History Taking, Preparation, Assessment, Desensitization, Installation, Body Scan, Closure, and Reevaluation. The bilateral stimulation happens only during Desensitization, while the client holds the targeted memory in mind. The other seven are where a client's history is gathered, where clients learn ways to manage anxiety before any memory work begins, and where each session is closed and progress is reviewed.
Jason Dean, a therapist trained in EMDR, describes one session in a 2025 video: the client follows a strobing light with his eyes while holding handles that pulse in sync with it, for 40 seconds, before picturing the traumatic scene again. The client rates his distress on a scale of 1 to 10 before reprocessing, and Dean reports that the rating "begins to come down" afterward. You can ask a therapist how they track that rating across sessions and what they do if it stops falling.
When you are comparing therapists, it is reasonable to ask how many sessions they usually plan and how much EMDR experience they bring to the work.
A commenter in a 2024 thread on the r/ptsd forum described their own course of EMDR this way: "The therapist is essential for the success, I had a brilliant one and she really saved me." I include it because it shows one client locating the change in the relationship and the process. It is a single account. It cannot tell us how often EMDR helps, or why.
The questions worth bringing to a first conversation with an EMDR therapist concern preparation, pacing, and what happens when a session becomes overwhelming.
Some traumatic memories are tied to the death of someone close. When a loss is part of the trauma, our grief therapy in Frisco, TX can work with the grief directly, alongside trauma processing.
Where does the eye-movement debate leave you if you are considering EMDR?
If you are considering EMDR, psychologist Jessica Burgess has described several forms of bilateral stimulation, including eye movements, manual tapping, tactile buzzers placed on the wrists and bilateral sound through headphones.
The two meta-analyses point in different directions. Paul Davidson and Kevin Parker's 2001 meta-analysis of 34 studies in the Journal of Consulting and Clinical Psychology found no incremental effect of the eye movements when EMDR was compared with the same procedure without them. Christopher Lee and Pim Cuijpers's 2013 meta-analysis in the Journal of Behavior Therapy and Experimental Psychiatry found a moderate added effect of eye movements in clinical studies (d = .41) and a larger one in laboratory studies (d = .74). The letter d is an effect size, a standard way of expressing how big a difference is. The U.S. Department of Veterans Affairs' clinician guidance on EMDR reports that in four trials with military Veterans, all published before 2000, EMDR improved PTSD symptoms about as much as comparison conditions that included EMDR without eye movements.
Group averages cannot tell any one client whether the eye movements will matter for them. No study design yet answers that.
Before you begin, you can ask a prospective EMDR therapist how they explain the role of the eye movements and what the rest of the protocol involves. Our team offers free consultations so you can decide whether we are a good therapeutic match, and you can call our office at 469-238-2686 to get started. If you are feeling overwhelmed by trauma memories or having thoughts of suicide, you can call or text 988 to reach the Suicide & Crisis Lifeline.
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Frequently Asked Questions
What else do people ask about EMDR and its eye movements?
Psychologist Jessica Burgess, presenting a 2024 webinar on EMDR and PTSD for Wombat: Psychology and Telehealth, said EMDR assessment includes screening for dissociation, because "higher levels of dissociation will require a different protocol."
Do I have to describe my trauma in detail during EMDR?
Not necessarily. Burgess explained that therapists can work "blind," processing a memory without the client disclosing its details. That option can matter a great deal if speaking about what happened feels impossible right now.
Is EMDR a good fit for everyone with trauma?
Some situations call for caution first. Active psychosis and dissociation, a state of feeling disconnected from yourself or your surroundings, need stabilization before memory processing. Burgess noted that epilepsy and cardiovascular conditions need confirmation from a physician, because sessions can involve "intense physiological arousal."
How does a therapist know when to stop the bilateral stimulation?
Sets continue until the client's distress about the memory drops to about "a one or a two out of 10," as Burgess described it. The client's own rating guides the pace.
Can EMDR be done by video?
Yes. Burgess described remote delivery using "remote guided visual bilateral stimulation" that is "clinician controlled and on a screen." Our practice provides trauma and EMDR counseling in person in Frisco and by video across Texas.
Does insurance cover EMDR at your practice?
Our therapists take most major insurances, but your independent benefits determine your specific payment per session. Our licensed professional counselor associates can take your insurance too. Call us at 469-238-2686 and we can tell you about your specific plan, and if we cannot accommodate you, we refer you to community partners that take your insurance.
Written by
Bonnie King
PhD, LPC-S, CSC
Bonnie King, PhD, LPC-S, CSC, has practiced as a counselor since 2010, working with children, adults, and teens with a variety of mental health concerns, including trauma, mood disorders, and specific concerns related to LGBTQ+ marginalization.
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