CPT vs. EMDR: A Guide to PTSD Treatments

In the world of trauma-specific therapies, the journey to healing can be multifaceted. Cognitive Processing Therapy (CPT) and Eye Movement Desensitization and Reprocessing (EMDR) have emerged as two of the most common therapies for PTSD. As we make sense of the therapeutic landscape, it is important to understand the nuances between CPT and EMDR, particularly when it comes to their evidence and effectiveness.

Cognitive Processing Therapy (CPT)

CPT is a cognitive-behavioral therapy where the primary goal is to help survivors comprehend and reframe negative thought patterns borne from traumatic events. The therapy is very skills-based, involving the completion of worksheets after every session.  The therapy operates in four stages:

1. Education: Understanding PTSD and its ramifications
2. Exploration: Discovering erroneous beliefs one holds about the traumatic event (e.g., “It was my fault,” “I knew better than to trust him”)
3. Reframing: Actively challenging and correcting these beliefs
4. Skill Development: Implementing strategies to prevent relapse and maintain a balanced perspective. CPT reviews 5 basic domains of life to ensure patients feel prepared for their future, including personal safety, their ability to trust, power and influence, self-esteem, and intimate relationships. 

CPT is firmly rooted in empirical research. In fact, studies show that CPT demonstrates a positive response in up to 90% of patients. Given CPT’s structured nature and substantial research backing, CPT is a first-line treatment in every PTSD treatment guideline, such as the one from the National Center for PTSD. Because it is based on CBT (cognitive behavioral therapy), it is a therapy that often improves co-occurring issues as well, including depression, anxiety, suicidal thoughts and substance use. 

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR, while beneficial to many, is shrouded in some debate. The hallmark of EMDR is “bilateral stimulation,” which is believed to assist in reprocessing traumatic memories. When completing EMDR, a patient is asked to re-immerse themselves in their trauma while a therapist has the patient follow their finger to induce eye movements. The goal of bilateral stimulation is to help patients reprocess and desensitize to their trauma. However, the research has yet to prove that the bilateral component is the reason EMDR shows some efficacy. Some experts call EMDR a "purple hat therapy," because EMDR’s effectiveness may not be due to the bilateral stimulation, but due to the cognitive and exposure elements of the therapy, which is common to all PTSD treatments. 

Regardless, many survivors benefit from EMDR, though it remains a second line treatment due to the less substantial evidence base when compared to therapies like CPT. It is also more widely available in the community and does not require assignments outside of session, which can be appealing for some survivors. 

The Question of Choice

Which therapy to pick is inherently a personal choice—and one that requires an understanding of individual preferences, therapist recommendation, and empirical evidence. While the weight of evidence tilts in favor of CPT, EMDR continues to serve as a transformative experience for many. Some factors that you may consider when deciding which trauma therapy is best for you include:

• Therapist Expertise: A therapist's experience and training in a modality can significantly influence outcomes. Certifications exist for both CPT and EMDR, and should be reviewed when selecting a therapist. 
• Personal Preference: Some individuals may appreciate the systematic and skills-based approach to CPT that better generalizes to everyday situations. Others may prefer EMDR due to the trauma exposure component or the lack of out-of-session assignments. ‍
• Availability: While more evidence-based, CPT is more difficult to find in many communities. Availability and access can significantly influence treatment choice.

Move Forward with Clarity

Both CPT and EMDR offer avenues to healing with their unique methodologies. If you or a loved one is at a crossroads of deciding which trauma-specific therapy to do, start by considering their research foundations, applications, and potential outcomes. Doing so can help illuminate the path to discovery.