EMDR vs. CPT vs. Prolonged Exposure vs. CBT: Choosing a Trauma Therapy

The Short Answer

Eye Movement Desensitization and Reprocessing (EMDR), Cognitive Processing Therapy (CPT), and Prolonged Exposure (PE) are all recommended first-line psychotherapies for PTSD in the 2023 U.S. Department of Veterans Affairs and Department of Defense (VA/DoD) Clinical Practice Guideline. Research comparing them generally finds similar overall results. The best treatment for you usually depends on:

• How much detail about the trauma you’re willing to share
• Whether guilt and self-blame, or fear and avoidance, are the biggest problems
• How much time you have for practice between sessions
• Your personal preference, which matters, since people do better in treatments they believe in

What Is CBT, and How Does It Relate?

Cognitive Behavioral Therapy (CBT) is a broad family of treatments that work on the links between thoughts, feelings, and behaviors. CPT and PE are both specific, trauma-focused forms of CBT. When people compare “EMDR vs. CBT” for trauma, they usually mean EMDR vs. trauma-focused CBT, such as CPT or PE. General CBT without a trauma focus is very effective for anxiety and depression, but for PTSD, the trauma-focused versions have the strongest evidence. Learn more about Cognitive Behavioral Therapy.

Side-by-Side Comparison

	EMDR	Cognitive Processing Therapy	Prolonged Exposure
How it works	Reprocess memories while using bilateral stimulation	Identify and change stuck beliefs	Approach memories and avoided situations
Describing the trauma	Brief	Optional written account	Detailed, out loud, repeated
Practice at home	Light	Daily worksheets	Daily recordings and real-life practice
Typical length	Often 6–12 sessions for one trauma	About 12 sessions	About 8–15 sessions
Session length	60–90 minutes	50–60 minutes	Often 90 minutes

EMDR: Best If You’d Rather Not Talk Through Details

In EMDR, you briefly hold a memory in mind while following side-to-side eye movements or another form of bilateral stimulation. You don’t need to describe the trauma at length, and there’s little homework. EMDR often appeals to people who find it hard to put the trauma into words or who feel overwhelmed by talking about it.

Consider EMDR if: you want minimal homework, you prefer not to recount details, or you’ve tried talk-focused therapy that didn’t help.

Cognitive Processing Therapy: Best When Guilt and Self-Blame Run Deep

CPT focuses on “stuck points,” beliefs like “It was my fault” or “I can’t trust anyone,” that keep PTSD going. You’ll use worksheets to examine and update those beliefs. CPT has especially strong research with veterans and survivors of sexual assault.

Consider CPT if: guilt, shame, or anger is central, you like structured, practical work, or you prefer thinking-based approaches.

Prolonged Exposure: Best When Avoidance Runs Your Life

In PE, you repeatedly revisit the trauma memory in session and gradually face safe situations you’ve been avoiding. It’s demanding, and it’s one of the most thoroughly researched PTSD treatments.

Consider PE if: avoidance is shrinking your life, you’re ready to face the memory directly, and you can commit to daily practice.

What About Other Options?

• Written Exposure Therapy (WET) is a brief, five-session treatment that involves writing about the trauma. Studies have found it works about as well as CPT and PE for many people, and it’s offered in VA care.
• Present-centered therapy and other non-trauma-focused approaches can help, but evidence is generally weaker than for trauma-focused therapies.
• Medication, such as certain antidepressants, may help some people and can be combined with therapy. Talk with your doctor or a psychiatrist about that option.

Can Treatments Be Combined?

Usually one trauma-focused treatment is delivered at a time, so you get its full benefit. Clinicians often add supporting skills, such as grounding, emotion regulation, or Cognitive Behavioral Therapy for Insomnia (CBT-I), before or alongside it. If one approach helps partly, a second can sometimes address what’s left.

How to Decide: Questions to Ask Yourself

1. Am I willing to talk about the trauma in detail, or do I want to avoid that?
2. Is my biggest struggle fear and avoidance, or guilt and shame?
3. How much time can I commit to practice between sessions each week?
4. Do I prefer structured worksheets, or a more experiential process?
5. Have I tried any of these before, and what did or didn’t help?

You don’t have to answer these alone. In your first sessions, your clinician will help you weigh them and recommend a starting point. If one approach isn’t working, you can switch.

Do These Treatments Work Online?

Yes. Randomized trials show CPT and PE delivered by video work about as well as in-person treatment, and research and clinical experience support online EMDR as well. Learn how our teletherapy works, or read about our trauma and PTSD therapy.

Insurance Coverage

Therapy is billed as standard outpatient psychotherapy, so most plans with mental health benefits cover it. We’re in-network with:

• Aetna, directly and through Headway. See our Aetna page.
• Optum and UnitedHealthcare, nationwide. See our Optum and UnitedHealthcare page.
• Oscar, through the UnitedHealthcare network
• Anthem and Carelon, through Headway
• Blue Cross Blue Shield, Ambetter, and others

We do not accept Medicare or Medicare Advantage plans.

Our clinicians are licensed across 20 states, and we have in-person offices throughout the US.

Frequently Asked Questions

Which is better for PTSD, EMDR or CBT? For PTSD, EMDR and trauma-focused CBT, such as CPT and PE, perform similarly in research. Neither is better for everyone. The best choice depends on your preferences and symptoms.

What is the most effective therapy for PTSD? The VA/DoD guideline recommends CPT, PE, and EMDR as first-line treatments with the strongest evidence. All three are highly effective.

Is EMDR faster than CPT or PE? Sometimes. EMDR can be relatively brief for a single trauma and involves less homework, but overall results and timelines are similar across treatments.

Can I switch therapies if one isn’t working? Yes. If you aren’t improving after several sessions, your clinician may suggest adjusting the approach or trying another treatment.

Is Prolonged Exposure harder than EMDR? PE asks you to describe the trauma in detail and practice daily, which many people find more demanding at first. EMDR involves less detailed retelling, but it can also bring up strong emotions.

Are these therapies covered by insurance? Usually, yes, as outpatient psychotherapy. We’re in-network with Aetna, Optum/UnitedHealthcare, and others. We do not accept Medicare or Medicare Advantage plans.

If you are in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline) or call 911.