EMDR VS. CBT?

EMDR Vs. COGNITIVE BEHAVIORAL THERAPY

When it comes to competition, EMDR and CBT are a little like the Denver Broncos and the New England Patriots. Both have fans who are convinced that their team is better than the other. The more dedicated the fans become, the more they are convinced that they are on the good side and the other team is just wrong.

Reality, as you’ve taught your clients, is not black or white. I am not going to try and convince you that EMDR works better than cognitive-behavioral therapy. CBT works better for some conditions (and people) and EMDR is more effective for others. It’s okay to be on different teams. Before we talk about the differences, let’s first talk about what EMDR and CBT have in common.

WHAT DO EMDR AND CBT HAVE IN COMMON?

Both approaches are very structured. EMDR and CBT have been shown to be more effective when the therapist specializes in the modality. Improvisation is not recommended in EMDR and CBT, and will likely lead to mediocre therapy outcomes, or, in some cases, worsening of symptoms.

Both CBT and EMDR have been shown to be effective in a relatively short period of time. It is not uncommon for clients to see a CBT therapist for 10, 12 or 15 sessions and achieve positive treatment outcomes. The same is true for EMDR. One study found that

The effectiveness of EMDR and CBT for treatment of trauma was summarized by one meta-analysis that found that “in the treatment of PTSD, both therapy methods tend to be equally efficacious.”

(Guenter & Seidler, 2006).

Another study, that compared the efficacy of EMDR vs. CBT for treatment of panic disorder, found that:

The severity of PD [Panic disorder] variables ACQ and BSQ showed non-inferiority of EMDR to CBT, while MI was inconclusive (adjusted analyses). Overall QOL and general health, Psychological health, Social relationships, and Environment showed non-inferiority of EMDR to CBT, while Physical health was inconclusive.

The results of the study, in plain English, say that EMDR is as effective as CBT for treatment of panic disorder. Different studies have different results, but overall, both CBT and EMDR have been shown to be effective with a wide range of diagnoses.

The bottom line is that both CBT and EMDR help clients to get relief from old thought patterns. Oftentimes, these thoughts (also known as schemas, automatic thoughts, and negative cognitions) were formed earlier in life.

As a therapist, you are going to help your client change these negative thought patterns – the thoughts that lead to emotional pain. But how do you do that? Here lies the main difference.

HOW ARE EMDR THERAPY & COGNITIVE BEHAVIORAL THERAPY DIFFERENT? 


While CBT focuses on cognitions (thoughts) and behaviors, EMDR therapists take a more holistic approach. In EMDR, the focus is on thoughts, emotions, physical sensations, and the worst image.

The image, the emotion, and the physical sensations are the non-verbal elements of what’s causing psychological pain. Trauma, depression, and anxiety are being processed in the non-verbal parts of the brain (limbic system and brain stem) and cannot always be accessed through language. EMDR helps to integrate the non-verbal and the verbal neural networks in the brain.

CBT therapists use a top-down approach. they teach their client the automatic nature of thoughts. By examining the evidence – the client learns to conclude that her thoughts are not always based on reality. In CBT, clients learn to identify their automatic thoughts and replace them with more balanced (reality-based) thoughts.

EMDR, as I mentioned above, takes a more holistic approach. Top-down therapeutic approaches have some very serious limitations. We know that when the limbic system is active, it shuts down some of our control center – our prefrontal cortex. People can feel anxious, triggered, and irritable, but they don’t know why because they didn’t make a conscious decision to become irritable.

Personally, I believe that the Cognitive-Behavioral approach has a simplistic view of the human psyche. A lot of what brings clients to therapy is not linear thinking and cannot be expressed through language. CBT is more effective for clients who can verbalize exactly what causes their distress.

Most people who come to therapy are more complex. The human mind is not a computer algorithm. A doesn’t always lead to B. Clients come to therapy for help with what is stuck in the non-verbal parts of the brain and that’s what makes EMDR is so effective – it helps with emotions, thoughts and body sensations that cannot be expressed in words.


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