EMDR and the New APA Guidelines: What Clients Should Actually Know
If you've been reading about EMDR therapy lately, you may have come across headlines suggesting the American Psychological Association downgraded EMDR in its 2025 guidelines. Some articles frame this as a warning sign. A few suggest it means EMDR doesn't work.
Neither is accurate.
As an EMDR therapist who has been doing this work for years, I want to give you a clear, honest explanation of what the APA guidelines actually say, why the "downgrade" framing is misleading, and what it means for you as someone considering or currently in EMDR therapy.
The short version: EMDR is still a recommended, well-researched, and clinically supported treatment for trauma. The guidelines don't change that.
Laurel van der Toorn, LMFT
Laurel is the founder of Laurel Therapy Collective and a trauma therapist specializing in EMDR. She is licensed in California, Colorado, Florida, Michigan, Texas, and Washington, and sees clients online throughout those states.
What the 2025 APA Guidelines Actually Say
In 2025, the APA published updated Clinical Practice Guidelines for the Treatment of PTSD. The guidelines sorted treatments into two tiers based on the strength of the available research evidence.
Four treatments received a strong recommendation: Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), Cognitive Behavioral Therapy (CBT), and Cognitive Therapy (CT). These are all variations of structured, exposure-based approaches.
EMDR received a conditional recommendation. So did several other treatments, including certain medications.
A conditional recommendation means the APA panel determined that the benefits of EMDR outweigh the harms, and that it is a valid treatment option. It does not mean EMDR is ineffective, experimental, or unsafe. It means the panel assessed the body of research supporting EMDR as having more variability in study quality or outcomes than the strongly recommended treatments.
That is a meaningful distinction, and it is worth understanding before drawing any conclusions.
Here's What the Headlines Got Wrong
The framing of a "downgrade" implies that EMDR lost standing it previously held. That's not quite right.
The 2017 APA guidelines also gave EMDR a conditional recommendation. The 2025 guidelines maintained that same position. EMDR was not moved down from a strong recommendation. It was never in that category under APA criteria to begin with.
What did change is that the 2025 guidelines more clearly elevated the CBT-based approaches to the strong tier. That's a reflection of the accumulated research base for those treatments, which is large and has been building for decades. It is not a statement that EMDR stopped working.
There is also a relevant methodological point here. Researchers have documented specific problems with how the APA's review process evaluated EMDR studies, including the use of an incorrect outcome measure in at least one study and the omission of studies that would have improved EMDR's evidence rating. A 2017 paper published in Frontiers in Psychology identified these errors and found that correcting them would have put EMDR's evidence rating on par with CPT and CT. The 2025 guidelines did not fully address these methodological concerns.
I'm not saying this to dismiss the guidelines. I'm saying it because clients deserve to know that treatment guidelines involve judgment calls, not just objective data, and that the story around EMDR's evidence base is more nuanced than a single tier placement conveys.
Tatevik Sarkisian, AMFT
Tatevik works with adults navigating trauma, anxiety, and the aftermath of experiences that haven't fully resolved with other approaches. She brings a warm, steady presence to EMDR work and stays current on the evolving research so her clients always receive care grounded in the best available evidence. She sees clients online throughout California.
What Other Major Guidelines Say About EMDR
The APA is one organization among several that publish clinical practice guidelines for PTSD treatment. Its rating system is not the only one that matters, and it is not the most favorable to EMDR.
Here is where EMDR stands across other major bodies:
The VA/DoD Clinical Practice Guidelines, which govern treatment for the largest PTSD-affected population in the United States, give EMDR their highest recommendation, on par with CPT and PE.
The World Health Organization recommends EMDR as a first-line treatment for PTSD in adults and children.
The International Society for Traumatic Stress Studies (ISTSS) gives EMDR a strong recommendation for adults with PTSD.
The UK's National Institute for Health and Care Excellence (NICE) recommends EMDR for adults with PTSD.
A 2025 independent systematic review found EMDR to be comparably effective to trauma-focused CBT in reducing PTSD symptoms.
The APA's conditional rating places EMDR in a minority position relative to the global consensus on this treatment. That context matters.
► Learn more about EMDR therapy at Laurel Therapy Collective
Why Some People Choose EMDR Over the Strongly Recommended Treatments
CPT, PE, and CBT are strong treatments. The research behind them is real. But "strong recommendation" describes the evidence base, not the experience of doing the work. For many people, that experience is a significant factor in whether they can complete treatment at all.
Here is what the strongly recommended approaches actually involve.
Prolonged Exposure asks you to repeatedly revisit traumatic memories in detail, both in session and through homework assignments done between appointments. The goal is habituation: over time, the memory loses its power through repeated contact. For people who can tolerate that process, it works well. For people whose nervous systems are already at capacity, the dropout rates are notable. Research has consistently found that PE has higher dropout rates than EMDR, particularly among people with complex trauma histories or significant avoidance.
Cognitive Processing Therapy involves structured written assignments in which you examine and challenge the beliefs that formed around your trauma. You write a detailed account of the traumatic event. You complete worksheets between sessions. It is systematic and effective. It also requires a level of cognitive engagement and emotional tolerance that not everyone has access to, particularly early in treatment when the nervous system is still dysregulated.
EMDR is different in a few important ways. It does not require you to narrate your trauma in detail. It does not involve homework between sessions in the same structured way. The bilateral stimulation creates a dual awareness that allows you to access the memory without being fully immersed in it. For people who have tried exposure-based approaches and found them too destabilizing, or who simply cannot access their trauma through language, EMDR offers a different entry point.
None of this makes EMDR easier, exactly. Processing trauma is uncomfortable regardless of the method. But the mechanism is different, and for a meaningful subset of clients, that difference determines whether treatment is completable at all.
A few situations where EMDR is often the better fit:
You have tried CPT or PE and found the homework or in-session exposure unmanageable
Your trauma occurred early in life, before you had language for it
Your trauma is stored primarily as body sensations, images, or emotional states rather than narrative memory
You have a complex trauma history with many interconnected memories rather than a single discrete event
You are highly avoidant and need a gentler on-ramp to processing
You are already overwhelmed and cannot take on structured between-session assignments
The goal of trauma treatment is resolution. The best treatment is the one you can actually complete.
What a Conditional Recommendation Means for You as a Client
If you are considering EMDR therapy, or already in it, here is what the APA's conditional recommendation practically means for your care:
It means EMDR is still recommended.
A conditional recommendation is still a recommendation. The APA panel concluded that EMDR is a valid treatment option for PTSD, that its benefits outweigh its risks, and that it is appropriate to offer. You are not choosing an unproven or fringe therapy.
It means treatment fit still matters more than tier placement.
Research averages tell us what works best across populations. Your nervous system, your trauma history, your previous treatment experiences, and your capacity for certain approaches all affect what will work best for you. CPT and PE are highly effective treatments. They also require structured written assignments and extended in-session exposure work that some people find difficult to tolerate. EMDR has a different mechanism and a different experience. For many clients, particularly those who struggle with verbal processing of trauma or who have tried other approaches without full resolution, EMDR is the better fit.
It means your therapist's clinical judgment still matters.
Good trauma treatment has never been about mechanically applying the highest-rated guideline recommendation to every client. It is about understanding who you are, what you've been through, and which approach is most likely to help you specifically. A well-trained EMDR therapist can make that assessment with you.
It does not mean you should switch treatments mid-process.
If you are currently in EMDR therapy and making progress, a guideline update is not a reason to stop. Talk to your therapist if you have questions about your treatment. Our post on what to do if EMDR isn’t working can help you evaluate where you are in the process.
Alexis Harney, LMFT
Alexis is a fully trained EMDR therapist who works with adults processing trauma, anxiety, and long-standing patterns that haven't responded to other approaches. She stays current on the research and brings that perspective directly into her clinical work. She sees clients online throughout California and Florida.
Why EMDR Remains the Right Choice for Many Clients
Guidelines are built around the average treatment response across study populations. Real clients are not averages.
In my clinical experience, EMDR tends to be particularly well-suited for people who:
Have tried talk therapy and gained insight but haven't fully resolved their symptoms
Have difficulty putting traumatic experiences into words
Experience trauma as body-based rather than primarily cognitive
Have complex or layered trauma histories that don't fit neatly into protocol-based exposure work
Prefer a treatment that doesn't require them to narrate their trauma in detail
Have experienced trauma that occurred before they had language for it
For these clients, EMDR often reaches something that structured CBT-based work does not. That is not a criticism of CPT or PE. Both are excellent treatments for the populations they serve well. It is a recognition that trauma is not one thing, and treatment should reflect that.
The APA guidelines acknowledge this implicitly. Their conditional recommendation includes specific contexts in which EMDR is particularly appropriate. The guidelines are not a blanket statement that EMDR is a lesser treatment. They are a summary of where the overall evidence currently sits, in the APA's methodology, for average outcomes across study populations. That is different from a clinical recommendation for an individual.
What This Looks Like in Practice
Claire* came to EMDR therapy after two years in cognitive behavioral therapy for PTSD following a medical trauma. She had learned a great deal about her triggers and her thought patterns. She could explain her trauma response clearly and cogently. She was still having nightmares twice a week and couldn't sit in a waiting room without her heart racing.
Her CBT therapist was skilled. The treatment was evidence-based. And something was still stuck.
In EMDR, the work looked different. Less language, more body. Less explaining, more noticing. Within a few months, the nightmares had stopped. The waiting room still brought some anxiety, but she could manage it without her nervous system taking over.
The APA's rating system would have pointed her toward CPT or PE first. For her, that approach hadn't been enough. EMDR was.
Guidelines describe populations. Therapists treat people.
*Name and identifying details changed.
Daniella Mohazab, AMFT
Daniella works with adults navigating trauma, anxiety, and burnout, including clients who have tried other therapeutic approaches without finding full relief. She has a particular interest in helping clients understand what is happening in their nervous system and why certain approaches reach what others don't. She sees clients online throughout California.
Questions Worth Asking Your EMDR Therapist
If you are evaluating whether EMDR is the right treatment for you, here are some questions that will give you more useful information than a guideline tier:
What is your EMDR training, and how long have you been practicing it?
Based on my history and what you know about me, why do you think EMDR is a good fit?
Are there other trauma treatments you'd recommend considering alongside or instead of EMDR?
How will we know if it's working, and what would make you suggest changing course?
A good EMDR therapist will welcome these questions. The answers will tell you more about whether this is the right treatment and the right therapist than any guideline document.
► Read: Does EMDR Therapy Work for Everyone?
The Guidelines Changed. The Evidence for EMDR Didn't.
The 2025 APA guidelines are a useful document. They reflect a careful, if imperfect, review of the research on PTSD treatments. They should inform clinical practice alongside, not instead of, clinical judgment.
What they don't do is tell you that EMDR therapy stopped working. It didn't. The VA, the WHO, the ISTSS, and decades of research with real clients say otherwise.
If EMDR is something you've been considering, a guideline update is not the reason to pause. A conversation with a well-trained EMDR therapist is still the best next step.
EMDR Therapy in San Francisco, Los Angeles, and Online Throughout California and Florida
At Laurel Therapy Collective, EMDR therapy is one of our core specialties. Our therapists are trained, experienced, and stay current on the evolving research — including its limitations and its nuances.
We work with adults navigating trauma, anxiety, and the kind of pain that hasn't fully resolved with other approaches. If you're curious about whether EMDR is right for you, we'd be glad to talk.
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Frequently Asked Questions
Did the APA downgrade EMDR in 2025?
No. The 2025 APA guidelines gave EMDR a conditional recommendation, which is the same rating EMDR received in the 2017 APA guidelines. What changed is that the 2025 guidelines more explicitly elevated CPT, PE, CBT, and CT to a strong recommendation tier. EMDR was not moved down from a higher position; it maintained the same standing. The "downgrade" framing circulating online overstates what actually changed.
Is EMDR still recommended for PTSD?
Yes. The APA's 2025 guidelines include a conditional recommendation for EMDR, meaning the panel determined its benefits outweigh its risks and that it is an appropriate treatment option. Beyond the APA, EMDR holds strong or highest recommendations from the VA/DoD, the World Health Organization, the International Society for Traumatic Stress Studies, and the UK's National Institute for Health and Care Excellence. The global clinical consensus on EMDR remains strongly supportive.
What is the difference between a strong and conditional recommendation?
In APA guideline terminology, a strong recommendation means the evidence base is large, consistent, and of high quality. A conditional recommendation means the treatment is supported and recommended, but the evidence may have more variability in study quality or outcomes. Conditional does not mean ineffective or unsafe. It means the panel had more certainty about some treatments than others based on the available research at the time the guidelines were written.
Should I switch from EMDR to CPT or PE because of the new guidelines?
If you are in EMDR therapy and making progress, a guideline update is not a reason to stop. Switching treatments mid-process can mean leaving traumatic material partially processed, which is generally not recommended. If you have genuine questions about whether your current treatment is working, that is worth discussing with your therapist directly. Our post on signs EMDR is working can help you think through where you are.
Why do different organizations rate EMDR differently?
Different guideline bodies use different methodologies for evaluating research evidence, and those methodological choices affect outcomes. The APA's framework has been criticized by researchers for specific inconsistencies in how it applied its rating criteria to EMDR studies, including the use of an incorrect outcome measure in at least one analysis. Other bodies, including the VA/DoD and WHO, use different frameworks and reach more favorable conclusions about EMDR's evidence base. This does not mean any one guideline is definitive. It means the picture is more complex than a single tier rating suggests.
