CT-PTSD or EMDR for PTSD: Does It Really Matter Which One Clients Have?

A new study this month analysing 11 years of PTSD data from NHS Talking Therapies answers this question.

We know both CT-PTSD (sometimes also known as TF-CBT) and EMDR have a large evidence base and NICE guidelines recommend both for treatment of PTSD - but how do they compare? And should we all be training in EMDR as a result?

What Actually Is EMDR?

For those unfamiliar with what EMDR involves, this video provides useful insight:

Despite Different Methods, Do Both Approaches Actually Lead to the Same Results?

A major 11-year study of PTSD treatments, published this month (Feb 2025) has found that both approaches produce similar recovery rates, offering important learnings for therapists and patients seeking trauma treatment.

Researchers examining over 1,500 cases found that trauma-focused cognitive behavioural therapy (CT-PTSD) and eye movement desensitisation and reprocessing (EMDR) had no significant difference between recovery rates of 40.8% for CT-PTSD and 43.6% for EMDR in NHS Talking Therapies services¹.

Differences Were Identified

While both therapies achieved similar PTSD recovery rates, researchers noted some interesting differences:

• CT-PTSD showed greater improvements in anxiety and depression symptoms.

• EMDR patients started treatment with lower anxiety and depression scores as measured on GAD-7 and PHQ-9, but started with similar PTSD symptoms. The reasons for this are unclear.

• Patients receiving EMDR completed more therapy sessions on average.

Did Therapist Skill and Delivery Impact The Findings?

The authors highlight that as this is a real-world evaluation study of outcome data, it is not possible to know how closely therapists adhered to each treatment protocol, whether there were large differences in quality of treatment, and specifically how ‘trauma-focused’ each treatment was.

We may hypothesise that having completed EMDR training on top of previous training in CBT, the EMDR therapists may have been more experienced in general. However, we do not know the exact years of qualification in the CT-PTSD group, and therefore cannot make this conclusion.

Interestingly, the mean number of sessions attended was 6.15. This appears relatively low for treatment that is recommended to be at least 8-12+ sessions². It is not clear why this is the case.

Did Age and Gender Impact?

The research also revealed important demographic patterns:

• Older adults and non-female patients showed higher anxiety and depression scores

• Men and non-binary individuals showed smaller reductions in certain PTSD symptoms

• The average patient was 37 years old, and 65% were women

• Ethnicity data was not included in the study, which the authors identify as a key shortcoming, due to the fact that people from minority ethnic backgrounds are often under-represented in NHS Talking Therapies even though they experience higher rates of PTSD than White British populations

Implications for Practice and Therapists

The study offers several key practice points for therapists:

1. Continue using patient preference to guide treatment selection, especially given smaller rates of therapists available that can deliver EMDR

2. Consistently collect PTSD-specific measurements alongside anxiety and depression scores, as this will allow for best comparison of treatment outcomes and therefore better conclusions for future clinical data

3. Services may want to consider training for clinicians around presenting problems, particularly experiencing trauma vs. PTSD

Moving Forward

What does this mean practically?

Therapists can confidently offer either option, knowing both are backed by strong evidence. For service managers, investing in specialised trauma training and supervision across both modalities may yield better results than favouring one approach.

It also suggests that clinicians can be confident in their CT-PTSD skills, and not feel under-skilled with trauma or pressure to spend large amounts of money on EMDR training, in the hope of significantly better outcomes in PTSD work.

However, this study and findings, whilst incredibly useful, focuses on outcomes. It does not focus on the subjective patient experience of the therapy, and this may be a further area of research.

You can read the study here.

1. Belli SR, Howell M, Grey N, Tiraboschi S, Sim A. Evaluating the effectiveness of tfCBT and EMDR interventions for PTSD in an NHS Talking Therapies service. The Cognitive Behaviour Therapist. 2025;18:e6. doi:10.1017/S1754470X24000497

2. https://www.nice.org.uk/guidance/ng116/chapter/Recommendations#principles-of-care