EMDR vs CBT for Anxiety: Which Therapy Works Best?
EMDR and CBT are two evidence-based therapies that the majority of our enquiries approach us about. But there can often be confusion around which one would be best for a specific issue, and a worry about choosing the right approach before proceeding to an intro call. As a clinical psychologist accredited in both therapies, I can address this question without taking ‘sides’ with either type. By drawing on my experience from twenty years in the therapy room, this blog is designed to explain the difference, to help you work out which one might suit you better, and also explain why you don’t need to have decided which one you need before you book in a call with one of us.
The short answer: CBT vs EMDR for Anxiety
The evidence base for both CBT and EMDR is positive. Personally, I find that the most effective therapy comes from the synergy between the client and the therapy style. The research backs this up too: if you gel with the therapy you’ll get a better outcome because you’re fully engaged with the whole process.
That said, it’s important to outline the headlines within the research for you. CBT has far more research in general for anxiety disorders. For some problems, such as persistent worrying, social anxiety and OCD, it’s got the clearest evidence base out of all therapy types. EMDR’s strongest evidence is for PTSD, with smaller but promising studies emerging for panic and phobias. However, this needs to be caveated with the fact that research into CBT has had a head start on EMDR research, because it’s a model that’s been around for longer and has had more funding available for studies. This is why it’s tricky to base an answer on the research alone.
The most effective therapies are the ones that people complete, which means staying with it until they’ve reached their goals. This brings me back to my earlier point that choosing a therapy style that you feel aligned with is going to be easier to stick at and give you a better result.
A final thought is that you do not need to choose which therapy you need by yourself. This is something that your psychologist will recommend and support you with after your initial assessment and planning sessions. At Plum Psychology our psychologists are trained in several approaches to therapy, and they will create a plan with you that could combine approaches depending on your specific goals or issues. I’ll show you what this actually looks like in practice in a moment.
What CBT for anxiety actually involves
CBT stands for Cognitive Behavioural Therapy. It’s based on the idea that persistent anxiety comes from a stuck loop between what you think, what you feel in your body and what you do. For example, in health anxiety a stuck loop might start when you notice a twinge in your chest. Your mind responds immediately with the worry: what if this is a heart attack? Your fear response understandably kicks in, which creates a stronger surge of physiological symptoms (now your heart is banging loudly), and you start to check your pulse or Google symptoms. These checking behaviours may bring a few minutes of relief, but the longer-term impact is that your brain then believes that checking is necessary in order to keep you safe. This means that the next time there’s a similar twinge the urge to check is stronger and you get stuck in this loop.
In CBT we get to understand when this fear of body sensations began (perhaps related to previous health issues in yourself or others), then we draw out the specific version of your own loop together, so we can explore how to break free from it. That usually means:
learning how to catch the predictions your mind makes and comparing them with what actually happens
gradually facing the things you’ve been avoiding (always at a pace that feels acceptable to you)
letting go of the ‘safety behaviours’ (things you do that feel helpful but could play a role in keeping the loop stuck) such as checking, asking for reassurance, over-preparing
learning to respond to worry-thoughts differently, so you’re not battling with every thought
CBT is quite an active style of therapy. There is usually something to read, practise, record or try between sessions, and much of the positive change happens during that time, not just in the therapy room. The therapist may refer to this as ‘between-session tasks’ or ‘homework’. If you find that word triggering from your childhood then you can let them know and agree a different wording.
What EMDR for anxiety actually involves
EMDR stands for Eye Movement Desensitisation and Reprocessing. It’s quite a mouthful, and can sound a bit intimidating at first. The theory behind EMDR is that some highly aversive experiences don’t get filed away as ordinary memories like our everyday experiences do. They stay raw and therefore painful in some way, which means that something in the present moment (a tone of voice, a smell, a feeling of being trapped) can trigger your body to react as though it’s happening all over again. This is a form of flashback.
With anxiety disorders, the memories we end up doing EMDR processing on in therapy are often things that the individual wouldn’t categorise as traumatic (because it wasn’t a life-or-death moment) but they've left their mark in some way. Examples could include being humiliated in front of others, a frightening experience, a moment of feeling trapped, or the very first panic attack.
In EMDR, we start by finding the memories that feed into your present-day anxiety. Then, while you hold this in mind, your therapist guides you through sets of side-to-side eye movements, taps or sounds, which are called Bilateral Stimulation. Gradually the memory should lose its level of intensity and you will be left feeling less affected by what happened, and less anxious as a result.
There are a few things that tend to surprise people about EMDR therapy which are handy to know at this point of your decision making:
You don’t have to describe what happened in detail for the therapy to be effective.
There is less homework than in other therapies.
We don’t launch in with the eye movements in the first session. Initial therapy sessions are spent understanding your history and making sure you have ways to come back out of intense moments of anxiety or distress using stabilisation tools.
Some people feel tired or more emotional for a day or two afterwards, or notice memories and dreams surfacing between sessions. We prepare for that before we begin, though.
For PTSD, NICE suggests 8 to 12 sessions, and more where there have been several traumas.
A fuller picture about the research
As already mentioned, CBT has decades of trials behind it, so at first glance it can look like the strongest option. Indeed, NICE recommends it as a first-choice talking therapy for generalised anxiety, panic disorder and social anxiety. CBT that includes exposure and response prevention is the recommended therapy for OCD. EMDR is currently only recommended by NICE for PTSD, as an effective alternative to trauma-focused CBT, because the two produce comparable outcomes when compared in PTSD studies.
Beyond PTSD presentations, the EMDR research is still at the emerging stage for anxiety:
Panic disorder. One trial has compared the two therapies directly. In 84 people, EMDR did about as well as CBT on most measures.
Phobias. There are only a small number of trials, albeit with positive results.
Generalised anxiety. Very little research has been carried out into EMDR for this so far. A 2025 trial of 65 people found EMDR helped, but this was compared with a waiting list and not with CBT.
Social anxiety. Again, this is not an area that has been researched from an EMDR approach yet.
So when we use EMDR for anxiety, we do it when there’s a clear link between your anxiety and particular traumatic or distressing experiences that have stayed with you in some form or another.
Often it comes down to which style suits you
Reviews of the research consistently show that people who get the kind of therapy they prefer are less likely to drop out and therefore will get a better recovery. NICE takes this preference seriously too, and names it as a reason to choose either EMDR or CBT in its PTSD guidance, so it’s important to give this proper thought.
So here is how the two compare in terms of therapy session content:
CBT | EMDR | |
Main focus | Mostly what keeps your anxiety going now | Mostly the experiences behind it |
A typical session | Talking, mapping out patterns, planning things to try and reviewing how they went | Some talking, then longer stretches of quiet processing with eye movements or taps |
Between sessions | Regular practice, recording information about patterns, testing out new ways of doing things | Very little although you may need to practice soothing strategies or be asked to record reflections that come up after processing or record your dreams |
Talking about the past | As much as helps make sense of the present | You bring memories to mind, but you don't have to describe them in detail. There is a 'blind-to-therapist' protocol for shame-based memories which can make EMDR easier for some |
The hard part | Facing feared situations can raise anxiety initially - we prepare together for this though | Sessions can be emotionally intense and may stir things up for a day or two, sometimes trauma processing can also be felt in the body e.g. nausea, muscle intensity etc |
What it aims for | Skills and confidence you can keep using, a fresh mindset that breaks you out of stuck loops | Memories that are no longer distressing you or setting off an anxiety alarm |
Which is more likely to suit you? A rough guide
If... | then it's likely that... | Because... |
you like to understand how things work and want tools you can use yourself | CBT will suit you | it's structured, practical and explains itself as it goes |
you're willing to practise between sessions | CBT will suit you | that practice is where most of the change comes from |
you want to focus on the here and now, and on getting back to what you've been avoiding | CBT will suit you | it works directly on daily life patterns, thoughts and behaviours |
you have a strong sense that particular experiences are behind your anxiety, and you want to work on them directly | EMDR will suit you | those memories are its whole focus |
you find it hard to put things into words, or would prefer not to describe what happened in detail | EMDR will suit you | There are EMDR techniques that can allow less talking about the events themselves |
your life is too full for regular homework | EMDR will suit you | most of the work happens in the session (but you may also want to consider an EMDR Intensive which is a block of EMDR in a week - this can be easier to carve out for some people) |
you've tried one of them properly and it only took you so far | the other, or a mix, is worth exploring | a different route sometimes reaches what the first one didn't |
This table DOES NOT REPLACE a full assessment. Just use this to start a conversation with a therapist and you can both take it from there.
Remember: a trained psychologist is there to help you work this out
Because our psychologists at Plum Psychology are trained in both CBT and EMDR, your therapy plan doesn’t need to be decided before you contact us. Our team members can flex around what is needed as it arises. For example, sometimes traumas don’t make themselves known until trust has been built in the therapy.
Here is an example of how therapy might combine both EMDR and CBT for a fictitious client who has been anxious about driving since a car accident:
Assessment. We would get to know their history, map out what keeps the anxiety going and agree what they want to be different (e.g. goals may include driving to the local shops, then driving a longer distance).
Getting steady. We would demonstrate how anxiety plays out in the brain and body (the neurophysiology of anxiety) and practise ways to settle it. This is part of both EMDR and CBT.
EMDR to process what happened. We might then do trauma processing of the accident itself, and any earlier memories it connects to. This should allow more helpful self-beliefs about safety and surviving what happened to become embedded.
CBT afterwards to get their life back. With the memory stored in a more manageable format, we build back up to driving step by step: testing the predictions the anxiety has been making, dropping the ‘safety behaviours’ and practising ways to respond to anxious thoughts.
Staying well. We pull together what worked into a plan the client can turn to if anxiety flares again after ending therapy.
This is just an example of a treatment plan, and it may not always play out in that order. Sometimes we begin with CBT and find that the same old memory keeps turning up, which is usually the moment to bring in EMDR. Sometimes a plan is mostly CBT, with a few EMDR sessions on one sticking point.
There is less research on combined plans than on either therapy alone, so we review as we go and change course if something isn’t helping.
But remember, you don’t have to work any of this out before you book a call. That’s what the assessment is for, and what your therapist is trained to figure out with you!
Where to go from here
If the guide above has you leaning one way, the next step is to read a little more about that therapy and see whether it still sounds right.
Leaning towards EMDR? Visit our EMDR resource page to find out more about how it works and what to expect.
Leaning towards CBT? Head to our CBT information page to see what's involved and whether it sounds like a fit.
Can't decide, or like the sound of both? You don't have to pick by yourself. Get in touch for a free 15 minute call and we can start to work out the right approach together.
Dr Claire Plumbly is a Clinical Psychologist, accredited CBT therapist and EMDR Consultant at Plum Psychology.
This post is general information and isn't a substitute for an individual assessment. If you're struggling to keep yourself safe, please contact your GP or NHS 111, or call 999 in an emergency.
References for EMDR Vs CBT for Anxiety blog
Carter, C. (2023). A systematic review exploring the role of eye movements in EMDR therapy from a working memory perspective. EMDR Therapy Quarterly, Spring 2023. https://etq.emdrassociation.org.uk/2023/05/10/a-systematic-review-exploring-the-role-of-eye-movements-in-emdr-therapy-from-a-working-memory-perspective/
Cuijpers, P., van Veen, S. C., Sijbrandij, M., Yoder, W., & Cristea, I. A. (2020). Eye movement desensitization and reprocessing for mental health problems: A systematic review and meta-analysis. Cognitive Behaviour Therapy, 49(3), 165–180. https://doi.org/10.1080/16506073.2019.1703801
Faretta, E., & Dal Farra, M. (2019). Efficacy of EMDR therapy for anxiety disorders. Journal of EMDR Practice and Research, 13(4), 325–332. https://doi.org/10.1891/1933-3196.13.4.325
Horst, F., den Oudsten, B. L., Zijlstra, W. P., de Jongh, A., Lobbestael, J., & de Vries, J. (2017). Cognitive behavioral therapy vs. eye movement desensitization and reprocessing for treating panic disorder: A randomized controlled trial. Frontiers in Psychology, 8, Article 1409. https://doi.org/10.3389/fpsyg.2017.01409
Jamshidi, F., de Jongh, A., Rajabi, S., Dehghani, Y., & Pakizeh, A. (2025). Face-to-face versus web-based EMDR therapy in the treatment of generalized anxiety disorder symptoms: A randomized controlled trial. Cognitive Therapy and Research. https://doi.org/10.1007/s10608-025-10641-x
Swift, J. K., Callahan, J. L., Cooper, M., & Parkin, S. R. (2018). The impact of accommodating client preference in psychotherapy: A meta-analysis. Journal of Clinical Psychology, 74(11), 1924–1937.
Windle, E., Tee, H., Sabitova, A., Jovanovic, N., Priebe, S., & Carr, C. (2020). Association of patient treatment preference with dropout and clinical outcomes in adult psychosocial mental health interventions: A systematic review and meta-analysis. JAMA Psychiatry, 77(3), 294–302. https://doi.org/10.1001/jamapsychiatry.2019.3750
Yunitri, N., Kao, C.-C., Chu, H., Voss, J., Chiu, H.-L., Liu, D., Shen, S.-T. H., Chang, P.-C., Kang, X. L., & Chou, K.-R. (2020). The effectiveness of eye movement desensitization and reprocessing toward anxiety disorder: A meta-analysis of randomized controlled trials. Journal of Psychiatric Research, 123, 102–113. https://doi.org/10.1016/j.jpsychires.2020.01.005
Clinical guidelines
National Institute for Health and Care Excellence. (2005). Obsessive-compulsive disorder and body dysmorphic disorder: Treatment (NICE clinical guideline CG31). https://www.nice.org.uk/guidance/cg31
National Institute for Health and Care Excellence. (2011). Generalised anxiety disorder and panic disorder in adults: Management (NICE clinical guideline CG113; last updated 2020). https://www.nice.org.uk/guidance/cg113
National Institute for Health and Care Excellence. (2013). Social anxiety disorder: Recognition, assessment and treatment (NICE clinical guideline CG159). https://www.nice.org.uk/guidance/cg159
National Institute for Health and Care Excellence. (2018). Post-traumatic stress disorder (NICE guideline NG116). https://www.nice.org.uk/guidance/ng116
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