Do People Drop Out of EMDR Less Often? What Treatment Studies Tell Us
Eye Movement Desensitization and Reprocessing (EMDR) is one of several well-established psychological treatments for Post-Traumatic Stress Disorder (PTSD). Along with questions about how well a treatment works, researchers also study something more practical: how many people complete it.
Treatment dropout matters because even an effective therapy cannot provide its full intended course if a large proportion of participants leave early. It is therefore reasonable to ask whether people are more likely to complete EMDR than other PTSD treatments.
The research does not support a simple claim that EMDR always has a lower dropout rate. Some individual studies have found fewer dropouts from EMDR than from another treatment, and newer analyses have reported relatively high completion rates for EMDR. Other large reviews, however, have found that differences among active PTSD therapies are often small or inconsistent.
The clearest conclusion is that dropout varies substantially from study to study, and treatment type is only one of several factors that may influence whether someone completes therapy.
What Does “Treatment Dropout” Mean?
In research, dropout generally means that a participant begins a treatment but does not complete the course of therapy defined by the study.
That sounds straightforward, but studies do not always define completion in exactly the same way.
For example, researchers may count someone as a dropout if the person:
stops attending before completing a specified number of sessions;
does not complete the final treatment assessment;
leaves treatment before the therapist considers the protocol complete; or
attends fewer sessions than the research protocol requires.
Those differences can affect reported dropout rates.
A review of 55 PTSD treatment studies found that dropout rates varied widely and noted that inconsistent definitions and reporting methods made comparisons across studies difficult. (PubMed)
So when one study reports a 15% dropout rate and another reports 30%, the difference does not necessarily mean that one treatment is twice as difficult to complete.
How Common Is Dropout From PTSD Therapy Overall?
Dropping out of PTSD treatment is not unique to EMDR.
A 2013 meta-analysis examined dropout across 42 clinical trials of active PTSD treatments. The average dropout rate was approximately 18%, although rates varied substantially among studies. (PubMed)
A later systematic review of randomized controlled trials involving psychological treatments for adults with PTSD estimated an overall dropout rate of about 16%. Again, there was considerable variation among studies. (PubMed)
These figures illustrate an important point: there is no single “normal” dropout rate for PTSD therapy.
Rates can change according to the treatment protocol, population being studied, number and frequency of sessions, research setting, and the way dropout is defined.
Does Trauma-Focused Treatment Cause More Dropout?
Researchers have examined this question because EMDR, Prolonged Exposure, Cognitive Processing Therapy, and several other PTSD treatments directly address traumatic experiences.
The evidence is mixed.
The 2013 meta-analysis found that trauma focus itself did not predict greater dropout. When researchers restricted their analysis to studies directly comparing active treatments, they found no overall difference in dropout between the treatments. (PubMed)
A later review reached a somewhat different conclusion. It estimated a pooled dropout rate of 16% and found an association between trauma-focused psychological treatments and greater dropout across studies. (PubMed)
These findings are not necessarily contradictory. The earlier review emphasized that much of the variation occurred between studies, while the later review compared patterns across a larger body of research.
The difference shows why dropout findings need to be interpreted carefully rather than reduced to the claim that trauma-focused therapy either “causes” or “does not cause” dropout.
What Do Studies Specifically Comparing EMDR Show?
Some direct treatment comparisons have reported lower dropout from EMDR.
One often-cited study compared EMDR with Prolonged Exposure (PE) in a community clinic treating people with PTSD, many of whom had experienced rape or other crimes.
Among participants who began active treatment, the researchers reported no dropouts among the 10 people assigned to EMDR, compared with three dropouts among the 10 participants included in the PE dropout comparison. The difference was statistically significant in that small study. (PubMed)
The same study also found faster early symptom improvement among the EMDR participants.
However, this was a very small pilot study. Results involving approximately 20 participants cannot establish that people generally drop out of EMDR less often than PE.
For a broader comparison of these treatments, see EMDR vs Prolonged Exposure Therapy: What Have Studies Found?
What Have Larger EMDR Reviews Found?
A more informative approach is to combine evidence across multiple randomized trials.
A systematic review and individual participant data meta-analysis examined EMDR compared with other psychological therapies for adults with PTSD. Fifteen randomized controlled trials met the review criteria, and individual participant data were available from eight trials involving 346 people.
The researchers examined PTSD symptoms, treatment response, remission, and treatment dropout.
Their analysis did not find evidence that dropout differed significantly between EMDR and the other psychological treatments examined. (PubMed)
That finding is particularly useful because it looks beyond a single trial.
It suggests that although particular studies may show lower dropout with EMDR, the broader randomized evidence has not established a consistent overall advantage.
What Does Newer Research Suggest?
More recent analyses have continued examining treatment completion rather than simply symptom reduction.
A 2026 meta-regression analyzed treatment frequency and completion across 66 studies and 84 treatment arms involving Cognitive Processing Therapy (CPT), PE, and EMDR.
Compared with CPT, participants in EMDR studies had substantially higher odds of completing treatment, while PE was associated with somewhat lower completion odds than CPT. (PubMed)
This is noteworthy because it suggests EMDR may have a retention advantage in some bodies of research.
But it is important to understand what this type of analysis can and cannot establish.
The researchers were comparing patterns across study arms rather than randomly assigning everyone in one large trial to EMDR, CPT, or PE under identical circumstances. Differences in study populations, treatment schedules, definitions of completion, and other features can influence the result.
So the finding strengthens the case for studying EMDR retention further, but it does not prove that choosing EMDR will automatically reduce an individual's likelihood of leaving treatment early.
How Does EMDR Compare With Trauma-Focused Cognitive Behavioral Therapy?
Trauma-focused Cognitive Behavioral Therapy (CBT) is a broad category that includes several treatments rather than one single therapy.
A large 2023 network and pairwise meta-analysis examined 157 randomized controlled trials involving 11,565 adults with PTSD. The researchers evaluated both effectiveness and acceptability, with acceptability measured using all-cause dropout.
Most of the research involved trauma-focused CBT, while EMDR represented a smaller portion of the evidence base. All of the psychological treatment categories were effective compared with control conditions. The analysis did not establish EMDR as having a universal dropout advantage over the other active interventions. (PubMed)
This fits the broader pattern: EMDR appears to have reasonably good treatment retention, but comparative dropout results depend heavily on which treatment, population, and study design are being examined.
For the broader effectiveness comparison, see EMDR vs Trauma-Focused CBT: What Does the Research Show?
What About Cognitive Processing Therapy and Prolonged Exposure?
CPT and PE are particularly useful comparisons because, along with EMDR, they are among the trauma-focused treatments most strongly recommended for PTSD by the US Department of Veterans Affairs and Department of Defense (VA/DoD).
Research shows that dropout can be substantial in both CPT and PE, especially in some veteran populations.
A recent large randomized trial involving 916 US veterans with PTSD compared dropout from CPT and PE. Dropout was significantly higher in PE: 52.3%, compared with 45.8% in CPT under the study's definition of treatment completion. (PubMed)
Those rates are much higher than the approximately 16% to 18% averages reported in some broader PTSD psychotherapy reviews.
That does not mean CPT or PE generally have dropout rates near 50%. The study involved a particular veteran population and used a specific definition of completion.
It demonstrates how strongly the population and study design can influence the number reported.
For a direct discussion of EMDR and CPT, see EMDR vs Cognitive Processing Therapy: What Do We Know?
Does the Population Being Treated Matter?
Yes.
A systematic review and meta-analysis of PTSD treatment studies involving active-duty military personnel and veterans included 26 studies and 2,984 participants.
Across all treatments, the pooled dropout rate was 24.2%. Trauma-focused treatments had a pooled dropout rate of 27.1%, compared with 16.1% for non-trauma-focused treatments. (PubMed)
A more recent individual participant data meta-analysis focusing on trauma-focused CBT found that military personnel and veterans were more likely to drop out than civilians. Among the available data, 42% of military personnel and veterans dropped out, compared with 23% of civilians. Younger age was also associated with greater dropout. (PubMed)
These findings matter when interpreting EMDR research.
A trial conducted with civilians who experienced a single traumatic event may produce a very different dropout rate from a study involving veterans receiving treatment for longstanding PTSD.
Comparing the raw percentages without considering those differences can therefore be misleading.
Does the Number of Sessions Matter?
It may.
The 2013 meta-analysis found that a greater number of treatment sessions was associated with higher dropout across PTSD studies. (PubMed)
That is understandable from a practical standpoint. A longer treatment course gives people more opportunities to encounter scheduling problems, work or family conflicts, changes in circumstances, or other reasons for leaving a study.
This may be relevant to EMDR because some treatment protocols use relatively limited numbers of sessions.
However, fewer sessions do not automatically guarantee better retention.
For more on treatment duration, see Does EMDR Take Less Therapy Time Than Other PTSD Treatments?
Can More Frequent Treatment Affect Dropout?
Research suggests that the way treatment is scheduled may matter as well.
A 2022 meta-analysis examined 35 randomized trials involving 1,508 adults receiving outpatient Prolonged Exposure.
When PE was scheduled at least twice weekly, the estimated dropout rate was 21%, compared with 34% when sessions were scheduled less frequently. (PubMed)
The researchers cautioned that this finding could not establish cause and effect because very few studies directly randomized participants to different treatment frequencies.
Still, it demonstrates that treatment retention can be influenced by how therapy is delivered, not merely which therapy is used.
Intensive PTSD programs provide another example. A systematic review of intensive evidence-based treatment programs found a pooled dropout rate of only 5.5%, despite the treatments directly addressing trauma. (PubMed)
These findings make it difficult to attribute dropout simply to whether a treatment is EMDR, PE, CPT, or another approach.
Does Dropping Out Mean a Treatment Did Not Work?
Not necessarily.
Dropout is an important research measure, but it does not tell researchers exactly why someone stopped treatment.
Someone might leave because:
symptoms improved enough that they did not feel a need to continue;
the treatment did not seem helpful to them;
scheduling became difficult;
they moved or changed jobs;
they preferred another treatment;
participation in the study became inconvenient; or
they stopped for another personal reason.
Many clinical trials report whether someone discontinued treatment without being able to determine precisely why.
This is one reason dropout is often described as a measure of acceptability, but it is an imperfect measure.
A lower dropout rate can be a positive sign, but it does not by itself prove that a treatment is more effective, easier, or preferable.
What About Children and Teenagers?
The dropout picture is somewhat different in younger populations.
A meta-analysis of 40 randomized controlled trials involving children and young people with PTSD estimated dropout from evidence-based treatments—including trauma-focused CBT and EMDR—at about 11.2%.
The researchers found no significant difference in dropout between evidence-based trauma-focused treatments and non-trauma-focused treatments or control conditions. (PubMed)
This is another reminder that findings from adult PTSD studies cannot automatically be applied to children and adolescents.
Why Is It Hard to Give EMDR One Dropout Rate?
There is no single dropout percentage that accurately represents EMDR across all research.
The rate depends on:
who is being treated;
how PTSD is defined;
whether treatment takes place in routine care or a research trial;
number and frequency of sessions;
whether treatment is individual or group based;
what other treatment EMDR is being compared with; and
how researchers define completion.
The same problem applies to PE, CPT, trauma-focused CBT, and other PTSD therapies.
A dropout percentage is therefore most useful when it is tied to a specific study or clearly defined group of studies.
What Can We Reasonably Conclude?
The research does not establish that people always drop out of EMDR less often than other PTSD treatments.
Some direct studies have found lower dropout with EMDR, and recent research comparing completion patterns across major PTSD therapies has found relatively high completion for EMDR. (PubMed)
However, larger reviews comparing active psychological treatments have generally not found a consistent dropout advantage for EMDR. (PubMed)
The strongest conclusion is therefore more measured:
EMDR appears to have treatment retention at least broadly comparable with other established PTSD psychotherapies, and some studies suggest it may have a retention advantage in particular settings. But dropout is strongly affected by the population, treatment schedule, study design, and definition of completion, so the evidence does not support one universal EMDR dropout rate or a claim that EMDR always has fewer dropouts.
Frequently Asked Questions
Do fewer people drop out of EMDR than Prolonged Exposure?
Some studies have found that. One small direct comparison reported no dropouts from EMDR and several from Prolonged Exposure. Larger bodies of research, however, have not established that this difference occurs consistently. (PubMed)
What is the average dropout rate from PTSD psychotherapy?
Reviews have produced estimates around 16% to 18% across PTSD psychological treatments, but rates vary substantially among studies and can be much higher in particular populations. (PubMed)
Are people more likely to quit because a therapy focuses on trauma?
The evidence is mixed. Some reviews have found higher dropout across trauma-focused studies, while other analyses of direct treatment comparisons have not found trauma focus itself to predict dropout. (PubMed)
Is dropout higher among veterans?
Some research suggests it can be. Studies of military and veteran populations have reported higher dropout than many civilian studies, although rates still vary substantially according to treatment and study design. (PubMed)
Does a lower dropout rate mean a therapy works better?
No. Dropout and effectiveness measure different things. A therapy can have good completion rates without producing the strongest symptom improvement, while an effective treatment may still have substantial dropout. Researchers therefore examine both treatment outcomes and retention.
Conclusion
Treatment dropout is an important part of PTSD research, but it is more complicated than simply counting how many people finish EMDR and comparing that number with another therapy.
Some individual trials have reported fewer dropouts from EMDR, and newer research suggests that EMDR may have relatively favorable completion rates compared with some major PTSD treatments.
At the same time, systematic reviews show substantial variation from study to study and do not establish a consistent EMDR advantage across every comparison.
What treatment studies tell us most clearly is that EMDR does not appear to have unusually poor retention and may have lower dropout in some circumstances, but the research does not support the broader claim that people consistently drop out of EMDR less often than every other effective PTSD treatment.
