EMDR for PTSD With Other Mental Health Conditions: What Does the Research Tell Us?
People taking part in Post-Traumatic Stress Disorder (PTSD) research do not always have PTSD alone.
Depression and anxiety commonly occur alongside PTSD. Some people also have Substance Use Disorders, bipolar disorder, psychotic disorders, or other mental-health conditions.
Researchers have therefore asked an important question: Does Eye Movement Desensitization and Reprocessing (EMDR) still reduce PTSD symptoms when other psychological conditions are present?
The evidence is increasingly informative.
Studies have found that EMDR can reduce PTSD symptoms in people with several different co-occurring conditions. In some research, symptoms of depression, anxiety, or other difficulties improve as well.
But those secondary improvements are not automatic, and treating PTSD does not necessarily mean that every other condition disappears.
A recent meta-analysis of 65 randomized studies involving 3,342 adults with PTSD found that EMDR produced significant reductions in PTSD symptoms and also had immediate beneficial effects on co-occurring anxiety and depression. PubMed Central (PMC)
Controlled research has also examined EMDR in more specific populations, including people with both PTSD and Substance Use Disorders and people with PTSD alongside psychotic disorders.
Those studies provide an important broader message: having another mental-health condition does not automatically mean that someone falls outside the EMDR research evidence for PTSD. JAMA Network
What Does “Co-Occurring” Mean?
A co-occurring condition simply means that a person meets criteria for more than one mental-health condition at the same time.
Researchers may also use the word comorbid, which means essentially the same thing in this context.
For example, someone in an EMDR study might have:
PTSD and depression;
PTSD and an anxiety disorder;
PTSD and a Substance Use Disorder;
PTSD and a psychotic disorder;
or PTSD alongside another diagnosed mental-health condition.
This matters because people seen in real-world mental-health settings often have more than one area of difficulty.
If EMDR research included only people with PTSD and no other symptoms or diagnoses, the findings would tell us less about how treatment works in more typical clinical populations.
Why Have Co-Occurring Conditions Been an Important Research Question?
Psychotherapy studies often use inclusion and exclusion criteria to make research groups easier to compare.
Historically, some PTSD trials excluded people with more complicated clinical presentations.
That can make a trial easier to conduct, but it also creates an important question later:
Will the treatment still help when PTSD occurs alongside another condition?
Researchers have increasingly tested this directly rather than assuming the answer.
One especially notable example involved people with psychotic disorders. The researchers specifically noted that psychosis had commonly been an exclusion criterion in PTSD trials, which meant there had been little randomized evidence about trauma-focused treatments in this population. PubMed
The solution was not to speculate. Researchers conducted a randomized controlled trial.
That approach—studying the population directly—is much more informative than assuming that another diagnosis automatically changes how PTSD must be treated.
What Does Research Show About Depression Alongside PTSD?
Depression is one of the most frequently measured additional outcomes in EMDR studies.
PTSD and depressive symptoms can overlap in several ways. Both can involve sleep difficulties, reduced interest in activities, negative beliefs, concentration problems, and changes in mood.
Researchers therefore often measure depression before and after PTSD treatment even when depression is not the primary diagnosis being treated.
The recent meta-analysis of 65 randomized studies found that EMDR had an immediate significant effect not only on PTSD symptoms but also on depression and anxiety symptoms. PubMed Central (PMC)
This finding fits with earlier clinical research showing that depressive symptoms frequently decline during successful EMDR treatment for PTSD.
That does not mean depression is always simply a consequence of PTSD or that every case of depression resolves when PTSD improves.
It means that when PTSD and depression occur together, treating the PTSD with EMDR can sometimes be accompanied by meaningful improvement in depressive symptoms as well.
The separate article EMDR for Depression: What Have Clinical Studies Found? looks at research in which depression itself is the primary treatment target.
What About Anxiety Alongside PTSD?
Anxiety is also commonly measured in PTSD studies.
Some anxiety may be closely connected with PTSD—for example, fear triggered by reminders of a traumatic experience. Other people may have an additional anxiety disorder.
The 65-study meta-analysis found significant immediate improvements in anxiety after EMDR in adults treated for PTSD. PubMed Central (PMC)
This adds to a broader EMDR literature showing reductions in anxiety across different research populations.
Again, the distinction is important.
A PTSD trial showing that anxiety symptoms improve does not automatically establish the effect of EMDR on every separate anxiety disorder.
But it does show that co-occurring anxiety does not prevent PTSD symptoms from improving with EMDR, and anxiety itself may improve during treatment.
The article EMDR for Anxiety: What Does the Research Show? examines anxiety-focused studies separately.
What Has Research Found When PTSD Occurs With a Substance Use Disorder?
Researchers have paid particular attention to PTSD occurring alongside a Substance Use Disorder (SUD).
These conditions frequently occur together, and an important research question has been whether PTSD treatment can be provided while someone is also receiving treatment for substance use.
A major randomized controlled trial published in 2025 included 209 people with both PTSD and a Substance Use Disorder.
All participants received substance-use treatment. They were randomly assigned either to that treatment alone or to substance-use treatment plus one of three trauma-focused therapies:
Prolonged Exposure;
EMDR;
or Imagery Rescripting.
Participants receiving EMDR completed a standard 12-session protocol within three months.
Compared with Substance Use Disorder treatment alone, adding EMDR produced a significantly greater reduction in clinician-rated PTSD symptoms. Wiley Online Library
That is an important finding because it shows that EMDR can treat PTSD even when active substance-use difficulties are also being addressed.
Did Treating PTSD With EMDR Also Reduce Substance Use?
Not necessarily.
The same study found no significant differences in Substance Use Disorder outcomes between the groups. Wiley Online Library
This illustrates one of the most important ideas in research on co-occurring conditions.
Treating one condition successfully does not guarantee that every other condition changes at the same rate.
In this study:
PTSD improved more when trauma-focused treatment such as EMDR was added.
But:
Substance-use outcomes did not show the same additional improvement.
That does not make the PTSD improvement less meaningful.
It tells researchers that the two conditions need to be measured separately.
The earlier article EMDR for Addiction and Cravings: What Have Researchers Studied? examines substance-use and craving outcomes in more detail.
Does Substance-Use Treatment Have to Finish Before PTSD Is Addressed?
Research increasingly suggests that it does not have to be approached that way in every case.
The 2025 randomized study specifically evaluated PTSD treatment delivered alongside Substance Use Disorder treatment.
EMDR significantly improved PTSD symptoms while substance-use treatment was continuing. Wiley Online Library
More recent analyses from the same 209-person trial have continued examining whether trauma-focused treatment is delivered simultaneously with or sequentially after substance-use treatment, as well as outcomes involving emotional regulation, interpersonal difficulties, guilt, and shame. PubMed
These studies are important because they test a practical question directly rather than assuming that one condition must always be completely resolved before another is addressed.
What About PTSD and Psychotic Disorders?
One of the most informative EMDR studies involved people with chronic psychotic disorders who also had PTSD.
This population had often been excluded from earlier PTSD treatment research.
A randomized clinical trial included 155 outpatients receiving treatment for psychosis who also had PTSD.
Participants were assigned to:
eight sessions of Prolonged Exposure;
eight sessions of EMDR;
or a waiting-list condition.
The trial found that both trauma-focused treatments were effective in reducing PTSD symptoms compared with waiting list. JAMA Network
The significance of this study extends beyond one diagnosis.
It showed that researchers could directly test trauma-focused EMDR in a population that had previously often been left out of PTSD trials.
Did EMDR Make Other Symptoms Worse in the Psychosis Study?
The follow-up research did not show that pattern.
Researchers examined not only PTSD but also symptoms related to psychosis, depression, and social functioning.
EMDR was associated with reductions in paranoid thoughts, and more people reached remission from their psychotic disorder at some assessments. Auditory hallucinations and overall social functioning did not show significant improvement from EMDR. PubMed
At 12-month follow-up, positive effects on PTSD, depression, paranoid-referential thinking, and remission from schizophrenia remained evident across the trauma-focused treatment study. Cambridge University Press
The important point is not that EMDR directly treats every aspect of psychosis.
It is that people with a psychotic disorder and PTSD were able to experience substantial PTSD improvement from trauma-focused treatment, and the presence of the additional condition did not eliminate the EMDR treatment effect.
Has EMDR Been Studied in People With Bipolar Disorder?
Yes.
A multicenter randomized controlled trial examined trauma-focused EMDR in 77 people with bipolar disorder who also had trauma-related symptoms.
Participants were assigned to either 20 sessions of trauma-focused EMDR adapted for bipolar disorder or 20 sessions of supportive therapy. ScienceDirect
This study asked a somewhat different question from the psychosis and Substance Use Disorder trials because bipolar illness itself—not only PTSD symptom severity—was an important part of the outcome being studied.
Research of this kind helps broaden understanding of how trauma-focused EMDR performs in populations who have traditionally been underrepresented in standard PTSD trials.
It also demonstrates why the phrase “PTSD with another mental-health condition” covers many different research questions.
The design needed to study PTSD with depression is not necessarily the same as the design needed to study PTSD in people with bipolar disorder.
Does EMDR Improve the Other Condition Too?
Sometimes—but not always.
This is probably the most important distinction in the entire article.
If researchers treat PTSD in someone who also has depression and both improve, that is useful evidence.
But if PTSD improves while the other condition changes little, the PTSD treatment has not necessarily failed.
Different conditions have different symptoms, mechanisms, and treatments.
The psychosis trial illustrates this well.
PTSD symptoms and paranoid thinking improved, but auditory hallucinations and overall social functioning did not show the same change. PubMed
The Substance Use Disorder trial shows the same principle from another direction.
PTSD improved significantly when EMDR was added, but Substance Use Disorder outcomes did not improve more than with substance-use treatment alone. Wiley Online Library
Research therefore needs to measure each outcome separately instead of treating “better” as one all-purpose result.
Does Having More Than One Condition Make EMDR Less Effective?
The research does not support a simple rule that EMDR stops working when another mental-health condition is present.
Studies have found meaningful PTSD reductions in people with:
depression and anxiety symptoms;
Substance Use Disorders;
psychotic disorders;
and other more complex clinical presentations. PubMed
That does not mean every person with every combination of diagnoses will respond identically.
It means that co-occurring conditions cannot automatically be treated as evidence that EMDR is unlikely to work for the PTSD.
Researchers increasingly study these populations directly because broad exclusion rules can hide useful information about how treatments work in real-world settings.
Why Do Depression and Anxiety Sometimes Improve When PTSD Is Treated?
There are several possible explanations.
PTSD symptoms can affect sleep, concentration, mood, relationships, daily activity, and a person's sense of safety.
If PTSD symptoms decrease, some connected anxiety or depressive symptoms may decrease as well.
Traumatic memories can also carry beliefs such as:
“I am powerless.”
“I am permanently damaged.”
“Something bad is always about to happen.”
Changes in how those memories are experienced may influence emotional symptoms beyond the narrow PTSD diagnosis.
However, researchers cannot assume that every secondary improvement occurs through the same mechanism.
The clinical evidence tells us that symptoms changed.
Mechanism research asks why they changed.
The article Can a Therapy Work Even If Scientists Do Not Fully Agree on Why It Works? The EMDR Mechanism Debate examines that distinction more closely.
Why Is This Research Important?
People seeking treatment rarely fit perfectly into one diagnostic category.
If research excluded anyone with depression, anxiety, substance use, or other psychological difficulties, treatment evidence would apply to a much narrower group than the people who actually experience PTSD.
Studies of co-occurring conditions therefore improve the usefulness of the evidence.
They help answer practical questions such as:
Does PTSD improve even when another condition is present?
Do symptoms of the other condition change too?
Can two conditions be treated during the same period?
Does treating PTSD interfere with treatment for the other condition?
Do benefits remain after treatment ends?
Those are more informative questions than simply asking whether someone has a “complicated” diagnosis.
What Are the Main Limitations of the Research?
The evidence is not equally extensive for every mental-health condition.
Depression and anxiety are measured frequently in PTSD research.
There are also substantial randomized studies involving Substance Use Disorders and psychotic disorders.
Other combinations have been studied in fewer trials.
Studies may also differ in:
how the additional condition is diagnosed;
whether it is actively treated at the same time;
treatment length;
medication use;
participant characteristics;
and which outcomes researchers measure.
A study showing that EMDR works for PTSD alongside one additional condition therefore cannot automatically establish that it works identically alongside every other condition.
But the research is now broad enough to challenge the older idea that people with co-occurring mental-health conditions necessarily need to be excluded from trauma-focused treatment studies.
What Can We Reasonably Conclude?
Research on EMDR for PTSD with other mental-health conditions supports several conclusions.
EMDR can still reduce PTSD symptoms when another psychological condition is present.
This has been demonstrated in research involving depression and anxiety symptoms, Substance Use Disorders, psychotic disorders, and other more complex populations. JAMA Network
Some co-occurring symptoms may improve alongside PTSD.
Depression and anxiety frequently decrease during successful EMDR treatment, and research in people with psychotic disorders found improvements in some additional symptoms as well. PubMed
Improvement in PTSD does not guarantee improvement in every other condition.
The Substance Use Disorder trial found significant PTSD benefits from adding EMDR but no additional improvement in substance-use outcomes. Wiley Online Library
Research increasingly supports studying and treating PTSD within the fuller context of people's lives rather than assuming PTSD must occur alone.
The most reasonable overall conclusion is:
Having another mental-health condition does not automatically place someone outside the evidence for EMDR treatment of PTSD. Controlled studies show that meaningful PTSD improvement is possible across several co-occurring conditions, while the effects on the additional condition need to be evaluated separately.
Frequently Asked Questions
Can EMDR work for PTSD if someone also has depression or anxiety?
Yes. Depression and anxiety are commonly measured in EMDR studies, and pooled randomized research finds significant improvements in both alongside reductions in PTSD symptoms. PubMed Central (PMC)
Can EMDR be used when PTSD occurs with a Substance Use Disorder?
Research has directly examined this combination. In a 209-person randomized trial, adding EMDR to substance-use treatment significantly reduced PTSD symptoms compared with substance-use treatment alone. Wiley Online Library
Does treating PTSD with EMDR also treat the other mental-health condition?
Sometimes other symptoms improve, but not always. Researchers measure the conditions separately. For example, PTSD improved in a Substance Use Disorder trial even though substance-use outcomes did not show additional improvement. Wiley Online Library
Has EMDR been studied in people with psychotic disorders?
Yes. A randomized trial involving 155 people with psychotic disorders and PTSD found that EMDR significantly reduced PTSD symptoms compared with waiting list, with some improvements in paranoid thinking also reported. JAMA Network
Does another diagnosis automatically make EMDR less effective for PTSD?
The available evidence does not support that broad conclusion. Controlled studies show substantial PTSD improvement in several populations with co-occurring conditions.
Conclusion
PTSD often occurs alongside other mental-health conditions, and EMDR research increasingly reflects that reality.
Studies show that EMDR can reduce PTSD symptoms even when people also experience depression, anxiety, Substance Use Disorders, psychotic disorders, or other psychological difficulties.
Sometimes improvement extends beyond PTSD. Depression and anxiety often decrease, and some studies report changes in other symptoms as well.
But research also shows why it is important not to treat all outcomes as one.
A person can experience substantial improvement in PTSD while another condition changes less. In the large Substance Use Disorder trial, for example, adding EMDR improved PTSD significantly without producing additional improvement in substance-use severity. Wiley Online Library
That leads to a useful and evidence-based conclusion:
EMDR does not require PTSD to exist in isolation. Research shows that it can remain an effective PTSD treatment in people with several kinds of co-occurring mental-health conditions, while the effects on each additional condition need to be considered on their own.
