EMDR for Veterans and Military Trauma: What Has Actually Been Studied?
Eye Movement Desensitization and Reprocessing (EMDR) is one of the psychological treatments recommended for Post-Traumatic Stress Disorder (PTSD) by the U.S. Department of Veterans Affairs and Department of Defense.
That can create an understandable impression that EMDR must have been tested in a very large number of military-specific clinical trials.
The research picture is more nuanced.
EMDR has a substantial overall evidence base for PTSD across many types of trauma. Veterans and active-duty service members have also been included in EMDR research, including randomized studies involving combat-related PTSD.
But the number of trials conducted specifically in military and veteran populations is much smaller than the overall EMDR PTSD literature.
The Department of Veterans Affairs' National Center for PTSD currently notes that most EMDR research has involved civilian rather than veteran samples. Its review identified four randomized controlled trials specifically involving military personnel or veterans, all published before 2000, and only one provided a full course of EMDR treatment. VA PTSD Resource Center
At the same time, the 2023 Department of Veterans Affairs/Department of Defense (VA/DoD) Clinical Practice Guideline gives EMDR one of its strongest recommendations for PTSD, alongside Cognitive Processing Therapy and Prolonged Exposure. VA PTSD Resource Center
Both facts can be true.
The guideline evaluates the broader PTSD treatment evidence, while the narrower question—exactly what has been studied specifically in veterans and military personnel?—has a smaller research base.
What Counts as Military Trauma in Research?
Military trauma is broader than combat alone.
Service members and veterans may experience traumatic events connected with:
combat exposure;
witnessing death or serious injury;
attacks or explosions;
military accidents;
captivity or imprisonment;
sexual assault or harassment;
or other events occurring during military service.
However, much of the older EMDR research specifically involving veterans focused on combat-related PTSD, particularly among Vietnam War veterans.
This is important when interpreting study results.
A trial involving a small group of Vietnam combat veterans is relevant to military PTSD, but it cannot automatically answer every question about EMDR following every type of military trauma or in every generation of veterans.
What Did the Early Combat-Veteran Trials Find?
Several of the earliest military-specific EMDR studies were conducted in the 1990s.
One randomized study included 35 combat veterans with combat-related PTSD.
Participants received either:
12 sessions of EMDR;
12 sessions of biofeedback-assisted relaxation;
or routine clinical care.
The EMDR group showed significantly greater improvement on several PTSD measures after treatment than the comparison groups. PubMed
This study is important because, unlike several other early military studies, it delivered a relatively complete treatment course rather than only one or a few sessions.
However, the sample was small: only 10 participants received EMDR.
That means the trial provides useful evidence, but it cannot carry the entire case for EMDR in military populations by itself.
Why Did Some Early Veteran Studies Produce Less Clear Results?
Not every early military EMDR trial showed a large advantage.
According to the Department of Veterans Affairs' current research summary, four randomized controlled trials were identified in military or veteran populations.
EMDR generally improved PTSD symptoms at levels comparable with the treatment or comparison conditions. Those comparisons included:
exposure therapy;
EMDR without eye movements;
usual care;
and biofeedback.
But three of the four trials tested only one to three EMDR sessions, rather than a full treatment course. VA PTSD Resource Center
That is a major limitation.
Testing one or two sessions does not answer the same question as testing a complete course of EMDR over several weeks.
Modern EMDR research commonly evaluates treatment over approximately three months, and the VA notes that more recent civilian studies using fuller protocols provide stronger evidence of effectiveness. VA PTSD Resource Center
So some inconsistency in the early military literature may partly reflect how EMDR was tested, not simply whether EMDR can help veterans.
What Did Reviews of Military and Veteran PTSD Research Find?
Researchers have also tried to combine military PTSD studies across different psychological treatments.
A 2015 meta-regression reviewed 57 studies representing 69 treatment samples of soldiers and veterans.
The review examined several guideline-recommended treatments, including EMDR, exposure therapies, Cognitive Processing Therapy, trauma-focused Cognitive Behavioral Therapy, and stress-management approaches.
Initially, exposure therapy and Cognitive Processing Therapy appeared to produce better outcomes than EMDR. However, after researchers adjusted for differences in study design, EMDR was no longer associated with poorer outcomes. PubMed
The review also found that military and veteran populations tended to show smaller treatment gains overall than civilian PTSD samples.
That finding was not unique to EMDR.
It raised a broader question about treating PTSD in military populations rather than demonstrating that one particular therapy was ineffective.
What Did the 2019 Military PTSD Review Find?
A later systematic review looked specifically at psychological treatments for active-duty and former military personnel with PTSD.
The review included 24 studies with 2,386 participants.
Individual trauma-focused Cognitive Behavioral Therapy had the strongest evidence in that analysis.
For EMDR specifically, the review identified only four studies involving 92 participants. When those studies were pooled, EMDR did not show a statistically significant advantage over waiting list or usual care.
However, the authors emphasized that the EMDR evidence was extremely limited and called for further high-quality trials. PubMed
The small number is crucial.
A conclusion based on four small, mainly older studies is very different from a conclusion based on dozens of modern randomized trials.
The review therefore tells us that military-specific EMDR evidence was limited, not that the larger PTSD evidence for EMDR disappeared when veterans were considered.
Why Does VA/DoD Still Strongly Recommend EMDR?
This is one of the most important questions.
The 2023 VA/DoD guideline does not require every PTSD treatment to have been studied only in veterans.
Instead, guideline panels evaluate the broader scientific literature on PTSD treatment and determine whether the evidence is strong enough to support use within VA and Department of Defense health systems.
The current guideline strongly recommends three individual trauma-focused psychotherapies:
Cognitive Processing Therapy;
Prolonged Exposure;
and EMDR. VA PTSD Resource Center
The Department of Veterans Affairs explains that these treatments have the strongest evidence from clinical trials and recommends individual trauma-focused psychotherapy over medication when possible. VA PTSD Resource Center
EMDR therefore occupies a strong position in current military and veteran PTSD guidance even though the number of veteran-only EMDR trials remains comparatively small.
This distinction is also relevant to the earlier article What Do Major Clinical Guidelines Say About EMDR?
Does the VA/DoD Recommendation Mean EMDR Is Proven Specifically for Combat PTSD?
Not quite.
A guideline recommendation and a population-specific trial are not the same form of evidence.
The VA/DoD recommendation tells us that the guideline panel considers the overall PTSD evidence strong enough to recommend EMDR for people receiving care within military and veteran systems.
Military-specific trials tell us how EMDR performed in particular samples of service members or veterans.
The older combat-veteran studies provide direct evidence in that population, but their small sample sizes and short protocols limit how precisely researchers can estimate the effect.
So the strongest statement is:
EMDR is a strongly recommended PTSD treatment in current VA/DoD guidance, while direct randomized research conducted specifically in military and veteran samples remains more limited than the overall PTSD evidence base.
Are Veterans Different From Civilian PTSD Research Participants?
Sometimes, in ways that can affect research outcomes.
Military PTSD populations may differ from civilian trial populations in several respects.
Participants may have experienced:
multiple traumatic events;
repeated combat deployments;
traumatic experiences spread over many years;
physical injuries;
grief and loss;
or other psychological difficulties occurring alongside PTSD.
Research reviews have found that PTSD treatments sometimes produce smaller average effects in military and veteran populations than in civilian samples. PubMed
That does not mean veterans cannot benefit.
It means that researchers cannot always assume the size of an effect will be identical across different populations.
The separate article EMDR for Complex Trauma: What Have Studies Found? discusses some of the broader evidence involving repeated and prolonged trauma.
Does Military PTSD Require a Different Form of EMDR?
The research reviewed by the Department of Veterans Affairs generally concerns standard EMDR rather than an entirely different treatment created for military personnel.
EMDR involves identifying distressing memories and associated beliefs, emotions, and physical reactions, then processing those memories while using bilateral stimulation such as side-to-side eye movements or tapping. VA PTSD Resource Center
The target memories may differ from one person to another, but the overall treatment structure remains recognizable as EMDR.
Military status by itself does not create a separate EMDR protocol.
However, someone with several combat experiences may have more than one relevant memory to process, which can affect treatment length.
What About Newer Military Trauma Treatments?
Researchers continue to develop and test additional approaches for military PTSD.
One example is Multi-Modular Motion-Assisted Memory Desensitization and Reconsolidation (3MDR), a technology-assisted treatment that combines walking on a treadmill, trauma-related images, therapist interaction, and other elements.
A randomized trial involving 42 male military veterans with treatment-resistant service-related PTSD found a greater reduction in clinician-rated PTSD symptoms at 12 weeks for veterans receiving immediate 3MDR compared with those in a delayed-treatment group. PubMed
3MDR is not standard EMDR, despite the similarity in parts of the name.
Research into technologies such as 3MDR therefore should not be counted as direct evidence for ordinary EMDR.
This illustrates why it is useful to look carefully at what treatment was actually studied, rather than grouping all therapies involving memory processing together.
What Do We Know About Treatment Dropout in Military Populations?
Dropout is an important issue across military PTSD research.
The 2019 systematic review found relatively high dropout rates across several trauma-focused treatments for active-duty and former military personnel. PubMed
This was not simply an EMDR problem.
Researchers have examined whether PTSD therapies can be made more acceptable, efficient, or flexible for military populations partly because completing treatment can be challenging across approaches.
The separate article Do People Drop Out of EMDR Less Often? What Treatment Studies Tell Us looks at dropout evidence more broadly.
Does EMDR Work Better Than Prolonged Exposure or Cognitive Processing Therapy for Veterans?
The current evidence does not support claiming that EMDR is universally superior.
The VA/DoD guideline places EMDR, Cognitive Processing Therapy, and Prolonged Exposure together among its most strongly recommended PTSD psychotherapies. VA PTSD Resource Center
Military-specific research, however, has not produced enough large direct EMDR comparisons to establish a clear ranking among these treatments specifically for veterans.
This is where the difference between guideline recommendation and head-to-head military trial evidence becomes important again.
The articles EMDR vs Prolonged Exposure Therapy: What Have Studies Found? and EMDR vs Cognitive Processing Therapy: What Do We Know? examine the broader comparative evidence.
Does EMDR Help With Depression and Anxiety in Veterans?
Some EMDR PTSD research measures additional symptoms such as depression and anxiety.
Across PTSD populations generally, meta-analyses find reductions in both depression and anxiety following EMDR. PubMed
But the military-specific randomized research is too small to provide equally precise estimates for every secondary outcome.
So it is reasonable to say that depression and anxiety can improve during successful PTSD treatment, but claims specifically about veterans are best tied to the individual study being discussed.
That same distinction applies throughout this topic: the general EMDR literature is large, while the subset conducted specifically in military samples is much smaller.
Why Does This Distinction Matter?
It prevents two opposite errors.
One would be to say:
“EMDR has barely been studied in veterans, so there is little evidence for using it in veteran PTSD.”
That ignores the much larger PTSD treatment literature and the VA/DoD guideline's strong recommendation.
The opposite error would be:
“VA strongly recommends EMDR, so dozens of large modern EMDR trials must have been conducted specifically in veterans.”
That is also inaccurate.
The actual evidence is more interesting.
EMDR has substantial support as a PTSD treatment generally. It has been directly studied in military and veteran populations, including combat veterans, but the military-specific randomized literature is relatively small and much of it is old.
The Department of Veterans Affairs itself makes this distinction and states that more military- and veteran-specific EMDR research is needed. VA PTSD Resource Center
What Can We Reasonably Conclude?
Several conclusions are supported by the research.
EMDR has been directly studied in military personnel and veterans with PTSD, including people with combat-related PTSD.
One randomized trial provided 12 sessions of EMDR to combat veterans and found significant improvement compared with biofeedback-assisted relaxation and routine clinical care. PubMed
The military-specific EMDR trial literature is relatively small.
The Department of Veterans Affairs identifies four randomized trials specifically involving military or veteran populations, all conducted before 2000, with only one testing a full course of EMDR. VA PTSD Resource Center
Reviews of military PTSD treatments have therefore been more cautious about drawing EMDR-specific conclusions than reviews of PTSD treatment overall. PubMed
At the same time:
The 2023 VA/DoD guideline strongly recommends EMDR for PTSD, alongside Cognitive Processing Therapy and Prolonged Exposure. VA PTSD Resource Center
These findings are not contradictory.
They tell us that EMDR's recommendation for veterans rests on a combination of direct military research and a much larger body of PTSD treatment evidence across populations.
Frequently Asked Questions
Has EMDR actually been studied in combat veterans?
Yes. Randomized studies have included combat veterans, particularly Vietnam War veterans. One trial compared 12 sessions of EMDR with biofeedback-assisted relaxation and routine clinical care and found significant improvement in the EMDR group. PubMed
Does the Department of Veterans Affairs recommend EMDR?
Yes. The 2023 VA/DoD PTSD guideline strongly recommends EMDR alongside Cognitive Processing Therapy and Prolonged Exposure as individual trauma-focused psychotherapies for PTSD. VA PTSD Resource Center
Are there many modern EMDR trials conducted only in veterans?
No. The Department of Veterans Affairs notes that most EMDR research has involved civilian populations and identifies only four randomized military or veteran trials in its review, all published before 2000. VA PTSD Resource Center
Does limited veteran-specific research mean EMDR is not evidence-based for veterans?
No. The VA/DoD recommendation draws on the broader PTSD treatment evidence as well as research relevant to military care. The limitation means researchers have less direct military-specific evidence than they have overall EMDR evidence.
Is EMDR proven better than Prolonged Exposure or Cognitive Processing Therapy for veterans?
The evidence does not establish that. VA/DoD strongly recommends all three, and there are not enough large head-to-head military-specific EMDR trials to conclude that one is universally superior. VA PTSD Resource Center
Conclusion
EMDR occupies an interesting place in the research on veterans and military trauma.
It has been directly studied in combat veterans, and controlled trials show that veterans can experience meaningful reductions in PTSD symptoms after EMDR.
But the military-specific research is smaller than many people may assume.
The Department of Veterans Affairs currently identifies only a handful of randomized EMDR trials conducted specifically with military personnel or veterans, most of them older and several involving very short treatment courses. VA PTSD Resource Center
That limited population-specific evidence sits alongside a much larger overall PTSD research literature.
After reviewing that broader evidence, the 2023 Department of Veterans Affairs/Department of Defense guideline strongly recommends EMDR as one of three leading trauma-focused psychotherapies for PTSD, together with Cognitive Processing Therapy and Prolonged Exposure. VA PTSD Resource Center
So the most accurate conclusion is not that EMDR has been exhaustively tested in military populations, nor that veteran-specific evidence is absent.
It is this:
EMDR has been directly studied in veterans and people with combat-related PTSD, and current VA/DoD guidance strongly supports it as a PTSD treatment. At the same time, more modern, large-scale research specifically involving veterans and active-duty military personnel would help clarify how closely outcomes in these populations match the broader EMDR evidence base.
