Online vs In-Person EMDR: What Have Studies Found?
Eye Movement Desensitization and Reprocessing (EMDR) can now be delivered both in person and online.
That raises a practical question:
Do people get the same results when EMDR is delivered remotely?
The research so far is encouraging, but the answer is not yet as simple as saying the two formats have been proven identical.
Studies of therapist-guided online EMDR show meaningful reductions in Post-Traumatic Stress Disorder (PTSD) symptoms. Direct comparisons between online and in-person EMDR have also begun to appear. Some have found similar completion rates and similar or favorable symptom outcomes online.
More recent research involving veterans found substantial improvement with both formats, although the in-person group showed somewhat greater PTSD symptom reduction in that particular study. PubMed Central (PMC)
The overall picture is therefore:
Online EMDR clearly can work, and direct comparison studies do not suggest that remote delivery makes EMDR ineffective. But the evidence is still too limited to conclude that online and in-person EMDR produce identical outcomes for every population and setting.
What Does “Online EMDR” Mean in These Studies?
In the research discussed here, online EMDR generally means therapist-guided EMDR delivered through live video.
The therapist and client meet in real time, but from different locations.
The treatment may still include:
identifying a distressing memory or experience;
noticing related thoughts, emotions, and physical sensations;
bringing the memory to mind;
using bilateral or other dual-attention stimulation;
noticing how the memory changes during the session;
and reassessing the experience afterward.
The main difference is not the overall treatment model.
It is the delivery format.
This is important because online therapist-guided EMDR is different from self-guided EMDR, where someone uses an EMDR-based process without a therapist conducting the session live.
The previous article, Can EMDR Be Done Online? What the Research Says About Therapist-Guided Online EMDR, focuses on whether remote EMDR works at all.
This article asks the narrower question:
How does it compare with EMDR delivered face to face?
Why Are Direct Comparisons Important?
Suppose researchers study 100 people receiving online EMDR and PTSD symptoms fall substantially.
That tells us online EMDR can be effective.
But it does not tell us whether the same people might have improved:
more;
less;
or about the same
if they had received EMDR in person.
A direct comparison helps answer that question.
The strongest design would randomly assign similar participants to:
online EMDR;
or in-person EMDR,
while keeping as many other parts of treatment as similar as possible.
There are still relatively few EMDR studies using that design.
Much of the available evidence instead comes from:
service evaluations;
retrospective chart reviews;
natural comparisons between clinics or time periods;
and surveys of people who have experienced one or both formats.
These studies are useful, but they cannot always separate the effect of delivery format from differences between the people who happened to receive each format.
What Did the UK Service Evaluation Find?
One of the most useful direct comparisons came from a traumatic-stress service in the United Kingdom.
Researchers compared people receiving online EMDR during one 12-month period with people who had received in-person EMDR in the previous year.
The study included:
45 people receiving online EMDR;
and 33 people receiving in-person EMDR.
Among those completing therapy, 32 were in the online group and 24 were in the in-person group. PubMed Central (PMC)
The researchers compared several outcomes:
PTSD symptom scores;
number of sessions;
therapy completion;
dropout;
and adverse events.
They found no evidence of a difference in therapy completion or dropout between the two formats. PubMed Central (PMC)
That is an important finding because one concern about remote treatment is that people might be less likely to stay engaged.
This study did not show that pattern.
Were PTSD Outcomes Different?
The online group actually had somewhat lower PTSD scores at the end of treatment than the in-person group.
Among people with available end-of-treatment data:
the online group's average PTSD score was 17.1;
the in-person group's average was 24.5.
The difference narrowly missed conventional statistical significance. PubMed Central (PMC)
It would therefore be too strong to say the study proved online EMDR was better.
More importantly, the groups were not randomly assigned.
The online group received treatment during one period, while the in-person group came from the previous year.
That means differences between the groups could have influenced the results.
The authors themselves emphasized that the study could not determine whether the slightly better online scores were actually caused by the online format. PubMed Central (PMC)
The most accurate interpretation is:
Online EMDR performed at least comparably in this real-world service, but the study was not designed strongly enough to prove superiority or exact equivalence.
Did Online EMDR Require More Sessions?
No.
In that service evaluation, people receiving online EMDR actually completed treatment in fewer sessions on average.
The in-person group averaged about 15.3 sessions.
The online group averaged about 12.4 sessions. PubMed Central (PMC)
Again, that does not prove that online EMDR is inherently faster.
Because the groups were treated during different periods and were not randomized, several other factors could have influenced session count.
But the finding is still useful because it shows that delivering EMDR online did not obviously require a much longer treatment course.
What Did Clients and Therapists Say About the Two Formats?
The same study also interviewed clients and therapists.
Overall, both groups viewed online EMDR positively.
Clients mentioned practical benefits such as:
not needing to travel;
feeling more in control in their own environment;
and finding remote treatment more convenient.
Some clients also mentioned drawbacks, including:
having less separation between therapy and ordinary home life;
or finding privacy more difficult at home. PubMed Central (PMC)
These are not questions about whether EMDR itself works.
They are questions about how the treatment format fits a person's life.
For some people, being at home may make participation easier.
For others, attending a separate office may feel more useful.
Research comparing online and in-person EMDR therefore needs to consider more than symptom scores alone.
What Has Research Found in Veterans?
A much larger comparison was published more recently using records from U.S. veterans who received EMDR.
Researchers reviewed outcomes for 279 veterans:
139 received EMDR in person;
140 received EMDR through telehealth.
Across the entire group, PTSD and depression symptoms improved substantially from the beginning to the end of treatment. PubMed
That is important because it confirms that both formats were associated with meaningful clinical improvement in a large real-world veteran sample.
But the comparison also found a difference.
After researchers adjusted for other factors, the in-person group showed a larger reduction in PTSD symptoms than the telehealth group.
The standardized effect size was approximately:
0.85 for in-person EMDR;
0.66 for telehealth EMDR. PubMed
Both were meaningful improvements.
The in-person improvement was simply larger in that particular study.
Does the Veteran Study Prove In-Person EMDR Is Better?
No.
This was a retrospective chart review, not a randomized controlled trial.
Participants were not randomly assigned to receive online or in-person treatment.
That matters because the two groups may have differed in ways that affected outcomes.
For example, people receiving telehealth could have differed in:
location;
treatment access;
clinical circumstances;
preferences;
time period;
or other characteristics.
Researchers statistically adjusted for measured differences, which improves the comparison.
But statistical adjustment cannot guarantee that every relevant difference between groups has been removed.
So the veteran study provides evidence that:
both formats were effective, and in-person treatment was associated with a somewhat larger improvement in that dataset.
It does not prove that switching the same person from online to in-person EMDR would necessarily produce a better result.
Why Do the UK and Veteran Studies Look Different?
At first glance, they may appear contradictory.
The UK service evaluation found slightly lower end-of-treatment PTSD scores in the online group.
The veteran study found a somewhat larger symptom reduction in the in-person group. PubMed Central (PMC)
But these studies involved different:
populations;
healthcare systems;
sample sizes;
treatment periods;
study designs;
and statistical analyses.
Neither randomized participants to delivery format.
That means they are better understood as two pieces of evidence rather than two competing verdicts.
Both support the same broad conclusion:
people can improve substantially with EMDR delivered either online or in person.
The more specific question of whether one format produces a consistently larger effect remains unsettled.
Are Completion and Dropout Rates Different?
The UK comparison found no evidence of a difference in therapy completion or dropout between online and in-person EMDR. PubMed Central (PMC)
This is useful because accessibility can affect whether people finish treatment.
Online treatment may remove barriers such as:
travel time;
transportation;
distance from a provider;
or scheduling difficulties.
At the same time, online treatment can introduce other practical issues, such as interruptions at home or unreliable technology.
Current EMDR comparison research does not show a clear universal advantage for one format in treatment completion.
The article Do People Drop Out of EMDR Less Often? What Treatment Studies Tell Us looks at dropout research more broadly.
Is the Bilateral Stimulation Different Online?
It can be.
In-person EMDR often uses therapist-guided eye movements, tapping, light bars, tactile devices, or other bilateral-stimulation methods.
Online EMDR may use:
visual movement on a screen;
following the therapist's hand;
self-tapping;
alternating sounds;
or other remote methods.
That difference could matter in principle because the specific bilateral-stimulation method may affect how demanding the task is.
However, the current online-versus-in-person literature does not show that a particular remote bilateral method is responsible for better or worse treatment outcomes.
The article Eye Movements, Tapping or Tones: What Has Research Actually Studied? examines the evidence on different forms of bilateral stimulation separately.
Do People Prefer Online or In-Person EMDR?
There is no single preference.
Survey research suggests many clients feel comfortable with online EMDR and would recommend it.
At the same time, preference depends heavily on practical circumstances.
Someone may prefer online EMDR because:
it eliminates travel;
appointments fit more easily into daily life;
treatment is available from home;
or access to an EMDR provider is otherwise difficult.
Someone else may prefer in-person EMDR because:
they like a separate physical setting;
they find it easier to concentrate away from home;
or they simply prefer face-to-face interaction.
Preference is worth studying because a treatment that fits a person's circumstances may be easier to attend and complete.
But preference alone does not tell us which format produces the larger average clinical effect.
Does Broader Telehealth PTSD Research Help Answer the Question?
Somewhat.
Research on other PTSD therapies shows that effective trauma-focused treatment can often be delivered through telehealth.
For example, studies involving veterans have compared in-person and telehealth delivery of evidence-based PTSD treatments and found meaningful improvement through both formats. PubMed Central (PMC)
This broader telehealth literature makes the effectiveness of online EMDR less surprising.
But EMDR-specific evidence is still important.
Different therapies use different procedures, so researchers cannot simply assume that findings from one treatment automatically apply to another.
The EMDR comparison studies discussed here therefore remain the most directly relevant evidence.
Why Haven't There Been More Randomized Online-vs-In-Person EMDR Trials?
Part of the reason is historical.
Before remote therapy became widely used, there was less reason to study online EMDR as a major alternative to office-based treatment.
The COVID-19 pandemic changed that quickly.
Therapists began providing remote EMDR much more often, which created opportunities for:
surveys;
service evaluations;
telehealth outcome studies;
and retrospective comparisons.
Those studies helped establish that online EMDR was workable and could produce substantial improvement.
The next step is methodologically stronger comparison research.
A large randomized trial directly assigning similar participants to online or in-person EMDR would provide much stronger evidence about whether the delivery format itself changes outcomes.
Can We Say Online and In-Person EMDR Are Equivalent?
Not yet in the strict scientific sense.
“Equivalent” has a specific meaning in treatment research.
Showing that two groups both improve is not enough.
Researchers generally need a sufficiently large study specifically designed to test whether any difference between the two treatments stays within a predefined equivalence or non-inferiority range.
The existing EMDR research does not yet provide a large body of trials designed that way.
So it is more accurate to say:
Both online and in-person EMDR are associated with meaningful improvement, and existing direct comparisons do not show that online delivery makes EMDR ineffective. But exact clinical equivalence has not yet been firmly established.
That wording keeps the conclusion aligned with the studies that have actually been conducted.
What Can We Reasonably Conclude?
Several conclusions are supported.
Online EMDR can produce substantial PTSD improvement.
That is supported by online-treatment studies and service evaluations.
Direct comparison research shows meaningful improvement with both online and in-person EMDR.
In a UK trauma service, the two formats showed similar completion and dropout patterns, with weak evidence of somewhat lower end-of-treatment PTSD scores in the online group. PubMed Central (PMC)
A larger veteran chart review found improvement with both formats but somewhat greater PTSD symptom reduction in the in-person group. PubMed
Neither comparison was a randomized head-to-head trial.
That limits how confidently researchers can attribute differences specifically to the mode of delivery.
The evidence therefore supports a balanced conclusion:
Online and in-person EMDR both appear capable of producing meaningful clinical improvement. Current studies do not establish that one format is universally superior, and stronger randomized comparisons are still needed before the two can be described as conclusively equivalent.
Frequently Asked Questions
Is online EMDR as effective as in-person EMDR?
Current research shows meaningful improvement with both formats, but the evidence is not yet strong enough to say they are universally equivalent. Direct comparison studies remain relatively limited. PubMed Central (PMC)
Has anyone directly compared online and in-person EMDR?
Yes. A UK service evaluation compared 45 online clients with 33 people who had previously received in-person EMDR. A later U.S. veteran study compared 140 telehealth cases with 139 in-person cases. PubMed Central (PMC)
Did the online group do worse in the UK study?
No. Completion and dropout did not differ significantly, and the online group actually had somewhat lower PTSD scores at the end of treatment. Because the groups were not randomized, however, researchers could not conclude that online treatment was better. PubMed Central (PMC)
Did the veteran study favor in-person EMDR?
The in-person group showed a somewhat larger reduction in PTSD symptoms, although both groups improved substantially. Because this was a retrospective chart review rather than a randomized trial, the difference cannot automatically be attributed to delivery format. PubMed
Does online EMDR use the same treatment process?
The broad EMDR treatment structure remains similar, although the method of bilateral stimulation and the practical setup may be adapted for remote sessions.
Conclusion
Research comparing online and in-person EMDR is beginning to provide a clearer picture.
The most consistent finding is that both formats can produce substantial improvement in PTSD symptoms.
A UK service evaluation found similar completion and dropout rates and no clear outcome disadvantage for online EMDR. A larger veteran study also found meaningful improvement with both formats, although PTSD symptom reduction was somewhat larger among those treated in person. PubMed Central (PMC)
Neither study randomly assigned participants to online or in-person treatment, so neither can give a final answer about whether one format is inherently better.
That leaves us with a useful but appropriately measured conclusion:
Online EMDR appears to be a legitimate alternative to in-person delivery, and current comparison studies show meaningful benefits with both. What research has not yet established is that the two formats produce exactly equivalent outcomes for every person, population, and treatment setting.
