Prolonged Exposure vs. EMDR: Which Trauma Therapy Is Right for You?
Imagine this - you are aware of your trauma or PTSD symptoms, and you decide to seek help. Now, you’re wondering what type of therapy is right for you? Well, you start your internet search and find out that the term “therapy” includes quite a wide range of treatments. And two modalities most commonly pop up for trauma therapy - Prolonged Exposure (PE) therapy and Eye Movement Desensitization and Reprocessing (EMDR). Both are highly recommended, yet the descriptions sound so different that you’re left wondering: Which one is right for me?
Understanding how overwhelming it can be to find the right type of therapy for trauma, I’ve decided to write on this topic. In this article, we will compare PE and EMDR, explore how they work, and see what factors might make one of these psychotherapies more suitable for you than the other. In the end, I hope to give you more clarity and help you make an informed decision about starting your healing.
Understanding PE and EMDR
Prolonged Exposure therapy, also known as PE, is a type of exposure therapy. The underlying theory behind exposure therapies is that the continuous reminders (triggers) for the trauma and the strong need for avoidance of traumatic memories are the two things that keep PTSD symptoms alive. So, to work through, the client needs to expose themselves to triggers and change their avoidant behavior tendency. In PE treatment, the client is gradually confronted with their unresolved traumatic memories in two ways.
The first step is called imaginal exposure. The client is invited to recall the traumatic memory in detail during the session, at the delicate line between feeling exposed and feeling safe. This helps the brain process the experience in a less distressing way, and under the guidance of an expert. The second step of the process is in vivo exposure, i.e., real-life exposure. This includes safely and gradually exposing the client to real-life situations or places that triggered them. This reduces the fear of those scenarios and the tendency to avoid them, while increasing self-support and coping strategies.
PE usually lasts between 8 and 15 sessions, conducted weekly. It also includes a lot of homework, like listening to session recordings or practicing exposure exercises outside of therapy. This helps the client reinforce the awareness and abilities that they practice in therapy, improve their resilience and confidence, and lower their fear-based behavior.
EMDR, on the other hand, takes a different approach in its aim to help the client work through traumatic experiences. It combines remembering parts of the traumatic experience and bilateral stimulation (eye movements, sounds, or taps). With EMDR, the client is also exposed to the traumatic experience, but only through imagination and focus on different, smaller elements of the experience and the memories. EMDR is a structured psychotherapy that is conducted through a defined protocol, gradually guiding the brain to reprocess the memories and lower their emotional charge. We’ve written extensively about EMDR in our Journal, so feel free to take a look at some of the other informative blogs there. If interested, you can learn more about EMDR itself, its benefits, or the common misconceptions that exist for this research-based, effective form of psychotherapy.
Comparative Effectiveness & Efficiency of PE and EMDR
Both PE and EMDR are highly researched forms of psychotherapy, with numerous studies supporting their effectiveness for mental health difficulties, especially PTSD.
One head-to-head pilot comparison done in a clinical setting found that both PE and EMDR significantly reduce PTSD and depression symptoms (Rothbaum, 1997). Those positive results were true both right after treatment and in a follow-up assessment after three months. Nonetheless, EMDR caused a faster symptom relief - as little as 3 sessions were enough to make around a 70% reduction of PTSD symptoms. Furthermore, EMDR participants had lower stress levels after the first session and were less likely to drop out of therapy compared to PE clients. This may be rooted in the way therapy is conducted, with EMDR using only small chunks of memories and PE using the whole experience right away.
Another randomized study compared EMDR, PE, and relaxation training for PTSD symptoms. This study found that PE can produce a significant reduction in avoidance behaviors and re-experiencing of symptoms, compared to EMDR and relaxation methods. Furthermore, it gives those results way faster than the other two modalities. By the end of the PE treatment, many clients with PTSD no longer met the PTSD diagnostic criteria.
As with any form of psychotherapy, the approach needs to be suitable for both the symptoms and the client themselves. Naturally, all approaches have their strong sides and limitations.
Strengths and Limitations of Each Approach
When comparing Prolonged Exposure and Eye Movement Desensitization and Reprocessing, it’s important to look into their overall effectiveness for your symptoms, but also to consider their pace, the way they structure healing, and the emotional demands they might require.
In this section, let’s check some of the strengths and limitations of PE and EMDR, helping you further define what might work best for you.
Effectiveness
Both PE and EMDR are effective in treating trauma and PTSD symptoms. Multiple meta-analyses already confirm that there is no significant difference in terms of long-term effects and benefits from these two modalities.
Time & Efficiency
When talking about efficiency, EMDR is known to require fewer sessions compared to PE. It also requires less homework, and progress is noticeable more quickly. So, it seems to be a great option for people who are looking to feel the benefits as soon as possible.
Nonetheless, in the long run, PE can be highly effective in equipping people who tend to be avoidant toward things that remind them of the trauma. Since PE works with safe and gradual exposure, it might be a great fit for people who are looking to improve their avoidance behavior and increase their self-esteem in terms of coping with triggers.
Emotional Intensity & Tolerability
PE includes repeated retelling of traumatic experiences, and that can be overwhelming for some clients. EMDR, on the other hand, uses a more mediated process in which the client works on their traumatic memories in smaller chunks.
So, EMDR might be better for people who are highly avoidant and don’t have any tolerance, i.e., are very easily triggered, and experience dissociation or destabilization, especially when talking about their traumatic experiences. PE, on the other hand, may be better for people who are looking to face triggers head-on and gain the skills and the tools to cope with their experiences without avoiding them.
Things to Consider before Choosing the Approach
When deciding between Prolonged Exposure and Eye Movement Desensitization and Reprocessing, it’s important to understand that the right fit depends on personal needs, preferences, and circumstances. Several key factors can help guide the decision:
Client preference & tolerance
Some clients prefer a structured framework that is focused on their thoughts and behavior, while they are empowered by gradual exposure, overcoming their avoidant tendencies, fear-based behaviors, and ruminative thoughts. These clients will benefit from PE.
Others might be more comfortable with a less direct engagement with their traumatic experiences, while they take their time and gently get exposed to only bits of their memories. For them, EMDR may resonate more.
Therapist expertise & availability
Another important consideration is access to trained, experienced, and licensed mental health providers. In some areas, the availability of certain methods may be limited, restricting the choices of clients about the modality they want to engage with. In these instances, it’s important to find therapists who work online and offer their services through telehealth platforms.
At EMDR therapy Nashville, we provide both in-person and telehealth practice, allowing you to work with the modality that works for you, regardless of your location.
Combination approaches
The underlined conclusion is this - both EMDR and PE are highly effective for trauma therapy and PTSD symptoms. It’s just deciding on which one works better. To alleviate this decision from a client who doesn’t have the technical knowledge to make an educated decision, at EMDR therapy Nashville, we combine methods of PE and EMDR. There is numerous evidence that suggests that integrated models work best, tailoring therapy to the individual. This approach allows the therapist and the client to make a decision together, one bringing the theoretical expertise, while the other brings the personal preferences.
Conclusion & Guidance
Both EMDR and PE are evidence-based treatments appropriate for PTSD and trauma symptoms. So, when deciding which one is best for you, you need to consider your personal circumstances - your tolerance for exposure, your readiness to be emotionally activated, your treatment goals, and the style you respond best to.
At EMDR Therapy Nashville, we create individualized and personalized holistic therapy plans, ensuring that we mix-and-match different modalities that work together to accommodate the client’s specific needs. This way, you and your therapist will jointly create a “modality” of EMDR and PE that works particularly for your specific needs and circumstances, considering the approach, the pace, the support, and the flexibility that works best for you.
You want help figuring out which trauma therapy approach might suit you? Reach out for a consultation to explore EMDR, PE, or an integrative model.
References
Ironson, G., Freund, B., Strauss, J. L., & Williams, J. (2002, January). Comparison of two treatments for traumatic stress: A community-based study of EMDR and prolonged exposure. Journal of clinical psychology. https://pubmed.ncbi.nlm.nih.gov/11748600/
Taylor, S., Thordarson, D. S., Maxfield, L., Fedoroff, I. C., Lovell, K., & Ogrodniczuk, J. (2023, April). Comparative efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training. Journal of consulting and clinical psychology. https://pubmed.ncbi.nlm.nih.gov/12699027/