EMDR Therapy and Treatment Completion: Why More Patients Stay the Course

Post-traumatic stress disorder (PTSD) is a complex and often chronic mental health condition that affects individuals exposed to traumatic events. While several evidence-based treatments are available, a recurring challenge across therapeutic approaches is patient dropout. High attrition rates can significantly undermine the effectiveness of even the best therapies, making treatment adherence a crucial component in clinical outcomes.

Among trauma-focused psychotherapies, Eye Movement Desensitization and Reprocessing (EMDR) stands out not only for its effectiveness but also for its higher treatment completion rates. Unlike trauma-focused cognitive behavioral therapy (TF-CBT) and prolonged exposure (PE), EMDR has demonstrated lower dropout rates in numerous meta-analyses. These findings suggest EMDR may be a more acceptable and sustainable treatment option, especially for those with high avoidance or emotional dysregulation.

The Scope of the Dropout Problem

Treatment dropout is one of the most significant barriers to PTSD recovery. Between 20% and 50% of patients in trauma-focused therapy discontinue before completing the full course of treatment (Lewis et al., 2020). This issue is not limited to one setting or population—it affects veterans, survivors of abuse, refugees, and adolescents alike.

Patients leave therapy for various reasons, including emotional overwhelm, lack of perceived progress, or practical challenges like scheduling. However, in trauma therapy specifically, dropout is often tied to the intensity of treatment exposure and emotional discomfort. Treatments that require detailed trauma retelling or difficult cognitive work can increase distress before improvement begins, pushing patients to abandon therapy prematurely.

EMDR’s Unique Approach to Trauma Processing

EMDR offers an alternative that appears to reduce this emotional burden. Unlike TF-CBT or PE, EMDR does not require clients to fully narrate their traumatic experiences. Instead, clients briefly bring up a distressing image or memory while following a therapist’s hand or light with their eyes—a process known as bilateral stimulation. This facilitates desensitization without prolonged exposure or verbal repetition.

Another key advantage of EMDR is its minimal out-of-session requirements. TF-CBT and PE typically involve extensive homework, such as exposure hierarchies or thought logs, which can feel burdensome and anxiety-inducing. In contrast, EMDR sessions are mostly self-contained, reducing the cognitive and emotional demands placed on the client between appointments.

These features make EMDR less taxing and more tolerable for many individuals. This is particularly important for those with severe symptoms, dissociation, or high avoidance, as they may struggle with therapy formats that feel invasive or overwhelming.

Evidence from Meta-Analyses: EMDR Leads in Retention

Empirical research supports the idea that EMDR is associated with lower dropout rates. A systematic review and meta-analysis by Lewis et al. (2020) found that EMDR had significantly lower attrition compared to PE and TF-CBT in adult PTSD populations. Patients were more likely to complete treatment, and those who did often reported faster symptom reduction.

This pattern is also evident in younger populations. Simmons et al. (2021) conducted a meta-analysis focusing on children and adolescents with PTSD and found that EMDR had the lowest dropout rates among all evidence-based therapies evaluated. These findings reinforce the conclusion that EMDR is generally more acceptable and sustainable across diverse age groups and trauma types.

Treatment adherence is not merely a matter of convenience—it has clinical implications. Patients who drop out prematurely are less likely to achieve symptom remission and may even experience worsened distress due to unprocessed trauma exposure. The fact that EMDR keeps patients engaged is a key indicator of its clinical practicality.

Why Patients Stay: Acceptability and Tolerability

There are several reasons EMDR is easier for patients to complete. First, the non-verbal nature of the treatment allows clients to process traumatic material without articulating every painful detail. This can be particularly beneficial for individuals who feel shame or fear judgment when discussing their trauma.

Second, EMDR’s structure empowers clients to proceed at a pace that feels safe. The therapist frequently checks in on the client’s distress level and can modulate the intensity of the session accordingly. This helps build a strong therapeutic alliance, which is one of the most reliable predictors of treatment completion and success across psychotherapies.

Third, EMDR’s tendency to deliver rapid symptom improvement motivates clients to continue. Many report noticeable changes in emotional reactivity, sleep, or flashbacks within the first few sessions. When patients see results early, their trust in the therapy increases, which reinforces commitment to completing the protocol.

Implications for Clinicians and Systems of Care

For clinicians, these findings are highly actionable. EMDR should be considered a first-line treatment, not just for efficacy, but for its likelihood of being completed. This is especially important for populations with high dropout risk—such as those with complex trauma, co-occurring disorders, or severe emotional avoidance.

From a systemic perspective, integrating EMDR into community mental health clinics, veteran services, and school-based programs could improve both engagement and outcomes. Given that dropout undermines cost-effectiveness, therapies with higher retention offer better value for healthcare systems.

Therapists trained in EMDR also report lower burnout, likely because the therapy does not require them to repeatedly hear detailed trauma accounts. This may improve clinician retention and job satisfaction—another important factor in sustainable mental health care delivery.

Completion Rates Matter

While many trauma therapies are effective in reducing PTSD symptoms, EMDR distinguishes itself by being easier for patients to complete. Lower dropout rates mean more individuals benefit fully from treatment, which translates into better public health outcomes and more efficient care. For individuals with PTSD—particularly those prone to avoidance—EMDR offers a path to healing that feels safer, more manageable, and more compassionate.

Mental health professionals should prioritize not just what works best in clinical trials, but also what patients are willing and able to complete in the real world. In this light, EMDR shines as a powerful and patient-centered approach.

References

Lewis, C., Roberts, N. P., Andrew, M., Starling, E., & Bisson, J. I. (2020). Psychological therapies for post-traumatic stress disorder in adults: Systematic review and meta-analysis. European Journal of Psychotraumatology, 11(1), 1729633. https://doi.org/10.1080/20008198.2020.1729633

Simmons, C., Meiser-Stedman, R., Baily, H., & Beazley, P. (2021). A meta-analysis of dropout from evidence-based psychological treatment for post-traumatic stress disorder (PTSD) in children and young people. European Journal of Psychotraumatology, 12(1), 1947570. https://doi.org/10.1080/20008198.2021.1947570