Online EMDR: What a Trial of 12 Sessions Can and Cannot Prove
Yes. When a trained clinician delivers EMDR by video with proper screening and safety protocols, it can help reduce trauma-related symptoms for many people. The EMDRIA virtual guidelines and a peer-reviewed service evaluation support this, and we offer it online at Heske Therapy. The main caveat: suitability for remote processing depends on individual circumstances and should be assessed by a qualified clinician. Anyone experiencing active suicidal thoughts should seek immediate emergency support.
TL;DR:
A systematic review found promising reductions in PTSD, anxiety, and depression, but small samples and mixed designs mean stronger trials are still needed.
Clinicians screen for dissociation, active suicidality, unstable severe mental illness, and low emotion tolerance; higher risk may call for stabilization or in person care.
Agree on a pause signal, phone fallback, local emergency contacts, and grounding steps before processing, because connection failures or overwhelm require a clear response.
Check that your clinician has EMDR and telehealth training, uses secure video, obtains informed consent, and explains how they assess readiness for processing.
One service evaluation found no evidence of different dropout rates or adverse events online versus in person, but it did not prove equal risks.
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What do clinical studies show about online EMDR?
The research is encouraging, though still young. A systematic review of remote EMDR studies found promising reductions in PTSD, anxiety and depression. The same review flagged small samples, mixed designs and a need for higher-quality trials, so we read the results as hopeful rather than settled.
A multi-method service evaluation looked at online EMDR for people with PTSD. Both therapists and clients viewed the online format as acceptable, safe and effective in that service. The authors still call for larger randomized trials.
No evidence of a difference in completion, drop-out rates or adverse events between in-person and online EMDR in that service evaluation. In that service evaluation, researchers found no evidence of a difference in drop-out rates or adverse events between online and in-person EMDR. This does not establish that the risks are identical.
Randomized evidence is growing too. A trial after the 2023 Kahramanmaraş earthquakes compared 12 sessions of remotely delivered EMDR and CBT. Both significantly reduced PTSD, depression and anxiety, and EMDR showed somewhat larger PTSD improvements in that sample. Disaster samples differ from everyday clinical practice, so we treat the finding with care.
The evidence base comes from a few kinds of studies:
Service evaluations, which show how online EMDR performs in real clinics.
Randomized trials, which compare online EMDR against another therapy.
Systematic reviews, which pool smaller studies and name their weaknesses.
How does EMDR work over video?
EMDR relies on bilateral stimulation, a rhythmic left-right input that you pair with a distressing memory. Online, your therapist recreates it in several ways:
A moving dot or shape on screen that your eyes follow.
Alternating sounds through headphones.
Self-tapping on your knees or shoulders.
The butterfly hug, where you cross your arms and tap each shoulder in turn.
The EMDRIA task group report states that virtual delivery can include all eight EMDR phases when a trained clinician administers it. It also warns against self-administered EMDR. History taking and assessment translate to video almost unchanged. Preparation, processing and closure need more care, because your therapist cannot be in the room if you become overwhelmed.
Some clinicians also use EMDR 2.0 and group formats. These rely on working-memory tasks, and a randomized study of an online group protocol with traffic accident survivors showed promising results.
Pro Tip: Agree on a pause signal and a reconnection plan with your therapist before processing starts, such as a raised hand and a phone call if the video drops.
Who is a good candidate for online EMDR?
Many adults with trauma-related symptoms are good candidates, provided they can stay grounded without a therapist in the room. Before any processing, a clinician typically screens for:
Significant dissociation.
Active suicidality.
Unstable severe mental illness.
Limited ability to tolerate strong emotion.
Affect tolerance and grounding skills matter more online. You should be able to calm yourself, return to the present and use a safe place exercise. A solid therapeutic relationship comes first, and EMDRIA guidance stresses expanded preparation and trust building before processing.
For higher-risk clients, a clinician may delay processing, spend longer on stabilization or ask for an initial in-person session. That is good practice, not a rejection. Also verify your therapist’s license and local telehealth rules. The General Council of Psychology of Spain advises clients receiving cross-border therapy to confirm that their therapist is licensed in their jurisdiction.
How should you prepare your tech and space?
A little planning keeps sessions smooth and safe:
Use a stable internet connection, ideally wired or close to your router.
Choose a device with a large enough screen to follow a moving target.
Wear headphones for alternating sounds and privacy.
Charge your device and keep a backup phone nearby.
Pick a secure video platform and ask how your data is handled under GDPR.
Find a private room where no one will interrupt you.
Leave time before and after for a buffer and a grounding routine.
Pro Tip: If the connection fails mid-processing, switch to a phone call at once and follow your therapist’s agreed grounding steps. Your therapist should also confirm local emergency contacts with you before you start.
What happens in an online EMDR session?
An online course follows the same eight phases as in-person work: history taking, preparation, assessment, desensitization, installation, body scan, closure and re-evaluation. Closure and re-evaluation matter more remotely. Your therapist will help you settle before you log off and will check in at the start of the next session on how the week went.
Session length and the number of sessions depend on your clinician, history and goals. The earthquake trial used 12 sessions, but your own plan may be shorter or longer.
The service evaluation found no evidence of different drop-out rates between online and in-person EMDR. The service evaluation found no evidence of a difference in drop-out rates between online and in-person EMDR, though that finding does not guarantee an individual outcome.
Between sessions, you may receive resourcing homework:
A daily grounding or breathing exercise.
A safe place or calm place practice.
A short log of triggers or dreams to discuss.
What should you look for in an online EMDR therapist?
Look for a clinician who combines EMDR training with telehealth skill. Signals worth checking:
Formal EMDR training and ongoing consultation.
Telehealth training and experience delivering remote EMDR.
A written informed consent process for online work.
An emergency plan with local contacts.
A secure video platform.
Extra resourcing and longer closures when you need them.
These matter more online because your therapist cannot physically be with you. The EMDRIA task group report recommends telehealth training, secure platforms, informed consent and emergency-preparedness planning. On a discovery call, ask how they handle a dropped connection, what they do if you become overwhelmed and how they decide you are ready for processing.
How do online EMDR platforms and tools compare?
Online EMDR relies on ordinary video platforms plus tools for bilateral stimulation, and each type has trade-offs.
General video platforms are familiar and easy to join. Their weakness is that the therapist may need a separate window or shared screen to move a dot, and a poor connection can make the movement jerky.
Dedicated bilateral stimulation tools give smoother, adjustable movement and sound. Some offer speed and color controls, which helps clients who find certain settings irritating. They add one more thing to learn, and a few require you to open a second link.
Audio-only alternating tones work well with a stable call and need almost no setup. Some people find tones less absorbing than visual tracking.
Self-tapping and the butterfly hug need no software at all, so they suit weak connections and are a useful backup. Their pace depends on you, and your therapist cannot see your hands as clearly.
We choose the method with you, based on comfort, technology and what keeps you steady. Whatever the tool, a trained clinician guiding the process matters more than the software.
How do you build a strong therapeutic alliance online?
A supportive therapeutic relationship can be built on video. The EMDRIA guidance says the therapeutic relationship and expanded preparation are critical, so we invest in both from the first session.
Several habits help:
We spend more time on rapport and stabilization before processing begins.
We check in verbally more often, since body language is harder to read on a screen.
We agree on pause signals and a plan for tech failures together.
We invite feedback on camera angle, sound and pacing.
We keep a consistent session time and routine so the process feels predictable.
You can help too. Join from the same quiet spot each week, keep your camera at eye level and tell your therapist when something feels off, even if it seems small. A free discovery call is a good way to test the fit before you commit.
What challenges are unique to online EMDR?
Online work brings problems that an office does not. Therapists address each with planning:
Connection drops. We agree on a phone fallback and a grounding routine in advance.
Overwhelm while you are alone. Experienced clinicians describe managing the client’s window of tolerance and having a safety plan if someone becomes overwhelmed at home. We extend stabilization and resourcing, and we never rush into processing.
No transition time. After a session you step straight back into your home. We build a longer closure and ask you to plan a buffer afterward, such as a short walk or a quiet cup of tea.
Privacy at home. We help you find a private space and use secure platforms.
Reading body language. We ask for a wider camera view and check in more often.
Potential challenges are worth discussing with a clinician, who can help assess whether online EMDR is appropriate and plan for potential problems.
Can online EMDR be combined with CBT, RTT or hypnotherapy?
Often, yes. At Heske Therapy we integrate approaches, combining EMDR with CBT, Rapid Transformational Therapy (RTT), counseling and clinical hypnotherapy, both online and in our office.
The remote trial after the earthquakes shows that EMDR and CBT can each work when delivered remotely, so they are natural partners. CBT and EMDR use different approaches, and a clinician can discuss which may suit your goals. RTT and hypnotherapy are other approaches we may discuss, depending on your goals and clinical needs.
The order matters. We usually start with stabilization, then add modalities that fit your goals and your capacity at that moment. Online, we keep each session focused on one clear task so you can close it safely. Your plan is personalized, and we review it as you progress.
A clinician’s view on making online EMDR work
Stabilization comes first, always. Agree on your tech backup plan, build a buffer before and after each session, and do your resourcing homework, because it is what holds you steady between sessions. Online EMDR also removes travel and mobility barriers, and for many people that access is what makes treatment possible at all.
— Heske
Start online EMDR with us
If you want trauma-focused care you can access from home, we offer integrative therapy online and in our Madrid office, in English, Spanish and Dutch. Our Classic RTT all-in Package Online is 750 euros one-off and suits integrative work on trauma, anxiety and emotional blocks.
Your first step is a free discovery call, where we talk through your history, screen for suitability and answer your questions. Book your discovery call to get started.
This article is general information, not a substitute for advice from a qualified doctor. Consult a qualified healthcare professional about your own circumstances before acting on anything here.
FAQ
Is EMDR therapy really effective?
Research suggests EMDR can reduce PTSD, anxiety and depression symptoms. A systematic review of remote EMDR studies found promising outcomes but noted small samples and the need for larger trials.
Is online therapy better than in-person?
Neither is better for everyone. A service evaluation found no evidence of different completion or adverse event rates between online and in-person EMDR. Choose the format that keeps you safe, grounded and consistent.
How much does an EMDR session cost?
Prices vary by clinician. Our online and in-person packages are listed on our Classic RTT all-in Package Online page. For insurance questions, see our guide to therapy insurance rules.
What are the disadvantages of online EMDR?
The main challenges are connection problems, privacy at home and having no transition time after a session. A trained clinician plans for each of these with backup methods, longer closures and stabilization.
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