EMDR and Military Veterans: What the Evidence Shows

Military personnel and veterans occupy a difficult position in trauma research. They are among the groups most likely to develop PTSD, yet study after study has found that they tend to benefit less from psychotherapy than civilians with PTSD. The reasons are debated, and probably include the sheer number of traumatic events many have experienced, the moral weight some of those events carry, and the practical realities of military and post-service life. EMDR is one of the therapies recommended for combat-related PTSD, including in the current United States Department of Veterans Affairs guidelines. But how well does it actually perform with this group? The honest answer is that the evidence is mixed, and worth presenting as such. A large meta-regression by Haagen and colleagues, published in Clinical Psychology Review (2015), pooled 57 studies of veterans and serving personnel. It found that exposure therapy and cognitive processing therapy outperformed EMDR overall. Importantly, though, once the researchers accounted for differences in how the studies were designed, EMDR no longer predicted poorer outcomes. In other words, some of the apparent gap may reflect the quality and structure of the trials rather than the therapy itself. The same analysis found that what mattered most was the number of genuinely trauma-focused sessions, not simply the total amount of therapy. There are also more encouraging findings. A study by Elizabeth Hurley, published in Frontiers in Psychology (2018), compared intensive daily EMDR with the standard weekly format in veterans. Across both approaches, participants no longer met the criteria for PTSD by the end of treatment, no adverse effects occurred, and dropout was strikingly low, with none at all in the intensive group. That last point matters more than it might appear. Dropout is a persistent problem in veteran trauma treatment, and EMDR has compared favourably with other trauma-focused therapies on retention. Where does this leave things? EMDR is a legitimate, guideline-recommended option for veterans, and some studies show excellent results, particularly in intensive formats. But it would be misleading to claim it consistently outperforms the alternatives in this population. The realistic picture is of several effective therapies, each suiting different people, with the choice best made alongside a clinician who knows both the evidence and the individual. Sources: Haagen, J. F. G., Smid, G. E., Knipscheer, J. W., & Kleber, R. J. (2015). The efficacy of recommended treatments for veterans with PTSD: A metaregression analysis. Clinical Psychology Review, 40, 184–194. Hurley, E. C. (2018). Effective Treatment of Veterans With PTSD: Comparison Between Intensive Daily and Weekly EMDR Approaches. Frontiers in Psychology, 9, 1458.