EMDR vs. CPT: Which Trauma Therapy Is Right for You?
As one of the few Seattle therapists certified in both EMDR and Cognitive Processing Therapy (CPT) through Harborview, I often help clients navigate between these two gold-standard trauma treatments. Both are extensively researched and highly effective, but they work in different ways. Understanding these differences can help you choose the approach that best fits your needs, trauma type, and personal style.
Understanding CPT (Cognitive Processing Therapy)
CPT is a specific type of cognitive behavioral therapy developed for PTSD. It focuses on how trauma has affected your thoughts and beliefs, helping you process trauma by:
Core Components of CPT
Written trauma accounts (though modified versions exist without this)
Identifying "stuck points" - thoughts keeping you stuck
Challenging trauma-related beliefs
Developing balanced, realistic thinking
12 sessions in standard protocol
How CPT Works
CPT helps you examine how trauma changed your beliefs about:
Safety ("The world is completely dangerous")
Trust ("No one can be trusted")
Power/Control ("I'm helpless")
Esteem ("I'm worthless")
Intimacy ("I can't be close to anyone")
Through worksheets and discussion, you learn to challenge these beliefs and develop more balanced perspectives.
Understanding EMDR
As covered extensively in previous FAQs, EMDR uses bilateral stimulation to help your brain reprocess traumatic memories, changing how they're stored and reducing their emotional charge.
Key Differences Between EMDR and CPT
Verbal Processing Requirements
CPT:
Requires discussing trauma in detail
Written accounts often required
Verbal analysis of thoughts
Homework involves writing
Group or individual format
EMDR:
Minimal verbal detail needed
No written assignments
Processing through bilateral stimulation
Less homework required
Individual therapy only
Cognitive vs. Neurological Focus
CPT:
Primarily cognitive (thinking-focused)
Challenges thought patterns
Uses logic and evidence
Left-brain dominant
Conscious processing
EMDR:
Neurological reprocessing
Changes memory storage
Uses bilateral stimulation
Whole-brain integration
Unconscious processing allowed
Structure and Timeline
CPT:
Highly structured protocol
12 sessions standard
Weekly sessions typical
Specific modules
Predictable progression
EMDR:
Flexible protocol
Variable timeline (3-20+ sessions)
Adapts to individual needs
Organic progression
Customizable pacing
Homework and Practice
CPT:
Daily practice worksheets
Thought logs
Written exercises
Reading assignments
Between-session work crucial
EMDR:
Minimal homework
Optional journaling
Self-care focus
Resource practice
Processing continues naturally
When CPT Might Be Better
You Prefer Structured Approaches
Like knowing exactly what to expect
Appreciate clear timelines
Want specific tools and worksheets
Prefer educational components
Value predictable progression
Your Trauma Involves Significant Guilt or Blame
Self-blame for trauma
Survivor guilt
Moral injury
Feeling responsible for others' actions
Complex guilt patterns
You're Comfortable with Writing and Talking
Process well through words
Enjoy journaling
Comfortable sharing details
Like analyzing thoughts
Value verbal processing
You Want Skills You Can Use Independently
Prefer tools for self-management
Like homework between sessions
Want to understand the method
Value educational approach
Seek long-term strategies
Your Trauma Is Military or First Responder Related
CPT was developed for veterans and remains highly effective for:
Combat trauma
Military sexual trauma
First responder PTSD
Line-of-duty trauma
When EMDR Might Be Better
You Struggle to Verbalize Trauma
Can't or won't discuss details
Trauma feels "unspeakable"
Shame prevents disclosure
Cultural privacy values
Preverbal trauma
You Have Strong Somatic Symptoms
Body holds the trauma
Physical symptoms prominent
Panic attacks
Chronic pain
Conversion symptoms
Traditional Therapy Hasn't Helped
Years of talk therapy without relief
Understand trauma intellectually but still triggered
Cognitive approaches feel surface-level
Need different approach
You Want Faster Processing
Single-incident trauma
Clear target memories
Good current stability
Ready for intensive work
Less time available
My Integrated Approach: Best of Both Worlds
Being certified in both approaches allows me to:
Combine Strategically
Use CPT for stuck points
Process with EMDR
CPT worksheets for preparation
EMDR for body symptoms
Flexible integration
Sequence Appropriately
CPT first for severe guilt
EMDR for overwhelming memories
CPT for cognitive integration
EMDR for remaining triggers
Customize to You
Match approach to learning style
Consider trauma type
Honor cultural factors
Adapt to your preferences
Shift as needed
Common Questions About Choosing
"Can I try both?"
Absolutely. Many clients benefit from both approaches, either sequentially or integrated. We can start with one and add the other if needed.
"What if I choose wrong?"
There's no "wrong" choice. Both are effective, and we can always adjust. Your response early in treatment guides our approach.
"Do you have a preference?"
I'm equally skilled in both and genuinely see value in each. My preference is whatever works best for you.
"Can we switch mid-treatment?"
Yes. Flexibility is key to effective trauma treatment. If one approach isn't working, we can pivot.
Factors I Consider in Recommendation
Trauma Type
Single incident vs. complex
Developmental vs. adult onset
Interpersonal vs. accidental
Military/first responder specific
Personal Style
Verbal vs. somatic processing
Need for structure vs. flexibility
Homework tolerance
Learning preferences
Current Functioning
Cognitive capacity
Emotional regulation
Life stability
Support system
Cultural Factors
Attitudes toward disclosure
Writing comfort
Authority relationships
Privacy values
The Research Comparison
Both approaches have extensive research support:
CPT Research
30+ randomized controlled trials
Effective for various trauma types
Maintains gains over time
Works in group or individual format
EMDR Research
WHO-endorsed for PTSD
Comparable outcomes to CPT
Often faster for single incidents
Effective across cultures
Making Your Choice
Consider these questions:
Do I prefer structure or flexibility?
Am I comfortable writing about trauma?
Do I process better through thinking or experiencing?
How much homework can I realistically do?
What has/hasn't worked in past therapy?
Beyond Either/Or
Remember, choosing a trauma therapy isn't always either/or. With my training in both approaches, plus somatic experiencing, AEDP, and attachment work, we can create a truly integrated treatment plan that draws from multiple evidence-based approaches.
The "best" therapy is the one that:
Feels right to you
Matches your needs
Respects your preferences
Creates lasting change
Your Next Step
During our free consultation, I can help you explore which approach, or combination of approaches, might work best for your specific situation. With certifications in both EMDR and CPT, plus extensive additional training, I'm equipped to guide you toward the most effective path for your healing.
