Brainspotting vs EMDR: Differences, Evidence & How to Choose

You’re sitting across from a trauma client who’s made progress with talk therapy but keeps hitting a wall. You’ve heard colleagues talk about EMDR therapy’s strong evidence base, and others rave about brainspotting therapy’s gentle flexibility. Here’s the thing: you want to offer something that actually shifts stuck patterns, but you’re not sure which modality fits your client - or your practice style.

This guide breaks down the practical differences between brainspotting and EMDR, from session structure to evidence quality to insurance coverage. You’ll find a 60-second matching checklist, provider-vetting questions, and real-world decision points that help you choose confidently. Whether you’re considering training or referring out, you’ll know exactly what each modality offers and where each one shines.

Disclaimer: This article provides educational information for licensed clinicians. It doesn’t replace individualized consultation, supervision, or training in either modality.

TL;DR

• EMDR therapy is highly structured and protocol-driven, with strong guideline support for post traumatic stress disorder from VA/DoD, WHO, NICE, and APA.
• Brainspotting therapy is flexible and attunement-driven, with promising early research but no major guideline endorsements yet.
• Both reduce emotional distress and support adaptive processing; choice depends on client arousal tolerance, dissociation level, personal preference for structure, and need for verbal recounting.
• EMDR therapy is more commonly recognized by insurers and easier to document; brainspotting therapy coverage varies by plan.
• Safety, pacing within the window of tolerance, and strong therapeutic alliance drive outcomes in both trauma therapies.

Brainspotting vs EMDR at a Glance

Quick Comparison Table

Key Differences for Fast Decisions

• EMDR therapy follows a highly structured eight phase model with robust guideline support for treating trauma.
• Brainspotting therapy is flexible and attunement-driven with promising but still emerging research.
• Both reduce emotional distress and support memory reconsolidation through different pathways.
• EMDR has stronger guideline-based evidence; brainspotting shows comparable distress reduction in comparative study samples.
• Choice depends on arousal tolerance, dissociation, personal preference for structure, and need for verbal recounting.

What Is EMDR

Core Mechanism in Brief

Eye movement desensitization and reprocessing (EMDR) is built on the Adaptive Information Processing (AIP) model, which proposes that traumatic memory gets stuck in maladaptive networks. Bilateral stimulation - eye movements, taps, or tones - engages both hemispheres and facilitates adaptive processing. Two proposed underlying mechanisms are working memory taxation (which reduces vividness of distressing images) and orienting response activation (which shifts the brain into a more integrative state).

The protocol follows eight defined phases: history-taking, preparation, assessment, desensitization, installation, body scan, closure, and reevaluation. EMDR therapists target specific memories along with linked negative beliefs, emotions, and physical sensations. Clients rate emotional distress (SUD, 0–10) and positive belief validity (VOC, 1–7) to track progress.

What EMDR Sessions Look Like

You start by identifying a target memory, the associated image, negative cognition (e.g., “I’m powerless”), positive cognition (e.g., “I did the best I could”), emotions, and where they’re felt in the body. You measure baseline SUD and VOC. Then you begin sets of bilateral stimulation - typically 20–40 eye movements or taps - followed by brief check-ins: “What do you notice now?”

Processing continues with repeated sets until SUD drops and emotional distress resolves. The therapist helps install the positive cognition and runs a body scan to clear residual tension. EMDR sessions end with closure techniques to ensure stability before the client leaves.

When eye movements aren’t feasible due to medical or ocular issues, you adapt with tactile taps or auditory tones. The protocol’s structure provides natural pauses that help clients stay within their window of tolerance.

Evidence Snapshot

EMDR has strong support for treating PTSD across multiple RCTs and is recommended by the VA/DoD 2023 guidelines, WHO, NICE, and APA. Growing evidence supports its use for anxiety, depression, grief, and as an adjunctive tool for OCD and chronic pain. Training standards are well-defined through EMDRIA-approved programs, and fidelity measures ensure consistent delivery.

Who Tends to Benefit

EMDR therapy works well for single traumatic event presentations and acute stress - think car accidents, assaults, or recent critical incidents. Clients who prefer structure, defined targets, and measurable progress often respond well. Those who can tolerate brief exposure to painful memories without overwhelming dissociation are good candidates.

Cautions

High dissociation without adequate stabilization can destabilize clients quickly. Complex trauma typically requires extended preparation and resourcing before targeting traumatic experiences. Medical conditions affecting eye movements require adaptations. Also consider that benzodiazepines or high-dose sedatives can blunt affective access and may reduce processing effectiveness.

What Is Brainspotting

Core Concepts

Brainspotting, originally developed by David Grand, is founded on the principle that “where you look affects how you feel.” Eye position links to subcortical brain activation sites called brain spots. The modality emphasizes dual attunement: relational attunement between therapist and client, and neurobiological attunement to the body’s signals.

Bilateral sound is optional - many clients use it, but brainspotting can be effective without continuous bilateral stimulation. The method relies on focused gaze, mindful body tracking, and sustained attuned presence from the therapist.

Techniques and Setups

Clinicians use inside window (client finds the spot where activation is strongest), outside window (therapist scans to identify micro-responses), and Z-axis approaches (moving closer or farther from the pointer). Gazespotting and rolling variations are common adaptations. The resource model helps titrate processing by starting with positive or neutral spots before working with emotional pain.

What Brainspotting Sessions Look Like

You identify a target issue or somatic sensation. Using a pointer or your finger, you guide the client’s gaze across their visual field while tracking physiological cues - eye flutters, breath changes, muscle tension. When you locate a brain spot, the client maintains focused gaze while tracking internal sensations.

The therapist helps hold steady, attuned presence with minimal verbal interruption. Processing unfolds through extended quiet tracking rather than frequent check-ins. Brainspotting sessions often feel less structured and more organic, with the therapist pacing based on real-time attunement to the client’s nervous system.

Evidence Snapshot

Understanding brainspotting requires looking at emerging support from pilot trials and comparative study data. A 2022 comparative study by D’Antoni and colleagues found similar reductions in SUD between brainspotting and EMDR in a non-clinical sample. However, large-scale RCTs and formal guideline endorsements are still needed. Research is promising but not yet at the level of EMDR’s evidence base.

Who Tends to Benefit

Brainspotting therapy suits clients with attachment injuries, complex trauma, and those who prefer less verbalization. It’s widely used for performance blocks - athletics, public speaking, creative arts - because it targets somatic and subcortical activation without requiring detailed narrative about past trauma. Clients with language barriers or sensitivity to overstimulation often find brainspotting more tolerable.

Cautions

Outcomes rely heavily on therapist attunement and pacing. Training quality varies, and there are fewer standardized fidelity checks compared to EMDR therapy. Monitor carefully for dissociation and hypoarousal; set clear containment practices to prevent flooding between sessions.

Brainspotting vs EMDR in Day-to-Day Practice

Structure and Pacing

EMDR uses defined phases with brief check-ins after each set of bilateral stimulation. This creates natural pauses that help you gauge where the client is and adjust pacing. Brainspotting therapy involves continuous processing with fewer interruptions, which can feel more immersive but requires careful real-time attunement.

Choose based on personal preference: some clients appreciate the measured structure of EMDR, while others benefit from the quieter, less directive flow of brainspotting.

Memory Access and Narrative

EMDR often targets specific memories with identified negative beliefs and explicit imagery. Brainspotting focuses on processing unresolved trauma without detailed narrative or even clear memory recall. This is especially useful when recounting traumatic experiences is hard, unsafe, or retraumatizing.

While EMDR requires some narrative activation, you can limit graphic detail about painful memories and still facilitate processing. Both trauma therapies can be adapted for clients who need discretion.

Arousal Window and Titration

Both require careful window-of-tolerance management when treating trauma. Brainspotting may suit clients who benefit from longer quiet tracking and sustained attunement. EMDR offers measured sets that create natural pauses, which help some clients achieve emotional regulation more easily.

If a client frequently leaves their window during processing, consider shorter sets in EMDR or more frequent resourcing breaks in brainspotting.

Dissociation and Parts Work

Both modalities can integrate parts-informed approaches like IFS. For high structural dissociation, extend stabilization and build internal collaboration before targeting traumatic memory. Use resource spots in brainspotting or interweaves and grounding in EMDR as needed.

Align your therapeutic approach with phase-oriented care: safety and stabilization first, processing second, integration and relapse prevention third (Herman’s tri-phasic model).

Telehealth and Logistics

EMDR adapts to telehealth with on-screen eye movements, tappers (mailed or client-procured), or audio tones. Brainspotting uses camera framing, pointer substitutes (like a pen or the therapist’s finger on screen), and bilateral music streamed through headphones.

Both require clear safety protocols: confirm the client’s physical location, establish a backup phone number, and develop a drop/disconnect protocol. If the call drops during activation, the client should immediately use a pre-agreed grounding technique (e.g., 5-4-3-2-1 sensory exercise) and you reconnect via backup line within two minutes.

Documentation and Measurement

For EMDR sessions, record the target memory, negative cognition, positive cognition, baseline and end-of-session SUD and VOC, bilateral stimulation modality used, interweaves provided, body scan results, and closure techniques. For brainspotting sessions, document the target theme or somatic anchor, eye position/spot, observed arousal range, resourcing used, shifts noticed, and closure.

Both benefit from alliance check-ins using tools like the Session Rating Scale (SRS) or Outcome Rating Scale (ORS) alongside symptom measures.

Safety and Preparation for Both Methods

Screening and Stabilization

Before starting either modality, assess for dissociation, suicidality, and substance use. Use screening tools to operationalize safety:

• Dissociation: DES-II or Brief Dissociative Experiences Scale
• Suicide risk: C-SSRS
• Substance use: AUDIT-C or DAST-10
• Baseline symptoms: PCL-5, PHQ-9, GAD-7

Build grounding, containment, and present-focused skills before targeting unprocessed trauma. Set clear expectations about abreactions and post-session care.

Contraindications and Red Flags

Avoid trauma processing when clients face unstable housing, ongoing abuse, active psychosis, unstable withdrawal from alcohol or benzodiazepines, current severe mania, unmanaged medical issues affecting safety, or inadequate crisis supports. Significant sleep deprivation is also a relative caution.

Managing Abreactions

If a client moves into overwhelming activation, pause immediately. Use these techniques:

• Orienting: 5-4-3-2-1 sensory grounding with eyes off the spot or bilateral stimulation
• Breath regulation: 3-3-3 breath (inhale 3, hold 3, exhale 3) or paced exhale emphasis to reduce emotional distress
• Resourcing: Reinstall Safe Place imagery or Container visualization to promote healing

Return to resourcing or end with closure if needed. Track breath, gaze, and micro-movements continuously to maintain focus on the therapeutic process.

How to Choose Between Brainspotting and EMDR

60-Second Matching Checklist

Use this quick guide to narrow your choice when comparing brainspotting vs EMDR:

• Prefers structure and clear targets → EMDR therapy
• Avoids recounting details; benefits from quiet tracking → Brainspotting therapy
• Strong dissociation cues and limited arousal tolerance → Start with stabilization; consider brainspotting resource model first
• Vivid recent single-event trauma → EMDR recent-event protocol
• Performance block, somatic focus, minimal talk → Brainspotting

Decision Factors

Consider client tolerance for structure and exposure intensity. Some clients find the eight phase model reassuring; others feel constrained. Evaluate the need for verbal processing versus quiet tracking. EMDR requires moderate narrative activation; brainspotting focuses on working with minimal verbalization.

Also assess target specificity: is there a clear distressing memory to target, or is the trauma more diffuse and attachment-based? EMDR excels with specific incidents; brainspotting handles global somatic themes well.

Therapist and Setting Factors

Your training level and fidelity to protocols matter. EMDR requires EMDRIA-approved basic training and consultation hours; brainspotting requires Phase 1/2/3 training. Access to consultation networks - EMDRIA consultants for EMDR, brainspotting consultation groups - supports quality delivery.

Session length also matters. Brainspotting often benefits from fewer interruptions, so 75–90 minute sessions work well. EMDR intensives may need 90–120 minutes but can be delivered in standard 50-minute sessions with careful pacing.

What Matters Most Across Both

Alliance quality and attunement drive outcomes more than modality choice. Pacing within the window of tolerance prevents destabilization. Consistent measurement and adjustment based on client feedback ensure you’re not forcing a poor fit with the right therapy.

Use honest fit testing after 2–3 sessions. If there’s no movement, pivot approaches rather than forcing adherence.

Matching Examples

• Recent car crash with vivid intrusive images: EMDR is often first-line; clear memory, acute onset, defined target.
• Diffuse attachment trauma with strong somatic shutdown: Brainspotting may fit better; less need for narrative, attunement-driven pacing, somatic focus on physical sensations.
• High avoidance and fear of recounting: Start with brainspotting to build tolerance; transition to EMDR later if needed.

Integrating With Other Treatments

Common Integrations and Phase-Based Care

Both brainspotting and EMDR integrate well with CBT, ACT, IFS, and somatic regulation skills. Use phase-based integration explicitly when healing trauma:

• Phase 1 (Safety/Stabilization): Psychoeducation, grounding, sleep hygiene, medication management
• Phase 2 (Processing): Eye movement desensitization and reprocessing or brainspotting therapy
• Phase 3 (Integration): Meaning-making, relapse prevention, values clarification (ACT)

Coordinate with prescribers when clients take medications that affect arousal or sleep. High-dose sedatives can dampen affective engagement; discuss timing with the prescriber to optimize processing sessions.

Measurement-Based Care

Track SUD and VOC changes across sessions. Use symptom scales (PCL-5, PHQ-9, GAD-7) and alliance/outcome tools (ORS/SRS) to monitor progress on the healing journey. Adjust targets or techniques based on data, not assumptions.

Session Frequency and Duration

Weekly sessions are most common. Some clients benefit from intensive formats - multiple sessions per day over several days - especially for treating single-incident trauma. Allow extra time for closure after heavy processing. Plan buffers before or after other appointments on processing days.

FAQs

Q. Can I switch between EMDR and brainspotting with the same client?

A. Yes. Many clinicians blend modalities across phases of treatment. You might start with brainspotting for tolerance-building or attachment work, then transition to EMDR when a clear target emerges. Just document your rationale and pacing decisions.

Q. Which modality is better for highly dissociative clients?

A. Neither should be used for deep processing until stabilization is strong. Brainspotting’s resource model and EMDR’s extended preparation phase can both help, but high dissociation often requires slower phase-oriented work before trauma processing.

Q. Is EMDR always the preferred choice because it has stronger research?

A. EMDR has stronger RCT evidence and guideline support, but “better” depends on the client’s presentation. Some clients tolerate brainspotting’s quieter, somatic focus more easily than EMDR’s structured exposure to specific memories.

Q. Do clients need to recall a specific traumatic memory for either approach to work?

A. EMDR typically requires identifying a target memory or cluster. Brainspotting does not, you can work with a body sensation, emotional theme, or performance block without clear narrative detail.

Q. Which modality is easier to use with clients who avoid talking about trauma?

A. Brainspotting tends to be more accessible for clients who prefer minimal verbalization. EMDR can be modified to reduce narrative detail, but still requires some activation of the target material.

Q. What should I choose if I only have 50-minute sessions?

A. Both modalities can be used in 50 minutes, but EMDR’s structured sets and built-in closure steps may fit that timeframe more predictably. Brainspotting often benefits from longer, uninterrupted processing.

Q. Are insurers more likely to reimburse EMDR than brainspotting?

A. Yes. EMDR is widely recognized because of guideline endorsements. Brainspotting is reimbursable but usually billed under general psychotherapy codes without specific recognition.

Q. How do I decide which modality to train in first?

A. Choose EMDR if you want strong structure, a large consultation network, clear fidelity standards, and broad insurance recognition. Choose brainspotting if you prefer attunement-driven, somatic therapies or work heavily with attachment and performance issues.

Q. Can both methods be delivered effectively over telehealth?

A. Yes, with adaptations. EMDR uses on-screen eye movements or tones; brainspotting uses camera framing and a virtual pointer. Both require strong safety planning and backup communication protocols.

Q. What if a client feels worse after a session, should I switch modalities?

A. Not necessarily. Post-processing activation happens in both approaches. First assess window-of-tolerance fit, pacing, and stabilization skills. If distress continues after 2–3 sessions, reassess modality match and consider a different approach or slower titration.

Conclusion

Both EMDR and brainspotting help clients move stuck trauma, but they work through different pathways. The best fit comes down to structure tolerance, narrative needs, arousal capacity, and your own clinical style. When in doubt, start slow, monitor the window of tolerance, and let the client’s response guide the next step.