Updated November 2026 · By Joel Blackstock, LICSW-S

Brainspotting and EMDR both pair a distressing memory with what the eyes are doing. EMDR moves the eyes back and forth inside a structured eight-phase protocol, and major PTSD guidelines recommend it. Brainspotting holds the gaze still on one spot linked to a body feeling and follows the client's lead. EMDR has far more research behind it. Brainspotting's evidence so far consists of a few small studies.

The more useful question is not which method is stronger. The two probably share a core ingredient: holding a painful memory, and the body sensations that come with it, in steady and accompanied attention while something keeps arousal low enough to stay present. If that is right, the choice comes down to two things. How much tested evidence do you want behind your treatment, and how much structure does your nervous system need to stay in the room? EMDR is the tested option. Brainspotting is a reasonable alternative for people who do better with less structure, as long as they know how thin its evidence still is.

What EMDR is and how a session runs

Eye Movement Desensitization and Reprocessing was introduced by the psychologist Francine Shapiro (1948–2019) in 1987. Her first controlled study, published in 1989 in the Journal of Traumatic Stress, tested what she then called the eye movement desensitization procedure on people troubled by traumatic memories.¹ Over the next three decades it grew into a full therapy, which her textbook lays out in eight phases: history taking, preparation, assessment, desensitization, installation, body scan, closure and reevaluation.²

The first sessions gather history and build stabilization skills. Then client and therapist choose a target memory and name its worst image, the negative belief attached to it ("I am not safe"), the belief the client would rather hold, the emotion, and where it sits in the body. The client rates distress from 0 to 10. During desensitization the client holds the memory in mind while following the therapist's fingers or a light bar from side to side, or while receiving alternating taps or tones, in short sets. After each set the therapist asks briefly what came up, and the next set starts from there. The procedure is standardized, which makes EMDR comparatively easy to study.

The theory behind it is Shapiro's Adaptive Information Processing model: a memory laid down under overwhelming threat stays stored in an unprocessed form, and therapy links it to more adaptive memory networks.² That is a clinical model, not a demonstrated brain mechanism. The popular explanation that eye movements "connect the two hemispheres" has little support. The better-tested account is about working memory. Holding a vivid memory while doing a demanding second task taxes a limited system, so the memory comes back less vivid and less emotional, and is stored again that way.³ An earlier meta-analysis had found no significant added effect for the eye movements. A 2013 meta-analysis of 26 studies found that they add a moderate effect in treatment studies (d = 0.41) and a large one in laboratory studies (d = 0.74), and its authors argued that the earlier null result may have reflected weaknesses in that analysis.⁴ That counts against the old charge that the eye movements are pure decoration, though it does not close the question.

The guideline picture is strong but not unanimous. The World Health Organization's 2013 stress guidelines said that cognitive-behavioral therapy or EMDR should be considered for people with PTSD.⁵ The 2023 VA/DoD guideline puts EMDR in its top tier alongside prolonged exposure and cognitive processing therapy, and recommends these therapies over medication.⁶ The American Psychological Association's guideline is more cautious. It strongly recommends cognitive-behavioral therapy, cognitive processing therapy, cognitive therapy and prolonged exposure, and gives EMDR a conditional recommendation, while noting that newer trials could move EMDR to strong.⁷

A 2020 meta-analysis led by Pim Cuijpers pooled 76 trials and found a large effect against control conditions (g = 0.93). But only four of 27 studies had a low risk of bias, there were signs of publication bias, and EMDR's small edge over other therapies (g = 0.36) disappeared when only low-risk-of-bias studies were counted. The authors concluded that EMDR may be effective for PTSD in the short term but that the studies were too weak for definite conclusions.⁸ Read alongside the guidelines, the fair summary is that EMDR works for PTSD about as well as the other trauma-focused therapies, not better. For the longer argument, see our piece on whether EMDR is pseudoscience or evidence based, and the critique of eye movements as a "purple hat" added to ordinary exposure therapy. The image is usually credited to the psychologists Gerald Rosen and Gerald Davison, who argued in 2003 that psychology should credit principles of change rather than trademarked treatment packages.⁹

What Brainspotting is

David Grand, a psychotherapist in private practice in Manhattan and Long Island, developed Brainspotting in 2003. He had trained in EMDR in 1993 and blended it with psychoanalytic and somatic work in an approach he called Natural Flow EMDR, the precursor to Brainspotting.¹⁰ Talbot and colleagues describe Brainspotting as an adaptation of EMDR.¹¹ The origin story, as Grand's publisher tells it, involves a top-level figure skater who could not land one particular jump. As she talked about it, Grand noticed her eyes react at one point in her visual field. He asked her to keep her gaze there, and she began working through traumas she had never raised in therapy.¹⁰ Grand turned the observation into the method's motto, "Where you look affects how you feel," and set out the method in a 2013 book from Sounds True.¹⁰

In a session the client brings up an issue and notices where it registers in the body and how strong it is, again on a 0 to 10 scale. The therapist moves a pointer slowly across the visual field to find the eye position where the activation is strongest. Brainspotting training calls this the "inside window" when the client reports the spot and the "outside window" when the therapist watches for reflexive signs such as a blink, a swallow or a wobble of the eyes. The client then keeps the gaze on that spot, often while listening to slow alternating "BioLateral" sound, and does not have to talk while processing.¹² There is no fixed sequence of steps. Much of the therapist's work is bringing the client's attention back to the body.¹² Brainspotting trainers describe the therapist's stance as "dual attunement," tracking the relationship and the client's nervous system at the same time.

The proposed mechanism comes from a 2013 paper by Frank Corrigan and David Grand in Medical Hypotheses. They suggest that focusing on a Brainspot engages a pathway from the retina to the superior colliculus in the midbrain and on to the pulvinar, the cingulate cortex and regions connected with the insula. They also suggest that "the capacity for healing of the altered feeling about the self is occurring in the midbrain at the level of the superior colliculi and the periaqueductal gray."¹³ The authors offer these as testable hypotheses. We could find no study that has tested that pathway directly in people receiving Brainspotting. Claims that Brainspotting "bypasses the prefrontal cortex" or reaches the place where "trauma is physically stored" go well beyond anything that has been measured.

Outside reviewers are more cautious, and some are openly hostile. A 2015 critical review of emerging trauma therapies examined Brainspotting alongside energy psychology and yoga as novel approaches whose added benefit over validated treatments was still an open question.¹⁴ In 2025 the neurologist Steven Novella, writing at Science-Based Medicine under the title "Brainspotting is classic pseudoscience," argued that the method was invented rather than discovered, that no known brain map links eye position to stored trauma, and that it grew from a single anecdote.¹⁵ Our longer piece on whether Brainspotting is evidence-based goes through the arguments on both sides.

How the two differ in the room

The differences are smaller than most comparison pages suggest. EMDR is not a purely cognitive therapy. It asks where a feeling sits in the body from the start, and one of its eight phases is a body scan. Brainspotting is not "purely subcortical" either. Clients remember, think, feel and often talk. Both use a 0 to 10 distress rating, both ask the client to keep one foot in the memory and one in the room, and both often include some form of alternating stimulation. D'Antoni and colleagues, who compared the two directly, pointed out that both invite the client to notice inner experience mindfully. They attributed the benefit they found to "paying attention with equanimity to one's body sensations during memory processing."¹²

The real differences are structure and belief work. EMDR gives the therapist a map and the client a predictable sequence, and it deliberately targets the belief a trauma left behind. Brainspotting hands more of the pace to the client and leaves any change in belief to happen on its own. Brainspotting sessions also tend to run longer; the D'Antoni team notes that clinical Brainspotting generally takes more than an hour.¹² One difference is less certain than either side admits. EMDR's eye movements appear to add a measurable effect of their own,⁴ while we could find no study that has tested Brainspotting's fixed gaze as a separate ingredient. So the shared-ingredient view above is a reasonable reading of the evidence, not a settled finding.

What the research actually shows

Three studies and a brain-imaging case report come up again and again in Brainspotting-versus-EMDR articles, including the earlier version of this one. Here is what each one reported, along with one small randomized study that gets mentioned less often.

Hildebrand, Grand and Stemmler (2017). This is the main head-to-head study in people seeking treatment. It treated 76 adults who had sought help after a traumatic event with three 60-minute sessions of either EMDR (23 people) or Brainspotting (53 people), and measured self-reported PTSD, depression and anxiety before treatment, after it, and six months later.¹⁶ Both groups improved significantly. The effect sizes from before to after treatment were 1.19 to 1.76 for EMDR and 0.74 to 1.04 for Brainspotting, numerically larger for EMDR. The authors concluded that Brainspotting "seems to be an effective alternative." The limits are serious. The published abstract does not describe random assignment, the groups were very unequal in size, every outcome was self-report, and Brainspotting's developer is a coauthor. The abstract reports no measure of comfort or tolerability, so the study cannot show that Brainspotting was easier to tolerate. Even the citations drift: a 2023 letter describes it as an "N = 53" trial, which was only the size of the Brainspotting group.¹¹

D'Antoni, Matiz, Fabbro and Crescentini (2022). Forty psychologists and physicians in psychotherapy training, screened to exclude serious mental illness, each brought four distressing but not necessarily traumatic memories. Each memory got one 40-minute session of EMDR, Brainspotting or body scan meditation, or, as a control, time reading a book about trauma.¹² Distress dropped after all three active techniques. EMDR and Brainspotting ended lower than body scan and book reading, both right after the session and at a follow-up about two months later, and EMDR and Brainspotting did not differ significantly from each other. That is a fair test of single sessions in healthy, motivated trainees. It is not a test of PTSD treatment, and it does not show that eye-based methods reach some deeper level of the brain.

Talbot, de la Salle and Jaworska (2023). This is a three-page research letter in the Canadian Journal of Psychiatry, not a clinical trial. It describes one case; an uncontrolled pilot in which nine patients with PTSD received six Brainspotting sessions and showed a significant drop on the PTSD Checklist for DSM-5 (PCL-5); and a 2021 survey of 112 therapists attending a Brainspotting training, all of whom had EMDR experience. Eighty-two percent of those therapists said their clients responded better or much better to Brainspotting than to EMDR.¹¹ Therapists who sign up for a Brainspotting training are not a neutral sample. The authors acknowledge "the biases of such self-report data and its limited generalizability" and present the work as a way to generate hypotheses for randomized trials.¹¹

Other small studies. In a study in the International Body Psychotherapy Journal, 63 clients who came to a clinic for PTSD treatment were randomly assigned to five weeks of Brainspotting or treatment as usual. Only 27 completed treatment and follow-up. Both groups improved. Treatment as usual looked better right after treatment and Brainspotting at a follow-up four to six weeks later, but with so few completers those differences are fragile, and one coauthor lists an affiliation with a Brainspotting institute.¹⁷ A single-case study in the Indonesian journal Konselor gave one patient with PTSD thirty online Brainspotting sessions, with PET scans before and after and one healthy person scanned for comparison. Symptoms fell, and the scans "demonstrated varied results."¹⁸ One patient cannot tell us anything reliable about how the method works in the brain.

Put together, we could find no systematic review of Brainspotting and no adequately powered randomized trial against EMDR, and Brainspotting does not appear in the WHO, APA or VA/DoD recommendations. The early results justify proper trials. They do not yet justify saying Brainspotting is as effective as EMDR for PTSD, let alone more effective.

Is Brainspotting gentler?

The claim you will see most often is that Brainspotting is easier to tolerate. For some people it may be. No published trial has measured tolerability directly. The Talbot letter says "emerging data" suggest Brainspotting "might be better tolerated by patients," but the only data it offers on the point are therapists' survey answers.¹¹ The one randomized study that had clients rate their sessions, the Horton study above, found no difference in session satisfaction between Brainspotting and treatment as usual.¹⁷

The question matters because dropout is a real problem in trauma treatment. A meta-analysis of randomized trials of psychological therapy for PTSD found a pooled dropout rate of 16 percent, with more dropout from trauma-focused therapies.¹⁹ Anything that helps people stay in treatment would be worth having. But "gentler" can also mean less contact with the memory, and less contact is not automatically better.

The one study that tried both methods on the same people found a split in preference. In an informal debriefing at the end of the D'Antoni study, some participants preferred Brainspotting because they had "felt freer" during processing. Others said they had felt "a little bit lost" in it and preferred EMDR, where the therapist guided them more.¹² That split makes clinical sense. Open-ended quiet is a relief for some people and destabilizing for others, especially people who dissociate and can drift away from the present when nothing structures the session. Either method can overwhelm someone if the therapist moves too fast. In the same study, one participant reported a fear of losing control of her mind during EMDR, which settled after a session with her own therapist.¹²

What this looks like in therapy

With either method, good trauma work starts slowly. The first sessions cover history, current symptoms and how the person tends to respond under stress: whether they flood, go numb or lose time. A therapist should know before any processing begins whether dissociation is part of the picture, because both methods have to be slowed down and contained for people who dissociate. Preparation also means having ways to settle the body between sessions, such as the somatic exercises you can practice at home.

The practical difference shows up in the assessment. EMDR asks for an image, a belief about the self, an emotion and a body location before processing starts. Some people find that easy. Others go blank, especially people with alexithymia, the difficulty identifying and naming feelings. Brainspotting asks mainly for a body location and a number, which can be an easier door in. The trade-off is that a person who needs a map may find the open frame unsettling.

Neither method was designed around developmental trauma, the kind that comes from years of neglect or misattunement rather than a single event. Many clinicians use EMDR or Brainspotting inside a broader relational or parts-based therapy, and approaches such as NARM, which focuses on developmental trauma, take a different angle on the same problem. Therapists trained in both methods can switch between them: a protocol for a clearly defined memory with an obvious belief attached, a quieter frame when the structured work keeps looping or the client cannot find words. In depth-oriented work, the images, memories and dreams that surface during either method become material for the ordinary talking part of therapy afterward.

Progress should be measured, not assumed. A short questionnaire such as the PCL-5 every few sessions gives both of you something more reliable than a good feeling at the end of an hour. If the scores are not moving after a reasonable trial, the plan should change.

Choosing a method and a therapist in Alabama

EMDR is the stronger first choice if you want the better-tested of the two, if your symptoms trace to identifiable events, and if you like a clear plan. It is also worth knowing that prolonged exposure and cognitive processing therapy carry recommendations at least as strong as EMDR's.^{6, 7}

Brainspotting is reasonable to consider if you have already tried a well-delivered trauma-focused therapy and stalled, if putting experience into words is hard, or if structured protocols leave you feeling managed rather than helped. Go in knowing that the evidence is preliminary, and agree with your therapist on how you will judge whether it is working.

Whichever you choose, ask the therapist a few direct questions. How far did you train in this method? How do you handle it if I get overwhelmed or start to dissociate? How will we measure progress, and what will we do if it stalls? For EMDR, EMDRIA, the EMDR International Association, keeps a "Find an EMDR Therapist" directory of its members and runs a separate certification process beyond basic training. Brainspotting.com keeps a practitioner directory that separates therapists who are trained from those who are certified. You can also confirm any therapist's license with the relevant Alabama licensing board.

An earlier version of this page listed other Birmingham-area practices with their addresses, fees and staff. We removed that list because those details change faster than a blog post does, and we could not keep them accurate. At Taproot Therapy Collective in Hoover, we offer both EMDR therapy and Brainspotting therapy for trauma, and part of an intake is deciding together which method, if either, fits what you are dealing with.

If you are weighing the two and want to talk it through with a clinician who uses both, you can reach us through our contact page. A first conversation is about fit and history, not processing, and you do not need to have decided anything beforehand.

References

1. Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2(2), 199–223. https://doi.org/10.1002/jts.2490020207
2. Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.). Guilford Press.
3. van den Hout, M. A., & Engelhard, I. M. (2012). How does EMDR work? Journal of Experimental Psychopathology, 3(5), 724–738. https://doi.org/10.5127/jep.028212
4. Lee, C. W., & Cuijpers, P. (2013). A meta-analysis of the contribution of eye movements in processing emotional memories. Journal of Behavior Therapy and Experimental Psychiatry, 44(2), 231–239. https://doi.org/10.1016/j.jbtep.2012.11.001
5. World Health Organization. (2013). Guidelines for the management of conditions specifically related to stress. World Health Organization. Summary: WHO releases guidance on mental health care after trauma.
6. Schnurr, P. P., Hamblen, J. L., Wolf, J., Coller, R., Collie, C., Fuller, M. A., Holtzheimer, P. E., Kelly, U., Lang, A. J., McGraw, K., Morganstein, J. C., Norman, S. B., Papke, K., Petrakis, I., Riggs, D., Sall, J. A., Shiner, B., Wiechers, I., & Kelber, M. S. (2024). The management of posttraumatic stress disorder and acute stress disorder: Synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline. Annals of Internal Medicine, 177(3), 363–374. https://doi.org/10.7326/M23-2757
7. Guideline Development Panel for the Treatment of PTSD in Adults, American Psychological Association. (2019). Summary of the clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. American Psychologist, 74(5), 596–607. https://doi.org/10.1037/amp0000473
8. Cuijpers, P., van Veen, S. C., Sijbrandij, M., Yoder, W., & Cristea, I. A. (2020). Eye movement desensitization and reprocessing for mental health problems: A systematic review and meta-analysis. Cognitive Behaviour Therapy, 49(3), 165–180. https://doi.org/10.1080/16506073.2019.1703801
9. Rosen, G. M., & Davison, G. C. (2003). Psychology should list empirically supported principles of change (ESPs) and not credential trademarked therapies or other treatment packages. Behavior Modification, 27(3), 300–312. https://doi.org/10.1177/0145445503027003003
10. Grand, D. (2013). Brainspotting: The revolutionary new therapy for rapid and effective change. Sounds True.
11. Talbot, J., de la Salle, S., & Jaworska, N. (2023). A paradigm shift in trauma treatment: Converging evidence for a novel adaptation of eye movement desensitization and reprocessing (EMDR). The Canadian Journal of Psychiatry, 68(4), 283–285. https://doi.org/10.1177/07067437221142283
12. D’Antoni, F., Matiz, A., Fabbro, F., & Crescentini, C. (2022). Psychotherapeutic techniques for distressing memories: A comparative study between EMDR, Brainspotting, and body scan meditation. International Journal of Environmental Research and Public Health, 19(3), Article 1142. https://doi.org/10.3390/ijerph19031142
13. Corrigan, F., & Grand, D. (2013). Brainspotting: Recruiting the midbrain for accessing and healing sensorimotor memories of traumatic activation. Medical Hypotheses, 80(6), 759–766. https://doi.org/10.1016/j.mehy.2013.03.005
14. Gurda, K. (2015). Emerging trauma therapies: Critical analysis and discussion of three novel approaches. Journal of Aggression, Maltreatment & Trauma, 24(7), 773–793. https://doi.org/10.1080/10926771.2015.1062445
15. Novella, S. (2025, May 14). Brainspotting is classic pseudoscience. Science-Based Medicine. https://sciencebasedmedicine.org/brainspotting-is-classic-pseudoscience/
16. Hildebrand, A., Grand, D., & Stemmler, M. (2017). Brainspotting – the efficacy of a new therapy approach for the treatment of posttraumatic stress disorder in comparison to eye movement desensitization and reprocessing. Mediterranean Journal of Clinical Psychology, 5(1), 1–15. https://doi.org/10.6092/2282-1619/2017.5.1376
17. Horton, L. M., Schwartzberg, C., Goldberg, C. D., Grieve, F. G., & Brdecka, L. E. (2024). Brainspotting: A treatment for posttraumatic stress disorder. International Body Psychotherapy Journal, 22(2), 57–72. https://ibpj.org/issues/articles/Horton,%20Schwartzberg,%20Goldberg,%20Grieve,%20Brdecka%20-%20Brainspotting.pdf
18. Foo, M., & Yudistiro, R. (2022). A study of brainspotting therapy in PTSD using 18FDG brain PET scan to evaluate glucose metabolism changes. Konselor, 11(4), 125–134. https://ejournal.unp.ac.id/index.php/konselor/article/view/121548
19. Lewis, C., Roberts, N. P., Gibson, S., & Bisson, J. I. (2020). Dropout from psychological therapies for post-traumatic stress disorder (PTSD) in adults: Systematic review and meta-analysis. European Journal of Psychotraumatology, 11(1), Article 1709709. https://doi.org/10.1080/20008198.2019.1709709