EMDR vs Brainspotting: How the Two Trauma Therapies Compare

By Christina Mathieson, LMFT #115093, founder of My Mental Climb.

TL;DR. Brainspotting was developed by David Grand in 2003 out of his EMDR practice, and the two share a bottom-up, body-based orientation to trauma processing. They differ in structure (EMDR is more phase-based, Brainspotting is more client-led), in mechanism (EMDR uses bilateral stimulation, Brainspotting uses fixed eye positions), and in evidence base (EMDR has substantially more research). Both are legitimate trauma treatments. Which fits depends on the presentation, the client, and what has been tried before.

Clients ask about Brainspotting most often after they have heard about EMDR from a friend or read about it online. The two therapies are related, both target trauma at a body-based rather than purely cognitive layer, and they are often offered by the same clinicians. What follows is a straight comparison, drawn from clinical practice and from what the research actually supports.

Where Brainspotting Came From

Brainspotting was developed by Dr. David Grand in 2003. Grand was a former EMDR trainer working with 9/11 survivors and noticed that when clients' eyes paused at specific positions during reprocessing, deeper and more sustained emotional release occurred. He hypothesized that particular eye positions correlate with where unprocessed emotional and somatic material is stored in the nervous system, and that holding attention at those "brainspots" allows the material to release without requiring the bilateral stimulation EMDR uses.

The mechanism Grand proposes is that Brainspotting accesses processing at the subcortical level of the brain, the same layer EMDR targets, but through a different door. Rather than moving the eyes across the visual field, the client holds their gaze at a specific position while the therapist tracks somatic and emotional responses. Some Brainspotting sessions add biolateral audio, music panned alternately between the ears through headphones, but the visual work is stationary.

Where EMDR Came From

EMDR was developed by Dr. Francine Shapiro in 1987 after she noticed that walking through a park while distressed produced an unexpected reduction in the intensity of her thoughts. She traced the effect to the involuntary eye movements happening as she scanned her surroundings, developed a protocol around that observation, and spent the following decades formalizing the eight-phase treatment now used worldwide.

The EMDR protocol targets a specific memory through sets of bilateral stimulation (eye movements, alternating tactile pulses, or alternating audio tones) while the client holds the memory, the associated negative belief, the body sensation, and the emotion in mind. Between sets, the therapist tracks what surfaces and follows the spontaneous chain of associations the brain produces. Sessions typically move through eight phases: history taking, preparation, assessment, desensitization, installation, body scan, closure, and reevaluation.

The Practical Differences in Session

Structure. EMDR is more phase-based. There is a defined preparation period, a defined reprocessing sequence, and a defined closure. Brainspotting is more client-led. The therapist tracks and follows rather than directing, and sessions can look very different from one to the next depending on what surfaces.

Bilateral stimulation. EMDR requires it. Brainspotting does not use it in the same way. Some Brainspotting includes biolateral audio, but the eye work is stationary rather than tracking.

Talking. EMDR clients report briefly between sets of bilateral stimulation. Brainspotting clients often report even less verbally, with more of the session happening in silence while the therapist observes somatic responses.

Pacing. EMDR pacing is protocol-guided. Brainspotting pacing is body-guided. Some clients find EMDR's structure containing; others find it constraining. Same client experience for Brainspotting in reverse.

Session length. Both often use 60-to-90-minute sessions rather than the standard 50-minute hour, because both benefit from time for closure at the end.

What the Research Actually Shows

EMDR is one of the most-researched trauma treatments in the field. The World Health Organization recommends it as a psychotherapy of choice for PTSD, the U.S. Department of Veterans Affairs 2023 clinical practice guideline gives it a "Strong For" recommendation, and the American Psychological Association issues a conditional recommendation for EMDR. Meta-analyses consistently show large effect sizes for single-incident PTSD and meaningful improvements for complex PTSD when the work is paced appropriately. The research base is measured in hundreds of studies over three decades.

Brainspotting has a much smaller research base. It is a newer modality (22 years old at the time of writing versus EMDR's 38) and formal research infrastructure has been slower to develop. The Brainspotting Trainings organization maintains a research page listing published studies, and clinical outcome reports from practitioners are broadly positive, but the field does not yet have the meta-analytic support EMDR has accumulated.

This does not mean Brainspotting doesn't work. It means the evidence base is less mature. For clients whose priority is treatment with the strongest formal research support, EMDR is the more established choice. For clients where EMDR has been tried without full benefit, or where the phase-based structure has felt constraining, Brainspotting is a reasonable next step supported by clinical outcomes even if not by the same volume of RCTs.

Who Might Benefit More From Each

EMDR tends to fit best when:

• The presenting concern is a specific event or discrete set of events (accident, assault, medical trauma, sudden loss)
• The client wants the treatment with the strongest research base
• The client benefits from structure and defined phases
• The trauma is developmentally recent enough that memory targets are accessible
• The client has done cognitive-focused therapy already and needs a body-based approach

Brainspotting tends to fit best when:

• The client has completed EMDR without full benefit
• The trauma is more diffuse, developmental, or hard to isolate into single memories
• The client finds highly structured protocols hard to stay with
• Performance blocks, creative work, or athletic performance are part of what is being addressed (Brainspotting has developed specific applications for these)
• The client's presentation includes complex dissociation and a less-directive approach fits better

Many clinicians who train in Brainspotting also train in EMDR and choose the approach based on the specific client and presentation rather than one being universally better than the other. At My Mental Climb, our EMDR work is led by Jalyse Stewart, AMFT #153712 (supervised by Christina Mathieson, LMFT #115093) using the standard eight-phase EMDR protocol.

If You Are Trying to Choose

Three questions that help sort:

1. What has been tried? If you have not done trauma-focused therapy before, EMDR is usually the more evidence-supported starting point. If you have done EMDR without full benefit, Brainspotting is a reasonable next step.

2. What does the target look like? Discrete traumatic events with clear memory targets align well with EMDR's phase-based protocol. Diffuse developmental trauma or presentations that resist single-memory targeting may fit Brainspotting's client-led approach better.

3. What kind of structure do you tolerate best? Some clients feel held by a defined eight-phase sequence. Others find it constraining and prefer the more open-ended tracking Brainspotting uses. Neither preference is right or wrong, and knowing your own tolerance for structure helps choose.

If you want help sorting which one fits your situation, a free 15-minute consult with our intake coordinator is the low-pressure way to talk it through. She will point you to the modality and clinician that fit rather than defaulting to whatever we offer most.

Related Reading

For a broader trauma-treatment comparison, our post on EMDR vs CBT for Trauma covers the decision between EMDR and cognitive-behavioral approaches. For who tends to benefit from EMDR specifically, see Who Can Benefit From EMDR Therapy. For the underlying neuroscience of how trauma is stored differently from ordinary memory, our EMDR therapy specialty page walks through the Adaptive Information Processing framework in detail.

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Related from My Mental Climb: EMDR Therapy · EMDR vs CBT for Trauma · Who Can Benefit From EMDR Therapy · Trauma Therapy · Free 15-minute consult

Common questions

What is the difference between EMDR and Brainspotting?

EMDR uses bilateral stimulation (eye movements, tapping, or alternating tones) within an eight-phase protocol to reprocess traumatic memories. Brainspotting uses fixed eye positions correlated with unprocessed material to access and release it, typically with biolateral audio (music panned left to right). EMDR is more structured and phase-based; Brainspotting is more client-led and less protocol-driven. Both work at a body-based rather than purely cognitive level, and both grew out of the same clinical lineage. David Grand, who developed Brainspotting in 2003, was originally EMDR-trained.

Which is more evidence-based, EMDR or Brainspotting?

EMDR has the stronger research base by a substantial margin. The World Health Organization recommends EMDR as a psychotherapy of choice for PTSD, the U.S. Department of Veterans Affairs 2023 guideline gives it a 'Strong For' recommendation, and the American Psychological Association issues a conditional recommendation. Brainspotting has a growing but smaller research literature. It is considered evidence-informed rather than evidence-based in the same tier as EMDR, though clinical outcomes reported by practitioners are consistent with the neuroscience underneath both approaches. For clients who want a treatment with the strongest formal evidence, EMDR is the answer; for clients where EMDR has been tried without full benefit, Brainspotting can be a reasonable next step.

Does Brainspotting use eye movements like EMDR?

No. Brainspotting uses fixed eye positions rather than the tracking eye movements EMDR uses. The theory is that specific gaze positions correlate with where unprocessed emotional and somatic material is stored, and holding attention at those positions allows the material to release. Some Brainspotting protocols include biolateral audio (music alternating between the ears through headphones), but the visual work is stationary rather than moving. EMDR by contrast asks the client to track a moving stimulus, whether a therapist's finger, a light bar, or a screen-based tool.

How do I know which one is right for me?

Consider EMDR first if you want a treatment with the strongest research base and the most structured phase-based protocol, or if you are working with single-event trauma where EMDR has the strongest outcome data. Consider Brainspotting if you have tried EMDR without full benefit, if you find highly structured protocols hard to stay with, if you feel more comfortable with a client-led approach, or if performance and creative work (where Brainspotting has developed applications) is part of what you are addressing. A free consult with the intake coordinator can help sort which fits your situation.

Can Brainspotting be done via telehealth?

Yes. Both EMDR and Brainspotting have been adapted for telehealth. The therapist positions the client's eye through the camera or with pointer tools shared on screen, biolateral audio can be delivered through headphones over the video call, and the pacing follows the same principles as in-person work. Research on remote versions of both modalities is still developing, but clinical outcomes reported by therapists using each via telehealth are broadly consistent with in-person outcomes.

Last clinically reviewed: June 30, 2026 by Christina Mathieson, LMFT #115093.