A critique of the 2025 American Psychological Association Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder in Adults: underrating EMDR effectiveness

The American Psychological Association’s (APA’s) most recent guidelines for the treatment of posttraumatic stress disorder in adults recommend cognitive processing therapy, prolonged exposure, and trauma-focused cognitive behavioral therapy as first-line psychological treatment approaches. Eye movement desensitization and reprocessing (EMDR) therapy is listed as a second-line treatment. This position contrasts with 5 international and national clinical practice guidelines published in the past decade, making the APA’s guidance an outlier. Reasons for this discrepancy are explored, including that the APA utilized outdated reviews, relied on lower-quality meta-analytic evidence, applied a conservative approach to what constitutes evidence, and provided limited transparency into how specific decisions about EMDR were made. The guidelines comment negatively on EMDR in 4 domains: long-term treatment gains, adverse effects, outcomes for comorbid conditions such as depression, and the acceptability of EMDR therapy across cultures. Yet the APA panel’s documented commentary on each of these issues is inconsistent with published research. The paper concludes with recommendations for enhancing future guideline development.