EMDR vs STAIR

EMDR

Tradition

Trauma-Focused

Founder

Francine Shapiro (1989)

Review status

3 condition assessments available

Official sources

Guidelines and official sources (7)

7 clinical guideline checks

Read the recommendation and its scope. A source may discuss an approach without recommending it.

• Clinical Practice Guideline for Management of PTSD and Acute Stress Disorder

  VA/DoD · 2023 · Clinical guideline · Recommendation 8; Table 6, p.36

  Recommendation for the stated population

  EMDR is explicitly strongly recommended.

  Scope: Adults with PTSD

  Source checked 2026-09-06

• Post-traumatic stress disorder (NG116)

  NICE · 2018-12-05 · Clinical guideline · 1.6.18–1.6.20; child recommendation 1.6.13

  Recommendation for the stated population

  For adults, NICE considers EMDR at 1–3 months if preferred and offers it after 3 months for non-combat trauma. This scope is not a contraindication for combat trauma.

  Scope: Adults after non-combat trauma; separate restricted option for ages 7–17

  Source checked 2026-09-06

• Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder in Adults

  American Psychological Association · Approved February 2025; 2025 update · Clinical guideline · Psychological intervention recommendations, printed page 7 (PDF page 11)

  Recommendation for the stated population

  APA conditionally recommends EMDR as a second-line adult PTSD treatment compared with no intervention or treatment as usual.

  Scope: Adults with PTSD; comparison with no intervention or treatment as usual

  Source checked 2026-09-06

• Clinical Practice Guideline for Management of PTSD and Acute Stress Disorder

  VA/DoD · 2023 · Clinical guideline · Recommendation 34; Table 6, p.38; discussion pp.82–83

  Discussed in the source

  VA/DoD suggests co-occurring disorders should not preclude these PTSD treatments. This addresses access to treatment, not a separate claim of treating substance use.

  Scope: PTSD with co-occurring substance-use disorder or other disorders; therapies named in recommendations 8 and 9.

  Source checked 2026-09-06

• Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder in Adults

  American Psychological Association · Approved February 2025; 2025 update · Clinical guideline · Comparative psychological treatments, printed p.9 (PDF p.13)

  Insufficient evidence for or against

  APA finds insufficient evidence to prefer EMDR over those comparators. Its recommendation versus no treatment or usual care does not establish superiority over active therapy.

  Scope: Adults with PTSD; EMDR versus the other active psychological treatments listed in the table.

  Source checked 2026-09-06

• Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders

  World Health Organization · Third edition, 20 November 2023 · Clinical guideline · STR1, pp. 46–47 (PDF pp. 78–79)

  Recommendation for the stated population

  WHO includes EMDR in a conditional recommendation. The 2023 guideline book rates certainty as low, while WHO’s web summary reports moderate quality; that discrepancy remains unresolved. Delivery requires appropriate training and supervision.

  Scope: Adults with PTSD, within the mhGAP non-specialist-care context.

  Source checked 2026-09-06

• Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders

  World Health Organization · Third edition, 20 November 2023 · Clinical guideline · STR2, pp. 48–49 (PDF pp. 80–81)

  Recommendation for the stated population

  WHO includes EMDR in a strong recommendation based on moderate-certainty evidence. Clinicians need relevant training and demonstrated competence; lay providers require comprehensive training and close supervision.

  Scope: Children and adolescents with PTSD.

  Source checked 2026-09-06

Focus

Processing

Format

Individual

Duration

Short-medium

Condition-specific assessments

Each conclusion applies to the population and use described. These source-based assessments do not certify the full entry or replace expert clinical review.

PTSD & Acute Trauma

Population and scope: Adults with PTSD receiving individual, manualized EMDR. This does not grade acute post-trauma prevention, pediatric care, attachment-focused EMDR, ketamine-assisted EMDR or other branded adaptations.

Guideline recommendation

VA/DoD 2023 recommendation 8 strongly recommends EMDR for adult PTSD. The American Psychological Association’s 2025 guideline gives a conditional recommendation versus no intervention or usual care. For non-combat-related trauma, NICE NG116 (2018) offers EMDR after more than three months and considers it at one to three months when preferred. WHO STR1 is conditional; its 2023 book reports low certainty while its web summary reports moderate quality, an unresolved discrepancy. These differences remain visible: the label records a guideline recommendation for this adult PTSD protocol, not unanimous recommendation strength, universal first-line status or a claim that EMDR is unsuitable after combat trauma.

Source assessment dated 2026-09-06

• VA/DoD (2023): Clinical Practice Guideline for Management of PTSD and Acute Stress Disorder — Recommendation 8; Table 6, printed/PDF p. 36; discussion pp. 46–49
• American Psychological Association (Approved by APA Council of Representatives, February 2025): Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder in Adults — Tier definitions, printed p. 6 / physical PDF p. 10; psychological recommendations, printed p. 7 / physical PDF p. 11; active comparisons, printed p. 9 / physical PDF p. 13; university-hosted copy
• NICE (2018-12-05): Post-traumatic stress disorder (NG116) — EMDR recommendations 1.6.18–1.6.20, printed/physical PDF p. 21
• World Health Organization (Third edition, 20 November 2023): Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders — STR1, printed p. 46 / PDF p. 78; executive summary p. xxii / PDF p. 24
• World Health Organization (2023 update; current HTML read 6 September 2026): Posttraumatic stress disorder (PTSD): psychological interventions – adults — Recommendation, strength and quality-of-evidence fields

Perinatal Mental Health

Population and scope: Adults with PTSD after traumatic birth, miscarriage, stillbirth or neonatal death (NICE CG192 phrases this recommendation for women); standard manual-based EMDR within the non-combat PTSD pathway, rather than treatment of perinatal depression or distress alone.

Guideline recommendation

NICE CG192 offers trauma-focused CBT or EMDR for PTSD resulting from traumatic birth, miscarriage, stillbirth or neonatal death, referring to its PTSD guideline. NICE NG116 distinguishes timing: consider EMDR at one to three months after non-combat trauma when it is preferred, and offer it after three months. It specifies a validated manual and trained, supervised practitioners. This supports EMDR for the stated trauma-related PTSD context, not a general treatment for perinatal depression, grief without PTSD, or prevention in every pregnancy. CG192 separately advises against single-session high-intensity interventions that explicitly relive traumatic birth. These recommendations do not establish safety for every pregnancy or endorse all EMDR adaptations.

Source assessment dated 2026-09-06

• NICE CG192 (2014), perinatal mental health: recommendation 1.9.5
• NICE CG192 (2014), perinatal mental health: recommendation 1.9.6
• NICE NG116 (2018), PTSD: recommendation 1.6.18
• NICE NG116 (2018), PTSD: recommendation 1.6.19
• NICE NG116 (2018), PTSD: recommendation 1.6.20

Depression & Mood Disorders

Population and scope: Adults aged 18–65 with recurrent depression receiving stable antidepressants and clinical management in the 82-person EDEN trial; EMDR used the depression-specific DeprEnd protocol.

Randomized studies

Ostacoli et al. (2018) randomized 12–18 sessions of adjunctive EMDR or CBT. The main BDI-II clinical-cutoff outcome did not differ significantly after treatment or at six-month follow-up. EMDR favored post-treatment symptom scores and a stricter remission threshold; that remission difference was absent at follow-up. Most analyses used 66 completers, with an exploratory imputed analysis for symptom scores. Although designed for noninferiority, these nonsignificant comparisons are not proof of equivalence. Findings do not establish standalone efficacy, recurrence prevention, or a depression guideline recommendation.

Source assessment dated 2026-09-08

• Ostacoli et al. (2018): EDEN randomized comparison of EMDR and CBT for recurrent depression

STAIR

Tradition

Cognitive-Behavioral

Founder

Marylene Cloitre (2002)

Review status

1 condition assessment available

Official sources

Guidelines and official sources (1)

1 clinical guideline check

Read the recommendation and its scope. A source may discuss an approach without recommending it.

• Clinical Practice Guideline for Management of PTSD and Acute Stress Disorder

  VA/DoD · 2023 · Clinical guideline · Recommendation 10; p.36

  Insufficient evidence for or against

  VA/DoD finds the evidence insufficient for a recommendation for or against STAIR. This is not a positive recommendation for complex PTSD.

  Scope: STAIR for adult PTSD treatment.

  Source checked 2026-09-06

Focus

Skill + Processing

Format

Individual

Duration

Short (16)

Condition-specific assessments

Each conclusion applies to the population and use described. These source-based assessments do not certify the full entry or replace expert clinical review.

Complex Trauma / Developmental Trauma

Population and scope: Adults aged 18–65 with CAPS-5 PTSD after repeated childhood sexual or physical abuse; eight STAIR sessions followed by 16 EMDR sessions, compared with 16 immediate EMDR sessions. Entry did not require a complex-PTSD diagnosis.

Randomized studies

Van Vliet et al. (2021) reports 135 randomized adults; analyses used 121 after 11 withdrawals before treatment and three delayed eligibility exclusions. Only 28.9% met SIDES complex-PTSD criteria at baseline; this was not an ICD-11 diagnostic interview. Both groups improved, with no statistically significant endpoint advantages for adding STAIR through six months or in treatment dropout. Immediate EMDR showed faster early improvement in self-reported PTSD symptoms, interpersonal problems and post-traumatic cognitions. The authors found no need for a preparatory phase in this sample. The study was not an equivalence trial, did not test standalone STAIR and had no inactive control. Twice-weekly STAIR may have limited time to practise skills between sessions. Exclusions included ongoing abuse, acute suicidality requiring crisis intervention and screened substance misuse/dependence. These findings do not establish that every person with complex PTSD needs, or should avoid, preparation.

Source assessment dated 2026-09-06

• Van Vliet et al. 2021, STAIR–EMDR versus immediate EMDR, PDF p. 3
• Van Vliet et al. 2021, STAIR–EMDR versus immediate EMDR, PDF p. 4
• Van Vliet et al. 2021, STAIR–EMDR versus immediate EMDR, PDF p. 5
• Van Vliet et al. 2021, STAIR–EMDR versus immediate EMDR, PDF p. 6
• Van Vliet et al. 2021, STAIR–EMDR versus immediate EMDR, PDF p. 7

EMDR

Core mechanism: Bilateral stimulation during trauma memory processing facilitates adaptive information processing and memory reconsolidation (proposed)

Ontology: Unprocessed trauma memories stored dysfunctionally with original affect, sensation, and cognition

STAIR

Core mechanism: Phase 1 builds emotion regulation and interpersonal skills; Phase 2 uses modified narrative exposure with these new capacities

Ontology: Complex trauma disrupts both affect regulation and interpersonal functioning; skills needed before narrative processing

Linked only in the EMDR entry

EMDR

Philosophical roots: Merleau-Ponty (body holds memory); Bion (processing/containment); Pavlov (orienting response); Shapiro (adaptive information processing: pragmatic, not philosophically derived)

Blind spots: Mechanism debate unresolved; protocol fidelity varies; may be applied to conditions beyond its evidence base

Therapeutic voice: Bring up the image and the negative belief. Notice what you feel in your body. Now follow my fingers.

STAIR

Philosophical roots: Herman (phase-oriented treatment); Cloitre (skills before exposure); developmental psychopathology; attachment theory

Blind spots: Two-phase structure lengthens treatment, and Phase 1 can feel slow to clients who are ready to process; the premise itself is contested, since a number of trauma researchers argue that phase-based sequencing delays effective treatment without clear evidence that a skills phase is necessary

Therapeutic voice: Let's practice naming what you're feeling with more precision, not just 'bad,' but specifically what kind of bad.