Can you process trauma through a screen?
If you have read about EMDR and understand that it involves following a therapist’s hand movements while holding a disturbing memory in mind, the idea of doing that over a video call raises a reasonable question. The bilateral stimulation that anchors EMDR’s reprocessing mechanism was developed for an in-person room. How does it translate when the therapist is in Midtown and the patient is in their living room in Marietta, or in a parked car in Alpharetta between meetings, or in a home office in Savannah with a locked door and a headset?
The short answer: the evidence supports it. The longer answer involves understanding what changes, what stays the same, and what needs to be in place to make virtual EMDR effective rather than merely available.
What the Research Shows
The efficacy evidence for online EMDR has grown substantially since telehealth expanded during 2020. A 2025 randomized controlled trial published in Frontiers in Psychiatry (Yasar et al.) demonstrated that online EMDR 2.0 Group Protocol produced significant reductions in PTSD symptoms, depression, anxiety, and stress compared to a waitlist control group among traffic accident survivors. The VA/DoD 2023 clinical practice guidelines place EMDR on the same recommendation tier as Prolonged Exposure and Cognitive Processing Therapy, and Fairbanks et al. (2025) confirmed effectiveness across both in-person and telehealth delivery formats for veteran populations.
A 2025 systematic review in the British Journal of Psychology (Simpson et al.), analyzing 29 RCTs, included studies using both in-person and remote delivery. The review found EMDR to be the most cost-effective intervention among 10 alternatives. While the review did not isolate telehealth as a separate subanalysis, the inclusion of remote-delivery studies in the evidence base reflects the growing clinical acceptance of virtual formats.
What the evidence does not yet provide is a large-scale head-to-head comparison of in-person versus online EMDR with matched populations and long follow-up. Individual studies and clinical experience consistently report comparable outcomes, but the definitive meta-analysis isolating format as a variable has not been published. The honest framing: online EMDR is well-supported, clinically accepted, and not yet proven to be precisely equivalent to in-person delivery through the kind of rigorous comparative trial that would settle the question permanently.
For practical purposes, the clinical community treats virtual EMDR as a validated delivery format. The EMDR International Association does not distinguish between in-person and telehealth delivery in its practice recommendations. Multiple training programs now include telehealth-specific protocols as standard curriculum.
How Bilateral Stimulation Works Remotely
The most common question about virtual EMDR is mechanical: how do you do the eye movements through a screen?
Several adaptations have become standard:
Visual tracking on screen. The therapist moves their finger or a cursor across the screen, and the patient follows it. The screen needs to be large enough and close enough that the eye movements achieve sufficient range. A laptop at arm’s length works. A phone screen does not.
Self-administered tapping. The patient alternates tapping their own knees, shoulders, or the sides of their chair. This is called “butterfly tapping” in some protocols. The bilateral stimulation is haptic rather than visual, but the working memory mechanism functions the same way: dual attention (holding the target memory while attending to the physical sensation) taxes working memory and reduces the emotional charge of the memory.
Auditory bilateral stimulation. Alternating tones delivered through headphones. The patient hears a tone in the left ear, then the right, at a pace set by the therapist. This requires the patient to have headphones, but it eliminates the screen-size constraint entirely.
The critical point: bilateral stimulation is a mechanism, not a specific technique. Eye movements are the most studied form, but research confirms that any task that divides attention and taxes working memory produces the therapeutic effect. The 2024 “state of the science” review in the Journal of Traumatic Stress (de Jongh et al.) specifically noted that the effect is not limited to eye movements and that the strength of working memory taxation correlates with outcome strength. Virtual delivery simply shifts which form of bilateral stimulation is most practical.
Creating a Containment Space at Home
This is where virtual EMDR places genuine demands on the patient that in-person therapy does not. In a therapist’s office, the environment is designed for the work: soundproofing, lighting control, no interruptions, a physical separation between the therapy space and daily life. At home, that separation has to be built deliberately.
Privacy is non-negotiable. EMDR reprocessing can produce visible emotional responses: tears, physical tension, startle reactions, and sometimes vocal expressions of distress. The space needs to be free from interruption, observation, or overhearing by anyone not involved in the session. A locked door, household members informed of the schedule, phone on silent, pets in another room if they tend to respond to emotional cues.
Physical comfort matters more than it might seem. The patient is asked to hold disturbing material in mind while maintaining dual attention. Physical discomfort (an uncomfortable chair, a screen at the wrong height, a room that is too cold) creates competing sensory input that degrades the processing. Setting up the space before the session as though preparing for something important reflects the reality of what is happening.
Post-Session Transition
Buffer time matters. In-person patients have a car ride home to decompress. Virtual patients step from the therapy screen directly into their living space, where the dishes are stacked and the children are asking about dinner. Clinicians recommend building at least 30 minutes of unscheduled time after each session: a walk around the block, sitting outside, giving the nervous system transition space.
A signal to close the session space. Some virtual EMDR patients develop a ritual: closing the laptop, changing the lighting in the room, or physically moving to a different area of the house. The function is to create a perceptual boundary between “therapy space” and “home space” that the nervous system learns to recognize.
Who Virtual EMDR Serves Best
Telehealth EMDR is not a consolation prize for people who cannot get to an office. For certain patient profiles, it is the better option.
Medically fragile patients. People recovering from surgery, managing chronic illness, or in the late stages of pregnancy (Post 3.4 discusses mental resilience during high-risk pregnancy) for whom traveling to a Midtown or Buckhead office adds physical strain and medical risk. Virtual sessions eliminate the commute without eliminating the care.
Patients with medical trauma. This is specifically relevant to Post 4.2 in this series. If walking into a clinical building triggers the very PTSD symptoms you are trying to treat, processing that trauma from a safe, non-clinical environment may produce faster therapeutic progress. The therapy room is supposed to feel safe. For someone with medical trauma, a familiar home environment may achieve that safety more effectively than any office can.
Patients across Georgia’s geographic spread. Specialized trauma therapists are concentrated in metro Atlanta. A patient in Macon, Augusta, or Valdosta seeking EMDR-trained clinicians may find limited local options. Telehealth extends access to any location within Georgia’s licensing jurisdiction without requiring a multi-hour drive for each session.
High-travel professionals. Consistency matters in trauma processing. If your work sends you across the Southeast every other week, maintaining a regular in-person schedule is logistically impossible. A virtual format that follows you to your hotel room in Nashville or your airport lounge in Charlotte provides the continuity that trauma work requires.
Privacy and Compliance
EMDR sessions involve processing sensitive material. Virtual delivery adds a technical layer to the confidentiality requirements that in-person sessions handle through physical walls.
Our practice uses HIPAA-compliant video platforms with end-to-end encryption. Session recordings are not made. No session data passes through consumer-grade video tools. The platform meets the security standards required by Georgia state licensing boards and federal healthcare privacy regulations.
On the patient’s end, the primary privacy risk is environmental, not technical. The encryption protects the data in transit. What it cannot protect is a family member walking into the room mid-session or a conversation overheard through thin apartment walls. Your responsibility in virtual therapy is to secure your physical environment. The practice’s responsibility is to secure the digital one.
If you are unsure whether your home environment can provide adequate privacy, raise this concern before the first processing session. Your therapist can help assess whether the space is workable or whether scheduling adjustments (timing sessions when the house is empty, for example) would resolve the issue.
Getting Started
Virtual EMDR sessions follow the same eight-phase protocol as in-person delivery. The clinical standards, the assessment process, the pacing of treatment, and the therapist’s training and supervision should be identical regardless of format. What changes is the medium, not the method.
An initial consultation, which can also be conducted virtually, determines whether EMDR is appropriate for your presentation and whether the virtual format suits your specific needs. Some patients begin virtually and transition to in-person as they become comfortable. Some do the opposite, starting in-office for the preparation phases and shifting to virtual for ongoing processing. The format should serve the treatment, not the other way around.
Patients across Georgia can access EMDR through telehealth without traveling to metro Atlanta. The requirements are straightforward: Georgia residency (for licensing jurisdiction), a private space, a stable internet connection, and a screen large enough to support bilateral stimulation.
This content is for educational purposes and does not replace professional medical or psychological advice. EMDR therapy should be conducted by a trained, licensed clinician regardless of delivery format. If you are experiencing a mental health crisis, contact the 988 Suicide and Crisis Lifeline or your local emergency services.