ART vs. EMDR: How Is Bilateral Stimulation Used Differently?
If you watch even a few minutes of Accelerated Resolution Therapy, or ART, and EMDR therapy, you will probably notice something immediately.
Both involve eye movements.
A therapist moves a hand or another visual target from side to side.
The client follows it with their eyes.
So it is reasonable to wonder:
Are ART and EMDR basically doing the same thing?
Not exactly.
The visible part may look similar.
But the eye movements occur inside two different therapeutic protocols.
The therapist gives different instructions.
The client is asked to do different things with the memory.
The processing unfolds differently.
And that means we should be careful about assuming that “bilateral stimulation” serves exactly the same function in both therapies.
First, what is bilateral stimulation?
Bilateral stimulation usually refers to stimulation that alternates from one side to the other.
In trauma therapy, this may include:
side-to-side eye movements,
alternating sounds,
or alternating tactile stimulation such as taps.
EMDR officially describes the reprocessing phases as involving dual-attention bilateral stimulation, which may include eye movements, sounds, or taps.
ART primarily uses visually guided lateral eye movements.
But calling both simply “bilateral stimulation therapies” can obscure what is actually happening.
The eye movements are embedded in different procedures.
EMDR is an eight-phase psychotherapy
EMDR is not just eye movements.
The standard protocol includes eight phases:
history taking and treatment planning,
preparation,
assessment,
desensitization,
installation,
body scan,
closure,
reevaluation.
Bilateral stimulation is used particularly during the reprocessing portions of the treatment.
Before that begins, the therapist identifies a target memory and assesses associated components such as the image, negative belief, preferred positive belief, emotion, body sensations, and level of disturbance.
That structure matters.
The eye movements are not being used in isolation.
What happens during EMDR reprocessing?
During the desensitization phase, the client brings the target memory and associated material to mind while engaging in sets of bilateral stimulation.
Then the therapist typically asks some version of:
“What do you notice now?”
The client reports what emerged.
That might be:
another memory,
an image,
a thought,
an emotion,
a body sensation,
or something unexpected.
Then another set begins.
EMDR allows the processing to unfold through those associations.
The therapist generally follows the client's emerging material rather than directing exactly what the client should imagine next.
EMDRIA describes new thoughts, images, feelings, and sensations as potentially emerging during this process.
EMDR often follows the client's associative network
This is one of the most noticeable differences between EMDR and ART.
EMDR may begin with one target and then move through related material.
For example:
You begin with an image from a painful relationship.
After a set of eye movements, another memory appears.
Then a childhood experience.
Then a body sensation.
Then a thought.
Then anger.
Then another memory.
The therapist follows that processing.
The assumption within EMDR's Adaptive Information Processing model is that disturbing experiences may be linked within memory networks and that reprocessing allows more adaptive information to become integrated.
That makes EMDR feel relatively associative.
ART is generally more directive
ART uses eye movements differently.
The therapist is typically more active in structuring the sequence.
ART incorporates:
memory recall,
attention to physical sensations,
repeated eye-movement sets,
imaginal exposure,
and imagery rescripting or voluntary image replacement.
Recent ART research protocols explicitly describe the intervention as combining imaginal exposure, lateral eye movements, and imagery rescripting.
So rather than primarily following whatever association arises, ART tends to move the client through a more defined sequence.
That is one reason ART and EMDR may feel quite different even though both involve moving the eyes from side to side.
ART often works through the memory more deliberately
In ART, the therapist may guide the client through a memory while the client notices what happens internally.
The client may be asked to attend to:
what they see,
what they feel in the body,
where they feel it,
and how those sensations change.
The therapist then uses additional eye-movement sets as the client moves through the process.
Later, ART may incorporate imagery procedures that allow the client to alter the internal representation associated with the event.
The facts do not have to change.
But the image can.
That is an important distinction.
EMDR does not usually deliberately rewrite the scene
In standard EMDR, the client may spontaneously develop new images, insights, meanings, or perspectives.
But the therapist generally does not instruct the client to deliberately replace the traumatic scene with a different version in the same way ART does.
Instead, EMDR allows new material to emerge through reprocessing.
Then, during the installation phase, the client strengthens a preferred positive cognition associated with the target memory.
ART's imagery procedures are more overtly directive.
That difference can significantly change the subjective experience of treatment.
ART may feel more structured from set to set
Clients often notice that ART has a clearer sense of:
“Here is what we are doing now.”
Then:
“Here is what we are doing next.”
The therapist guides the client through the protocol more actively.
EMDR may feel more like:
“Hold this in mind and notice where your brain goes.”
Neither is inherently better.
They are simply different therapeutic experiences.
Some clients prefer more structure.
Some prefer more associative freedom.
Some may benefit from one approach for one target and another approach for something else.
Is the eye movement itself doing the same thing in both?
We do not know.
This is an important scientific limitation.
Because ART and EMDR both use eye movements during emotionally meaningful memory work, it is plausible that at least some underlying processes overlap.
Working-memory competition is one candidate.
Dual attention is another.
Changes in emotional arousal may contribute.
Memory updating may contribute.
But the surrounding therapeutic procedures are different enough that we should not assume the total mechanism is identical.
The eye movements may share a cognitive effect while the protocols use that effect differently.
Working memory may be one area of overlap
One of the most researched explanations for EMDR eye movements is working-memory taxation.
The idea is that recalling a vivid emotional memory requires working-memory resources.
Tracking a moving visual target also requires resources.
Doing both simultaneously creates competition.
The memory may then become less vivid or emotionally intense.
This is one reason bilateral stimulation may not be best understood as simply “alternating the brain from left to right.”
The meaningful feature may be the additional cognitive load created while the memory is active.
This same principle could plausibly contribute to ART because ART also combines emotional memory activation with visually guided eye movements.
But that remains an inference from broader eye-movement research rather than a proven ART-specific mechanism.
Dual attention may also matter in both
Both therapies ask the client to do something unusual.
Attend internally.
And externally.
At the same time.
Part of the client's attention is on:
the memory,
the image,
the emotion,
or the body.
Another part remains engaged with:
the therapist,
the moving hand,
and the present room.
This is sometimes described as dual attention.
EMDR explicitly refers to dual-attention bilateral stimulation.
That may help create a distinction between:
“Then”
and
“Now.”
The client contacts the painful material while remaining connected to the present.
ART creates a similar present-plus-memory situation, although the therapist directs the experience differently.
Why this matters for traumatic memory
Traumatic memories can feel unusually present.
You may intellectually know:
“That happened ten years ago.”
But your body responds as though:
“It is happening now.”
A sound.
A smell.
A facial expression.
A medical setting.
A delayed text.
A particular tone.
Suddenly the past feels immediate.
Both ART and EMDR may help create conditions in which the memory is activated without the client being completely swallowed by it.
That may be part of what allows the memory to change.
ART pays more explicit attention to somatic sensations throughout the protocol
Both therapies attend to the body.
EMDR formally includes a body-scan phase after desensitization and installation, and somatic material may also emerge throughout processing.
ART, however, repeatedly works with body sensations as part of its structured processing sequence.
A client might notice:
pressure in the chest,
tightness in the throat,
nausea,
heat,
tension,
heaviness,
or another sensation.
Eye movements may continue while the client attends to what happens to that sensation.
That gives ART a somewhat different rhythm.
EMDR may move across memories more readily
Because EMDR often follows associations, one target can lead into another.
A present trigger may connect to:
a previous relationship,
then an early childhood memory,
then another related experience.
This can be clinically useful when the client's distress appears to be organized within a larger network.
ART may also reveal related material.
But its protocol tends to remain more deliberately focused on the chosen target and the structured steps surrounding it.
Again, this is not a judgment about which is superior.
It is a meaningful procedural difference.
ART often feels more contained
For some clients, ART's structure can feel containing.
There may be less uncertainty about what comes next.
The therapist remains active.
There is a defined sequence.
The work may remain more tightly organized around a target.
That can be appealing to clients who:
do not want to tell the whole story,
do not want open-ended processing,
want more guidance,
or feel anxious about where trauma therapy might take them.
Other clients may appreciate EMDR's more associative quality.
Fit matters.
Does EMDR require detailed retelling?
No.
This is an important correction because EMDR is sometimes inaccurately contrasted with ART as though EMDR requires extensive trauma narration.
It does not.
EMDRIA specifically notes that clients do not have to discuss disturbing memories in detail.
The client needs to identify enough about the target for the therapist to guide the work.
But EMDR is not primarily a detailed retelling therapy.
ART and EMDR actually share this advantage.
Neither necessarily requires repeatedly recounting everything that happened.
So what is really different?
The difference is less:
“ART does not make you talk, but EMDR does.”
That would be inaccurate.
The more meaningful differences are in:
protocol structure,
therapist direction,
associative processing,
imagery procedures,
how the body is incorporated,
what happens between sets,
and how the therapy defines completion of a target.
Those are clinically much more interesting distinctions.
EMDR explicitly installs a positive cognition
In EMDR, after disturbance around the target has reduced, the protocol includes an installation phase.
The client strengthens a preferred positive belief associated with the memory.
For example:
“I am safe now.”
“I have choices.”
“I am worthy.”
“I did the best I could.”
The validity of that positive cognition is assessed and strengthened with bilateral stimulation.
ART does not organize the work around an identical positive-cognition installation phase.
Its imagery procedures approach change differently.
ART's imagery rescripting is a major distinction
This may be one of the most significant differences between the two therapies.
ART gives the client substantial freedom to change distressing imagery.
That does not mean rewriting history.
A client knows what actually happened.
But the internal movie can change.
For example, the person may imagine:
having power they did not have at the time,
receiving protection,
leaving the situation,
saying what they wish they could have said,
or transforming a distressing image into something entirely different.
ART research protocols specifically include imagery rescripting alongside lateral eye movements and imaginal exposure.
That deliberate imagery component distinguishes ART from standard EMDR.
Why would changing an image matter?
Images can carry enormous emotional power.
Sometimes the thing that keeps someone stuck is not only the factual memory.
It is the image.
The hospital room.
The moment of discovery.
The face.
The accident scene.
The last moments with someone who died.
The humiliation.
The phone screen.
The intrusive mental picture.
If that image changes in vividness, meaning, or emotional intensity, the person's response to the memory may also change.
ART directly works with this possibility.
Does imagery rescripting mean creating a false memory?
No.
Changing an internal image therapeutically is not the same as convincing yourself that history was different.
You can know:
“This is what actually happened.”
And simultaneously choose a different way of representing it internally.
The goal is not historical revision.
It is changing the emotional impact of the representation.
That distinction is essential.
Does EMDR use imagery too?
Absolutely.
EMDR targets typically include an image representing the worst part of the memory.
New imagery may emerge spontaneously during reprocessing.
Future templates can involve imagery.
Resource development may involve imagery.
But standard EMDR does not generally use the same deliberate voluntary image-replacement procedure associated with ART.
Again:
similar tools,
different architecture.
Which therapy uses more eye movements?
There is no clinically useful universal answer.
The amount and pacing of eye movements vary according to protocol, therapist, client, target, and what occurs during processing.
Counting eye movements would also miss the more important point.
What matters is what the client is doing while the eye movements occur.
In EMDR, the person may be following emerging associative material.
In ART, the person may be moving through a more structured sequence involving memory, body sensations, and imagery.
Context changes the meaning of the technique.
Is one form of bilateral stimulation stronger than another?
We do not currently have good evidence showing that ART's eye movements are inherently more powerful than EMDR's or vice versa.
Research does suggest that characteristics of a dual-attention task—such as how demanding it is—can affect working-memory competition.
But clinical outcomes depend on much more than raw stimulation.
Target selection matters.
Readiness matters.
Therapist skill matters.
The protocol matters.
The client's history matters.
The therapeutic relationship matters.
The surrounding procedures matter.
“Faster eye movements equal better therapy” would be an enormous oversimplification.
Does ART use only eye movements?
ART is primarily associated with visually guided lateral eye movements.
EMDR has a broader formal tradition of using several forms of bilateral stimulation, including eye movements, alternating sounds, and tactile stimulation.
This distinction may matter because different dual-attention tasks place different demands on working memory.
Research increasingly suggests that the cognitive load of the task may matter as much as—or more than—the simple fact that it alternates left and right.
That is another reason the phrase “bilateral stimulation” can sometimes obscure more than it explains.
Is “bilateral stimulation” even the best term?
Clinically, the phrase is useful.
Scientifically, it may encourage people to focus too heavily on bilateral.
If the critical mechanism is partly working-memory taxation or dual attention, then the relevant question may not be:
“Did the stimulation alternate left and right?”
It may be:
“What additional attentional task occurred while the emotional memory was active?”
That is a much more interesting scientific question.
It is also why claims about “balancing the hemispheres” deserve skepticism.
Which approach is more structured?
Generally, ART.
EMDR is structured at the protocol level—it has eight defined phases and clear procedures.
But within the actual reprocessing phase, EMDR often allows the client's associations to guide the direction.
ART tends to be more therapist-directed within the processing itself.
That difference can matter significantly to clients.
A person who wants a clearly guided experience may prefer ART.
Someone comfortable allowing memory networks to unfold more organically may respond well to EMDR.
But preferences are only one part of treatment selection.
Which is better: ART or EMDR?
That is not a question with a universal answer.
EMDR has a substantially larger research base and is well established as a trauma treatment.
ART has a smaller but growing evidence base and may appeal to clients who prefer its structure and imagery-based procedures.
Clinical fit matters more than choosing a therapy based on branding.
Sometimes ART may make more sense.
Sometimes EMDR.
Sometimes another treatment entirely.
Can someone use both ART and EMDR?
Potentially.
They are not mutually exclusive identities.
A clinician trained in both can think about:
the client,
the target,
the treatment goal,
the client's tolerance for associative processing,
their preference for structure,
their history,
and what has already been tried.
Different tools may make sense at different times.
The point is not to collect modalities.
It is to select interventions thoughtfully.
How I think about ART and EMDR
Being trained in both has made me less interested in declaring one the winner.
It has made me more interested in the mechanism.
Both therapies can create striking changes in how emotionally charged memories are experienced.
Both use eye movements.
Both work with memory.
Both can involve body sensations.
Both can reduce the need for extensive verbal retelling.
But they organize that work differently.
ART feels more directed.
EMDR feels more associative.
ART deliberately uses imagery rescripting.
EMDR allows new images, thoughts, emotions, and memories to emerge through reprocessing and then explicitly installs an adaptive cognition.
Those differences are not cosmetic.
They shape the experience of treatment.
The science is probably more interesting than “bilateral stimulation”
I suspect the most useful questions going forward are not:
“Which therapy owns eye movements?”
or:
“Which one activates both sides of the brain better?”
The better questions are:
What happens when emotional memory and a demanding visual task occur simultaneously?
What role does working memory play?
What does dual attention contribute?
What changes when imagery is deliberately rescripted?
What happens when associative processing is allowed to unfold?
How does physiological arousal change?
How does a memory become less vivid or less present?
What elements are shared across effective trauma therapies?
And which components make ART and EMDR meaningfully different?
Those questions get us much closer to understanding what the therapies are actually doing.
Working with Laura Geftman, LCSW
I use both Accelerated Resolution Therapy and EMDR as part of a broader trauma-focused practice.
My work may also incorporate IFS, Cognitive Processing Therapy, Prolonged Exposure, CBT, psychodynamic, interpersonal, attachment, and schema therapies depending on the client and the clinical question.
I offer focused trauma therapy and therapy intensives for adults in Pennsylvania, New Jersey, New York, and Florida.
In-person therapy intensives are available in Ardmore, PA, on the Main Line near Philadelphia.
Virtual therapy may also be available when clinically appropriate.
Interested in ART, EMDR, or focused trauma work?
If you understand what happened but continue to feel stuck around a memory, image, trigger, body response, or emotional reaction, ART, EMDR, or another focused trauma approach may be worth exploring.
The goal is not to pick a modality because one sounds faster, newer, or more impressive.
The goal is to understand what kind of processing fits the person sitting in the room.
Suggested Reading
If you are interested in ART, EMDR, eye movements, bilateral stimulation, or trauma processing, these related articles may be helpful:
How Do Eye Movements Work in Accelerated Resolution Therapy?
What Therapists Should Know About Accelerated Resolution Therapy
FAQ
Do ART and EMDR use bilateral stimulation the same way?
No. Both use eye movements while emotionally meaningful material is active, but the eye movements occur within different protocols. EMDR generally uses bilateral stimulation within a more associative reprocessing process, while ART uses lateral eye movements within a more directive sequence involving memory recall, body sensations, and imagery rescripting.
Is ART basically a form of EMDR?
No. ART and EMDR are distinct therapies with different protocols. Their use of eye movements creates an obvious overlap, but the therapist's role, processing sequence, imagery procedures, and structure differ.
Does EMDR require you to tell the trauma story in detail?
No. EMDR does not require extensive detailed retelling of disturbing memories. The target needs to be identified, but clients do not have to repeatedly narrate everything that happened.
What happens during bilateral stimulation in EMDR?
During EMDR reprocessing, the client focuses on a target while engaging in eye movements, sounds, or taps. New thoughts, memories, images, emotions, and sensations may emerge, and subsequent sets generally follow what the client notices.
What happens during eye movements in ART?
ART combines lateral eye movements with structured memory work, attention to body sensations, imaginal exposure, and imagery rescripting. The therapist generally guides the process more directly than in standard EMDR. ART research protocols explicitly include imaginal exposure, lateral eye movements, and imagery rescripting.
Does ART use imagery differently from EMDR?
Yes. ART includes deliberate imagery-rescripting procedures in which the client may alter the internal representation associated with the distressing experience. EMDR may involve spontaneous imagery and future imagery, but standard EMDR does not use the same voluntary image-replacement procedure.
Why can ART and EMDR feel so different if both use eye movements?
Because eye movements are only one component of each therapy. The protocols differ in therapist direction, target processing, associative flow, body work, cognition work, imagery, and what happens between sets.
Is bilateral stimulation what makes both treatments work?
We do not know. Eye movements may contribute through mechanisms such as working-memory competition and dual attention, but both ART and EMDR contain multiple therapeutic components. It would be too simplistic to attribute the entire effect of either therapy to bilateral stimulation alone.
Which has more research, ART or EMDR?
EMDR has a substantially larger and longer-established research base. ART has a smaller, emerging research base. That does not determine what is best for every individual client, but it is an important distinction when discussing the evidence.
Can a therapist use both ART and EMDR?
A clinician trained in both approaches can consider which method may fit the client's target, history, preferences, readiness, and treatment goals. The two approaches do not have to be treated as competitors.