Methods: A single-case design was used, collecting minute-by-minute physiological data during EMDR therapy sessions. Feasibility of wearable use was assessed with customized questionnaires completed by participants and therapists. Physiological data were synchronized with EMDR protocol components and analyzed descriptively alongside subjective units of distress (SUD) scores. Overall patterns of arousal across sessions were summarized using boxplots.

Results: Wearables were considered acceptable by participants and therapists, although technical difficulties were reported. Participants showed reductions in subjective distress during EMDR therapy, but physiological findings were heterogeneous. Little support for a pronounced pattern of de-arousal across EMDR sessions was found, with observed changes being small relative to between-session variability.

Conclusion: Using wearables during EMDR therapy in adults with MID and PTSD appears acceptable although technical problems seem to be a feasibility barrier. Physiological findings were difficult to interpret, limiting conclusions about consistent patterns of ANS functioning during EMDR therapy. Future research should include larger samples, contextual factors, and baseline and follow-up measurements.

Highlights:

• Wearables were considered acceptable by participants and therapists.
• Technical difficulties remained a feasibility barrier.
• Participants showed reductions in subjective distress during EMDR therapy.
• Physiological responses were heterogeneous and difficult to interpret.
• Little support was found for an overall pattern of physiological de-arousal.

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