A real-world evaluation of treating post-traumatic stress disorder in military veterans with eye movement desensitization and reprocessing therapy: Comparing EMDR-indoors and EMDR-outdoors

In this small real-world study, veterans with PTSD improved whether EMDR therapy was done indoors or outdoors, but outdoor EMDR appeared to work faster and was more effective at maintaining reduced anxiety and depression over time.

Resource Abstract

“Objective: This real-world evaluation compared eye movement desensitization and reprocessing (EMDR) therapy delivered in a conventional outpatient environment (EMDR-Indoors/EMDR-I) with EMDR delivered in an outdoor environment (EMDR-Outdoors/EMDR-O) for military veterans with military-related post-traumatic stress disorder (PTSD), inclusive of combat exposure.

Method: Thirty veterans who routinely accessed Veterans NHS Wales in Hywel Dda University Health Board and had completed a course of EMDR-I or EMDR-O were included in this evaluation. Data collected regarding the veterans’ demographics, military background, mental health, patient-reported outcome measures (PTSD Checklist for DSM-5, Patient Health Questionnaire, General Anxiety Disorder, and Work and Social Adjustment Scale), and veterans’ written feedback about the service they received were subjected to mixed-methods analysis.

Results: Both EMDR-I and EMDR-O led to statistically significant and clinically meaningful improvements in military-related PTSD, depression, and anxiety. Improvements in PTSD were maintained at 6 months posttreatment; however, only EMDR-O demonstrated the maintenance of subclinical levels of anxiety and depression. Furthermore, EMDR-O was more time efficient in achieving improvements. Distinctions were evident in these 2 approaches to EMDR, with veterans viewing EMDR-O as an integrative approach in which being outdoors and walking serve as accelerants in the recovery process.

Conclusions: This evaluation demonstrates a proof of concept for EMDR-O, underpinned by a proposed neurobiological theory of the role of footsteps as a form of dual-attention bilateral stimulation in EMDR therapy. This evaluation tentatively supports the case for EMDR-O as a credible treatment. However, further research is required to scale EMDR-O toward a clinical trial.”

—Description from publisher

Resource Access

Open Access

Graham, J. (2026). A real-world evaluation of treating post-traumatic stress disorder in military veterans with eye movement desensitization and reprocessing therapy: Comparing EMDR-indoors and EMDR-outdoors. Journal of EMDR Practice and Research, 20, Article 39. https://doi.org/10.34133/jemdr.0039