EMDR Tapping vs Eye Movements vs Tones: Do They Differ?
Updated: Oct 12
Last reviewed: 10/04/2026
Reviewed by: Dr. Kiesa Kelly
Your therapist has asked how you would like to do the bilateral part of EMDR. You could follow a dot moving across the screen, listen to tones alternating through headphones, or hold two small pulsers that buzz in turn. One website told you the formats are all the same. Another said eye movements are the "real" EMDR. You do not want to pick the weaker option for something this important.
Here is the honest picture. In EMDR, eye movements are the most studied form of bilateral stimulation. In the few small studies that compared them directly, tones did somewhat less within a session. Taps have barely been compared with eye movements: we found one very small, single-session study from 1996. And no study has compared the formats on recovery from PTSD. So the formats are not proven equal, and they are not proven worse for your outcome either. That leaves room for a real choice, made with your clinician.
In this article, you'll learn:
What the three formats are, briefly, and what they have in common
Three misconceptions about EMDR formats
What head-to-head studies of eye movements, tones, and taps actually found
What the research does not settle
How you and your clinician can choose, and when to switch
The short answer: three formats, one protocol
Eye movements, tones, and taps are different ways of delivering the same element of EMDR. While you hold part of a memory in mind, you also attend to an external task, such as tracking a hand, a light, or a dot, listening to alternating sounds, or feeling alternating taps or vibrations [1]. Everything else about EMDR stays the same: the preparation, the target memory, the ratings, and how each session closes. The leading explanation is that the extra task competes with the memory for working memory, making the memory less vivid and less charged. Our explainer on how EMDR uses working memory covers that mechanism in more depth. Researchers who study it say that, for this purpose, the task needs to tax working memory, and that it does not have to be left-right [2]. That explains why the format question matters: the formats may not load working memory equally.
Three misconceptions about EMDR formats
"All the formats have been proven to work equally well." In reality, the head-to-head evidence is small, and it points to differences. In a small study of patients, eye movements reduced the vividness and emotional charge of a memory more than tones within a session [3]. In a larger one, tones trended less effective, though the difference was not clear-cut [4]. In lab studies, eye movements and other dual tasks reduced negative memories by similar amounts, with a small extra edge for eye movements on vividness [5]. And taps have almost no head-to-head evidence against eye movements: one small 1996 study, discussed below. "Equal" goes further than the research.
"If it is not eye movements, it is not real EMDR." According to the EMDR Institute, alternative stimuli such as hand-tapping and sounds have long been an integral part of the EMDR protocol [6]. A randomized trial of 139 people with PTSD also found that moving the eyes added nothing over fixing the eyes on a still hand, while both did better than exposure alone [7]. What seems to matter is having an external focus of attention during processing, not moving the eyes specifically [7].
"The strongest format is always the right one." Preference and performance do not always line up. In the larger tones study, most patients (64%) preferred tones, even though tones trended weaker in that session [4]. A format you can tolerate, stay present with, and use reliably, including when you do EMDR by telehealth, may serve you better than one that is slightly stronger on paper.
🧭 Key takeaway: The formats are not proven equal, and they are not proven worse for recovery. Eye movements are the best studied. The others are legitimate options with thinner evidence.
What each format is
Eye movements: the original format
You follow your clinician's hand, a light bar, or a dot moving side to side on a screen. This is the original and most widely studied form of EMDR [8][9].
Tones: alternating audio through headphones
You listen through headphones while short tones or clicks alternate between your left and right ears. Many therapists use tones [10], and by telehealth they can be delivered through a smartphone app [11].
Tappers: handheld pulsers or tapping
You hold a small pulser in each hand that vibrates in turn, or you or your clinician tap alternately on your knees or shoulders. Crossing your arms and tapping your shoulders is often called the butterfly hug [11]. Our online EMDR post, linked above, describes how each format is set up for remote sessions.
Do the formats work equally well? What the research shows
The studies comparing eye movements with tones
We found three studies that tested tones directly against eye movements, and all three point the same way, with important limits.
A lab study in healthy volunteers found that tones ("beeps") and eye movements both reduced the vividness of negative memories, but the effects were larger for eye movements. The tasks also showed that eye movements taxed working memory much more [10].
A study of 12 people with PTSD, done within a first EMDR session, found that eye movements outperformed tones in reducing how vivid and emotional a memory felt. It remained unclear whether tones added anything beyond simply recalling the memory [3].
A study of 64 patients, half with PTSD, found a trend for tones to be less effective than eye movements at reducing a memory's emotional charge, and more effective than recall alone. Most patients still preferred tones [4].
All three measured how a memory felt in the moment, not whether PTSD symptoms improved over a course of treatment. The two patient studies were small, and each looked at a single session.
Taps and tappers
We found one small, older study that compared alternating finger tapping with eye-movement EMDR. Eighteen people distressed by a traumatic memory were randomly assigned to a single session of eye-movement EMDR, alternating tapping, or a timed comparison condition. Everyone in the eye-movement group reported less distress, but only one person in the comparison groups did [12]. With about six people per group, and tapping used as a comparison condition rather than as part of the full EMDR protocol, it cannot settle the question. We found no study of handheld pulsers against eye movements. A 2026 lab study found that vibrating pulsers prevented the rise in emotion that recalling a negative memory caused in healthy participants, compared with no stimulation, though it did not test eye movements [13]. A 2020 meta-analysis of lab studies, mostly in students, found that eye movements and a mix of other tasks (such as counting, games, beeps, and tapping a tabletop with one finger) reduced negative memories by similar amounts, with eye movements reducing vividness slightly more (d = 0.29). None of the pooled tasks was the alternating tapping used in EMDR, and the authors said the result cannot be generalized to clinical practice [5]. That caution matters, because a 2024 study found that people with PTSD responded differently to tactile bilateral stimulation than healthy volunteers did: both groups reported less distress, but only the healthy volunteers showed body-level changes [14].
In an evaluation of an NHS PTSD service, therapists doing EMDR online were more likely to use tapping than eye movements, because some clients joined on phones and it was hard to ensure adequate eye movements. Some therapists felt tapping did not tax working memory as much, so they watched more closely to keep clients from becoming overwhelmed [15]. That is clinicians' experience, not a measured outcome, but it is the most practical evidence we have about how tapping is used.
What the evidence does not settle
The biggest gap is outcome. No study we found compares eye movements, tones, and taps on recovery from PTSD. The closest is a different kind of trial. In the 139-person trial mentioned above, both eye movements and a fixed external focus produced larger symptom improvements than exposure alone, with no difference between them [7]. A meta-analysis also found that adding eye movements to EMDR had a moderate effect compared with leaving them out [16]. Neither tells us how tones or taps would compare. More broadly, a systematic review describes research into how EMDR works as "still in its infancy" [17].
The mechanism-level difference: if the working-memory account is right, the formats are best understood as different levels of load. In a lab study, eye movements taxed working memory more than tones did [10], and in small patient studies they also reduced a memory's charge more, clearly in one study and as a trend in the other [3][4]. Clinicians can adjust the speed and rhythm of stimulation [8], and one therapist in an NHS service evaluation described making tapping more demanding when it felt "a bit too easy" [15].
🔬 Key takeaway: Within-session studies favor eye movements over tones. Taps have almost no head-to-head evidence against eye movements. No study has compared the formats on PTSD recovery.
How you and your clinician choose
Comfort, sensory sensitivity, vision, and telehealth logistics
Practical factors often decide the format before the research does. Online, a phone screen may be too small for adequate eye movements, which is one reason therapists switch to tapping or tones by telehealth [15][18]. Some people prefer to close their eyes during processing, which rules out eye movements. Others find tones in headphones grating, or find vibration distracting.
Some medical history matters too. A clinical review recommends that eye conditions, epilepsy, and other neurological conditions be evaluated carefully before EMDR, and lists eye problems as a caution for the eye-movement format specifically [1]. Tell your clinician about any of these before you start.
Switching formats partway through treatment
Switching is a normal part of EMDR, not a sign that something has failed. Clinicians adjust the stimulation to the client's needs [8], for example moving from eye movements to taps when sessions go online [15], or changing format when processing stalls. Our post on when EMDR stalls describes switching as one of the standard responses.
What each format feels like in session
Picture a woman doing EMDR by telehealth from her kitchen table. In the first reprocessing session she follows the dot on her laptop, but her eyes tire quickly and she loses track of the memory. Her clinician suggests handheld pulsers, which arrive before the next session. With the pulsers she can close her eyes, and she finds it easier to stay with the memory. When her clinician notices the work feels almost too easy, they talk with her about making the task more demanding, for example by changing the speed or rhythm of the pulses.
Or: a man with strong sensitivity to sound tries tones because a friend recommended them. Within a minute, the clicks feel like an alarm, and his distress rises for reasons that have nothing to do with the memory. He switches to taps on his knees and the session settles into a workable rhythm. Nothing was wrong with tones in general. They were wrong for him.
Or: a woman whose worst memory has not shifted after several sessions with taps asks whether the format could be part of the problem. She and her clinician decide to try eye movements during an in-person visit, since that is the most-studied option and she has no eye condition. The change is a deliberate experiment they review together, not a guarantee.
🎧 Key takeaway: The best format is one you can tolerate, stay present with, and use reliably, chosen and adjusted with your clinician as you go.
A simple way to decide
If you have epilepsy, a history of seizures, or another neurological condition, raise it before EMDR starts, whatever the format. A clinical review lists these as reasons for careful evaluation before EMDR in general, not only before eye movements [1].
If you can comfortably follow eye movements and have no eye condition, eye movements are a reasonable default because they are the most studied.
If you are doing EMDR on a phone or small screen, or prefer your eyes closed, taps, pulsers, or tones are practical choices. Ask your clinician how they will keep the task demanding enough.
If one format is uncomfortable, overwhelming, or distracting, switch. Comfort and staying present matter.
If processing stalls, ask whether changing the format, or the load within it, is worth trying alongside the other options your clinician considers.
Questions worth asking your clinician:
"Which formats do you offer, in person and by telehealth?"
"Why are you suggesting this format for me?"
"How will you adjust the speed or demand if the task feels too easy or too intense?"
"If processing stalls, would you consider changing the format?"
"Is anything in my medical history, such as an eye condition or seizures, relevant to EMDR or to which format we use?"
Our specialized therapy clinicians offer EMDR by telehealth across Tennessee, using the formats that suit each client.
Next step: getting support
The format question has a more interesting answer than "they are all the same." Eye movements are the best studied, tones did a bit less in small within-session studies, and taps have barely been tested head to head. None of this tells us that one format leads to better recovery. The most important choice is still the bigger one: working with a trained trauma-focused clinician who can match the format to you and adjust it as the work goes on.
Carrying something that still feels close?
Trauma-focused care — including approaches like EMDR — can help you process what happened at a pace that feels safe, with a clinician who understands trauma responses.
Frequently Asked Questions
Are EMDR tappers as effective as eye movements?
Nobody knows yet. We found only one very small, single-session study from 1996 comparing tapping with eye movements, and it favored eye movements. A 2026 lab study found that vibrating tappers prevented the usual rise in emotion when healthy volunteers recalled a bad memory, and therapists use tapping widely, especially online. Whether tappers work as well as eye movements for PTSD recovery has not been tested.
Are tones as effective as eye movements in EMDR?
In the few studies that compared them, tones did somewhat less. Two small studies of patients found eye movements reduced the vividness or emotional charge of a memory more than tones within a session, though in the larger study the difference was only a trend. Neither study measured recovery from PTSD, so tones are not shown to be worse for your overall outcome.
Can I switch EMDR formats partway through treatment?
Yes. Switching between eye movements, tones, and taps is a standard option in EMDR, and clinicians do it for comfort, for telehealth practicality, or to adjust how demanding the task is. Tell your therapist if a format feels too easy, too intense, or physically uncomfortable. Changing the format does not mean starting treatment over.
How long should you listen to bilateral stimulation audio?
There is no research-based answer. In EMDR, the length of each set of tones is directed by your therapist during a session, alongside the rest of the protocol. We found no evidence that listening to bilateral music or audio on your own treats trauma, and no study that sets a safe or effective listening time. Processing traumatic memories belongs with a trained clinician.
About the Author
Dr. Kiesa Kelly is a licensed clinical psychologist and the founder of ScienceWorks Behavioral Healthcare. EMDR is her preferred approach for treating trauma and PTSD, and her trauma training includes EMDR Basic Training and group consultation through VIA EMDR, EMDR for Attachment Injuries with Debra Wesselmann, and the Flash Technique with Philip Manfield, PhD, and Nina Zadurian. Choosing and adjusting the form of bilateral stimulation for each client, including for telehealth sessions, is part of her day-to-day EMDR practice.
Dr. Kelly earned her PhD in Clinical Psychology, with a concentration in Neuropsychology, from Rosalind Franklin University of Medicine and Science. She completed practica, internship, and an NIH-funded postdoctoral fellowship at the University of Chicago, the University of Wisconsin, the University of Florida, and Vanderbilt University, and has more than 20 years of experience in psychological assessment. She is a psychologist, not a physician, and does not prescribe medication.
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Disclaimer
This article is for informational and educational purposes only and is not a substitute for professional medical or mental health advice, diagnosis, or treatment. It cannot tell you which EMDR format is right for you; that decision belongs with a trained clinician who knows your history. EMDR, including any form of bilateral stimulation, should be delivered by a trained clinician and is not a self-help technique. If you are in crisis or thinking about harming yourself, call or text 988, or call 911 in an emergency.