Feeling Worse After EMDR? What Research Says About Flare-Ups Between Sessions
Last reviewed: 10/04/2026
Reviewed by: Dr. Kiesa Kelly
The session itself went fine. You left feeling tired but steady. Then, that evening, the memory you had been working on kept coming back. You were tearful over nothing. You slept badly and woke from a dream you could not shake. By the next afternoon, you were wondering whether you had made a mistake, and whether you should cancel next week.
If you are feeling worse after EMDR, you are not unusual, and it usually does not mean something has gone wrong. Research on trauma-focused therapy, including EMDR, finds that temporary flare-ups between sessions are common in some groups and are usually not linked to a worse outcome. But the research is thinner than many websites suggest, and a few kinds of worsening do call for a conversation with your therapist before the next session. This guide lays out what is known, what is not, and how to tell the difference.
In this article, you'll learn:
Three misconceptions about feeling worse after EMDR
How common flare-ups are in the research, and in whom
Whether a flare-up predicts a worse result or dropping out
What continued processing, vivid dreams, and the "EMDR hangover" are, and what research does and does not say
A practical way to decide whether to wait, call your therapist, or get urgent help
The short answer
EMDR is a structured trauma therapy, recommended for PTSD by the US Department of Veterans Affairs and Department of Defense alongside prolonged exposure and cognitive processing therapy [1]. Working on a traumatic memory can stir up distress, and that distress does not always end when the session does. Studies of trauma-focused therapy find that temporary increases in symptoms during treatment happen to a meaningful minority of people, more often in some groups, and that people who have them usually still improve [2][3][4]. What the research cannot yet tell you is exactly how often this happens in EMDR specifically, how long it typically lasts, or how often it shows up as dreams or fatigue. Those details have rarely been measured [5].
Three misconceptions about feeling worse after EMDR
"If I feel worse, EMDR must be harming me." In reality, temporary flare-ups and lasting harm are different things. In a study of people with PTSD and psychosis treated with EMDR or prolonged exposure, flare-ups early in treatment and between sessions were common, but they were unrelated to poor treatment response or to dropping out [4]. A 2022 meta-analysis of 56 trials of psychological therapies for PTSD found that harms, including worsening by the end of treatment, were generally uncommon (0 to 5%), and that treatment was linked to a lower risk of worsening than control conditions [6].
"If I feel worse, that proves it is working." This is not quite right either. In a study of prolonged exposure, people who had a reliable flare-up "benefited comparably" from treatment [2]. In another study of prolonged exposure and cognitive processing therapy, people who had flare-ups still improved meaningfully, but finished with slightly higher symptoms on average and were somewhat more likely to still meet criteria for PTSD [3]. A flare-up is neither a sign of failure nor a sign of progress. The trend over weeks is what matters, and reviewing it is built into EMDR's eight phases, starting each session with a look back at the last one.
"There is solid research on how long EMDR side effects last." Timeframes such as "24 to 72 hours" circulate widely, but we could not find research that supports a specific number. A 2025 review of 51 randomized trials of EMDR for PTSD found that only nine mentioned adverse effects at all, and only one used a systematic way of measuring them [5]. Where adverse effects were reported, they were described as typically mild and temporary, but often anecdotally [5].
🧭 Key takeaway: A flare-up after EMDR is not unusual, usually temporary, and usually not a sign that treatment is failing. It is also not a guarantee of progress, and its typical length has never been well measured.
What the research shows about flare-ups between sessions
How common is it?
The answer depends on who was studied and how "worse" was defined. Most of the data come from trauma-focused therapy in general, not EMDR alone, so each figure below comes with its population.
In two trials of women receiving prolonged exposure or cognitive processing therapy, between 14.7% and 28.6% had a symptom exacerbation during treatment; the differences between therapies were not statistically significant [3].
In a study of 99 people with PTSD and psychosis receiving EMDR or prolonged exposure, 32.3% had a flare-up in the first four sessions and 46.5% had a flare-up between sessions at some point during therapy [4].
In a trial of five EMDR sessions for people with a personality disorder but no PTSD (people at acute suicide risk were excluded), 10.0% of those receiving EMDR had a session-to-session rise in distress, compared with 28.0% of those on a waiting list [7].
In a small trial that compared prolonged exposure, EMDR, and relaxation training, the three treatments did not differ in how often symptoms worsened during the trial [8].
Two patterns stand out. First, results depend heavily on how a flare-up is defined. An earlier analysis from the same psychosis trial program, using a reliable-change cutoff, found that PTSD symptom flare-ups after the first treatment session were uncommon [9]. Second, people waiting for treatment have flare-ups too. In the personality-disorder study above, session-to-session rises in distress were more common on the waiting list than during EMDR [7]. In the psychosis trial, worsening of any symptom (PTSD, paranoia, or depression) from the start to the end of the study period also tended to be more common on the waiting list than in treatment [9]. Symptoms can rise and fall with or without therapy.
Does a flare-up predict a worse result or dropping out?
Mostly, no. Two studies found that flare-ups were not linked to a worse result [2][4], and three found that flare-ups were not related to dropping out [2][3][4]. The nuance comes from the third study, which found a small association with slightly higher symptoms at the end of treatment, alongside clinically meaningful improvement [3].
Dropout is a real issue in trauma therapy. A meta-analysis of randomized trials found an average dropout rate of about 18% across EMDR trials (22% for prolonged exposure and 30% for cognitive processing therapy, pooled from different trials, so not a head-to-head comparison) [10]. Those figures do not tell us why people stopped, and the 2025 review cautions that dropout is not a reliable indicator of adverse effects [5]. Still, if a hard week is making you think about quitting, that is exactly the moment to talk with your therapist, not to stop quietly.
What the research does not tell us
There is no good estimate of how often people feel worse between EMDR sessions in a general PTSD population, as opposed to the special populations above. There is no research-based figure for how long a typical flare-up lasts. And EMDR trials have rarely monitored side effects in a structured way [5]. That is a gap in the field, not a reason for alarm. It is also why your own experience, reported honestly to your therapist, matters so much.
🔬 Key takeaway: Flare-ups are common in trauma therapy research and usually do not predict a worse result. But most figures come from specific populations and mixed therapies, so treat them as context, not a forecast.
What a flare-up can look like
Continued processing: memories, insights, and feelings that surface later
The standard EMDR protocol expects that material may come up between sessions. The EMDR Institute describes asking clients to keep a log of "any related material that may arise" during the week [11], and the American Psychological Association's description of the final phase includes reviewing "what memories may have emerged since the last session" [12]. When reprocessing is not finished in a session, therapists use closure techniques to provide containment until the next one [12].
Picture a woman working on the memory of being followed home from a train station years ago. That evening she feels shaky and cries during a TV show that would not normally touch her. The next morning, a detail she had not thought about in years comes back: the color of the man's jacket. She feels unsettled, uses the calm-place exercise she practiced, and writes the detail down. By that evening she feels close to her usual self, and she still opens her next session by reading her note. This is the kind of between-session experience the protocol anticipates.
Sleep changes and vivid dreams
The EMDR Institute lists dreams, memories, and feelings among the things that may emerge as processing continues after a session [13], and unsettled sleep is something clients often bring up. But we could not find a study that measured dreams in the nights after individual EMDR sessions, so how common this is remains unknown. You may read that dreams show the memory "consolidating" through REM-like processes. That idea draws on a hypothesis about how EMDR might work, not from established findings [14][15]. Over a full course of treatment, sleep can improve. In one study of 13 people with PTSD, sleep was more consolidated the day after their last EMDR session [16].
Fatigue and the "EMDR hangover"
"EMDR hangover" is an informal phrase from clinic websites and client conversations, not a clinical term. It describes feeling drained, foggy, or emotionally raw for a while after a session. We found no research on it. In clinical practice, many people find a lighter evening after reprocessing sessions helps, but there is no evidence-based timeline for how long the feeling should last.
Compare this with a different picture. A man is reprocessing a childhood memory. For the next week he sleeps three or four hours a night, has nightmares most nights, calls in sick twice, and notices he is drinking more to get to sleep. He tells himself this must be "part of the process" and plans to mention it at his next appointment, ten days away. That is not the time to wait. Days of collapsed functioning and a new reliance on alcohol are the signs that warrant contacting his therapist now, so the pace or focus of treatment can be adjusted.
🌙 Key takeaway: Surfacing memories, unsettled sleep, and tiredness after sessions are commonly described, but their frequency and duration have not been studied. In clinical practice, what separates normal from concerning is whether it is easing, whether you can still function, and whether you feel safe.
Normal, call your therapist, or get urgent help
No study gives a validated boundary between an expected flare-up and something that needs attention. The rule of thumb below reflects clinical judgment, and your own therapist's guidance comes first. For a fuller checklist, our post on when EMDR stalls covers when to raise concerns and what to ask.
Usually fine to bring to your next session: you feel raw, tired, or tearful for a short while, memories or dreams surface, and you can still sleep, work, and look after yourself. Note what came up and share it.
Contact your therapist before your next session: you are still shaken several days later, or it is getting worse rather than easing; you cannot function at work or home; nightmares or flashbacks are getting steadily worse; you lose track of time or feel numb, unreal, or far away for long stretches; you have urges to drink, use drugs, or return to other old ways of coping; or you are thinking about stopping EMDR. If you cannot reach your therapist and feel overwhelmed, you can also call or text 988.
Get urgent help now: you have thoughts of suicide or of harming yourself, urges to self-harm, or feel you cannot keep yourself safe. Call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24/7 [17], or call 911 in an emergency.
What helps between sessions
The skills you build early in EMDR are designed for these moments. The UK's national guideline says EMDR should include teaching self-calming techniques and techniques for managing flashbacks, "for use within and between sessions" [18]. Our guide to the eight phases, linked above, explains the calm-place and container exercises and how closure works. If your sessions are online, our post on online EMDR therapy includes a short transition routine for the minutes after you log off.
A brief note of what comes up between sessions can help, and the EMDR Institute describes this as part of closure [11]. Some sources describe EMDR as having no required homework [19], so ask your therapist how they want you to handle it. Either way, honest reporting is more useful than a tidy one.
Questions worth asking your therapist, ideally before your first reprocessing session:
"What reactions should I expect in the days after a reprocessing session?"
"How do I reach you between sessions, and what counts as a reason to?"
"Which signs would make you want to slow down, change the target, or return to preparation work?"
"Do you want me to keep a log between sessions, and what should go in it?"
"How will we track whether my symptoms are improving across weeks, not just within a session?"
Our specialized therapy team includes clinicians trained in EMDR, and you can meet our clinicians before you decide who to work with.
🤝 Key takeaway: The most useful thing you can do after a hard session is report it. Your therapist can only adjust the pace if they know what the days in between are like.
Next step: getting support
Feeling worse after an EMDR session can make you doubt the whole process. The research offers a steadier view. Temporary flare-ups are common in trauma-focused therapy, and they usually do not mean treatment is failing. At the same time, some kinds of worsening deserve a call rather than a wait. If you are weighing whether to start EMDR, or whether to keep going, the right next step is a conversation with a trauma-focused clinician who can look at your history and adjust the pace with you.
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
Is it normal to feel worse after an EMDR session?
It is not unusual, and it is usually temporary. Depending on the group studied, trauma therapy research finds that roughly 1 in 10 to nearly half of people have a rise in symptoms at some point, usually without a worse result. Tell your therapist. If you cannot function for days or start using alcohol or drugs to cope, contact them before your next session. If you have thoughts of harming yourself, call or text 988, or call 911.
Can EMDR cause vivid dreams after a session?
It may. The EMDR Institute lists dreams and memories among the things that can surface after a session, and clients often mention them. But no study we could find has measured dreams in the nights after individual sessions, so how common they are is unknown. The link to REM sleep is a hypothesis, not an established fact. If nightmares are frequent or wrecking your sleep, raise it with your therapist.
What is an EMDR hangover, and how long does it last?
It is an informal phrase, not a clinical term. People use it to describe feeling drained, foggy, or emotionally raw for a while after a reprocessing session. We found no research that studies it, so there is no reliable figure for how often it happens or how long it lasts. A lighter schedule after sessions is a common practical suggestion; your therapist can help you plan around it.
Does feeling worse after EMDR mean the therapy is working?
Not necessarily. In trauma therapy studies, people who had temporary flare-ups usually still improved, so feeling worse is not a sign of failure. But it is not proof of progress either: one study of two other trauma therapies found a small link between flare-ups and slightly higher symptoms at the end of treatment. The useful signal is the overall trend across weeks, which your therapist can track with you.
Can EMDR make PTSD worse in the long run?
The evidence is reassuring but not EMDR-specific. A 2022 meta-analysis of trials of psychological therapies for PTSD found that harms, including worsening by the end of treatment, were generally uncommon, and treatment was linked to a lower risk of worsening than control conditions. EMDR trials have rarely measured side effects carefully, so the evidence is weaker than it should be. If you feel worse over weeks, tell your therapist.
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. In her clinical work, preparing clients for what reprocessing can stir up, and adjusting the pace when it does, is a routine part of EMDR care.
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.
References
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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 whether a reaction you are having after EMDR is expected or concerning; your treating clinician is the right person to judge that. EMDR 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.