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. 2026 Feb 8;59(5):1009–1022. doi: 10.1002/eat.70056

A Pilot Randomized Controlled Trial of Eye Movement Desensitization and Reprocessing Therapy for Adults With Binge‐Eating Disorder

Amaani H Hatoum 1,2,✉, Katie Richard 1, Amy L Burton 1,2, Elizabeth Rieger 3, Stephen Touyz 1, Maree J Abbott 1
PMCID: PMC13147140  PMID: 41655996

ABSTRACT

Objective

Binge‐eating disorder (BED) is a serious psychological condition, often associated with trauma, as well as many critical physical and psychological consequences. Despite the availability of several evidence‐based treatments, full remission rates and long‐term recovery rates remain suboptimal. Eye movement desensitization and reprocessing (EMDR) therapy has demonstrated early promise in the treatment of eating disorders (EDs) but has yet to be examined in those with BED. To our knowledge, the current study was the first pilot randomized controlled trial to examine the feasibility and preliminary efficacy of EMDR therapy in the treatment of core BED symptomatology.

Method

The clinical trial protocol was prospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR Registration Number: ACTRN12614000894695, 05/08/2014). A two‐arm (EMDR vs. waitlist control), single‐blind, pilot RCT was utilized to examine the feasibility and preliminary efficacy of this approach. Eligible participants (N = 38) were fluent English‐speaking Australian adults (18+ years) who met the diagnostic criteria for BED. An existing EMDR treatment protocol for bulimia nervosa (BN) was adapted for BED (10 sessions). Outcomes were examined before and immediately after treatment completion.

Results

A treatment completion rate of 68.8% supported the feasibility of the treatment protocol. Intention‐to‐treat (ITT) analyses demonstrated largely positive effects in favor of the intervention, including significantly larger reductions in binge eating (symptoms, days, and frequency), meta‐cognitive beliefs about eating, eating and shape concerns, anxiety, and sleep disturbance. However, there was no significant benefit of the intervention over control for dietary restraint, weight concerns, self‐esteem, or sexual problems. There were mixed findings for depressive symptoms and dissociative symptoms between the ITT sample and treatment‐completers.

Discussion

This pilot RCT supports the feasibility of applying this protocol to a larger‐scale, well‐powered effectiveness trial. It also addresses a critical gap in the literature by being one of the first to examine the potential efficacy of EMDR therapy for adults with BED, and thus contributes foundational preliminary data in support of an additional model of care for those with BED.

Keywords: binge‐eating disorder, EMDR, eye movement desensitization and reprocessing therapy, feasibility, randomized controlled trial, RCT, treatment

Summary

  • This pilot randomized controlled trial was the first to examine the feasibility and preliminary efficacy of eye movement desensitization and reprocessing (EMDR) therapy for core BED symptomatology in adults.

  • A two‐arm (EMDR vs. waitlist control) RCT enrolled 38 English‐speaking Australian adults meeting BED diagnostic criteria.

  • The 10‐session adapted EMDR protocol was found to be feasible, with comparable retention rates to that of 10‐session CBT, and slightly lower retention than pooled estimates from BED treatment trials more broadly.

  • Findings show preliminary benefits, such as reduced binge eating behaviors and related disordered eating cognitions, supporting the need for larger, well‐powered trials to determine their potential as an effective treatment option.

1. Introduction

Binge‐eating disorder (BED) is a serious psychological condition, characterized by regular episodes of consuming large amounts of food, alongside experiencing a loss of control over one's eating behavior, in the absence of compensatory behaviors (David et al. 2020; Giel et al. 2022). BED is more common than anorexia nervosa and bulimia nervosa (BN), with a worldwide prevalence rate of 1% in adults (David et al. 2020; Giel et al. 2022; Keski‐Rahkonen 2021), up to 6.9% for sub‐threshold BED in adult men and women (Hay et al. 2015), and an overall estimated prevalence of 1.3% for BED and 3.0% for subclinical BED in children and adolescents (Kjeldbjerg and Clausen 2023). Long‐term physical consequences of increasing weight over time as a result of objective binge eating (OBE) include increased risk of chronic medical conditions, including cardiovascular disease and type II diabetes (Keski‐Rahkonen 2021). This eating disorder (ED) often also has significant psychological consequences, including reduced social and emotional wellbeing, quality of life, and increased stigma (Appolinario et al. 2022). High comorbidity with other mental health conditions is another concern, most commonly comorbid generalized anxiety disorder (GAD), which often predates the onset of BED (Rosenbaum and White 2013), as well as major depressive disorder, post‐traumatic stress disorder (PTSD), and alcohol use disorder (Braun et al. 2019; Keski‐Rahkonen 2021). Relatedly, psychological risk factors for both subclinical and clinical levels of binge eating include trauma, adverse childhood experiences, and a history of abuse and neglect (Chu et al. 2022; Keski‐Rahkonen 2021). High prevalence and comorbidity rates, and the clear adverse impacts of BED underscore the need for effective treatment options.

Currently, lisdexamfetamine (LDX) is an approved pharmacological treatment, and GLP‐1 agonists have demonstrated benefits in BED management (Radkhah et al. 2025). Although a recent trial found comparable post‐intervention symptom reduction and remission rates between LDX (40.4%) and CBT (44.7%; Grilo et al. 2025), other pharmacological trials have suggested that treatment efficacy in BED is dependent on treating its core psychopathology (Heal and Gosden 2022). First‐line psychological treatment options include cognitive behavior therapy (CBT), interpersonal psychotherapy (IPT), and dialectical behavior therapy (DBT; Agüera et al. 2021; Giel et al. 2022). Each of these therapies has a body of empirical support and has been manualised to support standardized treatment (Giel et al. 2022). Although meta‐analytic reviews indicate large post‐treatment effects for CBT for BN and BED, these reviews also indicate there is a lack of follow‐up data to support the stability of these treatment effects (Bruns et al. 2025; Cuijpers et al. 2025). In fact, global patterns indicate low full remission and high chronicity, with recent meta‐analytic data suggesting BED is the only ED for which long‐term recovery rates have decreased, and chronicity rates have increased (Solmi et al. 2024). Further, there is ongoing need for alternative models of care for those who do not respond to primary treatment, whose illness is severe or enduring, and who experience comorbid symptoms (Hilbert et al. 2019; Monteleone et al. 2022), including for individuals with BED, given low remission rates (42.3%–45.1% remission at follow‐up; Miskovic‐Wheatley et al. 2023). Alternative second‐line treatments focus on targeting diverse risk and maintenance factors or utilize novel interventions to address established treatment targets.

Eye movement desensitization and reprocessing (EMDR) therapy is one such psychotherapeutic intervention, supported by a growing body of evidence, particularly in the context of treating PTSD and trauma symptoms (Laliotis et al. 2023). EMDR therapy was designed to help individuals reprocess and integrate memories that had not been processed adequately through bilateral stimulation (Shapiro 1989, 2007). In doing so, this approach aims to desensitize and reduce the discomfort associated with these memories (Shapiro 1989, 2007). Trauma is a well‐documented risk factor for developing EDs, including BED (Barakat et al. 2023), with evidence suggesting lifetime prevalence of experiencing at least one traumatic event is between 1.4% and 82.8% (Convertino et al. 2022). Trauma in adulthood has also been seen to be more common in BED (52.4%) than in other EDs (34.2%–34.7%; Backholm et al. 2013). Though, even in the absence of trauma, reducing the distress associated with and impact of emotional memories and ED relevant cognitions may be a viable mechanism for addressing core ED symptoms in this population. Indeed, EMDR has been found to be helpful in many conditions, including in chronic pain, where patients were not presenting with a primary presentation of trauma or had no trauma history (Scelles and Bulnes 2021).

EMDR therapy has its theoretical basis in the Adaptive Processing Model (APM) (Laliotis et al. 2023; Shapiro 2007). This model assumes that humans have an innate information system that processes and stores experiences and memories. It posits that negatively valanced unprocessed memories can maladaptively influence current thoughts, feelings, behaviors, and experiences (Shapiro 2007; Scelles and Bulnes 2021). As such, EMDR aims to process these memories, and associated emotions and beliefs, to help reduce associated distress and promote more realistic and balanced interpretations of situations and experiences (Shapiro 2007). EMDR is a structured therapy that is typically implemented in eight phases: (1) history/assessment, (2) introduction to EMDR and developing coping strategies, (3) evaluating treatment targets, (4) desensitization and reprocessing, (5) incorporating positive cognitions, (6) body scanning to reprocess negative body sensations, (7) relaxation to reduce distress, and (8) re‐evaluation (Scelles and Bulnes 2021; Shapiro 2001, 2007). Theoretically, EMDR also focusses on challenging negative cognitions and addressing emotional regulation, by addressing and reprocessing unhelpful beliefs and emotions (Grand 2009; Zaccagnino 2019), similar to CBT and primary ED treatments such as enhanced CBT (CBT‐E; Fairburn et al. 2008), albeit through distinct methods.

Several disorder‐specific EMDR therapy protocols have since been developed, including for body dysmorphia and poor body image (Forester 2009; Seijo 2019), anorexia nervosa (AN; Zaccagnino 2019), and for EDs more generally (Beer 2019; Forester 2019; Grand 2009). Since the development of these protocols, EMDR therapy has been utilized as both a stand‐alone or as adjunct therapy in combination with standard care or first‐line ED treatment, often for individuals who do not respond adequately to primary treatment, or for those with comorbid trauma or attachment difficulties (Brewerton 2023; Seubert 2018; Grand 2009). The evidence indicating that trauma and adverse childhood experiences are risk factors for developing EDs, including BED provides a strong rationale for the use of EMDR in these contexts (Agüera et al. 2021; Brewerton 2023).

A recent systematic review examined existing evidence for utilizing EMDR therapy in the treatment of EDs and body image concerns (Hatoum and Burton 2024). This review identified seven studies, including one randomized controlled trial (RCT) and six case studies, conducted with individuals presenting with a variety of ED concerns and diagnoses (Hatoum and Burton 2024). The RCT compared standard residential treatment (SRT) to a combination of SRT and EMDR, and was conducted in a mixed ED sample, with individuals diagnosed with AN (restrictive subtype), BN, and ED not otherwise specified (EDNOS; Bloomgarden and Calogero 2008). Outcomes from this RCT suggested there was no benefit from an adjunct EMDR component of treatment for body dissatisfaction, disordered eating attitudes, sociocultural attitudes towards appearance, body image investment, or appearance schemas, but that those in the EMDR treatment group had significantly less distress related to their “earliest” and “worst” body image related memories (Bloomgarden and Calogero 2008). However, this trial did not analyze outcomes separately by diagnostic groups, nor did it include a sample of individuals with BED, as it was conducted before BED was included as a diagnostic category in the Diagnostic and statistical manual of mental disorders (DSM‐5; American Psychiatric Association 2013).

The identified case studies included all female participants with varied presentations, including an individual with body image concerns (Dziegielewski and Wolfe 2000), one experiencing emotional eating (Halvgaard 2015), two ARFID patients (Yasar et al. 2019), two inpatients with AN (Cardazzone et al. 2021; Zaccagnino et al. 2017), and a patient with BN (Ergüney Okumuş 2021). Some encouraging outcomes were reported, such as decreased body dissatisfaction, reduced emotional eating urges and experiences, and reduced food avoidance and restriction (Hatoum and Burton 2024). However, it was also noted that most case studies utilized EMDR in combination with another treatment (such as CBT‐E), did not utilize standardized assessment measures, or focused only on behavioral outcomes, rather than cognitive and emotional ones (Hatoum and Burton 2024). The review also identified that no studies have been conducted assessing the feasibility or efficacy of EMDR with an individual or sample of individuals with BED, or subclinical binge eating (Hatoum and Burton 2024). Since then, one RCT examined the effectiveness of EMDR in women with BED, finding reductions in both dissociative experiences and behavioral inhibition, as well as increases in behavioral activation (Nikooseresht et al. 2024). However, this study did not examine the impact of EMDR on core disordered eating symptomatology.

1.1. The Present Study

There is a clear paucity of research assessing the potential of EMDR therapy in the treatment of BED despite its strong rationale for this condition and the ongoing demand for alternative models of care. The current study was designed to address this gap by conducting a pilot RCT examining the feasibility and preliminary efficacy of EMDR therapy in the treatment of BED and its core symptomatology. This preliminary study compared EMDR to a waitlist control condition in a sample of Australian adults who met diagnostic criteria for BED to assess whether recruitment and adherence to the treatment protocol are feasible, whether participants expect to benefit from treatment (i.e., is the treatment credible?), and whether there is evidence for preliminary efficacy of treatment.

Primary outcomes included BED symptoms, OBE episodes and days, positive and negative meta‐cognitive beliefs about eating, dietary restriction, eating, weight and shape concerns, and body mass index (BMI = kg/m2). Secondary outcomes included symptoms often associated with trauma (e.g., depression, anxiety, sleep, dissociative symptoms, sexual problems) and self‐esteem. We expected the trial to be feasible and the treatment approach to be credible, and we expected that those randomized to the EMDR treatment arm would demonstrate significantly greater benefits of treatment in both primary and secondary outcomes compared to the control group (i.e., treatment would demonstrate preliminary evidence of efficacy).

2. Method

The current study was approved by the University of Sydney Human Research Ethics Committee (HREC: 2014/025), and the clinical trial protocol was prospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR Registration Number: ACTRN12614000894695, 05/08/2014), and data were collected in 2014 and 2015.

2.1. Participants and Design

A two‐arm (EMDR vs. waitlist control), single‐blind, pilot RCT was utilized to examine the preliminary efficacy of treatment, whilst additionally examining the feasibility and credibility of treatment. Eligible participants were fluent English‐speaking adults (18+) who met the diagnostic criteria for BED (DSM‐5). Diagnoses were made by registered psychologists with specific training and expertise in diagnostic assessment and treatment of EDs. Exclusions were based on contraindicated psychiatric symptoms/conditions (e.g., dissociative identity disorder, borderline personality disorder, psychotic symptoms, substance use disorders, and current active suicidal ideation), current medications (e.g., benzodiazepines), or other relevant medical or environmental factors (e.g., pregnancy and major life stressors that might impact treatment adherence).

Of the 90 participants who responded to the recruitment advertisement, 85 were screened for eligibility. After excluding those who were ineligible, 38 participants (97.4% female) were randomly allocated to a treatment condition and completed pre‐treatment assessment (EMDR = 16, waitlist control = 22; see Figure 1). Mean age for the total sample at baseline was 48.8 years (SD = 16.55, range = 22–72) and 49.4 years (SD = 18.4) and 48.5 years (SD = 15.5) for the treatment and waitlist control groups, respectively.

FIGURE 1.

FIGURE 1

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CONSORT diagram. Reasons for attrition in waitlist control included moving away, engaged in other treatment, not contactable/unknown (n = 10). Reasons for attrition in EMDR group: medical complications (n = 1), difficulty with transportation (n = 1), overriding diagnosis requiring more urgent care (n = 3).

2.2. Randomization and Blinding

Randomization to a treatment arm was conducted independently of the research team. An independent statistician generated a random number sequence to ensure true randomization. Researchers involved in recruitment were blind to allocation until after assignment; however, they were not masked to allocation throughout treatment. Participants were unable to be blind to treatment allocation. Outcome assessors were blind to allocation, and the data analyst was not involved in allocation, data collection or entry, or treatment.

2.3. Intervention

An existing EMDR treatment protocol for BN (Forester 2009) adapted the standard eight‐phase EMDR model to address the unique features of EDs, particularly focusing on maladaptive memories, negative beliefs, and emotional triggers associated with BN. Phase 1 includes comprehensive history‐taking and case conceptualization to identify relevant modules and specific target memories or symptom clusters, such as distressing memories, ED–related fears, body image concerns or weight/shape specific negative cognitions, meta‐cognitions and cognitions about eating (e.g., “I can't control my eating”), general negative self‐referent beliefs (e.g., “I am not good enough”), and emotional imagery. Phase 2 preparation includes orientation to EMDR procedures to ensure readiness for memory processing, and “safe place” installation. During phases 3–8, assessment of target beliefs/memories, desensitization, installation, body scan, closure, and re‐evaluation phases are then applied to each identified target, with the process repeated until all relevant modules are sufficiently addressed. The protocol was adapted for BED by removing compensatory behaviors as a treatment target. The treatment protocol also does not directly address dietary restriction. Additional modifications involved shortening the standard treatment duration from 90 to 60 min per session to accommodate the time constraints typical of outpatient treatment delivery in private practice settings.

2.4. Procedure

Trial participants were recruited through community advertisements distributed in general medical practice clinics across Sydney and on the University of Sydney campus. Interested participants undertook eligibility screening before providing informed consent. This included a screening call with the researchers to determine eligibility. Once eligible, participants read participant information statements and voluntarily provided informed consent, whereby participants were informed they would be able to withdraw from the study at any time. After allocation to a trial arm, all participants completed an in‐person pre‐treatment assessment (T0). Participants allocated to the treatment arm (EMDR group) self‐selected their preferred location for attending treatment from three outpatient, private practices located in Sydney. Each site had an Australian registered psychologist who had additional certified EMDR Level II training with the EMDR International Association accreditation body.

The EMDR treatment included 1 h weekly individual therapy sessions for 10 weeks. Participants were asked to attend all sessions to standardize the treatment and were asked to pay $10 per session to encourage engagement retention during treatment. EMDR participants also completed additional questionnaires at session four to assess treatment credibility and the quality of the therapeutic alliance. Participants who completed treatment were asked to complete the post‐treatment questionnaires. T1 assessment was at 10 weeks, either immediately after treatment completion or a 10‐week waitlist period. The ED examination was administered post‐intervention by a trained independent assessor. After completion of the T1 assessment, waitlist control participants were given the opportunity to complete the 10‐week EMDR treatment.

2.5. Measures

2.5.1. Credibility and Therapeutic Alliance

The Credibility/Expectancy questionnaire was utilized to assess treatment credibility (Devilly and Borkovec 2000). The credibility subscale has three items: (1) How logical does this type of treatment seem to you? (2) How confident are you that this treatment will be successful? (3) How confident would you be in recommending this treatment to a friend? These items were rated on a 10‐point Likert scale (total score range = 3–30), where higher scores indicate higher perceived treatment credibility (1 = not at all logical/useful/confident, 10 = very logical/useful/confident).

Participants also completed the 36‐item Working Alliance Inventory short‐form (WAI; Horvath and Greenberg 1986) to assess the strength and quality of the therapeutic relationship with the treating clinician. Items were rated on a seven‐point Likert scale (1 = never, 7 = always). The WAI has previously displayed good psychometric properties (Paap et al. 2022) and showed good internal consistency in the current sample (α = 0.97).

2.5.2. Primary Outcomes

The binge eating scale (BES) is a 16‐item self‐report measure of binge eating symptoms, including attitudes about weight, body size, eating, binge eating urges and behaviors, and emotional eating (Gormally et al. 1982). Items (e.g., “I feel capable to control my eating urges when I want to”) were rated on a four‐point scale (0–3). The BES has been found to be valid and reliable (Duarte et al. 2015). In the present study, the BES demonstrated good internal consistency (α = 0.83).

The Eating Disorder Examination (EDE) is a 36‐item clinician administered measure of ED symptomatology (Fairburn and Beglin 1994). The EDE was utilized to assess primary outcomes including dietary restraint, eating concerns, weight concerns, and shape concerns subscales, where items were rated on a seven‐point scale (0–6). It was also utilized to assess past 28‐day OBE episodes and days. The EDE subscales have been found to be valid, reliable, and have high clinical utility (Berg et al. 2012). In the present study, internal consistencies of the dietary restraint (α = 0.87) and shape concerns (α = 0.81) subscales were acceptable, though the eating concerns (α = 0.61) and weight concerns (α = 0.61) subscales had borderline internal consistency.

The eating beliefs questionnaire (EBQ) is a 32‐item self‐report measure of positive and negative meta‐cognitive beliefs about eating (Groves 2008). Items are rated on a five‐point Likert scale (1 = strongly disagree, 5 = strongly agree). For each of the two subscales, higher scores indicate stronger meta‐cognitive beliefs about eating (e.g., positive beliefs: “Eating helps me to cope”; negative beliefs: “I will never be able to control my urges to eat”). The EBQ has demonstrated validity, reliability, and clinical utility (Burton et al. 2017). In the present study, pre‐ and post‐ internal consistency of both subscales were both acceptable (α = 0.84–0.93).

2.5.3. Secondary Outcomes

Self‐esteem was assessed using the Rosenberg Self‐Esteem Scale (RSES; Rosenberg 1965). The RSES is a 10‐item self‐report questionnaire, where items are rated on a four‐point Likert scale (0 = strongly disagree, 3 = strongly agree). Higher scores indicate higher self‐esteem (e.g., “I feel that I have a number of good qualities”). The RSES has previously demonstrated validity and reliability (Griffiths et al. 1999), and internal consistency was acceptable in the present study (α = 0.81).

The Trauma Symptoms Checklist (TSC; Briere and Runtz 1989) is a 40‐item self‐report questionnaire that was utilized to assess several secondary outcomes, including dissociative symptoms (range 0–18), depressive symptoms (range 0–27), anxiety (range 0–27), sleep disturbances (range 0–18), and sexual problems (range 0–24). Items are rated in accordance with past 2‐month frequency of symptom occurrence on a four‐point scale (0 = never, 3 = often). In the present study, internal consistencies were acceptable for all subscales (α = 0.71–0.83).

2.6. Statistical Analysis

Statistical analyses were carried out using IBM Statistical Package for Social Sciences (SPSS) Statistics (version 26.0) predictive analytics software. Demographic characteristics were reported, Shapiro‐Wilks tests were conducted to assess for violations of the normality assumption, and descriptive statistics were reported. Mean imputation was utilized for participants with responses with less than 10% missing data per scale. No imputation method was utilized if any scale was missing in its entirety for any given participant. One‐way analyses of variance (ANOVAs) were conducted to assess potential baseline differences between groups in outcome variables. Chi‐square analyses were conducted to assess for differences in attrition rates between groups and session attendance rates between treatment sites. Treatment completion rates will be reported as indicators of study feasibility, and perceived credibility and working alliance will be reported for those who completed treatment in the EMDR group. Little's missing completely at random (MCAR) test was conducted for all self‐report questionnaires at baseline. Percent BMI reduction was also calculated for those who we had post‐BMI data (treatment‐completer sample), and the between‐group difference in percent BMI reduction was compared and Cohen's d effect size reported.

To examine the preliminary efficacy of treatment, both intent‐to‐treat (ITT) and completer analyses were conducted for primary and secondary outcomes. To examine between‐group effects, ITT analyses using data from all participants who were randomized and completed baseline data were conducted using linear mixed models (LMMs), using a restricted maximum likelihood estimation method and an unstructured covariance structure. Fixed effects included condition (EMDR vs. waitlist control), time (pre vs. post), and their interaction. LMMs were utilized as they enable the estimation of unbiased model parameters when data is missing at random (Huta 2014), and account for nested data structures. For the treatment completer analysis, repeated measures of analysis of variance (ANOVAs) were conducted to assess pre‐post between‐group differences. Mauchley's test of sphericity was examined to assess for sphericity assumptions. Pre‐post between‐group Cohen's d effect sizes were also calculated for all outcomes using the pooled pre‐test SDs (Morris 2008), with effect sizes interpreted as small (d = 0.20), medium (d = 0.50) and large (d = 0.80; Cohen 1988).

Sample size estimates were based on the aim of examining pre‐post between‐group effects between the EMDR and waitlist control groups for primary and secondary outcomes. An a priori power analysis using G*power indicated that for a 2 × 2 repeated measures design, 24 participants were required to detect a medium effect (f = 0.3), with correlation amongst repeated measures set at 0.5, power (0.8) and a cutoff of α = 0.05 (Faul et al. 2007). As such, this study was adequately powered to detect medium effects (N = 38).

3. Results

3.1. Preliminary Analyses

Shapiro‐Wilks tests indicated most variables met normality assumptions. Apart from the depression subscale, all TSC subscales were non‐normal, as were the EDE shape and eating concerns subscales, and OBE days and episodes per month (all ps < 0.05). Both LMMs and repeated measures ANOVAs are robust to non‐normality (Blanca et al. 2023; Schielzeth et al. 2020). Sphericity assumptions were met for all repeated measures ANOVAs. Little's MCAR test indicated data were missing at random (χ 2 = 226.60, df = 246, p = 0.81). A series of independent samples t‐tests revealed no significant differences between conditions in baseline demographic or outcome variables (ps > 0.05), apart from the TSC dissociation subscale, which was significantly higher in the control group (p = 0.02). Independent samples t‐tests comparing completers and non‐completers at baseline also revealed no significant differences on any primary or secondary outcomes, nor in demographic variables (all ps > 0.05), apart from a significantly higher baseline BMI in treatment completers (p = 0.05).

3.2. Feasibility

The treatment completion rate for the EMDR group was 68.8% (11 of 16 participants; see Figure 1). Those who discontinued treatment (n = 5) did so for several reasons (e.g., overriding comorbid diagnosis requiring other care, medication complications, practical barriers). All 11 completers adhered to the full treatment protocol (i.e., attended 10 sessions). Including all those who were allocated to the EMDR group (n = 16), mean attendance was 8 sessions (range 3–10). Sixteen of 22 waitlist control participants completed post‐waitlist assessment (72.7%), whereby participants discontinued due to a variety of reasons (e.g., not contactable, engaged in other treatment, moved cities). Further, Chi‐square analyses also demonstrated that there was no significant difference in attrition between the treatment (31%) and waitlist control (31%) groups, χ 2 (1, N = 38) = 0.001, p = 0.97, nor a significant difference in session attendance rates between the three outpatient treatment sites (χ 2 (2, N = 16) = 4.79, p = 0.09).

3.3. Credibility and Therapeutic Alliance

Those in the EMDR group perceived treatment to be credible, as indicated by high CIT scores (M = 25.22, SD = 3.90). Further, those who undertook treatment reported high therapeutic alliance with their treating clinician (M = 5.82, SD = 1.09).

3.4. Primary Outcomes

3.4.1. Intent‐To‐Treat

In alignment with primary hypotheses, there was a very large, significant pre‐post between‐group difference in binge eating symptoms in favor of the EMDR group (d = −1.89 [−2.73, −1.04]; see Table 1). There were also significantly larger reductions in past month OBE days (d = −1.03 [−1.74, −0.32]) and OBE episodes (d = −1.16 [−1.88, −0.43]) for the EMDR group compared to controls. As expected, there were also significant pre‐post between‐group differences in both negative (d = −1.44 [−2.2, −0.68]) and positive (d = −1.29 [−2.04, −0.54]) meta‐cognitive beliefs about eating in favor of the EMDR group. There was no significant between‐group difference in BMI.

TABLE 1.

Intent‐to‐treat descriptive statistics (estimated marginal means and standard error) and inferential statistics from linear mixed models for primary and secondary outcomes.

Outcomes EMDR EMDR Control Control Pre‐post between‐group
Pre‐mean (SE) n Post‐mean (SE) n Pre‐mean (SE) n Post‐mean (SE) n B SE d [95% CI]
Primary outcomes
BES 1.91 (0.12) 14 1.04 (0.14) 11 1.95 (0.10) 21 1.94 (0.11) 16 0.86 0.24 −1.89 [−2.73, −1.04]
EDE OBE days 14.13 (2.38) 16 2.10 (3.01) 10 17.64 (2.03) 22 15.39 (2.24) 16 −9.78 4.88 −1.03 [−1.74, −0.32]
EDE OBE episodes 25.38 (4.32) 16 2.40 (5.46) 10 22.18 (3.68) 22 19.17 (4.08) 16 −19.96 8.87 −1.16 [−1.88, −0.43]
EBQ positive 50.21 (2.77) 16 37.06 (3.34) 11 54.61 (2.48) 20 55.75 (2.77) 16 −14.30 5.68 −1.29 [−2.04, −0.54]
EBQ negative 44.81 (2.06) 16 32.00 (2.49) 11 47.18 (1.84) 20 47.18 (2.00) 16 −12.82 4.22 −1.44 [−2.2, −0.68]
EDE restriction 2.51 (0.35) 16 1.52 (0.45) 10 2.71 (0.30) 22 2.46 (0.35) 16 −0.74 0.72 −0.52 [−1.20, 0.15]
EDE shape concerns 4.34 (0.31) 16 3.21 (0.40) 10 4.53 (0.27) 22 4.51 (0.30) 16 −1.11 0.64 −0.88 [−1.58, −0.18]
EDE weight concerns 3.69 (0.27) 16 2.84 (0.34) 10 4.42 (0.23) 22 4.24 (0.25) 16 0.67 0.55 −0.62 [−1.30, 0.06]
EDE eating concerns 2.99 (0.38) 16 1.50 (0.47) 10 2.81 (0.32) 22 2.91 (0.35) 16 −1.59 0.77 −1.28 [−2.01, −0.55]
BMI 31.69 (1.73) 16 33.25 (2.30) 9 31.91 (1.51) 21 34.03 (1.67) 16 −0.56 3.65 −0.08 [−0.74, 0.58]
Secondary outcomes
Self‐esteem 1.50 (0.11) 15 1.30 (0.13) 10 1.73 (0.09) 21 1.67 (0.10) 16 −0.14 0.22 −0.33 [−1.02, 0.35]
TSC anxiety 6.13 (1.19) 16 2.00 (1.44) 11 6.86 (1.04) 21 7.67 (1.13) 16 −4.94 2.42 −1.04 [−1.75, −0.32]
TSC depression 8.81 (1.08) 16 6.18 (1.30) 11 10.91 (0.94) 21 11.67 (1.01) 16 −3.39 2.18 −0.79 [−1.48, 0.09]
TSC sleep 9.19 (1.03) 16 5.73 (1.24) 11 9.33 (0.90) 21 10.28 (0.97) 16 −4.41 2.08 −1.07 [−1.79, −0.35]
TSC dissociation 3.31 (0.82) 16 2.27 (0.99) 11 4.71 (0.72) 21 6.11 (0.77) 16 −2.44 1.66 −0.74 [−1.43, −0.05]
TSC sexual problems 3.88 (1.12) 16 3.83 (1.45) 11 5.57 (0.98) 21 5.83 (1.06) 16 0.32 2.27 −0.07 [−0.74, 0.60]
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Note: Cohen's d refers to the pre‐post between‐groups effect size. *Significant effect sizes are bolded.

Abbreviations: BES, binge eating scale; BMI, body mass index; CI, confidence interval; EBQ, eating beliefs questionnaire; EDE, eating disorder examination; EMDR, eye movement desensitization and reprocessing; OBE, objective binge eating; SE, standard error; TSC, trauma symptoms scale.

Outcomes from the EDE in the ITT sample were mixed. There was a large, significant pre‐post between‐group difference in eating concerns in favor of the EMDR group (d = −1.28 [−2.01, −0.55]), and for shape concerns (d = −0.88 [−1.58, −0.18]). However, there was no significant pre‐post between‐group difference in weight concerns or for dietary restriction.

3.4.2. Treatment‐Completers

For treatment completers, there was a very large, significant pre‐post between‐group difference in BES scores in favor of the EMDR group (d = −2.37 [−3.43, −1.32]; see Table 2), as well as significantly larger reductions in both past month OBE days (d = −1.28 [−2.19, −0.37]) and OBE episodes (d = −1.14 [−2.04, −0.25]) for the EMDR group compared to controls. Moreover, at post‐treatment, 36.4% (n = 4/11) achieved full remission, as indicated by no episodes of OBE in the last 28 days, whereas only 12.5% (n = 2/16) achieved full remission in the waitlist control group. There were also large, significant pre‐post between‐group differences in negative (d = −2.14 [−3.15, −1.12]) and positive (d = −1.09 [−1.95, −0.23]) meta‐cognitive beliefs about eating in favor of the EMDR group. There was no significant between‐groups effect for mean BMI change. However, there was a large, significant between‐groups effect for percentage reduction in BMI (d = 1.18 [0.27, 2.06]), whereby the EMDR group had a 2.26% reduction [SD = 3.24] and the control group had a 1.20% increase in BMI.

TABLE 2.

Descriptive statistics (means and standard deviations) and inferential statistics from repeated measures analysis of variance for primary and secondary outcomes in treatment‐completers.

Outcomes EMDR EMDR Control Control Pre‐post between‐group
Pre‐mean (SD) n Post‐mean (SD) n Pre‐mean (SD) n Post‐mean (SD) n F d [95% CI]
Primary outcomes
BES 1.94 (0.40) 11 1.05 (0.55) 11 1.99 (0.35) 16 1.98 (0.40) 16 57.88 −2.37 [−3.43, −1.32]
EDE OBE days 17.50 (10.64) 11 2.10 (2.73) 10 16.00 (11.50) 16 14.88 (10.29) 16 20.44 −1.28 [−2.19, −0.37]
EDE OBE episodes 31.90 (27.20) 11 2.40 (2.76) 10 21.94 (19.51) 16 18.44 (18.01) 16 11.97 −1.14 [−2.04, −0.25]
EBQ positive 49.57 (11.60) 11 37.06 (11.70) 11 56.22 (10.77) 16 55.94 (9.88) 16 15.64 −1.09 [−1.95, −0.23]
EBQ negative 45.82 (6.48) 11 32.00 (10.01) 11 46.71 (6.64) 16 46.95 (7.79) 16 24.84 −2.14 [−3.15, −1.12]
EDE restriction 1.78 (1.60) 11 1.52 (1.32) 10 2.61 (1.36) 16 2.40 (1.25) 16 0.01 −0.03 [−0.86, 0.79]
EDE shape concerns 4.56 (0.88) 11 3.21 (1.78) 10 4.36 (1.18) 16 4.48 (1.12) 16 6.29 −1.36 [−2.28, −0.44]
EDE weight concerns 3.72 (0.90) 11 2.84 (1.15) 10 4.41 (1.33) 16 4.24 (1.05) 16 2.73 −0.60 [−1.44, 0.25]
EDE eating concerns 2.86 (1.42) 11 1.50 (1.16) 10 2.60 (1.51) 16 2.79 (1.67) 16 6.08 −1.05 [−1.93, −0.17]
BMI 34.05 (3.73) 11 33.25 (3.58) 9 33.87 (8.68) 16 34.17 (8.36) 15 7.85 −0.15 [−1.02, 0.72]
Secondary outcomes
Self‐esteem 1.49 (0.36) 11 1.31 (0.30) 10 1.71 (0.40) 16 1.71 (0.52) 16 2.16 −0.47 [−1.30, 0.37]
TSC anxiety 4.09 (2.66) 11 2.00 (1.00) 11 6.94 (5.00) 16 7.81 (5.48) 16 12.95 −0.70 [−1.53, 0.13]
TSC depression 8.09 (3.53) 11 6.18 (3.40) 11 11.00 (4.83) 16 11.75 (3.92) 16 3.20 −0.61 [−1.43, 0.21]
TSC sleep 8.55 (3.93) 11 5.72 (2.05) 11 9.38 (4.50) 16 10.31 (4.84) 16 7.54 −0.88 [−1.72, −0.04]
TSC dissociation 2.09 (1.58) 11 2.27 (1.95) 11 4.50 (3.18) 16 6.38 (3.88) 16 4.52 −0.64 [−1.46, 0.18]
TSC sexual problems 3.27 (4.17) 11 3.82 (4.33) 11 5.63 (5.03) 16 6.13 (4.91) 16 0.00 0.01 [−0.79, 0.81]
Open in a new tab

Note: Cohen's d refers to the pre‐post between‐groups effect size. *Significant effect sizes are bolded.

Abbreviations: BES, binge eating scale; BMI, body mass index; CI, confidence interval; EBQ, eating beliefs questionnaire; EDE, eating disorder examination; EMDR, eye movement desensitization and reprocessing; OBE, objective binge eating; SD, standard deviation; TSC, trauma symptoms scale.

Outcomes for the EDE were also mixed for treatment‐completers. There was a large, significant pre‐post between‐group difference in eating concerns in favor of the EMDR group (d = −1.05 [−1.93, −0.17]), as well as in shape concerns in favor of the EMDR group (d = −1.36 [−2.28, −0.44]). However, there was no pre‐post between‐group difference in dietary restriction or in weight concerns.

3.5. Secondary Outcomes

3.5.1. Intent‐To‐Treat

There was no pre‐post between‐group effect for self‐esteem (see Table 1). Outcomes from the TSC were mixed. There were large, between‐group effects indicating significantly larger reductions in sleep disturbances for the EMDR group (d = −1.07 [−1.79, −0.35]), as well for anxiety (d = −1.04 [−1.75, −0.32]). There was also a medium, significant between‐group effect for dissociative symptoms in favor of the EMDR group (d = −0.74 [−1.43, −0.05]), as well as a medium between‐group effect in favor of the EMDR group for depressive symptoms (d = −0.79 [1.48, −0.09]). There was no pre‐post between‐group effect for sexual problems.

3.5.2. Treatment‐Completers

For treatment completers, there was no significant pre‐post between‐group effect for self‐esteem (d = −0.47 [−1.30, 0.37]). Outcomes from the TSC were also mixed for treatment completers. There was a large, significant pre‐post between‐group difference in sleep disturbances in favor of the EMDR group (d = −0.88 [−1.72, −0.04]). However, there were no significant between‐group effects for anxiety, dissociative symptoms, depressive symptoms, or sexual problems.

4. Discussion

The present study is to the authors' knowledge the first study to examine the feasibility, credibility, and preliminary efficacy of EMDR therapy for BED, and to address and assess the impact of treatment on its core symptoms. The treatment completion rate of 68.8% observed in the EMDR group, for completers attending all 10 sessions, supports the feasibility of this 10‐session EMDR protocol. This rate is comparable to those of a recent EMDR pilot trial (70.2%; Doherty et al. 2025), comparable to dropout rates from 10‐session CBT for those with non‐underweight EDs (39% dropout; Keegan et al. 2022), and slightly lower than estimates from meta‐analytic data suggesting a 75.8% pooled retention rate from BED trials (Pellizzer et al. 2026). Though a meta‐analysis of EMDR studies indicated a mean completion rate of 82% (Lewis et al. 2020), there was high heterogeneity in this outcome (I 2 = 62.13%), and included studies had a wide range in number of sessions (2–12 sessions; Lewis et al. 2020). Thus, the observed completion rate (for those with 100% attendance) and mean session attendance (including those who dropped out; n = 8) is largely within the expected range from literature on the feasibility of EMDR therapy. The positive credibility and alliance ratings further support the feasibility of the treatment protocol.

In both the ITT and treatment completer samples, primary outcomes demonstrated largely positive effects in favor of the intervention. Both analyses indicated significantly larger reductions in binge eating symptoms (BES, OBE days, and OBE frequency) in the EMDR group compared to the control group, whereby control participants demonstrated no change. Promisingly in those whose data was available (treatment completers), there was a greater proportion of those in full remission (0 episodes of OBE) post‐intervention in the EMDR group (36.4%) than in the waitlist control group (12.5%), as well as a larger percentage reduction in BMI in the EMDR group compared to the control group. Additionally, both ITT and completer analyses indicated that there were larger reductions in positive and negative meta‐cognitive beliefs about eating in the EMDR group compared to control, as well as larger reductions in eating concerns for the EMDR over the control group. These novel findings, though preliminary, provide evidence for the utility of EMDR in treating BED symptoms and comorbidities, and in addressing not only behavioral symptom reduction but also associated cognitive and meta‐cognitive factors that perpetuate disordered eating. These findings contribute to the very limited body of literature in support of the efficacy of EMDR in the treatment of EDs (Hatoum and Burton 2024).

There was also a large significant between‐groups effect for eating concerns in favor of the EMDR group, as well as a medium between‐groups effect for shape concerns. However, there was no significant between‐groups effect for weight concerns in either the ITT or treatment completer analysis. The only other RCT of EMDR conducted in a mixed ED inpatient sample (that reported on core ED symptoms) reported no significant difference between treatment groups for body image outcomes or ED cognitions (Bloomgarden and Calogero 2008). It is possible that shape concerns are more related to specific imagery and memories, which are easier targets for EMDR and are thus more likely to shift during treatment, whereas weight concerns may be linked to more stable beliefs (e.g., chronic weight stigma, medical and social feedback). However, given our mixed preliminary outcomes, further study is certainly required in a larger sample to re‐examine these findings.

Further, there were no significant between‐groups effects for dietary restraint. This may be due to relatively low baseline EDE dietary restraint score in the EMDR group (1.78), which is in line with Australian community norms (range 1.28–1.34; Mond et al. 2006). In addition, it is also likely that there was little shift in this behavior given the EMDR protocol did not specifically target dietary restriction. Further, only one study has assessed the impact of EMDR on dietary restraint: a case study for a patient with BN, who had reduced dietary restraint following completion of combined EMDR and CBT‐E treatment (Ergüney Okumuş 2021). Thus, there is limited evidence to date to support the utility of EMDR for this outcome, particularly without specifically addressing it with the treatment protocol.

Secondary outcomes displayed larger variability in terms of outcomes in favor of EMDR.

From the trauma symptoms scale, there were significant post‐treatment reductions in anxiety and sleep disturbances in favor of intervention in the ITT sample. This outcome is in alignment with meta‐analytic data that supports the effectiveness of EMDR for reducing anxiety (with large effects; Yunitri et al. 2020), and makes sense given anxiety often predates and is a risk factor for developing EDs (Rosenbaum and White 2013). Further, previous studies in PTSD (Raboni et al. 2014) and chronic pain patients (Ghanbari Nia et al. 2019) have demonstrated post‐EMDR reductions in sleep disturbances. Although there was a significant between‐group reduction in anxiety in the ITT sample, in treatment‐completers, despite a medium‐large effect, the 95% CI indicated a lack of significance. This discrepancy might have been due to a lack of power, given the small sample size in the present study.

However, there were mixed findings between ITT and treatment‐completer in between‐groups effect sizes for depressive and dissociative symptoms, consistent lack of benefit of EMDR over waitlist control for sexual problems in both analyses. The ITT sample had a significant between‐groups effect for depressive and dissociative symptoms, which in part appears to be driven by increases in these symptoms in the control group, in addition to small symptom reduction in the EMDR group. The lack of reduction in depressive symptoms in treatment completers suggests a potential limitation of this approach, given common comorbidity between depressive symptoms and BED (Keski‐Rahkonen 2021). It was also an unexpected finding given that meta‐analytic data has demonstrated that EMDR has a significant, large effect on reducing depression symptoms (Seok and Kim 2024). However, meta‐regression on outcomes indicated that the severity of depressive symptoms significantly predicted treatment effectiveness (Seok and Kim 2024). It is possible that depressive symptoms may not have been severe enough in the present sample. Similarly, very low baseline scores for both dissociative symptoms and sexual problems likely explain the lack of between‐groups effects for these symptoms in treatment completers. Indeed, scores on these subscales in our sample were in line with non‐clinical community norms (Silver et al. 2018). Low baseline scores may have been due to stringent exclusion criteria for the present study, which likely excluded those with higher levels of dissociative symptoms.

Finally, treatment had no effect on self‐esteem. This outcome is in contrast with ED treatment studies that have demonstrated post‐treatment increases in self‐esteem, typically with medium effects (Hepburn and Wilson 2014). It is possible that this study lacked sufficient power to detect small effects, indicating that a larger, well‐powered RCT is needed to examine changes in several secondary outcomes. Additionally, the EMDR treatment protocol utilized may not have adequately addressed self‐esteem, whereas first‐line treatments often include modules specifically targeting self‐esteem (Fairburn et al. 2003). Further, a 10‐session EMDR protocol targeting low self‐esteem demonstrated significant post‐treatment increases in self‐esteem comparable to that of CBT (Griffioen et al. 2017), suggesting the inclusion of such a module is warranted in future investigations of EMDR for BED.

4.1. Limitations and Future Research

Although there were many promising outcomes of the present study, findings must be considered alongside several key limitations. Firstly, utilizing a waitlist control was the feasible option for this pilot due to being cost‐effective and practical. However, comparison to an active control (e.g., standard care or attention‐matched control) would have allowed accounting for specific versus non‐specific effects of treatment (e.g., expectancy). Further, offering standard care or an active control might have improved retention in the waitlist control group, where there was substantial attrition, partially due to participants discontinuing to start treatment elsewhere. Secondly, the strict eligibility criteria that were utilized may not reflect those who present clinically in routine practice, which limits the generalisability of outcomes. Interpretation of findings is further constrained by the small sample size in the current study, which meant that the current study was underpowered to detect small effects.

Moreover, the absence of follow‐up assessments precludes conclusions regarding the stability of treatment effects beyond the 10‐week intervention period. Although adherence to the full treatment (i.e., completion of the full 10 sessions) largely indicated the feasibility of the study protocol, there was still significant attrition (particularly in the waitlist control group) that reduced our sample even further. Additionally, treatment outcomes could not be evaluated for participants who dropped out, which may have introduced potential bias and further limited the generalizability of the findings. Potential bias may also exist given those with lower BMI were more likely to drop out. Importantly, trauma history or experience of traumatic events was not collected at baseline, and therefore we were unable to assess whether treatment was more or less effective depending on trauma history. Future study certainly should include baseline assessment of trauma history to address this question. Addressing these limitations in subsequent trials is essential to fully assess the optimal delivery and potential long‐term efficacy of EMDR for BED. Altogether, a larger scale, representative sample is critical for a future larger scale RCT to support and extend the preliminary findings of the current study. It would also be important and interesting for future non‐inferiority or superiority trials to compare EMDR with first‐line treatments, including CBT and LDX, as well as to examine who this treatment works best for, possibly targeting individuals with and without trauma history. Finally, no data on ethnic background of participants was collected, and thus we were unable to comment on sample representativeness or ethnic diversity. This is indeed a limitation that should be addressed in future study.

5. Conclusions

Altogether, this pilot RCT of EMDR therapy for BED demonstrated the feasibility of recruitment, retention, and intervention delivery in this population, while also providing preliminary evidence for its efficacy. This pilot offers important insight into the feasibility of applying this protocol to a larger‐scale, well‐powered effectiveness trial. It also addresses a critical gap in the literature by being one of the first studies to examine the utility of EMDR therapy for adults with BED, and thus contributes foundational preliminary data in support of an alternative model of care for those with BED.

Author Contributions

K.R., M.J.A., E.R., and S.T. were involved in the conceptualization and design of the methodology of the study. K.R. was project administrator of the trial and responsible for implementation of the treatment protocol at trial sites. K.R. and M.J.A. prepared the materials for the study, S.T. and E.R. provided consultation and support for finalising the study design, method and materials. K.R. and A.L.B. were involved with participant recruitment and data collection. A.H.H. was responsible for formal analysis the data and prepared the first draft of the manuscript for publication. M.J.A. supervised, and M.J.A. and A.L.B. assisted with preparation of the manuscript, review and editing. E.R. and S.T. were involved in review and editing. All authors read and approved the final manuscript. A.L.B. acquired funding for the preparation of the manuscript for publication.

Funding

The study was conducted as a requirement of the Master of Science degree at The University of Sydney and had no associated funding. Funding from the University of Technology Sydney Graduate School of Health supported preparation of the manuscript for publication. This funding was obtained and managed by A.B.

Disclosure

The authors have nothing to report.

Ethics Statement

This study was approved by the University of Sydney Human Research Ethics Committee (HREC: 2014/025). All participants were provided informed consent to participate in the study. All participants read a Participant Information Statement allowing them to make an informed choice as to whether they wanted to participate in the research or not. They were informed that they could also cease participation at any stage with no penalty to them. The ethics of the consent procedure were approved as above.

Conflicts of Interest

The authors declare no conflicts of interest.

Acknowledgments

The authors acknowledge the Statistical Consulting Service provided by Chris Howden from the Sydney Informatics Hub, a Core Research Facility of the University of Sydney, as well as statistical support from Kris Rogers at the University of Technology Sydney. Open access publishing facilitated by University of Technology Sydney, as part of the Wiley ‐ University of Technology Sydney agreement via the Council of Australasian University Librarians.

Hatoum, A. H. , Richard K., Burton A. L., Rieger E., Touyz S., and Abbott M. J.. 2026. “A Pilot Randomized Controlled Trial of Eye Movement Desensitization and Reprocessing Therapy for Adults With Binge‐Eating Disorder.” International Journal of Eating Disorders 59, no. 5: 1009–1022. 10.1002/eat.70056.

Action Editor: Tracey D. Wade

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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