Accelerated Resolution Therapy (ART) is an efficient and highly effective therapy for PTSD and many other psychiatric conditions. It was derived from Eye-Movement Desensitization and Reprocessing (EMDR), but it has a tighter protocol, is more directive, more procedural, and easier to learn. ART has been reported to be effective, efficient, easy on clients, and easy on clinicians.
Theory
The key to ART’s efficiency is believed to lie in its exploitation of natural memory consolidation mechanisms, specifically post-retrieval extinction. Post-retrieval extinction is different than traditional extinction in that a memory is specifically activated prior to the initiation of any extinguishing work. Extinguishing the distress associated with an actual, activated memory was suggested by one meta-analysis to be more effective than simply creating a competing memory, which may lose out over time to the more powerful original memory.
Memories undergo minor modifications every time we recall them, and this recall, or memory activation is critical to effective PTSD therapy. There is evidence to suggest that activating a memory, changing its emotional valence by introducing a more positive element (i.e. an image, song, fragrance, etc), and putting it away within a discrete period of time (a.k.a. reconsolidation window) can modify memory traces at the level of DNA transcription, essentially making the changes permanent.
Like other post-retrieval extinction and reconsolidation therapies, the ART protocol not only extinguishes the client’s fear response, but it also unwires distressing emotions from the factual memories of the events that created them. Said another way, these therapies “fulfill the brain’s requirements for allowing new learning to rewrite and erase an old, unwanted learning – and not merely suppress and compete against the old learning.” (Ecker, 2012)
Research
Unlike psychotherapies developed in university or research environments, the ART protocol was created by an experienced masters-level practitioner in private practice. For this reason, ART has not had as much research-based validation as other evidence-based therapies for PTSD. However, there have been three clinical trials on ART for PTSD, the largest of which is still pending publication. There has also been one trial of ART for complicated grief, which demonstrated a 5-fold greater reduction in grief symptoms among ART clients vs wait-list controls. In a published sub-analysis of a clinical trial of ART in veterans with PTSD, 88% of subjects with previous treatment experience with Prolonged Exposure or Cognitive Processing Therapy had a greater than 10-point reduction in their Military Posttraumatic Stress Disorder Checklist (PCL-M) after 3-4 sessions of ART.
These findings stand out against the backdrop of current PTSD gold standard treatments, which have demonstrated high dropout rates, low remission rates, and low rates of provider use after training. In the largest ART clinical trial published to date, ART yielded a 61% response rate (defined as at least a 10-point drop on the PTSD Checklist [PCL]) and a 94% completion rate. These are impressive results, given that established PTSD therapies have a response rate of 49% to 70% and a completion rate of only 60% to 65%. Furthermore, the number of ART sessions needed in this trial was only 3.7 ± 1.1. This number is significant not only because it is far fewer than the 8 to 15 sessions required by traditional evidence-based therapies for PTSD, but because up to 83% of clients who drop out of these treatments do so before their fifth session.
Clinical application
In many ways, ART may be easier to integrate into clinical practice than traditional PTSD therapies. Appealing and unique aspects of ART include that it:
- Is efficient and procedural (only 3-4 sessions are typically required)
- Encourages provider and client creativity
- Gives the client significant control over each session
- Does not require the client to do any homework or to talk about their trauma
- Does not require the therapist to prepare prior to sessions
- Does not require a set interval between sessions
- Is useful for a broad range of symptoms and conditions
- Can be used in children as well as adults
Each ART session is a stand-alone intervention and the time between sessions is not prescribed. ART can also be used in conjunction with other trauma-focused therapies. For example, ART may be a useful adjunct when a client arrives too distracted by a competing problem to engage in the planned session, when he or she is highly emotional, is unable to speak, is working on an especially emotional aspect of trauma, or will not be able to easily do homework before their next traditional psychotherapy session.
A client can return for the next ART session in one week or six weeks, and will generally not lose any gains they have made. This may make ART an appealing option for clients who travel frequently, have busy work schedules, have significant child/elder care duties, or who need to travel long distances for their appointments.
A client experienced with ART can often complete a session in 50 to 60 minutes, but at least 90 minutes should be allocated for initial sessions. Many providers have found that scheduling their new ART clients at the end of the workday provides them with the greatest flexibility and success.
Managing the client’s expectations about ART is critical because ART is quite different than traditional psychotherapies; an unmotivated client should not be offered ART.
A few other essential points about ART include:
- ART uses eye movements
- It is not hypnosis
- It involves little talking
- Each session requires a 10- to 15-minute mental review of painful life experiences
- The client may share as much or as little of these experiences as they choose
- It allows the client to select and replace negative images with positive ones
- Clients will retain the facts of the events they process, potentially even remembering more details than they did before their session
Bibliography
Buck HG, et al. Accelerated Resolution Therapy: Randomized Controlled Trial of a Complicated Grief Intervention. Am J Hosp Palliat Care. 2020 Oct;37(10):791-799.
Ecker B, Ticic R, Hulley L. Unlocking the Emotional Brain: Eliminating Symptoms at Their Roots Using Memory Reconsolidation. New York: Routledge; 2012.
Gutner CA, Gallaghe MW, Baker AS, et al. Time course of treatment dropout in cognitive behavioral therapies for posttraumatic stress disorder. Psychol Trauma. 2016;8:115-121.
Kip KE, Elk CA, Sullivan KL, et al. Brief treatment of symptoms of post-traumatic stress disorder (PTSD) by use of accelerated resolution therapy (ART). Behav Sci. 2012;2:115-134.
Kip KE, Rosenzweig L, Hernandez DF, et al. Randomized controlled trial of accelerated resolution therapy (ART) for symptoms of combat-related post-traumatic stress disorder (PTSD). Mil Med. 2013;178:1298-1309.
Kip KE, Shuman A, Hernandez DF, et al. Case report and theoretical description of accelerated resolution therapy (ART) for military-related post-traumatic stress disorder. Mil Med. 2014;179:31-37.
Kip KE, D’Aoust RF, Hernandez DF, et al. Evaluation of brief treatment of symptoms of psychological trauma among veterans residing in a homeless shelter by use of accelerated resolution therapy. Nurs Outlook. 2016;64:411-423.
Kredlow M, Unger L, and Otto M. Harnessing reconsolidation to weaken fear and appetitive memories: A meta-analysis of post-retrieval extinction effects. Psychol Bull. 2016 Mar;142(3):314-36.
Kroes M, Schiller D, LeDoux J, and Phelps E. Translational Approaches Targeting Reconsolidation. Curr Top Behav Neurosci. 2016;28:197-230.
Pang T, et al. Comparison of Accelerated Resolution Therapy for PTSD Between Veterans With and Without Prior PTSD Treatment. Mil Med. 2023 Mar 20;188(3-4):e621-e629.
Redondo, Kim J, Arons AL, et al. Bidirectional switch of the valence associated with a hippocampal contextual memory engram. Nature. 2014;513:426-430.
Schnyder U, Ehlers A, Elbert T, et al. Psychotherapies for PTSD: what do they have in common? Eur J Psychotraumatol. 2015;6:1-10.
Steenkamp MS, Litz BL, Hoge CW, Marmar CR. Psychotherapy for military-related PTSD, a review of randomized clinical trials. JAMA. 2015;314:489-500.
Waits W, Marumoto M, Weaver J. Accelerated resolution therapy (ART): a review and research to date. Curr Psychiatry Rep. 2017;19:18.
Dr. Wendi Waits (she/her) is an adult and child psychiatrist, certified lifestyle medicine physician, and consultant at MH Insight, LLC. She has written numerous articles, book chapters, and scientific publications on medical leadership and various mental health topics, and she is an experienced public speaker. To see more of Wendi’s work, please visit MHInsight.com.