Post-traumatic stress disorder (PTSD) can be devastating, and millions of people across the globe experience it.
The National Center for PTSD estimates that about 7–8% of the population will experience PTSD at some point in their lives (National Institute of Mental Health, 2019). PTSD can occur among people of any age and gender, including war veterans, children exposed to abuse, and people who have been through physical or sexual abuse, an accident, or serious event.
People with PTSD experience a range of often debilitating symptoms, including anxiety, hypervigilance, depression, addiction, codependency, and substance abuse (National Institute of Mental Health, 2019).
Several evidence-based therapies have been created to treat PTSD and its effects, including eye movement desensitization and reprocessing, Cognitive Processing Therapy, Dialectical Behavior Therapy, and somatic therapies.
Accelerated Resolution Therapy (ART) is a recent therapy offering unique benefits to alleviate a variety of negative symptoms associated with PTSD. This promising therapy can offer lasting relief after a short treatment period and can be easily implemented by therapists and trained healthcare practitioners.
Before you continue, we thought you might like to download our three Positive CBT Exercises for free. These science-based exercises will provide you with detailed insight into Positive CBT and give you the tools to apply it in your therapy or coaching.
This Article Contains:
- What Is Accelerated Resolution Therapy (ART)?
- How Does ART Work? 4 Examples of Scripts
- Is Accelerated Resolution Therapy Evidence Based?
- Does ART Help With Anxiety?
- How to Perform Accelerated Resolution Therapy
- Helpful Manual and Protocol for Your Sessions
- Training in ART: 3 Certifications and Online Options
- 3 Fascinating Books on the Topic
- Resources From PositivePsychology.com
- A Take-Home Message
What Is Accelerated Resolution Therapy (ART)?
Accelerated Resolution Therapy (ART) is a brief psychotherapy method that combines principles from several forms of therapy. It is an evidence-based therapy that can create dramatic improvements in a variety of psychiatric disorders (Waits et al., 2017).
It has been used to reduce the impact of symptoms related to stress, trauma, and distressful memories and increase the capacity for resilience in a short treatment plan.
ART was created in 2008 by Laney Rosenzweig, a licensed marriage and family therapist. It was crafted from the basis of eye movement desensitization and reprocessing (EMDR) and also includes treatment modalities from Gestalt, Cognitive-Behavioral Therapy (CBT), and Brief Psychodynamic Therapy (Hoge et al., 2015).
ART practitioners use these methods to change the way stressful images are stored in the brain, reducing the negative physical and emotional effects they create (Waits et al., 2017).
Benefits of ART
ART provides specific benefits that make it an exceptional therapy.
ART includes a standardized set of guidelines that last one to five sessions (usually three) that are 60–70 minutes in length over the course of a two-week period. The techniques employed during sessions are designed to provide quick relief from symptoms as they arise.
Directive and interactive
This form of psychotherapy uses interactive methods from CBT, such as in vivo exposure to guide triggered responses, imagery rescripting, and client-driven solutions to alleviate the effects of trauma.
The premise of ART is to help people change the way they feel about traumatic memories, rather than changing the facts. It involves a type of image rescripting involving voluntary memory replacement, where individuals are encouraged to replace a traumatic memory with a more positive one of their own.
ART vs EMDR
ART and EMDR have common elements in that they are both effective treatments for stress, trauma, and anxiety; use eye movement and body scans; and provide the client with a high degree of autonomy (Van den Hout & Engelhard, 2012).
However, EMDR uses a free-associative and open-ended guidance, while ART gives clients specific instructions and uses a series of explicit procedural steps. It also gives the therapist more opportunities for verbal direction, which imparts a sense of mastery more quickly than EMDR (Hernandez et al., 2016).
ART uses rescripting to positively change traumatic images while allowing the client to keep factual knowledge of the event. Where ART focuses on rescripting one stressful event each session, EMDR revisits the same memory as many times as necessary (Dunsmoor, 2015).
How Does ART Work? 4 Examples of Scripts
One of the most important aspects of ART is imagery rescripting, which helps change negative experiences of memory/trauma for the better (Hackmann, 2011).
The therapist has the client imagine a distressing memory or a scary image of a phobia and change the scene by rewriting it. This transforms the effect of the image and how the brain processes it at a neurological level.
Imagery rescripting is a way of processing and laying a memory to rest, rather than avoiding it or pretending that the bad thing/feeling did not happen (Hackmann, 2011). By rescripting, clients can learn new perspectives and find new meaning in the image, which changes the feelings attached to the image.
- A sample script for traumatic bullying might look like:
Imagine the negative experience of being bullied at the age of nine. Visualize the playground, the surrounding people, the sights, and sounds. See your bully and the actions they are taking. Notice how it feels.
Now visualize a comforting adult or your adult self coming in to save the nine-year-old. The adult sweeps you away and brings you to a safe place where you enjoy the company of friends. The helpful new meaning would be, “I am valued” and “There are people looking out for me.”
- An example rescripting for someone with depression, suicide, and self-harm:
This might include having the client clearly visualize a scene of self-harm and then see their mother intervene to stop it.
The client would take the script a step further to process somatic sensations by recreating the thoughts, feelings, and physical sensations experienced during self-harm.
- Future rescripting to help reduce anxiety and the likelihood of panic attacks:
For example, someone terrified of flying might imagine an upcoming plane trip, the airport, and the plane. Then visualize their wise, strong self entering the airport and plane.
Within the new picture, the image conveys things such as, “I can cope with anxiety” and “I know what to do.”
- Rescripting nightmares can also be helpful in dealing with trauma:
If a client continues to have a nightmare about drowning or getting shot, a therapist can help them recreate the scene and create a new picture of someone saving them from drowning or dodging the bullet and finding safety. The new dream images convey the meaning of “The nightmare is just a picture and nothing more” and “I am in fact safe and secure.”
More information and insight regarding the value of scripts and imagery in healing can be found in our article: Interactive Guided Imagery Therapy.
Is Accelerated Resolution Therapy Evidence Based?
ART is considered an evidence-based therapy, and the limited research has been extremely promising (Waits et al., 2017). Published studies have focused on the use of ART among individuals with PTSD.
The first published ART study examined 80 subjects with PTSD who experienced violent abuse, crime, or loss of a loved one. The study found that 79% of subjects who screened positive for PTSD screened negative after only 3.8 ART sessions. Further, 81% screened negative two months later with almost no adverse side effects (Kip et al., 2012).
A randomized controlled trial evaluating ART compared outcomes between 29 combat veterans who received short-term therapy (2–5 sessions of ART) to 28 randomly assigned controls who received health or career counseling (Kip et al., 2013).
Self-report measures demonstrated that the ART group had a 65% reduction in PTSD symptoms versus a 13% reduction in the control group (Kip et al., 2013). The benefits remained three months after completing treatment, and the dropout rate among the ART group was only 6%, which is significantly lower than traditional PTSD treatment protocols (Kip et al., 2013).
Further research has suggested similar benefits for reduced PTSD symptoms among civilians, military personnel, homeless veterans, and veterans within the community (Kip et al., 2016).
Researchers believe that ART is particularly unique because it can effectively help the entire spectrum of clinical PTSD symptoms as well as psychiatric conditions, depression, substance abuse, grief, and moral injury. The versatility is attributed to the ability to tap into different neural pathways that contribute to PTSD (LeDoux & Pine, 2016).
Does ART Help With Anxiety?
Empirical evidence supports the use of ART for PTSD symptoms, but therapists have also reported effectively using ART for anxiety disorders and obsessive-compulsive disorder (Waits et al., 2017).
The Substance Abuse and Mental Health Services Administration has deemed ART to be a potential treatment for symptoms of phobia, panic, anxiety, sleep disorders, and general wellbeing based on clinical research trials (Howe et al., 2018).
How to Perform Accelerated Resolution Therapy
The effective components of ART have been sifted into four major tasks that therapists aim to accomplish (Waits et al., 2017). These include facilitation, learning, change, and closure.
Facilitation involves building rapport and providing tools, skills, and information necessary for the client’s success. These will help clients remain engaged and manage symptoms of distress throughout the treatment process.
Learning is the core of ART. It includes either directly or indirectly accessing and confronting fears, maladaptive behaviors, sources of distress, and negative emotions.
Change is the primary goal of all therapies. This task requires that clients recognize past distortions, identify solutions, develop hope for the future, and minimize negative sensations, thoughts, and feelings.
Summarizing the work accomplished during treatment empowers the client to manage future challenges and sustain relief from distressful symptoms.
Helpful Manual and Protocol for Your Sessions
ART contains clinical elements that are critical for any trauma-focused therapy and should be incorporated into sessions during the brief treatment plan.
These include relaxation, exposure or desensitization, cognitive restructuring/memory reconsolidation, and assessment/closure (Hoge, 2011).
Step 1 – Relaxation and orientation
At the beginning of an ART session, the client is asked to identify a specific traumatic experience to process and the uncomfortable sensations they experience with it (e.g., anxiety or body sensations).
The client is asked to focus on the sensations while simultaneously following the clinician’s hand with horizontal eye movements, which have been reported to elicit a relaxation response, lower neurological arousal, and increase parasympathetic activity (Elofsson et al., 2008).
Step 2 – Desensitization
After the initial relaxation exercise, the client is directed to visualize the traumatic event in their mind as if they were watching a movie and continue practicing the horizontal eye movements.
Attention is then directed toward somatic, emotional, and physiological responses associated with the visualization. The process of relaxation while imagining and noticing uncomfortable sensations is repeated until the client can successfully complete the traumatic scene from beginning to end in their mind. Desensitization is confirmed when the client feels removed and in control (Kip & Diamond, 2018).
Step 3 – Memory reconsolidation
Memory reconsolidation happens after the desensitization phase where the client uses imagery rescripting to imagine a new, preferred way to visualize the traumatic event (like the director changing the ending of a movie scene).
The rescripting is also facilitated by sets of horizontal eye movements to reconsolidate the memory (Nader & Hardt, 2009).
Step 4 – Assessment and closing
After reconsolidating the memory, additional reinforcing techniques can be used to check for remaining “stuck” points or images that generate visceral responses. Once the client asserts that they can access the original memory without significant distress, a closing ritual of crossing a bridge or passing through a doorway can help reinforce that the trauma is now in the past (Kip & Diamond, 2018).
Training in ART: 3 Certifications and Online Options
- The Rosenzweig Center for Active Recovery offers Accelerated Resolution Therapy Training at three levels: basic, advanced, and enhancement. The trainings build on each other and are designed for mental health professionals and healthcare workers. There are in-person and online options for the intensive three-day courses.
- ARTfully Restored is an organization that promotes holistic healing and health and offers training and workshops in ART at the basic, advanced, and enhanced levels. They also offer continuing education ART presentations, which help those who are certified stay up to date on skills, knowledge, and abilities.
- This training is not ART specific but addresses many components and skills that are utilized in ART. The training provides EMDR, CBT, and somatic-based interventions to treat trauma and allows the practitioner to become a certified clinical trauma professional.
3 Fascinating Books on the Topic
Because ART is such a new therapy (developed in 2008), there are few books with information directly about the therapy. The following therapy books are helpful in that they reference ART techniques and concepts to achieve similar goals.
1. Imagery Rescripting: Theory and Practice – Remco van der Wijngaart
This book is a manual for clinicians explaining how imagery rescripting can help with trauma, personality disorders, and other issues.
Imagery rescripting is a technique used in ART that allows problematic/traumatic events to be modified in positive ways.
Find the book on Amazon.
2. Getting Past Your Past: Take Control of Your Life With Self-Help Techniques From EMDR Therapy – Francine Shapiro
This book explains the human condition of trauma and offers procedures from EMDR to help readers and clinicians overcome emotional roadblocks.
It simultaneously explains brain science and provides practical exercises for readers and practitioners to try.
Find the book on Amazon.
3. Rescripting Family Experiences: The Therapeutic Influence of John Byng-Hall – John Hills
Rescripting Family Experiences is an interesting approach to the family dynamic and attachment theories of John Bowlby.
It provides insight from six different psychotherapists and ideas on family scripts, myths, and the family system.
The book provides a useful theoretical framework, sharing concepts from ART, for individuals struggling with family trauma and how to rescript the narrative.
Find the book on Amazon.
Resources From PositivePsychology.com
The Growing Stronger From Trauma worksheet can provide a helpful foundation for clients as they work to rescript traumatic memories. Exploring personal strengths and finding the “silver lining” of a stressful event can help create more positive images and associated emotions.
Our Imagery-Based Exposure Worksheet provides seven steps in which the client recalls and accepts a difficult memory, despite the discomfort.
If you’re looking for more science-based ways to help others manage stress without spending hours on research and session prep, check out this collection of 17 validated stress management tools for practitioners. Use them to help others identify signs of burnout and create more balance in their lives.
A Take-Home Message
ART is a valuable technique for individuals struggling with PTSD or any of its negative symptoms. By allowing clients to process negative events emotionally and rescript them into more positive memories, individuals can overcome obstacles and find power and meaning in their life.
Through a combination of EMDR, imagery rescripting, and talk therapy, this short-term therapy is an exciting addition to the toolbox of treatment options for trauma and anxiety disorders. With the high prevalence of PTSD cases and the deleterious symptoms it causes, ART offers new hope for health and healing.
We hope you enjoyed reading this article. For more information, don’t forget to download our three Positive CBT Exercises for free.
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- Elofsson, U., von Schèele, B., Theorell, T., & Söndergaard, H. (2008). Physiological correlates of eye movement desensitization and reprocessing. Journal of Anxiety Disorders, 22(4), 622–634.
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- Hoge, C. W., Walter Reed Army Institute of Research, Walter Reed National Military Medical Center, & Office of the Army Surgeon General. (2015). Accelerated resolution therapy (ART): Clinical considerations, cautions and informed consent for military mental health clinicians. Author. Retrieved February 9, 2022, from http://acceleratedresolutiontherapy.com/wp-content/uploads/2016/08/ART-vs-EMDR_by-Hoge.pdf
- Howe, E., Rosenzweig, L., & Shuman, A. (2018). Ethical reflections on offering patients accelerated resolution therapy (ART). Innovations in Clinical Neuroscience, 15(7–8), 32–35.
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- Kip, K. E., & Diamond, D. M. (2018). Clinical, empirical, and theoretical rationale for selection of accelerated resolution therapy for treatment of post-traumatic stress disorder in VA and DoD facilities. Military Medicine, 183(9–10), e314–e321.
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- Kip, K. E., Rosenzweig, L., Hernandez, D. F., Shuman, A., Sullivan, K. L., Long, C. J., Taylor, J., McGhee, S., Girling, S. A., Wittenberg, T., Sahebzamani, F. M., Lengacher, C. A., Kadel, R., & Diamond, D. M. (2013). Randomized controlled trial of accelerated resolution therapy (ART) for symptoms of combat-related post-traumatic stress disorder (PTSD). Military Medicine, 178(12), 1298–1309.
- LeDoux, J., & Pine, D. (2016). Using neuroscience to help understand fear and anxiety: A two-system framework. American Journal of Psychiatry, 173(11), 1083–1093.
- Nader, K., & Hardt, O. (2009) Single standard for memory: The case for reconsolidation. National Review of Neuroscience, 20, 224–234.
- National Institute of Mental Health. (2019). Post-traumatic stress disorder. Retrieved January 20, 2022, from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd
- Shapiro, F. (2012). Getting past your past: Take control of your life with self-help techniques from EMDR therapy. Rodale Books.
- Van den Hout, M., & Engelhard, I. (2012). How does EMDR work? Journal of Experimental Psychology, 3(5), 724–738.
- Waits, W., Marumoto, M., & Weaver, J. (2017). Accelerated resolution therapy (ART): A review and research to date. Current Psychiatry Report, 19(3), 7–18.
- van der Wijngaart, R. (2021). Imagery rescripting: Theory and practice. Pavilion.
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