Accelerated Resolution Therapy

Sarah Floyd MH708 8/9/2025

Objectives

● Define Accelerated Resolution Therapy and core principles – Eye movements + Image Rescripting / Voluntary Image Replacement (VIR)

● Summarize the research evidence for ART across various populations

● Identify appropriateness of ART in psychiatric nursing practice for adult clients with PTSD

Historical Summary

● Developed in 2008 by Laney Rosenzweig, MS, LMFT ● Inspired by Eye Movement Desensitization Reprocessing (EMDR) ● Designed to effectively and directly treat trauma by targeting distressing images and

sensations ● Integrates elements from Gestalt therapy, imagery work, imaginal metaphors, and

solution-focused therapy to help replace – rather than simply reframe or desensitize – negative associations tied to past traumas

● Sessions are brief (typically 1-5), require no homework, and allow patients to remain silent if they choose, not verbalizing the trauma in detail

● Research at the University of South Florida has supported its safety and efficacy

Critique of Accelerated Resolution Therapy ● Components:

○ Aims to reprogram how distressing memories and images are stored so they no longer trigger strong emotional or physical reactions

○ Uses sets of rapid eye movements similar to those in REM sleep, to reduce arousal ○ Employs Voluntary Image (or Memory) Replacement (VIR/VMR) to rescript distressing

mental imagery and alter negative emotions and sensations associated with trauma and other mental health issues while preserving factual memory

○ Combines imaginal exposure with image rescripting to change the client’s emotional relationship to the trauma

○ Involves minimal verbal detail and frequent “sensation checks” to monitor physical/emotional activation

○ Clinician guidance prevents clients from feeling “stuck” and promotes problem solving ○ Can be used to process distressing or repetitive dreams/nightmares ○ Draws from Gestalt therapy, CBT, guided imagery, EMDR, brief psychodynamic, and

exposure therapies, often using metaphors to reinforce change

Critique of Accelerated Resolution Therapy

● Complexity: ○ Moderate: Protocol is manualized and structured, with specific techniques

and pacing requirements ○ Therapists complete a three-day basic ART training

● Scope ○ Middle-range, problem-focused model for trauma and stress-related

symptoms

● Usefulness for psychiatric nursing ○ Brief (average 2.7 sessions average), safe, structured and tolerable for patients

reluctant to recount trauma in detail ○ RCTs support efficacy for with combat-related PTSD, as well as for trauma

from sexual abuse, depression, anxiety and even smoking cessation ○ Ethical considerations include the need for more large-scale research before

widespread adoption

Techniques for Use

1. Grounding & Orientation: prepare client and establish safety

2. Imaginal Exposure with Eye Movements: Identify and briefly visualize the target memory referred to as Imaginal Exposure (IE) while performing guided eye movements; check sensations (somatic and emotional activation) regularly

3. Visual Imagery Rescripting (VIR): Replace distressing images/sensory components with neutral or positive alternatives chosen by the client

4. Completion Criteria: Treatment is complete when the client recalls the event with the replacement images, while retaining factual memory

Evidence Based Literature

● Posttraumatic Stress Disorder (PTSD) – among adult veterans and civilians, and victims of sexual assault/trauma) ○ RCTs show greater symptom reduction compared to control groups for veterans,

civilians, and survivors of sexual trauma ○ ART has also reduced comorbid depression and pain in veterans including those

facing homelessness ● Depression, Anxiety, Complicated grief

○ RCTs and case studies suggest benefit, though further research is needed ○ One RCT found ART effective for complicated grief in informal hospice caregivers

● Obsessive-Compulsive Disorder (OCD) ○ Small case studies indicate potential benefit; more research is needed

Lifespan Issues with use of theory

● Children and Adolescents ○ No direct ART trials in this group ○ PTSD prevalence ~5% in adolescents (girls 8%) vs boys 2.3%); increases

with age (according to the National Center for PTSD of the Veterans Administration)

● Older Adults ○ Trials in adults (including older adults) show ART effective for PTSD,

depression, pain, homelessness, sexual trauma, and complicated grief ○ Most evidence is for adults with PTSD, particularly veterans

Cultural issues with use of Theory

● Cultural Variations ○ Cultural norms, vulnerabilities and beliefs shape PTSD

symptom patterns, perceptions, coping, and treatment-seeking tendencies

○ PTSD prevalence is lower in areas with frequent exposure to life-threatening events; higher where such events are rare

○ Emotional expression varies by culture (e.g. suppression in some Asian cultures)

○ Systemic inequities can influence trauma presentation and access to treatment

○ Lifetime PTSD rates are higher in White, African American, and Afro-Caribbean Americans compared to Latino and Asian populations

Applied Therapy – Adults (military veterans) with PTSD (DSM-5-TR)

● DSM-5 TR Criteria (age > 6 years): ○ Exposure to actual or threatened death,

serious injury, or sexual violence ○ Intrusion symptoms, persistent avoidance,

negative mood/cognition changes, hyperarousal

○ Duration > 1 month, causing significant distress/impairment in social, occupational, or other important area of functioning

○ Not due to substance use or medical condition

*Further detailed criteria outlined in the DSM-5-TR

(American Psychiatric Association, 2022, pp 301-303)

PTSD – Epidemiology

● Epidemiology ○ U.S. adult lifetime prevalence ~ 6.8% ○ Adolescents: 5.0% – 8.1% lifetime; ~4.9% past 6 months ○ Worldwide prevalence 3.9% among WHO regions, though varies substantially among countries; (11% in

conflict-affected populations) ○ Higher rates among women, veterans, and high-risk professions (e.g. police, firefighters, emergency

medical personnel) ○ Racial differences show higher rates among U.S. Latinx, African Americans and American Indians

compared with Whites ○ Highest rates in survivors of rape, military combat, captivity, or political/ethnic persecution

● Veterans ○ PTSD in 7% of veterans vs. 6% non-veterans; more common in female veterans (13%) than males (6%) ○ Data unknown on transgender and non-binary Veterans

(American Psychiatric Association, 2022, pp 308)

PTSD – Assessment

● Screening: PC-PTSD-5 (5-item screening) ● Severity: PCL-5 (20-items self report) ● Structured Interview: CAPS-5 (30-items); Gold Standard ● Other Measure: SPRINT (8-item self-report) ● Typical Onset & Presentation

○ Median onset: 23 years old in adults ○ Symptoms: intrusion, avoidance, negative

mood/cognition changes, hyperarousal ● Cultural Impact on Presentation

○ Influences encoding/retrieval of trauma, emotional expression, coping, treatment-seeking and recovery

○ May affect preference for certain interventions (e.g., group vs. individual therapy)

PTSD – Diagnosis & Course (DSM-5-TR)

● Often associated with impaired functioning, reduced quality of life, health problems, and suicidal ideation/behavior

● Commonly co-occurs with poor relationships, work absences, lower income, and professional and educational setbacks

● Differential Diagnoses ○ Adjustment disorders, acute stress disorders, panic

disorders, anxiety and obsessive compulsive disorders, major depressive disorder, ADHD, personality disorders, dissociative disorders, functional neurological symptom disorder, psychotic disorders, and traumatic brain injury

(American Psychiatric Association, 2022, pp 312-313)

ART for PTSD

● In several RCTs among veterans with PTSD, ART produced significantly greater and lasting reductions in PTSD symptoms, depression, and guilt vs. attention control, typically within ~ 3-4 sessions

● Suitable for veterans and civilians with PTSD reluctant to disclose details of traumatic experience(s)

● Of benefit is the brevity, structure, and overall tolerability of ART ● Integrates well with other recommended therapies as an adjunct/alternative treatment ● According to the U.S. Veterans Affairs National Center for PTSD, the most recommended,

evidenced-based (first-line) therapies include: Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and Eye Movement Desensitization Reprocessing (EMDR)

Comparison and Contrast of ART with EMDR

● Processing Style ○ ART: Client visualizes and processes the full event; actively

replaces distressing images/sensations with positive ones (VIR)

○ EMDR: Targets specific “worst” elements of the memory (image, belief, sensation) and uses eye movements to distract from the scene and cognitive reframing (free association) rather than encourage direct recall or structured rescripting for processing

● Safety & Regulation ○ ART: Highly structured; designed to manage strong

emotional responses safely within session to ensure control and without overwhelming the client

○ EMDR: Effective, but noted to have higher risk of post-session distress if emotions are not carefully managed

● Session Format & Disclosure ○ ART: Brief (1-5 sessions),

minimal verbal disclosure, highly structured and procedural; clients not need disclose or verbalized trauma details; involves no homework

○ EMDR: Longer (8-12 sessions), involves more verbal processing and often includes homework

ART versus EMDR – Pros & Cons

● Pros ○ ART: Brevity, minimal disclosure,

well-tolerated; quickly reduces vivid & distressing imagery and somatic reactivity to past traumatic event(s) & experience(s)

○ EMDR: Significant and robust database of evidence; first-line recommended treatment according to U.S. Veterans Affairs and international guidelines

● Cons ○ ART: Less-evidence and trials

conducted; fewer trained therapist; less inclusion in major guidelines

○ EMDR: Involves more sessions; requires more detailed verbal processing of trauma; dropout risk

Clinical Appropriateness, Potential Risks and Consequences

● Choose ART: If time is limited, verbal disclosure is a barrier, or imagery-driven triggers dominate (nightmares, flash images), and when a patient wants a highly directive, brief option

● Choose EMDR: For a larger network of available, trained therapists; when a larger base of evidence is sought

● Potential Risks/Unintended Consequences

○ ART: Rapid imaginal work can spike arousal temporarily; grounding and safety plan needed; since evidence base is smaller, ethical dilemmas need to be considered

○ EMDR: Can increase distress and sleep disturbances; reports of increased anxiety and panic attacks post sessions; may not be appropriate in dissociative, psychotic or unstable states

PMHNP Recommendations

● For adult Veterans with PTSD, EMDR has stronger and a more robust evidence base. It is recommended as a first-line therapy by the U.S. Department of Veterans Affairs and the Department of Defense

● ART is an emerging and promising evidence-supported option with positive RCT findings showing significant reductions in psychological trauma among veterans and civilians with PTSD. It may be well-suited and considered for patients seeking rapid relief, those who prefer minimal verbal recounting of traumatic details, or as an adjunct to enhance existing therapeutic modalities

References AlonzoDesign. (2023). Client and therapist. [Getty Image]. NPR.

https://www.npr.org/sections/health-shots/2023/07/02/1185661348/start-therapy-find-therapist-how-to

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.

Bisson, J. I., Roberts, N. P., Andrew, M., Cooper, R., & Lewis, C. (2013). Psychological therapies for chronic post‑traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews, (12), Article CD003388. Retrieved August 10, 2025 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6991463/

Buck, H. G., Cairns, P., Emechebe, N., Hernandez, D. F., Mason, T. M., Bell, J., Kip, K. E., Barrison, P., & Tofthagen, C. (2020). Accelerated resolution therapy: Randomized controlled trial of a complicated grief intervention. American Journal of Hospice & Palliative Medicine, 37(10). Retrieved August 10, 2025 from https://acceleratedresolutiontherapy.com/wp-content/uploads/2023/01/18.-ART-for-Prolonged-Grief-2020.pdf

Eberle, D. J., Maercker, A., Levin, Y., Mutuyimana, C., Wen, J., Makhashvili, N., Javakhishvili, D., Papava, A., Yu, X., Qian, W., Wang, J., Asatsa, S., & Bachem, R. (2024). Cultural psychological factors in posttraumatic symptom development and expression: A study protocol. European Journal of Psychotraumatology, 15(1), Article 2364998. Retrieved August 10, 2025 from https://www.tandfonline.com/doi/full/10.1080/20008066.2024.2364998#abstract

References Finnegan, A., Kip, K., Hernandez, D., McGhee, S., Rosenzweig, L., Hynes, C., & Thomas, M. (2015, published online July 3). Accelerated resolution therapy: An innovative mental health intervention to treat post‑traumatic stress disorder.

Journal of the Royal Army Medical Corps, 162(2), 90–97. Retrieved August 10, 2025 from https://acceleratedresolutiontherapy.com/wp-content/uploads/2023/01/7.-ART-Review-J-Roy-Army-Med-Center-2015.pdf

Hamblen, J. (n.d.). PTSD in children and adolescents. National Center for PTSD, U.S. Department of Veterans Affairs. Retrieved August 11, 2025, from https://www.ptsd.va.gov/professional/treat/specific/ptsd_child_teens.asp

Hernandez, D. F., Waits, W., Calvio, L., & Byrne, M. (2016). Practice comparisons between Accelerated Resolution Therapy, eye movement desensitization and reprocessing and cognitive processing therapy with case examples. Nurse Education Today, 47, 74–80. Retrieved August 10, 2025 from https://acceleratedresolutiontherapy.com/wp-content/uploads/2023/01/10.-Hernandez-and-Waits-2016-Nurse-Education-T oday.pdf

Howe, E. G., Rosenzweig, L., & Shuman, A. (2018). Ethical reflections on offering patients Accelerated Resolution Therapy (ART). Innovations in Clinical Neuroscience, 15(7–8), 32–34. Retrieved August 10, 2025 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145606/

References

International Society of Accelerated Resolution Therapy. (2025, August 10). About IS- ART. https://is-art.org/about/

Kip, K. E., D’Aoust, R. F., Hernandez, D. F., Girling, S. A., Cuttino, B., Long, M. K., Rojas, P., Wittenberg, T., Abhayakumar, A., & Rosenzweig, L. (2016, October). Evaluation of brief treatment of symptoms of psychological trauma among veterans residing in a homeless shelter by use of Accelerated Resolution Therapy. Nursing Outlook, 64(5), 411–423. Retrieved August 10, 2025 from https://acceleratedresolutiontherapy.com/wp-content/uploads/2023/01/8.-ART-for-Homeless-Nursing-Outlook-2016.pdf

Kip, K. E., Hernandez, D. F., Shuman, A., Witt, A., Diamond, D. M., Davis, S., Kip, R., Abhayakumar, A., Wittenberg, T., Girling, S. A., Witt, S., & Rosenzweig, L. (2015). Comparison of Accelerated Resolution Therapy (ART) for treatment of symptoms of PTSD and sexual trauma between civilian and military adults. Military Medicine, 180(9), 964–969. Retrieved August 10, 2025 from https://acceleratedresolutiontherapy.com/wp-content/uploads/2023/01/6.-ART-for-Civilian-and-Military-PTSD-Military-Medic ine-2015.pdf

Kip, K. E., Rosenzweig, L., Hernandez, D. F., Shuman, A., Diamond, D. M., Girling, S. A., Sullivan, K. L., Wittenberg, T., Witt, A. M., Lengacher, C. A., Kadel, R., & others. (2014). Accelerated Resolution Therapy for treatment of pain secondary to symptoms of combat‑related post‑traumatic stress disorder. European Journal of Psychotraumatology, 5, Article 24066. Retrieved August 10, 2025 from https://acceleratedresolutiontherapy.com/wp-content/uploads/2023/01/5.-ART-for-Military-Pain-Eur-J-Psychotraumatology-2 014.pdf

References

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. Retrieved August 10, 2025 from https://acceleratedresolutiontherapy.com/wp-content/uploads/2023/01/3.-ART-for-Combat-PTSD-Mil-Medicine.p df

Kip, K. E., Sullivan, K. L., Lengacher, C. A., Rosenzweig, L., Hernandez, D. F., Kadel, R., Kozel, F. A., Shuman, A., Girling, S. A., Hardwick, M. J., & Diamond, D. M. (2013). Brief treatment of co‑occurring post‑traumatic stress and depressive symptoms by use of Accelerated Resolution Therapy®. Frontiers in Psychiatry, 4, Article 11. Retrieved August 10, 2025 from https://acceleratedresolutiontherapy.com/wp-content/uploads/2023/01/2.-ART-for-PTSD-and-Depression-Frontie rs-in-Psychiatry-2013-1.pdf

Lee, L. (2019). PTSD and aging (PTSD Research Quarterly, 30(4)). National Center for PTSD, U.S. Department of Veterans Affairs. Retrieved August 11, 2025, from https://www.ptsd.va.gov/publications/rq_docs/V30N4.pdf

References

Liddell, B. J., & Jobson, L. (2016). The impact of cultural differences in self- representation on the neural substrates of posttraumatic stress disorder. European journal of psychotraumatology, 7, 30464. https://doi.org/10.3402/ejpt.v7.30464

Mopic. (2020, December 27). Multi cultural society and multiculturalism as a celebration of diverse cultures and diversity or multicultural social unity with people of different races united in a 3D illustration style [Stock image]. Shutterstock. https://www.shutterstock.com/image-illustration/multi-cultural-society-multiculturalism-celebration- diverse-1883527213

National Center for PTSD. (n.d.). Clinician‑Administered PTSD Scale for DSM‑5 (CAPS‑5) [Measurement instrument]. U.S. Department of Veterans Affairs. Retrieved August 11, 2025, from https://www.ptsd.va.gov/professional/assessment/adult-int/caps.asp

National Center for PTSD. (n.d.). Overview of psychotherapy for PTSD [Webpage]. U.S. Department of Veterans Affairs. Retrieved August 11, 2025, from https://www.ptsd.va.gov/professional/treat/txessentials/overview_therapy.asp