civilian run programs: an alternative to traditional mental health care for veterans

Accelerated Resolution Therapy: A Different Psychotherapeutic Approach to Trauma

Many individuals continue to suffer from, or be susceptible to psychological trauma in the form of Post-Traumatic Stress Disorder (PTSD) following traumatic events.

This disorder can go on to permanently mar the lives of its victims, with one prone demographic being army or military personnel and/or veterans. Such individuals are prone to substance abuse, anxiety and panic disorders, and an elevated risk of suicidal ideation and behaviors.

While the Veterans Association (VA) and much of the mental health community has advocated and utilized various forms of cognitive behavioral therapy (CBT), such as prolonged exposure and cognitive processing therapy, these therapies have suffered from the caveat of having high drop-out rates because of their lengthy duration.

They have not had the effectiveness they should have in addressing PTSD in military personnel and other sufferers of trauma. As a result, to address such caveats, a different approach was formulated in 2008 by marriage and family therapist, Laney Rosenzweig, one which is garnering growing interest: that of accelerated resolution therapy (ART).

What ART Entails

To add context to ART, one must remember that each time we recall a particular memory, there is always some degree of modification that takes place. The content of the memory itself, and our emotional response to it are not set in stone. Therefore, introducing a novel stimulus during memory activation, such as incorporating new information, provided that it is done during a crucial ‘reconsolidation window’ (of approximately six hours), can actually alter the same memory.

This reconstructive malleability of memory may manifest at the neurobiological level because of plasticity of neurons within the dentate gyrus of the hippocampus, the crucial brain structure for memory consolidation (Quirk & Sotres-Bayon, 2009; Redondo et al., 2014). ART follows such logic by reprogramming how traumatic events and memories are stored in the brain.

It utilizes imaginal exposure and imagery re-scripting, in tandem with analysis of bilateral left-right eye movements, to modify memories of events.

Imaginal exposure, as its name suggests, entails having the patient recollect, to the best of his or her ability, the details of the event, while concurrently monitoring their physical, emotional, and cognitive responses to it.

Patients are guided by the therapist to be in an attentive but relaxed frame of mind, before being exposed to the memory during a short burst of time. They are then asked to elucidate their physical and emotional symptomatology during the event. This alternating between recollection and detection of symptoms during the memory episode is a crucial, first part of generating both an ephemeral exposure to the event, as well as pinpointing the specific source of trauma and the crippling effects it poses.

This step is followed by imagery re-scripting, whereby the negative elements of the memory itself are actually replaced with more positive elements. This point is where the malleability of memory reconsolidation during that ‘reconsolidation window’ comes into play.

You are not just suppressing the traumatic memory, but you are changing and reframing it such that it is stored in a different way going forward. The notion behind such an approach is that traumatic memories can lose their deleterious effects if incorporated with more positive elements. This way, the negativity of the memory is stymied, and hence, it loses its potency as an instigator of trauma (Boterhoven de Haan et al., 2017; Kip et al., 2014).

A key tenet to ART is that throughout the therapy, saccadic eye movements are elicited from the patient by the therapist, which are monitored both during imaginal exposure and imagery re-scripting. Unlike various forms of CBT, ART draws on the theory of eye movement desensitization and reprocessing (EMDR) therapy, which states that bilateral stimulation through saccadic eye movements can elicit a reduction in the unpleasant emotions associated with recollecting traumatic events.

There has actually been evidence suggesting that eye movements lower the vividness and emotional arousal associated with traumatic subjective memories (Barrowcliff et al., 2004).

There are a number of potential explanations, although a clear-cut mechanism by which eye-movements ameliorate such memories remains elusive. One such hypothesis suggests that performing a task like moving the eyes, while retrieving an emotional memory, actually taxes working memory, interfering with the storage of the information, and reduces vividness of the recollected event.

This process allows for the traumatic memory both to lose its intrusive, unpleasant elements, as well as to make it more susceptible to modification during imagery re-scripting (Lee & Cuijpers, 2013).

Comparison to Other Therapies

Unlike other conventional forms of therapy such as CBT, ART does not require repeated exposure to events, or homework, and has been demonstrated to exhibit beneficial results in only three to four sessions, each lasting approximately one hour, for over approximately two weeks. It’s a much more rapid effect when compared to therapies such as cognitive processing therapy and EMDR, which require at least 10 sessions, each of 90 minutes.

Additionally, unlike prolonged exposure therapy, which merely serves to extinguish the emotional response to the traumatic memory, ART actually alters the traumatic memory itself. This allows for the same benefit of eradicating the negative emotional response, while also allowing for the patient to shape the memory into something positive.

ART seems to incorporate elements from various CBT therapies, as well as the eye movement element of EMDR therapy. However, in its favor over EMDR therapy is that uses a specific number of eye movements (40) as opposed to the variable EMDR, making it easier to follow.

Additionally, ART focuses more on sensations, emotions, and the imagery of the memory as opposed EMDR, which focuses on the contents of the memory, making ART much more patient-oriented (Finnegan et al., 2015).

What the Future Holds

Given its rapid effect, as well as the fact that it incorporates elements from both cognitive and eye movement therapies, ART appears to be a very promising therapy going forward. The fact that it has not been the go-to therapy for psychological trauma is a manifestation of its sheer infancy, having not existed for more than 10 years.

Moreover, it is potentially beneficial in treating a number of conditions comorbid with PTSD, such as panic disorders, generalized anxiety disorder (GAD), and even substance abuse.

Going forward, more research will be needed to corroborate the apparent rapid effectiveness of ART. Particularly, more empirical studies utilizing and analyzing neural imaging and/or physiological responses should be conducted to better elucidate the biological bases underlying why ART seems to be effective in combating trauma and related psychological conditions.

However, findings thus far bode well for ART, which could have a crucial long-term impact on military personnel, survivors of war, survivors of mass shootings, and even victims of sexual assault or severe accidents. All of such individuals constitute a huge portion of the population and ART could be another instance of advancement in the field of psychology having marked, clinical, real-world implications.

Accelerated Resolution Therapy: A Different Psychotherapeutic Approach to Trauma