Accelerated Resolution Therapy: How It Works & What to Expect

By October 27, 2020 November 19th, 2020 News
Source: Choosing Therapy

 

Accelerated Resolution Therapy (ART) is an evidenced-based, rapid-eye-movement therapy for treatment of trauma, anxiety, depression, sleep problems, self-esteem problems and other issues. Research shows that the course of treatment averages between three and four sessions. The gains made from ART therapy were still in effect 4 months after its conclusion. The cost of this therapy is comparative to most other mental health therapies.

What Is Accelerated Resolution Therapy?

The key concepts of Accelerated Resolution Therapy include memory reconsolidation and smooth-pursuit eye-movements. Together, these techniques help patients deal with issues like trauma, anxiety, depression, or sleep problems.

Memory Reconsolidation

When we remember an emotionally-based memory, one of the natural processes that occurs in our brains is the “unfixing” or malleability of the memory. Scientists refer to this natural phenomenon as “Memory Reconsolidation.” Science has shown that the memory remains “malleable” in a period called the Reconsolidation Window for about 6 hours after recalling it.

During this period, under the direction of the therapist, the client would imaginatively create new images that are peaceful or evoke pleasant feelings and replace the old troubling images that were previously paired with fear, anger, or other distressing emotions.

Research shows that the new images and the accompanying positive feelings are still attached to the memory at follow-up 4 months after the treatment has ended. There are other published studies that show that the replacement images and positive feelings are still present as long as one year later. These improvements suggest that the therapy can be long-lasting.

Smooth-Pursuit Eye-Movements

Another effective ingredient of ART is the use of “smooth pursuit” eye movements. Imagine an audience watching a tennis match, their eyes, gliding back and forth as they follow the ball from one side of the court to the other, This example demonstrates smooth pursuit eye movements. There is evidence that this kind of eye movement, over a period of time, relates to a relaxation response in the brain.

The ART therapist would use their hand, moving it smoothly back and forth at a comfortable distance from the client, and ask the client to keep their head still and just track the hand. This exercise results in the engagement of smooth-pursuit eye movements.

Hypothesis About Eye-Movements

While eye movements have been extensively studied, there is still no definitive “proof” of how they work beyond creating the relaxation response. One popular hypothesis is that when a client is engaging in smooth-pursuit eye movements, they are roughly replicating Rapid Eye Movements (REMs) which occur while we are dreaming. It’s intuitive that dream simulation could somehow be used to solve problems and feel better about them, as indicated by expressions such as “sleep on it, you will feel better in the morning.”

However, when we are asleep and dreaming, much of the rational/thinking part of our brains is asleep. Perhaps this is why our problem-solving capacity while sleeping is limited. Some suggest that while we do ART, all of the brain is awake and participating in the voluntary process of image replacement. The image replacement is thought to automatically cause us to have the peaceful or positive feelings the arise with the new images selected.

Who Is Accelerated Resolution Therapy Right For?

During the initial visit an ART-trained therapist would determine whether ART is suitable for that individual.

The three criteria that the therapist would initially consider are:

  1. Can the individual hold on to a thought (or the theme of the problem) throughout a typical 1-hour therapy session?
  2. Can the individual frequently move their eyes smoothly from right to left and back again throughout the session?
  3. Is the individual truly ready to let go of the symptom or symptoms that motivated them to seek therapy?

How Is Accelerated Resolution Therapy Different From Other Therapies?

ART therapy is a “Manualized” protocol, meaning each therapist is taught how to proceed through an ART therapy session following a step-by-step procedure. The therapist is in control of which step the client is working on and the order of the steps. However, the client is always in complete control of the content of their experience. In other words, when the client is recalling a memory that illustrates the problem they are working on, they have complete control over the details of what they are imagining. In the same way, the client has total control over what new images they select to replace the old images that they do not want to see or experience any more.

Another important distinction is that a client can choose not to tell the therapist parts or all of the problem that they are working on, as well as the imaginative replacements that they think up and use in the recalled memory. If the client wishes, they can speak with the therapist outside of the explanations about the next step in the protocol. The therapist, however, will try and hold the talking to a minimum so that the client has plenty of time in the session to complete the changes that the client makes in their mind’s eye.

Reticent clients may prefer ART. Moreover, talking and sharing about the session can briefly occur in that session and at greater length in a subsequent session if that is what the client wishes.

Is ART Like Hypnosis?

ART is different from hypnosis. The client retains their ability to be consciously aware of their surroundings (externally) and what they are working on (internally). Sometimes clients do report that they feel very relaxed or even a little sleepy during an ART session. It is thought that this may be the natural result of the relaxation of the brain found to coincide with smooth-pursuit eye movements.

Sometimes people feel uncomfortable with the idea of changing images, as well as corresponding feelings, attached to troubling memories in a purposeful way. However, the client is given the information about Memory Reconsolidation to explain the scientific understanding that this is a natural process that we all engage in whenever we recall an emotionally based memory. With ART, we are taking advantage of this natural process and purposefully and consciously selecting replacement images to replace the formerly upsetting ones.

What can Accelerated Resolution Therapy Help With?

As stated above, ART has been found to be helpful in decreasing or resolving symptoms associated with Post Traumatic Stress Disorder (PTSD), pain, depression, anxiety, and issues of self esteem.

The Accelerated Resolution Therapy Website reports encouraging results when therapists use ART for disorders and problems including:

What’s the Goal of Accelerated Resolution Therapy?

The goal of ART therapy is that, in an average of one to four sessions, the client will experience decreased or eliminated symptoms associated with the problem or disorder that they came to therapy to treat. A randomized study of ART used for PTSD demonstrated that 70% of the participants experienced a substantial reduction in their PTSD symptoms. Clients report similar outcomes to problems connected to other issues as listed above.

ART therapists are taught to co-create a goal for the client to reach by the end of each ART therapy session. A typical goal will be that the client will show improvement in a measure called subjective units of distress (SUDs) that they experience from their issue.

Who Is Qualified to Practice Accelerated Resolution Therapy?

Any licensed mental health therapist or medically licensed clinician can be trained to use ART as long as their educational degree has included mental health intervention training for clients and patients who experience trauma. This distinction is made to ensure that the clinician using ART has the right skill-set to ensure the individual’s safety and comfort during an ART session. A listing of all of the different kinds of professional licenses that can receive Continuing Education Credits for the training can be found at the official ART website.

The ART protocol training is offered at three levels. The first level, “Basic Accelerated Resolution Therapy” provides all of the learning and practice necessary for a therapist to competently deliver ART to a client. The Basic Level training is delivered in three 8-hour days. The training includes instructive and experiential components and video examples of an ART session. A certificate of attendance is awarded to therapists who have successfully concluded the three-day training.

If a therapist wishes, they can join the International Society of Accelerated Resolution Therapy and take a quiz in order to be certified as an ART therapist, but this is not necessary to practice ART. The organization also presents the newest advances and practice skills in Accelerated Resolution Therapy at an annual conference.

The next two levels of ART training are called Advanced ART Training and Enhanced ART Training. These levels are not mandatory for ART therapists to take, but they teach ART therapists how to broaden and deepen their capacity to deliver ART to their clients. The additional 2-day training sessions can be taken together or separately.

Finally, for therapists who wish, a training is offered to therapists who have completed all the training and certification and wish to learn how to train other clinicians to include ART in their practice.

How to Find an ART-Trained Therapist

Anyone who is looking for relief from pertinent mental health symptoms may want to find a therapist who has been trained in delivering ART. There are two websites that list ART-trained therapists by state. They are www.artworksnow.com and https://artherapyinternational.org/

Cost & Insurance Coverage for ART Therapy

The cost for treatment with ART is comparable with other mental health therapies such as Cognitive Behavioral Therapy or Client-Centered Counseling. ART has been listed by the American Psychological Association as an approved treatment and therefore insurance can be billed. The listing can be found here. Therapists who accept payment “out of pocket” usually charge from $100 to $200 per session. Some therapists use a sliding scale to determine what the client can afford.

Examples of Accelerated Resolution Therapy

ART therapy is conducted in a clinician’s office while the client sits comfortably in a chair. The first session would be an intake session. The therapist would gather all of the information and history relevant to their formulation of the problem and in selecting appropriate interventions. If the client meets the criteria to do ART, the therapist will explain what ART is, and what is known and unknown about what makes ART work.

Usually the therapist will also give the client a few internet sites and videos to look at to help them make a decision about whether ART is right for them. (See “Additional Resources” for more).

Once the client has agreed to do ART, they are instructed to come up with a memory that illustrates the problem symptoms that they are experiencing and brings them to seek therapy. This may be the “first, worst or last” incident that illustrates the problem. With the therapist’s help, the client will select this memory, which in ART is referred to as the scene. This scene will be the focus of the session.

Next, the client is instructed to gaze out toward a blank wall while they follow the therapist’s hand and engage in the smooth-pursuit eye movements. The ART session is usually as long as a typical therapy session, from about 50 to 90 minutes.

Importantly, ART can be used for very debilitating problems such as symptoms of PTSD. However, ART can also be used for problems that may seem relatively minor, such as a student who struggles with test anxiety or an athlete that is academically underperforming.

Accelerated Resolution Therapy for PTSD

When the indicated problem is PTSD, if the trauma is caused by a single incident such as a car accident or a sexual assault, the scene will be the recalled incident, and all of the circumstances around that incident that the client finds relevant. On the other hand, if the client has experienced numerous traumatic events, such as on-going abuse, the therapist will assist the client in finding themes of these problems, and find a scene to represent each theme. It usually takes about 1 to 3 sessions to work on one theme.

First, the client and therapist agree on the scene to focus on for that day. The therapist then gauges the intensity of the feelings in the present moment while thinking about the scene. Alternatively, if the client wishes to keep their problem and their scene private, once they indicate that they have one in mind, the therapist can still gauge the level of distress.

Second, the client will start following the therapist’s moving hand and do the eye-movements while noticing how these feelings or sensations are experienced in the body. Sometimes the therapist will also invite the client to come up with an imagined tool to help relax these sensations while moving their eyes. Usually this exercise helps to reduce any distress to a manageable level so that the client can move to the next step of the protocol.

Third, the therapist will guide the client back and forth, between these two steps:

  1. The therapist will engage the client in eye movements while imagining the scene that illustrates the problem
  2. The therapist will have the client use the eye-movements to relax any uncomfortable sensations that have arisen while watching their scene

Once the client has completed seeing their scene, they will be invited to see their scene again and change any images or other sensations in their scene that are distressing. ART clinicians call this the Director. In this phase of the protocol, the client is free to change or replace any aspects of the problem scene with positive images and sensations. While the client is informed that they will still remember the facts of the memory, most people who engage in this voluntary image replacement, will retain the positive images and the positive sensations going forward, should something occur that brings up this memory.

Accelerated Resolution Therapy for Test Anxiety

A client who is coming for treatment for test anxiety would be prepared in the same way that was described above. The client would be instructed to find a memory that illustrates their problem of test anxiety. They are asked to find the first, worst, or last memory that is related to this problem.

With the assistance of the therapist, the client would select their scene and would go through the same steps of imagining their scene and relaxing body sensitization that were described above. During the Director they will change any aspect of the test experience to something that would bring relaxation or peace rather than anxiety. For example, they may imagine, with eye movements, taking the exam while sitting on the beach. This author could be a university-based clinician who has much success in aiding students with test anxiety using ART.

Accelerated Resolution Therapy for Eating Issues

A client who is seeking treatment for eating issues would be encouraged to continue specific therapy for this issue. In concert with an eating disorder specialist, ART can be a good augmentation. The same would be true for work with a client with a substance misuse. ART is used as an adjunct therapy and the expectation is that the client will continue their work with a recovery specialist.

For the ART sessions, the client would be prepared in the same way that was described above. The client would be instructed to find a memory that illustrates their problem with eating. They are asked to find the first, worst or last memory that is related to this problem. With the assistance of the therapist, the client would select their scene and go through the same steps of imagining their scene and relaxing body sensitization that were described above. In their positive image replacement scene, they would imagine their day going well without engaging in their eating issues.

Telehealth Delivery of ART

ART can also be delivered through tele-health. It is strongly advised by the developer of ART, Laney Rosenzweig, that the client is accompanied by someone who they feel comfortable with during the session, as an in-person source of support. That supportive person is taught how to do the back and forth hand movements, which the client follows with their eyes, and the rest of the therapy and instructions are conducted by the ART therapist on the internet video session.

Additional Resources for Accelerated Resolution Therapy

If you are interested in learning more about Accelerated Resolution Therapy, visit the following websites:

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