How Accelerated Resolution Therapy Differs from Prolonged Exposure Therapy

  In her Tedx talk “The Power of Rapid Eye Movements”, ART certified therapist Yolanda Harper paints a picture of a typical experience of a PTSD patient receiving treatment with prolonged exposure therapy:

“Tell me about war.”
“I was in Vietnam; people are dying.”  

More detail is required here to illustrate a full experience. 

“… I was on patrol at daybreak in the jungles of Vietnam, sweat was dripping from my body. I could smell Napalm in the air. There were shots in the distance, sounds of agony and torture. I look up and see a comrade hanging from a tree, his flesh dangling from his bones. My heart was racing, I felt sick to my stomach, I thought I was going to die.”

  After this recap, the patient must tell the story repeatedly until enough detail has been reached. In her early days of training, Harper recounts the discomfort felt as a practitioner in hearing such events both on behalf of her patient and as a fellow human being. However, frequent recounts of the traumatic event are required in Prolonged Exposure therapy and required for treatment.

What is Prolonged Exposure Therapy?

  Prolonged Exposure therapy is often used in Cognitive Behavioral Therapy to encourage individuals to face specific traumatic events “head on”, overriding the patient’s tendency to avoid anything that reminds them of the trauma. 
These sessions are often very anxiety-producing. A therapist must work intensely to ensure a safe environment is provided for the client while the client learns about how their trauma manifests in day-to-day life and helpful coping mechanisms for when it arises.
Prolonged Exposure therapy is typically performed weekly over three months with 90-minute individual sessions and uses two main elements: Imaginal Exposure and In vivo exposure. 

 Imaginal Exposure describes events in detail as if they were occurring in the present. With the assistance of the therapist, the patient will be prompted to process the arising emotions. The therapist will have the client repeat the story of the distressing event again and again until enough detail has been added. The session is recorded and the client is given the assignment to listen to the session multiple times a week.  
 In vivo exposure is the part of the therapy that earns the title “Prolonged”. As with any exposure-based treatment, the client is instructed to enter into environments and situations that trigger painful memories in order to develop practice coping with the discomfort and practice calming breathing techniques and awareness of how the trauma influences perceptions.  The patient and therapist pinpoint which triggers and situations to address in between sessions.  

  Harper noted how potentially painful, difficult, and retraumatizing prolonged exposure therapy was for the client. This seemed counterintuitive to her role as a practitioner whose job it is to arrange a safe space to encourage the healing process.  She found PE did not suit her style and looked for a more compassionate and less invasive way of working with clients.

How is ART different from Prolonged Exposure Therapy?

  Like Prolonged Exposure Therapy, ART uses Imaginal Exposure, where the patient is required to recall the traumatic instance over and over again as part of continuous Exposure. Unlike prolonged Exposure Therapy, the patient is not required to share out loud the details of their experience. When discomfort and physiological sensations occur, the therapist may use a number of different effective therapies or rapid eye movement to reduce the sensation.  

 Next, the therapist will engage the patient in imagery rescripting. In this stage the patient will imagine a new, more attractive way to visualize their event as if they were the director of their own movie, exercising their ability to rewrite the ending using one of ART’s many metaphorical scripted interventions. The combination of eye movements and the memory rewrites allows memory to become changeable in a short amount of time, while the old, traumatic memories are weakened. As a result, cognitive distortions that occur from the trauma are counterbalanced and emotional numbing, hypervigilance, fear, and avoidance are eliminated or greatly reduced.

Unlike Prolonged Exposure therapy, the process can be done without “homework” and no continuous exposure to triggering events as assignments. Results can be found in as little as one to five sessions, unlike the standard once a week for three months in PE.

Promising studies at the University of South Florida have been done to grant the title “evidence-based” regarding the efficacy of ART. Practitioners and clients have delivered positive testimonies regarding the results of the practice.
Harper recounts in her talk the personal success through practicing ART in her own life, reaching levels of peace she had not experienced before.  In her practice, she witnessed her clients, including victims of animal attacks, injuries, and sexual assault, regain peace, strength, and hope for the future, all without the potentially uncomfortable retraumatization from Prolonged Exposure therapy.

Watch Yolanda Harper’s Tedx talk “The Power of Eye Movements: The ART of Accelerated Resolution Therapy.

If you are interested in working with an ART-trained therapist visit https://artworksnow.com/therapist-directory/ to find a practitioner in your area.

Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770710/#R33
https://www.apa.org/ptsd-guideline/treatments/prolonged-exposure
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770710/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770710/#R31
http://acceleratedresolutiontherapy.com/wp-content/uploads/2016/08/ART-vs-EMDR_by-Hoge.pdf
https://positivepsychology.com/accelerated-resolution-therapy/
https://academic.oup.com/milmed/article/183/9-10/e314/4959949
https://www.is-art.org/research-and-evidence/