What are your thoughts on Accelerated Resolution Therapy?

Question

Recently I came into contact with my aunt, and it seems she has been doing very well. She has been developing a therapy technique that, she claims, helps resolves psychological problems from trauma, child abuse, domestic abuse, et cetera. She calls it Accelerated Resolution Therapy.

The essential thesis of her technique is that the problems caused trauma are being dealt with incorrectly. Therapists often try to help a patient deal with the facts of the situation. They help them understand what happened, why it happened, and why what happened should not impair their life. Unfortunately, therapy can often be slow in progress and some people never fully recover from a traumatic event. My aunt's therapy technique essentially discards the old method of dealing with facts and, instead, deals with memories and pictures. Coming to terms with facts, from a rational and conscious perspective, is usually achievable. But, for my aunt, the problem aren't the facts but the images revolving around those facts. Even when a person comes to understand their trauma, they still will suffer from depression, anxiety, and other psychological problems.

What she essentially does is encourage the patient to change the images to more positive, or, at the very least, into neutral memories. She does encourage them to change their knowledge on the matter; but, rather, she simply changes the physical memory into something less traumatic. The patient will still understand that they were wronged and hurt, but the image of the pain will be removed.

Usually I'm very skeptical with new therapy techniques and any practice that claims to solve problems within 2 or 3 sessions, but it honestly makes a lot of sense. It reminds me of ghost limbs and mirror therapy, and how placing a mirror next to a limb, in tact, will help a patient be relieved of his pain. He understands, clear as day, that he is missing a limb, but the physical image of having two limbs and seeing the limbs move removes many of the psychological problems associated with ghost limbs.

She has had peer reviewed studies and is encouraging training. So, what do you all think? Does it sound like it has potential, or is it just snakeskin oil?

Here is one study showing that patients experience relief from their symptoms within 1-5 sessions.

And another study. Another study. And another.

Answer 1

My concern is that there are many therapies being broadly promoted without sufficient evidence of effectiveness and this one is calling itself 'evidence-based". I worry that time and resources are being invested and that clients are being promised amazing, if not unbelievable, benefits. Clients may not be sophisticated consumers and I would hate for them to be misled by such inflated claims. I believe that we have a duty to be skeptical before jumping on board the 'next best thing' bandwagon. After all, much harm has been done in the past by advocates of sham therapies (think 'the schizophrenogenic' mother and Bateson's 'double bind' theory of schizophrenia and therapies endorsed by Jay Haley et al).

Taken directly from the ART website:

"Accelerated Resolution Therapy is a form of psychotherapy with roots in existing evidence-based therapies but shown to achieve benefits much more rapidly (usually within 1-5 sessions). Clients with depression, anxiety, panic attacks, post-traumatic stress disorder (PTSD), substance abuse, sexual abuse and many other mental and physical conditions can experience remarkable benefits starting in the first session."

It is surprising to me that this treatment - 'Accelerated Resolution Therapy' (ART) would even be recognized by SAMHSA [https://nrepp.samhsa.gov/ProgramProfile.aspx?id=7#hide4] as an evidence-based treatment. The data on ART is limited to 1 small sample RCT in which ART was compared to an attentional placebo, not a credible alternative treatment. Standards promulgated by APA Divison 12 based on Chambless and Hollon (1998, p.8) require at least two well controlled studies be conducted- (one ideally independent of the original investigators)

"As is the case in research in general, replication is critical, particularly replication by an independent investigatory team. The requirement of replication helps to protect the field from drawing erroneous conclusions based on one aberrant finding. Replication by an independent team of investigators also provides some protection against investigator bias or reliance on findings that prove unique to a particular setting or group of therapists. Thus, only when a treatment has been found efficacious in at least two studies by independent research teams do we consider its efficacy to have been established and label it an efficacious treatment [highlighting added]. If there is only one study supporting a treatment's efficacy, or if all of the research has been conducted by one team, we consider the findings promising but would label such treatments as possibly efficacious, pending replication." (p.8)

As noted in the single RCT manuscript (Kip et al., 2013) itself:

"A limitation is that the ART intervention was not compared to an active psychotherapy regimen, such as PE. Thus, no direct comparison of treatment efficacy of ART versus current firstline treatments (PE, CPT, and EMDR) can be made. Second, by design, the AC group was not parallel in contact hours to the ART intervention. " (p.1307)

This is pretty limited evidence on which to promote a new treatment. It was also surprising to me that:

1. the 'intervention' itself can be delivered delivered in as little as 2-5 60-75 minute sessions [as little as 120 minutes of an active intervention!]; and
2. the training and supervision of clinicians was limited as follows: "Clinicians were trained in ART over 2 days using the ART manual and supervised practice."

It is even more baffling that this intervention could be so highly effective with complex clients who have PTSD and multiple comorbid disorders. Here's what the ART website says:

Clients with depression, anxiety, panic attacks, post-traumatic stress disorder (PTSD), substance abuse, sexual abuse and many other mental and physical conditions can experience remarkable benefits starting in the first session. (highlighting added)

"In ART, the eye movements are thought to be conducive to sorting out problems quickly through increasing the integration of activities in the left and right sides of the brain. These movements also seem to help the client process information by producing a deep feeling of relaxation. Yet ART is not hypnosis. and

Importantly, clients do not even have talk about their traumas or difficult life experiences with the therapist to achieve recovery.

[downloaded from http://acceleratedresolutiontherapy.com/.]

Does this seem like a reasonable explanation of a therapeutic mechanism to you?

Given the fact that this was a small sample RCT compared against a non-credible attentional placebo, how do we know that these findings are not simply the result of positive investigator/clinician expectancies and essentially a placebo effect unrelated to any of the hypothesized mechanisms of treatment?

It is so attractive to belief that there are fast, easy and extremely effective treatments that require virtually no training or supervision vs. well-established treatments that are so difficult to master and deliver with fidelity and require intensive training and supervision [in the VA, clinicians might achieve competency in CBT if they complete a 3 day workshop combined with at least six months of weekly 90 minute supervision sessions on cases with bi-weekly submissions of tapes rated on the CTS.].

I did find the material on the ART website rather disturbing in terms of inflated claims of efficacy with testimonials from individuals to the effect that 1 hour of ART fully resolved their longstanding complex psychological problems when no previous therapies had been effective. If I made these types of claims on my website I would be in violation of the APA ethics code.

I do have a personal 'iron in the fire' in the sense that I devote a lot of my time to training and supervising clinicians in CBT and it is a difficult , resource intensive and time consuming process to achieve competency as a CBT clinician, let alone to be able to treat highly complex patients with co-occurring illness. In my own daily therapy practice I try to adhere closely to good CBT practices and I strive to improve my efforts with results that periodically fall short of my high expectations.

I look forward to seeing additional data on ART and it would be absolutely wonderful if additional studies-- controlled trials where ART is compared to a credible alternative therapy (CPT or PE) confirm these initial findings-- because this would be wonderful for patients.

In the meantime, I worry that we are investing our time chasing mirages instead of investing in and delivering established effective evidence-based treatments to our patients.

Answer 2

This sounds suspiciously like Neuro Linguistic Programming:

Changing the point of view from which a memory is viewed has a profound impact on a person’s understanding and emotional response to the content of the image. A variety of specific ways of changing visual perspective are presented, including the important distinction between associated images (seeing out of your own eyes) and dissociated images (seeing from an outside point of view). The therapeutic usefulness of these understandings in the treatment of phobias and couple and family problems is indicated. - Neuro-Linguistic Programming (NLP): Changing Points of View.

While NLP is now considered a pseudo-science, I do believe some of its beliefs and findings have been examined further to create some modern techniques under the framework of recent evidence based treatments.