What Does Accelerated Resolution Therapy (ART) Feel Like?

At Sundance this year I saw See You When I See You, a film based on Adam Cayton-Holland’s memoir Tragedy Plus Time. The movie unfortunately hasn’t gotten a public release as I write this, but the memoir is also excellent.

One of the things I loved about both was how concretely they portrayed EMDR. You could actually get a sense of what trauma processing looked like. Not just “he went to therapy and worked through his trauma,” but: What were they doing in there?

And I found myself thinking: I wish people could see Accelerated Resolution Therapy (ART) this way.

ART and EMDR are cousins. Both pair bilateral stimulation with a distressing memory. ART is more structured—there’s a protocol, and a place we’re trying to get to by the end of the session—and it leans much harder on one thing in particular: at a certain point, we start deliberately changing the memory.

Accelerated Resolution Therapy stirs up my old religious evangelism: Oh, that I were an angel, and could have the wish of my heart: that I could cry ART unto every people. I see how much suffering it can relieve, often with a relatively modest investment of time and money, and part of me wishes I could help everyone experience this.

Not because ART is magic. It doesn’t work for everyone. It isn’t where I like to start with complex trauma. There are times when someone absolutely should not be doing intensive trauma processing.

But especially when there is a fairly discrete trauma—or when someone understands something intellectually and their emotions just haven’t caught up—I often think: Why not try it?

When knowing why isn’t enough

A lot of people still picture therapy as mostly talking. You figure out what happened. You understand why you feel the way you do. You notice your patterns. You learn to think about things differently. That kind of top-down work can be enormously useful.

But there are also bottom-up ways of working: therapies that involve what is happening in the body, physical sensations, emotion, imagery, and other kinds of experience that aren’t purely verbal or intellectual.

And sometimes that matters because you already know. You know it wasn’t your fault. You know you’re safe now. You know your spouse is not your father. You know this financial situation is not the terrifying one you lived through fifteen years ago. You’ve understood it to death.

And then the plane door closes, your spouse says the thing, the stock market drops, or somebody mentions cancer, and your body is suddenly behaving as though none of that insight exists. This is one of the situations where I especially like Accelerated Resolution Therapy.

ART can feel to me like we are composting different layers of experience together:

What you know intellectually.
What you feel.
What your body does.
What images arise.

Everything gets turned over together. Insight informs emotion. Emotion informs insight. Something richer can come out the other side.

So what does ART actually feel like?

Showing your brain the problem

You don’t need to do any special preparation for the ART session itself.

We sit facing each other, close enough that I can see your face and you can see mine. You stay awake, sober, and in charge the entire time.

Plan on more time than a standard therapy hour if we can get it. Ninety minutes is often about right.

We work in short stretches. I’ll ask you to bring something to mind, we’ll do a set of bilateral stimulation, and then we stop and you tell me what you are noticing in your body: sensations, emotions. Not the content of the memory. It isn’t one long descent into the memory. It’s a series of passes with a check-in after each one, and I’m talking with you throughout. You are never in there alone.

You will go through the material more than once. Repetition is how the thing works.

You don’t have to tell me the painful nitty-gritty details of what happened if you don’t want to. ART can work without my knowing the whole story. Most of my clients actually do want to tell me quite a bit, and that’s fine too. If I have some idea of what they’re seeing and feeling, it can help me guide them. But you get to decide what you disclose.

Very broadly, we’re going to bring up the thing your brain is still reacting to.

Sometimes that’s obvious: The car accident. The assault. The cancer treatment. The violence you witnessed.

Sometimes it isn’t.

Maybe you have plenty of money now, but spending $100 still feels dangerous.
Maybe your religious beliefs changed ten years ago, but some part of you still keeps a running tally of whether you’re “worthy.”
Maybe your spouse sounds irritated and suddenly you’re responding to them like they’re the unpredictable parent you grew up with.
Maybe a delayed text from someone you’re dating feels like the beginning of the same awful story you lived through with your ex.

Your logical mind knows the present is different. Your emotional system apparently did not get the memo.

And sometimes you don’t know why you’re reacting at all. That’s okay too.

Sometimes the brain knows before you do.

Memories are messy. When we show the brain the problem, sometimes the story comes in order and sometimes it doesn’t. Sometimes a strange detail becomes important. Sometimes something entirely different shows up the next time through.

That’s okay. The brain has a way of showing us what matters.

The most difficult part

Showing your brain the problem is usually upsetting. But we need access to some of the emotional charge in order to work with the memory.

I sometimes compare this to lancing an infected wound. If something painful is trapped underneath the surface, we need enough access to it for healing to happen.

Accelerated Resolution Therapy gives us repeated opportunities to notice what is happening emotionally and physically—the sadness, anger, fear, tightness in the chest, sick feeling in the stomach, pressure in the head, whatever is there—and to use bilateral stimulation as we work back toward a calmer place.

Research on bilateral eye movements gives us some ideas about why this may help, including changes in physiological arousal and in how vivid or emotionally intense a memory feels. We’re still learning why it works.

From the client side, the important part is simpler: we can approach difficult material, notice what comes up, and then help the system settle again.

And something interesting happens as we go through the memory again: the brain starts changing it on its own.

Different details may stand out. Something that wasn’t there the first time shows up. The scene may organize itself differently. Memory just isn’t as fixed as it feels.

Changing what the memory feels like

If you’ve seen the first Inside Out movie, you may remember that memories are stored as orbs colored by the emotion attached to them, and that those colors can change. A memory Riley had carried as purely happy turns out to have sadness in it too, and by the end her memories hold more than one color at once. That’s surprisingly close to what we’re working with here.

Memories aren’t static recordings. You can remember something terrible that happened twenty years ago without experiencing it emotionally exactly the way you did when it happened.

ART works with that natural capacity intentionally.

And this is where, as my colleague Dee-Dee put it when we talked about ART on a podcast, “It definitely feels a little woo woo.”

We deliberately start changing the scene.

You still know perfectly well what really happened. This is not hypnosis. There are no medications involved. You can think, talk, disagree with me, reject my ideas and come up with your own.

But we play with the scene.

Sometimes the bad thing still happens, but this time you have support.
Maybe someone you love is there.
Maybe your older, stronger self comes in and protects the younger you.
Maybe God or another spiritual figure shows up, if that is meaningful to you.
Sometimes the bad thing doesn’t happen at all.
Sometimes the bad guy gets stopped.
Sometimes we abandon reality completely. The accident happens, but instead of hitting something hard, you land on an enormous fluffy mattress. Your logical mind knows there was no mattress. That isn’t the point.

We’re working with what I sometimes call the dream brain—the part of us that understands images and symbols and emotion and doesn’t particularly care whether something could happen in literal reality.

One client once put it especially well: The brain is kinda dumb. Your thinking mind knows the improved version didn’t happen. Emotionally, your system may respond to it anyway.

We’re changing what the memory feels like, not what you believe happened. You know the mattress wasn’t there. Nothing we do is meant to give you new beliefs about the facts, and I’m not going to suggest that something happened to you that you didn’t already know about.

Sometimes, after ART, people even have difficulty bringing the old disturbing pictures back. They still know what happened. The facts are intact.

But the emotional experience is more like: It happened. I made it through. And it isn’t happening now.

What if you don’t see pictures in your head? (Aphantasia and ART)

Some of my neurodivergent clients have aphantasia or limited mental imagery, and sometimes they worry that means ART can’t work for them. Sometimes their ART therapists worry about it too.

I know this one from the inside. My own mental imagery isn’t vivid. ART still works for me.

In my experience, it works fine for clients with limited imagery too. You might narrate the memory internally rather than “watching” it. You might have a sense of what is happening without actually seeing it. You might work more with emotions or physical sensations. Sounds or smells may be much more available than pictures.

Brains represent experience in lots of ways. The memories can still shift.

What if you can’t do the eye movements?

Accelerated Resolution Therapy is usually delivered as an eye-movement protocol: you follow the therapist’s hand as it moves back and forth in front of you.

For a lot of people that’s unremarkable. For some it isn’t.

Maybe you get seizures or migraines and tracking a moving object is a bad idea.
Maybe your eyes don’t track smoothly, or sustained visual focus is genuinely uncomfortable.
Maybe watching someone’s hand while you’re already flooded with emotion is more than you can manage.

Eye movements are one form of bilateral stimulation. There are others—alternating taps, or small handheld devices that buzz side to side. Therapists differ in what they use and what they’re willing to adapt.

If you think this might be an issue for you, ask. The answer will tell you something useful about how a particular therapist works.

What if you can’t tell what you’re feeling? (Alexithymia)

The check-ins depend on you being able to report something about your internal state. Some people find that easy. Others don’t.

If you have alexithymia—difficulty identifying and naming emotions—or you’ve spent a lifetime not paying attention to your body, “what are you noticing?” can be a genuinely hard question. Some people know something is happening but can’t find words for it.

That’s workable. You don’t need emotional vocabulary. Physical sensations are usually easier: tight, heavy, hot, buzzing, pressure, numb. Location works too—it’s in my throat. Comparison works—more than last time, less than last time, different but I don’t know how. And “I don’t know” is real information, not a failure to participate.

It also tends to get easier as we go. Plenty of my clients notice very little the first time through and considerably more the second. That’s normal. Paying attention to your internal state is an unfamiliar skill, and unfamiliar skills take practice. My impression is that the bilateral stimulation itself makes that layer easier to reach. If the first pass feels like nothing, that’s not a sign this won’t work.

Sometimes there isn’t one obvious memory

Not every problem comes with a convenient traumatic scene.

Maybe you grew up feeling fundamentally alone. There may not be one specific Tuesday afternoon that represents that. But perhaps when you imagine what that experience felt like, what comes to mind is being a very small child shivering alone in a cold cave. We can work with the cave.

Sometimes the relevant image comes from somewhere even less literal: a nightmare, a recurring image, something that emerged during another kind of therapy.

I’ve had several clients bring disturbing images that surfaced during ketamine-assisted psychotherapy into later ART sessions. In KAP, the image may have appeared without a clear explanation. In ART, we can deliberately return to it, explore it while the client is sober and directed, and work with what it seems to represent. That often brings insight and resolution.

What does it feel like immediately after?

An ART session itself can be exhausting. People may cry. They may feel grief or anger they’ve been successfully avoiding for years.

But usually people leave feeling lighter rather than cracked open. That containment is one of the things I value about ART.

My own experience of EMDR felt more like opening all the cans of worms at once. The heaviness of what happened long ago intrudes on the rest of life until the processing is done.

ART feels more contained to me. We open only one can of worms and then spend the session processing and integrating the worms in that particular can. Which is an unfortunate metaphor if you think about it too hard, but you get the idea.

Particularly when we have the full ninety minutes, the goal is to work thoroughly with what we opened rather than sending someone back into their week with the can sitting open.

What shifts afterwards in real life

Sometimes what happens afterwards looks very ordinary.

You notice an ache in your body, schedule the appropriate medical appointment, and do not spend the next three days mentally planning your funeral.
You can hear irritation in your spouse’s voice without suddenly becoming twelve years old.
You can be physically present with a safe partner without an old sexual trauma intruding into the room.
You can take a market downturn seriously without emotionally returning to the period when losing $1,000 actually could have been catastrophic.
You can date someone new without making them carry the emotional weight of every toxic person who came before them.
You can walk into a social group without immediately scanning for who is going to humiliate you.
You can buy the damn dishwasher.

One client, who gave me permission to share this, was extremely anxious about an upcoming cruise with her children and grandchildren. Being trapped on a boat frightened her. Flying was also difficult for her. We did ART. She went on the vacation. She had a blast.

Her life got bigger.

That’s the kind of outcome I care about. Not whether someone can give their trauma a distress rating of zero. Can you live your life?

When ART isn’t the right approach

Accelerated Resolution Therapy isn’t where I start with everybody.

People with complex developmental trauma can sometimes go blank as they approach difficult material. Some people would describe this as dissociation. Sometimes clients experience it almost literally as a wall: there is something there, but they can’t get past it.

When that happens, I don’t think my job is to defeat the wall. I encourage the person to send the wall gratitude and compassion: it protected them from something they shouldn’t have had to face. It developed for a good reason.

Sometimes acknowledging that helps it soften. Sometimes it doesn’t.

I respect that. The brain knows what it is ready to process.

These clients may need slower work over multiple ART sessions, or a different way of working, perhaps KAP or NARM. This is actually why I trained in NARM. I wanted good tools for my complex-trauma clients, including the people whose protective systems aren’t going to let us simply walk straight into the painful material.

And sometimes the problem isn’t internal readiness at all. Sometimes someone’s life is actively falling apart. That is not the moment to excavate trauma. If a fire is actively burning, you put out the fire. Later you can do the post-mortem about why there was a fire and what might prevent the next one.

Why not?

The accelerated in Accelerated Resolution Therapy is there because ART was developed as a brief trauma-processing treatment.

Complex trauma is complex. But relatively discrete trauma really can shift surprisingly quickly.

And that is part of my “why not?” attitude toward this. If you find an ART therapist who takes your insurance, you may be looking at an intake plus a longer trauma-processing appointment for a couple of copays. Even at cash-pay rates, a few hundred dollars and a few hours can be a very reasonable investment if the alternative is continuing to organize your life around something that happened years ago.

A word about the research: ART’s evidence base is young and thin. A 2024 systematic review by independent researchers found only five studies, two of them randomized. Nobody has yet published a head-to-head trial of ART against the established first-line treatments, so I can’t tell you it works better than they do.

What those studies did find: everyone got better. Symptom reductions were large and consistent, along with improvements in depression, anxiety, and sleep. Reported harms were minor. The reviewers concluded that ART shows real promise, with little risk of harm and a reasonable investment of resources.

What I can tell you is that the better-studied options—prolonged exposure, CPT, trauma-focused CBT—typically run twelve to sixteen sessions and ask a great deal of the person doing them. Most people in the ART studies finished in under four. That difference matters if the alternative is not getting treated at all.

I hope the research continues. I’d like to know more than I currently do.

No one therapy works for everyone. And sometimes what looked like a simple problem turns out to have more layers underneath it.

But this is why ART brings out my old evangelist. I hate the idea of somebody spending ten years avoiding the yard, or the airplane, or dating, or sex, or spending perfectly affordable money, because they don’t know that therapies like this exist.

There are ART-trained therapists all over the country. Find an ART therapist near you. I want more people to know they have options.

Sometimes something terrible happened. You made it through. And your brain may be able to learn that it is over.