Atlas›Domain VI · Brief, integrative, trauma, hypnosis & coaching›Guide 047
Guide VI-047

Accelerated resolution therapy

Laney Rosenzweig2008USA
A 21 · L 48 · M 3116 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: ART as manualised for the University of South Florida (USF) research programme (Kip, Rosenzweig et al. 2012; Kip et al. 2013), with the 2018 complicated-grief adaptation (NIH R21 protocol) and the developer's 2025 introductory presentation. The proprietary ART training manual and fidelity checklist (Rosenzweig Center for Rapid Recovery, RCRR) were not available to open; anything they contain beyond what the papers report is marked [uncertain].

Accelerated Resolution Therapy (ART; "ART" and "Accelerated Resolution Therapy" are registered trademarks of RCRR) was developed by Laney Rosenzweig, LMFT, and introduced in 2008. It is a brief, procedural, exposure-based trauma therapy that combines imaginal exposure and imagery rescripting with fixed sets of therapist-guided lateral eye movements. The authors describe it as drawing on cognitive-behavioural, experiential (Gestalt) and psychodynamic elements. [source: Kip et al. 2012; Kip et al. 2013 Frontiers; Rosenzweig 2025 UTA slides]

Core idea of change (as the developers state it): symptoms are driven by stored distressing images and bodily sensations, not by the facts of what happened. Rosenzweig's slides put it as "Facts in themselves don't cause symptoms." The client recalls a scene while doing eye movements, and separate eye-movement sets clear the physical sensations it brings up. The client then deliberately replaces the distressing images with preferred ones (Voluntary Image Replacement, VIR), while the factual (narrative) memory stays intact. The USF authors frame this as memory reconsolidation: lowering arousal while the memory is active lets it be re-stored in a less charged, better-integrated form. They state that cognitions shift on their own once images and sensations change. These are the developers' explanatory claims, not established mechanisms. [source: Kip et al. 2012; Kip et al. 2013 Frontiers; Rosenzweig 2025 UTA slides; NIH R21 protocol 2018]

2. Framework

Format. Individual, face to face, 60–75 minutes per session (research protocols). Research courses ran 1–5 sessions over about 3 weeks, with a mean of about 3.5–3.7 sessions. The 2018 grief protocol set a standard dose of 4 weekly sessions and reassessed symptoms after each. Rosenzweig's 2025 slides say a single past trauma often resolves in one session, while ongoing problems (e.g. substance use, eating disorders, OCD) may take 1 to more than 5 sessions; these are the developer's claims. [source: Kip et al. 2012; Kip et al. 2013 Frontiers; Kip et al. 2013 Mil Med abstract; NIH R21 protocol 2018; Rosenzweig 2025 UTA slides]

ART is not organised in multi-session phases. Its unit is a single session that processes one or more scenes. The stages below come from the published session structure, with the course-level logic added.

Stage A: Intake and screening (first contact, usually before or at the start of session 1).

  • Goals: confirm a trauma-related target, rule out exclusions, get informed consent and explain the procedure. The client is told they need not describe trauma details aloud.
  • Move on when there are no exclusions (see section 5), the client can follow eye movements, and at least one target scene has been identified.
  • [source: Kip et al. 2012; Kip et al. 2013 Frontiers; Rosenzweig 2025 UTA slides; Blueprint (secondary)]

Stage B: Within-session processing of a scene (repeated each session; up to about 3 scenes per hour). The 8-step order reported by Kip et al. 2012:

  1. Baseline SUDS (0–10).
  2. Discuss how VIR will be applied to the target scene(s).
  3. Imaginal exposure to the scene with sets of eye movements, alternating with separate sets that process body sensations.
  4. A therapist-directed creative intervention from the ART manual to achieve VIR.
  5. Recall the original scene and compare it with the new scene to check the response.
  6. Discuss expected future triggers, and use an ART intervention to reduce any that are found.
  7. Closure assessment, including naming other traumatic memories for later sessions.
  8. Closing SUDS.

[source: Kip et al. 2012]. In the 2018 grief protocol, clients went through two full courses of exposure-plus-sensation processing before rescripting began. [source: NIH R21 protocol 2018]

Criteria for moving within the session.

  • Rescripting starts once physical reactions to the scene have been processed and reduced.
  • After rescripting, the original scene is recalled again to confirm that distress is low and the new images come up.
  • Future-trigger work follows.
  • A session closes after the closure assessment and closing SUDS.

The sources do not give an exact SUDS threshold for starting rescripting [uncertain]. A secondary source suggests continuing eye-movement sets until SUDS is about 2 or below [uncertain; secondary]. [source: Kip et al. 2012; NIH R21 protocol 2018; Blueprint (secondary)]

Stage C: Course progression and ending.

  • Treatment targets an average of about 3 representative scenes. The authors report that effects generalise to related scenes.
  • New scenes that come up during processing are added to later sessions.
  • Treatment ends when the client reports significant or full relief from symptoms tied to the targeted memories.
  • Track progress with a standard symptom measure each session (the trials used PCL-C/PCL-5, CES-D and, for grief, the ICG).
  • [source: Kip et al. 2012; Kip et al. 2013 Frontiers; NIH R21 protocol 2018]

Training and fidelity.

  • USF therapists had two 8-hour days of training from the developer. Training covered theory, protocol, intake, intervention techniques, the eye-movement regimen, challenges and solutions, and closure techniques. Directly observed supervised practice followed.
  • After each session, therapists completed a 42-item ART fidelity checklist.
  • Current RCRR training is open to licensed clinicians and master's students (Rosenzweig 2025). Its present length and levels were not verified [uncertain].
  • [source: Kip et al. 2012; Kip et al. 2013 Frontiers; Rosenzweig 2025 UTA slides]

3. Guiding principles

  • Procedural and therapist-directed, not free-associative. Follow the set sequence and the manual's standard interventions; do not improvise open-ended association as in EMDR. [source: Kip et al. 2012; Kip et al. 2013 Frontiers]
  • Images and sensations, not facts, are the target. Keep attention on what the client sees and feels in the body, not on the story or its meaning. [source: Rosenzweig 2025 UTA slides; Kip et al. 2012]
  • No need for the client to voice trauma details. Exposure can be silent ("verbally or nonverbally"), so the client can process without telling you the content. [source: Rosenzweig 2025 UTA slides; NIH R21 protocol 2018]
  • The therapist is a guide. The client produces the new images; you structure, prompt and check. [source: Rosenzweig 2025 UTA slides; Kip et al. 2012]
  • Replacement is voluntary and client-authored. Never supply or impose the replacement scene; the client chooses what they would rather see. [source: Kip et al. 2012]
  • The narrative memory is preserved. The client still knows what happened; only the images and their charge change. Say so explicitly so the client does not fear "forgetting" or falsifying events. [source: Kip et al. 2012; Kip et al. 2013 Frontiers]
  • Fixed dose of eye movements. Sets are a fixed size (40), not varied by the therapist. [source: Kip et al. 2012; Kip et al. 2013 Frontiers]
  • Clear the body thoroughly. After every scene set, run a separate set for physical sensations; ART spends more time on sensations than EMDR does. [source: Kip et al. 2012; Kip et al. 2013 Frontiers]
  • Brief by design, with ongoing measurement. Aim to resolve each scene in-session, reassess symptoms every session and stop when relief is reported. Do not extend by default. [source: Kip et al. 2012; NIH R21 protocol 2018]
  • Imaginative and metaphorical work is central. Rescripting and metaphor are the main change tools after arousal reduction. [source: Waits et al. 2017 abstract]
  • Safety overrides protocol. Pause the session for heightened distress, use counselling and relaxation, and escalate care for suicidality or instability. [source: NIH R21 protocol 2018]
  • Memories are the client's experience, not evidence to uncover. Work only with memories the client already holds. Do not use ART to search for, "recover" or verify memories, and treat rescripted images as chosen imagery, not as fact. [synthesis, consistent with ART's stated preservation of narrative memory]

4. Intervention inventory

Scope note: the published papers name ART's components and their order. The scripted wording and the full set of named "creative interventions" are in the proprietary RCRR manual, which is not drawn on. Interventions below are limited to those the sources name. Where a source names a technique without describing it, the entry says so and gives only a generic [synthesis] frame. All example language is illustrative wording written for this guide, not ART manual text. Formal ART practice requires RCRR training. [source: Kip et al. 2012; Kip et al. 2013 Frontiers]

4.1 Intake, screening and orientation

  • Purpose / when: Before any processing. Confirm suitability, get consent and set expectations, including that details need not be disclosed.
  • Steps:
    1. Take a trauma and symptom history. Use a standard measure (the trials used PCL-C or PCL-5, plus CES-D for depression).
    2. Screen for the research exclusions: current suicidal or homicidal ideation; psychosis or acute crisis; a major psychiatric disorder (e.g. bipolar disorder, schizophrenia) that is primary to the trauma; current substance-use treatment or active dependence; brain injury that prevents speech, writing or purposeful action; an eye-movement disorder (e.g. amblyopia); and medical conditions that heightened emotion could make risky (e.g. prior heart attack, seizure disorder).
    3. Ask clients not to take PRN sedating medication right before a session; they may bring it with them. Do not change prescribed medication.
    4. Explain the procedure: eye movements, 60–75 minute sessions and the usual brief course. Explain that the client controls what is said aloud and that the factual memory will remain.
    5. Get informed consent. [source: Kip et al. 2012; Kip et al. 2013 Frontiers; NIH R21 protocol 2018; Blueprint (secondary)]
  • Example language (illustrative): "You won't need to tell me what happened. I'll ask you to picture it and follow my hand with your eyes. You'll still remember the facts; what we're working on is how the pictures and your body react."
  • Watch for: dissociation or poor reality testing; current crisis; whether the client can track a moving hand comfortably. Severe dissociation calls for stabilisation or another approach first [source: Blueprint (secondary)]. Also screen for current danger, such as ongoing abuse, which should be addressed before trauma processing [synthesis].

4.2 Baseline SUDS and target-scene selection

  • Purpose / when: At the start of each session, to anchor measurement and choose what to process.
  • Steps:
    1. Ask for a 0–10 SUDS rating.
    2. Agree on a specific scene, meaning a distressing memory with an identifiable beginning and end. Over the course, aim for a few representative scenes (about 3 on average) rather than every incident.
    3. In grief work, limit scenes to those tied to the death.
    4. Note any further memories for later sessions. [source: Kip et al. 2012; Kip et al. 2013 Frontiers; NIH R21 protocol 2018]
  • Example language (illustrative): "Pick one scene that stands for the worst of it. You can just give it a label, like 'the hallway.' Where's your distress right now, 0 to 10?"
  • Watch for: a target that is too broad (a whole period of life). Narrow it to one scene [synthesis].

4.3 Preparing for Voluntary Image Replacement (VIR)

  • Purpose / when: Before exposure, so the client knows a rescripting step is coming and agrees to it (step 2 of the session).
  • Steps:
    1. Explain that once the body reaction to the scene has settled, the client will be invited to create the version they would prefer to see.
    2. Explain that the factual memory stays.
    3. Answer questions about what "replacing" means. [source: Kip et al. 2012]
  • Example language (illustrative): "Later, you'll get to change what you see in that scene however you like, like editing a film. You'll still know what really happened."
  • Watch for: fears of falsifying the past or betraying someone, especially in grief. Address these before proceeding [synthesis].

4.4 Eye-movement sets (the delivery mechanic)

  • Purpose / when: Throughout exposure, sensation processing and other ART steps. The developers' stated aim is to reduce arousal while the memory is active.
  • Steps:
    1. Sit facing the client at a short distance.
    2. Move your hand smoothly left and right at the client's eye level. The client follows it with smooth-pursuit lateral eye movements, keeping the head still.
    3. Use a fixed set size of 40, not varied.
    4. After each set, check in briefly. [source: Kip et al. 2013 Frontiers; Kip et al. 2012; NIH R21 protocol 2018] Hand speed, whether "40" counts single passes or full cycles, and the use of any slower relaxing sets were not specified in the sources [uncertain]. A secondary source gives sets of about 30–40 seconds [uncertain; secondary].
  • Example language (illustrative): "Keep your head still and just follow my fingers with your eyes."
  • Watch for: eye strain, headache, dizziness or light-headedness, which were reported as minor events in the trials. Stop if the client cannot track, has eye pain, or has seizure risk [source: Kip et al. 2012; synthesis for the stop rule].

4.5 Imaginal exposure to the scene

  • Purpose / when: The first processing step for each target scene.
  • Steps:
    1. Ask the client to recall the scene from beginning to end, silently or aloud as they prefer, while doing a set of eye movements.
    2. Ask the client to notice the physical reactions that come up.
    3. After the set, ask briefly what they noticed, mainly in the body. Content is optional.
    4. Alternate scene sets with sensation-processing sets (4.6) until the client can go through the scene without notable physical reaction.
    5. The 2018 grief protocol specified two full courses of exposure plus processing before rescripting. [source: NIH R21 protocol 2018; Kip et al. 2012; Kip et al. 2013 Frontiers]
  • Example language (illustrative): "Start at the beginning and run the scene to the end in your mind while you follow my hand. You don't have to say anything. When we stop, just tell me what you notice in your body."
  • Watch for: distress levels, breathing, and signs of dissociation (glazed look, delayed responses). A drop in physical reactivity and SUDS across passes shows the step is working. If the client gets stuck partway, see section 5.

4.6 Sensation processing (body-focused eye-movement sets)

  • Purpose / when: Immediately after each scene-focused set. The developers' aim is to remove the physical sensations linked to the memory; they describe this as a shift from sympathetic to parasympathetic arousal.
  • Steps:
    1. Ask where in the body the client feels a reaction.
    2. Have the client focus on that sensation, not the scene, during the next set.
    3. Repeat until that sensation is gone or minimal.
    4. Move to any next sensation, then return to the scene. ART gives these sets considerably more time than EMDR. [source: Kip et al. 2012; Kip et al. 2013 Frontiers; NIH R21 protocol 2018]
  • Example language (illustrative): "Where do you feel it? ... Just put your attention on that tightness in your chest and follow my hand." Then: "What's there now?"
  • Watch for: sensations moving location, which is common; continue until they settle. Rosenzweig claims cleared sensations do not return [source: Rosenzweig 2025 UTA slides]. Treat that as the developer's claim and check again at the next session [synthesis]. Medically unexplained or new pain should be referred for medical assessment, not processed away [synthesis].

4.7 Voluntary Image Replacement / imagery rescripting

  • Purpose / when: After physical reactions to the scene have been reduced. This is ART's central change step.
  • Steps:
    1. Invite the client to create a "solution": the way they would prefer to see the scene, using any images or senses. The new images may be positive, imaginative or symbolic.
    2. The client may describe the new scene or keep it private.
    3. Run eye-movement sets while the client imagines the new version, from beginning to end.
    4. The therapist guides with standard creative interventions from the manual (see 4.8–4.10) but does not author the content.
    5. The narrative memory is not changed. [source: Kip et al. 2012; Kip et al. 2013 Frontiers; NIH R21 protocol 2018]
  • Example language (illustrative): "Now that your body has calmed, how would you rather see this scene? Anything goes. You can change what happens, who's there, how it ends. Run your version from start to finish while you follow my hand."
  • Watch for:
    • The client cannot think of a replacement. Offer the creative frames in 4.8–4.10 or ask what they wish had happened [synthesis].
    • Self-blame or revenge scenes that raise distress. Check that the new scene brings relief rather than arousal [synthesis].
    • Strengthening positive feelings linked to the new image with further sets is described only by a secondary source [uncertain; secondary].

4.8 "The Director" (named standard ART intervention)

  • Purpose / when: Named by Kip et al. (2012) as an example of the manual's standard interventions for achieving VIR. Its procedure is not described in the sources [uncertain].
  • Steps: Not documented in the sources. Learn the authorised version in RCRR training. A generic frame consistent with VIR would invite the client to take the role of a film director who can re-edit, re-shoot or re-cast the scene before running the new cut with eye movements [synthesis, not verified as ART's procedure].
  • Example language (illustrative, generic): "If you were directing this scene, what would you change?"
  • Watch for: do not present the generic frame as the ART technique.

4.9 Gestalt-style imaginal encounter (goodbye or amends)

  • Purpose / when: Optional in rescripting, especially for grief, guilt or unfinished business. The client imaginally "goes back" to say goodbye to someone or make amends.
  • Steps:
    1. After the scene has been processed, invite the client to imagine returning to the scene or meeting the person.
    2. The client says, silently or aloud, what they need to say.
    3. The client may imagine the other person's response.
    4. Use eye-movement sets with the imagery and process any sensations that arise. [source: NIH R21 protocol 2018 (Gestalt "may be used"); Kip et al. 2012 (experiential/Gestalt roots); detailed steps synthesis]
  • Example language (illustrative): "If you could go back to that room now, what would you want to say to her? Take your time, and follow my hand while you say it."
  • Watch for: intensified grief or guilt. Return to sensation processing. Do not push a reconciliation the client doesn't want [synthesis].

4.10 Metaphor and imaginative transformation

  • Purpose / when: The Waits et al. (2017) review describes ART as relying heavily on imaginative techniques, especially rescripting and metaphor. Use when literal rescripting is hard, or for abstract distress such as feeling contaminated or carrying a weight.
  • Steps: Specific named ART metaphor procedures are [uncertain]. A generic approach: let the client represent the distress as an image (an object, colour or weight), transform or dispose of it during eye-movement sets, then check the scene and the body again [synthesis].
  • Example language (illustrative): "If that heaviness were a thing, what would it look like? ... What would you like to do with it?"
  • Watch for: client-generated metaphors work better than therapist-supplied ones [synthesis].

4.11 Original-versus-new scene check

  • Purpose / when: After VIR (step 5 of the session). Tests whether processing has held.
  • Steps:
    1. Ask the client to deliberately bring up the original scene.
    2. Ask what they now see and feel, and whether the new images appear.
    3. Get a SUDS rating and do a body check.
    4. If distress or sensations remain, return to exposure and sensation sets, then repeat the check. [source: Kip et al. 2012; the loop-back is synthesis]
  • Example language (illustrative): "Try to bring the old scene back the way it used to be. What do you get now? Anything in your body?"
  • Watch for: reports that the old images are faint, distant or hard to bring up, with low SUDS. Developers present this as the target outcome [source: Kip et al. 2012; Rosenzweig 2025 UTA slides]. A vivid return of the old images with physical arousal means the scene is not resolved.

4.12 Future-trigger work ("in-vitro" exposure to feared future triggers)

  • Purpose / when: After the scene is resolved (step 6). Lowers the reactivity of cues the client expects to meet.
  • Steps:
    1. Ask what situations, sounds, places or dates might set the client off now.
    2. Have the client imagine encountering each trigger during eye-movement sets.
    3. Process any sensations that arise, and rescript if needed.
    4. Re-rate SUDS. The papers state only that "an ART intervention" is used here and list "in-vitro exposure to future feared triggers" as a core component; the detailed steps are [synthesis]. [source: Kip et al. 2012; NIH R21 protocol 2018]
  • Example language (illustrative): "Picture the next time you hear a siren. Follow my hand while you imagine it... What do you notice?"
  • Watch for: avoidance of naming triggers. Use the client's own symptom list to prompt [synthesis].

4.13 Closure assessment and closing SUDS

  • Purpose / when: The end of every session (steps 7–8).
  • Steps:
    1. Check that current SUDS and body sensations are low.
    2. Ask whether other memories surfaced and list them as targets for later sessions.
    3. Take a closing SUDS rating.
    4. Before the client leaves, ask about adverse effects; in the trials this was asked before each session.
    5. Make sure the client knows how to reach you. [source: Kip et al. 2012; Kip et al. 2013 Frontiers; NIH R21 protocol 2018] "Closure techniques" were part of ART training, but they are not described in the papers [uncertain]. Grounding and brief breathing at close are mentioned only by a secondary source [uncertain; secondary].
  • Example language (illustrative): "Where are you now, 0 to 10? ... Did anything else come up that we should come back to? Over the next days, just notice any changes; let me know if anything feels hard."
  • Watch for: leaving a session with a scene unprocessed. Use sensation sets and grounding before ending [synthesis]. Two trial participants reported transient low mood the day after a session; tell clients this can happen [source: Kip et al. 2012].

4.14 Session-by-session monitoring and dosing

  • Purpose / when: Between sessions, to decide whether to continue and with what target.
  • Steps:
    1. Re-administer the symptom measures at each session (PCL-5, CES-D, and ICG for grief).
    2. Review new targets that came up.
    3. End treatment when the client reports significant or full relief.
    4. If there is no change after the expected brief course, reassess (see section 5). No formal homework is reported in the papers [source: NIH R21 protocol 2018; Kip et al. 2012].
  • Example language (illustrative): "Your scores have dropped a lot. Is there anything from the list that still bothers you?"
  • Watch for: generalisation, meaning untreated related scenes also lose their charge, which the developers report. Confirm it before ending [source: Kip et al. 2012].

4.15 Distress pause: counselling and relaxation

  • Purpose / when: Whenever anxiety or distress rises beyond what the client can tolerate during processing.
  • Steps:
    1. Temporarily stop the procedure.
    2. Use supportive counselling and relaxation methods.
    3. Resume only once the client is settled and agrees.
    4. If there is suicidal ideation or severe instability, arrange immediate treatment or referral to a higher level of care. [source: NIH R21 protocol 2018] Specific relaxation methods are not named in the sources [uncertain]. Slow breathing, orienting to the room and naming objects can be used [synthesis].
  • Example language (illustrative): "Let's pause. Feel your feet on the floor, look around and tell me three things you can see."
  • Watch for: a return of present orientation and a steadier voice and breathing before resuming.

4.16 Adaptations: children, adolescents and grief

  • Purpose / when: For populations outside the adult PTSD protocol.
  • Steps:
    • Adolescents can use the full protocol. Preteens get a version tailored to their ability. Younger children may do sensation processing only. Children need not talk. [source: Rosenzweig 2025 UTA slides]
    • Complicated grief (2018 adaptation for adults 60 and over): 4 weekly sessions. Targets are scenes around the death. Exposure runs beginning to end, with two full processing courses, then rescripting toward a preferred way of remembering the person, with optional Gestalt goodbye or amends. [source: NIH R21 protocol 2018]
    • RCRR also offers SAF-T (Sensation Awareness Focused Technique), a one-day course for non-clinicians such as first responders. It is not covered here. [source: Rosenzweig 2025 UTA slides]
  • Example language (illustrative, child): "Where in your body do you feel the scary feeling? Let's watch my hand go back and forth and see what happens to it."
  • Watch for: in children, caregiver consent and involvement, and developmentally appropriate tracking [synthesis].

5. Handling problems

What the sources say on problems is limited to four points [source: NIH R21 protocol 2018; Kip et al. 2012; Kip et al. 2013 Frontiers]:

  • Pause and use counselling or relaxation when distress is heightened.
  • Escalate for suicidality or instability.
  • Use the manual's standard interventions rather than free association when processing stalls.
  • The training covered "challenges and solutions," but the content of that module was not available [uncertain].

Everything else below is [synthesis] unless tagged.

  • Overwhelm during exposure (SUDS spiking, crying, hyperventilation).
    • Stop the scene set and switch to a sensation-only set on the strongest body sensation; this follows ART's own sequence [source: Kip et al. 2012 for the alternation].
    • If that doesn't settle the client, do a full distress pause (4.15).
    • Shorten the next exposure pass: process the scene in segments, stopping at the first peak and clearing sensations before continuing [synthesis].
  • Dissociation (blank stare, numbness, losing track of the hand, delayed answers).
    • Stop the eye movements.
    • Orient the client: say their name, have them look around the room, name the date, feel their feet on the floor.
    • Resume only when the client is clearly present.
    • If dissociation recurs, stop processing for the session, close with grounding and reassess suitability. Severe dissociation is a flag for stabilisation first or another approach [source: Blueprint (secondary); procedure is synthesis].
  • Readiness concerns.
    • The research protocols processed trauma from session 1 in screened clients.
    • For clients with recent crisis, self-harm, unsafe circumstances or very poor affect regulation, provide stabilisation and safety planning first, and treat ART as a later step [synthesis].
    • Suicidal ideation or intent excluded participants in all opened trials [source: Kip et al. 2012; NIH R21 protocol 2018].
    • If suicidal ideation emerges, do a standard risk assessment, safety plan, lethal-means counselling (safe storage or removal) and step up the level of care as indicated [synthesis].
  • Stuck: SUDS won't drop, or the same sensation keeps returning.
    • Check whether a different, earlier or adjacent scene is driving the reaction, and target it as a new scene [synthesis consistent with Kip et al. 2012 on new scenes emerging].
    • Check for a belief such as "if I stop feeling this I'm disloyal."
    • Move to VIR: imaginative rescripting can shift what further exposure doesn't, as the review stresses imaginative techniques [source: Waits et al. 2017 abstract; application is synthesis].
  • Client can't create a replacement image, or rejects rescripting as "lying".
    • Restate that the narrative memory remains and that the new images are a chosen way of carrying it, not a claim about what happened [source: Kip et al. 2012 for VIR not changing narrative memory].
    • Offer smaller changes, such as adding a protector, changing the lighting or ending, or a symbolic image.
    • Or use a goodbye or amends encounter (4.9) [synthesis].
  • Images about which the client is unsure what happened.
    • Do not interpret or confirm. Work with what is present as imagery.
    • Never use ART, eye movements or rescripting to try to uncover or verify memories.
    • Document that the content is the client's current experience [synthesis].
  • Resistance or wariness about the eye movements or the speed of the method.
    • Explain the procedure and the client's control, including stopping at any time.
    • Demonstrate a neutral set first. If the client still objects, do not proceed [synthesis].
  • Non-attendance or dropping out after one session.
    • In the 2012 cohort, 14 non-completers reported no adverse effects, and some may have stopped because they felt better [source: Kip et al. 2012 for non-completer AE data; interpretation synthesis].
    • Contact the client, check symptoms with the measure and offer to finish the remaining scenes.
  • Ruptures (client feels rushed, unheard or "processed").
    • The brief, directive format and the minimal talk about content can feel impersonal.
    • Name it, slow down, allow the client to tell as much of the story as they want, and return to the protocol only by agreement [synthesis].
  • After-effects between sessions (low mood, headache, poor sleep, vivid dreams).
    • Transient next-day low mood was reported in the trials, and headache, dizziness and waking at night were reported but judged unrelated [source: Kip et al. 2012].
    • Warn clients these can happen, ask about them at the start of each session, and process any new material.
  • Medical issues.
    • Exclude or get medical clearance where heightened emotion is risky (cardiac history, seizure disorder) or eye tracking is impaired [source: Kip et al. 2012].
    • Somatic symptoms with no medical work-up should be assessed medically before ART targets them [synthesis].
  • Complex or ongoing trauma, comorbid substance use, bipolar disorder or psychosis. All were excluded from the trials [source: Kip et al. 2012]. ART in these groups is outside the evidence base of the opened protocols. Use it only within an integrated plan, after stabilisation, and with consultation [synthesis].
  • Developer claims to hold lightly. The claims that single traumas resolve "in an hour" and that images and sensations are permanently "erased" are the developer's statements [source: Rosenzweig 2025 UTA slides]. Plan for follow-up checks rather than assuming permanence [synthesis].

Sources

Sources:

Further reading (not drawn on) [uncertain]: the PMC copy of Kip et al. 2012 (PMC4217580), the PubMed record of Waits et al. 2017, the full text of Kip et al. 2013 Military Medicine, and the RCRR ART training manual and fidelity checklist (proprietary).

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