EMDR and Accelerated Resolution Therapy: How the Two Protocols Differ
Last reviewed: 10/21/2026
Reviewed by: Dr. Kiesa Kelly
If you have been searching for trauma therapy, you may have come across accelerated resolution therapy, or ART, in a therapist directory, often promoted as a faster alternative. EMDR and accelerated resolution therapy do have a lot in common. Both use guided eye movements, both follow a structured protocol, and neither requires you to describe your trauma in detail. But they work on a memory in different ways, they run on different timelines, and the research behind them is very different in size. This guide compares the two protocols side by side, so you can ask better questions before you choose.
One thing to know up front: we offer EMDR and other trauma-focused therapies, and we do not offer ART. We have tried to describe both fairly, and we say so wherever the evidence for either one is thin. Our trauma therapy page covers how we work with trauma more broadly.
In this article, you'll learn:
What EMDR and ART share, and the three places their protocols really differ
Three misconceptions about "faster" trauma therapy
How each therapy works on a memory: following associations or replacing an image
What the research and the major guidelines say about each
Questions to ask a provider, whichever therapy you are considering
The short answer: what ART and EMDR share and where they part
Both therapies ask you to bring a distressing memory to mind while following a therapist's guided eye movements, and both are delivered from a manual [1][2]. ART is the newer of the two. It was developed in 2008, and an independent review describes it as combining eye movements, exposure and image rescripting [3]. If you are new to EMDR itself, our guide to what EMDR helps with and what to expect is a good place to start. The main differences come down to three things:
What changes. In EMDR, you process a memory until it is less distressing, then strengthen a positive belief about yourself [1]. In ART, the therapist guides you to replace the distressing images with images you choose, while the factual memory of what happened stays [2].
How open the process is. EMDR's processing phase is designed to let new thoughts, feelings and memories come up as you go [1]. ART's researchers describe their protocol as "purposely not free-associative," with set steps and a fixed number of eye movements per set [2].
How long it takes, and how much it has been studied. Most participants in ART studies received three to four sessions [3], while the UK's NICE guideline describes a typical EMDR course as 8 to 12 [4]. EMDR has been tested in dozens of trials and appears in major PTSD guidelines. An independent review of ART found five primary studies [3].
🔁 Key takeaway: Both use eye movements within a structured protocol. EMDR follows where the memory leads and strengthens a new belief, while ART steers toward replacing the images, and EMDR's evidence base is far larger.
Three misconceptions about "faster" trauma therapy
"ART is just a faster version of EMDR." ART does share eye movements with EMDR, but it aims at something different. It works to replace distressing images, while EMDR works to reduce the distress attached to a memory and build a more adaptive belief [2][1]. No published trial has compared the two directly. One registered trial compared ART with cognitive processing therapy and finished in 2021, but no results have been posted on ClinicalTrials.gov [5].
"Only ART lets you avoid telling your trauma story." Not so. ART's developer and an independent review both say clients do not need to share details of the trauma with the therapist [6][3], and EMDR's professional association says EMDR "does not require talking in detail about a distressing issue" [7]. If avoiding a detailed retelling matters to you, both can be options. Our article on EMDR without describing the trauma explains how that works in practice.
"Fewer sessions means a therapy works better." Session counts are not like-for-like. ART's published averages come from small studies, several of them in veterans, where attrition ranged from 7% to 36% [3]. EMDR's typical 8 to 12 sessions is NICE's recommended length for a whole phased course, including preparation as well as reprocessing, and NICE notes some people need more, for example after multiple traumas [4]. A shorter protocol is appealing, but whether it fits you depends on your history, and the research has not tested ART against EMDR.
🧩 Key takeaway: ART is not simply a sped-up EMDR, both can be done without a detailed retelling, and a shorter average course is not evidence of a better result.
What each one is
EMDR: the eight-phase protocol
EMDR, or eye movement desensitization and reprocessing, is an eight-phase treatment built on standardized protocols and procedures, as described by its developer [1]. The early phases take a history and prepare you, including techniques for staying steady between sessions. In the assessment phase, you identify an image from the memory, the negative belief you hold now, the belief you would rather hold, and the emotions and body sensations attached to it [1]. During desensitization, you hold the memory in mind while following sets of eye movements, or taps or tones, and notice whatever comes up [1]. Later phases strengthen the positive belief, check for leftover physical tension, close each session safely and reassess progress [1]. Our walkthrough of the 8 phases of EMDR therapy goes through each one, and a typical session lasts 60 to 90 minutes [7].
ART: a manualized eye-movement protocol with set steps
Accelerated resolution therapy was developed in 2008 and first appeared in the research literature in 2012 [3]. It is a manualized protocol: therapists follow specific steps and a set of standard interventions, and in three of the five reviewed studies they used a fidelity checklist, though fidelity itself was not reported [2][3]. In each session, you recall a distressing scene while following sets of 40 eye movements, and the therapist checks your body sensations until the physical reaction eases [2]. Then comes the step ART is best known for, called voluntary image replacement. With the therapist's guidance, you replace the distressing images with ones you choose, while the factual memory of what happened stays [2]. Studies have used sessions of about 60 to 75 minutes [3], and according to its developer, therapists can begin using ART after a three-day basic training [8].
The protocol differences that matter
Free association versus set steps
The clearest structural difference is how much room each protocol leaves for the mind to wander. In EMDR's desensitization phase, the standardized procedure is meant to allow "the spontaneous emergence of insights, emotions, physical sensations, and other memories" [1]. Between sets, the therapist checks what you noticed and keeps processing until the memory's distress comes down [1]. ART's researchers describe their approach as "purposely not free-associative," with a fixed number of eye movements per set and standard interventions from a training manual [2]. That comparison comes from ART's own developers. EMDR is also delivered from a validated manual [4], so the difference is how much each one follows your associations, not whether one is structured. Our EMDR service page describes how we use bilateral stimulation in sessions.
The two examples below are composites, not real clients. Here is how that can feel in EMDR. You start with the memory of a car crash. A few sets in, your mind jumps to a hospital waiting room from childhood, then to a feeling of being blamed for something that was not your fault. Your therapist lets you follow that thread, checks in with you, and later brings you back to the crash. For some people, those connections are where the most important shift happens. For others, the wandering feels unsettling, and they want more of a map.
Or, in ART: you work on the same crash, and the session stays mostly with the scenes you and your therapist chose at the start. After several sets of eye movements, your therapist asks what you notice in your body and keeps going until the tightness in your chest eases. Then the therapist guides you to picture something different in place of the worst image, an image you decide on yourself. You still remember that the crash happened, but you are not asked to follow wherever your mind goes.
Voluntary image replacement versus installing a positive belief
In EMDR, the installation phase strengthens a positive belief you named earlier, such as "I survived" or "It was not my fault," and links it to the memory once its distress has come down [1]. In ART, voluntary image replacement changes the images themselves. The researchers describe it as replacing distressing images, "but not narrative memory," with more pleasing ones [2]. They also say this step parallels imagery rescripting, a technique that has been studied in other therapies [2]. A 2023 meta-analysis of 17 trials found imagery rescripting more helpful than passive controls, mostly waitlists, and no significant difference when it was compared with exposure, cognitive restructuring or EMDR [9]. That evidence is about imagery rescripting in general, across several conditions, not about ART. An independent review notes it is not known which parts of ART drive its results [3].
Session count and pacing
In the published ART studies, most participants received three to four sessions of 60 to 75 minutes [3]. In an uncontrolled study of 148 veterans and service members, 71.6% completed treatment, in an average of 3.5 sessions [10]. For EMDR, NICE describes a typical course of 8 to 12 sessions, with more when needed, such as after multiple traumas [4]. Those numbers are not directly comparable. The ART figures are averages from small studies of selected participants, the EMDR figure is a guideline's estimate for routine care, and no trial has compared the two.
⏱️ Key takeaway: EMDR follows your associations and builds a new belief over a longer course. ART keeps to set steps and replaces images over a shorter one, and the shorter course has not been tested against EMDR.
What the evidence does and does not show
EMDR's guideline-level evidence
EMDR has been tested in many randomized trials. A 2020 review of 76 trials, most of them on PTSD, found EMDR more effective than control conditions, but only four of 27 studies were at low risk of bias and there were signs of publication bias. The authors concluded EMDR may be effective for PTSD in the short term, but that study quality was too low for definite conclusions [11]. A 2025 review of 12 randomized trials found that EMDR may reduce PTSD symptoms compared with a waitlist, with low to very low certainty, and none of the trials assessed side effects [12].
Guidelines still include it. The 2023 US Department of Veterans Affairs and Department of Defense (VA/DoD) guideline recommends three psychotherapies for PTSD: prolonged exposure, cognitive processing therapy and EMDR [13]. The American Psychological Association's 2017 guideline gives EMDR a conditional, second-line recommendation, behind cognitive behavioral therapy, cognitive processing therapy and prolonged exposure [14]. The UK's NICE guideline recommends offering EMDR to adults with PTSD who present more than 3 months after a non-combat-related trauma. It limits the recommendation to non-combat trauma because its evidence review suggested EMDR was not effective for combat-related trauma [4]. The World Health Organization's 2013 guidance said referral for EMDR should be considered for people with PTSD [15].
ART's smaller evidence base
ART's research base is much smaller. A 2024 systematic review by independent authors found five primary studies with 337 participants enrolled, only two of them randomized trials [3]. All five reported significant drops in PTSD symptoms from before to after treatment, and the reviewers concluded that ART shows some promise but needs more high-quality studies, including comparisons with first-line therapies [3]. Just one study was rated good quality, and the reviewers could not draw conclusions about how ART compares with other treatments [3]. The only study the review rated good quality is a 2013 trial of 57 service members and veterans, which compared ART with an attention-control condition of fitness or career planning sessions and then offered the control group ART [16][3]. ART reduced PTSD, depression and anxiety symptoms more than the control, delivered in an average of three to four sessions [16]. All five studies in the review listed the same university nursing college as a treatment site [3], and ART's developer co-authored early papers, including the 2012 study, and has a commercial interest in the therapy, though that paper states she did not treat participants or collect or analyze data [2]. Newer work remains small, such as a 2025 single-group pilot in 20 cancer survivors [17].
ART is not among the psychotherapies the 2023 VA/DoD guideline synopsis lists as recommended, which are prolonged exposure, cognitive processing therapy and EMDR [13], and it does not appear on the APA guideline's list of recommended or suggested treatments [14]. The independent review describes ART as pending re-evaluation by the APA's clinical psychology division [3]. None of this means ART does not help anyone. It means the evidence is too thin to know how it compares with established options.
📚 Key takeaway: EMDR's evidence is large but imperfect, and guidelines support it. ART's evidence is small and early, all five reviewed studies were run at least partly at the same university nursing college, and no guideline we read lists it.
Which might fit you, and questions to ask a provider
A rule of thumb you can use now:
If you want the most-studied option, EMDR, cognitive processing therapy and prolonged exposure all have guideline support for PTSD [13].
If following your mind's associations sounds helpful, EMDR's open processing may suit you. If you have more than one trauma to work through, ask how a provider plans for that; NICE notes EMDR courses can run past 12 sessions after multiple traumas [4].
If you want a tightly structured, short protocol and accept that its evidence is early, ART is something to ask about with a trained provider, ideally one who also offers an established therapy.
If you are not sure you are ready for trauma processing at all, for example because of frequent dissociation or a current crisis, ask about preparation and stabilization first. Our article on who should not start EMDR right now covers the readiness questions that apply to most trauma processing.
Whichever therapy you choose, a checklist like the PCL-5 can track PTSD symptoms before and during treatment. Its first validation studies, in trauma-exposed college students, found it a reliable self-report measure [18]. If you are having thoughts of suicide, call or text 988 at any hour, and if you are in immediate danger, call 911.
Before you book, these questions can help you find a good fit:
Are you EMDR-trained or EMDRIA-certified? EMDR-trained means an approved basic training of at least 50 hours; certification adds at least 50 EMDR sessions with 25 or more clients and 20 hours of consultation [19][20].
If you offer ART, what training do you have in it, and what established trauma therapies do you also offer?
How will we prepare before processing a memory, and what do we do if I feel overwhelmed between sessions?
How will we measure whether treatment is working, and when would we change course?
If I am involved in a legal case connected to the trauma, should we talk about timing before processing the memory?
Next step: getting support
The choice between EMDR and ART is less about which one is faster and more about how you want a memory to be worked on, and how much evidence you want behind the method. EMDR follows your associations and strengthens a new belief, with a large, imperfect body of research and guideline support. ART keeps to set steps and replaces images, with a small early literature that has not yet been compared head to head with established therapies. We offer EMDR and cognitive processing therapy, among our specialized therapies, and if you are in Tennessee, our page on online trauma therapy explains how sessions work by telehealth.
Carrying something that still feels close?
Trauma-focused care — including approaches like EMDR — can help you process what happened at a pace that feels safe, with a clinician who understands trauma responses.
Frequently Asked Questions
What's the difference between accelerated resolution therapy and EMDR?
Both use guided eye movements within a structured protocol, but they change different things. EMDR follows the thoughts and memories that come up, then strengthens a positive belief about yourself. ART keeps to set steps and guides you to replace distressing images with ones you choose. EMDR also has a much larger research base, and no published trial has compared the two directly.
How many sessions does accelerated resolution therapy take?
In published studies, most people received three to four sessions of about 60 to 75 minutes, with a range of one to five. Those figures come from small studies, several of them in veterans, and not everyone finished: dropout ranged from 7% to 36%. The number you would need depends on your history, so ask any provider how they decide when treatment is done.
What is voluntary image replacement in ART?
It is the step where your therapist guides you to replace the distressing images from a memory with images you choose. ART's developers say the factual memory of what happened stays, and they compare the step to imagery rescripting, a technique studied in other therapies. It has not been tested on its own within ART, so it is not known how much it adds to results.
Is accelerated resolution therapy evidence-based?
Its evidence is early. An independent 2024 review found five small studies that all reported significant symptom reductions, but only one was rated good quality, and the reviewers could not say how ART compares with other treatments. ART is not among the therapies the 2023 VA/DoD PTSD guideline recommends. EMDR, cognitive processing therapy and prolonged exposure have much stronger support, so ask any ART provider what else they offer.
Can I try ART if EMDR has not helped me?
You can ask about it, but we found no study of ART specifically after EMDR. If EMDR has stalled, talk with your therapist about what might be blocking progress, such as pacing, dissociation or the choice of memory to work on, and whether adjusting the approach or trying another guideline-supported therapy, such as cognitive processing therapy, makes sense for you.
About the Author
Dr. Kiesa Kelly is a clinical psychologist and the founder of ScienceWorks Behavioral Healthcare. EMDR is her preferred approach for treating trauma, and her trauma work also draws on cognitive behavioral therapy and acceptance and commitment therapy. She earned her PhD in clinical psychology, with a concentration in neuropsychology, from Rosalind Franklin University of Medicine and Science.
She completed practica, internship and an NIH-funded postdoctoral fellowship at the University of Chicago, the University of Wisconsin, the University of Florida and Vanderbilt University, and she has more than 20 years of experience with psychological assessment. ScienceWorks does not offer accelerated resolution therapy.
References
1. Shapiro F. The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences. Perm J. 2014;18(1):71-77. https://doi.org/10.7812/TPP/13-098
2. Kip KE, Elk CA, Sullivan KL, et al. Brief treatment of symptoms of post-traumatic stress disorder (PTSD) by use of accelerated resolution therapy (ART). Behav Sci (Basel). 2012;2(2):115-134. https://doi.org/10.3390/bs2020115
3. Storey DP, Marriott ECS, Rash JA. Accelerated resolution therapy (ART) for the treatment of posttraumatic stress disorder in adults: a systematic review. PLOS Ment Health. 2024;1(4):e0000123. https://doi.org/10.1371/journal.pmen.0000123
4. National Institute for Health and Care Excellence. Post-traumatic stress disorder (NG116). 2018. Accessed October 21, 2026. https://www.nice.org.uk/guidance/ng116
5. ClinicalTrials.gov. A comparison of cognitive processing therapy (CPT) versus accelerated resolution therapy (ART) versus wait list (WL). NCT03384706. University of Cincinnati. Last updated December 1, 2022. Accessed October 21, 2026. https://clinicaltrials.gov/study/NCT03384706
6. Rosenzweig Center for Rapid Recovery. What is ART? Accessed October 21, 2026. https://acceleratedresolutiontherapy.com/what-is-art/
7. EMDR International Association. About EMDR therapy. Accessed October 21, 2026. https://www.emdria.org/about-emdr-therapy/
8. Rosenzweig Center for Rapid Recovery. What makes accelerated resolution therapy (ART) unique. Accessed October 21, 2026. https://acceleratedresolutiontherapy.com/what-makes-accelerated-resolution-therapy-art-unique/
9. Kip A, Schoppe L, Arntz A, Morina N. Efficacy of imagery rescripting in treating mental disorders associated with aversive memories - an updated meta-analysis. J Anxiety Disord. 2023;99:102772. Corrected in: J Anxiety Disord. 2025;115:103071. https://doi.org/10.1016/j.janxdis.2023.102772
10. Pang T, Murn L, Williams D, et al. Comparison of accelerated resolution therapy for PTSD between veterans with and without prior PTSD treatment. Mil Med. 2023;188(3-4):e621-e629. https://doi.org/10.1093/milmed/usab335
11. Cuijpers P, Veen SCV, Sijbrandij M, Yoder W, Cristea IA. Eye movement desensitization and reprocessing for mental health problems: a systematic review and meta-analysis. Cogn Behav Ther. 2020;49(3):165-180. https://doi.org/10.1080/16506073.2019.1703801
12. Villegas-Ortega J, Gálvez-Arévalo R, Castilla-Encinas AM, et al. Effects of EMDR vs. waiting list for adults with post-traumatic stress disorder: a systematic review and meta-analysis of randomized controlled trials. J Affect Disord. 2025;392:120134. https://doi.org/10.1016/j.jad.2025.120134
13. Schnurr PP, Hamblen JL, Wolf J, et al. The management of posttraumatic stress disorder and acute stress disorder: synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline. Ann Intern Med. 2024;177(3):363-374. https://doi.org/10.7326/M23-2757
14. American Psychological Association. Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults: treatments for PTSD. 2017, updated April 2025. Accessed October 21, 2026. https://www.apa.org/ptsd-guideline/treatments
15. World Health Organization. WHO releases guidance on mental health care after trauma [news release]. August 6, 2013. Accessed October 21, 2026. https://www.who.int/news/item/06-08-2013-who-releases-guidance-on-mental-health-care-after-trauma
16. Kip KE, Rosenzweig L, Hernandez DF, et al. Randomized controlled trial of accelerated resolution therapy (ART) for symptoms of combat-related post-traumatic stress disorder (PTSD). Mil Med. 2013;178(12):1298-1309. https://doi.org/10.7205/MILMED-D-13-00298
17. Tofthagen C, Donovan KA, Mandrekar J, Buck HG. Accelerated resolution therapy for cancer distress and post-traumatic stress symptoms: results of a pilot study. Psychooncology. 2025;34(1):e70058. https://doi.org/10.1002/pon.70058
18. Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. J Trauma Stress. 2015;28(6):489-498. https://doi.org/10.1002/jts.22059
19. EMDR International Association. Training vs. certification. Accessed October 21, 2026. https://www.emdria.org/training-vs-certification/
20. EMDR International Association. EMDRIA Certified Therapist application. Accessed October 21, 2026. https://www.emdria.org/emdr-training/emdr-certification-2/
Disclaimer
This article is for informational and educational purposes only and is not a substitute for professional medical or mental health advice, diagnosis, or treatment. Reading it does not create a clinician-patient relationship, and ScienceWorks does not offer accelerated resolution therapy. If you are having thoughts of suicide, call or text 988. If you are in immediate danger, call 911.