ART for combat trauma and military PTSD

Accelerated Resolution Therapy (ART) has been studied for combat trauma and military post-traumatic stress more than for any other problem, and much of its research was done with service members and veterans. One randomized trial found that PTSD symptoms fell more with ART than with a comparison condition. The VA/DoD guideline still rates the evidence as insufficient to recommend for or against it, and three other trauma therapies carry its strongest recommendation.

What combat trauma can look like afterward

It rarely looks like a single bad memory. Military trauma is often repeated rather than one event, and it is tied up with a unit, a role and an identity. The habits that kept people alive, such as scanning a room, staying switched on and keeping emotion out of the way, can look very different once they come home with you.

• Images, sounds or smells from deployment that arrive without warning
• Nightmares, or sleep that never feels like rest
• Staying away from crowds, driving routes, news or anything that pulls you back
• Being on edge, quick to anger, or startled by ordinary noises
• Guilt or shame about something done, seen or not prevented
• Feeling cut off from people who were not there

None of that is a diagnosis. It is a description of what people commonly bring in. Guilt and shame in particular can be a different problem from fear, often called moral injury, and it has its own page.

How ART is used for combat-related memories

ART works one memory at a time. You bring a specific scene to mind briefly, and I guide sets of about 40 side-to-side eye movements while you notice what your body does. Once the physical charge settles, you use a step called Voluntary Image Replacement to change the distressing images to something you choose. You keep the facts of what happened. You do not have to describe the scene to me, which matters to many veterans who have no wish to tell the story again.

With military trauma there is usually more than one memory. Researchers have described processing a few representative scenes in turn; whether that carries over to related memories is their hypothesis, not a measured result. How many sessions anyone needs is decided after assessment, and I will not quote a number before then. The session step by step page walks through what happens in the room.

I am trained in both ART and EMDR, and I have used ART with veterans through the Lone Survivor Foundation, which ran free retreats for veterans until it closed in 2026.

The treatments guidelines recommend first

The 2023 VA/DoD guideline for PTSD gives its strongest recommendation to three therapies: Cognitive Processing Therapy (CPT), Prolonged Exposure (PE) and EMDR. It places ART in the group with “insufficient evidence to recommend for or against,” explaining that “no RCTs of ART included the critical outcome of clinician-rated PTSD.” That is a statement about how much has been studied, not a finding that ART does not work.

One nuance for veterans: the UK's NICE guideline recommends EMDR for trauma that is not combat-related and does not extend that recommendation to combat trauma. CPT and PE have been recommended as first-line treatments across all the major guidelines.

A first-line therapy is usually the better place to start if you want the approach with the most evidence behind it, if the VA can offer you CPT, PE or EMDR promptly, or if a structured course with homework suits you. ART is sometimes chosen by people who do not want to narrate their trauma, have not got on with a first-line therapy, or want to try something different after one. ART compared with other trauma therapies sets the options side by side.

Things to raise before you start

• A head injury. Traumatic brain injury is on the list of things ART's developers say to consider at intake. Veterans with TBI were included in some ART studies, so it is something to talk through, not an automatic no.
• Eye problems, migraines or vertigo. The eye movements are the part most likely to be affected.
• Alcohol or drug use. Ongoing heavy use changes what is safe to take on, and some anxiety medications may blunt the response.
• Current safety. If you are having thoughts of suicide or are not safe right now, that comes first.
• Session length and coverage. ART sessions often run longer than a standard 50-minute session, and TRICARE generally covers individual psychotherapy sessions of up to 60 minutes. Ask your plan how a longer session would be handled. ART for veterans and TRICARE covers the benefits questions.

A few people in the ART trials felt low or anxious, or slept badly, after a session. This was uncommon and not serious. For a first course of ART I generally recommend meeting in person, partly so I can see how you are doing in real time.

Where to go from here

If you are a veteran, check what the VA, a Vet Center or TRICARE can offer before you pay privately. The veterans and military families page covers those questions in order. If you would like to talk about whether ART, EMDR or something else fits your situation, get started here.