ART for grief and traumatic loss

Accelerated Resolution Therapy (ART) has been tested for grief in one small randomized trial of older bereaved hospice caregivers, where grief symptoms fell more with ART than on a waiting list. A larger, better-controlled trial is recruiting now. ART is not meant to take grief away. It is used for the parts that keep someone stuck, such as intrusive images of how a person died.

Grief is not a disorder to be fixed

Missing someone, crying unexpectedly, feeling their absence on birthdays and holidays: that is love continuing after a loss, not a symptom. Most grief changes with time, though it rarely disappears, and nobody should be hurried through it by a therapist or anyone else.

Some grief gets stuck. In 2022 the American Psychiatric Association added prolonged grief disorder to the DSM-5-TR. For adults, the loss must have been at least a year ago, the person must have had at least three of the listed symptoms nearly every day for at least the past month, and the grief must last longer than would be expected by their social, cultural or religious norms. The APA estimates that 4% to 15% of bereaved adults develop prolonged grief disorder.

When a loss is also a trauma

Some deaths are sudden, violent or witnessed: a crash, a suicide, an overdose, a death in intensive care or in combat. Others involved months of caregiving and hard decisions. Then grief can come tangled with trauma responses:

• Images of the death or the hospital that play without warning
• Being unable to think of the person without landing on how they died
• Guilt about what you did, didn't do, or decided
• Avoiding the places, photos or people that bring it back
• Nightmares, or sleep that never recovers

These are the parts ART is used for. The aim is that you can remember the person, and the death, without being pulled back into the worst moment each time.

How ART is used for grief

ART works on one memory at a time. You bring a scene to mind briefly, such as the phone call, the hospital room or the last time you saw them, while I guide sets of about 40 side-to-side eye movements. We pay close attention to what happens in your body. When the physical charge has settled, a step called Voluntary Image Replacement lets you change the distressing images to something you choose.

You do not forget the person or how they died, and the sadness does not vanish. What changes, when it works, is how intrusive and overwhelming the image is. ART also has a technique called the “Director” that can be used for unfinished business, such as something you never got to say. Will I forget what happened? explains what stays.

Other options, and when they come first

Grief-focused therapies have been tested in far more trials than ART. The 2025 review above covered 30 randomized trials of therapies for prolonged grief disorder, most of them for approaches other than ART. If your grief is mainly longing, emptiness and not being able to re-engage with life, a grief-focused therapy may be the better fit. If a traumatic death has left PTSD symptoms, the therapies with the strongest guideline support for PTSD are Cognitive Processing Therapy, Prolonged Exposure and EMDR.

ART may be worth discussing when the problem is mostly the images: one or two moments that replay, that you cannot get past to remember the person as they were. It can also be one part of broader grief counseling rather than the whole of it. Support groups, hospice bereavement programs and time with people who knew the person matter too, and none of them are second best.

Before you start

• Timing. There is no rule, but ART is rarely the first thing in the weeks right after a death. Early grief usually needs support, not processing.
• Other therapy. The grief trial excluded people who were already in another psychotherapy. If you are seeing someone else, we would talk about how the two fit together.
• Safety. Grief can bring thoughts of wanting to be with the person who died. If those thoughts turn into thinking about ending your life, please reach out now, using the numbers below.
• Session length. ART sessions often run longer than a standard 50-minute appointment, and the length is agreed in advance. For a first course I generally recommend meeting in person.

If a loss is replaying in a way that stops you grieving the person, it may be worth talking about. When you are ready, get started here.