What treatment guidelines say about ART

No major PTSD treatment guideline recommends Accelerated Resolution Therapy (ART). The 2023 VA/DoD guideline is the only one that has rated it, and it found “insufficient evidence to recommend for or against” ART, because no randomized trial measured PTSD with a clinician-rated assessment. The American Psychological Association (2017 and 2025), ISTSS and NICE guidelines do not mention ART at all. The treatments these guidelines recommend first are cognitive processing therapy, prolonged exposure and, in most of them, EMDR.

That is not the same as a finding that ART does not work. It is a statement about how much good-quality research exists so far. The sections below quote each guideline directly so you can see the wording for yourself.

VA/DoD 2023: insufficient evidence, for or against

The VA/DoD Clinical Practice Guideline for the Management of PTSD and Acute Stress Disorder (version 4.0, June 2023) is written for veterans and service members, and it is the only major guideline that names ART. Its Recommendation 10 reads, in part:

The guideline gives its reason in the discussion section: “There was also insufficient evidence to recommend for or against Accelerated Resolution Therapy (ART) and Reconsolidation of Traumatic Memories (RTM). No RCTs of ART included the critical outcome of clinician-rated PTSD.”

In other words, the guideline panel treated a clinician’s structured assessment of PTSD as a critical outcome, and the ART trials measured PTSD only through participants’ own questionnaires. The main trial is described in the 2013 randomized trial, explained.

The earlier 2017 VA/DoD guideline did not name ART at all. The VA’s National Center for PTSD patient decision aid now lists ART under “Not enough evidence”, alongside supportive counseling and hypnosis.

A separate Defense Department review reached a similar view. The Psychological Health Center of Excellence evidence brief (August 2019) concluded that “the current state of the evidence base is not mature enough to recommend ART as a front-line treatment for PTSD in the MHS” (the Military Health System).

American Psychological Association: not reviewed

The APA’s Clinical Practice Guideline for the Treatment of PTSD, adopted in 2017, does not mention ART. Neither does the 2025 update, approved by the APA Council of Representatives in February 2025. ART does not appear anywhere in the 2025 document, including its list of treatments with insufficient evidence. The guideline notes that the list “is not a comprehensive list of all potential existing treatments.”

So the accurate statement is that the APA guideline simply did not review ART. It would be wrong to say the APA recommends ART, and equally wrong to say the APA found its evidence insufficient.

APA Division 12: “pending re-evaluation”

Some ART websites say ART is “recognized as evidence-based” by the Society of Clinical Psychology (APA Division 12). Division 12 runs a treatment website, which is separate from the APA’s clinical practice guidelines. Its ART page lists research support as “Modest” under older (1998) criteria and “Treatment pending re-evaluation” under its current (2015) criteria. The 2024 systematic review of ART noted that its own findings would not change that status.

ISTSS and NICE: not mentioned

The International Society for Traumatic Stress Studies (ISTSS) PTSD Prevention and Treatment Guidelines (2018, with the recommendations document amended in March 2019) do not mention ART anywhere. The same is true of the Australian PTSD guidelines from Phoenix Australia.

The UK’s NICE guideline NG116 (December 2018) does not mention ART in its recommendations. NICE did not publish formal “insufficient evidence” statements, so its silence is not a judgment either way.

SAMHSA’s registry: a 2015 listing, since discontinued

In 2015, ART was listed in SAMHSA’s former National Registry of Evidence-based Programs and Practices (NREPP), which SAMHSA discontinued in 2018. You will still see this listing cited, sometimes in the present tense, as if it were a current endorsement. It is not.

The NREPP profile, completed in November 2015, based its ratings on “one study”: the 2013 veterans trial, plus a pain analysis of the same trial. On that basis it rated ART “effective” for depression, personal resilience, and trauma-related symptoms, and “promising” for several other outcomes, including anxiety and sleep. It also recorded that pain-related fear rose significantly more in the ART group than in the control group. NREPP was a registry, not a treatment guideline, and it no longer exists.

What “insufficient evidence” does and does not mean

“Insufficient evidence to recommend for or against” is a careful phrase. It helps to read it literally.

• It does not mean ART was found not to work. A guideline that found a treatment ineffective or harmful would recommend against it. The VA/DoD did not.
• It does not single ART out. The same VA/DoD category includes acceptance and commitment therapy, interpersonal psychotherapy, narrative exposure therapy, psychodynamic therapy and supportive counseling.
• It does mean the research is not yet strong enough to recommend it. In ART’s case the stated gap is the lack of a clinician-rated PTSD outcome in any randomized trial. The small number of trials, and the absence of a published head-to-head comparison with a first-line therapy, are further gaps described in the study summaries.
• It does mean ART being used somewhere is not the same as being endorsed. ART has been used in some military clinics. That reflects local decisions, not a guideline recommendation.

What the guidelines do recommend first

For adults with PTSD, the guidelines agree more than they differ. The VA/DoD 2023 guideline recommends individual trauma-focused psychotherapy over medication, and gives a “strong for” recommendation to three therapies: cognitive processing therapy (CPT), eye movement desensitization and reprocessing (EMDR) and prolonged exposure (PE). It “suggests” (weak for) Ehlers’ cognitive therapy for PTSD, present-centered therapy and written exposure therapy.

The APA’s 2025 guideline lists CPT, prolonged exposure and trauma-focused CBT as first-line, and cognitive therapy, EMDR and narrative exposure therapy as second-line, along with certain antidepressant medications. ISTSS gives strong recommendations to CPT, cognitive therapy, EMDR, trauma-focused CBT and prolonged exposure. NICE recommends trauma-focused CBT (including CPT, cognitive therapy for PTSD, narrative exposure therapy and prolonged exposure) and EMDR for trauma that was not combat-related.

I am trained in both ART and EMDR, and I would rather you chose knowing all of this than found it out later. If you want to talk through which approach makes sense for you, you can get started here. For a side-by-side view, see ART compared with other trauma therapies.