ART compared

Trauma therapies compared: ART, EMDR, CPT, PE and more, side by side

Eight approaches people are offered for trauma, in one table: what you actually do, whether you have to describe what happened, how long it usually takes, and what the major guidelines say.

The trauma therapies with the strongest research behind them are cognitive processing therapy (CPT), prolonged exposure (PE) and EMDR. All three get the top “Strong for” rating in the 2023 VA/DoD guideline for PTSD. Accelerated Resolution Therapy (ART) is a newer approach, studied in short courses of one to five sessions, with promising early research, but that guideline rates the evidence for it as insufficient to recommend for or against. The table below sets out the differences so you can see where each one fits.

I am trained in ART and in EMDR. I don’t provide CPT, PE, WET, Brainspotting or hypnotherapy, so where one of them would suit you better, that means finding a clinician trained in it. I would rather you had the full picture than only the part I offer.

The comparison table

Eight trauma therapies compared (sources listed at the end of the page; checked September 2026)
	ART	EMDR	CPT	Prolonged exposure (PE)	Written exposure (WET)	Brainspotting	Hypnotherapy	Supportive / talk therapy
Developer and year	Laney Rosenzweig, LMFT, 2008	Francine Shapiro, PhD, late 1980s (first paper 1989)	Patricia Resick and colleagues (first trial published 1992)	Edna Foa (first randomized trial 1991)	Denise Sloan and Brian Marx (first randomized trial 2012)	David Grand, PhD, 2003	No single developer; a long-standing technique	No single developer, manual or protocol
What you do in session	Bring a scene to mind briefly while following sets of about 40 side-to-side eye movements until the body sensations ease, then replace the distressing images with a scene you choose	Hold a memory in mind while following a back-and-forth movement or sound, within an eight-phase protocol	Look at and change upsetting beliefs about the trauma (“stuck points”) through worksheets and discussion	Recount the memory aloud, repeatedly, and gradually face situations you have been avoiding	Write for about 30 minutes about one trauma memory, then briefly discuss it	Hold your gaze on an eye position (a “brainspot”) found with a pointer while mindfully noticing what comes up, often with bilateral sound	Enter a state of focused attention and use it to work toward change; methods vary	Talk through distress and current problems with a therapist who offers support, encouragement and reassurance
Do you describe the trauma in detail?	No. You recall it briefly, but you don’t have to tell the therapist the details	No, in most cases, though you think about it in session	Optional written account, from around session 3	Yes, aloud, from around session 3	Yes, in writing rather than aloud	Not clearly defined in published sources; you are invited to describe what you notice	Varies; no standard PTSD protocol	Not required
Homework	None	None	Yes: writing and worksheets	Yes: listening to session recordings and real-life practice	None	None described in published sources	Not defined	None
Typical course (per manuals or studies)	Studies used 1–5 sessions of about 60–75 minutes; averages of about 3.5–4 in the published studies	About 3 months of weekly 50- to 90-minute sessions	About 12 weekly sessions of 50–60 minutes	8–15 weekly sessions of 60–90 minutes	5 weekly sessions of about an hour	No standard course; the developer’s pilot study measured results after 3 sessions	No standard course for PTSD	Open-ended
VA/DoD 2023 PTSD guideline	Insufficient evidence: neither for nor against	Strong for	Strong for	Strong for	Weak for (“suggest”)	Not mentioned	Insufficient evidence: neither for nor against (“hypnosis or self-hypnosis”)	Insufficient evidence: neither for nor against (“supportive counseling”)
APA 2025 PTSD guideline	Not mentioned	Conditional (second-line)	Strong (first-line)	Strong (first-line)	Not among the recommended or suggested treatments	Not among the recommended or suggested treatments	Not among the recommended or suggested treatments	Not among the recommended or suggested treatments
Offered at The Denning Center	Yes	Yes	No	No	No	No	No	Ongoing counseling, yes

Scroll the table sideways to see every column.

Session counts are what manuals and studies describe, not a promise for any one person. ART session averages come from studies run mostly by researchers connected to ART’s development. APA 2025: first-line treatments are CPT, PE and trauma-focused CBT; second-line are cognitive therapy, EMDR and narrative exposure therapy. We could not confirm whether APA separately lists WET, Brainspotting, hypnotherapy or supportive counseling as having insufficient evidence, so the table says only that they are not among the treatments APA recommends or suggests.

What the ratings mean

The VA/DoD guideline sorts treatments by how confident its reviewers are that the benefits outweigh the harms. “Strong for” means they recommend it. “Weak for” means they suggest it. “Neither for nor against” means the research wasn’t good enough to decide either way. That is not a finding that a therapy fails. It is a finding that the question hasn’t been answered well enough yet.

For ART, the guideline gives one specific reason: “No RCTs of ART included the critical outcome of clinician-rated PTSD.” The randomized trial of ART in veterans measured symptoms with questionnaires the participants filled in themselves, and it compared ART with a non-therapy control, not with another trauma treatment. There is more on this in what the guidelines say about ART and the 2013 trial.

The American Psychological Association’s 2025 guideline doesn’t mention ART at all, in either direction. It simply wasn’t reviewed. The international ISTSS guidelines don’t mention ART or Brainspotting, and they list hypnotherapy and supportive counseling as having insufficient evidence.

How to choose

Most people don’t need the single best therapy on paper. They need one they can start, stay with and finish. These are the questions that usually decide it.

How strong do you want the evidence to be? If that matters most to you, start with CPT, PE or EMDR. That is a completely reasonable choice, and a good ART clinician should say so.
How do you feel about telling the story? PE asks you to recount the memory aloud, session after session. WET asks you to write it. CPT makes a written account optional. EMDR and ART don’t require you to describe the details, though both involve bringing the memory to mind. See ART without talking about it.
Can you do work between sessions? CPT and PE rely on homework. EMDR, WET and ART don’t use it. If your week has no room for worksheets or recordings, that is worth saying at the start.
How much time can you commit? CPT, PE and EMDR usually run around three months of weekly sessions. WET is five sessions. ART studies used one to five sessions, but session length is often longer, and no clinician can tell you your number before assessing you. More in how many sessions ART takes.
What have you already tried? If one approach stalled or you dropped out, trying something with a different procedure is a legitimate reason to choose it.
Is it a specific memory, or life right now? Trauma-focused therapies work on memories. If what you need most is support with current relationships, work or safety, ongoing counseling may come first. See ART vs talk therapy.

The head-to-head comparisons

ART vs EMDR: the two eye-movement therapies, from a clinician trained in both
ART vs prolonged exposure: brief recall and image replacement versus repeated retelling
ART vs cognitive processing therapy: working on images versus working on beliefs, and the unpublished trial
ART vs Brainspotting: two EMDR offshoots with very different procedures
ART vs hypnotherapy: whether ART is a form of hypnosis
ART vs talk therapy: when ongoing counseling is the better fit, and combining them

If you’re considering ART

ART is worth considering if a specific memory keeps intruding, you would rather not narrate it, and you understand that its research base is smaller and younger than the guideline-recommended options. Screening comes first, because it isn’t right for everyone (see who ART is not for). If you would like to talk through whether it fits, you can get started here.

Questions people ask

What is the most effective therapy for trauma?

For PTSD, the treatments with the strongest guideline support are cognitive processing therapy, prolonged exposure and EMDR, which the 2023 VA/DoD guideline rates “Strong for.” The APA’s 2025 guideline puts CPT, PE and trauma-focused CBT first and EMDR second. No therapy works for everyone, and the fit between you, the method and the clinician matters too.

Which trauma therapies don’t make you talk about what happened?

EMDR and ART don’t require you to describe the trauma in detail, though both ask you to bring the memory to mind. Written exposure therapy has you write about it rather than say it aloud. CPT makes a written account optional. Prolonged exposure asks you to recount the memory aloud. More on ART without talking.

Is ART recommended by the VA?

No. The 2023 VA/DoD guideline says there is “insufficient evidence to recommend for or against” ART, because no randomized trial of ART measured PTSD with a clinician-rated assessment. That is different from a finding that it doesn’t work. ART is used in some military clinics, but being used is not the same as being recommended.

Is ART faster than other trauma therapies?

That hasn’t been shown. ART studies used 1 to 5 sessions, averaging about 3.5 to 4, while CPT, PE and EMDR are usually delivered over about three months. But no trial has compared them directly, the ART studies were mostly run by researchers connected to ART, and how long anyone needs depends on what happened and for how long.

Can I switch trauma therapies if one isn’t working?

Yes. Stalling in one approach is a legitimate reason to try one with a different procedure. It helps to tell the new clinician what you tried, how far you got and what made it hard, because that shapes what is likely to suit you next.

Sources

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