Voluntary Image Replacement: the step that makes ART different

Voluntary Image Replacement (VIR) is the step in Accelerated Resolution Therapy (ART) where you replace the distressing images attached to a memory with images of your own choosing. You still know what happened. What changes is the picture your mind goes to when the memory comes up. The researchers who studied it describe it as replacing “the distressing images (but not narrative memory)” (Kip et al. 2012).

The developers write the name two ways, Voluntary Image Replacement and Voluntary Memory Replacement, often together as “VMR/VIR.” Both refer to the same step. The word that matters most is voluntary: the new images are chosen by you, not supplied by the clinician.

Where it fits in a session

VIR comes in the second half of an ART session. First you briefly recall the memory while following the clinician’s hand with your eyes, in sets of about 40 movements, until the body sensations tied to the memory have eased. Only then does the work turn to the images. The full order is on the session step-by-step page.

Researchers describe ART as having two main parts: imaginal exposure (brief, deliberate recall of the scene) and imagery rescripting (imagining the scene replaced “to any positive scene of their choice”) (Kip et al. 2014). Those are research terms. VIR is ART’s own name for the rescripting part.

What it looks like in practice

The clinician guides you with techniques from the ART manual. One the developers name is the “Director” intervention, which, in the researchers’ words, “directs the patient to establish a new narrative to address ‘unfinished business’ in much the way Gestalt techniques are used” (Kip et al. 2012).

In clearly hypothetical terms: someone troubled by the image of a crash scene might choose to see the car arriving home safely, or the road empty on a sunny day, or something with no obvious connection at all. Someone grieving might choose a scene where they get to say what they did not get to say. The content is personal. There is no correct replacement, and the clinician does not decide it for you.

Afterward, the clinician asks you to try to bring back the original scene and compare it with the new one. In one study, treatment of a scene was counted as complete when only the replacement could be accessed, “although knowledge of the original scene remained in memory” (Kip et al. 2014).

What it is not

The developer’s website uses the phrase “erased or replaced” about the images. That wording can sound as if something is being deleted. It is more accurate to say the images lose their grip: the distressing picture stops being the one that shows up. There is more on this on the page about whether ART changes what you remember.

Where the idea comes from

Replacing or rescripting imagery was not invented by ART. The developer’s organization lists imagery rescripting and guided imagery among the approaches ART draws on, along with exposure therapy, Gestalt, CBT, EMDR and brief psychodynamic therapy (Rosenzweig Center for Rapid Recovery). The authors of a 2020 military case series describe ART as an adaptation of EMDR that adds “visual and cognitive rescripting, and gestalt-style interventions” (Toukolehto et al. 2020).

What ART adds is a fixed place for replacement inside a structured protocol that also uses eye movements. EMDR is its closest relative, and the published descriptions of EMDR’s standard phases do not include a deliberate image-replacement step (VA, EMDR for PTSD). The ART vs EMDR comparison goes into the differences.

Does it work, and is it the part that works?

Honestly, nobody knows yet how much of ART’s effect comes from image replacement specifically. The only systematic review of ART found five studies, could not combine them statistically, and said: “It is not currently known to what degree each component contributes to the outcomes found” (Storey et al. 2024).

Overall, that review concluded ART “shows some promise” but that more high-quality studies are needed. The 2023 VA/DoD PTSD guideline rated the evidence for ART as insufficient to recommend for or against, and gives its strongest recommendation to cognitive processing therapy, prolonged exposure and EMDR. The research hub explains what the studies can and cannot tell you.

I am trained in ART and in EMDR. Some people are drawn to image replacement because it gives them something active to do with a memory rather than only enduring it. Others would rather not rework the picture at all. That preference is worth saying out loud at the start. If you would like to talk through whether ART fits, get started.