Who ART is not for, and when “not yet” is the right answer

There is no single list of people who can never have Accelerated Resolution Therapy (ART). The developer’s organization says there are “no absolute contraindications,” but advises a comprehensive clinical intake and lists several factors to weigh: eye disorders, dissociative disorders, poor ego boundaries, ongoing substance abuse, heart disease, breathing problems such as asthma, traumatic brain injury, vertigo and migraines, and some medications. Any of these can mean ART needs adapting, should wait, or is not the right choice.

That list comes from the Rosenzweig Center for Rapid Recovery, which trains ART clinicians. It is guidance, not the result of safety research, and it is worth reading as “things to talk through” rather than as a verdict.

The factors, and why they matter

Eye conditions

ART depends on following the clinician’s hand with your eyes, in sets of about 40 movements. The developer calls an ocular disorder “the most notable condition to think about.” In one early study, a participant dropped out because they could not perform the eye movements after surgery for amblyopia (Kip et al. 2012).

Heart and breathing conditions

ART “can resurface some painful emotions with strong physical sensations, such as rapid breathing and pulse rate,” in the developer’s words. If you have heart disease or asthma, that matters, and your physician may need to be part of the conversation.

Migraines and vertigo

The developer lists both as factors to consider. Because ART involves repeated sets of eye movements, mention either at the assessment so you can talk through whether they are likely to be a problem.

Traumatic brain injury

Listed as a factor to consider. People with a history of TBI have been included in ART research (a subgroup analysis by Kip et al. 2019), so a TBI history is a reason for careful assessment rather than an automatic no.

Dissociative disorders and poor ego boundaries

Both are on the developer’s list. If you tend to lose time, feel detached from yourself, or find it hard to stay present when distressed, say so at the assessment. It affects how, and whether, memory work should start.

Ongoing substance use

Listed as a factor to consider. Be honest about current alcohol and drug use at the assessment; it is part of deciding whether now is the right time.

Medications

The developer notes that some medications, such as anti-anxiety medicines and benzodiazepines, “may blunt your client’s response.” Do not stop or change medication on your own. Talk it through with your prescriber and clinician.

Research studies also screened people. The 2020 grief trial excluded people with a “major psychiatric disorder” or in other current psychotherapy (Buck et al. 2020). An earlier study offered referral instead of ART to people whose scores suggested they needed “a higher level of care” (Kip et al. 2012). That means the research tells us little about how ART works for those groups.

“Not yet” is different from “not this”

Being told ART is not the right step is a clinical answer, not a rejection. It usually falls into one of two kinds.

If I think ART is not right for you, I will say so and we will talk about what would be.

Groups the research has not covered

• Children and teenagers. Every ART trial so far enrolled adults. There are no published full studies of ART in children or adolescents.
• Telehealth. No published study has tested ART delivered by video. Every trial was in person. See ART online.
• Several specific problems. No published ART studies were found for first responders, phobias, birth trauma, moral injury, car accidents or substance use. That does not mean ART cannot help. It means there is no research to say whether it does. The what ART is used for hub goes through each.

What the alternatives are

ART is one option among several. For PTSD, the major guidelines agree on a small set of best-supported therapies, and it is fair to say they have much stronger evidence than ART does:

• Cognitive processing therapy, prolonged exposure and EMDR receive the strongest recommendation in the 2023 VA/DoD PTSD guideline (VA/DoD 2023).
• Written exposure therapy, present-centered therapy and Ehlers’ cognitive therapy receive a weaker “suggest” recommendation in the same guideline.
• Accelerated Resolution Therapy is listed with insufficient evidence to recommend for or against, because “No RCTs of ART included the critical outcome of clinician-rated PTSD.”

The trauma therapies compared page sets these out side by side, and ART vs EMDR covers the closest relative. If ART is “not yet” for you, the most useful next step is often trauma-focused work that builds stability first.

If you are unsure where you fall, that is exactly what an assessment is for. Get started.