Another trauma-focused therapy worth highlighting is Accelerated Resolution Therapy (ART), a form of eye movement therapy with similarities to EMDR, which offers promise in delivering clinically meaningful results within < 6 treatment sessions.29,30 Although ART has been tested in only 1 randomized clinical trial (RCT) to date, it incorporates the core elements of other traumafocused therapies, which have an extensive evidence base. 29 Accelerated Resolution Therapy is highly procedural, relatively simple for clinicians to learn, and focused on addressing physiologic and emotional reactivity linked to intrusive traumatic images and memories. It involves imaginal and in-vitro exposure through visualization, relaxation techniques, combined with rescripting traumatic imagery, using techniques similar to those used in cognitive therapies for insomnia and nightmares (eg, Imagery Rehearsal Therapy). All of the procedures are grounded in lateral eye movements.
The 2-arm, DoD-funded RCT involved evaluation of ART for treatment of combat-related PTSD (average 3.7 sessions) against an attention control condition among 57 veterans. Significant differences at 3 months’ follow-up were documented in PTSD, depression, anxiety, trauma-related guilt, sleep quality, and aggression. 29 Limitations of this study included reliance on the PCL rather than on a gold-standard diagnostic instrument, lack of independent blinded outcomes, and a control condition similar to a wait list. More rigorous RCTs with active control conditions, as well as dismantling studies, are needed. Nevertheless, the impressive reduction in PCL scores (averaging 17-20 points) after only 3 to 4 sessions and firm grounding in trauma-focused psychotherapy components was sufficient for clinicians at several military treatment facilities (including Walter Reed National Military Medical Center and Fort Belvoir Community Hospital) to become trained in this technique and begin offering it as an option to service members with PTSD. The popularity of this technique is likely to grow if more clinicians test it and confirm that rapid improvements in PCL scores and functioning are possible within a few sessions.
Other Important Clinical Considerations
Ongoing clinical trials are actively looking at compressed delivery of CPT and PE psychotherapy (several sessions per week for 2-3 weeks), which will likely have considerable benefits in reducing patient dropout rates. Another active area of research involves interventions based in primary care, and there is good evidence to support expansion of step- and collaborative-care models in primary care to address postwar health concerns more holistically, particularly with regard to symptoms attributed to mTBI. 4,7,24 Finally, considerable literature is emerging on conceptual problems with the overlap between mTBI and PTSD, problems of misattribution of generalized war-related health concerns to mTBI, and potential reinforcement of chronic postwar physical and cognitive symptoms through the current structure of mTBI specialty care. 4,7,24 All of this research strongly supports prioritizing interventions based in primary care.
Summary and Conclusion
The most clinically important development in PTSD is the new DSM-5 definition. Clinicians need to be thoroughly aware of the concerns with its clinical utility and have appropriate strategies for dealing with the clinical implications of discordant results (a prominent expert has even called for putting the new definition on hold). 11,12 Treatment strategies likely to have the greatest impact on improving effectiveness of treatment are those that emphasize engagement and retention in care and most importantly, delivery of the core components of trauma-focused psychotherapy in a patient-centered manner. 16,17 Promising developments in trauma-focused therapy include NET and ART.