Elsevier

Nurse Education Today

Volume 47, December 2016, Pages 74-80
Nurse Education Today

Practice comparisons between accelerated resolution therapy, eye movement desensitization and reprocessing and cognitive processing therapy with case examples

https://doi.org/10.1016/j.nedt.2016.05.010Get rights and content

Highlights

  • ART enhances collective competence, confidence, and job satisfaction.

  • Unique use of rescripting.

  • ART can complement CPT for improve outcomes.

  • ART may be applicable in high operational tempo.

Abstract

Recent outcomes for Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) therapy indicate that as many as 60–72% of patients retain their PTSD diagnosis after treatment with CPT or PE. One emerging therapy with the potential to augment existing trauma focused therapies is Accelerated Resolution Therapy (ART). ART is currently being used along with evidence based approaches at Fort Belvoir Community Hospital and by report has been both positive for clients as well as less taxing on professionals trained in ART. The following is an in-practice theoretical comparison of CPT, EMDR and ART with case examples from Fort Belvoir Community Hospital. While all three approaches share common elements and interventions, ART distinguishes itself through emphasis on the rescripting of traumatic events and the brevity of the intervention. While these case reports are not part of a formal study, they suggest that ART has the potential to augment and enhance the current delivery methods of mental health care in military environments.

Section snippets

Utilization of ART at Fort Belvoir Community Hospital

FBCH's experience with ART began in June 2014, when the University of South Florida College of Nursing (USF) hosted a Basic ART training for federal and military providers. An initial cohort of seven providers attended this training, including the hospital's Director for Behavioral Health (WW). Each provider was experienced treating PTSD in military populations and quickly recognized the potential advantages ART can offer over current treatments for PTSD. Their collective enthusiasm and early

Theoretical Similarities

EMDR is another eye movement-based psychotherapy that was initially viewed with great skepticism, but has gained popularity since its endorsement by the American Psychiatric Association in 2004 (APA, 2004). EMDR has accumulated a large body of evidence and is among the top three evidence-based therapies adopted by the DoD for the treatment of combat-related PTSD (DoD/VA, 2010). From a theoretical perspective, both EMDR and ART rely upon the assumption that traumatic memories are stored as

Theoretical Similarities

CPT contains elements of cognitive therapy and information processing theory (Resick and Schnicke, 1992). According to CPT, a traumatic event can disrupt a person's original schemas about the self, world, and others, and results in dysfunctional schemas. If dysfunctional schemas existed prior to the event, a traumatic event may re-activate and confirm them, compounding the individual's suffering. The aim of CPT is to help clients restructure these schemas to produce realistic and balanced

Discussion

Within the context of these case examples, ART, EMDR and CPT have different strengths and weaknesses. A summary of the components of treatment for CPT, EMDR and ART is provided in the table below: (Table 2)

In practice, CPT and EMDR may be most beneficial for individuals who do not have a complex trauma history, have comorbid or co-occurring depression, are willing to explore cognitions and change their thought processes, are open and able to write out their trauma narrative and/or thoughts, and

Summary

While addressing mental health concerns is paramount for the fitness and function of a nation's armed forces, traditional interventions are associated with recurring costs that extend beyond service members' active duty time to months and sometimes years after their completion of military service. Thus, there is a military-wide need for mental health interventions that are brief and effective, as well as mobile in some circumstances. Whereas the evidence base for ART is clearly not as robust as

Disclosure

Dr. Hernandez, Dr. Waits, Dr. Calvio, and Ms. Byrne have no financial disclosures or ethical conflicts of interest to report. The views and opinions represented herein are solely those of the authors and do not reflect the official policy or position of the United States Defense Health Agency, the United States Department of Defense, or the United States Government.

Acknowledgments

The authors would like to acknowledge ART founder Laney Rosenzweig and Dr. Kevin Kip for their continued support of this work at FBCH.

References (23)

  • J.E. Dunsmoor

    Novelty-facilitated extinction: providing a novel outcome in place of an expected threat diminishes recovery of defensive responses

    Biol. Psychiatry

    (2015)
  • American Psychiatric Association

    Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder

    (2004)
  • A.O. Bryan et al.

    Self-forgiveness, posttraumatic stress, and suicide attempts among military personnel and veterans

    Traumatology

    (2015)
  • Department of Veterans Affairs, Department of Defense

    VA/DoD clinical practice guideline for management of post-traumatic stress

  • A. Finnegan et al.

    Accelerated resolution therapy: an innovative mental health intervention to treat post-traumatic stress disorder

    Journal of the Royal Army Medical Corps

    (Jul 3. 2015)
  • K.E. Kip et al.

    Brief treatment of symptoms of post-traumatic stress disorder (PTSD) by use of accelerated resolution therapy (ART)

    Behav. Sci.

    (2012)
  • K.E. Kip et al.

    Comparison of accelerated resolution therapy (ART) for treatment of symptoms of PTSD and sexual trauma between civilian and military adults

    Mil. Med.

    (2015)
  • K.E. Kip et al.

    Randomized controlled trial of accelerated resolution therapy (ART) for symptoms of combat-related post-traumatic stress disorder (PTSD)

    Mil. Med.

    (2013)
  • K.E. Kip et al.

    Accelerated resolution therapy for treatment of pain secondary to symptoms of combat related posttraumatic stress disorder

    Eur. J. Psycho Traumatol.

    (2014)
  • K.E. Kip et al.

    Case report and theoretical description of accelerated resolution therapy (ART) for military-related post-traumatic stress disorder

    Mil. Med.

    (2014)
  • K.E. Kip et al.

    Brief treatment of co-occurring post-traumatic stress and depressive symptoms by use of accelerated resolution therapy

    Front. Psychol.

    (2013)
  • View full text