The brain and the body are always adjusting to what is going on internally (perception) and externally (environment). Most of this incredible natural healing and coping occurs during sleep, especially during rapid eye movement (REM) between 1:00-4:00 AM. Eye Movement Desensitization and Reprocessing, known as EMDR, is an integrative psychotherapy approach guided by the Adaptive Information Processing (AIP) model. It was developed by Dr. Francine Shapiro in 1987, who discovered that this natural healing and coping process could successfully treat persons diagnosed with PTSD.
Since then, the professional organization EMDRIA was organized to maintain standards of practice for licensed clinicians who found EMDR to to be an effective treatment for a wide range of mental health problems. The Journal of EMDR Practice and Research is a peer reviewed publication that is designed to educate EMDRIA members that are licensed clinicians on how to integrate and apply EMDR to diverse populations.
The AIP Model Approach
Most of the time the mindbody automatically manages new experiences and events without you being aware of it. However, when something out of the ordinary occurs that is shocking or causes repeat exposure to overwhelming stress or events, this overload can result in dysfunctional memories and feelings being stored or unprocessed by the brain. Examples of such incidents include: death, car accident, chronic health issues, childhood neglect, rape, sexual abuse or domestic violence. These long “forgotten” stored memories, when activated or triggered, are accompanied by high feeling states such as anxiety, panic, rage, shame, or despair. According to the AIP model, the triggered memory presents with the original emotions, physical sensations, and beliefs that occurred during the original events, but are now being activated and attempting to cope with the present trigger. Neuroscience research has shown that the brain has the possibility to unlock frozen memories, crippling the ability to separate what has happened then from what is happening now. The past is not the present and past defense mechanisms cannot deal with the present trigger.
What happens in an EMDR session?
After a thorough history taking in the first appointment and screening the client to identify whether EMDR is an appropriate treatment, the clinician should explain what happens during an EMDR session. The clinician should also identify whether the client is ready. Because of the rapid processing of traumatic events, the interviewer should determine if the client can tolerate painful and calming events, simultaneously, without remaining triggered. In other words, they should have the capacity to stay present while tracking the troubling sensations, emotions and images without becoming or remaining overwhelmed. This facilitates a releasing of the emotions attached to memories from the past. The pendulum ration, or shifting back and forth, between the calm and disturbed states, helps bring the mindbody back into a natural state of balance. The assessment process to determine appropriateness for the EMDR session may take several psychotherapy appointments. And in such cases where EMDR is not deemed appropriate, other approaches such as Cognitive Behavioral Therapy (CBT), or other somatic (body-based) interventions may be used. Approaches should be client driven.
During the EMDR sessions, memory reconsolidation utilizes eye movements similar to those in REM sleep to recreate the stored memory by asking the patient to respond to external stimuli such as a swinging pendulum, listening to headphones, holding tappers, or by tapping as the eye moves back and forth. After short sets of eye movements, the therapist will ask to report back on “what do you notice” during each set of eye movements, and will be prompted to “go with that.” Experiences during an EMDR session may update or release a previous memory, can change the original memories for the better, or find new meaning and feelings about what happened.
EMDR therapy seems to release the intensely painful emotions and helps store it differently so the memory becomes a neutral event that occurred in the past. It is found that with repeated sets of eye movements, other associated memories can be healed at the same time. This linking of events in the neural network has been reported by clients to lead to dramatic insight and healing in many aspects of life. Eye movements lead to a weakening or desensitizing of the original memory and the chain of associations that stimulates the modification of meanings.
EMDR and Addiction
Until recently, it was believed that addiction treatment should begin before trauma treatment, requiring the patient to reach abstinence first before exploring the pain from the past. However, today, experts suggest a more integrated, inclusive approach to include trauma in the addiction treatment.
While PTSD and addiction treatment can be challenging, it is practical and appropriate to treat them both. A significant reduction of PTSD symptoms is necessary and expected. It is recognized that trauma is one of the possible routes leading to addiction, and that every addiction has developed a life of its own with it's own memory. A memory network is thought to be composed of addiction related memories and behaviors that relate to substance use. At the moment, there is little evidence that trauma treatment will improve addiction outcomes in the short term. In fact, sometimes the therapist and the patient need to work through and process past traumas while addressing the addiction treatment concurrently. Addiction becomes the role the client used as a way to avoid or cope with negative emotions which can be stored as negative learning experiences. Working on these painful memories may help to avoid using substances as coping for the addictive person.
Craving is a key concept in substance abuse and addiction treatment in which the client might suddenly and unexpectedly be triggered. Modifications of the EMDR protocol (A-TIP, EMD, EMDr, Crav-Ex, Tapping, Feeling State Addiction Protocol (FSAP), and DETUR) have been developed to address these situations. The desensitization of triggers and urges can be reprocessed with these protocols, which are considered integrative approaches for treating substance-abuse disorders and other compulsive behaviors. All modifications of the EMDR protocols emphasize the need to enhance access to the client’s positive internal state by identifying and associating it with positive treatment goals. The protocols focus on present triggers that include new ways of coping. The models use the level of urge (LOU) scale or Motivation Interviewing (MI) scale which is identical to the SUD scale used in the EMDR standard protocol. After the memory representation of the trigger image is fully desensitized (LOU equals zero), or MI scale is increased, it is coupled with a positive state of the treatment goal, identifying or resuming already acquired self-control skills. These are anchored with bilateral stimulation, resembling conditioning from learning theory.
How To Use EMDR With Addiction
No one module should be used as an independent treatment option for addiction. There are many modules and other skills that can help make addiction therapy successful. EMDR and addiction treatment starts with explaining and asking about commitment regarding craving, use, therapy attendance, and refraining from substance use before and directly after therapy sessions. The 12 step program and other group support can be helpful. Therapy guidelines could include: 1) No substance use before EMDR therapy; 2) Openness about craving and substance use between sessions so that new targets can be identified and coping strategies discussed; and 3) No substance use immediately following the EMDR therapy to avoid direct association with the therapy process. Doing so demonstrates the patients commitment to trying new alternative strategies.
It is important to continuously gather a history in order to understand the problem behavior. Focus on the factors that contribute to the addiction behavior as well as specific vulnerabilities that may not have surfaced during the initial interviews.
At some point, a client can become very unmotivated after a relapse between sessions and could be fueled by a sense of powerlessness, fear, guilt, and shame. When there are clear deviations in motivation from the previous session, this should be discussed and a shared decision should be made on how to proceed.