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Using EMDR in the Treatment of AddictionJessica StewartState University of New York at BuffaloEye movement desensitization and reprocessing (EMDR) is a highly scrutinized but efficacious psychotherapy commonly used in the treatment of posttraumatic stress disorder CITATION Gun09 \l 1033 (Gunter & Bodner, 2009). What exactly is EMDR? How does it work? And does its effectiveness go beyond treating PTSD? Has it been proven to work in the treatment of addiction? This paper sets out to learn about the possible use of EMDR in an addiction rehabilitation setting.What is EMDR?According to its creator, Francine Shapiro, EMDR psychotherapy is an information processing therapy and uses an eight phase approach to address the experiential contributors of a wide range of pathologies. It attends to the past experiences that have set the groundwork for pathology, the current situations that trigger dysfunctional emotions, beliefs and sensations, and the positive experience needed to enhance future adaptive behaviors and mental health CITATION EMD11 \l 1033 (EMDR Institute, Inc, 2011). But what does that mean? What does EMDR look like in practice? Although eye movement is most often used, therapists can also use auditory tones, tapping, or other tactile stimulation CITATION EMD11 \l 1033 (EMDR Institute, Inc, 2011). The basic practice is that the client should mentally focus on the traumatic event while physically attending to the eye movement, tone or pulse. In the first phase, the therapist assesses the client’s readiness for EMDR, takes a history and identifies possible targets for EMDR processing including recent distressing events, current situations that cause emotional disturbances, historical events and the coping skills and behaviors that the client will need in future situations. During phase two the therapist evaluates whether or not the client is capable of handling emotional distress and is in a relatively stable state. Phases three through six are when the target is identified and processed using EMDR techniques:The client identifies a vivid image of the memory, a negative belief about themselves, and related emotions and physical sensations.The client identifies a preferred positive belief.The client rates the validity of the positive belief and the intensity of the negative emotions.The client focuses on the image, negative thought and body sensations while moving their eyes back and forth following the therapist’s finger for 20-30 seconds (the use of tones, pulses or other sensations can also be used instead of eye movement). The client is instructed to just notice whatever happens.The therapist guides the client to let his mind go blank and notice what they are thinking, feeling, seeing, remembering, or experiencing. The association process is encouraged by the clinician. This is repeated multiple times in each session.When the client no longer feels distressed in regards to the memory, the therapist has him think about the preferred positive belief established earlier, or a better one if it has emerged. The client then focuses on the incident while engaging in eye movement.After several repetitions, the client will usually report increased confidence in the positive belief. Phase seven is closure, when the client is asked to keep a journal to document any related material that occurs throughout the week. Re-evaluation is the last phase and takes place in the following session CITATION EMD11 \l 1033 (EMDR Institute, Inc, 2011).How Does EMDR Work?There are several theories on the mechanisms that cause EMDR to work CITATION Gun09 \l 1033 (Gunter & Bodner, 2009). One theory posits that EMDR creates a mind state that allows traumatic memories to be effectively processed CITATION Str02 \l 1033 (Strickgold, 2002). According to this belief, EMDR facilitates the processing of traumatic memories while they are integrated with adaptive, new information like “I am safe now” CITATION Sha01 \l 1033 (Shapiro, 2001).One recent study has found that subjects rated unpleasant memories as less vivid, emotional and complete after performing voluntary eye movements and focusing on the memory simultaneously CITATION Gun08 \l 1033 (Gunter & Bodner, 2008). This working-memory account claims that the benefits of EMDR occur when the working memory is taxed with the job of eye movement while also being required to hold a memory in mind. The benefits occur when the subject divide their attention between the two competing tasks. Yet another theory claims that eye movements appear to elicit a distancing effect in EMDR, meaning that the traumatic event can now be observed from a detached perspective CITATION Lee08 \l 1033 (Lee, 2008). This model suggests that EMDR works differently than prolonged exposure treatment where PTSD patients are encouraged to relive the trauma with as much detail as possible. While prolonged exposure treatment is effective in treating PTSD, it is claimed that EMDR works more quickly and is less distressing to the patients.Increased communication between brain hemispheres may also be the underlying mechanism behind EMDR. In Propper and Christman’s account, horizontal eye movement enhances episodic retrieval of memories and associated content through inter-hemispheric communication, which facilitates reprocessing CITATION Pro08 \n \t \l 1033 (2008). Many studies have found that eye movement during EMDR has psychophysiological effects CITATION Gun09 \l 1033 (Gunter & Bodner, 2009). Most of these studies suggest that the eye movements are associated with a relaxation response within the nervous system. The rapid eye movement (REM) account of eye movement suggests that the eye movement in EMDR produces a brain state similar to REM sleep which is involved in memory consolidation. It is proposed that EMDR reduces traumatic symptoms by taking autobiographical memories and making them more generalized semantic memories. A third psychophysiological approach suggests that eye movements induce a relaxed state that is incompatible with the anxiety associated with the traumatic memory. Repeated pairings of the traumatic memory and the relaxation response eventually extinguish the anxiety originally connected to the memory.Gunter and Bodner suggest the need for an integrative model of how EMDR works, where these different approaches can be combined CITATION Gun09 \n \t \l 1033 (2009). Before it can be established what is making EMDR so effective more research will need to be done.EMDR in the Treatment of AddictionO’Brien and Abel suggest that EMDR is effective when combined with traditional addictions treatment approaches, but making the decision about what clients to use EMDR with is complicated; the patient’s level of awareness of their addiction and their motivation to change need to be taken into account before administering EMDR CITATION OBr11 \n \t \l 1033 (2011). Their model proposes that EMDR and pre-EMDR should be applied differently while the client is in each of the stages of change established by Prochaska and DiClemente. During the precontemplation stage a client is unaware that their addiction is a problem. Clients at this stage may be in denial, minimize their problem, or just resistant to change. According to O’Brien and Abel, there is little use for EMDR at this point. They suggest the use of Affect Tolerance Protocol to help the client gain control of their feelings.The contemplation stage is when the client has considering ways to change their behavior regarding addiction. These clients are not ready to actually make a change yet, but they are considering it and have most likely experienced some of the negative effects of their drug or alcohol use. There are a few Pre-EMDR techniques that can be used to help the client become more aware of their choices and decide about whether or not to make a change. Robin Shapiro’s Two-Handed Interweave uses bilateral stimulation by having the client “weigh” two opposing thoughts, feelings or beliefs in their hands like a scale. The client is encouraged to focus on what is going on in each hand. Resource Development Installation (RDI) can be used to help the client develop or enhance qualities that may be needed before making a change. Desensitization of Triggers and Urge Reprocessing (DeTUR) may assist the client in realizing the positive effects of making a change in their addictive behavior. Using DeTUR the client can visualize what his life would look like after he made the change.Once the client has made a commitment to change, they are in the preparation stage of change. Here he develops goals and a practical plan to reach them. Again in this stage, the pre-EMDR protocols mentioned above are appropriate. A clinician may also consider using EMDR for the treatment of any trauma that the client may have experienced in their past (as trauma is common among addicts).The action stage is when the client has initiated the actual change and is taking steps to support their new behavior. During this stage pre-EMDR and EMDR techniques can be used to help facilitate rehabilitation. Pre-EMDR Affect Tolerance Protocol can be used to help clients manage the overwhelming emotions they may be experiencing. RDI may be used to help the client create additional resources to handle the stress of change. Using EMDR, a client can use DeTUR to help manage urges and prevent relapse, this may also help the client to identify triggers and desensitize them. Standard EMDR technique can also be used during the action stage to target the trauma that may be contributing to the addiction. The decision to address traumatic memories in addicts should be carefully considered. O’Brien and Abel suggest asking multiple questions before proceeding. Including, “Did the trauma trigger their addiction?” “What is the client’s motivation?” “What has happened when the client has tried to quit in the past?” And “What internal/external resources does the client have?” Their conclusion is that EMDR is an effective tool to be added to a counselor’s tool bag of interventions for the treatment of addiction.Hase, Schallmayer and Sack conducted a study with 34 participants placed in one of two conditions: treatment as usual or treatment as usual plus two EMDR sessions. The final results showed that the patients who received EMDR sessions in addition to regular treatment showed a significant decrease in craving post-treatment and at a one month follow up compared to the participants who did not receive EMDR CITATION Has08 \n \t \l 1033 (2008).Their research was based on the idea of an addiction memory (AM) which contains “a general memory of loss of control and a drug-specific memory of drug effects” (p.171). Activating this memory will least to drug-taking behavior and may be represented as a craving. The AM is an episodic memory and its cue-reactivity and power are similar to the traumatic memories at the core of PTSD. The study shows that reprocessing the AM with EMDR leads to changes of addiction symptoms. Final ThoughtsThere is not a lot of research available on the use and effectiveness of EMDR in treating addictions. However EMDR has proven to be very successful in the treatment of PTSD, and many addicts have a traumatic past that is often the root cause of their addiction. The few articles available show hope and promise for the field of drug and alcohol addiction rehabilitation. But there is still a need for more research not only on the mechanisms of EMDR, but also on its use in treating addictions. Without knowing exactly how EMDR works, the question remains: Do we need to know how a therapeutic technique works in order for us to use it? Does it really matter if we understand why, when we can clearly see that it is effective? Any treatment option that has shown such promise, and can offer hope to the millions of people struggling with addiction is worth researching further.References BIBLIOGRAPHY EMDR in Action. (2011). Retrieved 11 2011, from EMDR Institute, Inc. (2011). Retrieved 11 2011, from , R. W., & Bodner, G. E. (2008). How eye movemens affect unpleasant memories: Support for a working-memory account. Behaviour Research and Therapy, 46, 913-931.Gunter, R. W., & Bodner, G. E. (2009). EMDR works...but how? Recent progress in the search for treatment mechanisms. Journal of ENDR Practice and Research, 3(3), 161-168.Hase, M., Schallmayer, S., & Sack, M. (2008). EMDR reprocessing of the addiction memory: Pretreatment, posttreatment and 1-month follow up. Journal of EMDR Practice and Research, 2(3), 170-179.Lee, C. W. (2008). Crucial processes in EMDR: More than imaginal exposure. Journal of EMDR Practice and Research, 2, 262-268.O'Brein, J. M., & Abel, N. J. (2011). EMDR, addictions, and the stages of change: A road map for intervention. Journal of EMDR Practice and Research, 5(3), 121-130.Propper, R. E., & Christman, S. D. (2008). Interhemispheric interaction and saccadic horizontal eye movements: Implications for episodic memory, EMDR and PTSD. Journal of EMDR Practice and Research, 2, 269-281.Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures (2nd ed.). New York: Guilford Press.Strickgold, R. (2002). EMDR: A putative neurobiiological mechanism of action. Journal of Clinical Psychology, 58, 61-75. ................
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