Using EMDR for Addiction Therapy: What is It?

What Is EMDR Therapy?

EMDR is the acronym for Eye Movement Desensitization and Reprocessing. EMDR is a therapy that specifically targets trauma. The EMDR approach posits that trauma is typically at the root of mental health disorders as well as substance use disorders.

EMDR is composed of eight treatment phases, which can occur over the amount of time needed, based on the patient’s needs.

These treatment phases are:

  • History and treatment planning (typically 1-2 sessions)
  • Preparation (1-4 sessions)
  • Assessment (as many sessions as necessary)
  • Desensitization
  • Installation
  • Body scan
  • Closure
  • Reevaluation

As the name suggests, desensitization and processing are the main techniques. Regarding desensitization, an eye movement technique is used. At this point, it is helpful to briefly consider how EMDR came about, and then the eye movement technique will become clearer. In the 1980s, psychologist Francine Shapiro, PhD, was walking in a park, and the landscape was naturally causing her eyes to move from left to right. Shapiro had been recalling negative memories and felt calmed. Shapiro realized that the eye movements were the source of her greater calmness and thought to turn it into a technique that could help people when they are experiencing traumatic memories. But it wouldn’t be enough to calm negative thoughts. Shapiro recognized that new, positive thoughts would have to be installed in a person’s mind. Shapiro called this technique processing. It is important to note that processing is not the same as talking.

EMDR and Trauma

man experiencing anxiety and depression from trauma

The Fix provides an overview of EMDR, which includes a clear explanation about why this approach focuses on trauma. Speaking in broad strokes, a trauma can be seen as an experience that is so intensely disruptive that the brain’s natural defenses are inadequate. Due to the trauma, symptoms emerge, such as anxietyand/or depression. From this mental standpoint, the affected person will typically begin to develop negatives ideas about the self. In the face of the symptoms and the memory of the trauma, the affected individual will typically seek a way to cope. Some individuals will turn to drugs and progress to addiction.

Practitioners of EMDR came to believe that untreated trauma could cause a person’s mental health or addiction symptoms to persist. In this way, according to EMDR clinicians, a person who goes through a rehab program but does not resolve the trauma underlying the addiction is apt to relapse. In the case of drug addiction, a person may have experienced a trauma that led to the substance abuse. But even if such is not the case, the addiction itself could have caused trauma (e.g., breaking the law and being arrested, experiencing sexual assault, or harming another person) that can serve as a trigger for relapse”> if not resolved. Now that it’s clear EMDR targets trauma, it is necessary to look at how EMDR sessions do so.

Understanding the Different Treatment Phases of EMDR

The EMDRIA (EMDR International Association) provides the public with extensive information about this therapy. In the article, “What is the actual EMDR session like?” the organization provides a nuanced step-by-step explanation of what a client can expect in EMDR treatment. The discussion makes clear an often quoted statement that truthfully pertains to this therapy approach: EMDR is not a quick fix. This therapy is not about eye movements and helping to convince individuals to have positive thoughts and feelings about themselves. A look at the eight phases of treatment makes clear that this is a very detailed approach, and only a well-trained and qualified counselor should practice it at a drug rehab center, clinic, private practice, or other professional setting.

Phase 1 (again, usually takes 1-2 sessions) involves a lot of discussion. The therapist will usually ask the client to identify the present problem, the behaviors around that problem, and the symptoms that are being experienced. For instance, a person’s problem may be alcohol abuse. The abuse may have caused the person to argue with loved ones, and the symptoms can be related to the person’s heath (e.g., malnourishment), psychological state (e.g., depression), emotional state (e.g., self-loathing), and interpersonal status (e.g., in conflict with a spouse, loved one, or anyone affected by the drinking). The therapist will have actively listened to the client’s statements and will define a treatment plan that targets: (1) the trauma in the past that is causing the current alcohol abuse, (2) the present circumstances that are causing stress, and (3) the skills the client needs to learn to have a sober and healthy future.

Phase 2, the preparation phase (again, usually 1-4 sessions) is mainly dedicated to ways for the client and therapist to build a relationship of trust. The therapist recognizes that the client is going to get uncomfortable in the face of the trauma, which the therapist and client are working toward discussing. For this reason, the therapist will teach the client some calming or relaxing techniques that can be used to handle any pain that comes up. Essentially, this phase helps to ease the client into a more protracted discussion about the trauma. Once the client and therapist are ready to explore the trauma in greater depth, they can move into the next phase. Note: A client will not have to detail the traumatic events; even a broad look at them can be the basis of sessions.

Phase 3, the assessment phase (can be as many sessions as necessary) will involve the therapist asking the client to think of a scene that best represents the traumatic episode. The therapist will ask the client to provide a statement that reflects negative feelings that arose after the trauma. For instance, if the traumatic event is a parent leaving the family, the negative feeling stated may be “I feel worthless.” This negative self-belief can be erased, however, and replaced with a positive one. The therapist will ask the client to express a positive self-belief, such as, “I love myself and I am worthy of love.” It is critical to EMDR that individuals embody their positive statements. To gauge the depth of the person’s belief, the therapist will use a Validity of Cognition (VOC) scale. The scale goes from 1 (not at all) to 7 (complete belief in the positive statement). The therapist can repeatedly use the VOC scale and should, as this approach requires, keep working with a client until the positive self-belief receives the highest score.

In Phase 4, desensitization, the therapist uses the eye movement technique. The goal is to desensitize the client to the traumatic event. The therapist and client will focus on the traumatic episode and the associations that developed around it. For instance, to return to the abandonment scenario, an association with that trauma could be that fighting makes a person leave, and the client therefore may have gone through various emotions, such as anger, out of fear that expressing emotions would make loved ones leave. As the therapist takes the client from the traumatic event through the associations while using the eye movement technique, the goal is that the intensity of the trauma and associations is lessening to the point where it will be resolved.

Phase 5, the installation, focuses on the client’s new positive self-belief. To return to the abandonment scenario, the client may have working on the self-belief “I love myself and I am worthy of love.” EMDR is committed to helping clients recover from trauma, which in the addiction context potentially means ending the addiction for good. To ensure that the client has actually adopted the positive self-belief, the therapist will invoke the Validity of Cognition (VOC) scale again. In some instances, the client may need to take a certain action to rise to a grade of 7. For instance, a client may need to maintain abstinence for a period of time, as short as a few weeks, in order to truly believe it. The client and therapist can take as many sessions as needed to strengthen the installed positive self-belief.

Phase 6, the body scan, incorporates some very interesting research findings about how the body stores trauma. Research shows that when a person experiences trauma, the memory is stored in the motoric memory system rather than the narrative memory system. This means that a person can retain the negative emotions and physical feelings that arose at the time of the trauma. Through therapy, the sensations and emotions can move to the narrative memory and potentially be resolved. The body scan allows the therapist and client to check if the sensations that attached to the traumatic memory are still in the body. The therapist and client can continually bring up the traumatic event and do a body scan until tension is resolved. In other words, a person who scores a 7 on the VOC scale would have a body scan that shows there is no tension when the traumatic event is thought about.

Phase 7, closure, aims to make sure that each session is helpful to the client. At the end of each session, the therapist will check in with the client to ensure that they have the skills needed to cope with any negative emotions or memories that occur outside of sessions. The therapist will advise the client how and when techniques, such as journaling and self-calming, can be effectively used.

Phase 8, reevaluation, is how a therapist usually opens up the second session and every session thereafter. Reevaluation allows the therapist to make sure that the positive benefits of the treatment are being maintained and effectively integrated into the client’s life. The therapist may also use this time to work with the client to identify other traumas that may need to be targeted in EDMR. Clients may feel relief from EDMR rather quickly, but the therapist understands that each phase of EDMR must be worked through and completed. When a person is in pain, giving it attention can be soothing, but the pain remains intact. Each of the eight phases of treatment, as explained, work in conjunction to remove the memory of the traumatic event from the mind and body. EDMR is not a superficial therapy.

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