What Is EMDR and Is It Effective for Addiction Treatment?
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What Is EMDR and Is It Effective for Addiction Treatment?
Eye Movement Desensitization and Reprocessing (EMDR, going forward) therapy was originally discovered as an approach to work with traumatic events. EMDR was developed by the American psychologist Francine Shapiro, Ph.D., in the late 1980s, primarily as a treatment for Post Traumatic Stress Disorder—PTSD.
But what is EMDR?
EMDR therapy is an eight-phase treatment, which comprehensively identifies and addresses experiences that have overwhelmed the brain’s natural resilience or coping capacity (examples include but are not limited to war, rape, assault, sexual abuse, etc.) and have thereby generated traumatic symptoms and/or harmful coping strategies (flashbacks, anxiety, insomnia and possible harmful attempts to address these symptoms, such as isolating behavior and self-medication with drugs and alcohol.). Through EMDR therapy, patients are able to reprocess traumatic information until it is no longer psychologically disruptive.
Most people wonder what actually occurs in a typical EMDR session. There are phases of treatment, the initial one being the taking of a thorough client history followed by a preparation stage. In the Rapid Eye Movement portion, the individual focuses on a troubling memory and identifies the belief he/she has about himself connected to this negative memory (for example, in dealing with a rape, the person may believe "I am dirty"). The individual then formulates a positive belief that he would like to have about himself ("I am a worthwhile and good person in control of my life."). All the physical sensations and emotions that accompany the memory are identified. The individual then goes over the memory while focusing on an external stimulus that creates bilateral (side to side) eye movement. This is most often achieved by watching the therapist moving a finger. After each set of bilateral movements, the individual is asked how he feels. This process continues until the memory is no longer disturbing. The individual is processing the trauma with both hemispheres of the brain stimulated. The chosen positive belief is then installed, via bilateral movement, to replace the negative one. The session normally lasts for about one hour. It is believed that EMDR works because the “bilateral stimulation” by-passes the area of the brain that has become stuck due to the trauma and is preventing the left side of the brain from self-soothing the right side of the brain.
During this procedure, patients tend to “process” the memory in a way that leads to a peaceful resolution. This often results in increased insight regarding both previously disturbing events and long-held negative thoughts about the self that have grown out of the original traumatic event. For example, an assault victim may come to realize that he was not to blame for what happened, he is now safe, that the event is really over, and, as a result he can regain a general sense of safety in his world.
Robert Sickgold, Ph.D., of Harvard Medical School, told The Fix: “We believe that EMDR induces a fundamental change in brain circuitry similar to what happens in REM sleep—that allows the person undergoing treatment to more effectively process and incorporate traumatic memories into general association networks in the brain. This helps the individual integrate and understand the memories within the larger context of his or her life experience.”
There have been many adaptations of the process over the years and more psychological issues have been found to be helped by EMDR—one being addiction.
I spoke with a few experts in the fields of addiction treatment and EMDR to find out about their experiences utilizing EMDR in the treatment of addiction.
I asked Jamie Marich, Ph.D., if she found EMDR to be effective in her own experience of addiction as well as in the treatment of other addicts.
Dr. Marich responded: “EMDR therapy is now referred to as such—a therapy, a complete approach to psychotherapy and not just a technique like it was originally conceived. There is a model underlying EMDR therapy: the adaptive information processing model, which states that distress and other trauma symptoms result from a series of unprocessed traumatic memories. If we accept that unhealed traumatic wounds play a major role in causing or at the very least exacerbating the seriousness of substance use and addictive disorders, yes, EMDR therapy can be very effective.
“Since the beginning of my journey with EMDR in 2004, I've long viewed it as an effective relapse prevention/recovery enhancement strategy that truly targets trauma. It's been clear to me from the beginning of my own journey with recovery, and as a treatment provider, that unhealed PTSD and other trauma-related disorders pose a clear relapse risk. From my experience as an EMDR client (receiving it as a vital relapse prevention intervention when I had two years sober), a Certified EMDR Therapist/Consultant who also specializes in addiction, and now as an EMDRIA-Approved Basic Training Provider in EMDR, the key to EMDR's effectiveness with addicts is that the treatment provider understands the nature of addiction. Too often I see EMDR practitioners with little-to-no training in addiction who think that by just doing a series of EMDR protocols that they learned, some of which have now been developed to target things like cravings and feeling states, that they can fix the core trauma and thus fix the addictive manifestations. It is rarely that simple.
“Doing trauma reprocessing using EMDR Therapy with an addicted client takes a great deal of preparation that is both trauma-informed and addiction-informed. This may sound like common sense but too many clients and therapists are looking for EMDR therapy to be a quick fix and it's not that—it's meant to provide us with comprehensive understanding that neither trauma nor addiction develops in a vacuum. My experience clinically affirms what my dissertation research with women (none of whom were my clients) highlighted for me: EMDR is most effective when used as part of a comprehensive plan for treating addiction that must also include appropriate social supports and teaching of new lifestyle skills. EMDR is not the quick fix.”
Dr. Stephen Dansiger holds a doctorate in Clinical Psychology and is a licensed Marriage and Family Therapist in the state of California. Along with Noah Levine, Dr. Dansiger established the Refuge Recovery Centers, where he is currently the clinical director. Dr. Dansiger specializes in addiction, mood disorders and EMDR. The Fix spoke with him about the value of EMDR in the treatment of addiction.
First, what role do you see EMDR playing in addiction treatment?
EMDR therapy can play a central role in addiction treatment since trauma plays a central role in addiction etiology. Many people come into addiction treatment with diagnosable PTSD, and in that case EMDR is indicated as a front line treatment. Those of us who see the role of trauma regardless of the development of PTSD have seen how EMDR therapy can be the lens through which to conceptualize the case and set up the treatment plan, as well as the method of providing the treatment. Some people have the misconception that EMDR is simply waving a finger in front of someone's face. EMDR therapy is actually more of a theoretical orientation and a process. The first two phases of the eight-phase protocol are actually all about stabilization and building internal resources. That is what the client needs upfront. And then the therapist and team can determine readiness for phases three through eight, the trauma reprocessing.
Why do you think it is a useful technique for this population?
If you have worked in the addiction field for any amount of time, you can become disheartened or burned out by the seeming revolving door nature of things. One of the populations we have had some success with at Refuge Recovery Centers are those people who have been through multiple treatments, and it turns out that the untreated trauma was the block to their recovery. If an addicted person wasn't particularly traumatized in their young years, which they often are, then they almost inevitably have traumatic experiences as part of the consequences of their using. Honoring and validating this for people can go a long way in building trust and safety. For me, EMDR therapy provides a remarkable way to focus on the issues at hand and have concrete tools to treat the underlying problems.
Refuge Recovery Center is utilizing EMDR as a primary treatment approach for your addicted population. How are you implementing it in your program?
At Refuge Recovery Centers, we are creating a clinical environment that combines the wisdom of the Dharma (Dharma refers to the teaching of the Buddha – RW) with EMDR therapy as a primary case conceptualization, treatment planning and treatment protocol. Our entire program is a highly effective combination of several of the best stabilization and resource development modalities, or the first two phases of EMDR—Buddhist mindfulness, Somatic Experiencing, Attachment Theory, Mindfulness Based Relapse Prevention, yoga, art therapy, and others. I am also now able to provide EMDR training for all our licensed and pre-licensed clinicians and basic trauma training for all of our team. Once they are trained, I can provide EMDR consultation for our clinicians above and beyond their regular supervision. Antioch University has already identified us as a training site and other local universities are considering the same, and all trainees will receive EMDR therapy training. It's very exciting to build a facility that is rooted in Dharma and the highest level of trauma-informed care, and to bring together those clinicians who see the wisdom of this approach—to create a vibrant training and treatment environment.
Regina Walker is a regular contributor to The Fix.