Advanced clinical applications of EMDR to addictive behaviors

This workshop addresses the application of standard and modified EMDR treatment protocols to addictive and compulsive behaviors including substance abuse/dependence, overeating, smoking, love addiction. Individuals with addictive and compulsive behaviors frequently have suffered from childhood trauma and neglect resulting in developmental arrests, as well as a variety of maladaptive behaviors which are trauma-related and serve to minimize pain. The successful implementation of EMDR to addictive behaviors requires that EMDR be used as part of an overall treatment program carefully addressing the needs of individuals who have been traumatized and are exhibiting addictive behaviors. A thorough diagnostic work up is needed aimed at assessing comorbidity, dissociation, and a detailed trauma history covering childhood traumas and traumas suffered as adults including traumas that occur as a consequence of addictive behaviors. Careful client preparation is essential to assist individuals in coping adequately with the high levels of emotion experienced during EMDR Clients' readiness to stop compulsive/addictive behaviors needs to be carefully evaluated. A decision tree aimed at determining the appropriateness of EMDR to individuals diagnosed with addictive behaviors is presented which assists clinicians in minimizing the premature use of EMDR. EMDR is a client centered method, and thus, careful pacing is needed with this population to reprocess underlying traumatic issues. This frequently implies utilizing a modified EMDR treatment protocol with only partial resolutions of underlying traumatic material. Guidelines will be discussed to assist clinicians in selecting EMDR targets for optional results which relate to the stages of recovery. EMDR can be used at all stages of recovery to neutralize the negative impact of memories contributing to problematic behaviors, such as urges to use, ambivalence about treatment, fear of facing painfull feelings from the past. EMDR also has the power to install templates for future actions which assist individuals with skill deficits in more rapidly acquiring necessary skills for a successful recovery. Examples of cognitive interweaves are presented which take into consideration clients' readiness, as well as the need to accelerate the recovery process. EMDR has a unique role in the recovery of traumatized individuals with addictive and compulsive behaviors since the accelerated processing of negative experiences and the installation of positive adaptive cognitions assist clients in more rapidly overcoming barriers throughout the recovery process. It also challenges rigid approaches to recovery which frequently stress that trauma work should not be attempted before abstinence has been accomplished for a specified period of time. EMDR is especially valuable in processing core issues which center around shame and manifest in cognitions, such as "I am defective," "There is something wrong with me," "I am not good enough," "I am not quite right," "I don't belong," "I don't deserve to live." Case examples will be given as to how such core issues can be targeted to accelerate the recovery process. A.J. Popky has developed a specialized EMDR treatment protocol which targets levels of urges of addictive/compulsive behaviors directly and installs a positive internal state of feeling empowered without relying on compulsive and addictive behaviors. Case examples fiom clinical practice indicate that when levels of urges are targeted directly, underlying traumas frequently emerge without increasing clients' usage. The symposium addresses the application of this protocol to a range of addictive and compulsive behaviors. The Wades' integrative psychotherapy combines ego-state therapy and EMDR in a psychosocial developmental context. Their substance use disorders treatment program incorporates specialized applications of their integrative psychotherapy, which includes both individual and group therapy and employs hypnosis as well as EMDR Their presentation focuses on applications of the standard EMDR protocol in individual therapy, which is limited primarily to desensitization of dysphoric affect and reprocessing negative cognitions associated with grief and trauma. Their conceptual framework of substance use disorders proceeds from a goal of reducing the harm caused by substance use and a primary distinction between functional and autonomous use (rather than the DSM conceptualizations of "dependence" or "abuse") because this guides interventions. Initial treatment planning depends upon external constraints (e.g., lack of support for positive change, hostile environment), internal limitations (e.g., severity of substance use and its effects, neurocognitive deficits, inadequate "ego strength," lack of skills, disrupted psychosocial development, psychological trauma) and the nature of the substance use disorder (i.e., functional, autonomous, or both). Methods include education about substance use disorders and processes of change, group therapy to develop skills and obtain feedback and support, individual therapy to correct disrupted development and resolve traumatic stress reactions, and exercises to apply what is learned in real-life situations. The standard EMDR protocol is applied to disrupted development involving grief and to resolve psychological trauma that lead to substance use. Case vignettes in which such applications of the standard EMDR protocol were employed are presented in detail.

Conference

English

Silke Vogelmann-Sine
Arnold J. "AJ" Popky
Steve Lazrove
Larry Sine
Jonathan Speare
Darlene Wade
Terrence Wade

Vogelmann-Sine, S., Popky, A. J., Lazrove, S., Sine, L., Speare, J., Wade, D., & Wade, T. (1995, June). Advanced clinical applications of EMDR to addictive behaviors. Symposium conducted at the EMDR Network Conference, Santa Monica, CA