In the next few weeks we will be looking at EMDR in the treatment of Complex PTSD (C-PTSD) and then in relation to C-PTSD and addictive behaviours.
It has been demonstrated that many addicted individuals also have the co-morbid condition of C-PTSD (although it may be argued that this C-PTSD has contributed to addictive behaviour and is part of it’s aetiology) so it may be that this is an area that needs greater attention and resources in treatment strategies.
In the next few blogs we first get a brief overview of EMDR, below, simply using edited excerpts from an excellent paper by Dr Shapiro, the originator of EMDR treatment, explaining how EMDR works in processing the past by utilizing memory networks, then we examine a paper suggesting the psychological mechanisms by which it works, before discussing the neural correlates demonstrated to be linked to EMDR treatment success before blogging at a later date on how EMDR is increasingly used in various addictive behaviours and related co-morbid conditions.
EMDR may be a therapeutic tool that has the the potential to decrease relapse and improve recovery outcomes for many addicted individuals.
“EMDR is a comprehensive psychotherapy approach that is compatible with all contemporary theoretical orientations. Internationally recognized as a frontline trauma treatment, it is also applicable to a broad range of clinical issues. As a distinct form of psychotherapy, the treatment emphasis is placed on directly processing the neurophysiologically stored memories of events that set the foundation for pathology and health.
The adaptive information processing model that governs EMDR practice invites the therapist to address the overall clinical picture that includes the past experiences that contribute to a client’s current difficulties, the present events that trigger maladaptive responses, and to develop more adaptive neural networks of memory in order to enhance positive responses in the future.
While clinicians from the various psychological modalities agree on the symptomatology of the well-known disorders, their ways of conceptualizing and treating them differ as a result of the specific theoretical paradigm to which they adhere (Barlow et al. 2005). For EMDR (Eye Movement Desensitization & Reprocessing), this paradigm entails the view that psychopathology is based on memories of earlier disturbing experiences that have been incompletely processed by the brain’s inherent information processing system.
Incomplete processing means that a disturbing event has been stored in memory as it was originally experienced with the emotions, physical sensations, and beliefs fundamentally unchanged. Regardless of how much time has elapsed or whether the person remembers it, the memory remains unaltered and provides the basis of current responses and behaviors.
Most mental health professionals would agree that current clinical issues are based at least in part, on previous life experiences. However, the hallmark of EMDR therapy is the emphasis on the physiologically stored memory as the primary foundation of pathology, and the application of specifically targeted information processing as the primary agent of change.
The Adaptive Information Processing (AIP) model (Shapiro 1995, 2001, 2002, 2007; Solomon and Shapiro 2008) guides the clinical application of EMDR…
EMDR’s three-pronged approach of past, present and future guides the clinician in identifying and processing, (1) the relevant past experiences that inform the client’s problems in the present; (2) the ongoing present experiences that continue to trigger maladaptive responses to current life demands; and, (3) templates of future actions to optimize the client’s capacity to respond adaptively given the current context of their lives. This article provides an overview of both the theory and practice of EMDR as a distinct integrative psychotherapy approach…
EMDR processing can eliminate the dysfunctional emotions and physical sensations inherent in the memory itself changing the client’s experience in the present. Similarly, the processing of pivotal memories has been reported to result in the normalization of attachment style in adults and children (Madrid et al. 2006; Kaslow et al. 2002; Wesselman 2007; Wesselmann and Potter 2009). It is important to emphasize that memories of even ubiquitous events appear to set the foundation for a wide range of pathologies…
… its overarching goal is to achieve an alteration of the underlying condition that is generating the dysfunctional response in the present as part of a comprehensive treatment effect. These outcomes are achieved by placing memory networks and information processing at the center of both treatment and practice.
Adaptive Information Processing Model
The theoretical foundation for the therapeutic application of EMDR is the Adaptive Information Processing (AIP) model developed by Shapiro (1995, 2001, 2002, 2007)…
According to this model, and consistent with neurobiological findings, one identifies and makes sense of new experiences within the context of existing memory networks. In addition, the information processing system functions to move disturbances to a level of adaptive resolution. What is useful is incorporated, what is useless is discarded, and the event serves to guide the person appropriately in the future…
…when an event is not fully processed, the experience remains stored in memory with the emotions, physical sensations, and beliefs that were part of the original event. As a result, the memory is not integrated with other memories that were successfully processed. Consequently, when a similar experience occurs in the future, perhaps involving an authority figure like an insulting teacher, it triggers the unprocessed memory, which then automatically colors the perception of the present experience.
When clients seek psychotherapy for current problems in their lives, they are often focused on their symptoms as the problem. Consequently, the clinician wants to understand what the client is actually experiencing in the present, i.e., negative thoughts and feelings, uncomfortable body sensations that are out of proportion to the situations that are triggering the negative responses. Additionally, similar to other approaches such as psychodynamic therapy, the EMDR clinician seeks to identify the relevant past experiences that are perpetuating the maladaptive patterns of response, resulting in the client’s clinical complaints. According to the AIP model, the pathology is not driven by the person’s reaction (e.g., belief, emotion) to the past event as is postulated in cognitive-behavioral approaches. Rather, the reaction itself is informed by the responses and/or perceptions inherent within a dysfunctionally stored memory or network of memories that are disconnected from networks containing adaptive information.
…Clients are often relieved to understand that their problems have a neurobiological basis, as well as the universality of their human experience as a counterpoint to the common belief that they ‘‘should have’’ been able to resolve their problems on their own. We suggest that the presence of these unmetabolized components of memory explains why clients will often describe their childhood traumas in the same kind of language and intonation they used when the event occurred, and demonstrate the emotions, postures and beliefs consistent with that developmental stage. They do not merely describe the feelings of shame and helplessness of the past, but actually experience these emotions and physical sensations in the present.
These unmetabolized components of memory are accessed in a systematic way during EMDR processing. The targeted memory that is ‘‘frozen’’ in time becomes ‘‘unfrozen,’’ and new associations are made with previously disconnected adaptive information related to survival, positive experiences, and one’s sense of identity...
…processing allows an unpeeling of the veil to reveal and then resolve the core emotional source of the imagery (Shapiro 2001; Wachtel 2002). As this assimilation occurs, new insights and emotions emerge and the earlier affect states and perceptions are generally discarded. With the foundation of the fully processed memory, clients are no longer subject to the same emotional volatility, distorted perceptions and intense somatic responses, and instead experience a new sense of self that is congruent with their current life situation…
The client’s experience is more informed by the present, allowing for greater flexibility in their reactions, thus increasing the likelihood of developing more adaptive patterns of response that are informed by the current context of their lives…
In addition, new memories can be successfully incorporated as the therapist assists clients to acquire the social learning necessary to fill in their developmental deficits. However, until the processing of the earlier memories is complete, the dysfunctional neural storage will hamper the desired personal growth…
While specific stabilization and affect regulation techniques may be effective and highly desirable in many cases (Schore 2003), the instability is often caused by the unprocessed memories that are contributing to the dysfunction.
The overall goal of EMDR, therefore, is to address the current problems of daily living by accessing the dysfunctionally stored memories that are being triggered by the client’s current life conditions, and engage the natural neural processes by which these memories are transmuted into appropriately stored memories (Shapiro 1995, 2001, 2007; Shapiro et al. 2007; Siegel 2002; Stickgold 2002, 2008; van der Kolk 2002). The end result is an assimilation of the new information into extant memory structures. When this has occurred, individuals discover that, while they are able to verbalize the event and what they have learned from it, they no longer experience the associated negative affects and physical sensations. It is this rapid form of learning (i.e., reprocessing) that is the essence of EMDR treatment.”
If you link to this reference below it contains a case study of EMDR in practice.
Reference
Inside The Alcoholic Brain 