addiction

The Effectiveness of EMDR Therapy on Clients with Addictions

EYE MDR images (46)

 

PART 1

This study (1) was undertaken to determine how effective Eye Movement Desensitization and Reprocessing (EMDR) therapy is in helping clients to lessen or end their cycle of SUDs and behavioral addictions in the long term. Secondly, this study aimed to determine whether or not EMDR therapy increases a client’s likelihood of relapse, and whether or not relapse affects the outcome of treatment. Furthermore, this study looked at whether or not clients need to have abstained from their addictive substance for an extended period of time in order for EMDR therapy to be successful in their addictions treatment. The final question that this study intended to answer was whether or not there is a correlation between proposed key components of EMDR treatment and more positive treatment outcomes for people with addictions.

The major findings of the research were that EMDR therapy correlates with a significant reduction in research participants’ felt degree of addiction to both substances and addictive behaviors. Moreover, these results were maintained over time. Cravings to engage in the said behavioral addiction or SUD most frequently decreased after EMDR therapy sessions. Relapse to alcohol or drug use that research subjects attributed to an EMDR session was rare. In addition, the data revealed that having abstained for periods of time prior to engaging in EMDR therapy does not correlate with more positive treatment outcomes.

This most excellent and comprehensive study is a thesis so is quite long and requires chunking into different parts.

I will use excerpts to answer very important questions about the use of EMDR with those who suffer addictive behaviours of all kinds, not only substance but also behavioural addictions.

I would urge you to read this and other parts to this study/blog if you are considering using EMDR as an adjunct/supplement to your own addiction treatment/recovery plan.

I would not suggest using EMDR only in the treatment of addiction.

My own expereince is that addictive behaviour needs to be treated first then when recovery is stabilized, then consideration can be given to other treatments for co-morbidities or other disorders which have contributed to one’s additions.

The author of the study disagrees with this and illustrates cases whereby clients seeking EMDR were not abstinent and who were abstinent but relapsed during treatment but still acquried sobriety by the end of the treatment. I leave it to you  to decide. I only recommend ultimately what worked for me. I do however believe we should keep an open mind as “traditional” treatment of addiction seems to work for a small percentage of people seeking treatment for their condition.

 

“…According to Zweben and Yeary (2006), EMDR’s clinical efficiency and practicality are unmatched when looking at the results of its implementation with a wide range of trauma populations. Because of the well-established comorbidity between SUDs and PTSD, clinicians have been using EMDR with recovering addicts for years, despite the lack of empirical validation with addicted individuals (Marich, 2010). Because EMDR therapy doesn’t demand a full narrative of its participants, its implementation could prove to be particularly useful in addressing shame and disclosure, issues that are often inherent in the substance abuse population.

Studies have been conducted in recent years that provide some evidence that EMDR therapy is also effective in addressing the treatment of substance use addictions (Marich, 2009; Marich, 2010; Abel & O’Brien, 2010; Rougemont-Bucking & Zimmerman, 2012; Hase, Schallmayer, & Sack, 2008). However, this research is either the product of case studies or done on a relatively small population of participants. The research that was completed as part of this thesis reached out to a much larger population of clients than has ever been studied before in order to gauge how effective clients perceive EMDR to be in helping them to lessen their cycles of SUDs.

Clients with SUDs are typically expected to reach a certain level of sobriety before engaging in individual psychotherapy (Davis, 2006). Clients who are actively engaged in their substance addiction usually have not developed sufficient coping mechanisms to deal with powerful negative emotions, and tend to resort back to substance use when under emotional stress (Connors & Maisto, 2006; Moos & Moos).

Because EMDR therapy requires clients to process trauma and to experience powerful emotions, it is logical that some EMDR therapists would be hesitant to use EMDR therapy with clients who have SUDs; the powerful emotions that are evoked in therapy require coping skills that people with addictions have not developed, which in theory, would lead them to relapse. According to Rougemont-Bucking & Zimmerman (2012), the “refusal of psychotherapy in severely addicted SD [Substance Disorder] patients is based on a plethora of clinical observations dictating that a psychiatric patient has to be stabilized before she or he can enter a psychotherapeutic, typically somewhat confronting setting” (p. 108), even though there is no scientific evidence to support this exclusion of individuals who present with active substance abuse.

Failing to address the significant role that unresolved trauma plays in an addicted client’s attempt at recovery because of the risk of relapse may be one of the barriers to potentially providing a much more effective means for treating all addictions. This thesis investigates the role that relapse and abstinence of substance use play in overcoming addiction by answering the following questions: (a) Does EMDR therapy increase a client’s likelihood of relapse? (b) Does relapse affect the outcome of therapy? (c) Do clients need to abstain from substance use for an extended period of time for EMDR therapy to be successful?

Researchers currently suggest that compulsive behaviors such as those related to gambling, food, and sex, can also be conceptualized as addictions (Abel & O’Brien, 2014, Karim & Chaudhri, 2012; Khantzian & Albanese, 2008; Smith, 2012). These “addictions” are similar in how they affect the individual neurobiologically, psychologically and socially, to SUDs. Essentially, a person can be considered addicted to a substance or “a process of choice when he or she becomes focused on it to the exclusion of all other things” (Abel & O’Brien, 2014, p. 21).

Much of the recent literature points to the effectiveness of EMDR therapy in reducing behavioral addictions (Bae & Kim, 2012; Cox & Howard, 2007; Miller, 2012).  his study will examine the perceived effectiveness that EMDR therapy has on reducing behavioral addictions. In addition, it will look at the effectiveness that EMDR therapy has in reducing substance use addictions on a much wider population than has ever been studied before, thereby expanding the knowledge base and the potential to generalize results to the population at large.

The last research question that this study addresses is whether or not there are certain components of EMDR therapy that increase its potential effectiveness for clients who aim to overcome their substance and behavioral addictions. Studies point to the willingness of the client to change, the client’s motivation to change, the relationship with the therapist, the feeling of safety in the treatment setting, and the support available to clients outside of the therapeutic session as playing important roles in the outcomes of treatment (Abel & O’Brien, 2014; Marich, 2009; Marich, 2010; Cox & Howard, 2007).

This study will examine whether any of the aforementioned characteristics or kinds of EMDR treatment are statistically significant in contributing to more positive outcomes for addicted clients.

Given the likelihood that all clinicians will work with clients who struggle with addictions, having the skills to help people work through their addictions is a necessity. This study investigates the effectiveness of EMDR as a potential therapeutic model for clinicians to follow when working with their clients who have addictions.

Literature Review

The following review of the literature provides empirical evidence to support much of what many clinicians have already recognized in practice: the demonstrated effectiveness of EMDR therapy in helping people to rise above their addictions…investigating the major research questions in this study: (a) how effective EMDR is in helping clients to lessen or end their cycle of SUDs and behavioral addictions in the long term (b) whether or not EMDR therapy increases a client’s likelihood of relapse, and whether or not relapse affects the outcome of treatment, (c) whether or not clients need to have abstained from the addictive substance for an extended period of time in order for EMDR therapy to be successful in addictions treatment and (d) whether or not there is a correlation between proposed key components of EMDR treatment and more positive treatment outcomes.

EMDR and Behavioral Addictions Recent studies have shed new light on how EMDR therapy can be used to help people successfully overcome their behavioral addictions. (Bae & Kim, 2012; Cox & Howard, 2007; Miller, 2012).

Miller implemented the Feeling-State Addiction Protocol (FSAP), a modified version of the EMDR protocol designed by Shapiro (2001). The FSAP focuses on targeting and reprocessing the rush or euphoric sensations or Feeling State (FS) and the addictive behavior that is fixated with that feeling (Miller, 2012). Each of the four participants in Miller’s (2012) study completely eliminated their compulsive behaviors. Three of the four participants had previously been in therapy for their addictive behaviors without result.

According to Miller (2012), the treatment outcomes indicate that the behavior of the participants changed because the root cause of their behavior no longer existed. While the outcome of this study strongly suggests that this particular version of EMDR, the FSAP, may be quite useful for the treating of behavioral addiction, there are several limitations to the study. The FSAP was used on the study participants 23 to 30 times over a two week period. The likelihood that clinical therapists and social workers would be able to implement this kind of intensive treatment with their clients is low due to the time-laden nature of this kind of intervention.”

(We would add here that there is also more to addiction than urges, craving and obsession with addictive behaviours. Throughout this blogsite we have argued that trauma results in emotion processing deficits, emotion and stress dysregulation, reward (motivation) dysregulation and a persistent sense of negative self concept, none of which was “treated” here and in fact can only be managed rather than “cured” so we disagree with the assertion that the “root cause no longer existed“.)

Cox and Howard (2007) conducted a case study that observed the effects EMDR therapy on a client who was diagnosed with sex addiction. This client experienced significant progress, effectively treating much of the trauma that was associated with the addiction, and assisting in the prevention of relapse. The authors of the study see a clear connection between the role of trauma and the maintenance of the addictions cycle, which explains why they chose to use the Standard EMDR Protocol in their approach to treating their client who had a sex addiction. According to Cox and Howard (2007), processing the trauma of the client in their case study released the highly addictive attachment and relieved the sexual addiction. The research participant in this case study made significant gains in processing his trauma, as reflected by his release of irrational beliefs and faulty cognitions that had come into being as a direct result of childhood trauma (Cox & Howard, 2007).

While The Standard EMDR Protocol was the primary method of treatment, the research participant was also exposed to a variety of therapeutic techniques which, in combination with the implementation of the Standard EMDR Protocol, moved him forward with his treatment goals. The combination of therapeutic techniques (empty-chair work, letter-writing, psycho-education, 12-step and relapse prevention work) does not allow for the study to attribute the client’s successful treatment to EMDR exposure alone. However, these techniques, along with the characteristics of the Standard EMDR Protocol, emerge in this study as potential essential elements that contribute to successful treatment outcomes for clients with addictive behaviors.

EMDR and Substance Use Disorders

Marich (2010) conducted a phenomenological study on ten women who were alumni of an SUD treatment program. Findings revealed that the participants considered the EMDR interventions to be key to the successful outcome of their addictions treatment. EMDR alone or in combination with another aspect of therapy initiated a shift in their perspectives. Nine out of ten participants reported that EMDR interventions were critical in changing their beliefs about themselves (attitudes towards their past, their lives and their recoveries) which directly lead to changes in their behaviors.

However, because participants were self-selected for Marich’s (2010) study, it is possible that subjects who had a negative experience with EMDR did not choose to participate, a significant limitation to the study. Participants in Marich’s (2010) study agreed that EMDR treatment should not occur in isolation; a combination of factors contributed to their healing, not just EMDR alone. A major theme that emerged from the interviews with participants was “the existence of safety as an essential crucible of the EMDR experience” (Marich, 2010, p. 498). This revelation points to the possibility that safety is an essential element in creating successful treatment outcomes with EMDR therapy.

Marich (2009) also studied the use of EMDR in a case of a woman who had both an alcohol and sex addiction. Prior to this study, the client had received 12 courses of treatment for alcoholism and addiction over a 12-year period. She had never been able to obtain more than four months of sobriety at a time. The focus of the participant’s treatment was to remain abstinent and to address issues that were related to her self-image and past that were impacting her ability to abstain from the addictive behaviors. The research participant was interviewed six months post treatment. She had continued to maintain her sobriety and sexually acting out behaviors. When asked what she attributed her successful treatment to, the study participant cited the combination of EMDR and 12-step work, the relationship and trust that she established with her EMDR therapist, believing her addiction to be a life-and-death matter, being willing to change, and the deepening of her spirituality. She attributed the processing of her trauma, a direct result of EMDR therapy, to be what made it possible for her to self-examine her past and present in a more rational manner; EMDR therapy allowed the client the ability to put her life into perspective, and to examine her distorted view of herself.

Results from Abel & O’Brien’s (2010) case study lends further evidence that support the use of EMDR with clients who may not have reached sobriety. The study participant was a woman who presented with an addiction to alcohol as well as anxiety and other symptoms of PTSD. Prior to participating in this study, she had been to several therapists for counseling on her substance abuse without success. The study participant responded well to EMDR therapy, reaching and maintaining sobriety, even though she did experience relapse throughout the initial phases of treatment. At the time that this case study was written, the research participant had been sober for over two years.

Similar to the other aforementioned studies, the success of the participant in overcoming her addiction cannot be attributed to EMDR alone. This client was highly motivated to quit her addiction; she willingly attended AA meetings and obtained an AA sponsor on her own. Nevertheless, the client attributes her ability to finally stop using all together to EMDR therapy. She states: “After a few (EMDR trauma protocol) sessions I noticed a huge difference. It was like a door opened in the dark room I had locked myself into. For so long I had been unable to get out, afraid of the feelings that would inevitably find me and overwhelm me, driving me back” (Abel & O’Brien, 2010, p. 55).

The study also illuminates potential key elements of EMDR therapy to be investigated in future research such as motivation, and community support (this client attended AA meetings regularly).

Summary

A comprehensive review of the literature demonstrates that EMDR is potentially an effective treatment for clients who have both behavioral addictions (Bae & Kim, 2012; Cox & Howard, 2007; Miller, 2012) and SUDs (Marich, 2009; Marich 2010; Abel & O’Brien, 2010; Rougemont-Bucking & Zimmerman, 2012; Hase, Schallmayer, & Sack, 2008). Nevertheless, a few gaps in the research body remain, leaving the efficacy of EMDR in relation to addictions still in question. All but one of the studies done regarding the efficacy of EMDR and addictions (Hase, Schallmayer, & Sack, 2008) have been case studies; they have far too few participants to generalize the positive results to the population at large. Furthermore, most of the studies do not measure whether or not the effects of treatment are long-lasting. Bae & Kim’s (2012) study is the exception to this; the research participant in their study had completely stopped his technology addiction at the one year follow-up. Again, because the study was only on one person, the results cannot be generalized. Marich’s (2009 & 2010) studies found treatment results to be consistent six months after termination, but this data tells us little about what these same people will be experiencing one or more years from now.

Most of the studies cited in the literature review above referred to a variety of elements that accompanied EMDR treatment which could have contributed to positive outcomes.

Common themes that arose were how the motivation to quit the addiction, the relationship with the therapist, the feeling of safety in the treatment setting, and the support available to clients outside of the therapeutic session impacted the client treatment outcome.

All of the studies on EMDR and addictions treatment in this review of the literature vary in the kind of EMDR protocol that was used on research participants. Therefore, there continues to be a need for research around which particular EMDR therapies are the most effective for clients with SUDs and addictive behaviors, whether it be the Standard EMDR Protocol, or a modified version of it such as DeTUR, CRAVEX, or the Feeling-State Addiction Protocol. No studies have been done to date that compare the treatment outcomes among variations of EMDR treatment among clients who have addictions. This study compiles the data that was gathered from an extensive survey, completed by individuals who were exposed to EMDR therapy during a period in which they had a behavioral addiction, SUDs, or both.

The goal of this research is to fill the gaps in the literature, primarily by reaching out to a much wider sample of research participants.

The study investigates how effective EMDR therapy is in the long term. It also looks at how relapse manifested over the course of EMDR therapy, and how it impacted the outcomes of treatment, if at all. In addition, this research gathers evidence that will help to determine whether there is a correlation between the presence of proposed “key” elements of EMDR treatment (such as the motivation to quit the addiction, the relationship with the therapist, the feeling of safety in the treatment setting, and the support available to clients outside of the therapeutic session) and successful outcomes for participants.

The study will also try to determine what kind EMDR therapy was used in treatment, and how that particular treatment correlates to participant outcomes….

TBC

Reference

  1. Franklin, J. L. (2015). The effectiveness of EMDR therapy on clients with addictions (Doctoral dissertation).
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3 replies »

  1. This is a very interesting article and as someone who has had extremely successful EMDR treatment for behavioural addictions, OCD, I have some observations. Firstly I was far from abstinent when I started the EMDR I was still doing OCD checking rituals for 5 or 6 hours a day. EMDR HAD previously made me relapse when I did it with the wrong therapist who failed to generate a feeling of safety, while I was having a nervous breakdown, making the OCD worse. After about 15 sessions of EMDR I went from checking 6 hours a day to a few minutes a day with many OCD behaviours completely eliminated. However the relationship with the therapist was critical: I did many sessions with my first therapist that had almost no impact at all on my PTSD, the cause of the OCD. My view is that if you are not making improvements you should switch therapist early on. http://bit.ly/1ER5cLY

  2. thank you Caroline for that fascinating and illuminating input. Sharing stories of experiences with EMDR really brings the research to life, when we have real life people describing what worked for them and what didn’t – as you say the relationship with the therapists is vital – my wife would agree as she had two therapists herself, one much better than the other. Also for this and other reasons I recommended a separate treatment for addiction too as my C-PTSD influences my addictive behaviours but is not the sole reason for them. Other factors like genetics etc play a huge role too plus my addiction is perpetuated by things like stress and reward dysregulation and emotion dysfunctions which run parallel to the negative self concepts and so on from my C-PTSD – so these are like two rivers which run into each other from time to time and threaten to overflow. Treating both helps keep the overflow manageable.

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