We conclude our blog  –The effectiveness of EMDR therapy on clients with addictions – part 1 – looking at the findings and the discussion of the study we looked at in detail yesterday (1)

Findings…

the results of the data analysis are presented.

A few fundamental goals drove the collection of the data and the subsequent data analysis: (a) to determine how effective EMDR is in helping clients to lessen or end their cycle of SUDs and behavioral addictions in the long term (b) to determine whether or not EMDR therapy increases a client’s likelihood of relapse, and whether or not relapse affects the outcome of treatment, (c) to determine 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) to determine whether or not there is a correlation between proposed key components of EMDR treatment and more positive treatment outcomes. These objectives were achieved.

The major findings were that overall, EMDR therapy was shown to reduce the 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 sessions. Relapse to alcohol or drug use that research subjects attributed to an EMDR session was also rare. In addition, the data revealed that abstinence of the addition prior to treatment does not appear to be necessary in order for clients to have positive treatment outcomes.

Alcohol Addiction

Thirty-two survey respondents reported that they had experienced being addicted to alcohol. Addiction in the survey was defined as “wanting to use less or to quit using, but not being capable of achieving this goal.” The mean period of time that individuals reported feeling addicted to alcohol before starting EMDR therapy was 4.5 years. The mean amount of times people had tried to quit drinking was approximately 3 years. Both of these frequencies show that this group of people had a significant history of addiction. Only four of the respondents reported that their addiction had been the focus of the EMDR treatment.

Sobriety

…approximately half of the people in the study had engaged in drinking during the six months prior to receiving EMDR therapy, demonstrating that these people had not reached a year of sobriety at the time of treatment. Approximately that same number of people had been sober for a year or longer. Eleven participants in the study had been sober for two years or more prior to receiving EMDR therapy.

Relapse

66.6% of participants did not feel more inclined to relapse after receiving EMDR therapy. Approximately 11% of respondents reported that they had consumed alcohol as a direct result of being triggered or activated from an EMDR session, but only 3.6% of participants had missed out on work or something important to them as a direct result of a drinking relapse that was experienced because of an EMDR therapy session.

Drug Addiction

The following is the number of respondents who reported being addicted to each drug listed: nineteen (19) survey respondents reported that they had experienced being addicted to nicotine, 12 to marijuana/hashish, two to heroine, two to cocaine, two to amphetamines, one to methamphetamines, two to methylene-dioxy-meth-ampehtamine (MDMA), four to prescription medications, one to Lysergic Acid Diethylamide (LSD) or mushrooms, and one to inhalants. Ninety-six percent (96%) of the people reporting a drug addiction answered that they had been experiencing the addiction for over five years when they initiated EMDR therapy. Four percent (4%) had experienced the addiction for more than six months, but less than a year. Fifty-two percent (52%) of the respondents stated that they had tried to quit using drugs more than five times before starting EMDR therapy, while approximately 17% had tried to quit between three and five times, and 26% had tried to quit once or twice. These frequencies point to the likelihood that this group of people had significant addictions. Only three of the respondents reported that their addiction had been the focus of the EMDR treatment while nineteen answered that their addiction was not the focus of treatment.

…twelve (12) people in the study had used the drug to which they were addicted during the six months prior to receiving EMDR therapy; these people had not reached a year of sobriety at the time of treatment. Approximately that same number of people (11) had been sober for a year or longer. Nine (9) participants in the study had been sober for two years or more prior to receiving EMDR therapy.

Relapse

Respondents answered that 40% of the time, drug cravings were about the same before and after EMDR therapy sessions. This was followed in declining order by cravings decreasing after EMDR sessions (30%), cravings sometimes increasing and sometimes decreasing (15%), and cravings increasing after EMDR therapy (10%). Five percent of participants couldn’t remember how their cravings were affected. Therefore, 70% of participants did not feel more inclined to relapse after receiving EMDR therapy. Approximately 9.5% of respondents (2 people) reported that they had consumed drugs as a direct result of being triggered or activated from an EMDR session…

Compulsive Eating

Thirty (30) survey respondents reported that they had struggled with compulsive food consumption. Twenty five (25) of those participants answered that they had tried to address their compulsive eating more than three times before starting EMDR therapy, indicating the likelihood that this group of people had a significant behavioral addiction. Approximately 76% of the people surveyed had consumed food compulsively within the six months prior to receiving EMDR therapy…

…20 of 29 people who answered the question had consumed food compulsively two weeks prior to starting EMDR therapy, demonstrating that the majority of respondents were actively experiencing their addictive behavior upon the initiation of treatment. However, only five of those people recalled that addressing their compulsive eating behavior was a treatment goal.

Compulsive Eating Triggered by EMDR Sessions

Fourteen (14) people reported that their cravings after EMDR therapy sessions decreased. This was followed by cravings being about the same before and after EMDR sessions (6 people). Four (4) of the surveyed participants answered that their cravings sometimes increased and sometimes decrease, and four (4) of them also reported that they remembered their cravings increasing after EMDR therapy.

69% of participants did not feel more inclined to eat compulsively as a direct result of receiving EMDR therapy. Approximately 10% of respondents reported that they remembered having compulsively consumed food as a direct result of being triggered or activated from an EMDR session.

Sex Addiction

Fifteen survey respondents reported that they had experienced having a sex addiction. Addiction in the survey was defined as “wanting to be less consumed with the idea of or having sex, but not being capable of achieving this goal.” The mean period of time that individuals reported having a sex addiction before starting EMDR therapy was 3.73 years. The mean amount of times people had tried to address their sex addition was 2.53 years. Only four of the respondents reported that their sex addiction had been the focus of the EMDR treatment. Seventy three point three percent (73.3%) of the people surveyed on sex addiction answered that they had engaged in their addictive behavior less than six months prior to receiving EMDR therapy, while 93.3% had engaged in the sexually addictive behaviors over the year prior to treatment.

Sex Addiction Triggered by EMDR Sessions

Among the respondents, compulsion to engage in their sex addiction after EMDR therapy sessions decreased most frequently; ten (10) people (66.7% of respondents) reported this as their experience. This was followed by the compulsion sometimes increasing, sometimes decreasing and sometimes being neutral after EMDR sessions (2 people). One person answered that his or her compulsion increased, one person answered that it remained the same, and one person answered that he or she did not remember how the compulsion to have sex was affected. Two survey participants remember having engaged in sexual behaviors in an addictive manner as a direct result of being triggered or activated from an EMDR session with his or her therapist.

Technology Addiction

Nine (9) survey respondents answered that they had experienced being addicted to some version of technology. Technology addiction in the survey was defined as “compulsive use of the internet, video games, TV, etc.; wanting to use the technology less, but not being capable of achieving this goal.” Seven (7) of those nine (9) people reported that they had been addicted to technology for over five years, while the remaining two (2) reported that they had been addicted to technology for more than three years, but less than five years. The mean amount of times people had tried to stop their technology addiction was approximately 2.89 years. Seventy-seven point eight percent (77.8%) of the survey participants answered that they had engaged in their addictive behavior within the six months prior to receiving EMDR therapy.

Technology Addiction Triggered by EMDR Sessions

Three (3) respondents out of nine (9) total answered that their cravings for their technology addiction declined after EMDR sessions. Two (2) people reported that their cravings to engage with technology were about the same before and after EMDR sessions. One (1) survey participant answered that cravings sometimes increased, sometimes decreased and sometimes were the same after EMDR sessions, while one (1) other person reported that his or her cravings increased after EMDR therapy.  None of the subjects reported that they had engaged in their technology addiction as a direct result of being triggered or activated from an EMDR session.

Macro Findings: The Effect of EMDR Therapy on Survey Respondents as a Whole

One last analysis was run in order to determine the overall impact that EMDR had on survey respondents’ reported addiction levels, as a whole…  the mean addiction rating before starting EMDR therapy was 6.39, compared to a mean of 3.49 when terminating, demonstrating a significant decrease in the overall level of felt addiction by the end of EMDR treatment…The mean addiction rating when terminating EMDR therapy was 3.31, compared to a current mean of 2.84 that looks at the felt level addiction “as of today,” demonstrating that the decrease in felt addiction that had been obtained by the end of EMDR treatment was not only maintained over time, but continued to drop.

Discussion

…The Effect that EMDR Therapy has on Addictive Behaviors and SUDs Substance Use Disorders

The few studies that have been done on the effect of EMDR on SUDs all point to positive outcomes (Marich, 2009; Marich, 2010; Abel & O’Brien, 2010; Rougemont-Bucking & Zimmerman, 2012; Hase, Schallmayer, & Sack, 2008). Nine out of ten participants in Marich’s (2010) study reported that EMDR interventions lead directly to changes in their behaviors associated with their SUDs. Research participants in Rougemont-Bucking and Zimmerman’s study (2012) both experienced a decrease in drug consumption while one of the participants experienced a significant decrease in cravings and consumption. The participant in Marich’s (2009) study also reached and maintained alcohol sobriety as an outcome of EMDR therapy. The research subject in Abel and O’Brien’s study (2010) attributed her ability to stop using alcohol as rooted in being exposed to the Standard EMDR Protocol.

The findings of this study provide further evidence documenting the effectiveness of EMDR therapy in treating people who have SUDs. Cravings for alcohol either decreased or significantly decreased in 60.7% of the people who reported being addicted to alcohol at the initiation of EMDR therapy. Eighty point nine-three percent (80.93%) of survey respondents who reported having a drug addiction at the initiation of EMDR therapy experienced either a decrease or a significant decrease in their drug cravings. Furthermore, this study also found a statistically significant drop in the mean alcohol addiction and the mean drug addiction after the implementation of EMDR therapy.

All of the studies that were reviewed for this study regarding the impact of EMDR therapy on SUDs, explicitly discuss the duration of treatment outcomes. Marich’s (2010) subjects had to have six months pass since their last EMDR session and Marich’s (2009) subject was also interviewed six months post treatment; all of the participants in these studies had maintained sobriety. In addition, the research participant from Abel and O’Brien’s (2010) study had maintained sobriety for two years at the time of their writing.

Hase, Schallmayer, and Sack (2008) reviewed their results at one month and six months post treatment. While their participants had not all maintained sobriety, those who had received EMDR therapy in addition to Treatment as Usual (TAU) had relapsed far fewer times than the TAU control group; this difference between groups was statistically significant at the one-month and six-month follow up.

According to Rougemont-Bucking and Zimmerman (2012), it is mandatory to “address the many problems of SD patients in the medical, economical and relational domains prior to proposing EMDR therapy, or other kinds of integrative psychotherapy. The Hase, Schallmayer, and Sack (2008) lends further evidence to the possibility that the implementation of EMDR can be effective for people with addictions, even before sobriety has been reached for an extended period of time.

Participants in their study were normally under the influence of alcohol upon admittance to the in-patient hospital. The stay at the hospital was approximately two weeks, and two EMDR sessions were administered during the research participants’ time there. Therefore, EMDR treatment was administered without any significant period of sobriety. Because the subjects who received EMDR therapy in addition to Treatment as Usual (TAU) relapsed far fewer times than the TAU control group, this study also demonstrates that EMDR therapy is more helpful than harmful in treating people with addictions…

Essentially the research to date has shown that it is not necessary for clients to have a minimum time-period of sobriety before being treated with EMDR (Marich, 2009; Marich, 2010; Abel & O’Brien, 2010; Rougemont-Bucking & Zimmerman, 2012; Hase, Schallmayer, & Sack, 2008). Either clients who were exposed to EMDR therapy were able to reach a period of sobriety that they hadn’t been able to attain before, or their drug use and relapse decreased over time, corresponding with their exposure to EMDR therapy.

Essential Components of EMDR Therapy

The final research question that my study aimed to address was whether or not there are certain elements of therapy that contribute to positive outcomes of EMDR therapy…

I investigated a few of their aspects which I felt could be translated well into a survey: safety (comfort in the therapeutic setting and trust in the EMDR therapist), the level of motivation to quit, and the use of a combination of factors for successful treatment (support). I wondered if how knowledgeable the therapist appears to be in EMDR could also impact the level of trust in the therapist, and therefore the outcome of therapy.

Additionally, I noticed that in the review of the literature, a wide number of EMDR therapy protocols had been used, and I wanted to see if it would be possible to figure out what kind of EMDR the survey respondents had been exposed to and whether any particular protocols corresponded with better results. The number of EMDR sessions that were administered in each of the studies was also vastly different. Therefore, I also hoped to decipher whether or not an elevated number of EMDR sessions corresponded with better outcomes in treatment.

Summary

… none of the “essential elements” of EMDR therapy proved to be as important as they had been reported in the review of the literature. While none of them stand out as crucial on their own, it seems likely that in combination, they do have a significant impact on EMDR therapy outcomes.

Implications

Unresolved trauma often plays a significant role in thwarting an addicted individual’s attempts to reach sobriety or to gain control over their addiction (Zweben & Yeary, 2006); In fact, “many clients may never get clean and sober unless some of the emotional charge is taken out of their traumatic past” (p. 121). EMDR’s clinical efficiency and practicality are unmatched when looking at the results of its implementation with a wide range of trauma populations (Zweben and Yeary (2006). My study confirms the potential that EMDR has to be established as an evidence-based practice for people who have addictions, as well.”

I would suggest in addition to EMDR that those hoping to recover from addictive behaviours also get help via group support. This is especially pertinent in those with C-PTSD as  membership of recovery groups helps with attachment issues and other psychological consequences of both C-PTSD and addiction.

In other words, either C-PTSD could an adjunctive to 12 step (or other mutual support) groups or the other way around. Either way it may be that both add up to a fuller recovery.

Reference

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