Eye Movement Dessensitization and Reprocessing (EMDR) is an effective psychotherapy protocol for the treatment of post -traumatic stress disorder (PTSD).
Its validity has also been shown for multiple other types of disorder. For example, that of generalized anxiety, from panic and sleep attacks, for phobias and pathological dependencies from substances.
The high association between PTSD and pathological dependence – as well as the recurring presence of traumatic events in such patients – has led clinicians and researchers to imagine EMDR as an effective treatment also for the Addiction (Hase et al., 2008; Marich, 2010; Cecero & Carroll, 2000).
How can we explain the applicability of the EMDR protocol to substances dependence disorders?
In thoroughly, from a clinical point of view, the possibilities of employment of the EMDR protocol to the therapy of the ADMITRATION may be appropriate to consider on what specific aspect of addiction we want/we can work.
Below are the cases summarized by Gentile and colleagues in a 2013 job.
Case 1: a trauma is at the origin of addiction
In this case, the trauma has given rise to the development of an addiction exactly in the same way that a trauma could originate a PTSD.
If so, EMDR therapy could prove to be decisive as it would allow the person to work on the etiological agent of their dependence.
The authors, however, underline that there is a number of patients with addiction who has no memory/does not report memories of traumatic events pre -existing to the Assdiction (for which the possibility of applying the protocol).
Case 2: dependence causes trauma
When you are structured an addiction, it is very likely that, in the short or long term, the person unites in adverse or real experiences. Furthermore, those suffering from pathological dependence often have/develops greater vulnerability to stress.
In these cases a vicious circle in which the substance is sought to face traumatic events.
The problematicity of this case – if we think of an EMDR application – lies in the fact that a person who requires treatment for pathological dependenceespecially in the first phase, it can be found in a motivational phase of pre-contemplation or contemplation with respect to change.
With good probability, therefore, the intervention with EMDR should be postponed to a second moment. That is, after a phase of work on addiction (for example with cognitive behavioral therapy).
Case 3: the fall/relapse is constituted as a traumatic event
The fact that dependence is a chronic and recurrent disorder is a clear awareness of those who treat it and often also of those who are affected. Even in the most “happy” routes, the fall/relapse represents an extremely critical moment that could also take on the appearance of a traumatic experience.
If this occurs, the possibility of resuming/continuing the treatment decreases or canceled.
In this case the EMDR treatment It could find application in patients precisely in order to act on the impact event and prevent the drop-out.
Case 4: intervene with EMDR on the Craving Trigger
This fourth case is based on the idea that Craving and Ptsd is based on similar brain mechanisms.
In Craving, the stimuli associated with the assumption/reiteration of the dependence behavior (trigger stimuli) reactivate craving. In the same way in the PTSD internal or external stimuli they work as re-attractors of the traumatic event.
The dependent person often reports that he cannot escape/manage trigger stimuli, as well as in the ptsd the trauma recruit most of the patient’s mental resources while maintaining the problem active.
This fourth case, where we wanted to work with EMDR, requires applying the technique to those triggers who can be identified as traumatic events.
Case 5: the patient with addiction also has a borderline personality
Some research has highlighted the frequent comorbidity of dependence disorder with the borderline personality disorder.
It must be said that the clinician often is faced with a Borderline personological functioning that not pre -existing to the use of substances but is outlined following the alteration induced by the latter. Eg, with rapid changes in mood, impulsiveness, instability in self -image and in relationships, indefinite planning and unstable affectivity.
In the substances dependence disorderthe person, in a state of abstinence, behaves differently from how the state of intoxication or in a state of sobriety behaves. When a chronic picture of dependence is established, the rapid intoxication-accepting oscillation makes it appear outside as unstable (from a cognitive, emotional and behavioral point of view).
Following this vein, the people with DUS, in a state of intoxication, would have access to a system of affections-metal consistent with the state of intoxication, while, in a state of sobriety, they would access a system of affections-methemakes consistent with this other system (inaccessible when the patient is found in poisoning).
This would explain why some typical strategies of the cognitive-behavioral process of the DUS, such as the techniques in the face of Cving, if you learn in a state of sobriety, may not be easy to apply for the patient when he is in a state of intoxication.
It is in this meaning that the EMDR protocol It would find its applicability: it would allow the person to re-accepted to systems of affections and memories experienced during intoxication and to implement a reprogramming on these systems also in a condition of sobriety.
Bibliography
- Cecero, JJ, Carroll, km (2000). Using Eye Movement Desensitization and Reprocessing To Reduce Cocaine Cravings. American Journal of Psychiatry. 157 (1): 150-151.
- Hase, M., Schallmayer, S., Sack, M. (2008). EMDR Reprocessing of the Addiction Memory: PRETRATEMENT, POSTTREATMENT, AND 1 MONTH FOLLOW-UP. Journal of Emdr Practice and Research, 2 (3): 170-179.
- Marich, J. (2010). Eye Movement Desensitization and Reprocessing in Addiction Continuing Care: A Phenomenological Study of Women in Recovery. Psychological Addicctive Behavior, 24 (3): 498-507.
- Shapiro, F., Vogelmann-Sine, D., Sine, LF (1994). Eye Movement Dessensitization and Reprocessing: Treating Trauma and Substance Abuse. Journal of Psychoactive Drugs, 26 (4): 379-391.
