emdr approaches to addiction

EMDRApproaches to Addiction

EMDR Association of East AngliaNetworking Day – UEA Sportspark

21st November 2015

EMDR East Anglia Networking Day – 21st Nov 2015

The Chart Toppers (in no particular order)

Laurel Parnell’s Treatment Model for Addictions and Eating Disorders

Jim Knipe’s Treating Addictive Disorders With Adaptive Information Processing Methods

Arnold Popky’s Desensitization of Triggers and Urge Reprocessing (DeTUR)

Robert Miller’s Feeling-State Addiction Protocol (FSAP)


AddictionAddiction is a persistent, compulsive dependence on

a behaviour or substance. The term has been partially replaced by the word dependence for substance abuse. Addiction has been extended, however, to include mood-altering behaviours or activities. There is a growing recognition that many addicts, such as polydrug users, are addicted to more than one substance or process.

http://medical-dictionary.thefreedictionary.com/addiction


2 Types of AddictionIt is helpful to speak of two types of addictions:

Substance addictions (Examples are alcoholism, drug abuse and

smoking)

Process addictions(Examples are gambling, spending, shopping eating and sexual activity.)


Addiction is complex“An addiction may be held in place, in spite of its destructive

effect on a person’s life, by multiple factors, which might include avoidance of disturbing memories, avoidance of other trauma-related material, euphoric feelings, the use of the addictive behavior to facilitate dissociation, identification of self with the addictive behavior, helplessness about quitting, and many other factors that together create a web that traps the individual in a behavior that is ongoing and self-destructive.”

Jim Knipe


Taking a history – some hintsAddiction specific questions could include:When did the behaviour begin? What disturbance did the behaviour alleviate? How motivated is the client (0-100 scale)?Have they tried to stop before and what

contributed to relapsing?


Resourcing - First StepsWhat resources does the client have outside of therapy?

Some examples are:A 12 Step Programme (AA ; NA; GA; SLAA)Medications or nutritional supplements Mindfulness or Meditation (to lessen anxiety)Rehab or Detox support Supportive people in their lives (Sponsor)Balance (Sleep, nutrition, exercise)It is helpful to address current stressful issues


EMDR ResourcingThere are a range of possible resources

Resource figures:Nurturing, Protective, Inner Wisdom, Empowerment, Courage, Higher Power, Gratitude, Inspiration

Resource situations:To bring safety, peace, calm and comfort (anxiety reduction)

Embodied situations:Moments of Success, of Boundary Setting, of Self-worthJim Knipe’s question: : "Could you accept yourself completely, even if you never get over this addiction?"


EMDR Resourcing (cont.)Visualising a future day when free of the addictive

behaviour

Visualising the future is central to A J Popky’s approach but it is also used by Laurel Parnell and Jim Knipe. While it is like the future template, there are benefits to activating this neural network early in the therapy as a resource. Clients dealing with addictive behaviours frequently believe that there is no hope for them.


Urges / Cravings – L. ParnellWhat resources will help deal with the cravings?Examples that can be tapped in include:

The circle of resource figuresThe 12 Step group or SponsorPositive memories of behaving in a healthy

waySuccesses in staying sober or clean

(day/week)Have the client imagine their positive future and tap it in


Trauma & Triggers – L. ParnellActivate the memory network of the moment before doing the

behaviour to capture the emotions, sensations and thoughts. Get plenty of detail.

Bridge back from the triggers to locate the link in the past and process what comes up, until SUDS are 0 or 1.

Once she has dealt with past associations with the trigger, she then processes current associations.

Ask the client about their belief about themselves at that point. Install that positive cognition.

Return to the triggering incident and check it. Bridge back if necessary.

Do a future pace: “Imagine yourself in the future dealing appropriately with this trigger.” Add BLS as they imagine it.


The Consequences ProtocolL. Parnell

Get a 0-10 score on the Level of Urge (LOU)Use continuous BLS on a client-created movie including

the lead-up, the using, the ‘high’ and the consequences.Re-run movie until LOU=0Link the urge to the consequence and process with BLSImagine a future where the client continues to use, and a

future without the addictive behaviour


Addictive Memory Cycle – J. KnipeA trigger

The urge

The ‘High’Regret/shame

Vulnerability


Urges / Cravings – J. KnipeHave the client bring up a day in the future when they have

stopped. Strengthen this by including questions that generate a genuine ‘no interest’ state.

Make the day in the future as specific and as vivid as possible and have the client apply self-taps to anchor the experience in the body.

Have the client identify each trigger and process them in turn tracking progress using a Level of Urge (LOU) score (0-10). The LOU score is likely to drop as you go through the triggers.

When LOU=0, use self tapping to recall the positive day in the future.


Urges / Cravings – J. Knipe (cont)For many addicted people, it is important to identify the

anticipated positive experience that occurs when the person acts on urges. The client can be asked, “When you have that urge, what is the feeling, or the state of mind that you are seeking with the urge?”

Keep the Addictive Memory Cycle always in mind. It will provide other triggers.

Be alert to the possibility that the addiction may be a strong bulwark against feelings that originate in early life.


Positive compelling goal – A. PopkyHave the client bring up a day in the future when they

have stopped and create that day in as much detail as possible.

Before beginning BLS, anchor the experience with physical touch to the knuckle of little finger (with permission).

Use short BLS sets (12) and anchor each element of this compelling goal.

Test by having the client self-touch the same digit. (A pleasant feeling should follow.)


Triggers and Urges – A. PopkyIdentify all the known triggers that lead to the behaviour

and rank them in terms of strong and weak triggers.Start with the weakest triggerHave the client bring up the picture, with associated

words, tastes, smells etc. Obtain a LOU (0-10)Process in the usual way.If processing leads into a trauma thread, use the

Standard Protocol.


Triggers & Urges (cont) – A. PopkyWhen LOU = 0, test the success of the processing of each

trigger by doing BLS and applying pressure to the knuckle. If positive statements/feelings result, do BLS on these.

If a negative report, a new channel has opened and needs to be processed. When LOU = 0, test again.

When positive, think about the future positive goal and check the LOU again. If 0, have them think about the future and do another set with the touch anchor.

Gradually work through each trigger in this way.


Relapse & self-support: A. PopkyPopky encourages clients to do self-tapping and use their

anchor point to maintain their progress and deal with urges.

In subsequent sessions, check out for new triggers.Relapses should be seen as new opportunities to address

further triggers. This also helps reduce feelings of shame.He will also help people to process their successes.


Understanding Feeling-States (1)R. Miller

The formation of memory networks underpins the theory.

When a positive experience is particularly intense, that Feeling-State memory network forms in the brain.

The memory includes the future addictive component, together with thoughts, feelings and sensations.

When the feeling-state is triggered, so is the urge to do the addictive behaviour.

Feeling = Emotions, Cognitions, SensationsFeeling State = Feeling + Behaviour


Understanding Feeling-States (2)R. Miller

The real goal of the impulsive behaviour is the underlying feeling.

The feelings that are sought are normal healthy desires.If a person was deprived of that desire in early life, then

the more intensely they want the experience and the stronger their reaction when they have the experience.

That experience, when linked to a potentially addictive behaviour, creates and embeds the feeling-state network.

Addictions are caused by the linkage between feelings and behaviour.


The FSAP Protocol – R. MillerHistory taking, resourcing, info about EMDR and FSAP.A chain analysis: a series of question to fire up the

network.Identify the most intense aspect of the addictive

experience.Identify the Feeling-State(s), and its score (0-10)Have the client visualise performing the behaviour with

the sensations, feelings and thoughts.Process through until FS score = 0 or 1


The FSAP Protocol (cont) – R. MillerObtain a SUDS level of the feeling as a general feeling not

connected to the behaviour.With this question: “What negative belief do you have about

yourself that makes you feel you can’t have what you need (in terms of that desired feeling)?”, identify the NC underlying the need for the feeling-state, along with the negative feelings and sensations.

Bridge back to identify the earliest event linked to that inner state. If nothing emerges, target the Negative Cognition.

Process as normal until SUDs=0Future templates focus on how the person can experience that

feeling without the addictive behaviour.Evaluate the Feeling-State again and process, if needed.


FSAP, ongoing therapy – R. MillerRe-evaluate the Feeling-State from the previous session and

re-process if necessary. Process positive feelings with BLS.Process each identified Feeling-State with the Protocol and

install adaptive behaviour.Finally, address negative and shame-based beliefs that have

resulted from the addictive behaviour with the standard EMDR Protocol.

Install future templates of adaptive replacement behaviours.

The Protocol itself is divided into 5 Phases with 25 separate actions, so it is easy to work through it.


Useful source materialDeTUR, an Urge Reduction Protocol for Addictions and

Dysfunctional Behaviors - A. J. Popky(EMDR Solutions – Pathways to Healing: R. Shapiro [Ed])

Transformation Through the Power of EMDR: Advanced Clinical Applications – Laurel ParnellDVD Set (http://bfisummit.com/online-ce-courses-and-expert-dvds/ )

The Feeling-State Addiction Protocol – Robert Miller(www.fsapprotocol.com) 2 day Training Course

Treating Addictive Disorders with AIP Methods – J. Knipe(EMDR Toolbox – Theory and Treatment of Complex PTSD and Dissociation - Jim Knipe)


Joe [email protected] www.beechmount.co.uk

emdr approaches to addiction

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