EMDR therapy is a valuable tool for patients who struggle with PTSD and other emotional challenges. Recent evidence has also supported the use of EMDR in addiction treatment.
Substance use disorders are often associated with underlying mental health issues. Eye movement desensitization and reprocessing (EMDR) therapy has been empirically shown to assist people struggling with post-traumatic stress disorder (PTSD) and other disorders associated with emotional dysregulation. Recently, EMDR therapy has been evaluated as a potential treatment modality for individuals who struggle with addiction, particularly when their substance use disorder co-occurs with mental health disorders.
What Is EMDR Therapy?
EMDR is a form of psychotherapy administered by licensed clinicians or therapists. Its goal is to provide individuals with a way to gain control over negative memories or traumatic events. Initial EMDR trauma therapy studies focused on PTSD, with overwhelmingly positive results. More recently, EMDR has been evaluated as a therapeutic option for other mental health issues, including substance use disorders.
EMDR is an extension of traditional behavioral therapies that uses a combination of memory recall and therapy with guided bilateral eye movements to interrupt negative thought pathways. EMDR and trauma therapy allows individuals to reprocess negative or traumatic memories in such a way that the memories become associated with more positive, adaptive ones.
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Treating Trauma
Traumatic events often cause persistent negative memories and associations that can be very difficult to overcome. It is common for people to turn to drugs or alcohol to try to minimize the pain that these memories cause. Unfortunately, because substances can only mask symptoms temporarily, traumatic memories fester, and repetitive perception of the event can potentiate more severe memories of the trauma. Over time, more drugs and alcohol are required to ignore the memory, which sets up an individual for a substance use disorder.
There are several methods that can be used to treat trauma, including behavioral and pharmacological approaches. While these options have helped many people successfully overcome trauma, mounting evidence suggests that EMDR trauma therapy frequently outperforms both behavioral and pharmacological treatment modalities.
How Does EMDR Therapy Work?
EMDR therapy aims to treat unprocessed, negative memories by addressing the past, present and future aspects of a targeted memory and combining them with guided eye movements.
Visual processing in the brain is extremely complex. Each eye has both a left and a right visual hemisphere that are processed independently by the corresponding opposite hemispheres of the brain. Once the images are processed in each hemisphere, the hemispheres work together to form a coherent picture that represents what our eyes see.
This interhemispheric communication activates working memory and visual exploration, and EMDR takes advantage of these activated brain states to simultaneously update evoked memories. The science underlying this process is still an area of active research, but substantial evidence supports that EMDR successfully updates negative memories with more positive ones. The answer to the question “Does EMDR therapy work?” is a resounding “yes.”
EMDR Side Effects
Because the client is asked to remember distressing events, EMDR therapy side effects may include high levels of emotional stress during or after a session. Some clients report experiencing unpleasant dreams relating to the memory they are working on processing, but these tend to subside as therapy continues.
Dangers of EMDR Therapy
As with any psychotherapy, EMDR requires that the client actively recall traumatic events. Fortunately, the dangers of EMDR therapy are minimal when done under the guidance of a licensed practitioner, but may include emotional distress, insomnia, nightmares, anxiety and depression. It is important that the client be aware of these potential dangers and discuss them with their therapist before and during treatment. Anti-anxiety medications may be appropriate for some clients during this time to ease the process.
EMDR Phases
EMDR therapy is made up of eight phases that address three psychological pathologies that are associated with negative or traumatic memories: past events, current situations and future challenges.
The eight phases of EMDR therapy are:
1. History and Treatment Planning
Clients collect a comprehensive personal history from the client and determine if they could benefit from EMDR therapy. This stage includes standard questionnaires and diagnostics that evaluate past, present and future events that may trigger negative emotional responses.
2. Preparation
The client is provided with an overview of EMDR therapy, including what they can expect from treatment. A key goal is to establish trust between the clinician and patient and ensure that the patient is comfortable and has a sense of control.
3.Assessment
Effective EMDR therapy requires identification of specific negative memories, beliefs and images as well as positive beliefs and the client’s current emotional state (baseline parameters).
4. Desensitization
Once a memory has been targeted, the client will think about it while simultaneously tracking the therapist’s hand as it moves across the field of vision. This stage is where EMDR therapy comes into play. During desensitization, the client actively recalls aspects of the targeted memory while imagining positive associations that will help adapt the negative memory into a benign or positive one. During this process, the therapist guides the client’s eye motions with their hand, thus activating multiple regions of the brain and memory processing.
5. Installation
After actively recalling a negative memory (desensitization), a positive dialogue is established to replace the negative association.
6. Body Scan
The client is asked to observe physical responses to their memories and identify areas they hold tension in their bodies, which helps therapists pinpoint areas that need additional focus.
7. Closure
Guided imagery or self-control techniques may be used to calm clients and ensure that they are comfortable with the outcome of each session.
8. Reevaluation
Evaluation of the effectiveness of the treatment and the success of the client. The client may be given additional tools to ensure long-term maintenance.
How EMDR Helps Treat Addiction
Treating addictions with EMDR therapy follows the standard eight-phase protocol, although minor modifications may be made on a case-by-case basis. Most people who struggle with a substance use disorder have negative associations that either lead to addiction or were caused by their addiction. For those who have a traumatic event that underlies their drug or alcohol use, EMDR therapy can serve to help them process the memories associated with the event.
Other individuals do not have specific traumatic events that contribute to their substance use disorder but have accumulated a number of profoundly uncomfortable memories associated with drug or alcohol use. EMDR can be used to address all of these situations by targeting memories that cause the client significant discomfort or emotional distress and reprocessing these memories into ones that are benign or even positive.
Who Could Benefit From EMDR?
Using EMDR to treat PTSD, anxiety, depression and other mental health concerns has had overwhelmingly positive results, leading those involved with addiction treatment to evaluate whether EMDR therapy could benefit their clients. Recent data indicates that EMDR therapy is an effective treatment for many mental health concerns, including substance use disorder.
EMDR is particularly useful for addressing:
- PTSD: EMDR therapy for PTSD was among the earliest studies that proved the profound and rapid effectiveness of EMDR as a means to overcome trauma. EMDR therapy sessions for PTSD allowed therapists to identify the current eight-phase protocol and to evaluate whether similar strategies (EMDR light therapy for PTSD) were as effective as visually following hand movements.
- Childhood Trauma: Brain development in children is an active process, and trauma can significantly affect this development. EMDR therapy may be particularly effective for sufferers of childhood trauma because they are not required to discuss the trauma at length with their therapist, as adaptive memory reprocessing occurs internally.
- Anxiety: EMDR therapy for anxiety has also delivered impressive results. Anxiety is frequently caused when people have recurrent negative thoughts about their self-worth and value. EMDR can interrupt these thought processes and replace them with positive, self-validating processes. Similarly, EMDR therapy for depression has delivered very promising results.
EMDR Therapy Effectiveness
A recent meta-analysis of 26 randomized controlled trials found that EMDR therapy significantly reduced symptoms of PTSD, anxiety and subjective distress. Because substance use disorder is frequently associated with traumatic memories, anxiety, depression or subjective distress, EMDR therapy for addiction is a logical extension of the therapy’s existing clinical applications. Although EMDR therapy for addiction has less data backing its effectiveness than that collected for PTSD and other mental illnesses, preliminary results are quite promising.
How Long Does EMDR Therapy Take?
EMDR therapy has shown effectiveness after a single 60–90-minute session for some people, but some individuals require up to 12 sessions to fully reprocess a negative memory or traumatic event. Sessions are generally held on a weekly or bi-weekly basis.
Benefits of EMDR Therapy
EMDR therapy benefits are numerous. For one, EMDR gives clients the chance to regain control over traumatic memories that may have previously been debilitating. While much of the research that has been done on EMDR therapy assesses benefits to those who suffer from PTSD, recent research has shown that milder traumas, mental health disorders and addictions can all be addressed with EMDR therapy.
EMDR Therapy Risks
The risks of EMDR therapy are largely limited to potential emotional distress during or shortly after a treatment session. Other commonly reported risks associated with EMDR are vivid dreams or nightmares and short-term depression while the client begins to reprocess traumatic events. These risks can be minimized by working with experienced therapists who are part of a multidisciplinary team.
