Treatment of Addiction with EMDR St.Andrew’s Neuropsychiatric Hospital Bae Hwallip MD,PhD

Adaptive Information Processing (AIP) model  Developed to explain the rapid change toward positive resolution seen in the EMDR treatment process  AIP system  Reduction in distress and/or negative emotions that can be stored as a result of upsetting experiences  Integrating upsetting information into a more adaptive, positive memory network  May be hindered or blocked  trauma, other severe stress, influence of psychoactive drugs

EMDR 에서 AIP Model 의 적용 * Memory network where the trauma is stored * Different memory network where the client will find insight >< Without removing anything that is useful or necessary Rapid free association of information btw. two networks Accelerated information processing  EMDR  Gain access to and reprocess dysfunctionally stored information & memories  Facilitates an association process  Integration within appropriate contextual memory networks

EMDR as adjunctive treatment for addiction  Shapiro, Vogelman-Sine and Sine (1994).  Eye movement desensitization and reprocessing: Treating trauma and substance abuse. Journal of Psychoactive Drugs, 26(4),  For optimal therapeutic effects, the client should be  personally and systematically stabilized  engaged in a 12-step support group  abstinent for a sufficient period of time to prevent physical symptoms of withdrawal.  Effective treatment targets: stimuli that could trigger relapse  Internal: emotions, traumatic memories  External: peer group, drug paraphernalia, certain environments

Addiction Treatment Protocols

Resource Development and Installation (RDI) protocol  Used to enhance the preparation or stabilization phase  Increasing stability and developing self capacities that enhance current functioning  Purpose  Increase clients’ abilities to change (affective and behavioral) state adaptively by enhancing their access to functional memory network  Resources  Associated with positive affect (interest, excitement, enjoyment, pride), and adaptive responses (speaking the truth, protecting oneself from danger, or containing impulses)

 Types of resources  1. Mastery resources  자기자신의 기억으로 스스로 성공했던 경험  효과적인 자기 관리와 자기 위로 경험  2. Relational resource  긍정적인 역할 모델의 기억  개인적으로 아는 사람  책, 이야기, 만화, 영화, TV 의 인물  지지적 주위 인물의 기억  위로, 돌봄, 사랑 혹은 보호를 제공했던 보호자, 친척, 선생님, 긍정적인 권위 인물, 또래  3. Symbolic resources  자연 세계의 사물의 기억  종교, 원형, 토템, 자아 초월적 상징과 경험 뿐 아니라 바다, 바위 혹은 나무 같은 것

CravEx Protocol  Target “Addiction Memory”  Activating this memory will lead to drug-taking behaviors  General memory of loss of control  Drug-specific memory of drug effects  Relapse or a Craving  Protocol is similar with standard protocol  Rating scale  Level of Urge (LOU) instead of Subject Units of Disturbance Scale (SUDS)

 Hase, Schallmayer, and Sack (2008)  EMDR reprocessing of the addiction memory: Pretreatment, posttreatment, and 1-month follow-up. Journal of EMDR Practice and Research, 2(3),  Randomized controlled trial  34 patients with chronic alcohol dependency  “treatment as usual”(TAU) with or without EMDR  Obsessive-Compulsive Drinking Scale (OCDS)  Pre-, Post- and 1 month after treatment.  EMDR with TAU group significant reduction in Craving post- treatment and 1 month after treatment.

“Chemotion and EMDR” protocol  Omaha (1998)  Treating chemical dependency  Address deficitis in identity based on an object relations conceptualization of addiction  Processing resistances to recovery  The protocol utilizes the standard EMDR trauma protocol  Target traumatic incidents that are believed to underlie the addiction

Desensitization of Triggers and Urge Reprocessing (DeTUR) protocol  Popky, A. J. (2005). DeTUR, an urge reduction protocol for addictions and dysfunctional behaviors. In R. Shapiro (Ed.), EMDR solutions. New York: W.W.Norton  Urge related conditions  Substance use disorders  Behavior addiction  Problem gambling, Sexual activities, Exercise, Computer games, Shopping, Work  Impulse control disorder  Eating disorder  Obsessive compulsive disorder (OCD)  Phobia

 Patient’s attention is directed toward a positive, attractive, achievable compelling goal, NOT AWAY from a negative behavior  Coping and functioning in a positive manner as described by the patients are  Employs ego strength and empowerment to build coping skills  Relapse is reframed as new emerging opportunities to address  The process take place out of the patient’s level of awareness  Targeting triggers for systematic desensitization allow this model to be used with clients early in recovery

Twelve Protocol Steps 1. Rapport 2. History 3. Support resources 4. Internal resource state 5. Positive treatment goal 6. Associated positive state 7. Identify urge triggers 8. Desensitize triggers 9. Install positive state to each trigger 10. Test & future check 11. Closure & self work 12. Follow on sessions

Clinical Study

Study for Internet Addiction

Study for Pathological Gamblings  자의 입원  Weekly 3 DeTUR sessions  1 st session: Safe Place exercise + Resource Development and Installation protocol  2 nd & 3 rd session: Positive goal and Trigger desensitization  Assessment  Zung Self-Rating Depression Scale(SDS)  Zung Self-Rating Anxiety Scale (SAS)  Self-Esteem Scale (SES)  Korean translation of Gambling Symptom Rating Scale (KG- SAS)  Barratt Impulsiveness Scale (BIS)

Zung Self-Rating Depression Scale(SDS)

Zung Self-Rating Anxiety Scale (SAS)

Self-Esteem Scale (SES)

Korean translation of Gambling Symptom Rating Scale (KG-SAS)

Barratt Impulsiveness Scale (BIS)

Study for Alcohol Dependence  동의 입원  Weekly 3 DeTUR sessions  1 st session: Safe Place exercise + Resource Development and Installation protocol  2 nd & 3 rd session: Positive goal and Trigger desensitization  Assessment  Zung Self-Rating Depression Scale(SDS)  Zung Self-Rating Anxiety Scale (SAS)  Self-Esteem Scale (SES)  Penn Alcohol Craving Scale (PACS)  Obsessive Compulsive Drinking Scale (OCDS)  Hanil Alcohol Insight Scale (HAIS)

Zung Self-Rating Depression Scale(SDS)

Zung Self-Rating Anxiety Scale (SAS)

Self-Esteem Scale (SES)

Penn Alcohol Craving Scale (PACS)

Obsessive Compulsive Drinking Scale (OCDS)

Hanil Alcohol Insight Scale (HAIS)

Conclusion  Effective as adjunctive therapy of addiction treatment  Future direction  Randomized controlled study  Follow up  Relapse 까지의 기간 조사  Other substance dependency, Internet addiction 등 적용