A painful childhood. A sudden, unbearable loss. Harrowing flashbacks from war.
Traumatic experiences haunt the psyche and trap many people in addiction, blunting their emotional pain with alcohol and drugs. But what if disturbing memories could be processed differently — rendering them powerless to cause distress?
A research-validated therapy known as EMDR — for Eye Movement Desensitization and Reprocessing — may promote healing for people shackled to their past. EMDR helps resolve troubling emotions such as fear, self-doubt, guilt or shame that are associated with traumatic events, both large and small. These unsettling feelings may not be fully understood, yet they influence how we relate to others and perceive our lives.
EMDR therapy transforms “stuck” or unprocessed memories through “new learning,” resulting in healthier, more adaptive behaviors. Therapist-guided eye movements (or sometimes auditory tones or hand taps) help stimulate the brain’s memory network. Irrational beliefs we hold about ourselves that intellectually we know are false (“I have no choices,” “I am not lovable”) are altered by the process of EMDR therapy, along with negative emotions and physical distress that accompany those beliefs. This reduces or eliminates the need to escape the past using drugs and alcohol.
“EMDR is one of the hardest things I’ve ever done, but it’s the best thing I’ve ever done because I don’t have triggers anymore. It kept me sober,” says Andrea,* who left home at age 12 after enduring “the kind of things that just crush children.”
Andrea drank heavily to ease the pain of being rejected by her adoptive mother and terrorized by an abusive stepfather — causing her years of panic around any man who shared his same first name.
“I think I’m over him,” Andrea says of her results with EMDR. “I don’t have any horrible, welling-up feeling inside of me where I need to run, or panic. It feels like it happened to somebody else.”
The connection between trauma and addiction is ironclad, says Susan Brown, a licensed clinical social worker and EMDR researcher, trainer and therapist (the connection is detailed in the long-term Adverse Childhood Experiences (ACE) Study by the Centers for Disease Control & Kaiser Permanente, ongoing since 1995).
“Addictions often begin as a solution to the problem of unmanageable negative emotions, thoughts, or body states by instantly helping us feel better,” Brown says. EMDR therapy breaks the harmful addiction cycle, she notes, by re-processing triggers, urges and bad memories until they are neutralized with no further negative charge on them.
One of Brown’s patients, a recovering alcoholic, describes how EMDR freed him from lifelong powerful urges to drink:
“The EMDR sessions that targeted these triggers have had major effects. The triggers have simply lost their power, or, in some instances, are so rapidly replaced by countervailing thoughts as to be inconsequential . . .
I haven’t had a ‘triggering event’ since the last EMDR sessions, perhaps two years ago . . . I haven’t experienced craving, dizziness, lightheadedness or anxiety . . . I can still recall drinking and its euphoria, but it’s more like watching a movie than reliving an experience.”
Unlinking the Past
Developed in 1989 by California psychologist Francine Shapiro, EMDR therapy is now considered a front-line treatment for post-traumatic stress disorder (American Psychiatric Association, 2004).
A growing body of research also supports the effectiveness of EMDR therapy for others who endure trauma — including rape survivors, persons with phobias or panic disorders, amputees with phantom limb pain, and people affected by natural disasters.
Multiple rigorous studies demonstrate that single incident trauma victims, such as sexual assault survivors, are successfully treated within three sessions, Brown says. Not only are trauma symptoms gone, but also many kinds of chronic pain, including phantom limb pain, can be eliminated (de Roos, C., et al., 2010; Wilensky, 2006). Many phantom limb pain survivors end up abusing drugs and alcohol to try to cope with the pain that “can’t be found.”
EMDR is especially relevant in addiction medicine, given the link between trauma and substance use. More than two-thirds of people who seek help for addiction report one or more traumatic life events (Back et. al. 2000). They’re also up to three times more likely than others to experience physical assault and witness the death or serious injury of others (Cottler et. al 2001; Kessler et al. 1995).
“For those of us who treat addiction, we can count on one hand the individuals who report the absence of trauma or adverse life experiences associated with using drugs or alcohol to assist them in coping,” Brown says (see ACE study, Felitti et. al. 1998; also Felitti’s ‘Origins of Addiction’ article, 2004).
EMDR therapy works as a form of relapse prevention — targeting a person’s memory network at opposite ends: the negative memories and feelings from unresolved trauma that “push” substance abuse or addictive behavior, and the positive recall of euphoric highs that “pull” the person like a magnet, driving self-destructive, drug-seeking behavior.
“We deliberately ask the person to bring up the positive charge on the alcohol or the cocaine or the gambling,” Brown says. “EMDR unlinks and desensitizes both the negative drive to self-medicate as well as the euphoric “chasing” of the drug or behavior, rendering the entire experience more ‘neutral.’’’
What to Expect: A Typical EMDR Program
EMDR therapy is highly individualized. The length of treatment depends on the patient’s trauma history and unique recovery journey, Brown says. For single incident traumas (a rape, a car accident, etc.), most clients report significant relief or resolution within a few EMDR sessions, typically lasting 90 minutes. Complex trauma and/or neglect beginning in early childhood — especially co-occurring with substance abuse — requires more extensive treatment, at least 20-25 sessions (Brown & Shapiro, 2006; Korn, 2009). However, EMDR therapy is highly efficient, Brown says, cutting treatment time down significantly and producing lasting results (she notes a 15-month EMDR follow-up study by Wilson, Becker & Tinker, published in the Journal of Consulting and Clinical Psychology, 1997).
As a comprehensive psychotherapy intervention, EMDR is far more complex than a series of eye movements. So what happens in therapy? There are eight phases to EMDR treatment, which should only be guided by a trained clinician, experts say.
EMDR starts with history taking, as life traumas and current problems are identified. You don’t have to reveal painful memories in detail; a general statement of why you feel unworthy/afraid, etc. is sufficient (“it was something that happened to me in combat”). During the early EMDR phases, therapeutic rapport is built and an explanation given about how memory processing works and how to use self-calming techniques. A treatment plan is created to help the client achieve long-term goals and more functional behaviors.
Before processing begins, the client identifies the elements of the memory network to be targeted, including a negative self-belief “learned” from the trauma (i.e., “I am helpless”) and a preferred positive belief that is more productive and life-affirming (“I am safe now,” “I am in control”). The client also notes the emotions and disturbing physical sensations experienced while focused on the memory.
During the desensitization and memory reprocessing of a target, the client engages in sets of bilateral (side-to-side) eye movements — tracking the therapist’s hand motions back and forth. After each set of movements, the client briefly describes what he or she is now experiencing. Additional forms of dual attention stimulation such as taps or auditory tones are sometimes used as alternatives to eye movements to stimulate memory processing.
As the session continues, the positive belief grows stronger and feels more valid — and the intensity and validity of the negative belief, disturbing emotions and body sensations naturally decrease until no further distress is noted.
“I blocked out so much,” Andrea says of her realization in EMDR therapy. “I couldn’t understand why I didn’t feel worthy, why I didn’t feel loved.” Andrea’s perceptions of unworthiness and fear — rooted in childhood abuse — were eventually replaced by feelings of resiliency and inner strength. Today, she is nine years sober and happily married with a college-educated daughter and a young son.
“EMDR therapy transforms negative, distorted thinking about oneself that is just a result of traumatic and adverse life experiences, allowing the person to connect with and feel the positive “truth” about themselves, not just intellectually but emotionally and physically,” Brown says. “The client essentially sees through a new set of eyes, with changed perceptions of the original event.”
Between EMDR sessions, the client is encouraged to use self-calming skills as needed and be aware of any insights or ongoing triggers related to the target memory to be followed up in the next session.
“EMDR therapy is very easily tolerated because details and descriptions about the trauma are not necessary to be told as in exposure therapy or other forms of trauma-focused Cognitive Behavioral Therapy,” Brown says. “There are no hours of homework, all of EMDR therapy happens in the office, and the target memories tend to resolve quickly.”
The Evidence on EMDR
Research supports EMDR as a successful intervention for traumatic life experiences.
The U.S. Department of Veterans Affairs, in reviewing 16 controlled studies on EMDR, recognizes the therapy “as effective treatment for PTSD” (Clinical Practice Guidelines for the Management of Post-Traumatic Stress, Department of Veterans Affairs/Department of Defense, 2004). The World Health Organization and the American Psychiatric Association also cite EMDR as an effective method to treat PTSD.
More than 30 randomized clinical trials — as well as meta-analyses and case studies — have been conducted on EMDR and generally validate its success (for a research overview, go to http://www.emdr.com/general-information/research-overview.html).
One recent meta-analysis, published in 2013, reviewed 70 studies involving both EMDR and Cognitive Behavioral Therapy (CBT) among 4,761 people (Bisson JI, et. al., The Cochrane Collaboration, December 2013). While noting that the studies had only small sample sizes, and some were poorly designed — a concern echoed by other researchers — the authors concluded that EMDR and CBT “are more effective” than other psychotherapies.
There’s also support for EMDR therapy as an evidence-based treatment for sexual addiction, gambling, smoking and alcohol use. In one study, patients with chronic alcohol dependency who had two sessions of EMDR therapy focusing on addiction memory “showed a significant reduction in craving” after treatment and one month later, vs. patients who did not have EMDR (Hase, M. et. al., “EMDR reprocessing of the addiction memory: pretreatment, posttreatment and 1-month follow-up; Journal of EMDR Practice and Research, 2008).
Brown led a three-year pilot study using EMDR therapy in the Thurston County Drug Court Program in Washington. According to the study, 91 percent of non-violent drug offenders who had EMDR therapy graduated from the 12-18 month drug court program, compared to 62 percent who did not have EMDR therapy. Program completion and graduation are the strongest predictors of lower recidivism rates in the future (Mitchell et al. 2012). The study was accepted for publication in the Journal of EMDR Research and Practice, 2015.
The power of EMDR therapy is self-evident to clients like Andrea. “I see people struggling in the rooms of AA (Alcoholics Anonymous) and they keep bringing up the same things,” she notes. “It seems to me, it’s always because of past triggers that take them out.”
“You really need to go have EMDR, get some help. I try to explain to everybody who will listen what this trauma therapy is, because it can really change your life.”
“The brain’s information processing system naturally moves toward mental health. If the system is blocked or imbalanced by the impact of a disturbing event, the emotional wound festers and can cause intense suffering. Once the block is removed, healing resumes.”
EMDR Institute, Inc.
Experts say that memory processing with EMDR therapy should only be administered by licensed mental health practitioners who have completed both levels of a training approved by the E.M.D.R. International Association (www.emdria.org), an independent professional group that sets industry standards for EMDR training.
It’s wise to interview potential therapists to find a good fit; ask about their training and track record/results with EMDR therapy, and if they can treat your unique problem.
Unresolved traumas coupled with addiction are prime issues treated by EMDR therapy. But if you have a substance use disorder, EMDR is only one component of a successful recovery program. You may also need medication-assisted therapies, peer support programs, other psychosocial therapies or treatment for co-occurring mental health conditions to prevent relapse and achieve long-term recovery. Make sure your EMDR therapist also has experience in treating substance use disorders.
Here are some links to find a trained EMDR clinician, and learn more about this therapy:
- EMDR International Association (EMDRIA): includes a wealth of information on EMDR and a nationwide therapist locator: http://www.emdria.org/
- EMDR Institute, Inc.: the other key source of online information about EMDR therapy, with FAQs/general information for the public, and electronic discussion forums for clinicians: http://www.emdr.com/
- “Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy,” by Francine Shapiro, creator of EMDR, is a layman’s guide to the therapy and has lots of client case studies