For many people who struggle with substance abuse, addiction is not the main problem, only a symptom.
The root of the real issue is often unresolved trauma, and substances become a means to cope with it. But EMDR is designed to help you address not just addiction, but the reasons behind it. Through EMDR therapy, All In Solutions is able to help you explore your substance abuse and the driving factors of your addiction in a safe, confidential, and therapeutic setting.
What Is EMDR Therapy?
Eye Movement Desensitization and Reprocessing therapy (EMDR) is an evidence-based psychotherapy developed by Francine Shapiro in the late 1980s for the treatment of post-traumatic stress disorder (PTSD). Since then, EMDR has gained considerable recognition and is recognized as an evidence-based treatment by the Substance Abuse and Mental Health Services Administration (SAMHSA), the World Health Organization (WHO), and the American Psychological Association (APA).[1]
The EMDR process is based on the Adaptive Information Processing (AIP) model, which relates to how traumatic experiences are processed and stored in the brain. When an individual is unable to process a traumatic event at the time it occurs, that traumatic experience is stored in such a fragmented and emotionally charged manner that, decades later, the memory is still affecting the way an individual thinks, feels, behaves, and physically experiences the memory itself. Because of this, many people may turn to substances as a means of coping with past traumas that remain unprocessed.
Through the use of EMDR, clients are able to work through and resolve those traumatic memories by using bilateral stimulation techniques, most commonly, following the movement of a therapist’s finger, to activate both hemispheres of the brain and facilitate more efficient processing of previously unprocessed traumatic memories. This, in turn, allows the person to process the memory, which reduces its emotional charge and allows for healthier behaviors to emerge over time.
EMDR therapies are performed by trained EMDR providers. It is appropriate for adults and adolescents and can be integrated into a range of outpatient and inpatient treatment settings alongside other evidence-based therapies.
The 8 Phases of EMDR Therapy
EMDR follows an eight-phase treatment protocol developed by Shapiro that guides the therapist and client through the full process of trauma reprocessing
Phase 1 — History Taking and Treatment Planning The therapist collects an in-depth history and determines which traumatic memories and life experiences will be the focus of EMDR work. A treatment plan is collaboratively established, prioritizing which memories will be processed and in which order, based on clinical judgment and readiness of the client.
Phase 2 — Preparation The traumatic memory that is to be processed is identified along with the negative belief associated with it, the desired positive belief, and the physical sensations or emotional distress currently felt in relation to the traumatic memory. The client will also establish a baseline for the level of distress associated with the traumatic memory according to the Subjective Units of Disturbance (SUD) scale.
Phase 3 — Assessment The specific traumatic memory to be processed is identified, along with the negative belief associated with it, the desired positive belief, and the physical sensations and emotional distress currently connected to the memory. A baseline measure of distress is established using the Subjective Units of Disturbance (SUD) scale.
Phase 4 — Desensitization While focusing on the identified traumatic memory, the client will follow the therapist’s finger movements or be exposed to other bilateral stimulation, such as auditory or tactile. By using sets of bilateral stimulation, the therapist will help the client notice whatever comes to mind or otherwise occurs, without trying to direct the occurrence. The goal will be to gradually reduce the emotional charge associated with the traumatic memory over a series of sets of bilateral stimulation.
Phase 5 — Installation The positive belief identified in Phase 3 is strengthened and linked to the target memory using bilateral stimulation, replacing the negative belief that was previously associated with the traumatic experience.
Phase 6 — Body Scan The client scans their body to determine if there are any residual physical sensations or tension related to the targeted memory. Any remaining disturbance is addressed with additional bilateral stimulation until the body scan is clear.
Phase 7 — Closure The therapist will conclude the session in such a manner that the client is stabilized and calm when leaving the session. The therapist will describe possible experiences that the client may have between sessions, including possible spontaneous processing.
Phase 8 — Reevaluation At the beginning of each subsequent session, the therapist will assess the client’s response to the previous session of processing and determine if additional processing is needed before moving on to other traumatic memories.
EMDR vs. Exposure Therapy
How does EMDR differ from exposure therapy, when both approaches involve confronting traumatic memories? While both are trauma-focused and evidence-based, there are several key differences.
Exposure therapy — including Prolonged Exposure (PE) — works by having clients deliberately and repeatedly confront feared stimuli or traumatic memories until the anxiety response diminishes through a process called habituation. It is highly effective but can be demanding, as it requires sustained engagement with distressing material over multiple sessions.
While EMDR does not require clients to engage in long-term or prolonged exposure to a traumatic memory, clients will think about their memory briefly while receiving bilateral stimulation, which will help to facilitate the reprocessing of that traumatic memory. Many clients see this approach as less distressing than traditional exposure-based approaches, and EMDR typically yields clinically meaningful results in fewer sessions than exposure therapy. Nevertheless, EMDR and exposure therapy cannot be thought of as substitutes for each other. Each approach depends on an individual’s history, presentation, and clinical needs.
Efficacy of EMDR
SAMHSA, the World Health Organization, the Department of Veterans Affairs, the Department of Defense, and the American Psychological Association all support EMDR as an evidence-based approach to treating trauma.
According to one meta-analysis, EMDR was found to be significantly more effective than control conditions for reducing PTSD symptoms, with those effects comparable to trauma-focused cognitive behavioral therapies.[2] Research on the use of EMDR in addiction treatment specifically has found that EMDR may reduce trauma symptoms that drive substance use and may help reduce cravings and improve outcomes when integrated into comprehensive addiction treatment programs.[3]
EMDR is not a one-size-fits-all solution. Those with a clear history of trauma can expect good outcomes from EMDR; however, those with substance use disorders that do not have a clearly identifiable history of trauma will likely find the EMDR approach less effective than traditional evidence-based approaches.
EMDR Side Effects and Considerations
Like other trauma-focused psychotherapies, clients may experience temporary side effects from their EMDR experience, which can include:
- Heightened emotional sensitivity or tearfulness during and after sessions.
- Vivid dreams or spontaneously surfacing memories during the time between sessions.
- Significant temporary spikes in distress as previous memories become accessible.
- Physical symptoms such as moderate fatigue and headaches.
These side effects are common and are a part of the normal processing response. The preparation phase of EMDR provides the client with stabilization skills that will assist with any distress that arises between sessions. Throughout the EMDR process, the therapist will request that the client maintain regular contact to keep them informed of any significant distress experienced between sessions.
While many individuals can benefit from EMDR, it is not appropriate for everyone. Those who are experiencing acute psychosis, severe levels of dissociation without stabilization, or who are in acute crisis typically need additional preparation or a different form of therapy.[4] The decision to implement EMDR into a client’s treatment plan is based on the treating clinician’s assessment of the client.
What to Expect From EMDR Therapy
Beginning EMDR can create uncertainty for clients trying it for the first time. EMDR may feel unfamiliar because there are no other therapies that combine holding a traumatic memory in mind and bilateral stimulation.
The initial phases of EMDR therapy focus on creating safety and establishing trust between the client and EMDR therapist, developing clinical and emotional stabilization resources, and identifying specific memories to target for processing. Clients are not permitted to initiate the trauma processing phase of EMDR therapy until they feel safe and the EMDR therapist has assessed that the client has reached a level of clinical readiness.
While in the active processing phase of EMDR therapy, clients can expect to experience a variety of thoughts, images, emotions, and physical sensations as the bilateral stimulation supports the reprocessing of the traumatic memory. While this experience can be intense at times, the therapist will monitor the client throughout the session and will take breaks or adjust the pace to ensure the client remains comfortable.
Many clients report following an EMDR therapy session that they feel lighter, calmer, or less burdened by specific memories. Some clients will experience these reductions immediately, while other clients may experience reductions after several therapy sessions. The pace of processing should be individualized, and the client should never feel forced into processing their traumatic memory.
EMDR Therapy at All In Solutions
At All In Solutions, EMDR is delivered by our team of trained therapists as a part of individual therapy sessions and is integrated into each client’s comprehensive and individualized treatment plan. EMDR may only be offered in circumstances where clinical assessment shows there is a history of trauma triggering the client’s substance use or co-occurring mental health disorders, and the client has successfully completed the preparation for trauma processing.
EMDR at All In Solutions does not substitute for other aspects of treatment. EMDR is integrated within the larger treatment plan. EMDR clients will also have additional individual therapy sessions to assist with processing work integration, and the pacing of therapy will be adjusted according to the client’s clinical response and comfort throughout.
