One of the essentials in any EMDR therapist's set of treatment protocols is a way to address addictions and compulsive behaviors. I was introduced to DeTur by my consultant when I was in consultation and found it very useful. I heard Popky, Susan Brown, and another speaker present on addictions and the DeTur protocol at recent EMDRIA conference.

       I've used DeTur with compulsive eating and sex addiction as well as with alcohol binging, but haven't had the opportunity to apply it to other addictions or compulsive behaviors.  With addictions not being a specialty, it is all the more important to learn from those in EMDR who are experts on the topic. We all know how often this is part of a person's trauma presentation. and we cannot always refer to another EMDR therapist who does specialize in the area.

The latest development in EMDR specialty protocols for treating addiction comes from Robert Miller (see events for his latest midwest workshop).

         If you go to the Miller's website http://www.fsaprotocol.com/  you will find an overview, other training sites and registrations, and an outline of his protocol. FSAP to share about the latest understanding of treating addictions and compulsive behaviors that FSAP brings along with the similarity to DeTur.  I have received Susan Brown's permission to share  her Feb. 18 post on the EMDR Listserve, which exactly describes the differences in what we usually target, the distress, to targeting the positive feeling state that is linked to addictions and compulsions. This is what Dr. Miller is specifically dealing with in his protocol and what he articulates in his articles. Here is what she had to say, in response to an ongoing discussion about reconsolidation:

"….Reconsolidation research and its potential applications to a variety of issues beyond the reprocessing of 'fear and distress' memories, as we see so robustly with EMDR, is definitely cutting edge….

This is precisely the same phenomenon observed (in dire need of controlled research) when we target 'Addiction Memories' (i.e.: euphoric recall, urges, cravings, relapse triggers, and associated positive feeling-states) with modified EMDR approaches (Popky, Knipe, Hase et al., Miller). But instead of 'fear memories' being reprocessed to a calm, neutral state (hypothetically in part through reconsolidation), the learned conditioned stimuli (cues and triggers) associated with using drugs, alcohol, and other addictive behaviors, seem to undergo 'unlinking' just as we see in standard EMDR. As with fear memories, the euphoria memories once activated, soon face the 'mismatch' Robin referred to….the negativity, destruction, and irrationality of addiction in a field of 'new information' (adaptive networks).
 
Addiction memory reprocessing then leads to the 'appearance' of enhanced PFC activation, ie: increased rationality, like waking from a nightmare, and the ability to 'choose' (adaptively). The known hallmarks of addiction are the "appearance" of complete irrationality (continued use despite dire consequences: loss of control)….a disordered brain. Cue Exposure Therapy (extinction) is now one of the treatments recommended for addressing these 'addiction memories,' but as we know, creating a 'new' memory that co-exists with the 'old' memory is not expected to be as robust as a new stand-alone, adaptive memory (unlinked from its previous intense conditioning), since the old memory can always be re-ignited….Hence the difference between 'chronic PTSD' and 'remediable PTSD'. If EMDR can do for addictions what it's done for PTSD, then hope reigns supreme…."  Susan Brown, LCSW, BCD, EMDRIA Approved Consultant, EMDRIA Specialty Trainer, EMDR HAP and Institute Facilitator,4700 Spring St. #204, La Mesa, CA. 91942, (619) 698-5435, sbrownlcsw@gmail.comwww.saveamarriage.com .
 Susan gives us an understanding of the distinction of processing addictions and compulsions from standard EMDR processing.   All behavior is purposeful,  as my first social work instructor taught us. Addictive and compulsive behaviors begin as a solution,  consciously or not, then develops into a major problem. The addictions protocols unlink the positive feeling state that has been connected to these behaviors.  with Feeling State Addictions Protocol (FSAP), what the person was thinking and feeling right before doing the behavior is targeted for processing. When the positive feeling state is unlinked from the purpose, then that purpose (original need or issue) can link up with adaptive information, creating choice about the behavior. The DeTur protocol develops a positive feeling state as the visualized positive and desired outcome to begin with, then targets the history of Level of Urge (LOU) of the behaviors for processing. You can find the Detur protocol at www.psychinnovations.com/EMDRSD/DeTUR2in the Francine Shapiro Library www.emdr.nku.edu/emdr_subject.php?subject=DeTur , and as a chapter in Robin Shapiro's EMDR Solutions, Pathways to Healing, http://www.amazon.com/EMDR-Solutions-Pathways-Robin-Shapiro/dp/039370467X, an essential EMDR book I recommend to every EMDR therapist.
 
My EMDR study group colleagues began listening to Dr. Miller's conference presentation and practicing the Feeling State Addictions Protocol with each other as well as applying with clients.  In a colleague's practice with me, we targetted the relief I feel after eating chocolate, with which I have a long and varied history. The thought right before eating chocolate compulsively or in excess was identified as "I can't get what I need," with a positive feeling state of relief. The good news is that a brief, 15 minute practice of the protocol did unlink chocolate from the feeling of relief and I can choose to consume chocolate rather than mindlessly eating it without even remembering I have. Unfortunately, like many clients, I need more treatment before the positive feeling state of relief can be unlinked from sweets in general, though we all had hopes….
Sometimes the process does generalize, but remember I said I have a history and there is more than one NC and feeling state to be addressed. Enough said about that!
 
I hope to have more to say on this protocol and EMDR with addictions in general in future. O  I hope to have more information to add to this post after that.  Meanwhile, any comments, experiences with DeTur and FSAP, comparisons/contrasts, other addictions protocols, etc., are very much welcome.
 
Bonnie the Blogger