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 Eye Movement Desensitization Reprocessing Therapy -DeTUR Protocol

The Eye Movement Desensitization Reprocessing Therapy Framework

From its conception, Shapiro's model of Adaptive Information Processing (Shaprio, 2002) has spawned a new eclectic psychotherapy genre currently used today to treat a myriad of different psychopathologies: Eye Movement Desensitization Reprocessing (EMDR) therapy. EMDR is based on the basic premise that all dysfunctional neural responses, reactions, and perceptions stem from the inability of neural systems to integrate a traumatic root memory adequately (Shapiro, 2017). Before moving forward, let us consider the implications of this concept, as it is easy to disregard what it means in terms of treating psychological disorders as a whole. Typical psychotherapies aim to treat affective and trauma-based disorders through gradual exposure methods, which require patients to psychologically immerse themselves in past traumatic events to better understand the experience (Brown et al., 2020; Ovenstead et al., 2020). Although these methods often reduce affective symptoms, the treatment trajectory is extremely prolonged, and the desired outcomes are not always achieved. As a result, victims will avoid seeking these forms of treatment, thus remaining untreated for the most part. EMDR essentially bypasses gradual exposure methods and successfully treats affective and trauma-based disorders through bi-lateral stimulation, which consists of associating traumatic root memories with external stimuli that incite memory, forming neural processes to occur naturally (Castelnuovo et al., 2019). Over the years, this form of treatment has been extensively validated by research worldwide, with interventions expressing high success rates for treating trauma, addiction, eating disorders, depression, and so forth (Balkin et al., 2022; Lewey et al., 2018).

Eating Disorders & EMDR
Trauma & EMDR

 The Treatment of Substance Use & EMDR

 

EMDR for Addiction Disorders: The DeTUR Protocol

Initially oriented toward treating trauma and affective-based disorders, the EMDR framework has been shown to be remarkable in treating all forms of addiction and addictive behaviors. This addiction-based approach, termed the EMDR Desensitization of Triggers and Urge Reprocessing (DeTUR) protocol, is an approach that employs classical EMDR processing techniques to promote patient recovery and establish a healthy state of functioning (Popky, 2005). The DeTUR protocol targets triggers of cravings by recruiting a positive treatment goal to induce positive bodily states used for bilateral stimulation (Wise et al., 2016). This association enables trigger desensitization to occur, as well as connects triggers with adaptive responses that are congruent with the treatment goals. Moreover, DeTUR also implements techniques that support the client in strengthening their access to beneficial internal states, compounding the subsequent effects of trigger desensitization. Through this process, EMDR provides the space for the patient's ego to strengthen and reinforce the newly established connections. The DeTUR protocol has demonstrated successful results over a large variety of addictions and has expressed particular success in the realm of nicotine addiction (Markus, 2019). The protocol itself was first established as a strategy to stop nicotine addicts from smoking in 1993 and has since been deployed internationally to serve this purpose (Popky, 1993). Multiple lines of evidence point to its efficiency in reducing addictive behaviors such as smoking and other forms of addiction, where numerous reviews and case studies demonstrate high success rates (Wise et al., 2016; Roojimans et al., 2012; Franklin, 2015). One case of EMDR DeTUR’s successful implementation was in a study investigating the impact of the protocol on adolescent internet addiction (Bae & Kim, 2012). During the sessions, a positive treatment goal was identified, along with seven triggers desensitized through bi-lateral stimulation. After treatment, addictive symptoms successfully decreased to nonclinical levels, with therapeutic gains maintained at 6- and 12-month follow-ups (Bae & Kim, 2012). Moreover, subsequent reviews from Franklin (2015) on the overall impact of EMDR and DeTUR protocols on addiction demonstrated that these forms of therapy were significantly correlated with the reduction of participants’ felt degree of addiction toward addictive substances and behaviors. Similar to Bae and Kim (2012), these beneficial outcomes were also maintained over long periods of time following initial treatment.

 

EMDR DeTUR for Nicotine Addiction

In his book: Targeting Temptation, psychologist Markus Wiebren (2019) outlines how the DeTUR protocol successfully mitigates nicotine cravings for addicts. His research compiled studies investigating the impact of EMDR DeTUR on overall smoking cessation, which found that the protocol engendered smoking cessation through its impact on addictive memory vividness and nicotine cravings (Markus et al., 2016). This protocol works under the premise that addiction is primarily exacerbated by intense and persistent cravings that stem from addictive memories and increase relapse propensity (Seo & Sinha, 2014). Hence, to promote smoking cessation, EMDR DeTUR directly targets these factors in order to provide the client with additional agency in navigating their recovery from addiction. It is considered that daily life for a nicotine addict is fraught with risks and situations that have the potential to elicit cravings or, in more severe cases, a relapse. Typically, the best-recommended strategy to avoid risky situations is avoidance (Mann et al., 2004). However, this strategy is not always possible as an ex-smoker will inevitably inhale smoke or socialize with smokers at one point in their life. In these cases, it is vital that triggers to cravings are significantly desensitized so that they do not have the potential to evoke powerful urges, which is precisely what EMDR DeTUR addresses. The question remains of how EMDR DeTUR achieves these outcomes. Essentially, if classical EMDR successfully treats trauma symptoms by associating root memories with external stimuli, EMDR DeTUR reduces triggers and urges by associating them with positive bodily states (Popky,2005).

The Science Behind EMDR DeTUR

In the DeTUR protocol, an urge's behavioral drivers are considered to be bodily sensations that can be expressed by the degree to which they elicit physiological arousal within the individual. Previous studies into the underlying processes of addiction have demonstrated that a low degree of physiological arousal is significantly associated with a reduction in addictive symptoms (Freidenberg et al., 2002). Studies show that rapid symptom reduction is achieved by strengthening access to these internal bodily states, elicited through history taking and prompts from the therapist, and associating it with the positive treatment goal (Bae, Han & Kim, 2015). Unlike classical addiction therapies, EMDR DeTUR does not expose the client to triggering bodily states for a prolonged period but for a brief one to produce a spontaneous association during bilateral stimulation. Hence, once the desensitization of the urges is achieved and associated with the positive treatment goal, the client's ego strengthens and allows for desensitized triggers to be associated with the treatment goals instead of old addictive responses (Popky, 2005).

The Bottom Line

EMDR DeTUR is a therapeutic variation of classical EMDR, which has shown promising results in reducing addictive behaviors, namely for smoking addictions (Popky, 2005; Markus, 2019). Using the underlying AIP framework, EMDR DeTUR successfully reduces symptoms of addiction by mitigating triggers and urges for use. As a form of treatment, EMDR demonstrates rapid efficiency and is highly cost-effective for individuals looking to reduce their addictive behaviors. Addiction is a painful and highly debilitating condition that affects millions of people worldwide, and victims suffering from it deserve an accessible form of treatment that can support them on their road to recovery. With EMDR DeTUR, once the core urges have been processed and dealt with, triggers will be unable to invoke the acute anxiety previously associated with you, and your risk of relapse significantly drops.

References

Bae, H., & Kim, D. (2012). Desensitization of triggers and urge reprocessing for an adolescent with internet addiction disorder. Journal of EMDR Practice and Research, 6(2), 73-81.

Bae, H., Han, C., & Kim, D. (2015). Desensitization of triggers and urge reprocessing for pathological gambling: a case series. Journal of gambling studies, 31(1), 331-342.

Balkin, R. S., Lenz, A. S., Russo, G. M., Powell, B. W., & Gregory, H. M. (2022). Effectiveness of EMDR for decreasing symptoms of over‐arousal: A meta‐analysis. Journal of Counseling & Development, 100(2), 115-122.

Brown, E. J., Cohen, J. A., & Mannarino, A. P. (2020). Trauma-focused cognitive-behavioral therapy: The role of caregivers. Journal of Affective Disorders, 277, 39-45.

Castelnuovo, G., Fernandez, I., & Amann, B. L. (2019). Present and future of EMDR in clinical psychology and psychotherapy. Frontiers in Psychology, 10, 2185.

Franklin, J. L. (2015). The effectiveness of EMDR therapy on clients with addictions.

Freidenberg, B. M., Blanchard, E. B., Wulfert, E., & Malta, L. S. (2002). Changes in physiological arousal to gambling cues among participants in motivationally enhanced cognitive–behavior therapy for pathological gambling: A preliminary study. Applied psychophysiology and biofeedback, 27(4), 251-260.

Lewey, J. H., Smith, C. L., Burcham, B., Saunders, N. L., Elfallal, D., & O’Toole, S. K. (2018). Comparing the effectiveness of EMDR and TF-CBT for children and adolescents: A meta-analysis. Journal of Child & Adolescent Trauma, 11(4), 457-472.

Mann, R. E., Webster, S. D., Schofield, C., & Marshall, W. L. (2004). Approach versus avoidance goals in relapse prevention with sexual offenders. Sexual abuse: A journal of research and treatment, 16(1), 65-75.

Markus, W., de Weert–van Oene, G. H., Woud, M. L., Becker, E. S., & DeJong, C. A. (2016). Are addiction-related memories malleable by working memory competition? Transient effects on memory vividness and nicotine craving in a randomized lab experiment. Journal of Behavior Therapy and Experimental Psychiatry, 52, 83-91.

Markus, W. (2019). Targeting temptation: The feasibility and efficacy of addiction-focused eye movement desensitization and reprocessing therapy (Doctoral dissertation, [Sl]:[Sn]).

Ovenstad, K. S., Ormhaug, S. M., Shirk, S. R., & Jensen, T. K. (2020). Therapists’ behaviors and youths’ therapeutic alliance during trauma-focused cognitive behavioral therapy. Journal of Consulting and Clinical Psychology, 88(4), 350.

Popky, A. J. (1993). Smoking protocol. EMDR Institute Annual Conference, Sunnyvale, CA.

Popky, A. J. (2005). DeTUR, an urge reduction protocol for addictions and dysfunctional behaviors. EMDR solutions: Pathways to healing, 167-188.

Rooijmans, J., Rosenkamp, N. H., Verholt, P., & Visser, R. A. (2012). The effect of eye movements on craving, pleasantness and vividness in smokers. Social Cosmos, 3(2), 200-214.

Seo, D., & Sinha, R. (2014). The neurobiology of alcohol craving and relapse. Handbook of clinical neurology, 125, 355-368.

Shapiro, F. (2002). EMDR 12 years after its introduction: past and future research. Journal of clinical psychology, 58(1), 1-22.

Shapiro, F. (2017). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures. Guilford Publications.

Wise, A., & Marich, J. (2016). The perceived effects of standard and addiction-specific EMDR therapy protocols. Journal of EMDR Practice and Research, 10(4), 231-244.