EMDR for Complex Posttraumatic Stress Disorder and Addictions

By Jeff Dwarshuis LMSW ACSW

EMDR and Brain Functioning

Eye Movement Desensitization and Reprocessing (EMDR) is a treatment method used to eliminate the negative impacts of traumatic memory quickly and effectively. EMDR is a neurobiological intervention that makes use of eye movements to facilitate a physiological impact on brain functioning which creates permanent emotional and cognitive change in an individual when thinking about or visualizing a traumatic memory.

Recent studies on brain scans of individuals indicate that traumatic experience and traumatic recall negatively impact brain functioning and that EMDR corrects it. Specifically, during trauma a part of the brain called the amygdala, which controls many of our emotions and is responsible for autonomic responses associated with fear and fear conditioning, becomes over activated and this creates an impasse between itself and the hippocampus. The hippocampus plays an important role in the consolidation of information from short term memory to long term memory and spatial memory which is responsible for recording information about one’s environment and spatial orientation.

It is recognized that this impasse between the hippocampus and the amygdala creates symptoms found in generalized anxiety, panic attacks and posttraumatic stress disorder. During EMDR, this impasse is corrected as eye movements will both enlarge and activate the hippocampus so it can receive the overwhelming amount of information coming from the amygdala and then sort it. The hippocampus then completes the proper brain processing by sending information to the anterior cingulate cortex, which is involved in aspects such as attention, decision making, reward anticipation, ethics, morality, impulse control and emotion. The impact of opening this impasse and restoring proper brain functioning means that a negative memory, once too overwhelming to manage, is put into the proper context of time and space, has affective and cognitive aspects of the memory merged, is viewed with more rational thought, reason and control and exists in a clear distinction between the past and the present.

EMDR and Two Primary Reactions

During the EMDR procedure, which is administered by a psychotherapist, a client responds to the neurobiological process described above and experiences two primary reactions to a traumatic memory. First, there is a distancing from the memory

that includes an elimination of the negative emotional reactions related to the trauma. Second, the client experiences an increased level of rational perception related to the memory. This increased rational thinking is called Adaptive Information Processing (AIP). AIP is the result of successful EMDR reprocessing and allows the client to hold a more rational view of personal safety, personal responsibility and personal choice while visualizing or discussing a traumatic memory. AIP also allows the client to hold an accurate positive self perception or cognition while visualizing the trauma. This assists the client in problem solving how he or she would react or prefer to react differently in a similar situation.

Addictive Behavior and Irrational Thinking

All addictive behavior leads to hardship, loss and misery. While experiencing these negative things the addicted individual continues the behavior and maintains the irrational view that the addictive behavior, within the context of the person’s life, is a pleasurable thing. The individual is caught up in a physical, emotional and thought cycle which continues to perpetuate the idea that the behavior is okay. However, this perception is irrational, incomplete and cut off from the person’s actual capacities to both do and see things differently. This is also true with individuals who have a history of repeated abuse or repeated traumatic incidences causing Complex Posttraumatic Disorder. However, in these cases there can be additional patterns of using the addiction as a means of avoidance which will diminish through this protocol.

Using EMDR for addictions targets memories of addictive behavior to create more distance from the memory and to see it more rationally. Using EMDR for addictions assumes that EMDR will work not only with traumatic memories but also with memories that are pleasurable but, are both irrational and destructive. To do this procedure the therapist and client list what is known as The Feeling-State (FS) or that exact time the individual feels the greatest emotional, physical, and cognitive pleasure from the addictive behavior.  Then the positive emotional, physical and thinking reactions generated by visualizing the FS are recorded and measured by the therapist. The client uses the EMDR protocol applied to this FS and does eye movements while noticing all levels of pleasure from the imagery. As the client progresses through the EMDR procedure he will begin to respond with the two primary reactions described above. First, there will be more distance from the pleasure. Second, the EMDR protocol activates the AIP and the client more rationally recognizes the negative impacts of the addictive behavior such as cost, impacts on relationships, health and career. As the recognition of the reality of the hardship of the additive behavior increases, the physical, emotional and cognitive pleasure response decreases.

The Cognitive Replay and Preparing for the Future

During the listing, recording and measurement of the FS, the therapist also records the client’s negative cognitions, or self beliefs, that lead to or cause the addictive behavior leading to the FS. Also, the therapist records the negative cognitions that result from participating in the addictive behavior. For example, a person might have a bad day at work and falsely believe “I am a failure”. The emotional discomfort from this negative self talk might cause the person to want to drink to decrease the pain.

After drinking the client might then falsely believe “I am a bad person” since he drank.

Following the collection of the two negative cognitions, the therapist then asks what positive cognitions the client would rather believe than the two negative ones. After the client’s FS level decreases as illustrated above, the therapist instructs the client to imagine himself fully believing the first positive cognition and then visually reenact the beginning of the addictive behavior using the positive cognition. The client then imagines how he might respond differently to the temptation of the addiction. The client does eye movements both during the positive self talk as well as during the visualization of change. The therapist then instructs the client to repeat the same process but this time using the second positive cognition to see how he might handle the results of his addictive behavior differently. Again, eye movements are done at the therapist’s instruction. The use of reimagining the before and after behaviors using positive cognitions provides insights to the client that he has never considered within this context since his previous thinking, feeling and physical reactions were dominated by the cycle of the FS and seeing himself as unable to manage his temptation or negative results of his behavior.

A Different Kind of Therapy

EMDR is a neurobiological method of treatment that allows intense, effective and permanent change to occur. These changes are emotional, physical, and cognitive. Applied to addictions, EMDR will assist one to be more emotionally distant from a memory, see the realistic level of destruction of their own behavior and create an increased recognition of one’s abilities to act differently. All known addictions can be treated with this protocol including substance abuse, sexual addiction, gambling, alcoholism and compulsive eating. Additionally, this protocol can be used in combination with other treatment objectives and EMDR protocols to treat codependency, self-harm and Complex Posttraumatic Stress Disorder.

For more information on EMDR for addictions see Robert Miller’s “Treatment of Behavioral Addictions Utilizing the Feeling State Protocol: A Multiple Baseline Study”. This study, as well as the concepts of Adaptive Information Processing of Francine Shapiro PhD and Resource Installation by Andrew Leeds PhD influenced and directed many of the concepts in this article.


Cognitive Therapy – Basic and Beyond by Judith Beck (1995)

Cognitive Therapy for Challenging Problems by Judith Beck (2005)

Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures by Francine Shapiro PhD (2001)

EMDR as an Integrative Psychotherapy Approach: Experts from Diverse Orientations Explore the Paradigm Prism Edited by Francine Shapiro PhD (2002)

Getting Past Your Past: Take Control of Your Life with Self Help Techniques from EMDR Therapy by Francine Shapiro PhD (2012)  

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