Eye Movement Desensitization and Reprocessing (EMDR) is a highly recognized, effective treatment for those who are navigating responses to traumatic experiences and memories. EMDR is introduced into the therapeutic experience to process distressing memories and reduce symptoms stemming from unprocessed memories. As clinicians have become more familiar with the process of EMDR and how it can be integrated into treatment plans, the opportunity to push outside of trauma-focused work has become a new area to explore.
Two areas of treatment outside of trauma-informed care, in which EMDR can be just as effective, are phobias and addiction. Both situations may be in response to learned fears or negative experiences, maladaptive memory networks, and intense psychological responses. EMDR can be an additional tool for an individual to explore outside of more traditional forms of talk therapy, leaving certain symptoms still present. In this blog, we will be focusing on how EMDR can support the specific sectors of treatment within phobias and addiction.
Other ways to look at EMDR:
EMDR is a highly structured form of therapy designed to target reactions to traumatic memories and experiences. The symptoms of these traumatic memories may manifest differently in each person. Psychological distress occurs when experiences are stored in a maladaptive and unprocessed form. These unprocessed maladaptive experiences can trigger certain emotional reactions or coping behaviors, which may lead us to the two categories we are discussing in this blog. Phobias are often created as a fear-based learning, while addictive behaviors are more of a coping mechanism in order to manage emotional experiences. All in all, both phobias and addictive behavior may stem from traumatic experiences, but it may be possible that the individual is not aware of that, as they are just aware of the symptoms.
In both cases, the challenge is not simply cognitive; it is both experiential and physiological, and the emotional side of the experience often triggers a physical response, such as cravings or fight-or-flight reactions. In these cases, EMDR would function the same way as being treated for trauma; however, identifying the memory network, or collection of memories, starting with the first and the worst, that are at the root of the symptoms. Identifying the collection of memories may be difficult at first, especially if there has been dissociation or subconscious forgetting of the experiences and of how to cope with them. This is why it is important to look at trauma treatment with an open mind. Trauma does not look just one way, and often, people have their biases about what trauma treatment would mean for them. Opening up to the idea that if we treat the symptom causing distress, we can use a trauma-informed practice will expand the use of this modality.
EMDR for Phobias:
Phobias are classified as intense, persistent fears of specific objects or situations; ie, flying, animals, medical procedures, public speaking, or enclosed spaces, to name a few. These fears are often developed through direct negative experiences, observational learning, or repeated exposure to situations that feel traumatic or anxiety-inducing. As a result, the desire to avoid these specific fears makes it increasingly difficult to confront the trigger, causing a phobia.
EMDR for phobias, for some, can be in support of or an alternative modality to exposure therapy, which is typically the first line of treatment. However, there are situations in which exposure to the actual fear may be too overwhelming, and exposure to the memories or past experiences that gave rise to the fear may be easier to access.
When reflecting on the key experiences that contributed to the development of the fear, one would want to reflect on the following:
- The first time the fear occurred
- The most distressing experience related to the fear/phobia
- The anticipatory anxiety about future exposure
- The negative beliefs that accompany these memories, e.g., “I’m not safe” or “I can’t handle this.”
Once the memory network from the above experience was clearly outlined and reviewed together as a team, reprocessing would begin with some form of Bilateral Stimulation. As the first memory is reprocessed, the client’s emotional responses and intensity are assessed after revisiting the memory internally. As the intensity of the memory decreases, there can be an opportunity to instill a positive response to these memories. For example, a client who initially believed I am helpless in small spaces may be able to instill the belief that I can manage them.
Clinical Example:
A 35-year-old male reports a severe fear of dogs that has recently become problematic since he moved into a dog-friendly apartment building. The client experiences extreme panic and anxiety when he hears dogs barking and freezes completely if a dog approaches him, causing him to want to avoid the hallways and public spaces of his building, which leads to social isolation. The client highlights an early memory when he was 5 years old, when he was attacked by a dog, leading to multiple stitches on his arm and a traumatic hospital visit. Working with his therapist, they can together create a list of memories where this fear has been repeated and amplified. Targeting the first and worst examples of this with EMDR reprocessing and then the ancillary memories will lead this client to create distance between the phobia and himself.
EMDR can be helpful for people with phobias, with the following considerations:
- Helpful for someone who feels overwhelmed with direct exposure
- Someone who has a clear memory or feeling associated with the fear
- Experience strong, outsized reactions that affect daily life.
- Have not had complete success with traditional talk therapy modalities.
EMDR can be incredibly successful as a short-term complement rather than replacing traditional forms of therapy.
EMDR for Addiction:
Addicted behaviors can often be a response to regulate distressing emotions or cope with emotional triggers. Compulsive behaviors, which may involve using substances, eating, sex, and masturbation, may provide temporary relief from the symptoms, reduce anxiety, and numb the difficult experience. Over time, these coping strategies become reinforced and linked to specific triggers. EMDR can be used in conjunction with additional addiction treatments and rehabilitation in order to specifically target the root cause of some of the individuals’ well-entrenched triggers.
The goal is to reprocess experiences and memories in order to reduce the intensity around the memory and, therefore, the need to reach for an addictive coping skill. It would then be instilled to tolerate the discomfort without resorting to maladaptive behaviors. When reflecting on the key experiences that contributed to the development of the trigger and the addictive coping response, one would want to reflect on the following:
- First memory of a distressing experience that shaped coping patterns
- Situations associated with cravings
- The worst distressing experience that influenced coping patterns
- Memories of shame and self-criticism
- Relapse-related memories
- Future fears of coping without the addiction
Clinical Example:
A 26-year-old female struggling with alcohol use reports an increase in drinking after stressful workdays. The drinking has impacted her ability to care for herself, her dog, and sustain many meaningful relationships. The client has also had difficulty getting other work in the morning and completing tasks during the day as a result of her drinking. In therapy, the client reflects on and identifies that the most stressful days are when she presents her work to a specific boss who is incredibly critical and has yelled at her for making mistakes on multiple occasions. The client identifies that after these days, she is emotionally broken and always stops at the wine store on the way home in order not to think about what happened. When prompted to think about another time outside of this job if she experienced something like this, she recalled that she had felt similar when she was a teenager, and her father would scream at her and her mother, sometimes getting physically violent. The client and therapist string together a list of memories that become her memory network of this feeling and coping, which can then be reprocessed using EMDR.
EMDR can be helpful to assist addiction treatment with the following considerations:
- If understanding the trigger and coping skill relationship is challenging
- Targets the root experience and not just the symptoms
- If an individual is resistant to other forms of therapies
- Enhances autonomy and motivation to change
It can be so rewarding to target the root cause of a problem that has felt like it has been controlling you for so long, so that you can begin to choose what comes next!
EMDR continues to evolve as a tool to aid and support therapeutic goals and symptom relief. While originally developed to support trauma treatment, its application to phobias and addiction reflects a broader understanding of how trauma and distressing experiences shape behavior. By targeting maladaptive memory networks, EMDR may help reduce fear responses, target cravings, and strengthen healthy coping skills.
When thoughtfully integrated into treatment plans, EMDR offers mental health professionals a precise and structured tool to support clients who may have exhausted other therapeutic modalities.
