SSmmiitthh SScchhoollaarrWWoorrkkss Theses, Dissertations, and Projects 2015 TThhee eeffffeeccttiivveenneessss ooff EEMMDDRR tthheerraappyy oonn cclliieennttss wwiitthh aaddddiiccttiioonnss Jennifer L. Franklin Smith College Follow this and additional works at: https://scholarworks.smith.edu/theses Part of the Social and Behavioral Sciences Commons RReeccoommmmeennddeedd CCiittaattiioonn Franklin, Jennifer L., "The effectiveness of EMDR therapy on clients with addictions" (2015). Masters Thesis, Smith College, Northampton, MA. https://scholarworks.smith.edu/theses/921 This Masters Thesis has been accepted for inclusion in Theses, Dissertations, and Projects by an authorized administrator of Smith ScholarWorks. For more information, please contact [email protected]. Jennifer Lynn Franklin The Effectiveness of EMDR Therapy on Clients with Addictions ABSTRACT This study was undertaken to determine how effective Eye Movement Desensitization and Reprocessing (EMDR) therapy is in helping clients to lessen or end their cycle of SUDs and behavioral addictions in the long term. Secondly, this study aimed to determine whether or not EMDR therapy increases a client’s likelihood of relapse, and whether or not relapse affects the outcome of treatment. Furthermore, this study looked at whether or not clients need to have abstained from their addictive substance for an extended period of time in order for EMDR therapy to be successful in their addictions treatment. The final question that this study intended to answer was whether or not there is a correlation between proposed key components of EMDR treatment and more positive treatment outcomes for people with addictions. Data was collected with a questionnaire designed on Survey Monkey. EMDR therapists registered with The EMDR International Association (EMDRIA) were emailed a link to the survey and asked to respond to the survey themselves (if they met the criteria for participation) and to pass the survey onto current or former clients and people they know who have received EMDR therapy. The survey was also passed on directly to people in my professional network of therapists. The major findings of the research were that EMDR therapy correlates with a significant reduction in research participants’ felt degree of addiction to both substances and addictive behaviors. Moreover, these results were maintained over time. Cravings to engage in the said behavioral addiction or SUD most frequently decreased after EMDR therapy sessions. Relapse to alcohol or drug use that research subjects attributed to an EMDR session was rare. In addition, the data revealed that having abstained for periods of time prior to engaging in EMDR therapy does not correlate with more positive treatment outcomes. THE EFFECTIVENESS OF EMDR THERAPY ON CLIENTS WITH ADDICTIONS A project based upon an independent investigation, submitted in partial fulfillment of the requirements for the degree of Master of Social Work. Jennifer Lynn Franklin Smith College School for Social Work Northampton, Massachusetts 01063 2015 ACKNOWLEDGMENTS This thesis could not have been accomplished without the assistance of many people whose contributions I gratefully acknowledge. First and foremost, I am extremely grateful for the support of my family and friends who have stuck with me through this trying process. Jan and Dick Franklin, Kim Dasso, Staci McNeal, Shannon Crothers, Brook VandenBrink and Shveta Kumaria, I will be forever grateful for your love, on-going support, and encouragement. I’d like to thank the wonderful teachers, supervisors, professors and colleagues that have helped me to grow in the practice EMDR, and who have undoubtedly impacted my interest, enthusiasm and creativity in approaching this project. Marianne Schram, Chappell Marmon, Mary Sue Moore, Barb Maiberger, Rosemary Wrzos, Cindy Divino, Polly Douglass and Ashley Davis, you are an inspiration. I also wish to thank Robert Eschmann, my research advisor, for his time and help in bringing my research together. Thank you, Rob, for helping me to optimize the value of this study and my summary of it. I greatly appreciate all of the participants in this study who graciously volunteered their time in taking my survey. Lastly, thank you to the Eye Movement Desensitization and Reprocessing International Association (EMDRIA) for the distribution of my survey, which ultimately was what allowed me access to the people who made this study possible. ii TABLE OF CONTENTS ACKNOWLEDGMENTS ............................................................................... ii TABLE OF CONTENTS ................................................................................ iii LIST OF FIGURES ........................................................................................ iv LIST OF TABLES .......................................................................................... vi CHAPTER I. INTRODUCTION .................................................................................. 1 II. LITERATURE REVIEW ........................................................................ 4 III. METHODOLOGY ................................................................................. 15 IV. FINDINGS ............................................................................................. 31 V. DISCUSSION ......................................................................................... 77 REFERENCES ............................................................................................... 107 APPENDICES Appendix A: Institutional Review Board Approval Letter .............................. 112 Appendix B: Informed Consent ...................................................................... 113 Appendix C: Protocol Change Request ........................................................... 116 Appendix D: Recruitment Flier/Facebook Posting…………………………… 117 Appendix E: Protocol Change Request Acceptance letter……………………. 118 Appendix F: Regression Table………………………………………………... 119 Appendix G: Measuring Instrument (Survey)…………………………………. 121 iii LIST OF FIGURES Figure Page 1. Ages of Survey Participants……………………………………………… 33 2. Amount of Time Respondents had Abstained from Drinking Alcohol…. 35 3. Cravings for Alcohol Activated (or not) by EMDR Therapy Sessions… . 36 4. How Cravings for Alcohol were Affected over the Course of EMDR Therapy………………………………………………………………… 37 5. Mean Level of Alcohol Addiction……………………………………… . 38 6. Respondents' Perceived Impact of EMDR Therapy on Reducing Level of Alcohol Addiction Over Time……………………………………… 40 7. Amount of Time Respondents Had Abstained from Drug Use Prior to Receiving EMDR Therapy…………………………………………… . 42 8. Drug Addiction Cravings Activated (or Not) by EMDR Therapy Sessions 43 9. How Cravings for Drugs were Affected over the Course of EMDR Therapy 43 10. Mean Level of Drug Addiction………………………………………… . 44 11. Respondents' Perceived Impact of EMDR Therapy on Reducing Level of Drug Addiction Over Time………………………………………… .... 46 12. Time Lapsed Since Compulsive Food Consumption upon Initiation of EMDR Therapy………………………………………………………… 47 13. Cravings to Eat Compulsively, Activated (or Not) by EMDR Sessions… 48 14. How Compulsive Food Consumption was Affected over the Course of EMDR Therapy………………………………………………………… 49 15. Mean Compulsion to Consume Food Compulsively…………………….. 50 iv 16. Respondents' Perceived Impact of EMDR Therapy on Compulsive Food Consumption Over Time…………………………………………………. 52 17. Sex Addiction Cravings Activated (or not) by EMDR Sessions…………… 53 18. How Sex Addiction Craving were Affected over the Course of EMDR Therapy…………………………………………………………………… 54 19. Mean Self-Reported Level of Sex Addiction………………………………. 55 20. Respondents' Perceived Impact of EMDR Therapy on Sex Addiction Over Time……………………………………………………………………… 57 21. Cravings to Engage in Technology Addiction Activated (or not) by EMDR Therapy Sessions………………………………………………………… 58 22. How Technology Addiction Cravings were Affected over the Course of EMDR Therapy………………………………………………………….. 59 23. Mean Level of Technology Addiction…………………………………….. 60 24. Respondents' Perceived Impact of EMDR Therapy on Technology Addiction Over Time…………………………………………………….. 62 25. Cravings for "Other" Addictions Activated (or not) by EMDR Therapy Sessions…………………………………………………………………… 65 26. How "Other" Addiction Cravings were Affected over the Course of EMDR Therapy…………………………………………………………… 66 27. Mean Level of "Other" Addiction………………………………………….. 67 28. Respondents' Perceived Impact of EMDR Therapy on "Other" Addictions 68 29. Effect of EMDR on Survey Respondents as a Whole……………………… 70 30. Primary Characteristics of EMDR Therapy Administered………………… 77 v LIST OF TABLES Table Page 1. Regression Table………………………………………………….…… 117 vi CHAPTER 1 Introduction Mental health clinicians often speak of addictions work with clients as if it were a separate field, something to be specialized in, but not a necessary skill to have in order to work as a mental health professional. According to the Substance Abuse and Mental Health Services Administration (SAMHSA, 2013), a 2012 national survey of drug use and health reported that 22.2 million people in the U.S. aged 12 years or older were substance abusers or dependent. Moreover, 17.5% of people who were diagnosed with mental illness met the criteria for a substance use disorder (SAMHSA, 2013). Researchers have also found that about 50% of people who seek mental health treatment either have issues related to alcoholism in the family or of their own (Corrigan, Mueser, Bond, Drake, & Solomon, 2008 as cited in Abel & O’Brien, 2014). These numbers don’t include the wide range of behavioral addictions that undoubtedly impact the lives of millions of people. Both substance and behavioral addictions have a significant impact on health care, economics, work productivity, and social welfare, let alone the toll that they take on individuals and families (Juhnke & Hagedorn, 2006). Clearly, clients with both substance and behavioral addictions show up regularly in the mental health setting, whether clinicians are prepared to help their clients work through these issues or not. Mental health clinicians trained in traditional models of addiction recovery and relapse prevention don’t tend to consider the significant role that unresolved trauma plays in attempts at recovery from addiction (Miller & Guidry, 2001). It’s been estimated that 22% to 43% of people with post-traumatic stress disorder (PTSD) have had a substance use disorder (SUD) at some point in their lives, extending as high as 75% for veterans (Jacobsen, Southwick, & Kosten, 1 2003). According to Zweben and Yeary (2006), EMDR’s clinical efficiency and practicality are unmatched when looking at the results of its implementation with a wide range of trauma populations. Because of the well-established comorbidity between SUDs and PTSD, clinicians have been using EMDR with recovering addicts for years, despite the lack of empirical validation with addicted individuals (Marich, 2010). Because EMDR therapy doesn’t demand a full narrative of its participants, its implementation could prove to be particularly useful in addressing shame and disclosure, issues that are often inherent in the substance abuse population. Zweben and Yeary (2006) state that “there is more than enough evidence to warrant the study of EMDR in substance abusers in random assignment clinical trials” (p.119). Marich (2009) stated that “A need still exists for expanded, systematized research on using EMDR with chemically dependent and addicted individuals” (p. 99). Studies have been conducted in recent years that provide some evidence that EMDR therapy is also effective in addressing the treatment of substance use addictions (Marich, 2009; Marich, 2010; Abel & O’Brien, 2010; Rougemont-Bucking & Zimmerman, 2012; Hase, Schallmayer, & Sack, 2008). However, this research is either the product of case studies or done on a relatively small population of participants. The research that was completed as part of this thesis reached out to a much larger population of clients than has ever been studied before in order to gauge how effective clients perceive EMDR to be in helping them to lessen their cycles of SUDs. Clients with SUDs are typically expected to reach a certain level of sobriety before engaging in individual psychotherapy (Davis, 2006). Clients who are actively engaged in their substance addiction usually have not developed sufficient coping mechanisms to deal with powerful negative emotions, and tend to resort back to substance use when under emotional 2