Desensitization of Triggers and Urge Reprocessing for an

Adolescent With Internet Addiction Disorder

Hwallip Bae
St. Andrew’s Psychiatric Hospital, Incheon, South Korea
Daeho Kim
Hanyang University Guri Hospital, South Korea

This case study reports the successful treatment of Internet addiction in a 13- year-old male using four
45-minute sessions of the desensitization of triggers and urge reprocessing (DeTUR) protocol—an ad-
diction protocol of eye movement desensitization and reprocessing (EMDR; Popky, 2005). This protocol
uses EMDR procedures to process current triggers and positive future templates, but it does not identify
or directly address any past trauma. At baseline, the participant showed a moderate level of Internet ad-
diction (scoring 75 on Young’s Internet Addiction Test [IAT]) and moderate depression (26 on the Beck
Depression Inventory [BDI]). During assessment, he identified 7 triggers for Internet gaming and rated
the associated urge to engage in the activity with scores of 3–9 on the level of urge scale (0 5 lowest,
10 5 strongest). Using the DeTUR protocol, the level of urge for each trigger was reduced to 2, which
the participants defined as “not being able to think about or crave for the game.” After treatment, his
symptoms had declined to nonclinical levels (38 on IAT and 6 on BDI) and he was able to restrict his
time on the Internet to an hour per day. These therapeutic gains were maintained at 6- and 12-month
follow-up. The DeTUR may be a good treatment option for Internet addiction and further controlled
­studies are needed.

Keywords: Internet addiction; game addiction; EMDR; DeTUR

R
esearch has indicated that up to 18% of chil- were introduced later; however, they all share com-
dren and adolescents in developed countries mon components such as excessive use, withdrawal,
are currently affected by Internet addiction tolerance, and negative repercussions on the areas of
(Christakis, 2010). This is a growing, substantial men- interpersonal or personal well-being (Young, 2009).
tal health problem and it has been argued that Inter- Psychological instruments measuring IAD were
net addiction disorder (IAD) merits inclusion in future also introduced and their psychometrical prop-
psychiatric diagnostic systems (Block, 2008). Internet erties were tested. These include the Internet
addiction includes certain aspects of behaviors or im- Addiction Diagnostic Questionnaire (Young, 1998b),
pulse control problems over using this technology. It the  Internet Addiction Test (Young, 1998a), and the
has been suggested that three subtypes of Internet ad- Chen Internet Addiction Scale (Chen, Weng, Su, Wu,
diction exist: excessive gaming, online sexual preoc- & Yang, 2003).
cupation, and e-mailing/texting (Young, 2009). Despite efforts to recognize Internet addiction as
IAD was first defined as a maladaptive pattern of an  independent clinical disorder, there have been
Internet use leading to clinically significant impair- three main criticisms over using the term IAD, which
ment or distress (Goldberg, 1995). Young (1998b) also can be summarized as follows: (a) IAD, in fact, af-
viewed Internet addiction as an impulse control dis- fects only a small percentage of online users and the
order and proposed using diagnostic criteria modified actual prevalence is lower than previously thought
from the Diagnostic and Statistical Manual of Mental (Widyanto & Griffiths, 2006); (b) those with IAD are
Disorders, Fourth Edition (DSM-IV) criteria for patho- not addicted to the medium of the Internet per se, but
logical gambling. Modified versions and variations the contents such as gambling, games, chatting, or

Journal of EMDR Practice and Research, Volume 6, Number 2, 2012 73

© 2012 Springer Publishing Company  http://dx.doi.org/10.1891/1933-3196.6.2.73
shopping (Yellowlees & Marks, 2007); and (c) Internet students with Internet overuse. What they found was
addiction may be just another manifestations of some that although both the treatment and control (no in-
primary disorders, such as depression, personality dis- tervention) conditions decreased their time spent on
order, or substance abuse (Holden, 2010). the Internet, the intervention group showed larger
In addition, it is not clearly understood at present posttreatment increase in online satisfaction and de-
whether Internet addiction is a form of impulse control crease in the severity of Internet addiction. The limi-
disorder, behavior addiction, or both. More recently, tations of this study, as stated by authors, were that all
because there is an increasing consensus of moving participants had low levels of Internet addiction and
pathological gambling to the category of addiction in that their motivation might reflect the milder nature
the upcoming DSM-V, efforts are being made to list of this addiction. Du et al. also failed to find any supe-
Internet addiction within the category of behavior ad- riority of eight-session group CBT over the no treat-
diction (Holden, 2010). Supporting the view of IAD ment control in alleviation of the core symptoms of
as an addiction problem, recent neuroimaging studies adolescent IAD.
found that changes in brain activity among Internet The literature on other psychotherapeutic ap-
addicts were similar to those of substance addiction proaches to IAD is even scantier. The only additional
(Kim et al., 2011; Ko et al., 2011). suggestions for future studies that have been made
Notwithstanding its global nature of Internet ad- were for online support groups and motivational in-
diction, in some countries problems are more serious, terviewing (Griffiths & Meredith, 2009). Thus, further
suggesting cultural or societal influence. A South efforts are needed to test various psychotherapeutic
Korean national survey on Internet use revealed, for modalities to IAD.
example, that 8.5% of total population aged between
9 and 39 is addicted to the Internet. The figure is even
Addiction Treatment With Eye Movement
higher with adolescents (12.8%) compared to adults
Desensitization and Reprocessing
(6.4%; Korea Agency for Digital Opportunity, 2010).
This means that more than 2 million teenagers are One possible approach is eye movement desensitiza-
affected by IAD in South Korea. Consequently, the tion and reprocessing (EMDR). This approach was
South Korean government declared IAD as a serious originally developed for trauma-related conditions
public health issue and set up a governmental agency and has been empirically validated in the treatment
and nationwide counseling centers for adolescents of posttraumatic stress disorder (PTSD; Bisson &
with Internet addiction (Koo, Wati, Lee, & Oh, 2011; Andrew, 2007; Maxfield, 2007). EMDR uses bilateral
Korea Agency for Digital Opportunity, 2010). stimulation (BLS) such as horizontal eye movements,
alternative tapping, or alternative sounds to stimulate
the information processing system of the brain. Cli-
Treatment of Internet Addiction Disorder
ents are instructed to attend to the traumatic mem-
Several psychological treatments have been tested as ory while simultaneously moving their eyes in sets of
a treatment for IAD; these include cognitive behav- about 24 seconds. This process of attending to both
ioral therapy (CBT), behavioral therapy, motivational internal and external stimuli is called dual attention.
interviewing, family therapy, psychoeducation, and This dual attention and association are repeated until
online supports (Griffiths & Meredith, 2009; Murali the memory is no longer distressful. After each set,
& George, 2007; Orzack & Orzack, 1999). Of these, the client reports any associations that come to mind
CBT has received most attention and suggested as a (e.g., memories, feelings, thoughts, perceptions), and
promising treatment modality (Young, 2007). How- the elicited material usually becomes the focus of the
ever, the empirical literature on any treatment for next set of dual attention. This sequence is repeated
IAD is very scarce, and most of the studies were not until the next set of dual attention (Shapiro, 2001). After
controlled and were preliminary in nature. For exam- this, current triggers and future plans are addressed
ple, a recent systemic review revealed that only one using the same method to ensure that all aspects of
study adopted a randomized, controlled trial design the disturbing memory are completely resolved.
(King, Delfabbro, Griffiths, & Gradisar, 2011). In ad- EMDR applications to addiction problems such as
dition, two recently published studies from China substance abuse and sexual addiction have emerged
that were controlled did not report robust effects of in the literature (Cox & Howard, 2007; Hase,
CBT-based techniques (Du, Jiang, & Vance, 2010; Su, Schallmayer, & Sack, 2008; Shapiro, Vogelmann-Sine,
Fang, Miller, & Wang, 2011). Su et al. investigated & Sine, 1994). Shapiro et al. mentioned that EMDR
a one-session online self-help program for college can be used for substance abuse by targeting (a) the

74 Journal of EMDR Practice and Research, Volume 6, Number 2, 2012

Bae and Kim
memories that precipitate and drive substance abuse, outpatient clinic complaining of excessive use of In-
(b) the relapse triggers and craving to use drugs, (c) fu- ternet games. He was spending at least 5 hours a day
ture healthy and adaptive coping, and (d) treatment playing games, and as his mother described, when no
motivation and compliance. control was imposed on him, he could spend a whole
day doing nothing but playing games. This level of
The Desensitization of Triggers and Urge activity had lasted for nearly 4 years and his academic
Reprocessing Protocol performance had continued to decline. According to
his mother, he reacted angrily whenever his parents
Subsequently, Popky (2005, 2009) focused and con-
tried to control his Internet use, creating a continually
densed the last three targets (i.e., treatment goal,
tense home environment. The boy also looked tired
triggers and urge, and future action) into the desen-
and depressed when he was not logged on.
sitization of triggers and urge reprocessing (DeTUR)
The participant had first come in contact with on-
protocol. There exist a few anecdotal reports of the
line games when he was 6, and when, at the age of 9,
use of DeTUR for chemical dependency and sex ad-
he began to play the “MapleStory,” a massively mul-
diction (Abel & O’Brien, 2010; Barbieri, 2008; Popky,
tiplayer online role-playing game (MMORPG). “He
2005). However, this is the first published report using
became addicted to the game,” as his mother put.
this procedure for IAD.
The previous year, his parents had set a time limit for
Unlike EMDR that targets disturbing memories to
playing the game on the home PC at an hour per day.
transform them in neutral, nonstate-dependent memo-
This had led him to spend at least 4 additional hours
ries, DeTUR (Popky, 2005, 2009) focuses on the triggers
at a public Internet café (called PC Bang in Korea).
and urges identified by the patients themselves. It is
Networked gaming among friends is an extremely
similar to imaginal cue exposure in that it uses gradual
popular and affordable pastime for many Korean
exposure to a hierarchy of triggers (desensitization of
young people; PC Bang can be found in most neigh-
less difficult triggers to more potent ones); however,
borhoods in urban centers. He said that he had to play
from the outset, DeTUR uses BLS and free associa-
for at least 5 hours to get things going. This he had
tion after brief exposure to a cue. It does not involve
done every day for 4 years.
repeated focusing on a cue but rather moves on follow-
The consulting psychiatrist discussed with the pa-
ing the client’s free association. Moreover, the DeTUR
tient and his mother the possibility of using DeTUR,
protocol focuses only on the level of urge (LOU) and
and they gave consent for the treatment. DeTUR was
body sensation and does not touch on cognition and
recommended because of anecdotal reports of suc-
emotion, which are viewed as basic and essential
cessful application to behavior addiction (Barbieri,
channels for accessing the problem and as a source of
2008; Popky, 2005).
change in other psychotherapies, including standard
EMDR. Instead of requiring the client to rate the level
of emotional disturbance associated with a memory, Assessment
DeTUR asks the client to rate the LOU associated with
The youth was assessed using the Goldberg’s crite-
trigger using a Likert scale, where 0 5 lowest and 10 5
ria (Goldberg, 1995) for IAD. The Korean versions
the strongest urge (Popky, 2005, 2009). It is poorly under-
of Internet Addiction Test (Widyanto & McMurran,
stood how DeTUR works because it does not process
2004; Young, 1998a) and the Beck Depression Inven-
any past memory, which is an essential element of
tory (BDI; Beck, Ward, Mendelson, Mock, & Er-
treatment in standard EMDR (Shapiro, 2001).
baugh, 1961) were administered at pretreatment and
DeTUR consists of a 12-step protocol: (a) rapport;
posttreatment.
(b) history, assessment, and diagnosis; (c) support re-
Goldberg’s criteria include seven core features of
sources; (d) accessing internal resource; (e) positive
substance dependence (i.e., tolerance, withdrawal,
treatment goal; (f) associated positive state; (g) iden-
difficulty controlling the use, desire to cut down,
tifying the known triggers; (h) desensitizing each
spending significant time, neglecting activities, and
trigger; (i) installing positive state; (j) test and future
negative consequences) that were modified from
check; (k) closure and self-work; and (l) follow-up
DSM-IV criteria for substance dependence (American
­sessions (Popky, 2009).
Psychiatric Association, 1994).
Young’s Internet Addiction Test is a 20-item,
Case Presentation
Likert-type self-questionnaire to screen and measure
Persuaded by his mother, a 13-year-old adolescent the level of Internet addiction (Young, 1998a). Scores
in middle school came to a South Korean psychiatric in each item range from 0 (does not apply) to 5 (always),

Journal of EMDR Practice and Research, Volume 6, Number 2, 2012 75

DeTUR for Internet Addiction Disorder
the total score being 0–100. It is the first well-validated NeuroTek Corp., Wheat Ridge, CO); the stimulation
instrument for Internet addiction and is widely was initially applied in a set of about 24 left–right vi-
used in clinical practice and research (Widyanto & brations (about 24 seconds).
McMurran, 2004). Session 2.  Session 2 began with Step 4, accessing
The BDI is an extensively used self-report to mea- internal resources. The youth identified times when
sure the severity of depression. It contains 21 items he felt powerful and resourceful, and these internal
with four multiple-choice responses (0–3), and the to- resources were then enhanced by BLS. He began by
tal score, thus, can range from 0 to 63. This study used recalling an experience at kindergarten when he was
the original version, the BDI-I (Beck et al., 1961). playing with his friends. However, when the attempt
At pretreatment, the participant’s presentation was made to reinforce this experience with sets of
satisfied Goldberg’s criteria for IAD in that he had tol- BLS, the adolescent reported that the feeling of plea-
erance of time spent on games, withdrawal symptoms sure and energy evoked the thought of playing the
(e.g., anxiety, psychomotor agitation, fantasy about game. Therefore, the therapist reduced the number
games at night, obsessions), always playing games of left–right stimulations in each set to less than 10 vi-
longer than planned, poor concentration and aca- brations (about 10 seconds). After this adjustment,
demic difficulty at school, trying to cut down the use, the patient began to report feeling of happiness and
and uncontrollability. In addition, he scored 75 on yearning for those days without interruption by the
Young’s Internet Addiction Test, which was above the other thoughts.
cutoff value (i.e., 70) for Internet addiction (Widyanto Next, the therapist and the participant worked
& McMurran, 2004; Young, 1998a). He also showed together on Step 5, setting up a positive treatment
moderate depressive symptoms, scoring 26 on the goal. The boy stated that he wanted liberation from
BDI (Beck, 1967). games and obtaining freedom for life and happiness.
He associated that goal with a future image of playing
Course of Treatment soccer. The image was a picture of him cheering after
scoring a goal. This image and accompanying sensory
The second author provided four 45-minute weekly elements were reinforced using BLS, and the thera-
sessions of DeTUR to the participant. pist installed the treatment goal to a positive state.
Session 1.  The first session was attended by the Further visual and auditory adjustments were made
participant and his mother and involved provision of to make the goal more attractive and resourceful.
the DeTUR’s first three steps: (a) building rapport; When the urge for the Internet game emerged dur-
(b) history, assessment, and diagnosis; and (c) support ing the associations, the therapist then refocused the
resources. The session also introduced the type of BLS participant on the image of the goal and continued.
used in the treatment, and the participant selected a After experiencing and enhancing the treatment goal
vibrational form of tactile stimulation rather than eye and positive state, Step 6 was completed, with the par-
movements. The boy held a small oval-shaped pulser ticipant identifying seven triggers of the urge to play
in each hand, with each pulser vibrating alternately the game (Table 1).
(left, then right) for about 0.5 seconds. The pulsers Due to time constraints, only the first trigger (T1)
were connected to the equipment (EyeScan 4000; was processed in Session 2 using Steps 8 (desensitizing

TABLE 1.  Triggers (T) for DeTUR Treatment of an Adolescent With Internet Addiction
Triggers LOU Body Location

T1 His friends’ calling to go to a PC bang while playing 3 Hands

T2 Boring class at school 6 Head
T3 Getting bored during baseball (waiting for his batting turn) 5 Thighs
T4 A computer class, sitting in front of a PC 7 Eyes
T5 Friends talking about the game 8.5 Hands
T6 Having time and money 8.5 Hands
T7 His friends saying, “Let’s go to a PC bang and we will pay” 9 Hands
Note. DeTUR 5 desensitization of triggers and urge reprocessing; LOU 5 level of urge.

76 Journal of EMDR Practice and Research, Volume 6, Number 2, 2012

Bae and Kim
the trigger), 9 (installing positive state), and 10 (test Therapist: Now, please focus on your body. How does the
and future check). Because of the apparent evocative 5 feels in your body? Go with that.
power in longer sets of BLS, the therapist continued Participant: Feeling a butterfly in the stomach.
to use shorter sets of about 10 left–right stimulations Therapist: Keep focus on that sensation. Go with that.
in each set. The first trigger was being called by his Participant: It tells that I want to play the game.
friends to go to a PC Bang; the LOU was 3, and the Therapist: Is there any memory associated with that sen-
body location was in his hands. After six sets of BLS, sation? Let’s go with this.
however, the LOU was still the same, and the partici- Participant: When I was six, I was on the long lineup
pant reported a sense of urge in the right arm. When at amusement park, I wanted to ride the thing so
he was instructed to focus on the urge in his arm, the badly and I was losing my patience.
LOU declined to 0 after three more sets. During in- Therapist: Let your present self go back to the time when
stallation, he associated “nothing good about it.” For you’re six, waiting restlessly in the amusement park
future checks, he said that he would tell his friends and do something about your child self.
that he would not go. For Step 11, closure and self- Participant: I brought the child to a restaurant and
work, the therapist explained that the processing may got him his favorite food.
continue after the session and asked the participant to Therapist: Let’s go with it.
report any changes during the week at the next visit. Participant: Nothing.
Session 3.  A week later in Session 3, the participant Therapist: When you bring up the situation, what is your
started with Step 12, reevaluating the previous work. LOU now?
The participant reported that he had thought about Participant: 2.
the game less often but had actually played more. He Session 4.  In Session 4, the boy reported that he
scored the LOU for trigger 1 (T1) as 2 (it had been 0 felt less anxiety about the game. When the therapist
at the end of the previous session). When asked for checked the previous triggers, the LOU remained the
the explanation of 2 as an urge, the boy reported that same for the triggers that had been processed. There
a rating of 2 meant wanting to play the game very lit- appears to have been some generalization to one of
tle. Therefore, this level was accepted as ecologically the unprocessed triggers, in that the LOU for T6, hav-
valid and was regarded as baseline. ing time and money, had decreased from 8.5 to 6.
Therapy moved on to T2, a boring classroom with Processing then followed the standard proce-
an LOU of 6, which decreased to 2 after eight sets. dures for T6 with the LOU decreasing to 2. The
The participant described the score of 2 as “not being final ­trigger—T7, his friends saying, “Let’s go to a
able to think about or crave for the game.” T3, a feel- PC Bang and we will pay”—was still scored with an
ing of boredom while playing (LOU, 5), was reduced LOU of 9. After 10 sets, it was decreased to an LOU
to an LOU of 2 after seven sets, and T4, being in front of 2. For future check, the adolescent responded as
of a PC during computer class (LOU, 7), was also re- follows:
duced to an LOU of 2 after six sets of BLS. At the end
of Session 3, a higher trigger of LOU of 8.5 (T5) was Participant: I would say to them “No, thanks. Enjoy
tried. The experience was his friends talking about the yourselves.” And then I would go home.
game. The following are excerpts: Therapist: Go with that.
Participant: I am going hiking.
Therapist: Bring that image of your friends talking about Therapist: Go with that.
the game and focus also on the urge felt in your hands. Participant: Having fun with game is momentary but
And simultaneously attend to the vibration. hiking will bring longer happiness.
Participant: I am thinking about the game. Therapist: Go with that.
Therapist: Go with that. Participant: I was thinking about hiking. It felt good.
Participant: I can’t believe that their hands are so fast. But suddenly the picture of me at PC Bang came
Therapist: Go with that. up. That made me feel bad.
Participant: They praise me for my skill. Therapist: If you changed the picture, what kind of scene
Therapist: Let’s go with that. would it be?
Participant: Nothing came up. Participant: Perhaps myself playing ping pong with
Therapist: Let’s return to the original image and go with it. my friends.
Participant: Nothing. Therapist: Let’s go with that.
Therapist: What is your LOU now? Participant: I beat my friend at ping pong. I felt good.
Participant: It is 5. I had no more thoughts of the game.

Journal of EMDR Practice and Research, Volume 6, Number 2, 2012 77

DeTUR for Internet Addiction Disorder
Therapist: Go with that. which was in fact the scene of the positive goal of the
Participant: Happiness and being proud. therapy.
Therapist: Where do you find those feelings in your body?
Participant: I feel warm sensation in my belly.
Discussion
Therapist: Go with that.
This is the first research investigating the treatment of
Follow-Ups Internet addiction with DeTUR (Popky, 2005, 2009),
an addiction protocol based on EMDR. An adolescent
The participant was seen at the office 2 weeks after
with IAD lasting nearly 4 years was treated success-
Session 4. He reported that his urge to play the game
fully and maintained an improved status at 1 year
had decreased and he had been playing for only an
after termination of treatment. The relative briefness
hour a day, using the time-limiting software at home.
of therapy is worth highlighting; only four 45-minute
After the treatment, he had felt much less anger when
sessions were needed to achieve a meaningful reduc-
being cut off after 1 hour. He scored 38 on Young’s
tion in addiction behavior and depressive symptoms.
Internet Addiction Test (previously 75) and 6 on the
BDI (previously 26); both scores were within the
nonclinical range (Figure 1; Beck, 1967; Widyanto & Comparison of DeTUR With Other Internet
McMurran, 2004). Addiction Disorder Treatments
The boy was asked to be followed up after 6 months,
The reported time required for various IAD treat-
without any additional treatment. At that time, he
ments varied widely. For example, CBT usually re-
maintained these therapeutic gains and continued
quires twelve 90-minute sessions with homework
to control his time on the game to 1 hour per day.
(Young, 2007). A combined multicounseling pro-
This was confirmed by his mother. Moreover, when
gram based on motivational interviewing lasted
he revisited after another 6 months, he said he had
for 15  months (Shek, Tang, & Lo, 2009). However,
completely stopped playing MMORPG for 5 months,
Young noted that treatment of most clients with IAD
was using the Internet for e-mails and homework, and
was effective by the eighth session, and a recent study
sometimes playing simple games without PC control.
provided eight-session group CBT (Du et al., 2010).
After school, he usually played soccer with his friends,
Thus, the time and number of sessions required for
EMDR-based DeTUR may favor the use of this tech-
nique. The rapidity of effective treatment by EMDR
80 compared to exposure therapy has also been noted
in some PTSD studies (Ironson, Freund, Strauss, &
70 ­Williams, 2002).
The process of DeTUR contains elements that may
60 look similar to cue exposure and motivation enhance-
ment therapy. First, cue exposure has been claimed
50
to be as effective as CBT in the treatment of alcohol
40
dependence (Loeber, Croissant, Heinz, Mann, & Flor,
2006). Setting up a hierarchy of triggering situations
30 and exposure to each trigger until the urge declines
are common in both DeTUR and cue exposure.
20 However, unlike cue exposure, DeTUR continues
with spontaneous association during BLS, and pro-
10 longed and/or focused exposure is not required.
These aspects have also been suggested to differenti-
0
preDeTUR postDeTUR 6 months 12 months
ate EMDR from ­exposure-based therapy (Rogers &
Silver, 2002).
Internet Addiction Test Second, identifying the triggers of Internet addic-
Beck Depression Inventory tion is an essential part of both cue exposure and of
FIGURE 1.  Pre- and Post-DeTUR treatment scores with DeTUR. This suggests that this may be a basic ele-
6- and 12-month follow-up. ment of effective treatment.
Note. DeTUR 5 desensitization of triggers and urge Third, DeTUR begins with setting up a treatment
­reduction. goal. This is in line with motivational enhancement

78 Journal of EMDR Practice and Research, Volume 6, Number 2, 2012

Bae and Kim
therapy where the therapist and the patient work to- In addition, DeTUR fits well into the characteris-
gether to delineate specific, attainable goals (Orzack tics of Internet addiction. As illustrated in the previous
& Orzack, 1999). However, in DeTUR, the goal is an example, DeTUR does not require abstinence as a
image of positive self-attainment that attracts and mo- treatment goal; instead, it decreases the urge and the
tivates the client to proceed with the therapy. extent of use that the client can cope with in a positive
way (Popky, 2005). This approach makes particularly
good sense with IAD because the goal is to become
The Application of Internet Addiction Disorder
a normal Internet user. This less confrontational and
These considerations suggest that DeTUR may work more motivating aspect of DeTUR may be an advan-
differently from previous psychotherapies for addic- tage when dealing with clients who deny or avoid the
tion problems. Although it contains an element of de- problem.
sensitization of urges to use or be engaged in addiction Another benefit of the treatment was a decrease in
behavior, the application of BLS and spontaneous as- depressive symptoms. The patient had had significant
sociation seems to permit the client to progress fur- depressive symptoms before treatment, although no
ther. It is interesting to note that forward therapeutic diagnosis of major depressive disorder was given.
improvement resulted from DeTUR, targeting of only Studies consistently show that significant depressive
current triggers and future coping. This is contradic- symptoms are present in patients with IAD (Jang,
tory to the general EMDR model in which Shapiro’s Hwang, & Choi, 2008; Young & Rogers, 1998). The
(2001) three-pronged protocol states that the past participant’s depressive symptoms were dramatically
distressful memory must be processed first before reduced after the treatment of IAD, which implied
addressing current and future issues. Thus, the thera- that his depression may have been secondary to his
peutic mechanism underlying DeTUR may be distinct IAD (Young & Rogers, 1998).
from that which is posited for standard EMDR.
Popky (2005) recommended that when the clients
Study Limitations
present with both trauma and sexual compulsivity,
both EMDR and DeTUR are necessary. In his clinical Despite the successful treatment of IAD and the main-
practice with these clients, he found that both standard tenance of therapeutic gains at 1-year follow-up, our
EMDR and DeTUR alone decreased urge but did not findings should be interpreted with some cautions.
affect their symptoms of traumatic stress or promote First, the severity of addiction reported by the partici-
future healthy living. The participant in our clinical pant was mild—a score of 75 on the Internet Addic-
study did not have any traumatic experiences or dis- tion Test; 70–100 is the range of addiction (Widyanto
tressful memories; therefore, only DeTUR sessions & McMurran, 2004). Second, addiction was not ac-
were needed to complete the therapy process, with companied by severe comorbid psychiatric prob-
large reductions in his urge and compulsive behav- lems such as substance abuse or behavior problems.
iors, as well as an improvement in health lifestyle. Third, the participant accepted his illness and agreed
From another perspective, DeTUR can be viewed on treatment, although he had been initially reluctant
as a simple extension of standard protocol. The trig- to seek psychiatric help. This motivation may have
gers targeted in this study could be considered as played a part in the favorable outcome. Finally, the
“addiction memories.” A study by Hase et al. (2009) measurement for the treatment changes relied solely
found that processing memories of relapse or of in- on answers to self-report questions.
tense urge with EMDR was associated with decreased
craving in patients with alcohol dependence.
Recommendations
During our DeTUR sessions with the number of
clients, we have observed several occasions when Currently, no standard treatment of IAD has been es-
the participant spontaneously recalled past memories tablished. Given the seriousness of the problem and
associated with urge or its somatic sensation. These high prevalence of this illness worldwide, vigorous ef-
memories were processed within a few sets (see the forts should be made to develop effective treatment
first excerpt earlier). When the triggers (addiction modalities and obtain empirical evidence through
memories) were successfully reprocessed with BLS clinical trials. The strengths of DeTUR that were evi-
and EMDR procedures in DeTUR, the clients seemed dent in this study include the brevity of therapy time,
to react differently to cues that were previously irre- no extra hours for homework, rapid decrease in urge,
sistible and uncontrollable, and clients spontaneously and positive healthy changes in the adolescent’s life-
come up with better choices. style. It appeared that his engagement in treatment

Journal of EMDR Practice and Research, Volume 6, Number 2, 2012 79

DeTUR for Internet Addiction Disorder
was furthered by focusing on positive aspects. Con- posttreatment, and 1-month follow-up. Journal of EMDR
sequently, we recommend further research to ascer- Research & Practice, 2(3), 170–179.
tain if these positive outcomes can be replicated with Holden, C. (2010). Psychiatry. Behavioral addictions debut
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