Rewiring the Addicted Brain with EMDR Based Treatment

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 Contents

Introduction

PART I
TREATING TRAUMA AND SUPPORTING RESILIENCE
CHAPTER 1 Overview of the Rewiring the Addicted Brain Treatment Model
CHAPTER 2 Getting to the Root of the Problem: Reprocessing Traumas with EMDR
CHAPTER 3 Resource Tapping for Addictions: Activating and Integrating
Resilience

PART II
TOOLS FOR AFFECT REGULATION
CHAPTER 4 The Four Foundational Resources
CHAPTER 5 Resource Tapping Tools for Managing Anxiety
CHAPTER 6 Repairing Developmental Deficits
CHAPTER 7 Resources to Lift the Spirit: Antidotes for Depression and Inertia

PART III
REWIRING THE MOTIVATION–REWARD CIRCUITS
CHAPTER 8 Spiritual Resources
CHAPTER 9 Connecting to Inner Strength
CHAPTER 10 Resources for Restoring a Sense of Inner Goodness
CHAPTER 11 Resource Tapping to Enhance Motivation

PART IV
CHANGE THE BRAIN, CHANGE THE BEHAVIOR
CHAPTER 12 Defusing and Deactivating Urges and Triggers
 CHAPTER 13 The Connecting the Consequences Protocol

PART V
PUTTING IT INTO PRACTICE: CASES
CHAPTER 14 Using Attachment-Focused EMDR, Resource Tapping Techniques,
and the Connecting the Consequences Protocol to Work with a Young
Man Struggling with Shame and Alcohol Addiction
by Elena Felder, LMFT
CHAPTER 15 Using the Bridging Technique to Find the Early Roots and Triggers of
a Male Client Who Binges on Alcohol and Has Early Attachment
Deficits
by Constance Kaplan, LMFT
CHAPTER 16 Using Attachment-Focused EMDR, Resource Tapping, and
Connecting the Consequences Protocol to Treat a Woman with Life-
Threatening Diabulimia
by Julie Probus-Schad, LCSW

Concluding Thoughts
Resource Tool Kit
Acknowledgments
Notes
Index
 Introduction
Why do you stay in prison when the door is so wide open?
—RUMI

I have spent my 30-year career as a clinical psychologist working with

people who have experienced trauma. I have worked in clinics serving low-
income children, youth, and adults, as well as in private practice, treating
clients with a range of presenting problems. I have trained thousands of
therapists worldwide in the trauma therapy, Eye Movement Desensitization
and Reprocessing (EMDR) and provided consultation on thousands of cases.
Through all my work with traumatized people, I have noted the co-
occurrence of trauma and substance use and abuse and addictive disorders. I
have seen how people who have experienced trauma from abuse, neglect,
poverty, divorce, loss, and discrimination often turn to substances or
behaviors to help manage unmanageable feelings. People raised in unstable
families where parents or caregivers struggle with addiction or trauma may
not have their early attachment needs met in a way that allows them to
develop a secure sense of self and the capacity to soothe themselves when
distressed. As they grow into adolescence or early adulthood and discover
that substances or behaviors provide short-term symptom relief, they fall into
addictive patterns.
Addiction can also develop in people without histories of trauma. They
may have a genetic vulnerability or become addicted to a medication
originally prescribed for pain or attention deficit disorder.
Effective treatment of addiction requires a holistic approach that takes
into consideration its underlying causes and current behaviors and patterns.
Techniques to aid in emotional regulation as well as attachment repair are
required. Methods derived from what I call Attachment-Focused EMDR and
Resource Tapping can yield excellent results in a milieu that has proven very
difficult to treat with more traditional approaches.

WHY THE NEED FOR THIS BOOK?

Most of us in the United States have friends or family members who struggle
with addictions or addictive disorders. Some of us may struggle with such
addictions ourselves. The pain and impact of these disorders is tremendous.
Over the years, I have been frustrated with what I have observed to be a
limited approach to the treatment of addictions that does not adequately take
into consideration the complexity of each person’s situation and the drivers
for their behaviors. In my opinion, addiction treatment’s one-size-fits-all
approach has not kept up with what we know about addiction itself, or what
we know about brain science, trauma, and disordered attachment.
Rewiring the Addicted Brain with EMDR-Based Treatment is my attempt
to create a brain-wise, compassionate, resilience-supporting approach to the
treatment of addictions that I wish my family members and all others
struggling with addictions could access. Therapists and substance abuse
counselors can use this as a guidebook to help them navigate the difficult and
complex terrain of addiction treatment—one that recognizes and addresses
trauma and integrates repair of attachment deficits. With this guidance, I
believe many more people can be effectively helped and can then go on to
live fuller, more fulfilled lives.
Because I wanted to reach as large a group of therapists as possible, I
chose to write a book that is not primarily for EMDR-trained clinicians. This
book was written for therapists, substance abuse counselors, and laypeople
seeking user-friendly tools to help support themselves in recovery. It is full of
EMDR-based techniques that can be easily integrated into all levels of
addiction treatment.

Distinctions: EMDR and Resource Tapping

EMDR is a powerful trauma therapy that is only taught to licensed mental health
practitioners. It can open up deep emotions and dissociated early memories for which
clinical experience and advanced skills and training are required. Most of the counselors
working in the field of substance abuse are not licensed mental health professionals and
so would not qualify to be trained in EMDR.
 Many EMDR-trained therapists have found that an EMDR-related technique called
Resource Tapping can be helpful in the treatment of addictive disorders. These therapists
who use Resource Tapping report reductions in their clients’ craving for substances and
their anxiety levels, in addition to an increase in self-esteem—even without the use of
EMDR to reprocess the traumas. In many cases, the therapists never needed to employ
the more intensive and demanding EMDR trauma-processing work, as the client’s
symptoms cleared with the use of Resource Tapping alone. I wrote Tapping In to support
non-EMDR therapists and laypeople in using this simple technique.
Though this book focuses primarily on integrating Resource Tapping techniques into
the treatment of addictions, I also include ways EMDR can be employed, and certain
sections of the book will apply more to those trained in EMDR. For those without EMDR
training, it will still be useful to help all readers understand how this therapy might be
beneficial—where a referral to an EMDR therapist would make sense.

HOW THIS BOOK IS ORGANIZED

The emphasis in Rewiring the Addicted Brain with EMDR-Based Treatment
is on the practical clinical application of principles and techniques helpful for
addictions and addictive disorders. Case material is interwoven throughout
the text; also included are chapters presenting in-depth cases that illustrate the
techniques. These cases include history and background on the clients as well
as actual sessions employing the interventions specific to rewiring the
addicted brain. Also included in the case history chapters are details on the
rationale for the interventions used, information about the effects of those
interventions, and context around the overall course of treatment.
I have been teaching and presenting the material in this book for many
years and use it in my clinical practice. The protocols and Resource Tapping
techniques presented here evolved over several years, based on trial and error
and feedback from therapists I have taught. I am always interested in what
works, as well as in new ideas. I am deeply grateful to all of the talented
clinicians who have shared with me their experiences with their clients so that
I can share them with you.
Many people struggling with addictions know all they need to know
about overcoming them. They’ve been to meetings and treatment. They’ve
read self-help books. They know so much about it that they could teach a
class or give someone else great advice, yet they have difficulty applying
what they know to their own lives and addictions. This, of course, is not
because they are in denial; rather, it is because the part of the brain that has
all of this information is not linked up with the part that is driven by the
urges. There is a lack of communication in the brain. They know, but part of
them doesn’t know. It’s like a powerful race car that can’t get into gear to
move out of the garage and onto the road. The potential is there without the
means to utilize it.
Therapists can help clients actualize this potential for change.
Rewiring the Addicted Brain with EMDR-Based Treatment is divided into
five parts. You will find tools and techniques for supporting clients in
addiction recovery in all five parts.

PART I: Treating Trauma and Supporting Resilience,

is comprised of three
chapters: Chapter 1, “Overview of the Rewiring the Addicted Brain
Treatment Model,” Chapter 2, “Getting to the Root of the Problem:
Reprocessing Traumas with EMDR,” and Chapter 3, “Resource Tapping for
Addictions: Activating and Integrating Resilience.” These chapters provide
groundwork and rationale for specific techniques described in subsequent
chapters.

PART II: Tools for Affect Regulation,has four chapters, each of which
provides information and specific tools for managing difficult emotions
associated with addictions. Chapter 4, “The Four Foundational Resources,”
explains what those foundational resources are, how they can be tapped in,
and how they can be integrated into addiction treatment. Chapter 5,
“Resource Tapping Tools for Managing Anxiety,” provides resources that
clients and therapists can use to decrease anxiety, which is a major
contributor to relapse for clients in recovery. Chapter 6, “Repairing
Developmental Deficits,” provides resourcing ideas to aid repair of damage
resulting from childhood abuse and neglect. Chapter 7, “Resources to Lift the
Spirit: Antidotes for Depression and Inertia,” offers helpful Resource
Tapping techniques for clients who have an underlying depression fueling
their addiction.

PART III: Rewiring the Motivation–Reward Circuits,

provides Resource Tapping
techniques to help shift neural circuitry away from patterns conducive to
addictive behavior. Chapter 8, “Spiritual Resources,” provides several ideas
for helping clients discover, connect with, and reinforce a sense of something
larger than themselves. Chapter 9, “Connecting to Inner Strength,” provides
Resource Tapping ideas for helping clients integrate and embody their own
inner strength to support themselves in recovery. Chapter 10, “Resources for
Restoring a Sense of Inner Goodness,” aims to help heal the sense of shame
felt by many people who have struggled with addiction. This chapter
provides Resource Tapping protocols that support clients in bringing light to
inner darkness and increasing motivation to stay the course of recovery.
Chapter 11, “Resource Tapping to Enhance Motivation,” provides several
techniques to help clients focus on and remain motivated about goals.

PART IV: Change the Brain, Change the Behavior, provides protocols and
techniques to help defuse and deactivate triggers for addiction and also to
disrupt the reinforcement circuit that serves to maintain addictive patterns.
This section has two chapters: Chapter 12, “Defusing and Deactivating Urges
and Triggers,” contains several Resource Tapping techniques that can be
easily applied, as well as guidance on the use of the Bridging Technique to
get to the root incidents that link to the trigger—at which point, these
incidents can be reprocessed with EMDR. Chapter 13, “The Connecting the
Consequences Protocol,” introduces a new protocol for disconnecting the
addiction-reward circuitry and rapidly reducing addictive behavior.

PART V: Putting It into Practice: Cases,shares the experiences of three

talented therapists trained in Attachment-Focused EMDR and the addiction
protocols described in the previous chapters. These case study chapters may
be of special interest to therapists trained in EMDR as they demonstrate how
EMDR, Resource Tapping, and other EMDR-oriented protocols can be used
in the treatment of addictions. As these clinicians describe how they have
used the tools and techniques with their clients, readers can see how the
material introduced in this book might look in actual clinical practice.
Chapter 14, by Elena Felder, LMFT, describes the use of the Bridging
Technique to find triggers of a male alcoholic client with early attachment
issues. Chapter 15, by Constance Kaplan, LMFT, describes a case in which
Attachment-Focused EMDR and Resource Tapping techniques were used in
the treatment of binge drinking. In Chapter 16, Julie Probus-Schad, LCSW,
examines the use of Attachment-Focused EMDR, Resource Tapping, and the
Connecting the Consequences Protocol in treating a woman’s life-threatening
diabulimia.

HOW TO USE THIS BOOK

This book does not need to be read chapter by chapter; think of it as a tool kit
for supporting clients in addiction recovery. Search for the tool that might
most help your client at a given time. For example, if your client is struggling
with overwhelming anxiety, you might decide to begin with Chapter 5,
“Resource Tapping Tools for Managing Anxiety.”
Or imagine you have a client who is in recovery for alcohol addiction, is
attending AA, and has completed a 30-day residential treatment program. She
is emotionally fragile and struggling to stay sober. You might begin with
tapping in her foundational resources (Chapter 4) and then add in resources to
help strengthen and motivate her (Chapters 8 through 11). You might tap in
inner strength and even a dream team of addiction-support figures (Chapter
10). You could ask her to imagine herself in a future where she is strong,
healthy, and living a sober life, and then add BLS to better integrate that
information.
You might have a client who grew up with parents who struggled with
addiction and were unable to meet his basic attachment needs. Because of
this, he feels empty inside and lacks the capacity for emotional regulation.
This client may need to create and imagine parents who are able to provide
him with stability and physical and emotional safety—who are capable of
showing him love and meeting his developmental needs. The client can
imagine growing up in a home with these ideal parents to help him heal his
developmental deficits (Chapter 6).
You may have a client who was abused as a child and began to drink as a
way to keep troubling memories from surfacing and to manage fear and
anxiety. This client may need to tap in the four foundational resources. Then,
when the client is ready, the therapist can use EMDR to reprocess the abuse
memories that are activating the desire to drink. In all of these examples, we
are assessing the needs of the individual clients to find out what they need
first for support in recovery.
It may be that they need to begin with the foundational resources or to
immediately use the Connecting the Consequences protocol to disrupt the
trigger-addiction circuit. Some may need to use EMDR to address trauma
early in treatment because the trauma is driving their addiction. In many
cases, just beginning with the four foundational resources can make a big
difference in decreasing distressing emotions and providing clients with
something they can do to help themselves.
 CONVENTIONS USED THROUGHOUT THIS BOOK

I have used fictitious names for clients throughout the book. (I prefer the term
client to patient.) All identifying details of cases have been changed to
protect clients’ privacy. I have changed names, professions, family
constellations, ethnicities, and specific life events. Some cases represent
composites of more than one client. All clients are referred to by first names,
which I feel creates a more personal feeling about the people whose lives I
describe. Some case examples in the book are my clients; others are clients of
my EMDR colleagues.
In sections about particular cases where EMDR sessions are being
described, a device called the Tac/Audio Scan is used. The Tac/Audio Scan
has small pulsers clients hold in their hands or place under their legs that
vibrates alternately and also has headphones that emits a tone in either ear.
Some clients prefer both the sound and tactile stimulation together
synchronized, or choose either the sound or the vibrating pulsers. Some
people prefer human contact, or to provide their own bilateral stimulation by
alternate tapping on the sides of their legs or knees.

DEFINITION OF TERMS

Bilateral Stimulation (BLS)

BLS is the use of alternating right-left stimulation such as tapping on the
knees, legs, or shoulders; tapping toes or feet on the floor; or alternating eye
movements. Therapists also use a small portable device the size of a
Walkman called the Tac/Audio Scan which produces auditory and tactile
stimulation. BLS is used to activate and integrate information from the
brain’s two hemispheres.

Addiction
Addiction is a condition in which a behavior that can function both
to produce pleasure and to reduce painful affects is employed in a
pattern that is characterized by two key features (1) recurrent
failure to control the behavior, and (2) continuation of the behavior
despite significant harmful consequences.
 —A GOODMAN, 20081

ADDICTIVE PROCESS
This is the term used to designate:
[T]he underlying biopsychological process that addictive disorders
are hypothesized to share. It can be defined operationally as an
enduring, inordinately strong tendency to engage in some form of
pleasure-producing behavior in a pattern that is characterized by
impaired control and continuation despite significant harmful
consequences. The class of addictive disorders includes
psychoactive substance addiction, bulimia, pathological gambling,
shopping or buying addiction, sexual addiction, and other enduring
conditions in which a behavior that can function both to produce
pleasure and to reduce painful affects is employed in a pattern that
is characterized by two key features: (1) recurrent failure to
control the behavior, and (2) continuation of the behavior despite
significant harmful consequences.
—AVIEL GOODMAN, 20082

Eye-Movement Desensitization and Reprocessing (EMDR)

EMDR is a powerful and effective therapy for the treatment of trauma. It
incorporates eye movements or other bilateral stimulation (BLS) into a
comprehensive approach that processes and releases information trapped in
the mind and body, freeing people from disturbing images and body
sensations, debilitating emotions, and restrictive beliefs. This revolutionary
therapy has helped millions of people of all ages recover from such traumas
as war, accidents, assaults, disasters, and childhood abuse. EMDR has been
extensively researched as a treatment for post-traumatic stress disorder
(PTSD) and is considered to be an evidence-based therapy.
In addition to the treatment of PTSD, EMDR is also used to treat the
psychological effects of smaller traumas that manifest in symptoms of
depression, anxiety, phobias, low self-esteem, creativity blocks, and
relationship difficulties. Not only does healing occur much more rapidly than
in traditional therapy, but as a result of EMDR’s clearing of emotional and
physical blockages, many people also experience a sense of joy, openness,
and deep connection with others. EMDR is a quantum leap in the human
ability to heal trauma and maladaptive beliefs.
EMDR is based on the idea that negative thoughts, emotions, body
sensations, and behaviors are the result of unprocessed memories. The
treatment involves procedures that include focusing simultaneously on (1)
spontaneous associations of traumatic images, thoughts, emotions, and bodily
sensations and (2) BLS. Although EMDR therapy has been fully validated
only for PTSD, numerous research studies are underway to evaluate its
applications to a wide range of disorders. Excellent results have already been
achieved with myriad diagnoses. In addition to the reduction of symptoms
and the strengthening of adaptive beliefs, the client’s experience of self and
others typically shifts in ways that allow the person to respond in a healthier
way to current and future life demands.

Attachment-Focused EMDR
Attachment-Focused EMDR (AF-EMDR) is an approach to EMDR therapy
that I developed and described in my 2013 book, Attachment-Focused
EMDR: Healing Relational Trauma. AF-EMDR is client-centered and
emphasizes a reparative therapeutic relationship using a combination of (1)
Resource Tapping to strengthen clients’ resources and repair developmental
deficits, (2) EMDR to process traumas, and (3) talk therapy to help integrate
the information from EMDR sessions and to provide the healing derived from
therapist-client interactions.
AF-EMDR extends the use and benefits of EMDR and BLS for use with
clients who have been typically less responsive to traditional EMDR
protocols due to acute or chronic relational trauma and attachment deficits.
Those deficits include the effects of childhood physical or sexual abuse,
neglect, early losses, birth trauma, medical trauma, parental substance abuse,
lack of caregiver attunement, secondary trauma, and the cumulative effects of
all of these factors. These clients often present in therapy as depressed, with
relationship difficulties or problems at work. They don’t feel fully alive.
Childhood trauma has impacted their sense of safety and capacity to form
close, emotional relationships in adulthood.
Attachment-Focused EMDR has five basic principles:

1. It emphasizes the importance of safety.

 2. It is client centered.
3. The therapeutic relationship is fundamental.
4. A modified form of EMDR is used.
5. It employs Resource Tapping for ego strengthening, affect tolerance,
and the repair of developmental deficits.

Resource Tapping
Resource Tapping is an EMDR-related technique that is effective and easy to
use for ego strengthening, affect regulation, and stress reduction. Resource
Tapping uses imagination to activate inner resources, which are then paired
with bilateral stimulation to strengthen and integrate the resource. This
technique can be used to help rebalance the nervous system, activate the
parasympathetic restoration cycle, and teach self-regulation. This mind-body
technique can be interwoven throughout the course of treatment and taught to
clients to help with:

• anxiety and depression

• sleep problems
• triggers
• strong emotions such as fear, anger, shame, and sadness
• motivation
• addictive urges
• self-esteem

Resource Tapping can be used to prepare and strengthen clients prior to

initiating emotionally intensive trauma-processing work such as EMDR, to
help manage symptoms between EMDR sessions, to repair developmental
deficits, and as a stand-alone technique with many applications. As
previously mentioned, it can be used by therapists and counselors not trained
in EMDR and can be taught to clients for self-use to regulate their emotions
and help with symptoms. Resource Tapping can also be used with couples or
in groups.

Resources
Resources are people, places, images, qualities, memories, and experiences—
real or imagined—that we can draw upon to develop resilience. Resources
may include inherent qualities such as love, wisdom, and joy.

Tapping
Tapping is the use of alternating BLS (right-left, right-left), which may
include tapping on the knees, legs, arms, or shoulders, as well as alternating
eye movements.

Tapping In Resources
Tapping in resources refers to the pairing of an activated resource with
tapping or bilateral stimulation.. For instance, to tap in the resource of a
Peaceful Place, imagine a place where you feel a sense of peace, such as a
beach. When you can imagine the beach and feel peacefulness, alternately tap
right-left, right-left for at least 6 to 12 sets. Tapping serves to strengthen and
integrate the feeling of the resource so that it becomes more easily available.
REWIRING THE ADDICTED BRAIN
WITH EMDR-BASED TREATMENT
 PART I

TREATING TRAUMA AND

SUPPORTING RESILIENCE

CHAPTER 1
Overview of the Rewiring the Addicted Brain Treatment Model
CHAPTER 2
Getting to the Root of the Problem: Reprocessing Traumas
with EMDR
CHAPTER 3
Resource Tapping for Addictions: Activating and Integrating
Resilience