EMDR and Urge Reduction (DeTUR protocol)
This blog is another installment of “EMDR can treat THAT!?”, which is essentially me documenting my own excitement and disbelief in learning yet another thing that EMDR (or Eye-Movement Desensitization and Reprocessing) can treat, in case anyone else is curious too! To be upfront about this, this particular EMDR protocol, called the Desensitization of Triggers and Urge Reprocessing (DeTUR protocol), is meant to be used as just one small part of a complete treatment model. Other elements that make this model effective, depending on each client’s individual needs, include referrals for medication, outpatient treatment, inpatient treatment, detoxification programs, etc. That being said, let’s dive right on in and see what this protocol is all about!
Successful results utilizing this model have been reported regarding concerns with:
- Addiction to chemical substances
- Disordered eating (such as compulsive overeating, anorexia, bulimia, etc.)
- Sex
- Gambling
- Shoplifting
- Anger outbursts
- OCD behaviors
- Trichotillomania
The DeTUR protocol is an urge reduction protocol, meaning it can be used for a wide variety of concerns, including the behaviors listed above, but might also be helpful for addressing anxiety, panic, phobias, and more. When combined with other interventions (such as therapy to address the root causes of the addiction, medical support, case management, etc.), this protocol serves to treat all addictions similarly, whether they are chemical addictions or behavioral addictions.
You might find yourself thinking, “Okay, I’m interested in this. What can I expect?” Great question, let me outline this for you!
TREATMENT PLANNING/PREPARATION
The treatment planning stage includes identifying and strengthening internal resources to help you shift from negative states (such as feeling powerless, helpless, out of control, etc.) to more positive states (such as empowered, calm, resourceful, powerful). This is important because it’s hard to get things done, act effectively, or move towards your goals if you’re stuck feeling like nothing you do matters, you have no power/control, etc. By accessing more positive states, you can shift yourself into other states where you feel more empowered (like when you asked for a raise and got it!), calm (like when you take that first sip of coffee in the morning), connected (like when you laughed with your friend or pet that dog you saw while walking down the street), or accomplished (like how good it felt to cross that thing off your to-do list). When you’re in these states, you feel better, more connected to your values, and you’ll find that you act more effectively!
Treatment Planning Begins
Once in this state, treatment planning begins. Your EMDR therapist will help you identify treatment goals that align with what *you* want for yourself. You and your EMDR therapist will work on identifying goals that are stated in positive terms (e.g., a goal stated in positive terms: “I want to go out with friends and feel connected, calm, safe, and fully present,” vs. negative terms “I won’t drink when I go out with friends”), are achievable, are not too far away in the future, and are motivating and attractive to you, depending on your definition of coping and functioning successfully. To build motivation and commitment to this goal, your EMDR therapist will lead you through anchoring techniques utilizing slow bilateral stimulation (BLS) to help you better understand what it would be like to actually achieve this goal.
Identifying Triggers
Next is to begin identifying triggers that bring up the urge you and your EMDR therapist are targeting. These triggers are what are preventing you from being successful and can include things like:
- People
- Places
- Times
- Emotions
- Smells
- Tastes
- Events
- Actions
- Objects
Ordering and Desensitizing Triggers
Once identified, you and your EMDR therapist will put them in order from weakest to strongest. You’ll desensitize each trigger in this order because you’ll become more familiar and confident in the process as you go and desensitization of some triggers can generalize to others, so by the time you get to the strongest trigger, it might be easier to tackle because of your growing confidence and the desensitization of earlier triggers.
DESENSITIZATION
Now that the triggers are identified, you and your EMDR therapist will start the desensitization process. Once you two settle on the trigger to address, you’ll be instructed to: bring up the sensory information that comes with that trigger, identify your level of urge (LOU) on a 0-10 scale, associate the LOU with a body location, and begin BLS. Your EMDR therapist will help you set the pace for BLS, checking in with you between each set, until you notice your LOU drops to a 0, signifying that you no longer feel the urge to engage in the maladaptive behavior in response to this trigger.
INSTALLATION
Once the LOU is dropped to a 0, your EMDR therapist will then help you install this change by connecting it to the positive state/s you two have been working on throughout this process. This helps you replace the maladaptive urge with the anchored positive state. Your EMDR therapist will then test and future check-in session by asking you to bring that initial trigger back up and asking for your LOU. If there’s any residual urge, you’ll continue to do BLS as directed by your clinician. If it’s still a 0, then you’ll install that.
At the end of the session, your EMDR therapist will remind you:
-
- That processing continues after the session ends, so you may experience thoughts, emotions, body sensations, etc. throughout the day (you also might not!).
- Utilize the relapse prevention plan you’ll already have in place if you notice urges between sessions
- Take note of any urges between sessions, as these things might be what you choose to target moving forward.
REEVALUATION
Future sessions will likely involve:
- Checking in on previously desensitized triggers and seeing if the LOU is still 0 or if this has changed, and addressing any changes as needed
- New targets of opportunity
- Any new information
- Other types of EMDR processing, if needed
Please note: if a relapse does happen, I know this would likely be upsetting (to say the least) to you, and I’ll encourage you to view this as an opportunity to address the target (whatever led to the relapse) in the next session. Relapses can, and do, happen. Learning how to balance accountability without nose-diving into shame is not easy, AND is so necessary.
I hope this brings some clarity and understanding to what the DeTUR protocol is, what you can expect in treatment if you choose to go this route, and maybe even give you some hope for what is possible for you as you start this process. I’ll be wishing you the best of luck in your journey, and if you feel ready to take the next step schedule with a therapist at CCDBT. We’d love to be a part of that process with you.