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DeTUR TM Desensitization of Triggers and Urge Reprocessing

DeTUR TM Desensitization of Triggers and Urge Reprocessing. An Urge Reduction Protocol as A New Way to Address Addictions and Dysfunctional Behaviors Based on the AIP model of EMDR. Arnold J. Popky, Ph.D. RELAPSE MANAGEMENT. HISTORY. ASSESSMENT. REFERRALS MD MEDICATIONS.

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DeTUR TM Desensitization of Triggers and Urge Reprocessing

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  1. DeTURTMDesensitization of Triggers and Urge Reprocessing An Urge Reduction ProtocolasA New Way to Address Addictions and Dysfunctional Behaviors Based on the AIP model of EMDR Arnold J. Popky, Ph.D.

  2. RELAPSE MANAGEMENT HISTORY ASSESSMENT REFERRALS MD MEDICATIONS Addiction Treatment Model TRAINING DIAGNOSIS COMORBIDITY ISSUES DeTUR PROTOCOL OUTPATIENTINPATIENT (DETOX) JOB SKILLS SOCIAL DUAL ?? CRISIS MANAGEMENT DRUG EDUCATION SUPPORTAA, MM, RR RELIGOUS, ETC THERAPY GROUP/FAMILY HOUSING, FOOD

  3. Basis of Addictions TRAUMA DISEASE ? Genetic Chemical Modeling

  4. REM Internal Survival Mechanism COPE Daily Events CONTINUUM CONTINUUM TIME EXPERIENCE SUPPORT ADAPTIVE INFORMATION PROCESSING MODEL CUT HEAL Dysfunctional [not useful] Functional [useful]

  5. smells Trauma[Insufficient Resources] internal representations ANXIETY TRAUMA T&ts taste sounds feelings pictures body sensations

  6. SOLUTION CIGARETTES ALCOHOL DRUGS FOOD SEX ANGER ETC. tsmells Relieving Anxiety tinternal representations ANXIETY ANXIETY tsounds TRAUMA ttaste tfeelings tpictures tbody sensations

  7. SOLUTION CIGARETTES ALCOHOL DRUGS FOOD SEX ANGER ETC. internal representations t sounds Conditioned Response t ANXIETY smells pictures t t TRAUMA taste t feelings t POSITIVE REINFORCEMENT AND REPETITION ANXIETY t bodysensations

  8. SOLUTION CIGARETTES ALCOHOL DRUGS FOOD SEX ANGER ETC. tsmells Solution = Problem tinternal representations ANXIETY ANXIETY TRAUMA tsounds ttaste tfeelings tpictures tbody sensations

  9. SOLUTION CIGARETTES ALCOHOL DRUGS FOOD SEX ANGER ETC. internal representations NEWSOLUTION t sounds Polysubstance Abuse t ANXIETY smells pictures t t TRAUMA taste t t bodysensations feelings t ANXIETY

  10. ANXIETY SOLUTION CIGARETTES ALCOHOL DRUGS FOOD SEX ANGER ETC. t Trauma Reprocessed t internal representations sounds t t smells pictures t taste t bodysensations t feelings TRAUMA

  11. Addictive Population ? Gender Age Race Religion Culture Education Economic status Sexual preference

  12. Commonality DUAL+ DIAGNOSIS!!!!

  13. DeTUR • Developed through clinical experience (personal and others) • Written on Rubber • Flexible to match client’s world • Only ONE component of addiction treatment • Requires client desire and commitment • In depth use of therapeutic interweave • Utilizes therapist’s training and experience

  14. EMDR DeTUR EMDR or DeTURwhere to start EMDR DeTUR Trauma known Behavior EMDR [trauma] and/or DeTUR [relapse]

  15. Differences in Approach • Treatment goals are defined by the client • Therapeutic interventions accommodate clinician’s style and training • Individualize therapy to address core issues behind behavior • Targets triggers that bring up the urge to use [tn] • Builds coping skills • Deals with withdrawal symptoms • Addresses relapse • Ego strength enhancement • Treats all addiction behaviors as somewhat similar (alcohol, cigarettes, crack, speed, anger, gambling, sex, etc)

  16. TRAUMA Why Target Triggers vs Trauma? E G O S T R E N G T H t2 t1 tn TRIGGERS

  17. INSTALLPOSITIVE ASSESSMENT PREPARATION FOLLOW ON RELAPSE PREVENTION CLOSURE FUTURE TEMPLATE POSITIVESTATE RESOURCESTATE POSITIVEGOAL IDENTIFYTRIGGERS DESENSITIZETRIGGERS HISTORY R A P P O R T WHAT DO YOU WANT WHATWILL ITGET YOU WHATPREVENTSYOU WHATDO YOUNEED HOW WILL YOU KNOW EMPOWERMENT

  18. PAST [TE] PRESENT[TRIGGERS] FUTURE [TEMPLATE] PHASE 7 Explanation Mechanics Safe place Resource PHASE 5 PHASE 3 PHASE 1 learned/insights? BLS Incomplete? Relaxation PHASE 6 PHASE 4 PHASE 8 PHASE 2 Pic+nc+body BLS SUDS=0 *Target[TE] NC PC VOC SUD Body location EMDR Flow Chart Presenting problem NC PC Float back/affect bridge *Touchstone event[TE] FUTURE TEMPLATE DESENSITIZATION INSTALLATION PREPARATION ASSESSMENT BODY SCAN CLOSURE HISTORY VOC=7 *Target+pc BLS *Target+pc Pos or Neg BLS How would you prefer Run movie Notice snag/neg BLS Run till clear

  19. Safe Therapeutic Environment “Rapport” The foundation for trust in any relationship is rapport. It is the high level of trust the client feels with the therapist causing the safe therapeutic relationship. One of the most important characteristics of a therapist is the ability to gain trust rapidly, and to maintain it throughout the therapeutic process. Rapport gives the therapist the right to ask questions and to elicit appropriate answers. This is crucial for this for success in this model.

  20. History/Assessment • Genogram • Thinking/decision making process • Coping styles skills • Source of interweaves • Affect management • Addiction history • Safety issues • Resources: internal/external • Previous therapy • Medications

  21. Assessment • Medications? • Where to start? • AIP/EMDR - Trauma • AIP/DeTUR -Triggers • EMDR treats the client NOT the diagnosis

  22. Diagnosis • Abandonment Issues • Dissociative? How much/when • DID • EMDR treats the client NOT the diagnosis

  23. Where to start…. EMDR PROTOCOL TRAUMA IDENTIFIED PRESENTING PROBLEM TRIGGERS IDENTIFIED DeTUR PROTOCOL TRAUMA UNCOVERED

  24. Preparation • Commitment from the client and the desire to heal • Check for client safety and stability • Explanation of bi-lateral stimulation and the process • Train metaphor • Change: pictures, memories, body sensations [ Minnie mouse in Malibu] • Emotions [hill metaphor] • Stop signal • 12 step suggestions

  25. time freeze Accessing Internal Resources model someone known fictional character • Recall previous time when feeling empowered • Access fully - feed back to client • Bi-lateral stimulation to enhance (rapid =>24) • Word for auditory anchor • Check with client (non-verbals for congruence) • Test

  26. Positive Treatment Goal (PG) What do they want……..What will it get them? Theory [VISUALIZATION] • Elicited from client • Coping & Functioning • Abstinence not necessary • Positive terms • Component specifics • Within time constraints • Picture • Adjustments to enhance • BLS • Test

  27. Positive State (PS) = How will you know? • Theory • Associate with/step into [as if] • Anchoring the feelings • Build • Test • Enhance anchor w/BLS

  28. Identifying Triggers How do they know when to…… • Person • Place • Thing • Time • Emotion • Situational • Action • Smell • Taste

  29. Prioritize • The worst addiction firstCoke>Alcohol>Cigarettes • The least powerful urge (t) first • If smoking: start at the first of the day

  30. LOU0 to 10 “WHERE ARE YOU FEELING IT?” YES CHANGE “GO WITH THAT” Desensitize Triggers “WHAT ARE YOU GETTING NOW?” HOLD PICTURE & BODY SENSATION TOGETHER TRIGGER#1 BLS PICTURE CHANGE? YES ASSOCIATEDSMELLSTASTESFEELINGSSOUNDS LOU = Level of Urge BLS = Bi Lateral Stimulation

  31. CHANGEDIRECTIONSPEEDNUMBERWIDTHTAPSOUNDS Desensitize Triggers CHANGE? NO NO CHANGE “WHERE ARE YOU FEELING IT?” HOLD PICTURE & BODY SENSATION TOGETHER “WHAT ARE YOU GETTING NOW?” TRIGGER#1 LOU0 to 10 BLS PICTURE

  32. What Can Happen! • If client abreacts • If client dissociates • If client intellectualizes • If interruptions or therapist gets lost • If response changes to positive • If therapist notices change in physiology; Milton yes • If client looping • If thread opens to trauma

  33. NO CHECK LOUANDDESENSITIZE TRIGGER#1 YES “GO WITH THAT” “WHAT ARE YOU GETTING NOW?” Installation BLS POSITIVE RESPONSE? ASSOCIATEDPICTURESMELLSTASTESFEELINGSSOUNDS

  34. “GO WITH THAT” TRIGGER#1 Future Template “WHERE ARE YOU FEELING IT?” HOLD PICTURE & BODY SENSATION TOGETHER “WHAT ARE YOU GETTING NOW?” LOU0 to 10 BLS PICTURE CHANGE? YES • Install future positive state of success • Theory: Skills building to handle future triggers IMAGINE A TIME IN THE FUTURE ASSOCIATEDSMELLSTASTESFEELINGSSOUNDS

  35. Closure & Relapse • Reframing relapse (artichoke) • Continuing process • Use of support structures • Homework: Use of anchors • Emotional Freedom Techniques (EFT)

  36. Follow on Sessions • Enhance any/all successes w/BLS • Target new emerging triggers (relapse) • Work through remaining triggers

  37. ResearchSexual Compulsivity The use of the DeTUR method utilized as the primary treatment modality with 24 clients who identified sexual compulsivity as their principal treatment issue. DeTUR was utilized to access an internal resource state, install their positive goal state. and anchor it in their physiology), to desensitize known triggers to decrease the risk of relapse behavior, and access these positive resources in the future.

  38. ResearchSexual Compulsivity The subjects were selected from a client base of over 60 clients who self-reported sexual compulsivity and also met the clinical criterion for a diagnosis of sexual compulsivity using Dr. Patrick Carnes’ Sexual Assessment Screening Test (SAST).

  39. ResearchSexual Compulsivity • Group A-talk therapy only, reported a richer understanding of their sexually compulsive behaviors and also reported struggling with relapse issues due to no symptom relief. • Group B-EMDR treatment, reported a significant decrease in their SUDS, VoC, trauma profile, and an increase in their healthful living scale. They also reported struggling with relapse issues. • Group C-DeTUR treatment, reported a significant decrease in their LOU level, but did not report a significant decrease in their trauma profile or an increase in their healthful living scale. • Group D-EMDR and DeTUR treatment reported a significant decrease in their SUDS, VoC, LOU, trauma profile, and an increase in their healthful living scale.

  40. RESEARCHSexual Compulsivity RESEARCH DESIGN

  41. ResearchSexual Compulsivity • Preliminary findings appear to indicate that the use of EMDR and DeTUR are effective means in treating sexually compulsive behaviors. • Further research studies are needed to examine the use and effectiveness of EMDR, DeTUR and traditional talk therapy in the treatment of sexual compulsivity and other addictions.

  42. RESEARCHDomestic ViolenceDr. R. Bata • Conflict Tactic Scale 2 (CTS2) was administrated as pre and post test measurement scale. • Concentration was on Psychological Aggression & Physical Assault • 5 Individual sessions • Pre test was validated by police reports & history of abuse in relationships • Post test was validated by CJIC database by Domestic Violence Unit of the Distric Attorney’s Office at 1 & 2 years

  43. RESEARCHDomestic ViolenceDr. R. Bata

  44. RESEARCHDomestic ViolenceDr. R. Bata

  45. RESEARCHDomestic ViolenceDr. R. Bata After 2 years • A decrease of 45% in the number of emotionally abusive incidents • A decrease of 65% in the number of physically abusive incidents

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