EMDR therapy for the treatment of sex and porn addiction

EMDR is a therapy that can be very effective in the treatment of sex and porn addiction.

In this blog post, we will explore the use of EMDR (Eye Movement Desensitization and Reprocessing) therapy in the treatment of sex addiction. We will discuss the core principles of EMDR, how it targets traumatic memories, and its effectiveness in alleviating symptoms related to trauma. Additionally, we will delve into the complex nature of sex addiction, its link to childhood trauma, and the role of EMDR in addressing underlying trauma and promoting healing. We will also explore various addiction protocols within EMDR, such as DeTUR, LOUA, CraveEx, and FSAP, and how they can be utilized in the treatment of sex addiction.

EMDR

EMDR is a therapeutic approach developed by psychologist Francine Shapiro in the late 1980s. It combines elements of cognitive behavioral therapy (CBT) with bilateral stimulation techniques. The primary goal of EMDR is to alleviate distressing symptoms associated with traumatic experiences, phobias, anxiety, and other emotional disturbances.

The core principle of EMDR is that traumatic memories can become “stuck” in the brain, leading to ongoing distress and negative beliefs. Through a structured protocol, EMDR helps individuals process and integrate these memories, allowing for adaptive resolution and healing. During a session, the therapist guides the client through bilateral stimulation techniques while focusing on the traumatic memory. This stimulation facilitates reprocessing, enabling the development of more positive beliefs. EMDR is recognized as an evidence-based therapy for trauma-related conditions and can be valuable in addressing underlying trauma and emotional distress in the context of sex addiction.

Mental health professionals use EMDR to treat unresolved emotional trauma using sensory stimulation, including changing lights, gentle buzzing from handheld paddles, or sounds heard through headphones. These sensory inputs switch back and forth from the right to the left side while the client thinks about traumatic memories.

EMDR targets the way people’s brains store memories, thoughts, feelings, and bodily sensations. By doing this, EMDR can get to the root of clients’ struggles with those memories, thoughts, and feelings.

Sex addiction

Sex addiction is a condition that affects approximately 4% of the population, with higher rates among men (8%) compared to women (2%). The consequences of sex addiction can be severe, impacting relationships, finances, careers, and causing psychological distress, including suicidal thoughts. Despite its prevalence and impact, effective treatment for sex addiction remains elusive.

The term “sex addiction” has been a subject of controversy within the medical community. Some argue that it is a shaming label that pathologizes normal sexual behavior, while others believe it accurately describes a compulsive and addictive behavior. Alternative frameworks, such as hypersexuality disorder (see Aviel Goodman, Martin Kafka, Rory Reid), out-of-control sexual behavior model (Douglas Braun-Harvey), or problematic sexual behavior (Bill Herring) have been proposed, but none are perfect. In 2018, the ICD-11 included CBSD as an official diagnosis.

Childhood trauma has been identified as a significant factor in the development of sex addiction. Studies have shown that a high percentage of individuals with sex addiction experienced emotional or physical abuse during childhood or adolescence. Trauma affects brain development, leading to structural disruptions that make individuals vulnerable to addiction. Other adverse childhood experiences, such as neglect, loss of a parent, witnessing violence, or having a family member with a mental illness, can also contribute to addiction issues.

The link between sex addiction and trauma can be attributed to the need for escapism. Individuals who have experienced abuse or abandonment as children often internalize their emotions and seek ways to escape from their pain. Sex and other addictive behaviors provide temporary relief, but ultimately lead to feelings of shame, anger, and sadness, perpetuating the cycle of sex addiction.

Treatment for sex addiction typically involves therapy, support groups, and addressing underlying trauma. However, research on effective treatment options is limited, with only a small percentage of peer-reviewed articles focusing on treatment in the past decade.

Healing Trauma in Sex Addiction Clients using the standard EMDR Protocol

(take the charge off)

(root cause)

EMDR therapy is most associated with the standard protocol that is very effective for healing trauma. This section will cover traditional EMDR. EMDR Addiction protocols will be covered separately in this article. It’s important to understand the link between trauma and sex addiction. This relationship helps explain why people use behaviors that feel good to cope with traumatic emotions. By treating trauma in sex addiction clients, we are attempting to get to the root cause of the addiction. Gabor Mate famously said “we don’t ask ‘why the addiction?’, we ask ‘why the pain?'”

EMDR consists of eight phases, with the first three focusing on identifying the issues to be addressed and explaining the process. The next three phases, known as EMDR bilateral stimulation, are the active part of therapy. This involves stimulating both sides of the brain, through eye movement, auditory signals, or physical tapping, to process traumatic memories and difficult emotions in a different way. By doing so, EMDR aims to replace negative thoughts and emotions with more positive ones. The goal is to take the sting, take the charge off of traumatic memories. We don’t erase the memory, but now when they come up, we can stay in our Window of Tolerance.

In the context of sex addiction, EMDR can help clients process traumatic events or memories related to their addiction. By addressing these memories and the negative core beliefs that often accompany them, EMDR can provide relief from distressing symptoms and break the cycle of self-sabotaging behaviors.

A 2007 study by Ruth Cox and Michael Howard highlights the success of EMDR in treating sex addiction. They describe a case through EMDR, the client was able to confront and challenge irrational beliefs, leading to a shift in perceptions of self and the world. This ultimately resulted in a reduction in addictive behaviors and a sense of peace and self-acceptance.

EMDR is an evidence-based therapeutic practice with numerous research studies showing the effectiveness of alleviating symptoms related to trauma. Because trauma is so often an underlying root cause of sex addiction behavior, standard EMDR protocol can be very helpful in treatment of sex and porn addiction.

Though it’s well known that EMDR does help heal trauma, it’s not clearly understood why. Two common theories:

1. EMDR heals trauma by targeting the sub-cortical brain where traumatic memories are stored and activating the limbic brain through bilateral stimulation (BLS). This process integrates different sides of the brain and builds neuroplasticity, allowing for the reprocessing and integration of traumatic experiences. As Bessel van der Kolk, renowned trauma expert, explains, “EMDR appears to access information that is not ordinarily available to the conscious mind by activating the limbic system, EMDR helps to integrate traumatic memories into the larger neural network, thus diffusing their emotional intensity.” This integration of traumatic memories and emotions is crucial for healing and overcoming the distressing symptoms associated with trauma.
2. EMDR heals trauma through a form of exposure therapy, allowing individuals to confront and process distressing memories in a safe and controlled manner. As trauma expert Peter Levine explains, “EMDR seems to be similar to exposure therapy in that it allows the person to confront the traumatic memory… but it does so in a way that allows for the dual awareness of the present moment and the traumatic past.” By gradually exposing individuals to their traumatic memories while providing bilateral stimulation, EMDR helps to desensitize and reprocess these memories, reducing their emotional intensity and allowing for healing to occur.

Resourcing

EMDR helps clients develop internal resources to cope with distress and make healthier choices. The resourcing phase in EMDR therapy involves identifying and instilling coping skills to help individuals deal with difficult reactions. Some common resources used in EMDR include the Butterfly Hug, Safe/Calm/Healing Place, Container, Nurturing Figure(s), Protective Figure, Coherent Breathing, Mindfulness Exercises, and Parts Work.

The Butterfly Hug involves crossing your arms over your chest and gently tapping your hands on your body, while observing thoughts, images, and sensations without judgment. The Safe/Calm/Healing Place resource asks individuals to imagine a safe and calming place, using bi-lateral stimulation to strengthen the association. The Container resource involves visualizing a container to store upsetting thoughts and feelings. Nurturing Figure(s) and Protective Figure resources involve imagining nurturing and protective figures to provide support during distressing times. Coherent Breathing and Mindfulness Exercises help regulate breathing and promote present-moment awareness. Parts Work involves connecting with one’s inner child to foster insight and self-compassion.

These resources are tapped in using BLS to strengthen the resource. The resources are intended to be recalled outside of therapy sessions to maintain emotional stability and cope with distressing emotions, thoughts, and sexual urges.

The Ideal Parent Figure (IPF) method is a powerful tool in the treatment of attachment insecurity in adults. It involves visualizing ideal parent figures that provide the support and encouragement needed for healing and growth. The IPF method is based on the five qualities of secure attachment: felt safety, a sense of being seen and known, felt comfort, a sense of being valued, and felt support for fostering self-development. Over 90% of clients seeking treatment for sex addiction have insecure attachment. In fact, sex and porn addiction can be seen as a maladaptive attempt to seek connection.

The IPF method has been found to be effective in improving the quality of life for individuals with childhood trauma and Complex Post Traumatic Stress Disorder (CPTSD) symptoms. It helps change representational models and promotes regulation and healing. In sex addiction recovery, addressing attachment insecurity through the IPF method can lead to freedom from addiction and improved mental health. By achieving secure attachment, individuals can develop healthier relationships and align their sexual behavior with their values. Combining attachment repair work with behavioral change programs can optimize progress in recovery.

Addiction Protocols

A major aspect of EMDR related to sex addiction recovery is the specific addiction related protocols. These protocols use the power of bi-lateral stimulation and the traditional pattern of EMDR but focus on reinforcing or desensitizing specific behavioral patterns related to the addiction cycle. This article will review the major EMR addiction protocols.

DeTUR

The DeTUR treatment approach is an EMDR protocol developed by A.J. Popky to treat both chemical and behavioral addictions. It focuses on directing the client’s attention towards a positive, achievable goal rather than away from negative behaviors. The protocol does not require full abstinence as a goal, but rather focuses on helping the client cope and function in a positive manner according to their own description.

In the initial phase of DeTUR, the therapist helps install resources. This is followed by the formulation of a positive treatment goal that is attractive, achievable, and has a strong magnetic pull for the client. The therapist then helps the client fully associate with the positive state associated with the goal and anchors it into their physiology using physical and auditory representations.

The next step is the key phase in DeTur. In this step, the client identifies the triggers that bring up the urge to engage in the addictive behavior. These triggers can be places, people, times, emotions, smells, tastes, events, actions, or objects associated with the addiction. Then each trigger desensitized using using bilateral stimulation (eye movements, tapping, and/or sounds). At certain cues, the therapist checks to see if the level of urge (LOU) associated with the trigger is decreased.

Once the triggers have been desensitized, the therapist installs the positive state as the response to the triggers. This is done by applying the anchor touch and performing BLS while the client focuses on the triggering incident. The goal is to replace the learned dysfunctional response with the positive response that has been anchored and set into the client’s physiology.

The treatment concludes with testing the installations by having the client bring up the triggers again and checking the LOU. If there are any remaining urges, the desensitization process is repeated.

A study performed by Alex Spence and Charles Walker found that combining standard EMDR protocol for trauma with DeTUR was more effective in managing compulsive sexual behavior than comparison groups that just had one of the other protocol or a group that was treated with traditional talk therapy.

Source: Popky, A. J. (2005). DeTUR, an urge reduction protocol for addictions and dysfunctional behaviors. EMDR solutions: Pathways to healing, 167-188.

Jim Knipe’s LOUA Protocol

Jim Knipe’s level of urge avoidance (LOUA) treatment is another powerful EMDR intervention for addictions. Addictive behavior, especially porn and sexual compulsive behavior, is often used as an escape to avoid negative emotions. The LOUA treatment focuses on targeting avoidance behaviors that are often present in addictive disorders. Avoidance is a psychological defense mechanism that aims to protect individuals by minimizing or excluding from awareness disturbing memories or realizations. It can be direct and conscious, such as a decision to not think about something, or more subtle and unconscious.

The LOUA method involves identifying the representative visual image of the avoidance and scaling the intensity of the urge to avoid on a 0-10 scale. The therapist then guides the client through sets of bilateral stimulation (BLS) while focusing on the image and the urge to avoid. The goal is to reduce the urge and change the motivation to continue avoiding.

A part of the LOUA protocol is the “What’s good about…?” method. This method is effective when there is a dissociated part of a memory and overwhelming negative affect. By exploring what is good about not having the memory or avoiding it, clients can gain a sense of control over the avoidance and strengthen their emotional protection. This method can be used in conjunction with BLS to reduce anxiety and increase the client’s ability to process the memory.

CraveEx

CravEx, a protocol developed by German Pyschiatraist Michael Hase, specifically targets the addiction memory (AM) to reduce cravings and urges. The AM is a memory that contains a general memory of loss of control and a drug-specific memory of drug effects. Reprocessing this memory through EMDR can lead to measurable changes in addiction symptoms.

CraveEx is most similar to DeTUR. It is a way to help reduce the power of urges and cravings. Both use the Level of Urge (LoU) as the measurement instead of the traditional Subjective Units of Disturbance (SUDs) scale in standard EMDR.

Like the other protocols, CravEx consists of several steps, including history taking, preparation, assessment, desensitization, installation, body scan, closure, and reevaluation. The protocol is particularly useful for targeting the last urge or relapse while it is fresh in the client’s mind. CravEx is popular in drug treatment centers in Europe.

Feeling State Addiction Protocol (FSAP)

The Feeling State Addiction Protocol (FSAP), developed by Robert Miller, is a modified form of EMDR that is used in the treatment of addictions. It is based on the Feeling-State Theory of Addictions, which suggests that the feeling-states associated with addictions arise from intensely positive events and create positive, if rigidly applied, beliefs. The FSAP modifies the standard EMDR protocol because trauma and addictions arise from different kinds of events and have different underlying beliefs.

The Feeling-State Theory of behavioral addiction states that people create addictions when positive feelings become associated with specific objects or behavior. The link between emotion and behavior is a “feeling-state.” When that feeling-state triggers, the person uses the behavior to cope. After doing this repeatedly, an addiction forms.

The FSAP focuses on identifying and resolving the feeling-states that underlie the addictive behavior. For example, a client struggling with sexual compulsivity may form the belief “I am desired” when engaging in a sexual conquest and this belief becomes embedded in the feeling-state associated with illicit sexual behavior or even pornography consumption. The negative beliefs that underlie the compulsion are often covered up by the positive feelings generated by the feeling-state, making them difficult to identify. However, once the feeling-state is resolved, the negative beliefs emerge and can be more easily identified.

The FSAP targets the underlying feeling-states and aims to unblock the state-dependent memory associated with the addiction. This can lead to a transformation in the individual’s thought processes and a reduction in the intensity of the addictive behavior. The FSAP treatment is often brief, lasting around five to six sessions, and has shown promising results in reducing addictive behaviors.

The desired feeling linked to the behavior is the true goal of the addictive behavior, and the behavior itself is just a means to achieve that feeling. For example, a person may engage in sexual behavior to seek approval from others, rather than simply seeking sex itself. It’s the “approval” the person wants and what the subconscious is driving to get not the sex. By targeting the exact behaviors and feelings that compose the feeling-state, the FSAP can effectively address the underlying issues driving the addictive behavior.

By unblocking the state-dependent memory and addressing the core issues driving the addiction, the FSAP has shown promise in reducing addictive behaviors and promoting long-term recovery.

Miller shares a case study of a man named Jon who struggled with both gambling and sex addictions. During therapy, it was discovered that Jon’s gambling addictions were driven by the feeling-states of excitement, importance, winning, relaxation, and comfort. Similarly, his sex addictions were fueled by the feeling-states of excitement, importance, relaxation, intimacy, and connection.

As a result of the therapy intervention, Jon experienced a significant reduction in his desire to gamble and visit strip clubs and massage parlors. He was able to let thoughts of gambling pass through his mind without feeling compelled to act on them. Jon also stopped going to strip clubs and massage parlors, effectively breaking the cycle of his sex addictions. Jon reported that “the result of the FSAP technique is amazing. I have no desire to gamble whatsoever. It has been lifted completely.” He also reported the ability to manage his sexual addiction.

Future State

The Future State Template is a standard element of several of these protocols, including basic trauma-focused EMDR. I use a special variation of the Future State Template taught by my CSAT supervisor Dr. Matthew Hedelius.

I like to have my clients write out about a half to full page of a scene of how they would handle a very strong urge. In this scene, they would imagine the trigger, imagine how it feels in the body, imagine the thoughts forming in their head to want to act out. Then they would imagine all the important reasons they have not to act out. They would imagine what they would do to handle the urge. For example, they would do a RAIN meditation technique, or they would do Urge surfing, or they would talk to their parts. Then perhaps they would do some type of self-care to meet the underlying need. They might make a connection by calling their spouse, or a friend or sponsor. Then they would imagine how good they feel they decided not to act out and notice in the body how that feels. They write up a very detailed scene like that, and we tap it in with BLS.

EMDR, IFS, and the Two Hand Interweave

I love EMDR, but I am an IFS-first therapist. Internal Family Systems (IFS) is another effective therapy in treating sex addiction. Developed by Dick Schwartz in the 1980s, IFS views the human psyche as comprising different parts. In IFS, the goal is to cultivate the Self and allow it to heal the wounded parts. In sex addiction, there is often a harsh inner critic opposed to an extreme acting-out part. The addiction/shame cycle is a struggle for control between these two polarized parts. The therapeutic process in IFS involves listening to and validating the parts, nurturing and appreciating them, updating them, and exploring alternative options. This process allows for integration and healing within the system.

IFS and EMDR working together can be very powerful. A way I like to integrate IFS and EMDR is with the two-hand interweave technique. Let’s use a typical example for this. The client has a part that wants to watch and has another part that hates porn and the consequences it brings. I will have the client hold out both hands and imagine one part and all its thoughts and emotions and body sensations in the right hand and the other part in the left hand. Then we do BLS and the client notices what comes up. This can be a powerful way to augment traditional IFS therapy.

EMDR and Betrayal Trauma

EMDR is very powerful to use with betrayed partners. Julie Terry is an EMDR-trained therapist that specializes in betrayal trauma. She uses standard EMDR for processing the acute trauma the client experiences due to recent relationship betrayal. She also finds it very helpful in most cases to process childhood trauma that might be still lingering which exacerbates relationship trauma.

Conclusion

EMDR is a valuable therapeutic approach for addressing trauma and its connection to sex addiction. By targeting traumatic memories and negative beliefs, EMDR helps individuals process and integrate their experiences, leading to healing and resolution. The use of EMDR protocols, such as DeTUR, CravEx, and FSAP, specifically tailored to addiction-related behaviors, can further enhance the effectiveness of treatment. Additionally, incorporating resourcing techniques and integrating EMDR with other modalities, such as IFS, can provide a comprehensive and holistic approach to addressing sex addiction and promoting long-term recovery. Further research and exploration of EMDR’s potential in treating sex addiction is warranted to improve treatment outcomes and support individuals on their journey to healing and recovery.

 

About the Author

Rob Terry is co-founder of Karuna Healing and certified sex addiction therapist (CSAT). Rob is a member of EMDRIA and practices EMDR with clients seeking treatment for sexual compulsivity.

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Certified Sex Addiction Therapist (CSAT) Online Counseling