*Disclaimer: Please note that parts of this blog have been automatically translated.*
Cognitive behavioral therapy (CBT) is a well-known form of addiction treatment. However, CBT requires a certain amount of reflection and cognitive ability. Not all people are equally capable of this. Addressing automatic processes could therefore be promising in the treatment of addiction problems among a broader target group. Several types of techniques addressing automatic processes can be distinguished [1]. First, techniques that address the situation itself. For example, take a different route home so that you are not faced with addictive triggers. Second, techniques such as mindfulness, increasing (automatic) awareness and acceptance. Third, techniques in which addictive triggers are used in therapy to evoke a reaction. This reaction is then unlearnt. For example, through “Cognitive Bias Modification” (CBM), you learn through digital training to push images of alcohol away from you so that you learn to respond less strongly to alcohol cues.
We have called this third form of techniques ‘response-focused’ techniques because an addictive response (response) is evoked and modified [1, 4]. CBM trainings are used today as ‘add-ons’ alongside mostly CBT in alcohol addiction treatment. In particular, they offer additional effects for people who show high levels of impulsivity [1]. However, not everyone is motivated to perform such digital tasks. Motivation and autonomy in treatment choice are key factors for successful treatment adherence. Hence, it is important to offer a wider range of alternative “response-focused” techniques from which people can choose. A potentially promising alternative to CBM could be “imaginary restraining”. In this, CBM training takes place imaginatively [2]. For example, in your mind you take a sip of alcohol from a glass and then smash the glass with alcohol on the floor.
Other “response-focused” forms of therapy are “cue-exposure therapy” and “Eye Movement Desensitization and Reprocessing” (EMDR). In cue-exposure therapy, for example, people see alcohol and then learn not to respond to it. This seems to work well when the cue-exposure is offered in virtual reality [3]. But cue-exposure can also take place imaginatively by thinking about a situation that triggered the addiction. Then it overlaps with EMDR. EMDR has been proven effective for trauma and is sometimes considered a form of cue-exposure as well. The therapist asks a client to think back to a traumatic event. But this is then done in combination with distracting stimuli, such as sounds through headphones or movements that the client follows with the eyes. I think EMDR therapy for the treatment of addiction could be promising if properly focused on personal vulnerabilities that trigger substance cravings. For all these suggestions, more good research is needed first. Also, research on the comparison between such techniques. After that, proven alternative “response-focused” techniques can be offered according to personal needs and wishes.
Finally, it is important to understand how “response-focused” techniques can best be integrated into existing therapy. Here, the combination with mindfulness could be promising [4]. This presumably applies not only to the treatment of addiction but also to the broader field of mental health. For example, there are case studies suggesting that the treatment of trauma with EMDR and mindfulness is promising [5, 6]. Again, further research is needed. I hope to encourage research into such combinations of techniques with this blog.
This blog was written by Dr. Junilla Larsen (Radboud University) for RAD-blog, the blog on smoking, alcohol, drugs and diet.
References
1. Larsen, J. K., & Hollands, G. J. (2022). Targeting automatic processes to reduce unhealthy behaviours: a process framework. Health Psychology Review, 16(2), 204-219. https://doi.org/10.1080/17437199.2021.1876572
2. Larsen, J. K., Hollands, G. J., Moritz, S., Wiers, R. W., & Veling, H. (2024). How can imaginal retraining for modifying food craving be improved? Appetite, 202, 107639. https://doi.org/10.1016/j.appet.2024.107639
3. Nègre, F., Lemercier-Dugarin, M., Kahn-Lewin, C., Gomet, R., Zerdazi, E. H. M., Zerhouni, O., & Romo, L. (2023). Virtual reality efficiency as exposure therapy for alcohol use: A systematic literature review. Drug and Alcohol Dependence, 111027. https://doi.org/10.1016/j.drugalcdep.2023.111027
4. Larsen, J. K., Hollands, G. J., Garland, E. L., Evers, A. W., & Wiers, R. W. (2023). Be More Mindful: Targeting Addictive Responses by Integrating Mindfulness with Cognitive Bias Modification or Cue Exposure Interventions. Neuroscience and Biobehavioral Reviews, 105408. https://doi.org/10.1016/j.neubiorev.2023.105408
5. Sun, T.-F., Wu, C.-K., & Chiu, N.-M. (2004). Mindfulness meditation training combined with eye movement desensitization and reprocessing in psychotherapy of an elderly patient. Chang Gung Medical Journal,27(6), 464-469.
6. Tounsi, H., Pacioselli, P., Riou, L., Gouret, C., Gross, L., Quaderi, A., & Palazzolo, J. (2017). Psychotherapies for complex trauma: A combination between EMDR and mindfulness. European Psychiatry,41(S1), S726-S726. https://doi.org/10.1016/j.eurpsy.2017.01.1320[/su_spoiler]
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