EMDR Therapy for Veterans with PTSD and Addiction

EMDR is a treatment for PTSD that uses bilateral stimulation (such as eye movements) to help a person process previously unresolved memories of a past traumatic event. The goal of EMDR is to reduce the distress associated with past trauma and alleviate symptoms of PTSD.¹ This page will cover the use of EMDR with Veterans experiencing co-occurring PTSD and addiction, including its techniques and phases, why it works, and how to get help.

What Is EMDR?

Eye movement desensitization and reprocessing (EMDR) is a type of therapy that is used to treat posttraumatic stress disorder (PTSD).¹ The goal of EMDR is to help you process past traumas by working through them by changing how your brain stores traumatic memories⁴ so that you can heal from these experiences.¹

Treatments like EMDR can help service members and others who have experienced trauma process their experiences and alleviate symptoms of PTSD.¹ EMDR was developed by American psychologist Francine Shapiro in 1987 and is based on the Adaptive Information Processing model, which assumes that PTSD is caused by past traumas that are not properly processed. Traumatic memories contain thoughts, emotions, and physical sensations associated with the event, which often lead to avoidance. When memories are triggered or reminders are faced, symptoms of PTSD can result.⁴

EMDR is offered in one-on-one sessions with trained therapists. A typical course of EMDR is six to 12 sessions that take place one to two times per week.⁴ During these sessions, a therapist trained in EMDR will guide you through processing the traumatic event while having you focus on external stimuli, such as back-and-forth eye movements or sounds.

EMDR Phases and Treatment Process

EMDR is offered in one-on-one sessions with trained therapists. A typical course of EMDR is six to 12 sessions that take place one to two times per week.⁴ During these sessions, a therapist trained in EMDR will guide you through processing the traumatic event while having you focus on external stimuli, such as back-and-forth eye movements or sounds.⁴

Treatment with EMDR involves eight phases. Each phase focuses on a different aspect of treatment. Phases four through seven focus on processing the traumatic event and may take one to three sessions to complete.⁴

The eight phases of EMDR are:^4,5

1. History taking and treatment planning: The first phase of EMDR begins with gathering a full history and understanding how your past experiences have impacted your current symptoms. During this phase, your therapist and you will identify treatment goals and develop a plan.
2. Preparation: The second phase involves preparing you for EMDR by explaining what it will entail and introducing you to the techniques. The therapist will teach you coping skills to use during and between sessions when uncomfortable thoughts and feelings may be activated.
3. Assessment: During the assessment phase, your therapist will work with you to identify the traumatic memory that will be the focus of treatment. Working with your therapist, you will assess images, thoughts, emotions, and body sensations associated with the memory and identify a positive belief that you would like to adopt. The therapist will ask you to rate your distress associated with the memory and how true the positive belief feels right now. The therapist uses these questions to gauge your progress over the course of treatment.
4. Desensitization: The focus of the fourth phase of EMDR is changing your associations and sensory experiences associated with the traumatic memory. You will be asked to focus on the memory while engaging in rapid eye movements or listening to sounds. Between each set of eye movements or sounds, you are coached to take deep breaths and allow your mind to go blank. You will then be asked to share whatever new material comes up, which becomes the focus of the next set of eye movements or sounds. This continues until you no longer find the memory distressing.
5. Installation: During the installation phase, the therapist helps you increase the strength of the positive belief until it feels true and replaces other negative beliefs.
6. Body scan: The sixth phase, known as the body scan, involves having you observe any sensations in your body while thinking of the traumatic event and positive belief. If you experience any distress, then more processing is done.
7. Closure: The seventh phase involves the therapist explaining what you can expect between sessions and encouraging the use of coping techniques if the memory was not completely processed. The focus of this phase is to help you maintain safety and control until the following session. You will also be asked to keep a log of anything that comes up between sessions.
8. Reevaluation: During the next session, the therapist reevaluates your level of distress, progress, and any memories that have come up since the last session. From there you and your therapist identify any new targets for new sessions.

PTSD and Addiction in Veterans

PTSD and addiction co-occur in Veterans at alarming rates. Over 20% of veterans with PTSD also have a substance use disorder – the clinical term used by professionals for problematic use of drugs and alcohol. Nearly 33% of Veterans seeking treatment for a substance use disorder also have PTSD. Veterans who are diagnosed with PTSD are also more likely to use nicotine and binge drink.⁶

EMDR for PTSD and Addiction Treatment

Veteran mental health issues affect a significant number of Vets in the United States. Military service members face unique circumstances that can affect their mental health and cause them to be more vulnerable to addiction. For example, Veterans are more likely to experience combat injuries and traumatic brain injuries (TBIs) compared to civilians. TBIs are linked to higher rates of substance use and mental health disorders.⁸

Additionally, military service members may find it difficult to reintegrate into civilian life. Reintegration can be challenging for many reasons. Service members face the task of figuring out how to use their skills in a new career path or starting from scratch. They also must cope with feeling different than their civilian counterparts and trying to connect with family and friends who may not understand what they have been through.⁹

Though Veterans face additional stressors that can make recovering from PTSD and addiction challenging, treatments are available to help them recover. EMDR is one such treatment that is effective for treating PTSD in Veterans¹ and can also be used to treat co-occurring PTSD and substance use disorders in inpatient and outpatient settings.¹⁰

Does EMDR for PTSD and Addiction Work?

Yes, studies suggest that EMDR can be applied effectively as treat for PTSD and addiction, though the effectiveness of addiction-focused EMDR still warrants additional study ¹⁰ Studies have shown that EMDR is effective in helping people process past trauma and reducing symptoms of PTSD.¹ For people with co-occurring PTSD and addiction, resolving the underlying trauma that contributes to addiction is important for recovery.⁹

Research also suggests that EMDR can help desensitize a person to memories and images associated with drug and alcohol use. People with addictions often have positive memories and images associated with substance use. The eye movements used in EMDR have been found to desensitize people to these positive memories, which helps to reduce craving levels.¹¹ EMDR techniques can also be used to help process memories associated with past relapses and desensitize people to triggers.¹⁰

Some co-occurring disorders treatment programs offer EMDR alongside other forms of addiction therapy to help people who have experienced traumatic events, like many Veterans, recover.

Is EMDR Covered by the VA or Tricare?

Yes, EMDR is covered by the VA and TRICARE. EMDR is offered at many VA facilities and through local community providers.¹ For more information about finding a local VA facility or community provider, see the VA’s local care options. TRICARE also covers a range of mental health and substance use disorder treatments delivered in an inpatient or outpatient setting.¹² For help locating an in-network provider that offers EMDR, contact TRICARE directly.

Co-Occurring Disorder Treatment for Veterans

As a Veteran, dealing with PTSD and addiction can be incredibly difficult, but treatment that is tailored to your unique needs and circumstances is available. Treatment for Veterans with co-occurring disorders focuses on helping you cope with previous trauma and recover from addiction in a safe and supportive environment. Connecting with other Veterans and military service members and working with professionals who are trained in this area can help you heal from your PTSD and addiction.

If you are a Veteran experiencing PTSD and addiction, treatment for co-occurring disorders is available. For more information or help finding a treatment center near you, reach out to the addiction text line to find a drug and alcohol rehab near you.