selskab for misbrugspsykologi årsmøde odense 01.10. – 02.10.2009 hypnosis cue exposure and...

Selskab for misbrugspsykologiårsmøde Odense

01.10. – 02.10.2009

Hypnosis Cue Exposure and Addiction

Jörg Albers, clinical psychologistAugustenborg, Denmark

Jorg.Albers@pcm.regionsyddanmark.dk

Psychotherapy can be beautiful and colourful ….

… and simple

• “Any intelligent fool can make things bigger, more complex, and more violent. It takes a touch of genius -- and a lot of courage -- to move in the opposite direction.”

(Albert Einstein)

Activating inner Resource (AiR)

R D RD =State of Distress

R =State of Ressource

Beginning of Treatment

Succesful Treatment

D =State of Distress

R =State of Resource

”At galopere afsted” ”At gå i stå”

Problemtilstand Ressourcetilstand Problemtilstand

Angst Depression

”At galopere afsted” ”At gå i stå”

Problemtilstand Ressourcetilstand Problemtilstand

Angst at tænke kreativt/ at føle fornuftigt Depression

”At galopere af sted” ”At gå i stå”

Hypnosis, Cue Exposure and Addiction

• Six Themes

for Activating inner Resource (AiR)

Hypnosis, Cue Exposure and Addiction

• Six sessions1. Session: Positive results of sobriety

Activation of inner Resource concerning all positive effects that will occur if patients were to refrain from drinking when tempted

2. Session: Acknowledgement of significant others

Activation of inner Resource concerning the improvement of relationship to significant others who unconditionally appreciate their sobriety

Hypnosis, Cue Exposure and Addiction

• Six sessions (cont.)3. Session: Confirming the decision of sobriety

Activation of inner Resource concerning their decision for sobriety by powerful cognitions combined with a guided imagery of a “wonderful day”

4. Session: Negative consequences of drinkingActivation of inner awareness concerning the negative results that will occur in future in case of relapse

Hypnosis, Cue Exposure and Addiction

• Six sessions (cont.)

5. Session: Symptom management by biofeedback Reducing disturbing symptoms by using biofeedback device which indicates the level of heart rate synchronization (emWave)

6. Session: Waiting outReframing self –limiting expectation concerning the urge to drink

by waiting out the urge without using a strategy

Hypnosis, Cue Exposure and Addiction six steps in the course of each session

Hypnosis, Cue Exposure and Addiction six steps in the course of each session

Preparation

Double-blAiR

Rapid-blAiR

Rapid-blAiR

Rapid-blAiR

Reduction of tension

Hypnosis, Cue Exposure and Addiction

Step one

single - blAiR:

bilateral Activating of internal Resources (tactile)

Single – means only tactile right- left stimulations.

I) Most pleasant rhythm between the slowest and fastest tactile input (Tac/AudioScan) - meanwhile the eyes resting in the center of the visual field

II) Install resource (e.g. 3. session: “Decision of sobriety”)

III) Check “Validity of Ressource” (VoR; 1= false, 7 = correct)

Continue when VoR > 5Rapid-blAiR

Hypnosis, Cue Exposure and Addiction

Step one (cont.)

rapid - blAiR:

Recall Cue-Words in an infinite loop until patient's resource is installed

The first three Cue-Words are consistent (“The rituals”)

“Chair” – “Ground” – ”Breathe”

The last four Cue-Words are individually determined

(“The indiviuals”)

“Title” – “Cueword I” - ”Cueword II” – “Cueword III”

Continue, when VoR > 5

Rapid-blAiR

• 1. single-blAiR

Hypnosis, Cue Exposure and Addiction

Step two

Exposure

The patient anticipates being exposed. The patient visualizes a high-risk situation

Check the “Level of Urge” (LoU)

0 = no urge 10 = extreme urge

Rapid-blAiR

Hypnosis, Cue Exposure and Addiction

The range of cues that may serve as triggers

is potentially countless including

• external cues (the sight, smell and taste of alcohol)

• internal cues (physical effects, moods and cognitions)

• withdrawal related cues

Hypnosis, Cue Exposure and Addiction

Step two (cont.)

Exposure - Incitement

“The Level of Urge” (LoU) increases rapidly, the patient experiences already loss of control.

Appearance of annoying memories, self limiting beliefs, troublesome feelings and body tensionRapid-blAiR

Hypnosis, Cue Exposure and Addiction

Step two (cont.)

Avoidance point

The Level of Urge (LoU) increases to the point, where the patient habitually starts drinking or uses distraction strategies obtaining a short phase of relief

Rapid-blAiR

Hypnosis, Cue Exposure and Addiction

Step two (cont.)

The therapist increases actively

the “Level of urge”; LoU (>8)

•by exposing the patient to the favorite beverage

•by challenging to open the bottle

• by filling the glass

•by encouraging to smell alcoholRapid-blAiR

Hypnosis, Cue Exposure and Addiction

Step two (cont.)

Turning point:

The discomfort reaches its peak

more appearance of annoying memories, self limiting beliefs, troublesome feelings and body tension

Level of Urge (LoU) > 8Rapid-blAiR

• 1. Exposure 3 min

Hypnosis, Cue Exposure and Addiction

Step three

rapid- blAiR:

Depending on the title of the session

the therapist invokes the resource by applying rapid – blAiR

( “repeating the 7 cue words” )

Rapid-blAiR

Rapid-blAiR

Hypnosis, Cue Exposure and Addiction

Step three (cont.)

rapid - blAiR:

The resource counteracts the Level of Urge resulting in Reduction of tension

Continue when the “Level of Urge” (LoU) decreases to < 3

Rapid-blAiR

Rapid-blAiR

Reduction of tension

• 2. single-blAiR 5 min

Hypnosis, Cue Exposure and Addiction

Step four Second Exposure

The patient anticipates exposure for the second time

Rapid-blAiR

Rapid-blAiR

Reduction of tension

Hypnosis, Cue Exposure and Addiction

Step four (cont.)

The therapist increases actively the Level of urge

•by exposing the patient to the favorite beverage

•by challenging to open the bottle

• by filling the glass

•by encouraging to smell alcohol

Rapid-blAiR

Rapid-blAiR

Reduction of tension

• 2. Exposure 2 min

Hypnosis, Cue Exposure and Addiction

Step five

Second rapid- blAiR:

Defined by the title of the sessionthe therapist invokes the resource by applying rapid – blAiR

( “repeating the 7 cue words “)

Rapid-blAiR

Rapid-blAiR

Rapid-blAiR

Reduction of tension

Hypnosis, Cue Exposure and Addiction

Step five (cont.)Second rapid - blAiR:

The resource counteracts the Level of Urge resulting in Reduction of tension

Continue when the Level of Urge decreases to < 3

Rapid-blAiR

Rapid-blAiR

Rapid-blAiR

Reduction of tension

• 3. single- blAiR 3 min

Hypnosis, Cue Exposure and Addiction

Step six

Treating the trauma

Preparation:

Worst picture of trauma

Current self limiting belief

Current troublesome feeling

Current body sensation

Preparation

Rapid-blAiR

Rapid-blAiR

Rapid-blAiR

Reduction of tension

Hypnosis, Cue Exposure and Addiction

Step sixTreating the trauma:Increasing the subjective distress

Preparation

Rapid-blAiR

Rapid-blAiR

Rapid-blAiR

Reduction of tension

• Exposure and EMDR – Assessment

3,30 min

Hypnosis, Cue Exposure and Addiction

Double -blAiR

bilateral Activating of internal Resources

double– means right- left stimulation (tactile and visual).

Most pleasant rhythm between the slowest and fastest tactile input (Tac/AudioScan)

- meanwhile the eyes are following the tactile rhytm

Hypnosis, Cue Exposure and Addiction

Step six (cont.) Desensitisationby double-blAiR

Rapid-blAiR

Rapid-blAiR

Rapid-blAiR

Preparation

Double-blAiRReduction of tension

Hypnosis, Cue Exposure and AddictionStep six (cont.)

Double-blAiR

Single- blAiR

Single- blAiR

Single- blAiR

Preparation

Reduction of tension

• Desensitization 4 min

Hypnosis, Cue Exposure and Addiction

Step six (cont.) 5 x15 sec. “double-blAiR” Then close the session with

“single—blAiR”

Preparation

Double-blAiR

Rapid-blAiR

Rapid-blAiR

Rapid-blAiR

Single-blAiR

Reduction of tension

• Rest of the movie

Psycho-Sensory TherapyHypnosis, Cue Exposure and Addiction

Psycho-Sensory TherapyHypnosis, Cue Exposure and Addiction

Case -study • Uwe, 59 years,• Substance abuser for 45 years

• Psychiatric inpatient and outpatient client without remarkable results by medical treatment

• Has stayed sober for 3 months at inpatient treatment, though constantly distracted by severe craving symptoms often intensified spontaneously

Case –study (cont.)

• After 4 sessions Psycho-Sensory Treatment craving was significantly diminished over time.

• Has now been clean and sober for 10 months returned to work, engaged in charital activities

Psycho-Sensory TherapyAffect-Activation Sensory-Stimulation

Time usageTreatment of craving

• rapid-blAiR 3,30 min

• 1. Exposure 3 min

• 1. rapid-blAiR 5 min

• 2. Exposure 2 min

• 2. rapid- blAiR 3 min

Psycho-Sensory TherapyHypnosis Cue Exposure and Addiction

Time usage (cont.)Treatment of trauma

• Assessment 3,30 min

• Desensitization

(double-blAiR) 4 min

• Installation 2 min

• Body-scan 3 min

• Future installation 3 min

• Closure 1 min

Psycho-Sensory TherapyAffect-Activation Sensory-Stimulation

Jörg Albers, Denmark

www.jorgalbers.com

Jorg.Albers@pcm.regionsyddanmark.dk