selskab for misbrugspsykologi årsmøde odense 01.10. – 02.10.2009 hypnosis cue exposure and...
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Selskab for misbrugspsykologiårsmøde Odense
01.10. – 02.10.2009
Hypnosis Cue Exposure and Addiction
Jörg Albers, clinical psychologistAugustenborg, Denmark
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