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

[email protected]

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)


• 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


• 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


• 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


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


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


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


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


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


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


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


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


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


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


• 2. single-blAiR 5 min


Step four Second Exposure

The patient anticipates exposure for the second time

Rapid-blAiR

Rapid-blAiR



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



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



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


• 3. single- blAiR 3 min


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



Step sixTreating the trauma:Increasing the subjective distress

Preparation

Rapid-blAiR

Rapid-blAiR

Rapid-blAiR


• Exposure and EMDR – Assessment

3,30 min


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


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


• Desensitization 4 min


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


• Rest of the movie

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. rapid-blAiR 5 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

[email protected]

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

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