Summary: A new pilot study from Florida Atlantic University evaluates a targeted form of Eye Movement Desensitization and Reprocessing (EMDR) designed to alter the vivid mental imagery that fuels addiction cravings. Combined with cognitive behavioral therapy (CBT), this addiction-focused EMDR approach showed promising reductions in craving intensity, repetitive negative thoughts, and irrational beliefs tied to substance use, suggesting a potential new strategy to reduce relapse risk.
The study found that reducing the vividness of addiction-related imagery can lower craving and weaken maladaptive cognitions. These results point to a complementary therapy that addresses memory-based drivers of addiction beyond conventional treatments.
Key Facts:
- The study applied EMDR specifically to transform vivid imagery associated with addiction memories.
- EMDR was at least as effective as cognitive behavioral therapy for craving reduction, and combining both therapies produced greater reductions than CBT alone.
- The method showed potential for both chemical dependencies and compulsive behaviors such as Internet addiction and gambling.
Source: FAU
Background: In 2021, an estimated 61.2 million Americans aged 12 and older used illicit drugs, and more than 106,000 people died from drug-involved overdoses. Florida reported roughly 5,300 overdose deaths annually, ranking second among states and exceeding the national average by about 23 percent. Excessive alcohol use remains a leading cause of preventable death in the United States and is associated with heart disease, cancer, and poor mental health outcomes.
Despite the availability of outpatient supports and evidence-based interventions, relapse rates for substance use disorder remain high—often reported near 70 percent—highlighting the need for additional therapeutic options that address relapse mechanisms directly.
This FAU pilot study tested an addiction-focused EMDR protocol that combines guided bilateral eye movements with targeted memory processing. EMDR has established effectiveness for trauma-related conditions such as PTSD, depression, and anxiety, but its application specifically for substance use disorder has been limited in research.
The theoretical rationale for the study is that cravings are maintained and intensified by sensory imagery encoded in episodic memories; more vivid imagery predicts stronger cravings. By reprocessing these maladaptive addiction memories—similar in formation to traumatic memories in PTSD—EMDR may reduce the sensory intensity that drives craving.
“Because EMDR reduces the vividness of negative trauma memories, we expected it would also reduce the vivid imagery that feeds addiction cravings,” said Elizabeth Woodruff, the study’s first author and a clinician and graduate of FAU’s Phyllis and Harvey Sandler School of Social Work. The method targets specific memory elements to help ‘repair’ the mental injury tied to those memories.
The FAU trial, titled “Addiction-focused Eye Movement Desensitization Reprocessing,” measured outcomes for cravings, perseverative thoughts (repetitive negative thinking), and irrational cognitions related to participants’ substance of choice. Researchers compared an experimental arm that received AF-EMDR plus weekly individual CBT to a control arm that received CBT only.
Published in the Journal of Evidence-Based Social Work, the study reported a very high retention rate—nearly 100 percent—with 98.33 percent of participants completing all four treatment sessions. Both groups experienced clinically meaningful reductions in cravings, perseverative thoughts, and irrational beliefs; the experimental group (AF-EMDR + CBT) showed larger overall decreases, and combining both therapies resulted in greater craving reduction than CBT alone.
Participants in the experimental protocol completed 60 minutes of individual CBT followed by AF-EMDR. Therapists worked through memories linked to relapse and cravings (including first, worst, and most recent episodes), identified present triggers, and desensitized future-focused fears using AF-EMDR procedures. The EMDR framework followed the established eight-phase approach: comprehensive history, preparation, assessment, desensitization, installation, body scan, closure, and reevaluation.
Nearly 57 percent of participants identified alcohol as their primary substance, while about 20 percent reported heroin or other opiates as their main dependence. While usual inpatient and outpatient programs rely on group education, skills training, CBT, and medication-assisted options, this study suggests AF-EMDR could serve as a valuable add-on to directly target memory-driven cravings and maladaptive thought patterns contributing to relapse.
The authors note the approach also appears promising for nonchemical compulsive behaviors such as problematic Internet use and gambling, but they emphasize the need for larger randomized controlled trials to confirm efficacy, optimize session number, and determine long-term outcomes.
Study co-authors include Heather Howard, Ph.D., Manny Gonzalez, Ph.D., both associate professors at FAU’s Phyllis and Harvey Sandler School of Social Work, and Talib Jaber, RPh, vice president of customer success at Sunwave.
About this addiction research news
Author: Gisele Galoustian
Source: FAU
Contact: Gisele Galoustian – FAU
Image: Image credited to Neuroscience News
Original Research: Closed access. “Feasibility and Efficacy of Addiction-Focused Eye Movement Desensitization Reprocessing in Adults with Substance Use Disorder” by Elizabeth Woodruff et al., Journal of Evidence-Based Social Work.
Abstract
Feasibility and Efficacy of Addiction-Focused Eye Movement Desensitization Reprocessing in Adults with Substance Use Disorder
Purpose
Addiction-focused EMDR (AF-EMDR) is proposed as a feasible adjunct to treat the memory processes that drive cravings. This pilot study aimed to evaluate feasibility and test preliminary efficacy of AF-EMDR on overall craving intensity, perseverative thoughts related to addiction, and irrational cognitions among adults with substance use disorder.
Methods
This pilot used a two-arm randomized controlled design. Thirty adults in residential or partial hospitalization recovery programs in Florida (October 2021–January 2022) were randomized to either an experimental group (AF-EMDR + CBT, n = 15) or a control group (CBT only, n = 15). Each AF-EMDR participant received four 60-minute sessions plus standard CBT.
Results
Adherence was high: 98.33% of participants completed all four AF-EMDR sessions and post-intervention assessments. Both groups experienced significant reductions in cravings, perseverative thoughts about their substance of choice, and irrational cognitions during the intervention period. While both arms improved, differences between groups did not reach statistical significance in this small sample, though trends favored the combined AF-EMDR + CBT condition.
Conclusions
Findings indicate AF-EMDR is a feasible add-on treatment with promising effects on craving and maladaptive cognitive patterns. Larger trials are required to determine efficacy, optimal dosing, and the durability of treatment effects in people with substance use disorder.