Disclaimer: This blog entry is neither intended to provide a step-by-step guide to using the Feeling-State Addiction Protocol (FSAP), nor is it in any way meant to stand as a scientifically supported statement of effectiveness. The results described herein are merely illustrative of the anecdotal experience of its author when employing the protocol. The FSAP—or any other EMDR treatment protocol—should not be employed by anyone not specifically trained in EMDR and stabilization techniques. The following is meant to represent this writer’s impressions of the protocol and is not meant to supplant writings and research conducted by FSAP developer Robert Miller, PhD. This writer has taken utmost care to ensure that clients participating in this treatment have been fully supportive and desiring of the hoped for results.
After addressing such a challenging topic in last week’s blog post, I decided to take up a lighter subject in my second blog entry: Addictions and compulsions.
My observations have suggested to me that, for some therapists, regardless of their particular bent, addictions are often something that ‘other therapists deal with’. Addictions can feel overwhelming and scary, not only for the person experiencing them first hand, but for the therapist in the room with them. So often in treatment, it seems, there are far more questions than answers in addressing addictions. One of the most prominent questions, in my experience of conducting both group and individual therapy, is, ‘Why does knowing something not translate into feeling/believing it and result in changed behavior?’
As a social worker who employs EMDR rather frequently, I have become very comfortable with addressing the varied reasons why, by helping people move through the emotional barriers that prevent the ‘knowing’ from agreeing with the ‘feeling’—at least when it comes to negative irrational beliefs. (For an explanation of EMDR treatment, please click here.)
Although there are also ways of targeting irrational positive affect via EMDR (Knipe, 2005), until more recently, there seems not to have been an explanation of why someone might keep going back to the same behavior, over and over, even when the person knows that it is hurting them or others in their life. In March 2013, I attended a two-day, intensive workshop training that introduced the Feeling-State Addiction Protocol (FSAP). The FSAP is undergirded by the Feeling-State Theory of Addiction and Compulsion. Both the theory and the treatment protocol were developed by Robert Miller, PhD, based on the EMDR standard protocol developed by Francine Shapiro, PhD. According to Dr. Miller,
The feeling-state theory (FST) of [impulse control disorders (ICDs)] was developed by this author. The theory postulates that ICDs are created when positive feelings, linked with specific objects or behavior, form a state-dependent memory. This state-dependent memory, composed of feelings and the event, form a unit called a “feeling-state” (FS). The FS is hypothesized to be the cause of ICDs (Miller, 2010).
A ‘feeling’ is not the same as an ’emotion’ in this way of looking at things. Here, a feeling is the combination of an emotion, the physical experience of that emotion, and a positive cognition that accompanies them. For example, someone could experience happiness, feel it in their chest, head, and arms, and experience a thought such as, ‘Wow, I really belong with these people’. The three combine into, ‘I feel like I belong’.
The implications of this theory are pretty heady. Just as negative feelings that ‘won’t go away’ can be the result of a state-dependent memory (i.e., the state a person was in when the experience got emotionally ‘stuck’), so can positive feelings. This isn’t just any positive experience we’re talking about, though. This has to have been an overwhelmingly positive feeling for the person, rooted in a strong, unmet (and perhaps hidden) emotional need to feel whatever that feeling is (feeling powerful, feeling like a winner, feeling in control, etc.). The ‘feeling-state’ is a combination of the powerful, positive feeling(s) essentially fused with the behavior that gave the person that feeling. It appears that addictions and many compulsions are not done for the sake of the behavior, according to this theory, but as a deeply felt, emotionally driven desire to experience the overwhelming positive feeling(s) again. For more detailed information, please refer to Dr. Miller’s website.
So, always up for something that might help my clients move through their difficulties more swiftly (if possible), I’ve begun employing this protocol with clients. It’s not easy. (Well, sometimes it is, actually.) However, the key is to accurately identify with the client the feeling states they are experiencing connected to the specific behavior (or part(s) of the behavior) that yield the strongest positive feeling. Without having correctly identified those feeling-states, the protocol doesn’t work. The initial processing phase of the protocol is where the separation of the target behavior and the feeling-state(s) occurs.
I’ve not gotten all the way through the full protocol with any client yet. I’ve only begun employing the thing in the past three weeks, and I’m still getting a ‘feel’ for it (pitfalls, dead-ends, and all) but my clients and I have already seen some really impressive results. Examples include:
Client with a history of polysubstance dependence, focusing on past intravenous cocaine use. After one session, client reported no longer being able to trigger the craving to use cocaine.
Client with history of cutting behaviors. After two sessions (one focusing on the cutting itself, another focusing on the feeling of relief after cutting), client no longer finds cutting—or even other, harm reduction inspired alternatives—desirable or appealing.
Client with history of binge eating of both savory and sugary foods. After one session, client reported that she was able to choose to eat only two small pieces of chocolate rather than eating the whole chocolate bar—and still felt satisfied. Client reported that she had no additional urge to eat more than she wanted.
A single behavior can have multiple feelings attached, so the real trick for me has been to identify all those feeling-states. Also, different aspects of the behavior can been attached to different positive feelings for the client. The key is to weed all of them out at the root. The person does not even need to remember the original, powerful experience. However, it does require that the person be willing to engage in what is known as ‘euphoric recall’ in order to elicit those feelings. Also, if the targeted behavior has become one of a person’s primary coping strategies, then the therapist is potentially pulling the rug out from under their client if they blow through this treatment without a good amount of prep work and resource development, as should be standard with any employment of EMDR as a treatment.
According to Dr. Miller in the training, he has also seen success in taking what I would consider a harm reduction approach to addressing behaviors: Not entirely eliminating the feeling state, but reducing it slightly, so that the client feels a bit more in control and maybe feels that there is a bit more room in their life for other things. Some people may also be happy with reduced rather than entirely eliminated use or behavior.
The examples described above are but a few. However, it appears that this protocol can be used on most any behavior with an emotional compulsion component, including ‘process’ addictions, including relationship co-dependence, and substance abuse/dependence issues. Evidence offered by Dr. Miller in training suggested that this protocol is not effective with features that are specifically linked to Obsessive-Compulsive Disorder, owing to confounding factors.
For more information about the FSAP and Dr. Miller’s work and research, as well as training opportunities for EMDR clinicians, please direct your browser here.
References
Knipe, J. (2005). Targeting positive affect to clear the pain of unrequited love, codependence, avoidance, and procrastination. In R. Shapiro (Ed.). EMDR solutions: Pathways to healing (pp. 189-212). New York: W W Norton & Co.
Miller, R. (2010). The Feeling-State Theory of Impulse-Control Disorders and the Impulse-Control Disorder Protocol, 16(3), 2-10.