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Psychotherapy can be beautiful and colourful ….

Selskab for misbrugspsykologi årsmøde Odense 01.10. – 02.10.2009 Hypnosis Cue Exposure and Addiction Jörg Albers, clinical psychologist Augustenborg, Denmark Jorg.Albers@pcm.regionsyddanmark.dk. Psychotherapy can be beautiful and colourful …. … and simple.

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Psychotherapy can be beautiful and colourful ….

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  1. Selskab for misbrugspsykologiårsmøde Odense01.10. – 02.10.2009Hypnosis Cue Exposure and AddictionJörg Albers, clinical psychologistAugustenborg, DenmarkJorg.Albers@pcm.regionsyddanmark.dk

  2. Psychotherapy can be beautiful and colourful ….

  3. … and simple

  4. “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)

  5. Activating inner Resource (AiR)

  6. Beginning of Treatment RDR D = State of Distress R = State of Ressource

  7. Succesful Treatment D = State of Distress R = State of Resource

  8. ”At galopere afsted” ProblemtilstandRessourcetilstandProblemtilstand AngstDepression ”At gå i stå”

  9. ”At galopere afsted” ”At gå i stå”

  10. ProblemtilstandRessourcetilstandProblemtilstandAngstat tænke kreativt/ at føle fornuftigtDepression ”At gå i stå” ”At galopere af sted”

  11. SixThemes for ActivatinginnerResource (AiR) Hypnosis, Cue Exposure and Addiction

  12. Hypnosis, Cue Exposure and Addiction • Six sessions 1. 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

  13. 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 drinking Activation of inner awareness concerning the negative results that will occur in future in case of relapse

  14. 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 out Reframing self –limiting expectation concerning the urge to drink by waiting out the urge without using a strategy

  15. Hypnosis, Cue Exposure and Addictionsix steps in the course of each session

  16. Hypnosis, Cue Exposure and Addictionsix steps in the course of each session Rapid-blAiR Reduction of tension Double-blAiR Rapid-blAiR Rapid-blAiR Preparation

  17. 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 > 5 Rapid-blAiR

  18. 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-Wordsare consistent (“The rituals”) “Chair” – “Ground” – ”Breathe” The last four Cue-Wordsare individually determined (“The indiviuals”) “Title” – “Cueword I” - ”Cueword II” – “Cueword III” Continue, when VoR > 5 Rapid-blAiR

  19. 1. single-blAiR

  20. 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

  21. 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

  22. 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 tension Rapid-blAiR

  23. 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

  24. 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 alcohol Rapid-blAiR

  25. 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) > 8 Rapid-blAiR

  26. 1. Exposure 3 min

  27. Hypnosis, Cue Exposure and Addiction Rapid-blAiR 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

  28. Hypnosis, Cue Exposure and Addiction 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 Reduction of tension Rapid-blAiR

  29. 2. single-blAiR 5 min

  30. Hypnosis, Cue Exposure and Addiction Step four Second Exposure The patient anticipates exposure for the second time Rapid-blAiR Reduction of tension Rapid-blAiR

  31. 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 Reduction of tension Rapid-blAiR

  32. 2. Exposure 2 min

  33. Hypnosis, Cue Exposure and Addiction Step five Second rapid- blAiR: Defined by the title of the session the therapist invokes the resource by applying rapid – blAiR ( “repeating the 7 cue words “) Rapid-blAiR Reduction of tension Rapid-blAiR Rapid-blAiR

  34. 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 Reduction of tension Rapid-blAiR Rapid-blAiR

  35. 3. single- blAiR 3 min

  36. 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 Rapid-blAiR Reduction of tension Rapid-blAiR Rapid-blAiR Preparation

  37. Hypnosis, Cue Exposure and Addiction Step six Treating the trauma: Increasing the subjective distress Rapid-blAiR Reduction of tension Rapid-blAiR Rapid-blAiR Preparation

  38. Exposure and EMDR – Assessment 3,30 min

  39. 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

  40. Hypnosis, Cue Exposure and Addiction Step six (cont.) Desensitisation by double-blAiR Rapid-blAiR Double-blAiR Reduction of tension Rapid-blAiR Rapid-blAiR Preparation

  41. Hypnosis, Cue Exposure and Addiction Step six (cont.) Single- blAiR Double-blAiR Reduction of tension Single- blAiR Single- blAiR Preparation

  42. Desensitization 4 min

  43. Hypnosis, Cue Exposure and Addiction Step six (cont.) 5 x15 sec. “double-blAiR” Then close the session with “single—blAiR” Rapid-blAiR Reduction of tension Double-blAiR Rapid-blAiR Single-blAiR Rapid-blAiR Preparation

  44. Rest of the movie

  45. Psycho-Sensory TherapyHypnosis, Cue Exposure and Addiction

  46. Psycho-Sensory TherapyHypnosis, Cue Exposure and Addiction

  47. 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

  48. 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

  49. Psycho-Sensory TherapyAffect-Activation Sensory-Stimulation Time usage Treatment 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

  50. 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

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