EMDR and Sex Addiction

It may not be easy to quiet the sirens of one’s healthy sexual desires, and even more difficult when those desires have become addictive. When I work with sex addiction, I engage any number of modalities or techniques to help my clients make their way out of the maze of compulsions and bottom-line behaviors (behaviors representing one’s addiction) onto the guided path of recovery. One such modality that I employ both with sex addiction as well as traumatic stress is Eye Movement Desensitization and Reprocessing (EMDR). Read about EMDR here. Utilizing the practice of EMDR and expanding upon it is a protocol, or practice, called Feeling-State Addiction Protocol (FSAP).  Robert Miller, Ph.D., is the creator and lead researcher for the FSAP and defines the theory behind his research this way:

The Feeling-State Theory of Behavioral and Substance Addictions postulates that addiction (both behavioral and substance) are created when positive feelings become rigidly linked with specific objects or behavior. This linkage between feeling and behavior is called a feeling-state. When the feeling-state is triggered, the entire psycho-physiological pattern is activated. The activation of the pattern then triggers the out-of-control behavior. — (The Feeling-State Theory of Behavioral and Substance Addictions and the Feeling-State Addiction Protocol, Robert Miller, 2011)

What follows is Dr. Robert Miller’s article reprinted here with permission. Some content is edited for brevity and ease of understanding. (Scroll to the bottom of this article to read about Sex Addict- Steve)

“In Feeling State Theory (FST), the term “feeling-state” (FS) refers to the entire psycho-physiological arousal of the body and its connection with a specific behavior. FST proposes that a combination of sensations, emotions, cognitions, and behavior compose the feeling-state that causes the urges and cravings associated with both substance and behavioral addictions. A FS related to compulsive stealing, for example, might be composed of the sensations and emotions of excitement, the cognition “I’m getting what I want,” and the behavior of stealing. A FS related to smoking may be composed of the sensation and emotion of relaxation, the cognition “I’m okay,” and the behavior of smoking. In addition, any desired feeling can become fixated with any behavior. This means that a compulsive behavior such as gambling could be linked with the feeling (sensation + emotion + cognition) of “I’m a winner,” “I’m admired,” or “I’m successful.” Once created, the feeling-state continues to exist with the same feelings and behavior associated with it as when the feeling-state was originally formed.

Feeling = Sensation + Emotion + Cognition

Feeling-State = Feeling + Behavior 

The Origin of Feeling-States

“Don’s sexual behavior was an example of feeling-state dynamics. His behavior involved seducing women and making sure that one of his male friends knew about his victory. Once his victory was recognized, he was no longer interested in having sex with that woman but would seek out another victory. This behavior had been recurring since high school when he had an intense experience of approval from his friends for a sexual victory. Despite that fact that he was now 35 years old, the consequence of that experience appears to have been the acting out of the needs and feelings from his teen years. From the standpoint of the Feeling-State Theory of Addictions, Don’s behavior was the result of the feeling-state that had been created so long ago in high school.

The seeking of pleasurable feelings is an essential part of a healthy life. People seek feelings such as excitement, satisfaction, fun, bonding, power, and adventure. Normally, these feelings do not become fixated in the mind while being linked to a particular behavior. Excitement and power, for example, can be experienced in many different ways. The difference between a positive event that is just pleasurable and a positive event that creates a feeling-state is presumed to lie in a person’s emotional history. It is hypothesized that the more deprived of a feeling someone is, the more intensely the person wants to experience that particular feeling. The more intensely the person wants to experience a particular feeling, the stronger the reaction will be when the hunger is finally satisfied. This strong reaction creates the feeling-state that causes the compulsive behavior.

Sarah had an intense urge to have sex with a former boyfriend who had been abusive to her. Though she knew he was bad for her (stating this opinion vigorously during therapy sessions), Sarah would have to fight the urge to have sex with the abusive boyfriend. Sometimes she lost the fight.

Sarah’s childhood was one of emotional deprivation. She reported that there was almost no physical loving contact or emotional connection. Psychodynamic processing of these childhood experiences had no effect on her desire to have sex with her boyfriend. Using a different approach, the author asked her to describe the most positive experience she had ever had with her boyfriend. She described a time when she was having sex with him and felt, for the first time in her life, an intense and wonderful feeling of wholeness. Even though the event lasted only a few minutes, the result was that Sarah’s need for wholeness had become linked with having sex with her boyfriend. The intensity of Sarah’s desire for wholeness is presumed to be similar to a starving person’s reaction to food; the more hungry a person is, the more intense the response. Sarah’s emotional deprivation from childhood laid the foundation of her sexual addiction feeling-state.

Any feeling can be Linked with Any Behavior

John, Tim, and Dustin are good examples of this dynamic. John had a gambling problem. After losing over a million dollars in ten years, he still could not stop playing poker. John had been a non-compulsive gambler until he won a lot of money in one poker hand. From that point, his gambling was out of control. For John, the feeling-state was composed of the feeling of being a winner combined with the behavior of playing poker.

Tim, however, had a completely different feeling associated with playing poker. What Tim wanted was the feeling of connection with his father. When Tim was growing up, he watched his father playing poker with the ‘guys’. He longed to be part of the group so that he could be with his father. The longed-for event finally occurred when he was in college. The result was that, when Tim played poker, he felt bonded with his father. For Tim, the FS was composed of the feeling of connection with his father combined with the behavior of playing poker.

Dustin’s sexual compulsion began in high school. He and three other buddies set up a competition to see who could have sex with the most number of women. This game became widely known among many of the other kids at school, and bets were placed on who would be the winner. The outcome was close but Dustin won the competition. He described his feeling upon winning as “the best orgasm I have ever had.” For Dustin, the FS was composed of the feeling of winning combined with the behavior of having sex with as many women as he could.

The examples of John and Tim illustrate how the same behavior (playing poker) can be fixated with different feelings. John’s gambling was connected with a winning feeling while Tim’s gambling was connected with a bonding feeling. On the other hand, the same feeling (winning) can be connected with different behaviors. John experienced winning through playing poker; Dustin experienced winning through having sex with many women. That any feeling can become fixated with any behavior is, therefore, a fundamental premise of the FST.

The Underlying Feeling is the Real Goal of an Addiction

The FST of addictions presumes that the feeling underlying the behavior, not the apparent object or behavior, is the real goal of the impulsive behavior. For example, the real object of Don’s sexual behavior was to feel approval from others; sex was not the true object of his behavior. Sarah sought to feel whole, not to have sex with her boyfriend. Terri wanted excitement, not clothes she did not even wear. Therefore the assumption of this theory is that no matter what the object of the behavior is, what the person really seeks is the feeling that is linked to that behavior. The different types of behaviors that are often part of feeling-states include gambling, shopping, kleptomania, video games playing, sexual, pornography, socializing, and relationship “addictions”.

The Real Need is for Healthy Desires not Destructive Desires

An important premise of the FST is that all the destructive behaviors associated with Impulse-Control Disorders have their basis in normal, healthy desires that are part of everyone’s psyche. The desires for success, to belong, to win, for wholeness, etc. are all normal, healthy desires. The distortion into destructive behavior occurs because the desire has become rigidly linked with a particular behavior and is no longer subject to rational control. The good news for treatment is that it appears that once this FS is broken, the person automatically begins to seek more appropriate ways to obtain what he desires. Learning new social skills or other developments may then become the necessary focus of therapy.

Feeling-State Addiction Therapy

Feeling-State Addiction Therapy (FSAT) combines the FST of Behavioral and Substance Addiction with a modified form of Eye Movement Desensitization and Reprocessing (EMDR). EMDR has been shown to be effective in the treatment of Post Traumatic Stress disorder and other trauma-based disorders (Rothbaum, 1997; Shapiro, 1989; Van der Kolk et al., 2007). Just as EMDR can process traumas, clinical experience suggests that a modified form of EMDR can also be used in the treatment of behavioral and substance addictions. The therapy is often brief, 5 to 6 sessions, and results indicate a profound change in behavior that is noticeable to patients as well as to their relatives and friends.

In the FSAP, the feeling-state is the target for therapy. Composed of the desired feeling and a behavior fixated with that feeling, the feeling-state is processed through the use of eye movements. The most important modification of the EMDR protocol involves the approach used in the processing of the negative beliefs and the installation of positive beliefs.

Identifying the Real Addictive Behavior –  Don’s Story   

The exact compulsive behavior may not be obvious. When Don first described his sexual compulsion, he focused on the women he had sex with. The aspect of his behavior that involved telling a friend and not wanting sex afterwards was not obvious. It was only when the complete behavior was identified that the real feeling, the desire for approval, became clear. Therefore, identifying the exact behaviors and feelings that compose the feeling-state is crucial.

Compulsive behavior can also have more than one feeling-state associated with the behavior. For example, a person’s gambling behavior may be associated with two different feeling-states linked with the feelings of winning and freedom. These multiple feeling-states are usually not obvious at the beginning of therapy. Sometimes additional feeling-states emerge quickly and can be identified and processed. Other times these additional feeling-states require a month or more to surface. Clinical experience suggests that the behavior associated with the additional feeling-states may focus on a slightly different aspect of the compulsive behavior.

Identifying the Correct Feeling

As described previously, a FS can be composed of any desired feeling and any behavior. Because of the lack of any obvious or necessary connection between any particular feeling and behavior, identifying the exact behavior and feelings is the key element of the FSAP therapeutic process.  People often identify “excitement” as the feeling they experience when they imagine themselves about to act out the compulsive behavior. However, excitement is often the feeling of anticipation. The excitement of anticipation can also be triggered by other sought-after feelings.  This excitement of anticipation would still not be the real feeling that is a component of the FS. Discerning when excitement is the real target or when excitement is covering up the real target is important. Targeting a feeling that is not actually the feeling-state component of the memory will result in the FS not being processed.

Targeting Urges and Cravings

People usually associate with impulse control problems with the “feelings” of urges and craving. However, the urges and cravings are not the feelings that the person seeks but rather the drive for the feelings associated with the behavior that are linked with them. An urge is a wanting, but not the feeling that is wanted. Don felt the urge to have sex and tell a friend, but he was not aware of his need for approval. Sarah felt the urge to be with her ex-boyfriend, but was not aware of her need to feel whole. The focus on the feelings of urge or craving does not reveal the actual desired feeling.

To Abstain or NOT For Behavioral Addictions

For behavioral addictions, an important difference between the FSAP and other approaches is that abstinence is neither necessary nor desired. Quite the contrary.  FSAP requires that the feelings associated with the compulsion be experienced as intensely as possible during the therapy session. For those clients whose behavior is out of control, there is little trouble with this requirement. On the other hand, those people who have been controlling their behavior, have also been controlling their feelings as well. Because of past disasters, they are afraid of letting the feelings surface again. However, as with the processing of trauma with EMDR, if feelings are not present no processing takes place. In addition, when the behavior is out of control at the beginning of therapy, progress in therapy can easily be evaluated. The feelings and behavior that arise between therapy sessions point out areas that still need to be targeted. Further, the result of a successful FSAP treatment is that the out-of-control behavior is no longer out of control. In fact, the compulsive gambler can gamble, the compulsive buyer can buy, and the sex addict can have sex– without losing control. The goal of FSAP is not abstinence but normal, healthy behavior.

Case Study Of a Sex Addict- Steve

(The following case study illustrates the application of the Feeling-State Theory of Addiction used in conjunction with a modified form of the EMDR protocol.)

Steve came into therapy because his sex addiction had destroyed his marriage and was about to destroy his current relationship with his girlfriend. At age 39 he had been visiting strip clubs and massage parlors since his early 20’s. One marriage and $100,000 later, he was becoming desperate to change this behavior. He had tried self-help groups and some therapy and had been able to control his behavior for a while but each time had relapsed. At the beginning of therapy, Steve was going to strip clubs about 3 times a week and visiting massage parlors twice a week.

When we began analyzing Steve’s behavior, it turned out that Steve had two sexual addictions, not one. Even though the feelings had not been completely analyzed, it was evident that the strip club behavior and the massage parlor behavior were linked with different feelings. Steve noted that he would go to strip clubs for excitement and to massage parlors for relaxation. Therefore, these two behaviors would be treated as separate feeling-states.

Steve chose the strip club compulsion as the first target of therapy. He quickly identified that he felt powerful when he paid money to get women to perform for him. To process this feeling-state, Steve visualized this image and the feeling of power he experienced. After 3 sets of eye movements, the SUES level (Subjective Units of Experience Scale) dropped from 10 to 1. His homework was to go back to the strip club and to be aware of his feelings. A week later in the second session, he reported that, while the feeling was much less intense, he still wanted to go back. He again identified the feeling he was experiencing as “I’m powerful.” This feeling-state was again processed and the SUES went from 5 to 0. Afterward the negative belief “I’m weak” was identified and processed. The belief “I have a lot of strengths” was installed. His homework was again to go to the strip club and discover what feelings were still being triggered.

Two weeks later in the third session Steve reported that, after going twice to the strip club, he just stopped going. He said,” I haven’t even been thinking about it.” The compulsion to go to the massage parlor was targeted in the third session as well. The feeling Steve identified was that he felt safe; he did not have to perform, and nothing was expected of him. That feeling of safety evoked an image of him lying in the massage parlor room before any activities began. Using eye movements to process that feeling-state, the SUES level dropped from 8 to 2 by the end of the session. The homework was to become aware of his feelings about the massage parlor.

In the fourth session, Steve reported that his urge was less but still powerful. When asked to identify the feeling, the feeling of safety was still present. Targeting that feeling-state again, the SUES dropped to zero after the first set of eye movements. The author then asked Steve to imagine the entire sequence of events in the massage parlor and notice if he felt emotional intensity about any of them. He reported a SUES level of 7 when he imagined the woman touching him. The feeling he identified was that he felt loved. The feeling-state, composed of the image of the woman touching him and the feeling “safety”, was processed with eye movements, and the SUES  dropped from 7 to 1. Once again the homework was to be aware of his feelings about going to massage parlors.

In the fifth session two weeks later, Steve reported that he went to a massage parlor two days after the last session but left before completion. He said that the reality of the woman and the room overcame his fantasies; he felt totally “grossed out” about the situation. The rest of that session and the following session were devoted to processing the negative beliefs “I’m scared” and “no one loves me.” The positive beliefs installed were “I’m safe in the world” and “I’m lovable.” The seventh and eighth sessions were focused on altering the negative beliefs that were created by the sexual compulsion: “There’s something wrong with me” and “I’m no good.” The next session was scheduled for six weeks later to allow time for feeling-states to emerge that had not yet been identified.

Steve reported in the next session that for 4 weeks he had neither gone to nor had the urge to go to either strip clubs or massage parlors. After work one Friday, his co-workers ask him to go with them to a strip club. The co-workers knew he had a lot of experience with strip clubs and wanted him to show them the ropes, so to speak. Reluctantly, he agreed to go with them. This time he experienced a different kind of rush. After that experience, he went 3 times a week for the next 2 weeks to the strip clubs.

When Steve was asked to identify the image that resonated emotionally with him, the women were not the focus this time, as they were before. Instead, he felt admired and approved of because his fellow co-workers were impressed that he knew how to get the women to perform in certain ways. In his words, he felt like he was the “Big Man On Campus!” The feeling-state was processed with eye movements, and the SUES level dropped from 9 to 1. The negative belief related to that Big-Man-On-Campus feeling-state was “I’m a nobody.” The positive belief that was installed was “I’m a person in my own right.”

Another session was scheduled for 6 weeks later to again allow time for any additional feeling-states to emerge. During this session, Steve reported that, since the last session, he had not had any urges to visit either the strip clubs or the massage parlors. So this session was used to identify the beliefs that were the result of his out-of-control sexual behavior. Steve identified two beliefs–“I’m gross” and “There’s something wrong with me.” The positive beliefs chosen to be installed were “I’m really okay” and “I’m good in my life.” The usual homework was assigned, and the next session was scheduled for eight weeks later. One week before the scheduled session, Steve called to cancel the appointment saying that no episodes of his urges or behaviors had occurred. In a follow-up phone call 6 months later, he was happy to announce that his sexual addictive behavior had not reoccurred.

Case Discussion

Steve’s sexual addiction was composed of two behavior and two feeling-states. Steve’s situation was further complicated by the fact that the feeling-state involving approval emerged six weeks after he had stopped going to strip clubs. The additional feeling-state had been triggered by a situation he had not previously identified. Because people have many different needs and these needs can become linked with virtually any kind of behavior, the variety of feeling-states is enormous. These cases show a small sample of that multiplicity and complexity.

A similarity between behavioral addictions and substance addictions is that clinical experience suggests that there can be more than one FS underlying the addictive behavior. For example, a person with a sex addiction had two FSs, the feelings of “victory” and the feeling of being “admired,” associated with his sexual addiction. Three and even four FSs associated with one addiction are not unusual. An example of this related to substance addiction was a person with a cigarette addiction whose three FSs involved the rush connected with his reaction to nicotine, feelings of companionship, and feeling of defiance. Clinical experience suggests that the more interconnected the behavior is in the person’s life, the more likely that there will be multiple FSs involved in that behavior.

Traumas, Neglect, and Addiction

There is a strong correlation between traumas and behavioral and substance addictions. (Edited text) Studies indicate the same correlation between trauma and sexual addiction. The question then becomes how does the Feeling-State Theory of Addictions account for this association?

Traumas are known to create negative beliefs and feelings (Shapiro, 2005). The Feeling-State Theory proposes that traumas contribute to the formation of Addictions through the creation of negative beliefs and feelings. Negative beliefs such as “I am powerless”, “I’m a loser” and, “nothing I do makes a difference” become the basis for the creation of a feeling-state for addictions. For example, a person who feels he is a loser, due to a previous trauma, may feel intense feelings of being a winner if a wins a big poker hand. Clearly, multiple traumas will increase the intensity of these negative feelings as well as creating more negative beliefs. This can explain why people who have experienced more traumatic events are more likely to have impulse control problems. More traumatic experiences create more negative feelings. More negative feelings increase the intensity of the desire for the opposite/positive feeling. The increased intensity of desire for the positive feeling makes it more likely that when an event occurs that answers the need for that positive feeling, a feeling-state and therefore an Impulse-Control Disorder, will be created.

In addition to trauma, the other clear association with pathological gambling and sexual compulsion is neglect. A study showed that serious neglect as a child was a significant risk for pathological gambling. Another study of the family dynamics of people with sexual compulsion found that 68% came from families that were rigid and disengaged. There was little warmth or nurturing. The Feeling-State Theory proposes that the emotional deprivation created by the neglect creates an intense desire for the opposite/positive feeling. The result is that when an event occurs that answers that need, a feeling-state is formed and an Impulse-Control Disorder is created. Therefore, the Feeling-State Theory of Impulse Control Disorders explains the research that indicates the association between the experiences of traumas and neglect and Addictions.

FSAP can be useful in the overall treatment in working with people who come to therapy for other reasons such as depression and anxiety. Often, along with other difficulties, clients have an attachment that is the result of a feeling-state. Sometimes this attachment is a cause of depression. For example, one client would become severely depressed and drink whenever she thought of her ex-husband who had remarried. In this case, her depression appeared to be the result of her inability to carry out the behavior related to the feeling-state. The client had two memories related to the feeling of safety and the behavior of being with him. Once this feeling-state was processed with FSAP, she no longer became depressed when thinking of him.”

While EMDR, and specifically the FSAP, does not cure addictions,  there is strong anecdotal evidence along with preliminary research to suggest that treatment of substance addictions and behavioral compulsions and addictions will greatly benefit from this modality.” Robert Miller, 2011

If you or someone you know is struggling with sexual compulsive behaviors and addictions, please contact Debra to arrange an appointment.  Left untreated, sex addiction and its constellations of behaviors often worsen; not improve.