# Göz Hareketleriyle Duyarsızlaştırma ve Yeniden İşleme (EMDR) Müdahalesinin Alkol Kullanım Bozukluğunda Aşermeyi Önlemedeki Etkisi: Pilot Randomize Kontrollü Çalışma (The Effect of an Eye Movement Desensitization and Reprocessing (EMDR) Intervention on Preventing Craving in Alcohol Use Disorder: A Pilot Randomized Controlled Trial) - - URL: https://alisanburak.com/en/goz-hareketleriyle-duyarsizlastirma-ve-yeniden-isleme-emdr-mudahalesinin-alkol-kullanim-bozuklugunda-asermeyi-onlemedeki-etkisi-pilot-randomize-kontrollu-calisma - Language: en - Last updated: 2026-08-15 - Page title: Göz Hareketleriyle Duyarsızlaştırma ve Yeniden İşleme (EMDR) Müdahalesinin Alkol Kullanım Bozukluğunda Aşermeyi Önlemedeki Etkisi: Pilot Randomize Kontrollü Çalışma - | Assoc. Prof. Dr. Alişan Burak Yaşar > Göz Hareketleriyle Duyarsızlaştırma ve Yeniden İşleme (EMDR) Müdahalesinin Alkol Kullanım Bozukluğunda Aşermeyi Önlemedeki Etkisi: Pilot Randomize Kontroll This page was translated automatically from Turkish. [Read the original](https://alisanburak.com/goz-hareketleriyle-duyarsizlastirma-ve-yeniden-isleme-emdr-mudahalesinin-alkol-kullanim-bozuklugunda-asermeyi-onlemedeki-etkisi-pilot-randomize-kontrollu-calisma) [← Back to blog](https://alisanburak.com/en/blog) # Göz Hareketleriyle Duyarsızlaştırma ve Yeniden İşleme (EMDR) Müdahalesinin Alkol Kullanım Bozukluğunda Aşermeyi Önlemedeki Etkisi: Pilot Randomize Kontrollü Çalışma (The Effect of an Eye Movement Desensitization and Reprocessing (EMDR) Intervention on Preventing Craving in Alcohol Use Disorder: A Pilot Randomized Controlled Trial) - March 20, 2025Recent Articles **Göz Hareketleriyle Duyarsızlaştırma ve Yeniden İşleme (EMDR) Müdahalesinin Alkol Kullanım Bozukluğunda Aşermeyi Önlemedeki Etkisi: Pilot Randomize Kontrollü Çalışma - *Eye Movement Desensitization and Reprocessing Intervention in Preventing Craving in Alcohol Use Disorder: A Pilot Randomized Controlled Trial*** **Authors:** Yağmur Callak Sarğın1* , Zeki Yüncü2 , and Umut Kırlı3 1 Department of Child Care and Youth Services, Bursa Uludag University, Bursa 16059, Turkey. 2 Department of Child and Adolescent Psychiatry, Ege University, İzmir 35100, Turkey. 3 Institute on Drug Abuse, Toxicology and Pharmaceutical Science, Ege University, İzmir 35100, Turkey. ***Address correspondence to:**[ycallak@gmail.com](mailto:ycallak@gmail.com) **Translated by:** Specialist Psychologist Gizem Pozam **Objective:** This pilot study aimed to evaluate the effectiveness of addiction-focused eye movement desensitization and reprocessing (AF-EMDR) therapy compared with treatment as usual (TAU) in reducing alcohol craving in clients with alcohol use disorder (AUD). Based on the adaptive information processing model, changes in craving severity and experience were examined by targeting craving memories thought to be stored in episodic memory. **Method:** A randomized controlled trial was conducted. A total of twenty-four clients with a past or current diagnosis of AUD completed the study (nEMDR+TAU = 12; nTAU = 12). The intervention consisted of 3 sessions of AF-EMDR therapy. Clients completed assessments of craving severity, craving experience, clinical symptoms, self-efficacy, and functioning at baseline, post-intervention, and the 1-month follow-up. **Results:** Compared with TAU, craving severity decreased significantly following the intervention in the EMDR + TAU group. Functioning in the EMDR + TAU group continued to improve at post-intervention and the 1-month follow-up assessment. Although there was no significant between-group difference in self-efficacy following the intervention, self-efficacy in the TAU group decreased significantly at the 1-month follow-up. No significant between-group differences were found in craving experience or clinical symptom severity. **Conclusion:** Overall, the AF-EMDR protocol is a novel clinical approach in addiction treatment. One limitation of the present study is its small sample size, which may affect the generalizability of the findings. This method needs to be supported by future randomized controlled trials. **Introduction** Alcohol use disorder (AUD) is defined as a loss of control over alcohol use, excessive alcohol consumption, a strong desire to continue drinking, and continued alcohol consumption despite alcohol-related problems . It is a major public health concern because it is a common psychiatric disorder in the general population . Of the 137.4 million current alcohol users aged 12 and older, more than 60 million meet the criteria for AUD . The lifetime prevalence of AUD varies by region, ranging from 2.4% to 14.3% . Alcohol consumption ranks third in terms of the global burden of disease, and 3.3 million deaths each year are attributed to AUD . In addition, alcohol-related productivity losses [7, 8], social burden [9–11], and crime [9, 11, 12] are substantial. This highlights the importance of investing in AUD treatment for governments and individuals. One of the symptoms researchers focus on in AUD treatment is craving. Craving is defined as a strong urge to drink that makes it difficult to think about anything else and often leads to resumed alcohol use . The relationship between craving and addictive behavior was first described in the 1950s by Jellinek and colleagues, who identified craving as a core component of alcohol dependence. There is a strong relationship between craving and the persistence or relapse of AUD [15–18]. Alcohol craving severity has also been reported to predict the time until alcohol use resumes after treatment . Clients who experience more severe craving are more likely to return to alcohol use [19, 20]. Although effective pharmacological treatment options are available for AUD, they remain insufficient for preventing craving and relapse and maintaining abstinence [21–23]. Three-quarters of clients receiving pharmacological treatment resume drinking within the first year, and one-quarter still have at least one AUD symptom . When pharmacological treatment options are insufficient, the importance of incorporating psychosocial support and treatments into the treatment process has been emphasized . The best outcomes have been reported when pharmacological treatments and psychotherapy are combined . However, even combined treatments are known to fall short of the desired effect on alcohol craving . Psychotherapeutic interventions aimed directly at preventing alcohol craving are limited. Cognitive behavioral therapy [28, 29], mindfulness-based approaches [30, 31], repetitive imagery [23, 32], imagery rescripting [33–35], exercise, and exposure therapy show promise in preventing craving. However, the search for additional treatment options to prevent craving continues. **Eye Movement Desensitization and Reprocessing (EMDR)** Eye movement desensitization and reprocessing (EMDR) therapy is an 8-phase psychotherapeutic approach consisting of standardized protocols and procedures that target unprocessed memories of adverse life experiences . These memories are assumed to underlie current psychopathology or dysfunction. EMDR therapy was initially found to be effective in treating trauma-related disorders and has been adapted in recent years for other mental disorders, including addictions [40, 41]. Although the standard trauma-focused EMDR protocol has been reported to have a relatively limited effect on AUD symptoms, it may be effective in reducing traumatic symptoms, anxiety, and depression, while also improving factors such as quality of life and self-esteem [42–44]. These findings laid the groundwork for the development of addiction-focused EMDR protocols that directly target AUD symptoms [45, 46]. **Adaptive Information Processing Model** The adaptive information processing (AIP) model proposes that maladaptive representations develop when an individual is unable to adequately process and store a new experience in episodic memory networks. These maladaptive representations give rise to distorted thoughts, sensations, and emotions associated with the experience and form the basis of psychopathology . Bilateral stimulation (BLS), used in EMDR, facilitates the reactivation of traumatic memories within the context of episodic memory. Over time, these representations are desensitized, allowing a more adaptive view of the self to develop . Addictive behavior develops when neutral stimuli become conditioned stimuli through pairing with a substance, subsequently leading to substance-seeking behavior . According to Boening, the activation of addiction memory, in which substance-specific effects develop through substance-related cues, results in intense substance craving. Hase and colleagues noted that addiction memory is structurally similar to the traumatic memory reprocessed in EMDR. If addiction memory is assumed to be structurally similar to traumatic memory, EMDR therapy may be effective for addictive behavior . Based on this view, some researchers have revised the standard EMDR protocol to focus on addiction. Addiction-Focused Eye Movement Desensitization and Reprocessing (AF-EMDR) Protocols The first adaptation of addiction-focused EMDR (AF-EMDR) was the **desensitization of triggers and urge reprocessing (DeTUR) protocol**, developed by Popky . Popky stated that the primary purpose of using addictive substances is to prevent stress and maintain the reinforcing effect of the temporary relief provided by these substances. In the DeTUR protocol, memory representations of images that trigger addictive behavior are fully desensitized, after which the client is conditioned to the positive emotion or state selected as the treatment goal. This aims to increase clients’ resilience to stressful situations . The protocol uses the level of urge (LoU) scale, representing subjective units of disturbance (SUD), to assess craving levels. **Knipe’s AF-EMDR model** aims to process dysfunctional positive affect and uncover ambivalence toward treatment goals. The short-lived positive emotions experienced as a result of addictive behavior are considered one of the key factors maintaining addiction. In addition to the SUD and LoU scales, this protocol also uses the **level of positive affect (LoPA) scale**. However, this approach has not yet been evaluated in controlled or uncontrolled studies . Similar to Knipe’s model, the **feeling-state addiction protocol (FSAP)** proposes that dysfunctional positive emotions induced by addictive substances may become associated with specific behaviors, leading individuals to engage in addictive behavior to re-experience these positive emotions. In this protocol, after the most positive aspects of the addictive behavior have been identified, memories representing the link between the problematic behavior and the underlying healthy need are identified. These memories are elicited using the **affect bridge technique**. During the desensitization phase, negative associations that may have contributed to unmet needs or a negative self-image may emerge. This emerging negative material is processed using the standard EMDR protocol . **The "Craving Extinguished (CravEx) protocol," developed by Hase and colleagues**, focuses on the concept of an addiction memory network. This network is assumed to contain memories of addiction-related loss of control and memory representations of the specific substance . It includes craving and relapse memories related to the client’s substance of choice. The CravEx protocol follows Shapiro’s three-pronged approach. In this approach, past relapse memories (first, worst, most recent), craving memories (first, worst, most recent), current triggers, and fears about the future are desensitized. **Clinical Studies on Addiction and EMDR** The literature includes clinical studies evaluating the effectiveness of EMDR psychotherapy in treating traumatic symptoms in clients with alcohol and substance use disorders [40, 44, 56]. However, studies in which EMDR psychotherapy directly targets addiction symptoms are limited. Only a few of these studies have been conducted with clients diagnosed with AUD [50, 57] or have addressed craving [42, 50, 58, 59]. There is therefore a significant gap in the literature in this area. This pilot study aimed to address this gap by investigating the effectiveness of AF-EMDR psychotherapy in reducing craving severity and the level of craving experience in clients with AUD. The literature on the effects of EMDR psychotherapy on psychological well-being is very limited. This study also examined the effects of AF-EMDR psychotherapy on various psychological factors in clients with AUD. **Methods** **Study Design** This study was conducted as a randomized controlled trial. Participants were randomly assigned to EMDR + treatment as usual (TAU) or TAU alone. The primary outcome variables were craving severity and the level of craving experience. The secondary outcome variables were clinical symptoms, self-efficacy, and functioning. Assessments were conducted at three time points: - Pre-treatment (t₀) - Post-treatment (week 5, t₁) - One-month follow-up (week 9, t₂) **Participants** The study analyzed the records of clients who attended the addiction outpatient clinic at Ege University’s Institute on Drug Abuse, Toxicology and Pharmaceutical Science between 2021 and 2022 and had completed treatment or were still receiving it. **Inclusion criteria:** (a) Meeting the diagnostic criteria for AUD, (b) Currently receiving or having completed TAU at the outpatient clinic, (c) Being aged **18–65 years**. **Exclusion criteria:** (a) A history of a psychotic disorder, (b) Receiving any psychological or medical treatment for AUD other than the TAU provided at the addiction outpatient clinic, (c) Having at least one of the following: cardiovascular disease, vertigo, epilepsy, or an eye disorder, because bilateral eye movements have the potential to trigger medical problems specific to these conditions (see Figure 1). **Sample Size and Power Analysis** Hase and colleagues’ study was used as a reference to determine the sample size for this study. Their study was similar to the present study in its research methodology and sample type. Cohen’s d was calculated as 1.61. - Using G*Power 3.1.9.2 with α = 0.05 and power (1 - β) = 0.95, the required sample size for the “t-test family, difference between two independent means” was calculated as 24. - Markus and colleagues reported an attrition rate of 33% in their study. - Assuming a similar attrition rate, the final sample size was set at 30. **Materials and Measures** **EMDR Therapy** Following Shapiro’s standard 8-phase EMDR protocol, three targets related to the past, present, and future were processed. Memories related to alcohol dependence were addressed rather than traumatic experiences. The protocol model was based on the CravEx protocol developed by Hase and colleagues. - In the first session, the client’s most recent memory of intense alcohol craving was processed. - In the second session, a strong stimulus that triggered alcohol craving in the client was targeted. - In the third session, a scenario that could lead to future alcohol use was addressed. The general structure of a session is presented in Table 1. The psychotherapist who conducted the EMDR sessions was a specialist who had completed EMDR psychotherapy training provided by an internationally accredited trainer and held certification as an EMDR practitioner. **Treatment as Usual (TAU)** TAU consisted of medical treatment for AUD provided by a psychiatrist at the university’s addiction outpatient clinic. Motivational interviewing techniques were used when needed. **Assessment Instruments** **Sociodemographic Information Form** Information was collected on participants’ gender, age, occupation, perceived income level, previous treatment and diagnostic history, medical conditions, age at first alcohol use, age at onset of heavy alcohol use, and date of last alcohol use. This form was completed by the researcher during the clinical interview. **Alcohol Use Disorders Identification Test (AUDIT)** Developed by Saunders and colleagues, this is a 10-item self-report scale with 3- and 5-point Likert-type response options that measures AUD severity. It was adapted into Turkish by Saatçioğlu and colleagues. Cronbach’s α was found to be 0.65. Scores of 8 or above indicate hazardous use, while scores of 16 or above indicate high risk. **Childhood Trauma Questionnaire (CTQ)** Developed by Bernstein, this is a 5-point Likert-type self-report scale used to determine levels of physical, emotional, and sexual abuse. The scale contains 28 items across 5 subscales and assesses physical and emotional neglect, as well as physical, emotional, and sexual abuse. The cutoff score for the Turkish adaptation was set at 35 . **Penn Alcohol Craving Scale (PACS)** Developed by Flannery and colleagues, this is a 5-item self-report scale used to measure craving severity in clients with AUD. Craving severity is calculated from the total score by measuring the frequency and duration of craving over the preceding week. Its validity and reliability have been studied in Turkish . **Craving Experience Questionnaire** This was adapted from the Alcohol Craving Experience Questionnaire developed by May and colleagues. The scale measures craving-related imagery, intensity, and intrusiveness. - **Intensity**: Focuses on how strong, unmanageable, or urgent the craving feels. - **Imagery**: Assesses mental images or sensory experiences associated with craving. - **Intrusiveness**: Measures how much craving-related thoughts disrupt a person’s current activities or mental state. The scale can be evaluated as a single factor (total score) or across 3 factors. It was adapted into Turkish by Kılıç. **DSM-5 Level 1 Cross-Cutting Symptom Measure** Developed by Narrow and colleagues, this is a Likert-type self-report scale measuring 13 clinical symptom domains (depression, anger, mania, anxiety, somatic symptoms, suicidal ideation, psychosis, sleep problems, memory problems, repetitive thoughts and behaviors, dissociation, personality problems, and substance use). The Turkish adaptation was conducted by Çökmüş and colleagues, and the scale’s Cronbach’s α is above 0.90. **General Self-Efficacy Scale (GSES)** This is a 5-point Likert-type self-report scale developed by Sherer to measure individuals’ self-efficacy. The scale was evaluated as a single factor using the total score. It was adapted into Turkish by Yıldırım & İlhan, and Cronbach’s α was calculated as 0.80. **Global Assessment of Functioning (GAF)** Developed by the American Psychiatric Association in 1996, this scale assesses global functioning and constitutes Axis V of the DSM-IV. It is designed to assess social, occupational, and psychological functioning and is scored from 0 to 100. Lower scores indicate poorer functioning. **Study Procedure** - This study was approved by the Ege University Clinical Research Ethics Committee and registered on ClinicalTrials.gov under protocol number NCT05606900. - Face-to-face or telephone interviews were conducted with patients who attended the addiction outpatient clinic and were diagnosed with AUD. - An individual assessment session was scheduled for patients who wished to participate. - During the assessment, participants received detailed information about the study and signed a written consent form. **Table 1. AF-EMDR Protocol for Craving in Alcohol Use Disorder** 1. Phase: Client History 1. A standard client history was obtained, and dissociative symptoms and post-traumatic stress disorder (PTSD) symptoms were assessed. 2. The client’s existing and required resources were assessed. 3. The history of alcohol use disorder was reviewed, including when the client lost control over alcohol use and significant life events during that period. 4. Craving-related memories (most recent craving memory, first craving memory, most intense craving memory), situations that triggered craving, current stressors, and fears about the future related to addictive behaviors were identified. 1. Phase: Preparation 1. The basic principles and process of EMDR were explained. 2. The client was advised to prepare for re-experiencing substance-related effects during the sessions. 3. A safe place exercise was conducted to enhance the client’s emotional regulation during the session, and the exercise was tested using a mildly disturbing memory. 1. Phase: Assessment 1. Based on Shapiro’s three-pronged approach, an alcohol craving memory, a current trigger for alcohol use, and a future scenario that could threaten abstinence were addressed over three sessions. - The target material was broken down into sensory, cognitive, and emotional components. - After the target material was visualized, - Craving intensity [Level of Urge (LoU)] - Strength of belief in the positive cognition [Validity of Cognition (VoC)] were assessed. 1. Phase: Desensitization 1. The standard EMDR desensitization process continued until the LoU score reached 0 or 1. 1. Phase: Installation 1. After desensitization was completed, the VoC score was reassessed. - When necessary, the installation process continued until the VoC score reached 6 or 7. 1. Phase: Body Scan 1. In accordance with standard EMDR procedures, **bodily sensations associated with the memory were scanned**. 1. Phase: Closure 1. The session was concluded using the standard EMDR closure procedure. 1. Phase: Reevaluation 1. At the beginning of the second and third EMDR sessions, the LoU and VoC scores for previously processed material were reassessed. - When necessary, the previous target material was revisited in accordance with the standard protocol. **Study Procedure and Data Analysis** **Baseline Assessment and Random Assignment** Pre-treatment measurements for all participants were obtained during the assessment session (t₀). Each participant was assigned a protocol number. Participants were randomly assigned to the experimental and control groups. To prevent selection bias, stratified randomization was conducted by an independent researcher. Participants were randomized according to age, gender, previous treatment history, addiction severity, craving level, clinical symptoms, and childhood trauma scores. - Participants in the EMDR + TAU group were contacted and informed of their assignment to the treatment group and the date of their first session. - Participants in the TAU group were informed that they had been placed on a waiting list. **EMDR Treatment Procedure** - Participants in the EMDR + TAU group received treatment on the scheduled dates in a room suitable for psychotherapy. - Sessions lasted approximately 60–90 minutes. - The treatment, consisting of 3 sessions in total, was completed within approximately 3 weeks for each participant. - Sessions were held once a week. - Participants who attended only 1 or 2 sessions were considered not to have completed treatment and were excluded from the final analyses. - Post-treatment measurements were obtained an average of 5 weeks after the assessment session (t₁). - Follow-up measurements were obtained an average of 4 weeks after the post-treatment measurements (t₂). All assessment sessions, AF-EMDR sessions, and statistical analyses were conducted and reported by the same certified psychotherapist. **Data Analysis** - Statistical analyses were conducted using SPSS 24 (Statistical Package for the Social Sciences). - Nonparametric tests were used because of the sample size. - Skewness and kurtosis values were checked to assess normality. - At baseline, the homogeneity of the EMDR + TAU and TAU groups was analyzed using the Mann–Whitney U test. - The Friedman test was used for within-subject comparisons, and the Wilcoxon signed-rank test was used for post hoc analyses. - The Mann–Whitney U test was used for between-group comparisons. - Statistical significance was set at P < 0.05. - Statistically significant values in the tables were marked with an asterisk (*). **Results** **Demographic Data** According to the chi-square analysis, there were no significant differences in demographic distribution between the EMDR + TAU (M age = 41.75 ± 9.15) and TAU (M age = 45.66 ± 11.08) groups, except for income level. - The EMDR + TAU group consisted mainly of individuals with middle and high incomes. - The TAU group consisted mainly of individuals with low and middle incomes. **The groups were evenly distributed with respect to other variables:** - **Marital status**: Both groups included 7 single and 5 married participants. - **Psychiatric diagnostic history**: Each group included 5 individuals with a previous psychiatric diagnosis. - **Medical history**: Four participants in the EMDR + TAU group and 5 in the TAU group had medical conditions (conditions that did not interfere with treatment). - **Tobacco use**: Nine individuals in the EMDR + TAU group and 10 in the TAU group smoked. **There were no differences in ages at alcohol use onset:** - **EMDR + TAU group**: Age at first alcohol use 19.50 ± 5.38, age at onset of problematic use 35.16 ± 10.34 - **TAU group**: Age at first alcohol use 23.66 ± 6.09, age at onset of problematic use 40.16 ± 11.54 **There were no differences in previous treatment for alcohol dependence or family history:** - Number of individuals who had previously received treatment for alcohol dependence: - **EMDR + TAU group**: 6 individuals - **TAU group**: 9 individuals - Number of individuals with a family history of frequent alcohol consumption: - **EMDR + TAU group**: 7 individuals - **TAU group**: 5 individuals There were no between-group differences in time since last alcohol use or changes in medical treatment. **Changes in LoU and VoC** - **In the first and second sessions**, **level of urge (LoU) measurements** were obtained at the beginning and end of each session: - **Beginning of the first session**: Md. = 9.50, IQR = 6.25 – 10.00 - **End of the first session**: Md. = 2.00, IQR = 0.00 – 3.00 - **Beginning of the second session**: Md. = 7.00, IQR = 5.50 – 9.75 - **End of the second session**: Md. = 2.00, IQR = 0.00 – 2.75 - **In the third session**, **validity of cognition (VoC) measurements** were obtained: - **Beginning of the third session**: Md. = 3.00, IQR = 3.00 – 4.75 - **End of the third session**: Md. = 6.50, IQR = 5.25 – 7.00 According to the Wilcoxon signed-rank test, LoU scores decreased significantly by the end of the sessions. Similarly, VoC scores increased significantly by the end of the third session. **Baseline Measurements** - Both the EMDR + TAU and TAU groups were in the high-risk category for AUD severity and trauma levels. - Before treatment, the groups were homogeneous across all study variables. - There were no statistically significant differences between the baseline scores of the two groups. **Changes from Pre-treatment to Post-treatment and the 1-Month Follow-up** **EMDR + TAU Results** - **Penn Alcohol Craving Scale (PACS)**, - **Craving Experience Questionnaire (CEQ) – Intensity and Imagery**, - **DSM-5 Cross-Cutting Symptom Measure (DSM-XC)**, - **Global Assessment of Functioning (GAF)** Statistically significant differences in these variables were found in the within-subject analyses (see Table 2 and Table 3). **TAU Results** Within-subject analyses revealed significant differences in Penn Alcohol Craving Scale (PACS) and DSM-5 Cross-Cutting Symptom Measure (DSM-XC) scores (see Table 2). - The post-treatment DSM-XC score (Md. = 26.00, IQR = 12.00 – 36.75) was significantly lower than the baseline score (Md. = 29.00, IQR = 24.50 – 44.00). - Although post hoc pairwise comparisons revealed no significant differences in PACS scores, the Friedman test indicated a significant change in PACS scores over time (see Table 3). **Between-Group Comparisons – Post-treatment and 1-Month Follow-up** - The EMDR + TAU group showed a statistically significant decrease in PACS and GAF scores compared with the TAU group. - No significant post-treatment differences were found in the subfactors of the CEQ, DSM-XC, and General Self-Efficacy Scale (GSES). - At the 1-month follow-up, GAF scores in the EMDR + TAU group remained significantly lower than those in the TAU group. - However, the post-treatment difference in PACS scores was not maintained at the 1-month follow-up. - A significant difference in self-efficacy scores was observed at the 1-month follow-up, although there was no between-group difference at post-treatment (see Table 5). - This difference is thought to reflect the maintenance of self-efficacy in the EMDR + TAU group and its decline over time in the TAU group. **Dropout Rate** - Although the dropout rate in the EMDR + TAU group (27.7%) was higher than in the TAU group (7.6%), the difference was not statistically significant (χ² = 2.1, df = 1, P = 0.14). - The effect size (Cramer’s V = 0.08) was very small. - According to the Mann–Whitney U test, participants who dropped out of the EMDR + TAU group did not differ significantly in baseline variables from either the other participants in that group or participants in the TAU group (P > 0.05). **Discussion** **Within-Subject Changes** - In the EMDR + TAU group, craving severity, craving intensity, craving imagery, and functioning levels decreased after treatment. - However, while craving imagery and functioning levels remained low at the 1-month follow-up, the other variables returned to their previous levels. - In the TAU group, the total clinical symptom score decreased significantly after treatment compared with baseline. - No significant changes over time were found in the other variables in the TAU group. **Between-Group Changes** - Post-treatment craving severity and global functioning decreased significantly in the EMDR + TAU group compared with the TAU group. - However, no significant differences over time were found in the craving experience (CEQ) subfactors or the total clinical symptom score. - At the 1-month follow-up, functioning in the EMDR + TAU group remained significantly lower than in the TAU group. - However, the between-group difference in craving severity was not maintained at the 1-month follow-up. - Self-efficacy scores did not differ between groups after treatment, but a significant difference emerged at the 1-month follow-up. - This difference is thought to reflect the maintenance of self-efficacy in the EMDR + TAU group and its decline over time in the TAU group. **Comparison with Previous Research** - In the study by Hase and colleagues (50), craving severity decreased significantly in the EMDR + TAU group, and this reduction was maintained at the 1-month follow-up. - However, the results of the present study differed, as the reduction in craving severity was not maintained. - In a 4-session study conducted with individuals with substance use disorder, - Reductions were observed in craving severity, substance-related pleasure, and the vividness of target memories, but no differences in relapse rates were found at the 6-week and 6-month follow-ups . - In a 4-session study with individuals with opioid use disorder and a 7-session study with patients with AUD, no differences in craving severity were found between the EMDR + TAU and TAU groups. - In a study testing a combination of EMDR + cognitive behavioral therapy (CBT), - Craving and repetitive substance-related thoughts decreased in both groups, but no between-group difference was observed . - A recent study found that eye movements were no more effective than fixed gaze in reducing the emotional load of intrusive images that trigger alcohol craving . **Findings on Secondary Outcomes** - Regarding secondary variables, some studies have reported changes in depression [40, 50], anxiety, psychological symptoms, and functioning. - However, other studies have found no changes in variables such as depression, psychological symptoms, motivation to change, and self-esteem. **Conclusions and Recommendations** - Craving severity, intensity, and imagery decreased following the intervention in the EMDR + TAU group. - However, this effect did not appear to extend beyond 1 month. - Although craving severity and intensity decreased after treatment, a slight increase was observed during follow-up. - While there was a significant difference between the EMDR + TAU and TAU groups following the intervention, this difference disappeared after 1 month (see Figure 2). - Intrusive thoughts related to craving did not change. - These results are based on only 3 sessions of AF-EMDR. - Increasing the number of sessions may reduce craving severity for a longer period. - Longer-term follow-up sessions may help maintain low craving levels. - Combining AF-EMDR with other treatment methods may enhance its effectiveness. **Study Strengths and Limitations** This study is unique in being the first to investigate the effects of EMDR on AUD in a Turkish sample. Given that addiction-focused EMDR (AF-EMDR) protocols are still being tested in clinical research, it contributes to randomized controlled trials on craving in AUD. Although the sample initially reached the calculated size, dropouts during the study meant that the analyses were conducted with less data than planned. - Graphical analyses showed that the difference in Craving Experience Questionnaire (CEQ) scores between the EMDR + TAU and TAU groups increased progressively from baseline to week 9. - However, the difference at follow-up was not statistically significant, although it was very close to the significance threshold. - The smaller-than-planned sample size may have contributed to this result, but a definitive causal relationship cannot be established. Within-subject analyses revealed significant differences in clinical symptom scores in the EMDR + TAU group and craving severity scores in the TAU group. - However, these differences were not confirmed in post hoc pairwise comparisons. - Given that the analyses generally yielded medium or larger effect sizes, it was concluded that sample size contributed to the failure to detect differences. Although patients initially found AF-EMDR unfamiliar compared with conventional methods, most clients were observed to leave the sessions satisfied. - Some clients wished to continue EMDR sessions after the study ended. - However, whether patients in the EMDR + TAU group experienced any treatment-related adverse effects beyond the 1-month follow-up was not assessed. - One patient was reported to have complained of irritability and nightmares over the longer term. - Therefore, clinical studies focusing on addiction-specific symptoms are advised to use clinical interviews or scales to assess and report the long-term effects of treatment. The study used self-report data collection methods. - Self-report scales are known to be susceptible to bias for various reasons, such as placebo effects or a desire to please the therapist. - Therefore, integrating objective measurement methods, such as biological samples, alongside self-report scales would improve the reliability of evaluations of AF-EMDR’s effectiveness. The GAF scale was included in the study despite its absence from DSM-5 because it is widely used in clinical practice. - However, using the "Disability Assessment Schedule" to assess functioning in DSM-5 would be a more up-to-date and accurate approach. Dropout rates were low in both study groups. - Although the dropout rate in the EMDR + TAU group was slightly higher than in the TAU group, this difference was not statistically significant. - In addition, patients who dropped out of the EMDR + TAU group did not differ in baseline variables from other patients in that group or patients in the TAU group. - Possible reasons for the slightly higher dropout rate in the EMDR + TAU group include: - Patients’ unfamiliarity with EMDR - The need to attend the clinic for sessions - Difficulties related to working hours - The lack of follow-up measurements for patients who dropped out of the EMDR + TAU group is an important limitation of the study. - Including patients who drop out in follow-up assessments in future studies may allow additional protocol analyses and thereby contribute to the development of the AF-EMDR protocol. **Conclusion** The newly adopted AF-EMDR protocol primarily aimed to reduce craving severity and craving experience in AUD. - Alcohol craving severity was observed to decrease after treatment, but this effect was found to be short-term. - AF-EMDR therapy improved global functioning in clients with AUD through the end of the 1-month follow-up period. - Clients who received treatment were able to maintain their self-efficacy levels compared with those who did not. However, controlled studies in this area remain very limited, and the research findings need to be retested. - Although the findings are promising, this study was considered a pilot study. - Replicating the findings in larger and more diverse populations is important for increasing validity. - This study was able to include only a short-term follow-up period of 1 month. - However, studies with longer follow-up periods would provide more reliable results for observing the long-term effects of AF-EMDR therapy. **Acknowledgments** This article was **derived from Yağmur Callak Sarğın’s doctoral dissertation, completed in 2023,** *"Alkol Kullanım Bozukluğunda Aşermeyi Önlemede Göz Hareketleriyle Duyarsızlaştırma ve Yeniden İşleme (EMDR) Müdahalesi: Randomize Kontrollü Çalışma”* **as titled**. The dissertation is available at [**https://tez.yok.gov.tr/UlusalTezMerkezi/**](https://tez.yok.gov.tr/UlusalTezMerkezi/). **Funding Information** The authors received no specific grant or financial support for the research, authorship, or publication of this article. **Author Contributions** - All authors contributed to the study design and planning. - Material preparation and data collection were performed by Y.C.S. - Data analysis was performed by Y.C.S. and U.K. - The first draft of the manuscript was written by Y.C.S., and all authors reviewed previous versions. - All authors read and approved the final manuscript. **Conflict of Interest Statement** The authors declare that they have no conflicts of interest. **Data Availability** The data supporting the findings of this study are **not publicly available**. However, they **may be provided by the authors upon reasonable request**. [← Previous Edinilmiş Beyin Hasarı Sonrası Travma Sonrası Stres Bozukluğu İçin Göz Hareketleriyle Duyarsızlaştırma ve Yeniden İşleme: Dört Vakada Çoklu Temel Çizgi Tek Denekli Deneysel Tasarım Çalışması (Eye Movement Desensitization and Reprocessing for Posttraumatic Stress Disorder Following Acquired Brain Injury: A Multiple-Baseline Single-Case Experimental Design Study in Four Cases)](https://alisanburak.com/en/edinilmis-beyin-hasari-sonrasi-travma-sonrasi-stres-bozuklugu-icin-goz-hareketleriyle-duyarsizlastirma-ve-yeniden-isleme-dort-vakada-coklu-temel-cizgi-tek-denekli-deneysel-tasarim-calismasi)[Next → Audio Summaries of Various Books We Recommend for Therapeutic Purposes During Therapy](https://alisanburak.com/en/terapi-surecinde-terapotik-amacla-onerdigimiz-cesitli-kitaplarin-ozetleri) --- Kaynak / Source: https://alisanburak.com/en/goz-hareketleriyle-duyarsizlastirma-ve-yeniden-isleme-emdr-mudahalesinin-alkol-kullanim-bozuklugunda-asermeyi-onlemedeki-etkisi-pilot-randomize-kontrollu-calisma İletişim / Contact: Bağdat Caddesi, Veli Güneysu Apt. No:453 K:4 D:9, Suadiye / Kadıköy, İstanbul · +90 532 642 95 25 · info@alisanburak.com · https://alisanburak.com/bagdat-caddesi-psikoterapi-iletisim