The comorbidity of post-traumatic stress disorder (PTSD) and substance abuse gives sufficient reason to treat patients who are addicted with eye movement desensitization and reprocessing (EMDR). The concept of addiction memory (AM) and its importance in relapse occurrence and maintenance of learned addictive behavior has gained growing acceptance in the field of addiction research and treatment. The name craving extinguished (CravEx) was given to this EMDR strategy because craving seemed to vanish during EMDR reprocessing of the addiction memory in some of the patients. CravEx, as part of a treatment for comorbid addictive clients, focuses on reprocessing of the addiction memory thus leading to stabilization in the addiction. Major traumas can impact on addictive behaviors and are important to include in treatment planning. Anecdotal reports from clinicians indicate an effect of the reprocessing of the addiction memory in patients addicted to heroin or psychostimulants.

Studies show that there is a high risk for relapse in major depression (MD). Each depressive episode increases the risk of relapse by 15” and the episodes get more severe with each relapse. It is the third most common cause for primary health consultation and the leading cause of disability from ages 15 to 44. Research shows that distinct psychosocial stressors precede most of the depressive episodes by 1 or 2 months (episode triggers). Following the Adaptive Information Processing (AIP) model, DeprEnd© is an eye movement desensitization and reprocessing (EMDR) therapy protocol that addresses an important cause of depression that may also contribute to the maintenance of the symptoms of the disorder: pathogenic memory networks. In the DeprEnd© protocol, four main types of memories are addressed and worked with: classic traumatic memories (Criterion A), often non-Criterion A-based episode triggers, belief systems, and depressive and suicidal states.

There are certain types of memories, such as those of being depressed or suicidal, that patients experienced earlier in their lives; however, when these memories come up in the present, it feels as if they are true in the present, but they really are not. It is confusing for both patients and therapists alike. Often these memories are accompanied by intense feelings in the body but are not accompanied by images or thoughts. Often, they are overlooked even though they are, in our observation, a risk factor for depressive relapse. Even though many of the patients treated with eye movement desensitization and reprocessing (EMDR) DeprEnd improve during the previously mentioned parts of the DeprEnd Protocol, they may take another major step forward after their Depressive and Suicidal States/memories are reprocessed. In this chapter, we explain how to identify these Depressive and Suicidal States and how to process them with EMDR therapy.

In this chapter an outline of the eye movement desensitization and reprocessing (EMDR) DeprEnd Protocol, as well as the rationale for its interventions, are given. Also, an important instrument to identify some of the pathogenic memories behind the depressive episodes, the Symptom Event Map, is introduced. In EMDR therapy, treatment plans that adhere to formal guidelines are frequently called protocols. In our book, we use both terms synonymously. The DeprEnd Manual EMDR is the current treatment plan for depression, and it can largely be seen as evidence based. In addition to the steps for treatment and preparation for reprocessing, the protocol contains a sequence for targeting pathogenic memory networks.

The cornerstone of our new concept of treating depressive disorders is eye movement desensitization and reprocessing (EMDR) therapy. EMDR therapy is a psychotherapy approach that was developed by Francine Shapiro, PhD, in 1987 and it has proven its efficacy in treating posttraumatic stress disorder (PTSD). EMDR is recognized worldwide as one of the most effective treatments for PTSD. Different from the usual forms of talking therapy, EMDR is based on a completely different neurobiological mechanism that was discovered and documented by a Korean research group (Baek et al., 2019). To understand the processes that occurred during EMDR treatment and to improve treatment planning, the Adaptive Information Processing Model was hypothesized and the concept of biologically active, pathogenic memories that can be traumatic and nontraumatic was developed. In this chapter, EMDR therapy and its basic concepts, as well as the first pioneering publication in the field of depression, are discussed.

Somatic illness is often life-threatening and even if not it can bring along many stressful life experiences for one self and relevant others. Somatic disorders are of course very physical in experience. Also, medical treatment with its intensive use of medication can add a special flavor to the formation of the memory nodes later to be addressed in eye movement desensitization and reprocessing (EMDR) therapy. EMDR has demonstrated its efficacy in the treatment of patients traumatized by somatic disorders or medical treatment. Examples are the treatment of survivors of life-threatening cardiac events, the treatment of cancer patients, and the treatment of chronic regional pain syndrome. The treatment of patients traumatized by somatic disorders or medical treatment provides some challenges that one would like to address in this scripted protocol. This scripted protocol is designed to improve the treatment of these patients in need of help.