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From Addiction to Resilience: Tools and Approaches to Support Recovery

Author: Stephen Sideroff/Saturday, April 10, 2010/Categories: Chemical Dependency

Part II: Organismic Balance and Mastery

Resilience is a state highlighted by the ability to recover from stress and to optimally deal with the challenges that life delivers. In Part I of this article, we noted the mechanisms by which the addict’s difficulty managing stress results in a greater vulnerability to relapse (Sideroff, 2009). The developmental pattern of many addicts results in frequent functioning in survival mode, which may result in a permanent sensitization of the brain to stress (Wood, 2007). So, becoming resilient would be extremely beneficial for improving addicts’ chances of recovery and abstinence.

Part I addressed the first three components of the nine pillars of resilience. These were the three levels of relationship: with self, with others, and with something greater. In Part II of this author’s model and its application in addictions, we address the next area: organismic balance and mastery and its three components: physical, emotional and cognitive.

Physical Balance and Mastery: Component Four

It is commonly observed that addicts do not have a friendly relationship with their bodies. In fact, they are uncomfortable and don’t feel at home in their skin. There are many reasons for this, including early trauma and abuse, which demand some sort of dissociation in order to survive and not feel emotional pain. Also, stress, and the resulting agitation of stress, creates a discomfort that they want to avoid.

This disconnect leaves the addict with few means of coping with or recovering from life’s demands. As soon as there is stress, they want to run away, hide or — more typically — revert to their drug-seeking and using behavior.

The fourth component of resilience — physical balance and mastery — addresses this deficit in coping and self-regulation. Within this component are three aspects: the ability to deeply relax, the ability to return to baseline following a stressful situation, and the ability to avoid overreaction. There is no substitution for developing the ability to relax.

But addicts are not the only ones who have difficulty with a stressful life. Life is stressful for most people; nearly 75 percent of patient visits to doctors are for stress-related problems. Modern society throws a constant barrage of dangers, threats and uncertainty our way. This is compounded by thinking patterns and fears that further exacerbate our sense of danger. At the same time, there are few stimuli we encounter in our environment that trigger the opposite — the relaxation response.

Thus, we are continually turning on the stress mechanism of our bodies, our fight-or-flight response, with its adrenalin rush and neuromuscular tensing. Recovering addicts face an even greater array of stressors as they attempt to regain entry into normal life. On top of all these psychosocial factors, they are also dealing with internal biochemical and neurobiological deficits that impact their ability to self-regulate. In order to give their recovery a chance, it’s important for them to have tools to turn down the activation of their bodies, and to be able to self-soothe and feel a sense of comfort in their own skin. This component of resilience involves helping the addict regain (or perhaps learn for the first time) the ability to self-regulate.

Process for Improving Physical Balance and Mastery

Left to their own devices, addicts and recovering addicts will resist training their body to relax. In fact, this is true for most people. As soon as they begin to attempt the process, they are challenged by the discomfort they feel (as emotions emerge) or the judgments they make about the difficulties they are having. For some, the gap between current ability to relax and arousal levels, and the goal of calm and deep relaxation is so great that they feel hopeless to ever be able to achieve this goal. It is important for the therapist/counselor to take an active and supportive role in the training of this ability. Part of this process is to help the client manage their discomfort, to not make judgments and to learn and practice the proper procedures. Here are a few basic components of the relaxation training process:

  1. Start with an awareness of the body by guiding the client through it, specifically identifying potential holding places such as the jaw, the shoulders and the pelvic areas. Have them notice what they sense or feel, without any judgments or attempts to change the experience. Keep reminding them that whatever they are feeling is OK.
  2. Have them rate their level of body activation or tension. You can suggest a scale of zero to 100, where zero is totally relaxed and 100 would be as tense as can be imagined. Then have them assign a number within that range that approximates their current level of tension.
  3. Shift their focus to their breathing, noticing if it is shallow or rapid or if they are breathing at all. Again, emphasize that they are to make no judgments about themselves.
  4. Coach a breathing pattern that begins with a full exhale, which encourages the next breath to be full and deep. Have them take longer to exhale, and guide them into a breathing pattern that is about six breaths per minute, or 10 seconds for the full breathing cycle. Since they are to emphasize the exhale, this becomes four seconds in and six seconds out. Six breaths per minute helps a number of biological rhythms align.
  5. Another aspect of optimal breathing for relaxation involves keeping the shoulders relaxed upon inhale, while expanding the abdomen, followed by expansion of the chest, during inhalation.
  6. A client may begin to force or try to control their breath in order to change it from their current and inappropriate pattern to the new pattern. This will result in stopping and starting, or some other mechanical form of breathing. Tell them to visualize the optimal breathing pattern that you are suggesting, and then simply allow their body to keep approximating that optimal image of their breath. This may be facilitated by the therapist demonstrating and modeling the optimal pattern.
  7. Encourage patience.
  8. Ask the client to make each breath similar to the last.
  9. Suggest that the exhale be experienced as enjoyable, and as a model for letting go. By making the exhale enjoyable, you are encouraging future motivation to practice.
  10. Use images of sinking or melting into the chair to further encourage the letting-go process. Remind them to let the chair do all the supporting, instead of using their muscles.
  11. At the conclusion of the guided practice, ask the client again to assess their level of tension from zero to 100. If you have spent at least eight minutes doing this exercise, the client should report that their level went down. Use this as a prognosis of and to reinforce achieving success. But again, emphasize patience in this process.
  12. Innoculate against failure: Since the exercise might create discomfort when they are doing this by themselves, give permission to stop if this occurs — even if they have only done three or four minutes. Also, suggest that five minutes is better than none at all, in order to make it as easy as possible for them to engage in the practice. Make sure they have some type of cuing that reminds them to practice.

Emotional Balance and Mastery: Component Five

Addressing emotional issues, of course, is a major component of any therapeutic process. As the fifth pillar of this model of resilience, we approach this issue from the perspective of how emotional mastery can enhance resilience, or how emotional reactivity negatively impacts resilience. Our brains get hijacked by our emotional unfinished business. When this happens, we feel helpless over our reactions, which typically include autonomic and neuromuscular activation. These mimic the stress response and lead to depletion of personal resources, fatigue and a downward spiral in which we feel less capable of coping. This leads to further regression and threatens sobriety. Much of the time, we are not even aware of responding to unconscious motivations.

A component of the recovery process in addictions is the healing of the brain. Excessive stress during a person’s upbringing can alter brain function; specifically, it creates a hypersensitive stress reaction. This over-sensitized brain can be exacerbated during the addiction process. Developing a more constructive way of dealing with the inevitable triggering of emotions and reducing reactivity is helpful in training greater resilience and short-circuiting the downward spiral.

Emotional balance and mastery begins with a more constructive way of framing feelings when they get triggered. The goals of this framework are to A) reframe this as an opportunity to achieve resolution, B) feelings that are triggered is inevitable and part of life and C) it’s most beneficial to learn to accept these feelings. Here are some suggested aspects of this resolution process.

Process for Helping Clients Improve on Component Five:

  1. Coach acceptance of the feelings that will keep coming up during recovery.
  2. When feelings come up, reframe it as an opportunity to address another piece of unfinished business; educate them about a constructive way to deal with them.
  3. Teach them to notice their feelings without running from them or judging the feeling. There is no right or wrong with a feeling, just like there isn’t with hunger. It’s a natural process with common triggers or antecedents.
  4. Frame the feeling within the context of experiencing it, in order to let go of it. For old business, it’s about having the opportunity to accept and let go of it.
  5. Be with the feeling in order to identify what it’s about.
  6. Accept the feeling: not that it’s always a good one, but simply that it exists.
  7. Encourage them to allow themselves to express the feeling; its expression is the goal, not that the other person actually listens or even knows about it (this is of particular importance, since they may have unexpressed feelings toward someone who is no longer alive or in their lives).
  8. Have the client check in again to make sure they have accepted the situation as it is or was (versus wishing it were different, an impossibility).
  9. Go into a relaxation process (perhaps the one described in component four) and as they exhale, feel themselves letting go of the feelings.

Cognitive Balance and Mastery: Component Six

In this author’s concept of Primitive Gestalts (Sideroff, 2004-2005), we explore how our perspective is embedded in our lifelong neuropsychobiological framework of the world, and ourselves within it. From this perspective, it’s impossible to be objective or to even be aware that we aren’t being objective. Another way of saying this is that we are unconscious of our consistently inaccurate thinking, particularly about ourselves. In fact, we can often be objective with the rest of the world, but incapable of being objective with ourselves. This is highlighted by our difficulty to give ourselves the same breaks we give to others.

All of these distortions are magnified by the addict. They are either the victim of an impaired brain (such as with attention deficit disorder) or hampered by a brain disabled by the effects of addiction. There are, in fact, specific deficits in brain function that give the addict a tremendous cognitive disadvantage. The pre-frontal cortex — referred to as the executive brain, where decision making takes place — will typically be under-activated in recovering addicts. The ratio of slow-to-fast brainwave activity is typically higher than average. There also appears to be a disconnect between the structures of the limbic system and the frontal cortex. This population has a much more difficult time generating a calming alpha state.

The consequences of this brain alteration include poor decision making and poor inhibition of limbic or emotional factors, which tends to result in an over-activated behavioral response. This is coupled with difficulty going into a state of calm.

One of the most troublesome aspects of this inaccurate perspective is that it includes what we would consider our intuition. Whatever it is that we tune in to in order to determine if we are on the right track or not, when we refer to whether something “feels right”, is embedded in our Primitive Gestalts. In other words, we typically “check in” by tuning into the feeling state associated with our Primitive Gestalt; it’s inaccurate, but it is our reference point.

Process for Improving Component Six

In addressing this cognitive distortion, work with clients in the following manner:

  1. It is important to accept that one’s perspective can be inaccurate.
  2. This can typically be recognized if we describe a situation. In one case, have clients imagine this situation is happening to them, then determine the reaction. In the second case, have them imagine the same situation happening to someone they like or look up to. Have them notice the difference in how they evaluate the situation based on whether it’s happening to themselves or another person.
  3. This process will help clients recognize, for example, if they are self-abusive, punitive or overly self-critical. It might show them that they are not fair with themselves.
  4. “Stalk this pattern”: As an assignment, have them become alert to the playing out of their pattern in their lives, noticing its pervasiveness.
  5. Develop a more accurate perspective by using how they treat the person they admire as a model for how to treat themselves.

By enhancing your client’s balance and mastery of these three dimensions of resilience: physical, emotional and cognitive, you are enhancing their ability to cope with the stresses in their lives. Through this process they will be less likely to spiral downward and revert to old, addictive patterns. In the third installment of this resilience model, we will address the last three pillars: presence, flexibility and power.

References

Sideroff, S. I., (2004-2005). Primitive Gestalts: Early developmental patterns and their effect on later life. Somatics, 15(1): 10-17.

Sideroff, S., (2009). From Addiction to Resilience: Tools and approaches to support recovery, Part I: Relationships. RecoveryView online Journal, 4(2).

Wood, P., (2007). Stress enhanced hippocampal throughput & mesolimbic dopamine – A model for the development of fibromyalgia. Paper presented at the Association for Applied Psychophysiology & Biofeedback’s 38th Annual Meeting. Monterey, CA.

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