The pandemic has turned much of the world upside down. The danger, uncertainty, destabilization, and ubiquitous nature of the crisis has ramped up the level of stress. Stress creates fatigue and puts a strain on one’s ability to cope. It results in the impairment of good physiological self-regulation. This sets the stage for addiction vulnerability as well as leaving the recovering addict more susceptible to relapse. When self-regulation and healthy coping are disrupted, craving and default strategies, such as drugs become more attractive for quick relief.
A Model for the Restoration of Self-Regulation, Optimal Coping and Resilience
The relationship between stress and addiction compels any recovery process to incorporate methods for restoring an addict’s ability to handle stress and self-regulate.
I have described a nine-component model of resilience (Sideroff, 2015) that addresses all factors contributing to optimal self-regulation and stress coping. This model is useful for recovering addicts. It focuses on three general areas: relationship; organismic balance and mastery; and process, or how one engages with the world. Below I identify and describe each component.
Relationship with Self
In our therapeutic relationships we encourage, support and guide. But this can’t compete with the incessant voice in the addict’s head. This voice, developed during early childhood, undermines emotional healing. Thus, the first component is the relationship with oneself. The goal is to help the addict shift from an internal voice that’s critical, negative and self-abusive to one that comes from a place of love, support, compassion, acceptance and care.
To help develop a healthy internal parent or internal voice, I engage clients in a Gestalt Therapeutic dialogue between their existing, and typically negative, voice and a newer, weaker – but healthy – internal voice. I help them determine what a healthy parent sounds and acts like and then how to find that part, no matter how tiny, within themselves. This is supported by identifying someone in their lives to model who has these qualities of love and acceptance. If they don’t have personal experience with such a person, we look to literature or movies for examples.
I have them switch chairs in the dialogue process to help distinguish the two voices. I point out the inappropriate and critical or abusive messages of the old voice. This might include, “You don’t deserve because of all your mistakes,” “You should be better,” “You never get anything right.” My role is to help their new healthy voice switch from being defensive to being assertive, by attacking and labeling the old voice as wrong and inappropriate. It’s important to point out that at first, the “feeling of what’s right” is tied to old patterns I refer to as Primitive Gestalts. There is thus a tendency to trust these feelings and the old voice even though it is not accurate.
Relationship with Others
This is the ability to establish and maintain healthy relationships that are sources of support, acceptance, love and healthy feedback. This means being able to identify appropriate people for a healthy relationship and letting go of those who do not treat you well or support you. It means being able to maintain a healthy boundary for emotional protection, while being assertive to get your needs met. And finally, it means being vulnerable under the right circumstances in order to receive nurturing and healing.
This process involves asking whether a relationship makes life more or less stressful. Is the feedback you get from this person helpful and supportive, or critical and inappropriate? Do your friends or relatives make unreasonable demands that make you feel guilty, adding stress to your life? Do you feel like you're walking on eggshells? Are you fearful of their anger or of being rejected? It's important to be able to say no and to set boundaries.
One of my techniques comes from the research of John Gottman, a psychologist who has worked extensively with couples and has found that successful relationships have a 20-to-1 ratio of positive to negative interactions. I'll ask my clients to pay attention to the ratio of positive to negative comments and behavior, or what I refer to as the Gottman ratio. A ratio that drops below 5-to-1, indicates a relationship that is not healthy.
Relationship with Something Greater
This is at the heart of the 12-step program. Fostering a spiritual path is one way to feel connected. The two other ways this can be achieved is through giving service and developing a purpose in one’s life. I encourage my clients to find ways to serve. In addition, I work with them to find their passion and develop a purpose in their lives. Fostering this component of resilience creates a larger horizon and reduces the impact of daily hassles that can otherwise challenge one’s coping abilities.
Physical Balance and Mastery
Addicts are uncomfortable and don’t feel at home in their own skin resulting in poor self-regulation. Reasons for this include early trauma and abuse, which results in dissociation or disconnection from their bodies, to not be overwhelmed by emotional pain. There are four main aspects to this component: the ability to deeply relax, to feel comfortable and connected to their body, the ability to return to baseline following a stressful situation and the ability to get restorative sleep. There is no substitution or shortcut for developing the ability to relax. As with any skill, it takes practice.
Recovering addicts will resist training their body to relax. As soon as they attempt the process, they are challenged by the discomfort they feel as emotions emerge. It is important initially for the therapist to practice a relaxation process with clients. Part of this process is to help clients manage their discomfort, refrain from making judgments, and learn and practice the proper procedures. Biofeedback is a useful tool to support the ability to relax since it lets clients know when they are successful with concrete numbers that can't be denied. A free relaxation download can be found on my website: www.DrStephenSideroff.com
Mental or Cognitive Balance and Mastery
The normal cognitive distortions we all experience due to childhood lessons are magnified for the addict. In addition, specific deficits in brain function give the addict a cognitive disadvantage. For example the prefrontal cortex, where decision-making takes place, typically is under activated in recovering addicts.
With this component, it is important for clients to accept that their perspective is frequently inaccurate, especially when they are evaluating their own behavior. An objective reality check whenever they are questioning their judgment is to have them imagine that the situation happening to them were 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.
This component is also about maintaining a positive attitude and expectation. This can be facilitated by helping the addict discriminate between lessons learned during their childhood and drug related behavior, and more recent positive results since becoming sober.
Emotional Balance and Mastery
Emotional reactivity negatively impacts resilience. Our brains get hijacked by our emotional unfinished business. When this happens, we feel helpless about our reactions, which typically include autonomic and neuromuscular activation. In addition, feelings not dealt with and needs not recognized unconsciously drive behavior, increasing the chances of mistakes, accidents and undo pressure that exacerbates stress and emotional pain.
Lesson one is that feelings are neither right nor wrong but an organic part of life. When feelings come up, it's an opportunity to address unfinished emotional business and get resolution. Learning to tolerate the discomfort of their feelings is a necessary step in the process of letting go and healing. Here is a four-step process designed to facilitate this healing process:
- Become aware of and accept the feelings that come up.
- Sit with them and recognize what they are about and whom they involve (an important cognitive component of the process).
- Encourage clients to express these feelings – within the context of acceptance. If they are angry or sad surrounding a particular relationship, acceptance doesn’t mean they like what is going on. It is simply an acceptance of reality: you can’t make people different than they are - and you certainly can’t change past events. Expression of anger, therefore, may uncover sadness or loss about what they want but don’t have.
- Let go: once the feelings have been expressed, it is important to let go and not continue to expect the impossible.
Presence describes one’s ability to be in the moment, as well as the quality of the energy a person projects. In other words, there is a directional aspect to presence. The incoming aspect is about awareness and ability to notice and pay attention to your surroundings. This determines your ability to respond to events, as well as your awareness of internal cues, such as tension or fatigue, that need to be addressed. Presence is your ability to be in the moment, as opposed to being preoccupied or otherwise in your head.
The outgoing aspect of presence has to do with the energy one projects to the world. It’s sometimes referred to as charisma. This determines whether others are attracted to your or feel uncomfortable with you. An impaired sense of personal safety results in fear and withdrawal, and thus less responsive and less able to engage with others and the world.
The therapeutic relationship offers a safe laboratory for experimentation. At some point in my sessions, I will have clients take a moment to notice their surroundings. I will coach clients by having them report what they see in the room or have them close their eyes and tell me what I’m wearing.
To address clients’ energy and how they project this out into the world, I work with them in front of a mirror. I might have them notice their posture such as slumped shoulders. I might then have them exaggerate this posture noticing that it can create depression, lack of energy or negative self-assessment. As part of this evaluative process, I will also have them notice their facial expression and ask them what this expression says to the outside world.
I then have them adjust their posture, straighten up and hold themselves high. I’ll have them walk around the room and notice their feelings and sense of self. I will bring their attention to their breathing and have them adjust into a more supportive breathing pattern, and adjust their facial expression to a more positive one. These tools for self-adjustment help empower clients and support greater presence.
Flexibility is at the heart of the ability to adapt, to learn from new experiences and not be stuck in outmoded ways of doing or thinking. If you’re flexible, you can adjust and become comfortable with new and unexpected circumstances, rather than react with distress. Old patterns constrain our flexibility as they limit what’s OK. In fact, it’s the addict’s frozen adaptation to their childhood environment that interferes with a healthy adjustment to the present.
Educating clients about brain plasticity promotes their belief that change and flexibility are possible. At the same time, it’s important for them to “stalk their pattern” as I refer to increasing awareness of when they engage in their old habits and thinking. Visualization exercises to imagine acting and thinking in new ways are helpful as “dress rehearsal.” Their homework is to do some of their daily routines differently, such as using their other hand to brush their teeth and to eat. Doing this literally develops new neural pathways.
Power: The Ability to Get Things Done
This is the ability of the recovering addict to engage with the world to set and reach a new set of goals. It involves being persistent, holding the tension of uncertainty in their body without running or otherwise avoiding the constructive process. Most significant is an understanding of the learning and growth process: one needs to accept and tolerate the inevitable awkwardness and mistakes of new learning. Part of the process is helping them own their successes and abilities. This contributes to a sense of confidence. Most important, it contributes to their trust in themselves rather than dependence on others, or manipulation, and a greater feeling of control, which mitigates the effects of stress.
The COVID pandemic has put a strain on maintaining physiological stability and autonomic self-regulation leaving addicts more susceptible to addiction and relapse. These factors conspire to impair the efforts of treatment and leave the addict more vulnerable to relapse triggered by stress.
With a focus on my nine pillars of resilience and restoring the ability to self-regulate, the health professional helps the client gain foundational abilities that result in being better able to cope with today’s crisis, as well as feel more comfortable in their own skin and be more available and responsive to other treatment approaches.
Sideroff, S. (2015). The path: Mastering the nine pillars of resilience and success. Los Angeles, CA: Third Wind Press.