Filling in the Hole In the Soul

 

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The Light at the End of the Tunnel is You!

Just got back from EMDR therapy and thought I would write this right away as I will be very tired over the next few days.

A fundamental difference between PTSD and Complex PTSD is that Complex PTSD also addresses the consequence and effects of emotion dysregulation (the impaired ability to process and regulate negative emotions ) and insecure attachment to a primary care giver.

PTSD can happen in those with secure attachment and adaptive emotion regulation abilities and often relates to specific events or a one off event.

Much of the therapeutic work that goes into PTSD is about reprocessing a particular trauma and the related or associated feelings of guilt, blame and fearful helplessness etc that can result from that moment of traumatic powerlessness over a particular re-experienced traumatic event.

C-PTSD is more complex in it’s treatment as the trauma meshes with wider issues,  in my case, of emotion processing deficits (like alexithymia) and as a result emotion dysregulation.

We need to identify emotions in order to process then cognitively as feelings – we need to find words to put to the emotions before they become feelings – before we can properly regulate or control these feelings and whatever action we take in relation to these feelings will be the direct result of how these emotions are represented in our brain and mind.

If we have difficulty with representing these emotions as feelings then it is because the emotions are not labelled accurately (i.e. remain undifferentiated from other emotions) and do not become specifically represented in our brain and mind as particular and distinct feelings.

If we are not fully aware, cognitively, of emotions then we do not represent them as feelings to act on but act on these undifferentiated emotion states via impulsive and compulsive behaviours as if they are distress states. We act in relation to undifferentiated emotions as if they are distressing, like an emotional white noise.

I often act in an emotionally and experientially avoidant way. Most of my life I have avoided my emotions via maladaptive impulsive/compulsive behaviours.

I need to know my feelings in order to “self soothe” but as I could not “read” my  feelings my attempts at self soothing have normally been external to me in the form of susbtance use and abuse or in behaviours like gambling

The problem of “self soothing” thus is a legacy of emotion dysregulation but it is also a legacy of insecure attachment to my mother which resulted in an avoidant attachment style which can become disorganised when distressed.

This attachment style, I realised today, deep in my mind during bi-lateral stimulation, is partly  because I never learned to self soothe.

I was never taught it from my primary care giver and she did not appear to be able to do it either.

I never learnt to process and regulate emotions from my primary care giver either. So when I,  today, was attempting to  to investigate the horror of that fearful helplessness of watching my mother attempt a “cry for help” suicide attempt by trying to force pills down her throat I did not expect to suddenly understand the interlinking connection between all these things.

I expected to return to the horror of this most distressing scenario. I didn’t return to the horror emotionally but I did return to the scene and saw and felt that it was definitely a cry for help and not a serious attempt to kill herself – not completely otherwise she would not have made such a drama and spectacle out of it and had an audience to observe it.

I saw doubt in her eye, and shock at our reactions, a sudden realisation of “what the hell” am I doing here?

However, as she slumped to the floor, she, to my memory anyway, said it was all too much, that she wanted to die that she had had enough.

To us fearful children this  meant she had had enough of everything including us. That we were not enough, not good enough or not reason enough to keep her from wanting to die.

When asked to describe how I felt, I, to my surprise, had this massive feeling of a huge hole in my soul, as if someone had blasted the biggest hole in my chest with a double barrel  shot gun.

A hole that my alcoholism, addictive behaviours and traumatized self seeped from.

I was asked to act as an adult in this scene and immediately consoled the younger me, then my mother.

I asked mum to reassure the younger me that it was nothing to do with him/me, that she loved me. She did so.

Slowly but surely over ten minutes my younger me became united to my mother and then my sisters, and then my father. We all at on the bathroom floor, in the sunlight, holding each other and reassuring each other of our love for each other and that things would be alright.

My mother told me how she struggled on afterwards, through years of addiction and mental health problems, out of her love for me and my sisters. That this was not my fault, that I was not bad and it was not my fault – she was ill and couldn’t help it just like I could not prevent my own addictive illness.

It was the way it was. The way it is. We had to accept this.

Imperceptibly I could feel a membrane stretching and growing across my chest, over the circled edges of my hole in the soul.  Like a healing.

It is a start, a great start.

The inner child stuff I have often I have thought  a useful idea but not a reality until I married this psychological idea to something  called the resonance circuit in neuroscience. It is the emotional circuit in the brain through which the effects of insecure attachment resonate decades later.

It is like a frequency via which trauma and insecure attachment vibrates when distress in our everyday live strikes this fear circuitry. It may be as real as any neural circuitry in the brain.

Today I felt for the first time at a profound level that this resonance circuit is how the inner child communicates his distress. It is still  a “live ” part of me. A part that requires me to soothe it. To have compassion for.

I suddenly realised this is what healthy people do, they look after themselves, they self soothe. It is a part of emotion regulation.

They do so by having a compassion for their own suffering. They put their emotions and then their feelings first.

Today I experienced the benefits of self soothing, of realising that emotions were not to be avoided but discussed, shared and clarified and that I could eventually have a secure attachment with myself.

This is the main awakening. That the most important relationship is the one I have with myself.

 

Almost Time?

Tomorrow I am set for my next EMDR session.

The one thing I haven’t mentioned about EMDR and I should really for any of you lovely people considering this excellent treatment and that is that the treatment is very exhausting.

I spent three days on an adrenaline high followed by three days of pure exhaustion.

This is worth noting as it certainly effects one’s ability to do the things they normally do, such as their job!

I run my own business, I am self employed and I am not convinced I could do this EMDR treatment if I was not self employed. My wife did it while on sickness leave from her work.

Although, equally, I know of other people who have had to hold down a job while having EMDR therapy and did so. I am only talking from my own experience. My experience is that by the time the next EMDR therapy session is about to begin I am still recovering from the last one.

I have been dog tired, way beyond how tired I normally get and I do get tired quite often as I have a tendency to over do things, well everything really.

In addition to running my business, I do academic research with two Professors in a UK University, I blog on two blogsites, and I am carrying our hard manual building at least twice a week on a regular basis which is physically taxing. Most of this I haven’t had the energy for, in the last couple of weeks of EMDR.

EMDR treatment is fairly quick in it’s ability to quickly positive outcomes compared to some treatments  but it does  have the price of being very tiring.

I am writing this because I do not want to give the impression that it is simply a case of rolling up to treatment, it being great and then back for some of the same the next week! It is not like that, as I say it is exhausting.

I have also had over ten years in recovery which has helped greatly. I am not sure how I could have coped with this level of exhaustion eight years ago? Maybe I could, it is difficult to say.

I am not saying this to put anyone off, I think EMDR works for people in recovery whatever their length of recovery. I am just stating that it is very tiring and this should be factored into one’s awareness about doing EMDR.

Obviously I do not like being this tired but it is part of it I guess?

I find this level of tiredness makes me a bit more snappy with people, not as able to cope with frustration as usual and also it can create a low or sometimes negative mood that is not really linked to anything in particular other than being very tired. I have panda black rings under my eyes.

Okay that’s me done. An unusually short blog from me this time (shows how tired I am, lol!)

I do try to write shorter blogs but it rarely happens. Things gush our of me a bit and then I have written a chapter rather than a blog!!

All grist to the mill as they say in the UK. I would like to put this writing in a book one day. Explaining what happens in the brain of recovery but also using personal stories of recovery like the blogs I am writing now.

I noticed in my other blogsite Inside the Alcoholic Brain   that the most popular blogs by far have been on the topics of PTSD and C_PTSD and the treatment thereof via EMDR.

I think many people in recovery catch on to the idea eventually that they actually suffer C-PTSD (and other co-occurring disorders) and also insecure attachment the longer they are in recovery.

Through time recovery is about more than not relapsing, more than addiction and becomes a voyage of discovery and a search for increased well being and quality of life – William White calls it “better than well!”

These factors are also prompting me to do EMDR and finally get past my past. A past that has troubled me for over forty years.

I want to fully engage in the now, the present, I want the past fractures to be mended and the love that  I know is scattered across different areas of past and present life to finally be reconciled. .

I have choice now, I never had when in active alcoholism and addiction.

What a wonderful thing, choice!

 

The Final Destination Arrives At You

 

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One month ago I was hoping to start EMDR therapy for my PTSD.

Unfortunately it has not happened as yet. I spent the whole summer preparing myself to start therapy but it is yet to start.

Why?

My wife also suffers from PTSD and anxiety disorder. Due to this and that, I have been looking after her for the last few weeks, supporting her, and getting her back to work as she had been off with acute stress. This was exhausting given my current emotional state.

Then someone tried to kicked my front basement door in – unsuccessfully I am glad to say.

It was however a bit traumatic and upsetting, this invasion of our privacy, this violation of our home.

So I had to fix the door. Unfortunately it also rained and rained the night of the attempted break in and the basement room got flooded which cost nearly £2000 to fix.

Fortunately the Insurance will cover it but it is still distressing and stressful. I have spent days installing cctv and security lights.

So I had to get my wife back to work followed by this break in followed by having to work with builders for the last four-five weeks (a long story in itself!).

The basement door was replaced and then the laminate floor was taken up as it was ruined by the flood. Then we realised  we may have rising damp so we had to get that fixed.

The floor was treated and the walls painted with a tar. The basements steps are had to be re-cemented and the front windows and doors resealed to prevent further problems with damp.

We then laid tiles which took forever and re-plastered the ceiling which has been damaged, strangely by the flooding also as the roof is below ground level, i.e. in the basement.

It has been stressful and exhausting. I could lie down on the floor and sleep, if they weren’t full of dirt and plaster. I have done all this while in a stew of trauma which is like a puss capsule waiting to burst.

All my life I have been a person who fixes stuff, helps people out in an emergency. A go to guy.

As a child I tried to be a caregiver, caretaker to my Valium dependent mother. I parented her as she struggled to parent me. I also took all my father’ anxieties about his troubled wife and his general woes.

I grew up in role reversal.

I am primed to help in emergencies.

I never had anyone to share my concerns with.  My sisters would ask me how are you? Then not wait for the reply.

It was a prelude to me having to listen to how they were. I have been a receptacle for other’s to deposit their anxieties. Often without offering this service.

Who listened to me? I have always felt like a “poorly drawn boy” tiny, lacking definition in my mind’s eye when I look back at my childhood.

There is little substance to my self schema

I somehow need to get better drawn, coloured in, made more full, more me. Take back the pieces of me strewn across the wreckage of my past. Piece them together to see what I end up with, end up as.

At the moment I feel I am in danger of disappearing.

Is this a bad thing? This feeling of evaporating. Is the old me disappearing, am I shedding skin, a turtle-like replacing a shell with another?

Hopefully a lighter shell!

I do not fear emotions like before, however negative or troublesome. I think something is coming to the surface, like a vapour on my stew.

Impurities  being cleansed just by my decision to look at my trauma therapeutically, professionally.

This may have started a stampede of squashed emotions, trampling their way to the surface of my mind to get recognition, to finally be heard.

All I know is that if I don’t deal with my trauma it will deal with me. It is the most pressing concern for me not only in terms of general mental well being but in terms of relapse risk. It is by far the greatest risk to relapse.

I find AA meetings are good for sharing about certain things,   to a certain extent, for sharing what is going on with me but no longer fully. AA does not really deal with shame, trauma or the other issues that propelled my addictions to near death and psychosis.

It deals with shame of addiction for sure but The Big Book was written at a time when even psychotherapy did not consider shame, instead concentrating on guilt.

The steps deal effectively with guilt and the shame around what we have done to other people, sins of commission,  but they do little in my opinion for the sins of omission, the sins sinned against us. What do we do with this stuff?

The stuff that often propelled our addictions in the first place? Haven’t some of us been just dealing with the cart and not the horse?

Just some observations.

Roughly 65% of AAs have outside help, with what? The causes of their addictions?

Or certainly development childhood aspects which later contributed to the severity of their addictions?

This is where I am at, looking out for others while fit to burst myself. I am bottling up a primal yell, and request to be heard, at last.

As the youngest in my family I had no one in whom to deposit my anxiety and distress. To offload on.

AA has been instrumental in helping me share tonnes of stuff about my alcoholism. My trauma and neglect form childhood has often met with fairly closed ears. Some things people don’t want to talk about in depth. Some things they don’t want to touch for fear of making worse. I can relate to this. I have done this myself for years in recovery. But now it is inevitable that I deal with this stuff.

The damn is about to burst as I have said and will do…eventually.

I will hopefully keep you posted.

I am also very hopeful that it will have a chrysalis effect too.

I have  faith that God goes deep!

One from the Heart

I have started a page on my other blog on the role of trauma and post traumatic stress disorder (PTSD) in addictive behaviours. This is a condition very close to my heart, literally.

 http://insidethealcoholicbrain.com/ptsd/

For me PTSD is one “co-occurring” condition which has greatly contributed to  my overall alcoholism and the severity of my alcoholism.

It greatly contributed to my initial drinking especially via the effect alcohol had on me.

My traumatic incidents in early to middle childhood mixed with my insecure attachment to my mother meant I was always wary of people. I always left distinct from other people, even my immediate family.

I was wary and anxious, paranoid that people were thinking and talking about me. I never felt I could be myself around others even my best friends from childhood.

I was always holding something back, always left like I was protecting some invisible wound. I now believe that invisible wound was an emotional wound oozing shame.

Then I found alcohol. I felt I had come across the elixir of life.

It made me more me, a better me, a friendlier, warmer, less dismissive, less fearful me.

A me that got on great with others, effortlessly, even others I had not particularly liked before.

I became the life and soul of the party. I never classed alcohol as a drug because I thought drugs took you away from yourself whereas alcohol almost brought me home to myself.

I fitted my skin better and felt more comfortable in it after drinking alcohol. I loved that warm golden glow, the liquid bliss.

It made me go “phew!” and allowed me to escape myself.

A lot of this I believe was trauma mixed with insecure attachment mixed with an abnormal reaction to alcohol.

Trauma and insecure attachment alters the stress parts of the brain which heightens the effects of alcohol. It allowed me to connect with people. Gave me that “comfort and ease” which was illusive in everyday life.

In recovery this connection with people is essential too. We recover with the help of others, we learn the program via others.

We have to trust another person. So what happens when we lose that trust or never gained that trust. And don’t we have to trust in a God of our understanding?  Faith seems to  be about trust too?

The reality folks, is I don’t have a lot of trust period.

I love and trust my wife absolutely. After that…?

I have a lot of trust for various others such as some members of my family a few friends but generally my childhood has left me fearful  and mistrusting. All my immediate family and beyond love me but there is expressing love and there is demonstrating love, they are very different I find.

The worse thing is I also take over from God in many ways because I am not trusting enough to let Him get on with running the show.

This weekend proved to me I need additional help with trust, with my PTSD.

I mean I have come to the realisation I need outside help, professional help, EMDR help for my trauma – the two major issues I have in recovery and which act as my most likely relapse triggers scenarios are both to do with trauma.

This weekend I convinced myself that my unintentional actions had indirectly upset someone in recovery.

I had not real proof of this. I was kinda paranoid about it more than anything.

My head eventually went into a tail spin as a result of thinking I may inadvertently have caused harm in another recovering person. I was full of shame and anguish as my head immediately went into catastrophic thinking, thinking the worse, that his person might take it so bad that they may even relapse, and might even die!!

My thinking was constantly trying to convince me the worse case scenario was about to happen and it would be my fault. This is called PTSD thinking.

When I as a child something terrible happened and someone caused me trauma via a life threatening situation.

I blamed myself for this trauma, convinced myself that it was somehow my fault that this had happened. This was me dealing with my helpfulness and hopelessness in the face of extreme trauma. Trying to somehow control the uncontrollable.

Somehow I could have adverted this if I had acted differently? This is trauma in a nutshell, thinking one is guilty for something beyond one’s control.

In retrospect this seems insane to think I as a child could have any control over this incident. It had nothing to do with me.

Years later this incident (and others) had burnt into my brain and my heart. When I unintentionally hurt  (or otherwise think I have) who is vulnerable like someone in recovery I have this terrible reaction that they may relapse or die.

It is irrational but it is there and it has to be treated professionally.

Someone else’s adult life is not in my control, only my adult life is in my control (and I get a lot of help with that)!

In order to be in more in charge of this adult life I have to deal with that traumatised child, and via professional means.

The problem has become clear, it has become a broken record in my head. The scales have fallen from my eyes.

Action is required.

Recovery is about taking action, not thinking about taking action.

My PTSD and alcoholism got fused into one condition, although they each have different voices in my head.

There is other voices too – the trauma voice, the OCD voices, the insecure attachment voice/ the less than voice/ the not good enough voice – mostly voices of shame provoked by childhood trauma.

There is also the addict voice of the chronic malcontent, nothing is good enough and too much is never enough.

So there you have it, one definitely  from the heart.

That is where recovery has to happen ultimately.

This is where I hope the still voice of recovery will eventually reside.

Intolerance of Uncertainty and Distorted thinking About the Future

Another common area I feel addiction has with obsessive compulsive disorder (OCD) is intolerance of uncertainty (IU).

In fact it is also associated with post traumatic stress disorder (PTSD)- there is actually a high co-morbidity  (at least around 40% comorbidity) with addiction and PTSD and it is one so-called co-morbidity that does not naturally dissipate like some others months into recovery such as Generalized Anxiety Disorder or Depression (the 14% rates of depression and GAD in recovery people are the same as for a normal population) but remains and often makes the symptomatic manifestations of addiction more severe, especially the tendency to engage in “fight or flight” reactions” to uncertainty and ambiguity.

I will blog more on this co-morbidity in later blogs.

The study we cite today in fact looks at IU in addicts who have suffered trauma (1).

Intolerance of uncertainty is a term that refers to a certain way in which some people perceive and respond to situations that are uncertain, and it has been found to be associated with the experience of PTSD symptoms.

Individuals who respond to uncertain or unpredictable situations in this way are considered to have an intolerance of uncertainty. People who are intolerant of uncertainty may begin to experience constant worry about what could happen in the future.

One study (1) demonstrated that negative emotion regulation strategy and intolerance of uncertainty can significantly explain the craving beliefs in addicts (especially those who have suffered a traumatic experience).

This result is consistent with that of Asadi Majareh, Abedini, Porsharifi and Nilkokar (2013) and Nasiri Shushi (2011).

Nasiri Shushi (2011) revealed that there is a significant difference among substance abuse and intolerance of ambiguity and tolerance of uncertainty in two groups of drug abusers.

The other results of this study showed that addicts have less tolerance of ambiguity and tolerance of uncertainty. In the implications of these results it should be expressed that tolerance of uncertainty is associated with cognitive features and addicts when they are faced with difficult situations act in very low levels of performance in terms of decision-making.

Studies carried out to investigate the characteristics of drug abusers suggest that they use substances to regulate a wide range of cognitive events. Undoubtedly unpleasant emotional states, particularly anxiety, depression and stress in addicts are associated with the cognitive consequences.”

The authors suggest that “Drug abusers are not able to tolerate the unpleasant situations and uncertainty in the stressful conditions and their sensitivity leads to mental and emotional problems, therefore, they more turn to substances to regulate their own cognitive experiences (Spada, Nikčević, Moneta, Wells, 2007).

The results of a study showed that individuals with lower tolerance to ambiguity find the ambiguous situations threatening… Many of them may find the substance use in the face of difficulties the only solution and therefore are not able to think or consider other solutions.”

“….While, those with high tolerance to ambiguity in face of unpleasant situation and uncertainty try to find a good solution to get rid of this condition as soon as possible…those with a low tolerance to ambiguity and uncertainty cannot find an appropriate solution…and consequently turn to undetected compromise strategies such as the use of the substance (Ahmadi-Tahoorsoltani and Najafy, 2012).”

I can relate to this study. As I still suffer from intolerance of uncertainty (IU) in recovery, and some years into recovery, it is safe to assume that I suffered form IU in addictive addiction also, if not more so?

For me dealing with an uncertain future can still provoke anxiety. In recovery groups, like AA, we often hear sensible suggestions such as do not “project into the future”, which basically means do not attempt to control future events by thinking about them because this is not only impossible but also anxiety inducing.

The main reason why I think me and other alcoholics cannot project into the future and reasonably reflect and deliberate possible outcomes is because we may have an intrinsic impairment in this regard.

We, or some of us, especially those who have suffered trauma in earlier years, may have IU, like OCD sufferers.

The number of times I rang my sponsor in early recovery to help me with projecting into the future was legion.

Having some one else to talk and share with helps us recruit the pre frontal part of the brain so that we can either see the sense in not not projecting into an unknown future or get help in reasoning through what is likely to occur then.

The difficulty I had and can still have is that my projection into the future is still negatively biased, it is still prompted by distress based cognitive distortions.

As we will see in later blogs these types of cognitive distortions proliferate across a wide range of addictive disorders such as eating disorders which we consider in our next blog.

Among this cognitive distortions is catastrophic thinking which is also distressed based. I will also blog on this at a later date. My head can still run away with itself and convince itself about something which is patently not the case. It can persuade me that this is person or that is doing this or that for these reasons. All of which on reflection are usually nonsense. For me this is like a type of delusion. It is a part of my condition that my head can trick me into believing a whole range of ideas that are delusional. Sometimes I realise this only weeks and months later.

And some people wonder why we turn our lives over to a power greater than ourselves!!?

All this distorted thinking is distressed based.

Which means there is chronically excessive stress chemicals like glucocorticoids being synthesized and whirling around one’s brain. If you give some one enough glucocorticoid there is a good chance they will end up in psychosis. In the 1950s glucocorticoids were used as an anti depressant until people started ending up in psychosis.

Ultimately when we engage in this negatively biased and distorted thinking we have potentially taken the first steps in a walk to relapse because that will eventually seem a whole lot better idea than psychosis?

These cognitive distortions (and there are many)  may even be at the heart of this condition of addictive behaviour.

They are also the consequence of an impaired ability to process emotions (and to avoid) them and thus regulate them. This leads to a tendency to fight or flight which only leads to an heightening of this anxiety, and an increased proliferation of distressing thoughts about future possiblilities, all of which can seem to become more and more catastrophic. How much these thoughts are specifically linked to trauma has to be further explored by research.

For me IU and thought action fusion, especially in early recovery caused as many problems as so-called defects of character. The only difficulty is that they are not mentioned in AA literature, or the Big Book. That does not mean that they do not exist simply because they were not discussed as psychological manifestations commonly known to alcoholics in the 1930s.

They are however known now, which is why I write this blog. To add to our sum of knowledge about this strange illness…

That is not to say having a reassuring sponsor and taking inventory cannot deal with these issues. It is useful however to be aware of them and to realise that not every one in recovery has suffered traumatic incidents. Those who have can have additional requirements in terms of recovery.

I always found it comforting to have a sponsor in the early days who was there and who could also relate to the trauma side of my alcoholism and addiction. It helped soothe me when I could not self soothe. Helped me realise I was not alone in this, that I could recover like this other trauma sufferer could. We can do stuff we can’t do alone.

Ultimately with such an impaired ability to see things reasonably and to make decisions rationally it is imperative to evoke a cardinal recovery rule for me, Accept, Let Go and Let God.

The most profound way to regulated emotions. To Let it Be.

I also used a thing I borrowed and rephrased from Jeffey Schwartz, a leading expert on OCD, how suggested OCD sufferers when in the grip of some obsession to say to themselves “It’s not me it’s my OCD”.

So if your head gets into a downward spiral over some event your head distorts into being and likely to happen in the dark, threatening, Gothic never never world of the future, say to your self “It’s not me it’s my illness.”

In the UK it is called the fanatic in the attic.

It does the thinking for you, if you allow it. Guaranteed.

 

References

Fizollahi, S., Abolghasemi, A., & Babazadeh, A. THE ROLE OF EMOTION REGULATION, DISSOCIATIVE EXPERIENCES AND INTOLERANCE OF UNCERTAINTY IN THE PREDICTION OF CRAVING BELIEFS IN DRUG ABUSERS WITH TRAUMATIC EXPERIENCE.