acceptance

Powerless over Thinking!

When I first came into recovery I would be plagued by intrusive thoughts about drinking, I would have thoughts about drinking, at certain times of the day in particular, on sunny days etc.

These thoughts used to greatly distress me and I would end fighting with these thoughts which only seemed to make things worse, the thoughts seem to increase rather than decrease and I got increasingly distressed.

I had no control over these thoughts and would get into a terrible emotional state over this. All before I decided it was now a good time to ring my sponsor. I always waited until I was in as much emotional pain as possible before ringing my sponsor!

I thought I could go it alone – that I did not need any help. I was in control of this.

Geez, surely I could control my own thoughts for flips sake!

Hmmm…afraid not!?

In early recovery I was as powerless over thinking as well as my drinking.

It was obvious I had lost control of my thinking like my drinking – it took a lot longer (and I still forget this even today!) to realise I have no  control over my thinking.

It chatters away regardless of my will, my wishes. It I have found is not usually a friend.

So like everything else in recovery I decided to research this! To find out why my thinking seemed out to get me, to negatively affect my recovery. To find out why my thinking did not seem to help me in recovery.

I found out that the idea that abstinence will automatically also decrease alcohol-related intrusive thoughts had been dismissed by research and vast anecdotal evidence.

Practically all therapies for alcoholism e.g  AA, SMART and so on suggest that urges create automatic thoughts about drinking.

This has been demonstrated in research that distress automatically gives rise to intrusive thoughts about alcohol. (1) This reflects emotional dysregulation as these intrusive thoughts are correlated to emotional dysregulation (2).

These thoughts to the recovering/abstinent individual can be seen as egodystonic which is a psychological term referring to behaviors, values, feelings that are not in harmony with or acceptable to the needs and goals of the ego, or consistent with one’s self image.

Other conditions, such as OCD, have these egodystonic thoughts creating the distress that drives a compulsive need to act on them, rather than letting them pass.

In other words, these thoughts are seen as distressing and threatening and compel one to act to reduce this escalating sense of distress. A similar process can happen to those in early recovery.

Thoughts about drinking or using when you now wish to remain in recovery are egodystonic, they are contrary to the view of oneself as a person in recovery.  The main problem occurs when we think we can control these thoughts are that these thoughts mean we want to drink or are going to relapse!

Early recovery is a period marked by heightened emotional dysregulation and the proliferation of intrusive thoughts about alcohol .

In fact,  research demonstrates that alcohol-related thoughts can resemble obsessive-compulsive thinking (3,4).

In fact, one way to measure “craving” in alcoholics is by scale called the Obsessive Compulsive Drinking Scale (5) , thus highlighting certain similarities between alcoholism and OCD.

This finding is also supported by clinical observation and leads to the expectation that among abstinent alcohol abusers, alcohol-related thoughts and intrusions are the rule rather than the exception (6)

Relatively little is known about how alcohol abusers appraise their alcohol-related thoughts. Are they aware that alcohol-related thoughts occur naturally and are highly likely during abstinence?

Or do they interpret these thoughts in a negative way, for example, as unexpected, shameful, and bothersome? Misinterpretations of naturally occurring thoughts or emotional reaction to them  may be detrimental for abstinence (7).

 

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A number of papers and  studies have shown that individuals’ appraisal of their intrusive thoughts as detrimental and potentially out of their control may lead them to dysfunctional and counterproductive efforts to control their thinking.

Alcohol-related thoughts cause an individual to experience strong emotional reactions; however, alcohol abusers will increase their efforts to control their thinking only when they have negative beliefs about these thoughts.

For instance, spontaneous positive memories about alcohol (‘‘It was so nice to hang out at parties and to drink with my buddies’’) may be appraised—and misinterpreted—as ‘‘the first steps toward a relapse’’.

Such an appraisal of one’s thoughts about alcohol as problematic may instigate thought suppression and other efforts to control the thoughts.

These efforts must be assumed to be counterproductive and  will increase rather than prevent negative feelings and thoughts, and they may even demoralize alcohol abusers who are trying to remain abstinent

On the other hand if positive alcohol-related thoughts are not appraised as problematic but as a normal part of abstinence, the awareness of these thoughts might even lead to the selection of more adaptive coping responses, which could help to reduce the risk of relapse, such as talking to someone about them or just simply letting these thoughts go.

 

In one study (8), participants who reported on their thoughts about alcohol in the previous 24 hours, 92% reported experiencing at least some thoughts about drinking that ‘‘just pop in and vanish’’ without an attempt to eliminate them. This suggests that if both suppression and elaboration can be avoided, many intrusive thoughts will be relatively transient.

An “accept and move on’’ strategy provides an opportunity for the intrusion to remain a fleeting thought.

In other words, just let go.

This means the thoughts go, and the distress which activates them, too.

This is recovery a lo of the time.  Getting embroiled in thinking and then letting go, repeat…

That is why helping others is important  -it takes us out of our crazy heads

References

1. Zack, M., Toneatto, T., & MacLeod, C. M. (1999). Implicit activation of alcohol concepts by negative affective cues distinguishes between problem drinkers with high and low psychiatric distress. Journal of Abnormal Psychology, 108(3), 518.

2. Ingjaldsson, J. T., Laberg, J. C., & Thayer, J. F. (2003). Reduced heart rate variability in chronic alcohol abuse: relationship with negative mood, chronic thought suppression, and compulsive drinking. Biological Psychiatry, 54(12), 1427-1436.

3. Caetano, R. (1985). Alcohol dependence and the need to drink: A compulsion? Psychological Medicine, 15(3), 463–469

4. Modell, J. G., Glaser, F. B., Mountz, J. M., Schmaltz, S., & Cyr, L. (1992). Obsessive and compulsive characteristics of alcohol abuse and dependence: Quantification by a newly developed questionnaire. Alcoholism: Clinical and Experimental Research, 16(2), 266–271.

5. Anton, R. F., Moak, D. H., & Latham, P. (1995). The Obsessive Compulsive Drinking Scale: A self-rated
instrument for the quantification of thoughts about alcohol and drinking behavior. Alcoholism:
Clinical and Experimental Research, 19, 92–99.

6. Hoyer, J., Hacker, J., & Lindenmeyer, J. (2007). Metacognition in alcohol abusers: How are alcohol-related intrusions appraised?. Cognitive Therapy and Research, 31(6), 817-831.

7. Marlatt, G. A., & Gordon, J. R. (Eds.). (1985). Relapse prevention: Maintenance strategies in the
treatment of addictive behaviors. New York: Guilford Press

8. Kavanagh, D. J., Andrade, J., & May, J. (2005). Imaginary relish and exquisite torture: the elaborated intrusion theory of desire. Psychological review, 112(2), 446.

 

How Stories Transform Lives

When I first came to AA, I wondered how the hell sitting around in a circle listening to one person talking, and the next person talking and …. could have anything to do with my stopping drinking?

It didn’t seem very medical or scientific? Did not seem like any sort of treatment?  How could I get sober this way, listening to other people talking?

It didn’t make any sense. Any time I tried to ask a question I was told that we do not ask questions, we simply listen to other recovering alcoholics share what they called their “experience, strength and hope”?

How does this help you recover from one of the most profound disorders known, from chronic alcoholism?

I did not realise  that this “experience, strength and hope” in AA parlance, is fundamental in shifting an alcoholic’s self schema from a schema that did not accept one’s own alcoholism, to a self schema that did, a schema that shifts via the content of these shared stories from a addicted self schema to recovering person self schema.

Over the weeks, months and years I have grown to marvel at the transformative power of this story format and watched people change in front of my very eyes over a short period of time via this process of sharing one’s story of alcoholic damage to recovery from alcoholism.

I have seen people transformed from dark despair to the  lustre of hope and health.

One of the greatest stories you are ever likely to hear and one I never ever tire of hearing.

Through another person sharing their story they seem to be telling your story at the same time. The power of identification is amplified via this sharing.

If one views A.A. as a spiritually-based community, one quickly observe s that A.A. is brimming with stories.

The majority of A.A.’s primary text (putatively entitled Alcoholics Anonymous but referred to almost universally as “The Big Book,” A.A., 1976) is made up of the stories of its members.

During meetings, successful affiliates tell the story of their recovery. In the course of helping new members through difficult times, sponsors frequently tell parts of their own or others’ stories to make the points they feel a neophyte A.A. member needs to hear. Stories are also circulated in A.A. through the organization’s magazine, Grapevine.

But the most important story form in Alcoholics Anonymous describes  personal accounts of descent into alcoholism and recovery through A.A. In the words of A.A. members, explains “what we used to be like, what happened, and what we are like now.”

Members typically begin telling their story by describing their initial involvement with alcohol, sometimes including a comment about alcoholic parents.

Members often describe early experiences with alcohol positively, and frequently mention that they got a special charge out of drinking that others do not experience. As the story progresses, more mention is made of initial problems with alcohol, such as job loss, marital conflict, or friends expressing concern over the speaker’s drinking.

Members will typically describe having seen such problems as insignificant and may label themselves as having been grandiose or in denial about the alcohol problem. As problems continue to mount, the story often details attempts to control the drinking problem, such as by avoid-ing drinking buddies, moving, drinking only wine or beer, and attempting to stay abstinent for set periods of time.

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The climax of the story occurs when the problems become too severe to deny any longer. A.A. members call this experience “hitting bottom.”

Some examples of hitting bottom that have been related to me include having a psychotic breakdown, being arrested and incarcerated, getting divorced, having convulsions or delirium tremens, attempting suicide, being publicly humiliated due to drinking, having a drinking buddy die, going bankrupt, and being hospitalized for substance abuse or depression.

After members relate this traumatic experience, they will then describe how they came into contact with A.A. or an A.A.-oriented treatment facility…storytellers incorporate aspects of the A.A. world view into their own identity and approach to living.

Composing and sharing one’s story is a form of self-teaching—a way of incorporating the A.A. world view (Cain, 1991). This incorporation is gradual for some members and dramatic for others, but it is almost always experienced as a personal transformation.

So before we do the 12 steps we start by accepting step one  – We admitted we were powerless over alcohol——that out lives had become unmanageable –  and by listening to and sharing stories which give many expamples of this loss of control or powerlessness over drinking. .

Sharing our stories also allows us to stat comprehending the insanity or out of contolness (unmanageability)  of our drinking and steps us up for considering step 2 –  Came to believe that a Power greater than ourselves could restore us to sanity – through  to step three, so the storeies not only help us change self schema they set us on the way to treating our alcoholism via the 12 steps.

In these stories we accept our alcoholsimm and the need for persoanl, emotional and spirtual transformation. The need to be born anew, as a person in recovery.

Reference

1. Humphreys, K. (2000). Community narratives and personal stories in Alcoholics Anonymous. Journal of community psychology, 28(5), 495-506.

 

 

Who Wants to be an Alcoholic?

The social stigma of being an alcoholic prevents many from coming into recovery and treating their illness. And it is an illness but it takes time to realise that – a physiological, psychological, emotional, cognitive, behavioural and spiritual disease. It is as profound an illness as one can have.

It is the only illness that actively tells you that you do not have it!

How cunning, baffling and powerful is that!?  

In fact stigma, particular prevalent in the UK as compared to the US, helps kill alcoholics.

We all have ideas of tramp on park benches supping on bottles of alcohol when we think of alcoholics.

I know I did. When I went to my first meeting I thought I would be greeted by park tramps with strings holding their trousers up with food encrusted beards, no teeth and hygiene problems.

I wasn’t greeted by anyone like this.

I was greeted by a teacher, a lawyer, a counsellor, a business man, a builder, a nurse, an actress, among others.  Alcoholism effects every area of life, no strata of life is immune, there are recovering alcoholics everywhere.  The second man to have stepped on the moon is in recovery for alcoholism!

These shiny AA people were not drinking and some had not drank for decades!

Imagine not drinking for ten years and more? I could not imagine ten minutes…but now I am coming up to my tenth birthday in AA.

 

“Most of us have been unwilling to admit we were real alcoholics. No person likes to think he is bodily and mentally different from his fellows” (1)

Neuroscience has demonstrated repeatedly how the brain is taken over by the actions of alcohol and other substances which leave the brain severely restricted in it’s choice of behaviours. Self will has become so compromised we barely have any!?

We become so comprised in our own ability to make decisions that we are often “without mental defence against” drinking.

Alcohol via the alterations in stress and reward (survival) systems in the brain means our illness has literally taken over our brain and calls the shots, does the thinking which leads to the drinking.

We have a thinking disease as well as drinking one by the time we get into recovery.

It is the thinking of this illness, which we mistake for our own, quite understandably, as these thoughts are happening in our own head, that tells us we do not have an alcoholic problem, we do not need to go to an AA meeting, or when we have gone, that we do not need to stay, that we are different to the people at the meeting – that they need this recovery thing not me. I can work this out myself.

Why does it do this?

Why is it constantly chittering away between our ears. It has to be us, surely? Our thoughts can’t have been taken over like some 1960s episode of Star Trek where Captain Kirk and crew are struck down by some thought virus??

If you are new to recovery don’t bend your head over this stuff!

All you have to do is twofold. Get to a meeting and see if your experience of drinking tallies with those there and two, watch out for that motivational voice of alcoholism trying to get you far away from these people.

This is my test to see if you are alcoholic.

This voice of the illness is similar to the voice of OCD and other anxiety disorders which talk to us in thoughts which are contrary to our well being and health. Why?

Because our survival networks in the brain have gone so haywire that these conditions think they are helping us survive by suggesting certain actions which we previously used to reduce distress, i.e.compulsive behaviours, but which take us increasingly into even greater emotional distress and unhealthy behaviours.

They are like an Olympic coach training us to get chronically unwell.

They persist because they have ingrained in our brains unfortunately, possible forever. They are the torturous whispers of our neural ghosts!

They refuse to die but in time these voices become more manageable, the volume on them can be turned down or ignored altogether.

Turning down the distress signal that feeds them is at the key.

You are not alone – “Every natural instinct cries out against the idea of personal  powerlessness.” (2)

This powerlessness led me to surrendering. Paradoxically to win this war we must first surrender.

Surrendering to the idea that I may, possibly, be an alcoholic.

Acceptance of this possibility is the first step.

 

References

 

  1.  Alcoholics Anonymous. (2001). Alcoholics Anonymous, 4th Edition. New York: A.A. World Services.
  2. Twelve steps and twelve traditions. (1989). New York, NY: Alcoholics Anonymous World Services.

 

Appraising Alcohol-Related Thoughts

In this first in a series of blogs addressing the similarities between addiction and obsessive compulsive disorder (OCD).

This blog looks at the nature of obsessive thoughts about alcohol. It brings to focus the great sense in your sponsor suggesting the reason you may be having thoughts about alcohol, especially in early recovery, is because you are an alcoholic. Alcoholics have obsessive thoughts about  alcohol. Normal, healthy people don’t!

The other interesting thing about this study (1),  in addition to echoing that these thoughts are a natural occurrence to alcoholics, is that the authors explain how the nature of these thoughts are similar to those experienced in OCD, such as thought-action fusion. It also looks at how Metacognition which refers to higher order thinking which involves active control over the cognitive processes can be important to how we appraise our alcohol related thoughts and ultimately how we react to them.

 

“… the idea that abstinence will automatically also decrease alcohol-related thoughts might be too optimistic. Empirical research contradicts this expectation, demonstrating instead that alcohol-related thoughts can resemble obsessive-compulsive thinking (Caetano, 1985; Modell, Glaeser, Mountz, Schmaltz, & Cyr, 1992). This finding is also supported by clinical observation and leads to the expectation that among abstinent alcohol abusers, alcohol-related thoughts and intrusions are the rule rather than the exception.

Relatively little is known about how alcohol abusers appraise their alcohol-related thoughts. Are they aware that alcohol-related thoughts occur naturally and are highly likely during abstinence? Or do they interpret these thoughts in a negative way, for example, as unexpected, shameful, and bothersome? Finding answers to these questions has implications for relapse prevention, because misinterpretations of naturally occurring thoughts may be detrimental for abstinence (Marlatt & Gordon, 1985).

Metacognitive theory provides a theoretical context for analyzing these open questions about alcohol-related thoughts. It focuses on the role that beliefs about one’s thoughts and appraisal of these thoughts play in the development and persistence of psychological disorders (Nelson, Stuart, Howard, & Crowley, 1999; Purdon & Clark, 1999; Wells, 2000; Wells & Matthews, 1994).

A number of conceptual papers and empirical studies have shown that individuals’ appraisal of their intrusive thoughts as detrimental and potentially out of their control may lead them to dysfunctional and counterproductive efforts to control their thinking. These efforts to control can explain the development and maintenance of various disturbed cognitive processes, including those seen in generalized anxiety disorder (Wells, 1999), obsessive-compulsive disorder (Purdon & Clark, 1999; Rachman & Shafran, 1999), depression (Teasdale, 1999), hypochondriasis (Bouman & Mijer, 1999).

Although these disorders clearly differ from one another in their clinical presentation, the basic assumption unifying the metacognitive models for each of them is that ‘‘metacognitive beliefs are always involved in guiding the content and nature of cognition that modulates emotional disturbance’’ (Wells, 2000, p. 31).

If alcohol abusers do experience alcohol-related thoughts that they metacognitively monitor and evaluate on the basis of metacognitive knowledge, they are likely to use various metacognitive strategies in an effort to control the thoughts.

Alcohol-related thoughts cause an individual to experience strong emotional reactions; however, alcohol abusers will increase their efforts to control their thinking only when they have negative metacognitive knowledge structures and beliefs that are activated. For instance, spontaneous positive memories about alcohol (‘‘It was so nice to hang out at parties and to drink with my buddies’’) may be appraised—and misinterpreted—as ‘‘the first steps toward a relapse’’ and as ‘‘a bad sign’’…or as documenting the person’s inability to stay away from alcohol.

Such an appraisal of one’s thoughts about alcohol as problematic may instigate thought suppression and other efforts to control the thoughts. Because these efforts must be assumed to be counterproductive (Fehm & Hoyer, 2004), they will predict rather than prevent negative feelings, and they may even demoralize alcohol abusers who are trying to remain abstinent.

If …alcohol-related thoughts are not appraised as problematic but as a normal part of abstinence, the awareness of these thoughts would be a neutral mental event, or might even lead to the selection of more adaptive coping responses, which could help to reduce the risk of relapse

The analysis of metacognitive appraisal of alcohol-related thoughts may also help to solve a core theoretical problem in craving research (Drummond, 2001): The validity of craving for predicting relapse is ambiguous. The assumption that metacognitive variables mediate reactions to alcohol-related cues may help to explain why craving does not inevitably lead to relapse.

 

Based on the results of two samples of alcohol abusers receiving cognitive-behavioral treatment in this study, the Metacognition Questionnaire for Alcohol Abusers (MCQ-A) was developed and refined and preliminary validation was conducted. The latest version of the MCQ-A measures two factors identified in Study 1 and replicated in Study 2. They were named Uncontrollability/Thought-Action Fusion and Unpleasantness. A third dimension of metacognition about alcohol-related thoughts was examined in Study 2. It is called Subjective Utility of the Thought was developed through theoretical and clinical considerations.

These factors covered the following:-

Factor 1: Uncontrollability/Thought-Action Fusion.

This thought is stronger than my will. I cannot stop this thought once I have it in mind. This thought has too much impact on me. I can control this thought.  I cannot push away this thought. This thought increases my desire to drink. This thought stimulates craving for alcohol.  This thought can really make me drink.

Factor 2: Unpleasantness

I feel bad when this thought comes up. This thought makes me lose my good mood. It is unpleasant to have this thought. I get annoyed at this thought. This thought disturbs me. I wish I could stop thinking this thought. I do not want to have this thought. It is annoying that this thought always returns.

Factor 3: Subjective utility

This thought can be of help by waking me up. This thought serves as a warning signal for me. I can use this thought when I understand it as a warning sign. This thought can warn me. I can learn something through this thought.

…nearly all of the alcohol abusers in both studies indicated having experienced intrusions and thoughts about alcohol during the prior weeks. This result is not surprising considering that research has suggested that craving is associated with enhanced processing of alcohol-related episodes and recollections. Thus, the result confirms the relevance of studying the role that alcohol-related thinking plays in the process of abstinence.

Uncontrollability/Thought-Action Fusion and Unpleasantness scales were positively correlated, as expected, with detrimental social-cognitive variables, such as craving and thought suppression, and negatively with drug-taking confidence.

The study clearly showed that metacognitive appraisal of alcohol-related thinking can be measured in alcohol-abusing patients. The appraisal is linked to symptoms such as craving and may lead to counterproductive coping efforts, such as thought suppression.”

I cite this study because the factors it identifies are the types of reactions to thoughts I experienced myself in early recovery.

As I am mentioned it is a cognitive-affective reaction to these naturally occurring thoughts via e.g thought suppression that gives rise to “craving”. If we remain mindful of them and accept them as being natural, a neutral event, they can pass without prompting a craving episode.

One aspect that is not mentioned in this article but which is a part of OCD type thinking is the notion of ego dystonic thoughts.

I believe that thoughts about alcohol move from being egosyntonic in active drinking to egodystonic in recovery.

Egosyntonic is a psychological term referring to behaviors, values, feelings that are in harmony with or acceptable to the needs and goals of the ego, or consistent with one’s ideal self-image.

Egodystonic (or ego alien[1]) is the opposite of egosyntonic and refers to thoughts and behaviors (e.g., dreams, impulses, compulsions, desires, etc.) that are in conflict, or dissonant, with the needs and goals of the ego, or, further, in conflict with a person’s ideal self-image.

Hence we may react to these thoughts because we feel they are not longer consistent or are threatening to our new found sense of self as a recovering person.

 

As we shall see in the next few blogs there are similarities between OCD and addiction.

 

References

1.  Hoyer, J., Hacker, J., & Lindenmeyer, J. (2007). Metacognition in alcohol abusers: How are alcohol-related intrusions appraised?. Cognitive Therapy and Research, 31(6), 817-831.

 

 

Acceptance is the Key – Using Acceptance-Based Mindfulness to Promote Emotional Regulation

One of the leading researchers in the area of emotional regulation difficulties and the advocacy of acceptance-based Mindfulness in treatment of these emotional regulation problems is  Kim Gratz.

In the first in a series of blogs about how different treatments address the intrinsic emotional dysregulation at the heart of addiction we consider Gratz’s view on emotional regulations and the role of mindfulness in alleviating some of this dysregulation (1).

The idea of acceptance of things as they are is central to acceptance based treatments such as Mindfulness, DBT and 12 step programs (“acceptance is the key”).

Difficulties in emotion regulation underlie many of the clinically relevant behaviors and psychological difficulties for which clients seek treatment, including substance use (2,3), binge eating (4,5).

In response, treatments for a variety of difficulties are increasingly incorporating a focus on emotion regulation and seeking to promote adaptive emotion regulation skills (6- 8 ).

There has been a great deal of research in the past decade indicating that efforts to control, suppress, or avoid unwanted internal experiences (including emotions) may actually have paradoxical effects, increasing the frequency, severity, and accessibility of these experiences (9-10 ).

Studies in this area have focused on thought suppression (i.e., deliberately trying not to think about something). Consistent with the findings of this research, another approach to emotion regulation emphasizes the functionality of all emotions (11,12) and suggests that adaptive emotion regulation involves the ability to control one’s behaviors (e.g., by inhibiting impulsive behaviors)

acceptance-revised

 

These studies show that attempts to avoid or suppress internal experiences may actually have paradoxical effects (referred to as ironic processes (13)) were attempts to suppress thoughts leads to them increasingly rebounding in one’s mind so this has the opposite effect, ironic, to what one hopes to achieve, to lessen these thoughts.  More recently, researchers have  found similar results when attempting to suppress emotions (14). All in all, these findings suggest that conceptualizations of emotion regulation that equate regulation with  the control or avoidance of certain emotions may be counter productive to emotion regulation.

Some researchers have suggested suggests that adaptive emotion regulation involves the ability to control one’s behaviors when experiencing negative emotions, rather than the ability to directly control one’s emotions themselves (7,15). This approach distinguishes emotion regulation from emotional control and, instead, defines regulation as the control of behavior in the face of emotional distress

According to this approach, although adaptive regulation may involve efforts to modulate the intensity or duration of an emotion (16) these efforts are in the service of reducing the urgency associated with the emotion in order to control one’s behavior (rather than the emotion itself).

In other words, this approach suggests the potential utility of efforts to “take the edge off” an emotion or self-soothe when distressed, rather than to get rid of the emotion or escape it altogether.

Moreover, when it comes to efforts to modulate the intensity or duration of an emotion, attachment to the outcome of these efforts is thought to have paradoxical effects (as directly trying to reduce emotional arousal to a particular level or make an emotion end after a certain amount of time is considered to reflect an “emotional control” agenda indicative of emotional avoidance).

Some researchers conceptualize emotion regulation as any adaptive way of responding to one’s emotions, regardless of their intensity or reactivity.

Given evidence that many individuals who engage in maladaptive behaviors struggle with their emotions (17,18), treatments that focus on teaching individuals ways to avoid or control their emotions may not be useful, and may inadvertently reinforce a non-accepting, judgmental, and unhealthy stance toward emotions. Instead, the fact  that such individuals may be caught in a struggle with their emotions suggests that they may benefit from learning another (more adaptive) way of approaching and responding to their emotions

Acceptance- and mindfulness-based treatments may be particularly useful for promoting emotion regulation and facilitating the development of more adaptive ways of responding to emotions. For example, the process of observing and describing one’s emotions (an element common across many mindfulness- and acceptance-based treatments,) to promote emotional awareness and clarity, as clients are encouraged to observe their emotions as  they occur in the moment and to label them objectively.

Through this process, clients are increasing contact with these emotions and focusing attention on the different components of their emotional responses (expected to increase emotional awareness). Further, the process of describing emotions is expected to facilitate the ability to identify, label, and differentiate between emotional states.

Moreover, the emphasis on letting go of evaluations such as “good” or “bad”) and taking a nonjudgmental and non evaluative stance toward these emotions

 

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Given that the evaluation of emotions as bad or wrong likely both motivates attempts to avoid emotions and leads to the  development of secondary emotional responses (e.g., fear or shame), learning to approach emotions in a nonjudgmental fashion is expected to increase the willingness to  experience emotions and decrease secondary emotional reactions.

Indeed, it is likely this nonevaluative stance (i.e., the description of stimuli as “just is,” rather than as “bad” or “good”) that underlies many of the potential benefits of observing and describing one’s emotions

Mindfulness training may also promote the decoupling of emotions and behaviors, teaching clients that emotions can be experienced and tolerated without necessarily acting on them. As such, these skills may facilitate the ability to control one’s behaviors in the context of emotional distress.

One factor thought to interfere with the ability to control impulsive behaviors when emotionally distressed  is the experience of emotions as inseparable from behaviors, such that the emotion and the behavior that occurs in response to that emotion are experienced as one (e.g.,anxiety and taking an anxiolytic). Thus, the process of observing one’s emotions and their associated action urges is thought to facilitate awareness of the separateness of emotions and the behaviors that often accompany them, facilitating the ability to control one’s behaviors when distressed.

 

1. Gratz, K. L., & Tull, M. T. (in press). Emotion regulation as a mechanism of change in acceptance-and mindfulness-based treatments. In R. A. Baer (Ed.), Assessing mindfulness and acceptance: Illuminating the processes of change. Oakland, CA: New Harbinger Publications.

2. Fox, H. C., Axelrod, S. R., Paliwal, P., Sleeper, J., & Sinha, R. (2007). Difficulties in emotion regulation and impulse control during cocaine abstinence. Drug and Alcohol Dependence, 89, 298-301.
3.  Fox, H. C., Hong, K. A., & Sinha, R. (2008). Difficulties in emotion regulation and impulse control in recently abstinent alcoholics compared with social drinkers. Addictive Behaviors, 33, 388-394.

4. Leahey, T. M., Crowther, J. H., & Irwin, S. R. (2008). A cognitive-behavioral mindfulness group therapy intervention for the treatment of binge eating in bariatric surgery patients.  Cognitive and Behavioral Practice, 15, 364-375.

5.  Whiteside, U., Chen, E., Neighbors, C., Hunter, D., Lo, T., & Larimer, M. (2007). Difficulties regulating emotions: Do binge eaters have fewer strategies to modulate and tolerate negative affect? Eating Behaviors, 8, 162-169.

6. Gratz, K. L., & Gunderson, J. G. (2006). Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with borderline personality disorder. Behavior Therapy, 37, 25-35.

7. Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford Press.

8. Mennin, D. S. (2006). Emotion regulation therapy: An integrative approach to treatment-resistant anxiety disorders. Journal of Contemporary Psychotherapy, 36, 95-105

9. Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes, and outcomes. Behaviour Research and Therapy, 44, 1-25

10. Salters-Pedneault, K., Tull, M. T, & Roemer, L. (2004). The role of avoidance of emotional material in the anxiety disorders. Applied and Preventive Psychology, 11, 95-114

11. Cole, P. M., Michel, M. K., & Teti, L. O. (1994). The development of emotion regulation and  dysregulation: A clinical perspective. In N. A. Fox (Ed.), The development of emotion regulation: Biological and behavioral considerations. Monographs of the Society for Research in Child Development, 59, (pp. 73-100, Serial No. 240)

12. Thompson, R. A., & Calkins, S. D. (1996). The double-edged sword: Emotional regulation for children at risk. Development and Psychopathology, 8, 163-182.

13. Wegner, D. M. (1994). Ironic processes of mental control. Psychological Review, 101, 34-52.

14. Salters-Pedneault, K., Roemer, L., Tull, M. T., Rucker, L., & Mennin, D. S. (2006). Evidence of  broad deficits in emotion regulation associated with chronic worry and generalized anxiety disorder. Cognitive Therapy and Research, 30, 469-480.

15. Melnick, S. M., & Hinshaw, S. P. (2000). Emotion regulation and parenting in AD/HD and comparison boys: Linkages with social behaviors and peer preference. Journal of Abnormal Child Psychology, 28, 73-86.

16. Thompson, R. A. (1994). Emotion regulation: A theme in search of definition. In N. A. Fox  (Ed.), The development of emotion regulation: Biological and behavioral considerations. Monographs of the Society for Research in Child Development, 59, (pp. 25-52, Serial No.
240)

17.   Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self harm: The experiential avoidance model. Behaviour Research and Therapy, 44, 371-394.

18. Whiteside, U., Chen, E., Neighbors, C., Hunter, D., Lo, T., & Larimer, M. (2007). Difficulties regulating emotions: Do binge eaters have fewer strategies to modulate and tolerate  negative affect? Eating Behaviors, 8, 162-169

Don’t fight your thoughts!

The idea that abstinence will automatically also decrease alcohol-related intrusive thoughts has been dismissed by research and vast anecdotal evidence.

Practically all therapies for alcoholism e.g  AA, SMART and so on suggest that urges create automatic thoughts about drinking. This has been demonstrated in research that distress automatically gives rise to intrusive thoughts about alcohol. (1) This reflects emotional dysregulation as these intrusive thoughts are correlated to emotional dysregulation (2).

These thoughts to the recovering/abstinent individual can be seen as egodystonic which is a psychological term referring to behaviors, values, feelings that are in harmony with or acceptable to the needs and goals of the ego, or consistent with one’s self image.  Other conditions, such as OCD, have these egodystonic thoughts creating the distress that drives a compulsive need to act on them, rather than letting them pass. In other words, these thoughts are seen as distressing and threatening and compel one to act to reduce this escalating sense of distress. A similar process can happen to those in early recovery. Thoughts about drinking or using when you now wish to remain in recovery are egodystonic, they are contrary to the view of oneself as a person in recovery.  The main problem occurs when we think we can control these thoughts are that these thoughts mean we want to drink or are going to relapse!

Early recovery is a period marked by heightened emotional dysregulation and the proliferation of intrusive thoughts about alcohol .

In fact, empirical research demonstrates that alcohol-related thoughts can resemble obsessive-compulsive thinking (3,4).

In fact, one way to measure “craving” in alcoholics is by scale called the Obsessive Compulsive Drinking Scale (5) , thus highlighting certain similarities in pathomechanisms between alcohol and OCD.

This finding is also supported by clinical observation and leads to the expectation that among abstinent alcohol abusers, alcohol-related thoughts and intrusions are the rule rather than the exception (6)

Relatively little is known about how alcohol abusers appraise their alcohol-related thoughts. Are they aware that alcohol-related thoughts occur naturally and are highly likely during abstinence? Or do they interpret these thoughts in a negative way, for example, as unexpected, shameful, and bothersome? Answers to these questions obviously inform with implications for relapse prevention, because misinterpretations of naturally occurring thoughts may be detrimental for abstinence (7).

 

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A number of conceptual papers and empirical studies have shown that individuals’ appraisal of their intrusive thoughts as detrimental and potentially out of their control may lead them to dysfunctional and counterproductive efforts to control their thinking. Alcohol-related thoughts cause an individual to experience strong emotional reactions; however, alcohol abusers will increase their efforts to control their thinking only when they have negative beliefs about these thoughts. For instance, spontaneous positive memories about alcohol (‘‘It was so nice to hang out at parties and to drink with my buddies’’) may be appraised—and misinterpreted—as ‘‘the first steps toward a relapse’’.

Such an appraisal of one’s thoughts about alcohol as problematic may instigate thought suppression and other efforts to control the thoughts. Because these efforts must be assumed to be counterproductive (Fehm & Hoyer, 2004), they will increase rather than prevent negative feelings and thoughts, and they may even demoralize alcohol abusers who are trying to remain abstinent

If positive alcohol-related thoughts are not appraised as problematic but as a normal part of abstinence, the awareness of these thoughts might even lead to the selection of more adaptive coping responses, which could help to reduce the risk of relapse.

In the context of mental health, metacognition can be loosely defined as the process that “reinforces one’s subjective sense of being a self and allows for becoming aware that some of one’s thoughts and feelings are symptoms of an illness.”

The assumption that metacognition mediates reactions to alcohol-related cues may help to explain why “craving” does not inevitably lead to relapse.

In one reported study (8), participants who reported on their thoughts about alcohol in the previous 24 hours, 92% reported experiencing at least some thoughts about drinking that ‘‘just pop in and vanish’’ without an attempt to eliminate them. This suggests that if both suppression and elaboration can be avoided, many intrusive thoughts will be relatively transient.

An “accept and move on’’ strategy provides an opportunity for the intrusion to remain a fleeting thought.

 

References

1. Zack, M., Toneatto, T., & MacLeod, C. M. (1999). Implicit activation of alcohol concepts by negative affective cues distinguishes between problem drinkers with high and low psychiatric distress. Journal of Abnormal Psychology, 108(3), 518.

2. Ingjaldsson, J. T., Laberg, J. C., & Thayer, J. F. (2003). Reduced heart rate variability in chronic alcohol abuse: relationship with negative mood, chronic thought suppression, and compulsive drinking. Biological Psychiatry, 54(12), 1427-1436.

3. Caetano, R. (1985). Alcohol dependence and the need to drink: A compulsion? Psychological Medicine, 15(3), 463–469

4. Modell, J. G., Glaser, F. B., Mountz, J. M., Schmaltz, S., & Cyr, L. (1992). Obsessive and compulsive characteristics of alcohol abuse and dependence: Quantification by a newly developed questionnaire. Alcoholism: Clinical and Experimental Research, 16(2), 266–271.

5. Anton, R. F., Moak, D. H., & Latham, P. (1995). The Obsessive Compulsive Drinking Scale: A self-rated
instrument for the quantification of thoughts about alcohol and drinking behavior. Alcoholism:
Clinical and Experimental Research, 19, 92–99.

6. Hoyer, J., Hacker, J., & Lindenmeyer, J. (2007). Metacognition in alcohol abusers: How are alcohol-related intrusions appraised?. Cognitive Therapy and Research, 31(6), 817-831.

7. Marlatt, G. A., & Gordon, J. R. (Eds.). (1985). Relapse prevention: Maintenance strategies in the
treatment of addictive behaviors. New York: Guilford Press

8. Kavanagh, D. J., Andrade, J., & May, J. (2005). Imaginary relish and exquisite torture: the elaborated intrusion theory of desire. Psychological review, 112(2), 446.