The Roots of All Our Troubles!?

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Most of my distress and emotional pain in recovery comes from wanting stuff, and not getting my way or not accepting things as they are.

As Bill Wilson noted, we seem to get distressed when we don’t get what we want or feel people or trying to take away what we have.

This was his observation after a decade of psycho analysis with the psycho analyst Harry Tiebout.

A decade of therapy also showed Bill Wilson he has two default settings in his relationship to other human beings – he either tried to dominate them or he became dependent on them for his sense of self and emotional well being. In other words, he became dependent on others, on external means for approval and elevating his self esteem.

This is similar to relying on external means, i.e. alcohol, drugs, addictive behaviours to regulate our emotions and bolster our low self esteem.

We are in a sense co-dependent on other people for our sense of esteem.  We rely on others in terms of how we feel about ourselves.

As a result we are guarded against those that we perceive will reject us or be negative to us, harm us in some way and we seek to dominate these folk or we are dependent on those who are kind to us, help us and care for us. We swing at times between these extremes.

Some of us are “people pleasers”, some of us are dismissive towards others. I can be a dismissive person more than a people pleaser. It is all manipulating our interaction with others to our selfish ends.

Some of these tendencies are the result of our childhoods and how closely attached we were to our parents.

Some of us have this knawing feeling of not being good enough, have a hole in the soul which we are/were kinda always unconsciously trying to protect, shield from the world.

It is a strange feeling of not wanting to be found out of being less than, not good enough. “If people realise what the real me is like, they will reject me!” type thinking although a lot of this is unconscious and does not pop in to our minds as thoughts but is an unconscious self schema that shapes our behaviours.

In simple terms we manipulate via people pleasing or we push people away via being dismissive and putting others down, we guard against any threat of perceived rejection or threats to the self via defense mechanisms such as projecting what we do not like about ourselves on to others.

We often do not like traits in others because they somehow mirror traits in ourselves although we are not always conscious of this.

We have difficulties in our relationships with others, these relationships are often unhealthy and ill.

Some of this is touched on in the Big Book of Alcoholics Anonymous, but much of it comes from later observations by Bill Wilson after the publication of the Big Book and my and others’ observations since.

I have seen in myself how fear and shame seem to drive most of my maladaptive behaviour.

My illness of addictive behaviours.

I have an illness of chronic malcontent, things are rarely good enough and I am rarely good enough, according to my “out of kilter”  thinking which  I usually try to ignore, turn over to God or on occasion challenge via reasoning and sharing with other people.

My thoughts are often not my friends, they are often not in the service of my ongoing well being, quite the opposite in fact.

This is how a mental health disorder manifests itself as distorted fear based thinking which appear, if acted upon, to make one’s situation a whole lot worse.

We can not rely on our thoughts and feelings or, in other words, our Self Will. Our self will has become impaired and is no longer in the service of our successful survival.

I have found over the last decade in recovery that when I turn my Will over to the care of the God of my understanding that I am restored to sanity and my thoughts are sound, they are on a higher plane as the Big Book tells me.

I can become the fullest expression of me in the God, not the ill, deluded version while running under my own self will. That has been my experience.

It is only with God’s help that I get restored to sanity or reasonableness.

When I have a fear of not getting stuff and this is linked to insecurity, as mentioned in the Big Book, it is usually in relation to my pocket book, financial insecurity, personal relationships, self esteem etc.

I will now look at this fear based reaction to my security which is mainly to do with stuff out  there (external) such as work, people and how they affect my sense of self before looking at how my internal sense of self, based on the fear based emotion of shame seems to play a pivotal role in my relationship with others and the world around me.

I am assailed externally by fear of what other’s think about me and internally about what I think of me – when these two line up it can have a powerful and damaging effect on my psyche.

Desiring stuff seems at the root of my fear based stuff – the exquisite torture of desire which soon loses it’s so-called relish and just becomes torturous.

Alcoholics do not seem want stuff like normal folk, but have a pathological wanting, an all consuming need to get stuff regardless of it’s worth or value.

We seem to compulsively seek to relieve an inherent distress of not having what we set out to get. Our decision making seems fueled at times by this need to relieve distress rather than the intrinsic value of what we are seeking.

We seem to become manic in our pursuit of things and end up overdoing whatever we are doing via this stress-based manic activity.

This seems compounded by not always being able to read our emotions or somatic states.

One of my own difficulties is realising I am hungry or tired and I can often end up exhausted by over-doing stuff especially manual work around my house. My stop button broke a long time a ago and probably did not work very well to begin with.

So we have  stress-based compulsive need to do something and very limited brakes in the brain stopping us and very little emotional feedback going on, a limited consideration of  “aren’t we overdoing this a bit?”

Desire obviously runs contrary to the idea of being in God’s will, in fact it is being in Self Will that seems to create distress in many people with addictive behaviours.

I would add to this that I also get distress via fears of rejection from others, I suffer from fear based shame to a chronic extent.

Shame, also the consequence of being in Self Will, was not really mentioned in the Big Book of Alcoholics Anonymous, mainly because it was not really known about as a psychological or psycho-therapeutic concept then.

Much of the Big Book was influenced by  psycho-analysis which did not consider shame, but rather guilt, in psychological disturbance.

In fact, it has only started considering the role of shame in the last few decades.

So I would add fear of not getting what we want or having something taken away is also complemented by shame-based fears of being rejected.

For example there is an undercurrent in fear of things being taken away, of it being because we are not good enough, deserving enough, have failed in some way, which are shame based reactions.

In fact the Big Book gives me a good idea of the “sins” or “defects of character” I have when I have a resentment but does not explain why I have resentments in the first place.

It explains this as selfishness, self centredness… the root of all our troubles.

It does not, for me, clearly explain why we resort to these selfish, immature, emotional reactions or why we persist with resentments?

It does not explain the emotional immaturity at the heart of alcoholism,  this spiritual malady of inappropriate emotional response to the world around us?

Bill Wilson was struck himself, when he started working with other alcoholics, how much they were plagued constantly by various resentments. How they were haunted by memories of situations in the past, how they swirl around and pollute their minds in the present. How they could not let go of events in their past?

For me he was seeing the root of this spiritual malady, this emotional disease.

For me we engage futilely and distressingly in resentment because we have an inability to process and control our emotions, they overwhelm us and we often react by people pleasing (shame) or react via various defense mechanisms (also shame based).

Defense mechanisms are central to psycho-analytic thought – such as projection etc, the idea that we  expel “out of ourselves what we do not like about ourselves onto others.

Sometimes others expel the same negative emotions on to us. I have found this a fairly common trait among male alcoholics in recovery settings and meetings.

I was discussing this with a newcomer last week, how people who seek to “put us down”  do so out of shame and induce in us all the negative emotions they are experiencing themselves!

The newcomer gave me an example of a resentment he was experiencing after this guy at a meeting said “get off your pink cloud” a phrase that refers to the sometimes  mildly ecstatic feelings of early recovery.

This made the newcomer ashamed that he could have been so stupid for being on this pink cloud, as if this was a selfish indulgence!?

I explained to him that his pride had been hurt, he was in shame and his “apparent” depression every since was simply prolonged self pity.

If we leave self pity to fester long enough it becomes depression, that is my experience anyway.

I said the other guy was probably “hurt” to see a newcomer having such a good period of recovery (God does want us to be happy, joyous and free after all) – I said his false pride was hurt too, that he was not having the recovery experience at present of the newcomer (possibly because he wasn’t putting the effort in) and was in shame (not good enough) and self pity. This mesh of negative emotions can link up fairly instantaneously I find.  It is the web my spiritual malady seeks to ensnare me in.

The guy was probably in guilt too as he could been working on his recovery more.

As a result this guy put the newcomer down to alleviate his own sense of self, his low self esteem.

He “had to” react with arrogance, dismissiveness, impatience and intolerance, because his shame, which is a fear based emotion, made him fearful of his own recovery and fear makes one strangely dishonest (at times deluded), This is my experience.

All because a newcomer had the temerity to be enjoying his recovery?

Not completely, this is half the answer.

The other part is that this guy, if an alcoholic like me, has real difficulties accessing in his heart and mind how he actually “feels” at any particular time. Or rather what emotions he is experiencing at any particular time.

This guy could have been experiencing guilt or shame for example.

Instead of saying to himself I am feeling guilt that my recovery is flabby  compared to this newcomer or that I am being an arrogant “know it all”, putting this newcomer in his place because  he had been in recovery longer – although being in recovery and being sober are different things I have found.

Either way, if he could perhaps of had the ability to say this is how exactly I am feeling he could have acted on this emotional information rather than reacted to it.

What do I mean by this?

Well, if I was feeling guilty about this newcomer it would cause a disturbance in me because I have difficulties processing my emotions.

It would have turned up therefore as a resentment of someone having something I do not have and as them taking away the illusion that my recovery was going OK?

I would have found this threatening to my sense of self so I would have reacted via defense mechanisms. I would have strangely blamed this person for making me feel the way I did! Even if this person had no such intention of hurting my feelings I would blame him nonetheless via my defensive reactions.

It is as if my emotional well being is dependent on other people and their behaviours, this is my spiritual malady, my emotional disease.

As I would have had a resentment, it would have had a wolf pack of negative emotions attached.

In this instance I might have have acted differently.

If I had been in God I would have been more sane for a start and had more loving tolerance for a newcomer.

I would have been acting not reacting. I would have had empathy for where the newcomer  “was at in his recovery” as I had been there once too.

This love and tolerance for the newcomer evolves the displaying of virtues (the opposite of defects are virtues).

What virtues? Well as the newcomer was relatively new I would attempted to be patient, empathetic, kind, gentle, tolerant, considerate  etc. These prevent the defects occurring I find.

If we practice virtues instead of defects then the brain changes for the better and we recover quicker. Our positive loving, healthy behaviours change us and our brains via neuroplasticity for the better.

Attempting to live according to God’s Will (which is a state of Love) also helps me not react but to act with Grace.

In Grace we can still experience negative emotions but God allows us to see them for what they are and not react. His Grace takes the distress out of thee negative emotions. This is my experience.

This allows me to do a quick inventory of my negative emotions and a prayer to God to have them removed. My experience is that they are always removed and that we are immediately restored to sanity.

I do not necessarily have to react to my feelings of negativity about myself, someone else does not need to experience the consequence of my resentments.

I can manage my spiritual malady or emotional dysfunction, I have the tools to do so.

I also impressed upon the newcomer that what the other guy was experiencing and was reacting is also how he, the newcomer, reacts and how I react too.

It is what our spiritual malady looks like I believe, it is the map of my impaired emotional responding.

I also impressed upon him that mostly I can manage this emotional dysfunction but often I fail to and get into a resentful anger.

This is why I have to forgive the other guy as I have been forgiven but also to forgive myself (or ask God to forgive me my shortcomings) for my reactions.

We are not perfect, far from it. We are far from being Saints but have a solution Saints would approve and achieve a kind of transient sanctity in this 12 step solution of letting go and letting God.

We have to show love and tolerance for each other as we suffer the same illness/malady. Dismissing others like us for having what we have and acting as we do is like a form of self loathing. We have to forgive ourselves and each other for being ill. Self compassion allows us to be compassionate  towards others.

Also we need to be aware what we project on to other alcoholics is the same thing as they project on to use and sometimes we project if back.

So we have two main ailments, distressed based wanting which results in the same negative emotions as being in a shame- based fear of rejection.

I can get out of the distress of wanting/needing stuff by asking God to remove those negative emotions which block me off from Him.

For example, if I really want something and feel someone is preventing me getting that thing or that they are taking this thing away from me I have a hunting pack of negative emotions running through by heart and pulsating through my veins, propelling me to want that thing even more! As if my very life depended on it?

These feelings are translated as “how dare you take that thing/stop me getting that thing” – False Pride – followed by fear of being rejected – Shame (this is because I am not good enough)  and possible Guilt (for something I must have done wrong as usual) – then leading to “poor me” and feelings of Self pity, all because I am in Self, so I am being Self Centred and not considering someone else’s view so I am Selfish.

I retaliate via by “I”ll show you/I’ll get you” emotions of Dismissiveness, Intolerance, Arrogance and Impatience – my “I’ll put you down to make me feel better!”

All because I am fearful that you are taking away something from me or rejecting  me –  Fear and Fear is always accompanied by dishonesty.

I will act out on these somethings, if I do now use my spiritual tools and let Go and Let God, usually by eating too much, Gluttony, having a shopping spree, Greed, engaging  sexual fantasy/activity Lust of “freezing” through fear in the subltle sin of Sloth (procrastination).

A perceived slight or a rejection can have an incredible emotional effect on me

This is all emotion dysfunction and immaturity. I have resentments because they are a true sign of emotion dysfunction.

The mature way to to access, identfiy and label how one is feeling and use this information to reasonably express how one is feeling. This way we do not retaliate, fight, flee or freeze. Instead our emotions do what they are supposed to do. They are suppose the tell the fronts of our brains to find words for our feelings. Not to tell the bottom of our brains to fight back or run or freeze.

Let me use an example.

I had an argument with a guy once who suddenly proclaimed he was upset by what I had said. I was amazed as this guy was reading his emotions, identifying verbalising/expressing them to me in a way I have never been able to do.

My alcoholism is rooted in an impaired ability to read, identify, label and express my emotions (otherwise called emotion processing) – as a result my emotions have always troubled me and been so troubling in their undifferentiated state that I have always either avoided them or ran away from them.

I have sought refuge from my negative emotions in alcohol, drugs and other addictive behaviours. It is this that propelled my addictions, this inability to deal with my negative emotions. I dealt with them externally via addictive behaviours, not internally via emotion processing.

My emotions became wedded in time to being undifferentiated arousal states that prompted me to seek an external way to deal with these troubling emotional/arousal states.

Today when I engage in the above emotion dysfunction, engage in the above web of defense mechanisms it is because I have not been able to locate in me what feeling is disturbing me ?

On occasion it is, as the guy above said, because I am upset. I have not learnt the ability to say that I am upset etc. The words for these feeling states somehow can continue to elude me unless I am in God’s Grace.

God does for us what we can not do for ourselves!

Finding out what is really going on with us emotionally is at the heart of recovery. That is why we have to constantly share how we are feeling with others so that we can find out what we are feeling.

Unless, we let Go and Let God and ask God to remove these negative emotions/sins/defects of character we end up in a futile increasingly distressed spiral of negative emotions.

We end up cultivating much greater misery.

As soon as you can, let Go and Let God.

 

How Mindfulness could help Recovery?

Mindfulness training modifies cognitive, affective, and physiological mechanisms implicated in alcohol dependence.

Yesterday we looked a how low heart rate variability in alcoholics (active and in recovery) may influence self, emotion and stress regulation, and have a limited effect on impulsivity, and result in a “locked in” attention to alcohol-related cues, all of which have obvious consequences for relapse.

Here we cite and use excerpts from an article by Eric Garland et al (1) which addresses the effects of mindfulness  meditation on those with alcohol dependence.

Although Garland suggest mindfulness could be an alternative to other treatment and recovery programs, I suggest that it can be used most effectively with other treatment and recovery programs, e.g. with step 11 of 12 step programs.

I believe the consequence of emotion dysregulation  over many years of addiction leaves behind numerous unprocessed emotions which have not been consigned to long term memory and as a result float around the mind as resentments, shame and guilt based memories etc.

Emotion dysregulation has not allowed us to consigned them properly to the past (the so-called wreckage of the past) or long term memory and only an intensive process of emotional processing these e.g. via step 4 or 5 or via an alternative stock taking of our pasts seems to resolve this problem.

I know from my previous experience of intensive meditation involving various 10 day intensive courses and meditating on a very regular basis, before realising I am an alcoholic, would always result in relapse via the distress of the past being resurgent in my mind.

Some method of addressing all of these past behaviours, which invariably have hurt someone, need to be addressed and processed, even making amends to those hurt by our previous behaviours,  before we profoundly ease the distress of the past and help facilitate a greater recovery and more effective meditation practice.

Anyway, that’s my vies, on with the article…

“When attention is fixated on visual or olfactory alcohol cues, alcohol dependent individuals exhibit significant psychophysiological reactivity (Carter & Tiffany 1999). In turn, this alcohol cue-reactivity may lead to increased craving, which can trigger alcohol consumption as a means of reducing distress. Many persons recovering from alcohol use disorders attempt to suppress cravings, which, paradoxically, can serve to increase intrusive, automatic alcohol-related cognitions (Palfai, Monti, Colby, & Rohsenow 1997), dysphoria, and autonomic arousal (Wenzlaff & Wegner 2000). Indeed, among alcohol dependent persons, thought suppression is negatively correlated with vagally-mediated heart rate variability (Ingjaldsson, Laberg, & Thayer 2003), a putative index of emotion regulation and parasympathetic inhibition of stress reactions (Thayer & Lane 2000).

As thoughts of drinking intensify and are coupled with psychobiological distress, the impulse to consume alcohol as a form of palliative coping may overcome depleted self-regulation strength (Muraven, Collins, & Nienhaus 2002; Muraven & Shmueli 2006) leading to relapse. The attempt to avoid distress or allay its impact through compulsive alcohol consumption results in negative reinforcement conditioning that may perpetuate this cycle by further sensitizing the brain to future stressful encounters via allostatic dysregulation of neuroendocrine systems (Koob 2003). Components of this risk chain may be especially malleable to targeted behavioral therapies.

One such intervention, mindfulness training, which originates from Buddhist traditions but has been co-opted by Western clinicians, has recently gained prominence in the psychological and medical literatures for its salutary effects on stress-related biobehavioral conditions (Baer & Krietemeyer 2006; Ludwig & Kabat-Zinn 2008). Mindfulness involves self-regulation of a metacognitive form of attention: a nonreactive, non-evaluative monitoring of moment-by-moment cognition, emotion, perception, and physiological state without fixation on thoughts of past or future (Garland 2007). A growing body of research suggests that mindfulness affects implicit cognition and attentional processes (e.g., Jha, Krompinger, & Baime 2007; Lutz, Slagter, Dunne, & Davidson 2008; Wenk-Sormaz 2005) as well as heart rate variability indices of parasympathetic regulation (Tang et al. 2009).

 

Mindfulness treatments may enhance clinical outcomes in substance-abusing populations.

Bowen et al. (2007) found that mindfulness training of incarcerated inmates reduced post-release substance use, substance-related problems, and psychiatric symptoms to a greater extent than standard chemical dependency services offered at the prison. Other pilot studies of mindfulness-based interventions with substance abusers have found significant reductions in distress, negative affect, stress-related biomarkers, and substance use (Marcus, Fine, & Kouzekanani 2001; Marcus et al. 2003;Zgierska et al. 2008).

To that end, a randomized, controlled design was used to compare the therapeutic effects of a mindfulness-oriented recovery enhancement (MORE) intervention to those of an evidence-based alcohol dependence support group (ASG).

We hypothesized that, relative to ASG, MORE would result in significantly greaterdecreases in perceived stress, impaired alcohol response inhibition, craving for alcohol, psychiatric symptoms, and thought suppression and significantly greater increases in mindfulness and in heart rate variability (HRV) recovery from stress-primed alcohol cues.

 

MINDFULNESS TRAINING REDUCES STRESS AND THOUGHT SUPPRESSION

Among recovering alcohol-dependent individuals, mindfulness training appears to be a potentially effective stress reduction technique. MORE reduced perceived stress to a greater extent than did ASG, which is noteworthy given that social support reduces stress reactivity and buffers deleterious effects of stressful life events (Christenfeld & Gerin 2000). The stress reduction effects of mindfulness training among nonclinical populations are well known in the literature (Grossman, Niemann, Schmidt, & Walach 2004), but it is notable that significant effects were obtained in a sample of clinically-disordered, alcohol-dependent adults with extensive trauma histories who may be more vulnerable to stress-precipitated relapse due to allostatic dysregulation of neural stress circuitry (Valdez & Koob 2004).

Like stress, thought suppression significantly decreased over the course of ten weeks of mindfulness training. In turn, decreases in thought suppression among MORE participants were significantly correlated with decreases in impaired alcohol response inhibition, raising the possibility that participants who improved their ability to regulate drinking urges may have done so via reductions in thought suppression.

In the context of alcohol dependence, thought suppression seems to enhance the conscious awareness of alcohol-related cognitions and affective reactions. MORE, with its emphasis on nonjudgmental, metacognitive awareness of present-moment experience, appeared to counter this deleterious cognitive strategy and therefore may have prevented post-suppression rebound effects from exacerbating negative affect and intrusive alcohol-related cognitions that can promote relapse.

CONCLUSION

In sum, the unwitting attempts of recovering alcohol dependent persons to suppress appetitive cognitive-emotional reactions towards alcohol may obscure these responses from consciousness only to perpetuate and intensify them within the cognitive unconscious. In the domain of unconscious mental life, automatic processes run smoothly and efficiently uninhibited by volitional control (Kihlstrom 1987). Hence, by shunting appetitive reactions into the unconscious, the alcohol dependent individual may increase the very appetitive response towards alcohol he or she is trying to suppress and exacerbate psychophysiological reactivity to alcohol cues. Mindfulness training may serve to undo this process, making unconscious responses conscious. Thus, practice of mindfulness may promote the recovery of alcohol dependent persons through: a) deautomatization of alcohol use action schema, resulting in diminished attentional bias towards subliminal alcohol cues and increased craving as a result of disrupted automaticity; and b) decreased thought suppression resulting in increased awareness of alcohol urges over time, increased HRV recovery from alcohol cue-exposure, and improved ability to inhibit appetitive responses.

Accordingly, mindfulness training may be a tractable means of promoting enduring behavior change. Although brief motivational interventions may be highly effective at impelling the desire towards sobriety, participants of such motivational enhancement therapies remain prone to eventual relapse; indeed, relapse is often a part of the recovery process. As such, interventions that consolidate short-term treatment gains into broader lifestyle change are of major significance to the addictions treatment field. During the gradual practice of mindfulness, one learns to work with negative emotions in a metacognitive context, resulting in nonreactivity to difficult mental contents and improved self-regulation in the face of stressors. The developmental process of cultivating and embedding mindfulness principles into all aspects of one’s life may solidify gains made in prior treatment and provide an effective, long-term approach to coping with stress-precipitated relapse.

Despite evidence suggesting that stress appraisal and attentional biases are key components of alcohol dependence, the form of addictions treatment most available to poor and marginalized persons, social support groups, does not target these pathogenic mechanisms directly. In contrast, practice of mindfulness may attenuate stress reactivity and thought suppression while disrupting addictive automaticity, resulting in increased awareness of craving and greater ability to cope with and recover from alcohol urges in stressful contexts. Hence, mindfulness training may hold promise as an alternative, targeted treatment for stress-precipitated alcohol dependence among vulnerable members of society.”

Equally mindfulness meditation may be used alongside other treatment regimes. For example, it can be used in a daily manner as part of step 11 in the 12 step program. It is also used as part of DBT, for example.

I think that there are ideas out there, is so-called different treatment regimes, which can simply compliment each other. Whatever works, works.

I personally meditate using both  Christian and Buddhist meditation techniques.

Sometimes appreciating the therapeutic strengths of different treatment philosophies and practice can augment one’s own main treatment and recovery program.

References

1.  Garland, E. L., Gaylord, S. A., Boettiger, C. A., & Howard, M. O. (2010). Mindfulness training modifies cognitive, affective, and physiological mechanisms implicated in alcohol dependence: results of a randomized controlled pilot trial. Journal of psychoactive drugs, 42(2), 177-192.

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The terror of “Locked In” Attention!

I remember when I was in the first days, weeks and months of early recovery I used to give myself such a hard time when my attention was drawn to some alcohol-related cue, like someone drinking ,or finding it difficult not dealing with some  reminder of people places and things from my alcohol abusing past; finding that I found it nigh on impossible dragging my attention away from these and related memories associated with my drinking past.

It was as if I was entranced by it, in some of tunnel vision. It used to scare the life out of me.

I rarely found these thoughts appetitive but if I dwelt on these thoughts or trained my attention on cues I would find that the adverse, fearful things would turn to more desire based physiological reactions like salivating and so on.

I took these to mean that I actually wanted to drink and not stay sober. My sponsor at the time said two things which helped – a. I have an alcoholic brain that wants to drink period, 2. cues from my past may always have this effect on me. Accept it, don’t fight it.

That was what I had been doing in fact. Fighting it, these cues reminders and their automatically occurring intrusive thoughts about the past. It is in fighting these thoughts that they proliferate and then become “craving”.

Years later after much research I found that all alcoholics seem to have an attentional bias towards alcohol-related cues which leads to a cue reactivity.

Originally I thought this meant that I simply wanted to drink but found out that in  any manifestation of urge to drink (which is slightly different from a craving which requires an affective response on the part of the alcoholic in order to become a craving similar to mental obsession of the Big Book ) there is a stress reponse like the hear beat quickening, differences in galvanic skin conductance, increased saliva production etc .

Thus this cue reactivty seems to involve not only appetitive or desire states, i.e. it activates the reward system in the brain to motivate one to drink but also contains a stress based reactivity.

Any so-called “craving” state also manifests as either an anxiety state in simple cue reactivity e.g. the sight of alcohol or in negative emotions such as fear, anger and sadness in terms of a stress based craving.

Together, i.e. a cue based reactivity in the face stress/distress leads to a greater urge to drink than by either alone. By reacting to these one is increasing the stress/distress.

To the alcoholic brain having a drink or the desire to drink is the brain suggesting to us as alcoholics that this is the best way to attain transient homeostasis from an allostatic state of distress because this is how we used to balance the effects of emotional distress when we were drinking. We experience distress and automatically had thoughts about drinking. Thus alcoholism is a distress-based condition. We think it is us wanting the drink but it is the distress prompting the wanting of the drink!!

The distress does the drinking for us, itgets us out of our seats and down the street to the bar, it gets us on the bar stool….We may think it is our actions as we use rationalisng and justifying schemata afterwards to justify behaviour that had, in fact, been automatic or compulsive, compulsive meaning to relieve a distress state.

As a schema, which is implicit, i.e. it is automatically prompted and activated by distress also. We are not even in charge of this. We feel and think that we are in control over behaviour bit this is not the case as self control has become so impaired and limited it is distress doing the action and the subsequent rationalising.

The compusive part of the brain, the dorsal striatum, is the only part of the brain that requires us to make a post hoc rationalisation of why we did an action that was essentially automatic and compulsive.

We have become passengers in our own lives. Distress is now doing the driving.

So the brain thinks it is simply telling us the best way to survive this distress or in other words to regulate this distress. Thus it is an incredibly impaired way to regulate stress and emotional distress.

I want to further explain how some of this is linked to low heart rate variability. If we have low HRV we find it difficult inhibiting automatic responses and in changing behaviour. We become behaviourally rigid, and locked into attending to things like cues when we don’t really want to.

This is often the result of distress reducing the ability of the heart rate variability to inform and change our responses.

I cite and use excerpts form one of my favourite articles again by co-authored by Julian Thayer (1).

 

“The recovering alcoholic must face the difficulty of having his or her ambition to remain abstinent challenged in various situations in which memories about the pleasurable effects of alcohol are activated and the striving for abstinence no longer seems meaningful (Anton 1999; Marlatt and Gordon 1985). The odds for successful coping with such temptations are related to numerous factors, such as one’s subjective affective state and the ability to shift one’s focus from the automatic impulse to drink toward a cognitive reconstruction of the situation (Palfai et al 1997b; Tiffany 1990). Despite the importance of  attentional flexibility in effectively modulating such “highrisk” situations, research on the topic is scarce.

Thayer and Lane (2000) suggested that the interplay between positive (excitatory) and negative (inhibitory) feedback circuits in the nervous system (NS) allows for flexible and adaptive behavior across a wide range of situations. The uniqueness of this model lies with its emphasis on the importance of inhibitory processes in effective modulation of affective experience. In short, these researchers propose that the defects in neurovisceral regulation of affective experience seen in various psychiatric conditions (e.g., anxiety disorders) may be better explained by faulty inhibitory function in the NS than by unitary arousal models.

Tonic heart rate variability (HRV) may be a physiologic indicator of such inhibitory processes (Friedman and Thayer 1998a; Porges 1995). Heart rate variability refers to the complex beat-to-beat variation in heart rate produced by the interplay of sympathetic and parasympathetic (vagal) neural activity at the sinus node of the heart.

Importantly, heart rate (HR) is under tonic inhibitory control via the vagus nerve (Levy 1990). These neural connections to the heart are linked to brain structures involved in goal-directed behavior and adaptability (Thayer and Lane 2000). Compelling evidence now exists to show that high levels of HRV are related to cognitive flexibility (Johnsen et al 2003), modulation of affect and emotion (see Bazhenova 1995, cited in Porges 1995), and increased impulse control (Allen et al 2000; Porges et al 1996).

The hypothesis that reduced HRV is related to defective affective and emotional regulation has been supported in recent research in which reduced HRV was present in clinical disorders such as generalized anxiety disorder (Thayer et al 1996), panic disorder (Friedman and Thayer 1998b), posttraumatic stress disorder (Cohen et al 1997) several scientific arguments suggest that impaired inhibitory function may play a role in chronic alcohol abuse.

First, alcoholics have repeatedly been shown to have problems shifting attention and directing their attention away from task-irrelevant information (Johnsen et al 1994; Setter et al 1994; Stormark et al 2000). Second, frontal areas of the brain are most affected by the acute and chronic effects of alcohol, and these structures are of crucial importance in inhibitory functioning and self-control (Lyvers 2000). Third, acute effects of alcohol ingestion result in reductions in HRV, implying that chronic alcohol ingestion may result in a long-lasting impairment of the vagal modulation of HR (Reed et al 1999; Weise et al 1986)

Fourth, severely dependent alcoholics show a sustained phasic HR acceleration when processing alcohol information, indicating defective vagal modulation of cardiac function (Stormark et al 1998). Tonic HRV has similarly been found to be a useful measure of physiologic activity in challenging situations (Thayer and Lane 2000). Appropriate modulation of HRV (increases, decreases, or no change) depends on the type of challenge and the characteristics of individuals as they interact with specific contextual manipulation (Friedman and Thayer 1998a; Hughes and Stoney 2000; Porges et al 1996; Thayer et al 1996).

For example, during attention demanding tasks, healthy individuals show appropriate reductions in HRV (Porges 1995). In general, high tonic levels of HRV allow for the flexible deployment of organism resources to meet environmental challenges. With respect to attention, it is suggested that high levels of HRV reflect flexible attentional focus, whereas low HRV is related to “locked in attention” (Porges et al 1996). Moreover, increased tonic vagal activity is related to adaptive development and lack of behavioral and emotional problems (Hughes and Stoney 2000; Porges et al 1996).

Furthermore, it has been demonstrated that increases in vagal activity during challenging tasks discriminates between individuals who have experienced traumatic events and managed to recover from them and those who still suffer from chronic symptoms of posttraumatic stress (Sahr et al 2001). Such increases in vagal activity during challenging tasks are particularly interesting because studies on alcohol abusers have found increases in HRV after exposure to alcohol-related cues (Jansma et al 2000; Rajan et al 1998).

One could speculate that such enhanced vagal activity could be a sign of compensatory coping aimed at taming automatic drinking related processes (Larimer et al 1999). Such an interpretation is in agreement with cognitive theories predicting that alcoholics and other drug users do not simply respond passively to exposure to drug-related cues, but, on the contrary, in such situations conscious processes are invoked, inhibiting execution of drug-related cognition (Tiffany 1990, 1995). If this explanation is correct, alcoholics who have more effective coping resources should show stronger increases in vagal activity during such challenging exposure than alcoholics who express greater difficulty in resisting drinking-related impulses.

Also  general differences in HRV between alcoholics and nonalcoholics are interesting indicators of defective inhibitory functioning, a measure of rigid thought-control strategies and lack of cognitive control should be an important indicator of defective inhibitory function and “positive feedback loops” reflected as low HRV (Wegner and Zanakos 1994).

Linking these measures to the physiologic index of HRV makes a stronger case for attributing reduced vagal tone (HRV) to a defective regulatory mechanism resulting in unpleasant affective states and maladaptive coping with psychologic stressors

The main results of our study may be summed as follows. First, as expected, alcoholic participants had lower HRV compared with the nonalcoholic control group. Second, the imaginary alcohol exposure increased HRV in the alcoholic participants. Third, across the groups, an inverse association was found between HRV and negative mood and a positive association between positive mood and HRV. Fourth, HRV was negatively correlated with compulsive drinking during the imaginary alcohol exposure in the alcoholic participants. Fifth, within the alcoholic group, HRV was negatively associated with chronic thought suppression (WBSI).

Generally, these findings are in agreement with the neurovisceral integration model and the polyvagal theory that suggests HRV is a marker of the level of cognitive, behavioral, and emotional regulatory abilities (Thayer and Lane 2000).

The fact that the alcoholic group had generally lower tonic HRV compared with the nonalcoholic control group indicates that such reduced HRV may also be a factor in alcohol abuse; however, such group differences in HRV provide only indirect support for the theory that low HRV in alcoholics may be related to impaired inhibitory mechanisms

Because HRV is related to activity in frontal brain areas involved in cognition and impulse control (Thayer and Lane 2000), we speculated that tonic HRV would be an index of nonautomatic inhibitory processes aimed at suppressing and controlling automatic drug-related cognitions. To test this hypothesis more directly, the association between HRV and problems with controlling drinking-related impulses were studied.

Consistent with this hypothesis, the compulsive subscale of the OCDS was found to be inversely associated with HRV in the alcohol-exposure condition, thus suggesting that HRV may be an indirect indicator of the level of impulse control associated with drinking. These findings are therefore consistent with Stormark et al (1998), who found that sustained HR acceleration (lack of vagal inhibition) when processing alcohol-related information was related to compulsive drinking and “locked-in attention.”

Post hoc analysis further suggested that alcoholics who expressed a relatively high ability to resist impulses to drink (OCDS) had the clearest increase in HRV under the alcohol exposure this study suggests that alcoholics may actively inhibit or compensate for their involuntary attraction to alcohol-related information by activation of higher nonautomatic cognitive processes (Tiffany 1995). Such conscious avoidance has previously been demonstrated in studies on attentional processes in alcoholics (Stormark et al 1997) and by the fact that frontal brain structures involved in inhibition and control of affective information are often highly activated in the processing of alcohol related cues (Anton 1999). Furthermore, this interpretation is in agreement with other studies suggesting that high HRV during challenging tasks is associated with recovery from acute stress disorders (Sahr et al 2001).

Several studies have indicated that low HRV is associated with impaired cognitive control and perseverative thinking (Thayer and Lane 2002). Consistent with these reports a negative association was found between HRV and chronic thought suppression. The WBSI assesses efforts to eliminate thoughts from awareness while experiencing frequent intrusions of such “forbidden” thoughts and thus represents an interesting and well-validated measure of ineffective thought control (Wegner and Zanakos 1994). Thought suppression has been found to be an especially counterproductive strategy for coping with urges and craving (Palfai et al 1997a, 1997b) and may even play a causal role in maintaining various clinical disorders (Wenzlaff and Wegner 2000).

To our knowledge, this is the first time a link between physiologic indicators of a lack of cognitive flexibility (low HRV) and chronic thought suppression has been demonstrated.

Thayer and Friedman (2002) have reviewed evidence indicating that there is an association between vagally mediated HRV and the inhibitory role of the prefrontal cortex. Consistent with Thayer and Lane (2000), this study suggests that impaired inhibitory processes are significantly related to ineffective thought control.

The fact that this association between HRV and WBSI was only found in the alcoholics may be related to the fact that only this clinical group shows signs of such faulty thought control.

Wegner and Zanakos (1994) suggested that thought suppression is particularly ineffective when the strategic resources involved in intentional suppression are inhibited or blocked (Wegner 1994). Consistent with this hypothesis, our findings show that those reporting high scores on WBSI show signs of impaired inhibitory functioning as indexed by low vagally mediated HRV.”

This excellent article fro me is also alluding to the fact that those with increased HRV was related to successfully related to regulating negative emotion,  stress/distress and affect, not just the thoughts that these affective states gave rise to .

Thus any strategies that help with improving  the ability to increase HRV will likely have positive results in coping with cue associated materials.

We look at one of these therapeutic strategies next…that of mindfulness meditation.

 

References

1. 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 Psychiatry54(12), 1427-1436.