Alcoholism is the disease

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• Alcoholism is the disease
• of living elsewhere.
• (William Alexander, 1997)

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Defining Stress

• Non specific response of the organism to any
  pressure or demand (Hans Selye 1950s)
• How you see things and how you handle them makes
  the difference in how much stress you will
  experience. If we change the way we see, we can
  change the way we respond (Kabat-Zinn, 1990)

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Stress Response

• Fight or flight responses are the physiological
  changes we undergo when feeling threatened
• Hyper-arousal can become a way of life being
  stuck in stress reactivity (Kabat-Zinn, 1990)
• Internalizing the stress reaction doesnt bring
  the resolution of fighting or fleeing and can
  lead to illness

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Relaxation Response

• Relaxation Response published in 1975 by Herbert
  Benson, MD,
• Offered a biological explanation for how stress
  makes people ill, and how relaxation techniques
  decrease stress and help people heal--techniques
  used for thousands of years
• Responding vs. reacting to stress (addictive
  behavior) through awareness and mindfulness

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Mindfulness and Relapse Prevention

• Addictive behaviors are maladaptive attempts at
  suppressing symptoms of disregulation--physical
  and mental (Kabat-Zinn, 1990)
• Chemicals are used to change our mind-body state
  when we dont like how were feeling

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Mindfulness

• An intentional focused awarenessa way of paying
  attention on purpose in the present moment,
  non-judgmentally (Kabat-Zinn, 2005)
• Quality of openness, of present-moment awareness
  and acceptanceexperiencing this moment as the
  only one that exists (Bien,2002)
• Mindfulness meditation involves observation of
  constantly changing internal and external stimuli
  as they arise (Baer, 2003)

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Mindfulness in Addiction Treatment

• Relapse Prevention for addictive disorders using
  mindfulness skills (meditation) for coping with
  urges to use (urge surfing) Alan Marlatt, Ph.D.
• Addiction is a mindless state characterized by
  an inability to accept impermanence. The addict
  desires to fix impermanence by clinging or
  grasping on to the high (Alan Marlatt, Ph.D.)

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Mindfulness and Addiction

• Addiction is a means of trying to control reality
  by maintaining the highs and avoiding the lows.
• Nature of present experience is one of constant
  change or flux. Thoughts come and go, physical
  sensations rise and fall. Everything is
  impermanent.
• No need to fix what happens next. Addicts are
  devoted to the next fix because of the great
  difficulty in accepting the present moment.
  (Marlatt)

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Mindfulness and Addiction

• Mindfulness in this sense is learning to let go
  of the desired outcome, to practice non-doing as
  an alternative to the addictive fix (Marlatt)
• Where mindfulness is, addiction is not.
  Cultivation of one leaves room for the other
  (Bien, 2002)
• Calm awareness is an antidote for an addicted
  state of mind (Bien, 2002)

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Mindfulness and Addiction

• Mindfulness is characterized by a freedom from
  rigid attitudes, cognitions and behaviors
• Marlatts Relapse Prevention Model clients are
  taught to recognize triggers and cravings
  (desire) and the urge (intention)
• Practice non-doing as an alternative to the
  next fix

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Relapse Prevention

• Intervening in addictive, classically conditioned
  responses
• Recognizing triggers, cravings, and the urge
  (intent) to use
• Teach clients to open to and accept cravings and
  urges without engaging in the addictive behavior

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Relapse Prevention Cont.

• Urge Surfingmindfully riding the urge. The
  urge is portrayed as an ocean wave. Like a wave,
  an urge begins slowly and gradually, grows in
  size until it crests, and then gently subsides.
• Rather than giving in, letting go

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• Its not just a set of techniquesits about
  paying attention, moment by moment
• One day at a time in the present we have
  choices, including sobriety
• Honoring ones experience, just as it is, even
  when theres guilt and shame present
• Bringing compassionate awareness to whatever is
  going on (cravings, regrets, etc.)
• Awareness helps diminish self destructive
  impulses when they first arise, before the
  behavior begins

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• Balance is the antidote to craving. In the
  absence of balance, we take away one thing, only
  to replace it with another--cross-addiction
• With balance stress is decreased, change is a
  process and happens more effectively when the
  mind is calm
• Increased self awareness and self efficacy
• Compatibility with 12-Steps
• Acceptance of relapses vs. abstinence violation
  effect

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Mechanisms of Change

• Exposure and desensitization experiencing
  physical pain or emotional distress without
  excessive emotional reactivity which tends to
  make symptoms worse
• Cognitive Change non-judgmental observation can
  lead to understanding that thoughts, sensations,
  and emotions do not necessitate escape or
  avoidance behaviors
• Self-Management Improved self-observation may
  promote use of a range of coping skills (cues and
  urges are noted without giving in to them)

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• A Few Comments About Mindfulness and the
  Treatment of Eating Disorders

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CBT Model

• Low self-esteem
• Overvaluation of weight and shape
• Strict dieting

Binge eating
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Orientation to DBT Model for Maladaptive Emotion
Regulation
Event (Internal or External)
Increased anxiety, fear, sense of overwhelm
Deficits in adaptive emotion regulation skills
Low expectancy for mood regulation
Negative emotion/ need for emotion regulation
Urgency to stop emotion escalation
Overlearned, impulsive, maladaptive, mood
regulation behavior BINGE EATING PURGING
Decreased self-esteem, neg self-view. Increased
guilt and shame.
Avoidance of adaptive mood regulation
Temporary decrease in distress
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Affect Regulation ModelBinge Eating
temporary relief from negative affect

• Linehans Dialectical Behavior Therapy (DBT)
• Emotional dysregulation seen as core problem in
  borderline personality disorder (BPD)
• Binge Eating relief from
  negative affect
• IN THE SAME WAY AS
• Impulsive Behaviors (e.g.
  self-mutilation)
• relief in BPD

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Mindfulness Based Stress Reduction
Psychotherapy

• Steve Shealy, PhD
• www.BeMindful.org
• 813-980-2700