Note: This article was originally published in the Summer 2005 issue of The Meadows‘ alumni magazine, MeadowLark.
Dissolving Fear and Nurturing Joy: the Personal Story of a Recovering Agoraphobic with Panic Disorder
By Charles Atkinson, MA, MSW, LCSW
Hello, my name is Charles Atkinson. I am a 55- year-old recovering agoraphobic with panic disorder. The term "agoraphobia" derives from the Greek language. The interpretation of "agora" is marketplace, and a "phobos" is defined as flight. Hence, agoraphobia literally means "flight from the marketplace." Further examination of the word agora reveals it was not only a place of intense commerce where goods were sold and bartered, but also the social hub of town for the exchange of exciting new ideas and concepts. Consequently, an agoraphobic could not venture into the marketplace for fear of overstimulation in unpredictable and chaotic surroundings. Therefore, at an unconscious level, the marketplace represented to the agoraphobic a mirror image of his childhood environment.
Today, the definition of agoraphobia has been refined to include an avoidance of a specific place or situation in which one feels trapped and may experience embarrassment. The terms "panic attack" and "anxiety attack" can be applied interchangeably. Panic attacks occur when the sympathetic nervous system goes into overdrive and generates a cognitive distortion of second-order fear, or "fear of fear." This emotion of fear is felt on both the conscious (physical) and unconscious (emotional) levels. The results are panic attacks that feel as if the sufferer is going to lose control, go crazy or die.
It is not fully understood if agoraphobia with panic disorder has its fundamental inception in biology or is a learned behavior. I believe this disorder has its roots in both theoretical paradigms. However, additional schools of thought can be applied.
Dr. Shelley Uram, a Harvard-trained psychiatrist at The Meadows, helps articulate a layperson's perspective of how the neuropsychiatry model of the mind and body adapts to stress and trauma. She explains that our amygdala is located in the limbic system of the brain. The limbic system is located in the midbrain, where our emotions originate. Constant stresses, such as childhood traumas, rattle and sensitize our amygdala, which is also referred to as the "smoke detector," a moniker indicative of its function. It does not gradually activate the sympathetic nervous system for the fight or flight response. It spontaneously stimulates the adrenal glands to flood the body with adrenaline. This results in a state of arousal for the body and mind. If the brain continually perceives the message of an external threat, whether real or imagined, it will create an internal state of perpetual hypervigilance and angst. It is analogous to revving your car's engine to the highest RPMs while in park.
Pia Mellody's longtime work in the area of trauma and addictions has resulted in a behavioral model called "Developmental Immaturity." This model addresses the problems of being relational and achieving intimacy. To gain a better understanding of Pia's model, imagine a tree.
The roots of the tree are the childhood traumas, including physical, sexual and emotional abuse. The trunk of the tree allows the core issues of immaturity to fester and impede personal growth. These core issues include problems with self-esteem, boundaries, reality, dependency and containment. The branch of the tree denotes the secondary symptoms of unmanageability. This is the stage when addictions, depression, fear and panic disorders appear. The leaves of the tree represent the final outcome of all of the dysfunctional stages and an inability to establish and maintain healthy intimate relationships.
My first panic attack occurred at age 27, six weeks after I was married. It as if I were losing control, going crazy and having an emotional breakdown. A visit to the emergency room ensued. The hospital medical staff said I was having an anxiety attack, gave me a tranquilizer and sent me home. Not only did I feel emotionally trapped and ill-equipped to engage in an intimate relationship, but the sense of overwhelming fear and impending doom was ever-present. I tentatively speculated that marriage was the problem. It was too incomprehensible to think that the problem was endogenous to me. So began my journey through life, filled with hidden shame, fear and depression spanning the next three decades.
After two years of visiting a myriad of psychotherapists and experimenting with numerous psychotropic drugs, I was still battling depression, fear and anxiety. Fortunately, at 29, I found a psychologist who diagnosed my condition as agoraphobia with panic disorder. He explained that my disorder stemmed not from my perception of marriage, but from the cognitive distortions and childhood trauma embedded in my psyche due to physical abuse. Recalling the physical abuse experience was so powerful that it felt as if my heart and soul were being suffocated. I could not address my childhood abuse issues.
However, as I developed more psychological ego strength and better coping skills, I gradually reflected back to my childhood. I was physically battered multiple times between the ages of 5 and 13. I tried unsuccessfully to stave off my father’s abuse with my feeble attempts to express anger. My retaliation was met with scorn, disdain and an escalation of violence. This violence would trigger my body to mobilize and prepare my internal milieu for the most primitive response: survival.
Today, my father would be labeled a "rage-aholic." His impulsivity and inability to contain his rage were equivalent to a ticking time bomb, ready to explode at any time, for no reason. Since I was the oldest male child in the family, I was the focal point of his outbursts. This dysfunctional
behavior perpetuated the male rite of passage in our family. The sins of the father were being passed to the next generation as an acceptable form of discipline.
After decades of therapy, I found that the model that helped me grasp and understand my problems most clearly was Pia Mellody's. Her approach illustrated that my father had an extreme failure in maintaining his boundaries, contributing to my feelings of being exceedingly vulnerable and without boundaries. His constant verbal and physical abuse was an edict to our family; he was the boss. If he was in the perennial position of one-up, we were always one-down. Being one-down all the time obviously had a negative impact on my self-esteem. Also, he emphatically and without question demanded obedience, putting himself in a position of omnipotence. This eventually distorted my reality, dislodging me from the spiritual path to my higher power. My father was continually on the verge of being out of control. His lack of control influenced my behavior, as I always tried to be in control and perfect.
As a survival technique, especially during the physical battering, I dissociated my emotions from my body. If I felt any feelings, I cognitively appraised them as anxious feelings. This psychological tactic of turning my anger at my father into anxiety within myself allowed me to function in a chaotic and unpredictable home.
Consequently, after decades of dissociating from my feelings, convoluting and twisting my emotions, I was unable to identify and appropriately express emotions. Therefore, every time I had a feeling, I assessed it as anxiety - and only anxiety. This increasing accumulation of stress and inappropriate processing of emotions provided a fertile environment for the onset of panic attacks. Pia Mellody would call this psychological process "carried feelings" or "carried shame." More pointedly, during my father's rage attacks, I felt shame, and he was shameless. As a vulnerable child, I symbolically swallowed all of his emotional frailties and inadequacies. The psychological process of feeling my shame, fear and anger, plus my father's feelings, was too overwhelming. A panic attack was the result of the carried fear and shame.
Healing the sins of the father is a Herculean effort. Many therapists employ traditional talk psychotherapies, which are extremely helpful. However, traditional talk therapies primarily engage the higher cortical portions of the brain. Some research indicates that childhood trauma seems to be locked in the more primitive limbic system. One of the most effective ways to access the limbic system of the brain is through modalities that stimulate the midbrain, or our seat of emotions. An example of this modality is guided imagery used to re-experience the childhood trauma as an adult. Pia Mellody uses this technique and others that bridge both portions of the brain, the frontal cortex (thinking) and the limbic system (feeling).
In closing, the abatement of the carried feelings is not the end; it is the beginning of one's spiritual path. Ironically, recovery is not only achieved with the dissolution of fear, but with the nurturing of joy.
The newest edition of The Cutting Edge, published by The Meadows, is now available. Feature articles include Emotional Incest and What's Wrong about Being Special by Debra L. Kaplan, The Next Step... Life Pleasure in Advance Recovery by Steven Hoskinson, and an excerpt from The Intimacy Factor by Pia Mellody and Lawrence Freundlich.
Also included are two staff spotlights and information on a featured workshop (Sexual Recovery), additional 2010 workshops, free lectures, and other upcoming events.
The Cutting Edge is available in HTML and PDF formats.
Note: This article originally appeared in the Fall 2005 of MeadowLark, the magazine for alumni of The Meadows.
The Electricity of Carried Shame
By Lawrence S. Freundlich
Children need and expect love and nurturing from their parents. This expectation is built into the genes of the human infant, who needs affirmation and protection as much as milk and warmth. Pia Mellody believes that, when parents fail in their role as caregivers to their very young, such behavior is "shameful," - essentially the betrayal of trust between infant and parent.
The reason most parents who act "shamefully" do so is not because they are overtly evil, but that they are "immature" and have become baffled and/or overwhelmed by the complex and emotionally taxing task of parenting a young child. This is not an unusual human phenomenon. Most of us have had to deal with the inheritance of immature parenting. Some of us have been immature parents ourselves.
The irritation that parents feel with their children may be expressed through anger and/or neglect. Such demeaning behavior gives the parent relief from the stresses of caring for the child. However, it makes the child feel frightened or worthless. The child thinks that something is wrong with him and becomes, in Pia Mellody's phrasing, "allergic to his own humanity." The mechanism by which this "allergy" is transferred from parent to child is what Pia identifies as "carried shame."
It is important to differentiate one's own shame from Pia's concept of "carried shame." Pia views shame to be both a gift from God and a legacy of abuse. When it's a gift from God, the experience of our own natural shame makes us aware that we are fallible. But shame as a legacy of abuse ("carried shame") has to do with the devastating and crippling experience of induced shame, as it diminishes our sense of inherent worth, making us feel less valued than others. According to Pia, "When we experience our own shame, we believe that someone has seen us as we really are - human and imperfect. When we feel our own shame, we know we are not a god or a goddess. Our own shame makes it possible to be relational, a gift our body gives to us, as we have to consider the impact that our behavior has on other people."
When Pia and Pat Mellody first began to discuss the concept of "carried shame," Pat provided a useful metaphor from the physics of electricity. He likened the transfer of a parent's shaming of a child to what happens when one coil of electric wire is placed next to another coil, and one coil is charged with an alternating current. The adjoining coil picks up the energy from the charged coil, even though the coils are not touching. Since human emotions, like electrical currents, are energy fields, they can be transferred from the person who is feeling the emotion to another person in close proximity. Of course, the emotional energy must be powerful enough for effective transfer (in physics, this is called "induction").
It was Pia's startling insight that the emotion of shame reaches the crucial "voltage" for "induction" when the person acting shamefully does not acknowledge that his/her behavior was shameful. The shame energy unabsorbed by an act of conscience or contrition has no where to go but out into the atmosphere to be picked up by the "adjoining receptor" that "adjoining receptor" is the child. The child then feels the parent's shame as if it were his own. What he feels is not the result of something that is wrong with himself, but something that is wrong with his parents. If the child were a mature, rational adult, he would recognize that his feeling of shame could not be alleviated by trying to figure out how he himself is inadequate, worthless, or"bad." The mature, rational adult would have to learn how, in Pia's terms, "to release the carried shame."
I believe that "carried shame" is one of the more difficult concepts in recovery. Many of us acknowledge that we are "shame-based," and we try to modify our behaviors so that we can have a sense of value. While the effects of carried shame live within us, the origins of shame do not belong to us, and attempting to fix our shame identifies the wrong transmitter. The shame belongs to the original shamers. And it is only by releasing it that we can rid ourselves of carried shame.
Many of us feel uneasy at the prospect of laying the blame of disastrous careers on our parents. We have been taught to take personal responsibility for our failures. Didn't our parents try as hard as they could to raise us? As culturally admirable as such reflections may seem, they are psychologically delusional. A child is in no position to take responsibility for his parents' shamelessness.
It has been the experience of many patients at The Meadows that the release of carried shame contributes to a sense of balance and moderation. And yet, we have come to understand that some pathways back to the pain of our carried shame traumas can, from time to time, be triggered. It is at these painful moments that we can shield ourselves from the effects of the voices of the past. We have learned to take time out, we have learned to breathe into the pain, and we have learned the skill and art of boundaries. We have learned that our pain is not evidence of our worthlessness. And, if we can do these things most of the time, we are reminded that we are okay, even if it has been a long journey back to believing it.
Note: This article was originally published in the Fall 2005 issue of MeadowLark, the magazine for alumni of The Meadows.
Remembering Who We Are: Tools to Gain Clarity
Kathleen O'Brien, LCSW
"I want to change, but I don't know how."
How many times have you heard yourself utter these very words? Most people come to counseling knowing that their lives need to change, but they often don't feel confident enough in their abilities to make that happen.
Confusion about what is most important can lead, at the very least, to poor choices and mildly co-dependent behavior and, in the extreme, to serious addiction problems.
It doesn't work for us to behave in ways that go against our own values. We can suffer depression and/or anxiety when we ignore what we believe to be most important. We then "treat" our unhappiness with self-destructive behaviors, such as dysfunctional relationships, substance abuse, irresponsible spending and so forth. One poor choice leads to another, and soon we find ourselves at the bottom of a very deep hole.
That downward spiral is daunting, to say the least. My experience both personally and professionally has shown me that, in order to make a significant life change, we need to remember who we are, i.e. to have clarity about what we value most.
The truth is that most people know intuitively what is most important to them. When a client finds herself in a predicament, I ask what she would tell a son or daughter to do in the same situation. Almost without fail, she has an instant answer for the problem at hand. It is as though she can access her wisdom for someone else's benefit (especially her child's), but not for her own. It's not that she doesn't know the answer; she just doesn't feel entitled to act on her own behalf. As a result, she usually doesn't develop the skills necessary to get her needs met in a healthy way.
Take a few moments to ponder the following:
The point here is to focus on remembering who you are. Pia Mellody calls this "remembering that you are precious."
Over the years, I've tried many techniques to help clients clarify how they feel and what they value. I call this "accessing one's own wisdom." Here are some techniques I've found helpful:
In conclusion, remember that the way to heal yourself is to know who you are and to live according to what is true for you. When a person acts in truth, it resonates down to the cellular level. You are your own best healer!
The Fall/Winter 2009 edition of MeadowLark, the magazine for alumni of The Meadows, has just been published. This issue contains several feature articles:
Also included this issue in are staff spotlights, alumni contributions, a featured workshop (Sexual Recovery), free lectures, and other educational opportunities. MeadowLark is available in both HTML and PDF formats.
Note: This article was originally published in the Summer 2008 issue of MeadowLark, the alumni magazine of The Meadows.
Science and Ancient Wisdom: Treatment Here-and-Now
Before reading further, take 20 to 30 seconds to do this exercise: Let your gaze leave this article and let your eyes look around wherever, and at whatever, they want - just 20 seconds or so. (Really, try it, and then come back to reading.) People in my Somatic Experiencing® (SE) Trauma Treatment courses who try this are surprised that, in a very short time, they feel noticeably more relaxed, peaceful, and in the "here-and-now." Some say they should do this all the time!
Thanks to the forward-thinking people at The Meadows, the connection between trauma and addiction is better understood and more effectively treated. Part of this treatment at The Meadows' extended-care facilities consists of working with the trauma-resolution skills of Peter Levine’s Somatic Experiencing®. The relationship between trauma and the exercise you just tried is that, according to Bessel van der Kolk, post-traumatic stress is fundamentally a disorder in the ability to be in the here-and-now. This means that the state of- the-art in trauma therapy is no longer intense regressive or cathartic therapy. Instead, state-of-the-art therapy is the process of becoming alive to the moment.
For those I train in SE, like those at The Meadows, working in the here-and-now is a cornerstone of clinical theory and practice. When doing his dissertation decades ago, Peter Levine met Stephen Porges and explored his research. Porges' "Polyvagal Theory" (Porges, 2001) shows how one pathway of the nervous system engages freeze and another relates to social engagement. Levine discovered how to work with the transition of the nervous system through these phases (freeze and engagement), as well as the phases of fight and flight. This is SE. This article’s focus is on the engagement phase, which must be integrated into all other nervous system phases.
While Porges' emphasis is based on single linear phase transitions, in SE we work with non-linear and rapid cycling states, for instance, freeze and fight, or flight and orientation. Traumatic symptomology such as intrusion of fight, flight and freeze means that the past has become the present. Flashbacks are the classic example of such disorientation - innocuous cues can trigger an all-out response. In other words, the person temporarily experiences a state that is disconnected from the actual here-and-now environment. One of the antidotes to this traumatic recollection is orientation. I provisionally define orientation as "connecting to the environment through the senses" - in other words, coming back to our senses. This is a broader understanding of engagement than social engagement, per se. For clients whose early life experiences were marked by trauma and abuse, social engagement is actually a trigger for fight, flight and freeze. In this process of orientation, rather than being inundated with a cycle of feelings, thoughts, and sensations associated with unresolved trauma, the client's attention can be directed to the reality of the environment that is available through the senses. Typically we see decreased blood pressure and decreased heart rate, as well as the subjective experience of greater relaxation and interest. In other words, it is the difference between stopping to smell the roses and reliving getting stuck by a thorn!
With many severely disoriented clients, much of the initial therapeutic work (in addition to establishing rapport) consists of the stabilization that comes from establishing better cognitive pathways or habits of here-and-now sensory attention. In attending to the sensory experiences of the external world, physiological mechanisms for assessing safety are allowed to occur without undue influence from traumatic memory. The mechanisms of this assessment are far too important, in a survival sense, for the slow processing of linear thought or conscious effort. Porges aptly names this subconscious process of safety assessment "neuroception" (Porges, 2004). Thus, a natural orientation to the external environment via the senses facilitates the neuroception of safety.
This approach is receiving increasing scientific and popular attention (Time Magazine: Mind & Body Special Issue, January 27, 2007, pp. 55ff). Whether incorporated into CBT, DBT or meditation, the role of the observer is crucial. The process of orientation is fundamental to this cognitive activity. However, many traditions that recommend observation may not adequately reinforce with clients the importance of orientation to the outer versus the inner environment. For those with significant disorientation, it is nearly impossible to track the interior landscape without being involuntarily drawn into what SE terms the "Trauma Vortex." The involuntary and repetitive attraction to this "vortex" is the disruption of the approach-avoidance system, and it is one of the dynamics that underlies addiction and compulsive behaviors in general. Although somatically informed therapists draw from Levine's work, they often make the mistake of inviting clients' attention to the inward sensate experience, without consideration to the vital criteria that indicate whether a client can negotiate such attention without reactivating and reinforcing trauma states. For instance, one of the most common beginner's mistakes is when a therapist asks an anxious client to focus on that sensation in the body. For some clients, this can work well and provide a sense of relief and transition to a more relaxed state; for others, this can lead to further discomfort and other states of disintegration. It is vital for the therapist to immediately and accurately assess the client's capacity in order to determine the appropriate intervention. Without such assessment skill, the safer route is to begin with external orientation, which can stimulate the innate orienting response and build stability.
Once relative stability is attained, a balance of interior and exterior attention can be facilitated. Then a more neutral and practiced observation of the range of experiences can be enjoyed, as the attention can shift naturally between affective experiences, both positive and negative. (This fundamental process at the heart of SE is known as "pendulation," which I discussed briefly in the Summer 2006 edition of The Cutting Edge) This natural swing between polarities is the normal condition of the balanced nervous system. And interestingly, the resulting integration that comes from this innate oscillation is a broader and more nuanced life in the here-and-now. The experience brings awareness, presence, and a greater ability to experience life on its own terms, without undue constriction or elation. Obtained after significant work of attending, this resulting state can yield an expanse of awareness with an increasing ease of relation and a connectedness to everything that is. This state, known among meditative adepts, is simply our human mind freed of its overlay of conditioning hewn by survival networks related to approach-avoidance. Freed from the dominance of an ill-conditioned approachavoidance paradigm, one enjoys engagement with what is now, new and alive. And so, as clinicians, we can orient to the fact that we live in a time of opportunity, when mind and body are becoming reacquainted, and when science can shake hands with ancient wisdom.
Hoskinson, S. (2006) "SE's Systemic View of Functional Reward Systems." The Cutting Edge, Summer 2006. See TheMeadows.org.
Porges S. W. (2001) "The polyvagal theory: phylogenetic substrates of a social nervous system." International Journal of Psychophysiology, 42, 123-146.
Porges, S. (2004) "Neuroception: A subconscious system for detecting threats and safety." Zero to Three [Online] National Center for Infants, Toddlers and Families. No. 5, May. See zerotothree.org.
Stengel, R. (Ed.). (2007). The brain: A user's guide [Mind and body special issue]. TIME, 169 (5).
ABOUT THE AUTHOR
STEVEN HOSKINSON, MA, MAT
Under the auspices of Hoskinson Consulting in Encinitas, California, Steven Hoskinson, MA, MAT, is an international consultant and trainer for clinicians and trauma treatment providers. Steven is a Senior International Instructor for the Foundation for Human Enrichment and has done research in creativity, myth and spirituality. His perspectives include evolutionary, developmental, cognitive-behavioral and systems approaches within a mindfulness framework. Other major influences include personal mentoring with Peter Levine, PhD, more than 20 years of experience in the contemplative arts, and a decade as a practicing aikidoist. www.HoskinsonConsulting.org
John Bradshaw, MA, Fellow of The Meadows, was mentioned in a recent article in the Sudbury Star. In "Different Views on Ethics", librarian Kaija Maillloux rounds up eight books with unique perspectives on ethics. From the article:
"Reclaiming Virtue: How We can Develop the Moral Intelligence to do the Right Thing at the Right Time for the Right Reason, by John Bradshaw, shows that each of us has what he calls an inborn moral intelligence, an inner guidance system that can lead us - if we know how to cultivate it in ourselves and others. His fascinating discussion ranges from the ancient Greek philosophers to modern explorations of emotional development, from provocative historical insights to the recent discoveries of neuroscience."
To learn more about Reclaiming Virtue, see this interview with John Bradshaw from earlier this year. For more information about Bradshaw and The Meadows, visit www.themeadows.org.
Note: This article originally appeared in the Spring/Summer 2009 edition of MeadowLark, the magazine for alumni of The Meadows.
By Judith S. Freilich, MD
I am a psychiatrist thinking about knitting - about dropped stitches, in particular. Knitters know that a dropped stitch weakens the whole cloth, disrupts the garment's integrity and leaves a hole that may not even show until there is a stretch or stress on it. Then, the fabric is likely to begin unraveling from the hole, no matter how carefully the rest is knitted.
I wonder about this in my life. In the fabric of my life, there were many dropped stitches - emotions suppressed, voices blocked, roads not taken, losses not grieved before moving on, trauma endured. Life.
My way was to keep moving forward with determination, compassion and courage. I loved, worked hard, accomplished, learned and helped others along my way. On the surface, my efforts seemed of strong cloth. As time went on, those invisible holes - the dropped stitches - began to show and unravel.
"The body is the mind's subconscious," says respected neuroscientist Candace Pert, PhD. That which our minds can't absorb is held for us in our bodies. Dropped stitches remain in our garment, a part of us. They do not just disappear.
What to do about my dropped stitches? Do I leave the past untouched and continue pressing forward? What would that mean for the whole cloth? Does it end up in the trash that way? Do I choose the difficult task of repairing my garment, so it has more integrity for the future?
When a knitter discovers a dropped stitch, she repairs it. She unknits back to it, picks up the dropped stitch and then knits forward again. Knitters call this "tinking" - &"tink" being "knit" spelled backwards.
I think I will "tink." Many of my dropped stitches are losses not fully grieved. There are trauma-made holes, too. The largest is from when my daughters died in a tragic car accident in 1985. Then, I had no ability to grieve. I might have died or gone crazy had I not become frozen and dissociated.
I did not consciously make a decision to freeze. Perhaps my soul did, in order to preserve my life. And by doing so, the memories and grief were frozen and stored in my body - until the time came to unfreeze and release them. And, yes, it left dropped stitches. I think this was preferable to having no garment at all.
There are many ways to "tink." Each begins with recognizing a hole. We can complete a grief left undone. We may reconnect with an attenuated relationship. There is repair that is spiritual in nature, such as gratitude and forgiveness in their many forms.
There is trauma work. Effective trauma release is "tinking" at its best. Sometimes it involves finding memory pictures, then developing them to bring buried treasure to light or frozen emotions to life. Sometimes, tracking body sensations is the way to find and release them. Or we might return to an old physical environment, restoring an emotional state that was left behind before it was time.
The purpose is to transform trauma. It helps to think about chemistry and alchemy. Like knitting, these are transformational processes. They turn one thing into another. If a single step in the process is missed, the whole thing won't go to completion. It just doesn't work.
Tinking is precise, too. It begins with intention - and some resistance, as undoing is unpleasant. The knitted strand is carefully pulled apart, all the way back to the hole. The yarn is neither lost nor cut. It remains an integral part of the garment. When reknitted forward, it becomes part of a stronger garment.
Knitting creates links. A bridge is a link. To pick up a dropped stitch is to build a new bridge, make a strong link where one was weak or not even there. Building a strong bridge requires first building good foundations at each end of the span.
Not long after my girls died, a friend talked to me of bridges. She said that when your child dies, the foundation of your life collapses. For a while, you must go forward, building a new foundation. At some point, you then can build a bridge back to the past. Healing happens then. Connecting past and future makes a stronger whole.
With thanks to Descartes: "I 'tink,' therefore I am."
- Judith S. Freilich, MD, is a psychiatrist at The Meadows who is board-certified in psychiatry and neurology.
Peter A. Levine, Clinical Consultant for The Meadows, was recently quoted in the Psychology Today blog Let's Connect. In a post entitled "Enjoying Your Emotions", Thomas Scheff explores the psychological aspects of grief and fear, and suggests that too often, we are told to learn to control our emotions, instead of learning to enjoy them. For instance, grief can be a painful emotion to a person who does not feel safe to grieve.
"We have 'good cries' when we are able to rapidly move in and out of the grief. Peter Levine (1997) called it pendulation. Without this movement, we either don't feel at all, repression, or feel so much that we get lost in it (a 'bad cry')."
Scheff concludes that critics of catharsis haven't considered pendulation, but ought to.
For more information on Peter Levine's works, please visit the Meadows Addiction Treatment Center website.
Note: This article originally appeared in the Spring/Summer 2009 edition of MeadowLark, the magazine for alumni of The Meadows.
The Triggering Effect
By Claudia Black, PhD, MSW
Article excerpted from newly released CD Triggers and DVD The Triggering Effect.
Triggers are specific memories, behaviors, thoughts and situations that jeopardize recovery - signals you are entering a stage that brings you closer to a relapse. The process is much like riding a roller coaster that loops over itself. Once the roller coaster car gets to a certain spot in the track, a threshold is met, there is no turning back, and it starts the downward loop.
It is very likely you have heard your husband, wife, partner, mother, father, boss, a friend, attorney or even a judge say, "What were you thinking?" The answer is: you weren't thinking.
The inability to recognize the impact of your behavior, the willingness to risk what is significant in your life, and in this case, the quick lapse into old behaviors in spite of good intentions appear to be connected to brain chemistry. Addiction hijacks the brain. The reward/pleasure center holds captive the thinking center.
The good news is that the brain has plasticity. That means, in treatment and recovery practices, you can learn skills to calm the brain's emotional responses and reactivity area. You can learn to avoid triggers that activate the emotional area, and you can learn to enhance the decision-making area so you can rationally think through decisions, rather than respond impulsively and from such a strong emotional basis. But it takes time for the brain to be rewired, and it gets rewired with the repetition of new skills and new ways of thinking; hence, we strongly urge ongoing involvement in aftercare and other support systems.
Willpower alone is not a defense against relapse. Recovery is achieved, maintained and enjoyed through a series of actions. Learn to identify your triggers and, with each, identify a plan that anticipates and de-escalates the power of the trigger. With that, your reward is another day of sobriety with endless possibilities.
Five common triggers are:
1. Romanticizing the Behaviors
Romanticizing involves a tunnel focus on the positive feelings you associate with the behavior; it involves glamorizing using behaviors and, in the moment, totally forgetting about the negative consequences.
Getting overwhelmed at times is to be expected, but it's very easy to slip into romanticizing without any insight as to how you got there. At that moment, you enter a slippery zone, touching the trigger. While romanticizing is itself a trigger, it often occurs in tandem with an external trigger such as noises, sights, sounds or even tastes. You could be watching a movie and the next thing you know it is depicting the power of alcohol, drugs and sex in a positive way, and you are romanticizing. Or you're listening to the radio and an advertisement for a drug comes on, and you think about your pain pills as the commercial goes on to tell you how much better you'll feel, and off you go. Or you're watching a ball game on TV and can almost smell the popcorn and peanuts, and you see the spectators drinking large cups of beer and everyone is smiling like it's only a good time.
Take a few moments to think about how you romanticize your addictive behavior. What do you find yourself thinking about? What is the romanticizing covering up? What are you forgetting to take into account?
Addicts have used their behaviors and substances for years to separate from their emotional states. And there is so much to feel - guilt for how your behavior has hurt others, sadness for your losses, anger with yourself, fear of what is in front of you, shame for thinking you are inadequate, not worthy. You can act out in response to every feeling imaginable.
You lessen or get rid of feelings when you own them, talk about them or, in some cases, engage in problem solving. It is when you try to divert, ignore, and numb that you get into trouble. Feelings are a part of the human condition and you can't escape them. Recovery is the ability to tolerate your feelings without the need to medicate or engage in self-destructive or self-defeating behaviors and thoughts.
Recognize the gifts that come with feelings. Feelings are cues and indicators telling you what you need. Loneliness tells you, in your humanness, you need connection; fear can offer you protection, sadness offers growth, guilt is your conscience, offering direction for amends. It is critical for you to have this insight and, more importantly, to start to take ownership of the feelings when you have them.
Coupled with the trigger of feelings is the fact that those feelings are often associated with loss. By the time you get to recovery, you have had multiple losses in your life, often related to childhood, many times due to being raised with abuse, addiction, mental illness, etc. While you may have experienced trauma within your original family, pain of loss may be from a specific situation.
You may have experienced the loss of relationship with your parents or children, the death of friends or family, abortions, or career or work opportunities missed. As an addict, you are likely to have experienced losses related to health issues. Perhaps you have Hepatitis C, HIV, or injuries due to accidents.
It is not that you are suddenly thinking about these losses, but there may be a trigger. Perhaps you are in treatment and you see other people's children come to visit, and you have three kids and you don't even know where they live. Your daughter tells you that your ex-husband has just moved in with someone else. The goal is not to dwell on your losses, to not live in the pain and anguish. This is what happens when you don't acknowledge them and what they mean, triggering you back to your using behavior. With some losses, you can only grieve and ultimately come to find some meaning from your experience; with others, in time, you can attempt to repair damaged relationships.
Resentment is also a feeling, but I think it warrants its own place as a significant trigger. Resentments are like burrs in a saddle blanket; if you do not get rid of them, they fester into an infection. Resentments are often built on assumptions, i.e., "When you don't look at me, I assume you think you are better than me." "When you don't include me in a social gathering, I am assuming you think I am not good enough to be with you and your friends." Resentments are also built on entitlement, which is a form of unrealistic expectations and impatience.
Unrealistic expectations + impatience = resentments.
Move from resentments. When assuming, check it out. Put yourself in someone else's shoes (it may allow expectations to be more realistic). Identify and own the feelings the resentment is covering (often it's a cover for feelings of inadequacy and/or fear). Be willing to live and let live.
5. Slippery people, places or situations
You need to identify specific triggers - the people, places, and situations that are high-risk. Slippery people could be your ex-lover, certain family members, or past using/party buddies. A slippery place might be a bar you used to frequent, a casino, or an area in your community where you cruised - in essence, any place that triggers a positive association about the use of your drug of choice. Slippery situations could be an emotionally charged social gathering, such as a wedding, family event, or vacation.
Medication may be a trigger for which you need to be accountable. While there are situations when medication is needed, you are at high risk to abuse. You need to be proactive in how you are going to cope with this situation, because it is likely that your brain is going to remember a good feeling, saying more is better. Again, there are situations when medications are necessary, but self-diagnosis and/or self-prescribing only create a recipe for disaster.
What are the people, places or situations that are potential triggers? What provides safety for you to not be triggered? What triggers can you avoid? While some decisions around triggers are absolute, others are not necessarily in place for the rest of your life. Know your triggers and plan accordingly. In the face of a trigger, what do you need to do? What do you need to tell yourself? To whom can you reach out for support and/or problem solving?
Today in recovery:
1. Practice staying in the present; don't sit in the past or project into the future.
2. Validate the gifts of recovery for the day - practice gratitude daily.
3. Identify, build and use a support system - you need to stay connected. History and experience have proven time and time again that recovery is not a solitary process and cannot be sustained in isolation.
4. Trust that your Higher Power is on your side.