Presents:. Research and information on compulsive behavior. Neuroscience and brain imaging...

The Institute for the Research and Treatment of Addictive Disorders

Presents:

The Paradox:Taking Back the Hijacked Brain through the use of Specific and Innovative

Tools.

Presented by: Dr. A. Todd Freestone, Psy.D., LCSW,CSAT

The IRATADwww.addictions-healing.com

Why do we need any other tools?

Research and information on compulsive behavior. Neuroscience and brain imaging technologies

have given us the information that literal physical changes in the brain occur when we experience high emotional states.

Automated processes are formed and become compulsive when these high emotional states are combined with repetitive uses of maladaptive coping skills.

Why do we need any other tools?

We need tools that directly address these changes in the brain on a cellular level.

Healing takes place when the brain becomes plastic through feeling safe in therapy, and then assisting in stimulating the parts of the brain that are experiencing deficits (Dysregulation).

Dr. Patrick Carnes 30 Tasks

Dr. Carnes initial research into treatment programs and what worked, this research yielded 30 tasks that had clients showing recovery(Carnes, 2001).

These tasks will be listed besides the interventions that follow and show which of Dr. Carnes’ 30 tasks this tool covers to help them recover.

This is not program designed to compete with Dr. Carnes’ program, but to use additionally developed tools to help client’s recover and complete the 30 tasks.

The 30 Tasks

1. Break Through Denial2. Understanding the nature of addictive illness3. Surrenders to the process4. Limits damage from behavior5. Establish Sobriety6. Ensure physical integrity7. Participates in a culture of support8. Understand multiple addiction and sobriety9. Acknowledge cycles of abuse10. Reduce shame11. Restructure relationship with self12. Grieve losses13. Bring closure and resolution taking responsibility for self14. Restore Financial viability15. Restore meaningful work

The 30 Tasks Continued

16. Create lifestyle balance17. Build supportive personal relationships18. Establish health exercise and nutrition patterns19. Involve family members in therapy20. Commit to recovery for each family member21. Resolve original conflicts/wounds22. Alter dysfunctional family relationships23. Resolve issues with children24. Resolve issues with extended family25. Work through differentiation26. Succeed in intimacy27. Commit/recommit to primary relationship28. Explore coupleship recovery29. Restore healthy sexuality30. Develop a spiritual life

Where have the tools come from?

Principles of Neuroscience. Principles of Cognitive-Behavioral

Therapy. Principles of Addictionology. Dr. Matthew Hedelius and Dr. Todd

Freestone at the Comprehensive Treatment Clinic.

Tools We Have Developed Treatment Pillars Tracking Form/Treatment Journal Mind Mapping Music/Video Intervention Equilibrium Model DAPSA Model Multiple Redundancies to Relapse Scripting Bio/Neural Feedback use with Sexual

Addiction Forgiveness work Healthy Cycle and Sexuality

Additional Tools Autobiography (modified outline) Sexual Map/Template Work Attachment work Inner Child/Shame Work (John Bradshaw) Sexual Boundaries (Defined for themselves) Cyclework (Modified for sexual addiction) Thinking Errors or Cognitive Distortions Full Disclosure Empathy work (Modified) Brain Neuroscience and Vertical Integration These tools all are to be used in conjunction

with traditional cognitive-behavioral treatment.

Tools We Have Developed

Treatment Pillars Tracking Form Mind Mapping Music/Video Intervention Equilibrium Model DAPSA Model Multiple Redundancies to Relapse Biochemistry of Addiction and Trauma Levels of Learning Scripting and Bio/Neural Feedback

Treatment Pillars (Tasks 1,2,3,5,8,10, 11, 13, 16, 18, 19, 21, 30)

There are 12 treatment pillars. Pillars are to be read at least 3 times

per day, every day, for a month per pillar.

These pillars are designed to elicit a desire or willingness to change, much like positive affirmations do.

These can be used with or without neurofeedback.

Pillar #1:I am ready to change. I have lived the way I

have lived for too long. When I began this journey, long ago, my choices were just that, choices. But now, they have grown in to an addiction that controls me to the point that I feel I have no control. Those close to me, whom I love the most, have also been impacted to the point that the life we once had has almost been destroyed. But now, I am ready to change. And I commit to pay whatever price is necessary to accomplish this. I have already seen the power of a single choice in my addiction. Now I employ that same power, except I employ it for the purpose of growth and positive change. I will begin the change now and I will heal.

How Pillars Work

Neural-pathways form in a use dependant fashion. They are reinforced or strengthened by consistency, frequency, intensity, and duration.

If these pillars are read and used as prescribed, they accomplish all of the strengthening criteria.

Pillars used this way, allow the client to introduce important aspects of healing to their lives and have them become ingrained.


Treatment Pillars Tracking Form Mind Mapping Music/Video Intervention Equilibrium Model DAPSA Model Multiple Redundancies to Relapse Scripting and Bio/Neural Feedback

Comprehensive Treatment ClinicHealing Tracking Form(1, 2, 3, 5, 6, 7, 8, 10, 13, 16, 17, 18, 30)

Date P1 P2 P3 SS PS ES TX Sobriety MB AO Total

1

2

Pillars P1, P2, P3 +1

Spiritual Soothing SS +1

Physical Soothing PS +1

Emotional Soothing ES +1

Treatment Individual Therapy +2

Group Therapy +2

Therapy Homework +2

Sobriety Defined by themselves

0-10

My Beliefs MB +3

Acting Out AO -5

Healing Tracking Form

This form was developed for three purposes› Accountability

In individual and group sessions numbers can be given.

› Treatment Compliance If client stagnates, he/she can look at why. Self-awareness through observation of patterns or

cycles.

› To integrate several parts of the program in one place. The tracking form gives a visual reminder of daily

treatment goals. This form is now integrated into a journal format in

addition to the tracking form shown on previous slide.

Mindmapping: A Therapeutic Technique(1, 2, 3, 8, 9, 10, 11, 12, 13, 16, 19, 21, 22, 23, 24, 26, 27)

The way to unlock and remap the mind. The concept of Mindmapping is

originally from a book by the same title from Tony and Barry Buzan (1990).

The concept was to use the way that the mind stores information (by association) to aid in memory, planning and organization.

In therapy, we can use these concepts and take a step further.

Mindmapping: A Therapeutic Technique

Mindmapping can be used as a diagnostic tool. To mimic neural pathways already established in

the brain. It can also be used to remap or make more

healthy associations in the brain of a client. This technique can also be used to make

these new pathways powerful through the use of the same tools that make an addiction (Consistency, Frequency, Intensity, and Duration).


A Central Word or Phrase

Related to the Client’sParticular Addictive

Cycle

First word or phrase to come to mind

Second word or Phrase to come to

Mind

Central and second wordThen this one

Then this one

A Central Word or Phrase

Related to the Client’sParticular Addictive

Cycle

First word or phrase to come to mind

Second word or Phrase to come to

Mind

Central and second wordThen this one

Then this one


We have 4 words or phrases off the first word and then two from each of those words and out 4 generations.

We then look at what is associated with what. We look for negative or unhealthy associations and have them do a second mind map with positive associations replacing the negative.


The last piece to this technique is to have the client put each of the new associations on a separate sheet of typing paper and then put on the paper visual images that are associated (in the client’s mind) with that word or phrase. These pages are placed in a three ring binder and are read 5 times each day for a month, and then used as an intervention thereafter.

Music/Video Intervention(1, 2, 3, 5, 7, 8, 9, 10, 11, 12, 16, 17, 19, 23, 24, 30)

The music and the DVD were developed to help client’s and their spouses understand the process of sexual addiction from first discovery to the celebration of healing. Music is one of the fastest and most powerful ways of altering the mood of a client and directly accessing the Limbic System.

The Beginning to an End: A Journey of Healing

from Pornography and Sexual Addictions

Music/Video Intervention

We also use popular music and cinema to facilitate learning.

The Equilibrium Model and 4 Axes of Self-Soothing (2, 4, 6, 10, 11, 13, 16)

Posits that we have 4 major domains or axes in our human experience.› Axis I - psycho-emotional› Axis II - biological/physical› Axis III - social› Axis IV - spiritual

Intra-axis and inter-axis dysregulation creates imbalance.› Avoidance, hyper-focus, or lack of focus

Equilibrium is achieved by embracing discomfort, facing consequences and fears, and coping “in the middle” in each axis and in every axis.

The Equilibrium Model and 4 Axes of Self-Soothing

Identify at least 4-5 soothing activities in each axis.

Implement at least one activity from each axis as part of new daily rituals and when experiencing a craving, trigger, or high risk.

This is incorporated on the ‘Healing Tracking Form’.

These behaviors become the new coping strategies integrated into developing neural-pathways when engaged in consistently, frequently, and over time.

Depression, Anxiety, Pornography, Sex Addiction Model (DAPSA)

A model that demonstrates the progression and eventual pairing of mood dysregulation and sexual behavior as a mood-altering coping strategy, eventually leading to dependence on the behavior and ultimately compulsivity.

Educate about the model. Allow the client to then personalize the

model by going through each step of the progression and pairing in their own life.

Multiple Redundancy Assignment

This is an assignment that was developed to allow the client to slow down the limbic system response and give them time to engage their cortical response to a perceived threat, before acting out.

This assignment deals with having the client develop a list of possible situations that they might run into (of a high risk manner) and develop multiple plans to address this situation without acting out. They must then rehearse them.

Multiple Redundancy Assignment

When we have a plan in place to address these situations, we allow our cortex to catch up with our limbic system and resume the executive control that is necessary to make good, reasoned decisions.

Scripting and Bio/Neural Feedback(3, 4, 5, 6, 8)

Alpha brain waves (8-12 Hz) are shown to be associated with relaxation and feelings of well-being.

Theta waves (4-7 Hz) are associated with spontaneous imagery or hypnogogia.

When the amplitude of these two waves are increased in synchrony, the person moves to the state between wakefulness and sleep.

Scripting and Bio/Neural Feedback

During this state, the mind is the most receptive to suggestion and memories are moved to long term storage.

Simonton & Simonton (1978) suggest that images may communicate with tissues and organs, even cells, to effect change.

“Programming the unconscious with mental rehearsal of new images and intentions of desired change seems to effect healing and change both physiologically and psychologically” (Green & Green, 1977; Achterberg, 1985; Simonton & Simonton, 1978).


Dr. Tom Budzynski (1971-1997) indicated that a predominance of theta waves was the ideal state for re-scripting and re-imprinting the brain and facilitated the elimination of destructive behaviors and attitudes that are often laid down in childhood during which time the child is naturally in the theta state. This process allows the individual to establish more appropriate traits for adulthood.


Rossi (1986) suggested that each time that an individual accesses state dependent memory he or she has an opportunity to “associate and reorganize” the problem in a manner that can resolve it.


Gene Penniston (Evans &Arbenal, 1999) created a very successful protocol for addiction recovery by scripting successful outcomes for avoiding relapse and reinforcing them with relaxation and alpha-theta training. He was so successful with alcoholics, that without the use of drugs, he created in the alcoholics a state similar to taking antabuse for them. Alcohol would create in the patient a violent sickness they termed “the Penniston Flu.”


Scripting Definition: The process of creating a

blueprint of behavior through which the patient presents the ideal behavior that he/she desires to experience in real life situations.

It needs to be written using the first person, present tense, as if it had already happened or as if it were happening at present.


Scripting (Continued) 2 types of scripts

Refusal script Script starts by having the client write their highest

risk situation, followed by them intervening before they act on the trigger.

Optimal functioning script The script outlines how they will be functioning in

all areas of their lives once they reach recovery.

Sample Script

I see myself at home alone and I begin to get depressed. I immediately think of what would help me feel better and I decide to download some of my favorite porn sites. I go to the computer and type in the addresses. As I do this I remember my sobriety contract and what I have been working on in treatment. I recognize that if I act out it will impact my partner and family and I may risk losing them. At that moment I choose to turn off the computer and leave the room. I say the serenity prayer and read my treatment pillars. I also call my sponsor and talk to him. After speaking with him for a few moments I feel relieved that I was able to intervene as I had planned.


Neurofeedback allows the scripts to become a part of the long term memory of the client, “tricking” their brain into believing that the scenario of the scripting has actually happened. The client gains confidence and actually begins to act as the scripts suggest he/she has acted in the past.


Have the client write his/her refusal script.

Begin basic relaxation therapy either with “Em-wave” work or hand temperature biofeedback. These procedures facilitate the relaxation response.

Have the client read the script right before the relaxation exercise begins.


Get the client into the relaxation response.

Periodically have the client review the script in his/her mind once in the relaxation response.

After 3-4 sessions replace “Em-wave” and hand temperature sessions with Alpha/Theta training.Approximately 25-30 Alpha/Theta sessions are recommended. The more the better.


The client has EEG electrodes placed on his/her head over the sensory-motor cortex.

The EEG machine is set to provide an auditory and/or visual reinforcement whenever the alpha and theta waves are increased above a certain threshold.

This is an operant conditioning process by which feedback to the brain reinforces the desired wave lengths to continue.

Neurogenesis

Definition: The creation of new neuronal connections through the differentiation of stem cells becoming new neurons in the brain. Synaptogenesis: Short term changes such as

hope, excitement and motivation. Often seen in the initial stages of therapy.

Neurogenesis: The development of new neurons and their integration into neural networks. Likely a part of the long-term recovery process. Likely a 3-4 month process at a minimum according to Dan Siegel, MD.

Neurogenesis

The 4 keys to brain change. Consistency Frequency Intensity Duration

Three things that facilitate Neurogenesis. Novelty Aerobic Exercise Focused Attention (Dan Siegel).

Desired Outcomes

Vertical Integration Refers to integrating cortex, limbic system,

and lower brain functions so that communication is strong and the cortex is in executive control.

When this occurs, the client begins behaving in real life as they have rehearsed in treatment.

They begin to learn that they have control.

Conclusion

Neuroscience is now shaping and informing our understanding of compulsive behavior.

Neuroscience is also shaping and informing our understanding of the healing process.

Tools and interventions must be geared to facilitate and promote change at the neural and cellular level.

These tools have been developed with the core principles of neuroscience and cognitive-behavioral theory in mind.

Contact and Use of Tools

You are welcome to use any of these tools for your individual purposes. Please do not modify these tools or remove the copyright information. You may duplicate and use them for your personal use or that of your practice.

E-mail [email protected] for these forms or tools.

DVD or Video can be purchased at Amazon.com or off our website at www.comprehensivetx.com

mailto:[email protected]

References

Budzynski, T. (1971). Some applications of biofeedback-produced twilight states. Presented at the Annual Meeting of the American Psychological Association. Washington, DC.

Budzynski, T. (1997). The case for alpha-theta: A dynamic hemispheric asymmetry model. Presented at the Annual Conference of the Society for the Study of Neuronal Regulation, Aspen, CO.

Carnes, P. (2001). www.iitap.com/documents/Tasks1-30-Detailed.pdf

Buzan, T. (1996). The Mind Map Book. Penguine books, New York.

Evans, J.R. & Abarbanel, A (1996) Introduction to Quantitative EEG and Neurofeedback. Academic Press. San Diego, Ca

References

Gibson, R. (2000). Post-traumatic stress disorder and the thalamic/cortical pause. Etc, 57 no 3, 354-61

Kolb, B., Whishaw, I. (1998). Brain Plasticity and Behavior. Annual Review of Psychology, Vol. 49

Norton, Merill (2008). What’s up – The Neurobiology of Leaning and Adolescent Substance Abuse. Presented at the annual conference of Neuroscience Meets Recovery, Las Vegas, NV.

Rosenzweig, M.R. (1996). Aspects of the search of neural mechanisms of memory. Vol. 47

References

Rossi, E. (1986). The Psychobiology of Mind-Body Healing. W. W. Norton, New York.

Sapolsky, R. (1998). Why Zebras Don’t Get Ulcers. W.H. Freeman and Company, New York.

Simonton & Simonton, (1978). Getting Well Again. J.P. Tarcher, Los Angeles.

ADD……..Dan Siegel, Pat Carnes, John Bradshaw

Presents:. Research and information on compulsive behavior. Neuroscience and brain imaging...

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