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In some interesting research on obsessive-compulsive disorder, researchers at the University of California Los Angeles have developed an artificial intelligence system that predicts whether patients with OCD will benefit from Cognitive Behavior Therapy (CBT).
The February 2018 study, published in the Proceedings of the National Academy of Sciences, used a functional MRI machine, or fMRI, to scan the brains of 42 people with OCD before and after four weeks of intensive, daily cognitive behavioral therapy. Researchers specifically analyzed how different areas of the brain activate in sync with each other — a property called functional connectivity — during a period of rest.
The researchers then fed the participants’ fMRI data and symptom scores into a computer and used machine learning (that’s where the artificial intelligence comes in) to predict which people would respond well to treatment. The machine-learning program demonstrated 70 percent accuracy. It also correctly predicted participants’ final scores on a symptoms assessment within a small margin of error, regardless of how they responded to the treatment.
Dr. Jamie Feusner, a clinical neuroscientist and the study’s senior author, said:
“This method opens a window into OCD patients’ brains to help us see how responsive they will be to treatment. The algorithm performed far better than our own predictions based on their symptoms and other clinical information.”
Dr. Feusner goes on to say that if the study’s results are replicated, treatment for OCD could someday start with a brain scan.
While I find this study fascinating, it also makes me a little uncomfortable. I will be the first to admit I have a limited understanding of neuroscience and artificial intelligence, but I shudder to think that CBT (specifically exposure and response prevention therapy which is the evidence-based treatment for OCD) would not even be offered to someone with OCD based on a preliminary scan of their brain. I see obsessive-compulsive disorder as so complicated. Could it really be that easy to predict who will or will not benefit from Cognitive Behavioral Therapy?
There are already many known reasons why exposure and response prevention (ERP) therapy doesn’t work for some people. You have to be totally committed to it, and there are various aspects of OCD and this therapy that can make that commitment difficult. The degree of family support and understanding of OCD as well as comorbid diagnoses are just two more examples of why exposure and response prevention therapy might not initially be successful. In addition, there are therapists out there who think they understand ERP therapy, only to make common mistakes during treatment that jeopardize their patients’ success. As I’ve said, OCD is complicated, so it is not surprising that treating it is often a complex undertaking best left to experts in obsessive-compulsive disorder.
To me, it’s a bit of a paradox — the fact that an impersonal machine (artificial intelligence) might lead to more personalized treatment. I know this is the wave of the future, and of course I can imagine the possible benefits and discoveries that are likely to arise from cutting edge research involving the brain. I just hope that we don’t get so caught up in data and test results that we neglect to pay attention to the whole person and their individual circumstances.
Do you often feel hopeless, like you’ve failed so many times that it’s not even worth trying anymore? Do you frequently dwell on all the mistakes you’ve made and all the relationships you’ve lost? Maybe you just feel like your life will never be meaningful so there’s no use trying to be anything or do anything.
If thoughts like this are controlling your life, you may be using self-victimization to cope with issues you feel unable to manage.
Exploring the Victim Mentality and the Role of the Victim
The victim mentality can display itself in a variety of ways. People who play the role of a victim believe everything that happens to them is completely out of their control, therefore, it is never their responsibility. They blame others when bad things happen to them and they have an extremely negative outlook on life. They are resistant to help and respond to any advice or assistance with reasons why it won’t work and explanations as to why the problem is unsolvable.
Many people with a victim mentality also use passive aggressive behavior and manipulation to get what they want from others. This type of behavior is frequently seen in those who are addicted to drugs and alcohol. They will feel and act helpless to convince their loved ones and friends that their life is really as bad as they believe it is. They frequently use this behavior to manipulate loved ones into enabling their addictive behaviors by giving them money, drugs, protection, or companionship.
Playing the victim is an extremely damaging and self-defeating behavior. Individuals who do this tend to develop relationships that involve mistreatment or abuse, they reject opportunities to have fun or deny any enjoyment, and they fail to prioritize their own well-being, eventually setting themselves up for failure and pain.
Many individuals in recovery from drug and alcohol addiction are comfortable in the role of the victim, but drug and alcohol rehab programs challenge them to assume responsibility for their behaviors and take control of their lives. This requires giving up that victim role and the helplessness that comes with it and taking ownership of their lives instead.
Identifying Victim Mentality
It’s not always easy to identify the behaviors of victim mentality within yourself, but to overcome self-victimization and addiction, it is necessary to identify the beliefs that fuel these behaviors.
According to WebMD, there are several characteristics and beliefs associated with the victim mindset that you can identify within your own thought patterns.1
You believe that others are intentionally trying to hurt you. You don’t consider the other person’s perspective and automatically assume that they are out to get you.
You feel helpless. You believe the world is against you and you are powerless to change anything. As a result, you expect the worst and blame others for your problems.
You relive painful memories repeatedly and seek revenge. Instead of forgiving and moving on, you choose to keep those memories alive and refuse to forgive those who have harmed you in the past.
You refuse to accept the help of others or consider other methods for coping. You identify as a victim by refusing the help of others and assuming other coping strategies will not work. Because you gain attention, money, affection, or some other advantage by being a victim, you don’t want to stop.
You tend to exaggerate your problems. You believe that everyone else’s lives are so much easier than yours and you are the only one who experiences such extreme problems.
These five beliefs are some of the most common ones held by individuals who struggle with identifying as a victim. If you believe that a loved one is self-victimizing, here are a few questions to ask yourself that may help you identify his or her behavior:2
Do conversations tend to revolve around their problems and issues?
Do they constantly say negative things about themselves?
Do they always seem to be miserable?
Do they blame others for the bad things that happen to them?
Do they always expect the worst?
Do they express the belief that the world is out to get them?
Modifying Thoughts and Beliefs to Change the Victim Mindset
Playing the victim greatly hinders any efforts towards sobriety. At a drug rehab center, counselors and therapists work with addicted individuals to identify and address the victim mentality. In doing so, people learn that while they may not be able to control everything that happens to them in life, they do control their feelings, emotions, responses, and their overall happiness, and if they continue to blame others for their unhappiness, they will never be fully focused on their sobriety.
Additionally, in rehab, people are encouraged to practice self-reflection and acknowledge that perhaps their victim mentality is a result of traumatic experiences, a need for validation, or a desire for human connection. Because of this internal reflection, individuals in recovery can learn to modify negative thoughts and beliefs about themselves with the following strategies (among others).
Accept responsibility for past and present decisions and actions. Taking ownership of decisions, as well as the consequences of those choices, is a huge step in overcoming the victim mentality and the addictive behaviors that accompany it. Accepting responsibility empowers an individual to help themselves by using the resources, coping strategies, and skills they have learned in drug and alcohol rehab instead of using all their effort to blame others.
Learn to accept mistakes. In order to stop being miserable, bitter, and angry, a person must accept that the people in their lives have made mistakes, and they have made mistakes too. To move forward in a life of sobriety and wellness, they must let go of these negative feelings and potentially even forgive those who have wronged them.
Recognizeself-worth. Instead of assuming that they don’t deserve to live a happy life, continually repeating negative self-talk, or intentionally doing things to harm themselves, individuals in drug rehab will learn to understand their own value and self-worth, as well as the importance of self-care in recovery. In modifying these negative thoughts and beliefs about themselves, they will be empowered to let go of the victim role and accept responsibility for their lives.
Breaking the victim mentality isn’t easy, but it is a necessary part of recovering from addiction. Many aspects of drug and alcohol rehab will help individuals identify and resolve this behavior, so they can live a fulfilling, meaningful life that is free from substance abuse.
I bet you think you’re a weak person. You suffer from an illness and feel your vulnerability if not daily, moment by moment. You can’t just shrug off a look, disappointment or bad news the way a friend can. This makes you feel super sensitive, temperamental or even weak.
It makes sense to think this way. And yet, those who struggle are amongst the strongest warriors in the world. Think about war veterans. Think about the neighbor’s daughter who is physically ill, but emotionally strong. Think about how much you’ve overcome.
Wearing your heart on your sleeves may seem like a sign of weakness. But it’s what makes you emotionally strong. It’s your resilience that pushes you to persevere through all the oodles of challenges you face every day.
As we begin this week, you’ll read what really defines weakness and emotional strength. It just may surprise you.
If you were to ask most people if they are in charge of their life, the majority of people would likely respond that they themselves were. Yet what most people don’t understand is the tremendous power their subconscious mind has on the choices they make and how they approach life on a daily basis.
In order to live your ideal life — the one you were innately designed to live rather than the one your family or society may have designed for you — it is important to learn to be more conscious of the programming you may have inherited.
The Difference Between Your True Self and the Database of Your Mind
When we are first born, we are grounded in our unique consciousness — an awareness that begins to explore the world that is our true self. This true self enters the world with a unique set of potentials (physically, athletically, musically, artistically, and personality wise) that only we could bring to the world. The metaphor that I like to use when referring to our true self is that of an acorn. An acorn contains the full potential of an oak tree, it is never going to be a maple or pine no matter what. Similarly, each of us comes with the potential to fulfill purposes that only we can.
Our unique consciousness enters the world with two incredible tools at its disposal, our bodies and the database of our mind. From the moment we start observing the world, our subconscious or implicit mind is continuously collecting information like a sponge without the need for our conscious attention. This implicit mind first forms mental models about ourselves, others, and the world. As our ability for language emerges, we then start putting words to these mental models and forming our core beliefs about ourselves and life in general. Examples of key core beliefs include: “I’m loveable just for who I am (or not)”; “Relationships are a source of comfort (or not)”; “I’m designed for a unique purpose” or rather, “I need to do what others want in order to be worthwhile.”
When we develop the ability to use language our conscious explicit mind also develops. This rational part of our mind’s database is what people are referring to when they say they’re remembering something. This part of our mind has several key advantages in that it organizes information based on logic and chronology. It is the “smart” part of our mind’s database. Unfortunately, because it relies on our conscious attention to get information into it, the explicit mind is very limited in the amount of and speed at which it can accumulate information.
Our implicit subconscious mind is a far more dominant part of our mind’s database. Because it does not require our conscious attention, it can collect far greater amounts of information than our explicit mind ever could and do it at significantly greater speeds. One of the major drawbacks of the implicit subconscious mind, however, is that it is not smart per se. When it collects information, it organizes it based on neural associations (things that occur together become linked) or classical conditioning (as Pavlov demonstrated in his work with dogs) rather than logic or chronology. Also, once an association is made, the implicit mind is not good at contextually updating this association. In other words, it doesn’t take into consideration that we may have grown, matured or gathered more resources that would dramatically change the nature of that association.
How Our Mind Traps Us
When we are first born, we are firmly grounded in our unique consciousness—there is relatively little information in the database. But as we develop, particularly as we acquire language, the information in the database grows exponentially. Instead of staying grounded in our unique consciousness and using the incredible problem-solving thinking machine that is our mind’s database to help us fulfill our true purpose, we all too often get trapped by the very mind that was supposed to help us.
As the core beliefs about ourselves, others, and the world get more and more entrenched in our mind’s database, in essence, we get enveloped by the database. We end up living life from inside the database, believing those core beliefs as if they were absolute truths rather than recognizing them as reflections of the relative health or dysfunction of our families, friends, schools, society, and media. We, unfortunately, lose sight of the fact that we are much greater than our mind’s database would ever have us believe. We lose sight of our true self or the unique consciousness with which we began life.
The path to self-actualization or living the life you were innately designed to live involves becoming increasingly aware of the programming of your subconscious implicit mind, regrounding yourself in your unique consciousness and then learning to consciously program your mind constructively. I outline this process in greater depth in my book Constructive Thinking: How to Grow Beyond Your Mind.
However, another book that I would like to bring your attention to is My Stroke of Insight by Jill Bolte Taylor. Through the traumatic life-changing experience of having a stroke in her left hemisphere, brain scientist Dr. Taylor shares one of the most poignant examples of freeing oneself from the dysfunctional programming of one’s database and rediscovering one’s true self. Because Dr. Taylor’s stroke was in her left hemisphere, where the ability for language resides, in essence, the stroke wiped out her mind’s database (as if all the programming on the whiteboard of her mind was instantly wiped clean).
Dr. Taylor describes the ironic euphoria she experienced being freed from this programming leaving her to connect only with her true self—the unique consciousness. Through her long arduous recovery from the stroke, Dr. Taylor was given the unique opportunity to program her mind’s database consciously from scratch (beginning with having to relearn how to read and write again). She describes how she was much more deliberate about being sure to program her mind’s database more constructively, leaving much of her dysfunctional ways of relating to herself and others with her pre-stroke self. Ironically, from Dr. Taylor’s depiction, it appears that the whole experience led to deeper contentment and a more self-actualized path than she may have ever discovered had the stroke not occurred.
While Dr. Taylor’s journey is obviously an extremely dramatic case, the path she discovered — freeing herself from her mind’s database, rediscovering her true self and then learning to program her mind constructively—is the path to self-actualization. It is this path that I’m most passionate about helping as many people as possible to discover. For the greater number of individuals who discover and live their lives on the path of self-actualization the greater the exponential positive impact will be on the world.
Bolte Taylor, J. (2009). My stroke of insight. New York, NY: Penguin Group
Hayes, S (2005) Get out of your mind and into your life: the new acceptance and commitment therapy Oakland, CA: New Harbinger Publications
Lentino, L. (2014) Constructive thinking: how to grow beyond your mind. Sudbury, MA: Grow Beyond Your Mind Press
Siegel, D (2012) The developing mind (2nd edition). New York, NY: The Guilford Press
Tolle, E (1999) The power of now: a guide to spiritual enlightenment Novato, CA: New World Library
Being afraid isn’t popular. Real men aren’t supposed to quake in their boots during a crisis. Our collective vision of the successful woman does not include her hiding in her office hyperventilating. Once we’re grown up, we’re supposed to be confident, competent and fearless. Right? Right. Yeah. But life doesn’t always cooperate. Life keeps handing us things that, if we’re at all sane and paying attention, make us a little scared — or a lot terrified.
Inability to manage fear is the stuff of situation comedies and chick flicks: We find it funny when a goofy guy awkwardly tries to look more on top of things than he really is. We find it hilarious when a nervous gal gets tongue-tied in her efforts to impress. But there is nothing funny when we find ourselves in such situations. Admitting to the fear or, worse, showing it gnaws at our self-esteem and our self-confidence.
There is an unfortunate result to our reluctance to acknowledge fear. Fear feels like a dirty little secret we can’t talk about except in the form of jokes, disclaimers or confidences deep in the night, preferably under the influence so we can deny it all later.
Giving fear new names does make it possible to talk about it with our friends — at least a little. “I’m so stressed out” at the job is okay. “I’m terrified” isn’t. It’s okay to talk about being “a little nervous” when going on a date with a new love interest but it’s not okay to talk about being “scared stiff” except maybe with our most trusted friend. It seems that we live in a culture where it is more okay to be tense, upset, angry, even furious, than it is to be afraid.
Regardless, the impulse when we’re afraid is to retreat from people and challenges and hide under the covers. Staying “safe” takes priority even when whatever is scary might be manageable or even might make us grow.
Sometimes such a time-out is all we need to gather our courage to confront a new challenge. But sometimes we need to do more than take a day off from life.
By all means, see a mental health professional if anxiety or a depressed mood are regularly interfering with your ability to carry on regular life or to make and maintain relationships. There is no shame in getting help when we can’t help ourselves. A counselor can provide some needed support and help you learn more effective ways to deal with challenges in life.
If, however, your fears haven’t reached that level of distress but are still difficult to manage, here are 5 tricks of the mental health trade that anyone can do at home in their spare time for free.
1. Identify your fears.
Get your fears out of the shadows. Anything hidden tends to grow metaphorical teeth and claws. When it does, you are not only dealing with the original fear, but you have added a layer of fear about the fear to deal with. Admit to what you are, down deep, really afraid of. For example, most people who say they are anxious around other people are really afraid of being judged. It’s the judgment, not the people, that inspires the fear. Whatever it is that scares you, you are more likely to be able to overcome it, if you take on the real problem.
2. Remember your strengths.
You’ve handled things in the past. You are probably handling some nervous-making things now. The same ability can be brought into play to manage whatever is upsetting you.
Make a list of times you conquered your fear. Write down what made it possible. This is important data. Much of the time, people do know what to do. Their fear just makes them forget to do it. Keep a reminder list in your wallet so you have it on hand to help remind yourself what you need to do.
3. Reach out to someonewho can offer emotional support.
It isn’t helpful to surround yourself with others who feel helpless or hopeless or who numb themselves to their fears with substance abuse. Nor is it helpful to talk with someone who tells you “get over it” or who minimizes your problem. They may mean well, but they will only discourage you further. Pick someone who will commiserate a bit but who will also encourage you while you work on coping.
4. Practice mindful breathing.
Waiting to calm down so you can think is rarely effective. Doing something to make yourself calmer is much more likely to help. Breathe in to the count of 5. Breathe out to the count of 10. There are good physiological reasons for doing this. You are literally slowing your system down so you can think straight.
5. Act “as if”.
Don’t underestimate the power of faking it. This isn’t a new idea. Philosopher Hans Vaihinger, in 1911, wrote that by acting as if we have already achieved a desired feeling or change in behavior, we can accomplish it. Alfred Adler, early 20th century psychologist, urged his patients to act as if they were already feeling and doing better. It often worked. Today, Positive Psychology and Cognitive Behavior Psychology utilize the same idea. “Fake it until you Make it” is a slogan used in Alcoholics Anonymous.
They can’t all be wrong. So — imagine yourself free of your fear. Think about how you would behave differently. Then do it. Start small. Act as if you are already less fearful any chance you get. Often practice makes an idea into a reality.
Gabe Howard (Bipolar) and Michelle Hammer (Schizophrenic) decide to play Two Truths and a Lie. Each tells three remarkable stories of the past. The other tries to guess which are true and which are not. Hear Gabe’s stories of Demi Lovato, after-hours strip clubs, and bar fights. Hear Michelle’s stories of dating hell, apartment fires, and medication hallucination. Which ones do you think are real?
“I am hallucinating squirrels running all around my room.” ~ Michelle Hammer
Highlights From ‘Stories From a Bipolar and a Schizophrenic’ Episode
[2.15] Rules of the game.
[3.00] First Stories:“DEMI L” vs. “CRAZY CHICK”
[6:50] Second Stories:“GABE’S FIGHT STORY” vs. “FIRE WEED”
[14:20] Third Stories:“STRIP CLUB MANNERS” vs. “SPIDER TIGER”
[20:00] Gabe and Michelle question each other on the stories.
[25:00] The big reveal.
Meet The Hosts of #BSPodcast
GABE HOWARD was formally diagnosed with bipolar and anxiety disorders after being committed to a psychiatric hospital in 2003. Now in recovery, Gabe is a prominent mental health activist and host of the award-winning Psych Central Show podcast. He is also an award-winning writer and speaker, traveling nationally to share the humorous, yet educational, story of his bipolar life. To work with Gabe, visit gabehoward.com.
MICHELLE HAMMER was officially diagnosed with schizophrenia at age 22, but incorrectly diagnosed with bipolar disorder at 18. Michelle is an award-winning mental health advocate who has been featured in press all over the world. In May, 2015, Michelle founded the company Schizophrenic.NYC, a mental health clothing line, with the mission of reducing stigma by starting conversations about mental health. She is a firm believer that confidence can get you anywhere. To work with Michelle, visit schizophrenic.NYC.
I’ve previously written about some of the factors involved in recovery avoidance in OCD. Often those with the disorder are fearful of giving up rituals they believe keep them and their loved ones “safe.” Even though people with OCD usually realize their compulsions do not make sense, the terror that comes with losing what they perceive as control over their lives can be so real that they choose not to fully engage in exposure and response prevention (ERP) therapy. They are afraid of getting better, of living a life without the “safety net” of OCD.
There are those with obsessive-compulsive disorder who compare how they feel to Stockholm Syndrome, where hostages (those with OCD) side with their captors/abusers (the OCD). While I’d known those with OCD might find it hard to leave their disorder behind, it had never occurred to me that they might not want to rid themselves of obsessive-compulsive disorder and all it entails. To me it is so counter-intuitive that I never even considered it. Why would anyone want to live with an illness that robs them of everything they hold dear?
It’s hard for me to comprehend, but then again, I don’t have OCD.
Perhaps because living with obsessive-compulsive disorder is the only life many who suffer with OCD have known, it might feel, in a way, comfortable. It is like family (though a dysfunctional one, at best). No matter how much our family might annoy us, and no matter how much we might even despise some of our family members, we still love them and want them around. Is this same type of love/hate relationship common with OCD?
And what will those with OCD do with all the extra time they’ll have once they are not slaves to hours and hours of daily compulsions? While this freedom is obviously a good thing, it can also be a daunting and frightening task to try to figure out how to spend time previously stolen by OCD.
Also, there is no question we are all shaped and influenced by many different factors in our lives, including our illnesses. Do those with OCD believe they won’t be their real selves if their illness is under control? For those who are able to see their obsessive-compulsive disorder as separate from themselves, I wouldn’t think this would be an issue. But maybe it is. Perhaps those with OCD believe not having their disorder as an integral part of their lives might change their true identity. To complicate matters more, it might be difficult for people with the disorder to even know what they believe. Are their thoughts their own or is it their OCD talking?
In my son’s case, getting treatment for his OCD is what allowed the real Dan to emerge. In over ten years as an advocate for OCD awareness and treatment, I have never heard from anyone with obsessive-compulsive disorder who felt their true self had been compromised after ridding themselves of this horrible disorder. Indeed, it is just the opposite. With OCD on the back burner, they were finally free to be their authentic selves.
Oppositional defiant disorder (ODD) was first listed in the DSM in 1980. The disorder is described as a condition in which a child displays extreme defiant behavior including vindictiveness, irritability, and anger.
ODD is an ongoing disorder that starts very early in child development, usually preschool, and continues throughout their teens. Several studies indicate that roughly 3 percent of children have it. Symptoms may include many common problems for children, but on a much grander scale.
For instance, many children throw temper tantrums. It is a healthy part of growing up and tends to happen during 2-3 years of age. When a child becomes tired, hungry or stressed, they may lash out or become irritable. All of these actions are completely normal. Uncooperative and hostile behavior on a regular basis that seems more severe than other children’s temperament may be cause for concern.
Signs of ODD include:
Frequent or daily temper tantrums
A preoccupation with seeking revenge
Mean and hateful speech
Constant questioning of rules
Deliberate attempts to upset other children or adults
These behaviors are often seen not only in a school setting, but at home as well.
It is important to note that oppositional defiant disorder is separate from a conduct disorder. While both are considered “problems in the self-control of emotions and behaviors,” according to the DSM-5, “the behaviors of oppositional defiant disorder are typically of a less severe nature than those of conduct disorder and do not include aggression toward people or animals, destruction of property, or a pattern of theft or deceit.”
Anthropology associate professor Carolyn Smith-Morris from the University of Arizona worries that the diagnosis may subconsciously be given to children of a certain gender or race because of the cultural differences in the way children are raised. Defiance can be an appropriate behavior in response to injustice and/or oppression and to mute the behavior may also blunt the ability to think critically. A popular criticism of ODD stems from the fact that compliance is not always a desirable trait.
Despite the controversy of this diagnosis, ODD can have a major impact on the education of the child as well as the psyche of the parent. Recognizing ODD may raise awareness of trauma or anxiety that has impacted the child. The sooner the problem is understood, the quicker a solution may be implemented.
Before seeking help for ODD, it is important to understand whether the child has a learning difficulty or emotional disturbance created by either circumstance or biology. If the hostility is too intense or lasts longer than developmentally appropriate, the behavior may become pathological. Children with ODD rarely outgrow their aggression as it is the child’s most stable trait. According to ASCD.org, difficulty getting along with preschool peers is the single best predictor of antisocial behavior at age 11.
Coping strategies for parents include:
When disciplining your child, make consequences immediate and fair. A lack of consistency may confuse the child and ultimately delay good behavior.
Keep track of the child’s behavior and make a list on what specific changes you wish to see. Start with just one behavior rather than focusing on multiple behaviors at once.
Allow your child to pick from a list you create of consequences that he/she thinks is fair for each punishment.
Communicate with your child to make sure she/he understands why it is important that each behavior change.
Take time to focus on you and your partner/spouse. Stressful parenting can take a toll on relationships, sometimes when you need them most.
There are many different options for professional treatment. Family therapy addresses the whole of the situation and will usually last several months. Parent training is a process that helps parents learn how to be consistent and involve the child in shared goals. Parent-Child Interaction Therapy involves a therapist that coaches the parent on how to relate to their child. They may guide the parent through strategies that reinforce positive behavior for their child.
Another route for treatment includes social skills training. A child may need help learning how to navigate his/her social world better to learn how to relate to others and form long lasting skills to form strong connections. Ultimately, a strong connection can help bond the child to healthy relationships, causing more security and less pain.
In 2010, the American Academy of Sleep Medicine published the first summary guidelines on how to effectively treat nightmare disorder (Aurora et al., 2010). Based on a comprehensive review of the literature, the two top interventions were psychological and pharmacological. They are Imagery Rehearsal Therapy (IRT) and venlafaxine or Prazosin. The data show the two interventions as comparable in efficacy and, therefore, a trial of the psychological intervention — before medications — is usually recommended. The context and nature of the nightmares, of course, are central to how best to use this approach and, thus, an equally important recommendation, is that you the client or patient seek the assistance of a clinical provider trained and qualified to deliver this treatment.
The Four Steps of Imagery Rehearsal Therapy (IRT)
1. WRITE DOWN the narrative or the central elements of the bad dream. To facilitate recall, it is best to use a lighted pen and paper at your bedside to record the content. Do not use your phone or tablet because of excessive light stimulation. You may also use a dedicated micro-recorder to orally record content upon awakening.
Later, spend some time turning the notes into a more detailed paragraph or two describing what happened in the dream and to whom. What is most important is to capture the most frightening elements of the dream on paper: the actual injury or death, horrific images or sounds, and what led up to the dramatic ending.
Please note that this alone may be intolerable for some trauma survivors with severe posttraumatic stress disorder (PTSD), problems with dissociation, or other severe mental illness. For those of you with extreme fear, make sure you have professional or personal support before attempting this alone!
2. REWRITE the dream on another piece of paper CHANGING the arc of the story so that it results in A POSITIVE ENDING. This requires some imagination but can be done with the help of heroic stories of survival you recall from literature, the movies or the media. The story can be outlandish, introduce rescuers, invoke your own Super Hero superpowers or a realistic use of self-defense, martial arts, weaponry and/or the help of well-trained defenders such as the military or law enforcement.
3. JUST BEFORE FALLING ASLEEP, INDUCE THE INTENTION TO RE-DREAM. Use each of the following steps and do not skip any of them! Please note that the simple intention of being receptive to having the nightmare again leads to immediate remission (absence) of the recurrence for a lucky few. The steps below have elements of a technique borrowed from a phenomenon called lucid dreaming, the experience of being aware that you are dreaming while you are dreaming. Do not be discouraged if you do not have that gift. You will still get excellent results without being able to lucid dream.
Say this to yourself (really use these exact words), “If or when I have the beginnings of the same bad dream, I will be able to INSTEAD have this much better dream with a positive outcome.” (If you think you are a lucid dreamer, you can say to yourself, “If or when I have this dream again, I will be aware of having it and not only can I dream the better version, but I will shape it more positively while it happens!”)
IMAGINE the details of the REWRITTEN DREAM from beginning to end. Review any part to make sure you can really see it or feel it.
Repeat to yourself the statement in Step 1 above ONCE MORE, before you allow yourself to FALL ASLEEP.
4. Once you have successfully had your first success, REJOICE IN YOUR RE-DREAMING! You are on your way to managing and mastering the content of your upsetting dream life. REPEAT the procedure every time you have a nightmare or fear a recurrence. If you do not have success on the first many attempts, do not despair. Keep experimenting with rewrites. All efforts will be a good source of information that you can provide to your physician or psychologist. Give the techniques a minimum of a 10-night trial. Note the challenges you are facing. Typical problems that interfere are related to alcohol or cannabis use (try abstaining while you attempt the methods) or breathing problems related to asthma, allergies or apnea. Get additional help for these problems and when suspecting severe sleep disorder, consider a sleep medicine specialist (physician, neurologist, clinical psychologist, or neuropsychologist).
Although not a panacea for the problems surrounding nightmares such as PTSD or recent traumatic exposure, IRT is indeed powerfully effective in reducing and eliminating nightmares. This technique has been used with great success by psychologists with veterans of war and survivors of abuse, physical and sexual, for decades. It is gratifying to finally see the leaders in sleep medicine research doing the research to warrant formal endorsement.
Statistically, if you know ten people in the US, at least one of them is expected to enter a near futile battle with addiction — chances of long-term recovery are low. Traditional drug rehabilitation alone isn’t working for enough people, not even slightly. Finally, the foundations for the creation of next-generation therapies have been laid that could help turn these numbers on their head.
Recent developments in our understanding of the biological and neural networks involved in substance abuse disorders and psychological theories of behavioral change, coupled with the rapid evolution of technology-assisted therapy mean that the pivotal time is now.
As we speak, over 30 of the World’s leading experts on ending addiction and facilitating life-long recovery—including expert scientists and therapists, TED speakers, thought-leaders, and international best-sellers—are speaking at the online Healing Addiction Summit.
And that is what it is going to take: The knowledge from the best minds in their respective fields, being united at the frontline in creating holistic, multipronged, therapeutic systems that adapt to the individual and their support network to effectively prevent relapse round the clock and reliably promote lifelong, successful recovery.
We are failing addiction sufferers and their families.
Most addicts in the US never receive treatment (estimated at 10% or less), and although heatedly debated it is clear that most conventional addiction recovery programs alone do not result in lifelong recovery for the majority of people. Tragically, this equates to lifelong suffering that ripples through the addict’s lives to their loved ones and our communities and society as a whole. As put by Summer Felix-Mulder, co-founder of Clear Health Technologies and host of the currently running Healing Addiction Summit:
Addiction doesn’t just affect the addict, it affects families, it affects friends, it affects every relationship.
Ultimately, the seemingly endless addiction cycle of sobering up, relapsing, and hitting rock bottom often ends in drug-related death. In the US, a shocking 100> people die every single day from the number one cause of injury-related death, drug overdoses and poisoning.
With such high stakes at risk, failing to treat and heal those suffering from addiction, the addicts themselves, and their families, is not an option.
Why do addicts relapse?
Behavioral change maintenance, also known as sustainable behavior change, is the ultimate goal in addiction recovery, where a recovering addict refrains from old addiction sustaining behaviors (e.g., drug seeking and use) and maintains new abstinent behaviors (e.g., use of craving coping and wellness strategies).
Think of a Jenga tower as the power to resist cravings and desires to use. It is made of many useful, interconnected blocks that represent the perhaps 100s of factors that can help prevent relapse:
Some of these blocks are red. They represent the emotional and physiological resources (e.g., good sleep, low stress, neutral/positive mood) needed to start entraining a new behavior to make it an automatic habit while resisting an old habit.
Some of these blocks are green. They represent the tools and abilities one has to self-regulate and exercise self-control over old addiction habits and behaviors.
Some of these blocks are blue. They represent the good habits that prevent drug relapse. Self-control requires fewer resources the more that the behaviors that prevent relapse and promote recovery are entrained in the brain and become a habit.
And then add contextual factors into the mix. Changes to the addict’s physical and social environment can shake things up. An emotional rock of a friend moves away, having to attend a wedding with an open-bar, or a new club opens next door and it’s like pointing a power fan at the Jenga tower. You better hope the right blocks are in the right places!
In reality, some of the blocks can be removed without too much fuss. One night’s bad sleep, so what? The tower might sway, cravings might even go through the roof in stressful moments throughout the day, but balance is regained and relapse is resisted—the tower stands strong. Remove a few more blocks and another couple fall off, create weak patches, or remove some of those important foundational blocks and, very quickly, when just a second ago the tower stood steady, it all comes tumbling down.
This is how falling off the wagon seems to creep up on addicts and their support network. No one can monitor all of these blocks all of the time, not even the addict, and certainly not their counselors, therapists, friends, and family.
All it takes is the wrong block to be removed at the wrong time. For non-addicts wanting to start new healthy habits or quit bad ones this equates to an “off day” or moment of poor self-control, but for addicts, this can be devastating and life-threatening.
Why aren’t conventional drug rehab programs enough?
One of the current mainstays of drug and alcohol rehab treatments involves engagement in a 12-step program pioneered by Alcoholics Anonymous that the majority of rehabilitation centers rely upon.
About 60% of public treatment programs in the U.S. report that the 12-step model is their primary approach, and most encourage or mandate 12-step involvement, with about half holding 12-step meetings onsite.
Research on the effectiveness of these programs is controversial and is subject to widely divergent interpretations and will not be discussed in this article. Nonetheless, it is resoundingly clear from the latest reviews and meta-analysis that while there are undoubtedly recovery-related benefits for some people, the most effective programs of the future will NOT be based on the 12-steps.
And why should we expect 12-steps-based rehab programs and treatments to work across the board today? It was created in 1935 (when we knew next to nothing about addiction) and is essentially a set of religious/spiritual principles that have changed surprisingly little over the years. It is not a carefully crafted system based on proof of what works best for the majority of people or under various circumstances. And it is certainly not tailored to the individual to maximize effectiveness and ensure that the recovering addict has maximal protection against relapse 24/7.
There is not one single reason to expect such drug rehab programs to be universally effective.
And how can future drug rehab programs be better at preventing relapse and promoting recovery?
By evidence-based design.
By providing round the clock assessment and care.
By developing holistic approaches that take into behavioral change theory and account for psychology (mind), biology (the body and brain), and, for some, spirituality (soul).
By helping addicts use interventions and tools tailored to the individual’s needs at the exact moment they need them, not simply learning about them in a meeting and hoping they are used when times are tough. Prompts and guidance are needed to guarantee success under stress.
By helping addicts maintain the healthy habits and quality of life needed to stay clean that even the most healthy and successful individuals can struggle to maintain on the daily.
By being affordable, desirable, and accessible for all.
This can only be achieved realistically by designing programs that integrally capitalize on smart devices. Objective biosensors and mobile phone applications can be used to detect and tell the addict and their support network when one block has been removed from the tower, when two blocks go, and when that power fan is trying to blow the whole blooming tower down. And can provide the tools to prevent relapse both before and when the crisis moments strike.
With recent research demonstrating both the effectiveness of predicting relapse from wearables and smart device-derived data, as well as reports of high user compliance and adherence to wearables and mobile phone applications that are used to tackle and study addiction, the time is now to develop dynamic, research-based, person-centered, technology-assisted drug rehab programs.
The future of substance abuse disorder treatment is bright, is holistic, is personalized, is round the clock, and most importantly, will be designed to help heal from addiction, brick by brick.
Grant, B., Saha, T., Ruan, W., Goldstein, R., Chou, S., & Jung, J. et al. (2016). Epidemiology ofDSM-5Drug Use Disorder. JAMA Psychiatry, 73(1), 39. doi:10.1001/jamapsychiatry.2015.2132
Huhn, A., Harris, J., Cleveland, H., Lydon, D., Stankoski, D., & Cleveland, M. et al. (2016). Ecological momentary assessment of affect and craving in patients in treatment for prescription opioid dependence. Brain Research Bulletin, 123, 94-101. doi:10.1016/j.brainresbull.2016.01.012
Humphreys, K., Blodgett, J., & Wagner, T. (2014). Estimating the Efficacy of Alcoholics Anonymous without Self-Selection Bias: An Instrumental Variables Re-Analysis of Randomized Clinical Trials. Alcoholism: Clinical And Experimental Research, 38(11), 2688-2694. doi:10.1111/acer.12557
Kaskutas, L. (2009). Alcoholics Anonymous Effectiveness: Faith Meets Science. Journal Of Addictive Diseases, 28(2), 145-157. doi:10.1080/10550880902772464
Kwasnicka, D., Dombrowski, S., White, M., & Sniehotta, F. (2016). Theoretical explanations for maintenance of behaviour change: a systematic review of behaviour theories. Health Psychology Review, 10(3), 277-296. doi:10.1080/17437199.2016.1151372
McCarthy, M. (2015). Drug overdose has become leading cause of death from injury in US. BMJ, 350(jun22 3), h3328-h3328. doi:10.1136/bmj.h3328
Substance Abuse and Mental Health Services Administration. (2011) National Survey of Substance Abuse Treatment Services (N-SSATS): 2010. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
Substance Aabuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
Volkow, N., Wang, G., Fowler, J., & Tomasi, D. (2012). Addiction Circuitry in the Human Brain. Annual Review Of Pharmacology And Toxicology, 52(1), 321-336. doi:10.1146/annurev-pharmtox-010611-134625