Category Archives: CBT

Sober Friday Jukebox: STAIR-way to heaven

So it feels like all the reading I’ve done of late has been heading to this point.  I recently received an email from Mind the Brain about Complex PTSD, STAIR and social ecology that you can read here.

STAIR is the acronym for Skills Training in Affective and Interpersonal Regulation.  It’s a training programme that has been developed in the US by psychologist Dr. Marylene Cloitre.  Here’s  how the programme is described on the US Department of Veteran Affairs website:

STAIR is an evidence-based cognitive behavioral therapy (CBT) for individuals suffering from PTSD, including chronic and complicated forms as well as for individuals with PTSD and co-occurring disorders.

Complex PTSD results from repetitive, prolonged trauma involving harm or abandonment by a caregiver or other interpersonal relationships with an uneven power dynamic .

“Anger directed against the self or others is always a central problem in the lives of people who have been violated and this is itself a repetitive re-enactment of real events from the past. Compulsive repetition of the trauma usually is an unconscious process that, although it may provide a temporary sense of mastery or even pleasure, ultimately perpetuates chronic feelings of helplessness and a subjective sense of being bad and out of control. Gaining control over one’s current life, rather than repeating trauma in action, mood, or somatic states, is the goal of healing” (Bessel A. van der Kolk)

Using STAIR will allow you to teach your patients skills in:

  • emotion regulation
  • interpersonal functioning

This online STAIR training consists of 8 modules covering several core treatment components. STAIR can be provided as a standalone therapy or as a complement to trauma-focused therapies.

Goals and Objectives

  • To become informed about the impact of trauma on emotion regulation and social (interpersonal) functioning
  • To be able to identify at least one strategy that increases emotional awareness
  • To be able to identify at least three strategies that improve emotion regulation in PTSD patients
  • To be able to formulate interpersonal schemas related to problematic social and interpersonal functioning
  • To be able to develop and test alternative interpersonal schemas with client
  • To learn at least two strategies for effective assertiveness behaviors
  • To learn at least one strategy for improving flexibility in interpersonal expectations and behaviors

What I found so striking about this is it mirrors the process I’ve been going through as part of my emotional recovery and particularly in my recent discover of the brilliant book The Tao of Fully Feeling by Pete Walker.

Here’s more detail on Session Two: Emotional Awareness:

  • Emotions, emotion regulation, and the impact of trauma on emotion regulation.
  • Why feelings are important, the influence of trauma history on feelings, how to use a feelings wheel to help label feelings.
  • How to use a self- monitoring form to identify the relationships between thoughts, feelings, and behavior.

And Session Three: Emotional Regulation:

  • Recognize that all of their behaviors are efforts to cope with their feelings and environment.
  • Evaluate current coping strategies, their efficacy, and alternative strategies.
  • Learning physiological, cognitive, and behavioral channels of mood regulation

Link to full course content pdf here.

Maybe it’s just my experience and I am generalising wildly but I think many of us boozers struggle with emotions which is part of the reason why we drank how we drank.

There are well researched links between substance misuse and trauma (74% sexual abuse, 52% physical abuse & 72% emotional abuse in this research)  and sources estimate that 25 – 75 percent of people who survive abuse and/or violent trauma develop issues related to alcohol abuse.

All of these skills seem so applicable to a life lived well in sobriety as we learn to deal with all those pesky emotions and renegotiate relationships and learn about boundaries and agency without our crutch.  I’m sharing these resources here in case you would like to research further because to me they feel like a stairway to (emotional) heaven 😉

Repetition Compulsion (Friday Sober Jukebox: I Heard)

So this is something I’ve been reading about in Pete Walker’s Tao of Fully Feeling.  The best description I read was from a blog by Graffiti Girl 2013 and she encapsulates beautifully what repetition compulsion is:

“Repetition compulsion is the repetition of a traumatic event and an attempt at mastery of one’s feelings and experience, in the sense that she unconsciously want to go through the same situation but that it not result negatively as it did in the past. Some people make the same mistakes over and over. The individual unconsciously arranges for variations of an original theme which he has not learned either to overcome or to live with.”

This is what Psych Central had to say about repetition compulsion:

Humans seek comfort in the familiar. Freud called this repetition compulsion, which he famously defined as “the desire to return to an earlier state of things.”

This takes form in simple tasks. Perhaps you watch your favorite movie over and over, or choose the same entrée at your favorite restaurant. More harmful behaviors include repeatedly dating people who might emotionally or physically abuse you, or using drugs (including alcohol) when overcome with negative thoughts. Freud was more interested in the harmful behaviors that people kept revisiting, and believed that it was directly linked to what he termed “the death drive,” or the desire to no longer exist.

But there may be a different reason.

It could be that many of us develop patterns over the years, whether positive or negative, that become ingrained. We each create a subjective world for ourselves and discover what works for us. In times of stress, worry, anger, or another emotional high, we repeat what is familiar and what feels safe. This creates rumination of thoughts as well as negative patterns in reactions and behaviors.

As an example, someone who struggles with insecurities and jealousy will find that when his significant other does not return a call or text immediately, his mind begins to wander to negative and faulty thoughts. The thoughts begin to accumulate and emotionally overwhelm the person, which leads to false accusations and unintentional harm to the relationship.

In spite of not wanting to react this way, the person has created a pattern over years that then becomes familiar to him. To react differently, although more positively, would feel foreign. When someone has done something the same way for years, he or she will continue to do so, even if it causes harm for both herself and others.

This idea also resonates with the concept known as the law of the instrument.  Maslow’s hammer (or gavel), or a golden hammer is an over-reliance on a familiar tool; as Abraham Maslow said in 1966, “I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail.”

People also revert to earlier states if the behavior is in any way rewarding, or if it confirms negative self-beliefs. For someone who inflicts self-harm in a time of emotional distress, it is a behavior that momentarily relieves the pain even if later on the individual feels shame over it. In the example of a person who continuously enters abusive relationships, we might find that he or she is highly insecure and does not believe that he or she is worthy of being cared for.

Cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and rational emotive behavior therapy (REBT) can provide effective treatment routes for reshaping thought patterns that lead to maladaptive behaviors. These types of therapeutic approaches focus on bringing awareness to cognitive distortions, irrational beliefs, and negative thought tracks.

By working on different techniques, one can learn how to recognize when thoughts or actions are more harmful than beneficial, and how to stop them from occurring. The brain’s cognitive processes will be rewired and retrained to develop new patterns that are productive, rational, and positive, which ultimately leads to more adaptive behaviors and choices.

It takes years for people to develop maladaptive patterns, habits, and repetitive choices, and it may also take years to reshape them into something that becomes worth revisiting.

References

Dryden, W. (Ed.). (2012). Cognitive Behaviour Therapies. SAGE Publications Limited.

Inderbitzin, L. B., & Levy, S. T. (1998). Repetition compulsion revisited: implications for technique. The Psychoanalytic Quarterly, 67(1), 32.

I was struck by this psychological theory because it is something I’ve come to learn about only recently and it reverberates through my life in many ways, including my past use of alcohol to psychologically hammer my emotional discomfort.

I recently spent a couple of months working at Focus12 in a nursing consultancy capacity and the Consultant Psychiatrist I was working with there was an eminent and learned fellow.  His parting words to me that summarised his work and life wisdom was:

Sit still and do nothing.

I think much of my repetition compulsion would do well to heed this sage advice!  How about you?

This tune so sums up how this feels for me:

Who needs a drink when you’ve got the Feel Stress Free app?

feel-stress-free-appSo managing all feelings, and particularly difficult feelings like depression and anxiety, was a big part of the early days and months of getting sober for me.  Even now I’m always on the look out for new sober treats and self-care tools to make this easier for all of us.  The new Feel Stress Free app released this year, is the second mindfulness app I have tried as I have talked on the blog before about Headspace.

For me psychological self-care and fitness is as important as physical fitness and self-care so this was a great addition to my sober tool-box particularly on the go when life gets tricky.  As you know I’m a District Nurse and some patient visits can be emotionally difficult so having an app in my pocket that I can tap into, potentially between patient visits if needed, is a much welcomed respite.  The apps image and sounds of a desert island, lapping waves and seagulls with background calming music was lovely every time.

This above image is the first screen that greets you once you have downloaded for free the Thrive’s Feel Stress Free Mobile App which is available for iOS and Android.  It works on a subscription basis,which can be purchased for one month, three months or a year. For one month it will set you back £4.99, for 3 months it will cost £3.33 each month and for a year it’s £1.99 each month.  I was lucky enough to get a month’s free trial from the developers 🙂

This is what their website says:

Be Stress Free has been created over two years of development and research to pro-actively prevent and manage stress and anxiety.

  • Keeps track of your mood over time
  • Enables you to train your thoughts so you can manage how you feel about different situations
  • Trains you in 4 relaxation techniques that give you control over your stress

Stressed or anxious? We can help! Using evidence-based techniques, we help you learn to relax and build your resilience to these common—yet hard to conquer—problems. Featuring our thought trainer, zen garden, and unique ‘message in bottle’ social feature, there’s plenty to explore!

I loved the zen garden and ‘message in a bottle’ social feature (that enables you to send a message of encouragement to others using the app) and fed back to the developers:

“Have recently spent a year training part time to be a child and adolescent psychotherapeutic counsellor at the University of Cambridge and one of the therapeutic tools we used was a sand tray!  It was lovely to be able to immerse myself in that way again and very valuable.”

I wasn’t the only reviewer who really liked this as Moonlolly in the City agreed: ‘If you swipe left, you go to a second island called the ‘Zen Garden’, a virtual Japanese rock garden used to aid meditation. Here you can design your own space and save your best designs.  I loved this part, probably because I’m a big kid – it was one of those absorbing exercises akin to adult colouring books. Totally on board with this.’

One of the things I liked about this app is it is designed by clinicians:

Dr Andres Fonseca – CEO, is a psychiatrist with almost 20 years of clinical experience. He believes the way mental health services work at the moment is very broken. Services are focused on intervening when people are in crisis, which is already too late. He believes therapeutic software that is fun to use is the way to help people Thrive.

A bit more detail about some of the key features:

Mood Meter

Start every day tracking your mood to receive the best recommendations to get through it. Based on your results the Mood Meter will recommend different activities. It will record your results on your progress so you can look back and see what works for you. It will learn itself what you find helpful and get better at advising you over time.

Thought Trainer

Our cognitive behavioural therapy based thought trainer is how we help you to re-frame your negative thoughts. We all have negative thoughts at times, but is there a better way we can think about things? That is what the thought trainer is here to do. It tracks how you feel, giving recommendations and helping you to see a positive in the negative. With everything tracked in Progress and the app learning more about you as you use it, the Thought Trainer will soon personalise itself to your experiences.

The evidence

Computerised Cognitive Behavioural (cCBT) therapy has accumulated 10 years of evidence. It has been shown to work as a self-directed treatment without intervention from a therapist. In 2016 Jill Newby and colleagues from St Vincent’s Hospital in Australia undertook a review of all the evidence of cCBT used for depression and anxiety showing it is a very effective technique and comparable to face to face therapy. Here is a link to the study.

Calm Breathing

This is the simplest technique, one that you can learn in the app and practice anywhere you are. It is based on the fact that increasing chest pressure by taking very slow and deep breaths, and then reducing by slowly breathing out, triggers a reflex. This reflex slows down your pulse and gives you a relaxed feeling in your body. As body and mind are connected this then results in relaxation in your mind. Give it a go for 3, 5, 7 or 10 minutes!

The evidence

Deep slow breathing is an essential technique incorporated in many relaxation exercises. It has been extensively examined in the literature in different setting. A good review of the evidence behind it and its uses can be found in General Principles and Empirically Supported Techniques of Cognitive Behavior Therapy, Chapter 14 by Hazlett-Stevens and Craske. You can read a preview of the chapter here.

Progressive Deep Muscle Relaxation

In this technique we also take advantage of the mind-body connection. We will teach you to contract and relax various muscles progressively allowing you to enjoy the difference between the tense sensations in the muscle and the relaxed sensations that come after you have let the tension go

The evidence

Since its description by Jacobson in 1938 this technique has a record of proven efficacy. There is a 2007 review of the literature that summarises all the available evidence up to that date which you can find here.

Self Hypnosis

Not for everyone but those of you who are able to reach a state of hypnosis can benefit greatly from this technique. We will try to teach you to put yourself into a hypnotic trance. If you are able to achieve it, he will help you teach yourself a word of phrase that will quickly bring you back to that state of relaxation whatever your circumstances.

The evidence

It has proven efficacy in anxiety related to many situations. It has been particularly studied in people going through different medical treatments like dialysis, chemotherapy, surgery and dentistry. There is a 2010 review that goes through all that evidence. The main issue with hypnosis is that the person must be suggestible to benefit from it. Here is a recent study on how suggestibility influences outcomes in using hypnosis to manage pain.

Meditation

Simple to learn but hard to master this is quite a powerful technique for relaxation.  It requires dedication and practice but if you persevere it can bring about the most benefits. You will need a quiet space and to achieve a sensation of comfort. You will be able todevelop a passive attitude that allows you to just watch your feelings, sensations and thoughts as they pass through your mind. You will also use word or phrase to help you refocus.

The evidence

This is probably the technique that has received the most attention recently. It requires practice to master but everyone can use it if they devote the time to learn it and practice it. There is a complete review and meta-analysis of all the evidence of meditation in the management of anxiety published in the British Journal of Psychology in 2012.

And you can track your progress:

Progress keeps track of everything you do in the app. It is what the app uses to give you better and better tips. If you are working with a therapist you can use Progress as your full-fledged therapy journal.

You can choose how long you want to do each exercise for, from a quick 3 minutes of deep breathing to 25 minutes of meditation, which is great if you want to fit a session into a busy day.  The app also remembers which exercises you’ve done before and how many times, encouraging regular use and making the whole experience feel very personalised.

Echoing the words of Moonlolly: if you’re going to invest in a mindfulness app, it’s worth bearing in mind that this is one of the first to have actual CBT therapy incorporated and be officially ‘clinically proven.’

So next time you’re feeling stressed or anxious rather than reaching for a drink, or thinking that a drink would help, why not try this?

Depression-related drinking: going against the grain

I’ve reblogged this from Libby over at the Depression Lab who has let me re-blogged her work before here.

In Britain, people who experience anxiety or depression are said to be twice as likely to be heavy or problem drinkers.  It surprises me the risk is not much higher.  I mean, why wouldn’t anyone with depression want to get ‘off their head’ with alcohol and into a different head, one with colour, laughter, song, relief and sleep? Perhaps it doesn’t feel like that for everyone; perhaps the light-headedness and loss of control that comes with intoxication is not pleasant to some drinkers. Or the hangover is worse than the anguish of depression.

Sadly, even for people like me who love(d) drinking – from the initial, fleeting pulse of joy at the start of a session, to the numbing slide into sleep – too much of a good thing is a Bad Thing.  Too much alcohol brings headache, fatigue and nausea the morning after. Too much too often and the mental and physical effects become hard to ignore: weight gain (in that peculiar waist-thickening pattern female drinkers have), puffy complexion, jowls appearing from nowhere, sleep deprivation, and loss of self esteem as the drinking starts to take priority over things and people that used to be important.  These are profoundly unhelpful for depression sufferers.

If you persist with the getting off your head trick, as I did for many years, (long after passing the point of too much too often), you may well find yourself with an alcohol dependency problem to add to the depression.  Trying to moderate your drinking becomes extremely difficult, and the inevitable failure to do so further reduces self esteem, with a new twist of despair on top. Very bad news for depression sufferers.

How to tackle a depression-related drinking problem

The NHS has struggled to cope well with ‘dual diagnosis’ – where patients have co-existing mental ill-health and alcohol dependency.  Indeed this was my own experience when I was referred to a CBT course for depression via my GP, only to be told I was drinking too much, and thus unsuitable. (In the end I reduced my consumption levels as much as I could, lied a bit, and was accepted. The CBT course was useful for managing depression, but did not address my drinking. At all.)

I wrote here about how I stopped drinking, and how it only became possible when my depression had improved to a certain level. It had got to that level – and no further – after a few months of trying to do all the right things, eg getting plenty of sleep, healthy eating, exercise, absorbing activity, social contact.  I realised I had to stop drinking if I wanted to feel any better.

Stopping drinking was not easy, but the improvement in my depression and overall health is undeniable, and the benefits came mercifully quickly. If you find yourself in the situation I was in – depressed and drinking out of compulsion (not desire) every day, unable to stop – take heart, there is hope. Here’s what I recommend:

1. Cut back the drinking to a level you can comfortably stand whilst you concentrate on tackling your depression (I am not suggesting you drink  ‘moderately’ – just try to keep the level stable, and not increasing)

2. Use your most lucid/sober spells to do some work on your depression eg CBT, mindfulness, diet, sleep, exercise, social activity. In theory, unless you are drinking 24+ units of alcohol a day, there will be times when the alcohol has cleared your system and you are not ‘under the influence’ – this is the time to tackle the depression.

3. When you start to feel a bit better, plan how and when you will stop drinking – there’s lots of useful guidance and support online eg here, here, here and here as well as AA etc.

4. If you are physically dependant on alcohol (eg experiencing shakes, sweats, hallucinations or fits), take the risks associated with alcohol withdrawal very seriously, as they can be fatal – read this.

5. Stop drinking as per your plan, and give it top priority for as long as it takes. Here’s what I found successful:

  • pick a symbolic date to stop
  • tell nearest and dearest what you are doing
  • find some like-minded new friends in the sobersphere (see links above), or AA
  • use the Soberistas chatroom or other forums to talk through cravings
  • eat lots of chocolate to cope with cravings
  • read lots of sober books
  • buy lots of alcohol free beer and wine here (but note not everyone finds this helpful)
  • start running
  • buy regular treats as a reward

6. Go back to working on the depression when you feel ready. It took me about 6 months to feel stable enough in my not-drinking to go back to prioritising depression.

Note this approach is the exact opposite of official guidance, which is to stop drinking before tackling the depression.  That just was not possible for me; I tried many, many times. Drinking was a habitual coping mechanism, and the depression seemed unbearable without it.  One could easily use this as an excuse to carry on drinking: don’t.

Sources/Further reading

Drinkaware: Mental health and alcohol

NICE Guidance CG115

Alcohol Policy UK

Thanks once again Libby for an excellent guide on depression-related drinking and going against the grain.  Don’t forget to go check out her blog here 🙂

Edited to add: 06/10/2015 A new review and meta-analysis

Depression in patients with alcohol use disorders

Alcohol use disorders are highly comorbid with depression in both the general population and in treatment (Schuckit, 2006). It is estimated that 30-40% of individuals with an alcohol use disorder, experience an episode of comorbid depression (Anthenelli and Schuckit 1993; Schuckit et al. 1997a). In particular patients entering treatment for alcohol use disorders often have high levels of depressive symptoms (Davidson, 1995; Brown et al, 1995)

Depression and drinking

I’d like to thank Libby Ranzetta over at positively depressed for permission to re-publish her blog post on depression and drinking.  Her blog is excellent if depression is something you are struggling with and you are looking for answers or for things to help.

Does depression make you drink too much, or is it the other way round?  There’s lots written on this topic – ‘dual diagnosis’ – some of it even by me.  I have a personal interest: my heavy drinking started in early teens and kept going.  Over the past 20 years or so I have unsuccessfully tried many times and many methods to stop drinking.  These include public pledges of sobriety, bribes, competitive cycling, antabuse (bought online), baclofen (again, bought from the internet, having read The End of My Addiction), counselling, hypnotherapy, naltrexone (internet again), AA, giving up work, shaving my head to shame myself into stopping. All failed beyond a few days.

However, since my depression has improved, I have been able to remain alcohol free from 1st January 2014, thanks in no small degree to peer support from the ‘sobersphere’, particularly Soberistas and Belle. Turns out there are many, many women like me who, whilst not being physically dependent on alcohol, are hooked all the same.

What is different this time, such that my decision to stop on New Year’s Day actually stuck? Here are some thoughts:

  • I was ready; I wanted to live. My determined efforts to beat my lifelong depression were only working up to a point. Drinking was not helping.
  • The New Year was a symbolic, easy-to-aim for starting point.  A discussion thread (on Soberistas.com) about stopping drinking on 1st Jan popped out of the universe and I signed up with a public declaration on it. I now felt that bit more accountable.
  • I told my nearest and dearest what I was doing. They have heard it all before but were kind and supportive as ever.
  • I took it dead seriously and gave it top priority. Being alcohol free is more important right now than losing weight, working, housework, my in-tray, going out etc etc.
  • I ate lots of chocolate initially. Less so now.
  • In the early days I went to the Sobersitas chatroom to help cope with cravings.
  • I bought a huge stash of alcohol free beer and wine from The Alcohol Free Shop. Nearly all the beer and some of the red wine is v nice.
  • I made myself post on the Soberistas discussion, as mentioned above. I am not comfortable talking about myself or trying to engage with strangers but it has got much easier.  Quite a few are no longer strangers; more like friends.
  • The engagement and support on Soberistas is much more powerful than I expected. Knowing I am not alone in this struggle and that people I respect are struggling too makes me feel less of a useless shitbag.
  • Morso-S80-90-insert-stoveI still look at Soberistas.com and read sober blogs most days. I don’t allow myself to think about whether that is healthy or not.
  • After a couple of months I signed up to Belle’s 100 Day Challenge, and then her Team 180 and Team 365 challenges. I try not to think beyond that, it is still too daunting to consider being alcohol free forever (although I know that’s what I need).
  • Belle says you need treats when you go alcohol free.  My treats were fresh cut flowers from the market twice a week in the early days, and playing jazz on my trombone more often. Now I have monthly treats. My treat for being alcohol free for a year will be a woodburning stove in the sitting room. I have always wanted one.

 The NHS doesn’t deal well with ‘dual diagnosis’. My thoughts on this will follow at some point.

Read her post here: http://www.positivelydepressed.org.uk/?p=79

I’d like to congratulate Libby on her 1 year soberversary and I hope to share more of what she’s doing to help people with depression in the future.  I share her frustration at how bad the NHS is at dealing with ‘dual diagnosis’.  She and I are on the same wavelength as we both covered this topic and you can read what I wrote again here.

Our quit stories are similar too – no physical dependence, sober blogging community, AF beers and wines and lots of sober treats.  She and I have been talking about researching the effectiveness of peer support via the sober online community in helping people get sober.  Watch this space 🙂

The inside of my drinking thinking head

So I said that I would share the final formulation that my CBT therapist gave me towards the end of us working together.

When I started CBT these were my goals:

  1. Thinking around drinking – if I unpicked this , could I go back to moderate drinking?
  2. How could I unpick my thinking about my overwhelming sense of personal responsibility
  3. I would like to take things less personally
  4. To change my default setting from the ‘it’s my fault/I’m to blame’ one
  5. To be functioning as an equal partner in my relationship (this was about my need to control not MrHOF)
  6. I want to be surer of myself
  7. I’d like to be more boundaried in relation to other people regarding them taking responsibility
  8. To have a stronger sense of self-worth

There has been vast improvements in all of them except no 1.  That one is off the table as moderating isn’t the answer to the problem, drinking was part of the problem.

CBT formulation

The words used in this are hers not mine and I would just ask for kindness in any responses about the information shared.  This really is what a schematic of the inside of my head looks like in terms of  how I think and therefore feel and goes a long way to explain why I drank.  Partly to hide from these overwhelming feelings and partly to continue to confirm my own self-belief that I wasn’t good enough.  Nice self-sabotage huh?

I had a whole set of rules in my head that I lived by and I thought they were immutable.  Turns out they weren’t! 😉

I thought the world would collapse if I relaxed my grip on trying to control everything so that I had no negative consequences.  Turned out I was driving those negative consequences by not loosening my grip!

CBT turned a great deal of my thinking on it’s head – and it needed to happen.  I was literally my own worst enemy but only because I grew up thinking that I was and that this was a fact and would never change 🙁

Turns out I was wrong ……… my drinking thinking head was wrong.  Turns out drinking wasn’t’ the answer or a help but the problem and a hindrance.  And now it’s gone just like those rules and thoughts are slowly going too 🙂

 

Year two sober and one week on

So how was that day for me?  Amazing! Bit up and down and must have been a big deal as I had some anxiety going on and slept really badly because of having a drinking dream!  Big milestones can destabilise is what I’ve learned this year so gird your loins as it could get bumpy around these times!

I had a lovely day with a session of CBT in the morning which is going really well and will write more about soon.  Then went to our monthly village tea (we are a very small village and the pub is long gone so this is how we get together as a community) for tea and lemon drizzle cake and home-made apple and blackberry crumble.  Yum!  Then a visit to some close family for more tea and then mexican food and chocolate cake back home.  I completely sugar binged (sound familiar?!)

My I’m done drinking app says I’ve not consumed 1460 drinks (although this is based on beer and I believe they’ve updated the app to include wine now so I need to re-download to be more accurate for me). I’ve saved 175,226 calories – which I would debate what with all the cake and chocolate I’ve scoffed in the last year!  That said I am 10lbs lighter than when I quit a year ago even with all the extra sweet stuff 🙂  And I’ve saved £2178 so x2 for me and MrHOF makes us £4356 better off – enough for a lovely family holiday if we so desire 😉

My health and fitness are just generally better all round and am achieving faster run times and I just feel better and I look well – really well.  I had not appreciated how crap I looked and felt most of the time a year ago.  And I’m suffering much less from all the lurgies that my job exposes me too and my kids bring home from school!

Relationships are much improved all round although some still struggle to understand the decision we have made but I’ll trade that for our much happier and calmer household on a daily basis.  Personally my job situation is shifting, my Masters starts in a couple of weeks and I’m pursuing other ideas and possibilities which I’ll talk about more in the coming months.

Oh and I bought myself a sober treat 🙂

Aurora Borealis Butterfly

https://www.etsy.com/uk/listing/204674139/swarovski-aurora-borealis-ab-and?ref=pr_shop

And I have all of you to share this journey with thanks to getting sober! Happy Days 😀

 

 

Flooding the booze away

Thanks to Prim for the idea for this post 🙂

Since I’ve stopped drinking I’ve been addressing many issues in CBT that have felt at times intractable as they have been my way of thinking for so long that they felt as hardwired as drinking did back in the day.

What I’ve been experiencing is systematic desensitization, a milder less traumatic version of a type of behaviour therapy called flooding.

The process of systematic desensitization occurs in three steps. The first step of systematic desensitization is the identification of an anxiety inducing stimulus hierarchy. The second step is the learning of relaxation or coping techniques. Once the individual has been taught these skills, he or she must use them in the third step to react towards and overcome situations in the established hierarchy of fears. The goal of this process is for the individual to learn how to cope with, and overcome the fear in each step of the hierarchy.

It is a form of counter conditioning, a type of Pavlovian therapy developed by South African psychiatrist, Joseph Wolpe. In the 1950s, Wolpe discovered that the cats of Wits University could overcome their fears through gradual and systematic exposure (thanks Wiki!)

So in the post I wrote about ‘the 15 minute rule‘ I talked about my almost Pavlovian drinking: certain time on the clock = wine o’clock.  So Pavlov’s dogs have been treated by Wolpe’s cats! 😉

When we give up booze many of us withdraw from social situations that involve drinking as this becomes an anxiety inducing stimulus (step one above).  Then we learn self-care strategies to replace the drinking with, similar to the second step described above as ‘learning of relaxation or coping techniques’.  This enables us to then return to the previously anxiety inducing stimulus with the fear of the situation removed because we have completed step three and can then use these skills to react towards and overcome our fear of those scenarios.

But once we’ve conquered drinking many other scenario’s that were fear inducing present themselves and our former way of coping with them has now been resolved/removed.  So then we have to apply the same processes to all the new anxiety inducing stimuli whether it’s job interviews for me or paperwork and desk sorting for Prim!

This feels like one of those really big aha moments for me in the continual journey to a life lived straight-edged.  If I can remember this in times of fear and stress it should offer some respite from the Itty Bitty Shitty Committee who pipe up at these times and that I’m edging ever closer to firing from the inside of my head! 🙂

8 days to go

 

Almost Alcoholic to Social Drinker

I loved reading the book ‘Almost Alcoholic’ by Robert Doyle and Joseph Nowinski but I was left with this nagging question that I can’t shrug off and which wolfie is quietly nurturing.

So many of their case studies who were in the ‘almost alcoholic’ zone seemed to be able to go back to normal social drinking after some self-help work or psychological therapeutic input.  Now don’t get me wrong they are clear that there are some who cannot go back to this type of drinking however hard they try.  They talk about drinking developing to the point of dependence or a person having co-occurring conditions, such as mental health problems.

In the UK substance abuse or misuse is seen and treated as part of the mental health service within the wider children and young people’s services if you are under the age of 17.  Both mental health, drugs and alcohol carry the same type of stigma for young people and adults despite huge campaigns to change it (for example the time to change campaign).  Which is why I struggle to accept where I am and am still looking for a way round.  As you know I’ve been having Cognitive Behavioural Therapy (CBT) specifically to look at my drinking and having done a series of posts on drinking thinking.   In the near future I will start to look at my thoughts and the formulations that we are working on to share them with you here.  I posted before about a friend of mine who had CBT and turned their drinking around completely.  This both fascinates, excites and scares me.  Could I do the same, would I want to and what if I can’t?  I’m still trying to figure that out.

89 days to go

Research on CBT for alcohol use disorder

So I receive email updates from Alcohol Policy UK and recently one of them highlighted a new meta-analysis of published studies on the effectiveness of combining cognitive-behavioural therapy (CBT) and motivational interviewing (MI) to treat comorbid clinical and subclinical alcohol use disorder (AUD) and major depression (MDD) and estimate the effect of this compared with usual care.

The researchers conducted systematic literature searches in PubMed, PsycINFO and Embase up to June 2013 and identified additional studies through cross-references in included studies and systematic reviews. Twelve studies comprising 1721 patients met their inclusion criteria. The studies had sufficient statistical power to detect small effect sizes.

They concluded that combined cognitive-behavioural therapy and motivational interviewing for clinical or subclinical depressive and alcohol use disorders has a small but clinically significant effect in treatment outcomes compared with treatment as usual.

Let’s see if my anecdotal experience supports their research findings? I hope so 🙂  If you were prone to depression before when you were drinking has it improved if you’ve stopped?

Riper, H., Andersson, G., Hunter, S.B., de Wit, J., Berking, M. and Cuijpers, P. 2014
Treatment of comorbid alcohol use disorders and depression with cognitive-behavioural therapy and motivational interviewing: a meta-analysis. Addiction. Mar;109(3):394-406. doi: 10.1111/add.12441. Epub 2014 Jan 16.