Category Archives: Psychological

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 😉

Hi My name is Lou, and I’m a recovering emotophobic

So this was another new word to me that I heard recently – emotophobia meaning to be emotophobic.  Not to be confused with emetophobic, the fear of being sick!

What is emotophobia?  It is the fear of negative emotion; i.e. a fear of expressing anger, frustration or disapproval.

I am a recovering emotophobic because I grew up with the ‘toxic trio’ as it is called in children’s safeguarding.  The term ‘Toxic Trio‘ has been used to describe the issues of domestic abuse, mental ill-health and substance misuse which have been identified as common features of families where harm to children has occurred. They are viewed as indicators of increased risk of harm to children and young people.

As I wrote recentlyIn my household growing up our family ‘didn’t do’ emotions as we were often reminded.  I now understand that we (the children) weren’t allowed to do negative emotions.  I learned very early on to keep my head down, my mouth shut and a smile on my face.  Look happy even if you were dying inside.

As Pete Walker describes “emotional emancipation happens when a person is both abused for emoting and is, at the same time, abused by toxic emotional expression.  This scares us out of our own emotions while simultaneously making us terrified of other people’s feelings ”  He goes on to say that “much of the plethora of loneliness, alienation, and addictive distraction that plagues modern industrial societies is a result of people being taught and forced to reject, pathologise or punish so many of their own and others’ normal feeling states.”

There was so much negative emotion expressed around me that I effectively developed a fear of them and learned very early on to dissociate as a way of coping with the anxiety and stress that it caused within me.  I also learned to self-soothe my anxiety by skin picking (also called dermatillomania).

Even now if someone around me is verbally expressing an aroused and heightened emotional state, and this is personally rather than professionally where I have learned to manage it well due to the nature of my job, I will tend to dissociate as I find it triggers emotional flashbacks to my childhood. And I still struggle with occasional skin-picking although it’s nowhere near as bad as it used to be as I am only too aware of the many scars on my arms and legs that remind me of my past.

This is something I am working hard on as this is according to Braiker’s self-help book,[1] part of the “disease to please”/codependency behaviours I am aware that I struggle with along with these other cluster of traits:

My fear has meant that I have not been good at self-championing which is vital as part of our emotional recovery journey because as Matt at Surviving My Past says:

being our own champion and showing ourselves compassion, erases shame.

For me all of this comes back to shame.  Shame around my childhood and past experiences, shame around my drinking, shame around being me.

A great resource about C-PTSD, toxic shame and recovery from emotophobia is Richard Grannon and in this blog post he gives some great tips for working with toxic shame or in this video on  YouTube he talks about emotional literacy.  I am working my way away from it and towards self-championing one day at a time – a lifelong process.

Friday Sober Jukebox in memory of Robert Miles, RIP

 

 

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:

Thoughts of the escape of drinking/Impostor Syndrome

<– This is what drinking was for me.  An escape hatch from myself and the world.  And I still miss this at times of stress and crisis.  Even now this last week I’ve recalled memories where I’ve thought and felt that drinking made the unbearable bearable.  I KNOW that this is a salvation fantasy but it still persists.

So I’ve been struggling a bit recently to feel happiness in life generally prompting mid life musings of the ‘Is this it?’ variety.  Not in a ‘f*ck it, a drink is the answer’ way but in a ‘I wish I could escape these thoughts/feelings’ type way.  The ever present hangover free clear head lamented as a burden, not a gift.  I yearn for an escape or miracle and feel overwhelmed with impostor syndrome.  I must be a fraud right?  Approaching 4 years sober and yet still wishing for an off switch to my brain – the release of being comfortably numb.  And then as often happens I order the perfect book from the library to aid my discomfort.

I’ve been reading ‘Making Miracles in 40 days – turning what you have into what you want‘ by Melody Beattie.  She is a recovery warrior and has written numerous books including seminal works on co-dependency and these were the words that stopped me reading and found me here writing a blog post to share her words:

Either we refuse to talk about the loss or we can’t stop telling the story.  Guilt and obsession are the sixth and seventh stages of loss.

Once I made my choice, I began to consciously grow despite the numbness, rage, and sadness I felt.

When deep change begins – whether it’s a miracle or loss – expect to feel uncomfortable for a while.

I feel all of these things right now.  Not about not drinking – although I can’t stop telling the story here still – but about living life not numbed by booze but numb, rageful and sad because of the reflections on my past life, how they have left me feeling in the present and how it then impacts on my future tripping thinking (which is not the first time either!).  It feels like the deep change with recovery is two-fold: the stopping drinking part and then the emotional learning part.  Getting sober is both a miracle and a loss so you feel very uncomfortable in the beginning and then get waves of uncomfortable as you continue to change emotionally.  This is where I am.

She goes on to talk about happiness after loss:

Your happiness will look and feel more like peace.  But now it will be real, and it will be yours.  It won’t depend on others or what they do or don’t do.  That long, dark tunnel of transformation – when we really become empowered to make miracles – only happens once. 

Happiness means being at peace with ourselves, wherever we are, whoever we’re with, whatever we feel, whatever we’re going through, and whatever we have or lack.  Happiness means working for the sake of doing the work, not for a particular outcome.  Happiness means we’re with someone, because we enjoy the person’s company, not because we want to get that person to ask us to get married.   To feel this kind of happiness, we need to release old unfelt emotions, and feel whatever we feel.  We’re not desperately seeking someone to love us.  We want everyone to be themselves – to be who they really are.

She goes on:

Most of the time we aren’t learning what we think we are.  Being open and empty are the requirements for learning something new.  Later, when we master the lesson, we’ll see what we learned.

By being present for each moment, we learn to live in the Mystery.  We stop trying to figure things out (another form of control) and relax into not knowing.  We trust that our answers will come in their own time.

Time to learn to let go of my impostor syndrome and work on that salvation fantasy of a realistic miracle, non-drinking escape hatch or just peace within myself.

 

Friday Sober Inspiration: Heads Together + Mad World podcast

So this caught my eye over the Easter week-end and struck a cord in so many ways.  The London Marathon is this week-end – Sunday 23rd April and this is the Virgin Money London Marathon chosen charity which is also supported by Prince William & Catherine and Prince Harry.

Here’s what their website says:

ABOUT HEADS TOGETHER

Through our work with young people, emergency response, homeless charities, and with veterans, we have seen time and time again that unresolved mental health problems lie at the heart of some of our greatest social challenges.

Too often, people feel afraid to admit that they are struggling with their mental health. This fear of prejudice and judgement stops people from getting help and can destroy families and end lives. Heads Together wants to help people feel much more comfortable with their everyday mental well-being and have the practical tools to support their friends and family.

The Heads Together campaign will build on the great work being done by our partner charities so that prejudice and fear no longer stand in the way of people getting the help they need.

Being the 2017 Virgin Money London Marathon Charity of the Year is the perfect springboard for the Heads Together campaign. We cannot wait to see hundreds of runners hitting the streets of London this April to end the stigma and change the conversation on mental health once and for all.

Bryony Gordon and The Telegraph have supported them by launching a podcast series discussing mental health with high profile UK figures – the first interview being with Prince Harry himself.  Their website features other well known personalities such as Rio Ferdinand and Lady Gaga.

This is The Telegraph’s brief:

Bryony Gordon’s Mad World is a new ten episode podcast brought to you by The Telegraph. Each week, Bryony will talk to a different guest about how their mental health has been affected by events in their own lives and find out why feeling weird is the most normal thing in the world.

You can listen to Bryony’s podcast interviews and the first one with Prince Harry is well worth your time:

Bryony Gordon’s Mad World

And the impact of this was immediate:

Schoolchildren will get access to NHS mental health workers in wake of Prince Harry’s ‘brave’ intervention

Alcohol dependency is a mental health issue and Prince Harry mentions it specifically in his interview so this is an important new charity both for those suffering because of the devastation of alcohol on them directly and the impact on those around them including children.  The destigmatization and normalisation of the conversation around mental health, and particularly the bolstering of mental health support for children and adolescents, is long overdue and I’m so pleased the Royal Family have got behind the cause and changed the direction of effect!

Friday Sober Inspiration: The Four Essential Processes of Grieving

So I’ve spoken about grief and grieving before in this post and this was a great podcast about the subject too.

As I’ve continued to read Pete Walker The Tao of Fully Feeling he has described his four essential processes of grieving .  So I’m going to add to my knowledge from Kubler-Ross and include it here as a reference for you too.

He argues that “grieving is the key process for reconnecting with our repressed emotional intelligence.  Grieving reconnects us with our full complement of feelings.  Criticism of emotional expression is especially damaging when it is expressed towards expressions of emotional pain as it forces our all-important capacity for healthy grief into developmental arrest.”

Pete Walker maintains that grieving is not just crying but for it to be fully effective it must include the processes of “angering”, verbal ventilation, and feeling.  He says the active resolution comes from crying, “angering” and talking about it whereas the passive resolution comes from simply focusing on and feeling what is stored somatically in our bodies.

I’ll cover a short summary of each here but again go read the book if you want to understand fully (although here is a link to a pdf on grief and complex PTSD written by Pete).

  • Crying is the healing release of pain through tears.  Unashamed crying creates deep, bodily-based feelings of peace and relaxation as tears are the body’s most powerful way of releasing emotional tension.  He believes that crying heals ‘catastrophising‘ and ‘drasticizing’ which are forms of toxic shame that taint our thought processes with unfounded perceptions of dread and doom.  What Brene Brown calls ‘foreboding joy‘.  Crying also allows for positive nostalgia or ‘euphoric recall’.
  • Angering is the process of actively expressing anger in a a safe and healthy way and is as essential to effective grieving as crying.  He believes we can break the ‘repression-accumulation-explosion-guilt-repression’ cycle by befriending our anger and refusing to guiltily squash it when it arises.  He says we can use a range of approaches to releasing anger to allow joy such as: thinking to writing to speaking to shouting to shadowboxing to pounding on pillows to finally breaking expendable objects.  He maintains when we finally end our repression of our anger we often feel exuberant relief and that it also builds confidence and self-assertiveness.
  • Verbal ventilation is when language is charged with feeling and is the release of pain through talking or writing about it.  This is where I have found this blog and therapy the most valuable in moving through my own grief.  It is also therapeutic he says to record jokes, anecdotes, and incidents that make you laugh as these can serve as heartening reminders of the joys of life.  Swearing is a powerful form of  verbal ventilating particularly if you chose words judiciously and sparingly.  He also talks about fully emoting which is when we cry, rage and verbally ventilate all at the same time!
  • Feeling is the process of grieving that focuses on pain with the intention of relaxing any resistance to it, so that it may pass through and out of the body.  I often think of funeral wakes when I think of this as this is where I would use alcohol to not feel the pain and sadness that the loss had triggered.  Some of my most spectacular relapses when I was moderating were after funerals where I would hold it together at the event and then drown myself in alcohol on getting home.  Feeling involves the direction of attention to the internal experiences in the body below the realm of thinking.  Feeling experiences are often accompanied by physical sensations in the heart area or “guts”.  No wonder I struggled with Irritable Bowel Syndrome (IBS) for so much of my adult life.  Feeling is a kinesthetic rather than a cognitive experience.  It’s why I’ve avoided yoga for so long – as I know that this is where I finally need to release the somatic feeling states that I’ve been resisting facing in recovery.  After all this therapy I know they are there and I’ve been scared to confront them …..

He finishes by saying that a balanced approach to grieving includes an openness to feeling emotions as well as emoting feelings.  He says “if we do not accept and value both processes, we will not become fully feeling human beings”.

Here’s to moving on to the next and final stage of learning to fully feel – connecting totally the mind and body experience where feeling becomes a spiritual experience.  He says “perhaps the greatest freedom attainable is that which is born out of a consistent willingness to stay lovingly and acceptingly present to whatever unfolds inside oneself.”

I saw this film again recently and this clip felt so apt:

Sober Inspiration: The four key dynamics of the emotional nature

So continuing on from last week’s post about the Tao of Fully Feeling I’m going to continue inspiring you with Pete Walker’s insights and knowledge on emotions.  He talks about the four key dynamics of the emotional nature which was all completely new to me but yet made perfect sense!

These are: wholism, polarity, ambivalence, and flow.  I’ll do a brief synopsis of his interpretation but I really recommend you go read the whole book.

  1. Wholism: This refers to the fact that the emotional nature cannot be broken down into individual, separate feelings existing independently from one another.  How the psyche cannot be filled with pleasant emotions only while the negative ones are left behind.  As he so beautifully puts it: “Individuals who only identify with ‘positive’ feelings often become bland, deadened and dissociated in a feeling-less desert, a true no-man’s land.  In the psychic desert of disavowed emotion, the smouldering heat of repressed anger evaporates our feelings of love and affection, leaving us emotionally dehydrated.  Rejecting emotions because they are sometimes unpleasant is like cutting off body parts because they are not pretty
  2. Polarity: This is about emotional polars – opposite but complementary halves.  There are graded bands of emotional intensity that stretch between each pair of emotional opposites.  Our emotional experience shifts from one pole to another along a continuum of feeling, and there are many different degrees of feeling on each particular emotional continuum.  We are all subject to both gradual and sudden oscillations between the emotional extremes of the various feeling continua.  As he says: “When we refuse to feel the full intensity of our emotions, we become depressed and stuck in the ‘safe’ and dreary midland plains of the emotional continua.  Apathy is a common result of throwing out the baby of emotional vitality with the bath water of unaccepted feelings“.  He argues that understanding polarity helps us deal with normal loneliness as a certain amount of loneliness is absolutely intrinsic to the human condition.
  3.  Ambivalence: These ‘mixed feelings’ occurs when we entertain opposing emotional experiences simultaneously and he feels this is possibly the most misunderstood and vilified of all the complex emotional experiences.  Ambivalence is also the state of rapidly vacillating between contradictory feelings.  Ambivalence is a normal and healthy response but because it is culturally incomprehensible most  of us repress the unpreferred half of the ambivalence, and only experience it as anxiety.  He argues that intolerance of ambivalence destroys relationships through a process known as splitting.  Ambivalence and splitting are opposite responses to emotional polarity.  A less extreme form of splitting is ambivalating – a relatively rapid wavering back and forth between opposing emotional experiences.  When we welcome our normal ambivalence we achieve a deeper self-understanding and make better decisions about complex life issues.
  4. Flow: The ever-shifting, unpredictable rise and fall of emotions.  An appreciation of flow, the fluid quality of the emotional nature, allows us to respond to our feelings in healthy ways.  He states: “Avoidance of unwanted emotions also commonly leaves us trapped in chronic, low grade manifestations of them.  Many long-enduring moods are caused by repressed emotions that slowly and biliously leak into consciousness.  When underlying emotions are offered no effective expression and release, the moods they create contaminate and dominate awareness for inordinately long periods of time.  Moodiness is a very slow and inefficient way of processing feelings.

He write so much more detail about each element that I can’t even begin to encapsulate here and closes the chapter with “A wonderful grace of self-renewal comes from immersion in the invigorating waters of fully and flexibly feeling.”

I couldn’t agree more! 🙂

Sober Inspiration: The Tao of Fully Feeling

So I’m reading a new book that I heard talked about recently by Pete Walker called The Tao of Fully Feeling.  I’m only a few pages in but text is already jumping out at me and screaming to be shared!

Here’s the opening:

Feelings and emotions are energetic states that do not magically dissipate when they are ignored.  When we do not attend to our feelings, they accumulate inside us and create a mounting anxiety that we commonly dismiss as stress.

So, like so many of us, I believed that all those years of pouring wine down my neck to manage ‘stress’ was helpful.  In reality I was busy self-medicating away my feelings and emotions.

I felt that emotions were something to be corralled, minimised, denied even.  In my household growing up we ‘didn’t do’ emotions as we were often reminded.  I now understand that we weren’t allowed to do negative emotions.  I learned very early on to keep my head down, my mouth shut and a smile on my face.  Look happy even if you were dying inside.  No wonder I ended up emotionally constipated and believing that drinking allowed me to express my emotions fully because it was only in that dis-inhibited state that I actually heard them as they roared from their cage inside.  “A drunk mind speaks a sober heart” right?  A saying often attributed to French Enlightenment philosopher Jean-Jaques Rousseau which we know not to be true.

Pete goes on:

We can learn to be emotional in benign ways.  We can have our emotions without holding onto them.  We can soften and relax into our feelings without exiling or enshrining them.  We can let our feelings pass through us when they have fully served their function.  When we learn to experience our feelings directly, we eventually discover that surrendering to them is by far the most efficient – and, in the long run, least painful – way of responding to them.  We realise first-hand that life does not have to be pain-free to be fully enjoyed.  Life is inordinately more painful than necessary when we hate, shame, and abandon ourselves for not feeling ‘good.’

As we become more emotionally whole, our health and vitality naturally improve.  When we disburden ourselves of old unresolved trauma, energy wasted holding the past at bay becomes available for celebrating daily life.  As we learn to befriend our emotions, we suffer less and less from self-damaging flights from feelings.  We gracefully accept the reality that our emotional nature, like the weather, often changes unpredictably with a variety of pleasant and unpleasant conditions.  We realize that a positive feeling cannot be induced to persist any more than the sun can be forced to continuously shine.

And this reflects my experience over the last 3 1/2 years.  Emotions are no longer something to be scared of but welcomed and embraced, whether happy, sad or mad.  My emotional repertoire has grown incredibly as I have allowed my caged and numbed heart to feel what my head was taught to deny for so long.

Welcome to emotional recovery that forms the biggest part of recovery from addiction.  I think I’m going to really enjoy this book 🙂

 

Radical ketamine therapy could treat alcohol addiction

This was featured in The Guardian in January whereby a one-off dose of the drug, ketamine could help alcohol addicts reduce their intake by ‘erasing’ drink-related memories, say psychologists testing treatment.

Ketamine is used as an anaesthetic agent and also in terminal care in my professional experience and as a recreational drug in my personal experience.

Here’s what the researchers say:

Scientists believe that a radical treatment involving the tranquilliser ketamine could help overcome alcohol addiction by “erasing” drink-related memories.

Psychologists based at University College London are testing whether a one-off dose of the drug could help hazardous drinkers who are trying to reduce their alcohol intake. Alcohol addiction is notoriously difficult to treat, and there are few effective therapies available.

Using a recreational drug to treat addiction may sound counterintuitive, but the researchers say there is a growing body of research suggesting that ketamine can be used to disrupt harmful patterns of behaviour.

Ravi Das, one of the lead researchers, said: “There is evidence that it could be useful as a treatment for alcoholism.”

Crucially, ketamine can disrupt the formation of memories, and scientists believe that this property could be harnessed to over-write the memories that drive addiction and harmful patterns of behaviour.

“Memories that you form can be hijacked by drugs in some people,” said Das. “If you were an alcoholic you might have a strong memory of being in a certain place and wanting to drink. Those memories get continuously triggered by things in the environment that you can’t avoid.”

For instance, seeing a glass of beer, hearing the clinking of glasses or even arriving home from work may trigger memories of the rewarding sensation of taking a drink – and might prompt a person to follow this urge.

“The main problem is the really high relapse rate after treatment,” said Das. “People can successfully quit using over the short term while they’re being monitored in the hospital … but when they return home they’re exposed to those environmental triggers again.”

There is increasing evidence, however, that memories are less stable than once assumed and may be open to manipulation.

Each time our brain accesses a memory, the neural connections that encode it are temporarily destabilised, meaning that our recollection can be slightly altered before it goes back into storage. This is one reason why, in everyday life, people can recall wildly different versions of the same events.

In the clinic, scientists believe this short period of instability, represents a window of opportunity. Ketamine blocks a brain receptor called NMDA, which is required for the formation of memories. So the logic is that giving someone the drug just as a memory has been destabilised could help weaken the memory, or even erase it.

A similar approach with a different drug was shown to eradicate people’s phobia of spiders. And research in rats that were made to be addicted to cocaine showed that the memories underpinning their addiction could be completely wiped out using a similar strategy (although this involved injecting a chemical into the brain).

In the UCL trial, the scientists will intentionally trigger alcohol-related memories by placing a glass of beer in front of the participants, who are all heavy drinkers. They will then disrupt the memory, by surprising the participant (the team is not disclosing the exact details as this could bias the results).

Participants will then be given either a ketamine infusion, with a concentration equivalent to a high recreational dose, or a placebo. The team will follow up the people for a year and monitor whether their drinking has changed and by how much.

In total the scientists are aiming to include 90 people in the trial and more than 50 have already taken part. It involves people who drink harmful quantities of alcohol, but excludes anyone who meets the clinical criteria for alcoholism. The participants were drinking at least 40 units for men (equivalent to four bottles of strong wine) and 28 units for women, and drinking on at least four days.

Nikki, 31, who works as a consultant in London said she decided to take part in the study when she had some time off between jobs and realised she was drinking more than she wanted to. “It’s just in the culture, that’s what all my friends are like. Everyone drinks to excess,” she said.

She described the experience of being given the ketamine as “overwhelming and intense”, but not unpleasant. “My body felt like it was melting away,” she said. “It was quite psychedelic, I felt untethered from my body.”

In the week after the session, she said, she felt in an “incredibly positive mood” and that since taking part she has been more conscious about deciding whether to have a drink, although said this could also be linked to starting a new job and taking up meditation. “In the past, there were occasions where I would be drinking and I’d be on autopilot ‘Let’s get another drink’,” she said.

If the trial yields promising results, the team hope that the approach could form the basis for therapy sessions targeted at alcoholics and people who are drinking unhealthily. However, they acknowledge that there may be resistance to the use of a recreational drug to treat people with addiction.

“There’s just the general social attitude that everything that’s illegal is terrible. There will obviously be that kind of narrow-sighted pushback,” said Das. “But if it’s safe and effective enough it should be recommended.”

Andrew Misell, a spokesman for Alcohol Concern, said: “The researchers have quite rightly highlighted what a lot of people in recovery from alcohol problems know from experience, namely that cues or triggers like the smell of beer can cause a relapse even after long periods of abstinence. Any work looking at how people can overcome these pitfalls is going to be useful.”

However, he added, no drug-based therapy is risk-free “and that certainly includes ketamine”.

Professor Michael Saladin, of the Medical University of South Carolina, is looking at similar approaches to help people quit smoking. “There is a vast animal research literature that suggests memories can be manipulated following reactivation,” he said. “I am convinced that there is sufficient evidence to believe that memory reconsolidation can be harnessed for clinical purposes.”

The Evening Standard also picked up on the research:

Researchers at University College London are trialling the use of ketamine, a powerful anaesthetic used in the NHS and on animals, to block or dismantle the “alcohol reward” memories that cause cravings and addictions. It is hoped the drug, known as ‘Special K’ on the party scene, will help drinkers “reboot” their brain and get their habit under control.

Well I’m all for research and trying new things if it will potentially help.  Although I’d be slightly concerned about cross-addiction because if it is a very pleasant experience people may wish and seek to repeat it and ketamine is available as a street drug.

Sober Inspiration: Dan Siegel Wheel of Awareness

drdansiegel_wheelofawarenessSo the further into recovery I’ve got the more mindful and conscious I have become and in fact my awareness continues to deepen all the time.  With that in mind I wanted to share with you Dan Siegel‘s work on the Wheel of Awareness.  The reason I’m posting this today is because yesterday he led a meeting in LA to mark the beginning of his ‘Wheel of Awareness Community’.

Here is an image of “The Wheel of Awareness.” The hub represents the experience of awareness itself — knowing — while the rim contains all the points of anything we can become aware of, that which is known to us. We can send a spoke out to the rim to focus our attention on one point or another on the rim. In this way, the wheel of awareness becomes a visual metaphor for the integration of consciousness as we differentiate rim-elements and hub-awareness from each other and link them with our focus of attention.

I attach below a presentation on the subject that Dan has shared on SlidePlayer:

Mindsight Presentation by Dr Dan Siegel

And now a Youtube guided meditation that he has created:

And then finally the pdf handout that was created by him to support our further understanding of the Wheel of Awareness:

wheelofawareness-guided-meditation

The total package free on the internet from him – how wonderful is that? 🙂

For me this is what it is all about now.  Deepening my  understanding and integration of my sixth, seventh and eighth senses – so my somatics and my ability to perceive my mind by reflecting on my experience.  As Dr Siegel says:

“When we carry out a mindfulness practice of focused awareness, we develop mindsight”

Here’s to that and me finally acting on all the universes hints that I need to start a yoga practice to compliment my running!