This is your brain on dope(amine)

  • January 25, 2013 11:32 am

Dopamine is a neurotransmitter responsible for movement, pleasure, motivation, and cognitive processes, such as learning. For the purposes of understanding its role in addiction, let’s concentrate on pleasure and motivation.

Whenever we do something that propagates the advancement of our species, dopamine is released in order to motivate repetition of the action. When we sleep, eat, and have sex dopamine is released in our brain and the message is, “That was great, do it again!” We also release dopamine whenever we find something pleasurable. Be it 18th century poetry, heroin, or Radiohead, our brain will release dopamine to encode the stimulus as something that brings us pleasure.

Dopamine not only serves to categorize the good things we encounter in life, it also programs our pre-frontal cortex (the part of the brain involved in judgement and decision making) to alert us when the pleasurable stimulus is available. If your brain cells could talk, it might sound something like, “OMG! There’s a flyer on that lamppost for a Radiohead concert. Go look at it!” In other words, we become hyperaware of opportunities for engaging in behaviors that bring us pleasure. In fact, a study on people with alcoholism found they were more likely to spot alcoholic beverages in a busy photograph than people who don’t have problems with alcohol.

When we consume substances, it makes us feel good because our brains release dopamine, but drugs elicit a higher amount of dopamine release than is necessary. This is part of what causes experiences of euphoria and feeling high. Sometimes the amount of dopamine released is so great, the chemicals in our brain become unbalanced and we may experience hangover or withdrawal. In time, our brain regains chemical equilibrium. However, if one abuses substances, the brain may develop a tolerance (meaning the person needs to use greater amounts to get high) or dependence on the substance as a source of dopamine. If one becomes dependent on a drug, it may take some time for the brain to regain equilibrium and the person may experience extreme physical discomfort and emotional distress when they aren’t using. The period of re-calibration depends on the amount, type, and frequency of the drug used. For this reason, it’s always a good idea to be under medical supervision and receive support from friends, family, and a mental health professional if you’re dependent on a drug and want to stop or decrease your use.

The mechanism of tolerance is also evident in impulse control disorders, such as sex addiction, kleptomania, and compulsive gambling. Although it doesn’t appear that persons with an impulse control disorder undergo the same intensity of withdrawal that persons addicted to substances experience, there can certainly be a period of re-calibration of dopamine receptors during which a person feels irritable and agitated after stopping a behavior.

Based on the information presented here, we can conclude that we are all hard-wired to potentially become addicts and you may be asking yourself, “If this is true, why do some people become addicted and others don’t?” This is a really good question and the answer is “We don’t really know.” We can predict the likelihood of someone becoming an addict based on factors such as first age of substance use and family history of addiction, and we know that a lack of social support and coping strategies (especially when coupled with mental illness) can also lead to addiction, but there is no conclusive answer to date.

The best ways to prevent addiction are to educate yourself about the substances you use (or to abstain from substance use altogether) and to be mindful about the choices you make. If you have a mental illness, ensuring that you are getting appropriate treatment and maintaining social support are good preventative measures.

Jennifer Fernandez, PhD

We Admitted We Were Powerless

  • December 3, 2012 4:13 pm

The very first step of every 12-Step program begins with these words – an admission of powerlessness. For many people, that very first step makes participation in a 12-Step program very difficult and with good reason: powerlessness is an uncomfortable feeling and not one that most people seek out or admit to.

In fact, most of us spend a great deal of energy, time, and effort attempting to try to control things and other people in our lives. We work hard to try to create a life of happiness, as we should. However, these efforts often involve trying to gain control over something we don’t have control of, like an addiction. Other times, the efforts involve trying to change or control other people who are in our lives. And understandably, because the people in our lives – their choices and behaviors – affect us; sometimes profoundly.

But when we stop and look at how effective our efforts are to bend others’ actions to our will – when we really examine how well our efforts to control things go – we find that, in fact, we cannot figure out a way to make others be or do what we want. We discover that using all of our efforts to control someone so they don’t cause us pain doesn’t, in fact, protect us. As the program of Alanon says: we don’t cause the behavior of others, we can’t control it, and we can’t “fix” it. Trying to do so simply makes our life feel unmanageable and increases our unhappiness.

Acknowledging that we are powerless is not about acknowledging that we are weak. Instead it acknowledges what is true, and allows us to focus on the things that we can control and the person who we can help: ourselves. Acknowledging the ways we are powerless also allows us to be more accepting of others, and to find a more peaceful way of being in the world and in relationships.

Security is mostly a superstition. It does not exist in nature, nor do the children of men as a whole experience it. Avoiding danger is no safer in the long run than outright exposure. Life is either a daring adventure, or nothing. Helen Keller

Enjoy Your Life

  • September 1, 2012 8:51 am
Sometimes change is simple, even if it’s not easy

Enjoy your life and be happy. Being happy is of the utmost importance. Success in anything is through happiness. More support of nature comes from being happy. Under all circumstances be happy, even if you have to force it a bit to change some long standing habits.

Just think of any negativity that comes at you as a raindrop falling into the ocean of your bliss. You may not always have an ocean of bliss, but think that way anyway and it will help it come. Doubting is not blissful and does not create happiness. Be happy, healthy and let all that love flow through your heart.

— Maharishi Mahesh Yogi

 

To many, this quote by Maharishi Mahesh Yogi may seem trite, or overly simplistic. And indeed, there are times when we need more than this to create happiness—we may to make changes in our lives or our behaviors, we may need insight and/or healing. We may need transformation through meditation, psychotherapy, or relationship before we can apply new ways of thinking effectively.

However, there is a basic truth to the above quote, as evidenced by Cognitive Behavioral Therapy (CBT); a psychotherapeutic approach that addresses dysfunctional emotions, behaviors, and cognitions through a goal-oriented, systemic process. It is also evidenced through programs such as the 12-Step programs, which helps its members transform, in part, through addressing habits of thought. Programs such as this address a basic truth in the same way Maharishi does: habits of thought create an experience in life, and sometimes we have to consciously change those habits in order to create a different experience, one of happiness.

Addiction or Excuse?

  • September 1, 2012 8:47 am
Public shaming is counterproductive and simply wrong.

Whether it’s food, alcohol, or sex, there are a number of people who react strongly to hearing that someone has engaged in self-destructive behaviors because they are an addict by saying, “Don’t use addiction as an excuse for your behavior! Take responsibility!”

This concept of an “addiction excuse” is relatively new, and while it captures the imagination of those who are hurt, angry, or frustrated by the behavior of an addict, or by someone who lacks basic understanding of addiction, it simply doesn’t hold water for people who are addicts or those who work with people who struggle with addiction. People who speak about addiction as a “convenient excuse for bad behavior” or a “way to not take responsibility,” don’t comprehend what addiction is, and what the experience is like for the person who struggles with it.

Addiction is a psychological and physiological disorder. Even for “process addictions” such as those related to eating, sugar, sex, gambling, and stealing, there is strong scientific evidence that the neurological pathways related to dopamine are activated similarly to an addiction to cocaine. So addiction is not something made up by people to explain something away, it is a real condition, with both biological and psychological underpinnings.

For the vast majority of people who suffer from an addiction or impulse control disorder, acknowledging an addiction is one of the most difficult steps they will ever take. Most are in denial for years, believing in the “free will” that addiction naysayers speak about; addicts want to believe they are in control, and can stop any time they want. Many struggle for years to gain that control and feel deep shame when they fail, again and again.

Acknowledging an addiction, therefore, is an incredibly important first step. No problem can be solved if the problem is not acknowledged. Until someone admits, “I have lost control of this situation and can’t stop myself,” they cannot possibly be open to learning and working on the steps it takes to change their behavior. To the addict, acknowledging an addiction may be the most difficult, shameful, and scary step they take … but is also a crucial first step in saving his or her life. In fact, rather than being about shirking responsibility, acknowledging an addiction is the first step to taking responsibility.

As a society, we must stop shaming them further by telling them that acknowledging their addiction is an “excuse” and that they should “take responsibility for acting badly” and just feel ashamed. Instead, addicts must be supported in their first step and invited to take the many steps— psychological, physiological, spiritual, and emotional—that must take place for them to become well.

It may be that part of what people are reacting to is the overwhelming list of addictions that we hear about these days. People have begun to feel as if it is an overused term, and that there simply can’t be so many people in our society addicted to so many different things. Sadly, this is also not something that is made up. It doesn’t take much work to look around and see the sheer numbers of people who are addicted to food, shopping, electronics, alcohol, drugs, gambling, sex, and the myriad of ways available to us to avoid the profoundly beautiful but sometimes acutely painful process of being human.

Samantha Smithstein, Psy.D.

When Is Therapy Done?

  • March 27, 2012 3:27 pm

Everyone who has been in psychotherapy has had the question arise: When am I done here?

This question is a good one, as there is no obvious ending point for psychotherapy – it isn’t like a course of antibiotics, or a broken bone, when the ending of treatment can be prescribed.  With psychotherapy, the ending has to do with 1. the goals of the therapy (which can grow and change), 2. the ability of the therapist to adequately address those goals and 3. the ability and/or willingness of the patient to do the work necessary to complete the goals.

Let’s address each of those questions individually.

1.    Have I achieved the goal(s)?

This question is an interesting one.  Often, people come into therapy with acute problems which tend to improve after a while, sometimes within several months.  If the goal was to address these acute problems, there can be a perception on the part of the patient that therapy has done its work and they are therefore done.  That is certainly one way of looking at it but is it a good enough reason to end therapy?

Often the improvement someone experiences is because they have been able to identify the problem, learn new communication skills, and experience being heard through nonjudgmental inquiry and feedback from the therapist.  They learned their part in their problem and/or the psychological impact of the problem and have been able to begin to talk freely about the problem.

However, several months, or even a year, is usually not long enough to address the underlying vulnerabilities that led to the acute problems in the first place.  This makes the person highly vulnerable to repeating the acute problems in the future.  It is also not typically long enough to create a lasting change, so that the person may find that they are coping better but they have not made the deeper changes that address their orientation to life, work, or relationships.  If the goal is to have fewer symptoms and feel generally better, that goal might have been met, but if the goal is to have a broader understanding of themselves and a shift of perception enough to implement lasting change, they may not be.

Take, for example, the case of Marty: Marty came to therapy to try to figure out why she was so burnt out in her chosen field as a creative director in an advertising agency.  Her goal for therapy was to get back her passion and excitement about her work.  Through therapy she discovered that it wasn’t really her work that was the problem.  She and her husband were parenting three teenagers and had very little time for themselves and each other.  Her therapist came to feel that an underlying issue was Marty’s lack of self-care, and began to work with Marty on it. Marty discovered it wasn’t that easy.  It was easy to support her husband to go swimming and get back to his passion for woodshop.  But for some reason she couldn’t seem to sign up for yoga, painting and ask her kids to pitch in more.  Slowly her therapist suggested that perhaps they needed to look a little more closely at her childhood growing up with an alcoholic mother and father.  Marty was willing to consider adding this to her goals and realized that she was never very good at taking care of herself, she was good at surviving in an out of control alcoholic family.  After a few months she was able to sign up for yoga and a few months after that she signed up for weekend painting class.

As in the example above, deeper work often means a revision of the goals.  Sometimes it means that the therapist and patient do not have shared goals – the therapist may see the potential for greater change and the patient may not be interested (see #3).  But often as the patient and therapist work together they come to see that there are goals that were not initially apparent.

2.    Is my therapist capable of helping me achieve my goals?

This is also a very important question and one that can be difficult to assess.  Sometimes people encounter frustration with their therapist and feel they must leave – that they are not done with therapy but done with that therapist. This very well may be an accurate assessment on the part of the patient: even if people seek specialists for their particular problem, or they get a recommendation from someone who they know, not every therapist can work well with every person – there needs to be a “fit” for the therapy to work.  Additionally, some therapists are more skilled than others.

However, often people underestimate their therapist and leave instead of working with their therapist to see if the frustration can be resolved.

Take, for example, the case of Sue and Dave: Sue and her husband Dave brought their child to a therapist because they had reports from school that he wasn’t doing well academically and were concerned that their son had an emotional issue that was causing him to lose concentration.  Sue and Dave luckily saw an adult & child psychologist, Dr. Lee, who not only specialized in mood disorders but also in learning disorders.  After an initial evaluation the psychologist told them that he felt their son didn’t have mood based learning problems, rather he suspected the neurological based learning disorder dyslexia.  Initially Sue and Dave were upset by this thought, and felt Dr. Lee was the wrong therapist for their son. However, after discussing it further with Dr. Lee they agreed to testing and discovered Dr. Lee had been correct.  Dr. Lee was able to work with the family to help them accept the diagnosis, including the depressed feelings Dave initially experienced as a result. Dr. Lee was able to support Dave to work on all his feelings and now both Sue and Dave are involved parents and advocates for their son, and their son was able to receive the help that he needed.

Often, the therapist and patient can work through the impasse together and the process itself can be a very effective part of the therapy.

3.    Am I willing and/or able to do the work necessary?

This final question is crucial.  The process of therapy is intense and powerful. Often when people find their symptoms are (temporarily) alleviated, they feel incredible relief, and this feeling of relief allows them to feel the possibility of wellness.  Typically, as they continue in therapy, they then begin to feel uncomfortable. The therapy process begins to take a deeper look into the person and his or her life. Unpleasant feelings can emerge, such as feelings of dependency, or a deeper unhappiness.  More subtle thought distortions, relationship patterns, or acting out can begin to be revealed, and all of this can be frightening or make the patient feel worse.  This is a common time when people have the urge to leave.

Take, for example, the case of Tony: Tony came to therapy after his partner discovered Tony’s compulsive sexual behavior involving internet pornography, multiple affairs and frequent encounters with prostitutes.  His partner had told Tony if he didn’t get help to stop his behaviors, she would leave and take their three kids with her.  Tony was motivated to change, got into an intensive outpatient treatment program, joined a twelve step program and his wife joined a support group. Tony was hugely relieved that things started to calm down at home and he and his wife were finally able to communicate without painful arguments.  Six months into the therapy, Tony had a very deep session with his therapist acknowledging he thought he’d been depressed since his mom died when he was eleven years old.  A week later Tony came to therapy stating he was confident he was over his problems and decided after six months of no longer acting-out in his sexual compulsivity he was done.  His therapist asked him if he thought he’d touched on something very painful when he had brought up his mother and that he had more work to do to grieve her loss and look at the corresponding depression he’d had since that time.   Tony disagreed and in a couple of days sent her an email stating he would not return.  His therapist called him back and told him that her door was always open to him and encouraged him to consider a final session for closure.  Two months later he returned to therapy and said his wife had caught him again on an internet pornography site. His twelve step sponsor said he was still in his addiction and he needed to get additional help of therapy to get and stay sober.  He acknowledged he wasn’t done and indeed was really just getting started.  Tony later learned that when he had been in so much pain remembering his mother, it wasn’t his sober adult mind doing the thinking and acting, it was the addict defensive part of his mind that was telling him to run and hide from therapy. That was a part of his mind that had developed to help him survive a traumatic event when he was young but it was no longer helpful – it was self-destructive.

People spend a large portion of their lives acting without knowing really why or where the action is coming from.  Part of the goal of therapy is to develop a mind that can think “real thoughts” versus automatic responses, awareness of feelings and ability to tolerate them, so that conscious decisions can be made and intimacy can be created.  The discomfort – experienced as frustration, irritability, restlessness, sadness, pain, anger, unhappiness, etc – can be an indication that the real work can begin – the work of discovery and healing.  The deeper problems are now within reach and are available to be explored and resolved.

Samantha Smithstein, Psy.D. & Elizabeth Corsale, MFT

We may be human, but we are also animals

  • March 4, 2011 9:50 am

Cognitive Behavioral Therapy (CBT) has been around for a long time and has shown significant success in use for the treatment of difficult to treat disorders such as depression, impulse disorders, addictions, obsessive-compulsive disorder, anxiety, and others.  That said, for those of us who are deep thinkers – who are always asking “But why?” – the idea of changing our lives for the better by simply changing the way we think or behave feels superficial, overly simplistic, or even distasteful.

In truth, there are values to all types of therapy, and because of this many therapists who consider themselves to be psychodynamic and relationship-focused have incorporated techniques that involve CBT – especially the “cognitive” part that addresses reflexive thinking.  But research continues to demonstrate that behavioral modification techniques can help a great deal – for people of all ages.  In spite of wanting to use our capacity for insight, thought, and reasoning to place ourselves above our fellow animals, it turns out we are also subject to the same basic behavioral conditioning that teaches a dog to “sit” using a treat, or training a cat to stay off the dining room table by using a squirt gun.

An example of this was demonstrated in recent research published in Psychological Science.  University of Amsterdam experimental psychologist Reinout W. Wiers and his associates had alcoholics practice “pushing away” images of alcohol with a joystick when they appeared.  When studied originally, those addicted to alcohol had an immediate impulse to “pull” these images towards them when they appeared.  Through the very simple practice, that impulse was re-trained as one that would reflexively push the image away.  They were then given the standard abstinence-based, cognitive behavioral three month program with everyone else.

During the follow-up study it was found that there were expected relapses by all groups.  However, the group with the cognitive-bias modification (CBM) or “pushing away” technique had significantly lower incidents of relapse. One still-abstinent patient told a story illustrating how the technique had worked for him. At a party, looking for a soda, the man opened the refrigerator, but found it full of beer. “Immediately, he made the push movement” — he closed the door.  Certainly, in the moments following he would have to think about whether or not he wants to take a drink and will have a decision to make.  But it appears that this CBM technique enabled people to reverse their initial impulse, giving them the time to think and make the choice not to drink.

This reversal of impulse has tremendous implications in the treatment of other addictions and impulse disorders.  This study will not be news for those who treat sex offenders and have used aversive techniques for years.  However, it does open the door for those who suffer from addictions to drugs and alcohol, or process addictions such as gambling or stealing.  These simple techniques might help, in the moment, to give people who suffer from these impulses the time they need to make a better choice.

Samantha Smithstein, Psy.D.

Charlie Sheen: we are “sick and tired” but is he?

  • January 30, 2011 10:58 am

A patient of mine once told me the story of when he “hit bottom” and stopped drinking.  He had promised his wife he would stop drinking but they were headed towards a party and he felt panicked.  He asked her to stop at a grocery store on the way to pick something up, ran in to the store, and searched frantically for anything with a screw top.  As he sat in the bathroom of the grocery store downing a bottle of cheap booze he thought to himself with disgust, “What the hell am I doing here?”  That was the last time he took a drink.

That man didn’t need to destroy his marriage, lose his job, get arrested, or make headlines to come to the realization that he couldn’t keep doing what he was doing; but others are not so fortunate.  Charlie Sheen just entered rehab for the third time in the past 12 months and his behavior over the course of the last year has included extreme substance abuse, destruction of property, tens of thousands of dollars spent on prostitutes and porn stars, and loss of his marriage, just to name a few.  Is this the end of substance abuse and sex addiction for him?  Only he has the answer for that; we can hope for him but it may not be.

In 12-step programs, “hitting bottom” is defined as the moment when someone becomes “sick and tired of being sick and tired.” In other words, the pain accrued from continuing the behavior outweighs the pain anticipated from stopping the behavior.  Sometimes family members, therapists, friends, or others will try to “raise the bottom” for an addict by intervening in some way, calling attention to the self-destructive (life-destructive, relationship-destructive) nature of their behaviors.  This can have some success and is certainly worth the effort.  However, repeatedly trying to intervene often leads to frustration and despair, or to a cycle of codependency.  People in an addict’s life need to accept that for an addict, just like for anyone under any circumstances, change has to ultimately be internally motivated.

Change is hard.  There is no way around that.  It takes great courage and usually perseverance.  So as much as any one of us would like to, we can’t force someone to get tired enough to “stop digging the hole they are standing in.”  And in truth, any moment can be that “bottom.”  It could be (and for some, needs to be) a painful, life-changing event; but it could also just be a simple moment of waking up to the reality of your life.

And of course, “hitting bottom” and getting into recovery is only the first step on a long road of every day making a choice to live a different kind of life – a life for which you are fully present and conscious.

Samantha Smithstein, Psy.D.

Sometimes what you need is hard to swallow

  • December 14, 2010 2:02 pm

Frequently when a therapist suggests that his or her patient might be helped by psychotropic medication the suggestion is met with concern, doubt, or even anger. This is even the case when a patient has been suffering for years from mood, impulse, or attention-related issues. Additionally, often patients try medication, experience relief, and then decide abruptly to stop taking medication without consultation with their therapist and psychiatrist; often while simultaneously self-medicating with illegal drugs, alcohol, or unhealthy behaviors. This can be especially true during the holidays, when the pressure to be happy is intense, the feelings of depression are frequent, and the availability of unhealthy behaviors is high.

No doubt prescribed psychiatric medication is not a perfect science: there are side-effects and sadly medication doesn’t always work and provide the relief of symptoms and quality of life improvement sought by the patient. However, all too often side effects and/or the efficacy of the medication are not the reasons people stop taking helpful medication. Instead, the reason expressed is more likely to be “I just don’t want to be on medication (for the rest of my life).” Why?

Unfortunately, in large part this is because there remains serious stigma, shame and fear of psychiatric medication and psychological treatment. According to NARSAD, the Mental Health Research Association, one in five Americans suffer from mental illness in a given year but only one-third seek treatment. In San Francisco it is estimated that close to ten percent of the population suffers from a serious mental illness. In a recent study, psychiatry residents – those doctors learning to help people with mental illness – acknowledged that while they would tell others about being in psychotherapy, they had not admitted to anyone that they were taking psychotropic medication because of the perceived stigma even amongst their peers and superiors. In a study earlier this year, it was found that even the drug companies that market psychotropic medications to doctors were perpetuating rather than breaking-down the stigma attached to mental health problems.

Of course, the ads from the medication companies and fears of the psychiatry residents are simply a reflection of the societal stigma that still exists. And yet medications have given so many people a chance at living a happier, more fulfilled life. Rather than a weakness, character flaw, or sign of a mental deficiency, a psychiatric condition is a medical condition that needs to be treated. Without a doubt, there are many ways to approach psychological problems without medication. This can range from psychotherapy, to meditation and/or yoga, to exercise, to lifestyle interventions, or some combination these interventions. But in some cases, just as with any medical issue, medication can make a tremendous difference. For example, medication can make a profound change in a patient who has been in psychotherapy for years and has made tremendous progress psychologically, emotionally, and in making healthy lifestyle choices, but remains unable to shake a pervasive negativity about herself that makes it very difficult for her to achieve satisfying, intimate relationships. Once on a low dose of anti-depressants, she may find that the negativity has lifted and she is much more healthy psychologically and capable of relationships than she imagined.

Part of the resistance to medication is due to a societal backlash. Pharmaceutical companies make a profit from selling medication and our culture has a tendency to look for the easy answer to problems, sometimes in a pill. Many have turned to medication inappropriately – over-medicating our children or those struggling with mental illness. It has become clear through these experiences and in research that medication is not always the answer and most often not enough as a solution. However, it is also clear that in some cases medication is one tool in the toolbox of interventions that can make a tremendous difference.

Samantha Smithstein, Psy.D. and Elizabeth Corsale, MA, MFT

Pleasure vs. stress

  • November 28, 2010 1:30 pm

Often people turn to pleasurable activities when feeling stressed, and we tend think of this as being an “escape” or an unhealthy coping mechanism. This is especially true when the pleasurable activity is unhealthy for us and/or our relationships with others. But recent research at the University of Cincinnati has demonstrated that pleasurable activity such as food or sex actually reduces stress via brain pathways by inhibiting anxiety responses in the brain.

The researchers found that even small amounts of yummy food can reduce stress for a week – and that it was the taste that made the difference rather than the content or the quantity. Additionally, access to a sexual partner also had a similar effect. This helps to explain why seeking such activities continues during stressful times, even when it is a behavior that is unwanted, such as overeating or sexual acting-out.

But these findings are not simply important because they explain issues related to obesity or sexual addiction, although certainly that is important. These findings also point us towards finding a solution – alternatives to behaviors that someone desires to change. In other words, if it is true that a small taste of something delicious or pleasurable sexual activity can reduce stress, then it would follow that other pleasurable activities can reduce stress as well.

Furthermore, we know from prior research that there are activities that the body and mind can find deeply pleasurable and highly effective in reducing stress, even if intellectually we may not think of them as enjoyable. For example, exercise is an effective stress reduction activity (and pleasurable for the body), even if the person exercising imagines it to be a chore or tiresome. Similarly, people complain that they wouldn’t be able to find time to mediate or think of it as a waste of time, when techniques such as Transcendental Meditation have been found not only to be pleasurable for the mind and body but also highly effective stress-reduction techniques.

The link between stress reduction and pleasure is becoming clearer, and adds to the list of explanations as to why some people may engage in activities that aren’t necessarily good for them during periods of stress. But this link also provides us with alternatives that can bring about the (ultimately) same desired result in a better way. This is especially important in the weeks ahead, as we head towards the holidays. Holidays often bring a combination of both stress and the availability of unhealthy pleasurable activities. Becoming conscious of the link between the two can help us choose the option for pleasure that not only helps us to relieve the stress but makes us healthier in the long run.

Samantha Smithstein, Psy.D.

The importance of listening to yourself (and saying the right thing)

  • September 30, 2010 3:12 pm

“I’m never going to be able to beat this thing.”
“It seems like it happens again no matter what I do.”
“I’m never going to win this battle, no matter how hard I try.”
“Oh well… it’s to be expected.”

These are common thoughts people who struggle with impulsive or compulsive have each time they relapse. They struggle to gain control over themselves and their behavior, fail to maintain that control, and think to themselves, “I’m not surprised it happens again… it always does.”

Certainly we can understand why someone might have these thoughts after countless times of trying to gain control over a behavior and failing. But what people don’t realize is that the thoughts themselves may actually be contributing to the relapse.

New research out of the University of Toronto supports the idea that what we tell ourselves plays a pivotal role in our ability to control ourselves. The study demonstrated that talking to ourselves and utilizing our “inner voice” helps us to exercise self control and prevents us from making impulsive decisions or taking impulsive action. In other words, when we are able to helpfully talk ourselves through a decision we are less likely to act in an out-of-control way.

This is also true of how we evaluate our behavior afterwards. When we tell ourselves, “I am getting better. I just had a slip-up but it is only a stumble on my road towards being a different person” we give ourselves an entirely different message then “it happened again, I guess I’m doomed to fail.” This difference in message doesn’t only affect our mood, but it also has an effect on whether or not we will relapse – we carry this belief forward and it becomes part of our self-talk the next time we are attempting to do something differently.

If there is a behavior you are trying to change, be it large or small, listen to what you are saying to yourself as you work on it. You could be the only person/voice standing in your own way.

Samantha Smithstein, Psy.D.

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