Beyond the 12 Steps

Addiction Epidemic? What is the Cause?

The first ever U.S. surgeon general’s report on addiction was released in November 2016. It concluded that 21 million Americans have a drug or alcohol addiction, making the disorder more common than cancer.

Are We in Charge of Ourselves?

Most human beings have aspects of impulse control and self-discipline that are problematic to them.

The Free Will Debate

Why don’t people just choose to become sober?

Human beings have been aware of the free will problem for at least two thousand years. It is thus easy to understand why this problem has the reputation of being the quintessential perennial question, one on which nothing new can be said, no progress can be made, nor any agreement reached.

Saul SmilanskyUniversity of Haifa, Haifa, Israel

“I Think I Can” is Not Enough!

The prediction of behavior from theory of reasoned action/planned behavior variables is less than impressive. Intentions and perceived behavioral control, on average, explain only 20-30% of the variance in behavior in prospective studies (Ajzen, 1991; Armitage & Conner, 2001; Godin & Kok, 1996; Randall & Wolff, 1994; Sheeran & Orbell, 1998; Sheppard et al., 1988; van den Putte, 1993).

Why Do People Get Addicted?

1. Addiction is caused by weakness of character and moral deficiency?

2. Addiction is triggered by the desire to avoid the physical symptoms of withdrawal?

3. Addictions represent the misguided attempts of troubled people to cope with stress and get their inner needs met?

4. It’s a disease of the brain and not a moral issue at all?

How Effective is the Treatment of Addiction and What Works?

Allen J. et al. Matching alcoholism treatments to clientheterogeneity: Project MATCH three-year drinking outcomes.Alcohol Clinical and Experimental Research 1998; 22,1300–11.

Randomly controlled trial with 1726 subjects, 3 year follow-up. Three treatment groups - twelve weeks of cognitive-behavioral therapy, twelve weeks of 12-Step facilitation, and 4weeks of motivational interviewing. All had generally equalresults. (Financial cost - $27 million)

Most of the improvement was instantaneous, occurring atweek 1, before the participants had received the bulk of theirtreatment. Although the full treatment group received 11more therapy sessions, the additional improvement was ofsmall magnitude. For example, at week one the percent daysabstinence had increased by over 60%, and the additional 11weeks of treatment increased it by only 4%.

British UKATT Study Results

UK Alcohol Treatment Trial Research Team (UKATT). Effectiveness of treatment for alcohol problems: findings of the randomized UK alcohol treatment trial (UKATT). British Medical Journal 2005; 331: 541–4. (742 clients with alcohol problems; 689 were interviewed at three months and 617 at 12 months).

Social behavior and network therapy consisted of cognitive and behavioral strategies to help clients build social networks supportive of change. The therapy comprised eight 50 minute sessions over eight to 12 weeks.

Motivational enhancement therapy consisted of three 50 minute sessions over eight to 12 weeks. It combined counseling in the motivational style with objective feedback.

Results from both groups combined: No differences between the two groups. The adjusted proportion of days on which clients reported that they had abstained improved from 29% to 43% at three months and to 46% at 12 months. Mean adjusted alcohol consumption reported by continuing drinkers fell from 27 drinks per drinking day to 18 at three months and to 19 at 12 months.

Literature Review cont.

Magill, M. & Ray, L. Journal of Studies on Alcohol & Drugs. Jul2009, 70, 4, p516-527Literature review: 56 controlled studies of CBT produced a small, but statistically significant treatment effect g= .154, p<.005, at 12 month follow-up g=.096, p<.05

Cochrane Database of Systematic Reviews (Online) · July 2006 Effectiveness of AAAA was combined with other interventions and compared to other treatments. There were few differences in the amount of drinks and percentage of drinking days between 12 Steps Facilitation TSF versus comparison treatment interventions, and no conclusive differences in treatment drop out rates were reported. AA does not appear to be any more effective than other treatments.

How effective is alcoholism treatment in the United States?

Miller WR, Walters ST, Bennett ME. Journal of Studies on Alcohol. 2001 Mar;62(2):211-20.

METHOD: Findings from seven large multisite studies were combined to derive estimates of the average effectiveness of alcoholism treatment.

RESULTS: During the year after treatment, 1 in 4 clients remained continuously abstinent on average, and an additional 1 in 10 used alcohol moderately and without problems. The remaining clients, as a group, showed substantial improvement, abstaining on 3 days out of 4 and reducing their overall alcohol consumption by 87%, on average. Alcohol-related problems also decreased by 60%.

CONCLUSIONS: About one third of clients remain asymptomatic during the year following a single treatment event. The remaining two thirds show, on average, large and significant decreases in drinking and related problems.

The rate of spontaneous recovery of individuals with addictions is between 16 and 20 percent. (No treatment)

First Controlled Study for Reducing Internet Pornography Addiction

Twohig, M. P., & Crosby, J. M. (2010). Acceptance and Commitment Therapy as a Treatment for Problematic Internet Pornography Viewing. Behavior Therapy, 41(3), 285-295.

Serving as the therapist for all six men, Dr. Twohig treated each with a flexible protocol of 8 weekly, 1.5 hour sessions. Sessions addressed the major ACT processes. Participants practiced mindful awareness and acceptance of inner experiences such as urges and arousal. Between sessions, they committed to engaging in activities in accordance with their values.

At the end of the last treatment session, five of the six showed significant reductions in viewing pornography. At a follow-up three months after treatment ended, two people weren’t viewing pornography at all and three were viewing at significantly reduced levels.

Emotional Regulation and AddictionsCashwell, C., Giordano, A., et al. Emotion Regulation and Sex Addiction among College Students. International Journal of Mental Health & Addiction. Feb2017, 15,1, p16-27. :Sample of 337 college students, 57 (16.9 %) scored in the clinical range of sexual addiction. The students in the clinical range differed significantly on three aspects of emotion regulation: (a) nonacceptance of emotional responses, (b) limited engagement in goal-directed behaviors in response to negative affect, and (c) minimal emotion regulation strategies.

Comorbidity studies identify mood disorders,—mainly major depression (Brooner, King, Kidorf, Schmidt, & Bigelow, 1997; Christenson et al., 1994; Halmi et al., 1991; McCormick, Russo, Ramirez, & Taber, 1984; Merikangas & Gelernter, 1990) and bipolar disorders (Maremmani et al., 2007; Vornik &Brown, 2007)—as the most frequently diagnosed problems among addictive patients.

Obsessive-compulsive disorder shows high correlation not only with the use of psychoactive substances (Regier et al., 1990) but with behavioral addictions (Frost, Krause, & Steketee, 1996; Grant, Mancebo, Pinto, Eisen, & Rasmussen, B. 2006).

Therapist Effect

Miller, W. and Moyers, T. Addiction, 110, 401–413

This review of the literature found that 90 different treatment methods for alcohol use disorders varied widely in their evidence base, from some with strong support across dozens of RCTs to others with overwhelmingly negative evidence in dozens of trials. He attributes these differences to therapist competency, particularly in regards to empathy, connecting with clients, and skill in the use of motivational interviewing. Miller suggests that more research be geared to understanding therapist differences versus comparing treatment techniques.

Okiishi, J. & Lambert, M. et al. Clinical Psychology and Psychotherapy 10, 361–373 (2003) Waiting for SupershrinkReported great differences among therapists, some therapists were as much as 10 times as effective as others. Some of these outcomes were based on interventions of only a few sessions. (Used the OQ as the measurement device).

Conclusions from the Review of the Literature on Addictions

• There are a number of viable approaches for treatment of addictions that yield basically equal, but moderate results.

• Therapist skill level appears to be the variable that accounts for the greatest variance in outcome. What are the super shrinks doing differently?

• There are no treatment approaches that surpass motivational interviewing. As many as 20 percent of individuals who recover and remain abstinent do so without any treatment. In both these conditions, clients are not being trained in new skills to help them remain sober.

• When skill training is provided (e.g. CBT), subjects are not tested to see if they gained any real proficiency.

12 Step Theory• Addicts are powerless to change

by themselves.

• Sobriety can be achieved by relying upon a higher power.

• They remain addicts, but focus on remaining sober one day at a time through service and living by good values.

• Going through the 12 steps changes your character and increases your ability to receive God’s grace.

• 12 Step members receive support and guidance from other group members.

Other Components of Addiction Treatment

• Motivation

• Boundaries

• Accountability

• Cognitive skills to manage moods

• Relationship enhancement

• Trauma work

• Mindfulness

• Acceptance

• Exercise

• Writing a personal history

Specific Treatment Approaches for Sexual Addictions

• EMDR (view addictions as trauma based)

• ACT (values based behavior, acceptance to tolerate cravings, defusion techniques to manage negative thoughts)

• CBT (change mood by correcting negative thoughts)

• Lifestar (comprehensive skill-based group approach)

• The Next 12-Steps (spiritually-based skills approach)

• ADDO (skill-based educational approach)

• Sons of Helaman (spiritual, behavioral approach)

• Sexaholics Anonymous -SA (12-step approach)

• PASG (LDS Church’s 12-step approach)

Are We Double-Minded?

Plato – Each person is a charioteer with two horses. The black horse is passion and the white horse is reason.

James 1:8 – A double-mindedman is unstable in all his ways.

The Dual Systems Theory of the Brain

• The emotional system allows us to act fairly spontaneously using pre-established subroutines (quick and energy efficient).

• The rational (conscious) system allows us to make sense of set behavioral patterns, interrupt them, and establish new, more effective patterns.

Incognito -David Eagleman(neuroscientist)

Two Distinct Neurobiological Systems

System 1, the ‘‘socioemotional system,” which is localized in limbic and paralimbic areas of the brain, including the amygdala, ventral striatum, orbitofrontal cortex, medial prefrontalcortex, and superior temporal sulcus;

System 2 the ‘‘cognitive control system,” which is mainly composed of the lateral prefrontal and parietal cortices and those parts of theanterior cingulate cortex to which they are interconnected

Steinberg, L. (2010) A Dual Systems Model ofAdolescent Risk-Taking, Developmental Psychobiology, 52: 216 – 224.

The Brain

The Limbic System

• The Hippocampus plays an important role in emotion, learning, and memory.

• The Amygdala plays a role in aggression, eating, drinking, and sexual behaviors.

• The Hypothalamus monitors blood levels of glucose, salt, blood pressure, and hormones. It also helps to regulate processes in the body through its connection to the central and autonomic nervous systems and endocrine system.

• The Anterior Cingulate Gyrus is involved in error detection, anticipation of tasks, attention, motivation, and modulation of emotional responses

Striatum in Decision-Making

B. Libet, 1983 (brain activity measured by EEG)

2003, first recipient of the Virtual Nobel Prize in Psychologyfrom the University of Klagenfurt, "for his pioneering achievements in the experimental investigation of consciousness, initiation of action, and free will".

C.S. Soon, 2008 (brain activity measured by fMRI)

J. Dylan-Haynes, 2008 (brain activity measured by fMRI)

Answers to simple choices can be predicted 7 seconds or more in advance by subconscious activity.

In the Dylan-Haynes and Soon studies the activity in the subconscious predicted the ultimate response about 60 percent of the time.

Types of Evidence for the Dual Processing Model

Strong (and converging) evidence comes from three separate sources.

1. Experimental manipulations designed to affect one type of processing while leaving the other intact. Common manipulations are designed either to increase Type 2 processing effort (by instruction or motivation) or to suppress it by use of concurrent tasks that load working memory or by use of speeded tasks that allow little time for reflective thought.

2. Application of neural imaging in order to show that different brain areas are active when Type 1 or 2 processing is being observed.

3. The psychometric approach, which demonstrates selective correlations, especially to show that Type 2 processing has a strong relation with cognitive ability whereas Type 1 processing does not.

Evans, J. (2008) Dual-Processing Accounts of Reasoning, Judgment, and Social Cognition Annual Review of Psychology, 59, 255–78

Evans, J. St. B. T. & Stanovich, K. E. (2013). Dual-process theories of higher cognition: Advancing the debate. Perspectives on Psychological Science, 8, 223-241, 263-271.

Stanovich, K. E. (2012). On the distinction between rationality and intelligence: Implications for understanding individual differences in reasoning. In K. Holyoak & R. Morrison (Eds.) (pp. 343-365), The Oxford handbook of thinking and reasoning. New York: Oxford University Press.

The Brain and Alcohol Cravings

Results: During the alcohol condition compared with the control condition, significantly increased cerebral blood flow was found in the ventral putamen a round structure at the base of the forebrain, part of the basal ganglia (movement and learning). Additionally, activated areas included insula (body sensation), cerebellum (sensory perception) and dorsolateral prefrontal cortex (executive functions).

Hans M. Olbrich, Gabriele Valerius, et al. Brain activation during craving for alcohol measured by positron emission tomography, Australian and New Zealand Journal of Psychiatry 2006; 40:171–178.

The Core Brain Regions of Drug Craving

Increased activity in the anterior cingulatecortex (ACC), right pallidum and ventral striatum were related to drug cue reactivity as well as self-reported craving. All these areas are contained in the limbic system.

Kühn, Simone; Gallinat, Jürgen. Common biology of craving across legal and illegal drugs – a quantitive meta-analysis of cue reactivity brain response, European Journal of Neuroscience. Apr2011, Vol. 33 Issue 7, p1318-1326.

What Value Does the Dual Systems Model Bring to Addiction Recovery Theory?

It appears that the emotional system is the part of the brain that desires the addictive substance or behavior. We can learn how this part of the brain system makes its decisions?We can study the best way to intervene to change desires or to gain better control of impulses?

Evans, J. St. B. T. (2003). In two minds: Dual process accounts of reasoning. Trends in Cognitive Sciences, 7, 454–459.

Sloman, S. A. (1996). The empirical case for two systems of reasoning. Psychological Bulletin, 119, 3–22.Newstead, S. E. (2000). Are there two different kinds of thinking? Behavioral and Brain Sciences, 23, 690–691.Osman, M. (2004). An evaluation of dual-process theories of reasoning. Psychonomic Bulletin & Review, 11, 988–1010. Eagleman, David (2011) Incognito. New York, Vintage Books.

Transcranium Magnetic Stimulation TMS

Premise: Stimulate the prefrontal cortex so people will have more self-control over impulses coming from the emotional

system.

The Scriptures: Another Source of Truth

Create in me a clean heart, O God; and renew a right spirit within me. (Psalms 51:10)

A good man out of the good treasure of the heart bringeth forth good things: and an evil man out of the evil treasure bringeth forth evil things. (Matthew 12:35)

For where your treasure is, there will your heart be also. (Matthew 6:19-21)

For I, the Lord, will judge all men according to their works, according to the desire of their hearts. (D&C 137:9)

For as he thinketh in his heart, so is he: (Proverbs 23:7)

The Thoughts and Feelings of the Heart Can Be Different Than Those of the Mind

Purify your hearts, ye double minded. (James 4:8)

Well hath Esaias prophesied of you hypocrites, as it is written, This people honoureth me with their lips, but their heart is far from me. (Mark 7:6)

(D&C 64:34) 34 Behold, the Lord requireth the heart and a willing mind.

“I should” versus “I want”

Man’s Spirit is Part of His Personality

President James E. Faust: The main mission of the Church is to change the inner self.

President David O. McKay: The highest purpose of man is to develop the spirit within him.

President David O. McKay: The spirit in man controls this physical body just as the driver of an auto may control that machine.

President Brigham Young: The spirit is the intelligent part of man, and it is intimately connected with the tabernacle.

The spirit of man expresses its desires through the emotional system. The Lord calls this inner part of our being “the heart.”

The Secret of Change • We can communicate with the emotional

mind (the heart). We can change behavior and modulate negative emotions through the strategic use of truth.

• The emotional system provides information and feedback to the conscious mind, and the conscious mind provides analysis and direction.

• We can also reprogram the heart to act differently. Later positive experiences will cement in the new behaviors.

And again, verily I say unto you, and I say it that you may know the truth, that you may chase darkness from among you. (D&C 50:25)

Personal Exercises

1. Communing with the heart

2. Persuading the heart (Goal-setting)Choose a habit you would like to develop or one you would like to get rid of.

MotivationAs this exercise creates a dialogue between the logical and emotional systems of the brain,

the word “you” represents the emotional system.

1. The big enchilada: Why I want to achieve this goal and what will be different in my life if I accomplish this.2. Cold water in the face: If you do not follow through on this goal, what will be the end results? Is that what you really want?3. Accepting reality: If the answer to #2 is no, then you must do something to get the rewards you want. What is some small amount of work you are confident you can get yourself to do in one consecutive stretch? If more needs to be done this day, then plan a short break doing something you know you can definitely pull yourself away from. Then perform your next small segment, and others if necessary.4. Present benefits: What rewards might you experience as you are doing the activity? 5. Intermediate benefits: What will be the rewards you will experience during the day after you have completed the activity?6. Plan for success: Make a plan for when and how you can best continue to pursue this goal. Use the same motivational strategy outlined in the previous steps to get started each day. Remember that if you can get through the first 30 days, your habit will take root and you will experience the great satisfaction of feeling more in control of your life’s course.7. Blast off: Get going right away. No excuses. Watch out for delays, distractions, and self-deception. Time to launch. 5, 4, 3 ,2, 1.

Strategic Impulse Control1) Beliefs and attitudes - Choose a behavior you wish to manage better and examine your beliefs and attitudes. a. Does the behavior in question fit in with my personal values?b. What benefit does it give me?c. Does it work over time? That is, do the benefits for me outweigh thecosts in the long run?d. What are the consequences of my behavior on others?e. What are the most compelling reasons to change?f. Am I ready to make a real and lasting commitment to change? If not, what would it take?

2) Boundaries - Set firm, clear boundaries. These limits or rules if wisely kept will make it harder for you to indulge in your habit in the same way. The boundaries can be associated with physical distance, portions, time, situation, etc.

3) Advertising - Write an advertising cue sheet. List several negative outcomes associated with continuing the behavior as usual. Make the situations as dramatic as realistically possible. Think about the undesired action for a few seconds, then visualize the various negative consequences for 30 seconds. Do this at least once daily.

4) Resistance - Analyze any resistance to change. What are your fears or concerns? Are they realistic? How could those concerns be managed so you can reach your goals?

5) Substitution – What is one positive alternative way to meet the same need as the behavior of concern? Although you may not prefer this, could you live with the switch?

6) Self-care – If tempted to cross your boundaries, remind yourself that lapses in the plan will eventually result in failing in the goal? Ask yourself if that is really what you want? Counteract any self-deceptions your emotional self brings up with truth and logic. Than ask yourself what the real need is (physical, emotional, or spiritual) and plan on how to address that need appropriately. What needs may not have been sufficiently addressed in the past?

The Next 12 Steps Group

Main Components of Recovery

The Holy Spirit and the Atonement

Light and Truth Skills for FindingJoy

Chapter Topics in the Next 12 Steps Manual

1. Faith It is through faith in Jesus Christ that we can receive the power and knowledge to overcome addictions.

2. Monitoring desires The continual monitoring of impulses in the context of rules, boundaries, and triggers is an important element in abstinence.

3. Changing desires True success in recovery involves changing the desires of the heart.

4. Seek the gift of the Atonement We can obtain forgiveness and added peace and strength as we receive the blessings of the Atonement.

5. Trust in God Turn your life and will over to Jesus Christ by making spirituality your greatest goal.

6. One day at a time Maintain a spiritual focus. Concentrate on the experience of the moment. Find joy and purpose in each day.

Chapter Topics in the Next 12 Steps Manual

7. Peace through acceptance We can find greater peace by utilizing the wisdom of the Serenity Prayer from the 12-step model.

8. As a man thinketh Correct thinking is a vital element in recovery and spiritual living.

9. Take care of the inner self The inner self is the core part of man and the center of our emotions and desires. Emotional success involves developing the wisdom and self-discipline to lead a moral and responsible life, while also taking care of personal needs.

10. Individual worth Secure self-worth comes through humility, acknowledging personal progress, and accepting our value as children of our Heavenly Father.

11. Strengthen social connections Love is all-important. Being part of a community of family, friends and neighbors provides joy and emotional strength.

12. Continual self-improvement Resolve to change defects in behavior and character and strive to become a better person__more kind, sensitive, honest, disciplined, and temperate

The Enabling Power of the Atonement

Elder David A. Bednar: The two dimensions of the Atonement (redeeming and enabling) are connected and complementary. Pray and seek for strength to change your circumstances rather than praying for your circumstances to be changed. We will become agents who act rather than objects that are acted upon.

And he will take upon him death, that he may loose the bands of death which bind his people; and he will take upon him their infirmities, that his bowels may be filled with mercy, according to the flesh, that he may know according to the flesh how to succor his people according to their infirmities. (Alma 7:11-12)

The Holy Ghost testifies of truth, guides us, empowers us, purifies our desires, and provides revelation as we search and ponder.

The Entrance of Sin

Every spirit of man was innocent in the beginning; and God having redeemed man from the fall, men became again, in their infant state, innocent before God.

And that wicked one cometh and takethaway light and truth, through disobedience, from the children of men, and because of the tradition of their fathers. (D&C 93:38-39)

The Conditioning Process

We learn to desire that which we associate with pleasure. These strong feelings are called cravings.

Side Effects of Addictive Behavior

Loss of perspective and honesty: the heart overpowers the logical mind pressuring it to conspire with it to avoid squarely facing the problem.

And the angel spake unto me, saying: Behold the fountain of filthy water which thy father saw; yea, even the river of which he spake; and the depths thereof are the depths of hell.

And the mists of darkness are the temptations of the devil, which blindeth the eyes, and hardeneth the hearts of the children of men, and leadeth them away into broad roads, that they perish and are lost. (1 Nephi 12:16-17)

Avoid Self-Deception

There is no sin without self-deception. Truth is our powerful ally. Avoid rationalization, justification, minimization, and denial.

Five Means to Self-Deception

1. Hardness of heart- Willfullness “I do not want to do it.”

2. Rationalization- “I’m too busy. It is not really important. Someone else can do it.”

3. Procrastination: “Maybe I’ll do it next week. I’ll get to it some other time.”

4. Lack of organization- Weak goals. Lack of specifics in plans and deadlines.

5. Lack of motivation- not fully recognize the importance of being diligent, not see the “big picture,” failure to think about the rewards.

Changing the Heart with Truth

The emotional system provides information and feedback to the conscious mind and the conscious mind provides analysisand direction.

We are able to communicate with the emotional system, the heart. Our main leverage with the emotional mind is persuasion and truth. Subsequent experiences change the heart.

And ye shall know the truth, and the truth shall make you free. (John 8:32)

Seek Light and Truth

He that keepeth his commandments receiveth truth and light, until he is glorified in truth and knoweth all things. (D&C 93:28)

The glory of God is intelligence, or, in other words, light and truth. (D&C 93:36)

Light and truth forsake that evil one. (D&C 93:37)

Salesmanship in Self-Talk

The heart will be enticed for good or evil. We need to sell ourselves on good.

*Our personal power lies in persuasion, not force or guilt.

The Rule of Distance

The greater the distance from temptation the greater the self-control and safety.

Boundaries

The Lord gives us laws and boundaries for good reasons.

•Rituals and patterns – be aware of where, when, and how the behavior occurs

•Set personal boundaries and rules

Computers in open areasPasswordsFilters

The Emergency Kit: Concentrated TruthREAD YOUR PERSONAL KIT WHENEVER STRONGLY TEMPTED

Part A Write out a convincing message to yourself about the positive reasons why you wish to stay morally clean.

Part B List all the possible consequences for continuing in this perilous behavior. Do not pretend that they cannot be serious. Add some personal messages to yourself that highlight not just what can happen, but how you will feel about these consequences should they occur.

Part C Add other information that can inspire you. These can be scriptures, statements by General Authorities, quotes, encouraging statements from loved ones, pictures of family members, or anything else that touches your heart.

Part D Add some last minute instructions to yourself suggesting what to do when sorely tempted (e.g. pray, read scriptures, call someone, take a walk, get involved in work or a hobby). You may also wish to add a couple of especially pointed remarks aimed at encouraging you to do the right thing immediately.

Group Check-In

Time sober

Formula

Action Step

Positive days

Lessons learned

The Self-Management Formula

1. Hit a home run each day (prayer, scriptures, Next 12 Steps manual, read your emergency kit). Make sobriety and spirituality your greatest daily goals.

2. Set your boundaries and limits. Defeat any rationalizations with truth and logic.

3. Thought-shifting techniques__sing a hymn, repeat a scripture, visualize a nature scene, use the cover-up technique.

4. If temptation persists, re-read your emergency kit.

5. What is my real need? BLASTED - bored, lonely, angry, stressed, tired, empty, depressed. Find positive solutions.

6. Resolve negative emotions. Acceptance, contemplation hour, magic list, editing technique. Use the Coping Skills App.

7. Keep in safe places, pray, call support people.

Role of the Rational Mind

1. Manage emotions. Sort out emotional thinking.

2. Impulse control

3. Motivation and self-discipline

4. Meet the needs of the emotional self- planning and wisdom

5. Develop effective attitudes and philosophies so can find joy and meaning in life.

Spousal Trauma

• Shock- I can’t believe this happening to me!• Hurt- How could he do this to me? He is my husband. He is supposed to

love me and care about my feelings.• Disgust- Who are you? How could you do those terrible things?• Betrayal- I thought I could trust you. You have lied to me. I don’t feel

safe with you anymore.• Insecurity- Did I cause this? Maybe this happened because I am not as

good a wife as he needed?• Anger- He is such a jerk to have done this to me. I’ll make him go

through hell and he won’t dare do this anymore. I will also make him suffer a little for what he has put me through. He deserves it.

• Fear- How can I cope with these emotions? I am completely overwhelmed.

• Powerlessness- Nothing I have done to fix this situation has worked.• Hopelessness- My life is a train wreck. Things will never be good again.• Emotional distance- I have no feelings for him. I just don’t care what he

does anymore.

Partner Daily Check-In

How are you doing today regarding:Temptation?- use the traffic light rating system

(green-good yellow- moderate concerns red- serious concerns)Physically? Emotionally? Spiritually?What made you happy today?What might have frustrated you today?Did you experience any sadness?What kinds of activities were you involved with?Did you have any good social experiences?Did anything interesting happen? Can I go over the Formula with you? What tools from the Coping Skills App are you going to use to manage your feelings? Let me know if you want me to help in any way.

• When sharing, try to keep it in the present for the most part. Practice vulnerability. Share how you feel, but avoid attacking or blaming.

• Guidelines for listening: Do not interrupt, avoid being defensive, use empathy skills to validate feelings, do not say the other person should not feel that way, avoid giving directions or suggestions.

Empathy: The Miracle Solution

Empathy Exercise1. I agree with your views in the following way...2. Considering your position on this issue, I think you might feel:(Circle the emotion words that apply.)

Sad, hurt, disappointed, frustrated, surprised, afraid, overwhelmed, panicked, pressured, lonely, angry, hopeless, crushed, disgusted, neglected, insecure, threatened, rejected, humiliated, uncertain, or discouraged.

3. Considering what you have told me, I believe you specifically want...4. I feel your desires are important and valid because...5. I am willing to show support by...

Coping Skills

The Positive PathChange your life by focusing on being happy

and relaxed one day at a time

1. Positive activities- The 4 L’s (love, labor, learning, leisure).

2. Spirituality- maintain the positive emotions of love, peace, and joy.

3. Truth- focus on keeping thoughts logical and positive.

4. Meaning- Be involved in good causes. Be passionate about developing talents.

The Contemplation Hour

People easily fall into a trap of feeling sad, angry, or guilty about the past and anxious or hopeless about the future. In short, they make themselves miserable by focusing on things they have little control over. We can change our lives by choosing how much time to spend dwelling on problems each day. One hour per day or less is recommended.

OK that’s enough on that problem. I can’t do anything about it right now. I need to keep busy and move on. I’ll think about it tomorrow.

Magic List Method

1. Tell your inner self you would like to know what the issues of concern are.

2. Write on a piece of paper the five greatest possibilities for what could be bothering you. Be creative and try to not censor anything.

3. Slowly read the list out loud to yourself.

4. As you read the list, note which issues bring forth the greatest levels of emotion. (This is how the inner self communicates about its troubles.)

Acceptance of Reality

The Serenity Prayer

God grant me the ability to accept the things I cannotchange, the courage to change the things I can, and thewisdom to know the difference.

The Editing Technique

a) Write out your distressing thoughts about the problem of concern.

b) Cross out lines containing exaggerating, judging and labeling, denial of reality, or predicting from your self-talk.

c) Use the Key Thoughts Guide below to correct your thinking:• What are some logical and rational statements I can make to help me

view this problem more clearly?

• Am I being positive in my attitude? What are some encouraging declarations I can make? What things are working in my favor?

• If the worst did come to pass, how could I handle it constructively?

d) Read the new statement five times.

Post-Battle AnalysisDid I pray and read my scriptures?

Where was I?

How was my mood?

Had I been productive?

What time of day was it?

What was my trigger?

What boundaries did I cross and what words of self-deception did I use for each wrong step?

Did I take out the Formula when I knew I was being tempted?

What tools could I have used?

If I won the battle, how would I have handled it?

What was the effect of giving in?

What was my real need and how could I have met it in a positive way?

What can I learn from this lapse?