Trauma & Attachment Therapy

Addiction, a form of dissociation, II

Ulrich Lanius, a clincial psychologist, researcher, therapist, and writer in Vancouver sent me this:

"The connection between dissocation, depression and addiction is a fascinating one and more likely than not  related to attachment. An article written by Bessel van der Kolk some insight into this:

http://www.cirp.org/library/psych/vanderkolk/

For more intensive reading, Alan Schore describes the effect between attachment and infant trauma and how they lead to traumatic stress syndromes:

http://www.trauma-pages.com/a/schore-2001b.php

There is little doubt that dissociation is in part mediated by an excessive release of endogenous opiates/endorphins. Animal studies that mimic neglect also suggest that animals that have experienced lack of caregiving have fewer opiate receptors. This likely  leads to lack of pleasure and sometimes intolerance of positive emotions, a common phenomenon in human beings that have experienced attachment trauma and who suffer from depression.

Addictions can be seen as an attempt by the addict to make up for impaired functioning of their own opiate system. Except that the pleasure derived is short lasting and commonly leads to negative outcomes in the long run, health or otherwise.

Another exciting development in the research on opiates are the effects of opiate antagonists on immmune system disorders but also potentially positive effects on depression. A review paper can be found here:

www.ldn4cancer.com/techpapers/ldn_for_disease_prevention_quality_of_life.pdf  "

Thanks Ulrich!

Mindfulness Through Pleasure

Mindfulness is a major goal of psychotherapy. We want our clients to be able to savor the moment free of intrusive memories or worries about the future: Right Now. There are many ways to bring a client to the present moment: teaching mindfulness meditation, body awareness, or playing what do you notice? ("Name 3 things in the room that are red, 3 things you hear, 3 sensations.")

Some of my more anxious clients find that their obsessiveness scuttles attempts to meditate ("Am I doing it right? This is stupid? What am I supposed to be focusing on? I can't do it!). Body awareness reminds them of what could go wrong with their bodies. ("What if I stop breathing?!) I'm teaching these folks to make state changes through noticing pleasure. Here's how it works:

"Look around the office. Look out the window. Notice what catches your eye. Notice what's fun to look at or that you enjoy seeing. Stay with whatever it is, as long as it's interesting or pleasurable. (Usually they start to smile and to relax at this point.) When you're ready, and only when you're ready, look around for something else that pleases you. Stay with that object or view until you feel like moving on. Stay with it as long as you like. Great!" (We usually do 3 objects or views. I say that my eye can be pleased by looking at the angles on a molding, or 3 planes coming together in the corner of the room. I only have art that I like and little objects scattered about to look at. I tell them how much I like to look at the big tree across the street. This kind of pleasure can be a new experience for some, and quite profound. For others, it's not new, but consciously using it for mindfulness or self-soothing might be new.) "Now notice how you're sitting on the couch. Could you do anything to make that more comfortable? Try sinking into those cushions. How's that? Try sitting straighter or sticking this pillow behind your back. What feels the best? What fabric feels the best under your fingers? How about your hair on your hand? Do you like that texture?" (Crew cuts win this one!) Hang with what feels the best. Can you imagine the next time you take a shower, totally feeling that hot water, and enjoying it? Can you imagine being worried about something that you don't have power over, and finding something pleasing to look at or feel or smell or do? Think of something that might happen at work, and soothing yourself with something you enjoy. Think of something that happens at home, and coming back to yourself and this moment with something pleasing. If you commute, think of the irritating drivers and the waiting, and how you can shift your body in the car for your best comfort, and look at something interesting, a cool car, the view, a cloud, a bumper sticker, and while still paying attention to driving, have a little pleasure vacation."

People do this homework. And it works, even with the most anxious. And it doesn't feel like work. And they learn both mindfulness and painless state change. It doesn't clear underlying trauma. It doesn't take away an anxiety disorder. But it's a nice, easy habit to take on.

Is addiction a form of dissociation?

I read an article about how naltrexone, an opiate suppressant, curbs the urge to engage in kleptomania. I've had dissociative clients who have successfully used naloxone and naltraxone to vanquish their endogenous (internal) opiates, in order to be able to stay present and process traumatic events, instead of switching or spacing out completely. (See EMDR Processing w/ Dissociative Clients: Adjunctive Use of Opioid Antagonists by Ulrich Lanius, in EMDR Solutions: Pathways to Healing, 2005). I've also had success using ego state work with addicts, alcoholics, and people with compulsive/addictive behaviors. Here's my theory: Opiate Antagonists work on dissociation because much of dissociation is run by endogenous opiates. When addicts think of their drug or behavior of choice, they begin to enjoy their endogenous opiates. When they engage in their drug or behavior it gives them an even better high. The neural pathways to the repetitive addictive behavior become wide and strong, until they become ego states. When people in recovery talk about "my addict", they refer to this strong ego state. Integrate the ego state and help heal the addiction.

So how does this work? Have clients bring up the last time they were frantic to use, or the last time they did use. "Where do you feel that inside? What's the feeling? Float back to the first time you had that feeling. How old is that? What was happening then? Can you bring your adult back to that time/that kid? What do you need to tell that child? You're with her. You can fly her up to the present time. She's with you all the time, now, and you're with her. Can you tell her that now, as a competent adult, you can tolerate those enormous feelings? Can you show her how you have learned to soothe yourself without that drug/behavior? How's that kid doing now? (Do whatever it takes to calm her down.) And are you ready to hug her into you now and forever?"

There is usually a frantic little child and often an angry/protective teenage part. Sometimes there are several "parts" involved in different pieces of the addiction. It has worked on several clients.

A.J. Popky and Jim Knipe have protocols that seem to fit my opiate theory. Popky developed the Level of Urge to Use. Knipe spun off the Level of Urge to Avoid. In both of these you have the person imagine whatever triggers them to use a drug or to avoid a task and to feel how good it would feel to use or avoid. Then you do eye movements and watch the good feeling start to fade away. (DeTUR, an Urge Reduction Protocol for Addictions and Dysfunctional Behaviors by Popky, and Targeting Positive Affect to Clear the Pain of Unrequited Love, Codependence, Avoidance, and Procrastination-- both in EMDR Solutions: Pathways to Healing, 2005, Norton.) You target inappropriate positive affect in both cases. When the positive affect (the good endogenous drugs) fade, you target the distressing affect underneath, and the trigger stops being a trigger. I've done this many times, for many addicts. It works amazingly well.

I've watched clients and people in my private life turn into unrecognizable demons, sociopaths, and screaming or pleading children while in thrall to their addictions. The dissociation/opiate theory explains these behavioral shifts. Please comment and give me your opinion about this theory.