Emotional and Behavioral self management, behavioral self control, mindfulness, mental illness and addiction, co-morbidity

1. The Sciences & Recovery
A Whirlwind Tour of the Research and Strategies
October 7-9, 2011
David O. Saenz, PhD, EdM, LLC
Clinical and Consulting Psychologist
www.psych-consulting.com
(412) 853-2000

2. Learning outcomes-participants will….
1. How I got here
2. Have knowledge of basic statistics surrounding
addiction, and addiction & mental illness
3.Understand the research behind self control
4.Understand the basics of “mindfulness”, the
research behind it, and how it applies to improving
emotional and behavioral self control
5.Be able to apply a few Dialectical Behavior Therapy
skills (e.g., radical acceptance, emergency coping
plan, self control skills building) to improve self
management

4. 4
VULNERABILITY to ADDICTIONS
• 40% - 50% Genetics
• 50% - 60% Environment
Early Onset
Chemical Environment
Poor Nutrition
Emotional Stress
Poor Coping Skills
Chronic Physical Illness
Grief & Loss
Mental illness

5. Comparison of Relapse Rates Between Drug
Dependence and Other Chronic Illnesses
0
10
20
30
40
50
60
70
80
90
100
Drug
Dependence
Type I
Diabetes
Hypertension Asthma
40to60%
30to50%
50to70%
50to70%
Source: McLellan, A.T. et al., JAMA, Vol 284(13), October 4, 2000.
PercentofPatientsWhoRelapse

6. 6
Treatment Admissions by Primary Substance
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
1,800,000
2,000,000
1992 1994 1996 1998 2000 2002 2004
Alcohol Opiates Cocaine
Marijuana/hashish Methamphetamine
Source: Treatment Episode Data Set (TEDS) – Highlights 2004

9. Drug abuse costs in increased health care costs, crime, and lost
productivity.

10. EmotionalandBehavioral
Self-Control

11. Self-Control (SC) as a deplete-able Resource
• Self-control isn’t a characteristic or
trait that we either have or don’t
have- it’s on a continuum.
• It is typically a set of skills that
people develop through
experience (like a muscle).
• Not everyone’s experiences
facilitate the development of self-
control. (SC vs. self esteem)
• People exhibit self-control skills to
differing degrees in different
situations; it is not an all-or-none
phenomenon. RoyF.Baumeister,etalstudeies

12. Does making decisions deplete self control?
• Simple (?) choices & decisions in the last 35 years:
• Average American supermarket in 1960 carried
<3000 unique items: in 1976 it carried 9,000
different, unique products
• By 1980–30,000 (Waldman, 1992)
• By 2005–1 million & the average supermarket
carried 40,000 of them (Trout, 2005)
• Starbucks boasted in 2003 that it offered each
customer 19,000 beverage possibilities
• TV in the 1950’s - <13 stations (NBC, ABC, CBS),
today >600

13. • Iyengar and Lepper (2000) found that consumers who
faced 24 options, as opposed to 6 options, were less willing
to decide to buy anything at all.
• Those who did buy were less satisfied with their purchase.
The more decision-making required in choosing/deciding,
the greater the burden and the less able people are to
decide w/o anxiety and stress.
Does making decisions deplete self control?

14. • When people have exerted some of their self-
regulatory strength on a moderately to highly difficult
task they:
– Drink more alcohol even when anticipating a driving
test (Muraven, Collins,& Nienhaus, 2002),
– Are more prone to make impulsive purchases (Vohs
& Faber, 2004),
– Show higher levels of aggressive responding (Stucke
& Baumeister, 2006),
– Dieters are more prone to over-eat fattening foods
(Vohs & Heatherton, 2000)
Does making decisions deplete self control?

15. – Perform
inappropriate or
under-controlled
sexual behaviors (i.e.,
willing to have more
affairs when
depleted) (Gailliot &
Baumeister, 2005)
– Present themselves in
ways less likely to
make a good
impression (Vohs,
Baumeister, &
Ciarocco, 2005)
Self-Control as a deplete-able Resource

16. • Self-regulation consumes resources -
the self must override one response
and then substitute a different
response, and energy is required to
perform these interrupt and initiate
functions. Imagine all of the decisions
you have to make by the end of the
day!
• “ Men and their caves”
• Some choices are more depleting than
others. Pleasantness likely reduces the
stress level of choosing, therefore
there might be less depletion.
Self-Control as a deplete-able Resource

17. Drains on Self Control
• Making repeated choices/decisions over time or 1-2
difficult decisions (Vohs et al., 2004)
• Interacting with people about whom one has a
prejudice, e.g., minorities, obese people, LGBT’s,
(Richeson & Shelton, 2003)
• Being in a situation requiring much impression
management (Vohs et al., 2005) (Shakespeare & Goffman)
• Suppressing stereotypes is emotionally depleting
(Gordijn, Hindriks, Koomen, Dijksterhuis, & Van Knippenberg, 2004),
Anagram studies: George Bush = He bugs Gore; Madonna Louise
Ciccone = Occasional nude income

18. Replenishing Self Control

19. What is Mindfulness???
The practice of becoming focused and aware
of the present moment, rather than
ruminating on the past or projecting into the
future. Rumination/ worrisome projecting into
the future (or from the past) significantly
increases the struggle and weakens resolve,
problem solving, decision-making, logical-
rational thinking and emotional availability.
It’s about being "in the now” w/o judgment or
trying to change things–acceptance is key (it is
what it is).

20. • Acceptance is about not avoiding or fighting for
control, but about allowing things to be as they
are.
• The aim is to try and change reactions to the
emotions or thoughts, while being careful not to
reject, challenge or minimize the emotion itself.
What is Mindfulness???

21. www.Thwink.org

25. • 1979 Dr. Jon Kabat-Zinn founded the Mindfulness-
Based Stress Reduction program at UMass to treat
the chronically, physically ill. Now used as a
primary treatment for pain, stress, anxiety, anger
issues, explosive disorders, histrionic and avoidant
personality disorder, paranoid personality
disorder, major depression, eating disorders,
addiction, etc.
• Police officers in Los Angeles and in Madison,
Wisconsin, have received mindfulness training
• Many law firms offer mindfulness classes.
Replenishing Self Control

26. Who Uses Mindfulness
• Mindfulness is used in prisons, reducing hostility
and mood disturbance among inmates, and
improving their self control
• There are >300 mindfulness programs in hospitals
and clinics throughout the U. S.
• Many government organizations offer mindfulness
training, including parts of the Armed Services
• AYD program in Pittsburgh teaches mindfulness to
at risk inner city middle schoolers.

27. Outcomes Research on Mindfulness
• Jain and Shapiro (2007)–mindfulness is specific in
its ability to “reduce distractive and ruminative
thoughts and behaviors”. Reduces emotional
reactivity to stressors.
• Garland (2009)—found declines in stress after
mindfulness interventions, which were potentially
due to the positive re-appraisals of what were at
first appraised as stressors.
• Arch (2006)–Mindfulness provided positive
responses to emotionally neutral visual slides,
while "unfocused attention and worry" control
groups responded significantly more negatively to
neutral slides.

29. Outcomes Research on Mindfulness
• Davidson (2003)—found that mindfulness exercises
decreased anxiety and "negative" affect and
increased positive affect long after the exercises
had ended.
• Brown (2009)—found that a large discrepancy
between financial desires and financial reality
correlated with low subjective well-being, but that
the accumulation of wealth did not tend to close
the gap. After mindfulness training, there was a
lower financial-desire discrepancy and thus higher
subjective well-being (mindfulness may promote
the perception of “having enough”).

30. • Enable people to better notice, observe, and
attend to sensations and perceptions and not
allow strong visceral sensations to drive behavior.
• Increase awareness and recognition of the effects
of decisions and thoughts.
• Increase the ability to describe experiences in
words and less in senses followed by
action/decisions.
• Decrease closed judgmental thinking and the
spiral of critical and self defeating cognitions &
mood.
What mindfulness can do….

31. • From street bride to valedictory speech
• Nostril to nostril breathing
• Consciously sit up straight and improve posture
• Research shows that when sticking to a mild exercise program,
participants:
– Became more successful at reducing cigarette smoking,
alcohol use, and caffeine consumption
– Ate less junk food and ate more healthy food
– Reported improvements in emotional control and a
reduction in impulsive spending
– Reported studying more and watching less television.
– Improved domestic habits (e.g., washing dishes instead of
leaving them in the sink) Oaten & Cheng, 2004, Pylyshyn & Storm, 1988;
Scholl, Pylyshyn, & Feldman, 2001).
The Art of Replenishing Self Control/Willpower

32. • Researchers found that self-regulation training in
money management (simply keeping close track of
spending on a daily basis and making small
spending decisions) resulted in the following
positive changes:
–Significant decreases in psychoactive substance
use, including smoking, caffeine, and alcohol
consumption. These reductions were not just
significant but also substantial (mean reductions
of 15 cigarettes, 2 cups of coffee, and 2 alcohol
drinks per day!).
The Art of Replenishing Self control

33. • Cont.:
–Decreased expression of negative emotional
reactivity
–Higher maintenance of household chores
–Improved study habits
–Shift to healthier foods even if such foods cost 3-
4 times more than unhealthy foods
PSS: Cohen, Kamarck, & Mermelstein, 1983, GHQ:
Goldberg, 1972),
The Art of Replenishing Self Control/Willpower

34. Comorbidity: Addiction and Mental Illness

35. Comorbidity: Addiction and Mental Illness

36. Comorbidity: Addiction and Mental Illness

37. Comorbidity: Addiction and Mental Illness

38. Mental Illness and Alcohol Dependence
• 35% of women with ED have AD
• 30-40% with schizophrenia have AD
• 30-50% with Major Depression have AD
• 60% with Borderline Personality have AD
• 28-30% with Bipolar Disorder have AD
• If you have alcoholism, or an anxiety disorder, you
are 3 times as likely to have the other. Between 22
percent and 69 percent of alcohol-dependent patients
have comorbid anxiety disorders.
• Extras: 40% of tobacco is sold to those with MI
• 85% of those experiencing schizophrenia smoke

39. A large majority of people who
are addicted to illegal drugs
have a concurrent alcohol
disorder:
Cocaine 89 percent
Amphetamine 78 percent
Opioid 74 percent
Cannabis 68 percent
Most people who have alcohol
use disorders do not have
drug use disorders, but >50%
people with drug use
disorders also have an alcohol
use disorder.

40. Comorbidity increases complexity of alcoholism…

41. Teens: Comorbidity can mean more conditions…

45. Radical Acceptance: Acceptance is about
turning your mind toward the acceptance road
and away from the “rejecting reality” road. It
minimizes the struggle and does not deplete self
control b/c emotional resources are targeted into
managing emotions and problem resolution.
A Few Dialectical Behavior Therapy Strategies

46. Dialectical Behavior Therapy

47. A Few Dialectical Behavior Therapy Strategies
Radical Acceptance Coping Statements:
• It is what it is, this is how it has to be
• All the events have led to this
• I can’t change what has happened (Poker hand)
• Fighting the past only eats up limited energy
• This too will pass
• Even if I don’t like what’s happening right now, it’s
perfect.

48. • Make an inner COMMITMENT to accept things as
they are, akin to working with the hand your dealt as
opposed to sweating it (what happens if you sweat it
out in a poker game?).
• The COMMITMENT 1st turns person toward a path.
• Turn the mind to commit to acceptance repeatedly.
Sometimes, one has to make the commitment several
times in the space of a few minutes
• Commitment binds one to a course of action, which
research indicates increases performance in that
direction.
A Few Dialectical Behavior Therapy Strategies

49. Distraction plan: develop a detailed plan for
distracting yourself during stressful periods:
• Hold an ice cube in your hand
• Do chores
• Call someone
• Volunteer at the Humane Society
• Go for a bike ride or a walk
• Watch a movie
• Learn self soothing skills
• Safe place visualization: My safe space is_____
• The reason I feel safe here is________.
A Few Dialectical Behavior Therapy Strategies

50. • Obstacles to improving on self control:
• Desire: The desire that things were different right now. A
wish that reality was not as it is. A desire to be someone
different, to feel better, to be happier.
• Aversion: Being angry, afraid, anxious, or ruminating at
what is happening now. A negative judgment about what
is now is an expression of aversion.
• Tired/sleepy/dull/heavy: Not actual but brought on by
the sensation of yet another crisis, issue or concern.
• Restlessness: An overwhelming storm of thoughts,
sensations, demands and distractions.
• Doubt: Inner voice of “I can’t do this any more… I can’t
handle it… What good is this… How can this happen to
me?”
A Few Dialectical Behavior Therapy Strategies

51. • Simple strategies to Overcoming Obstacles:
• Desire: Notice and name desire for what it is (keep
feelings cards). Recognize that getting what you want is
never enough. Realize that desire w/o preparation is like
bench pressing 400lbs 10 times on your 1st day at the gym.
• Aversion: Name the feeling. Recognize it’s teaching
potential– why anger now? What is its function/purpose?
• Tired/sleepy/dull/heavy: Sit up straight… water on your
face. Take a break and be active- walk, jog, vacuum.
• Restlessness: Narrow your focus. Wandering minds
result from this, focus on a body part (nose), count your
breaths, deep breath slowly, be mindful.
• Doubt: Focus only on present moment. Bring nothing
from the past to the moment.
A Few Dialectical Behavior Therapy Strategies

52. • Create an emergency coping plan:
• When I’m upset with myself, someone else or a
situation,
• First I’ll do_________________________
• Next, I’ll do ________________________
• Then I’ll___________________________
• Finally, I’ll__________________________
Copy the plan and keep one in your wallet or purse,
another one on the fridge, and still another one on
your restroom and bedroom door. These are reminders
and keep you from stressing over what you’re
determined to do.
A Few Dialectical Behavior Therapy Strategies

53. Why do women live longer than men?

57. What No One Will Ever Tell You…. But I Will
Sooo… why do women
live longer than men?....