Ditch Your AddictionPart 2

A step by step approach by Henck van Bilsen

Exercise 1

Step two: Are you in charge or the addiction? = regaining self control

• here you keep a record of your addictive behaviour and/or desire for it, make a plan for gradual reduction that includes rewards for effort and goals achieved

• For this step it is very important to get an overview of how frequently you engage in the habit behaviour. It is also important to investigate what other kinds of activities you do during the days (in preparation for step 3). So it would be very helpful if you could complete the next exercise for at least two weeks.

Exercise 4: Activity and Problem recording

Conclusions based on two weeks of self-observation

• Are you content with the level of pleasure and satisfaction in your life?• Can you see a pattern in your habitual/addictive behaviour

– Time of day– People and places– Feelings and moods– Activities– Days

• Think about where you would like to be regarding your habit. Some habits can be eradicated completely, others need to be controlled.– It is possible to stop drinking alcohol completely– It is not possible to stop eating completely

• Based on your experience of the last two weeks, complete exercise 5a.

Exercise 5a: Identifying your goal

Further Instructions

• Now you have set your end goal it is time to set goals for the next week. Complete the first part of exercise 5b and continue to keep records with exercise 4, so you can complete the rest of 5b at the end of the week.

• Each week you also need to add a new rule to your habit (see page 11 for a list).

• Each time when you do your habit WHEN YOU DID NOT PLAN TO DO IT, please complete form 6.

• Each week you have achieved your goal you need to give yourself a small suitable reward.

Intermezzo

• Why do we do things too much that are not good for us and why is it so difficult to change?

• Human beings are hard-wired for fast working effects: this means that we are more inclined to repeat behaviours that quickly have an impact on how we feel and think. Many problematic habits fall in this category:– Drinking alcohol: alcohol takes effect very quickly– Eating ‘junk food’: these are often filled with fat, salt and/or sugar

AND they are sometimes designed to be absorbed rapidly in our bloodstream

– Working: concentrating on work can be all-absorbing and everything else moves to the background.

What feels good

• if we do something (eating chocolate) frequently and it produces good feelings (you have to think outside the box here as ‘good feeling’ could be the removal of negative feelings), then doing the activity (eating chocolate) will result adding positive feelings to otherwise negative feelings.

• For instance a person with a habit of eating too much chocolate may find that when they are bored, eating chocolate helps to feel less bored, even if the amount of chocolate they eat makes them physically sick.

All habits

• that we have engaged in frequently and over an extended period of time will trigger a physical and psychological effect if we stop doing it. You can try this easy by stop doing ‘normal’ things you do frequently: stop drinking coffee, stop drinking tea, stop doing your morning walk etc.

• If there is a substance involved (coffee, chocolate, alcohol etc.) then the physical ‘withdrawal’ symptoms may be more intense. However, even people who stopped watching TV for a week reported physical withdrawal symptoms! So don’t be surprised if your mind and body protest against having the take less then what they are used to!

New Rules for Habits

• Time Rules– Only do the habit after …..hours.– Only do the habit before …… hours.– Only do the habit between ….hour and ….hour.– Only do the habit for …….hours at any given time.

Location Rules

• Only do the habit in the kitchen.• Only do the habit in the bathroom.• Only do the habit in the toilet.• Only do the habit standing up, outside.• Only do the habit in the car.• Only do the habit in the office.• Never do the habit in the…….

Activity Rules

• Before doing the habit, do the following• Drink……• Eat…..• Walk…..• Run……• Make a phone call……• Have a bath• Watch a movie• Sing a song• Do the dishes• Clean the kitchen• Vacuum the house• Start a conversation with a stranger• Finish the sentence: I need to do ….(habit) because……

Habit rules

• Change the way you consume:– From knife and fork to eating with hands– From eating with hands to eating with knife and fork– Drink the substance warm instead of cold– Drink the substance cold instead of warm– Take the food/drink in your mouth, don’t swallow it and spit it out after 10

seconds• Pausing

– When drinking make one glass/bottle last ….minutes.– Drink from a different (bigger/smaller) glass– When eating keep the food in your mouth, while chewing, for at least …

minutes– Pause for …. Minutes between sips or bites.– When you feel the desire to do the habit wait ….minutes before doing it.

Exercise 6: Finding out what makes you use too much: eliciting circumstances

Step three: Your need for the good things in life

• Life style balancing: here you learn to engage in and plan for other pleasurable and satisfying activities besides your addiction

How to re-activate your Yourself?

• People engaging in certain habits too frequently find it often difficult to retain daily routines and stay active. This is an enormous problem.

• Lack of activity brings with it a range of psychological and physical problems.

• Reduced activity patterns lead to:– increased feelings of lethargy, – increased depression,– increased vulnerability to emotional upset, – sleep problems etc.

• These problems in their turn might make it more difficult to remain/get active and lead to becoming more and more engaged with the addictive behaviour/habit.

The problem

• Addiction is a vicious circle. • It slows you down, mentally and physically. • Everything –apart from the habit/addictive

behaviour- becomes an effort, and you tire easily. You do less, and then blame yourself for doing less. You come to believe that you can do nothing, and that you will never get over this problem. Then you start to feel depressed. It becomes even more difficult to do anything. And so it goes on.

Overcoming the problem: activity scheduling

• Becoming more active is one way of breaking the vicious circle. It has a number of advantages:

• Activity makes you feel better. – At the very least, it takes your mind off your painful feelings. It can give you the sense

that you are taking control of your life again, and achieving something worthwhile. You may even find that there are things you enjoy, once you try them.

• Activity makes you feel less tired. – Normally, when you are tired, you need rest. When you are depressed, the opposite is

true. You need to do more. Doing nothing will only make you feel more lethargic and exhausted. And doing nothing leaves your mind unoccupied, so you are more likely to brood on your difficulties, and to feel even more depressed.

• Activity motivates you to do more. In addictions, motivation works backwards.– The more you non-addiction activities you do, the more you feel like doing more of

them.• Activity improves your ability to think.

– Once you get started, problems that you thought you could do nothing about come into perspective.

Getting Going• In spite of these advantages, getting going again is not easy. This is because the

gloomy, pessimistic thoughts that are typical of depression stand in your way. When you are depressed, you may think that you are doing nothing, achieving nothing, and enjoying nothing. It may be difficult to organize your time productively, or to involve yourself in things you normally enjoy. When you are faced with something you want to do, you may find yourself thinking: 'I won't enjoy it', 'I'll only make a mess of it', or 'It's too difficult.' Thoughts like these stop you from taking action and help to keep you in the vicious circle.

• Later on in therapy, you will learn how to work directly on depressing and addiction promoting thoughts, which stop you from getting down to what you want to do. Your goal will be to notice and challenge the thoughts, so that they no longer stand in your way. First of all, though, you need to get a detailed idea of exactly what you are doing, and how much pleasure and satisfaction you get from what you do. What you discover will help you to plan your time so as to get the most out of each day's activities. This is called 'activity scheduling', and you will find details on how to do it below. There are two steps involved: self-monitoring, and planning ahead.

Step I: Self-monitoring

• 'Self-monitoring' simply means observing your pattern of activities. It involves keeping a detailed record of what you do, hour by hour. You can do this in a notebook or diary, or your therapist will give you a special record-sheet.

• Your record will show you in black and white how you are spending your time, and will make you aware of how much satisfaction you get from what you do. This will allow you to test thoughts like 'I'm not doing anything', or 'I don't enjoy anything I do', and to see if they hold water when compared with the facts. You may well find that you are more active and competent than you assumed, and that you are enjoying yourself more than you thought. Even if this is not the case, you will have a factual record to help you find out more about what is getting in your way, and to form a basis for changing how you spend your time.

How to do it

• For the next few days, in your diary or on your record-sheet, write down:

• 1. Your activities– Record exactly what you do, hour by hour (you can use exercise 4 for this.

• 2. Pleasure and satisfaction/satisfaction/achievement – Give each activity a rating between 0 and 10 for pleasure (P) and for

satisfaction (S). 'P' refers to how much you enjoyed what you did. So 'P10' would mean that you had enjoyed something very much. 'PO' would mean that you had not enjoyed it at all. You could use any number between 0 and 10 to show how much you had enjoyed a particular activity. 'S' refers to how much satisfaction you experienced in what you did. How much of an achievement was it, given how you felt? 'S 1 O' would mean that what you did was a real achievement. 'S O' would mean that it was not an achievement at all. Again, you could use any number between 0 and 10 to show how much satisfaction was involved in a particular activity.

Common problems in self-monitoring

• Thinking you are doing nothing – Sitting in a chair in front of the television is an activity. So are going to bed, and staring out of the

window brooding. You are never doing 'nothing'. But some activities may be less helpful to you than others. It will help you to identify these if you specify on your record-sheet what they are, rather than simply writing 'nothing'.

• Underestimating your achievements – 'S' should be rated for how difficult an activity is for you now, not how difficult it was for you before

you got depressed, or how difficult another person might find it. When you are depressed, things that would normally be very easy become difficult. Even getting out of bed, or making a slice of toast, can be a major achievement, given how you feel. Beware of thoughts like 'But I should be able to do this well', or 'So what? Any fool could do this.' This will only keep you trapped in depression's vicious circle. Take a stand against them by making sure that you give yourself credit for what you do.

• Delaying your ratings. – It is important to rate your activities for P and for S at the time. If you wait until later, your depression

will colour how you see your day, and may well cause you to ignore or devalue good things you have done. When people are depressed, bad things that happen are easily noticed and remembered. In contrast, good things are often blotted out or discounted. If you make your ratings at the time, this bias in how you see things is less likely. Immediate ratings will also help you to become sensitive to even small degrees of pleasure and satisfaction, which might otherwise go unnoticed.

Step 2: Planning ahead

• Now that you can see how you are spending your time, the next step is to plan each day in advance, making sure that you include activities, which will give you a sense of pleasure and satisfaction.

• Planning ahead will allow you to feel that you are taking control of your life, and will give you a sense of purpose. The framework you give yourself will prevent you from sinking into a swamp of minor decisions ('What shall I do next?'), and will help you to keep going even when you feel bad. Once the day's activities are laid out in writing, they will seem less overwhelming. You will have broken the day down into a series of manageable chunks, rather than a long shapeless stretch of time, which you must somehow fill.

How to do it

• Plan your activities – Every evening, or first thing in the morning, set aside time to plan the day ahead. Find out which time suits

you best to do this, remembering that you are likely to be able to plan most realistically and constructively when you are feeling relatively well and clear-headed. If you find it difficult to remember to make time to plan ahead, give yourself reminder cues. Put up signs around the house, for example, or ask someone to remind you that 7.30 is your time for planning tomorrow. As far as possible, try to ensure that your planning time is not interrupted, and that there are no other pressing demands to distract you. Turn off the television, and take the phone off the hook.

– Aim for a balance between pleasure and satisfaction in your day. if you fill your time with duties and chores, and allow no time for enjoyment or relaxation, you may find yourself feeling tired, resentful, and depressed at the end of the day. On the other hand, if you completely ignore things you have to do, you may find your pleasure soured by a sense that nothing has been achieved, and your list of necessary tasks will mount up. You may find it helpful to aim for the pattern of activities you found most rewarding in the past. There is a fair chance that, once you get going, you will find this pattern works for you again.

– Encourage yourself by starting the day with an activity which will give you a sense of satisfaction or pleasure, and which you have a good chance of completing successfully. This is particularly important if you have trouble getting going in the morning. And plan to reward yourself with a pleasurable or relaxing activity when you tackle something difficult. You might, for example, set aside time to have a cup of coffee and listen to your favourite radio programme when you have spent an hour doing housework. Avoid bed. Beds are for sleeping in, not for retreating to during the day. If you need rest or relaxation, plan to achieve it in some other way.

– To begin with, you may find that trying to plan a whole day at a time is too much for you. If so, break the day down into smaller chunks, and deal with them one at a time.

Record what you actually do • Put your plan into practice. Write down how you in fact spend your time on your record sheet, just as you

did at the self-monitoring stage. Rate each activity out of 10 for satisfaction and pleasure.• Review what you have done

– At the end of each day, review what you have done. Take the time to sit down and examine how you spent your day, how much pleasure and satisfaction you got from what you did, and how far you managed to carry out the activities you had planned. This will help you to see clearly how you are spending your time, what room there is for improvement, and what changes you might like to make in the pattern of your day.

• If you have managed overall to stick to your plan, and have found what you did reasonably satisfying, this gives you something positive to build on. If on the other hand you did not stick to your plan, or you got little satisfaction from what you did, this will give you valuable information about the kind of things that are preventing you from making the most of your time. – What exactly was the problem? – Did you over-estimate what you could do in the time available? – Did you feel too tired to carry out everything you had planned? – Did you aim too high, forgetting to take into account how you feel at the moment? – Did you spend your day doing things that you felt you ought to do, rather than things that would give you

pleasure and help you to relax? – Were your best efforts blocked by pessimistic thoughts?

• If you could not find sufficient satisfying and/or enjoyable activities to do the next list may be helpful.• If you can find out what went wrong, you can learn from these experiences. Use what you have found

out to help you plan in future.

A List of Activities that could give pleasure and/or satisfaction

Step four: Re-train the brain =

• Thinking about your thinking: here you need to learn to think differently about chocolate and things that trigger a desire for the addictive behaviour (stress).

• You will have noticed by now that before you engage in your habit at moments when you did not want to do it you are often thinking things that ‘promote’ doing the habit.

• John a workaholic noticed that each time when he drank alcohol (although he wanted to stay abstinent), he said to himself:– I really deserve it, so I must have it!– I have to have a drink– I can’t stand being without a drink for another minute.

• If the goal is to not drink alcohol, it is immediately clear that thoughts like this:– Are not helpful– Are not based on factual reality.

• Thinking that produces negative feelings and/or leads to behaving in an unhelpful way is called IRRATIONAL THINKING.

• If you want to ditch your addiction, you also have to ditch and replace your irrational thinking.

Some examples of irrational thinking.

Now list these thoughts in the column on the left and see if you can identify the thinking error you are making.

From NATS to RATS• Recognising your irrational thinking is one step, the next step is to

replace it with more rational thinking. The thinking you listed on the previous page is what we can call negative addiction thinking (NAT) and in order to overcome your addiction it is important to replace that with rational addiction thinking (RAT). So in other words you need to go from NATS to RATS!

• Rational Addiction Thinking is based on:– It is helpful to break the addiction– It is realistic AND BELIEVABLE– It acknowledges negative feelings (as opposed to denying them)– It is focused on self-acceptance (as apposed to self-condemnation)– It is focused on personal resilience (as opposed to ‘I can’t stand-itis!’)– It is focused on personal preferences (as opposed to demanding thinking).

In summary

• To ditch your addiction– Plan for it!– Start by recording how much, how often, when and

where– Plan a gradual reduction (or if you must a sudden

stop)– Set up rules and regulations regarding your addiction– Plan for rewards– Change your life style: plan for the good things in life– Go from NATS to RATS