Mindfulness and Addiction Recovery: A Brief History of Psychotherapy
First-generation therapies (the 1960s) are therapies that were born to overcome the limitations of psychoanalytic therapy, the dominant treatment at that time. You know, Sigmund Freud, a sofa, free association, repressed memories, all that mumbo jumbo.
First-generation therapies in opposition pitched behaviorism.
We are talking about Watson’s Classical Conditioning and Skinner’s Operant Conditioning. These types of therapies were useful for treating fears or phobias and were based on the principles of conditioning and learning.
However, neither the associationist learning model, Watson’s characteristic stimulus-response paradigm, nor Skinner’s experimental advancement was effective in treating a variety of psychological issues that some people presented.
Then, the second-generation therapies (the 1970s) emerged, which are mainly Cognitive-Behavioral Therapies (CBT) such as Rational Emotive Behavioral Therapy (REBT) by Albert Ellis and Cognitive Therapy by Aaron Beck.
They consider thinking or cognition as the leading cause of human behavior and, therefore, of psychological disorders.
However, the second wave of behavioral therapies continued (and continues) using techniques and procedures of the first generation and, therefore, focus on the modification, elimination, avoidance, and, ultimately, the alteration of private events (thoughts, beliefs, emotions, feelings, and even one’s bodily sensations).
In other words, these forms of therapy revolve around the idea that if the reason for the behavior is a private event, it must be modified to change the behavior.
This premise is widely accepted today, thus as a consequence, we leverage what’s established socially as normal as criteria to identify abnormal behavior or mental illness. Something that fits perfectly with a medical-psychiatric and even pharmacological model.
In the 1970s, Jon Kabat-Zinn, who was trained as a molecular biologist, began testing a new program called mindfulness-based stress reduction (MBSR), based on practices that have been around for thousands of years.
Mindfulness is grounded in the idea that we can relieve suffering by focusing our attention on our experiences in the present moment, as opposed to ruminating on the past or worrying about the future. Mindful awareness also includes a deliberate openness to our reality.
This was the birth of the third wave.
Third-generation therapies emerged in their totality in the 1990s, and differ from the latter because they approach the disorders from a contextualist, functional perspective. Their main objective was not to reduce the symptoms presented by the patient but to educate and reorient their life to a more holistic course.
They are based on the idea that it is not the events that cause discomfort or anxiety, but how we link emotions to them and how we relate to them (a behavioral, cognitive, and mindfulness angle).
Now each wave has its own approach to treating addiction. In this article, we are going to explore the third wave, its emphasis on mindfulness, and why it’s so revolutionary.
We’ve seen the medical and behavioral models as the primary routes for most of the 20th and 21st centuries. Confessedly and tragically, the judicial model may be the most prevalent i.e., incarceration for those afflicted.
Therapeutic communities seemingly blossomed with the massive growth of Alcoholics Anonymous. This makes sense, behavioral modification is patently directive as is AA, thus the two complimented each other as cheese is to a cracker.
Once CBT started to become more and more prevalent, in my estimate, it was observed to be largely ineffective in terms of producing long-term recovery. Therefore, the harm reduction model went into full sway.
What was missing was not, however, the need for more medication or a redefining of sobriety, but rather a shift in treatment loci.
Too much attention was paid to the mind at the cost of detrimental negligence of the body.
Finally, treatment has delivered a more holistic method, but this is not unanimous, and frequently centers will claim holism but only offer one yoga class!
Holism is that the human being is the sum of her parts. There isn’t a Cartesian split, as if humanity is merely a mind. Instead, holism is mind, body, relationships, and spirit. Grasping this truth is the essence of mindfulness.
What Is Mindfulness?
Have you ever noticed what you’re noticing? This is mindfulness.
Have you ever thought about what you’re thinking? This is mindfulness.
Have you ever picked up the bodily sensation that accompanied an emotion? This too is mindfulness.
Mindfulness means maintaining a moment-by-moment awareness of our thoughts, feelings, bodily sensations, and surrounding environment, through a gentle, nurturing lens.
If this doesn’t scream third-generation therapy then I don’t know what does!
If he takes the holistic elements seriously, mindfulness is indispensable to recovery. This is because addiction affects the mind, self, relationships, social systems, and the body. CBT can address the mind in relation to these other quadrants, but it doesn’t target them directly.
Mindfulness is always targeting and simultaneously in relation to everything else because it’s always experiencing the self in context.
Mindfulness As A Technique
Usually when a therapist uses the term mindfulness they refer to the active attention of one’s consciousness to the present moment.
Yet, this is an observation with the absence of an evaluation. We set aside judgment, analysis, and diagnoses. We do not critique how we feel but instead just tend to notice what it is we are thinking and feeling.
Emotional dysregulation is almost always in an intimate relationship with evaluation. It’s consistently in regret or resentment of the past and anxious anticipation of the future. In this manner, addiction is also romantically involved with an evaluative mindset. Until we can distance ourselves from this habit, our sobriety will be rocky at best.
As Gandhi said, “Don’t confuse what is a habit with what is natural.”
Our nature isn’t hostile, critical, and competitive. Instead, it’s steeped in nuanced relationships, nonjudgmental, and cooperative.
I won’t go into a philosophical squabble as to why this is so. I rather encourage you to practice mindfulness and arrive at this truth experientially on your lonesome. Or, if you so choose, disagree and bathe in your quagmire of analysis and critique.
A daily mindfulness practice will develop a growth mindset that will produce a contented and likely long-term recovery. Let’s pop the hood and ponder some of the mechanics.
The Tripod of Mindfulness in Recovery
As with everything in life, each therapeutic process has various mechanisms one can follow to make it successful. I’ve identified three major components that I’ve termed the tripod of mindfulness.
It’s worth noting that there is a spirit to these elements that extends beyond the mechanisms. Simply teaching one the mechanics can actually make it harder. To illustrate, let us use the analogy of riding a bicycle.
Learning To Ride A Bicycle
I remember teaching my oldest daughter to ride a bike with no training wheels. It was big girl time. As this was my first child I was prepared to show the world just what my bloodline was capable of.
I developed blueprints of the bicycle. I broke down the mechanics of cycling with the detail of a Biblical scribe. She had every smidge of information I could possibly inject her tiny brain with to make her a confident cycler.
Unfortunately, the plan backfired. It was information overload. She focused way too much on how it was “supposed to be done” and couldn’t find her rhythm. She just kept tossing the bike and landing on her ass. She finally found her balance but it only happened once she freed her mind of all the minutiae I polluted it with!
To experiment, with my second child I taught her nothing. I said, “You have to get on the bike and find your balance, good luck!” She was off and running in no time.
So, whereas I can teach some of the fundamentals, don’t let them bog you down. Start doing it and find your balance.
Intentionality: Mindfulness doesn’t occur on its own; the person must be consciously cataloging what they’re going through with each moment of time
Acceptance: The person must accept the feelings they are sensing and must not deny them
Non-judgment: Mindfulness doesn’t work if the person is actively judging and criticizing themselves. This is true if a person is overly confident or thinks highly of their emotions. It must be neutral and nonjudgmental to truly achieve mindfulness
Setting The Context: Meditation And The Racing Mind
One of my favorite comments regarding mindfulness and meditation is, “I can’t do it, my thoughts just won’t stop racing.” If your thoughts weren’t racing, guess what you wouldn’t need?
Yup, you got it – meditation.
Seasoned meditation practitioners don’t cease to have racing thoughts; they instead merely observe them.
They remain unattached and disidentified with the thoughts as they race on by. Whereas the novice swears a solemn oath that they are “my thoughts,” the sage acknowledges they are merely thoughts – they belong to no one until they are claimed, as in ownership.
In a similar fashion, if I go to Foot Locker to buy sneakers and surround myself with hundreds of shoes I certainly wouldn’t be bold enough to claim they are all mine, I’m not willing to pay the price.
Similarly, I’m not prepared to claim all thoughts as my thoughts – I’m unwilling to pay the price.
Not Willing to Pay the Price?
Many times, a struggling addict will take a string of negative thoughts and purchase them. They whip out the credit card and make them their own!
The general theme of mindfulness is to enable the addict to explore, interact with, and understand these thoughts in a safe and supportive environment.
Mindfulness allows the individual to return the shoes to Footlocker. Get your refund, not a relapse.
The bottom line is that mindfulness provides insight into triggers, behaviors, and the thoughts that accompany them. This empowers the addict by creating a manageable mental state and enabling the power of choice (the very faculty that disappeared during their addiction).
How Does a Person Achieve Mindfulness?
As already noted, the fundamentals are the tripod of mindfulness. Here we can impact them a bit.
To illustrate, imagine you’re feeling overwhelmed with negative thoughts and intense emotions. What now? How is mindfulness employed?
Well, begin by anchoring the wandering thoughts (that could exist in the past, future, some fantasy land, or distorted present) in the body. How? By focusing on one of its primary components: breathing.
Once the breathing is captured and rhythmically tapped into it, you can further ground yourself by picking up various sensations in the body and surfing the intense emotional wave until it crashes out. Check out ACT Urge Surfing to grasp this concept further.
Or, you can begin focusing on tangible things in your environment i.e., the chair, wall, color, clothes, etc. One such technique that utilizes all five senses of the body is the 5,4,3,2,1 Technique. This is comprehensive grounding at its finest!
The 5-4-3-2-1 Technique
5: Acknowledge FIVE things you see around you. It could be a pen, a spot on the ceiling, or anything in your surroundings.
4: Acknowledge FOUR things you can touch around you. It could be your hair, a pillow, or the ground under your feet.
3: Acknowledge THREE things you hear. This could be any external sound. If you can hear your belly rumbling that counts! Focus on things you can hear outside of your body.
2: Acknowledge TWO things you can smell. Maybe you are in your office and smell a pencil, or maybe you are in your bedroom and smell a pillow. If you need to take a brief walk to find a scent you could smell soap in your bathroom, or nature outside.
1: Acknowledge ONE thing you can taste. What does the inside of your mouth taste like—gum, coffee, or the sandwich from lunch?
Staying grounded keeps the thoughts from overpowering you, and keeps you from dissociating from the world around you. It might seem like mindfulness is tapping out, but in reality, you’re richly tapping in.
Tip: maintain an unconditional acceptance of your thoughts as they are. Recall the tripod: intentionally tap in, accept what you observe, and maintain a nonjudgmental stance. If you break the tripod you’ll lose your grounding.
Thoughts are temporary, they do not define you, and in a sense, they aren’t even yours. They just are. Never forget it.
Mindfulness and Rebuilding Past Relationships During Recovery
Let’s get real, addiction doesn’t just cause immense harm to your emotional state, your mind, and your body, but it significantly impairs you socially.
Addiction creates such distress to those around us that entire fellowships have emerged just to support people that love us.
That being said, treatment needs to pay close attention to our social systems. In the recovery world this is called Recovery Capital (you can read about it here).
While this consists of various components, a good support system composed of loved ones is essential to recovery. In short, all parties recover together.
This is one area where mindfulness can shine brighter than ten thousand suns!
One author writes,
Mindfulness, with its focus on what is happening now and doing so with openness, curiosity and acceptance, intensifies our sense of belonging. Paradoxically, being still and silent leads us to compassionate action towards others through recognition of our connectedness.
At any point in time, we can sense our connection to the community of people throughout the world who are meditating, doing Tai Chi or engaging in some other mindfulness practice; or experiencing chronic pain; or dealing with the impacts of adverse childhood experiences or other trauma; or trying to manage grief; or attempting to overcome an addiction or craving; or are experiencing anxiety and depression; or any other manifestation of the human condition. We can also become more conscious of our connection to every other living being as well as our connection with nature.
In other words, mindfulness allows a sense of unity and optimism in relationships. Not just with those closest to us but with the entire planet.
Mindfulness has been proven to create more satisfaction and unity in couples. Whereas addiction has been proven to do the exact opposite. I don’t need to cite a reference here, examine the evidence yourself.
Mindfulness can enable couples to work together, cope together, and recover together. How? It breaks down the various social conditionings, biases, emotional trauma, and pains that keep our individual selves separated from others.
One theory in particular, rightly called Ontological Addiction Theory, actually asserts addicts are merely addicted to themselves.
The following quote is a bit meaty, but if you take your time with it the information can be extraordinarily illuminating.
Ontological addiction is defined as “the unwillingness to relinquish an erroneous and deep-rooted belief in an inherently existing ‘self’ or ‘I’ as well as the ‘impaired functionality’ that arises from such a belief.”
In line with the growing integration of Buddhist principles into Western treatment settings, aspects of the theoretical underpinnings of OAT derive from the Buddhist philosophical perspective that all phenomena, including the self, do not manifest inherently or independently.
The Buddhist teachings assert that human beings – and all phenomena they interact with – are marked by the property of “emptiness” or “non-self.”
Emptiness (Sanskrit: śūnyatā) does not mean that phenomena do not exist or are not perceptible to the human mind but implies that they exist in dependence on all other phenomena and that they manifest only in a relative sense.
Thus, it could also be said that “emptiness” somewhat paradoxically implies “fullness,” because the attribute of interdependent existence that infers that a given phenomenon is empty of an independent self, means that by default, it signifies the existence of all other phenomena.
For example, a tree exists in reliance upon (among other things) (a) water (i.e., that in turn relies upon rain, oceans, and rivers); (b) air with an appropriate composition of gaseous elements (i.e., that in turn relies upon respiration in other life forms); (c) nutrients and minerals (i.e., that in turn rely on the decay of organic matter); and (d) light of an appropriate composition, temperature, and intensity (i.e., that relies upon the sun and the filtering effect of the earth’s atmosphere).
If any one of these contributing phenomena were absent, then the tree would not exist. Similarly, the tree is integral to the existence of all other phenomena. The tree is “empty” of an inherently or independently existing self but is “full” of the universe
If that was a bit too much, I sympathize with you. But it does demonstrate that who we think we are, we most certainly aren’t, but what we think, we probably are.
Let’s keep going.
How Mindfulness Can Help Cope with Violent Thoughts and Behaviors
Rage, anger, hostility, and unpredictable emotions can be extremely dangerous for addicts and alcoholics.
On page 66 in the Big Book Alcoholics Anonymous they write, “If we were to live, we had to be free of anger. The grouch and the brainstorm were not for us. They may be the dubious luxury of normal men, but for alcoholics these things are poison.”
Anger is a volatile and unpredictable emotion. Once it takes hold of you fully you don’t know where it will take you nor how quickly it will get you there.
It’s a beeline relapse to active substance use.
Mindfulness can powerfully counteract this. However, spontaneous mindfulness likely will not. It’s something that must be consistently applied daily for it to come in handy during low points and trials.
Nobody just wakes up one morning with zero training or preparation and runs a marathon. The same principle applies to our mental health.
The Importance of Practicing Mindfulness in Recovery
There is a strong correlation and mounds of direct and circumstantial evidence that mindfulness is a powerful model in the treatment of substance abuse.
Thoughts and emotions often overpower us, take control of us, throw us in the passenger seat, and drive us straight back into hell. Mindfulness helps you remain aware and in control – your hands on the wheel.
Attached is a wonderful PDF on various mindfulness practices you begin to implement in your daily routine immediately.
It was put together by the University of Wisconsin. Some of the content only applies to students, so disregard that. Pay close attention to the exercises and find a few you to begin practicing at once.