New Year Resolution

How long can you hold your breath? If you are a smoker, the results of this test would predict the likelihood of being successful at quitting those cigarettes. This is not because holding your breath is related to your lung capacity. Rather, it has something to do with distress tolerance.

 Now that New Year is with us again it’s time to think about resolutions, like giving up smoking, doing more exercise or going on a diet

Smoking is tricky to stop for three basic reasons: 1) It is a well-rehearsed habit. 2) Nicotine is physically addictive. 3) Smoking provides and maintains a sense of comfort. Although there are good treatments for smoking cessation, a sizable percentage of people attempting to quit never abstain from cigarettes for more than a few days. 

Modern ideas of health and wellbeing are based on the idea of an absence of illness or feeling bad, this implicitly implies that a healthy person will never feel bad and is in complete control. Of course there’s nothing like giving up smoking to make one feel bad, due to the additive nature of nicotine. The idea that we can give up smoking by willpower alone is a myth that Acceptance and Commitment Therapy (ACT) tackles.

 In normal circumstances if something external makes us feel bad we can try to get rid of it, and this strategy works well 9 out of 10 times we use it. But because this strategy is verbally established in society we will use it in situations where it will not be helpful, such as trying to stop feeling bad when we’re stopping smoking. This is what is known in ACT as an “unworkable change agenda”.

ACT proposes a different approach; basically two processes of Acceptance and Committed Action are tackled using 6 core principles of ACT.

1: Undermining Control, Acceptance and Willingness: Understanding that the strategy of willpower and trying to control is futile for trying to stop smoking. Opening up to, or being willing to feel bad because we are doing something that is important to us. Lastly accepting and just noticing how we feel and what we are thinking.

2: Undermine Cognitive Fusion: This the process of realising that when our mind tells us “you have to smoke or you’ll die” it is just trying to protect you from nicotine withdrawal, so just gently thank it and remind it that smoking a cigarette right now is not helpful. Remember your mind is there to protect you, and often has its own agenda. I used to think my brain was the most important part of my body, until I realised who was telling me that.

3:  Getting in Contact with the Present Moment:           This is all about showing up and being there. Pain and suffering are part of the human experience, but we refuse to accept it and spend a great amount of our time avoiding life, which at times can be unpleasant. To give up smoking we must be present and be prepared to experience cigarette withdrawal. I’m not talking about tolerating, but really being present with it and not trying to avoid it. Get in contact with the withdrawal, where does it appear in your body, how does it feel. Is it big, small or hot or cold? When urges come, imagine surfing on them until they break like waves, but never try to avoid them.

4: Distinguish Conceptualized Self from the Self as Context: This is the ability to separate ourselves from our inner private experience. In Western Culture we don’t have a name for this, but in many eastern cultures there is a difference between a transcendental self which observes ourselves as thinkers and planners. We are not these thoughts or these plans but just the arena where they take place. If we can get in touch with this transcendental self we could observe ourselves thinking and planning and realise that those thoughts and feeling and emotions are not us and we can create distance between us and any thoughts and feelings we may have related to smoking.

5: Values: There is a reason why we want to give up smoking. Giving up is a goal that we wish to achieve, but to understand why we must look at the values that undermine the goal of stopping smoking. Although the goal is the same for everyone, the value will be different. To feel fitter, so my baby doesn’t grow up in a smoky atmosphere, to save money...etc. The list of values as to why we give up smoking can be endless. Work out what are your values in relation to smoking. Then let everything you do be in service of these values. Ask yourself if smoking will help you live a value guided life.

6: Committed Action: This where we bring everything together, as we begin committed action that is coherent with our values (in this case stopping smoking)we will encounter psychological barriers as our mind tries to protect us and convince us that stopping smoking is not such a good idea. We will experience unpleasant feelings and the big question is, are we willing to have these unpleasant thoughts and feelings without trying to change their form or their frequency? Accept and be willing because you’re doing something that’s important to you.

Good luck if you’re going to stop smoking. The most important thing to remember is that if you fail, then that’s OK too. Simply take responsibility and remember your values. Be present, open up and be willing. Learn to accept and distance yourself from your thoughts and feelings and continue with committed action.

Merry Christmas and a Bipolar New Year

Once again Christmas is upon us and the same as every year I have entered into a bipolar love hate relationship with the festive season. Now I don’t want don’t appear frivolous towards Bipolar disorders as I am well aware of the damage they can cause to both sufferers and the persons close to them. But bipolar is really the only way to express how I feel about the festive season.

I, like many foreigners live far from home and due to circumstances it is impossible to get to visit old friends and family. This week I put up the Christmas tree and as I was decorating it, the only feeling I could describe was one of melancholy as I ruminated over the past year, opportunities missed, friends and family missed. Cultural differences also make me sad as the culturally shared concept I have of Christmas is different to Christmas as celebrated here in Spain.

There’s nothing like positive festive messages to get my back up and start me grumbling and complaining about Christmas. “364 days a year of doing each other over and one day in the year for love” or “it’s all about commercialism” are two of my favourite cynical retorts about the Christmas period. You see I always hated Christmas from my younger days when all the shops were closed the dealers had gone away to visit family, it always bored me.

Like any good bipolar disorder my swings are fast and extreme as I go from hating Christmas to loving Christmas, from a type of extreme melancholy to an overwhelming feeling of happiness and contentment. It is in this phase of my bipolar swings that my “attention spotlight” will home in on, goals achieved, relations maintained and moments shared with loved ones. I love the idea of Christmas, putting up the tree, decorating, Christmas dinner and laughing with friends and family. Of course this is an idealised version of Christmas that has nothing to do with reality.

My Christmas feels real; a mixture of melancholy and wellbeing; a contradiction of over indulgence in times of austerity, but I myself am also a contradiction and I’m happy with that. I can love and hate at the same time, that’s OK it’s allowed. The same as for me Christmas can represent the worst and also the best, and that’s OK too.

To all my friends, family and patients. Merry Christmas and a Bipolar New year.

McDiplomas (version española)

Despues de muchos animos, mi primer "post" en español. Pido disculpas a Cervantes por el destrozo de su idioma.

Seamos realistas, hacer un esfuerzo en realidad es un poco coñazo. En mi caso estuve iluminado después de un episodio de Gandía Shore, un programa donde los candidatos disfuncionales, tipo gran hermano a lo bestia se sueltan en la sociedad y el caos resultante, los insultos y los encuentros sexuales espontáneos, están grabados por un equipo técnico siempre presente. Fama, o más bien la infamia por nada.

Al final del día, ¿quien no quiere escaquearse? Vivimos en una época en la que exigimos perfección sin esfuerzo. Queremos que nuestras guerras sean virtuales sin víctimas ni conflictos, queremos  tareas sin esfuerzos, los servicios públicos sin impuestos, la unidad sin lealtad, los derechos sin responsabilidades, fama sin talento, ropa deportiva sin los deportes, el sexo sin el esfuerzo que supone una relación.

Esto no se limita sólo al reino de los plebeyos, nosotros la gente mortal. En este momento, España parece tener  políticos sin política, una política de empleo sin empleo y bolsas de trabajo sin trabajo. A medida que Europa se une en la cumbre europea de empleo para tratar de encontrar una manera de hacer frente a su amenaza más grande, la del desempleo masivo. La ministra española de Interior, Fátima Báñez decidió que realmente no valía la pena ir en representación de... Un poco extraño si tenemos en cuenta que España es el país de Europa con los niveles de desempleo más alto, se podría haber pensado que habría sido de interés para la ministra. Pues no, aparentemente no.

                                                           

Esta falta de interés es sin duda un reflejo de las sociedades modernas del mercado. Sería injusto afirmar que España es única en este tipo de desinterés general por el empleo y la búsqueda de una alternativa. Recientemente, un profesor universitario francés se enorgullecía de cómo se enseña literatura sin haber leído ninguno de los libros con los que impartía su asignatura. Pero probablemente lo más alarmante es el hecho de que en Gran Bretaña, McDonalds  actualmente está reconocida como entidad formadora oficial en las Ciencias Empresariales.  ¡Eso si es horrible!

McDiplomas

Let’s face it; making an effort is really a bit of an effort. This was really brought home to me after watching an episode of jersey Shore, where dysfunctional big brother type candidates are let loose on society and the resulting chaos, insults and spontaneous sexual encounters are recorded for us by an ever present film crew. Fame or rather infamy for nothing.

At the end of the day, who isn’t lazy? We live in an age where we demand perfection but without effort. We want our wars to be virtual without casualties or conflict, we want our homework without the work, public services without taxes, unity without allegiance, rights without responsibilities, fame without talent, sportswear without the sports and sex without the effort of a relationship.

This is not just limited to the realms of us mortal folk. At this moment Spain seems to have politicians without policy, employment policy without employment and job shops without jobs. As Europe unites at the European summit of employment to try to find a way to face its biggest threat ever, that of mass unemployment. The Spanish minister for home affairs, Fatima Bañez decided that it wasn’t really worth going along. A little strange when you consider that Spain is the country in Europe with the highest levels of unemployment, you’d think that it may have been of some interest to the minister. No apparently not.

This lack of interest is surely a reflection of modern market societies where our needs are met immediately and any type of discomfort is considered wholly unacceptable . It would be unfair to claim that Spain is unique in this type of general disinterest in working and finding an alternative. Recently a French university lecturer gloated about how he taught literature without ever having read one of the books he teaches about. But probably the most alarming is the fact that in Britain, McDonalds have been awarding their own diplomas in business studies. Now that is horrifying!!     

Antonio Escohotado

I’ve been working in the addiction field now for more years than I care to remember, but was recently surprised by one of my English students who put me on the trail of Antonio Escohotado born in Madrid Spain 1941. I was so impressed by his writing that I have to share at least something of his polemic stance. Very much a liberal stance, in the traditional meaning of the word in that he believes Government should have no authority over the body of an individual. Escohotado explores in his writings the mixture of euphoria, authority, control, morals, ethics and politics. I wonder how many of the people I have worked with; their friends and families have been ostracized, criminalized or pathologized by self-serving drug laws. Obviously there is no room here to explore in depth, but I’ll leave you with a small taster and just thank Elena for directing me and showing me that I still have a lot to learn.

“Prohibition might be considered “the greatest moral experiment of our time”, as F.D.Roosevelt stated in 1932. But banishing drugs from human life is, in fact, a war against self-induced euphoria, and also a war against chemistry and human invention. Such an enterprise was born in the USA, and has been exported by this country at the very same rhythm in which it became the world's superpower. The effect of this American crusade is identical to the general effect of crusades, and especially of the crusade against witchcraft: aggravating to unheard extremes a hypothetical evil, justifiying the destruction and plundering of countless persons, promoting the ill-gotten wealth of corrupt inquisitors, and creating a prosperous black market for all the forbidden items -which in the seventeenth century were sorcerer's concoctions, and today are heroin, cocaine, crack, etc.

We will not break the crusade's vicious circle, unless the standards of barbaric obscurantism are replaced by principles of enlightenment, focused on the spreading of knowledge among the populations. Drugs have always been around, and they will certainly ever remain. To pretend that both users and non-users will be better protected because some of them are impure, very expensive and sold by criminals (who are, by the way, indistinguishable from undercover police and plain businessmen) is simply ridiculous, and yet more so when the street supply grows year after year. The obvious result is a growing output of crimes and illiterate youngsters, who use the illicit substances partly as an adulthood initiation rite, and partly as an alibi that suggests declaring oneself irresponsible, unfree, victim of a chemical devil. This is very comfortable at such a critical moment of life, in which they should rather learn responsibility, imitating the abnegation displayed by their elders with them. So the true option is not vice as opposed to law and order. The real choice is between an irrational consumption of adulterated products, compared to an informed use of pure drugs”.

Acceptance and Commitment Therapy

Based on Relational Frame Theory, Acceptance and Commitment Therapy (ACT) argues that language is the basis of many of our psychological problems, making inevitable that in certain conditions arising thoughts and feelings may be experienced as annoying. Being verbal allows us to get entangled in our own private events and to continue that way even though the result of this struggle backfires on us. Through metaphors, paradoxes and experiential exercises ACT teaches us to contact the thoughts, feelings, and memories that have been previously feared and avoided as any others that may arise. In this way, people learn the ability to re-contextualize these private events, clarify what matters in your life and evaluate the commitment necessary to make positive change.

ACT maintains philosophies of life that have been exposed over time throughout history, but due to modern market societies are now frowned upon.  Human suffering is part of life and inherent to the experience of being human. This involves accepting the fact that we are verbal beings and we express ourselves through verbal symbolism. A skill that serves us well in organizing work or overcoming problems as it enables us to learn from past mistakes and plan for the future by not making the same mistake.

Problems can begin when we become entangled in a struggle with unpleasant memories of past events, regretting or continually re- running them over and over in our heads. Just the same as we can get ensnared with future outcomes as we repeat continually what we will say or do in imagined future settings. This type of entanglement with our private events is what leads us to avoid emotional discomfort and lead us to repeat undesirable behavior in an effort to avoid feeling bad.

 ACT argues that due to the type of society in which we live, unhappiness, sadness and other so called negative emotions are seen as a problem and admitting to being sad or unhappy is a sign of failure. We are encouraged not to express them and to get rid of them as quickly as possible. However, focusing on unpleasant, troublesome thoughts and memories in an attempt to avoid them is counterproductive.

Often, attempts to eliminate or prevent unwanted thoughts and memories and the consequent attempts to immediately feel good , not only do not succeed but generate a "boomerang" effect. Paradoxically the more something is not wanted, then the more present and extended it becomes in many areas of our personal life.  Life becomes a constant struggle for the immediate elimination of discomfort as a requirement for living, but this not only extends the discomfort but also leads people away from what ultimately matters and what is important.  

Life Directed by Values

I went to my local motorbike workshop to complain that when I took my hands off the handlebar of my motorbike it starts to wobble. After questioning me about when this happened, Juan my mechanic replied “well don’t take your hands off the handlebar”. At the time his comments were about as welcome as a bacon sandwich at a Jewish wedding, and I went away feeling embarrassed and angry by his comments.

 As the red mist cleared (those of you who have anger management problems like me will know what I mean) It dawned on me that he is probably right. When I have my hands firmly placed on the handlebars, there is no wobble. Why would I want to dedicate time and energy and not least of all money, to something that is not of value in my life? I decided that riding my motorbike without my hand on the handlebar is just not really important to me. In fact in the scale of values that guide my life, riding my motorbike with no hands comes pretty low down on the list. So I don’t need to do anything, apart from not take my hands off the handlebars.

This is similar to doing exposure in therapy to overcome phobias and fears, either social or physical fears. If there is no real need to overcome a fear or a motivation to do so, then we must ask if it is entirely necessary to go through the effort of exposure. Exposure to anxiety and fear is pretty unpleasant and if it is not accompanied by a high motivation it can be destined to failure.

                                                                                                                

This is where goals come in very useful. I have a friend who recently asked about fear of flying and if I knew of any English speaking hypnotherapists who could help him with his fear. As a behaviourist I always encourage people to feel the fear and continue with what you need to do. In this case fear and anxiety is perfectly rational and I feel there would be something wrong with you if you were at 30,000 feet and didn’t feel the slightest bit anxious, well that or you’d be dead. So I personally would encourage against trying to change or avoid fear or anxiety, at the end of the day that’s what alcohol is there for.

 What value driven action is he depriving himself of? It turns out that the next journey is to France to participate in a music publishing festival in Cannes. It is a job that he enjoys; the business trip will be a great experience. Basically this journey forms part of his values in the work aspect of his life. That is it is coherent with how he sees himself, how he wishes others to see him and also coherent with what he wants to stand for as a person.

With our values guiding our behaviour, we can decide whether we wish to put up with some emotional discomfort if it will enable us to live a full and meaningful life that is coherent with our values. We can choose to make room for emotional discomfort knowing that we are doing what is important to us. Or we can continue to avoid unpleasant experiences such as anxiety and fear and stay in our comfort zone, but also run the risk of leading an unfulfilled life. In the words of Susan Jeffers, we can feel the fear and do it anyway. Why? Because it’s important to us.