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CLEAR MIND (DISTRESS TOLERANCE HANDOUTS 18–18A)

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megan gewitz

on 19 August 2017

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Transcript of CLEAR MIND (DISTRESS TOLERANCE HANDOUTS 18–18A)

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CLEAR MIND (DISTRESS TOLERANCE HANDOUTS 18–18A)
Discussion:
Can you think of examples of behaviors or personal characteristics indicating that you are in the grip of addict mind?
Clean Mind
Clean mind occurs when you are ‘clean’ and have not engaged in the problem behavior for a period of time, but you are oblivious to the dangers and temptation of relapsing.
In clean mind, you may feel invincible in your fight against your addiction, and immune to the temptation to engage in the addictive behavior ever again.
The distortion of clean mind is believing that you don’t have an addiction problem any more.
The danger of clean mind is that you may not avoid temptations and addiction cues, and may fail to use relapse prevention strategies you have developed at other times. In clean mind, you lower your guard and defenses against urges, and so you are not prepared when they hit.
Clear Mind
Clear mind represents the synthesis between clean mind and addict mind. In clear mind, you are clean, while at the same time you stay aware of the dangers of relapse and actively engage in behaviors to prevent a lapse or relapse.
It is the safest place to be.
Clear mind is very similar to wise mind when addiction is involved.
The danger of addict mind is that you are not engaging in any of the steps necessary to stop the addictive behavior.
In addict mind, you are willing to do whatever is necessary to get the high that addictive behaviors bring. You may lie, steal, hide, break promises, and deny that you are in fact addicted.
Behavior Patterns Characteristic of Addict Mind, Clean Mind, and Clear Mind
Addict Mind Behaviors
Practice Exercise:
Read through the list of addict mind behaviors on Distress Tolerance Handout 18A and check those off that you remember doing
Story Point:
Overcoming addiction is like fighting a long war against urges to engage in the addictive behavior. The urges win a battle when you end up doing the addictive behavior, and you win when, despite the urges’ attacks on you, you don’t do the addictive behavior. Clean mind is forgetting the war once a few battles are over; it’s thinking that because you’ve repelled the urges a few times, they will not come back, or that if they do come back they will be easy to repel. When you are in clean mind, you don’t prepare for battle, and your defenses are down. Urges can catch you unprepared and win. Addict mind is like being under siege by the urges and believing that you can never repel them again. When you are in addict mind, you don’t remember your victories; when you are defeated, you don’t regroup and ght back. Clear mind is remembering both your victories and your defeats, fighting with all your might, and staying prepared for battle
Discussion:
Can you think of examples of times when you were in clean mind and were not vigilant to the dangers of relapsing?
Here are
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Addict Mind, Clean Mind, and Clear Mind
Addict mind is your state of mind when you have given in to your addiction.
You may have never tried to stop your addictive behavior, or you may have tried but relapsed.
In addict mind, you are ruled by your addiction; urges to engage in the addictive behavior govern your thoughts, emotions, and behaviors. In addict mind, you are not even trying to resist your addictive behavior—or, when you are, the effort is half-hearted and ineffective.
Behaviors characteristic of addict mind include engaging in the addictive behavior; glamorizing addiction; stealing to pay for addictive behaviors; lying, hiding, and isolating; stealing; not making eye contact with people; avoiding doctors, therapists, or people or groups who can help you; and so on.
Behaviors characteristic of clean mind include thinking you have now learned your lesson and do not have to worry any more about the addiction; going into environments where others engage in addictive behaviors; seeing or living with people who have your addictions; acting as if all you need to get over addictions is willpower; isolating yourself; and so on.
Clean Mind Behaviors
These are actions that take you closer to engaging in the addictive behavior; they are steps toward addictive behaviors.
On the surface, they look reasonable and unrelated to the addiction, but, collectively, they help set up a slip back into addictive behaviors.
They are usually based on not thinking about your behavior and its consequences, on flat-out denial, or on delusion.
Example: “You are having a party for a close friend. Thinking that you really want to have her favorite foods, you buy her favorite cookies and ice cream for the party. You get a lot of each because you want to be sure you don’t run out at the party. You have problems with bingeing and purging (and these are your usual binge foods).”
Example: “You are currently abstinent from alcohol. You have a craving for a hamburger, and you decide to go out to dinner at your corner bar, where they have really good hamburgers.”
Apparently Irrelevant Behaviors
Often the problem is not the first behavior, but rather a multiple set of behavior in a sequence, all of which bring you closer to an overwhelming cue for addictive behavior.
Example: “Gambling is your addiction. You decide to go to visit a friend’s country house north of your home. On the way, you decide to stop off at a shopping center. On the way out of the shopping center, you realize you are hungry for lunch. There is a really nice hotel next to the shopping center that serves good food in a relaxing environment. You go there and have a nice lunch. You have several hours before your friend is expecting you, so you decide you will just look in on the casino in the same hotel. As you look in, you decide you will just walk around but not gamble. Before you know it, you are gambling and never make it to your friend’s house.”
Review the list of clean mind behaviors on Handout 18a ad check off the ones that you engage in.
Please add any behaviors that are indicative of clean mind for you.
Examples of apparently irrelevant behaviors you engage in?
Practice Exercise:
Clear mind behaviors are abstinent and vigilant for temptation. You are acutely aware that without skills, intense urges can return at any moment.
Examples of times you have acted from clear mind?
Clear Mind Behaviors
Homework:

Distress Tolerance Worksheet 15: From Clean Mind to Clear Mind.
COMMUNITY REINFORCEMENT (DISTRESS TOLERANCE HANDOUT 19)
Reinforcement Maintains Addictive Behavior
Immediate Reinforcement Is Stronger Than Delayed Consequences

Unfortunately, the immediate reinforcement of an emotional high or emotional relief that an addictive behavior provides has a stronger effect than the delayed aversive consequences (such as remorse, guilt, and depression), which is why the addiction is maintained.
Does your addictive behavior lead to immediate pleasure or immediate relief from distress and if so, how?
Discussion:
As Addictive Behavior Increases, Other Activities Decrease
As addictive behavior increases, other activities (e.g., sports, community involvement, social activities) decrease, and isolation increases.
When this happens, the addictive behavior becomes more and more associated with the immediate reinforcing consequences, and thus becomes stronger and more entrenched.
Discussion:
What are the positive and negative consequences of your addictive behaviors?
Replace Addiction Reinforcers with Abstinence Reinforcers

Stopping addictive behaviors requires replacing addiction reinforcers with abstinence reinforcers. Why? It is because willpower is not sufficient to change behavior, or else we would all be perfect. In the long run, it requires making a lifestyle without the addictive behavior more rewarding than a lifestyle with that behavior. Go over the following action steps that can be helpful:
“Search for people to spend time with who aren’t addicted.”
“Increase the number of pleasant activities you engage in that do not involve your addiction.”
(See Emotion Regulation Handouts 16 and 17.)
“If you cannot decide what addiction-free people or activities you like, sample a lot of different groups of people and a lot of different activities.”
Practice Exercise:
Please read through “Replace Addiction Reinforcers . . . ” section of Distress Tolerance Handout 19 (the list just above corresponds to this part of the handout) and check those you think might work for you.
What did you check?
Get Reinforcement from Others for Not Engaging in Addictive Behaviors
1. Stay Away from Other Addicted People
Stay away from other addicts who are uncomfortable with you if you are not also engaging in addictive behaviors.
2. Talk to People Who Really Love You
Teach your non-addicted loved ones about reinforcement (if you have to). Then ask them to be vigilant for when you appear to be abstinent, and give you lots of reinforcing comments or other things they have available that could function as reinforcers.

3. Try a “Deprive, Then Reinforce” Strategy

The following strategy is designed for (1) people who do not have many potential reinforcers for abstinence in their lives; (2) people who already have most of the things that could be used as reinforcers (usually people with a fair amount of money); or (3) people who are so poor that they cannot add anything reinforcing to their lives.
The basic idea is first to deprive yourself of something important that you would work hard to get back, and then give it back to yourself as a reward if you engage in the behavior you want to reinforce.

“Decide on three things in your life that you really like, but that you could deprive yourself of for a week if you really had to.”
Examples: Coffee; toothpaste; use of a car; carrying cash and/or credit cards; all jewelry; all but one pair of socks or underwear; texting or calling others on cell phones; sitting in chairs; watching TV; playing games.
Week 1: “Deprive yourself of one item (Item 1) for the week.” This is the equivalent of B. F.
Skinner’s depriving rats of food before putting them in an experiment where food was the reinforcer. Note that the deprivation is not contingent on anything, and thus it is not being used as a punishment.
Week 2: “For each day you are abstinent, give yourself back Item 1 the day after. Deprive yourself of a second item (Item 2) for the week.”
Week 3: “For each day you are abstinent, give yourself back Item 2 the day after. Give yourself back Item 1, but deprive yourself of a third item (Item 3) for the week.”
Week 4: “For each day you are abstinent, give yourself back Item 3 the day after. Give your- self back Item 2, but deprive yourself of Item 1 again for the week.”
“Continue to repeat the sequence.”

4. Monitor Your Abstinence Motivation
When your abstinence motivation starts to drop off, do these things.
Review your plan for dialectical abstinence.
Review your pros and cons for abstinence versus addictive behaviors.
Abstinence Sampling
Abstinence sampling is deciding to try out abstinence to see what it is like and to see if there are any benefits to you of abstinence. This is like doing a personal experiment. You do not have to commit for the long term until you see how it goes. Although the short-term emotional high and relief of addiction will not be there, neither will the terrible consequences of addictive behavior.
“Commit to a specific number of days of abstinence, to sample what it would be like to live without addictive behavior.”
“To get through abstinence sampling, implement your dialectical abstinence plan.”
“Observe all the extra positive events occurring when you are not engaging in addictive behaviors.”

Distress Tolerance Worksheet 16: Reinforcing Nonaddictive Behaviors.
Homework:
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