freestone2013 - The Society for the Advancement of Sexual

Report
Presents:
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Research and information on compulsive
behavior.
 Neuroscience and brain imaging technologies
have given us the information that literal physical
changes in the brain occur when we experience
high emotional states.
 Automated processes are formed and become
compulsive when these high emotional states
are combined with repetitive uses of
maladaptive coping skills.
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We need tools that directly address
these changes in the brain on a cellular
level.
Healing takes place when the brain
becomes plastic through feeling safe in
therapy, and then assisting in stimulating
the parts of the brain that are
experiencing deficits (Dysregulation).
Dr. Carnes initial research into treatment
programs and what worked, this research
yielded 30 tasks that had clients showing
recovery(Carnes, 2001).
 These tasks will be listed besides the
interventions that follow and show which of
Dr. Carnes’ 30 tasks this tool covers to help
them recover.
 This is not program designed to compete
with Dr. Carnes’ program, but to use
additionally developed tools to help client’s
recover and complete the 30 tasks.
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1.
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15.
Break Through Denial
Understanding the nature of addictive illness
Surrenders to the process
Limits damage from behavior
Establish Sobriety
Ensure physical integrity
Participates in a culture of support
Understand multiple addiction and sobriety
Acknowledge cycles of abuse
Reduce shame
Restructure relationship with self
Grieve losses
Bring closure and resolution taking responsibility for self
Restore Financial viability
Restore meaningful work
16.
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18.
19.
20.
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24.
25.
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27.
28.
29.
30.
Create lifestyle balance
Build supportive personal relationships
Establish health exercise and nutrition patterns
Involve family members in therapy
Commit to recovery for each family member
Resolve original conflicts/wounds
Alter dysfunctional family relationships
Resolve issues with children
Resolve issues with extended family
Work through differentiation
Succeed in intimacy
Commit/recommit to primary relationship
Explore coupleship recovery
Restore healthy sexuality
Develop a spiritual life
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Principles of Neuroscience.
Principles of Cognitive-Behavioral
Therapy.
Principles of Addictionology.
Dr. Matthew Hedelius and Dr. Todd
Freestone at the Comprehensive
Treatment Clinic.
Treatment Pillars
Tracking Form/Treatment Journal
Mind Mapping
Music/Video Intervention
Equilibrium Model
DAPSA Model
Multiple Redundancies to Relapse
Scripting
Bio/Neural Feedback use with Sexual
Addiction
 Forgiveness work
 Healthy Cycle and Sexuality
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Autobiography (modified outline)
Sexual Map/Template Work
Attachment work
Inner Child/Shame Work (John Bradshaw)
Sexual Boundaries (Defined for themselves)
Cyclework (Modified for sexual addiction)
Thinking Errors or Cognitive Distortions
Full Disclosure
Empathy work (Modified)
Brain Neuroscience and Vertical Integration
These tools all are to be used in conjunction
with traditional cognitive-behavioral
treatment.
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Treatment Pillars
Tracking Form
Mind Mapping
Music/Video Intervention
Equilibrium Model
DAPSA Model
Multiple Redundancies to Relapse
Biochemistry of Addiction and Trauma
Levels of Learning
Scripting and Bio/Neural Feedback
There are 12 treatment pillars.
 Pillars are to be read at least 3 times per
day, every day, for a month per pillar.
 These pillars are designed to elicit a
desire or willingness to change, much like
positive affirmations do.
 These can be used with or without
neurofeedback.
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Pillar #1:
I am ready to change. I have lived the way I
have lived for too long. When I began this
journey, long ago, my choices were just
that, choices. But now, they have grown in
to an addiction that controls me to the
point that I feel I have no control. Those
close to me, whom I love the most, have
also been impacted to the point that the
life we once had has almost been
destroyed. But now, I am ready to change.
And I commit to pay whatever price is
necessary to accomplish this. I have
already seen the power of a single choice
in my addiction. Now I employ that same
power, except I employ it for the purpose of
growth and positive change. I will begin
the change now and I will heal.
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Neural-pathways form in a use dependant
fashion. They are reinforced or
strengthened by consistency, frequency,
intensity, and duration.
 If these pillars are read and used as
prescribed, they accomplish all of the
strengthening criteria.
 Pillars used this way, allow the client to
introduce important aspects of healing to
their lives and have them become
ingrained.
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Treatment Pillars
Tracking Form
Mind Mapping
Music/Video Intervention
Equilibrium Model
DAPSA Model
Multiple Redundancies to Relapse
Scripting and Bio/Neural Feedback
Comprehensive Treatment Clinic
Healing Tracking Form
(1, 2, 3, 5, 6, 7, 8, 10, 13, 16, 17, 18, 30)
Date
P1
P2
P3
SS
PS
ES
1
2
Pillars
P1, P2, P3
+1
Spiritual Soothing
SS
+1
Physical Soothing
PS
+1
Emotional Soothing
ES
+1
Individual Therapy
+2
Group Therapy
+2
Therapy Homework
+2
Treatment
Sobriety
Defined by
themselves
0-10
My Beliefs
MB
+3
Acting Out
AO
-5
TX
Sobriety
MB
AO
Total
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This form was developed for three purposes
› Accountability
 In individual and group sessions numbers can be given.
› Treatment Compliance
 If client stagnates, he/she can look at why.
 Self-awareness through observation of patterns or
cycles.
› To integrate several parts of the program in one
place.
 The tracking form gives a visual reminder of daily
treatment goals.
 This form is now integrated into a journal format in
addition to the tracking form shown on previous slide.
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Treatment Pillars
Tracking Form
Mind Mapping
Music/Video Intervention
Equilibrium Model
DAPSA Model
Multiple Redundancies to Relapse
Scripting and Bio/Neural Feedback
The way to unlock and remap the mind.
 The concept of Mindmapping is originally
from a book by the same title from Tony
and Barry Buzan (1990).
 The concept was to use the way that the
mind stores information (by association) to
aid in memory, planning and organization.
 In therapy, we can use these concepts
and take a step further.
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Mindmapping can be used as a diagnostic
tool.
 To mimic neural pathways already established in
the brain.
It can also be used to remap or make more
healthy associations in the brain of a client.
 This technique can also be used to make
these new pathways powerful through the
use of the same tools that make an
addiction (Consistency, Frequency,
Intensity, and Duration).
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A Central Word or Phrase
Related to the Client’s
Particular Addictive
Cycle
First word or phrase
to come to mind
Second word or
Phrase to come to
Mind
Central and second word
Then this one
Then this one
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We have 4 words or phrases off the first
word and then two from each of those
words and out 4 generations.
We then look at what is associated with
what. We look for negative or unhealthy
associations and have them do a
second mind map with positive
associations replacing the negative.
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The last piece to this technique is to have
the client put each of the new
associations on a separate sheet of
typing paper and then put on the paper
visual images that are associated (in the
client’s mind) with that word or phrase.
These pages are placed in a three ring
binder and are read 5 times each day
for a month, and then used as an
intervention thereafter.
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Treatment Pillars
Tracking Form
Mind Mapping
Music/Video Intervention
Equilibrium Model
DAPSA Model
Multiple Redundancies to Relapse
Scripting and Bio/Neural Feedback
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The music and the DVD were developed
to help client’s and their spouses
understand the process of sexual
addiction from first discovery to the
celebration of healing. Music is one of
the fastest and most powerful ways of
altering the mood of a client and directly
accessing the Limbic System.
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We also use popular music and cinema
to facilitate learning.
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Treatment Pillars
Tracking Form
Mind Mapping
Music/Video Intervention
Equilibrium Model
DAPSA Model
Multiple Redundancies to Relapse
Scripting and Bio/Neural Feedback
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Posits that we have 4 major domains or
axes in our human experience.
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Axis I - psycho-emotional
Axis II - biological/physical
Axis III - social
Axis IV - spiritual
Intra-axis and inter-axis dysregulation
creates imbalance.
› Avoidance, hyper-focus, or lack of focus
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Equilibrium is achieved by embracing
discomfort, facing consequences and
fears, and coping “in the middle” in
each axis and in every axis.
Identify at least 4-5 soothing activities in
each axis.
 Implement at least one activity from each
axis as part of new daily rituals and when
experiencing a craving, trigger, or high risk.
 This is incorporated on the ‘Healing Tracking
Form’.
 These behaviors become the new coping
strategies integrated into developing
neural-pathways when engaged in
consistently, frequently, and over time.
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Treatment Pillars
Tracking Form
Mind Mapping
Music/Video Intervention
Equilibrium Model
DAPSA Model
Multiple Redundancies to Relapse
Scripting and Bio/Neural Feedback
A model that demonstrates the progression
and eventual pairing of mood
dysregulation and sexual behavior as a
mood-altering coping strategy, eventually
leading to dependence on the behavior
and ultimately compulsivity.
 Educate about the model.
 Allow the client to then personalize the
model by going through each step of the
progression and pairing in their own life.
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Treatment Pillars
Tracking Form
Mind Mapping
Music/Video Intervention
Equilibrium Model
DAPSA Model
Multiple Redundancies to Relapse
Scripting and Bio/Neural Feedback
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This is an assignment that was developed to allow
the client to slow down the limbic system
response and give them time to engage their
cortical response to a perceived threat, before
acting out.
This assignment deals with having the client
develop a list of possible situations that they might
run into (of a high risk manner) and develop
multiple plans to address this situation without
acting out. They must then rehearse them.
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When we have a plan in place to
address these situations, we allow our
cortex to catch up with our limbic system
and resume the executive control that is
necessary to make good, reasoned
decisions.
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Treatment Pillars
Tracking Form
Mind Mapping
Music/Video Intervention
Equilibrium Model
DAPSA Model
Multiple Redundancies to Relapse
Scripting and Bio/Neural Feedback
Alpha brain waves (8-12 Hz) are shown to
be associated with relaxation and
feelings of well-being.
 Theta waves (4-7 Hz) are associated with
spontaneous imagery or hypnogogia.
 When the amplitude of these two waves
are increased in synchrony, the person
moves to the state between wakefulness
and sleep.
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During this state, the mind is the most
receptive to suggestion and memories are
moved to long term storage.
 Simonton & Simonton (1978) suggest that
images may communicate with tissues and
organs, even cells, to effect change.
“Programming the unconscious with mental
rehearsal of new images and intentions of
desired change seems to effect healing
and change both physiologically and
psychologically” (Green & Green, 1977;
Achterberg, 1985; Simonton & Simonton,
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Dr. Tom Budzynski (1971-1997) indicated
that a predominance of theta waves was
the ideal state for re-scripting and reimprinting the brain and facilitated the
elimination of destructive behaviors and
attitudes that are often laid down in
childhood during which time the child is
naturally in the theta state. This process
allows the individual to establish more
appropriate traits for adulthood.
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Rossi (1986) suggested that each time
that an individual accesses state
dependent memory he or she has an
opportunity to “associate and
reorganize” the problem in a manner
that can resolve it.
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Gene Penniston (Evans &Arbenal, 1999)
created a very successful protocol for
addiction recovery by scripting successful
outcomes for avoiding relapse and
reinforcing them with relaxation and alphatheta training. He was so successful with
alcoholics, that without the use of drugs, he
created in the alcoholics a state similar to
taking antabuse for them. Alcohol would
create in the patient a violent sickness they
termed “the Penniston Flu.”
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Scripting
 Definition: The process of creating a
blueprint of behavior through which the
patient presents the ideal behavior that
he/she desires to experience in real life
situations.
 It needs to be written using the first person,
present tense, as if it had already happened
or as if it were happening at present.
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Scripting (Continued)
 2 types of scripts
 Refusal script
 Script starts by having the client write their highest risk
situation, followed by them intervening before they
act on the trigger.
 Optimal functioning script
 The script outlines how they will be functioning in all
areas of their lives once they reach recovery.
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I see myself at home alone and I begin to get
depressed. I immediately think of what would help
me feel better and I decide to download some of
my favorite porn sites. I go to the computer and
type in the addresses. As I do this I remember my
sobriety contract and what I have been working
on in treatment. I recognize that if I act out it will
impact my partner and family and I may risk losing
them. At that moment I choose to turn off the
computer and leave the room. I say the serenity
prayer and read my treatment pillars. I also call my
sponsor and talk to him. After speaking with him for
a few moments I feel relieved that I was able to
intervene as I had planned.
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Neurofeedback allows the scripts to
become a part of the long term memory
of the client, “tricking” their brain into
believing that the scenario of the
scripting has actually happened. The
client gains confidence and actually
begins to act as the scripts suggest
he/she has acted in the past.
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Have the client write his/her refusal script.
Begin basic relaxation therapy either
with “Em-wave” work or hand
temperature biofeedback. These
procedures facilitate the relaxation
response.
Have the client read the script right
before the relaxation exercise begins.
Get the client into the relaxation response.
 Periodically have the client review the script
in his/her mind once in the relaxation
response.
 After 3-4 sessions replace “Em-wave” and
hand temperature sessions with
Alpha/Theta training.
Approximately 25-30 Alpha/Theta sessions
are recommended. The more the better.
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The client has EEG electrodes placed on
his/her head over the sensory-motor cortex.
 The EEG machine is set to provide an
auditory and/or visual reinforcement
whenever the alpha and theta waves are
increased above a certain threshold.
 This is an operant conditioning process by
which feedback to the brain reinforces the
desired wave lengths to continue.
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Definition: The creation of new neuronal
connections through the differentiation of
stem cells becoming new neurons in the
brain.
 Synaptogenesis: Short term changes such as
hope, excitement and motivation. Often seen in
the initial stages of therapy.
 Neurogenesis: The development of new neurons
and their integration into neural networks. Likely
a part of the long-term recovery process. Likely a
3-4 month process at a minimum according to
Dan Siegel, MD.
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The 4 keys to brain change.
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Consistency
Frequency
Intensity
Duration
Three things that facilitate
Neurogenesis.
 Novelty
 Aerobic Exercise
 Focused Attention (Dan Siegel).
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Vertical Integration
 Refers to integrating cortex, limbic system,
and lower brain functions so that
communication is strong and the cortex is in
executive control.
 When this occurs, the client begins behaving
in real life as they have rehearsed in
treatment.
 They begin to learn that they have control.
Neuroscience is now shaping and informing
our understanding of compulsive behavior.
 Neuroscience is also shaping and informing
our understanding of the healing process.
 Tools and interventions must be geared to
facilitate and promote change at the
neural and cellular level.
 These tools have been developed with the
core principles of neuroscience and
cognitive-behavioral theory in mind.
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You are welcome to use any of these tools
for your individual purposes. Please do not
modify these tools or remove the copyright
information. You may duplicate and use
them for your personal use or that of your
practice.
 E-mail [email protected]
for these forms or tools.
 DVD or Video can be purchased at
Amazon.com or off our website at
www.comprehensivetx.com
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Budzynski, T. (1971). Some applications of
biofeedback-produced twilight states. Presented
at the Annual Meeting of the American
Psychological Association. Washington, DC.
Budzynski, T. (1997). The case for alpha-theta: A
dynamic hemispheric asymmetry model.
Presented at the Annual Conference of the Society
for the Study of Neuronal Regulation, Aspen, CO.
Carnes, P. (2001).
www.iitap.com/documents/Tasks1-30-Detailed.pdf
Buzan, T. (1996). The Mind Map Book. Penguine
books, New York.
Evans, J.R. & Abarbanel, A (1996) Introduction to
Quantitative EEG and Neurofeedback. Academic
Press. San Diego, Ca
Gibson, R. (2000). Post-traumatic stress
disorder and the thalamic/cortical pause.
Etc, 57 no 3, 354-61
 Kolb, B., Whishaw, I. (1998). Brain Plasticity
and Behavior. Annual Review of
Psychology, Vol. 49
 Norton, Merill (2008). What’s up – The
Neurobiology of Leaning and Adolescent
Substance Abuse. Presented at the annual
conference of Neuroscience Meets
Recovery, Las Vegas, NV.
 Rosenzweig, M.R. (1996). Aspects of the
search of neural mechanisms of memory.
Vol. 47

Rossi, E. (1986). The Psychobiology of
Mind-Body Healing. W. W. Norton, New
York.
 Sapolsky, R. (1998). Why Zebras Don’t
Get Ulcers. W.H. Freeman and
Company, New York.
 Simonton & Simonton, (1978). Getting
Well Again. J.P. Tarcher, Los Angeles.
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ADD……..Dan Siegel, Pat Carnes, John
Bradshaw

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