It has been a while since I posted, so I decided to post this article on neuroplasticity. Neuroplasticity is what allows change in our brain and thus in the rest of our lives. Neurons that fire together, wire together is the old adage. Because our brain can change, through new neuronal connections and through neurogenesis, we are able to learn and develop. Here are some ways to make neuroplasticity work for you.
I thought I had posted this video before, but it doesn't seem to be on my blog. So as a companion to my post on depth deprivation is Johann Hari's TED Talk on the cause of addiction. It is powerful and spot on. Enjoy!
Johann Hari: Everything You Know About Addictions Is Wrong
"You are suffering from depth deprivation." -James Finely, contemplative retreat, Tucson, AZ 2016
According to Finley, depth deprivation is the essence of addiction. Addiction is an attempt to create a sense of connection and depth, to escape the void inside ourselves. Depth deprivation is also the essence of most of our troubles. Trauma separates us from ourselves and others. In the depths of depression and anxiety we are disconnected from the world around us. The busyness of our daily lives keeps us from pausing. A pause which would allow for a qualitatively deeper awareness of the world and our connection to the world. Our busyness, too, is a symptom. We want to avoid the pain we feel, the anger, the loneliness, and unconsciously everything we do is a distraction from ourselves. And of course! The unconscious does a great job at protecting us from pain. Who wants to be uncomfortable? Who wants to feel the pain? Conversely, when we dig deep, we may realize we even fear the joy. The discomfort of "Who am I without this pain?" The uneasiness of the unknown. Yet, if we can be curious about ourselves, without judgment, and find a companion to help us through our Dark Night, we can fulfill our desire for connection and depth.
To do so we have to pause "in a sustained, heartfelt manner" (Finley). Naturally we do this when we are in nature, admiring art, when in solitude, in moments of intimacy, in prayer, and in meditation. The challenge is to develop the stance of least resistance, as this connection can not be forced, but comes about through our sustained presence to ourselves and the word (Finley). It need not be perfect. Through our contemplative stance, our being with ourselves, this sustained presence builds upon itself. There is no spiritual bypassing, no glossing over the hurt by focusing on the positive. The gift of the process is the love and understanding of ourselves, which without even realize it we express in the world. We must have the courage to explore our depths, our pain and joys, in order to fulfill our deepest longing.
"Find your practice, and practice it." - James Finley
When active in an addiction, the drug (or behavior) of choice becomes the addict's higher power. Everything is second to fulfilling the needs of the craving. When entering recovery the individual can feel lost and empty, as ironic as that may seem. There is a void and emotions the addiction masked now are front and center. Nothing works as quickly or as thoroughly as the drug and the newly sober do not know how to end the distress. Developing a spiritual practice is one way to help lead a more fulfilling life.
However, developing and maintaining a spiritual practice can be difficult for anyone, with or without addiction. Life is busy and stressful. How much easier is it to lay on the sofa watching television than to do something which takes intention and patience? Deciding what we want our practice to be is just as challenging: yoga, meditation, prayer, lectio divina, martial arts, hiking, journaling, church, synagogue, the options are endless. If you are agnostic or atheist, you can choose a practice as well- a gratitude practice, mindfulness practice, inspirational reading . Interestingly, even atheists have been known to pray (here, here, and here).
The newly sober are looking for something to fill the hole the addiction masked; longing for something just as intense. I tell my clients that they have to get used to being bored without their addiction, but perhaps boredom is not quite right. Those in recovery have to get used to the lack of intensity. Your practice likely will not bring about some wonderful, blissful feeling on a regular basis, which makes consistent practice a challenge. Channeling all the energy that was used to act out into an intentional life is the work. That life may not feel exciting, but the faith needed is the faith that you will find serenity. That you will discover your authentic self.
First find something that is meaningful and/or doable for you. Then commit to engaging with it. Maybe initially you try different forms of spiritual practice until you find one that resonates with you. (I do not recommend letting this "sampling" go on to long, or your practice will lack depth that comes from long term consistency). Perhaps you settle on reading a daily meditation. Commit to doing this on a regular basis, maybe not daily at first, so as not to shame yourself when it doesn't happen, but a minimum number of times per week. If you choose to sit in meditation, start with 5 or 10 minutes and build from there. Don't start with a 30 minute sit, or it is likely you will abandon your practice out of frustration.
Your spiritual discipline may grow and transform over time. For this to happen find a practice and practice it. You will not always want to, wanting to is irrelevant. You may not always like it. As my yoga teacher told me, you don't have to like your practice, you have to like the result. (Then he said not be attached to the result, but that is another post.) YOU have the choice to practice or not to practice. No shame, no guilt if you choose not to do so. It is simply a choice. It is YOUR CHOICE. Remember, self compassion is also a spiritual practice. How you speak to yourself is important. So when you choose to practice tell yourself, "I am choosing to practice." When you don't, say to yourself, "I am choosing not to practice" or "I am choosing to watch this show with my daughter instead." This leads to more intentionality, more mindfulness in your daily life. Finally, choose with the knowledge that the only way to reap the benefits of a spiritual discipline is to consistently choose to practice over time. Doing so is not easy, but consistently making intentional and healthful choices will lead to a sense of empowerment and agency in life.
Knowing is not enough,
We must APPLY.
Willing is not enough,
We must DO."
- Bruce Lee
(Photo: David Reed)
“I hate feeling this way.” She said, “…it is like I am wired to feel like this.”
I have heard variations of this sentiment many, many times. (Each time I am reminded, Yes! Yes you are wired to feel like this.) We as mammals ARE wired to feel like this, but that doesn’t mean it is never ending, that there is no hope. I then explain the process that occurs deep in our brain and she expresses a sense of relief. “THAT makes sense!” she exclaims. Understanding the underlying neurobiology to our processes helps us not just understand but regulate our nervous systems and those of our clients. Dan Siegel’s Interpersonal Neurobiology uses this principal as the basis for conceptualization and treatment (Badenbock, 2008)
According to Jaak Panksepp, PhD, ALL mammals have seven primary affective (emotional) neurocircuits deep in the brain. They are adaptive, essential to our survival, and part of our basic brain structure. (Panksepp, 2014) While it is relatively well known now that the emotional center of the brain is in the limbic system, what Panksepp has found is that emotions are much more primitive, and hence much more powerful. The emotional pathways extend far beyond the limbic system into the upper and middle brain stem. (Panksepp, personal communication, 2014) These circuits reside in “ancient parts of the brain;” they are unconscious, hence the term primary. (Panksepp, 2014; Panksepp, 2012; Panksepp, 2010a) “All aspects of mental life can be influenced by our primary-process feelings and the overall affective spectrum of the lower MindBrain is foundational for higher mental health issues” (Panksepp, 2012, p. xii). Emotions do not originate by a cognitive process. They begin in basic biological experiences deep in our brains and the subtleties (determining if we are feeling shame or guilt, anxiety or excitement) are then determined by our life experiences and our interpretations (secondary and tertiary processes, respectively, which I will explain below). The term MindBrain or BrainMind is Panksepp’s acknowledgment that we can not separate mind from brain and body. His theory is controversial in the field of affective neurobiology, but his decades of research supports his proposals. This model will make sense to those who feel their emotions take over and to those therapists working with trauma and addiction. It also helps to explain the power of sex addiction and other process addictions.
First a few words of caution. This is a very basic overview. The labels Panksepp chose for these seven circuits are not necessarily what we think of when we hear the word he uses for the circuit (RAGE for example). He is not talking about the act of rage, but the neurological circuit in the brain that is the basis of the feeling (in this example anger and its associated behaviors). Getting past the labels of the circuits may take some time, that is okay. Because these systems are evolutionary and found in ALL mammals, he uses capital letters. Also, this helps distinguish them from our experience of an emotion, our first thought when we hear the word rage. The emotion in parentheses is the feeling equivalent that we experience so that there is a personal context for the neuronal structures in the brain. I will capitalize as well when referring to the primary process structures, rather than the feelings as we know them. Finally, the interpretation of how these systems play out in sex addiction are my conjectures and are not proven by his research. They are possibilities given my experience working with people and my understanding of his work. So what are these seven primary-process feelings?
FEAR (anxiety): There are two anxiety networks in the brain. One is FEAR; it is the flight system. It is there when we feel threatened and helps us stay out of danger. It is the one activated when we worry.
PANIC/GRIEF (sadness): PANIC is the other anxiety network in the brain; it is imperative to attachment. PANIC is separation anxiety or grief over the loss of a loved one. All mammals need an adult to survive when born, and the PANIC circuit is what helps infants attach to their parents. “Animals who are often separated from their mothers for extended periods of time become maladjusted” (Weintraub, 2012) Opioids are a significant part of the attachment and PANIC system in mammals, along with oxytocin and prolactin. Anyone addicted to opioids understands the power of the bond with this drug.
RAGE (anger): RAGE is the fight circuit. When backed into a corner an animal attacks, RAGE tells us we have to fight to survive. RAGE indicates that a boundary has been violated. Although uncomfortable, without anger there would be no civil rights movement, no defending of ourselves when attacked or when our loved ones are threatened. There are two types of anger, the first is agitated rage, which is uncomfortable and is the rage/anger most of us think of when we think of anger. This agitated rage is based in the RAGE circuit. The second is related to the SEEKING circuit.
SEEKING (expectancy): SEEKING is our curiosity, our need for newness. What is called the reward system is a part of this expansive, perhaps primary system. It is the largest affective circuit in the brain. In fact the term reward system is misleading, “as the brain has many reward systems” (Panksepp, 2014, Personal communication). This is what helps our brains develop new neurons (yes our brains do develop new neurons and new neuronal connections). According to Panksepp SEEKING is the basis of addiction (we all know the term drug seeking). What psychology calls the reward system is a small part of the SEEKING network. The reward system is, in part, Medial Forebrain Bundle, but it is so much more than just reward (Panksepp, 2014). It is curiosity and enthusiasm. It impacts anger. Interestingly, there are different types of anger, one is related to the SEEKING system which is predatory rage and is considered pleasurable. Rage associated with SEEKING may also be primary to sexualized rage, part of the rage associated with sexual addiction and sexual perpetrators (sex addicts are not necessarily sexual perpetrators). Animals with predatory rage try to increase it, while those with agitated rage try to decrease the experience. It seems that both RAGE and SEEKING circuits would be involved in sexualized rage and may be dependent upon the individual’s life experiences and genetics.
Panksepp argues that the description of “reward systems” in the brain disregards much of the processes and role of affect in our behavior. In fact deep brain stimulation of the Medial Forebrain Bundle (the reward system) create “states of positive enthusiasm, that normally accompany the appetitive-foraging phase of behavior in our species, as we have long predicted” (Panksepp, 2014, p. 210). This suggests that much more is happening than a simple behavioral view of reward and punishment. It adds a level of understanding to why the rewards are so powerful. If it were as simple as the behaviorists suggest, quitting an addiction would be easy via extinction and other behavioral interventions. Unfortunately addiction are not so easy to stop. It is not simply pleasure but an enjoyable feeling state that is directly related to our survival instincts.
However, he recognizes secondary and tertiary emotional processes that work in a circuit (see chart). Secondary processes are learning processes that arise from various forms of conditioning (rewards and punishments); while the tertiary process is our thinking and ruminating and what is commonly associated with emotional life and that is impacted by interventions such as Cognitive-Behavioral Therapy. Tertiary processes are the worrying over and over what will happen if, the catastrophizing in anxiety, and the thoughts about how one will get a fix in addiction (Panksepp, 2010a).
In Archeology of Mind (2012), Panksepp writes, “Most modern psychoanalytic and cognitive-behavioral approaches to therapy fail to see SEEKING as a basic emotional urge. Some researchers also tend to confuse FEAR and PANIC/GRIEF, seeing anxiety as a single manifestation” (p.xv). I would add that therapist and doctors too see anxiety as a singular expression, when often the nuances are quite distinct. It is important to determine the difference as interventions may be more or less effective depending on the system involved. For example, when PANIC is involved I often need other strategies than cognitive interventions. Since SEEKING is such an important factor in addiction, more will be written about this and other systems in later posts.
CARE (nurturance): CARE is as it sounds, it is our affection for those close to us and for the world around us. It is our need to feel cared for and to care for others. It too is primary to our bonding with those we love.
LUST (sexual excitement): LUST is also part of our love for others and our need for sexual intimacy. In terms of survival we must have sex to propagate the species. Clearly in sexual compulsivity LUST is a primary process, however, it may not be the first activated for many individual but become active after the FEAR or PANIC or another system is involved.
PLAY (social joy): PLAY is integral to our emotional life, all animals play. It is the basis of joy in the brain. PLAY is imperative to brain development and attachment. Research has shown that playing enhances frontal lobe development. Play therapists know that getting on the floor and playing with one’s child improves attachment, this is why. As adults we must continue to have social engagement and playfulness. This is often a difficult task for recovering addicts, in part because play seems confused by SEEKING (excitement) and fun becomes the use of the drug or behavior. In other words the excitement of fix feels like fun, although it is another brain circuit altogether. This is where our secondary and tertiary processes come into the mix. PLAY stems from brain areas that are more basic - not higher order thinking. This is in part why Panksepp believes the removal of play from schools has led to a spike in ADHD. Finally, play reduces aggression, suggesting the link between these systems.
As you can see these networks interrelate. There is a saying in neuroscience, what fires together, wires together. This means that neurons that fire at the same time become paired together. This is a completely unconscious process. You can see how this plays out in various forms of addiction. SEEKING if activated with LUST leads to sexual searching. If our PANIC circuit is triggered and was alleviated by the enjoyment of LUST (sex), and this happens frequently the two networks in the brain will then fire off simultaneously when even one is activated. Additionally, if CARE and LUST become paired, for example through sexual abuse or other secondary and tertiary processes, then sex and intimacy become confused in a basic, unconscious way. I asked Dr. Panksepp if this is possible and he explained yes it was, in this manner:
"The SEEKING System is truly enormous, and beside integrating appetitive eagerness (enthusiasm), it also can be devoted to LUST issues where gonadal hormone receptors are concentrated (POA), as well as CARE where oxytocin and prolactin receptors are concentrated. Thus, all the positive emotional system, including PLAY converge on the SEEKING urge, but are distinct enough to be seen as distinguishable appetitive urges" (personal communication, 2014).
When secondary process of rewards and punishments come into play and then our interpretation of events and what this means about who we are, patterns of coping become quite complex. Given this complexity, changing behavior becomes very difficult. Anyone who is in recovery from sexual compulsion can attest to the difficulty of staying on the path.
This is not to say that all is lost and that adults are not responsible for their behavior. They most certainly are, but what this suggests is that we have to be aware of and work with the primary circuits for change to occur. Those working with addictions know this and do this inherently. Programs try to develop healthy fun activities to reengage the PLAY circuit with new behaviors. They are trying to disconnect PLAY from SEEKING, specifically drug seeking, and build the important social connection all of us need. SEEKING then changes too. In essence part of the work is pairing PLAY with CARE. However, addictions can be cunning, powerful, and baffling- a trigger can arise at any time. The primacy of these circuits gives us an understanding of why.
Finally, what most people call positive feelings, “indicate that animals are returning to “comfort zones” that support survival, while negative affects reflect “discomfort zones” that indicate that animals are in situations that may impair survival” (Panksepp, 2010a; Panksepp 2010b). Despite Panksepp’s word choice, this model suggests, and as Linehan and many others explicitly point out, that emotions are not good or bad, negative or positive, but they are either what Katie O’Shea describes as life protecting (FEAR, RAGE, PANIC) or life enhancing, helping us regulate our nervous systems by calming us and returning us to homeostasis (SEEKING, CARE, etc) (2014, training). Thinking about your feelings in this way can helps you accept your emotional experiences, become mindful of the process, and therefore less reactive to a feeling. Judging your feelings as bad only leads to resistance and a desire for the unpleasantness to go away and fear that the pleasant emotions won’t last. When faced with a difficult feeling, remind yourself that this is how your brain is designed to respond in order to protect you. Asking, “What is this emotion trying to protect me from?” can help shift your perspective.
Bradenbock, Being a Brain-Wise Therapist.
O’Shea, K. (2014). When There are No Words. Training.
Panksepp, J. (2014.) Integrating Bottom-up Internalist Views of Emotional Feelings with Top-down Externalist Views: Might Brain Affective Changes Constitute Reward and Punishment Effect within Animal Brains? Cortex; 59: 208-213.
Panksepp, J. October 27, 2014. Email communication
Panksepp, J. (2012). Archeology of Mind. New York: W. W. Norton & Company, Inc.
Panksepp, J. (2010a) Affective neuroscience of the emotional BrainMind: Evolutionalry perspectives and implications for understanding depression. Dialogues in Clinical Neuroscience; 12(4): 533-545.
Panksepp, J. Archeology of Mind P.xii
Panksepp, J. (2010b). Dialogues Clinical Neuroscience. 12(4):533-545. Affective Neuroscience of the Emotional BrainMind: Evolutionary Perspectives and Implications for Understainding Depression.
Weintraub, P. (2012, May 31) Discover Interview: Jaak Panksepp Pinned Down Humanity’s 7 Primal Emotions. Discover Magazine. http://discovermagazine.com/2012/may/11-jaak-panksepp-rat-tickler-found-humans-7-primal-emotions.
Although sex addiction is becoming more recognized, there is still controversy around this disorder. Many think, "if sex can be an addiction then anything can be an addiction!"- and well, that may be true - but sex addiction has clear parameters. Just because someone has an affair does not mean there is an addiction. People also believe sex addiction is an excuse. When a loved one says "I have a sexual compulsion," it is easily translated by family members as, “it really isn’t my fault, I am not responsible.” Admitting to a sex addiction in no way removes accountability for one’s behavior. What it means is a complex interplay of psychological, neurological, and cultural processes are at play that make the behavior difficult to change.
So, what is sex addiction?
Like any other addiction, sex addiction means that despite efforts to stop the behavior, the addict continues to act out, often feeling shame in the aftermath. People think that if it is an addiction, then it is enjoyable. However, often the acting out stops being pleasurable and instead feels painful and overwhelming. Tolerance develops such that the behaviors escalate. What felt good before no longer achieves the high. For example, internet porn may increase to strip clubs, then to paying for sex, or repeated affairs with many partners, or riskier and riskier behaviors. Addicts become preoccupied with sex, thinking about it rather than focusing on work or family. They can appear withdrawn or distracted. More and more time is spent preparing for sex or acting out, even risking work and relationships to engage in sexual activities. Consequences of acting out are ignored or denied, “it isn’t THAT bad” or “if no one finds out then, I’m not really hurting anyone.” As in drug addiction, sex addicts experience withdrawal; they may feel irritable or agitated when prohibited from engaging in the behavior. At least 3 of these criteria must be met to qualify as an addiction. Finally, the behaviors are not attributed to another disorder such as a manic episode.
Sex addiction cuts across genders and socio-economic status (although for purposes of this post I will use the pronoun he for ease of reading). It can lead to deep depression and suicidal thinking. For many individuals, particularly women, the focus is relationships rather than sex itself. They may idealize partners and romanticize, getting bored when the fantasy wears off. They may not end a relationship without someone waiting in the wings. They have difficulty not being in a relationship and self-esteem becomes dependent upon relationship status. A pattern develops of becoming too vulnerable too soon leading to pain and despair.
Ultimately, sexual compulsivity is an intimacy disorder - a difficulty being vulnerable and fully authentic with others. Sex, while mistakenly viewed as a way to connect, inevitably keeps distance between the addict and those he loves. True intimacy is not boundary-less. Revealing all to feel close too soon is not healthy intimacy.
A sex addict is NOT the same as a sex offender. While addicts may violate boundaries (such as acting outside of a committed relationship), not all addicts engage in offender behavior. Further not all sex offenders are sex addicts addicts. Sex offenders require a different form of treatment than a sex addict.
Family of origin dynamics can predispose someone to an addiction, not just sex addiction. Having a parent who is a sex addict can impacts a child’s view of sexuality and intimacy, especially if left untreated. There can be unclear boundaries in the home and children may be exposed to the addict's behavior. Enmeshment with a parent, or a child being a surrogate spouse to a parent negatively influences the child's ability to develop healthy relationships. Eighty percent of sex addicts come from emotionally disengaged and rigid, authoritarian households. These are households where “it is my way or the highway” with little or no discussion or consideration of the child’s needs and wants. Physical, emotional, and sexual abuse also play a role. Because the child grows up learning that love is painful, as an adult the child can have difficult accepting healthy, respectful, loving relationships. Those with a sexual abuse history can confuse sex with intimacy, and may re-enact the trauma by acting out sexually. Often re-enactment is an unconscious attempt to master or gain power over the abuse. The unconscious belief can take many forms such as, "if I can get this person to love me, then I will be okay/worthy/loveable." Because this rarely, if ever, works the re-enactment continues. That said, not all sex addicts were sexually abused.
Sex addiction impacts the entire family, even if the addict believes he is hiding it. The addict's focus on sex
precludes him from being present to those around him. Family members feel neglected or dismissed. Subtly or overtly, life revolves around the addict while the addict's life revolves around sex. If the partner suspects infidelity and begins to question his behavior, the addict’s vehement denial leaves partners feeling deep self-doubt, like they are "going crazy." Also, this addiction influences the partner's sexuality, such that the partner may engage in unwanted sexual activities (for example, having sex more often than wanted or having multiple partners). Scenes from the movie The Unbearable Lightness of Being portray this dynamic, although this is NOT a movie I recommend to addicts or their partners. A common pattern is avoiding sex in the relationship while the the addict is sexual elsewhere. Because those with sex addiction can compartmentalize so well, when discovered, partners may wonder, “Who is my wife? Who is my husband?... I don’t know this person!” The betrayal is deep and often traumatic. Some with sex addiction become jealous of the partner’s sexuality or suspicious of the partner’s behavior, even if trustworthy. What the addict can not own in himself is seen in the outside world, particularly in those close to him.
In order to heal from this addiction, as in any other addiction, acknowledging there is a problem crucial. If in a committed relationship the addict must work to rebuild trust to make the relationship safe. Partners have to learn healthy boundaries as well. Support groups are recommended as is therapy by a professional trained in treating sex addiction. Ideally, both the addict and the partner will have their own therapist and when ready a separate couple's therapist. Finding a support group is very important in the healing process particularly to reduce shame and isolation. If you think you or someone you love may be struggling with this disorder, click here for links to free online assessments. Be honest and compassionate with yourself and others, there is hope.
Jami Parrish, LPC, CSAT, CMC is a therapist and coach whose aim is to help others live fully and find true freedom. She is currently practicing in Tucson, AZ.