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Inspiring Success on the Road to Recovery

Tuesday, May 29, 2018

Living Disconnected

The relationship between Eating Disorders, Addiction, and Trauma

By Tanja Haaland, LCPC, Clinical Director, The Meadows Ranch

Eating Disorders are a mental illness that affects an individual’s ability to have a healthy relationship with food and their bodies. Anorexia, Bulimia, Binge Eating Disorder, and Other Specified Feeding and Eating Disorders are prevalent psychiatric diseases that can be life threatening. In fact, eating disorders have the highest mortality rate of any psychiatric illness. About 20% of individuals who struggle with these disorders die from medical complications or by suicide (Hudson, Hiripi, Pope, and Kessler, 2007). 

Prevention and early intervention are critical with these disorders; however, even those who have struggled for decades are able to recover with the help of trained professionals. Effective treatment can be conducted in an outpatient setting, in an inpatient or residential setting with the level of care needed by the patient based on the active symptomology, severity, and duration of the disorder. 

Anorexia Nervosa is categorized by an intense fear of gaining weight, a distorted body image, denial of the severity of the illness, and a weight that is lower than expected for the individual. Persons suffering from Bulimia Nervosa engage in recurrent binge eating (consuming an excessive amount of food in a short time) followed by self-induced vomiting, laxative abuse, excessive exercise, and/or fasting. This disorder also has an extreme focus on weight and shape, but unlike individuals who struggle with Anorexia, those who have Bulimia will often be of average, or even higher weight. 

Binge Eating Disorder exhibits similarities to Bulimia, in that recurrent binge eating episodes take place, but differs because no compensatory behaviors subsequently occur. The binge eating episodes are often when the person is alone, the person eats even when not hungry, and food consumption goes past the point of feeling comfortable.

Some physiological and psychological complications of eating disorders are abnormal sleep patterns, difficulty concentrating, preoccupation with food, weight, and shape, panic attacks, social isolation, mood swings and irritability. Eating disorders are often difficult to assess and are not always readily detected by others. Those who struggle with these illnesses are often very secretive and shameful about their behaviors and will go to great lengths to hide what they are doing. They often function very well in their lives and are frequently successful high achievers. Also, with the normalization of disordered eating patterns in today’s society, eating disorders can go unnoticed and be minimized in severity. 

Who is Affected?

Eating disorders affect all genders, races, socioeconomic classes. They can develop at any age and impact not only the individual who has the diagnosis, but the entire family system. Family therapy is a crucial part of treatment, particularly if the struggling individual resides at home. Eating disorders often place much strain on the family system and support for the family members is not only helpful for them, but in turn also helps the patient receive better support from their loved ones. 

Temperament, genetic predisposition, cultural, and environmental factors, can all contribute to the development of an eating disorder. Those who suffer from an Eating Disorder often have other co-occurring disorders. Anxiety, Depression, Substance Abuse, Obsessive Compulsive Disorder, and PTSD are just a few of the other diagnoses observed in this patient population. Many of those who have an Eating Disorder have also experienced some form of abuse. Sexual, physical, and emotional abuse is rampant in this patient population and is a core issue that needs to be addressed for the individual to fully recover. Studies estimate that 74% of eating disorder patients have experienced abuse (Brewerton, 2008).

The type of trauma and the mediating factors, such as developmental phase, self-image at the time of the trauma, family support, and ability to process the trauma at the time of the event, all contribute to the level of integration or level of dissociation that the individual has with the traumatic event. The higher level of dissociation or the inability to integrate the trauma in a healthy manner, the more likely that the individual will resort to unhealthy coping mechanisms to mitigate the effects of the trauma. 

It’s Not About the Food

Having suffered abuse often creates much emotional turmoil and shame, which if left unresolved can trigger the need to use eating disorder behaviors in an attempt to avoid uncomfortable feelings. It’s inappropriate to just treat the symptoms of an eating disorder, so we often find ourselves saying to patients, “It’s not about the food!” Perfectionism, over-functioning, the avoidance of feelings, unresolved grief, and feeling out of control, are some examples of therapeutic work that must be undertaken to enable the individual to let go of their need for maladaptive behaviors.

It is not uncommon for individuals who have an eating disorder to also struggle with substance abuse. Rates of substance abuse in this population are estimated to be 12-18% for those who struggle with Anorexia and 40-45% for those who struggle with Bulimia and Binge Eating Disorder. Treating both the eating disorder and the substance abuse simultaneously is imperative to a successful recovery. 

Managing symptom substitution and the development of other negative coping behaviors is crucial. 
When starting the treatment process, therapists often talk about the game of Whack-a-Mole, the arcade game where a soft foam bat is used to hit moles that pop up only to have others pop up in different holes. When patients start to address one symptom, the clinician and patient need to remain vigilant to recognize other symptoms that may begin to appear or reappear. Trading symptoms is just another form of avoidance and inhibits the recovery process. 

Substance abuse can also contribute to the adoption of eating disorder behaviors. For example, one of my patients restricted her food intake and over-exercised as a way to counter the calories she was taking in from her alcohol use. Both the use of substances and the eating disorder served as a way for her to disconnect from the grief she was avoiding. 

Just as a therapist must be cognizant of the severity of eating disorder symptomology and the potential medical complications that may arise with these behaviors, the clinician must also be aware of the level of physiological dependence that the patient with substance use disorder may present when starting treatment. It is impossible to begin any meaningful treatment while under the influence of substances and medical attention may be needed to help the individual address any issues of withdrawal. 

Treating Eating Disorders

As mentioned, treatment settings vary based on what the individual will need to be successful in starting their recovery process. The first step is finding a clinician who specializes in treating this specialty population. Once a trusting relationship has begun with the therapist and/or the treatment facility, the initial step in treating trauma in eating disorder patients is to stabilize and manage the maladaptive responses, such as restricting, bingeing, purging, or other compensatory behaviors. 

Psychotherapy is not as effective if an individual is in active addiction, both with an eating disorder and substances. The normalization of brain function through nutritional stabilization is critical to begin the therapeutic work. Refeeding, or normalizing meal patterns, significantly alleviates anxiety and regulates mood. It allows anti-depressants to function properly and allows psychological issues to be fully assessed. Due to the chaos disordered eating can have on the body and brain, it is vital to first nutritionally stabilize an individual before one can fully determine full treatment planning. 

Entering a higher level of care can help a patient stabilize their eating disorder. With the support of trained professionals, they can safely address the underlying reasons for their eating disorder. When an individual has experienced abuse, an adaptive function of the maladaptive eating disorder behavior is to provide a sense of control. Patients often look for ways to hold onto some sense of power in their lives. They create discipline around food and/or exercise, hyper control around their bodies, and the predictability and structure takes them out of the chaos that they internally or externally are experiencing. Managing food intake becomes much easier than managing or processing emotions regarding abuse that occurred. The eating disorder can be used by the individual to feel seen and heard when they feel they have not had a voice. Becoming emaciated or obese are very visible ways that pain can be physically observed. I have frequently heard stories of an individual discharging tension and anger that they have toward their perpetrator through purging. There is an aspect of wanting to feel “clean” or “empty” that individuals who have experienced sexual trauma try to create by restricting their food intake, using laxatives and/or diuretics.

I cannot reiterate enough how the underlying factors of the eating disorder must be addressed to help the patient achieve full and long-lasting recovery. While helping a patient achieve nutritional stability is vital, it is not sufficient to create recovery. 

One patient, Sally, came into treatment having been to multiple other facilities that were fantastic at helping her stabilize her eating disorder behaviors; however they did not process her trauma. Consequently, after treatment, her underlying traumatic memories would resurface making her unable to cope with her emotional distress, thereby triggering her regression back to using her eating disorder behaviors to cope with her unresolved trauma. This left her feeling both increasingly defeated and hopeless, and in a cycle of entering treatment centers where she was unsuccessful at achieving a full and long-lasting recovery. Intensive trauma work, while simultaneously addressing her eating disorder behaviors, was the necessary key to help Sally work through her pain and fully heal. 

Trauma processing through somatic experiencing, narrative story-telling, and other trauma treatment modalities helped her heal the hurt and pain that had burdened her for so long. A pivotal moment came during psychodrama group, where she was able to give voice to her wounded and traumatized child part. Sally was able to say to her perpetrator what she wished she could have said both as a child and now as an adult. She regained her power and was able to unburden feelings of anger, guilt, and shame, which she had held onto for years. Sally’s interpersonal relationships improved once she engaged with a more empowered sense of self. I was able to witness Sally move from operating in the world from a “less than” position to feeling more positively about herself. Once her trauma was processed, she was fully able to connect with herself and with others. Overcoming her apprehension and fear she once again connected with her body, which she had previously avoided since her childhood abuse. Establishing this connection allowed her to learn how to meet her emotional and physical needs. Addressing the underlying factors that contributed towards her need for her eating disorder was the only way Sally was going to be able to maintain recovery and live the life of which she is worthy and deserves to enjoy. 

The Goals of Therapy

The goal of therapy is to take the rejected and disconnected parts of self and work to form an authentic whole. When a person experiences traumatic events they often disconnect, split, and separate from their wounded and hurt parts of self. They avoid feeling the feelings that they deem as being, “too much,” or, “overwhelming.” As clinicians, we help individuals process the emotions that have often been repressed or ignored, allowing them to be fully present and engaged in the world. By addressing underlying issues, they can operate in the world without the need to avoid or distract and subsequently they find their life more meaningful and their relationships improved. 

Post Traumatic Growth

I love the concept of Post Traumatic Growth. The premise of this theory is that through adversity and struggle we can become more connected with ourselves, with others, and with our bodies. If an individual allows themselves to fully engage in the process of working through their struggles, whether they result from trauma, addiction, or attachment issues, the person connects with a level of self-awareness and enlightenment that many others do not make the effort to achieve. I find this to be especially true when applied to those living with eating disorders, addiction, and/or trauma.

Robert Frost says, “The only way out is through.” 

The beauty about having struggle is that if we are willing to muster up the strength to face our adversity, we can come out stronger. To be clear, “stronger” does not mean tougher; in this case, it is the sense that we can face the world in a more connected and meaningful way. Recovery is being mindful and engaged. It is being connected in a way that is impossible when the eating disorder or addiction is taking the lead or the trauma responses are primary. Through recovery, people realize that as they step away from their destructive coping behaviors, they can embrace life with a new view and a new way of relating to others. They make the time to connect more with their feelings in the treatment process, allowing them to fully engage in the world in an emotionally regulated way. When an individual processes the way they are responding to the world and their environment, they automatically become more connected with their sense of self and often deepen their values and belief system.

When a person can let go of the need to hold onto a sense of control, they can begin to blossom in a world where they previously felt out of control. They become more in tune with their thoughts and feelings. With this new perspective, they can thrive. There is a sense of gratitude towards the body that develops; a person recognizes they are a human being not a human doing. The person can often identify feelings of strength and self-resilience that they have never felt before. Patients that leave treatment often find new interests that they had never spent time and energy to consider; they sometimes establish a new life path, they re-evaluate priorities, and true healing occurs. Not only that, but when a person works through a traumatic event, they often find themselves better able to withstand future struggles.

Psychological stress, whether a trauma, addiction, or an eating disorder, is an opportunity for an individual to flourish. It is an opportunity for the individual to take something destructive and negative, and process it so that it can be used to re-establish oneself in the world in a different way, one that is more meaningful and resilient.

Conason AH, Brunstein Klomek A, Sher L. Recognizing alcohol and drug abuse in patients with eating disorders. QJM. 2006 May; 99(5): 335-9. Epub 2006 Feb 23.
Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61(3), 348–358.

Tanja Haaland, MA, LPC, Clinical Director The Meadows Ranch
Tanja received her undergraduate degree in Psychology and her master’s degree in Counseling at the University of South Dakota. Since 2006, she has specialized in the treatment of eating disorders and trauma. Her experience includes working as a trauma therapist in a psychiatric hospital setting, running her own private practice, and program director for an eating disorder partial hospitalization program. Currently, she is the Clinical Director of The Meadows Ranch, an inpatient, residential, and partial hospitalization program for women and girls, who suffer from and Eating Disorders. Tanja has lectured nationally on the topics of eating disorders and trauma and has provided clinical consultation and supervision to clinicians working toward deepening their knowledge of treating this specific population. 866-390-5100. www.meadowsranch.com


“I make choices that evolve me”

By Jolene Baney

I jumped out of a plane  few weeks ago… on purpose. And while many people have skydiving on their bucket list, truth be told, I most certainly did not. A completely different motivation was pulling at me, one that both intrigued and terrified me. How would it feel to confront a significant fear that has gripped me for much of my life with the payback of breaking free of it? How would it change me?

I am the opposite of an adrenaline junkie; I absolutely hate fast cars, roller coasters and high places. I get nauseous on boats and merry-go-rounds. I zip-lined once and hated it. A ropes course challenge at the top of a telephone pole ended in dismal failure. Of the four elements of Earth, Wind, Fire and Water, my spiritual home is Earth. Earth is predictable, solid, nurturing… safe. I’m perfectly and utterly fine with saying no to the things that threaten my safety and peace of mind.

I’ve also learned the hard way about having healthy boundaries, coming from a family history of addiction. Addiction can wreck havoc on relationships within families. If you have loved ones in active addiction or in the critical beginning steps of recovery, creating boundaries restores sanity, moving from enabling the dysfunctional behavior to supporting mutual respect. Boundaries are good.

Boundaries keep us safe. Boundaries help us and others become more self-reliant. Boundaries are personal and empowering.

So, why in the world would I agree to do this thing that threatens to violate my safe and secure boundaries? Of course, when the opportunity first came up to join my husband and a group of friends on this skydiving adventure, my automatic response was “Oh hell no!” But then I stepped back to dig deeper, and the real reason that came through was oh-so-revealing. You see, it wasn’t that I really believed it was dangerous (it’s really not), it’s that I didn’t trust myself. I believed that the fear was bigger than me… that I’d get up in that plane and would be paralyzed by a panic attack of epic proportions, with no way out. But then again, I mused, what if there was a gift in the experience, revealing a self-limiting part of me that really doesn’t serve any purpose, and maybe I just wasn’t ready to see my own ability to transcend fear? What if those false beliefs were at work in other parts of my life, keeping me from stepping into opportunities to live a more connected life?

Choosing Fear or Faith

If the opposite of fear is Faith, why was I not willing to trust in something bigger than my limited human ego? I didn’t want to be on the sidelines and wish I’d been brave enough to push through the fear, never knowing what might be on the other side. I’m brave and adventurous in so many other things — travelling off the beaten path, moving to a new country alone, presenting to groups, starting a new career, pushing my limits.  Why am I so fearful about heights and speed? It’s annoying. It was a jumble of thoughts and emotions, and finally, in a moment of false bravado, I pushed through it all and just said yes to the jump!

In the weeks and days and hours leading up to J-Day, I refused to think about or even entertain any emotional attachment around this looming event. Compartmentalize; that’s a handy, albeit sometimes unhealthy, skill! Even driving to the jump site, signing legal documents (which basically were saying “You fool, you really shouldn’t do this. You know you could die, right?”). Watching others stick their landing ahead of us, suiting up, getting instructions, boarding the plane… all good, high fives, jokes all around.

Don’t look down, don’t think ahead, don’t let the fear take over. I’m good, yay me! I began repeating a mantra, I’m not really sure what part of my reptilian brain it came from… “I am boundless… I am boundless… I am boundless”… as a slight feeling of dread started to creep in.

Then the moment of truth. We had finally climbed two miles up in the sky and others were starting to disappear through that gaping hole in the side of the plane. The rush of cold air was sucking us into the abyss. The noise was deafening. The ground below was now a real “thing” to be reckoned with. I was at the edge and there was no turning back. It was my turn.
“Oh. My. God. I’m doing this.”

We tumbled out (jumping isn’t really accurate, as it turns out). I surrendered and let go. God might have been involved… I certainly spoke his name, along with some other colorful characters who I thought might save me. I was disoriented, every fiber of my being and all five senses were on red alert. We spun, we fell, the force was like a category three hurricane.

But despite being thrust into the most unnatural of circumstances, falling down to earth from 13,000 feet up at 125 mph, it wasn’t terror at all that suddenly flooded my being. I surrendered. I trusted. I focused. I reminded myself to be present. It struck me… I am boundless. I can choose to be open to this experience. And what I noticed was — I was absolutely held in this bubble of safety. Roberto strapped in behind me, guiding every move, and Aaron flying around me, taking a video and reminding me to smile and enjoy the experience. They became metaphors for life. My spiritual training and my deep conviction is that God… Spirit, Divine Source, my Higher Power, the eternal energy of life… ALWAYS has my back and has a plan. And in my journey through life, there’s an inner awareness… my higher self, my observer, my soul… there to remind me to be present to it all and find joy along the way. Thank you, Roberto and Aaron, for being my teachers in those few profound minutes as we glided down and ever so gently landed on solid ground, slightly nauseous and weak in the knees, but completely exhilarated! I was glad it was over, I must admit. Earth never felt so good.

“I make choices that evolve me”… this has been my mantra for the last 15 years. My choice to test my boundaries through this skydiving adventure has evolved me in ways I’m just beginning to understand. I am boundless in a different way now. I still have healthy boundaries, but I think I may move though my limiting fears in a new and more powerful way. Where am I “stuck” and tethered to the ground, preventing me from experiencing more out of life? When can I say “YES” to a new possibility? What am I afraid of… and is it really true? How can I be more present to what is, even when I’m feeling a little out of control? Who can I trust to be there to mentor and guide me through it all, and how can I lovingly release the rest? When is the timing right to “let go and let God”?  These are the big questions, the lessons yet to be learned, the great mysteries of life.

So here’s a challenge for you to consider… what are the ways that YOU can break free and know a greater freedom? Don’t worry, you don’t have to jump out of an airplane to discover your false limiting beliefs, but I challenge you to find your own test, confront your fears, and come along with me to feel the difference it makes to be “boundless”!

Jolene Baney is a Clinical Outreach Representative for Las Vegas Recovery Center.  LVRC is a residential treatment center in the foothills of Las Vegas near the beautiful Spring Mountains, providing a complete continuum of care: inpatient medical managed detox, inpatient treatment, residential and partial hospitalization, and outpatient services.  LVRC’s Pain Recovery Program, lead by the nation's leading authority in pain recovery, Dr. Mel Pohl, has long been considered the best in the country.  LVRC accepts complicated detox treatment, including high levels of methadone and Suboxone withdrawl and have programs for Veterans and First Responders.  Jolene and her husband Rick live in Cave Creek, AZ.  Rick plans to jump out of a plane again, Jolene plans on watching from solid ground. lasvegasrecovery.com

What’s the Under-Employment Index?

LIFE 101 - Coach Cary Bayer

“If you’re not doing God’s work find another employer.”
—Phil Laut, author, “Money is my Friend”

The Bureau of Labor Statistics keeps a monthly tab on the unemployment rate. This number, 4.1 percent in March 2018 — gives a thumbnail look at how many people aren’t working in America.

This index, treating people as statistics, measures their financial cost for not having regular paychecks. What this quantitative measurement fails to measure, however, is the qualitative statistic I call under-employment. There’s no way to measure how 96 percent of the working population suffer for being under-employed.

If a musical composer in Woodstock, New York— and I know plenty of them — works as a handyman or contractor instead of as a composer, he’s under-employed. He’s using circular saws instead of pianos. He’s giving society a wooden bookcase that he makes with his hands instead of the song or the musical he’s writing in his head in the limited spare time that contracting affords him.

The loss is to him and to us. He suffers emotionally, and we suffer for getting less than what he’s here to offer.

Actresses in Hollywood who wait tables aren’t giving the world their best. There may be a Meryl Streep among them. Instead of giving possible Academy Award-winning performances in movies, she’s bringing customers today’s blue plate special in diners or mustard-crusted branzino in bistros.
Writers in New York working as proofreaders in law firms may lack the time or energy to write the next Death of a Salesman or Catcher in the Rye after long days or nights catching typos on lawsuits. I’ve known many of these people in my time.

This isn’t New

Paul Gaugain was a stockbroker. Walt Whitman toiled in the Patent office. Dracula creator Bram Stoker managed a theater. T.S. Eliot worked at Lloyds Bank in London while writing The Wasteland. Wallace Stevens was an insurance attorney for the Hartford.  William Carlos Williams was a medical doctor. Kurt Vonnegut managed a Saab dealership. Philip Glass drove a cab and did plumbing.  Composer Charles Ives co-founded Ives & Myrick Insurance. Jeff Koons was a Wall Street commodities broker. It’s a phenomenon that would be great to retire.

Colleges and universities train people for jobs, often in a terrific manner — at least many do. We need steady streams of new engineers, computer scientists, and medical doctors. The MITs, Stanfords, and Yale Medical Schools of the world are there to train such people for such employment.

What we really need, in addition, are entrepreneurial schools that train composers to make a living as composers, actors to provide for themselves as actors, writers who write successfully for a living so they can also write checks for their mortgages that won’t bounce.

There are institutions like the Juilliard School in New York to train creative people for the arts. There’s the Eastman School of Music in Rochester, and the American Conservatory Theater in San Francisco to train actors, among such reputable centers. But because actors, writers, singers, and dancers are filled with creative ideas they often aren’t very good at marketing these ideas, and so these training centers need to simultaneously train their charges in basic business and marketing skills, as well, so they can work professionally in the arts and not be hyphenates like the actresses-waitresses and composer-carpenters discussed above.

Woodstock, NY, where I have lived for nearly 30 years, is a town filled with hyphenates. It has long attracted artists of all stripes, but because artists—and healers and spiritual folk, as well—are right-brained oriented, they’re not usually strong in the left-brained talents of doing business. What we really need are Entrepreneurial Institutions that focus on creative people. This would enable millions of gifted people to be sharing the talents they’ve been given and be fully supporting themselves in the process. This would lower the Under-Employment Index significantly, make them so much happier, give the society we live in the very best they have to offer, and put a smile on the face of the Great Spirit that has gifted all of these people so lovingly.

Monday, May 28, 2018

Code: Red

Helping others from Summer Heat

In anticipation of what could be its hottest summer ever recorded, the Code: Red Summer Heat Relief has begun. The program, which will run through August 31, and is dedicated to providing food, water, and other heat relief to the elderly and homeless population in the Valley.
Men, women, and children experiencing homelessness are at risk of dying from excessive heat, a fate that 114 individuals fell victim to in 2017 in Phoenix.

Here's how you can help:

Organize a water drive — challenge your co-workers, family, friends, or church to join you in providing life-saving water this summer to those who need it most. Ready to start your drive? Contact Catie Hammann: chammann@phoenixrescuemission.org or 602-346-3347 to get started.

Volunteer — there are plenty of opportunities at the Phoenix Rescue Mission to make a difference in the lives of those we serve. See the latest volunteer opportunities at phoenixrescuemission.org.

Donate — If you live in Arizona, you know costs rise in the summer. From air to energy, man-power and extra equipment, our summer time costs are high. Make your greatest impact by simply donating. Because of a generous donor, your GIFT WILL DOUBLE thanks to a matching grant.

Volunteer drivers will help the Hope Coach Outreach program to deliver needed items to the Valley’s homeless and elderly population. Drop-off sites that accept donations of heat relief items like hats, sunscreen and water are located throughout the city.

If you are interested in helping The Red Summer Heat Relief Campaign, contact Catie Hammann: chammann@phoenixrescuemission.org or 602-346-3347 or learn more phoenixrescuemission.org/

The Brain: A New Frontier

By Dr. Stacey Smith, PhD, CSAT, EMDR

For over a decade I’ve worked in the recovery industry at multiple programs that have used the neuroplasticity of the brain to increase/enhance brain performance. 
These programs have come under a variety of names including: Biofeedback, neurofeedback, and brain optimization. In an environment where research continues to grow and professional conferences continue to focus on these issues (over 50 conferences internationally and 30 this year in the U.S. alone). Whether for personal use, professional referrals, or use in treatment programs, it is important we know what how these programs work.

I have seen these tools assist clients with self-regulation and improved affect tolerance which has allowed them to remain in treatment and develop the needed foundation for recovery Some clients focus better in session, allowing for better development of coping skills. And, many have seemed to be better equipped to deal with anxiety, depression, shame, and anger experienced during the treatment process. Many clients report feeling grounded and become willing to address traumas earlier in treatment. Therapists report their clients have better active listening skills, engage and participate in group. They respond better to difficult feedback and are more aware of thinking processes. AMA (Against Medical Advice)rates decreased as the brain balancing/optimization began. 

Since the 1950’s, biofeedback has been used to measure body signals that are not normally perceptible1. Examples include heartbeats, hand temperature, muscle tension, and galvanic skin response2. Biofeedback programs work with the peripheral nervous system and through an associative learning model where the body mirrors system signals and responds to create ‘normalized’ responses. It does so through shaping (operant/instrumental conditioning), using reinforcement (visual/audio or both) to train the body to increase or decrease functionality of the peripheral nervous system. 

An example: An individual can ‘feel’ the beginnings of a panic attack in the body, based on physical cues, and knows to use coping skills (i.e., breathing, meditation, etc.)3. 
Neurofeedback is a form of biofeedback that works specifically with the central nervous system and brain. This process is neither static or independent. The electroencephalography (EEG) as a measurement tool can be impacted by factors such as sleep, age, caffeine use, etc., so it measures a system in motion (not static). When a ‘push’ is made on any of the systems that are measured by an EEG, other systems also make changes (thus not independent)4. As a tool, the EEG is prognostic and not diagnostic and is used to predict likely outcomes, measured against a database of norms for such areas as speed of processing, interconnectedness, regulation of arousal states and connectivity. 

Neurofeedback does not control system changes, it identifies systems out of balance and through electronic signals, gives a ‘push’ to these weak areas, allowing plasticity of the brain to adjust systems into a more balanced position. It has been suggested that EEG technologies could be used as an adjunctive evaluation method for cerebrovascular disease, dementia, learning and attention disorders, mood disorders and post-concussion syndrome5. In addition it has been suggested that neurofeedback can be beneficial in the treatment of depression6, anxiety disorders7, and ADHD8.

Brain optimization processes typically incorporates aspects of neurofeedback allowing the brain to examine current established neuronal patterns, to recognize those patterns adaptability for our current circumstances, and then to develop a plan that would allow for optimization. The most recent program that I’ve worked with, Vitanya, uses supplements (i.e., enzymes, antioxidants, etc.), support gut health and nutrition delivery, clears toxins from the brain, promotes neuroplasticity, and supports improved focus and stress management. Some of the results for clients included; a better ability to deal with anxiety, depression, shame, and anger, increased ability/willingness to participate in processing of trauma, better sleep, and ability to participate in groups at a higher level. AMA rates declined during this time.

One might wonder about the scarcity of gold standard clinical research studies (double blind, placebo controlled) published to provide validity, efficacy, and specificity for neurofeedback.  This would allow individuals to use insurance for assessment and would facilitate assessment for more individuals. Some practical reasons this research has not been done include the difficulty in doing double blind EEG analysis. EEG signals currently are so sensitive they can be influenced by body movements (coughing, sneezing, and other types of movement) that can create difficulties. Another factor is that brain wave processes are highly individualized and not easily generalizable. It would take a study with tens of thousands of participants with individualized treatments to follow standards needed for FDA approval. Unfortunately, the typical provider of these types of treatment modalities do not have the resources to conduct this size of study5. 

Hopefully, this has helped to give a brief introduction to processes on which books have been written. In short, at this time biofeedback and neurofeedback have been used as a form or treatment or assessment, which can be used in conjunction with other treatment modalities to facilitate clients in making significant changes in their lives. 

1Miller, N. E. (1978). Biofeedback and visceral learning. Annual Review of Psychology, 29, 373-404.
2Miller, L. (1989a). What biofeedback does and doesn't do. Psychology Today, November, 22-23.
3Lehrer, P. & Gevirtz, R (2018). Heart rate variability biofeedback: Current and potential aplications. In Magnavita, J (Ed). Using technology in mental health practice, (p. 123-141). Washington D.C., American Psychological Association.
4Schmachtenberger, D. (2018). Understanding Neurofeedback: Brain Optimization – Dr. Andrew Hill. Retrieved from https://neurohacker.com/understanding-neurofeedback-brain-optimization-dr-andrew-hill
5Hughes J.R. & John, E.R. (1999) Conventional and Quantitative Electroencephalography in Psychiatry. The Journal of Neuropsychiatry and Clinical Neurosciences, 11, 190-208.
6Hammond, D. C. (2001). Neurofeedback treatment of depression with the Roshi. Journal of Neurotherapy, 4, 45-56.
7Moore, N. C. (2000). A review of EEG biofeedback treatment of anxiety disorders. Clinical Electroencephalography, 31, 1-6.
8Masterpasqua, F. & Healey, K.N. (2003). Neurofeedback in Psychological Practice. Professional Psychology: Research and Practice, 34, 652-656.

Dr. Stacey Smith is licensed psychologist in both Arizona and Texas and has been working in the addictions field in residential and IOP settings since 2010. He has a wide variety of experience in the addiction field, including work with individuals who suffer from addictions to alcohol, drugs, intimacy/relationships, sex, and gaming addictions.  Early in his career, Dr. Smith trained in EMDR techniques, knowing the important role that trauma work plays in the recovery process. Most recently, examination of how the brain works and how technology can play a key role in client recovery has been a focus of his work. To reach Dr. Smith email him at ssmith@healthehero.org

ME First!

By Dr. Dina Evan

We are living in extraordinary times. We have young and older people marching side by side for women’s rights, for educational funding, for LGBT rights, for fair wages, for sexual abuse issues, for drug abuse and the mis-use of power. Today, we are really standing up — but I am still worried.

I know it’s different now, the numbers are greater, the anger is hotter, the demonstrations are bigger, and the demands are louder. However, in my life, over the last 40 plus years, along with millions of other people, I have donated thousands of dollars and written hundreds of letters to every cause I believe in.

I’ve marched with Whoopi for AIDS funding, I have marched with Gloria Steinem and Kathy Najimy and spoken to legislative bodies for women’s rights. My children and I have walked hundreds of precincts getting signatures on petitions. With only three states left needed to ratify, I fasted 37 days on water for The passage of the Equal Right Amendment which was started in 1920! And yet, we are not much farther ahead with any of these issues. So, what’s the problem?

I think it’s because we are looking out there, instead of in here. Many of us are still looking for someone else to fix it. Change never occurs on a grand scale unless we change inside first.

I want to challenge us to stop, be impeccable in our integrity and ask ourselves some deep questions, questions about how much we believe what we say we believe.

For instance, we are all feeling discouraged about the number of lies coming out of Washington. We feel unsafe and no longer know what to believe. We are rightfully angry we are not getting the truth about much of anything. But, when was the last time you told what you consider to be a white lie, or a big whopper, to someone in your family, your business, to your boss, your kid, your partner or beloved — or anyone else? Can you commit to impeccable truth telling? It can’t change out there, if lies are still happening in here.

We are upset and appalled about the sexual abuse and misuse of power we see in the world today.

Women are enraged, rightfully so and men are enraged at being accused after years of thinking what they were doing was acceptable. However, is there a friend or someone in your family who is being abused — and have you offered to help? Have you volunteered at a crisis center? Are you allowing be yourself to be abused or dealing with a misuse of power in your own life and needing to reach out for support? It can’t change out there if abuse is still happening in here.

We see parents today that are so worried about their kid’s education and they want changes made in the schools. But, how many of us have put our cell phones and lap tops away every night to spend quality time with our kids on homework or just being together, talking? It can’t change out there if we are disconnected in here.

How many of us think what is happening to minorities is outrageous? And yet, how many of us still feel we are more entitled, or should not have to share our blessings with other people? How many of us still feel some fear when around a person from another country? How many of us stop to smile, shake a hand or invite a family in for dinner who is different from us? How many of us still don’t understand there is only one planet and one people? It can’t change out there if prejudice is still happening in here.

Here’s the cold truth. We are living what we created and nothing is going to change until we do. It’s all about the energy. Accumulative energy creates change, but not by asking for someone else to do it for us. I think I have told this story before but it’s worth telling again.

Gandhi is a well know spiritual leader. One afternoon a woman brought her daughter to him, having walked from a very far away city. She asked that Gandhi tell her daughter to stop eating candy. Gandhi looked and her and told her to come back in a week. She was exhausted and confused but agreed. 

The next week she returned with the same request, “Tell my daughter to stop eating candy.” Once again, Gandhi looked and her and told her to come back in a week. Now she was really angry given how difficult the road back and forth was, but she finally agreed. A week later she returned with the same request and Gandhi said to the daughter, “Stop eating candy!” Well the mother was totally frustrated and demanded to know, “Why did you make me come back three times to get you to tell her that!” Gandhi responded, “I had not yet stopped eating candy myself.”

Let us have that same impeccable integrity and make the changes we need on the inside so that together we can change the direction in which we and the world are going. I believe in us. I believe in you. Change is not out there, it’s in here.

Dr. Evan specializes in relationships, personal and professional empowerment, compassion and consciousness. 602-997-1200, 602-571-8228, Dina.Evan@gmail.com and www.DrDinaEvan.com.

28 Years Later

In a few weeks, Father’s Day falls on June 17th, just like it did in 1990 — my first day of sobriety. That was the day I made the first commitment to something I’ve stayed true to ever since.

After getting hit over the head with the Cosmic 2 x 4, (When things need to change.... Sudden, dramatic and painful things happen that tend to result in miraculous shifts), I reached out for help and a dear friend took me to my first 12 step meeting. I don’t remember much about it, except feeling confused, full of fear, shame, nervous, shaky, and slowly coming out of a fog.

As we walked through the doors, I asked her why every one was smiling, hugging and laughing. Who are “THESE” people?, I wondered. I came to understand “those” people are “my people!” Had I found a place where I belonged and was welcomed?

When I got home after that meeting, I called my dad, making up some excuse about why I forgot to send him a Father’s Day card — and without hesitation, went right into where I had just been. I was nervous as hell saying out loud, “Dad, I’m an alcoholic; I went to this meeting.” I heard a sigh of relief in his voice and a bit of hesitation, too. At the end of the call he said, “take it a day at a time, I love you.” That brief call was the beginning of the father/daughter relationship I had hoped for all my growing years, one that I had sabotaged with my addictive behaviors, lies and unfulfilled promises.

When we stay clean and sober, while we aren’t forced to — we tend to grow up. We become responsible, accountable and honest. Days can turn into months and months into years.

In sobriety, I’ve learned how to listen, care about others, reach out, ask for help, and be vulnerable. I’ve done what was suggested when I didn’t want to, dug deep inside and spilled my secrets to women I admire and respect. I’ve made mistakes and many amends. I’ve laughed hard, cried even harder, loved deeply and had my share of pain and loss.

I’ve faced challenges and made it through to the other side of every one of them, whether I believed I would or not — without numbing out.  Alcohol and drugs never did and never will solve any problem. 

The biggest gift sobriety has given me is a belief and connection to a Higher Power who always has my back; all I have to do is Trust and get out of the way! (Something I still work on).

When I heard fasten your seat belt, sobriety is going to be a wild ride, they weren’t kidding. Being sober means I show up for real life whether I like what’s happening or not— because I’m never alone.

To each and all who have helped, guided, steered, and called me on my &*!!!!!! — I am humbled and grateful to you.

To my dad, though no longer here, Happy Father’s Day, and I’m still taking it a day at a time!