Self-Harm Revisited: Pornography, the Intimacy Hijacker

1. Self-Harm Revisited:Pornography, the Intimacy Hijacker Daniel A. Glaser MSW, LCSW The New Orleans Institute River Oaks Hospital SASH, 2013

2. Sex Addiction Excessive use of mood altering behaviors are a sex addict’s path of escape from life stress and overwhelming emotions of loneliness, anger, fear and shame. [Lofgreen (2012). The Storm of Sex Addiction: Rescue & Recovery.]

3. Lie of Addiction • Seeking altered consciousness here and now to evade distressing feelings. • Something outside me can fix what is wrong or missing inside me. egs. Pornography will replace lack of excitement. Food indulgence will compensate for loneliness. Gambling success will override lack of promotion. [Prin, John (2006). Secret Keeping: Overcoming Hidden Habits & Addictions]

4. Self Harm Intentions External Factors (circumstances) • Social isolation, poor family support, sudden losses, abusive relationships. Internal Factors (psychological state) • Depression, perfectionism, tendency to suppress emotions. [Palmer, ed. (2008) Suicide: Strategies and Interventions for Reduction and Prevention.]

5. Direct and IndirectSelf Harm Exploitative experiences may create a sense of powerlessness and helplessness. Lack of control may lead to control seeking behaviors (e.g. eating disorders, self destruction, or exploitation of others.) [Ryan et .al. (1999). Web of Meaning.]

6. Basic Motives of the Self • Terror Management Theory – (organismic preservation) • Emphasizes the defensive aspects of self and the fundamental motive of anxiety control • Defends against dangers • Self Determination Theory – (organismic expansion) • Emphasizes the expansive aspects of self and the processes of intrinsic motivation and growth • Skills development [Leary & Tangney [eds.] Handbook of Self & Identity, 2003]

7. Self Regulation • Ability to be aware of, control and monitor emotional reactions, impulses, and behaviors. • Ability to repair emotional distress, usually through taking control and renegotiating the environment. [Katehakis (2010). Erotic Intelligence]

8. Coping With the World • Unhealthy passivecoping skills = escape, avoidance, chronic sexual fantasies, isolation and withdrawal from others. This unhealthy non-relational set of skills is referred to as auto-regulation. • Unhealthy activecoping skills = gamut from substance abuse to engaging in process addiction (i.e. sexual addiction). The relationship is with the substance or the experience (i.e. excessive masturbation, pornography, strip clubs, sexual massage parlors, frequenting sex clubs, hiring prostitutes, cruising restrooms, voyeurism, exhibitionism, etc.) [Katehakis (2010). Erotic Intelligence]

9. Coping With the World • 3. Healthy passive coping skills = solitary activities such as journaling, reading, meditating and contemplation. • This healthy set of auto-regulatory skills is a form of self regulation which can be done alone or include other people (physical activities = skiing, swimming, hiking; creative expression = composing music, writing, art). [Katehakis (2010). Erotic Intelligence]

10. Coping With the World • 4. Active coping skills = engaging or acting upon the environment, such as seeking support or solace from others and getting help to generate possible solutions. • Active coping (a form of self regulation) seeks control of the situation using productive methods to build resilience. (12-step meetings, asking for hug, reaching out, forming friendships). • Interactive regulation is getting comfort and support from relationships or other people. [Katehakis (2010). Erotic Intelligence]

11. Behavioral Addictions Pathological gambling Kleptomania Trichotillomania Pyromania Intermittent explosive disorder Hoarding Pathological skin picking Compulsive buying Compulsive Internet use Compulsive sexual behavior Self injurious behavior Binge eating [Grant (2008). Impulse Control Disorders.]

12. Compulsions • Compulsive Behavior • Comes from an identifiable source, • Operates in a predictable pattern, and • Can be alleviated through a process of awareness, clarification and recovery. • “Compulsions serve as clues to the deeper stories of our lives, an individual’s history of emotional woundedness.” [Larkin & Whiting (1991)]

13. Behavioral Addictions • Core qualities of many impulse control disorders: • Repetitive or compulsive engagement in a behavior despite adverse consequences. • Diminished control over the problematic behavior. • An appetitive urge or craving state prior to engagement in the problematic behavior. • A hedonic quality during the performance of the problematic behavior. [Grant (2008). Impulse Control Disorders.]

14. Sex Addiction • Considered a severe intimacy disorder because one’s “significant other” is a mood altering behavior rather than a substance or a real person. • Often progresses to the point of risking everything for the euphoria and escapism of a sex “Fix.” • Some have ready excuses to minimize, rationalize or deny their addiction [Lofgreen (2012). The Storm of Sex Addiction: Rescue & Recovery.]

15. Sex Addiction • Many feel deep shame about acting outside their rules. • Many fear the risk and consequences but are unable to quit. • With addiction there is a broken promise; a promise to oneself or to another person. • Misguided efforts to self soothe the discomfort of extreme emotions. [Lofgreen (2012). The Storm of Sex Addiction: Rescue & Recovery.]

16. “The pain in the past hijacks the present, activating reactive behavior to current events!’

17. “The difference between the past and present related to trouble controlling sexual desire is that today there are many more sources for sexual gratification and many more ways to establish secrecy than in the past.” [Sbraga & O’Donohue (2005). The Sex Addiction Workbook.]

18. Types of Neuropathways That Addictions Use To Activate The Brain NumbingSeeks a calming, soothing, relaxing, or sedative experience. FantasyEscape to alter perception of reality. DeprivationControl is the goal and self deprivation is the surest way to defend against terror. This is the purge portion of a binge / purge cycle. ArousalAll about pleasure and intensity. [Gerogianna, Underhill, & Kelland (2010). Hyperstimulation: Teens, Pornography, and Online Addictions.]

19. Neuropathways of Addiction • Addicts as children did not learn positive adaptive behaviors for emotional self-regulation. • Children who experience trauma learn maladaptive responses: they dissociate, numb, and develop negative core beliefs. • Stress Response Syndrome: brains are hijacked by memories of trauma, emotional responses are spontaneous and their self medicating actions are impulsive and lack adequate forethought. [Lofgreen (2012). The Storm of Sex Addiction: Rescue & Recovery.]

20. Neuropathways of Addiction • Chronic state of hyperarousal in which exaggerated emotions compel one to seek an escape. • Escape comes from compulsively arousing and soothing with sex. • Habitual sexual “doping” forges an arousal template in the addict’s brain which establishes a consistent and reliable pattern of mind-altering escape (psychological, biological and chemical). [Lofgreen (2012). The Storm of Sex Addiction: Rescue & Recovery.]

21. Neuropathways of Addiction Neuropathways are strings of chemical transmitters that, when stimulated by sexual thoughts or behaviors, provide intense relief by producing sensory and emotional experiences of fantasy, arousal, numbing and/or deprivation [Lofgreen (2012). The Storm of Sex Addiction: Rescue & Recovery.]

22. Neuropathways of Addiction • Programmed sexual response to intense emotion. • Without conscious effort, the addict “mainlines” the sexual drug directly to the pleasure centers of the brain. • A tolerance develops as sex is used repeatedly with neuropathways activated. • Larger doses of the sexual drug will be needed to promote the same emotional effect which requires increasing the risk, intensity or frequency of sexual behaviors. • Most addicts combine, alternate, and cycle in and out of their use of neuropathways. [Lofgreen (2012). The Storm of Sex Addiction: Rescue & Recovery.]

23. The Confluence of Forces Driving the Sex Addiction Epidemic • The roots of addiction are usually found in childhood trauma. • Sex is an extremely powerful force in-and-of itself. • The ultimate addiction because it taps into a biological life force. [Lofgreen (2012). The Storm of Sex Addiction: Rescue & Recovery.]

24. The Confluence of Forces Driving the Sex Addiction Epidemic • The availability of pornography on the internet. • iPorn is plentiful, cheap, and private. • Adding fear and aggression supercharges the experience. • Graphic images lead viewers deeper into a world of chemically charged fantasy and further away from real relationships. • iPorn is a gateway to more intense and risky sexual behavior, both on and off line. [Lofgreen (2012). The Storm of Sex Addiction: Rescue & Recovery.]

25. The Confluence of Forces Driving the Sex Addiction Epidemic • So prevalent, its use is often seen as unremarkable and even routine. • Excessive use of porn may become a portal to a more extreme fantasy or experience. • Increased tolerance and cravings can drive one into risky real life encounters [Lofgreen (2012). The Storm of Sex Addiction: Rescue & Recovery.]

26. Pornography’s Hidden Power Pornography’s hidden power is not limited to its elusive nature, availability and compelling styles and formats, but it is also based on its ability to produce extremely pleasurable experiences. [Maltz & Maltz (2008). The Porn Trap: The Essential Guide to Overcoming Problems Caused By Pornography.]

27. Normal Childhood Needs Satisfied By Porn Use • Learning About Sex • Belonging to a Group • Sexual Permission and Pleasure • Coping With Emotional Stress [Maltz & Maltz (2008). The Porn Trap.]

28. The Porn Relationship • Porn is always there, seducing and enticing us to start or continue a relationship. • Porn is about having a good time, escaping worries and pressures and getting a chance to do things one couldn’t do in real life. • Porn is about developing an emotional and sexual relationship that can lead to a whole host of problems. [Maltz & Maltz (2008). The Porn Trap.]

29. The Porn Relationship • Porn can slip into the role of “Significant Other.” • Studies show that about half of the men and one-tenth of the women exposed to pornography in childhood go on to use it regularly as adults. • Use encourages more use because we learn to associate pleasure with each interaction. [Maltz & Maltz (2008). The Porn Trap.]

30. Commitment to the 4 “C’s” of Treatment • CHALLENGEold thoughts • COPEwith strong feelings • CHANGEyour environment • CREATEa balanced life

31. Cognitive Process in Targeting Dysfunctional Thoughts • Identify the Situation • Identify the Feelings • Identify the Underlying Thoughts • Evaluate the Thought • Take Action [Mueser, Rosenberg, & Rosenberg (2009). Treatment of PTSD in Special Populations.]

32. Format for Challenging Self Limiting Beliefs Where did the belief originate? How does the belief impact/affect life now? What situations provoke this belief? What are negative consequences to the belief? What are the positive consequence of continuing this belief? (What am I getting? What am I avoiding?) [Dr. Jordan & Margaret Paul, From Conflict to Caring, 1989]

33. DBT Skills Targeting Risk Needs For Sexual Compulsivity • Mindfulness– address maladaptive thought processes and teaches skills for improved self monitoring and regulation. • Emotional Regulation– addresses mood lability and affective dysregulation and teaches skills for effectively identifying and managing emotions. • Distress Tolerance– addresses maladaptive coping behaviors and teaches skills for managing impulsive/ harmful behaviors in the face of inevitable life stressors. • Interpersonal Effectiveness– addresses interactions with others and teaches skills for more effectively meeting needs/goals without violating the rights/needs of others. [Marlatt & Donovan (2006). Relapse Prevention]

34. Process of Change • Consciousness Raising: Learns more about self and causes, consequences and coping. • Self Liberation: Becomes aware of alternatives and makes more active choices in life. • Social Liberation: The environment allows more choices. • Counterconditioning:Changes responses to stimuli, substituting healthy behavior. [Wenzel, Luise, Bech, & Freedman Wheeler (2012). Group Cognitive Therapy for Addictions.]

35. Process of Change • Stimulus Control: Manages triggers that prompt problem behaviors. • Self Regulation: Assesses feelings and thoughts about self with and without the problem behavior. • Environmental regulation:Considers the social and physical impact of the problem behavior. [Wenzel, Luise, Bech, & Freedman Wheeler (2012). Group Cognitive Therapy for Addictions.]

36. Process of Change • Contingency Management: Changing the contingencies in the environment (rewards / punishers). • Helping Relationships: Uses relationships in life to garner support for changes. • Dramatic Relief: Experiences and expresses affect about problems and proposed solutions. [Wenzel, Luise, Bech, & Freedman Wheeler (2012). Group Cognitive Therapy for Addictions.]

37. Psychological Family • Intrinsic in the human psyche. • Compensates for loss. • Collection of remembered ties. • Active and affective bond that helps people live with loss and trauma in the present. • Private perception of home and family for coping. • May coincide or conflict with official records. • Who is viewed as being in the family is of therapeutic importance. • Staying connected in the mind’s eye. • Relational reality is comprised of more than can be objectively quantified or physically measured. [Boss (2006). Loss, Trauma and Resilience: Therapeutic Work With Ambiguous Loss.]

38. Healing : Guiding Principles • Recovery for the whole person = physiological and spiritual healing. • Law of Increase / Decrease = “What you feed grows, what you starve dies.” [Leahy (2008). Porn Nation: Conquering Americas #1 Addiction.]

39. Action Steps for Porn Recovery • Tell someone else about your porn problems. • Get involved in a treatment program. • Create a porn-free environment. • Establish 24-hour support and accountability. • Take care of physical and emotional health. • Start sexual healing. [Maltz & Maltz (2008). The Porn Trap.]

40. 4 “P’s” of Anger • Your anger has a PAST– when you learned hurtful ways of dealing with angry feelings. • Your anger has a PURPOSE– what you use anger for. • Your anger has a PATTERN– what you think, feel, and do over and over in response to the same kinds of situations. • Your anger has a PAYOFF– what you get by being angry and acting it out. [Men & Anger [1995] Cullen & Freeman-Longo]

41. Techniques • List reasons to identify feelings. • List ways to have expressed feelings. • Keep feeling journal (log). • Do feeling lifeline. • Identify blocks to feelings. • Identify stuffed feelings. • List positive and negative effects of feelings. • Situation Perception Training (triggers, thoughts, feelings, action). • Distinguish between healing reaction and feeling response. [Adapted from Men & Anger [1995] Cullen & Freeman-Longo]

42. Facing Fear Breathing– (“combat Lamaze”) train the fear response. Breathing is so powerful because the breath is one of the few actions that reside in both our somatic nervous system (which we can consciously control) and our autonomic system (which includes heartbeat and other actions we cannot easily access). So the breath is a bridge between the two. By consciously slowing down the breath, the primal fear response can de-escalate. [Ripley (2008). The Unthinkable]

43. Facing Fear Studies have shown that brain tissue in the parts of prefrontal cortex that are engaged in meditation – the parts that handle emotion regulation, attention and working memory, all of which help control stress – thickened during meditation. Laughter, like breathing, reduces our emotional arousal levels. It has the benefit of making us feel more in control of the situation. The single strongest weapon is a mental plan of what you will do in a certain crisis, and an absolute commitment to follow through. Self-confidencecan save your life. [Ripley (2008). The Unthinkable]

44. Trauma Related Guilt • Guilt= an unpleasant feeling accompanied by a belief(s) that one should have thought, felt or acted differently. • Self Monitoring Homework • Track: • Statements that include “should have,” “could have,” “if only” or “why.” • Self put-down statements. • “I feel…” statements that end with words that are not emotions. [Kubanyin Cognitive Behavioral Therapies for Trauma [1008] ed. Follette, Ruzek, Abueg]

45. Facing Fear • Resilience– People who have resilience tend to have three underlying advantages: • A belief that they can influence life events; • A tendency to find meaningful purpose in life’s turmoil; and • A conviction that they can learn from both positive and negative experiences. [Ripley (2008). The Unthinkable]

46. Emotion Regulation Skills • Recognizing your emotions • Overcoming barriers to healthy emotions • Reducing physical vulnerability • Reducing cognitive vulnerability • Increasing positive emotions • Being mindful of emotions without judgment • Emotion exposure • Doing the opposite of emotional urges • Problem solving [McKay, Wood & Brantley (2007) The Dialectical Behavior Therapy Skills Workbook]

47. Healing Interventions Focusing Techniques: Sit quietly and focus on body sensations. Notice prominent sensations or feelings. Hone kinesthetic awareness. Focus on all five senses. [Crowder (1995). Opening the Door.]

48. Healing Interventions Increasing Affective Expression: Gestalt Empty Chair Psychodrama Letter Writing Art Work (collage) Anger List Role Play Breathing Techniques Bioenergetic Release Debrief Affective Experiences [Crowder (1995). Opening the Door.]

49. Healing Interventions Visualization: Identify “anchors” for adult self. Inner Self Visualization Container Visualization Safe Place Resource Visualization [Crowder (1995). Opening the Door.]

50. Boundaries Boundaries can be too openor too closed. 1. “Too Open” boundaries: -Can’t say no. -Share too much personal information. -Take responsibility for other’s feelings. -Allow yourself to be abused. -Reveal personal thoughts, feelings, or experiences. -Believe you deserve bad treatment. -Can’t see flaws in others. -Will do anything to avoid conflict. -Engage in public displays of affection. -Wear revealing or seductive clothing. -Stand or sit too close to others. -Make sexual comments, jokes, or voices in public. -Trust strangers. -Believe everything you hear. -Have sexual encounters with strangers or acquaintances. [McGee & Buddenberg (2003). Unmasking Sexual Con Games.]