 This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through all CEUs. Register at allceus.com slash counselor toolbox. I'd like to welcome everybody to today's presentation on the introduction to addressing sex and pornography addiction. And this is such a in-depth topic. We are just going to scratch the surface a little bit today. And we're going to examine really what might be happening with some of our clients. So we're going to define sex addiction and we know that it's not in the DSM yet. So what we're looking at is a compulsive behavior that is causing clinically significant distress. Identify the negative messages that may be supporting the sex addiction. Understand addictive triggers, both the original triggers and the conditioned ones. Mindfulness and purposeful action, how we can use that or help clients use that in order to silence the internal critic and reduce stress and reduce that negative message that tells them that they are not good enough. Getting to know yourself, helping the clients start to figure out who they are and helping them regain control to a certain extent of their emotions. Now, DBT is not going to help them necessarily gain control of all of their urges, but we are going to talk about riding the wave and all that stuff. In response to your question, does it qualify under OCD? No. And okay, I will fix the quiz timing after class. Here are scenarios. John is a 53-year-old man whose pornography use has gotten him fired, caused problems in his marriage, but he feels unable to stop. So he's shown up at your office and he's like, Doc, what do I do? Sally is a 34-year-old woman who reports an insatiable desire for sex, which has caused problems in her marriage, let her to seek other outlets, including, you know, going to bars and pickups, and seeking out prostitutes during lunch breaks. Sam is a 23-year-old college student who reports masturbating six or more times a day, nearly every day. He sometimes leaves class to do it and it causes him a lot of emotional distress that he thinks about it so much. He wants to stop thinking about it so he can refocus on other things. So, you know, I'm just going to ask you the question ahead of time. What do you think is the function of sexual release for each of these people? And what's maintaining the compulsion? Why do they keep thinking about it? Why do they keep engaging it, despite the fact that it's causing problems in their marriages, at work, potentially legal problems or health problems from sexually transmitted diseases, emotional distress, not wanting to think about it all the time, and, you know, leaving class I have to imagine is also probably somewhat detrimental. So, you know, what might be motivating these people or motivating the behavior? Sure. The sexual release does give them immediate relief. Even though it causes long-term problems, they get that dopamine rush, and dopamine is our friend. And, you know, they've done all those experiments with rats, and not to say that we're rats, but they have done experiments to show that rats will continue to push a lever to get cocaine, which causes a release of dopamine, and not eat and not do anything else until they actually fall over and die. So, dopamine is a really powerful neurotransmitter. Dopamine is responsible for other things than pleasure. It also helps concentration, and it does help with mood. So, if you are already feeling, you know, apathetic and you're having difficulty concentrating, you know, this dopamine could be implicated. It may be serotonin, it may be a whole lot of things, but, you know, we don't want to rule out dopamine. Okay. So addiction, just to review really quickly. Any person's substance or activity, and this is the broad view. Obviously, the DSM doesn't label anything as an addiction. You say substance use disorder. But an addiction, as we talk about it, sort of in the... I don't want to say lay community, but in the addiction community, is any person's substance or activity used to escape from negative feelings, both emotional and or physical, so it can be to numb physical pain or emotional pain, and continues to be used despite negative consequences. Emotionally, mentally, physically, socially, legally, occupationally, the list goes on. So we want to look and see, and again, I've mentioned this in other classes, there is recreational use. People all around the world have sex and don't have a problem with it. They're not sex addicts. Some people have really healthy sex lives, and they don't have a problem with it. It's not causing negative consequences in any one area of life. It's not causing them to have difficulty concentrating or be unable to become aroused in their current situation or whatever the case may be. So these are the things we're looking for that... when they cross that line and it starts causing them problems in multiple areas of life and or clinically significant distress. Obsessions and compulsions to go back to the OCD question. Obsessions are repetitive thoughts. Compulsions are activities done in order to escape the negative feelings, to make those thoughts stop. And it's generally an anxiety-based sort of thing. It's the only way the person currently has to stop or escape the negative feelings state. All addictions are compulsions. You know, if you have an addiction, you're going to obsess over it and you're going to have this compulsive behavior to engage and get relief. But not all compulsions are addictions. So people may have a compulsion to check the door and make sure it's locked 17 times. We wouldn't necessarily say that's an addiction. That's not providing any sort of rush or high from it. It may provide some anxiety relief. So taking a look at it is hard to really look at the difference between addictions and compulsions. And I don't want to get down on the weeds too much right now. We're not talking about diagnosis because this isn't in diagnosis. Generally when I have somebody who comes in who's presenting with one of these kinds of scenarios, we're usually looking at adjustment disorder, generalized anxiety disorder, sometimes depression, sometimes. There's generally some underlying mood disorder going on. Now you can see intense sexual behavior in a hypomanic or manic episode. So you definitely want to look and see if the hypersexuality might be being caused by a manic episode or hypomanic. So pornography addiction affords people never ending novelty, which can lead to escalation. I mean back in the day, before computers, you had Playboy, Penthouse, whatever those other ones were. And there were a certain number of pages and that was it. A little later, if you got really lucky and you could get one of those scrambled chandles and you'd get little glimpses here and there of pornographic material. But there wasn't the plethora that there is today. Today people can go online and start surfing and they may not even intend to get into a pornography website. I know my son does a lot of computer gaming. And apparently there's a lot of pornography kind of inserted in there and he can accidentally, I will take that, click on a link or get redirected to a link that is not so kosher. I mean we have all kinds of firewalls at our house and with youth, it's really important. We're going to talk about later to sort of guard their brains against the pornographic overload because it's still developing. And the impulse control areas are still developing and they've shown that there is a much greater chance of later mental health problems in youth who get involved in watching pornography at a young age. So anyway, there's never ending novelty. You start out with mundane, whatever pornography and then eventually that's not doing it. So you look for something that's more hardcore. And I've seen people or heard of people who have escalated from run of the mill pornography up to hardcore snuff films, child porn, you know, all kinds of things that are problematic and they can't get aroused unless they are in that hardcore situation. So this is one of the problems with pornography and then a lot of times people who are addicted to porn, I mean it takes something intense to get them aroused, then in real life, sex seems seems kind of like a let down. So it oftentimes can start causing them problems in their IRL in real life sex life. Sex addiction is the use of actual sex to get a rush. So pornography is masturbation and using the computer and or any sort of visual materials and for some auditory materials. Sex addiction is actual person to person. So we're thinking more the Tiger Woods of the world. But it's using actual sex to get a rush to get that dopamine release. But we're not talking once or twice a day, you know, we're talking a lot of times we're talking leaving work to go do it. Love addiction and I wanted to touch this because a lot of times you hear the term sex and love addiction. And yes, you can have the two of them co occurring. Love addiction may or may not involve sex, but the person may use sex as a means for ensuring he or she is not abandoned. So they may need love and they're going out and they're engaging in these sexual behaviors in order to feel that oxytocin in more cases than not. And that rush. If the person's out of a relationship who is love addicted, they feel worthless, hopeless. So there's a lot of self esteem stuff. We're not going to focus on love addiction today, but I did kind of want to put it in there that not all love addicts are sex addicts. But they do have issues in their relationships. So riding the addiction train, dopamine rush, the brain is really awesome because it protects us. And at a certain point after it has enough, you know, surges of dopamine, it says, ooh, you know, this is getting dangerous. We're not supposed to be this happy this much. So it starts shutting down receptors for lack of a more clinical term right now. So with fewer, fewer receptors open, less dopamine gets through to help you feel that feeling. Okay, you're like, all right, well, that's fine. It's protecting itself. Well, that what that means is when you have a normal thing like a birthday or, you know, you find $20 or something. Those normal experiences produce a normal amount of dopamine for that person. And it goes through, but it's not enough because those some of the receptors are shut down. So they start meeting more dopamine in order to feel what is and I use the term normal for that person. And I liken it to Black Friday. I mean, think about a normal day in Walmart or Target, you know, people come in, come out. There's like eight doors open on Black Friday. What happens? You know, all the doors are locked until 5am or something. And then all of a sudden the doors open and there is just this rush. What happens to the store? If you've seen a store after Black Friday, you know, the store is kind of decimated for a while and it takes the employees a while to regroup. So in order to avoid going over fire codes and all that kind of stuff, they may have to stop some people from coming in. Now, I've never seen this on Black Friday, but we're going to go with the hypothetical. So they shut some of the doors to make sure they don't overload the fire capacity of the building. That's what your brain's doing with the dopamine at saying, you know what? I'm going to prevent the overload. We're going to put a guard here and we're only going to let a little bit in at a time so we don't get overloaded again. After Black Friday, it takes the store a while to restock the shelves and clean up after a dopamine rush, especially if somebody is doing it for a long time. It may take a while for their brain chemicals to rebalance. So we want to encourage them to give themselves time. When they're going through that period, and I call it a detox period because basically it is, they're detoxing themselves from those dopamine rushes and their brain is rebalancing the neurochemicals. They may have difficulty concentrating. They may feel flat, apathetic. We don't use dysthymic anymore, but mildly depressed. So we want to educate people that that will go away. They may still have difficulty engaging in sexual relations with their current partner because it's just not enough stimulation. You know, that will return with time most of the time. And I say most of the time because sometimes there's underlying issues in the relationship. When someone has been used porn for an example, has been using porn for a while, and you know, whatever porn they're using stops producing the ability to get them aroused. They want to feel that way again. So they increase, they artificially increase the dopamine through increased amount or intensity. So either they increase how much they're watching the porn, or they increase the intensity of the shock value or whatever works for them. So we need to pay attention to the fact that people do become sexually tolerant if they are regularly exposed. And I mean, when we're talking about regular exposure here, again, we're not talking about, you know, people who are in a marriage, for example, who are having sex once a day, or even twice a day if they've got a really good sex life, they're not, their brain's not going to go whoa, that's way too much. But so we need to look at what's too much for that person and when they're going to start to habituate to it. In long term relationships, people generally find ways to spice things up. Well, that's increasing the intensity, that's changing something so it can produce arousal. So the takeaway message, addictive behaviors have been the most reliable tool to help the person escape whatever it is or feel normal. And again, normal is what is baseline for them. Whether the person has been using pornography, for example, and then when they quit using, you know, they feel flat, apathetic, have difficulty concentrating, have no motivation. These are very common because dopamine's responsible for all that. So if that's been tuned down, if those receptors are shut down or reduced, then the person may feel kind of blah. So in order to avoid feeling blah, they may use again, they may engage in some sort of sexual activity again. It served a survival function. For whatever reason, it helped them keep going and get through so they didn't feel miserable, so they didn't feel depressed. And many times it's become the one thing that won't let the person down or abandon him. You know, they can always count on that particular release. Addictive behaviors may be caused by negative messages, but addictive behaviors and whatever's causing those addictive behaviors can be altered. You know, the brain can rebalance and get back to where it should be. So first things first, the brain is adjusted to frequent dopamine rushes. So to feel normal, the person may have to engage in stimulating behavior. They wake up in the morning. You know, it's kind of like the eye opener when we're talking about people who drink, you know, in order to get rid of the hangover, they have to have a drink in order to feel normal. The brain has adjusted to a level of stimulation such that traditional sex may fail to cause arousal. All right, so this is a problem too. They need to figure out, you know, this is causing problems. The person's life has become imbalanced. So not just their brain chemicals, but their life. As the need for sexual stimulation increased, it often causes problems in one or more areas of their life. When you start thinking about how does it impact their relationship if they can't get aroused with their partner? How does it impact their work if they're having to leave to go, you know, find a release or if they're watching porn on their work computer or whatever. How does it affect them legally if they're watching pornography that is less than legal? So interventions, the first thing first is sort of like I talked about earlier, the detox period. Ideally, the person reduces sexual activity to only consensual sex between partners in a committed relationship. And, you know, I leave that kind of broad because not everybody believes in monogamy. Not everybody believes in marriage. And so I want to be as embracing as I can of lifestyles while encouraging, you know, a healthy movement forward. So obviously consensual is important. But partners in a committed relationship, if there is a polygamy or whatever, that would be a bridge to cross when you come to it. And, you know, sometimes when you've got somebody who is involved with a sex addict, they may become obsessed to a certain extent, and it may be challenging for them to not think about what kinds of things that person engaged in in prior relationships. So it's going to be important to open doors of communication and have them figure out how to make their current intimate life as beneficial as possible, as mutually beneficial as possible. I'm not coming up with the right word. So what causes sex addiction? Well, we don't know, like we don't know what causes other addictions. We do know that early sexual sexual exploration, especially with pornography can actually cause visual, you know, if you do a brain scan can actually cause changes in the brain because of that over stimulation at an early age. And the brain is so much more plastic and at that age that it just responds. And so it can form bad, you know, hardwired connections that can be problematic. And early sexual exploration, every kid does it, you know, not necessarily with pornography. So I'm not saying that early curiosity is causing it. I'm talking about the eight and nine year olds who are watching porn on their portable devices, excessively using sex at any age to escape from negative feeling states. Excessively. So if every time you're stressed, you go masturbate or you go find somebody to have sex with, that's going to be a problem because you're probably going to be having those dopamine rushes too frequently. It also probably indicates that the person doesn't have sufficient coping skills to deal with it any other way. So we've got a kind of a two for right there. Using sex is a way to feel loved and quell fears of abandonment because of low self-esteem. So some people will engage in excessive sex in order to try to show their love and try to make sure that somebody else is reciprocating. And parental or societal emphasis on sex and sexuality raising children from the time they're little to be. So they believe that they're sex objects. So they believe that appearances matter and their sexuality is not just important, but the most important thing. All of these things can trigger sex addiction later in life, but the big ones that we've got the most research on our early sexual early exposure to pornography and excessive use of sex at any age. So let's look at the root to the problem. Where might this come from? Children are born with a blank slate. Okay, we're going to go with this theory for right now. As they grow, the zone of proximal development is, you know, who's around them, who helps them figure out things, who helps them problem solve, who exposes them or keeps them from being exposed to different things. These are called the more knowledgeable others and their guardians of some sort. These people influence what the child tends to and learns. So it influences what the child grows up to believe makes him or her lovable and good. You know, what is good? What do I need to do to be good? And if they don't feel like they measure up because remember kids think dichotomously, then they might start internalizing negative messages from the get go. And parents also knowledgeable others, not just parents, also model and teach how to cope with stress. But if those knowledgeable others don't know how to cope with stress, then again, the child is left feeling anxious and doesn't have a way to deal with it so they that anxiety can build can lead to other things. If they find a way to make that anxiety go away, they're probably going to latch on to it. Inconsistent or negative messages from the parent can also be internalized. So here we're really looking at the person with the addiction issue that is struggling with self esteem, negative self image and poor coping skills. During each stage of development, the child must accomplish certain tasks to avoid developing a negative self image. And this negative self image is that what we call hecklers in the amphitheater. And I don't know if you remember the Muppets and they always had those two old guys that sat in the balcony and heckled the Muppets. But it's kind of like that they're always going to have something negative to say. And it's important that we help people deal with their, their hecklers. If the person develops a negative self image and fails to develop healthy coping skills, then they may end up relying on addictive behaviors to escape smoking, drinking sex. You know, there are a variety of things that people can do. Negative messages drive feelings of despair, anxiety and insecurity. When people want to use, it's important to encourage them to listen to what their addicted voices saying to them. Why do you need to use right now? If the addicted voice is saying, I can't stand this or I'm never going to be lovable or what is the, what are the messages? If you want to go with a REBT approach, what are the underlying beliefs that are motivating these urges? Encourage the person to identify the other voices or messages they hear. So where is this message coming from? Is it something your parents said to you? Is it something your teacher said to you? And let's talk about whether that has basis in reality right now, you know, or, and maybe even go back and look at that. I remember when I was little, we were sitting around the table at my grandparents house and they were passing around food and I apparently took more bacon than I was supposed to. And my grandfather looked at me and he said, my aren't you a little piggy? And he was trying to gently say, you know, leave some for everybody else, but that stuck with me to this very day. But so I'm always whenever I'm getting food, I'm always hearing that voice in the back of my head when I'm at gatherings. And I can silence it now. I know it's, you know, a negative interject. But it's important to recognize that just a passing comment that's not even meant to be mean necessarily can stick with people. So have them identify those voices and then learn to silence them. Dialogue with the voices and learn more about where they came from and how to shut them up. So, you know, in my dialogue with that voice, I was like, you know, what was he trying to communicate to me? And, you know, it was leave more for other people. And so that I can deal with. And so when I hear the aren't you a little piggy? You know, I kind of replay that with make sure to share. Cognitive behavioral theory says thoughts, feelings and actions are all related. Y'all know this. Everything you do is the result of a prior learning experience. So we go into your ABCs and we want to help people who are struggling with feelings of insecurity, anxiety, depression, identify some of those automatic beliefs, which are in the middle. And figure out, you know, what are the consequences when you have those beliefs? And then you go the next step and you dispute those beliefs. In the present, is this true? What may have been true 20 years ago may very well not be true right now. So is this true? And is it something that matters to you at this point in time? So now what? Now, you know, we've identified that this person has a problem. It's causing them distress. We've said, all right, you know, we need to start letting the brain and the body rest and rebalance a little bit. So you're going to need to think about ways to detox, so to speak. What else? Mindfulness. Encourage people to focus on the present moment, not the past or the shoulds or coulds, because that's just going to increase anxiety. People need to remember that they are not their thoughts. They can have thoughts and they don't have to act on them. You know, instead of going, I can't deal with this. I can't survive saying I am having the thought that I can't deal with this thoughts come and go. Trust me, you know, I had six thoughts this morning before I got out of bed and I can't tell you what any of them were. They're out. People are not the same people they were 10 years ago or even yesterday. So yeah, you may have made mistakes in the past. You're probably going to make mistakes in the future. That doesn't make you a bad person and you've learned you've changed. So what may have been true back then may not be true now. So you need to be mindful of what is it that you need? What is it that you have? What are your strengths? Mindfulness helps people become aware of their triggers too. So it helps them start becoming aware of, okay, when I'm starting to feel this little pit in my stomach, then I know anxiety is creeping up. Or, you know, so they can start identifying physiological and cognitive reactions and even emotional, to a certain extent, feelings that happen before they have the urge to engage in pornography, masturbation or sex. So encourage clients to practice mindfulness and mindful awareness using a mindfulness log. I always do mindful, mindful meals. And if they can do it other times, if they notice they're having a weird feeling, if they can stop and do a mindfulness log, that's awesome. But I want them to check in with themselves so they start becoming more in tune. A lot of times people with addictions, especially, or who use compulsive behaviors to escape from feelings, don't even really know how they're feeling. But when, if they start feeling something, that's really terrifying, so they try to make it go away. So getting people more in touch with themselves and what their feelings are, whether it's anger, anxiety, resentment, you know, let's give them a good emotional vocabulary. They can start figuring out these feelings and what they need. I also have them keep a craving log because they may do a mindfulness log and, you know, everything's hunky-dory. But then two hours later they start having a craving. Now they can do another mindfulness log at that point, but I also want to know what the craving was for, what triggered the craving. They can be combined into the same log. It can make it easier. I try to keep the worksheets or logs that I have people do less than one page. Because I find that if you get multiple pages, compliance starts to go way down. So what are the triggers for people? Things that can trigger, you know, the desire to use. Emotions. If they're feeling depressed or stressed, I know a lot of anxious. Those are three big ones that a lot of people may turn to some sort of sexual activity in order to forget about that, in order to feel a little bit better. Sometimes anger too depends on the person. So certain emotions may trigger the urge to engage in it. Certain smells that remind you of somebody you were in love with or may trigger one of those unpleasant emotions may make you want to use, and I'm just going to use the term use for right now, a taste of something. And that's not usual for it to happen. You know, taste is not one of those common triggers for sex addiction, but it could be there. So we want to say, is there a particular taste, like maybe wine or beer or hard liquor or something that makes somebody feel more amorous? Touch. Are there certain touches that make people feel, you know, the desire to use. Sounds. And this can be normal sounds, you know, the sound of the door opening, whatever it is, or it can be the sounds of sex. And there is a lot of that. You know, I've noticed, and I'm an old foggy now, I guess, but back in the 80s, there wasn't, it wasn't near as graphic. And now you watch things on Netflix and you've got like full nudity and I'm just, okay, trying to kind of adjust myself to that. But you also, there is a lot more graphic sexual display, which the sound of that may trigger somebody. So they may need to be aware of what they're watching and cognizant of it. The time of day for some people, first thing in the morning, last thing at night, it may have to do somewhat with their hormone cycles, including their cortisol levels that make them feel more like using anniversary dates, maybe anniversaries of breakups or whatever habits. Sometimes it's just a habit, you know, people get up in the morning and they masturbate and they go to work. And then they go to lunch and they masturbate. And it's just one of those things they do. They don't even think, am I stressed? Do I need to? It's just what they're doing. Sites, obviously things you see on TV, pornography, images, places. Certain places are going to be a bigger trigger for sexual arousal than other places. I mean, a kindergarten class, not so much. A bar at a hotel, definitely more. So we want to help people see what their triggers are. And certain people may trigger an amorous reaction. So dealing with triggers, you know, we're having the people try to back off from their sexual activity. So what do they do so they can wait until they get home and they're with their consensual other person in the committed relationship, distract themself, you know, distract, don't react. So they need to have a list of three or four things that they can do to distract themselves. They can choose mindfulness, focus on something in the room, like this pen, you know, you've usually got something. There's always something you can focus on and identify five things about this pen. And if I'm sitting here thinking about this pen, it's kind of a downer and, you know, that urge is probably going to go. But we need to help people distract their brain from what's going on. Ride the wave. Remind people that just like a wave comes in and goes out, urges come in and go out in about 20 minutes. And I use the analogy of the bee on your arm. You know, if you swatted the bee on your arm, it's going to sting you. If you just let the bee fly off in its own time, in a few minutes, it's going to fly away. So we want to encourage them to control their urges by riding the wave. Distract until that wave starts to go out. Choose alternative, less harmful behaviors. You know, this is always an option. Hold ice cubes. This is another one of those things that you can't really focus on much of anything if you're holding on to ice cubes. I have carpal tunnel in both of my hands. And after I go out and I garden for a few hours. I need to stick my hands in ice baths to reduce the swelling because, you know, I always overdo it. That's just what I do. But when I do that, I can tell you the pain is excruciating for a few minutes and I am not concentrating on what's on TV or anything else at that point, except for keeping my hands in the water. I wouldn't necessarily suggest this, but if it is an option for some people. There are other ways other less harmful activities and you can brainstorm with people counter condition the trigger. So whatever the trigger is, pair it with something unpleasant or pair it with response prevention. If the person has an urge when every time, you know, maybe they're a traveling business person, and every time they go to the whole hotel lobby, they have this urge to have sex with somebody. Well, response prevention would say go to the hotel lobby, experience that urge and make sure that you don't get up and do it. Have somebody there to help you make sure you don't engage in it or pair it with something unpleasant such as when you start getting that urge. Imagine your mother naked. You know, most people are going to be like, oh my gosh, let me gouge out my eyes. Dialogue with yourself. Encourage people to talk to the talk themselves out of it. This is not what you want to do. I know it seems like it would be an idea to do right now, but write a goodbye letter to the voice or to the trigger. You know, I'm not going to let you control me anymore. Sinara complete the faulty beliefs activity and faulty beliefs that is part of cognitive processing therapy. Ask them what's the evidence for my thought. So if they're having the thought that I need to have sex right now. All right, what is the evidence for my thought? Is there any evidence contrary to my thought? Well, rarely do we need to have sex. We may want to, but we don't need to. We're not going to die if we don't. Do I have all the evidence? Well, may. Is this based on feelings or facts? What are the facts that I need to have it right now versus the feelings that I want to have it right now? What would a friend think about this? You know, if I told them my dilemma, what would they tell me to do? If I look at this situation positively, how is it different? So if I look at having having sex right now positively, what would be different? And will this matter a year from now? So I'm feeling like I have to have sex. And that's just a thought. You know, because I'm saying I feel, well, that's a tip right there. It's a feeling, not a thought. So if I'm having this thought, I can urge surf. You know, I'm having this thought. So I'm going to watch that wave come in and go out. And I tend to be more of a cloud person than a wave person. But either way, they come in and they go out. And so encourage people to think about their thoughts like that as they watch the thought morph and just kind of disappear. Encourage people to take away the thought's power by viewing them as just thoughts. When we, when I work with people who smoke, I say, you know, when you feel like you have to have a cigarette, I'm having the thought that I have to have the cigarette. And then you watch that thought come in and go out. I personally don't have a lot of success watching the thought because it makes me keep thinking about it. But I would encourage people to identify it as a thought that can be let go and then distract themselves. You know, thinking about times when they've had a thought, like they wanted to go to the kitchen for something. And by the time they got to the kitchen, they forgot. All right. So what did you do in the intervening time to make yourself forget? A lot of times it's distracting yourself with something that's more important. And encourage them to play the tape all the way through. All right. You're having this thought that you have to have sex right now. You've identified that it's a thought. And what happens if you do, if you decide to hook up with somebody or pick up a prostitute, what's going to happen? You're going to go have sex with them. How are you going to feel afterwards? What are the repercussions going to be? And playing it all the way through is really important. Another thing that you can do is to have an accountability partner or a sponsor. There are 12-step meetings for people with sex addiction. But having someone that you can call and say, I'm feeling weak right now or I'm having urges can really help. And having somebody who can accompany you sometimes to those places that are dangerous, avoiding putting themselves in places that are problematic. So if a hotel bar is a big trigger for you, well, don't get a room in a hotel that has a bar. That takes away that trigger right there. And start thinking about it that way. Now just being in a hotel may be a trigger. So then the person's going to have to think, how do I deal with this? Because it may be something they have to do for their job. But these are all things we can help them brainstorm. So we identify the high-risk situations and the triggers and help them mitigate that. It's important that people when they're going through recovery for whatever, but today we're talking about sex and pornography addiction, that they take care of themselves because it's harder to deal with life on life's terms when you're sick, in pain, exhausted, malnourished, bored, isolated. The list goes on. Dopamine, back to our friend, helps us not feel pain. It helps us concentrate. It helps us feel pleasure. You know, it's our pleasure chemical. So all of these things are going to may happen if we don't have enough dopamine. So we need to make sure that we're getting our body, the building blocks through proper nourishment and sleeping. So we're not unrested. So we're not exhausted all the time and setting ourselves up for a relapse. When people are in early recovery, especially boredom can be super, super dangerous. So it's important that they have a list of activities that they can do when they've got free time. We don't want them to have too much downtime. Now, if they're introverts, they may not want to be spending time with, you know, 20 other people, but they need to have something they can do. Read a book, crochet, cook a meal, things that they enjoy doing that can keep them from just sitting there on the couch going, it would be really nice right now to boot up that computer and look at some porn. You know, have them do something else. Definitely having clients make a what, what you're Carl's calling a failsafe list. There's list of things, their emergency plan that can help them get through cravings and urges. You may not be able to reach your support person or your sponsor or your pastor or whoever. So you need to have backups. You need to have things that you can rely on. So you prevent as much as possible through good self care, identifying high risk situations and figuring out how to mitigate those like the hotel room. And making sure that you have an emergency plan. For each trigger, I have people identify three ways. I love the number three that they can deal with or avoid it. So if being in a hotel room is a trigger for me, then I would identify three ways that I can cope with being in a hotel room to prevent a relapse. Make a plan for taking better care of yourself. So this should be part of the relapse prevention plan in order to make sure that I am doing things that are going to help me and not set me up for relapse. It's important that I get enough sleep that I eat well that I avoid alcohol, for example, alcohol is a disinhibitor makes it harder to deal with. Deal with urges when they come and create an emergency plan for dealing with relapse warning signs and keep this on an index card or on their mobile device where they can find it all the time. And this is kind of what you're talking about is the failsafe list. So they're going to have all these different things. And as they work through their relapse prevention plan. They may have times most clients are going to have times when they have a slip. It just, it happens. And I don't say it happens to everybody, but for a lot of people they have a slip. Either they think about it or they do it once or maybe a couple of times, but then they're back on the proverbial wagon and we say, okay, what happened? Why did this behavior? Why was this choice more rewarding than your other options? What kept you from using any of these other options? And they could say, they may say, well, I didn't even think of it. Okay. Well, the next time this happens, how can you make sure to think of it? How can you remind yourself to check your relapse prevention plan before you do something? Or if they're talking about a specific intervention, you know, why didn't you engage in this? It didn't seem like it would do it. Okay. What else might have helped in this situation or done it for you in order to help you prevent your relapse in the future? So maybe we need to add some things. You know, we want to look and see why things fail if there was, maybe there was nothing there. You know, something they hadn't even thought of as a trigger or a high risk situation. Well, all right, let's put that on the plan. We're not going to have an intervention for everything. It's just not possible. So we want to help people generalize and look at what's already in the plan and say, okay, find some similar triggers or warning signs in your relapse prevention plan. What are you doing for those? All right. Would those things, you know, counting to 10, reading a book, calling a friend, would those have worked in this situation? They may say yes. They may say no, but it gives you a place to brainstorm. For relapse prevention planning, I really want my clients to come up with their own interventions because interventions that are built on their strengths, they're probably more likely to do. Activities to help people move through the recovery process alone and still. Not everybody can do this once some people, their anxiety goes up too high. They get too frustrated. So obviously use this with a certain amount of clinical discretion. Many people try to stay busy when they're not using to give themselves something to focus on besides the negative voices telling them that they're not good enough. The habit or just the general emotional or physical discomfort. So they're trying to stay busy to avoid feeling things. We have people who stay at work all the time, people who go home from work and then they go to the gym and they exercise for four hours. And you know, there's a lot of different ways to stay busy. So encouraging people to look at, you know, when you're alone and still, why does that feel uncomfortable? What's going on? What happens? And then have them start identifying, you know, if they're negative thoughts or if they feel antsy, you know, we want to figure out what's causing that and why they have such difficulty relaxing. Identify positive activities they can do to stay busy while learning to silence the negative voices. So what positive things? What can you do to relax? Not to, not to divert, not to avoid, but to help you, you know, calm down, relax, not be so agitated. Part of it may be just silencing the voices and but part of it may be just learning how to relax and learning how to deal with anxiety and worry and resentment. Market yourself. This helps people develop a sense of who am I. Write a one page sales pitch about yourself. So I have clients, you know, write this thing, they're selling themselves to me. Why are you just the most amazing person in the world? Or sometimes I say, you know, you're going to be CEO of your own company and you want me to fund, you want me to be a supporter of your company. Why would I do this? Support yourself. Why should I believe in you? And this encourages them to figure out things like that. That even if they don't believe it 100%, if they get it out there and they start saying it, they may start to believe it a little bit. Then I encourage them to refine that ideal image, spend 20 minutes writing a list of all the qualities of their ideal self. And I say 20 minutes, because if you say just write a list, some people will spend two minutes, some people will spend two days. So 20 minutes is a good amount of time. What are all the qualities of your ideal self? Who do you think you want to be? Mark off any qualities that you don't care about. You know, would I like to be 510 blonde hair and blue eyed? Sure, but I'm not. So I can cross that off because I really don't care, you know. If am I awesome at math? No, you know, ideally I would be smart and everything, but I'm not and I'm not going to be so I can cross that off. This helps people pare down so they can start seeing what's important to them and hush the messages that came from society, their parents, wherever that said, you should be good at this, you should do this. That's how they can start whittling away some of those shoulds. And then encourage them to make a plan to achieve the qualities that are important to them, because maybe they haven't become completely self actualized, probably haven't. So what do you need to do to become the person that you really want to be? You want to be able to say, I'm all that in a bag of chips. Some clients need to say goodbye. They need to say goodbye to their hecklers, the person inside of their head that, you know, is constantly criticizing them. Sometimes you just need to say, you know what, person inside my head, you are always going to have issues with me and I don't have issues with me. So your opinion doesn't matter. They may need to say goodbye to their addicted selves. They don't, they're having difficulty envisioning life without their substance or activity of choice. So they may need to say goodbye to that. Now with sex addiction, a lot of times it's not pure abstinence like it is with alcohol. So this letter may be to using, saying goodbye to using sex for things other than their committed relationship. And say goodbye to other negative people who've been living rent free in their head. Anybody who is causing them to feel resentment, anger, jealousy, guilt, you know, they need to look at those issues and deal with them as they see appropriate. But then there are other people who are just squatting there and we need to kick them out. Help them deal and say goodbye to loss and grief. They may need to go through the different stages of grief to move to a place of acceptance. They may need to say goodbye to their addiction or these negative people in their head or to the idea of who they should be. They may need to grieve that loss and work through it. Some of our clients need to work on intimacy and vulnerability. So part of intimacy is being vulnerable both physical, physically and emotionally. And sometimes clients are have had experiences in the past that have taught them that it's not safe to be vulnerable. So they may need to work on those issues in order to be able to create an actual intimate relationship with somebody, not just a mechanical sex relationship or not just one that's based on porn so they don't have to be vulnerable with anyone. Encourage them to look at what happened in the past when they've been vulnerable. It could have been when they were two years old and their mom went to the bathroom while they were at the park and they couldn't find mom and they felt lost and they were afraid she left. There are a lot of things that can make them feel vulnerable. It could be from teenage years, but we want to help them look at that. Ask them what they internalized from that experience. And then examine whether the internalized message is valid and whether it's over generalized. So mom left, maybe everybody's going to leave. That's kind of over generalized vulnerability means trust and letting go of some control, not all control vulnerability doesn't necessarily mean throwing a caution to the wind and go and it's, I'm completely powerless. It means letting go of the control you choose to let go of. So encourage people to think of three situations or ways in which they would like to be vulnerable. In thinking about a situation in the past, how might they, how might it have been different and more favorable if they would have allowed themselves to be vulnerable. When there was a negative assess negative outcome. They were vulnerable, or they could have felt vulnerable, how might that have affected them. Encourage them to look at future situations in which they would like to be vulnerable and make a plan. So how can you create a situation in which you can safely be vulnerable because not everybody's safe, not everybody's trustworthy. So it's important to figure out, you know, if you're going to decide to let yourself be vulnerable, how do you know who's safe to be vulnerable with and how do you build that trust because trust isn't one of those things that it's like hi how you do and I trust you with my life. No, trust has to be earned. So helping people learn that it's a developmental process. It's not just something that's you have. You don't necessarily just have trust with somebody from from jump. Encourage them to say no to self blame and sabotage have them spend 30 minutes identifying the 10 most important messages for their child to receive and why and if they don't have children just have them hypothesize. Have them review those messages and identify which ones they did not receive and what they can do to internalize those messages now such as you're good, you're worthy on going guilt shame self blame and loathing is the result of ineffective past learning experiences. Addiction is often used to escape from these feelings. People have three options to sabotage themselves and relapse if they're feeling any of these feelings. To deal with the issue and it's going to be uncomfortable, you know, no doubt, but how can you deal with this issue. Or to choose not to invest any more energy in it. Some people may decide, you know what this happened is unfortunate. I feel guilty about it. It's in the past. I'm just going to let it go. And that's their choice. The fourth choice is to stay the same and stay miserable but I don't usually like to offer that because I want them to feel empowered to do something and they do have choices. Encourage people to remember that the skills and tools they've developed have allowed them to survive until now. Yeah, it might not have been the most helpful way helpful thing, but it allowed them to survive. Their experiences shaped who they are, but don't have to negatively impact their future. So if they had a crappy childhood, a lot of people did, you know, it's unfortunate, but it doesn't have doesn't mean they have to have a crappy future. The 35 year old man has many more tools and experiences and supports than the five year old child. So what felt overwhelming and rejecting and damning as a five year old child may not as a 35 year old. You know, when you're a child, your parents kind of are at the center of your world. When you get older, you've got other people that may say, you know what, you know, I love you for who you are, you know, your parents may be rejecting you. That's their loss. But the 35 year old person has a broader support base. So they know one person is as able to sink their ship. Encourage them to give themselves permission to grieve whatever they need to grieve. It sucked and it isn't fair. And that's true. You know, so they need to be able to look back and it could be what happened today at work or it could be what happened during their childhood. But if they need to grieve a situation, you know, help them work on that continuing to keep their demons locked up drains precious energy. So keeping all this stuff, this resentment, this anger, you know, that's a lot of energy and you're just holding it down kind of like stuffing a closet. And eventually that closet so full you've got to throw your whole body weight into it or suitcase. You got to sit on it in order to get it zipped shut. That's what happens when we don't deal with our demons. So what would happen if you accepted the past and you know forgiveness is a difficult word for a lot of clients. So I usually start with the word acceptance. And then we talk about forgiveness being a power play. When you forgive somebody, you're choosing to not let them have power over you anymore. But what would happen if you accepted the past? What would happen if you accepted yourself? What does it mean if you quit holding on to the past? If you quit being resentful and angry? Or what does it mean if you quit disliking yourself? If you start to accept yourself? What does that mean to you? Some people are terrified to do that because they were always taught that liking themselves was boastful and it was wrong. So we need to consider to look at that too. So sex addiction, pornography addiction is real. It does alter the neurochemicals. There's plenty of research that shows that. It's not obviously the same as taking cocaine or methamphetamine. But a lot of people experience significant problems at work and in their functioning in their real life relationships when they develop sex addiction or pornography addiction. So it does start causing problems. They do often start needing to have a sexual release more often in order to just feel normal. So when we start looking at the criteria for addiction, it really does kind of plug in pretty well. Dealing with sex or pornography addiction involves healing and rebalancing the brain chemistry. Good nutrition, good rest, good circadian rhythms, making sure people are getting enough sleep and enough sunlight and relaxation, living a healthy lifestyle and backing off, not necessarily being celibate. Some people think it's easier to just be completely celibate for three or six months and that's their choice. Terry Cruz, the actor, he and his wife chose to take a vow of celibacy for six months when he was dealing with his sex addiction issues. And that's definitely something that partners can consider, but not everybody's going to want to go to that extreme. So we want them to be able to back off so their brain can rest. We want to help them deal with any issues that they're trying to escape from that they might be that might be fueling their stress and find alternate ways of dealing with stress to prevent that neurochemical imbalance. So when you have a bad day at work, when you're trying to figure out how you're going to pay this month's bills, what do you do or what else can you do besides masturbate or have sex that will help you get some relief? Are there any questions? Do your clients need a little help staying on track between sessions? Are you looking for a great aftercare resource? Look no further than docsnipes.com. For as little as $15 per week, Dr. Snipes provides concierge coaching services to clients through online weekly groups, chat availability seven days a week, and members only resources. Learn more at docsnipes.com.