Fostering Resilience™ RELAPSE PREVENTION PROGRAM Dr. Karrol-Jo Foster, LMHC, CAP, ACRPS The Mini-Manual Center for Sobriety, Spirituality & Healing 7100 W. Camino Real, Suite 302-6 Boca Raton, Florida 33433 www.soberspirithealing.com (561) 569-7372 DEDICATION This relapse prevention program and supporting research is dedicated to the millions of people who struggle with substance use disorders, and to the friends and family who love them unconditionally. It is also dedicated to the tireless efforts of everyone working in the field of addiction treatment, who compassionately devote themselves each day to helping people to successfully recover and live happy, healthy and purposeful lives. Shame and stigma still permeate the souls of those who are affected by addiction. May this program model be a positive step toward helping those who suffer, and helping those who don’t know what they don’t know, come to understand. Dr. Karrol-Jo Foster, LMHC, CAP, ACRPS
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Fostering Resiliencetreatment approaches for alleviating shame are scarce (Luoma et al, 2011, Gutierrez & Hagedorn, 2013). As part of her qualitative research on shame, Brown (2006)
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Fostering Resilience™ RELAPSE PREVENTION PROGRAM
Dr. Karrol-Jo Foster, LMHC, CAP, ACRPS
The Mini-Manual
Center for Sobriety, Spirituality & Healing 7100 W. Camino Real, Suite 302-6
Boca Raton, Florida 33433
www.soberspirithealing.com
(561) 569-7372
DEDICATION
This relapse prevention program and supporting research is dedicated to the millions of people who
struggle with substance use disorders, and to the friends and family who love them unconditionally. It is also
dedicated to the tireless efforts of everyone working in the field of addiction treatment, who compassionately
devote themselves each day to helping people to successfully recover and live happy, healthy and purposeful
lives. Shame and stigma still permeate the souls of those who are affected by addiction. May this program
model be a positive step toward helping those who suffer, and helping those who don’t know what they don’t
know, come to understand.
Dr. Karrol-Jo Foster, LMHC, CAP, ACRPS
Table of Contents
Fostering Resilience: A Theoretical Model 1-5
Overview 6
SECTION ONE – RELAPSE PREVENTION 7
Relapse Warning Sign List 8
Relapse Prevention and Coping Skills 9-10
Core Beliefs 11
Cognitive Distortions 12
SECTION TWO – MINDFULNESS-BASED RELAPSE PREVENTION 13
Mindfulness Meditation Core Skills 14-16
What is Rumination? 17
What is Neuroplasticity? 18
Using Mindfulness to Manage Anger 19
Ten Tips to Foster Compassion through Mindfulness 20
1) ALL-OR-NOTHING THINKING: You see things in black and white categories. If your performance falls short of perfect you see yourself as a total failure.
2) OVERGENERALIZATION:
You see a single negative event as a never-ending pattern of defeat.
3) MENTAL FILTER: You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened, like the drop of ink that discolors the entire beaker of water.
4) DISQUALIFYING THE POSITIVE: You reject positive experiences by insisting they "don't count'' for some reason or other. Inthis way you can maintain a negative belief that is contradicted by your everyday experiences.
5) JUMPING TO CONCLUSIONS:
You make a negative interpretation even though there are no definite facts that convincingly
support your conclusions.
6) MIND READING:
You arbitrarily conclude that someone is reacting negatively to you, and you don't bother to check this out. ·
7) FORTUNE TELLING:
You anticipate that things will tum out badly, and you feel convinced that your prediction
is an already established fact.
8) MAGNIFICATION (CATASTROPHIZING) OR MINIMIZATION:
You exaggerate the importance of things (such as your goof-up or someone else's achievement). Or you inappropriately shrink things until they appear tiny (your own desirable qualities or the other fellow's imperfections). This is also called the "binocular trick."
9) EMOTIONAL REASONING:
You assume that your negative emotions necessarily reflect the way things really are: "I feel it,
therefore it must be true."
10) SHOULD STATEMENTS:
You try to motivate yourself with should and shouldn'ts, as if you had to be whipped and punished before you could be expected to do anything. "Musts"and "oughts"are also offenders. The emotional consequence is guilt. When you direct should statements toward others, you feel anger, frustration, and resentment. STOP SHOULDING ON YOURSELF!!
11) LABELING AND MISLABELING:
This is an extreme form of over-generalization. Instead of describing your error, you attach a negative label to yourself: "I’m a loser.,' When someone else's behavior rubs you the wrong way, you attach a negative label to him: "He's a idiot." Mislabeling involves describing an event with language that is highly colored and emotionally loaded.
12) PERSONALIZATION: You see yourself as the cause of some negative event which in fact you
Automatic Pilot describes our tendency to react without awareness. When we experience cravings and urges
to use alcohol or other drugs, we often go into automatic pilot mode. Based upon past patterns, we
subconsciously have acted upon thoughts, feelings and situations without full awareness of what was
happening and what the consequences would be. Have you ever driven to the liquor store or turned down the
street of your drug dealer feeling like you don’t know how you got there or felt you were not in control of
your actions? Mindfulness can help to step out of this automatic pilot mode, help raise awareness and make
more conscious choices in how we respond rather than reacting in habitual, self-defeating, and self-
destructive ways. The ability to pause and successfully move through cravings and respond more effectively
to high-stress, high-risk situations is gained through the practice of mindfulness meditation. This starts
with learning the basics of mindfulness meditation.
2. Awareness of Triggers and Cravings
Triggers and cravings (thoughts of using) are experiences that can cause an automatic pilot response. By
identifying personal triggers and observing how they often lead to a chain of sensations, thoughts, emotions
and behaviors, mindfulness can bring this process into awareness and disrupt the automatic reactive
behaviors. Awareness of triggers are identified through the In-depth Interview and Relapse Warning Sign
core exercises. By identifying personal triggers and warning signs, it can be illustrated how these reactions
have led to habitual behaviors and caused us to lose awareness of what is actually happening in the moment.
Mindfulness helps allow for greater flexibility and choice in responding to personal triggers and warning
signs.
3. Mindfulness in Daily Life
The SOBER breathing space practice is introduced to participants and intended to provide a foundation for
integrating mindfulness meditation into daily sober recovery practice. The SOBER (Stop, Observe, Breath,
Expand, Respond) breathing space. This is an exercise that can be done almost anywhere, anytime because
it is brief and simple. It can be used in the midst of a high-risk or stressful situation, or when experiencing
urges and cravings to use. It can counteract the Automatic Pilot response system.
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The acronym SOBER helps to remember the steps, as follows:
S – STOP. When you are in a high-risk, highly emotional, stressful situation or having an urge or craving to
use – or even at random times throughout the day as a way to practice building resiliency – remember to
STOP or slow down and check in with what is happening. This is the first step in countering the Automatic
Pilot response system.
O – OBSERVE. Observe the sensations that are happening in your body. Also observe any thoughts,
emotions, or moods that you are having. Notice and acknowledge as much as you can about what is
happening within you during this experience.
B – BREATHE. Gather your attention and bring it to your breathe.
E – EXPAND. Expand your awareness to include the rest of our body, your experience, and to the situation,
seeing if you can gently hold it in your awareness.
R – RESPOND. Respond mindfully (contrary to react), with awareness of what is truly needed in the
situation and how you can best take care of yourself. Whatever is happening in your mind and body, you
still have a choice in how you respond.
4. Mindfulness in High Risk Situations
The Sober Breathing Space in a Challenging Situation meditation, What You Want to Experience
meditation, and the Cognitive Restructuring exercise are all ways to practice mindfulness and reprocess high
risk situations. The idea and goal is that through the mindfulness meditation experiences and the cognitive
restructuring exercises you will have the opportunity to picture yourself in a high-risk situation and reprocess
the situation and emotions associated with the high-risk situation differently. Imagining yourself making
different choices and responding in ways that support your recovery.
5. Seeing Thoughts as Thoughts
Group members will become more aware of, and learn about, automatic thinking. Individuals early in
recovery often have a hard time differentiating between thoughts and feelings. Group members learn about
the role their thoughts play in the relapse process and the link between thoughts, feelings and
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behavior. You will also learn the process and practice of becoming more aware of thoughts and how to slow
down the racing thoughts through mindfulness meditation practice. By starting to slow down and observe
thoughts, the goal is to ultimately achieve the ability to become the third-party observer of your own thinking
and then start to practice and learn how to redirect automatic negative thoughts. This skill practice is where
group members start to learn about addicted thinking patterns (Red Wolf) versus true self, sober thinking
patterns (Green Wolf) and can begin to question themselves, “is this an addictive thought or a sober
thought?” This is where we look at the dysfunctional addictive thought process and more importantly, we
challenge the addictive and irrational thoughts and learn how to manage our thinking to develop a healthier
and more powerful sober thought, feeling, and action process.
6. Social Support and Continuing Practice
Group members become aware and learn the value of interdependence rather than independence, and the
critical importance of support networks as a way of reducing risk and supporting a stable recovery. Here we
expand on the information presented relative to handling stressful and high-risk situations by examining
individual environments and participation (or lack thereof) in recovery groups and/or communities.
Identifying possible barriers ahead of time in order to anticipate what might put recovery at risk, and finding
ways to overcome barriers to asking for help. Here we also emphasize that active recovery and mindfulness
is an ongoing practice and lifelong journey that requires daily diligence and commitment. We also can once
again use the Red Wolf, Green Wolf metaphor and describe ways in which we can unwittingly feed the Red
wolf and give it strength other than by using alcohol or drugs. We also examine how support networks and
continuing mindfulness meditation will help to keep the Green wolf strong.
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What Is Rumination?
Rumination is:
Dwelling on difficulties and things which distress us
Repeatedly thinking about events from our past
Becoming preoccupied with something and not being able to get it out of your mind
A learned strategy for trying to deal with our problems.
Is Rumination normal?
Yes, to some extent everyone ruminates or dwells on their problems
Thinking about our problems can be helpful: especially if we reach a solution and put it into action.
Most os the time, and for most people, rumination is time-limited: it stops when the problem is
solved.
Although rumination is normal, excessive use of it can be problematic.
What are the problems with Rumination:
Unhelpful rumination tends to focus on causes and consequences instead of solutions “What did I do
to deserve this” and “Will my life ever get better” instead of “How can I make my life better”
Rumination tends to focus on what has gone wrong and can lead to negative thinking.
When used excessively rumination can lead to depression.
When used excessively, rumination can maintain an episode of depression
Unhelpful rumination can lead to inactivity and avoidance of problem-solving.
Dwelling on a problem can lead to….
Rumination – Getting stock in a loop that causes distress…. What is wrong with me? Why do these things
always happen to me? What did I do to deserve this?.... This type of thinking leads to a never-ending
negative feedback loop.
Resolution – How can I solve this problem? What do I need to do? Take action to resolve the problem.
Unhelpful Rumination asks more “why….” Questions
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What is Neuroplasticity?
Close your eyes and picture a lawn of green grass.
Now imagine that someone walks across the grass diagonally from one corner of the lawn to the opposite
corner. Notice how the grass changes. Perhaps the grass is a bit matted down where they walked.
Now imagine lots of people walking across the grass following the same path. After a while, notice that
some of the grass is dying where so many footsteps have fallen. Imagine that this process continues until
there is a path worn in the lawn where there is no longer any grass – just a dirt path worn smooth from all the
foot traffic.
This is like the process of neuroplasticity in the brain. According to Hebb’s axiom, neurons that fire together
wire together (Hebb, 2009) and dendrites increase in size and efficiency when something is repeated over
and over. So, like the path worn in the grass, the neuronal pathway gets stronger and stronger with
repetition. Mindfulness practice is an effective way to create more healthy pathways in the brain.
Now imagine the lawn with the path across it. Notice what happens to it over time when no one walks on it
anymore. The grass slowly starts to grow where the path was until at some point there is no longer a path at
all. Mindfulness practice can help rewire the brain so it no longer automatically responds with anxiety; or
anger, or fear, or feeling stressed. Mindfulness helps to decrease the negative pathways to the brain.
Implicit Memory
Implicit Memory is encoded throughout our lives starting at birth (some believe it occurs in the womb). Dan
Siegel states that it involves perception, emotion, bodily sensation, behavior, mental models, and priming
(Siegel, 2010). Essentially, implicit memory is a memory that you don’t realize you are retrieving from the
past. Implicit memory is useful and necessary as it involves recollection of skills and things you know how
to do that you don’t need to recall consciously. For example, implicit memory helps you remember how to
ride a bike without consciously feeling like you are having a memory of learning to ride. Implicit memory
operates below the level of awareness and drives current behaviors.
Implicit memory can be particularly troublesome in the present if you experienced intense emotions or
trauma in the past. The implicit memory of these things can emotionally hijack you in the present without
your being aware this is happening. This is why mindfulness can be helpful to increase awareness.
It is important to understand how powerful some implicit memories can be and why it is so important to use
mindfulness to prevent implicit memory from driving behavior in negative ways.
Implicit memories can emotionally hijack our prefrontal cortex and drive behavior without our awareness.
Implicit memories show up in bodily sensations. Implicit memory is like the child that lives within us.
Implicit memory can create misinterpretation of current situations.
Mindfulness allows us to integrate implicit with explicit memory to improve emotional response and
behavior patterns.
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Using Mindfulness to Manage Anger
When thinking about mindfulness, images of meditating and practicing yoga may come to mind. But
mindfulness techniques can also be used to help you manage your anger. Unexpressed anger can result in
all sorts of physical and emotional issues so it's critical that we find a way to channel that energy in a
more productive way.
Do something productive and physical:
Notice the word "productive" in this tip. It won't make much sense to physically beat the object of your anger
(whether it's a person or an object). But you can get out some of your frustration by doing something physically
challenging. Run, go to the gym, take a hot yoga class, or even visit a boxing gym. Getting your adrenaline level
up along with a flood of calming endorphins will help you feel centered, clear, and focused.
Make a list of your triggers:
One of the hallmarks of living mindfully is to be conscious. Rather than moving through life as a ball of
unmindful reactions, mindfulness asks us to be aware and live with our eyes open. When it comes to
problems with recurring anger, the first step is to identify your triggers. Make a list of things that set you off
and get your blood boiling. This is only the first step but is an important one in managing anger.
Create new responses (as opposed to reactions):
Once you have an idea of what sets you off, the next step is to find some new responses to each trigger. If one
of your triggers is a person, like your spouse or co-worker, find new ways to manage that relationship. If
having a heart-to-heart conversation is out of the question, find other ways to deal with it. Make a list, talk to a
friend, counselor of therapist and be creative.
Give up the urge to be right:
Deepak Chopra talks about the approach of giving up our feelings of self importance and the need to be
'right.' When that person cuts us off while driving or a co-worker drops the ball on a project, instead of using
all your energy to convince them of your side, let it go. Think about other ways you can use that energy to
do something for yourself.
Imagine a different way:
While the idea of meditating may not interest you, the idea of visualizing yourself acting in a different way
might. Close your eyes and imagine yourself in one of your trigger situations. Then, ''see" yourself acting
differently than you usually do. See it in your mind's eye and use that as the start of making a new
approach.
Get to the root of it:
While anger is a powerful emotion, the root cause is usually fear. Some believe that there are really only two
core emotions, fear and love, and everything else we experience is an extension of one of those. Take the time
to get underneath your reactions and identify your fear. It could be fear of being alone, fear of being hurt or
fear of failure. This is hard work and takes honesty and courage but can help you resolve your outbursts for
good.
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Be nice to yourself – Ten Tips to Foster Self-Compassion
through Mindfulness
Practice adding these mindfulness tips into your day for a few days. Notice if you feel kinder
toward yourself and those you come in contact with.
1. Start your day with 5 minutes of quiet - waking up mindfully can help you set the tone for the
day. Taking time to eat a small nutritious meal will send a message to your body that you have it
within your reach to take care of your basic needs. Reading even the shortest of inspirational
passage can help you feel centered for at least the first part of your day.
2. Take three deep breaths - before you leave your car or the bus to start your workday take three
deep breaths. Planning brief pauses throughout the day will keep stress hormones from activating.
Remember that stress hormones are not kind to the body! Focusing on the exhale will help activate
the rest and digest response.
3. What is going right? - take a moment to think about one or two recent accomplishments before
tackling your daily to-do list These can be really small; getting to work on time, keeping your desk
neat, helping a coworker, family member or sober support.
4. Drink water - a very small kindness toward the self but so important. Staying hydrated will help all
your bodily systems run more smoothly. We can feel tired, cranky and stressed, just because we
forget to take time for basic needs like drinking enough water.
5. Take frequent stretch breaks - whether you spend the bulk of your day sitting or running around,
taking time out for few quick stretches will send a message to your body and mind that you are safe and
well.
6. Try to under-schedule yourself - Instead of packing as much as you can into every day, try a few
days of under-scheduling. Do only what is absolutely necessary one day a week. Does this sound too
challenging? Alternatively, make sure you add in one activity a day that is purely joyful for you.
Notice how you feel at the end of the day.
7. Look people in the eye - slow down, and be in the present moment with as many conversations
as you can today. Notice how this calms the nervous system and makes conversations more
meaningful and enjoyable.
8. Play - get in touch with your silly inner-child. Squish some clay, draw a funny picture, ride a bike.
9. Move slowly toward the end of the day - Try cutting your pace in half after five. Sending the
signal to your body that it's time to think about getting some rest. 1o. What went right? - Before closing your eyes, note three small things that you are grateful for. These items can be as small as a staying sober today, a place to sleep and food to eat.
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Mindfulness of Relationships ELEVEN WAYS TO BE MINDFUL IN YOUR RELATIONSHIPS
All types of relationships can benefit from mindfulness. These include relationships with family;
loved ones, significant others, friends; co-workers, bosses, employees, teachers, and so on.
Substitute the person you are in a relationship with (or an imagined future relationship) for "loved one"
in the following steps:
1. Stop what you are doing and be totally present with your loved one either in person
or in your imagination. Listen to them. Look them in the eye. Smile at them. Give them
your undivided attention.. Let them know you think they are terrific. Avoid judgment.
Show them your unconditional love and acceptance. Think of all the things you love about
them.
2. Notice what thoughts or feelings arise in you as you think about your loved one.
Acknowledge and accept the thoughts or feelings and then let them go.
3. Ask, "What does my loved one need from me right now?'' Ask yourself how you can
give them your unconditional love and acceptance. Tune-in to their needs as well as your
own.
4. Try to see the world from your loved one's point of view. What stressors do they have?
How would you feel if you were your loved one?
5. Write down your expectations for your relationship. Are your expectations realistic? Are
they in your loved one's best interest? In yours?
6. Practice accepting your loved one exactly how they are. Love them
unconditionally. Let them know you love them no matter what. Look past their
difficult behavior to the beautiful being underneath. They are already good enough.
7. Understand what your loved one is feeling. Validate their feelings.
8. Avoid the trap of constantly telling your loved one what to do or how to do it.
Practice being in charge of yourself but not of your loved one.
9. When you. need. to represent yourself with your loved one, do it with love. Use "I"
statements to say, "I think, I feel, I want." "I like it when ..." Be positive, dear, and
kind.
10. Practice compassion and some type of loving kindness mindfulness regularly. Allow
yourself to be still. Be silent. Think about all the things you love, like, and are grateful for
about your loved one. Focus on the positive.
11. Take care of yourself so you can be in the best condition to be mindful.