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How The "Stages of Change" can help you 23 Jan 2020 23:38 #346927

  • menachemgye
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The most widely tested and proven approach to understanding behavior change is called the Stages of Change. (The full official name is "The transtheoretical model of behavior change".)

I don't see any threads about it yet, so this thread will be dedicated to explaining this concept and how it can help you.

Like a Rosetta Stone, understanding the Stages of Change, can help you understand yourself much better, and also help clarify what you should be focusing on. 

The Stages of Change talks that for each behavior/habit/addiction we want to change, we can be in one of 5 stages:
  1. Precontemplation - You're not interested in changing. Your goal is to start considering change.
  2. Contemplation - You're considering the change, but have mixed feelings. Your goal is to make a decision.
  3. Preparation - You're making a personal realistic and acceptable plan. Your goal is to make a commitment to implement the plan. 
  4. Action - You're taking action to implement the plan, improving the plan with trial and error, dealing with slips and falls. Your goal is to apply the plan for 6 months and gain confidence that you can really do it.
  5. Maintenance - You're sustaining your new behavior and working to prevent relapse. Your goal is to improve your lifestyle in a way that supports the change for the long term.

Now, the question of what to do next depends heavily on what stage you're currently at. I'll talk about that in the next post.
There's Life Beyond Addiction

Re: How The "Stages of Change" can help you 24 Jan 2020 00:24 #346928

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Contemplation
If you have mixed feelings about doing a change, then you're in the contemplation stage. Here's a classic post written by someone in contemplation:

I have not been around for a long time...... what a mistake..... I was at 35 days clean and booom, came crashing down!!!!!! I had such a spiritual rosh hashanah and vowed never to act out again!! And now i am back where i started, on the one hand I really feel like giving up but on the other hand i also feel that this is my tafkid to fight this addiction, i am now going into shidduchim and need to STOP asap. 
I have said just two days ago that I am not going to be oiver but it has just happened!!

On the one hand, "I really feel like giving up". I.e. porn is really sweet, and I really want it. On the other hand it makes me feel guilty, and it's bad for shidduchim...

When we're in contemplation, we're essentially ambivalent about change, so we feel stuck. We feel like we'll be dissatisfied no matter what we do.

So some days the pendulum swings - consciously or subconsciously in favor of change (especially after an inspirational Rosh Hashanah) and on other days, it goes the other way.

:pinch: Warning: Spoiler!

That's why the goal during contemplation is to resolve our ambivalence, and make a decision to stop. 

There are various techniques how to achieve that:

If you quit porn while still in contemplation, it probably won’t last. After all, you still have mixed feelings about the change. You might say to yourself “I wish I can just stop, let me just do it”. But deep down you may also think, “I don’t know if I can manage without porn, I really need it.” Premature commitment is weak and doesn’t last. It might work for a few days or weeks, but eventually it wears off.

To be continued...
There's Life Beyond Addiction
Last Edit: 28 Jan 2020 12:07 by menachemgye.

Re: How The "Stages of Change" can help you 28 Jan 2020 12:01 #347000

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Preparation 
If we've made a decision to stop, and you're planning to seriously quit within 30 days, then you're in the Preparation stage.  

During this stage the question is no longer IF to stop, but HOW to stop. Our goal in this stage is to create a realistic plan of action, and committing to set aside the time and energy needed to follow through. 

The things you can focus on during Preparation are:
  • Learning about the available options: What does GYE have to offer? What support groups are available (SA, PA, SMART)? Do you want to try therapy? If you're not sure, this is time to discuss it with other GYE members or someone on the GYE hotline.
  • Figure out what type of Urge Management strategies would work for you.
  • Decide which filters you can use for all your devices, and what else you can do to control your environment and avoid triggers.
  • See if you can find friends to be in touch with through the forum, or mentor/partner program.
  • You might want to consider ways to reward your successes.
  • Start experimenting with stopping

Then collect all your findings and put together your personal plan of action, and set a start date of when you are committing to begin implementing the plan.

As you can imagine, doing all this preparation takes energy. Unless you already have a lot of experience with stopping, figuring all this out is not a 1-day project... However, by preparing properly, we greatly increase our chances of long term success. 

Yesterday, I got an email from a new member on GYE:

I can't believe I just fell I'm barely on the program a few hours I don't know if it's worth the work to try to stop


It's like, "I can't believe it, I've used my new phone for barely a few hours and it already stopped working!" 

Change doesn't work like that. Nothing significant will happen if we don't prepare -- סוף מעשה במחשבה תחילה. Even becoming a shoemaker takes some learning. Changing habits takes time, energy, and sometimes money.
  • Time - It takes 6 months on average from when we start implementing the plan until we move to the Maintenance stage (see the posts below for more info).
  • Energy - There's no magic button to achieve long term change. It takes work. When using the right techniques, it can become much easier and sustainable than if we just try brute force, but it still takes quite a bit of energy, especially in the beginning when we might experience withdrawal.
  • Money - Although all GYE tools are free, good filters cost money. If we need therapy, that can cost money as well. (By the way, GuardYourEyes recently started a service to help guys who absolutely cannot afford a filter).

In the Big Book it says "Half measures availed us nothing". We'll only be successful if we are ready to do whatever it takes. It needs to be our top priority. If we have lots of goals we are working on it, and this is only one of them, it probably will not get enough attention. 

The Contemplation stage is where we psych ourselves up for being ready to invest in making this change. The Preparation stage is where things start to become real. Instead of thinking "I wish I could quit", we start thinking "I will quit."
"I'll free up some in my life to allow time and energy to work on this. I'll push of some other goals I'm working on for later. For the next few months, I'll consider it a good day even if my only accomplishment is that I've been clean..."

ike any project we are serious about, it takes planning. As Benjamin Franklin said, "If you fail to plan, you are planning to fail".

The next stage is Action, where you actually start implementing the plan, and try it out in the real world.
There's Life Beyond Addiction
Last Edit: 28 Jan 2020 14:35 by menachemgye.

Re: How The "Stages of Change" can help you 28 Jan 2020 14:27 #347001

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Action

The action stage is the time we implement the plan, revise it as necessary, deal with falls and slips, and use strategies to prevent relapse. The goal is to create a new pattern of behavior.

When we're in the Action stage, we're no longer thinking or talking about change, we're actually doing something about it. We're taking our plan, and implementing it step by step:
  • We actually use the urge management techniques we've selected in our plan when we get hit by an urge.
  • We take action to avoid triggers and urges as much as possible.
  • If we have a slip or fall, we check our plan to see if anything needs to be revised and get right back on track. See here for more info.

On average we remain in this stage for 3-6 months, and then move to the maintenance stage. (Just to be clear, this does not mean that you need a 3-6-months clean without a single fall, only that you are working on the change for 3-6 months without giving up in middle.) 

Why does it take so much time?

Quitting a habit or addiction has been compared to "leaving an intense love relationship" [1]. It takes time to adjust. There are many activities or feelings that we experience during the day, that until now have been associated with acting out, and it takes time and energy to disrupt these connections. [2]

Another reason for the length of the Action period is that it takes time to recover from the neurobiological and neurocognitive effects of the addiction on the brain. —Addiction and Change [3]


Also, many people find social support to become increasingly important during action. It can help a lot to have someone you can update about your progress. If you're not part of a 12-step meeting, you can find someone to talk to using the mentor/partner program. Of course, you can also post about it in the forum.   

Action is also the time to deal with any underlying issues and attitudes that feed the addictive behavior. Dealing with these issues can help us prevent relapse, and it makes it possible to sustain our new behavior for the long term.

The 12-step program and SMART Recovery have very different approaches on how to deal with underlying issues.12-step programs focuses on spiritual and character development, while SMART Recovery (and therapy in general) focuses on learning how to cope with unhelpful thoughts and feelings. 

Regardless if you join a 12-step program, SMART Recovery, start therapy, or try to work it out on your own, the stages are always the same. 

Preventing Relapse
There are many definitions to the terms slip, fall, lapse, and relapse. In the stages of change, it's defined as follows:

The slip is an occasion or two of use or a brief episode of reengagement in the addictive behavior. Relapse represents a significant return to the problematic pattern of use or engagement in the behavior. From this perspective, slips provide the occasion for learning how to avoid the relapse. The goal continues to be prevention of relapse. Relapse represents a failure for this change attempt and something to be avoided. However, it should not be equated with total failure and the inability to change... Relapse occurs when the individual in Action or Maintenance gives up on the change attempt. That can occur no matter what the goal. Whether I am trying to quit completely or stop bingeing and reduce drinking, relapse would represent when I stop trying. Before that, recurrence of the target behavior can represent a slip or a struggle to sustain Action. Until the individual gives up and relapses, there is still hope for the individual to right the change process and attain success without necessarily having to re-cycle through earlier stages.

The bottom line is that as long as we didn't give up trying on this change attempt, we remain in the Action stage. If we do give up on this attempt it is called a relapse. This is a setback that brings us back to one of the earlier stages. But even if that happens, it does not mean that we cannot change. It's common to cycle through the stages a few times before reaching permanent change. Each time this happens, we can learn lessons from the previous attempts and create a plan that addresses the weak points in our previous plans.   

For this reason, the amount of "clean days" we have on the 90 day chart, or the length of time that passes since our "sobriety date" doesn't tell the full story of how far we've come. One guy might have 0 days clean and be in the Contemplation stage, and another guy can have 0 days clean, but be close to finishing the Action stage. What a world of difference!

For more on this topic, click here.

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[1] Peele, S. (1985). Meaning of addiction: Compulsive experience and its interpretation. Lexington, MA: Lexington Books, as quoted in DiClemente, Carlo C.. Addiction and Change.

[2] Addiction and change Ch. 1.
[3] Ibid, see there for references. This has been studied with substance addiction, so it might not apply to other addictions.
There's Life Beyond Addiction
Last Edit: 29 Jan 2020 12:41 by menachemgye.

Re: How The "Stages of Change" can help you 28 Jan 2020 17:50 #347006

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Maintenance

The last stage in the stages of change is called Maintenance. On average, you reach this stage if you've been in the action stage for 3-6 months without relapsing (i.e. without giving up in middle). 

During Maintenance, we still need to remain alert for infrequent triggers that happen infrequently (changing jobs, dating, get engaged/married, have a baby, summer vacation / yomim tovim).

If we've went through the previous stages successfully, such nisyonos (temptations) won't be as intense as they seem, but they still might be tempting, as we still have a "soft spot" for porn/masturbation. 

Therefore, just like in action, we need to remain alert:
  • We need to continue using urge management techniques whenever we get tempted. (Hopefully by now it's second nature)
  • Since we're still not immune to our old behavior, we need to do our best keep a healthy distance from them by avoiding triggers and urges as much as possible.
  • Porn serves as an escape from stress. If that's the case for you, then learning and practicing healthy coping skills can reduce the yearning for it. You can learn the SMART techniques by getting the SMART handbook or by joining SMART meetings. You can use online resources or therapy to learn CBT, Mindfulness or relaxation techniques. 

These are all things you have already started working on in the Action stage. What's new in the Maintenance stage is a focus on Lifestyle Balance. The more satisfying our life is, the less appeal our old addictive behaviors will have.

In SMART Recovery, this is divided into 2 areas:
  1. ​Lifestyle Balance - Dealing with important areas of your life that are not getting enough attention.
  2. Adding Pleasant Activities. If we focus too much on "shoulds" without balancing them with kosher pleasures it can lead to relapse. Such activities also improves our mood which makes us more resistant to temptation.[1]

Mr. Gary Wilson, in Your Brain on Porn makes some specific suggestions:

When you remove one source of dopamine (porn) it's vitally important to replace it with other, healthy sources of dopamine. As you consider which additional tools to try, keep in mind that heavy porn use is actually a synthetic substitute for the activities that naturally help keep your brain in balance. Not surprisingly, the most common tools employed include exercise, time in nature, creative activities, meditation, healthy diet, and socializing.


Another author, Mr. Andrew Ferebee, in The Porn Pandemic elaborates on how balancing our life can help make us more resistant to porn/masturbation addiction:

I believe the only way someone will quit watching porn and masturbating forever is when they create a life of their choosing and are living their best life. When a man receives his stimulus from a healthy sex life, has strong friendships, loves his work, and is financially free (not a millionaire but just doesn’t worry about money), and pursues his passions, there is little room for porn and masturbation.


Living a balance life is not all or nothing. The more balanced our life is, the less temptation we will have and the lower the risk of relapse. It doesn't need to be perfect. 

In an ideal world, we can reach a point where we don't miss porn and masturbation at all. Where we've created a lifestyle that is as fulfilling, comfortable and satisfying without porn, as it was previously with porn. Where we don't feel that anything significant is missing from our life because we gave up porn and masturbation. In that case, the level of temptation goes down to level of regular men who were never addicted. This can happen if you're happily married and the level of struggle was also on the lower end of the spectrum. 

Otherwise, keep in mind the following words of the Tanya (Ch. 27):

"... by averting his mind from sinful thoughts he fulfills the injunction, “You shall not follow after your heart and after your eyes, by which you go astray.”  - If erotic thoughts enter his mind, whether of an innocent nature [or otherwise], and he averts his mind from them, he fulfills this injunction. 

Our Sages have said:  “When one passively abstains from sin, he is rewarded as though he had actively performed a mitzvah.” Consequently, he should rejoice in his compliance with the injunction just as he does when performing an actual positive precept. 

Sadness due to such thoughts is due to conceit.For he does not know his place, and that is why he is distressed because he has not attained the level of a tzaddik, to whom such foolish thoughts surely do not occur. For were he to recognize his station, that he is very far from the rank of tzaddik, and would that he be a Beinoni and not a rasha for even a single moment throughout his life (i.e., this is what he should be striving for at present, rather than vainly desiring to be a tzaddik), then surely, this is the due measure of the Beinonim and their task: To subdue the evil impulse and the thought that rises from the heart to the mind, and to completely avert his mind from it...

With every repulsion of this thought from his mind, the sitra achra is suppressed here below in This World... Indeed the Zohar, in Parshat Terumah (p. 128), extolls the Divine satisfaction that occurs when the sitra achra is subdued here below,  for “thereby G‑d’s glory rises above all, more than by any other praise, and this ascent is greater than all else, etc.”

Therefore one should not feel depressed or very troubled at heart even if he be engaged all his days in this conflict with the thoughts which will always enter his mind.For perhaps this is what he was created for, and this is the service demanded of him — to subdue the sitra achra constantly... For there are two kinds of Divine pleasure:one, from the complete annihilation of the sitra achra, and the conversion of bitter to sweet and of darkness to light, which is accomplished by tzaddikim; and the second: when the sitra achra is subdued while it is still at its strongest and most powerful, soaring like an eagle, and from this height G‑d topples it in response to human initiative i.e., as a result of one’s efforts at subduing the sitra achra in his soul. This is accomplished by Beinonim.
This is alluded to in the verse, “And make me delicacies, such as I love,” where the word matamim (“delicacies”) is written in the plural, indicating two kinds of pleasure.



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[1] This rationale is explained in Hester and Miller, Handbook of Alcoholism Treatment Approaches, 3rd Edition, in the chapter on the Community Reinforcement Approach.
There's Life Beyond Addiction
Last Edit: 30 Jan 2020 12:58 by menachemgye.
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