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Anthony Quintiliani, Ph.D, LADC

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July 23, 2017 By Admin

Relapse Prevention Plans – Basics (T. T. Gorski) Anthony R. Quintiliani, Ph.D., LADC

Relapse Prevention Plans – The Basics

T. T. Gorski, Anthony R. Quintiliani, Ph.D., LADC

The following information about how to develop effective relapse prevention plans has been paraphrased from the Work of Terrence T. Gorski.  It is highly practical and a concrete way to develop your skills in relapse prevention interventions. Intermediate (Marlatt and Gordon) and advanced relapse prevention (MBSR, ACT) strategies will follow in future posts. The core steps are noted below.

  1. Stabilization: After detox and a few days without using substances, the core issue is WHAT do you need to do so you will not use substances today? This is very early abstinence, so best to be highly respectful, gentle, concrete, and proceed slowly with your client.
  2. Assessment of Realities: A primary rationale for assessment is to discover the client’s patterns of problems and related behaviors that most often lead to relapse.  Key areas to examine are patterns of use, recovery effort history, sources of emotional dysregulation, and details about repeated self-medication to reduce experienced suffering. You will most likely discover areas involving childhood trauma, various forms of person abuse, unhelpful familial patterns, serious losses, peer group problems, and insults to the integrity of the self.
  3. Education: Key areas of client education include that relapse is a normal part of recovery process; extremes of guilt and shame need to be combatted; identification and counteracting the progressive warning signs; and, instilling a strong sense of hope.
  4. The Warning Signs: It is important to individualize the plan for each client. Although common core categories of unpleasant life experiences leading to self-medication exist, each person’s response to them differs in the details. Your best bet for success is to include both self-help and clinical applications regarding the warning signs of relapse. Help the client take a personal inventory about their known warning signs. Some signs may not be in awareness.
  5. Dealing with Warning Signs: It is important to teach the client skills for managing their warning signs.  It is not enough to simply talk about the skills (generic talk therapy); it is important that clients practice the skills – a bit more Behavior Therapy.  Behavioral approaches help to concretize ways of being and doing that counteract automatic unhelpful sequences forming from warning signs. Often poor responses come after unhelpful thinking patterns. So it may be helpful to use some Cognitive Therapy to help client understand and counter unhelpful, automatic negative thinking. Rational Emotive Behavior Therapy may be helpful in helping clients modify self-defeating behaviors, and Mindfulness-Based Stress Reduction may be helpful in improving mind-body emotional dysregulation and behavioral urges. If you know how to do Dialectical Behavior Therapy, it can be highly effective here. Last but not least, use whatever might be helpful from AA’s 12 steps. Do not expect that one shoe fits all; do not expect that your favorite approach is the correct approach. A varied and skilled application of various approaches tends to work best.
  6. Recovery Plans: Clients will obtain the best outcomes by participating in both self-help and clinical applications of recovery and relapse planning. A concrete relapse prevention plans, founded on good personal information and scientific interventions, tend to be most successful.
  7. Personal Inventory: It is often helpful for clients to learn how to do morning and evening inventory work. This is similar but not the same as Psychosynthesis, in which people use preview to prepare to deal with expected challenges and joys of the day, and review in the evening to see what worked and what did not. If clients become anxious after evening review, they will be helped by MBSR’s body scanning technique.   It may help people enter sleep and remain  in sleep.
  8. Family Role: Supportive family involvement is strongly encouraged, but only if it is supportive in nature. Don’t try to force family roles if systemic support is lacking.
  9. Follow-Up: We need to check in with clients to see what is working and what is not working.  This should help us to monitor progress and revise relapse prevention plans as needed. A periodic urine screen may be helpful to work with both self-report and evidence of progress.

For more information refer to Gorski, T. T. (2003). How to Develop an RP Plan. At the Addictions Web Site of Terrence T.Gorski. See www.tgorski.com; www.cenaps.com; and, www.relapse.org.

Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, VermontChiYinYang_EleanorRLiebmanCenter

Author of Mindful Happiness  

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Filed Under: Addiction, Featured, Ideas & Practices, Meditation, MIndfulness, Prevention, Relapse Tagged With: ANTHONY QUINTILIANI, MINDFUL HAPPINESS, MINDFULNESS, PREVENTION, RELAPSE, RELAPSE PREVENTION PLAN

May 25, 2017 By Admin

Using Cognitive Defusion in Mindfulness Psychotherapy

Cognitive Defusion in Mindfulness Psychotherapy

A well-meaning therapist might ask: What is cognitive defusion. Well this practice, as used in Acceptance and Commitment Therapy, is beyond cognitive restructuring of cognitive distortions and automatic negative thoughts ( I call “Red Ants”). The practice concretely de-literalizes the personal truth and meaning of unhelpful, repetitive thoughts and words. As The Buddha warned: We probably should NOT believe the distinctions of thoughts in our heads. Our strong thoughts may be our best friends or our worst enemies. In neuroscience the fact that more negative than positive thoughts occur in humans implies we are more attached to limbic reactivity and fear than to positive thoughts and emotions. When we get stuck in negative cycles of thinking, feeling and doing our right brain and limbic area dominate. A very old mindfulness belief is that you are not your thoughts, your emotions, or your behaviors; these parts of you are simply associated with your life experiences. When a client learns to defuse a though it means they have changed its linguistic structure and removed it from being cemented into their CABs, or cognition-affect-behavior cycles. In all good therapies, especially Cognitive-Behavioral Therapy and various mindfulness therapies (MBCR, DBT, MBCT, MBRP, ACT), helpers often work on truth-analysis of unhelpful, repetitive, negative thoughts patterns – especially those embedded into CABs cycles of ineffective experiences. Self-medication, isolation, and avoidance are commonly associated with these realities. Sometimes this work includes meta-cognitive analysis regarding your thoughts about your thoughts or the patterns of your thoughts. The clear logic is that the words we often tell ourselves in times of stress or fear are NOT often true. Of course, if indeed you are seriously endangered best to allow your limbic brain area to save your life. The list below will note various approaches used to defuse thoughts from our experience of being, our CABs cycles.

  1. Stay the thoughts out loud and mindfully notice the sensations, images, emotions, and associated CABs cycles that arise. Now say the words over and over again for at least half a minute. Note any changes that follow.
  2. Use scrambling of the phrase to change it grammatical brain-connections. Your brain should react a different way to the “scrambled” message. It is like changing the code of the phrase. For example: try saying “am person a bad” or “person I a bad am” instead of “I am a bad person.”  Notice what your brain-mind does now.
  3. Speed up and then slow down the rate of inner and outer speech. Try all four options; notice any relief you have obtained.
  4. Reduce then intensify your energy level when saying the phrase. Notice, again.
  5. Elongate the sounds of the key words in your phrase.  Keep elongating and notice what happens. Elongate and slow as far as you can.
  6. I like this approach. Change the most important one or two words in your phrase.  Now say the phrase out loud with one or two slightly less harsh words.  You will need to repeat this technique for effects. For example: “I am so worthless” helps solidify your brain plasticity about personal meanings and images. Try this: “Sometimes I feel worthless” or “When really bad things happen, I can feel worthless”  or “My unpleasant feeling can relate to feeling less worthwhile.”
  7. Change the language code of your key word/s. For example: change “I am a terrible person” to “I am a spanty person.” Spanty being Czech for terrible or bad.  Notice how the brain/mind/body responds to this simple change.
  8. You could also sing your statement, or say it in a foolish voice tone.
  9. I have used defusion and added body movements to the process. Here are four examples.

A) Find a spot on the floor where you try to project all your bad feelings about your repetitive phrase. You are consciously projecting the bad feeling into the spot on the floor. Now stand in it and notice how your mind body reacts. Slowly, but with some bodily energetic force, step out of the spot on the floor.  Notice the effects.

B) Stand in the same spot, and pretend you are taking off a pair of pants – BUT when you are out of the imaginary pants, immediately step aside. Notice.

C) Find a pleasant place to go for a brief walk. Enjoy the environment, but say your statement to yourself. Split your attention in two: attention to the beauty of the walk (and watch your step), and attention to repeating your phrase. Notice any changes and shifts that occur.

D) This one is out-there but fun. Energize yourself (if healthy enough) into a rapid skipping movement. At the same time say your phrase, and pay attention to where you are skipping. Your body will respond by contrasting the negative statement against the body-memory of good-old skipping. For most adults, skipping was a fun thing to do. Notice the effects.

For more information refer to: Blackledge, J. T. (2015). Cognitive Defusion in Practice: A Clinician’s Guide… Oakland, CA: Context Press/New Harbinger, pp. 3-42, 87-109, 159-162.

Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, VermontChiYinYang_EleanorRLiebmanCenter

Author of Mindful Happiness  

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New Edition of Mindful Happiness in Production…Coming soon!

Filed Under: Clinical Practice, Clinicians, Cognitive Behavioral Therapy, Featured, Ideas & Practices, Meditation, Meditation Activities, Mindful Awareness, MIndfulness, MIndfulness Activities, Mindfulness Training, Psychotherapy, Therapy, Therapy Tagged With: ANTHONY QUINTILIANI, COGNITIVE DEFUSION, MINDFUL HAPPINESS, MINDFULNESS

April 1, 2017 By Admin

The Power of Interpersonal Mindfulness

Interpersonal Mindfulness

Various forms of mindfulness-based compassion training help us to care more about the needs, happiness, and health of other people. However, direct applications of interpersonal mindfulness activates these influences into direct action on behalf of others.  Thus, if lucky, we learn to care more about others and less about ourselves.  The self-centered ego gives way to compassionate tolerance. Buddhist practices and meditations may improve our interpersonal relations, both intimate and distant.  Today our world, nation, regions, and families are locked in bitter conflict; the entitled view of “my ideas are right” holds sway and prevents any forward movement for negotiated co-existence of different ideas and people.  If we hope to save ourselves as well as our world, we MUST practice more interpersonal mindfulness. Such practices of random acts of kindness, general compassion, taking in suffering and giving out joy, tolerance, openness to differences, general gratitude and others all support  more inter-personally cooperative thoughts and behaviors. Such thoughts and behaviors will improve self, dyads, relationship, family, community, race, ethnic group, religion, state, nation, and world. The need for this shift is highly urgent! We must change our being from greed, aversion, and hate to generosity, inclusivity, and love. If not our species and our world may fail.

In some ways this conflictual existence is the outcome of our old limbic brain structures (my own survival above all else), and our aggressive greediness as a species. According to very old Buddhists writings, one thing we can do right now if practice deep, active listening. By listening more to others and their opinions, and talking less about ourselves, we may achieve an emotional balance of mutuality. Basic mutuality (we are BOTH important) may lead to more deep listening and personal reflections of what is happening right now in this present moment.  What, exactly, is it that is upsetting me? What, exactly, is it that may lead to mutual satisfaction here now?  Begin your changes by starting with yourself.  Notice what conflictual inner self-messages continue to play and re-play themselves over and over again in your own mind.  Begin by listening to your own inner conflicts, and work at listening and reflecting deeply on both sides of this dynamic. Work on a solution, even if it is not a perfect one. First practice more radical acceptance with your own inner conflicts, then gently move to outer conflicts – begin gently with significant others.  Practice, practice, practice and practice more.  There cannot be a winner! Once you feel the sensations and emotions of successful compromise, begin to practice beyond intimate circles and into your general world environments. It is all about sharing your love and acceptance of self with others, and being for the betterment of others. On this path also practice good self-care.

Practice letting go of harsh self-centered judgments and learn to appreciate both similarities and differences – even BIG differences. After all, impermanence is real – as is the time-limited life you now have. Better to work at compassion and openness NOW. Better to work on caring about others and loving people NOW. Our total interdependence causes great energetic frictions at times. Learn how to find the MIDDLE WAY and encourage others to follow that path. The subtle energies of love and the very powerful energies of hatred both have immense influence in our lives. Live for love! Live to reduce hatred and reed! Be authentically intelligent and kind-hearted in your relatively short life.

For more information refer to Musho Hamilton, D. (2017). The Zen of You and Me: A Guide to Getting Along with Just About Anyone. Boulder, CO: Shambhala Publications.

Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, VermontChiYinYang_EleanorRLiebmanCenter

Author of Mindful Happiness  

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New Edition of Mindful Happiness in Production…Coming soon!

Filed Under: Benefits of Mindfulness, Featured, Ideas & Practices, Leadership, Meditation, Mindful Awareness, MIndfulness, Mindfulness Training, Therapy, Thoughts & Opinions, Training Tagged With: INTERPERSONAL, MINDFULNESS, TRAINING

March 26, 2017 By Admin

How to Improve Client/Patient Collaboration

Improving Client/Patient Collaboration  in Treatment

To improve collaboration between you and your clients/patients, simply practice the following behaviors as your norms.  See the

list below, and practice, practice, practice.

  1. Present with an attitude of helpfulness and authentic caring. Empathy and authentic concern are required.
  2. Recognize the reality that clients/patients are at different levels of readiness to make changes – almost alway NOT where you are in the process.
  3. Know how to use cognitive-behavioral therapies, mindfulness-based stress reduction, deepo psychodynamics in alliance building, and other effective approaches.
  4. Complete a cost-benefit analysis grid with the person, and work with pros/cons of staying the same vs changing.
  5. Do whatever you can to enhance the quality of the clinical relationship.
  6. Act within an understanding of equality; you are not able to control any person who is suffering.
  7. Provide psychoeducation where needed.
  8. Anticipate barriers to making desired changes; offer concrete support and help in doing so.
  9. Your clinical interventions should be evidence-based for a higher probability of success.
  10. Use the person’s personal hopes, goals, and motivations.
  11. Use task analysis as a behavioral method to break down larger tasks into smaller, more manageable tasks.
  12. Be willing to try harm reduction when people appear pre-contemplative in stages of change.
  13. Provide direct feedback, with more emphasis on reinforcing praise rather than scolding.
  14. Remain in the Middle Way regarding too much/too little expected change, as well as the timing and time required for any changes to occur.
  15. Be highly mindful of both your own emotion regulation and that of the person you are working with. Practice emotion regulation skills often.
  16. Intervene quickly in anxiety, depression, substance misuse, and trauma.  Intervene carefully, intelligently, and again with evidence-based actions.
  17. Remember in crisis situations that  safety is first, stabilization is second.
  18. Identify people, places, and things that help and hinder progress into healthier life patterns.
  19. Monitor serious symptoms and act accordingly.  If medications are required, be part of the monitoring system and do “check-ins” often.
  20. Use self-help groups if the client/patient finds them helpful.  One needs to participate to know the correct answer here.
  21. Do GOOD self-care and get effective clinical supervision when needed.

For more information refer to Daley, D. C. and Zuckoff, A. (1999). Improving Treatment Compliance: Counseling and Systems Strategies for Substance Abuse and Dual Disorders. Center City, MINN. Hazelden.

Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, VermontChiYinYang_EleanorRLiebmanCenter

Author of Mindful Happiness  

Mindful Happiness cover designs.indd

New Edition of Mindful Happiness in Production…Coming soon!

Filed Under: ANTHONY QUINTILIANI, Clinicians, Counselor Activites, Featured, Ideas & Practices, Leadership, MIndfulness, Practices, Self -Kindness, Self Care, Self Compassion, Self Esteem, Stress Reduction, Therapist, Therapy, Thoughts & Opinions, Training

November 26, 2016 By Admin Leave a Comment

Holiday “Blues” and a Few Antidotes

Holiday “Blues” and a Few Antidotes

It is common for many people to experience a full range of emotions during the holiday season.  It is also quite common for many people to experience holiday “blues.” In a more clinical understanding, this condition often includes both sadness/depression and anxiety/apprehension. Ideally, we should be able to experience thankfulness, gratitude, kindness, and joy; however for a myriad of reasons (family-of-origin issues, sibling rivalry, family systems “stuckness,” attachment problems, health issues, emotional problems, addictions, worries, etc.) many people do not look forward to the holidays. Buddhist Psychology offers a taste of reality: life is made up of suffering, joy/happiness, and neutrality/boredom.  That is it! THIS is the WAY it is! As has been stated over 2,500 years ago, the mind/thought can either be our best friend or our worse enemy. Add to these holidaynlues-mindful-happinessrealities the issues of rampant self-referencing and entitlement seen in so many people today – “Me/Mine Mind” (my terms). As we make our way through samsara, we condition/reinforce ourselves to the desire/attachment for sense pleasures; we understand that such states are temporary, and that we cannot hold onto them. Thus we are soon back in dissatisfaction as a norm. We crave too much; we crave too often.  We lack mindful abilities and skills to be content and satisfied with what we have right now.  This does not imply that you not work at personal improvement; it does imply that to do so in an authentic manner, requires great mindfulness, self-understanding, and patience.

Lucky for us, many enlightened beings from a long time ago have passed down teachings that will help us with these conditions. First, is awareness: we must become aware of the realities noted above.  We need to be willing to allow life to be our teacher; we need to be willing to learn from whatever happens to us – pleasant and unpleasant. Primary suffering will occur – we cannot avoid it in life.  Secondary suffering, however, does not have to exist.  As the story of the “two arrows” goes, we get hit by primary suffering, which is out of our personal control. That painful arrow should cue us to not allow habitually reactive thoughts, emotions, and escape behaviors to dominate our experience at that time.  It requires great mindfulness and determination (skills and practices) to keep the second arrow out of our future.  I am sure you know a person (perhaps it is you) who suffered from the first arrow many, many years ago and has been unable to free her/himself from the second arrow – habitual reactive, negative mindfulhappiness-holiday-bluesthoughts, emotions and behaviors associated with the first arrow. Second, is life purpose. Why are we here? We are here to live, to be, to learn, to experience, to cope, to love, to be spirit, and to find our deeper personal meanings. Impermanence is third. Nothing stays exactly the same; everything is in a state of change. Bad experiences do not last forever, and good experiences do not last forever – in fact because we desire them they may be more short-lived. Ultimate reality is next. All the problems we face (troubled love, the lack of it, finances, jobs, family relations, loneliness, illness, etc.) test our resolve and skills. To use the true ways of reality or the way things are (impermanence, emptiness, dependent origination, and no-self) in our service is to become more resilient to our suffering. These teachings and ways of being require much practice and understanding. It is not that you will not suffer; it is hoped that you will not react so harshly to your suffering and see it as simply one form of our temporary reality. Gratitude is the next doorway. Do your best to have gratitude and contentment with what you do have now – whatever the immediate personal experience is. We humans often take for granted many positive aspects of our lives, until we lose one of them. Have gratitude as your norm. Next to last, be in your true self. Yes, you will have negative emotions and suffering. And yes you will have joy and happiness.  The highest form of happiness is to learn not to suffer so much even when you are suffering.  Live in full honesty with who/what you are.  Also seek to find meaningful pathways to lasting happiness, which is most often not attached to possessions. Love yourself more, and love others as well. Lastly, be and act in compassionate ways to yourself and to others. This is the most true pathway to lasting happiness. Be kind, and act to put the interests of others ahead of your own self-interests.

Happiness follows such sacrifice. I hope you will try some of these wisdom teaching during the holidays, especially if you experience “the blues.” After the holidays keep living this way.   You will become a happier person.

By Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, VermontChiYinYang_EleanorRLiebmanCenter

Author of Mindful Happiness  

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New Edition of Mindful Happiness in Production…Coming soon!

Filed Under: ANTHONY QUINTILIANI, Commentary, Featured, Holiday Blues, Human Needs, Ideas & Practices, Inner Peace, Mindful Awareness, MIndfulness, MIndfulness Activities Tagged With: COPING, HOLIDAY BLUES, MINDFULNESS, PRACTICE

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