Behavior Intervention Manual Hawthorne: Fill & Download for Free

This answer may contain sensitive images. Click on an image to unblur it.Addiction DefinedAn addiction is a physiological and/or psychological need to continue to use a substance, behavior, or activity after it is no longer useful or healthy to continue. So, an addiction is destructive.Addiction takes us, briefly or not, out of reality. Addiction provides a temporary respite from life’s challenges and the emotional pain of life. All addictions change brain chemistry, increasing the activity in the pleasure centers of the brain. So, addictions increase a flood of pleasure-producing neurotransmitters, some addictions more than others.There is difference between an addiction to escape reality and legitimate leisure to leave the usual reality scene for a while. By their fruits you will know them. Addictions are not life sustaining. By contrast, after a family vacation in the mountains with time to sleep in, read a book and spend time with each other, the person returns nourished. After an addictive binge, food or sex or whatever, the person feels dark and glutted.Addictions render a person alone and powerless to stop the behaviors. Lenten resolutions, New Year’s resolutions don’t work. In general,the various 12 Step programs hold a promising solution to most addictions.…………………………………………………………………………Addressing "Sexual Addiction"From the outset, let's make one point perfectly clear: There is no such thing as sexual addiction or other any addiction category (including alcohol) in the medical literature (American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision [DSM-IV-TR], 2000). Rather, dependency and withdrawal fall under the category of Substance Abuse Disorders. This disorder presupposes a substance which is exogenous (outside the body) of the individual.Included in the category of substance abuse is the concept of tolerance. Tolerance is defined as "the need for increased amounts of the substance to achieve intoxication or desired effect" and/or diminished effects if the use of the substance remains the same and is not increased (DSM-IV-TR, 2000).Substance withdrawal symptoms are related to the effects of the specific substance on the body. These symptoms can be reduced by substituting chemically similar substances. To help clarify these distinctions consider these substances and the withdrawal symptoms associated with them:Alcohol: Sweating and pulse rate increase, body tremors, insomnia, nausea and vomiting, hallucinations, agitation, anxiety and seizures.Cocaine: Heart increase or decrease rate, dilation (opening) of the pupils, elevated or lowered blood pressure, perspiration or chills, nausea, weight loss, body agitation (uncontrolled movements), muscular weakness (including heart, breathing, chest pain), and mental confusion and coma.Opiates (such as heroin): Sad mood, nausea, muscle aches, tearing eyes, nasal discharge, dilation of pupils, bodily hair standing up, sweating, diarrhea, yawning, fever and insomnia.Sexuality and Addictive BehaviorWhat in popular terminology is often called "sexual addiction" is properly called hyperactive sexual desire and differs from other addictions in that no exogenous chemical substances are introduced into the body. This does not mean however, that some people with hyperactive sexual desire don't undergo bodily processes similar to dependency or withdrawal that are characteristic of substance abuse. Nor does it mean that these individuals differ in their body chemistry from a person who has average sexual desire and arousal.Individuals are different concerning a number of characteristics associated with sexuality (Morelli, 2005). These include:Sexual Orientation: The sex of the individual the person is sexually attracted to, ie: same sex or opposite sex attraction.Sexual Desire or Strength: The degree of attraction, from weak to strong.Sex Partner Differences in ArousalMales: Multiple partners.Females: A single bonded individual.Gender Identity: The sexual characteristics a person perceives himself as having that are socially defined, irrespective of their biological sex.Brotto and Graziottin (2004) define excessive sexual desire as "a persistent or recurrent excess of sexual desire, expressed as constant and/or intrusive sexual thoughts and/or fantasies, or perception of a high and/or strong sexual drive." These researchers point out that excessive desire leads to "(multiple) partnered or solitary behavior," and list the usual psycho-social consequences of acting out the hyperactive sexual desire: frustration, anger, aggression, unwanted pregnancies, sexual transmitted disease, paraphilia (unconventional sexual behavior, animals, inanimate objects).In my clinical experience I have encountered significant personal, social and occupational dysfunction as a result of compulsive hypersexuality such as canceling dates and social functions, excessive staying at home, tardiness or absence from work, giving up friends, disengagement from spouse, just to name a few.Brotto and Graziottin make no mention spiritual consequences of compulsive hypersexuality. The closest they come to the spiritual dimension is their conclusion that excessive sexual desire can cause personal distress and be egodystonic (thoughts and behaviors viewed by the individual as unacceptable or distressing). More on this below.Attempts by medical and psychological researches to understand the etiology (physical causes) of hypersexuality draw from several sources:Substance abuse: e.g. cocaine and amphetamines (Black, Kehrberg, Flumerfelt and Schlosser (1997).Medical treatment: e.g. androgen, cortisone dopaminergic drugs (to treat Parkinson's disease).Medical conditions: e.g. Kluver-Busy Syndrome (temporal brain lobe damage caused by herpes, encephalitis, dementia, Alzheimers Disease, lipid [fat] metabolism deficiencies, cerebrovascular disease, trauma.) (Solms and Turnbull, 2002). Amygdala, Prefrontal and frontal lobe damage. (Anderson, Bechara, Damasio, Tranel and Damasio, 1999).Psychiatric Conditions: Obsessive Compulsive Disorder and Eating Disorders. (Black, Kehrberg, Flumerfelt and Scchlosser, 1997).The common physiological underpinning of dependency and withdrawal syndromes deals with the reward system of the brain (Olds, 1958; Panksepp, 1993, 1998). Biogenic amines such as dopamine and related substances such as phenethylamine mediate "anticipatory eagerness" and sexual arousal suggests that there are compulsive qualities in human response (Leibowitz, 1983).The behavioral aspect of this compulsion are outlined by Carnes (2001) who suggests that anxiety and dysphoric emotions are temporarily relieved by a "sexual high." Carnes outlines four phases that make up the dysfunctional cycle:Obsessional "trance like" preoccupation creating an overbearing need.Ritualistic behaviors such as looking at or passing by objects related to the obsession intensifying the sexual excitement.Sex acts that are actually performed.Dysfunctional - maladaptive emotions such as anxiety, depression, despair, hopelessness and worthlessness.This cycle is repeated increasing the intensity of the experience, the unmanageability of the problem, and reconfirming the worthlessness of the individual.Sexual Addiction and SpiritualityAnalyzing the physiological underpinnings is crucial in understanding the nature of any kind of addictive behavior. Moreover, in many ways the findings of modern clinicians are congruent with the teachings of the Church Fathers although the Fathers used a different vocabulary and worked from different concepts. This is particularly clear when comparing the practical advice of the Fathers to modern cognitive psychotherapeutic interventions.The Fathers are masters at understanding the type of preoccupying and sometimes obsessive thoughts discussed by the scientific clinicians and researchers. From the outset it is clear that the Fathers got their terms right. "Addiction" for example, is not a term the Fathers ever used. Instead, they refer to addiction as "passions" and "habits."They also understood the distinction between compulsion and behavior. Nikitas Stithatos, the disciple and biographer of St. Simeon the New Theologian said, "A passion is not the same as a sinful act; they are quite distinct." The effects of pleasure as a reward system of the brain was noted by St. Simeon 1000 years ago -- long before the modern discovery. "A passion operates in the soul, a sinful act involves the body ... love of pleasures (are) noxious passions of the soul; but unchastity (is a) sinful act of the flesh," he taught (Philokalia IV).The Church Fathers were able to discern the interactions between thoughts, passions and acts which has been the subject of current psychological research (Morelli, 2003). St. Gregory of Sinai wrote:Sinful acts provoke passions, the passions provoke distractive thoughts and distractive thoughts, provoke fantasies. The fragmented memory begets a multiplicity of ideas, forgetfulness, causes the fragmentation of the memory, ignorance leads to forgetfulness, and appetites are aroused by misdirected emotions, and misdirected emotions by committing sinful acts. A sinful act is provoked by a mindless desire for evil and a strong attachment to the senses and to sensory things (Philokalia IV).The Fathers taught that sense factors can evoke the passions, lust in this case. The senses are mainly visual, but can be auditory, taste, touch and smell as well. Research psychology is filled with studies suggesting cognition, memory and emotions scan also be triggered by such cues.St. Gregory of Sinai expressed the cognitive factor well:Distractive thoughts arise and are activated in the soul's intelligent faculty, violent passions in the incensive faculty, the memory of bestial appetites in the desiring faculty, imaginary forms in the mind and ideas in the conceptualizing faculty ... We are provoked to sin by such thoughts; the irruption of evil thoughts is like the current of a river, and when as a result of this we give our assent to sin, our heart is overwhelmed as though by a turbulent flood (Philokalia IV).The senses are activated by such distractive thoughts. St. Gregory continued:By the "deep mire" (Ps. 69:2) understand slimy sensual pleasure or the sludge of lechery, or the burden of material things. Weighed down by all this the impassioned intellect casts itself into the depths of despair ... sin ... is named according to its external manifestation (Philokalia IV).St. Maximus the Confessor expanded the teaching:The power of sin is somehow mingled with the senses and induces the soul by means of sensual pleasure to have pity for the flesh, to which it is joined. When the soul pursues the impassioned and pleasurable cultivation of the flesh ... (it) is impelled to become the author of evil" (Philokalia II).The Fathers recognized that these thoughts are so powerful that they cannot be entertained without succumbing to them. St. John of the Ladder warned:Do not imagine that you will overwhelm the demon of fornication by entering into an argument with him. Nature is on his side and he has the best of the argument ... So the man who decides to struggle against his flesh and to overcome it by his own efforts is fighting in vain" (Philokalia I).In 1938 behavioral research psychologist B.F. Skinner investigated the powerful effects of stimulus "elicitation" or "control" of behavior noted many centuries earlier by the Church Fathers. Skinner concluded that specific responses occur automatically (learned by repetition followed by reward) in the presence of specific stimuli or cues. Put another way, Skinner discovered that cues work because they signal the reward that follows a behavioral response.To illustrate: a telephone rings (stimulus cue) and automatically a person picks it up and says "Hello." The picking up and "Hello" would not occur if the stimulus cue had not elicited it. The response of those suffering from sexual dependency works the same way. A visual stimulus such as a pornographic picture for example, controls the response, ie: actions that lead to further sexual arousal.Skinner and others found that so called "neutral cues" associated with cues that "naturally" elicit responses eventually come to elicit the response themselves. A computer screen for example, appears to be a neutral cue. However, when the screen is frequently associated with pornographic images, it can elicit sexual arousal and the response associated with it. A response chain forms: Turn on the computer and then go to a pornographic website. Another, less obvious, example concerns the term "Red Light." The term is found everywhere in the country and can elicit the response: Park car, walk into the strip club, start a lap dance. These responses are reinforced by the reward system of the brain discussed above.The Fathers also understood how entrenched the cues and associated behaviors can become. St. Nilus noted, "A practice leads to a habit, and habit takes root like second nature. It is difficult and painful to stir or transform a nature (Haucherr, 317). St. Gregory of Sinai wrote, "The cause and origin of the passions is the misuse of things ... (and) expresses the bias of the will ... " (Philokalia IV).The Church Fathers were able to discern this process without any knowledge of behavioral neurophysiology and were aware of how subtly the process works. St Nilus wrote that it "attacks through alluring ruses." Ruses today include computer pornography, email spam, or semi nude models or performers in advertising and entertainment, for example.Even presentations that appear innocuous on the surface can contain stimulus cues associated with arousal and the triggering of habits that prove corruptive in the end. St. Nilus described how seemingly innocent temptations grow. "Innocent sympathy, encounters, eyes and ... pleasantries ... Over time, a tenaciously clinging root makes the most skillfully and solidly built wall decay; it makes rock burst asunder" (Philokalia IV).In the 1950's behavioral psychologists formulated the "Approach Curve" which measured the strength of attraction within arousal. This too replicated knowledge the earlier Church Fathers already possessed. The formulation posits that the closer a person is to a desired stimulus, the stronger his level of attraction. Furthermore, drive (the intensity of the arousal) levels increase the strength of attraction (Dollard and Miller, 1950). Thus, not only do sexual cues elicit arousal, but the arousal level increases the subsequent attraction of the cues. This becomes a pernicious vicious cycle.ReferencesAmerican Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) . Washington, DC: author.Andereson, S.W., Bechara, A., Damasio, H., Tranel, D. Damasio, A. (1999). Impairment of Social and Moral Behavior Related to Early Damage in Human Prefrontal Cortex. Nature Neuroscience. 2 1032-1037.Bandura, A. (1986). Social Foundations of Thought and Action. Englewood Cliffs, NJ: Prentice HallBlack, D.W., Kehrberg, L.L.D., Flumerfelt, D.L., and Schlosser S.S. (1997). Characteristics of 36 Subjects Reporting Compulsive Sexual Behavior. American Journal of Psychiatry. 154: 243-249.Brotto, L.A. and Graziottin A. (2004). Hyperactive Sexual Desire in Women. Urodinamica. 14: 84-87.Carnes, P. (2001). Out of the Shadows: Understanding Sexual Addiction. Center City, MN: Hazelden.Dollard, J., & Miller, N.E. (1950). Personality and Psychotherapy. NY: McGraw-Hill.Hausherr, I. (1990). Spiritual Direction in the Early Christian East. Cistercian Publications, St. Joseph's Abbey: Spencer, MA.Jones R, Britten N, Culpepper L, Gass DA, Grol R, Mant D, Silagy C, eds. (2005) Oxford Textbook of Primary Medical Care. Oxford: Oxford University Press.Liebowitz, M.R. (1983) The Chemistry of Love. Boston: Little, Brown.Martin, G. & Pear, J. (1992). Behavior Modification: What It Is and How To Do It. Englewood Cliffs, NJ: Prentice Hall.Menninger, K. (1973). Whatever Became of Sin? NY: Hawthorn Books.Morelli, G. (2005, July 19) Sex is Holy: Psycho-Spiritual Reflections in a Secular World. https://www.orthodoxytoday.org/articles5/MorelliSexIsHoly.phpMorelli, G. (2005, August 11). Homosexuality: Some Psycho-Theological Reflections and Pastoral Implications. https://www.orthodoxytoday.org/articles5/MorelliHomosexuality.php.Olds, J. (1958). Self stimulation experiments and differentiated reward systems. In H. H. Jasper, L. D. Proctor, R. S. Knighton, W. C. Noshay, R.T. Costello (eds), Reticular Formation of the Brain. Boston: Little, Brown.Palmer, G.E.H., Sherrard, P., & Ware, K. (Eds.). (1979). The Philokalia: The Complete Text Compiled by St. Nikodimos of the Holy Mountain and St. Makarious of Corinth (Vol. I).Winchester, MA: Faber and Faber.Palmer, G.E.H., Sherrard, P. & Ware, K. (1981). The Philokalia II . Faber & Faber: London.Palmer, G.E.H., Sherrard, P. & Ware, K. (1995). The Philokalia IV . Faber & Faber: London.Panksepp, J. (1993) Neurochemical control of moods and emotions: amino acids to peptides. In M. Lewis and J.M. Haviland eds. Handbook of Emotions. NY: Guilford.Skinner, B.F. (1938). The Behavior of Organisms: An Experimental Analysis. NY: Appleton-Century-Crofts.Solms, M. Turnbull, O. (2002). The Brain and the Inner World. London: Kamac.V. Rev. Fr. George Morelli Ph.D. is a licensed Clinical Psychologist and Marriage and Family Therapist, Coordinator of the Chaplaincy and Pastoral Counseling Ministry of the Antiochian Orthodox Christian Archdiocese, (Antiochian Orthodox Christian Archdiocese of North America) and Religion Coordinator (and Antiochian Archdiocesan Liaison) of the Orthodox Christian Association of Medicine, Psychology and Religion. Fr. George is Assistant Pastor of St. George's Antiochian Orthodox Church, San Diego, California.Fr. Morelli is the author of Healing: Orthodox Christianity and Scientific Psychology (available from Eastern Christian Publications, $15.00).