Treatment and Relapse Prevention : The Use of Bodymindspirit Intervention to reduce Gambling trigger

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Treatment and Relapse Prevention The Use of
Body-mind-spirit Intervention to reduce Gambling
triggers in Hong Kong Chinese Society
Singapore Problem Gambling Conference 2007
Understanding Addressing Problem Gambling 5-6
July 2007
Dr. LI Cheuk-yan Miss. Wong Yuk -ming
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3 DOMAINS OF HEALTH

• Suffering
• Physical pain, anxiety, depression, distress
• 2. Functional Ability
• Blood pressure, muscle strength, cognitive,
  emotional, sexual and psychomotor functions
• Coherence in life
• Inner peace, hardiness, resilience,
  learned optimism, a sense of meaning and purpose
  in life
• Source Antonovsky, A. (1979). Health, stress
  and coping. San Francisco
  Jossey-Bass

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Clients Suffering

• Two kinds of pain
• Physical pain
• e.g. stomachache, migraine
• Mental pain
• e.g. frustration, loss of money, loss of
  relationships
• The essence of suffering lies in our thinking and
  perceptions

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Clients Suffering

• Suffering PAIN X RESISTANCE
• Suffering is the product of the pain and the
  resistance to it
• If resistance equals to zero, then suffering also
  equals to zero

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Gamblers Pain

• Loss of money is a mental pain gt it affects
  physical pain e.g. loss of appetite, loss of
  sleep, headache
• Gamblers resist or refuse to seek treatment gt
  they suffer both physical and mental pain

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Types of Common Treatment in Gambling Dependence

• Contemporary psychotherapeutic approaches focus
  on identification of reasons for gambling,
  confrontation of defenses and cessation of
  chasing behaviors.
• Cognitive treatments may challenge and correct
  the gambler's irrational thought.
• Behavioral therapy approach opines that
  pathological gambling is a learned behavior.
  Techniques include systematic exposure,
  desensitization, and skill development to improve
  social skills.

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Types of Common Treatment in Gambling Dependence

• Spiritual approach focuses on defects of
  character
• In twelve-steps of Gambling Anonymous, members
  require self-inventory, developing the traits of
  honesty, humility, and tolerance) and outside
  oneself (reliance on a Higher Power, prayer,
  confession, acts of restitution, acts of service,
  participation in a community of shared
  experience)

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Which treatment is most effective?

• Recoveries from gambling addiction can differ in
  their scope (the range of measurable changes) and
  depth (degree of change within each measured
  dimension).
• In eastern culture, the mind, the soul and body
  are viewed as unified, with energy fields both
  inside and around the body seen as part of the
  total health system.

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A Holistic Model of Recovery

• Traditional
• Bio-Psycho-Social
• Treatment focuses on a clients biological,
  psychological, and social problems. Success is
  assumed to be achieved when the client stops
  gambling.
• 21 century
• Bio-Psycho-Social-Spiritual
• Success is measured by the quality of new
  lifestyle. A client is willing to pay attention
  to the deeper and higher dimensions of life.

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Addictive Behaviour Spiritual Deficits

• Consistent, ongoing feelings of sadness,
  fearfulness or anger
• Disregarding ones own needs and always giving in
  to others
• Feeling lonely and isolated
• Low energy level
• Extreme need to be helpful, listening, agreeing,
  understanding, accepting and forgiving with others

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Addictive Behaviour Negativity

• People pay attention to negative information more
  than positive information
• Negative information is weighted more heavily in
  peoples evaluations than positive information
• Negativity is a matter of perception rather than
  something objective about reality
• e.g. a depressed client does not see the reality
  with calmness, clarity, and acceptance

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Factors Causes Ex-gamblers to Relapse

• Unmanageable debts
• Uncertainty about future
• Poor relationships with family members and
  friends
• Negative feelings or emotions
• Remorse
• Delusion to win back the lost self-image

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SPIRITUAL WELL- BEING

• Having a sense of purpose and direction
• Believe life is meaningful
• Inner peace
• Trust relationship
• Use of inner energy

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SPIRITUAL WELL- BEING

• Although each persons belief in higher power may
  be different, spiritual well-being is a
  protective factor to prevent relapse
• For instance, personal peace will disconnect a
  person from threatening thoughts and will shift
  the focus from problems that cannot be solved to
  a higher vision of hopefulness.
• If a person feels gratitude, one
• will be amazed at the changes
• in oneself, ones health,
• relationships, and the entire life

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Ways To Enhance Clients Spirituality

• Dwelling happily in the present moment
• People always connect with the past
• Or are busy rushing into the future
• But seldom live in the present moment
• Life can only occur in the present tense
• We cant enjoy a future meal
• We cant drink a glass of water from the past
• We can only do these things NOW

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Use of Psycho-education

• Cognitive psychology in psycho-education it
  involves challenging maladaptive thinking
  processes and suggesting alternative adaptive
  patterns of thinking (Wood, Brendtro, Fecser
  Nichols 1999) .
• Individuals can gain information about their
  illness by interacting with and listening to
  their peers (Ascher-Svanum Whitesel 1999) .

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Benefits of Psycho-education

• Improved knowledge
• Decreased negative symptoms
• Improved interpersonal skills
• Decreased relapse rates
• And abbreviation of lengths of stay or illness
  duration.

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Zion Social Service---Yuk Lai Hin
Bio-psycho-social-spiritual model

• Psycho-education
• Spirituality Group

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Goals

• to help those clients with gambling problems or
  ex-gambler family members discover their
  spiritual beliefs and practices as a way to
  develop healthy lifestyles.
• To develop social support network as well as to
  help ex-gamblers prevent relapse.

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Targets

• Ex-gamblers both male or female
• Ex-gamblers family members spouses, siblings
  and parents

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Content

• Six sessions ( total 12 hours)
• 1. Spirituality and Life, Mindfulness
• 2. Stress Management
• 3. Letting Go of Anger
• 4. Boundaries and Assertiveness
• 5. Forgiveness
• 6. Goal Setting

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Spirituality and Life

• Spirituality means many different things to
  many different people. Some common
  conceptualizations include
• a sense of meaning and purpose in life
  (Diarmuid, 1994)
• connectedness to oneself, to the environment, or
  to a higher power (Adams Bezner, 2000).
• Clients are taught to integrate their
  awareness of the deeper and higher realities of
  life into their everyday living.

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Mindfulness

• Mindfulness in daily lives - to attend to the
  present moment without evaluation or judgment to
  cloud perception.
• The Skills
• Learn to notice thoughts, emotions, and bodily
  responses in day-to-day situations heighten
  self-awareness, and calmly adapt to new
  situations

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Benefits of Being Mindfulness

• Reduced Suffering
• Effects on Health
• Stress Reduction
• Self Actualization
• Happiness
• Deep Relationships - Sense of Oneness with Others

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Stress Management

• Stress can be a response to a change or strain
  that is physical or emotional
• High stress can be a result of either an
  accumulation of many small stresses, or a large
  stress that even positive changes can produce
  stress
• Many ex-gamblers reflect that their excessive
  gambling behaviors are the result of
  inappropriate handling stress

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Stress Management

• Mindfulness practice By focusing deeply on
  simply being aware and alert in the present
  moment, without judgment, and without moving into
  thinking about either the past or the future help
  to manage stress.
• Emotional Freedom Techniques (EFT) A tapping
  skills serve to release the blockages that are
  created when a person thinks about or becomes
  involved in an emotionally disturbing
  circumstance. Clients are taught by the EFT to
  release the disturbed emotions.

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Anger Management

• Anger is a destructive force that creates
  negative effects
• The more anger a person has, the more the
  distortion about the reality, the poorer the
  behaviour will be.
• Only when the client develops inner peace and
  calm, anger can be released.
• Better anger control help the client to maintain
  better social relationships and to develop
  clarity mind in problem solving.

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Boundaries and Assertiveness

• To understand what unhealthy boundaries come from
  and how boundaries are enmeshed
• To distinguish assertiveness and aggressiveness
  behaviors
• Develop assertive skills

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Forgiveness

• Most ex-gamblers always regretted what they did
  to their family and themselves. Such feelings
  became a blockage to their recovery.
• Those ex-gamblers who managed to forgive
  themselves were easy to release their sufferings
  caused by pathological gambling behaviors.

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Goal Setting

• To achieve personal ambitions by setting goals,
  setting priorities, keeping operational goals
  small and precise, and being attainable
• - To teach clients how to set goals
  short-mid-term goals, long-range goals, which
  help them to maintain their motivation to succeed

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Clients Overall Feedback

• Those who find the program useful feel (72)
• More appreciation of life
• Increase self-awareness, self-trust, and
  self-acceptance
• Improve better relationships with other people
• Catalyzing inner growth
• More confident and develop serenity in the face
  of difficulties
• More accepting attitude toward life and its
  challenges

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Clients Overall Feedback

• In doing the relaxation exercises, breathing and
  mindfulness meditation, most of the participants
  (64) claimed that it is useful.
• Some (30) replied not useful and (6) had no
  feedback.

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Limitations of the Program

• 28 has comments
• Time for each session is too short. It may not
  be sufficient for debriefing after practicing the
  exercises
• No scientific measures for the programme
  effectiveness e.g. no control group
• No differentiation of the participants
  educational level
• The room is not large enough and the environment
  is not quiet

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Difficulties in Enhancing Spirituality in Our
Experiences

• Spiritual behaviours do not just appear
  spontaneously or occur randomly
• Develop and maintain a lifestyle of regular
  spiritual discipline require committed efforts
  over a period of time
• Material reinforcers may not be the best choice
  for establishing and maintaining spiritual
  behaviours

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Difficulties in Enhancing Spirituality in Our
Experiences

• Although spirituality is not necessary related to
  religious, most clients believe that breathing,
  meditation and mindfulness are religious
  practices.
• Some clients even resist to practice the exercise
  

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Difficulties in Enhancing Spirituality in Our
Experiences

• Some find it difficult to understand, e.g. the
  meaning of mindfulness, the difference between
  pain and suffering
• Need time to practice, but feel busy in their
  daily lives

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Difficulties in Enhancing Spirituality in Our
Experiences

• Take time to learn
• Some find it boring, e.g. when discussing meaning
  and propose of life, learning how to be calm when
  practicing breathing
• Some feel uncomfortable to do the exercise
  together

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Conclusion

• Spirituality may not be associated with religion
• As social workers, we see spirituality as an
  individuals exploration of things of ultimate
  value, and their relationship with these issues.
• It is an intensely personal thing, involving each
  persons understanding and living out of the
  purpose and meaning of their life
• With spirituality, gamblers focus are not
  narrowed solely to seek excitement on gambling
  and to avoid pain, but to enjoy the simple things
  in life.

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Conclusion

• By learning to handle the past, and by developing
  the inner peace, clients learn to let go of the
  debilitating consequences of guilt, and finally
  move on.
• For those family members of the gamblers, they
  learn how to get along with the gamblers using
  different perspectives and to have greater
  acceptance to them
• Those family members also know how to take care
  of themselves.

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• THANK YOU
• Contact Jessie or Ben
• info_at_zss.org.hk