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

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Behavioral therapy approach opines that pathological gambling is a learned behavior. ... In twelve-steps of Gambling Anonymous, members require self-inventory, ... – PowerPoint PPT presentation

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


1
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
2
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

3
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

4
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

5
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

6
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.

7
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)

8
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.

9
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.

10
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

11
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

12
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

13
SPIRITUAL WELL- BEING
  • Having a sense of purpose and direction
  • Believe life is meaningful
  • Inner peace
  • Trust relationship
  • Use of inner energy

14
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

15
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

16
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) .

17
Benefits of Psycho-education
  • Improved knowledge
  • Decreased negative symptoms
  • Improved interpersonal skills
  • Decreased relapse rates
  • And abbreviation of lengths of stay or illness
    duration.

18
Zion Social Service---Yuk Lai Hin
Bio-psycho-social-spiritual model
  • Psycho-education
  • Spirituality Group

19
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.

20
Targets
  • Ex-gamblers both male or female
  • Ex-gamblers family members spouses, siblings
    and parents

21
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

22
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.

23
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

24
Benefits of Being Mindfulness
  • Reduced Suffering
  • Effects on Health
  • Stress Reduction
  • Self Actualization
  • Happiness
  • Deep Relationships - Sense of Oneness with Others

25
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

26
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.

27
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.

28
Boundaries and Assertiveness
  • To understand what unhealthy boundaries come from
    and how boundaries are enmeshed
  • To distinguish assertiveness and aggressiveness
    behaviors
  • Develop assertive skills

29
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.

30
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

31
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

32
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.

33
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

34
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

35
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

36
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

37
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

38
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.

39
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.

40
  • THANK YOU
  • Contact Jessie or Ben
  • info_at_zss.org.hk
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