Title: Treatment and Relapse Prevention : The Use of Bodymindspirit Intervention to reduce Gambling trigger
1Treatment 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
23 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
3Clients 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
4Clients 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
5Gamblers 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
6Types 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.
7Types 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)
8Which 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.
9A 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.
10Addictive 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
11Addictive 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
12Factors 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
13SPIRITUAL WELL- BEING
- Having a sense of purpose and direction
- Believe life is meaningful
- Inner peace
- Trust relationship
- Use of inner energy
14SPIRITUAL 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
15Ways 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
16Use 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) .
17Benefits of Psycho-education
- Improved knowledge
- Decreased negative symptoms
- Improved interpersonal skills
- Decreased relapse rates
- And abbreviation of lengths of stay or illness
duration.
18Zion Social Service---Yuk Lai Hin
Bio-psycho-social-spiritual model
- Psycho-education
- Spirituality Group
19Goals
- 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.
20Targets
- Ex-gamblers both male or female
- Ex-gamblers family members spouses, siblings
and parents
21Content
- 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
22Spirituality 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.
23Mindfulness
- 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
24Benefits of Being Mindfulness
- Reduced Suffering
- Effects on Health
- Stress Reduction
- Self Actualization
- Happiness
- Deep Relationships - Sense of Oneness with Others
25Stress 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
26Stress 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.
27Anger 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.
28Boundaries and Assertiveness
- To understand what unhealthy boundaries come from
and how boundaries are enmeshed - To distinguish assertiveness and aggressiveness
behaviors - Develop assertive skills
29Forgiveness
- 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.
30Goal 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
31Clients 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
32Clients 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.
33Limitations 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
34Difficulties 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
35Difficulties 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
36Difficulties 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
37Difficulties 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
38Conclusion
- 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.
39Conclusion
- 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