The role of goal setting and goal proximity in treating addiction

A comprehensive plan for recovery will often require setting goals. This may include goals around moderation criteria, improving physical health, attending educational and support groups, attaining a new job or housing, and systematically working through relationship dynamics. One key ingredient to goal setting, which is often overlooked, is goal proximity. This simply means how near or far the end-goal is from the present point in time.

Research in motivation theory has consistently proven that, to maximize your chance of success with goals, you must set both near-term and long-term goals that support each other. In the research literature, this is referred to as setting proximal (near) and distal (far) goals. One of the most recognized experts in goal setting is Albert Bandura, who is a Professor of Social Science in Psychology at Stanford University. Apart from being a renowned researcher in the field of psychology, Bandura has also served as the president of the American Psychological Association.

One finding in Bandura’s research is that people perform better when there is a condition that involves both near and far goals, as opposed to just a single, and distant goal. For instance, instead of setting a goal of losing 12 pounds in 90 days, it is more effective to set goals along the lines of this:

  • Lose 1 pound per week.
  • Lose 12 pounds in 90 days.

This can be even more granular by setting smaller goals even more frequently. In the above example, this could be done by introducing small and attainable goals throughout the course of a week, to support moving towards that week’s goal.

It has also been shown that attainment of a near term goal improves one’s belief in their ability to attain a longer-term goal. Another surprising side effect of this approach is that people wind up setting more difficult goals for themselves when setting both proximal and distal goals.

Lastly, the attainment of near-term goals also has the strong benefit of helping one develop intrinsic motivation towards attainment of a given goal. This is very important particularly in difficult and transformational work like addiction recovery. In very general terms, extrinsic motivation is when you do something because someone else is telling you to. This is similar to getting therapy because the court system has imposed it on you. On the other hand, intrinsic motivation is when you do something because it is internally rewarding. For instance, this may be similar to playing a sport because you enjoy it. So, when one attains a near-term goal, the event helps develop intrinsic motivation towards the pursuit of a longer-term goal.

Setting goals is an essential part of the recovery plan. Goals can be set for various areas of life. In doing so, it is important for the therapist and the patient to work together to devise goals that are attainable, are spaced apart properly, and work together in such a way so as to maximize success.

Author: Seda Gragossian, Ph.D.

Talk Therapy Psychology Center

References:

  • Bandura, A; Schunk, D. Cultivating competence, self-efficacy, and intrinsic interest through proximal self-motivation. Journal of Personality and Social Psychology. Vol. 41, 1981.
  • Bandura, A. Self-Efficacy. 1997.

Benefits of IOP for Borderline Personality Disorder

An Intensive Outpatient Program (IOP) can be beneficial for people suffering from borderline personality disorder. By its nature, an IOP program provides structure, active participation, and a forum where maladaptive behaviors can be investigated and evaluated over time in a setting with others working through similar challenges.

One study performed on the use of IOP for borderline personality disorders suggested that: “An intensive outpatient program for patients with borderline personality disorder should contain the four main elements of effective treatment for this population—reliance on structure, the expectation that each patient will be an active participant in the development and implementation of his or hertreatment plan, ongoing identification of maladaptive interpersonal functioning, and a focus on adaptation to community life and a longitudinal perspective on the patient’s life.” Source: An Intensive Outpatient Program for Patients With Borderline Personality Disorder. Smith, Ruiz-Sancho, and Gunderson. Psychiatric Services. 2001.

Author: Seda Gragossian, Ph.D.

Talk Therapy Psychology Center

How to help a friend who is suffering from addiction

Here are some things to consider when a friend is suffering from addiction:

  • Share with your friend that you are concerned about his or her misuse or abuse of the substance in question.
  • Encourage your friend to seek professional help. You may support your friend in the process of finding such help.
  • Offer him/her your support and unconditional love. Avoid judgments. Let him/her know you will be willing to help only if they are willing to help themselves by seeking professional help or making healthy changes.
  • Take care of yourself and set healthy boundaries. Loved ones can get quite hurt in such situations. Such healthy boundaries also are the catalyst for individuals to seek our help. It sends a strong message to the person that they need to get help and become healthier if they want to avoid losing the connections they have.
  • Avoid enabling your friend. For example, if your friend is abusing alcohol, do not go out drinking with him or her. If your friend is broke, do not give them money knowing they will spend the money on their habit.

Author: Seda Gragossian, Ph.D.

Talk Therapy Psychology Center

The role of acceptance in treating mental health issues

Recently, we were asked by a publication about our views on the use of restraint and the concept of acceptance. This is how we responded:

Having worked in lock-down facilities where the use of “putting hands on” patients was acceptable, I can tell you that sometimes it is necessary for the safety of the individuals and those around them to intervene with different methods. Those may involve restraining them, holding them in a safe facility for a period of time, and occasionally using medication. But such things are more about immediate risk management and deescalation. They are not meant to treat a condition.

So, onto the subject of treating the individual, it is very important to accept people for who they are and meet them at the place they are at in their lives. Once immediate safety concerns are addressed, the therapist then needs to work with them to help them find their way. Genuinely accepting their idiosyncrasies as a therapist gives them the strength for them to accept themselves. This requires a strong maturity and openness expressed by the provider.

There are many mental conditions and many more treatment methods. Some work in some scenarios and some don’t. An experienced psychotherapist needs to utilize different tools and also know when it is time to refer someone out to a specialist. We primarily work with addictions and we find Intensive Outpatient Programs (IOP) to be very effective. The consistency of the treatment schedule, the intense emphasis on working through issues, and the power of the group, all come together to create a certain momentum towards wellness that isn’t easily created in individual therapy. And yes, there are situations where other methods, including inpatient rehabilitation, staying at a sober living facility, taking medication, and using other new methods may be necessary. The goal of the therapist is to help people help themselves. Giving them an arsenal of tools is key.

Author: Seda Gragossian, Ph.D.

Talk Therapy Psychology Center

What Google Trends are telling us about Addictions

Google search trends offer us a unique view into the habits and interests of our society. With approximately 88% of the US population on the Internet, according to internet live stats, and with the ubiquitous usage of google search, much can be learned about what people are interested in.

 Here at Talk Therapy, we are particularly interested in understanding addiction and google has some interesting contributions to make to our understanding.

 Electronics Addiction

 One interesting and not yet fully studied area of addiction is electronics addiction. This includes the addiction to cell phones, texting, and social sites, like facebook, youtube, and others. We leave out addiction to video games as we believe that is an area that demands focused and separate investigation.

Google Trends - Facebook Addiction

 

According to google trends, the term “facebook addiction” peaked in 2011 and has been on a steady decline since. This could mean several things:

  • Interest in facebook as a whole is declining
  • Addiction to facebook is declining

It is reported that facebook usage is declining, though exact numbers are not published. What seems to be happening is that different populations are shifting from one social platform to another. One growing trend is in the tween population, where the shift is away from facebook and into instagram and youtube.

When looking at facebook, youtube, instagram and twitter side-by-side, we see that concern over addiction to those platforms is in fact growing. The Google trends around addiction tied to these platforms, seems to suggest a steady incline.

Google Trends - Addiction to top social sites

 

In the coming months, we will be conducting a study in this area to further understand the unique nature of addiction to electronics and to social sites, in particular. Please let us know if you would like to participate.

Author: Seda Gragossian, Ph.D.

Talk Therapy Psychology Center

Addicted to Jello Shots

According to Google Trends, the top searched “red white and blue” item during the 4th of July holiday was “Jello shots”. Additionally, the fourth most searched recipe was also “Jello shots”.

While 4’th of July is a wonderful holiday where friends and family come together to celebrate, let’s not forget that it is also a time where alcohol consumption is a part of most social gatherings. This is particularly problematic if you are underage and are just trying to have a good time during the holidays.

Jello Shot Consumption by Adolescents

We are picking on Jello shots partly in jest but we also realize that it represents one of our society’s playful ways of sweeping the alcohol consumption problem under the carpet. Let’s be honest: people are not searching Google to find the tastiest Jello recipe. They are searching for which alcohol combination is best and when in the cooking process to add the alcohol without ruining its potency.

What people don’t realize is that Jello shot consumption is high among older adolescents. Based on a study performed by Boston University, using a national sample of kids ages 16 to 20, they concluded that “jello shot use is prevalent among youth, representing a substantial portion of their alcohol intake.” In fact, of the population they interviewed, 21% had consumed Jello shots in the last 30-days, and this study was not even done during a holiday season. That same population indicated that 14.5% of their alcohol consumption came from Jello shots.

No, we are not starting a campaign against Jello. But we do wish to raise awareness to the growing issue of alcohol consumption in our population and especially in adolescents.

Please eat Jello responsibly.

 

Author: Seda Gragossian, Ph.D.

Talk Therapy Psychology Center

Study: Boston University Study on Jello Shot Consumption

Talk Therapy is featured in TalkSpace on Addiction in the LGBT Community

Dr. Seda Gragossian was recently interviewed by TalkSpace, on the subject of addiction in the LGBT community.

Dr. Seda spoke about the bisexual person’s sense of guilt and the absence of a strong community and a sense of belonging that is often found in the gay community.

Opioid addiction and the link to prescription pain medication

This is a multi-faceted problem and I would like to shed some light on the prescribing process. Unfortunately, general physicians are often not well-equipped with the knowledge to evaluate if a certain individual has addiction tendencies. As a result, they lack the protocols to properly evaluate long-term risks associated with opioid use by certain individuals. While there is a time and a place for use of opioids in the course of care, the risks of creating dependence are much higher in some populations than others.

Additionally, there does appear to be an over-prescription scenario. When certain individuals have tolerance or do not respond to a certain pain medication, a physician will often switch them to another — and then another — until a good fit is found. Unfortunately, that creates an overexposure for the individual and when you couple this with addictive predispositions, you have a recipe for dependence.

In some cases we have evaluated, we see patients moving off of prescribed pain medications and embarking on a heroin addiction. It is reported by the National Institute of Drug Abuse that nearly half of heroin users, in one particular study, reported having started as abusers of opioid-based pain medication.

Author: Seda Gragossian, Ph.D.

Talk Therapy Psychology Center

Source of citation: NIDA Drug Facts