Sex Addiction CEUs

Hi and welcome to tonight's presentation Tonight we'll be talking about treating sex addiction

This is sort of a new field and of course in the DSM We still really haven't recognized the sex addiction as a diagnosable problem, but what we do see in clinical practice is it's posing a problem So whether or not we can actually put it as the DSM diagnosis or not is sort of irrelevant We need to figure out how to help people deal with this situation So today we're just going to go over a brief introduction and I emphasize brief and I'll talk about some of the caveats along the way but this will at least give you an idea about which direction you may need to take if you decide that you want to work with clients who have some sort of sex addiction issue

So what we're going to do in this brief little time is define sex addiction discuss similarities and differences between things like drug addiction and sex addiction and explore possible interventions that we could use to help people who are struggling with sex addiction so just to review an addiction is a person activity or substance used to escape from negative feelings despite experiencing negative consequences ok so just about anything that sort of activates our pleasure Center could potentially be addictive and it becomes addictive which cross from recreational use or normal use or whatever you want to call it to addiction when we continue to use despite it causing problems so if our relationship is falling apart if we're become going bankrupt if we get fired if we're just really starting to feel bad depressed about ourselves whatever the case may be but we're still doing it then we've got to look at what the rationale is behind that why are we choosing this behavior which is causing our life to fall apart and instead of choosing other behaviors we don't do things unless they're reinforcing we don't do things unless there rewarding so then you've got to say well what is the reward if it's worth all of these consequences and we'll talk more about that okay so sex addiction is similar to other addictions similar not the same causes a dopamine surge it excites that pleasure Center we are biologically programmed to procreate and to survive so fight flight fight flee or fornicate if you want to put it that way just so you can remember it cravings people when they stop using drugs or even when they are using drugs between episodes they may have cravings for drugs you're going to have the same cravings here our brain craves that dopamine surge it's not necessarily craving whatever the activity is when we're talking about drugs cocaine gambling those sorts of things what it's craving is that rush you're chasing the biochemicals triggers and conditions stimuli naturally some things are going to cause sexual arousal when we deal with addictions we see that a lot of other things may cause people to become aroused if they are addicted to internet porn just seeing a computer can be enough to make somebody start obsessing certain times a day now times a day seeing a computer that's not normally a stimulus that's going to cause a lot of people to get aroused it's like the computer let me check my email but when we're dealing with sex addiction these things start to come to represent what's coming it's kind of like when you walk into a bakery and you smell whatever you're smelling you know the bread the cookies the pastries and your brain goes oh I remember what that is we're gonna have some good food in a minute and it starts to release some of those pleasure chemicals your motivation is there to eat okay I'm crying I'm ready let's go with drugs we know about cravings we know about triggers we know that in addiction recovery from drugs we talked about changing people places and things because they are triggers they say this is somebody you used to you used to use with so if you're with them probably ought to use I've talked about before and a lot of my videos that people often equate drinking with watching football or other sports activities so in recovery one of the things that people need to do is recondition or rewire and we'll talk about rewiring in a minute that's stimulus so it doesn't say Oh football games on must have a drink it says Oh football games on must watch football both drug chain drug addiction and sex addiction caused brain changes our brains want to maintain some level of balance okay so if you're constantly flooding it with dopamine at a certain point it goes whoa you know over stimulation shutdown if you've ever been and this is not the best example but it's the one I can come up with right now if you've been ever been in a kindergarten class and there are 15 little children running around I love kids love being around kids kids are wonderful but at a certain point with 15 of them running around it's just over stimulation please make it stop just for a minute somebody has a nap time okay brains taking a nap time unfortunately in addiction your brain actually goes through some changes and start shutting down some receptors so you're not constantly overstimulated well what does that mean that means the person is left to chase the hi those receptors have been shut down so what used to be a whoo is now they do it do what they expect to bring a will ooh and it doesn't bring that it brings it so there they have to use more of the substance or ramp it up a little bit which we see with the increasing severity or increasing intensity of use the good thing is the brain is extremely flexible and it can rewire itself and it can recover from a bunch of different stuff if we give it enough time and we'll talk about that in several slides sex addiction and drug addiction both can start as recreational trying it out see how things are going exploring experimenting then at a certain point for one reason or another and people differ on whatever their reasons are for why it crosses over from recreational or typical use I don't want to say normal but average to an addiction relationship financial emotional problems common drug addiction gambling sex addiction if you're in a relationship with someone and you're a sex addict a lot of times at a certain point one partner is not going to do it so you're either going to be turning to internet porn or you're going to be turning to other live recipients either way usually not good for a relationship and I will say right here there is a caveat in the approach to treatment and some of the underlying issues when we're talking about addiction to internet porn versus addiction to having sex with multiple partners so there is there are some differences that do need to be addressed there are some similarities between that two but just like when you're treating a patient who has poly substance dependence no two patients are alike and some of their underlying issues may be similar they may be different we don't want to lump all people together and say oh okay you're a sex addict we're going to put you in this little treatment path right here we need to be able to individualize does the person have a trauma history was the person sexually abused as a child was the person you know did they have problems in school did they have a great life growing up and then something changed think about Tiger Woods and we'll talk about that whole chasing the high and a little while but thinking about Tiger Woods he has won an amazing number of golf tournaments wonderful tournaments he ended up marrying a very beautiful woman but then he developed the sex addiction and you're sitting there scratching your head going huh what what in the world could have possessed him and it was chasing that high after a while winning the tournaments wasn't no boo-boo it was a yeah I expected that after a while going home to that same gorgeous wife wasn't the whoo-hoo it was a so he started looking for highs elsewhere that would be one theory of course I've never met the man but if we're looking at a general picture of sex addiction he is kind of one of your good examples because there are so many things in his life that produce the adrenaline rush that competition the being on in the center of attention in the spotlight all the time lots of stress lots of tension and release tension and release eventually you need more of a release kind of like the guy who goes and drinks if you initially start drinking to relieve stress you know bad day at work go to the bar not that I'm advocating for that maybe one or two drinks and that's good after a while it's you know 12 or 24 drinks addictions progress and the reason this tolerance develops again is because our brain is changing it's trying to say whoa I'm over stimulating and we're saying whoa I want to be over stimulated so it's this fight between us wanting to chasing that rush wanting that feeling again and our brain saying Oh ease off buddy okay sex addiction differs from other addictions and this is one of those areas that becomes really challenging because food and sex are two things that theoretically we can't do without we are programmed to procreate and eat I mean eat is part of survival that whole you don't eat you wither away you die so we need to eat so it's biologically driven urge the other urge which is unique to sex addiction is something called the Coolidge effect they've determined in rats as well as in humans rats evidently do really well in these experiments that if they put a electrode in the rats pleasure center if he's with a certain mate for a while that's all well and good he's good to go again and again but after a while he gets tired of that one and he's just like yeah you know you're a rat you're available whatever hey Rick that rat out and put a new rat in and all of a sudden he's like oh you're new and he's good to go the same sort of thing applies with humans unfortunately we are somewhat driven by primitive urges not saying that that means you should just kind of jump around from mate to mate but it does explain a little bit about why some people have to try to work to keep up interests and excitement in the bedroom it also explains why some people develop addictions and are more rewarded or more aroused by multiple different partners instead of the same one we crave novelty one of the reasons they speculate for the Coolidge effect is that if that one rat mates with that other one rat you're going to basically get the same genetic material coming out give or take each time well if there's a deficiency in that genetic material it's a problem so if male rat mates with multiple other rats the chances of producing some really awesome offspring are much better because he's spreading the genetic material around to find or to potentially make a really good combination yeah that's kind of not the romantic version that anybody wanted to hear but that's what it is they've seen it in rats they speculate that on some level in our primitive brain that's still going on in humans back to this biologically driven urge can you abstain from sex sure can you do it forever probably not that's not what we're meant to do so there are going to be for every give there's a take for every take there's a gift so eventually urges and desires and all that kind of stuff may start coming back now sex is part of normal healthy living so it is important to understand that people who have sex addiction have to figure out how they can engage in healthy sexual relationships most of this presentation we're going to talk about internet porn that's a little bit easier to deal with than necessarily sex addiction multiple partners that sort of thing but so let's go back to sex is socially sanctioned if somebody if a guy especially in our culture goes out and is managing to spread his genetic material the thought is oh what a stud so our society in a way sort of says that's okay but they don't say where the breaking point is they don't say where it's whoa you know you know let's slow down socially sanctioned it's illegal at least when you start out it's not now you may progress to the point where you're engaging in a little illegal stuff but we'll talk about that later symptoms needing more of the same substance to get the same high you need something that's more exciting now in the case of internet porn internet porn is never-ending images click click click you want to get to something more exciting more graphic more something it's a mouse click away so it is really easy to progress into more intense levels of internet porn the problem is real life and the internet not the same so it rapidly becomes the case not only does the internet provide intense levels of stimulation it provides lots of novelty and it's just way different than what you've got in real life so it becomes more difficult to become aroused by a like living 3-dimensional consenting partner tolerance again develops because the dopamine system is self-regulating and because of that darn old Coolidge effect so we've got to figure out ways to help people move past that I remember when I was taking my human sexuality in counseling course they talked about romantic love moving into some other form of love as people are in a relationship longer that's basically that arousal and that rush kind of going away a little bit doesn't mean that the people don't love each other it means they just need to look for different ways to get that dopamine rush because you're not gonna have the same necessarily the same high when you're with your partner after 20 as you did after three dates needing more of the same substance can also be in response to worsening problems you come out when we talk about drug addiction people sober up they realize that oh crap I bailed on my spouse for this I was late getting back to work I have all these other problems crap I just need another drink in terms of sex addiction people you know become aroused get their release start going about their business and start realizing that there are other problems well no matter where you're getting it whether it's through internet or human beings sex does produce something of a pleasurable effect at least in the beginning ish as you engage in sexual activity more eventually your brain just starts to kind of fizzle out and you start to lose motivation and become depressed but we'll talk about that when we get down get down lower but initially people when they start to feel stressed about other things that may be falling apart they engage in the addiction again because it makes them feel good using more for longer than intended going to those online porn sites or those dating apps provides never-ending novelty people tend to say oh I'm going to get online for 15 minutes and before you know it it's three hours and they're just emerging it's really important to realize that these sites aren't any different than gambling sites or other sites that engage that pleasure center your brain is going you can get a rush you can get a rush you can get a rush and so you're motivated to keep doing that activity trying to get that same you initially had unsuccessful efforts to cut down again we're chasing Matt a neurotransmitter surge it's not necessarily and with sex addiction you've got both part of you is going you need to spread genetic material the other part of you is going I need the rush so you've got it's a double whammy with sex addiction there's a biologically driven urge for stimulation boredom you come home you're like there's nothing on TV I'm bored boredom leads to restlessness restlessness leads to making poor choices so now we're spending significant time and/or resources thinking about it you're at work you're having a bad day you can't wait to get home so you can get on your computer on your favorite internet site you prepare for it you got to make sure you get home get logged on door's locked so your roommate doesn't walk in or heaven forbid your spouse and acquiring it finding just the right site that fits that mood using and recovering from use now you think sex recovering from it give me ten minutes and I'm good to go yeah after a while that's not the case after a while the brain doesn't have any dopamine left to squirt so you know it's kind of like trying to squeeze blood out of a turnip no matter how many times you do it it's just not going to do it for you some people get to the point where it's so bad off they don't even have motivation to do it or if they try to engage in masturbation or sex they can't get aroused their brains just like yeah no not going there today this is where it starts causing problems when people can't get aroused because with their partners because they've been using internet porn or they've gotten to the point with internet porn that they're engaging in progressively egregious internet pornography then they start going you know is this really who I am and where I want to be depression starts to set in now there's this whole thing of Who I am at where I want to be but there's also the there's no dopamine left and your neurotransmitters are all wonky you have no motivation to do anything right now cuz dopamine is our motivator people actually start the feel depressed depression is your body's way of saying hello stop you either stop or I'm gonna stop you because something is wrong and needs to be addressed so you're starting to get depressed you've lost your motivation you don't really care about work anymore nothing does it for you you know sounding like the basic symptoms of depression continued use well maybe this will make me feel better not gonna happen now you're depressed you have no motivation which means if you don't have motivation for sex you probably don't have motivation to do laundry or the dishes either so chances are there's some relationship problems your spouse or significant other may be wondering if you're cheating or what's going on increases in arguments financial problems because you're spending a lot of money on some of those sites or maybe you're not paying for the sites but you got some malware on your computer and you spent to the shop three times in the last six months work it's hard to concentrate at work because you're constantly thinking about getting on the computer and engaging with internet porn to masturbate or whatever the case may be emotional talked about depression as your motivation goes down loss of pleasure or loss of interest in most things most of the time criteria one for depression restlessness irritability you when we get aroused arousal that means amp up whether it's aroused for fight or flee or aroused for sex were aroused arousal can sometimes come out as restlessness do something yes you do now in recovery this is one of the places where we really need to help people get through that arousal state that restlessness that you're at ability we also need to help people with depression and motivation because if they don't feel good it's hard to do anything if they don't have the energy or the motivation to get out of bed then it's going to be hard to help them achieve recovery so sex addiction can be said to be driven by certain survival mechanisms to reduce pain if you're stressed if you're anxious if you're depressed good old dopamine surge may make you feel better physical pain endorphin rushes dopamine rushes some drugs that people take reduce pain loneliness if people are using internet porn they may have this whole fantasy world where they are needed they are loved they are in a beautiful wonderful relationship or maybe not but they don't feel alone they don't feel lonely they feel needed safety we are driven to eliminate threats now internet porn doesn't really pose a threat but it does ensure survival of the species if you want to look think about it that way because in a little two-dimensional world your brain sort of thinks that you're fertilizing those images and you know we need food and water we are driven these things we do things to ensure our survival and the survival of the species porn masturbation sex all of these things we're going to kind of lump them together right now are maintained by positive and negative reinforcement positive reinforcement you get that rush negative reinforcement you're not bored you're not lonely you're not thinking about the stress of the day you're not doing whatever at that point in time maybe it's just for ten minutes maybe it's for two hours that intense positive reinforcement combined with the negative reinforcement so you're not thinking about the nasty stuff maintains addictions in a way that makes them difficult to break when we talk about treatment we've got to address both the positive and negative reinforcing effects of the addiction we need to help people feel happy feel euphoria feel a rush at times just not necessarily the same way we also need to help them that negative reinforcement whatever they are trying to escape from we need to help them figure out better ways to deal with that instead of having to run away and hide or try to avoid or ignore let's figure out how to deal with it so and it sounds a lot more simple than it really is in order to deal with this we need to reboot and rewire haha no it's not that easy people need to give their brain a rest from the rush which means stop masturbating if you're having sex with human consenting partners limited to one most likely if people are to the point where they're seeking help for this they're a partner with whom they're in a relationship with they're not able to get aroused in order to have sex with that partner so this may not be an issue with who they're having sex with if they're not having sex with the partner they're not having sex take care of yourself to allow your brain to recover okay not only has it started shutting down some of those dopamine receptors but you've also squirted out so much dopamine there's none left so you need to eat a healthy diet so your brain can have the precursors which come in the form of amino acids and stuff from your diet a whole different presentation eat a healthy diet so your body has the building block to make more dopamine I'm pausing because I want you to kind of hear that and digest it no pun intended people who just stop doing something and start doing something else may not be addressing the whole issue we need to look at it from a holistic perspective people need to rebuild those neurotransmitters so they need the nutrition they need to sleep think about when you work out you work out your muscles hurt you want to sleep more children when they're going through a growth spurt what do we see they sleep more when our body needs to recover from something or grow something you sleep more so we need to encourage our patients to give themselves a break sleep more now it needs to be quality sleep not 18 hours a day of restless tossing and turning we may need to work with them on sleep habits circadian rhythms not drinking too much coffee dealing with the anxiety that's keeping them up those sorts of things and exercise now exercise is a funny thing exercise can be great is then shown in some studies to be almost as effective as zoloft and some other antidepressants in relieving symptoms of mild depression thirty minutes of aerobic exercise every day wonderful and that's what we want to shoot for is 30 minutes of moderate-intensity exercise every day or at least several days a week once you get up to that in tense exercise when you're building muscle and doing all that kind of stuff in comes the testosterone at this point we really don't want to be encouraging testosterone surges and all that he-man junk okay it usually ends up causing more urges and feeling counterproductive to the person who is in early recovery now granted if your patients can go and lift weights and gain weight and not use steroids and not have any negative effects then by all means do it whatever it takes when they're aroused and remember coming back to that word restless edgy there's this energy that's floating around they got to do something with it exercise is a good thing housecleaning is another good thing mowing the yard whatever it takes they need to move sitting there and going on let me find something on TV probably not going to do it worse yet they may land on something that is inappropriate and may trigger their desire to masturbate or go back to the internet porn so people need to move physically not you know what I mean consider pharmacological interventions yeah this is one of the interesting things if you've watched any of the commercials about antidepressants you'll know that a lot of your SSRIs selective serotonin reuptake inhibitors and SNRIs selective norepinephrine reuptake inhibitors have significant sexual side-effects well with your patient who may be recovering from sex addiction this could be a good thing it could be a bad thing if they're having difficulty controlling their urges and they're still driven almost compulsively to masturbate or have sex and they're depressed they may want to talk to their doctor about a short course of antidepressants now if they're really not having problems with those urges but they're still depressed or once they to the point that they're trying to have sex with live consenting partners again there are certain antidepressants that can be effective Remeron is one of them that has been identified as not having the sexual side-effects the key point here is patients need to work not only with a counselor but also with a psychiatrist or physician who can help them with pharmacological interventions testing hormone levels to make sure physically the person is headed towards physical mental emotional recovery identify other things that make you or used to make you happy maybe you used to like walking on the beach and now it doesn't do much for you all right you may get back there what is it that used to make you happy and see if you can find things now other than sex or masturbation and make you happy find things to occupy your time like I said if you're bored you're gonna start feeling Restless if you start feeling Restless you may want to feel tension building feel that tension building you want to release so it's important to find ways to occupy your time and we'll get more specific in this later but all this is the rebooting process we're letting your brain just kind of shut down not have those surges anymore recover build the dopamine back up get all those receptors back and operational again and this is a very oversimplified explanation for what's going on but if you want a better explanation I will have a website that you can refer to along with this video but right now we're really focusing on the counseling aspects of it and what to do alrighty I then we have to rewire so you want to identify and eliminate or recondition things that can trigger your cravings so people places things including TV shows emotions times a day so let's think about people if there are certain people in your life that trigger you to want to engage in excessive sexual activity probably how to avoid them for a while now is not the time to be going out to the bars and being somebody's wingman not going to happen places oftentimes with internet porn places means at home by yourself so try not to be at home by yourself any more than you have to be instead of going to your room to watch TV sit out in the living room with your roommates and watch TV take your dog for a walk do just about anything to remove that element of temptation I'm not doing anything better so okay we don't want to be able to say that be cognizant of what you're watching on TV if it's something that is triggering you you may not want to watch it even if it's not necessarily sexually explicit material it could be something with a very attractive lead actor or actress be aware of that if you're watching that going yeah I'd hit that probably need to change the channel being aware of what's triggering you some people can watch it and not have a problem again it's up to the patient what they need to change emotions if you know that you tend to be more triggered to escape into internet porn or to escape into sex if you're stressed angry depressed be aware of that and develop action plans we'll talk later dialectical behavior therapy interventions are excellent for helping people deal with emotions and urge surf times of day some people just get into a habit that they get up they watch some internet porn go to work come home watch some internet porn go to sleep that is their life so there are two times a day where their body goes hey aren't you forgetting something those times a day are when the person needs to be doing something else just sitting at home not going to work engage in competing behaviors that's one of the easiest things to do during those times you're probably not going to watch porn on the computer at the library I know some people do not supposed to please don't so go to the library go to the park you're probably not going to be sitting in the park watching it on your iPhone and you know so these are competing behaviors you're creating a situation where you will not engage in sex or Mexican masturbation going to the gym again depends on the person depends on the gym maybe more triggering than just not going to the gym identify the function of your behavior and develop alternatives if you started maybe started as recreation and then it became an addiction in response to stress or depression or relationship problems until you deal with those issues you're still going to have underlying relapse triggers rewiring only allow yourself to experience sexual pleasure with a single other person and a monogamous relationship yes I'm positing again so you can digest that understand that during the rewire there may be a period where you can't get aroused by another human being that's okay that's your brain going I don't remember this it needs to rewire it needs to hook up again the blessing if you want to say it that way about sex being a biological urge is eventually your brain will rewire and everything will start functioning again but don't freak out if you can't get aroused with a human partner procreation is genetically programmed once your brain recovers arousal will be possible again sometimes it takes two months sometimes it takes six months give yourself some time if you're concerned about it obviously go talk with your doctor you can have some hormone tests run to make sure that you don't have low tea or something but it is important to realize that this is a potential temporary issue it's also important to remember that if you start taking antidepressants your typical run-of-the-mill SSRI ascent our eyes that you also may completely lose your libido if that's the case talk to your doctor because there are other antidepressants that can work that don't have the sexual side-effects so we talked a lot about this whole dopamine system rebooting means you're allowing your brain to recover build the dopamine again so we can feel motivated to do stuff in the meantime what do we do just sit in this like haze of gray and I don't want to do anything that's no way to live we need to address loss of motivation through goal-setting decisional balance exercises figure out why you want to do it and make sure there are rewards I want to do it because it needs to be done not very rewarding put rewards in place for yourself yes it seems artificial it seems extreme but if it helps you get through this period until your natural motivation chemicals and reward center kicks in again by all means make it happen as your dopamine system recovers motivation will return mindfulness skills live in the present not the past not the future what's going on with you right now how are you feeling how are you acting what's good in your life observe be aware of your internal states these sometimes can be called vulnerabilities or assets if you're feeling strong and energetic and clear-headed those are all assets if you're feeling foggy and restless and irritable those are vulnerabilities vulnerabilities mean you are going to be more likely to be triggered if you're aware of that you can plan for it be kind to yourself don't put yourself in high-stress situations that you don't have to if you know that you're going into it and you're already sort of irritable describe describe to yourself what's going on sometimes it makes it easier to figure out what's going on if you kind of go through a mental checklist if you've ever been tired you know you go to the gym and you work out and you have a hard workout and you feel great but you're exhausted but you're not sleepy tired you're physically tired okay is that kind of explaining and really defining how you feel that's important because it will help you figure out what to do next and how to take care of yourself there's a new concept taking care of yourself most people if they've developed an addiction haven't been taking care of themselves for a long time you need to start taking care of yourself accept without judgment however you're feeling I know some mornings I get up and I'm like I just I can't focus I am really I maybe I didn't sleep well the night before or something and I have difficulty getting things done that day if I focus on that and get irritable about it and frustrated it just compounds the problem if I accept the fact that yeah I'm not gonna be my normal productive self today and move on at least I'm not using excess energy dwelling on the fact that I'm gonna be less productive and act with awareness this is the difference in dialectical behavior therapy they call it the wise mind versus the emotional mind our emotional mind or our primitive I'll call it our primitive mind is the one that is driven by wanting to feel good is wanting to feel happy wanting to feel good our wise mind says yeah that might feel good in the short term but in the long run is it really getting us where we want to go example I was shopping for a new car and I went and I sat in the seat of a Buick Enclave it was like sitting on butter it was the most incredibly comfortable seat I never sat in in a car or otherwise I was like a whole I have to have this and then I looked at the gas mileage now my car is old but it still gets much better gas mileage than the Buick Enclave now my primitive mind was going but we've gotta have that it's so comfortable my wise mind was going he in the long run you're really not gonna like paying the gas bill for that car and it's not going to end up serving your purpose because it'll irritate you more than anything after a week or so why is mine versus emotional mind emotional mind is impulsive wise mind is more rational so we need to act with awareness they accept our feelings I really really want to do this and then think about it and choose our actions based on our goals is this what you really want in the case of internet porn somebody may really really want to get on the computer but their wise mind kicks in and goes but I really rather stay married and I know that if I get on the computer again there's a chance it's going to completely obliterate the relationship and I'm gonna end up divorced gotta weigh the consequences this one's longer out there but which one is more important distress tolerance now this is where we need to really focus for folks in early recovery when they're dealing with cravings whether it's drugs sex or otherwise this craving comes on and cravings feel uncontrollable sometimes what can you do there are some several things you can do number one recognize it that's the first thing is to go okay I'm craving this really sucks what am I gonna do about it urge surfing is saying okay I'm craving and I know it's going to get to a peak and then it'll go away a lot of people it's 10-15 minutes if you can urge surf through that great wonderful it's kind of like well that would be a good example urghhh surfing ride that wave you know if you're surfing you go out you catch a wave you ride it in and then it kind of washes out into the shore envision the same thing with this urge as the compulsion goes up and then eventually goes down it's like yeah whatever I forgot what I was even craving alternate activities less problematic activities when we're talking about people who self-injure and one of the things that we suggest doing is holding ice instead of cutting because they both hurt like crap but one is much less detrimental in the case of sex addiction ice can be used in a slightly different way in order to or a cold shower in order to help the person move through that urge other activities include active distraction do 15 minutes plan on whatever it is you're gonna throw yourself into it for 15 minutes and remember that we're talking about a state of arousal so doing 15 minutes of sitting on the couch reading a book probably isn't going to get most people through it most people probably need to do something active walk the dog go out and weed the garden clean the house do jumping jacks whatever it is do it for 15 minutes if after 15 minutes is over most of the time they're like made it through that urge or at least it's at a level that's controllable emotional regulation manage and tolerate your emotions if you're not feeling pleasure and most things then you may be feeling depressed you may be feeling hopeless helpless weepy irritable except those emotions are there then figure out what to do about them learn what makes your negative emotions worse too often I see people who when they're depressed they stay in bed all day and listen to sad music while staying in bed all day is going to increase depression not eating a healthy diet is going to increase depression and listening to sad music is going to let me hear you say it increased depression so if you know what increases your depression or increases your anxiety or your irritability don't do it for me and this is just totally me when I'm irritable watching the news is probably the worst thing I can do I end up yelling at the television and it doesn't do any good so if you wake up you're irritable don't put yourself in situations that you're going to get more irritable now I can go to the gym and get on the treadmill and run really hard and after 15-20 minutes or so I'm feeling a lot better now not only have I passed urge surfed gotten through that 15 minutes or so so there that urge to like freak the freak out is gone but I also got an endorphins from exercising hard get support proper positive social supports are some of the greatest buffers against stress if we go with the theory that stress depression and anxiety are underlying some of people's cravings to use and desires to escape the vent social support is going to help mitigate that but it has to be healthy sane social support see the silver lining now this can be really annoying at first but try it just try it try to see the glasses half full instead of half empty yeah see I can't even say it sarcastically if you have a negative outlook on life if everything you do you wake up in the morning and you're like that's partly cloudy instead of oh it's partly sunny then everything from the seem worse and grayer and more negative so try to be obnoxiously optimistic and see how it affects your mood interpersonal effectiveness moving from obnoxiously optimistic to being interpersonally effective maintain healthy relationships these are those relationships where you can count on people to be there for you it's a give-and-take it's not somebody who's just there because you can do something for them act assertively if you're not feeling well if you are having a bad day if you want to go do something be assertive you matter your feelings matter your thoughts matter take care of yourself eating sleeping exercising nah you know when I say exercise you don't have to go out and run a 5k take your dog for a walk whatever is exercise for you move your body it'll help you feel better and don't forget about karma if you've watched my name is Earl one of my patients told me about that show and I turned it on my Netflix and kind of got hooked karma is when you give away good stuff good stuff comes back when you give away crap crap comes back so when you're working in relationships if you're putting your best foot forward if you're being positive then guess what you're going to attract people that do the same thing and those are the healthy relationships you want to nurture so in summary sex addiction has similarities and differences with drug addiction they're still addiction they're still kind of related to that dopamine system we still understand that there are brain changes that happen but we do understand that the brain can heal itself the younger brain changes occur the greater the possibility of damage so if you take this brain that's still trying to form and all of a sudden you flood it with dopamine you could break it the changes we've seen tend to be much worse if these dopamine rushes for whatever reason start much younger in life it's harder for the brain to recover a little bit of a side note think about the research that has shown that it's easier for children to learn language at a much earlier age you know pre-kindergarten kindergarten they can start learning a second language because the brain is changing and undergoing all this wiring that's the initial wiring think about the initial wiring for your house once they put up the drywall it's a whole lot harder to change some of the wiring when you get to be an adult the drywall is up in your little brain house so it's harder to reboot and rewire it's not impossible but it's harder antidepressants can be helpful in the short term there are some antidepressants that have libido dampening sexual side-effects and there are antidepressants that don't talk with your doctor about what would work best in your particular situation based on your presenting issues dialectical behavior therapy or DBT interventions can be extremely helpful if you google DBT interventions online there's a dvb-t Self Help website that has a lot of really awesome suggestions that can be tailored to work with sex addiction as with any addiction the reason someone started and continues to use or engage in the behavior has to be addressed otherwise they're just kind of holding on for dear life and a relapse is probably imminent finally unlike other addictions permanent abstinence from sex is probably not recommended for most people so you're going to need a strong relapse prevention plan common triggers to many addictions including sex addiction include anxiety boredom depression guilt habit relationship problems shame stress television and media and low self-esteem these things need to be assessed in your patients and if they are present they need to be addressed otherwise again relapse is potentially imminent we need to set our patients up for success make sure that they have the tools they need to get through the urges and to help their brain and body recover from the dysfunctional behaviors alright thank you for coming today and have a wonderful rest of your day

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