Addiction Theories

Adapted from AIPC (2022), Institute Inbrief, Issue 363.

Oftentimes, a brand new year is used like a clean slate. We can do this any time throughout the year, however, I understand that there is an added element of our “collective consciousness” in the universal atmosphere motivating us with some renewed energy and will. At this time of year, humans perceive that everyone else is also feeling hopeful, invigorated, and full of promise. But the road to realisation of goals is littered with the carcasses of broken dreams, unfulfilled promises, and intentions that dissipated in the stress and mundane of everyday life – our goals did not receive the “oxygen” required to be sustainable.

What is our “Will”?

Have you ever fallen short of accomplishing you New Year’s Resolution? Sometimes, even before the end of New Year’s Day? People many think, “I don’t have the will power to sustain it”, however, if we look at this from the perspective of Psychosynthesis, a transpersonal psychology, we will understand why our understanding of “will power” if often incorrect. If you did anything today, you have will inside you. You have drive, motive, and energy.

While our will may not have all the “power” that we would like it to have, our will is always present with us, somewhere. Psychosynthesis counsellors, especially trained to be observant about will, acknowledge that one of their sacred duties with clients is to track their will, but all mental health professionals can tune more into the willing function of self, for the ultimate good of the client. What do we need to know to do that?

First, will isn’t just desire energy. It is not synonymous with control, it is not about “strong-arming” someone, and it isn’t merely about repressing undesirable material.

Personal and transpersonal will

At a personal level, “will” can be understood as an essential impulse toward our own wholeness. It is that drive within us which coordinates the often-conflicting parts of our personalities into self-expression. As the function closest to the self, it regulates and directs other functions, such as imagination, intuition, impulses, sensations, thoughts, and feelings. It is will which guides us toward personal integration. As we align our lives with a broader vision for what we may be, we go beyond personal will, receiving guidance from transpersonal will: the will of Self (as opposed to “self”).

Along that journey, however, people can fail to execute our will in a way which allows our goals to be realised. This post looks at the aspects of will, which, if they are not employed or are employed badly, can stunt the client’s intentions, keeping their goals from ever realising.

Aspects of will: Strength, Skill, and Virtue

Strength

When people make statements as mentioned above, decrying their lack of “will power” or “internal energy”, they are probably referring to the most well-known aspect of will: that is, “strong will”. It is believed that when we are born, we are unaware that we are separate from our birth giver. The beginning of individuation (the process of forming a stable personality) is the beginning of recognising that “will” exists. We are not only separate from Mum; we actually want something other than what Mum seems to be giving us. We come to see that we have arms and legs and a mouth, so we use these tools to explore the world the way we want to. We learn that crying will have certain needs met. It is the aspect of “strong will” that ensures that our willed act — say, crying for food — contains enough intensity or “drive” to carry out its purpose (getting us fed).

In other words, have you ever seen a really hungry baby stop crying after a very short time if it is not fed? Generally, not. It is possible that our new diet or exercise regime has failed because we didn’t elicit the intensity or “drive” to the intention to exercise or stick to our new diet. We may need to explore what situations in life are keeping us from applying greater intensity to the question. Maybe our desire to change is not worth the requisite “will” or “energy”. The road of least resistance is very common as we age and accumulate more life responsibilities.

This is not true for everyone. Some people will vehemently proclaim that do want to change. It is not lack of wanting, or lack of “will”. What is missing may be the second aspect of “will”, equally important to the first: that of skilful will.

Skill

Several sayings are relevant here:

1. Environment is stronger than will power.
2. When imagination and will power go up against one another, imagination wins every time.

These axioms allude to the often-unrecognised reality that we cannot generally achieve our goals through strong will, alone. Consider the alcoholic who desperately wants to stop drinking but they continue relapsing. If we put our will into competition with other psychological forces — such as impulse or feeling — it becomes overwhelmed; we end up stressed without accomplishing our goal. What we are missing in this case is likely to be the capacity to develop strategy, approaching the goal skilfully, and practically. Oftentimes, we want to achieve our goal without attaining the skills necessary to achieve it.

If you want to lose weight, for example, could think that you simply need to eat fewer calories and the extra kilo’s will start dropping off. Calories in Vs Calories out. But your role as strategist can be very helpful if you establish, for example, whether you’re often in situations where controlling food intake is difficult: say, when going out to eat or eating at private parties, or it’s the holiday like Christmas. Are you eating balanced meals, with sufficient protein (for example) to sustain yourself? Are you getting enough sleep to avoid overproduction of the hunger-inducing hormone ghrelin? How much do you know about body composition, the endocrine system, metabolism, nutrition, and exercise physiology?

There are myriad ways to be skilful around weight loss plans, and you may need to consider adopting some of them for success. For example, do you have effective interpersonal skills to communicate your needs to the people in your life that exercise and healthy eating is valuable to you, and you need their support? Or do you have the skills to join a peer group that exercises regularly. Perhaps you could improve your financial skills to budget for a Personal Trainer.

If we must merely “strong-arm” ourselves to achieve every end, we end up exhausted and discouraged, with few accomplishments. “Skilful will” allows us to use will not as a direct power or force, but as a function which stimulates, regulates, and directs other functions of ourselves so that they lead to the goal. For example, learning mindful eating skills may cultivate a relationship with bodily sensations which allows you to observe the sensation of true hunger pains as opposed to times when you eat because of boredom or wanting to feel good (temporarily). You can also learn skills to meet alleviate boredom or feeling emotionally nourished in other ways.

Even with employing strong and skilful will, however, your may not achieve your goal(s). That’s okay. Please do not judge yourself. It’s what Buddhism called the second arrow. That is, you already didn’t meet your goal (the first arrow) and then you judge yourself for it (the second arrow). You are human, not superhuman.

A third aspect, equally important with the first two, may also need to be employed. It is “Virtuous Will”.

Virtue

Is your goal something you can achieve all by yourself through prudent use of strong and skilful will? No one is an island; we all live in communities and interact with family, friends, co-workers, gym instructors, enemies, and others on a regular basis. Those willed acts that succeed in accomplishing the will-er’s goal do so because they have considered the need to choose goals that are consistent with the welfare of others and the common good of humanity. They also must be consistent with “virtuous will” to the “self”.

The bottom line here is that many people need to do serious work around having virtuous will for themselves. For example, if you “hate” yourself for weighing more than what you would like, the motivation for change is unlikely to succeed because it is born in self-hatred. It is more effective to improve your self-esteem and sense of worth as a person, independent of your goal, so that any weight loss and subsequent weight maintenance can be in the context of “something I do to value myself; I like myself as I am and want to enhance the health of that self”.

Accessing transpersonal will

According to Roberto Assagioli, the founder of Psychosynthesis, using our will doesn’t stop with developing strong, skilful, and virtuous will: the three aspects of personal will. Assagioli claims that we can manifest all three of those and still be unhappy if we do not see how our personal goals align with something greater than ourselves. Having that solid sense of meaning and purpose to achieve something beyond the benefit of our little “self” helps us to reach beyond the limitations of ordinary consciousness to more expanded, intense states of awareness.

To yearn for that and not have it is what Viktor Frankl called “the abyss experience”: the opposite of Maslow’s peak experience (Boeree, 2006). Yet it is often in the abyss and despair of meaninglessness that we feel the pull of the superconscious, activating our transpersonal will and giving us access to another level of being. And then life becomes more interesting, as we try to balance the needs of material life (our immanence) and those of our higher levels of being (our transcendence), experienced as intentions arising from our transpersonal will.

Even the hypothetical person’s goal of weight loss (seemingly a very personal goal) may be able to access transpersonal will. Let’s say you lose the weight, arriving at your goal weight. You may enjoy a slender new body for a while, but ultimately that may not be enough to sustain lasting contentment, peace, and satisfaction. Looking “good” may not be the sole purpose of the original intention. If you can transform your goal, however, to a goal more inclusive of potential good for humanity as a whole — you may find that your personal will is aligned with transpersonal will. Just look at all the people on Youtube trying to help others, or the reward and continued sobriety members of Alcoholics Anonymous are given by “helping others”. Transpersonal will goes beyond the self and comes back to support our intention. Perhaps you want to write about healthy-body image as a method to transcend your Will to others.

The Will and the End of this Article

An effective and intentional use of will increases joy, openheartedness, and equanimity. Through use of not only strong will, but also skilful and good will — and perhaps even transpersonal will — your New Year’s resolutions will be far more likely to succeed, and you can experience willing as an act that leads to joy.

References

3. Assagioli, R. (1973/1984). The act of will: A guide to self-actualization and self-realization. Wellingborough: Turnstone Press.
4. Boeree, C. G. (2006). Viktor Frankl. Personality theories. Shippensburg University. Retrieved on 5 November, 2012, from: Website.
5. Mental Health Academy. (n.d.). Understanding Will. Mental Health Academy.

Retrieved from Issue 346 of Institute Inbrief 20/01/2021

Paranoia: Definition and levels

When a person believes that others are “out to get them”, trying to stalk or harm them, or paying excessive attention to them for no reason, they may be experiencing paranoia. Occurring in many mental health conditions, paranoia is most often present in psychotic disorders. It involves intense anxious or fearful feelings and thoughts, most often related to persecution, threat, or conspiracy (Mental Health America, n.d.). It can be a symptom of illnesses such as schizophrenia, brief psychosis, paranoid personality, psychotic depression, mania with psychotic features, delusional disorders, or substance abuse (chronic or momentary) (Barron, 2016).

Mental health experts have identified three levels of paranoia:

1. Paranoid personality disorder (PPD): Characterised by odd or eccentric ways of thinking, PPD involves an unrelenting mistrust and suspicion of others when there is no reason to be suspicious. It is one of the personality disorders in the DSM-5’s Cluster A, along with schizoid and schizotypal personality disorders. Thought to be the mildest form of paranoia, a person with PPD may still be able to function in relationships, employment, and social activities. The onset is typically in early adulthood and is more common in men than in women.
    
2. Delusional (paranoid) disorder: Found in the DSM-5 chapter, “Schizophrenia spectrum and other psychotic disorders”, this is a condition in which an individual holds one major false belief or delusion; it will often be an implausible but not bizarre delusion. A delusional disorder typically occurs without any other signs of mental illness. So a person might think that others are talking behind their back if they have a persecutory delusion, or believe that they need immediate medical attention for a (non-existent) medical problem if they have a somatic delusion. This condition is slightly more common in women than men.
    
3. Schizophrenia with bizarre delusions: People with this condition do not function well in society and need consistent treatment (Sunrise House, 2018; WebMD, 2018).This is the most severe form of paranoia, involving bizarre delusions without basis, such as that aliens are trying to abduct them, or that an unseen enemy is removing their internal organs and replacing them with others’ organs.

This article is about Levels (1) and (2), the paranoid personality disorder (PPD) and delusional disorder, which you may encounter more commonly, either in your client or the client’s partner.

Identifying paranoia

We have several options for finding out what characteristics should be called “paranoid”: we can assess how we experience the person — how we describe them and what they evoke in us — and/or we can run with DSM-5 descriptions, which outline the clinical symptoms we can observe specifically with the paranoid personality disorder and delusional disorder. Let’s do both.

Descriptions of the paranoid person

Joe Navarro, who has written extensively about mental disorders, asked those who had either lived with or been victimised by paranoid personality types to describe this personality type from their experiences. Here is the list of some of their words:

“Angry, anxious, apprehensive, combative, complainer, contrarian, critical, delusional, demanding, difficult, distrustful, disturbed, eccentric, fanatic, fearful, fixated, fussy, guarded, hard-headed, inhospitable, intense, irrational, know-it-all, menacing, mentally rigid, moralistic, obsessed, odd, offensive, opinionated, sensitive, peculiar, pedantic, quarrelsome, questioning, rigid, scary, strict, stubborn, suspicious, tense, threatening, tightly-wound, touchy, unforgiving, unhappy, vindictive, wary, watchful, withdrawn” (Navarro, 2016).

What they evoke in us:

Experiencing a relationship with someone described by such intense words as those above cannot fail to bring forth a reaction in us. Laurel Nowak (2018) outlines the common feelings evoked by paranoid individuals in those with whom they are in relationship. She talks about: “feeling weighed down, negative, stressed, isolated from the people and activities you used to enjoy, and like you’re walking on eggshells”. Some have noted that it can feel to the other person like they are not being seen — ever — for who they truly are. The exaggerated negative spin on events or in response to statements occurs in the context of relating which lacks tenderness, humour, or comfort (Navarro, 2016). While these authors are describing feelings evoked in intimate relationships with paranoid individuals, they could have been talking about how therapists feel when faced with a client with this condition. Dealing with such a person eats away at the most robust sense of happiness and self-esteem. Here are the DSM-5 symptoms.

Paranoid Personality Disorder: DSM-5 symptoms description

According to the DSM-5, there are two primary diagnostic criteria for Paranoid Personality Disorder, of which Criterion A has seven sub-features. Four of these must be present to warrant a diagnosis of PPD:

Criterion A is: Global mistrust and suspicion of others’ motives which commences in adulthood. The seven sub-features of Criterion A are:

1. Belief others are using, lying to, or harming them, without apparent evidence thereof
2. Doubts about the loyalty and trustworthiness of friends and associates
3. Inability to confide in others due to the belief that their confidence will be betrayed
4. Interpretation of ambiguous or benign remarks as hurtful or threatening
5. Holding grudges (being unforgiving of insults, injuries, or slights)
6. In the absence of objective evidence, belief that their reputation or character are being assailed by others; retaliation in some manner
7. Being jealous and suspicious without cause that intimate partners are being unfaithful.

Criterion B is that the above symptoms will not be during a psychotic episode in schizophrenia, bipolar disorder, or depressive disorder with psychotic features (American Psychiatric Association, 2013).

Delusional Disorder: DSM-5 definition and types

According to the DSM-5, this condition is characterised by at least one month of delusions but no other psychotic symptoms. Delusions are false beliefs based on incorrect inference about external reality that persist despite the evidence to the contrary; these beliefs are not ordinarily accepted by other members of the person’s culture or subculture. In delusional disorder (a moderate level of paranoia), a person experiences non-schizophrenic (i.e., not bizarre) delusions, such as that they are that they are being spied on. Because only thoughts are affected, a person with a delusional disorder can act normal and function in everyday life, although they may display paranoia or other symptoms related to their delusion. The five types of delusions people with this disorder have are:

1. Erotomanic, where there is a belief that a person with higher social or financial standing (such as the president or a movie star) is in love with them; it can lead to stalking and obsession.
    
2. Grandiose, involving the false belief that the person has a special power or ability not shared by anyone else (such as that they are extremely lucky and will always win at the casino).
    
3. Jealous: a mistaken belief that a current or former loved one is unfaithful or even harmful. Paranoia about the loved one’s words or actions can be a symptom of these delusions.
    
4. Persecutory, in which the common sense of the paranoia is that someone is out to get the individual, because the person believes they are being threatened, mistreated, or that they will be harmed in the future.
    
5. Somatic: a delusion in which the individual believes that they have an illness, disability or physical defect (Sunrise House, 2018; Mental Health America, n.d.; Bourgeois, 2017).

Treating and coping with paranoia

For the therapist

First, we must note the common advice: a person suffering from either PPD or a delusional disorder needs to seek professional help, although most such individuals do not believe that they are paranoid; rather, they think they are perceptive, noticing things that no one else sees. In this sense, it can be difficult to get such a person to therapy, as the condition tends to be ego syntonic. If such an individual turns up in your therapy rooms, however, note that a referral to a medical doctor is in order to determine if medication is needed.

Medication generally is not a major focus of treatment for PPD; therapy is. However, medications, such as anti-anxiety, antidepressant, or anti-psychotic drugs, might be prescribed if the person’s symptoms are extreme, or if he or she also suffers from an associated psychological problem, such as anxiety or depression (WebMD, 2018).

With delusional disorders, the diagnosed individual begins a combination of medication and psychotherapy. The anti-psychotic medication helps the individual improve enough to be able to understand reality and the need for therapeutic help. In milder cases, the individual may receive anti-anxiety medications or anti-depressants, which allows them to undergo therapy, where they learn coping skills, how to recognise delusions as false, and how to manage stress or difficult feelings. Hospitalisation may sometimes be indicated to stop the person from harming themselves or others during violent delusions (Sunrise House, 2018).

As the condition affects the client’s thought patterns and beliefs, it can be worked with effectively using cognitive behavioural therapy, which transforms the unrealistic, maladaptive thoughts by replacing them with more helpful, realistic adaptive thoughts. In addition, some therapists have observed that psychodynamic work, such as object relations, can help paranoid clients look into reasons for becoming mistrustful and suspicious which arise from early childhood relationships (Everyday Health, n.d.).

You might be asking, “Wait a minute; chief symptoms are a tendency to be suspicious and an inability to trust. How, then, can a therapist make any reasonable headway with such a client, given that trust is the basis for any solid therapeutic alliance?” If you twigged to this issue, congratulations; you have nailed the problem: how to keep the paranoid client in therapy long enough for enough trust to be built so that real progress can be made. Building trust is where the challenge is, no matter what modality is being used with the client.

To help a client in relationship with a person living with paranoia

You are likely to see the partner of a person acting paranoid. Once it is established that some form of paranoia is indeed the diagnosis, some clear guidelines exist for helping the partner. Some of the following tips also hold true for therapists working with this client population.

Setting boundaries. The paranoid person needs compassion and understanding, true, but that does not equate to acceptance of poor treatment on the grounds that the person has a disorder and is frustrated. Clear lines of what is acceptable and what is not must be drawn; those expectations for decent treatment must be communicated clearly, including around the issue of refusing to collude with delusional thinking (compromising one’s own needs) because of the person’s paranoia or fear.

Practicing self-care. For therapists and partners alike, this one is paramount! Dealing with this disorder is exhausting and sometimes heart-breaking. Those in close relationships (whether intimate or therapeutic) with paranoid individuals must have regular, solid habits of self-care. All the usual practices go into this category: relaxation/meditation, exercise, decent diet, support systems activated, and perhaps journalling or creative work to vent frustrations. Particularly for partners of those with PPD or a delusional disorder, maintaining a healthy social life — not allowing oneself to become isolated — is important.

Don’t abandon own stance, but empathise with their fear. If either the partner of the paranoid person or you, as therapist, hear an accusation that seems really “off” — totally unfounded — you can employ the tactic of empathising with the feeling, but not necessarily agreeing with the facts (though outright disagreeing doesn’t work, either). Carrie Baron, M.D., and Director of the Resilience Program at Dell Medical School in Texas, explains that consoling the person and refuting what they have said will not likely alter any paranoid convictions or delusions. What works better is “observation, reflection, curiosity and openness without judgment”, which lead to better understanding (Barron, 2016). Thus, the partner could say to the paranoid person, “I can imagine you’re worried if you think that the inheritance you counted on for your retirement might be taken away through your dad marrying. Have you observed any behaviour that made you question her motives?” (curiosity). However they do it, partners of people with any form of paranoia must look beneath the surface before getting swept up in the partner’s claims (Barron, 2016).

Recognise that the paranoid person can still contribute to life. Because of the fact that mild or moderate forms of paranoia are circumscribed, showing up only in particular thoughts and delusions, only those involved or accused may be aware of the psychopathology of the condition. The person can thus contribute to family life, work, and aspects of social life in positive ways, which you as therapist can help highlight for the partner.

Having either a client or a client’s partner who is paranoid is not easy, but the worst heartbreak and chaos can be avoided if the person can engage treatment, including medication when necessary.

References:

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders.(5th Edition). Washington, DC.: APA.
2. Barron, C. (2016). 7 Tips for coping with a paranoid partner. Psychology Today. Retrieved on 4 December, 2018, from: Website.
3. Bourgeois, J. (2017). Delusional disorder. Medscape. Retrieved on 9 December, 2018, from: Website.
4. Everyday Health. (n.d.) Coping with paranoia in a loved one. Everyday Health. Retrieved on 4 December, 2018, from: Website.
5. Mental Health America. (n.d.). Paranoia and delusional disorders. Mental Health America. Retrieved on 6 December, 2018, from: Website.
6. Navarrro, J. (2016). The paranoid partner: Identifying the paranoid personality in relationships. Psychology Today. Retrieved on 4 December, 2018, from: Website.
7. Nowak, L. (2018). Paranoid personality disorder and relationships: Moving past fear, together. Bridges to Recovery. Retrieved on 4 December, 2018, from: Website.
8. Sunrise House. (2018). Is there a difference between paranoia and delusional disorders? American Addiction Centers. Retrieved on 9 December, 2018, from: Website.
9. WebMD. (2018). Paranoid personality disorder. WebMD LLC. Retrieved on 9 December, 2018, from: Website.

Managing moderate to intense anxiety often involves a combination of techniques that address both the mind and body. Here are some effective strategies:

1. Breathing Exercises: Practice slow, deep breathing to calm your nervous system. For example, inhale for a count of four, hold for four, and exhale for four.

2. Progressive Muscle Relaxation: Tense and then relax each muscle group in your body, starting from your toes and working upward.

3. Grounding Techniques: Use the 5-4-3-2-1 method to focus on your senses—identify 5 things you see, 4 you feel, 3 you hear, 2 you smell, and 1 you taste.

4. Mindfulness and Meditation: Engage in mindfulness practices to stay present and reduce anxious thoughts. Apps like Headspace or Calm can be helpful.

5. Physical Activity: Exercise, even a short walk, can release endorphins and reduce anxiety levels.

6. Cognitive Behavioural Techniques: Challenge negative thoughts by questioning their validity and replacing them with more balanced perspectives.

7. Healthy Lifestyle Choices: Maintain a consistent sleep schedule, eat nutritious meals, and limit caffeine and alcohol intake.

8. Journaling: Write down your thoughts and feelings to process them and identify triggers.

9. Social Support: Talk to trusted friends, family, or support groups to share your experiences and gain perspective.

10. Professional Help: If anxiety persists, consider seeking therapy or counselling. Techniques like Cognitive Behavioural Therapy (CBT) or medication prescribed by a professional can be highly effective.

When traditional strategies don’t seem effective for managing intense, chronic anxiety, there are additional approaches you can explore:

a. Therapeutic Modalities:

Acceptance and Commitment Therapy (ACT): Focuses on accepting anxious thoughts rather than fighting them, while committing to actions aligned with your values.

Dialectical Behavior Therapy (DBT): Combines mindfulness with skills for emotional regulation and distress tolerance.

Eye Movement Desensitisation and Reprocessing (EMDR): Often used for trauma-related anxiety, it helps reprocess distressing memories.

b. Medication:

Anti-anxiety medications or antidepressants may be prescribed by a psychiatrist. These can help manage symptoms when therapy alone isn’t sufficient.

c. Lifestyle Adjustments:

Explore dietary changes, such as reducing sugar and processed foods, which can impact mood and anxiety levels.

Incorporate consistent physical activity tailored to your preferences.

d. Support Groups:

Joining a group for individuals with anxiety can provide a sense of community and shared understanding.

e. Intensive Programs:

Consider enrolling in an intensive outpatient program (IOP) or residential treatment program for anxiety, which offers structured and comprehensive care.

f. Emerging Treatments:

Research into treatments like ketamine therapy or transcranial magnetic stimulation (TMS) shows promise for treatment-resistant anxiety.

g. Alternative Therapies:

Practices like acupuncture, yoga, or tai chi can promote relaxation and reduce anxiety.

Biofeedback and neurofeedback can help you gain control over physiological responses to stress. They are techniques that help individuals gain control over certain physiological and mental processes. Here’s a breakdown:

i. Biofeedback is a mind-body therapy that uses sensors to monitor physiological functions like heart rate, muscle tension, breathing, or skin temperature. The goal is to provide real-time feedback to help individuals learn how to regulate these functions consciously. For example:

Heart Rate Variability Biofeedback: Helps manage stress by teaching control over heart rate.

Muscle Tension Biofeedback: Useful for conditions like chronic pain or tension headaches.

By practicing biofeedback, people can develop skills to manage stress, anxiety, and other health conditions2.

ii. Neurofeedback, a specialised form of biofeedback, focuses on brain activity. It uses electroencephalography (EEG) to monitor brainwaves and provides feedback to help individuals regulate their brain function. For instance:

It can help with conditions like ADHD, anxiety, depression, and PTSD.

During a session, individuals might watch visual cues or listen to sounds that reflect their brainwave activity, learning to adjust their mental state for better focus or relaxation4.

Both techniques are non-invasive and can be effective tools for improving mental and physical well-being.

IMPORTANT NOTE: It’s necessary to consult with a mental health professional or medical doctor to tailor these options to your specific needs.