Understanding self-harm, self-injury, and self-destruction

Did you know that through a series of controversial (and incredibly sad) experiments, psychologist Harry Harlow, was able to demonstrate the importance of early attachments, affection, and emotional bonds on the course of healthy development. Harlow discovered that love and affections may be primary needs that are just as strong as or even stronger than those of hunger or thirst.

1 Think positive

This sounds easier said than done. I challenge you to intentionally consider alternatives to your habitual, default thinking pattern. We all want to be liked by others – because we want to belong to a group and to feel valued, needed and wanted. Worrying about social situations is very natural because we want to be perceived by others in a certain way. Other people’s perceptions are out of our control. So, we worry about it. We worry about things that are out of our control. We also know that we control our own behaviour, therefore, we feel responsible for behaving in ways that will mesh with others. We believe the likelihood of being liked will increase if we behave in certain ways.

Worrying can become problematic if we overthink past and future interactions, and perhaps we choose to avoid some or all interactions to protect ourselves. But then we don’t get the social connection we need.

I challenge you to think positive. Choose that instead. It will take energy because it might not be your default thinking pattern. Set your positive intention. Use mental energy. Trust that the opposite of your thinking can be true as well.

2 Forget comparison – unless you are a clone of someone else, you don’t have their genes, their life experience, their upbringing, their family history etc. It’s kind of illogical to compare yourself to someone else if you think about it, hey.

Don’t be concerned if others appear to have more or better friends than you. Quality and enjoyment matter more than quantity. Savour the moments of connection, wherever you can find them.

3 Anticipate change

Our life circumstances can leave us vulnerable to a sense of isolation. Relationships shift over time, and we may lose touch with friends who were once important. People form new relationships, move away, start families, become busier at work or start studying etc. Accepting change as normal can help you adjust to a change in your relationships. Just as we grow, evolve, and change, so will our relationships. Couples who were once in love will fall out of love. And friendships that were once enjoyed may become less enjoyable overtime.

4 Tolerate discomfort

Anxiety may cause you to avoid socialising. Understand that feeling awkward or embarrassed in social situations does not mean you are doing anything “wrong”. I remember a period I went through growing up. I noticed people around me starting to use for sophisticated language. I thought I had nothing of value to say, or nothing of interest. I would struggle to form sentences in my head. I was becoming so anxious that my social cognition was compromised. Learning to be comfortable with myself, relaxing into conversations, and listening more deeply to the other person helped me. I remember going on dates thinking I have absolutely nothing to say to this person. That cognition, that thought, wasn’t true. It was part of a larger story that I was creating in my mind.

Reach out to others and your skills will improve with time.

5 Listen well

Practice listening. Ask questions and really listen to the answers, rather than just waiting for your turn to talk, or worrying about how you will respond. If you’re curious about what someone is saying, your mind will naturally form a question or recall a similar experience that you can share.

Respond warmly to people’s experiences through your posture, facial expressions and words. Put the mobile phone away and be present.

6 Rehearse

Out of practice with small talk? Spend some time thinking about questions you can use when conversation stalls. You might ask if the other person has been overseas or travelled, what music do they like, or what movies they like to see at the cinema. A natural question to ask is what did you get up to today? What do you have planned for the weekend?

I once attended a training for work. The facilitator shared her experience of often finding herself in similar situations, and she decided to formulate a “go-to” script for when she became tense, and a conversation stalled. Rather than panic, she had a mental go-to script to bridge the gap until the conversation returned to a natural flow. Sometimes it’s nice to allow for a silence, scan your environment and discuss something happening around you.

7 Go offline

Social media helps many people, but it can also increase disconnection, depression, loneliness, anxiety, and headaches. Ensure you have a healthy offline life. Perhaps invite trusted online friends to an offline meeting to build your relationship.

8 Help and service

Helping someone gives a feel-good rush. Oxytocin and dopamine neurotransmitters have been shown to be involved in human bonding. These chemicals can make us feel pleasure. Create a bond with someone by offering help or asking for it. If we’re not someone who asks for help often, the people who know us well will likely feel closer to you because you need them for something, nourishing the bond you have. Have you noticed that strangers in the street are often very willing to help someone with directions? It makes people feel good to help others and be helped in return. Something as little as assistance with a bag or holding a lift can help people feel seen and cared for.

9 Get involved

I know this one may make some people go “Eeeeek” and cringe. However, evolutionary and developmental psychology … and all psychology, has suggested time and time again, that feeling part of a larger community and getting involved makes us feel alive and part-of. Joining in connects you to other people, unites you in a shared activity, and provides an easy way to get to know people better.

Have you ever watched a group of people in the street having a laugh, or watched people playing a sports game, or doing an activity together – while you’re sitting alone on the outside. You might mock them to yourself to make yourself feel superior or protected. We’d rather be part of. It’s just the truth.

10 Manage stress

Everybody has some social situations they dread. Practice simple stress management techniques, such as breathing deeply and slowly, to help keep your stress in check through awkward moments.

We need stress to perform optimally. Befriend your stress. When it becomes overwhelming, recognise that it’s happening, allow it to be there, investigate where it’s living in your body, and nurture that part of yourself. Talk to a trusted friend in times of excessive or toxic stress. Do whatever you need to come back home to yourself. Rest. Drink water. Eat nutritious food. Shower or bathe. Spend time outdoors in nature. Watch something on tv. Listen to music. Come home to your true self, recharge the batteries, and then jump back in. You’re allowed to switch off for a while.

11. Practice, practice, practice

Relationship skills can be learnt. Don’t be discouraged. Remember that social connections are good for you. If you feel like you need support to build better connections skills, a counsellor or therapist can help.

We learn from new experiences. They create, wire, and strengthen, neural pathways in the brain. You can be silent and listen during social interactions. Get curious about the other person. Ask questions. Share some of your story and ideas. And breath. Practice makes progress – not perfection.

When to Fake It Till You Make It (and When You Shouldn’t)

Faking it for the right reasons can change you for the better. Here’s why.

Posted Jun 27, 2016By Amy Morin

One day, a client came to see me because she felt socially awkward. She knew that her inability to make small talk was holding her back both personally and professionally. As a shy person, she hated going to networking events. But making connections was vital to her career.I asked, “What do you usually do when you go to a networking event?” She said, “I stand awkwardly off to the side and wait to see if anyone will come talk to me.” I asked her, “What would you do differently if you felt confident?” and she said, “I’d initiate conversation and introduce myself to people.”

Right then and there, she discovered the solution to her problem: If she wanted to feel more confident, she had to act more confident. That wasn’t quite what she wanted to hear. She’d hoped for a solution that would immediately make her feel more confident. But the key to becoming more comfortable in social situations is practice.Her instinct was to wait until she felt more confident, but that confidence wasn’t going to magically appear out of thin air—especially if she was standing around by herself. However, if she started talking to people like a confident person, she’d have an opportunity to experience successful social interactions, and each of these would boost her confidence.

Acting “As If”

Acting “as if” is a common prescription in psychotherapy. It’s based on the idea that if you behave like the person you want to become, you’ll become like this in reality:

1. If you want to feel happier, do what happy people do—smile.

2. If you want to get more work done, act as if you are a productive person.

3. If you want to have more friends, behave like a friendly person.

4. If you want to improve your relationship, practice being a good partner.Too often we hesitate to spring into action. Instead, we wait until everything feels just right or until we think we’re ready. But research shows that changing your behavior first can change the way you think and feel.

The Biggest Mistake Most People Make

Faking it until you make it only works when you correctly identify something within yourself that’s holding you back. Behaving like the person you want to become is about changing the way you feel and the way you think.If your motives are to prove your worth to other people, however, your efforts won’t be successful, and research shows that this approach actually backfires. A study published in the Journal of Consumer Research found that people who tried to prove their worth to others were more likely to dwell on their shortcomings. Ambitious professionals who wore luxury clothing in an effort to appear successful, and MBA students who wore Rolex watches to increase their self-worth just ended up feeling like bigger failures. Even worse, their attempts to project an image of success impaired their self-control. They struggled to resist temptation when they tried to prove that they were successful. Putting so much effort into faking it used up their mental resources and interfered with their ability to make good choices.

How to “Fake It” the Right Way

Acting “as if” doesn’t mean being phony or inauthentic. It’s about changing your behavior first and trusting the feelings will follow. As long as your motivation is in the right place, faking it until you make it can effectively make your goals become reality. Just make sure you’re interested in changing yourself on the inside, not simply trying to change other people’s perceptions of you.

There have been various theories and models proposed over time to help us understand why individuals use alcohol and other drugs, and why some people become dependent or ‘addicted’ but not others. The following are several models or theories of addiction. They reflect the political, medical, spiritual, and social forces of those times in history.

The Moral Model

Alcohol and tobacco was introduced in the Western countries during the 1500’s. The widespread use and misuse of chemical substances resulted in a range of social problems and it was thought by some that substance use was “problematic” and “morally wrong” (Lassiter & Spivey, 2018). The moral model viewed AOD dependency as a moral and personal weakness that involved a lack of self-control, and was often viewed as a potential danger to society (Stevens & Smith, 2014).

The moral model considered addiction a “sin” and a result of free, yet irresponsible, choice. Therefore, many politically conservative groups, religious groups, and legal systems tended to punish the individual who uses AOD. The moral model or attitude towards addiction can still be seen today in certain cultures. Those who still believe addiction is morally “wrong” tend to perceive the most appropriate way to treat the individuals who use AOD are through legal sanctions, such as imprisonment and fines. For example, in many countries, drivers who are caught under the influence of alcohol or other drugs are not considered for treatment programs but instead receive court sentences as punishments (Fisher & Harrison, 2017).

This model has been rejected by alcohol and other drugs professionals as unscientific and contributes to the stigma surrounding addiction and substance use (White, 1991, cited in Fisher & Harrison, 2017).

The Disease Model

This model takes up the medical viewpoint and proposes addiction as a disease or illness that an individual has. It proposed that addiction is a disease that is progressive and chronic whereby the individual holds no control as long as the substance use continues. In other words, their addiction will continue to deteriorate with the continuous AOD (Thombs & Osborn, 2019). It also proposes that individuals who uses AOD can never be cured from addiction, though it can be readily treated through sustained abstinence such as self-help fellowships and treatment community. 

In the 1940s, Jellinek proposed a disease model in relation to alcoholism, arguing that it is a disease caused by a physiological deficit in an individual, making the person permanently unable to tolerate the effects of alcohol (Stevens & Smith, 2014). Jellinek identified signs and symptoms and clustered them into stages of alcoholism, as well as progression of the disease, which form the basis of 12-step or Anon-type programs (e.g., Alcoholics Anonymous and Narcotics Anonymous; Stevens & Smith, 2014). 

Under the disease model, treatment requires complete abstinence. Once an individual has accepted the reality of their addiction and ceased substance use, they are labelled as being in recovery, but are never ‘cured’ (e.g., “Once an alcoholic, always an alcoholic”; Thombs & Osborn, 2019). Whilst originally applied to alcohol dependency, it has now been generalised to other substances and many traditional substance use treatment models are based on this model (Capuzzi & Stauffer, 2020; Stevens & Smith, 2014).

The disease model offered an alternative to the moral theory, helping to remove the moral stigma attached to addiction and replacing it with an emphasis on treatment of an illness (Capuzzi & Stauffer, 2020). Disease theory helped to explain how some people experience the physiological effects of addiction such as dependence, tolerance, and withdrawal more than others, and how these mechanisms are caused by a biochemical abnormality in an individual which increases their likelihood of developing a dependency (DiClemente, 2018). 

While the disease model was well received by a range of professionals, many criticised it because research did not find that the progressive, irreversible progression of addiction through stages always occurs as predicted (Capuzzi & Stauffer, 2020). Additionally, many in the AOD field argued that the model did not address the complex interrelated factors that accompany dependency (Stevens & Smith, 2014). Finally, some professionals argued that the concept of addiction being a disease may also convey the impression to some individuals that they are powerless over their dependency and/or not responsible for the consequences of destructive addictive behaviours, which can be counteractive to treatment (Capuzzi & Stauffer, 2020).

Genetic and Neurobiological Theories

These theories suggest that some people may be genetically predisposed to develop drug dependency. For example, individuals usually begin substance use on an experimental basis. They then continue using because there is some reinforcement for doing so (e.g., a reduction of pain, experience of euphoria, social recognition, and/or acceptance, etc.). Some people may continue to use substances in a controlled or recreational manner with limited consequences while others progress to non-medical use and eventually develop a dependency. Why? Genetic and neurobiological theories propose that this is the result of a genetic predisposition to drug dependency (Fisher & Harrison, 2017). 

Factors being considered by researchers in the genetic transmission of dependency on alcohol include neurobiological features such as an imbalance in the brain’s production of ‘feel good’ neurotransmitters or in the metabolism of ethanol, which is the key component of alcohol (Stevens & Smith, 2014). Other researchers explored genetic differences in temperament and personality traits which they argued may lead to certain individuals becoming more vulnerable in the face of challenging environmental circumstances, leading to AOD use (Stevens & Smith, 2014). Genetic predispositions such as these may explain why some individuals develop dependency on AOD while others in similar situations do not.

The Psycho-dynamic Model

This model proposes that substance use may be due to an unintentional response to some difficulties that an individual experienced in their childhood. This explanation is based on the theory that was put forward by Sigmund Freud, whereby the problems of whether we are able to cope with difficulties as adults are linked to our childhood experience. Many counselling approaches today are based on this theory which aim to seek understanding of people’s unconscious motivations and to enhance how they view themselves (Capuzzi & Stauffer, 2020).

The Psycho-dynamtic model also believes that AOD use is often secondary to a primary psychological issue. In other words, alcohol and other drugs is a symptom rather than a disorder, and AOD use is a means to temporarily relieve or numb emotional pain. For example, an individual suffering from depression might self-medicate with stimulants to relieve the enervating effects of depression or manage their anxiety by using benzodiazepines (Fisher & Harrison, 2017). 

There is evidence to support this model, whereby childhood traumatic events are associated with mental health problems and substance use disorders. Wu et al. (2010) conducted a study among 402 adults who were receiving substance use disorder treatments. They revealed that almost all (95%) of the participants experienced one or more childhood traumatic events, and 65.9% of them experienced emotional abuse and neglect from their childhood. The authors also reported that the higher the number of childhood traumatic events experienced, the higher the risk of substance use disorders and mental health problems such as post-traumatic stress disorder. 

Personality Traits

Some theorists suggest that certain individuals have certain personality traits that are linked to AOD dependency. For example, dependency on alcohol has been associated with traits such as developmental immaturity, impulsivity, high reactivity and emotionality, impatience, intolerance, and inability to express emotions (Capuzzi & Stauffer, 2020).

Social Learning Model

This model suggests that social learning processes such as observing other peoples behaviours (i.e., modelling) and cultural norms are important in the process of learning behaviours. Albert Bandura proposed Social Learning Theory which would argue that substance use is initiated by environmental stressors or modelling people around you with “perceived status”. For example, a child observes their parents use alcohol in social situations and the child is therefore more likely to perceive that AOD use for social situations is appropriate (Harrison & Fisher, 2017); the association between socialisation and alcohol has been established.

The social learning model also recognises the influence of cognitive processes such as coping, self-efficacy, and outcome expectancies. Some researchers are currently focusing on how an individuals expectation of the effects of drugs influence the pattern of AOD use and resulting dependency. Russell (1976, cited in Wise & Koob, 2013) suggested that dependency on substance is not only chemical (biological) but also behavioural and social in nature. 

It has also been suggested that substance use occurs when an individual thinks substance use is a coping mechanism. This can be learned from television and film, social medial, peer influence, or messages from caregivers during childhood. The individual hopes the AOD use will relieve from them from stress (Stevens & Smith, 2014). 

Socio-cultural Model

Different from the previous models, the socio-cultural model perceives substance use as an issue of society as a whole instead of focusing only on the individual. People tend to overestimate the influence of internal and psychological factors while underestimating the external and environmental factors, even among some alcohol and other drugs workers (Gladwell, 2000, cited in Lewis, Dana, & Blevins, 2015). Thus, this model highlights the importance of how society shapes substance use behaviours, such as cultural attitudes, peer pressures, family structures, economic factors, and more (Bobo & Husten, 2000). For example, Coffelt et al. (2006) found that parents’ alcohol use are associated with their children’s drinking behaviour, whereby when the adult’s alcohol problems increased, the likelihood of their adolescent child’s alcohol use increased. 

The Biopsychosocial Model

Substance use behaviour cannot be explained or understood scientifically or spiritually based on a single variable, antecedent, or “cause”. Biological, psychological, learning, social and cultural context all contributes to explaining why addiction develops and maintains. The interactions between these factors are presented in The Biopsychosocial Model – arguably the most commonly used model to explain addiction today. The model suggests that substance use and the progression of substance dependency can be explained by recognising that the body and mind are connected within a social and cultural context (Skewes & Gonzalez, 2013).

The model allows any combination of biological, psychological, social and cultural factors to contribute to AOD misuse and dependency, rather than a single dominating factor. This is much more holistic and integrative when attempting to understand the determinant of addiction (Stevens & Smith, 2014).

References:

1. Bobo, J. K., & Husten, C. (2000). Sociocultural influences on smoking and drinking. Alcohol Research and Health, 24(4), 225-232. 
2. Capuzzi, D., & Stauffer, M. D., Sharpe, C. W. (2020). History and etiological models of addiction. In D. Capuzzi, & M. D. Stauffer (Eds.), Foundations of addictions counseling (pp. 1-22). Pearson Education.
3. Coffelt, N. L., Forehand, R., Olson, A. L., Jones, D. J., Gaffney, C. A., Zens, M. S. (2006). A longitudinal examination of the link between parent alcohol problems and youth drinking: The moderating roles of parent and child gender. Addictive Behaviours, 31, 4, 593-605. https://doi.org/10.1016/j.addbeh.2005.05.034 
4. DiClemente, C. C. (2018). Addiction and change: How addictions develop and addicted people recover. The Guilford Press.
5. Fisher, G. L., & Harrison, T. C. (2017). Substance abuse: Information for school counsellors, social workers, therapists, and counsellors. Pearson Education. 
6. Lassiter, P. S., & Spivey, M. S. (2018). Historical perspectives and the moral model. In P. S. Lassiter, & J. R. Culbreth (Eds.), Theory and practice of addiction counselling. (pp. 27-46). Sage Publications. 
7. Lewis, J. A., Dana, R. Q., & Blevins, G. A. (2015). Substance abuse counselling. Cengage Learning.
8. Skewes, M. C., & Gonzalez, V. M. (2013). The biopsychosocial model of addiction. In P. M. Miller, A. W. Blume, D. J. Kavanagh, K. M. Kampman, M. E. Bates, M. E. Larimer, N. M. Petry, P. D. Witte, S. A. Ball (Eds.), Principles of addiction: Comprehensive addictive behaviours and disorders (pp. 61-70). Academic Press.
9. Stevens, P., & Smith, R. L. (2014). Substance abuse counselling: Theory and practice. Pearson Education. 
10. Teesson, M., Hall, W., Proudfoot, & Degenhardt, L. (2012). Addictions. Taylor & Francis Group.
11. Thombs, D. L., & Osborn, C. J. (2019). Introduction to addictive behaviours. The Guilford Press. 
12. Wise, R. A., & Koob, G. F. (2013). The development and maintainance of drug addiction. Neuropsychopharmacology, 39, 254-262.
13. Wu, N. S., Schairer. L. C., Dellor, E., & Grella, C. (2010). Childhood trauma and health outcomes in adults with comorbid substance abuse and mental health disorders. Addictive Behaviors, 35(1). 68-71. https://doi.org/10.1016/j.addbeh.2009.09.003