A Therapists Guide to Sex and Porn Addiction

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 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 a 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. Okay, 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 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, instead of choosing other behaviors? We don't do things unless they're reinforcing. We don't do things unless they're 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 those 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 condition 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. Children, just seeing a computer can be enough to make somebody start obsessing certain times of day. Now, times of 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 going to have some good food in a minute. And it starts to release some of those pleasure chemicals. Your motivation is there to eat. It's like, okay, I'm primed, 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 talk about changing people places and things because they are triggers. They say, this is somebody you used to use with, so if you're with them, probably ought to use. I've talked about before in a lot of my videos that people often equate drinking with. 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 stimulus. So it doesn't say, oh, football game's on. Must have a drink. It says, oh, football game's on. Must watch football. Both drug addiction and sex addiction cause 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, Overstimulation. Shut down. If you've ever been. And this is not the best example, but it's one I can come up with right now. If you've 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 overstimulation. And you're like, oh, please make it Stop just for a minute. Somebody say nap time? Okay, brain is taking a nap time. Unfortunately, in addiction, your brain actually goes through some changes and starts shutting down some receptors so you're not constantly overstimulated. Well, what does that mean? That means the person is left to chase the high. Those receptors have been shut down. So what used to be a woohoo is now a eh. They do what they expect to bring a woo hoo. And it doesn't bring that, it brings an eh. So they either 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 are 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 are some differences that do need to be addressed. There are some similarities between that too. But just like when you're treating a patient who has polysubstance 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 in 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 this sex addiction. And you're sitting there scratching your head going, huh? What in the world could have possessed him? And it was chasing that high. After a while, winning the tournaments wasn't a woohoo. It was a yeah, I expected that. After a while, going home to that same gorgeous wife wasn't the woo hoo, it was the 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 in the center of attention and 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 overstimulating. And we're saying, whoa, I want to be overstimulated. 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 a biologically driven urge. The other urge, which is unique to sex addiction is something called the Coolidge effect. They have determined in rats as well as in humans. Rats evidently do really well in these experiments that if they put an electrode in the rat's 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, eh, you know, you're a rat, you're available, whatever, take 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 interest 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 give. 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. Let's go back to Sex is socially sanctioned. If a guy, especially in our culture, goes out and is managing to spread his genetic material, the thought is, oh, what a student. 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, let's slow down. Socially sanctioned, it's not illegal. At least when you start out, it's not. Now, you may progress to the point where you're engaging in 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, three dimensional, consenting partner. Tolerance again develops because the dopamine system is self regulating and because of that Darnold 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 going to have the same, necessarily the same high when you're with your partner after 20 years 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. Ah, crap, I just need another drink. In terms of sex addiction, people, you know, become aroused, get their release, start going about their business, then 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 rush you initially had unsuccessful efforts to cut down. Again, we're chasing that neurotransmitter surge. It's not necessarily. And with sex addiction, you've got both. Part of you is going, 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, eh, 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, doors 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 10 minutes and I'm good to go. 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 brain is 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 and 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 because dopamine is our Motivator. People actually start to feel depressed. Depression is your body's way of saying, hello, stop. You either stop or I'm going to 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 going to 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 the 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 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, loss of interest in most things, most of the time. Criteria one for depression. Restlessness. Irritability. Yeah, when we get aroused. Arousal. That means amp up. Whether it's aroused for fight or flee or aroused for sex or aroused arousal can sometimes come out as restlessness. You're like, I gotta 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 irritability. 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 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 by 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 10 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 were 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. Ha ha. 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, limit it to 1. Most likely. If people are to the point where they're seeking help for this, the 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 their 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. Whole different presentation. Eat a healthy diet. So your body has the building blocks 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. It's been shown in some studies to be almost as effective as Zoloft and some other antidepressants in relieving symptoms of mild depression. 30 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 intense 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. House cleaning is another good thing. Mowing the yard, whatever it takes, they need to move. Sitting there and going, oh, 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. Now, 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 get 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. Alright, 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 that make you happy. Find things to occupy your time. Like I said, if you're bored, you're going to 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. 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 in 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 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 of 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 ought 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 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 of day where their body goes, hey, aren't you forgetting something? Those times of 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 masturbation. Going to the gym again, depends on the person. Depends on the gym may be more triggering than just not going to the gym. Identify the function of your behavior and develop alternatives. If you started, maybe you 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 in a monogamous relationship. Yes, I'm pausing again so you can digest that. Understand that during the rewire, there may be a period where, 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 T or something. But it is important to realize that this is is a potential temporary issue. It's also important to remember that if you start taking antidepressants, your typical run of the mill SSRI SNRIs, 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 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 not 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. 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 going to be my normal productive self today and move on, at least I'm not using excess energy, dwelling on the fact that I'm going to 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'd ever sat in, in a car or otherwise. I was like, oh, 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 got to have that. It's so comfortable. My wise mind was going, in the long run, you're really not going to 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. Wise mind versus emotional mind. Emotional mind is impulsive. Wise mind is more rational. So we need to act with awareness, say, 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 going to 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 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 going to 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 wouldn't be a good example. Urge 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 urgent as the compulsion goes up and then eventually goes down. I was like, yeah, whatever, I forgot what I was even craving. Alternate activities, less problematic activities. When we're talking about people who self injure, 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 going to. Just 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, phew, 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 in most things, then you may be feeling depressed. You may be feeling hopeless, helpless, weepy, irritable. Accept those emotions are there, then figure out what to do about them. Learn what makes your negative emotions worse. Too often I see people when they're depressed. They stay in bed all day and listen to sad music. Well, 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, increase 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 and 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 urge, surfed, gotten through that 15 minutes or so, so that urge to, like, freak the freak out is gone. But I also got an endorphin rush 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, then 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. See, I can 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, ooh, it's partly sunny. Then everything's going to 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. 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 on 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. There's 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 can 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. On 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's 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 DB DBT 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. All right, thank you for coming today and have a wonderful rest of your day.