Overcoming Emotional Challenges in Porn Addiction Recovery

A YouTube video (April 8, 2024) by Dr. Dawn‑Elise Snipes that explains the emotional dynamics in porn addiction recovery. It emphasizes the cognitive‑behavioral triad (thoughts, feelings, behaviors), how prior learning and neurobiology (HPA axis, hypofrontality) influence cravings and relapse risk, and practical tools—unhooking, distress tolerance, forgiveness (mnemonic: ALL), hardiness (commitment, control, challenge), and grief work—to manage distress and support recovery.
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Hey there, everybody, and welcome to this video on the emotional aspects of porn addiction recovery. I'm your host, Dr. Donnelly Snipes. In this video, you're going to explore how emotions, thoughts, and behaviors interact and identify triggers for your distressful feelings and tools to manage them. Now, I know many people may think you know emotions, motions. What do I need to deal with that? Well. Well, when you have distressful emotions and you don't deal with them, your body has to cope in some way. If you're feeling anxious, angry, irritable, then your body is pumping out those excitatory neurochemicals that are going to make your recovery slow at best and maybe relapse at worst. So let's start out by talking about the cognitive behavioral triad. We need to recognize that emotions are very natural. They are automatic responses to our environment based upon prior learning. It's our brain's shortcut. It's sort of like a smoke alarm that tells you, hey, based on my programming, there might be a threat, there might be a fire. Doesn't mean there is. It means there might be. And it's important to recognize that we don't want to get rid of emotions. We don't want to feel flat all the time, and we don't want to get rid of distressful emotions because sometimes they give us good information and tell us to get the heck out of somewhere. But emotions are not something that we want to make decisions based upon. Emotions influence what you pay attention to and how you process or think about things. If you're in a threat state, you're scared or you're angry, or even if you're depressed, your brain automatically pays more attention to the threats which increase your distress. Your brain looks for confirmatory evidence. It doesn't look for information to try to disprove how you're feeling. Therefore, when you're feeling unhappy in some way, it's important to recognize that and recognize that your brain is selectively paying attention to that stuff. Your thoughts or your cognitions influence how you feel. If you're having positive thoughts about yourself for the day or whatever, then it'll tend to have you feeling happier and more positive and optimistic, and therefore, guess what? You're going to focus on the positive things that are going on. Your thoughts and your feelings work together to impact behaviors. If you're having stressful thoughts, then it will trigger stressful feelings, which will often trigger a reaction to try to make that stress stop. If you are having stressful feelings, then sometimes your brain's going, well, I feel anxious. Right now, I don't know why. H there must be something to be afraid of. So then you start having stressful thoughts and ruminations, which again, impacts your behavior. So the three of them interact. Any one of the three can kick off the reaction. However, it's important to recognize that to address your behaviors, you're going to also have to address your emotions and your thoughts. Feelings aren't facts. A balanced view of life, problems and the world is necessary. You may feel like something is intolerable, but what are the facts? You may feel like you're craving. You may feel like you have to do something, but what are the facts for that you feel that way? Is it true? You may feel like talking to someone is threatening, but what are the facts? If you go up and introduce yourself, yeah, that's anxiety provoking for most of us. But is there actually a threat? What's the worst thing that could happen? Basically, think of three times you felt like something was hopeless or were afraid of something and it ended up turning out okay. And it's important to recognize your successes. Our brain tends to remember and be able to come up with all kinds of examples of things you times when you felt that something was hopeless or you were angry about something and it went bad, that's easy to remember because your brain doesn't want you to ever experience that again. But thinking about times when you thought something was hopeless or you couldn't do something and it turned out okay for some reason, our brains take that for granted a lot of times. So we need to encourage ourselves to embrace the whole picture. What have you succeeded at? When have you succeeded? Yeah, we know about the failures, but also let's balance those by acknowledging the successes. Emotions or feelings can be pleasant or unpleasant, but they are natural and necessary. The goal is not to get rid of feelings, as I said earlier, but to be mindful of them, understand them, and respond in the best way possible in the present context. So that's really important. You may feel anxious or angry about something and you're at home and you can scream really loud or, you know, go take a bath so you can calm down whatever it is that you do, but probably not the same response you're going to use when you're at work or in the middle of the shopping mall. So it's important to acknowledge your feelings, be mindful of them, identify if there is a threat in the current context, and the best way possible to use your energy to respond to that threat in the present context. So again, facts for and against my feelings Right now, what parts of it do I have control over? And what is the best response to move toward my rich and meaningful life? The brain interprets information from the environment based on your prior experiences. The more a trigger leads to a behavior, the stronger the memory pathway and the more influence that memory has on future expectations. For example, if your pleasure has been regularly derived from watching porn, from edging and then orgasming, then that is what your brain is going to expect will do it for you. If on the other hand it has come from real life sex, then that is going to be more motivating than porn would be. Likewise, if you have interacted with people in real life before and experienced a lot of rejection, then that pathway has become a lot stronger than the one in which you've interacted with people and felt accepted and it went well. It's important to not ignore the things that went well, but know that that those experiences are fewer and farther between, so that connection is a lot weaker and you're going to have to work to build that up. Just because it happened once, whether it was rejection or inability to perform or something else, just because it happened once doesn't mean it will happen again. Unfortunately we create this situation that's like a self fulfilling prophecy. The more you tell yourself something, the more you look for data to confirm your belief which creates a self fulfilling prophecy. If I tell myself I'm going to be unable to perform, and I repeatedly tell myself that, then I am likely going to have difficulty with performance. If I tell myself I'm going to get rejected, everybody always rejects me. Now those are a bunch of cognitive distortions in there, but I digress. If I'm telling myself that then when I go to introduce myself to people or try to spend time with people, I am going to be hyper aware of all of their non verbals that I interpret as meaning they're rejecting me. It may not mean they're rejecting me. I remember a conference I was at for suicide prevention and we were in a lodge and it was really cold. This lodge didn't have central heat and we were in Florida, so you don't usually need central heat, but I dig. And all of us, most of us in the circle that were listening to the speaker were sitting there like this. And it wasn't because we were bored with what the person was saying, it wasn't because we disagreed with what the person was saying, it was because we were freaking cold. It's important to understand that where you may have seen that non verbal behavior in someone before and it meant rejection or it meant disapproval. Okay, that's what it meant with coming from that person at that point in time in this context with this person, you don't know what it means until they actually tell you I'm going to relapse. If you keep telling yourself that guess what? You're going probably going to relapse. That's one of the hurdles that a lot of people experience in early recovery when you because their loved ones are often hyper vigilant and looking for signs that they're going to relapse and they feel like they're being accused of it when they're not doing anything wrong and ultimately it creates a fulfilling prophecy. What self fulfilling prophecies do you have? I. E. How do you self sabotage and how can you change those self fulfilling prophecies to be what ones of courage and empowerment instead of fear of rejection and feeling hopeless and powerless? Neither feelings nor thoughts are facts. I know. Let that sink in for a second. Feelings, as I mentioned, come from expectations based on your prior experiences, your assumptions. And when we talk about assuming, we can break that down in to when you assume it makes an ass out of you and me. You don't want to make assumptions. Feelings are your smoke alarm. They're your warning sign that tell you, hey, pay attention. Feelings do not usually consider the facts in the current context alone. They may not even be considering the facts in the current context at all. It's just this triggers a memory, this triggers an experience. Experience I've had and I don't know what's going on here, but I expect it's going to end up the same way. So feelings aren't facts. And it's important to note when you're feeling vulnerable, when you're feeling anxious, is there actually a threat? In the current context, thoughts are not facts either. Most thoughts are conclusions based upon past experience. Thoughts. Thoughts mean you take in information, you take in facts, and then you filter them through your own little mental filters to understand what they mean. Your mental filters may be inaccurate to begin with, so you may misinterpret a situation or the mental filter. The experience you had in the past may not be the same as the current situation, so you're using faulty information. If you have a thought, then again you need to check the fact for and against your thought to make sure that you are as accurate as possible. And finally, facts are facts. Examine the facts for and against your feelings and beliefs in the current context. I'm going to say that a lot in this video and the next Video because it's that important. Unhooking is a tool that a lot of people find really helpful to deal with intrusive thoughts and to deal with unpleasant feelings. You can have a feeling, you can have an urge, you can have an intrusive thought and still do the next right thing. Unhooking means saying, instead of saying I am anxious, I am afraid, you're saying I. I'm having the feeling that I'm afraid. So you've got this feeling that you're holding on to and you got to figure out what to do with. It's not part of you, it's something you have. I'm having the thought that I'm going to relapse. All right, well, we all have thoughts. Not all of them are accurate. You've got this thought here, what are you going to do with it? I'm having the feeling or thought that I have to use, that this is unbearable, that recovery is hopeless, that I am unacceptable, or that I will never find a partner and have a fulfilling sex life. These are some really common feelings and thoughts and beliefs that people have in early recovery. And just in general, it's important for each one of those to unhook from it, making another a separate car on your little choo choo train of thoughts. You're holding it. You've got this feeling or thought, what are you going to do with it? Are you going to leave it at the station or are you going to drag it along with you? What thoughts or feelings trigger your desire to use porn? Unhook from them. You do not have to act on them. You will not die. It may feel really unpleasant, but you do not have to act. Imagine putting those thoughts or feelings on a shelf that eventually you can go back to if you feel like you need to. If the facts support that you need to, you can go back and address it. But put it on a shelf for now and use your distress tolerance skills. We've talked about this in other videos. Acknowledge how you're feeling. Be aware of how you're feeling and acknowledge it. It is what it is. If you're angry, all right. If you're depressed, all right. If you're flat, don't feel much of anything. Guess what? All right, it is what it is. Down. Regulate. If you are feeling anxious or angry, it's important to get into your wise mind. Get out of fight or flee so you can engage your higher order thinking. Get out of threat mode and into thinking mode and then decide the best course of action to address the Current thoughts, feelings, environment that is triggering to you in the moment and get to safety. Whether that means calling a friend so or facetiming with a friend so you don't relapse or going to the gym, going out, whatever it is that you're going to do, where you feel less drawn, less tempted, less pulled to relapse. Now let's talk about anger and his buddies. Irritability is a mild form of anger. It's not anger, it's not rage. It's just you're cranky. Irritability is a generalized crankiness that happens when the body factory is imbalanced and tends to be worse. In early recovery, the body is recognizing, hey, everything is out of sync, out of whack. Things aren't running the way they're supposed to. I don't feel the way I'm supposed to. Which triggers a mild form of the threat response. All right, that's okay. You feel irritable. You don't want to start arguing with yourself and telling you yourself how you should feel or embracing the irritability. But because both of those things are going to increase the threat response, when you are irritable, you're vulnerable to overreacting to situations and disregulating. Think of your body like a pressure cooker. Your pressure cooker is already at max pressure when you're irritable. It's where it can be any more, even a little bit more may blow the lid off the pressure cooker. So it may not take anything. That old adage, the straw that broke the camel's back. Well, you may be dealing with a lot of that in early recovery. When your neurotransmitters become imbalanced, your HPA axis, that stress response gets triggered. Lack of porn use and withdrawal is going to cause an imbalance. Lack of quality sleep is going to cause an imbalance. Poor nutrition. Remember, what you put in your body is what your body uses to make the neurotransmitters and the hormones. So if you're eating like crap, you're gonna feel like crap. Excess exercise, getting over trained, or working out too hard where you actually injure yourself or you're just too sore. In general, just having too much stress or feeling overwhelmed in your life can cause you to feel, feel irritable. You are not on the same playing field as everybody else or not starting at the same point on the playing field as everybody else. In early recovery, you're starting 20 yards back. And it's important to recognize that and not measure what you should be able to handle against what somebody else is handling. If you're sick or in pain, you're probably going to be at least a little bit more irritable. I'm sure there are other things that trigger your irritability and it's important to just be aware of those so you can mitigate the impact of the irritability if it happens and when possible, prevent things that are preventable. How are your triggers related to porn use? For example, lack of quality sleep? Well, if you got your circadian rhythms out of whack because of porn use, that's one of the things that's going on. If your neurotransmitters are out of whack because of porn use, that's going to impair your sleep, impair your mood and trigger your irritability. So I want you to really look at these things that typically can trigger irritability and think how's porn related to that? And how can a porn free life help me minimize these triggers? The HPA axis, that stress response is like a child. It wants to make stress or pain stop and it wants to do it now. It doesn't want to wait, it wants immediate gratification. Your prefrontal cortex, the higher order thinking part of your brain, is like the parent. That can help calm the HPA axis, calm the stress response and help you tolerate momentary distress for long term gain. You can tolerate those urges and those cravings for the short term, knowing that in the long term the benefits that recovery holds for you. Hypofrontality in early recovery causes the parent, that prefrontal cortex starts not working as well. And, and so hypofrontality in early recovery causes the parent to have difficulty managing the child, which means you may have more cravings and you may exhibit more tantrums. You just, it seems like life is a whole lot harder to deal with on life's terms. That is normal. As your brain starts to rewire itself, you will be able to and and you develop your skills for distress tolerance. You will be able to downregulate when you get stressed and get into your w mind. So you're no long, no longer hypo frontal, no longer lacking reason in your behaviors. Do what you can to minimize unnecessary stress and triggers. And we've talked in other videos about maintaining your circadian rhythms, keeping a sleep schedule, eating healthfully, etc, do what you can to minimize them. If you know that your uncle Bob is going to be at the family reunion and he gets on your every last nerve, all right, that's okay. Make a plan for it. If you have to go to the reunion, make a plan for how you're going to handle that so you don't get as irritable. Practice acceptance and compassion, your feelings and irritability. It's like the flu. It is what it is. You can't make it just magically go away. It happened for a reason. Now you can address it. Just like with the flu, you can do things to get better, but with feelings, they will happen. They're automatic reactions with urges and cravings. Kind of like the flu. Sometimes you just got to wait them out and paying attention to them. Getting upset about them, struggling with them is only going to prolong how long they stick around. Try not to tangle with the trio. And this is what Hayes calls dirty distress. When you start being angry about the fact that you're irritable, when you start feeling guilty like woulda, coulda, shoulda for biting somebody's head off and being in this situation in the first place. So you were irritable, you bit somebody's head off, and now you're looking back, back at it saying, I woulda, coulda, shoulda handled it differently. But I didn't. Now I feel guilty about the fact that I was irritable. You've just turned up the volume of that stress response. The other example is depression because you're worried about whether you can succeed in recovery and you're ever going to feel happy again. That just adds additional perceived threats to your brain for it to cope with, which is going to make it turn up that stress response. Struggling to eliminate or being angry about having feelings only increases the intensity of the distress. Anger is more intense than irritability, and it's a feeling that's usually triggered by a perceived threat in the present. If someone disrespects you, you may get angry because you feel like you're out of control. You feel like they're a threat to you because they're not respecting you in some way. When we fail, when we're rejected, we often get angry because we think we shoulda, coulda, woulda. But a lot of times, success and acceptance are tied to feeling safe. And when we don't feel safe, it's re registered as a threat. And then we get angry. And loss of control can also trigger anger. Think about times you've gotten cut off in traffic or been behind somebody who was just painfully slow and you had somewhere to be and you just couldn't get around them. How'd you feel? Did you get angry well, you were out of control. Resentment is a form of anger that's been nurtured and marinated for a long time. If I have resentments about something, it's something that I've just been holding on to. Anger is something that happens in in the moment. Resentment, something that you've been carrying with you. How does admitting addiction to pornography trigger anger at yourself? How does it trigger anger at others for giving you access to it, for creating it in the first place, for making you have to use that in order to satisfy your sexual appetite? How does finding out about your porn use trigger anger in others at you? How does it make them feel threatened? How does it trigger anger in others at themselves? How does it make them feel guilty or for what they did or didn't do? What other thoughts or experiences trigger your anger? And how are they directly or indirectly related to pornography use? In order to cope with anger, ultimately we need to forgive. And the mnemonic here is all. So we're forgiving all. Forgiveness is a power play. It's saying, you know what, staying angry or holding on to this resentment, resentment at you or at what happened, it ain't worth my energy and it's not doing me any good. It's actually keeping me from moving forward in my rich and meaningful life. I'm going to forgive you. I'm going to let it go. It doesn't mean I'm going to let it happen again. You can forgive and you can still learn and set boundaries and prevent from happening in the future. Forgiveness is saying, I'm not going to keep throwing energy at that thing in the past. Acknowledge the feeling and thoughts for and against the threat. If there was whatever happened triggered your anger, triggered your resentment. Okay, what thoughts and feelings did you have that contributed to you feeling threatened? Learn about how to stay safe or prevent the behavior in the future and live using your energy to move toward your rich and meaningful life. Make a purposeful choice and say, you know what? That ain't worth my energy. It ain't worth the ulcers it's going to cause me. Apply it. For giving all anger at others, for not understanding or for making you get in this message. How can you acknowledge that feeling and the thoughts that you have that are contributing to that feeling? How can you learn how to stay safe or prevent the behavior in the future? And how can you live using your energy for your rich and meaningful life? For example, if you're in a relationship and your significant other doesn't have the same sexual appetite that you do, so you're not getting sex as much as you want and you start watching porn and then porn just seems easier because you're not risking rejection and blah blah blah. It porn becomes an addiction, it becomes a problem. Then you start getting angry once you realize that you're addicted because that person wouldn't satisfy your needs and desires. Therefore they made you become addicted to porn. All right, well let's look at some of those feelings and thoughts and how accurate or inaccurate they are. Did they actually make you do anything? How can you stay safe or prevent using porn in the future? In many cases with couples, there is a gross lack of communication about sex and sexuality and sexual needs and maybe some non creative or lack of creative problem solving in order to make sure that both partners feel satisfied. So learning how to prevent this situation where you feel resentful because you're not getting laid and you're watching porn and then live using your energy to move toward your rich and meaningful life. How can you use all to forgive others for their anger toward you because of your behaviors? If your significant other or your mother or somebody is angry at you for watching porn, then how can you forgive them for their feelings? How can you acknowledge your feelings about their reaction? How can you learn to stay safe and prevent triggering their anger in the future? And how can you live using your energy to move toward your rich and meaningful life? Moving from anger onto shame and embarrassment, which is a they're forms of anger. Embarrassment is a momentary reaction to a situation that made you feel uncomfortable. When you get rejected, when your roommate walks in on you while you're watching porn. Whatever the case is, we've all been embarrassed. Shame, on the other hand, is a core feeling of being defective or unlovable. When you feel ashamed, you feel like you are unacceptable. It's important to separate the behaviors from who you are. Instead of saying I am unacceptable, maybe saying I did something unacceptable. You are acceptable as a human being. The behavior may not be explore messages and experience that increased your shame. Did that experience actually mean you were unlovable or unacceptable? And this may be you asked somebody out and you got rejected and you felt ashamed. You felt like you were unlovable or unworthy. It may not. Some of them will have to do with watching porn, but some of them may do have to do with what led you to watching porn or becoming addicted to porn. Are you using any cognitive distortions like personalization, mind reading, or all or nothing thinking in order to understand that experience and feel cause it to make you feel ashamed? Explore the facts in Context and alternate explanations. Why did that person reject you? Maybe they just weren't interested. Does that mean that you're not acceptable and lovable? I'll go out on a limb and I'll say, no, that's not what it means. It means you're not their cup of tea. But as my mother used to say, there's plenty of fish in the sea. We don't all fit together like a hand in a glove. If the experience happened to be your best friend, if your best friend went through that experience, would you tell them that they should be ashamed for what happened? Or would you say, you know what sucks, but it's not about you, it's about them. Guilt is different than shame. And too often people say, I'm ashamed for doing this. Shame is a core feature of being unacceptable. Guilt is being angry at yourself for a behavior. If you did something that was unacceptable or you failed to do something that you should have done and that was unacceptable, you may have guilt about using guilt about hurting someone. You care about guilt about losing your job because you were distracted by cravings or using porn all the time. There may be a lot of different things that you feel guilty for, and it will be important to address those and let go of that anger, because guilt is kind of like resentment at yourself. Let go of that anger so you're not continually chastising yourself for it. What triggers your feelings of guilt and how are they directly or indirectly related to your porn use? If your guilt is self anger, which it is, then resolving guilt means letting go of that anger, which means self forgiveness. Oh, coping with guilt or self forgiveness uses that same mnemonic all you acknowledge the mistake with compassion. You learn how to prevent it in the future. And you live by redirecting your energy toward your rich and meaningful life and making amends where needed, using that energy to continue to beat yourself up. Not productive depression. Now we're going to switch gears a little bit. Depression is a feeling of being hopeless and helpless. When your neurotransmitters are out of balance, it's common to feel flat, apathetic, unmotivated, or even outright depressed in early recovery. Some of this may be coming from grief. To resolve the depression, one of the things you're going to have to do is heal your HPA axis your stress response so your neurotransmitters can rebalance, your sleep can improve, and inflammation can be reduced. You also need to identify the things that you believe are hopeless. What beliefs do you have that are contributing to your feeling of being Hopeless and helpless. Explore what aspects of those things you do have the power to control and take steps to change the things you can and figure out how to accept the things that you cannot change. You can't change other people. You can't change other people's feelings or reactions toward you. You can only change how you react to their reactions. Be mindful of the things you do have control over and that make you happy or give you hope in addition to the other stuff that you're dealing with. When you feel hopeless and helpless, the world often seems very gray, very dangerous, dark, very depressing. Hence the depression. It's important to force yourself to notice the things that you where you do have power, where you do have hope and that do make you happy or did make you happy at one point. You may not feel the same level of happiness, but acknowledging that it's not that your whole life sucks and always will, this aspect of it sucks right now. Grief, as I said, may be contributing to the depression. Grief is a complex feeling involving anger and depression. When we have go through the grieving process, there's denial, anger, depression and acceptance. Sometimes there's bargaining, but we're just going to jump that one anger. I feel threatened because I'm losing or have lost something that's important to me. This could be time, this could be relationships, this could be self esteem. There's a lot of things that you may have to grieve. Then you move on to depression. I feel powerless to change the situation and exhausted from this surge of energy, exhausted from being angry. That's okay. Acknowledging that recognizing your depression, being compassionate with yourself is important and and then moving toward acceptance. Grief triggers can include grief over not being able to use porn anymore. Even though you are addicted to porn, it's found a place in your life. And for many people with addictions, the addiction is sort of like their best friend. And it may be hard to think about not ever having that in your life anymore. You may have to grieve over lost time and energy that you could have been using to move toward your rich and meaningful life. And instead you were watching porn. Grieve those lost relationships. What other things do you need to grieve? How are these losses directly or indirectly related to porn use? And is there anything you can do to improve the situation? Resolving grief means deciding to forgive yourself that let go of that guilt and that self anger, forgive yourself, letting go of the anger and using your power to learn from the situation and write the next chapter. It's sort of like the character arc There's a lot of stuff that has happened in your life that has gone into making you who you are today. And you can choose from this moment forward how that stuff impacts you. You can choose in many ways, whether you let yourself perceive yourself as a victim or perceive yourself as a survivor, if you perceive yourself as powerless or perceive yourself as powerful. Hardiness and tragic optimism are two more tools that you can use to deal with distressful emotions in tragic optimism. Instead of toxic optimism that says you just should ignore the bad things and focus on the good things and everything. Sunshine and rainbows. That's not helpful, that's toxic. Tragic optimism acknowledges what is wrong, but also acknowledges what is right and encourages you to have hope for positive change. Building on that is hardiness. And the three core aspects of hardiness are commitment, control, and challenge. Commitment means looking at that rich and meaningful life that you've laid out that you want to work toward and recognizing all of the things in your life that are important that you're committed to, acknowledging which ones are going well and which ones are not going well. At any point in time, if you want to look at it like a pie cut into like a million pieces, there's going to be a portion of that pie that's not going well. I dare say nobody's life is ever, ever 100% perfect in every single way, at least not for a very long period of time. Control. Identifying the aspects of the things that are important to you that are going well, that you can use your energy to control. How can you continue to nurture those things? And what parts of the things that are going poorly can you control? Your porn addiction? All right, you're not going to be able to control how fast your brain rewires itself, but you can control whether or not you engage in behaviors that are going to set your recovery back. And viewing those things that you can do to address the behaviors, viewing those things that you can control as a challenge, thinking, okay, how can I make this better? How can I most effectively use my energy? Think of it like running a 400 yard sprint, and it's a challenge to see if you can beat your own best time. Emotions may or may not be something that you're comfortable thinking about, but they're natural reactions and they're your body's way of communicating with you, saying, hey, based on prior knowledge, there might be a threat, or hey, based on prior knowledge, this is fun. Let's do it again. What you do with your emotions is something you can control, which starts by checking your feelings and your thoughts against the facts. Additionally, what you do with your emotions impacts your recovery trajectory. If you hold on to those distressful thoughts and you continue to beat yourself up for the mistakes that you've made, you're going to slow your progress. There's just no two ways about it. Emotions always impact behaviors and thoughts and are impacted by behaviors and thoughts. You have to address all three in order to achieve true recovery.










