Stress Self-Monitoring and Relapse

By Terence T. Gorski
www.relapse.org 

An exciting new development in the treatment of addiction is the integration of stress management into the treatment and recovery process.  Although stress management has been recognized as an important adjunct to addiction treatment for over twenty years, the relationship between acute stress reactions, denial and treatment resistance is now becoming clear.  As stress goes up, so does denial and treatment resistance.  A key to effectively managing denial and treatment resistance is to teach recovering people to recognize their stress levels and use immediate relaxation techniques to lower their stress.

Recovering people are especially vulnerable to stress.  There is a growing body of evidence that many addicted people have brain chemistry imbalances that predispose them to both addiction and difficulty in managing stress.  The regular and heavy use of alcohol and other drugs can cause toxic effects to the brain that create symptoms that cause additional stress and interfere with effective stress management.

Many recovering people have severe problems with Post Acute Withdrawal (PAW).  PAW is caused by brain chemistry imbalances that are related to addiction that disrupt the ability to think clearly, manage feelings and emotions, manage stress, and self-regulate behavior.  PAW is stress sensitive.  As the level of stress goes up, the severity of PAW symptoms increases.  As PAW symptoms get worse, recovering people start losing their ability to effectively manage their stress.  As a result they are locked into chronic states of high stress that cause them to vacillate between emotional numbness and emotional overreaction.

According to the National Institute on Drug Abuse, exposure to stress is one of the most powerful triggers for relapse to substance abuse in addicted individuals, even after long periods of abstinence.  Stress can cause a problem drinker to drink more, and a recovering alcoholic to relapse.

Many counselors are dealing with these stress related problems by using a simple tool called The Stress Thermometer.

The Stress Thermometer

The Stress Thermometer is a self-monitoring tool that teaches people to become aware of their current stress levels, notice increases and decreases in stress during sessions, and encourages the use of immediate relaxation techniques to lower stress as soon a stress levels begin to rise.  The stress thermometer makes the problem of stress an acceptable issue to bring up any time stress levels increase to a point where denial and resistance are activated.

The concept of using a stress thermometer came from thinking about how we use a temperature thermometer to measure our body temperature.  When we take our body temperature we use a thermometer to tell us accurately and objectively what our body temperature is.  When we use a stress thermometer, we use a system for self-monitoring our stress levels that can tell us accurately and objectively how high our stress levels are.

The stress thermometer is divided into four color-coded regions: blue – relaxation, green – functional, yellow – acute stress reaction, and red – trauma reaction.

Relaxation: Stress levels of 1, 2, and 3 are coded blue. Blue is a color that represents a state of relaxation. We are relaxed and attending to the completion of any tasks. Stress Level 1: Relaxed Nearly Asleep; Stress Level 2: Relaxed – Not Focused; and Stress Level 3: Relaxed – Focused

Functional Stress: Stress levels 4, 5 & 6 designate the zone of functional stress. They are coded green because green is a color that represents “go”.  At stress levels 4, 5, and 6 we are experiencing stress levels that are high enough to give us the energy we need to get things done but are not so high that the stress begins to impair our performance.  Stress Level 4: Focused and Active; Stress Level 5: Free Flow With No Effort; and Stress Level 6: Free Flow With Effort.

Acute Stress Reaction: Stress level 7, 8, and 9 are coded yellow. The color yellow represents caution. At stress levels 7, 8, and 9 we are experiencing an acute stress reaction. The word acute means immediate and severe. Our immediate levels of stress have gotten so high that we can’t consistently function normally. We’re in danger. Stress Level 7: Space Out; Stress Level 8: Get Defensive; and Stress Level 9: Overreact.

Traunatic Stress: Level 10 Plus

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