Step 7: Conquer Challenging Emotions
Now that you have some helpful strategies for coping with cravings, you will need skills on board for dealing with some of the other unpleasant feelings that are common in recovery, such as anxiety, sadness, and anger. Most of the CBT, mindfulness, and motivational techniques you’ve already learned can actually help you with these types of emotions. To mobilize these “go-to” skills in a different way, we will review how you can use them when negative feelings come up.
You will face your share of ups and downs in this new phase of your life. Getting equipped to anticipate and cope with them without relapsing will be the focus of this chapter.
More often than not, addictions go hand in hand with other psychological problems. Studies show that as many as two-thirds of people with addictions have mental health issues, the most common of which are anxiety and mood disorders, such as depression (Glasner-Edwards et al. 2009). This is not surprising, right? It makes sense that alcohol or other substances could become a sort of “refuge” for dealing with unpleasant emotions or symptoms.
By now, if you are someone who used to self-medicate your depression or anxiety by drinking or using, you’ve probably learned that in the long run, alcohol and drugs are not the most effective antidepressants. In fact, they make depression and anxiety worse over time. But at the time when you started using them that way, they probably made pretty good Band-Aids. To avoid falling back into the trap of drinking or using as a Band-Aid for negative emotions, you can use the following techniques, which you’ve already practiced for coping with cravings: (1) monitoring and challenging negative thoughts that lead to triggering emotions, (2) revisiting your motivation to remain abstinent, (3) engaging in pleasant activities and other behavioral coping strategies, and (4) using mindfulness-based coping skills. We will briefly review how to apply each of these approaches to coping with negative moods below.
Know Your Negative Emotional Triggers
Back in chapter 5, you completed an exercise on identifying your internal triggers. Those emotional triggers may have included depression, anxiety, anger, jealousy, irritability, boredom, rejection, frustration, guilt or shame, or feeling overwhelmed. Turn back to that exercise (5.1) and review your internal emotional triggers. If you can be one step ahead of these triggers—meaning that you are able to recognize when the emotions are coming on, before they’re full-blown and driving you into relapse mode—then you can stay ahead in your recovery, preventing a relapse before the triggering events can lead you there.
We all feel down sometimes. In early recovery in particular, it is very common to feel sad or depressed on and off for a period of time. This can often be explained by the withdrawal syndrome—in other words, the effects of alcohol or drugs leaving your body. After a month or longer of abstinence from drug or alcohol use, these symptoms may resolve themselves. In some people, however, those depressed feelings persist for longer, and may require additional treatment using medications or therapy.
If you find that you have lingering depression symptoms, it is important to get them evaluated and properly treated, as they can lower your chances of success in addiction recovery if they are not managed (Glasner-Edwards et al. 2009). A list of common symptoms of depression follows; if a few of these persist for longer than a month after you’ve gotten sober, you should consult a professional for evaluation and possible treatment recommendations.
Cognitive Distortions That Lead to Depression and Anxiety
In chapter 6, you took an in-depth look at cognitive distortions that lead to red flag thoughts. As it turns out, these same categories of distortions can lead you to think in ways that fuel sadness and anxiety. Below, you’ll find examples of anxious and depressing thoughts in each of the categories of irrational thoughts that you learned about in chapter 6.
Although there are other types of cognitive distortions, these examples should give you a sense of the types of thoughts linked with depression and anxiety that fit into the various categories of mistakes in thinking. In this next exercise, you are going to begin tracking your own emotionally triggering thoughts, and monitoring how they relate to your cravings for alcohol or drugs.
Exercise 9.1: Mood and Craving Log
To begin to understand what types of thoughts may trigger you to feel sad or depressed, complete the following log, including the specific thoughts, along with a depression rating from 1 to 10—with 1 meaning very slightly depressed, and 10 being the most depressed. Also complete a craving rating from 0 to 10, representing your overall level of cravings for alcohol or drugs on that same day.
| Date | Situation | Thought | Depression Rating (0–10) | Craving Rating (0–10) |
|---|---|---|---|---|
Now that you’ve had some experience with rating your moods and cravings, can you see a connection between them? Do you tend to have stronger cravings on days when you have more frequent depressing thoughts? Or is it when you have a higher depression rating (when the thoughts affect your mood more negatively)? Are there themes or situations that are coming up repeatedly that trigger depressing thoughts? Just take notice of these patterns as a way of deepening your self-understanding. Continue to complete these ratings for at least a few weeks using this form, which is available at http://www.newharbinger.com/32783. Knowing what makes you depressed and how this relates to urges to drink or use will help you to anticipate urges on a down day and put some of your new coping skills to use to get you through it without relapsing.
As you are learning more about the mood symptoms that may make you vulnerable to relapse, it might help you to know that mood and anxiety symptoms often go hand in hand. That is, most people who suffer from depression also experience some level of anxiety. There are different types of anxiety disorders; the most common types that overlap with addiction are reviewed briefly below:
If you think that you may suffer from any of these problems, it is advisable for you to get evaluated by a mental health professional to confirm a diagnosis and consider some treatment recommendations. You may find, though, that you have some symptoms of worry, anxiety, or panic even if it is not a diagnosable disorder. These symptoms could worsen temporarily in early recovery, as alcohol or drugs leave your body and you begin to experience some of the emotions that you might have been suppressing while you were drinking or using. With the log below, you can start recording your anxious thoughts, just as you did for your depression, to get a sense of how frequently they are happening, what situations they are linked to, and how they might relate to your cravings or urges to use.
Exercise 9.2: Anxiety and Craving Log
To begin to understand what types of thoughts may trigger you to feel anxious, complete the following log, including thoughts that make you feel anxious or nervous, along with an anxiety rating from 1 to 10, with 1 meaning very slightly anxious, and 10 being the most anxious you’ve felt. Also complete a craving rating from 0 to 10, representing your overall level of cravings for alcohol or drugs on that same day.
| Date | Situation | Thought | Anxiety Rating (0–10) | Craving Rating (0–10) |
|---|---|---|---|---|
Just as you did with your log of depressing thoughts, take a look at your responses here and look for patterns. How do your anxious thoughts relate to your cravings for alcohol or drugs? Do you notice any themes or situations that are common to many of your anxious thoughts? Use this exercise to continue to build your self expertise. Do you need to read up more on anxiety and how to manage it? Or are depressing thoughts more of an issue for you? Understanding the emotions that you experience that make you the most vulnerable will empower you in your healing process. If you are currently in counseling or therapy, you can review these exercises with your counselor or therapist.
Earlier in this workbook, you learned to challenge red flag thoughts using the three T’s: (1) identifying the triggering situation, (2) describing the thought, and (3) placing the thought on trial. You can use the same strategy to challenge negative, depressing, or anxious thinking—what we’ll call dysfunctional thoughts. Let’s consider Alicia’s example:
Alicia’s Negative Thinking
Alicia has been sober from alcohol for nearly a month. She is invited to a work party at a restaurant with a bar, where she knows that many of her colleagues will be drinking and dancing. Alicia decides to invite Vince, a new love interest of hers who is also sober. She and Vince have been out for coffee together a few times, on his invitation, but this is the first time Alicia has asked him out. He enthusiastically accepts her invitation, but then, on the day before the party, he tells her that he got called in to work on a project and he won’t be able to make it. He apologizes and asks her if she’d like to go out for dinner another night, after his project is completed. Alicia feels very hurt and rejected. She thinks, I was probably completely wrong about him. I have nothing going for me. I’m sure Vince only said yes in the first place because he feels sorry for me. I’m always going to be alone.
In the past, Alicia would have wound up going to the party and drinking as a result of these types of depressive and anxious thoughts, but this time she tries thought challenging, using the three T’s:
Now that Alicia has considered her thoughts using the three T’s, she can see that she made a few mistakes in thinking: she was discounting the positive when she told herself that Vince was just feeling sorry for her; she was using black-or-white thinking when she told herself that she had nothing going for herself, and she was jumping to conclusions when she thought that she would always be alone. In the right hand column, titled “The Facts,” Alicia successfully challenged and replaced her negative thoughts with more rational thinking.
In this next exercise, you can practice challenging some of your own depressed or anxious thoughts using the three T’s.
Exercise 9.3: Challenging Your Negative Thoughts
In this exercise, you are going to think about two recent situations in which you felt depressed or anxious, and describe them. For each situation, you will write down the negative thought that went through your mind, along with the emotion that you felt. After you identify the thought error you made, you will practice the three T’s of thought challenging. You can refer back to Exercise 6.1 to refresh your memory about how you did this when you were working on your red flag thoughts.
Situation #1:
Negative thoughts and emotions that the thoughts led to:
Thoughts on trial:
Evidence that the thoughts are accurate:
Evidence that the thoughts are not accurate:
Response (What can you tell yourself to see the situation more realistically?):
Situation #2:
Negative thoughts and emotions that the thoughts led to:
Thoughts on trial:
Evidence that the thoughts are accurate:
Evidence that the thoughts are not accurate:
Response (What can you tell yourself to see the situation more realistically?):
Do you ever find yourself losing your cool when you’re angry? Most of us do, at one time or another. If this is a frequent experience for you, and if anger is one of your relapse triggers, then having some healthy coping tools and outlets for it is going to come in really handy for you as you work toward your recovery.
One of the most important things to keep in mind is that there are many disadvantages to losing your temper, aside from how it feels and the potential for relapse that it brings. When you raise your voice or otherwise act out aggressively in anger:
The first step to getting a handle on your anger is to understand how it feels, so that you can anticipate when it’s coming on. Take a moment and think about how you experience anger. Where do you feel it in your body? What kinds of thoughts go through your head when you are feeling angry? Jot down some notes about it below.
When I am angry:
These are the physical sensations I experience:
These are some of the thoughts that frequently go through my mind:
These are some of the ways that I express it when I can’t control it:
The next step to learning how to effectively manage anger is to figure out what triggers it. In the exercise that follows, you are going to identify your anger triggers. First, let’s look at an example of how uncontrollable anger can unfold and create unwanted consequences.
Jenny Gets Angry
Jenny has been sober from alcohol for six weeks. She and her husband have been in some conflict recently about the division of responsibilities between them. On Saturday, their son Sammy has basketball practice at two o’clock. Jenny wants to get together with some friends around one o’clock and she tells her husband that he needs to take Sammy to practice. He refuses, saying that he has things to do. He leaves the house before she can get a word in edgewise. Jenny is enraged. Thoughts are racing through her head. He has no respect for me, or my time! If he keeps this up I will never have a life. I’m going to let him have it! Unable to reach him, she leaves him a very angry, screaming voice mail. Her son, after witnessing all of this, says, “Mommy, why are you so mad at Dad? You don’t like going with me to basketball?” Jenny feels very guilty and ashamed of her behavior. Suddenly she finds herself experiencing a very strong craving for alcohol.
Thinking about Jenny’s situation, you can probably see the various consequences of her inability to control her anger. She felt out of control; she reacted toward her husband in a way that probably did not resolve anything; and in the process, she unintentionally hurt her son’s feelings and modeled poor anger control. She ended up feeling ashamed, and this affected her recovery by setting her up for a strong alcohol craving.
Exercise 9.4: Anger Triggers
Identifying your personal anger triggers is the first step toward learning how to cope with anger more effectively. Usually, anger triggers fall into one of five categories:
• People (such as Jenny’s husband)
• Places (such as the car, if you’re someone who experiences frustration and anger management problems on the road)
• Feelings (such as feeling rejected, ignored, restless, or impatient)
• Thoughts (such as thoughts about the inefficiency of other people—for example, Why is this line taking so long? I have somewhere to be!)
• Physical sensations (such as physical discomfort from alcohol or drug withdrawal, which can create irritability and anger)
Write down your anger triggers in each of these categories below:
People:
Places:
Thoughts:
Feelings:
Physical sensations:
Now that you are aware of your personal anger triggers, you need to learn to give it a beat—to take a few moments to calm down when you feel angry and think about next steps. You don’t need to react on impulse or “take the bait” from someone who says or does something that provokes you to feel angry. Instead, you can choose to remain in control, rise above it, and cope with it in such a way that you will be able to look back and think, I’m proud of the way I handled that. This doesn’t mean that you shouldn’t feel angry. Anger control is not about preventing the experience of anger; it is about controlling your response to it. Here are some coping strategies that you can try when you give it a beat:
When you’ve calmed yourself down in the moment, then you can begin to think about how you can challenge angry thoughts. Use the assertive communication skills that you practiced in chapter 4 to communicate about the situation that made you angry in an effective manner that enables you to get your needs met.
Coming back to Jenny’s situation, let’s take a look at how she might challenge her angry thoughts by considering the consequences of her behavior and coming up with an inner dialogue that can help to lessen her angry feelings:
Triggering situation: Feeling that her needs were ignored by her husband. He refused to take Sammy to basketball practice, which made her unable to carry out her social plans.
Angry thoughts: He has no respect for me, or my time! If he keeps this up I will never have a life. I’m going to let him have it!
Alternative responses:
Using any of these alternative responses will help Jenny to feel less angry and to build confidence in her ability to manage anger as it comes up. In this next exercise, you will give some thought to your own anger and how you can plan to respond to angry feelings differently.
Exercise 9.5: Changing Angry Behavior
In this exercise, you will think about a time when you were angry and reacted to your anger in ways that were unhelpful. You will then come up with some alternative responses that you could have used. Thinking this through can prepare you to use healthier strategies the next time you feel angry.
When I felt angry…
The trigger was:
These thoughts went through my mind:
My unhealthy responses were:
Some alternative, healthier responses might have been:
So far in this chapter, you’ve been practicing cognitive strategies for managing negative emotions—namely, identifying and challenging the thoughts that lead to them. This can be a very effective approach. But sometimes, for various reasons, a behavioral technique (in other words, doing something therapeutic rather than thinking your way through it) or a less time-intensive cognitive technique (like saying a quick reassuring phrase to yourself) may be a better choice for you. Here, we review a range of therapeutic strategies that you can try in the face of any negative feeling that might be triggering for you, whether it’s anger, sadness, guilt, shame, anxiety, or another emotion.
No matter what it is that triggers an urge to drink or use, reminding yourself of the reasons that you are working so hard to stay sober can be a very effective tool to keep you on track with your recovery goals. This is no different when it comes to negative emotions. Go back to exercise 3.2 in chapter 3, Resolving Your Ambivalence, in which you explored the benefits and drawbacks of quitting versus continuing to drink or use. If you completed this exercise thoroughly, you should see something about relief from depression, anxiety, or any other triggering negative emotion for you as one of the benefits of continuing to drink or use. Now take a look at the drawbacks you listed of continuing to drink or use, along with the benefits of quitting. Any time you feel tempted by a negative emotion, you can revisit this exercise. After you’ve thought carefully about your reasons for quitting, then rate your motivation for sobriety on a scale from 0 to 10, with zero meaning that you are not motivated at all, and 10 meaning that you are as motivated as you can possibly be.
0 1 2 3 4 5 6 7 8 9 10
Not Motivated Somewhat Motivated Motivated Highly Motivated
Wherever you are on the scale, ask yourself what it would take to move one point higher. Keeping your motivation strong—partly by reminding yourself of the reasons you are going to all of this trouble to stay sober—will help you resist the temptation to drink or use when you are feeling down.
Studies show that negative emotions are among the most common relapse triggers. The great news is, the most useful techniques for coping with negative emotions are the same as those that you’ve been using to cope with cravings to drink or use—such as challenging your thoughts, practicing mindfulness, learning acceptance, and engaging in pleasant activities. Now you just need to apply these strategies to your negative thoughts and feelings, as you’ve been practicing by using the exercises in this chapter.
By this point you’ve learned all of the essential skills that you need to manage the road to recovery. In the next and last chapter of this book, putting all of your hard work together, you will reflect on all that you’ve learned and—based on what you’ve observed to be the most helpful strategies—you will put together an integrated, personalized relapse prevention plan that you can use going forward in your recovery process.