Behavioural Change

Regular meditation has been on my list of things to do for a long time. Well known benefits of meditation include providing a sense of peace, relaxation and a greater level of self-awareness to those engaging in the discipline. I decided to make it the basis for my self-management project or an attempt to make behavioral change. This blog entry provides a review of the project and includes a description of the reinforcers used, results of the intervention, and a discussion about the outcome. The blog examines the role of meditation as a treatment for substance abuse, in addition to explaining why the behaviour was chosen.

The Chosen Behaviour

In the year 2000, I met a Swami from India at a local yoga studio. During hot summer days in Santa Monica, we would meet for tea and attempt to solve the problems of the world. Mostly we would discuss my problems! It was not long before I realized the Swami had one answer for my problems, and it was always the same answer: meditation. He insisted I meditate for ten minutes in the morning, and ten minutes in the evening. He assured me my problems would resolve themselves. I did not listen to him. Maybe I preferred a life of problems. However, I participated in meditation retreats, and loved the experience of several days in silence with the occasional hours spent listening to my “drunken monkey mind”: a phrase donated by a previous therapist. I enjoyed the sense of peace which pervaded my soul and put regular meditation on my list of things to do. 

In my work as a drug and alcohol counsellor, I encouraged meditation as a routine practice that helps support relapse prevention. Since much of relapse happens unconsciously, the act of placing the attention with intention can seep into one’s everyday life. Automatic thoughts or unconscious behaviours might be more apparent if one makes it a regular practice to focus one’s attention with intention. Personally, I had not been diligent enough to add meditation to my own routine. Consequently, it was still on the list when we were given this project. I was excited to begin my meditation practice.

Baseline

I began my diary with two meditation sessions a day: one at 7am for ten minutes, and the other at 10pm for ten minutes. Meditation was operationalized as the sitting down in a room with eyes closed. I focused on my breath going in and out, while paying attention to my thoughts. I refocused my attention on my breath whenever I felt my attention drift. During the first three weeks I meditated five times out of a possible 42. The result was disappointing, but exciting because I hoped with the use of interventions, my performance could only improve.

The Interventions

According to and in response to the provided instructions for the project, I chose five interventions. The interventions were mini Snickers, Milky Way both dark and milk, mini Twix and mini Baby Ruths. I decided I would start with the chocolates I liked least and work my way up to Twix if I needed a boost. Unfortunately, the mini Twix did not even work, so I changed the intervention and ate the chocolate before meditating instead of afterwards. This did not improve results. One Sunday, I was fed up and ate the remainder of the giant bag of mini chocolates. The following Monday, interventions were clarified and I realized I needed five totally different interventions.

I started to set an alarm especially for meditation. I set the alarm ten minutes early in the morning and I set it to ring in the evenings. Most of the time, I switched off the alarm. In the morning, I snoozed the alarm and mostly went back to sleep. 

My next intervention involved setting reminders on my iPad. They are very loud and impossible to ignore. I set a visual alert in addition to a sound alert. Unfortunately, I found out there was an on/off button for the auditory alert, and I “learned” to shut down my ipad before 10pm, so as not to be reminded visually.

As I glanced over my data, I noticed that I made a habit of walking the pups at meditation time. I tried changing their walk times to accommodate meditation. This was unsuccessful, as the pups would invariably want to walk on their schedule not mine. My meditation schedule was consequently not enforced.

As time went by and my morale started to disintegrate, I wondered about the way in which I help my clients to change their behaviour. I encourage them to balance all areas of life, and change multiple areas to support their primary behavioural change. I began to wonder if that would help. Unfortunately, this wonderment began after the five weeks were finished. 

I did improve my percentage of sessions in meditation during the intervention stage versus the baseline stage. I meditated 12% of the time during the baseline phase and 18% of the time with the interventions. The results were disappointing and made me think about my job as a counsellor.

The Hypocrisy

There is a suggestion that one can only take their clients where one has been themselves. I felt like a fraud. How could I show my face at work? The thought irked me. After the experiment was over, and the pressure to perform was relieved, I decided to change other areas of my life.

I changed my diet and lowered my intake of carbohydrates, especially the empty calories and especially the chocolate. I tried to get myself into a regular exercise routine beyond walking the pups. I went to bed at the same time each night and got up slightly earlier. I began to feel better. And then I began to meditate. Since the experiment has been over, I meditate once or twice a day with few exceptions. I learned the importance of balance, and the importance of changing areas of life that will support an overall healthier lifestyle.

Meditation as a Treatment for Substance Abuse

Interestingly enough, there were not as many studies done on the subject of mindfulness or meditation in the last five years as I expected. Jon Kabat-Zinn (2005) defines mindfulness as ‘‘moment to moment nonjudgmental awareness cultivated by paying attention in a specific way, that is, in the present moment, and as non-judgmentally and as openheartedly as possible’’ (p. 108).  O’Connell, an Australian psychiatrist wrote of his experiences in an acute dual-diagnosis unit for substance abuse. He defined addiction as “the absence of mindfulness” (2009, p.150) and made strong recommendations for a mindfulness centered treatment for chemical dependency.

Brewer conducted studies on the benefits of mindfulness training particularly for people struggling with Major Depressive Disorders (MDD) or Substance Abuse Disorders (SUD). Brewer (2012) cites one of the major benefits of mindfulness training as “the placement of attention on the immediate experience” (p. 130). The study also showed that the benefits of mindfulness training emerged due to the subject engaging the experience in an open, curious way (Brewer, 2012).

The Challenges in Changing Behaviour

Changing any kind of behaviour is no minor task. Human beings are creatures of habit making daily decisions based on what they know and have always done. If one thinks that behaviour is mostly learned, this theory makes sense. Presumably all one needs to do is retrain the brain; this is easier said than done. Flora (2012) conducted a study in Greece in 2012 with 46 adults in treatment for substance abuse. She tried to help people become better agents of change by working on changing their underlying schemas. She had little success either with changing people’s schemas or their narratives (Flora, 2012).

Flora (2012) did not explore the idea of self-efficacy in her study. Others have looked at self-efficacy, amongst them Ilgen. In 2007, Ilgen conducted a study with 2350 people who were attempting sobriety. Ilgen (2007) discovered that certain traits made some people more likely to stay sober than others. “ Because of the close relationship between self-efficacy and treatment outcomes, providers may want to target patients with low self-efficacy for interventions” (p.126). This study was also impressive because he was actually able to find such a big sample of people claiming a year’s sobriety.

Conclusion

Although the experiment for me to add a twice daily meditation session was difficult, I learned a great deal through the process. I learned to have more empathy and compassion for my clients addicted to substance or process. I found it difficult to add a behaviour without the neurochemical complications inherent in addiction. It made me realize what an uphill struggle change can be, and also gave me insight into why few people want to work in a field with few success stories.

My research on the subject validated that meditation helps people become more self-aware and consequently better equipped to deal with potential relapse scenarios. The experiment and research also validated that a multi-modal plan of treatment is likely to have a better outcome. As Aristotle said, “moderation in all things;” maybe he would have had more success at adding meditation to his daily routine than I had.

And why did I add this story to my blog on this website? Mainly because of the importance of a consistent meditation practice alongside a tending to the dream world. Meditation assists in the attention paid to dreams at night. As I pay attention to my thoughts during the day, I pay attention to my dreams at night. The more self-aware I am, the more likely I am to have a lucid dream.

Let the behavioural change begin…

References

Brewer, J. A., Elwafi, H. M., & Davis, J. H. (2012). Craving to quit: Psychological models and neurobiological mechanisms of mindfulness training as treatment for addictions. Psychology of Addictive Behaviors, doi: 10.1037/a0028490

Flora, K. (2012). Recovery from substance abuse: A narrative approach to understanding the motivation and ambivalence about change. Journal of Social Work Practice in the Addictions, 12(3), 302-315. doi: 10.1080/1533256X.2012.702630

Ilgen, M. (20070101). Personal and treatment-related predictors of abstinence self-efficacy. Journal of Studies on Alcohol and Drugs, 68(1)

Kabat-Zinn, J. (2005). Coming to our senses. (1^st ed.). New York: Hyperion.

O’Connell, O. (2009). Introducing mindfulness as an adjunct treatment in an established residential drug and alcohol facility. The Humanistic Psychologist, 37(2), 178-191. doi: 10.1080/08873260902892162