Coping with Urges

Robert Westermeyer, Ph.D.

Habits & urges go hand in hand. In fact, many people in the throes of an addictive behavior problem, whether it's overeating, drug use or alcohol abuse, claim that they derive no pleasure from their habit -that it's nothing but the relentless craving that fuels ongoing addictive behavior.

What's usually most difficult for people when changing a bad habit is coping with the sometimes relentless urges. The initial days of a habit kicking plan can be exhausting as urges dominate thinking & interfere with daily routine.

Many people give up change efforts because they feel that there isn't a way they can function without their habit as the urges interfere too much with the quality of life.

It's important to remember that urges, in & of themselves, are normal. We experience craving in varying degrees every day. And because your habit has been important to you for a long time, it may be unreasonable to expect urges to vanish completely.

What's hoped is that you'll come to experience urges with less frequency & that when they're experienced you'll be able to react in a way that avoids relapse.

The "three Ds" can be helpful in coping with urges & craving, whether these urges are related to alcohol or drug use, overeating , tobacco use or any habit you're attempting to change. The D's stand for Decatastrophizing, Disputing expectancies & Distracting.

Decatastrophizing

Especially early on in your change efforts, craving can seem excruciating. Your daily routine has been altered by the elimination of an important part of life & now you can't get your mind off it. Everything you see reminds you of your habit. If you smoke, every room you enter may bring to mind the image of a cigarette & associated pleasure.

The inability to satisfy the urge can lead to frustration & inner statements like, "I can't stand this!" or "There is no way I'll be able to live without giving in. I'll just go crazy!" Statements like this can be overwhelming. So much so that people often give up efforts.

As is the case with anxiety, catastrophic thoughts can lead to a great deal of arousal which can, in turn, make things seem worse than they are. If you believe that you're completely out of control, your emotions will follow. What's important to remember is that urges are normal & typically decline in intensity as you continue implementing change.

To combat catastrophic reactions to urges it's important to remind yourself of times in the past when you have successfully changed habits (think now, we all have done so at least once or twice!). Do you still experience urges?

If so, are they as intense as during the initial phase of your change efforts? Probably not, right?

Furthermore, think about other people you've known who have undergone significant change. Do they seem haunted by urges such that they can't function? If not, who is to say that you can't accomplish that also?

Try to take some of the power away from a black & white adjective like "horrible" or "unbearable." Belief in horrible extremes only makes you feel worse. Just how unbearable is your urge right now?

To accurately answer this you may need to conjure images of what other types of suffering reported as unbearable are like. Is this as unbearable as getting stabbed in the stomach? Or better still, what have you endured which was worse than your current urge? Was that unbearable? If so, does it follow that your urge is less than unbearable & perhaps only "very uncomfortable."

Disputing Expectancies

Craving is, in essence, the activation of expectancies. Beck & his colleagues (Cognitive Therapy of Substance Abuse, 1993, Guilford Publications) believe that there are 3 beliefs associated with "the acute decision to engage in substance abuse."

They're Anticipatory, such as "I'm gonna be Mr. Wonderful after one line." Relief Oriented, such as "I won't have to think about work if I drink this bottle of wine." & Facilitative or Permissive, such as , " I've been good all week, I'm entitled to an evening high."

Though Beck & his colleagues presented these fundamental beliefs in reference to substance abuse problems, it's this author's contention that these beliefs can function in any habit urge.

Since we rarely think about distant consequences when craving, bring them to mind deliberately. Bring to mind the negative emotions which may be experienced at a later time due to engaging in your habit. Urges are "myopic" in that they can only see advantages. You must shed some light on your craving in order to effectively control it.

Ask yourself questions like:

* How will I feel later if I give in to my urges?"

* What consequences might I suffer if I give in?"

* Will the negatives outweigh the positives in the long run if I give in?"

Another way to cope with urges is to imagine that someone very close to you is voicing the very urge you're experiencing. How would you go about convincing them not go give in. Sometimes distancing ourselves from our urges is imperative before you can subject them to any scrutiny.

Your ability to conjure vivid images can be used in your favor when you experience craving. In the presence of a strong urge, try to imagine a very negative outcome. The more negatively graphic the better. The more true to your life the better; i.e., if you have a problem with alcohol & experience a strong urge to walk down to the convince store & buy a bottle of Vodka, imagine the worst hangover possible.

Imagine vomiting all morning. Better still - imagine someone very important dropping by, someone you really want to impress & seeing you in that condition. It's amazing how powerful our own imagination can be in fueling & impeding behavior. Use it to your advantage in your habit change efforts!

Distracting

Some urges are so relentless that talking back to them is insufficient. You still can't get your mind off your habit. Good old fashioned distraction is sometimes the only medicine that can pull your thoughts away.

Distraction can be cognitive, in the form of some mental exercises, or behavioral, in the form of activity. Certainly the latter is going to be the most effective, in that urges tend to occur in environments with are the same or similar to those in which the habit occurred in the past.

If you're trying to quit smoking & you've previously smoked at in your office all day, being in your office is going to elicit a strong drive to light up. Certainly if possible, taking your work into a conference room, or taking a break & walking outside will often be enough to decrease the urge to a manageable level.

You must evaluate your schedule & determine which situations evoke the most intense craving & create as much flexibility as possible so that you can "escape" if necessary - especially in the initial days of your change efforts.

Cognitive distraction can be very powerful. Certainly imagery has been used as a means of helping stressed people learn to relax. You too can use imagery to take your mind off an urge which is dominating consciousness. Conjuring a pleasant place like a beach or on a raft in a lake can help you not only take your mind off the urge but relax as well.

However, "relaxing" images aren't helpful for everyone. Some find that if they relax when craving they'll only want it more. This makes sense as we've discussed that many habits are associated with relaxation & pleasure & evoking these feelings in places previously associated with your habit can strengthen urges tremendously.

I recommend that you find some mental task that will be very difficult to finish but which is interesting & consuming that you can activate in response to an urge. I like to refer to these as Mental Tapes. Some examples of tapes which have been helpful are:

* Writing the perfect epic novel or screenplay.

*  Planning the perfect vacation.

*  Creating the ideal money-making business

*  Interpreting a dream from the night before

* Picking an acquaintance & trying to "figure them out."

Certainly what you choose will depend on your interests, but the key is to make it something that'll be easy & perhaps interesting & fun to do. Choosing to think about all the mistakes you've made this year & how you could have done things differently isn't going to prove a good distraction tape as it won't be enjoyable.

In fact it may increase the power of your urge, especially if stress has precipitated your habit in the past.

It's sometimes best to try one urge control technique at a time so that you don't get overwhelmed. These techniques work, but they also require a great deal of mental energy & conscious effort. The aim here isn't to make change excruciating or extraordinarily taxing, but to provide you with some tools which you can add to your armory at a your own pace.

Triggers, Panic Attacks & Flashbacks

After I was raped, I was surprised to find myself being reminded of the experience constantly. These reminders, which I soon found out were called triggers, were incredibly intrusive. A simple word sometimes can still leave me feeling anxious or sad.

When I heard my rapist's very common last name spoken over a loudspeaker, I was brought back into my bedroom, screaming for Bill. Even things that weren't related to the attack brought on panic attacks.

i.e., I woke up late for work one morning & found myself in the midst of a terrifying panic attack. Simply feeling out of control had brought those feelings out in me again. It takes hard work to learn to cope with these feelings, but we're capable of understanding & mastering them.

Flashbacks

Flashbacks occur when we're triggered to remember what happened. A flashback can be a terribly frightening experiencing, involving all of the senses.

Many survivors say that they can see, hear, smell & feel everything that had happened to them during a flashback. After a traumatic experience, it isn't unusual for us to block part of the memory, banish it from consciousness.

Sometimes a forgotten memory of rape or abuse will resurface in the form of a flashback, which can be particularly terrifying & confusing.

Often, flashbacks have something to tell us & they present themselves to let us know that part of the trauma is waiting to be resolved. If you're having flashbacks, I urge you to find a safe place to think about them or talk about them.

Counseling is an especially important option, since flashbacks can be a symptom of Post Traumatic Stress Syndrome.

Dealing With Flashbacks

• Recognize what triggers flashbacks for you. Our triggers are all personal. For some friends, drinking out of a bottle can trigger a flashback. Others say that hearing words spoken during the rape or abuse can cause a flashback. For me, hearing "Me & A Gun" can send me right into one.

• I carry a rock with me when I'm feeling triggery & when I have a flashback, it helps to hold onto it because it provides a sense of stability.

• Try to remind yourself of your surroundings. Open your eyes & look around, telling yourself that you're safe can help

• After the flashback is over, try to understand it. They're terrifying, but usually a sign that we are ready to remember & feel the emotions connected to what has happened to us.

Panic Attacks

A panic or anxiety attack is a radical & quick acting physiological reaction the human body can have when we feel fear. As people who have know true & profound fear we survivors are more prone to them than most. If you have them, you're not alone. Most survivors have had them.

Signs of A Panic Attack

Your heart may be beating quickly or seem to be skipping beats.

You may have difficulty breathing or catching your breath.

Constant shaking &/or twitching

You may feel like you can't think straight, like you can't make decisions or have too many thoughts bouncing around in your head.

Your mouth may become dry & you may find it hard to swallow.

You may feel tingling in the hands, feet or other parts of the body (I get it in my back)

Tense muscles, clenched jaws.

There are many more, but these are some of the major ones. Keep in mind, you don't need to have all of these to be having a panic attack. A friend of mine only has difficulty breathing but she was diagnosed as having panic attacks. If you have some of these symptoms I hope you'll talk to a counselor about them.

Thoughts on Confronting Panic Attacks

• It's OK to be having them. It doesn't make you wierd or abnormal. You'd be surprised at how many people have them. In fact, I had dinner with 3 other girlfriends & told them about my panic attacks & they all told me that they also have panic attacks. We decided that only boring people don't have them.

• Many of us fear having one in public, at work or school etc. First of all, even though you feel like you're going nuts, there are few outward symptoms. If you're scared of having one in public give yourself permission to go to the bathroom & spend some time by yourself.

• A lot of people are terrified of having them. Look at it as practice, to gain control of them & learn techniques to deal with them, what works, what doesn't. Fearing them gives the panic reaction more power over you than it deserves.

• Putting pressure on yourself to deal with them RIGHT now is not a great idea. It makes them worse. Try & give yourself permission to have them wherever you are. Find a quiet place, go to the bathroom, go outside. Do whatever makes you comfortable.

• If you're going to be in a stressful situation & fear panicking, it may help to visualize yourself going thru the experience calmly before it actually occurs.

If You are Panicking

• Take deep breaths from the stomach, not the lungs. Lie down & watch your tummy move up & down to practice these deep breaths. Someone gave the tip of lying down with a book on your stomach & watching the book. I don't remember who, but I can't take credit for this brilliant idea.

• I try to stay focused on my breathing, by counting the breaths or just thinking.

• I might inhale & think "Focused" Exhale & think "Centered"

• Sometimes I inhale & think "It's going to be..." Exhale..."Okay"

• Simple repetitive tasks can help. At work, I used to make flashcards for my students, which is dull but focusing. One good idea might be to organize all of the change in your pockets. Put the pennies in year order, then the nickels, then the dimes, then the quarters. Just a stupid non-thinking but focusing task. Count how many people are wearing red & how many are wearing blue & compare the numbers.

• Herbal remedies have helped me. Lavendar essential oil is a very calming scent. I used to wear it constantly. In addition, I like Rescue Remedy, which is a natural solution for stressful moments. However, my doctor did prescribe medication for me & I carried it around with me for months, just in case I had an attack.

While you try these it's important to think positively. Thinking "Why isn't this working? It has to start working!" doesn't help & makes the situation worse. It may take a few minutes, it may take more. That doesn't mean that you're doing anything wrong. It just means that it's taking time.

Also, getting to know your physical symptoms helps. I know that the first sign of an attack is tingling in my back & my hair standing up on end. If that happens, I start breathing right away, making tea for myself or trying a herbal remedy.

Sleeping & Nightmares

After my rape, I had a lot of difficulty falling asleep & when I finally did my sleep was sometimes interrupted by nightmares. I've found that this is really common among survivors. Most of us experience these problems at some point in time in our healing.

Sleeping Tips

• Wake early to excercise. I find that going to they gym in the evening gives me enough energy to start my whole day again.

• Make sure you use your bedroom for sleeping only. If you live in a college dormitory or with your family, try to use your desk for activities like studying & reading.

• Make a bedtime ritual. I usually drink a cup of Celestial Seasoning's Sleepytime Extra. It has herbs in it to aid sleep, but since it is a ritual, I feel like it sends my body a signal saying, "Sleep is coming."

• Some people find that natural remedies, like Valerian, Kava Kava & Melatonin, which can be found at your health food store help. Others find that melatonin, in particular, causes nightmares.

• Avoid caffienated beverages in the afternoon.

• Alcohol might make you fall asleep, but you'll probably wake up after long, so try to avoid drinking before bed.

• Avoid exciting activities before bed. Watching exciting movies or playing competitive games doesn't put most of us in the mood for sleep.

• Lock your bedroom door if it makes you feel safer. Sometimes, I'll picture people I love standing outside the door, ready to protect me. Silly, I know, but it helps me feel safe.

• Daydream when you get into bed. I usually day dream about being at the beach, watching the sunset, which sometimes brings me into a dream.

• Relax each muscle, starting with your feet & working up to the rest of your body.

• Sleep with a stuffed animal!. It's not silly. I sleep with Puppy & I know a lot of other people who have their favorite friends accomany them to bed.

• Wear lavendar oil to bed. It's a really calming scent. I dab it onto my pillowcases & there are lavendar washes that you can buy to scent your sheets, like this one.

• If you have difficulty falling asleep or sometimes wake up in the middle of the night, make sure that a quiet, relaxing activity is available to you, like a rather dull book. Try doing this instead of lying in bed awake.

Nightmares

After I was raped, I was often woken up by nightmares. The most common one I had was of an attacker outside of my bedroom door or standing above my bed, but I had lots of other more complex & difficult ones. Reliving the trauma thru dreams is common for all of us & are a normal part of the healing process. That doesn't make it fun though. I hope you'll find these ideas helpful.

• When you wake up, write the nightmare down.

• Alternately, you could try drawing or painting it. I'm not artistic, so this idea wouldn't work for me, but it has for others.

• Usually, when I'm awoken by a bad dream, I'll try to imagine it ending differently. For instance, when I dream that there's someone outside my door, I'll look around & wake up enough to feel safe. Then I immediately put my head down & imagine that my dog is chasing the attacker out of the house. Usually this will become a dream & I'll end up falling asleep.

• At other times, I'm able to somehow consciously control my dream without ever waking up.

• Talk about them with a trusted friend or counselor. Talking about them can give them less control over us.

• Try to understand them. They're an important part of healing & usually have something to tell us about any unresolved feelings we have Understanding our nightmares & dreams can be a step towards identifying these emotions & resolving them. You can do this just by thinking about what the nightmare meant to you, or by looking at dream books to find the symbolism in them.

Questions

Triggers are difficult to face because they can produce extraordinarily difficult reactions in us, ranging from discomfort & anxiety to panic attacks or flashbacks.

However, most of us would like to live without being triggered, which can require us to confront our triggers & really work on them. Below are questions meant to aid you in understanding & facing your triggers.

• What specifically triggers you? Our triggers are all unique. Some women find that phrases the abuser used are triggering, while others find that places, smells or sights provoke a response.

• How are these triggers affecting you? Nightmares, flashbacks, panic attacks, anxiety & intrusive thoughts can all be signs that we're being triggered.

• Which triggers produce the biggest response? Which triggers provoke a milder response? It may help to actually rate them.

• How do these triggers interfere with your life? Some people find that they avoid specific places where they're likely to be triggered. Others find that they don't go out often to avoid a trigger response.

• Which triggers interfere with your life the most? Which ones interfere the least?

• Which triggers are probably unsafe? Which triggers are safe to work on? For instance, going out alone at night produces anxiety in some survivors & this may be very unsafe. Going to the grocery store might produce the same reaction, but it's probably safe.

• Can you evaluate your trigger? i.e., I was initially frightened to go to work, but after thinking about the worst that could happen & the likelihood of that happening, I decided that it was a safe place for me to start. This kind of evaluation process can help with all sorts of triggers.

• After thinking about your triggers, which ones can you manage to work on at the moment? It's probably not a great idea to work on the most difficult to face trigger, because those are tough.

• How can you work on facing the trigger safely? Sometimes it helps to actually imagine yourself handling a situation that triggers you, like going to a crowded place, before you actually do it.

• Can you make a plan to keep yourself feeling safe while you do? I've worked on a lot of triggers with the help of a counselor or my partner, which helps me feels prepared when I'm facing a trigger.

• How did you feel as you faced your trigger? It may have been uncomfortable, but could you do it again? What helped? What made you feel more uncomfortable?

I hope these suggestions help you. Panic attacks, nightmares & flashbacks feel horrible, but you can overcome them.