Solving a challenge to `one day at a time`

“One day at a time” is a slogan of recovery synonymous with the 12-Step path. Those who enter 12-Step treatment or meeting culture are likely to hear it at their first exposure, and even people outside the 12-Step sphere are familiar with the term. Movies such as “28 Days,” where Sandra Bullock’s recovering character Gwen protests, “What, like two or three days at a time is an option!”, and other pop culture references have made “one day at a time” more than just a 12-Step phenomenon. As a counselor and a recovering woman, I do not challenge the relevance of now-centered living and staying in today. My concern involves the irresponsibility of throwing this slogan at newly recovering people as an instant solution without helping them learn how to live one day at a time.

In this article, I will briefly explore why living one day at a time poses a particular challenge for newly sober people, especially those who are also struggling with unhealed trauma. Then I will explain how another buzzword in the helping professions, “mindfulness,” offers an elegant solution for helping people learn how to live in today, and more specifically in each moment.

Understanding the brain

For survivors of trauma, what happened 10, 20 or 50 years ago can quite literally seem like today. When newly recovering individuals allude to being stuck in their past, experiencing it like it’s still happening, it is not just a matter of “the disease talking” or such people “making excuses.” A simple understanding of how unprocessed traumatic memories affect the brain shows us how a wounded person’s past can still very much be his present.

Trauma, which comes from the Greek word meaning “wound,” is not just diagnosable post-traumatic stress disorder (PTSD); rather, it is any physically, spiritually, sexually or emotionally wounding experience that requires processing at the level of the brain. When traumas are not processed, it is like depriving a physical wound of the proper care it needs to heal fully. Yes, some wounds might clear up on their own, but many will leave lasting complications.

The limbic brain, also known as the mammalian brain or midbrain, is the central processing unit for mammalian learning and emotional response. Paul MacLean, originator of the triune brain model, explains that the limbic brain developed very early in mammalian evolution to regulate the motivations and emotions we now associate with feeding, reproduction and attachment behaviors. MacLean explains that everything in the limbic system is either agreeable (pleasure) or disagreeable (pain/distress), and survival is based on the avoidance of pain and the recurrence of pleasure.

The limbic brain contains the amygdala, the instinctive flight-fight response we associate with trauma, and the hypothalamus, associated with survival. The limbic brain, as this regulatory center, is also responsible for the dopaminergic responses of pleasure that we associate with being stuck in the addiction cycle.

Most important to recognize for this discussion, the limbic brain does not operate on the same rational sense of time we know as human beings. Quite literally, the limbic brain has no clock. Rational time management is a function of the cerebral cortex, unique to primates. When trauma goes unprocessed, it stays stuck in the limbic brain, which essentially keeps it stuck in the time that it happened. Once again, a trauma survivor’s felt sense of today might chronologically be many years in the past. Thus, adopting “one day at a time” living becomes easier said than done.

Twelve-Step traditionalists might argue that adopting another slogan, such as “fake it 'til you make it,” offers the solution for getting a person to shift into a “one day at a time” mindset, and that the person needs just to “keep coming back” to the support of meetings in order for it to click. While I’m not opposed to the logic in either of these slogans, I’ve consistently posited that this conventional 12-Step wisdom is not sufficient, especially when we are working with survivors of trauma.¹

It is not enough just to barrage newly sober people with slogans and platitudes, either in treatment or in meetings. As professionals, our charge is to teach clients action-oriented skills for learning to be in the present moment without having to self-medicate or react to stress in an unhealthy manner. From a trauma-informed perspective, skills that are action-oriented and not just cognitive or verbal are optimal at working with the limbic brain.² By learning, adopting and then practicing such skills with greater consistency, living one day at a time becomes more possible because we are helping clients to reorganize their neurological storage.

Introducing mindfulness

Mindfulness is a practice that, by its very meaning, can teach newly recovering individuals how to navigate the ups and downs of learning to live in the now. Mindfulness has attracted a great deal of attention in the helping professions in recent decades. In 2012 alone, there were approximately 500 peer-reviewed articles published that demonstrated the clinical benefits of mindfulness in a variety of populations, including those with addiction.³ However, there are still people out there who make the stereotypical assumption that mindfulness only means sitting in a perfectly postured lotus pose under a tree somewhere, while you rest in total silence with your hands fashioned in a pristine meditation gesture.

Mindfulness comes from the Sanskrit word smriti, which literally means “to come back to awareness.”⁴ This suggests that even though awareness may be our natural state as human beings, it is normal to wander from it, and we can always come back to it. So many clients struggle with mindfulness practices or other simple guided exercises (e.g., breath, visualization) because they feel they are doing it wrong if they can’t focus right away. I share with my clients that if their attention is wandering, that’s actually a very natural response. The practice is in the “coming back.”

Mindfulness, as defined by Jon Kabat-Zinn, PhD,^4,5 is simply paying attention in the presence of the moment, nonjudgmentally, as if paying attention were your only job. Kabat-Zinn, founder of the popular mindfulness-based stress reduction (MBSR) program for managing stress and illness, is the seminal figure in bringing the ancient practice of mindfulness into contemporary healthcare. A major inspiration I’ve drawn from his writing is that any human activity can be engaged in mindfully. In MBSR, for instance, eating meditation, walking meditation, and yoga are all implemented, albeit within a structured program. In my own life, I take this inspiration a step further—I dance mindfully, stretch mindfully, take baths mindfully, and breathe in my favorite aromas mindfully. Truly, any aspect of human life, even chores such as vacuuming or washing the dishes, can be turned into the practice of being totally present and in the moment.

I explain to my clients that mindfulness is the idea of slowing down activities that we normally do on autopilot. Something as simple as getting up from a chair or sipping water can seem hypnotically relaxing if we slow it down. You can try it with anything, and encourage your clients to do the same.

Taking this simplified approach is a great place to start, emphasizing to both our clients and ourselves that if attention wanders, it doesn’t mean that we are failures at mindfulness. Rather, learning to live in the moment takes practice, and practicing mindfulness is where the growth happens because it helps our brains, quite literally, to transform.

As Kabat-Zinn⁴ simplifies, structured mindfulness practice can cause positive structural changes in the brain related to learning and memory (hippocampus) and can cause a thinning in the amygdala, lessening the charge of fear-based responses. Trauma neurology scholar Stephen Porges elucidates that mindfulness can calm a client’s inner experience and promote greater introspection.⁶ I’ve generally experienced that when clients and newly recovering people are learning to practice mindfulness on some level, they are better able to do later Step work (Steps 4 to 12) because they have the skills to keep themselves calm and regulated if the work proves too intense or triggering.

Mindfulness also plays a key role in activating the prefrontal cortex (the more rational brain) and promoting a greater sense of concentration.⁷ As a result, mindfulness is often considered the practice of responding to stress instead of reacting to it. Reactivity is usually a sign that limbic-level, unprocessed responses are being triggered, which can put a person at risk for relapse or acting out in other ways.

Strategies for professionals

The options for integrating mindfulness work with your clients are numerous. Choosing a time-tested program such as MBSR or mindfulness-based relapse prevention (MBRP) may be optimal for aftercare services in clinical settings because of the structure they teach in addition to the mindfulness skills themselves. The major goals of MBRP⁸ are to:

• Develop awareness of personal triggers and habitual reactions and learn ways to create a pause in this seemingly automatic process.
• Change our relationship to discomfort, learning to recognize challenging emotional and physical experiences and responding to them in skillful ways.
• Foster a nonjudgmental, compassionate approach toward ourselves and our experiences.
• Build a lifestyle that supports both mindfulness practice and recovery.

Although some meta-analytic evidence suggests that structured programs in mindfulness seem to work best in clinical populations⁹, I have discovered that implementing small measures of mindful practice throughout treatment (e.g., something as simple as mindfully getting out of chairs) is possible, regardless of the specific modality you practice or the program you offer.¹⁰

The key to developing this competency as a professional is to engage in some mindful practice yourself in one or more areas of your life. Doing so will make it easier to teach these skills to clients throughout treatment and aftercare. Be sure to consult with the reference listing for ideas on how you can expand your own practice of mindfulness if you are still feeling uncertain.

Consider starting with how you stand up, or maybe even try taking a few mindful breaths before a difficult phone call, and you’ll see how simple yet challenging it can be to practice mindfulness in daily life. I hope you will find that, if practiced consistently, even getting up from your chair, sipping a glass of water, or being in the moment with a few deep breaths can help you be more present in your now, which will help you to live more presently in your day.

Jamie Marich, PhD, LPCC-S, LICDC-CS, is a licensed clinical counselor and chemical dependency counselor in Ohio, and the creator of the “Dancing Mindfulness” practice. She travels the world offering continuing education workshops and retreats on issues related to trauma and addiction. She is the author of Trauma Made Simple: Competencies in Assessment, Treatment, and Working with Survivors, Trauma and the Twelve Steps: A Complete Guide to Enhancing Recovery, and EMDR Made Simple: Four Approaches for Using EMDR with Every Client. Her e-mail address is jamie@jamiemarich.com.

References

1. Marich J. Trauma and the Twelve Steps: A Complete Guide to Enhancing Recovery. Warren, Ohio: Cornersburg Media; 2012.

2. Marich J. Trauma Made Simple: Competencies in Assessment, Treatment, and Working with Survivors. Eau Claire, Wis.: PESI Publishing & Media; 2014.

3. Shonin E, Van Gordon W, Griffiths MD. Mindfulness based interventions: towards mindful clinical intervention. Frontiers Psychol 2013; doi: 10.3389/fpsyg.2013.00194

4. Kabat-Zinn J. Mindfulness for Beginners: Reclaiming the Present Moment—and Your Life. Boulder, Colo.: Sounds True Books; 2011.

5. Kabat-Zinn J Wherever You Go, There You Are (10th anniversary edition). New York City: Hyperion; 2005.

6. Porges S. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. New York City: W. W. Norton & Co.; 2011.

7. Graham L. Bouncing Back: Rewiring Your Brain for Maximum Resilience and Well-Being. New World Library; 2013.

8. Bowen S, Chawla N, Marlatt GA. Mindfulness-Based Relapse Prevention for Addictive Behaviors: A Clinician’s Guide. New York City: The Guilford Press; 2010.

9. Eberth J, Sedlmeier P. The effects of mindfulness meditation: a meta-analysis. Mindfulness 2012;3:174-89.

10. Marich J. Creative Mindfulness: 20+ Strategies for Recovery and Wellness. Warren, Ohio: Mindful Ohio; 2013.