Dr Donald Hilton
Dr. Don Hilton Neurosurgeon, author and presenter.

Neuroscience and PSBs

In recent years, neuroscience discoveries about the reward system and human sexuality have shed new light on both problematic and healthy sexual behavior. As can be expected with any new paradigm, however, some doubtful neuroscience claims have also appeared in the media. As a neurosurgeon and the author of several papers on problematic sexual behavior and the appetite/reward mechanisms of the brain, I sometimes help to correct these misunderstandings. Here are a few examples that might be of interest to our readers.

ERROR #1 - “Dopamine does not underlie addiction”

Some peculiar claims about dopamine have appeared in recent months, such as “If you want to make an argument that porn is addictive, you can, but if you're relying on dopamine to do it. lol, you're wrong” and “Please stop calling dopamine an addictive rewarding neurochemical.”

Dopamine plays many benign roles in our physiology, such as facilitating movement and choices. However, all experts in the fields of addiction or neuroscience acknowledge the central role of dopamine in addiction.

In fact, addiction cannot develop without high, but brief, bursts of dopamine in response to an addictive substance or activity. As experts Volkow and Koob explained in a recent paper, these dopamine surges elicit reward signals at a cell receptor level, which then trigger so-called Pavlovian learning. The molecular mechanisms that facilitate this process appear similar for all forms of learning and memory. Repeated experiences of reward (for example, porn viewing) become associated with the stimuli in the user’s environment that precede them.

Interestingly, after repeated exposure to the same reward (in this example, porn), dopamine cells tend to fire more strongly in anticipation of viewing rather than in conjunction with actual viewing – although internet porn’s endless novelty means that using and anticipation are interwoven, in contrast with, say, a cocaine habit. As any addiction develops, cues and triggers, such as hearing a porn star’s name, time alone, or a mental state associated with past use (boredom, rejection, fatigue, etc.) can elicit conditioned, sudden surges of dopamine release. These surges then trigger cravings to use or even binge. Such conditioned responses may become deeply ingrained and can bring on strong cravings even long after someone quits using porn.

Although dopamine is sometimes thought of as a "pleasure molecule," this is technically inaccurate. Dopamine drives seeking and searching for reward – the anticipation, the wanting. In some unfortunate people, this seeking deepens into the disorder known as addiction. The user’s desperate search for satiety (that eventually often proves fleeting or unattainable) progresses to the point of marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.

However, addiction is now being defined not solely by this behavioral definition.  It is also increasingly defined as a form of disordered reward learning.  As Kauer and Malenka said, “addiction represents a pathological but powerful form of learning and memory.” This is why the American Society of Addiction Medicine (ASAM) redefined addiction as including both substances and behaviors. ASAM’s position is a recognition of the brain’s central role in driving what Marc Lewis called a “rut, a line of footprints in the neural flesh, which harden and become indelible.” (Lewis, Memoirs of an Addicted Brain, 2011).

ERROR #2 -  “At a brain level sexual activity is no different from playing with puppies”

While playing with puppies might activate the reward system (unless you are a cat person), such activation doesn’t support the claim that all natural rewards are neurological equivalents. First, sexual arousal and orgasm induce far higher levels of dopamine and endogenous opioids than any other natural reward. Rat studies reveal that the dopamine levels occurring with sexual arousal equal those induced by the administration of morphine or nicotine.

Sexual arousal is also unique because it activates precisely the same reward system nerve cells as do addictive drugs.  In contrast, there's only a small percentage of nerve-cell activation overlap between addictive drugs and natural rewards such as food or water. Not surprisingly, researchers have also established that the natural reward of food does not cause the same persistent change in synaptic plasticity as sexual activity (Chen et al., 2008).

However, this is not to say that gustatory reward cannot become addictive or disruptive to individuals and precipitate public health concerns, or cause brain changes in reward circuits. Any physician knows that obesity is a tremendous health concern consuming billions in medical costs, and dopamine receptor depletion in the brain’s reward center returns to more normal density with weight loss after gastric banding surgery. Also, the DNA transcripts which produce reward system proteins important in the craving states that are evoked with salt depletion/repletion are identical to those produced with drug craving (Leidke et al., 2011, PNAS).  A National Geographic article on this paper said drugs “hijack” these natural reward pathways, and this is true for all addiction, whether to poker, porn, or popcorn.

Addictive drugs not only hijack the precise nerve cells activated during sexual arousal, they co-opt the same learning mechanisms that evolved to make us desire sexual activity. Activation of the same nerve cells that make sexual arousal so compelling helps explain why meth, cocaine, and heroin can be so addictive. Also, both sex and drug use can induce transcription factor DeltaFosB, resulting in neuroplastic alterations that are nearly identical for both sexual conditioning and chronic use of drugs.

 

While far too complex to elucidate in detail, multiple temporary neurological and hormonal changes occur with orgasm that do not occur with any other natural rewards. These include decreased brain androgen receptors, increased estrogen receptors, increased hypothalamic enkephalins, and increased prolactin. For example, ejaculation mimics the effects of chronic heroin administration on reward system nerve cells (the ventral tegmental area, or VTA). Specifically, ejaculation temporarily shrinks the same dopamine producing nerve cells that shrink with chronic heroin use, leading to temporary down-regulation of dopamine in the reward center (nucleus accumbens).

A 2000 fMRI study compared brain activation using two different natural rewards, one of which was porn. Cocaine addicts and healthy controls viewed films of: 1) explicit sexual content, 2) outdoor nature scenes, and 3) individuals smoking crack cocaine. The results: cocaine addicts had nearly identical brain activation patterns when viewing porn and viewing cues related to their addiction. (Incidentally, both cocaine addicts and healthy controls had the same brain activation patterns for porn.) However, for both the addicts and controls, brain activation patterns when viewing nature scenes were completely different from the patterns when viewing for porn. In short, there are multiple biological reasons we experience an orgasm differently from playing with puppies or viewing sunsets.  Millions of adolescent boys and increasingly girls are not just watching puppies on the Internet, and Mindgeek knows that to make billions in ad revenues you name a site “Pornhub,” not “PuppyHub!”

 

ERROR #3 - “The brain effects of today’s porn are no different than static porn of the past”

This claim implies that all porn is equally harmless. However, as the recent paper Park et al., 2016 points out, research demonstrates that video porn is significantly more sexually arousing than other forms of porn. (I know of no research on VR porn yet.) In addition, the ability to self-select material makes internet porn more arousing than pre-selected collections. Today’s porn user can also maintain or heighten sexual arousal by clicking to a novel scene, new video or fresh genre. Novel sexual visuals trigger greater arousal, faster ejaculation, and more semen and erection activity than familiar material.

Thus today’s digital porn, with its limitless novelty, potent delivery (hi-def video or virtual), and the ease with which the user can escalate to more extreme material, appears to constitute a “supranormal stimulus.” This phrase, coined by Nobel laureate Nikolaas Tinbergen, refers to an exaggerated imitation of a stimulus that a species has evolved to pursue due to its evolutionary salience, but which can evoke more of a neurochemical response (dopamine) than the stimulus it imitates.

Tinbergen originally found that birds, butterflies, and other animals could be duped into preferring artificial substitutes designed specifically to appear more attractive than the animal's normal eggs and mates. Just as Tinbergen's and Magnus's ‘butterfly porn’ successfully competed for male attention at the expense of real females (Magnus, 1958; Tinbergen, 1951), so today’s porn is unique in its power to compete for users’ attention at the expense of real partners.

The three errors discussed above are typical of commentators anxious to ignore the brain’s central role in human volition, behavior, and emotion.  One sexologist wrote, “There is brain science and neuroscience, but none of that applies to sexual science.”  On the contrary, those educated in biology will increasingly understand the brain’s central role in every human activity. After all, both sexologists and neuroscientists alike should understand that the genitals take their marching orders from the brain, the primary sex organ.

Donald L. Hilton Jr, MD, FACS, FAANS is an adjunct associate professor of neurosurgery at the University of Texas Health Science Center at San Antonio, the director of the spine fellowship and the director of neurosurgical training at the Methodist Hospital rotation. He has authored numerous articles and speaks nationally and internationally on the neurobiology of porn use.

 

Blog Disclaimer

The Society for the Advancement of Sexual Health (SASH) sponsors this blog for the purpose of furthering dialog in the field of problematic sexual behaviors and their treatment. Blog authors are encouraged to share their thoughts and share their knowledge. However, SASH does not necessarily endorse the content or conclusions of bloggers.

Information in blogs may not always be complete, up-to-date, accurate, relevant, or applicable to all situations. Legislation, case law, standards, regulations, descriptions of products and services, and other information are often complex and can change rapidly. Always double-check and confirm that any information you find on the internet is accurate, current, and complete in regard to your specific situation, question, concern, or interests.

This website and its agents make no promises, guarantees, representations, or warranties, expressed or implied, and assume no duty or liability with regard to the information contained herein or associated in any way therewith. No legal or other professional services are being rendered and nothing is intended to provide such services or advice of any kind. The inclusion of external hyperlinks does not constitute endorsement, recommendation, or approval of those sites or their contents. This website bears no responsibility for the accuracy, legality or content of the external sites or for that of subsequent links. Those who visit or use this website, links or any other information assume all risks associated therewith.

Sharon Rinearson, LCSW is a creative therapies specialist.

Be A Super Hero

Creative therapies can nurture resilience in a client. When used to heal individuals it can be an impactful tool in moving clients along in the therapeutic process. My passion is working with clients who are experiencing relational trauma, especially those traumas that are created by intimacy issues, infidelity and/or sex/love addicted spouses.

Resilience is a key component to an emotionally balanced, healthy lifestyle and sometimes, through childhood neglect and abuse, many of us were unable to have opportunities to practice the skill of resilience in childhood. If a client’s childhood was unstable and unsafe, resilience skills could not flourish due to incoherence of left and right brain assimilation. According to the American Psychological Association, “resilience is the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress.” It is our ability to “bounce back” from difficult experiences. We all have the ability to be resilient but trauma reactivity gets in the way of us using it as often as we can.

How do we tap into our clients’ natural stores of resilience? How do we help clients mine it and use it? One way I help is through an ongoing picture/story that is created.  I often, while hearing their stories of trauma and survival, think of clients as super heroes helping themselves as an action figure.  I state that one of their super powers is resilience. It could be fashioned into a lasso, a sword, magic hands, magnified heart, etc. I share this superhero vision with them when appropriate in their journey (once quite a bit of safety has been established or once sufficient therapeutic alliance is created) and a client can begin to imagine her own version of what this looks like and she draws/paints or sculpts a rendition while in my presence. Art therapy is remarkable in its ability to allow the client to create space for play and learning about themselves, while providing unspoken clues of what is needed to best help and support their journey. Art, when used as part of the experiential therapies, helps us do that better while reminding our clients that play and learning are connected in our brains. When completed, clients will often take pictures of their creations, using this as a reminder of their power. We get to add to that picture with more superpowers along the way. “Super Powers” such as: Safety, Truth, Passion, Clarity, Wisdom and Courage are some that usually are added. This right-brain-focused activity (creative/art therapy activity) helps create brain change that is healing and the clients have created a "different" or enlarged vision of themselves in a playful, non-threatening and really non- triggering way.

This superhero persona then becomes part of our clients’ narratives and they can dream and act in a comic strip or a story, practicing doing things differently in a safe place until they can use it (live it) somewhere in their lives.

Questions you can ask as you utilize this therapeutic technique are:
How would your super-woman handle this scenario?
What would your superhero tell you in this situation?

The ability to playfully engage in practicing the superhero’s strengths in the world creates an opening for it to actually happen.  It brings up the best of our inner child strength, that magic power of trusting in many possibilities, with the propelling power of believing in our dreams. I believe resilience, joy and passion are connected.. Along the journey of healing, the client can, hopefully, engage in meaningful self discovery, which gives them (and us - thank goodness!) markers and glimpses about their true self/higher self, the self THEY want to be, not the self everyone else wants them to be.

 

superhero, creative therapies, SASH, CORE
This photo illustrates what a super hero drawing could look like.

Draw Yourself As A Superhero activity:

What will your costume look like?

How will you protect yourself from villains?

What will you use to activate your resilience?

What other superpowers do you have?

Will they be activated with a lasso, bow and arrow, wand?

Is the costume infused with any magic?

If we, as therapists, are present enough with them, we can take the clues and shine lights on them – bringing them to our clients’ conscious, aware mind. Anything that has to do with action that comes from that true self is inspiring and gives them motivation to move forward… sometimes in tiny steps and sometimes in great leaps and bounds. This is resilience in action!

creative therapies, SASH, CORE, traumaI have included pictures of this creative therapy tool being used by a partner of a sex addict over time. (Note: Photos were added with permission from the client for educational purposes.) This client, “Fran” had become stuck and alienated from her true self because she was living a life full of PTSD symptoms enhanced by her husbands porn addiction and his extra marital affairs. She didn’t even recognize herself by the time she asked me for help. She was diagnosed with depression and complex-PTSD. In the first year of her treatment, she created many superhero personas to engage as she worked toward feeling better.

These pictures are Sandtray depictions of her superhero narratives. Remember, you can just offer markers and paper to create this opportunity for a client. At our center, we are lucky enough to have an art room and a Sandtray room so that clients have a choice about how they create their superhero story.

In the first one, you see a standard bearer (her superhero was named “First in Line”) readying herself to climb up and over her community/family/self beliefs with her superpowers in the standard that carries endless amounts of "energy" and "courage". Her goal was to get to the rainbow and the treasure: endless hope and endless riches. The only direction from me was, "Let us see what ‘First In Line’ looks like today."

creative therapies, CORE, SASH, trauma

Toward the end of her therapy, she created a new superhero persona and created this Sandtray: It shows Fran as Wonder Woman, elevated and with her arms as wide open as she could extend them, addressing her attributes (her superpowers) of Intellect, Sense of Humor (and Peace and Honor… she just didn't know that yet), and Tenacity. When she combined her three superpowers she became Powerful and Competent. This image became her grounding and empowering force and she used it in her daily life. She has since gone on to create a fulfilling business that feeds her passion and wisdom and is rarely touched by PTSD symptomology or depression symptoms.

I hope this post will challenge your creative superhero in how you do therapy with your own clients. The more passionate and creative we are, the more we can help nurture those aspects in them. Helping them recognize and practice the resilience within them will help to create sustained mental health growth and progress.

Sharon Rinearson, LCSW, Certified clinical Partners specialist-candidate, and a certified clinical trauma professional has extensive experience treating individuals, couples, and families with mental health disorders, including those associated with addiction and the trauma reactions created from living with an addict. She has many certifications in play therapy, sandtray and sandplay therapies and is an innovative experiential therapist. Sharon is the co-founder and Director of Clinical Services of CORE Behavioral Healthcare


Blog Disclaimer

The Society for the Advancement of Sexual Health (SASH) sponsors this blog for the purpose of furthering dialog in the field of problematic sexual behaviors and their treatment. Blog authors are encouraged to share their thoughts and share their knowledge. However, SASH does not necessarily endorse the content or conclusions of bloggers.

Information in blogs may not always be complete, up-to-date, accurate, relevant, or applicable to all situations. Legislation, case law, standards, regulations, descriptions of products and services, and other information are often complex and can change rapidly. Always double-check and confirm that any information you find on the internet is accurate, current, and complete in regard to your specific situation, question, concern, or interests.

This website and its agents make no promises, guarantees, representations, or warranties, expressed or implied, and assume no duty or liability with regard to the information contained herein or associated in any way therewith. No legal or other professional services are being rendered and nothing is intended to provide such services or advice of any kind. The inclusion of external hyperlinks does not constitute endorsement, recommendation, or approval of those sites or their contents. This website bears no responsibility for the accuracy, legality or content of the external sites or for that of subsequent links. Those who visit or use this website, links or any other information assume all risks associated therewith.

Bill Stoner, SASH, sex addiction, journaling
Bill Stoner,MHC, counselor and author.

For those in recovery, journaling may be a common practice. It is the process of recording your thoughts on a regular basis. The value in doing this exercise is it often provides clarity in thoughts that may be in our minds or it allows one to visually experience and see the words that clutter the recesses of our brains. No matter the reason for practicing journaling daily, there are many ways to do it. Some people put pen to paper. Others use electronic media to type or draw. Some people paint or make things (think of art as therapy).  

Images have often been used to record important historical events. Petroglyphs depicting a successful hunt were created with charcoal from a fire. Later sharp stones were employed to make images on rocks (petroglyphs).

One of this country’s founding fathers, Ben Franklin, used a daily journal that he called a “scheme.” As part of this scheme, every morning he asked himself, “what good shall I do today,” followed by “what good have I done today,” every evening.

Business owners, may use this technique to document events that take place within the business.  This was a natural routine of Virgin Group owner Sir Richard Branson who used a book style journal to capture written events, drawings, and doodles.

From a mental health perspective, it can be very helpful to engage in a routine of self-reflection. Your emotions, thoughts and behaviors change and journaling is a good way to see how those changes have taken place over a lifetime or a period of time. Much like how a photo album reveals how your physical appearance has changed over time, a hard copy journal shows how your interior world has also changed. 

In my personal family tree, there are at least four family members who were diagnosed with schizophrenia. For one of these individuals, I had the opportunity to see drawings they completed over the course of several decades. When reviewing these it really struck me that what they drew and how they drew seemed to parallel how they lived life over time. This really helped me understand their interior world much better.

I recommend journaling to many of the clients I see in my therapy practice. Many of these clients report that they benefit from a routine of self-reflection while journaling and when shared in a counseling session there is an additional benefit to the work we do together. Journaling also helps cement the connection and recall to the written issues.   

To get the most out of your journaling practice, consider incorporating three things: images, felt-sense, and words.

Images. Researchers have shown and psychological theory supports the belief that images allow for better recall of events compared to using only words (citations below). Artistry and artistic talent is not necessary so add the drawing or doodle. Any doodle will do. Thin and thick. Bold and subtle. Single color or lots of colors. Abstract and detailed. It really doesn’t matter.

Felt-sense. As you draw, doodle, or write, pay attention to your body. Are there sensations in your body, breathing changes, certain thoughts or feelings? Maybe a song pops into your head or  you experience different temperature changes.  What occurs is less important to that you’re noticing it.  

Words. You may find if you combine images and your felt-sense, then words will flow easier, and this will lead to deeper self-understanding or connections and aha moments. This is because you are engaging both sides of the brain. The body and mind are connected when a writing or drawing tool is handled creating an atmosphere for drawing and feeling. And that leads to more meaningful writing.

I recommend journaling using hardcopy, that is pen or pencil to paper. However, for those people who are more comfortable with electronic media, there are several apps that allow various ways to record your thoughts, emotions, and felt sense. These apps can be just as helpful for some people, but they are not for everybody.

Whether you use a hardcopy journal or an electronic version, consider journaling on a daily basis to enhance your life journey.  

Bill Stoner is a mental health counselor and author of, “Journaling the InnerLenz Way,” a workbook that teaches innovative ways to incorporate images, felt-sense, and words into a regular journaling practice. Further information is available at InnerLenz.com.


Partial list of research used:

Alesandrini, K.L “Pictures and Adult Learning,” Instr Sci (1984) 13: 63. doi:10.1007/BF00051841

Alvermann, Donna, E, “The Compensatory Effect of Graphic Organizers on Descriptive Text”, in The Journal of Educational Research Vol. 75 , Iss. 1,1981. Retrieved 27 May 2017 from:

http://www.tandfonline.com/doi/abs/10.1080/00220671.1981.10885354?src=recsys

Friedman, Michael C., “Notes on Note-Taking: Review of Research and Insights for Students and Instructors,” Harvard Initiative for Learning and Teaching Harvard University. Retrieved 27 May 2017 from: http://hilt.harvard.edu/files/hilt/files/notetaking_0.pdf

Houts, Peter, S et al “The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence,” in Patient Education and Counseling, Volume 61 , Issue 2 , 173 – 190. Retrieved 27 May 2017 from: http://www.pec-journal.com/article/S0738-3991(05)00146-1/fulltext?cc=y=

Jung, Carl G, ed. “Man and his Symbols,” Dell Publishing 1954

Roeckelein, Jon E, “Imagery in Psychology: A reference Guide,” Praeger Publishers, 2004

Shelburne, Walter A, “Mythos and Logos in the Thought of Carl Jung,” State of University of New York Press, Albany, New York, 1988


Blog Disclaimer

The Society for the Advancement of Sexual Health (SASH) sponsors this blog for the purpose of furthering dialog in the field of problematic sexual behaviors and their treatment. Blog authors are encouraged to share their thoughts and share their knowledge. However, SASH does not necessarily endorse the content or conclusions of bloggers.

Information in blogs may not always be complete, up-to-date, accurate, relevant, or applicable to all situations. Legislation, case law, standards, regulations, descriptions of products and services, and other information are often complex and can change rapidly. Always double-check and confirm that any information you find on the internet is accurate, current, and complete in regard to your specific situation, question, concern, or interests.

This website and its agents make no promises, guarantees, representations, or warranties, expressed or implied, and assume no duty or liability with regard to the information contained herein or associated in any way therewith. No legal or other professional services are being rendered and nothing is intended to provide such services or advice of any kind. The inclusion of external hyperlinks does not constitute endorsement, recommendation, or approval of those sites or their contents. This website bears no responsibility for the accuracy, legality or content of the external sites or for that of subsequent links. Those who visit or use this website, links or any other information assume all risks associated therewith.

Area of Refuge, Schulman, SASH, sex addiction
Roger Schulman, Certified Recovery Coach, Together, we'll write your sober story.℠

It was my first meeting of a men’s society of addiction treatment specialists, and my nervousness made me arrive early. Anxious questions ran the hamster wheel in my head. Would I fit in? I’m a recovery coach; would the gray conference room be filled with condescending psychiatrists and psychologists? That was my fear, anyway. The apparently humorless fellow sitting in the corner—or perhaps it was a sculpture titled Man Gazing at Smartphone—didn’t make things easier for me.

Since I was early, I grabbed the men’s room key and headed down the hallway. Maybe it would help to pee, or to splash some water on my face. I fitted the key into the men’s room door and…nothing. It wouldn’t open. Damn. Was there already someone inside? So why didn’t it have one of those “OCCUPIED” badges on the door? Regardless, I wasn’t getting in.

Well, I couldn’t just walk back into the meeting room so soon. Then I’d have to explain to Mr. Motionless that I couldn’t work a doorknob.

I decided to walk the hallway a little, see what the place was like. The meeting was taking place at the headquarters of a large outpatient center for sex addicts, and I had only been there once before and seen very little. It turned out there wasn’t much to see: a rectangle of monochrome hallways lined with office doors belonging to therapists.

 

I turned to head back to my meeting room when my eye caught a phrase I had never seen before. A sign mounted to the doorway of a stairwell was emblazoned, “AREA OF REFUGE.”  Area of Refuge.  I had no idea what that phrase meant technically, but I understood the words and I liked what I felt.

Area of Refuge.

A place—maybe not even a place, just a borderless “area”—where I could feel safe. Merely walking into an area of refuge triggered feelings of calmness, serenity, safety. Given my anxiety before this meeting, I could use my own area of refuge right now.  But I couldn’t open the door; there wasn’t time.

I had to handle my anxiety without visiting this new land. So instead, I fell back on techniques I already knew worked.  I stood there, near the Area Of Refuge sign, and slowed my breathing. Then I prayed. God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

Then I murmured a couple of ad-lib affirmations.

I am a wonderful and qualified recovery coach. I have excellent social skills.

Then I tried to become mindful of the industrial carpet beneath my shoes, the over-conditioned air, and slow hushed rush of the ventilation system. I became present. My knees thawed.

A moment later, I walked back to the meeting room, where other men had begun to gather, waiting for the meeting to begin. One older gentleman in a Hawaiian shirt (he looked like Santa Claus on vacation), asked me to help him get the bagels from his car parked on the street just outside the building. He was a jolly sort (naturally, being Santa Claus on a break) and I immediately felt my spine soften. It was going to be fine.

Later at home, I remembered the phrase that had given me comfort and consulted Wikipedia.

Area of Refuge: a location in a building designed to hold occupants during a fire or other emergency, when evacuation may not be safe or possible. Occupants can wait there until rescued or relieved by firefighters. This can apply to the following:

It struck me how right this definition was for my situation. Sure, Wikipedia was talking about physical emergencies, but everyone knows there are spiritual emergencies, too. I usually have one daily.

At the addiction treatment center, I had an important meeting coming up in a strange place with strange people. Evacuation was not possible. In my job as a recovery coach I often help people who are prevented from escaping by their addiction. Sick people. People with a disability. Sometimes people who wind up in a hospital. I really did need an area of refuge at that moment.

And I found one. Right there, at the sign clearly marked “Area of Refuge,” I found mine. By slowing my breathing, praying, feeling the ground under me, I created an area where I could and did take refuge. I surrounded my spirit with safety and soon the crisis passed.

I wondered if my techniques would have been approved by the people who designed the area of refuge in that building, the experts. I read further.

An area of refuge typically has a steady supply of fresh or filtered outside air with emergency lighting. A call box is required, which can call into a central location. Yep, my area of refuge was up to spec. I had a steady supply of filtered air, right in my lungs. It was just a question of slowing and deepening my breathing to tap into it. I used my built-in call box to notify a central location: I prayed.

We all carry an area of refuge within us, waiting to be used any time a spiritual emergency arises.

A safe place within each of us where we can access fresh air, feel the solidity of the walls and floor, and even place an emergency call. It’s understandable that many of us, myself included, forget about this fantastic facility: it isn’t as clearly labeled as that in the hallway of the treatment center.

So decide right now to post a big permanent placard somewhere near you heart, your solar plexus, or your belly. Wherever you decided your area of refuge is waiting. Be sure to maintain it in pristine condition, with meditation (for the air supply), prayer (to maintain the call box) and connection to healthy friends (to keep the ground solid and insulating). Next time you have a spiritual emergency and feel that evacuation is not a possibility, don’t forget. You have immediate access to your very own Area of Refuge.

Roger Schulman, the founder of CoAchieving, is a Life Coach certified by the International Coach Federation and an Oscar® and Emmy-nominated and BAFTA-winning screenwriter. He believes we are hard-wired for narrative and that you can write a new, sober story to create a new truth --  and a new reality.

 

SASH, Risky Business, Sexual Health

 

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