Urge surfing is a term coined by Alan Marlatt as
part of a program of relapse prevention he developed for people recovering from
addictions to alcohol and other drugs. It can actually be used to help with any
addictive behaviour such as gambling, overeating, inappropriate sex or any other
destructive impulses.
Urges for substance use rarely last for very long. In
fact, they almost never last for longer than about 30 minutes, if there is no
opportunity to use. People admitted to a high quality detoxification centre
where there is no access to their drug of choice often find it remarkable how
little craving they get.
If there is no opportunity to use then there is no
internal struggle. It is this internal struggle that feeds the cravings. Trying
to fight cravings is like trying to block a waterfall. We end up being
inundated. With the approach of mindfulness, we step aside and watch the water
(cravings, impulses & urges) just go right past. This is true for
everybody, but few addicts ever give themselves the chance to prove it.
Exercise: Reflecting on
Urges
Ask yourself whether there have been times when
you could not give in to an urge when it presented. Did the urge pass?
Most of
us will have had past experiences of urges passing. This is an important
strategy to identify, as it can greatly improve self efficacy for riding out
urges. The main message is that urges do not have to be acted upon.
Exercise: Experiencing The
Changing Nature & Impermanence of Urges
•
Sit with back unsupported in a chair or on a
cushion on the floor
•
Start Mindfulness Meditation
•
Wait for any sense of discomfort
e.g.
Restlessness, an itch
•
Note the desire to move and resist it
•
Notice thoughts that arising. “I wish this
itch would go”…………..”It is driving me crazy”…………..”This too will pass” – in a
calm tone………..”This too will pass” – in an irritable tone…………..”It is is not
bloody well passing!”………….”I would love to scratch right now” etc etc
•
These thoughts are just thoughts. So gently
bring your attention back to your breath and bodily sensations
•
Note the changing position, shape and quality of
the discomfort over time. Be interested in feeling it as precisely as you can.
Notice how the shape and intensity changes with the cycle of the breath. Is it
stronger during the in breath or during the out breath?
•
You might find your thoughts spontaneously going
to other matters,
e.g. Your shopping list, a fight with you partner, a football
game, planning a holiday
These are still just thoughts. Gently bring your
attention back to your breath and body sensations. They are probably different
again.
You have just observed the changing nature and
impermanence of urges. When you notice the physical sensations with interest,
you are directly facing the urges rather than feeding them through fighting
them.
How fighting urges feeds
them
Often people try to eliminate the urges by
distraction or talking themselves out of them. This usually just feeds the
urges and creates the illusion that they are interminable until you give in to
them.
Suppressing a thought feeling or sensation, including pain ultimately
increases it.
For example Wegner et al (1987) conducted a
series of experiments to assess the effects of thought suppression called the
“white bear” experiments. The bear was chosen because one of the researchers
remembered reading that when Russian author Tolstoy challenged his brother not
to think of a white bear, the brother remained perplexed for quite a while.
In
one of the more sophisticated experiments people were shown a movie about white
bears. These people were then given a sorting task which required
concentration. They were then divided into two groups. The first group was
instructed to suppress the white-bear thoughts. The second group was given no
instruction to suppress these thoughts. Both groups were asked to hit a counter
button every time they thought of white bears while doing the other task. The
initial suppression group reported a significantly higher rate of “white bear”
thoughts during this time.
Prochaska (1992) et al in their study of how people
change habitual behaviour, note that most people go through a long
contemplative stage before they actually change. This stage is marked by
ambivalence. Argumentation usually results in the client completing the other
side of the ambivalent equation thus maintaining a state of therapeutic
paralysis. It is reasonable to assume that the same problem exists with the
client’s internal disputation over the ambivalently regarded behaviour. (e.g.
“I have to give up smoking because I could get cancer” receives a reply “Yes
but that isn’t going to happen to me – at least not for a long time.”)
The Technique of Urge Surfing
Mindfulness allows us to bypass these problems
associated with avoidance and disputation. Instead of trying to distract from
or argue with the unpleasant thoughts, feelings or urges, mindfulness simply
makes the thoughts, feelings or urges less important. When we use mindfulness
we stay exposed to the thoughts feelings or urges for their natural duration
without feeding or repressing them.
In fact, if we just let an urge be – non
judgmentally – without feeding it or fighting it (Fighting it is just another
way of feeding it anyway) then it will crest subside and pass.
Of course they
come back again but over a period of time. However each time you overcome a
bout of cravings they become less intense and less frequent if we don’t feed
the urges and if we don’t give in to the addiction. Moreover our mindfulness
technique of urge surfing improves. If we have a slip and give into the impulse
we will have increased urges for a while. However we can still apply urge
surfing all over again.
Urges can be compared with feeding a stray cat. In the
beginning, you may want to feed the cat because it cries for food and
attention. You may find that it is a nice thing to do and you feel good for
being kind. However, your act of feeding the cat encourages it to repeat its cries
and attention seeking. You find yourself giving in each time. Over a period of
time the cat grows bolder and other cats join it in crying for food and
attention.
You may begin to regret your actions, as a large number of strays
are now contributing to noise and other problems. But you cannot resist the
feeling of ignoring their cries. You may believe that their survival now
depends on you, and that your actions are more important than ever. They have
you trapped in a cycle of your own pattern of repeated problem behaviours.
If
you make a decision to resist feeding the “cat army,” there will be loud and
pitiful cries for a few days. In fact they will be at their strongest when you
have decided not to reinforce their behaviour. Soon, however, they will come to
realise that they are no longer being reinforced, and will gradually diminish
and disappear. Your decision to stick with the action you know is best for you
will “undo” the problem that you unknowingly built up in the first place.
Urges
do go away, but they may be very strong for a short while immediately after
quitting. Knowing that they will weaken will help you to continue to surf the
impulses that you feel, especially in response to your personal triggers.
Urge Surfing Summary
Purpose
To experience the cravings in a new way and to
“ride them out” until they go away
Preparation
1.
Remember that urges pass by themselves.
2.
Imagined that urges are like ocean waves. that
arrive crest and subside. They are small when they start, will grow in size,
and then will break up and dissipate.
3.
Practise mindfulness regularly and especially
notice any impulses or urges that appear. Then we are well prepared to ride
these waves without giving in to the urge by using mindfulness.
Urge surfing itself
•
Practise mindfulness
•
Watch the breath. Don’t alter it. Let the breath
breathe itself.
•
Notice your thoughts.
•
Without judging them, feeding them or fighting
them gently bring your attention back to the breath
•
Notice the craving experience as it affects the
body.
•
Focusing on one area where the urge is being
felt and noticing what is occurring.
◦
Notice quality, position, boundaries &
intensity of the sensation
◦
Notice how these change with the in-breath and
out-breath
•
Repeating the focusing process with each part of
the body involved.
•
Be curious about what occurs and notice changes
over time.
The key is replacing the fearful wish that
craving will go away with interest in our experience. When we do this we notice
the cravings change, crest and subside like waves in the ocean. In this way it
becomes more manageable.
Teaching Urge Surfing To
Clients
It is very difficult for clients to understand
urge surfing unless they have an experience of it. Even though the idea of
watching cravings come and go makes sense, it is a skill that can only be
learnt through practice. Just as it is easier to coach someone how to kick a
football, when they are actually kicking a football is also easier to coach
someone as to how to surf urges when they are actually having urges.
We can do this in two ways. Firstly we can
create a situation where urges arise and secondly we can respond opportunistically
when a craving arises spontaneously in the presence of the therapist.
Manufacturing Opportunities for Urge Surfing.
This is not as difficult as it sounds, as there
are many kinds of urges apart from drug cravings. There are urges to scratch,
to move, to eat, to drink, to go to the toilet etc. When we reflect on this as
it becomes clear that all adults including those who consider they have
hopeless addictions have the capacity to have urges come and go without acting
on them. After all, unless we are physically ill we can all control our need to
go to the toilet!
When we sit with our back supported in a chair
or on a cushion on the floor and start mindfulness meditation, sooner or later
some sense of discomfort will arise, such as restlessness or an itch. Along
with these sensations there will be a urge to move. This is an opportunity to
practice urge surfing. So we can notice the difficult sensations that go with
this and the thoughts that arise. Instead of acting in our normal way of trying
to get rid of this unpleasant feeling, we become curious. We become like
natural scientists seeing a strange plant or animal for the first time. We try
to describe what we are observing as closely as possible. In this way we
replace an aversion with curiosity. So we do this by noticing the physical
sensation that goes with the urge as precisely s possible.
If we are guiding a client through this process
we then ask them to notice:
•
The exact physical sensation in the body,
•
It’s quality:
◦
Whether it is tight or loose
◦
It’s temperature whether it is hot or cold.
•
The location of the sensation,
•
It’s exact borders
•
Whether these borders are well defined and firm
like the edge of a football or soft and fuzzy like cotton wool.
•
How these qualities vary with the respiratory
cycle
We need to watch it for at least five cycles of
breathing to get a sense if it.
Does it get larger or smaller, more or less
intense or does the quality of it change?
When we find our mind turning to thoughts, notice
the thoughts and come back to the physical sensations of the urge.
Opportunistically Teaching Urge Surfing
Sometimes when talking to a client an urge
arrises spontaneously. Sometimes it can be spotted as a subtle smile on the
face as the client fondly remembers using the drug. At this point, the
therapist can say to the client:
“It looks like you might be having an urge to
use right now.”
If the client agrees to this, then the therapist
can ask them:
“How does this urge feel in your body?
Whereabouts is it in your body?”
Then slowly guide the client through the
questions that define the sensations or the urge in the body.
At first there will be a resistance and a desire
to go into the story about the urges. It is then helpful to explain to the
client that we can go into the story later. We can explain:
“It would be good if you could become aware of
how this urge feels in your body right now. I’m very interested in knowing
exactly how it feels for you. This is an opportunity for you to practice urge
surfing. So see if you can just bear with it for a little while.”
Then ask the client to define the edges of this
sensation, where they are and the quality of the edges, then the quality of the
actual sensation itself including the temperature. And finally how it changes
with the cycle of breathing. Then you can ask the client if the sensations has
changed since we first started talking about it. Any observation of change is
good. It does not matter if the feeling is stronger. What is important is that
the client can see the sensation is not one solid unchanging entity.
So having done this, it is worthwhile to then divert
the client’s attention a little by talking about the matter at hand that
elicited the urge in the first place. After doing this for a few minutes, it is
very useful to return attention to the body and ask the client how the
sensation feels now. At this point with their increased level of mindful
awareness of the physical sensation they are capable of noticing how the urge
has changed. It has often changed dramatically. When a client has had the
opportunity to be taken though this three or four times, they begin to have
enough faith in the process to practice urge surfing successfully by
themselves.
