Friday, December 14, 2007

Exercise 3: Compulsive "Acting Out" Cycle

The acting out cycle is a framework to explain how people “act out” their compulsive behaviors. The entire treatment is connected to this cycle. The key to changing the cycle is first recognizing the feeling triggers, high risk settings, and thinking,” identifying “active and passive” ways of acting out, and the perceived payoffs. We will review each of these concepts in subsequent exercises. But for now, a brief review is provided to help you develop an initial understanding.

Expanding upon the cycle:


Set ups are often easily recognized. Most people who struggle with sexual compulsivity can identify various feelings before they act out. For the sake of simplicity, I have reduced the types of set-ups to three: Emotional Triggers, Thinking Errors, and High Risk Situations. An example of a feeling trigger can help explain the concept. A person feels depressed, so he or she makes a call to the phone line which leads to a sexual encounter. The feeling identified in this example, depression, precedes the acting out incident. In the same example, a thinking error that might be present includes the thought “I’ll only make a phone call, it isn’t a big deal. I won’t hook-up afterwards.” The high risk situation in the example includes making a call to the phone line. As you move through the treatment process, you will start to identify additional setups that increase the risk for acting out. In the end, you’ll probably be able to identify ten to fifteen setups of each type.

Acting Out

The acting out phase of the cycle is often recognized as the sexual behavior (for example, I had sex with this person; I watched some porn). What you will recognize is that the sexual behavior is only one type of acting out. In the field of chemical addition, there is a term used called “cross-addiction.” I have worked with clients who have stopped their chemical use, but then their sexual behavior gets out of control. Once both the sexual behavior and chemical use are under control, it isn’t surprising to see another issue develop such as eating disorders, compulsive spending, and or gambling behaviors. The key to understanding the cycle is that the sexual behavior is only an expression of the cycle; you need to gain a better understanding of all the different ways you may act out. In recognizing the range of behaviors, you can then address the real problem: the cycle and avoid a band-aid approach to sexual health. As we move through the process, you will discover passive ways of acting out are as important as active ways of acting out. For example, I’ve worked with clients who will withdraw from conflict because of fear. This will result in the person feeling resentful which is a set up for explosive anger (another type of acting out).

Pay offs/Costs

Pay offs refer to the perceived outcome of the behavior. In the example above, the perceived pay off was a relief from the depression. As you can probably recognize, the payoff is usually temporary. Sometimes the perceived payoff leads to the cycle starting all over again. It is important to think strategically in this area. You might not always recognize other payoffs. Yes, the sexual behavior might be pleasurable, but another payoff might be avoiding the fear of being hurt in a relationship, so choosing a casual encounter is also “safe.” Costs are more easily recognized. In behavioral terms, we identify these as “consequences, ” examples include my partner is angry about my behavior; I was arrested; I got drunk.

Relationship between the components.

If you examine the arrows in the cycle, you will see that each is double pointed. The cycle is dynamic, meaning it is always shifting, moving and adapting. The cycle provides feedback to the individual, and the individual adapts as necessary to continue the cycle. This relationship will be reviewed throughout the exercises as well. An acting out encounter may have a consequence (cost) that sets the person up to act out again. Treatment involves working through this cycle and addressing all aspects.

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