The process of brain resiliency is supported by neuroscientist Michael Merzenich, whose research at the University of California shows that the brain has the capacity to change itself in both physical and functional ways.8 Merzenich is a leading proponent of therapeutic approaches to overcome functional limitations. These ideas are supported by a 2006 study by Dr. Sherry Willis and colleagues with the National Institute on Aging that was the first to document long-term, positive effects of cognitive training on brain function in older adults. The study showed that at nearly any point in your life, you can strengthen your brain by doing tasks that are new and complex and that stimulate a balanced variety of areas within the brain.9
The work of Ernest Rossi, PhD, has provided a platform from which we have designed and implemented many of our activities. Rossi posits we can enhance neural networking, stimulate dendritic growth, and promote a healthy rebalance of neurotransmitters through engaging in three areas: novelty, environmental enrichment, and physical activity. Rossi states, “Novelty, exercise, and life enrichment facilitate gene expression and brain growth.”10 He emphasizes that by pushing beyond boundaries of comfort, one can expand possibilities as well as accelerate the process of healing. Rossi has initiated supportive research, currently in progress, to document the effect of creative problem solving on genetic expression. In addition, “Gene expression and brain plasticity can consolidate the healing reconstruction of fear, stress, and traumatic memories and other symptoms in everyday life.”11
Expression that is not limited by cognitive or verbal elements is a basic and fundamental construct of our approach. Another is being able to envision a positive future without the limitations of addiction. Elements of past, present, and future behaviors are entwined in our activities. Acceptance of what is unchangeable, learning needed skills in the present, and envisioning success in a future time are embedded lessons in most activity. In subtle ways, the activities teach learning to relax, enjoying the moment, looking at how others have fun in sober ways, recognizing that all individuals have limitations, and making associations with current capabilities that will lead to a healthy and happy future.12
What makes Engage the Group, Engage the Brain distinct is we tested each of these activities in groups with actual clients in recovery. We obtained feedback from participants and refined and adjusted activities as needed. All samples displayed in this book are the original work of clients in our groups, who graciously gave us permission to use them. The process of compiling these activities has been immeasurably rewarding for us. The clients are consistently appreciative and enthusiastic, and each session brings its own novelty and enrichment. The unexpected resourcefulness that seems to arise in nearly every session is exciting and gratifying.
It is our hope and expectation that our efforts will offer practical directions for other clinicians to feel the energy generated through this process. Science has not yet brought us to a place where we can state with certainty that these activities actually lead to neuroplasticity and help strengthen recovery; however, we offer these materials as our contribution to a promising new direction.
Introduction Notes
1. A. Thomas McLellan, David C. Lewis, Charles P. O’Brien, and Herbert D. Kleber, “Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation,” JAMA, no. 284 (13, 2000): 1689–1695.
2. “Drug Abuse and Addiction: One of America’s Most Challenging Public Health Problems,” National Institute on Drug Abuse, last modified June 2005, accessed June 29, 2015. http://archives.drugabuse.gov/about/welcome/aboutdrugabuse/index.html.
3. James O. Prochaska, John Norcross, and Carlo DiClemente, Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward (NewYork: Avon Books, 1994).
4. William R. Miller and Stephen Rollnick, Motivational Interviewing: Helping People Change, Third Edition (New York: Guiford Press, 2012).
5. Ernest L. Rossi, Roxanna Erickson-Klein, and Kathyrn L. Rossi, eds., The Collected Works of Milton H. Erickson Volume 3: Opening the Mind (Phoenix: Milton H. Erickson Foundation Press, 2008).
6. Norman Doidge, The Brain that Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science (New York: Penguin, 2007).
7. Jon Kabat-Zinn, Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness (New York: Delta, 2005).
8. Dean C. Buonomano and Michael M. Merzenich, “Cortical Plasticity: From Synapses to Maps,” Annual Review of Neuroscience, no. 21 (1998), 149–86.
9. Sherry L. Willis, Sharon L. Tennstedt, Michael Marsiske, Karlene Ball, Jeffrey Elias, Kathy Mann Koepke, K. M., et al., “Long-term Effects of Cognitive Training on Everyday Functional Outcomes in Older Adults,” Journal of the American Medical Association, no. 296 (23: 2006), 2805–2814.
10. Ernest L. Rossi and Kathyrn L. Rossi, Creating New Consciousness in Everyday Life: The Psycho-Social Genomics of Self Creation (Los Osos: Palisades Gateway Publishing, 2013).
11. Ibid., 964–967.
12. Philip Zimbardo, Richard Sword, and Rosemary Sword, Time Cure: Overcoming PTSD with the New Psychology of Time Perspective Therapy (San Francisco: Jossey-Bass, 2012).
How to Use This Book: A Facilitator’s Guide
Through our experience in the field, we have learned a variety of strategies that will help you conduct dynamic groups. In this section, we share our methods for engaging participation and maximizing opportunity for therapeutic transformation.
The activities in the book may be done in any order as they might fit into your group.
Group Management: We always begin these activities with a short summary emphasizing patience, being aware of self in the present moment, and the importance of self-care. Starting with a brief review of the body’s needs for a balance of nutrition, sleep, and exercise, we also emphasize a need for good spiritual and mental health. We briefly call attention to each of the six areas this book is divided into and clarify how the chosen activity relates to those areas.
We use analogies about how addiction has commonalities with other conditions. People who have brain damage from stroke, head injury, or alcohol and other drug use often have impairments in short-term memory, long-term memory, verbal or written language expression, motor skills, and emotional regulation. The concept of neuroplasticity is introduced in simple terms. Group activities are then described from the perspective of being an opportunity to enrich oneself through conditions (novelty, enrichment, and exercise) that hold promise for accelerating healing and enhancing the probability of success in recovery.
We invite participants rather than instruct, and we accept the depth and direction of engagement each participant chooses. Over and over we stress: There is no right way to do an activity; it is a process of trial and error, a discovery, a journey. We hope each person will find some aspects of the activity useful in recovery.
As clinicians and facilitators, we find it essential to stay flexible and compassionate and be willing to modify activities to suit the capabilities and moods of each particular group. One of the lessons implicit in the activities is that artistic creations rarely come out the way they are envisioned. The processes of using unfamiliar materials, making mistakes, recognizing limitations, and accepting what is imperfect are all part of what is expected. Repeatedly, we stress that it is not the product but rather the participation. The process of being expressive, creative, and challenged by a new activity is therapeutic in itself, with or without a final product. We suggest participants turn attention inward and notice what is happening in the moment (thoughts, sensations, emotions, or moods). Learning can come