Monday, December 3, 2018

Equine Therapy and How It Helps Recovery


A frequent remedy for mental health issues is to be in a situation where you're not being judged and you have the opportunity to express your true self. However, talk therapy may not initially be the best course of action for someone if he or she has difficulty accessing deep feelings with other people.

Animal-assisted therapy changes this dynamic: you have a chance to simply love and be loved. The interplay between you and your animal companion is one of pure spirit, as two beings find their way to each other. The animal senses your energy and emotions, and this may pose a challenge at first to connect. 

The animal will also continue to exist in its own way, and there's little you can do about this behavior. But each encounter allows you to overcome your fears, change your perceptions, and gain confidence by stepping into a caregiver role and doing what you can to put the animal at ease and understand its nature. As trust develops, the animal responds with an open heart. This connection helps guide you along your healing process.

For someone in recovery from substance abuse, learning to trust, share feelings, recognize a surety in the present moment, and make valuable connections are just a few benefits of animal interactive therapeutic treatments.

Equine Therapy for Healing

One of the most successful forms of this process is equine therapy. Mounting scientific and anecdotal evidence points to the success of this experiential therapy method: a more hands-on approach for working through negative thoughts, feelings, behaviors, and experiences by doing enjoyable activities. For example:
  • A study sponsored by the Animals and Society Institute revealed that individuals participating in equine-assisted therapy "reported significant improvements in psychological functioning immediately following [this therapy] program, and these changes were stable at a six-month follow-up."
  • In a 2018 report by CNN, equine therapy experts relayed information about its success with a number of individuals, including those with autism, chronic pain, PTSD, depression, and other conditions.
  • Psychology Today referenced nearly 50 studies that indicate benefits from working with equine and other animals in therapeutic settings include emotion stabilization, improved socialization and communication skills, better self-regulation or impulse control, reduced depression and anxiety, realignment of stress responses while doing something pleasurable, and increased feelings of calm, comfort, and safety.
  • Counseling Today shared an in-depth story of one equine therapist's experiences helping children and teens with mental and behavioral issues.

A lot of drug and alcohol rehabilitation facilities use some type of equine therapy. As herd animals, horses frequently need to create bonds and form new relationships. If an individual in recovery has attachment or trust issues, working with a horse helps him or her acknowledge these circumstances, and learn to move beyond them in a healthful way. Additionally, a horse's innate hypersensitivity is the perfect mirror for someone's verbal and nonverbal communication. Therapy experts believe the way a person interacts with a horse is an indicator of how he or she is with humans. This awareness can be a pivotal point to explore later in group or individual counseling.

Aspects of an Equine Therapy Session

There are usually three types of equine therapy programs:
  • Therapeutic riding: Considered a recreational activity guided by a non-therapist instructor who helps someone learn to control a horse while riding. Often used with people to build self-confidence and work on communication skills.
  • Hippotherapy: Incorporating the expertise of physical or occupational therapists, language and speech pathologists, or recreation therapists, this practice uses a horse's movements to help a rider improve sensorimotor systems, balance, coordination, and other aspects of movement. Frequently a course of treatment for people with cerebral palsy, autism, or brain damage.
  • Experiential interactivity: Although sometimes riding is a component, most engagement is conducted through ground exercises such as grooming, massaging, leading the horse in a training circle, and a variety of human/horse activities that may be metaphors for what a person is feeling or experiencing. This is the most common method used at drug and alcohol addiction treatment centers.

What people learn during experiential equine therapy for substance abuse treatment may include:
  • Evaluating addiction and its impact
  • Addressing trauma-sensitive issues
  • Improving self-esteem and confidence
  • Using grounding methods to help manage triggers, depression, and anxiety
  • Establishing better relationships and defining necessary boundaries
  • Trying mindfulness and other stress-relieving or coping techniques

What's more, individuals learn that other creatures suffer, too—and that it's within their ability to ease their pain and help them recover. The award-winning documentary Buck follows the life and experiences of trainer Buck Brannaman and how his humanity, vulnerability, and compassion helped him find new purpose, overcome past trauma, and change the lives of hundreds of horses. Watch the captivating movie trailer here.

Cottonwood Tucson's Equine Program

As part of our holistic recovery services, we offer equine-assisted therapy as a means to help an individual develop a better sense of feeling alive in the present moment, and to regain peace and connectivity.

The horses in our therapy team are retired from previous careers, and demonstrate the importance of second chances. Each relationship between horse and human starts on the ground with various activities and exercises to foster trust and communication. A horse can easily detect human emotions, and provide biofeedback to help people establish new ways of understanding their behaviors, perspectives, feelings, and beliefs.


By Tracey L. Kelley


Wednesday, November 28, 2018

Getting Treatment for an Eating Disorder



Sometimes, we know the truth, even if it's hard to face or we don't know where to turn. With so much focus in society on weight gain, weight loss, and model-perfect images in social media and on magazine covers, it's no wonder problems with eating disorders often are overlooked—and sometimes dismissed.

But, if you feel certain behaviors are harming your health, and loved ones or friends express concern about these behaviors, it might be time to consider treatment.

The National Institute of Mental Health (NIMH) defines eating disorders as "serious medical illnesses marked by severe disturbances to a person’s eating behaviors. Obsessions with food, body weight, and shape may be signs of an eating disorder. These disorders can affect a person’s physical and mental health; in some cases, they can be life-threatening."

NIMH clarifies that anyone can suffer from an eating disorder, regardless of gender, body weight, ethnic or racial background, or age. At any time in life, someone can develop an eating disorder, and there are many contributing risk factors, including biological, genetic, psychological, behavioral, and environmental.

The National Eating Disorders Association (NEDA) estimates 20 million women and 10 million men have experienced eating disorders. Someone struggling with an eating disorder has a health condition which NIMH categorizes as biologically-influenced. It's also quite common for these conditions to be co-occurring disorders with other mental health issues or substance abuse.

Anorexia Nervosa

Anorexia nervosa involves actions such as eating extremely small quantities of food, avoiding food, eating miniscule quantities of certain foods, and restricting food in a severe manner. There's also a misconception about body image: many sufferers feel they're grossly overweight when they're often underweight to the point of compromising physical health.

This condition includes two subtypes: restrictive, which is when people limit the kind or amount of food they eat to an extreme level; and binge-purge, which includes restriction as well as behavior that involves laxatives, vomiting, and diuretics as a form of food elimination.

Common symptoms of anorexia nervosa include, but aren't limited to:
  • A heightened fear of weight gain, including refusal to maintain a normal weight for body type and style
  • Intense thinness, often to the point of emaciation
  • Patterns of excessive exercise and food restriction

Initially, anorexia nervosa causes mild health problems such as brittle nails and hair, constipation, and constantly feeling cold. A prolonged condition of starvation weakens muscles, compromises heart function, manifests brain damage, and can result in failure of major organs. NIMH reports anorexia has a greater death rate than any other mental health condition.

Bulimia Nervosa

Bulimia nervosa is defined by eating excessively large quantities of food and not having control over this behavior. Quite often, sufferers maintain a normal weight or may be overweight. They also follow patterns of food elimination similar to anorexia nervosa, in addition to a tendency to exercise too much.

Frequent symptoms and health concerns of bulimia include one or more of the following:
  • Gastrointestinal issues and acid reflux
  • Side effects of laxative abuse, such as intestinal problems
  • Inflammation and swelling of the throat, neck glands, and jaw
  • Teeth issues, including loss of enamel, sensitivity, and decay
  • Serious dehydration and electrolyte depletion from purging or intense exercise
  • Heart attack or stroke brought on by excessive binging and purging

Binge-Eating Disorder

Binge-eating disorder is different from bulimia nervosa in that sufferers may still binge, but they don't exercise, purge, or use other methods for food elimination. Consequently, they're often obese or morbidly obese.

Binge-eating is classified by three or more recurring symptoms:
  • Eating excessively in a short timeframe, such as one or two hours
  • Consuming food quickly during one of these episodes
  • Eating even when not hungry or when feeling full
  • Experiencing intense digestive issues
  • Brain fog and confusion
  • Stealing or hoarding food
  • Hiding during episodes like these, or the evidence of the amount of food consumed
  • Experiencing feelings of shame, guilt, stress, or embarrassment about this behavior

Once someone develops a pattern for binging, it becomes a compulsion, similar to alcohol or drug abuse. Additionally, people with bulimia nervosa and binge-eating disorders are at greater risk for medical complications and suicide.

Getting Help for Eating Disorders

To help determine if you have a problem, NEDA provides a screening tool and a guide on how to start a conversation with a mental health professional about treatment.

Causes for eating disorders vary considerably, so an individualized approach is a must. There is a range of options available to address the underlying reasons for a condition, such as:
  • Acceptance and commitment therapy
  • Cognitive behavioral therapy
  • Dialectical behavioral therapy
  • Interpersonal psychotherapy
  • Family-based therapy
  • Eye Movement Desensitization and Reprocessing (EMDR)
  • Body-oriented applications such as yoga, somatic experiencing, and biofeedback

Levels of care that may be recommended include:
  • Inpatient treatment, if an individual suffers with medical complications, testing reveals acute risk factors, or symptoms are rapidly worsening
  • Residential treatment, if someone doesn't require serious medical treatment but may have a psychiatric impairment
  • Partial hospital treatment, if a person's health is stable but they are having trouble functioning in daily life, such as working or going to school; or are still engaging in potentially harmful behavior such as fasting, purging, or binge eating
  • Intensive outpatient treatment, if an individual is psychiatrically and medically stable, doesn't require monitoring, and doesn't have compromised daily functions

The intent of eating disorder treatment is to help someone regain a healthy relationship with food, a more realistic perspective of body image, and stronger emotional and mental balance.

Eating Disorder Treatment at Cottonwood Tucson


To help people suffering from eating disorders, our facility provides specialty treatment so they may change their relationship with food from an additive concern to one aspect of a healthy lifestyle. Learn more here.


By Tracey L. Kelley

Sunday, November 18, 2018

Handling the Holidays While in Recovery


The festive holiday season is often filled with work parties, gatherings with family and friends, themed activities, and other events. We celebrate certain traditions, cook or bake specialty foods, and enjoy customs that only happen once a year.

As happy as these times often are, they might also be gateways to stress, disappointment, and concern. It's not unusual to seem overwhelmed while in a rush to get everything done. Sometimes, assumptions of how things should look or be are dashed due to lack of time or finances. Frequently, family interactions can be fraught with certain expectations as well or worse, conflict.

For a variety of reasons, many people have difficulty handling the holidays—and not just people in recovery. This is important to remember if you believe something's wrong because you think or feel the way you do. Emotions, such as depression and anxiety, are so common during winter festivities, several health organizations have provided suggestions for coping with the season.

  • Reduce the rush by creating a plan. Schedule visits, shopping, and other holiday-related activities to avoid last-minute hassles.
  • Stick with your healthy living routine. This includes plenty of sleep, regular exercise, and whole food meals. 
  • Make a budget and stick to it. A frequent stress trigger is money. Think about what other types of gift giving have value so you don't overspend.
  • Manage expectations carefully. Whether it's engaging with family members or determining how much time or money should be spent, set realistic goals. 
  • Give yourself a break. Remember how self-care is vital to your wellbeing, so plan for some quiet time to take a breath and refresh yourself.
  • Stay connected. Whether you're active in a local church or charity, or have some other type of support network or professional care team, keep in touch and reach out if you need help.

The Cleveland Clinic offers additional suggestions for handling the holidays, such as:
  • Be honest about feelings of loneliness, sadness, and anger. Just because it's the holidays doesn't automatically mean everything is merry and bright. There are no "shoulds." Talk with someone you trust about these emotions and the best way to manage them.
  • Accept any disappointments. If you've recently completed a rehabilitation program, it's easy to get the blues as you reflect on all that happened prior to treatment. Spend time with caring individuals who understand what you're going through so you can move forward.
  • Remember not to overschedule yourself. This is your holiday time, too. If you spend too much time trying to plan activities to please other people, you might drain your energy. Do what's important to you and be open about your commitments. A brief but thoughtful card or phone call might be a better use of time than stretching yourself too thin.

Acknowledge Triggers and Be Prepared
Even if you're not one who makes a detailed list and checks all boxes one-by-one, it's important to plan ahead for the holidays. This time of year often triggers a number of people, including those who aren't in recovery. Unresolved family issues, past hurts, isolation, financial concerns, and high expectations of having the "perfect" holiday season all put a strain on even the most resilient people. 

If you're sober and plan to stay that way, use this time to come to terms with some of the things that may lead to relapse. Devise strategies to stay on course, such as:
  • Keep away from the places and circumstances that and even people who don't reinforce your sobriety. There's no reason to be in a potentially compromising situation.
  • Talk to a party host ahead of time about how you can stay active during the festivities such as taking pictures, keeping score during games, or helping to clean up. This way, you're a valuable part of the activities without worrying about what people may think or ask when you're not drinking or using.
  • Feel free to leave if a situation threatens how you feel. You might need to tell someone ahead of time that you'll only stay for a short while. Once you reach that benchmark, you can gauge how you feel and decide if you should stay or go.
  • Reach out to your support team. Once again, it's important to remember you're not alone. Rely on your network to help you work through whatever makes you feel uncomfortable.
Make Time for Gratitude

No matter what you've been through, use this time of year to identify what you're truly grateful for, and why it matters. This is one of the best methods to avoid relapse. Psychotherapist Amy Morin writes in Psychology Today that there are seven scientifically-proven benefits gratitude provides:
  • Fosters new relationships when demonstrated through appreciation
  • Improved physical health through fewer aches and pains and a stronger focus on wellness
  • Enhanced mental health by reducing depression and increasing happiness
  • Improved empathy for and sensitivity toward others
  • Better sleep, especially if an acknowledgement of gratefulness happens before bedtime
  • Increased self-esteem and less social comparisons
  • Lessened trauma and an increased ability to ward off stress
Simply creating moments to focus on what you have and what you've accomplished helps reinforce true meaning during the upcoming festivities.

Relapse Prevention at Cottonwood Tucson
The behavioral health clinicians at Cottonwood Tucson establish individual relapse prevention plans to help each resident work through potentially challenging emotions and situations. Learn more about what may work for you. 


By Tracey L. Kelley

Tuesday, November 13, 2018

Benefits of Art Therapy



Our souls respond to art, even if we don't believe we're creative in any way. Because of this, art therapy is often a good holistic approach for maintaining sobriety. It allows you to experience emotion, relay perceptions, find peace, and explore new ideas.

The human relationship with art is integrated into our very being. Think of any ancient culture, and you know it through the pottery, paintings, architecture, writings, and other media left behind. We have a primal connection to the aspiration of beauty, and it does us good to be in the seat of creation for a while. 

You don't have to be the next Kahlo, Bernstein, Morrison, or Chihuly to benefit from art therapy. Simply permit yourself the time to create without fear or filters.

The Definition of Art Therapy

Using art as a deliberate form of therapy started in the 1940s. Many official organizations exist around the world to help license professionals in the practice. The Art Therapy Credentials Board (ATCB) defines it as "using art media, the creative process, and the resulting artwork as a therapeutic and healing process."

Healing after substance abuse often requires a multi-layered plan. The physical aspect is usually taken care of through detoxification and other medical care. The mental and emotional components are sometimes addressed through a variety of techniques such as cognitive behavioral therapy; talk therapy with a group or counselor; exercise and other forms of recreation; eye movement desensitization and reprocessing, also known as EMDR; and many other methods. Art therapy is another tool to help people move toward better wellness.

This technique is often used in addiction treatment because it offers someone the chance to:
  • Restore or improve wellbeing
  • Develop better self-awareness and healthier self-esteem
  • Experience emotions through a safe, nonjudgmental approach
  • Understand and resolve emotional conflicts
  • Reduce anxiety
  • Improve social skills
ATCB professionals stress that participating in this therapy isn't simply for the sake of creating art: it's to expand whole person wellness. Process matters more than product. Learning to enjoy the process is an extra bonus.

The Benefits of Art Therapy

Participants in art therapy may use any number of creative outlets and mediums to help move through certain issues, such as:
  • A traumatic event, either experienced or witnessed
  • Reconciling past addiction behavior
  • A mental health condition
For individuals recovering from substance abuse, an art therapist may suggest creating something that reveals how they feel about themselves or a certain event. This clinical approach won't evaluate how someone paints or draws as much as it explores what tangible representation reveals about an emotion.

Art therapy is particularly helpful for encouraging people to acknowledge negative emotions and find meaningful ways to work through them. This recognition leads to a better understanding that sadness, anger, grief, and other feelings are part of being human. Understanding a wide range of emotions opens the door to managing them effectively.

Participants may also learn more about being mindful in the present moment and what that looks or feels like. This is a beneficial technique for controlling reactions to triggers and learning how to pause.

Expression through art is also another tool that helps change behavior. For example:
  • Sketching out a problem may be a way to resolve it, because it's out of your head and placed in front of you, where the answers are clearer.
  • Using free movement, with or without music, as a method to release nervous pent-up energy allows for an acceptance of why this is necessary from time to time.
  • Creating a collage of people, places, experiences, and moments you're grateful for reaffirms this through visual representation when you're feeling down.
  • Writing a letter to someone who hurt or betrayed you, but never sending it, permits you to safely explore the emotions involving this person, and learn constructive ways to let go.
Creative therapeutic applications like these and many others are direct yet non-verbal ways to:
  • Reduce the psychological distress that may have prompted addictive behavior
  • Develop greater resilience to handle external stressors
  • Identify boundaries, when to establish them, and when to let them go
  • Alleviate anxiety or depression
  • Communicate fears and insecurities
  • Deal with concerns about addiction and recovery
  • Accept a difficult decision or situation
There are many clinical techniques your certified art therapist may use. These include active imagination, which is more free association to aspects of the recovery process; Gestalt method, which uses the art as a starting point to prompt deeper discussion; and third-hand approach, during which the therapist helps someone create art but gives the individual total control over the end result.

Take What You Learn into Daily Life

So, while art therapy isn't always about the art, you may discover it's the perfect conduit to allow more joy and stability in your life. As you develop new habits for maintaining sobriety, look around your community for opportunities for creative self-expression.

For example, in the Tucson area, there are many artistic outlets, including:
  • The All Souls Procession. Initially created by artist Susan Johnson after the death of her father, it's "a sanctuary for community members from all walks of life to express their grief and loss in a celebration of creative energy and rejoicing of life." The annual event is a lively mix of dance, aerial arts, workshops, installations, and more. It's organized by Many Mouths One Stomach, a non-profit arts collective, and always welcomes new artists and volunteers.
  • The Sonoran Glass School. Work with delicate yet resilient glass as a metaphor for forming new life from raw material. Various classes in torch work, glass blowing, kiln-fusing, and more.
  • The Drawing Studio. "Where art meets life" is its motto. Multiple classes throughout the year invite you to try your hand at a variety of options.

Opportunities at Cottonwood Tucson

The inpatient rehabilitation schedule at Cottonwood Tucson includes various forms of holistic approaches designed to help you develop recovery methods that work for you, including art therapy. Review a typical patient schedule to learn more. 


By Tracey L. Kelley

Monday, October 22, 2018

Yoga for Recovery: Interview with Emily Mattimoe



Emily Mattimoe, MS, CTRS, is the coordinator of recreation therapy services at Cottonwood Tucson. She explores how leisure and recreational activities can be coping mechanisms for sobriety and how these methods help add joy to the recovery process. 

Yoga is a vital component of the holistic recreational approach at Cottonwood Tucson. "Treatment isn't just about getting counseling—it's about the whole experience. We truly believe in this idea that it's the entire body, mind, and spirit that are affected when it comes to recovery," Mattimoe says. "Many times when people come to us, they're not only having problems with depression, anxiety, and addiction, they're also dealing with somatic experiences. Their bodies are hurting."

Yoga movement and its focus on universal wellness are often considered forms of somatic therapy. Soma is Greek for "living body." This approach examines the connection between body and mind and uses both physical techniques as well as cognitive or behavioral therapy to release underlying causes for many co-occurring conditions people might face when suffering with addiction.

"A lot of times, they're disconnected from their spiritual selves. They're so focused on trying to be functional in life," Mattimoe says. "One of the pieces that Cottonwood does well is we're able to meet residents where they're at, and then maybe pull in the physical aspect and the spiritual aspect and explore how those connections can be such a key element of recovery."

How does yoga practice help with this? "Many times, we don't want to feel emotions, or we don't want to experience what's happening in our bodies because it's so painful. So, what happens is people hold those emotions or trauma in their bodies," Mattimoe says. "It's our job as professionals to really help them move all of that through their bodies, then bring some language to it. Afterward, when they feel safe, start touching on those pieces that might be stuffed down." 

The Importance of Participatory Medicine

Cottonwood Tucson presents residents with the theory of participatory medicine that includes not only physical movement, but emotional movement. It's a form of internal empowerment that Mattimoe says is crucial to the concept of recovery.

"People come in here thinking something external is going to heal them. They're going to have medication-assisted therapies, or 'I haven't able to do it for myself, but this therapist is going to fix me.' Through participatory medicine, we teach them how to have the mindfulness to be better healers for themselves," she says. "People aren't going to be in the Cottonwood bubble for the rest of their lives. Things are going to happen in the real world, but they can use yoga as a mindfulness practice to develop a tolerance for discomfort. For example, 'I can hold this pose for another 30 seconds, it's okay, I don't have to move my foot or react right now.' Someone learns they don't have to disconnect from that experience. They can be a little uncomfortable, but still be safe."

The concepts of ownership and agency are critical to successful recovery. Mattimoe says people often learn through yoga what matters most to them about the process of healing, and not that they're doing it for their parents or the cute guy back home. Honoring yourself and being present for yourself are primary messages conveyed through yoga that most people haven't heard before.

"It's an ability to understand that we have more impact on ourselves than anyone else does. Some people come in and feel victimized, often for very valid reasons," Mattimoe says. "It's our goal to walk them through that feeling of being a victim toward the feeling of 'I can make changes. I can be an empowering person for myself. I have this toolbox that other people help me put together, yet I'm the person who chooses what tool to use, where I use it, and for how long.'"

Yoga, she says, helps reinforce embrace ownership and agency through the power of choice. "Do I want to hold this pose for another breath, put my hand on a block, or can I push the edge a little more? It's all about choices and listening to ourselves as to what we truly need," she says. "Does this feel safe? Does this feel comfortable? Is this too much? Is this too little? We just become more aware of where we are in space, and make choices accordingly."

The Cottonwood Approach to Yoga

Cottonwood Tucson provides new residents first with a lecture that leads to a yoga practice. The staff intends to help break down any barriers regarding yoga so people can learn about the pieces that are important. Many people have never done yoga, think they can't do it, or have a concept of it that doesn't align with what they know. Mattimoe believes one of the best things the staff can do is to help people feel safer and more comfortable while encouraging them to speak up about particular boundaries.

"If someone is willing and open to it, we like to have a conversation about how can we help with any barriers. For example, if someone's fear is 'I have trauma, and I don't want the teacher to touch me in yoga class,'—it's important to vocalize that, because it's a great place to start. And then we can ask 'How do you have control over that, what can you do to address it?' 'Well, I can ask the teacher not to touch me.' And then we assure them the instructors will respect them and this choice."

Yoga instructors at Cottonwood Tucson are often multi-disciplined in other wellness components, such as counseling, behavioral therapy, and nutrition. They design yoga sessions based on the people in the class, allowing for individual experiences to guide the flow. Teachers often need to be considerate of how different participants have triggers that involve everything from someone standing behind them to trust of strangers, but it's also important for individuals to find their voices and be open about what they need.

"This is so huge. It's part of the goals we have of them being here: being able to share honestly what they're feeling and what's happening with them without shame, without judgement," Mattimoe says. "So many times, we feel things are happening to us. Our staff wants to validate that this is their opportunity to have some buy-in. They've been feeling out of control, maybe due to depression, isolation, and trauma, or to using. We want to help them regain control."

Mattimoe notes that addiction creates chaos. Yoga, she says, is the opposite: it fosters a space of stillness, of calm. "Chaos is often the way we distract ourselves from what's happening. With yoga, we build a foundation to face all of that," she said. "People may not have any idea yet what it's doing for them, but we can hopefully help make small adjustments that have a huge impact." 

What Allows You to Succeed

The professionals at Cottonwood believe communication is fundamental to many aspects of life during treatment and beyond. Through the variety of holistic practices offered at the facility, people develop the mindfulness to acknowledge their experiences, work through them, and step on the path to a more healthy life with the ability to make their voices heard. To learn how this approach may help you, please contact us today.


By Tracey L. Kelley

CARF - Commission on Accreditation of Rehabilitation FacilitiesNATSAP | National Association of Therapeutic Schools and ProgramsNBCCNAADAC