Counselor Toolbox Podcast: Recent Episodes
Dr. Dawn-Elise Snipes
Counselors, coaches and sober companions help hundreds of thousands of people affected by Addictions and Mental Health issues each year. Learn about the current research and practical counseling tools to improve your skills and provide the best possible services. Counselor Toolbox targets counselors, coaches and companions, but can also provide useful counseling self-help tools for persons struggling with these issues and their loved ones. AllCEUs is an approved counseling continuing education provider for addiction and mental health counselors in most states. Counseling CEUs are available for each episode.
Chapters: 00:00:00 - Signs of Toxic Guilt 00:04:31 - Signs of Toxic Guilt and Ways to Deal With It 00:09:04 - How the Media, Communities, and Family Shape Beliefs Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapters: 00:00:00 - Signs and Causes of Avoidant Attachment 00:04:21 - Interventions for Insecure Attachments 00:08:53 - Developing Friendships with Avoidant Attachment 00:13:17 - Developing emotional awareness and regulation Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapters: 00:00:00 - Anxious Attachment and How to Address It 00:04:09 - Understanding Anxious Attachment and Emotional Dysregulation 00:09:01 - Understanding the Caregiver-Child Relationship and Anxious Attachment 00:13:42 - Distress Tolerance and Overcoming Anxious Attachment 00:18:19 - Tips for Anxious Attachment in Relationships 00:22:52 - Understanding and Changing Anxious Attachment Behaviors Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapters: 00:00:00 - Understanding the Drama Trauma Triangle of Codependency 00:04:28 - Understanding Codependency: Reasons for Rescuing Others 00:08:52 - The Cycle of Codependency and Trauma Responses 00:13:37 - The Cycle of Codependency and Trauma 00:18:18 - Understanding Codependency and Abandonment Trauma Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapters: 00:00:00 - Increasing Motivation Through Identifying Benefits and Drawbacks of a Behavior 00:04:18 - Tips for Increasing Motivation 00:08:36 - Motivational Enhancement and Depression Recovery Resources Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapters: 00:00:00 - Introducing 7 Ways to Stop Emotional Eating 00:04:44 - Techniques to Reduce Emotional Eating 00:09:06 - Managing Emotional Eating and Anxiety Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapters: 00:00:05 - Developing Self-Esteem in Kids: Components and Practical Tips 00:04:34 - Importance of Caregivers in Children's Emotional Intelligence Development 00:09:19 - Tips for Developing a Secure Attachment with Children 00:13:52 - Tips for Effective Communication with Children 00:18:47 - Tips for Managing Children's Behavior in Public Places 00:23:24 - Addressing Cognitive Distortions in Children 00:28:09 - Developing Self-Awareness and Values in Children 00:33:06 - Teaching Values to Children, Including Empathy and Caring 00:37:59 - Promoting Skill Exploration and Opinion Formation in Children 00:42:37 - Helping Children Cope with Unfortunate Events 00:47:15 - Encouraging Emotional Vocabulary in Children 00:52:06 - Enhancing Self-Esteem by Encouraging the Best Version of Yourself Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapters: 00:00:00 - Nine Ways to Overcome Jealousy About Their Exes 00:04:18 - Don't Dig on Social Media: How to Avoid Relationship Insecurities about Exes 00:08:49 - Letting Go of Abandonment Issues in Relationships Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapters: 00:00:00 - 10 Tips for Verbal Crisis De-escalation 00:04:25 - Approaching and De-escalating a Person in Crisis 00:09:09 - De-escalation Techniques: Walk and Talk, Offer a Piece of Gum, Hear Their Perspective, Empowerment. 00:13:35 - Understanding Your Emotional Reactions in the Moment Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapters: 00:00:00 - Five Tips for Creating a Secure Relationship with Yourself 00:02:48 - The Importance of Self-Encouragement and Loving Kindness for Inner Child 00:05:30 - The Importance of Secure Attachment with Self Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapters: 00:00:00 - Six Ways to Overcome Jealousy 00:02:43 - How to Deal with Jealousy and Learn from Others 00:05:32 - Managing Jealousy to Improve Your Health and Relationships Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapters: 00:00:00 - Five Signs You Never Formed a Secure Attachment 00:02:47 - The Importance of Healthy Boundaries for Emotional and Cognitive Intimacy 00:05:28 - Strategies for Addressing Insecure Attachment and Low Self-Esteem 00:08:07 - Developing Attachment and Learning to Love Yourself Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapters: 00:00:02 - Commonalities between Codependency, CPTSD, and BPD 00:02:46 - The Impact of Addiction on Neurotransmitters and Relationships 00:05:50 - The Impact of Addicted and Enabling Caregivers on Children's Development 00:08:46 - Trauma and the Importance of Self-Care in Mental Health 00:11:51 - Dysregulation of the HPA axis in caregiving situations 00:14:49 - Anxiety and Emotion Regulation in Dysfunctional Environments 00:17:39 - The Effects of Dysfunctional Caregiving on Children's Self-Perception and Learning Abilities 00:20:28 - The Effects of Trauma on Learning and Relationships 00:23:17 - Dysfunctional Families: Lack of Communication and Validation 00:26:02 - The Impact of Dysfunctional Environments on Self-Worth and Emotional Regulation 00:28:53 - Understanding Self-Destructive Behaviors and Dysfunctional Relationships 00:32:04 - The Link between Trauma and Codependency/BPD 00:35:04 - Recognizing Trauma-related Re-experiencing in Codependency 00:37:48 - Hyper Vigilance and Emotional Dysregulation in Trauma and Codependency 00:40:47 - Internalized Messages and Relationship Difficulties in CPTSD and Codependency 00:43:44 - Emotional Dysregulation and Relationship Issues in Narcissistic Personality and Codependency 00:46:27 - Developing Strong Boundaries for Codependency, CPTSD, and BPD 00:49:17 - Developing Distress Tolerance Skills for Overwhelming Emotions 00:51:59 - Techniques for Managing Emotion and Stress levels 00:54:46 - Coping Skills and Interventions for Mental Health 00:57:29 - Preventing and Mitigating Pacer Vulnerabilities 00:59:57 - Helping Traumatized Individuals with Personal Empowerment and Behavioral Progress 01:02:32 - Healing from Attachment Trauma with Self-Connection Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapters: 00:00:00 - Understanding Adverse Childhood Experiences and PTSD 00:02:47 - Adverse Childhood Experiences and Complex Post-Traumatic Stress Disorder 00:05:31 - The Terrifying Effects of Child Abuse and Neglect 00:08:24 - Symptoms of Complex Post-Traumatic Stress Disorder (CPTSD) Learn more about your ad choices. Visit megaphone.fm/adchoices
TIMESTAMPS 00:00 Intro 00:30 Reactive Attachment Disorder 12:30 Disinhibited Social Engagement Disorder 24:30 Differential diagnosis 33:33 Attachment Disorder Treatment Targets
Peer Reviewed Articles referenced in this presentation can be found here https://pubmed.ncbi.nlm.nih.gov/?term=vitamin+d&filter=simsearch2.ffrft&filter=years.2012-2022 And specifically as it relates to psychiatric issues here https://pubmed.ncbi.nlm.nih.gov/?term=vitamin+d+psychiatric&filter=simsearch2.ffrft
TIMESTAMPS 00:00 FACE PALM Challenging Questions 07:25 Moving Forward 13:15 Paving the Way to letting go 20:55 Moving Forward
TIMESTAMPS 00:00 Introduction 00:38 Human Pet Bond 07:35 Impact of Pet Loss 15:50 Grief and Disenfranchised Grief 30:00 Coping Strategies
TIMESTAMPS 00:00 Introduction to schizophrenia spectrum disorders 04:00 Types of delusions 08:50 Hallucinations 10:30 Disorganized thinking 12:45 Abnormal motor behavior 15:10 Negative symptoms in schizophrenia 17:30 Schizophrenia, brief psychotic disorder schizophreniform 21:55 Delusional Disorder 22:40 Differential diagnosis 31:05 Associated features | treatment targets 39:45 Functional impairment | Treatment targets
TIMESTAMPS 00:00 Intro 04:56 Secure Attachments 08:59 Assuming 13:11 Why Developing Self-Esteem is Important 14:14 Nurture your other roles and relationships
TIMESTAMPS 00:00 Intro 00:35 Where to find a therapist 04:57 What to look for in a good therapist 16:50 American Counseling Association #ACA Ethics 20:25 Why a good connection is important 24:15 How to talk with your therapist about what you think your diagnosis is and treatment planning
TIMESTAMPS 00:00 Intro and What is attachment 02:32 Functions of secure attachment 05:02 Anxious insecure attachment styles 07:35 Anxious ambivalent attachment 09:35 Avoidant Attachment Dismissive Attachment 16:00 Consequences of insecure attachment 18:35 Creating secure attachment
TIMESTAMPS 00:00 Intro 00:34 Symptoms of Weak Boundaries 04:56 Symptoms of Rigid Boundaries 15:28 Physical Boundaries 28:15 Affective Boundaries 35:55 Cognitive Boundaries 44:20 Environmental Boundaries 53:08 Relationship / interpersonal boundaries 56:09 Other Tips for Maintaining Boundaries
TIMESTAMPS 00:00 How do I set and maintain personal boundaries intro 00:35 Symptoms of weak personal boundaries 04:55 Symptoms of rigid personal boundaries 15:28 Physical personal boundaries (I have the right to my personal space and to not be touched) 28:13 Affective or emotional boundaries (I have the right to my own feelings) 35:51 Cognitive […]
TIMESTAMPS 00:00 Introduction 04:35 Secure Attachment and Emotional Intelligence How consistency develops EI 07:10 Secure attachment. What responsiveness develops 10:05 How validation and encouragement develop emotional intelligence 13:15 Summary
TIMESTAMPS 00:00 Introduction 02:15 Diagnostic Criteria for autism spectrum disorders according to the DSM-5-TR 19:19 Strengths of Autistic people 26:25 Prevalence of ASD 28:00 Development and course of Autism Spectrum Disorders per the DSM-5-TR 30:35 Risk factors for Autism 39:00 Gender differences sex differences in presentation and rate of diagnosis 40:58 Challenges from Social Impairments […]
Review why vagal tone is important in releasing
Explore strategies to help you gain more control over your autonomic nervous
Define addiction / substance abuse
Eldentify the general categories in the DSM 5 TR
Explore diagnostic criteria for SUDs and addictions
-Define rheumatoid arthritis and ankylosing spondylitis
-Explore the symptoms of these two disorders and how it impacts mental health
-Highlight general treatment strategies
Describe the orienting response
Explore the relationship between the orienting response, the vagus nerve and the HP-Axes
-Review the concept of the inner child -Identify the needs of the inner child -Explore strategies to reparent the inner child through developing secure attachment
Adding Court Mandated Services to your Practice – Interview Sponsored by: The Diversion Center
👋 Chat with me at https://t.me/docsnipesbot NOTE: ALL VIDEOS are for educational purposes only and are NOT a replacement for medical advice or counseling from a licensed professional. 12 Rules for Life Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC AllCEUs.com Continuing Education Rule 1: PAVE PAVE the way to healthy relationships by being assertive in […]
Explore the unique issues causing adolescents anxiety NOTE: ALL Podcasts are for educational purposes only and are NOT a replacement for medical advice or counseling from a licensed professional. #adolescentanxiety #parenting #childdevelopment Adolescent Anxiety Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC AllCEUs.com Continuing Education Objectives Identify prevalence Explore triggering issues Discuss how/why adolescents […]
Behavior Modification Tools for Obsessions, Cravings and Addictive or Compulsive Behavior #behaviormodification #NCMHCE #OCD NOTE: ALL Podcasts are for educational purposes only and are NOT a replacement for medical advice or counseling from a licensed professional. Objectives Review basic behavior modification interventions and their utility with addictive and compulsive behaviors Baseline To understand […]
meditation #mindfulness #lovingkindness 👋 Chat with me at https://t.me/docsnipesbot NOTE: ALL Podcasts are for educational purposes only and are NOT a replacement for medical advice or counseling from a licensed professional.
👋 Chat with me at https://t.me/docsnipesbot NOTE: ALL Podcasts are for educational purposes only and are NOT a replacement for medical advice or counseling from a licensed professional. #justfortoday #meditation #mindfulness #anxiety #depression 1. Just for today I will be honest with myself and have the courage to accept life as it is without trying […]
👋 Chat with me at https://t.me/docsnipesbot NOTE: ALL Podcasts are for educational purposes only and are NOT a replacement for medical advice or counseling from a licensed professional. Empathy helps you explore their reality through their eyes Detachment allows you to know clearly where you end and they begin so you can step in and […]
👋 Chat with me at https://t.me/docsnipesbot NOTE: ALL Podcasts are for educational purposes only and are NOT a replacement for medical advice or counseling from a licensed professional. Most people have a certain amount of anxiety in relationships because they are vulnerable, and that person is important to them Abandonment anxiety is an issue when […]
👋 Chat with me at https://t.me/docsnipesbot NOTE: ALL Podcasts are for educational purposes only and are NOT a replacement for medical advice or counseling from a licensed professional. Body dysmorphic disorder (BDD) is characterized by the belief that some aspects of one’s appearance are ugly, unacceptable, or otherwise deformed, while this is in fact not […]
POTS is extremely common and frequently misdiagnosed as anxiety POTS is an invisible disability that impacts every area of life which can lead to impaired self esteem, depression, anxiety, guilt, grief, relationships and secondary health issues Stress from the effects of POTS on the individual’s life can make their POTS symptoms worse.
Moral Injury of Abandonment Moral injury is traumatic and may involve the loss of a sense of Self (This is not who I am / I am a bad person) Safety (I am not safe, others will reject me because of what I did) Personal power (I had no choice or say in the matter) It is important to use context and consider all the factors at play when helping people examine and reconcile the situation Often they did the best they could with the tools they had in that situation at that time Moral injury is defined as the profound psychological distress which results from actions, or the lack of them, which violate one’s moral or ethical code. Abandonment means leaving, relinquishing or even choosing one over another. People sometimes have to make the devastating choice to abandon one thing for the good of another Other times (terminal illness) they may not have a choice People may also suffer moral injury by proxy when the leaders of a culture with whom they identify engage in morally reprehensible acts. Moral injury has multiple PACER impacts
We often focus on the primary grief after a breakup but fail to consider: Secondary losses that need to be grieved (friends, routine, role/identity, dreams) Guilt (and the need for processing) Changes in self reference and default mode (and the need for alterations) Depressive symptoms that result from the stress of the breakup as well as being a part of the grieving process Grief has 5 phases: Denial, anger, bargaining, depression, acceptance #cheapceus #allceus #counselingskills #dawnelisesnipes
Listening and Hearing Set ground rules Stop mind reading Stop projecting One person and one thing at a time Use objective language Have a safe-word and de-escalation plan if you feel like you are getting defensive or being attacked
-Discuss multiple methods for motivating diverse groups including teams, groups, and families.
-Create a safe and empowering environment by recognizing and being responsive to the impact of prior traumas.
-Synergize to balance individual differences
-Identify strategies to create secure attachments
- Explore physical, affective and cognitive evidence-based practices for PTSD Physical
- Medications
- Use of benzodiazepines following trauma was not beneficial, and may increase the risk of developing PTSD
- Use of the beta-blocker propranolol have been conflicting but one RCT did show a significant decrease in the severity of PTSD symptoms and lower likelihood of developing subsequent PTSD
- SSRIs may be helpful for addressing anxiety and depressive symptoms related to PTSD
This content was inadvertently released as part of Childhood Experiences episode. It is being re-release as a stand alone episode. - Explore the comorbidities with PTSD
Objectives ~ Explore the relationship between ACEs and trauma ~ Identify the impact of ACEs and traumatic injury on mental, physical and interpersonal health in adults ~ Explore risk factors for ACEs and subsequent prevention and intervention measures.
» Define Neurodegenerative Disorders » Explore the bidirectional interaction of mood and NDs » Review the functions of serotonin and dopamine in mood and neurodegenerative disorders » Describe the symptoms of NDs » Explore Primary, Secondary and Tertiary prevention of NDs
- Review the characteristics of BPD
- Explore the functions of these symptoms
- Identify what may cause these symptoms to develop
- Explore what is maintaining these symptoms (benefits to the client)
- Explore the effects of these symptoms on significant others
- Identify interventions to help the person more effectively manage emotions and relationships
- Define postpartum depression
- Identify signs of postpartum psychosis
- Identify Risk factors of PPD
- Identify screening tools and protocols
- Discuss the impact of PPD on the mother, child and family
- Identify the cause of PPD
- Explore current biopsychosocial interventions for PPD
- Postpartum depression usually occurs in the first 4 to 6 weeks after giving birth, and it is unlikely to get better by itself.
- 50% of patients experienced depression for more than 1 year after childbirth.
- Women who were not receiving clinical treatment, 30% of women with postpartum depression were still depressed up to 3 years after giving birth
Summary ~ Young traumatized children’s reactions and behaviors are best understood in the context of relationship. ~ Foster care is an active intervention with the goal of helping the young child to recover from their traumatic experience, not just a “place to stay.” ~ The foster/resource parent is an essential partner in the recovery of the young child. ~ Transitions for young children should be carefully planned
Chat with me at https://members.docsnipes.com/ For $10/month where you get access to my tips for health and wellness and you can text chat with me privately 7 days a week. #cheapceus #SAMHSA #counselingskills #dawnelisesnipes TIP 51 Specific Needs of Women Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP Executive Director, AllCEUs Objectives – Identify how the needs […]
Objectives ~ Explore what caregivers really are ~ Identify some of the things caregivers do ~ Identify the consequences of adopting a caregiver role ~ Review cognitive behavioral strategies to help caregivers prevent physical, emotional and interpersonal problems
Summary - Normal aging is a gradual process that ushers in some physical decline, such as decreased sensory abilities (e.g., vision and hearing) and decreased pulmonary and immune function - Decline in cognitive capacity with aging is partly preventable - Older persons display flexibility in behavior and attitudes and the ability to grow intellectually and emotionally - Losses with aging include Social status, self-esteem, physical capacities, death of friends and loved ones - Anxiety disorders are the most prevalent mental health disorders in older adults - There are many causes of cognitive impairment besides Alzheimers. - Mild cognitive impairment is not unusual and generally does not meet accepted criteria for Alzheimers Schizophrenia in Late Life - Focus on the person's strengths and how they can remain as independent as possible - Encourage quality sleep, daily routines and proper nutrition - Cognitive behavioral and problem solving therapies have both been found to be effective. - Older persons clear medication from their system more slowly and are more susceptible to side effects of many medications. - Day treatment/drop in centers are available throughout the country for respite care as well as to facilitate interaction and allow caregivers to work - Caregivers often have their own emotional, financial and social needs that need to be addressed when caring for a parent or spouse.
Objectives ~ Learn about hepatitis and its prevalence ~ Identify the consequences of hepatitis ~ Explore the impact of hepatitis on mental health and effective interventions
Objectives ~ Define and examine the prevalence of HBP and CVD ~ Explore the impact of HBP and CVD on mental health ~ Identify strategies to improve wellness while living with HBP/CVD
~ Explore the role of the endocannabinoid system in ~ Mood disorders ~ Cognitive disorders ~ Autoimmune and inflammatory disorders ~ Pain ~ Stress
~ Define the three types of prevention ~ Review risk factors for abuse ~ Identify strategies for preventing abuse and neglect ~ Discuss reasons prevention programs fail 3 Types of Prevention ~ Primary: Keep it from happening ~ Secondary: Prevent worsening ~ Caregiver: Verbally abusive or neglectful caregiver ~ Child or Elder: Anxiety, depression, low self esteem ~ Tertiary: Prevent additional issues
Objectives - The Goal of ACT - What is Mindfulness? - How Does ACT Differ from Other Mindfulness-based Approaches? - What is Unique to Act? - Destructive Normality - Experiential Avoidance - Therapeutic Interventions - Confronting the Agenda - Control is the Problem, Not the Solution - Six Core Principles of ACT
Objectives - Why was DBT created - Understanding Emotional Dysregulation - Identify DBT assumptions about clients and therapists - Explore skills to help clients learn - Distress Tolerance - Emotional Regulation - Interpersonal Effectiveness
Sponsored by BetterHelp. Clinicians, sign up with BetterHelp to increase your bookings and work from teh comfort of your own home. https://hasofferstracking.betterhelp.com/aff_c?offer_id=20&aff_id=2373 Co-Occurring Disorders Current Evidence Based Treatments Dr. Dawn-Elise Snipes Objectives ~ Review current research on evidence based and promising practices for Co-Occurring Disorders Intro ~ Most people with addictions also have other co-occurring […]
Objectives ~ Define Neuro-Atypical ~ Explore how they may experience the world differently ~ Reflect on experiences not traumatic to people who are neurotypical may be traumatic to those who are neuroatypical ~ Hypothesize about how common parenting practices might be traumatic and overwhelming to the infant/toddler who is neuro-atypical ~ ACEs in individuals who are neuroatypical ~ TIC for people who are neuroatypical
Objectives ~ Explore the impact of alcohol on neurotransmitters and major bodily systems Intro ~ Heavy drinking worsens morbidity from chronic disease as it exacerbates the effects of hypertension, diabetes mellitus, and hepatitis, and interferes with the metabolism and therapeutic actions of various medications ~ According to the "Dietary Guidelines for Americans 2015-2020,” U.S. Department of Health and Human Services and U.S. Department of Agriculture, moderate drinking is up to 1 drink per day for women and up to 2 drinks per day for men.
Summary ~ Thyroid hormones can be altered by physical or emotional stress ~ Thyroid hormones via the HPT axis are intertwined with the HPA-Axis –dysfunction in one produces dysfunction in the other ~ Many cognitive, affective and behavioral symptoms commonly seen in behavioral health settings may have some underpinnings in thyroid dysfunction ~ Mental health clinicians can educate patients about the far-reaching impact of thyroid hormones; help them address cognitive and emotional stress and trauma and address sleep and circadian rhythms.
*Podcast had to be done with a backup microphone, I apologize for the sound quality.
Sponsored by BetterHelp. Clinicians, sign up with BetterHelp to increase your bookings and work from the comfort of your own home. https://hasofferstracking.betterhelp.com/aff_c?offer_id=20&aff_id=2373
Objectives ~ Define the impact of disabilities on the 7 categories of functional capacity ~ Explore unique challenges for people with disabilities ~ Identify attitudinal, procedural and treatment barriers and methods to mitigate them ~ Review other identified behavioral targets
Sponsored by BetterHelp. Clinicians, sign up with BetterHelp to increase your bookings and work from the comfort of your own home. https://hasofferstracking.betterhelp.com/aff_c?offer_id=20&aff_id=2373
Objectives ~ Learn what PAWS is ~ Explore why PAWS happens ~ Identify steps to take to reduce and cope with PAWS
Sponsored by BetterHelp. Clinicians, sign up with BetterHelp to increase your bookings and work from the comfort of your own home. https://hasofferstracking.betterhelp.com/aff_c?offer_id=20&aff_id=2373
oxytocin #hormones #cheapceus
Objectives ~ Learn about the functions of oxytocin ~ Identify how oxytocin may impact mood, cognition, behavior (including addiction) and social functioning ~ Explore current research involving the use of intranasal oxytocin for treatment
Summary - Acetylcholine is not often talked about but is a necessary excitatory neurotransmitter - Acetylcholine interacts with gonadal hormones, thyroid hormones and several neurotransmitters - Acetylcholine is important for energy, memory, attention, regulation of muscle contraction and much more. - Choline is necessary to make acetylcholine - Tyrosine is necessary to make acetylcholine - Too much acetylcholine contributes to anxiety and irritability, too little contributes to anhedonia
Video games, online gambling, online shopping and pornography all have the potential to become problematic Social media also has an addictive quality that can cause withdrawal and exacerbate mood disorders and/or addictions What Makes a Video Game Addictive High Score Beating the Game No Ending to the Game – i.e. Massive Multiplayer Online Role-Playing Games (MMORPGs) Role Playing Novelty/Discovery A good portion of World of Warcraft is spent exploring imaginary worlds, and Minecraft is spent designing new worlds Relationships Acceptance A place to anonymously try out different personas
Like other addictions, internet addiction can have physical, social, financial and emotional consequences In our digital age, it is highly unlikely that people can completely unplug. Similar to other behavioral addictions like eating and sex, it is necessary to identify the motivations behind the internet use Additionally, by its very rewarding nature, internet addiction will cause neurochemical imbalances which can lead to depression and apathy.
Based in Part on Brief Therapy with Eating Disorders by Barbara McFarland, and the Overcoming Disordered Eating Protocol by the Centre for Clinical Intervention - Shifting paradigms to one of resourcefulness vs. sickness - Identifying key interviewing questions to develop a strengths-based alliance
Objectives - Core Mindfulness - Walking the Middle Path - Distress Tolerance - Emotion Regulation - Interpersonal Effectiveness - Mindfulness Exercises - DBT Games and Activities Core Mindfulness - Three States of Mind - Reasonable: School Brain, scientist, robot - Emotional: What your heart says - Wise: The logical choice that makes you as happy as possible
- Example: Animal rescue
- Example: Extracurricular activities
Objectives - BREIFLY review the findings from the research identifying the connection between the brain and the gut - Differentiate gut health from proper nutrition - Identify signs and consequences of poor gut health - Explore the bidirectional relationship between the brain and the gut (second brain) - Identify promising alternative approaches to treating mood (and other) disorders. Overview - Depression is the leading cause of disability in the world according to the World Health Organization. The effectiveness of the available antidepressant therapies is limited. - Data from the literature suggest that some subtypes of depression may be associated with chronic low grade inflammation. - The uncovering of the role of intestinal microbiota in the development of the immune system and its bidirectional communication with the brain have led to growing interest on reciprocal interactions between inflammation, microbiota and depression. - The intestinal microbiota: A new player in depression? Encephale. 2018 Feb;44(1):67-74
Objectives - Explore the unique needs of loved ones and caregivers of people with cancer Diagnosis - 650,000+ people die of cancer EACH year - When someone is diagnosed, the patient and loved ones grieve - Even if the cancer is “cured” or goes into remission there may be lasting disabilities and/or losses - Loss of security (health anxiety in the patient and SOs) - Loss of function or changes in appearance - Cognitive impairment (“chemo-brain”) impacts attention, working memory, executive function, and processing speed - Unmet needs of caregivers and patients were associated with increased physical symptoms, anxiety, and reduced QoL - Not everyone experiences grief in the same way - Families need to be educated about the grief bill of rights
Biopsychosocial Aspects of HPA-Axis Dysfunction Objectives - Define and explain the HPA-Axis - Identify the impact of trauma on the HPA Axis - Identify the impact of chronic stress/cumulative trauma on the HPA-Axis - Identify symptoms of HPA-Axis dysfunction - Identify interventions useful for this population Based on
Summary - Additional modules will focus on topics including… - Accommodations for the clinician to prevent exasperation and burnout. - FASD in the criminal justice system - Case management and Unmet needs for caregivers
Summary -Mental health is a biopsychosocial issue -A healthy body, positive emotional experiences, effective thinking strategies, positive environments and healthy interpersonal relationships are essential -A weakness in any of these areas can contribute to extended distress and HPA-Axis dysregulation which can lead to mental health or addiction relapse.
Summary ~ Neurotransmitters and hormones exist in a very delicate balance. ~ Changing one often results in a cascade of other changes ~ Mood and cognitive symptoms may be caused by problems with a variety of different neurotransmitters or hormones ~ Aging naturally reduces certain hormones and consequently neurotransmitters ~ Differential diagnoses requires exploring the possibility of a deficit in a neurotransmitter or hormone due to ~ Insufficient raw materials to make it ~ Deficiency in other chemicals that trigger its release ~ Excess of chemicals that degrade it or trigger reuptake ~ Problems in neuronal signaling within the system. ~ The human body is extremely complex ~ Symptoms of mood and cognitive disorders can be caused by a variety of problems in physiological systems ~ Cognitions and emotions can trigger the HPA-Axis and alter the functioning of internal systems and set off a cascade. ~ Effective treatment of mood and cognitive disorders requires addressing all physiological as well as psychological issues contributing to neurochemical imbalance.
Summary - Helping your body to balance hormones and neurotransmitters requires - Good nutrition and good health behaviors(exercise, sleep, breathing) to reduce physical stress and inflammation - Addressing cognitive and emotional stress
Summary ~ More than 60% of people have experienced ACEs ~ It is believed the rate of exposure to ACEs has increased significantly during COVID ~ Not everyone who experiences ACEs will develop traumatic injury ~ Injuries related to ACE trauma include: ~ Borderline and antisocial personality disorder ~ Mood disorders ~ PTSD ~ Addictions ~ Autoimmune issues including IBS, Chron’s, Diabetes ~ Heart disease, cancer, chronic lung disease, liver disease ~ Increased difficulty in interpersonal relationships due to above issues ~ Increased risk to become a perpetrator of ACEs
traumainformedcare #adversechildhoodexpoeriences #aces #mentalhealth
Mindfulness and Self Care to Prevent Burnout Dr. Dawn-Elise Snipes, PhD, LPC-MHSP Counselor Toolbox Podcast CEUs available at: https://allceus.com/member/cart/index/product/id/1410/c/ Objectives – Identify signs and causes of burnout – Explore techniques for burnout prevention Signs of Burnout – Physical and emotional exhaustion – Insomnia – Impaired concentration or memory – Physical symptoms (heart palpitations, HBP) – […]
Explore PACER strategies to help children develop tools to stay healthy and happy Motivation ~ 5 Dimensions ~ Physical: Energy, comfort, health ~ Affective: Happy ~ Cognitive: Why is it something you would want to do? ~ Environmental: Prompts/Triggers; star charts; token economies ~ Relational: How will it make [caregiver] happy ~ Other ~ Seek […]
PACER Strategies for Mental Health ~ Relational ~ Social support to prevent distress and aid in coping and prevention of cognitive decline (which means supports need to be mentally and physically healthy too) ~ Significant others ~ Support groups ~ Spiritual leaders ~ Self esteem ~ Communication skills to ask for what is needed and maintain boundaries ~ Respite care for caregivers
Summary - HIV impacts the person Physically, Affectively, Cognitively, Environmentally and Relationally - Behavioral health professionals can aid in screening for comorbid/confounding conditions and making referrals as appropriate - Behavioral health professionals can - Enhance and maintain motivation for treatment compliance - Assist in processing powerful emotions related to the diagnosis and associated issues - Introduce cognitive behavioral tools and strategies to help the person cope - Educate the individual, SOs and community about HIV transmission and treatment (reduce stigma and improve health behaviors)
Summary ~ Diabetes impacts people multidimensionally (PACER) ~ Counselors, social workers and case managers can assist through ~ Screening ~ Health education ~ Goal setting and planning ~ Motivational enhancement and maintenance ~ Addressing grief and anxiety issues associated with having a chronic illness
Summary - Employment provides a variety of benefits to the person in recovery - Self-Esteem - Structure - Financial independence - Social Support - A safe(er) place to practice new skills - ONet provides an online resource to identify career skills and abilities and jobs that fit the person - The first 6 months of employment often require significant support from a coach/sponsor/therapist - Maintaining Motivation - Identifying family of origin issues
Summary ~ Family approaches recognize the reciprocal impact of every individual and every relationship on the functioning of the whole system ~ Family systems resist change in favor of homeostasis ~ It is important to assess ~ The health and wellbeing of all members of the family ~ The PACER needs of each individual and their readiness for change for every treatment goal. ~ Develop a unified vision of what health and happiness look like and each person’s tasks in helping the family move toward that goal.
Summary ~ According to the CDC approximately ~ 13% of American adults have diabetes ~ 35% have prediabetes ~ Diabetes is an autoimmune condition ~ Autoimmune conditions cause and are caused by inflammation ~ Inflammation hyperexcites the HPA-Axis ~ Inflammation and HPA-Axis overactivation are associated with depression and anxiety ~ All people with depression and anxiety should be evaluated for autoimmune issues including diabetes ~ Integrative recovery plans should focus on reducing inflammation, regulating the HPA-Axis to prevent or mitigate any autoimmune issues.
Summary ~ Stress is ubiquitous and comes in many forms ~ The goal is to reduce distress to free up energy for eustress and still have some left over. ~ Like a cell phone battery ~ Use the energy for the apps and activities you want ~ Eliminate or suspend apps that drain your battery ~ Each day your phone needs time to plugin and recharge
Objectives - Define bullying - Explore the types of bullying - Identify characteristics of bullies - Identify motivations for bullying - Identify effects of bullying - Explore interventions to - Stop Bullying - Help bullying victims
Intro ~ ADHD is often a life-long condition and predisposes people to the development of mood and addictive disorders. ~ Mood disorders are associated with worse ADHD symptoms. ~ As such, early intervention and a life-span approach needs to be considered
Intro ~ ADHD is one of the most common psychiatric disorders, with a worldwide prevalence of 5.2 % among children and adolescents, persisting into adulthood in 60–70 % of cases either as a residual or as a full clinical disorder ~ Medications used to treat ADHD such as methylphenidate, amphetamine, and atomoxetine indicate a dopamine/norepinephrine dysfunction as the neurochemical basis of ADHD and a potential target for anxiety and depression ~ The presence of probable ADHD and the severity of ADHD symptoms are related with the severity of insomnia, even after controlling the depression, anxiety
Summary - There is significant overlap between OCD and other psychiatric disorders - While ERP and SSRIs are the gold standard for addressing OCD behaviors, it is also important to address other underlying issues which may contribute to neurotransmitter disruption. - Trauma history (powerlessness and unsafeness) - Lack of emotional regulation skills - Lack of happiness promoting behaviors - Lack of secure attachment (oxytocin) - Poor nutrition, sleep, iron deficiency - Hormone imbalances (gonadal or thyroid) - Medication side effects (hormones, steroids, thyroid, RLS, antipsychotics)
Obsessive Compulsive Disorder and Addiction Awareness #ocdawareness #obsessivecompulsivedisorder Cheap CEUs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/1352/c/ Objectives ~ Define obsessions and compulsions ~ Define obsessive compulsive personality disorder ~ Define addiction ~ Explore common obsessions and compulsions and their function ~ Explore why addiction often co-occurs with OCD ~ Identify interventions appropriate to assist […]
Symptoms of the Flu - Fever or feeling feverish/chills, sweats - Cough, chest discomfort - Sore throat - Runny or stuffy nose, sinus congestion - Muscle or body aches - Headaches - Exhaustion - Vomiting and diarrhea Types - Major Depressive Disorder (including w/psychotic features) - Persistent Depressive Disorder (High Functioning Depression) - Postpartum Depression - Premenstrual Dysphoric Disorder - Depression in Early Recovery From Addiction - Bipolar Depression - Seasonal Affective Disorder - Grief - Situational Depression (not including grief) - Depression due to a general medical condition (autoimmune issues, stroke, heart disease, dementia…)
Improving Health Literacy with Health Coaching Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Counseling CEUs Objectives – Define health literacy – Explain why health literacy is important – Explore health literacy in a recovery oriented system of care – Identify at least 5 ways to improve health literacy – Explain what health coaching […]
Summary - Like a bonzai tree there are times when the brain is developing and malleable. - The brain begins development in the first trimester and continues until age 24. - During adolescence different parts of the brain develop at different times (different branches of the tree) - An insult to the immature brain can cause much more dramatic changes because of its malleability (sapling vs. hardened branch) - All drugs appear to alter parts of the brain associated with learning, memory, emotion regulation, planning and problem solving and impulse control.
Objectives - Identify risk and protective factors for - Prematurity/Miscarriage/Stillbirth - Sudden Infant Death Syndrome - Explore treatment issues for the family
Summary - Opioids have a place for acute pain management - Opioids have also been associated with reductions in anxiety and depression - Dependence and tolerance develop quickly - Currently opioids are very easily diverted - Prevention needs to focus on all of the reasons people abuse opioids including stress and anxiety management, depression, and pain
Summary - Suicidality is not uncommon - It is important to regularly screen all clients for suicidality (e.g. check in sheets, monitoring logs) - Suicidality is an opportunity for change - A variety of different issues can contribute to suicidality. - Early recovery is a period of extreme vulnerability for many people and treatment plans should always contain a suicide prevention plan (does not substitute for active monitoring)
Summary - Telemental Health is here to stay - Many self-directed programs are extremely useful for all ages and a multitude of diagnoses, especially for early intervention - The use of virtual technologies enables a clinician to individualize treatment to increase compliance, accessibility and effectiveness - There are many ethical, regulatory and legal issues surrounding the use of electronic devices in any aspect of counseling.
Summary ~ Addiction is a biopsychosocial condition ~ No single treatment or intervention is likely sufficient for sustained recovery. ~ Many complimentary therapies help rebalance the neurotransmitters / CNS which often underly craving, withdrawal symptoms and mood issues which are being self-medicated. ~ Many therapies can be used in conjunction to address the myriad of underlying issues contributing to relapse risk (depression, anxiety, low self efficacy, insomnia, fatigue, pan)
-Extent of the Problem -Risk Factors for Suicide -Protective Factors -Warning Signs and Precipitating Events -Neurobiological and Genetic Factors -The Role of Substance Use in Suicidal Behavior -Specific Populations -Co-Occurring Mental Disorders and Suicidal Behavior -Accidental Versus Suicidal Overdose -The Role of Trauma and Abuse -Assessment of Suicidal Thoughts and Behaviors -Treatment of Suicidal Thoughts and Behaviors -Substance Abuse Treatment and Suicidal Thoughts and Behaviors -The Effects of Suicide on Family and Friends -The Effects of Suicide on Counselors
Objectives - Review the purpose and efficacy of MAT in general - Review current research on MAT for - Nicotine - Alcohol - Opioid - Methamhetamine
Objectives - Learn what intervention is - Identify who typically does an intervention and for what reasons - Explore the basic steps in intervention- Register for the 100+ hour Interventionist Certification at AllCEUs
Objectives ~ Learn what PAWS is ~ Explore why PAWS happens ~ Identify steps to take to reduce and cope with PAWS What is PAWS ~ PAWS affects people who have engaged in addictive behaviors ~ The effects are based on factors ~ Age ~ Gender ~ Length and amount of use ~ Physical health ~ PAWS begins after acute withdrawal and lasts for up to a year
Summary - Long-term pharmacotherapy is available and effective for several addictions - Medication + counseling = recovery - Smoking cessation - Nicotine replacement is available over-the-counter - Bupropion and varenicline are available by prescription for smoking cessation - Multiple medications are available by prescription for alcohol dependence - Methadone/buprenorphine maintenance proven to reduce mortality, crime, & spread of infection - Substitution therapy to eliminate withdrawal, cravings, & heroin effects - Individualized dose
Objectives - Identify purpose, sources of information and areas of concern for screening - Explore the pitfalls of diagnosis in the CJ system - Identify preferred screening and assessment instruments and what they measure - Examine placement strategies based on criminality, mental health and addiction issues - Discuss general treatment issues in CJ
Objectives - Explore the prevalence of homelessness for children and people with mental illness - Discuss causes of homelessness - Explore the relationship between homelessness and ACEs - Discuss how homelessness impacts the HPA Axis - Review areas to be screened - Identify creative interventions - Identify resources to help people access needed services
~ Review some of the unique triggers for co-occurring disorders in adolescents and college students ~ Identify current best practices for preventing those ~ Explore ways to enhance college student engagement in prevention and health promotion activities
Explore psychopharmacology and the role and effect of psychotropic medications in mental health Define the problem Identify and discuss differential diagnosis for various pain conditions Examine the similarities between CNCP and addiction Identify the impact of CNCP on patients Discuss effective interventions for CNCP Identify what counselors can do
•Recognize and address homelessness as a special dynamic that affects your clients. •Help prevent potential crises that result from becoming homeless. •Provide preventive services for individuals and families who are homeless, •Be more aware of the effects of psychological trauma and co-occurring disorders (CODs) among people who are homeless. •Provide integrated, more effective services to people who are homeless. •Understand and know how to utilize resources for homelessness in your community. •Influence the understanding of others in your community regarding the interrelationship of homelessness, substance abuse, and mental illness.
Define Autoimmune Issues Examine the relationship between autoimmune issues and depression Explore the relationship between inflammation and autoimmune disorders and mood disorders Identify interventions needed by people with autoimmune and mood disorders.
- Define the socio-ecological model
- Apply the socioecological model to addiction
- Explore different variables in the socio-ecological model
- Discuss how this framework can be used in prevention and treatment of Co-Occurring Disorders Prevention
- Prevention can take the form of:
- Preventing the problem
- Preventing worsening of the problem
- Preventing associated fall out
• Review current information about the prevention, transmission and treatment of HIV, Hepatitis and Blood Borne Pathogens • Review current information about hepatitis transmission, symptoms and treatment.
Summary ~ There are many similarities between Pain, mood and addictive disorders ~ Integrated, concurrent, biopsychosocial treatment is vital ~ Mood impacts pain which impacts life satisfaction ~ Recovery supports realistic beliefs and identifies controllable factors Eenhanced outcomes ~ Patients with current addictions or mental health issues need concurrent treatment
Summary - Counseling should focus on where the person is (testing/treatment) and their level of readiness for change. - Counseling goals should be to - Reduce risk of infection/complications or infecting others - Improve health literacy regarding hepatitis - Encourage social support - Assist the person in connecting with needed biopsychosocial resources
Summary - Explored the culture, values and traditions of African Americans to include communalism and the importance of spirituality for many clients - Identify issues and barriers which need to be considered to provide culturally responsive treatment including ineffective assessment tools, lack of insurance or transportation and lack of awareness of the types and benefits of counseling services - Learn about how to provide culturally responsive group psychoeducation including how to teach to the collective culture in a multicultural group and how to be an effective group facilitator. - Learned about a variety of evidence based practices demonstrated to be effective with African Americans.
Summary/Advice to Counselors - Provide bilingual services. - Use family therapy as a primary method of treatment. - Assess cultural identity and acculturation level for each family member. - Determine the family's level of belief in traditional and complementary healing practices; integrate these as appropriate. - Discuss the family's beliefs, history, and experiences with standard American behavioral health services. - Explore migration and immigration experiences, if appropriate. - Provide additional respect to the father or father figure in the family. Summary/Advice to Counselors - Interview family members or groups of family members (e.g., children) separately to allow them to voice concerns. - Generate solutions with the family. Do not force changes in family relationships. - Provide specific, concrete suggestions for change that can be quickly implemented. - Focus on engaging the family in the first session using warmth and personalismo - Group leaders should allow members to learn from each other and resist functioning as a content expert or a representative of the rules of the system. Otherwise, members could see group therapy as oppressive
Summary - Academic success - Impacts student’s self-esteem by providing frequent small successes - Empowers them and reduces depression and hopelessness and helplessness by teaching them how to solve problems and opens up a world of possibilities - Reduces anxiety by helping them develop an “I can” mantra and learn how to embrace failure as a learning opportunity - Each child has their own unique learning needs based on their learning style and temperament. - Once children know how they learn best they can be empowered to modify lessons and study habits to accommodate their unique needs.
Objectives - Explore the impact of homeschooling on the family - Identify issues that may come up during homeschooling - Explore creative ways to help families effectively homeschool Impact of Homeschooling - Physical - It is easy for the child’s schedule to get out of synch when they don’t have to get up to meet a bus - Maintain a schedule - There is a risk of greater weight gain related physical problems due to a lack of enforced PE and 24/7 availability of food - Mindful eating, cooking, fun activities, nutrition literacy - Some children may rely on free and reduced breakfast and lunch and will no longer be able to access that. - Work with food pantries and volunteers to disperse care packages - Increased risk for unnoticed child abuse or neglect when children are home all day - Conversely, children could get more sleep, be exposed to fewer germs, encouraged to be active in meaningful ways, learn how to eat mindfully as well as develop culinary skills.
- Learn about Asian cultures, traditions and values as they relate to mental health
- Learn about communication styles to help the counselor more effectively communicate with culturally different clients
- Explore health disparities
- Explore appropriate approaches to counseling General Information
- Asian Americans have a 17.30 percent overall lifetime rate of any psychiatric disorder and a 9.19 percent 12-month rate, yet Asian Americans are three times less likely to seek mental health services than Whites
- Cultural factors, such as language, age, gender, and others, can influence the mental health of Asians, particularly immigrants
- Asians place great value on the family as a unit. Each individual has a clearly defined role and position in the family hierarchy and is expected to function within that role, submitting to the larger needs of the family.
- Social stigma, shame, and saving face often prevent Asians from seeking behavioral health care
- Asian patients are likely to express psychological distress as physical complaints
- Learn what juvenile and rheumatoid arthritis are
- Identify the prevalence of JA/RA
- Explore the relationship of JA/RA and affiliated medications to mental health
- Identify interventions to assist people with JA/RA achieve their highest quality of life Autoimmune Issues and Children
- Autoimmune disorders that occur in childhood include:
- Juvenile arthritis, which affects about 1 in 1,000 children
- Type 1 (juvenile) diabetes, which affects 1 to 2 of every 400 children
- Celiac disease which impacts 1-3% of the population
Summary - There is no one right way. Providing direction on how something should be done is not a comfortable or customary practice for American Indians and Alaska Natives. For them, healing is interconnected with others and comes from within, from ancestry, from stories, and from the environment. RESPECT - Respect communication styles and how respect is shown in the culture - Explanatory model: Understand how clients perceive/understand their presenting issues - Sociocultural context affect treatment - Participation expectations for treatment may be different than mainstream. (family, community, faith healers etc.) - Empathy - Concerns and fears should be elicited (at the beginning and at points of resistance) - Trust is based on who you are not what you accomplished.
Summary - CBD is showing promise as an alternative or adjunctive treatment for a variety of ailments ranging from Alzheimer’s and Addiction to Parkinson’s and Schizophrenia. - CBD does not have the psychogenic effects that THC does, however, THC has been found to be more effective at addressing some issues - OTC CBD is nonstandardized so dosages, even from the same manufacturer, but in different lots may have different potencies - CBD interacts with most medications, so it is vital to consult a physician prior to using it. - Dosages of CBD in the literature varied widely. - Currently there are a couple CBD based medications for the treatment of seizure disorder - CBD oils also may have a trace of THC in them—again, in OTC formulations, it may be variable, but supposed to be less than 0.3%
From a survival standpoint, the symptoms of Post Traumatic Stress make a lot of sense. We will explore the possible reasons for these symptoms and interventions that can be used to assist clients in creating a resilient recovery narrative.
Objectives
Review multiple ways of writing treatment plans including using the integrative summary, FARS, CANS, ASAM and LOCUS Review pitfalls in writing effective treatment plans and how to avoid them Review the purpose of the reassessment and best practices for documentation Identify time-effective methods for completing treatment plans and reassessments
Objectives ~ Review the characteristics of BPD ~ Compare and contrast BPD with addictive behaviors ~ Examine ways to implement the activities presented in the book in a group format Characteristics of BPD ~ Poorly developed, or unstable self-image, often associated with excessive self-criticism ~ Difficulty recognizing the feelings & needs of others ~ Interpersonal hypersensitivity (i.e., prone to feel slighted or insulted) ~ Perceptions of others tend to focus on negative attributes or vulnerabilities.
Objectives ~ Review the function of mindfulness and a variety of mindfulness techniques ~ Explore the concept of relaxation ~ Identify different methods of relaxation
-Post-traumatic stress disorder: the neurobiological impact of psychological trauma Dialogues Clin Neurosci. 2011 Sep; 13(3): 263-278. https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC3182008/
-This article lays out the many changes and/or conditions seen in the brain of people with PTSD.
-As clinicians, awareness of these changes can help us educate patients about their symptoms and find ways of adapting to improve quality of life.
» Define grief » Conceptualize grief in terms of any loss » Identify how failure to deal with grief can impact a person » Explore the stages of grief » Review activities and interventions to help people grieve
» Review the symptoms of anxiety in adults and children » Explore the impacts of anxiety » Identify strategies for prevention and intervention
- Explore the function and impact of anger
- Identify the types of threats that may prompt anger
- ldentify different types of anger to include
- Run of the mill anger
- Irritation
- Resentment
- Envy/Jealousy
- Guilt/Regret
-Identify signs of relationship insecurities
-Explore how past relationships impact present relationships
-Identify at least 5 interventions to address relationship insecurities
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Identify the characteristics of each dimension of temperament and how awareness of temperament can improve relationships.
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Learn about love languages and how those can be used to enhance relationships.
» Learn about boundaries signs of violations and how to maintain them
» Summarize the characteristics of healthy relationships
Identify the function of negative self talk Explain the benefits of positive self talk Describe 15 methods for teaching positive self talk to people of all ages
» Define psychological flexibility
» Explore how to apply psychological flexibility
» Identify the shortcut question
-Review the cognitive triad -Identify ways to teach the following cognitive behavioral skills in group -ABC-DEs, Cognitive Restructuring, Unhooking, Psychological Flexibility Matrix
Overcoming hoarding, a mental disorder recognized by the American Psychiatric Association, requires more than pop psychology and a 30-gallon garbage bag. In the new book Conquer the Clutter, social worker Elaine Birchall, founder of the Canadian National Hoarding Coalition, and co-author Suzanne Cronkwright, provide practical strategies for regaining control.
You can find Elaine at https://www.hoarding.ca to learn more and to buy her book.
~ Review the basics of psychodynamics ~ Phenomenological reality (autobiography) ~ Transference ~ Compare and contrast (are you safe now?) ~ Creating PACER safety and Mindfulness of the Present
Explore why it is important to envision a rich and meaningful life Identify how to envision a rich and meaningful life Learn how to set goals to achieve that rich and meaningful life
• Define vulnerabilities • Identify some of the most common vulnerabilities • Their effects • Ways to prevent them - Note: Each of the vulnerabilities has its own presentation. This section is designed to give you an overview and get you thinking about possible small changes that might have a big impact.
Mindfulness Overview - Differentiate between mindLESSness and mindFULness - Understand where mindLESSness came from - Define mindFULness - Explore ways mindFULness can help - Reduce emotional and physical distress and pain - Improve sleep - Improve Relationships - Explore activities that will help you - Become truly aware of your feelings, wants and needs - Develop skills that will help you observe, describe and participate
Review how tolerance develops Discuss the impact of addictive substances and behaviors on the brain and body
Review how tolerance develops Discuss the impact of addictive substances and behaviors on the brain and body
Types of Motivation
- Motivation is essential for change
- Motivation helps you identify why it is worth the effort to make a change
- Motivation helps you keep going when the going gets tough
- Change can be hard and uncomfortable
- Motivation is different for different goals » Changing people, places and things « Motivation may decrease over time unless you actively maintain it
- Going to meetings or counseling
- Placing a priority on adequate quality sleep and stress management
Explore physical, affective, cognitive, environmental and relational triggers for both distress and happiness and discuss ways of mitigating the negative and enhancing the positive.
Summary - Trauma can enhance feelings of disconnectedness, helplessness and anxiety. - Trauma impacts people emotionally, mentally, physically, interpersonally, occupationally - By helping people develop trauma resiliency we can assist them in preventing PTSD after a trauma and breaking the cycle of intergenerational trauma
Summary ~ Anger is a natural emotion. It is designed to alert people that there MIGHT be a problem. ~ When people are vulnerable or learned maladaptive ways of dealing with anger or simply never learned healthy coping skills they can experience anger management problems ~ Excessive anger negatively impacts people emotionally, mentally, physically, socially, occupationally, legally and spiritually. ~ Effective anger management involves preventing vulnerabilities, being aware of and working on “sensitive areas” or “threat areas,” preventing anger whenever possible and developing immediate coping responses to deal with it when it occurs.
Summary ~ Supportive interventions are necessary to help people radically accept their feelings and situation and get into their wise mind. ~ Solution-focused interventions will help them address the situation and start moving forward to break the distress cycle.
Interview with Dr. Lindsay Weisner. Author of "Ten Steps To Finding Happy: A Guide to Permanent Satisfaction."
The book is available for pre-order at: https://amzn.to/2wmCTcU
Summary - Schema are lenses through which we predict and interpret situations - They are only as good as the knowledge and understanding of the situation - Schema often need to be altered as we gain new information
- Learn about bariatric surgery
- Explore reasons for the surgery and increase in popularity
- Identify the psychosocial outcomes of bariatric surgery
- Identify common presenting issues in persons seeking bariatric surgery
- Explore current recommendations for assessment protocols and presurgical preparation for bariatric surgery
- Identify postoperative mental and physical health issues which may occur and need to be addressed Types of Bariatric Surgery
Summary • There are many unknowns with the current coronavirus situation • The flu is widespread and catastrophic for tens of thousands of people in the US each year and we do not panic. • High levels of stress and anxiety however will reduce immunity and make people more susceptible to all types of illnesses • Steps to reduce anxiety • Get accurate information • Limit your exposure to negative media • Practice mindful acceptance of your reactions • Use belly breathing to help de-escalate the physical anxiety reactions • Identify proactive, positive ways to cope with the situation • Regularly evaluate your beliefs against the FACTS at that time
Coronavirus, election anxiety and financial stress is getting to people right now. This is the audio version of a three part series just released on YouTube on dealing with that stress.
Creating Psychological Flexibility in Children with Dr. Dawn-Elise Snipes Executive Director, AllCEUs Host: Counselor Toolbox Podcast
CEUs are available at https://www.allceus.com/member/cart/index/product/id/1029/c/
Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free months of TherapyNotes with coupon code "CEU"
Objectives ~ Define Psychological Flexibility ~ List the Main Principles of Psychological Flexibility ~ Identify the Components of Psychological Flexibility ~ Describe How to Teach Psychological Flexibility ~ Explain the Short Cut Question Preventing Vulnerabilities ~ When people are tired, malnourished, hungry, stressed, sick or in pain, they tend to have more difficulty dealing with life on life’s terms. ~ Sleep ~ Set a bedtime routine and teach about good sleep hygiene ~ Help them learn the value of sleep ~ Point out that they will have a better day if they get a good nights sleep and when they are having a bad day because they didn’t get enough rest
Preventing Vulnerabilities ~ Nutrition ~ Help children learn good eating habits ~ Participate in cooking ~ Help create menus with 3 colors at each meal ~ Keep prepared fruits and veggies available ~ Minimize refined foods for stable blood sugar ~ Make sure lunches have sufficient protein and complex carbohydrates ~ Talk to them about why nutrition is important
Activity: Food Art ~ Tell children to build a Mr. Potato Head but take out one set of pieces. ~ When children cannot complete the project, explain that just like they need all the pieces to make Mr. Potato Head, for them to be healthy and happy their body needs all the different types of food building blocks Preventing Vulnerabilities ~ Positive Health Behaviors (Model it. Do it with them.) ~ Relaxation ~ Ergonomics (backpack, desk, bed) ~ Hand Washing (sing Baby Bumble Bee 2x) ~ I’m washing up my baby bumble bee ~ Won’t my mama be so proud of me ~ I’m washing up my baby bumble bee ~ Scrubba scrubba scrub scrub scrub scrub scrub ~ Exercise
Battery or Money Metaphor ~ If you get a good nights sleep, eat a healthy diet and learn to relax, then each day you start with (a fully charged cell phone battery/ $100) ~ If you don’t get a good nights sleep, eat a healthy diet and learn to relax then you may not fully recharge (your phone/bank account) ~ Throughout the day each time you do something you are (draining your battery / spending money). The more intense the activity or emotion or the longer it lasts, the more (battery is used/money spent) ~ Eating, walking, exercising etc. ~ Worrying ~ Getting angry
Questions… ~ Think about a day you didn’t sleep well. Did you run out of (battery/money) earlier in the day? ~ What about a day you were really stressed about a test coming up? ~ How much easier do things seem when you are rested and relaxed?
Clarifying the Destination Values & Goals ~ A lack of clarity about values can underlie much of people’s distress or keep them “stuck.” ~ Help children identify what is really important in their life and become willing to focus their energies on those things Clarifying Values & Goals ~ Clarifying ~ Who is most important, deep in your heart? ~ Which people? ~ What do you want those relationships to be like? ~ Note: Help small children create a collage of people who are in their life (family, higher power, pets) ~ What events, things, experiences are important to you? ~ Getting on the ___ team/club ~ Getting good grades ~ Going to college to be a _____ ~ Being good at ______ ~ My health (without that you can’t do the others as easily) ~ Note: Small children may not have anything here Clarifying cont… ~ Values ~ What values do you want to embody (Choose 5)?
~ For small children, ~ Choose 5 that are important for your family values and/or characterize the child (Honesty, Resourcefulness, Compassion, Faithfulness, Determination…etc.) and help the child learn to embody these things ~ Tell me what animal you are like and why.
When Unpleasant Things Happen Psychological Flexibility ~ Is the ability to be aware of situations and consciously choose from available options
~ Choose to stay angry ~ Choose to do what you have always done OR ~ Choose to use that energy to do something to improve the situation or improve how you feel about the situation Main Principles of Psychological Flexibility ~ The goals are to: ~ Create a happy life, while accepting that sometimes things can be unpleasant. ~ Learn to recognize that distress is often a harmless, even if uncomfortable, passing psychological event. ~ Make effective choices for how to use your energy based on your goals and values to improve the next moment Six Core Principles of ACT ~ Six core principles of psychological flexibility: ~ Awareness of Values ~ The Observing Self/Mindfulness ~ Diffusion ~ Acceptance ~ Contact with the Present Moment ~ Committed Action
The Observing Self The Audience ~ Fly on the Wall / Your Dog / Sid the Science Kid ~ Curious ~ Objective ~ Nonjudgmental
Awareness of What Is ~ Bringing full awareness to your here-and-now experience ~ Take 3 deep breaths and notice how it feels for the air to go in your belly and out ~ What happened? (Using objective words) ~ Tommy was mean Tommy knocked me down ~ My day sucked I got a C on a quiz and nobody sat with me at lunch ~ How do you feel? ~ What are your thoughts, wants and urges? ~ What physical sensations are you experiencing? ~ What is the purpose of your feelings? Cognitive Diffusion Unhooking Thoughts and Behaviors ~ Cognitive diffusion means ~ “Stepping back” and recognizing that thoughts and urges are just passing events, not part of us and do not have to lead to action (Getting pushed, becoming resentful at classmates) ~ Allowing them to come and go without running from them or giving them undue attention. ~ Perceiving thoughts, images, and memories as bits of language, and pictures—as opposed to what they can appear to be—threatening events, objective truths (Example: I’m not safe; nobody likes me; nightmares, fears about the doctor)
Two Wolves ~ A fight between two wolves is going on inside every person. ~ One is anger, fear, envy, sorrow, regret, arrogance, self-pity, guilt, and ego. ~ The other is peace, love, hope, contentment, humility, compassion, generosity, truth, determination, and faith. ~ Which wolf will win? ~ The one you feed.
Cognitive Diffusion Activities ~ Clouds ~ Trains ~ Thought Box ~ Bubbles ~ Balloons (with darts) don’t release them into the air! ~ Dandelion seeds
Unhooking from Negative Self-Talk ~ Activity: ~ Think of a negative self-judgment that takes the form “I am X” such as “I’m stupid.” ~ Think about it. Believe it as much as you can. ~ Notice how it affects you when you are “hooked” to a thought. ~ Now insert the phrase “I’m having the thought that….” in front of “I am X.” ~ Think about it. ~ Notice what happens when you are no longer “hooked.” Unhooking from Urges ~ Activity: ~ Think of an urge such as “I have to get even” or “I have to get an A on this test” ~ Think about it. Believe it as much as you can. ~ Notice how it affects you when you are “hooked” to a thought. ~ Now insert the phrase “I’m having the thought that….” in front of “I have to X.” ~ Think about it. ~ Notice what happens when you are no longer “hooked.” Committed Action ~ Once you can: ~ Be in the present moment ~ Identify your thoughts, feelings and urges ~ Recognize their purpose ~ Unhook your thoughts/urges and your behaviors Committed Action ~ Then… ~ Assess the situation ~ Tommy pushed me ~ Susan posted something mean on my IG feed ~ I have to get an A on this test ~ Nobody sat with me at lunch ~ Decide ~ Is this thought or issue even worth my attention? Will addressing it get me closer to the people and things that are important to me? ~ If it is, what thoughts and behaviors will be helpful at addressing the issue AND getting you closer to your goals? ~ If it isn’t, how can you let it go Becoming Flexible—Prevention Becoming Flexible—Prevention Becoming Flexible—Prevention Becoming Flexible—Prevention Flexibility Activity ~ On a magnetic white board draw the matrix ~ Make cards ahead of time, laminate them and attach a small magnet ~ Activities that drain my battery and do not help me achieve my goals (Use things your child does) ~ Thoughts and nurtured feelings that drain my battery and do not help me achieve my goals (Use things your child thinks) ~ Activities that help me achieve my goals ~ Thoughts and nurtured feelings help me achieve my goals ~ Discuss with the child each card and which quadrant it belongs in and have him/her put it in the correct space
Becoming Flexible— Susan was mean on IG Becoming Flexible— Susan was mean on IG Shortcut Question ~ Are my current thoughts, feelings and actions helping me get what is important to me? If not, what could I do differently?
~ Young child throws a tantrum because ~ He wants to watch television but his homework is not yet done ~ He wants dessert but has not eaten his dinner yet ~ Sally never wants to go to school again… ~ Jane wants to fight Julie… Summary ~ Every event is an opportunity to choose thoughts and behaviors that will help you use your energy to move toward your goals and values ~ Children often do not have long-term goals and values, so help them see how their choices can help them get what they want in the near future ~ Acceptance means accepting, without judgement, how you feel and the situation as it is instead of fighting against it. ~ Using the Flexibility Activity or worksheet youth can apply this on a daily basis. ~ Keep the prevention matrix up where kids can see it
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474 - Metacognitive Therapy Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Counselor Education Host: Counselor Toolbox Podcast
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Objectives • Learn about metacognitive therapy • Explore the multiple aspects of metacognition • Practice applying MCT to depression, pain, learned helplessness and other stressful situations Introduction • Distress is a signal that the person is trying to respond to threats to their wellbeing • Distress is normally reduced by effective coping strategies • Disorders result when • The person’s coping skills backfire • Believe they have no control over their thoughts • Believe it is in their best interest to keep ruminating. Rumination often focuses on questions that have no easily identifiable answers. • What if? • Why do I feel this way? • Why me? • What does this symptom mean? Introduction • Metacognitive essentially means “thinking about thinking” and refers to the knowledge and regulation of one’s own cognitive processes • MCT agrees that prior experiences create schema which influence interpretation of events, however, MCT focuses not on the content of the thoughts but the what the person pays attention to. • Metacognitive experiences are the reactions people have as a result of their cognitive appraisals • MCT focuses on disorder specific cognitive biases such as mood congruent memory • In one study, NFC, acted as the only mediator between treatment and depression recovery Metacognitive Components • Metacognitive knowledge refers to declarative knowledge of cognitive processes and includes • Personal knowledge (e.g., Ways of thinking (rumination, analysis), and personal abilities and limitations) (Mindfulness) • Negative metacognitive beliefs (distress intolerant thoughts) focus on • The uncontrollability of thoughts and belief that thoughts need to be controlled • Rumination • Threat monitoring • Unhelpful reactions that backfire (away behaviors) • Positive metacognitions are beliefs about the need to have the particular beliefs to stay safe or prepared • Task knowledge (e.g., How to do something (cook, meditate, learn, control thoughts)) (Skills Training) • Strategic knowledge (e.g., Advantages/disadvantages and applicability of each strategy) (Problem Solving) Metacognitive Components • Metacognitive experience is the personal experience and perception of difficulty that accompanies cognitive activity. • How confident do I feel that I can do it and it will be successful? (Fact-based reasoning vs. Emotional reasoning) • Metacognitive monitoring and control refers to self-supervision and regulation of the cognitive processes including their ability to plan, monitor, evaluate and regulate their cognitive activities by adjusting task goals, regulating attentional awareness (shot), and selecting cognitive strategies. • What is the best course of action • How effective is this course of action • What needs to be done differently or continued? Example Application • (Rumination) If I think about it enough I will find answers. • How long have you been at it? How much longer will it take? • What if there is no answer? • (Need to control thoughts) If I do not control my thoughts I will do something bad. • How do you know which ones to control? • What types of bad things have happened by not controlling your thoughts? Example Intervention • A à B C • A=Critical and unconstructive feedback • B=They hate me. They don’t consider other perspectives. They are entitled. They aren’t accepting responsibility for their part. • C=Anxiety, helplessness • A M C • A=Critical and unconstructive feedback • B=I need to ruminate to identify all of the ways to defend myself. • How many ways do you need to think of? When will you have enough? • Will continuing to ruminate change their opinion? • Is their opinion truly a threat? • C=Anxiety, helplessness
Example • Imagine you have social anxiety and you do not like going to parties because you are worried that you will do something embarrassing and humiliate yourself. • In MCT, you don’t pay attention to specific thought content. You instead challenge the process that leads to the thought. For example, you could say: • “Worrying about this does not make it less likely to happen, so I am not going to spend the time worrying.” • “I have the ability to focus my thoughts on other things.” (tame my monkey mind)
Cognitive Attentional Syndrome • In MCT, cognitive attentional syndrome (CAS) refers to a tendency to believe thoughts are uncontrollable, rely on ineffective coping skills, ruminate and focus undue attention on threat monitoring • CAS focuses attention on sources of potential threat • Increases the sense of danger • Increases focus of thoughts and awareness on sources of threat • Prevents noticing the safety features or “threat-free” environment • Increases intrusions such as memories, intrusive thoughts and potentially nightmares A-M-C Assessment • Over the past month what emotional, behavioral and physical symptoms have you noticed? • Has any thought or situation made you feel worse? • What thought or feeling did you have when that happened? • When you had that experience, what happened to your thinking? • Did you dwell on things? For how long? • What did you do to try to control the way you felt? • Did you try to change your thoughts? If so, how? • Are there advantages to worrying or ruminating? • Are there advantages to focusing on your thoughts and feelings? • What do you think will happen if you continue to feel or think like this? • How much control do you have over your thoughts? Metacognitions in Pain Management • Metacognitions about pain related cognitions have been linked to pain intensity, disability, emotional distress, and greater physical dysfunction • Negative: I cannot stop thinking about my pain. I cannot focus on anything else because of being distracted by my pain. • Positive: I need to continue to focus on my pain to ensure it doesn’t get worse. • Participants who reported greater levels of emotional distress also tended to endorse stronger negative meta-cognitive beliefs • Neuroimaging research showing that catastrophic thinking and specifically rumination on pain activate the brain similar to an anxiety disorder Pain Application • Personal knowledge (e.g., Ways of thinking (rumination, analysis), and personal abilities and limitations) (Mindfulness) • Negative metacognitive beliefs • The uncontrollability: I can’t stop thinking about the pain • Rumination: Often thinking about the pain, its negative impact on life • Threat monitoring: Constantly looking for things that will increase pain and scanning for signs of worsening pathology • Unhelpful reactions that backfire (If I go to sleep I will wake up and feel better. A few beers will help me relax and stop thinking about it) • Positive metacognitions: I must stay alert to changes in my pain • Task knowledge (How to use guided imagery, CPMR, stretching techniques, evaluate ergonomics) (Skills Training) • Strategic knowledge (Advantages/disadvantages and applicability of each strategy) (Problem Solving)
Depression Application • Personal knowledge (e.g., Ways of thinking (rumination, analysis), and personal abilities and limitations) (Mindfulness) • Negative metacognitive beliefs • The uncontrollability: I can’t stop thinking about all the things I have no control over and how unfair the world is. • Rumination: Focusing on the things outside of personal control • Threat monitoring: Constantly looking for things that confirm negative mood bias • Unhelpful reactions that backfire (If I go to sleep I will wake up and feel better. A few beers will help me feel better) • Positive metacognitions: ? • Task knowledge (Nutrition, sleep hygiene, distress tolerance skills, Backward chaining) (Skills Training) • Strategic knowledge (Advantages/disadvantages and applicability of each strategy) (Problem Solving)
Metacognition and Depression • Less than 1/3 of patients with depression recover, and relapse rates for those who do recover are estimated to be 50% after 2 years • In Metacognitive Therapy depression is understood as a consequence of perseverative thinking styles (especially rumination and worry) called the cognitive attentional syndrome (CAS) • 70–80% of patients with depression were recovered at post-treatment and 6-month follow-up (Hagen et al., 2017). • The treatment was also associated with large reductions in interpersonal problems • Why? Example • When Sally fails at something, she tends to ruminate on it. • Uncontrollability of thoughts • Rumination (What does she ruminate about? Why does she ruminate? ) • Threat Hypersensitivity (In what ways is she hypersensitive to threat? Why is this necessary?) • When John gets into a fight with his partner he tends to ruminate on it • Uncontrollability of thoughts • Rumination (What does he ruminate about? Why does he ruminate?) • Threat Hypersensitivity (In what ways is he hypersensitive to threat? Why is this necessary?)
Example • Learned Helplessness as a Metacognitive Target • Uncontrollability: No matter what I do, the thoughts keep coming back or the situation keeps recurring. • Rumination: Focusing on all the things I have tried that have failed and the continuing presence of the threat. • Threat Awareness: Everywhere I turn something bad is waiting. • Instead of confronting the content, evaluate the utility of these beliefs. Metacognitive beliefs as psychological predictors of social functioning • 50% of those with an at risk mental state (ARMS) engaged in 30 h or less of structured activity per week and were considered to be ‘socially disabled’ • Negative beliefs about uncontrollability of thoughts and danger (the situation) was found to predict reductions in structured activity (withdrawal, helplessness) • Age was found to significantly predict social functioning with younger people experiencing poorer social functioning than older people. Domain Enhancements of Metacognitive Ability Through Adaptive Training • An individual with good metacognition is aware of fluctuations in task performance, and appropriately modulates their confidence level • Two key aspects of metacognitive performance (Fleming & Lau, 2014). • Efficiency: How accurately do participants discriminate between effective and ineffective strategies. (Problem solving training) • Bias: Are participants generally more or less confident in a particular strategy or task? (Efficacy enhancement) • Writing a 50 page thesis Summary • People can have millions of automatic cognitive distortions. Addressing each one may not be possible. • Becoming aware of thought patterns, their function, their usefulness and alternatives underlies MCT. • MCT moves from addressing the content of thoughts (What is being thought?) to the function of those thoughts (Why are the thoughts occurring and are they helpful?)
473 - The Neurobiological Impact of Psychological Trauma: The HPA-Axis Objectives • Define and explain the HPA-Axis • Identify the impact of trauma on the HPA Axis • Identify the impact of chronic stress/cumulative trauma on the HPA-Axis • Identify symptoms of HPA-Axis dysfunction • Identify interventions useful for this population Based on • Post-traumatic stress disorder: the neurobiological impact of psychological trauma Dialogues Clin Neurosci. 2011 Sep; 13(3): 263–278. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182008/ • This article lays out the many changes and/or conditions seen in the brain of people with PTSD. • As clinicians, awareness of these changes can help us educate patients about their symptoms and find ways of adapting to improve quality of life. Introduction • Neurobiological abnormalities in PTSD overlap with features found in traumatic brain injury • The response of an individual to trauma depends not only on stressor characteristics, but also on factors specific to the individual. • Perception of stressor • Proximity to safe zones • Similarity to victim • Degree of helplessness • Prior traumatic experiences • Amount of stress in the preceding months • Current mental health or addiction issues • Availability of social support Introduction • For the vast majority of the population, the psychological trauma is limited to an acute, transient disturbance. • The signs and symptoms of PTSD reflect a persistent, abnormal adaptation of neurobiological systems to the witnessed trauma. What is the HPA Axis • Hypothalamic-Pituitary-Adrenal Axis AKA the Threat Response System • Controls reactions to stress and regulates many body processes, including digestion, the immune system, mood and emotions, sexuality, and energy storage and expenditure • The ultimate result of the HPA axis activation is to increase levels of cortisol in the blood during times of stress. • Cortisol's main role is in releasing glucose into the bloodstream in order to facilitate the "flight or fight" response. It also suppresses and modulates the immune system, digestive system and reproductive system. HPA-Axis Dysfunction • The body reduces its HPA axis activation when it appears that further fight/flight may not be beneficial. (Hypocortisolism) • Hypocortisolism seen in stress-related disorders such as CFS, burnout and PTSD is actually a protective mechanism designed to conserve energy during threats that are beyond the organism's ability to cope. • Dysfunctional HPA axis activation will result in • Abnormal immune system activation • Increased inflammation and allergic reactions • IBS symptoms such as constipation and diarrhea, • Reduced tolerance to physical and mental stresses (including pain) • Altered levels of sex hormones Fatigue • Fatigue is actually an emotion generated in the brain, which prevents damage to the body when the brain perceives that further exertion could be harmful. • Fatigue in sports is largely independent of the state of the muscles themselves and is more related to: • Physical factors • Core temperature • Glycogen levels • Oxygen levels in the brain • Thirst • Sleep deprivation • Levels of muscle soreness/fatigue Fatigue • Fatigue cont… • Psychological factors reducing fatigue • Emotional state • Knowledge of the endpoint • Other competitors/motivation • Visual feedback • Fatigue is one sign that the body is getting ready to downregulate the HPA-Axis • In counseling practice, how can we reduce fatigue and help clients restore HPA-Axis functioning?
Low Cortisol and PTSD • Low cortisol has been found to relate to more severe PTSD hyperarousal symptoms. • Sensitised negative feedback loop in veterans diagnosed with PTSD by means of a greater gluticorticoid responsiveness. (0-100) • Generally low cortisol, but when a threat is perceived there is an exaggerated stress response. (Flat or furious) • Evidence points toward a role of trauma experience in sensitizing HPA axis regulation, independent of PTSD development. • Those with prior trauma may be more at risk of PTSD from later traumas (Area for prevention)
Endocrine Factors • Core endocrine features of PTSD include abnormal regulation of Cortisol and thyroid hormones • Hypocortisolism in PTSD occurs due to increased negative feedback sensitivity of the HPA axis. • Studies suggest that low Cortisol levels at the time of exposure to psychological trauma may predict the development of PTSD. (Prior trauma exposure may predispose to PTSD) • Glucocorticoids interfere with the retrieval of traumatic memories, an effect that may • Independently prevent or reduce symptoms of PTSD • Or contribute to difficulty treating PTSD
Neurochemical Factors • Core neurochemical features of PTSD include abnormal regulation of catecholamine, serotonin, amino acid, peptide, and opioid neurotransmitters, each of which is found in brain circuits that regulate/integrate stress and fear responses. • the catecholamine family of neurotransmitters, including dopamine (DA) and norepinephrine (NE), derive from the amino acid tyrosine • When a stressor is perceived the HPA Axis releases CRH which interacts with NE to increase fear conditioning and encoding of emotional memories, enhance arousal and vigilance, and integrate endocrine and autonomic responses to stress. • there is an abundance of evidence that NF, accounts for certain classic aspects of PTSD symptomatology, including hyperarousal, heightened startle, and increased encoding of fear memories
Neurochemical Factors • Serotonin (5HT) • Poor serotonin transmission in PTSD may cause impulsivity, hostility, aggression, depression, and suicidally • Serotonin binding to 5HT1A receptors do not differ between patients with PTSD and controls. Serotonin Receptors (Soap Box) 5-HT1A • Addiction • Aggression • Anxiety • Appetite • Blood Pressure • Heart Rate • Impulsivity • Memory • Mood • Respiration • Sexual Behavior • Sleep • Sociability 5-HT1B • Addiction • Aggression • Anxiety • Learning/Memory • Mood
5-HT1D • Anxiety 5-HT2A • Addiction • Anxiety • Appetite • Cognition • Imagination • Learning • Memory • Mood • Perception • Sexual Behavior • Sleep 5-HT2B • Anxiety • Appetite • GI Motility • Sleep 5-HT2C • Addiction • Anxiety • Appetite • Mood • Sexual Behavior • Sleep
5-HT3 • Addiction • Anxiety • GI Motility • Learning • Memory • Nausea 5-HT4 • Anxiety • Appetite • Learning • Memory • Mood 5-HT5A • Sleep
5-HT6 • Anxiety • Cognition • Learning • Memory • Mood
5-HT7 • Anxiety • Autoreceptor • Memory • Mood • Respiration • Sleep
https://en.wikipedia.org/wiki/5-HT_receptor
Neurochemical Factors • GABA has profound anxiolytic effects in part by inhibiting the CRH/NE circuits • Patients with PTSD exhibit decreased peripheral benzodiazepine binding sites. • May indicate the usefulness of emotion regulation and distress tolerance skills due to potential emotional dysregulation • We need to reduce excitotoxicity in order to reduce distress, improve stress tolerance and enable the acquisition of new skills
Neurochemical Factors • NMDA Receptors • The NMDA receptor system has been implicated in synaptic plasticity, as well as learning and memory • Glutamate binds to NMDA receptors. High levels of glutamate are secreted during high levels of stress • Overexposure of neurons to glutamate is known to be excitotoxic, and may contribute to the loss of neurons in the hippocampus of patients with PTSD • Elevated glucocorticoids increase the sensitivity of NMDA receptors, rendering the brain more vulnerable to excitoxic insults at times of stress. • Points to ponder • It may take clients with PTSD more time to master new skills • If the brain becomes excitotoxic during stress, inhibiting learning and memory, then exposure therapies may also be dangerous. Neurochemical Factors • Endogenous opioids act upon the same CNS receptors activated by exogenous opioids such as morphine or heroin. • Opioids (depressants) exert inhibitory influences on the HPA axis. • Alterations in endogenous opioids may be involved in certain PTSD symptoms such as numbing, stress-induced analgesia, and dissociation. • Naltrexone, appears to be effective in treating symptoms of dissociation and flashbacks in traumatized persons. • Highlights the risk for opiate abuse of persons with PTSD • How can we assist with physical and emotional distress tolerance Changes? In Brain Structure • A hallmark feature of PTSD is reduced hippocampal volume. • The hippocampus is implicated in the control of stress responses, memory, and contextual aspects of fear conditioning. • Prolonged exposure to stress and high levels of glucocorticoids damages the hippocampus • Hippocampal volume reduction in PTSD may reflect the accumulated toxic effects of repeated exposure to increased glucocorticoid levels (Flat or Furious) • Decreased hippocampal volumes might be a pre-existing vulnerability factor for developing PTSD. Changes? In Brain Structure • The amygdala is a limbic structure involved in emotional processing and is critical for the acquisition of fear responses. • Functional imaging studies have revealed hyper-responsiveness in PTSD during the presentation of stressful scripts, cues, and/or trauma reminders. • PTSD patients further show increased amygdala responses to general emotional stimuli that are not trauma-associated, such as emotional faces. • So clients with PTSD may be more emotionally responsive across the board (dysregulation) Changes? In Brain Structure • Early adverse experience, including prenatal stress and stress throughout childhood, has profound and long-lasting effects on the development of neurobiological systems, thereby “programming” subsequent stress reactivity and vulnerability to develop PTSD. • Adult women with childhood trauma histories exhibit sensitization of both neuroendocrine, and autonomic stress responses Summary • A variety of changes take place in the brains and nervous systems of persons with PTSD • Pre-existing issues causing hypocortisolism (the brain has already down regulated) increases the likelihood of the development of PTSD • This points to the importance of prevention and early intervention of adverse childhood experiences • People with hypocorticolism may or may not have PTSD • Hypocorticolism sets the stage for the Flat and the Furious à toxic levels of glutamate upon exposure to stressors reduction of hippocampal volume persistent negative brain changes Summary • People with PTSD are more reactive to emotional stimuli, even stimuli unrelated to trauma • Hypocorticolism results when the brain perceives that continued effort is futile. • Feelings of “fatigue” set in (akin to reduced stress tolerance) • Reducing fatigue can be accomplished, in part, with psychological factors including • Motivation/Knowledge of “competitors” • Feedback (frequent successes) • Knowledge of an endpoint
Summary • 46% of people in the US are exposed to adverse childhood experiences. (Early Intervention) • Instruction in skills to handle emotional dysregulation • Mindfulness • Vulnerability prevention and awareness • Emotion Regulation • Distress Tolerance • Problem Solving • Of those exposed to trauma, education about and normalization of heightened emotional reactivity and susceptibility to PTSD in the future may be helpful Subscribe
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The Psychological Impact Of Quarantine And How To Reduce It Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education
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Objectives Based on The psychological impact of quarantine and how to reduce it: rapid review of the literature
~ Review the effects of quarantine ~ Explore ways to mitigate these effects Intro ~ Quarantine means the separation and restriction of movement of people who have potentially been exposed to a contagious disease ~ However, during a contagious outbreak like influenza, SARS, H1N1, Ebola etc., many people choose to voluntarily restrict their movement to prevent getting ill ~ Many of the principles we will discuss here also apply to extended “sheltering in place” which people experience after hurricanes or blizzards. Stressors During Quarantine ~ Those quarantined for more than 10 days showed significantly higher post-traumatic stress symptoms ~ Fears about own health or getting sick and infecting others (which continued for several months post-quarantine) ~ Hypervigilance to any symptoms of illness ~ High risk populations (pregnant women, parents of young children and the elderly showed negative rumination) Short Term Problems ~ Separation from loved ones ~ Detachment from others ~ Loss of freedom ~ Loss of routine ~ Lack of access to basic supplies ~ Uncertainty over status of the situation ~ Financial losses due to inability to work and stock market ~ Dependence on family members to provide financial assistance during quarantine caused conflicts ~ Those who live at or below 300% of the poverty level showed greatest stress in response to financial losses Short Term Reactions ~ In the case of potential exposure, acute stress disorder (34% vs. 12%) ~ Exhaustion ~ Anxiety when around people who are sick ~ Irritability ~ Anger ~ Insomnia ~ Poor concentration ~ Indecisiveness ~ Deteriorating work performance ~ Reluctance to go to into public and consideration of resignation from work Short Term Effects ~ Confusion and a perception of lack of transparency about the severity of the problem can be created due to differences in style, approach, and content of various public health messages because of poor coordination between the multiple jurisdictions and levels of government involved.15 ~ Lack of clarity about the different levels of risk causes participants to fear (and ruminate on) the worst ~ Stigma continued long after the outbreak had been contained for those perceived to be at high risk, who had been sick or exposed ~ Avoiding them, withdrawing social invitations, treating them with fear and suspicion, and making critical comments ~ Stigma could lead to disenfranchisement of minority groups as families under quarantine often belonged to different ethnic groups, tribes, or religions
~ General education about the disease and the rationale for quarantine and public health information provided to the general public can be beneficial to reduce stigma ~ Detailed information targeted at schools and workplaces might also be useful. ~ Media reporting contributes to stigma and trauma due to their dramatic headlines and fear 36 ~ Public health officials must provide rapid, clear messages delivered effectively for the entire affected population to promote accurate understanding of the situation. ~ Mandatory Public Broadcasts ~ Social Media ~ Single point of contact website (i.e. CDC) Longer Term Effects ~ 3 years after the SARS outbreak, alcohol abuse or dependency symptoms were positively associated with having been quarantined or worked with high risk populations.32 ~ After quarantine, many participants continued to engage in avoidance behaviors such as minimizing direct contact with patients and not reporting to work. ~ 54% of people who had been quarantined continued to avoid and were anxious around people who were coughing or sneezing ~ 26% avoided crowded enclosed places ~ 21% avoided all public spaces in the months following the quarantine period.
Longer Term Effects ~ Longer-term behavioral changes after the quarantine period, included ~ continued vigilant handwashing ~ avoidance of crowds ~ Lack of access to basic supplies was associated with continued anxiety and anger 4–6 months after release
Interventions ~ Provide a unified public message about what is happening, safety measures that are being undertaken, emergency plans, the likelihood of deterioration of the situation and how long it will continue. ~ Providing meaningful activities while in quarantine. ~ Ensure basic supplies (such as food, water, and medical supplies) are available. ~ Reinforcing the sense of altruism and safety. ~ Those involved with public safety and healthcare are in uniquely dangerous positions and require additional organizational support and “disaster planning” to mitigate risk ~ Health officials charged with implementing quarantine, who often have reasonable job security, should also remember that not everyone is in the same situation. Summary ~ Information is key; people who are quarantined need to understand the situation ~ Effective and rapid communication is essential ~ Supplies (both general and medical) need to be provided or available (i.e. online shopping) ~ The quarantine period should be short and the duration should not be changed unless in extreme circumstances ~ Most of the adverse effects come from the imposition of a restriction of freedom ~ Voluntary quarantine is associated with less distress and fewer long-term complications ~ Public health officials should emphasise the altruistic choice of self-isolating
Helping Parents of Children with Autism Better Engage and Communicate with Their Children Objectives – Move from a deficits based to a differences based approach to interaction – Describe the unique interpersonal needs of people with autism spectrum disorders – Identify characteristics necessary to form secure attachments – List at least 5 practices that caregivers and teachers can use to improve connection with children on the autism spectrum.
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Think of a time – You were totally overstimulated (Laguardia, wedding) – You were exposed to high levels of sensory input (concert, cologne, O2B) – You had something wrong, but couldn’t seem to explain it (Car, computer, overwhelmed but don’t know why…)
– Did you feel safe- – What was your mood- – How was your concentration- – What were your thoughts-
Secure Attachment/Connection – Helps people feel safe and loved. – Requirements (CRAVES) – Consistency in routines and expectations – Responsiveness (mirror and soothing) – Knowing child’s distress triggers and cues – Providing early intervention – Accommodating the child’s learning style & environmental preferences – Attention – Praise the positive / UPR – Validation of feelings, thoughts and needs – Empathy – Solutions: Identify ways to prevent and mitigate distress
Special Needs – Language and speech – Slow speech development or not talking at all – Trouble or inability to start a conversation (or to keep it going) – Constant repetition of certain words or phrases – Difficulty expressing (communicating) one’s desires or needs – Failing to understand humor and taking things too literally – Using single words when communicating – Failing to understand simple questions or sentences or slow processing
Special Needs – Social Interactions – Failing to understand and respect other people’s personal space – Difficulty understanding other people’s gestures, body language, reactions, and feelings – Not responding to one’s name being called – Lack of desire to interact with other people – Difficulty making friends with kids of the same age – Avoiding eye contact – Not enjoying situations and events that kids usually love – Not showing interest in other people’s interests
Special Needs – Behavior – Repetitive movements (stimming) – Being obsessively interested in one area or topic – Playing with toys in a repetitive way (for example, lining the blocks all the time instead of building with them) – Insisting on a certain familiar routine or order – Unusual sensory manifestations (like sniffing toys or people) – Being hypersensitive to certain textures, sounds, or light – Being sensitive to touch and reacting negatively to it
Skills – Focus on the positive. Praise what is good. Be specific. Praise not only behaviors, but also who they are. – Use positive discipline and redirection (Tearing paper) – Stay consistent and on schedule – Have routines to ease transitions (vibrating notifications) – Take your child with you during everyday activities – Select playmates with similar language and physical skills. – Invite only one or two friends at a time at first, and have a zero-tolerance policy for hitting, pushing and yelling. – Encourage your child to play, and reward good behaviors often and immediately. – Role play or use Comic Strip Conversations to help the child learn the social rules that others learn more naturally. Bubbles representing a conversation can bump into or overlap one another to illustrate “interrupting” and “thought” bubbles can show others' thoughts during conversation
Skills for ASD & ADHD – Structure and routine – Stay organized—Everything has a place – Clocks, timers and transitions – Simplify the schedule – Have clear expectations and rules (Visual guides) – Create a sanctuary place – Encourage movement (fidgets, stability balls) – Ensure adequate, quality sleep (Sensory issues) – Ensure regular, healthy nutrition (even with picky eaters) – Maintain a positive attitude
Skills for ASD & ADHD – Role-play various social scenarios with your child. Trade roles often and try to make it fun. – Choose your battles and be willing to make compromises – Make a list of everything that is positive, valuable, and unique about your child. Trust that your child can learn, change, mature, and succeed. Reaffirm this trust on a daily basis as you prepare for your day Enhancing Connection – Children on the spectrum do not necessarily provide the responses that trigger parent’s innate impulses to care for them. – Some children initially don’t respond much at all, others have responses that we don’t understand, and many respond differently every time the parent approaches. – Unexpected response styles create confusion and a sense of inadequacy in many parents. – Remember that although children may not respond in the way expected, they are still responding. – Become a detective, discover clues to triggers for children’s behaviors – Use backward chaining – Remember that their behavior is functional in some way Enhancing Connectedness – Joining children in their world requires caregivers to imitate and follow. – Don’t make demands or ask him to perform (i.e., “What color is this-” or “What does a cow say-”) – Don’t direct the play. – Talk about what you and the child are doing without asking too many questions (i.e., “Boy, these designs in the carpet are really interesting” or “You really like the sound of that block banging on the table.” “It makes me really happy when you share with me.”). – Don’t be afraid to add to the play with your own creations in the hope that your child will someday become interested in you, too.
Enhancing Connectedness – If the child has limited awareness of others, create situations in the play to get the child to notice you. If he is building with blocks, you might build a complimentary section or ask him to help you do the same thing. – Label children’s feelings so they can start developing an emotional vocabulary and reduce frustration – Let children develop their special capabilities and keep your expectations in check – Use scaffolding (Going to the grocery) – Endure a little suffering with your children so they can grow Enhancing Connectedness – Many children with special needs have problems with sequencing and/or processing auditory and/or verbal information. It is important to learn about your child’s different ways of learning. – Visual, auditory, kinesthetic – Reflective, active – Many children with autism take longer for to register an interaction and decide how to respond. Learn to wait for your child’s response before repeating yourself. (Autism Support Network)
Enhancing Connectedness – They don’t pay attention to what I’m saying – Always use their name at the beginning so that they know you are talking to them. – Make sure they are paying attention before you ask a question or give an instruction. – Use their special interest, or the activity they are currently doing, to engage them. – “I can see you are having fun playing in the sandbox. We have to leave the park in 5 minutes.” – “You are making such good choices today. I know it has been very stimulating. I bet you will be happy to get home to pet Suzie.” Enhancing Connectedness – They find it hard to process what I say – They may find it difficult to filter out the less important information which can lead to ‘overload’ and no further information can be processed. – Pay attention to the other sources of internal and external input – Say less and say it slowly. – Pause between sentences/requests to give the person time to process what you’ve said, and think of a response. – Don’t use too many questions. – Use less non-verbal communication (e.g. eye contact, facial expressions, gestures, body language) when a person is showing signs of anxiety. – Use visual supports (e.g. pictures, timetables) Enhancing Connectedness – They struggle with open ended questions – Keep questions short. – Ask only the most necessary questions. – Structure your questions to offer options or choices. – Be specific. For example, ask “Did you enjoy your lunch-” and “What did you learn in math today-” rather than “How was your day-” – They don’t ask for help. Give them a visual help card to use. Enhancing Connectedness – They are disinterested in others (and me): – Get involved in groups that foster positive peer relationships and social skills development – Get interested in their interests – They takes things literally: Avoid using irony, sarcasm, figurative language, etc. – They may ask a lot of questions and paraphrase to ensure understanding. Be patient.
Enhancing Connectedness – They takes things literally: Avoid using irony, sarcasm, figurative language, etc. – They may ask a lot of questions and paraphrase to ensure understanding. Be patient. – They tend to be frank, honest and matter of fact. Some people may interpret this as blunt or rude. They don’t intend to be rude. – Instead of making a facial expression you expect the person with autism to read and respond to, tell the individual, in a matter-of-fact but helpful way, that his choice of words or actions was not appropriate, and guide him to a better expression.
Enhancing Connectedness – They react badly when I say no – They may be confused about why you said no. – If it’s an activity that they can do later on that day or week, try showing this in a timetable (No park today) – If it’s a safety issue, look at ways of explaining danger and safety. (No playing hide and seek in the store) – If you are saying ‘no' because they are behaving inappropriately a calm reaction with redirection may help to decrease this behavior in time. (No ice cream after the park) – If it is something you have allowed before, explain the reason why it is no longer okay. (Candy) – Set clear boundaries and explain why and where it is acceptable and not acceptable to behave in certain ways.
Enhancing Connectedness – They hit me if they don’t want to do something I ask – Keep a log to identify what is triggering or maintaining the behavior. – Include antecedents: Sleep, nutrition, time of day, stressors, is this a regular or unique experience-, what else might have happened that added to his stimulation/distress- What are the benefits of hitting- – “Clean your bedroom”
Enhancing Connectedness – They hit me if they don’t want to do something I ask – Keep a log to identify what is triggering or maintaining the behavior. – Include antecedents: Sleep, nutrition, time of day, stressors – “Clean your bedroom” – Help them identify what they are feeling and offer other ways of expressing ‘no’ or ‘stop’ – “Calm down couch” (Reframe) – Stability ball – Thinking putty – Drawing corner – Dragon breather or harmonica – Belly breathing
Reducing Tantrums – Punishing autism-driven behaviors won’t extinguish them. – Understanding what is driving the behavior and the early warning signs will help you and the person with autism cope or adapt. – Distress signals – Motivation for the behavior – Sensory input: Sights, sounds, smells, exhaustion. – Overstimulation can lead to behavioral issues out of self-preservation – Under and overstimulation can both lead to stimming behaviors – Reinforce positive behaviors in the moment Reducing Tantrums – Portable Toolkit – Timer for transitions – We will be in the store for 20 minutes – We are leaving in 5 minutes – Schedule or activity book – Sunglasses – Weighted lap-pad or shawl – Noise cancelling headphones – Crunchy snack – Unscented hand wipes or handkerchief
– A fidget toy (spinner, paper, tennis ball, ink pen, playdough, sand or liquid timer, something that vibrates, stuffed animal or small blanket) – Scented hand lotion, spritz, atomizer or sachet (essential oils mandarin, lavender, cedarwood, frankincense) – Tablet (Tetris)
Parenting Styles that Do Not Work – Helicopter Parenting: Unable to learn by observation, children with autism must learn through direct instruction and by actually doing. Helicopter parents do it for them – Free-Range Parenting: Children with autism need regular, focused parental engagement. They need your help to actively learn to pretend, socialize, and investigate the world. Without another person to help them build these critical skills, children with autism can become increasingly withdrawn and self-focused – Frenetic Parenting: Some parents frantically search for engaging therapies and activities, but when children have too many appointments and obligations they have no opportunity to practice what they’ve learned. Consider setting aside a few hours a day of calm, unfocused parent-and-child time each week. Summary – Consistency: Rules, routines, reactions – Responsiveness: To individual needs and preferences – Attention: For being lovable and positive behaviors – Validation: Of their thoughts, feelings and way of being in the world – Empathy: For how their sensory and neurological differences impact them emotionally, cognitively, interpersonally, physically – Solutions: – To help them become more mindful and mitigate or prevent triggers for unwanted behaviors. – To help them develop the skills needed to engage with a neurotypical world. Other Resources – 10 Tips on How to Communicate with Autistic People References – https://www.verywellhealth.com/parenting-styles-that-dont-work-with-an-autistic-child-259958 – https://www.parenting.com/health-guide/autism-spectrum-disorders – https://iancommunity.org/ssc/stress-and-autism-parent – https://www.webmd.com/brain/autism/parenting-child-with-autism#1 – http://parentingadhdandautism.com/ – http://www.autismsupportnetwork.com/news/top-10-strategies-success-emotional-parenting-child-autism-or-pdd-83838322 – https://www.nidcd.nih.gov/health/autism-spectrum-disorder-communication-problems-children – https://www.spectrumnews.org/news/social-communication-autism-explained/ – https://www.autism.org.uk/about/communication/communicating.aspx – https://link.springer.com/article/10.1007/s10802-007-9139-y – https://howtoadult.com/attachment-behaviors-autistic-children-17618.html – https://www.sciencedirect.com/science/article/pii/S1750946716301659 – https://network.autism.org.uk/knowledge/insight-opinion/autistic-spectrum-condition-and-attachment-–-what’s-connection – http://otarc.blogs.latrobe.edu.au/bound-together/ – https://autismum.com/2012/05/07/10-tips-on-how-to-communicate-with-autistic-people/ – https://www.crisisprevention.com/Blog/September-2012/Tips-for-Interacting-With-People-With-Autism – https://youmemindbody.com/disabilities/Communicating-with-adults-who-have-autism-spectrum-disorders – http://theconversation.com/supporting-students-with-autism-in-the-classroom-what-teachers-need-to-know-64814 – https://www.autismspeaks.org/blog/five-ways-teachers-can-support-students-autism
470 - Distress Tolerance Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Podcast Host: Counselor Toolbox & Happiness isn’t Brain Surgery with Doc Snipes
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Objectives ~ Define goals of distress tolerance ~ Discuss why some clients do not choose distress tolerance ~ Explore a variety of Distress Tolerance and Reality Acceptance Skills including ~ STOP ~ Pros and Cons ~ TIP ~ ACCEPTS ~ Self Soothing ~ IMPROVE the Moment ~ Radical Acceptance ~ Turning the Mind
Objectives Goals of Distress Tolerance ~ The goal of distress tolerance is to accept, find meaning for and tolerate distress ~ Pain and distress are part of life. Refusing to accept this leads to suffering ~ Any attempts at change will produce distress, therefore distress tolerance skills are necessary
Change causes crisis and crisis causes change Distress Tolerance ~ Distress tolerance is a natural progression from mindfulness ~ Accepting, nonjudgmentally, oneself and the situation ~ Not trying to change the situation, your feelings, thoughts or urges ~ Distress tolerance means surviving crises, accepting life as it is in the moment.
Tolerance and acceptance of reality do not equate with approval Proving How Bad It Is ~ Sometimes people so want others to understand how bad it is they focus on that instead of surviving the situation ~ Short Term Gains (Look what you made me do) ~ Controlling another’s behavior ~ Going to the hospital and getting attention/break ~ Long Term Benefits ~ ??
~ Have clients remember a time they acted out to try to get someone to see how bad it was. What were the results?
Distress Intolerance Thoughts ~ I can’t stand this ~ It’s unbearable ~ I hate this feeling ~ I must stop this feeling ~ I must get rid of it ~ Take it away ~ I can’t cope with this feeling ~ I will lose control ~ I’ll go crazy ~ This feeling will keep going on forever ~ It is wrong to feel this way ~ It’s stupid and unacceptable ~ It’s weak ~ It’s bad ~ It’s dangerous
Avoidance Behaviors Urge Surfing ~ Urges are generally intense for 20-30 minutes ~ Every time you have an urge think, I have a choice! ~ Surf the urge by opening yourself up to the urge. This doesn't mean that you consume yourself in it (which feels horrible) or fight it and push it away. What you do is experience the feeling of the urge with acceptance, non-judgement, and be sensitively aware that it is there.
STOP Skills ~ Stop ~ Take a step back ~ Observe ~ Proceed Mindfully Pros and Cons ~ What are the benefits to acting on impulsive urges? ~ What are the drawbacks to acting on impulsive urges? ~ What are the benefits to __[insert the skill] __ ~ What are the drawbacks to __[insert the skill] __
TIP Skills ~ Temperature ~ Intense Exercise ~ Paced Breathing ~ Paired Muscle Relaxation ~ The act of muscle relaxation is paired with a verbal cue ~ What reactions do you have that are paired with verbal cues?
Distract with Wise Mind ACCEPTS ~ Activities (pleasant) ~ Contributing ~ Comparisons ~ Emotions (opposite) ~ Pushing Away ~ Think about something totally different ~ 4 3 2 1 ~ What did you used to do on long car trips? Self-Soothing ~ Body Scan Meditation ~ Self-Soothing Using the 5 Senses ~ Sight ~ Smell ~ Hearing ~ Touch ~ Taste IMPROVE the Moment ~ Imagery ~ Safe place ~ Successfully dealing with this ~ A force field ~ A coach/fairy godmother/angel ~ Feelings and thoughts are clouds in the sky ~ An unstoppable train ~ Meaning ~ Changing how you think about yourself and your situation ~ Make lemonade. Find the silver lining. ~ Prayer ~ Relaxation
IMPROVE the Moment ~ One thing in the Moment ~ Focus on one thing you are doing right now ~ Sitting in a chair ~ Driving ~ Weeding ~ Vacation ~ Mental vacation ~ Take a short break ~ Leave stress at work ~ Encouragement ~ Be your best friend ~ Create a mental coach
Reality Acceptance ~ Radical Acceptance ~ Complete and total acceptance of the facts of reality ~ Turning the mind ~ Mentally looking to the other side Reality Acceptance ~ Seeing Emotions Differently ~ Fear and anger kick in when there is a threat ~ Sadness kicks in when you lose something important to you in some way, If you didn’t feel sadness when these things occurred, it would mean that nothing was important.
Negative emotions are important to survival, rather than something to be feared and avoided at all costs
Reality Acceptance ~ Willingness vs. Willfulness ~ Willfulness forgets, ignores or actively tries to change, master, direct, control or manipulate what is ~ Willingness is a surrendering to a process in which one is already a part
Reality Acceptance ~ Half Smiling and Willing Hands ~ Emotions are partially controlled by facial expressions. ~ Half smiling with lips slightly upturned ~ Hands are unclenched, palms up, fingers relaxed ~ Mindfulness of current thoughts ~ Recognize that thoughts are just neural firing in the brain, not facts about the world ~ Allow the thoughts to come and fade Additional Tools ~ Clear Mind ~ Addicted Mind is governed by addictive behaviors ~ How is addicted mind similar to the emotional mind? ~ Clean Mind (Pink Cloud) forgets that relapse is possible ~ How is the clean mind similar to the rational mind? ~ Clear mind is not engaging in addictive behaviors but remains aware that relapse is possible. ~ How is the clear mind similar to the wise mind? Additional Tools ~ Burning Bridges and Building New ~ Actively eliminating triggers/vulnerabilities ~ Finding physical and emotional sensations and creating mental images that compete with the addiction ~ Alternate Rebellion ~ Finding alternative ways to act out which are safer ~ Harm reduction ~ Sublimation ~ Loud music
Important Questions ~ How does [this technique] make you feel? ~ How does it impact your feelings in the moment? ~ How does it affect how you handle the problem? Emotional Comebacks ~ Sometimes emotions, thoughts, urges reappear ~ Notice them without negative judgement. ~ Tolerate the distress ~ Problem solve Summary ~ Once clients are mindfully aware of their thoughts, sensations and urges and willing to accept the moment, they need skills to tolerate that distress ~ Help clients develop a menu of options which they can select from when they are in crisis. ~ They feel how they feel ~ Help them tolerate the distress until the intense emotions subside and they can get into their wise mind.
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Social Work & Case Management for Depression Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs
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Objectives • Define depression (symptoms) • Learn how to ask strengths-based assessment questions • Identify a range of potential causes for depression • Explore activities and interventions that can help people address some of the underlying causes
Depression • Depression represents a cluster of symptoms • Diagnosis with depression only requires people to have a few of the symptoms • Depression indicates the loss of something important • A variety of different things can cause depression • Emotions: Anger, anxiety, grief, guilt, shame • Thoughts: Cognitive distortions • Relationships: Poor self-esteem, unhealthy/unsupportive relationships, need for extremal validation • Physical: Neurochemical imbalances, poor nutrition, exhaustion, insufficient sleep, medication side effects • Environmental: High stress environments that prevent relaxation/rest and increase hopelessness/helplessness
Depression Assessment • What does depression mean to you? (apathy, sadness, mood swings) • Which symptoms are most bothersome for you and why? • For each symptom • What makes depression worse? • What makes depression better? • How was life more pleasurable prior to getting depressed? • What is different during times when you are NOT depressed? • How do you expect life to be different when your depression is gone? Neurotransmitters • Ability to feel pleasure/Apathy/Emotional Flatness • Memory issues • Difficulty concentrating • Sleep issues • Lack of motivation • Fatigue • Pain • Irritability/Agitation • Fight or flight stress symptoms
HPA-Axis • HPA-Axis hyperactivity causes the release of inflammatory cytokines which cause symptoms of behavioral depression (lethargy, reduced locomotor activity and food intake, increased sleep) in the effort to conserve energy for physiological repair Reduce HPA-Axis Activation • Get quality sleep • Sleep deprivation increases risk for major depression, which in turn increases risk for decreased sleep • Sleep disturbances contribute inflammatory disorders and major depressive disorder • Increased HPA-Axis activation after sleep deprivation • Create a routine • Eliminate blue-light • Reduce stimulants • Address pain and apnea (article 2) • Improve the sleep environment (noise, allergens, light, temperature) • Other factors: Shift work, time zones, safety/PTSD • Antidepressants: Many antidepressants with activating effects may disrupt sleep, while those with sedative properties improve sleep, but may cause problems in long-term due to oversedation
Reduce HPA-Axis Activation • Relaxation • Biofeedback • Progressive muscular relaxation • Meditation and yoga • Recreation • Forest / Eco Therapy • Address medication side effects • Psychotropics • Beta Blockers • Statins • Anticholinergic (bladder, Parkinson’s, COPD, Asthma, motion sickness) • Opioids • Corticosteroids • Certain antibiotics (levofloxacin and ciprofloxacin) • Birth control / HRT
Reduce HPA-Axis Activation • Improve nutrition • Access to nutrition • Transportation • Affordability • Cooking • Awareness of nutritional principles • Macros • Hydration • Dehydration had negative effects on vigor, affect, short-term memory, and attention • Aspartame Neurotransmitters • Addictive behaviors • Alter dopamine, serotonin, norepinephrine levels • Impacts of different types of neurotransmitters • Stimulants • Depressants • Alcohol • Gaming/Gambling • Sex/Pornography
Hormones • Thyroid • Impact mood, libido and energy levels • Estrogen • Impacts neurotransmitters that affect sleep, mood, memory, libido, pain perception, learning and attention span. • Increased estrogen may alter the availability of serotonin • Low testosterone may alter the availability of serotonin • Enhances libido, improves stamina and sleep, assists brain function, and is associated with assertive behavior and a sense of well-being.
Hormones • Cortisol • Cortisol is made by the adrenal glands. • Helps the body adapt to stress by increasing heart rate, respiration, and blood pressure by impacting serotonin and norepinephrine levels • Cortisol levels increase early in the morning to prepare to meet the demands of the day, and gradually decrease throughout the day (“circadian rhythm”). • DHEA • DHEA can also increase libido and sexual arousal. It improves motivation, engenders a sense of well-being, decreases pain, facilitates the rapid eye movement (REM) phase of sleep, enhances memory and enhances immune system function. Dr. Elise Schroder
Hormones • Get a physical to identify and address what may be causing any imbalances • Eat a low-glycemic diet • “The less sleep you get, the higher your cortisol will be; the more sleep you get, the lower your cortisol will be.” John Romaniello, co-author of Man 2.0 Engineering the Alpha: A Real World Guide to an Unreal Life. Hormones • Final Thoughts on Hormonal Imbalances: • Hormonal imbalances affect many millions of people • Symptoms include feeling anxious, tired, irritable, gaining or losing weight, not sleeping well and changes in sex drive, focus and appetite • Causes for hormonal imbalances include poor gut health, inflammation, high amounts of stress, genetic susceptibility, and toxicity • Natural treatments include eating an anti-inflammatory diet, consuming enough omega-3s, getting good sleep, exercising and controlling stress
Pain • Exercise • Guided imagery • Muscle Relaxation • Alternate focus • TENS therapy • Physical therapy • Hydrotherapy • Ice/Heat • Hypnosis Emotions • Anger/Resentment/Jealousy/Envy/Guilt • Anger is half of the fight or flight • It pushes people away and/or asserts dominance/control • Excessive anger can • Exhaust the stress-response system • Contribute to negative cognitions • Impair relationships • Cause physical harm Emotions • Anger/Resentment/Jealousy/Envy/Guilt • Activity (Group or Individual) • When you are angry, what do you notice? • What are your anger triggers? • How can you address each trigger to feel safer and more empowered? Emotions • Anxiety • Anxiety is the other half of fight or flight • Chronic anxiety/worry/stress will also exhaust the stress response system causing neurochemical and hormonal imbalances and increasing muscle tension and pain • This causes the body to adapt to excessive stress chemicals by shutting down the receptors à apathy • Anxiety makes it harder to sleep exhaustion hormonal imbalances depression
Emotions • Grief • Grief is sadness/depression experienced as a result of loss • The grief process involves • Anger (at self, other, existential) • Depression • Helplessness to change the situation • Hopelessness that you will move on • Losses are not just about death
Emotions • Happiness… (Duh!) • You cannot be happy and depressed at the same time • Happiness chemicals reduce stress and depression chemicals (I know, real clinical explanation there!) • Increase the happy times • Comedians • Children (even youtube videos of babies laughing) • Animal Videos • https://www.youtube.com/watch?v=Ln2Xq8fCNI8 • https://www.youtube.com/watch?v=FMBchZmPlXA
Cognitive • Negative thinking styles • Contribute to exhaustion • Highlight what is out of your control • Heighten a sense of helplessness/hopelessness (depression) • Cognitive distortions • All-or-Nothing (Nobody ever) • Self-fulfilling prophesies
Relationships • Poor self-esteem • Contributes to self-loathing, shame and a feeling of unlovability • Negatively impacts relationships (loneliness/rejection) • Often causes a person to seek external validation • Activity: • Complete a self-esteem inventory • For all the characteristics you don’t have, answer the question: • If your child/best friend had this flaw, would I still love them? Relationships • Unhealthy/unsupportive relationships • Negative relationships can take a toll on self esteem • Fears of abandonment can maintain high levels of stress and feelings of helplessness • Fail to buffer people against stress à exhaustion neurotransmitter imbalances depression Environmental • High stress environments • Prevent relaxation/rest • Increase hopelessness/helplessness • Increase stress hormones / decrease relaxation hormones • Activity • Design a low stress area in • Your home (bedrooms are good) • At work/school • Identify ways to reduce the stress in your environment in both places (noise, interruptions, poor lighting, negativity) • Identify ways to turn the negative into a positive
Summary • Depression is the cluster of symptoms created when there is a neurochemical imbalance in the brain. • What causes the imbalance can be emotional, cognitive, physical, interpersonal, environmental or some combination of the above. • Part of the strengths based approach means helping people see what they already are doing to prevent or deal with the symptoms • Biopsychosocial means • Examining all causative factors • Recognizing that all factors are reciprocal in nature.
468 - Individual and Group Exercises for Anger and Anxiety
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Journey to Recovery Individual and Group Exercises for Anger and Anxiety Objectives What is the Purpose • Anger (Fight) and anxiety (Flee) protect you from perceived threats by alerting you there MIGHT be a problem • Have you ever gotten angry or stressed out about something just to find out that it wasn’t a big deal? • Problems • Based on prior learning experiences (but life changes) • Unsafe situations • Need for someone’s approval • May be overgeneralized (all or nothing) • Dogs barking • Semis What is the Purpose • Problems • May be the result of transference • First love • Worst boss • May simply be inaccurate (Fire alarm) • Car backfiring • Sean’s “paint” Effects • How does anger or anxiety affect you: • Physically: Sleep, pain, GI, immunity • Emotionally: Regret, guilt, feeling helpless • Socially: Fear vs. respect, negative impact on relationships • Occupationally: How you work with others, customer service • Spiritually: Your sense of contectedness to and impact within the world, karma • Environmentally: Break stuff, holes in walls, throw out things impulsively
Anger • Since anger protects people and it often results from application of prior knowledge or experiences, then it can be supposed that people with a lot of anger may have been exposed to significant threats (traumas) in their past • When you have a hammer, every problem looks like a nail
Anger and Anxiety Triggers • The Alphabet List • A= Attitude • B= Bullying • C= Creating drama • D= Disagreeing • E= Expecting too much • F= Failing to keep a promise • G= … Anger and Anxiety Interventions • Recognize anger and anxiety as a protective response based on that persons experiences and worldview. • In what way did the current situation make the person feel unsafe emotionally, interpersonally, physically or remind them of a time he or she was unsafe? • What emotions were triggered by this event and what vulnerabilities or skill deficits contributed to the event? • In what way did the situation trigger a sense or memory of loss? • How does the persons experience of the event alter his/her future?
Anger and Anxiety Interventions • The Alphabet List • A= Acceptance • B= Breathing • C= Compassion, Challenge • D= Dispute, Distract, Distress Tolerance • E= Express myself • F= Friend’s support • G= Gratitude • H= Higher Power/Hope • I=… Anger and Anxiety Interventions • Identify 2 ways you could deal with the following symptoms, why they might occur and why it is important to recovery • Beach ball • Jenga (card draw) • Hat draw (same cards from Jenga) • Symptoms • Always feeling worried or stressed out • Insomnia • Fatigue • Shortness of breath • Muscle tension • Headaches • Irritability Anger and Anxiety Interventions • Anxiety/Anger graphic novel or skit • Anxiety/Anger says… • Evidence for and against • Anger/anxiety thermometer • Vulnerability predictor/prevention • Handling criticism (role play) • Worry stone or beads • Worry box • Positive writing • Anger “Onion”
Anger and Anxiety Interventions • Hidden Heart • Fill a ziplock baggie with slips that tell about all of your hurts and anger (This is your heart) • Put the little bag inside of a paper lunch bag. Write on the outside all the ways they present themselves to the world to hide what is hidden on the inside. • For kids: Anger Tornado • RELAX Jar: Using beads with the letters R-E-L-A-X and other small beads and sequins, fill a small jar with rice. Leave a little air at the top so as it is rotated, the rice will slide around inside revealing the letter beads and sequins. When the person gets angry, she/he can turn the jar until finding all the letters that spell relax. (more resources here https://www.creativecounseling101.com/anger-management.html)
Anger and Anxiety Interventions • Hidden Heart • Fill a ziplock baggie with slips that tell about all of your hurts and anger (This is your heart) • Put the little bag inside of a paper lunch bag. Write on the outside all the ways they present themselves to the world to hide what is hidden on the inside. • No Rewards • What is going on with them • Role play an incident that triggers anger with neck cards Anger and Anxiety Interventions • How can you use mindfulness to start to break that habit? • I am angry/anxious. • What am I angry/anxious about? • Is this actually a threat to me in the present moment? • What is the best response in this situation to help me achieve my goals
Prevention • Reduce stimulants • Get enough rest • Strive for work/life balance (add fun) • Keep blood sugar stable • Be aware of your triggers • Environmental • Situational/interpersonal • Have a plan • Get support
Emergency Planning • How can you get safe? • Who can you call or text? • Strategies can you use to help you get into your wise mind? • Why is it important to you to manage these feelings? Summary • Anger and anxiety are normal emotions that help people survive. • Answers can often be found by asking: “What happened to this person that would trigger this reaction?” • Situations that trigger anger and anxiety often involve a sense of being unsafe, a loss of something, emotions that are unable to be handled effectively, and an alteration of how that person envisions the future. • Problems arise when anger and anxiety are misinterpreted or the person does not have the skills to deal with the problem • Anger is not a simple emotion, it often covers up shame, embarrassment, guilt and/or anxiety. • By helping people identify the roots of their anger and more effective strategies, they can be empowered to reduce the frequency and intensity of these emotions and more effectively cope when they do arise.
466 - Developing Self-Esteem and Self-Efficacy
Developing Self-Esteem and Self-Efficacy Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Counseling Continuing Education Podcast Host: Counselor Toolbox, Case Management Toolbox
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Objectives • Understand what self esteem and self-efficacy are, why they are important and how to develop them
The Nature of Self-Esteem • How people feel about theirself in contrast to who people think people “should” be • The more rejecting people are of theirself, the more • Distress people experience • people seek external validation or withdraw • In order to develop healthy relationships people need to • Feel good about theirself • Get in touch with theirself and their true values • Believe people are a lovable and worthwhile person • Choose actions in harmony with their true self
The Gift of Mindfulness • Teaches people to live in the moment • Not stuck in guilt or resentment of the past • Not paralyzed by fear of the future • Putting one foot in front of the other • Cornerstone of mindfulness is acceptance • Nonjudgmental • Letting be • Patient • Mindfulness teaches that when people trust theirself and act with awareness and purpose people become more self reliant
Note: The book will give people access to online, recorded versions of several meditations
Impact of Mindlessness • Ignoring or invalidating how people feel • Failing to integrate feelings, thoughts, sensations and urges • Running on autopilot and not making time for the things that are important (getting us closer to our ideal selves) • Blindly adopting mainstream messages of who/what we should be • Not in harmony with who we really want to be • Not achievable or realistic Developing a Self-Concept and Efficacy • You are more than your accomplishments or your bank account. • What do you want to stand for (values)? • Download a values list and circle the ones that are important to you. • Identify how you CURRENTLY demonstrate those. • Identify other ways you could demonstrate those. • What things do you do that go against your values? (i.e. impatience) • What could you start doing today to address one of those?
Developing a Self-Concept • What things are you good at, and what are your accomplishments? • What traits/values do those accomplishments and strengths represent? Success, courage, determination, creativity, compassion • How would your friends describe you? • Loyal, compassionate, caring, honest… • How do you demonstrate those? • Self Esteem Acronym (THINK)
Breathing and the Body • The constant noise often keeps people from addressing the underlying issues of emotional turmoil • Life becomes focused on treading water • Forward goals are exchanged for just surviving • This reduces self-efficacy • Mindfulness and self-awareness help people quiet their thoughts • By making contact with the present moment people can: • Find their strength • Learn to grow • Choose how people wish to respond Activities • A Deep Full Breath • Abdominal breathing signals the brain to slow down and relax. “Rest and digest” • Simply paying attention to breath often causes it to slow down • Feel the loving touch (their Breath) • Life begins and ends with breath • Breathing helps relax the body and move Qi • Add visual and auditory breathing reminders Activities cont… • In and Out • Do a body scan and yay attention to what their body is trying to tell them • Inhale and take in positive affirmations • Make a list of 1-3 affirmations • Exhale and let go of stress and negative energy • Envision stress leaving like a wave/cloud/balloon • Note: This can also be done with bubbles • Practice noticing points of tension/tightness/heaviness and feel them relax or loosen as they exhale • Develop confidence that they can feel feelings and not have to impulsively act.
Thinking and the Mind • An Impartial Witness (Fly on the wall) • Stop Sorting (into good and bad) • See the Whole Room, Not Just the Elephant • The issue • The strengths • Everything/everyone involved • Check the Hecklers • Identify self talk • Examine its source and reliability. • No Blame Emotions and the Heart • Spaciousness • Recognize all the emotions contained within their heart • Cultivate warm heartedness • Plant your garden (What are you going to use your energy to cultivate?) • Tend and befriend • Count your Blessings • Delight for Others Being in the World • Claim Emotional Baggage • Don’t let it stay on the conveyor • Don’t give it to someone else • Listen—Just Listen • Listen to hear and understand (self and others) • Speak with Compassion (To self and others) • Write a Job Description • Goals • Duties
Mindfulness to Increase Self-Efficacy • Reflect daily on how they embodied the values most important to them • Value progress over perfection • Develop self compassion • Use backward chaining to identify vulnerabilities which may have contributed to mindless behavior Summary • Self esteem begins in childhood • Being aware of self helps people identify their strengths and develop their “me” identity. • Part of self esteem development includes • Values identification • Understanding wants vs. needs • Addressing cognitive distortions • Being aware of sensations, feelings and thoughts • Helps choose behaviors which are in unison with values • Helps support people through the difficult moments • Silences the critics • Clarifies who people are and what people want
465 - Grief
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Grief Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Objectives • Define grief • Conceptualize grief in terms of any loss • Identify how failure to deal with grief can impact a person • Explore the stages of grief
What is Grief • Grief is a label assigned to all of the emotions associated with dealing with any kind of loss • Physical (Things, abilities, freedoms) • Self-concept (Roles, values, labels) • Worldview (Innocence, safety) • Dreams (How things should be) • Social (Loss of relationships…) Stages of Grief • Denial: Numbness, dream, alternate explanations) • Anger: The unknown, loss of control, death, isolation, failure—(shouldas and couldas) • Bargaining: If I … then I will wake up and realize this was only a really bad dream • Depression: Helpless, hopeless • Acceptance: Radical acceptance that the loss occurred and determining how to proceed from there BioPsychoSocial Impact of Grief • Biological • Sleep disturbances • Changes in weight • Increased blood pressure • Increased cortisol and other endocrine changes • Muscle weakness • Social • Withdrawal/Isolation • Enmeshment
• Psychological • Depression • Anxiety • Relief • Changes in worldview • Guilt • Anger • Difficulty concentrating • Difficulty making decisions • Avoidance of triggers
Exacerbating & Mitigating factors • How people react in a crisis depends • How close the situation was to them (physical and emotional proximity) • How many other stressors them experienced in the last year • Mental health issues/Effective coping skills • Social supports • Understanding of the loss • How much control/responsibility they feel like they had in the situation • Type of loss and predictability • Age of the bereaved
Impact of Unresolved Grief • Most people get stuck in either anger (including guilt)or depression • Anger (shoulda, couldas and if onlys) • At self • At others • At higher power • Depression (Hopelessness, Helplessness—I don’t now how to go on) Denial • Denial is the mind’s way of protecting people from what lies ahead. • Denial can start before the actual loss as in the case of terminal illness (anticipatory grief) • Therapist Activities • Assess level of acceptance and denial of each person in the support system • Discuss hope and acceptance • Action strategies • Shore up resources • Gather accurate information • Facing the loss: Narrative therapy
Anger • Anger is the power play • Push people away to avoid getting hurt again • Blame others as an outlet for helplessness---somebody somewhere could have prevented this • Blame self to try to regain some control/prevent it from happening again, make themselves suffer • Question belief system and world schema • Guilt is a form of anger
Anger • Action steps • Identifying primary and secondary losses • Explore what the losses mean to the person (Ex. Job, Parent, Victimization) and how they feel about it • Angry (other losses) • Scared (which fears and why?) • Depressed (I feel helpless to… ; I feel hopeless to…) • Ventilation and Validation
Anger • Action steps • Examine the stated beliefs for • All or nothing thinking • Emotional reasoning • Fallacy of fairness • Emotional Reasoning (I feel angry therefore someone must be to blame) • Begin exploring solutions to fears and issues (What is within their control)
Bargaining • If I do x, y and z, maybe I can wake up and it will have been a nightmare • Contributes to depression because the person wakes up everyday hoping the reality is different • Hope is squelched every morning • Develop hope for the new reality • I can grief and experience this loss AND still have a RML Bargaining • Action Steps • Help clients stay in the present reality • Examine how bargaining just creates more exhaustion and frustration • Validate the wants and educate about the realities including personal responsibility Depression • Hopelessness and helplessness • Reality that the loss occurred AND it cannot be changed • Action Steps • Develop hope and empowerment • Begin exploring all aspects of the person’s life to which they are committed. • Explore how they can use their energy to continue to nurture the important things in their life (loss of a child; victimization; cancer) • Encourage knowledge acquisition • Identify what cannot be changed • Identify what can be changed
Acceptance • Accepting the reality of the loss • Action steps • Explore how life will be different (and the same) since the loss • Make a plan to change the things you can • If that loss can be prevented from recurring, take proactive steps • Advocacy groups • Personal behaviors Not a Linear Process • Most people experience grief surrounding a loss for at least a year (up to 3 years for uncomplicated grief). • Holidays • Anniversaries • Reminders (people, places, things, media, smells) • Many people will vacillate between depression and anger. • Normalize people’s experiences • Encourage them to reach out to supports • Address happiness and survivor guilt
Additional Tips • When someone is grieving they are in a state of crisis • Minimize vulnerabilities • Make lists • Minimize demands (unless staying busy helps) • Keep a normal sleep routine • Set a defined amount of time to revisit the loss each day • Be compassionate to yourself
Summary • Losses encompass more than death or a person or loss of property • Failure to acknowledge losses can cause unhelpful reactions in similar future situations • It is important to explore feelings and reactions in terms of their functionality---how are they benefitting the person • It takes at least a year to deal with significant losses • Many times there are multiple ancillary losses that need to be addressed Summary • How people deal with grief and loss varies widely. • Grieving is a form of crisis • The body is on high alert which likely impacts sleep, eating and energy to work or socialize • Minimizing vulnerabilities is important to reduce unnecessary frustration and avoid confirming helplessness • Ultimately it is hoped that the person can identify how they are stronger or better off from the experience
460 - Complicated Grief and Attachment
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Complicated Grief and Attachment Dr. Dawn-Elise Snipes PhD, LPC-MHSP Podcast Host: Counselor Toolbox and Happiness Isn't Brain Surgery Objectives ~ Define Complicated Grief ~ Identify how loss of or lack of an attachment relationship may represent a loss that needs to be grieved. ~ Explore the overlap between complicated grief and trauma ~ Identify risk factors for CG ~ Explore tasks for successful grief resolution Definitions: ~ Loss: Change that includes being without someone or something in this case the primary attachment relationship ~ Secondary loss: Other losses as a result of a primary loss. Example, loss of security when rejected by primary caregiver ~ Grief: Reaction or response to loss; includes physical, social, emotional, cognitive and spiritual dimensions. ~ Trauma: Any situation that causes the individual to experience extreme distress
Attachment ~ Attachment ~ Attachment is the quality of the relationship with the caregiver characterized by trust, safety and security. ~ The quality of the infant-parent attachment is a powerful predictor of a child's later social and emotional outcome ~ Determined by the caregiver's response to the infant and toddler when the child's attachment system is 'activated' Internal Working Model ~ Children's attachment with their primary caregiver leads to the development of an internal working model which guides future interactions with others. ~ 3 main features of the internal working model ~ a model of others as being trustworthy (what is the loss here?) ~ a model of the self as valuable (what is the loss here?) ~ a model of the self as effective when interacting with others. (what is the loss here?) ~ Secure attachments also help children ~ Feel loved and accepted ~ Learn to manage their emotions ~ Address dichotomous thinking and cognitive distortions
Bowlby on Attachment and Grief ~ Attachment Relationships Help Regulate Psychological And Biological Functions Including: ~ Mastery and performance success ~ Learning and performing ~ Relationships with others (and future attachment) ~ Cognitive functioning ~ Coping and problem solving skills ~ Self-esteem ~ Emotion regulation ~ Sleep quality ~ Pain intensity (physical and emotional)
Bowlby ~ Attachment and safety stimulate a desire to learn, grow and explore ~ Caregivers provide support and reassurance (Safe haven) ~ Encouragement and pleasure (secure base) Feeney J Pers Soc Psych 631 -648 2004
Bowlby ~ Loss of an attachment relationship ~ Disrupts attachment, caregiving and exploratory systems ~ Attachment: Activates separation response and impacts restorative emotional, social and biological processes ~ Exploratory system: Inhibits exploration with a loss of a sense of confidence and agency. ~ Caregiving: Produces a sense of failure and can include self blame and survivor guilt
Trauma ~ Trauma is any event that is distressing or disturbing ~ How do we know what is distressing or disturbing ~ Erodes a sense of safety (Triggers fight or flight) ~ Emotional (including dysregulation) ~ Mental (interpretations and schemas) ~ Physical (object permanence, darkness, pain, prior experiences) ~ Adverse Childhood Experiences that may disrupt primary attachment ~ Immediate family member with a mental health or addiction issue ~ Immediate family member who is incarcerated ~ Divorce ~ Abuse (child or DV) ~ Neglect
How Can Disrupted Attachment Trauma ~ The primary attachment figure remains crucial for approximately the first 5 years of life ~ Trust/mistrust (Ages 0-2) ~ Object Permanence ~ Autonomy/shame (Ages 2-7) ~ Egocentrism: children assume that other people see, hear, and feel exactly the same as they do ~ Children's moral sense in this phase of development is rigid and believe that a punishment is invariable, irrespective of the circumstances. ~ They regard bad things that happen as a consequence for misdeeds and a punishment for misbehavior. http://www.childhealth-explanation.com/cognitive-development.html Attachment and Discussion ~ What is a child supposed to have from a caregiver? ~ Emotionally ~ What happens when this doesn't occur? ~ How is that traumatic? ~ Cognitively ~ What happens when this doesn't occur? ~ How is that traumatic? ~ Physically ~ What happens when this doesn't occur? ~ How is that traumatic? ~ What is a caregiver supposed to be like? ~ What happens when this doesn't occur? ~ How is that traumatic? ~ How might these traumas also represent a loss?---Let's look
Complicated Grief ~ Symptoms ~ Separation distress involving intrusive, distressing preoccupation with the loss ~ Traumatic stress reflecting specific ways the person was traumatized by the loss ~ Avoidance of reminders ~ Intrusive painful thoughts ~ Emotional numbing ~ Irritability ~ Feelings of hopelessness and purposelessness ~ Shattered self identity Risk Factors for Complicated Grief Related to Attachment ~ Child ~ Age ~ Physical issues ~ Emotional issues (pre-existing) ~ Cognitive understanding ~ Personality and character traits ~ Nature of the loss ~ Number of losses ~ Circumstances of the loss ~ Resources available ~ Nature of the relationship ~ Length/duration ~ Importance ~ Culture/Roles ~ Quality ~ Dependence ~ Hopes and Dreams (retrospectively) ~ Amount of Daily Change (foster care, relative placement)
Emotional Effects of Trauma and Complicated Grief ~ Dysregulation ~ Anxiety ~ Separation anxiety ~ Reactive Attachment ~ Angry/Irritable/Oppositional ~ Depressed ~ Lonely/Isolated ~ Guilty/Regretful Physical Effects of Trauma and Complicated Grief ~ Appetite (eating) disturbances ~ Energy, fatigue, lethargy ~ Sleep disturbance ~ Anxiety ~ Gastrointestinal disturbance ~ Compromised immune response; increased illness
Intellectual Effects of Trauma and Complicated Grief ~ Confusion; “What is real? ~ Difficulty concentrating; ex. Read the same page several times ~ Short attention span; ex. Can't finish a 30 minute TV program ~ Difficulty learning new material; short term memory loss; ex. Income taxes ~ Difficulty making decisions ~ Lack of a sense of purpose ~ Inability to find meaning in the events and life itself
Social Effects of Trauma and Complicated Grief ~ Withdrawal ~ Isolation ~ Searching ~ Avoidance ~ Self absorption ~ Clinging/dependence Reconciliation Tasks ~ To help adults or adolescents who never formed that attachment ~ Acknowledge the reality of the loss. ~ Move toward the pain of the loss while being nurtured physically, emotionally, and spiritually. ~ Develop a new self identity based on a life without that relationship. ~ Experience a continued supportive presence in future years Reconciliation ~ Learn basic trust, which serves as a basis for all future emotional relationships ~ Learn how to develop fulfilling intimate relationships ~ Develop strategies to maintain emotional balance and resiliency ~ Develop the ability to control behavior, which results in effective management of impulses and emotions ~ Enhance confidence and self-esteem ~ Learn how to share feelings and seek support
Reconciliation ~ Create a foundation for the development of identity, which includes a sense of capability, self-worth, and a balance between dependence and independence ~ Establish a core set of beliefs that leads to empathy, compassion, and conscience ~ Begin exploring the environment with feelings of safety and security, which leads to healthy intellectual and social development
AVOIDANCE ~ Recognize the loss ~ Acknowledge the loss of or lack of establishment of the attachment relationship ~ Understand the losses as a result of the lack of attachment
CONFRONTATION ~ React to the realization of the loss ~ Experience the pain ~ Feel, identify, accept, and give some form of expression to all the emotional, cognitive and physical reactions to the lack of or loss of the attachment figure ~ Identify and mourn secondary losses ~ Loss of safety ~ Loss of happiness (distress) ~ Loss of the childhood I should have had ~ Loss of self esteem ~ Loss of success
CONFRONTATION ~ Recollect and re-experience the relationship ~ Review and remember realistically ~ Revive and re-experience the feelings ~ Relinquish the old attachments to the old assumptive world
ACCOMMODATION ~ Readjust to move adaptively into the new world without forgetting the old ~ Revise the assumptive world ~ Develop a new relationship with the self ~ Adopt new ways of being in the world ~ Form a new identity ~ Reinvest
Summary ~ Failure to develop a primary attachment relationship can be viewed as a loss (or something that was needed that was never achieved) ~ When examining the behaviors of adult or adolescent clients whose primary attachment was disrupted, the traumatic impact can be seen. ~ In order to help people reconcile the trauma it is essential to help them ~ Identify and grieve the losses ~ Review and remember realistically what happened (to combat inaccurate schema) ~ Review the assumptive world (if I just…then she will be love me) ~ Develop a new loving relationship with the self ~ Learn how to trust the self and others to form meaningful and supportive relationships
464 - Contextual Cognitive Behavioral Therapy
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Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast Objectives • Define and review the concepts of contextual cognitive behavioral therapy • Explore the impact of context on people’s phenomenological reality • Explore how addiction and mental health issues can be influenced by context • Explore how acceptance, awareness, mindfulness and psychological flexibility can be used transdiagnostically.
Why Contextual • Addiction and mental health issues are often intergenerational • Addiction and Mental Health issues are strongly correlated with: • Each other • Adverse childhood experiences (history of and children with) • Impaired occupational and social functioning • Health problems Contextual Approaches • Encourage mindfulness in the present moment • Accept each person’s “truth” is constructed from their schema and the resulting interpretation of the current moment • The goal is to consider the context and function of the past and present issue and empower the person to make a conscious choice toward their valued goals • Remember that the prefix RE means to do again • REpeat • REdo • REgress • RElapse • REaction
Childhood Context and Development • The family context can be a preventative or risk factor for the development of issues • Children develop schema about themselves, others and the world through these early interactions • In later life people continue to develop schema influenced by their past learning.
Caregiver Requirements for Secure Attachment and Healthy Development • Consistent Age-Appropriate Responsiveness • Trust • Autonomy • Industry • Identity • Empathy • Compassion • Effective Communication Skills • Unconditional Love
Think About It • What is it like for a child growing up in a house in which one or both parents has: • An addiction • A mental health issue Common Addicted Characteristics • Difficulty dealing with life on life’s terms • Difficulty dealing with distress (poor coping) • Impulsivity / lack of patience and distress tolerance • Neglectfulness • Hostility • Defensiveness • Blaming • Manipulation • Withdrawal • From others/disconnected • No pleasure in other activities • Justification/minimization/denial • Low self-esteem • Guilt and shame
Common Characteristics in People with Mental Health Issues • Difficulty dealing with life on life’s terms • Difficulty dealing with distress (poor coping) • Impulsivity / lack of patience and distress tolerance • Neglectfulness • Hostility • Irritability
• Withdrawal • From others/disconnected • Apathy • Low self-esteem • Guilt and shame • Fatigue • Sense of hopelessness or helplessness
The End Product • People’s REactions to things are based on prior learning + present moment. • Bridges • Stress • Depression • Self-esteem
Core Concepts in Contextual CBT Mindfulness • Improves people’s ability to be present in the present • Shift from automatically reacting to thoughts and feelings based on schema to being aware of ALL experiences in the present to provide more flexibility
Encouraging Acceptance of Internal Experiences • Accepting thoughts, feelings, sensations without having to act on them • Radical Acceptance • Unhooking • Dialectics • I can be a good person AND be divorced • I can be happy AND grieving • I can stay sober AND be stressed Acceptance of Internal Experiences • Accepting thoughts, feelings, sensations without having to act on them • Distress Tolerance • ACCEPTS • Activities • Contributing • Comparisons • Emotions (opposite) • Push Away • Thoughts • Sensations Focus on Adding vs. Eliminating • Help the person define a rich and meaningful life and make choices based on that vs. eliminating a problem • Depression • What do we do to eliminate depression? • What are we left with when we eliminate depression? • How do you prove the absence of depression? • Addiction • What do we do to eliminate addiction? • What are we left with when we eliminate addiction? • How do you prove the absence of addiction? • Accepting feelings thoughts and reactions and changing your relationship with them
Creating a Rich and Meaningful Life • Increasing Awareness • For each of the following areas identify which are important in your RML and what that looks like now and what you want it to look like
Changing Your Relationship • Radically accept feelings, thoughts and urges • Think of them like road signs • You can take them under advisement and decide what to do. • Speed limit/Anger • Construction/Giving up • No passing/Addiction • Rest stop/Depression Motivational Enhancement (Functional) • Understanding motivation for change as well as no change in the context of the person’s RML in order to motivate purposeful action
Use a Broad Functional Approach • Transdiagnostic • Common mechanisms underlying an array of difficulties: Depression, Low Self-Esteem, Addiction • Shoulds and Shouldn’ts (Acceptance) • I should feel • I shouldn’t think • I should be • Lack of Awareness of Needs/Wants (Mindfulness) • Vulnerabilities • Autopilot or Rigid Thinking (Psychological Flexibility) • A willingness to accept all aspects of ones experience without unnecessary avoidance—Emotional, Cognitive, Behavioral, Physical • The ability to ponder multiple possible actions and thoughts and consciously choose Difficulties with Self-Processes • Difficulty with self esteem or self efficacy may cause or maintain problems • Self-as-content – Narrative about one’s self and attributes • Being overly attached to the conceptualized self can prohibit flexibility • Ex. Being a good worker in a bad job • Ex. Being a good daughter but getting a divorce
Addressing Self as Content • Who do you want to be? • Explain why each of those is important? • In what ways does the current situation prevent you from being who you want to be? • What areas in your life are going as you want them to? (addressing global attributions) • Are there other ways to achieve or conceptualize the same end? • Examples • A size 3 (attractive/lovable) • A doctor (successful) • Not divorced (not a failure) • Loyal/dependable (not a quitter)
Difficulties with Self-Processes cont… • Difficulty with self esteem or self efficacy may cause or maintain problems • Self-as-process • Awareness of internal experience • Many people have difficulty attending to their internal experience in a flexible way • Handling urges, feelings • Identifying thoughts, feelings, urges, sensations etc. Addressing Self-As-Process • Mindfulness journals/logs • Meditation to increase awareness • CBT Exposure-Noticing / In-Vivo Logs • Anger • Fear • Craving • Relapse prevention plans to handle internal processes • Make a committed action worksheet for each thing that is important to you.
Difficulties with Self-Processes • Difficulty with self esteem or self efficacy may cause or maintain problems • Self-as-context • Adopting the perspective of the self in the past, present and future—Who you were-are-want to be • Ability to take the perspective of others • Rigid self as context—or inability to take perspective may inhibit effective problem solving. • I am and always will be a failure/an addict/depressed Addressing Self-As-Context • Increasing Perspective • Looking at your definition of a RML, what does your… • Past self tell you about your current situation? (schema) • What might your future self tell you about your current situation? (Flexibility) • What might you tell someone else in a similar situation? • How do your current thoughts, feelings, behaviors help you move toward what is important to you?
Summary • Contextual CBT involves understanding people’s phenomenological truth • Problems can arise when people • Thinks/feels that they are not who they should be or things are not as they should be • Are unaware of their internal feelings, thoughts, urges • Are unaware of the motivation (in context) of their feelings, thoughts, urges • Use rigid problem solving and conceptualization without considering context or perspective • Contextual CBT uses awareness, mindfulness, radical acceptance and psychological flexibility activities to help people move toward a rich and meaningful life instead of trying to escape or avoid discomfort.
462 - Understanding Anxiety Through a Child’s Eyes
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Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Counselor Education Host: Counselor Toolbox Podcast Objectives - Identify symptoms of anxiety in children - Review common misdiagnoses - Explain how children’s developmental stage impacts their fears - Propose interventions to help children deal with anxiety Symptoms of Anxiety in Children - Emotional Signs of Anxiety - Is extremely sensitive - Irritable - Is afraid of making even minor mistakes including test anxiety - Panic attacks - Has phobias (about bees, dogs, etc.) and exaggerated fears (about things like natural disasters, etc.) - Worries about things that are far in the future - Has frequent nightmares - Gets distracted from playing by his worries - Has compulsive, repetitive behaviors Symptoms of Anxiety in Children - Behavioral Signs of Anxiety - Starts having meltdowns or tantrums. - Asks “what if-” constantly. - Avoids participating in group activities. - Remains silent or preoccupied during group work - Refuses to go to school. - Avoids social situations with peers after school or on weekends - Becomes emotional or angry when separated from parents - Constantly seeks approval - Low self-esteem and efficacy - Overly concerned about negative evaluations Symptoms of Anxiety in Children - Physical Signs of Anxiety - Frequently complains of head or stomachaches - Refuses to eat snacks or lunch at school - Can become restless, fidgety, hyperactive - Difficulty concentrating - Starts to shake or sweat in intimidating situations. - Dizziness
- Frequent urge to urinate
- Constantly tenses muscles
- Exaggerated startle response
- Has trouble falling or staying asleep
- Falls asleep in school
- Repetitive activities (tapping, leg shaking…)
- Nail biting / skin picking
- Rigid routines Not Little Adults
- How do children think differently
- 0-2: Object permanence; personal agency (crying, “Uh Oh,” Ask for drinks)
- When you are overtired, startled, too hot/cold, or have low blood sugar, the HPA-Axis is activated --> Threat Response (Anxiety)
- 2-7: Egocentric, personalized, concrete/dichotomous, mystical
- Daddy yelled at me. Daddy left. Daddy hates me. It is my fault.
- I told Mommy I hated her. She got sick. It is my fault.
- I didn’t say my prayers last night. We got into a car accident because God is mad at me.
- The neighbor’s dog always charges the fence and wants to bite me. This makes me scared. Dogs are dangerous. Not Little Adults
- How do children think differently
- 7-11: Inductive (Start making global attributions from specifics)
- I didn’t make the team. I got a C on my spelling test. I must be a failure
- 11+: More advanced reasoning but little life experience and often have not questioned prior faulty schema What is Anxiety
- Anxiety is fear which is the flee part of the fight or flight (stress) response
- What do we/children fear
- Death (Biological Needs/Safety(self & others))
- Rejection/Isolation/Abandonment (Biological Needs, Safety, Love and Belonging)
- The Unknown (Biological Needs, Safety, Love)
- Loss of Control (Parental, older children)
What is Causing the Anxiety - Cognitive - Unhelpful thoughts - Lack of knowledge - Physical - Lack of sleep - Poor nutrition or hunger - Hormones (sex, thyroid) - Emotional - Highly sensitive child
- Environmental/social
- Bullies
- Teacher pressure
- Parental enmeshment or disengagement
- Chaotic home environment (mental health, addiction and/or abuse or neglect)
- Social learning
Differential Diagnosis - Anxiety Disorders (multiple) - Depression - ADD - Autism - PTSD / ASD - Oppositional Defiant Disorder
Interventions - Infants-2years old - Be responsive - "Before six months, you're just extinguishing," explains Chilton matter-of-factly. "Eventually, the baby just gives up." Loss of parental contact is a serious danger signal for young babies, and they're designed to cry until it's restored. But beyond a certain point, even a hysterical baby will stop crying. This is because, in an evolutionary sense, an unprotected crying baby is broadcasting its whereabouts to predators. Instinct tells it that its parents have vanished, and that the tiger that killed them is close. It falls silent in order to survive. Dr. Howard Chilton Interventions - Infants-2years old - Talk it out - Start teaching emotional vocabulary and needs identification (hungry, scared, sleepy, overstimulated) - “The dog scares you. The is loud is loud. Loud sounds can be scary for you.” - Toddlers struggle with being able to correctly identify their emotions and find the right word to describe that emotion. - Use feeling faces - Identify feelings in videos. Ask questions about how characters feel. - Play games to help with fears - Hide and seek (start small) - Mommy and Me classes or play dates
Interventions - 2-7 year olds - Provide structure and consistency - Let children know the plans for the day and what is happening next—Daily schedule chart - Give plenty of warning before transitioning– verbal, bell, chant - The clock on the wall says it’s time to stop, time to stop, time to stop! The clock on the wall says it’s time to stop. It’s time to go to lunch/bed/outside - (Twinkle, Twinkle) Stop, look and listen. Hands by your side. Listen close and I’ll tell you why. - Everybody buckle up to ride in the car. Were going to the [park/school] /Billy’s house it’s not very far.
Interventions - 2-7 year olds - Provide structure and consistency - Ensure children know what is expected - Rules chart and/or coloring pages. Review ahead of time - Be patient when children test rules - Teach mindful awareness - Physical sensations, urges, thoughts associated with emotions - Teach distress tolerance - Deep breathing - Positive self talk - Getting support
Interventions - 2-7 year olds - Join them in their reality - Reassure them that there is no danger. - Talk about anxiety monkey that likes to play tricks on them. Then deal with the monkey mind. (Monkey stuffed animal) Sometimes Reginald isn’t ready to sleep… Use guided imagery with the monkey. - Sometimes Reginald doesn’t know what is going to happen so he makes you think about the worst possible thing that could happen. What can you tell Reginald-
Interventions - 2-7 year olds - Address distortions to reassure kids they are safe and loved - All or none - I can be mad at your behavior and still love you - Address global attributions by looking at the facts, provide info - Discourage the use of extreme words like everyone, always - Magnification - Keep a frequency chart (leaving, trying, going to school) to see the likelihood - Minimize exposure to the news (or discussions about the news)
Interventions - 2-7 year olds - Address distortions to reassure kids they are safe and loved - Personalization - Identify your emotions (generally) why you feel that way - Have you ever [felt] but it wasn’t Sally’s fault- - Sometimes bad things happen and it is nobody’s fault. [Give an example]
Interventions - 7+ Year Olds - Remember the small size of their world and relative lack of experience makes everything seem much bigger - They are constantly growing and changing so some days they may feel more tired, may have difficulty feeling like they fit in may feel more awkward and less capable General Anxiety Management Skills - Keep blood sugar stable - Get enough sleep - Practice positive self-talk - Check the facts - Use visualizations - Deep breathing - Mindfulness to nip anxiety in the bud - Get support from people who care about you unconditionally - Find mentors who have gone through the same thing - Spend 5 minutes focusing on the positives each day - Remember that just because you have a thought that something is scary or feel anxious doesn’t mean it is fearsome (rollercoasters, wasps) Summary - Children’s cognitive, physical and experiential differences make their anxiety different than that of adults - Children’s symptoms of anxiety also often manifest differently with more irritability, defiance and somatic complaints. - Anxiety disorders are frequently misdiagnosed as ADD, autism, ODD and PTSD - Children’s fears often focus around Maslow’s lower three needs: Biological, Safety, Love and Belonging - Addressing anxiety means helping the child understand, in a developmentally appropriate way, that they will have what they need, they are safe and they will always belong and be loved.
461 - Internal Family Systems Theory
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Dr. Dawn-Elise Snipes Objectives ~ Define Internal Family Systems Theory ~ Identify when it is used ~ Explore guiding principles
~ For more information and training programs in IFS, go to https://www.selfleadership.org/ Overview ~ IFS was developed in the 1990s by family therapist Richard Schwartz, Ph.D., ~ It is based on the concept that an undamaged core Self is the essence of who you are, and identifies three different types of sub-personalities or “families” that reside within each person, in addition to the Self. ~ Wounded and suppressed parts called exiles (lost child) ~ Managers, that keep the exiled parts suppressed (enabler) ~ Firefighters, that distract the Self from the pain of exiled parts. (hero/mascot/scapegoat) ~ The Internal Family Systems Center for Self-Leadership conducts training programs Basic Assumptions ~ The mind is subdivided into an indeterminate number of subpersonalities or parts. ~ Everyone has a Self which can lead the individual's internal system. ~ The non-extreme intention of each part (exile, manager and firefighter) is something positive for the individual. ~ There are no "bad" parts ~ The goal of therapy is not to eliminate parts but instead to help them find their non-extreme roles. ~ As we develop, our parts develop and form a complex system of interactions among themselves ~ When the system is reorganized, parts can change rapidly. ~ Changes in the internal system will affect changes in the external system and vice versa. Parts ~ Subpersonalities are aspects of our personality that interact internally in sequences and styles that are similar to the ways in which people interact. (exile and the manager or the firefighter and the Self) ~ Parts may be experienced in any number of ways -- thoughts, feelings, sensations, images, and more. ~ All parts want something positive for the individual and will use a variety of strategies to gain influence within the internal system. ~ Parts that become extreme are carrying "burdens" -- energies that are not helpful, such as extreme beliefs, emotions, or fantasies. ~ Parts can be helped to "unburden" or recognize their role and return to their natural balance. ~ Parts that have lost trust in the leadership of the Self will "blend" with or take over the Self. Exiles ~ Young parts that have experienced trauma and become isolated or suppressed in an effort to protect the individual from feeling the pain, terror, fear, and so on, of these parts ~ Exiles are often young parts holding extreme feelings and/or beliefs that become isolated from the rest of the system (such as “I’m worthless,” “I must be successful to be lovable,” “I am a failure”) ~ Exiles become increasingly extreme and desperate as they look for opportunities to emerge and tell their stories ~ Want to be cared for and loved and constantly seek someone to rescue and redeem them ~ Can leave the individual feeling fragile and vulnerable
Managers ~ Managers are proactive and try to avoid interactions or situations that might activate an exile’s attempts to break out or leak feelings, sensations, or memories into consciousness. ~ Different managers adopt different strategies controlling, perfectionism, co-dependency ~ The primary function of all mangers is to keep the exiles exiled…. ~ Common managerial behaviors: controlling, perfectionism, high criticism, narcissism, people pleasing, avoiding risks, being pessimistic, constantly striving to achieve ~ Ask…What would trigger the exiles and how can that be prevented? ~ Common managerial symptoms: Emotional detachment, panic attacks, somatic complaints, depressive episodes, hypervigilance Firefighters ~ Have the same goals as managers (to keep exiles away) but different strategies ~ Managers want you to look good and be approved of, FFs only care about distracting from the pain so they are often in conflict. (Shoulds) ~ Are reactive and automatically activated when an exiled part is activated (rejection, isolation, failure, traumatic memories…) ~ Their function is to eliminate the dysphoric feelings, thoughts, sensations and memories without regard for the consequences. (Autopilot/reactive/emotional mind) ~ Can do this in any number of ways, including drug or alcohol use, self-mutilation (cutting), binge-eating, compulsive sexuality
Self ~ The self is the “moderator” that the parts are talking to, that likes or dislikes, listens to, or shuts out various parts ~ When differentiated, the Self is competent, secure, self-assured, relaxed, and able to listen and respond to feedback. (afraid/wounded; should and avoidant) ~ The Self can and should lead the internal system. ~ Various levels of experience of the Self: ~ When completely differentiated from all parts (Self alone), people describe a feeling of being "centered." ~ When the individual is "in Self" or when the Self is in the lead while interacting with others (day-to-day experience), the Self is experienced along with the non-extreme aspects of the parts. ~ An empowering aspect of the model is that everyone has a Self.
3 Goals of IFS ~ Free the parts from their extreme roles ~ Restore trust in the Self ~ Coordinate and harmonize the Self and the parts, so they can work together as a team with the Self in charge.
Beginning to Use the Model ~ Assess client's parts and sequences around the problem. ~ Check for individual's awareness of parts -- ask how he or she experiences the part: thoughts, feelings, sensations, images, and so on. ~ When the manager is in control ~ When the firefighter is desperately trying to suppress the pain ~ When the exile is hurting and starting to emerge ~ Look for polarizations ~ Anorexia: Extreme Manager ~ Substance Abuse: Extreme Firefighter ~ Clinical Depression or Anxiety or PTSD: Extreme Exile Relationship Between Internal & External Systems ~ The way you relate to your own parts parallels the way you relate to parts of others. ~ How does your exile interact with the exile of others ~ How does your manager interact with the exile of others ~ How does your firefighter interact with the exile of others ~ Individual's internal system affects and is affected by the external system of which he or she is a part. ~ Internal and external systems often parallel each other.
Beginning to Use the Model ~ When working with families, check for the family's awareness of parts in self and others. ~ Make a decision about how to begin using the model: language, direct access, imagery, and so on. ~ Assess the fears of manager parts and value the roles of the Managers; explain how the therapy can work without the manager’s feared outcomes happening. ~ Inventory dangerous Firefighter behaviors; work with managers' fears about triggering firefighters. ~ Assess client's external context and constraints to doing this work.
Working with Individuals ~ Important to assess protective parts (managers and firefighters) and work with them first. (Create safety) ~ Develop a direct relationship with the part. ~ May need to negotiate pace of work -- give the part an opportunity to talk about concerns. ~ Work out a system for the part to let you know when things are moving too fast. ~ Respect the concerns of the part. ~ Eventually, identify the Exiles and start helping them tell their story and become empowered and integrated
Working with Individuals ~ Non-imaging techniques ~ Assessing internal dialogue ~ Location/sense of a part in the body ~ Diagrams -- relationships among parts
Working with Individuals ~ Non-imaging techniques ~ Assessing internal dialogue ~ Journaling: What is the exile/manager/firefighter/self saying or wanting to do about this situation? ~ Direct access: ~ Therapist to parts: Let me talk to the manager for a moment. ~ Self to parts: What are the parts saying and what is the Self’s reaction ~ Part to part: What is the manager saying to the exile?
Conversation ~ Manager: “You better not do that because you know there is no way you can succeed.” ~ Exile: “I will never get Dad’s approval because I always fail at everything I do.” ~ Firefighter: “I need a drink” ~ Self: “Manager, thank you for the warning. I know it is a risk. Can you help Exile think of times she has succeeded, because it is important to me to try this? Firefighter, you don’t know that bad things are going to happen. Thank you for being at the ready. What else can I do if this doesn’t go how I want?”
Conversation ~ Manager: “I’m in control. Everything has to go as planned.” ~ Exile: “I remember when I was little and couldn’t fix [it] Mom would get really depressed. It is my fault she was so sad.” ~ Firefighter: “They aren’t listening. You better start yelling and showing them who is boss or you will feel even more out of control” ~ Self: “Manager, thank you for trying to take such good care and help me feel empowered. Exile, it did hurt to see Mom struggle so much, but it wasn’t your fault she was so sad. You were too little to do anything. What is the worst that will likely happen in this situation if I am not in control? Firefighter, yelling is one way to get my point across, but that is not how I want to interact with others. How else could I approach this situation? Working with Individuals ~ Going back in time with a part, then “unburdening” ~ Exile: What do you wish would have happened? ~ Manager: What do you think you “should” have done to protect the Self? ~ Bringing parts into the present – “retrieval” ~ What is different about you now? ~ Future imaging ~ Exile: What do you want to happen ~ Manager: How can you deal more effectively with situations like that in the future Working with Individuals ~ Concept of Blending: Keeping the feelings of the part from overwhelming the Self ~ Working with the Self to understand why/how not to blend ~ Working with the part to understand why/how not to blend
Strengths of the Model ~ Focuses on strengths: The undamaged core of the Self, the ability of parts to shift into positive roles ~ IFS language provides a way to look at oneself and others differently. ~ Instead of seeing someone as being self-destructive, we may see their Firefighter being triggered and trying to protect the Exile ~ There is no such thing as a bad part, just a part that has become extreme ~ Language encourages self-disclosure and taking responsibility for behavior. ~ Ecological understanding of entire therapy system, including therapist ~ Respect for individual's experience of the problem ~ Clients provide the material -- the therapist doesn't have to have all the ideas. ~ Therapist looks at client's Self as "co-therapist" and trusts the wisdom of the internal system.
Summary ~ Every person has within them a Self, exile, firefighter and manager ~ Each of these parts has a survival function ~ One goal is helping parts communicate and not overwhelm each other is essential ~ Another goal is helping the Self get back into a position in which it can listen and discern feedback from the parts to determine the best course of action
30 Art Therapy Activities for Individual or Group
CEUs are available for this presentation at AllCEUs https://www.allceus.com/member/cart/index/product/id/1229/c//
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast Objectives • Identify 30 art therapy activities and the goals and benefits for each 1. Collage • Medium (2 or 3-D) • Picture • Bulletin Board • Book or Notebook Cover • Scrapbook • Photo Blanket • Quilt • Website (Canva, MineCraft) • Materials • Odds and ends (buttons, keys, material, yarn) • Nature • Pictures from magazines, online, wrapping paper, greeting cards, food bags/boxes • Paint • Stamps • Macaroni/Beans • Benefits • Fine motor coordination • IRL: Scissor use, turning pages, gluing • Virtual: Typing, mousing, photoediting • Visual expression • Problem solving/creativity “How can I depict…” 1. Collage • Uses • Before and After • Layered with Goals • Most Important • Happiness (or other emotions) • My Accomplishments • Tribute/Memory • Nature (with leaves, feathers, sticks…)
• Positive Affirmations • Superhero (anxiety) • Friendship • My Happy Place
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Sculpture • Medium • Clay • Playdough or salt dough • Paper Mache • Pinata / Piggy Bank • Wadded Newspaper • Scarecrow • Multimedia (jars, foam balls, felt, popsicle sticks, pipecleaners, paper towel tubes, plastic shopping bags, cardboard from boxes)
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Sculpture • Benefits • Fine motor skills • Creativity and problem solving • Visual self expression • Uses • Superhero • Family • Memory • Self-Portrait • Emotion
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Puppets • Material • Socks • Felt finger puppets • Pipe cleaner finger puppets • Popsicle stick puppets • Brown paper bag • Toilet paper roll • Benefits • Fine motor skills • Verbal communication • Creativity • Uses • Giving a voice (What I wish I could say) • Addressing the anger/monster • Observation (What does the alien see) • Angel vs. Devil • Teach interpersonal skills (Sally is sad, what should Sammy do???) • Team work
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Gratitude Tree • Medium • On the wall • On paper • With sticks and tags • Materials • Paper cutouts • Paint (finger, brush, pens) • Sticks and gift tags or cardboard “leaves” • Uses • Remember things that are going right (depression, frustration) • Help remembering to focus on the good (negativity) • Gratitude in grief
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Wind chime • Materials • Keys • Buttons • Beads • Silverware • Bamboo pipes • Shells • Chandelier crystals • Bells • Terracotta pots • Feathers (and bells) • Cookie cutters • Decorated soda or tin cans • Soda bottle tops (metal) • Benefits • Fine motor skills • Creative expression • Uses • Grief • Favorite things • Happy memories • Mindfulness
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“Stained Glass” • Materials • Shrinkable plastic sheets or ornaments (Shrinky Dinks) • Benefits • Find motor skills • Creative expression • Uses • Mindfulness • Memory window or attach to LED Christmas light strand to make a garland • Things that make me feel… • Things that remind me of (grief) • Things that inspire me (goals)
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Flag • Medium • Solid color nylon flag (~$8) • Cut a king sheet and sew or glue edges • Large piece of cardboard (large shipping box or appliance box). Fortify edges with colored duct tape • Hint: Take a picture of the flag and print it out or have it added to water bottles for each person to have a miniature version • Benefits • Fine motor skills • Encourage communication and discussion • Visual expression
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Flag • Uses • Identify common and complimentary attributes • Enhance unity/group cohesion • Self-Awareness: What do I/we stand for • Communication about similarities and differences between groups (flags)
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Family or Personal Crest/Logo • Medium • Digital • Hand-Drawn • Can be added to cups, bottles, blankets… • Benefits • Self-reflection • Visual expression through colors and symbols • Fine motor • Uses • Enhance family communication • Encourage reflection on personal values and history • Enhance verbal expression by explaining what the symbols mean • Create a symbol of resilience and strength
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Promotional Flyer or Ad • Medium • Online • Paper/Posterboard • Video (watch Anthony Sullivan or 10 best infomercials) • Benefits • Verbal communication • Fine motor skills • Uses • Self-esteem building • Empowerment (How can this product address a problem?) • Exploration of impact on others (What can this product do for you)
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Photography • Medium • Digital photos • Benefits • Similar to collages it encourages critical/creative thinking skills • Fine and gross motor skill development • Communication skills • Social Justice
- Photography • Uses • Mindful Awareness: 10 pictures of something green • Emotions: 10 pictures of things that make you happy • Problem solving: 10 pictures of things that make you unhappy (and what to do about it) • Nonverbal communication • Scavenger hunt: 1 thing that is green, 1 thing that is plastic… • Creative expression with blur and focus • Find the shapes in a picture and discuss how different shapes, like different people give life depth and pizazz • Take a picture of something and ask people to write down 5 thoughts or assumptions they have
- Stepping Stone • Medium • Stones and paint • Concrete/plaster and forms • Benefits • Fine motor skills • Creative expression
• Uses • Achievements/Goals • Hardiness: Important things in my life (can be turned over when not going well) • Each member of the family and discuss attributes and how each contributes to your path • Memorial • Resilience/Dialectics (2 sided stones with the crisis on one side and resolution on the other) • Conceptual: Hope, Faith, Courage 12. Build a Home • Medium: • Legos and markers • Each block represents something you need for your house to feel like a • Cardboard Box / pictures, construction paper • Outside and Inside • Benefits • Creative expression • Fine motor skills • Uses • Explore what and who is important in someone’s life • Have people discuss the differences between what they need to make a house a home
- Jewelry / Meditation Beads/Key Chain • Materials • Floss or yarn • Beads, twine and closures • Finished strips of material or 1” wide ribbon with a button closure • Uses • Meditation/Anxiety • Use beads to prompt meditative thought (like rosary beads) • Mindfulness/Distress Tolerance • Use beads of different shapes, materials, colors etc. • Inspiration (STACK: Smart, Trustworthy, Agreeable, Caring, Kind)/Anxiety/Depression/Self-Esteem
- Masks • Medium • Store bought • Paper/plastic plates and string • Paper bag • Ski mask • Benefits • Fine motor skills • Visual communication
• Uses • Split mask (side to side or front and back) “My inside and my outside” “Happy and Sad” “Child and Adult” • Superhero inside • Emoti-Masks • My many hats • The chameleon inside • The person I most admire
- Graphic Novels/Cartoon Strip Bookmarks • Materials • Digital storyboard • Notebook • Cardstock bookmarks • Felt bookmarks • Large popsicle sticks • Old wide belt • Benefits • Fine motor skills • Visual expression • Written communication • Uses • Anxiety: Write out a success • Anger: Tell the story and explore assumptions and omissions • Grief: Close one chapter and open a new one • Mindfulness/Affirmations/Encouragement • Interpersonal skills: Improve emotional intelligence
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Worry Jar or Box • Materials • Old jelly or pickle jar • Pencil box • Benefits • Fine motor skills • Improves self awareness • Uses • Anxiety/Distress Tolerance 16B. Happiness Box • Materials • Old jelly or pickle jar • Pencil box • Benefits • Fine motor skills • Improves self awareness • Uses • Depression management • Opposite emotions
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Grief Pot • Materials • Large terra cotta pot (gently broken) or clay heart • Benefits • Fine motor skills • Verbal/written expression • Uses • Grief: Write on the inside the things you lost, write on the outside the things you still have and your resources
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Terrarium/Image in a Bottle/Diorama • Materials • Fish bowl, aquarium or gallon pickle jar. • Four of my favorite themes are: • My safe place • My favorite place • Heaven • My life in 2 years • Best things in my life • Benefits • Fine motor skills • Uses • Anxiety • Depression • Grief • Goal Setting/Motivation
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Motivation Buttons • Medium– Blank Buttons • Benefits • Creativity • Fine motor • Uses (create one each day) • Awards/rewards/Accomplishments • Inspirational sayings • Distress skills • Favorite activities • Things that make me happy • My strengths • Gratitude • Things I like about you… (group or family therapy) • Hint: Get a set of 30 and swap out images each month. Store images in a happiness box
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Crochet or Finger Crochet • Medium • Yarn—extra soft • Benefits • Fine motor coordination • Sensory integration • Uses • Create a soft scarf, mini blanket or small pouch/purse that can be held or worn when anxious. • Provides a manual activity to do when anxious
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Lighthouse • Medium • Draw or print a picture of a lighthouse. • Discuss the purpose of the lighthouse and what in their life is a consistent source of guidance • Have the person draw themselves in relation to the lighthouse and color the scene to represent how they feel (stormy, calm, isolated etc.) Then explain how they feel • Unhappy • Discuss who is in the lighthouse guiding them to safety (can be people or HP) • How are those people creating light in the darkness • Happy • How does knowing the lighthouse is always there make them feel safer?
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Lighthouse • Benefits • Fine motor • Verbal communication • Visual expression • Uses • Mindful awareness • Creative visualization for anxiety, anger or depression
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Self-Care Box • Medium • Medium sized box • Tackle box • Diaper bag or backpack • Benefits • Fine motor skills • Gross motor skills • Planning
• Uses • Vulnerability prevention • Anxiety—General/situational • Depression • Sickness • Communicate to others what you need/want
- Coasters • Medium • Cork tiles • Ceramic tiles • Benefits • Fine motor • Visual expression
• Uses • Happiness reminders (photos, leaves, drawings, wrapping paper, greeting card images…) • Notable quotes • Concepts: Hope, Faith, Love, Courage, Humility, Honesty, Loyalty…
- Daisy Chain or “Brick” Path • Medium • Construction paper • Shower curtain hooks with gift tags • Benefits • Fine motor skills • Visual expression • Uses • Steps to achieve a goal • Necessary activities to prevent relapse • Accomplishments (self-esteem) • Behavioral chaining (Where could you have broken the chain of negative events)
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“Recipe” Box • Medium • Recipe box and index cards • Benefits • Fine motor skills • Goal setting • Written communication • Uses.. Create a recipe for positive feelings—What ingredients do you need? How do you put them together? • My recipe for happiness • My recipe for courage when I am anxious • My recipe for comfort when I am sad
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Paper Fortune Teller • Medium: Paper • Benefits • Fine motor skills • Uses • Affirmations • Self-Esteem • Random Acts of Kindness • Distress Tolerance Activities (8 tolerance or coping skills) • Mindful Awareness (mood, attitude, focus/concentration, health, energy, friends, family, work/school)
- Balance • Medium • Build your own balance with a coat hangar and 2 cans or plastic cups. You will need stones, marbles (at least 5 shooters) or coins of at least 2 different sizes (dimes and quarters work well). Decorate on side of the can to represent happy and the other side to represent unhappy. • Uses • Fine motor • Math/weight estimation • Decision making • Verbal communication • Uses • Teaching purposeful action • Self awareness of distress vs. happiness • Motivational enhancement (pros and cons)
- Eggs • Medium • Extra large plastic Easter eggs—When eggs hatch, they bring new life • Benefits • Fine motor skills • Uses • Distress Tolerance: Write an emotion on the outside. Fill with strips of paper with coping skills • Important people: Write their name on the outside. Fill with descriptions of them • Goals: Write the goal on the outside. Fill with plans to achieve it • Resources: Write the resource on the outside and fill it with resources (Safety, support, encouragement, creativity, humor, problem solving)
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Alphabet Awareness • Medium • Poster Board Letters • Wooden Letters • Cardboard Letters with O-Ring • White-Board Letter (Temporary) • Poster board (1 for each person) • Popsicle Sticks in Decorated Jar • Benefits • Fine motor skills
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Alphabet Awareness • Uses • Positive affirmations. Participants use the positive word in a self-statement and an other-statement. (i.e. able, agreeable, adaptable, adventurous, able, authentic, ambitious, amusing, appreciative) • Mindfulness: Find something positive for the letter of the day and decorate accordingly • Distress Tolerance: Identify activities you enjoy that begin with each letter and decorate accordingly • Gratitude • Daily goals
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Snowflakes • Just like each snowflake is different, so is each person • Medium: Paper • On each part of the snowflake have the person write something special about themselves (or pass around in group) laminate snowflakes to preserve • Benefits • Fine motor skills • Uses • Self-esteem • Ice breaker (Guess who!)
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Balloons • Medium • Party balloons • Take the wind out of their sails: Inflate each balloon and tie off write on the balloon something that makes you unhappy which you have no control over. Have the person hold the balloon closed and then let go when they are ready to stop giving it energy. (can also use masking tape to re-use balloons) • Write an emotion on each balloon. Have participants decorate them accordingly. Start by having the group try to keep one in the air. Then add another emotion and so on until they are having to juggle 4 or 5 emotions. The last emotion to add is happiness. They will be so distracted trying to keep the other balloons in motion they will likely not notice happiness when it is added • Balloon Sculptures
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Balloons • Benefits • Gross motor skills • Fine motor skills • Team work • Uses • Teaching mindfulness and purposeful action. • Improving coordination and agility
Summary • There are endless things you can do with art therapy to: • Express emotions • Enhance mindfulness and self-awareness • Increase happiness • Improve interpersonal communication • Enhance fine and gross motor skills • Develop self-esteem • Teach teamwork
459 - Biopsychosocial Impact of Depression and Strategies for Prevention and Intervention
CEUs are available for this presentation at AllCEUs https://www.allceus.com/member/cart/index/product/id/1227/c/
Biopsychosocial Impact of Depression and Strategies for Prevention and Intervention Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Podcast Host: Counselor Toolbox, Case Management Toolbox, NCMHCE Exam Review Objectives • Define depression (symptoms) • Explore the biopsychosocial impact • Learn how to ask strengths-based assessment questions • Identify a range of potential causes for depression • Explore activities and interventions that can help people address some of the underlying causes
Depression • Depression represents a cluster of symptoms • Diagnosis with depression only requires people to have a few of the symptoms • A variety of different things can cause and be caused by depression • Emotions: Anger, anxiety, grief, guilt, shame • Thoughts: Cognitive distortions • Relationships: Poor self-esteem, unhealthy/unsupportive relationships, need for extremal validation • Physical: Neurochemical imbalances, poor nutrition, exhaustion, insufficient sleep, medication side effects • Environmental: High stress environments that prevent relaxation/rest and increase hopelessness/helplessness
Strengths-Based Assessment • What does this mean to you? (apathy, sadness, mood swings) • Which symptoms are most bothersome for you and why? • For each symptom • What makes depression worse? • What makes depression better? • How was life more pleasurable prior to getting depressed? • What is different during times when you are NOT depressed? • How do you expect life to be different when your depression is gone? Neurotransmitter Imbalances • Ability to feel pleasure/Apathy/Emotional Flatness • Memory issues • Difficulty concentrating • Sleep issues • Lack of motivation • Fatigue • Pain • Irritability/Agitation • Fight or flight stress symptoms
Neurotransmitters • Get quality sleep • Create a routine • Address pain and apnea • Improve the sleep environment • Other factors: Shift work, time zones, daylight savings time • Relaxation • Biofeedback • Progressive muscular relaxation • Address medication side effects • Psychotropics • Opioids Neurotransmitters • Improve Nutrition • Address addictive behaviors • Address chronic or extreme stress • Refresher • Both of these increase the amount of neurotransmitters flooding the synapses. • To protect the body from overload, the brain shuts down some of the receptors so the body does not overload (tolerance/desensitization) • When the neurotransmitters return to a normal level, the receptors are still shut down, so not enough neurotransmitter gets sent out. • Things that normally caused a reaction, no longer are strong enough to cause a reaction Hormones • Thyroid • Are altered in response to chronic stress • Impacts mood, libido and energy levels • Estrogen • Boosts neurotransmitters that affect sleep, mood, memory, libido, pain perception, learning and attention span. • Increased estrogen may increase the availability of serotonin • Testosterone • Low testosterone may be implicated in reducing the availability of serotonin • Testosterone is manufactured by the adrenal glands, • Enhances libido, improves stamina and sleep, assists brain function, and is associated with assertive behavior and a sense of well-being.
Hormones • Cortisol • Cortisol is made by the adrenal glands. • Helps the body adapt to stress by increasing heart rate, respiration, and blood pressure. • Cortisol levels increase early in the morning to prepare to meet the demands of the day, and gradually decrease throughout the day (“circadian rhythm”). • Insufficient cortisol (glucocorticoid resistance) can lead to HR and BP reductions as well as reductions in energy and motivation • DHEA • DHEA levels decrease as we age • DHEA can increase libido and sexual arousal. It improves motivation, engenders a sense of well-being, decreases pain, facilitates the rapid eye movement (REM) phase of sleep, enhances memory and enhances immune system function.
Hormones • Get a physical to identify and address what may be causing any imbalances • Eat a low-glycemic diet • “The less sleep you get, the higher your cortisol will be; the more sleep you get, the lower your cortisol will be.” John Romaniello, co-author of Man 2.0 Engineering the Alpha: A Real World Guide to an Unreal Life. Hormones • Final Thoughts on Hormonal Imbalances: • Hormonal imbalances affect many millions of people • Symptoms include feeling anxious, tired, irritable, gaining or losing weight, not sleeping well and noticing changes in your sex drive, focus and appetite • Causes for hormonal imbalances include poor gut health, inflammation, high amounts of stress and depression, genetic susceptibility, and toxicity • Natural treatments include eating an anti-inflammatory diet, consuming enough omega-3s, getting good sleep, exercising and controlling stress
http://draxe.com/10-ways-balance-hormones-naturally/
Pain • Low serotonin is associated with increased pain perception • Depression contributes to muscle tension as well as stiffness and achiness • Interventions • Exercise • Guided imagery • Muscle Relaxation • Alternate focus • TENS therapy • Physical therapy • Hydrotherapy • Ice/Heat • Hypnosis Emotions • Anger/Resentment/Jealousy/Envy/Guilt • Anger is half of the fight or flight • It pushes people away and/or asserts dominance/control • Excessive anger can lead to depression when it • Exhausts the stress-response system • Contributes to negative cognitions • Impairs relationships Emotions • Jealousy and envy can be thought of as: • Anger at someone else for having something you want • Self anger for not having it • Existential anger for the universe not being fair • Jealousy may contribute to feelings of hopelessness and helplessness • Activity • Make a list of people you envy or are jealous of. • Identify why you are jealous of them. • In what way are they better or better off than you because of those things? • How does envy/jealousy affect your ability to live a rich and meaningful life? • What is a more productive way to use this energy? Emotions • Guilt can be thought of as shame, embarrassment or self-anger for something you did or should have done • Some people have difficulty letting go of guilt because they think • They deserve to suffer • If they forgive themselves they might do it again
Emotions • Activity: Guilt • Make a list of things you feel guilty about (aka fearless moral inventory) • How can you: • Make amends? • Learn from it? • Forgive yourself? • Let it go? • Guilt Bill of Rights • Forgiveness • What does forgiveness mean to you? • How does the concept of forgiveness make you feel? • What does the phrase “Forgiveness is for you” mean? • Forgiveness fire activity Emotions • Activity (Group or Individual) • When you are angry, what do you notice? • What are your anger triggers? • Why do those triggers make you feel vulnerable? • Is it an external threat? • Is it an internal threat? • Is this a current threat or something from your past? • Does this threat keep you from living an RML? • How can you address each trigger to feel safer and more empowered? Emotions • Anxiety • Anxiety is the other half of fight or flight • Chronic anxiety/worry/stress will also exhaust the stress response system causing neurochemical and hormonal imbalances and increasing muscle tension and pain • This causes the body to adapt to excessive stress chemicals by shutting down the receptors à apathy • Anxiety makes it harder to sleep exhaustion hormonal imbalances depression
Emotions • Anxiety • Activity • For each of the following fears, identify three situations in which you experience it • Rejection/Isolation • Failure • Loss of control • The Unknown • Explore why those situations trigger anxiety • Brainstorm ways to deal with them • Fact checking • Guided imagery • Dialectics (See it as a challenge) Emotions • Grief • Grief is sadness/depression experienced as a result of loss • The grief process involves • Anger (at self, other, existential) • Depression • Helplessness to change the situation • Hopelessness that you will move on • Losses are not just about death
Emotions • Grief • Activity Part 1: Loss Identification • Identify your losses • Existential (dreams, hope, faith, safety, independence, innocence…) • Social (moves, death (people & pets), relationships ending) • Physical (abilities, health, appearance) • Property (houses, favorite bike, grandmother’s broach) • Explore what about each of those losses makes you angry, fearful or hopeless (depressed) • Develop an action plan to deal with those unpleasant feelings • Give yourself permission to grieve
Emotions • Grief • Activity Part 2: Acceptance • True losses cannot be reacquired. • The final step in the grief resolution process is acceptance. • What does acceptance mean to you? • For each of your losses, describe what acceptance means • Other Activities • Narrative therapy (chapters or letters) • Wind chimes • Sun/light catchers Emotions • Happiness… (Duh!) • Happiness chemicals reduce stress and depression chemicals (I know, real clinical explanation there!) • It is possible to be depressed about one aspect of your life and happy about 5 others. • Generally you will not be happy and depressed in the EXACT same moment. • Increase the happy times • Comedians • Focus on what is going right • Congratulate yourself for progress not perfection • Exercise • Environmental happiness triggers
Cognitive • Negative thinking styles • Contribute to exhaustion • Highlight what is out of your control • Embrace the dialectics by identifying the parts that are in your control • Heighten a sense of helplessness/hopelessness (depression) • Cognitive distortions • All-or-Nothing (Nobody ever) • Find the exceptions • Self-fulfilling prophesies • Positive mental imagery • Personalization • Find 3 alternate explanations
Relationships • Poor self-esteem • Contributes to self-loathing, shame and a feeling of unlovability • Negatively impacts relationships (loneliness/rejection) • Often causes a person to seek external validation • Activity:Self-esteem inventory • For all the characteristics you don’t have, answer the question: • If your child/best friend had this flaw, would I still love them? • Activity: Group Snowflakes • Activity: Sell Yourself Relationships • Unhealthy/unsupportive relationships • Negative relationships can take a toll on self esteem • Fears of abandonment can maintain high levels of stress and feelings of helplessness • Fail to buffer people against stress à exhaustion neurotransmitter imbalances depression • Interventions • Enhance adult attachment with people who CARES (Consistency, Attention, Responsiveness, Empathy, Solution Generation) Explore what each looks like. • Do CARES activities for yourself • Address prior abandonment experiences • Enhance mindfulness
Environmental • High stress environments • Prevent relaxation/rest • Increase hopelessness/helplessness • Increase stress hormones / decrease relaxation hormones • Activity • Design a low stress area in • Your home (bedrooms are good) • At work/school • Turn the negative into a positive • Dog hair EVERYWHERE • Noisy family • Have to go to work
Why I Care/How It Impacts Recovery • We experience emotions through neurochemical signals • Imbalances in the neurochemical system à problems in mood, concentration, energy, libido, sleep and eating behaviors imbalances in the neurochemical system • Depressive symptoms are huge triggers for relapse • Identifying what causes these neurochemical imbalances for each individual and addressing them is crucial to recovery • What helps? • What makes it worse? • What is different when the problem doesn’t exist? Summary • Depression is the cluster of symptoms created when there is a neurochemical imbalance in the brain. • What causes the imbalance can be emotional, cognitive, physical, interpersonal, environmental or some combination of the above. • Part of the strengths based approach means helping people see what they already are doing to prevent or deal with the symptoms • Biopsychosocial means • Examining all causative factors • Recognizing that all factors are reciprocal in nature.