Case Study: Depression
438 Depression Case Study Using the PACER Method Counselor Toolbox Podcast Episode 438 Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs.com Podcast Host: Counselor Toolbox and Case Management Toolbox Objectives - Review a case study using the transdiagnostic, transtheoretical PACER approach - As they say on Law and Order… - The following story is fictional and does not depict any actual person or event.” Case - Tom is a 36 year old male and has been struggling with depression on and off for years, but the past 2 months it has gotten intolerable. He recently lost 85 pounds to try to help get his diabetes under control and improve his sleep apnea and blood pressure. He was thrilled with his weight loss progress, but he hit a plateau and feels like he is going backwards. Physical - Sleep - On an average night how much sleep do you get- REM 1__ Deep .5__ Light 6 - On an average night how many times do you wake up- _3-4 but has sleep apnea Has not been waking up as much since he lost weight and started on the CPAP - After an average night’s sleep how do you feel- Tired x__ Okay Energetic - When you wake up feeling refreshed, how much sleep do you get- REM 3_ Deep __2+_ Light __3+ - Sleep hygiene self assessment. Physical - Nutrition - Using a free app like SparkPeople, track your nutrition for a week. - Which nutrients do you get less than 75% the full RDA- Zinc - Which nutrients do you get less than 25% of the RDA- None - When was the last time you had a full panel blood test to examine your kidney and liver function, thyroid and vitamin D levels- 6 months - Describe your eating habits: I have been eating healthier on my diet and try not to get too crazy because of diabetes - Do you eat due to stress or for comfort when you are upset- yes - Do you drink at least 64 ounces of noncaffeinated, nonalcoholic beverages each day- yes - How much caffeine do you have on an average day- (100-150 mg/8oz of regular coffee; 35-50 mg/8oz of soda) ~600mg Physical - Nutrition - How much nicotine do you have on an average day- (1mg/1 cigarette; 6-24mg/vaping cartridges) 0 - Are you currently over or under fat- (Note: People can have a lot of muscle and not be unhealthy) no - Have you recently had any problems with excessive thirst or hunger- no - Do you have problems with hypoglycemia (your blood sugar dropping)- _yes (diabetic) - Have you recently gained or lost a lot of weight- Yes - Has your doctor tested your blood sugar lately (fasting blood test)- __yes - Do you mainly gain weight around your belly- __yes - Referral to PCP Physical - Pain - Do you have any chronic pain- Yes - If so what causes it-bad knees How long have you had it- since college_ - What makes it worse- __standing, walking_ - What makes it better- _heat, ice, elevation - How has it impacted your mood/relationships/energy/sleep/self-esteem- Knee pain is annoying and keeps me from playing tennis with my daughter Physical - Exercise/sedentariness - Do you exercise- _not anymore If yes, how often and for how long- daily 45 minutes_ - How is your energy, mood and appetite after you exercise- _I’m exhausted__ - Do you sleep better on days you exercise- - Does muscle soreness make it harder to sleep- _No Physical - Energy - Which best describes your average energy level Low__x_ I can get through the day Great! - Have you had your thyroid levels tested lately- N If so were they in normal range- - - Using a pulse ox monitor: What is your resting heart rate- __85_ What is your O2 saturation- __98 - Do you have high blood pressure- Y (managed with medication) Heart conditions- _N____ if so, what Physical - Libido/Sex hormones - How is your sex drive- Low x Good Incredible__ - Has there been any change in your sex drive- N If so when and what caused it- _- Been low for a couple years - If you are over 45 have you had your sex hormone levels tested in the past year- N - How often do you masturbate or have sex- 5 days a week _ - What triggers it- - What helps you feel better- __- - I feel angry, resentful 0-3 days a week 4 or 5 days a week X_ >5 days a week - What triggers it- The news, my depression, messages about “toxic masculinity” and white male privilege. - What helps you feel better- Nothing - I feel guilty 0-3 days a week 0_ 4 or 5 days a week >5 days a week - What triggers it- - What helps you feel better- ____ Affective - In the past year, I have experienced the following losses which caused me to feel grief: None - What stressors are currently present- __Lost a promotion to someone who was less qualified and had less seniority but was not a white male. I am still [bitter] about that, my diabetes, kids getting ready for college which will be expensive. So many people get paid a crap ton of money for “jobs” that don’t contribute to society (anchors, actors, athletes). - What is different when you are happy- I am not tired all the time. I am able to workout. People don’t [annoy] me as much - How long does it take for you to calm down after you get upset- _+/- 1hr - What helps you calm down- __I vent about it to my wife___ Educate about HPA-Axis activation, biofeedback and relaxation techniques. Discuss affective issues in counseling Cognitive - How is your attention/concentration- awful - Have you ever been diagnosed with ADHD- N_ - Has there been a change in your ability to concentrate lately- Y How long- 6 months - If so, what is causing it- __lack of sleep- Depression- I don’t know. - Does it seem to be taking longer to process information- _Y - How is your memory- __awful__ Have you been more forgetful than usual- _y_ - If so, when did your forgetfulness start- A few months ago What is causing it- I don’t know - When you think about yourself, your life, the world, other people, do you tend to feel angry, suspicious or hopeless- _Y - If yes, have you always felt this way or did something happen to change your feelings- _Started watching the news and spending time around people Cognitive - Negative self-talk - Do you frequently judge or criticize yourself- Not really_ - Do you hold yourself to a higher standard than you hold other people- _N__ - Do you think you are lovable/likeable only if you are perfect (or almost perfect)- _N_ - Where did you learn your negative self talk- __ Cognitive - Pay attention to your thoughts for a week. Place a check by the thinking errors which are most common for you and contribute to your unhappiness. X All or none thinking Find Exceptions X Assuming/Jumping to conclusions without all the facts Get the facts X Focusing on a small aspect instead of the bigger picture Consider alternate explanations X Expecting life to be fair Explore living in the AND X Taking things too personally Consider alternate explanations X Focusing on the negative and ignoring the positive Learn about radical acceptance - Taking something bad and blowing it out of proportion (catastrophizing) - Expecting people to be able to read your mind Evaluate how you communicated what you wanted and practice assertive communication - Assuming you know what others are thinking. Evaluate your evidence. Get the facts. Educate about cognitive distortions and interventions. Provide worksheets to address CDs. Cognitive: Hardiness Cognitive - Time management - How effective are you at managing your time- Good when I am not depressed - Do you often take on too much and feel overwhelmed or rushed- No - Are you a perfectionist- __N If yes, how does that impact your mood, sleep and relationships- - Do you procrastinate- _Y I just don’t have the energy to do anything so I put it off until it is a crisis. - If yes, how does that impact your mood, sleep and relationships- __I tend to get irritable when I have something to do that I am procrastinating then irritable when I feel rushed. Develop a schedule that includes the “must dos” delegates and simplifies when possible. Environmental - Do you feel safe most of the time- _Y_ If no, where do you not feel safe and why- - What helps you feel safe- My dogs. My neighborhood. My guns (Former Reserves. No deployments) - Are you able to have peace and quiet when you want it and when you sleep- YesI wear earplugs to block out the sound of the CPAP If no, what can you do to reduce unwanted noise- - During the day are you able to access natural light, or at least a really bright working area- Yesbut I don’t - When you sleep, are you able to make your room totally dark or block out the light- Y - Do you eliminate blue light from television and electronic devices at least 2 hours before bed- N I watch television until I drift off__ Environmental - What smells are you regularly exposed to- - Noxious/unpleasant/irritating nothing. My allergies keep me from smelling much - Triggering (reminds you of something unpleasant) - Happy/relaxing/energizing - Are you able to keep your environments at a temperature you find comfortable- __No. My wife keeps it hot in the summer and cold in the winter. Relationships - Do you feel you are capable, lovable and deserving- _y_ If not, why not- - Do you have healthy relationships or regularly fear abandonment- _Healthy overall - Can you effectively identify and communicate feelings and thoughts and get your needs met- y_ - Do you have a social support system that can provide practical assistance and emotional support- Practical assistance, yes…Emotional support from my parents, not so much my wife. Initial Tx Plan goals - Referral to PCP for hormone evaluation and to check blood pressure medication levels due to rapid weight loss. Discuss antihistamines and allergies Get feedback from physician visit.(Week 0) - Sleep duration and quality--Sleep hygiene assessment handout (Week 0) - Make a sleep hygiene enhancement plan based on handout data. (Review progress and impact weekly through week 8) Initial Tx Plan goals - Emotional Dysregulation and Psychological Flexibility Matrix - Week 0: Define a rich and meaningful life—People, activities, thoughts, behaviors to achieve it - Week 1: Identify autopilot thoughts and behaviors in response to distress and discuss radical acceptance - Week 2: Develop a list of distress tolerance skills and empowerment oriented self-talk to add to the matrix. Provide matrix handout (complete at least one each day) - Weeks 3-8: Practice applying the matrix at home and in session Initial Tx Plan goals - Cognitive distortions worksheet/log. Focus on one distortion each week. (due weeks 3-8) - Hardiness Enhancement to increase positive chemicals (Week 3-8). Create a schedule to help better use time to focus on the important things. - Specific Stressors for Discussion (Beginning Week 1) - Unfairness in the world - Discrimination due to being a white male and feelings of rejection due to society’s stance on “toxic masculinity” - Financial stress of kids getting ready to leave for college Reassessment - Tom went to his PCP and had a physical. The doctor was pleased with his weight loss and reduced his blood pressure medications. Tom’s thyroid hormones were on the low end of normal range and testosterone levels were low so he was put on a low dose testosterone replacement gel. He discussed his allergies with his doctor who switched him to an antihistamine nasal spray. Tom is still not being totally open with his doctor about alcohol and caffeine use. - Sleep hygiene assessment identified issues with allergies, blue light exposure, caffeine intake, daytime napping, and staying in the dark. Tom ordered a blue light filter for his TV and now sets a sleep timer. He also ordered noise cancelling ear buds and wears those at night when he watches television and they help block out CPAP noise the rest of the night. He stopped drinking alcohol after 7pm and has cut out caffeine after 3pm. - Tom’s energy seems to be improving. He rated his energy “good” or “okay” 6 out of 7 days for the last 3 weeks. Reassessment - Tom’s persistent frustration with “life” seems to be contributing to learned helplessness and hypocortisolism which is also impacting his blood pressure, diabetes and mood. - Tom is becoming more aware that a sense of disempowerment is contributing to his depression and is practicing using the matrix each day. - Tom has been consistent with sticking to his hardiness enhancement plan which has left him less time to perseverate on the news and is getting him out of the house more - He has removed all news apps from his phone and only allows himself to watch the news when he is on the stationary bike at the gym. He says he can work out his frustrations easier that way. Reassessment - Tom is still struggling with some cognitive distortions because he feels like if he doesn’t focus on the injustices in the world, “they” are winning. We are continuing to work on identifying what parts are within his control, which irritants are worth his energy and refocusing attention on what is going right in his life instead of what he perceives as wrong with the world. - Tom has stopped looking for a new job as he likes his current job and believes he will experience the same injustices elsewhere. Summary - Depression can be the result of low serotonin, dopamine, norepinephrine or glutamate; excessive anxiety or trauma causing hypocortisolism; buildup of adenosine as a result of poor quality sleep. - Sleep can be disrupted by alcohol, caffeine, sleep apnea, blue light exposure, circadian rhythm disruption, - Fatigue can be caused by poor sleep, some antihistamines, blood pressure medication, diabetes, excessive stimulant use, poor nutrition, low testosterone. - Social and behavioral withdrawal can be caused by anhedonia, fatigue and irritability.
2 Nov 2019
Attachment Theory and Adult Relationships
452 Attachment Theory and Adult RelationshipsAttachment and Adult RelationshipsDr. Dawn-Elise SnipesExecutive Director, AllCEUs.comHost: Counselor Toolbox Podcast, NCMHCE Exam Review PodcastObjectives • Briefly define attachment theory • Learn about the impact of attachment • Identify triggers for attachment behaviors • Explore the relationship between ACEs and attachment issues • Learn about adult attachment theory • Examine how attachment impacts emotional regulation and vice versa • Identify ways to help people become more securely attached.What is Attachment Theory? • Attachment behaviors, such as crying and searching, were adaptive responses to separation from with a primary attachment figure someone who provides support, protection, and care. • Erikson postulated the periods of trust vs. mistrust, and autonomy vs. shame and doubt during this same time period • Maintaining proximity to an attachment figure via attachment behaviors increases the chance for survival • From this initial relationship we learn • How scary or safe the world is. • What it is like to be loved.What is Attachment Theory? • The attachment system essentially "asks" the following fundamental question: Is the attachment figure nearby, accessible, and attentive? • If the answer is "yes," the person feels loved, secure, and confident, and, behaviorally, is likely to explore his or her environment, interact with others. • If the answer is "no," the person experiences anxiety and, is likely to exhibit attachment behaviors ranging from simple visual searching to active following and vocal signaling on the other • These behaviors continue until either • The person is able to reestablish a desirable level of physical or psychological proximity to the attachment figure • Until the person "wears down." Impact of Attachment • How loved or unloved we feel as children deeply affects the formation of our self-esteem and self-acceptance. It shapes how we seek love and whether we feel part of life or more like an outsider. • As we individuate we often again seek approval.Does it Stop After Infancy • Maybe yes, maybe no. • Consider the child that regularly did not get needs met. • Persisted with attachment seeking behaviors • Those behaviors were eventually rewarded (so they will happen again) or not, so the child stops seeking comfort from others. • How does this impact • Self-esteem? • Trust in others? • Future relationships?Does it Stop After Infancy • Maybe yes, maybe no. • Consider the adult who got needs met as a child, but in adult relationships regularly does not get needs met. • What role do significant others play in the survival of the adult human? • Think about Erikson’s stage of intimacy vs. isolation • How does not getting needs met impact • Self-esteem? • Trust in others? • Future relationships?Adult Attachment Theory • (1987) Hazan and Shaver noted that the relationship between infants and caregivers and the relationship between adult romantic partners share the following features: • both feel safe when the other is nearby and responsive • both engage in close, intimate, bodily contact • both feel insecure when the other is inaccessible • both share discoveries with one another • both play with one another's facial features and exhibit a mutual fascination and preoccupation with one another • both engage in "baby talk" Adult Attachment Theory • If adult romantic relationships are attachment relationships, then: • We should observe the same kinds of individual differences in adult relationships that Ainsworth observed in infant-caregiver relationships. • The way adult relationships "work" should be similar to the way infant-caregiver relationships work. • The same kinds of factors that facilitate exploration in children (i.e., Having a responsive caregiver) should facilitate exploration among adults (i.e., Having a responsive partner). • Whether an adult is secure or insecure in his or her adult relationships may be a partial reflection of his or her experiences with his or her primary caregivers. (During infancy or later in life)Triggers for Attachment • Certain kinds of events trigger a desire of closeness and comfort from caregivers. • Three main sets of triggers: • Conditions of the person (fatigue, hunger, illness, pain, cold, etc.) (HALT) • Conditions involving the caregiver (absent, departing, discouraging of proximity, giving attention to another, etc.) • Conditions of the environment (alarming events, criticism or rejection by others)Adverse Childhood Experiences Impacting Attachment • Physical, sexual and verbal abuse. • Physical and emotional neglect. • A family member who is: • Depressed or diagnosed with other mental illness • Addicted to alcohol or another substance • In prison • Witnessing a parent being abused. • Losing a parent to separation, divorce or other reason.Attachment Styles • Avoidant infants avoid the parent—physically, visually. • Avoidant adults are somewhat uncomfortable being close to others. They find it difficult to trust others completely, to allow themselves to depend on others or to let anyone get too close. (What would cause this?) • Resistant / ambivalent infants either passively or actively show hostility toward the parent. • Anxious / ambivalent adults often worry that their partner doesn't really love them or won't want to stay with them and want to merge completely with another person, and this desire sometimes scares people away. (What would cause this?)Attachment Styles • Secure infants often cry briefly when the parent leaves, but is consolable, greeting the parent warmly upon return. • Secure adults find it easy to get close to others and are comfortable depending on others and having others depend on them. They don't often worry about being abandoned or about someone getting too close to them. • What would cause this? • Consistency (emotional and physical) • Unconditional positive regard • Comfort/support/encouragement (It is okay to have feelings and it is okay to fail)Insecure Attachment– Emotional RegulationAvoidant Attachment –Emotional RegulationSecure Attachment– Emotional RegulationQuestion • Can people have different attachment styles to different people who are significant in their lives? • Children • Spouse • Best friend • ParentAttachment--CARES • Consistency • Attention • Responsiveness • Empathy • SupportChanging Your Attachment Style • Build self-esteem to begin seeing yourself as lovable • Practice acceptance of yourself and others to become less faultfinding — a tall order for codependents and distancers. • Take calculated risks to get outside of your comfort zone (including intimacy building) so you can learn how strong you are. (Gloria Gaynor “I Will Survive”) • Get healthy to nurture emotional stability and strength. (vulnerability prevention) • Develop emotional regulation and distress tolerance skills • Increase insight and understanding • Identify when and why you are using unhelpful relationship strategiesChanging Your Attachment Style • Increase mindfulness (awareness) • Learn to be assertive and authentic • Stop reacting, and learn to resolve conflict and compromise from a “we” perspective • Dialectics • Win/win • Challenging questions (next slide)Changing Your Attachment Style • Challenging Questions • Attachment problems often arise out of past traumas • These traumas may have contributed to thinking errors • Questions • What is my belief • What are the facts for and against my belief in this context (i.e. this person, this situation) • Am I using emotional or factual reasoning (reacting from the past or the present) • What are other factors that may have contributed/other explanations • Are you using extreme words?Summary • Attachment theory was first proposed by Bowlby as an adaptive survival function for helpless infants • Bowlby proposed that the infant-caregiver relationship was the relationship that all future relationships would be build from. • People’s self-esteem develops from and is impacted by how loved and secure they feel • Adults show similar attachment behaviors to their significant others (m/l age appropriate) • Attachment styles can be changed by developing self esteem, emotion regulation skills, self-awareness, interpersonal skills (boundaries, communication) and self confidence.
24 Dec 2019
Relationship Insecurities: Causes, Consequences and Interventions
446 - Relationship InsecuritiesDr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC, NCCExecutive Director, AllCEUs*Based in part on Love Me Don’t Leave Me by Michelle Skeen, PsyD.Objectives • Identify signs of relationship insecurities • Explore causes of relationship insecurities • Identify at least 5 interventions to address relationship insecuritiesSigns of Relationship Insecurities • Difficulty trusting your partner • Comparing yourself to your partner’s exes or random people in the community • Requiring frequent reassurance that you are enough • Anxiety when separated • Internalizing negative thoughts creating self-fulfilling prophesies • A feeling of distance or detachment • Reading negative into everything your partner saysRelationship Bricks • Often past relationships cause us to build a wall around our heart • Have clients write the name of people from prior relationships on bricks and put them in a backpack • Have them put on the backpack and go on a nature walk for 15 minutes. • When you get back, ask about all of the things they noticed on the walk and how carrying that heavy backpack kept them from being mindfulCauses of Relationship Insecurities • Insecurities indicates anxiety or fear of being hurt or abandoned • Prior learning (Unpack those bags---1 bag/person/session) • Create paper “bags” for each past relationship brick • Write a pros and cons list of that relationship • Write a goodbye letter to that person/relationship detailing what happened, how you felt and how it impacted you • In sharing what is in the bag, take back your power. • Instead of saying “You made me feel” say “I felt” • Instead of a narrative of abandonment and betrayal because of personal inadequacies, explore other reasons the other person to left the relationship • Explore forgiveness in terms of choosing not to allow that person to continue to hurt youCauses of Relationship Insecurities • Insecurities indicates anxiety or fear of being hurt or abandoned • Prior learning (Unpack those bags---1 bag/person/session) • When you are ready to let go of that anger and hurt, take the brick out of the backpack. • Each week notice how much lighter the backpack feels and how much less energy it takes to tote aroundCauses of Relationship Insecurities • Insecurities indicates anxiety or fear of being hurt or abandoned • Trying to master a prior failed relationship • Make a Venn diagramCauses of Relationship Insecurities • Insecurities indicates anxiety or fear of being hurt or abandoned • Low self-esteem (Self-validation) • Collage • Best friend activity • Values activity • Sell yourself • People may have difficulty developing self-esteem based on a pathological inner critic • Thought stopping • Handling hecklers • Validate in the present / check for accuracy • Embrace imperfection and synergyCauses of Relationship Insecurities • Insecurities indicates anxiety or fear of being hurt or abandoned • Poor communication • Stop assuming you know and expecting mind reading • Mindfulness • Lack of Connection • Intentional activity—Make a list of all of the things you like to do. Intentionally spend time with each other each day.Causes of Relationship Insecurities • Insecurities indicates anxiety or fear of being hurt or abandoned • Imbalance in power (She does everything… If he leaves, I will not be able to survive.) • Address anxieties about dependency or helplessness • Develop support systems and strategies and disaster plansCauses of Relationship Insecurities • Insecurities indicates anxiety or fear of being hurt or abandoned • Jumping to conclusions/Personalization • Relationship Assumptions “Family Feud”--- We surveyed a bunch of people. What are the top 3 explanations for this…Smells like perfume, is late, doesn’t text back right away, doesn’t want to do anything lately, lost interest in sexInterventions • Address emotional vs. factual reasoning • Grieve past losses • Partners • Friends • Parents • Heart-Break Pot (break into large pieces) • Using paint pens and markers write on the inside of the broken pieces their feelings about the loss • On the outside of the pieces name or draw their sources of support. • Glue back togetherInterventions • Love yourself and believe you deserve love • Love languages know yours and your partners • Touch • Quality time • Acts of service • Words of affirmation • GiftsCore Principles of Relationships • Uniqueness of the relationship from others • Celebrate the uniqueness—How is this time different? • Integration of beliefs, behaviors and motivations • Relationships are about synergy • What beliefs, motivations and behaviors do you share? • What beliefs, motivations and behaviors do you each have that compliment each other? • Temperament • Tendencies • ValuesCore Principles of Relationships • Mutually envisioned trajectory • Relationship goals • Relationship activities • Relationship pace • Positive and negative evaluation • Emphasize the positives • Mitigate the negatives • Responsiveness • Pay attention and be responsive to your needs • Pay attention, ask about and be responsive to your partner’s needsCore Principles of Relationships • Communication and challenge resolution • Develop rules for discussing and resolving challenges • Maintenance • Ensure both partners are engaging in self and relationship maintenance activities • Recognize the importance of self-maintenanceCore Principles of Relationships • Shared goals and needs • Discuss shared goals and needs • Compromise on differing goals and needs (i.e. money, sex, activities) • Knowing and exceeding relationship expectations/standards • Know what a “good” relationship looks like to you and your partner and strive to exceed expectationsMindfulness Questions for Clients • What am I feeling? • What is triggering it? • Am I safe (emotionally and physically) now? If not, what do I need to do? • Is this bringing up something from the past? • How is this situation different? • How am I different? • How can I silence my inner critic? • What would be a helpful reaction that… • Moves you more toward your goals • Moves you toward a positive emotional experienceSummary • Low self esteem and failed prior relationships can cause problems in future relationships • Transference, cognitive distortions, low self esteem and poor relationship maintenance can all contribute to relationship insecuritiesExcellent Resources for ClientsI absolutely love both of these books. Google previews are available on the New Harbinger website: https://NewHarbinger.comRemember to use promocode 1168SNIPES to get 25% off your entire order. (Clients can use the code too)
1 Dec 2019
Cognitive Interventions for Depression
Social Work & Case Management for DepressionDr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHCExecutive Director, AllCEUsCEUs available for purchase at https://www.allceus.com/member/cart/index/product/id/1266/c/Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free months of TherapyNotes with coupon code "CEU"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 causesDepression• 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/helplessnessDepression 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 symptomsHPA-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 repairReduce 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 oversedationReduce 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 / HRTReduce 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• AspartameNeurotransmitters• Addictive behaviors• Alter dopamine, serotonin, norepinephrine levels• Impacts of different types of neurotransmitters• Stimulants• Depressants• Alcohol• Gaming/Gambling• Sex/PornographyHormones• 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 SchroderHormones• 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 stressPain• Exercise• Guided imagery• Muscle Relaxation• Alternate focus• TENS therapy• Physical therapy• Hydrotherapy• Ice/Heat• HypnosisEmotions• 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 harmEmotions• 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 depressionEmotions• 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 deathEmotions• 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=FMBchZmPlXACognitive• 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 prophesiesRelationships• 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 depressionEnvironmental• 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 positiveSummary• 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.
19 Feb 2020
Most Popular Podcasts
Developing Self-Esteem and Self-Efficacy
466 - Developing Self-Esteem and Self-EfficacyDeveloping Self-Esteem and Self-EfficacyPresented by: Dr. Dawn-Elise SnipesExecutive Director, AllCEUs Counseling Continuing EducationPodcast Host: Counselor Toolbox, Case Management Toolboxhttps://www.allceus.com/member/cart/index/product/id/1030/c/Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free months of TherapyNotes with coupon code "CEU"Objectives• Understand what self esteem and self-efficacy are, why they are important and how to develop themThe 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 selfThe 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 reliantNote: The book will give people access to online, recorded versions of several meditationsImpact 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 realisticDeveloping 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 respondActivities• 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 remindersActivities 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 BlameEmotions 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 OthersBeing 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• DutiesMindfulness 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 behaviorSummary• 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
8 Feb 2020
Mind-Body Connection How Health, Thoughts, Feelings and Behaviors Interact
Mind-Body Connection: How Health, Thoughts, Feelings and Behaviors InteractCounselor Toolbox Podcast Episode 433Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHCExecutive Director, AllCEUs.comPodcast Host: Counselor Toolbox, Case Management ToolboxSponsored by TherapyNotes.comManage your practice securely and efficiently. Two free weeks of TherapyNotes with coupon code “CEU”Objectives- A healthy body is essential to health and happiness.- Explore…- How emotions are created - How physical symptoms including pain, fatigue are created- How is this done (general overview)- ANS/PNS- HPA Axis- Circadian Rhythms- Gut-Brain Axis and the Vagus Nerve- The bidirectional relationship between the mind and bodyHow are Emotions Created (Simplified)- Born with the capacity for anger (fight), fear (flee/freeze), depression (f-It) - Emotional responses are regulated by the autonomic nervous system (ANS)- SNS- Sympathetic (Fight or Flee)- PSNS- Parasympathetic (Rest and Relax)- The limbic system helps control the ANS and PNS- Hippocampus (memory consolidation, learning, attention, olfaction)- Amygdala (fight or flee/survival)- Hypothalamus (hormone regulation (HPA-Axis))How are Emotions Created- Unconditioned emotional responses are reactions to stimuli which did not need to be learned– i.e. present from birth- Startle (puppy)- Pain-Cry (shots)- “Love”/ “contentment” (kangaroo care)How are Emotions Created- Conditioned emotional responses are learned emotional reactions to stimuli- What things get conditioned and how can they cause or reduce stress-- Dogs/Fire/Police/Guns- Phone Calls- Being Alone (child vs. adult)- Transference- Failure- Rejection- Loss of ControlHPA –Axis (Threat Response System)- Secretion of adrenaline, norepinephrine and corticotropin releasing hormone (CRH)- Cortisol is released - Glutamate is released and GABA is inhibited- Blood pressure increases- Blood glucose is elevated- Some 5HT receptors are activated, others are inhibitedNeurobiology of Attachment - Hormones including dopamine, norepinephrine, cortisol, oxytocin and the serotonergic system modulate attachment- Opioids may inhibit oxytocin and reduce feelings of social connectionHow Physical Sensations Are Created- Nociception can occur in the absence of awareness of pain, and pain can occur in the absence of measurably noxious stimuli- CNS receives a pain signal from the PNS (peripheral nervous system)- This triggers the Autonomic Nervous System and HPA-Axis- All pain “information” is transmitted via glutamate- An “inflammatory soup” is created which results in signals to the CNS as well as initiating inflammation which releases substance P and causes vasodilation, leakage of proteins and fluids into the extracellular space near the terminal end of the nociceptor (swelling), and stimulation of immune cells- Substance P is associated with depression and anxiety symptomsNeurotransmitters Pain & Fatigue- Serotonin- 5-HT2A receptor produces anxiety, pain, insomnia- 5HT1A receptors reduce anxiety, pain, insomnia - Serotonin directly and indirectly regulates dopaminergic neurons- GABA may decrease the perception of pain.- Dopamine- Helps relieve pain- Increases energy- Norepinephrine- Activated during pain (emotional and physical) and causes decreased sensitivity to painful stimuli (hypoalgesia) and pain relief (analgesia).- Mobilizes the brain and body for action Gut-Brain Axis- Up to 95% of some neurotransmitters are made in the gut- The gut communicates with the brain via the vagus nerve, the enteric nervous system- Lactobacillus produces acetylcholine- Controls voluntary movement, memory, learning, and sleeping patterns. Excess can cause depression whereas deficiencies cause Dementia- Candida, streptococcus, E. Coli and enterococcus produce 5HT- Serratia (gram neg. bacteria) produces dopamine- Lactobacillus, Bifidbacterium, candida and streptococcus secrete GABA and regulate endocannabinoid expression- A healthy gut microbiome can decrease depression and anxiety, regulate sleep, appetite and improve cognition (1000 species)- An unhealthy gut microbiome contributes to an exaggerated HPA-Axis responseGut-Brain Axis- The effect of acute stress is limited due to microbiota's long time relative stable state, but chronic stress can disturb this balance- The structure of intestinal microbiota is strongly influenced by diet and environmental stressors - Corticotrophin-releasing factor (CRF) plays an important role in changing intestinal permeability- Research suggests that gut-brain axis dysfunction may be involved in the development of mood disorders, schizophrenia, addiction, and neurodevelopmental and neurodegenerative diseases as well as age-related cognitive decline*- The treatment of these conditions may adversely affect the composition of intestinal microbiota since antipsychotics and antidepressants are antibacterial agentsEndocannabinoid System- Clinical studies revealed altered endocannabinoid signaling in patients with chronic pain and depression- Dysregulation is associated with - Schizophrenia and depression - (CB1) plays a crucial role in preventing the neurotoxicity caused by activation of glutamate N-methyl-D-aspartate receptors (NMDARs).- “Inadequate endocannabinoid control may produce excess or insufficient dampening of NMDAR activity, thus promoting dopamine signaling, such as in schizophrenia, or diminishing serotonergic activity, as observed in depression”- Problems in neurotransmission, neuroendocrine, and inflammatory processes- Omega3s have a neuroprotective function and can modulate activity in the endocannabinoid systemCircadian Rhythms (Sleep!)- Cortisol helps regulate our circadian rhythms, and circadian rhythms regulate cortisol levels.- Circadian disruption is a stressorRecap- Perception of and response to internal and external stimuli shape how we interact with the world and the world interacts with us.- Stimuli interpreted by the limbic system as threatening based on past experiences to similar situations- Triggers ANS and HPA-Axis activation (stress response)- Increased norepinephrine, glutamate, adrenaline - Reduced GABA - Alterations in the 5HT system (increased 5-HT2CR receptor activity & reduced 5HT 1A) and sex hormonesRecap What Causes Stress- Physical pain (injury, inflammation, Intense exercise and overtraining)- Physical illness or dysregulation (hormones, brain health, sickness)- Nutrient availability & medications- Gut Health (microbiome homeostasis)- Nutrition- Deficiencies due to lack of nutrient consumption or malabsorption- Hypo/hyperglycemia/insulin resistance- Lack of sleep- Prior learning experiences (schemas/PTSD)- Physical environment- Social environment Consequences of Chronic Stress- In a state of chronic stress, the body does everything it can to survive leading to one of two situations:- Hypercortisolism—The negative feedback mechanism doesn’t kick in to protect against ever present danger (Fight, Flee, Freeze)- Hypocortisolism – The negative feedback mechanism kicks in too much to conserve energy for only the most severe emergencies (F-It)- Base cortisol levels are reduced after exposure to chronic uncontrollable stressors.- Chronic stress causes inflammatory cytokines to be released which interfere with H & P function- H & P are responsible for producing precursors to thyroid hormones producing hypothyroid- Suppress the sensitivity of thyroid hormone receptors to thyroid hormones.Consequences cont...- Emotional impact of a stressor is determined by our allostatic load- Social Environment- Physical Environment- Physical Health- Cognitive Perception of the Problem- Behavioral ReactionsConsequences of HPA-Axis Activation- Until the person feels safe…- Irritability (physiological, behavioral emotional)*- Perseveration* - Hypervigilance*- Sleep disruption*- Increased pain (long term)- Increased GI motility*- Changes in gut microbiome*- Reduced libido- Hypothyroid- Social withdrawal*- Eating changes (ghrelin alterations)- Inflammation*- Decreased latency to immobility and increased duration of immobility after exposure to stressors*Summary- The mind helps the body interpret signals based on stimulus input and prior learning- The body sends out messages in the form of hormones and neurochemicals which produce physiological reactions we label with “emotions”- Positive emotions promote HPA-Axis downregulation which improves attachment and sleep, reduces cortisol, increases 5HT1A, GABA, dopamine and reduces pain- The mind-body system is bidirectional and complex therefore it is essential to explore all causes of “symptoms” and enhance factors that promote positive changes.
17 Oct 2019
Motivational Enhancement & Stages of Readiness for Change
484 - Motivational Enhancement & Stages of Readiness for ChangeSponsored by TherapyNotes.comManage your practice securely and efficiently. Two free months of TherapyNotes with coupon code “CEU”CEUs available at: http://allceus.com/member/cart/index/product/id/1275/c/Types of Motivation* Motivation is essential for change* Motivation helps you identify why it is worth the effort to make achange* 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
8 Apr 2020
Anger, Irritation and Resentment (Clear the AIR)
455 - Anger, Irritation and Resentment: Clearing the AIRInstructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHCExecutive Director: AllCEUs Counseling CEUs and Specialty CertificatesPodcast Host: Counselor Toolbox, Case Management ToolboxObjectives • Explore the function of anger • Identify the types of threats that may prompt anger • Identify different types of anger to include • Run of the mill anger • Irritation • Resentment • Envy/Jealousy • Guilt/RegretFunction of Anger • Anger is part of the fight or flight reaction which is your brain’s natural response to a perceived threat • Anger pushes away or helps you dominate a threatTypes of Threats • Threats can be to your… • Person (physical harm) • Property (Damage or take my stuff) • Self-esteem or self-concept • Hurt your feelings • Make you question your goodness as a person • Make you concerned that other people will think poorly of you • Origin • Things others do or don’t do • Internal critic/old tapes/others from the past • Conscience (guilt and regret)Types of Threats • Themes • Rejection/Isolation • Loss of Control/The Unknown • Death/Loss • Failure • Real vs. Perceived Threats • Real threats actually exist • Perceived threats are based on • Cognitive distortions • Prior experiences • Emotional reasoning • Incomplete informationActivity • How do you handle threats to your: • Person/property? • Self-Esteem? • How can you handle threats from: • Others • Your internal critic (Past Others) • Your conscience (self anger, guilt and regret)Anger/Irritation • Anger is a generic term that describes the fight reaction in response to a threat • You feel like you can conquer the threat OR • You do not see any options for escape (think cat in a corner) • Anger happens on a continuum ranging from mild irritation to rage • The level of anger experienced is usually in proportion to • The immediate threat • The cumulative effect of multiple threats • Many times when people feel angry, underneath they also have a sense of helplessness or disempowerment.What Triggers Your Anger • Threats • Rejection/Isolation • Loss of Control/The Unknown • Death/Loss • FailureWhat to Do About Anger • Identify the threat • Explore the automatic beliefs triggering the anger • Why is this making you angry? (It makes me angry when…. I hate it when…) • How is this similar to other (unresolved) situations in your past? • Are there alternate explanations for the situation?What to Do About Anger • Identify the threat cont… • What threat theme is it related to? • Rejection: Is it really about you? • Failure: • Are you globalizing? • What can you learn? • Loss of Control/The Unknown: • What parts of this were and were not in your control? • What actions are worth your energy • Death/Loss • How does this impact how you see the world? • How does it impact how you see yourself?ActivityResentment • Resentment is anger directed at others for things they either did and shouldn’t have or didn’t do and should have. • What is the impact of holding on to resentments? • Emotionally • Mentally • Physically • Socially • Spiritually (Hope, faith, courage/willingness, discipline, integrity) • Many times underlying resentment are hurt feelings. (Example: You invited Jane to the party and not me.)What Do You Resent • Make a chart with 4 columns, one for each threat • Rejection/Isolation • Loss of Control/The Unknown • Death/Loss • Failure • Take 30 minutes and identify as many resentments as you can and place them in the appropriate column (only one) • Review the finished list and mark off all resentments of things over which you have no control. • Now, cross off any that have no effect on your ability to live a rich and meaningful life • Explore how you can accept these things and let go of the anger • Of the ones left, brainstorm ways of addressing that resentmentEnvy/Jealousy • Envy and jealousy can be thought of as anger at someone else for having something you want. • What is the impact of holding on to envy? • Emotionally • Mentally • Physically • Socially • Spiritually (Hope, faith, courage/willingness, discipline, integrity)Envy/Jealousy • Many times underlying envy and jealousy are: • Low self-esteem • People don’t like me because I am not as pretty as her. • Lack of gratitude awareness • Focusing primarily on all the things you don’t have • Lack of clarity about personal goals • I wish I were a CEO like her (but that would mean sacrificing other things more important to me) • Erroneous conclusions • If I were rich I would be happy.Activity: What Do You Envy? • Identify each of the people and things you envy. • In what way does each of those things represent: • Acceptance and Inclusion –the “in” crowd • Control and Power • Success • Someone having something you lostNotice how each of these is the opposite of a threat theme • Why might people envy you?Activity: What Do You Envy? • Why might people envy you? • In what way does each of those things represent: • Acceptance and Inclusion • Control and Power • Success • Someone having something you lost • What does it mean if people don’t envy you? • Rejection • Loss of power/control • FailureActivity: What Do You Envy? • Identify three people you respect and/or love but don’t envy • Is it possible to respect/love someone and not want to be like them or have what they have?Guilt/Regret • Guilt and regret are anger directed at yourself for things you either did and shouldn’t have or didn’t do and should have. • Anger represents your minds way of identifying a threat and getting you to do something. • In what way is holding on to guilt and regret • An effective response to the threat • Preventing you from effectively responding to the threatActivity: Guilt/Regret • Take 30 minutes and identify as many regrets as you can • Review the finished list and mark off all guilt & regret of things over which you have no control. (Ex. Guilt because the house was destroyed in a fire) • Now, cross off any that have no effect on your ability to live a rich and meaningful life. (Ex. Not taking parents advice…) • Explore how you can accept these things and let go of the anger at yourself • Of the ones left, brainstorm ways of addressing those resentments. Consider addressing one each day.Forgiveness • Forgiveness is a power move. • Forgiveness allows you to choose to stop giving your power to something or someone else. To stop “letting it make you angry.” • Forgiveness doesn’t mean it was okay. • Forgiveness means accepting reality as it is and choosing to learn from the experience and use your energy for things that are more meaningful.Summary • Anger exists on a continuum • It is a response to a real or perceived threat designed to get you to do something • The intensity of the response often represents the level of threat • Many times threats are perceived based on prior learning experiences that trigger memories or critical self-talk • By knowing what is important and meaningful in your life you can more effectively identify what things actually present a threat and respond more effectively.
8 Jan 2020
Enhancing Trauma Resiliency
482 - Enhancing Trauma ResiliencyDr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHCExecutive Director, AllCEUs Counselor EducationHost: Counselor Toolbox PodcastCEUs available: http://allceus.com/member/cart/index/product/id/997/c/Sponsored by TherapyNotes.comManage your practice securely and efficiently. Two free months of TherapyNotes with coupon code “CEU”Enhancing Trauma ResiliencyObjectives- Learn about the effects of acute and intergenerational trauma- Review risk and protective factors for PTSD- Identify strategies to enhance resiliency in persons who have experienced past traumaEffects of Lack of Resilience from Primary and Intergenerational Trauma - Anxiety and Depression- PTSD- Addictions- Personality Disorders- Relationship Issues- Poverty / Reduced Success- Stress Related Physical Health Problems- Intergenerational Trauma- Attachment Issues- Pessimism- Rigid Thinking- Lack of Psychological FlexibilitySigns of Resilience- Optimism / Pessimism- Empowerment / Helplessness- Flexibility / Rigidity- Confidence / Meekness/Anxiety- Competence / Incompetence- Insightfulness / Lack of Insight- Perseverance / Gives Up Easily- Perspective / Lack of Perspective- Self Control / DysregulationPTSD Risk Factors- Age- Developmental level- Prior history of trauma- Prior history of mental health or substance abuse issues (including autism and FASD)- Number of stressors in the prior 6 months- Availability of social support within 4/24/72 hours- Effective problem solving & coping skills- Effective distress tolerance skillsProtective Factors- Psychological FlexibilityProtective Factors- Mindfulness- The awareness of the present moment and ones needs in the moment without judgement- Activities- 5-4-3-2-1- What’s in the Room- Word’s in a Word- Scavenger Hunt – (i.e. All things green)- Noticing LogProtective Factors- Mindfulness/Vulnerability Prevention- Morning/Evening (Whiteboard) MindfulnessProtective Factors- Mindfulness- Evening- How do I feel physically-- Do I have pain anywhere-- What am I thinking about the most-- How do I feel emotionally-- What is one thing I am grateful for today-- What do I need to do so I can get relaxed enough to go to sleep-Distress Tolerance / Self Control- Activities- Contribute- Comparisons (to when you were in a worse state, to how things could be worse)- Emotions- Push Away- Thoughts- SensationsFraming/Perspective Skills- What is the evidence for and against that fear or belief-- Am I considering the big picture (all the factors) - My active part- My current situation and vulnerabilities that contributed- Other people’s active part in it- Transference issues- Am I catastrophizing/confusing high and low probability events Problem Solving Skills- Brainstorming– (Hand drawing for children, mind-map for adults)- Ask someone who has been through it- How does this keep me from moving closer to my goals and what can I do about it-Flexibility- Helps people learn that things won’t always go the way they want, BUT it doesn’t mean it will be awful.- Does not come easy to those with a “J” personality- Identify things we need to be flexible in (vacations, workouts, job duties, relationships, time management)- Activities- Choices Hat (meals, vacations, television programs)- Schedule a spontaneous day- How many uses game (Duct tape, coconut oil, plastic shopping bags, cardboard boxes, wire coat hangers…)\- How are you like a…. gameFlexibility- Learned Optimism (Martin Seligman)- The traumatized brain stays on alert and notices the dangers or potential threats- Teaching people to identify the good things as well can be helpful (Hardiness, Kobasa 1979; ACT Russ Harries, Steven Hayes; DBT Marsh Linehan)- Commitment – The current situation is unfortunate AND what other aspects of your life are you committed to which are going okay- (Dialectics, Living in the AND)- Control—What parts of this situation can you control- What aspects of the other parts of your life are in your control-- Challenge—In what ways can the current situation be viewed as a challenge or obstacle instead of a barrier-Flexibility- Learned Optimism (Martin Seligman)- Activities- Positive journaling- Gratitude (wall, tree, branch)Empowerment- Activities- Learn about others like you who have overcome challenges- Break big tasks into small steps- Give credit where credit is due. “I did that” wall- Make a “My support” list- Make sure not to put all your eggs in one basket.Confidence and Competence- When people feel incompetent and lack confidence, the world seems much more threatening and they can feel more helpless.- Signature strengths - Ad campaign- Body Poster / Collage- “Biography”- Who I look up to…- Personal scrapbook of accomplishments- Emotional/Courage/Perseverance/Dedication- Physical- Mental/Occupational/Creativity/Hobbies- Interpersonal/Friendship/Patience/Advocacy- SpiritualConfidence and Competence- Signature strengths - Goals Workbook- My Goal- Why I want it- What could stand in my way- How I can deal with that- The steps to get itPerseverance- From a young age it can be difficult to keep going in the face of adversity, especially if you are already stressed and feeling disempowered.- Activities- Scaffolding (Tying shoes, doing laundry, reading a book)- For adults--Mentorship- Chunk It- Decisional BalanceSocial Support and Connectedness- Social support is a great resource when trauma knocks people off balance- Developing Connectedness - Participate in hobby groups- Join clubs, faith organizations- Put effort into developing realtionshipsSummary- 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
28 Mar 2020
449 - Happiness HabitsInstructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHCExecutive Director: AllCEUs Counseling CEUs and Specialty CertificatesPodcast Host: Counselor Toolbox, Happiness Isn’t Brain SurgeryObjectives~ Learn why these habits contribute to recovery from addiction and mood issues and techniques to help clients implement them~ Habit: Awareness and Authenticity ~ Habit: Acceptance ~ Habit: Gratitude ~ Habit: Compassion ~ Habit: Breathing ~ Habit: Purposeful action and Long-Term Goals ~ Habit: Back-Talk ~ Habit: Thought Conditioning ~ Habit: Be Sense-sationalBiological Impact of Happiness~ Reduced risk of diabetes (41% - 100%), autoimmune issues, cardiovascular disease (anxiety, depression 80%)~ Reduced activation of the HPA-Axis~ Improved hormone balance~ Improved sleep~ Reduced pain~ Slowed aging process~ More energy~ Releases endorphinsEmotional & Cognitive Impacts of Happiness~ Difficulty to be simultaneously happy and unhappy~ Changes the lens through with the world is viewed~ Increases cognitive flexibilitySocial Impacts of Happiness~ Happy people tend to attract happy people~ Happy people often have more energy to devote to relationships~ Improved social relationships increase happinessAwareness and Authenticity~ To get your wants and needs met, you first need to be aware of them~ Practice Mindfulness~ What do you need~ What vulnerabilities do you currently have~ How can you mitigate them~ How can you prevent them~ Why is it important to prevent them?Awareness and Authenticity~ Living authentically means living in a way that is true to yourself.~ Define what happiness means to you:~ What makes you happy?~ How will your thoughts and outlook change when you are happy? ~ What is the impact of happiness on your health and body (energy, sleep, weight, pain, illness…)?~ When you are happy, who do you see in your support system and what will your relationships be like?~ What will be different in your day to day life, hobbies and activities when you are happy?~ How can you start making these things happen? (Principle of Reciprocity)Acceptance~ Fighting against things that are unchangeable (or not realistically changeable by you) wastes a TON of energy.~ Feelings~ Other people~ Certain situations~ Accept the situation by saying “Okay, what now?”~ Decide whether you will…~ Change part of the situation to make it more tolerable~ How can you do this?~ Change your reaction to the situation ~ How can you do this?Gratitude~ It can be easy to focus on all of the things you don’t have or what is not going right~ An attitude of gratitude helps you ~ refocus on the positive~ appreciate the simple things~ Let go of envy and jealousy~ Even if one area of your life is a mess, it is likely that you have other things to be grateful for.~ Activities~ Keep a gratitude list. Add at least one thing that went well each day~ Look around and compare yourself to others who are not doing as well and/or the you in the pastCompassion~ Compassion means sympathetic awareness of others' distress and a desire to alleviate it~ People may have compassion for others but not for themselves~ Many of us were raised to think that if we are compassionate with ourselves it means we are lazy, weak or a failure.~ Activity~ Think of three times you have been compassionate in the past week. To whom? Why? How did it impact them?~ How are you compassionate to yourself? How could you be?Breathing (and Laughter)~ Deep breaths help oxygenate blood and reduce fatigue~ Slow deep breaths also help lower heart rate and trigger the relaxation response.~ Laughter not only makes you breathe deeper, but it also releases endorphins.~ Activity~ Practice deep breathing after each meal~ When you are stressed, take a few deep breaths~ Schedule in 10 minutes to laugh every day.Purposeful Action and Long-Term Goals~ When you see that you are moving closer to your long term goals it inspires hope.~ Each small step toward a rich and meaningful life can make you feel happier.~ Purposeful action means ~ Using your energy to do things to achieve your goals~ Focusing on things you can control~ Activity~ Define what a rich and meaningful life means to you~ Identify 3 small changes you can make today to move closer to that life.Back Talk~ Your internal critic and ingrained habits can cause you a lot of distress.~ Choosing happiness habits means quieting the negativity and changing behaviors~ Back talk means~ Telling the critic to be quiet and pushing away negative thoughts.~ Telling yourself “No” when you start to engage in unhelpful habits (Stress eating, smoking, engaging in unnecessary conflict) Thought Conditioning~ Most of us are not in the habit of always seeing the bright side or the silver lining.~ Just like conditioner softens your hair, thought conditioning softens your thoughts by helping you:~ Look for the positive~ Walk the middle path~ Eliminate cognitive distortionsBe Sense-ational~ Your moods are largely impacted by your environment. ~ What smells make you happy? (Essential oils, memory-related smells)~ What sights make you happy? (Pictures, colors, organization)~ What sounds make you happy? (birds, music, water)~ What feelings/touch makes you happy? (warm fireplace, thick angora sweater, cool silk…)~ How can you integrate these into your:~ Home~ Car~ Work spacePeer Pressure~ Surround yourself with positive people~ Positive people can often help you condition your thoughts, provide support and are more encouraging~ Negative people tend to drain energy and enhance a feeling of helplessness and hopelessness.~ Energy in conversations and relationships is contagious.~ Think of a person you know who is extremely negative.~ How do you feel when you see they are calling?~ How do you feel after spending time together?~ Think of a person you know who is extremely positive.~ How do you feel when you see they are calling?~ How do you feel after spending time together?Forgive~ Resentment, regret and guilt are natural responses to a threat ~ Holding on to these feelings drains your energy.~ The feeling is telling you~ Something bad happened~ You need to fix it and/or protect yourself~ Activity~ Think about something you are resentful about.~ How does holding on to the resentment help protect you?~ What would happen if you let go of the resentment?~ How can you forgive the person, or yourself, so it stops draining your energy Project Happiness (Fake It ‘Til You Make It)~ When you walk hunched over, looking at the ground you~ Feel more depressed~ Miss some of the simple pleasures~ Miss opportunities to positively engage with people~ Sit and walk sitting up~ Look up from your phone~ Make eye contact and smile~ How else can you project happiness so others can tell you are happy?Summary~ Happiness doesn’t magically happen.~ By choosing habits that promote happiness, you can start feeling happier.~ Your thoughts, emotions, physical sensations and environment all contribute to your mood. Choose happy!
14 Dec 2019