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October 11, 2019
Overview of the PACER Method and Transdiagnostic Assessment Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs.com Podcast Host: Counselor Toolbox and Case Management Toolbox Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free weeks of TherapyNotes with coupon code “CEU” Objectives – Define the PACER model – Explore how PACER dimensions interact – Examine the transdiagnostic assessment process Why A New Approach- – 10% of Americans are on antidepressants for anxiety or depressive issues – Without medication 20-40% of people with clinical depression noticed symptom improvement in 6-8 weeks – WITH antidepressants 40-60% of people with clinical depression noticed symptom improvement in 6-8 weeks – That leaves as many as 40% of people still struggling with significant symptoms after 6-8 weeks. – No high- or moderate-strength evidence for any intervention to effectively treat any phase of any type of BD versus placebo or an active comparator Why A New Approach- – Cognitive Behavioral Therapy appears to be effective in approximately 47% of cases – Results are mixed regarding whether CBT + antidepressants can augment treatment response – Cognitive behavioral interventions for depression and anxiety prevention showed a small effect for prevention of depression but not anxiety and no effect at 3-6 months and at 12 months follow-up – In a study of over 33,000 patients, only patients who had 18 or 20 CBT sessions showed more improvement than generic counseling. Why a New Approach – Counseled patients are significantly more likely to have recovered than non-counseled patients – Client outcomes are most often determined by client variables such as – Chronicity and severity – Complexity of symptoms – Motivation – Acceptance of responsibility for change – Therapeutic change is less about talk-therapy interventions and more about the patient’s ability to maintain motivation and efficacy and clinician team’s ability to look multidimensionally at issues PACER Method – The PACER Method uses a transdiagnostic (many symptoms are common to multiple disorders) and transtheoretical (there are many ways to address each symptom) approach to recovery to assist people in optimizing their quality of life – Physical – Affective – Cognitive – Environmental – Relationships – The PACER method consistently looks at bidirectional interactions PACER Method – The PACER Method – Counselor Functions – Counseling and motivational enhancement – Connecting with multidisciplinary referrals (MD, RD, PT etc.) – Case Management (Integrating & monitoring tx plans) – Improving Health and Mental Health Literacy – Goal – To address PACER issues which create or maintain imbalances in the nervous system that cause unnecessary dysphoria. Physical – Rule out organic dysfunction in the system – If the body cannot make or balance the neurotransmitters due to health or behavioral issues, those must be addressed. – There are over 30 hormones the body must construct to regulate neurotransmitters – There are over 100 neurotransmitters the body must construct and balance to regulate attention, memory, sleep, feeding, heart rate, respiration, energy, motivation, mood and more. – Up to 95% of some neurotransmitters and hormones are made in the gut (Setting concrete in the rain) – The body requires vitamins, minerals and amino acids to make hormones and neurotransmitters Physical – Rule out dysfunction in the system – If the body cannot produce or effectively regulate hormones and neurotransmitters, people will have “symptoms” – Example: HPA axis dysfunction and exposure to stress are critical components that increase risk for developing addictions – Some hormones and neur
October 5, 2019
429 -Intuitive Eating Basics and Benefits Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Counselor Education Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free weeks of TherapyNotes with coupon code “CEU” Podcast Host: Counselor Toolbox and NCMHCE Exam Review Objectives – Identify the 10 + 1 principles of intuitive eating – Describe the interaction between mood, health and eating – Begin identifying tools to help people get off the dieting rollercoaster Basic Principles – From IntuitiveEating.Org – Reject the diet mentality – Honor your hunger – Make peace with food (Forbid forbidding) – Challenge the food police in your head – Respect your fullness – Discover the satisfaction factor (Mindfulness) – Use food for physical nourishment not in response to feelings – Respect your body – Exercise – Honor your body with good nutrition Reject the Diet Mentality – Develop a lasting way of eating – Yo-yo dieting wreaks havoc on your body and leads to weight gain and low self esteem – Recurring attempts to diet signals the body that the food supply is often insufficient and leads to greater fat storage than if food was always abundant – Dieting is correlated with the development of metabolic syndrome characterized by central obesity, insulin resistance and hypertension that increase risk of type 2 diabetes and cardiovascular disease. – Puts additional stress on the cardiovascular system Reject the Diet Mentality – Identify what you do differently when you are on a diet that can be helpful – Set small goals – Pay attention to what you are eating – Only eat when you are sitting down and not distracted – Eat from dishes not the box – Carry a water bottle Reject the Diet Mentality – Remain aware of hidden forms of dieting – Low carb – Low fat – Grain free – Intermittent fasting – Taking supplements to lose weight – Excessive exercise Honor Your Hunger – Become aware of your body cues – Hunger – Thirst – Type of food – Eat when you are physically hungry, not because – The clock says so or says not so – You are tired – You are bored, upset, happy – You are with people or alone – It is a habit – You want more Make Peace with Food – Forbid forbidding (unless medically contraindicated) – Disinhibition and self-efficacy – Address your food phobias Challenge the Food Police – What do the voices in your head say about: – Which foods to eat or not eat- – How much to eat- – How much to weigh- – When to eat- – The clean plate club- – Who is judging you- – What you should or shouldn’t have eaten- – Where did those voices come from- – Media, family, comments from others, personal knowledge – Make fact-based choices – Don’t insist on 100% compliance Make Peace with Fullness – It takes 20 min. for your body to cue your brain that you are full – Your empty belly is about the size of your fist – Learn the difference between full and stuffed – Savor what you are eating when you eat it – Left hand – Mini bites – Fork down – Remember that leftovers will be there to enjoy tomorrow – Stay hydrated – Learn about foods and eating patterns that promote fullness Eat for Satisfaction – Make sure you are not dehydrated – Cravings tell you something – Salty, sweet, sour… – Red meat or spinach (Iron) – Cheese (Tryptophan) – Chocolate (Theobromine, magnesium) – Soda (Calcium) – Fatty foods – Eat colorfully and flavorfully – Eat mindfully and reflect on how the food nourishes your body, gives you energy, improves your mood Use Food for Hunger
October 5, 2019
430 -Addressing the Unique Mental Health Needs of College Students Dr. Dawn-Elise Snipes AllCEUs Counselor Continuing Education Podcast Host: Counselor Toolbox Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free weeks of TherapyNotes with coupon code “CEU” Objectives – Identify the scope of the mental health problem in college students – Identify the impact of mental health issues on learning and student retention – Learn about the connection between mental health issues and substance abuse – Explore unique issues faced by college students – Identify the components of a good campus mental health program and other strategies to reduce stressors Scope of the Problem – According to a 2016 American College Health Association survey, – 37percent of students reported feeling so depressed within the last 12 months that it was difficult to function – 21 percent felt overwhelming anxiety – A survey of students seen for mental health services at 66 college counseling centers found that prior to college – 10 percent of these students had used psychiatric medications – 5 percent had been hospitalized for psychiatric reasons – 11 percent had seriously considered suicide – 5 percent had attempted suicide. Scope of the Problem – The 2015 NSDUH shows that adults ages 18 or older with past year mental health issues were more likely than other adults in that age group to have used illicit drugs in the same period (32.1 vs 14.8%) – The risk of co-occurring disorders is pronounced among college students as they transition from adolescence to adulthood, an age when mental health issues often surface for the first time and in a new environment where substance use is common – Increased academic distress is associated with increased mental health issues including suicidal ideation – Misuse of drugs and alcohol is correlated with – Need to cope with the pressures of college life (6.4% of college students report nonmedicinal use of ADHD medications) – Campus culture of alcohol use Why Do We Care- – The overall state of student’s health affects learning. – Mental health problems and harmful health behaviors such as substance abuse can impair the quality and quantity of learning. – They decrease students’ intellectual and emotional flexibility, weaken their creativity, and undermine their interest in new knowledge, ideas, and experiences. – Behavioral health issues such as binge drinking, drug use, cutting and other self-injurious behavior, eating disorders, pornography addiction, and problematic gambling can all be understood as maladaptive strategies to reduce stress and anxiety. – Several of those behaviors are reinforced and supported in the social culture of many colleges and universities. (Which behaviors are reinforced in your university-) Why Do We Care- – Students may self-medicate by turning to substance use – Substance use is frequently associated with negative personal, social, and community consequences, from regretted actions while intoxicated to “hooking up.” – Students need access to care to cope with these events to prevent PTSD, depression and suicidal ideation. Issues Students Face – Stressors – New freedoms and independence – New surroundings and experiences – New social networks – Separation from family and established friendships – New academic demands – Some students may be afraid to seek certain types of help or request accommodations for a mental health issue for fear of being viewed as incapable or being expelled. – However, without accommodations, their performance may be negatively affected Developing Resilience – A key component of well-being is resilience—the ability to recognize, face, and manage or overcome problems and challenges, and to be strengthened, rather than defeate
October 4, 2019
428- Changing Habits with Acceptance and Purposeful Action Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free weeks of TherapyNotes with coupon code “CEU” Objectives – Review the –Habits of Highly Effective People and how they apply to recovery from mental health and addiction issues Be Proactive – Be response-able – Your life (Vehicle) – What people things and activities are important to your life- What is your destination / Good Orderly Direction- – What thoughts, attitudes and self talk will help you move toward that destination- (Empowering, accepting, compassionate) – What actions will help you move toward that destination- (self-care, building support, therapy, new job…) – What challenges or adversities can you plan for and mitigate- (Illness, financial stresses, bad days, deaths, holidays…) Be Proactive – Be response-able – Your recovery (Engine) – What people things and activities are important to your recovery- What do you need to do to maintain your happiness- – How is your recovery important to your overall life goal or destination- In what ways does it impact the people and things that are important to you- – What challenges or adversities can you plan for and mitigate- Be Proactive – Focus on what is within your control – Imagine a blizzard or hurricane is coming – What is and is not within your control- – How can you minimize the distress – How can you maximize the happy and build your reserves – Make a list of things (including positive things) that are within your control Be Proactive – Develop skills to help you regulate your emotions, urges and actions and choose those that help you move toward happiness. – Admit and learn from mistakes – Practice the 3 finger rule ACT – Action – Changes – Things – What action can you take right now to start changing things for the better- Begin with the End in Mind – Most failures result from failure to envision/plan (within reason) – Going to the gym – Going to the grocery without a list – Going on vacation without a destination – Starting a project without a plan Begin with the End in Mind – Envision in your mind what you cannot at present see – If you were happy, what would be same and different- – What is your personal mission statement (revisable)- – What do you do- – How do you do it- – Why do you do it- – What do I really want out of life- – What am I uniquely put on earth to achieve- – What do I believe my purpose or mission is in life- Begin with the End in Mind – Envision in your mind what you cannot at present see – If you were happy, what would be same and different- – What is your personal mission statement (revisable)- – What do you do- – How do you do it- – Why do you do it- Begin with the End in Mind – Plan ahead and set goals – Specific – Measurable – Achievable – Time Limited – Realistic – Rewarding – Envision reaching your destination daily. – Keep track of progress toward your destination. Put First Things First (Purposeful Action) – Recognize that not doing everything is okay. – Prioritize by practicing mindful discipline – Remind yourself why you do the things you do – For new opportunities, ask “Does X get you closer to the things that are most important to you-” – Organization reduces stress and energy expenditure – Do you have energy and time to do it over if you don’t do it right the first time- (Outlining) – It's all right to say no or ask for help when necessary to focus on your highest priorities. Put First Things First (Purposeful Action) – Practice Time Management – List the “have tos” for a week – Cross off
September 28, 2019
427 -Psychosocial Aspects of Diabetes CEUs are available at allceus.com/counselortoolbox    Get two free months of Therapy Notes by using the promocode CEU when you sign up for a free trial at TherapyNotes.com Psychosocial Aspects of Diabetes Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs.com Host: Counselor Toolbox Podcast Objectives ~ Define diabetes type 1 & 2 and Gestational Diabetes ~ Learn about complications of diabetes 1 & 2 ~ Learn about the causes of diabetes 1 & 2 ~ Learn how blood sugar alterations can impact mood, cognition and energy ~ Identify chronic conditions associated with uncontrolled diabetes ~ Describe emotional issues associated with having a diagnosis of diabetes ~ Describe social issues associated with having diabetes ~ Explore common treatment goals for persons with diabetes 1 or 2 Diabetes and Mental Health ~ Nearly 10% of the US population has diabetes ~ 84 million adults ages 18 years or older (34 percent of U.S. adults) have prediabetes ~ People with mood and psychotic disorders are at increased risk of developing diabetes, emphasizing the bi-directional relationship of diabetes and mental disorders ~ Inflammatory changes associated with diabetes itself can be linked to the development of depression Types of Diabetes ~ Type 1 AKA Juvenile Onset or Auto-Immune ~ Chronic condition where little or no insulin production is observed due to autoimmune reaction against the pancreas ~ Can be caused by pancreatic diseases, genetics or auto-immune destruction of pancreatic cells. ~ Type 1 diabetes can appear at any age, it appears at two noticeable peaks. The first peak occurs in children between 4 and 7 years old, and the second is in children between 10 and 14 years old. ~ Some children inappropriately may be referred for mental health care due to irritability and/or depression Types of Diabetes ~ Symptoms of Type 1 can appear relatively suddenly and may include: ~ Increased thirst ~ Frequent urination ~ Extreme hunger ~ Unintended weight loss ~ Bed-wetting in children who previously didn't wet the bed during the night ~ Irritability and other mood changes ~ Fatigue and weakness ~ Blurred vision ~ There's no known way to prevent type 1 diabetes Type 2 Diabetes ~ Type 2 diabetes develops due to a combination of insulin deficiency and ineffective use of insulin ~ Diets that lack certain nutrients, such as magnesium, calcium, fiber, and potassium. ~ Smoking: This can impair insulin sensitivity and production ~ Sleep issues: Losing 1-3 hours of sleep per night for as few as 3 nights can increase insulin resistance. ~ Age: Being over 45 years of age might increase the risk of insulin resistance. ~ Use of steroids due to arthritis, blood disorders, breathing problems, severe allergies, skin diseases, cancer, eye problems, and auto immune disorders Type 2 Diabetes ~ Causes cont… ~ Underlying health conditions: High blood pressure, previous episodes of stroke or heart disease, and polycystic ovarian syndrome (PCOS) can all increase a person's risk of developing insulin resistance. ~ Hormonal disorders: ~ Cushing's syndrome (too much cortisol) ~ Menopause: Estrogen and progesterone affect how your cells respond to insulin ~ Lack of exercise ~ Obesity ~ Adults may present for mental health care when diabetes is the underlying cause of their mood and energy changes. Gestational Diabetes ~ Pregnancy complications. High blood sugar levels can be dangerous for both the mother and the baby. ~ Miscarriage, stillbirth and birth defects ~ Diabetic ketoacidosis ~ Diabetic eye problems (retinopathy) ~ Pregnancy-induced high blood pressure and preeclampsia. ~ Women with diabetes often have more difficulty getting and staying pregnant ~ Gestational diabetes is not the cause of an increased risk of Type 2 diabetes. The increased risk of Type 2 diabetes was there all along and is the cause of the gestational diabetes ~ Mothers who gain a lot of weight when pregnant and do not lose it increase their ris
September 28, 2019
426 -Polyvagal Theory and Trauma Recovery with Curtis Buzanski CEUs are available at allceus.com/counselortoolbox    Get two free months of Therapy Notes by using the promocode CEU when you sign up for a free trial at TherapyNotes.com
September 27, 2019
425 -Meditation Techniques CEUs are available at allceus.com/counselortoolbox    Get two free months of Therapy Notes by using the promocode CEU when you sign up for a free trial at TherapyNotes.com Meditation Techniques Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs.com Counselor Education Host: Counselor Toolbox Podcast Objectives ~ Learn the benefits of meditation ~ Identify the goals of meditation ~ Describe how to get started with meditation ~ Explore 15 types of meditation Benefits of Meditation ~ Reviews to date have demonstrated that both “mindfulness” and “mantra” meditation techniques reduce emotional symptoms (e.g., anxiety and depression, stress) and improve physical symptoms (e.g., pain) from a small to moderate degree ~ Mindfulness meditation was found to show moderate improvement for ~ Anxiety (44%) ~ Depression (52%) ~ Pain (31%) ~ Effects were seen during treatment and maintained at the 3 and 6 month marks. Benefits of Meditation ~ Eight weeks of Mindfulness-Based Stress Reduction (MBSR) increased thickness in the hippocampus, which governs learning and memory, and in certain areas of the brain that play roles in emotion regulation. There were also decreases in volume in the amygdala, which matched the participants’ self-reports of their stress levels. Mindfulness practice leads to increases in regional brain gray matter density Psychiatry Res. 2011 Jan 30; 191(1): 36–43. ~ “People who learned mindfulness were many times more likely to have quit smoking by the end of the training, and at 17 weeks follow-up… Meditation helps people “decouple” the state of craving from the act of smoking” Brewer JA, Mallik S, Babuscio TA, et al. Mindfulness training for smoking cessation: results from a randomized controlled trial. Drug Alcohol Depend. 2011;119(1-2):72-80. ~ Mindfulness meditation has shown utility in the treatment of other addictions as well. Brewer JA, Elwafi HM, Davis JH. Craving to quit: psychological models and neurobiological mechanisms of mindfulness training as treatment for addictions. Psychol Addict Behav. 2012;27(2): 366-79. Benefits of Meditation ~ “Long-term meditators had better-preserved brains than non-meditators as they aged. Participants who’d been meditating for an average of 20 years had more grey matter volume throughout the brain. Forever Young(er): potential age-defying effects of long-term meditation on gray matter atrophy. Front. Psychol., 21 January 2015 | https://doi.org/10.3389/fpsyg.2014.01551 ~ Mindfulness meditation decreases activity in the area of the brain network responsible for mind-wandering and self-referential thoughts – a.k.a., “monkey mind” which is typically associated with being less happy, ruminating, and worrying about the past and future. Meditation experience is associated with differences in default mode network activity and connectivity PNAS December 13, 2011 108 (50) 20254-20259; https://doi.org/10.1073/pnas.1112029108 Goals of Meditation ~ Reducing negative emotions, cognitions, and behaviors ~ Increasing positive emotions, cognitions, and behaviors toward self and others ~ Altering relevant physiological processes (immune, inflammation, bp etc.) and pain perception ~ Boosting one’s ability to empathize with others Getting Started ~ Start with 2 minutes a day ~ Do it first thing in the morning or right before bed ~ Consider doing it with a friend or family member ~ Don’t get caught up in how…just do it. Spend 2 minutes focused on the present moment ~ Focus on your breaths and/or your heart rate ~ Come back when you wander ~ Develop a loving, nonjudgmental attitude ~ Don’t worry about clearing your mind, just practice focusing your attention Getting Started cont… ~ Do a body scan ~ Notice the light, sounds, energy ~ Stay with whatever arises. Instead of avoiding feelings like frustration, anger, anxiety, just stay, and be curious. ~ Get to know yourself. Learn how your mind works. By watching your mind wander, get frustrated, avoid difficu
September 21, 2019
424 -Supporting the Person Without Enabling Instructor: Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counselor Continuing Education Podcast host: Counselor Toolbox and Happiness Isn’t Brain Surgery Objectives – Explore how a person becomes an enabler – Define enabling – Examine the consequences of enabling – Learn about the connection between enabling and co-dependency – Define characteristics of codependency and how they may develop from being in an enabling relationship – Examine practical strategies to provide support and encouragement to the loved one without enabling. What Makes an Enabler – A person that you love who is in trouble or experiencing pain – An addicted person – A person with mental health issue – A person with chronic pain – A child – A sense of responsibility for the problem (If I would have been more aware…, If I had…) – Denial that there is a problem requiring professional help (initially) – Once you have “helped” once it is hard to stop – Emotional manipulation to maintain the behavior What is Enabling – Enabling behavior: – Protects the person from the natural consequences of his behavior – Keeps secrets about the person’s behavior from others in order to keep peace – Makes excuses for the person’s behavior (with teachers, friends, legal authorities, employers, and other family members) – Bails the person out of trouble (pays debts, fixes tickets, hires lawyers, and provides jobs) – Blames others for the person's behaviors (friends, teachers, employers, family, and self) – Sees “the problem” as the result of something else (shyness, adolescence, loneliness, broken home, ADHD, or another illness) – Avoids the person in order to keep peace (out of sight, out of mind) – Gives help that is undeserved, unearned or unappreciated What is Enabling – Enabling behavior: – Attempts to control the other person by planning activities, choosing friends, and getting them jobs and doctor appointments – Makes threats that have no follow-through or consistency – “Care takes” the person by doing what she/he is expected to do for herself/himself – Ignoring the person’s negative or potentially dangerous behavior – Difficulty expressing emotions –especially if there are negative repercussions for doing so – Prioritizing the needs of the person with the addiction before their own – Acting out of fear – Since addiction can cause frightening events, the enabler will do whatever it takes to avoid such situations – Resenting the person with the addiction What Does Enabling Look Like – “He’s so irresponsible with money, he could never make it on his own. If I kicked him out, he would be homeless. What else can I do-” – “Every time I’ve tried to talk to her about her addiction, she’s gone on an even worse binge, and I’m afraid she will overdose.” – “I know I shouldn’t have paid for his lawyer after the third DUI, but if he went to jail, he would lose his job, and we rely on his income.” – “Every time she and her boyfriend fight, she crashes here. I let her because I know he can be violent, and I don’t want her to be hurt.” – “If I don’t get the emails, he will miss them and lose his scholarship.” – “It is my fault she is in pain, so I must do whatever she wants.” – “If I can’t change what he did, at least I can limit the damage.” – “Maybe he will wake up and come to his senses.” – “Maybe I just need to find the right treatment for him.” Consequences of Enabling – Enablers detest the behaviors of the enabled, but fear the consequences of those behaviors even more. – They are locked into a lose-lose position in the family. Setting boundaries feels like a punishment or abandonment of the person they love. – Enablers may struggle with th
September 19, 2019
423 -Nephrology Social Work Between writing notes, filing insurance claims, and scheduling with clients, it can be hard to stay organized. That’s why I recommend TherapyNotes. Their easy-to-use platform lets you manage your practice securely and efficiently. Visit TherapyNotes.com to get two free months of TherapyNotes by just using the promo code CEU when you sign up for a free trial at TherapyNotes.com. Objectives – Identify the causes of kidney failure – Explore the consequences of kidney failure Facts about CKD – 1 in 7 or 30 million American adults have CKD and 1 in 3 are at increased risk. – Early detection can help prevent the progression of kidney disease to kidney failure. – Heart disease is the major cause of death for all people with CKD. – Hypertension causes CKD and CKD causes hypertension. – High risk groups include – those with diabetes, hypertension and family history of kidney failure. – African Americans (diabetes, HBP), Hispanics, Pacific Islanders, American Indians and Seniors – The progression of CKD can be stopped if caught before stage 4 Causes of Kidney Disease – Diabetes – 30-40% of people with diabetes also have kidney disease (>2% of the adult population) – People with diabetes and CKD are more prone infections and anemia increasing their vulnerability to acute complications – High blood pressure – Glomerulonephritis, a group of diseases that cause inflammation and damage to the kidney's filtering units. – Inherited diseases, such as polycystic kidney disease – Malformations that occur as a baby develops – Lupus and other diseases that affect the body's immune system. – Obstructions caused by problems like kidney stones, tumors or an enlarged prostate gland in men. – Repeated urinary infections. Symptoms – Feel more tired and have less energy – Have trouble concentrating – Have a poor appetite – Have trouble sleeping – Low back pain – Have muscle cramping at night – Have swollen feet and ankles – Have puffiness around your eyes in the morning – Have dry, itchy skin – Need to urinate more often, especially at night – Blood in the urine – Nausea – High blood pressure (headache, blurred vision, pounding in ears) End Stage Renal Disease – End stage renal disease (ESRD) is the point when the kidneys cannot filter waste and excess fluid from the body. – Dialysis mechanically removes waste when the body is no longer able to do so and takes 3-4 hours per session. – In hemodialysis, blood travels through a tube and is filtered by an artificial kidney – In-center hemodialysis is done three times per week in a clinic setting – In peritoneal dialysis, a solution is administered through a catheter in the abdomen and is later removed – Peritoneal dialysis and home hemodialysis can be done at a time and a location chosen by the patient Functions of a Nephrology Social Worker – Psychosocial evaluation and treatment planning – Counseling and conferences with patients, families, and support networks – Discharge planning – Groupwork (education, emotional support, self-help) – Information and referral – Facilitation of community agency referrals – Team care planning and collaboration – Advocacy on patients’ behalf within the setting and with appropriate local, state, and federal agencies and programs – Patient and family education Problems Addressed – Adjustment to chronic illness and treatment as they relate to quality of life – Changes in activities and friendships/ Inability to engage in previous activities – Transportation assistance – Childcare needs – Fatigue – Age, employment and finances were significant predictors of adjustment issues and treatment compliance – The perception of an ill
September 17, 2019
ReRelease Gut Health & Mental Health: The Impact of the Second Brain Dr. Dawn-Elise Snipes PhD, LPC-MHSP, Executive Director: AllCEUs.com CEUs are available for this presentation at AllCEUs https://www.allceus.com/member/cart/index/product/id/959/c/ Between writing notes, filing insurance claims, and scheduling with clients, it can be hard to stay organized. That’s why I recommend TherapyNotes. Their easy-to-use platform lets you manage your practice securely and efficiently. Visit TherapyNotes.com to get two free months of TherapyNotes by just using the promo code CEU when you sign up for a free trial at TherapyNotes.com. Disclaimer ~ This is for educational purposes only and not intended to replace medical advice. Always have clients discuss any nutritional changes or supplements with a Registered Dietician or their primary care physician. 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 Overview ~ Gut microbiota appear to influence the development of emotional behavior, stress- and pain-modulation systems, and brain neurotransmitter systems ~ Microbiota changes caused by illness, dietary changes, probiotics and antibiotics impact endocrine and neurocrine pathways (bottom up) ~ The brain can in turn alter microbial composition and behavior via the autonomic nervous system (“stress”) (top down) ~ Even mild stress can change the microbial balance in the gut, making the host more vulnerable to infectious disease and triggering a cascade of molecular reactions that feed back to the central nervous system Overview ~ Exposure to chronic stress decreased the relative abundance of Bacteroides species and increased the Clostridium species in the caecum; and caused activation of the immune system (i.e. inflammation) ~ Children with Autism Spectrum Disorder treated with oral vancomycin —antibiotic to reduce Colostridium– had significant improvement in behavioral, cognitive and GI symptoms ~ Acute and chronic stress increase GI and BBB permeability through activation of mast cells (MCs) Gut Inflammation and Mood ~ Inflammation of the GI Tract places stress on the microbiome through the release of cytokines and neurotransmitters. ~ Coupled with the increase in intestinal permeability, these molecules then travel systemically. ~ Elevated blood levels of cytokines TNF-a and MCP (monocyte chemoattractant protein) increase the permeability of the blood-brain barrier, enhancing the effects of rogue molecules from the permeable gut. ~ Their release influences brain function, leading to anxiety, depression, and memory loss. Gut-Brain Connection ~ The vagus nerve is one of the biggest nerves connecting your gut and brain. It sends signals in both directions ~ In mice it was found that feeding them a probiotic reduced the amount of cortisol in their blood. However, when their vagus nerve was cut, the probiotic had no effect ~ Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve. Proc Natl Acad S
September 8, 2019
421 -Mental Health & the Elderly 12 Key Points Podcast is part of A La Carte Course: https://www.allceus.com/member/cart/index/product/id/112/c/ Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs.com Podcast Host: Counselor Toolbox & Case Management Toolbox Objectives – Review 12 key issues that either differ or often go overlooked in people over 65 Psychosocial Adjustment to Aging – There are multiple psychosocial aspects to aging – Integrity vs. Despair – Loss of physical functioning – Death of friends – Changes in social relationships – Frequent mental distress (FMD) may interfere with major life activities, such as eating well, maintaining a household, working, or sustaining personal relationships. – Older adults with FMD were more likely to engage in behaviors that can contribute to poor health, such as smoking, not getting recommend amounts of exercise, or eating a diet with few fruits and vegetables (11) Emotional Health – Mood issues are not a consequence of normal aging – Depression – Situational (grief, life transitions) – Vascular – Bidirectional association between depression and cardiovascular diseases – Elderly men have the highest rate of suicide of any age group – When untreated, depression reduces life expectancy, worsens medical illnesses, enhances health care costs and is the primary cause of suicide among older people – Both exercise and dietary interventions can promote mental health – Almost half of older adults who are diagnosed with a major depression also meet the criteria for anxiety Cognitive Decline – It is often partly preventable – Slowing or some loss of other cognitive functions takes place, most notably in: – Information processing – Selective attention – Problem-solving ability – Prevention and early intervention should focus on – Encouraging different problem solving tasks (hobbies, puzzles etc.) – Maintaining physical activity to improve blood flow – Maintaining a good sleep routine (including addressing bladder issues) Cognitive Health – Dementia Risk Factors – Smoking – Alcohol use – Hypertension – Diabetes – TBI from falls – Dementia Interventions – Physical activity – Control of blood pressure – Not smoking – Social engagement – Depression prevention/intervention – Diabetes management Chronic Health Conditions – Medications – Pain – Increased injury risk – Parkinson’s Disease – Frailty Syndrome is a geriatric syndrome characterized by the clinical presentation of identifiable physical alterations such as loss of muscle mass and strength, energy and exercise tolerance, and decreased physiological reserve – Malnutrition – Lack of Exercise – Depression – Horticulture Therapy shows great potential in enhancing mental health, cognitive functioning and physical health in the elderly Medication – Age-related physiological changes that can impact drug effects include the following: – absorption: increasing gastric pH, decreasing absorptive surface – distribution: decreasing total body water, lean body mass, and serum albumin – metabolism: decreasing hepatic mass and blood flow – excretion: decreasing renal blood flow, glomerular filtration rate, and tubular secretion. – Some of the most common medicines likely to have adverse effects include anticoagulants, antibiotics, diuretics, hypoglycemic agents, benzodiazepines, opioids, NSAIDs Sexuality – Hormonal changes and other physiological changes associated with aging affect sexual interest. – Erectile dysfunction is a problem in men increasing with age. – Diabetes, cardiovascular, cancerous, and chronic respiratory diseases and also some medications can reduce sexual capacity and d
September 5, 2019
420 -Wellness & Illness Prevention Concepts & Strategies Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs.com Podcast Host: Counselor Toolbox & Case Management Toolbox Objectives – Explain the purpose of wellness and disease prevention – Identify the benefits of it – Define the 3 types of prevention and intervention activities – Describe the steps to initiate a change – Apply knowledge of the principles of effective programs Purpose of Prevention and Early Intervention – Attainment of the highest possible standard of health depends on a comprehensive, holistic approach which goes beyond the traditional curative care, involving communities, health providers and other stakeholders. – This holistic approach should empower individuals and communities to take actions for their own health, foster leadership for public health, promote intersectoral action to build healthy public policies and create sustainable health systems in the society Benefits – Benefits include: – Knowledge about risk factors for developing health problems – Awareness of personal risk factors – Screening to identify whether health conditions may be present – Coaching about how to manage newly identified health problems – Strategies for prevention of future health problems Dimensions Model of Health – The Dimensions Model of Health includes 6 dimensions – Biophysical Dimension – Psychological and Emotional Dimension – Behavioral Dimension – Socio-cultural Dimension – Environmental Dimension – Health Systems Dimension Goals – Reducing Risk Factors – Individual – Microsystem (immediate family, peers) – Exosystem (neighborhood, school, work) – Macrosystem (culture) – Enhancing Protective Factors – Individual – Microsystem (immediate family, peers) – Exosystem (neighborhood, school, work) – Macrosystem (culture) Types of Prevention – Primary prevention (Wellness) aims to prevent problems before they ever occur by reducing risk and enhancing protective factors. (Diabetes, TBI, Smoking, Depression) – Education about healthy and safe habits – Safe schools and communities through effective enforcement of community laws and norms regarding health and mental health behaviors. – Annual, universal screenings for health and mental health issues. – Access to safe housing, nutrition and medical care. – Opportunities for gainful employment to prevent poverty and increase community connection. – Access to parenting education. Types of Prevention – Secondary prevention reduces the impact of problems that have already begun, with the goal of halting and reversing the progression. (Diabetes, TBI, Smoking, Depression) – Access to early intervention, self-help groups and counseling – Access to medication and patient assistance programs – Access to safe, sober housing Types of Prevention – Tertiary prevention prevents additional issues from Diabetes, TBI, Smoking, Depression – Job coaching and advocacy to ensure employment – Financial counseling and assistance to prevent poverty and financial stress – Access to adequate nutrition, medication and healthcare for overall health and wellbeing – Access to safe, sober housing to prevent homelessness Types of Interventions – Universal interventions attempt to reduce specific health problems across all people in a particular population such as children in your county, by reducing risk and promoting protective factors (Prevent TBI) – Selective interventions are aimed at a subgroup determined to be at high-risk due to their exposure to risk factors (football players) – Indicated interventions are targeted to individuals who are already experiencing problems or distress. (Football players with TBI) Steps to Initiate Cha
August 31, 2019
419 -13 Useful Brief Interventions Instructor: Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC CEUs are available at allceus.com/counselortoolbox Objectives ~ Review the benefits of brief interventions ~ Identify the goals of brief interventions ~ Explore 13 brief interventions that can be used with most clients Benefits ~ Reduce no-show ~ Increase treatment engagement ~ Increase compliance ~ Increase self-efficacy ~ Reduce aggression and isolation ~ Provide an interim for clients on waiting lists Goals of Brief Interventions ~ Goals should be… ~ Specific ~ Measurable ~ Achievable in 8-10 weeks ~ Relevant ~ Time Limited ~ Purpose: ~ Reduce the likelihood of damage/additional problems from the current issue. (i.e. family, work, health, self-esteem, guilt, anger) ~ Provide rapid measurable change to increase hope and motivation Target Symptoms ~ General Symptoms ~ Depression/anxiety (mood) ~ Muscle tension ~ Sleep disturbances ~ Concentration ~ Irritability ~ Fatigue ~ Lethargy/psychomotor retardation ~ Hopelessness/helplessness (efficacy) ~ Meta Issues ~ Relationship issues ~ Unhealthy habits (smoking, emotional eating etc.) ~ Modern populations are increasingly overfed yet malnourished, sedentary, sunlight-deficient, sleep-deprived, and socially-isolated Assessment for Brief Interventions ~ Identify what the resolution of the problem looks like. ~ Define a starting point to create one measurable change in the client’s behavior ~ Explore the array of causes of the behavior ~ Physical (sleep, nutrition, relaxation, medicine, health, pain, hormones, addiction…) ~ Affect (anxiety, depression, grief) ~ Cognitions (Cognitive distortions) ~ Environment and Employment ~ Social Relationships (quality, boundaries, communication) Assessment cont… ~ Explore Current Strengths/Mitigating Factors ~ Support systems ~ Client strengths ~ Situational advantages (mitigating factors) ~ Previous treatment (What has and has not worked) 1. Backward Chaining ~ Identify triggers and mitigating factors by backward chaining. ~ Ask the client to describe a situation that triggered the problem ~ John came home late and I got angry ~ I had a bad day and came home and drank a bottle of wine ~ It was valentine’s day and I wasn’t in a relationship so I got depressed ~ I didn’t sleep well and everything seemed to make me feel overwhelmed ~ Ask the client to think of a similar situation that did not trigger the problem ~ John came home late but he called and let me know. ~ I had a bad day and decided to go out to dinner with friends from work to commiserate ~ It was valentine’s day and I wasn’t in a relationship so I went out with friends and we celebrated un-valentine’s day together ~ I didn’t sleep well, so I kept my office door closed and reminded myself that I can only do what I can do 2. Forward Chaining ~ Add in triggers for behaviors you want to start doing ~ Push notifications ~ Visual cues ~ Change buddy ~ Rewards ~ Add in obstacles to behaviors you wish to stop ~ Make it more difficult to start ~ Journal ~ Inaccessibility ~ Temporal distance ~ Aversion 3. Positive Reflection ~ Positive Affect Journaling for 20 minutes per day improves depression and anxiety , enhanced resilience, reduced medical visits ~ Alternatives for those who hate journaling ~ Tell someone about the positive things in your day for ~10-20 minutes ~ Mentally reflect on all the positive things in your day and life for ~10-20 minutes ~ Draw a picture about something incredibly awesome in your life 4. Sleep ~ Benefits: Enhances cognition, enhances immunity, reduces depression and reduces anger, anxiety, and fatigue ~ Only quality sleep within normal limits (7-9 hours) is helpful ~ Incorporation into treatment ~ Review sleep hygiene ~ Develop a sleep routine ~ Keep a log of symptom severity and sleep 5. Sunlight and Circadian Rhythms ~ The body uses sunlight to set circadian rhythms and make vitamin D ~ Vitamin D deficiency is implicated in seasonal affective disorder, behavioral withdrawal
August 30, 2019
418 -Psychosocial Aspects of Disability CEUs are available at allceus.com/counselortoolbox Objectives ~ Define Disability ~ Review the phases of disability adjustment ~ Explore the concept of Disability Identity ~ Identify aspects of disabilities which increase stigma ~ Explore the 5 As of intervention ~ Using ecological theory, explore the psychosocial impact of the disability on the individual and family. Define Disability ~ Any mental health, addictive or physical health issue which restrict or alter a person’s regular or desired activities. ~ Examples ~ Addiction ~ HIV ~ Paraplegia ~ Deafness ~ Visual Impairment ~ Down’s Syndrome ~ Schizophrenia ~ Autism ~ Muscular Dystrophy ~ Chron’s Disease Adjustment to Disability ~ Many people experience more than four stages of adjustment to a physical disability: ~ Shock ~ Anxiety ~ Denial ~ Mourning/Depression ~ Withdrawal ~ Internalized anger & Externalized aggression ~ Acknowledgment ~ Acceptance ~ Adjustment Disability Identity ~ The beneficial self-beliefs that PWDs hold regarding their disabilities, as well as any ties they possess to members of the disability community ~ People with “invisible” disabilities often have a low disability identity ~ Disability identity is negatively correlated with mood disorders ~ Identity development is a fundamentally social process, and identities are formed through mirroring, modeling, and recognition through available identity resources, and so it is imperative that professionals working with individuals with disabilities become aware of this developmental process to be able to better support individuals along this journey Disability Identity Development ~ Key Themes ~ Communal attachment—wishes to affiliate with other PWDs ~ Affirmation of disability—Living in the And ~ Self-worth—values the self and feels equal to nondisabled people ~ Pride—feels proud of identity despite recognizing that disabled is often viewed to be a devalued quality ~ Discrimination—aware of prejudicial behavior in daily life ~ Personal meaning—finds significance in, identifies benefits with, and makes sense of disability Stigmatizing Dimensions ~ Source/responsibility for condition—Is a stigma congenital, accidental, or self-inflicted? ~ Aesthetic—Does the stigma distress or otherwise upset other people? (Addiction, amputation, wheelchair…) ~ Apparent or concealable—Is a stigma obvious (e.g., amputation) or invisible (e.g., psychological or mood disorder, chronic pain, diabetes)? ~ Disruptiveness—Does the stigma’s presence hinder or otherwise prevent social interaction or communication? (aesthetics, cognition, verbalization) ~ Perilous—Can the stigma be seen as contagious or even dangerous to others? (HIV, addiction, psychosis, autism…) ~ Course—Is the stigma getting worse or better? Fundamentals ~ Clients must feel empowered to make decisions regarding self-management ~ Educational and empowerment strategies must be individually tailored ~ Information and support should be consistent with current best practices ~ Collaborative relationships with patients and supporters is critical to success 5 As ~ Assess ~ The condition ~ The client’s and SO’s understanding of the condition ~ Their current coping strategies and efficacy ~ The impact of the condition on the client’s (PACER) ~ Physical Health ~ Affect ~ Cognitions ~ Environment and Economic Well-being ~ Relationships and Recreation ~ Advise/educate the client and significant others 5 As ~ Agree/collaborate to develop a workable plan ~ Short term ~ Long term ~ Assist client and supports in identifying and accessing services ~ Arrange for referrals and follow-up as needed ~ Raise awareness of their rights and of the possibilities and services available to them to ~ Enhance their mental and physical ~ Engage in social/recreational activities ~ Act to eliminate discrimination Ecological Systems Individual Dimensions ~ Risk/Mitigating Factors ~ Age ~ Health (concurrent conditions and health behaviors) ~ Mental Health ~ C
August 17, 2019
417 -Communicating with the Cognitively Impaired Instructor: Dr. Dawn-Elise Snipes, PhD Executive Director: AllCEUs.com, Counselor Education and Training Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery Objectives ~ Define cognitive impairment ~ Explore symptoms of cognitive impairment in ~ Alzheimer’s ~ Dementias ~ Fetal Alcohol Spectrum Disorders ~ Review APA Treatment Guidelines for counselors working with persons with Alzheimer’s ~ Identify methods for effective communication ~ Learn how to handle difficult behaviors ~ Identify specific issues and interventions for a person with a FASD Symptoms of Cognitive Impairment ~ The development of multiple cognitive deficits manifested by both ~ (1) memory impairment (impaired ability to learn new information or to recall previously learned information) ~ (2) one (or more) of the following cognitive disturbances: ~ (a) aphasia (language disturbance) ~ (b) apraxia (impaired ability to carry out motor activities despite intact motor function) ~ (c) agnosia (failure to recognize or identify objects despite intact sensory function) ~ (d) disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting) Symptoms of Cognitive Impairment ~ Other Symptoms ~ Attention ~ Perception ~ Insight and judgment ~ Organization ~ Orientation ~ Processing speed ~ Problem solving ~ Reasoning ~ Metacognition Causes of Cognitive Impairment ~ Wernike-Korsakoff’s Syndrome ~ Vascular Dementia ~ Stroke ~ Impeded blood flow to brain ~ Alzheimers ~ Fetal Alcohol Spectrum Disorders ~ Brain Injury (Car accident, football, fall, boxing) ~ (Temporarily) Hyper or Hypo-glycemia Screening for Cognitive Impairment ~ The AD8 (PDF, 1.2M) and Mini-Cog(PDF, 86K) are among many possible tools. ~ Patients should be screened for cognitive impairment if: ~ The person, family members, or others express concerns about changes in his or her memory or thinking ~ You observe problems/changes in the patient’s memory or thinking ~ The patient is age 80 or older(12) ~ Low education (IQ, FASD, stroke…) ~ History of type 2 diabetes ~ Stroke ~ Depression ~ Trouble managing money or medications ~ Episodes of delirium (confusion/disorientation) Important Aspects of Management ~ Important aspects of psychiatric management include ~ Educating patients and families about ~ the illness ~ treatment ~ sources of additional care and support (e.g.,support groups, respite care, nursing homes, and other long-term-care facilities) ~ the need for financial and legal planning due to the patient’s eventual incapacity (e.g., power of attorney for medical and financial decisions, an up-to-date will, and the cost of long-term care) Important Aspects of Management ~ Behavior oriented treatments ~ Identify the antecedents and consequences of problem behaviors ~ Reduce the frequency of behaviors by changing the environment to alter these antecedents and consequences. ~ Stimulation-oriented treatments ~ recreational activity, art therapy, music therapy, and pet therapy, along with other formal and informal means of maximizing pleasurable activities for patients ~ Emotion-oriented treatments ~ supportive psychotherapy can be employed to address issues of loss in the early stages of dementia ~ Reminiscence therapy has some modest research support for improvement of mood and behavior ~ Tolerate, Anticipate, Don’t Agitate Communication ~ Written, oral, body language/signs ~ Let the client write, draw or speak to communicate ~ Use real objects when possible. (i.e. an apple) ~ Use picture books, posted lists ~ Story boards can be utilized to discuss a behavior incident ~ Use assistive devices when needed (glasses, hearing aids, large font) ~ Have spare reading glasses, hearing assistance (~$150) as people may misplace them ~ Get their attention ~ Orient them to who you are and why you are there ~ Establish rapport before jumping into “business” ~ Get the person’s attention by identifying her by name Communication ~ Us
August 16, 2019
416 -Supporting Clients on Medication Assisted Therapies Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Counselor Education Podcast Host: Counselor Toolbox, Case Management Toolbox, NCMHCE Exam Review CEUs at: https://www.allceus.com/member/cart/index/product/id/1123/c/ Objectives – Define MAT – Explore barriers to treatment What is Our Goal – Help people – Reduce symptoms of depression and anxiety – Agitation – Sleep disruption – Anhedonia – Fatigue – Feelings of worthlessness and guilt – Stay alive (not overdose or commit suicide) – Be relatively pain free (bidirectional with depression and anxiety) – Be independent – Improve interpersonal relationships – Be financially secure – Be “productive” members of society to their ability Goals – Pain, financial instability, lack of independence, poor relationships, mood disorders, low self-esteem, lack of effective coping skills are common in people addicted to opioids To Achieve This Goal – Clients must – Enter treatment – Stay in treatment long enough to: – Get through any PAWS syndromes caused by switching to MAT – Enable their neurotransmitters to balance out – Address biopsychosocial issues that trigger or maintain illicit drug use (SPACE) – Social – Physical – Affective – Cognitive – Environmental Question – Do you have biases towards clients who take antidepressants- Benzodiazepines- – Methadone is a serotonin re-uptake inhibitor – Buprenorphine is a partial agonist – Do you have biases toward clients who take opioids or gabapentin for chronic pain- – It is possible to develop physical dependence on gabapentin and experience withdrawal effects for up to 45 days Review of Terms – Agonists–medications that bind with the brain’s receptors and produce opioid-like effects (Methadone, morphine, fentanyl, heroin) – Partial agonists-medications that bind with given receptors and only produce limited opioid-like effects.(Buprenorphine) – Antagonists-medications that block receptors and prohibit opioid-like effects.(Naloxone) – Street and pain-killer opioids are “short acting” – MAT is “long acting” Benefits of MAT – Methadone does not create a pleasurable or euphoric feeling from mu-receptor activation – The medications used in MAT reduce cravings, prevent withdrawal and help normalize brain function so that you can focus on developing the healthy thought and behavior patterns that will sustain recovery. (SAMHSA, 2003) – MAT provides individuals a taper of long-acting opioid medications as a way to wean them off of stronger opioids such as heroin – A minimum of 12 months is required for methadone maintenance to be effective (NIDA, 2009). Benefits of MAT – Reduce overdose risk – Improve the chance of survival – Reduce the risk of relapse – Improve retention in treatment for an adequate period of time to address biopsychosocial issues – Employment – Pain – Other health issues – Relationship problems – Mood disorders (The correct SSRI takes up to 2 months to take effect) – Reduce criminal activities associated with substance use disorders – Reduce negative health outcomes, including HIV and hepatitis infection – Improve birth outcomes among addicted pregnant women Stigma – Stigma is typically a social process characterized by exclusion, rejection, blame or devaluation that results from an adverse social judgment about a person or group – The presence of stigma leads to ongoing discrimination and marginalization with detrimental effects for clients, families and communities including decreased self esteem, increased isolation and vulnerability, and a reduced likelihood of service access. – Associative stigma is the process of being s
August 13, 2019
415 -Relapse Prevention Groups for Addiction and Mental Health Disorders Part of the Co-Occurring Disorders Recovery Coaching Series Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Objectives ~ Define Relapse ~ Identify triggers and warning signs of relapse ~ Review Relapse Syndrome and possible interventions ~ Explore the acronym DREAM ~ Define and identify vulnerabilities ~ Define and identify exceptions ~ Develop a relapse prevention plan Types of Relapse ~ Emotional relapse ~ Mental relapse ~ Physical relapse ~ Behavioral Relapse Relapse Warning Signs ~ Emotional Cues ~ Anger and irritability ~ Anxiety ~ Depression ~ Resentment ~ Mood Swings ~ Boredom ~ Mental Cues ~ Negativity ~ All or none thinking ~ Concentration problems ~ Memory problems ~ Rigidity/Problem solving difficulties ~ Physical Cues ~ Sleep problems ~ Appetite problems ~ Medication noncompliance ~ Fatigue ~ Pain ~ Tension ~ Social Cues ~ Unhelpful friends ~ Isolation ~ Not asking for help ~ Secrets ~ Stop meetings/support groups/counseling Relapse Warning Signs ~ Discuss the above relapse warning signs ~ How they are rewarding ~ Best ways to address them Relapse Warning Signs and Triggers ~ Family Feud ~ Preparation ~ There are 4 questions for the first part of the game ~ Name the top 5 emotional relapse warning signs ~ Name the top 5 cognitive relapse warning signs ~ Name the top 5 physical relapse warning signs ~ Name the top 5 social relapse warning signs ~ Write the first letter of each word of the 5 warning signs to guide people (You can make your own warning signs if you want) Name the Top 5 Emotional Relapse Warning Signs Name the Top 5 Emotional Relapse Warning Signs Relapse Warning Signs and Triggers ~ Discussion ~ Have people identify the key questions to address each relapse warning sign ~ How are you feeling? ~ Why are you doing this/feeling this way? ~ Who can help you? ~ What 3 things can you do to change the situation or how you feel about the situation? ~ When will you do it? ~ As you discuss each warning sign, have clients fill out a worksheet with solutions for themselves Recovery Signals ~ Dot Chart (Bingo markers) 10 Most Common Triggers of Relapse ~ Withdrawal symptoms (anxiety, nausea, physical weakness, psychological withdrawal and craving) ~ Post-acute withdrawal symptoms (anxiety, irritability, mood swings, poor sleep) ~ Poor self-care (stress management, eating, sleeping) ~ People ~ Places (where you used or where you used to buy drugs) ~ Things (that were part of your using, or that remind you of using) ~ Uncomfortable emotions (H.A.L.T.: hungry, angry, lonely, tired) ~ Relationships and sex (can be stressful if anything goes wrong) ~ Isolation (gives you too much time to be with your own thoughts) ~ Pride and overconfidence (thinking you don’t have a drug or alcohol problem, or that it is behind you) Recovery Triggers ~ Recovery triggers are things that remind you to do the next right thing to keep moving toward your goals (Design plan (car, home, work)) ~ Mood (Happiness, compassion, gratitude, hope, optimism, courage, determination) ~ People (That inspire you to move forward and support and encourage you) ~ Sights (décor (dishes, pictures, blankets, pillows, framed memories), mobile device) ~ Smells (that trigger a recovery mood or remind you of a goal or to do something) ~ Sounds (That help you relax, get energized or focused) Goal Awareness ~ Recovery is about heading toward a happier, healthier life. ~ Define what that looks like ~ Relationships with… ~ Kids that trust and confide in me and want to spend time with me ~ Pets that are happy ~ Activities ~ Run a marathon ~ Foster rescue animals ~ Health ~ Have ample energy to get through the day ~ Be in good health ~ Things ~ Own my house ~ Be able to comfortably pay my bills Goal Awareness Worksheet PAWRS ~ Hot Potato/Beach Ball OR Small Group Work ~ First write the symptoms on the board and discuss what might cause these symptoms in recovery from depre
August 12, 2019
414 -5 Elements of Motivational Interventions & 5 Principles of Motivational Interviewing Instructor: Dr. Dawn-Elise Snipes, PhD Executive Director: AllCEUs.com, Counselor Education and Training Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery Objectives – Learn how motivation is dynamic – Explore reasons and methods for enhancing motivation – Identify 3 critical elements of motivation – Delineate the 5 elements of motivational approaches – Review the FRAMES model – Identify ways to deal with resistance – Review how to use decisional balance exercises Why Enhance Motivation- – Inspiring change – Preparing clients to enter treatment – Engaging and retaining clients in treatment – Increasing participation and involvement – Improving treatment outcomes – Encouraging a rapid return to treatment if symptoms recur – Creates a therapeutic partnership 6 Characteristics of Motivation – Motivation is positive and a key to change – Motivation “harnesses” energy to use to accomplish a task – What happens when you are not motivated– To clean, exercise, work 6 Characteristics of Motivation – Motivation is multidimensional • Emotional • Mental • Physical • Social Support and Pressures • Legal • Financial – Cube activity – #1 – On a large box identify all the reasons to NOT change on each face – Can include drawbacks to change and benefits to staying the same – Discuss ways to eliminate those drawbacks – #2 – Get small-ish square boxes for clients to decorate – On each face of the cube, have them identify motivations for change 6 Characteristics of Motivation – Motivation is multidimensional – Scale Activity – Get at least 10-20 regular marbles and 10 shooter marbles (bigger) – Get (or fashion a scale) One side is labeled “change” the other side is labeled “same” – Write on the white board 2 columns – Benefits to Staying the Same (and drawbacks to change) – Benefits to Change (and drawbacks to staying the same) – Have clients complete each list – Then talk about how some “reasons” carry more weight. – Bring out the scale and stones. – Have clients assign a “weight” to each reason and deposit it in the appropriate side – Goal is to see that it is about the total weight that tips the balance 6 Characteristics – Motivation is dynamic and fluctuating – Is a dynamic state that can fluctuate over time and in relation to different situations rather than a static personal attribute – Can vacillate between conflicting objectives – Differs between objectives – Varies in intensity, faltering in response to doubts and increasing as doubts are resolved and goals are envisioned more clearly. – Example: Getting Healthy – Nutrition – Exercise – Sleep – What conditions would make you motivated and what conditions would undermine your motivation- 6 Characteristics – Motivation is dynamic and fluctuating – SMART Goals increase efficacy – Specific – Measurable – Achievable – Relevant – Time Limited – Examples – Get healthy to reduce my risk of cancer – Lose weight to get my partner to pay attention to me Goal Setting Activities – Out of the Hat – Write goals on strips of paper and put them in a hat or box – Have clients draw a strip and restate the goal in specific, measurable, Achievable, Relevant and Time limited terms – The strip might say: Lose Weight – The client might say: Lose 10 pounds in 2 months so I am more comfortable in my clothes – The strip might say: Not be depressed – The client might say: Increase my overall happiness to a rating of 4 out of 5 at least 5 days per week in the next 8 weeks. – The strip might say: Improve my rel
August 9, 2019
413 -E-Therapy Ethics 2019 Dr. Dawn-Elise Snipes LMHC, LPC-MHSP Charles Snipes, CTO AllCEUs.com State Laws and Boards ~ State laws and Board regulations vary considerably ~ You must know the requirements for your license in the states in which you are licensed and/or certified ~ Independent practice ~ E-Therapy ~ Privacy laws and policies vary between states and entities. Ethical Codes and Etherapy ~ Guidelines for the Practice of Telepsychology American Psychological Association (APA) ~ The ACA 2014 Code of Ethics and Technology: New Solutions to Emerging Problems American Counseling Association (ACA) ~ ACA 2014 Code of Ethics Section H “Distance Counseling, Technology, and Social Media” ~ NBCC Policy Regarding the Provision of Distance Professional Services ~ ISMHO/PSI Suggested Principles for the Online Provision of Mental Health Services International Society for Mental Health Online (ISMHO) ~ NASW Standards for Technology in Social Work Practice Other Resources ~ TIP 60: Using Technology-Based Therapeutic Tools in Behavioral Health Services ~ HIPAA FAQs from HHS.gov Objectives ~ Identify differences between etherapy and face-to-face counseling ~ Discuss the pros and cons of etherapy ~ Discuss issues with client confidentiality ~ Explore issues related to boundaries, dual relationships and social networking ~ Review various ethical codes as they relate to etherapy ~ Dealing with disinhibition ~ Common ethical violations in etherapy Reasons/Benefits ~ Access experts on a particular problem in a greater area ~ More cost effective for the practitioner and the patient ~ More convenient ~ Wider range of available business hours ~ Provides a degree of anonymity ~ People are generally more open since they are in their comfort zone (home) ~ Many of the youth prefer etherapy ~ An adjunct to traditional therapy “Therapist Extenders” ~ Accessible with a DSL connection and a $15 webcam Drawbacks to Etherapy ~ Set-up takes some cost and technical know-how ~ You must be thoroughly familiar with HIPAA and HiTECH Act ~ There are a lot of HIPAA and HiTECH Act violations making etherapy seem less professional ~ Can be more difficult to handle crises and identify decompensation ~ Some argue that accurate assessments cannot be done virtually ~ All modes of etherapy can be captured and redistributed ~ In cases of domestic violence there are unique challenges ~ Not as effective with cultures that use high-context communication Monitoring ~ Technology/intervention usage rates ~ Demographic characteristics of clients ~ Retention and satisfaction rates ~ Staff satisfaction ~ Equipment malfunctioning rates/downtime ~ Costs of care and cost offsets ~ Rates of referral ~ Changes in symptoms Considerations for Appropriateness ~ Clients level of comfort, preference for and access to technology ~ Cognitive capacity and maturity ~ Past and current medical and behavioral health diagnoses including psychosis ~ Communication skills ~ Client’s support system ~ History of violence or self-injurious behavior Appropriate Clients ~ Diagnoses ~ Generalized anxiety disorder ~ Depression and postpartum depression ~ Obsessive compulsive disorder ~ Post Traumatic Stress Disorder ~ Seasonal Affective Disorder ~ Binge Eating Disorder ~ Substance Abuse Informed Consent ~ According to ISHMO and NBCC, all of the following must be part of the informed consent ~ The possibility of misunderstandings, particularly with text-based forms of E-therapy ~ Cultural and/or language differences that may affect delivery of services ~ The increased response time involved in asynchronous forms of communication and average response time ~ Time zone differences Informed Consent ~ According to ISHMO and NBCC cont… ~ Social media policy and the counselor’s right to privacy and the possibility of restrictions on the client’s use of any communication with the practitioner ~ Counseling credentials, physical location of practice, and contact information ~ Alternatives to receiving assista
August 2, 2019
Violence Prevention in the Workplace CEUs available at: https://www.allceus.com/member/cart/index/product/id/1082/c/ Dr. Dawn-Elise Snipes, PhD, LPC-MHSP Executive Director: AllCEUs Counselor Education Podcast Host: Counselor Toolbox, Case Management Toolbox Based in Part on – Registered Nurses’ Association of Ontario (2012). Managing and Mitigating Conflict in Health-care Teams. Toronto, Canada: Registered Nurses’ Association of Ontario. – Registered Nurses’ Association of Ontario (RNAO). Preventing violence, harassment and bullying against health workers. 2nd ed. Toronto (ON): RNAO; 2019. Objectives – Define types of violence in the workplace – Explore best practices for prevention Types of Violence – Type I (Criminal intent): perpetrator has no relationship to the workplace – Type II (Client or customer): perpetrator is a client at the workplace who becomes violent toward a worker or another client – Type III (Worker-to-worker): perpetrator is an employee or past employee of the workplace – Type IV (Personal relationship): perpetrator usually has a relationship with an employee (e.g. domestic violence in the workplace) – Type V (Worker-to-client): perpetrator is an employee who becomes violent towards a client Violence in the workplace – Involves a misuse of power and control and it may take the form of physical, psychological or sexual abuse; and/or harassment, mobbing, bullying, or aggression. – May involve action or withholding action. – May be done unintentionally or intentionally. – Often involves interactions between people in different roles and power relationships – Is inevitable in the work setting due to inherent differences in goals, needs, desires, responsibilities, perceptions and ideas Conflict Inevitability – Conflict is inevitable in work settings. – Perceived and actual differences that may contribute to conflict include: – Professional identity and/or education – Cultural identity – Gender and gender identity – Marital status – Disability – Work values – Goals – Interests – Treatment approach Other Factors Contributing To Conflict – Effects of shift work – Team composition and size – Workload and staffing – Role ambiguity – Manager span of control – Power differences – Level of staff involvement in decision-making and provision of care – Resource allocation – Diversity in the workplace – Physical space – Diagnoses/stressors in the person’s life Underpinnings of Violence Prevention – Leadership is required across all organizational levels to create environments that practice management and mitigation of conflict. – All conflict has a meaning and/or contributing underlying cause. – Anger is often a response to a threat of loss of control, rejection, isolation, failure, the unknown – Understanding, mitigating and managing conflict may result in positive outcomes such as new ideas and initiatives. – Conflict is addressed in different ways depending upon who the conflict is with Systems & Processes to Minimize Conflict – Regular assessments (clients, employees, team, org) – Improve emotional intelligence – Develop conflict management skills – Educate individuals, teams, and the organization regarding conflict management in specific settings and target groups. – OP, detox, CSU, Alzheimer’s, psychosis, home visits, SOs – Staff on staff; staff on client; client on staff – Implementing refresher courses and/or updates – Require managers to demonstrate accountability for effective conflict management, clear communication and transformational leadership Transformational Leadership – Leader works with teams to identify needed change and create a vision to guide the change – Highlighting important prioritie
July 31, 2019
411 -Cognitive Behavioral Interventions for PTSD CEUs available at: https://www.allceus.com/member/cart/index/product/id/1100/c/ Dr. Dawn-Elise Snipes, PhD, LPC-MHSP Executive Director, AllCEUs Counselor Education Podcast Host: Counselor Toolbox Podcast, Case Management Toolbox Podcast Objectives – Review the symptoms of PTSD – Explore interventions in the following areas – Cognitive: Including ACT, DBT and CPT – Behavioral: Including exercise, sleep, nutrition and relaxation PTSD Symptoms – Re-experiencing the traumatic event (Intrusion) – Intrusive, upsetting memories of the event – Flashbacks – Nightmares – Feelings of intense distress when reminded – Intense physical (panic) reactions to reminders – PTSD symptoms of avoidance and emotional numbing – Avoiding reminders of the trauma – Inability to remember important aspects of the trauma – Loss of interest in activities and life in general – Feeling detached from others or emotionally numb – Sense of a limited future PTSD Symptoms – PTSD symptoms of increased arousal – Difficulty falling or staying asleep – Irritability or outbursts of anger – Difficulty concentrating – Hypervigilance (on constant “red alert”) – Feeling jumpy and easily startled – Negative alterations in cognitions and mood – Inability to recall key features of the trauma – Overly negative thoughts and assumptions about oneself or the world – Exaggerated blame of self or others for causing the trauma – Negative affect – Decreased interest in activities – Feeling isolated What Happens in Trauma – When exposed to a stressor, the HPA-Axis and amygdala are activated and cortisol is released to trigger the fight or flight response – Sustained exposure to cortisol has an adverse impact on the hippocampus resulting in reduction of neurogenesis and dendritic branching – Blunted response to cortisol stimulation indicate that pituitary receptors in the HPA-Axis have been downregulated in patients with PTSD – Hypocortisolism in PTSD occurs due to increased negative feedback sensitivity of the HPA axis Neurochemical Effects of Trauma – 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 – The hippocampus (learning and memory) and prefrontal cortex(impulse control and higher-order thought) mediate the HPA-Axis activity…but… – Reduced volume of the hippocampus, the major brain region inhibiting the HPA axis, is a cardinal feature of PTSD Neurochemical Effects of Trauma – Hypocortisolism is thought to be an autoimmune response. – Physical and psychological stress has been implicated in the development of autoimmune disease – Hypocortisolism may occur after a prolonged period of hyperactivity of the hypothalamic-pituitary-adrenal axis due to chronic stress – The phenomenon of hypocortisolism has been reported not only for people with PTSD, but also for healthy individuals living under conditions of chronic stress emotional and/or physical stress. – Hypocortisolism dysfunction at the time of exposure to psychological trauma may predict the development of PTSD. Neurochemical Effects of Trauma – Glucocorticoids (Cortisol) interfere with the retrieval of traumatic memories, an effect that may independently prevent or reduce symptoms of PTSD. – Therefore, hypocortisolism might be a risk factor for maladaptive stress responses and predispose to future PTSD or stress-related bodily disorders. – Simulation of a normal circadian Cortisol rhythm using exogenously introduced hydrocortisone is effective in the treatment of PTSD. Neurochemical Effects of Trauma – Core
July 25, 2019
Mental Health Aspects of Bariatric Surgery Objectives – 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 – Bariatric surgeries all aim to make the stomach smaller so it can hold less food through removal, banding or bypassing. – Some surgeries also bypass part of the small intestine which inhibits calorie as well as nutrient absorption – Long-term weight loss is associated health improvements – Concerns have been raised about potential ongoing risks of mental health disorders, including substance abuse, self-harm and suicidality, especially following bariatric surgery. In this meta-analysis, surgery was not associated with an improvement in mental health quality of life. Two main hypotheses have been proposed to help explain these findings: (a) patients who choose to undergo bariatric surgery are at a higher baseline risk of psychiatric complications than their non-surgically managed counterparts, or (b) surgery itself increases the risk for adverse mental health outcomes due to potential post-operative issues such as difficult with pain control, complications requiring further treatments, dissatisfaction with weight loss, and weight regain. Therefore, intensive mental health follow-up post-surgery should be routinely considered. Mental health quality of life after bariatric surgery: A systematic review and meta-analysis of randomized clinical trials Reasons for Bariatric Surgery – There has been an increasing amount of evidence for bariatric surgery as a more effective treatment for morbid obesity compared to dietary advice, exercise, lifestyle changes and medication. In particular,the procedure is more effective in achieving significant weight loss, longer term maintenance, improvements in physical co-morbidities and reductions in mortality – Obesity and Cancer Fact Sheet – Obesity and Eating Disorders Fact Sheet – Obesity and Heart Disease Fact Sheet – Obesity and Hypertension Fact Sheet – Obesity and Lipid Issues Fact Sheet – Obesity and Osteoarthritis Fact Sheet – Obesity and Stroke Fact Sheet Bariatric Surgery Outcomes – Health and Health-Related Quality of Life Improvement – Bariatric surgery is associated with sustained weight loss and improved physical health status for severely obese individuals. Mental health conditions may be common among patients seeking bariatric surgery. Mental Health Conditions Among Patients Seeking and Undergoing Bariatric Surgery: A Meta-analysis – 20-30% of patients undergoing bariatric surgery experience premature weight stabilization or weight regain postoperatively. Cognitive behavioral therapy and predictors of weight loss in bariatric surgery patients. – Mental Health Related Quality of Life Improvement – mood often improves in the immediate aftermath of surgery, psychiatric disturbances often re-emerge within two to three years. These patients were almost three times more likely to attempt suicide than a general population – Another study by Bhatti et al., 2016 looked at self-harm emergencies, including suicide attempts and found that these increased by 50% after RYGB – De Zwaan et al investigated the course of anxiety and depressive disorders over the first 2 years post surgery in 107 extremely obese bariatric surgery patients using face-to-face interviews conducted before surgery and after surgery. Although prevalence of depressive disorders decreased significantly immediately after surgery, participants with both depressive a
July 17, 2019
Enhancing Healthy Adolescent Development Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast, Case Management Toolbox Podcast Objectives – Identify the developmental tasks of adolescents and what can be done to facilitate those – Review unique points to remember when dealing with adolescents – Identify protective factors – Identify antecedents to high risk behaviors – Brainstorm ways to address antecedents with the individual, in school, in communities and in families Developmental Tasks of Adolescence Points to Remember – Adolescents are competent individuals with strengths and potential – Adolescents are diverse in their developmental stages and their abilities to comprehend and respond to specific tasks and expectations. – Adolescent behavior is meaningful to the adolescent. – Adolescents desire a sense of belonging, wish to participate in decisions, and have a voice about issues that affect their lives. – The context of an adolescent’s environment (i.e. family, school, peers, culture/ethnic group, neighborhood and community) should always be considered. Points to Remember – Build on adolescent’s strengths – Much of the morbidity and mortality during adolescence is related to unhealthy or risky behaviors (e.g. smoking, drinking and driving, unprotected sex, drug use, violence) – Adolescents who engage in one risky behavior are more likely to engage in others – Focus on the antecedents of high-risk behavior instead of the behavior itself Antecedents to High Risk Behaviors – Adverse Childhood Experiences – Abuse, neglect or victimization—Experienced or witnessed IPV – Divorce and separation – Mental health or substance abuse issues in the household – Undiagnosed learning disabilities – School failure – Academic failure was a greater risk factor for later adolescent drinking than adolescent drinking was for later academic failures Addressing Antecedents Adolescent Brain Development – The brain matures from “back” to “front. ” Adolescent decision-making behaviors are more influenced by the amygdala than the prefrontal cortex: – Decision-making is influenced by emotional/gut responses vs. higher order cognitions – The pre-frontal cortex is responsible for planning, strategizing, judgment, impulse control and regulation of emotions – Initial “growth spurt” at 11-12 years and continues through 25 years – From 12-12 there is a pruning process of unused neuronal connections – The temporal gap between the development of the socio-emotional and cognitive control systems of the brain underlies some aspects of adolescent reckless behavior and risk-taking Comprehensive Health – Healthy young people learn better and achieve more. – Schools can directly influence students’ health and behaviors. – Schools and communities can encourage healthy lifestyle choices, and promotes adolescent health and well-being. – Health literacy can be incorporated into all aspects of school as well as recreation – Schools, families and communities need to collaborate with youth to develop workable strategies Strategies – Enhance cognitive “wise mind” processing during adolescence to retain those synapses – Actively engage youth by providing opportunities for meaningful participation and sustained involvement in protective activities – Develop resiliency skills – Enhance protective factors Protective Factors – Family support – Positive family communication – Clear and consistent boundaries and expectations – Other adult relationships – Encouragement to develop relationships – Connection to the family, school and community – Youth are provided opportunities to be useful resources (meaningful participation) – Youth feel emotionally an
July 12, 2019
408 -Ethics, Burnout & Self Care in Human Service Professions Dr. Dawn-Elise Snipes, PhD, LPC-MHSP Counselor Toolbox Podcast Objectives – Identify signs and causes of burnout – Explore techniques for burnout prevention Is Self Care an Ethical Issue – Burnout is associated with suboptimal care and reduced patient safety. 1, 3, 4 – High demands are associated with greater risk of burnout, regardless of level of other work supports. 2 – Suboptimal care can negatively impact the public’s view of the profession and deter people from seeking treatment – 26% of MAT counselors in one study reported burnout – Depersonalization is characterized by loss of empathy and Your Brain on Stress – Even mild acute uncontrollable stress can cause a rapid and dramatic loss of prefrontal cognitive abilities. – Prolonged stress exposure –> Anatomical changes in prefrontal nerve cells and amygdala enlargement – Focus, Attention – Self Control of Behavior and Speech – Plan and Organize – Perspective Taking – Cognitive Flexibility – Medical and other Decision Making – Ability to Defer Gratification – Estimating Time – Working Memory Ethics – In 1996, the National Association of Social Workers updated the NASW Code of Ethics to cover issues of professional impairment (section 4.05). – Social workers should not allow personal problems, psychosocial distress, or mental health difficulties to interfere with their professional judgment, performance, or responsibilities to clients – Social workers who experience these problems should “immediately seek consultation and take appropriate remedial action” by seeking professional help, making adjustments in workload, terminating practice, or taking any other steps necessary to protect clients and others” – Social workers with direct knowledge of another social worker’s impairment should, when feasible, consult with and assist the social worker in taking remedial action Signs of Burnout – Physical and emotional exhaustion – Insomnia – Impaired concentration or memory – Physical symptoms (heart palpitations, HBP) – Appetite changes – Increased illness – Increases in depression and/or anxiety – Absence of positive emotions – Cynicism and disillusionment – Lack of patience – Lack of resilience (everything is a crisis) – Relationship deterioration – Substance abuse – Forgoing important personal activities Malasch Burnout Inventory – The Maslach Burnout Inventory (MBI) is the most commonly used self assessment tool for burnout – The MBI explores three components: Exhaustion, depersonalization and personal achievement. – MBI pdf C. Maslach, S.E. Jackson, M.P. Leiter (Eds.), Maslach Burnout Inventory manual (3rd ed.), Consulting Psychologists Press (1996) – Abbreviated MBI from SAMHSA Causes of Burnout – Excessive workload – Emotionally draining work – Lack of support – Lack of resources – Lack of rewards – Lack of a sense of control/say – Unclear or everchanging requirements – Severe consequences of mistakes – Work/life imbalance – Perfectionistic tendencies; nothing is ever good enough – Pessimistic view of yourself and the world – The need to be in control; reluctance to delegate to others – High-achieving, Type A personality – Poor work/person fit – Value conflicts – Lack of debriefing (See Restoring Sanctuary by Sandra L. Bloom) – Unpleasant environment – Cultural differences Burnout and Difficult Clients Reactions to Difficult Patients – Anger that you have to see the client when there are other people who WANT help you could be seeing – Guilt that you truly dislike the client – Fear that you will not be able to deal with the problem – A
July 11, 2019
407 -Understanding the Autism Spectrum Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free weeks of TherapyNotes with coupon code “CEU” CEUs available at: https://www.allceus.com/member/cart/index/product/id/1079/c/ Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LPC Executive Director, AllCEUs Host: Counselor Toolbox Podcast Objectives – It is called a “spectrum” disorder because people with ASD can have a range of symptoms Symptoms – Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history – Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions. – Direct communication – Honesty – Nonjudgmental listening – Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication. – They often think in pictures or video Symptoms – Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history – Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in  sharing imaginative play or in making friends; to absence of interest in peers. – Less concern for what others may think of them can make them more independent thinkers – Difficulty recognizing and processing the feelings of others, “mind-blindness” which may result in the inability to identify if another person’s behaviors are intentional or unintentional which can cause others to believe that the individual with autism does not have empathy or understand them. OR – A fantastic ability to “read” people (Fiona and Sherlock “Elementary”) Symptoms – Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text): – Stereotyped or repetitive motor movements, use of objects, or speech (hand-flapping, rocking, jumping and twirling, arranging and rearranging objects and repeating sounds, words or phrases. Sometimes the repetitive behavior is self-stimulating, such as wiggling fingers in front of the eyes) – Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day). – Some individuals pay attention to minor details, but fail to see how these details fit into a bigger picture. – Others have difficulty with complex thinking that requires holding more than one train of thought simultaneously – Others have difficulty maintaining their attention or organizing their thoughts and actions. Symptoms – Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text): – Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest). – Attention to detail – Often highly skilled in a particular area – Deep studying resulting in encyclopedic knowledge – Hyper- or hy
July 6, 2019
406 -Biopsychosocial Impact of Addiction and Mental Disorders on the Individual Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counseling Education Podcast Host: Counselor Toolbox Objectives – Examine the biological (physical) impact of addiction and mental health issues on the individual – Examine the psychological impact of addiction and mental health issues on the individual – Examine the social impact of addiction and mental health issues on the individual – Identify interventions in each area. Biological Impact of Mood Disorders – Caused by an imbalance of: – Serotonin (Calming/balancing) – GABA (Calming) – Glutamate (Excitatory) – Norepinepherine (Excitatory) – Dopamine (Pleasure) Biological Impact of Mood Disorders – Effects – Disrupted sleep – Fatigue – Irritability – Nutritional changes – Increased muscle tension – Reduced pain tolerance – Gastrointestinal disturbances Biological Impact of Addictions – Direct (neurotransmitter imbalances) – Tolerance – Withdrawal Neurotransmitters, Addiction & Black Friday – Normal day – Normal store capacity is 750 people. – The store needs a constant 500 to stay open – The store has 8 doors to allows for people to easily enter and exit without getting “bunched” – Black Friday – 1500 people push through the door as soon as it opens – Store is destroyed – Staff is exhausted – Takes time to restock and refresh staff – Management closes all but two doors and adds security guards to manage flow Biological Impact of Addictions – Indirect – Reduced Immunity – More rapid aging – Sleep difficulties – Nutritional deficits – Reduced pain tolerance & Increased pain – Disease (Hepatitis, HIV, TB, MRSA) The Brain Under Stress Biological Impact of Alcohol – Alcohol – Heart damage – High blood pressure – Fatty liver – Hepatitis – Cirrhosis – Pancreatitis – Cancers of the mouth, throat, liver and breast – Reduced immunity – Brittle bones Biological Impact – Alcohol – Brain damage through: – The toxic effects of alcohol on brain cells – The biological stress of repeated intoxication and withdrawal – Alcohol-related cerebrovascular disease – Head injuries from falls sustained when inebriated. – Alcohol related birth defects (FASD) Biological Impact – Alcohol – Nutrient deficiencies: – Vitamins: A, E, D, K,B12, folic acid, thiamine – Thiamine deficiencies, which cause severe neurological problems such as impaired movement and memory loss seen in Wernicke/Korsakoff syndrome (memory disorder often seen in Alzheimers) – Calcium – Iron (intestinal bleeding) – Dehydration Biological Impact of Caffeine – Negative – Stimulant/jitters – Increased blood pressure – Heart palpitations – Heartburn/Diarrhea – Disrupted sleep – Dehydration – Miscarriage – Osteoporosis – Positive (with moderate intake) – Lower risk of Alzheimer's and dementia – Decreased suicide risk – Increased endurance – Decreased risk of oral cancer Biological Impact of Nicotine – Nicotine (including gums and vapors) – Highly addictive – Activates neurotransmitters – Pain and anxiety relief – Reduced appetite – Respiratory irritation – Increased heart rate and blood pressure – Hyperglycemia – Decreased immune response – Increased oxidative stress (which leads to cancer) – Increased risk of diabetes Biological Impact of Marijuana – Positive – Altered senses – Hallucinations – Nausea reduction – Pain management (3 puffs a day) – Improved sleep Biological I
July 4, 2019
405 -Social Work Considerations for Addressing Chronic Conditions Dr. Dawn-Elise Snipes Counselor Toolbox Podcast CEUs can be earned for this presentation at https://www.allceus.com/member/cart/index/product/id/1078/c/ ~ Chronic conditions such as diabetes, arthritis, chron's disease, and depression Introduction ~ 60% of people in the US have a chronic illness ~ Many serious illnesses have a much longer course with episodes of exacerbations and remissions ~ Chronic Illness can be highly stressful for patients and families ~ Care for people with chronic illnesses is increasingly done by family in the home. ~ Untreated mood disorders in individuals with co-morbid chronic health conditions increases morbidity and mortality rates and reduces the capacity for self-management Biopsychosocial Impact of Chronic Conditions ~ Sleep ~ Pain ~ Medication side effects ~ Fatigue ~ Circadian rhythm disruption ~ Physical changes (weight changes, ports, pumps, hair loss) ~ Loss of mobility ~ Depression ~ Anxiety ~ Anger ~ Grief/Adjustment ~ Jealousy or resentment ~ Irritability ~ Withdrawal ~ Self Esteem changes ~ Loss of social support ~ Smothering social support ~ Inability to engage in prior important activities ~ Loss of independence ~ Vocational problems ~ Financial hardships (Medical expenses, job loss, environmental modifications) ~ Access to nutritious food ~ Physical, sexual and emotional relationship problems Goals of Chronic Care Models ~ Shift from acute, episodic treatment to one of ongoing proactive care ~ Emphasizes ~ Prevention (getting worse, developing other conditions) ~ Patient’s role in managing health with mutual goal setting and action planning (self-management) ~ The goal of self-management interventions are to: ~ Improve knowledge about the condition and intervention options ~ Increase confidence in the ability to change ~ Leverage what he or she can do to promote personal health (prevention) Goals of Chronic Care Models ~ The goal of self-management interventions are to ~ Improve motivation and problem solving rather than simple compliance with a caregiver’s advice ~ Help the participants’ master six fundamental self-management tasks: ~ Solving problems ~ Making decisions ~ Using resources ~ Forming a patient -provider partnership ~ Making action plans for health behavior change ~ Self-tailoring Categories of Interventions (FRAMES) ~ Self Management Support ~ Feedback ~ Develop collaborative relationships ~ Use an ask-tell-ask framework with clients and caregivers ~ Responsibility ~ Ability and motivation for self-management fluctuates. Tailor interventions appropriately (symptom exacerbations, med changes, life changes…) ~ Advice ~ Use education and scaffolding to empower clients to adjust their behaviors and take control of health self-management ~ Menu of Options depends on individual circumstances, and resource availability ~ Empathy and Encouragement ~ Self-Efficacy “5 A’s” of Behavioral Change ~ Assess ~ Advise/engage ~ Agree/collaborate ~ Assist/identify obstacles and interventions (treatment) ~ Arrange for follow up (evaluate/review) Categories of Interventions ~ Assess ~ Regular assessment and enhancement of motivation and readiness for self-management ~ Ongoing Biopsychosocial Assessment (including quality of life and a Health Risk Appraisal (HRA) ~ An HRA is a systematic approach to ~ Collecting information about risk factors ~ Providing individualized feedback ~ Linking the person with at least one intervention to promote health, sustain function and/or prevent disease Categories of Interventions ~ Advise: ~ Multimodal education about the condition and treatment options ~ Teach self-monitoring for clients and caregivers ~ Families and clients are educated about ~ The illness ~ What to expect from a family member who has the illness ~ How they can best help ~ How to take care of themselves Categories of Interventions ~ Agree and Assist (Collaborate) ~ Engage through goal directed counseling and conferences
June 29, 2019
NCMHCE Exam Review Crisis Assessment Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director AllCEUs Host: Counselor Toolbox Podcast and NCMHCE Exam Review Podcast CEUs are available for this presentation at https://www.allceus.com/CE/course/view.php?id=1414 Objectives ~ Review crisis theory and the varying types of crises ~ Describe the stages of crisis ~ Identify the features of a general crisis assessment ~ Differentiate between a crisis and suicide assessment ~ Identify factors associated with a high risk of suicide ~ Review legal and ethical responsibilities (Tarasoff and Bellah vs. Greenson ~ Explore prevention and intervention strategies Crisis Definition ~ Crisis involves ~ A pivotal moment in which a decision must be made which involves facing both peril and promise (Echterling, 2005) ~ “People are in a state of crisis when they face an obstacle to important life goals—and obstacle that is, for a time, insurmountable by the use of customary methods of problem-solving.” (Caplan, 1961) ~ Symptoms of crisis: ~ Emotional distress ~ Physical distress/stress response ~ Cognitive disruption (concentration, problem solving, memory) ~ Behavioral changes Basic Human Needs (CHARGES) ~ When a basic human need has been impacted, it may prompt a crisis ~ Maslow: ~ Air, water, food, sleep, shelter, medical care, safety, love and belonging ~ Elliot (CHARGES) ~ Connection to something bigger than one’s self or a system of meaning to help us understand the world ~ Health and biological needs ~ Acceptance (love and belonging) ~ Relationships (intimate) ~ Goals and Purpose (Identity) ~ Efficacy/Control ~ Safety Types of Crisis ~ Situational crises are not anticipated and usually outside a person’s control ~ Physical (accident, illness, prematurity, birth defects) ~ Interpersonal (death of a person or pet, abuse, divorce) ~ Financial/Environmental/Material (Job loss, Foreclosure, House fire, hurricane, burglary, stock market crash, not getting accepted to …) Types of Crises ~ Cultural/Societal ~ Individuals have less control over these due to the fact that they are perpetuated by the action or inaction of others ~ Political unrest, discrimination and stigma related to gender, race, sexual orientation, violence Types of Crisis ~ Maturational ~ Normal developmental changes produce developmental crises (see Erikson), however, when these crises overwhelm a person’s ability to cope, they may prompt a mental health crisis. ~ To successfully resolve developmental crises, people need support, energy and safety. ~ Examples: Child to adult, empty nest, retirement, child birth, marriage… Types of Crisis ~ Normal developmental reaction or mental health issue? ~ *Determine which symptoms are expected reactions to a normal developmental transition vs. a sign of an emotional or mental health issue ~ Adjustment disorder with depressed mood, anxiety, both or behavior disturbances is conditional upon a particular situation, a life change or a stressor of some sort that precipitates the event ~ Carefully differentially diagnose between adjustment disorder, anxiety, depression, PTSD and personality disorders. ~ Normalize expected reactions to developmental transitions Types of Crisis ~ Normal developmental reaction or mental health issue? ~ The symptoms of adjustment disorder with disturbance of conduct can include: ~ Behaviors that are outside the norms of society ~ Actions that violate the rights of others ~ Outbursts of anger ~ Attempts at revenge ~ Substance use or abuse ~ Emotionality/mood swings that are acted upon Factors Affecting the Response ~ Demographics (DARES) ~ Age ~ Religion ~ Ethnicity ~ Situational and social supports ~ Perception of the event– How does it impact (BASIC) ~ Biological necessities ~ Acceptance and belonging ~ Similarity to prior traumas or crises ~ Interpretation/world view ~ Control (sense of) ~ Available coping (CRAP) ~ Crises in the past 6-12 months ~ Resources ~ Addiction ~ Psychiatric Stages of Crisis ~ The eve
June 28, 2019
Teaching Psychological Flexibility Dr. Dawn-Elise Snipes Executive Director, AllCEUs Counselor Education Host: Counselor Toolbox Podcast CEUs are available at allceus.com and Australia.allceus.com Objectives – Define psychological flexibility – Explore how to apply psychological flexibility – Identify the shortcut question What is Psychological Flexibility – The willingness to: – accept things as they are in the moment – make a conscious choice to act – purposefully choose behaviors, thoughts and feelings that move them toward a rich and meaningful life—as they define it. Step 1 – Define what a rich and meaningful life looks like Describe Destination Happiness Values & Goals – Clarifying (collage) – Relationships: Who is most important to you- – Which people- – What do you want those relationships to be like- – Under the picture of the person, on a post-it note identify 5-10 ways to realistically create that relationship. – Beneath that, on another post-it note, identify anything about that person or relationship that causes you distress or unnecessarily drains your energy (criticism, lack of responsiveness) and what you can do about it. Describe Destination Happiness Values & Goals – Clarifying (collage) – What events, things, experiences are meaningful to you- – Work, Health, & Personal Growth – Under the pictures identify what aspects of Work, Health, & Personal Growth are important (accomplishment, money, camaraderie, helping others, mental stimulation/creativity…) and what you can do to ensure that work is using your energy for happiness – Under that identify aspects of Work, Health, & Personal Growth that cause you distress or unnecessarily drain your energy and how you can better use your energy to address it (let it go, accept it, have compassion, check your interpretation (CDs), address the issue, transfer…) (cranky co-worker; helicopter/critical boss) Describe Destination Happiness – Clarifying Values – What values do I want to embody (Choose 4 and write them on the top, bottom and sides of your collage)- Step 2: Visualize options – Like a cell phone battery, you only have so much energy… you have to decide how you are going to use it to achieve your goals for the day. – Mindfulness: At 4am I have 100% charge. – Goal: My battery needs to last from 4am until 6pm and allow me to monitor my heart rate at the gym, listen to music at the gym, make calls if needed, get directions if needed, receive text messages from my kids – Brightness – Music (screen on or off) – Videos – Apps (Garmin, Polar, chat apps, email*, research* etc.) Psych. Flex.to Reach Destination Happiness Psych. Flex.to Reach Destination Happiness AWAY Thoughts and Feelings – All feelings are normal. It is what you do with those feelings that can be harmful. – Think of an emotion like the smell of dog poop. – When you smell it, you get up to check if the dog crapped in the house. If not, you chalk it up to gas and go about your day. If you find dog poop, you don’t just get angry and leave it there. You do something about it or it will make the whole house stink. – Negative emotions are like the dog poop of the soul. If you don’t address them, they will permeate your whole being and repel others. AWAY Thoughts & Feelings Questions – What thoughts do you regularly have that keep you from being happy- (make a list/keep a journal, so you can start addressing them. Include your inner critic’s commentary) – When you get angry, what thoughts do you have that keep you stuck in the quicksand of anger- – Remember resentment, jealousy, envy and guilt are all forms of anger. – When you are sad or grieving what thoughts do you have that keep you stuck- – When you are anxious/afraid what thoughts do you have that keep you stuck- – When you are l
June 27, 2019
Addressing Childhood Obesity Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast CEUs are available at allceus.com and Australia.allceus.com Objectives – Learn about the effects of obesity on health – Identify best practices for addressing obesity in childhood Clinician Functions – Engage – Children – Caregivers – Communities (task forces, county commission committees) – Assess – Risk factors – Barriers – Motivations – Set SMART Goals at the individual, family and community level Clinician Functions – Implementation of goals – Monitoring – Risk factors – Protective factors – Evaluation – Engagement – Goal achievement Why do We Care- Impact of Obesity – Physical Health – Increased risk of becoming an adult with obesity – Glucose intolerance and insulin resistance – Type 2 Diabetes – Multiple cancers – High blood pressure – High cholesterol – Adult heart disease – Low testosterone (males) – Polycystic Ovarian Syndrome – Endometriosis – Asthma – Sleep apnea – Joint problems – Gastric Reflux – Non-Alcoholic Hepatitis – Back pain – Mental Health – Anxiety and depression – Low self-esteem – Lower perceived quality of life – Being bullied – Stigma – Discrimination Assess – Use established guidelines to routinely assess children’s – Health literacy – Nutrition – Sleep – Physical activity/Sedentary behavior – Mental Health – Coping Skills – Self-Esteem – Pediatrician, school counselor/social worker, school nurse/health teacher, preschool teacher, caregiver Assess – Assess the risk factors in the environment – Parenting/primary caregiver influences – Conditions that promote sedentary or less active lifestyles—Reliance on cars, increased time watching t.v. or on computers – Time and financial constraints that can adversely affect caregivers’ ability to provide healthy food options – Overconsumption of high-fat, high-calorie foods – Biology and genetics – Breastfeeding for less than 6 months – Lack of sufficient sleep Assess – Assess the risk factors in the environment – Parenting/primary caregiver influences – Caregiver mental illness, especially depression – Lack of modeling positive nutrition and movement – Lack of knowledge about nutrition or cooking – Coercive clean your plate rules – Mindless eating (with television on etc.) – Over-normalizing growth-related weight gain – Caffeine consumption during pregnancy Assess – Assess the risk factors – Individual influences – Rewarded behaviors – How can good nutrition be made rewarding: Cooking tasty foods, making palatable snacks available – How can exercise be made rewarding: Play with the dog, parks, trampolines – Interests – Geocaching, Pokémon go, martial arts, X-box/wii etc. – Unsupervised time – Peer values Assess – Assess the risk factors – Individual influences – Health – Genetics – Hypothyroid – Diabetes – Yo-yo dieting – 80% of 10 year olds have been on at least 1 diet – Insufficient sleep Assess – Assess the risk factors in the environment – Sociocultural factors – Income and social status – Social support network to reduce stress, increase supervision, activities and availability of healthy food – Affordability of healthy foods—Connect with sources of healthy food, community gardening – Food marketing (media) and distribution (portions) Engage – Collaborate with school leaders to address risk factors that influence childhood obesity, including: – Student
June 19, 2019
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. CEUs are available at https://www.allceus.com/member/cart/index/product/id/1076/c/ 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 &#
June 13, 2019
Behavioral Health Services for American Indians and Alaskan Natives SAMHSA TIP 61 Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counseling Education Host: Counselor Toolbox Podcast CEUs are available at: https://www.allceus.com/member/cart/index/product/id/1114/c/ Objectives – Addiction and mental health professionals will improve their understanding of: – American Indian and Alaska Native behavioral health. – The importance of cultural awareness, cultural identity, and culture-specific knowledge when working with clients from diverse American Indian and Alaska Native communities. – The role of native culture in health beliefs, help-seeking behavior, and healing practices. – Prevention and treatment interventions based on culturally adapted, evidence-based best practices. – Methods for achieving program-level cultural responsiveness, such as incorporating American Indian and Alaska Native beliefs and heritage in program design, environment, and staff development. Factoids – 22% of AI/AN live on reservations. 60% live in urban areas – There are more than 200 tribes in Alaska. – The term “Eskimo” is considered derogatory – Health solutions come from within the community using local models – 25% of AI/IN live in poverty in comparison with 13% of the general population – Fewer than 50% of AI/AN women who experience violence report it, and of those only 10%-40% of cases are ever prosecuted. Factoids – Education protects against substance abuse, depression, suicidality, and other behavioral health problems for American Indians and Alaska Natives, as well as for other populations, yet they are less likely than the general population to graduate – AI/AN typically define family as extending beyond the nuclear unit – About half of American Indian and Alaska Native households include members of the extended family, and one-quarter include people who are not directly related. – About 30 percent of American Indian and Alaska Native families are headed by single mothers. Grandparents also often raise children Factoids – Not all native cultures are the same. Similarities exist, but each nation may have its own beliefs and traditions – AI/AN are less likely to drink than White Americans; however, those who do drink are more likely to binge drink and to have a higher rate of past-year alcohol use disorder than other racial and ethnic groups. – AI/AN experience anxiety disorders at a higher rate than other Americans – Native youth have a much higher suicide rate than youth or adults of other races more than double those for the U.S. population – Suicide and suicide attempts among young men ages 15–24 account for nearly 40 percent of all suicide deaths among natives. Factoids – Likely reasons for today’s high rates of substance use, suicide, and domestic abuse among AI/AN are that their communities are exposed to a greater degree to the same risk factors that are predictors of problems for everyone: Poverty, unemployment, trauma (including historical trauma), and a loss of cultural traditions. – Maintaining ties to one’s culture can help to prevent and treat substance use and mental disorders – Among many Native Americans, substance use and mental disorders are not defined as diseases or character flaws. They are seen as a symptom of an imbalance in the individual’s relationship with the world. Historical Trauma – One of those causes of imbalance stems from wide spread abuses and injustices experienced by AI/AN – Loss of their communities – Loss of life – Loss of freedom – Loss of land – Loss of self-determination – Loss of traditional cultural and religious practices – Practicing many cultural traditions was illegal for AI/AN from 1878 until 1978. – Loss of native languages – The removal of children from their families
June 8, 2019
Using Groups to Address Anger, Anxiety, Depression and Addiction Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director: AllCEUs.com Host: Counselor Toolbox Podcast Purchase CEUs at: https://www.allceus.com/member/cart/index/product/id/1112/c/ Objectives – Review the benefits of groups – Identify the modalities for group – Discuss goals for psychoeducational and skills groups addressing anger, anxiety, addiction and depression – Explore activities that can be used to enhance group engagement Benefits of Group – Cost effective – Peer feedback and support – Development of interpersonal skills – Reduce isolation and “uniqueness” – Many observers Modalities for Group – Face-to-face – Web-meeting – Video with or without breakout rooms – Chat – Asynchronous – Psychoeducational/skills video – Group participation by responding to questions on a discussion board and receiving feedback from group members and the clinician – HIPAA, HITECH and 42 CFR Part 2 all apply Commonalities – Low self esteem – Cognitive distortions – Emotional dysregulation – Poor Interpersonal Skills – Fear of isolation, rejection, failure, loss of control, the unknown – Poor lifestyle behaviors Awareness (2) – Learn about anger, anxiety, depression and addiction and their symptoms – Learn about the Mind-Body Connection (Jeopardy) – Potential causes of symptoms – Effects of symptoms – Interventions for symptoms – Have clients identify (Worksheet/Beach Ball or Jenga) – Symptoms – What changed which causes or worsens the symptom – How they have dealt with the symptom in the past – Impact of the symptom on them Awareness (1) – Negative Triggers – Those things that cause or worsen the symptom – Hungry Angry Lonely Tired (HALT) – False Evidence Appearing Real (FEAR) – People Places Things – Times (of day, anniversaries, holidays) – Small Group Activity/Presentation – Which ones can be avoided or prevented- – Which ones are unavoidable- – Identify three ways to deal with the unavoidable ones to mitigate their impact. Awareness (1) – Positive Triggers (Flip chart stations) – Those things that remind you to use your new tools – Sights – Sounds – Smells – Touch – Those things that trigger positive emotions – Sights – Sounds – Smells – Touch – How can you add those to your environment- Awareness (1) – Vulnerabilities – Explain the concept of vulnerabilities – Identify the most common vulnerabilities: What causes them and how to prevent and mitigate them – Emotional (anger, jealousy, envy, depression, anxiety, guilt, grief) – Mental (Poor concentration, rigid thinking, poor problem solving) – Physical (Sleep, nutrition, pain) – Social (lack of supportive relationships, presence of unsupportive relationships) – Environmental Awareness (1) – Mindfulness and Vulnerability Prevention – Learn about mindfulness – Purpose – Benefits – Difference from meditation – Methods – 5 minute exercise – 5,4,3,2,1 – Color focus: Find all the things that are blue – What are my thoughts, urges, sensations when I feel stress, anger, fear, depression, happiness, excitement Awareness (1) – Goal Identification (Top 3s) What is most important to focus your energy on so you can be happy- // What does happiness/recovery look like to you- (Collage) – What 3 things are most important to you- – What 3 relationships are important to you and what do you want them to look like- – What 3 personal growth goals are important to you- – What are your values that support your goals (Top 3) Distress Tolerance (1) – Clients with mood or addict
June 6, 2019
Group Therapy (TIP 41) Chapter 6&7 Leadership Skills & Common Errors Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Purchase CEUs for this podcast at: https://www.allceus.com/member/cart/index/product/id/1111/c/ Objectives ~ Discuss the characteristics of group leaders. ~ Describe concepts and techniques for conducting substance abuse treatment group therapy. Leaders Choose ~ How much leadership to exercise ~ How to structure the group ~ When to intervene ~ How to effect a successful intervention ~ How to manage the group’s collective anxiety ~ How to resolve other issues Personal Qualities of Leaders ~ Constancy ~ Active listening ~ Firm identity ~ Confidence ~ Spontaneity ~ Integrity ~ Trust ~ Humor ~ Empathy ~ Communicates respect and acceptance ~ Encourages ~ Is knowledgeable ~ Compliments ~ Tells less; listens more ~ Gently persuades ~ Provides support Leading Groups ~ Leaders vary therapeutic styles to meet the needs of clients. ~ Leaders model behavior. ~ Leaders are sensitive to ethical issues: •Overriding group agreement •Informing clients of options •Preventing enmeshment •Acting in each client’s best interest Leading Groups (cont.) ~ Leaders improve motivation when: ~ Members are engaged at the appropriate stage of change. ~ Members receive support for change efforts. ~ The leader explores choices and consequences with members. ~ The leader communicates care and concern for members. ~ The leader points out members’ competencies. ~ Positive changes are noted in and encouraged by the group. Leading Groups (cont.) ~ Leaders work with, not against, resistance. ~ Leaders protect against boundary violations. ~ Leaders maintain a safe, therapeutic setting: •Emotional aspects of safety •Substance use •Boundaries and physical contact ~ Leaders help cool down affect. ~ Leaders encourage communication within the group. Interventions ~ Connect with other people. ~ Discover connections between substance use or mood issue and thoughts and feelings. ~ Understand attempts to regulate feelings and relationships. ~ Build coping skills. ~ Perceive the effect of mental illness or addictive behaviors on life. ~ Notice inconsistencies among thoughts, feelings, and behavior. Avoid a Leader-Centered Group ~ Build skills in members; avoid doing for the group what it can do for itself. ~ Encourage group members to learn the skills necessary to support and encourage one another. ~ Refrain from overresponsibility for clients. Clients should be allowed to struggle with what is facing them. Confrontation ~ Can have an adverse effect on the therapeutic alliance and process. ~ Can point out inconsistencies such as disconnects between behaviors and stated goals. ~ Can help clients see and accept reality, so they can change accordingly. Transference & Countertransference ~ Transference. Clients project parts of important past relationships into present relationships. ~ Countertransference. The other person projects emotional response to a group member’s transference: ~ Feelings of having been there ~ Feelings of helplessness when the leader/other person is more invested in the treatment than the client is are ~ Feelings of incompetence because of unfamiliarity with culture and jargon Resistance ~ Resistance arises to protect the client from the pain of change. ~ Resistance is an opportunity to understand something important for the client or the group. ~ Resistance indicates the proposed solutions are less rewarding/appealing than the old behaviors or there is a fear that they will be ~ Efforts need to be made to understand the problem. Confidentiality ~ Strict adherence to confidentiality regulations builds trust. ~ Leaders should explain how information from sources may and may not be used in group. ~ Violations of confidentiality should be managed in the same way as other boundary violations. Integrating Care ~ Professionals in the healthcare network need to be aware of the role of group therapy and how it integrates with
June 4, 2019
Relapse Prevention Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Objectives ~ Define Relapse ~ Identify triggers and warning signs of relapse ~ Review Relapse Syndrome and possible interventions ~ Explore the acronym DREAM ~ Define and identify vulnerabilities ~ Define and identify exceptions ~ Develop a relapse prevention plan Why I Care/How It Impacts Recovery ~ Relapse indicates that the old behaviors have returned either because ~ New skills were ineffective ~ Old behaviors were more rewarding ~ Recovery involves understanding what triggers each individual person’s relapse Relapse Syndrome ~ Relapse generally follows a predictable and readily identifiable pattern ~ Return of denial “I’ve got this.” “I’m fine.” ~ Teach support people about recovery and relapse. Encourage them to probe about problems. ~ Write down problems on a daily basis and share this list with someone. ~ Avoidance of defensive behavior…Focusing more energy on fixing others than on working on self and failing to do relapse prevention exercises. ~ Surround themselves with support people who will encourage them to continue working on their relapse prevention program. ~ Maintain a “negative image” reminder of what it is like when they are symptomatic ~ Develop and review a cost/benefit analysis of their coping behavior. Relapse Syndrome ~ Crisis Building…problems begin to pile up and it becomes more and more difficult to see options. The person develops tunnel vision and loses the ability to perform constructive planning ~ Remind them to take one day at a time. ~ Review coping behavior. ~ Encourage acceptance of personal limits. ~ Remind them that it is the thoughts about an event and not the event that is “bad” or “good”). Relapse Syndrome ~ Immobilization When a crisis builds up, the person becomes crushed and trapped by the problems and incapable of initiating action A sense that nothing can be solved may develop. ~ Use the Serenity Prayer. ~ Use the support people that they have developed. ~ Review the concept of lapse as opposed to relapse (accept the reality that they may make some small mistakes but this does not mean that they have failed). ~ Confusion and overreaction While the problems continue to grow and the person feels stuck, he often becomes confused and angry leading to irritability, a general sense of tension, and sense that others are out to get him. ~ Identify the source of the feelings. ~ Accept responsibility for problems. ~ Possible professional intervention. Relapse Syndrome ~ Depression. As the anger begins to build, so does a sense of hopelessness and begins to turn the anger inward in the form of depression. ~ Focus on those things that the person can control ~ Identify strengths ~ Set SMART goals to develop self-efficacy ~ Seek social support ~ Behavioral loss of control The person becomes unable to control or regulate personal behavior and a daily schedule. ~ Develop a routine ~ Regroup and redifine those people, things and activities that are truly important to a meaningful life ~ Make a task basket (or list) ~ Set more SMART goals to start taking steps forward 10 Most Common Triggers of Relapse ~ Withdrawal symptoms (anxiety, nausea, physical weakness) ~ Post-acute withdrawal symptoms (anxiety, irritability, mood swings, poor sleep) ~ Poor self-care (stress management, eating, sleeping) ~ People (old using friends) ~ Places (where you used or where you used to buy drugs) ~ Things (that were part of your using, or that remind you of using) ~ Uncomfortable emotions (H.A.L.T.: hungry, angry, lonely, tired) ~ Relationships and sex (can be stressful if anything goes wrong) ~ Isolation (gives you too much time to be with your own thoughts) ~ Pride and overconfidence (thinking you don’t have a drug or alcohol problem, or that it is behind you) Types of Relapse ~ Emotional relapse ~ Mental relapse ~ Physical relapse Relapse Warning Signs ~ Emotional Cues ~ Are you more angry,
June 3, 2019
PTSD Exploring the Functional Nature of Symptoms Instructor: Dr. Dawn-Elise Snipes LPC-MHSP, LMHC, CCDRC Executive Director: AllCEUs Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Podcasts Objectives ~ Review PTSD Symptoms and explore their functional nature Purpose ~ By understanding the function of symptoms we can ~ Normalize the behavior ~ Identify alternate ways to meet that same need or address the issue ~ Re-Experiencing ~ Trying to replay it to figure out how to integrate into your schema (like fitting a puzzle piece) ~ Reminding the person of similar situations to “protect” them Purpose ~ Avoidance ~ The system is already over taxed. Avoiding upsetting stimuli by blocking out most stimuli, memories of the event. ~ Avoiding unnecessary use of energy by not getting “excited.” ~ Changes in Beliefs ~ Protects against future “surprises” ~ Tries to assimilate the experience into schema ~ Increased Arousal ~ Protects the individual Re-Experiencing ~ You re-experience things every day ~ Access schema that guide your actions ~ When you go to work ~ When you encounter a particularly volatile client ~ When you approach a stop light ~ Re-Experiencing in PTSD ~ The context is often overgeneralized ~ The precipitating factors are often unknown ~ In many cases the resolution was not one of empowerment, resulting in trying to continually figure out how to not be disempowered Re-Experiencing: Assimilation or Accommodation ~ Intrusive distressing memories of the traumatic events ~ In children repetitive play may occur in which themes or aspects of the traumatic events are expressed. ~ Recurrent distressing dreams in which the content or feeling of the dream is related to the events ~ In children there may be frightening dreams without recognizable content. ~ Flashbacks or other dissociative reactions in which the individual feels or acts as if the traumatic events are recurring ~ In children trauma-specific reenactment may occur in play. Re-Experiencing ~ Intense or prolonged psychological or physiological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic events ~ The event represents a time in which the person experienced or witnessed something horrifying ~ The brain is trying to help the client ~ Avoid future similar situations ~ Learn how to protect during future similar situations Avoidance ~ Purpose: Avoidance of Recurrence of Pain or Arousal of Stress Response System ~ Emotional numbness and avoidance of places, people, and activities that are reminders of the trauma. ~ Inability to remember an important aspect of the traumatic events (not due to head injury, alcohol, or drugs) ~ Purpose: An exhausted system conserves energy in case there is another threat ~ Markedly diminished interest or participation in significant activities ~ Feelings of detachment or estrangement from others ~ Persistent inability to experience positive emotions Hypocortisolism ~ Cortisol is the stress chemical ~ After extreme stress and/or under chronic stress the brain may reduce the responsiveness of the stress response system by reducing the cortisol ~ This is protective, it keeps the organism from using precious resources by getting “excited” about anything (including pleasure) ~ Due to fear conditioning, when a stressor is detected, the stress response is exaggerated. Changes in Beliefs ~ Purpose: The need for order and meaning (Regaining control, Ability to predict) ~ Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world ~ “I am bad” ~ “No one can be trusted” ~ “The world is completely dangerous” ~ Persistent, distorted blame of self or others about the cause or consequences of the traumatic events Changes in Beliefs ~ Persistent ~ Fear, horror ~ Anger ~ Guilt, shame ~ Trauma taps in to nearly every basic fear ~ Loss of Control ~ The Unknown ~ Death (Am I going to die? I could have died. I was unable to prevent someone from dying) ~
June 2, 2019
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 developm
May 29, 2019
CEUs available at: https://www.allceus.com/member/cart/index/product/id/1102/c/ Holistic (Biopsychosocial) Approach to Diagnosis and Treatment Objectives Why Holistic? ~ 30% to 40% of patients with major depressive disorder (MDD) do not respond sufficiently to usual antidepressant treatment ~ Even under optimal treatment conditions, only one-third of patients achieve remission ~ Among patients who fail to respond to two pharmacologic interventions, remission rates with the next antidepressant are as low as 12% ~ A patient becomes less likely to respond clinically with each additional nonresponse to antidepressant treatment Why Holistic ~ 1. The cause may not be the “obvious” reason ~ 2. Positive changes in any symptom will positively impact the rest of the system ~ 3. For people to feel happy and healthy, the system (body machine) needs to be running efficiently Why Holistic HPA & Gut-Brain-Axis Medical ~ Medical conditions that alter sex or thyroid hormone levels, blood sugar regulation or oxygenation can cause symptoms of anxiety, irritability, hypomania, depression ~ Diabetes ~ Blood sugar dysregulation activates the HPA-Axis which can cause irritability, difficulty concentrating ~ Autoimmune Disorders (CF, Fibro, Chron’s, Rheumatoid arthritis) are triggered by stress and trigger inflammation and additional HPA-Axis Activation ~ Cardiac Disorders can prevent adequate oxygenation or resemble panic attacks Medical- Thyroid ~ Thyroid imbalances can be caused by autoimmune disease, genetics, nutritional imbalances, hormone imbalances ~ Anxiety symptoms can precede an official diagnosis of hyperthyroid by up to 5 years ~ Thyroid hormones impact the availability of serotonin which impacts mood ~ Cortisol from chronic “stress” reduces thyroid levels, ergo anxiety, PTSD and even depression can impact thyroid levels ~ Hypothyroid has a prevalence of ~10% in women and 2% in men ~ The risk of hypothyroidism increases during pregnancy, after delivery and around menopause. Medical- Sex Hormones ~ Sex hormone imbalances can be caused by diabetes, testicular injury, drug use including, oral corticosteroids, inhaled corticosteroids (LTU) or birth control, menopause, polycystic ovarian syndrome, hysterectomy, child birth, cessation of breast feeding… ~ Estrogen and testosterone impact serotonin availability. ~ Too much or too little of either can produce anxiety or depressive symptoms ~ High levels of the estrogen affect our ability to deal with stress ~ The production of cortisol affects the concentration of all sex hormones. Medical- Sex Hormones ~ Both men and women produce luteinizing hormone, testosterone, and estrogen. ~ Under stress the body shuts down libido so that we can deal with more urgent, survival needs. ~ Testosterone is suppressed under chronic stress/cortisol ~ Estrogen is often elevated but luteinizing hormone is reduced under chronic stress/cortisol Medical ~ Mood ~ Changes in availability of neurotransmitters ~ Lack of adequate oxygenation ~ Thyroid imbalances ~ Increased “stress” due to medical conditions ~ Sleep ~ Apnea ~ Exhaustion (thyroid or low oxygen) ~ Pain ~ Circadian rhythm imbalance ~ Too little or too much testosterone may affect overall sleep quality ~ Nutrition / Malabsorption ~ Building Blocks ~ Gut-Brain Axis ~ Substances (including caffeine and nicotine) ~ HPA-Axis ~ Thyroid Imbalances ~ Sex Hormones Imbalances ~ Pain ~ Pain ~ Reduced serotonin  Reduced pain tolerance ~ Too little movement  Stiffness and pain Pain ~ Pain can be caused by a variety of things including aging, autoimmune issues, medication side effects, musculoskeletal or neurological problems ~ Mood and Thoughts ~ Increase anxiety ~ Cognitions ~ Things will get worse ~ Mortality ~ Rejection ~ Increase depression ~ Cognitions: Hopelessness and helplessness ~ Feelings of guilt, envy, resentment, anger Pain ~ Activates the HPA-Axis ~ Increased stress ~ Perception of pain/vulnerability ~ Nutrition ~ Especially substances and medicat
May 23, 2019
Learn about pathological gambling with Dr. Daniel Kaufmann
May 22, 2019
Pain, Moods and Management Dr. Dawn-Elise Snipes PhD, LPC-MHSM, LMHC Executive Director, AllCEUs Host, Counselor Toolbox President, Recovery and Resilience International CEUs are available as part of a larger course here: https://www.allceus.com/member/cart/index/product/id/616/c/ Objectives – Characteristics of pain – Effects of pain – Depression – Anxiety – Guilt – Lowered Self Esteem – Lethargy – Circadian Rhythm Disruption – Understanding Your Pain – Exacerbating factors – Mitigating factors Objectives – Medical Interventions – Tylenol – NSAIDS – Opiates – Muscle Relaxants – Nerve Blocks – Accupuncture/Accupressure – Nonmedical Interventions – Guided Imagery – Radical Acceptance – Stretching/Balancing Exercises – Ice or Heat Packs – Massage – TENS units – Stress Management Characteristics of Pain – Everyone has pain sometimes – Our bodies are incredibly resilient – Knowing your pain can help your doctor/physical therapist – Acute or Chronic – Stabbing, aching, throbbing, burning… – Constant or intermittent – Stationary or radiating – Any numbness Effects of Pain – Depression – Fatigue – Sleep Disturbances – Hopelessness/Helplessness – Negative thoughts -> Stress -> Serotonin -> Pain – Interventions – Mindfulness – Good sleep habits – Circadian rhythm maintenance – Identify the things you CAN control and that are GOOD – Eat healthfully to support Serotonin functioning Effects of Pain – Anxiety – Things wont get better – It is getting worse – Consequences of pain (lost job, relationships, fitness…) – Interventions – Avoid caffeine and nicotine – Educate yourself about the disorder and the PROBABILITY things will get worse – Keep a log of the good and bad days – Practice distress tolerance skills – Use the Challenging Questions Worksheet to address anxiety provoking thoughts Effects of Pain – Guilt – Self anger for not being able to… – Can cause you to lash out at others—push them away so you don’t disappoint them like you disappointed yourself – Interventions – Think about how you would want your child or best friend to feel if they were in your position – Get rid of the shoulds – Focus on the things that you CAN do – Decide whether it is worth using your energy to be mad at yourself (and the world) Effects of Pain – Grief – Stages: Denial, Anger, Bargaining, Depression, Acceptance – Interventions – Work through the stages of grief for each of the losses because of the pain (Physical, self-concept, job, freedom (driving/mobility), dreams…) Effects of Pain – Self-Esteem – How you feel about the difference between who you want to be and who you are – Interventions – Make a list of the positive things about you – Identify 1 or 2 goals you can work toward – Celebrate small things – Silence the inner critic Effects of Pain – Circadian Rhythm Disruption – Not getting out of bed – Staying inside in the dark – Sleeping too much – Interventions – Get out of bed at roughly the same time each morning – Get dressed in “day-clothes” – Turn on lights and sit in front of a window or get outside to get your “day-clock” started – If you must take a nap, keep it under 45 minutes to avoid messing up your sleep schedule Understanding Your Pain – Exacerbating factors – Emotional – Mental – Physical – Environmental – Social – Mitigating factors – Do these – Emotional – Mental – Physical – Environmental – Social Medical Interventions – Tylenol and NSAIDS (Over the counter) –
May 18, 2019
The Interaction Between Neurotransmitters, Thoughts & Emotion Objectives Learn about your central control center, the brain What role does it play in Emotions Thoughts Physical Reactionsl Sensations How things can go wrong How to fix those things Summary After a hard day, you often want to relax and “veg” This is the brain sending out the “all clear” message and “inhibitory” or calming chemicals to balance out the stress of the day. When the brain does not get the “all clear” it recognizes that it needs to conserve the “excitatory” chemicals for a true emergency so it turns down the sensitivity of the threat response system (basically saying if you wont conserve energy, I will force you to) By addressing those old, unhelpful thoughts and interpretations you can reduce physical and mental stress and anxiety. This in turn helps your body have some “down time” to recovery between stressors. Recovery involves not only helping your mind and thoughts become healthy, but also your body
May 15, 2019
Internal Family Systems Theory Dr. Dawn-Elise Snipes Purchase CEU class for this podcast at: https://www.allceus.com/member/cart/index/product/id/1034/c/ 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 distracti
May 10, 2019
Understanding Anxiety Through a Child’s Eyes Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Counselor Education Purchase CEUs at: https://www.allceus.com/member/cart/index/product/id/1033/c/ 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 th
May 8, 2019
Facilitating Open-Ended Groups Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast Objectives ~ Define closed, open and single-session groups ~ Explore the benefits and challenges for each ~ Identify the developmental phases for open groups ~ Discuss necessary skills for managing open-ended groups Definitions ~ Closed groups are those which begin with a group of people and do not add anyone else (i.e. a 12 week anxiety management group) ~ Single session groups are stand-alone groups in which participants are not expected to return (i.e. A 4 hour grief workshop) ~ Open groups are those which do not have a set number of sessions and participants regularly rotate in and out. Closed Group Benefits ~ Participants all begin at the same time and learn the same material ~ When all begin together, the developmental process occurs in a predictable way: Forming, storming, norming and performing (Tuckman 1965) ~ Participants form more intimate bonds Drawbacks ~ As people leave, there is no replacement ~ There is often a waiting period for people to get into groups which is not ideal for emergent issues. ~ When people drop out, they usually cannot return Single Session Group Benefits ~ Uses a brief intervention model during a longer session. ~ Available like a “menu” ~ Does not require the participant to return another day Drawbacks ~ Requires the full development of the group in one session ~ Does not typically help participants translate knowledge into practice ~ Typically more psychoeducational in nature Open Ended Groups Benefits ~ Available on-demand for emergent concerns ~ Meets the guidelines for co-occurring disorder treatment of episodic care ~ Provides a gentle transition back into care Drawbacks ~ A certain amount of forming and norming happens each time a new member arrives or rejoins ~ It is harder to develop a deep level of trust with client rotations ~ Requires clinicians to be highly structured, able to foster cohesion between old and new members and ~ Facilitators must be able to develop a clear and specific purpose ~ Facilitators must thoroughly research expected needs to be able to facilitate “on the fly” Forming in an Open Ended Group ~ Facilitator Planning ~ Divide the topic into stand-alone groups ~ Someone who was not there last week should still be able to benefit this week. ~ Consider a cyclic rotation (every 8-16 sessions w/new information ) Forming in an Open Ended Group ~ Pre-group orientation ~ Explain the expectations and the rules for group ~ Attendance and how to withdraw ~ Participation ~ Reasons for discharge ~ Review what will be covered in group (weekly schedule) ~ Provide introductory information (handouts, videos) ~ Develop personal goals for group ~ Before group starts ~ Buddy up the new member with an existing member Forming in An Open Ended Group ~ The first (or only) session ~ Goals: Create cohesion, provide a useful nugget ~ New people introduce themselves and identify what they hope to get out of group (5-10 minutes) ~ Have current members share if they have similar goals ~ Tom: I am just so tired of being tired and depressed all the time. I want to find a way to get some pleasure back. ~ Jim Responds: I hear you. When I joined the group life almost didn’t seem worth living, but each week I learn more about the reasons I feel this way and small changes that have made a big difference. ~ Go around the group and have members share how they are doing, one way they dealt with their [issue] since the last group and one challenge they have experienced (if any) (10 minutes) Storming in An Open Ended Group ~ Existing members typically take a facilitative lead to help empower new members to take full advantage in the group ~ Facilitators need to ensure one person does not dominate the group Norming in An Open Ended Group ~ The first (or only) session ~ Present the topic for the day and link it to people’s tools and challenges ~ Chal
May 3, 2019
Building Positive Self Talk for Confidence and Self-Esteem Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast CEUs for this podcast are available at: https://www.allceus.com/member/cart/index/product/id/1030/c/ Objectives ~ 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 Function of Negative Self Talk ~ Protection from threats and failure ~ I can’t do this. ~ I’m not smart enough to… ~ I cannot find a decent partner ~ Nobody wants to be my friend ~ I am ugly ~ I could lost my job at any moment ~ Attention (See UFD Game…) Ugly, Fat and Dumb Game ~ The ugly, fat, and dumb game is a method of attaining attention by the individual in any given group whom needs the most attention (not necessarily the individual with the lowest self-esteem). ~ An individual draws attention to their own (perceived or real) flaws in order to get others to announce their own in an attempt to make the first person feel better and subsequently, lowering their own self-esteem ~ For example: ~ While eating dinner, Sally announces her weight to the table and calls herself fat causing all the other girls at the table (who nearly all clearly weigh more) to announce their weight in an attempt to make Sally feel better about herself. ~ If someone at the table isn’t of lower weight, they find another deprecating thing to say about themselves– “But you are so pretty. I would kill to have your hair. Mine is like a rats nest.” Benefits of Positive Self Talk ~ Reduced cortisol and HPA-Axis activation ~ Reduced pain ~ Improved physical health (Less stress-related disease) ~ Increased energy ~ Greater life satisfaction ~ Improved immunity Unconditional Positive Regard ~ From attachment figures who teach positive talk ~ From self ~ Encourage the use of the phrase ~ “I love you even if…” Self Awareness ~ Who you are ~ I have the ability to… (things you do) ~ I am… (inner qualities) ~ Keep a daily journal or account of your successes, good qualities and accomplishments ~ What you say to yourself ~ Journaling Mantras ~ Don’t wait until you are stressed. Practice positive self talk throughout the day—Every day (Positive Thinking Apps) ~ Mantras ~ I am capable. ~ I am lovable. ~ Today is going to be an awesome day. ~ I choose to be present in all that I do. ~ I feel energetic and alive. ~ I can achieve my goals. ~ I love challenges and what I learn from overcoming them. ~ I’ve got this Visualization ~ Visualization helps people’s brains “see” how they can succeed (or fail) ~ Negative self talk “teaches” the brain that negative things will happen which increases anxiety and distress, reduces concentration and increases a sense of helplessness. ~ Positive self-talk helps people’s brains “see” that ~ Success is possible ~ Happiness is possible ~ The person has power Visualization ~ Visualizations combined with desensitization help reduce anxiety and distress around… ~ Public speaking ~ Tryouts or job interviews ~ Driving ~ Starting a new school/job ~ Taking a test ~ … ~ Have people watch others who are successful and/or role play then use that data to visualize. Environments ~ Surround yourself with positivity ~ Parents model positivity ~ Listen to positive songs ~ Have family members bring a positive quote or song (lyrics) with them to dinner once a week and put it on the fridge. ~ Give yourself a pep talk every morning. ~ Keep a success wall/scrapbook Personalizing ~ When you take things personally you are often assuming you have control over how other people feel or react or the way things happen. ~ Sally didn’t text me today. She must be mad at me. ~ I didn’t get that job/role/position they must have hated me. ~ I don’t know what I did, but Dad was in an awful mood all day today. ~ Encourage people to ~ Look for 3 alternate (nonpersonal) explanations ~ Examine the facts. Did it have anything to do with you?
May 1, 2019
20 Ways to Nurture Children’s Mental Health CEUs are available for this presentation at AllCEUs https://www.allceus.com/member/cart/index/product/id/1028/c/ Objectives ~ Identify 25 ways to nurture children’s mental health Children’s Mental Health ~ Children need to feel ~ Safe ~ Emotionally ~ Physically ~ Competent (efficacy) ~ Able to succeed in school ~ Able to succeed in managing emotions ~ Able to succeed at … ~ Confident (esteem) ~ Lovable for who they are ~ That they belong How does NOT feeling these contribute to mental health issues? Physical ~ Sleep and Sunlight ~ Help set your circadian rhythms and vice versa ~ Circadian rhythms regulate (feeding, sleeping, stress) hormones ~ Lack of sleep  fatigue, irritability, low distress tolerance, poor concentration ~ Sunlight produces far more bioavailable vitamin D ~ How much? ~ 3-6 Years Old: 10 – 12 hours per day (8p-6a) ~ 7-12 Years Old: 9 – 11 hours per day (9p-6a) ~ 12-18 Years Old: 8 – 10 hours per day (10p-6a) ~ Create a sleep routine ~ Evaluate sleep hygiene AllCEUs.com/sleep Physical ~ Eliminate Caffeine ~ Caffeine stimulates the HPA-Axis leading to a perpetual state of stress ~ Caffeine has a half-life of 5-8 hours ~ Chronic caffeine intake ~ Has been shown to increase serotonin and acetylcholine and inhibits the release of GABA, which contributes to our feeling of alertness. ~ Reduces the number of active receptors (tolerance) ~ When it is stopped, the brain’s abundant supply of happy chemicals is abruptly cut off and the person feels depressed. ~ Reduces cofactors necessary for neurotransmitter synthesis ~ Inhibits the absorption of iron and B-vitamins involved with the synthesis of serotonin, dopamine and GABA ~ People often use caffeine to compensate for inadequate sleep Physical ~ Nutrition ~ Provides the building blocks to make neurotransmitters responsible for mood, motivation, libido, concentration and energy. ~ Maintains a healthy gut microbiome to help produce 80% of the neurotransmitters and prevent leaky gut (AllCEUs.com/gut) ~ Deficits of specific nutrients (i.e., vitamins A, B6, B12, C, folate, iron, zinc, and calcium) are associated with lower grades (CDC) ~ Interventions ~ Involve youth in creating a weekly menu ~ Encourage maintenance of an online food diary ~ Eat colorfully (Yellow, Red, Green, Blue/Purple/Black, Brown) ~ Start a hydroponic (or regular garden) ~ Keep fruits and chopped vegetables easily accessible Physical ~ Exercise ~ Higher physical activity and physical fitness levels are associated with improved concentration and memory. ~ Time spent in recess has been shown to positively affect students’ attention, concentration and classroom behaviors ~ Consider the motivation of behaviors ~ Brief classroom physical activity breaks (i.e., 5-10 minutes) are associated with improved attention, concentration, on-task behavior, and educational outcomes ~ How much ~ Children and adolescents ages 6 through 17 years should do 60 minutes (1 hour) or more of moderate-to-vigorous physical activity daily. (moderate=50-70% of max HR, vigorous =70-85% max HR) Physical ~ Relaxation and Recreation ~ Many youth get up, go to school, come home, do homework until 8 or 9 o’clock then go to bed with little time for true relaxation. ~ Relaxation is the state of being free from psychological and muscle tension ~ Techniques to calm the HPA-Axis and Teach Self-Regulation ~ Guided Imagery (even to space) ~ Yoga, Tai Chi ~ Progressive Muscular Relaxation ~ Deep breathing Physical ~ Screen for ~ Autism: 1:59 (CDC) ~ Developmental Delays: Cognitive, social and emotional, speech and language, fine and gross motor ~ Learning disabilities impact up to 10% of children ~ AD/HD ~ Must watch for differential dx Asperger's Disorder, and Other Common Misdiagnoses and Dual Diagnoses of Gifted Children ~ Mood disorders (NIMH) Depression 3%; Anxiety 8%; PTSD 4% ~ Thyroid Disorders ~ 4.6% of the U.S. population age 12 and older has hypothyroidism ~ Hypothyroidism
May 1, 2019
Forming a Foundation that Nurtures Secure Attachment at All Ages Instructor: Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast CEUs are available for this presentation at AllCEUs https://www.allceus.com/member/cart/index/product/id/1027/c/ Objectives ~ Identify the CARES approach to creating secure attachment ~ Explore the needs of children in infancy, early childhood and middle and high school to identify ~ Challenges ~ Ways to promote secure attachment in an age-appropriate manner Attachment–CARES ~ Requirements ~ Consistency ~ Attention ~ Responsiveness (mirror and up-regulation (soothing)) ~ Empathy and validation ~ Solutions (generate) Attachment ~ Effects ~ They are lovable and worthy of support ~ Others are available and responsive ~ They have good emotional regulation skills ~ They have frustration/distress tolerance ~ They have self-efficacy ~ They can tolerate ambiguity in life ~ They can deal effectively with others ~ They can effectively problem solve and elicit assistance when needed Infants (Maslow) ~ Biological Needs ~ Food when hungry ~ Shelter/Physical comfort ~ Protection from overstimulation ~ Sleep when sleepy ~ Contact ~ Safety ~ Consistent presence vs. Abandonment (no object permanence) ~ Startle / loud noises / pain ~ Love and Belonging ~ Caregivers provide attention, affection and nurturance ~ Unconditional positive regard Erickson's Stages Psychosocial Development: Trust Success ~ Ability to interpret, trust and act on own feelings (self-confidence) ~ Belief that others will help fulfil needs (hope) ~ Self reliance ~ Comfortable with attention ~ Ability to be “alone” ~ Contentment Failure ~ Inability to trust own instincts/urges/feelings ~ Reliance on others to tell them what they need ~ Inability to trust others will be supportive ~ Discomfort with and craving of attention (Abandonment fears) ~ Irritability/anxiety Piaget– Cognitive Development ~ Sensorimotor: ~ Children do not yet have object permanence ~ Children do not yet have much of a frame of reference so they rely on parental feedback ~ Schemas formed during this time rely heavily on ~ Were needs adequately met (empowered vs. powerless) ~ Parental reaction (stress-level/attentiveness/consistency) ~ Think about the impact of adverse childhood experiences during this time. (Abuse/neglect, addiction, absence, mental illness) Mindful Parenting ~ Be attentive to the baby’s cries and cues before they become hysterical ~ Accept the baby’s needs as they are to create a validating environment ~ Be consistent ~ Calm yourself ~ Stressed parent  stressed baby ~ Keep a routine to help set baby’s circadian rhythms ~ Feeding ~ Sleeping ~ View the world from baby’s eyes (esp. children with autism, FASD or sensory impairments) Toddlers and beyond (Maslow) ~ In addition to biological, safety and love and belonging needs… ~ The toddler is now developing ~ Self-Esteem ~ I am lovable for who I am ~ I am loveable even when I make a mistake ~ Self-Efficacy ~ I am capable of trying new things ~ If I make a mistake, my caregiver is there to help me Early Childhood: Psychosocial Development ~ Will: Autonomy vs. Shame & Doubt (Toddlers, 2 to 3 years) “Can I do things myself or am I reliant on others?” ~ Purpose: Initiative vs. Guilt (Preschool, 4 to 6 years) Children begin asserting control and power ~ Interferences ~ Overly permissive or overly strict parents ~ How does this prevent children from feeling safe and accepted? ~ Lack of praise for exploration and experimentation ~ How does this prevent children from feeling safe and accepted? Early Childhood: Piaget–Cognitive ~ 2-6 years early childhood (Preoperational) ~ Preschoolers have difficulty discerning truth from fiction/dreams/imagination ~ Parenting challenge: Truth vs. Fiction ~ How can parents sometimes lack empathy/validation; responsiveness or problem solving? ~ Toy Story; imaginary friends, poof-up powers ~ Preschoolers tend to think i
May 1, 2019
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/ 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 s
April 27, 2019
Moving from Supportive to Solution Focused Interventions Objectives ~ Differentiate between supportive and solution-focused interventions ~ Identify the function of each ~ Explore interventions to facilitate transition into problem solving What’s the Difference ~ Supportive interventions are grounded in empathy and helping the person survive the moment. ~ Plugging a hole in the hull of a ship until you can get to port ~ Solution focused interventions aim to help the person move from surviving the moment to thriving. ~ Repairing the ship and figuring out how to avoid the reef the next time Supportive Interventions ~ Establish rapport ~ Validate the person’s feelings ~ Can help the person return to baseline/wise mind ~ Examples: ~ Active listening ~ Radical acceptance ~ Distress tolerance Why People Get Stuck ~ Supportive interventions are like removing boiling rice from a hot stove. ~ When the rice starts to boil, it often boils over ~ The cook removes the rice from the heat and the bubbles go down. ~ The rice still needs to cook (the problem is still there) but the immediate crisis (boiling over) is past ~ The cook returns the rice to the stove to try and get it to finish cooking. Solution Focused Interventions ~ Help people identify ~ The problem ~ Their hoped-for resolution of the problem ~ Ways they have solved similar problems ~ Exceptions ~ Other possible solutions ~ Require a clear head and the ability to concentrate (a little) ~ Require that the person feels heard and understood ~ Require motivation to make a change Decisional Balance (Increase Motivation) Maintain Motivation ~ Use assignments to keep people on task between sessions ~ Have daily check-ins to complete the problem log ~ Use scaffolding to develop a game plan ~ Provide reinforcement for successful completion of tasks ~ Highlight improvements ~ Try to avoid rewarding backsliding ~ Consider all factors that may enhance or impede motivation ~ Emotional ~ Mental ~ Physical (sleep, nutrition, pain, hormones) ~ Social (friends and family) ~ Occupational (school/work) Remember ~ Everything people do serves a purpose and is generally more rewarding than the alternative. ~ Why does Sally seem to shut down or yes-but any suggestions? ~ Why does John insist on taking an excessive load even though he knows it will stress him out? ~ Why does Jane continue to use social media if it upsets her so much? Cognitive Processing Cont… ~ Can help therapists identify and address ~ Cognitive distortions ~ Emotional reasoning ~ Faulty goal setting and problem solving skills ~ Can help clients ~ Gain a different perspective ~ Identify what parts are within their control ~ Set SMART goals and increase efficacy Cognitive Processing ~ Tell me the problem (or write it down) ~ What are the known facts for and against your beliefs about the problem? ~ What other factors and people are involved? ~ Are you assuming things about other people or the future? ~ Are you confusing high and low probability events? ~ Which parts can you control? Which part’s can’t you control? ~ What is your hoped for resolution? ~ Is this realistic? Why or why not? ~ What are possible steps to a solution? Problem Solving ~ Use authenticity to communicate how much you want to help the person find a way to stop hurting. ~ Look for exceptions ~ Identify ways the person or someone else has solved the problem in the past ~ Set small, achievable goals ~ Follow up regularly. Narrative Therapy ~ Have people write down ~ What is going on (this chapter) ~ How they see the future (the next chapter) ~ Include ~ Who is there? ~ What do they do? ~ How do they feel? Living in the AND ~ Validate people’s hurts and perspectives. ~ You are devastated and it seems like the pain will never end. ~ Help them identify things that are important to them that are going well ~ Tree ~ Collage ~ Scrapbook ~ Index cards: Who or what it is and why it is important and going well. Summary ~ Supportive interventions are necessary to help peopl
April 24, 2019
Building Resilience in Children Objectives ~ Define resilience ~ Explore characteristics of Resilient People ~ Identify how to help people become more resilient ~ Highlight activities which can help people deal with unpleasant events when they happen The Art of Resilience ~ Resilience is a process or lifestyle that enables people to bounce back in the face of adversity ~ “a dynamic process encompassing positive adaptation within the context of significant adversity” (Luthar, Cicchetti, & Becker, 2000) ~ Resilience develops over time as people are exposed to, and successfully navigate, stressors ~ We can help children by allowing them to try…and sometimes fail Resiliency Theory ~ The central principles of the theory include ~ Risk factors and vulnerabilities ~ Protective factors/mechanisms ~ Risk factors and mechanisms are the events or conditions of adversity that cause distress in early life ~ Poverty ~ Prematurity ~ Residential mobility / lack of family or community ties ~ Addicted or dysfunctional family environment ~ Illness (cancer, M.S., chron’s disease) The Art of Resilience ~ Vulnerability factors are individual traits, genetic predispositions, or environmental and biological deficits which may cause heightened response, sensitivity, or reaction to stressors. ~ Cognitive impairment (including FASD)—Early steps ~ Lack of social support– Social skills ~ Emotional dysregulation –Distress tolerance & Mindfulness ~ Ineffective coping skills –Coping skills ~ Mood or addictive disorders in the person –Screening and early intervention ~ Poor physical health (pain, nutrition, hormones, sleep) –Wellness behaviors, health education The Art of Resilience ~ Protective factors and mechanisms are things which enhance or promote resistance, or which may moderate the effect of risk factors. ~ Rutter (1987) suggests that protective mechanisms may operate in one of four ways to allow overcoming adversity: ~ Reducing risk impact ~ Reducing negative chain reactions to risk factors ~ Promoting resiliency traits ~ Setting up new opportunities for success. The Art of Resilience ~ Fergus and Zimmerman (2005) identified two types of protective factors. ~ Assets are positive factors that reside within individuals, such as: ~ Self-efficacy and self-esteem ~ Social competence and communication skills ~ Resources refer to factors outside individuals, such as: ~ Social support ~ Opportunities to learn and practice skills ~ Wellness programs that support biological health Make Every Moment a Learning Opportunity ~ Practice mindfulness with your children at breakfast and before bed ~ When they are upset ~ Empathize ~ Comfort and help them de-escalate ~ Process ~ In young children, provide advice and role play ~ In older children, brainstorm possible reactions for the future 6-Cs of Resilience ~ 6-Cs ~ Coping ~ Control ~ Character ~ Confidence ~ Competence ~ Connection (resource) Characteristics “Assets” of Resilient People ~ Coping: Can effectively balance negative and positive emotions and manage strong impulses. ~ Emotion Regulation / Prevent or mitigate vulnerabilities ~ Daily mindfulness ~ Screening and early intervention for DD/LD ~ Structure at home (Sleep, nutrition) ~ Distress Tolerance ~ Poster on the fridge and bedroom (and classrooms) ~ Problem Solving Skills ~ Focus on facts and what you can change ~ Remain aware of resources Characteristics “Assets” of Resilient People ~ Character ~ Who are you, and who and what is important to you? ~ What things can you change in this situation? ~ The situation? ~ Your reaction to the situation? Characteristics “Assets” of Resilient People ~ Control/Autonomy: Belief in your ability to act independently to exert some control over one’s situation ~ Purposeful Action: Make realistic plans for a meaningful life based on what is important to you ~ Take the steps necessary to achieve goals ~ Notice positive, forward moving thoughts and behaviors in yourself and others ~ Confidence in one’s strength
April 20, 2019
Couples Therapy Objectives ~ Identify common mistakes in couples therapy ~ Explore things counselors need to consider when working with couples CEUs are available for this podcast at https://www.allceus.com/member/cart/index/product/id/1024/c/ ~ Provide a confidential dialogue, which normalizes feelings ~ Enable each person to be heard and to hear themselves ~ Set boundaries so each person feels safe and empowered to express his or her point of view in a way the other can hear and understand, even though he or she may not agree ~ Teach active listening, using I statements and objective terms from the beginning ~ Reflect the relationship's difficulties and the potential for change ~ Inform couples that it is not a matter of one person being right or wrong, since both partners make sense from their perspective. They will be learning how to better understand each other and improve communication to restore harmony and intimacy ~ Identify times in the past that have been good and what was different ~ Help each partner begin to understand how he or she is contributing to the conflicts and can contribute to solutions ~ Move from the “blame game” to looking at what happens to them as a process. ~ Look for exceptions ~ Help both partners see the relationship in a more objective manner ~ Identify repetitive, negative interaction cycles as a pattern ~ Sex/Intimacy ~ ResentmentsExplosions ~ Change the view of the relationship via functional perspective taking ~ How is this behavior helpful to him/her/you? ~ Help each partner begin to understand how he or she is contributing to the conflicts and can contribute to solutions ~ Understand the source of reactive emotions that drive the pattern ~ How does this situation trigger past hurts? ~ How does this situation trigger feelings of failure, rejection, loss of control or isolation? ~ Empower the partners to take control and make vital decisions ~ What are workable solutions to this problem? ~ Facilitate a shift in partners' interaction ~ Which solution will you choose? ~ What is each person’s responsibility? ~ Create new and positively bonding emotional events and establish intimacy ~ Meet the couple where they are— What can they currently comfortably do? ~ What do they hope they will eventually be able to do? ~ Teach the 5 love languages (touch, gifts, words, acts, quality time) ~ Have each partner make a list of what those things are for them ~ Foster a secure attachment between partners ~ Responsiveness ~ Consistency ~ Compassion/empathy ~ Caring ~ Mindfulness paraphrasing activity ~ Decrease emotional avoidance ~ When you are feeling [upset] what will you do? ~ Mindfulness ~ Radical acceptance ~ Distress tolerance ~ Problem solving ~ When you are upset with your partner, what will you do? ~ Promote strengths ~ What are your strengths as a couple? ~ What are your strengths as individuals and how can you synergize? ~ What positive things did your partner do last week? ~ 9 minutes of connection (3 morning, 3 after work, 3 before bed) Assessment Areas ~ Communication ~ Conflict Resolution ~ Appreciate Individual Differences ~ Financial Management ~ Leisure Activities ~ Sexuality and Affection ~ Family and Friends ~ Relationship Roles ~ Children and Parenting ~ Spiritual and Cultural Beliefs and Values Assessment ~ Each person’s goals for treatment ~ What changes are you hoping will come out of therapy ~ Phenomenological truth for each person ~ Temperament ~ E/I ~ S/N ~ T/F ~ J/P Conflict Resolution ~ Set a time and place for discussion ~ Define the problem (specific and objective) ~ List the ways you each contribute to the problem ~ Identify past unsuccessful attempts at resolution ~ Brainstorm 10 possible solutions ~ Discuss and evaluate each solution ~ Agree on a solution to try ~ Describe how you each will work toward that solution ~ Set another time to discuss your progress ~ Reward each other’s efforts Fair Fighting ~ Know when you need a time out ~ Do not enagage whe
April 17, 2019
Caring for Transsexual, Transgender & Gender Nonconforming People Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast CEUs are available for this podcast https://www.allceus.com/member/cart/index/search?q=transgender Based in Part On ~ Standards of Care for Transsexual, Transgender & Gender Nonconforming People a publication by The World Professional Association for Transgender Health Objectives ~ The Difference between Gender Nonconformity and Gender Dysphoria ~ Epidemiologic Considerations ~ Explore the sources of stigma and discrimination and their impact on health ~ Overview of Therapeutic Approaches for Gender Dysphoria ~ Assessment and Treatment of Children and Adolescents with Gender Dysphoria ~ Mental Health Introduction ~ Both across and within nations, there are differences in all of the following: social attitudes towards transsexual, transgender, and gender nonconforming people; constructions of gender roles and identities; language used to describe different gender identities; epidemiology of gender dysphoria; access to and cost of treatment; therapies offered; number and type of professionals who provide care; and legal and policy issues related to this area of health care (Winter, 2009). ~ There are examples of certain cultures in which gender nonconforming behaviors are less stigmatized and even revered (e.g., in spiritual leaders) Intro. Cont… ~ Even a similar proportion of transsexual, transgender, or gender nonconforming people existed all over the world, it is likely that cultural differences would alter both the behavioral expressions of different gender identities and the extent to which gender dysphoria –actually occurs. ~ Terminology is culturally and time-dependent and is rapidly evolving. It is important to use respectful language in different places and times, and among different people. Intro cont… ~ Gender nonconformity is the extent to which a person’s gender identity, role, or expression differs from the cultural norms prescribed for people of a particular sex (Institute of Medicine, 2011). ~ Gender dysphoria refers to distress caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth ~ Only some gender nonconforming people experience gender dysphoria at some point in their lives ~ Treatment for gender dysphoria depends on the individual Intro cont… ~ A disorder is a description of something with which a person might struggle, not a description of the person or the person’s identity. ~ Transsexual, transgender, and gender nonconforming individuals are not inherently disordered. The distress of gender dysphoria may precipitate a diagnosable disorder. Intro cont… ~ Some individuals describe themselves not as gender nonconforming but as unambiguously cross-sexed (i.e., as a member of the other sex) ~ Other individuals affirm their unique gender identity and describe their gender identity in specific terms such as transgender, bigender, or genderqueer, affirming their unique experience that may transcend a male/female binary understanding identifying with neither, both, or a combination of genders (agender, bigender, trigender, pangender, demigender, gender fluid or third or other-gendered) Intro cont… ~ Gender identity is separate from sexual or romantic orientation ~ Importantly, some individuals may not experience their process of identity affirmation as a “transition” because they never fully embraced the gender role they were assigned at birth Transgender Persons and Stigma ~ There is stigma attached to gender nonconformity in many societies around the world. ~ Stigma can lead to prejudice and discrimination, resulting in “minority stress” ~ Minority stress is unique (additive to general stressors experienced by all people), socially based, and chronic, and may make transsexual, transgender, and gender nonconforming individuals more vulnerable to developing mental health concerns ~ National Transgender Di
April 13, 2019
Nonpharmacological Pain Management Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast Objectives ~ Types of pain ~ Impact of pain on sleep, HPA-Axis and mood ~ Treatment options for chronic pain ~ CBT Interventions Types and Locations of Pain ~ Chronic pain ~ Lasts more than 3 months ~ May have a known or unknown cause ~ Persists beyond expected healing time or despite treatment ~ Best conceptualized as a condition to be managed rather than cured Types of Pain ~ Nocioceptive Pain ~ Pain that is caused by damage to body tissue and is based on input by specialized nerves called nociceptors ~ Most nociceptive pain is musculoskeletal, and is often described as aching or deep ~ Examples ~ Back and neck pain ~ Arthritis/Gout ~ Tendonitis ~ Bursitis ~ Pelvic floor disorders Types of Pain ~ Neuropathic Pain ~ Occurs when there is nerve damage that typically involves either the peripheral or central nerves ~ It is often described as burning, shooting, tingling, or electric ~ Examples ~ Radicular pain—radiates along a nerve (sciatica) ~ Phantom limb ~ Fibromyalgia ~ Peripheral neuropathy ~ Spinal tap/epidural ~ Carpal tunnel Types of Pain ~ Headache Pain ~ Tension (15 days/month for at least 6 months) ~ Cluster (15-180 minutes every other day to 8x/day) ~ Migraine (2-72 hours) ~ TBI (may last 6 or more months) ~ Cervicogenic (referred pain from the neck/cervical spondylosis or fracture) ~ Medication Overuse/Rebound Headaches Treatment Options ~ TENS units ~ Massage ~ Physical Therapy ~ Stretching ~ Ergonomics ~ Heat/cold ~ Chiropractics ~ Acupuncture/Acupressure ~ Yoga/Tai-Chi Treatment Options ~ Biofeedback: Noticing HPA-Axis activation and responding with relaxation exercises ~ Relaxation Training ~ Mindfulness ~ Behavioral Therapy. Observable behaviors such as grimacing, sighing, or limping are often socially reinforced and can lead to increased self-perceptions of pain ~ Cognitive Behavioral Therapy (CBT) addresses thoughts, behaviors and emotions associated with pain ~ Acceptance and Commitment Therapy (ACT) aims to develop greater psychological flexibility and learn to “live in the and.” ~ Hypnotherapy CBT-CP Theoretical Components Factors Maintaining Pain Psychological Factors Associated with Pain ~ Pain Cognitions. Negative cognitions and beliefs about pain can lead to maladaptive coping, exacerbation of pain, increased suffering, and greater disability ~ Catastrophizing. Catastrophic thoughts contribute to increased pain intensity, distress, and failure to utilize adaptive coping techniques. Examples “my pain will never stop” or “nothing can be done to improve my pain.” ~ Hurt versus Harm. When pain is interpreted as evidence of further damage to tissue rather than an ongoing stable problem that may improve, individuals with chronic pain will report higher pain intensity regardless of whether damage is occurring (Smith, Gracely, & Safer, 1998). Psychological Factors Associated with Pain ~ Negative Affect. The relationship between pain and negative affect is complex and bidirectional. ~ Answer-Seeking. Failing to accept the offered cause of pain or being unwilling to accept that a source of pain cannot be determined can lead to increased distress and pain intensity ~ Pain Self-efficacy is the level of confidence that some degree of control can be exerted over the pain. Social Factors Associated with Pain ~ Solicitous significant other who is highly responsive to an individual’s pain or to expressions of behavior indicative of pain results in increased reports of pain. ~ Social interactions that focus the individual’s attention away from pain and onto different topics or activities. ~ Punishing responses involve either angry or ignoring responses, each aimed at limiting expression of pain ~ Potential consequences of punishing responses include dramatic (loud) expressions of one’s pain experience in an effort to be “heard” or, alternately, inability to expres
April 6, 2019
Treating Addictions and Borderline Personality Disorder Symptoms Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Host: Counselor Toolbox Podcast CEUs are available for this presentation at AllCEUs https://www.allceus.com/member/cart/index/product/id/1002/c/ Objectives ~ Review the characteristics of BPD and Addictions ~ Explore the functions of these symptoms ~ Identify interventions to help the person more effectively manage emotions and relationships Internal Reality ~ Lack of a sense of self—If they aren’t someone’s something, then they are nothing ~ Unlovable for who they are ~ Constant fear of abandonment Consequences ~ Lack of emotional boundaries ~ Anger is used to control others and is rewarded ~ Emotional dyscontrol ~ Inability to self-soothe/Impulsivity ~ Lack of coping skills ~ Relationship problems ~ Physical health problems and complaints ~ Cognitive distortions are reinforced First ~ Identify the most salient symptoms ~ Their function (and alternate ways to meet that need) ~ Identify what it looks like for that person ~ When X happens, how do you feel? What do you think? What are your urges? What do you do? ~ How that behavior is being maintained (what are the benefits and other ways to get the same benefit) Frantic efforts to avoid real or imagined abandonment ~ Function: The person only knows how to exist as a role, such as being someone else’s spouse/parent etc. (Co-dependency) ~ Preventing abandonment means preventing death or dissolution ~ What does it look like (Benefits/Drawbacks) ~ Hypervigilant/hypersensitive to rejection/criticism ~ Anger at/belittling others to control them ~ Acting out to control through guilt, manipulation ~ Emotional dyscontrol Abandonment cont… ~ Origins ~ Failure to develop a sense of self due to constantly trying to appease the caregivers ~ Addict –Don’t Talk, Don’t Trust, Don’t Feel ~ Borderline –Do as I say or else… ~ History of abandonment/rejection/CPR ~ If they are something to someone then they are filling a need and are less likely to be abandoned ~ History of neglect/abuse (You (as a person) are not worthy of love) Abandonment Cont… ~ Interventions ~ Develop a sense of self and self-esteem ~ Differentiate between who you are and what you do ~ Explore what makes someone/something “lovable” ~ Dogs/horses ~ Children ~ Others ~ Which of those characteristics do you have in yourself? ~ Identify and address messages/events in the past that communicated unlovability Abandonment Cont… ~ Interventions ~ Explore the notion of responsibility (Who and what are you responsible for) ~ Not responsible for the parent ~ Responsible for you ~ Nobody else can make you… ~ Explore and address abandonment/rejection triggers ~ Is it about you? What are alternate explanations? ~ Explore faulty thinking Relationships are Unstable ~ Function: Controlling others provides a feeling of safety and predictability ~ What does it look like (Benefits/Drawbacks) ~ Intense and unpredictable interactions ~ If you do what I want, I love you ~ If you do not, you are rejecting me and I hate you ~ Everyone walks on eggshells ~ Jekyll/Hyde Relationships are Unstable ~ Origins ~ Children were rejected (or the caregiver was unavailable) at an age in which they were still thinking in concrete, all-or-nothing terms ~ The A/B expects rejection and has never experienced an authentic relationship with self-or others ~ Inability to self-soothe is terrifying and the A/B fears they cannot cope on their own ~ Repeated rejections become most salient and support all-or-nothing thinking Relationships are Unstable cont… ~ Interventions ~ Use CBT to explore and address perceived rejection ~ From others in real life ~ From the gallery/hecklers ~ From yourself ~ Use contextual approaches to separate REactions to the present ~ Differentiate dislike of actions/ideas from dislike of person (People can disagree or dislike something you do but that doesn’t mean they don’t like you Relationships are Unstable cont…
April 3, 2019
Mindfulness & Acceptance of Addictive Behaviors Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast CEUs are available for this presentation at AllCEUs https://www.allceus.com/member/cart/index/product/id/1001/c/ 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 yo
March 29, 2019
The Porn Trap Based in part on the book by Wendy and Larry Maltz, LCSWs Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Education Host: Counselor Toolbox Podcast CEUs are available for this presentation as part of the Sex and Pornography Addiction Recovery Coaching Certificate Track https://www.allceus.com/member/cart?c=42 or as an individual 2 hour class at https://www.allceus.com/member/cart/index/product/id/999/c/ Want to listen to it as a podcast instead? Subscribe to Counselor Toolbox Podcast Objectives ~ Explore the hidden power of porn ~ Identify the characteristic relationships with porn ~ Review the consequences of porn ~ Review the impact of porn on partners ~ Identify 6 action steps to quit porn ~ Learn about handling and preventing relapses ~ Identify strategies for healing as a couple Effects of Porn on the Brain ~ Dopamine is the main motivation chemical ~ Dopamine is all about seeking and searching for rewards, the anticipation, the wanting. ~ Dopamine surges for novelty ~ Dopamine provides the motivation and drive to pursue potential rewards or long term goals ~ Endogenous opioids are the main reward chemical. ~ Naltrexone has been found effective for blocking the endogenous opioids and reducing the reward https://www.ncbi.nlm.nih.gov/pubmed/18241634 ~ Stimulates testosterone Effects of Porn on the Brain ~ The adolescent brain has an: ~ immature prefrontal cortex ~ over-responsive limbic circuits ~ overactive dopamine system ~ a pronounced HPA axis ~ augmented levels of testosterone https://www.ncbi.nlm.nih.gov/pubmed/30754014 Hidden Power of Porn ~ The Coolidge Effect ~ Tiring of one partner/stimulus, but having a powerful automatic response to novelty ~ The brain does not differentiate (very much) between 2-D and 3-D partners ~ The desire and motivation to pursue sex arises largely from a neurochemical called dopamine which compels you to do things that further your survival and pass on your genes ~ Sexual stimulation offers the biggest natural blast of dopamine available to your reward circuitry ~ Porn can give people the illusion of power and control ~ Variable ratio schedule of reward ~ Dopamine is released for: ~ Seeking and searching for novelty, food, sex, safety ~ Novel stimuli (i.e. internet porn) ~ Anything that violates expectations – shock, surprise, or more than we could have imagined ~ Strong emotions – such as desire, guilt, disgust, embarrassment, anxiety & fear https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0017047 ~ Strong emotions elevate dopamine and boost norepinephrine, and cortisol. This increases excitement while amplifying dopamine’s effects. ~ Over time a porn user’s brain can mistake feelings of anxiety or fear for feelings of sexual arousal ~ Internet porn can alter brain circuitry for sexuality– especially during adolescence when the brain is highly malleable and programed to learn all about sex. ~ Video porn is far more arousing than static porn because it involves more senses and is more “life-like”. ~ To increase sexual arousal (and raise declining dopamine) one can instantly switch genres ~ Porn videos replace your imagination, and may shape your sexual tastes, behavior, or trajectory (especially so for adolescents). ~ Porn is stored in your brain, which allows you to recall it anytime you need a “hit.” ~ Unlike food and drugs, for which there is a limit to consumption, there are no physical limitations to internet porn consumption. The brain’s natural satiation mechanisms are not activated, unless one climaxes. Even then, the user can click to something more exciting to become aroused again. Porn and Sexual Conditioning ~ Psychological Messages ~ This how people have sex, and this is how I should do it. ~ This is what turns me on. ~ This is what people should look and act like Porn and Sexual Conditioning ~ Physiological Conditioning ~ Excess masturbation is the signal to your primitive brain that you have hit the evolutionary jackpot.
March 27, 2019
Love You, Hate the Porn by Mark Chamberlain, PhD Facilitator: Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast CEUs are available for this presentation as part of the Sex and Pornography Addiction Recovery Coaching Certificate Track https://www.allceus.com/member/cart?c=42 or as an individual 2 hour class at https://www.allceus.com/member/cart/index/product/id/1000/c/ Want to listen to it as a podcast instead? Subscribe to Counselor Toolbox Podcast Objectives ~ Explore the impact of pornography on relationships ~ Identify common reactions to finding out about porn ~ Explore needs that may fuel negative cycles ~ Interventions “Relationship Rescue Breaths” ~ Improving intimacy ~ Dealing with insecurity, vulnerability and grief ~ Helping your partner understand what porn does for you ~ Addressing triggers for porn use Prevalence and Problems ~ 70.8 percent of men and 45.5 percent of women thought they would watch. ~ 22.3 percent of men and 26.3 percent of women thought pornography had no role in a romantic partnership (Olmstead et. al) ~ Michael Kimmel reported in his 2008 book Guyland, young men often watch porn with their peers and for different reasons than older men. Kimmel writes that “guys tend to like the extreme stuff, the double penetrations and humiliating scenes. They watch it together with guys and they make fun of the women in the scene. Impact of Pornography on Relationships ~ “After viewing pornography, participants became less satisfied with their real-life sexual partners, saw monogamy as less desirable and faithfulness to one’s spouse as less important, and were more prone to overestimate the prevalence of less common sexual practices” (p. 5) ~ “After viewing pornography subjects became more cynical in their attitudes about love and more accepting of the idea that superior sexual satisfaction It attainable without having affection for one’s partner” (p. 5) (Zillman and Bryant 1988) Impact of Pornography on the Relationship ~ “The partner viewing the pornography had less faith in his wife’s fidelity.” (p. 6) ~ Spouses/partners complained that ~ Their pornography using partner had less sexual desire for them ~ They way they were treated during sex made them feel more like a sex object (Bergner & Bridges 2002) Impact of Pornography on Relationships ~ Association between consumption of pornography and engaging with multiple and/or occasional partners, emulating risky sexual behaviors, assimilating distorted gender roles, dysfunctional body perception, aggressiveness, anxious or depressive symptoms https://www.ncbi.nlm.nih.gov/pubmed/30761817 Effects of Pornography ~ Robust dopamine response ~ Void of oxytocin after masturbation ~ Sleep deprivation ~ Erectile dysfunction, delayed ejaculation, and an inability to reach orgasm ~ Body adjusts to the intensity of the neurochemical response by dampening its response leading people to feel worse than before they started ~ The shame of pornography use builds walls between partners brick by brick ~ Porn is always available Effects of Pornography ~ The more people seek pornography, the more isolated they feel ~ Porn teaches viewers to objectify their partners ~ Porn sets unrealistic standards and expectations ~ Partners who have caused pain in their relationships may feel they have lost privileged status and withdraw out of shame and to spare the NP partner the pain. Common Reactions ~ Helplessness ~ Inability to look at spouse without being reminded of the infidelity ~ Nightmares ~ Worrying your partner is thinking about the porn when with you ~ Suspicion ~ Hypervigilance to your partner ~ Depressive/GAD symptoms ~ Withdrawing from others ~ Becoming more critical towards your partner ~ Becoming increasingly angry toward your partner ~ May want to turn to the PU Partner for reassurance and comfort and “punch him in the face and get him away from me” at the same time Questions the NP Partner May Ask ~ Why am I not enough? ~
March 23, 2019
Breaking the Cycle of Porn Addiction Based in part on the book “Breaking the Cycle” by George Collins Objectives ~ Explore how porn addiction can be a cycle ~ Explore how porn (like video games) can be addictive ~ Explore technological interventions to help pornography addicts ~ Identify critical treatment Issues for porn addiction Similarities Between Porn and Gaming ~ Available anywhere/anytime ~ Never ending excitement ~ New stuff constantly added ~ No particular end ~ Increases dopamine and norepinephrine ~ May (falsely) provide the feeling of social connection ~ Easy to minimize porn as a harmless online activity ~ Some sites have monthly fees which encourage more use to “get your money’s worth.” Recognizing It ~ Recognizing Porn (or Sex) Addiction (Compulsion) ~ You cannot get enough ~ You spend more time thinking about, engaging in and recovering from the behavior than intended ~ You give up important social, recreational activities to engage in the behavior ~ It causes problems in one or more areas of your life, but you continue to do it: emotional, social, occupational, legal ~ You have been unsuccessful at trying to quit Who Becomes a Porn Addict ~ Anybody who… ~ Had a troubled childhood and found masturbation as an effective means of self-soothing ~ Was exposed to sexually explicit material at an early age ~ Has difficulty in real-life relationships ~ Is depressed, stressed or having difficulty sleeping ~ So…anybody is vulnerable The Cycle of Porn ~ Porn addiction is really about the neurochemical reactions from looking at porn (excitement/tension building) and masturbation (release/reward) ~ When people encounter distressing situations (or boredom) they may masturbate. ~ This produces a sensation of calming and/or pleasure that ~ The person wants to experience again ~ The person remembers the next time a distressing situation arises Step 1: Identifying the Triggers ~ Triggers are people, places, things, feelings and events that prompt a person to want to escape ~ What emotions trigger you to want to view porn? ~ What thoughts or self-talk? ~ What people? ~ What situations or times of day? Step 2: Address Euphoric Recall ~ Make a list of the unpleasant effects ~ Emotional (Shame, guilt, anger, anxiety, depression…) ~ Cognitive (Obsessions, lack of concentration…) ~ Interpersonal (Inability to get aroused IRL, changed sexual preferences and expectations, difficulty not objectifying, paying less attention to kids, less desire to interact with other people…) ~ Occupational (losing time at work, late for work, poor work performance) ~ Legal (divorce, child custody, criminal charges, bankruptcy (webcam viewers) Step 3: Pair the Porn ~ Pairing the situations in which you want to use porn with something competing. ~ Put a picture of your kids or a religious symbol next to your computer and on your desktop/home screen Step 4: Lock It Down ~ Firewalls to block adult content that you don’t have the password to ~ Nanny apps (like Bark) that notify someone if you go to an adult site Step 5: Reboot ~ When the brain is regularly flooded with dopamine and excitatory neurochemicals it becomes less sensitive. ~ Things that used to make you happy don’t have the same effect. ~ You may also start feeling depressed, have difficulty concentrating and lack energy. ~ Removing all pornography from the equation is most helpful. ~ Restricting sexual activity to only that between you and a consenting partner is also helpful. ~ Initially you may experience anxiety and/or depression as well as sexual craving since the brain is depending on regular doses of feel-good chemicals and porn has been a staple coping strategy ~ As the brain recovers your obsessions about porn and compulsive behaviors will start to remit Step 5 ~ Unhook from their thoughts ~ Instead of saying “I am a failure” say “I am having the thought that I am a failure.” ~ Instead of saying “I can’t wait to get home to look at porn/masturbate” say “I am having the thought that…” St
March 20, 2019
Enhancing Trauma Resiliency Objectives ~ 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 trauma Effects 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 Flexibility Signs 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 / Dysregulation PTSD 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 skills Protective Factors ~ Psychological Flexibility Protective 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 Log Protective Factors ~ Mindfulness/Vulnerability Prevention ~ Morning/Evening (Whiteboard) Mindfulness Protective 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 ~ Sensations Framing/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 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…. game Flexibility ~ 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 st
March 16, 2019
Trauma, Grief and Personality Disordered Symptoms Dr. Dawn-Elise Snipes CEUs can be earned for this podcast by going to https://www.allceus.com/member/cart/index/product/id/996/c/ Objectives ~ Explore the similarities between grief, traumatic reactions and personality disordered symptoms. ~ Explore possible etiology of symptoms ~ Change the language from why are you doing this, to How does this make sense?/What happened to you? ~ As we go through the presentation, continually ask yourself…How could this behavior be an adaptive reaction? Grief, Trauma & Personality Disorders ~ Persistent Complex Bereavement Disorder ~ Conditions for Further Study (DSM-V p. 789-792) ~ PTSD ~ Personality Disorders ~ Pervasive, long-standing ways of being ~ Ways of perceiving and interpreting self, others and events ~ Range, intensity and appropriateness of emotional response ~ Interpersonal functioning (empathy, trust, desire for relationships) ~ Impulse control Emotional ~ Shock, denial, or disbelief ~ Guilt, shame, self-blame ~ Feeling sad or hopeless ~ Feeling disconnected/numb ~ Dysregulation ~ Anxiety ~ Separation anxiety ~ Reactive Attachment ~ Angry/Irritable ~ Depression ~ Loneliness Cognitive ~ . ~ Confusion, difficulty concentrating ~ Difficulty concentrating ~ Short attention span ~ Difficulty learning new material; short term memory loss ~ Difficulty making decisions ~ Lack of a sense of purpose ~ Inability to find meaning in the events and life itself Physical Most physical effects of grief/trauma are effects of stress/anxiety ~ Fatigue ~ Being startled easily ~ Racing heartbeat ~ Aches and pains ~ Muscle tension ~ Appetite disturbances ~ Sleep disturbance ~ Gastrointestinal disturbance ~ Compromised immune response; increased illness Social ~ Isolation/detachment ~ Avoidance ~ Withdrawal ~ Distrust/suspicion ~ Self absorption ~ Searching ~ Clinging/dependence ~ Insecurity ~ Distorted self image ~ How could these symptoms lead to PD behaviors? Putting It Together ~ Personality Disordered Behavior in Context ~ PD behavior must be traceable back to adolescence or early adulthood! (not early childhood as most of us were taught) ~ ~1% of children are victims of (reported) abuse or neglect each year ~ 37% of American children are reported to Child Protective Services by their 18th birthday ~ 48% of US Children experience at least one “serious trauma” / Adverse Childhood Experience http://www.invisiblechildren.org/2016/12/29/1-in-3-children-investigated-for-abuse-by-18-washington-university-study/ https://www.childhelp.org/child-abuse-statistics/ https://acestoohigh.com/2013/05/13/nearly-35-million-u-s-children-have-experienced-one-or-more-types-of-childhood-trauma/ Behavioral ~ Cluster A ~ Paranoid: Suspiciousness, hold grudges, jealousy ~ Schizoid: Social detachment, restricted emotions, oblivious to social cues ~ Cluster B ~ Antisocial: Disregard for rights of others, aggression, poor impulse control, blame victims, lack of empathy ~ Histrionic: Uncomfortable being alone, need to be CoA, easily influenced by others ~ Narcissistic: Sense of entitlement, disregard the rights and feelings of others, lack empathy, need to be admired ~ Borderline: Unstable sense of self, dichotomous thinking, emotional dysregulation, impulsivity—self-destructive, difficulty interpreting the motivations of others Behavioral ~ Cluster B ~ Borderline: Unstable sense of self, dichotomous thinking, emotional dysregulation, impulsivity—self-destructive, difficulty interpreting the motivations of others ~ Cluster C ~ Avoidant: Social inhibition, feelings of inadequacy, hypersensitivity to criticism ~ Dependent: Strong need to be taken care of by others (submission, serial relationships), challenged to make decisions or begin a task without help ~ Obsessive Compulsive: Preoccupied with rules and order, devoted to work, perfectionistic, unable to delegate Summary ~ Grief and trauma symptoms overlap considerably ~ Many of the symptoms of personality disorders ca
March 13, 2019
Complicated Grief and Attachment Dr. Dawn-Elise Snipes PhD, LPC-MHSP Podcast Host: Counselor Toolbox CEUs are available for this presentation at AllCEUs https://www.allceus.com/member/cart/index/product/id/995/c/ 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.
March 9, 2019
Psychosocial Impact of Trauma Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education To access the CEU/OPD/CPD course go to  https://allceus.com/counselortoolbox  in the US or  https://australia.allceus.com/counselortoolbox if you are in Australia. Objectives ~ Learn about the effects of trauma on the person and the family ~ Explore how these effects impact ~ Mood ~ Behavior ~ Relationships ~ Identify tools to help people navigate life while adjusting to their new reality. What are the Traumas You See ~ House fire ~ Death ~ Domestic violence ~ Child neglect ~ Miscarriage ~ Forcible felonies: Rape/Robbery ~ Chronic exposure to people who have experienced the above (Counselors, LEO, ER docs, EMS) Remember ~ What is traumatic to one person may not be traumatic to another ~ What is traumatic to a child may not seem traumatic to an adult Trauma Triage ~ Being the victim or similarity to the victim ~ Proximity to safe-zone ~ Stressors in the prior 6 months ~ Prior mental health, trauma or substance abuse issues ~ Access to social support within 4, 24, 72 hours Effects of Trauma on the Person ~ Chronic stress or repeated trauma can result in a number of biological reactions, including a persistent fear state which shapes the perception of the environment. ~ Positive journaling ~ Mindfulness ~ Cognitive behavioral interventions ~ A single trauma can alter a person’s sense of safety and worldview ~ People with a persistent fear response may lose their ability to differentiate between danger and safety, and they may identify a threat in a nonthreatening situation. ~ Fact checker (https://www.childwelfare.gov/pubPDFs/brain_development.pdf. National Scientific Council on the Developing Child, 2010b) Fact Checker ~ What is the situation that is causing me to feel anxious or angry? ~ What are the facts supporting this feeling? ~ Am I confusing high and low probability events? ~ How does this situation remind me of other times when I have been angry or afraid? ~ What is different in this situation? ~ Ex. Walking to your car at night Trauma’s Impact on the Person ~ Emotions ~ Emotional numbing: Pandora’s box is locked up tight ~ Depression: Hopeless, helpless, loss ~ Anxiety: That it will happen again, that they are broken/unlovable, that they won’t recover, ~ Anger: At God, blaming others and self, ~ Grief: Denial, Anger, Bargaining, Depression, Acceptance ~ Guilt: Self anger for what they did, did not do or just because they survived. ~ PTSD ~ Evaluate for relapse of prior conditions Trauma’s Impact on the Brain ~ Neuronal pathways that are developed and strengthened under negative conditions prepare children to cope in that negative environment, and their ability to respond to nurturing and kindness may be impaired (Shonkoff & Phillips, 2000). ~ The brain is still forming these pathways until about 25 years of age. (Soldiers are 18—hmmmm) ~ Children and adolescents who experienced neglect often have: ~ Decreased electrical activity in their brains ~ Decreased brain metabolism ~ Poorer connections between areas of the brain that are key to integrating complex information ~ Abnormal patterns of adrenaline activity (i.e. Hypocortosolism) (National Scientific Council on the Developing Child, 2012). Trauma’s Impact on the Brain ~ Hippocampus: ~ Reduced volume in the hippocampus, which is central to learning and memory (McCrory, De Brito, & Viding, 2010; Wilson, Hansen, & Li, 2011). ~ Reduced ability to bring cortisol levels back to normal after a stressful event has occurred (Shonkoff, 2012) ~ Corpus callosum: ~ Decreased volume in the corpus callosum, which is responsible in part for arousal, emotion, higher cognitive abilities) (McCrory, De Brito, & Viding, 2010; Wilson, Hansen, & Li, 2011). Brain cont… ~ Prefrontal cortex: ~ Reduction in the size of the prefrontal cortex, which is critical to behavior, cognition, and emotion regulation (National Scientific Council on the Developing Child, 2012; Hanson et a
March 6, 2019
Working with Individuals Who Self-Harm To access the CEU/OPD/CPD course go to https://allceus.com/counselortoolbox in the US or https://australia.allceus.com/counselortoolbox if you are in Australia Objectives ~ Define self-injury / self-harm ~ Differentiate SSI from NSSI Self Harm vs. Suicide ~ Self-injury / Self-Harm ~ Any voluntary behavior that intentionally injures or harms the body ~ Some self-injurious behaviors are done for reasons other than suicide. ~ Distress-Tolerance/Emotion Regulation ~ Attention seeking ~ Absolution from demands ~ Suicide attempts involve a conscious intention to die. The objective of NSSI injury seems to be to relieve unbearable pain or sense of powerlessness (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4835048/pdf/pone.0153760.pdf) Differences Between NSSI & Suicidal Behaviors ~ Intent of NSSI is to feel better ~ NSSI methods are generally not lethal ~ NSSI is used frequently. Suicidal behaviors are must less common ~ The level of psychological distress is often lower in NSSI ~ People who are suicidal often see things dichotomously. Those with NSSI are less dichotomous ~ Aftermath of NSSI is often short term improvement BDSM and Body Modification ~ BDSM/Sensation play and body modification, while injurious, are not considered NSSI unless the intent of the action was to harm the body. ~ (DSM-5) still includes Sexual Sadism Disorder and Sexual Masochism Disorder as potential diagnoses. But a diagnosis now requires the interest or activities to cause “clinically significant distress …” (or to be done without consent). ~ In NSSI, people experience overwhelming negative feeling states prior to self-injury, then feel relief and distraction, followed by regret and shame. ~ BDSM practitioners feel excitement and anticipation ahead of time, pleasure during the encounter, and a sense of deep connection and a stronger sense of self-empowerment and authenticity afterward. https://www.psychologytoday.com/us/blog/standard-deviations/201610/bdsm-harm-reduction Myths ~ Only females self injure. ~ 30-40% of people who self-injure are male ~ It is a failed suicide attempt ~ Often NSSI is a means of avoiding suicide (but can accidentally escalate too far) ~ Self-injury is untreatable ~ Everyone who self-injures has BPD ~ Cutting is the only form of self-injury ~ People who self-injure enjoy the pain ~ People who self-injure are a danger to others Prevalence and Risk Factors ~ NSSI is most common among adolescents and young adults, and the age of onset is reported to occur between 12 and 14 years. ~ DSM-5 includes NSSI as a condition requiring further study. ~ Prevalence rates (7.5–46.5% adolescents, 38.9% university students, 4–23% adults) ~ High correlation with trauma and comorbidity with many other mental or physical health disorders https://www.frontiersin.org/articles/10.3389/fpsyg.2017.01946/full ~ Gratz et al. (2002) emphasized the role of parental relationship in the etiology of self-injurious behaviors: ~ Insecure paternal attachment and both maternal and paternal emotional neglect were significant predictors of NSSI within women ~ NSSI in men was primarily predicted by childhood separation (usually from father) Risk Factors cont… ~ NSSI is often an unhealthy approach to emotional regulation and distress ~ For approximately 90% of patients, NSSI decreases symptoms and/or aids in dissociation ~ Anxiety ~ Depressed mood ~ Racing thoughts ~ Anger ~ Flash-backs ~ NSSI may generate desired feelings (power, control, euphoria, “something”) ~ During periods of grief, insecurity, loneliness, extreme boredom, self-pity, and alienation, NSSI also may signal distress to elicit a caring response from others Risk Factors ~ High levels of negative and unpleasant thoughts and feelings ~ Poor communication skills and problem-solving abilities ~ Trauma via abuse, maltreatment, hostility, and marked criticism during childhood ~ Under- or over-arousal responses to stress ~ High valuation of NSSI to achieve a desired r
March 4, 2019
Learn about the Mathis Method developed by Dr. Jennifer Mathis to provide trauma-informed treatment services.
March 2, 2019
Overview of 12-Steps & Interview with John M from Sober Speak Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast To access the CEU/OPD/CPD course go to https://www.allceus.com/member/cart/index/product/id/1005/c/ in the US or https://australia.allceus.com/member/cart/index/product/id/1005/c/ if you are in Australia Objectives ~ Learn more about 12-Step Programs, the Big Book, the 12 & 12 ~ Hear from Sober Speak Podcast Host John M. about ~ A variety of tools from the trenches ~ How clients can get started in 12-Step programs Intro for Counselors ~ What are 12 Step Programs and how do they help? ~ What is the Big Book and what is its purpose? ~ To show other alcoholics precisely how they can recover is the main purpose of this book. (Experience, strength and hope) ~ What is a Big Book study and why do people do it? ~ Study of a specific part of the text that conveys a particular meaning ~ What is the 12 and 12 and what is its purpose? ~ What is a step study and what is its purpose ~ What does it mean to “work the steps?” ~ Aren’t 12-Step Programs religious in nature? ~ What is the difference between a sponsor and a counselor? ~ If someone has multiple addictions and grew up in an addicted family, which type of meeting should they go to? AA? NA? Al-Anon? Intro for Counselors ~ How do 12-Step programs feel about people on prescribed psychotropic medication (i.e. for bipolar disorder)? ~ The Big Book says, “We are convinced that a spiritual mode of living is a most powerful health restorative. … But this does not mean that we disregard human health measures. … though God has wrought miracles among us, we should never belittle a good doctor or psychiatrist. Their services are indispensable in treating a newcomer and in following his case afterward.” [Alcoholics Anonymous, 4th Edition, p. 133] ~ How do 12-Step Programs feel about medication assisted therapy? MARA International ~ From ASAM.org “Alcoholics Anonymous and Psychiatric Medication (September 7, 2010) says that “it became clear just as it is wrong to enable or support any alcoholic to become re-addicted to any drug, it equally wrong to deprive any alcoholic of medication which can alleviate or control other disabling physical and or emotional problems.“” Intro for Counselors ~ How do 12-Step Programs feel about treatment? ~ The Big Book says, “… we favor hospitalization for the alcoholic who is very jittery or befogged. More often than not, it is imperative that a man’s brain be cleared before he is approached, as he has then a better chance of understanding and accepting what we have to offer.” [Alcoholics Anonymous, 4th Edition, pp. xxvi-xxvii] ~ “Of course an alcoholic ought to be freed from his physical craving for liquor, and this often requires a definite hospital procedure …” [Alcoholics Anonymous, 4th Edition, pp. xxvii-xxviii] Interview with John M. ~ What tools either you have or you have learned from others on your podcast that help people stay sober ~ Relapse prevention ~ Maintaining a recovery focus and not getting caught up in day to day minutiae ~ Dealing with PAWS ~ Returning or being in an environment that is dysfunctional ~ Regaining trust and support of significant others ~ Finding the right meeting for the individual John M. cont… ~ How does someone start going to meetings? ~ How does your podcast, Sober Speak, provide experience, strength and hope and why are these three things so important? Summary ~ 12 Step Programs are a viable option for many people. ~ For some, a history or trauma or other factors causing co-occurring mood issues and/or pain, professional treatment may be necessary. ~ For others, the desire to change, really working the program and the experience, strength, hope and support provided from the fellowship may be sufficient. ~ Not every meeting is for every person. It is important to try out different meetings to find the right fit. ~ Resources like intheroom
March 1, 2019
Ethics, Counseling Skills Development, Self-Care and Ongoing Supervision Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast To access the CEU/OPD/CPD course go to https://www.allceus.com/member/cart/index/product/id/994/c/ in the US or https://australia.allceus.com/member/cart/index/product/id/994/c/ if you are in Australia Objectives ~ Review the philosophical ethical principles ~ Explore how the following are ethical imperatives and how to fit them in ~ Counseling Skills Development ~ Ongoing Supervision ~ Self-Care 5 Ethical Principles ~ Nonmaleficence ~ Do no harm ~ Beneficence ~ Help further important interests (education, advocacy, outreach) ~ Justice ~ Giving all people what they are due ~ Fidelity ~ Faithful in keeping promises including confidentiality ~ Autonomy ~ Supporting clients right to choose ~ Recognition of the impact of one’s behavior on another Steps in Ethical Decision Making ~ Recognize an Ethical Issue as a decision or situation be damaging to someone or to some group which involves a choice between a good and bad, two “goods” or two “bads” ~ Get the Facts ~ What are the relevant facts of the case? What facts are not known? Can I learn more about the situation? Do I know enough to make a decision? ~ What individuals and groups have an important stake in the outcome? Are some concerns more important? Why? ~ What are the options for acting? Have all the relevant persons and groups been consulted? Have I identified creative options? Steps cont… ~ Evaluate Alternative Actions ~ Which option will produce the most good and do the least harm? (Utilitarian) ~ Which option best respects the rights of all who have a stake? (Rights) ~ Which option treats people equally or proportionately? (Justice) ~ Which option leads me to act as the sort of person I want to be? (Virtue) ~ Make a Decision ~ If I told someone I respect — or told a television audience — which option I have chosen, what would they say? ~ Act and Reflect on the Outcome ~ How can my decision be implemented with the greatest care and attention to the concerns of all stakeholders? ~ How did my decision turn out and what have I learned from this specific situation? https://www.scu.edu/ethics/ethics-resources/ethical-decision-making/a-framework-for-ethical-decision-making/ Counseling Skills Development ~ When you have an illness, do you want a physician who has not been trained on new techniques since she graduated medical school? ~ Our understanding of people, development, the brain and what “causes” mental health issues is in its infancy. ~ Skills development helps us ~ Avoid providing sub-par treatment (N) ~ Ensures we are providing the best possible care (B) ~ Allows us to keep our promise of providing the best possible care (fidelity) Counseling Skills Development ~ Not all skills development comes in the form of continuing education/professional development courses. ~ How to fit it in ~ Find a mentor to work under ~ Get task-focused supervision ~ Self-supervise ~ Read ~ Journal articles ~ Clinical Guidelines SAMHSA APA ACA NICE COPE ORYGEN Social Work Policy ~ Resource Websites ~ Watch videos ~ Webinars ~ Conferences Ongoing Supervision ~ Ongoing supervision helps us ~ Become more self-aware ~ Helps identify areas for early intervention ~ Become accountable for skill development Ongoing Supervision ~ Fitting it in ~ Self-supervision ~ Colleague meetings ~ Peer review (using a rubric) ~ Staff meeting brown bags ~ Supervision at work from your supervisor ~ Supervision from an independent supervisor Self-Care/Burnout Prevention ~ 11 characteristics of burnout work environments. What can we do to protect ourselves from these things and what can be done at the organizational level to try to address them before they cause burnout? ~ From TLC to TNC. There's little boundary between work and home. Work environment driven by “time, numbers and cr
February 27, 2019
Person Centered Theory of Personality and Behavior The CEU/OPD/CPD course can be found at https://allceus.com/member/cart/index/product/id/1006/c/ for clinicians in the US and at https://australia.allceus.com/member/cart/index/product/id/1006/c/ for clinicians in Australia. Objectives ~ Define “person centered theory” ~ Explore how the PCT can help us understand differences in individuals responses to situations ~ Explore how PCT can be useful in developing effective treatment plans/interventions Core Concepts in Person Centered Theory ~ According to Rogers, the self concept is an organized and consistent set of beliefs about oneself, and includes valuation of what the self is and can do. ~ All people are competent, trustworthy and forward moving ~ Individuals can move in a positive forward direction as defined by that person when provided with empathy, congruence and unconditional positive regard What is Personality & How Does It Develop ~ The way we behave and respond across situations ~ What makes a “good personality” ~ Empathy/self and other awareness ~ Respect for self and others ~ Stable sense of self ~ Ability to self-validate/self-love ~ Emotional stability ~ Responsibility ~ Motivation and a desire to grow ~ Generally content ~ Enjoy the company of others* 5 Characteristics of the Fully Functioning Person According to Rogers ~ Open to experiences –both positive and negative ~ In touch with everyday experiences without preconceptions (mindful) ~ Focused on the present, not always in the past or future ~ Aware of and attentive to facts, feelings and gut-reacPerson Centered Theory of Personality and Behavior Objectives ~ Define “person centered theory” ~ Explore how the PCT can help us understand differences in individuals responses to situations ~ Explore how PCT can be useful in developing effective treatment plans/interventions Core Concepts in Person Centered Theory ~ According to Rogers, the self concept is an organized and consistent set of beliefs about oneself, and includes valuation of what the self is and can do. ~ All people are competent, trustworthy and forward moving ~ Individuals can move in a positive forward direction as defined by that person when provided with empathy, congruence and unconditional positive regard What is Personality & How Does It Develop ~ The way we behave and respond across situations ~ What makes a “good personality” ~ Empathy/self and other awareness ~ Respect for self and others ~ Stable sense of self ~ Ability to self-validate/self-love ~ Emotional stability ~ Responsibility ~ Motivation and a desire to grow ~ Generally content ~ Enjoy the company of others* 5 Characteristics of the Fully Functioning Person According to Rogers ~ Open to experiences –both positive and negative ~ In touch with everyday experiences without preconceptions (mindful) ~ Focused on the present, not always in the past or future ~ Aware of and attentive to facts, feelings and gut-reactions ~ Willing to take risks and be creative ~ A sense of contentment with life and desire for new challenges and experiences (growth) ~ How do these impact personality and behavior? Therapeutic Question ~ How can self concept (I am) impact personality and behavior ~ I am a soldier ~ I am a Christian ~ I am a woman ~ I am a geek/nerd ~ I am a bully ~ I am a failure/screw up ~ I will always be a disappointment ~ I am unlovable/everybody leaves me ~ I am a victim ~ I am a (schizophrenic, addict) Basic Principles of Behavior ~ When faced with a choice people do things that are most rewarding ~ Short Term (in the moment) ~ Long Term (to their true selves/identity) ~ People will continue to do behaviors that are rewarded and cease behaviors that are punished ~ Even intermittent reinforcement can maintain a behavior ~ FR/VR ~ FI/VI Core Concepts in Person Centered Theory ~ Treat people with dignity and respect, and support personal perspectives ~ Provide autonomy and choice ~ Build on individual Strengths, Needs, Abilities and Pre
February 24, 2019
Sex Hormones The CEU/OPD/CPD course can be found at https://allceus.com/member/cart/index/product/id/961/c/ for clinicians in the US or https://australia.allceus.com/counselortoolbox if you are in Australia Objectives ~ Identify the effects of estrogen, progesterone and testosterone levels on mood ~ Explore the effect of cortisol on sex hormones (and mood) ~ Identify causes of sex hormone imbalances and possible interventions Estrogen ~ Estrogen is linked to mood disruptions that occur only in women — premenstrual syndrome, premenstrual dysphoric disorder, and postpartum depression. ~ Estrogen levels in women with PMS or PMDD are almost always normal. The problem may instead lie in the way estrogen “talks” to the parts of the brain involved in mood ~ During perimenopause, up to 10% of women experience depression that may be caused by unstable estrogen levels. ~ Some studies suggest that using a transdermal estrogen patch by itself can improve depression during perimenopause Estrogen ~ Mood-Related Functions of Estrogen ~ Increasing serotonin and the number of serotonin receptors in the brain. ~ Modifying the production and the effects of endorphins ~ https://www.webmd.com/women/guide/estrogen-and-womens-emotions Estrogen and Serotonin ~ Serotonergic neurons in the brain have also been found to contain estrogen inducible progestin receptors ~ Ovarian hormones have also been shown to affect numerous factors regulating serotonin synthesis and serotonin levels in the central nervous system (see Bethea et al., 1999 for review) ~ Estrogen inhibits the enzyme monamine oxidase (MAO) which is responsible for breaking down serotonin Estrogen ~ Chronically elevated levels of estrogen can actually induce depression by causing functional hypothyroidism. ~ Chronically elevated levels of estrogen can contribute to anxiety by contributing to excess serotonin ~ Estrogen also interferes with the release of cortisol ~ Estrogen deficiency that occurs with menopause can cause anxiety. ~ Estrogen enhances the excitatory neurotransmitters dopamine, and histamine ~ https://aspirenaturalhealth.com/estrogen-progesterone-anxiety-and-addiction/ Causes of Low Estrogen ~ Estrogen levels decline for several reasons including: ~ Age ~ Premature ovarian failure ~ Congenital conditions, such as turner syndrome ~ Thyroid disorders ~ Excessive exercise ~ Being severely underweight ~ Chemotherapy ~ Low-functioning pituitary gland Causes of High Estrogen ~ Leaky gut ~ Thyroid dysfunction ~ Processed food intake ~ Stress ~ Pharmaceutical / drug use (all of which change gut flora and digestive function) ~ https://www.drnicolerobertsnd.com/articles-1/2017/11/9/estrogen-and-anxiety Progesterone ~ Progesterone affects the GABA receptors in the brain ~ Increases in progesterone cause dose-dependent improvements of premenstrual anxiety, irritability and nervous tension. ~ Cortisol and progesterone are both made from pregnalone ~ When we are chronically stressed and make more cortisol, cortisol production steals from progesterone levels. https://www.drnicolerobertsnd.com/articles-1/2017/11/9/estrogen-and-anxiety High Estrogen and Low Progesterone ~ Progesterone is anti-anxiety ~ Estrogen is anti-depressant ~ Too much of either can produce an “on edge” feeling ~ The higher estrogen levels go, the more cortisol is released making us less able to adapt to stress. ~ High estrogen levels can contribute to subclinical hypothyroidism which decreases GABA release. ~ High estrogen affects levels of dopamine Serotonin and Estrogen ~ Serotonin can increase estrogen ~ Estrogen is excitatory ~ Too much serotonin is associated with anxiety ~ Too little serotonin is associated with depression in some but not all Testosterone ~ Testosterone can have a significant impact on mood, as well. It helps with one’s sense of well-being and self-confidence, which are important aspects to a positive mood. In fact, depression and anxiety are well-known symptoms of low testosterone
February 23, 2019
GABA and Glutamate The CEU course is located at  https://australia.allceus.com/member/cart/index/product/id/960/c/   In Australia, the professional development course is located at  https://australia.allceus.com/member/cart/index/product/id/960/c/   Objectives ~ Identify the functions of GABA and Glutamate ~ Explore the interaction between these neurotransmitters and the rest f the big 5 ~ Identify symptoms of too much of either ~ Explore ways to reduce them ~ Identify symptoms of deficiencies of either ~ Explore ways to increase them What is GABA ~ GABA reduces the activity of the CNS. ~ Made from and counterbalances Glutamate ~ GABA plays a role in the healthy functioning of the body’s immune and endocrine systems, as well as in the regulation of appetite and metabolism. ~ GABA supports gut motility and control inflammation ~ GABA is an inhibitory transmitter in the mature brain, its but primarily excitatory in the developing brain ~ GABA regulates the growth of embryonic and neural stem cells What is GABA ~ GABA is synthesized from Glutamate which is synthesized from Glutamine (amino acid) ~ B-6 is required for the synthesis of these neurotransmitters as well as serotonin and dopamine https://healthesolutions.com/gaba-food-sources/ https://www.webmd.com/vitamins-and-supplements/qa/what-is-gaba https://www.thesleepdoctor.com/2018/06/19/understanding-gaba/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4065474/ https://en.wikipedia.org/wiki/Gamma-Aminobutyric_acid J Clin Psychiatry. 2003;64 Suppl 3:21-7. The role of GABA in anxiety disorder Insufficient GABA ~ Low GABA activity in the body can result in: ~ Anxiety, Stress and Depression* ~ Difficulty concentrating and memory problems ~ Muscle pain and headaches ~ Insomnia and other sleep problems ~ Epilepsy ~ Chronic pain and inflammation ~ Alcoholism ~ Hypertension ~ Artificially increasing GABA may trigger a depressive episode ~ People with MDDs show reduced brain concentration of GABA Insufficient GABA ~ https://www.webmd.com/vitamins-and-supplements/qa/what-is-gaba ~ https://www.thesleepdoctor.com/2018/06/19/understanding-gaba/ ~ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4065474/ ~ http://www.denvernaturopathic.com/news/GABA.html ~ Gamma-Aminobutyric Acid Involvement in Depressive Illness Interactions with Corticotropin-Releasing Hormone and Serotonin https://www.ncbi.nlm.nih.gov/books/NBK107210/ ~ The GABAergic Deficit Hypothesis of Major Depressive Disorder https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3412149/ Increasing GABA ~ Valerian ~ Kava ~ Magnesium ~ L-theanine ~ L-arginine ~ Passionflower ~ Magnesium ~ B6 ~ Ginseng ~ Green, black, and oolong tea ~ Fermented foods including kefir, yogurt and tempeh ~ Whole grains, oats ~ Fava, soy, lentils and other beans ~ Nuts including walnuts, almonds and sunflower seeds ~ Tomatoes ~ Berries ~ Spinach ~ Broccoli ~ Potatoes ~ Cocoa ~ Whey protein ~ Gabapentin (a GABA analogue) ~ Benzodiazepines ~ Hypnotics Essential Oils Increase GABA ~ Jatamansi ~ Lemon Balm ~ Valerian ~ Jasmine ~ Chamomile ~ Lavender ~ Bergamot increases GABA and Glutamate but may also protect against glutamate excitotoxcicity https://www.consciouslifestylemag.com/best-essential-oils-for-anxiety-and-stress/ https://drjockers.com/gaba/ Pharmacol Res. 2007 Apr;55(4):255-62 https://www.ncbi.nlm.nih.gov/pubmed/19607983 Excess GABA ~ Low Blood Pressure ~ Gastric distress ~ Nausea ~ Diminished appetite ~ Constipation ~ Drowsiness and fatigue ~ Muscle weakness ~ Shortness of breath, at very high doses https://www.webmd.com/vitamins-and-supplements/gaba-uses-and-risks https://www.thesleepdoctor.com/2018/06/19/understanding-gaba/ Reducing (or Counteracting) GABA ~ Stimulants including: Caffeine, nicotine temporarily may reduce GABA ~ Ginko ~ GABAA antagonists may be possible targets for reducing morphine reward http://www.denvernaturopathic.com/news/GABA.html https://www.ncbi.nlm.nih.gov/pubmed/29781560 GABA Interactions ~ Hypertension medications ~ Antidepressan
February 20, 2019
Gamification in Counseling The CEU/OPD/CPD course can be found at https://allceus.com/member/cart/index/product/id/962/c/ for clinicians in the US and at https://australia.allceus.com/member/cart/index/product/id/516/c/ for clinicians in Australia. Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast Objectives ~ Define gamification ~ Explore the benefits of gamification ~ Describe techniques for gamification What is Gamification ~ Gamification is simply using games or challenges to make something more motivating or enjoyable to learn. Gamification Motivation Enhancers ~ The student with the most stars at the end of the day gets a prize ~ The child with the most stars gets to choose the movie ~ The group that gets all their assignments in ~ Simple token economies Why Gamification for Learning ~ Makes it fun and increases attention ~ Encourages mental manipulation ~ Encourages recall and strengthening of memory pathways ~ Usually uses multiple visual, auditory and kinesthetic ~ Enhances communication skills ~ Increases memory and focus chemicals Hot Potato ~ Toss a ball until someone calls “time” ~ Whoever catches it has to answer a question ~ If they answer correctly they get a token/prize ABC ~ Go around the circle and identify things that begin with alphabet letters ~ Things that make me happy ~ Things to do when I am stressed ~ Things I would like to do or see ~ Opposites: Angry and Happy ~ Mindfulness Activities ~ Gratitude Jeopardy ~ Create 4-6 categories ~ Coping skills; distress tolerance activities; vulnerability prevention; dialectics ~ Fruits, vegetables, proteins, grains ~ Stimulants, depressants, marijuana, opioids ~ Divide the group into 3 teams Taboo ~ Divide into 2 teams ~ Each team gets to have 1 minute ~ The goal is to have the clue giver get the guesser to identify the “taboo” word ~ If the guesser guesses correctly they get a point and the next team gets to go ~ After 1 minute if they do not get the answer, then another team has a chance to “steal” and simply identify what the correct answer is. ~ If they get it right then they get to take the next turn. ~ If they get it wrong, then the turn goes to the next pair on the other team Jenga ~ Make 3-5 stacks of cards, each a different color ~ Paint the jenga blocks the same colors as the cards ~ When someone pulls a block, they have to answer a question from the stack of cards corresponding to the color of the block Family Feud ~ Create a set of questions that has multiple answers and assign them a point value (can be equal)…i.e. ~ The top 8 ways to cope with distress ~ The top 6 things to do to prevent vulnerabilities ~ The top 6 cognitive distortions ~ The top 8 causes of depression ~ Divide the group into two teams (families) ~ Play just like Family Feud Charades ~ Divide into two teams ~ Use a timer and allow the actor 1 minute to act out the concept and his or her team to guess it ~ If they don’t guess it after 1 minute, then the other team gets a chance to guess and “steal” the points ~ The active team switches after each turn. ~ Each correct guess = 5 points ~ Suggestions ~ Nonverbal communication (jealous, resentful, curious, exhausted, confident…) (synonyms may be okay as long as it is not happy, scared or angry…those are too easy) ~ Concepts such as dialectics or cognitive distortions Self Designed Games ~ Create 2 or 3 decks of cards ~ Examples ~ Distress tolerance skills ~ Mind-body connection ~ Grief tools ~ Depression Triggers (mitigators) ~ Anger Management ~ Create a game board with spaces (put a question type on each space if you want) ~ Players roll the die ~ They pick a card from the deck corresponding to the space they landed on and answer the question. ~ Wrong answers—go back 2 spaces ~ Right answers keep your space Board Game ~ Supplies: ~ Create a game board with Gratitude (G) and Random Acts of Kindness (K) spaces, ~ A die ~ 2 stacks of index cards with gratitude and ra
February 16, 2019
Cannabidiol: Mental Health Uses and Cautions The CEU/OPD/CPD course can be found at https://allceus.com/member/cart/index/product/id/982/c/ for clinicians in the US and at https://australia.allceus.com/member/cart/index/product/id/516/c/ for clinicians in Australia. Intro to CBD ~ THC is the psychoactive component of cannabis ~ THC has antispasmodic, analgesic, anti-tremor, anti-inflammatory, appetite stimulating and anti-emetic properties ~ High levels of THC is commonly used for its sleep-inducing effects ~ THC mimics the effects of anandamide and 2-AG (endogenous cannabinoid) which modulates sleeping and eating habits, the perception of pain ~ GABA neurons contain CBD receptors which are activated upon useof THC (and maybe CBD) https://www.royalqueenseeds.com/blog-the-link-between-marijuana-and-dopamine-n823 https://www.ncbi.nlm.nih.gov/pubmed/22625422 CBD cont… ~ CBD is the major nonpsychoactive component of Cannabis sativa. ~ According to a 2013 study published in the British Journal of Clinical Pharmacology, CBD benefits include acting as an anti-inflammatory, anticonvulsant, antioxidant, antiemetic, anxiolytic, neuroprotective, immunomodulatory and antipsychotic effects ~ A biphasic drug has different effects on the body at different blood concentration levels. ~ Ex. Alcohol acts as a stimulant until BAC levels reach 0.05%. After this point it causes sedation and depression ~ At a low concentration CBD increases wakefulness, alertness and other elevating responses. ~ At higher levels CBD has a sedating effect CBD cont… ~ 36% of respondents reported that CBD treats their medical condition(s) “very well by itself,” while only 4.3% reported “not very well.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6043845/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604171/ The Cannabinoid Receptors ~ CBD and THC both bind to the CB 1 & 2 receptors, they interact with them different ways ~ CB1 and CB2 are both responsible for regulating neuro-hormones which are involved in memory, mood, sensations of pain and appetite regulation ~ CB1 ~ Found in the CNS and responds to endogenous cannabinoids, as well as THC (agonist) and CBD (mild antagonist). ~ Abundant in areas of the brain concerned with movement, coordination, pain and sensory perception, emotion, memory, cognition, autonomic and endocrine (hormone) functions The Cannabinoid Receptors ~ CB2 ~ Found only in the immune system and not in the CNS, but seems to reduce inflammation and related pain. ~ It responds to endogenous cannabinoids, as well as CBD, THC Alcohol and CBD ~ The CB1 receptor is a significant player in the reinforcing and motivating attributes of alcohol. Combining alcohol and CBD results in significantly lower blood levels of alcohol. ~ CBD reduces the reinforcement, motivation and relapse for alcohol. ~ CBD attenuates alcohol-induced liver steatosis, metabolic dysregulation, inflammation and neutrophil-mediated injury. ~ Cannabinoids have an effect on nearly all enzymes responsible for metabolizing alcohol. ~ Cannabinoid antagonists also mitigate alcohol withdrawal symptoms. ~ CB1 receptor agonists (THC) encourage alcohol consumption, while CB1 receptor antagonists (CBD) decrease it. Benefits of CBD ~ According to the National Institute of Health, manipulating the endocannabinoid system by introducing external cannabinoids like CBD could be useful in treating a variety of medical ailments, including: How CBD Impacts Mood ~ CBD can help people recover from Clostridium difficile toxin A toxicity and restore the intestinal barrier* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5721977/ ~ CBD reduces chronic pain https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503660/ ~ CBD binds with estrogen receptors https://www.ncbi.nlm.nih.gov/pubmed/6296360 ~ Impacts insulin levels via cannabinoid receptors in the pancreas http://www.cbdforbenefits.com/top-3-ways-cbd-oil-balances-estrogen-levels/ ~ 160mg-600mg of cannabidiol may play a therapeutic role in sleep regulation, increas
February 15, 2019
This is the replay of Episode 20 from 2016.  CEUs are available at https://www.allceus.com/member/cart/index/product/id/486/c/ In Australia, the professional development course is located at  https://australia.allceus.com/member/cart/index/product/id/486/c/
February 13, 2019
This is a replay of Counselor Toolbox Episode 3 from 2016.  CEUs are available at https://www.allceus.com/member/cart/index/product/id/485/c/ In Australia, the professional development course is located at  https://australia.allceus.com/member/cart/index/product/id/485/c/
January 26, 2019
To my listeners, I apologize for repeating content, but have been called away with a family emergency.  I will repost new content beginning in February. These were recorded in 2016, so, hopefully they are new to you.  ~Dr. Snipes
January 23, 2019
To all my loyal listeners, I apologize for recycling podcasts, however, my mother suddenly passed away Saturday and we are a bit off schedule.  I will release new podcasts beginning the first week in February.  CEUs are available for this podcast at https://www.allceus.com/member/cart/index/product/id/497/c/ In Australia, the professional development course is located at  https://australia.allceus.com/member/cart/index/product/id/497/c/   ~Dr. Snipes
January 16, 2019
Norepinephrine The Get Up and Go Neurotransmitter Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Counselor Education CEUs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/960/c/ In Australia, the professional development course is located at  https://australia.allceus.com/member/cart/index/product/id/960/c/   Objectives ~ What is it and what is it’s function? ~ How does it interact with serotonin, dopamine and GABA? ~ What are symptoms of excess? ~ How do you decrease it? ~ What are symptoms of insufficiency? ~ How do you increase it? What is it ~ General function of norepinephrine is to mobilize the brain and body for action ~ Norepinephrine release is lowest during sleep, rises during wakefulness, and reaches much higher levels during situations of stress or danger ~ Norepinephrine functions mainly as a neurotransmitter with some function as a hormone (being released into the bloodstream from the adrenal glands) ~ NE affects the behaviors of individuals including a modulation of vigilance, arousal, attention, motivation, reward and also learning and memory What is it ~ It enhances processing of sensory inputs, attention, and formation and retrieval of long-term and working memory ~ NE is involved in the clinical features of cerebral aging, cognitive slowing, and loss of behavioral adjustment ~ Both NE and 5-HT activity is lower in bipolar disorder ~ Neither 5-HT nor NE depletion induced clinical depression in healthy subjects or worsened depression in unmedicated symptomatic patients with major depression. ~ This finding suggests that the cause of depression is more complex than just an alteration in the levels of 5-HT and/or NE, and may be more directly caused by dysfunction in brain areas or neuronal systems modulated by neurotransmitters. What is it ~ Like SSRIs, SNRIs are thought to work by promoting neuroplasticity in the brain. ~ Higher levels of norepinephrine and serotonin may stimulate neurons to remodel themselves and their circuits in a variety of ways that promote increased flexibility. ~ NE plays a determinant role in executive functioning regulating cognition, motivation, and intellect, which are fundamental in social relationships. ~ Social dysfunction is possibly one of the most important factors affecting the quality of life in depressed patients What is it ~ Phenylalanine->Tyrosine->L-dopa->Dopamine->Epinephrine->Norepinephrine ~ Norepinephrine is synthesized from dopamine (tyrosine) amino acid found in proteins such as meat, nuts, and eggs. Dairy products such as cheese also contain high amounts of tyrosine (the amino acid is named for “tyros,” the Greek word for cheese). ~ Modulates immune response. Suppress neuroinflammation when released in the brain. ~ Up to 70% of norepinephrine projecting cells are lost in Alzheimer’s Disease ~ Increase the force of skeletal muscle contraction and the rate and force of contraction of the heart. ~ Increase heart rate, blood pressure, and levels of glucose and fat in the blood What is it ~ In the eyes, an increase in production of tears, making the eyes moister, and pupil dilation. ~ In brown adipose tissue, an increase in calories burned to generate body heat. ~ In the kidneys, a release of renin and retention of sodium in the bloodstream. ~ In the liver, an increase in production of glucose ~ In skeletal muscles, an increase in glucose uptake. ~ In fat cells, an increase in fat burning. ~ In the stomach and intestines, a reduction in digestive activity and decreases in gastrointestinal mobility Norepinephrine Deficiency & Prolonged Stress ~ In the early stages of prolonged or severe stress, the stress response system is overactive and norepinephrine and other adrenal stress hormone levels are typically elevated. ~ This increases arousal, amplifies the emotional reaction to stress, and can manifest as insomnia, anxiety, depression, irritability, or emotional ins
January 12, 2019
Dopamine Dr. Dawn-Elise Snipes, PhD Executive Director, AllCEUs Counselor Education Host: Counselor Toolbox Podcast CEUs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/960/c/ In Australia, the professional development course is located at  https://australia.allceus.com/member/cart/index/product/id/960/c/   Objectives ~ What is it and what is it’s function? ~ How does it interact with serotonin, norepinephrine and GABA? ~ What are symptoms of excess? ~ How do you decrease it? ~ What are symptoms of insufficiency? ~ How do you increase it? What is it and what is it’s function? ~ Neurotransmitter located throughout the body including the brain immune system, the kidneys and the pancreas. ~ Dopamine does not cross the blood–brain barrier, so its synthesis and functions in peripheral areas are to a large degree independent of its synthesis and functions in the brain ~ Synthesized from L-Dopa ~ Is the main motivation/pleasure chemical “motivational salience” ~ Reduces insulin production (increase food intake) which impacts serotonin levels What is it and what is it’s function? ~ Reduces gastrointestinal motility and protects intestinal mucosa ~ Reduces the activity of lymphocytes ~ Mood ~ Coordination and muscle movements ~ Learning, attention & memory (prefrontal cortex) ~ Regulates the flow of information from other areas of the brain (problem solving) (Frontal lobe and thalamus) ~ Wakefulness (people with Parkinson’s or on antipsychotics are often sleepy) Subtypes of Dopamine Receptors ~ D1 ~ Most abundant dopamine receptor in the central nervous system ~ Regulate neuronal growth and development, mediate some behavioral responses ~ Agonists ~ Parkinson’s medications Receptors ~ D1 ~ Agonists ~ Terguride: ~ Treatment for hyperprolactinemia (hypoestrogenism)/PCOS and treatment of pulmonary arterial hypertension ~ Serotonin receptor antagonist (5-HT2B, 5HT2A) ~ 5-HT2A receptor antagonists interfere with the heightened state of dopamine activity, and may be useful in the treatment of psychosis, and alcohol and cocaine dependence. ~ 5-HT2B antagonists have previously been proposed as treatment for migraine headaches and heart disease ~ Dopamine receptor agonist Subtypes of Dopamine Receptors ~ D2 ~ Schizophrenia can be attributed to an imbalance in dopaminergic pathways that signal D2 and D1 receptors ~ Most antipsychotics are antagonists for the dopamine D2 receptor ~ Parkinson’s disease (PD) is an extrapyramidal motor disorder characterized by dopaminergic neuronal degeneration, esp. D2 ~ Rewarding food stimulates dopaminergic transmission especially to the D2 receptor suggesting that dopamine deficiency in obese individuals may perpetuate pathological eating as a means to compensate for decreased activation ~ MDD patients showed decreased dopamine in the central and basal nuclei of the amygdala of postmortem depressed patients who committed suicide compared with control subjects Subtypes of Dopamine Receptors ~ D1 receptors ‘prepare' the set of possible appropriate responses. ~ D2-shape and ‘select' from this initial response set framework Dopamine and Depression ~ 2/3 of patients are not achieving remission with current SSRI medications ~ Anhedonia contributes to the persistence of MDD ~ Depression and anhedonia have been shown to be associated with a reduced striatal (dopamine)response to reward ~ Most antidepressant treatments do not directly enhance dopamine, which may contribute to residual symptoms, including impaired motivation, concentration, and pleasure ~ Tricyclic Antidepressants and MAOIs increase serotonin, norepinephrine and dopamine but have significant side effects Dopamine and Depression ~ Latest generation of antidepressants ~ Norepinephrine and Dopamine reuptake inhibitors (bupropion/Wellbutrin) ~ Dopamine can decrease inflammation ~ Dopamine excess may cause vitamin B6 deficiency Dopamine and Anxiety ~ Both dopamine D1 and D2 receptor mechanisms are imp
January 9, 2019
Serotonin CEUs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/960/c/ In Australia, the professional development course is located at  https://australia.allceus.com/member/cart/index/product/id/960/c/   Objectives ~ Identify the functions of serotonin ~ Explore the connection between serotonin and depression and anxiety ~ Explore the relationship of serotonin to other neurotransmitters ~ Learn about causes of low serotonin ~ Identify interventions to naturally increase serotonin Identify The Functions of Serotonin ~ Serotonin is among the many neurotransmitters that participate in the regulation of cortisol, prolactin and growth hormone secretion ~ Low dopamine  low prolactin ~ Prolactin regulates behavior, the immune system, metabolism, reproductive systems ~ Prolactin decreases estrogen and testosterone ~ Prolactin is high during times of stress Identify The Functions of Serotonin ~ Serotonin also appears to be involved in the regulation of circadian rhythms. ~ Melatonin is synthesized from serotonin ~ 5-HT and SSRIs have an inhibitory effect on feeding behavior. ~ Hypothalamus also receives signals from pleasure pathways that use dopamine, endocannabinoids and serotonin as messengers, which influence eating behavior and influence the release of ghrelin (hunger) or leptin (satiation) Serotonin & Depression and Anxiety ~ 5HT1A, 5HT2A, 5HT2C, 5HT4,6,7 are all involved in the regulation of depression and anxiety ~ People with too much serotonin have anxiety symptoms. ~ Frick A, Åhs F, Engman J, et al. Serotonin Synthesis and Reuptake in Social Anxiety Disorder: A Positron Emission Tomography Study. JAMA Psychiatry. 2015. ~ https://www.zrtlab.com/blog/archive/impact-hormones-serotonin-depression ~ Patients with anxiety produced more serotonin in the amygdala https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2319711 ~ People with too little serotonin may not feel depressed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471964/ Causes of High Serotonin ~ Selective serotonin reuptake inhibitors (SSRIs) ~ Serotonin and norepinephrine reuptake inhibitors (SNRIs), antidepressants such as trazodone, duloxetine (Cymbalta) and venlafaxine (Effexor) ~ Bupropion (Wellbutrin, Zyban), an antidepressant and tobacco-addiction medication ~ Tricyclic antidepressants ~ Monoamine oxidase inhibitors (MAOIs) ~ Anti-migraine medications such as triptans (Axert, Amerge, Imitrex), carbamazepine (Tegretol) and valproic acid (Depakote) ~ Opioid pain medications Causes of High Serotonin ~ Lithium (Lithobid), a mood stabilizer ~ Illicit drugs, including LSD, Ecstasy, cocaine and amphetamines ~ Herbal supplements, including St. John's wort, ginseng and nutmeg ~ Over-the-counter cough and cold medications containing dextromethorphan ~ Anti-nausea medications such as metoclopramide (Reglan), and ondansetron (Zofran) ~ Linezolid (Zyvox), an antibiotic ~ Ritonavir (Norvir), an anti-retroviral medication used to treat HIV/AIDS Serotonin Syndrome–HARMFUL ~ Hyperthermia ~ Anticognitive ~ Reflexes ~ Myoclonus ~ Fast heart rate ~ Unconsciousness ~ Loss of GI control Causes of Low Serotonin ~ High Cortisol ~ Pain/inflammation ~ Stress ~ Low estrogen ~ High testosterone ~ Poor diet (Tryptophan, Vitamins) ~ Insufficient vitamin D 5-HT1A ~ Memory(agonists ↓) ~ Learning (agonists ↓) ~ Anxiety (agonists ↓) ~ Depression (agonists ↓) ~ Positive, negative, and cognitive symptoms of schizophrenia (partial agonists ↓) ~ Analgesia (agonists ↑) ~ Aggression (agonists ↓) ~ Dopamine release in the prefrontal cortex (agonists ↑) ~ Serotonin release and synthesis (agonists ↓) 5-HT1A partial agonists ~ Antianxiety: Buspar ~ Antidepressant: Vilazodone/Viibryd ~ Atypical Antipsychotics ~ Clozapine/Clozaril ~ Ziprasidone/Geodon ~ Aripiprazole/Abilify 5-HT1B ~ Play a critical role in autoregulation of serotonergic neurotransmission, and are implicated in disorders of serotonergic function, particularly emotional regulation ~ In
January 4, 2019
Gut Health & Mental Health: The Impact of the Second Brain Dr. Dawn-Elise Snipes PhD, LPC-MHSP, Executive Director: AllCEUs.com CEUs are available for this presentation at AllCEUs https://www.allceus.com/member/cart/index/product/id/959/c/ In Australia, the professional development course is located at  https://australia.allceus.com/member/cart/index/product/id/959/c/   Disclaimer ~ This is for educational purposes only and not intended to replace medical advice. Always have clients discuss any nutritional changes or supplements with a Registered Dietician or their primary care physician. 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 Overview ~ Gut microbiota appear to influence the development of emotional behavior, stress- and pain-modulation systems, and brain neurotransmitter systems ~ Microbiota changes caused by illness, dietary changes, probiotics and antibiotics impact endocrine and neurocrine pathways (bottom up) ~ The brain can in turn alter microbial composition and behavior via the autonomic nervous system (“stress”) (top down) ~ Even mild stress can change the microbial balance in the gut, making the host more vulnerable to infectious disease and triggering a cascade of molecular reactions that feed back to the central nervous system Overview ~ Exposure to chronic stress decreased the relative abundance of Bacteroides species and increased the Clostridium species in the caecum; and caused activation of the immune system (i.e. inflammation) ~ Children with Autism Spectrum Disorder treated with oral vancomycin —antibiotic to reduce Colostridium– had significant improvement in behavioral, cognitive and GI symptoms ~ Acute and chronic stress increase GI and BBB permeability through activation of mast cells (MCs) Gut Inflammation and Mood ~ Inflammation of the GI Tract places stress on the microbiome through the release of cytokines and neurotransmitters. ~ Coupled with the increase in intestinal permeability, these molecules then travel systemically. ~ Elevated blood levels of cytokines TNF-a and MCP (monocyte chemoattractant protein) increase the permeability of the blood-brain barrier, enhancing the effects of rogue molecules from the permeable gut. ~ Their release influences brain function, leading to anxiety, depression, and memory loss. Gut-Brain Connection ~ The vagus nerve is one of the biggest nerves connecting your gut and brain. It sends signals in both directions ~ In mice it was found that feeding them a probiotic reduced the amount of cortisol in their blood. However, when their vagus nerve was cut, the probiotic had no effect ~ Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve. Proc Natl Acad Sci U S A. 2011 Sep 20;108(38):16050-5 Overview ~ Alterations in the gut microbial community have been implicated in multiple host diseases such as obesity, diabetes, and inflammation, while recent evidence suggests a potential role of the microbiota-gut-brai
January 4, 2019
Attachment Theory: Implications for Treatment Instructor: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Counselor Education CEUs are available at https://www.allceus.com/member/cart/index/product/id/958/c/   In Australia, the professional development course is located at  https://australia.allceus.com/member/cart/index/product/id/958/c/   Objectives ~ Review Attachment Theory ~ Identify stages of distress ~ Discuss the benefits of secure attachment ~ Explore the effects of insecure attachment ~ Learn about different attachment styles and their associated problems ~ Hypothesize interventions to create secure attachment regardless of age. Infancy and 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 when the infant’s attachment system is ‘activated’ ~ Beginning at six months old, infants come to anticipate caregivers’ responses to their distress and shape their own behaviors accordingly (eg, developing strategies for dealing with distress when in the presence of that caregiver) ~ Sensitive, Responsive, Loving = Secure ~ Insensitive, Rejecting or Inconsistent = Insecure Attachment cont… ~ The primary attachment figure remains crucial for approximately the first two years of life ~ Forming this attachment is almost useless if delayed until after two and a half to three years ~ If the attachment figure is broken or disrupted between ages 1 and 5, the child may suffer irreversible long-term consequences. ~ Bifulco (1992) Women who had lost their caregiver through separation or death doubled their risk of depressive and anxiety disorders. The rate of depression was the highest in women whose caregivers had died before the child reached the age of 6. 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 ~ a model of the self as valuable ~ a model of the self as effective when interacting with others Adult Attachment ~ Adult attachment style refers to systematic patterns of expectations, beliefs, and emotions concerning the availability and responsiveness of close others during times of distress ~ Often among multiple people with one primary attachment ~ Provide a bidirectional attachment relationship which provides adults with a secure base that they are able to depend on a daily basis. Attachment ~ Psychological problems can increase attachment insecurity. ~ Davila et al found that late adolescent women who became less securely attached over periods of 6 to 24 months were more likely than their peers to have a history of psychopathology ~ Among soldiers with PTSD Attachment anxiety and avoidance increase over time, and the increases are predicted by the severity of PTSD symptoms Three Progressive Stages of Distress ~ Protest: The child cries, screams and protests angrily when the caregiver leaves. They will try to cling on to the caregiver to stop them leaving. ~ Despair: The child’s protesting begins to stop, and they appear to be calmer although still upset. The child refuses others’ attempts for comfort and often seems withdrawn and uninterested in anything. ~ Detachment: If separation continues the child will start to engage with other people again. They will reject the caregiver on their return and show strong signs of anger. Effects of Secure Attachment ~ Learn basic trust, which serves as a basis for all future emotional relationships ~ Develop fulfilling intimate relationships ~ Maintain emotional balance ~ Feel confident and good about themselves ~ Enjoy being with others ~ Rebound from disappointment and loss ~ Share their feelings and seek support ~ Explore
January 3, 2019
Gambling Problems: An IntroductionInstructor: Dr. Dawn-Elise SnipesExecutive Director: AllCEUs.com Counselor Continuing Education & Training CEUs/OPD/CPDs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/664/c/ for clinicians in the US and https://australia.allceus.com/member/cart/index/product/id/664/c/ for clinicians in Australia. Objectives~ Define Pathological Gambling, Gambling Disorder, and Problem Gambling~ Explore the Prevalence of Gambling Issues~ Identify Wo Has a Gambling Problem~ Identify Links Between Gambling Problems and Other Behavioral Health Conditions~ Identify Tools for Screening, Assessing, or Diagnosing Gambling Problems? ~ Identify Treatment Issues and Strategies ~ Gambling problems can co-occur with other behavioral health condition~ Only about 10 percent of people with a gambling problem seek treatment~ a variety of other problems can be related to gambling, including victimization and criminalization; social problems; and health issues, including higher risk for contracting sexually transmitted diseases and HIV/AIDSDefinitions~ Gambling is defined as risking something of value, usually money, on the outcome of an event decided at least partially by chance~ Action gamblers are typically men and gamble because it is stimulating~ Action gambling requires some type of skill or knowledge (poker, sports…)~ Relief gamblers are often female, gamble for the escape and often gamble using games of chance (bingo, lottery, slot machines…)Definitions~ In the DSM V~ “Pathological Gambling” was renamed “Gambling Disorder.” ~ Gambling disorder is categorized under Substance Related and Addictive Disorders~ Problem gambling does not meet the criteria for pathological gambling.Diagnostic Criteria~ Problematic gambling behavior leading to clinically significant impairment or distress, as indicated by four (or more) of the following in a 12-month period: ~ 1. Gambles with increasing amounts of money to achieve the desired excitement. ~ 2. Is restless or irritable when attempting to cut down or stop gambling. ~ 3. Has made repeated unsuccessful efforts to cut back, or stop gambling. ~ 4. Is often preoccupied with gambling~ 5. Often gambles when feeling distressed ~ 6. After losing money gambling, often returns another day to get even~ 7. Lies to conceal the extent of involvement with gambling. ~ 8. Gambling as jeopardized or lost a significant relationship, job, or career ~ 9. Relies on others to provide money to relieve financial problems. ~ B. The gambling behavior is not better accounted for by a manic episode.Warning Signs~ Financial problems exist despite an adequate income. ~ Money has gone missing from a bank account or wallet, or valuables have disappeared.~ There is a lot of borrowing, cash advances, living off credit cards, etc. ~ Retirement, insurance plans, etc., are cashed in or allowed to lapse. ~ The person avoids family functions or other social events~ Neglects responsibilities or makes excuses~ Drops other leisure activities to focus on gambling~ Arrives late for work or other commitments~ Disappears for large blocks of time ~ Appears deceptive/secretive about behavior, particularly re: money~ Seems edgy, reactive or defensive~ Changes sleep, eating or sexual behaviorsWarning Signs in Adolescents~ Can’t account for missing money~ Skips school~ Borrows or steals money from friends or family~ Sometimes has large amounts of unexplained cash~ Has a fake ID, casino entry card, or gambling receipts among belongings~ Is preoccupied with video arcades, internet gambling sites or day trading~ Has left a trail of internet visits or credit card charges to gambling sites.Prevalence ~ Roughly 1.5 million Americans have experienced pathological gambling~ An estimated 6 million Americans struggle with problem gambling.~ Men are more likely than women to have gambling problems~ People diagnosed with pathological gambling, 73.2% had an additional addictive disorder, 50%
December 31, 2018
Gambling and Mental HealthInstructor: Dr. Dawn-Elise SnipesExecutive Director: AllCEUs.com Counselor Education & Training CEUs/OPD/CPDs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/664/c/ for clinicians in the US and https://australia.allceus.com/member/cart/index/product/id/664/c/ for clinicians in Australia. Objectives~ Post-traumatic stress symptoms in pathological gambling: Potential evidence of anti-reward processes~ Problem gambling in bipolar disorder~ Alexthymia and Pathological Gambling~ Food addiction in gambling disorder~ Gambling, domestic violence and trauma~ Understanding stigmaPost Traumatic Stress and Gambling~ When the number of traumatic events were controlled for, individuals with pathological gambling disorder had significantly higher PTS scores~ “Anti-reward” gambling provides momentary relief from PTS but contributes to the “spiraling distress cycle”~ In a study of pathological gamblers, gambling behavior significantly decreased upon completion of PTSD treatment (Najavits et al., 2013)~ People with a history of trauma should be counseled about their increased risk for developing gambling problemsBipolar Disorder~ People who met criteria for Bipolar 1 (full manic) and pathological gambling were identified~ The general population had a 3.8% prevalence of problem gambling ~ The group with bipolar disorder had a 11.6% prevalence of problem gambling ~ Of all psychiatric categories examined, respondents screening positive for a manic episode had the highest risk of pathological gambling~ Selective serotonin reuptake inhibitors may be effective for some patients with pathological gamblingBipolar Disorder~ Sustained release lithium appears to produce significant positive results in gambling behaviors and affective stability after 8 to 10 weeks as measured by the ~ Clinical Global Impression (CGI) pathological gambling improvement scale~ Clinician-Administered Rating Scale for ManiaAlexthymia~ Individuals with high levels of alexithymia become prone to addictive behavior via emotional dysregulation~ Alexithymia ~ difficulty in describing feelings~ distinguishing one’s feelings from bodily sensations~ having restricted imaginative processes~ a stimulus-dependent, externally oriented cognitive style ~ challenges in emotional processing and coping with stressful feelings/ emotional regulation ~ Alexithymic individuals ~ attempt to regulate their emotions through compulsive behaviors. ~ show addictive behaviors due to their lack of self-knowledge and insight.Alexthymia~ Emotional dysregulation was measured using the Difficulties in Emotion Regulation Scale (DERS)~ Difficulties in emotion regulation and alexithymia are positive, significant predictors of pathological gamblingGambling and Domestic Violence~ 25-50% of spouses of compulsive gamblers have been abused~ Odds ratio of intimate partner violence increased 10.5 times when partner was problem gambler~ Children of problem gamblers are 2 to 3 times more likely to be abused by a parent~ For many women gambling venues are refuge from violence and gambling becomes a method of escape~ Family violence and addiction have several common features including loss of control, continuation despite adverse consequences, tolerance and withdrawal, involvement of the entire family, preoccupation or obsession and defenses of denial, minimization and rationalizationGambling and Trauma~ In a twin cohort study, experiencing traumatic events increases the risk of having a gambling problem by up to 453%~ Problem gamblers are 620% more likely to develop PTSD~ Soldiers who are returning from deployment tend to have a greater propensity for risk taking and often have experienced trauma putting them at greater risk for the development of PGFood Addiction in Gambling Disorder~ Recent research supports the notion that food may have addictive potential in some individuals due to the increased potency of certain nutrients, palatability, or
December 28, 2018
Polyamory and Open Relationships CEUs are available for this presentation with an unlimited access membership to AllCEUs.com Trigger Warning and Cautions~ The following presentation involves frank discussions of kink and sexuality.~ While not graphic, some of the content might be triggering for some people.~ This series is meant to provide an overview to help clinicians to understand kink, BDSM and Poly, but is by no means all inclusive. It is designed to increase awareness of common issues and help clinicians identify areas where they may need further training.Objectives~ Explore the difference between polyamory and open relationships~ Learn some of the reasons people may choose polyamory~ Explore the prevalence of polyamory~ Explore some of the many polyamorous relationship structures Polyamory vs. Open Relationships ~ “An open relationship is one where one or both partners have a desire for sexual relationships outside of each other, and polyamory is about having intimate, loving relationships with multiple people,”~ In polyamory, the whole point is to fall in love with multiple people, and there’s not necessarily any relationship hierarchy~ Open relationships typically start with one partner or both partners wanting to be able to seek outside sexual relationships and satisfaction, while still having sex with and sharing an emotional connection with their partner Why Be Poly~ Differences in sexual orientation~ Differences in sexual desire~ Ability to allow relationships to form organically, whatever those may be ~ More love/companionship~ Physical and emotional closeness with different people who meet different needs~ Greater depth of social relationships~ Power dynamics (BDSM)~ Creation of Chosen Family~ Sexual excitement and/or fulfillment~ Distance – when partners live in separate parts of the world for part or all of the time Why Be Poly~ Additional financial stability~ Logistics (multiple people to provide childcare, household chores, various skills, etc.)~ They are unable to have sex with their primary partner~ They fell in love with someone else but want to remain in their current relationship~ Capacity to meet more of one’s emotional, intellectual and sexual needs through accepting that one person cannot provide all~ Release from the expectation that one must meet all of a primary partner’s needs~ Desire to remain in long term relationship for the benefits and/or child-rearing~ Fun/Novelty/Excitement/Escape Prevalence~ 4-5% of American relationships fall into some category of CNM~ YouGov survey: 17% persons between 18-44yrs had participated in some sort of sexual activity with their partner’s consent, and ~ 50% people interviewed said that their ideal relationship would have some form of CNM flexibility ~ There are more CNM relationships within the LGBTQ community as compared to heterosexual community ~ BalzariniRN, Campbell L, Kohut T, Holmes BM, Lehmiller JJ, Harman JJ, et al. (2017) Perceptionsof primary and secondary relationships in polyamory. PLoS ONE 12(5): e0177841.https://doi.org/10.1371/journal. pone.0177841~ Lovingmorenonprofit.orgTypes of Poly Relationships~ Polyamory relationship style that allows people to openly conduct multiple sexual and/or romantic relationships simultaneously~ Polyaffective relationships are emotionally intimate, non-sexual connections among people connected by a polyamorous relationship~ Individual with multiple primaries V~ Triad 3 people in an equally committed relationship~ Primary plus: primary relationship partners each explore other relationships~ Polygamy/Grou Marriage–a form of marriage consisting of more than two persons Types of Poly Relationships~ Monogamish–a couple is primarily monogamous, but allows varying degrees of intimate contact with others. Rules structuring these external contacts vary by couple: Some allow only one-night stands or only specific kinds of activity (i.e., kissing and groping are OK, but no inte
December 26, 2018
Dominant/submissive & Female Led RelationshipsDr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHCExecutive Director: AllCEUs.com CEUs/OPD/CPD for this presentation can be found at allceus.com for clinicians in the US or Australia.allceus.com for clinicians in Australia. Trigger Warning and Cautions~ The following presentation involves frank discussions of kink and sexuality.~ While not graphic, some of the content might be triggering for some people.~ This series is meant to provide an overview to help clinicians to understand kink, BDSM and Poly, but is by no means all inclusive. It is designed to increase awareness of common issues and help clinicians identify areas where they may need further training.Objectives~ Explore different structures of Dom/sub relationships including:~ Master/slave (TPE)~ Daddy (Mommy)/little~ Female Led Relationships~ Identify reasons for engaging in this type of relationship~ Review signs of abuse ~ “D/s and master and slave relationships are about a hierarchy,” says Ferrer. “They are about structure, protocol, respect. A lot of the newbies are coming in and they don’t understand the dynamics.”D/s Structures~ Daddy or Mommy Doms/littles~ Daddies/Mommies take on a parental role as the Dominant. ~ They are there to protect, guide, nurture and love their little. ~ They will order or set rules for their little based on nurturing goals and what is best for their little.~ A Daddy/Mommy should enjoy the regression that their little naturally does and appreciate the child-like attributes of their little, but they will also find their adult side attractive.~ Daddies/Mommies are not interested in pedophilia, incest or any other paraphernalia associated with children even though their title is often misunderstood and associated with that D/s Structures~ Daddy or Mommy Doms/littles~ Daddies/Mommies vs. Masters~ Cherish their submissive's little side and encourage them to come out and play. ~ Daddies/Mommies are strict about their littles behavior to ensure they meeting their goals and needs. ~ They can be more playful than most Masters. Masters tend to have to be more rigid with their submissive or slaves. ~ Mentor and teacher, they demonstrate by example and by explicit verbal communications priorities and perspectives that help littles better understand and learn form their past and current life experiences.~ Most Daddies/Mommies avoid the terms daughter or sonD/s Structures~ Daddy or Mommy Doms/littles~ Sex in a Daddy/little relationship does not stem from interest in incest or pedophilia. ~ Sex between a Daddy and his little is just like sex between any people in a relationship; as two consenting adults.~ Provide emotional sanctuary and 100% trust~ Don’t always live together D/s Structures: Master/slave~ In BDSM, Master/slave, M/s or sexual slavery is a relationship in which one individual serves another in an authority-exchange structured relationship. ~ Sometimes referred to as Total Power Exchange~ Unlike Dominant/submissive structures found in BDSM  or Female Led Relationships in which love is often the core value, service and obedience are often the core values in Master/slave structures.~ The relationship uses the term “slave” because of the association of the term with ownership rights of a master to the slave's body, as property. ~ Sex is not always a component of a Master/slave relationship D/s Structures: Master/slave~ The slave’s limits ~ Are not set by her/him in a TPE dynamic.~ Are whatever the Master desires. A slave’s master has total control. ~ A slave doesn’t have hard and soft limits~ Safe words are often not afforded to a slave.~ Though the Master is dominant and the slave is the submissive, the slave can withdraw submission at anytime, which in turn would emasculate the dominance of the Master~ Male masters are called “Master” Female Masters are called “Master” or “Mistress” Service Oriented~ Service-oriented refers to a
December 22, 2018
BDSM CEUs/OPD/CPD for this presentation can be found at allceus.com for clinicians in the US or Australia.allceus.com for clinicians in Australia. Trigger Warning and Cautions ~ The following presentation involves frank discussions of BDSM and sexuality. ~ While not graphic, some of the content might be triggering for some people. ~ This series is meant to provide an overview to help clinicians to understand kink, BDSM and Poly, but is by no means all inclusive. It is designed to increase awareness of common issues and help clinicians identify areas where they may need further training. Objectives ~ Review the benefits of BDSM ~ Explore the prevalence of BDSM ~ Learn about BDSM relationship structures ~ Identify possible areas of physical and psychological injury that therapists need to be aware of ~ Dispel some common BDSM myths ~ Identify danger signs of abuse in BDSM ~ Explore the concept of consent and the impact of mental illness on the ability to consent Benefits of BDSM (When done right) ~ Improves communication and increases intimacy ~ Encourages fidelity ~ Many who embrace the lifestyle are not interested in sabotaging the safety and trust that is imperative to its success. ~ Improved mental health ~ 2013 study from the Journal of Sexual Medicine, Medical Daily claims “people who practiced BDSM scored better on certain mental health indicators than those who had vanilla sex. The BDSM-friendly participants were less neurotic, more open, more aware of and sensitive to rejection, more secure in their relationships, and had a better overall well-being.” Benefits of BDSM (When done right) ~ Reduced cortisol (Cutler, 2003, Sagarin et Al 2009) ~ Endorphin rush an “altered state of consciousness” akin to a runner’s high ~ Consensual BDSM Facilitates Role-Specific Altered States of Consciousness: A Preliminary Study. Psychology of Consciousness: Theory, Research and Practice 4 (1). Sept 2016 ~ Increases confidence ~ Increases mindfulness. Participants enter a ‘flow state' of mindfulness, similar to the mindset athletes report when they're ‘in the zone' BDSM Facts ~ No evidence that BDSM orientation is caused by childhood trauma or a history of abuse BDSM is simply a sexual interest or subculture attractive to a minority, and for most participants not a pathological symptom of past abuse or difficulty with “normal” sex. ~ Demographic and psychosocial features of participants in bondage and discipline, “sadomasochism” or dominance and submission (BDSM): data from a national survey. J Sex Med. 2008 Jul;5(7):1660-8. ~ BDSM does not [necessarily] cause distress and dysfunction, but sociocultural and political persecutions do. (Kleinplatz & Moser 2006; Richters, 2003) BDSM Facts ~ Psychological characteristics of BDSM practitioners. ~ The results mostly suggest favorable psychological characteristics of BDSM practitioners compared with the control group ~ BDSM practitioners were less neurotic, more extraverted, more open to new experiences, more conscientious, less rejection sensitive, had higher subjective well-being, yet were less agreeable. ~ Comparing the groups, if differences were observed, BDSM scores were generally more favorably for those with a dominant than a submissive role, with least favorable scores for controls. J Sex Med. 2013 Aug;10(8):1943-52. BDSM Facts ~ Many BDSM participants perceive sexual BDSM experiences as not only significantly different from but also better than mainstream or “vanilla” sex. ~ BDSM participants construct sex as requiring genital contact, while framing sexual BDSM as creating sexual fulfillment not requiring normative indicators of sexual experiences (e.g., orgasm). ~ Sexual BDSM is centered on emotional and mental experiences, while sex is being centered on physical experiences. ~
December 14, 2018
Sexual DiversityDr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHCExecutive Director: AllCEUs CEUs/OPD/CPD for this presentation can be found at allceus.com for clinicians in the US or Australia.allceus.com for clinicians in Australia. Trigger Warning and Cautions~ The following presentation involves frank discussions of kink and sexuality.~ While not graphic, some of the content might be triggering for some people.~ This series is meant to provide an overview to help clinicians to understand kink, BDSM and Poly, but is by no means all inclusive. It is designed to increase awareness of common issues and help clinicians identify areas where they may need further training.Objectives~ Explain why it is important to understand various sexual practices including kink, polyamory and asexuality~ Define different types of sexual practices that clinicians may encounter~ Explain the DSM V’s stance on kink and other practices~ Describe the mental health impact of kink on participants In this Series~ Human Sexuality and Cultural Responsiveness~ 12/13/2018 LIVE Human Sexuality: Exploring Kink (Overview)~ 12/18/2018 LIVE Human Sexuality: BDSM~ 12/20/2018 LIVE Human Sexuality: Dom/sub and Female Led Relationships~ 12/26/2018 LIVE Human Sexuality: Polyamory and Open Relationships Activity Part 1~ Would you be concerned or not if a friend or a client revealed taking part in this activity? ~ An individual gets a rush out of being put in terrifying situations which makes him scream and cry out in fear. He engages other people to put him in a special device which will result in these effects. When his time in the device is up, his face is white and he has tears in his eyes, but he begs them to let him go through it again.~ A woman asks strangers to cause her extreme pain to her genital area. She does this regularly, as she feels more attractive following the painful session. Sometimes, she’ll even do it to herself. If it’s done right, no permanent harm results. Activity Part 1~ Would you be concerned or not if a friend or a client revealed taking part in this activity? ~ A small group of people arrange to meet in a private space in order to watch others role-playing being raped, humiliated and tortured. They find this an enjoyable way of spending their evening.~ Two people arrange to take part in a public scene. They spend a great deal of time preparing separately in advance. On the night they dress for the occasion in clothes made of satin. Watched by a gathered group of people they strike each other. The scene is considered successful if one of them briefly loses consciousness. The beatings are so severe they can result in permanent damage. Activity Part 1~ Would you be concerned or not if a friend or a client revealed taking part in this activity? ~ A woman spends several hours preparing her appearance. She chooses from items of clothing on which she has spent a lot of money, all of which painfully restrict parts of her body, forcing it into an unnatural shape and making it impossible for her to function normally. Over an extended period of time she knows this will damage her permanently. However, she experiences great pleasure despite the pain.~ As part of a group ritual a man consents to an event which he knows will be grueling, although he doesn’t know exactly what will take place. During the event, among other things, he is put in an altered state of consciousness, stripped and left alone in public. Activity part 2~ All of the activities listed are actually commonplace practices in mainstream culture. ~ a rollercoaster~ a bikini wax~ watching a horror movie ~ a boxing match~ wearing high heeled shoes or a corset~ a stag/bachelor party or fraternity pledging~ https://www.rewriting-the-rules.com/ tons of books and resources Kink~ It’s a form of “playing,” Cavanah said. It’s everything that falls outside of the confines of having sex simply to orgasm, which means it can take many different forms. ~ The term kink d
December 11, 2018
Fetal Alcohol Spectrum Disorders Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs.com Counselor Education Host: Counselor Toolbox Podcast CEUs/OPD/CPDs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/127/c/ for clinicians in the US and https://australia.allceus.com/member/cart/index/product/id/127/c/ for clinicians in Australia. Objectives ~ Define FASDs ~ Identify prevalence of FASDs ~ Identify areas of over-representation of people with FASDs ~ Explore the impact of FASDs on the person and intergenerationally ~ Discuss interventions and modifications to assist the person with a FASD What are FASDs ~ A disorder that occurs along the spectrum which ranges from full-blown Fetal Alcohol Syndrome to Neurodevelopmental Disorder-Prenatal Alcohol Exposure (ND-PAE) “Other Specified Neurodevelopmental Disorder,” code 315.8 in the DSM V ~ Fetal Alcohol Syndrome (FAS) ~ Partial FAS (pFAS) ~ Alcohol-Related Neurodevelopmental Disorder (ARND) ~ Alcohol-Related Birth Defects (ARBD) Stats ~ National Institute on Alcohol Abuse and Alcoholism, the prevalence of FAS in the general population ranges from 2% to 5% for the entire continuum of FASD. ~ 94% of individuals with an FASD also have a mental illness ~ 73-80% of children with FAS are in foster or adoptive placement ~ 61% of adolescents with an FASD experienced significant school disruptions ~ The prevalence of FASD in the child welfare system is 17 to 19 times higher than that in the general population in US (meta-analysis published online September 9 in Pediatrics). ~ 60% of people with an FASD have a history of trouble with the law ~ 12.8 is the average age children with an FASD begin having trouble with the law. (https://www.mofas.org/2014/05/fasd-and-the-criminal-justice-system/) Symptoms ~ People with FASD may have difficulty in the following areas: ~ Learning and remembering ~ Understanding and following directions ~ Shifting attention ~ Controlling emotions and impulsivity ~ Communicating and socializing ~ Performing daily life skills, including feeding, bathing, counting money, telling time, and minding personal safety ~ Tendency toward explosive episodes, often triggered by ~ Sensory overload ~ Slower rates of processing the information around them ~ Feeling “stupid” Special Considerations for Adolescents ~ Evidence shows that adolescents will commonly exhibit learning and behavior challenges, especially in: ~ Adaptive function/getting along from day to day ~ Remaining organized and regulated ~ Learning information slowly (especially what is said to them) ~ Tending to forget things they have recently learned ~ Making the same mistakes over and over. ~ Impulsivity/finding it hard to inhibit responses ~ Social communication (leaving out important details/being vague). ~ Suggestibility (and therefore easily influenced by others) ~ Immature social skills. (too friendly/trusting,/difficulty recognizing dangerous situations). Chronological vs Developmental ~ Chronological Age ————————————————————–18 ~ Physical Maturity—————————————————————18 ~ Developmental Level of Functioning——————–9 ~ Daily Living Skills———————————————11 ~ Expressive Language—————————————————————23 ~ Receptive Language——————————–7 ~ Artistic Ability (or other strength)————————————————–29 ~ Reading: Decoding———————————————————16 ~ Reading Comprehension———————–6 ~ Money and Time Concepts————————–8 Members of the Team Differential Dx ~ There is some evidence for distinguishing between children with FASD and children with ADHD. Using the four-factor model of attention it has been shown that: ~ Children with FASD have difficulties with encoding (taking in and processing information) and shift (shifting attention (hyperfocus)) ~ Children with ADHD have problems with focus and sustaining attention. (Using Mirsky (1989) 4 factor model of attention) ~ Distinguishing between attention-deficit hyperactivity and fetal alcohol spectrum disorders in children: clinical gu
December 8, 2018
Spiritual Steps to Happiness Part 4 Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Host: Counselor Toolbox Podcast CEUs/OPD/CPDs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/953/c/ for clinicians in the US and https://australia.allceus.com/member/cart/index/product/id/953/c/ for clinicians in Australia. Objectives ~ Learn how the following principles can help people live happier, healthier lives ~ Authenticity/Integrity ~ Patience & Forgiveness ~ Gratitude Authenticity/Integrity ~ Why this logically makes sense that it could improve happiness and reduce distress ~ When people live authentically, they are being true to themselves, not denying their feelings and thoughts. ~ When people live with integrity they are living in a way that is true to their principles they not only feel whole but also (often) set a good example Authenticity/Integrity ~ What the Bible Says ~ Psalm 73 The wicked are successful but also can easily fall and be destroyed. ~ Proverbs 4: 25-26 Fix your gaze directly before you. Give careful thought to the path for your feet and be steadfast in all your ways. ~ Luke 6:31 Do unto others as you would have them do unto you ~ Matthew 10:14 If anyone will not welcome you or listen to your words, leave that home or town and shake the dust off your feet. ~ 1 Corinthians 12 For the body does not consist of one member but of many. If the foot should say, “Because I am not a hand, I do not belong to the body,” that would not make it any less a part of the body. (Don’t try to be something you are not. You are important as you are.) 7 Days of Authenticity/Integrity ~ Day 1: Begin with the end in mind/Decide now ~ This helps you develop Good Orderly Direction. ~ What is important to me? Know and state your intentions. ~ What do I value in my life? ~ Day 2: Define your purpose in life. ~ I was put on this earth to… ~ My talents and skills enable me to… 7 Days of Authenticity/Integrity ~ Day 3: Foster an open mind to help you live life fully from every perspective ~ What is/are other perspectives ~ What else contributed to this ~ What other solutions could help me live more in line with my Good Orderly Direction ~ Day 4: Practice Psychological Flexibility and Radical Acceptance ~ It is what it is. I feel… My thoughts about this are… How can I improve the next moment? (Note: Authenticity does not mean succumbing to every urge) 7 Days of Authenticity/Integrity ~ Day 5: Quit the rationalizations ~ What things do you rationalize that go against your values? ~ What “little” choices have you made that went against your values? (Stealing supplies, slacking off at work, gossiping, taking credit for other’s successes, making unethical decisions for work, emotional cheating) ~ Day 6: Synchronize—Head, heart and gut honesty ~ Check your thoughts for validity and distortions ~ Ask, “Does this move me closer to what is important in a rich and meaningful life?” ~ Ask, “Is this in line with my values?” 7 Days of Authenticity/Integrity ~ Day 7: Practice mindfulness ~ Check your baggage: Let go of patterns and relationships that no longer serve you. Let go of unnecessary guilt and anxiety. Surround yourself with those who love you, believe in you, and want the best for you. ~ Find your voice and your truth. Express yourself…but remember to THINK (Truthful, Helpful, Inspiring, Necessary, Kind) Gratitude ~ Why this logically makes sense that it could improve happiness and reduce distress ~ Improved relationships ~ Improved physical health ~ Increased happiness ~ Neuroscience demonstrates that gratitude reduces stress and increases well being by stimulating the hypothalamus and the ventral tegmental area—part of the brain’s reward/pleasure circuitry (Cereb Cortex. 2009 Feb; 19(2): 276–283.) ~ Enhanced empathy and reduces aggression ~ Improved sleep. ~ Enhanced self-esteem. ~ Increased resiliency Gratitude ~ What the Bible Says ~ Job 5:2 Resentment kills a fool and envy slays the simple. ~ Ecclesiastes
December 4, 2018
Primer on Recovery Residences Instructor: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Counselor Education CEUs/OPD/CPDs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/619/c/ for clinicians in the US and https://australia.allceus.com/member/cart/index/product/id/619/c/ for clinicians in Australia. What is a Recovery Residence ~ “Recovery residence” (RR) is a broad term describing a sober, safe, and healthy living environment that promotes recovery from alcohol and other drug use and associated problems. ~ RRs offer peer-to-peer recovery support with some providing professionally delivered clinical services all aimed at promoting long-term recovery and improvement in physical, mental, spiritual, and social wellbeing that will support their recovery as they transition to living independently Effectiveness ~ The primary studies on Oxford Houses (e.g., Jason, Davis, Ferrari, & Anderson, 2007; Jason, Olson, Ferrari, & Lo Sasso, 2006) interviewed residents at 12- and 24-month follow-up. ~ A study of sober living houses in California (Polcin, et al., 2010) interviewed residents at 18-month follow up. ~ These studies documented significant longitudinal improvements including gains in employment, family and social functioning, psychological and emotional well-being, as well as reductions in criminal involvement. ~ Social support for recovery, recovery self-efficacy, and length of stay (6 months or longer) predicted change in cumulative recovery Levels ~ Recovery residences are divided into Levels of Support based on the type as well as the intensity and duration of support that they offer. ~ Level I-Peer-Run: Democratically run, drug screens, house meetings, self-help ~ Level II – Monitored: House manager, peer run groups in addition to Level I activities Levels ~ Level III- Supervised: Employ paid staff who provide on-site services, such as linkage to resources in the community. There is administrative oversight for service providers, state licensing, emphasis on life skill development. A recovery approach that has become known as ~ The “Florida model” combines intensive outpatient or day treatment services with residence in a sober living house. ~ Level IV- Service Provider: Residential treatment programs that are more structured than level III and that provide a variety of on-site clinical services (Therapeutic communities) Phases within Levels ~ Many residences define levels of recovery progress within the resident community which correspond with time in the residence, recovery progress as assessed by peers and/or staff, and the degree to which residence behavioral requirements have been met. ~ Each level or phase is typically accompanied by an increase in privileges, greater personal autonomy, exemption from certain requirements of previous phases, and possibly different physical accommodation choices. ~ Many residences with this type of system often pair later phase residents with new arrivals in a sort of “buddy system.” Phases cont… ~ A blackout period is required in the initial phase of some recovery residences in which the new resident is required to break communication with the outside world or with their natural supports in order to stabilize and focus on their recovery. ~ Many residences limit the activities for new residents for a length of time after admission. These restrictions might include always being accompanied by a more senior resident when outside the home, limits to contacts with family or friends, and expectations for a higher degree of involvement in recovery support activities. Length of Stay ~ Level 1 and 2 are open ended (on average 1-3 years) ~ Level 3 and 4 RRs average 3-9 months RRs and the Community ~ NARR-certified recovery residences meet standards addressing safety from an administrative, operational, property, and good neighbors perspective ~ Preferred location ~ In residential areas that provide RR residents an opportunity to integrate into the co
December 1, 2018
Spiritual Steps to Happiness Part 3 Dr. Dawn-Elise Snipes Counselor Toolbox Podcast CEUs/OPD/CPDs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/953/c/ for clinicians in the US and https://australia.allceus.com/member/cart/index/product/id/953/c/ for clinicians in Australia. Objectives ~ Openmindedness/Teachability/Curiosity ~ Optimism ~ Compassion Openmindedness/Teachability/Curiosity ~ Why this logically makes sense that it could improve happiness and reduce distress ~ When people are openminded, they are not fighting against other points of view or trying to control everything or fit it into a particular box ~ How can openmindendness help people with ~ Relationships (everyone was raised with their own set of “should”) ~ How can closed-mindedness negatively impacted people in ~ Their relationships ~ Problem solving Openmindedness/Teachability/Curiosity ~ Why this logically makes sense that it could improve happiness and reduce distress ~ Teachability can also reduce stress because, guess what, there are probably people out there who know more about some things than you do. Openmindedness/Teachability/Curiosity ~ What the Bible Says ~ Psalm 119:18 Open my eyes, that I may behold wondrous things. ~ Romans 12:2 Do not be conformed to this world, but be transformed by the renewal of your mind ~ Ephesians 4:18 They are darkened in their understanding, alienated from the life of God because of the ignorance that is in them, due to their hardness of heart. ~ Acts 22:9 Now those who were with me saw the light but did not understand the voice of the one who was speaking to me. ~ Proverbs 19:20 Listen to advice and accept instruction, that you may gain wisdom in the future. ~ James 1:5 If any of you lacks wisdom, let him ask God, who gives generously to all without reproach. ~ Psalm 25:4-5 Make me know Your ways, O LORD; Teach me Your paths. You are the God of my salvation. 7 Days of Openmindedness ~ Day 1: Open-mindedness ~ Be open to alternate solutions ~ Find 5 life hacks ~ Find 10 creative ways to use: 2-Liter Bottles, plastic grocery bags, duct tape, Soybean Oil (wd-40 alternative), baking soda… ~ Time management tricks ~ Removing stains ~ Day 2: The Third Agreement: Don’t make assumptions and always question your reality for the absolute truth ~ Practice listening with curiosity, “How might this work?” instead of shutting down with “That’s not how I do it.” ~ What is the goal? (Hint: It is not to be right) ~ How does each solution help arrive at the goal? 7 Days of Openmindedness ~ Day 3: Teachability ~ What have you learned from… ~ How does teachability help people in their relationships (we learn what others like, we learn about their perspectives…) ~ Day 4: Teachability: Try Something New ~ What is something new you have learned that you might have resisted? (Brussel sprouts, roller coasters) ~ Identify something you want to learn and how it might impact you. (Example: Organic gardening, parenting approaches, meditation) 7 Days of Openmindedness ~ Day 5: It Takes a Village ~ Many problems are multifaceted. Being willing to work with a group or consult diverse resources can help people “see” their blind spots, identify alternate solutions. ~ Ask: What are the causes? What are the benefits? What are the solutions? What are the consequences of those solutions? ~ How can this apply to: ~ Parenting a child who “won’t listen” ~ Addiction Prevention ~ Relapse Prevention ~ Focus today on identifying 3 solutions/perspectives to challenges. 7 Days of Openmindedness ~ Day 6: Through the Eyes of A Child ~ Expertise and experience are valuable assets, but they can be roadblocks to change. ~ Check your preconceptions, stereotypes, and biases, and approach a challenge with fresh eyes, people who are unfamiliar with the problem. ~ Challenge assumptions: Ask why…Does this rule exist? Do I think I must…? Does so and so react this way? Do I feel…? ~ Ask what if… we stopped… we are wrong… (honey & pe
November 23, 2018
Trauma Informed Interventions Dr. Dawn-Elise Snipes, PhD, LPC-MHSP Podcast Host: Counselor Toolbox CEUs/CPDs/OPDs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/955/c/in the US or for clinicians in Australia at https://www.allceus.com/member/cart/index/product/id/955/c/ Objectives ~ Review the components of Trauma Informed Care ~ Identify a variety of interventions and considerations for the provision of trauma informed care Principles of TIC ~ Safety ~ Emotional, cognitive, physical, interpersonal ~ Trustworthiness and transparency ~ Peer support and mutual self-help ~ Collaboration and mutuality ~ Sharing of power and decision-making and recognition that everyone has a role to play Principles of TIC ~ Empowerment, voice, and choice ~ Strengths are built on and validated and new skills developed as needed. ~ Belief in resilience and individuals, organizations, and communities. ~ Building on what clients, staff, and communities have to offer, rather than responding to perceived deficits. ~ Cultural, historical, and gender issues ~ Leverages the healing value of cultural connections, and recognizes and addresses historical trauma. Three E's of Trauma: ~ Events: Objective—What happened ~ Experiences: How the person experienced the event based upon ~ Developmental age ~ Prior history ~ Available resources Three E's of Trauma: ~ Effects ~ Emotional ~ Mental ~ Physical ~ Social ~ Spiritual ~ Environmental The Four R’s ~ Realization of the event ~ Recognize the experience and the effects ~ Respond to help people live a high quality of life ~ Resist re-traumatization. Summary of the Intention of Interventions ~ Create safety and develop trust through the use of ~ Cultural resources ~ Peer support ~ Transparency ~ Collaboration and empowerment ~ To ~ Explore events, experiences and effects ~ Respond in a way to help people live a rich and meaningful life without retraumatizing them Creating Safety ~ Develop a nurturing voice ~ Develop a crisis plan (and a post-crisis plan) ~ Mindfulness activities (Awareness of self) ~ Grounding techniques (Awareness of the present) ~ Unhooking ~ Pandora’s box ~ Boundaries ~ Physical ~ Emotional ~ Cognitive Transparency ~ Always explain the rationale behind activities ~ Improve communication ~ Stop mindreading ~ Ask for what you need (and stop expecting mind reading) ~ Using I-statements ~ Develop an awareness of the motivations behind thoughts, feelings and urges Collaboration and Empowerment ~ Multisensory guided imagery ~ Values identification ~ Living in the And ~ How are you different? ~ Identify and enhance strengths for coping with ~ Irritability ~ Hypervigilance ~ Sleep disturbances ~ Flashbacks ~ Numbing ~ Withdrawal Collaboration and Empowerment ~ Creating Meaning ~ Play it out… ~ Trigger identification and modification ~ Red flags & green flags ~ Systematic Desensitization ~ Narrative therapy written or charted ~ Broken pot Cultural and Peer Resources ~ Involve cultural supports ~ Faith healers, pastors ~ Colleagues ~ Identify peer-based resources (specialty groups) ~ Family/support therapy Responding without Retraumatizing ~ Building resiliency and preventing vulnerabilities ~ Challenging Questions ~ Facts for and against? ~ Emotional or factual reasoning? ~ Is there a high or low probability that your belief is or will be true? ~ What else contributed to the situation? ~ Are you catastrophizing or using all or nothing thinking? Summary ~ Create safety and develop trust through the use of ~ Cultural resources ~ Peer support ~ Transparency ~ Collaboration and empowerment ~ To ~ Explore events, experiences and effects ~ Respond in a way to help people live a rich and meaningful life without retraumatizing them ~ Ask yourself if any intervention is disempowering, nontransparent, or could be triggering in any way. ~ Inform clients before the intervention of the potential benefits and effects
November 22, 2018
Spiritual Steps to Happiness Dr. Dawn-Elise Snipes Host: Counselor Toolbox Podcast CEUs/OPD/CPDs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/953/c/ for clinicians in the US and https://australia.allceus.com/member/cart/index/product/id/953/c/ for clinicians in Australia. Objectives ~ Acceptance, honesty and awareness can help people live happier lives ~ We must first become aware of what is going on within and around us ~ Then we must get honest about what we need and can do ~ Finally we have to accept the dialectics of hardships with successes, happiness with pain and control with powerlessness. Awareness (Mindfulness) ~ Why this logically makes sense that it could improve happiness and reduce distress ~ Awareness helps us: ~ become aware of ourselves ~ improve our connectedness ~ improve our focus on those things important in a rich and meaningful life ~ keep from being led astray ~ make deliberate decisions guided by mind and logic, instead of emotions and instincts ~ be a good judge of character ~ avoid mistakes Awareness ~ What the Bible Says ~ 1 John 1:9 If we confess our sins, he is faithful and just to forgive us our sins and to cleanse us from all unrighteousness. ~ Proverbs 20:5 The purpose in a man's heart is like deep water, but a man of understanding will draw it out. ~ Throughout the bible people are aware of God’s miracles and actively seek Him out with optimism and faith. 7 Days of Awareness ~ Day 1: Learn Mindfulness Meditation ~ At least at each meal become aware of your feelings, thoughts and physical sensations and needs. ~ What do you do differently as a result of this awareness? ~ How does this awareness impact your day? ~ Day 2: Awareness of those around you ~ Review the temperament sorter and/or enneagrams to better understand yourself and see how you compliment other people Activity Sheet 7 Days of Awareness ~ Day 3: Humility ~ Being aware of what you are and are not capable of and willing to ask for help or lower the bar ~ Being grateful for other people’s contributions (great kids) ~ Day 4: Head-Heart-Gut Honesty ~ Logic-Love-Fear: Identify 3 big decisions you have made that you ended up regretting. Identify 3 big decisions you have made that you are very satisfied with. ~ Day 5: Gratitude ~ Become aware of the supports, and resources available to help you live a rich and meaningful life. ~ Which do you already have? 7 Days of Awareness ~ Day 6: My Mark ~ How have you impacted the yourself, the earth, other people? ~ How could you? 7 Days of Awareness ~ Day 7: Tame the Monkey ~ Monkey mind happens when we are focused or “aware” of too many things at once. ~ Practice being aware of what you are doing in the moment. ~ Watching television ~ Driving ~ Writing a report ~ When your mind starts to wander bring it back without judgement. (note it if you must) Honesty ~ Why this logically makes sense that it could improve happiness and reduce distress ~ When people are honest with themselves about what they need and want, they can better attend to those issues ~ When people are honest with others they are more likely to get their needs met, and do not have to keep track of lies ~ Activity: Consequences of Dishonesty ~ Emotional ~ Mental ~ Physical ~ Social Honesty ~ What the Bible Says ~ 2 Timothy 2:15 Do your best to present yourself to God as one approved, a worker who does not need to be ashamed and who correctly handles the word of truth. ~ Ephesians 4:25 Each of you must speak truthfully since we are all members of one body. ~ Proverbs 28:18 The one whose walk is blameless is kept safe, but the one whose ways are perverse will fall into the pit ~ Proverbs 21:3 To do what is right and just is more acceptable to the Lord than sacrifice. (Better to be honest then to make amends) ~ 1 John 1:19 If we confess our sins, he is faithful and just to forgive us our sins and to cleanse us from all unrighteousness. ~ John 8:32 You will know the truth, and the truth wil
November 21, 2018
Burnout and Self Care in Human Service Professions Dr. Dawn-Elise Snipes, PhD, LPC-MHSP Counselor Toolbox Podcast CEUs/OPD/CPDs are available for this presentation at  https://www.allceus.com/member/cart/index/product/id/966/c/ in the US or for clinicians in Australia at https://www.allceus.com/member/cart/index/product/id/966/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) ~ Appetite changes ~ Increased illness ~ Increases in depression and/or anxiety ~ Absence of positive emotions ~ Cynicism and disillusionment ~ Lack of patience ~ Lack of resilience (everything is a crisis) ~ Relationship deterioration ~ Substance abuse ~ Forgoing important personal activities Causes of Burnout ~ Excessive workload ~ Emotionally draining work ~ Lack of support ~ Lack of resources ~ Lack of rewards ~ Lack of a sense of control/say ~ Unclear or everchanging requirements ~ Severe consequences of mistakes ~ Work/life imbalance ~ Perfectionistic tendencies; nothing is ever good enough ~ Pessimistic view of yourself and the world ~ The need to be in control; reluctance to delegate to others ~ High-achieving, Type A personality ~ Poor work/person fit Interventions ~ Set SMART goals for work ~ Brainstorm ways to work smarter, not harder ~ Squeegee (Cleansing) breath ~ Take time to add in the positive DAILY ~ Each day identify 3-5 things that went well ~ Keep a scrapbook or journal of your positive experiences (no PHI) ~ Perennial Garden ~ Ornaments/windchimes/stepping stones/Lego wall/backsplash tile wall ~ Journal Interventions ~ Develop support (co-workers, peers, supervisor) ~ Know and ask for what you need in terms of resources ~ Create Work/Life Balance ~ Develop and nurture relationships (schedule it in if needed) ~ Leave work at work (sorta) ~ Take time for self-care and relaxation ~ Eat healthfully ~ Check your need for perfectionism and control ~ Describe why you got into the field and visualize that intention (collage, etc)—money, help, adrenaline, status/power Interventions ~ Use psychological flexibility ~ To me, a rich and meaningful life is… ~ Is what I am doing/thinking/feeling helping me move toward those things? ~ If not, what can I do to improve the next moment ~ Perspective taking ~ Decision making ~ Coping and emotion regulation ~ Assertiveness ~ Relaxation ~ Cognitive restructuring Interventions ~ Identify the strengths and resources you do have ~ Mental Agility: ~ The ability to look at situations from multiple perspectives and to think creatively and flexibly. (state the other perspectives or solve from multiple approaches: cheap, fast or right) ~ Practice mindfulness ~ How do you feel emotionally and where is it coming from? ~ How do you feel physically and what does it mean? ~ What are your current thoughts and where are they coming from? ~ Be aware of your trauma triggers Interventions ~ Limit your contact with negative people. ~ Connect with a cause or a community group that is personally meaningful to you. ~ Advocate for yourself and others with your supervisor/human resources ~ Resources ~ Consistency ~ Transparency ~ Ability to admit mistakes ~ Support and celebration ~ Boundaries ~ Job control Interventions ~ Develop resiliency ~ Vulnerability prevention and mitigation ~ Awareness of what you can and cannot control ~ Distress tolerance ~ Optimism and hope ~ Gratitude ~ Optimistic explanatory style: the ability to notice and expect the positive, to focus on what you can control, and to take purposeful action ~ Character strengths: Use your top strengths to engage authentically, overcome challenges, and create a life aligned with your values Summary ~ Burnout work environments are a reality ~ Burnout does not have to be ~ Burnout causes problems in ~ Health ~ Mental Health ~ Relationships ~ Work environment and employee retentio
November 20, 2018
Relapse Prevention and Accountability Dr. Dawn-Elise Snipes Counselor Toolbox Podcast CEUs/OPD/CPDs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/964/c/ in the US or for clinicians in Australia at https://www.allceus.com/member/cart/index/product/id/964/c/ Objectives ~ Review techniques for writing a relapse prevention plan that emphasizes accountability What is Accountability ~ Accountability is the ability to demonstrate follow through on a promise or contract ~ How do you hold your kids accountable? ~ How do you hold employees or contractors accountable? ~ How do you hold yourself accountable? ~ Why is it more difficult to be accountable to yourself? Congratulations ~ Upon entering treatment, have clients develop a relapse prevention plan (which will be modified and built upon) ~ Introduction (Page 1) ~ Have client “introduce” themselves. “I am Rose. I am a loving, loyal, determined mother of 3 beautiful children, and I am dedicated to maintaining my recovery for the following reasons”(State the personal benefits of recovery): ~ When I am in recovery, I am [emotionally], because ___ ~ When I am in recovery, I am [mentally] , because ___ ~ When I am in recovery, I am [physically], because ___ ~ When I am in recovery, my relationships with my kids is ____, because ___ ~ When I am in recovery, my relationships with my friends is ____, because ___ ~ When I am in recovery, my relationships with … ~ The 3 most important reasons I am in recovery are… Relapse Prevention Planning ~ Types of Relapse ~ Emotional ~ Mental ~ Behavioral ~ Written Relapse Prevention Plan ~ Identify your personal relapse warning signs and interventions (Page 2) ~ Emotional ~ What feelings indicate that you are falling back into old patterns? ~ Mental/Attitudinal ~ What attitudes or thoughts indicate that you are falling back into old patterns? ~ Behavioral ~ What behaviors indicate that you are falling back into old patterns? Relapse Prevention Planning ~ Written Relapse Prevention Plan ~ Identify triggers and vulnerabilities and methods for prevention and mitigation (Page 3) ~ Emotional (Anger*, Anxiety*, Depression, Grief…) ~ Mental (Distress Intolerant Thoughts) ~ Physical (Exhaustion, hunger, pain) ~ Social (People or social situations that trigger you, Social situations that put you on edge (parties, crowds…)) ~ Environmental (sights, sounds, smells, times of day, places, decorations/holidays, anniversaries…) RPP cont… ~ Written Relapse Prevention Plan ~ Identify 5 people and/or organizations who could be a vital part of your recovery, why, and how and when you will contact them.(Page 4) ~ Create a vision of a rich and meaningful life to guide the development of a comprehensive recovery lifestyle plan, because relapse prevention is about building a recovery lifestyle, not just preventing triggers. (Page 5) Accountability Putting It Together ~ The actual plan (Page 6 and beyond)…Set SMART goals and rewards ~ Time management plan that includes (see Page 5) ~ When you will sleep and how you will ensure it is quality sleep ~ How you will ensure you are eating a nutritious diet and drinking enough water ~ Your work schedule ~ Household chores and other misc. to-dos ~ When you will spend time with the children ~ When you will connect with your inner circle ~ Time for recreation ~ A twice daily mindfulness check-in with accountability buddy ~ Recovery related activities (aftercare, support groups, coaching) Putting It Together ~ The actual plan (Page 6 and beyond)…Set SMART goals and rewards ~ A contract with family/roommates to practice mindfulness, use red flags and be respectful of triggers ~ A financial plan ~ A statement of things you will NOT do during the next 12 months without extensive consultation. (i.e. make major decisions or purchases, get into a relationship, change jobs…) Techniques for Accountability ~ It is more productive to hold people accountable for doing something than NOT doing something ~
November 17, 2018
Spiritual Steps to Happiness CEUs/OPD/CPDs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/953/c/ for clinicians in the US and https://australia.allceus.com/member/cart/index/product/id/953/c/ for clinicians in Australia. What is Spirituality ~ A sense of connectedness ~ Humans were meant to connect ~ A belief that there is something bigger than oneself that promotes a sense of awe and wonder. Connetedness ~ A recognition of our impact on others and everything and vice versa ~ A recognition that we belong and are a vital part of the universe ~ Why this logically makes sense that it could improve happiness and reduce distress ~ When we have a positive impact, on others ~ It makes us feel good ~ It can earn us positive points and strengthen our supports Connetedness ~ What the Bible Says ~ 1 Corinthians 12 We are all part of one body with many members each serving a unique function. ~ 14 For the body does not consist of one member but of many. 15 If the foot should say, “Because I am not a hand, I do not belong to the body,” that would not make it any less a part of the body. ~ 17 If the whole body were an eye, where would be the sense of hearing? If the whole body were an ear, where would be the sense of smell? 19 If all were a single member, where would the body be? ~ 21 The eye cannot say to the hand, “I have no need of you,” nor again the head to the feet, “I have no need of you.” 22 On the contrary, the parts of the body that seem to be weaker are indispensable. 7 Days of Connectedness ~ Day 1 Self-Connectedness ~ Mindfulness of how you feel emotionally, mentally, physically ~ Awareness of how they way you feel emotionally, mentally and physically impacts your ability to be kind to yourself and be in a positive frame of mind ~ Day 2 Self-Connectedness ~ Pay attention to the “gallery” in your head. ~ What do you tell yourself? ~ Who planted these seeds in your psyche? 7 Days of Connectedness ~ Day 3: ~ How does each of these “non-essential” or weaker parts enrich life? ~ Non-dominant hand; hearing, smell ~ How does the body cope when a part goes away? ~ What part of the body are you and why? ~ Embrace that today and think about it in everything you do (flip charts). ~ Skin, heart, brain, nervous system, mouth, hands, lungs, muscles, ligaments/tendons 7 Days of Connectedness ~ Day 4: Involvement ~ Synergize, create win/win situations, seek first to understand then to be understood ~ Look for ways to be involved in things that are important to you ~ Involve the whole group/family and reinforce the importance of every voice ~ Mindfulness check-ins ~ Decisions 7 Days of Connectedness ~ Day 5: Ponder your unique strengths and qualities that make you —you. ~ Each member of the group/family identifies a unique quality of each other member… ~ You have improved my world/this group by… or You have taught me…. ~ Make a profile wall (old fashioned wiki) for each person in the group/family using cork boards 7 Days of Connectedness ~ Day 6: Ponder your impact on others ~ Make a dedicated effort to practice random acts of kindness (most important people, co-workers, random strangers) Flip chart or small group ~ Acts of service ~ Words of appreciation ~ Quality time ~ Gifts (even little notes or cookies) ~ Physical touch ~ Be aware all day of how your words, nonverbals and actions impact other people. (Journal) 7 Days of Connectedness ~ Day 7: Ponder other’s impact on you ~ Be aware all day of how other people’s words and actions and your environment impact you ~ Make a plan to deal with unpleasant impacts ~ Failure to do what is expected ~ Rude drivers ~ Grumpy people ~ People with opposite temperaments ~ Disorganization ~ Lots of noise or sudden noises Questions Awe and Wonder ~ What is it ~ A sense of wonder is characterized by full engagement, flow, being present in the moment, and a high “wow” factor. – Rachel Carson ~ Awareness of the beauty around you ~ Sense of amazement ~ Rec
November 14, 2018
A Trauma-Informed Approach to the Holidays. Prevention for the Holidays: Preventing Trauma and Vulnerabilities Dr. Dawn-Elise Snipes Executive Director: AllCEUs.com Counselor Education Host: Counselor Toolbox Podcast Objectives ~ Identify trauma and depression triggers ~ Explore ways to deal with them Trauma Triggers ~ Expectations and grieving ~ Expectations for an extraordinary holiday ~ Past memories of disappointment ~ Present expectations  anticlimactic ~ Reminders of what does not exist ~ Expectations for how people will behave (this year) ~ Anniversaries ~ Deaths (1st Christmas since grandma died) ~ Reminders of bad things that happened on that holiday Trauma Triggers ~ Sensory ~ Songs ~ Icy roads ~ Scents ~ Rituals ~ That remind of abuse ~ That focus on God ~ Alcohol ~ Disinhibition ~ Intoxicated people ~ Stress ~ Insufficient sleep Trauma Triggers ~ Financial worries ~ Trigger reminders of abuse from stressed parents ~ Reminders of disappointing their kids ~ Shopping ~ Trigger reminders of criticism and abuse ~ In crowds Interventions ~ Self Care ~ Sleep ~ Nutrition (including water) ~ Sunlight ~ Me Time ~ Exercise ~ Boundaries ~ Ask for help to avoid getting overwhelmed ~ Make a Bill of Rights to deal prevent guilt Interventions ~ Turn off triggering shows ~ Take a media/news break ~ Shop on line or ahead of time ~ Start a new tradition or just get away ~ Make a plan for the day ~ Trigger identification and prevention/intervention plan ~ Set a time limit ~ Have a friend to call ~ Make a plan ~ Memory journal ~ Release your resentments / Loving kindness meditation Interventions ~ Create a memory ornament or do something in honor of someone who has died ~ Reflect on happy memories (empty nest) ~ Volunteer/Random acts of kindness ~ Invite people over who have nowhere to go or are un-holidaying it too ~ Go on a hike ~ Treat yourself as you want to be treated ~ Love yourself and forget perfection ~ Video chat with friends/family at a distance Interventions ~ Rehearse how to answer “What are your plans?” ~ “Getting some much needed rest,” ~ “Catching up on projects” ~ “Spending time with friends,” even if your friends are me, myself and I ~ Envision an Un-Holiday ~ What parts are in your control ~ Who is (and is not) there ~ What are you doing Summary ~ The holidays are hard for a LOT of people ~ They can bring up feelings of grief, guilt, loneliness, anger, trauma/helplessness, and depression/hopelessness ~ People need to be aware of what their triggers are, what those triggers are related to and have a plan to stop them. ~ Vulnerability prevention is also essential to help people have the energy and reserves to deal with unavoidable stressors.
November 10, 2018
Meditation Techniques Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs.com Counselor Education Host: Counselor Toolbox Podcast CEUs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/951/c/ or in Australia at https://australia.allceus.com/member/cart/index/product/id/951/c/ Objectives ~ Learn the benefits of meditation ~ Identify the goals of meditation ~ Describe how to get started with meditation ~ Explore 15 types of meditation Benefits of Meditation ~ Reviews to date have demonstrated that both “mindfulness” and “mantra” meditation techniques reduce emotional symptoms (e.g., anxiety and depression, stress) and improve physical symptoms (e.g., pain) from a small to moderate degree ~ Mindfulness meditation was found to show moderate improvement for ~ Anxiety (44%) ~ Depression (52%) ~ Pain (31%) ~ Effects were seen during treatment and maintained at the 3 and 6 month marks. Benefits of Meditation ~ Eight weeks of Mindfulness-Based Stress Reduction (MBSR) increased thickness in the hippocampus, which governs learning and memory, and in certain areas of the brain that play roles in emotion regulation. There were also decreases in volume in the amygdala, which matched the participants’ self-reports of their stress levels. Mindfulness practice leads to increases in regional brain gray matter density Psychiatry Res. 2011 Jan 30; 191(1): 36–43. ~ “People who learned mindfulness were many times more likely to have quit smoking by the end of the training, and at 17 weeks follow-up… Meditation helps people “decouple” the state of craving from the act of smoking” Brewer JA, Mallik S, Babuscio TA, et al. Mindfulness training for smoking cessation: results from a randomized controlled trial. Drug Alcohol Depend. 2011;119(1-2):72-80. ~ Mindfulness meditation has shown utility in the treatment of other addictions as well. Brewer JA, Elwafi HM, Davis JH. Craving to quit: psychological models and neurobiological mechanisms of mindfulness training as treatment for addictions. Psychol Addict Behav. 2012;27(2): 366-79. Benefits of Meditation ~ “Long-term meditators had better-preserved brains than non-meditators as they aged. Participants who’d been meditating for an average of 20 years had more grey matter volume throughout the brain. Forever Young(er): potential age-defying effects of long-term meditation on gray matter atrophy. Front. Psychol., 21 January 2015 | https://doi.org/10.3389/fpsyg.2014.01551 ~ Mindfulness meditation decreases activity in the area of the brain network responsible for mind-wandering and self-referential thoughts – a.k.a., “monkey mind” which is typically associated with being less happy, ruminating, and worrying about the past and future. Meditation experience is associated with differences in default mode network activity and connectivity PNAS December 13, 2011 108 (50) 20254-20259; https://doi.org/10.1073/pnas.1112029108 Goals of Meditation ~ Reducing negative emotions, cognitions, and behaviors ~ Increasing positive emotions, cognitions, and behaviors toward self and others ~ Altering relevant physiological processes (immune, inflammation, bp etc.) and pain perception ~ Boosting one’s ability to empathize with others Getting Started ~ Start with 2 minutes a day ~ Do it first thing in the morning or right before bed ~ Consider doing it with a friend or family member ~ Don’t get caught up in how…just do it. Spend 2 minutes focused on the present moment ~ Focus on your breaths and/or your heart rate ~ Come back when you wander ~ Develop a loving, nonjudgmental attitude ~ Don’t worry about clearing your mind, just practice focusing your attention Getting Started cont… ~ Do a body scan ~ Notice the light, sounds, energy ~ Stay with whatever arises. Instead of avoiding feelings like frustration, anger, anxiety, just stay, and be curious. ~ Get to know yourself. Learn how your mind works. By watching your mind wander, get frustrated, avoid difficult feeling
November 7, 2018
Encouraging Optimism Based on Positive Expectations CEUs/OPD/CPD are available for this presentation are at https://www.allceus.com/member/cart/index/product/id/950/c/ or https://australia.allceus.com/member/cart/index/product/id/950/c/ Objectives ~ Define hope and optimism ~ Explore the connection between positive expectations and optimism ~ Identify blocks to optimism ~ Identify steps to optimism Research on Optimism ~ Patient coping and expectations about recovery predict the development of chronic post-surgical pain after traumatic tibial fracture repair. Br J Anaesth. 2016 Sep; 117(3): 365–370. ~ Patients who are optimistic about recovery following an injury will actually recover and return to work faster than patients who are less optimistic. At Work, Issue 65, Summer 2011: Institute for Work & Health, Toronto ~ Positive patient expectations associated with positive patient-reported outcomes in Surgery: A Systematic Review Surgery. 2014 May; 155(5): 799–808. ~ Optimism was found to have a positive effect on personal recovery and mental health after a tornado outbreak. Psychol Health. 2017 May;32(5):530-548 ~ Optimism has been shown to significantly influence the course of some diseases (cancer, HIV, coronary heart disease) J Health Psychol. 2016 Aug;21(8):1758-67 Health Effects of Optimism ~ Reduced cortisol ~ Improved sleep ~ Reduced blood pressure https://www.health.harvard.edu/heart-health/optimism-and-your-health ~ Improved health-related behaviors ~ Faster healing Carver, C. S., Scheier, M. F., & Segerstrom, S. C. (2010). Optimism. Clinical psychology review, 30(7), 879-89. Hope and Optimism ~ Hope is a passive emotion unrelated to the likeliness of the outcome. (winning the lottery) ~ Hope is based on the anticipation of positive future developments. ~ Optimism is confidence in attainment of the goal (getting into graduate school) through a belief that the person will find a path to achieve the desired goal and will be motivated to walk this path. ~ How could you be optimistic about winning the lottery? ~ You are hopeful before a job interview and optimistic after it. ~ The more control people perceive they have the more optimistic (and hopeful) they can be, because the outcome is now attainable Optimism ~ To any challenge, an optimist reacts with faith in reaching desirable results and continually taking part in the activity even if the process is long and difficult ~ An optimistic explanatory style can be characterized by the attribution of external, unstable and specific causes to failures and negative events ~ People using an optimistic strategy do not think too much about possible risks and imagine themselves in a situation where they are coping successfully. Hope and Optimism ~ Hope and optimism consists of three basic components – ~ Goals ~ Will/determination/motivation ~ Pathways to the goals Hope and Optimism ~ When you are negative and hopeless you tend to notice the things that are not going the way you want* ~ When you are positive, you seize on the good things. (pan for gold) ~ If optimism is hope combined with perceived control and ability to achieve goals then…. ~ Positive expectations can help people become more optimistic. ~ Note: This only works for things people have some degree of control over. Step One ~ Create Positivity ~ Start looking at events in terms of what you want instead of what you lost or do not have. ~ What is it that I want (my goal)? ~ What parts of this can I control? ~ What resources and capabilities do I have that I can use? ~ How have I, or someone I know, gotten through similar situations? ~ What is the likelihood that this will go well? ~ Why is it worth the effort (motivation)? Step 2 ~ Create a self-fulfilling prophesy ~ Create a POSITIVE self fulfilling prophesy ~ Reframe the situation ~ Set SMART goals ~ Avoid rigid expectations (for other peoples behaviors, for the way things are going to turn out, for something extraordinary) ~ Shore up resources ~ Envision the posit
November 3, 2018
Self-Esteem Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Objectives ~ The Nature of Self-Esteem ~ Identifying and Disarming the Critic ~ Creating an Accurate Self Assessment ~ Identifying Cognitive Distortions ~ Developing Compassion ~ Shaking the Shoulds ~ Handling Mistakes ~ Responding to Criticism ~ Goal Setting ~ Core Beliefs ~ Building Self Esteem in Children The Nature of Self-Esteem ~ How you feel about yourself in contrast to who you think you “should” be ~ The more rejecting we are of ourselves, the more ~ Distress we experience ~ We seek external validation ~ In order to develop healthy relationships people need to feel good about themselves Benefits of Strong Self Esteem ~ Stable moods ~ Ability to set healthy boundaries ~ Stronger sense of self-confidence ~ Improved relationships ~ Less stress and feelings of emptiness Where Does It Come From ~ Positive Regard (Direct & Indirect) ~ Media ~ Family ~ Friends ~ Self What Do I Value ~ 5 Admirable People ~ Identify 5 people you admire. ~ What qualities do you admire about them ~ For each quality, explain why it is admirable ~ What do you wish was different about them? The Pathological Critic ~ Arsenal of shoulds ~ Origin of the Critic: Conditions of Worth ~ Why you listen to the critic ~ Catching your critic ~ Talking back Accurate Self-Assessment ~ Self-Concept inventory ~ Listing your strengths and weaknesses ~ Developing a new self-description ~ Celebrating your strengths Miracle Question — Activity ~ Based on your (revised) ideal self ~ If you woke up tomorrow with a strong self esteem, what would it be like? What would be different? The same? ~ In your relationships ~ In how you handle stress ~ In your mood ~ In your job, etc. Cognitive Distortions ~ The Distortions and Combating Them ~ Magnification/Exaggeration ~ Minimization ~ All or Nothing ~ Availability Phenomenon ~ Emotional Reasoning ~ Overgeneralization ~ Mental Filter (only seeing the bad) ~ Personalization and Blaming Compassion ~ Compassion defined ~ Developing self-compassion ~ Developing compassion for others ~ Creating a compassionate world The Shoulds ~ The tyranny of should ~ How should affects your self esteem ~ Challenging and revising your should ~ Can, will, cannot, choose not to ~ Atonement and guilt Handling Mistakes ~ Reframing mistakes ~ The problem of limited awareness (context) ~ Your mistake-success ratio Responding to Criticism ~ The myth of reality ~ Reality is everchanging ~ Now two people share the exact same reality ~ Responding to criticism ~ What does criticism mean about you? ~ About the situation? ~ About that person? ~ Take what is useful and leave the rest ~ Why are suggestions or feedback not useful? Asking for What You Want ~ Needs vs. wants ~ Wants inventory ~ Creating a win-win Goal Setting and Planning ~ What do you want ~ Prioritizing goals ~ Making your goals SMART ~ Making a commitment ~ Blocks and un-blocks to achieving goals Core Beliefs ~ Identifying Core Beliefs ~ I am… ~ Developing new core beliefs Improving Self-Esteem ~ To improve self-esteem, you must ~ Change the way you feel about yourself (i.e. change your feelings about your self-evaluation) ~ Focus on your strengths ~ Aim for effort, not perfection ~ Decide if some of the “ideal” characteristics are important to you ~ Change yourself ~ Likely there are some areas in which you want to improve ~ Make a plan to tackle them ONE at a TIME Improving Self-Esteem ~ Make a list of positive affirmations and add one new one each day ~ When you find a fault in yourself, remind yourself of three positive qualities ~ Do not minimize your accomplishments. Take credit where credit is due. ~ Surround yourself with people who are positive and encouraging ~ Instead of complaining about faults, take positive action Improving Self-Esteem ~ If there is something you feel “bad” about that is impossible to change, then add a new, positive quality. ~ Do a good deed every day ~ Make cha
October 31, 2018
Developing Healthy Support Networks Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Podcast Host: Counselor Toolbox Objectives ~ Define interpersonal effectiveness ~ Identify barriers to interpersonal effectiveness ~ Examine the goals of interpersonal effectiveness ~ Review techniques for improving interpersonal effectiveness Developing Relationships ~ Relationships are our greatest buffer against stress ~ The first relationship to develop is that with yourself characterized by self-esteem, self-respect and self-compassion. ~ Relationships require attention and a clear awareness of what you want/need/expect from other people and yourself. ~ Make full use of opportunities to interact with others ~ Interact with people who share similar interests and generally respond positively to you. Interpersonal Effectiveness ~ Interpersonal effectiveness is the ability to ~ Get others to do things you want them to do ~ Get others to take you seriously ~ Effectively say no to unwanted requests ~ Strengthen current relationships ~ Find and build new relationships ~ End hopeless relationships ~ Create and maintain balance ~ Balance acceptance and change Interpersonal Effectiveness with 7 Habits ~ Be proactive ~ Communicate often and effectively ~ Know what you need and want in life and from others ~ Know what your partner needs** ~ Believe that you deserve what you want ~ Begin with the end in mind ~ What does a good relationship look like? ~ What does it NOT look like? Interpersonal Effectiveness with 7 Habits ~ Put first things first ~ Prioritize your partner and yourself ~ Don’t sacrifice long term goals for short term relief/urges ~ Think win-win ~ Give up always being right Interpersonal Effectiveness with 7 Habits ~ Seek First to Understand, Then to Be Understood ~ Be aware of your impact on others ~ Pay attention to transference issues ~ Pay attention with interest and curiosity ~ Avoid assuming what other people think ~ Stop multitasking ~ Stay in the present instead of planning your response ~ Develop good communication skills ~ Be open to new information ~ Let go of judgmental thoughts about others Interpersonal Effectiveness with 7 Habits ~ Synergize ~ Combine your strengths** ~ Ensure there is give and take ~ Balance your needs and the other person’s needs ~ Sharpen the Saw ~ Dedicate quality time ~ Take time away Temperament ~ In order to understand what you and others need and effectively communicate and synergize, it is helpful to understand temperament ~ Environment/Socialization ~ Conceptualization ~ Making Meaning/Values ~ Time Management Temperament Extrovert ~ Are expansive; less passionate ~ Easy to get to know ~ Like meeting new people ~ Would rather figure things out while they are talking ~ Know what is going on around them rather than inside them Introvert ~ Are intense and passionate ~ Difficult to get to know ~ Exert effort to meet new people ~ Figure things out before they talk ~ Are more likely to know what is going on inside them Temperament Sensing ~ Are practical and realistic ~ Prefer facts and live in the real world ~ Would rather do than think ~ Focus on practical, concrete problems ~ See the details and may ignore the big picture ~ Believe “if it isn’t broken, don’t fix it” iNtuitive ~ Are imaginative dreamers ~ Prefer abstraction, inspiration, insights ~ Would rather think than do ~ Focus on complicated abstract problems ~ See the big picture but miss the details ~ Believe anything can be improved Temperament Thinking ~ Want to apply objective principles ~ Value objectivity above sentiment ~ May think that those who are sentimental take things too personally ~ May argue both sides of an issue for mental stimulation Feeling ~ Want to apply values and ethics ~ Value sentiment above objectivity ~ Think that those preferring objectivity are insensitive ~ Prefer a to agree with those around them Temperament Judging ~ Plan ahead ~ Thrive on order ~ Maybe hasty in making decisions ~ Time and dead
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