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July 1, 2020
From a survival standpoint, the symptoms of Post Traumatic Stress make a lot of sense. We will explore the possible reasons for these symptoms and interventions that can be used to assist clients in creating a resilient recovery narrative.
June 27, 2020
Objectives Review multiple ways of writing treatment plans including using the integrative summary, FARS, CANS, ASAM and LOCUS Review pitfalls in writing effective treatment plans and how to avoid them Review the purpose of the reassessment and best practices for documentation Identify time-effective methods for completing treatment plans and reassessments
June 22, 2020
Objectives ~ Review the characteristics of BPD ~ Compare and contrast BPD with addictive behaviors ~ Examine ways to implement the activities presented in the book in a group format Characteristics of BPD ~ Poorly developed, or unstable self-image, often associated with excessive self-criticism ~ Difficulty recognizing the feelings & needs of others ~ Interpersonal hypersensitivity (i.e., prone to feel slighted or insulted) ~ Perceptions of others tend to focus on negative attributes or vulnerabilities.
June 17, 2020
- Review common life skills Communication Skills - Types - Written - Nonverbal - Oral
June 13, 2020
Objectives ~ Review the function of mindfulness and a variety of mindfulness techniques ~ Explore the concept of relaxation ~ Identify different methods of relaxation
June 6, 2020
-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.
June 3, 2020
» Define grief » Conceptualize grief in terms of any loss » Identify how failure to deal with grief can impact a person » Explore the stages of grief » Review activities and interventions to help people grieve
May 30, 2020
» Review the symptoms of anxiety in adults and children » Explore the impacts of anxiety » Identify strategies for prevention and intervention
May 27, 2020
- Explore the function and impact of anger - Identify the types of threats that may prompt anger - ldentify different types of anger to include - Run of the mill anger - Irritation - Resentment - Envy/Jealousy - Guilt/Regret
May 23, 2020
-Identify signs of relationship insecurities -Explore how past relationships impact present relationships -Identify at least 5 interventions to address relationship insecurities
May 20, 2020
> Identify the characteristics of each dimension of temperament and how awareness of temperament can improve relationships. > Learn about love languages and how those can be used to enhance relationships.
May 16, 2020
» Learn about boundaries signs of violations and how to maintain them » Summarize the characteristics of healthy relationships
May 13, 2020
> 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
May 9, 2020
» Define psychological flexibility » Explore how to apply psychological flexibility » Identify the shortcut question
May 6, 2020
-Review the cognitive triad -Identify ways to teach the following cognitive behavioral skills in group -ABC-DEs, Cognitive Restructuring, Unhooking, Psychological Flexibility Matrix
May 2, 2020
Overcoming hoarding, a mental disorder recognized by the American Psychiatric Association, requires more than pop psychology and a 30-gallon garbage bag. In the new book Conquer the Clutter, social worker Elaine Birchall, founder of the Canadian National Hoarding Coalition, and co-author Suzanne Cronkwright, provide practical strategies for regaining control. You can find Elaine at https://www.hoarding.ca to learn more and to buy her book.
May 2, 2020
~ Review the basics of psychodynamics ~ Phenomenological reality (autobiography) ~ Transference ~ Compare and contrast (are you safe now?) ~ Creating PACER safety and Mindfulness of the Present
April 25, 2020
Explore why it is important to envision a rich and meaningful life Identify how to envision a rich and meaningful life Learn how to set goals to achieve that rich and meaningful life
April 22, 2020
• Define vulnerabilities • Identify some of the most common vulnerabilities • Their effects • Ways to prevent them - Note: Each of the vulnerabilities has its own presentation. This section is designed to give you an overview and get you thinking about possible small changes that might have a big impact.
April 18, 2020
Mindfulness Overview - Differentiate between mindLESSness and mindFULness - Understand where mindLESSness came from - Define mindFULness - Explore ways mindFULness can help - Reduce emotional and physical distress and pain - Improve sleep - Improve Relationships - Explore activities that will help you - Become truly aware of your feelings, wants and needs - Develop skills that will help you observe, describe and participate
April 15, 2020
Review how tolerance develops Discuss the impact of addictive substances and behaviors on the brain and body
April 11, 2020
Neurobiology of Addiction Dr. Dawn-Elise Snipes Purchase CEUs at: allceus.com/member/cart/index/product/id/1277/c/ Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free months of TherapyNotes with coupon code “CEU” Objectives – Review how tolerance develops – Discuss the impact of addictive substances and behaviors on the brain and body Tolerance (Addiction or Physiological or Physical Stress) – The brain tries to maintain homeostasis in the body (warm bath) – When you take drugs or experience stress it increases the levels of certain neurotransmitters (stimulants = hot water; depressants=cold water) – To normalize the chemical levels the brain for survival, the brain “balances the temperature” – Increases the secretion or receptor activation of the opposite neurotransmitters – Reduces activation of targeted receptors (cortisol, glutamate etc.) – To get the same high, more or different triggers are needed – Withdrawal triggers opposing physiological and psychological symptoms
April 8, 2020
484 – Motivational Enhancement & Stages of Readiness for Change Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free months of TherapyNotes with coupon code “CEU” CEUs available at: http://allceus.com/member/cart/index/product/id/1275/c/ Types of Motivation * Motivation is essential for change * Motivation helps you identify why it is worth the effort to make a change * Motivation helps you keep going when the going gets tough * Change can be hard and uncomfortable * Motivation is different for different goals » Changing people, places and things « Motivation may decrease over time unless you actively maintain it * Going to meetings or counseling * Placing a priority on adequate quality sleep and stress management
April 8, 2020
485 – Triggers Out With the Bad and In With the Good Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free months of TherapyNotes with coupon code “CEU” CEUs available at: http://allceus.com/member/cart/index/product/id/1274/c/ Objectives – Identify PACER triggers for stress and relapse, ways to prevent and mitigate them and steps to remind yourself to do the prevention activities. – Switch focus from eliminating triggers for your addiction or mental health issues to ADDING triggers for health and recovery. Triggers – Triggers are sights (including people, places and things), sounds, smells, situations that make you think about doing something or bring up particular memories or emotions. – Triggers can be positive. They remind you to do things that are good for you or make you happy. – Puppies – Push notification to remind you to do to a meeting or do a mindfulness check. – Triggers can also be negative. They make you think about or want to do things that are not helpful for your recovery, cause cravings or bring up memories or feelings that are unpleasant. – Alcohol in the house – “Stress” Triggers During a Crisis – During a crisis people are at risk for the development or resurgence of mental health issues because there are so many things that trigger anxiety, anger, hopelessness and helplessness – Emotional valence can refer to the strength of a trigger. – Research has shown that negative triggers and events are about 5 times stronger than positive ones. – We will go through PACER triggers for distress that can be mitigated and for happiness that can be enhanced. Triggers Gamification – ABCs – Pictionary – Taboo – Acronym maker – Trivial Pursuit (Physical, Affective, Cognitive, Environmental, Relationships, Spirituality) – Flip chart (causes, interventions) – Beach ball – Small group activity – Family Feud—top 5 physical triggers for depression… – Jeopardy—A good pillow can help with this… Physical Triggers – How can each of the following be a trigger for depression, anxiety or addiction during a crisis- What might cause it and how can you prevent or minimize each one- – Pain – Fatigue – Hunger – Sickness (gastric upset, allergies, a cold) – Substance use – Sleeping too much/altered circadian rhythms – What things can you do to remind yourself to do the prevention activities (i.e. a push notification to get ready for bed)- Affective Triggers – During a crisis what might cause each emotion and how can you prevent or minimize each one- – Anger – Loneliness – Hopelessness/Helplessness – Depression – Envy/Jealousy – Guilt – Grief – What can you do to remind yourself to do the prevention activities- (i.e. Turn off the television. Call a friend. 5:1 control activity) Cognitive Triggers – How can each of the following thought patterns be a trigger for addiction, depression or anxiety during a crisis- How can you prevent or minimize each one- – Thinking you can control nothing (What can you control) – All or nothing thinking (Find exceptions) – Personalization (What are other explanations-) – Emotional reasoning (Find the facts) – Negative perceptions (Find the positive) – What can you do to remind yourself to do the prevention activities- Challenging Questions: REAP REWARD – Reasoning: Facts vs. Emotions – Extremes – All Aspects – Probabilities: High vs. Low – Recognize your reactions (How and why) – Examine your options and resources to improve the next moment – Welcome the challenge – Accept the things you cannot change – Reach out for support and to help others – Determine the best use of your energy (purposeful action) Environmental Triggers &
April 5, 2020
484 – Motivational Enhancement & Stages of Readiness for Change Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free months of TherapyNotes with coupon code “CEU” CEUs available at: http://allceus.com/member/cart/index/product/id/1275/c/ Types of Motivation * Motivation is essential for change * Motivation helps you identify why it is worth the effort to make a change * Motivation helps you keep going when the going gets tough * Change can be hard and uncomfortable * Motivation is different for different goals » Changing people, places and things « Motivation may decrease over time unless you actively maintain it * Going to meetings or counseling * Placing a priority on adequate quality sleep and stress management
April 4, 2020
Hardiness and Resilience Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Host: Counselor Toolbox Objectives – Define resilience – Identify characteristics that make people more resilient and ways we can enhance those characteristics – Define Hardiness – Examine what hardiness is important to resilience Resilience – Resilience is the capacity to bounce back – Characteristics of resilient people: – Awareness of and minimized vulnerabilities – Healthy self-esteem – Strong social support system – Self-awareness – Self-Efficacy – Problem Solving Skills – Practice acceptance – Can tolerate distress – Have an optimistic viewpoint Awareness of Vulnerabilities – Emotional Distress – Emotional Eustress – Mental Distress – Mental Eustress – Physical Distress – Nutrition (poor nutrition, dieting, too much caffeine) – Sleep – Exercise (pain, exhaustion) – Pain – Illness Vulnerabilities cont… – Social Distress – Social Eustress – Environmental Distress – Environmental Eustress Self Esteem – Ability to provide validation and acceptance of self – Identify personal strengths and positive characteristics – Separate who you are from what you do – Explore cognitions about: – Why other people’s opinions matter – Attributions Strong Social Support System – Social supports are our greatest buffers against stress – Relationships can be one of the greatest causes of stress – Identify characteristics of healthy vs. unhealthy relationships. – Explore ways to nurture and enhance healthy relationships. – Identify ways to deal with unhealthy people – Learn about temperament and complimentarity Self-Awareness – Temperament – Needs – Wants – Values (Truly important, driving forces) – Goals – Is what I am doing getting me closer to or further away from what is important to me – Physical and emotional state in the present – Triggers (positive and negative) Self-Efficacy – Believing in one’s own capacity to accomplish goals (effectiveness) – Identification as a survivor not a victim (Locus of control) – Hardiness – Commitment: Motivation – Control: Realistic understanding of what is within one’s control – Challenge: Not too easy, but not overwhelming. Exciting opportunity Problem Solving Skills – Ability to conceptualize problems – Willingness to seek out help – Motivation to actually take action – Don’t bring me a problem unless you have an idea for at least one realistic solution. Acceptance – Sometimes things just are… – Unfortunate – Inaccessible – Unchangeable – Willingness to accept life on life’s terms without – Judging – Trying to change the unchangable Distress Tolerance – Ability to feel a feeling without having to react – “I am angry” – “I am having a feeling of being angry” – “I am angry but can choose whether or not to stew in it” – Note – There are no “You made me” (victim stance) – There is no active attempt to change it at this point – Feelings are there to tell us something. Fighting them or nurturing them only prolongs them. Optimism – Finding the silver lining – Failure = Learning opportunity – Relationships = Compassion – Rainy day = Watering the plants – Life change = Opportunity to find a new direction Summary – Resilience is the capacity to bounce back – Resilience is a quality we can enhance in our clients while also helping them reduce distress. – Characteristics of resilient people: – Awareness of and minimized vulnerabilities – Healthy self-esteem – Strong social support system – Self-awareness – Self-E
March 28, 2020
482 – Enhancing Trauma Resiliency Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Counselor Education Host: Counselor Toolbox Podcast CEUs available: http://allceus.com/member/cart/index/product/id/997/c/ Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free months of TherapyNotes with coupon code “CEU” 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 high and low probability events Problem Solving Skills – Brainstorming– (Hand drawing for children, mind-map for adults) – Ask someone who has been through it – How does this keep me from moving closer to my goals and what can I do about it- Flexibility – Helps people learn that things won’t always go the way they want, BUT it doesn’t mean it will be awful. – Does not come easy to those with a “J” personality – Identify things we need to be flexible in (vacations, workouts, job duties, relationships, time management) – Activities – Choices Hat (meals, vacations, television programs) – Schedule a spontaneous day – How many uses game (Duct tape, coconut oil, plastic shopping bags, cardboard boxes, wire coat hangers…)\ – How are you like a…. game Flexibility – Learned Optimism (Martin S
March 25, 2020
Anger Management 9 Session Protocol Dr. Dawn-Elise Snipes PhD, LMHC Executive Director, AllCEUs.com Objectives ~ Learn about anger and it’s functions ~ Explore events and cues ~ Develop an anger control plan ~ Learn about the aggression cycle and how to change it ~ Review the ABCDEs and thought stopping ~ Assertiveness and conflict resolution skills ~ Alternatives for expressing anger ~ Relaxation Interventions ~ Explore how past learning from your family of origin can influence current behavior Session One: Learn About Anger ~ Anger is an emotion triggered by a threat which prompts the fight (aggression) or flight reaction ~ Hostility refers to a set of attitudes, thoughts and judgments that motivate aggressive behaviors. ~ Aggression is behavior that is intended to protect oneself by causing harm or injury to another person or damage to property. (Fight or Flee) ~ Many times what we initially perceive as a threat is not currently one Session 1 cont. ~ Misperceptions ~ Example: Fire alarm ~ Example: Sean and Elias ~ Initial experience: Brewster perceived a danger ~ Future experiences—Elias is associated with a threat ~ Example: Rescues ~ Initial experience: A man hurt you ~ Future experiences are overgeneralized: All men are dangerous ~ Example: Domestic Violence ~ Initial experience: Raised voices leads to violence ~ Future experiences: Anytime someone raises their voice it is a threat Session 1 ~ Anger becomes a problem when it is felt too intensely, is felt too frequently, or is expressed inappropriately ~ How does anger affect you: ~ Physically: Sleep, pain, GI, immunity ~ Emotionally: Regret, guilt, feeling helpless ~ Socially: Fear vs. respect, negative impact on relationships ~ Occupationally: How you work with others, customer service ~ Spiritually: Your sense of connectedness to and impact within the world, karma ~ Environmentally: Break stuff, holes in walls, throw out things impulsively Session 1… ~ Anger initially has apparent payoffs (e.g., releasing tension, controlling people). ~ In the long-term, however, these payoffs often lead to negative consequences. ~ What benefits/payoffs does anger have for you? ~ Habits are things we do almost automatically. ~ In what ways is anger a habit ~ How can you use mindfulness to start to break that habit? ~ I am angry? ~ What am I angry about? ~ Is this actually a threat to me? ~ What is the best response in this situation to help me achieve my goals Session 1 ~ Identify anger control strategies you have used in the past ~ Which ones worked? Why? ~ Which ones didn’t work? Why? Session 1 ~ Homework: Keep a log of your anger intensity the next week. Keeping a log helps you become more aware of your triggers and cues and see your progress. ~ On the top of the page, put the date (use a different sheet each day) ~ Make 3 columns with the following headers Session 2: Identifying Triggers, Events & Cues ~ When you get angry, it’s because you have encountered an something that has made you feel threatened (provoked you) ~ What are some general situations that make you irritable? Angry or enraged? ~ Many times, specific events touch on sensitive areas. These sensitive areas or “red flags” usually refer to long-standing issues that can easily lead to anger ~ Loss of Control ~ Rejection/Isolation ~ Death/Loss ~ Failure ~ Why does each of these “sensitive areas” make you feel threatened/trigger your anger? Session 2 cont… ~ Cues are indicators that you are getting angry. ~ Cues can be broken down into four cue categories: ~ Physical Cues (how your body responds; e.g., with an increased heart rate, tightness in the chest, feeling hot or flushed) ~ Behavioral Cues (what you do; e.g., clench your fists, raise your voice, stare at others) ~ Emotional Cues (other feelings that may occur along with anger; e.g., fear, hurt, jealousy, disrespect) ~ Cognitive Cues (what you think about in response to the event; e.g., hostile self-talk (“I’ll fix her little red wagon!”), images of aggression and
March 21, 2020
Purchase CEUs at:http://allceus.com/member/cart/index/product/id/1026/c/ Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free months of TherapyNotes with coupon code “CEU” 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 ~
March 21, 2020
Interview with Dr. Lindsay Weisner. Author of “Ten Steps To Finding Happy: A Guide to Permanent Satisfaction.” The book is available for pre-order at: https://amzn.to/2wmCTcU
March 18, 2020
How Schema Affect Anxiety & Depression Dr. Dawn-Elise Snipes Objectives – Define schema – Explain how schema are formed – Discuss why schema may be inaccurate or outdated – Identify 5 strategies to address unhelpful schema What are Schema – Schema are mental representations or beliefs about a particular person or event that we repeat(and hopefully adjust) throughout our lives – Schema about ourselves and our goodness – Schema about going to the doctor – Schema about job interviews – Schema about news media – Schema about flu season – Schema about the stock market – Schema about coronavirus – Schema about the safety or dangerousness of other people – Schema are a type of metacognition General Categories of Schema – Security/ Abandonment – Trust & Safety / Abuse – Emotional Support / Emotional Deprivation & Invalidation – Self Determination / Vulnerability To Emotional or Physical Harm – Positivity & Optimism / Negativity & Pessimism – Acceptance And Contentment / Hypercriticalness – Competence / Defectiveness – Independence / Dependence – Self Concept & Esteem /Enmeshment – Success & Empowerment / Failure – Self Control / Lack of Self Control & Subjugation – Belongingness, Connectedness vs. Alientation How are they formed – Schema are formed based on the interpretation and memories of experiences – They are a short-cut the brain creates to help us better anticipate future situations – Interpretation is impacted by – The person’s age and prior similar experiences – The person’s cognitive development and metacognition – Children tend to personalize, dichotomize and overgeneralize – People with trauma histories may notice and remember more threats in the environment (Hypervigilant thinking) – If you have had a bad experience with something, then you likely expect another bad experience (waiting in a doctor’s office; shots; the flu; thunderstorms) How Schema Become Outdated – What was dangerous to you as a child may no longer be dangerous (staying home alone) – What was dangerous to you in the past (abusive significant other, emotional dysregulation) may not apply in the present (current SO, emotional regulation) – The expectations that applied to something 20 years ago may not apply now (stock market, cancer, HIV) Why Schema May Be Inaccurate – Emotional Valence – We tend to notice threats when we are in a dysphoric mood – Lack of Knowledge – Fear mongering headlines – Conflicting or inaccurate information Forming Healthy Schema – Basic needs include: – Consistency and Predictability – Responsiveness – Acceptance and Attention – Validation – Empathy and Encouragement – Safety and Support in Solution Generation Adjusting Schema – Identify and evaluate current schema that cause distress – Evaluate the facts – Address cognitive distortions (overgeneralization) – Explore schema related to old situations with “fresh eyes” – Abandonment – Safety – Emotional dysregulation Schema Restructuring – Security/ Abandonment – Trust & Safety / Abuse – Emotional Support / Emotional Deprivation & Invalidation – Self Determination / Vulnerability To Emotional or Physical Harm – Positivity & Optimism / Negativity & Pessimism – Acceptance And Contentment / Hypercriticalness – Competence / Defectiveness – Independence / Dependence – Self Concept & Esteem /Enmeshment – Success & Empowerment / Failure – Self Control / Lack of Self Control & Subjugation – Belongingness, Connectedness vs. Alientation Summary – Schema are lenses through which we predict and interpret sit
March 14, 2020
Mental Health Aspects of Bariatric Surgery Purchase CEUs at: https://www.allceus.com/member/cart/index/product/id/1139/c/ Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free months of TherapyNotes with coupon code “CEU” 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 pa
March 12, 2020
Coronavirus Stress & Anxiety Cognitive Behavioral Tools & Life Hacks Host: Dr. Dawn-Elise Snipes CEUs available for purchase at: https://www.allceus.com/member/cart/index/product/id/1272/c/ Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free months of TherapyNotes with coupon code “CEU” Objectives • Objectives • Identify why controlling stress and anxiety is important • Describe cognitive behavioral tools and “life hacks” to address stress and anxiety during viral outbreaks • Identify reliable resources to acquire accurate information about the virus • Identify practical steps clinicians can encourage mainstream media to take to reduce the negative impact of the situation on the mental health of the general public. Why is Controlling Stress and Anxiety important? • Stress and anxiety cause the body’s threat response system (HPA-Axis) to be activated • In the short term like when you get cut off in traffic, this system might be helpful • When it stays activated for days or even weeks it causes • Impaired sleep • Difficulty concentrating • Weight changes • Fatigue • Reduced immunity • Irritability (behavioral issues in children) • Reduced libido • Increased risk of anxiety and depression Why is Controlling Stress and Anxiety important? • Interpersonally stress and anxiety increases distrust, suspicion and social isolation/distancing which negatively impacts interpersonal support and personal self esteem and safety. Cognitive Behavioral Tools • Use fact-based reasoning • Who does this impact? (elderly, those with compromised immune systems or cardiovascular issues) • How much will it really impact me? • Payroll tax cuts with “very substantial relief,” as well as ways to help hourly wage workers who cannot get paid when they stay home sick “so they don’t get penalized for something that’s not their fault.” Washington Post • How many people have it who have not been tested and recovered? • What practical steps can you take to protect yourself? • If the government declares a state of emergency—what does that actually mean? Cognitive Behavioral Tools • Don’t confuse possibility with probability • What is the probability it will happen to you AND be the worst cast scenario • In 2019-2020 there have been 34 MILLION cases of the flu, 350,000 hospitalizations and 20,000 deaths (CDC) • The mortality rate of people who have been tested for the flu is .1% but for coronavirus ranges from .2% (10-39 year olds) to 3.6% (elderly) (China CDC Weekly study) Cognitive Behavioral Tools • Practice Mindful Acceptance • Notice how you feel without judgement • Identify the options for dealing with the situation (including tolerating uncertainty) • Choose an option to help you improve your next moment (instead of continuing to feed the anxiety) • Engage in meaningful activities instead of channel surfing to find more of the same information that is causing your distress • Get reliable facts and use fact based vs. emotional reasoning • Stop trying to control things that are out of your control • Figure out a way to make this an opportunity • Live in the AND (This virus can exist AND I can have a rich and meaningful life / go to work) Cognitive Behavioral Tools • Be aware of all or nothing thinking or catastrophizing • There is nothing I can do to protect myself • If I get the virus I will die • No public places are safe • If my daughter gets the virus, she will die and I won’t be able to go on. • Make an effort to find the positives in your life • Currently I do not have it • There are steps I can take to protect myself • Thanks to online shopping I will be able to get my basic needs met • Thanks to the internet I will be able to stay in touch with loved ones and possibly work from home • This is encourag
March 11, 2020
Covid-19, election anxiety and financial stress is getting to people right now. This is the audio version of a three part series just released on YouTube.
March 11, 2020
Psychosocial Aspects of Terminal Illness Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free months of TherapyNotes with coupon code “CEU” Purchase CEUs at: https://www.allceus.com/CE/course/view.php?id=1547 Objectives • Identify services which may be needed to address terminal illnesses • Define what constitutes a terminal illness • Identify tools to help screen and monitor patients and families throughout the process • Explore PACER needs and integrative approaches to care Services • Counseling • Client alone • Caregivers • Client and caregivers • Case Management for client and caregivers • Support (clinical and peer) • Supplies • Food / medication • Housekeeping • Navigating the medical/ insurance systems • Legal and financial issues • After death Conditions • Aging • Cancer • Heart failure • HIV • Acute Illness (flu, sepsis) • Alzheimers • Other progressive illnesses (Lou Gehrig’s disease, COPD, organ failure) Tools • COMPASS • National Comprehensive Cancer Network Distress Thermometer and Problem List Physical • Patient • Pain and availability of palliative care • Sleeping • Nutritional support • Medication side effects • ADLs (mobility, bathing, toileting) • Changes in responsiveness • Caregivers • Exhaustion • Sleeping • Physical requirements of caregiving • Nutritional support (preventing low blood sugar and secondary effects) Immediately Prior to Death • Symptoms • Confusion • Drifting in and out • Restlessness and agitation • Attempting to removing clothing • Crying out or moaning • Sleeping a LOT or very little • Breathing becomes irregular • “Death Rattle” Coughing and noisy breathing are common as the body’s fluids accumulate in the throat. This breathing is often distressing to caregivers but it does not indicate pain or suffering • Causes • Pain • Constipation/Urinary restriction • Lack of oxygen • Fear Interventions • Keep the patients safe • Provide constant supervision (with a camera if the person wants to be alone) • Always act as if the dying person is aware of what is going on and is able to hear and understand voices. • Keep the room as peaceful as possible, or however the person wants it • Talk in a calm voice • Try to reassure the patient and address fears Affective / Emotional • Client • Grief • Anger (situation, physicians, “causes,” self, body, family and outside caregivers) • Depression • Embarrassment • Guilt • Anxiety (progression, unknown, survivors) • Acceptance • Family • Grief • Anger (situation, physicians, “causes,” outside caregivers, client) • Examine multiple losses • Depression • Anxiety (progression, suffering) Affective • Coping may be either adaptive by reducing stress and promoting psychological adjustment or maladaptive preventing necessary adjustments • Coping Strategies • Seeking information • Keeping busy / distress tolerance • Redefining options/Examining alternatives / Create a win-win • Expressing feelings • Taking time away to recharge • Getting support / synergize • Mindfulness • Purposeful action Affective • Antidepressant therapy is usually relatively well-tolerated • Expert consensus statement recommends a low threshold for initiating treatment. • Psychostimulants, SSRIs, and tricyclic antidepressants are the main pharmacologic treatment modalities for depression at the end of life. • Sertraline, paroxetine, mirtazapine, and citalopram have demonstrated effectiveness for fatigue and depression in patients at the end of life • Several studies document the effectiveness of methylphenidate in patients with cancer or HIV to address low energy and apathy • Cochrane review concluded that there is no
March 7, 2020
Creating Psychological Flexibility in Children with Dr. Dawn-Elise Snipes Executive Director, AllCEUs Host: Counselor Toolbox Podcast CEUs are available at https://www.allceus.com/member/cart/index/product/id/1029/c/ Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free months of TherapyNotes with coupon code “CEU” Objectives ~ Define Psychological Flexibility ~ List the Main Principles of Psychological Flexibility ~ Identify the Components of Psychological Flexibility ~ Describe How to Teach Psychological Flexibility ~ Explain the Short Cut Question Preventing Vulnerabilities ~ When people are tired, malnourished, hungry, stressed, sick or in pain, they tend to have more difficulty dealing with life on life’s terms. ~ Sleep ~ Set a bedtime routine and teach about good sleep hygiene ~ Help them learn the value of sleep ~ Point out that they will have a better day if they get a good nights sleep and when they are having a bad day because they didn’t get enough rest Preventing Vulnerabilities ~ Nutrition ~ Help children learn good eating habits ~ Participate in cooking ~ Help create menus with 3 colors at each meal ~ Keep prepared fruits and veggies available ~ Minimize refined foods for stable blood sugar ~ Make sure lunches have sufficient protein and complex carbohydrates ~ Talk to them about why nutrition is important Activity: Food Art ~ Tell children to build a Mr. Potato Head but take out one set of pieces. ~ When children cannot complete the project, explain that just like they need all the pieces to make Mr. Potato Head, for them to be healthy and happy their body needs all the different types of food building blocks Preventing Vulnerabilities ~ Positive Health Behaviors (Model it. Do it with them.) ~ Relaxation ~ Ergonomics (backpack, desk, bed) ~ Hand Washing (sing Baby Bumble Bee 2x) ~ I’m washing up my baby bumble bee ~ Won’t my mama be so proud of me ~ I’m washing up my baby bumble bee ~ Scrubba scrubba scrub scrub scrub scrub scrub ~ Exercise Battery or Money Metaphor ~ If you get a good nights sleep, eat a healthy diet and learn to relax, then each day you start with (a fully charged cell phone battery/ $100) ~ If you don’t get a good nights sleep, eat a healthy diet and learn to relax then you may not fully recharge (your phone/bank account) ~ Throughout the day each time you do something you are (draining your battery / spending money). The more intense the activity or emotion or the longer it lasts, the more (battery is used/money spent) ~ Eating, walking, exercising etc. ~ Worrying ~ Getting angry Questions… ~ Think about a day you didn’t sleep well. Did you run out of (battery/money) earlier in the day? ~ What about a day you were really stressed about a test coming up? ~ How much easier do things seem when you are rested and relaxed? Clarifying the Destination Values & Goals ~ A lack of clarity about values can underlie much of people’s distress or keep them “stuck.” ~ Help children identify what is really important in their life and become willing to focus their energies on those things Clarifying Values & Goals ~ Clarifying ~ Who is most important, deep in your heart? ~ Which people? ~ What do you want those relationships to be like? ~ Note: Help small children create a collage of people who are in their life (family, higher power, pets) ~ What events, things, experiences are important to you? ~ Getting on the ___ team/club ~ Getting good grades ~ Going to college to be a _____ ~ Being good at ______ ~ My health (without that you can’t do the others as easily) ~ Note: Small children may not have anything here Clarifying cont… ~ Values ~ What values do you want to embody (Choose 5)? ~ For small children, ~ Choose 5 that are important for your family values and/or characterize the child (Honesty, Resourcefulness, Compassion, Faithfulness, Determination…etc.) and help the child learn to embody these things ~ Tell me what animal you are like and why. When Unpleasa
March 4, 2020
474 – Metacognitive Therapy Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Counselor Education Host: Counselor Toolbox Podcast CEUs available: https://www.allceus.com/member/cart/index/product/id/1270/c/ Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free months of TherapyNotes with coupon code “CEU” Objectives • Learn about metacognitive therapy • Explore the multiple aspects of metacognition • Practice applying MCT to depression, pain, learned helplessness and other stressful situations Introduction • Distress is a signal that the person is trying to respond to threats to their wellbeing • Distress is normally reduced by effective coping strategies • Disorders result when • The person’s coping skills backfire • Believe they have no control over their thoughts • Believe it is in their best interest to keep ruminating. Rumination often focuses on questions that have no easily identifiable answers. • What if? • Why do I feel this way? • Why me? • What does this symptom mean? Introduction • Metacognitive essentially means “thinking about thinking” and refers to the knowledge and regulation of one’s own cognitive processes • MCT agrees that prior experiences create schema which influence interpretation of events, however, MCT focuses not on the content of the thoughts but the what the person pays attention to. • Metacognitive experiences are the reactions people have as a result of their cognitive appraisals • MCT focuses on disorder specific cognitive biases such as mood congruent memory • In one study, NFC, acted as the only mediator between treatment and depression recovery Metacognitive Components • Metacognitive knowledge refers to declarative knowledge of cognitive processes and includes • Personal knowledge (e.g., Ways of thinking (rumination, analysis), and personal abilities and limitations) (Mindfulness) • Negative metacognitive beliefs (distress intolerant thoughts) focus on • The uncontrollability of thoughts and belief that thoughts need to be controlled • Rumination • Threat monitoring • Unhelpful reactions that backfire (away behaviors) • Positive metacognitions are beliefs about the need to have the particular beliefs to stay safe or prepared • Task knowledge (e.g., How to do something (cook, meditate, learn, control thoughts)) (Skills Training) • Strategic knowledge (e.g., Advantages/disadvantages and applicability of each strategy) (Problem Solving) Metacognitive Components • Metacognitive experience is the personal experience and perception of difficulty that accompanies cognitive activity. • How confident do I feel that I can do it and it will be successful? (Fact-based reasoning vs. Emotional reasoning) • Metacognitive monitoring and control refers to self-supervision and regulation of the cognitive processes including their ability to plan, monitor, evaluate and regulate their cognitive activities by adjusting task goals, regulating attentional awareness (shot), and selecting cognitive strategies. • What is the best course of action • How effective is this course of action • What needs to be done differently or continued? Example Application • (Rumination) If I think about it enough I will find answers. • How long have you been at it? How much longer will it take? • What if there is no answer? • (Need to control thoughts) If I do not control my thoughts I will do something bad. • How do you know which ones to control? • What types of bad things have happened by not controlling your thoughts? Example Intervention • A à B  C • A=Critical and unconstructive feedback • B=They hate me. They don’t consider other perspectives. They are entitled. They aren’t accepting responsibility for their part. • C=Anxiety, helplessness • A  M  C • A=Critical
February 29, 2020
473 – The Neurobiological Impact of Psychological Trauma: The HPA-Axis Objectives • Define and explain the HPA-Axis • Identify the impact of trauma on the HPA Axis • Identify the impact of chronic stress/cumulative trauma on the HPA-Axis • Identify symptoms of HPA-Axis dysfunction • Identify interventions useful for this population Based on • Post-traumatic stress disorder: the neurobiological impact of psychological trauma Dialogues Clin Neurosci. 2011 Sep; 13(3): 263–278. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182008/ • This article lays out the many changes and/or conditions seen in the brain of people with PTSD. • As clinicians, awareness of these changes can help us educate patients about their symptoms and find ways of adapting to improve quality of life. Introduction • Neurobiological abnormalities in PTSD overlap with features found in traumatic brain injury • The response of an individual to trauma depends not only on stressor characteristics, but also on factors specific to the individual. • Perception of stressor • Proximity to safe zones • Similarity to victim • Degree of helplessness • Prior traumatic experiences • Amount of stress in the preceding months • Current mental health or addiction issues • Availability of social support Introduction • For the vast majority of the population, the psychological trauma is limited to an acute, transient disturbance. • The signs and symptoms of PTSD reflect a persistent, abnormal adaptation of neurobiological systems to the witnessed trauma. What is the HPA Axis • Hypothalamic-Pituitary-Adrenal Axis AKA the Threat Response System • Controls reactions to stress and regulates many body processes, including digestion, the immune system, mood and emotions, sexuality, and energy storage and expenditure • The ultimate result of the HPA axis activation is to increase levels of cortisol in the blood during times of stress. • Cortisol's main role is in releasing glucose into the bloodstream in order to facilitate the “flight or fight” response. It also suppresses and modulates the immune system, digestive system and reproductive system. HPA-Axis Dysfunction • The body reduces its HPA axis activation when it appears that further fight/flight may not be beneficial. (Hypocortisolism) • Hypocortisolism seen in stress-related disorders such as CFS, burnout and PTSD is actually a protective mechanism designed to conserve energy during threats that are beyond the organism's ability to cope. • Dysfunctional HPA axis activation will result in • Abnormal immune system activation • Increased inflammation and allergic reactions • IBS symptoms such as constipation and diarrhea, • Reduced tolerance to physical and mental stresses (including pain) • Altered levels of sex hormones Fatigue • Fatigue is actually an emotion generated in the brain, which prevents damage to the body when the brain perceives that further exertion could be harmful. • Fatigue in sports is largely independent of the state of the muscles themselves and is more related to: • Physical factors • Core temperature • Glycogen levels • Oxygen levels in the brain • Thirst • Sleep deprivation • Levels of muscle soreness/fatigue Fatigue • Fatigue cont… • Psychological factors reducing fatigue • Emotional state • Knowledge of the endpoint • Other competitors/motivation • Visual feedback • Fatigue is one sign that the body is getting ready to downregulate the HPA-Axis • In counseling practice, how can we reduce fatigue and help clients restore HPA-Axis functioning? Low Cortisol and PTSD • Low cortisol has been found to relate to more severe PTSD hyperarousal symptoms. • Sensitised negative feedback loop in veterans diagnosed with PTSD by means of a greater gluticorticoid responsiveness. (0-100) • Generall
February 28, 2020
The Psychological Impact Of Quarantine And How To Reduce It Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education CEUs available at: https://www.allceus.com/member/cart/index/product/id/1268/c/ Objectives Based on The psychological impact of quarantine and how to reduce it: rapid review of the literature ~ Review the effects of quarantine ~ Explore ways to mitigate these effects Intro ~ Quarantine means the separation and restriction of movement of people who have potentially been exposed to a contagious disease ~ However, during a contagious outbreak like influenza, SARS, H1N1, Ebola etc., many people choose to voluntarily restrict their movement to prevent getting ill ~ Many of the principles we will discuss here also apply to extended “sheltering in place” which people experience after hurricanes or blizzards. Stressors During Quarantine ~ Those quarantined for more than 10 days showed significantly higher post-traumatic stress symptoms ~ Fears about own health or getting sick and infecting others (which continued for several months post-quarantine) ~ Hypervigilance to any symptoms of illness ~ High risk populations (pregnant women, parents of young children and the elderly showed negative rumination) Short Term Problems ~ Separation from loved ones ~ Detachment from others ~ Loss of freedom ~ Loss of routine ~ Lack of access to basic supplies ~ Uncertainty over status of the situation ~ Financial losses due to inability to work and stock market ~ Dependence on family members to provide financial assistance during quarantine caused conflicts ~ Those who live at or below 300% of the poverty level showed greatest stress in response to financial losses Short Term Reactions ~ In the case of potential exposure, acute stress disorder (34% vs. 12%) ~ Exhaustion ~ Anxiety when around people who are sick ~ Irritability ~ Anger ~ Insomnia ~ Poor concentration ~ Indecisiveness ~ Deteriorating work performance ~ Reluctance to go to into public and consideration of resignation from work Short Term Effects ~ Confusion and a perception of lack of transparency about the severity of the problem can be created due to differences in style, approach, and content of various public health messages because of poor coordination between the multiple jurisdictions and levels of government involved.15 ~ Lack of clarity about the different levels of risk causes participants to fear (and ruminate on) the worst ~ Stigma continued long after the outbreak had been contained for those perceived to be at high risk, who had been sick or exposed ~ Avoiding them, withdrawing social invitations, treating them with fear and suspicion, and making critical comments ~ Stigma could lead to disenfranchisement of minority groups as families under quarantine often belonged to different ethnic groups, tribes, or religions ~ General education about the disease and the rationale for quarantine and public health information provided to the general public can be beneficial to reduce stigma ~ Detailed information targeted at schools and workplaces might also be useful. ~ Media reporting contributes to stigma and trauma due to their dramatic headlines and fear 36 ~ Public health officials must provide rapid, clear messages delivered effectively for the entire affected population to promote accurate understanding of the situation. ~ Mandatory Public Broadcasts ~ Social Media ~ Single point of contact website (i.e. CDC) Longer Term Effects ~ 3 years after the SARS outbreak, alcohol abuse or dependency symptoms were positively associated with having been quarantined or worked with high risk populations.32 ~ After quarantine, many participants continued to engage in avoidance behaviors such as minimizing direct contact with patients and not reporting to work. ~ 54% of people who had been quarantined continued to avoid and were anxious around people who were coughing or sneezing ~ 26% avoided crowded enclosed places ~ 21% avoided all public sp
February 26, 2020
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 – Structure and routine – Stay organized—Everything has a place – Clocks, timers and transitions – Simplify the schedule – Have clear expectations and rules (Visual guides) – Create a sanctuary place – Encourage movement (fidgets, stability balls) – Ensure adequate, quality sleep (Sensory issues) – Ensure regular, healthy nutrition (even with picky eaters)
February 22, 2020
470 – Distress Tolerance Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Podcast Host: Counselor Toolbox & Happiness isn’t Brain Surgery with Doc Snipes Objectives ~ Define goals of distress tolerance ~ Discuss why some clients do not choose distress tolerance ~ Explore a variety of Distress Tolerance and Reality Acceptance Skills including ~ STOP ~ Pros and Cons ~ TIP ~ ACCEPTS ~ Self Soothing ~ IMPROVE the Moment ~ Radical Acceptance ~ Turning the Mind Objectives Goals of Distress Tolerance ~ The goal of distress tolerance is to accept, find meaning for and tolerate distress ~ Pain and distress are part of life. Refusing to accept this leads to suffering ~ Any attempts at change will produce distress, therefore distress tolerance skills are necessary Change causes crisis and crisis causes change Distress Tolerance ~ Distress tolerance is a natural progression from mindfulness ~ Accepting, nonjudgmentally, oneself and the situation ~ Not trying to change the situation, your feelings, thoughts or urges ~ Distress tolerance means surviving crises, accepting life as it is in the moment. Tolerance and acceptance of reality do not equate with approval Proving How Bad It Is ~ Sometimes people so want others to understand how bad it is they focus on that instead of surviving the situation ~ Short Term Gains (Look what you made me do) ~ Controlling another’s behavior ~ Going to the hospital and getting attention/break ~ Long Term Benefits ~ ?? ~ Have clients remember a time they acted out to try to get someone to see how bad it was. What were the results? Distress Intolerance Thoughts ~ I can’t stand this ~ It’s unbearable ~ I hate this feeling ~ I must stop this feeling ~ I must get rid of it ~ Take it away ~ I can’t cope with this feeling ~ I will lose control ~ I’ll go crazy ~ This feeling will keep going on forever ~ It is wrong to feel this way ~ It’s stupid and unacceptable ~ It’s weak ~ It’s bad ~ It’s dangerous Avoidance Behaviors Urge Surfing ~ Urges are generally intense for 20-30 minutes ~ Every time you have an urge think, “I have a choice!” ~ Surf the urge by opening yourself up to the urge. This doesn’t mean that you consume yourself in it (which feels horrible) or fight it and push it away. What you do is experience the feeling of the urge with acceptance, non-judgement, and be sensitively aware that it is there. STOP Skills ~ Stop ~ Take a step back ~ Observe ~ Proceed Mindfully Pros and Cons ~ What are the benefits to acting on impulsive urges? ~ What are the drawbacks to acting on impulsive urges? ~ What are the benefits to __[insert the skill] __ ~ What are the drawbacks to __[insert the skill] __ TIP Skills ~ Temperature ~ Intense Exercise ~ Paced Breathing ~ Paired Muscle Relaxation ~ The act of muscle relaxation is paired with a verbal cue ~ What reactions do you have that are paired with verbal cues? Distract with Wise Mind ACCEPTS ~ Activities (pleasant) ~ Contributing ~ Comparisons ~ Emotions (opposite) ~ Pushing Away ~ Think about something totally different ~ 4 3 2 1 ~ What did you used to do on long car trips? Self-Soothing ~ Body Scan Meditation ~ Self-Soothing Using the 5 Senses ~ Sight ~ Smell ~ Hearing ~ Touch ~ Taste IMPROVE the Moment ~ Imagery ~ Safe place ~ Successfully dealing with this ~ A force field ~ A coach/fairy godmother/angel ~ Feelings and thoughts are clouds in the sky ~ An unstoppable train ~ Meaning ~ Changing how you think about yourself and your situation ~ Make lemonade. Find the silver lining. ~ Prayer ~ Relaxation IMPROVE the Moment ~ One thing in the Moment ~ Focus on one thing you are doing right now ~ Sitting in a chair ~ Driving ~ Weeding ~ Vacation ~ Mental vacation ~ Take a short break ~ Leave stress at work ~ Encouragement ~ Be your best friend ~ Create a mental coach Reality Acceptance ~ Radical Acceptance ~ Complete and total acceptance of the facts of reality ~ Turning the mind ~ Mentally looking
February 19, 2020
Social Work & Case Management for Depression Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs CEUs available for purchase at https://www.allceus.com/member/cart/index/product/id/1266/c/ Objectives • Define depression (symptoms) • Learn how to ask strengths-based assessment questions • Identify a range of potential causes for depression • Explore activities and interventions that can help people address some of the underlying causes Depression • Depression represents a cluster of symptoms • Diagnosis with depression only requires people to have a few of the symptoms • Depression indicates the loss of something important • A variety of different things can cause depression • Emotions: Anger, anxiety, grief, guilt, shame • Thoughts: Cognitive distortions • Relationships: Poor self-esteem, unhealthy/unsupportive relationships, need for extremal validation • Physical: Neurochemical imbalances, poor nutrition, exhaustion, insufficient sleep, medication side effects • Environmental: High stress environments that prevent relaxation/rest and increase hopelessness/helplessness Depression Assessment • What does depression mean to you? (apathy, sadness, mood swings) • Which symptoms are most bothersome for you and why? • For each symptom • What makes depression worse? • What makes depression better? • How was life more pleasurable prior to getting depressed? • What is different during times when you are NOT depressed? • How do you expect life to be different when your depression is gone? Neurotransmitters • Ability to feel pleasure/Apathy/Emotional Flatness • Memory issues • Difficulty concentrating • Sleep issues • Lack of motivation • Fatigue • Pain • Irritability/Agitation • Fight or flight stress symptoms HPA-Axis • HPA-Axis hyperactivity causes the release of inflammatory cytokines which cause symptoms of behavioral depression (lethargy, reduced locomotor activity and food intake, increased sleep) in the effort to conserve energy for physiological repair Reduce HPA-Axis Activation • Get quality sleep • Sleep deprivation increases risk for major depression, which in turn increases risk for decreased sleep • Sleep disturbances contribute inflammatory disorders and major depressive disorder • Increased HPA-Axis activation after sleep deprivation • Create a routine • Eliminate blue-light • Reduce stimulants • Address pain and apnea (article 2) • Improve the sleep environment (noise, allergens, light, temperature) • Other factors: Shift work, time zones, safety/PTSD • Antidepressants: Many antidepressants with activating effects may disrupt sleep, while those with sedative properties improve sleep, but may cause problems in long-term due to oversedation Reduce HPA-Axis Activation • Relaxation • Biofeedback • Progressive muscular relaxation • Meditation and yoga • Recreation • Forest / Eco Therapy • Address medication side effects • Psychotropics • Beta Blockers • Statins • Anticholinergic (bladder, Parkinson’s, COPD, Asthma, motion sickness) • Opioids • Corticosteroids • Certain antibiotics (levofloxacin and ciprofloxacin) • Birth control / HRT Reduce HPA-Axis Activation • Improve nutrition • Access to nutrition • Transportation • Affordability • Cooking • Awareness of nutritional principles • Macros • Hydration • Dehydration had negative effects on vigor, affect, short-term memory, and attention • Aspartame Neurotransmitters • Addictive behaviors • Alter dopamine, serotonin, norepinephrine levels • Impacts of different types of neurotransmitters • Stimulants • Depressants • Alcohol • Gaming/Gambling • Sex/Pornography Hormones • Thyroid • Impact mood, libido and energy levels • Estrogen • Impacts neurotransmitters that affect sleep, mood, memory, libido, pain perception, learning and attention span. • Increased estrogen may alter the availability of serotonin • Low testosterone may alter the availability of serotonin • Enhances libido, improves stamina and sleep, assists brain function, and is associated with asserti
February 15, 2020
468 – Individual and Group Exercises for Anger and Anxiety https://www.allceus.com/member/cart/index/product/id/969/c/ Journey to Recovery Individual and Group Exercises for Anger and Anxiety Objectives What is the Purpose • Anger (Fight) and anxiety (Flee) protect you from perceived threats by alerting you there MIGHT be a problem • Have you ever gotten angry or stressed out about something just to find out that it wasn’t a big deal? • Problems • Based on prior learning experiences (but life changes) • Unsafe situations • Need for someone’s approval • May be overgeneralized (all or nothing) • Dogs barking • Semis What is the Purpose • Problems • May be the result of transference • First love • Worst boss • May simply be inaccurate (Fire alarm) • Car backfiring • Sean’s “paint” Effects • How does anger or anxiety affect you: • Physically: Sleep, pain, GI, immunity • Emotionally: Regret, guilt, feeling helpless • Socially: Fear vs. respect, negative impact on relationships • Occupationally: How you work with others, customer service • Spiritually: Your sense of contectedness to and impact within the world, karma • Environmentally: Break stuff, holes in walls, throw out things impulsively Anger • Since anger protects people and it often results from application of prior knowledge or experiences, then it can be supposed that people with a lot of anger may have been exposed to significant threats (traumas) in their past • When you have a hammer, every problem looks like a nail Anger and Anxiety Triggers • The Alphabet List • A= Attitude • B= Bullying • C= Creating drama • D= Disagreeing • E= Expecting too much • F= Failing to keep a promise • G= … Anger and Anxiety Interventions • Recognize anger and anxiety as a protective response based on that persons experiences and worldview. • In what way did the current situation make the person feel unsafe emotionally, interpersonally, physically or remind them of a time he or she was unsafe? • What emotions were triggered by this event and what vulnerabilities or skill deficits contributed to the event? • In what way did the situation trigger a sense or memory of loss? • How does the persons experience of the event alter his/her future? Anger and Anxiety Interventions • The Alphabet List • A= Acceptance • B= Breathing • C= Compassion, Challenge • D= Dispute, Distract, Distress Tolerance • E= Express myself • F= Friend’s support • G= Gratitude • H= Higher Power/Hope • I=… Anger and Anxiety Interventions • Identify 2 ways you could deal with the following symptoms, why they might occur and why it is important to recovery • Beach ball • Jenga (card draw) • Hat draw (same cards from Jenga) • Symptoms • Always feeling worried or stressed out • Insomnia • Fatigue • Shortness of breath • Muscle tension • Headaches • Irritability Anger and Anxiety Interventions • Anxiety/Anger graphic novel or skit • Anxiety/Anger says… • Evidence for and against • Anger/anxiety thermometer • Vulnerability predictor/prevention • Handling criticism (role play) • Worry stone or beads • Worry box • Positive writing • Anger “Onion” Anger and Anxiety Interventions • Hidden Heart • Fill a ziplock baggie with slips that tell about all of your hurts and anger (This is your heart) • Put the little bag inside of a paper lunch bag. Write on the outside all the ways they present themselves to the world to hide what is hidden on the inside. • For kids: Anger Tornado • RELAX Jar: Using beads with the letters R-E-L-A-X and other small beads and sequins, fill a small jar with rice. Leave a little air at the top so as it is rotated, the rice will slide around inside revealing the letter beads and sequins.  When the person gets angry, she/he can turn the jar until finding all the letters that spell relax. (more resources here https://www.creativecounseling101.com/anger-management.html) Anger and Anxiety Interventions • Hidden Heart • Fill a ziplock baggie with slips that tell about all of your hurts and anger (This is your
February 12, 2020
467 – Case Management for Chronic Pain Dr. Dawn-Elise Snipes PhD, LPC, LMHC Executive Director, AllCEUs Objectives • Define the problem • Examine the similarities between CNCP, mental health issues and addiction • Identify the impact of CNCP on patients • Explore biopsychosocial resource needs for secondary and tertiary prevention. Introduction • Historically, pain without an apparent anatomical or neurophysiological origin was labeled as psychopathological. This approach is damaging to the patient and provider alike. It pollutes the therapeutic relationship by introducing an element of mutual distrust. It is demoralizing to the patient who feels at fault, disbelieved, and alone. • Moreover, many medically unexplained pains are now understood to involve an interplay between peripheral and central neurophysiological mechanisms that have gone awry. • Adjustment disorder remains the most appropriate, accurate, and acceptable diagnosis for people who are overly concerned about their pain. Facts • CNCP patients with addictive disorders 32% • People >20 with pain lasting >3 months 56% • People with disabling pain in the previous year 36% • Children with chronic pain 11%-38% • Pain may have a long course with multiple episodes • Chronic pain can be highly stressful for patients and families • Care for people with chronic pain is increasingly done in outpatient • Untreated mood and addictive disorders in individuals with chronic pain increases morbidity and mortality rates and reduces the capacity for self-management Facts • Chronic pain due to one condition can cause increases in systemic inflammation and widespread pain • Across CP conditions there is generally a shift away from brain regions engaged in processing the sensory component of pain toward regions that encode emotional and motivational subjective states • Experiences of physical and social pain (ie, social rejection, exclusion, bullying, negative social evaluation, loss of a close relationship), share neurochemical and neural substrates • Young people with comorbid depression and CP are at an increased risk of suicide Pain and Mental Health • CNCP and addiction or mood disorders frequently co-occur and fluctuate in intensity over time and under different circumstances • They share neurophysiological patterns including • Increased inflammatory cytokines • Altered levels of dopamine, serotonin and norepinephrine • Hyperactive HPA-Axis Effective pain management in patients with comorbid issues must address all conditions simultaneously. Similarities– Pain, MH and SUD • Treatment of one condition can support or conflict with treatment for the other. • A medication appropriately prescribed for a particular chronic pain condition may be inappropriate, given the patient’s SUD or mental health history. • Are mediated by genetics and environment. Biopsychosocial Impact of Pain • Sleep • Pain • Medication side effects • Fatigue • Circadian rhythm disruption • Physical changes (weight changes, ports, pumps, hair loss) • Loss of mobility • Depression • Anxiety • Anger/Irritability • Grief/Adjustment • Jealousy or resentment • Withdrawal • Self Esteem changes • Loss of social support or paternalism • 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 Common Chronic Pain Conditions • Low Back Pain • Neck Pain • Upper Back Pain • Arthritis • Fibromyalgia • TMJ • Chron’s Disease • Migraines Assessing for Chronic Pain • Assessment instruments include the McGill Pain Questionnaire For a list of additional assessment tools, see TIP 54 • Assessment
February 8, 2020
466 – Developing Self-Esteem and Self-Efficacy Developing Self-Esteem and Self-Efficacy Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Counseling Continuing Education Podcast Host: Counselor Toolbox, Case Management Toolbox Objectives • Understand what self esteem and self-efficacy are, why they are important and how to develop them The Nature of Self-Esteem • How people feel about theirself in contrast to who people think people “should” be • The more rejecting people are of theirself, the more • Distress people experience • people seek external validation or withdraw • In order to develop healthy relationships people need to • Feel good about theirself • Get in touch with theirself and their true values • Believe people are a lovable and worthwhile person • Choose actions in harmony with their true self The Gift of Mindfulness • Teaches people to live in the moment • Not stuck in guilt or resentment of the past • Not paralyzed by fear of the future • Putting one foot in front of the other • Cornerstone of mindfulness is acceptance • Nonjudgmental • Letting be • Patient • Mindfulness teaches that when people trust theirself and act with awareness and purpose people become more self reliant Note: The book will give people access to online, recorded versions of several meditations Impact of Mindlessness • Ignoring or invalidating how people feel • Failing to integrate feelings, thoughts, sensations and urges • Running on autopilot and not making time for the things that are important (getting us closer to our ideal selves) • Blindly adopting mainstream messages of who/what we should be • Not in harmony with who we really want to be • Not achievable or realistic Developing a Self-Concept and Efficacy • You are more than your accomplishments or your bank account. • What do you want to stand for (values)? • Download a values list and circle the ones that are important to you. • Identify how you CURRENTLY demonstrate those. • Identify other ways you could demonstrate those. • What things do you do that go against your values? (i.e. impatience) • What could you start doing today to address one of those? Developing a Self-Concept • What things are you good at, and what are your accomplishments? • What traits/values do those accomplishments and strengths represent? Success, courage, determination, creativity, compassion • How would your friends describe you? • Loyal, compassionate, caring, honest… • How do you demonstrate those? • Self Esteem Acronym (THINK) Breathing and the Body • The constant noise often keeps people from addressing the underlying issues of emotional turmoil • Life becomes focused on treading water • Forward goals are exchanged for just surviving • This reduces self-efficacy • Mindfulness and self-awareness help people quiet their thoughts • By making contact with the present moment people can: • Find their strength • Learn to grow • Choose how people wish to respond Activities • A Deep Full Breath • Abdominal breathing signals the brain to slow down and relax. “Rest and digest” • Simply paying attention to breath often causes it to slow down • Feel the loving touch (their Breath) • Life begins and ends with breath • Breathing helps relax the body and move Qi • Add visual and auditory breathing reminders Activities cont… • In and Out • Do a body scan and yay attention to what their body is trying to tell them • Inhale and take in positive affirmations • Make a list of 1-3 affirmations • Exhale and let go of stress and negative energy • Envision stress leaving like a wave/cloud/balloon • Note: This can also be done with bubbles • Practice noticing points of tension/tightness/heaviness and feel them relax or loosen as they exhale • Develop confi
February 5, 2020
465 – Grief Purchase Link: https://www.allceus.com/member/cart/index/product/id/582/c/ Grief Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Objectives • Define grief • Conceptualize grief in terms of any loss • Identify how failure to deal with grief can impact a person • Explore the stages of grief What is Grief • Grief is a label assigned to all of the emotions associated with dealing with any kind of loss • Physical (Things, abilities, freedoms) • Self-concept (Roles, values, labels) • Worldview (Innocence, safety) • Dreams (How things should be) • Social (Loss of relationships…) Stages of Grief • Denial: Numbness, dream, alternate explanations) • Anger: The unknown, loss of control, death, isolation, failure—(shouldas and couldas) • Bargaining: If I … then I will wake up and realize this was only a really bad dream • Depression: Helpless, hopeless • Acceptance: Radical acceptance that the loss occurred and determining how to proceed from there BioPsychoSocial Impact of Grief • Biological • Sleep disturbances • Changes in weight • Increased blood pressure • Increased cortisol and other endocrine changes • Muscle weakness • Social • Withdrawal/Isolation • Enmeshment • Psychological • Depression • Anxiety • Relief • Changes in worldview • Guilt • Anger • Difficulty concentrating • Difficulty making decisions • Avoidance of triggers Exacerbating & Mitigating factors • How people react in a crisis depends • How close the situation was to them (physical and emotional proximity) • How many other stressors them experienced in the last year • Mental health issues/Effective coping skills • Social supports • Understanding of the loss • How much control/responsibility they feel like they had in the situation • Type of loss and predictability • Age of the bereaved Impact of Unresolved Grief • Most people get stuck in either anger (including guilt)or depression • Anger (shoulda, couldas and if onlys) • At self • At others • At higher power • Depression (Hopelessness, Helplessness—I don’t now how to go on) Denial • Denial is the mind’s way of protecting people from what lies ahead. • Denial can start before the actual loss as in the case of terminal illness (anticipatory grief) • Therapist Activities • Assess level of acceptance and denial of each person in the support system • Discuss hope and acceptance • Action strategies • Shore up resources • Gather accurate information • Facing the loss: Narrative therapy Anger • Anger is the power play • Push people away to avoid getting hurt again • Blame others as an outlet for helplessness—somebody somewhere could have prevented this • Blame self to try to regain some control/prevent it from happening again, make themselves suffer • Question belief system and world schema • Guilt is a form of anger Anger • Action steps • Identifying primary and secondary losses • Explore what the losses mean to the person (Ex. Job, Parent, Victimization) and how they feel about it • Angry (other losses) • Scared (which fears and why?) • Depressed (I feel helpless to… ; I feel hopeless to…) • Ventilation and Validation Anger • Action steps • Examine the stated beliefs for • All or nothing thinking • Emotional reasoning • Fallacy of fairness • Emotional Reasoning (I feel angry therefore someone must be to blame) • Begin exploring solutions to fears and issues (What is within their control) Bargaining • If I do x, y and z, maybe I can wake up and it will have been a nightmare • Contributes to depression because the person wakes up everyday hoping the reality is different • Hope is squelched every morning • Develop hope for the new reality • I can grief
February 2, 2020
460 – Complicated Grief and Attachment Purchase Link: https://www.allceus.com/member/cart/index/product/id/995/c/ Complicated Grief and Attachment Dr. Dawn-Elise Snipes PhD, LPC-MHSP Podcast Host: Counselor Toolbox and Happiness Isn't Brain Surgery Objectives ~ Define Complicated Grief ~ Identify how loss of or lack of an attachment relationship may represent a loss that needs to be grieved. ~ Explore the overlap between complicated grief and trauma ~ Identify risk factors for CG ~ Explore tasks for successful grief resolution Definitions: ~ Loss: Change that includes being without someone or something in this case the primary attachment relationship ~ Secondary loss: Other losses as a result of a primary loss. Example, loss of security when rejected by primary caregiver ~ Grief: Reaction or response to loss; includes physical, social, emotional, cognitive and spiritual dimensions. ~ Trauma: Any situation that causes the individual to experience extreme distress Attachment ~ Attachment ~ Attachment is the quality of the relationship with the caregiver characterized by trust, safety and security. ~ The quality of the infant-parent attachment is a powerful predictor of a child's later social and emotional outcome ~ Determined by the caregiver's response to the infant and toddler when the child's attachment system is ‘activated' Internal Working Model ~ Children's attachment with their primary caregiver leads to the development of an internal working model which guides future interactions with others. ~ 3 main features of the internal working model ~ a model of others as being trustworthy (what is the loss here?) ~ a model of the self as valuable (what is the loss here?) ~ a model of the self as effective when interacting with others. (what is the loss here?) ~ Secure attachments also help children ~ Feel loved and accepted ~ Learn to manage their emotions ~ Address dichotomous thinking and cognitive distortions Bowlby on Attachment and Grief ~ Attachment Relationships Help Regulate Psychological And Biological Functions Including: ~ Mastery and performance success ~ Learning and performing ~ Relationships with others (and future attachment) ~ Cognitive functioning ~ Coping and problem solving skills ~ Self-esteem ~ Emotion regulation ~ Sleep quality ~ Pain intensity (physical and emotional) Bowlby ~ Attachment and safety stimulate a desire to learn, grow and explore ~ Caregivers provide support and reassurance (Safe haven) ~ Encouragement and pleasure (secure base) Feeney J Pers Soc Psych 631 -648 2004 Bowlby ~ Loss of an attachment relationship ~ Disrupts attachment, caregiving and exploratory systems ~ Attachment: Activates separation response and impacts restorative emotional, social and biological processes ~ Exploratory system: Inhibits exploration with a loss of a sense of confidence and agency. ~ Caregiving: Produces a sense of failure and can include self blame and survivor guilt Trauma ~ Trauma is any event that is distressing or disturbing ~ How do we know what is distressing or disturbing ~ Erodes a sense of safety (Triggers fight or flight) ~ Emotional (including dysregulation) ~ Mental (interpretations and schemas) ~ Physical (object permanence, darkness, pain, prior experiences) ~ Adverse Childhood Experiences that may disrupt primary attachment ~ Immediate family member with a mental health or addiction issue ~ Immediate family member who is incarcerated ~ Divorce ~ Abuse (child or DV) ~ Neglect How Can Disrupted Attachment ïƒ 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 misdee
February 1, 2020
464 – Contextual Cognitive Behavioral Therapy Purchase Link: https://www.allceus.com/member/cart/index/product/id/1001/c/ Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast Objectives • Define and review the concepts of contextual cognitive behavioral therapy • Explore the impact of context on people’s phenomenological reality • Explore how addiction and mental health issues can be influenced by context • Explore how acceptance, awareness, mindfulness and psychological flexibility can be used transdiagnostically. Why Contextual • Addiction and mental health issues are often intergenerational • Addiction and Mental Health issues are strongly correlated with: • Each other • Adverse childhood experiences (history of and children with) • Impaired occupational and social functioning • Health problems Contextual Approaches • Encourage mindfulness in the present moment • Accept each person’s “truth” is constructed from their schema and the resulting interpretation of the current moment • The goal is to consider the context and function of the past and present issue and empower the person to make a conscious choice toward their valued goals • Remember that the prefix RE means to do again • REpeat • REdo • REgress • RElapse • REaction Childhood Context and Development • The family context can be a preventative or risk factor for the development of issues • Children develop schema about themselves, others and the world through these early interactions • In later life people continue to develop schema influenced by their past learning. Caregiver Requirements for Secure Attachment and Healthy Development • Consistent Age-Appropriate Responsiveness • Trust • Autonomy • Industry • Identity • Empathy • Compassion • Effective Communication Skills • Unconditional Love Think About It • What is it like for a child growing up in a house in which one or both parents has: • An addiction • A mental health issue Common Addicted Characteristics • Difficulty dealing with life on life’s terms • Difficulty dealing with distress (poor coping) • Impulsivity / lack of patience and distress tolerance • Neglectfulness • Hostility • Defensiveness • Blaming • Manipulation • Withdrawal • From others/disconnected • No pleasure in other activities • Justification/minimization/denial • Low self-esteem • Guilt and shame Common Characteristics in People with Mental Health Issues • Difficulty dealing with life on life’s terms • Difficulty dealing with distress (poor coping) • Impulsivity / lack of patience and distress tolerance • Neglectfulness • Hostility • Irritability • Withdrawal • From others/disconnected • Apathy • Low self-esteem • Guilt and shame • Fatigue • Sense of hopelessness or helplessness The End Product • People’s REactions to things are based on prior learning + present moment. • Bridges • Stress • Depression • Self-esteem Core Concepts in Contextual CBT Mindfulness • Improves people’s ability to be present in the present • Shift from automatically reacting to thoughts and feelings based on schema to being aware of ALL experiences in the present to provide more flexibility Encouraging Acceptance of Internal Experiences • Accepting thoughts, feelings, sensations without having to act on them • Radical Acceptance • Unhooking • Dialectics • I can be a good person AND be divorced • I can be happy AND grieving • I can stay sober AND be stressed Acceptance of Internal Experiences • Accepting thoughts, feelings, sensations without having to act on them • Distress Tolerance • ACCEPTS • Activities • Contributing • Comparisons • Emotions (opposite)
January 29, 2020
462 – Understanding Anxiety Through a Child’s Eyes Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Counselor Education Host: Counselor Toolbox Podcast Objectives – Identify symptoms of anxiety in children – Review common misdiagnoses – Explain how children’s developmental stage impacts their fears – Propose interventions to help children deal with anxiety Symptoms of Anxiety in Children – Emotional Signs of Anxiety – Is extremely sensitive – Irritable – Is afraid of making even minor mistakes including test anxiety – Panic attacks – Has phobias (about bees, dogs, etc.) and exaggerated fears (about things like natural disasters, etc.) – Worries about things that are far in the future – Has frequent nightmares – Gets distracted from playing by his worries – Has compulsive, repetitive behaviors Symptoms of Anxiety in Children – Behavioral Signs of Anxiety – Starts having meltdowns or tantrums. – Asks “what if-” constantly. – Avoids participating in group activities. – Remains silent or preoccupied during group work – Refuses to go to school. – Avoids social situations with peers after school or on weekends – Becomes emotional or angry when separated from parents – Constantly seeks approval – Low self-esteem and efficacy – Overly concerned about negative evaluations Symptoms of Anxiety in Children – Physical Signs of Anxiety – Frequently complains of head or stomachaches – Refuses to eat snacks or lunch at school – Can become restless, fidgety, hyperactive – Difficulty concentrating – Starts to shake or sweat in intimidating situations. – Dizziness – Frequent urge to urinate – Constantly tenses muscles – Exaggerated startle response – Has trouble falling or staying asleep – Falls asleep in school – Repetitive activities (tapping, leg shaking…) – Nail biting / skin picking – Rigid routines Not Little Adults – How do children think differently – 0-2: Object permanence; personal agency (crying, “Uh Oh,” Ask for drinks) – When you are overtired, startled, too hot/cold, or have low blood sugar, the HPA-Axis is activated –> Threat Response (Anxiety) – 2-7: Egocentric, personalized, concrete/dichotomous, mystical – Daddy yelled at me. Daddy left. Daddy hates me. It is my fault. – I told Mommy I hated her. She got sick. It is my fault. – I didn’t say my prayers last night. We got into a car accident because God is mad at me. – The neighbor’s dog always charges the fence and wants to bite me. This makes me scared. Dogs are dangerous. Not Little Adults – How do children think differently – 7-11: Inductive (Start making global attributions from specifics) – I didn’t make the team. I got a C on my spelling test. I must be a failure – 11+: More advanced reasoning but little life experience and often have not questioned prior faulty schema What is Anxiety – Anxiety is fear which is the flee part of the fight or flight (stress) response – What do we/children fear – Death (Biological Needs/Safety(self & others)) – Rejection/Isolation/Abandonment (Biological Needs, Safety, Love and Belonging) – The Unknown (Biological Needs, Safety, Love) – Loss of Control (Parental, older children) What is Causing the Anxiety – Cognitive – Unhelpful thoughts – Lack of knowledge – Physical – Lack of sleep – Poor nutrition or hunger – Hormones (sex, thyroid) – Emotional – Highly sensitive child – Environmental/social – Bullies – Teacher pressure – Parental enmeshment or disengagement – Chaotic home environment (mental health, addiction and/or abuse or neglect) – Social learning Differential
January 25, 2020
461 – Internal Family Systems Theory Dr. Dawn-Elise Snipes Objectives ~ Define Internal Family Systems Theory ~ Identify when it is used ~ Explore guiding principles ~ For more information and training programs in IFS, go to https://www.selfleadership.org/ Overview ~ IFS was developed in the 1990s by family therapist Richard Schwartz, Ph.D., ~ It is based on the concept that an undamaged core Self is the essence of who you are, and identifies three different types of sub-personalities or “families” that reside within each person, in addition to the Self. ~ Wounded and suppressed parts called exiles (lost child) ~ Managers, that keep the exiled parts suppressed (enabler) ~ Firefighters, that distract the Self from the pain of exiled parts. (hero/mascot/scapegoat) ~ The Internal Family Systems Center for Self-Leadership conducts training programs Basic Assumptions ~ The mind is subdivided into an indeterminate number of subpersonalities or parts. ~ Everyone has a Self which can lead the individual's internal system. ~ The non-extreme intention of each part (exile, manager and firefighter) is something positive for the individual. ~ There are no “bad” parts ~ The goal of therapy is not to eliminate parts but instead to help them find their non-extreme roles. ~ As we develop, our parts develop and form a complex system of interactions among themselves ~ When the system is reorganized, parts can change rapidly. ~ Changes in the internal system will affect changes in the external system and vice versa. Parts ~ Subpersonalities are aspects of our personality that interact internally in sequences and styles that are similar to the ways in which people interact. (exile and the manager or the firefighter and the Self) ~ Parts may be experienced in any number of ways — thoughts, feelings, sensations, images, and more. ~ All parts want something positive for the individual and will use a variety of strategies to gain influence within the internal system. ~ Parts that become extreme are carrying “burdens” — energies that are not helpful, such as extreme beliefs, emotions, or fantasies. ~ Parts can be helped to “unburden” or recognize their role and return to their natural balance. ~ Parts that have lost trust in the leadership of the Self will “blend” with or take over the Self. Exiles ~ Young parts that have experienced trauma and become isolated or suppressed in an effort to protect the individual from feeling the pain, terror, fear, and so on, of these parts ~ Exiles are often young parts holding extreme feelings and/or beliefs that become isolated from the rest of the system (such as “I’m worthless,” “I must be successful to be lovable,” “I am a failure”) ~ Exiles become increasingly extreme and desperate as they look for opportunities to emerge and tell their stories ~ Want to be cared for and loved and constantly seek someone to rescue and redeem them ~ Can leave the individual feeling fragile and vulnerable Managers ~ Managers are proactive and try to avoid interactions or situations that might activate an exile’s attempts to break out or leak feelings, sensations, or memories into consciousness. ~ Different managers adopt different strategies controlling, perfectionism, co-dependency ~ The primary function of all mangers is to keep the exiles exiled…. ~ Common managerial behaviors: controlling, perfectionism, high criticism, narcissism, people pleasing, avoiding risks, being pessimistic, constantly striving to achieve ~ Ask…What would trigger the exiles and how can that be prevented? ~ Common managerial symptoms: Emotional detachment, panic attacks, somatic complaints, depressive episodes, hypervigilance Firefighters ~ Have the same goals as managers (to keep exiles away) but different strategies ~ Managers want you to look good and be approved of, FFs only care about distracting from the pain so they are often in conflict. (Shoulds) ~ Are reactive and automaticall
January 19, 2020
30 Art Therapy Activities for Individual or Group Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast Objectives • Identify 30 art therapy activities and the goals and benefits for each 1. Collage • Medium (2 or 3-D) • Picture • Bulletin Board • Book or Notebook Cover • Scrapbook • Photo Blanket • Quilt • Website (Canva, MineCraft) • Materials • Odds and ends (buttons, keys, material, yarn) • Nature • Pictures from magazines, online, wrapping paper, greeting cards, food bags/boxes • Paint • Stamps • Macaroni/Beans • Benefits • Fine motor coordination • IRL: Scissor use, turning pages, gluing • Virtual: Typing, mousing, photoediting • Visual expression • Problem solving/creativity “How can I depict…” 1. Collage • Uses • Before and After • Layered with Goals • Most Important • Happiness (or other emotions) • My Accomplishments • Tribute/Memory • Nature (with leaves, feathers, sticks…) • Positive Affirmations • Superhero (anxiety) • Friendship • My Happy Place 2. Sculpture • Medium • Clay • Playdough or salt dough • Paper Mache • Pinata / Piggy Bank • Wadded Newspaper • Scarecrow • Multimedia (jars, foam balls, felt, popsicle sticks, pipecleaners, paper towel tubes, plastic shopping bags, cardboard from boxes) 2. Sculpture • Benefits • Fine motor skills • Creativity and problem solving • Visual self expression • Uses • Superhero • Family • Memory • Self-Portrait • Emotion 3. Puppets • Material • Socks • Felt finger puppets • Pipe cleaner finger puppets • Popsicle stick puppets • Brown paper bag • Toilet paper roll • Benefits • Fine motor skills • Verbal communication • Creativity • Uses • Giving a voice (What I wish I could say) • Addressing the anger/monster • Observation (What does the alien see) • Angel vs. Devil • Teach interpersonal skills (Sally is sad, what should Sammy do???) • Team work 4. Gratitude Tree • Medium • On the wall • On paper • With sticks and tags • Materials • Paper cutouts • Paint (finger, brush, pens) • Sticks and gift tags or cardboard “leaves” • Uses • Remember things that are going right (depression, frustration) • Help remembering to focus on the good (negativity) • Gratitude in grief 5. Wind chime • Materials • Keys • Buttons • Beads • Silverware • Bamboo pipes • Shells • Chandelier crystals • Bells • Terracotta pots • Feathers (and bells) • Cookie cutters • Decorated soda or tin cans • Soda bottle tops (metal) • Benefits • Fine motor skills • Creative expression • Uses • Grief • Favorite things • Happy memories • Mindfulness 6. “Stained Glass” • Materials • Shrinkable plastic sheets or ornaments (Shrinky Dinks) • Benefits • Find motor skills • Creative expression • Uses • Mindfulness • Memory window or attach to LED Christmas light strand to make a garland • Things that make me feel… • Things that remind me of (grief) • Things that inspire me (goals) 7. Flag • Medium • Solid color nylon flag (~$8) • Cut a king sheet and sew or glue edges • Large piece of cardboard (large shipping box or appliance box). Fortify edges with colored duct tape • Hint: Take a picture of the flag and print it out or have it added to water bottles for each person to have a miniature version • Benefits • Fine motor skills • Encourage communication and discussion • Visual expression 7. Flag • Uses • Identify common and complimentary attributes • Enhance unity/group cohesion • Self-Awareness: What do I/we stand for • Communication about similarit
January 19, 2020
30 Art Therapy Activities for Individual or Group Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast Objectives • Identify 30 art therapy activities and the goals and benefits for each 1. Collage • Medium (2 or 3-D) • Picture • Bulletin Board • Book or Notebook Cover • Scrapbook • Photo Blanket • Quilt • Website (Canva, MineCraft) • Materials • Odds and ends (buttons, keys, material, yarn) • Nature • Pictures from magazines, online, wrapping paper, greeting cards, food bags/boxes • Paint • Stamps • Macaroni/Beans • Benefits • Fine motor coordination • IRL: Scissor use, turning pages, gluing • Virtual: Typing, mousing, photoediting • Visual expression • Problem solving/creativity “How can I depict…” 1. Collage • Uses • Before and After • Layered with Goals • Most Important • Happiness (or other emotions) • My Accomplishments • Tribute/Memory • Nature (with leaves, feathers, sticks…) • Positive Affirmations • Superhero (anxiety) • Friendship • My Happy Place 2. Sculpture • Medium • Clay • Playdough or salt dough • Paper Mache • Pinata / Piggy Bank • Wadded Newspaper • Scarecrow • Multimedia (jars, foam balls, felt, popsicle sticks, pipecleaners, paper towel tubes, plastic shopping bags, cardboard from boxes) 2. Sculpture • Benefits • Fine motor skills • Creativity and problem solving • Visual self expression • Uses • Superhero • Family • Memory • Self-Portrait • Emotion 3. Puppets • Material • Socks • Felt finger puppets • Pipe cleaner finger puppets • Popsicle stick puppets • Brown paper bag • Toilet paper roll • Benefits • Fine motor skills • Verbal communication • Creativity • Uses • Giving a voice (What I wish I could say) • Addressing the anger/monster • Observation (What does the alien see) • Angel vs. Devil • Teach interpersonal skills (Sally is sad, what should Sammy do???) • Team work 4. Gratitude Tree • Medium • On the wall • On paper • With sticks and tags • Materials • Paper cutouts • Paint (finger, brush, pens) • Sticks and gift tags or cardboard “leaves” • Uses • Remember things that are going right (depression, frustration) • Help remembering to focus on the good (negativity) • Gratitude in grief 5. Wind chime • Materials • Keys • Buttons • Beads • Silverware • Bamboo pipes • Shells • Chandelier crystals • Bells • Terracotta pots • Feathers (and bells) • Cookie cutters • Decorated soda or tin cans • Soda bottle tops (metal) • Benefits • Fine motor skills • Creative expression • Uses • Grief • Favorite things • Happy memories • Mindfulness 6. “Stained Glass” • Materials • Shrinkable plastic sheets or ornaments (Shrinky Dinks) • Benefits • Find motor skills • Creative expression • Uses • Mindfulness • Memory window or attach to LED Christmas light strand to make a garland • Things that make me feel… • Things that remind me of (grief) • Things that inspire me (goals) 7. Flag • Medium • Solid color nylon flag (~$8) • Cut a king sheet and sew or glue edges • Large piece of cardboard (large shipping box or appliance box). Fortify edges with colored duct tape • Hint: Take a picture of the flag and print it out or have it added to water bottles for each person to have a miniature version • Benefits • Fine motor skills • Encourage communication and discussion • Visual expression 7. Flag • Uses • Identify common and complimentary attributes • Enhance unity/group cohesion • Self-Awareness: What do I/we stand for • Communication about similarit
January 18, 2020
459 – Biopsychosocial Impact of Depression and Strategies for Prevention and Intervention  Biopsychosocial Impact of Depression and Strategies for Prevention and Intervention Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Podcast Host: Counselor Toolbox, Case Management Toolbox, NCMHCE Exam Review Objectives • Define depression (symptoms) • Explore the biopsychosocial impact • Learn how to ask strengths-based assessment questions • Identify a range of potential causes for depression • Explore activities and interventions that can help people address some of the underlying causes Depression • Depression represents a cluster of symptoms • Diagnosis with depression only requires people to have a few of the symptoms • A variety of different things can cause and be caused by depression • Emotions: Anger, anxiety, grief, guilt, shame • Thoughts: Cognitive distortions • Relationships: Poor self-esteem, unhealthy/unsupportive relationships, need for extremal validation • Physical: Neurochemical imbalances, poor nutrition, exhaustion, insufficient sleep, medication side effects • Environmental: High stress environments that prevent relaxation/rest and increase hopelessness/helplessness Strengths-Based Assessment • What does this mean to you? (apathy, sadness, mood swings) • Which symptoms are most bothersome for you and why? • For each symptom • What makes depression worse? • What makes depression better? • How was life more pleasurable prior to getting depressed? • What is different during times when you are NOT depressed? • How do you expect life to be different when your depression is gone? Neurotransmitter Imbalances • Ability to feel pleasure/Apathy/Emotional Flatness • Memory issues • Difficulty concentrating • Sleep issues • Lack of motivation • Fatigue • Pain • Irritability/Agitation • Fight or flight stress symptoms Neurotransmitters • Get quality sleep • Create a routine • Address pain and apnea • Improve the sleep environment • Other factors: Shift work, time zones, daylight savings time • Relaxation • Biofeedback • Progressive muscular relaxation • Address medication side effects • Psychotropics • Opioids Neurotransmitters • Improve Nutrition • Address addictive behaviors • Address chronic or extreme stress • Refresher • Both of these increase the amount of neurotransmitters flooding the synapses. • To protect the body from overload, the brain shuts down some of the receptors so the body does not overload (tolerance/desensitization) • When the neurotransmitters return to a normal level, the receptors are still shut down, so not enough neurotransmitter gets sent out. • Things that normally caused a reaction, no longer are strong enough to cause a reaction Hormones • Thyroid • Are altered in response to chronic stress • Impacts mood, libido and energy levels • Estrogen • Boosts neurotransmitters that affect sleep, mood, memory, libido, pain perception, learning and attention span. • Increased estrogen may increase the availability of serotonin • Testosterone • Low testosterone may be implicated in reducing the availability of serotonin • Testosterone is manufactured by the adrenal glands, • Enhances libido, improves stamina and sleep, assists brain function, and is associated with assertive behavior and a sense of well-being. Hormones • Cortisol • Cortisol is made by the adrenal glands. • Helps the body adapt to stress by increasing heart rate, respiration, and blood pressure. • Cortisol levels increase early in the morning to prepare to meet the demands of the day, and gradually decrease throughout the day (“circadian rhythm”). • Insufficient cortisol (glucocorticoid resistance) can lead to HR and BP reductions as well as reductions in energ
January 11, 2020
456 – Building Positive Self Talk for Confidence and Self-Esteem Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast 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
January 11, 2020
457 – Biopsychosocial Impact of Guilt and Strategies for Prevention and Intervention Dr. Dawn-Elise Snipes Executive Director AllCEUs.com Podcast Host: Counselor Toolbox, Case Management Toolbox Objectives • Define guilt • Explore the impact of guilt • Identify activities to help people deal with guilt What is it? • Guilt is anger at yourself, and comes from an Old English word that means “delinquency.” Today Merriam-Webster’s Collegiate Dictionary defines it as “feelings of culpability, especially for imagined offenses or from a sense of inadequacy; self-reproach.” • Note: Nowhere does it say that guilt is related to things you actually did wrong What Can Guilt Do? • Make you become over responsible trying to fix everything to atone for perceived sins • Make you over-conscientious • Make you overly sensitive • Immobilize you and interfere with decision making • Co-dependency • Overshadow other feelings • Mislead you (Shoulda, coulda, woulda) • Motivate change • Sometimes guilt is necessary otherwise people would not know how to exercise self-control or have a conscience. Where does it come from • Autonomy vs. Shame • Major Question: “Can I do things myself or am I reliant on the help of others?” • Will, Efficacy • When criticized, overly controlled, or not given the opportunity to assert themselves, people begin to feel inadequate in their ability to survive, and may then become overly dependent upon others Where does it come from • Initiative vs. guilt • Major Question: “Am I good or bad?” • Purpose, Acceptability • When efforts to engage in activities are stifled by significant others, people begin to feel that their self-initiated efforts are a source of embarrassment. • If the person’s questions are treated as a nuisance or embarrassing then the person may feel like a nuisance. • People who are over-directed by others may struggle to develop a sense of initiative and confidence in their own abilities. Sources of Guilt • The following things can cause guilt in the actor or their significant others • Addiction • Abuse • Relationship issues – infidelity and divorce • Parenting – non supportive or absent parenting • Crime – by the perpetrator and the victim • Trauma – survivor guilt • Cultural expectations – family or religious demands on our behavior Sources of Guilt • Toxic guilt • A nagging feeling of pervasive but nonspecific badness, as if your whole life has something wrong with it • Often has roots in early childhood: mistakes that your parents or teachers treated as a big deal, for example, or religious training • Gluttony vs. Abstinence (Moderation) • Sloth vs. Diligence (Balance) • Greed vs. Generosity (Benevolence) • Lust vs. Chastity (Moderation) • Anger vs. Passivity (Assertiveness) • Pride vs. Humility (Authenticity) • Envy vs. Rejection (Respect, contentment) Other Sources of Guilt • Existential Guilt • Guilt you feel for having a negative impact • Guilt you feel for having more than someone else • Guilt you feel for surviving • When toxic guilt gets mixed up with existential guilt, people often suffer from a feeling that they are responsible for everyone else's pain Other Sources of Guilt • Shoulda, Coulda, Woulda Game • I shoulda, coulda, woulda…but didn’t • Go to the gym • Call my friend • Finish my report • I shouldn’t have…but did • Have that second piece of cake • Lie • Call in sick • Go out drinking all night Questions • How does guilt impact your attitude, optimism and emotions? • How does guilt impact your self-esteem? • How does guilt impact your health? • How does guilt impact your energy? • How does guilt impact all other areas of your life? • How does guilt impact your relationships? Psychological Flexibility Matrix • Behavior
January 9, 2020
Let Go of Emotional Overeating and Love Your Food This book is for anyone who would like to eat whatever they like, yet stop just at the point of satisfaction without overeating. Written by a Columbia University trained psychotherapist and former emotional overeater, Let Go of Emotional Overeating and Love Your Food offers psychologically sound techniques for recognizing the symptoms of emotional overeating and methods for addressing it in ways that are both effective and enjoyable. You can learn more about the author and book at: https://arleneenglander.com The book is available for purchase via Amazon: https://amzn.to/36D9zfp
January 8, 2020
455 – Anger, Irritation and Resentment: Clearing the AIR Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counseling CEUs and Specialty Certificates Podcast Host: Counselor Toolbox, Case Management Toolbox Objectives • Explore the function of anger • Identify the types of threats that may prompt anger • Identify different types of anger to include • Run of the mill anger • Irritation • Resentment • Envy/Jealousy • Guilt/Regret Function of Anger • Anger is part of the fight or flight reaction which is your brain’s natural response to a perceived threat • Anger pushes away or helps you dominate a threat Types of Threats • Threats can be to your… • Person (physical harm) • Property (Damage or take my stuff) • Self-esteem or self-concept • Hurt your feelings • Make you question your goodness as a person • Make you concerned that other people will think poorly of you • Origin • Things others do or don’t do • Internal critic/old tapes/others from the past • Conscience (guilt and regret) Types of Threats • Themes • Rejection/Isolation • Loss of Control/The Unknown • Death/Loss • Failure • Real vs. Perceived Threats • Real threats actually exist • Perceived threats are based on • Cognitive distortions • Prior experiences • Emotional reasoning • Incomplete information Activity • How do you handle threats to your: • Person/property? • Self-Esteem? • How can you handle threats from: • Others • Your internal critic (Past Others) • Your conscience (self anger, guilt and regret) Anger/Irritation • Anger is a generic term that describes the fight reaction in response to a threat • You feel like you can conquer the threat OR • You do not see any options for escape (think cat in a corner) • Anger happens on a continuum ranging from mild irritation to rage • The level of anger experienced is usually in proportion to • The immediate threat • The cumulative effect of multiple threats • Many times when people feel angry, underneath they also have a sense of helplessness or disempowerment. What Triggers Your Anger • Threats • Rejection/Isolation • Loss of Control/The Unknown • Death/Loss • Failure What to Do About Anger • Identify the threat • Explore the automatic beliefs triggering the anger • Why is this making you angry? (It makes me angry when…. I hate it when…) • How is this similar to other (unresolved) situations in your past? • Are there alternate explanations for the situation? What to Do About Anger • Identify the threat cont… • What threat theme is it related to? • Rejection: Is it really about you? • Failure: • Are you globalizing? • What can you learn? • Loss of Control/The Unknown: • What parts of this were and were not in your control? • What actions are worth your energy • Death/Loss • How does this impact how you see the world? • How does it impact how you see yourself? Activity Resentment • Resentment is anger directed at others for things they either did and shouldn’t have or didn’t do and should have. • What is the impact of holding on to resentments? • Emotionally • Mentally • Physically • Socially • Spiritually (Hope, faith, courage/willingness, discipline, integrity) • Many times underlying resentment are hurt feelings. (Example: You invited Jane to the party and not me.) What Do You Resent • Make a chart with 4 columns, one for each threat • Rejection/Isolation • Loss of Control/The Unknown • Death/Loss • Failure • Take 30 minutes and identify as many resentments as you can and place them in the appropriate column (only one) • Review the finished list and mark off all resentments of things over which you have no control. • Now, cross off any th
January 4, 2020
454 – Behavior Modification, Goal Setting and Avoiding Common Traps Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Host: Counselor Toolbox A direct link to the CEU course is https://www.allceus.com/member/cart/index/product/id/29/c/ Objectives ~ Define behavior modification ~ Explore how behavior modification can be useful in practice ~ Learn basic behavior modification terms: ~ Unconditioned stimulus and response ~ Conditioned stimulus and response ~ Discriminitive stimuli ~ Learned helplessness Why Do I Care ~ Change means doing something different or modifying a response ~ That response can be a neurochemical one (stress response) or an overt behavioral one (smoking) ~ Behavior modification principles will help you understand some of the reasons people act/react the way they do ~ By understanding what causes and motivates people’s behavior we can better address their issues ~ The focus on observable, measurable conditions to the exclusion of cognitive interpretation underscores the mind-body connection Definition ~ Behavior modification in its truest form is concerned only with observable, measurable behaviors, stimuli and reinforcement ~ Emotions, interpretations and mental processes have no bearing How can this be useful in practice ~ Traditional (strict) behavior modification can be quite useful in simplifying stimulus/reaction ~ Integrating the cognitive interpretations (labels) can help people in identifying and addressing what is causing their “distress” (Behaviorists would refer to excitatory response) ~ Understanding what causes feelings can also give people a greater sense of empowerment. Example ~ Puppies learn appropriate behavior through reinforcement and correction ~ Puppy 1 tackles puppy 2  threat ~ Puppy 2 responds by tackling puppy 1  counter threat ~ Both puppies get a surge of adrenaline ~ The puppy that dominates receives a dopamine surge that reinforces the prior behaviors — do that again. ~ If Puppy 1 plays too rough, then puppy 2 will either become more aggressive or leave. ~ Either way, puppy 1s behavior is punished. Example 2 ~ Humans have learned to label certain internal experiences with feeling words (angry, scared, happy) ~ Sally goes to a pet store ~ A puppy comes out, sits in her lap and puts is head on her leg ~ This contact (we know from studies) usually causes the release of dopamine and oxytocin –both reward chemicals ~ Sally calls this “happy” ~ If Sally had previously had a threatening experience with a dog, when she saw it, her body would likely respond by secreting adrenaline, kicking off the fight or flight reaction. Sally would label this as “fear” Points ~ The brain receives signals and, based on prior learning (conditioning), responds with either: ~ Fight/Anger or Flee/Fear (adrenaline/norepinepherine) ~ No reaction/neutral ~ Pleasure/Happy/Do this again (Dopamine/norepinephrine/Serotonin/GABA/Oxytocin?) ~ Humans label these different chemical responses with feeling words. ~ The same response can be labeled differently by two different people (fear vs. exhilaration) Points ~ People with anxiety, anger or resultant depression may need to: ~ Recondition X is not actually a threat (anymore) ~ Relabel ~ Excited vs. terrified ~ Stressed vs. hungry ~ Helpless/anxious vs. fat ~ ACT approach– X is causing me to have the feeling that… ~ In American culture we often use nonfeeling words to describe emotional states. ~ Part of recovery is identifying the physiological response to the stimulus and labeling it with a feeling word Basic Terms ~ Unconditioned stimulus and response ~ Something that evokes an unconditioned/automatic response in an infant and adult ~ Loud noises ~ Pain ~ Excessive cold/heat ~ Contact Basic Terms ~ Conditioned Stimulus ~ Something that in itself has no meaning to the person (yel
December 28, 2019
453 – Biopsychosocial Impact of Stress and Strategies for Prevention and Intervention Dr. Dawn-Elise Snipes Objectives – Define stress and distress – Identify the impacts of stress – Explore sources of stress and interventions
December 24, 2019
452 Attachment Theory and Adult Relationships Attachment and Adult Relationships Dr. Dawn-Elise Snipes Executive Director, AllCEUs.com Host: Counselor Toolbox Podcast, NCMHCE Exam Review Podcast Objectives • Briefly define attachment theory • Learn about the impact of attachment • Identify triggers for attachment behaviors • Explore the relationship between ACEs and attachment issues • Learn about adult attachment theory • Examine how attachment impacts emotional regulation and vice versa • Identify ways to help people become more securely attached. What is Attachment Theory? • Attachment behaviors, such as crying and searching, were adaptive responses to separation from with a primary attachment figure someone who provides support, protection, and care. • Erikson postulated the periods of trust vs. mistrust, and autonomy vs. shame and doubt during this same time period • Maintaining proximity to an attachment figure via attachment behaviors increases the chance for survival • From this initial relationship we learn • How scary or safe the world is. • What it is like to be loved. What is Attachment Theory? • The attachment system essentially “asks” the following fundamental question: Is the attachment figure nearby, accessible, and attentive? • If the answer is “yes,” the person feels loved, secure, and confident, and, behaviorally, is likely to explore his or her environment, interact with others. • If the answer is “no,” the person experiences anxiety and, is likely to exhibit attachment behaviors ranging from simple visual searching to active following and vocal signaling on the other • These behaviors continue until either • The person is able to reestablish a desirable level of physical or psychological proximity to the attachment figure • Until the person “wears down.” Impact of Attachment • How loved or unloved we feel as children deeply affects the formation of our self-esteem and self-acceptance. It shapes how we seek love and whether we feel part of life or more like an outsider. • As we individuate we often again seek approval. Does it Stop After Infancy • Maybe yes, maybe no. • Consider the child that regularly did not get needs met. • Persisted with attachment seeking behaviors • Those behaviors were eventually rewarded (so they will happen again) or not, so the child stops seeking comfort from others. • How does this impact • Self-esteem? • Trust in others? • Future relationships? Does it Stop After Infancy • Maybe yes, maybe no. • Consider the adult who got needs met as a child, but in adult relationships regularly does not get needs met. • What role do significant others play in the survival of the adult human? • Think about Erikson’s stage of intimacy vs. isolation • How does not getting needs met impact • Self-esteem? • Trust in others? • Future relationships? Adult Attachment Theory • (1987) Hazan and Shaver noted that the relationship between infants and caregivers and the relationship between adult romantic partners share the following features: • both feel safe when the other is nearby and responsive • both engage in close, intimate, bodily contact • both feel insecure when the other is inaccessible • both share discoveries with one another • both play with one another's facial features and exhibit a mutual fascination and preoccupation with one another • both engage in “baby talk” Adult Attachment Theory • If adult romantic relationships are attachment relationships, then: • We should observe the same kinds of individual differences in adult relationships that Ainsworth observed in infant-caregiver relationships. • The way adult relationships “work” should be similar to the way infant-caregiver relationships work. • The same kinds of factors
December 21, 2019
451 – Biopsychosocial Impact of Anxiety and Strategies for Prevention and Intervention Impact of Anxiety and Interventions Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Objectives ~ Review the symptoms of anxiety in adults and children ~ Explore the impacts of anxiety ~ Identify strategies for prevention and intervention Why I Care/How It Impacts Recovery ~ Anxiety can be debilitating ~ In many cases neurotransmitter imbalances not the initial cause of anxiety, but a symptom ~ Low-grade chronic stress/anxiety erodes your energy and ability to concentrate ~ Anxiety is a major trigger for: ~ Addiction relapse ~ Depression ~ Increased physical pain ~ Worsening of physical illnesses ~ Chronic anxiety can make people more vulnerable to PTSD What is Anxiety ~ Anxiety is half of the “Fight or Flight Response” ~ It is an excitatory response ~ It’s function is to protect you from possible danger (Thank you!) ~ It can become a problem when it is overly intense/uncontrollable because of ~ Overgeneralization ~ Poor coping skills ~ Emotional reasoning and cognitive distortions ~ Biochemical issues (nutrition, hormones, sleep deprivation) ~ It can be caused by excess serotonin, norepinepherine or glutamate or too little GABA (est. 80% adults have neurochemical imbalance) ~ What is causing the neurochemical imbalance (water heater) Symptoms of Generalized Anxiety ~ Generalized anxiety disorder symptoms can vary. They may include: ~ Persistent worrying or obsession about small or large concerns that's out of proportion to the impact of the event ~ Inability to set aside or let go of a worry ~ Inability to relax, restlessness, and feeling keyed up or on edge ~ Difficulty concentrating, or the feeling that your mind “goes blank” ~ Distress about making decisions for fear of making the wrong decision ~ Carrying every option in a situation all the way out to its possible negative conclusion ~ Difficulty handling uncertainty or indecisiveness Symptoms of Generalized Anxiety ~ Generalized anxiety disorder may include: ~ Physical signs and symptoms may include: ~ Fatigue ~ Irritability ~ Muscle tension or muscle aches ~ Trembling, feeling twitchy ~ Being easily startled ~ Trouble sleeping ~ Sweating ~ Nausea, diarrhea or irritable bowel syndrome ~ Headaches Symptoms of Generalized Anxiety (Kids) ~ Excessive worry about: ~ Performance at school or sporting events ~ Being on time (punctuality) ~ Earthquakes, nuclear war or other catastrophic events ~ A child or teen with GAD may also: ~ Feel overly anxious to fit in ~ Be a perfectionist ~ Lack confidence ~ Strive for approval ~ Require a lot of reassurance about performance Physical Impacts ~ HPA-Axis overstimulation / excess cortisol ~ Metabolic syndrome ~ High blood pressure ~ High blood sugar ~ GI disturbances and ulcers ~ Sleep disturbances ~ Increased aging ~ Headaches ~ Infertility ~ Sexual dysfunction ~ Weakened immune system ~ Fatigue ~ Restlessness ~ Hair loss ~ Autoimmune issues Cognitive & Emotional Impacts ~ Difficulty taking perspectives ~ Difficulty concentrating ~ Becoming easily confused ~ Having memory problems ~ Negative self-talk ~ Having marked mood swings (emotional dysregulation) ~ Finding it hard to make decisions Social Impacts ~ Social withdrawal ~ Reduced support system ~ Difficulty taking perspectives ~ Reduction in leisure activities Biological Interventions ~ Your body thinks there is a threat. Help it restore itself so it is ready to fight the lion ~ Supportive Care ~ Create a sleep routine ~ Helps the brain and body rebalance and restore HPA-Axis functioning ~ Improves energy level through removal of adenosine and systemic repair ~ Nutrition ~ Provides the building blocks ~ Provides sufficient energy ~ Helps set circadian rhythms Biological Interventions ~ Supportive Care ~ Medication ~ SSRIs/SNRIs ~ Buspirone ~ Exercise ~ Exercising at a low intensity (40-50% of THRZ) has been shown to reduce cortisol ~ Yoga +
December 18, 2019
450 – 14 Tips for Addressing FOMO Counselor Toolbox Podcast Episode 449 Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs.com Podcast Host: Counselor Toolbox, Case Management Toolbox Objectives • Define FOMO • Explore reasons for FOMO • Identify consequences of FOMO • Review interventions to reduce the impact of FOMO What is FOMO • FOMO has been around since before social media, but persistent connectivity has exacerbated it • Social media both causes FOMO and is sustained by it • The fear of missing out refers to the feeling or perception that others are happier or living better lives than you are, promoting a deep sense of envy, increasing helplessness (Why not me?) and reducing self-esteem. • FOMO is not just the sense that you might be missing something. It is the feeling that you are missing out on something fundamentally important that others are experiencing right now. • Explore fundamental importance What is FOMO • Social media intensifies FOMO by only providing the highlights of others' lives leading client’s sense of “normal“ to become skewed • In the past our friends often did not do everything with us, but with social media it is more obvious when we are excluded or miss out on something. • Social media creates a platform for bragging; it is where things, events, and even happiness itself seems to be in competition at times. (Keeping up with the Jones’ worldwide) • Problematic social media use tends to be higher among • Surface learners • People with high rumination • Those with pre-existing depression or anxiety Types of SMS/SNS Commonly Implicated • Facebook • LinkedIn • Instagram • Twitter • Snapchat • Pinterest • Dating and connecting apps like MeetMe, POF, Tinder • Youtube (Van Life, Influencers…) Consequences of FOMO • Addiction • More time • Giving up friends and activities • Psychological withdrawal • Biopsychosocial impairment (sleep, relationship stress, texting and driving, reduced productivity…) • Anxiety • Depression • Relationship stress • Stress related health problems Consequences of FOMO • FOMO impacts relationships • Being on multiple social media sites and constantly “swiping left” to find something better out there • 22% of Tinder users were married and 44% were involved in a relationship suggests poor satisfaction • Rapid increase in polyamory/CNM and relationship anarchy partly due to skepticism about monogamy • Phubbing describes the habit of ignoring IRL contacts to focus on social media • There is a negative correlation between Facebook use and relationship satisfaction • Social media (esp. sites like Tinder) may be used to regulate depressive affect in females and anxiety in males. Interventions for FOMO • Focus on what you have not what you lack • Decide what is important • Find inspiration instead of envy • Increase positive metacognitions about social media • Develop meaningful relationships with people to get the full picture. • Keep an offline journal of fun things you do to shift from public approval to personal satisfaction • Use cognitive processing—Reframing • What are the facts for and against the belief? • Am I using extreme words? Interventions for FOMO • Practice self-regulation skills • Address rumination with thought stopping, distress tolerance skills and ACT • Enhance “deep learning” • Limit time on social media and address the anxiety (detox) • Explore how social media involvement or your involvement (or lack of) in other people’s lives contributes to a rich and meaningful life (ACT) • Identify what the emotional reactions to other people’s posts mean • Practice random acts of kindness and gratitude (even online) Summary • Fear of Missing Out or FOMO transcends ages, genders and socioeconomic statuses • Not ev
December 14, 2019
449 – Happiness Habits Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counseling CEUs and Specialty Certificates Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery Objectives ~ Learn why these habits contribute to recovery from addiction and mood issues and techniques to help clients implement them ~ Habit: Awareness and Authenticity ~ Habit: Acceptance ~ Habit: Gratitude ~ Habit: Compassion ~ Habit: Breathing ~ Habit: Purposeful action and Long-Term Goals ~ Habit: Back-Talk ~ Habit: Thought Conditioning ~ Habit: Be Sense-sational Biological Impact of Happiness ~ Reduced risk of diabetes (41% – 100%), autoimmune issues, cardiovascular disease (anxiety, depression 80%) ~ Reduced activation of the HPA-Axis ~ Improved hormone balance ~ Improved sleep ~ Reduced pain ~ Slowed aging process ~ More energy ~ Releases endorphins Emotional & Cognitive Impacts of Happiness ~ Difficulty to be simultaneously happy and unhappy ~ Changes the lens through with the world is viewed ~ Increases cognitive flexibility Social Impacts of Happiness ~ Happy people tend to attract happy people ~ Happy people often have more energy to devote to relationships ~ Improved social relationships increase happiness Awareness and Authenticity ~ To get your wants and needs met, you first need to be aware of them ~ Practice Mindfulness ~ What do you need ~ What vulnerabilities do you currently have ~ How can you mitigate them ~ How can you prevent them ~ Why is it important to prevent them? Awareness and Authenticity ~ Living authentically means living in a way that is true to yourself. ~ Define what happiness means to you: ~ What makes you happy? ~ How will your thoughts and outlook change when you are happy? ~ What is the impact of happiness on your health and body (energy, sleep, weight, pain, illness…)? ~ When you are happy, who do you see in your support system and what will your relationships be like? ~ What will be different in your day to day life, hobbies and activities when you are happy? ~ How can you start making these things happen? (Principle of Reciprocity) Acceptance ~ Fighting against things that are unchangeable (or not realistically changeable by you) wastes a TON of energy. ~ Feelings ~ Other people ~ Certain situations ~ Accept the situation by saying “Okay, what now?” ~ Decide whether you will… ~ Change part of the situation to make it more tolerable ~ How can you do this? ~ Change your reaction to the situation ~ How can you do this? Gratitude ~ It can be easy to focus on all of the things you don’t have or what is not going right ~ An attitude of gratitude helps you ~ refocus on the positive ~ appreciate the simple things ~ Let go of envy and jealousy ~ Even if one area of your life is a mess, it is likely that you have other things to be grateful for. ~ Activities ~ Keep a gratitude list. Add at least one thing that went well each day ~ Look around and compare yourself to others who are not doing as well and/or the you in the past Compassion ~ Compassion means sympathetic awareness of others' distress and a desire to alleviate it ~ People may have compassion for others but not for themselves ~ Many of us were raised to think that if we are compassionate with ourselves it means we are lazy, weak or a failure. ~ Activity ~ Think of three times you have been compassionate in the past week. To whom? Why? How did it impact them? ~ How are you compassionate to yourself? How could you be? Breathing (and Laughter) ~ Deep breaths help oxygenate blood and reduce fatigue ~ Slow deep breaths also help lower heart rate and trigger the relaxation response. ~ Laughter not only makes you breathe deeper, but it also releases endorphins. ~ Activity ~ Practice deep breathing after each meal ~ When you are stressed, take a few deep breaths ~ Schedule in 10 minutes to laugh every day. Purposeful Action and Long-Term Goals ~ When you see that you are moving closer to your long term goals it in
December 11, 2019
448 – Post Stroke Psychosocial Issues Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Podcast Host: Counselor Toolbox, Case Management Toolbox, NCMHCE Exam Review Objectives • Examine the prevalence of and risk factors for stroke • Identify Post-Stroke Psychosocial Issues Intro • Many of our clients are at high risk of stroke • People with anxiety disorders have a 33% higher risk of stroke partly due to HBP and lifestyle factors such as smoking • Mood stabilizers were collectively associated with a significantly increased risk for stroke in participants with bipolar disorder • Benzodiazepine use is associated with a 20% higher risk of stroke • Almost 40% received 1 or a combination of drugs hypothesized to impair recovery during the first 30 days after stroke.(e.g. clonidine which reduces NE levels, atypical antipsychotics, benzodiazepines) Risk for Stroke • Smokers are 2-4x as likely to have a stroke • Make blood sticky and more likely to clot, which can block blood flow to the heart and brain • Damage cells that line the blood vessels • Increase the buildup of plaque (fat, cholesterol, calcium, and other substances) in blood vessels • Cause thickening and narrowing of blood vessels • Alcohol increases stroke risk by 38% • Causing A-Fib • Development of atherosclerosis, or the hardening and narrowing of arteries • Liver damage impairing blood clotting • HBP during detoxification Risk for Stroke • Stimulant abuse increasing blood pressure • High blood pressure • Sleep apnea • Non-sleep-apnea sleep disorders • Age • Diabetes doubles the risk of stroke • Use of nonsteroidal anti-inflammatory drugs (NSAIDs), but not aspirin, may increase the risk of heart attack or stroke, particularly in patients who have had a heart attack Mini-Strokes • The signs and symptoms of a TIA resemble those found early in a stroke and may include sudden onset of: • Weakness, numbness or paralysis in your face, arm or leg, typically on one side of your body • Slurred or garbled speech or difficulty understanding others • Blindness in one or both eyes or double vision • Dizziness or loss of balance or coordination • Sudden, severe headache with no known cause • 70% reported that their TIA had long-term effects including memory loss, poor mobility, problems with speech and difficulty in understanding. 60% of people stated that their TIA had affected them emotionally Assessments • When • Just before discharge • One month after stroke • Three months after stroke • Six months after discharge • What to look for • Cognitive functioning • Depression • Anxiety • Social withdrawal • Changes in physical presentation Impacts of Stroke • General Physical Issues • Reduced mobility / independence • Vision problems • Difficulty with ADLs • Difficulty swallowing • Sleep problems (36%) • Chronic headaches • Pneumonia • Pain Impacts of Stroke • Difficulty understanding or expressing emotions • Post-stroke depression (PSD) (67%) • Post-stroke depression may remit as the person regains function • Correlated with hospitalization, functional loss and particular areas of the brain being damaged • Post-stroke anxiety (25%) • Post-stroke emotional incontinence (PSEI) uncontrollable outbursts of involuntary laughing or crying for no apparent reason (34%) • Functional status, serotonin polymorphisms, and low social support were related to PSEI at three months post-stroke • SSRIs are often effective Impact • Post-stroke anger proneness (PSAP) • serotonergic dysfunction seems to play a role in the development of PSAP • Post-stroke fatigue (PSF) (50%-86%) • Depression • Neurological deficits • Antidepressants • Sleep disturbances • Post-stroke pain • Changes to thinking, memory and perc
December 7, 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 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 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
December 1, 2019
446 – Relationship Insecurities Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC, NCC Executive Director, AllCEUs *Based in part on Love Me Don’t Leave Me by Michelle Skeen, PsyD. Objectives • Identify signs of relationship insecurities • Explore causes of relationship insecurities • Identify at least 5 interventions to address relationship insecurities Signs of Relationship Insecurities • Difficulty trusting your partner • Comparing yourself to your partner’s exes or random people in the community • Requiring frequent reassurance that you are enough • Anxiety when separated • Internalizing negative thoughts creating self-fulfilling prophesies • A feeling of distance or detachment • Reading negative into everything your partner says Relationship Bricks • Often past relationships cause us to build a wall around our heart • Have clients write the name of people from prior relationships on bricks and put them in a backpack • Have them put on the backpack and go on a nature walk for 15 minutes. • When you get back, ask about all of the things they noticed on the walk and how carrying that heavy backpack kept them from being mindful Causes of Relationship Insecurities • Insecurities indicates anxiety or fear of being hurt or abandoned • Prior learning (Unpack those bags—1 bag/person/session) • Create paper “bags” for each past relationship brick • Write a pros and cons list of that relationship • Write a goodbye letter to that person/relationship detailing what happened, how you felt and how it impacted you • In sharing what is in the bag, take back your power. • Instead of saying “You made me feel” say “I felt” • Instead of a narrative of abandonment and betrayal because of personal inadequacies, explore other reasons the other person to left the relationship • Explore forgiveness in terms of choosing not to allow that person to continue to hurt you Causes of Relationship Insecurities • Insecurities indicates anxiety or fear of being hurt or abandoned • Prior learning (Unpack those bags—1 bag/person/session) • When you are ready to let go of that anger and hurt, take the brick out of the backpack. • Each week notice how much lighter the backpack feels and how much less energy it takes to tote around Causes of Relationship Insecurities • Insecurities indicates anxiety or fear of being hurt or abandoned • Trying to master a prior failed relationship • Make a Venn diagram Causes of Relationship Insecurities • Insecurities indicates anxiety or fear of being hurt or abandoned • Low self-esteem (Self-validation) • Collage • Best friend activity • Values activity • Sell yourself • People may have difficulty developing self-esteem based on a pathological inner critic • Thought stopping • Handling hecklers • Validate in the present / check for accuracy • Embrace imperfection and synergy Causes of Relationship Insecurities • Insecurities indicates anxiety or fear of being hurt or abandoned • Poor communication • Stop assuming you know and expecting mind reading • Mindfulness • Lack of Connection • Intentional activity—Make a list of all of the things you like to do. Intentionally spend time with each other each day. Causes of Relationship Insecurities • Insecurities indicates anxiety or fear of being hurt or abandoned • Imbalance in power (She does everything… If he leaves, I will not be able to survive.) • Address anxieties about dependency or helplessness • Develop support systems and strategies and disaster plans Causes of Relationship Insecurities • Insecurities indicates anxiety or fear of being hurt or abandoned • Jumping to conclusions/Personalization • Relationship Assumptions “Family Feud”— We surveyed a bunch of people. What are the top 3 explanations for this…Smells like perfume, is late, doesn’t te
November 30, 2019
445 – Malnutrition Impact and Intervention Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Podcast Host: Counselor Toolbox & NCMHCE Exam Review Podcast Objectives • Review the nutritional building blocks for health and wellness • Examine how these nutrients (or lack thereof) contribute to neurotransmitter balance • Identify several nutrient dense foods that you can include in your diet • Note: Nutritional changes should always be made under the supervision of a registered dietician or your primary physician. This presentation is for general informational purposes only. Why I Care/How It Impacts Recovery • In early recovery, nearly every person’s neurotransmitters are out of balance. • This causes feelings of depression, apathy, anxiety, and/or exhaustion. • Understanding why you feel the way you do is the first step • Figuring out how to help yourself feel better is the next What are Neurotransmitters • The human brain is composed of roughly 86 billion neurons. • These cells communicate with each other via chemical messengers called neurotransmitters. • Neurotransmitters regulate • Mood • Cravings, addictions • Energy • Libido • Sleep • Attention and concentration • Memory • Pain Sensitivity Neurotransmitters Cont… • About 86% of Americans have suboptimal neurotransmitter levels — our unhealthy modern lifestyle being largely to blame. • Chronic stress, poor diet, environmental toxins, drugs (prescription and recreational), alcohol, nicotine, and caffeine can cause neurotransmitter imbalances. Think about it • How do you feel when you are not getting enough oxygen? (Hint: You yawn) • What effect might a low carb diet have on mood? • What effect might a low protein diet have on mood? (Most non-vegan Americans get plenty of protein) • Why do doctors test for vitamin-D levels in patients with depressive symptoms? Effect of Nutrition on Brain Function • Early-life malnutrition is highly correlated with neurodevelopment and adulthood neuropsychiatric disorders • Improvements in nutrition are known to bring tangible benefits and many diseases and conditions can be prevented, modulated or ameliorated by good nutrition • Iodine is necessary for energy metabolism in the brain cells. • Vitamin B1 is necessary for the utilization of glucose in the brain. • Vitamins B6 and B12, among others, are directly involved in the creation of neurotransmitters. • Nerve endings contain the highest concentrations of vitamin C in the human body. • Vitamin E is necessary for effective transmission of neurological signals Effect of Nutrition on Brain Function • Eating foods with a low glycemic index improves the quality and duration of intellectual performance http://www.glycemicindex.com/ • Dietary proteins contribute to good brain function • Tryptophan is necessary for the creation of serotonin and melatonin • Brain cell functioning requires omega-3 fatty acids. • Omega-3s have also been found to help prevent and/or treat mood disorders, particularly depression • Iron is necessary to ensure oxygenation and for the synthesis of neurotransmitters. Effect of Nutrition on the Person • Reduced libido • Low energy • Impaired relationships • Impaired concentration/attention • Sleep disturbances Amino Acids (Protein Building Blocks) Essential Amino Acids • Must be acquired from diet: • Valine • Isoleucine • Leucine • Lysine • Methionine • Phenylalanine • Threonine • Tryptophan Complete vs. Incomplete Proteins • Complete proteins are those that contain all essential amino acids: • Meat • Fish • Dairy products (milk, yogurt, whey) • Eggs • Quinoa* • Buckwheat* • Chia seed* • Spirulina* Complete vs. Incomplete Proteins • Incomplete proteins are those that don’t contain all 9 essential amino
November 27, 2019
444 – PTSD Case Study Using the PACER Method Counselor Toolbox Podcast Episode 444 Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs.com Podcast Host: Counselor Toolbox and Case Management Toolbox Objectives • Review a case study using the transdiagnostic, transtheoretical PACER approach • As they say on Law and Order… • The following story is fictional and does not depict any actual person or event.” Case • John is 48 years old. When he was 24 his house caught on fire due to faulty Christmas lights which were accidentally left on when the family went to bed. His wife and 2 children died in the fire. He has remarried and had 3 more children (14, 12, 9) since the event and continues to experience PTSD related symptoms. His wife insisted he come to counseling after he was caught having another affair. Summary • PTSD causes a variety of physical, cognitive, emotional and interpersonal alterations to protect the person from future trauma. • Until the trauma is integrated the HPA-Axis will often stay activated and have exaggerated responses to reminders of the trauma. • Persistent activation can lead to sleep deprivation, irritability, anger and hypocortisolism altering the levels of testosterone, thyroid hormones and neurotransmitters. • Sexual activity and risk taking both increase dopamine • It is important to explore all behaviors and symptoms through the lens of how they might be a reaction to the trauma, to hypocortisolism or something totally different.
November 23, 2019
443 – Sleep Disturbances: Impact and Intervention Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Podcast Host: Counselor Toolbox & NCMHCE Exam Review Objectives • Learn about sleep • The function of sleep • Sleep cycles • How much is enough • How lack of sleep contributes to feelings of depression, anxiety and irritability • Understand the connection between sleep and circadian rhythms • Learn techniques for sleep hygiene Impact of Sleep Disturbance • People whose circadian rhythms are off • Have a difficult time getting restful sleep • Usually have higher cortisol levels • Often report being tired at all the wrong times • Have difficulty concentrating • Confuse sleep and hunger cues What is the Function of Sleep • Sleep is time to rest and restore • Adequate sleep improves memory and learning, increases attention and creativity, and aids in concentration and decision making. • Toxins that accumulate in the brain are thought to be cleared out during sleep • Healing and repair of cells takes place during sleep • Sleep helps to maintain the balance of hormones in the body: • Ghrelin and leptin, which regulate feelings of hunger and fullness • Insulin, which is responsible for the regulation of glucose in the blood Functions cont… • Sleep deficiency is also linked to a higher risk of • Cardiovascular disease • Stroke • Diabetes • Kidney disease • Sleep deprivation is correlated to • Difficulty concentrating • Irritability • Fatigue/Loss of energy Understanding Sleep Cycles • Stage 1 NREM sleep is when you drift in and out of light sleep and can easily be awakened. • Stage 2 NREM brainwaves slow with intermittent bursts of rapid brain waves, the eyes stop moving, the body temperature drops and the heart rate begins to slow down.  • This stage usually lasts for approximately 20 minutes • Stage 3 NREM sleep, also known as deep sleep or delta sleep, is marked by very slow delta brainwaves. There is no voluntary movement. You are very difficult to wake. • This stage usually lasts for approximately 30 minutes • The largest percentage of Deep Sleep comes in the early part of the total night's sleep pattern Understanding Sleep Cycles • REM Sleep (Rapid Eye Movement) is characterized by temporary paralysis of the voluntary muscles and fast, irregular breathing, inability to regulate body temperature, faster brain waves resembling the activity of a person that is awake. • Most dreams occur during REM sleep How Much is Enough? Sleep and Hormones • Estrogen usually improves the quality of sleep, reduces time to fall asleep, and increases the amount of REM sleep • Too little or too much testosterone may affect overall sleep quality • Cortisol is your stress hormone and prevents restful sleep • Thyroid hormones which are too high can cause insomnia and too low can cause fatigue and lethargy Nutrition and Sleep • Tryptophan is used to make serotonin • Serotonin is used to make melatonin • Melatonin functions to help you feel sleepy • Caffeine is a stimulant with a 6-hour half life • Nicotine is a stimulant with a 2-hour half life • Decongestants are stimulants with a 2-hour half life • Antihistamines make you drowsy but contribute to poor quality sleep • Alcohol blocks REM sleep and can cause sleep apnea Nutrition cont… • Eat a high protein dinner to ensure you have enough tryptophan in the body • Make sure you are getting enough • Selenium • Vitamin D • Calcium • Vitamin A • Magnesium • Zinc Function of Sleep • Allows the brain to focus on rebuilding and repairing • Animals deprived entirely of sleep lose all immune function and die in just a matter of weeks. • Prisoners deprived of sleep entirely often develop psychotic symptoms • New parents deprived of sleep have diffic
November 20, 2019
442 – Adjustment Disorder Case Study Using the PACER Method Counselor Toolbox Podcast Episode 442 Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs.com Podcast Host: Counselor Toolbox and Case Management Toolbox Objectives • Review a case study using the transdiagnostic, transtheoretical PACER approach • As they say on Law and Order… • The following story is fictional and does not depict any actual person or event.” Case • Dana is a 18 year old freshman attending the University of Gallifray. This is the first time she has been away from home for any length of time. She did not get a bid at the sorority she wanted to join, does not like her roommates in the dorm and is finding it difficult to attend classes and keep up with her work. Physical • Sleep • On an average night how much sleep do you get? REM _1__ Deep _.5__ Light _3___ Just can seem to sleep. • On an average night how many times do you wake up? __1-2 (When roommates come home) • After an average night’s sleep how do you feel? Tired _x__ Okay ___ Energetic ____ • When you wake up feeling refreshed, how much sleep do you get? REM __3_ Deep __2+_ Light __3+__ • Sleep hygiene self assessment. Physical • Nutrition • Using a free app like SparkPeople, track your nutrition for a week. • Which nutrients do you get less than 75% the full RDA? Selenium • Which nutrients do you get less than 25% of the RDA? None • When was the last time you had a full panel blood test to examine your kidney and liver function, thyroid and vitamin D levels? Unknown • Describe your eating habits: I have been eating a lot of pizza and Jimmy Johns lately • Do you eat due to stress or for comfort when you are upset? yes • Do you drink at least 64 ounces of noncaffeinated, nonalcoholic beverages each day? yes • How much caffeine do you have on an average day? (100-150 mg/8oz of regular coffee; 35-50 mg/8oz of soda) ~600mg Physical • Nutrition • How much nicotine do you have on an average day? (1mg/1 cigarette; 6-24mg/vaping cartridges) __0___ • Are you currently over or under fat? (Note: People can have a lot of muscle and not be unhealthy) _no____ • Have you recently had any problems with excessive thirst or hunger? __no • Do you have problems with hypoglycemia (your blood sugar dropping)? _no • Have you recently gained or lost a lot of weight? No • Has your doctor tested your blood sugar lately (fasting blood test)? __no • Do you mainly gain weight around your belly? __no__ Physical Physical • Pain • Do you have any chronic pain? __no__ • If so what causes it?_____ How long have you had it? ___ • What makes it worse? ___________ • What makes it better? _How has it impacted your mood/relationships/energy/sleep/self-esteem? N/A Physical • Exercise/sedentariness • Do you exercise? ____yes______ If yes, how often and for how long? ____daily 60-90 minutes_____ • How is your energy, mood and appetite after you exercise? ___good________________ • Do you sleep better on days you exercise? __yes___ Does muscle soreness make it harder to sleep? __No___ Physical • Energy • Which best describes your average energy level Low__x_ I can get through the day___ Great! ___ • Have you had your thyroid levels tested lately? __N__ If so were they in normal range? __?__ • Using a pulse ox monitor: What is your resting heart rate? __70_ What is your O2 saturation? __98___ • Do you have high blood pressure? _N__ Heart conditions? _N____ if so, what Physical • Libido/Sex hormones • How is your sex drive? Low __x___ Good _____ Incredible______ • Has there been any change in your sex drive? __N___ If so when and what caused it? ____?__ Been low for a couple years • If you are over 45 have you had your sex hormone levels tested in the past year? ___N/A___ • How
November 16, 2019
441 – Biopsychosocial Aspects of HPA-Axis Dysfunction Objectives – Define and explain the HPA-Axis – Identify the impact of trauma on the HPA Axis – Identify the impact of chronic stress/cumulative trauma on the HPA-Axis – Identify symptoms of HPA-Axis dysfunction – Identify interventions useful for this population Based on – 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/ – Lifestyle Factors Contributing to HPA-Axis Activation and Chronic Illness in Americans Archives of Neurology and Neuroscience. 2019 Oct.; 5(2) ANN.MS.ID.000608. DOI:10.33552/ANN.2019.05.000608 https://irispublishers.com/ann/pdf/ANN.MS.ID.000608.pdf What is the HPA Axis – Hypothalamic-Pituitary-Adrenal Axis – Controls reactions to stress and regulates digestion, the immune system, mood and emotions, sexuality, and energy storage and expenditure – The signs and symptoms of HPA-Axis dysfunction reflect a persistent, abnormal adaptation of neurobiological systems to trauma or chronic stress. – In addition to trauma, multiple lifestyle factors have been associated with HPA-Axis dysregulation including – Noise – Stimulant use (caffeine, nicotine, ADHD medications) – Insufficient quality sleep – Media exposure Consequences of HPA-Axis Dysfunction – More than 50% of Americans suffer from one or more chronic conditions associated with disturbances of the HPA-Axis with an estimated cost of $3.3 trillion annually including: – Major depressive disorder (20%) – Generalized anxiety disorder (18.1%) – Sex hormone imbalances (25%) – Diabetes (9.2%) – Autoimmune disorders (23%) – Chronic pain – Metabolic syndrome (30%) – Cardiovascular disease (44%) – Hypothyroid (4.6%) – IBS symptoms such as constipation and diarrhea – Reduced tolerance to physical and mental stresses (including pain) Overview of Healthy HPA-Axis Function – When exposed to a physical, environmental or social stressor, the HPA-Axis is activated and prompts the “fight or flight” reaction. – Glutamate and Norepinephrine are released – The hypothalamus releases corticotropin releasing factor (CRF) and arginine vasopressin (AVP) to stimulate the anterior pituitary to produce and secrete adrenocorticotropic hormone (ACTH). – ACTH causes glucocorticoid (cortisol) synthesis and release from the adrenal glands Overview of Healthy HPA-Axis Function – Cortisol’s primary function is to – Increase blood glucose and modify fat and protein metabolism to fuel the fight or flight reaction – Modulate immune and brain function to effectively manage stressors. – Cortisol initially causes a potent anti-inflammatory response which allows the organism to react to the stressor without being pain or fatigue. – Glucocorticoids interfere with the retrieval of traumatic memories – As cues of the threat wane, the body increases inflammation by releasing proinflammatory cytokines to accelerate wound healing Stress Response – The response of an individual to stress 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 – Compared to positive events, negative events, or “stress” causes greater awareness and recall of event details leading to stronger encoding of negative or stressful events. Emotional Valence – The NEVER (Negative Emotional Valence Enhances Recapitulation ) model of emotional valence, asserts that the greater
November 13, 2019
440 – Addiction Case Study Using the PACER Method Counselor Toolbox Podcast Episode 440 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 – Review a case study using the transdiagnostic, transtheoretical PACER approach – As they say on Law and Order… – The following story is fictional and does not depict any actual person or event.” Case – John is 37 years old and presents for marijuana use as a requirement of his probation. He has a wife and 2 kids, 4 and 9. Physical – Sleep – On an average night how much sleep do you get- 6 hours – On an average night how many times do you wake up- __not often – After an average night’s sleep how do you feel- Tired ___ Okay __x_ Energetic ____ – When you wake up feeling refreshed, how much sleep do you get- 8+ – Sleep hygiene self assessment. Physical – Nutrition – Using a free app like SparkPeople, track your nutrition for a week. – Which nutrients do you get less than 75% the full RDA- D, Calcium, potassium – Which nutrients do you get less than 25% of the RDA- None – When was the last time you had a full panel blood test to examine your kidney and liver function, thyroid and vitamin D levels- ___- months – Describe your eating habits: I eat a lot of fast food and meat – Do you eat due to stress or for comfort when you are upset- yes – Do you drink at least 64 ounces of noncaffeinated, nonalcoholic beverages each day- No – How much caffeine do you have on an average day- (100-150 mg/8oz of regular coffee; 35-50 mg/8oz of soda) 300 mg Physical – Nutrition – How much nicotine do you have on an average day- (1 mg/1 cigarette; 6-24mg/vaping cartridges, 100mg/cigarillo) __200mg___ – Are you currently over or under fat- (Note: People can have a lot of muscle and not be unhealthy) _yes I need to lose about 30#____ – Have you recently had any problems with excessive thirst or hunger- __no – Do you have problems with hypoglycemia (your blood sugar dropping)- _no – Has your doctor tested your blood sugar lately (fasting blood test)- __no – Do you mainly gain weight around your belly- __yes__ – Referral to PCP for physical to include nutritional evaluation, hormone evaluation and possible addition of multivitamin to address nutritional deficiencies. Physical Physical – Pain – Do you have any chronic pain- __no__ – If so what causes it-________________ How long have you had it- ____ – What makes it worse- ___________ – What makes it better- _____________________ – How has it impacted your mood/relationships/energy/sleep/self-esteem- Physical – Exercise/sedentariness – Do you exercise- ____no______ If yes, how often and for how long- _________ – How is your energy, mood and appetite after you exercise- ___N/A________________ – Do you sleep better on days you exercise- __N/A___ Does muscle soreness make it harder to sleep- __N/A___ Physical – Energy – Which best describes your average energy level Low___ I can get through the day_x__ Great! ___ – Have you had your thyroid levels tested lately- __N__ If so were they in normal range- __-__ – Using a pulse ox monitor: What is your resting heart rate- __75_ What is your O2 saturation- __98___ – Do you have high blood pressure- _Y__ (medicated) Heart conditions- _N____ if so, what Physical – Libido/Sex hormones – How is your sex drive- Low __ Good _x__ Incredible__ – Has there been any change in your sex drive- __Y___ If so when and what caused it- ____-__ – If you are over 45 have you had your sex hormon
November 9, 2019
439 – Biopsychosocial Impact of Hormone Imbalances Objectives – Review the sex hormones and their functions – Review the impact of sex hormones in the HPA-Axis – Review causes and consequences of imbalances in – Estrogen – Progesterone – Testosterone Estrogen – Multiple forms – Estradiol is predominant prior to menopause – Estrone is the primary form postmenopausally – Synthesized by fatty tissue – Estrogen works synergistically with many biological systems to promote physical, cognitive and affective function – Estrogens can modulate neuronal excitability, through serotonin, norepinephrine, dopamine, and endorphin regulation – Estrogen supplementation can decreased both systolic and diastolic blood pressures and reduced norepinephrine levels Estrogen – Estrogen modulates mood via the serotonergic system – Estrogen also contributes to the – Downregulation of 5-HT-2 (stimulating) receptors and monoamine oxidase (think MAOIs) – Downregulation of 5HT1A receptors presynaptically – Upregulation of postsynaptic serotonin 5-HT1A (calming) receptors – In one study, 80% of women given estradiol reported significantly decreased mood symptoms after three or six weeks, compared to only 22% of women on placebo – Similarly, estradiol resulted in improved mood in 68% of peri-menopausal women with depressive disorders, whereas only 20% of women on placebo experienced similar benefit Estrogen – Estrogen also regulates glucose metabolism and energy production – Declines in these processes are characteristic of neurodegenerative diseases – Estrogens exert neuroprotective actions to maintain cerebrovasculature health including prevention glutamate-induced excitotoxicity and hippocampal shrinkage – Estrogens exert some anti-inflammatory effects – Naturally occurring higher levels of estrone were associated with poorer cognition, specifically working memory performance – Estradiol acts in part through nitric oxide (arginine)to increase extracellular dopamine levels. The Sex Hormones – Estrogen – Premenopausal females have a better response than males to serotonergic antidepressants, indicating female hormones may improve the efficacy of SSRIs – Depressed postmenopausal females on supplemental estrogen plus SSRIs showed improved response compared with depressed postmenopausal females without estrogen – Estrogen alone did not relieve depression – Largest clinical trials of HT ever conducted revealed an increased risk of cancer, dementia and cognitive decline with prolonged administration of conjugated equine estrogen (CEE) Estrogen and the HPA-Axis – Higher levels of Estradiol produced a stronger HPA axis response during non-threatening situations and during and after stressors – Under conditions of anxiety and stress, women attend to threat differently depending on endogenous estradiol levels, being avoidant when estradiol is lower, and vigilant when estradiol is higher – Estradiol increases the activation of Corticotropin Releasing Hormone and base levels of ACTH – Chronic stress produces a hyporesponsive HPA axis that is hypersensitive to the modulating effects of estrogen – Changes in 5-HT1A receptor binding in the hippocampus and hypothalamus are restored by estrogen replacement. Estrogen and the HPA-Axis – Treatment with estradiol could inhibit the negative feedback effects of cortisol increasing cortisol levels – Estradiol treatment has been shown to increase corticosteroid binding globulin (CBG ) which inactivates cortisol in males – Crosstalk between the hypothalamic–pituitary–gonadal (HPG) and HPA axes could lead to abnormalities of stress responses, and as a result exacerbate peripheral pathologies i.e.: – Low estrogen –> blunted HPA-Axis response (depression) – High estrogen –
November 6, 2019
438 -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
November 2, 2019
437 Depression Case Study Using the PACER Method Counselor Toolbox Podcast Episode 438 Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs.com Podcast Host: Counselor Toolbox and Case Management Toolbox Objectives – Review a case study using the transdiagnostic, transtheoretical PACER approach – As they say on Law and Order… – The following story is fictional and does not depict any actual person or event.” Case – Tom is a 36 year old male and has been struggling with depression on and off for years, but the past 2 months it has gotten intolerable. He recently lost 85 pounds to try to help get his diabetes under control and improve his sleep apnea and blood pressure. He was thrilled with his weight loss progress, but he hit a plateau and feels like he is going backwards. Physical – Sleep – On an average night how much sleep do you get- REM _1__ Deep _.5__ Light _6___ – On an average night how many times do you wake up- __3-4 but has sleep apnea___ Has not been waking up as much since he lost weight and started on the CPAP – After an average night’s sleep how do you feel- Tired _x__ Okay ___ Energetic ____ – When you wake up feeling refreshed, how much sleep do you get- REM __3_ Deep __2+_ Light __3+__ – Sleep hygiene self assessment. Physical – Nutrition – Using a free app like SparkPeople, track your nutrition for a week. – Which nutrients do you get less than 75% the full RDA- Zinc – Which nutrients do you get less than 25% of the RDA- None – When was the last time you had a full panel blood test to examine your kidney and liver function, thyroid and vitamin D levels- 6 months – Describe your eating habits: I have been eating healthier on my diet and try not to get too crazy because of diabetes – Do you eat due to stress or for comfort when you are upset- yes – Do you drink at least 64 ounces of noncaffeinated, nonalcoholic beverages each day- yes – How much caffeine do you have on an average day- (100-150 mg/8oz of regular coffee; 35-50 mg/8oz of soda) ~600mg Physical – Nutrition – How much nicotine do you have on an average day- (1mg/1 cigarette; 6-24mg/vaping cartridges) __0___ – Are you currently over or under fat- (Note: People can have a lot of muscle and not be unhealthy) _no____ – Have you recently had any problems with excessive thirst or hunger- __no – Do you have problems with hypoglycemia (your blood sugar dropping)- _yes (diabetic) – Have you recently gained or lost a lot of weight- Yes – Has your doctor tested your blood sugar lately (fasting blood test)- __yes – Do you mainly gain weight around your belly- __yes__ – Referral to PCP Physical – Pain – Do you have any chronic pain- __Yes__ – If so what causes it-__bad knees___ How long have you had it- _since college___ – What makes it worse- __standing, walking_________ – What makes it better- _heat, ice, elevation – How has it impacted your mood/relationships/energy/sleep/self-esteem- Knee pain is annoying and keeps me from playing tennis with my daughter Physical – Exercise/sedentariness – Do you exercise- ____not anymore ______ If yes, how often and for how long- ____daily 45 minutes_____ – How is your energy, mood and appetite after you exercise- ___I’m exhausted________________ – Do you sleep better on days you exercise- __-___ Does muscle soreness make it harder to sleep- __No___ Physical – Energy – Which best describes your average energy level Low__x_ I can get through the day___ Great! ___ – Have you had your thyroid levels tested lately- __N__ If so were they in normal range- __-__ – Using a pulse ox monitor: What is your resting heart rate- __85_ What is your O2 saturation- __98___ – Do you have high blood pressure- _Y__ (managed with
November 2, 2019
437 -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
October 27, 2019
436- Anxiety Case Study Using the PACER Method Counselor Toolbox Podcast Episode 436 Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs.com Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free weeks of TherapyNotes with coupon code “CEU” Podcast Host: Counselor Toolbox and Case Management Toolbox Objectives – Review a case study using the transdiagnostic, transtheoretical PACER approach – As they say on Law and Order… – The following story is fictional and does not depict any actual person or event.” Case – Sally is a 49 year old female with one child in college and a second child who is a senior in high school. She has started having anxiety, difficulty sleeping and panic attacks over the last 6 months. – Her doctor prescribed her Xanax to take as needed to prevent panic attacks and help her sleep. She says the rebound anxiety from that is terrible and won’t take it anymore. She cannot identify any particular precipitating factor. She says the anxiety came on kind of gradually over the past few months and the panic attacks only started in the past few weeks. – She reports that she was in counseling for a month with someone else but it wasn’t helping very much. Things are getting worse and her doctor Physical – Sleep – On an average night how much sleep do you get- REM _2__ Deep _.5__ Light _6___ – On an average night how many times do you wake up- __3-4___ – After an average night’s sleep how do you feel- Tired _x__ Okay ___ Energetic ____ – When you wake up feeling refreshed, how much sleep do you get- REM __3_ Deep __2+_ Light __3+__ – (Sleep has worsened significantly in the last 4 months.) – Sleep hygiene self assessment. (This will also address caffeine after noon and alcohol)  Physical – Nutrition – Using a free app like SparkPeople, track your nutrition for a week. – Which nutrients do you get less than 75% the full RDA- Mg, Zn, Fe – Which nutrients do you get less than 25% of the RDA- None – When was the last time you had a full panel blood test to examine your kidney and liver function, thyroid and vitamin D levels- ___18 months – Describe your eating habits: I eat pretty healthy but tend to be a stress eater and have cut out all processed foods (breads, cereals) and red meat – Do you eat due to stress or for comfort when you are upset- yes – Do you drink at least 64 ounces of noncaffeinated, nonalcoholic beverages each day- yes – How much caffeine do you have on an average day- (100-150 mg/8oz of regular coffee; 35-50 mg/8oz of soda) 1200 (one pot) Physical – Nutrition – How much nicotine do you have on an average day- (1mg/1 cigarette; 6-24mg/vaping cartridges) __0___ – Are you currently over or under fat- (Note: People can have a lot of muscle and not be unhealthy) _no____ – Have you recently had any problems with excessive thirst or hunger- __no – Do you have problems with hypoglycemia (your blood sugar dropping)- _yes – Has your doctor tested your blood sugar lately (fasting blood test)- __no – Do you mainly gain weight around your belly- __yes__ – Referral to PCP for physical to include nutritional evaluation, hormone evaluation and possible addition of multivitamin to address nutritional deficiencies. Discuss with PCP sleep problems with onset ~beginning of Mirapex and the possibility of iron deficiency anemia causing RLS. Discuss with PCP the frequent headaches with floaters. Discuss with PCP chronic pain issues and possibility of a physical therapy referral. Physical Physical – Pain – Do you have any chronic pain- __Yes__ – If so what causes it-____Back injury_______________ How long have you had it- _18 months___ – What makes it worse- __Bending, sitting_________ – What makes it better- _heat, ice, muscl
October 24, 2019
Biopsychosocial Impact and Strategies for Prevention and Intervention Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs 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 – Review the following effects of pain – Depression – Anxiety – Circadian Rhythm Disruption – Grief – Self Esteem problems – Explore mitigating and exacerbating factors – Identify primary, secondary and tertiary prevention activities Characteristics of Pain – Everyone has pain sometimes – Our bodies are incredibly resilient – Knowing your pain can help your care team. – Acute or Chronic – Stabbing, aching, throbbing, burning… – Constant or intermittent – Stationary or radiating – Any numbness Prevention – Primary –Prevent the pain from happening – Secondary –Prevent the pain from getting worse – Tertiary –Prevent the pain from causing other problems like depression, anxiety, addiction Primary Prevention – Proper ergonomics/form at work, home, in bed and at the gym – Exercise bilaterally – Stretch frequently – Don’t overtrain – Gradually increase activity by time not quantity – Eat a healthy diet with omega3s, anthocyanins Secondary Prevention Managing Pain – Pain interferes with enjoyment of life – Pain management can improve quality of life – The first step is diagnosis – Assessing your pain – Keeping track – Descriptive language – Numerical Scales – Verbal Scales – Visual Scales Understanding Your Pain – Exacerbating factors—Makes it worse – Emotional – Mental – Physical – Environmental – Social – Mitigating factors – Helps You Feel Better – Emotional – Mental – Physical – Environmental – Social Mapping a Treatment Plan – Complex equation – Some treatment might involve a team of professionals – Pain therapy goals – Multimodal approach – Treatment interference – Holistic/complementary care – Treat the cause Mapping a Treatment Plan (Cont’d) – Available treatment options include: – Pharmacotherapy – Psychosocial Interventions – Rehabilitation Techniques – Complementary & Alternative Medicine (CAM) – Injection/Infusion – Implantable Devices and Surgical Interventions Pharmacotherapy – Using medicine to control pain – OTC or Prescription – Special programs available to assist people who cannot afford their medication – 3 Classes of Analgesics – Non-Opiods – Opiods – Adjuvant Analgesics Medical Interventions for Pain – Tylenol and NSAIDS (Over the counter) – Opiates – Provide relief by attaching to opioid receptors – Body stops making natural (endogenous) opioids when flooded with prescription opiates – Over time body reduces amount of opiate being let through (tolerance) (after only several days) – When you stop taking prescription opioids the body takes a few days to start making natural opioids again so pain threshold is markedly decreased Adjuvant Analgesics – Corticosteroids – Muscle Relaxants – Topical Analgesics – Local Anesthetics – Drugs for Anxiety, Depression (Serotonin) and Sleep (cortisol, GABA and Serotonin) Complimentary Therapies – Mind-Body Interventions – Prayer, Guided Imagery, Pilates – Biologically Based Therapies – Aromatherapy, Dietary Supplements/Nutrition – Manipulative and Body-Based Methods – Chiropractic Care, Massage, TENS, Dry Needling, PT – Energy Therapies – Qigong, Healing Touch, Reiki, Therapeutic Touch, Accupuncture Complimentary Ther
October 22, 2019
434- Impact of Social Media on Mental Health Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs.com Podcast Host: Counselor Toolbox Podcast, Case Management Toolbox Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free weeks of TherapyNotes with coupon code “CEU” Objectives – Examine the extent of social media use – Explore the positive and negative impacts of social media on mental and physical health – Identify resiliency factors What Research Tells Us – The number of social media accounts is moderately correlated inattention, hyperactivity/impulsivity, ODD, anxiety, and depressive symptoms, as well as fear of missing out (FoMO) and loneliness. – Chicken/Egg- What Research Tells Us – Internet use in general significantly affects participation in IRL experiences. – Increased time spent online is related to – A decline in communication with family members (or inadequate support to begin with) – Reduction of the internet user's social circle – Reduction in sleep – Increased feelings of depression and loneliness – Chicken or egg – Internet cause or ancillary behaviors cause- What Research Tells Us – People spend the majority of their time on SNS looking at peers’ profiles and photos, rather than posting or updating their own profiles – Computer-mediated communication may lead to the mistaken impressions about physical appearance, educational level, success, intelligence, moral integrity, and happiness of other people, thus increasing depression. – Constant self-evaluation and competition with other users, incorrectly perceiving characteristics of others and feelings of jealousy may positively or negatively influence self-esteem. What Research Tells Us – Technology-based Social Comparison and Feedback-Seeking (SCFS) was found to be associated with depressive symptoms when comparing people with similar levels of overall frequencies of technology use, offline Excessive Reassurance-Seeking (ERS), and prior depressive symptoms – Stronger associations between technology-based SCFS and depressive symptoms for unpopular individuals – May increase FoMo – Allows for unhealthy perseveration What Research Tells Us – Higher psychological distress was associated with displaying depression language on Facebook and with less satisfaction with friend’s responses – Depression was negatively correlated with how much social support participants thought they received from their Facebook networks – Sudden cessation of online social networking (i.e., lack of Internet connection) may in some chronic users cause signs and symptoms of psychological withdrawal – Some researchers identify that due to the wide array of activities available on SNS, it is difficult to conclude which parts contribute to preoccupation and withdrawal (gaming, FoMo, attention etc…) Benefits – Easily reach millions of people with information to improve their health literacy – Increase health-related behaviors through gamification and social support (Garmin, Bodybuilding.com, SparkPeople) – Allows for potential screening and early identification of problems #bigbrother – May bring to light conversations and behaviors that existed all along IRL – Increases communication with IRL friends at a distance Resiliency Factors – IRL support – Self esteem – A sense of belonging – Self-awareness – Effective communication skills – Psychological flexibility – Alternate sources of validation – Understanding of the algorithms on SNS – Fewer stranger connections Question – What social media factors influence depression/anxiety in people – Number of likes – Whether it appears other people are happier, more successful or more popular – Check-ins during extended absences – Comments (support, flam
October 17, 2019
Mind-Body Connection: How Health, Thoughts, Feelings and Behaviors Interact Counselor Toolbox Podcast Episode 433 Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs.com Podcast Host: Counselor Toolbox, Case Management Toolbox Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free weeks of TherapyNotes with coupon code “CEU” Objectives – A healthy body is essential to health and happiness. – Explore… – How emotions are created – How physical symptoms including pain, fatigue are created – How is this done (general overview) – ANS/PNS – HPA Axis – Circadian Rhythms – Gut-Brain Axis and the Vagus Nerve – The bidirectional relationship between the mind and body How are Emotions Created (Simplified) – Born with the capacity for anger (fight), fear (flee/freeze), depression (f-It) – Emotional responses are regulated by the autonomic nervous system (ANS) – SNS- Sympathetic (Fight or Flee) – PSNS- Parasympathetic (Rest and Relax) – The limbic system helps control the ANS and PNS – Hippocampus (memory consolidation, learning, attention, olfaction) – Amygdala (fight or flee/survival) – Hypothalamus (hormone regulation (HPA-Axis)) How are Emotions Created – Unconditioned emotional responses are reactions to stimuli which did not need to be learned– i.e. present from birth – Startle (puppy) – Pain-Cry (shots) – “Love”/ “contentment” (kangaroo care) How are Emotions Created – Conditioned emotional responses are learned emotional reactions to stimuli – What things get conditioned and how can they cause or reduce stress- – Dogs/Fire/Police/Guns – Phone Calls – Being Alone (child vs. adult) – Transference – Failure – Rejection – Loss of Control HPA –Axis (Threat Response System) – Secretion of adrenaline, norepinephrine and corticotropin releasing hormone (CRH) – Cortisol is released – Glutamate is released and GABA is inhibited – Blood pressure increases – Blood glucose is elevated – Some 5HT receptors are activated, others are inhibited Neurobiology of Attachment – Hormones including dopamine, norepinephrine, cortisol, oxytocin and the serotonergic system modulate attachment – Opioids may inhibit oxytocin and reduce feelings of social connection How Physical Sensations Are Created – Nociception can occur in the absence of awareness of pain, and pain can occur in the absence of measurably noxious stimuli – CNS receives a pain signal from the PNS (peripheral nervous system) – This triggers the Autonomic Nervous System and HPA-Axis – All pain “information” is transmitted via glutamate – An “inflammatory soup” is created which results in signals to the CNS as well as initiating inflammation which releases substance P and causes vasodilation, leakage of proteins and fluids into the extracellular space near the terminal end of the nociceptor (swelling), and stimulation of immune cells – Substance P is associated with depression and anxiety symptoms Neurotransmitters Pain & Fatigue – Serotonin – 5-HT2A receptor produces anxiety, pain, insomnia – 5HT1A receptors reduce anxiety, pain, insomnia – Serotonin directly and indirectly regulates dopaminergic neurons – GABA may decrease the perception of pain. – Dopamine – Helps relieve pain – Increases energy – Norepinephrine – Activated during pain (emotional and physical) and causes decreased sensitivity to painful stimuli (hypoalgesia) and pain relief (analgesia). – Mobilizes the brain and body for action Gut-Brain Axis – Up to 95% of some neurotransmitters are made in the gut – The gut communicates with the brain via the vagus nerve, the enteric nervous system – Lactobacillus produces acetylcholine &
October 12, 2019
432 -Animal Assisted Therapy Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs.com Podcast Host: Counselor Toolbox, Case Management Toolbox Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free weeks of TherapyNotes with coupon code “CEU” Objectives – Define Animal Assisted Therapy – Explore the research around animal assisted therapy – Review some general cautions Definitions – Animal Assisted Activities/Pet-Therapy – Integration of animals into activities to facilitate motivation, education and recreation, encouraging casual interaction without following a specific set of criteria or goals – Animal Assisted Therapy – Intentional and therapeutic, whereby the animal’s role is integral in assisting with mental health, speech, occupational therapy or physical therapy goals, and augments cognitive, physical, social and/or emotional well-being General Benefits – Reduced blood pressure – Release of oxytocin – Increase in understanding of UPR (3 legged dog, one eyed cat, blind horse) – Increase ability to take multiple perspectives – Enhance empathy and compassion – Biofeedback/Mindfulness – Stress reduction and laughter – Increased physical activity – Consistency and clear communication – Decrease learned helplessness behaviors and increase a sense of control over self and environment General Benefits – Act as a bridge by which therapists can reach patients who are withdrawn, uncooperative, and uncommunicative – Participants interacting with the animals were more inclined to smile and demonstrate pleasure, and were more sociable and relaxed with other participants – More sensitive issues can be rendered less incendiary when an animal is involved – A multisensory aspect is also available when an animal is involved; increasing the level of attention and interest of the client who is active or struggles with focus or concentration Which Animals Can Be used – Any Animals… – Fish (AAA) – Guinea Pigs (AAA) – Dogs (AAA, AAT) – Cats (AAA, AAT) – Rabbits (AAA) – Horses (AAA, AAT) – Dolphin (AAA, AAT) Hippotherapy (Equine) – Using horse movement to compliment therapy – Self-awareness – Developing trust and respect – Meeting/Join Up (understanding the prey/predator relationship) – Petting – Feeding – Addressing personalization/exploring dialectics – Going into a barn or trailer – Bonding/relaxation – Confidence – Acceptance (despite being different) – Choosing animals with differences – Highlighting unique animal pairs (donkey and goat) Farm Animals – The diversity of a farm experience offers much stimulation, and provides the basis for creative and varied interventions, such as providing the client with opportunities to practice – Nurturing activities – Organizational skills – Perspective taking (no 2 animals are exactly alike) – Problem solving Dogs – A “dog’s social life is organized around dominance-subordinance relationships” – Dogs are expected to obey commands and offer clients what is often referred to as “unconditional acceptance” (Brewster vs. Duke) – Difference in the children’s response during sessions, including more laughing, increased eye contact, communication with the dog, and a desire to connect through feeding the animal dog treats – Teaching people positive dog training techniques could help them understand – Clear communication – Relationship development (trust, respect, nurturance and termination) – Empathy – Perspective-taking – Delayed gratification – The connection between behaviors and consequences in a non-threatening manner Dogs – Teaching people positive dog training techniques could help them – Learn patience and
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
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