Counselor Toolbox Podcast

Addressing the Unique Mental Health Needs of College Students 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 defeated, in the process. ~ Resilient graduates better navigate today’s uncertain and volatile economic, employment, and career environments. ~ Challenges to health and well-being undermine resilience by making it more difficult for the student to deal with life on life’s terms ~ Less resilient students take fewer intellectual and creative risks and are poor partners in group learning situations Developing Resilience ~ Hardiness (Commitment, control

Best Practices for the Treatment of Anxiety Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Objectives ~ Explore common causes for anxiety symptoms ~ Identify common triggers for anxiety ~ Identify current best practices for anxiety management including ~ Counseling Interventions ~ Medications ~ Physical Interventions ~ Supportive Treatments Why I Care/How It Impacts Recovery ~ Anxiety can be debilitating ~ Low-grade chronic stress/anxiety erodes energy and ability to concentrate ~ Anxiety is a major trigger for: ~ Addiction relapse ~ Increased physical pain ~ Sleep problems Triggers for Anxiety ~ Abandonment & Rejection ~ Low self-esteem ~ Irrational thoughts and cognitive distortions ~ Unhealthy social supports/relationships ~ Ineffective interpersonal skills  relationship turmoil and/or social anxiety ~ The unknown & Loss of control ~ Negative self talk and cognitive distortions ~ Negative others ~ Physical complaints ~ Sense of powerlessness Triggers for Anxiety ~ Death & Loss ~ People and pets ~ Jobs and promotions ~ Safety and security ~ Dreams and hopes ~ Sickness, spiders and other phobias ~ Failure ~ Perfectionism ~ Negative self-talk General Treatment Recommendations ~ Anxiety, depression and substance disorders as well as a range of physical disorders are often comorbid. This provides researchers key opportunities to explore pathways to mental disorders and provides clinicians key opportunities to intervene accordingly. ~ Anxiety disorders should be treated with psychological therapy, pharmacotherapy, or a combination of both. ~ Cognitive behavioral therapy can be regarded as the psychotherapy with the highest level of evidence. ~ Current conceptualization of the etiology of anxiety disorders includes an interaction of psychosocial factors such as childhood adversity or stressful events, and a genetic vulnerability. General Treatment Recommendations ~ Current conceptualization of the etiology of anxiety disorders indicates clinicians need to explore the interaction of: ~ Psychosocial factors such as: ~ Childhood adversity or stressful events ~ Trauma related brain changes ~ Coping skills (learned or not learned) ~ Trauma issues still needing to be dealt with (domestic violence, parental absence, bullying…) ~ Current stressors ~ Current availability of social support General Treatment Recommendations ~ Current conceptualization of the etiology of anxiety disorders includes an interaction of: ~ Genetic vulnerability ~ Medications ~ Susceptibility to effects and development of dependence ~ Which medications will be effective ~ Vulnerabilities – Which conditions are more challenging for each person Medications ~ First-line drugs are the SSRIs and SNRIs ~ Effexor was effective according to the Hamilton Rating Scale for Anxiety ~ Zoloft, Paxil, Luvox, Lexapro, Celexa have all been found effective. ~ At least 4 different genetic variations can be correlated with development of generalized anxiety disorder. Different medications are more or less effective depending upon the genetic makeup of the person. ~ There is a higher mortality rate among benzodiazepines users compared with nonusers. ~ There is an increased risk for dependence with use for more than 6 months. ~ An increased risk of dementia was also identified in long-term (>6 months) benzodiazepine users. ~ Benzodiazepines do not treat depression, and may be associated with a higher suicide risk in comorbid anxiety and depressive disorders. ~ Other treatment options include tricyclic antidepressants, seroquel, buspirone. WebMD Health News Reviewed by Louise Chang, MD on May 06, 2008 ~ After remission, medication should be continued for ~12 months. Symptoms of Generalized Anxiety ~ Physical signs and symptoms may include: ~ Fatigue ~ Irritability ~ Muscle tension or muscle aches ~ Trembling, feeling twitchy ~ Being easily startled ~ Trouble sleeping ~ Nausea, diarrhea or irritable bowel syndrome ~ Headaches ~ Mitigate the symptoms

Counseling Theories for Individuals Instructor: Dr. Dawn-Elise Snipes Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery & The Addiction Counselor Exam Review Objectives ~ Review the most common counseling theories and related interventions Cognitive Behavioral ~ Premise ~ People respond to their representation of events rather than the events themselves ~ Learning is cognitively mediated ~ Thoughts impact emotional and behavioral reactions ~ Some types of thoughts can be monitored and modified ~ Modifying thoughts can help modify emotions and behavioral responses ~ Both behavioral and cognitive techniques are useful and can be integrated ~ Goal: ~ To identify and correct unhelpful cognitions by clarifying and challenging unhelpful or inaccurate cognitive schema and increase the client’s problem-solving abilities Cognitive Behavioral Assessment ~ Clinical interviews can clarify antecedents and consequences to emotions and behaviors and strategies that have and have not been helpful in the past ~ Inventories and questionnaires are helpful in identifying cognitive distortions ~ Self-monitoring can help identify the frequency, antecedents and consequences of unhelpful thoughts and/or reactions ~ Data from the assessment helps identify the client’s: ~ Problem solving ability ~ Attributional style (Global/Stable/Internal) ~ Underlying belief systems (Cognitive distortions) Cognitive Behavioral Interventions ~ Daily mood and activity monitoring ~ Increase rewarding behaviors and establish a daily routine ~ Develop understanding of the relationship between feelings, thoughts and behaviors ~ Graded tasks to help clients start approaching and addressing seemingly overwhelming problems ~ Teach new skills and have client practice them between sessions ~ Address automatic thoughts ~ Teach the concept ~ Elicit the client’s thoughts ~ Label the distortion ~ Identify, challenge and modify maladaptive schemas ~ Develop helpful alternatives Cognitive Behavioral Interventions ~ ABC-DE ~ Activating Event ~ Beliefs (Automatic) ~ Consequences (Emotional and behavioral reactions) ~ Dispute cognitive distortions and inaccurate schema ~ Evaluate the reaction/consequences for helpfulness ~ Cognitive Processing ~ Fact vs. emotional reasoning ~ Facts for and against ~ Big picture or tunnel vision (context/hindsight) ~ High vs. low probability ~ Cognitive distortions? Cognitive Behavioral Interventions ~ Downward arrow (Follow it through) ~ If so, then what… ~ Questioning the evidence ~ Decatastrophizing ~ Cognitive rehearsal ~ Problem solving skills training ~ Thought stopping ~ Behavioral ~ Narrowing (unlinking) ~ Cue strengthening for positive behaviors ~ Self-reinforcement and punishment Cognitive Behavioral Indicators ~ Indications ~ Mood disorders (depression, anxiety, phobias) ~ Fears of failure, rejection, abandonment ~ Eating disorders ~ Personality disorders ~ Counterindication ~ Significant cognitive dysfunction, psychosis or mania Behavioral Models ~ Premise ~ Emphasis on current behaviors which are under stimulus control ~ Reject the idea that maladaptive behaviors reflect underlying pathology ~ Elimination of the behavior is the primary goal of treatment ~ Assessment takes the form of a functional analysis ~ Antecedents, consequences and discriminative stimuli ~ Naturalistic observation ~ Self monitoring ~ Role playing ~ Rating scales Behaviorism Principles ~ Operant conditioning ~ Behaviors are increased or decreased through punishment and reinforcement ~ Observational learning Behavioral Therapy ~ Goal: Identify stimuli, reinforcers and punishments in the environment which are maintaining the problem behavior ~ Remove reinforcement and cues for target behavior ~ Increase reinforcement and cues for new behavior ~ Assessment ~ Emphasizes observable, measurable behaviors and patterns ~ Client and therapist agree on the definition of the problem behavior ~ Baseline data is acquired Behavioral Therapy Interventions ~ Systema

Addressing the Unique Mental Health Needs of College Students 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 defeated, in the process. ~ Resilient graduates better navigate today’s uncertain and volatile economic, employment, and career environments. ~ Challenges to health and well-being undermine resilience by making it more difficult for the student to deal with life on life’s terms ~ Less resilient students take fewer intellectual and creative risks and are poor partners in group learning situations Developing Resilience ~ Hardiness (Commitment, control

Introduction ~ Past 30 Day statistics, According to the 2012 National Survey on Drug Use and Health, ~ 6.5% of the population over 12 reported heavy drinking ~ 9.2% reported illicit drug use ~ The majority of people who use recreationally will not need treatment ~ Addiction is characterized by compulsive craving for the substance and using that substance despite negative consequences ~ Cravings and compulsive behavior are caused in large part as a consequence of substance use or addictive behaviors on the brain causing ~ Emotional ~ Cognitive ~ Physical ~ Behavioral changes Definition of Addiction ~ Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. ~ Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations reflected in pathological pursuit of a reward and/or relief by a substance. ~ Without treatment and/or engagement, addiction is progressive and can result in disability or premature death. (ASAM 2011, NIDA 2007) Characteristics of Chronic Disease ~ Disrupts normal functioning ~ Have serious, harmful consequences ~ Are preventable and treatable ~ Can last a lifetime ~ May be fatal if untreated Addiction—A Description, not a Diagnosis ~ Addiction is a description, not a diagnostic term. ~ Addiction erodes a person’s self-control and ability to make sound decisions ~ The DSM V has 3 categories – ~ Intoxication ~ Withdrawal ~ Substance Use Disorder Factors Influencing Addiction ~ No single factor is causative ~ General Categories ~ Biological/genetic makeup ~ Gender ~ Ethnicity ~ Developmental stage/early use ~ Social environment ~ Proximal (neighborhood, school/work, friends, family) ~ Cultural/Media/Availability ~ Method of administration Factors Influencing Addiction ~ Genetic Factors ~ 40-60 % of a person’s vulnerability is genetic. ~ Expression of these genes is influenced by: ~ Effects of the environment ~ Reactions/effects of addictive behaviors ~ Genetic predisposition to mental health issues (self-medication) ~ Social Environment & Peer and School ~ Access ~ Social learning of acceptability and use patterns ~ Exposure to peers/family who engage in criminal behavior ~ Academic/work failure ~ Poor social skills / unstable relationships Factors Influencing Addiction ~ Developmental/Early Use ~ The earlier the initiation, the greater the likelihood it progresses to addiction ~ Addictive behaviors have a stronger impact on the developing brain (esp. the prefrontal cortex) ~ Indicative of a set of vulnerabilities/triggers ~ Genetics ~ Mental Illness ~ Unstable family relationships ~ Exposure to abuse Factors Influencing Addiction ~ Method of Administration ~ Smoking and injection increase addictive potential due to ~ Rapid transit to the brain (seconds) ~ Rapid fade of effects (crash) Continuum of Addiction ~ Social – risky/problematic –abuse –dependence ~ Many individuals never progress beyond risky consumption ~ Recovery from addiction is a multidimensional process which differs between people and changes over time. ~ Risky/problematic users have some amount of control and can learn methods to cope. ~ Dependent users seem to have no control over their use. ~ One and done ~ Progression over time Summary -Definition of addiction -Characteristics of a chronic disease -Factors Influencing Addiction -Continuum of addiction -Theories of causation -Reinforcers within the cycle of addiction

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 the guilt they would feel if the person they’re enabling were hurt by the real consequences of their actions. ~ Enablers are also protecting themselves and/or children from those consequences ~ Enabling means that someone else will always fix, solve, or make the consequences go aw

Hazing Prevention in High School and College Hazing Alternatives ~ What is the supposed function of hazing? Objectives ~ Define hazing ~ Explore the purpose of hazing ~ Identify alternatives to hazing ~ Identify the timeline for hazing prevention ~ Identify the role of administrators, coaches, the Panhellenic council, student-athletes, sorority and fraternity members and presidents, and counseling departments ~ Review the hazing “test” What is Hazing ~ Any action taken or any situation created intentionally that causes embarrassment, harassment or ridicule and risks emotional and/or physical harm to members of a group or team, whether new or not, regardless of the person’s willingness to participate ~ 79% of NCAA athletes report coming to college with a prior hazing experience from high school or middle school What is Hazing ~ Types of Hazing ~ Verbal abuse ~ Forced activities for new recruits to ‘prove’ their worth to join ~ Being asked to perform acts that go against personal beliefs such as committing a crime, humiliating someone else ~ Simulating sexual activities ~ Being subjected to a perceived physical danger (including beatings, ~ Requirement to endure hardships such as staying awake, physical labor ~ Coerced alcohol abuse ~ Personal servitude or meaningless tasks Hazing Facts to Know ~ Any setting in which total respect for everyone’s dignity is not present can lead to a hazing climate/environment. ~ “Severity” is not always measured in observed harm . Some hazing victims report that the mental hazing they endured was worse that being physically abused. ~ Earlier trauma can make what may seem like a prank to some, emotionally distressing to others. ~ Pre-emption and prevention is much more effective than reaction. ~ Hazing is denied by using aliases: Pranks, stunts, antics, traditions, initiations, rites of passage ~ Alcohol reduces inhibitions and the ability to resist or protest. ~ Where there is a power imbalance, there is a risk of coercion. Difference Between Hazing and Bullying ~ The Intersection of Bullying and Hazing – how are they similar? ~ Motivation for bullying and hazing is often identity-based ~ Imbalance of power exists ~ Left unchecked each can contribute to an environment where the behavior is acceptable ~ Each is a precursor to more destructive, hateful behavior ~ The Intersection of Bullying and Hazing – how are they different? ~ Bullying excludes the target from the group, whereas hazing is a ritual or process imposed on a person who wants to be part of the group ~ Bullies often act alone, but hazing usually involves a group, team or organization How is Hazing Justified? ~ Moral Justification – Make it socially worthy (e.g., creating bonds, building unity). ~ Euphemistic labeling – Sanitized language of non-responsibility (e.g., “team building”). ~ Advantageous comparison – War analogy – “We’re going to battle.” ~ Diffusion of Responsibility – Normative conformity “Everyone is doing it;” avoidance of personal responsibility. ~ Disregard/distortion of consequences – No evidence anyone was seriously injured. ~ Athlete on a scholarship ~ Sorority member who has paid dues, meal plan, lives in house ~ Team member who dropped out because he “changed his mind.” How is Hazing Justified? ~ Displacement of responsibility ~ “We’re just carrying on tradition” ~ Intentionally uninformed – “We don’t have a problem with hazing here,” or “I don’t want to know.” ~ Surreptitious sanctioning (wink and nod) ~ Dehumanization – Perception of freshmen as “less than”; use of masks, costumes, etc. ~ Attribution of Blame – Blame the victim – “They agreed to it.” Impact of Hazing ~ Physical, emotional, and/or mental illness ~ Eating disorders ~ Substance abuse (laxatives, steroids, numbing drink) ~ Lowered self-esteem from rejection ~ Suicide ~ Poor grades ~ Withdrawal from activities ~ Sleep disruption from depression, trauma or anxiety ~ Loss of sense of control and empowerment ~ Relationships with friends, significant o

Teaching Social Justice Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Objectives ~ Define social justice ~ Explore the goals of social justice education to include ~ Identity ~ Diversity ~ Justice ~ Action Define Social Justice ~ The National Association of Social Workers defines social justice as “the view that everyone deserves equal economic, political and social rights and opportunities.” Why Is Social Justice Important in Counseling ~ In what ways can a social justice education assist clients… ~ Emotionally ~ Cognitively ~ Socially ~ Occupationally ~ Physically Why Is Social Justice Important in Counseling ~ In what ways can a social justice education assist counselors ~ Identify community needs and strengths ~ Help clients tap into appropriate resources ~ Connect with and better understand clients Social Justice ~ Discrimination and bias contribute to ~ Emotional: Stress ~ Cognitive: Low elf esteem and self-efficacy, creation of erroneous biases, ~ Interpersonal: Conflict ~ Occupational/Environmental: Reduced access to opportunities and services and a reduction in What is the Impact ~ Women are bad at math ~ During the last 30 years, the gaps in these scores have dropped dramatically in the U.S. In some nations (like Indonesia and Iceland), women outperform men in the tip-top of mathematical performance. ~ Stereotype susceptibility Asian-American women who were reminded of their Asian identities their math performance improved, while reminders of their femininity had the opposite effect. ~ People with mental illness are dangerous ~ – “…the vast majority of people who are violent do not suffer from mental illnesses (American Psychiatric Association, 1994).“ ~ only 3 to 5 percent of violent acts can be attributed to serious mental illness. (mentalhealth.gov) What is the Impact ~ People with mental illness are bad employees ~ Many are medicated and asymptomatic ~ About 18% of workers in the U.S. report having a mental health condition in any given month. (The NSDUH Report https://www.samhsa.gov/data/population-data-nsduh. The ADA National Network https://adata.org/factsheet/health) ~ Criminals are bad people ~ All people with addictions are criminals Goals for Social Justice Education Identity ~ Students will develop positive social identities based on their membership in multiple groups in society. ~ Students will develop language and historical and cultural knowledge that affirm and accurately describe their membership in multiple identity groups. ~ Students will recognize that people’s multiple identities interact and create unique and complex individuals. ~ Students will express pride, confidence and healthy self-esteem without denying the value and dignity of other people. ~ Students will recognize traits of the dominant culture, their home culture and other cultures and understand how they negotiate their own identity in multiple spaces. What is your identity ~ Take 5 minutes and complete the sentence “I am a _______________” as many times as needed to define who you are. ~ I am a mother, daughter, teacher, business owner, friend, college graduate, farmer, advocate for animal welfare, runner, white, female, Christian, middle class… ~ What does it mean to be a part of each of those groups? ~ Which identities interact (i.e. animal welfare and farmer; business owner and mother)? ~ How does each of my identities impact my interactions with others and the world? ~ How does each of these identities impact my work with clients? Example: ~ As part of a class project, Rebecca completes the following personal mission statement: “I am more than one identity. I will celebrate all of my in-group and out-group identities and work to understand how they overlap to make up who I am as an individual. I will not allow others to put me into boxes.” ~ Rebecca explains that being a student, sister, female, Latina, Spanish speaker and dan

Strengths based Biopsychosocial Approach to Addressing Addiction Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Objectives ~ Identify relapse triggers ~ Identify the components of a strengths based approach ~ Explore the types of strengths to identify in each of the 9 life domain areas ~ Review some basic strengths-based questions Relapse Triggers ~ Sense of powerlessness and hopelessness ~ Lack of self-confidence ~ Low self-esteem ~ Poor relationships / lack of social support ~ Ineffective interpersonal skills ~ Lack of sufficient resources 5 Components of a Strengths-Based Approach ~ Components ~ 1. Client responsibility for recovery ~ 2. Client-directed goal-setting ~ 3. Focus on client strengths and resources ~ 4. Collaboration and partnership ~ 5. Community-based services and resources ~ Function ~ Make the most of client and community strengths ~ Build the most effective therapeutic relationships with clients ~ Develop clients’ ability to believe in themselves and in the success of treatment 9 Life Domains for Strengths and Goals ~ 1. Life Skills ~ 2. Finance ~ 3. Leisure ~ 4. Relationships ~ 5. Living Arrangements ~ 6. Occupation/Education ~ 7. Health ~ 8. Internal Resources ~ 9. Recovery Client Responsibility for Recovery ~ When people take responsibility for their own recovery, they feel a greater sense of investment in the outcome. ~ An urge to go back to self-destructive behavior looks less like rebellion or resistance, and more like a threat to their own interests. ~ As the ability to take responsibility is exercised and strengthened, a sense of confidence and self-esteem grows. ~ The focus on the client’s own strengths and resources helps people become empowered and feel confident in their ability to succeed in recovery ~ The strong sense of collaboration and partnership in the treatment process creates a more active partnership role Benefits ~ Finding resources within the family, culture, and community helps develop supportive relationships and provides a broad base of ongoing resources that the client can use beyond the treatment setting. ~ Clients learn more about themselves and their goals as they try out their plans in real life and reflect on their results in treatment sessions ~ Clients learn and practice goal-setting and solution-building skills that they can use throughout their lives. ~ Each revision of their goals and plans carries clients farther in the recovery process Client Directed Goal Setting ~ Strength-based providers become teachers, coaches, and resources to their clients, as clients learn to: ~ Set their own goals, including treatment goals ~ Make plans to meet their goals, using the strengths that they continue to identify ~ Try out their goals and plans and report on the results ~ Revise their goals and plans as they gain more information and experience Client Directed Goal Setting ~ As the goals are defined, providers also help people identify: ~ Small, manageable steps toward those goals ~ Concrete actions they can take ~ Resources they can call on to complete these tasks ~ Strengths within themselves that will help them reach their goals ~ Paradigm shift from ~ Pointing out the problems to eliminate ~ Developing treatment goals for their clients, or directing clients in the goal-setting process ~ Focusing on complete abstinence as the only legitimate treatment goal Focus on Client Strengths and Resources ~ A number of techniques help in the strength-finding process, including: ~ First learning about their clients from the people's own words, rather than from case histories or primarily negative intake or assessment forms ~ Encouraging people to tell their stories and talk about their experiences in their own words ~ Listening for evidence of people's values, skills, inner strengths, cultural strengths, family and community resources, etc. ~ Watching people's behavior for signs of strength ~ Pointing

Working with Parents with Premature Infants Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director: AllCEUs.com Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Objectives ~ Review medical issues for preemies ~ Discuss life in the NICU ~ Explore the range of feelings in NICU families ~ Identify strategies to help bond with baby ~ Explore parenting under the microscope (in the NICU) ~ Identify methods for easing discharge anxieties Health Problems That May Affect Preemies ~ Intraventricular hemorrhage (IVH). This is bleeding in the brain. It usually happens near the ventricles in the center of the brain. A ventricles is a space in the brain that’s filled with fluid. ~ Patent ductus arteriosis (PDA). This is a heart problem that happens in the connection (called the ductus ateriosus) between two major blood vessels which can c ause breathing problems or heart failure. ~ Necrotizing enterocolitis (NEC). This is a problem with a baby’s intestines that can cause feeding problems, a swollen belly and diarrhea. It sometimes happens 2 to 3 weeks after a premature birth. ~ Retinopathy of prematurity (ROP). This is an abnormal growth of blood vessels in the eye. ROP can lead to vision loss. ~ Anemia. This is when a baby doesn’t have enough healthy red blood cells to carry oxygen to the rest of the body. Health Problems That May Affect Preemies ~ Jaundice. This is when a baby's eyes and skin look yellow. A baby has jaundice when his liver isn't fully developed or isn't working well. ~ Most preemies become jaundiced at some point and need to bask in the billi-lights (light therapy) Health Problems That May Affect Preemies ~ Apnea caused by immaturity in the area of the brain that controls the drive to breathe (the brain doesn't “remember” to take a breath). ~ These breathing abnormalities may begin after 2 days of life and last for up to 2 to 3 months after the birth ~ The first line of treatment for apnea is simply stimulating the baby to help him or her remember to breathe. This can mean rubbing the baby's back or tapping the feet ~ May limit interaction time with baby (overstimulation) ~ Apnea of prematurity usually ends on its own with time. ~ Healthy infants who have had AOP usually do not go on to have more health or developmental problems than other babies. ~ AOP does not cause brain damage, and a healthy baby who is apnea free for a week will probably never have AOP again. Health Problems That May Affect Preemies ~ Respiratory distress syndrome (RDS). This is a breathing problem because the baby doesn’t have a surfactant that keeps small air sacs in the lungs from collapsing. ~ Bronchopulmonary dysplasia (BPD). This is a lung condition that can develop in premature babies as well as babies who have treatment with a breathing machine. Babies with BPD sometimes develop fluid in the lungs, scarring and lung damage. ~ Infections. Premature babies often have trouble fighting off germs because their immune systems are not fully formed. Infections that may affect a premature baby include pneumonia, a lung infection; sepsis, a blood infection; and meningitis, an infection in the fluid around the brain and spinal cord. ~ Other diagnoses can be found here: https://kidshealth.org/en/parents/nicu-diagnoses.html NICU Life Life in the NICU ~ The NICU is a wealth of sensory input. ~ Machines have unique operating noises and alarms that may frighten you or make you feel something is not right with your baby. ~ The NICU staff will explain what they mean. ~ As you spend more time in the NICU, you too will begin to distinguish among various alarm sounds. ~ Depending on the time of day, the unit may be a flurry of activity. ~ Many different health care providers involved in your baby’s care will introduce themselves to you. Don’t worry about remembering their names or what they do. The staff understand that you are taking in a lot of new information. Life… ~ Some hospitals will allow the mother to stay on the L&D

Strengths Based Biopsychosocial Approach to Recovery from Depression Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery 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 ~ 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 external 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 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 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 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 ~ Opiates ~ Improve nutrition Neurotransmitters ~ 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 ~ Impact 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 Behavioral and Cognitive Neuroscience Reviews Volume 4 Number 1, March 2005 43-58 ~ 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”). ~ DHEA ~ DHEA can also increase libido and sexual arousal. It improves motivation, engenders a sense of well-being, decreases pain, facilitates the rapid eye movement (REM) phase of sleep, enhances memory and enhances immune system function. Dr. Elise Schroder http://womeninbalance.org/about-hormone-imbalance/hormones-101/ Hormones ~ Get a physical to identify and address what may be causing any imbalances ~ Eat a low-glycemic diet ~ “The less sleep you get, the higher your cortisol will be; the more sleep you get, the lower your cortisol will

Strengths Based Biopsychosocial Approach to Recovery from Bipolar Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Objectives What is bipolar What causes bipolar disorder (and how to mitigate it) Emotionally (Stress reduction, Anger Mangement, Happiness) Mentally (Cognitive Errors and Negativity, Self-Esteem) Physically (Exercise, Nutrition, Sleep, Medication) Environmentally Understanding your bipolar Triggers (Depression & Mania) and interventions Warning Signs (Depression & Mania) and interventions Symptoms (Depression & Mania) Co-Occurring Conditions (and interventions) Why I Care/How It Impacts Recovery Uncontrolled bipolar disorder puts people at risk for Suicide Addictions and Addiction Relapse Extreme risk taking behavior Poorly controlled bipolar disorder can leave people feeling hopeless and helpless Well controlled bipolar, like well controlled addictions helps a person feel happy, optimistic, motivated and energized. What is Bipolar Disorder It is a brain a disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Many very successful people have managed their bipolar disorder including Mel Gibson Demi Lovato Axl Rose Britney Spears Jean-Claude Van Damme Mark Vonnegut Amy Winehaus Lee Thompson Young & Robin Williams were both quite successful and revered in their fields, despite losing the battle with bipolar What Causes Bipolar Disorder What causes bipolar disorder Imbalances in neurochemicals, especially dopamine, serotonin and norepinephrine Imbalances can be genetic, triggered by sex-hormone changes or stress-hormone changes Prevalence More than 1 in 50 adults are classified as having bipolar disorder in any 12-month period (2.6% of the adult population) Among patients seen in a primary care setting for depressive and/or anxiety symptoms, 20% to 30% are estimated to have bipolar disorder. Bipolar disorder is still underrecognized, primarily due to misdiagnosis as unipolar depression. Understanding Your Bipolar Understanding your bipolar Symptoms Depression Feel very sad, down, empty, or hopeless Have very little energy Have decreased activity levels Sleeping changes Feel worried and empty Have trouble concentrating Forget things a lot Eat too much or too little Feel tired or “slowed down” Understanding Your Bipolar Understanding your bipolar Symptoms Mania Feel very “up,” “high,” or elated Have a lot of energy and increased activity levels Feel “jumpy” or “wired” Have trouble sleeping Talk really fast about a lot of different things Be agitated, irritable, or “touchy” Feel like their thoughts are going very fast Think they can do a lot of things at once Engage in risky and/or reckless behavior Understanding Your Bipolar Understanding your bipolar Symptoms Mixed Includes symptoms of both manic and depressive symptoms Feeling very sad, empty, or hopeless AND Feeling extremely energized. Bipolar I: At least one manic episode Bipolar II: Understanding Your Bipolar Bipolar I patients experiencing depressive symptoms more than 3 times as frequently as manic or hypomanic symptoms Bipolar II patients experiencing depressive symptoms approximately 39 times more often than hypomanic symptoms. Common misdiagnoses Generalized anxiety disorder Goal directed activity is often related to an anxiety theme Mood is more irritable and energetic vs. elated Understanding Your Bipolar ADHD Approximately 60 to 70 percent of people with bipolar disorder also have ADHD. 20 percent of people with ADHD have bipolar disorder. Hyperfocus. This may happen on deadline pressure or when wrapped up in a compelling project, book, or video game. Hyperfocus may cause a decreased need for sleep and look like “increased goal-directed activity,” but is short-lived in people with ADHD, who often feel exhausted when hyperfocus fades. A manic episode is independent of external circumstances People with bipola

PostPartum Depression Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director: AllCEUs.com Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Objectives ~ Define postpartum depression ~ Identify signs of postpartum psychosis ~ Identify Risk factors of PPD ~ Identify screening tools and protocols ~ Discuss the impact of PPD on the mother, child and family ~ Identify the cause of PPD ~ Explore current biopsychosocial interventions for PPD ~ Postpartum depression usually occurs in the first 4 to 6 weeks after giving birth, and it is unlikely to get better by itself. ~ 50% of patients experienced depression for more than 1 year after childbirth. ~ Women who were not receiving clinical treatment, 30% of women with postpartum depression were still depressed up to 3 years after giving birth Define Postpartum Depression ~ Perinatal mood disorders (20-weeks gestation to 4 weeks of age) ~ According to the Centers for Disease Control and Prevention (CDC), up to 20 percent of new mothers experience symptoms of postpartum depression ~ Postpartum blues is a relatively common emotional disturbance with crying, confusion, mood lability, anxiety and depressed mood. ~ The symptoms appear during the first week postpartum, last for a few hours to a few days and have few negative sequelae. ~ At the other end of the spectrum, postpartum psychosis refers to a severe disorder beginning within four weeks postpartum, with delusions, hallucinations and gross impairment in functioning ~ Postpartum depression begins in or extends into the postpartum period and core features include dysphoric mood, fatigue, anorexia, sleep disturbances, anxiety, excessive guilt and suicidal thoughts for at least one month Signs of Postpartum Psychosis ~ Postpartum Psychosis is a rare illness, compared to the rates of postpartum depression or anxiety. It occurs in approximately 1 to 2 out of every 1,000 deliveries, or approximately .1 -.2% of births. The onset is usually sudden, most often within the first 2 weeks postpartum. ~ Symptoms ~ Delusions or strange beliefs which are ego syntonic ~ Hallucinations (seeing or hearing things that aren’t there) ~ Feeling very irritated ~ Hyperactivity ~ Decreased need for or inability to sleep ~ Paranoia and suspiciousness ~ Rapid mood swings ~ Difficulty communicating at times ~ The most significant risk factors for postpartum psychosis are a personal or family history of bipolar disorder, or a previous psychotic episode. ~ Note: Valproic Acid has a high rate of causing multiple congenital abnormalities as do carbamazepine and lithium (first trimester) Scary Thoughts ~ Scary thoughts are a very common symptom of postpartum depression. ~ Scary thoughts can come in the form of thoughts (“what if I …”) or images (imagining the baby falling off the changing table) ~ Scary thoughts can be indirect or passive (something might happen to the baby) or they can imply intention (thoughts or images of stabbing the child) ~ Scary thoughts are NOT indication of psychosis. ~ Scary thoughts can be part of a postpartum OCD diagnosis or PPD Scary Thoughts Interventions ~ Scary thoughts will make the woman feel like she is a bad mother. ~ They will make her feel guilty and ashamed. ~ It is a good sign if the thoughts are worrisome. ~ Remind her that these thoughts are NOT about who she is or her capability as a mother. Scary Thoughts ~ The nature of these thoughts: ~ Scary thoughts typically focus on the baby, but can also center on thoughts about you, or your partner. ~ Scary thoughts can be intermittent or constant. ~ They may be accompanied by compulsive behaviors (e.g. checking) ~ Some examples of scary thoughts: ~ “I’m afraid I might take one of the knives in my kitchen and stab the baby” ~ “I can picture myself driving off the road with my baby in the car” ~ “I think my family would be better off without me” ~ “I’m having sexual thoughts about my baby.” ~ “I can see terrible graphic violent things happening to my baby.” Scar

Question ~ What are some common issues or thoughts that trigger panic in people? Strengths Based Biopsychosocial Approach to Recovery from Panic Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC, NCC Executive Director, AllCEUs Objectives ~ Define panic ~ Examine how the fight or flight reaction can be corrupted to prompt panic attacks ~ Examine the cognitive, emotional, behavioral, biological sources of the stress reaction ~ Explore a variety of interventions that may assist people in counterconditioning the panic response How It Impacts Recovery ~ Panic attacks can feel overwhelming ~ Panic attacks are exhausting and can leave people feeling out of control of their own body ~ People can avoid things they have phobias of, but panic attacks seem to come out of the clear blue ~ People with panic attacks often restrict what they do (superstitiously) to avoid panic triggers ~ Awareness of what a panic attack is and what triggers them for each individual is crucial to recovery. The Body’s Response to Anxiety/Panic ~ We have a primitive response system that protects us from danger “Fight-Flight-Freeze” ~ To prepare to take on the threat, the body sends out “excitatory” signals ~ Increase in heartrate ~ Increase in respiration ~ Numbness or tingling in hands (blood to the core) ~ Sweating (temperature and slipperiness) ~ Pupil Dilation (blurred vision/spots/brightness) ~ Muscle Tension The Mind’s Response to Panic ~ Oh CRAP! ~ Something bad is going to happen or I wouldn’t be feeling this way ~ Catastrophic thinking— I’m going to ~ Pass out ~ Die ~ Throw up ~ ??? The Panic Cycle Track Panic Symptoms: Anxiety Log ~ Log your anxiety episodes (not just panic) ~ What were your symptoms ~ Physical ~ Cognitive ~ Emotional ~ What triggered it ~ Why did that trigger it ~ What may have made you more vulnerable to your triggers ~ How can you prevent those in the future? ~ What have you done in the past that might have helped in this situation? ~ Review your log each week to ~ Identify particular situations that might trigger panic and begin to address those ~ Identify times when you are not panicky and increase those Life Through Panic Colored Glasses ~ If you are hypervigilant about panic triggers, you will find them (Emotional reasoning) ~ Review your Anxiety Log ~ Identify your triggers ~ Make a plan to deal with them ~ Identify vulnerabilities ~ Make a plan to prevent them Body Awareness | Physical Mindfulness ~ Body Scan ~ What am I experiencing ~ What might be causing it ~ Blood Sugar ~ Stimulants ~ Adrenaline Rush ~ Orthostatic Hypotension ~ Hormones ~ Excitement or Panic Its only a False Alarm ~ Mindfully attending to panic ~ Feel the sensations (ride the wave) ~ Focus on breathing ~ Use positive self-talk ~ Distract ~ Keep a list of 3 things you can do to distract yourself ~ Pray ~ Sing ~ Call someone ~ Listen to music Exercise ~ When the body is on high alert because it is getting stress signals, but you are sitting still, there is a disconnect which causes: ~ An increase in stress chemicals ~ May trigger catastrophic thinking ~ One way to get the mind and body back in synch is to move ~ Providing a reasonable explanation for the increased heartrate and respiration ~ Using the stored energy that has been released to fuel the fight or flight reaction ~ Exercise also releases serotonin (a calming effect) Nutrition ~ Stimulants, medications and certain supplements can trigger a stress response. ~ Caffeine ~ Decongestants ~ Guarana ~ Hot peppers can trigger indigestion and a stress response (sweating, increased heart rate, difficulty breathing/chest tightness) ~ Low blood sugar can trigger ~ Cold hands ~ Dizziness ~ Trembling Nutrition ~ Keep your blood sugar steady by minimizing processed sugars/carbohydrates and if appropriate, having a protein with your carbs ~ Drink enough water ~ Explore decaffeinated green tea which is thought to have anti-anxiety effects Breathing, Meditation and Guided Imagery ~ Interventions ~ Mindful Breathing

Using a Strengths-Based Biopsychosocial Approach to Addressing Anxiety Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Objectives ~ Define a strengths based approach ~ Define a biopsychosocial approach Why I Care/How It Impacts Recovery ~ Anxiety can be debilitating ~ Low-grade chronic stress/anxiety erodes your energy and ability to concentrate ~ Anxiety is a major trigger for: ~ Addiction relapse ~ Increased physical pain ~ Sleep problems ~ Depression What Does Strengths Based Mean ~ It is easier (and more effective) to build upon something that already works to some extent. ~ Strengths-based approach helps people identify how they are already trying to cope and builds on that ~ There are two types of strengths ~ Prevention/Resilience Strengths ~ What you do on a daily basis to stay healthy and happy ~ Intervention/Coping Strengths ~ In the past when you have felt this way, what helped? ~ What made it worse? What is a Biopsychosocial Approach ~ Bio-logical ~ Neurochemicals ~ Nutrition ~ Sleep ~ Sunlight & Circadian Rhythms ~ Psycho-logical ~ Mindfulness ~ Distress Tolerance ~ Coping Skills ~ Cognitive Restructuring What is a Biopsychosocial Approach ~ Social ~ Improving self-esteem and your relationship with self ~ Improving relationships with healthy, supportive others 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) ~ 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 Biological Interventions ~ Your body thinks there is a threat. Figure out why ~ Supportive Care ~ Create a sleep routine ~ Helps the brain and body rebalance ~ Can help repair adrenal fatigue ~ Improves energy level ~ Nutrition ~ Minimize caffeine and other stimulants ~ Try to prevent spikes (and drops) in blood sugar ~ Drink enough water ~ Medication ~ SSRIs/SNRIs ~ Benzodiazepines ~ Buspirone Biological Interventions ~ Supportive Care cont… ~ Sunlight ~ Vitamin D deficiency has been implicated in some mood issues ~ Sunlight prompts the skin to tell the brain to produce neurotransmitters ~ Sunlight sets circadian rhythms which impact the release of serotonin, melatonin and GABA ~ Exercise ~ Studies have shown that exercise can have a relaxing effect. Start slowly. Ps