Counselor Toolbox Podcast

Adult Education & Teaching Skills to Improve Treatment/Service Planning Dr. Dawn-Elise Snipes, PhD, LMHC Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Find CEUs for this podcast on the Counselor Toolbox CEU spreadsheet Objectives ~ Redefine treatment plans ~ Examine how adult learning theory can help us create more individualized plans and objectives What are treatment plans? ~ Opportunities for teaching clients ~ Problem solving skills ~ Identifying and using personal strengths ~ Dynamic documents ~ Address client’s current functioning and needs ~ Evaluate client’s progress toward specified goals and objectives ~ Guide treatment for identified problems or issues ~ Enhance multidisciplinary team communication What is Treatment Planning? ~ Process in which counselor and client: ~ Identify and rank problems needing resolution ~ Establish agreed upon immediate and long-term goals ~ Decide on treatment methods ~ Identify necessary resources Treatment Plan Foundation ~ Biopsychosocial assessment ~ Current stressors ~ Coping skills ~ Self-esteem ~ Mental health ~ Substance abuse ~ Social network ~ Physical health Treatment Plan Development ~ Individualized treatment plan ~ Structured ~ Goal-oriented ~ Schedule of services ~ Developed jointly with client ~ Written document ~ Treatment-related goals ~ Measurable objectives ~ Interventions grounded in client’s learning style Adult Learning ~ Adults need to be involved in the planning and evaluation of their instruction. ~ Adults are most interested in learning subjects that are practical and have immediate relevance and impact to their job or personal life. ~ Adults are more engaged when there is a presenting crisis ~ Adult learning is problem-centered rather than content-oriented ~ Explain the reasons specific things are being taught ~ Instruction should be task-oriented instead of promoting memorization ~ Adult learners prefer collaboration and ability to think critically ~ Instruction should take into account the wide range of different backgrounds of learners ~ Since adults are self-directed, instruction should allow learners to discover things and knowledge for themselves without depending on people ~ Adults are juggling multiple responsibilities Adult Learning Methods ~ Concrete learning (role play or activity) ~ Reflective observation (What did you learn? How does this change things for you?) ~ Abstract conceptualization (How might this apply to your life/other situations? How could you teach this to your kids?) ~ Active Experimentation ~ Apply it in a variety of contexts and discuss with group ~ Role play a variety of situations (applying ot or teaching it) Learning ~ 3 parts to the learning process: • Cognition ~ How people acquire knowledge ~ seeing, hearing or doing • Conceptualization ~ How people process information ~ abstract, specific, memory pathways • Affective ~ People’s motivation, decision-making styles, values and emotional preferences ~ how much does this information matter Understanding Learning Styles ~ Active/Reflective ~ Processing information ~ Auditory/hearing, visual/seeing, or kinesthetic/doing ~ Receiving information ~ Attitudinal or Emotional (Thinking or Feeling) ~ Conceptualizing information ~ Global vs. Specific (Sensing vs. Intuitive) ~ Parts to whole or vice versa Active/Reflective Learner Tips ~ Reflective learners ~ Think it through first ~ Prefer working alone ~ Active learners ~ Difficulty sitting quietly through lectures ~ Like group work ~ Need discussion or problem-solving activities ~ Action without reflection ~ Trouble ~ Reflection without action ~ Inaction Auditory, Visual, Kinesthetic ~ Kinesthetic learners ~ Mentally or physically work with material ~ Auditory learners ~ Need to hear the material ~ Visual learners ~ Need to see the material ~ To meet different learning needs, present material: ~ Visually (notes, graphs) ~ Verbally (talk about it) ~ Manipulatively (questions, group activities) Attitudinal/Emotional ~

Assertiveness Skills Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Find CEUs for this podcast on the Counselor Toolbox CEU spreadsheet Objectives ~ Define Assertiveness ~ Overcoming the Stress Barrier ~ Overcoming the Social Barrier ~ Overcoming the Belief Barrier ~ Reality Check ~ Nonverbal behavior ~ Giving your opinion ~ Giving constructive (not critical) feedback ~ Making requests without trying to control What is Assertiveness ~ Assertiveness means stating your feelings, wants and needs ~ Clearly ~ With ownership ~ With conviction…. (but…I don’t know…) ~ Assertive behavior may not be appropriate in all workplaces. Some organizational and national cultures may view assertive behavior as rude or even offensive. ~ Research has also suggested that gender can have a bearing on how assertive behavior is perceived, with men more likely to be rewarded for being assertive than women. Advantages of Assertiveness ~ Assertiveness helps us feel good about ourselves and others ~ Assertiveness leads to the development of mutual respect with others ~ Assertiveness increases our self-esteem ~ Assertiveness helps us achieve our goals ~ Assertiveness minimizes hurting and alienating other people ~ Assertiveness reduces anxiety ~ Assertiveness protects us from being taken advantage of by others ~ Assertiveness enables us to make decisions and free choices in life ~ Assertiveness enables us to express, both verbally and non-verbally, a wide range of feelings and thoughts, both positive and negative Why is Assertiveness Important ~ When people are passive or aggressive, their feelings wants and needs are often not heard ~ Direct aggression: bossy, arrogant, bulldozing, intolerant, opinionated, and overbearing ~ Indirect aggression: sarcastic, deceiving, ambiguous, insinuating, manipulative, and guilt-inducing ~ Submissive: wailing, moaning, helpless, passive, indecisive, and apologetic ~ Assertive: direct, honest, accepting, responsible, and spontaneous ~ This lead to feelings of: ~ Isolation ~ Resentment/Anger ~ Depression/Helplessness The Stress Barrier: Fight, Flee or Freeze ~ Becoming assertive is stressful ~ You have to change the way you interact with others ~ Others have to change the way they interact with you ~ In the past when you were in a stressful situation did you withdraw? Become aggressive? Shut down? ~ The stress response is designed to protect you ~ Ignoring the urge to fight or flee is extremely difficult until assertiveness has proven itself. The Social Barrier ~ People in your social circle expect you to act and react a certain way. ~ Changing your behavior confuses other people ~ Our egocentric society leads people to expect that if you change your behavior, it has to do with THEM ~ People strive for consistency. ~ If you used to be aggressive, they may interpret the change as depression, disengagement or exploitable weakness ~ If you used to be passive, they may interpret the change as rejection and push away The Belief Barrier ~ Reality is 90% perception and 10% fact ~ Our interpretations greatly influence our reactions ~ What influences interpretations ~ Vulnerabilities (pain, exhaustion) ~ Prior learning experience ~ Transference and overgeneralization ~ The other person’s nonverbals Why Not Be Assertive? ~ Failure to be assertive stems from: ~ Prior efforts to be assertive being punished ~ Fear of rejection ~ Need for external validation ~ Assertiveness requires ~ Confidence ~ Emotional control ~ Effective verbal and nonverbal communication skills Staying Calm ~ Checking your automatic or current beliefs against reality ~ What is my perception of what is going on? ~ What evidence do I have for and against this perception? ~ What were the words? ~ What were the nonverbals? ~ How valid is that evidence? ~ Am I reacting to feelings or FACTS? ~ Am I magnifying or catastrophizing? ~ Have I stated my feelings and needs objectively and clea

Grief Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Find CEUs for this podcast on the Counselor Toolbox CEU spreadsheet 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 ~ Review activities and interventions to help people grieve 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…) What is Grief ~ Primary losses also produce secondary losses which also need to be acknowledged and grieved. ~ Loss of a part of ourselves ~ Loss of identity ~ Loss of self confidence ~ Loss of a chosen lifestyle ~ Loss of security or a sense of safety ~ Loss of dreams What is Grief ~ What secondary losses might occur for these events? ~ Death of a parent ~ Separation or divorce ~ Miscarriages ~ Injury or disability ~ Loss of a job ~ Moving to a new place ~ A child leaving home ~ House fire/tornado Types of Grief ~ Anticipatory Grief: Experiencing anticipatory grief may provide time for the preparation of loss, acceptance of loss, the ability to finish unfinished businss, life review and resolve conflicts ~ Normal Grief: Normal feelings, reactions and behaviors to a loss; grief reactions can be physical, psychological, cognitive, behavioral ~ Complicated Grief: ~ Disenfranchised Grief: Chronic Grief: Normal grief reactions that do not subside and continue over very long periods of time ~ Delayed Grief: Normal grief reactions that are suppressed or postponed. The survivor consciously of unconsciously avoids the pain of the loss. ~ Masked Grief: Survivor is not aware that behaviors that interfere with normal functioning are a result of the loss. ~ The grief encountered when a loss is experienced and cannot be openly acknowledged, socially sanctioned or publicly shared. 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 Exacerbating & Mitigating factors ~ How people react in a crisis depends upon 6 factors ~ 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 Impact of Unresolved Grief ~ Most people get stuck in either anger 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) ~ At self ~ At others ~ At higher power Denial ~ Denial is the mind’s way of protecting people from what lies ahead. ~ Action strategies ~ Facing the loss Denial ~ Identify the dialectics which might accompany each loss ~ Activity ~ Death of a loved one ~ Separation or divorce ~ Miscarriages ~ Injury or disability ~ Loss of a job, property, or pet ~ Moving to a new place ~ A child leaving home 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 Anger ~ Action steps ~ Identifying what the loss means to the person (Ex. Job, Parent, Victimization) ~ Angry (other losses) ~ Scared (which fears and why?) ~ Depressed (I feel helpless to… ; I feel hopeless to…) ~ Validation ~ Examination of the stated beli

Neurobiology: Dopamine, GABA, Serotonin, Acetylcholine Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC, CCDC Executive Director, AllCEUs.com Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Objectives ~ Define Neurobiology ~ For the following neurotransmitters, Dopamine, GABA, Serotonin, Acetylcholine, identify ~ Their mechanism of action/purpose ~ Where they are found ~ Symptoms of excess & insufficiency ~ Nutritional building blocks ~ Medications What is Neurobiology ~ Neurobiology is the study of the brain and nervous system which generate sensation, perception, movement, learning, emotion, and many of the functions that make us human Think about ~ A client who presents with apathy/loss of pleasure, sleep disturbances, fatigue, and difficulty concentrating ~ What would your diagnosis be? ~ What medication would you expect the doctor to put him on? Dopamine ~ Mechanism of action/purpose ~ movement ~ memory ~ pleasurable reward ~ behavior and cognition ~ attention ~ inhibition of prolactin production ~ sleep ~ mood ~ learning Dopamine ~ Mechanism of action/purpose ~ Altered dopamine neurotransmission is implicated in: ~ Cognitive control (racing thoughts) ~ Attentional control ~ Impulse control ~ Working memory ~ Mood ~ Motivation ~ Sleep Dopamine ~ Where is it found ~ Precursor, L-DOPA is synthesized in brain and kidneys ~ Dopamine functions in several parts of the peripheral nervous system ~ In blood vessels, it inhibits norepinephrine release and acts as a vasodilator (relaxation) ~ In the kidneys, it increases sodium and urine excretion ~ In the pancreas, it reduces insulin production ~ In the digestive system, it reduces gastrointestinal motility and protects intestinal mucosa ~ In the immune system, it reduces lymphocyte activity. ~ The dopaminergic system in autoimmune diseases https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3968755/ Dopamine ~ Symptoms of excess & insufficiency ~ Excess of dopamine ~ Unnecessary movements, repetitive tics ~ Psychosis ~ Hypersexuality ~ Nausea ~ Most antipsychotic drugs are dopamine antagonists ~ Dopamine antagonist drugs are also some of the most effective anti-nausea agents Dopamine ~ Symptoms of excess & insufficiency ~ Insufficient dopamine ~ blunting of affect/apathy ~ Loss of motivation ~ Pain ~ Parkinson’s Disease ~ Restless legs syndrome ~ Attention deficit hyperactivity disorder (ADHD) ~ Neurological symptoms that increase in frequency with age, such as decreased arm swing and increased rigidity. ~ Changes in dopamine levels may also cause age-related changes in cognitive flexibility. Dopamine ~ Symptoms of excess & insufficiency ~ Insufficient dopamine ~ Lack of motivation ~ Fatigue ~ Apathy, Inability to feel pleasure ~ Procrastination ~ Low libido ~ Sleep problems ~ Mood swings ~ Hopelessness ~ Memory loss ~ Inability to concentrate Dopamine ~ Nutritional building blocks ~ Eating a diet high in magnesium and tyrosine rich foods will ensure you’ve got the basic building blocks needed for dopamine production. ~ Here’s a list of foods known to increase dopamine: Dopamine ~ Medications ~ Dopamine in blood is unable to cross the blood-brain barrier to reach the brain. ~ Most common dopamine AGONISTs (Parkinson’s, Restless Legs, negative symptoms) ~ Mirapex & Requip ~ Levodopa-Carbidopa combination is actually converted to dopamine in the brain ~ Buspirone Dopamine ~ Medications ~ Most common dopamine antag

50 Mindful Steps to Self-Esteem Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Objectives ~ Understand what self esteem is, why it is important and how to develop it ~ Explore how physical sensations give clues to what is important and whether you are living in harmony with our values (Gut) ~ Identify and address thinking errors that keep you stuck (Head) ~ Evaluate how emotions and the heart contribute to the development of self-esteem (Heart) ~ Examine how the environment impacts your self-esteem The Nature of Self-Esteem ~ How you feel about yourself in contrast to who you think you “should” be ~ The more rejecting you are of yourself, the more ~ Distress you experience ~ You seek external validation ~ In order to develop healthy relationships you need to ~ Feel good about yourself ~ Get in touch with yourself and your true values ~ Choose actions in harmony with your 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 you trust yourself and act with awareness and purpose you become more self reliant Note: The book will give you access to online, recorded versions of several meditations Impact of Mindlessness ~ Ignoring or invalidating how you 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 Breathing and the Body ~ By developing mindfulness and self-awareness you can quiet your thoughts ~ The constant noise often prohibits from addressing the underlying issues of your emotional turmoil ~ Life becomes focused on treading water ~ Forward goals are exchanged for just surviving ~ By making contact with the present moment you can: ~ Find your strength ~ Learn to grow ~ Choose how you 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 your breath often causes it to slow down ~ Feel the loving touch (Your 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 ~ Inhale and take in positive affirmations ~ Exhale and let go of stress and negativity ~ Taken another step further, imagine inhaling cooling/calming blue air and exhaling stresses (red, black, gray) ~ Read the Inscription ~ Pay attention to what your body is trying to tell you (Lenny) ~ Practice noticing points of tension/tightness/heaviness and feel them relax or loosen as you exhale Thinking and the Mind ~ An Impartial Witness (Fly on the wall) ~ Stop Sorting (into good and bad) ~ See the Whole Elephant ~ The issue ~ The strengths ~ Spin the Wheel of Paradox ~ Work ~ Traffic ~ No Blame Emotions and the Heart ~ Spaciousness ~ Recognizing all the emotions contained within your heart ~ Cultivating warm heartedness ~ Plant your garden (What are you going to care about) ~ Tend and befriend ~ Count Your Blessings ~ Delight for Others Being in the World ~ Claim Your Emotional Baggage ~ Don’t let it stay on the conveyor ~ Don’t gi

Surfing the Worry Imp's Wave What  prompted you to write this book? I talk a lot in my classes about basic fears of rejection, isolation, failure, loss of control and the unknown triggering the fight or flight response.  What types of things do children often worry about? Why do children worry about things that adults don't worry about? Why do some things (like a fight with your best friend) feel so unbearable….and why can't youth understand that, in the big scheme of things, this is not that big of a deal? Mistakes and bad things happen.  How does the concept of fault vs. responsibility impact a child's anxiety, for example, when parents divorce? What are signs of anxiety and worry in children, and how do they differ by age 2-5, 6-10, 11-16? After a traumatic event such as an earthquake or school shooting, what types of stress and anxiety reactions might we see? Aside from reading this book with children and going through the discussion and activity guide, what can parents do to help children prevent anxiety? I noticed on your website that you blog quite extensively on issues related to anxiety, attachment, discipline, self-regulation and resilience.  How are all of these things related? Where is the best place to get this book and the activity guide? (Your website, kickstarter, Amazon??) Learn more at https://www.sharonselby.com/

Introduction to Addressing Sex and Pornography Addiction Instructor: Dr. Dawn-Elise Snipes Objectives ~ Define Sex Addiction ~ Identifying the Negative Messages ~ Understanding Addictive Triggers (Original and conditioned) ~ Mindfulness and Purposeful Action (Silencing the inner critic) ~ Getting to Know Yourself ~ Regaining Control: Essential DBT Scenarios ~ John is a 53 year old man whose pornography use has gotten him fired, caused problems in his marriage, but he feels unable to stop ~ Sally is a 34 year old woman who reports an insatiable desire for sex which has caused problems in her marriage and led her to seek “other outlets” including during lunch breaks. ~ Sam is a 23 year old college student who reports masturbating 6 or more times a day every day. He sometimes leaves class to do it and it causes him distress that he thinks about it so much. ~ Questions ~ What is the function of sexual release for these people? ~ What is maintaining the compulsion? Addiction is… ~ Any person, substance or activity ~ Used to escape from negative feelings (Emotional and Physical) ~ Continues to be used despite negative consequences ~ Emotional ~ Mental (self esteem/thought processes) ~ Physical (health and neurochemical balance) ~ Social Relationships Obsessions and Compulsions ~ Obsessions are repetitive thoughts ~ Compulsions are activities done in order to escape negative feeling states ~ It is the only way the person currently has to stop or escape the negative feeling state ~ All addictions are compulsions, but all compulsions are not addictions Sex and Pornography ~ Pornography addiction affords people never ending novelty which can lead to escalation ~ Sex addiction is the use of actual sex to get a rush ~ Love addiction may or may not involve sex, but the person may use sex as a means for ensuring he or she is not abandoned. If the person is out of a relationship he feels worthless, hopeless. Riding the Addiction Train ~ Dopamine rush (Like Black Friday) ~ Brain shuts off receptors to prevent overload ~ Normal amounts of dopamine don’t produce the same feeling ~ Chasing the High/Tolerance ~ Requires artificially increasing dopamine through increased amount/intensity Take Away Message ~ Addictive behaviors have: ~ Been the most reliable tool to help the person escape ~ Served a survival function ~ Become the one thing that won’t let him down or abandon him ~ Addictive behaviors and negative messages can be altered First Things First: ReBalance ~ The brain has adjusted to frequent dopamine “rushes” so to feel “normal” the person may need to engage in stimulating behavior ~ The brain has adjusted to a level of stimulation such that traditional sex may fail to cause arousal ~ The person’s life has become imbalanced as the need for sexual stimulation increased it caused problems in on or more areas of their life ~ Interventions ~ Reduce sexual activity to only consensual sex between partners in a committed relationship What Caused It? ~ Some triggers ~ Early sexual exploration, especially with pornography ~ Excessively using sex at any age to escape from negative feeling states ~ Using sex as a way to feel loved and quell fears of abandonment because of low self-esteem ~ Parental or societal emphasis on sex and sexuality Identify the Roots of the Problem ~ Children are born with a blank slate ~ As they grow, the zone of proximal development and the more knowledgeable other influences what the child attends to/learns ~ What makes him lovable, good ~ How to cope with stress (or not) ~ Early learning is egocentric and dichotomous ~ Inconsistent or negative

Food Addiction Counseling CEU Course: https://www.allceus.com/member/cart/index/product/id/493/c/ Objectives ~ Examine the difference between overeating and food addiction ~ Evaluate myths about food addiction ~ Explore the behavioral and biological mechanisms underlying food addiction ~ Identify ways to address food addiction triggers Why I Care/How It Impacts Recovery ~ Excessive food consumption is socially acceptable and food addiction rarely causes imminent legal problems, so it can go unchecked for a long time ~ For some people, addictive behaviors started with food addiction ~ For others, when their substance of choice was removed, food was available for self-soothing ~ Regularly using food to self-soothe is, at the very least, a relapse warning sign if not a full-blown relapse. Food Addiction vs. Overeating ~ Food can become an addiction, when it is used to ~ Escape from negative feeling states AND ~ Continues to be used despite negative consequences ~ The person experiences psychological withdrawals and cravings when he or she cannot access food to cope ~ Overeating is often a bad habit, but can be stopped with education, planning and mindfulness Food Addiction vs. Overeating ~ Experiments show that, for some people, the same reward and pleasure centers of the brain that are triggered by other addictions are also activated by food, especially highly palatable foods. ~ Highly palatable foods are foods rich in: ~ Sugar ~ Fat ~ Salt Signs and Symptoms ~ You frequently crave certain foods ~ You often eat even when you are not hungry. ~ You eat much more than you intended to, sometimes to the point of feeling excessively “stuffed.” ~ You often feel guilty after eating particular foods ~ You sometimes make excuses in your head about why you should eat something that you are craving. ~ You have repeatedly tried to quit eating or setting rules (includes cheat meals/days) about certain foods, but been unsuccessful. ~ You often hide your consumption of unhealthy foods from others. ~ You feel unable to control your consumption of unhealthy foods, despite knowing that they are causing you physical harm (includes weight gain). Signs and Symptoms cont… ~ You eat certain foods so often or in such large amounts that you start eating food instead of working, spending time with the family, or doing recreational activities. ~ You avoid social situations where certain foods are available because of fear of overeating. ~ You have problems functioning effectively at your job or school because of food and eating. ~ When you cut down on certain foods (excluding caffeinated beverages), you have symptoms such as anxiety, agitation ~ Eating food causes problems such as depression, anxiety, self-loathing, or guilt. ~ You find yourself eating more and more often due to stress Myths ~ Food addiction is an excuse for over eating ~ FALSE: Someone with a food addiction is using food to cope and activate reward pathways to help them feel “normal” or “calm.” ~ Any emotional eating is wrong ~ FALSE: Just like having a few drinks occasionally after a hard day does NOT qualify a person as an alcoholic, occasionally eating to self soothe is a normal reaction to an abnormal situation ~ Our society actually teaches self-soothing through food, so one would expect using that as a fall-back occasionally Myths ~ Abstinence is key ~ FALSE: Unlike addiction to illicit drugs, a person cannot quit eating. ~ Elimination of an entire food or food group is rarely recommended as it makes it more likely for a binge. ~ Since one addiction will likely be replaced by another, understanding and awareness of WHY the person is eating is more important than eliminating a food

Relapse Prevention for Co-Occurring Disorders Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Counseling CEU Course link https://www.allceus.com/member/cart/index/product/id/18/c/ Objectives ~ Define Relapse ~ Identify triggers and warning signs of relapse ~ Review Relapse Syndrome and possible interventions ~ Explore the acronym DREAM ~ Define and identify vulnerabilities ~ Define and identify exceptions ~ Develop a relapse prevention plan Why I Care/How It Impacts Recovery ~ Relapse indicates that the old behaviors have returned either because ~ New skills were ineffective ~ Old behaviors were more rewarding ~ Recovery involves understanding what triggers each individual person’s relapse Relapse Syndrome ~ Relapse generally follows a predictable and readily identifiable pattern ~ Return of denial “I’ve got this.” “I’m fine.” ~ Teach support people about recovery and relapse. Encourage them to probe about problems. ~ Write down problems on a daily basis and share this list with someone. ~ Avoidance of defensive behavior…Focusing more energy on fixing others than on working on self and failing to do relapse prevention exercises. ~ Surround themselves with support people who will encourage them to continue working on their relapse prevention program. ~ Maintain a “negative image” reminder of what it is like when they are symptomatic ~ Develop and review a cost/benefit analysis of their coping behavior. Relapse Syndrome ~ Crisis Building…problems begin to pile up and it becomes more and more difficult to see options. The person develops tunnel vision and loses the ability to perform constructive planning ~ Remind them to take one day at a time. ~ Review coping behavior. ~ Encourage acceptance of personal limits. ~ Remind them that it is the thoughts about an event and not the event that is “bad” or “good”). Relapse Syndrome ~ Immobilization When a crisis builds up, the person becomes crushed and trapped by the problems and incapable of initiating action A sense that nothing can be solved may develop. ~ Use the Serenity Prayer. ~ Use the support people that they have developed. ~ Review the concept of lapse as opposed to relapse (accept the reality that they may make some small mistakes but this does not mean that they have failed). ~ Confusion and overreaction While the problems continue to grow and the person feels stuck, he often becomes confused and angry leading to irritability, a general sense of tension, and sense that others are out to get him. ~ Identify the source of the feelings. ~ Accept responsibility for problems. ~ Possible professional intervention. Relapse Syndrome ~ Depression. As the anger begins to build, so does a sense of hopelessness and begins to turn the anger inward in the form of depression. ~ Focus on those things that the person can control ~ Identify strengths ~ Set SMART goals to develop self-efficacy ~ Seek social support ~ Behavioral loss of control The person becomes unable to control or regulate personal behavior and a daily schedule. ~ Develop a routine ~ Regroup and redifine those people, things and activities that are truly important to a meaningful life ~ Make a task basket (or list) ~ Set more SMART goals to start taking steps forward 10 Most Common Triggers of Relapse ~ Withdrawal symptoms (anxiety, nausea, physical weakness) ~ Post-acute withdrawal symptoms (anxiety, irritability, mood swings, poor sleep) ~ Poor self-care (stress management, eating, sleeping) ~ People (old using friends) ~ Places (where you used or where you used to buy drugs) ~ Things (that were part of your using,

Co-Dependency Counseling CEU Course https://www.allceus.com/member/cart/index/product/id/492/c/ Objectives ~ Define codependency ~ Identify characteristics of the codependent relationship Why I Care/How It Impacts Recovery ~ Co-dependency can serve as an alternate addiction or distraction ~ Co-Dependents may use relationships to try to deal with depression or anxiety ~ Ultimately codependency is self-defeating because one of the few things that cannot be controlled is the will of another person. Definition ~ Codependency describes a type of relationship in which: ~ One partner defines his or her worth or goodness based on someone else ~ The codependent person often chooses relationships in which the other person needs to be rescued, thereby making himself or herself indispensable. Warning Signs ~ Have an excessive and unhealthy tendency to rescue and take responsibility for other people. ~ Derive a sense of purpose and boost your self-esteem through extreme self-sacrifice to satisfy the needs of others. ~ Choose to enter and stay in lengthy high-cost caretaking and rescuing relationships, despite the costs to you or others. ~ Regularly try to engineer the change of troubled, addicted, or under-functioning people whose problems are far bigger than your abilities to fix them. ~ Seem to attract low-functioning people looking for someone to take care of them so they can avoid adult responsibility or consequences, or attract people in perpetual crisis unwilling to change their lives. ~ Have a pattern of engaging in well-intentioned but ultimately unproductive unhealthy helping behaviors, such as enabling. Co-Dependency as an Addiction ~ Tolerance ~ Need more of the same substance/activity ~ In a codependent relationship, as time passes, the codependent’s identity becomes increasingly defined by the relationship with the other person ~ Withdrawal ~ Not getting the substance, being around the person results in physical or psychological withdrawals ~ When apart from or unable to control the other person, the codependent experiences extreme anxiety and/or depression Co-Dependency as an Addiction ~ Spending more time thinking about, engaging in or recovering from the behavior ~ Co-dependents are always hypervigilant to other peoples behavior, and obsessing about what they are or are not doing ~ Co-dependents spend large amounts of time rescuing or covering up for the other person “fixing it” ~ The codependent gets exhausted taking care of the other person, but cannot stop because they rely on the other person to tell them Co-Dependency as an Addiction ~ Foregoing other interests in order to maintain the addiction ~ The relationship is the “drug” of choice in the codependents’ lives ~ Having that person in their life makes them feel “okay” or “whole” ~ The relationship takes the place of self-love Co-Dependency as an Addiction ~ Continuing the addiction/relationship despite negative consequences ~ Emotional (depression, anxiety, anger, resentment) ~ Social (Loss of other friends) ~ Physical (stress-related physical issues) ~ Occupational (poor job performance) Addicts and Codependents ~ Low self esteem ~ Depression, anxiety ~ Need to control ~ Fear of abandonment ~ Relationship comforts/numbs ~ Relationship becomes the addict’s primary focus ~ Minimizing, denying, blaming to protect the relationship ~ Stinkin’ Thinkin’ ~ Have difficulty identifying what they are feeling. ~ Lack empathy for the feelings and needs of others. ~ Mask pain in various ways such as anger, humor, or isolation. ~ Experience significant aggression/resentment and negativity ~ Have difficulty making decisions. ~ Judge

Treatment Planning for Depression Dr. Dawn-Elise Snipes Executive Director: AllCEUs.com Podcast Host: Counselor Toolbox, Addiction Counselor Exam Review and Happiness Isn’t Brain Surgery Objectives ~ Identify instruments to guide treatment planning ~ Identify the causes of depression ~ Identify behavioral interventions ~ Identify cognitive interventions ~ Identify Emotional Interventions Effects of Depression on Treatment ~ The client with depressive symptoms may have difficulty in any or all of the following areas: ~ Ability to follow instructions and keep appointments. ~ Energy to participate in or maintain interest in program activities. ~ Motivation for change. ~ Ability to make appropriate decisions about treatment needs and goals. ~ Belief that he or she can be helped. ~ Responsiveness to reinforcements. ~ Ability to handle feelings. ~ Ability to handle relations with other clients. ~ Ability to attend to (and not disrupt) group activities. ~ Ability to avoid relapse after treatment is completed. Placement Instruments ~ ASAM ~ Acute crisis and dangerousness ~ Biomedical conditions and complications ~ Emotional, behavioral or cognitive issues (See assessment instruments, next slide) ~ Readiness for change for EACH issue/objective ~ Improve mood ~ Address sleep hygiene ~ Improve nutrition ~ Cut out caffeine ~ Increase exercise ~ Relapse or continued problem potential ~ Recovery environment Screening Instruments: Emotional ~ DSM V PROMIS ~ Severity Measure for Depression, Adult(Patient Health Questionnaire [PHQ-9]) ~ Zung Self-Rating Depression Scale ~ Center for Epidemiologic Studies Depression Scale (CES-D), NIMH ~ Severity of Posttraumatic Stress Symptoms, Adult (National Stressful Events Survey PTSD Short Scale [NSESS]) ~ Severity Measure for Generalized Anxiety Disorder, Adult Screening Instruments: Cognitive ~ Attributional Style ~ Hardiness and Perceived Stress Scales ~ Stress Awareness/Hardiness Causes of Depression ~ Biochemical imbalance ~ Norepinepherine (focus, motivation) ~ Serotonin (contentment, relaxation, pain, sleep, hunger, heart rate) ~ Dopamine (motivation/pleasure, memory, focus, pain) Causes of Depression ~ What is causing the biochemical imbalance ~ Physical ~ Lack of quality sleep ~ Exhaustion/burnout ~ Poor nutrition ~ Chronic pain ~ Diabetes ~ Thyroid and sex hormone imbalances ~ Vitamin D deficiency ~ Hypocortisolism/Adrenal Fatigue ~ Anemia ~ Side effects of medications ~ Other illnesses such as MS, lupus, fibromyalgia, chronic fatigue, lyme disease, stroke… Interventions Physical ~ Changing Behaviors ~ Identify a behavior that can be addressed: ~ Keep it simple and achievable. ~ Break big problems down into smaller, achievable components. ~ Identify the goal (outcome) the client would like to achieve: ~ Make the goal measurable so the client can know when he or she has achieved it. ~ Explore ways the client has achieved similar goals in the past. ~ Identify barriers (internal and environmental) to success and identify what parts the client can control. ~ Identify how those barriers can be overcome in specific behavioral terms. Make addressing the barrier something to do, rather than something not to do. ~ Identify supports and specific steps needed to achieve success ~ Elicit a commitment and take action to achieve the goal Interventions: Physical ~ Get a physical to rule out hormone imbalances, physical issues causing lack of energy, fatigue, difficulty concentrating, sadness, irritability ~ Address nutrition to provide

Vulnerabilities Dr. Dawn-Elise Snipes Executive Director, AllCEUs.com Objectives • 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. Why I Care/How It Impacts Recovery ~ Vulnerabilities are situations or things that ~ Make it more difficult to deal with life on life’s terms leading to depression, anxiety or “stress” ~ Make it easier for you to over-react or get stuck ~ Depression occurs if you feel helpless or hopeless ~ Anxiety occurs if you feel powerless or out of control ~ Addictive behaviors increase when you feel a need to escape because of stress, anxiety, depression or pain Individual Vulnerabilities: Physical ~ Pain ~ Effects ~ Sleep problems ~ Difficulty concentrating ~ Irritable mood ~ Medications are depressants and can worsen all of the above ~ Interventions ~ Talk with your doctor ~ Explore nonpharmacological interventions Individual Vulnerabilities: Physical ~ Poor nutrition ~ Your body needs the building blocks to ~ Recover from injury ~ Keep you from getting sick ~ Make happy chemicals ~ Interventions ~ Water…. 60 ounces per day ~ Have three colors on your plate at each meal (condiments don’t count) ~ Try to eat smaller meals every few hours Individual Vulnerabilities: Physical ~ Lack of sufficient, quality sleep ~ Drug/alcohol induced sleep is rarely good quality ~ Lack of Sleep Effects ~ Fogginess ~ Difficulty concentrating ~ Irritability ~ Over eating ~ Interventions ~ Develop a sleep routine ~ Cut back on caffeine 6-12 hours before bed. Individual Vulnerabilities: Physical ~ Illness ~ Effects ~ Sleep disruption ~ Exhaustion ~ Foggy head/difficulty concentrating ~ Irritability ~ Interventions ~ Compassion ~ Good nutrition Individual Vulnerabilities: Physical ~ Brain changes ~ Brain changes can be ~ Hereditary ~ From an accident ~ As a result of addictive behaviors ~ Effects ~ Changes in the structure of the brain have all kinds of effects including memory, concentration, and mood. ~ Intervention ~ Eat a good diet to give the body the necessary building blocks ~ Get adequate quality rest ~ Medication Individual Vunerabilities: Emotional ~ Anger ~ Anxiety ~ Depression ~ Grief ~ Guilt ~ Jealousy ~ Resentment ~ Inability to self-soothe Individual Vunerabilities: Emotional ~ When you are feeling negative emotions ~ Effects ~ It causes the brain to keep the fight-or-flight reaction going (which takes energy) ~ It lacks or prevents the happy, calming neurotransmitters from being excreted ~ Interventions ~ Develop coping skills to deal with them ~ Insert positive/rewarding experiences ~ Get plenty of rest ~ Eat a healthy diet ~ Exercise Individual Vulnerabilities: Mental/Cognitive ~ Global, internal, stable attributional style ~ Effects ~ When everything is always it adds extra stress ~ When anything that happens reflects on you as a person, it adds extra stress ~ Interventions ~ Focus on things being specific and alterable ~ Identify what is good about you as a person ~ Explore the difference between what makes you a good person vs your skills Individual Vulnerabilities: Mental/Cognitive ~ Extremely external or internal locus of control ~ Both situations add stress

Intensive Outpatient Services: Clinical and Administrative Issues TIPs 46 & 47 Dr. Dawn-Elise Snipes, PhD, LMHC Overview IOT ~ Multidimensional/Biopsychosocial ~ Recognizes dual disorders as chronic ~ Values case management ~ Blends evidence-based with community based services Core Features ~ 6–30 contact hours per week ~ Individualized step-up and step-down levels of care ~ Minimum duration of 90 days followed by step-down Core Features cont… ~ Enhanced services ~ Ambulatory detoxification ~ Childcare ~ Outreach ~ Case Management ~ For more detailed information, see TIP 47, pp. 1–6 Core Services ~ Screening ~ Assessment ~ Treatment planning ~ Treatment engagement ~ Group, individual and family counseling ~ Psychoeducational programming ~ Integration into support groups Core Services cont… ~ Relapse prevention training ~ Substance use screening and monitoring ~ Vocational and educational services ~ Referral to wrap-around services ~ Mentoring? Principles of IOT ~ Treatment available to a wide spectrum of clients ~ Treatment access ~ Straightforward and welcoming ~ No Wrong Door ~ Enhance existing motivation ~ Trust between counselor and client ~ Client retention priority ~ Individualized assessment and treatment Principles cont… ~ Implements flexible, chronic/episodic care model ~ Monitor abstinence ~ Help clients integrate into support groups ~ Medications to manage co-occurring disorders ~ Educate clients and family members ~ Families, employers, and significant others ~ Evidence-based training and materials ~ Improve program administration Clinical Considerations ~ Challenges in Adolescents and Others ~ Inconsistent ability for abstract /future thinking ~ Impulsive/short attention span ~ Vulnerable to peer influence ~ Frequent emotional fluctuations ~ Lack of involvement in pro-social activities ~ Pessimistic/fatalistic attitudes Treatment Engagement ~ Goals ~ Initiate a treatment contract ~ Resolve acute crises ~ Engage in a therapeutic alliance ~ Involve clients in preparing a treatment plan ~ Duration — A few days to a few weeks Engagement Activities  Confirm diagnosis, eligibility, appropriate placement  Conduct biopsychosocial assessment  Develop treatment plan  Develop a relapse prevention plan  Provide assessment feedback  Explain program rules and expectations  Address acute crises  Resolve administrative issues  Foster therapeutic alliances ◦ Client, counselor, group members Engagement Activities cont… ~ Begin psychoeducational activities ~ Identify sources of social support ~ Initiate family contacts and education Phase 1 Completion Criteria ~ Assessment and treatment plan completed ~ Client completely stabilized ~ Client demonstrates adequate attendance and participation Early Recovery ~ Goals ~ Abstinence ~ Sustain behavioral changes ~ Identify relapse triggers and develop relapse prevention strategies ~ Identify and begin to resolve personal problems ~ Begin active involvement in a 12-Step or other mutual-help program ~ Duration — 6 weeks to about 3 months Counselor Activities ~ Help clients follow their plans to recovery ~ Assist identify and develop strategies for relapse triggers ~ Initiate random drug tests and provide rapid feedback of results if appropriate ~ Help clients and families integrate into mutual-help programs ~ Assist develop and strengthen positive social support networks ~ Continue appro

Complicated Grief Dr. Dawn-Elise Snipes PhD, LPC-MHSP Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Objectives ~ Define Complicated Grief ~ Examine the impact of CG ~ Identify risk factors for CG ~ Explore tasks for successful grief resolution Definitions: ~ Loss: Change that includes being without someone or something; physical loss of something tangible like a person, a car, a house, a breast; psychosocial loss of something intangible like a divorce, an illness, a job, a dream, a hope. ~ Bereavement: comes from the same Latin root word as “to have been robbed….” i.e. to have experienced loss. ~ Secondary loss: Other losses as a result of a primary loss. Example, loss of income when bread winner dies. ~ Grief: Reaction or response to loss; includes physical, social, emotional, intellectual and spiritual dimensions. ~ Mourning: Rituals or behaviors associated with grief; i.e. courses of action in response to loss. Rando, Complicated Mourning, p. 22. Complicated Grief ~ Symptoms ~ Separation distress involving intrusive, distressing preoccupation with the deceased ~ Traumatic stress reflecting specific ways the person was traumatized by the death ~ Avoidance of reminders ~ Intrusive painful thoughts ~ Emotional numbing ~ Irritability ~ Feelings of hopelessness and purposelessness ~ Shattered self identity ~ Failure to assimilate the loss can create an identity crisis and problems with self-regulation ~ Who am I if I am not John’s wife/Sally’s mother? ~ Who is there to protect me now that both of my parents are gone? Complicated Grief ~ Complicated grief can be reliably identified by administering the Inventory of Complicated Grief (ICG) more than 6 months after the death of a loved one. What exactly are we talking about? ~ There is significant overlap between grief and trauma ~ In one study, 53% of participants had significant elevations in trauma symptoms ~ Losing a therapist or discharge could trigger past CG reactions ~ The first and most pressing question in a crisis is: What just happened? ~ Immediately following is the question: How can I manage right now? ~ Finally, the larger questions of grief and meaning are formulated. Grief Takes Time ~ Whole first year is one loss after another ~ Beware of special occasions and holidays all year ~ Uncomplicated mourning is normally 2-3 years ~ Complicated mourning may be a 5-7 year process. ~ Grief continues for a lifetime through major life milestones. Grief impacts us holistically… Physical responses: ~ Appetite (eating) disturbances ~ Energy, fatigue, lethargy ~ Sleep disturbance ~ Cold (especially for children) ~ Anxiety (sweating, trembling, etc.) ~ Gastrointestinal disturbance ~ Compromised immune response; increased illness Intellectual ~ Confusion; “What is real?” ~ Difficulty concentrating; ex. Read the same page several times ~ Short attention span; ex. Can’t finish a 30 minute TV program ~ Difficulty learning new material; short term memory loss; ex. Income taxes ~ Difficulty making decisions ~ Lack of a sense of purpose ~ Inability to find meaning in the events and life itself Social… ~ Withdrawal ~ Isolation ~ Searching ~ Avoidance ~ Irritability ~ Self absorption ~ Clinging/dependence Emotional… ~ Angry ~ Depressed ~ Sad ~ Crying ~ Irritable ~ Afraid ~ Can’t go on ~ Death anxiety ~ Lonely ~ Relieved/Guilty/Regretful Spiritual beliefs are challenged… ~ The question “Why” reverberates ~ Where was God? ~ If God is all powerful, why allow this? ~ If God loves me,

Crisis Intervention and Preventing Suicide Dr. Dawn-Elise Snipes, PhD, LMHC Objectives ~ The student will learn about: ~ How to estimate suicide risk ~ Factors altering risk of suicide and attempted suicide ~ Additional considerations in specific treatment settings ~ Strategies for enhancing motivation and promoting treatment engagement ~ Education points for the client and family ~ Risk management and documentation issues Crisis Intervention Principles ~ All clients perceive events uniquely ~ All clients participate in care that is respectful and non-judgmental ~ Reflection and empathy is most effective ~ Ego strength is variable among individuals and is influenced by past experiences and social support ~ All clients and families are actively involved in collaboration and decision-making ~ Stress is a normal part of existence and can foster self-development and growth ~ All clients are capable of assuming personal responsibility Crisis Intervention Principles cont… ~ All clients grow and change in an environment of acceptance, trust and empathic understanding ~ Sustained change occurs when clients feel ready & supported ~ People have a need for self-mastery and control ~ Crises can be construed as danger or opportunity for growth ~ Crisis intervention is an active process that focuses on the immediate problem ~ Crisis intervention is time-limited ~ Client advocacy is essential ~ The focus is always on increasing the client’s level of social, occupational, cognitive and behavioral functioning 10 Step Trauma Management Protocol • Assess for danger/safety for self and others, this means for the victim, counselor, and others who may have been affected by the trauma. • Consider the physical, emotional and perceptual mechanisms of injury. • Victim's level of responsiveness should be evaluated. • Address medical needs • Identify signs of traumatic stress. • Connect with the individual by building rapport. • Build rapport by allowing the client/person to tell their story. • Provide support through active and empathetic listening • Normalize, validate, and educate the individuals emotions, stress and adaptive coping styles. • Bring the person to the present, describe future events, and provide referrals as needed. (Lerner & Shelton) SAFER-R Model ~ Stabilize ~ Acknowledge ~ Facilitate understanding ~ Encourage adaptive coping ~ Restore functioning ~ Refer Prevention ~ Prevention is always the best ~ Levels ~ Primary ~ Secondary ~ Tertiary Suicide Assessment ~ Obtain information about the patient's psychiatric and other medical history and current mental state. ~ Identify specific psychiatric signs and symptoms ~ Assess past suicidal behavior, including intent of self-injurious acts ~ Review past treatment history and treatment relationships ~ Identify family history of suicide, mental illness, and dysfunction ~ Address the patient's immediate safety and determine the most appropriate setting for treatment. ~ Develop a biopsychosocial differential diagnosis to further guide planning of treatment. ~ Remember that suicide assessment scales lack the predictive validity necessary for use in routine clinical practice. Assessment cont… ~ Identify specific factors and features that may generally increase or decrease risk for suicide or other suicidal behaviors and that may serve as modifiable targets. ~ Social support network ~ Cultural/religious beliefs, particularly as they relate to death/suicide ~ Nature, frequency, depth, timing and persistence of suicidal ideation ~ If ideation is present, request more detail about plans ~ Identify current