Counselor Toolbox Podcast

Systems Influences on Mood and Addictive Disorders Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counseling CEUs and Specialty Certificates Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery A direct link to the CEU course is https://www.allceus.com/member/cart/index/search?q=systems+impact Objectives ~ Examine the prevalence of mood and addictive disorders ~ Learn about the history of addictive behaviors in the US Prevalence ~ Anxiety: ~ 32% lifetime prevalence ~ 18% 12-month prevalence ~ 13% of those with the disorder are receiving treatment ~ Depression ~ 7% 12-month prevalence ~ Prevalence is higher among people of 2 or more races Prevalence ~ Alcoholism ~ 6% 12-month prevalence ~ 6% of that 6% receive treatment ~ Sex/Pornography Addiction 3%-5% ~ Drug Abuse ~ 27% of Americans reported using illicit drugs ~ 3% of Americans over 12 reported nonmedical use of prescription drugs. Themes to look for… ~ Initiation from the medical community to treat something—more people treated  greater availability for diversion ~ Economic motivations for producers, government ~ Giving in to political pressures to repeal ~ Where there is a will there is a way (or an alternative) ~ Cheaper alternatives being produced (crack, fentanyl) History of Substance Use ~ Cannabis was introduced to the US in 1545 ~ In 1775, hemp culture was introduced into Kentucky and large hemp plantations flourished many states until well into the 1800s. ~ Until the late 1800s, tobacco, alcohol and opium could be purchased readily, free from government controls and was fashionable. ~ Civil War blockades on southern ports curtailed imports of tea and coffee, so cassia leaf drinks became a viable alternative ~ Morphine was used commonly as a pain killer during the Civil War. So large a number of soldiers became addicted ~ Late in the 1800s, morphine was prescribed as a substitute for “alcohol addiction’ ~ In 1844, cocaine was first isolated from coca leaves. Dr. Theodor Aschenbrandt issued a supply of pure cocaine to soldiers to increase endurance and alertness ~ In 1885, John Styth Pemberton of Atlanta, Georgia introduced coca-cola. A combination of cocaine and caffeine from the Kola nut (caffeine). History of Substance Use ~ From 1850 until 1942, marijuana was recognized as a legitimate medicine, under the name “Extractum Cannabis.“ ~ Heroin, the newest opium derivative, was first produced commercially by Germany's Bayer Company in 1898. “It was widely advertised as being at least ten times as potent a painkiller as morphine with none of the addicting properties ~ 1920 Prohibition Act was passed and repealed in 1933. (politics, economics and unenforcability) ~ It was not until 1925 that import of opium for the manufacture of heroin finally was banned in this country. ~ Throughout the nineteenth century, opium and marijuana users enjoyed their diversion with little harassment. ~ The federal Harrison Narcotic Act was passed in 1914. in order to “provide for register and impose a special tax upon all persons who produce, import, manufacture, compound, deal in, dispense, sell, distribute, or give away opium or coca leaves, their salts, derivatives or preparations.” History of Substance Use ~ In 1918, just three years after the Harrison Act went into effect, a study by a Congressional committee (which members included Dr. A. G. Du Mez, Secretary of the United States Public Health Service) released these findings: ~ Opium and other narcotic drugs [including cocaine] … were being used by about a million people. ~ T

Sociological Approach to Reducing Risk and Building Resilience Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counseling CEUs and Specialty Certificates Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery Counseling CEUs can be earned at AllCEUs Counselor Continuing Education Objectives ~ Define the socio-ecological model ~ Apply the socioecological model to addiction ~ Explore different variables in the socio-ecological model ~ Discuss how this framework can be used in prevention and treatment of Co-Occurring Disorders Prevention ~ Prevention can take the form of: ~ Preventing the problem ~ Preventing worsening of the problem ~ Preventing associated fall out Socio-Ecological Model ~ This model explores and explains human behavior as the interaction between the individual and 5 environmental systems ~ The Microsystem ~ The Mesosystem ~ The Exosystem ~ The Macrosystem ~ The Chronosystem Exploring the Model ~ Microsystem: Institutions and groups that most directly impact the person including: personal biology, family, school, church, peers, neighborhood. ~ Mesosystem: Interconnections between microsystems ~ Interactions between the family and teachers, relationship between the child’s peers and the family Question ~ How does the mesosystem impact the development of mental health (or illness)? ~ How does mental health (or illness) impact the mesosystem? Exploring the Model ~ Exosystem: Involves links between a social setting in which the individual does not have a direct active role (spouse’s work, community) and the individual's immediate context (home environment). ~ Macrosystem: Describes the culture (i.e. socioeconomic status, poverty, and ethnicity.) People, homes and individual work places are part of a large cultural context. Question ~ How does the Exosystem (social setting in which the individual does not have a direct active role (i.e. spouse’s work, community events—unemployment, high foreclosure rate) impact: ~ The family ~ The development of mental health (or illness)? Exploring the Model ~ Chronosystem: Events and transitions over the life course, as well as sociohistorical (birth, divorce, marriage, moves) Question ~ How does the attitude of the culture impact ~ The community ~ The family ~ The development of mental health (or illness)? ~ How do the community, family and individual with mental health (illness) impact the culture Individual (Biological and Personal History) Risk Factors ~ Pre-Existing Mental Illness ~ Chronic Pain ~ Low self-esteem ~ Substance use ~ History of abuse ~ Genetic vulnerability ~ Inappropriate coping responses ~ Violence/ aggression ~ Risk taking /impulsivity Individual (Biological and Personal History) Risk Factors ~ Rebelliousness ~ Rejection of pro-social values ~ Lack of peer refusal skills ~ Being bullied ~ Early and persistent problem behaviors ~ Early sexual activity ~ Peer rejection ~ Academic Failure ~ Lack of information on positive health behaviors Individual Protective Factors ~ Positive health/wellness behaviors ~ Bonding to pro-social culture ~ Participation in extracurricular activities ~ Positive relationships with adults ~ Social competence ~ Sense of well-being/self confidence ~ Has positive future plans ~ Knowledge about risks associated with addictive behaviors ~ Negative attitudes toward substances and substance use   Individual Prevention Strategies ~ Prevention strategies are

Models and Theories of Mental Health and Addictive Disorders Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counseling CEUs and Specialty Certificates Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery Earn counseling CEUs for this course Objectives ~ Explore why the mental health counselor needs to understand addictive behaviors ~ Learn the scientific and theoretical basis of models of addiction and mental distress from multiple disciplines ~ Develop criteria for assessing models and theories ~ Explore the appropriate application of models ~ Learn how to access addiction and mental health related literature from multiple disciplines Why is this important to the Counselor ~ Prevalence (proportion of cases in the population) and incidence (number of new cases) of addiction is increasing ~ New understanding/awareness of behavioral addictions ~ Improved knowledge of clinicians across disciplines to diagnose ~ Enables the clinician to provide more ethical and comprehensive treatment to the client by understanding ~ The influence of drugs and certain behaviors on brain chemistry which could ~ Lead to the development of additional MH, Legal, health, social, economic or addiction problems ~ Negatively impact MH treatment progress ~ Less than % of people who try to stop an addiction succeed for more than days ~ Patients often interpret a systemic failure (what we don’t know or understand) as a personal failure leading to low self esteem, depression, guilt, shame Criteria for Assessing Models and Theories ~ Does it explain the development of the condition in some people and not others (Predictive validity and reliability)~ ~ Can this explanation be applied across people and situations (Generalizability)~ ~ Can it be used to develop effective prevention and intervention strategies~ ~ Does it explain the use of seemingly destructive behaviors~ ~ Are there other unaccounted for factors which may influence development or recovery~ What are the Theories of Addiction ~ Biological/Disease Model ~ Moral/Spiritual Model ~ Behavioral Model ~ Environmental/Social Learning Model ~ Sociocultural Model ~ Enviro-Bio-Psychosocial Model ~ And many, many more…. Case Studies ~ John year old male reports no problems with addictive behaviors until years ago. Has had recurrent bouts of depression since he was . ~ Susan year old female began experimenting with drugs in high school. Currently does not meet criteria for any addictive or mood-related disorder. ~ Ralph is a year old male. Prior to this episode, reports no history of mental health or addiction issues. Recently had rotator cuff surgery and was on pain killers for days. Meets criteria for opiate dependence and generalized anxiety disorder. ~ Sally has a long history of major depressive disorder. She reports that after a recent surgery she was given Vicodin which she found made her feel much happier and more relaxed. ~ Julian is a year old male. Reports beginning recreational use of substances at . Currently meets criteria for generalized anxiety, marijuana dependence Biological/Disease Theories ~ Include ~ Genetic predisposition ~ Brain dysfunction ~ Theory ~ Addiction and mental health issues are primarily a brain disorder ~ In mental health, neurochemical imbalances cause the mental disorder ~ In addiction, the brain is disordered causing “cravings” for behaviors or substances to balance or rebalance the system ~ Example: Craving for dopamine and norepinepherine releasing activities supports survival by motivating certain behaviors Biological/Disease Theory ~ Addiction

Addressing Procrastination Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counseling CEUs and Specialty Certificates Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery Objectives ~ Identify and learn how to address some of the most common causes including: ~ Fear of failure (and success) ~ Perfectionism ~ Being overwhelmed ~ Laziness/Lack of motivation ~ Boredom/aversion ~ Uncertainty about how or where to start Objectives ~ Identify techniques to overcome procrastination ~ Eliminate other more rewarding options ~ Do 15 and Apply Parkinson’s Law ~ Small Steps ~ Provide rewards ~ Shorten the daily to do list ~ Leverage peak energy times ~ Be accountable to someone ~ Premack the boring ~ Pay attention to temperament ~ Increase adversity tolerance/gratitude ~ Find (and eliminate) procrastination rewards Cause: Fear of Failure (and Success) ~ Examples: Applying to college or for a job; going to counseling ~ Failure can be threatening ~ Society often frames failure in a negative light ~ Many young people have been so shielded from failure that they don’t have the skills to tolerate it. One and done. ~ Success can also be threatening because it “raises the bar” Cause: Fear of Failure (and Success) ~ Interventions ~ Explore what failure means. Find quotes from successful people about failure. ~ Avoid overgeneralization and personalization about failure. ~ Maintain a cheering squad ~ Remember past successes ~ Use the challenging questions to explore your fears in each situation ~ Identify all of the other things in your life that make it worth living   Cause: Perfectionism ~ Examples: homework/ work projects, appearance ~ Perfectionism often accompanies fear of failure ~ Perfectionists often either never get started or never finish a task… so it can never be evaluated ~ Perfectionism takes an inordinate amount of time  overwhemed ~ Perfectionists are never satisfied and maintain self anger for any imperfections ~ Perfectionists may also have low self esteem and base their worth on what they do instead of who they are Cause: Perfectionism ~ Interventions ~ Learn about the principles of diminishing returns ~ Practice purposeful action to improve life balance ~ Explore where the need to be perfect comes from ~ What does it mean if you are not perfect? ~ Where did you learn that you are only lovable if you are perfect? Do you believe this and hold your friends to this? ~ Enhance your self-esteem so you are not looking for external validation. Who are you vs. What you do Cause: Being Overwhelmed ~ Examples: A huge project, Too much else going on ~ Large projects can be daunting ~ Poor time management may also contribute to people feeling overwhelmed. ~ Interventions ~ For large projects, break it into manageable sub-projects (Dissertation, Spring cleaning, Recovery) ~ If there is too much else going on and you can’t find the time to get started, evaluate your time management. ~ Eliminate, Prioritize, Delegate & Combine, Plan ~ Clear clutter in that area (Doesn’t = organization binge) ~ Be mindful and have a laser focus Cause: Laziness/Low Motivation ~ Examples: Homework, house cleaning/bills, gym ~ Motivation is your get up and go ~ Low motivation (procrastination) is impacted by ~ Rewards for procrastinating ~ Competing activities ~ No consequences/accountability ~ Punishments for starting: ~ Activity isn’t rewarding ~ Distress (overwhelmed, fear of failure…) Cause: Laziness/Low Motivation ~ Motivation can be increased by ~

Happiness Habits Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counseling CEUs and Specialty Certificates Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery A direct link to the counseling CEU course is https://www.allceus.com/member/cart/index/product/id/745/c/ Objectives ~ Learn why these habits contribute to recovery from addiction and mood issues and techniques to help clients implement them ~ Habit: Awareness and Authenticity ~ Habit: Acceptance ~ Habit: Gratitude ~ Habit: Compassion ~ Habit: Breathing ~ Habit: Purposeful action and Long-Term Goals ~ Habit: Back-Talk ~ Habit: Thought Conditioning ~ Habit: Be Sense-sational Awareness and Authenticity ~ To get your wants and needs met, you first need to be aware of them ~ Practice Mindfulness ~ What do you need ~ What vulnerabilities do you currently have ~ How can you mitigate them ~ How can you prevent them ~ Why is it important to prevent them? Awareness and Authenticity ~ Living authentically means living in a way that is true to yourself. ~ Define what happiness means to you: ~ What makes you happy? ~ How will your thoughts and outlook change when you are happy? ~ What is the impact of happiness on your health and body (energy, sleep, weight, pain, illness…)? ~ When you are happy, who do you see in your support system and what will your relationships be like? ~ What will be different in your day to day life, hobbies and activities when you are happy? ~ How can you start making these things happen? (Principle of Reciprocity) Acceptance ~ Fighting against things that are unchangeable (or not realistically changeable by you) wastes a TON of energy. ~ Feelings ~ Other people ~ Certain situations ~ Accept the situation by saying “Okay, what now?” ~ Decide whether you will… ~ Change part of the situation to make it more tolerable ~ How can you do this? ~ Change your reaction to the situation ~ How can you do this? Gratitude ~ It can be easy to focus on all of the things you don’t have or what is not going right ~ An attitude of gratitude helps you ~ refocus on the positive ~ appreciate the simple things ~ Let go of envy and jealousy ~ Even if one area of your life is a mess, it is likely that you have other things to be grateful for. ~ Activities ~ Keep a gratitude list. Add at least one thing that went well each day ~ Look around and compare yourself to others who are not doing as well and/or the you in the past Compassion ~ Compassion means sympathetic awareness of others' distress and a desire to alleviate it ~ People may have compassion for others but not for themselves ~ Many of us were raised to think that if we are compassionate with ourselves it means we are lazy, weak or a failure. ~ Activity ~ Think of three times you have been compassionate in the past week. To whom? Why? How did it impact them? ~ How are you compassionate to yourself? How could you be? Breathing (and Laughter) ~ Deep breaths help oxygenate blood and reduce fatigue ~ Slow deep breaths also help lower heart rate and trigger the relaxation response. ~ Laughter not only makes you breathe deeper, but it also releases endorphins. ~ Activity ~ Practice deep breathing after each meal ~ When you are stressed, take a few deep breaths ~ Schedule in 10 minutes to laugh every day. Purposeful Action and Long-Term Goals ~ When you see that you are moving closer to your long term goals it inspires hope. ~ Each small step toward a rich and meaningful life can make you

Spiritual Steps to Recovery Here is a direct link to the counseling CEU class Objectives ~ Define spirituality ~ Explore why the following spiritual principles are important to recovery and how to develop them ~ Honesty ~ Hope ~ Faith ~ Courage and Willingness ~ Discipline Define Spirituality ~ Spirituality can be thought of as: ~ Spontaneous joy and wonder and a sense of fascination, mystery, awe and delight at the universe. ~ Recognition of connectedness between all things. Honesty ~ Honesty builds trust ~ Dishonesty with self causes many people to ~ Deny or ignore their own needs, wants and feelings ~ Stop trusting their instincts ~ Dishonesty with others creates relationships based on false principles and destroys trust. ~ To please self ~ To please others ~ Activity: ~ How does dishonesty affect you, your relationships and your environment? ~ How does honesty affect you, your relationships and your environment?   Honesty With Yourself ~ Get honest about what you need want and feel through mindfulness ~ Activity: Keep track of these things 3 times a day for a week ~ What did you learn about yourself? ~ What do you need to start doing differently to meet your needs? ~ Get honest about the reasons you are not honest ~ Activity: Think of 3 times you were not honest with yourself and 3 times you were not honest with someone else ~ Why were you dishonest? ~ What past experiences made you think dishonesty was a better choice? Honesty With Yourself ~ Eliminate excuses ~ Justifying your own behaviors ~ To yourself often avoids addressing the real issue ~ To others to elicit sympathy often also leads to a loss of respect and still avoids addressing the real issue ~ Justifying other’s behaviors ~ To yourself may minimize feelings of anger or anxiety but may cause you to miss signs of an unhealthy relationship Honesty With Yourself ~ Eliminate excuses ~ Activity ~ Be mindful for a week of how often you make excuses ~ Why did you do it? ~ What would have happened if you were honest? ~ Is this based on facts or feelings? ~ How likely is this? ~ Is this prediction based on the present or past experiences with others? ~ How can you deal with rejection or someone getting mad if it happens? Honesty ~ Deal effectively with conflict ~ Avoidance of conflict can lead to ignoring your feelings and needs ~ Why do you avoid conflict? ~ Do you avoid conflict only with certain people? ~ What needs to change so you can effectively deal with conflict? ~ What would it look like to successfully resolve a conflict ~ Mentally rehearse this prior to the situation. Honesty ~ Deal effectively with conflict ~ Ineffectively dealing with conflict can take the form of: ~ Seeing only how you are right ~ Seeing only how the other person is wrong (ignoring their perspectives and feelings) ~ Activity ~ Think about situations in your life in which there is conflict. ~ What are your feelings and needs in the situation? ~ In what ways are you right? ~ What might the other person’s perspective be? ~ In what ways is the other person right? ~ How can you create a win-win? Honesty ~ Develop Self-Esteem ~ Many times fear of rejection or someone getting mad at you will keep you from being honest. ~ You: “It really disappointed me when you broke your promise.” ~ Fear of rejection—If I tell her this she will think I am being stupid or get mad at me. ~ Activity ~ Think about 3 times when you were not honest with someone for fear of

Empowering Clients to Embrace Success Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counseling CEUs and Specialty Certificates Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery Click here to purchase the 2 hour CEU Counseling Course for $6 Objectives ~ Learn techniques to help clients ~ Describe Successful vs. Unsuccessful People ~ Develop compassion ~ Manage Stress ~ Use Positive Visualization Question ~ What does it mean to embrace success? ~ Think of a time in your past in which you have set out to do something and embraced success. ~ What did you do? ~ How did your mindset impact your motivation? Why Embracing Success Is Important ~ Increases empowerment and hope which increases motivation ~ Turns obstacles into challenges ~ Helps people focus on successes instead of failures Successful vs. Unsuccessful People Successful People ~ Think of 3 successful people. List 5 reasons why you perceive them as successful. ~ Do they succeed at everything? ~ How do they handle failures? ~ How does viewing themselves as successful help them?   Unsuccessful People ~ Think of 3 unsuccessful people. List 5 reasons why you perceive them as unsuccessful ~ Do they fail at everything? ~ Do they perceive themselves as unsuccessful? Businessman and the Fisherman Successful vs. Unsuccessful People ~ What does success mean to you? (What would life look like if you were successful?) ~ Power ~ Financial/material possessions ~ Relationships ~ Respect of others ~ Self-respect (Can you look at yourself in a mirror) ~ What is the difference between being an unsuccessful person and not succeeding at certain things? ~ Where did your ideas about success come from? ~ Do you agree? Developing Compassion ~ You tend to hold yourself to a higher standard than others and are more critical of yourself. ~ How does this impact your sense of success? ~ What does compassion mean? ~ Accepting that not every day is an “A” day ~ Taking all factors into consideration ~ Being willing to ask for help without judgement ~ Viewing success in the context of the present moment… “With all that is going on right now…” ~ Recognizing that everyone has strengths and weaknesses (Synergy is the key) Developing Compassion ~ Mindfulness ~ Compassion is grounded in an awareness of what you need. ~ Mindfulness helps you increase your awareness of ~ When you need to back off or ask for help ~ When you are succeeding (instead of taking the positives for granted) ~ What would happen if you extended the same compassion to yourself as you extend to others?   Managing Stress ~ Stress is another word for anxiety ~ Anxiety is a response to a threat ~ Examine what is causing your “stress” ~ Fear of failure? Success? Loss of Control? Rejection/being judged? ~ Poor time management? Lack of balance? ~ Ineffective goals/lack of reward ~ What is the effect of stress on success ~ Underlying “stress” drains energy ~ Less energy for success  less movement toward success Using Positive Visualization ~ Does your definition of what success looks like look the same as your definition of what life would look like if you were happy? ~ How can you be happy and successful? ~ What is most important to you? ~ Describe what a happy and successful life will look like. ~ What needs to change? What is the first step to this change? ~ What will stay the same? ~ Review this description daily. ~ When making decisions, a

The Many Facets of Anger Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counseling CEUs and Specialty Certificates Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery Click here to go directly to purchase the Counseling CEU course for $6 Objectives ~ Explore the function of anger ~ Identify the types of threats that may prompt anger ~ Identify different types of anger to include ~ Run of the mill anger ~ Irritation ~ Resentment ~ Envy/Jealousy ~ Guilt/Regret Function of Anger ~ Anger is part of the fight or flight reaction which is your brain’s natural response to a perceived threat ~ Anger pushes away or helps you dominate a threat Types of Threats ~ Threats can be to your… ~ Person (physical harm) ~ Property (Damage or take my stuff) ~ Self-esteem or self-concept ~ Hurt your feelings ~ Make you question your goodness as a person ~ Make you concerned that other people will think poorly of you ~ Origin ~ Things others do or don’t do ~ Internal critic/old tapes/others from the past ~ Conscience (guilt and regret) Types of Threats ~ Themes ~ Rejection/Isolation ~ Loss of Control/The Unknown ~ Death/Loss ~ Failure ~ Real vs. Perceived Threats ~ Real threats actually exist ~ Perceived threats are based on ~ Cognitive distortions ~ Prior experiences ~ Emotional reasoning ~ Incomplete information Activity ~ How do you handle threats to your: ~ Person/property? ~ Self-Esteem? ~ How can you handle threats from: ~ Others ~ Your internal critic (Past Others) ~ Your conscience (self anger, guilt and regret) Anger/Irritation ~ Anger is a generic term that describes the fight reaction in response to a threat ~ You feel like you can conquer the threat OR ~ You do not see any options for escape (think cat in a corner) ~ Anger happens on a continuum ranging from mild irritation to rage ~ The level of anger experienced is usually in proportion to ~ The immediate threat ~ The cumulative effect of multiple threats ~ Many times when people feel angry, underneath they also have a sense of helplessness or disempowerment. What Triggers Your Anger ~ Threats ~ Rejection/Isolation ~ Loss of Control/The Unknown ~ Death/Loss ~ Failure What to Do About Anger ~ Identify the threat ~ Explore the automatic beliefs triggering the anger ~ Why is this making you angry? (It makes me angry when…. I hate it when…) ~ How is this similar to other (unresolved) situations in your past? ~ Are there alternate explanations for the situation? What to Do About Anger ~ Identify the threat cont… ~ What threat theme is it related to? ~ Rejection: Is it really about you? ~ Failure: ~ Are you globalizing? ~ What can you learn? ~ Loss of Control/The Unknown: ~ What parts of this were and were not in your control? ~ What actions are worth your energy ~ Death/Loss ~ How does this impact how you see the world? ~ How does it impact how you see yourself? Activity Resentment ~ Resentment is anger directed at others for things they either did and shouldn’t have or didn’t do and should have. ~ What is the impact of holding on to resentments? ~ Emotionally ~ Mentally ~ Physically ~ Socially ~ Spiritually (Hope, faith, courage/willingness, discipline, integrity) ~ Many times underlying resentment are hurt feelings. (Example: You invited Jane to the party and not me.) Wha

CBT Interventions Group Activities Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counseling CEUs and Specialty Certificates Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery Objectives ~ Explore ways to teach Cognitive behavioral interventions in group Basis ~ Changing thoughts (cognitions) has a direct impact on physiological response (urges and behaviors) ~ Changing behaviors has a direct response on thoughts and emotional reactions ~ At its core CBT has the principles of noticing, understanding and addressing thoughts feelings and behaviors Functional Analysis ~ The process of identifying the antecedents (causes/triggers) and consequences (positive/negative) of behaviors ~ Causes ~ Emotional ~ Mental ~ Physical ~ Social ~ Environmental (including time & Date) Problem Identification and Solving ~ Stop. Use self talk, distress tolerance and/or relaxation techniques to restrain impulsive actions ~ Identify the problem—Who, where, what, why ~ Develop alternative solutions ~ Explore the short and long term consequences/outcomes of solutions ~ Choose a response ~ Evaluate the outcome Activity ~ When you experience a problem… ~ How can you remember to practice the pause? ~ What techniques can you use to get through the initial adrenaline rush? ~ Describe a time you get upset and effectively managed it. ~ Give an example of a time you got upset and did not effectively manage it. ~ What was the difference? Activity ~ Practice identifying the problem ~ Who is involved –Think broadly ~ What happened – Explore objectively ~ When did it take place – In the chain of events ~ Where did it take place – Is there significance to this place ~ Why did it happen? Why did it bother you? – Explore broadly ~ Identify alternatives ~ Immediate response – Benefits and drawbacks ~ Alternate responses – Benefits and drawbacks ~ Choose and implement the response Contracting ~ Identify the problem/target behavior ~ Identify a new behavior to replace it ~ Identify rewards ~ Write a contract ~ Monitor behavior Activity ~ Target Behaviors ~ Persistent worrying ~ Not getting out of bed ~ Anger outbursts ~ Smoking ~ Stress-Eating ~ Caving/being overly passive ~ Identify the antecedents of each ~ Identify the benefits and drawbacks of each ~ Identify alternate ways of dealing with the behavior Cognitive Distortions ~ Personalization ~ Taking everything personally—Its your fault. It was meant to hurt you. ~ Exaggeration ~ Making a mountain out of a molehill or seeing the worst-case scenario ~ All-or-Nothing ~ Viewing things in dichotomous terms ~ Availability Heuristic ~ Noticing what is most prominent in your mind   Cognitive Distortions ~ Minimization ~ Not giving credit where credit is due ~ When you do good things ~ When other factors are involved ~ Selective Abstraction ~ Seeing only what fits your mood/perspective Activity ~ Give an example of when you have used each distortion ~ Discuss why each distortion may develop ~ Explore the benefits and drawbacks of each distortion ~ Identify ways to address each distortion ~ Personalization ~ Exaggeration ~ All-or-Nothing ~ Minimization ~ Selective Abstraction ~ Availability Heuristic   ABC-DE ~ A=Activating Event ~ B=Automatic Beliefs ~ C=Consequences ~ D=Dispute automatic beliefs ~ E=Evaluate effectiveness of reactions Activity ~ Target Behaviors ~ Identify 3

Behavior Modification Universal Application Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counseling CEUs and Specialty Certificates Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery Objectivers ~ Apply behavior modification in the home, workplace and for self-improvement ~ Reward and Punishment: Examining the positives and negatives ~ Triggers and Stimuli: For new and old behaviors ~ Chaining and Trouble Shooting: Examining missed triggers and increasing motivation Application ~ Think about a situation in which you want to change the behavior of: ~ A pet ~ Someone you live with (child, roommate) ~ Someone you work with ~ Yourself Rewards ~ Increase the frequency of behaviors ~ Positive: Adds something ~ Presents, raises, praise ~ Negative: Takes away something unpleasant ~ Chores, eating vegetables, go home early ~ What is rewarding ~ Words of affirmation ~ Acts of service ~ Receiving gifts ~ Quality time ~ Physical touch Application ~ Identify 3 positive and one negative reward ~ A pet ~ Someone you live with (child, roommate) ~ Someone you work with ~ Yourself Punishment ~ Decrease the frequency of behaviors ~ Positive: Adds something negative ~ Lecture, additional work, picking up sticks in the yard ~ Negative: Takes away something enjoyable ~ Air conditioning, television, freedom (time out) ~ Punishment is not necessarily the opposite of reward ~ Generally behavior change is more successful if you reward the positive ~ Simply eliminating behaviors leave the person with no response options Application ~ Identify 1 positive and 3 negative punishments ~ A pet ~ Someone you live with (child, roommate) ~ Someone you work with ~ Yourself Extinction Burst ~ Occurs when a behavior fails to provide a reward or prior to stopping a cherished behavior ~ Intensifies until… ~ The energy to get the reward exceeds the value of the reward ~ A punishment is put in place ~ Examples… ~ Kid in the candy aisle ~ Day before you start your diet/stop drinking ~ Client becoming more symptomatic the week before discharge ~ It is important to examine the motivation for the extinction burst… why is the person not wanting to stop the old behavior Behavior Strain ~ The person/animal will not do the new behavior ~ When the reward is not strong (rewarding) enough ~ When the punishment is not strong enough to deter the behavior ~ When rewards/punishments/follow up is inconsistent ~ There is too long between rewards ~ There is an alternate reward ~ Examples: ~ Providing a treat to an animal an later ~ Having a 4 year old “behave all week” to get a reward ~ Losing 30 pounds before a reward ~ Couch potato to completing a 5k ~ Completing paperwork by Thursday’s staff meeting each week Other Principles ~ Rewards and punishments should ~ Use natural consequences when possible ~ Dog submission ~ Teen too distracted loses distractions (cell phone, computer) ~ Child acts out in store has to go sit with parent outside vs. behaving and getting to stay in the air conditioning and go play at McDonalds later ~ Follow as closely to the behavior as possible ~ Ineffective: Yelling at the dog when you get home for something he did hours ago. He will pair yelling with whatever he just did (i.e. greet you) ~ Effective: Charting nutrition after each meal, coffee when you get into work, comment on case notes as soon as you review them   Pairing ~ Conditioning a person or animal so that a “token” marks the good behavior and t

Developing Momentum in Therapeutic Relationships Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counseling CEUs and Specialty Certificates Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery Objectives ~ Describe the ideal momentum in a therapeutic relationship ~ Examine causes of “stuckness” ~ Review phases of readiness for change and appropriate interventions to increase readiness ~ Explore issues in the therapeutic relationship that may lead to stuckness and interventions Question ~ What causes your client’s “stuckness?” ~ What does “stuckness” look like for your clients? ~ What do you do to keep momentum going? Ideal Momentum ~ Assessment: Client identifies problem, and is highly motivated to work on it ~ First session: Client actively participates and is open and willing to hear feedback and take suggestions. ~ Second session and beyond: Client thoroughly completes homework, arrives on time, participates actively and reports near continuous improvement Reality for Many ~ Assessment: Client identifies problem and is highly motivated to have us fix it ~ First session: Client participates but often looks to the therapist to fix it. Expects what is done in session to be enough ~ Second session and beyond: Client rarely or partially completes homework, participates passively (reports problems, but doesn’t draw connections or look for solutions) and reports sporadic improvement   Stuckness vs. Plateau ~ Expect clients to experience plateaus where gains seem to stall. ~ A plateau lasting more than about a month in which the client has not reached maximal gains should be explored ~ Is something else going on and the client doesn’t have the energy resources to devote to counseling right now? ~ Or is has the client just lost steam? ~ Do treatment plan objectives need to be changed? Causes of Stuckness ~ Client has competing priorities ~ Client is not motivated to abandon old behaviors ~ Wrong or incomplete problem/cause identification ~ Goals are too broad, poorly defined or complicated ~ Client doesn’t feel heard or understood (yes buts or the same issue repeatedly comes up) ~ Client doesn’t understand the importance of homework or connection to recovery ~ Client isn’t challenged through socratic questioning to arrive at own solutions Readiness for Change ~ Precontemplation: Not ready ~ Contemplation: Realizing there may be a problem ~ Preparation: Trying to figure out what to do and decide if they are ready to change their behaviors ~ Action: Ready to change ~ Maintenance ~ Maintain progress on problem A while addressing B Reflection ~ Think about a change you wanted to make that lost it’s momentum. ~ What happened? ~ Why were the benefits of the new behavior not rewarding enough? ~ What did you miss about the old behaviors? Not (Totally) Ready for Change Change causes crisis and crisis causes change ~ Examine the benefits of the old behaviors ~ Ensure interventions meet the same need to a similar degree ~ Develop discrepancies between current behaviors and goals ~ Explore & address the drawbacks to the interventions ~ Increase frequency and or intensity of rewards for the new behavior Wrong/Incomplete Problem Identification ~ Examine the problem from a biopsychosocial perspective ~ Depression ~ Physical ~ Cognitive ~ Interpersonal ~ Environmental/situational ~ Examine what the person hopes to get out of the change (Miracle question) ~ Depression Treatment Happiness Relationship Improvement ~ Anxiety treatment Happiness Stop bingeing Issues in the Therapeutic Relationship ~ Client

Developing Interpersonal Skills Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counseling CEUs and Specialty Certificates Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery Counseling CEUs can be found for this course at https://www.allceus.com/member/cart/index/search?q=interpersonal+skills Objectives ~ Explore why it is important to develop interpersonal skills in clients ~ Identify the goals of interpersonal skill development ~ Explore why the relationship with self is vital in developing healthy relationships with others ~ Identify personal vulnerabilities which may impact interactions with others ~ Discuss boundaries, why they are important and common boundary issues ~ Explore resentment and jealousy and how to help clients address these feelings ~ Learn how to help clients develop a plan for nurturing relationships Interpersonal Skills in Counseling ~ Why are they important ~ Relationships are a buffer against stress but can be a stressor ~ Help people manage relationships in context taking into account the reciprocal nature Interpersonal Skills Goals ~ Develop awareness of, and honesty with, self and others ~ Develop and maintain meaningful relationships with healthy boundaries ~ Navigate unpleasant interpersonal experiences Interpersonal Skills in Counseling ~ Types of Relationships ~ Relationship with self | Getting needs met ~ Perception + Self-Talk + Situation ~ Relationships with others ~ Perception and reaction to the situation/people ~ People’s perception and reaction and impact on the situation to you ~ Example: Verbal De-Escalation ~ Example: Feed the fury vs. Brainstorm solutions ~ Example Mad at your boss vs. your spouse vs. your best friend Interpersonal Self Skills ~ Before you can be honest with and effectively interact with others in a way that meets your needs, you need to know ~ How the situation and prior experiences are impacting you ~ That you can trust yourself to accurately identify your needs and respond. ~ Example: Low self-esteem vs. High self-esteem alone ~ Example: Extrovert/Feeler vs. Introvert/Thinker handling a problem ~ Example: Domestic violence survivor vs. Non-survivor in a heated argument Interpersonal Self Skills ~ Mindfulness: Honesty and Awareness ~ Vulnerabilities (interpersonal vulnerabilities) ~ Transference ~ Counterteransference ~ Displacement ~ Safe target ~ Seeking comfort ~ Triggers ~ Needs ~ What are my needs and how is this situation affecting them? ~ Reaction driven (autopilot fight or flee) vs. Goal driven Interpersonal Self Skills ~ Awareness of your temperament and the temperament of others can improve communication and reduce stress. ~ Temperament ~ Extroverts need activity and talk while they think ~ Introverts need quiet time and think then talk ~ Sensors need details and concrete data points and can put it together as they go ~ iNtuitors need the bigger picture before the data (wiki) ~ Thinkers approach problems from a practical fix-it the right way point of view ~ Feelers often need their feelings validated (harmony), then solve problems from a fix it in a way that makes the most people happy ~ Judgers need structure, schedules and may not adapt well ~ Perceivers need spontaneity or they get bored. Interpersonal Communication Skills ~ Practice the pause ~ Address one thing at a time ~ Truly listen to what the other person is saying ~ Try to take their perspective or theorize why they might be reacting this way ~ Boss snaps at you when

Walking the Middle Path Locus of Control and Attributions Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counseling CEUs and Specialty Certificates Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery Counseling CEUs can be earned for this presentation at https://www.allceus.com/member/cart/index/product/id/715/c/2 Objectives ~ Define Locus of Control (Empowerment vs. Powerlessness) ~ Explore how both an extreme internal or external locus of control can increase stress, anxiety, anger and/or depression. ~ Learn how basic fears and past trauma may contribute to use of an extreme locus of control ~ Define/review attributions ~ Explore how extreme attributions can increase stress, anxiety, anger and/or depression. ~ Learn Individual and group activities that can help clients walk the middle path in terms of attributions and locus of control. Locus of Control ~ Internal (empowerment) vs. External (powerlessness) ~ Internal Locus: I am fully in charge of my destiny and everything that happens. ~ External Locus: My destiny lies fully in the hands of fate. ~ Extreme locus of control can increase stress, anxiety, anger and depression ~ Middle Path ~ Although some things are out of my control, I have the ability to control many things in my life and my reactions to things. Locus of Control– Activity ~ Depression ~ Depression is often the result of disempowerment, a sense of helplessness and hopelessness and/or exhaustion from trying to control the uncontrollable. ~ What caused you to be depressed this week? ~ What things were out of your control? ~ What things were within your control? ~ (Facilitator prompt) Situations including prevention ~ (Facilitator prompt) Reactions to/thoughts about situations ~ Past trauma can lead to an extreme locus of control ~ External—Nothing I do will change anything ~ Helplessness of trauma generalized ~ Internal – It was my fault and I must control everything to prevent bad things from happening. ~ Middle Path ~ I cannot change what happened, but I can take steps to protect myself in the future. (Fire, rape, hurricane/tornado) Trauma Activity ~ How does your past trauma affect how you react to failure and setbacks today? ~ (Facilitator prompt) Rekindle a sense of helplessness? Create a burning determination? ~ How does your past trauma impact the way you live your life and your relationships today? ~ (Facilitator prompt) Overprotective and controlling or disengaged and overly permissive? ~ (Facilitator prompt) Are you constantly on the lookout for others to hurt you? Basic Fears ~ Basic Fears ~ Rejection/Isolation ~ I get rejected because I am unlovable ~ I am rejected because others are jealous or stupid. ~ Failure ~ I fail because I am stupid ~ I failed because the team/equipment didn’t function properly ~ Loss of Control/Unknown ~ Life and happiness is a crap shoot ~ It is vital to my survival that I know what is going on at all times. Fears Activity ~ For each category below, identify 3 examples of when you have experienced them. ~ Rejection ~ Failure ~ Unknown/Loss of Control ~ For each example, identify 3 reasons each happened. ~ Examine the reasons and look for examples of extreme locus of control Fears Activity ~ Walk the middle path ~ How can you be both rejected and accepted ~ How can you both fail and succeed ~ How can you both be in control and out of control Attributions ~ Global or Specific ~ Global: It applies to everything all the time ~ Too general can cause failure

Tips for Responding After a Disaster Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counseling CEUs and Specialty Certificates Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery The Counseling CEU course for this presentation can be found at:  https://www.allceus.com/member/cart/index/search?q=disaster+Response Objectives ~ Review common reactions to disaster and interventions ~ Identify common stressors in shelters ~ Identify common issues when sheltering in place ~ Explore how to help reduce stress and anxiety through ~ Facilitated and independent activities ~ Facilitated groups Disaster Response ~ Acute stress is a NORMAL reaction to an ABNORMAL event ~ The majority of people will recover with no long-term effects Sheltering in Place ~ Common Stressors ~ Anxiety about the situation and your safety ~ Concern about loved ones who are elsewhere ~ Feelings of isolation, loneliness, sadness or boredom ~ Guilt about not being able to perform normal duties or help out ~ Fear over loss of income/cost of repairs ~ Changes to sleeping and eating patterns Disaster Response: Shelters ~ People who are in shelters ~ Have suffered a trauma (loss of control/sense of helplessness) ~ May experience significant losses (possessions, pets) ~ May not know where some of their loved ones are Additional Stressors in Shelters ~ Environment that is ~ crowded/noisy/overstimulating ~ less secure than home ~ Poor sleep: Routine, Safety, Ergonomics ~ Pain ~ Nutritional changes ~ Additional caffeine and nicotine ~ Ambiguity about what lies ahead ~ Boredom/time to dwell Common Responses in Adults & Adolescents ~ Difficulty communicating thoughts ~ Difficulty sleeping ~ Difficulty with balance in life ~ Low threshold of frustration ~ Increased use of drugs/alcohol ~ Limited attention span & poor work performance ~ Headaches/stomach problems ~ Colds or flu-like symptoms ~ Disorientation or confusion ~ Difficulty concentrating ~ Reluctance to leave home ~ Depression, sadness, hopelessness ~ Mood-swings ~ Overwhelming guilt ~ Fear of crowds, strangers, or being alone ~ Argumentativeness / refusing to follow rules / being overly controlling Common Responses in Children ~ Birth through 2 years. ~ Irritability ~ Crying more than usual ~ Wanting to be held and cuddled ~ Regression to an earlier age (crawling, mama-dada) ~ The biggest influence on children of this age is how their parents cope. Common Responses in Children ~ Preschool – 3 through 6 years. ~ Preschool children often feel helpless and powerless in the face of an overwhelming event. Because of their age and small size, they lack the ability to protect themselves or others. As a result, they feel intense fear and insecurity about being separated from caregivers. ~ Preschoolers cannot grasp the concept of permanent loss. ~ In the weeks following a traumatic event, preschoolers’ play activities may reenact the incident or the disaster over and over again. Common Responses in Preschool cont… ~ Crying/Depression ~ Inability to concentrate ~ Bedwetting ~ Withdrawal and isolation ~ Thumbsucking ~ Not wanting to attend school ~ Nightmares ~ Headaches ~ Clinging/fear of being left alone ~ Changes in eating and sleeping habits ~ Regression to previous behaviors ~ Excessive fear of darkness or storms ~ Fighting ~ Increase in physical complaints Common Responses in School Children

Addressing Treatment Noncompliance Instructor: Dr. Dawn-Elise Snipes CEUs for this presentation can be found at https://www.allceus.com/member/cart/index/search?q=noncompliance Objectives ~ Examine some of the reasons for treatment noncompliance including ~ Learning vs. Performance ~ Low motivation ~ Not feeling heard / White-Coat Syndrome ~ Roll with Resistance ~ Tipping the Scales Questions ~ In what ways are your clients noncompliant? ~ What things are your clients often resistant about? Noncompliance ~ Is NOT a respect issue ~ Can result from ~ Lack of knowledge ~ Lack of ability ~ Lack of effective skills for that person ~ Lack of motivation ~ No buy-in to new skill or behavior ~ New skill or behavior less effective than old skill or behavior Types of Resistance ~ Issue resistance ~ Related to a specific issue such as smoking cessation, changing a dietary pattern, physical activity, etc. ~ Relational resistance ~ Has to do with the relationship between you and the client. ~ There is discord in the interactions. ~ Comments may include ~ You don’t understand ~ You can’t help me Learning vs. Performance ~ Client is motivated but not following through ~ Do they know it? ~ Can they do it? ~ Do they have confidence that they can do it? ~ How do you teach adult learners: ABCD ~ Acquisition: Auditory, Visual, Kinesthetic ~ Buy In (Why do I care?) ~ Connected to current/prior situations ~ Divided into manageable parts Learning vs. Performance ~ How do you teach performance? ~ Role play ~ Hypothesizing ~ Systematic exposure/experience ~ Example: Distress Tolerance for Anxiety ~ Have client develop distress tolerance plan ~ Remember a time last week when you were distressed and explain how you could have applied the plan ~ Role play a situation that often causes you distress and use the new skills ~ Envision yourself successfully navigating a stressful situation using new skills Learning vs. Performance ~ Systematic exposure/experience ~ Example: Distress Tolerance for Anxiety ~ IRL: Practice using the skill at least once a day on things that cause you anxiety. ~ Identify how successful it was ~ Identify what parts worked ~ Identify what you could do differently next time Tipping The Scales of Motivation ~ Stages of Readiness for Change ~ Precontemplation ~ Contemplation ~ Preparation ~ Action ~ Pain  Withdrawal  Romanticize/minimize drawbacks to old behavior ~ Motivation ~ Stages are NOT linear Motivation ~ Why is the new behavior less motivating? ~ Benefits of old behavior (Drinking, Eating, Cutting, Screaming, Sleeping) ~ How can you meet those needs now ~ Drawbacks to new behavior (Less immediately effective, less enjoyable, hard to remember to use them) ~ How can you minimize those ~ Benefits of the new behavior ~ How can you maximize those ~ Drawbacks to the old behavior ~ How can you magnify/remember these Motivation ~ What about the new behavior is less motivating ~ No buy in ~ Too hard/complicated/theoretical ~ Assumes skills not available (i.e. need to pause before DT; Need self awareness before communicating needs) ~ Not individualized ~ Meditation/PTSD/ADHD ~ Writing and reading for Extroverts ~ Support group and social gatherings for Introverts, cultures that prefer privacy ~ Tried and failed   Motivation Maintenance ~ Regularly review and add to the ~ Benefits of change ~ Drawbacks to st