Counselor Toolbox Podcast

The Neurobiological Impact of Psychological Trauma: The HPA-Axis An on-demand course based on this product is available for CEUs at https://www.allceus.com/member/cart/index/product/id/650/c/ Objectives ~    Define and explain the HPA-Axis ~    Identify the impact of trauma on the HPA Axis ~    Identify the impact of chronic stress/cumulative trauma on the HPA-Axis ~    Identify symptoms of HPA-Axis dysfunction ~    Identify interventions useful for this population Based on ~    Post-traumatic stress disorder: the neurobiological impact of psychological trauma Dialogues Clin Neurosci. 2011 Sep; 13(3): 263–278. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182008/ ~    This article lays out the many changes and/or conditions seen in the brain of people with PTSD. ~    As clinicians, awareness of these changes can help us educate patients about their symptoms and find ways of adapting to improve quality of life. Introduction ~    Neurobiological abnormalities in PTSD overlap with features found in traumatic brain injury ~    The response of an individual to trauma depends not only on stressor characteristics, but also on factors specific to the individual. ~    Perception of stressor ~    Proximity to safe zones ~    Similarity to victim ~    Degree of helplessness ~    Prior traumatic experiences ~    Amount of stress in the preceding months ~    Current mental health or addiction issues ~    Availability of social support Introduction ~    For the vast majority of the population, the psychological trauma is limited to an acute, transient disturbance. ~    The signs and symptoms of PTSD reflect a persistent, abnormal adaptation of neurobiological systems to the witnessed trauma. What is the HPA Axis ~    Hypothalamic-Pituitary-Adrenal Axis AKA the Threat Response System ~    Controls reactions to stress and regulates many body processes, including digestion, the immune system, mood and emotions, sexuality, and energy storage and expenditure ~    The ultimate result of the HPA axis activation is to increase levels of cortisol in the blood during times of stress. ~    Cortisol's main role is in releasing glucose into the bloodstream in order to facilitate the “flight or fight” response. It also suppresses and modulates the immune system, digestive system and reproductive system. HPA-Axis Dysfunction ~    The body reduces its HPA axis activation when it appears that further fight/flight may not be beneficial. (Hypocortisolism) ~    Hypocortisolism seen in stress-related disorders such as CFS, burnout and PTSD is actually a protective mechanism designed to conserve energy during threats that are beyond the organism's ability to cope. ~    Dysfunctional HPA axis activation will result in ~    Abnormal immune system activation ~    Increased inflammation and allergic reactions ~    IBS symptoms such as constipation and diarrhea, ~    Reduced tolerance to physical and mental stresses (including pain) ~    Altered levels of sex hormones Fatigue ~    Fatigue is actually an emotion generated in the brain, which prevents damage to the body when the brain perceives that further exertion could be harmful. ~    Fatigue in sports is largely independent of the state of the muscles themselves and is more related to: ~    Physical factors ~    Core temperature ~    Glycogen levels ~    Oxygen levels in the brain ~    Thirst ~    Sleep deprivation ~    Levels of muscle soreness/fatigue Fatigue ~    Fatigue cont… ~    Psychological factors reducing fatigue ~    Emotional state ~    Knowledge of the endpoint ~    Oth

Assessment: Neurobiology of Mental Health and Addiction Issues An on-demand course based on this product is available for CEUs at https://www.allceus.com/member/cart/index/product/id/650/c/ Objectives ~Neurotransmitters ~Sex Hormones ~Thyroid Hormones ~Stress Hormones ~Physiology of Emotion and Motivation ~Physiology of Sleep ~Physiology of Eating ~Physiology of Stimulants ~Physiology of Depressants Neurotransmitters–Inhibitory ~Serotonin ~Broken down to make melatonin/sleep ~Bowel function ~Anxiety/Aggression ~Impulse control ~Depression? ~Pain control ~Sleep ~Alcohol impairs body’s ability to convert tryptophan to serotonin… Neurotransmitters–Inhibitory ~GABA ~Sedative/depressive/anti-anxiety neurotransmitter ~Improves concentration by filtering out “background noise” ~Impulse control ~Glucose is necessary for the formation of GABA…hypoglycemia can lead to a reduction in GABA Neurotransmitters–Excitatory ~Glutamate ~Glutamate is generally acknowledged to be the most important transmitter for normal brain function. ~Excitatory Neurotransmitter ~Learning and Memory ~Norepinepherine/Noradrenaline (Catecholamine) ~Increases arousal and alertness ~Promotes vigilance and focuses attention ~Enhances formation and retrieval of memory ~Restlessness and anxiety. Neurotransmitters–Excitatory ~Dopamine (Catecholamine) ~Broken down to make norepinehperine ~Motivation chemical (increased arousal and pleasure) ~High levels of free dopamine in the brain generally enhance mood and increase body movement (i.e., motor activity) ~Too much dopamine may produce nervousness, irritability, aggressiveness, and paranoia Stress/HPA-Axis ~In response to stress, the level of various hormones changes. ~Reactions to stress are associated with enhanced secretion of a number of hormones including glucocorticoids and catecholamines to increase mobilization of energy sources ~The HPA-Axis is activated ~Cortisol (gluticocorticoid) is released ~Chatecholamines (i.e. adrenaline and dopamine) are released ~Gonadotropins are suppressed Sex Hormones ~Androgen/Testosterone ~Concentration ~Mood (Irritability and depression) ~Increase in belly fat ~Estrogen (neurostimulant) ~Receptors are very abundant in the amygdala (emotion center) and hypothalamus (autonomic nervous system/fight-flight-freeze) ~Estrogen increases serotonin receptor responsivity, increases the number of serotonin receptors and enhances serotonin transport and uptake ~High levels of estrogen associated with anxiety ~Low levels of estrogen associated with depression Sex Hormones ~Progesterone ~Imbalance in ratio with estrogen is implicated in mood disorders. ~Referred to as the relaxation hormone ~Synthetic progesterone is associated with depression ~Gonadotropins: Hormones synthesized and released by the anterior pituitary, and promote production of sex hormones ~Oxytocin (bonding hormone): Can counteract cortisol and vice versa Thyroid Hormones ~Thyroxine (T4) and Triiodothyronine (T3) ~Too much thyroid hormone speeds things up and too little thyroid hormone slows things down ~The pituitary gland releases thyroid stimulating hormone to get the thyroid to release T4 and T3 ~Majority of thyroid hormones produced by the thyroid are T4, however T3 is the most active useable form ~The conversion of T4 to T3 is a critical element in this puzzle. ~By testing TSH and T4 alone, doctors are assuming that our bodies are properly converting the T4 to active T3. Thyro

Assessment: Identifying the Problem Objectives ~ Define screening and assessment ~ Define the purpose of assessment ~ Explore the steps in the assessment ~ Recognize the stage of change a client is in with regards to mental health and substance abuse and utilize this towards creating a treatment plan. ~ Learn about the first steps in moving toward happiness Why Is This Important ~ 47% of US Adults suffers from maladaptive signs of an addictive disorder over a 12-month period ~ Co-Occurring Disorders are the EXPECTATION not the Exception ~ Statistics indicate that the majority of people seen in mental health treatment struggle with addictive behaviors. ~ Refer for treatment or treat yourself Screening and Assessment ~ Screening is a very quick process which can be done by ~ Physicians ~ Coaches ~ Specialists/Techs ~ Counselors ~ Screening simply determines if there may be a need for further evaluation. Purpose of Assessment ~ To identify symptoms ~ Explore the course of the symptoms ~ Identify exacerbating and mitigating factors ~ Determine the impact of symptoms ~ Identify change goals ~ Develop an action plan based on identified goals Assessment Provides Awareness of SNAP  Strengths ◦ Resources ◦ Skills ◦ Mitigating Factors and exceptions  Needs ◦ Biological ◦ Safety ◦ Love and Belonging  Attitudes ◦ About recovery ◦ Cultural Awareness of SNAP ~ Preferences ~ Learning style ~ Treatment approach ~ Quality of Life 5 Principles of Motivational Interviewing  Generate a Gap  Roll with Resistance  Avoid Arguing  Can Do  Express Empathy Stages of Readiness for Change ~ Most people have multiple issues ~ Readiness for change can be different for each issue—even each symptom of each issue ~ Stages ~ Precontemplation ~ Contemplation ~ Preparation/Determination ~ Action ~ Maintenance (needs attention when addressing new issues) Addiction (vs. Recreational Use) ~ Tolerance need more to get the same rush, high or feeling. ~ Withdrawal: Anxiety, irritability, shakes, sweats, nausea, depression when unable to access the addiction ~ Negative consequences: Continued to use even though there have been negative consequences. ~ Neglected or postponed activities because of your use? ~ Significant time or energy spent obtaining, using, concealing, planning, or recovering from your use. ~ Unsuccessful attempts to cut down or control your use Chemical and Behavioral ~ Addictive behaviors causes a “flood” of neurochemicals ~ This flood contributes to an imbalance ~ Like a “hangover” occasional use does not necessarily alter brain functioning ~ Repeated use causes the brain to shut down certain pathways so it is not constantly being flooded (tolerance) ~ Many other issues such as pre-existing anxiety or depression can indicate a pre-existing neurochemical imbalance which is being self-medicated ~ Requires additional stimulation to produce the same relief because many fewer “doors” are open Mental Health ~ Depression/Hopelessness/Apathy ~ Anxiety/Worry ~ Difficulty Concentrating ~ Irritability ~ Agitation ~ Fatigue ~ Changes in sleep duration or quality ~ Changes in eating First Steps ~ Identify the Problem ~ Identify the Solution ~ Learn about what causes the problem in general ~ Learn about what causes the problem for you ~ Learn about possible solutions ~ Identify solutions that will work for you ~ Develop a plan to start implementing those solutions Presenting Problem ~ Presenting problem ~

Anger, Anxiety and Depression Making the Connection Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Objectives Define the transdiagnostic and transactional theories Define anger and anxiety Explore types of threats and threat assessment techniques Explore intervention techniques Define depression Examine the connection between depression, anger and anxiety Identify transdiagnostic interventions Transdiagnostic & Transactional Approaches ~Transdiagnostic Model ~Asserts that many symptoms are common to many disorders such as ~Changes in sleeping patterns ~Changes in eating patterns ~Irritability ~Fatigue ~Transactional Model ~Asserts that there is a reciprocal interaction between everything. ~Transactions can be positive or negative What are Anger and Anxiety ~Emotional labels assigned to physiological responses to a perceived threat. ~Threats ~Death ~Rejection/Isolation ~Loss of Control ~The Unknown ~Failure Anger ~The fight response because ~It is a threat you can conquer ~You are trapped and have no choice ~Types of Anger ~Rage/Anger/Irritation ~Jealousy/Envy ~Guilt ~Hate/Resentment Anxiety ~The flight response because ~You choose not to use the energy to fight ~You do not believe you can win ~Types of Anxiety ~Worry/Fear/Terror ~Stress Threat Assessment Threat Assessment: General Threat Assessment: BreakUp Examine the Triggers ~How many anger and anxiety triggers is the person experiencing on a typical day ~Is there a relationship between the number of triggers and the intensity of the reaction? ~Is there a particular threat those triggers relate to? ~What automatic Beliefs are supporting that threat ~What are some alternate beliefs the person could use to dispute the unhelpful ones? Examine the Impact ~What is the impact of the emotional/behavioral reaction on the person and his or her environment? ~Emotions ~Thoughts ~Physical comfort and energy ~Relationships Depression ~A sense of hopelessness and helplessness ~Most people with depression have (or had) ~High levels of anxiety/anger ~Inability to change the situation or eliminate the threat Transactional Analysis ~Threat Response System is triggered ~Person attempts to fight or flee ~Attempts are unsuccessful ~Threat Response System continues to protect the person ~Sleep is impaired ~Hormones regulating sleep and feeding are impaired ~Irritability increases as the stress load increases ~Exhaustion sets in ~Lack of quality sleep and continuation of stress response causes neurotransmitter imbalance ~Excitatory neurotransmitters go into conservation mode ~Concentration becomes difficult ~Motivation wanes (Apathy, Lack of pleasure) ~Hopelessness and helplessness sets in (Depression) Where to Intervene ~Sleep ~Sets circadian rhythms (sleep/eat/wake (cortisol)) ~Balances neurotransmitters and other hormones ~Will help with ~Eating disturbances ~Exhaustion ~Irritability ~Low libido ~Interventions ~Create a sleep routine ~Identify reasons sleep is difficult Where to Intervene ~Nutrition ~Provides the building blocks for mood (neurotransmitters) and health (libido, pain perception) ~Blood sugar issues, IBS, Chrons and excessive use of caffeine can all intensify or prolong the stress response and negatively impact sleep and hormone balance. ~Dehydration contributes to difficulty concentrating and fatigue ~Interventions ~Limit caffeine, especially 8 hours before bed. ~Try

Dialectical Behavior Therapy Skills Interpersonal Effectiveness Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Objectives ~    Define interpersonal effectiveness ~    Identify barriers to interpersonal effectiveness ~    Examine the goals of interpersonal effectiveness ~    Review techniques for improving interpersonal effectiveness Definition and Goals ~    Interpersonal effectiveness is the ability to ask for what you want and say no to unwanted requests ~    Goals ~    Get others to do things you want them to do ~    Get others to take you seriously ~    Effectively say no to unwanted requests ~    Strengthen current relationships ~    Find and build new relationships ~    End hopeless relationships ~    Create and maintain balance ~    Balance acceptance and change Barriers ~    Lack of effective communication skills ~    Lack of clarity about what you want from others ~    Difficulty balancing your needs and the other person’s needs ~    Emotions get in the way ~    You sacrifice long term goals for short term relief/urges ~    Other people get in the way ~    Other people are more powerful than you ~    Need for external validation ~    Beliefs that you don’t deserve what you want Techniques ~    Clarify priorities…How important is ~    Getting what you want ~    What, exactly, do you want, and how can the other person provide this. ~    Feel better ~    Fix it ~    Know you will never leave ~    Keeping the relationship ~    Maintaining your self-respect DEAR MAN ~    Describe in specific, objective terms ~    Express feelings and opinions using “I” statements ~    Assert ~    Ask for what you want ~    Don’t expect mind reading ~    Reinforce by explaining the benefits to the other person ahead of time DEAR MAN ~    Mindfulness ~    Stay focused on your goal ~    Ignore diversion techniques-blaming, magnification, justification or switching topics ~    Appear confident in verbal and nonverbal behavior ~    Negotiate ~    Offer and ask for other solutions ~    Compromise ~    Say no but offer alternatives Keeping Relationships- GIVE ~    Gentle—No attacks, threats, manipulation, judging (should, shouldn’t, moralizing), no sneering, smirking, eye rolling, name calling ~    Interested ~    Listen ~    Pay attention to nonverbals (yours and theirs) ~    Maintain eye contact ~    Try to unhook from your emotions Keeping Relationships- GIVE ~    Validate ~    Pay attention ~    Reflect back ~    Pay attention to what is not being said ~    Understand how the other person’s reactions and thoughts make sense based on their past and present ~    Acknowledge the valid ~    Show equality treating the other person as an equal not as fragile, incompetent or domineering ~    Easy manner Keeping Self-Respect– FAST ~    Fair to yourself and the other person (validate both of your feelings) ~    Apologies ~    Don’t apologize for your feelings or opinions ~    Don’t invalidate the valid ~    Stick to your values ~    Truthfulness ~    Don’t lie, exaggerate or make up excuses Asking for Something or Saying No Asking for Something or Saying No ~    Points to Consider ~    Capability of either person to deliver ~    Does it relate to a high or low priority goal? ~    How will it impact your self respect to say or take no? ~    What are each person’s rights and values in the situation? ~    What type of relationship do you have with the person ~    What is the effect of your action on your long-te

Dialectical Behavior Therapy Techniques Distress Tolerance Presented by: Dr. Dawn-Elise Snipes  Executive Director, AllCEUs Podcast Host: Counselor Toolbox & Happiness isn’t Brain Surgery with Doc Snipes President: Recovery and Resilience International Objectives ~    Define goals of distress tolerance ~    Discuss why some clients do not choose distress tolerance ~    Explore a variety of Distress Tolerance and Reality Acceptance Skills including ~    STOP ~    Pros and Cons ~    TIP ~    ACCEPTS ~    Self Soothing ~    IMPROVE the Moment ~    Radical Acceptance ~    Turning the Mind Goals of Distress Tolerance ~    The goal of distress tolerance is to accept, find meaning for and tolerate distress ~    Pain and distress are part of life.  Refusing to accept this leads to suffering ~    Any attempts at change will produce distress, therefore distress tolerance skills are necessary Change causes crisis and crisis causes change Distress Tolerance ~    Distress tolerance is a natural progression from mindfulness ~    Accepting, nonjudgmentally, oneself and the situation ~    Not trying to change the situation, your feelings, thoughts or urges ~    Distress tolerance means surviving crises, accepting life as it is in the moment. Tolerance and acceptance of reality do not equate with approval Proving How Bad It Is ~    Sometimes people so want others to understand how bad it is they focus on that instead of surviving the situation ~    Short Term Gains  (Look what you made me do) ~    Controlling another’s behavior ~    Going to the hospital and getting attention/break ~    Long Term Benefits ~    ?? ~    Have clients remember a time they acted out to try to get someone to see how bad it was.  What were the results? Distress Intolerance Thoughts ~    I can’t stand this ~    It’s unbearable ~    I hate this feeling ~    I must stop this feeling ~    I must get rid of it ~    Take it away ~    I can’t cope with this feeling ~    I will lose control ~    I’ll go crazy ~    This feeling will keep going on forever ~    It is wrong to feel this way ~    It’s stupid and unacceptable ~    It’s weak ~    It’s bad ~    It’s dangerous Avoidance Behaviors Urge Surfing ~    Urges are generally intense for 20-30 minutes ~    Every time you have an urge think, “I have a choice!” ~    Surf the urge by opening yourself up to the urge. This doesn’t mean that you consume yourself in it (which feels horrible) or fight it and push it away. What you do is experience the feeling of the urge with acceptance, non-judgement, and be sensitively aware that it is there. STOP Skills ~    Stop ~    Take a step back ~    Observe ~    Proceed Mindfully Pros and Cons ~    What are the benefits to acting on impulsive urges? ~    What are the drawbacks to acting on impulsive urges? ~    What are the benefits to  __[insert the skill] __ ~    What are the drawbacks to  __[insert the skill] __ TIP Skills ~    Temperature ~    Intense Exercise ~    Paced Breathing ~    Paired Muscle Relaxation ~    The act of muscle relaxation is paired with a verbal cue ~    What reactions do you have that are paired with verbal cues? Distract with Wise Mind ACCEPTS ~    Activities (pleasant) ~    Contributing ~    Comparisons ~    Emotions (opposite) ~    Pushing Away ~    Think about something totally different ~    4       3     2    1 Self-Soothing ~    Body Scan Meditation ~    Self-Soothing Using the 5 Senses ~    Sight ~    Smell ~    Hearing ~ 

Dialectical Behavior Therapy Techniques Emotion Regulation Presented by: Dr. Dawn-Elise Snipes  Executive Director, AllCEUs Podcast Host: Counselor Toolbox & Happiness isn’t Brain Surgery with Doc Snipes President: Recovery and Resilience International Objectives ~    Review the basic premises of DBT ~    Learn about the HPA-Axis ~    Define emotion regulation ~    Identify why emotion regulation is important and how it can help clients ~    Explore emotion regulation techniques Basic DBT Premises ~    Dialectical Theory ~    Everything is interconnected ~    Reality is not static ~    Constantly evolving truth can be found by synthesizing differing points of view DBT Assumptions ~    People do their best ~    People want to get better/be happy ~    Clients need to work harder and be more motivated to make changes in their lives ~    Even if people didn’t create their problems, they still must solve them ~    The lives of suicidal [or addicted] people are unbearable ~    People need to learn how to live skillfully in all areas of their lives. ~    People cannot fail in treatment What is Emotion Regulation ~    Emotional dysregulation results from a combination of ~    High emotional vulnerability ~    Extended time needed to return to baseline ~    Inability to regulate or modulate one’s emotions ~    Emotional vulnerability refers to [situation] in which an individual is more emotionally sensitive or reactive than others ~    Differences in the central nervous system and HPA Axis play a role in making a person more emotionally vulnerable/reactive ~    The environments of people who are more emotionally reactive are often invalidating What is Emotion Regulation ~    According to Linehan, “Emotional regulation is the ability to control or influence which emotions you have, when you have them, and how you experience and express them.” ~    Emotion Regulation ~    Prevents unwanted emotions by reducing vulnerabilities ~    Changes painful emotions once they start ~    Teaches that: ~    Emotions in and of themselves are not good or bad ~    Suppresses emotions makes things worse Emotion Regulation ~    Emotions are effective when: ~    Acting on the emotion is in your best interest. ~    Expressing your emotion gets you closer to your [ultimate] goals. ~    Expressing your emotions will influence others in ways that will help you. ~    Your emotions are sending you an important message. The HPA-Axis ~    Hypothalamic Pituitary Adrenal (HPA) axis is our central stress response system ~    Hypothalamus ~    releases a compound called corticotrophin releasing factor (CRF) ~    Pituitary ~    Triggers the release of adrenocorticotrophic hormone (ACTH) ~    Adrenal ~    ACTH is released and causes the adrenal gland to release the stress hormones, particularly cortisol and adrenaline HPA Axis ~    The Adrenals ~    Control chemical reactions over large parts of your body, including your ‘fight-or-flight’ response. ~    Produce even more hormones than the pituitary gland ~    Steroid hormones like cortisol (a glucocorticoid) increasing availability of glucose and fat ~    Sex hormones like DHEA, estrogen ~    Stress hormones like adrenaline ~    Once the perceived threat passes, cortisol levels return to normal ~    What if the threat never passes? HPA Axis ~    The amygdala and hippocampus are intertwined with the stress response (Higgins & George, 2013) ~    The amygdala modulates anger and fear / fight or flight ~    The hippocampus helps to develop and store memories ~    The brain of a child or adolescent is particularly vu

Cognitive Behavioral Therapy Addressing Negative Thoughts Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Host, Counselor Toolbox, Happiness Isn’t Brain Surgery CEUs for this podcast can be earned at https://www.allceus.com/member/cart/index/search?q=cognitive+behavioral Objectives ~Define Cognitive Behavioral Therapy and its basic principles ~Identify factors impacting people’s choice of behaviors ~Explore causes and impact of thinking errors ~Identify common thinking errors and their relationship to cognitive distortions Why I Care/How It Impacts Recovery ~The way people perceive the world and interpret events leads to behavioral reactions ~A person who perceives the world as hostile, unsafe and unpredictable will tend to be more hypervigilant (until they exhaust the stress response system) ~A person who perceives the world as generally good and believes they have the ability to deal with challenges as they arise will be able to “allow” their stress response system to function normally. Factors Affecting Rational Behavior ~Stress ~Negative emotions ~Physical ~Pain ~Illness ~Sleep deprivation ~Poor Nutrition ~Intoxication (Alcohol, Barbiturates, Street Drugs) ~Environmental ~The introduction of a new or unique situation ~Exposure to un-preferable situations Factors Affecting Rational Behavior ~Stress ~Social ~Peers or family who convey irrational thoughts as necessary standards for social acceptance. ~“Nobody wants to associate with “those” people” ~Lack of supportive peers to buffer stress A Note About Irrationality ~The origins of most beliefs were rational and helpful given: ~The information the person had at the time ~The cognitive development (ability to process that information) ~“Irrationality” or unhelpfulness of thoughts comes when those beliefs are: ~Perpetuated without examination ~Continue to be held despite causing harm to the person Sometimes it is more productive for clients to think of these thoughts as “unhelpful” instead of “irrational.” Basic Principles ~In cognitive therapy, clients learn to: ~Distinguish between thoughts and feelings. ~Become aware of the ways in which thoughts can influence feelings in ways that sometimes are not helpful. ~Learn about thoughts that seem to occur automatically, without even realizing how they may affect emotions. ~Constructively evaluate whether these “automatic” thoughts and assumptions are accurate, or perhaps biased. ~Evaluate whether the current reactions are helpful and a good use of energy, or unhelpful and a waste of energy that could be used to move toward those people and things impotent to the person. ~Develop the skills to notice, interrupt, and correct these biased thoughts independently. Causes of Thinking Errors ~Information-processing shortcuts ~Using outdated, dichotomous schemas ~Mental noise ~The brain's limited information processing capacity ~Age ~Crisis Causes of Thinking Errors ~Emotional causes ~I feel bad, therefore it must be bad ~Moral causes ~It was the right thing to do ~Social causes ~Everyone is doing it Impact of Thinking Errors (Fight or Flee) ~Emotional upset ~Depression ~Anxiety ~Behavioral ~Withdrawal ~Addictions ~Sleep problems/changes ~Eating changes ~Physical ~Stress-related illnesses ~Headaches ~GI Distress ~Social ~Irritability/impatience ~Withdrawal Thinking Errors ~Emotional Reasoning –Feelings are not facts ~Learn to effec

The ACT Matrix What Every Counselor Should Know with Dr. Dawn-Elise Snipes Executive Director, AllCEUs Host: Counselor Toolbox & Happiness Isn’t Brain Surgery Continuing education credits are available for this podcast at: https://www.allceus.com/member/cart/index/product/id/519/c/ Objectives ~    Review the main points of Acceptance and Commitment Therapy ~    Review how to apply the ACT matrix ~    Identify the shortcut question The Main Principles of ACT ~    The goals are to: ~    Create a rich and meaningful life, while accepting the pain that inevitably goes with it. ~    Transform your relationship with your difficult thoughts and feelings, learn to perceive them as harmless, even if uncomfortable, transient psychological events. ~    Take effective action guided by your deepest values and in which you are fully present and engaged. The Main Principles of ACT ~    ACT does not have symptom reduction as a goal. ~    The ongoing attempt to get rid of “symptoms” actually creates a clinical disorder ~    Private experience (feeling) is labeled a symptom  ~    A “symptom” is, by definition, something “pathological” and should be eliminated.  ~    A struggle with the symptom. ~    Have you considered there might be a purpose for that symptom? Changeable Variables in Context ~    Humans learn language (i.e., communication) through interactions with the environment ~    You learned to call certain physical sensations “anger,” “fear,” “sadness.” ~    Emotions are a very natural way your body prompts you to do something ~    Focus on changeable variables in the context in which these events occur in order create general rules to predict and influence psychological events such as thoughts, feelings, and behaviors. ~    Fear ~    In the presence of a snake ~    Before making a presentation Experiential Avoidance ~    The more time and energy we spend trying to avoid or get rid of unwanted private experiences (feelings), the more we are likely to suffer “Quicksand” ~    Anxiety (Fear things won’t get better) ~    Anger (Frustration things aren’t getting better) ~    Depression (Hopelessness and helplessness—resignation that things can’t get better) Confronting the Agenda ~    Control is the Problem, Not the Solution ~    Clean Discomfort: When emotions and reactions are accepted, it leads to a natural level of physical and emotional discomfort ~    Dirty Discomfort: Once you start struggling with it, your “struggle switch is turned on” and discomfort increases rapidly. ~    Struggle switch is like an emotional amplifier—switch it on, and you can have anger about your anxiety, anxiety about your anger, depression about your depression, or guilt about our guilt. Stop Fighting with Your Feelings It hasn’t worked before It probably won’t work now. Six Core Principles of ACT ~    Once the emotional control agenda is undermined, we then introduce the six core principles of ACT to help clients develop psychological flexibility: ~    Diffusion ~    Acceptance ~    Contact with the present moment ~    The Observing Self ~    Values ~    Committed action The Observing Self The Audience ~    Fly on the Wall / Data / Your Dog ~    Curious ~    Objective ~    Nonjudgmental Mindful Contact with the Present Moment Awareness of What Is ~    Bringing full awareness to your here-and-now experience ~    How do I feel? ~    What are my thoughts, wants and urges? ~    What physical sensations am I experiencing? ~    Describe the environment—smell, temperature, colors, objects, people, s

Happiness Isn’t Brain Surgery: Goal Setting Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Host: Counselor Toolbox & Happiness Isn’t Brain Surgery CEUs can be earned for this podcast at: https://www.allceus.com/member/cart/index/search?q=Motivation+and+Goal Goal Setting Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Host, Counselor Toolbox President, Recovery and Resilience International Objectives ~    Identify the purpose of setting goals ~    Learn about SMART goals and how to set them ~    Explore ways to help clients identify their goals ~    Identify the 6 most common pitfalls in goal setting, and how to prevent them Why Do I Care ~    Goal setting is an integral part of behavior change ~    Goal setting is something everyone does every day ~    Ineffective goals can have a negative impact on self esteem ~    Ineffective goals can make people mistakenly think they are helpless to change anything. Activity ~    Identifying pitfalls in goal setting ~    Prepare an authentic Italian meal. ~    Learn what an authentic Italian meal consists of ~    Decide what is going to be in YOUR meal ~    Learn about how to prepare that meal ~    Identify what ingredients you need for that meal (and get what you don’t have) ~    Do you do everything at the same time? (Hint: No, the sauce is made first so the seasonings can blend) SMART Goals ~    Specific ~    Measurable ~    Achievable ~    Realistic ~    Time Limited ~    Think about the last goal you set that was successful… ~    Think about the last goal you set that was unsuccessful. ~    What is the difference between the two? ~    SMART? ~    Motivation? Goals—The Beginning ~    Goals (WHY)þ ~    Goals are the overarching reason a person begins to do something. ~    Often goals are broad and abstract. “I want to be healthier.”  “I want to be happy.” ~    Goals need to be broken down into manageable, meaningful, observable objectives. ~    Phrase goals as adding a positive instead of removing a negative. Start With Problem Definition ~    How is the problem evidenced in the client? ~    How is the problem affecting the client’s overall functioning? ~    What is the client’s perception of the problem? ~    What are the client’s strengths? Goal Development ~    What is the broad goal for resolution of the problem? ~    What is the absence of the problem? ~    How will your best friend know when you have achieved your goal? Miracle Question ~    One way to elicit goals is through the miracle question: ~    If you woke up tomorrow and you were _____ (i.e. your problem was resolved/goal was achieved) what would be different? ~    This gives you insight into the symptoms/definition of the problem and motivations for change. Specific ~    Overall Goal for Treatment ~    What is the problem? ~    Example: Depression ~    How will you know when the problem is resolved? ~    Emotionally, I won’t feel as hopeless and helpless.  I wont dread getting out of bed. ~    Mentally, I won’t be so foggy headed and will be able to concentrate ~    Physically, I will have more energy and lose some weight ~    Socially, I will enjoy spending time with friends Specific ~    Subgoals ~    Main Issue ~    Learn about the overall problem (Depression) ~    Learn about your symptoms/causes/triggers of the problem ~    Identify ways to address your specific symptoms/causes/triggers ~    I won’t dread getting out of bed each day ~  

Happiness Isn’t Brain Surgery: Multiple Dimensions of Motivation Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Host: Counselor Toolbox & Happiness Isn’t Brain Surgery Counseling continuing education can be earned for this presentation at https://www.allceus.com/member/cart/index/product/id/617/c/ Objectives ~    Define motivation ~    Identify the 5 principles of motivational enhancement ~    Review the concepts of motivation ~    Identify the types of motivation and ways to enhance them Think About It… ~    Why do people change? ~    What is motivation? ~    Can individuals' motivation to change their behavior be modified? ~    Do clinicians have a role in enhancing clients' motivation for recovery? What is Motivation ~    Motivation is a combination of desire, willingness and ability to do something. ~    Effectively enhancing motivation requires ~    Empathy and understanding ~    Identifying discrepancies between your desired situation and your current situation ~    Overcoming resistance to change (more rewarding behaviors or fears about change) ~    Supporting self-efficacy What is Motivation cont… ~    Change involves: ~    Recognizing that something needs to be done ~    Increasing Motivation ~    Defining the problem (create crisis) and the end goal (identify the solution) ~    Identifying the benefits to doing what you need to reach your goal ~    Addressing the drawbacks to doing what you need to reach your goal ~    Creating a plan ~    Implementing that plan ~    Adjusting the plan as needed to ensure that working toward this goal is more rewarding than staying the same What is motivation ~    Motivation is doing something to get a reward ~    Assumptions about the nature of motivation: ~    Motivation is a key to change ~    Motivation is multidimensional ~    Motivation is dynamic and fluctuating ~    When the going gets tough, motivation gets going ~    Motivation can be modified ~    Additional rewards can be added to make the new behavior more rewarding, even in the face of adversity Motivation is a key to change ~    Think about the last time you were not motivated to do something? ~    Resistance is often… ~    A lack of motivation for the new behavior ~    More motivation for the old behavior ~    One of the first steps in developing motivation for change is to create a crisis ~    What are the problems with the current situation? ~    In what ways will the change be worth the effort? Motivation is multidimensional ~    Emotional:  Makes the person happy ~    Mental: Is the logical choice ~    Physical: Improves physical health, energy or reduces pain ~    Social: Improves relationship with self or others, elicits positive feedback from self and others ~    Environmental: Makes the environment more comfortable Interventions ~    Create the Crisis ~    Examine the ways that the mood issues or addictive behaviors impact each area of wellness ~    Recognize that each negative impact is likely the result of energy shortages. ~    Identify individualized interventions ~    Identify ways to reduce stress and improve each area of wellness ~    Highlight motivations for change in as many areas as possible ~    Define and identify motivations to change in each dimension. Motivation is Dynamic and Fluctuating ~    When the going gets tough, motivation gets going ~    Motivation is a combination of ~    Commitment (Willingness) ~    Control (Self-Efficacy) ~    Challenge ~    Too easy and too hard 

Pain, Moods and Management Dr. Dawn-Elise Snipes PhD, LPC-MHSM, LMHC Executive Director, AllCEUs Host, Counselor Toolbox and Happiness Isn't Brain Surgery with Doc Snipes President, Recovery and Resilience International Counseling CEUs can be earned for this podcast at: https://www.allceus.com/member/cart/index/product/id/616/c/ Objectives ~    Characteristics of pain ~    Effects of pain ~    Depression ~    Anxiety ~    Guilt ~    Lowered Self Esteem ~    Lethargy ~    Circadian Rhythm Disruption ~    Understanding Your Pain ~    Exacerbating factors ~    Mitigating factors Objectives ~    Medical Interventions ~    Tylenol ~    NSAIDS ~    Opiates ~    Muscle Relaxants ~    Nerve Blocks ~    Accupuncture/Accupressure ~    Nonmedical Interventions ~    Guided Imagery ~    Radical Acceptance ~    Stretching/Balancing Exercises ~    Ice or Heat Packs ~    Massage ~    TENS units ~    Stress Management Characteristics of Pain ~    Everyone has pain sometimes ~    Our bodies are incredibly resilient ~    Knowing your pain can help your doctor/physical therapist ~    Acute or Chronic ~    Stabbing, aching, throbbing, burning… ~    Constant or intermittent ~    Stationary or radiating ~    Any numbness Effects of Pain ~    Depression ~    Fatigue ~    Sleep Disturbances ~    Hopelessness/Helplessness ~    Negative thoughts -> Stress ->  Serotonin -> Pain ~    Interventions ~    Mindfulness ~    Good sleep habits ~    Circadian rhythm maintenance ~    Identify the things you CAN control and that are GOOD ~    Eat healthfully to support Serotonin functioning Effects of Pain ~    Anxiety ~    Things wont get better ~    It is getting worse ~    Consequences of pain (lost job, relationships, fitness…) ~    Interventions ~    Avoid caffeine and nicotine ~    Educate yourself about the disorder and the PROBABILITY things will get worse ~    Keep a log of the good and bad days ~    Practice distress tolerance skills ~    Use the Challenging Questions Worksheet to address anxiety provoking thoughts Effects of Pain ~    Guilt ~    Self anger for not being able to… ~    Can cause you to lash out at others—push them away so you don’t disappoint them like you disappointed yourself ~    Interventions ~    Think about how you would want your child or best friend to feel if they were in your position ~    Get rid of the shoulds ~    Focus on the things that you CAN do ~    Decide whether it is worth using your energy to be mad at yourself (and the world) Effects of Pain ~    Grief ~    Stages: Denial, Anger, Bargaining, Depression, Acceptance ~    Interventions ~    Work through the stages of grief for each of the losses because of the pain (Physical, self-concept, job, freedom (driving/mobility), dreams…) Effects of Pain ~    Self-Esteem ~    How you feel about the difference between who you want to be and who you are ~    Interventions ~    Make a list of the positive things about you ~    Identify 1 or 2 goals you can work toward ~    Celebrate small things ~    Silence the inner critic Effects of Pain ~    Circadian Rhythm Disruption ~    Not getting out of bed ~    Staying inside in the dark ~    Sleeping too much ~    Interventions ~    Get out of bed at roughly the same time each morning ~    Get dressed in “day-clothes” ~    Turn on lights and sit in front of a window or get ou

Happiness Isn’t Brain Surgery Eating to Support Mental Health Host, Counselor Toolbox and Happiness Isn't Brain Surgery with Doc Snipes President, Recovery and Resilience International Counseling CEUs can be earned for this podcast at: https://www.allceus.com/member/cart/index/product/id/616/c/ Objectives ~    Review the function of the most common neurotransmitters (Dopamine, Serotonin, GABA, Glutamate, Norepinepherine, Acetylcholine) ~    Identify mental health issues associated with imbalances between these neurochemicals ~    Examine ways to deal with chemical imbalances Why I Care/How It Impacts Recovery ~    In early recovery, nearly every person’s neurotransmitters are out of balance. ~    This causes feelings of depression, apathy, anxiety, and/or exhaustion. ~    Understanding why you feel the way you do is the first step ~    Figuring out how to help yourself feel better is the next What are Neurotransmitters ~    The human brain is composed of roughly 86 billion neurons. ~    These cells communicate with each other via chemical messengers called neurotransmitters. ~    Neurotransmitters regulate ~    Mood ~    cravings, addictions ~    Energy ~    Libido ~    Sleep ~    Attention and concentration ~    Memory ~    Pain Sensitivity Neurotransmitters Cont… ~    About 86% of Americans have suboptimal neurotransmitter levels — our unhealthy modern lifestyle being largely to blame. (3) ~    Chronic stress, poor diet, environmental toxins, drugs (prescription and recreational), alcohol, nicotine, and caffeine can cause neurotransmitter imbalances. Effect of Nutrition on Brain Function ~    Eating foods with a low glycemic index improves the quality and duration of intellectual performance http://www.glycemicindex.com/ ~    Dietary proteins contribute to good brain function ~    Tryptophan is necessary for the creation of serotonin and melatonin ~    Brain cell functioning requires omega-3 fatty acids. ~    Omega-3s have also been found to help prevent and/or treat mood disorders, particularly depression ~    Iron is necessary to ensure oxygenation and for the synthesis of neurotransmitters. Effect of Nutrition on Brain Function ~    The iodine is necessary for energy metabolism in the brain cells. ~    Vitamin B1 is necessary for the utilization of glucose in the brain. ~    Vitamins B6 and B12, among others, are directly involved in the creation of neurotransmitters. ~    Nerve endings contain the highest concentrations of vitamin C in the human body. ~    Vitamin E is necessary for effective transmission of neurological signals Think about it ~    How do you feel when you are not getting enough oxygen? (Hint: You yawn) ~    What effect might a low carb diet have on mood? ~    What effect might a low protein diet have on mood? (Most non-vegan Americans get plenty of protein) ~    Why do doctors test for vitamin-D levels in patients with depressive symptoms? B Vitamins ~    Low levels of B-12 and other B vitamins i.e  vitamin B-6 and folate may be linked to depression. ~    Vitamin B3 (Niacin) ~    Food sources: Poultry, fish, meat, whole grains, and fortified cereals ~    What it does: ~    Helps with digestion and changing food into energy ~    Helps body conserve tryptophan and convert it into serotonin B Vitamins ~    Vitamin B 5 Pantothenic Acid ~    Food sources include:  beef, mushrooms, eggs, vegetables, legumes, nuts, pork, saltwater fish, whole rye flour, whole wheat ~    What it does ~    Help control the secretion of cortisol ~    Help with migraines and chronic fatigue syndrome

Happiness Isn’t Brain Surgery:  Sleep Effects Host, Counselor Toolbox and Happiness Isn't Brain Surgery with Doc Snipes President, Recovery and Resilience International Counseling CEUs can be earned for this podcast at: https://www.allceus.com/member/cart/index/product/id/616/c/ Objectives ~    Learn about sleep ~    The function of sleep ~    Sleep cycles ~    How much is enough ~    How lack of sleep contributes to feelings of depression, anxiety and irritability ~    Learn techniques for sleep hygiene What is the Function of Sleep ~    Sleep is time to rest and restore ~    Adequate sleep improves memory and learning, increases attention and creativity, and aids in concentration and decision making. ~    Toxins that accumulate in the brain are thought to be cleared out during sleep ~    Healing and repair of cells takes place during sleep ~    Sleep helps to maintain the balance of hormones in the body: ~    Ghrelin and leptin, which regulate feelings of hunger and fullness ~    Insulin, which is responsible for the regulation of glucose in the blood Functions cont… ~    Sleep deficiency is also linked to a higher risk of ~    Cardiovascular disease ~    Stroke ~    Diabetes ~    Kidney disease ~    Sleep deprivation is correlated to ~    Difficulty concentrating ~    Irritability ~    Fatigue/Loss of energy Understanding Sleep Cycles ~    Stage 1 NREM sleep is when you drift in and out of light sleep and can easily be awakened. ~    Stage 2 NREM brainwaves slow with intermittent bursts of rapid brain waves, the eyes stop moving, the body temperature drops and the heart rate begins to slow down. ~    This stage usually lasts for approximately 20 minutes ~    Stage 3 NREM sleep, also known as deep sleep or delta sleep, is marked by very slow delta brainwaves. There is no voluntary movement. You are very difficult to wake. ~    This stage usually lasts for approximately 30 minutes ~    The largest percentage of Deep Sleep comes in the early part of the total night's sleep pattern Understanding Sleep Cycles ~    REM Sleep (Rapid Eye Movement) is characterized by temporary paralysis of the voluntary muscles and fast, irregular breathing, inability to regulate body temperature, faster brain waves resembling the activity of a person that is awake. ~    Most dreams occur during REM sleep How Much is Enough? Sleep and Hormones ~    Estrogen usually improves the quality of sleep, reduces time to fall asleep, and increases the amount of REM sleep ~    Too little or too much testosterone may affect overall sleep quality ~    Cortisol is your stress hormone and prevents restful sleep ~    Thyroid hormones which are too high can cause insomnia and too low can cause fatigue and lethargy Nutrition and Sleep ~    Tryptophan is used to make serotonin ~    Serotonin is used to make melatonin ~    Melatonin functions to help you feel sleepy ~    Caffeine is a stimulant with a 6-hour half life ~    Nicotine is a stimulant with a 2-hour half life ~    Decongestants are stimulants with a 2 hour half life ~    Antihistamines make you drowsy but contribute to poor quality sleep ~    Alcohol blocks REM sleep and can cause sleep apnea Nutrition cont… ~    Eat a high protein dinner to ensure you have enough tryptophan in the body ~    Make sure you are getting enough ~    Selenium ~    Vitamin D ~    Calcium ~    Vitamin A ~    Magnesium ~    Zinc Sleep Hygiene ~    Create a wind-down ritual ~    Reduce or eliminate exposure to blue-light 1 hour before bed (TV, Computer, Phone, some

Happiness Isn’t Brain Surgery: Understanding Symptoms Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Counseling continuing education can be earned for this presentation at https://www.allceus.com/member/cart/index/product/id/570/c/ Objectives ~    Identify the common symptoms for anxiety and depression-based disorders ~    Learn how a positive change in one area or symptom can have positive effects on all symptoms or areas. ~    Explore ~    The function of each of those symptoms ~    The potential causes of each of those symptoms ~    Interventions for each of those symptoms Review ~    Everything you feel, sense, think and do is caused by communication between your nerves with the help of chemical messengers called neurotransmitters. ~    “Higher order” thinking is able to over-ride sensory input and tell us there is a threat when none exists, or that there isn’t a threat when there really is. ~    Think of your brain as a computer processor.  It simply does what it is told, based on the information that it has. What are symptoms ~    Symptoms are your physical and emotional reactions to a threat. ~    Symptoms are designed to protect you. ~    They are not bad or good. They just are. ~    Instead of trying to make the symptom go away, it may help to: ~    Understand the function of them ~    Identify alternate, more helpful, ways to deal with the threat Lack of Pleasure ~    Form/Symptom ~    Lack of pleasure in most things, most days for a period of at least 2 weeks. ~    Cause ~    Neurochemical imbalance (insufficient dopamine, norepinephrine?) caused by: ~    Lack of sleep ~    Excessive stress ~    Drug or medication use ~    Hormone imbalances including thyroid problems Lack of Pleasure ~    Function ~    This is your body's way of ~    Signaling that there may be a problem ~    Conserving excitatory neurotransmitters for a “real” crisis ~    Forcing you to address it.  After all, nobody wants to be depressed for very long. ~    How You Cope ~    Think back over a few times when you have been depressed, even if it was just for a few hours. ~    What did you do to help yourself feel better? ~    What makes the depression/lack of pleasure worse? ~    What can you do to prevent triggering your depression/lack of pleasure? Lack of Pleasure ~    Simple-ish Interventions ~    Don’t expect exhilaration, but try to do some things that make you mildly happy. ~    Get plenty of quality sleep.  You need to stabilize your circadian (sleep-wake-eat) rhythms. ~    Improve your nutrition.  You can search online for “nutrition for depression.” ~    Think back to when you didn’t feel this way. ~    What was different? ~    What changed that started you feeling depressed ~    Remember that depression is a natural part of the grief process and also very normal after a trauma.  Be compassionate Eating Behaviors ~    Form ~    Eating too much or loss of appetite ~    Cause ~    Imbalance in the brain chemicals that help you feel motivated to eat, such a norepinepherine and serotonin. ~    There are three primary causes of over-eating: ~    Your body needing the building blocks ~    Low serotonin ~    Your circadian rhythms are out of whack ~    Habit/self soothing Eating Behaviors ~    Function ~    When nutritional building blocks aren't there, the body goes into overdrive trying to rebalance the system.  This means it needs more raw materials to make the brain chemicals; therefore, you may crave certain foods. ~    Disruption in your circadian rhyth