Counselor Toolbox Podcast

By understanding the origins of distress, we are better able to deal with distress. Counseling Theories assert that problems stem from ineffective relationships or thoughts in adulthood. Personality Theories speculate that distress stems from more innate, long standing problems often starting in childhood Learning Theories emphasize the fact that distress and behavior is learned from exposure to rewards and punishments Theories: Person Centered Humans are good and forward moving unless they are blocked Blockages often occur from a lack of unconditional positive regard which leads to low self esteem and low self efficacy By creating a nurturing, positive environment, people will naturally move in the right direction. 6 necessary conditions required for change: Therapist-Client Psychological Contact: a relationship between client and therapist Theories: REBT/CBT Focuses on changing the current evaluations and/or reactions Distress is caused by a combination of the event and the person's perception of the event By using the A-B-Cs, people can evaluate their beliefs and reactions (consequences) to events. A-B-C CBT/REBT: Irrational Thoughts Focus on the present Avoid discussing symptoms and complaints. Focus on what counselees can do directly-act and think. Spend less time on what they cannot do directly: changing their feelings and physiology. Avoid criticizing, blaming and/or complaining Remain non-judgmental, but encourage people to ask: Is what I am doing getting me closer to the people I need? Focus on specifics. Who are counselees are disconnected from Help them make specific, workable plans to reconnect with the people they need. Follow through on what was planned by helping them evaluate their progress. Be patient and supportive but keep focusing on the source of the problem, disconnectedness. Personality Theories: Psychoanalysis The conscious mind is what you are aware of at any particular moment, your present perceptions, memories, thoughts, fantasies, feelings Working closely with the conscious mind is what Freud called the preconscious, what we might today call “available memory.” The largest part by far is the unconscious. It includes all the things that are not easily available to awareness The id, the ego, and the superego Personality Theories: Erickson We develop through a predetermined eight stages. Progress through each stage is determined by our success in all the previous stages. Each stage involves certain developmental tasks If a stage is managed well, we develop a certain virtue or strength Learning Theories: Classical Conditioning Learning Theories: Operant Conditioning Operant conditioning is the use of consequences to modify the occurrence and form of behavior (Treatment planning) Reinforcement is a consequence that increases a behavior. +/- Punishment is a consequence that decreases a behavior. +/- Extinction is the elimination of a behavior by removing the reward. Learning Theories: Social Learning People learn from one another, through observational learning, imitation, and modeling. People can learn by observing behavior and the outcomes of those behaviors. Learning can occur without a change in behavior. Cognition, awareness and expectations of future consequences can have a major effect on the behaviors that people exhibit. Reciprocal causation: The person, the behavior, and the environment can have an influence on each other. 4 conditions that are necessary before an individual can learn Attention: the person must first pay attention to the model/situation Retention: the observer must remember the behavior that has been observed. Rehearsal: the third condition is the ability to replicate the behavior. Motivation: Learners m

Happiness Isn-t Brain Surgery: Understanding Addiction Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Continuing Education (CE) credits for addiction and mental health counselors, social workers and marriage and family therapists can be earned for this presentation at https://www.allceus.com/member/cart?c=3 Objectives – Learn about addiction – Prevalence – Cause – Functions of addiction – Develop an understanding of how addictive behavior regardless of the origin often ends up being a form of self-medication – Explore different approaches to addressing addiction Addiction Prevalence – Alcoholism – 16.3 million adults ages 18 and older(6.8 percent of this age group) had an AUD in 2014 http://pubs.niaaa.nih.gov/publications/AlcoholFacts&Stats/AlcoholFacts&Stats.pdf – Drug Addiction – In 2013, an estimated 24.6 million Americans-9.4 percent of the population-had used an illicit drug in the past month https://www.drugabuse.gov/publications/drugfacts/nationwide-trends – All Addictive behaviors – About 47% of the U.S. adult population suffers from an addictive behavior-with serious negative consequences-in a 12-month period. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134413/ Addiction Definition – General – Use of a pleasurable activity or substance – To escape emotional or physical pain – That continues to be used despite causing problems in one or more area of life – Other – Tolerance -Needing more of the substance or activity or combining substances or activities to get relief. – Withdrawal – Physical – Psychological Causes of Addiction – Neurochemical imbalance from- – Excessive recreational use of a substance or activity (Party pooper) – Use of a substance or activity to eliminate feelings of depression, anxiety, stress, anger or pain (open wound theory) – Leads to- – Unsuccessful efforts to cut down or quit – Spending more time and/or money thinking about, engaging in or recovering from use – Neglect of important areas of functioning – Leads to-depression/anxiety/anger –>more use to escape A Note About Cravings and Triggers – Cravings are persistent thoughts or desires for a rewarding behavior. – Cravings are for one of 2 reasons: – To produce pleasure (chocolate) – To eliminate pain (physical or emotional) – Triggers remind you of the addiction and kick off a craving: – People – Places – Things – Emotions – Memories – Habits Functions of Addiction – Produce feelings of pleasure, euphoria, happiness when none exist (by altering brain chemicals). – Numb emotional or physical pain when nothing else works (by altering brain chemicals). – Help the person survive when they cannot tolerate the pain and feel overwhelmed, hopeless and helpless. Self Medication Hypothesis – Develop an understanding of how addictive behavior regardless of the origin often ends up being a form of self-medication. – 3 consequences of excessive engagement in pleasurable activities: – The brain -uses- the neurotransmitters faster than they can be made. – The brain shuts down the receptors to conserve the neurotransmitters and prevent the body from being overstimulated (Think: Movie Theater) – An imbalance is created between the neurotransmitters leading to an inability to feel pleasure without external stimulation Examp

Happiness Isn-t Brain Surgery: What is Diagnosis Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Continuing Education (CE) credits for addiction and mental health counselors, social workers and marriage and family therapists can be earned for this presentation at  https://www.allceus.com/member/cart/index/search?q=differential Objectives – Define Diagnosis – Identify the Reasons for Diagnosis – Discuss the Drawbacks to Diagnosis – Personification – Symptoms are common in multiple disorders – People fall through the cracks when they don-t -fit- a diagnsis What is Diagnosis – Short hand for a cluster of symptoms Why is Diagnosis Necessary – Insurance reimbursement – Makes it easier for providers to communicate – Gives providers a starting point for understanding – Your symptoms – What may be causing your symptoms – A variety of different things can cause someone to feel -depressed- that is, not find pleasure in most things – Neurochemical imbalances – Nutritional deficits – Exhaustion – Illness (Chronic fatigue, chronic pain) – Thyroid or hormone imbalances Drawbacks to Diagnosis – Personification – When you have the flu, you don-t say I am the flu. You say I have the flu. – Something you have is something you can get rid of – Something you are is a part of you and more enduring – When you have identified as being -depressed- or an -addict- for a period of time – It becomes part of you like being a -student- or a -mother- – Letting go of that role involves adjusting to a new -self- and grieving the loss of that part of you. – -If I am not an addict anymore, what am I- (lots of pressure there) Drawbacks cont- – Symptoms are common in multiple disorders (physical and mental) – Sleep Disturbances – Eating Disturbances – Difficulty Concentrating – Racing Thoughts – Fatigue – General achiness Drawbacks cont- – People fall through the cracks – Prevention is far more effective and efficient than treatment – People do not seek help until they nicely -fit- a diagnosis – Minimizing the problem (I-m not depressed *all* the time) – Insurance will not reimburse – Problems in relationships, mood, work etc. Will continue to get worse which makes the mood disorder or addiction worse. Summary – Diagnosis is a necessary evil – It provides a starting place for exploring a cluster of symptoms – It is part art and part science. – It is important for you to remember that the symptoms are your body-s way of telling you something is wonky. – You can help your care team by understanding (and communicating) your symptoms and what makes them worse and better for you

Happiness Isn-t Brain Surgery Dr. Dawn-Elise Snipes PhD, LPC-MHSM, LMHC, NCC Executive Director, AllCEUs Host, Counselor Toolbox President, Recovery and Resilience International Continuing Education (CE) credits for addiction and mental health counselors, social workers and marriage and family therapists can be earned for this presentation at https://www.allceus.com/member/cart/index/product/id/570/c/ Objectives – Learn about how the brain, body and how you feel are impacted by: – Nutrition – Sleep – Stress – Pain – Sickness Review – You have already learned that: – The brain receives information from the senses. – The brain interprets this information based on prior experiences and current data. – The brain sends signals using neurotransmitters to command the body to react (fight or flee). – Side effects of excess or continued stress are: – Sleep problems – Blood sugar issues – Overall fatigue – Muscle aches and tension and reduced immunity The Feedback Loop – Sleep problems – Fatigue (Difficulty getting things done) –> stress – Difficulty concentrating (frustration) –> stress – Reduced immunity –> illness – frustration – stress – Blood sugar issues – Fatigue (Difficulty getting things done) –> stress – Difficulty concentrating (frustration) –> stress – Stress/comfort eating or lack of appetite –> blood sugar crashes The Feedback Loop – Overall fatigue – Difficulty concentrating (frustration) –> stress – Feelings of guilt/frustration from negative self-talk –> stress – Muscle aches and tension – Difficulty sleeping – Fatigue – Pain – Reduced immunity – Increased illnesses – Increased allergies (as cortisol gets depleted) Breaking the Cycle: Nutrition – Good nutrition provides the building blocks to make neurotransmitters, rebuild and repair tissue and keep your immune system fully charged. – Poor nutrition and dehydration contribute to: – Fatigue – Poor concentration – Irritability, depression, anxiety – Increased pain perception Breaking the Cycle: Nutrition – Making changes in your eating habits should: – Be undertaken slowly (1 change per week) – Be moderate (not eliminating anything*) – Focus on progress not perfection – Be modified so you are motivated to maintain the change Breaking the Cycle: Nutrition – Easy changes – Replace sugary sodas with 80% diet soda. – Find fruits you love to eat instead of candy. – Add a little cheese to your veggies. – Replace 50% of your instant coffee with equal amount of unsweetened cocoa powder. – Drink 64-120 ounces of water daily. (Add a little lemon or citric acid to make it more palatable) – Use a salad plate instead of a dinner plate. Breaking the Cycle: Nutrition – Easy changes – Take what you want and put half back. – Have 3 colors on your plate at each meal. – Start weaning off sugary drinks and foods. – Eat every 3-4 hours. – Start using a food diary app to track which nutrients you may not be getting enough of. – Reduce caffeine, especially 6 hours before bed. See the booklet: Happiness is-Nutrition for an in-depth information, self assessmen

Happiness Isn-t Brain Surgery: The Mind-Body Connection Dr. Dawn-Elise Snipes PhD, LPC-MHSM, LMHC, NCC Executive Director, AllCEUs Host, Counselor Toolbox President, Recovery and Resilience International Continuing Education (CE) credits for addiction and mental health counselors, social workers and marriage and family therapists can be earned for this presentation at https://www.allceus.com/member/cart/index/product/id/570/c/ Objectives – Learn about your central control center, the brain – What role does it play in – Emotions – Thoughts – Physical Reactions/Sensations – How things can go wrong – How to fix those things The Brain – Your central control center – Takes in information – Compares it to what it already knows (or thinks it knows) from prior experiences – Makes a decision about what to do. – Based on that decision it activates action centers which excrete neurotransmitters in order to produce the desired reaction. Neurotransmitters – Chemical messengers take -orders- to and from the brain through the nervous system – The Big 6 fall into 3 main categories – Excitatory: Dopamine, Norepinepherine, Glutamate – Inhibitory: GABA, Serotonin – Neuromodulator: Acetylcholine Neurotransmitters Function – Emotional – Happiness – Sadness – Anger – Fear – Mental – Concentration – Learning – Decision Making – Physical – Sleep behavior – Eating behavior – Libido – Gastrointestinal Functioning/motility – Pain perception Neurotransmitters cont- – An imbalance in neurotransmitters will cause emotional, mental, or physical -distress- – What causes imbalances – Too much -stress- for too long – Poor nutrition – Insufficient sleep – Addictive behaviors Your Stress Sensor: Peripheral Nervous System – Your nervous system continues to feed the brain information about whether the threat is: – Continuing and something else needs to be done – Subsiding and your brain can tell your body to relax. – How does all this happen- – How does the brain -know- what is threatening- Lets find out- The Brain – When you were born, there were very few things that were -meaningful- – You assigned meaning to things through observation and experience – When something happens you compare it to prior experiences to decide what to do The Brain – Unfortunately until about age 7 children-s interpretation of behavior is: – Centric-Based on one thing at a time – Concrete – All-or-nothing – Egocentric The Brain – Interpretations are only as good as: – The information coming in – The prior knowledge – Things that are learned in early childhood need to be re-examined as we grow – Once you were in middle school you could be taught to start – Considering multiple aspects of a situation – Using abstract reasoning (Looking for other interpretations of events) Example 1 – Child brings home report card – Child hears negative messages from a parent – Why did you get a C, I know you are not that stupid. – Why can-t you do anything right- – Child interprets – All-or-Nothing: I cannot do anything to make my parent proud. – Ego

Vulnerabilities Dr. Dawn-Elise Snipes Executive Director, AllCEUs.com Continuing Education (CE) credits for addiction and mental health counselors, social workers and marriage and family therapists can be earned for this presentation at https://www.allceus.com/member/cart/index/product/id/616/c/ Objectives – Define vulnerabilities – Identify some of the most common vulnerabilities – Their effects – Ways to prevent them – Note: Each of the vulnerabilities has its own presentation. This section is designed to give you an overview and get you thinking about possible small changes that might have a big impact. Why I Care/How It Impacts Recovery – Vulnerabilities are situations or things that – Make it more difficult to deal with life on life-s terms leading to depression, anxiety or -stress- – Make it easier for you to over-react or get stuck – Depression occurs if you feel helpless or hopeless – Anxiety occurs if you feel powerless or out of control – Addictive behaviors increase when you feel a need to escape because of stress, anxiety, depression or pain Individual Vulnerabilities: Physical – Pain – Effects – Sleep problems – Difficulty concentrating – Irritable mood – Medications are depressants and can worsen all of the above – Interventions – Talk with your doctor – Explore nonpharmacological interventions Individual Vulnerabilities: Physical – Poor nutrition – Your body needs the building blocks to – Recover from injury – Keep you from getting sick – Make happy chemicals – Interventions – Water-. 60 ounces per day – Have three colors on your plate at each meal (condiments don-t count) – Try to eat smaller meals every few hours Individual Vulnerabilities: Physical – Lack of sufficient, quality sleep – Drug/alcohol induced sleep is rarely good quality – Lack of Sleep Effects – Fogginess – Difficulty concentrating – Irritability – Over eating – Interventions – Develop a sleep routine – Cut back on caffeine 6-12 hours before bed. Individual Vulnerabilities: Physical – Illness – Effects – Sleep disruption – Exhaustion – Foggy head/difficulty concentrating – Irritability – Interventions – Compassion – Good nutrition Individual Vulnerabilities: Physical – Brain changes – Brain changes can be – Hereditary – From an accident – As a result of addictive behaviors – Effects – Changes in the structure of the brain have all kinds of effects including memory, concentration, and mood. – Intervention – Eat a good diet to give the body the necessary building blocks – Get adequate quality rest – Medication Individual Vunerabilities: Emotional – Anger – Anxiety – Depression – Grief – Guilt – Jealousy – Resentment – Inability to self-soothe Individual Vunerabilities: Emotional – When you are feeling negative emotions – Effects – It causes the brain to keep the fight-or-flight reaction going (which takes energy) – It lacks or prevents the happy, calming neurotransmitters from being excreted – Interventions – Develop coping skil

Continuing Education (CE) credits for addiction and mental health counselors, social workers and marriage and family therapists can be earned for this presentation at https://www.allceus.com/member/cart/index/product/id/518/c/

Continuing Education (CE) credits for addiction and mental health counselors, social workers and marriage and family therapists can be earned for this presentation at  https://www.allceus.com/member/cart?c=24

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Continuing Education (CE) credits can be earned for this presentation at  https://www.allceus.com/member/cart/index/search?q=chronic+pain

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Goal Setting Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs On Demand course can be found here: https://www.allceus.com/member/cart/index/product/id/521/c/ Objectives Why Do I Care ~    Goal setting is an integral part of treatment ~    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. 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. 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 foundations of this particular persons symptoms/definition of the problem. 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 ~    Reframed– I will be happy to wake up and face the day ~    Identify causes of dread for you and interventions ~    I will have more energy ~    Learn about causes of fatigue and low energy ~    Identify potential causes of your fatigue and low energy Measurable ~    Frequency   (#/time) ~    Number of times per day or week ~    i.e. Number of crying episodes ~    i.e. Number of eating episodes NOT due to hunger ~    i.e. Number of glasses of water consumed/day ~    i.e. Number of wake-ups during the night ~    Duration (How long) ~    Sleep ~    Exercise ~    Crying episodes ~    Intensity ~    Likert (1-mild; 2-moderate; 3-intense; 4-excruciating) ~    Number of calories per binge Measurable ~    Main Issue: Depression ~    Likert scale 1-can’t go on, 2-okay, 3-pretty good, 4-Awesome ~    I won’t dread getting out of bed each day –Cause of dread–Job ~    Likert scale 1-can’t go on, 2-okay, 3-pretty good, 4-Awesome ~    I will have more energy—Cause of low energy– poor sleep ~    Record hours slept; number of awakenings; quality of sleep Activity: Observable and Measurable ~    Write each of the following “goals” on a piece of paper: ~    Lose weight ~    Get in shape ~    Feel better about myself ~    Be happier ~    Identify at least 2 ways for each goal that tells the person he or she

Cognitive Behavioral Therapy Skills Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Continuing Education (CE) credits can be earned for this presentation at  https://www.allceus.com/member/cart/index/product/id/520/c/ 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 motivations ~I feel bad, therefore it must be bad ~Moral Motivations ~It was the right thing to do ~Social influence ~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 effectively identify feelings and separate facts ~I am terrified