Counselor Toolbox Podcast

Acceptance and Commitment 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/519/c/ Objectives ~The Goal of ACT ~What is Mindfulness? ~How Does ACT Differ from Other Mindfulness-based Approaches? ~What is Unique to Act? ~Destructive Normality ~Experiential Avoidance ~Therapeutic Interventions ~Confronting the Agenda ~Control is the Problem, Not the Solution ~Six Core Principles of ACT Why I Care/How It Impacts Recovery ~”You can't stop the waves, but you can learn to surf”  Kabat-Zinn 2004 ~Distracting oneself from distress is akin to constantly running away from one’s shadow. In the attempt to control the negative thoughts and feelings, one is at a loss for control in other life situations. ACT Acronym ~Accept your reactions and be present ~Choose a valued direction ~Take action Overview ~ACT is based on relational frame theory (RFT) ~a psychological theory of human language. ~developed largely through the efforts of Steven C. Hayes of University of Nevada, Reno and Dermot Barnes-Holmes of National University of Ireland, Maynooth. ~Relational frame theory argues that the building block of higher cognition (reasoning) is ‘relating', i.e. the human ability to create links between things. Overview ~Contextualists seek to understand the complexity and richness of a whole event through appreciation of its participants and features. ~Functional contextualism emphasizes: ~Humans learn language (i.e., communication) through interactions with the environment ~We must 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. The Goal of ACT ~The goal of ACT is to create a rich and meaningful life, while accepting the pain that inevitably goes with it. ~Who is important? ~What is important to me? (Values, things, experiences) ~How can I move toward those goals? ~“ACT” is a good abbreviation, because this therapy is about taking effective action guided by our deepest values and in which we are fully present and engaged. What is Mindfulness? ~“Consciously bringing awareness to your here-and-now experience with openness, interest and receptiveness. ~Facets to mindfulness ~Living in the present moment ~Engaging fully in what you are doing rather than “getting lost” in your thoughts ~Allowing your feelings to be as they are, rather than trying to control them ~Mindfulness does not require meditation What is Mindfulness? ~Mindfulness skills are “divided” into four subsets: ~ Acceptance ~ Cognitive diffusion ~ Contact with the present moment ~ The Observing Self How Does ACT Differ ~ACT can be used in a wide range of clinical populations and settings ~Not manualized ~ACT allows the therapist to create and individualize their own mindfulness techniques, or even to co-create them with clients. What is Unique to 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 is labeled a symptom  a struggle with the symptom ~A “symptom” is by definition something “pathological” and something we should try to get rid of. ~In ACT, the aim is to transform our relationship with our difficult thoughts and feelings, learn to perceive them as harmless, even if uncomfortable, transient psychological events. D

Dialectical Behavior Therapy Skills Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC, Executive Director, AllCEUs CEs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/518/c/ Based in part on ~    Doing Dialectical Behavior Therapy: A Practical Guide by Kelly Koerner (Guilford Press) ~    The Dialectical Behavior Therapy Skills Workbook (New Harbinger Publications) ~    DBT Made Simple (New Harbinger Publications) ~    Use promocode 1168SNIPES at New Harbinger for 25% off your entire order. ~    www.dbtselfhelp.com ~    DBT for Substance Abusers Objectives ~    Why was DBT created ~    Understanding Emotional Dysregulation ~    Identify DBT assumptions about clients and therapists ~    Explore skills to help clients learn ~    Distress Tolerance ~    Emotional Regulation ~    Interpersonal Effectiveness Why I Care/How It Impacts Recovery ~    Many of our clients experience emotional dysregulation ~    The inability to change or regulate emotional cues, experiences and responses. ~    They have tried to change and failed, leaving them feeling hopeless and helpless (depressed/anxious) ~    Untenable emotional experiences lead to self preservation behaviors such as addiction, non-suicidal self-injury, even suicidality Why DBT Was Created ~    People with emotional dysregulation have: ~    High sensitivity ~    Hypervigilance ~    Overgeneralization ~    Easily thrown off kilter (vulnerabilities) ~    No “emotional skin” ~    High reactivity ~    Fight or Flight ~    Slow de-escalation (Persistent heightened awareness) ~    Invalidating environment The Emotional Reaction ~    Hyperawareness of stimuli (Perceptions) ~    Threat perceived (Cognitions) ~    All hands on deck response (Physiological response—Fight or flight) ~    Actions (Survival) Primary Invalidation ~    Caregivers dismiss emotional reactions as invalid ~    Child is mocked, shamed for emotional response ~    Child is not taught ~    Self-soothing/de-escalation ~    Mindfulness ~    Effective cognitive processing Secondary Trauma/Invalidation ~    Coping skills can be overwhelmed by trauma or intense stress leading to a high-alert “raw” status ~    Many people do not receive necessary support during these times and may be shamed for being weak or needy ~    Crisis is a normal response to an abnormal event ~    Most humans are not inherently prepared to deal with crisis alone ~    What precipitates a crisis may vary between people based on pre-existing stress or mental health issues Result ~    High sensitivity + high reactivity + invalidation = Frantic efforts to numb/withdraw/protect ~    People learn that who they are and HOW they are results in rejection ~    Avoidance of threats ~    Avoidance of thoughts, feelings, sensations that may lead to invalidation Assumptions About Clients ~    Clients ~    Are doing the best they can ~    Want to improve ~    Cannot fail at DBT ~    Are existing in an unbearable state ~    Need to learn new behaviors in all contexts ~    Are not responsible for all of their own problems, but are responsible for all of their own resolutions ~    Need to be motivated for change Assumptions About Therapists ~    Clarity, precision and compassion are of the utmost importance ~    The therapeutic relationship is between equals ~    DBT or therapists can fail to achieve the desired outcome ~    Therapists who treat patients with pervasive emotional dysregulation need support Global—Core Mindfulness

Love Me Don’t Leave Me Addressing Fears of Abandonment Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC, NCC Executive Director, AllCEUs *Based in part on Love Me Don’t Leave Me by Michelle Skeen, PsyD. CEs can be earned for this presentation at https://www.allceus.com/member/cart/index/product/id/517/c/ Objectives ~    Help clients increase awareness of their story including beliefs about and behavioral reactions to situations that trigger their fear of abandonment ~    Learn about fear of abandonment ~    Explore the concept of schemas or core beliefs ~    Examine common traps in thinking, reacting and relationships ~    Learn skills necessary to ~    Accept their past as part of their story ~    Acknowledge that their past does not have to continue to negatively impact them in the present How It Impacts Recovery ~    Connection is a basic human need ~    As infants and children, survival was dependent upon the relationship with the primary caregiver ~    People’s beliefs about other people and relationships was formed largely based on their interactions with their caregivers ~    Healthy relationships serve as a buffer against stress How It Impacts Recovery ~    Addressing beliefs that formed as a result of these relationships will help people: ~    Create a new understanding of these events ~    Better understand themselves and their reactions ~    Help them make more conscious, healthy decisions in their current relationships Abandonment Experience ~    In childhood, survival depends on caregivers. ~    Fear of abandonment is a natural survival response ~    Meeting biological needs and safety are key triggers for anxiety at any age. ~    When focused on survival people cannot focus elsewhere ~    Every stressful situation becomes a crisis in the insecurely attached child Abandonment Experience ~    In infancy/early childhood, caregivers were: ~    Away for long periods (Work, military, jail, choice, death) ~    Been inconsistently or unpredictably physically or emotionally present. (emotional distress, addiction, ill equipped to deal with a child) ~    In later childhood ~    Poor family fit/black-sheep ~    Trauma that ruptures the relationship with the primary caregiver ~    Introduction of a new, less emotionally or physically safe caregiver Reactions to Fears of Abandonment ~    Fight or flight ~    Anger toward someone who is unavailable ~    Sadness (helplessness) when someone goes away ~    Shame (Self anger) about feeling needy ~    Fear ~    Rejection/isolation ~    Loss of control/the unknown ~    Failure ~    Questions for clients ~    What caused these fears as a child?  How were they reasonable/helpful. ~    What causes these fears now?  How are they unhelpful? Temperament ~    Based on their temperament, children need different types and amounts of caregiver interaction ~    Wide open and easily overstimulated ~    The energizer bunny ~    The introvert ~    The extrovert ~    If abandonment fears are triggered in early childhood, it can be addressed. *It is important to pay attention to the behaviors that are being reinforced Schemas ~    Based on their needs and caregivers reactions, children form schemas or core beliefs about the world and others ~    Important points about children under 7: (ages 8-12 children are developing alternate cognitive skills) ~    Children think dichotomously ~    Children are egocentric ~    Children can only focus on one aspect at a time ~    Children cannot think abstractly (consider other “possible” options)

Understanding the Impact of Adrenal Fatigue in the Mental Health and Addiction Recovery Process Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs CEs for this course can be earned at: https://www.allceus.com/member/cart/index/product/id/516/c/ Objectives – Define adrenal fatigue – Identify symptoms of adrenal fatigue – Learn about the function of the HPA-Axis and cortisol – Explore how excessive stress may cause adrenal fatigue – Identify interventions for adrenal fatigue Why I Care/How It Impacts Recovery – Adrenal fatigue can cause many symptoms that are commonly classified as depression and/or anxiety. – Standard antidepressant treatment will likely be unsuccessful in addressing these symptoms in this situation – Many people suffering from adrenal fatigue self medicate with stimulants and may eventually seek relief through escape provided from addiction The Effect of Prolonged Stress – Normal – Stressor/threat –> fight or flight response which stimulates/excites the person – person eliminates the stressor/threat – recovery period – Example: Final Exams, Big Project at Work The Effect of Prolonged Stress – Abnormal – Stressor/threat –> fight or flight response which stimulates/excites the person – person cannot totally eliminate the stressor/threat or another stressor threat comes along – continued stimulation – adjustment to high stress “turn down the response” to prevent harm to the person -lack of normal excitement at mild to moderate stimulus (Apathy, Depression) – Examples: Law Enforcement, Type-A, Negative Self-Talk, Excess Stimulant Intake Adrenal Fatigue and the HPA – The HPA (Hypothalamic-Pituitary-Adrenal) Axis controls the stress response. – The Hypothalamus is the brain center that determines if there is a threat – The pituitary is the relay switch that turns on or off the adrenal glands – The adrenal glands are responsible for secreting cortisol/adrenaline that excites and prepares the organism for fight or flight – Dysfunction anywhere in the system can cause the person to either be too stimulated/stressed/anxious or not stimulated enough/depressed Symptoms of Adrenal Fatigue – Restless sleep – When under significant stress, adrenaline and cortisol levels are high which interrupts the natural 24-hour cycle of cortisol levels, leading to a state of permanent alertness that prevents restful sleep – Waking up in a panic attack or anxious state – Difficulty maintaining blood sugar – In late stage adrenal fatigue cortisol levels are too low (the thermostat turned down). Cortisol is responsible in part for maintaining blood sugar Symptoms of Adrenal Fatigue – Excessive fatigue, apathy, depression – In the later stages of Adrenal Fatigue, your adrenals become unable to produce enough of the hormones that you need. – This means that your levels of cortisol, along with neurotransmitters like adrenaline and norepinephrine, are lower than they should be. – Emotionality- Barely holding it together. Any stressor becomes a crisis. Symptoms of Adrenal Fatigue – Apathy about or inability to handle even minor stressors due to the low hormone levels associated with late-stage Adrenal Fatigue. – The adrenals are no longer able to keep up with the continued demand for cortisol, adrenaline and norepinephrine production needed to address the stress. – These hormones regulate the stress response and allow us to increase our strength, focus and awareness wh

Vocational Goals & Skills Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Continuing Education (CE) credits can be earned for this presentation at  https://www.allceus.com/member/cart/index/product/id/515/c/ Objectives ~    Identify the purposes of vocational goals ~    Learn ways to help people explore vocational wants and needs ~    Learn about the CGOE online ~    Define and explore the concept of functional assessment ~    Review skills related to finding, getting and maintaining a job ~    Discuss job coaching Why I Care/How It Impacts Recovery ~    Jobs ~    Provide structure ~    Fill time ~    Help clients practice new interpersonal, coping, refusal skills in a semi-structured environment ~    Reinforce the concepts of honesty, faith, trust and hope ~    Provide a sense of accomplishment ~    Financially support Vocational Needs and Wants ~    Needs ~    Regular hours (preferably not overnight) ~    Boundaries ~    Drug free environment ~    Reasonable stress ~    Extrovert vs. Introvert ~    Structure vs. Spontaneous (Judging vs. Perceiving) ~    An effective supervisor Vocational Wants ~    Wants ~    Pay ~    Opportunity for advancement ~    Power DOT and CGOE Online ~    Dictionary of Occupational Titles ~    Guide for Occupational Exploration ~    Print ~    O*NET OnLine ~    Interest Profiler ~    Results can be directly linked to over 900 occupations in O*NET OnLine ~    Checklist ~    Identifying Skills Finding and Getting a Job ~    Create a resume ~    Use skills and abilities identified from ONet functional assessment ~    Keep it one page ~    Be prepared to address gaps in employment ~    Interview ~    Dress for the occasion ~    Be on time ~    Don’t overdo the perfume/cologne/makeup ~    Stay positive Finding and Getting a Job Guide for Occupational Exploration  Print O*NET OnLine Interest Profiler Functional Assessment Checklist Identifying Skills Interviewing How To Ace The 50 Most Common Interview Questions 50 Most Common Interview Questions – Glassdoor Blog Ten Tough Interview Questions and Ten Great Answers – CollegeGrad.com Top 10 Interview Questions (…And How To Answer Them) Top Job Interview Questions | Monster.com 31 Most Common Interview Questions and Answers | The Muse Hiring and Supported Employment Federal Bonding Program Article about hiring people with a mental illness SAMHSA

Continuing Education (CE) credits can be earned for this presentation at  https://www.allceus.com/member/cart/index/product/id/507c/ Objectives|Define Personality Disorders|List the characteristics of Antisocial Personality|Examine the similarities between the behaviors of certain personality disorders and addictions|Identify ways to address these behaviors and thought patterns|Encourage clinicians to critically examine behaviors in patients with addiction in order to effectively differentially diagnose ~Why I Care/How It Impacts Recovery|When personality disorders are viewed as pervasive & perpetual, it|Provides an “excuse for relapse”|Often derails treatment because patterns of behavior thought to be due to the PD are essentially ignored|Personality Disordered & Addictive Behavior often look the same|Goals for recovery from both:|Honesty with self & others about thoughts/feelings/needs/wants (Mindfulness)|Distress tolerance and the ability to self-soothe|Hope and faith in self/future/others through addressing cognitive errors|Development of self esteem to eliminate need for external validation|Development of healthy, supportive relationships ~Personality Disorders|Represent a cluster of behaviors that is pervasive beginning before the age of 15.|Addictive behaviors also often begin before 15|Due to immature cognitive development, children tend to be more egocentric, overgeneralize and think in terms of dichotomies|From a survival perspective, most of these behaviors make perfect sense when viewed through the eyes of a child ~Personality Disorders|Treatment|Since these behaviors formed the foundation for further development patients must Understand their function in the past Identify how these behaviors and beliefs are faulty in the present Develop alternative skills Be empowered to interface with the world with the strengths, knowledge and tools of the adult ~Addictions|Represent one way to cope with distress|Can begin early in life|Have overlapping symptoms with personality disorders, especially Cluster B ~Addictions & Personality Disorders|Cluster A (Paranoid, Schizoid, Schizotypal)|Characterized by social awkwardness and withdrawal|Often co-occur with addictions|Cluster C (Obsessive-Compulsive; Dependent)|Characterized as anxious and fearful|May co-occur with addiction|Cluster B (Borderline, Narcissistic, Histrionic, Antisocial)|Characterized by dramatic, emotional, erratic behavior|Behavioral patterns overlap with addiction ~ Addictions & Personality Disorders|Cluster B (Borderline, Narcissistic, Histrionic, Antisocial)|Characterized by -Dramatic, emotional, erratic behavior -All or Nothing thinking -Hostility and Aggression -Hypersensitivity -Manipulative -Low Self-Esteem / Weak Self-Concept ~Antisocial Personality Disorder|CORRUPT (3 criteria)|C: Conformity to law lacking|O: Obligations ignored|R: Reckless disregard for safety of self or others|R: Remorse lacking|U: Underhanded (deceitful, lies, cons others)|P: Planning insufficient (impulsive)|T: Temper (irritable and aggressive) ~Addictions vs. Personality Disorders|Many behaviors characteristic of active addiction|Overlap with personality disorders|Begin in late childhood/early adolescence|Are pervasive As people’s experiences and knowledge expanded, their coping skills and behaviors remained relatively primitive|Recovery from both requires|Development of effective coping skills|Addressing cognitive distortions ~Recovery Interventions|Dramatic, emotional, erratic behavior|Distress Tolerance|Mindfulness to identify and process the source of the distress|Coping skills|All or Nothing thinking|Awareness and elimination of cognitive distortions (CBT)|Hostility and Aggression|Understanding of the fight or flight response|Development of anger awareness and management skills ~Addictions vs. Personality Disor

Continuing Education (CE) credits can be earned for this presentation at  https://www.allceus.com/member/cart/index/product/id/507c/ Objectives | Define Personality Disorders | Examine the similarities between the behaviors of certain personality disorders and addictions | Identify ways to address these behaviors and thought patterns | Encourage clinicians to critically examine behaviors in patients with addiction in order to effectively differentially diagnose Why I Care/How It Impacts Recovery | When personality disorders are viewed as pervasive & perpetual, it | Provides an “excuse for relapse” | Often derails treatment because patterns of behavior thought to be due to the PD are essentially ignored | Personality Disordered & Addictive Behavior often look the same | Goals for recovery from both: | Honesty with self & others about thoughts/feelings/needs/wants (Mindfulness) | Distress tolerance and the ability to self-soothe | Hope and faith in self/future/others through addressing cognitive errors | Development of self esteem to eliminate need for external validation | Development of healthy, supportive relationships Personality Disorders | Represent a cluster of behaviors that is pervasive beginning before the age of 15. | Addictive behaviors also often begin before 15 | Due to immature cognitive development, children tend to be more egocentric, overgeneralize and think in terms of dichotomies | From a survival perspective, most of these behaviors make perfect sense when viewed through the eyes of a child Personality Disorders | Treatment | Since these behaviors formed the foundation for further development patients must |Understand their function in the past |Identify how these behaviors and beliefs are faulty in the present |Develop alternative skills |Be empowered to interface with the world with the strengths, knowledge and tools of the adult Addictions | Represent one way to cope with distress | Can begin early in life | Have overlapping symptoms with personality disorders, especially Cluster B Addictions & Personality Disorders | Cluster A (Paranoid, Schizoid, Schizotypal) | Characterized by social awkwardness and withdrawal | Often co-occur with addictions | Cluster C (Obsessive-Compulsive; Dependent) | Characterized as anxious and fearful | May co-occur with addiction | Cluster B (Borderline, Narcissistic, Histrionic, Antisocial) | Characterized by dramatic, emotional, erratic behavior | Behavioral patterns overlap with addiction Addictions & Personality Disorders | Cluster B (Borderline, Narcissistic, Histrionic, Antisocial) | Characterized by |Dramatic, emotional, erratic behavior |All or Nothing thinking |Hostility and Aggression |Hypersensitivity |Manipulative |Low Self-Esteem / Weak Self-Concept Addictions & Personality Disorders | Cluster B (Borderline, Narcissistic, Histrionic, Antisocial) | Antisocial: |Disregard for the rights of other people |Impulsivity |Hostility and/or aggression |Deceit and manipulation |Seem to lack empathy Addictions & Personality Disorders | Cluster B | Histrionic |Excessive emotionality and attention seeking | May become enraged at perceived rejection |Need to be the center of attention |Inability to engage in authentic relationships but uncomfortable being alone |Imagine relationships to be more intimate in nature than they actually are |Tend to be suggestible and easily influenced by other people's suggestions and opinions. Addictions & Personality Disorders | Cluster B (Borderline, Narcissistic, Histrionic, Antisocial) | Borderline: |Low self-esteem |Feel helpless, anxious and constantly fear abandonment |Perceptions of themselves and others may quickly vacillate back and forth |Hypervigilant |Extremely emotionally reactive with inability to de- escalate |Often have a history of neglect, abuse or a dismissive s

Continuing Education (CE) credits can be earned for this presentation at  https://www.allceus.com/member/cart/index/product/id/507c/ Objectives Define Personality Disorders | Examine the similarities between the behaviors of certain personality disorders and addictions | Identify ways to address these behaviors and thought patterns | Encourage clinicians to critically examine behaviors in patients with addiction in order to effectively differentially diagnose Why I Care/How It Impacts Recovery | When personality disorders are viewed as pervasive & perpetual, it | Provides an “excuse for relapse” | Often derails treatment because patterns of behavior thought to be due to the PD are essentially ignored | Personality Disordered & Addictive Behavior often look the same | Goals for recovery from both: | Honesty with self & others about thoughts/feelings/needs/wants (Mindfulness) | Distress tolerance and the ability to self-soothe | Hope and faith in self/future/others through addressing cognitive errors | Development of self esteem to eliminate need for external validation | Development of healthy, supportive relationships Personality Disorders | Represent a cluster of behaviors that is pervasive beginning before the age of 15. | Addictive behaviors also often begin before 15 | Due to immature cognitive development, children tend to be more egocentric, overgeneralize and think in terms of dichotomies | From a survival perspective, most of these behaviors make perfect sense when viewed through the eyes of a child Personality Disorders | Treatment | Since these behaviors formed the foundation for further development patients must |Understand their function in the past |Identify how these behaviors and beliefs are faulty in the present |Develop alternative skills |Be empowered to interface with the world with the strengths, knowledge and tools of the adult Addictions | Represent one way to cope with distress | Can begin early in life | Have overlapping symptoms with personality disorders, especially Cluster B Addictions & Personality Disorders | Cluster A (Paranoid, Schizoid, Schizotypal) | Characterized by social awkwardness and withdrawal | Often co-occur with addictions | Cluster C (Obsessive-Compulsive; Dependent) | Characterized as anxious and fearful | May co-occur with addiction | Cluster B (Borderline, Narcissistic, Histrionic, Antisocial) | Characterized by dramatic, emotional, erratic behavior | Behavioral patterns overlap with addiction Addictions & Personality Disorders | Cluster B (Borderline, Narcissistic, Histrionic, Antisocial) | Characterized by |Dramatic, emotional, erratic behavior |All or Nothing thinking |Hostility and Aggression |Hypersensitivity |Manipulative |Low Self-Esteem / Weak Self-Concept Addictions & Personality Disorders | Cluster B (Borderline, Narcissistic, Histrionic, Antisocial) | Antisocial: |Disregard for the rights of other people |Impulsivity |Hostility and/or aggression |Deceit and manipulation |Seem to lack empathy Addictions & Personality Disorders | Cluster B | Histrionic |Excessive emotionality and attention seeking | May become enraged at perceived rejection |Need to be the center of attention |Inability to engage in authentic relationships but uncomfortable being alone |Imagine relationships to be more intimate in nature than they actually are |Tend to be suggestible and easily influenced by other people’s suggestions and opinions. Addictions & Personality Disorders | Cluster B (Borderline, Narcissistic, Histrionic, Antisocial) | Borderline: |Low self-esteem |Feel helpless, anxious and constantly fear abandonment |Perceptions of themselves and others may quickly vacillate back and forth |Hypervigilant |Extremely emotionally reactive with inability to de- escalate |Often have a history of neglect, abuse or a dismiss

A Strengths Based Biopsychosocial Approach to PTSD Instructor: Dr. Dawn-Elise Snipes Ph.D., LMHC Continuing Education (CE) credits can be earned for this presentation at  https://www.allceus.com/member/cart/index/product/id/508/c/ Objectives – Highlight the functional nature of most behaviors and reactions – Define PTSD – Examine the function and meaning of PTSD symptoms – Develop an understanding of why some people develop PTSD and others do not – Explore useful interventions for persons with PTSD Reward and Survival – Humans and animals experience reactions to prompt behavior – Anger/Fight – Fear/Flight – Reactions are responses designed to – Protect life – Achieve a reward/avoid punishment PTSD and Gradual Onset PTSD – PTSD: Traditional exposure to an event or multiple events – Military – Crime Victims – Gradual Onset PTSD: repeated exposure to horrific or threatening events causing a sense of helplessness – Law Enforcement – Military – Child Abuse/Neglect Definition – Exposure to a horrifying event in which there was a sense of helplessness – For each symptom that follows, we will identify – The function – What triggers that symptom or exacerbates it – How the person deals with/mitigates that symptom – Other things he or she could do Symptoms – Re-experiencing the traumatic event – Intrusive, upsetting memories of the event – Flashbacks (acting/feeling like the event is happening again) – Nightmares – Feelings of intense distress when reminded – Intense physical (panic) reactions to reminders Symptoms – PTSD symptoms of avoidance and emotional numbing – Avoiding reminders of the trauma – Inability to remember important aspects of the trauma – Loss of interest in activities and life in general – Feeling detached from others or emotionally numb – Sense of a limited future Symptoms – PTSD symptoms of increased arousal – Difficulty falling or staying asleep – Irritability or outbursts of anger – Difficulty concentrating – Hypervigilance (on constant “red alert”) – Feeling jumpy and easily startled Other common symptoms of PTSD – Anger and irritability – Guilt, shame, or self-blame – Substance abuse – Depression and hopelessness – Suicidal thoughts and feelings – Feeling alienated and alone – Feelings of mistrust and betrayal – Headaches, stomach problems, chest pain Triage – Similarity to the victim (or being the victim) – Proximity to your safe zones (home, work) – Social support after the trauma – History of mental health problems – Number of stressors in the past 6 months Assessment – If you were not the victim, how were you similar to the victim- – How are people around you similar to the perpetrators- – What was (or would have been) helpful for people to do after the trauma- – Who can you rely on to do those things now- Creating Safety – What can you do to take back your “safe zones” – How can your protect yourself from this in the future- – How did the experience change – How you view things- – What is important to you- – How you will live your life now- Sleep – Function

Strengths Based Biopsychosocial Approach to Recovery from Bipolar 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/509/c/ Objectives – What is bipolar – What causes bipolar disorder (and how to mitigate it) – Emotionally (Stress reduction, Anger Mangement, Happiness) – Mentally (Cognitive Errors and Negativity, Self-Esteem) – Physically (Exercise, Nutrition, Sleep, Medication) – Environmentally – Co-Occurring Conditions (and interventions) Why I Care/How It Impacts Recovery – Uncontrolled bipolar disorder puts people at risk for – Suicide – Addictions and Addiction Relapse – Extreme risk taking behavior – Poorly controlled bipolar disorder can leave people feeling hopeless and helpless – Well controlled bipolar, like well controlled addictions helps a person feel happy, optimistic, motivated and energized. What is Bipolar Disorder – It is a brain a disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. – Many very successful people have managed their bipolar disorder including – Mel Gibson – Demi Lovato – Axl Rose – Britney Spears – Jean-Claude Van Damme – Mark Vonnegut – Amy Winehaus – Lee Thompson Young & Robin Williams were both quite successful and revered in their fields, despite losing the battle with bipolar What Causes Bipolar Disorder – What causes bipolar disorder – Imbalances in neurochemicals, especially dopamine, serotonin and norepinephrine – Imbalances can be genetic, triggered by sex-hormone changes or stress-hormone changes – Prevalence – More than 1 in 50 adults are classified as having bipolar disorder in any 12-month period (2.6% of the adult population) Understanding Your Bipolar – Understanding your bipolar – Symptoms – Depression – Feel very sad, down, empty, or hopeless – Have very little energy – Have decreased activity levels – Sleeping changes – Feel worried and empty – Have trouble concentrating – Forget things a lot – Eat too much or too little – Feel tired or “slowed down” Understanding Your Bipolar – Understanding your bipolar – Symptoms – Mania – Feel very “up,” “high,” or elated – Have a lot of energy and increased activity levels – Feel “jumpy” or “wired” – Have trouble sleeping – Talk really fast about a lot of different things – Be agitated, irritable, or “touchy” – Feel like their thoughts are going very fast – Think they can do a lot of things at once – Engage in risky and/or reckless behavior Understanding Your Bipolar – Understanding your bipolar – Symptoms – Mixed – Includes symptoms of both manic and depressive symptoms – Feeling very sad, empty, or hopeless  AND – Feeling extremely energized. Keeping a Life Chart – Ideally for 3-6 months – Chart – Sleep – Dietary Habits – Exercise – Life stressors – Hormones (women) – Bipolar symptoms Understanding Your Bipolar – Understanding your bipolar – Depression Understan

Strengths Based Biopsychosocial Approach to Recovery from Depression 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/510/c/ Objectives – Define depression (symptoms) – Learn how to ask strengths-based assessment questions – Identify a range of potential causes for depression – Explore activities and interventions that can help people address some of the underlying causes Depression – Depression represents a cluster of symptoms – Diagnosis with depression only requires people to have a few of the symptoms – A variety of different things can cause depression – Emotions: Anger, anxiety, grief, guilt, shame – Thoughts: Cognitive distortions – Relationships: Poor self-esteem, unhealthy/unsupportive relationships, need for extremal validation – Physical: Neurochemical imbalances, poor nutrition, exhaustion, insufficient sleep, medication side effects – Environmental: High stress environments that prevent relaxation/rest and increase hopelessness/helplessness Depression Assessment – What does this mean to you- (apathy, sadness, mood swings) – Which symptoms are most bothersome for you and why- – For each symptom – What makes depression worse- – What makes depression better- – How was life more pleasurable prior to getting depressed- – What is different during when you are NOT depressed- – How do you expect life to be different when your depression is gone- Neurotransmitters – Ability to feel pleasure/Apathy/Emotional Flatness – Memory issues – Difficulty concentrating – Sleep issues – Lack of motivation – Fatigue – Pain – Irritability/Agitation – Fight or flight stress symptoms Neurotransmitters – Get quality sleep – Create a routine – Address pain and apnea – Improve the sleep environment – Other factors: Shift work, time zones, daylight savings time – Relaxation – Biofeedback – Progressive muscular relaxation – Address medication side effects – Psychotropics – Opiates – Improve nutrition Neurotransmitters – Address addictive behaviors – Address chronic or extreme stress – Refresher – Both of these increase the amount of neurotransmitters flooding the synapses. – To protect the body from overload, the brain shuts down some of the receptors so the body does not overload  (tolerance/desensitization) – When the neurotransmitters return to a normal level, the receptors are still shut down, so not enough neurotransmitter gets sent out. – Things that normally caused a reaction, no longer are strong enough to cause a reaction Hormones – Thyroid – Impact mood, libido and energy levels – Estrogen – Boosts neurotransmitters that affect sleep, mood, memory, libido, pain perception, learning and attention span. – Increased estrogen may increase the availability of serotonin Behavioral and Cognitive Neuroscience Reviews Volume 4 Number 1, March 2005 43-58 – Low testosterone may be implicated in reducing the availability of serotonin – Testosterone is manufactured by the adrenal glands, – Enhances libido, improves stamina and sleep, assists brain function, and is associated with assertive behavior and

Strengths Based Biopsychosocial Approach to Recovery from Panic Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs CEs available at: https://www.allceus.com/member/cart/index/product/id/505/c/ Objectives – Define panic – Examine how the fight or flight reaction can be corrupted to prompt panic attacks – Examine the cognitive, emotional, behavioral, biological sources of the stress reaction – Explore a variety of interventions that may assist people in counterconditioning the panic response Why I Care/How It Impacts Recovery – Panic attacks can feel overwhelming – Panic attacks are exhausting and can leave people feeling out of control of their own body – People can avoid things they have phobias of, but panic attacks seem to come out of the clear blue – People with panic attacks often restrict what they do (superstitiously) to avoid panic triggers – Awareness of what a panic attack is and what triggers them for each individual is crucial to recovery. The Body's Response to Anxiety/Panic – We have a primitive response system that protects us from danger “Fight-Flight-Freeze” – To prepare to take on the threat, the body sends out “excitatory” signals – Increase in heartrate – Increase in respiration – Numbness or tingling in hands (blood to the core) – Sweating (temperature and slipperiness) – Pupil Dilation (blurred vision/spots/brightness) – Muscle Tension The Mind's Response to Panic – Oh CRAP! – Something bad is going to happen or I wouldn't be feeling this way – Catastrophic thinking— I'm going to – Pass out – Die – Throw up – — The Panic Cycle Track Panic Symptoms: Anxiety Log – Log your anxiety episodes (not just panic) – What were your symptoms – Physical – Cognitive – Emotional – What triggered it – Why did that trigger it – What may have made you more vulnerable to your triggers Life Through Panic Colored Glasses – If you are hypervigilant about panic triggers, you will find them – Review your Anxiety Log – Identify your triggers – Make a plan to deal with them – Identify vulnerabilities – Make a plan to prevent them Body Awareness | Physical Mindfulness – Body Scan – What am I experiencing – What might be causing it – Blood Sugar – Stimulants – Adrenaline Rush – Orthostatic Hypotension – Excitement or Panic Its only a False Alarm – Mindfully attending to panic – Feel the sensations – Focus on breathing – Use positive self-talk Exercise – When the body is on high alert because it is getting stress signals, but you are sitting still, there is a disconnect which causes: – an increase in stress chemicals – may trigger catastrophic thinking – One way to get the mind and body back in synch is to move – providing a reasonable explanation for the increased heartrate and respiration – Using the stored energy that has been released to fuel the fight or flight reaction – Exercise also releases serotonin (a calming effect) Nutrition – Stimulants, medications and certain supplements can trigger a stress response. – Caffeine – Decongestants – Guarana – Hot peppers can trigger indigest

Using a Strengths-Based Biopsychosocial Approach to Addressing Anxiety Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC, NCC Executive Director, AllCEUs CEs available at: https://www.allceus.com/member/cart/index/product/id/504/c/ Objectives – Define a strengths based approach – Define a biopsychosocial approach Why I Care/How It Impacts Recovery – Anxiety can be debilitating – Low-grade chronic stress/anxiety erodes your energy and ability to concentrate – Anxiety is a major trigger for: – Addiction relapse – Increased physical pain – Sleep problems What Does Strengths Based Mean – It is easier (and more effective) to build upon something that already works to some extent. – Strengths-based approach helps people identify how they are already trying to cope and builds on that – There are two types of strengths – Prevention/Resilience Strengths – What you do on a daily basis to stay healthy and happy – Intervention/Coping Strengths – In the past when you have felt this way, what helped- – What made it worse- What is a Biopsychosocial Approach – Bio-logical – Neurochemicals – Nutrition – Sleep – Sunlight & Circadian Rhythms – Psycho-logical – Mindfulness – Distress Tolerance – Coping Skills – Cognitive Restructuring – Social – Improving self-esteem and your relationship with self – Improving relationships with healthy, supportive others What is Anxiety – Anxiety is half of the “Fight or Flight Response” – It is an excitatory response – It’s function is to protect you from danger – It can become a problem when it is – Overgeneralized – Overly intense/uncontrollable – Constant due to brain injury – Like depression, it can be caused by excess serotonin  Serotonin: A Common Neurobiologic Substrate in Anxiety and Depression.  EISON, MICHAEL S. PhD Symptoms of Generalized Anxiety – Generalized anxiety disorder symptoms can vary. They may include: – Persistent worrying or obsession about small or large concerns that's out of proportion to the impact of the event – Inability to set aside or let go of a worry – Inability to relax, restlessness, and feeling keyed up or on edge – Difficulty concentrating, or the feeling that your mind “goes blank” – Distress about making decisions for fear of making the wrong decision – Carrying every option in a situation all the way out to its possible negative conclusion – Difficulty handling uncertainty or indecisiveness Symptoms of Generalized Anxiety – Generalized anxiety disorder symptoms can vary. They may include: – Physical signs and symptoms may include: – Fatigue – Irritability – Muscle tension or muscle aches – Trembling, feeling twitchy – Being easily startled – Trouble sleeping – Sweating – Nausea, diarrhea or irritable bowel syndrome – Headaches Symptoms of Generalized Anxiety (Kids) – Excessive worry about: – Performance at school or sporting events – Being on time (punctuality) – Earthquakes, nuclear war or other catastrophic events – A child or teen with GAD may also: – Feel overly anxious to fit in – Be a perfectionist – Lack confidence – Strive for appr

Thinking Errors Understanding and Addressing Them Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs CEs are available at: https://www.allceus.com/member/cart/index/product/id/497/c/ Objectives – Define Thinking Errors – Explore the different types of thinking errors – Cognitive distortions – Irrational Thoughts – Evaluate how thinking errors can play into our basic fears: Rejection, isolation, the unknown, loss of control, failure – Identify ways to – Increase awareness of thinking errors – Address thinking errors – Address basic fears Why I Care/How It Impacts Recovery – Thinking errors, or stinkin’ thinkin’ plays a large part in keeping people miserable – Addiction, depression, anxiety, anger and guilt often stem or are made worse by faulty thinking – Addressing these thought patterns will help you: – Not make a mountain out of a molehill – Focus on the things you can change – Identify and eliminate thought patterns that are keeping you stuck What are Thinking Errors – Cognitive Distortions take a thought and manipulate it to – Fulfil your expectations of a situation – Conform to your current head space (negative begets negative) – Irrational Thoughts are beliefs/thoughts that you may hold that – Are usually extreme (I must have love and approval from everyone all the time) – Are unrealistic – Create feelings of failure, inadequacy, disempowerment Cognitive Distortions – Personalizing – Mindreading – All-or-Nothing/Polarized – Catastrophizing – Overgeneralization – Shoulds – Recency/Availability Heuristic Evaluate how thinking errors can play into our basic fears: Rejection, isolation, the unknown, loss of control, failure Irrational Beliefs – If I make a mistake, it means that I am incompetent. – When somebody disagrees with me, it is a personal attack. – I must be liked by all people. – My true value depends on what others think of me. – If I am not in a relationship, I am completely alone. – Success and failure are black and white.  There is no gray. Evaluate how thinking errors can play into our basic fears: Rejection, isolation, the unknown, loss of control, failure Irrational Beliefs – Nothing ever turns out the way you want it to. – If the outcome was not perfect, it was a complete failure. – If something bad happens, it is my fault. – The past always repeats itself. – If it was true then, it must be true now. Evaluate how thinking errors can play into our basic fears: Rejection, isolation, the unknown, loss of control, failure Irrational Thoughts Quick Help – What is upsetting me- – Why is this upsetting me- – What are the FACTS for and against this belief – Am I reacting based on facts or feelings- – What cognitive distortions am I using- – What irrational thoughts am I using- ABC-DEF – Activating Event (What happened) – Beliefs – Obvious – Negative self-talk//Past tapes – Consequences – Dispute Irrational Thoughts – Evaluate the Most Productive Outcome – Is this worth my energy- – How can I best use my energy to deal with or let go of the situation- Triggers—Coping Skills – Distract don’t react – Talk it through – Urge surf –

Interplay Between Addiction & Mental Health Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC, Executive Director, AllCEUs.com CEs are available: https://www.allceus.com/member/cart/index/product/id/515/c/ ~Objectives: Define co-occurring disorders  Identify the impact of addiction on the individual  Identify the impact of mood disorders on the individual  Identify the impact of chronic illness or pain on the individual  Explore the interplay between the three  Why I Care/How It Impacts Recovery  Co-Occurring Disorders are the EXPECTATION, not the EXCEPTION.  A person who is sober but depressed is at risk for addiction relapse  A person who is using is actively in an addiction (even a behavioral one) is altering the balance of neurotransmitters. ~Define Co-Occurring Disorders  Mental Health, Addiction, Physical Health problems and their interaction  Must be treated concurrently ~Think About It  When you are stressed out how does it impact your  Mood  Patience  Ability to concentrate/productivity  Problem solving/creativity  Sleep  Energy levels  Appetite  Headaches  Muscle Aches ~Think About It  People with addictions are:  Trying to get some relief from emotional or physical distress  Inadvertently worsening the problem by altering the neurochemicals ~Mental Illness Effects  Emotionally  Depression or anxiety  Cognitively  Difficulty concentrating  Perception of hopelessness and helplessness (Victim mentality)  Physically  Sleep disturbances  Eating Disturbances  Restlessness/agitation  Achiness  Fatigue ~Mental Illness Impact  Socially  Withdrawal/Difficulty dealing with people  Low self-confidence  Lack of energy or desire to interact  Relationship deterioration  Environmentally (The outside reflects the inside)  Disorganization  Lack of energy or desire to care for anything ~Mental Illness Addictive Behaviors  Emotionally  Addiction numbs or medicates depression or anxiety  Cognitively  Addiction reinforces hopelessness and helplessness (Victim mentality/stinking thinking)  Physically  Addiction helps people relax to get to sleep OR keeps them up instead of sleeping  Food is often used as a secondary self-soothing/addictive behavior OR people get so caught up in their addiction they forget to eat ~Mental Illness  Addictive Behaviors  Physically  Addiction helps soothe restlessness/agitation, but detoxing can intensify it  Achiness can be relieved or numbed by addictions, but (especially in the case of opiates) may cause the body to stop making or using endogenous opioids.  Addiction to stimulants may be used to self-medicate fatigue, but causes rebound exhaustion. ~Mental Illness  Addictive Behaviors  Socially  Addictions may be used to “loosen up” or make it easier to interact with others  The addiction may provide an alternate peer group that is tolerant  Environmentally (The outside reflects the inside)  In active addiction, there is little concern for the environment UNLESS the person is trying to hide the addiction in which case, they may become more attentive to cleanliness and organization. ~Addiction Effect (Benefits?)  Emotionally  Numbing  Relaxation  Euphoria  Cognitively  Stinking thinking  Physically  Energy  Improved Sleep  Relaxation  Socially  A new peer group  Environmentally ~Addiction Mental Illness  Emotionally  Addiction causes neurotransmitter imbalances  As depression and anxiety worsen, the need for the addiction/numbing increases. Life starts to revolve around using  The brief benefits lead to a continued need for the addiction to feel “normal”  Mentally/Cognitively  Addiction leads to lying, manipulation, and exacerbates cognitive distortions (stinking thinking)  Physically  Addiction usually disrupts circadian rhythms through too much or too little sleep  Addiction can alter hunger/satiation cues  Addiction can cause health problems leading to