Counselor Toolbox Podcast

Fetal Alcohol Spectrum Disorders in Mental Health and Criminal Justice Instructor: Dr. Dawn-Elise Snipes Executive Director AllCEUs.com, Counseling Continuing Education Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery CEUs are available for this podcast at https://www.allceus.com/member/cart/index/product/id/127/c/ Objectives ~    Where to begin… ~    Explore the scope of the problem ~    Identify the impact of the impairments across life domains ~    Discuss specific issues for adolescents ~ Identify special issues for suicide intervention ~ Explore techniques to modify the treatment environment to accommodate the needs of a person with an FASD Stats ~    National Institute on Alcohol Abuse and Alcoholism, the prevalence of FAS in the general population ranges from 2% to 5% for the entire continuum of FASD. ~    94% of individuals with an FASD also have a mental illness ~    73-80% of children with full-blown FAS are in foster or adoptive placement ~    61% of adolescents with an FASD experienced significant school disruptions Stats cont… ~    The prevalence of FASD in the child welfare system is approximately 17 to 19 times higher than that in the general population in North America (meta-analysis published online September 9 in Pediatrics). ~    12.8 is the average age children with an FASD begin having trouble with the law. (https://www.mofas.org/2014/05/fasd-and-the-criminal-justice-system/) ~    60% of people with an FASD have a history of trouble with the law What is FASD ~    FASD is not a diagnostic term, but is an umbrella term encompassing four categorical diagnostic entities: ~    Fetal alcohol syndrome (FAS) ~    Partial FAS ~    Alcohol-related neurodevelopmental disorder ~    Alcohol-related birth defects Impact of Functional Impairment ~    Problems in multiple domains interferes with treatment success, including inability to: ~    Remember program rules or follow multiple instructions. ~    Remember and keep appointments, or to get lost on the way there. ~    Independently make appropriate decisions about treatment needs/goals. ~    Appropriately interpret social cues ~    Observe appropriate boundaries, either with staff or other clients. ~    Attend to (and not disrupt) group activities. ~    Process information readily or accurately. ~    ‘Act one's age.’ ~    When indicators occur in any these domains (and particularly when they occur across multiple domains), it is worthwhile to apply the FASD 4-Digit Code Caregiver Interview Checklist (Astley, 2004b) Special Considerations for Adolescents ~    Evidence shows that adolescents will commonly exhibit learning and behavior challenges, especially in ~    Adaptive function/getting along from day to day ~    Remaining organized and regulated ~    Learning information slowly (especially what is said to them) ~    Tending to forget things they have recently learned ~    Making the same mistakes over and over. ~    Impulsivity/finding it hard to inhibit responses ~    Social communication (leaving out important details/being vague). ~    Suggestibility (and therefore easily influenced by others) ~    Immature social skills. (too friendly/trusting,/difficulty recognizing dangerous situations. Differential Dx ~    There is some evidence for distinguishing between children with FASD and children with ADHD. Using the four-factor model of attention it has been shown that: ~    children with FASD have difficulties with encoding (taking in and processing information) and shift (shifting attention (hyperfocus)) ~    children with ADHD have problems with focus and s

Screening and Motivational Enhancement Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC CEUs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/40/c/ Objectives ~    Compare and contrast MET with other approaches to therapy ~    Briefly review the FRAMES approach ~    Describe the stages of change ~    Define EE-DD-AA-RR-SS ~    Define OARS ~    Explore strategies for increasing motivation MET Unique Characteristics ~    Emphasis on personal choice regarding future behavior ~    Objective evaluation focused on eliciting the CLIENT’s OWN concerns ~    Resistance is an interpersonal behavior pattern indicating failure to accurately empathize ~    Resistance is met with reflection Motivational Enhancement Therapists Do NOT ~    Argue with clients ~    Impose diagnostic labels ~    Tell clients what they “must” do ~    Seek to “break down” denial through direct confrontation ~    Imply client’s powerlessness OARS ~    Open Ended Questions ~    Affirmations ~    Reflective Listening ~    Summaries Stages of Change ~    Motivation needs to be enhanced and maintained in all stages of change ~    Stages ~    Precontemplation ~    Contemplation ~    Preparation ~    Action ~    Maintenance Basic Principles: EE-DD-AA-RR-SS ~    Express Empathy ~    Reflective listening (accurate empathy) is a key skill ~    Develop Discrepancy ~    Perceive a discrepancy between where they are and where they want to be ~    Raise clients’ awareness of the personal consequences of their drinking in order to precipitate a crisis increasing motivation for change ~    Avoid Arguing ~    No attempt is made to have the client accept or “admit” a problem Basic Principles cont… ~    Roll with resistance ~    New ways of thinking about problems are invited but not imposed. ~    Ambivalence is viewed as normal, not pathological, and is explored openly. ~    Solutions are usually evoked from the client rather than provided by the therapist ~    Support self-efficacy ~    People will not try to change unless they believe there is HOPE for success Hardiness ~    Control ~    Self-efficacy ~    Hope and Faith ~    Commitment ~    Courage and Discipline ~    Challenge CBT vs. MET Cognitive Behavioral ~    Assumes client is motivated ~    Identify and modify maladaptive cognitions ~    Prescribes change strategies Motivational Enhancement ~    Builds client motivation ~    Explores and reflects client perception without correcting ~    Elicits change strategies from the client Nondirective vs. MET Nondirective ~    Client determines content and direction ~    Avoids injecting counselor’s advice and feedback ~    Empathy is used noncontingently MET ~    Directs client toward motivation ~    Offers advice and feedback ~    Empathic reflection used selectively to reinforce certain points Building Motivation ~    Since you are here, I assume you have been having some concerns or difficulties related to your use. Tell me about them. ~    Tell me a little about your drinking. What do you like about it? What’s positive about drinking for you? And what’s the other side? What are your worries about drinking? ~    How has your drinking has changed over time? What things do you think could be problems, or might become problems? ~    What have others said about your drinking? What are they worried about? ~    What makes you think that perhaps you need to make a change in your drinking?

Complex Trauma in Children and Adolescents CEUs can be earned for this presentation at https://www.allceus.com/member/cart/index/product/id/158/c/ Resources ~ This presentation is based, in part, upon ~ a white paper from the National Child Traumatic Stress Network: “Complex Trauma in Children and Adolescents” 2003 ~ Child-Witnessed Domestic Violence and its Adverse Effects on Brain Development https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193214/ ~ The Adverse Childhood Experiences Study https://www.cdc.gov/violenceprevention/acestudy/ Objectives ~ Define complex trauma ~ Define and explore Adverse Childhood Experiences ~ Highlight the cost of complex trauma ~ Examine the impact and diagnostic issues of complex trauma What is Complex Trauma ~ Exposure to traumatic events plus the short and long term impact of exposure resulting in: ~ Emotional dysregulation ~ Loss of safety ~ Inability to detect or respond to danger cues ~ Inability to detect or respond to internal cues ~ Generalization of cues More About Complex Trauma ~ Complex Trauma is most likely to develop if the danger is unpredictable and uncontrollable (p.8) ~ The greatest source of danger, unpredictability and uncontrollability is the absence of a caregiver who reliably and responsively nurtures and protects the child. Adverse Childhood Experiences ~ ACEs measured in the study include: ~ Physical, sexual, emotional abuse ~ Physical or emotional neglect ~ Mother treated violently ~ Substance misuse within household ~ Household mental illness ~ Parental separation or divorce ~ Incarcerated household member *Could happen anytime prior to 18th birthday *Two thirds of the 17,000 people in the ACE Study had at least one ACE Effects of ACEs ~ Psychosocially induced biological alterations (in the brain and the HPA-Axis) related to maladaptation (especially post-traumatic stress disorder) in the context of child-witnessed DV ~ Child-Witnessed Domestic Violence and its Adverse Effects on Brain Development https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193214/ Effects of ACEs ~ Nearly 60% of women and 35% of men with 4 or more ACEs reported chronic depression ~ The risk of perpetrating violence increased dramatically with the ACE score was over 5 ~ Those with at least 4 ACEs had nearly double the chance of being raped later in life. ~ 18% of those with at least 4 ACEs attempted suicide. National Incidence Study of Child Abuse and Neglect ~ NIS-3 (1996) ~ Harm Standard: 1,553,800 ~ Endangerment Standard  2,815,600 ~ Emotional (584,100) ~ NIS-4 (2006) ~ Harm Standard: 1,256,600 million (1:58) ~ Endangerment Standard: 2,905,800 (1:25) ~ Significant finding: Emotional (1,173,800) 7 Domains of Impairment ~ Attachment ~ Biology ~ Affect Regulation ~ Dissociation ~ Behavioral Regulation ~ Cognition ~ Self-Concept As defined by the NCTSN Complex Trauma Taskforce Attachment ~ Secure attachment ~ Internalize regulation strategies ~ Identify internal and external cues ~ Learn to use support systems in the face of overwhelming experience Attachment ~ Insecure attachment (80% maltreated children) ~ 3 types ~ Avoidant ~ Rejecting caregiving—What does this look like ~ Disregard and distrust self and others Attachment ~ Ambivalent ~ Parents alternate between validation and invalidation/detachment and enmeshment (Borderline-esque) ~ Children become hypersensitive to cues and overgeneralize ~

Relapse Prevention CEUs can be earned for this presentation at https://www.allceus.com/member/cart/index/product/id/574/c/ Dr. Dawn-Elise Snipes PhD, LMHC, LPC Objectives ~    Define Relapse ~    Identify Relapse Warning Signs ~    Identify Strengths ~    Learn about how your issue developed Relapse Definition ~    Relapse is the return to something that has been previously stopped ~    Relapse is multidimensional ~    Emotional ~    Mental ~    Physical ~    Social ~    A relapse is when you start returning to any of these people, places, things, behaviors or feeling states. Activity: Distress vs. Happiness Worksheet In your Unhappiness ~    Emotionally ~    Mentally ~    Physically ~    Socially When you are Happy ~    Emotionally ~    Mentally ~    Physically ~    Socially Triggers ~    Triggers are stimuli that set off an event. ~    Triggers can prompt positive or negative event as ~    Triggers can be ~    Visual ~    Auditory ~    Tactile ~    Olfactory ~    Cognitive ~    Temporal (Time or location) Emotional Relapse ~    In emotional relapse, your emotions and behaviors become negative and unpleasant. ~    You start finding it difficult to experience pleasure ~    What triggers your negative emotions (Anger/resentment/jealousy/guilt; anxiety/fear/stress; depression) ~    Things/Media ~    People ~    Places ~    Events Emotional Relapse ~    Negative emotions make us uncomfortable ~    Identify the emotion, explore why you are feeling that way and take steps to fix the problem ~    You can become stuck in the emotion, sometimes ~    Nurturing and blowing it out of proportion ~    Compounding it with other emotions like anger and guilt ~    Personalizing it ~    Trying to escape from it ~    Remember that emotions are just cues like a stoplight. ~    You feel how you feel in the moment ~    You can choose to change or improve the next moment Preventing Emotional Relapse ~    Practice mindfulness ~    Increase positive experiences (real and guided imagery) ~    Keep a gratitude journal ~    Avoid personalizing something that may not be about you ~    Remember that… ~    Negative emotions are the mind’s way of telling us to get off our butts and do something—Like our car’s idiot light or hunger pangs ~    Dwelling on, nurturing, avoiding or hiding from negative emotions never makes anything better ~    You can *choose* to feel and fix, or relapse and repeat ~    Identify and put in place triggers for positive emotions Activity ~    List 10 things that you chose to get anxious or angry about over the last week ~    Why did you get upset?  (What was your mind telling you needed to be fixed) ~    Did holding on to the upsetness do any good? ~    What was your initial reaction, and was it helpful? ~    What could you do differently next time to either ~    Change/fix the situation (Improve the next moment) ~    Change how you feel about the situation  (Walk the middle path) ~    Let it go (Radical Acceptance) Mental Relapse ~    In mental relapse there's a war going on in your mind. ~    Part of you wants to stay positive, but part of you is struggling with tolerating the distress. ~    The signs of mental relapse are: ~    Focusing on the negative ~    Having a pessimistic/helpless/hopeless attitude ~    If you had an addiction, you may also be: ~    Thinking about people, places, and things you used with ~    Glamorizing your past use ~    Lying

PTSD Exploring the Functional Nature of Symptoms Instructor: Dr. Dawn-Elise Snipes LPC-MHSP, LMHC, CCDRC Executive Director: AllCEUs Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Podcasts Continuing education Credits for this podcast are available at https://www.allceus.com/member/cart/index/product/id/59/c/ Objectives ~    Review PTSD Symptoms and explore their functional nature Purpose ~    By understanding the function of symptoms we can ~    Normalize the behavior ~    Identify alternate ways to meet that same need or address the issue ~    Re-Experiencing ~    Trying to replay it to figure out how to integrate into your schema (like fitting a puzzle piece) ~    Reminding the person of similar situations to “protect” them Purpose ~    Avoidance ~    The system is already over taxed.  Avoiding upsetting stimuli by blocking out most stimuli, memories of the event. ~    Avoiding unnecessary use of energy by not getting “excited.” ~    Changes in Beliefs ~    Protects against future “surprises” ~    Tries to assimilate the experience into schema ~    Increased Arousal ~    Protects the individual Re-Experiencing ~    You re-experience things every day ~    Access schema that guide your actions ~    When you go to work ~    When you encounter a particularly volatile client ~    When you approach a stop light ~    Re-Experiencing in PTSD ~    The context is often overgeneralized ~    The precipitating factors are often unknown ~    In many cases the resolution was not one of empowerment, resulting in trying to continually figure out how to not be disempowered Re-Experiencing: Assimilation or Accommodation ~    Intrusive distressing memories of the traumatic events ~    In children repetitive play may occur in which themes or aspects of the traumatic events are expressed. ~    Recurrent distressing dreams in which the content or feeling of the dream is related to the events ~    In children there may be frightening dreams without recognizable content. ~    Flashbacks or other dissociative reactions in which the individual feels or acts as if the traumatic events are recurring ~    In children trauma-specific reenactment may occur in play. Re-Experiencing ~    Intense or prolonged psychological or physiological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic events ~    The event represents a time in which the person experienced or witnessed something horrifying ~    The brain is trying to help the client ~    Avoid future similar situations ~    Learn how to protect during future similar situations Avoidance ~    Purpose: Avoidance of Recurrence of Pain or Arousal of Stress Response System ~    Emotional numbness and avoidance of places, people, and activities that are reminders of the trauma. ~    Inability to remember an important aspect of the traumatic events (not due to head injury, alcohol, or drugs) ~    Purpose: An exhausted system conserves energy in case there is another threat ~    Markedly diminished interest or participation in significant activities ~    Feelings of detachment or estrangement from others ~    Persistent inability to experience positive emotions Hypocortisolism ~    Cortisol is the stress chemical ~    After extreme stress and/or under chronic stress the brain may reduce the responsiveness of the stress response system by reducing the cortisol ~    This is protective, it keeps the organism from using precious resources by getting “excited” about anything (including pleasure) ~    Due to fear conditioning

Medication-Assisted Therapies for Addiction Presented by: Dr. Dawn-Elise Snipes, Ph.D, LMHC, LPC-MHSP Executive Director of AllCEUs.com An on-demand course based on this product is available for CEUs at https://www.allceus.com/member/cart/index/product/id/16/c/ Objectives ~    Discuss the purpose of long-term pharmacotherapy ~    Identify pharmacotherapies for ~    Smoking ~    Alcohol ~    Opioids ~    Methadone ~    Buprenorphine ~    Cases Why Medication Assisted Therapy ~    Early Recovery ~    Reduces cravings ~    Provides increased self-efficacy and a greater sense of control ~    Anxiety Reduction due to: ~    May alleviate some of the anxiety/fear about relapsing ~    Pharmacological effects of certain MATs ~    May improve depressive symptoms by ~    Enhancing hope and an sense of empowerment ~    Pharmacological effects of certain MATs What is our Goal in Early Recovery ~    Reduce Co-Occurring issues ~    Identify and address vulnerabilities ~    Improve overall health ~    Sleep ~    Nutrition ~    Energy (exercise) ~    Maintain abstinence ~    Increase time to relapse ~    Reduce intensity of binge if relapse occurs Clinical Use of Pharmacotherapy ~    Part of comprehensive plan that addresses the following issues or problems: ~    Emotional ~    Cognitive ~    Physical ~    Social ~    Occupational ~    Environmental ~    Not a substitute for counseling ~    Works best in combination with psychosocial support Co-Occurring Model of Addiction ~    Co-Occurring Disorders are the Expectation ~    Mood issues must be addressed to prevent relapse ~    Relapse begins when thoughts/urges or behaviors return to “addicted” mindset ~    Addictive behaviors were “learned” as a way to stop distress. ~    Learned behaviors cannot be unlearned. ~    Alternate behaviors and their consequences must be more rewarding than addictive behaviors and the consequences. (LT vs. ST) Drugs or No Drugs     No pharmacotherapy for most abused drugs ◦    Stimulants ◦    Hallucinogens (LSD, PCP, Ketamine, Dextromethorphan, Benadryl, Dramamine) ◦    Inhalants ◦    Marijuana     What is the function of… ◦    Stimulants ◦    Hallucinogens ◦    Psychedelics (5HT2A); “state of empathetic wellbeing” ◦    Dissociatives (reduces glutamate); altered pain perception, depressant; Ketamine, Dextromethorphan ◦    Deliriants (reduces acetylcholine) Benadryl, Dramamine ◦    Inhalants (Depressants) ◦    Marijuana (increases dopamine); generally “relaxing,” pain relieving Drugs or No Drugs     Factors to consider ◦    Cost ◦    Availability ◦    Side effects ◦    Barriers     Workplace drug testing     Other meds taken     Incarceration ◦    Motivation Barriers ~    Stimatization ~    Science vs. dogma ~    Evidence-based treatment vs. “drugs for drug addicts” ~    12-Step groups ~    Becoming more progressive ~    Methadone Anonymous is alternative ~    Counselors ~    Different experiences and biases ~    Payors ~    Most payors require medication assisted therapy be “considered when available.” What is the endpoint? ~    Duration of most pharmacotherapy is not indefinite ~    Months to years ~    Goal is stabilization ~    Flexibility ~    Individualized ~    Allow for relapse Smoking Cessation Pharmacotherapy ~    Replacement ~    nicotine patches ~    nicotine gum ~    nicotine lozenges ~    nic

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 mini

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