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August 17, 2019
417 -Communicating with the Cognitively Impaired Instructor: Dr. Dawn-Elise Snipes, PhD Executive Director: AllCEUs.com, Counselor Education and Training Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery Objectives ~ Define cognitive impairment ~ Explore symptoms of cognitive impairment in ~ Alzheimer’s ~ Dementias ~ Fetal Alcohol Spectrum Disorders ~ Review APA Treatment Guidelines for counselors working with persons with Alzheimer’s ~ Identify methods for effective communication ~ Learn how to handle difficult behaviors ~ Identify specific issues and interventions for a person with a FASD Symptoms of Cognitive Impairment ~ The development of multiple cognitive deficits manifested by both ~ (1) memory impairment (impaired ability to learn new information or to recall previously learned information) ~ (2) one (or more) of the following cognitive disturbances: ~ (a) aphasia (language disturbance) ~ (b) apraxia (impaired ability to carry out motor activities despite intact motor function) ~ (c) agnosia (failure to recognize or identify objects despite intact sensory function) ~ (d) disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting) Symptoms of Cognitive Impairment ~ Other Symptoms ~ Attention ~ Perception ~ Insight and judgment ~ Organization ~ Orientation ~ Processing speed ~ Problem solving ~ Reasoning ~ Metacognition Causes of Cognitive Impairment ~ Wernike-Korsakoff’s Syndrome ~ Vascular Dementia ~ Stroke ~ Impeded blood flow to brain ~ Alzheimers ~ Fetal Alcohol Spectrum Disorders ~ Brain Injury (Car accident, football, fall, boxing) ~ (Temporarily) Hyper or Hypo-glycemia Screening for Cognitive Impairment ~ The AD8 (PDF, 1.2M) and Mini-Cog(PDF, 86K) are among many possible tools. ~ Patients should be screened for cognitive impairment if: ~ The person, family members, or others express concerns about changes in his or her memory or thinking ~ You observe problems/changes in the patient’s memory or thinking ~ The patient is age 80 or older(12) ~ Low education (IQ, FASD, stroke…) ~ History of type 2 diabetes ~ Stroke ~ Depression ~ Trouble managing money or medications ~ Episodes of delirium (confusion/disorientation) Important Aspects of Management ~ Important aspects of psychiatric management include ~ Educating patients and families about ~ the illness ~ treatment ~ sources of additional care and support (e.g.,support groups, respite care, nursing homes, and other long-term-care facilities) ~ the need for financial and legal planning due to the patient’s eventual incapacity (e.g., power of attorney for medical and financial decisions, an up-to-date will, and the cost of long-term care) Important Aspects of Management ~ Behavior oriented treatments ~ Identify the antecedents and consequences of problem behaviors ~ Reduce the frequency of behaviors by changing the environment to alter these antecedents and consequences. ~ Stimulation-oriented treatments ~ recreational activity, art therapy, music therapy, and pet therapy, along with other formal and informal means of maximizing pleasurable activities for patients ~ Emotion-oriented treatments ~ supportive psychotherapy can be employed to address issues of loss in the early stages of dementia ~ Reminiscence therapy has some modest research support for improvement of mood and behavior ~ Tolerate, Anticipate, Don’t Agitate Communication ~ Written, oral, body language/signs ~ Let the client write, draw or speak to communicate ~ Use real objects when possible. (i.e. an apple) ~ Use picture books, posted lists ~ Story boards can be utilized to discuss a behavior incident ~ Use assistive devices when needed (glasses, hearing aids, large font) ~ Have spare reading glasses, hearing assistance (~$150) as people may misplace them ~ Get their attention ~ Orient them to who you are and why you are there ~ Establish rapport before jumping into “business” ~ Get the person’s attention by identifying her by name Communication ~ Us
August 16, 2019
416 -Supporting Clients on Medication Assisted Therapies Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Counselor Education Podcast Host: Counselor Toolbox, Case Management Toolbox, NCMHCE Exam Review CEUs at: https://www.allceus.com/member/cart/index/product/id/1123/c/ Objectives – Define MAT – Explore barriers to treatment What is Our Goal – Help people – Reduce symptoms of depression and anxiety – Agitation – Sleep disruption – Anhedonia – Fatigue – Feelings of worthlessness and guilt – Stay alive (not overdose or commit suicide) – Be relatively pain free (bidirectional with depression and anxiety) – Be independent – Improve interpersonal relationships – Be financially secure – Be “productive” members of society to their ability Goals – Pain, financial instability, lack of independence, poor relationships, mood disorders, low self-esteem, lack of effective coping skills are common in people addicted to opioids To Achieve This Goal – Clients must – Enter treatment – Stay in treatment long enough to: – Get through any PAWS syndromes caused by switching to MAT – Enable their neurotransmitters to balance out – Address biopsychosocial issues that trigger or maintain illicit drug use (SPACE) – Social – Physical – Affective – Cognitive – Environmental Question – Do you have biases towards clients who take antidepressants- Benzodiazepines- – Methadone is a serotonin re-uptake inhibitor – Buprenorphine is a partial agonist – Do you have biases toward clients who take opioids or gabapentin for chronic pain- – It is possible to develop physical dependence on gabapentin and experience withdrawal effects for up to 45 days Review of Terms – Agonists–medications that bind with the brain’s receptors and produce opioid-like effects (Methadone, morphine, fentanyl, heroin) – Partial agonists-medications that bind with given receptors and only produce limited opioid-like effects.(Buprenorphine) – Antagonists-medications that block receptors and prohibit opioid-like effects.(Naloxone) – Street and pain-killer opioids are “short acting” – MAT is “long acting” Benefits of MAT – Methadone does not create a pleasurable or euphoric feeling from mu-receptor activation – The medications used in MAT reduce cravings, prevent withdrawal and help normalize brain function so that you can focus on developing the healthy thought and behavior patterns that will sustain recovery. (SAMHSA, 2003) – MAT provides individuals a taper of long-acting opioid medications as a way to wean them off of stronger opioids such as heroin – A minimum of 12 months is required for methadone maintenance to be effective (NIDA, 2009). Benefits of MAT – Reduce overdose risk – Improve the chance of survival – Reduce the risk of relapse – Improve retention in treatment for an adequate period of time to address biopsychosocial issues – Employment – Pain – Other health issues – Relationship problems – Mood disorders (The correct SSRI takes up to 2 months to take effect) – Reduce criminal activities associated with substance use disorders – Reduce negative health outcomes, including HIV and hepatitis infection – Improve birth outcomes among addicted pregnant women Stigma – Stigma is typically a social process characterized by exclusion, rejection, blame or devaluation that results from an adverse social judgment about a person or group – The presence of stigma leads to ongoing discrimination and marginalization with detrimental effects for clients, families and communities including decreased self esteem, increased isolation and vulnerability, and a reduced likelihood of service access. – Associative stigma is the process of being s
August 13, 2019
415 -Relapse Prevention Groups for Addiction and Mental Health Disorders Part of the Co-Occurring Disorders Recovery Coaching Series Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Objectives ~ Define Relapse ~ Identify triggers and warning signs of relapse ~ Review Relapse Syndrome and possible interventions ~ Explore the acronym DREAM ~ Define and identify vulnerabilities ~ Define and identify exceptions ~ Develop a relapse prevention plan Types of Relapse ~ Emotional relapse ~ Mental relapse ~ Physical relapse ~ Behavioral Relapse Relapse Warning Signs ~ Emotional Cues ~ Anger and irritability ~ Anxiety ~ Depression ~ Resentment ~ Mood Swings ~ Boredom ~ Mental Cues ~ Negativity ~ All or none thinking ~ Concentration problems ~ Memory problems ~ Rigidity/Problem solving difficulties ~ Physical Cues ~ Sleep problems ~ Appetite problems ~ Medication noncompliance ~ Fatigue ~ Pain ~ Tension ~ Social Cues ~ Unhelpful friends ~ Isolation ~ Not asking for help ~ Secrets ~ Stop meetings/support groups/counseling Relapse Warning Signs ~ Discuss the above relapse warning signs ~ How they are rewarding ~ Best ways to address them Relapse Warning Signs and Triggers ~ Family Feud ~ Preparation ~ There are 4 questions for the first part of the game ~ Name the top 5 emotional relapse warning signs ~ Name the top 5 cognitive relapse warning signs ~ Name the top 5 physical relapse warning signs ~ Name the top 5 social relapse warning signs ~ Write the first letter of each word of the 5 warning signs to guide people (You can make your own warning signs if you want) Name the Top 5 Emotional Relapse Warning Signs Name the Top 5 Emotional Relapse Warning Signs Relapse Warning Signs and Triggers ~ Discussion ~ Have people identify the key questions to address each relapse warning sign ~ How are you feeling? ~ Why are you doing this/feeling this way? ~ Who can help you? ~ What 3 things can you do to change the situation or how you feel about the situation? ~ When will you do it? ~ As you discuss each warning sign, have clients fill out a worksheet with solutions for themselves Recovery Signals ~ Dot Chart (Bingo markers) 10 Most Common Triggers of Relapse ~ Withdrawal symptoms (anxiety, nausea, physical weakness, psychological withdrawal and craving) ~ Post-acute withdrawal symptoms (anxiety, irritability, mood swings, poor sleep) ~ Poor self-care (stress management, eating, sleeping) ~ People ~ Places (where you used or where you used to buy drugs) ~ Things (that were part of your using, or that remind you of using) ~ Uncomfortable emotions (H.A.L.T.: hungry, angry, lonely, tired) ~ Relationships and sex (can be stressful if anything goes wrong) ~ Isolation (gives you too much time to be with your own thoughts) ~ Pride and overconfidence (thinking you don’t have a drug or alcohol problem, or that it is behind you) Recovery Triggers ~ Recovery triggers are things that remind you to do the next right thing to keep moving toward your goals (Design plan (car, home, work)) ~ Mood (Happiness, compassion, gratitude, hope, optimism, courage, determination) ~ People (That inspire you to move forward and support and encourage you) ~ Sights (décor (dishes, pictures, blankets, pillows, framed memories), mobile device) ~ Smells (that trigger a recovery mood or remind you of a goal or to do something) ~ Sounds (That help you relax, get energized or focused) Goal Awareness ~ Recovery is about heading toward a happier, healthier life. ~ Define what that looks like ~ Relationships with… ~ Kids that trust and confide in me and want to spend time with me ~ Pets that are happy ~ Activities ~ Run a marathon ~ Foster rescue animals ~ Health ~ Have ample energy to get through the day ~ Be in good health ~ Things ~ Own my house ~ Be able to comfortably pay my bills Goal Awareness Worksheet PAWRS ~ Hot Potato/Beach Ball OR Small Group Work ~ First write the symptoms on the board and discuss what might cause these symptoms in recovery from depre
August 12, 2019
414 -5 Elements of Motivational Interventions & 5 Principles of Motivational Interviewing Instructor: Dr. Dawn-Elise Snipes, PhD Executive Director: AllCEUs.com, Counselor Education and Training Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery Objectives – Learn how motivation is dynamic – Explore reasons and methods for enhancing motivation – Identify 3 critical elements of motivation – Delineate the 5 elements of motivational approaches – Review the FRAMES model – Identify ways to deal with resistance – Review how to use decisional balance exercises Why Enhance Motivation- – Inspiring change – Preparing clients to enter treatment – Engaging and retaining clients in treatment – Increasing participation and involvement – Improving treatment outcomes – Encouraging a rapid return to treatment if symptoms recur – Creates a therapeutic partnership 6 Characteristics of Motivation – Motivation is positive and a key to change – Motivation “harnesses” energy to use to accomplish a task – What happens when you are not motivated– To clean, exercise, work 6 Characteristics of Motivation – Motivation is multidimensional • Emotional • Mental • Physical • Social Support and Pressures • Legal • Financial – Cube activity – #1 – On a large box identify all the reasons to NOT change on each face – Can include drawbacks to change and benefits to staying the same – Discuss ways to eliminate those drawbacks – #2 – Get small-ish square boxes for clients to decorate – On each face of the cube, have them identify motivations for change 6 Characteristics of Motivation – Motivation is multidimensional – Scale Activity – Get at least 10-20 regular marbles and 10 shooter marbles (bigger) – Get (or fashion a scale) One side is labeled “change” the other side is labeled “same” – Write on the white board 2 columns – Benefits to Staying the Same (and drawbacks to change) – Benefits to Change (and drawbacks to staying the same) – Have clients complete each list – Then talk about how some “reasons” carry more weight. – Bring out the scale and stones. – Have clients assign a “weight” to each reason and deposit it in the appropriate side – Goal is to see that it is about the total weight that tips the balance 6 Characteristics – Motivation is dynamic and fluctuating – Is a dynamic state that can fluctuate over time and in relation to different situations rather than a static personal attribute – Can vacillate between conflicting objectives – Differs between objectives – Varies in intensity, faltering in response to doubts and increasing as doubts are resolved and goals are envisioned more clearly. – Example: Getting Healthy – Nutrition – Exercise – Sleep – What conditions would make you motivated and what conditions would undermine your motivation- 6 Characteristics – Motivation is dynamic and fluctuating – SMART Goals increase efficacy – Specific – Measurable – Achievable – Relevant – Time Limited – Examples – Get healthy to reduce my risk of cancer – Lose weight to get my partner to pay attention to me Goal Setting Activities – Out of the Hat – Write goals on strips of paper and put them in a hat or box – Have clients draw a strip and restate the goal in specific, measurable, Achievable, Relevant and Time limited terms – The strip might say: Lose Weight – The client might say: Lose 10 pounds in 2 months so I am more comfortable in my clothes – The strip might say: Not be depressed – The client might say: Increase my overall happiness to a rating of 4 out of 5 at least 5 days per week in the next 8 weeks. – The strip might say: Improve my rel
August 9, 2019
413 -E-Therapy Ethics 2019 Dr. Dawn-Elise Snipes LMHC, LPC-MHSP Charles Snipes, CTO AllCEUs.com State Laws and Boards ~ State laws and Board regulations vary considerably ~ You must know the requirements for your license in the states in which you are licensed and/or certified ~ Independent practice ~ E-Therapy ~ Privacy laws and policies vary between states and entities. Ethical Codes and Etherapy ~ Guidelines for the Practice of Telepsychology American Psychological Association (APA) ~ The ACA 2014 Code of Ethics and Technology: New Solutions to Emerging Problems American Counseling Association (ACA) ~ ACA 2014 Code of Ethics Section H “Distance Counseling, Technology, and Social Media” ~ NBCC Policy Regarding the Provision of Distance Professional Services ~ ISMHO/PSI Suggested Principles for the Online Provision of Mental Health Services International Society for Mental Health Online (ISMHO) ~ NASW Standards for Technology in Social Work Practice Other Resources ~ TIP 60: Using Technology-Based Therapeutic Tools in Behavioral Health Services ~ HIPAA FAQs from HHS.gov Objectives ~ Identify differences between etherapy and face-to-face counseling ~ Discuss the pros and cons of etherapy ~ Discuss issues with client confidentiality ~ Explore issues related to boundaries, dual relationships and social networking ~ Review various ethical codes as they relate to etherapy ~ Dealing with disinhibition ~ Common ethical violations in etherapy Reasons/Benefits ~ Access experts on a particular problem in a greater area ~ More cost effective for the practitioner and the patient ~ More convenient ~ Wider range of available business hours ~ Provides a degree of anonymity ~ People are generally more open since they are in their comfort zone (home) ~ Many of the youth prefer etherapy ~ An adjunct to traditional therapy “Therapist Extenders” ~ Accessible with a DSL connection and a $15 webcam Drawbacks to Etherapy ~ Set-up takes some cost and technical know-how ~ You must be thoroughly familiar with HIPAA and HiTECH Act ~ There are a lot of HIPAA and HiTECH Act violations making etherapy seem less professional ~ Can be more difficult to handle crises and identify decompensation ~ Some argue that accurate assessments cannot be done virtually ~ All modes of etherapy can be captured and redistributed ~ In cases of domestic violence there are unique challenges ~ Not as effective with cultures that use high-context communication Monitoring ~ Technology/intervention usage rates ~ Demographic characteristics of clients ~ Retention and satisfaction rates ~ Staff satisfaction ~ Equipment malfunctioning rates/downtime ~ Costs of care and cost offsets ~ Rates of referral ~ Changes in symptoms Considerations for Appropriateness ~ Clients level of comfort, preference for and access to technology ~ Cognitive capacity and maturity ~ Past and current medical and behavioral health diagnoses including psychosis ~ Communication skills ~ Client’s support system ~ History of violence or self-injurious behavior Appropriate Clients ~ Diagnoses ~ Generalized anxiety disorder ~ Depression and postpartum depression ~ Obsessive compulsive disorder ~ Post Traumatic Stress Disorder ~ Seasonal Affective Disorder ~ Binge Eating Disorder ~ Substance Abuse Informed Consent ~ According to ISHMO and NBCC, all of the following must be part of the informed consent ~ The possibility of misunderstandings, particularly with text-based forms of E-therapy ~ Cultural and/or language differences that may affect delivery of services ~ The increased response time involved in asynchronous forms of communication and average response time ~ Time zone differences Informed Consent ~ According to ISHMO and NBCC cont… ~ Social media policy and the counselor’s right to privacy and the possibility of restrictions on the client’s use of any communication with the practitioner ~ Counseling credentials, physical location of practice, and contact information ~ Alternatives to receiving assista
August 2, 2019
Violence Prevention in the Workplace CEUs available at: https://www.allceus.com/member/cart/index/product/id/1082/c/ Dr. Dawn-Elise Snipes, PhD, LPC-MHSP Executive Director: AllCEUs Counselor Education Podcast Host: Counselor Toolbox, Case Management Toolbox Based in Part on – Registered Nurses’ Association of Ontario (2012). Managing and Mitigating Conflict in Health-care Teams. Toronto, Canada: Registered Nurses’ Association of Ontario. – Registered Nurses’ Association of Ontario (RNAO). Preventing violence, harassment and bullying against health workers. 2nd ed. Toronto (ON): RNAO; 2019. Objectives – Define types of violence in the workplace – Explore best practices for prevention Types of Violence – Type I (Criminal intent): perpetrator has no relationship to the workplace – Type II (Client or customer): perpetrator is a client at the workplace who becomes violent toward a worker or another client – Type III (Worker-to-worker): perpetrator is an employee or past employee of the workplace – Type IV (Personal relationship): perpetrator usually has a relationship with an employee (e.g. domestic violence in the workplace) – Type V (Worker-to-client): perpetrator is an employee who becomes violent towards a client Violence in the workplace – Involves a misuse of power and control and it may take the form of physical, psychological or sexual abuse; and/or harassment, mobbing, bullying, or aggression. – May involve action or withholding action. – May be done unintentionally or intentionally. – Often involves interactions between people in different roles and power relationships – Is inevitable in the work setting due to inherent differences in goals, needs, desires, responsibilities, perceptions and ideas Conflict Inevitability – Conflict is inevitable in work settings. – Perceived and actual differences that may contribute to conflict include: – Professional identity and/or education – Cultural identity – Gender and gender identity – Marital status – Disability – Work values – Goals – Interests – Treatment approach Other Factors Contributing To Conflict – Effects of shift work – Team composition and size – Workload and staffing – Role ambiguity – Manager span of control – Power differences – Level of staff involvement in decision-making and provision of care – Resource allocation – Diversity in the workplace – Physical space – Diagnoses/stressors in the person’s life Underpinnings of Violence Prevention – Leadership is required across all organizational levels to create environments that practice management and mitigation of conflict. – All conflict has a meaning and/or contributing underlying cause. – Anger is often a response to a threat of loss of control, rejection, isolation, failure, the unknown – Understanding, mitigating and managing conflict may result in positive outcomes such as new ideas and initiatives. – Conflict is addressed in different ways depending upon who the conflict is with Systems & Processes to Minimize Conflict – Regular assessments (clients, employees, team, org) – Improve emotional intelligence – Develop conflict management skills – Educate individuals, teams, and the organization regarding conflict management in specific settings and target groups. – OP, detox, CSU, Alzheimer’s, psychosis, home visits, SOs – Staff on staff; staff on client; client on staff – Implementing refresher courses and/or updates – Require managers to demonstrate accountability for effective conflict management, clear communication and transformational leadership Transformational Leadership – Leader works with teams to identify needed change and create a vision to guide the change – Highlighting important prioritie
July 31, 2019
411 -Cognitive Behavioral Interventions for PTSD CEUs available at: https://www.allceus.com/member/cart/index/product/id/1100/c/ Dr. Dawn-Elise Snipes, PhD, LPC-MHSP Executive Director, AllCEUs Counselor Education Podcast Host: Counselor Toolbox Podcast, Case Management Toolbox Podcast Objectives – Review the symptoms of PTSD – Explore interventions in the following areas – Cognitive: Including ACT, DBT and CPT – Behavioral: Including exercise, sleep, nutrition and relaxation PTSD Symptoms – Re-experiencing the traumatic event (Intrusion) – Intrusive, upsetting memories of the event – Flashbacks – Nightmares – Feelings of intense distress when reminded – Intense physical (panic) reactions to reminders – 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 PTSD 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 – Negative alterations in cognitions and mood – Inability to recall key features of the trauma – Overly negative thoughts and assumptions about oneself or the world – Exaggerated blame of self or others for causing the trauma – Negative affect – Decreased interest in activities – Feeling isolated What Happens in Trauma – When exposed to a stressor, the HPA-Axis and amygdala are activated and cortisol is released to trigger the fight or flight response – Sustained exposure to cortisol has an adverse impact on the hippocampus resulting in reduction of neurogenesis and dendritic branching – Blunted response to cortisol stimulation indicate that pituitary receptors in the HPA-Axis have been downregulated in patients with PTSD – Hypocortisolism in PTSD occurs due to increased negative feedback sensitivity of the HPA axis Neurochemical Effects of Trauma – Early adverse experience, including prenatal stress and stress throughout childhood, has profound and long-lasting effects on the development of neurobiological systems, thereby “programming” subsequent stress reactivity and vulnerability to develop PTSD – The hippocampus (learning and memory) and prefrontal cortex(impulse control and higher-order thought) mediate the HPA-Axis activity…but… – Reduced volume of the hippocampus, the major brain region inhibiting the HPA axis, is a cardinal feature of PTSD Neurochemical Effects of Trauma – Hypocortisolism is thought to be an autoimmune response. – Physical and psychological stress has been implicated in the development of autoimmune disease – Hypocortisolism may occur after a prolonged period of hyperactivity of the hypothalamic-pituitary-adrenal axis due to chronic stress – The phenomenon of hypocortisolism has been reported not only for people with PTSD, but also for healthy individuals living under conditions of chronic stress emotional and/or physical stress. – Hypocortisolism dysfunction at the time of exposure to psychological trauma may predict the development of PTSD. Neurochemical Effects of Trauma – Glucocorticoids (Cortisol) interfere with the retrieval of traumatic memories, an effect that may independently prevent or reduce symptoms of PTSD. – Therefore, hypocortisolism might be a risk factor for maladaptive stress responses and predispose to future PTSD or stress-related bodily disorders. – Simulation of a normal circadian Cortisol rhythm using exogenously introduced hydrocortisone is effective in the treatment of PTSD. Neurochemical Effects of Trauma – Core
July 25, 2019
Mental Health Aspects of Bariatric Surgery Objectives – Learn about bariatric surgery – Explore reasons for the surgery and increase in popularity – Identify the psychosocial outcomes of bariatric surgery – Identify common presenting issues in persons seeking bariatric surgery – Explore current recommendations for assessment protocols and presurgical preparation for bariatric surgery – Identify postoperative mental and physical health issues which may occur and need to be addressed Types of Bariatric Surgery – Bariatric surgeries all aim to make the stomach smaller so it can hold less food through removal, banding or bypassing. – Some surgeries also bypass part of the small intestine which inhibits calorie as well as nutrient absorption – Long-term weight loss is associated health improvements – Concerns have been raised about potential ongoing risks of mental health disorders, including substance abuse, self-harm and suicidality, especially following bariatric surgery. In this meta-analysis, surgery was not associated with an improvement in mental health quality of life. Two main hypotheses have been proposed to help explain these findings: (a) patients who choose to undergo bariatric surgery are at a higher baseline risk of psychiatric complications than their non-surgically managed counterparts, or (b) surgery itself increases the risk for adverse mental health outcomes due to potential post-operative issues such as difficult with pain control, complications requiring further treatments, dissatisfaction with weight loss, and weight regain. Therefore, intensive mental health follow-up post-surgery should be routinely considered. Mental health quality of life after bariatric surgery: A systematic review and meta-analysis of randomized clinical trials Reasons for Bariatric Surgery – There has been an increasing amount of evidence for bariatric surgery as a more effective treatment for morbid obesity compared to dietary advice, exercise, lifestyle changes and medication. In particular,the procedure is more effective in achieving significant weight loss, longer term maintenance, improvements in physical co-morbidities and reductions in mortality – Obesity and Cancer Fact Sheet – Obesity and Eating Disorders Fact Sheet – Obesity and Heart Disease Fact Sheet – Obesity and Hypertension Fact Sheet – Obesity and Lipid Issues Fact Sheet – Obesity and Osteoarthritis Fact Sheet – Obesity and Stroke Fact Sheet Bariatric Surgery Outcomes – Health and Health-Related Quality of Life Improvement – Bariatric surgery is associated with sustained weight loss and improved physical health status for severely obese individuals. Mental health conditions may be common among patients seeking bariatric surgery. Mental Health Conditions Among Patients Seeking and Undergoing Bariatric Surgery: A Meta-analysis – 20-30% of patients undergoing bariatric surgery experience premature weight stabilization or weight regain postoperatively. Cognitive behavioral therapy and predictors of weight loss in bariatric surgery patients. – Mental Health Related Quality of Life Improvement – mood often improves in the immediate aftermath of surgery, psychiatric disturbances often re-emerge within two to three years. These patients were almost three times more likely to attempt suicide than a general population – Another study by Bhatti et al., 2016 looked at self-harm emergencies, including suicide attempts and found that these increased by 50% after RYGB – De Zwaan et al investigated the course of anxiety and depressive disorders over the first 2 years post surgery in 107 extremely obese bariatric surgery patients using face-to-face interviews conducted before surgery and after surgery. Although prevalence of depressive disorders decreased significantly immediately after surgery, participants with both depressive a
July 17, 2019
Enhancing Healthy Adolescent Development Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast, Case Management Toolbox Podcast Objectives – Identify the developmental tasks of adolescents and what can be done to facilitate those – Review unique points to remember when dealing with adolescents – Identify protective factors – Identify antecedents to high risk behaviors – Brainstorm ways to address antecedents with the individual, in school, in communities and in families Developmental Tasks of Adolescence Points to Remember – Adolescents are competent individuals with strengths and potential – Adolescents are diverse in their developmental stages and their abilities to comprehend and respond to specific tasks and expectations. – Adolescent behavior is meaningful to the adolescent. – Adolescents desire a sense of belonging, wish to participate in decisions, and have a voice about issues that affect their lives. – The context of an adolescent’s environment (i.e. family, school, peers, culture/ethnic group, neighborhood and community) should always be considered. Points to Remember – Build on adolescent’s strengths – Much of the morbidity and mortality during adolescence is related to unhealthy or risky behaviors (e.g. smoking, drinking and driving, unprotected sex, drug use, violence) – Adolescents who engage in one risky behavior are more likely to engage in others – Focus on the antecedents of high-risk behavior instead of the behavior itself Antecedents to High Risk Behaviors – Adverse Childhood Experiences – Abuse, neglect or victimization—Experienced or witnessed IPV – Divorce and separation – Mental health or substance abuse issues in the household – Undiagnosed learning disabilities – School failure – Academic failure was a greater risk factor for later adolescent drinking than adolescent drinking was for later academic failures Addressing Antecedents Adolescent Brain Development – The brain matures from “back” to “front. ” Adolescent decision-making behaviors are more influenced by the amygdala than the prefrontal cortex: – Decision-making is influenced by emotional/gut responses vs. higher order cognitions – The pre-frontal cortex is responsible for planning, strategizing, judgment, impulse control and regulation of emotions – Initial “growth spurt” at 11-12 years and continues through 25 years – From 12-12 there is a pruning process of unused neuronal connections – The temporal gap between the development of the socio-emotional and cognitive control systems of the brain underlies some aspects of adolescent reckless behavior and risk-taking Comprehensive Health – Healthy young people learn better and achieve more. – Schools can directly influence students’ health and behaviors. – Schools and communities can encourage healthy lifestyle choices, and promotes adolescent health and well-being. – Health literacy can be incorporated into all aspects of school as well as recreation – Schools, families and communities need to collaborate with youth to develop workable strategies Strategies – Enhance cognitive “wise mind” processing during adolescence to retain those synapses – Actively engage youth by providing opportunities for meaningful participation and sustained involvement in protective activities – Develop resiliency skills – Enhance protective factors Protective Factors – Family support – Positive family communication – Clear and consistent boundaries and expectations – Other adult relationships – Encouragement to develop relationships – Connection to the family, school and community – Youth are provided opportunities to be useful resources (meaningful participation) – Youth feel emotionally an
July 12, 2019
408 -Ethics, Burnout & Self Care in Human Service Professions Dr. Dawn-Elise Snipes, PhD, LPC-MHSP Counselor Toolbox Podcast Objectives – Identify signs and causes of burnout – Explore techniques for burnout prevention Is Self Care an Ethical Issue – Burnout is associated with suboptimal care and reduced patient safety. 1, 3, 4 – High demands are associated with greater risk of burnout, regardless of level of other work supports. 2 – Suboptimal care can negatively impact the public’s view of the profession and deter people from seeking treatment – 26% of MAT counselors in one study reported burnout – Depersonalization is characterized by loss of empathy and Your Brain on Stress – Even mild acute uncontrollable stress can cause a rapid and dramatic loss of prefrontal cognitive abilities. – Prolonged stress exposure –> Anatomical changes in prefrontal nerve cells and amygdala enlargement – Focus, Attention – Self Control of Behavior and Speech – Plan and Organize – Perspective Taking – Cognitive Flexibility – Medical and other Decision Making – Ability to Defer Gratification – Estimating Time – Working Memory Ethics – In 1996, the National Association of Social Workers updated the NASW Code of Ethics to cover issues of professional impairment (section 4.05). – Social workers should not allow personal problems, psychosocial distress, or mental health difficulties to interfere with their professional judgment, performance, or responsibilities to clients – Social workers who experience these problems should “immediately seek consultation and take appropriate remedial action” by seeking professional help, making adjustments in workload, terminating practice, or taking any other steps necessary to protect clients and others” – Social workers with direct knowledge of another social worker’s impairment should, when feasible, consult with and assist the social worker in taking remedial action Signs of Burnout – Physical and emotional exhaustion – Insomnia – Impaired concentration or memory – Physical symptoms (heart palpitations, HBP) – Appetite changes – Increased illness – Increases in depression and/or anxiety – Absence of positive emotions – Cynicism and disillusionment – Lack of patience – Lack of resilience (everything is a crisis) – Relationship deterioration – Substance abuse – Forgoing important personal activities Malasch Burnout Inventory – The Maslach Burnout Inventory (MBI) is the most commonly used self assessment tool for burnout – The MBI explores three components: Exhaustion, depersonalization and personal achievement. – MBI pdf C. Maslach, S.E. Jackson, M.P. Leiter (Eds.), Maslach Burnout Inventory manual (3rd ed.), Consulting Psychologists Press (1996) – Abbreviated MBI from SAMHSA Causes of Burnout – Excessive workload – Emotionally draining work – Lack of support – Lack of resources – Lack of rewards – Lack of a sense of control/say – Unclear or everchanging requirements – Severe consequences of mistakes – Work/life imbalance – Perfectionistic tendencies; nothing is ever good enough – Pessimistic view of yourself and the world – The need to be in control; reluctance to delegate to others – High-achieving, Type A personality – Poor work/person fit – Value conflicts – Lack of debriefing (See Restoring Sanctuary by Sandra L. Bloom) – Unpleasant environment – Cultural differences Burnout and Difficult Clients Reactions to Difficult Patients – Anger that you have to see the client when there are other people who WANT help you could be seeing – Guilt that you truly dislike the client – Fear that you will not be able to deal with the problem – A
July 11, 2019
407 -Understanding the Autism Spectrum Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free weeks of TherapyNotes with coupon code “CEU” CEUs available at: https://www.allceus.com/member/cart/index/product/id/1079/c/ Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LPC Executive Director, AllCEUs Host: Counselor Toolbox Podcast Objectives – It is called a “spectrum” disorder because people with ASD can have a range of symptoms Symptoms – Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history – Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions. – Direct communication – Honesty – Nonjudgmental listening – Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication. – They often think in pictures or video Symptoms – Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history – Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in  sharing imaginative play or in making friends; to absence of interest in peers. – Less concern for what others may think of them can make them more independent thinkers – Difficulty recognizing and processing the feelings of others, “mind-blindness” which may result in the inability to identify if another person’s behaviors are intentional or unintentional which can cause others to believe that the individual with autism does not have empathy or understand them. OR – A fantastic ability to “read” people (Fiona and Sherlock “Elementary”) Symptoms – Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text): – Stereotyped or repetitive motor movements, use of objects, or speech (hand-flapping, rocking, jumping and twirling, arranging and rearranging objects and repeating sounds, words or phrases. Sometimes the repetitive behavior is self-stimulating, such as wiggling fingers in front of the eyes) – Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day). – Some individuals pay attention to minor details, but fail to see how these details fit into a bigger picture. – Others have difficulty with complex thinking that requires holding more than one train of thought simultaneously – Others have difficulty maintaining their attention or organizing their thoughts and actions. Symptoms – Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text): – Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest). – Attention to detail – Often highly skilled in a particular area – Deep studying resulting in encyclopedic knowledge – Hyper- or hy
July 6, 2019
406 -Biopsychosocial Impact of Addiction and Mental Disorders on the Individual Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counseling Education Podcast Host: Counselor Toolbox Objectives – Examine the biological (physical) impact of addiction and mental health issues on the individual – Examine the psychological impact of addiction and mental health issues on the individual – Examine the social impact of addiction and mental health issues on the individual – Identify interventions in each area. Biological Impact of Mood Disorders – Caused by an imbalance of: – Serotonin (Calming/balancing) – GABA (Calming) – Glutamate (Excitatory) – Norepinepherine (Excitatory) – Dopamine (Pleasure) Biological Impact of Mood Disorders – Effects – Disrupted sleep – Fatigue – Irritability – Nutritional changes – Increased muscle tension – Reduced pain tolerance – Gastrointestinal disturbances Biological Impact of Addictions – Direct (neurotransmitter imbalances) – Tolerance – Withdrawal Neurotransmitters, Addiction & Black Friday – Normal day – Normal store capacity is 750 people. – The store needs a constant 500 to stay open – The store has 8 doors to allows for people to easily enter and exit without getting “bunched” – Black Friday – 1500 people push through the door as soon as it opens – Store is destroyed – Staff is exhausted – Takes time to restock and refresh staff – Management closes all but two doors and adds security guards to manage flow Biological Impact of Addictions – Indirect – Reduced Immunity – More rapid aging – Sleep difficulties – Nutritional deficits – Reduced pain tolerance & Increased pain – Disease (Hepatitis, HIV, TB, MRSA) The Brain Under Stress Biological Impact of Alcohol – Alcohol – Heart damage – High blood pressure – Fatty liver – Hepatitis – Cirrhosis – Pancreatitis – Cancers of the mouth, throat, liver and breast – Reduced immunity – Brittle bones Biological Impact – Alcohol – Brain damage through: – The toxic effects of alcohol on brain cells – The biological stress of repeated intoxication and withdrawal – Alcohol-related cerebrovascular disease – Head injuries from falls sustained when inebriated. – Alcohol related birth defects (FASD) Biological Impact – Alcohol – Nutrient deficiencies: – Vitamins: A, E, D, K,B12, folic acid, thiamine – Thiamine deficiencies, which cause severe neurological problems such as impaired movement and memory loss seen in Wernicke/Korsakoff syndrome (memory disorder often seen in Alzheimers) – Calcium – Iron (intestinal bleeding) – Dehydration Biological Impact of Caffeine – Negative – Stimulant/jitters – Increased blood pressure – Heart palpitations – Heartburn/Diarrhea – Disrupted sleep – Dehydration – Miscarriage – Osteoporosis – Positive (with moderate intake) – Lower risk of Alzheimer's and dementia – Decreased suicide risk – Increased endurance – Decreased risk of oral cancer Biological Impact of Nicotine – Nicotine (including gums and vapors) – Highly addictive – Activates neurotransmitters – Pain and anxiety relief – Reduced appetite – Respiratory irritation – Increased heart rate and blood pressure – Hyperglycemia – Decreased immune response – Increased oxidative stress (which leads to cancer) – Increased risk of diabetes Biological Impact of Marijuana – Positive – Altered senses – Hallucinations – Nausea reduction – Pain management (3 puffs a day) – Improved sleep Biological I
July 4, 2019
405 -Social Work Considerations for Addressing Chronic Conditions Dr. Dawn-Elise Snipes Counselor Toolbox Podcast CEUs can be earned for this presentation at https://www.allceus.com/member/cart/index/product/id/1078/c/ ~ Chronic conditions such as diabetes, arthritis, chron's disease, and depression Introduction ~ 60% of people in the US have a chronic illness ~ Many serious illnesses have a much longer course with episodes of exacerbations and remissions ~ Chronic Illness can be highly stressful for patients and families ~ Care for people with chronic illnesses is increasingly done by family in the home. ~ Untreated mood disorders in individuals with co-morbid chronic health conditions increases morbidity and mortality rates and reduces the capacity for self-management Biopsychosocial Impact of Chronic Conditions ~ Sleep ~ Pain ~ Medication side effects ~ Fatigue ~ Circadian rhythm disruption ~ Physical changes (weight changes, ports, pumps, hair loss) ~ Loss of mobility ~ Depression ~ Anxiety ~ Anger ~ Grief/Adjustment ~ Jealousy or resentment ~ Irritability ~ Withdrawal ~ Self Esteem changes ~ Loss of social support ~ Smothering social support ~ Inability to engage in prior important activities ~ Loss of independence ~ Vocational problems ~ Financial hardships (Medical expenses, job loss, environmental modifications) ~ Access to nutritious food ~ Physical, sexual and emotional relationship problems Goals of Chronic Care Models ~ Shift from acute, episodic treatment to one of ongoing proactive care ~ Emphasizes ~ Prevention (getting worse, developing other conditions) ~ Patient’s role in managing health with mutual goal setting and action planning (self-management) ~ The goal of self-management interventions are to: ~ Improve knowledge about the condition and intervention options ~ Increase confidence in the ability to change ~ Leverage what he or she can do to promote personal health (prevention) Goals of Chronic Care Models ~ The goal of self-management interventions are to ~ Improve motivation and problem solving rather than simple compliance with a caregiver’s advice ~ Help the participants’ master six fundamental self-management tasks: ~ Solving problems ~ Making decisions ~ Using resources ~ Forming a patient -provider partnership ~ Making action plans for health behavior change ~ Self-tailoring Categories of Interventions (FRAMES) ~ Self Management Support ~ Feedback ~ Develop collaborative relationships ~ Use an ask-tell-ask framework with clients and caregivers ~ Responsibility ~ Ability and motivation for self-management fluctuates. Tailor interventions appropriately (symptom exacerbations, med changes, life changes…) ~ Advice ~ Use education and scaffolding to empower clients to adjust their behaviors and take control of health self-management ~ Menu of Options depends on individual circumstances, and resource availability ~ Empathy and Encouragement ~ Self-Efficacy “5 A’s” of Behavioral Change ~ Assess ~ Advise/engage ~ Agree/collaborate ~ Assist/identify obstacles and interventions (treatment) ~ Arrange for follow up (evaluate/review) Categories of Interventions ~ Assess ~ Regular assessment and enhancement of motivation and readiness for self-management ~ Ongoing Biopsychosocial Assessment (including quality of life and a Health Risk Appraisal (HRA) ~ An HRA is a systematic approach to ~ Collecting information about risk factors ~ Providing individualized feedback ~ Linking the person with at least one intervention to promote health, sustain function and/or prevent disease Categories of Interventions ~ Advise: ~ Multimodal education about the condition and treatment options ~ Teach self-monitoring for clients and caregivers ~ Families and clients are educated about ~ The illness ~ What to expect from a family member who has the illness ~ How they can best help ~ How to take care of themselves Categories of Interventions ~ Agree and Assist (Collaborate) ~ Engage through goal directed counseling and conferences
June 29, 2019
NCMHCE Exam Review Crisis Assessment Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director AllCEUs Host: Counselor Toolbox Podcast and NCMHCE Exam Review Podcast CEUs are available for this presentation at https://www.allceus.com/CE/course/view.php?id=1414 Objectives ~ Review crisis theory and the varying types of crises ~ Describe the stages of crisis ~ Identify the features of a general crisis assessment ~ Differentiate between a crisis and suicide assessment ~ Identify factors associated with a high risk of suicide ~ Review legal and ethical responsibilities (Tarasoff and Bellah vs. Greenson ~ Explore prevention and intervention strategies Crisis Definition ~ Crisis involves ~ A pivotal moment in which a decision must be made which involves facing both peril and promise (Echterling, 2005) ~ “People are in a state of crisis when they face an obstacle to important life goals—and obstacle that is, for a time, insurmountable by the use of customary methods of problem-solving.” (Caplan, 1961) ~ Symptoms of crisis: ~ Emotional distress ~ Physical distress/stress response ~ Cognitive disruption (concentration, problem solving, memory) ~ Behavioral changes Basic Human Needs (CHARGES) ~ When a basic human need has been impacted, it may prompt a crisis ~ Maslow: ~ Air, water, food, sleep, shelter, medical care, safety, love and belonging ~ Elliot (CHARGES) ~ Connection to something bigger than one’s self or a system of meaning to help us understand the world ~ Health and biological needs ~ Acceptance (love and belonging) ~ Relationships (intimate) ~ Goals and Purpose (Identity) ~ Efficacy/Control ~ Safety Types of Crisis ~ Situational crises are not anticipated and usually outside a person’s control ~ Physical (accident, illness, prematurity, birth defects) ~ Interpersonal (death of a person or pet, abuse, divorce) ~ Financial/Environmental/Material (Job loss, Foreclosure, House fire, hurricane, burglary, stock market crash, not getting accepted to …) Types of Crises ~ Cultural/Societal ~ Individuals have less control over these due to the fact that they are perpetuated by the action or inaction of others ~ Political unrest, discrimination and stigma related to gender, race, sexual orientation, violence Types of Crisis ~ Maturational ~ Normal developmental changes produce developmental crises (see Erikson), however, when these crises overwhelm a person’s ability to cope, they may prompt a mental health crisis. ~ To successfully resolve developmental crises, people need support, energy and safety. ~ Examples: Child to adult, empty nest, retirement, child birth, marriage… Types of Crisis ~ Normal developmental reaction or mental health issue? ~ *Determine which symptoms are expected reactions to a normal developmental transition vs. a sign of an emotional or mental health issue ~ Adjustment disorder with depressed mood, anxiety, both or behavior disturbances is conditional upon a particular situation, a life change or a stressor of some sort that precipitates the event ~ Carefully differentially diagnose between adjustment disorder, anxiety, depression, PTSD and personality disorders. ~ Normalize expected reactions to developmental transitions Types of Crisis ~ Normal developmental reaction or mental health issue? ~ The symptoms of adjustment disorder with disturbance of conduct can include: ~ Behaviors that are outside the norms of society ~ Actions that violate the rights of others ~ Outbursts of anger ~ Attempts at revenge ~ Substance use or abuse ~ Emotionality/mood swings that are acted upon Factors Affecting the Response ~ Demographics (DARES) ~ Age ~ Religion ~ Ethnicity ~ Situational and social supports ~ Perception of the event– How does it impact (BASIC) ~ Biological necessities ~ Acceptance and belonging ~ Similarity to prior traumas or crises ~ Interpretation/world view ~ Control (sense of) ~ Available coping (CRAP) ~ Crises in the past 6-12 months ~ Resources ~ Addiction ~ Psychiatric Stages of Crisis ~ The eve
June 28, 2019
Teaching Psychological Flexibility Dr. Dawn-Elise Snipes Executive Director, AllCEUs Counselor Education Host: Counselor Toolbox Podcast CEUs are available at allceus.com and Australia.allceus.com Objectives – Define psychological flexibility – Explore how to apply psychological flexibility – Identify the shortcut question What is Psychological Flexibility – The willingness to: – accept things as they are in the moment – make a conscious choice to act – purposefully choose behaviors, thoughts and feelings that move them toward a rich and meaningful life—as they define it. Step 1 – Define what a rich and meaningful life looks like Describe Destination Happiness Values & Goals – Clarifying (collage) – Relationships: Who is most important to you- – Which people- – What do you want those relationships to be like- – Under the picture of the person, on a post-it note identify 5-10 ways to realistically create that relationship. – Beneath that, on another post-it note, identify anything about that person or relationship that causes you distress or unnecessarily drains your energy (criticism, lack of responsiveness) and what you can do about it. Describe Destination Happiness Values & Goals – Clarifying (collage) – What events, things, experiences are meaningful to you- – Work, Health, & Personal Growth – Under the pictures identify what aspects of Work, Health, & Personal Growth are important (accomplishment, money, camaraderie, helping others, mental stimulation/creativity…) and what you can do to ensure that work is using your energy for happiness – Under that identify aspects of Work, Health, & Personal Growth that cause you distress or unnecessarily drain your energy and how you can better use your energy to address it (let it go, accept it, have compassion, check your interpretation (CDs), address the issue, transfer…) (cranky co-worker; helicopter/critical boss) Describe Destination Happiness – Clarifying Values – What values do I want to embody (Choose 4 and write them on the top, bottom and sides of your collage)- Step 2: Visualize options – Like a cell phone battery, you only have so much energy… you have to decide how you are going to use it to achieve your goals for the day. – Mindfulness: At 4am I have 100% charge. – Goal: My battery needs to last from 4am until 6pm and allow me to monitor my heart rate at the gym, listen to music at the gym, make calls if needed, get directions if needed, receive text messages from my kids – Brightness – Music (screen on or off) – Videos – Apps (Garmin, Polar, chat apps, email*, research* etc.) Psych. Flex.to Reach Destination Happiness Psych. Flex.to Reach Destination Happiness AWAY Thoughts and Feelings – All feelings are normal. It is what you do with those feelings that can be harmful. – Think of an emotion like the smell of dog poop. – When you smell it, you get up to check if the dog crapped in the house. If not, you chalk it up to gas and go about your day. If you find dog poop, you don’t just get angry and leave it there. You do something about it or it will make the whole house stink. – Negative emotions are like the dog poop of the soul. If you don’t address them, they will permeate your whole being and repel others. AWAY Thoughts & Feelings Questions – What thoughts do you regularly have that keep you from being happy- (make a list/keep a journal, so you can start addressing them. Include your inner critic’s commentary) – When you get angry, what thoughts do you have that keep you stuck in the quicksand of anger- – Remember resentment, jealousy, envy and guilt are all forms of anger. – When you are sad or grieving what thoughts do you have that keep you stuck- – When you are anxious/afraid what thoughts do you have that keep you stuck- – When you are l
June 27, 2019
Addressing Childhood Obesity Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast CEUs are available at allceus.com and Australia.allceus.com Objectives – Learn about the effects of obesity on health – Identify best practices for addressing obesity in childhood Clinician Functions – Engage – Children – Caregivers – Communities (task forces, county commission committees) – Assess – Risk factors – Barriers – Motivations – Set SMART Goals at the individual, family and community level Clinician Functions – Implementation of goals – Monitoring – Risk factors – Protective factors – Evaluation – Engagement – Goal achievement Why do We Care- Impact of Obesity – Physical Health – Increased risk of becoming an adult with obesity – Glucose intolerance and insulin resistance – Type 2 Diabetes – Multiple cancers – High blood pressure – High cholesterol – Adult heart disease – Low testosterone (males) – Polycystic Ovarian Syndrome – Endometriosis – Asthma – Sleep apnea – Joint problems – Gastric Reflux – Non-Alcoholic Hepatitis – Back pain – Mental Health – Anxiety and depression – Low self-esteem – Lower perceived quality of life – Being bullied – Stigma – Discrimination Assess – Use established guidelines to routinely assess children’s – Health literacy – Nutrition – Sleep – Physical activity/Sedentary behavior – Mental Health – Coping Skills – Self-Esteem – Pediatrician, school counselor/social worker, school nurse/health teacher, preschool teacher, caregiver Assess – Assess the risk factors in the environment – Parenting/primary caregiver influences – Conditions that promote sedentary or less active lifestyles—Reliance on cars, increased time watching t.v. or on computers – Time and financial constraints that can adversely affect caregivers’ ability to provide healthy food options – Overconsumption of high-fat, high-calorie foods – Biology and genetics – Breastfeeding for less than 6 months – Lack of sufficient sleep Assess – Assess the risk factors in the environment – Parenting/primary caregiver influences – Caregiver mental illness, especially depression – Lack of modeling positive nutrition and movement – Lack of knowledge about nutrition or cooking – Coercive clean your plate rules – Mindless eating (with television on etc.) – Over-normalizing growth-related weight gain – Caffeine consumption during pregnancy Assess – Assess the risk factors – Individual influences – Rewarded behaviors – How can good nutrition be made rewarding: Cooking tasty foods, making palatable snacks available – How can exercise be made rewarding: Play with the dog, parks, trampolines – Interests – Geocaching, Pokémon go, martial arts, X-box/wii etc. – Unsupervised time – Peer values Assess – Assess the risk factors – Individual influences – Health – Genetics – Hypothyroid – Diabetes – Yo-yo dieting – 80% of 10 year olds have been on at least 1 diet – Insufficient sleep Assess – Assess the risk factors in the environment – Sociocultural factors – Income and social status – Social support network to reduce stress, increase supervision, activities and availability of healthy food – Affordability of healthy foods—Connect with sources of healthy food, community gardening – Food marketing (media) and distribution (portions) Engage – Collaborate with school leaders to address risk factors that influence childhood obesity, including: – Student
June 19, 2019
Helping Parents of Children with Autism Better Engage and Communicate with Their Children Objectives – Move from a deficits based to a differences based approach to interaction – Describe the unique interpersonal needs of people with autism spectrum disorders – Identify characteristics necessary to form secure attachments – List at least 5 practices that caregivers and teachers can use to improve connection with children on the autism spectrum. CEUs are available at https://www.allceus.com/member/cart/index/product/id/1076/c/ Think of a time – You were totally overstimulated (Laguardia, wedding) – You were exposed to high levels of sensory input (concert, cologne, O2B) – You had something wrong, but couldn’t seem to explain it (Car, computer, overwhelmed but don’t know why…) – Did you feel safe- – What was your mood- – How was your concentration- – What were your thoughts- Secure Attachment/Connection – Helps people feel safe and loved. – Requirements (CRAVES) – Consistency in routines and expectations – Responsiveness (mirror and soothing) – Knowing child’s distress triggers and cues – Providing early intervention – Accommodating the child’s learning style & environmental preferences – Attention – Praise the positive / UPR – Validation of feelings, thoughts and needs – Empathy – Solutions: Identify ways to prevent and mitigate distress Special Needs – Language and speech – Slow speech development or not talking at all – Trouble or inability to start a conversation (or to keep it going) – Constant repetition of certain words or phrases – Difficulty expressing (communicating) one’s desires or needs – Failing to understand humor and taking things too literally – Using single words when communicating – Failing to understand simple questions or sentences or slow processing Special Needs – Social Interactions – Failing to understand and respect other people’s personal space – Difficulty understanding other people’s gestures, body language, reactions, and feelings – Not responding to one’s name being called – Lack of desire to interact with other people – Difficulty making friends with kids of the same age – Avoiding eye contact – Not enjoying situations and events that kids usually love – Not showing interest in other people’s interests Special Needs – Behavior – Repetitive movements (stimming) – Being obsessively interested in one area or topic – Playing with toys in a repetitive way (for example, lining the blocks all the time instead of building with them) – Insisting on a certain familiar routine or order – Unusual sensory manifestations (like sniffing toys or people) – Being hypersensitive to certain textures, sounds, or light – Being sensitive to touch and reacting negatively to it Skills – Focus on the positive. Praise what is good. Be specific. Praise not only behaviors, but also who they are. – Use positive discipline and redirection (Tearing paper) – Stay consistent and on schedule – Have routines to ease transitions (vibrating notifications) – Take your child with you during everyday activities – Select playmates with similar language and physical skills. – Invite only one or two friends at a time at first, and have a zero-tolerance policy for hitting, pushing and yelling. – Encourage your child to play, and reward good behaviors often and immediately. – Role play or use Comic Strip Conversations to help the child learn the social rules that others learn more naturally. Bubbles representing a conversation can bump into or overlap one another to illustrate “interrupting” and “thought” bubbles can show others' thoughts during conversation Skills for ASD & ADHD &#
June 13, 2019
Behavioral Health Services for American Indians and Alaskan Natives SAMHSA TIP 61 Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counseling Education Host: Counselor Toolbox Podcast CEUs are available at: https://www.allceus.com/member/cart/index/product/id/1114/c/ Objectives – Addiction and mental health professionals will improve their understanding of: – American Indian and Alaska Native behavioral health. – The importance of cultural awareness, cultural identity, and culture-specific knowledge when working with clients from diverse American Indian and Alaska Native communities. – The role of native culture in health beliefs, help-seeking behavior, and healing practices. – Prevention and treatment interventions based on culturally adapted, evidence-based best practices. – Methods for achieving program-level cultural responsiveness, such as incorporating American Indian and Alaska Native beliefs and heritage in program design, environment, and staff development. Factoids – 22% of AI/AN live on reservations. 60% live in urban areas – There are more than 200 tribes in Alaska. – The term “Eskimo” is considered derogatory – Health solutions come from within the community using local models – 25% of AI/IN live in poverty in comparison with 13% of the general population – Fewer than 50% of AI/AN women who experience violence report it, and of those only 10%-40% of cases are ever prosecuted. Factoids – Education protects against substance abuse, depression, suicidality, and other behavioral health problems for American Indians and Alaska Natives, as well as for other populations, yet they are less likely than the general population to graduate – AI/AN typically define family as extending beyond the nuclear unit – About half of American Indian and Alaska Native households include members of the extended family, and one-quarter include people who are not directly related. – About 30 percent of American Indian and Alaska Native families are headed by single mothers. Grandparents also often raise children Factoids – Not all native cultures are the same. Similarities exist, but each nation may have its own beliefs and traditions – AI/AN are less likely to drink than White Americans; however, those who do drink are more likely to binge drink and to have a higher rate of past-year alcohol use disorder than other racial and ethnic groups. – AI/AN experience anxiety disorders at a higher rate than other Americans – Native youth have a much higher suicide rate than youth or adults of other races more than double those for the U.S. population – Suicide and suicide attempts among young men ages 15–24 account for nearly 40 percent of all suicide deaths among natives. Factoids – Likely reasons for today’s high rates of substance use, suicide, and domestic abuse among AI/AN are that their communities are exposed to a greater degree to the same risk factors that are predictors of problems for everyone: Poverty, unemployment, trauma (including historical trauma), and a loss of cultural traditions. – Maintaining ties to one’s culture can help to prevent and treat substance use and mental disorders – Among many Native Americans, substance use and mental disorders are not defined as diseases or character flaws. They are seen as a symptom of an imbalance in the individual’s relationship with the world. Historical Trauma – One of those causes of imbalance stems from wide spread abuses and injustices experienced by AI/AN – Loss of their communities – Loss of life – Loss of freedom – Loss of land – Loss of self-determination – Loss of traditional cultural and religious practices – Practicing many cultural traditions was illegal for AI/AN from 1878 until 1978. – Loss of native languages – The removal of children from their families
June 8, 2019
Using Groups to Address Anger, Anxiety, Depression and Addiction Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director: AllCEUs.com Host: Counselor Toolbox Podcast Purchase CEUs at: https://www.allceus.com/member/cart/index/product/id/1112/c/ Objectives – Review the benefits of groups – Identify the modalities for group – Discuss goals for psychoeducational and skills groups addressing anger, anxiety, addiction and depression – Explore activities that can be used to enhance group engagement Benefits of Group – Cost effective – Peer feedback and support – Development of interpersonal skills – Reduce isolation and “uniqueness” – Many observers Modalities for Group – Face-to-face – Web-meeting – Video with or without breakout rooms – Chat – Asynchronous – Psychoeducational/skills video – Group participation by responding to questions on a discussion board and receiving feedback from group members and the clinician – HIPAA, HITECH and 42 CFR Part 2 all apply Commonalities – Low self esteem – Cognitive distortions – Emotional dysregulation – Poor Interpersonal Skills – Fear of isolation, rejection, failure, loss of control, the unknown – Poor lifestyle behaviors Awareness (2) – Learn about anger, anxiety, depression and addiction and their symptoms – Learn about the Mind-Body Connection (Jeopardy) – Potential causes of symptoms – Effects of symptoms – Interventions for symptoms – Have clients identify (Worksheet/Beach Ball or Jenga) – Symptoms – What changed which causes or worsens the symptom – How they have dealt with the symptom in the past – Impact of the symptom on them Awareness (1) – Negative Triggers – Those things that cause or worsen the symptom – Hungry Angry Lonely Tired (HALT) – False Evidence Appearing Real (FEAR) – People Places Things – Times (of day, anniversaries, holidays) – Small Group Activity/Presentation – Which ones can be avoided or prevented- – Which ones are unavoidable- – Identify three ways to deal with the unavoidable ones to mitigate their impact. Awareness (1) – Positive Triggers (Flip chart stations) – Those things that remind you to use your new tools – Sights – Sounds – Smells – Touch – Those things that trigger positive emotions – Sights – Sounds – Smells – Touch – How can you add those to your environment- Awareness (1) – Vulnerabilities – Explain the concept of vulnerabilities – Identify the most common vulnerabilities: What causes them and how to prevent and mitigate them – Emotional (anger, jealousy, envy, depression, anxiety, guilt, grief) – Mental (Poor concentration, rigid thinking, poor problem solving) – Physical (Sleep, nutrition, pain) – Social (lack of supportive relationships, presence of unsupportive relationships) – Environmental Awareness (1) – Mindfulness and Vulnerability Prevention – Learn about mindfulness – Purpose – Benefits – Difference from meditation – Methods – 5 minute exercise – 5,4,3,2,1 – Color focus: Find all the things that are blue – What are my thoughts, urges, sensations when I feel stress, anger, fear, depression, happiness, excitement Awareness (1) – Goal Identification (Top 3s) What is most important to focus your energy on so you can be happy- // What does happiness/recovery look like to you- (Collage) – What 3 things are most important to you- – What 3 relationships are important to you and what do you want them to look like- – What 3 personal growth goals are important to you- – What are your values that support your goals (Top 3) Distress Tolerance (1) – Clients with mood or addict
June 6, 2019
Group Therapy (TIP 41) Chapter 6&7 Leadership Skills & Common Errors Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Purchase CEUs for this podcast at: https://www.allceus.com/member/cart/index/product/id/1111/c/ Objectives ~ Discuss the characteristics of group leaders. ~ Describe concepts and techniques for conducting substance abuse treatment group therapy. Leaders Choose ~ How much leadership to exercise ~ How to structure the group ~ When to intervene ~ How to effect a successful intervention ~ How to manage the group’s collective anxiety ~ How to resolve other issues Personal Qualities of Leaders ~ Constancy ~ Active listening ~ Firm identity ~ Confidence ~ Spontaneity ~ Integrity ~ Trust ~ Humor ~ Empathy ~ Communicates respect and acceptance ~ Encourages ~ Is knowledgeable ~ Compliments ~ Tells less; listens more ~ Gently persuades ~ Provides support Leading Groups ~ Leaders vary therapeutic styles to meet the needs of clients. ~ Leaders model behavior. ~ Leaders are sensitive to ethical issues: •Overriding group agreement •Informing clients of options •Preventing enmeshment •Acting in each client’s best interest Leading Groups (cont.) ~ Leaders improve motivation when: ~ Members are engaged at the appropriate stage of change. ~ Members receive support for change efforts. ~ The leader explores choices and consequences with members. ~ The leader communicates care and concern for members. ~ The leader points out members’ competencies. ~ Positive changes are noted in and encouraged by the group. Leading Groups (cont.) ~ Leaders work with, not against, resistance. ~ Leaders protect against boundary violations. ~ Leaders maintain a safe, therapeutic setting: •Emotional aspects of safety •Substance use •Boundaries and physical contact ~ Leaders help cool down affect. ~ Leaders encourage communication within the group. Interventions ~ Connect with other people. ~ Discover connections between substance use or mood issue and thoughts and feelings. ~ Understand attempts to regulate feelings and relationships. ~ Build coping skills. ~ Perceive the effect of mental illness or addictive behaviors on life. ~ Notice inconsistencies among thoughts, feelings, and behavior. Avoid a Leader-Centered Group ~ Build skills in members; avoid doing for the group what it can do for itself. ~ Encourage group members to learn the skills necessary to support and encourage one another. ~ Refrain from overresponsibility for clients. Clients should be allowed to struggle with what is facing them. Confrontation ~ Can have an adverse effect on the therapeutic alliance and process. ~ Can point out inconsistencies such as disconnects between behaviors and stated goals. ~ Can help clients see and accept reality, so they can change accordingly. Transference & Countertransference ~ Transference. Clients project parts of important past relationships into present relationships. ~ Countertransference. The other person projects emotional response to a group member’s transference: ~ Feelings of having been there ~ Feelings of helplessness when the leader/other person is more invested in the treatment than the client is are ~ Feelings of incompetence because of unfamiliarity with culture and jargon Resistance ~ Resistance arises to protect the client from the pain of change. ~ Resistance is an opportunity to understand something important for the client or the group. ~ Resistance indicates the proposed solutions are less rewarding/appealing than the old behaviors or there is a fear that they will be ~ Efforts need to be made to understand the problem. Confidentiality ~ Strict adherence to confidentiality regulations builds trust. ~ Leaders should explain how information from sources may and may not be used in group. ~ Violations of confidentiality should be managed in the same way as other boundary violations. Integrating Care ~ Professionals in the healthcare network need to be aware of the role of group therapy and how it integrates with
June 4, 2019
Relapse Prevention Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Objectives ~ Define Relapse ~ Identify triggers and warning signs of relapse ~ Review Relapse Syndrome and possible interventions ~ Explore the acronym DREAM ~ Define and identify vulnerabilities ~ Define and identify exceptions ~ Develop a relapse prevention plan Why I Care/How It Impacts Recovery ~ Relapse indicates that the old behaviors have returned either because ~ New skills were ineffective ~ Old behaviors were more rewarding ~ Recovery involves understanding what triggers each individual person’s relapse Relapse Syndrome ~ Relapse generally follows a predictable and readily identifiable pattern ~ Return of denial “I’ve got this.” “I’m fine.” ~ Teach support people about recovery and relapse. Encourage them to probe about problems. ~ Write down problems on a daily basis and share this list with someone. ~ Avoidance of defensive behavior…Focusing more energy on fixing others than on working on self and failing to do relapse prevention exercises. ~ Surround themselves with support people who will encourage them to continue working on their relapse prevention program. ~ Maintain a “negative image” reminder of what it is like when they are symptomatic ~ Develop and review a cost/benefit analysis of their coping behavior. Relapse Syndrome ~ Crisis Building…problems begin to pile up and it becomes more and more difficult to see options. The person develops tunnel vision and loses the ability to perform constructive planning ~ Remind them to take one day at a time. ~ Review coping behavior. ~ Encourage acceptance of personal limits. ~ Remind them that it is the thoughts about an event and not the event that is “bad” or “good”). Relapse Syndrome ~ Immobilization When a crisis builds up, the person becomes crushed and trapped by the problems and incapable of initiating action A sense that nothing can be solved may develop. ~ Use the Serenity Prayer. ~ Use the support people that they have developed. ~ Review the concept of lapse as opposed to relapse (accept the reality that they may make some small mistakes but this does not mean that they have failed). ~ Confusion and overreaction While the problems continue to grow and the person feels stuck, he often becomes confused and angry leading to irritability, a general sense of tension, and sense that others are out to get him. ~ Identify the source of the feelings. ~ Accept responsibility for problems. ~ Possible professional intervention. Relapse Syndrome ~ Depression. As the anger begins to build, so does a sense of hopelessness and begins to turn the anger inward in the form of depression. ~ Focus on those things that the person can control ~ Identify strengths ~ Set SMART goals to develop self-efficacy ~ Seek social support ~ Behavioral loss of control The person becomes unable to control or regulate personal behavior and a daily schedule. ~ Develop a routine ~ Regroup and redifine those people, things and activities that are truly important to a meaningful life ~ Make a task basket (or list) ~ Set more SMART goals to start taking steps forward 10 Most Common Triggers of Relapse ~ Withdrawal symptoms (anxiety, nausea, physical weakness) ~ Post-acute withdrawal symptoms (anxiety, irritability, mood swings, poor sleep) ~ Poor self-care (stress management, eating, sleeping) ~ People (old using friends) ~ Places (where you used or where you used to buy drugs) ~ Things (that were part of your using, or that remind you of using) ~ Uncomfortable emotions (H.A.L.T.: hungry, angry, lonely, tired) ~ Relationships and sex (can be stressful if anything goes wrong) ~ Isolation (gives you too much time to be with your own thoughts) ~ Pride and overconfidence (thinking you don’t have a drug or alcohol problem, or that it is behind you) Types of Relapse ~ Emotional relapse ~ Mental relapse ~ Physical relapse Relapse Warning Signs ~ Emotional Cues ~ Are you more angry,
June 3, 2019
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 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, when a stressor is detected, the stress response is exaggerated. Changes in Beliefs ~ Purpose: The need for order and meaning (Regaining control, Ability to predict) ~ Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world ~ “I am bad” ~ “No one can be trusted” ~ “The world is completely dangerous” ~ Persistent, distorted blame of self or others about the cause or consequences of the traumatic events Changes in Beliefs ~ Persistent ~ Fear, horror ~ Anger ~ Guilt, shame ~ Trauma taps in to nearly every basic fear ~ Loss of Control ~ The Unknown ~ Death (Am I going to die? I could have died. I was unable to prevent someone from dying) ~
June 2, 2019
The Neurobiological Impact of Psychological Trauma: The HPA-Axis 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 ~ Other competitors/motivation ~ Visual feedback ~ Fatigue is one sign that the body is getting ready to downregulate the HPA-Axis ~ In counseling practice, how can we reduce fatigue and help clients restore HPA-Axis functioning? Low Cortisol and PTSD ~ Low cortisol has been found to relate to more severe PTSD hyperarousal symptoms. ~ Sensitised negative feedback loop in veterans diagnosed with PTSD by means of a greater gluticorticoid responsiveness. (0-100) ~ Generally low cortisol, but when a threat is perceived there is an exaggerated stress response. (Flat or furious) ~ Evidence points toward a role of trauma experience in sensitizing HPA axis regulation, independent of PTSD developm
May 29, 2019
CEUs available at: https://www.allceus.com/member/cart/index/product/id/1102/c/ Holistic (Biopsychosocial) Approach to Diagnosis and Treatment Objectives Why Holistic? ~ 30% to 40% of patients with major depressive disorder (MDD) do not respond sufficiently to usual antidepressant treatment ~ Even under optimal treatment conditions, only one-third of patients achieve remission ~ Among patients who fail to respond to two pharmacologic interventions, remission rates with the next antidepressant are as low as 12% ~ A patient becomes less likely to respond clinically with each additional nonresponse to antidepressant treatment Why Holistic ~ 1. The cause may not be the “obvious” reason ~ 2. Positive changes in any symptom will positively impact the rest of the system ~ 3. For people to feel happy and healthy, the system (body machine) needs to be running efficiently Why Holistic HPA & Gut-Brain-Axis Medical ~ Medical conditions that alter sex or thyroid hormone levels, blood sugar regulation or oxygenation can cause symptoms of anxiety, irritability, hypomania, depression ~ Diabetes ~ Blood sugar dysregulation activates the HPA-Axis which can cause irritability, difficulty concentrating ~ Autoimmune Disorders (CF, Fibro, Chron’s, Rheumatoid arthritis) are triggered by stress and trigger inflammation and additional HPA-Axis Activation ~ Cardiac Disorders can prevent adequate oxygenation or resemble panic attacks Medical- Thyroid ~ Thyroid imbalances can be caused by autoimmune disease, genetics, nutritional imbalances, hormone imbalances ~ Anxiety symptoms can precede an official diagnosis of hyperthyroid by up to 5 years ~ Thyroid hormones impact the availability of serotonin which impacts mood ~ Cortisol from chronic “stress” reduces thyroid levels, ergo anxiety, PTSD and even depression can impact thyroid levels ~ Hypothyroid has a prevalence of ~10% in women and 2% in men ~ The risk of hypothyroidism increases during pregnancy, after delivery and around menopause. Medical- Sex Hormones ~ Sex hormone imbalances can be caused by diabetes, testicular injury, drug use including, oral corticosteroids, inhaled corticosteroids (LTU) or birth control, menopause, polycystic ovarian syndrome, hysterectomy, child birth, cessation of breast feeding… ~ Estrogen and testosterone impact serotonin availability. ~ Too much or too little of either can produce anxiety or depressive symptoms ~ High levels of the estrogen affect our ability to deal with stress ~ The production of cortisol affects the concentration of all sex hormones. Medical- Sex Hormones ~ Both men and women produce luteinizing hormone, testosterone, and estrogen. ~ Under stress the body shuts down libido so that we can deal with more urgent, survival needs. ~ Testosterone is suppressed under chronic stress/cortisol ~ Estrogen is often elevated but luteinizing hormone is reduced under chronic stress/cortisol Medical ~ Mood ~ Changes in availability of neurotransmitters ~ Lack of adequate oxygenation ~ Thyroid imbalances ~ Increased “stress” due to medical conditions ~ Sleep ~ Apnea ~ Exhaustion (thyroid or low oxygen) ~ Pain ~ Circadian rhythm imbalance ~ Too little or too much testosterone may affect overall sleep quality ~ Nutrition / Malabsorption ~ Building Blocks ~ Gut-Brain Axis ~ Substances (including caffeine and nicotine) ~ HPA-Axis ~ Thyroid Imbalances ~ Sex Hormones Imbalances ~ Pain ~ Pain ~ Reduced serotonin  Reduced pain tolerance ~ Too little movement  Stiffness and pain Pain ~ Pain can be caused by a variety of things including aging, autoimmune issues, medication side effects, musculoskeletal or neurological problems ~ Mood and Thoughts ~ Increase anxiety ~ Cognitions ~ Things will get worse ~ Mortality ~ Rejection ~ Increase depression ~ Cognitions: Hopelessness and helplessness ~ Feelings of guilt, envy, resentment, anger Pain ~ Activates the HPA-Axis ~ Increased stress ~ Perception of pain/vulnerability ~ Nutrition ~ Especially substances and medicat
May 23, 2019
Learn about pathological gambling with Dr. Daniel Kaufmann
May 22, 2019
Pain, Moods and Management Dr. Dawn-Elise Snipes PhD, LPC-MHSM, LMHC Executive Director, AllCEUs Host, Counselor Toolbox President, Recovery and Resilience International CEUs are available as part of a larger course here: https://www.allceus.com/member/cart/index/product/id/616/c/ Objectives – Characteristics of pain – Effects of pain – Depression – Anxiety – Guilt – Lowered Self Esteem – Lethargy – Circadian Rhythm Disruption – Understanding Your Pain – Exacerbating factors – Mitigating factors Objectives – Medical Interventions – Tylenol – NSAIDS – Opiates – Muscle Relaxants – Nerve Blocks – Accupuncture/Accupressure – Nonmedical Interventions – Guided Imagery – Radical Acceptance – Stretching/Balancing Exercises – Ice or Heat Packs – Massage – TENS units – Stress Management Characteristics of Pain – Everyone has pain sometimes – Our bodies are incredibly resilient – Knowing your pain can help your doctor/physical therapist – Acute or Chronic – Stabbing, aching, throbbing, burning… – Constant or intermittent – Stationary or radiating – Any numbness Effects of Pain – Depression – Fatigue – Sleep Disturbances – Hopelessness/Helplessness – Negative thoughts -> Stress -> Serotonin -> Pain – Interventions – Mindfulness – Good sleep habits – Circadian rhythm maintenance – Identify the things you CAN control and that are GOOD – Eat healthfully to support Serotonin functioning Effects of Pain – Anxiety – Things wont get better – It is getting worse – Consequences of pain (lost job, relationships, fitness…) – Interventions – Avoid caffeine and nicotine – Educate yourself about the disorder and the PROBABILITY things will get worse – Keep a log of the good and bad days – Practice distress tolerance skills – Use the Challenging Questions Worksheet to address anxiety provoking thoughts Effects of Pain – Guilt – Self anger for not being able to… – Can cause you to lash out at others—push them away so you don’t disappoint them like you disappointed yourself – Interventions – Think about how you would want your child or best friend to feel if they were in your position – Get rid of the shoulds – Focus on the things that you CAN do – Decide whether it is worth using your energy to be mad at yourself (and the world) Effects of Pain – Grief – Stages: Denial, Anger, Bargaining, Depression, Acceptance – Interventions – Work through the stages of grief for each of the losses because of the pain (Physical, self-concept, job, freedom (driving/mobility), dreams…) Effects of Pain – Self-Esteem – How you feel about the difference between who you want to be and who you are – Interventions – Make a list of the positive things about you – Identify 1 or 2 goals you can work toward – Celebrate small things – Silence the inner critic Effects of Pain – Circadian Rhythm Disruption – Not getting out of bed – Staying inside in the dark – Sleeping too much – Interventions – Get out of bed at roughly the same time each morning – Get dressed in “day-clothes” – Turn on lights and sit in front of a window or get outside to get your “day-clock” started – If you must take a nap, keep it under 45 minutes to avoid messing up your sleep schedule Understanding Your Pain – Exacerbating factors – Emotional – Mental – Physical – Environmental – Social – Mitigating factors – Do these – Emotional – Mental – Physical – Environmental – Social Medical Interventions – Tylenol and NSAIDS (Over the counter) –
May 18, 2019
The Interaction Between Neurotransmitters, Thoughts & Emotion Objectives Learn about your central control center, the brain What role does it play in Emotions Thoughts Physical Reactionsl Sensations How things can go wrong How to fix those things Summary After a hard day, you often want to relax and “veg” This is the brain sending out the “all clear” message and “inhibitory” or calming chemicals to balance out the stress of the day. When the brain does not get the “all clear” it recognizes that it needs to conserve the “excitatory” chemicals for a true emergency so it turns down the sensitivity of the threat response system (basically saying if you wont conserve energy, I will force you to) By addressing those old, unhelpful thoughts and interpretations you can reduce physical and mental stress and anxiety. This in turn helps your body have some “down time” to recovery between stressors. Recovery involves not only helping your mind and thoughts become healthy, but also your body
May 15, 2019
Internal Family Systems Theory Dr. Dawn-Elise Snipes Purchase CEU class for this podcast at: https://www.allceus.com/member/cart/index/product/id/1034/c/ Objectives ~ Define Internal Family Systems Theory ~ Identify when it is used ~ Explore guiding principles ~ For more information and training programs in IFS, go to https://www.selfleadership.org/ Overview ~ IFS was developed in the 1990s by family therapist Richard Schwartz, Ph.D., ~ It is based on the concept that an undamaged core Self is the essence of who you are, and identifies three different types of sub-personalities or “families” that reside within each person, in addition to the Self. ~ Wounded and suppressed parts called exiles (lost child) ~ Managers, that keep the exiled parts suppressed (enabler) ~ Firefighters, that distract the Self from the pain of exiled parts. (hero/mascot/scapegoat) ~ The Internal Family Systems Center for Self-Leadership conducts training programs Basic Assumptions ~ The mind is subdivided into an indeterminate number of subpersonalities or parts. ~ Everyone has a Self which can lead the individual's internal system. ~ The non-extreme intention of each part (exile, manager and firefighter) is something positive for the individual. ~ There are no “bad” parts ~ The goal of therapy is not to eliminate parts but instead to help them find their non-extreme roles. ~ As we develop, our parts develop and form a complex system of interactions among themselves ~ When the system is reorganized, parts can change rapidly. ~ Changes in the internal system will affect changes in the external system and vice versa. Parts ~ Subpersonalities are aspects of our personality that interact internally in sequences and styles that are similar to the ways in which people interact. (exile and the manager or the firefighter and the Self) ~ Parts may be experienced in any number of ways — thoughts, feelings, sensations, images, and more. ~ All parts want something positive for the individual and will use a variety of strategies to gain influence within the internal system. ~ Parts that become extreme are carrying “burdens” — energies that are not helpful, such as extreme beliefs, emotions, or fantasies. ~ Parts can be helped to “unburden” or recognize their role and return to their natural balance. ~ Parts that have lost trust in the leadership of the Self will “blend” with or take over the Self. Exiles ~ Young parts that have experienced trauma and become isolated or suppressed in an effort to protect the individual from feeling the pain, terror, fear, and so on, of these parts ~ Exiles are often young parts holding extreme feelings and/or beliefs that become isolated from the rest of the system (such as “I’m worthless,” “I must be successful to be lovable,” “I am a failure”) ~ Exiles become increasingly extreme and desperate as they look for opportunities to emerge and tell their stories ~ Want to be cared for and loved and constantly seek someone to rescue and redeem them ~ Can leave the individual feeling fragile and vulnerable Managers ~ Managers are proactive and try to avoid interactions or situations that might activate an exile’s attempts to break out or leak feelings, sensations, or memories into consciousness. ~ Different managers adopt different strategies controlling, perfectionism, co-dependency ~ The primary function of all mangers is to keep the exiles exiled…. ~ Common managerial behaviors: controlling, perfectionism, high criticism, narcissism, people pleasing, avoiding risks, being pessimistic, constantly striving to achieve ~ Ask…What would trigger the exiles and how can that be prevented? ~ Common managerial symptoms: Emotional detachment, panic attacks, somatic complaints, depressive episodes, hypervigilance Firefighters ~ Have the same goals as managers (to keep exiles away) but different strategies ~ Managers want you to look good and be approved of, FFs only care about distracti
May 10, 2019
Understanding Anxiety Through a Child’s Eyes Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Counselor Education Purchase CEUs at: https://www.allceus.com/member/cart/index/product/id/1033/c/ Host: Counselor Toolbox Podcast Objectives ~ Identify symptoms of anxiety in children ~ Review common misdiagnoses ~ Explain how children’s developmental stage impacts their fears ~ Propose interventions to help children deal with anxiety Symptoms of Anxiety in Children ~ Emotional Signs of Anxiety ~ Is extremely sensitive ~ Irritable ~ Is afraid of making even minor mistakes including test anxiety ~ Panic attacks ~ Has phobias (about bees, dogs, etc.) and exaggerated fears (about things like natural disasters, etc.) ~ Worries about things that are far in the future ~ Has frequent nightmares ~ Gets distracted from playing by his worries ~ Has compulsive, repetitive behaviors Symptoms of Anxiety in Children ~ Behavioral Signs of Anxiety ~ Starts having meltdowns or tantrums. ~ Asks “what if?” constantly. ~ Avoids participating in group activities. ~ Remains silent or preoccupied during group work ~ Refuses to go to school. ~ Avoids social situations with peers after school or on weekends ~ Becomes emotional or angry when separated from parents ~ Constantly seeks approval ~ Low self-esteem and efficacy ~ Overly concerned about negative evaluations Symptoms of Anxiety in Children ~ Physical Signs of Anxiety ~ Frequently complains of head or stomachaches ~ Refuses to eat snacks or lunch at school ~ Can become restless, fidgety, hyperactive ~ Difficulty concentrating ~ Starts to shake or sweat in intimidating situations. ~ Dizziness ~ Frequent urge to urinate ~ Constantly tenses muscles ~ Exaggerated startle response ~ Has trouble falling or staying asleep ~ Falls asleep in school ~ Repetitive activities (tapping, leg shaking…) ~ Nail biting / skin picking ~ Rigid routines Not Little Adults ~ How do children think differently ~ 0-2: Object permanence; personal agency (crying, “Uh Oh,” Ask for drinks) ~ When you are overtired, startled, too hot/cold, or have low blood sugar, the HPA-Axis is activated  Threat Response (Anxiety) ~ 2-7: Egocentric, personalized, concrete/dichotomous, mystical ~ Daddy yelled at me. Daddy left. Daddy hates me. It is my fault. ~ I told Mommy I hated her. She got sick. It is my fault. ~ I didn’t say my prayers last night. We got into a car accident because God is mad at me. ~ The neighbor’s dog always charges the fence and wants to bite me. This makes me scared. Dogs are dangerous. Not Little Adults ~ How do children think differently ~ 7-11: Inductive (Start making global attributions from specifics) ~ I didn’t make the team. I got a C on my spelling test. I must be a failure ~ 11+: More advanced reasoning but little life experience and often have not questioned prior faulty schema What is Anxiety ~ Anxiety is fear which is the flee part of the fight or flight (stress) response ~ What do we/children fear ~ Death (Biological Needs/Safety(self & others)) ~ Rejection/Isolation/Abandonment (Biological Needs, Safety, Love and Belonging) ~ The Unknown (Biological Needs, Safety, Love) ~ Loss of Control (Parental, older children) What is Causing the Anxiety ~ Cognitive ~ Unhelpful thoughts ~ Lack of knowledge ~ Physical ~ Lack of sleep ~ Poor nutrition or hunger ~ Hormones (sex, thyroid) ~ Emotional ~ Highly sensitive child ~ Environmental/social ~ Bullies ~ Teacher pressure ~ Parental enmeshment or disengagement ~ Chaotic home environment (mental health, addiction and/or abuse or neglect) ~ Social learning Differential Diagnosis ~ Anxiety Disorders (multiple) ~ Depression ~ ADD ~ Autism ~ PTSD / ASD ~ Oppositional Defiant Disorder Interventions ~ Infants-2years old ~ Be responsive ~ “Before six months, you're just extinguishing,” explains Chilton matter-of-factly. “Eventually, the baby just gives up.” Loss of parental contact is a serious danger signal for young babies, and th
May 8, 2019
Facilitating Open-Ended Groups Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast Objectives ~ Define closed, open and single-session groups ~ Explore the benefits and challenges for each ~ Identify the developmental phases for open groups ~ Discuss necessary skills for managing open-ended groups Definitions ~ Closed groups are those which begin with a group of people and do not add anyone else (i.e. a 12 week anxiety management group) ~ Single session groups are stand-alone groups in which participants are not expected to return (i.e. A 4 hour grief workshop) ~ Open groups are those which do not have a set number of sessions and participants regularly rotate in and out. Closed Group Benefits ~ Participants all begin at the same time and learn the same material ~ When all begin together, the developmental process occurs in a predictable way: Forming, storming, norming and performing (Tuckman 1965) ~ Participants form more intimate bonds Drawbacks ~ As people leave, there is no replacement ~ There is often a waiting period for people to get into groups which is not ideal for emergent issues. ~ When people drop out, they usually cannot return Single Session Group Benefits ~ Uses a brief intervention model during a longer session. ~ Available like a “menu” ~ Does not require the participant to return another day Drawbacks ~ Requires the full development of the group in one session ~ Does not typically help participants translate knowledge into practice ~ Typically more psychoeducational in nature Open Ended Groups Benefits ~ Available on-demand for emergent concerns ~ Meets the guidelines for co-occurring disorder treatment of episodic care ~ Provides a gentle transition back into care Drawbacks ~ A certain amount of forming and norming happens each time a new member arrives or rejoins ~ It is harder to develop a deep level of trust with client rotations ~ Requires clinicians to be highly structured, able to foster cohesion between old and new members and ~ Facilitators must be able to develop a clear and specific purpose ~ Facilitators must thoroughly research expected needs to be able to facilitate “on the fly” Forming in an Open Ended Group ~ Facilitator Planning ~ Divide the topic into stand-alone groups ~ Someone who was not there last week should still be able to benefit this week. ~ Consider a cyclic rotation (every 8-16 sessions w/new information ) Forming in an Open Ended Group ~ Pre-group orientation ~ Explain the expectations and the rules for group ~ Attendance and how to withdraw ~ Participation ~ Reasons for discharge ~ Review what will be covered in group (weekly schedule) ~ Provide introductory information (handouts, videos) ~ Develop personal goals for group ~ Before group starts ~ Buddy up the new member with an existing member Forming in An Open Ended Group ~ The first (or only) session ~ Goals: Create cohesion, provide a useful nugget ~ New people introduce themselves and identify what they hope to get out of group (5-10 minutes) ~ Have current members share if they have similar goals ~ Tom: I am just so tired of being tired and depressed all the time. I want to find a way to get some pleasure back. ~ Jim Responds: I hear you. When I joined the group life almost didn’t seem worth living, but each week I learn more about the reasons I feel this way and small changes that have made a big difference. ~ Go around the group and have members share how they are doing, one way they dealt with their [issue] since the last group and one challenge they have experienced (if any) (10 minutes) Storming in An Open Ended Group ~ Existing members typically take a facilitative lead to help empower new members to take full advantage in the group ~ Facilitators need to ensure one person does not dominate the group Norming in An Open Ended Group ~ The first (or only) session ~ Present the topic for the day and link it to people’s tools and challenges ~ Chal
May 3, 2019
Building Positive Self Talk for Confidence and Self-Esteem Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast CEUs for this podcast are available at: https://www.allceus.com/member/cart/index/product/id/1030/c/ Objectives ~ Identify the function of negative self talk ~ Explain the benefits of positive self talk ~ Describe 15 methods for teaching positive self talk to people of all ages Function of Negative Self Talk ~ Protection from threats and failure ~ I can’t do this. ~ I’m not smart enough to… ~ I cannot find a decent partner ~ Nobody wants to be my friend ~ I am ugly ~ I could lost my job at any moment ~ Attention (See UFD Game…) Ugly, Fat and Dumb Game ~ The ugly, fat, and dumb game is a method of attaining attention by the individual in any given group whom needs the most attention (not necessarily the individual with the lowest self-esteem). ~ An individual draws attention to their own (perceived or real) flaws in order to get others to announce their own in an attempt to make the first person feel better and subsequently, lowering their own self-esteem ~ For example: ~ While eating dinner, Sally announces her weight to the table and calls herself fat causing all the other girls at the table (who nearly all clearly weigh more) to announce their weight in an attempt to make Sally feel better about herself. ~ If someone at the table isn’t of lower weight, they find another deprecating thing to say about themselves– “But you are so pretty. I would kill to have your hair. Mine is like a rats nest.” Benefits of Positive Self Talk ~ Reduced cortisol and HPA-Axis activation ~ Reduced pain ~ Improved physical health (Less stress-related disease) ~ Increased energy ~ Greater life satisfaction ~ Improved immunity Unconditional Positive Regard ~ From attachment figures who teach positive talk ~ From self ~ Encourage the use of the phrase ~ “I love you even if…” Self Awareness ~ Who you are ~ I have the ability to… (things you do) ~ I am… (inner qualities) ~ Keep a daily journal or account of your successes, good qualities and accomplishments ~ What you say to yourself ~ Journaling Mantras ~ Don’t wait until you are stressed. Practice positive self talk throughout the day—Every day (Positive Thinking Apps) ~ Mantras ~ I am capable. ~ I am lovable. ~ Today is going to be an awesome day. ~ I choose to be present in all that I do. ~ I feel energetic and alive. ~ I can achieve my goals. ~ I love challenges and what I learn from overcoming them. ~ I’ve got this Visualization ~ Visualization helps people’s brains “see” how they can succeed (or fail) ~ Negative self talk “teaches” the brain that negative things will happen which increases anxiety and distress, reduces concentration and increases a sense of helplessness. ~ Positive self-talk helps people’s brains “see” that ~ Success is possible ~ Happiness is possible ~ The person has power Visualization ~ Visualizations combined with desensitization help reduce anxiety and distress around… ~ Public speaking ~ Tryouts or job interviews ~ Driving ~ Starting a new school/job ~ Taking a test ~ … ~ Have people watch others who are successful and/or role play then use that data to visualize. Environments ~ Surround yourself with positivity ~ Parents model positivity ~ Listen to positive songs ~ Have family members bring a positive quote or song (lyrics) with them to dinner once a week and put it on the fridge. ~ Give yourself a pep talk every morning. ~ Keep a success wall/scrapbook Personalizing ~ When you take things personally you are often assuming you have control over how other people feel or react or the way things happen. ~ Sally didn’t text me today. She must be mad at me. ~ I didn’t get that job/role/position they must have hated me. ~ I don’t know what I did, but Dad was in an awful mood all day today. ~ Encourage people to ~ Look for 3 alternate (nonpersonal) explanations ~ Examine the facts. Did it have anything to do with you?
May 1, 2019
20 Ways to Nurture Children’s Mental Health CEUs are available for this presentation at AllCEUs https://www.allceus.com/member/cart/index/product/id/1028/c/ Objectives ~ Identify 25 ways to nurture children’s mental health Children’s Mental Health ~ Children need to feel ~ Safe ~ Emotionally ~ Physically ~ Competent (efficacy) ~ Able to succeed in school ~ Able to succeed in managing emotions ~ Able to succeed at … ~ Confident (esteem) ~ Lovable for who they are ~ That they belong How does NOT feeling these contribute to mental health issues? Physical ~ Sleep and Sunlight ~ Help set your circadian rhythms and vice versa ~ Circadian rhythms regulate (feeding, sleeping, stress) hormones ~ Lack of sleep  fatigue, irritability, low distress tolerance, poor concentration ~ Sunlight produces far more bioavailable vitamin D ~ How much? ~ 3-6 Years Old: 10 – 12 hours per day (8p-6a) ~ 7-12 Years Old: 9 – 11 hours per day (9p-6a) ~ 12-18 Years Old: 8 – 10 hours per day (10p-6a) ~ Create a sleep routine ~ Evaluate sleep hygiene AllCEUs.com/sleep Physical ~ Eliminate Caffeine ~ Caffeine stimulates the HPA-Axis leading to a perpetual state of stress ~ Caffeine has a half-life of 5-8 hours ~ Chronic caffeine intake ~ Has been shown to increase serotonin and acetylcholine and inhibits the release of GABA, which contributes to our feeling of alertness. ~ Reduces the number of active receptors (tolerance) ~ When it is stopped, the brain’s abundant supply of happy chemicals is abruptly cut off and the person feels depressed. ~ Reduces cofactors necessary for neurotransmitter synthesis ~ Inhibits the absorption of iron and B-vitamins involved with the synthesis of serotonin, dopamine and GABA ~ People often use caffeine to compensate for inadequate sleep Physical ~ Nutrition ~ Provides the building blocks to make neurotransmitters responsible for mood, motivation, libido, concentration and energy. ~ Maintains a healthy gut microbiome to help produce 80% of the neurotransmitters and prevent leaky gut (AllCEUs.com/gut) ~ Deficits of specific nutrients (i.e., vitamins A, B6, B12, C, folate, iron, zinc, and calcium) are associated with lower grades (CDC) ~ Interventions ~ Involve youth in creating a weekly menu ~ Encourage maintenance of an online food diary ~ Eat colorfully (Yellow, Red, Green, Blue/Purple/Black, Brown) ~ Start a hydroponic (or regular garden) ~ Keep fruits and chopped vegetables easily accessible Physical ~ Exercise ~ Higher physical activity and physical fitness levels are associated with improved concentration and memory. ~ Time spent in recess has been shown to positively affect students’ attention, concentration and classroom behaviors ~ Consider the motivation of behaviors ~ Brief classroom physical activity breaks (i.e., 5-10 minutes) are associated with improved attention, concentration, on-task behavior, and educational outcomes ~ How much ~ Children and adolescents ages 6 through 17 years should do 60 minutes (1 hour) or more of moderate-to-vigorous physical activity daily. (moderate=50-70% of max HR, vigorous =70-85% max HR) Physical ~ Relaxation and Recreation ~ Many youth get up, go to school, come home, do homework until 8 or 9 o’clock then go to bed with little time for true relaxation. ~ Relaxation is the state of being free from psychological and muscle tension ~ Techniques to calm the HPA-Axis and Teach Self-Regulation ~ Guided Imagery (even to space) ~ Yoga, Tai Chi ~ Progressive Muscular Relaxation ~ Deep breathing Physical ~ Screen for ~ Autism: 1:59 (CDC) ~ Developmental Delays: Cognitive, social and emotional, speech and language, fine and gross motor ~ Learning disabilities impact up to 10% of children ~ AD/HD ~ Must watch for differential dx Asperger's Disorder, and Other Common Misdiagnoses and Dual Diagnoses of Gifted Children ~ Mood disorders (NIMH) Depression 3%; Anxiety 8%; PTSD 4% ~ Thyroid Disorders ~ 4.6% of the U.S. population age 12 and older has hypothyroidism ~ Hypothyroidism
May 1, 2019
Forming a Foundation that Nurtures Secure Attachment at All Ages Instructor: Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast CEUs are available for this presentation at AllCEUs https://www.allceus.com/member/cart/index/product/id/1027/c/ Objectives ~ Identify the CARES approach to creating secure attachment ~ Explore the needs of children in infancy, early childhood and middle and high school to identify ~ Challenges ~ Ways to promote secure attachment in an age-appropriate manner Attachment–CARES ~ Requirements ~ Consistency ~ Attention ~ Responsiveness (mirror and up-regulation (soothing)) ~ Empathy and validation ~ Solutions (generate) Attachment ~ Effects ~ They are lovable and worthy of support ~ Others are available and responsive ~ They have good emotional regulation skills ~ They have frustration/distress tolerance ~ They have self-efficacy ~ They can tolerate ambiguity in life ~ They can deal effectively with others ~ They can effectively problem solve and elicit assistance when needed Infants (Maslow) ~ Biological Needs ~ Food when hungry ~ Shelter/Physical comfort ~ Protection from overstimulation ~ Sleep when sleepy ~ Contact ~ Safety ~ Consistent presence vs. Abandonment (no object permanence) ~ Startle / loud noises / pain ~ Love and Belonging ~ Caregivers provide attention, affection and nurturance ~ Unconditional positive regard Erickson's Stages Psychosocial Development: Trust Success ~ Ability to interpret, trust and act on own feelings (self-confidence) ~ Belief that others will help fulfil needs (hope) ~ Self reliance ~ Comfortable with attention ~ Ability to be “alone” ~ Contentment Failure ~ Inability to trust own instincts/urges/feelings ~ Reliance on others to tell them what they need ~ Inability to trust others will be supportive ~ Discomfort with and craving of attention (Abandonment fears) ~ Irritability/anxiety Piaget– Cognitive Development ~ Sensorimotor: ~ Children do not yet have object permanence ~ Children do not yet have much of a frame of reference so they rely on parental feedback ~ Schemas formed during this time rely heavily on ~ Were needs adequately met (empowered vs. powerless) ~ Parental reaction (stress-level/attentiveness/consistency) ~ Think about the impact of adverse childhood experiences during this time. (Abuse/neglect, addiction, absence, mental illness) Mindful Parenting ~ Be attentive to the baby’s cries and cues before they become hysterical ~ Accept the baby’s needs as they are to create a validating environment ~ Be consistent ~ Calm yourself ~ Stressed parent  stressed baby ~ Keep a routine to help set baby’s circadian rhythms ~ Feeding ~ Sleeping ~ View the world from baby’s eyes (esp. children with autism, FASD or sensory impairments) Toddlers and beyond (Maslow) ~ In addition to biological, safety and love and belonging needs… ~ The toddler is now developing ~ Self-Esteem ~ I am lovable for who I am ~ I am loveable even when I make a mistake ~ Self-Efficacy ~ I am capable of trying new things ~ If I make a mistake, my caregiver is there to help me Early Childhood: Psychosocial Development ~ Will: Autonomy vs. Shame & Doubt (Toddlers, 2 to 3 years) “Can I do things myself or am I reliant on others?” ~ Purpose: Initiative vs. Guilt (Preschool, 4 to 6 years) Children begin asserting control and power ~ Interferences ~ Overly permissive or overly strict parents ~ How does this prevent children from feeling safe and accepted? ~ Lack of praise for exploration and experimentation ~ How does this prevent children from feeling safe and accepted? Early Childhood: Piaget–Cognitive ~ 2-6 years early childhood (Preoperational) ~ Preschoolers have difficulty discerning truth from fiction/dreams/imagination ~ Parenting challenge: Truth vs. Fiction ~ How can parents sometimes lack empathy/validation; responsiveness or problem solving? ~ Toy Story; imaginary friends, poof-up powers ~ Preschoolers tend to think i
May 1, 2019
Creating Psychological Flexibility in Children with Dr. Dawn-Elise Snipes Executive Director, AllCEUs Host: Counselor Toolbox Podcast CEUs are available at https://www.allceus.com/member/cart/index/product/id/1029/c/ Objectives ~ Define Psychological Flexibility ~ List the Main Principles of Psychological Flexibility ~ Identify the Components of Psychological Flexibility ~ Describe How to Teach Psychological Flexibility ~ Explain the Short Cut Question Preventing Vulnerabilities ~ When people are tired, malnourished, hungry, stressed, sick or in pain, they tend to have more difficulty dealing with life on life’s terms. ~ Sleep ~ Set a bedtime routine and teach about good sleep hygiene ~ Help them learn the value of sleep ~ Point out that they will have a better day if they get a good nights sleep and when they are having a bad day because they didn’t get enough rest Preventing Vulnerabilities ~ Nutrition ~ Help children learn good eating habits ~ Participate in cooking ~ Help create menus with 3 colors at each meal ~ Keep prepared fruits and veggies available ~ Minimize refined foods for stable blood sugar ~ Make sure lunches have sufficient protein and complex carbohydrates ~ Talk to them about why nutrition is important Activity: Food Art ~ Tell children to build a Mr. Potato Head but take out one set of pieces. ~ When children cannot complete the project, explain that just like they need all the pieces to make Mr. Potato Head, for them to be healthy and happy their body needs all the different types of food building blocks Preventing Vulnerabilities ~ Positive Health Behaviors (Model it. Do it with them.) ~ Relaxation ~ Ergonomics (backpack, desk, bed) ~ Hand Washing (sing Baby Bumble Bee 2x) ~ I’m washing up my baby bumble bee ~ Won’t my mama be so proud of me ~ I’m washing up my baby bumble bee ~ Scrubba scrubba scrub scrub scrub scrub scrub ~ Exercise Battery or Money Metaphor ~ If you get a good nights sleep, eat a healthy diet and learn to relax, then each day you start with (a fully charged cell phone battery/ $100) ~ If you don’t get a good nights sleep, eat a healthy diet and learn to relax then you may not fully recharge (your phone/bank account) ~ Throughout the day each time you do something you are (draining your battery / spending money). The more intense the activity or emotion or the longer it lasts, the more (battery is used/money spent) ~ Eating, walking, exercising etc. ~ Worrying ~ Getting angry Questions… ~ Think about a day you didn’t sleep well. Did you run out of (battery/money) earlier in the day? ~ What about a day you were really stressed about a test coming up? ~ How much easier do things seem when you are rested and relaxed? Clarifying the Destination Values & Goals ~ A lack of clarity about values can underlie much of people’s distress or keep them “stuck.” ~ Help children identify what is really important in their life and become willing to focus their energies on those things Clarifying Values & Goals ~ Clarifying ~ Who is most important, deep in your heart? ~ Which people? ~ What do you want those relationships to be like? ~ Note: Help small children create a collage of people who are in their life (family, higher power, pets) ~ What events, things, experiences are important to you? ~ Getting on the ___ team/club ~ Getting good grades ~ Going to college to be a _____ ~ Being good at ______ ~ My health (without that you can’t do the others as easily) ~ Note: Small children may not have anything here Clarifying cont… ~ Values ~ What values do you want to embody (Choose 5)? ~ For small children, ~ Choose 5 that are important for your family values and/or characterize the child (Honesty, Resourcefulness, Compassion, Faithfulness, Determination…etc.) and help the child learn to embody these things ~ Tell me what animal you are like and why. When Unpleasant Things Happen Psychological Flexibility ~ Is the ability to be aware of situations and consciously choose from available options ~ Choose to s
April 27, 2019
Moving from Supportive to Solution Focused Interventions Objectives ~ Differentiate between supportive and solution-focused interventions ~ Identify the function of each ~ Explore interventions to facilitate transition into problem solving What’s the Difference ~ Supportive interventions are grounded in empathy and helping the person survive the moment. ~ Plugging a hole in the hull of a ship until you can get to port ~ Solution focused interventions aim to help the person move from surviving the moment to thriving. ~ Repairing the ship and figuring out how to avoid the reef the next time Supportive Interventions ~ Establish rapport ~ Validate the person’s feelings ~ Can help the person return to baseline/wise mind ~ Examples: ~ Active listening ~ Radical acceptance ~ Distress tolerance Why People Get Stuck ~ Supportive interventions are like removing boiling rice from a hot stove. ~ When the rice starts to boil, it often boils over ~ The cook removes the rice from the heat and the bubbles go down. ~ The rice still needs to cook (the problem is still there) but the immediate crisis (boiling over) is past ~ The cook returns the rice to the stove to try and get it to finish cooking. Solution Focused Interventions ~ Help people identify ~ The problem ~ Their hoped-for resolution of the problem ~ Ways they have solved similar problems ~ Exceptions ~ Other possible solutions ~ Require a clear head and the ability to concentrate (a little) ~ Require that the person feels heard and understood ~ Require motivation to make a change Decisional Balance (Increase Motivation) Maintain Motivation ~ Use assignments to keep people on task between sessions ~ Have daily check-ins to complete the problem log ~ Use scaffolding to develop a game plan ~ Provide reinforcement for successful completion of tasks ~ Highlight improvements ~ Try to avoid rewarding backsliding ~ Consider all factors that may enhance or impede motivation ~ Emotional ~ Mental ~ Physical (sleep, nutrition, pain, hormones) ~ Social (friends and family) ~ Occupational (school/work) Remember ~ Everything people do serves a purpose and is generally more rewarding than the alternative. ~ Why does Sally seem to shut down or yes-but any suggestions? ~ Why does John insist on taking an excessive load even though he knows it will stress him out? ~ Why does Jane continue to use social media if it upsets her so much? Cognitive Processing Cont… ~ Can help therapists identify and address ~ Cognitive distortions ~ Emotional reasoning ~ Faulty goal setting and problem solving skills ~ Can help clients ~ Gain a different perspective ~ Identify what parts are within their control ~ Set SMART goals and increase efficacy Cognitive Processing ~ Tell me the problem (or write it down) ~ What are the known facts for and against your beliefs about the problem? ~ What other factors and people are involved? ~ Are you assuming things about other people or the future? ~ Are you confusing high and low probability events? ~ Which parts can you control? Which part’s can’t you control? ~ What is your hoped for resolution? ~ Is this realistic? Why or why not? ~ What are possible steps to a solution? Problem Solving ~ Use authenticity to communicate how much you want to help the person find a way to stop hurting. ~ Look for exceptions ~ Identify ways the person or someone else has solved the problem in the past ~ Set small, achievable goals ~ Follow up regularly. Narrative Therapy ~ Have people write down ~ What is going on (this chapter) ~ How they see the future (the next chapter) ~ Include ~ Who is there? ~ What do they do? ~ How do they feel? Living in the AND ~ Validate people’s hurts and perspectives. ~ You are devastated and it seems like the pain will never end. ~ Help them identify things that are important to them that are going well ~ Tree ~ Collage ~ Scrapbook ~ Index cards: Who or what it is and why it is important and going well. Summary ~ Supportive interventions are necessary to help peopl
April 24, 2019
Building Resilience in Children Objectives ~ Define resilience ~ Explore characteristics of Resilient People ~ Identify how to help people become more resilient ~ Highlight activities which can help people deal with unpleasant events when they happen The Art of Resilience ~ Resilience is a process or lifestyle that enables people to bounce back in the face of adversity ~ “a dynamic process encompassing positive adaptation within the context of significant adversity” (Luthar, Cicchetti, & Becker, 2000) ~ Resilience develops over time as people are exposed to, and successfully navigate, stressors ~ We can help children by allowing them to try…and sometimes fail Resiliency Theory ~ The central principles of the theory include ~ Risk factors and vulnerabilities ~ Protective factors/mechanisms ~ Risk factors and mechanisms are the events or conditions of adversity that cause distress in early life ~ Poverty ~ Prematurity ~ Residential mobility / lack of family or community ties ~ Addicted or dysfunctional family environment ~ Illness (cancer, M.S., chron’s disease) The Art of Resilience ~ Vulnerability factors are individual traits, genetic predispositions, or environmental and biological deficits which may cause heightened response, sensitivity, or reaction to stressors. ~ Cognitive impairment (including FASD)—Early steps ~ Lack of social support– Social skills ~ Emotional dysregulation –Distress tolerance & Mindfulness ~ Ineffective coping skills –Coping skills ~ Mood or addictive disorders in the person –Screening and early intervention ~ Poor physical health (pain, nutrition, hormones, sleep) –Wellness behaviors, health education The Art of Resilience ~ Protective factors and mechanisms are things which enhance or promote resistance, or which may moderate the effect of risk factors. ~ Rutter (1987) suggests that protective mechanisms may operate in one of four ways to allow overcoming adversity: ~ Reducing risk impact ~ Reducing negative chain reactions to risk factors ~ Promoting resiliency traits ~ Setting up new opportunities for success. The Art of Resilience ~ Fergus and Zimmerman (2005) identified two types of protective factors. ~ Assets are positive factors that reside within individuals, such as: ~ Self-efficacy and self-esteem ~ Social competence and communication skills ~ Resources refer to factors outside individuals, such as: ~ Social support ~ Opportunities to learn and practice skills ~ Wellness programs that support biological health Make Every Moment a Learning Opportunity ~ Practice mindfulness with your children at breakfast and before bed ~ When they are upset ~ Empathize ~ Comfort and help them de-escalate ~ Process ~ In young children, provide advice and role play ~ In older children, brainstorm possible reactions for the future 6-Cs of Resilience ~ 6-Cs ~ Coping ~ Control ~ Character ~ Confidence ~ Competence ~ Connection (resource) Characteristics “Assets” of Resilient People ~ Coping: Can effectively balance negative and positive emotions and manage strong impulses. ~ Emotion Regulation / Prevent or mitigate vulnerabilities ~ Daily mindfulness ~ Screening and early intervention for DD/LD ~ Structure at home (Sleep, nutrition) ~ Distress Tolerance ~ Poster on the fridge and bedroom (and classrooms) ~ Problem Solving Skills ~ Focus on facts and what you can change ~ Remain aware of resources Characteristics “Assets” of Resilient People ~ Character ~ Who are you, and who and what is important to you? ~ What things can you change in this situation? ~ The situation? ~ Your reaction to the situation? Characteristics “Assets” of Resilient People ~ Control/Autonomy: Belief in your ability to act independently to exert some control over one’s situation ~ Purposeful Action: Make realistic plans for a meaningful life based on what is important to you ~ Take the steps necessary to achieve goals ~ Notice positive, forward moving thoughts and behaviors in yourself and others ~ Confidence in one’s strength
April 20, 2019
Couples Therapy Objectives ~ Identify common mistakes in couples therapy ~ Explore things counselors need to consider when working with couples CEUs are available for this podcast at https://www.allceus.com/member/cart/index/product/id/1024/c/ ~ Provide a confidential dialogue, which normalizes feelings ~ Enable each person to be heard and to hear themselves ~ Set boundaries so each person feels safe and empowered to express his or her point of view in a way the other can hear and understand, even though he or she may not agree ~ Teach active listening, using I statements and objective terms from the beginning ~ Reflect the relationship's difficulties and the potential for change ~ Inform couples that it is not a matter of one person being right or wrong, since both partners make sense from their perspective. They will be learning how to better understand each other and improve communication to restore harmony and intimacy ~ Identify times in the past that have been good and what was different ~ Help each partner begin to understand how he or she is contributing to the conflicts and can contribute to solutions ~ Move from the “blame game” to looking at what happens to them as a process. ~ Look for exceptions ~ Help both partners see the relationship in a more objective manner ~ Identify repetitive, negative interaction cycles as a pattern ~ Sex/Intimacy ~ ResentmentsExplosions ~ Change the view of the relationship via functional perspective taking ~ How is this behavior helpful to him/her/you? ~ Help each partner begin to understand how he or she is contributing to the conflicts and can contribute to solutions ~ Understand the source of reactive emotions that drive the pattern ~ How does this situation trigger past hurts? ~ How does this situation trigger feelings of failure, rejection, loss of control or isolation? ~ Empower the partners to take control and make vital decisions ~ What are workable solutions to this problem? ~ Facilitate a shift in partners' interaction ~ Which solution will you choose? ~ What is each person’s responsibility? ~ Create new and positively bonding emotional events and establish intimacy ~ Meet the couple where they are— What can they currently comfortably do? ~ What do they hope they will eventually be able to do? ~ Teach the 5 love languages (touch, gifts, words, acts, quality time) ~ Have each partner make a list of what those things are for them ~ Foster a secure attachment between partners ~ Responsiveness ~ Consistency ~ Compassion/empathy ~ Caring ~ Mindfulness paraphrasing activity ~ Decrease emotional avoidance ~ When you are feeling [upset] what will you do? ~ Mindfulness ~ Radical acceptance ~ Distress tolerance ~ Problem solving ~ When you are upset with your partner, what will you do? ~ Promote strengths ~ What are your strengths as a couple? ~ What are your strengths as individuals and how can you synergize? ~ What positive things did your partner do last week? ~ 9 minutes of connection (3 morning, 3 after work, 3 before bed) Assessment Areas ~ Communication ~ Conflict Resolution ~ Appreciate Individual Differences ~ Financial Management ~ Leisure Activities ~ Sexuality and Affection ~ Family and Friends ~ Relationship Roles ~ Children and Parenting ~ Spiritual and Cultural Beliefs and Values Assessment ~ Each person’s goals for treatment ~ What changes are you hoping will come out of therapy ~ Phenomenological truth for each person ~ Temperament ~ E/I ~ S/N ~ T/F ~ J/P Conflict Resolution ~ Set a time and place for discussion ~ Define the problem (specific and objective) ~ List the ways you each contribute to the problem ~ Identify past unsuccessful attempts at resolution ~ Brainstorm 10 possible solutions ~ Discuss and evaluate each solution ~ Agree on a solution to try ~ Describe how you each will work toward that solution ~ Set another time to discuss your progress ~ Reward each other’s efforts Fair Fighting ~ Know when you need a time out ~ Do not enagage whe
April 17, 2019
Caring for Transsexual, Transgender & Gender Nonconforming People Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast CEUs are available for this podcast https://www.allceus.com/member/cart/index/search?q=transgender Based in Part On ~ Standards of Care for Transsexual, Transgender & Gender Nonconforming People a publication by The World Professional Association for Transgender Health Objectives ~ The Difference between Gender Nonconformity and Gender Dysphoria ~ Epidemiologic Considerations ~ Explore the sources of stigma and discrimination and their impact on health ~ Overview of Therapeutic Approaches for Gender Dysphoria ~ Assessment and Treatment of Children and Adolescents with Gender Dysphoria ~ Mental Health Introduction ~ Both across and within nations, there are differences in all of the following: social attitudes towards transsexual, transgender, and gender nonconforming people; constructions of gender roles and identities; language used to describe different gender identities; epidemiology of gender dysphoria; access to and cost of treatment; therapies offered; number and type of professionals who provide care; and legal and policy issues related to this area of health care (Winter, 2009). ~ There are examples of certain cultures in which gender nonconforming behaviors are less stigmatized and even revered (e.g., in spiritual leaders) Intro. Cont… ~ Even a similar proportion of transsexual, transgender, or gender nonconforming people existed all over the world, it is likely that cultural differences would alter both the behavioral expressions of different gender identities and the extent to which gender dysphoria –actually occurs. ~ Terminology is culturally and time-dependent and is rapidly evolving. It is important to use respectful language in different places and times, and among different people. Intro cont… ~ Gender nonconformity is the extent to which a person’s gender identity, role, or expression differs from the cultural norms prescribed for people of a particular sex (Institute of Medicine, 2011). ~ Gender dysphoria refers to distress caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth ~ Only some gender nonconforming people experience gender dysphoria at some point in their lives ~ Treatment for gender dysphoria depends on the individual Intro cont… ~ A disorder is a description of something with which a person might struggle, not a description of the person or the person’s identity. ~ Transsexual, transgender, and gender nonconforming individuals are not inherently disordered. The distress of gender dysphoria may precipitate a diagnosable disorder. Intro cont… ~ Some individuals describe themselves not as gender nonconforming but as unambiguously cross-sexed (i.e., as a member of the other sex) ~ Other individuals affirm their unique gender identity and describe their gender identity in specific terms such as transgender, bigender, or genderqueer, affirming their unique experience that may transcend a male/female binary understanding identifying with neither, both, or a combination of genders (agender, bigender, trigender, pangender, demigender, gender fluid or third or other-gendered) Intro cont… ~ Gender identity is separate from sexual or romantic orientation ~ Importantly, some individuals may not experience their process of identity affirmation as a “transition” because they never fully embraced the gender role they were assigned at birth Transgender Persons and Stigma ~ There is stigma attached to gender nonconformity in many societies around the world. ~ Stigma can lead to prejudice and discrimination, resulting in “minority stress” ~ Minority stress is unique (additive to general stressors experienced by all people), socially based, and chronic, and may make transsexual, transgender, and gender nonconforming individuals more vulnerable to developing mental health concerns ~ National Transgender Di
April 13, 2019
Nonpharmacological Pain Management Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast Objectives ~ Types of pain ~ Impact of pain on sleep, HPA-Axis and mood ~ Treatment options for chronic pain ~ CBT Interventions Types and Locations of Pain ~ Chronic pain ~ Lasts more than 3 months ~ May have a known or unknown cause ~ Persists beyond expected healing time or despite treatment ~ Best conceptualized as a condition to be managed rather than cured Types of Pain ~ Nocioceptive Pain ~ Pain that is caused by damage to body tissue and is based on input by specialized nerves called nociceptors ~ Most nociceptive pain is musculoskeletal, and is often described as aching or deep ~ Examples ~ Back and neck pain ~ Arthritis/Gout ~ Tendonitis ~ Bursitis ~ Pelvic floor disorders Types of Pain ~ Neuropathic Pain ~ Occurs when there is nerve damage that typically involves either the peripheral or central nerves ~ It is often described as burning, shooting, tingling, or electric ~ Examples ~ Radicular pain—radiates along a nerve (sciatica) ~ Phantom limb ~ Fibromyalgia ~ Peripheral neuropathy ~ Spinal tap/epidural ~ Carpal tunnel Types of Pain ~ Headache Pain ~ Tension (15 days/month for at least 6 months) ~ Cluster (15-180 minutes every other day to 8x/day) ~ Migraine (2-72 hours) ~ TBI (may last 6 or more months) ~ Cervicogenic (referred pain from the neck/cervical spondylosis or fracture) ~ Medication Overuse/Rebound Headaches Treatment Options ~ TENS units ~ Massage ~ Physical Therapy ~ Stretching ~ Ergonomics ~ Heat/cold ~ Chiropractics ~ Acupuncture/Acupressure ~ Yoga/Tai-Chi Treatment Options ~ Biofeedback: Noticing HPA-Axis activation and responding with relaxation exercises ~ Relaxation Training ~ Mindfulness ~ Behavioral Therapy. Observable behaviors such as grimacing, sighing, or limping are often socially reinforced and can lead to increased self-perceptions of pain ~ Cognitive Behavioral Therapy (CBT) addresses thoughts, behaviors and emotions associated with pain ~ Acceptance and Commitment Therapy (ACT) aims to develop greater psychological flexibility and learn to “live in the and.” ~ Hypnotherapy CBT-CP Theoretical Components Factors Maintaining Pain Psychological Factors Associated with Pain ~ Pain Cognitions. Negative cognitions and beliefs about pain can lead to maladaptive coping, exacerbation of pain, increased suffering, and greater disability ~ Catastrophizing. Catastrophic thoughts contribute to increased pain intensity, distress, and failure to utilize adaptive coping techniques. Examples “my pain will never stop” or “nothing can be done to improve my pain.” ~ Hurt versus Harm. When pain is interpreted as evidence of further damage to tissue rather than an ongoing stable problem that may improve, individuals with chronic pain will report higher pain intensity regardless of whether damage is occurring (Smith, Gracely, & Safer, 1998). Psychological Factors Associated with Pain ~ Negative Affect. The relationship between pain and negative affect is complex and bidirectional. ~ Answer-Seeking. Failing to accept the offered cause of pain or being unwilling to accept that a source of pain cannot be determined can lead to increased distress and pain intensity ~ Pain Self-efficacy is the level of confidence that some degree of control can be exerted over the pain. Social Factors Associated with Pain ~ Solicitous significant other who is highly responsive to an individual’s pain or to expressions of behavior indicative of pain results in increased reports of pain. ~ Social interactions that focus the individual’s attention away from pain and onto different topics or activities. ~ Punishing responses involve either angry or ignoring responses, each aimed at limiting expression of pain ~ Potential consequences of punishing responses include dramatic (loud) expressions of one’s pain experience in an effort to be “heard” or, alternately, inability to expres
April 6, 2019
Treating Addictions and Borderline Personality Disorder Symptoms Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Host: Counselor Toolbox Podcast CEUs are available for this presentation at AllCEUs https://www.allceus.com/member/cart/index/product/id/1002/c/ Objectives ~ Review the characteristics of BPD and Addictions ~ Explore the functions of these symptoms ~ Identify interventions to help the person more effectively manage emotions and relationships Internal Reality ~ Lack of a sense of self—If they aren’t someone’s something, then they are nothing ~ Unlovable for who they are ~ Constant fear of abandonment Consequences ~ Lack of emotional boundaries ~ Anger is used to control others and is rewarded ~ Emotional dyscontrol ~ Inability to self-soothe/Impulsivity ~ Lack of coping skills ~ Relationship problems ~ Physical health problems and complaints ~ Cognitive distortions are reinforced First ~ Identify the most salient symptoms ~ Their function (and alternate ways to meet that need) ~ Identify what it looks like for that person ~ When X happens, how do you feel? What do you think? What are your urges? What do you do? ~ How that behavior is being maintained (what are the benefits and other ways to get the same benefit) Frantic efforts to avoid real or imagined abandonment ~ Function: The person only knows how to exist as a role, such as being someone else’s spouse/parent etc. (Co-dependency) ~ Preventing abandonment means preventing death or dissolution ~ What does it look like (Benefits/Drawbacks) ~ Hypervigilant/hypersensitive to rejection/criticism ~ Anger at/belittling others to control them ~ Acting out to control through guilt, manipulation ~ Emotional dyscontrol Abandonment cont… ~ Origins ~ Failure to develop a sense of self due to constantly trying to appease the caregivers ~ Addict –Don’t Talk, Don’t Trust, Don’t Feel ~ Borderline –Do as I say or else… ~ History of abandonment/rejection/CPR ~ If they are something to someone then they are filling a need and are less likely to be abandoned ~ History of neglect/abuse (You (as a person) are not worthy of love) Abandonment Cont… ~ Interventions ~ Develop a sense of self and self-esteem ~ Differentiate between who you are and what you do ~ Explore what makes someone/something “lovable” ~ Dogs/horses ~ Children ~ Others ~ Which of those characteristics do you have in yourself? ~ Identify and address messages/events in the past that communicated unlovability Abandonment Cont… ~ Interventions ~ Explore the notion of responsibility (Who and what are you responsible for) ~ Not responsible for the parent ~ Responsible for you ~ Nobody else can make you… ~ Explore and address abandonment/rejection triggers ~ Is it about you? What are alternate explanations? ~ Explore faulty thinking Relationships are Unstable ~ Function: Controlling others provides a feeling of safety and predictability ~ What does it look like (Benefits/Drawbacks) ~ Intense and unpredictable interactions ~ If you do what I want, I love you ~ If you do not, you are rejecting me and I hate you ~ Everyone walks on eggshells ~ Jekyll/Hyde Relationships are Unstable ~ Origins ~ Children were rejected (or the caregiver was unavailable) at an age in which they were still thinking in concrete, all-or-nothing terms ~ The A/B expects rejection and has never experienced an authentic relationship with self-or others ~ Inability to self-soothe is terrifying and the A/B fears they cannot cope on their own ~ Repeated rejections become most salient and support all-or-nothing thinking Relationships are Unstable cont… ~ Interventions ~ Use CBT to explore and address perceived rejection ~ From others in real life ~ From the gallery/hecklers ~ From yourself ~ Use contextual approaches to separate REactions to the present ~ Differentiate dislike of actions/ideas from dislike of person (People can disagree or dislike something you do but that doesn’t mean they don’t like you Relationships are Unstable cont…
April 3, 2019
Mindfulness & Acceptance of Addictive Behaviors Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast CEUs are available for this presentation at AllCEUs https://www.allceus.com/member/cart/index/product/id/1001/c/ Objectives ~ Define and review the concepts of contextual cognitive behavioral therapy ~ Explore the impact of context on people’s phenomenological reality ~ Explore how addiction and mental health issues can be influenced by context ~ Explore how acceptance, awareness, mindfulness and psychological flexibility can be used transdiagnostically. Why Contextual ~ Addiction and mental health issues are often intergenerational ~ Addiction and Mental Health issues are strongly correlated with: ~ Each other ~ Adverse childhood experiences (history of and children with) ~ Impaired occupational and social functioning ~ Health problems Contextual Approaches ~ Encourage mindfulness in the present moment ~ Accept each person’s “truth” is constructed from their schema and the resulting interpretation of the current moment ~ The goal is to consider the context and function of the past and present issue and empower the person to make a conscious choice toward their valued goals ~ Remember that the prefix RE means to do again ~ REpeat ~ REdo ~ REgress ~ RElapse ~ REaction Childhood Context and Development ~ The family context can be a preventative or risk factor for the development of issues ~ Children develop schema about themselves, others and the world through these early interactions ~ In later life people continue to develop schema influenced by their past learning. Caregiver Requirements for Secure Attachment and Healthy Development ~ Consistent Age-Appropriate Responsiveness ~ Trust ~ Autonomy ~ Industry ~ Identity ~ Empathy ~ Compassion ~ Effective Communication Skills ~ Unconditional Love Think About It ~ What is it like for a child growing up in a house in which one or both parents has: ~ An addiction ~ A mental health issue Common Addicted Characteristics ~ Difficulty dealing with life on life’s terms ~ Difficulty dealing with distress (poor coping) ~ Impulsivity / lack of patience and distress tolerance ~ Neglectfulness ~ Hostility ~ Defensiveness ~ Blaming ~ Manipulation ~ Withdrawal ~ From others/disconnected ~ No pleasure in other activities ~ Justification/minimization/denial ~ Low self-esteem ~ Guilt and shame Common Characteristics in People with Mental Health Issues ~ Difficulty dealing with life on life’s terms ~ Difficulty dealing with distress (poor coping) ~ Impulsivity / lack of patience and distress tolerance ~ Neglectfulness ~ Hostility ~ Irritability ~ Withdrawal ~ From others/disconnected ~ Apathy ~ Low self-esteem ~ Guilt and shame ~ Fatigue ~ Sense of hopelessness or helplessness The End Product ~ People’s REactions to things are based on prior learning + present moment. ~ Bridges ~ Stress ~ Depression ~ Self-esteem Core Concepts in Contextual CBT Mindfulness ~ Improves people’s ability to be present in the present ~ Shift from automatically reacting to thoughts and feelings based on schema to being aware of ALL experiences in the present to provide more flexibility Encouraging Acceptance of Internal Experiences ~ Accepting thoughts, feelings, sensations without having to act on them ~ Radical Acceptance ~ Unhooking ~ Dialectics ~ I can be a good person AND be divorced ~ I can be happy AND grieving ~ I can stay sober AND be stressed Acceptance of Internal Experiences ~ Accepting thoughts, feelings, sensations without having to act on them ~ Distress Tolerance ~ ACCEPTS ~ Activities ~ Contributing ~ Comparisons ~ Emotions (opposite) ~ Push Away ~ Thoughts ~ Sensations Focus on Adding vs. Eliminating ~ Help the person define a rich and meaningful life and make choices based on that vs. eliminating a problem ~ Depression ~ What do we do to eliminate depression? ~ What are we left with when we eliminate depression? ~ How do yo
March 29, 2019
The Porn Trap Based in part on the book by Wendy and Larry Maltz, LCSWs Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Education Host: Counselor Toolbox Podcast CEUs are available for this presentation as part of the Sex and Pornography Addiction Recovery Coaching Certificate Track https://www.allceus.com/member/cart?c=42 or as an individual 2 hour class at https://www.allceus.com/member/cart/index/product/id/999/c/ Want to listen to it as a podcast instead? Subscribe to Counselor Toolbox Podcast Objectives ~ Explore the hidden power of porn ~ Identify the characteristic relationships with porn ~ Review the consequences of porn ~ Review the impact of porn on partners ~ Identify 6 action steps to quit porn ~ Learn about handling and preventing relapses ~ Identify strategies for healing as a couple Effects of Porn on the Brain ~ Dopamine is the main motivation chemical ~ Dopamine is all about seeking and searching for rewards, the anticipation, the wanting. ~ Dopamine surges for novelty ~ Dopamine provides the motivation and drive to pursue potential rewards or long term goals ~ Endogenous opioids are the main reward chemical. ~ Naltrexone has been found effective for blocking the endogenous opioids and reducing the reward https://www.ncbi.nlm.nih.gov/pubmed/18241634 ~ Stimulates testosterone Effects of Porn on the Brain ~ The adolescent brain has an: ~ immature prefrontal cortex ~ over-responsive limbic circuits ~ overactive dopamine system ~ a pronounced HPA axis ~ augmented levels of testosterone https://www.ncbi.nlm.nih.gov/pubmed/30754014 Hidden Power of Porn ~ The Coolidge Effect ~ Tiring of one partner/stimulus, but having a powerful automatic response to novelty ~ The brain does not differentiate (very much) between 2-D and 3-D partners ~ The desire and motivation to pursue sex arises largely from a neurochemical called dopamine which compels you to do things that further your survival and pass on your genes ~ Sexual stimulation offers the biggest natural blast of dopamine available to your reward circuitry ~ Porn can give people the illusion of power and control ~ Variable ratio schedule of reward ~ Dopamine is released for: ~ Seeking and searching for novelty, food, sex, safety ~ Novel stimuli (i.e. internet porn) ~ Anything that violates expectations – shock, surprise, or more than we could have imagined ~ Strong emotions – such as desire, guilt, disgust, embarrassment, anxiety & fear https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0017047 ~ Strong emotions elevate dopamine and boost norepinephrine, and cortisol. This increases excitement while amplifying dopamine’s effects. ~ Over time a porn user’s brain can mistake feelings of anxiety or fear for feelings of sexual arousal ~ Internet porn can alter brain circuitry for sexuality– especially during adolescence when the brain is highly malleable and programed to learn all about sex. ~ Video porn is far more arousing than static porn because it involves more senses and is more “life-like”. ~ To increase sexual arousal (and raise declining dopamine) one can instantly switch genres ~ Porn videos replace your imagination, and may shape your sexual tastes, behavior, or trajectory (especially so for adolescents). ~ Porn is stored in your brain, which allows you to recall it anytime you need a “hit.” ~ Unlike food and drugs, for which there is a limit to consumption, there are no physical limitations to internet porn consumption. The brain’s natural satiation mechanisms are not activated, unless one climaxes. Even then, the user can click to something more exciting to become aroused again. Porn and Sexual Conditioning ~ Psychological Messages ~ This how people have sex, and this is how I should do it. ~ This is what turns me on. ~ This is what people should look and act like Porn and Sexual Conditioning ~ Physiological Conditioning ~ Excess masturbation is the signal to your primitive brain that you have hit the evolutionary jackpot.
March 27, 2019
Love You, Hate the Porn by Mark Chamberlain, PhD Facilitator: Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Podcast CEUs are available for this presentation as part of the Sex and Pornography Addiction Recovery Coaching Certificate Track https://www.allceus.com/member/cart?c=42 or as an individual 2 hour class at https://www.allceus.com/member/cart/index/product/id/1000/c/ Want to listen to it as a podcast instead? Subscribe to Counselor Toolbox Podcast Objectives ~ Explore the impact of pornography on relationships ~ Identify common reactions to finding out about porn ~ Explore needs that may fuel negative cycles ~ Interventions “Relationship Rescue Breaths” ~ Improving intimacy ~ Dealing with insecurity, vulnerability and grief ~ Helping your partner understand what porn does for you ~ Addressing triggers for porn use Prevalence and Problems ~ 70.8 percent of men and 45.5 percent of women thought they would watch. ~ 22.3 percent of men and 26.3 percent of women thought pornography had no role in a romantic partnership (Olmstead et. al) ~ Michael Kimmel reported in his 2008 book Guyland, young men often watch porn with their peers and for different reasons than older men. Kimmel writes that “guys tend to like the extreme stuff, the double penetrations and humiliating scenes. They watch it together with guys and they make fun of the women in the scene. Impact of Pornography on Relationships ~ “After viewing pornography, participants became less satisfied with their real-life sexual partners, saw monogamy as less desirable and faithfulness to one’s spouse as less important, and were more prone to overestimate the prevalence of less common sexual practices” (p. 5) ~ “After viewing pornography subjects became more cynical in their attitudes about love and more accepting of the idea that superior sexual satisfaction It attainable without having affection for one’s partner” (p. 5) (Zillman and Bryant 1988) Impact of Pornography on the Relationship ~ “The partner viewing the pornography had less faith in his wife’s fidelity.” (p. 6) ~ Spouses/partners complained that ~ Their pornography using partner had less sexual desire for them ~ They way they were treated during sex made them feel more like a sex object (Bergner & Bridges 2002) Impact of Pornography on Relationships ~ Association between consumption of pornography and engaging with multiple and/or occasional partners, emulating risky sexual behaviors, assimilating distorted gender roles, dysfunctional body perception, aggressiveness, anxious or depressive symptoms https://www.ncbi.nlm.nih.gov/pubmed/30761817 Effects of Pornography ~ Robust dopamine response ~ Void of oxytocin after masturbation ~ Sleep deprivation ~ Erectile dysfunction, delayed ejaculation, and an inability to reach orgasm ~ Body adjusts to the intensity of the neurochemical response by dampening its response leading people to feel worse than before they started ~ The shame of pornography use builds walls between partners brick by brick ~ Porn is always available Effects of Pornography ~ The more people seek pornography, the more isolated they feel ~ Porn teaches viewers to objectify their partners ~ Porn sets unrealistic standards and expectations ~ Partners who have caused pain in their relationships may feel they have lost privileged status and withdraw out of shame and to spare the NP partner the pain. Common Reactions ~ Helplessness ~ Inability to look at spouse without being reminded of the infidelity ~ Nightmares ~ Worrying your partner is thinking about the porn when with you ~ Suspicion ~ Hypervigilance to your partner ~ Depressive/GAD symptoms ~ Withdrawing from others ~ Becoming more critical towards your partner ~ Becoming increasingly angry toward your partner ~ May want to turn to the PU Partner for reassurance and comfort and “punch him in the face and get him away from me” at the same time Questions the NP Partner May Ask ~ Why am I not enough? ~
March 23, 2019
Breaking the Cycle of Porn Addiction Based in part on the book “Breaking the Cycle” by George Collins Objectives ~ Explore how porn addiction can be a cycle ~ Explore how porn (like video games) can be addictive ~ Explore technological interventions to help pornography addicts ~ Identify critical treatment Issues for porn addiction Similarities Between Porn and Gaming ~ Available anywhere/anytime ~ Never ending excitement ~ New stuff constantly added ~ No particular end ~ Increases dopamine and norepinephrine ~ May (falsely) provide the feeling of social connection ~ Easy to minimize porn as a harmless online activity ~ Some sites have monthly fees which encourage more use to “get your money’s worth.” Recognizing It ~ Recognizing Porn (or Sex) Addiction (Compulsion) ~ You cannot get enough ~ You spend more time thinking about, engaging in and recovering from the behavior than intended ~ You give up important social, recreational activities to engage in the behavior ~ It causes problems in one or more areas of your life, but you continue to do it: emotional, social, occupational, legal ~ You have been unsuccessful at trying to quit Who Becomes a Porn Addict ~ Anybody who… ~ Had a troubled childhood and found masturbation as an effective means of self-soothing ~ Was exposed to sexually explicit material at an early age ~ Has difficulty in real-life relationships ~ Is depressed, stressed or having difficulty sleeping ~ So…anybody is vulnerable The Cycle of Porn ~ Porn addiction is really about the neurochemical reactions from looking at porn (excitement/tension building) and masturbation (release/reward) ~ When people encounter distressing situations (or boredom) they may masturbate. ~ This produces a sensation of calming and/or pleasure that ~ The person wants to experience again ~ The person remembers the next time a distressing situation arises Step 1: Identifying the Triggers ~ Triggers are people, places, things, feelings and events that prompt a person to want to escape ~ What emotions trigger you to want to view porn? ~ What thoughts or self-talk? ~ What people? ~ What situations or times of day? Step 2: Address Euphoric Recall ~ Make a list of the unpleasant effects ~ Emotional (Shame, guilt, anger, anxiety, depression…) ~ Cognitive (Obsessions, lack of concentration…) ~ Interpersonal (Inability to get aroused IRL, changed sexual preferences and expectations, difficulty not objectifying, paying less attention to kids, less desire to interact with other people…) ~ Occupational (losing time at work, late for work, poor work performance) ~ Legal (divorce, child custody, criminal charges, bankruptcy (webcam viewers) Step 3: Pair the Porn ~ Pairing the situations in which you want to use porn with something competing. ~ Put a picture of your kids or a religious symbol next to your computer and on your desktop/home screen Step 4: Lock It Down ~ Firewalls to block adult content that you don’t have the password to ~ Nanny apps (like Bark) that notify someone if you go to an adult site Step 5: Reboot ~ When the brain is regularly flooded with dopamine and excitatory neurochemicals it becomes less sensitive. ~ Things that used to make you happy don’t have the same effect. ~ You may also start feeling depressed, have difficulty concentrating and lack energy. ~ Removing all pornography from the equation is most helpful. ~ Restricting sexual activity to only that between you and a consenting partner is also helpful. ~ Initially you may experience anxiety and/or depression as well as sexual craving since the brain is depending on regular doses of feel-good chemicals and porn has been a staple coping strategy ~ As the brain recovers your obsessions about porn and compulsive behaviors will start to remit Step 5 ~ Unhook from their thoughts ~ Instead of saying “I am a failure” say “I am having the thought that I am a failure.” ~ Instead of saying “I can’t wait to get home to look at porn/masturbate” say “I am having the thought that…” St
March 20, 2019
Enhancing Trauma Resiliency Objectives ~ Learn about the effects of acute and intergenerational trauma ~ Review risk and protective factors for PTSD ~ Identify strategies to enhance resiliency in persons who have experienced past trauma Effects of Lack of Resilience from Primary and Intergenerational Trauma ~ Anxiety and Depression ~ PTSD ~ Addictions ~ Personality Disorders ~ Relationship Issues ~ Poverty / Reduced Success ~ Stress Related Physical Health Problems ~ Intergenerational Trauma ~ Attachment Issues ~ Pessimism ~ Rigid Thinking ~ Lack of Psychological Flexibility Signs of Resilience ~ Optimism / Pessimism ~ Empowerment / Helplessness ~ Flexibility / Rigidity ~ Confidence / Meekness/Anxiety ~ Competence / Incompetence ~ Insightfulness / Lack of Insight ~ Perseverance / Gives Up Easily ~ Perspective / Lack of Perspective ~ Self Control / Dysregulation PTSD Risk Factors ~ Age ~ Developmental level ~ Prior history of trauma ~ Prior history of mental health or substance abuse issues (including autism and FASD) ~ Number of stressors in the prior 6 months ~ Availability of social support within 4/24/72 hours ~ Effective problem solving & coping skills ~ Effective distress tolerance skills Protective Factors ~ Psychological Flexibility Protective Factors ~ Mindfulness ~ The awareness of the present moment and ones needs in the moment without judgement ~ Activities ~ 5-4-3-2-1 ~ What’s in the Room ~ Word’s in a Word ~ Scavenger Hunt – (i.e. All things green) ~ Noticing Log Protective Factors ~ Mindfulness/Vulnerability Prevention ~ Morning/Evening (Whiteboard) Mindfulness Protective Factors ~ Mindfulness ~ Evening ~ How do I feel physically? ~ Do I have pain anywhere? ~ What am I thinking about the most? ~ How do I feel emotionally? ~ What is one thing I am grateful for today? ~ What do I need to do so I can get relaxed enough to go to sleep? Distress Tolerance / Self Control ~ Activities ~ Contribute ~ Comparisons (to when you were in a worse state, to how things could be worse) ~ Emotions ~ Push Away ~ Thoughts ~ Sensations Framing/Perspective Skills ~ What is the evidence for and against that fear or belief? ~ Am I considering the big picture (all the factors) ~ My active part ~ My current situation and vulnerabilities that contributed ~ Other people’s active part in it ~ Transference issues ~ Am I catastrophizing/confusing Problem Solving Skills ~ Brainstorming– (Hand drawing for children, mind-map for adults) ~ Ask someone who has been through it ~ How does this keep me from moving closer to my goals and what can I do about it? Flexibility ~ Helps people learn that things won’t always go the way they want, BUT it doesn’t mean it will be awful. ~ Does not come easy to those with a “J” personality ~ Identify things we need to be flexible in (vacations, workouts, job duties, relationships, time management) ~ Activities ~ Choices Hat (meals, vacations, television programs) ~ Schedule a spontaneous day ~ How many uses game (Duct tape, coconut oil, plastic shopping bags, cardboard boxes, wire coat hangers…)\ ~ How are you like a…. game Flexibility ~ Learned Optimism (Martin Seligman) ~ The traumatized brain stays on alert and notices the dangers or potential threats ~ Teaching people to identify the good things as well can be helpful (Hardiness, Kobasa 1979; ACT Russ Harries, Steven Hayes; DBT Marsh Linehan) ~ Commitment – The current situation is unfortunate AND what other aspects of your life are you committed to which are going okay? (Dialectics, Living in the AND) ~ Control—What parts of this situation can you control? What aspects of the other parts of your life are in your control? ~ Challenge—In what ways can the current situation be viewed as a challenge or obstacle instead of a barrier? Flexibility ~ Learned Optimism (Martin Seligman) ~ Activities ~ Positive journaling ~ Gratitude (wall, tree, branch) Empowerment ~ Activities ~ Learn about others like you who have overcome challenges ~ Break big tasks into small st
March 16, 2019
Trauma, Grief and Personality Disordered Symptoms Dr. Dawn-Elise Snipes CEUs can be earned for this podcast by going to https://www.allceus.com/member/cart/index/product/id/996/c/ Objectives ~ Explore the similarities between grief, traumatic reactions and personality disordered symptoms. ~ Explore possible etiology of symptoms ~ Change the language from why are you doing this, to How does this make sense?/What happened to you? ~ As we go through the presentation, continually ask yourself…How could this behavior be an adaptive reaction? Grief, Trauma & Personality Disorders ~ Persistent Complex Bereavement Disorder ~ Conditions for Further Study (DSM-V p. 789-792) ~ PTSD ~ Personality Disorders ~ Pervasive, long-standing ways of being ~ Ways of perceiving and interpreting self, others and events ~ Range, intensity and appropriateness of emotional response ~ Interpersonal functioning (empathy, trust, desire for relationships) ~ Impulse control Emotional ~ Shock, denial, or disbelief ~ Guilt, shame, self-blame ~ Feeling sad or hopeless ~ Feeling disconnected/numb ~ Dysregulation ~ Anxiety ~ Separation anxiety ~ Reactive Attachment ~ Angry/Irritable ~ Depression ~ Loneliness Cognitive ~ . ~ Confusion, difficulty concentrating ~ Difficulty concentrating ~ Short attention span ~ Difficulty learning new material; short term memory loss ~ Difficulty making decisions ~ Lack of a sense of purpose ~ Inability to find meaning in the events and life itself Physical Most physical effects of grief/trauma are effects of stress/anxiety ~ Fatigue ~ Being startled easily ~ Racing heartbeat ~ Aches and pains ~ Muscle tension ~ Appetite disturbances ~ Sleep disturbance ~ Gastrointestinal disturbance ~ Compromised immune response; increased illness Social ~ Isolation/detachment ~ Avoidance ~ Withdrawal ~ Distrust/suspicion ~ Self absorption ~ Searching ~ Clinging/dependence ~ Insecurity ~ Distorted self image ~ How could these symptoms lead to PD behaviors? Putting It Together ~ Personality Disordered Behavior in Context ~ PD behavior must be traceable back to adolescence or early adulthood! (not early childhood as most of us were taught) ~ ~1% of children are victims of (reported) abuse or neglect each year ~ 37% of American children are reported to Child Protective Services by their 18th birthday ~ 48% of US Children experience at least one “serious trauma” / Adverse Childhood Experience http://www.invisiblechildren.org/2016/12/29/1-in-3-children-investigated-for-abuse-by-18-washington-university-study/ https://www.childhelp.org/child-abuse-statistics/ https://acestoohigh.com/2013/05/13/nearly-35-million-u-s-children-have-experienced-one-or-more-types-of-childhood-trauma/ Behavioral ~ Cluster A ~ Paranoid: Suspiciousness, hold grudges, jealousy ~ Schizoid: Social detachment, restricted emotions, oblivious to social cues ~ Cluster B ~ Antisocial: Disregard for rights of others, aggression, poor impulse control, blame victims, lack of empathy ~ Histrionic: Uncomfortable being alone, need to be CoA, easily influenced by others ~ Narcissistic: Sense of entitlement, disregard the rights and feelings of others, lack empathy, need to be admired ~ Borderline: Unstable sense of self, dichotomous thinking, emotional dysregulation, impulsivity—self-destructive, difficulty interpreting the motivations of others Behavioral ~ Cluster B ~ Borderline: Unstable sense of self, dichotomous thinking, emotional dysregulation, impulsivity—self-destructive, difficulty interpreting the motivations of others ~ Cluster C ~ Avoidant: Social inhibition, feelings of inadequacy, hypersensitivity to criticism ~ Dependent: Strong need to be taken care of by others (submission, serial relationships), challenged to make decisions or begin a task without help ~ Obsessive Compulsive: Preoccupied with rules and order, devoted to work, perfectionistic, unable to delegate Summary ~ Grief and trauma symptoms overlap considerably ~ Many of the symptoms of personality disorders ca
March 13, 2019
Complicated Grief and Attachment Dr. Dawn-Elise Snipes PhD, LPC-MHSP Podcast Host: Counselor Toolbox CEUs are available for this presentation at AllCEUs https://www.allceus.com/member/cart/index/product/id/995/c/ Objectives ~ Define Complicated Grief ~ Identify how loss of or lack of an attachment relationship may represent a loss that needs to be grieved. ~ Explore the overlap between complicated grief and trauma ~ Identify risk factors for CG ~ Explore tasks for successful grief resolution Definitions: ~ Loss: Change that includes being without someone or something—in this case the primary attachment relationship ~ Secondary loss: Other losses as a result of a primary loss. Example, loss of security when rejected by primary caregiver ~ Grief: Reaction or response to loss; includes physical, social, emotional, cognitive and spiritual dimensions. ~ Trauma: Any situation that causes the individual to experience extreme distress Attachment ~ Attachment ~ Attachment is the quality of the relationship with the caregiver characterized by trust, safety and security. ~ The quality of the infant-parent attachment is a powerful predictor of a child’s later social and emotional outcome ~ Determined by the caregiver’s response to the infant and toddler when the child’s attachment system is ‘activated’ Internal Working Model ~ Children’s attachment with their primary caregiver leads to the development of an internal working model which guides future interactions with others. ~ 3 main features of the internal working model ~ a model of others as being trustworthy (what is the loss here?) ~ a model of the self as valuable (what is the loss here?) ~ a model of the self as effective when interacting with others. (what is the loss here?) ~ Secure attachments also help children ~ Feel loved and accepted ~ Learn to manage their emotions ~ Address dichotomous thinking and cognitive distortions Bowlby on Attachment and Grief ~ Attachment Relationships Help Regulate Psychological And Biological Functions Including: ~ Mastery and performance success ~ Learning and performing ~ Relationships with others (and future attachment) ~ Cognitive functioning ~ Coping and problem solving skills ~ Self-esteem ~ Emotion regulation ~ Sleep quality ~ Pain intensity (physical and emotional) Bowlby ~ Attachment and safety stimulate a desire to learn, grow and explore ~ Caregivers provide support and reassurance (Safe haven) ~ Encouragement and pleasure (secure base) Feeney J Pers Soc Psych 631 -648 2004 Bowlby ~ Loss of an attachment relationship ~ Disrupts attachment, caregiving and exploratory systems ~ Attachment: Activates separation response and impacts restorative emotional, social and biological processes ~ Exploratory system: Inhibits exploration with a loss of a sense of confidence and agency. ~ Caregiving: Produces a sense of failure and can include self blame and survivor guilt Trauma ~ Trauma is any event that is distressing or disturbing ~ How do we know what is distressing or disturbing ~ Erodes a sense of safety (Triggers fight or flight) ~ Emotional (including dysregulation) ~ Mental (interpretations and schemas) ~ Physical (object permanence, darkness, pain, prior experiences) ~ Adverse Childhood Experiences that may disrupt primary attachment ~ Immediate family member with a mental health or addiction issue ~ Immediate family member who is incarcerated ~ Divorce ~ Abuse (child or DV) ~ Neglect How Can Disrupted Attachment  Trauma ~ The primary attachment figure remains crucial for approximately the first 5 years of life ~ Trust/mistrust (Ages 0-2) ~ Object Permanence ~ Autonomy/shame (Ages 2-7) ~ Egocentrism: children assume that other people see, hear, and feel exactly the same as they do ~ Children’s moral sense in this phase of development is rigid and believe that a punishment is invariable, irrespective of the circumstances. ~ They regard bad things that happen as a consequence for misdeeds and a punishment for misbehavior. http://www.
March 9, 2019
Psychosocial Impact of Trauma Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education To access the CEU/OPD/CPD course go to  https://allceus.com/counselortoolbox  in the US or  https://australia.allceus.com/counselortoolbox if you are in Australia. Objectives ~ Learn about the effects of trauma on the person and the family ~ Explore how these effects impact ~ Mood ~ Behavior ~ Relationships ~ Identify tools to help people navigate life while adjusting to their new reality. What are the Traumas You See ~ House fire ~ Death ~ Domestic violence ~ Child neglect ~ Miscarriage ~ Forcible felonies: Rape/Robbery ~ Chronic exposure to people who have experienced the above (Counselors, LEO, ER docs, EMS) Remember ~ What is traumatic to one person may not be traumatic to another ~ What is traumatic to a child may not seem traumatic to an adult Trauma Triage ~ Being the victim or similarity to the victim ~ Proximity to safe-zone ~ Stressors in the prior 6 months ~ Prior mental health, trauma or substance abuse issues ~ Access to social support within 4, 24, 72 hours Effects of Trauma on the Person ~ Chronic stress or repeated trauma can result in a number of biological reactions, including a persistent fear state which shapes the perception of the environment. ~ Positive journaling ~ Mindfulness ~ Cognitive behavioral interventions ~ A single trauma can alter a person’s sense of safety and worldview ~ People with a persistent fear response may lose their ability to differentiate between danger and safety, and they may identify a threat in a nonthreatening situation. ~ Fact checker (https://www.childwelfare.gov/pubPDFs/brain_development.pdf. National Scientific Council on the Developing Child, 2010b) Fact Checker ~ What is the situation that is causing me to feel anxious or angry? ~ What are the facts supporting this feeling? ~ Am I confusing high and low probability events? ~ How does this situation remind me of other times when I have been angry or afraid? ~ What is different in this situation? ~ Ex. Walking to your car at night Trauma’s Impact on the Person ~ Emotions ~ Emotional numbing: Pandora’s box is locked up tight ~ Depression: Hopeless, helpless, loss ~ Anxiety: That it will happen again, that they are broken/unlovable, that they won’t recover, ~ Anger: At God, blaming others and self, ~ Grief: Denial, Anger, Bargaining, Depression, Acceptance ~ Guilt: Self anger for what they did, did not do or just because they survived. ~ PTSD ~ Evaluate for relapse of prior conditions Trauma’s Impact on the Brain ~ Neuronal pathways that are developed and strengthened under negative conditions prepare children to cope in that negative environment, and their ability to respond to nurturing and kindness may be impaired (Shonkoff & Phillips, 2000). ~ The brain is still forming these pathways until about 25 years of age. (Soldiers are 18—hmmmm) ~ Children and adolescents who experienced neglect often have: ~ Decreased electrical activity in their brains ~ Decreased brain metabolism ~ Poorer connections between areas of the brain that are key to integrating complex information ~ Abnormal patterns of adrenaline activity (i.e. Hypocortosolism) (National Scientific Council on the Developing Child, 2012). Trauma’s Impact on the Brain ~ Hippocampus: ~ Reduced volume in the hippocampus, which is central to learning and memory (McCrory, De Brito, & Viding, 2010; Wilson, Hansen, & Li, 2011). ~ Reduced ability to bring cortisol levels back to normal after a stressful event has occurred (Shonkoff, 2012) ~ Corpus callosum: ~ Decreased volume in the corpus callosum, which is responsible in part for arousal, emotion, higher cognitive abilities) (McCrory, De Brito, & Viding, 2010; Wilson, Hansen, & Li, 2011). Brain cont… ~ Prefrontal cortex: ~ Reduction in the size of the prefrontal cortex, which is critical to behavior, cognition, and emotion regulation (National Scientific Council on the Developing Child, 2012; Hanson et a
March 6, 2019
Working with Individuals Who Self-Harm To access the CEU/OPD/CPD course go to https://allceus.com/counselortoolbox in the US or https://australia.allceus.com/counselortoolbox if you are in Australia Objectives ~ Define self-injury / self-harm ~ Differentiate SSI from NSSI Self Harm vs. Suicide ~ Self-injury / Self-Harm ~ Any voluntary behavior that intentionally injures or harms the body ~ Some self-injurious behaviors are done for reasons other than suicide. ~ Distress-Tolerance/Emotion Regulation ~ Attention seeking ~ Absolution from demands ~ Suicide attempts involve a conscious intention to die. The objective of NSSI injury seems to be to relieve unbearable pain or sense of powerlessness (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4835048/pdf/pone.0153760.pdf) Differences Between NSSI & Suicidal Behaviors ~ Intent of NSSI is to feel better ~ NSSI methods are generally not lethal ~ NSSI is used frequently. Suicidal behaviors are must less common ~ The level of psychological distress is often lower in NSSI ~ People who are suicidal often see things dichotomously. Those with NSSI are less dichotomous ~ Aftermath of NSSI is often short term improvement BDSM and Body Modification ~ BDSM/Sensation play and body modification, while injurious, are not considered NSSI unless the intent of the action was to harm the body. ~ (DSM-5) still includes Sexual Sadism Disorder and Sexual Masochism Disorder as potential diagnoses. But a diagnosis now requires the interest or activities to cause “clinically significant distress …” (or to be done without consent). ~ In NSSI, people experience overwhelming negative feeling states prior to self-injury, then feel relief and distraction, followed by regret and shame. ~ BDSM practitioners feel excitement and anticipation ahead of time, pleasure during the encounter, and a sense of deep connection and a stronger sense of self-empowerment and authenticity afterward. https://www.psychologytoday.com/us/blog/standard-deviations/201610/bdsm-harm-reduction Myths ~ Only females self injure. ~ 30-40% of people who self-injure are male ~ It is a failed suicide attempt ~ Often NSSI is a means of avoiding suicide (but can accidentally escalate too far) ~ Self-injury is untreatable ~ Everyone who self-injures has BPD ~ Cutting is the only form of self-injury ~ People who self-injure enjoy the pain ~ People who self-injure are a danger to others Prevalence and Risk Factors ~ NSSI is most common among adolescents and young adults, and the age of onset is reported to occur between 12 and 14 years. ~ DSM-5 includes NSSI as a condition requiring further study. ~ Prevalence rates (7.5–46.5% adolescents, 38.9% university students, 4–23% adults) ~ High correlation with trauma and comorbidity with many other mental or physical health disorders https://www.frontiersin.org/articles/10.3389/fpsyg.2017.01946/full ~ Gratz et al. (2002) emphasized the role of parental relationship in the etiology of self-injurious behaviors: ~ Insecure paternal attachment and both maternal and paternal emotional neglect were significant predictors of NSSI within women ~ NSSI in men was primarily predicted by childhood separation (usually from father) Risk Factors cont… ~ NSSI is often an unhealthy approach to emotional regulation and distress ~ For approximately 90% of patients, NSSI decreases symptoms and/or aids in dissociation ~ Anxiety ~ Depressed mood ~ Racing thoughts ~ Anger ~ Flash-backs ~ NSSI may generate desired feelings (power, control, euphoria, “something”) ~ During periods of grief, insecurity, loneliness, extreme boredom, self-pity, and alienation, NSSI also may signal distress to elicit a caring response from others Risk Factors ~ High levels of negative and unpleasant thoughts and feelings ~ Poor communication skills and problem-solving abilities ~ Trauma via abuse, maltreatment, hostility, and marked criticism during childhood ~ Under- or over-arousal responses to stress ~ High valuation of NSSI to achieve a desired r
March 4, 2019
Learn about the Mathis Method developed by Dr. Jennifer Mathis to provide trauma-informed treatment services.
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