Author: Leaman Ralph

 This episode was pre-recorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through ALLCEUs. Register at ALLCEUs.com/CounselorToolbox. I’d like to welcome you to today’s presentation on the sociological approach to reducing risk and building resilience. As I was putting together This presentation it was kind of like right in the wake of when Harvey hit. And then you know recently we’ve had the shooting in Las Vegas, and some of the counselors, especially counselors in training that can’t be practiced independently yet that are in some of my social media groups and in my professional groups have been talking about how frustrating it is and even some of us who are licensed but just can’t wake up and go help the Red Cross right now about how frustrating it is not to be able to help and how much we want to help so what I usually do because you know I I’m generally not upwardly mobile where I can just drop everything and go to a crisis what I did after 9/11 was look at what things in that situation could I positively impact and how could I do it in a way that made sense but you know for my life because I can’t you know at that point I for 9/11 I had an infant at home and you know other stuff so we’re going to look when we’re talking about addressing issues like the opiate epidemic or the major problem of depression almost I guess anxiety almost one in four people has anxiety issues and we’re gonna look at some of that and try to figure out what can be done what can we do from where we are in a way that makes sense because yes we can influence politics and advocacy but what can we do with small chunks of time that are beneficial to helping the cause as well as you know could help the clients we have currently so we’ll define the socio-ecological not model which is Broth and Brenner’s model we’re going to apply it to addiction and mental health issues and explore different variables in this model and then discuss how this framework can be used in prevention and treatment of co-occurring or independently occurring disorders so we’re going to talk about how it may sense to conceptualize not only the development of addiction but also the development of things like eating disorders and mood disorders in terms of a socio-ecological model and even some things like bipolar and schizophrenia can be a person being genetically predisposed or whatever but there could be certain environmental factors that could you know trigger that first psychotic episodes so we want to look at what might be going on and how can we help prevent or treat now prevention can take the form of three different activities if you will prevent the problem so helping people not get depressed at all ever so starting to provide those skills and tools when people are knee-high to a grasshopper hopefully preventing worsening of the problem so people don’t get severely clinically depressed where they can’t get out of bed so the early intervention services and effective you know frontline resources and preventing associated fallout okay the person gets to press gets clinically depressed well let’s see if we can help them avoid losing their job because they can’t get out of bed to go to work develop additional health problems from being depressed or developing an addiction in order to self-medicate that depression so we’ve there are three different methods or avenues we can take in prevention and you know we want to look at them all because when you’ve got somebody who’s becoming clinically depressed you know they’re depressed you know situationally whatever something happened and it started to turn into something more than just a couple of days it’s going to start having associated fallout early and you know it’s not going to be huge they’re not going to lose a job right off they’re not going to start having major family problems right off but they are going to start having little hiccups because that depression causes an imbalance in their in their environment and we know environments like to maintain homeostasis and you know the kids are gonna be like well Mom why aren’t you getting up and doing these things and what’s going on and you know things are going to start changing and the person will need to be able to deal with that so the socio-ecological model explores and explains human behavior as the interaction between the individual and environmental systems there’s a fifth one that is more of your longitudinal but we’re going to talk about the four main ones today the micro the meso the EXO and the macro systems the microsystem involves well let’s start before that the individual if you look at the model is sort of the bull’s eye here and the individual is not considered a system but it involves all of the things about the individual including biology and personal learning that make people who they are okay so this person exists within a microsystem and that micro system is their family peers School Church synagogue whatever and health services things that they probably interface with regularly work should also be on that but it’s for some reason it’s not on this diagram anyway the mesosystem is the interconnection between microsystems so how do family and peers interact I don’t know about you thankfully my family might be very accepting of most of my peers but I know other friends of mine who brought home peers who were not as well accepted by their family so there was some conflict between the the family and the peers and we know how much peer pressure and peer relationships are important in an adolescents’ lives which creates conflict and consternation how does the family interface with school how does Pierce how does your peer group interact with school and do they see it as a good thing to do they see it as worthwhile you know etc so when we’re talking about the microsystem and the mesosystem we’re talking about things that people interface with daily so I want you to think about how the mesosystem and you can feel free to chime in on the chat room if you want how does the mesosystem family peer school church you know recreational activities health services impact the development of mental health or illness now you notice I’m trying to kind of switch ears for health because we want to promote health and we can look at the opposite for mental illness but you know if you have positive family peer interactions it’s probably going to support mental health it’s probably going to support decision-making in the adolescent it’s probably going to I mean and I’m thinking adults and adolescents here but family and friends you know if you want to think about you know how do you get along with your significant others peer groups and do they interface well or is it kind of like oil and water how does the how does your family interface with your work how do they deal with how many hours you have to work whether you’re getting called in at night or getting emails or text messages at 8 p.m. or you know what are their expectations and how does that influence if there’s a conflict you know if the family doesn’t like what’s going on at work or the fact that you know your boss is emailing you at 8 p.m. then it can create conflict within the environment which can lead to increased anxiety and depression and Yabadabadoo now how does mental health or illness impact the mesosystem so again thinking about how if someone is clinically depressed how does it impact their family how does it impact their peers and if you have a family member who has you know clinical depression or generalized anxiety how does it impact how your family interfaces with everything else because you know you end up having somebody or somebody in the family who may be caretaking for the person who has depression or anxiety or whatever the mental health issue is who’s not able to do the stuff that they were able to do so the rest of the families kind of pick slack so how does that affect how they interface you know the rest of the family members interface with school and work you know maybe they end up showing it more exhausted so it’s important to look at the mesosystem the exosystem involves links in a social setting in which the individual does not have a direct active role so for example how would I impact my spouse’s work and again if I am the identified patient and I’ve got clinical depression and I’m calling my spouse to come home because I just can’t be alone or my spouse is late to work or unproductive because he’s always exhausted when he gets to work because he has so much to do since I am you know not able to do as much right now then it could negatively impact his work and so we want to look at how that impacts how the home environment impacts work and how work impacts the home environment the macro system describes the culture socioeconomic status poverty ethnicity etc so what we’re looking at in the macro system is really the larger you know not just within your city maybe or even closer to your neighborhood we’re looking at what you see in the media what you see on national TV your your statewide elections your national elections your state laws and culture and what’s being communicated if you are a religious person what your religious culture communicates because you know religion generally is not just in one little area it’s international or national so what types of things does that communicate to to the person and how does that influence the development or not development if you will of depression anxiety or addiction so again think about how the exosystem of the social setting in which the individual doesn’t have a directive or an active role think about how much people were influenced after the elections I mean yeah we had a role if you went out and voted you had a role but you don’t decide the election so once that happens how do you know the exosystem impact you know your your emotions your other community events employment etc and how those things impact the family I know you know there was a lot of consternation and concern among some of my friends who are Jewish after the last election so their families experienced a high ink or a great increase in anxiety development of mental health or mental illness how does all this stuff that’s going on in the exosystem and stuff that you don’t have direct control over how does it impact the development of mental illness you know or mental health and we’re going to talk more specifically in a couple of minutes and again likewise how does mental illness or mental health impact the exosystem if you have a healthy workforce if you have healthy people who are actively participating in work and going to community activities voting to participate then you’re probably going to have a healthier outcome than if you have people who are not able I mean they’re so depressed they’re not able to even get out and participate so we want to look at the reciprocal nature it’s not one way the community doesn’t just affect us you know it may affect us but then how we react affects the community how does the attitude of the culture impact the community if you’ve got a a culture that is accepting of certain ideologies they’re accepting of LGBTQI they’re accepting of people who are Muslim in their religion they’re accepting of people who are Christian and their religion they’re accepting of you know fill in the blank if the culture is accepting of that how does that affect the community and those people within the community who might you know otherwise not have been accepting does it kind of pressure them in or does it cause anxiety and consternation in those people how does the attitude of the culture for example about premarital sex and marriage affect the family how does it affect the development of and again we’re thinking about anxiety depression and addiction so how does it affect the development of stress which may lead to mood disorders or problems and how did the community families and individuals with mental health or mental illness impacts the culture you know so we have an impact on our culture we get together we see you know we have Generation X Generation Y but the baby boomers all had their sort of or we all have our sort of unique cultures and things that we bring to the table and things you know that was given to us we said no we don’t want to thank you very much so there is a give-and-take among the individuals within the culture and that’s good because that means we can start small you know start in our locale and create this positive mesosystem and then build from there if If you have a positive community then that’s probably going to spread think about when a company goes and dumps fertilizer for example into a waterway it doesn’t just stay there over time that fertilizer bleeds out and you start having algae blooms everywhere things don’t stay I mean in our society things don’t stay in one place for very long they tend to move they tend to migrate so positive will migrate that’s awesome negative can also migrate so we want to look at how can we enhance the positive migration and keep down the negative if you will so now let’s start talking about what can we do and how can we operationalize all of this we realize that if we affect the individual it’ll have a positive effect on the meso system which can have a positive effect on the exosystem Yabadabadoo so great we also realize that one of the only things we have a lot of control over is the individual ourselves so a lot of people come to counseling individually score so this is where we’re going to start so what things contribute I start by listing risk factors for the development of mood disorders and addictions and then we talk about capital you know what you have in order to you need to have to prevent these things and then prevention strategies so that’s kind of how we’re going to go it’s not going to stay depressing individuals with chronic pain are at higher risk of mood disorders or addiction addiction because of the pain management you know drugs that are out there and you know once they start taking payment management drugs opiates a lot of times the brain quits producing endogenous opioids the natural painkillers so when they first come off the body doesn’t automatically pick up so it takes a little while for the person’s pain tolerance to build back up which keeps some people from wanting to get off the medication among other things but chronic pain can also be debilitating it can make people lose some abilities that they used to have or crush some dreams if you will you no, I think I’ve told you before that I have a bad shoulder and carpal tunnel so I can’t garden the way I used to you know I still go out and do it but I’ve got to pay attention and only be out there for an hour too instead of spending six hours out on the farm which is frustrating to me it was only mildly frustrating but my grandfather when he started developing Parkinson’s couldn’t make his miniatures anymore and he made gorgeous miniatures and I know that’s not chronic pain but it’s kind of the same thing if you’ve got rheumatoid arthritis he couldn’t make his miniatures and he became devastated and became withdrawn so understanding that pain has multiple influences that can cause depression that may trigger a grief reaction that we need to help people address now the things I put in bold are things that we as clinicians can easily help people prevent or/or address chronic pain we can help For people with low self-esteem that’s a no-brainer if people don’t feel good about themselves and they’re looking for external validation they’re going to be at a higher risk for anxiety fear of abandonment fear of not being good enough fear of failure and depression a sense of hopelessness and helplessness substance use especially early substance use can cause changes in the prefrontal cortex leading to problems with impulse control and decision-making but it can also disrupt the balance of neurochemicals leading to symptoms of depression and/or anxiety so it’s important to understand that especially the earlier the substance use starts the greater the chance that it’s going to cause some sort of brain changes and we’ve also found that a lot of people, not the majority but there is a percentage a significant percentage of people that when they start using early they kind of quit developing coping skills after that they find something that works they’re like oh I like this I think I’ll use that from now on when we start talking about people who started drinking or smoking marijuana when they were you know 9 10 11 12 you might see more mood issues or addiction issues in those people than people who didn’t start using mood-altering drugs as early as a history of abuse can contribute to the development of PTSD but not everybody who is abused develops PTSD but there can be episodes of anxiety and depression as well as it increases the chances of the development of addiction genetic vulnerability we know that mood disorders and addictions tend to run in families and they’ve done studies that have shown that there is a genetic component doesn’t mean it’s going to happen it just means you have this gene there that could be triggered so we don’t want we want to make sure that clients know that they are not just doomed you know they can prevent triggering that but they need to be aware that they may be more vulnerable inappropriate coping responses if we are not born with coping skills so if somebody doesn’t know how to cope with life on life’s terms because either because they’ve always been shielded or because they’ve never had anybody helped them maybe they were kind of on their own from the get-go so they learned to lash out and get angry or withdraw and get depressed but they never really learned how to deal with the stuff they’re gonna be at higher risk of mood and addictive disorders we can help people develop coping responses are one of the things you want to look at when people are using seemingly unhelpful behaviors is to remember to ask what is the cause of this so we want to look at what is the root cause of what is prompting this behavior and what is the benefit of the current behaviors and I’m going to keep reminding you of that as we go through this violence and aggression you know again what’s the cause of the violence and aggression did people do this person learn that’s how you cope with distress in their family of origin is it a protective mechanism because they’ve experienced situations where that has helped them deal with conflict before what prompts this and what the benefit to it when they act out when they’re violent and aggressive what is the benefit it gives them power it pushes people away they just enjoy hurting people hopefully that’s the minority but we want to ask that because we can’t figure out an alternative until we know what the function is same thing with risk-taking and impulsivity there are certain theories that says some people need more stimulation than others they get bored easily so they tend to be higher risk-takers and maybe more impulsive than you want to ask if this person doing this you know I have a friend who is an adrenaline junkie you know skydiving rock climbing you name it he’s done it and you know more power to him I don’t see a purpose of jumping out of a perfectly good airplane but he he thrives on that and when he can’t get out and do those sorts of things he feels good so what is it about this risk-taking and what kind of risk-taking it risk-taking as in holding a balloon liquor store or is it risk-taking as in doing something like skydiving which is theoretically safe and what’s the benefit it makes gives them a rush makes they feel good helps him you know escape or whatever great that’s fine the rebellious nests you know again what is and this is a key for adolescents especially but even if you’re a supervisor working with employees if they’re being rebellious you want to look and say what’s the point what’s the benefit to being rebellious what are they holding on to and refusing to let go of that you want them to let go of or what are they refusing to do that you want them to do and what’s the benefit to it if they are being rebellious and they’re staying like think again adolescents staying out all night OK well what’s a motivating factor is it to get under their parent’s skin probably not is it to conform to peer pressure you know oftentimes that’s maybe the case but you have to look at the individual and say ok how can you do this in a way that helps you move forward rejection of pro-social values if the people who espouse the pro-social values are the people that the person rejects then they’re probably going to reject those values so we want to look at you to know if you’re rejecting those what values are you espousing and why are those important to you and why are you rejecting these over here you know not saying it’s right or wrong I’m just trying to understand where you’re coming from and you know that’s something that we’ve got to be sensitive to and different people are going to hold different values lack peer refusal skills to stay out late to get into trouble to use drugs to have early sex whatever it is those things a lot of times indicate poor communication skills and low self-esteem need to be accepted you know all that stuff that’s challenging during during teen and early adolescent years those are things we can help with being bullied you know that’s a risk factor when people are bullied they tend to get depressed and when they’re bullied they may turn to substances to try to make themselves feel better to numb the pain they make self-injure there’s a lot of different things might happen we can help people develop skills to deal with being bullied since we don’t understand a hundred percent why people bully we need to help the victims become survivors we need to help them have the tools to be able to deal with it and understand why it happens without letting it hurt them early and persistent problem behaviors that’s just so broad but again look at why the person’s child acting out an early sexual activity could be a history of sexual abuse could be a dysfunctional family of origin and the child is trying to get out I worked with a 14-year-old who once told me she was gonna get pregnant as soon as she turned 15 because that’s when she could get into housing on her own so she was intentionally going to get pregnant at 15 and there was a reason for it she was very clear about her logic a lot of times it’s peer pressure and acceptance but uh asking what is that what is the cause and is this cause going to keep the person from developing healthy coping skills and being happy is potentially going to lead to depression peer rejection you know that hurts so helping people figure out how to navigate peer rejection because you’re not going to be liked by everybody academic failure we can help with now not necessarily as clinicians but we can advocate for the person we can help them find tutors resources etc lack of information on positive health behaviors put it out there most of the time youth these days have a pretty good idea of what’s healthy and what’s not they just aren’t motivated for it they’re motivated for something else when addictive behaviors are you used to cope with stress or unpleasant feelings I said coping skills may fail to develop or when they’re used to enhance self-confidence such as drinking before going to a party then they may start to develop anxiety and self-consciousness when they don’t have a drink on board so it may start prompting the development of some mood disorders in addition to the fact that repeated use especially in a young brain can cause some neurotransmitter imbalances using addictive behaviors also to enhance other experiences ties it to those experiences making them person more likely to use those and similar situations desensitizing the brain’s pleasure centers so what am I what do I mean I mean if you typically drink when you are watching football then you’re going to be more likely to drink every time you watch football it’s just one of those things you do when you watch football if you’re one of those people who eat when they watch TV then when you watch TV you’re more likely to eat when you go to the movies because that’s a similar situation you’re more likely to want to have popcorn or eat so it’s important to understand that with addictive behaviors if you have something that produces pleasure it can be triggered you know the person can start thinking about it in a similar situations using repeatedly can cause neurochemical imbalances in genetics you know you can’t be born with a neurochemical imbalance not enough serotonin too much whatever and poor health behaviors as I’ve talked about a bunch of times not enough sleep quality poor nutrition and high stress can also cause neurochemical imbalances so we can educate people about some of the things that can cause depression and anxiety so they can prevent it we can educate parents so they can start coaching their kids from the get-go so personal recovery capital to develop what we need to be happy and healthy human beings we have to have certain things to help us along the way we need to have the things to enable us for physical health think about Maslow’s pure hierarchy bottom level is all your health and biological needs we need to have our physical health and that includes nutrition Slee and you know not being in pain all the time sometimes you’re gonna feel pain that’s being human that’s being alive but we need to have our health for the the most part we need to have financial assets to get our basic needs met you now get that food keep clothing on our back transportation roof over our heads health insurance and access to medication and there are two different things health insurance covers theoretically going to the doctor and the mental health counselor etc access to medication is not covered under a lot of insurance so remember that most pharmaceutical companies have patient assistance programs that can help clients access their medication if they can’t afford it because some medication is a really expensive safe housing conduct that’s conducive to recovery and that’s not just addictions if you’ve got somebody who is clinically depressed or highly anxious living in a radically dysfunctional household where there’s lots of yelling or arguing or other people who are similarly dysfunctional it’s probably not going to prompt those positive cognitions and mindfulness and everything that we’re trying to establish doesn’t mean they can move unfortunately a lot of people can’t so we got to talk about how can you create an area in your housing environment that’s safe people need to have adequate clothing to stay warm to be able to dress for work and you know go to their job and be dressed appropriately and transportation to get their needs met most of us don’t live in a city where we can just walk but walking I guess is a form of transportation we need to be able to access the resources that are out there whether it be food or going to work so we can pay our light bill or whatever it is values awareness people need to know what’s important to them to figure out what they need to do to be happy a sense of purpose helps people keep going and we can help people with this I mean these are easy exercises when you give them a values activity worksheet you know what are your top five values when you look at the sense of purpose what is your purpose in life and a lot of us don’t know but we know what we want it to be or we can start theorizing about what is the purpose of what I do as a job on a day-to-day basis, what is the purpose of this activity that I’m doing so they can start to see some meaning in the stuff they do we can help people develop hope and optimism and we’ve talked about that one people need to have a perception of their past present and future they need to be able to look over the past and it may suck or it may be great but they need to be able to look back over it and go yep that’s it they need to be able to look at their present and realistically assess what they’ve got and maybe what they don’t have but realistically assess what they’ve got and look at their future and go where do I want to go from here because you’re here and you don’t want to stay here forever you can’t stay here forever because times gonna move on what next people need to be able to see but understand that they’re not necessarily controlled by their past or stuck in the present that they have the ability to make choices every single moment to work toward what they want for the future education training and job skills people need to be able to make a living that’s just the way it is you need to be able to feed yourself and put a roof over your head so we can make referrals to job training agencies we can make referrals to social service agencies problem-solving skills interpersonal skills and self-esteem are all things that we are super skilled at teaching and we can teach these in chunks they don’t have to be these long groups don’t have to be big drawn-out sessions we can provide people snippets you can provide somebody with the concept of distressed tolerance and the improve acronym in a handout and have them look at that or in an email you know if you email your clients once each day or on your blog there are a lot of different ways, you can just get that information out there and in front of people so I can look at it I call I tell my clients it’s bathroom reading you know I usually give them a handout or two and I just put it on the back of the toilet and when you’re in there you know take a look at it if it’s useful great if not bottle it up and throw it in the the trashcan I’m good with that but there’s no pressure and I’m not putting extra assignments on them I’m just providing information about a skill and then if they want to pursue it further when they come back to counseling we can talk about it so what can we do we can promote positive health and wellness behaviors by educating people about why they’re important and what to do and where to find more information you know because some of these things like nutrition we can’t be prescriptive but we can point people in the direction of where to get good advice and information and we can also model this you know in our treatment plan at least in mind I try to make sure that people are putting a print emphasizing getting enough quality sleep eating well and maybe exercising at least moving around if they don’t want to call it exercise but taking care of themselves and getting some relaxation and recreation in their bonding to a pro-social culture is difficult for us to do for people or do with people we can talk about what are your hobbies what are things that you enjoy doing and encourage people to try out volunteering or get involved in meetups to engage in activities with other people but that’s something that they’re going to have to do on their participation in extracurricular activities again kind of the same thing we can point them in the right direction of volunteerism meetups things through their through their church or their synagogue or their you know whatever clubs that they’re involved in positive relationships with adults now obviously this is more important if we’re working with children or teenagers we want to help children and teenagers kind of see where adults don’t have their head that far in the ground but we also want to help adults learn how to more effectively communicate with teenagers because a lot of adults lecture at and I know this and you’ll you’ll understand when you’re older and you know lots of that kind of stuff so things that we can do to enhance relationships with adults is to educate people about you know how to effectively communicate with teenagers for example who are trying to find their way and trying to assert independence and resisting some rules how do you deal with that how do you communicate with them in a way because a lot of parents have difficulty navigating that boundary between friend and parent so we can help with that active workshops in the community workshops you can do at churches at libraries those are things you can do there you can put them on for like an an hour once a month it’s good if you’re it’s free but it’s a good promotion for your practice if you know you go out and do it and people come to learn something from you, they’re like hey that might be helpful social competence it’s another one of those things that we can do in little snippets we can provide tips and tips and tools whether infographics on an Instagram page are really useful for a lot of teenagers they want something that’s you know in a picture and fast it’s a snapshot so social competence checklists are another really good thing if you’re teaching different types of skills for communication or how you’re supposed to use different forks I know the first time I went to a formal dinner I was looking at all the silverware going I have no idea what to do with this stuff the sense of well-being and self-confidence we can help people develop this by encouraging them to focus on what they do well we want to make sure they have plans well that means goal setting and since a lot of people don’t know how to goal-set they don’t have goals, so they’re just kind of floating out there not looking at the future we want to help people look at the future and figure out how they’re going to get there so they’re like wow this is doable this is attainable this is another thing you can put work put worksheets on your website you can do short workshops to help people figure out how to look at how to define or learn how to define a rich and meaningful life and figure out how they’re going to define their goals and achieve their knowledge about risks associated with addictive behaviors now a lot of kids you know think back to the old dare programs I had a lot of clients tell me that those programs only taught me how to you safely I was like well that’s not what they were intended for but we do want to educate youth about you know still about the risks of some of those drugs and even adults not just youth educate people about how dangerous or how potentially addictive opiates for example can be after three to five days your body has already started to build up a tolerance that’s kind of scary so helping people understand that but also addictive behaviors like pornography a lot of teens don’t think about it a lot of adults don’t think about it until they’re stuck in it or online gambling you know those are some things that can kind of catch people unawares because they didn’t think about it wasn’t a substance we typically think of addictions as substances since it’s not a substance they didn’t think about the effect that the pleasure from those activities were going to have on our neurochemicals and create a a situation where they didn’t feel okay they didn’t feel normal they didn’t feel happy without having that in their life because their dopamine receptors had been blunted individual prevention strategies the big summary is we want to promote attitudes beliefs and behaviors that ultimately provide the person with healthy coping skills whether it’s through health class whether it’s through workshops I know at organizations I’ve worked at before the Jaypee would come in and do periodic workshops that’s a great way to connect with people and reduce utilization if you do psycho-educational prevention group because an ounce of prevention is worth a pound of cure we want to make sure that they’re aware of positive health behaviors and how to access those resources in Gainesville I don’t know about up here but I know in Gainesville the mall used to open at six o’clock in the morning so people could walk inside in a safe place and you know be out of the elements and yadda-yadda so just letting people know that that existed was a big step because they were like well I don’t want to join a gym and go to the mall with effective interpersonal skills we want to make sure people know how to effectively communicate set boundaries all that stuff that we talked about this can be taught it’s nice if your local news is willing to use you to do you know wellness minute I find one of the best places to do that is either right before or right after the weather because most everybody Tunes in for the weather, I may not stick around for the animal of the day or whatever well I always do but I’m always tuned in for the weather so if you get either right before or right after that you tend to get higher viewership and reach more people and a minute gives somebody a chunk of something that they can use today-specific approaches may include education and life skills training in schools you know is provided to the kids and have them share it with their parents through the media and community center or library workshops those are all great ways to get stuff out I encourage you if you want to get into providing prevention and helping to help your community helping people to prevent getting depressed or anxious or developing other problems to look at doing some of these very time-limited things because you don’t want to lose a lot of billable hours but we still want to be able to do more than we’re doing at least that’s what a lot of a lot of us tend to feel like the mesosystem so we’ve been talking about the individuals so far because that’s where we can have the greatest effect the mesosystem examines close relationships that may increase the risk of experimenting with high-risk behaviors or developing mood disorders people’s closest circle of peers partners and family members influence their behavior and contribute to their range of experience if you’ve got a child that grows up in a household where the parent or parents are clinically depressed they’re not able to model effective coping skills where they model cognitive distortions guess what jr. Is gonna pick up if you are in a household where you know you’re in college and you’ve got four other roommates and all of your your other roommates tend to be negative and naysayers you’re either probably going to move or you may that might start wearing off on you a little bit likewise if they are you know all kinds of go-getters that can wear off on you too so you know there’s going to be an impact risk factor is peer and family reinforcement of negative or unhealthy norms and expectations so if your family says you know people suck they’re always going to take advantage of you what are you going to take away from that and is that going to contribute to you probably having difficulties with trusting and maybe developing depression possibly so we want to look at what kind of messages is the peer group or family sending to the individual that may contribute to the development of mood or anxiety disorders early sexual activity among peers could communicate that well this is the norm so everybody’s doing it ties to deviant peers and gang involvement you know especially at that particular group there’s a lot of pressure to conform or there’s a negative consequences family members who don’t spend much time together and this could be because parents work a lot this could be because everybody’s you know involved in all kinds of other stuff but they found that when families are disengaged the parents tend to miss out on subtle cues when families are disengaged even if they don’t have children in the mix that there tends to be a weakening of those bonds supportive bonds so people are at higher risk for development of depression and anxiety because they don’t have that you know everybody’s behind me sort of feeling parents who have trouble keeping track of youth can indicate that the youth may be at risk for developing substance or more mood disorders lack of clear rules and consequences you think about even just being at work when there’s a lack of clear rules and consequences you don’t exactly know what you’re supposed to do I know for me that creates doodles of anxiety I like manuals and to date pretty much every job I’ve ever taken I’ve walked in and there hasn’t been a manual and I’ve been like okay there must be a manual written and that’s been my first thing now I’m kind of on the structured side so I don’t expect everybody is that way but most of us tend to experience a little bit of anxiety about failure about acceptance if we don’t know what’s expected so it’s important whether it’s a family or a job situation to make sure there’s clear rules and consequences you know what’s expected and what’s going to happen if you mess up or if you don’t meet this expectation there also needs to be consistent expectations and limits you know when people especially children but a lot of us tested our limits when we were kids and even as adults you know I know you know going back to working in organizations I would have staff who would test limits and see how long they could go without turning in a progress note before I’d be knocking on their door going paperwork it’s natural for people to kind of test limits especially with stuff they don’t want to do stuff that’s not rewarding family conflict and abuse can cause a high risk of depression and anxiety whether adults or children I mean if there’s a a lot of conflict and chaos it’s exhausting and it can cause a lot of dysphoric emotions and loss of employment that’s kind of self-explanatory protective factors close family relationships so as clinicians we can encourage people to identify who they consider their family it may not be their blood relatives or their family who are there for them who can they call it 2:00 in the morning and how can they nurture those relationships encourage people to develop relationships with peers that are involved in pro-social activities like hiking or volunteering in the community consistency of parenting is important in terms of producing children who are who are stronger healthier more resilient encouraging education and parents who are actively involved can help prevent future depression because they’re creating children who can join the workforce and have that individual capital to prevent depression and anxiety and cope with stress positively and this is a family protective factor and a peer for protective factor why because we learn from observation so if our peers cope with stress positively by prayer or exercise or whatever it is they do and our family has other positive ways of coping with stress and we’re going to have a greater venue of stuff to choose from supportive relationships with caring for adults beyond the immediate family is encouraged so we want children to grow up being able to interact with teachers coaches with you know Scout leaders whomever and start seeing that people outside of the nuclear family are trustworthy sharing and family responsibilities including chores and decision making and that’s true for children teenagers and even adults you know if you’re living in the same household it important that everybody feels like they have a say in what’s happening and participates in the upkeep of the family environment and family members are nurturing and support each other and this is one where I tend to stop and I do a love languages little mini class to help people remember that we don’t always experience nurturance in the same way so understanding one another’s love language is really important to be able to nurture in a way that’s meaningful to that other person peer and family interventions are designed to identify norms goals and expectations in the family foster family problem-solving skills so there’s not just one person always fixing it develop structure and consistency within the family unit promote healthy relationships and engage peers and family of choice in the recovery process so if somebody’s already depressed we need to be able to hopefully engage everybody that’s involved in this person’s immediate environment in helping them move towards recovery and you know preferably not dragging them back down so we want to engage them and make sure that people have a supportive others school and work risk factors lack of clear expectations both academic or performance-wise and behavioral lack of commitment or sense of belonging at school or at work if you just kind of go and you feel like a number you punch in punch out that may not make you feel appreciated which can contribute to depression and you know just bad feelings high numbers of students failing academically at school and work translates to high amounts of turnover if you never know who’s going to get laid off it increases stress and anxiety and parents and community members who are not actively involved in keeping kids in school and helping make sure that the workforce workforce is strong but we want to make sure that people have access to how when it’s needed we want to make sure that people have access to tutoring in school if they need it to prevent failing school they have access to transportation to get to work now those are things those are meta concepts that are more on the community level but it’s important that as a community member you know we look at different things that we may be able to participate in advocacy and say you know it’s really important to get a bus system going I live out about 30 miles east of Nashville and we must have the the train that goes from my city out to Nashville so people have access to more jobs so that was important for us to get past the City Commission protective factors school and work positive attitudes gotta find a reason why you’re doing this you know and sometimes it’s hard to find a reason for algebra but we need to help kids find a reason for that we need to help adults find a reason for why they’re going to work why are they doing what they’re doing regular attendance shows you know it is associated with higher mood less less risk of mood or addictive disorders because you’re able to get up and do it and interface with people and get that social support hopefully from your colleague’s high expectations are communicated effectively in setting and positive social development is encouraged you know whether it’s at work or at school, there are goals there are things you’ve got to accomplish there are performance objectives but we also want to encourage morale and positive social bonding whatever the setting having a positive instructional climate again whether at work or school, I know we learn things when we’re on the job we learn things and I don’t want people to feel like they’re having difficulty like they’re stupid I want people to feel like anything that we teach them as a challenge and something that may be beneficial down the road leadership and decision-making opportunities are really important again for students or employees to prevent burnout keep morale up reduce anxiety and increase a sense of personal empower and connection and active involvement for everybody is fostered and the school or organization is responsive to the student’s needs making sure that in school in the case of school they have access to tutoring resources it’s a safe environment for them to be in and the children that are going to that school have enough food in their bellies you know they can’t learn if they’re hungry all the time workplace is a little bit different but we still need to be responsive to people’s needs in terms of you know family requirements whether they need to if they’re going back to school shifting schedules a little bit we need to try to work with people instead of being completely rigid and it’s my way or the highway when possible to promote the best mental health characteristics of settings in which relationships are often associated with the development of mood disorders and addictive behaviors so we want to look at the characteristics of schools that are they safe are they positive environments are they cheering squads or are they places where people know they’re gonna go and get thrown under the bus same thing with workplaces you know when you walk into a place you get most of we get a sense and you’re either like oh this is a cool place to work or oh I can’t wait til I can get out of here you know we want to go toward the other end and neighborhoods when you go into a neighborhood – people take care of their environment do they or do they have trash strewn all over their lawn all of these things communicate how people feel about their environment and generally how they feel about themselves and whether they have the energy to take care of stuff or they just feel completely disenfranchised and don’t care more about community risk factors no sense of connection to the community neighborhood disorganization rapid changes high unemployment a lack of strong social institutions lack of monitoring of youths activities imbalanced media portrayals of safety health and appropriate behavior misleading advertising and alcohol or drugs readily available a lot of stuff we do we’re not going to be able to affect on the community level so much but we’re gonna hit them real quick we want to improve the climate process and policies within community schools and workplaces to make it safe and promote positive health behaviors prevention strategies are designed to reduce social isolation reduce and address stigma increase awareness of local recovery models you know who’s out there that has recovered and can serve as a role model improve economic and housing opportunities so people have a house a safe roof over their head and they can you know earn money and feel good about themselves increasing the accuracy and improving the positivity of media messages and increasing physical and financial ability availability of recovery so like I said I live in a little town so it’s nice that we have a community mental health center here so people don’t have to rely on going into Nashville but also making sure that services are financially available whether you have a free clinic once a month or you know make sure you’ll you take Medicaid but there are still a lot of people who have no insurance so where do they go the socio-ecological model identifies how the end the individual impacts and is impacted by not only his own characteristics but also those of family peers community and culture prevention takes the form of preventing the problem preventing the worsening of the problem and preventing associated fallout like I said as clinicians a lot of what we’re going to do is target the individual providing them with resiliency skills to deal with some of this adversity that might be around them and to help them sort through some of those media messages and go yeah that’s not even true you know if I drink this vodka I’m not suddenly going to have 14 supermodels hanging on me or whatever it is that’s being communicated so encouraging people to be informed and Wylie consumers any change in the the system will affect other parts of this system so if it’s a positive change is probably going to have positive changes negative has negative changes addressing addictive and mood disorder behaviors require a the multi-pronged approach we need to look at the individual and you know provide provide as many skills as possible there because that’s where we’re going to have a lot of our impact especially in prevention but we also need to realize that this person resides within a family you know whether they live alone which sometimes is less problematic or they live in a household with other people, we need to make sure that where they lay their heads at night where they spend their non-working hours feel safe and is conducive to recovery where they work or go to school also needs to feel safe and be conducive to recovery and that’s part of the community so we need to kind of look at these areas and if they aren’t safe or they don’t feel safe or aren’t conducive to recovery, we need to help people how to figure out how they can fix that or address it like I said they may not be able to move so what can you do to set some boundaries to create as much safety as you can how can you do this and there are a lot of different techniques that I’m sure you already have that you used to help people but it’s important again not to just focus on the individual because they don’t live in a bubble we need to look at everything right and are Are there any questions now we have or I have added a Wednesday class, so you don’t don’t have to come but if you have unlimited membership same time same station Wednesday so Tuesday Wednesday and Thursday we have a class from noon. CST 1 p.m. EST 2 for an hour all righty I will talk to y’all maybe tomorrow maybe on Thursday have a great day if you enjoy this podcast please like and subscribe either in your podcast player or on YouTube you can attend and participate in our live webinars with Doctor Snipes by 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