Author: Leaman Ralph

Really sugar is shaky because it originates from a straight stick see the play is Granny yes Grandma plus new style luv MaryJane so listen (Granny Apple last years blue ribbon production winner AKA) I, I, I ain't on the right side of my house Jane something or the other is in my room: finally after an extermination Grannie speaks once more "let my (old man) Pacman step on it". See it is home on the range so solo as it be truity speaks got a problem it is your own. But alter scenario: Z/n time; narcotics I got that candy s.p.ee..d360 Bar itch its' and Mickey Mouse for the Sultan 7 1 4er well a hem a hem, it went early in the morning like a smack chanting sugar structure 7 -one 1 +eleven and 4 do an ate 'er 8 eight 'er? Well that aint nice. NARCO says do you know them numbers change (response) Yes it is a FiX they are MF's Ope yeah Ope Douglas is it. Surrounded by Alkaloid is both Mary and Grandma in an never ending circle of membership. French mandates declare put up their dukes... ZEN Pepsi can talk half Chocolate and your ole man Pacman down in Cuba posing as the worlds one and only Coffee Wizard "back 1:1" tis Coffee time... ||

How to stop palpitations without medicine II Palpitation को बिना दवाई के तुरंत कैसे ठीक करे Hindi

  Hello everyone Today we will discuss how to stop palpitation immediately without any medicine , and equipment Now first of all what is Palpitation unpleasant sensation of own heart beat In some types arrhythmia neck vein pulsations also seen clearly with palpitations There are many causes for palpitation Most of cause are simple Like anemia or low hemoglobin Anxiety, stress, these conditions released adrenaline Which causes palpitation Or overactive thyroid and pregnancy If you take heavy caffeine, coffee, alcohol and smoking Or taking some drugs like cocaine and marijuana all increased palpitations Some palpitations have serious causes Like Heart related factors which increased palpitations Heart failure, valvular heart disease, mitral valve prolapse and cardiomyopathy palpitation is serious 4 easy ways/methods to stop palpitation immediately anywhere, anytime First is valsalva Maneuver It stimulates vagus nerve Vagus nerve is connected to heart and brain And as soon as vagus nerve stimulates it decreased heart rate and palpitation finger and thumb Then close your mouth also Then forcefully exhale outside, means breath out while your nose and mouth both closed This Maneuver you do for 10-30 second This valsalva Maneuver increased your intrathoracic pressure Which stimulates the vagus nerve and your heart rate will come down Second method is coughing You do forcefully coughing, As you do forcefully coughing it increased your intrathoracic pressure And bring down your heart rate and palpitation Third method is Deep breathing Deep breathing is simple method to break or stop heart palpitation It also decreased your anxiety and panic attacks And increased oxygen supply to brain To perform Deep breathing you sit comfortably at one place Then take deep and shallow breathing through your nose Then exhale slowly slowly through mouth This procedure do continue for some couple of minutes till your heart rate become normal Fourth method is cold water When you feel palpitations wash your face with cold water Or splash cold water on your face Or take shower or bath in cold water Very simple is to keep ice cubes in towel and Apply on your face, it stimulates your vagus nerve and decreased your heart rate and palpitation So these four are very simple method by which you can break your palpitations In these maneuvers no need any medicine or equipment Thanks   As found on YouTube This solution reverses kidney disease! Guaranteed to be effective or your money back: Beat kidney disease. Just by following a simple treatment plan, you can reverse kidney disease. No matter how old you are! Just listen to what people who have tried this solution have to say. “Thank God I came across your solution by accident! Dad’s kidney function decreased from 36% to 73% in just two months. He’s 90 years old! His doctor said people his age shouldn’t have kidneys that efficient!” Graeme Asham, QLD, Australia, And this… “No more dizzy spells! My creatinine has gone down from a staggering 1800 to 1100. My blood count has greatly improved and I’ve been taken off my blood pressure medication. Your solution really works! ” Joe Taliana, 55, Malta Simply follow the scientifically backed solution and restore your kidneys, fast! => This solution reverses kidney disease! ← https://www.facebook.com/100000332115031/videos/590895892954739/ яαℓρн ℓєαмαи

Should You Take Xanax For Anxiety? (Benefits/Side Affects)

  Alprazolam also known as Xanax, belongs to a group of medications called benzodiazepines Benzodiazepines act on the brain and central nervous system, CNS to produce a calming effect, People use and take Xanax to help them with their anxiety and panic disorders. Xanax is the number 1 prescribed psychiatric medication in the United States.   If you’ve been prescribed Xanax for your anxiety or panic disorder, you may feel normal after your first dose.   You may also feel relaxed, quiet, or tired, depending on your dosage.   Xanax is prescribed in doses that are available in milligrams depending on the symptoms.   You experience anxiety or panic disorder.   You may be prescribed a high or low dosage.   The dosages are 0 25 mg, 0 5 mg 1mg, and 2mg.   The effects of Xanax become more significant.   The higher the mg you take.   Doctors always recommend that first time, Xanax users start with the lowest possible dose until they know exactly how it will affect them. Higher doses can be fatal and you should never take more than what your doctor has prescribed.   The effects of taking Xanax should be mild, but detectable.   If you experience any of the following symptoms, you should seek medical attention immediately: Extreme drowsiness Muscle weakness, Confusion, Fainting, Loss of balance, and Feeling lightheaded Xanax is taken orally and absorbed quickly into the bloodstream.     Some people experience the effects of Xanax within 5 to 10 minutes of taking it, and everyone should feel the effects of it within an hour.   Why Xanax is so popular for people struggling with anxiety and panic attacks during a panic attack or anxiety attack.   You can take a Xanax and within a few minutes you should start to feel the symptoms of your attacks fade away.   The effects of Xanax are brief.   Most people feel the strongest impact for 2 to 4 hours after taxing it.   However, you may feel a fuzzy feeling for several hours after that It s also possible to build up a tolerance to Xanax.   If that happens, then you may notice it takes longer for you to feel the effects and the effects may wear off more quickly. Xanax has a half-life of about 11 hours, which means by that time your body will eliminate half of the dose from your bloodstream.   So should you take Xanax for your anxiety, As you’ve heard, and seen in this video Xanax is extremely beneficial in removing the symptoms of anxiety and panic.   Attacks such as a racing heart feeling out of control and restlessness.   If you think Xanax could help you, please see a doctor and get a prescription, never self-medicate or take it recreationally. As found on YouTube This solution reverses kidney disease! Guaranteed to be effective or your money back: Beat kidney disease. Just by following a simple treatment plan, you can reverse kidney disease. No matter how old you are! Just listen to what people who have tried this solution have to say. “Thank God I came across your solution by accident! Dad’s kidney function decreased from 36% to 73% in just two months. He’s 90 years old! His doctor said people his age shouldn’t have kidneys that efficient!” Graeme Asham, QLD, Australia, And this… “No more dizzy spells! My creatinine has gone down from a staggering 1800 to 1100. My blood count has greatly improved and I’ve been taken off my blood pressure medication. Your solution works! ” Joe Taliana, 55, Malta Simply follow the scientifically backed solution and restore your kidneys, fast! => This solution reverses kidney disease! ← https://www.facebook.com/100000332115031/videos/590895892954739/ яαℓρн ℓєαмαи

9 Mental Disorders That Can Be Mistaken for Personality Traits

  Lily Hi there indistinct Before we begin, we would like to thank you for your support on our channel. Our mission is to help everyone learn about psychology in a digestible way.   Now let’s start Despite the growing number of online resources on mental disorders.   There’s still a lot of misinformation and stigma surrounding them.   Mental disorders are sometimes misrepresented and even glamorized on social media and personality traits can be mistaken for mental disorders or vice versa.   As such, this video aims to raise awareness about different mental disorders.   However, it should not be used to self-diagnose If you relate to any of the signs in this video.   Please seek help from a licensed mental health professional.   To avoid improper diagnosis With that said, let’s begin One perfectionism and OCD.   According to the American Psychological Association, perfectionism is the desire to achieve an extremely high level of performance, accompanied by overly critical self-evaluations and other people.’s, evaluations of you In people with the obsessive, compulsive disorder, perfectionism often manifests in compulsions, or the need to do something.   Like organizing things in a particular way or repeatedly doing something in a way that disrupts their normal life, Unlike perfectionism in typically functioning people or people with anxiety or major depressive disorder, people with OCD are perfectionists in response to the obsessive part of their disorder. Failure to follow through with perfectionist compulsions often leads to feelings of anxiety, panic, or a sense of doom that can harm their personal life and relationships As such.   Praising people with OCD for their perfectionism or attention to detail can be harmful because it negates the uncomfortable and fearful feelings that motivate their actions.   Not only that using the term OCD to describe a perfectionistic typical functioning person, downplays.   The struggles of people who are diagnosed with OCD Two procrastination and major depressive disorder.   While procrastination is a common trait, it can occur as a side effect of major depressive disorder or clinical depression.   Research has linked brooding and lower levels of self-compassion, with procrastination to factors that are also common signs of depression.   Other symptoms of depression that might cause procrastination are fatigue, difficulty, concentrating restlessness, and feelings of hopelessness or emptiness.   It can be difficult for those experiencing a depressive episode to be productive because even small tasks like getting out of bed to take a lot of energy to accomplish Those who don’t understand how it feels to have depression may label those with major depressive disorder.   As lazy or bad with time management, But their procrastination may stem from their disorder rather than their personality, Three suspicions, and paranoid personality disorder, While most people have jumped to conclusions or felt like they’re being watched at some point in their life.   When these suspicions are almost constant, they could be a sign of paranoid personality disorder. Symptoms of paranoid personality disorder include fear that people in your life are trying to harm you without evidence, extreme distrust and suspicion that others will use your words against you, reading malicious intent in people’s benign or indifferent actions towards you, and lashing out.   In response, Paranoia could also be a symptom of mental disorders such as schizophrenia or borderline personality disorder Because personality disorders affect parts of someone’s personality.   It may be even harder for people without a mental health background to distinguish between someone,’s personality and their mental disorder.   It’s important to have empathy in these situations and avoid telling people who have been diagnosed with these personality disorders that they’re overreacting because this creates a false narrative that associates paranoia with their personality, Four shyness, and social anxiety disorder.   Although there can be an overlap between shyness and social anxiety, shyness is a personality trait that is usually defined as hyper-awareness of other people.   Physical symptoms such as shaking and sweating, and quietness or withdrawal in social situations, While social anxiety is presented as more intense and distressing towards a person’s everyday functioning.   In addition, the basis of shyness comes from someone’s personality, while social anxiety stems from fear.   Shy people are usually aware of themselves in social situations and take a longer time to open up to and get to know others, but they don’t feel it as strongly or worry about it as much as people with social anxiety disorder.   Do Social anxiety can cause people to panic, as a result, they often avoid social situations, because it triggers fear responses and they might be extremely fearful of people’s judgments.   This anxiety goes far deeper than the discomfort that may come from shyness, Five egotism, and narcissistic personality disorder. You can probably think of a person who has talked themselves up and boasted about their successes at some point, But if this person vastly exaggerates their accomplishments, finds it difficult to empathize with others, and demand special treatment from everyone, including people of the same or higher qualification, They could be suffering from narcissistic personality disorder rather than an egotistical personality.   Six impulsivity and bipolar disorder.   Impulsivity is often seen as a fun and even desirable, trait, with self-help resources frequently encouraging us to switch up our routine, But in the case of bipolar disorder, impulsivity comes in the form of risky decisions that people with BD may later regret.   Impulsivity in people with bipolar disorder usually occurs during manic episodes heightened moods that typically come with increased energy, multitasking and irritability, and an increased risk for dangerous or harmful behaviors.   Examples of impulsive, behaviors, someone with bipolar disorder might do are spending sprees, gambling, reckless driving, unprotected sex, drug use, or binge eating and drinking, And although movies and TV shows often portray these actions as exciting, the real-life consequences include financial loss relationship, conflict property damage, health Complications and even death Glamorizing them takes away from what someone with bipolar disorder might be experiencing as a result.   Seven distractions and ADHD ADHD is a mental disorder that involves three types of behaviors inattention, hyperactivity, and impulsivity.   People who are diagnosed with ADHD may have one or a combination of these signs.   People with inattentive ADHD, often forget things, have trouble, concentrating on a single task struggle to be organized, and have difficulty paying attention to others For a person who is less educated about ADHD.   They may take negatively to a person with inattentive ADHD for not listening to them or caring about them when, in fact, their disorder makes it difficult for them to pay attention without getting distracted by their thoughts or external stimuli.   Eight attention-seeking and histrionic personality disorders. There are many reasons why someone might seek attention or validation from others, including low self-esteem, self-doubt, and trust issues.   But if someone is a part of the two to 3 of the population diagnosed with histrionic personality disorder, their need for external validation goes beyond seeking reassurance.   People with histrionic personality disorder can feel worthless or undervalued if they are not at the center of attention and often react with strong emotional outbursts in response to these feelings, Those with HPD might also try to retain other people,’s attention through flirtatious and sometimes inappropriate.   Behavior, bright, clothing, and bold claims, A person with a histrionic personality disorder is more than just needy or high maintenance, and labeling them as such can be harmful because it shifts the focus from their personality, affecting the disorder to their personality.   Nine people pleasing and dependent personality disorder.   Many people find it difficult to say no to others and struggle to set boundaries.   However, people with dependent personality disorder feel an intense fear when they have to do anything by themselves, which can include everyday tasks like choosing when to wake up or what to have for breakfast.   Those with dependent personality disorder are also more likely to stay in an abusive relationship, change jobs or move to stay with their significant other or another person.   They’re dependent on and jump into a new relationship immediately after their previous one ends At the heart of it.   All. The difference that sets personality traits apart from mental disorders is the impact it has on someone’s daily life Traits such as perfectionism and attention-seeking are okay for the majority of people, but when it comes to a source of significant stress in your everyday life, Preventing you from living normally, it may be a sign of something more and thus requires the advice and diagnosis of a mental health professional.   It’s important to give people the benefit of the doubt.   There may be reasons why someone is acting in a certain way that you are unaware of Again.   Please note that this video aims to clear up different ambiguities and confusion surrounding personality traits and mental disorders, but does not claim to diagnose anyone with or without a disorder.   Have you or someone you know ever experienced confusion between these traits and mental disorders? What was your experience with it, and how did you react? Let us know in the comments below, If you enjoyed this video and learned something new, please consider giving us a like and subscribing to our channel for more videos like this Thanks for watching and we’ll see you next time.   As found on YouTube This solution reverses kidney disease! Guaranteed to be effective or your money back: Beat kidney disease. Just by following a simple treatment plan, you can reverse kidney disease. No matter how old you are! Just listen to what people who have tried this solution have to say. “Thank God I came across your solution by accident! Dad’s kidney function decreased from 36% to 73% in just two months. He’s 90 years old! His doctor said people his age shouldn’t have kidneys that efficient!” Graeme Asham, QLD, Australia, And this… “No more dizzy spells! My creatinine has gone down from a staggering 1800 to 1100. My blood count has greatly improved and I’ve been taken off my blood pressure medication. Your solution works! ” Joe Taliana, 55, Malta Simply follow the scientifically backed solution and restore your kidneys, fast! => This solution reverses kidney disease! ← https://www.facebook.com/100000332115031/videos/590895892954739/ яαℓρн ℓєαмαи

10 Signs of Hidden Anxiety

  According to the American Psychological Association People with anxiety have a future-oriented fear which leads them to avoid anything that could potentially trigger a stress response. In 2017, the National Institute of Mental Health reported that approximately forty million people worldwide suffer from anxiety Anxiety disorders are highly treatable but recent surveys show that only 36.9% of those suffering from it seek treatment This might be because most people with anxiety worry about the judgment of others and how the stigma against mental illness might negatively affect their lives. Does this sound familiar to you? Do you worry you might be suffering from anxiety and just don’t realize it? Here are 10 tell-tale signs of hidden anxiety to look out for. 1. You don’t like talking to people face to face. You can easily keep a conversation going for hours when you’re texting or chatting online with a friend but talking to someone in person…   No… that’s an entirely different story. Even if you already know them well or have talked to them online you still get tense and nervous talking to them in person You have trouble making eye contact or finding the words to respond and you want to end face-to-face conversations as soon as they begin to 2. You’re always self-conscious. Do you walk into a room and immediately feel like everyone is staring at you, listening to you, and judging your every move? Or perhaps you’re overly conscious of the way you walk, the way you eat, the way you sit, the sound of your voice when you talk and so on This could be a sign that you have hidden anxiety 3. You’re easily upset or irritated. Has anyone ever told you you’re too sensitive? Do you find your feelings getting hurt easily? Are you quick to get angry or upset with others over the littlest things? This kind of emotional volatility may be a sign that you have high-functioning anxiety.   As anxiety can often make us easily overwhelmed and emotionally imbalanced frequent mood swings, temper tantrums, and irritability can be expected when you’re overly anxious 4. You’re panicky and easily startled. Anxiety makes you want to be as in control and vigilant as possible. An unexpected phone call, a random knock on the door, an email with no subject, or a forgotten task you can easily finish. Anything is enough to send you reeling with panic. You go into a tailspin whenever something catches you off-guard and you find it hard to relax even when the smallest things don’t go exactly as planned. 5. You’re indecisive. Do you have trouble making even the simplest of choices? Are you afraid of making up your mind about something because you’re so sure that whatever decision you make is gonna be the wrong one? Oftentimes, anxiety can manifest as perfectionist tendencies, fear of failure, or distrust in oneself.   If you can’t make your own choices without thinking about it for hours and hours first or consulting with all your friends and family, you might be harboring some hidden anxiety. 6. You overthink past conversations. You tend to get hung up on past conversations no matter how much time has passed since then. You analyze the other person’s body language, facial expressions, choices of words, and even the tone of their voice. You can’t help but think about what you should have done or said instead and it drives you crazy and keeps you on edge every time you remember it 7. You’re always making yourself busy It’s common for people with anxiety to have a strong need to keep themselves busy They’d like to occupy themselves with simple tasks and do as many things as possible in a day because sitting still and doing nothing for a long time can make them feel restless and on edge 8. You talk yourself down all the time.     Life isn’t always kind to us and self-love and a balanced lifestyle don’t come easily. Living with anxiety, especially if it’s hidden or suppressed, can make it hard for us to feel good about ourselves and let ourselves feel happy. It makes us believe that we don’t deserve it and traps us in a vicious cycle of negative self-talk and constant pressure to be perfect. 9. You have a lot of negative thoughts. Are you a pessimist whose quick to find the downsides in every situation? Do you find yourself getting upset or stressing out over even the most minor inconveniences? Is every day a constant battle with yourself against the spiral of panicked and rational thoughts you have? In 1997, famed psychologist and cognitive therapist, Aaron Beck, termed this kind of thought pattern as catastrophic thinking, Which he often observed in his patients who suffered from anxiety. And 10. You experience physical symptoms. Sometimes anxiety can be entirely physical because while your conscious mind may not always be aware of your anxiety it will make itself known to your body. Things like erratic heartbeats, chest palpitations, muscle tension, a clenched jaw, shaky hands up a little sweating are all indicative of anxiety.   Your body may be trying to let your mind know that you’re feeling anxious and stop it before it gets any worse. Do you relate to any of the problems listed here? Or do you do your best to seem ok? And hide your symptoms because you feel embarrassed about your anxiety? The truth is: you’re not alone and having mental health issues is nothing to be ashamed of. What do you plan to do next? Let us know in the comments below! Don’t forget to like this video and subscribe to Psych2Go for more psychology content.   Thanks for watching and we’ll see you soon. As found on YouTube This solution reverses kidney disease! Guaranteed to be effective or your money back: Beat kidney disease. Just by following a simple treatment plan, you can reverse kidney disease. No matter how old you are! Just listen to what people who have tried this solution have to say. “Thank God I came across your solution by accident! Dad’s kidney function decreased from 36% to 73% in just two months. He’s 90 years old! His doctor said people his age shouldn’t have kidneys that efficient!” Graeme Asham, QLD, Australia, And this… “No more dizzy spells! My creatinine has gone down from a staggering 1800 to 1100. My blood count has greatly improved and I’ve been taken off my blood pressure medication. Your solution works! ” Joe Taliana, 55, Malta Simply follow the scientifically backed solution and restore your kidneys, fast! => This solution reverses kidney disease! ← https://www.facebook.com/100000332115031/videos/590895892954739/ яαℓρн ℓєαмαи

ADHD and Anxiety Tips: Exercise | Find out How You can Benefit Starting Now.

  Hi. I’m Lynette, from PanicAttackRecovery.com Through our videos we want to help you. In this particular video, I want to share with you the benefit of exercise, particularly for sufferers of anxiety, panic attacks, and agoraphobia. I will mention some findings which not only demonstrate the benefits of exercising but illustrate how these might extend far beyond what you might have imagined. You may have heard that exercise helps you generate dopamine and other feel-good chemicals that can help you feel a sense of well-being. But there’s more … Dr. John Ratey, M.D. who has written a book called “Spark: The Revolutionary New Science of Exercise and the Brain” explains how exercise, particularly sustained aerobic exercise, promotes improved learning, memory, and executive functioning.   Executive functioning refers to the ability to organize a variety of tasks in our day-to-day lives, for example, the ability to initiate and stop actions, monitor and change behavior as needed, and plan future behavior when faced with novel tasks and situations. Additionally, Dr. Ratey reports that people who perform sustained aerobic exercise are more mentally alert and attentive, less fidgety, have longer attention spans, and their ability to sort through information and take it in is increased. How does it work? As mentioned, exercise promotes the release of brain chemicals that are very good for you such as hormones, neurochemicals, and growth factors – which Dr.   Ratey describes it as a fertilizer to help our cells function optimally – including brain cells – which helps cells adapt and change. This is important because change is the neurological process that allows you to learn. You see it is we learn by a process whereby the brain changes. He explains that exercise also promotes neurogenesis which helps the brain grow new brain cells. It turns out that exercise is the best-known way to grow brain cells. How cool is that? You can grow your brain cells by exercising! It turns out that the research and findings cited in Dr. Ratey’s book are backed by hundreds of more studies. Dr. Ratey also looked at exercise in school settings, where many of the students had attention deficit hyperactive disorder, as well as other disorders which inhibited their learning. By integrating an aerobic workout into regular classes, students were able to increase their grades by an average of one grade point. Students also began to behave better, had longer attention spans, and fidgeted much less.     We think that realizing the connection between exercise and panic attacks can be very helpful not only because of the reasons above. But the reason is that exercise allows you to be in a controlled situation where are increasing your pulse. This demonstrates that you can deal with an increased pulse – an increased pulse, as you are no doubt aware, is often one of the concerns the sufferer has during a panic attack. I would like to mention a study completed at Charite University Medicine in Berlin. This study found that 50% of subjects who completed 30 minutes of daily aerobic exercise were able to avoid having a panic attack in the experiment. Researchers wrote: “Our results for the first time suggest that exercise has an acute anti panic activity.” Pretty good evidence for a correlation between exercise and panic attacks. So what’s cool: The energy that one might have invested in their anxiety, in the past, can be redirected to their well-being through exercise. This realization in itself can make one feel better. Be sure to subscribe to our channel and like our videos if they are helpful to you.   Please feel free to share our videos with others who may benefit from them. Your communication is important to us. If you have any questions or comments, please feel free to leave them in the in comments below. To get started with more help you can join our free newsletter at: PanicAttackRecovery.com. As found on YouTube This solution reverses kidney disease! Guaranteed to be effective or your money back: Beat kidney disease. Just by following a simple treatment plan, you can reverse kidney disease. No matter how old you are! Just listen to what people who have tried this solution have to say. “Thank God I came across your solution by accident! Dad’s kidney function decreased from 36% to 73% in just two months. He’s 90 years old! His doctor said people his age shouldn’t have kidneys that efficient!” Graeme Asham, QLD, Australia, And this… “No more dizzy spells! My creatinine has gone down from a staggering 1800 to 1100. My blood count has greatly improved and I’ve been taken off my blood pressure medication. Your solution works! ” Joe Taliana, 55, Malta Simply follow the scientifically backed solution and restore your kidneys, fast! => This solution reverses kidney disease! ← https://www.facebook.com/100000332115031/videos/590895892954739/ яαℓρн ℓєαмαи

ADHD and Anxiety Tips: Assertive Communication & Overcoming Social Anxiety

  Hi. I’m Lynette from PanicAttackRecovery.com. We’re a collaboration of former sufferers who are helping those currently struggling with anxiety, panic attacks, and agoraphobia. However, anyone can benefit from our videos. One challenge for many people who have anxiety is learning to say no. We discussed this issue with a psychologist who ran a group for teaching assertiveness and he told us about an interesting experience he had with the group.   One evening, all of the attendees were performing an exercise where the person next to them would ask them to do something. They were simply instructed to say no in reply to whatever the other person asked them to do. Many people had trouble doing this. Instead, they felt the need to also explain why their answer was no. This is interesting because the situation was a controlled group exercise and not a real-life situation. The important takeaway messages from this example are the following: First: Many people have trouble saying no. Period. Second: Many people feel the need to reveal additional information because they aren’t comfortable simply saying no. However, the problem is that by explaining themselves, they often give the other person making the request more of an opportunity to challenge their original response. In other words, explaining yourself makes it harder to say no in the end. Had you just graciously said no, that might have ended the discussion. We’re not suggesting that you should go through life simply saying no all of the time. However, if you have a problem being assertive in this regard, try practicing role-playing this suggestion with a friend.     By practicing this suggestion over time you will get better at it. Often anxiety sufferers can be helped by learning how to be gracefully assertive in their relations with others. By learning polite assertiveness, you can decrease your anxiety across several situations. We hope that you have enjoyed this video. To get more help with your anxiety, and obtain instant access to the 5 steps to recovery from panic attacks and agoraphobia, just visit our website and provide your email address. All of our information is free. Please visit our website at PanicAttackRecovery.com. As found on YouTube This solution reverses kidney disease! Guaranteed to be effective or your money back: Beat kidney disease. Just by following a simple treatment plan, you can reverse kidney disease. No matter how old you are! Just listen to what people who have tried this solution have to say. “Thank God I came across your solution by accident! Dad’s kidney function decreased from 36% to 73% in just two months. He’s 90 years old! His doctor said people his age shouldn’t have kidneys that efficient!” Graeme Asham, QLD, Australia, And this… “No more dizzy spells! My creatinine has gone down from a staggering 1800 to 1100. My blood count has greatly improved and I’ve been taken off my blood pressure medication. Your solution works! ” Joe Taliana, 55, Malta Simply follow the scientifically backed solution and restore your kidneys, fast! => This solution reverses kidney disease! ← https://www.facebook.com/100000332115031/videos/590895892954739/ яαℓρн ℓєαмαи

Anxiety Tips: Is caffeine helpful or a hindrance?

  Hi, I m Lynette from PanicAttackRecovery com. We are a collaboration of former sufferers who are helping current sufferers of anxiety, panic attacks, and agoraphobia.   If you are a consumer of caffeine and a panic, attack, or anxiety sufferer, then you might consider this video to be an important one, To begin with.   What are the effects of caffeine, Caffeine s effects include stimulation of the central nervous system, CNS, and stimulation of the cardiac muscle.   It has been suggested that caffeine can lead to jitters, headaches, irritability, confusion, muscle, aches, heartburn, increased blood pressure, and other effects on the body.   However, you might be asking the following question: is there any real connection between caffeine and anxiety, Authors of an article in the Journal of Caffeine Research completed a thorough literature review. The authors indicated that their review showed that caffeine produces behavioral and physiological effects similar to those produced by other drugs of dependence.   The article points out that caffeine consumption has been associated with several negative health consequences, including anxiety, insomnia, hypertension, myocardial infarction, bladder instability, gastroesophageal reflux spontaneous abortion, and reduced fetal growth.   So should you consume caffeine, You might be able to consume caffeine in moderation.   However, it s important to become aware of all of the foods and drinks that contain caffeine and to consider the level of caffeine in each of these foods and drinks, For instance, consider the following caffeine levels: according to the Mayo Clinic Brewed cup 8 oz of coffee 95 200 mg Cola, 30 40 mg, Black tea, 14 61 mg Energy drinks, such as Red Bull, 80 mg.   The Mayo Clinic indicates that you might consider reducing your intake of caffeine if you are consuming more than 500 mg of caffeine per day.   However, ultimately, we would suggest that you may want to determine your tolerance levels to caffeine. We certainly don t recommend that you quit caffeine or cold turkey.   If you are trying to quit, If you are trying to cut back, you should gradually reduce your caffeine intake levels.   Instead of making big changes all of a sudden, You should remember that caffeine is a drug, so you may initially go through some withdrawal symptoms when levels are reduced.     Withdrawal symptoms have been reported, such as headache, irritability, sleeplessness, confusion, nausea, restlessness, tremor palpitations, and raised blood pressure.   You might be asking how to kick the caffeine habit or reduce the amount of coffee you consume.   We would suggest you may want to think about two things.   1 Become aware of all your sources of caffeine by taking an inventory of all of your caffeine levels and 2.   Consider substituting green tea in place of all or some of your daily coffee.   Why green tea? Although green tea, has some caffeine? It s not nearly as much as coffee As mentioned, while a brewed 8 oz cup of coffee can have about 95 200 mg of caffeine.   Green tea has about 14 40 mg of caffeine. Only In addition to subscribing to our YouTube channel, you can visit our website and Sign up for our free email newsletter, Obtain a range of articles about panic, attacks, anxiety, and agoraphobia, and Follow us on Twitter and Facebook.   By taking advantage of these options, you can be assured that you will not be missing out on any of our resources.   Please visit our website at PanicAttackRecovery com.   . As found on YouTube This solution reverses kidney disease! Guaranteed to be effective or your money back: Beat kidney disease. Just by following a simple treatment plan, you can reverse kidney disease. No matter how old you are! Just listen to what people who have tried this solution have to say. “Thank God I came across your solution by accident! Dad’s kidney function decreased from 36% to 73% in just two months. He’s 90 years old! His doctor said people his age shouldn’t have kidneys that efficient!” Graeme Asham, QLD, Australia, And this… “No more dizzy spells! My creatinine has gone down from a staggering 1800 to 1100. My blood count has greatly improved and I’ve been taken off my blood pressure medication. Your solution works! ” Joe Taliana, 55, Malta Simply follow the scientifically backed solution and restore your kidneys, fast! => This solution reverses kidney disease! ← https://www.facebook.com/100000332115031/videos/590895892954739/ яαℓρн ℓєαмαи

Abandonment Anxiety– Video corrupted See https://www.youtube.com/watch?v=XQWUYWeiHB0

 
  this episode was pre-recorded as part of a live continuing   education webinar on-demand CEUs are still available for this presentation   through all CEUs registered at all CEUs comm slash counselor toolbox I’d like to welcome everybody today to the presentation love me doesn’t leave me addressing   fears of abandonment the purpose of this presentation is really to help us help clients   increase their awareness of their story including beliefs about behavioral reactions to situations   that trigger their fear of abandonment so how do we do that well the first thing we need to   figure out is what fear of abandonment is and how can we identify it in a clinical set setting then   we’re going to explore the concept of schemas or core beliefs and these are things that are formed   in early childhood you know if you remember prior classes we’ve talked about early childhood   cognition is generally very dichotomous in children young children don’t have the ability to look at   that gray area so these schemas if they’ve gone unchecked can lead to some very extreme belief   patterns which lead us into common traps in thinking reacting and relationships if your   schemas are based on all-or-nothing you either love me or you’re going to leave me hence the   name of the book then your reactions are going to tend to be more extreme and more all-or-nothing   which increases anxiety because then anytime a person who perceives any amount of disapproval   obviously is going to go to that extreme so we want to talk about bringing it more toward the   middle line and helping people learn to appreciate and love themselves for themselves while they may   not approve of the behaviors of other people they can still love other people so just because somebody   doesn’t approve of your behavior doesn’t mean necessarily that they’re going to abandon you so   we’re going to talk about that and then we’ll learn skills necessary to help people accept   their past as part of their story maybe they do have a lot of abandonment issues and you know   some people do and it really is painful it cuts to the core especially when those abandonment   issues occur in early childhood when kids going what that does so we’re going to talk about that   and help people learn how to integrate it into their present and we’ll learn the skills necessary   to acknowledge that their past does not have to continue to negatively impact them in the present   so if they were abandoned when they were a child you know we need to deal with that however if they   continue to expect that every significant person in their life will abandon them notice I use the   word every because we’re still in those extremes then they’re going that the past is negatively   impacting them in the present so we’ll talk about how to sort of moderate those belief systems how   does this impact recovery whether you’re talking about addiction or mental health issues connection   is a basic human need we are not meant for the most part to be Hermits in the middle of the   woods there are introverts and in my husband’s an introvert he has a couple of really good friends   he needs quiet time each day he doesn’t need to be surrounded by people and he’s fine but I mean   we’ve got human connection he’s not going to be one that’s just going to you know move out to the   middle of nowhere I’m an extrovert on the other hand and I tend to have a lot of acquaintances   and a lot of friends I draw energy from being around other people so just because   someone doesn’t have 150 acquaintances doesn’t necessarily mean they don’t need connections so   we want to recognize that connection is a basic human need when infants are born they are put   on their mother’s chest when we embrace each other whether it’s mother and child or friends   or whatever a chemical called oxytocin is released and it’s our bonding chemical we are programmed we   are hardwired for connection and oxytocin is a very rewarding chemical so we want to recognize   this that if people are so afraid of abandonment that they push everybody away what are they losing   as far as quality of life as infants and children survival is dependent upon the relationship with   the primary caregiver so if mom or dad wasn’t happy if mom or dad was rejecting the young   child was pretty much helpless to think about a child who’s growing up in a family that’s just riddled   with addiction and mental health issues and the primary caregiver or caregivers are completely   emotionally unavailable they may be physically there but they may be so high or so depressed or   so psychotic that they cannot attend to the children’s need what does that communicate to   the child feels abandoned the child feels a sense of neglect for people’s beliefs about   other people and relationships were formed largely based on their interactions with their caregivers   so if this child was going mom I’m hungry and nothing happened or worse yet child was going   mom I’m terrified and nothing happened or they were just given a pacifier and told to shut up   then that is they were told they were communicated to that their beliefs their feelings their wants   and their needs were not important so they were being rejected healthy relationships serve up as   a buffer against stress so even if they had all these negative experiences in early childhood teenage years you know maybe up until they walked into your office it doesn’t mean it   has to continue and how much can they gain from having healthy relationships with a lot of clients   that I work with who have pretty significant abandonment issues can’t even fathom trusting   someone enough to be in a healthy relationship so we’re going to talk about how to sort of ease into   that because you’re not going to say don’t let your past influence your future and we’ll wave   a magic wand and they’re ready to trust people even once you point out that what happened in   the past was largely not their fault or maybe not even their fault at all they’re still going   to have difficulty not accepting responsibility and going everybody leaves me so what talk about   that addressing beliefs that formed as a result of these relationships the past dysfunctional   relationships we can help people create a new understanding of events was mom or dad or   caregiver really being rejecting were you being abandoned emotionally and physically because of   you or because mom or dad just was able to do what they needed to do to be a caregiver at that point   in time they were doing the best they could with the tools they had but it wasn’t enough to meet   your needs so we want to talk about alternate explanations for why parents and caregivers may have   behaved in that way if you have a young child well an adult now but who was put up for adoption or   abandoned by their caregivers at a young age the a young child was probably very confused because   one moment their caregiver was there in the next moment they were in the system so they were   trying to figure out what did they do wrong and why doesn’t that person love me anymore it must be   me because children really can’t see well you know mom is not able to function as a parent   right now or dad is having difficulty coping we want to help people better understand themselves   in their reactions so that when they start getting this urge to just cut all ties and be like you   know what fine you know I’ll take my ball and go home no problem what does that mean at there’s a   certain point in all relationships in all healthy relationships that you know sometimes people have   to distance themselves from one another because it’s becoming dysfunctional but for the most part, people will in relationships encounter hiccups will encounter disagreements but in   healthy relationships, they can work through them in relationships with people who fear   abandonment there are going to be two extremes there’s going to be complete compliance and   please don’t leave me or complete disengagement and whatever I don’t care the final thing we want   to do is help make people more conscious of what they’re doing so they can make healthy   decisions in their current relationships so when they get that urge to either comply or disengage   is that a healthy normative reaction right now or are you reacting out of your past experiences the abandonment experience in childhood survival depends on caregivers a four-year-old left alone   for five days is not going to do so well you know they may be able to scavenge food but   once the food runs out where do they get it you know there’s only so much that a child   can do an infant can’t even get their own food so survival depends on their caregivers and if   their caregivers fail to meet those needs there are high levels of anxiety and I will refer regularly   to caregivers who are emotionally unavailable and emotionally absent in addition to physically   unavailable or absent because some parents and I worked in the field of co-occurring disorders for   over two decades and some parents just they are so overwhelmed and so paralyzed by life itself they   can’t even attend to anything else that’s going on they’re doing good just to be breathing but   if they have a child and that child’s needs are getting neglected and fear of abandonment is a natural   survival response when your food source goes away what happens you start to freak the freak out so   this is normal we look at this and say that that’s that’s natural if a child thinks about the first   time you take a child to kindergarten or pre-k or daycare or whatever it is and you drop the   child off even if they’re securely attached what do they cry because they’re afraid that   mom or dad won’t come back and they’re afraid of this new situation that’s changed securely attached   children will you know adjust and then be happy to see mom or dad when they come back but the point   is there’s that initial oh crap reaction meeting biological needs and safety are key triggers for   anxiety at any age so we’re talking about housing we’re talking about safety we’re thinking about   Maslow’s hierarchy if somebody is not meeting the child’s needs or if the person is not getting   their needs met then they may have high levels of anxiety and I add to the safety concept not   only physical safety but also emotional safety people need to feel safe in their own heads and   they need to be free from emotional abuse when focused on survival people can’t focus elsewhere   so if they’re not getting their physical needs met guess what you know if you take somebody who   is in pain who is sick who is hungry and who is homeless are they going to work on self-esteem   are they going to work on relationship skills no, they’re focused on survival they need to have   those basic needs met they need to have a certain sense of security if they are in a situation that   is dangerous physically obviously they’re not going to be focusing on how can I better myself   when they’re worried about somebody coming in and hurting them physically likewise it’s hard to   focus on how can I better myself when everywhere they turn they perceive someone telling us you’re   not okay you’re stupid you’re lazy you’re bad you were the worst decision I ever made in my   life they can’t focus on personal growth when all they’re getting is these verbal beatdowns all the time so people need to have acceptance if they don’t have acceptance kind of the opposite of   acceptance is abandonment two kinds of extremes again we’ll bring it back to the middle every   stressful situation becomes a crisis the in securely attached child now you can go back to   and read Bowlby’s work on secure and all that kind of stuff great reading but for the short version   of this presentation remember that certs securely attached children feel anxiety when their parents   leave but then they can adjust and they’re happy to see the parents return in securely attached   children feel a great amount of anxiety when their parents leave and are terrified that mom or   dad won’t come back and then when mom or dad does come back it’s your very very clingy or very very   rejecting so with this child that’s in securely attached it’s just like one to a hundred as soon   as something happens that they think they may be abandoned you see this pattern again in adults who   are still struggling with these abandonment issues that schema that they’ve formed and I’m getting a   little ahead of myself that schema that they form says if you let this person at your site or if   this person disagrees with you or if this person criticizes you they’re rejecting you and they’re   going to abandon you so we want to you know check in with those cognitions and look for trying to   make those thoughts a little bit more helpful in infancy or early childhood if caregivers were away   for long periods of time because of work because of military, if they were in jail if they just   chose to be away or if they passed away children may experience some abandonment issues now if   the parents are away because a parent is a way because of work or military or even jail and the   other parent can help the child work through it there’s much less drama if you will there’s much   less issue with abandonment issues in totality now if it’s whatever parent it is if the pay, if the father happened to be the one, went away that person may have some residual issues with   adult figures in their life that they need to deal with but they may not know I’m not saying that   every child of a soldier or a service person is going to have abandonment issues that are so   not true however if the experiences of the time apart was not handled in a way where the child   felt secure then it could have consequences that are going into present-day if in early childhood   caregivers were inconsistently or unpredictably physically or emotionally present so think about   a parent who has major recurrent major depressive disorder addiction or is just ill-equipped to deal   with a child when I was working at the treatment center in Florida I had 14 15 16-year-old young   women coming in and having babies and you know what does a 14-year-old know about giving birth   and raising a child so it’s not that they weren’t necessarily trying you know they didn’t have great   role models raising them in most cases and so they don’t have anything to work with they don’t know   how to be a parent they’ve never been taught so it’s not always I don’t want to pathologize or   make the parents look like bad people because I believe that people do the best they can with   the tools they have at any given time parents don’t choose to be sucky parents sometimes it   happens but I really don’t believe they choose to anyhow off my soapbox in later childhood as the   child becomes elementary school middle school age if they’re a poor family fit or they feel   like they’re the black sheep they just don’t have the same beliefs that the other people do   they don’t seem to have the same interest that their family does they may not feel accepted   especially if the family’s going no that’s wrong to believe and invalidate them so going back to   that psychological safety if they’re constantly being told their ideas are stupid they’re wrong   they have the wrong point of view and they can feel very isolated something can happen that   ruptures the relationship with the primary care giver whether it’s abuse or you know some kind   of other trauma and introduction of a new less an emotionally or physically safe caregiver can also   lead to abandonment if the child feels like the biological caregiver chose a new spouse over him   or her say if you see where I’m going with that because if this new person comes in and is less   safe is abusive in some way emotionally physically sexually it doesn’t matter the child is going to   feel like they didn’t have a voice the child is going to feel like the biological caregiver   didn’t care and brought this other person in any way which leads to feelings of rejection   and abandonment so what are the reactions fight-or-flight whenever there’s a threat we   fall back to fight or flight or freeze but we’ll talk about that when there’s a threat our anxiety   goes up and we say in the past in these kinds of situations, if I fought, did I succeed if so then   we’ve got fights in the past did I succeed and if the answer’s no then the response is to flee pretty simply so anger towards someone who’s unavailable if they got angry and felt like it got them   some sort of acceptance from somewhere that might be the prevailing reaction sadness when someone   goes away a sense of helplessness this person just left me shame or self-anger about feeling   needy or about pushing someone away fears related to rejection and isolation, nobody will ever love my loss of control or the unknown everybody always leaves see how I’m using these extreme   words again and fear of failure I can’t maintain a relationship nobody wants to be with me because   I’m not good enough so the questions for clients in these situations what caused these fears as a   child so when someone starts to have these fears about a relationship if the relationship starts   to get rocking first question is what is it that you’re afraid of in this situation if you stay   together what is it that you’re afraid of if this the person leaves what is it you’re afraid of and how   likely is it that this person is going to leave based on whatever is going on right now so let’s   get some objective evidence here and another the tool you can use is the challenging questions   worksheet in cognitive processing therapy if you google it challenging questions worksheet   CPT or cognitive processing therapy really helps people walk through the logic in some of their   cognitions and identify some know unhelpful distortions so then after you figure out kind of   what the fear is then we say what caused that as a child in the past when you felt like this what   caused that and how was this reasonable or helpful you know in the past when you felt like this and   you reacted in anger what was the outcome and how was it helpful in some sort of way you know   did it get somebody to pay attention to you did it gets somebody to come comfort you, okay so you   were identifying the function of the current behaviors and then we want to say what causes   these fears now a lot of times it’s the same symp or similar stuff but we could say how are these   reactions now unhelpful because as independent you know adult-type people we can fend for ourselves   we can put food on the table we can go to work we can do we can function independently whereas this   is a child we couldn’t you know there were just some barriers to that does that mean again that   we should live in isolation and say well I don’t need anybody no that’s not what I’m   saying what I’m saying is is these fears that are overwhelming about abandonment that causes   people to push others away or cling on like you know whatever clings on uh are these reactions   helpful in the present day you know do you still need to hold on to people like there’s no tomorrow temperament based on their temperament children need different types and amounts of caregiver   interaction um some children are wide open and easily overstimulated you know my son was that   way when he was born well to this very day um when he’s awake he is like the Energizer Bunny   on methamphetamine I’m he’s just going going going and talking and talking to himself and   he needed a lot of structure and he would get overstimulated easily but we were able to help   him figure out how to handle that instead of getting mad at him for what seemed to be acting   out we were able to help him channel and figure out when he needed to take a break the introvert   may not need as much one-on-one attention with the caregiver may need a comforting word   here and there but they may not need the amount of the attention that an extrovert may need an extrovert   tends to need more interaction with parents with family with other people because they draw energy   and they think while they talk and they think while they talk with other people so they feel   a lot more isolated if they are isolated so we want to understand the person’s temperament and   how they may or may not have gotten their needs met how they may have been told they were wrong   and invalidated when they were younger and you can hear some of this is kind of going towards   Linda hands DBT environment um but what we want to look at what do you need now how can we create   an environment that’s accepting and welcoming to you now based on their needs and caregivers’ reactions children form schemas or core beliefs about the world and others so if they state their   opinion and it’s squashed or it’s ridiculed then they’re going to form this core belief that it   is not safe ever to share my opinions because I am always wrong now we’re talking about children here   but a lot of times think back for yourself there I think most of us have at least some all-or-nothing   dichotomous thoughts that come in every once in a while and you know we can catch them but if   these dichotomies go unaddressed the person starts feeling very lost and very abandoned because it’s all-or-nothing important points about children under 7 from 8 to 12 children are developing   alternative cognitive skills they’re starting to be able to think abstractly they’re   starting to be able to see the gray area and alternate explanations but even you know during   that period so zero to 12 children are having difficulty envisioning all the possibilities   so anything that happens before that we want to encourage them to look at the schemas that were   formed and challenge them to examine whether they are currently accurate and helpful children think   dichotomously when they’re that young it’s all or nothing it’s good or bad it’s not kind of sort   of something it is what it is I mean even think about thinking back to grades that we would get   it was satisfactory or unsatisfactory there was no ABCD F when we were in elementary school and   I don’t remember middle school then it was a dichotomous grading scale you either did it or you   didn’t children are egocentric so whatever happens they say what was it about me that made this   happen if mom’s in a bad mood what did I do if you know Mom is rejecting well that was stupid I’m   stupid children are very egocentric so you take all or nothing combined with all about me and you   can see we’re creating the perfect storm of children can only focus on one aspect at a time when I work   with adult clients you know they come in and they tell me that they had an interaction with their   boss he was walking down the hall and he was in a bad mood and I just knew I did something and so   we talked about that and I’m like how do you know that because he had it he had angry look on his   face okay what are some other possibilities what else might have been going on with him at that   point in time and a lot of times we can brainstorm ideas about a call he just got or where they just   left a meeting that didn’t go so well or who knows what else in this day and time when we’ve   got our cell phones and PDAs and everything there are a lot of things that can trigger a   mood besides just whoever you pass in the hallway children can’t think about those other things that   might have triggered the mood they see somebody unhappy and they’re like I’m sorry um so we want   to encourage as adults we want to encourage them to say all right what are the other possibilities even as children I try to work with my kids to encourage them to look at alternate reasons   why somebody may be acting a certain way children can’t think abstractly and consider those possible   options um even with kids you know knee-high to a grasshopper, if you’re in a situation and   maybe in a store and somebody behaves not kindly to you, you can talk about that later with the kids   and say you know that was kind of unpleasant to go through what you think might have caused that   and brainstorm three ideas my favorite number is three I don’t know why but brainstorm three ideas   for alternate explanations for why that person may have been in an unpleasant mood if children   learn to do this when they’re younger it’s a a lot easier to transition to as adults schemas   are a broad way of perceiving things based on memories feelings and thoughts basically it’s   our go-to perception of what something’s going to be like we have schemas about everything if   you go to church you have a schema about what’s going to happen when you go to your mother’s   house you have a schema about how mom’s going to behave and what’s going to happen we form these   it’s our brain’s short shortcut instead of having to analyze every situation it says oh I remember   this been here before it’s probably going to be like X Y Z unfortunately sometimes things change   and one of the things we see in addictions treatment as is as caregivers into recovery and   really get a hold on it and start working that a new way of life and sobriety and all that stuff   old family members or family members still expect that old behavior they have that schema that when   Jane comes in this is what’s going to happen because they’re remembering how she behaved and   acted in her addictive self so we want to help people identify their schemas and check them   sometimes they’re still accurate sometimes not so much schemas that trigger abandonment fear center   around the cell acceptability is this person going to like me which is one of the reasons we do a lot   of self-esteem work in reducing abandonment fears because we want to reduce the need for people to   solicit external validation we want them to say I’m all that and a bag of chips and I would love   to play with you but if you don’t want to play I’m okay with that love ability if they were   told they were unlovable if they perceived they were unlovable then in the present they   may fear isolation they may fear that they’re not lovable so they will try to do whatever they can   or likewise they will build a lead wall that is 5 feet thick all the way around them so nobody can   hurt them they may have fears about their own the competence you know thinking back to Erikson   you never thought some of these theorists from the past would keep coming up even in current practice   but they do if a child going through that period of industry versus inferiority Erik Erikson’s   stages of psychosocial development and they felt like a failure, all the time or they were never   good enough the parents never recognized their positive achievements then they may question their   own competence and feel like a failure if they feel like a failure they may feel they may believe   that nobody wants to be around them so they will leave so if I fail they will leave and fears may   center around adaptability some people are not able to tolerate any loss of control they’re just   like that they’re holding on with a death grip to the relationship to anything that’s going on and   it starts to go wonky they are going to freak out so we want to look at what it means if you’re   not in control of everything what does it mean if you trust that this person is going to do the   next right thing if you are doing the next right thing as well schemas that trigger abandonment   fears can also be sent around center around others if someone is rejecting distant cold or is unable to   handle the person’s needs then the person may not feel acceptable so if they are in relationships   with people like this then we need to look at is Is it you who’s not acceptable or is something else   going on with that person that may be making them unable to deal with anybody else’s stuff   right now the person may feel isolated if other people are absent if people fail to keep promises   they may feel like nobody’s ever there for them competence if other people are always critical   then the person will question their own competence and if others are unpredictable a lot of the time   when people who have anxiety about abandonment they come from situations where other people have   not been predictable or if they were they were unpredictably absent and relationship of self to   others if they are afraid about their ability to relate with others if they’re afraid of rejection   if they’re afraid that if they start to love they will be rejected and then they will be isolated   forever if they are afraid of the unknown and they I just want consistency more than anything and   as soon as consistency starts to waver a little a bit because as we grow things change and people   with abandonment issues don’t like things to change because that’s not predictable and that’s   not consistent so they may have difficulty if one the person starts to change what they do I see this   a lot not saying that it’s an abandonment issue necessarily but when law enforcement officers   retire you know because they can retire after 20 years so they may start a new career and   that causes a lot of change schedule changes they’re not law enforcement anymore and the   spouse sometimes has culty adjusting to it as does the retired officer but controllability   if the person holds on to relationships and everything in their life with white knuckles   because they’re so afraid if they let go of control that they are going to disappear or   disintegrate then if something seems like it’s not in their control, it’s going to be a catastrophe so attachment Styles secure if there’s an emotionally available caregiver the child   will seek the caregiver for comfort and guess what the caregiver will be there and will more   often than not meet the need for comfort with the the correct type of comfort so hungry cold scared kind   of following the child’s upset when the caregiver leaves especially in new situations but the child   gets over it it’s not a child that’s going to sit there and cry for eight hours and then the child’s   happy when the caregiver returns in this kind of attachment the child learns to trust others will   be responsive to their needs and validate their needs a child learns to be self-reliant and try   new things but if they fail they know they can return to the home base they can go out and go well   that didn’t go as planned and the caregiver will be there to say alright let’s figure out what to do   next not you are such a failure the child learns to adapt to a variety of situations because when   they’ve been faced with something that’s a little scary caregivers been there to kind of coach them   on and go you got this it’s scary I got it but you can do it the child learns to deal with   stress because the caregivers are there to coach them or to process it with them afterward because the   caregiver is not always physically there but if you’ve got children you know sometimes they’ll   come home from school and they’ve had a really bad day and you’d pull them aside and go you know   what’s going on let’s talk about it so in this way the child learns to deal with stress and the child   learns to have accurate expectations of others in the secure attachment, emotionally available   situation remember children are egocentric so if mom’s upset the child goes what did I do or   oh my gosh I hope mom’s not going to leave in a secure situation sometimes the parent has to   say something like mommy had a really bad day at work today has nothing to do with you I need to go   take a timeout that helps a child understand that you know what it’s not all about me and   I can understand that sometimes moms upset for something besides me and I can understand that   if moms up said it doesn’t mean she’s going to leave so obviously this is the ideal situation   avoidant attachment styles the rejecting or harsh caregiver the person depends less on the caregiver   for security because every time they go saying, mom mom, I had a nightmare can I come into bed with you   they’re met with going back to your own bed and the caregiver rolls over it’s not oh I’m sorry you had   a nightmare let me walk you back to your room when the child is separated from the caregiver   there’s little response when the caregiver leaves or returns because the kids like what uses that   person to me the child learns not to depend on a caregiver for comfort connection or security   now imagine yourself a four-year-old child or a six-year-old child thinking I can’t count on my   caregivers for comfort connection or security that must be a terrifying place to be and I   can see why you would develop some pretty strong defense mechanisms the ambivalent relationship between the   cave caregiver is inconsistent or can bow can’t talk caregiver is inconsistent or chaotic this   is really true in a lot of homes where there are at least one parent who is battling some sort of   addiction or mental health issue so the parent may or may not be available you don’t know what   the good days are going to be you don’t know what the bad days are going to be so the child may be   anxious and afraid to try new things or explore because they’re like things are going good right   now I don’t want to top will be an applecart just going to sit here and ride it out a child may be   clinging and demanding trying to elicit a response remembering negative attention is better than no   attention at all and the child is upset when the caregiver leaves but also inconsolable when the   caregiver returns because you know I was upset I was scared you went away but you came back and   that’s good but I don’t know when you’re going to go away again and if you’re going to come   back so it’s this constant anxiety of abandonment core abandonment beliefs all people leave so we   want to challenge that by identifying exceptions mistrust people will hurt reject take advantage   of me or just not be there when I need them you know what that’s true sometimes because people   have their own stuff so when this happens let’s look at whether it’s happening all the time and/or   let’s also look at what else might be going on with that person that caused them to hurt reject   take advantage or not be there when you needed the emotional deprivation I never get the love I   need nobody understands me cares about me or even ever tries to meet my needs here how dramatic and   extreme that is so one of the things as clinicians we can do is say if you are getting the   love you needed what would it look like what would be different what is it that you need   that you’re not getting once we identify then we can create a plan to get it but a lot   of times other people don’t understand or may not be able to interpret what you need so let’s help   let’s try to figure out how to make this happen nobody understands me alright let’s talk about   why that might be and you know let’s look at some people who’ve kind of gotten a grasp sometimes   with clients with abandonment beliefs nobody understands me translates to I don’t give a buddy   a chance and I cut them off as soon as they become confused and because they associate confusion with the rejection so we might talk about communication skills we might work on what it is that people   don’t understand and how to better communicate that and where to find people who have similar   interests nobody ever even tries to meet my needs you know here I would really look for exceptions   but I would also challenge the person and I would say when do you meet your needs what do you do   to take care of yourself a lot of times clients with abandonment beliefs are so freaked   out and afraid of being abandoned that they’re not taking care of themselves either they’re   just living and are paralyzed going back to fight flee or freeze they’re living a paralyzed state   of I want to be loved but if I love I’m gonna get hurt and I don’t know what to do they don’t even   love themselves so we want to start talking about if you had your best friend you know create this   best friend persona what would he or she say to you what would he or she do right now let’s try to   help you understand yourself with mindfulness exercises are really good here because a lot of times these   clients don’t understand themselves they’ve got so much anxiety they’re so afraid and they don’t   know where it’s coming from because a lot of it has been going on for so long defectiveness   if people knew me they would reject me you know not everybody’s going to like you why do you need   everybody to like you why is it important that everybody likes you and failure I don’t measure   up and I’m not able to succeed I usually put pull out the obnoxious quote that if you haven’t failed   you haven’t tried and we talked about what it means to get outside your comfort zone and you’re   not going to be perfect at everything you’re not going to be Michael Phelps you’re not going to be   the president of the United States that doesn’t mean that you’re a failure that definitely   doesn’t mean you’re a failure so what things are you good at what can you and have you succeeded at and   go back and look over things like you graduated high school, not everybody does that you know   raised a family not everybody does that so we want to challenge all nothing’ languages we   want to look for exceptions and we want to look for in what ways can you provide yourself the   validation so you don’t fear abandonment you don’t need other people to tell you you’re okay because   guess what you’re telling yourself I’m okay and before I go on to unhelpful reactions I do want   to point out that if we tell people to tell themselves you know I’m okay that sounds great   but if they don’t believe it if it’s not supported with evidence, it’s actually probably going to slow   their growth because they’re sitting there going telling themselves I’m okay and in the back of   their head going you know you’re not so we need to get that internal critical voice to kind of   hush up by providing the person with the objective evidence of why they’re okay why they’re good   enough and that’s a slow process it’s not going to happen overnight but encourage people to figure   out why they believe what they believe and then you can work from there okay unhelpful reactions   fighting with someone you don’t want to leave me because so the person may engage in dominant   sort of posturing behavior aggression hostility blaming and criticizing trying to tear down the   other person to say you know what I don’t care and you should be grateful that I’m in your life recognition seeking to get attention validation or approval so if they feel something’s going   wrong in a relationship they may start trying to do something to gain recognition to prove that   they’re worthy of a relationship for what they do versus who they are manipulation and exploitation   said lying justifying I did this because you made me so sometimes we all occasionally do things that   aren’t the nicest people who fear abandonment have difficulty saying you know what I screwed   up and they’re more likely to go you made me do I wouldn’t have done it if you would have X   Y & Z people again who are worried about a relationship is going to fall apart and may also make excuses for   other people’s inappropriate behavior it’s like you know I really hate what this person does but   if I don’t make excuses for it if I condemn it then this person is going to leave in counseling   we can talk about the difference between loving a person and loving a person’s behavior you know I   love my kids to death there is no question about that but some of their behavior makes me want to   climb a wall I’m very clear to separate from them the difference between the behavior that I dislike   and them because you know like I said I love them to pieces and we want to help people start making   this differentiation if they don’t do it already and clinging and chasing is the other fight   reaction stalking and messaging somebody 47 times on Facebook in an hour all these kinds of behaviors   and even online bullying those sorts of things can be fight reactions in response to feeling like   there’s a threat of abandonment flight is more of the I don’t care if you leave so the person   will withdraw physically and emotionally and maybe even numb themselves with some sort of   addictive behavior or distract themselves with something completely different or find a new   person just proof that you know what I didn’t need you because I’ve got this new person now questions for clients about core beliefs all people leave okay so what does it look   like if somebody’s available to you if they don’t abandon you who in your past left you   or was unavailable emotionally now a lot of I find it helpful for mental health   and addiction clients to have them write an autobiography because then we can go back   and kind of review it and identify the core people at certain stages in a person’s life what did the person who left you do to make you feel rejected or abandoned in retrospect   you know it was hard to see the difference what was going on back then because you were a kid in   retrospect what are the alternate explanations for why this may have happened was it really   you or was it more about them who in your past has been available to you emotionally most of   the time people can point to one maybe two people who have generally been there it’s unreasonable to   expect someone to always be there who in your present is available to you emotionally you   know maybe they’ve only been in your life for six months or a year but they are available and I say   emotionally because you know not everybody can be available physically all the time we’ve got   jobs kids all that kind of stuff but can you pick up the phone and call them or text them and say   hey you know what I’m really struggling right now what do you do in your current relationships that cause people to leave do you push them away if so how what are alternatives to pushing them away cutting all ties and just saying fine be that way I wipe my hands off you if you cling how do you do  this in what ways do you perceive yourself as being clinging and what are some alternatives   to holding on with all desperation and mistrust people will hurt reject or take advantage of me or just   not be there when I need them so again what does it looks like when somebody’s or what does it feel   like when someone is trustworthy and safe who in your past was untrustworthy or unsafe what do they   do they taught you this and what are alternate explanations who in your past has been trustworthy  and safe who in your present is available and trustworthy what do you do to yourself that   is unsafe or dishonest that’s one of those tricky questions you’re there talking about other people   other people then it’s like what do you do to yourself how do you lie to your  self or how are you mean and hateful to yourself how does your distrust of other people or even  yourself impact your current relationships some people distrust their own internal intuition so  much that they don’t want to make friends with other people they’re like I can’t tell who’s  going to hurt me and who won’t so just yeah I’m going to wipe my hands of it all what could you  do differently what do you think you could do in order to start building trust and what does  it look like to build trust because Trust doesn’t just appear it builds gradually emotional deaths  deprivation I don’t get the love I need nobody understands me so again what does it look like  when somebody understands you and meets your needs who in the past failed to meet your needs  emotionally and how can you deal with that now you know it may have been mom it may have been   ex-husband it may have been you know who knows how can you deal with it now yourself so you can   put it to rest who in your past is understood you who in your present understands you how   can you start again better understanding yourself because it’s hard for other people to understand   us when we don’t even understand ourselves and what can you do to start getting your needs met you one of the things was starting to get your own needs met is to figure out what your needs are and   this is one of the exercises I have people do as a homework assignment they keep track of what is   it they want on a daily basis keep a log and then let’s talk about what common themes were seeing   if people knew me they would reject me okay so how do you know when you’re accepted or acceptable to   someone who when you’re past may make you feel defective are there alternate explanations and   how can you silence those old tapes because that person that statement stays as a heckler   in the gallery we need to hush the heckler what can you do part of it could be talking back and   saying you know what I’m not going to listen or I don’t have time for this right now who’s   been accepting and supportive who is in your life that’s accepting and supportive and how can you   start accepting yourself and being compassionate so some compassion focus training mindfulness work   to help people understand themselves and start being compassionate with themselves understanding   their vulnerabilities and cutting themselves some slack I don’t measure up I’m not able to succeed   okay that’s a pretty big success you know what is what success means success means different   things to different people so what does it look like to you to be successful let’s kind of hammer  that out what is it if you are successful what would be different what in your past has made  you feel like a failure what are some alternate ways of viewing it such as a learning experience  or something I had to go through to grow or you know brainstorming alternate explanations for   why people fail they don’t have a response to sometimes I ask them to kind of take on   a flip role and say pretend you’re a parent and your child comes home and they’ve tried out for   the football team and they didn’t make the team they failed what are you going to tell on what   have you succeeded at doing in the past what are you good at in the present and we really want to   pay attention to minimization here because a a lot of our clients are not good at identifying   their strengths what does being successful mean in terms of your relationship with others do you have   to be successful in order to be loved and be a the good relationship you know obviously you’re going   to be successful in a relationship if you’re but do you have to be financially successful and powerful all whatever you define success as in order to be in healthy relationships who are   three successful people you know and what makes them successful in your eyes does success equal  happiness you can do a whole group on that and what do your kids need to do to be successful  in life you know we want our kids to succeed in us want our kids to be happy so what is it that I  envision my child’s life to be 10 to 15 years from now triggering relationships the abandoner is  unpredictable unstable and unavailable the an abusive relationship is untrustworthy and  unsafe the deprived err depriving relationship the a person is detached or withholding the Devastator  is always judgmental rejecting and critical and the critic is critical and narcissistic usually   a lot of times people replay their past to try to kind of get it right the second time so we want   to look at do you have a habit of getting into relationships with people who are not safe we can   also ask them how do you exhibit these behaviors in what ways are these behaviors present your   current relationships and in what ways were these present and your primary caregiver relationships behavioral triggers abandonment and mistrust if somebody starts acting differently they change  their behavior in some way a person who fears abandonment goes oh that’s not good if they’re   not getting constant reassurance that’s that external validation can trigger   abandonment fears so again we want to work on internal validation and why is it that you   feel you need constant reassurance from the other person’s relationships feel threatening so   work relationships those sorts of things the a person who has abandonment issues won’t want   their significant other around other people and they become hyper-vigilant to rejection   and disconnection even if it’s just somebody going I had a really bad day I need 20 minutes  and go into the room and shut the door the person with abandonment issues will likely   have a high level of anxiety so we want to ask how these behaviors have threatened them in the   past what are alternate explanations for why this is happening with this person right now and what   would be a helpful reaction to these behaviors now so this is happening what would be a helpful   reaction instead of assuming that the sky is going to fall defectiveness and failure so if   somebody is critical if they have unexplained time apart there’s absent or inconsistent reassurance   or if the person tells them they’re a failure these or they fail at something these could   all be behavioral triggers they could be like I failed at something I’m not getting reassurance that this relationship fixing to end question how is this threatened you in the past alternate   explanations and what would be a helpful reaction to this particular situation right now envisioning activity what does a healthy the relationship looks like presence versus abandonment   acceptance versus rejection emotional support versus emotional unavailability trustworthy   versus untrustworthy and safe versus harmful these are extremes what does it look like to   be a middle ground there are going to be exceptions you know things are going to happen so what does   a healthy relationship look like and how to do you deal with exceptions if somebody’s not always   present how can you create this relationship with yourself that’s the big one and then how can you   create this relationship with others’ mindfulness questions what am I feeling what’s triggering it   am I safe right now and if not what do I need to is this bringing up something from the past if   so how is this different how am I different then I was when I was six or four and how   can I silence my inner critic finally what would be a helpful reaction that would move me  more toward my goals and toward a positive emotional experience summary core beliefs  about the self and others are formed in early life due to children’s lack of knowledge of other  experiences and primitive cognitive abilities these core beliefs are often very dichotomous   core beliefs can be formed around events or experiences outside of the conscious memory   identifying and being mindful of abandonment triggers in the present can help people choose   alternate more helpful ways of responding in the present in secure and loved me   don’t leave me are two really excellent books there are google previews if you want to look   at them to see if it’s something that you like but they do take what we talked about in this   presentation and expand upon it a whole bunch more 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 subscribing at all CEUs comm slash counselor toolbox, this   episode has been brought to you in part by all CEUs com provides 24/7 multimedia continuing   education and pre-certification training to counselors 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Common Co Occurring Issues in Addiction | Addiction Counselor Exam Review

this episode was pre-recorded as part of a live continuing   education webinar on-demand CEUs are still available for this presentation   through all CEUs registered at all CEUs comm slash counselor toolbox I’d like to welcome everybody to today’s presentation on common co-occurring issues   exploring the interaction between mental health physical health and addiction so we’re kind of   putting together the stuff that we’ve been talking about for a couple of sessions now   we’re going to start by talking about some questions and then reviewing what a healthy   person needs and then going through and talking about how different addictions may cause or be   caused by mood disorders and physical health issues and we’re going to talk about things   that you may see in private practice or the a facility that you’re working in just real quickly   for those of you who are here how many people if you would just type in the chat window if you’re   a mental health counselor type mhm if you are a addictions counselor type SI or whatever so just   kind of so and know who I’m talking to you okay so mostly mental health ok cool so what we’re going to look at is what you may see in private practice or a mental health   setting because these clients a lot of clients that have substance abuse or addiction issues   and I use the term addiction because we’re talking about behavioral addictions too many   times they don’t meet the criteria for admission for substance abuse because they don’t meet that   threshold of a substance use disorder tolerance withdrawal yay yay so substance abuse agencies   can’t get funding to provide the treatment so they end up in a mental health facility or a   mental health counselor’s office and they may be dealing with some of these addiction issues   and wanting to address them or they may not be but those issues are out there and exist so   we want to know how they interact so told you we’re gonna have a couple of questions to think   about and I’m just asking you to ponder these for right now and you can add throughout the class if   you want but we’re gonna talk about it more at the end how can we and why is it important   to address chronic illness and disabilities that result from or that cause mood disorders   or addictions so thinking about you know like HIV or hepatitis are two of the big one’s cirrhosis of the liver chronic obstructive pulmonary disease from smoking so these are   things that can result from addiction why or how is it important for us as clinicians mental health   clinicians mainly to think about addressing these how can we address depression and/or anxiety kind   of our mood disorder genre and hopelessness that results from or causes depression and anxiety so   we know that thinking back affects acceptance and commitment therapy there’s clean discomfort   which is what he calls your initial emotion when you feel something if you feel depressed   if you feel anxious that’s how you feel and it’s uncomfortable but it’s clean it is it is   what it is and then he calls dirty discomfort the feelings that we have about those feelings   so we can get angry that we are depressed we can get depressed that we’re still depressed and he   calls that dirty discomfort because we’re kind of layering on and piling in think about just kind of   throwing somebody into a hole and piling more dirt on top of them so we want to think about   how can we address these issues that result from depression or anxiety or sleeping eating or energy   changes so if you’ve got somebody who is dealing with a chronic illness or something else has   happened or they’re they’ve got some sort of an addiction and they are not eating well not   sleeping well it could trigger depression or anxiety so we’re going to talk about that how   can we address sleeping eating and energy changes seems like we’re getting repetitive we’re looking   at how each one interface and how can we address these things that are caused by or cause mood   disorders or addictions because we know when we look at the diagnostic criteria for depression   for example sleeping eating and energy changes primary in there and how can we address guilt   and regret which may accompany addiction recovery or the diagnosis of the disease as the result of   addiction such as lung cancer or HIV or cirrhosis of the liver and people who have liver disorders   cirrhosis of the liver and hepatitis are at a greater risk of liver cancer so that can they   can have some additional anxiety that is related to that so they may look back and go I wish I   hadn’t well you have so how can we help you deal with that and come to some level of acceptance so   my little editorialized soapbox when we’re talking about addictions I mean sometimes we don’t want to   think that they exist we want to pretend that our clients are coming in their mental health clients   otherwise their perfectly healthy things are going great well that may not be the trick the   case a lot of people begin to use and I mean think about ourselves when we’re when we were   in high school and college or you know even later some people use it for recreation you know they want   to go out have a few beers do whatever cool you know that’s fine some people drink or use it for   relaxation my son has a love of we will use that word videogames and he will get on his videogames   and we’ll kind of get lost in it it helps him escape from you know life as we know it for a   little bit of time some people use because of peer pressure you know it’s everybody’s   doing it or you know you’re at a football party or something and everybody’s having a beer and   somebody offers you one and you don’t want to be rude things like that can happen and some people   begin to use straight up for self-medication they’re like I feel crappy I need something to   help me feel better or numb the pain so there’s a lot of reasons people begin to use so then you   might say well why don’t they just say no because it’s easy to say no well it’s not some   people start to use it because they’re bored and they want something to bring some excitement some   euphoria to their life and we’re talking about everything from sex addiction to internet addiction to cocaine use I mean we’re running the gamut here they may lack the awareness of the dangers or how   quickly you can become addicted I know when I was working in the facility in Florida there was the   sort of knowledge if you will and knowledge is not the right word rule I guess that with crack   cocaine for some people, it was a one-hit wonder you did it once and you were hooked and several drugs can be highly addicting quickly especially if they’re taken either   through injection or inhalation but we’ve talked before about the fact that our bodies can start   developing tolerance to opiates within 3 to 5 days so you know people may not a lot of people   don’t realize when they go in and their doctor writes him a script for two weeks of opiates and   they take it as prescribed that they’re actually becoming somewhat addicted to those opiates if   they take the whole prescription so they may not understand that some people don’t say no because   they have low self-esteem so they’re looking for comfort to help them relax to help them loosen   up so they can be more fun at the party and or to peer pressure somebody tells them why don’t use or why don’t come out and go drinking with us or whatever the case may be so to fit in   they may try to use it to fit in to feel part of a crowd and part of it can also be you   know with that peer pressure just generally the culture promoting this kind of behavior going   it’s ok I think I’ve shared with you before at At the beginning of some of the original Beverly   Hillbillies episodes they still advertised Winston cigarettes, like they are the greatest thing and cool people, have them and that’s the thing to do so if that message gets out people may start   believing it and not do their research so to speak on what the true problems or risks may be and then again self-medication some people may be struggling just to get by from day to day and   this helps them survive the best they can with the tools they have until we give them some new tools   so just saying you know I had I grown up during the era of Nancy Reagan and you know God loves her she was trying to help and for a certain small percentage she probably did but for a larger   percentage just saying no is not that easy we need to give people the tools so they can say no so   they don’t so they aren’t relying on these drugs for some reason because when people start using it for recreation and relaxation some people may not have a big big issue with it other people may   start throwing their neurotransmitters kind of out of whack depending on how much how often they use   what combinations if they’re on any medication so people may inadvertently start messing with their   neurotransmitters and creating and we’ll talk about this creating depression or anxiety   that they end up trying to self-medicate so that that is my soapbox for it is not that easy to just   say no we as a culture not just as clinicians have some work to do so what do we need to do to help people be able to just say no they need to have access to healthy nutrition   and knowledge of what that means my son and it’s still like drawing fingernails on a blackboard   to me today this week, I told his sister that you no, he didn’t understand why she was so concerned   with the nutrition he’s a guy he doesn’t need to pay attention to nutrition it’s just whatever and I   was just like oh my gosh you know everything I’ve said has fallen on deaf ears but okay we’ll back   up and figure out a way they need access to it and then they also need to eat it you know if   we have healthy foods available but people are still eating peanut butter and jelly sandwiches   for every single meal it’s not going to help so we need to make sure people understand what a healthy   diet looks like and how to do it in a way that’s not painful you know we’re not asking you to just eat   rabbit food as my daddy used to say but so what does it look like to eat a diet or nutrition that   makes you feel good that’s happy that makes you feel happily fulfilled you like it tastes good   whatever you want to say but that’s also healthy you know it’s not just pizza or just   peanut butter we need to educate people and a lot of adults that I work with have no clue about   sleep hygiene you know they know they’re supposed to try to go to sleep but they don’t know anything   about turning off the blue turning on blue light filters so the blue lights are not keeping them   up so we need to do some education here ideally in elementary schools but if we can get it out to the   community so they can pass it on to their little minions we’ll be on a good path to pain control we   need people to start having pain control but we need to also have them have alternatives to   pain control besides opiates and there are a lot of them out there again people don’t know about   so we must educate and we’re not prescribing pain control that’s not our job but   if we have a client who’s in chronic pain we can suggest that they work with their doctor that they   look into options for pain control you can google it and find a lot of different alternatives now   if they don’t want to go to the doctor but you know there are a lot of different things from   acupressure it attends units to things that are nonpharmacological that can help people manage   their pain so they can sleep which will help the rest and rebalance to deal with fatigue and   be able to deal with life kind of on life’s terms because they won’t be in this constant state of   stress people need access to regular medical care to prevent problems so you know we want to prevent   this thing on your face from becoming skin cancer we want to prevent anything else that that might   trigger problems and early intervention so like with Lyme disease, if people get early intervention   mentioned they don’t end up with the chronic problems with HIV the earlier the intervention   the better same thing with hepatitis you know the list goes on so we want to make sure that if   people have some sort of issue that’s disrupting their ability to get enough sleep process   nutrition go to work do any of these things that they have access to some method whatever method   they need to address it so sometimes it’s medical sometimes it’s mental health it’s social   services they need safe housing so we’re on to social services now and that includes a roof   over their head that they’re not worried when they go to sleep at night but also being safe   from domestic violence and things like that safety and this kind of goes with safe housing and I put   internal and external because you know the first part is external safety we want to be able to know   that our patients can relax wherever they’re at they have enough money to keep a roof over their   head in a safe place and you know typically that’s not something that we think about as mental health   counselors we think about helping them deal with their anxiety but if they can’t get enough sleep   and they never feel safe when they’re at home they’re not going to be able to rest and they’re   at best their recovery is going to be impeded at worst you know it’s going to contribute to the   issue that they’re seeing us for so safe housing is important we’re not going to get it for them   but we can point them in the right direction your local United Way which is 2-1-1 and most places   generally has a listing of different resources for accessing safe housing if you don’t work   in a facility that’s used to dealing with that and then internal safety that’s shutting up that   internal critic that’s being able to go through a day without being derogatory to yourself and that’s something that we definitely can help with we can help people shut down that   internal critic or that internal person that is always calling gloom and doom and you know   waiting for the other shoe to drop or whatever the case maybe we can help clients change their   cognitions so it’s safe inside their head and then people need love and acceptance and   this should sound pretty familiar are you know Maslow’s hierarchy here kind of in Reverse   but people need love and acceptance but in order for love to have love and acceptance in many cases   they also need to love and accept themselves so we’re gonna work on self-esteem we’re gonna help   people develop relationship skills hopefully there are some people in their life that have provided   some level of love and acceptance maybe not the unconditional positive regard we’ve hoped for but   they’re there so these are things that the healthy happy person needs and these are things in large   part we can do through education referral and direct services help people get so why do we care about   co-occurring issues as mental health counselors well 35 percent of people with anxiety disorders   have according to one of these studies abused opiates so that’s a lot if you’ve got somebody   with an anxiety disorder this isn’t just panic this isn’t just something you know severe   this is you know any of your anxiety disorders one in three roughly have abused opiates they’ve   used some sort of opiate drug to help them kind of chill out of opiate or alcohol dependent patients   20% have major depressive disorder so of that 35% you know there’s going to be a percentage   of them who may be opiate or alcohol dependent and there are a lot of our clients that we see in   mental health treatment who are not willing to be truthful about how much they really drink or how   often they drink because they might be suspecting it’s a little bit of a problem but   they’re not wanting to go there yet they’re in what we call pre-contemplation okay so let’s   just go with this in mind that there may be some underlying other stuff that they haven’t told us   about opiate or alcohol-dependent patients 20% have major depressive disorder so you know we’re   taking them and we may be seeing them in the clinic for depression and we do want to be suspect of   whether there’s either some opiate or alcohol issues there depression and opioid-dependent patients including pain management patients so those who are opiate-dependent by prescription have been associated with poorer physical health decreased quality of life increased risk-taking behaviors and suicidality am I saying that pain management clinics are bad no but what I’m saying   is those who are in pain management clinics for a variety of reasons are at a high in a higher risk   category I mean think about it if your pain is bad enough that you need to be going to a pain   management clinic think about how much that must hurt think about how much that must impair your   daily life think about the impact of the drugs that you’re taking on your mood your energy levels   and the stigma in some cases associated with it some people here suboxone and they’re like yeah   whatever my neighbor takes that other person here suboxone and they’re like ah you can’t be taking   that so there is still a lot of social stigmas that goes along with medication-assisted therapies so there are a lot of things that may contribute to depression in opioid-dependent patients   the prevalence and severity of depression tend to decline within the first few weeks after treatment   initiation so if they are trying to get off of you know ideally their detox and they’re   trying to you know remain sober the prevalence and the severity of depression tends to decline so we   need to get them off of it first and get them through that acute withdrawal from a depressant   including alcohol and I know this slide is boring but we’re gonna be through in a second withdrawal   from depressants including alcohol opioids and even stimulants invariably include potent anxiety   symptoms so it’s important to pay attention and withdrawal from stimulants can also include potent   depressive symptoms if they’ve been on a crack binge for you know five days that won’t sleep for   a while many people with substance use disorders may exhibit symptoms of depression that fade over   time and are related to acute with drawl well we talk about acute withdrawal we’re talking about   the first three months we’re not talking about the detox period which is generally three days so   encourage people who’ve gone through detox and maybe they’re seeing you on an outpatient basis   encourage people to you know be patient and work with the treatment team if they need to but the first   three months is always the hardest so chicken or the egg you know did the person start using and become   depressed or was the person depressed so they self medicated does it matter depression and anxiety   are associated with addiction because because if you have stimulant withdrawal or recovery   that period after you quit using that’s maybe a week maybe two weeks where your body is going   whew that was a run people may feel depressed fatigued have difficulty concentrating which can   impact how well they eat it’ll impact their sleep they’re gonna sleep a lot more but the   quality of sleep may be poor so they can mess up their circadian rhythms and you know they   may not have access to the social support that they wanted they may but really with stimulant   withdrawal we’re looking at nutrition and sleep so we want to educate patients if they   decide to stop taking stimulants what they need to look at stimulant use can also be associated   with depression and anxiety because many people not you know the majority but a lot of people   out there will self-medicate depression with stimulants from anything from caffeine which   you know maybe like mild dysthymia but if you abuse enough caffeine you know it starts getting   into your system you become dependent on it but if you start combining caffeine and nicotine plus oh   let’s add in some workout supplements or you know the occasional Ritalin or something not suggesting   it then it’s these things can wear the body down which can lead to additional depression but people   may use these things to try to feel better because think depression is related for some people   they may not feel like they can wake up they’re fatigued they’re lethargic all the time and   they’re feeling blue so if they take stimulants they get that dopamine rush they’re starting   to feel good and they’re awake stimulant use can cause anxiety well the so if you’ve got   somebody who already has maybe they are depressed but they’ve also got some anxiety and they start   using stimulants which may make the anxiety way worse alcohol or opiate use some people use these things   to numb or to forget and that’s just your the standard used the depressant some people will   use either one of these but especially opiates to deal with physical pain to medicate depression or   anxiety remember there are a lot of trials not several trials right now that are looking at   using opiates to treat intractable depression but a lot of people also use opiates off-label illegally to address anxiety so if you’ve got a client with depression or anxiety just kind of   be alert for how they’re behaving if they’ve got pinpoint pupils or if they’re itching and   picking all the time I mean not the occasional are winter and the heat just turned on I’ve got   dry skin itch but constantly itching and picking and you know where you’re like please just settle   down detox from opiates can all often produce depression produces a lot of flu-like symptoms   which can make people feel crappy and the flu-like symptoms I won’t get graphic impaired   nutrient absorption impaired sleep you know they’re sleeping a lot because they feel like   crap but they’re also having to get up every 10 minutes to go to the bathroom sometimes so   this first week or so during the initial if they go cold turkey so to speak can be rough   detox from alcohol as I’ve talked about before can produce anxiety symptoms so understanding   that when people are going through detox whether they are alcohol dependent and have been drinking   a whole lot which needs to be medically monitored I can’t say this enough and I’ll say it a lot more   tomorrow when we talk about where Nikki Korsakoff syndrome but people who are detoxing from alcohol   will have anxiety symptoms and a period of high blood pressure and sometimes depression and anxiety are associated with addiction just because they sober up one morning and they look at their life   and they’re like what the hell have I done so you know and you’re looking at them going yeah   I don’t blame you for feeling that way now let’s see what we can do to improve the next moment   so make sure that we understand that these things are going to go hand in hand and to be   on the lookout because like I said a lot of people aren’t forthcoming even about alcohol use which is   legal but if they’re using something illegally or using maybe their kid’s Ritalin or something   they’re pretty much almost guaranteed not to tell you so we want to be on the lookout for signs and   symptoms bipolar disorder can be triggered by drug use so we just know that we can the person could   get worn down mess with the neurotransmitters enough they’re not exactly sure how it happens   but we have seen the initial acute episode of bipolar disorder-triggered mania triggered by   drug use it is more common for people with bipolar to use stimulants when they’re depressed and just   about anything when they’re manic now if you’re working with somebody with bipolar you know   you’re probably already having these discussions about how you stay safe when you’re in a manic   episode people with ADHD may use to self-medicate and we’re talking cannabis is a big one for ADHD   to help people feel like they’ve got more focus and not feel like they’ve got so much coming in   and so much stimulation all the time which can be exhausting and after the use of any of the substances   of abuse the disruption and neurotransmitters can make people feel like they’ve got ADHD-type symptoms faculty concentrating difficulty following through with things etc so understanding   that even if things don’t meet the threshold for DSM-5 diagnosis we want to look at what symptoms   are there and how can we help people manage them so they’re getting adequate sleep nutrition pain   control social support and safety borderline and antisocial personality just kind of threw those   in there because we see those a lot when we’re working in dual diagnosis facilities more people   are more likely to use addictions to cope with a lack of sense of self and their emotional lability   if they’re borderline so I mean their world is so chaotic many people with borderline personality   disorder are likely to use to try to get some calm in the storm now I will put out my other soapbox   here with both of these personality disorders when you see somebody in active addiction or early recovery they probably have symptoms that would meet diagnosis you know their symptoms   are pervasive in multiple areas of life their symptoms would meet the diagnosis for one of these   two personality disorders during this period but it resolves as recovery becomes the norm   as the neurotransmitter stabilizes they develop interpersonal skills so you know giving people   a little bit of time before we say it’s borderline personality disorder versus borderline personality   characteristics if you will be helpful because both of these diagnoses can block people from   getting into certain treatment centers and getting some of the services they need okay so we’re going   to move on to some of our more common addictions alcoholism is associated with eating disorders   there’s a really strong Association and it usually flip-flops between bulimia and alcoholism so if   somebody’s symptomatic for bulimia they may not be drinking a lot of alcohol but they may during   periods of remission from the bulimia drink a lot more alcohol become alcohol dependent so there’s   a lot of research out there that shows there’s a strong correlation between these two things and   it’s also associated with binge eating disorder but especially bulimia nutritional deficiencies   from alcoholism can cause mood disorders so even if somebody is not and I use the term   I should have put alcohol instead of alcoholism because even the term heavy use without physical   dependence can cause nutritional deficiencies that can cause ulcers it can cause physical problems   physical exhaustion which can disrupt sleep alcohol impairs sleep quality alcohol makes   apnea worse so if you’ve got a client who has sleep apnea they’re drinking they’re probably   gonna sleep even worse than they normally do depression is the result of using well alcohol as a depressant so what do people expect well most people expect to relax they don’t think about the   rest of the stuff that’s going on in neurochemical imbalances because the alcohol exits our system a   lot faster than our brain can catch up and go okay it’s not in there anymore so I need to adjust the   temperature and in sleep disruption anxiety can also, be triggered as a result of use I’ve said   before say it again after that initial period where people feel the depressant or relaxing   effects of alcohol there is an upsurge in anxiety so a lot of people have another drink to kind of   quell that anxiety feeling but you know people with anxiety disorders are gonna feel it more   prominently and the neurochemical imbalances that alcohol use causes can worsen pre-existing   anxiety conditions or trigger anxiety conditions nicotine is another one that we see a lot even   in just straight-up mental health clinics not co-occurring so what effect does nicotine have   well anxiety and depression are 70% more likely in smokers so that’s one of those statistics we want   to look at nicotine triggers dopamine release okay so nicotine is one of the most addictive drugs on   the planet and you’re thinking I thought that was opiates well opiates are in there but nicotine   not only is nicotine legal but it’s also one of the most addictive drugs on the planet so that’s   another important point to think about people are using their trigger and dopamine release their   brain gets used to being flooded with dopamine so their receptors on the other end start sensitizing   so we’re creating an artificial environment basically when people are smoking blood vessel   changes when people smoke it causes blood vessel changes that can cause high blood pressure as well   as depression and fatigue and confusion in the blood vessels narrow and get stiffer so the oxygenated   blood has a harder time getting to where it needs to be so people start feeling blah and that can   cause them to think that they’re starting to feel depressed can also cause those cause loss of   energy people with severe and persistent mental illnesses are two to three times more likely than   the general population to use nicotine so that’s just an interesting little fact to have out there   if you work with people with SP MI and people with ADHD may smoke because it increases their   concentration and attention for about five minutes literally, for about five minutes but during that   five minutes they’re like oh my gosh it’s a relief I can like focus for half a second so we   want to look at what else is going on whether the a person has adult ADHD for example physical health   mental nicotine is linked with COPD and emphysema and lung cancer so you know all kinds of lung   and cardiopulmonary stuff well when that happens you know we have less oxygenated blood efficient   efficiently getting through the system we’re going to have increased fatigue increased confusion some   grief that may go along with that especially if people are starting to have to carry an oxygen   tank around with them or something you know we may have to help them deal with disability acceptance   and depression and stroke because smoking like I said increases blood pressure and reduces   circulation so cutting off or greatly reducing circulation to the brain they have shown that   people who smoke especially heavy smokers are at a much greater risk of stroke and addiction nicotine   is strongly correlated with other addictions a a lot of people when they’re in the bar well not   so much anymore since smoking is not allowed in public places but used to be when they were in   the bar they would also be smoking but a lot of people associate alcohol and nicotine or nicotine   and other drugs so if somebody is using other drugs likely they’re smoking now it doesn’t work   the other way around just because they’re smoking doesn’t mean they’re likely using other drugs the   reason this is more important is that people who continue to smoke after they have gone into   recovery for their drug of choice have a relapse rates as high as 68 percent higher than for people   who quit smoking so we start thinking about that and we say well why is that well because nicotine is a mood-altering substance you know we don’t think of it as such because it’s not a   woohoo it’s Marva hey okay it’s not as prominent of interaction as maybe cocaine or something   but it does change the balance and people still do use smoking to cope with life when things get   stressful they smoke well if things get stressful and you know they’re too stressed for smoking to   handle then they may start going back to what else can I take use or do that will make this   feeling go away right now we know also that was smoking and that repeated release of dopamine   they’re messing with the neurochemical balances in their brain, so it makes sense that eventually   just like tolerance to other drugs happens it may not be enough at a certain point and they may fall   back into other habits nicotine has been known to suppress appetite and but whether it keeps weight   off or not they haven’t shown alcohol and nicotine both are appetite suppressants which   is another reason people with bulimia tend to drink and one of the reasons why people quit   smoking they tend to be hungrier so helping them get through that period now whether it   helps them keep weight off the party that deals with the reason that they eat it’s not really that it’s   suppressing their or increasing their metabolism so much its nicotine suppresses the anxiety   and sometimes the desire the hunger but if people are still eating out of anxiety if they’re still   eating under stress eating then you know when they stop smoking and they don’t have a cigarette to put   in their mouth when they’re stressed they tend to go for other things and so we need to help people   figure out when they stop smoking are you eating because you’re hungry or are you eating   because you’re stressed if they’re eating because they’re hungry and they’re getting heavier   than they want to be they need to talk with their doctor about you know thyroid tests and also let   their doctor educate them on biological setpoint theory of you know not everybody’s going to be   a zero so you know that may be something we can help them deal with body acceptance issues if   you know maybe they’re programmed genetically to be you know a size X whatever that is and they’re   not happy because they want to be a zero which our culture does tell us to do as clinicians   we can help them look at you know the costs and benefits of continuing to smoke and what being   you know a size zero means for them to opiate abuse there’s a lot of physical stuff and we’re   just gonna run through it real quick because you’re not as concerned with it the physical   stuff the doctors are gonna see but we need to be aware of from a clinical point because it can keep   people from getting their basic needs met blood and injection site infections you know that’s   probably going to lay them up for a while but if they have repeated infections and are repeatedly   out of work they can lose their job they can lose their housing they can you know get some sort   of MRSA or something else which can be really expensive it can be life-threatening ya-ya   collapsed veins and this is more common obviously this is only for injection drug users but   collapsed veins just as you would expect keep the oxygenated blood from getting where it needs to be   so people are more likely to experience strokes and may have certain forms of vascular dementia   because of the strokes dementia we’re familiar with endocarditis is the inflammation around   the heart so again this is only for needle drug users but if you’ve got a client who is using   needles to inject any kind of drug be aware of that and what they get and what they inject is   rarely pure so knowing what else they’re injecting into their system if they’re you know crushing   pills from the pharmacy you’re a little bit more sure about what they’re getting as opposed to if   it’s from the corner dealer and sometimes they’re cut with really nasty things like   you know comic bathroom cleaner and stuff HIV if people get HIV from injection or some other risky   behavior they’re probably going to experience some depression and a lot of times HIV from   opiate abuse they’re gonna experience depression remorse regret all that kind of stuff anxiety   about how long they’re going to live what’s going to happen and oh those medication side   effects those the antiretroviral medications that they have to take are doozies I’ve seen people go   through the induction weeks on their medications and it is a rough time so helping people   get through it so they are medication compliance so they can continue to live we need to help them   maintain hope and self-efficacy and all that kind of stuff to maintain that forward movement to get   through the induction period liver damage from acetaminophen can set people up for you know   physical pain among other things and it decreased pain tolerance now this generally the decreased   pain tolerance goes away after the the body starts producing its endorphins and   natural painkillers again but that initial period Stevie-Wright-rare-interview if somebody quits using and maybe you know you are seeing them as a mental health client and they had an accident or had surgery or something   they started using pills they got a couple of refills then the doctor said no I’m cutting you   off and now they’re going through a detox period detox from opiates is unpleasant but it is rarely   life-threatening unless somebody becomes their electrolytes get imbalanced because of the flu   symptoms but we still may see this in private practice in mental health practice because   of the scenario I just told you people can start taking painkillers as prescribed for something   they may get addicted you know take them for a month or so then when they get off of them   not only do they feel like you know really bad but their pain is also back and it may be they   had their wisdom teeth out that pain may be gone but other aches and pains and everything you feel is probably going to be intensified until the body kicks back in so educating clients about   this is what happens you know it’s not uncommon if you think it’s too bad go see your   doctor helping them make sure they’re getting good nutrition you know it’s hard if you’ve got   flu symptoms to feel like you want to eat or hold anything down so what can you do to make   sure your body has the building blocks to make the stuff that it needs to help you feel better what   can you do to improve your sleep and a lot of our clients and you know where I used to work we   had a methadone clinic and we also had a mother baby unit and as soon as the mothers would give   birth then the doctor would start them on their detox from methadone and he didn’t believe   in the kinder gentler taper he was just like okay baby’s gone threats gone because you can’t detox   from somebody from opiates when they are pregnant because it can cause the baby to die anyway   so as soon as they would stop or as soon as they weren’t pregnant anymore he would just   D see them and they would feel really bad I mean not only did they just push an 8-pound something   out of their body but they also are experiencing a decreased pain tolerance because they’re not   on the opiates anymore and all they want to do is sleep it’s just like please so understanding that   is important in helping people get through that period even though they may want to sleep   all the time helping them understand that it’s important to maintain their circadian rhythms   if they have to take two or three ten-minute power naps throughout the day to get through   the day you know more power to them but if they can practice good sleep hygiene they’re gonna   be way better off in the long run OPD opiate abuse is also or opiate use is also associated   with the treatment of depression but it can cause depressive symptoms due to its pharmacological   properties I mean it slows everything down from you’re gastrointestinal to your heart rate to your   respiration you’re not breathing as much you’re not getting as much oxygen in you’re gonna have   more fatigue you’re gonna have more confusion you’re going to have more of those symptoms of   depression for some people they find it is and certain opiates they find it is a powerful way   to reduce anxiety it makes them feel like they’ve got a ton of energy because they’re not stressed   out anymore and this last one is one of the The main reason that I find people don’t want to give   up opiates is that they finally feel better when they’re on the eating disorders commonly a coat   co-occur with depression and anxiety which can be caused by nutritional deficiencies you know   you’re not giving your body the building blocks so it can’t make the neurotransmitters it needs   and it also probably disrupts your sleep some and depression anxiety can cause or trigger or   whatever you want to say eating disorders because people with eating disorders may fear becoming fat   have low self-esteem have a sense of lack of self-control or have body dysmorphic disorder   so we also want to be aware that there are mental health stuff that can trigger dysfunctional eating   patterns there’s about a 24% prevalence of PTSD among people with eating disorders so if you’ve   got a client with eating disorders especially bulimia be on the lookout for depression anxiety   body dysmorphic disorder alcoholism and PTSD they maybe smoking too but of the things, I just listed   that’s probably the least of their worries it’s all eating disorders are also associated with   alcoholism and smoking I said physical health issues now you’re seeing somebody with an eating   disorder it’s a mild eating disorder you’re seeing them once a week outpatient so you’re not and you   have you know you have training and working with eating disorders or maybe it’s   mild enough that you’re just getting supervision on treating this issue whatever being aware that   people with eating disorders anorexia or bulimia can have irregular heartbeats and cardiac arrest   due to potassium imbalances and electrolyte imbalances so if they’re not eating or if   they are binging and purging in some way shape or form and that includes excessive exercise which can   trigger a lot of heart problems they may have loss of bone mass and osteoporosis so they may   break bones a little bit easier going back up to the heartbeat not to belabor the point but again   heart problems mean a lack of available oxygen mean confusion fatigue potential difficulty   sleeping depressive symptoms and you know cardiac arrest in and of itself is bad kidney damage from   Doretta caboose and low potassium can also potentially drain damaged the adrenals which   are on the kidneys and so it’s important to be aware of what people are using a lot of people   with eating disorders are going to creatively use stimulants to suppress their appetite think   about any of your diet drugs your enter mean I think it’s one of them the ones they give to help   people lose weight they’re stimulants they’re intense stimulants so people who are   struggling with eating disorders are likely to go towards abusing stimulants or at least using them   which can drain the adrenals it can in some cases have been linked to the development of   Addison’s disease liver damage from not eating or binging and purging causing toxin buildup   and possibly pain we can help people deal with it as much as we can anemia which can cause symptoms   of depression in and of itself so goes back to that nutrition making sure they’re getting enough infertility which in and of itself can be devastating for young women if they can’t   have children anymore or can’t have children ever that may be a grief issue that we need to   help them deal with cathartic: and this is an important one to be aware of because you   don’t have to have somebody who uses laxatives all the time but people who regularly use or   abuse laxatives can become dependent on them so when they don’t use them they have a feeling of   bloating feeling full and abdominal pain which especially in people with eating disorders or   body morphic disorders surrounding just general body fit bad back body fat can greatly increase   anxiety depression hopelessness and in some cases of suicidality so again educating people   is the first step to helping them understand what’s going on and how dangerous laxatives can be but   also if somebody is trying to cut back on their use of laxatives or just recently stopped using   laxatives like when people stopped using opiates it takes the body a while to get back   online but for most people it eventually does people with eating disorders also have chronic   ulcers which are painful and can keep you up at night As you know gastric reflux and pancreatitis   which can flare up at a moment’s notice will is extraordinarily painful and can cause people to   lose time from school or work social activities feel bad about themselves and also   pancreatitis causes a lot of bloating which in eating disorders is a huge trigger   for anxiety and depression pathological gambling is associated with stimulant abuse especially   cocaine methamphetamine and Ritalin to stay focused disrupted sleep and rebound depression   when they quit taking that stuff they wake up and they’re like oh wow what did I just do alcoholism   is also associated with pathological gambling some people drink to calm their nerves some   people drink because it’s the culture if you go to any of the casinos you know their hand-and-out drinks, they’re trying to get you drunk so you keep gambling more and there’s as we spoke about   earlier rebound depression or anxiety smoking may help people increase their focus or make   them think they can increase their focus so if you can’t smoke in public places this is more of   an issue if you have somebody who does a lot of online gambling or they gamble at their friend’s   house or somebody’s house where there’s poker games and stuff smoking has some anti-anxiety   anti-anxiety properties and may be part of the the culture I know when my daddy used to have his   poker games everybody would smoke cigars and even the one woman who went there would be smoking a   cigar with everybody else and it was just the culture of being there so there are a lot of   different reasons that people may use substances in addition to gambling mental health issues from   gambling anxiety from the stimulant use or from the tension and release of am I going to you know   I’m down $20,000 am I going to make it back ADHD is also strongly associated with pathological   gambling bipolar disorder, especially during manic phases are associated with pathological gambling   generally you see them co-occurring it’s not like gambling causes it it’s you will see co-occur depression can occur due to losses and gambling can start because somebody’s depressed   because of their financial situation and their trying to figure out a way to you know borrow from   Peter to pay Paul and get ahead you also see pathological gambling is more strongly associated   with people who have obsessive-compulsive disorder if you’ve got clients with these   diagnoses just kind of you know be attentive to the fact that they are more likely to engage in   pathological gambling or if they start gambling it’s more likely to become a problem than for   people who don’t have these issues internet an addiction that is diagnoseable so   you know I’m not just making something up depending on your resource affects eight   point two percent to thirty-eight percent of the general population now obviously we were looking   at you know like games versus you know games plus Facebook plus shopping or something so depending   on the study you looked at their parameters were a little bit different but either way up   to 38 percent of the population has sacrificed significant personal recreational activities to engage in some sort of internet behavior Internet addiction can cause anxiety or   depression due to eyestrain and chronic headaches you know if you’re hurting all the time it can   make you feel wonky it can also interrupt your sleep can cause circadian rhythm disorder which   can trigger depression fatigue reduced stress tolerance this is a condition when your body   doesn’t know whether it’s supposed to be awake or asleep because a lot of people who engage in internet-addictive behaviors do so in the dark or you know they don’t pay attention to whether the   lights are on or not they may just sit there kind of in their cave carpal tunnel contributes to pain   and sleep disruption because carpal tunnel does wake you up at night back ache again may disrupt   your sleep and can cause chronic pain during the a day which can interrupt your daily activities poor   nutrition I know a lot of gamers that will sit there for an entire weekend and not get up to go   eat so if it’s not brought to them they don’t eat they’ll even wear adult diapers so they don’t have   to get up to go to the bathroom reduced immunity due to exhaustion from not sleeping and job or   relationship problems I know uh several people whose marriages ended over a world of warcraft’   so internet addiction is a real thing and it’s something that we need to be cognizant of because   it does cause a lot of problems and a lot of relationships and it may be one of many problems   but it’s something to look at sex addiction can cause hepatitis and a variety of different STDs   which if not treated can cause systemic problems it’s related to anxiety and depression because sex   addiction may begin in order because somebody wants to feel loved or connected maybe after   a breakup or because they never felt loved you’re connected and then they feel that rush and they’re   like oh I like that I want to do that again part of it could be engaging in that behavior which is   so thrilling you know depends on the person psychological withdrawal from sex addiction   people who have been engaging in sex addiction type behaviors and I include pornography addiction   in it for this presentation if they’re not able to access that may start feeling anxious or depressed   they can’t get to that they can’t get to the the thing that’s gonna cause the dopamine rush and   reflection on behaviors that they’ve engaged in as a part of their sex addiction can also prompt   anxiety about a spouse finding out you know am I going to develop an STD and am I you know how I feel about what I’ve been doing so as clinicians if we’re working with somebody who has compulsive   sexual behaviors even if you know anywhere about that the spectrum we need to be aware that these things may   exist and figure out or help them figure out how they feel about it and what they need to   do to make sure that they’re getting good sleep that they’re dealing with their depression and   their anxiety so that they can have a safe internal and external environment so back to that global   perspective how can we and why is it important to address chronic illness and disabilities   that result from or cause mood disorders or addictions how can we address depression anxiety   and hopelessness that results from or causes depression anxiety or physical problems how can   we address physical problems that are caused by mood or addictions and how can we address   guilt or regret which may accompany addiction recovery or the realization of a diagnosis of a   disease caused by the addiction so while you kind of ponder those there was a question that came in so question what about robbing Peter to pay Paul in association with trauma specifically childhood trauma so if you could clarify that for me a little bit I had mentioned robbing Peter   to pay Paul in terms of gambling so I’m just so mental health issues can be caused by or trigger   addictions or physical health issues addictions can cause or trigger mental health issues or   physical health issues that can be caused by addictions or mental health issues   so again chicken-or-egg we don’t necessarily know which one came first when you have any one of   these it’s probably going to or likely impact each other person or each other area common   issues are seen in all three changes in sleeping changes in nutrition fatigue and grief effective   treatment requires addressing the underlying causes as well as the ripple effects you know so yes after childhood trauma or trauma of any sort, some people may spend a lot   of time feeding the addiction as you put it or engaging in addictive behaviors to avoid some   of the PTSD symptoms to avoid thinking about it to deal with the grief to deal with the shame so   they may engage in something that makes them feel better or helps them forget to cope with the trauma that happened until they have other tools so they can come to   some sort of terms with it and you know as I say close that chapter in their book already   if there are no other questions tomorrow’s the presentation I learned a lot creating is   on alcohol-related dementia and vascular dementia and fetal alcohol spectrum disorders all three of   which are issues that are caused by substance use and specifically alcoholism and then I’ll   give you a hint about where an acute Korsakoff a a lot of clients who abuse alcohol but they’re not   alcohol dependent who decide to stop drinking can trigger where Nikki Korsakoff syndrome   and causes alcohol-related dementia-type symptoms so again in mental health, we need to be on the   lookout for it if we hear that our clients are trying to cut down on their alcohol use   alrighty everybody and so tomorrow is that presentation and then Thursday we’re going to   look at different models of new bottles of treatment 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 subscribing at all CEUs com VirtualBox this   episode has been brought to you in part by all CEUs calmly provide 24/7 multimedia continuing   education and pre-certification training to counselors therapists and nurses since 2006 used coupon code consular toolbox to get a 20% discount on your order this month     As found on YouTube Animated Video Maker – Create Amazing Explainer Videos | VidToon™ #1 Top Video Animation Software To Make Explainer, Marketing, Animated Videos Online It’s EASIER, PRODUCTIVE, FASTER Get Commercial Rights INCLUDED when you act NOW Get Vidtoon™

Emotional Eating Signs and 7 Tips Cope | Making Peace with Food | Counseling Techniques

This episode was pre-recorded as part of a live continuing education webinar on demand. Ceus are still available for this presentation through all CEUs registered at allies com, counselor toolbox, hi everybody, and welcome to today’s presentation on emotional eating and making peace with food during the next hour. So we’re going to define emotional eating and differentiate it really from eating when to celebrate and when it’s a problem and also differentiate, differentiating it from eating disorders will explore emotional eating in terms of its, beneficial functions and rewards and discuss. Why restrictive diets, don’t resolve emotional eating a lot of times? People will say you know, I have been on this diet forever and it doesn’t seem to be working or I can’t seem to stick to any diet that I try and we’re going to look at different reasons why this might Be what is emotional eating and it’s exactly what it sounds like it:’s eating in response to emotions and feelings other than hunger. So if you’re eating, because you’re bored, if you’re eating at someone and sometimes especially if you are angry at someone or disappointed in someone, you may eat and sort of be eating and thinking you made me do this so eating At someone eating to forget or distract yourself eating, to feel better because when you eat, regardless of what you’re eating, but especially if you eat high sugar high-fat foods, you’re going to release serotonin and dopamine eating out of boredom. You know hand to mouth bang, eating out of habit and, as I said a few minutes ago, not all emotional eaters have an eating disorder um and we want to differentiate that. Does it mean that their eating is not problematic to them? No, not at all. OIP-28 If they’re telling you it’s a problem, then it’s a problem. They may not meet the criteria for binge eating disorder or bulimia, but it’s important to address it because they understand that they’re eating for a reason. Other than hunger, they want to stop because they want to eat, for hunger, but not otherwise, and for us as clinicians. The first thing we need to do is understand: why is it that they’re eating? Is it boredom? Is it a habit, so they need to keep a food log or a food journal for over a week or two weeks, and sometimes when people come in for an assessment, especially if that’s one of their main presenting issues? I’ll start by just doing a retrospective of the last three days to get an idea of what may be triggering some of their eating episodes. And then we can look at some of the habits or bad habits, maybe that they’ve gotten into, and start talking about ways to address those remembering that Rome wasn’t built in a day this isn’t going to go away overnight. But a lot of times, if you give people some tips, tricks, and tools to think about implementing when they walk out of your office after the assessment before the first official session, it provides them some hope and gets the momentum going and again you don’t Have to binge to be an emotional eater, some people graze all day long. Some people will eat and it’s not what would be considered technically a binge, but it’s more than they had anticipated. Maybe they go back for second helpings or third helpings when they weren’t hungry, but it was good. So why is eating so soothing? There are a lot of reasons. Now there’s obvious it’s, tastes good, so that’s. You know the big obvious bonus, but thinking about the function eating serves, we have to eat to survive. When you were an infant, it eating involved a closeness with your parental unit, which could release oxytocin, and I say, parental unit because even if it was dad feeding the baby a bottle there was that connection. There was that contact that caused the infant and the parent to release oxytocin. This is our bonding chemical, so eating was associated early on with bonding food may also have been associated with sleep. If the infant or child was given a bottle every night to go to sleep, then they may start thinking or they may be in the habit of eating to wind down or calm down, and we need to help them figure out different ways to do That as a toddler, what eating mean think about when you went from well, we probably don’t, remember that, but think about when your kids went from eating. You know food out of a jar to even their first Cheerios. That was a huge figure out. How to pick up that little cheerio and get it in their mouth and it involved exploration and mastery. They were discovering all different types of textures and tastes and figuring out what smell went with what taste, and it was a cool and exciting time for kids, and I mean think about it. They’re like a year old, so it doesn’t take much to amuse them, but this was the rewarding reward. Equals dopamine equals let’s do that again. It involved power and control of the child. At this point was starting to be able to feed himself or herself and was starting to be able to be somewhat independent of the parent when it came to the basic physiological function of eating. So eating itself had its rewards and it was self-esteem building because the child started learning. You know how to feed yourself and how to ask for what he or she wanted, at least in terms of food. There are formations of memories around foods, even as early as toddlerhood. You know we have celebrations, we have birthdays, we have different things and most children have certain foods that they like, and it could be because the first time that ate that food was a really happy experience or it could be just that’s, their favorite Food and that’s all they want to eat, but they remember that food and they remember when they ate it, they felt good. They felt happy so as an adult there,’s a part of their brain going chicken nuggets. Make me happy now that’s, how the toddler thought as an adult. We can understand that chicken nuggets themselves, aren’t making you happy, but you see the connections that we’re making. Here there’s been an association between happiness and chicken nuggets unhealthy foods, especially for children when, as adults, we’re still able to control what they eat. Your sugary foods and your unhealthy foods are usually reserved for treats or rewards. So when you’re feeling like you need to be rewarded when you’re feeling like you want to feel good, sometimes you’ll resort to those things. When you were a kid that made, you feel good like chocolate, chip, cookies, Haagen Dazs, or whatever it was for you. We’ve talked in the past, about associations and conditioning, and this is all coming back kind of full circle now because we need to understand that our brain has associated pleasure and reward with food for a lot of different reasons. Not just because of nourishment looking at the reasons why your patient eats is going to help you understand what underlying issues you may need to address in treatment. Culturally, we associate eating with caring and celebration and think about birthdays and holidays. What do we get together? We have buffets, we have pot Luck,’s. When someone passes away. What do you bring food over when somebody’s sick? What do you bring food over to in our culture? There is a lot of emphasis put on eating and nourishing, and that’s, true of a lot of different cultures. Low blood sugar can cause feelings of depression and anxiety which are quelled by food. So if somebody typically doesn’t eat well during the day, you know they go long periods without eating or if they have blood sugar issues, to begin with, and then they eat they feel better. So when they start feeling not so good, what do you think their first reaction is, let me eat and see if that helps evolution, predisposes the human body to crave high sugar, high fat, high-calorie foods for quick energy and to prepare for a famine. Our bodies are cool and frustrating at the same time because you know your body takes in this these foods and it says we’re going to secrete, the most amount of dopamine and the most amount of reward for these high-calorie foods because We want to make sure we’re prepared in case there’s a famine back. You know in the day many many many years ago, hundreds of years ago we couldn’t guarantee. We would have a meal every day, let alone three meals every day. So the body prepared – and it said alright – we need to get whatever we can when we can. So we’re going to make this higher fat higher calorie food more rewarding. Now I said it:’s also can be a blessing and a curse. Today, there’s still a little part of our primordial brain. That says, if it thinks there’s a famine, it will slow down your base metabolic rate, which causes people to gain weight. We see this a lot in people with eating disorders, who tend to not take in very many calories, or if they take them in they purge them. So the body goes well. I can’t guarantee I’m gon to get enough food. I’m going to get enough energy to survive. So I’m just going to turn down the thermostat a little bit and turn down the base metabolic rate, which compounds the problem for the person with the eating disorder. So it’s important to understand that the brain is somewhat active in what’s going on. So I keep saying we need to figure out what’s behind or underlying the craving. First, we need to rule out physical causes for some people. It’s as simple as this. If they’ve got low blood sugar because they’re not eating too often and obviously as counselors, we’re not going to diagnose this their doctor or their nutritionist will, but we can start exploring and go. It sounds like you might need to look at having your blood sugar checked or talk to your doctor about how frequently you need to eat because some people – and I know I’m – are very guilty of it. If I get into it into a groove doing something I’ll eat breakfast and then I’ll get into a groove and before I know it, it’s 3 00 in the afternoon and I haven’t eaten for like a whole bunch of Hours I’m not doing math today and my blood Sugar’s low and I’m starting to get foggy, headed and irritable and tired. So it’s a real, simple fix there in our society we are so driven and we are so. We get so caught up in things because that’s such a fast pace that it’s easy to forget to eat or is easy to avoid eating so that’s. The first thing we want to rule out. Are you eating in response to low blood sugar, which is making eating, seem more rewarding when you eat in response to low blood sugar a lot of times, people who do that end up eating more than they normally would because they start eating fast. It’s like I’m going to shovel, in as much as I can. Your brain doesn’t register you’re eating for 20 minutes or so so, before their brain, even registers. What’s gone on and gets the blood sugar back up? They’ve already eaten a whole ton of food. Why is this under-emotional eating? Well because generally, when they go in to just start eating, yes, they’re hungry, but they’re, also cranky and irritable, and most of the time they’re. Not thinking about I’m eating for the nourishment it’s, I’m eating, feel better lack of sleep, and this is so true for shift workers as well. As you know, new parents and college students, and anybody who’s not getting enough sleep. If we are surviving on sugar and stimulants, we’re going Peak and Lower Valley, Peak, and Lower Valley, and you just keep going up and down until you just crash, because every time you crash you crash a little bit lower. So if somebody’s on that roller coaster, they’re going to feel worse between you know: eating episodes they’re going to feel tired. They’re going to feel a flood of sluggish irritable fatigued and, to a certain extent, maybe depression, and they may be missing attribute those feeling, those emotional feelings to emotions versus physical causes, and likewise we also want to make sure that you know we’re addressing The emotional causes because there’s probably stuff there too, but if they’re not getting enough sleep and they’re living on sugar and stimulants their body is kind of in a state of hyper-vigilance, a lot of times it’s exhausted. So they’re going to be tired and cranky. So those are a couple of things that we want to look at. Those are relatively easy fixes or at least relatively easy things to point out and go let’s think about this. One of the things that I suggest for a lot of my clients is just to take a week and mindfully and it is difficult but try to eat healthfully. You know try to eat a few times a day. You know try to eat like three meals a day and get enough water and try to get enough sleep and try not to overdo it. On the stimulants at the, beginning I, 39, am not going to say cut out anything because that 39, is not, realistic and it’s not fair, and they 39, are probably already struggling if they’re coming in to see me, so if I go hey Let’s just turn your world upside down and guess what you’re not going to drink any caffeine anymore. It’s not going to create a happy person, so I asked them to try to make some small changes and see if that starts, to help dehydration causes fogginess and symptoms of depression We want to make sure that they rule that out and too many stimulants Also causes dehydration, so you know we’re looking at some of the physical causes of irritability and fatigue and cravings because again we’re going back to when I felt this way before not looking at it. Why I felt this way. But when I felt irritable depressed cranky, what made me feel better and generally food, and generally it’s, not good food. For me, it’s M Ms. I love my M Ms, especially the ones with almonds, but I digress. Nutritional causes of cravings, high carbohydrate, and high starch foods caused a greater release of serotonin and endorphins. So if you’ve got somebody who’s depressed for whatever reason that they may crave these kinds of foods to increase their serotonin level or increase the endorphins, their energy levels, chocolate people who crave chocolate may be low in magnesium. It also um the level of magnesium affects how much serotonin is available again. Just I keep saying this just for legal reasons. We want to make sure their doctor or nutritionist goes in and makes this diagnosis, but if there are particular foods that they do crave, they need to bring that up with their medical provider if they’re craving fatty foods. Now again, fatty foods are just good. I love fried foods, but it also could mean that they’re not getting enough Omega threes, Americans, typically don’t and interestingly, if they crave soda, they may be calcium deficient, who knew so? These are things to take a look at to ask people. You know if they’re craving soda, maybe cutting back on their soda a little bit and seeing what happens and or getting blood work done. R-1 Once we’ve ruled out the obvious physical causes. They’ve gone to the doctor. Gotten blood work done everything I’m coming back happy. They’re getting enough sleep, but they’re still eating when they’re, not hungry, we need to rule out habits. Is there a particular time or activity that makes you crave this food? When I was growing up, I would go to the grocery store with my mother, and on the way back home from the grocery store. She would always we would always get junk food and she would get a bag of chips and put them in the front seat. It was like a 20-minute drive from the grocery store to our house and by the time we would get back to the house. We would have put a good dent in those potato chips. That being said, I got into the habit of whenever I went to the grocery store. I would get something out of the bag and put it in the front seat and eat on the way home. Now am I paying attention to what I’m eating? No likely am I eating, because I was hungry, probably not so. We want to look at habits. A lot of people will eat when they are watching TV. It’s a huge one. So we want to not do that or if you’re going to eat when you’re watching TV make sure you sit at the table. At least that makes you a little bit more mindful so think about whether are there particular times or activities that you eat and you’re just not hungry. Are there particular times that you mindlessly eat, like, like, I said when you’re driving or when you’re watching television? Those are both habits and can be mindless because you’re not paying attention to how much is going in your mouth. You’re not probably paying attention to the taste and you’re not paying attention to whether you’re full or not. So if you’re mindlessly eating, then there’s going to be a lot more calorie consumption. In addition to the fact that you’re not eating because you’re hungry, you’re just eating to eat, are you going too long between meals than needing a sugar boost which leads to a sugar crash? So again that’s a physical cause? But we want to rule it out. These are bad habits that we can tend to get into other things that can be construed as bad habits are eating without putting food on a plate. If you eat straight out of the bag, you’re going to eat. More than if you put it on a plate, so put it on a plate, sit down, try not to watch TV, all the things that your grandmother would have told you. So what do we do about it? Emotional eating interventions? I talked earlier about the food diary. Do a retrospective during the assessment if they want to get a jumpstart on things, but have them keep a food diary, preferably for the duration of treatment, but at least for a week. What time did they eat? Were they craving just any old food or something salty, something that was sweet, something that was sour? This will give you a general idea and can give their medical provider a general idea if there are any nutritional imbalances or if there are particular associations. What emotion or state were you in, I say state because being exhausted is not necessarily really an emotion. Were you happy sad, mad glad exhausted drained whatever state feels like it would work, and then, because of why were you feeling this way it doesn’t have to be a dissertation? It can be short and sweet, but I encourage clients to write down everything. They eat before they eat it during the first week, or you know, like I said, preferably throughout the entire course of treatment why, before they eat it because it’s a stop, remember we’ve talked before about how we have an urge. We have a craving, we have an urge and then we engage in the behavior oftentimes without stopping mindfully. Think is this what we want to do this provides that stop. It says: okay, I’ve got it to write down the time, and then I’ve got to think about why I’m eating, and honestly a lot of clients notice, a reduction and their habit of eating when they have to do this, just because they don’t want to record-keeping that up for a month or two months helps break some of the habits, eating that they might do like. I said before when they’re eating, I encourage them to use a plate. Sit down. Don’t walk around don’t stand at the counter, eliminate distractions as much as possible and focus on the food you’re eating that goes with mindfully eating. What does it taste like? Is it good to take small bites when my son was young, I think I’ve shared this before he had gastric reflux and we would sit down at the table and I would shovel in food as fast as I could get it in my mouth because He couldn’t be put down for too long before he would start to get fussy, at least until we figured out that he had gastric reflux and Zantac was just a lifesaver. I developed that habit when he was little and I kept it up for a while. It took a while to learn for me to learn to go back to take. You know reasonable bites and tasting my food, and even today, if I’m not paying attention too much, I’ll eat my dinner fast and then I’ll sit there and I’ll be like well. Yes, I’ll taste that a little bit later, because I didn’t taste it when I ate it encourage clients to be aware of their eating habits, and try to avoid setting up a binge by restricting certain foods. Now. Does that mean you have to have cakes and candy and whatever your trigger foods are in your house all the time and in your face? No, I would encourage people not to do that, but to say you know, I said for me M Ms, is one of my favorite reward foods. If you will, I don’t keep them in the house, but I will allow myself occasionally to buy a small snack-size pack of M Ms, when I’m out or I will get a regular-size pack and I’ll share it with my daughter, so I’m not restricting it. I’m not saying I can never M. Ms again, I’m just not making it available to myself when I might have some unrestricted time, try to avoid buying a bunch of comfort foods and keeping them around the house, and when you’ve got kids when you’ve got family, it’s not entirely possible, usually to not have some of that stuff around but try to avoid having the things that you particularly used for comfort, because if it’s not readily available, then you’ve got to focus on guess what dealing with the emotions. Instead of stuffing them with food, try not to go too long without eating. Like I said earlier, if you go too long, then by the time you get to the food, your blood, Sugar,’s low and you’re just shoveling it as fast as you can initially distract. If you know that you’re getting you’re eating and you’re, like I’m – really not hungry, but I want to eat, take a bath, take a walk, call a friend, heaven forbid get on Facebook. Whatever it is, you can do to distract yourself for 10 or 15 minutes if, after 10 or 15 minutes, you’re still going, I want whatever it is, then you can decide what to do about it. Then, most of the time when people stop and go, I’m not hungry. Let me distract myself. They get caught up in that distraction and before they know it, they’ve forgotten about the craving, and identify the emotions. If you know that you’re not hungry, but you want to eat, then say: okay, what’s going on what’s going on with me? It doesn’t mean that the person is never going to eat when, when they’re upset, because a lot of people do, and is it the end of the world, probably not necessary if they can start reducing the frequency of times that they eat. In response to emotional distress that’s, what we want, we want to progress, not perfect if it’s, depression, what’s causing them to feel hopeless or helpless right now, if it’s, stress, anxiety, or anger, remember our big kind of lump together stuff. What are they stressing out about? Do they feel like they’re overwhelmed? Are they afraid of failure, rejection, and loss of control of the unknown? We’ve gone through those things. We want them to identify what’s going on with them, and then they can make better choices about how to deal with it. So general coping helps them develop, alternate ways of coping with distress. Distract we’ve, already kind of gone over that one. I encourage people – and you know it’s – one of those DBT things – that a lot of therapists encourage their clients to keep a list of things. They can do to distract themselves because it’s not always practical to get up and go on a walk. If you’re at work or it’s, you know two in the morning. So what else can you do to distract yourself? Talk it out with a friend with yourself with your dog? Sometimes you just got to get it out. People who are more auditory will prefer talking it out as opposed to journaling it now. If they talk it out with themselves, they can record it if they want to, or sometimes it’s just better to have a dialogue with themself. If it worked for Freud, it can work for other people journaling. If your clients are inclined to journal, encourage them to write it down. Sometimes just getting stuff out of your head and onto paper will help the feelings dissipate a little bit. So you’re not mulling them over and obsessing over them and getting stuck in those thoughts and feelings. Additionally, while you’re distracted talking it out or journaling, this is also your break. Your stop between the urge and the behavior make a pro and con list of the de-stress, not the eating whatever it is, that’s stressing you out and how can you fix it or what are the pros of this situation and what are the downsides To this situation, encourage them to focus on the positive. You know. If something stressing you out at work, you know you’ve got a big meeting coming up or something you don’t want to do or what it is. You can get stuck on focusing on that or you can focus on the positive that you do have a job. That meeting only comes around once a month. You can it’s time you don’t have to be doing paperwork whatever the pros are for that person encourage them to focus on the positive. If you’re distressed because of some kind of a failure or perceived failure, figure out what you learned from it, whether it was a relationship failure, or maybe you learned what not to do in a relationship anymore. Maybe you learned things that you may have ignored. Maybe you learned what you should have done instead, but how can it be a learning opportunity, instead of somewhere to stay stuck and finally, if something’s making you upset if something’s causing anxiety, depression, hopelessness, helplessness, whatever the negative feeling figure out. If it’s worth your energy to get stuck here, is it worth the turmoil? Is it worth you know having to pacify yourself with food or whatever? It is a lot of times people say you know what now it’s, just it’s, not even worth my effort. It’s not worth moving me away from my goals, because my goal is to stop emotional eating. My goal is to eat for hunger, so I can go to dinner with people and feel comfortable. I can be at a party where there’s a buffet and not feel stressed out that I’m going to go and eat half the stuff on the buffet that’s my goal so is holding on to whatever this de-stress is getting me Closer to being able to do those things and generally the answer:’s no develop alternate ways of coping with the stress the ABCs, the a is the activating event. What is stressing you out and what’s causing the de-stress C is the emotional reaction. Angry depressed stressed, whatever be: are your behaviors? What behaviors or B are your beliefs? Sorry, what are the beliefs that are in there that may need to be addressed? What kind of things are you telling yourself, and, and how can you counter them? Cognitively eliminate your vulnerabilities. You knew we couldn’t get through a presentation without talking about vulnerabilities. If someone is well-rested. Well, the fed has a good social support network, not stretch timewise. Then it will be easier to deal with stress or stressors when they come your way. You’ll have more energy to deal with it, so there won’t be this overwhelming feeling of I just want to bury my head in a jar of peanut butter, be compassionate with yourself. Some days, you know you’re, just going to feel anxious. You’re going to feel depressed. You’re going to get angry. You can beat yourself up over it and you know a lot of people do. Is that the best use of your energy or can you be compassionate? Can you learn from it? Can you give yourself a break and go? You know what I’m having a bad day today and that’s okay, I’m not going to unpack and stay here, but I’m not going to fight. It either helps clients learn how to urge surf help. They understand that, just like a panic attack just like a wave just like a lot of other things in life, it will come, it will crest and it will go out again, so they can sort of identify where they are on the energy of that Urge other tools people can use close the kitchen once I have the kitchen cleaned and you know all the dishes are done and it looks pretty. I hate going in there and finding dishes in the sink again now I’ve got teenagers, so we always have dishes in the sink. But before I had children, you know at seven o’clock. I finished all the dishes and closed the kitchen, and that would be enough motivation for me to not go in there and at least not use plates and stuff to eat. So if we’re saying that we’re going to only eat using utensils plates and sitting and all that stuff that we already talked about, then once you close the kitchen, you’re not going back in, there turn off the light. That also helps so you’re not being attracted to the pretty lights, and you know all the goodies that are in the kitchen to brush your teeth. This is something my grandmother used to do and it works. There’s some research behind it. Minty flavors reduce our appetite. So if you brush your teeth, you get all the other flavors out of your mouth and it reduces your urges to eat because it again it’s clean and fresh. And do you really want to brush your teeth again, and meditate, sometimes just getting in a space where you’re, not obsessing about anything, can help people get past that urge to self-soothe by eating a CT for emotional eating. What am I feeling or thinking about what’s going on with me right now? What is important to me? So if I am thinking I want to eat, I want to you know just dive into this jar of peanut butter, and then I think about what’s important to me. Is it important to me to get control of this? Is it important to me to you know, be able to fit into my clothes in six months or not? So what is it in? What way is controlling my eating habits and eliminating emotional eating important to me, and how does that get me closer to other things that are important to me, and what other things could I do? That would get me closer to my goals. So if the goal is to have improved relationships, be able to feel more comfortable around food reduce the stress around going out to eat, and just around food in general, what else can you do when you are stressed out? Somebody also suggested that adding a blue light in the refrigerator decreases the appeal of foods, which is interesting because yellow red and orange, and browns, I think Pizza Hut – are all foods that increase people’s, hunger and desire to eat. But blue is just a completely different primary color, and adding a blue hue seems like that would be effective, so cool thanks for that. Little tidbit there holiday help, and you know we’re coming into the holidays. So I’ve got to bring that up at every single glass and choose lower-calorie foods. If you tend to get stressed out or caught up or mindlessly eat when you are at family gatherings. Okay, you know cut yourself a break, know that that’s, probably going to happen, and fill up on the lower-calorie foods. The carrot sticks the broccoli, the white meat, turkey, anything that’s available, that’s, not like sweet potato pie or brownies, keep water or low-calorie beverage. In your hand, if you’ve got your hand full, you can’t eat at the same time. So you know if you walk around with a cup in your hand, it helps talk to people. Hopefully, you don’t talk with your mouth open or talk with food in your mouth. So if you’re talking to people, you’re not going to be as inclined to go and get something to eat because you’re wanting to stay engaged in that conversation. Stay away from the buffet, especially if you know that it could get stressful, or maybe you know for me, I turn into a pumpkin at like 7 30 at night. I get up at 4 00, but I turn into a pumpkin at 7, 30 and a lot of times holiday parties and those sorts of things are at eight, nine, o’clock at night, and you know I’ve already turned into a pumpkin. So I know that if I go to those I’m going to be more likely to eat just to kind of stay away because I’m tired and it’s a bad habit. It’s not because I’m hungry. So I know I need to stay away from the buffet during those times we rehearse refusal skills. If somebody says. Oh, you, I’ve got to try it by two. This figure out how you’re going to address that ahead of time, because there’s generally probably a lot of really good foods, and you may really want to taste some, but sometimes people who emotionally eat know if they start eating. If they start eating high-fat high calorie foods, they’re going to want to eat everything. So if I start with one bite of a brownie, I’m going to want to eat every suit that’s on the table. If they know that, then they may want to choose to not even go down that road at that juncture, encourage people to stay mindful of their distress meter before they go back for another helping and ask themselves, am I hungry? Am I just wanting to taste what’s here and how do I feel about that? Or am I eating just because I don’t want to be here and I’m bored and I want to fill the time? Have people keep an index card with their coping mantra and two reasons they don’t want to emotionally eat, so I need to be here. I can do this whatever the mantra is that’s going to get them through the night, whatever they’re. Telling themselves that it’s going to help them plow through and make the right choices, but also two reasons that they don’t want to eat, or they’re going to get around it. Maybe they’ve got something at home that they can eat when they get home eating before they go to. The party may also help prevent some grazing holidays, bringing out a lot of emotions in people. Some people struggle with depression, anxiety, jealousy, grief, and anger. You know the whole gamut during this time and during this time there’s food everywhere I mean starting at Halloween when your kids bring home the Halloween candy, which usually lasts about a week in our house baby. Oh, Halloween candy followed by getting ready for Thanksgiving, followed by doing all the baking or whatever you do, and the holiday parties coming up on the December holiday season. There’s just food everywhere, so it’s really easy to cope. If you will, with stress being overwhelmed with being tired by not eating enough healthy food by binging on unhealthy and soothing food if you will so it’s, encouraged it’s important to encourage people to stay. Mindful of why they’re eating what they’re eating, when constantly bombarded with high-fat high carbohydrate foods, people are tempted to eat to feel calm yeah. I challenge anybody to say that they’ve never eaten and go okay. You know I’m. Just focused on this right now I’m not thinking about everything out here and it feels good um. I’m good now, good, probably not the word I should use, but it does help people distract themselves sometimes when they eat, especially those high-intensity foods. You feel happier serotonins are released. Dopamine is released. You’re, like oh, that’s good. I want to do that again or you just feel numb. You can get into a zone where you’re just eating and not caring about it’s. Not that you’re feeling calm, you’re just not feeling anything, and a lot of times when people get into that zone. They’re not tasting the food either. They’re just kind of on autopilot for emotional eating, like most other escape behaviors. Never addresses the underlying emotions and their causes, so we need to look at them. Are you feeling anxious? Are you feeling jittery? Are you feeling depressed because your blood Sugar’s low, because you’re nutritionally deficient because you’re not getting enough sleep or because there’s something cognitive going on, or all of the above emotional eating, often results in physical issues like weight gain Poor sleep and reduced energy weight gain, are you know in and of itself a few pounds here and they’re not a big deal, but some people can start emotionally eating to feel better. They gained a lot of weight. Then they start feeling less energetic. It starts being harder to move around. They get to the point where they are clinically obese. Then they’re going. I’m never going to take all this weight off. They feel hopeless and helpless. You see where this is going, so they eat some more. Can cause poor sleep apnea, it’s hard to get it’s also hard to get comfortable. Sometimes, if you’ve eaten a whole bunch of food right before you go to bed, you know your bellies are all full, and little you wake up. The next morning and your belly are still awful, which means you probably didn’t, sleep very well the night before and emotional eating often results in reduced energy because the foods we binge on the foods we eat for self-soothing often end up causing a sugar Crash some people try to undo emotional eating by restricting other calories which can lead to nutritional deficits and more cravings. I had a girlfriend when I was in high school and you know think back to I don’t know if they still do it, but when we were in high school there was always some kind of candy sale going on and she would always forgo all Other food, so she could have two chocolate bars each day and you know we’re not going to get into the all the other issues surrounding only eating two chocolate bars. But the point I’m making it right now is the fact she wasn’t getting protein. She wasn’t getting it. You know most of her vitamins and minerals and stuff that her body needed to make the neurotransmitter. So she could feel happy and she was contributing to a sugar crash, but I also know that it’s common around the holidays for people to do this. They’ll let go all day without eating because they know they’re going to a party tonight and there’s going to be a lot of really good food doing that once in a while. Not a big deal doing that 10 or 15 times in a month could start to have problems. Emotional eaters need to first find a way to stop before they eat, so, whether it’s writing in a journal or adding. There are a lot of apps on your phone that you can put your food in, even if you’re, not writing about your emotions and your cravings and all that kind of stuff. Sometimes it’s enough to make people stop before they reach. For the food – or you know, kind of an extreme way to go is to not keep pre-processed or prepackaged foods in the house. So anything that you’re going to eat you’ve got to make second identify the underlying reason for your eating figure out. Do I generally eat in response to and then address the thoughts and emotions leading to the urges? So if you figure out the underlying emotions for your eating or your depression, then what thoughts are maintaining that depression? And how can you address it once you address the underlying issues, some of the emotional eating will go away, but some of its habits? We’re going to have to break that habit and, throughout you know, the past couple of decades of working with people. My experience has been the majority of the time people don’t want to hear. Well, once you deal with your emotional issues, the emotional eating will go away now. They’re there because they want to stop that behavior right now. So, yes, we need to work on all the underlying issues but give them a tip or a trick or a tool whatever you want to call it to use before they walk out of your office after every single session. That way, they have something else they can put in their toolbox and feel more empowered to have control over what’s going on with them. And what’s coming their way, having the knowledge of what and why is 80 of helping them get to the recovery point now, if there’s co-occurring or if the eating issues are more than just emotional eating, if there’s, the person meets The criteria for binge eating disorder, bulimia or anorexia. There are a lot of other underlying issues they’re going to have to be dealt with. So I don’t want to trivialize that, but I do want people to feel like they’ve got some hope over what’s going on. Are there any questions? 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