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Dialectical Behavior Therapy (DBT) Skills | Mental Health CEUs for LPC and LCSW
Unlimited CEUs for 59 at AllCEUs com welcome everybody. Today,’s, presentation is on dialectical, behavior therapy skills.
This presentation is based in part on dialectical, behavior therapy a practical guide by Kelly Koerner.
This is one of those books that, if you want to do dialectical therapy as a practice, not just look at some of its tools is a must-read.
Then it’s also based in part on dialectical, behavior therapy skills, workbook DBT made simple and DBT for substance abusers, which is an article that was published by Marsha Linehan.
So the links to those are in your class, but just give you an idea about sort of the breadth of what we’re going to be looking at today.
In the short time that we have together, what we’re going to do is take a look at why DDT was created, we’ll look at understanding emotional regulation, dis-regulation and regulation will identify DBT assumptions about both clients and therapists, and we’ll Explore skills to help clients learn to stress tolerance, emotional regulation, and interpersonal effectiveness.
As an aside, we’re taking – or I’ve taken the information from this course and combined it with a bunch of other information to make a six-hour on-demand course.
That will be available by the end of the week, but for now, we’re just going to hit the highlights in the 1-hour introduction.
So why do we care? Why do we want to learn about DBT skills and DBT tools? Many of our clients, experience emotional dysregulation, or the inability to change or regulate their emotional cues experiences, and responses.
Think for a minute about any of your clients, if they’re depressed, if they’re anxious, they’ve got anger management issues, something is going on with their emotional states, or they’re not able to either get unstuck or control their behavioral responses. So they may be engaging in self-injurious, behavior risky, behavior, or addictive behaviors.
They’ve tried to change and failed, leaving them helpless and hopeless.
In a lot of our clients.
We try to fit them in not that we should, but we do try to fit them into this box.
If you’re depressed, then we’re going to look at these things, and one thing I hope you get from these webinars is the fact that every single client is different and there is no box that we can put them in and you’re, Like well, then, how can you do group therapy? Group therapy is awesome because you can tailor and that’s, part of the challenge of doing psycho.
Educational group therapy is tailoring the tools and helping people tailor the tools to meet their individualized needs, but they can get feedback and they can see how different tools can be modified just a little bit to fit different individual needs and untenable emotional experiences that lead to Self-preservation behaviors such as addiction, you know to kind of numb the pain to give them a distraction, nonsuicidal self-injury.
We’re talking about cutting, we’re talking about those sorts of things, and then even those suicidal behaviors.
At a certain point, the pain has got to stop, so some people may end up going as far as trying to stop the pain by stopping their existence instead of hurting anyone else.
People with emotional dysregulation have high sensitivity, so these people tend to be highly hyper-vigilant.
They’re aware of a lot of things that go on now. This was created and I want you to really kind of think about it.
It was created as a tool or a protocol to use with people with borderline personality disorder.
What do we know about people with BPD? They grew up in really ineffectual environments, so they had to be hyper-vigilant about everything that was going on for their safety and security.
So you have someone who, either by nature or by nurture, is hyper-vigilant.
These situations have been over-generalized.
The dangerous situations have been over-generalized, so the world tends to seem more and dangerous, and out of control, people with emotional dysregulation are easily thrown off kilter because they often have a lot of vulnerabilities.
They’re not eating.
Well, they’re depressed which is contributing to them not being able to sleep.
Well, they can’t focus yadda, we’ve talked about vulnerabilities.
One thing that dr Turner talks about is no emotional skin and she likens it to someone who has third-degree burns and every single thing, even the air when it touches it, is just excruciating there’s no middle ground. There’s.
No, oh! That’s kind of uncomfortable it’s either not hurting or it’s.
Excruciating.
People with emotional dysregulation are also highly reactive, so they’re hyper-vigilant.
They’re aware of everything that’s going on and then every time something happens that sort of triggers their awareness they jump into this immediate fight or flight reaction.
Then they’re slow to de-escalate.
So we’re talking about situations in which someone is hyper-vigilant.
They’re on edge, maybe because of situations in the past or not.
They have this sort of persistent fight or flight or frequent fight or flight reaction.
And again, I’ll refer back to our dream fatigue class that talked about how the body can only stand to be all hands on deck for so long before it’s just like dude I give up, and then the sense of depression and helplessness and Apathy starts to set in people who are who have emotional dysregulation, really they’re either like flat and none nonexistent in their emotions. They just can’t even deal with it when they should, or they’re, overly reactive and then the person isn’t in a validating environment.
What would be a to some of us on a scale of 1 to 10? As far as how distressing something is it’s, probably like an 8 to somebody with emotional dysregulation, think about a time when you were stressed out or you had a lot of vulnerabilities going on.
Maybe you had a new baby at home, so you were, ‘t sleeping and your other kids were acting out.
There were just all kinds of stuff going on and you reacted to something with an 8 that everybody else was like that.
Doesn’t deserve that.
Much of a reaction is that’s it what’s wrong with you, people with emotional dysregulation that’s their environment, all the time, everybody’s looking at them and going what’s wrong with you there?
This is not that upsetting.
So we need to help people understand that their experience is their experience and it’s not for me to say whether it’s a 2 or an 8.
For me, it’s a 2, but let’s look at why it’s an 8 for you.
So the emotional reaction – and this is I didn’t – get red eye reduction when I took this picture of bruit but bless his heart. When I got him, he was a rescue and he had such terrible terrible abandonment issues and is so hyper-vigilant.
Even to this day, I’ve only had him like four months, but he’s hyper-aware of stimuli and people can be hyper.
Aware of stimuli so anytime somebody moves, he’s up, he’s.
Looking he’s like.
Are you going to leave me alone again when he perceived that something is changing when there was a threat, he goes into all hands on deck and turned into a survival sort of thing and starts acting out?
He goes and finds toys and brings them to me.
Heaven forbid.
We should have to put him out in the garage because we have visitors or something and it’s.
You know climate controlled, it’s not like it’s horrible, but he will sit out there and how, until I let him in or go out and tell him it’s going to be okay, now see as a person I’m going.
That is not a valid reaction. He’s like totally overreacting to having to spend ten minutes in the garage, whereas from his perspective he’s not overreacting, because in the past when he’s been put in the garage he left out there for days weeks months.
Who knows I don’t know his story too.
Well, now I use that to kind of highlight the fact that people with emotional dysregulation don’t know what their experience was.
What they’re doing is trying to survive.
Now they may be trying to survive a situation in their past.
You know when there were six and we’re going back to the abandonment discussion that we had the other day, but it’s important to understand that all these things play in together.
Something happens and the body’s response system takes in these stimuli and it says it’s dangerous it’s, not dangerous.
What do we do with it? The brain decides to fight or flee, and then they go into the survival response with treatment.
What we want to do is help people be able to feel that feeling and not have to act on it right away until they can de-escalate some and use a combination of assessing their cognitions and deciding whether their perceptions are based.
On the present. The present moment or the past moment so primary invalidation caregivers dismiss emotional reactions as invalid.
We just talked about that.
The child or person could be mocked or shamed for their emotional response.
We have all probably met parents or worked with parents who have children that are highly emotionally reactive, and who tend to get frustrated and overwhelmed by the constant drama that seems to be presented by this child all the time.
So the child is often not taught how to self-soothe or de-escalate the parents just like really let it go and go away, which is not helpful because the child doesn’t learn how to deal with it.
The child is not taught mindfulness to figure out okay, what’s causing this, and the child is not taught effective cognitive processing in most situations in validating environments, if the child gets upset, even if it seems to be disproportional to whatever the event was, the caregiver Will take the child in and say? Okay, I hear you’re upset right now, let’s talk about it and we’ll walk the child through, maybe not thinking about it, but just being a good parent walks.
The child, through this de-escalation process and the cognitive processing of secondary trauma or invalidation, is, and I’m putting this in here.
Coping skills can be overwhelmed by trauma or intense stress, leading to this high alert raw status.
Think about the people who were survivors of Hurricane Katrina or Hurricane Andrew.
I come from Florida, so I think hurricanes, but any big event that is ongoing enduring, and distressful at a certain point. You’re on your last nerve, so anything could precipitate sort of a crisis.
Many people don’t receive the necessary support during these times and may be shamed for being weak or needy.
Sometimes nobody can cope and everybody’s kind of decompensating.
At once, which is a lot of what we saw with Katrina but other times there may be people that are functioning just fine and they don’t understand why some other people are 39, t coping just fine, and they see that as abnormal and want to distance themselves from it, it’s important for us to communicate to people because we already noticed that crisis is a normal response to an abnormal event.
What was abnormal, though, is it this particular incident? Maybe, or is it the fact that this particular incident kind of was the straw that broke the camel’s back on a whole chain of incidents leading up to it that was abnormal? What caused this person? Excessive stress I was talking to a woman the other day who, in the past six years, has had half a dozen significant losses and I’m just like wow.
You know that that’s pretty intense to have all those and she’s, also starting her practice and everything else.
Right now – and I’m – just like oh my gosh – I can’t imagine the amount of stress this woman is – going through most humans, aren’t inherently prepared to deal with the crisis alone.
We’re kind of group sort of people.
We rely on other people, so if we have this reaction and it’s judged to be disproportionate and people kind of distance themselves from us, because they see us as abnormal or dysfunctional, then we lose any social support that might have been able to serve as A buffer which just kind of in turn, feeds back and exacerbates the sense of hopelessness, helplessness, and isolation.
What precipitates a crisis may vary between people based on pre, existing stress or mental health issues, and it also may vary with the same person longitudinally across time. What may be overwhelming today – maybe not may not be overwhelming six months from now, because all of those prior stressors that I’m dealing with right now may have had time to kind of work themselves out.
So we must help people understand that their reaction is their reaction and let’s just go from there.
Let’s not say it’s bad or is disproportionate or it’s whatever it just is so the result of this sort of unpredictable reactivity results in frantic efforts to numb withdraw or protect.
I need to numb the feelings because I can’t take this kind of pain.
If you’ve ever had a burn that’s had to be cleaned or even an open wound that’s had to be cleaned out.
You know that’s pretty excruciating so thinking in terms of that, you can see why people would want to kind of get a little novocaine withdrawal if this support system is invalidating, that has extra pain and that’s excruciating to be rejected.
On top of everything else, so a lot of times, people withdraw which eliminates any opportunity for social support, and it also exacerbates this sense of rejection, and they do this to protect themselves.
People learn who they are in invalidating environments.
They learn who they are and how they are resulting in rejection, so they avoid threats.
They avoid putting themselves out there. They avoid making relationships because they’re afraid of rejection and they avoid thoughts and feelings and sensations that may lead to invalidation.
I don’t want to feel these things because then if I do and I communicate them, you may tell me I’m wrong.
Okay, we’ve laid the groundwork.
Now we see where this is a problem.
So what do we do about it? Well, the first thing we want to do is look at some of the DBT assumptions about clients.
Clients are doing the best they can given the tools they have at this present point in time, and I truly believe that clients want to improve themselves.
Wouldn’t be in your office if they didn’t want to improve for one reason or another.
It may be an involuntary referral and they want there’s a means to end there.
They are in your office because they have hope that something can change and it will benefit them.
They cannot fail at DBT if they go through dialectical behavior therapy, the protocol and it fails, then the protocol failed them or we as clinicians, fail to implement it correctly. Now, today, again, we’re talking just about tools that are present in DBT, not how to do dialectical, behavioral therapy.
The evidence-based practice wants to make that very clear clients are existing in what is for them an unbearable state.
This pain has got to stop.
They need to learn new behaviors in all contexts, not just at work, not just in their relationships, but they need to learn how to function and deal with life on life’s terms in all contexts, so they can go to the grocery store they can get In a traffic jam, they can be in a crowded Airport and not feel like the walls are closing in on them.
Clients are not responsible for all of their problems.
We know this some things they had no control over are causing problems for them, but they are responsible for all of their solutions, and we’re going to talk about the four options for problem-solving in a few minutes, but they are responsible.
They choose to do something and clients need to be motivated to change motivation, choosing the more rewarding option out of the available options.
Well, yeah that whatever they’re doing right now is the most rewarding option they have available in their toolbox.
So we’re going to give them new tools, but then we need to teach them how to make those tools effective.
If you just hand me a jigsaw and say, okay go about woodworking and whatever I’m, not a woodworker, but I’m not going to know what to do with that. So I may go back to using my circular saw or whatever the case may be, which may be very clunky.
We need to help clients learn how to use these new tools, so it’s more rewarding to use those than those old behaviors.
They just numbed out the pain or distracted them assumptions about therapists, clarity, precision, and compassion are of the utmost importance.
We need to be clear with our clients about what’s going on.
Let’s not speak in generalities.
We want to try to avoid some of the Socratic questions that we would normally do.
We want to be clear about what we’re getting at and what we want them to look at.
We need to be precise.
Do we need to not say well what is it last week that caused all the problems in your relationships? Well, if they had four different fights that’s four different things we need to look at, we need to be precise to identify all of the things that trigger and we’re going to talk about behavior chains in a few minutes.
So we need to be precise. We also need to be compassionate, even if we don’t agree, or we think that the reaction was disproportionate, putting ourselves in their mind in their place in their raw state.
We need to be compassionate and go okay, you survived it, you did the best, you could let’s take a look at what might have caused that.
Why you made the choices you did and what you might choose better next time.
The therapeutic relationship is between equals, DBT or therapists can fail to achieve the desired outcome, but the client can’t fail and therapists who treat patients with pervasive emotional dysregulation needs support we need to remember that patients who are always in crisis by their very nature, it’s, exhausting because they’re always in crisis, which means we are responding in a crisis manner, not that we need to get all upset and worked up because that’s just modeling the wrong thing.
But there is a lot of energy that it takes for us to use the DBT tools for us to model the DBT tools and for us to help work.
The client is out of their emotional state into one where they can use their wise mind.
So the first step is core mindfulness.
Until they figure out what’s going on, they can’t fix it, so we want to help them integrate their rational mind they’re cognitive.
This is what happened factual mind with their emotional mind.
This is what it felt like in the wise mind, so you can take the facts. You can take your feelings and you can say with what I know and what I felt.
What would be the best interpretation of this or the correct one for me?
Interpretation of this event at this point, and what can I do about it? One of the things DBT talks about is the fact that truth is sort of subjective.
What is true for one person may not be the truth for the other person, because we’ve all had different experiences, but we need to help people not underreact and stay.
In that cognitive mind, if you’re a star, trek fan, think data um.
He was the AI that was kind of human-robot sort of thing or, and we also don’t – want people to act in their emotional mind, acting solely based on feelings and trying to make feelings facts because feelings aren’t facts.
They’re feelings, so we want to help them integrate these two things, and that is more difficult and it sounds like it takes time.
Mindfulness is using effective, nonjudgmental observation and description of experiences, those thoughts, and feelings, and identifying what’s the objective evidence for and against what’s going on right here, how I’m feeling what is all the evidence. Let’s look at the big picture, not just one little aspect of it, and what are my feelings about this event? Getting in touch with what’s going on inside their mind and inside their body is going to be one of the first steps.
So I talked about those four options: when there’s a problem, you have four options.
You can tolerate it, grit your teeth, and Barratt there. Sometimes you just can’t do anything about it.
Traffic jams probably can’t do much of anything about it.
Change your beliefs about the event.
Instead of seeing a traffic jam as a waste of time and just a complete pain in your butt, you can see it is a time to check voicemail and maybe return.
Some phone calls are productive, make it billable, and you can solve the problem or change the situation, while you’re in a traffic jam and stopped, of course, looking at Google Maps to figure out where the next exit is so that you can get off.
So you can change that situation or you can choose to just stay miserable and choosing to stay miserable is a valid choice.
When clients make these decisions, we need to look at them.
Why was that? Whatever their option was? Why was that option more rewarding than all the others? Why is it more rewarding sometimes to stay miserable for some people that’s what they know and they’re afraid if they feel happy, then they may get disappointed and end up feeling sadder than they already do now?
Some people tolerate the problem because it’s what they know and change is hard and they would rather just tolerate it and deal with it and suck it up than have to muster up the energy to try to change whatever’s going on.
So again we want to look and ask them or ask ourselves, maybe because they may not know right away the choice that you made. Why was it more rewarding? Why did you choose that over the other three options, distress, and tolerance we’re going to talk about a lot of acronyms here acronyms are really important in DBT because it helps clients have sort of a drop back and punt.
There are some worksheets.
There are lots of worksheets online for DBT but the acronyms we’re going to hit here are going to be some of the highlights that are going to be important for you to remember tip temperature.
So you’re tipping your physiological balance now temperature.
I’m not necessarily advocating for this.
You don’t want to do it.
If you’ve got a heart condition.
You don’t want to suggest it to clients that have a history of child abuse, especially anything that involved drowning.
So this one’s a little tricky one of the things I suggest to some of my clients instead of this is holding on to ice cubes.
But the suggestion in the book holds your breath. Dunk your face in for as long as you can hold your breath into a sink full of ice water, then come up.
Exhale, inhale and dunk, again repeat as many times as you need until you feel calmer.
Well, guess what we’ve talked about combat breathing.
If you are slowing your breathing, which you do, if you’re holding your breath, your heart rate is naturally going to slow.
When your heart rate slows down your brain says: oh the threats going away, yippee yay, I can call off the dogs.
There are other ways to slow down your breathing.
Besides necessarily dunking your dunking, your head holding ice cubes is one of the reasons that that can be helpful.
Instead of cutting the person’s focus, it’s a distracting technique.
The person focuses on the pain because it is painful to hold on to ice cubes for a long time, instead of cutting themselves, but it also gives their body something to focus on to go.
Oh, my heart rate is up because there’s a pain when the pain goes away. I can make my heart rate go down, so we’re redirecting the brain to go.
Oh, this is why the heart rates are up it’s, not because there’s emotional distress, it’s because of extreme physical pain.
Intense exercise increases body temperature, but it also increases the heart rate when you’re sitting still and your heart rate is 120 beats a minute because you are in a panic attack or a state of panic.
It’s very, very uncomfortable and your mind is going.
I don’t understand you, ‘re not moving.
Why is the heart racing when you start exercising, which is why walking and getting those big muscles moving often helps? Then the body gets less confused.
It’s, like Oh heart rates, beating fast, because the body is moving score, got it so when the person stops moving, the heart rate starts to go down, and this is true, even if you’re walking around.
If you take a client out to walk when they’re upset – and you are talking about whatever the distressing thing is – I have found without exception.
When they come back inside, they can start to calm down a little bit more and their heart rate naturally starts to go down when they stop their physical exercise and then progressive relaxation.
You’re going to move from head to toe or toe to head. Whatever you prefer but head to toes, usually how we do it focusing on muscles focusing on breathing slowing, breathing relaxing muscles forcing the body to relax.
So this addresses physiological arousal, so the temperature, intense exercise, and progressive relaxation.
All of these serve as an ability serve the function of distracting the person from whatever cognitively or inter psychically wants to say, is going on, and all of these either explain to the brain why the heart rate is going so fast or Help reduce the heart rate, so you know there’s something to be said for them.
The important thing is for you to brainstorm with your clients when you get physiologically aroused when you get upset, and you are just your hands – are shaking your palms are sweating.
You’re breathing fast, and your heart rate going fast.
How do you calm yourself down what works for you and we’re back to bruit again?
Another acronym is accepted to distract when there’s emotional turmoil, so you can kind of let that adrenaline surge go because you have that initial fight or flight reaction and then the body kind of goes.
Alright, let’s reassess and see if there’s still a threat, get involved in activities that will help you distract yourself from whatever’s going on when kids get upset.
You know if they’re getting stressed out because they’re sitting in the lobby and the doctor’s office, and they know they’re going to get a chhoti.
We give them something to do. We read a book, we talk we play because then they’re not focusing on the fact that they’re going to get a shot, contributing to the welfare of others.
Do something nice for someone to volunteer.
Do something productive that gets.
If you are focused on someone else, compare yourself to others who are doing less well, that doesn’t work for everybody.
You can also compare yourself in the present to your old self and focus on how much better you’re doing now compared to what you were doing six months ago, this doesn’t always work.
You know these are options.
Not everyone is going to work for every person, emotions do the opposite.
If you’re feeling really sad get a comedian, get it to go to YouTube, and Google a comedian and watch a skit or two or ten, so you’re doing something that makes you laugh.
That makes you happy to sing.
Silly songs, dude silly dances go out and there’s very little. I find it more amusing than just listening to a baby laugh.
If I’m having a really bad day, I will find those stupid videos of babies laughing at paper tearing if you can’t help, but laugh with them pushing away build an imaginary wall between yourself in the situation.
Imagine yourself pushing away the situation with all your might or blocking the situation in your mind, and each time it comes up, tell yourself to tell it to go away.
So if you start thinking about something that is particularly hurtful as soon as it comes into your mind and it comes into your awareness go no, I am NOT going to think about that right now.
Thoughts counting some people count to ten, a hundred whatever it takes to get through that initial rush.
Some people sing for me.
I think I’ve shared before I have this irrational fear of bridges, but so, whenever I Drive over a bridge I sing, and usually, it’s, not songs on the radio.
Usually, it’s songs.
I used to sing to my kids.
I’ll sing the ABCs something that doesn’t require a whole lot of cognitive interaction because I’m doing pretty good just to get over the bridge. And yes, I know I should be over it, but I’m not and that’s just the way it is the 10 game.
I like this one think of 10 things that you like the smell of think of 10 green things.
Think of 10 things you see where we’re going with this, and you can incorporate all the different senses with it.
If you go through multiple iterations of it 10 things that you smelled yesterday, 10 things that you see right now, 10 things that you hear when you’re on your way to work.
This helps people focus on something other than what’s going on.
Here the 5 4 3 2 1 game is sort of similar to the 10 things game, identify 5 things.
You see, 4 things you smell, 3, things that you can touch and follow down.
Sensations like I talked about on the last slide.
Sensations can help distract you from what’s going on until you have a chance to kind of get through that initial adrenaline rush, cold, holding ice, cubes, rubber band – and I don’t like this one.
But some people do they put a rubber band on their arm and every time they start to perseverate on a negative thought. They snap its smells and find some good smells.
Some smells bring back good memories, smells that you like.
Maybe it’s roses: maybe it’s a purse-specific perfume.
Maybe you just go to Walmart and start smelling all the air fresheners.
Whatever makes you happy, I do suggest avoiding taste, because if you start using taste as distress tolerance, then you start moving toward emotional eating.
I’ve seen it happen, so I would avoid that for most people, but if they just desperately want to go there, then you know we’re going to go there because they are choosing how to distract from their cognitive or intrapsychic.
Sensations improve at the moment.
Imagery goes to your happy place.
Whatever your happy place is meaning find an alternate, meaning for what’s going on now.
This can be Linehan refers to it as making lemonade. We all know how to do that.
We don’t we’re, not necessarily the best at it, but try to make lemons.
I try to look for the optimistic meaning in whatever it is prayer.
Now, even if someone is not religious, they can be using radical acceptance.
Accepting it is what it is and not trying to change it, just putting it out there for the universe, relaxation is always good to relax one thing at a time and this isn’t focusing on one problem at a time.
This is focusing on something we’re talking about distress, tolerance, and improving the moment so focus on one thing, like your breathing: get your breath and calm down once your breathing calmed down.
If you need to focus on something else, then move to.
Maybe the tension in your neck.
Maybe you need to lower your shoulders and release the tension in your neck, focusing on physiological things and focusing on other senses.
Besides, that abstract stuff that’s in your head and your emotions can help people tolerate the distress until they can think more clearly vacation takes a timeout. Sometimes you just need to get away from it.
For a few minutes, we’ve had time at work.
I’m sure we all have where you’ve just been like.
You know what I’m done and you lock your computer screen.
You get up, you walk out of the building, and none of its clients are in there, but you walk out of the building and do a couple of laps around the campus and then you’re like okay.
I can deal with this again just clear your head before you try to tackle whatever it is, an encouragement providing yourself, because you can’t necessarily rely on anyone else.
Positive and calming self-talk now back to those stupid, memes and videos that I love to death there’s, one has a kitten on a laundry wire and it says: hang in there, I love having those things on screensavers.
It’s, juvenile, maybe but whatever it makes me happy, and it reminds me you know even when I’m, not in a state of emotional distress.
It reminds me all right keep on hanging in there.
You got it and it’s got an all-factor too. So I always like anything with an all factor: the goals of emotional regulation.
So once you’ve tolerated this distress, you’ve gotten through that initial surge.
That initial, I cannot take this pain or upset.
Then we need to move into emotional regulation, help people identify labels, understand their emotions and the functions of those emotions, decrease unwanted emotional responses and decrease emotional vulnerabilities.
So what they’re going to do is identify and label emotions and their functions.
I’m scared.
Okay, you 39.
Re scared.
Tell me why what’s the function of you being scared? What do you want to do, and what do you think is causing this scared? 39.
No self-awareness through questioning, like that through talking it out, people will start to understand where their emotional reactions are coming from and they can choose whether or not to follow up with it a behavior. What I guess I didn’t put in a behavior train analysis is the way you can go about helping people work through that and that’s a couple more slides cop.
We want to police our thoughts and check the facts.
Look at doing opposite actions.
If you want to hurt yourself, look at being kind to yourself, if you want to run, maybe you need to look at staying and then look at the problem.
Solving reduced vulnerability through the ABC p accumulate.
The positives, remember, vulnerabilities, are those situations that happen leading up to whatever the distress is.
Those are the things that make you more likely to be irritable, overwhelmed angrily depressed get sad about anything.
Instead of not so, we want to eliminate those vulnerabilities or reduce them.
As much as possible, so we’re going to accumulate positive gratitude, journals pictures if well, everybody has things in their life that they care about.
Have those on your phone in you know little picture galleries that have them as your screen. Savers have reminders around about it.
Why you get up in the morning builds mastery, so you have mastery of the skills you need to deal with emotional distress and upset cope ahead of time plan for distressing situations.
If you’re getting ready to go in for an annual evaluation and those things stress you out to no end rehearse, it ahead of time plan on coping ahead of time, and figure out how you’re going to react.
If it goes bad figure out how you’re going to react, if it goes good figure out how you’re going to cope and physical vulnerability prevention, maintain your health, chronic pain, chemical, chemical imbalances, hormonal imbalances, those can all cause vulnerabilities or set you up.
Make you predisposed to feeling like something’s at eight when it’s only two get plenty of sleep when we’re sleep deprived, is a whole lot harder to deal with life on life 39.
S terms and exercise.
Exercise is a great way of releasing or using up some of that stress energy that you release during the day.
Behavior chain analysis.
The first thing you do and a strict behaviorist will have slightly different explanations for how to do this, but just bear with me here: name the behavior reaction.
What happened now, if you’re thinking back to the ABCs, this is going to be your C. Your consequence, what happened identifying the prompting event ABC is, that would be the what was the activating event now.
This is where it differs a little bit.
Then we want to look at the behavioral links, so you had the activating event, and then there was this reaction and in between, there were um automatic beliefs, and we have that there.
We have thoughts, but there were also sensations events, and feelings between what happened and your reaction.
What sensations did you feel? Did you get flushed? Did you feel nervous? Did you feel scared? Did you feel sad? Did you have a twinge of something? What feelings were there and what events happened? Did you act out in a certain way? Did you scream? Did you yell about what happened? Because these are all things that are going to go into what ultimately ended up being the behavioral reaction, then I want to look at the short-term positive and negative effects of what you did.
The behavior of the reaction.
If you started screaming and throwing things okay, you did what was the short-term positive effect of that? What was the benefit of that? Because that was what you chose, which means it was likely the most beneficial response you could come up with in your highly emotionally charged mind then.
So what were the benefits and what? With immediate short-term negatives and then looking at the positive and negative long-term effects in the long term, if you react to this upset by screaming and throwing things what’s the impact going to be, are there any positive impacts? Are there any potential positive effects of this and a lot of times it’s? No, but we want to ask the question just in case there are because some people will have a positive and we need to address that this is sort of.
If you go back to motivational interviewing what we think about when we’re talking about decisional balance, exercises address the problematic links with skills.
If some sensations or actions exacerbated the distress, then we need to look at distress and tolerance. If all of a sudden you had this immediate panic reaction and you couldn’t breathe, we need to work on distress, and tolerance skills, so you don’t go to that point where you are just for lack of a better phrase in a tizzy thoughts and Feelings if your thoughts get negative and start racing and your feelings are negative and anxious and worried and all those negative words we want to look at emotional regulation.
You know if you can get through it, where you get through that initial rush and you’re still having these getting stuck in the negativity.
Then we want to look at emotional regulation most of the time we’re going to look at both of them and then the third component, once we’ve learned how to get through the initial flood, the initial all-hands-on-deck call, and then people Have learned to regulate their emotions and identify helpful responses, and instead of talking about good and bad, we want to talk about helpful and less helpful responses.
Then we need to look at interpersonal effectiveness and how to interact with other people to make that validating environment exist.
So we want to start with interpersonal and intrapersonal if you will be effective with yourself and then move to others describe what’s going on assess how you’re feeling what your reactions are, and what the best next step is asserting.
Your choice reinforces the good things.
Be mindful appear confident and willing to negotiate, and yes sometimes we have to negotiate with ourselves because there’s something that we want to do right now – and this is very true – with people with addictions a lot of times – they want to use.
They know the long-term consequences of use are not where they want to be, so they have to negotiate with themselves to say alright.
I want to do this right now, but I’m going to choose a different option in their relationship with others.
We want to encourage them to give me gently instead of critically, and harshly, which a lot of times is what they’ve gotten all of their life, being gentle with other people, accepting them where they are modeling how they want to be treated, be interested in What other people have to offer, what other people have to say and what’s going on with them? A lot of people with emotional dysregulation can’t handle their own life on life’s terms. They can’t even begin to handle anybody else.’s stuff, so a lot of times they appear disinterested, validate other people and their experiences, and have an easy manner.
You know sometimes we get too intense and if everything in your world is either a zero or a ten, it’s easy to be intense.
About everything, as they develop emotional regulation, things will be different.
You know they’ll have fours and fives in there, but practicing that not being intense and over the top about everything, and then in their relationship with the self, be fast, be fair with themselves, not judgmental just fair, avoid apologies, stick to values and be truthful.
12-step recovery step, one starts with honesty, being honest with yourself step two.
We start talking about hope and faith, which is sticking with values and being fair to oneself.
Being compassionate comes couple more steps down that’s not hard or not harmful.
For any of our clients to teach them to be fair, to be kind to themselves, and to be honest with themselves and others.
So how does treatment progress when we’re talking about dialectical, behavior therapy as an evidence-based practice stage? One is safety.
We want people to move from behavioral disk control to behavioral control. We don’t want people getting a phone call, maybe a significant other has to back out on a weekend trip which was someone with behavioral disk control could send them into a state where they are self-injuring.
So we want to make sure that they have the skills to not self-harm, and you know you can’t just say.
Well, you can’t cut the person’s like okay, so finish, what am I going to do? Instead? If I can’t cut, if I knew how to do something else, I’d be doing it right now.
We need to help them increase their self-care behaviors instead of cutting.
What can you do, I’ve talked before about some of the interventions I’ve used with some of my clients that have self-harmed.
It’s not ideal.
It’s not where you want to end up, but moving from self-harm, too, like I said, holding ice cubes or using a ballpoint pen to draw on yourself is preferable to cutting yourself.
So we want to look at small steps, not going from.
You know five or six self-harm episodes a week to nothing.
You’re setting yourself and your client up for failure. We want to reduce the intensity of the self-harm, so they’re not breaking the skin, so they’re not damaging themselves decrease therapy interfering behaviors what we typically call resistance and that can be showing up late that can be always coming in and trying to derail therapy sessions, it can be being bossy, it can be being reserved whatever it is that’s interfering with the therapeutic process.
It’s important to understand that therapy-interfering behaviors can be exhibited on the part of the counselor too.
If the client is experiencing a lot of emotional discount role, sometimes counselors will start being late to sessions and will start forgetting to review the chart before they go in and remember what homework was assigned will start forgetting to do things.
So we need to make sure that both the counselor and the client are engaging in motivating therapy participatory behaviors.
We want to increase the quality of life, and behaviors and decrease the quality of life-interfering behaviors.
So if they’re engaging in addictions, if they’re, not sleeping if they’re, changed smoking if they are and again these are things when we look at the priority list, my main focus at first is going to be on self-harm.
You know I don’t want them to be engaging in those behaviors, and then we’re going to start looking at the other things that create vulnerabilities that make them more likely to be unhappy or to be reactive in situations that would make them unhappy.
We’re going to increase behavioral skills, core mindfulness, and accurate awareness, encouraging clients, not just when they’re upset, but to engage in mindfulness scans body scans, four or five times a day.
So they know where they are and they know if they are starting to feel vulnerable.
If they’re, it feeling exhausted all of a sudden. If they’re feeling foggy, then they know to be kind to themselves: distress, and tolerance.
We talked about those skills, interpersonal effectiveness talked about those skills, emotional regulation, and active problem-solving.
So these are all going to be introduced in stage one, but they’re introduced.
The client has been using their old behaviors for a lot longer than stage 1 is ever going to last.
So we need to remember that we have to help clients strengthen these behaviors, remember to use them if they use them at first, one out of every five times as one more time than they were using them.
Last week let’s focus on the positive forward movement and not on what we think they should have done.
We don’t want to set goals that are going to set them up for failure in stage two.
We want to help clients, moderate emotions from excruciating and uncontrollable to modulated and emotional um.
We want to feel feelings.
Well, I mean, theoretically, we do so. We don’t want people to completely numb out and become robots, but we also don’t want every single emotional experience to be like debriding.
For a third-degree wound, we want something in between.
We need to help them decrease intrusive symptoms, like flashbacks memories, and hecklers, the things that created the situation where they feel unlovable and unacceptable for who they are.
We want to decrease avoidance of emotions, and I know that sounds kind of counterintuitive to increasing emotional awareness.
Again, we don’t want them to be numb.
We want them to feel because if they feel, then they can choose how to act and how to react.
Decreased withdrawal increases exposure to live a lot of times, clients with emotional dysregulation have withdrawn because they don’t want to be rejected so they don’t go out with friends.
They don’t experience life on life’s terms.
They just sit in front of the television watching Netflix.
We want to decrease self-invalidation and help them understand that their experiences are their experiences and they’re not right or wrong. Their choices may be helpful or less helpful, but at any point in time that is their best as well as they can see their best options for survival.
So let’s not be critical.
I’m just happy you’re still here and we want to reduce mood dependency of behaviors part of this process.
We’re going to teach people how to create SMART goals that are specific, measurable, achievable, realistic, and time-limited SMART goals and make sure they’re successful by validating and teaching them to self-validate, encouraging them to imagine the possibilities when you’re successful When you accomplish this goal, what’s going to be different? How awesome will it be to encourage them to take small steps, not all or nothing? You know we want to get get rid of the dichotomy’s small steps towards recovery and applaud themselves for even trying to encourage them to lighten their load and get rid of stuff that they don’t need to be stressing over right now.
You know maybe now’s not the time to start remodeling the house and then sweeten the pot and encourage clients to provide themselves with rewards for the successful completion of a goal, maybe getting through an entire week or for some clients even an entire day without self-injury.
I encourage you to practice these skills yourself because you’ll see how much we don’t do and how helpful these skills can be, but it also gives you more insight into two ways to help explain thanks to clients and help them apply.
These tools to themselves think about which skills you’ve used that were helpful or skills you could have used.
That would have been helpful in the past week for you because you’re going to ask the clients to do this.
So let’s do it for ourselves, so we can put ourselves in their position and think about which skills might have been helpful for a client that you’ve worked with in the past week.
Many disorders involve some amount of emotional dysregulation. That dysregulation can be caused by high sensitivity and reactivity due to innate characteristics and poor environmental fit or external traumas and lack of support, or both DBT seeks, first to help the person replace self-defeating behaviors with self-care behaviors, and then moves toward emotional regulation and Interpersonal effectiveness to help people develop the support system and learn how to feel feelings, including the good ones.
A variety of tools are imparted to clients to help them set SMART goals, identify and understand, emotions and their functions, decrease, unwanted, emotional and behavioral responses, and develop a more effective, compassionate, and supportive relationship with themselves and others.
Finally, remember that not every tool is going to work for every person it takes some experimentation, so prepare your clients for that.
Otherwise, if they try something and it doesn’t work, they’re going to feel rejected and validated and like failures.
Again, it’s a process to work together to help them figure out how they can start interfacing with life and integrate the two dichotomies of thought and emotion to make wise choices to help them live happier and healthier.
.
5 Signs of Teenage Depression #shorts
– [Instructor] Five ways
to recognize depression. One is continuous low mood or sadness. You may feel low or cry
for no specific reason. Two, being irritable or
intolerant of others. Often, you’ll have a very short temper and snap at people you love
for no apparent reason. Three, showing feelings of helplessness. Feelings of unhappiness,
worry, guilt, being fearful, helplessness, hopelessness, or lonely,
could all be signifying that something more serious is wrong. Four, increasing social isolation. Do you want to just be left alone? If you notice you’re starting
to withdraw from people, talk to someone. Five, little to no enjoyment
of things you once liked. You might not even watch
your favorite TV shows with as much interest. Not enjoying things you once liked could be a sign you’re depressed.
DBT Skills Emotion Regulation | Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes
CEUs are available at AllCEUs.com this episode was pre-recorded
as part of a live continuing education webinar on-demand, CEUs are still available for this presentation at AllCEUs.com/counselortoolbox I’d like to welcome everybody to today’s
presentation of dialectical behavior therapy techniques emotion regulation we are going to
start by reviewing the basic premises of DBT and the reason we’re doing that we’re only
going to do it in this one because emotion regulation we’re starting kind of at
the beginning but we want to go over what is the theory underlying a lot of what we’re going
to talk about we’ll learn about the HPA axis and this isn’t something that Linehan talks about
in DBT but it is important for understanding our physiological stress reactions will define
emotion regulation identify why emotion regulation is important and how it can help clients ourselves
staff yay and we will finally explore some emotion regulation techniques there are things
besides just preventing vulnerabilities that we can provide to clients to help them regulate
their emotions before moving into that distress tolerance realm of skills and activities so basic
DBT premises everything is interconnected when you get up in the morning if you’re having a bad
the day you know you didn’t sleep well your back hurts you’re cranky you got a lot of stuff to do
it’s raining outside you know yay you’re noticing all the negatives your thoughts
maybe more negative you may be more likely to notice the negative you may be more likely to have
what we call commonly call a bad attitude if you start to have a better attitude what happens to
what you observe and we’ll talk about that in a little while the reality is not static what is true
right now in the present may not be true which is you know was the future from what
the present was half a second ago so reality changes when we look at a situation when we look
at an event, we’re looking at how am i reacting and what is my feeling about the situation right now
you know we can learn to change where we’re at but with the information, I have right now what’s
going on and a constantly evolving truth can be found by synthesizing different points of view
because most of the time as humans it’s just kind of part and parcel of being humans we don’t have
the whole picture and I did the best I could with these little graphics here think back if you will
to some of PJ’s experiments when he was trying to demonstrate egocentrism when we’re looking at
this yin and yang sort of model the girl’s stick figure what does she see if you ask her what
color is this orb she would probably say black because we’re assuming she sees the black side
if we ask this little thick figure model over here what color is the orb she’s seeing the white
side so he’d say white now if we asked a little confused guy who is standing kind of on the third
side or the south side he sees both of them so he hears the stick figure girl say it’s black he
sees a stick figure boy say it’s white and he’s going well it’s kind of both you can synthesize
both perspectives and figure out that this is an orb that has multiple colors even though she
can’t necessarily see those colors and he can’t necessarily see those colors so BBT says let’s try
to take a look and see if there are blind spots see if there are things we’re not seeing or things
we didn’t observe the basic assumptions of DBT and well people do their best if we didn’t think
that we probably wouldn’t be in this profession so people are doing their best with the tools they
have and the knowledge they have at any given time and I added that extra part people
want to get better and be happy most people don’t want to be miserable if it seems like they don’t
want to get better then we need to ask ourselves what is the benefit to staying miserable why is
it is scarier more threatening more awful to look at getting better or being happy and that’s one of
those motivational things we’re not going to go there today but in general people are going to
choose the most rewarding option when prevents presented with multiple options okay now this
one area in that I kind of diverge from the official statement is clients need to work harder and be
more motivated to make changes in their lives I’ve had a lot of clients who have been working their
butt off but they may not have the right tools it’s like trying to unscrew something that is
Phillips head with a butter knife they’re working hard but it’s not going anywhere because
they can’t get any traction so I crossed out the work harder and I tend to replace it with work
smarter clients need to work smarter they need to have more tools they need to have more effective
tools and some of the tools they have may be awesome if we just tuned them up a little
bit sharpen their oil and grease them whatever you need to do and be more motivated to make changes
in their life and you’re saying well they’re in therapy they’re coming here for whatever reason
there why aren’t they motivated to make changes well again let’s look back at motivation and what’s
the most rewarding choice is if they tried to make changes before and it hasn’t worked out and
they’ve been told that it was their fault they were being resistant or you know they were blamed
in some way or they just felt disempowered what’s going to make them motivated to try to do that
again please let me run the gauntlet most people don’t want to do that so we need to help
clients work smarter and understand that they are working hard and they need to continue to do so
and we’re going to help them get more effective tools and we need to help them get more motivated
we need to help them see that this time it’s going to be different maybe a little bit different
but this time we’re trying something new it may be different even if people didn’t create their
problems they still must solve yep you know if you grew up in a dysfunctional household you
didn’t create that problem but it is negatively impacting you today so you’re going to have to fix
it if you want to be happy which is the whole goal of the lives of suicidal or addicted
people are unbearable and when we’re talking about DBT we’re generally talking about people
who are highly emotionally reactive and suicidal self-harm those behaviors are away at this point
that they’re trying to figure out how to tolerate what seems like an unbearable situation in their
head addiction is much the same way it provides some relief from something they feel they have no
control over people need to learn how to skillful live skillfully in all areas of their life well
yeah because every area is interconnected if you’re stressed out at work do you just
leave work go home and you have not stressed out anymore no that’s not the way it works it would
be great if it did but it’s just not even if you don’t take all your stresses of work home with you
it has taken a toll on your energy level so when you get home you’re more vulnerable to emotional
upset or just fallen asleep on the couch at 6:00 p.m.
Whatever it is so we need to help people
learn how to live skillfully in each area so the exhaustion or negativity or whatever it is
from one area doesn’t bleed over into the other area so we need to learn how to juggle stresses
in all of our areas to prevent vulnerabilities and people cannot fail in treatment when someone
relapses when someone you know backslides whatever word you want to use I look at it as a learning
the opportunity I say okay you made a different choice than we wanted you to make a different choice than
you were hoping you would make so let’s learn from and figure out why that was the most rewarding
choice than what was on your treatment plan the goal that you’re working toward why what
happened what were you more vulnerable so you didn’t choose the newer behaviors because they
weren’t as readily available let’s use this as a learning opportunity to figure out what’s going
on it’s not a failure it’s a learning moment or a teachable moment so what is emotion regulation
emotional dysregulation will start there results from a combination of high emotional
vulnerability so you’ve got somebody who is kind of reactive and extended time needed to return to
baseline so that when they get upset it takes them longer to de-escalate and get back to baseline
and an inability to regulate or modulate one’s own emotions so I want you to think about some
the time that you’ve been driving on the interstate and you’re just driving along cruising along and
heaven forbid if this has happened I hope not but if it did you’re probably just late a semi comes
along and runs you off the road onto the shoulder and oh my gosh you get onto the shoulder your legs
just to go in like this you can’t even press the gas pedal because you are so stressed out you’re
gripping your knuckles are white from gripping the steering wheel so tight your heart racing you’re
breathing fast you’re in full-out fight-or-flight mode so you went from a1 on the stress meter
you know kind of cruising along aware of the fact that you need to be cognizant of dangers to
a5 of oh crap that could have been bad alright so you take a couple of deep breaths you
your breathing goes down a little bit you get to the point where you can press the gas
pedal and you pull back out onto the highway now are you returning to baseline and just like
la-dee-da cutting around like you were before most likely not you’re a little bit more
on edge and you’re checking your bat rearview mirror more often you’re looking back making
sure nothing’s in your blood spot more awesome so you’re not returning to that same level of less
stress Tunis if you will you stay a little bit elevated because your brain is gone you know I
thought it was kind of a safe situation but I’m realizing now that not so much so I’m going to
keep you on higher alert and it’s going to take longer for you to return to baseline because
you’re looking for those threats now you’re much more aware that it could happen to people who
come from invalidating environment people who are regularly chronically stressed they’re constantly
looking around for anything else that is going to threaten them anything else that’s going to stress
them out so they’re not going from a 1 to a 5 back down to a 1 again they’re going from a 1 to a 5
back down to a 2 and then back up to a 5 and then now we’re only going down to a 3 it’s that
stress is ramping up so we need to figure out how to help people deescalate get back down to that
one and realize okay I got this that was an unpleasant situation but I got this now emotional
vulnerability refers to the situation in which an individual is more emotionally sensitive or
reactive than others or then they normally would be you know some people this is kind of and when
we’re talking about personality disorders this is pervasive when we’re talking about someone who
has been under a bunch of stress for six months this may be a situational sort of thing that we
need to help them figure out how to get out of but it may not be something that is completely
and utterly pervasive in any event when you are stressed you know you’re already kind of on edge
and something happens do you react the normal way that you normally would if you were just like
sitting there and going off oh well okay let’s figure out how to handle this or does it throw
you up sort of into the stratosphere and for a lot of people with emotional dysregulation when
they’re their relaxation is on the brink of chaos so they’re standing there teetering
and they’re going okay I cannot take one more wind or it’s going to push me over and then they
call them damp they get upset and they’re kind of on freefall for a while they get their balance
again but then they’re still right there on that precipice they never come down so what
we want to look at is what’s going on with these people that’s making them more reactive that’s
making them more alert and more hyper-vigilant to stresses and stressors some of these may be
because of differences in the HPA axis which play a role in making people more vulnerable or
reactive and we’re going to talk about the HPA axis in a minute environment of people who are
more emotionally reactive or often invalidating and what does that mean well pick Jane Jane
has had a heck of two years you know there’s just been death after death a job loss
she lost her home she’s living in an apartment right now but she’s not happy and you know yeah
you can just pile stuff on okay so James struggling right now she’s holding on and really
trying to do the next right thing she’s trying to make ends meet trying to do what’s right
by our kids just feeling stressed out and then something happens something that most of us
would react with it to you know it’s annoying but it wouldn’t throw us into utter chaos well James
on that precipice Jane’s already at a four maybe a four and a half depending on the day so when
this happened just that too puts her on a scale of one to five puts her at a
six-and-a-half which is in freefall but people may not understand that they may not understand
what’s going on in Jane’s life and they’re like this is not that big of a deal why are you just
overreacting which makes Jane feel guilty Phil is self-conscious and feels misunderstood so
then she feels isolated and rejected and we’ve talked about basic fears being rejection isolation
failure loss of control and the unknown well James kind of experiencing all of those right now and
the people around her instead of being validating and going okay you were already stressed out I
can see how this was just the straw that broke the camel’s back they’re going what is your
the problem so she doesn’t feel like she’s got social support she’s out there on an island unto
herself so we want to help Jane with emotional regulation because we know she’s up here and we
know she doesn’t like going into that freefall but how do we help her emotional regulation is the
ability to control or influence which emotions you have when you have them and how you experience or
express them and that’s a quote straight out of Linda hands book so emotion regulation prevents
unwanted emotions by reducing vulnerabilities so you can go through life you can go through
the day you can experience stress but instead of feeling overwhelmed or enraged you might feel
mildly irritated for a second and then choose to move on emotion regulation helps people learn how
to change painful emotions once they start so you don’t get stuck nurturing that emotion or feeding
into it and being angry with yourself because you got angry about something you have no control over
it teaches that emotions in and of themselves are not good or bad they just are it’s your brains
hardwired way of responding based on waiting for it the information that it has at this particular
point in time spiders if you’re afraid of spiders that is your brain’s way you see a spider and you
feel fear it’s your brain’s way of going threat spiders can be a poisonous big threat so you want
to get away from it that’s your body’s way your brain’s way of going let’s survive we want to do
this now you can figure out you can learn more about spiders so in the future when you encounter
then you realize that they’re not you know 99% of them are not threatening to humans but right now
at this moment your brain is saying warning getaway you probably want to do that so it teaches
that emotions internet themselves are just prompting us to do something they are survival
responses and suppressing them makes things worse telling yourself I shouldn’t feel afraid does that
do any good if your kid comes to you and tells you that you know I’m having a crappy day or I
hate this does it usually do any good to tell them well you shouldn’t feel that way feel better you
know just be happy does that work I’ve never had an experience where that worked now it may work
for some people but so we want to help people identify their emotions and not get consumed
by the emotions are effective when acting on the emotion is in your best interest so sometimes
it’s in your best interest expressing your emotion gets you closer to your ultimate goals sometimes
expressing your emotion gets you closer to your short-term goals like making the pain stop
and true pain is unpleasant however in the big scheme of things 15 minutes from now 3 hours
from now is that getting you closer to the goals that you want to achieve or was it just a
stopgap expressing your emotions will influence others in ways that will help you so if you want
to influence others in ways that are positive and will help you then emotions can be very kinder
that can be very helpful emotions are sending you an important message and we already talked about
that so I’m thinking the devil’s advocate amigos well I can think of a client that goes you rage
is a great emotion to express is it in my best interest yeah gets people to leave me the heck
alone does it get me closer to my ultimate goals yeah it reduces my stress by getting people to
leave me the heck alone will it influence others in ways that will help you, yeah it make them
go away and are these emotions sending you an important message yet rage is telling me that
these people like everybody are a threat to me so in the short term when you look at it that
way it can be tricky to see but we want to help people get outside of this immediate threat and
say where you want to be what happiness looks like to you or however you want to define
that ultimate goal and then once you get into distress tolerance was your Thursday talk about
how do you endure unpleasant emotions so you don’t take the stopgap route now on to our favorite
HPA axis the hypothalamic-pituitary-adrenal axis is our central stress response system and doesn’t
get too caught up and all the psychobiology of this I think it’s good to be cognizant of but
we’re not prescribing hypothalamus place in the brain release is a compound
called corticotropin-releasing factor or CRF which triggers the release of adrenocorticotropic
hormone from the pituitary gland which triggers the adrenal glands to release stress hormones
particularly cortisol and adrenaline now your adrenal glands are actually on your
kidneys and why is that important what I want you to see or understand is there are a lot of systems
involved there are a lot of hormones involved there’s a lot of stuff involved it’s not just box
you know you’re releasing a bunch of chemicals in your body that are altering the neurochemicals
and the other hormones to prepare you for spiders the adrenals control chemical reactions over large
parts of your body including the fight-or-flight response and produce even more hormones than
the pituitary gland so you’ve got these adrenals this is kind of your stress area if you will it
produces steroid hormones like cortisol which is a gluteal corticoid which means it makes your
body release glucose what we know is that glucose is blood sugar energy all right so it increases the
availability of glucose and fats for the long-term fight-or-flight reaction it also produces sex
hormones like DHEA and estrogen okay why is that important because we know that when estrogen
goes up serotonin availability goes up so if there are the adrenals are busy doing something
else it may cause other hormonal imbalances and it also produces stress hormones like adrenaline
that is going to ramp you up they’re going to increase your respiration increase your heart rate
all that kind of stuff so once you have that whole reaction we talked about and the perceived threat
passes cortisol levels return to normal great this is what happens in the ideal situation but what if
the threat never passes what if we’re working with a client who is constantly fearing rejection
and isolation they need external validation because they don’t feel good enough as they are
they don’t have social support because their emotional reactivity kind of pushes everybody
away so they’re constantly feeling this threat of rejection isolation failures loss of control
and the unknown they’re holding on just like you were holding on to the steering wheel after you
ran off the road and you got back on you know you kept chugging because you wanted to get to
your destination but you were scared witless okay so you’re chugging along what’s going
on what’s going on in that body the amygdala and the hippocampus are intertwined with the
stress response the amygdala modulates anger fear or fighter flight and the hippocampus helps
to develop and store memories when you’re under stress and think about a time when you are under
a lot of stress were you effective at learning and paying attention to the good things and the bad
things or were you just trying to make the pain stop and make the threat go away from the brain of the
child or adolescent is particularly vulnerable because of its high state of plasticity which is
why do we see people who tend to have personality disorders much of their trauma and stuff really
started early in their development and which is why it’s pervasive in every area or many areas
of their life, bad things are learned emotional upset prevent learning new positive things to
counterbalance it if you’re in a bad mood if you’re scared if you’re threatened you know if
you’re hungry homeless put whatever stuff is there are you paying attention to the
bluebirds that are flying around and singing pretty songs or are you paying attention
to the fact that you got an a on a test maybe not so, we need to understand this person who lives
in a chronically stressful environment may also have an overactive HPA axis so they’re already
they’ve already got some adrenaline and cortisol going on they live kind of in this state
of hyper-vigilance and then something happens and they’re just like through the roof kind of like
when you scare a cat what happens to the brain one is a chronic threat to its safety and a constant
the underlay of anxiety is constant undercurrent as it learns your brain forces synaptic connections
from experience and pruned away connections that aren’t utilized by people who feel a lack of control
over their environment are particularly vulnerable to excessive stimulation of the stress response
now it’s not just children abuse and neglected children pop right up there but abuse and
neglected adults think about a client you’ve worked with who’s been in an abusive relationship
for years does she have all the happy connections or is she pretty much terrified exhausted and
stressed out most of the time adults with anxiety or depressive disorders it doesn’t even
have to be an abusive or neglectful situation if you have someone that forever whatever reason has
clinical anxiety or depressive symptoms they are in this state of constant threat and constant of
people if you will so they’re not seeing they’re not able to learn and take in as much of the
good stuff so there’s more bad stuff coming in they’re paying attention to more of the bad stuff
or unpleasant stuff the synaptic connections that form the foundation of people’s schema of
themselves in the world become skewed towards the traumatic event at the expense of a synaptic
Network-based on positive experiences and healthy relationships so we had this client here and these
are her negative experiences she has a lot of them and she’s got these going through her head a lot
and it’s not they don’t just go away whenever she meets somebody and she’s like well they’re going
to leave me whenever something happened she feels isolated and alone she may fear so she’s got
really strong connections to those memories and past experiences and when you’re in the midst
of all this, there’s not a lot of happy stuff and even when she appears happy a lot of times she’s
faking it she’s not seeing and remembering all the happy stuff she just wants to avoid the pain
another example I could give you is thinking about a city planner now a city planner only has a
the certain budget just like we only have a certain amount of energy the city planner looks and says
what roads and what connections between cities get the most traffic and let’s devote our resources
and strengthen those connections because we know we’ve got all kinds of traffic going over there
and those roads that don’t travel those back roads we don’t need to pay much attention to
them right now because we need to make sure that those roads that are used the most are strong
but that’s the best analogy I can give without putting out strings and everything else but so
the hyper-vigilant state active IDEs activated by the stress response that disrupts our ability
to focus and learn you know we’re just trying to not die we’re trying to not be consumed by pain
it impairs the ability to form new memories and recall information due to the physiologic changes
in the hippocampus, it’s not time to learn and process and do all that kind of stuff have you
ever tried to study for a test when you had 16 other things going on that you are stressed about
how well did you remember this stuff over here sometimes people relate things to prior experience
well most of the time so maybe they’ve had a lot of dysfunctional relationships and they start to
get in a relationship which side is going to be triggered the negative memories are the positive
memories and then you have somebody who may be attached to some positive relationships they start to
get into a relationship and they remember some of the positives because there have been some really
good relationships but you know they may remember the negative too but most likely they’re going
to remember more strongly the positive so what’s their reaction going to be if we’re trying to help
our clients develop a healthy support system we need to help them address some of those highways
that are going towards the negative memories emotion regulation is transdiagnostic or useful
with many disorders it helps people increase their present focused emotion awareness it says right
now right here right now what are your feelings what are your physical sensations what are your
thoughts and what are your urges it helps people increase cognitive flexibility because it helps
the kind of step back and take a look and say okay what are my options let me step back from
being intertwined with this feeling and go okay I feel angry got it what are my options here what
do I usually do what I want to do when I’m on autopilot what are some other options I could
do that might help me move toward where I want to go identifying and preventing patterns of emotion
avoidance and emotion-driven behaviors we don’t want to get into the situation of constantly trying
to avoid unpleasant emotions by lashing out by hurting ourselves or by doing things reactively
when I feel this way I must smoke a cigarette I must cut myself I must fill in the blank we want
to help people find alternate ways and be able to step back and say that is an option is it the
option I want to choose today increasing awareness and tolerance of emotion-related physical
sensations sometimes these physical sensations are just so powerful and so overwhelming and
sometimes the rush of adrenaline and that foggy wibbly-wobbly feeling you get in your head when
you have just adrenaline coursing through your veins is so overwhelming that people don’t know
what to do with it and are afraid it won’t stop so let’s help them increase their awareness and
tolerance of this helped them understand that it passes and use emotion-focused exposure procedures
when they get upset help them think about things in the group sessions that get them a little bit
revved up you know we don’t want to precipitate a full-scale crisis or talk about something that
happened last week that got them upset and let’s apply these procedures emotional behavior is
functional to change the behavior it’s necessary to identify the functions and reinforcers of the
behavior so when they did it you know let’s talk about cutting because you know that is one of
those behaviors that we see are self-injury it’s what is the function of that behavior cutting
or self-injury is a way of inflicting physical pain where the person has control and they focus
on that and they feel a sense of mastery when the stuff going on in their head feels completely
uncontrollable and intolerable it diverts their attention and it also is something that they
they can control how much pain they’re in so that’s how it’s functioning now is the best
the response we want no but we can see why somebody might engage in that behavior and what reinforces that
behavior well when they do that not only do they get a reprieve from this emotional turmoil that
they don’t feel like they can touch or control or do anything with but their body also releases
endorphins release natural painkillers to kill that physical pain which makes them feel a little
a bit better so they’ve got kind of a double whammy on reinforcers there so we understand that
now we need to find something else that they can do and help them figure out how to tolerate
the turmoil emotions function to communicate to others and influence and control their behaviors
and serve as an alert or an alarm to motivate one’s behaviors so let’s talk about the first
one communicate to others so I’m communicating to a rat around me the people around me through my
emotions what’s going on if I’m angry I’m lashing out I’m going to influence people’s behavior and
they’re probably going to back off if I am sad or crying or scared that might bring them closer
and in a more supportive sort of thing you know again you’ve got to look at some of the behavior
self-injury can elicit a caretaking response but these emotions before somebody start
acting out the behaviors the emotions serve as a cue that okay Sally is getting ready to go in
free fall so they can start reacting sooner and it serves as an alert or an alarm to the person to
motivate their behaviors if they know you’re on the precipice if you know you’re right on the
edge of being vulnerable cranky being irritable that day can motivate your own
behaviors to figure out how to reduce some of your vulnerabilities and identify obstacles to
changing emotions now we can’t just say be happy and all of a sudden somebody’s like oh I
don’t know why I didn’t think of that I’m just going to go ahead and be happy that’s just not
how it works we want to look at organic factors do they have an organic long-standing chemical
imbalance of some sort and it may not be neurochemical it may be hormonal they may have too
much estrogen too much testosterone too little estrogen too little testosterone whatever let’s
figure out you know have them go see their doctor and figure out if there is something fibroids
or moans whatever that might be affecting their mood okay once we identify anything that we can
tweak there we can’t measure neurotransmitters we’re out of luck there because they’re found
in so many places in the body that there’s no way to isolate how much serotonin is actually
in the brain can’t do it yes we want to look at other factors that are biological imbalances
neurochemical imbalances that are caused by chronic stress that cause addiction to sleep
deprivation and nutritional problems so what sort of chemical imbalances are we precipitating
by keeping the stress going and keeping the adrenaline going keeping your body revved up
all the time we want to look at obstacles well let me stay with biological factors here real
quick the organic things if we can refer to the physician and we can figure out ways to address
those that give the person one step forward so they’re not feeling as depressed or they’re not
feeling as reactive people with hyperthyroid you know when their thyroid is overactive may have
some anxiety issues or some other mood issues that can be addressed with medication then we
Looking at situationally caused things is the ways we can help them reduce their chronic stress
sometimes there are some easy right-now sort of solutions other times but chronic stress comes
from issues that are so long-standing it’s going to take a while it’s not that we can’t do it but
it’s going to be a process so we move on and we say okay addiction we know that when people use
stimulants rev them up and then they crash and it makes them more than emotional yo-yo caused
by the substances or the addictive behaviors also makes them more vulnerable to emotional
reactivity sleep deprivation is all kinds of hormones out of whack and tends to make people more
irritable that’s one almost everybody can look at addressing right now and nutritional problems
if they’re not eating well not eating at all encourage them to see a nutritionist to
make sure they’re getting something balanced that they will adhere to not something that
they look at and go yeah that looks great but no way I’m eating nuts skill factors what can we help
they with we can identify cognitive responses that are obstacles which as I can’t do that
I won’t do that resistance in some way my response to that obstacle is set to look at it and weigh
the positives and the negatives do a decisional balance exercise to address the cognitive
responses and figure out why is the dysfunctional or unhelpful reaction more rewarding why is it
more rewarding to be angry or scared than to look at doing things and thinking of things that will
help you feel happier what’s the disconnect generally, it comes back to prior failures and fear of
failure because they’ve been down that road before and it’s such a letdown when they’re feeling
good for like three weeks and then they crash behavioral responses that are obstacles to
changing emotions if somebody lashes out when they get upset they lash out and throw things
and then they feel guilty so this behavioral response may lead to having more difficulty
changing emotions because we’ve got to help them figure out how to pause before the behavioral
the response so they don’t compound the situation with more negative emotions and environmental factors
people places and things being in environments where you’re surrounded by people who either agon
negativity or who bring out you know they’re there with you they’re talking about conspiracy theories
they’re just negative about everything or they’re critical of you or remind you of situations where
you’ve been criticized before so first, we want to help people identify and label emotions a lot
of our clients are relatively Alex Simon you know they have a small repertoire if any of
noting their emotions they just generally go from situation to reaction and label what they
felt is kind of a mystery so we want to help them and doing it retrospectively is fine at first
because that’s probably all you’re going to be able to get the event profiting the emotion what
were your thoughts your physical sensations and your urges help me describe this in enough detail
that if we were going to give it to an actor or an actress they could recreate the situation what
expressive behaviors were associated with that emotion you know did you cry did you throw
things did you hit the wall what were your interpretations of that event at the moment not
retrospectively but at the moment what were your interpretations of what was going on
what history before the event increases your vulnerability to emotional dysregulation lots
of big words what happened before that that already stressed you out or had you on edge
and you know we go through a whole bunch of different things and this is you know behavior
chaining we’re looking at kind of what led up to the event what made you more vulnerable and what
were you feeling at that time and then what were the after-effects of the emotion or the reaction
on your other types of functioning so after this event and you went into freefall and you got angry
and you lashed out and you screamed and you threw things how did that affect your work how did that
affect your relationships with your family how did that affect your mood and just generally your
sense of being in yourself for the rest of the day changing unwanted emotions okay so we started
labeling them we figure out what we’re feeling we figure out that yeah when we feel that way
we act in ways that you know make us feel worse afterward what do we do about it let’s change
All alright we already talked about the obstacles and we’re trying to address those but in a moment
check for facts ask yourself what are the facts for and against your belief if you believe that
someone did something to be antagonistic towards you okay what was their motivation what is the
facts for and against that also ask yourself is this emotional or factual reasoning am I making
a decision based on how I felt I felt attacked therefore I must have been being attacked or
facts you know I felt attacked yes but that was because this person said ABCDE and all of those
were very attacking and I felt like I needed to defend myself so those are to check the facts sort
of steps or you can go with problem-solving so let’s change the situation that’s called cause
any unpleasant emotion like I said with spiders at the moment you may not have enough information
to not feel scared but maybe your spouse loves hiking and camping and you want to go but
you’re afraid of those aren’t spiders so how can you change the situation so spiders don’t
trigger that same reaction increase knowledge increase exposure there are a lot of different
ways but problem-solving says ok what can I do so my reaction my correct reaction is not one of
threat or anger but it is one of at least mild acceptance prevent vulnerabilities which helps
reduce reactivity if you are a hundred percent you know you get up and you’re like this is going
to be a good day to day things that come your way are probably going to roll more like water off a
duck’s back then smack you upside the face like a mud pie so we want to prevent vulnerabilities from the turn
down the stress response because when you’re not when you’re not up here already then you know
you can fluctuate a little bit more and they help the person be aware of and able to learn and
remember positive experiences so if you turn down that vulnerability and somebody’s in a good place
or a better place than they were at least they’re going to be able to notice and we’re going to
want to encourage them to notice the positive experiences you know instead of thinking that all
people are threatening all people are going to hurt me all people are going to leave they might
notice that you know there’s Sally over here who’s worked here for 15 years with me and you know
she’s there she sometimes calls in sick but then she comes back she’s generally in a good mood
you know she’s not such a bad person and you start noticing some of the things that are
not self-fulfilling processes building mastery through activities that build self-efficacy
self-control and competence smuggle we don’t want to say you don’t want to set a goal
where somebody needs to go an entire week without having an emotionally reactive response let’s
say go for hours or maybe even a whole day that would be wonderful but first, we’ve got to talk
about how to reduce those vulnerabilities so we set the person up for success what things can you
do and well and we’re going to get down here in a minute what can you do if you wake up and you’re
feeling vulnerable you know the creepy crowds are going around they cancel school
for the entire week for school the county school system kids are off for an entire week
because of illness right now but you wake up in the morning and you’ve got a fever and a sore
the throat you’re like I don’t want to go to work and get out of bed today what can you do
to prevent being grumpy and overly reactive throughout the day’s mental rehearsal and this can
go for if you’re getting ready to do something scary or threatening seeing yourself do that and
do it successfully and this can even be during the day just envisioning yourself getting up and eating
your breakfast driving to work going through your day seeing that one person at the office that
always has some sort of snarky comment to say or whatever irritates you laughing at it or dealing
with it just fine going through everything in your day as you would like to see it happen envision it
see see what you can do rehearse it rehearse how to handle negativity you know if you know you’re
going to have to go in for your annual evaluation with your boss okay so mentally rehearse how it’s
going to go how are you going to react what’s going to happen so you’re prepared for it you have
your responses and it takes some of the unknown out of the situation physical body mind care pain
and illness treatment and the acronym for this is please I changed one of them to laughter
it used to be physical illness and that was both PNL but I like laughter anyway we’ll get there
when you’re in pain or when you’re sick you’re vulnerable to being a little bit cranky you know
that’s just because your body is already saying you are weak you know back in the day when you had to
defend yourself against predators the sick ones and the ones that were in pain were the ones
that usually got taken out first as a part of our brain that still remembers that for whatever
the reason so when we’re in pain or when we’re sick our body keeps that cortisol keeps our cortisol
levels higher and the stress response a little bit higher so we want to deal with those things but
know if we wake up and we’re in that situation moment that was a little bit more vulnerable
so we need to handle it with care and laughter you can’t be miserable and happy at the same time laughter
releases endorphins laughter helps people feel a little bit better and find something to laugh at
and have on my phone I keep comedy skits every once in a while I’ll just pop one in even if
I’m not having a bad day pop it in because I like to laugh eat two-sport mental and physical
health avoid addictive or mood-altering drugs or behaviors that are going to put you on that
the up-and-down roller coaster that goes up and it goes even further down than you were when you
started to get adequate quality sleep and exercise also helps increase serotonin and release
endorphins which help people be in a better mood mindfulness is a judgemental observation and
description of the current emotions we’re not going to go deep into this right now
another class on mindfulness and you can also google it remembering that primary emotions
are often adaptive and appropriate I know I said that like six times much emotional distress
is a result of your secondary responses shame over having it I shouldn’t feel this way anxiety
about being wrong you know maybe this is the wrong way to respond or you know what if
I’m wrong about this or rage doing due to feeling judged for feeling that way I feel this way
and you’re telling me I shouldn’t how dare you so mindfulness is kind of an exposure technique
because it helps people identify that yes I feel that way but it helps them learn to step back and
figure out how to not judge that and just go okay I feel that way better or worse whatever that’s how I
feel exposure to intense emotions without negative consequences that non-judgmental acceptance just
going all right is what extinguishes the secondary emotional responses of feeling guilty
about it or feeling ashamed or angry at yourself for being angry so think of it this way if you
can’t see this one’s the best Bruce Lee picture I could come up with scenario one is an unpleasant
experience the person has an unpleasant emotion and then feels guilt shame or anger for feeling that
an emotion so instead of having to deal with one emotion one-on-one now you’re having to fight for
different unpleasant emotions and you start acting to try to stop the avalanche of negativity in the
absence of adequate skills now Bruce Lee he was able to take out four or five at a time but most
of us you know we would be beaten because all of these adversaries would be coming at us and
we would be building on them in scenario two and this is where we want people to get they have an
unpleasant experience which is part of life they identify unpleasant emotions again part of
life is sucky but part but they can deal with one emotion they’re like okay I’m
angry what do I do about it instead of I’m angry what do I do about it and I’m guilty and you
see how you know she’s got this she can take that one emotion so what we’re helping people do is
uncomplicated this regulation is common to many disorders people with dysregulated emotions
have a stronger and longer-lasting response to stimuli yes they’re already kind of stressed
out they’re already hyper-vigilant if you want to say they’re already wound up a little bit and
then something happens and it amps for months now we have a scale of 1 to 5 if they’re already on
a 4 and it amps them up 2 points they’ve fallen off the scale they’re in freefall so we need to
understand that what we perceive as an excessive emotional reaction they may not have been starting
from the same place that we were, we’re starting from a 1 if they’re starting from a 4 you know
then their reaction to the same thing you seemed pretty reasonable emotional dysregulation is often
punished or invalidated and increases hopelessness and isolation emotional regulation means we help
people use mindfulness to be aware of and reduce their vulnerabilities so we help them take it so
they’re not at a 4 there may be a 2 you know they’re in therapy for a reason we’re going to
help them work on the other stuff and get them down to a 1 but right now let’s help them figure
out ways, they can take down their stress response take down their just underlying anxiety, and stuff
identify the function and reinforcers for current emotions when they happen was understand where
they came from because they’re functional do that chaining worksheet check for facts ok now that
I know how I feel I know what my reactions are I know what my thoughts are I know what my urges
are let’s check the facts in the situation for and against that forces people to kind of step
back which lets the urge sail out some and then problem-solves what can I do right now to improve
the situation and what can I do in the future so I don’t necessarily experience this exact
the same situation again how can I break that mold okay so emotion regulation doesn’t provide us
with a whole lot of distress tolerance skills, emotion regulation is really about preventing
vulnerabilities and helping people figure out okay here’s where I’m at how do I pause so then
I can choose from my disgust distress tolerance problem-solving or interpersonal effectiveness
skills but it’s a big step how awesome would it be if you could eliminate some of your
vulnerabilities and think about it just for a minute or two what vulnerabilities you’ve
got going on in you right now and how many of those you know could you potentially over
the next week or two kinds of address sleeping and eating maybe you have 16 things going on
and you could pare it down to eight there are a lot of different things that you might
be able to kind of pull out of the rabbit hat if you will and what kind of a difference
would it make if you’re talking to your staff and looked around at your organizational environment
what vulnerabilities are there environmental vulnerabilities physical vulnerabilities my best
friend’s working somewhere right now where pretty much everybody is required to work doubles because
they are so short-staffed they’re going to start getting vulnerable pretty soon so look around
what can you do to moderate that so they can model effective emotional regulation but they
can also not be emotionally dysregulated by a client who has emotional dysregulation issues all
right so that concludes our discussion today if you have any questions I would love to hear them
if you want to discuss that’s awesome if you want to get on to your next client you know I totally
understand that I want to wish everybody a happy Valentine’s Day for me I don’t particularly pay
a lot of attention to Valentine’s Day but it is the eve before half-price chocolates
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Group Counseling Modules 1 & 2 Based on SAMHSA TIP 41
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 group therapy, which is a product of treatment improvement.
Protocol 41.
Today we’re going to be going over chapters 1 and 2 tips 41.
They did make it into an in-service, which is what I loosely based.
The next set of presentations on and we’re, going to talk about some of the different ways you can use group and make it beneficial and hopefully easier than some other ways of approaching treatment.
So, in the first part of today’s presentation, the goal is to provide an overview of group therapy which is used in substance, abuse, and mental health treatment, and, as I said, I’m, loosely basing it on it, but a lot of times the groups That we’re doing in substance abuse are the same ones.
We’re doing in mental health.
We’re going to discuss the uses of group therapy in treatment, define five therapy models, explain the advantages of group therapy and modify group therapy to treat and address substance abuse issues.
So group therapy is awesome because it supports members in times of pain and trouble. It’s something that we can make available to the community mental health center that I worked at before and if you’ve worked in community mental health or even private mental health.
Maybe a lot of times.
There are waiting lists to get into IOP to get into PHP to get into residential to get into detox.
So one of the things that we started instituting was an intervention-level psycho-educational group, so we were able to sort of keep a tab on people who are on our waiting list.
They got on the waiting list and they started coming to these groups that provided them with tools provided them skills.
We weren’t treating any particular issue.
We were focusing more on life skills, distress, tolerance, emotion, regulation, and all that other DPP kind of stuff.
Helping them get through, was also enabling us to provide them with some hope and keep their motivation going.
Group therapy can enrich members with insight and guidance.
I found, and one of the reasons I love doing group so much is because you can ask a question to a group of 10 people and get 8 or 10 different answers to it, and the cool thing about that is that each person has their blind spots, so what they might not have thought about before might still be germane to them, and somebody else puts it out there. So when you start putting asking questions and putting the answers on the board or using the flip chart papers and having stations around the room that people go and contribute to the group process, you start getting a lot more feedback from individuals and they’re going To come up with ideas and suggestions and thoughts that not only each other had never had so they’re going to enrich each other’s lives, but they teach me something every single time.
So I loved doing and still do love doing group and it’s.
A natural ally with addiction, treatment or treatment in general group therapy enables us to provide a basic framework of information to people in a cost, effective manner.
You know there are a lot of things like emotion, regulation, distress, tolerance, self, esteem, skills, effective interpersonal communication relationship skills, and self-esteem.
I may have already said that we give to all of our clients whether it’s substance, abuse or mental health, and everybody who’s coming through the program.
Has this curriculum? If you will go through now, it’s going to apply a little bit differently to each one and they’re going to take the stuff they get from those groups and they’re going to be able to take it back to their Therapists and say this is what I learned in group.
If it is just a group process, then they’re going to be able to talk among each other and come up with their ideas, but IOP, PHP, and residential all have individual accounts.
One component, if you’re doing an intervention level group 0 05 on the ACM.
If you will, you may not have that individual therapy component.
So you want to make sure that when you provide members with information – and you help them start gaining insight you tie it up in a nice little bow at the end and help them apply it. So what did you get out of today?’s group that could have been helpful last week and how could you have used it then go back around the room and say from whatever you got from today:’s group or what’s a morsel you got from today,’s, group that You’re going to use next week, and how do you expect to do that? So I encourage them to take one or two morsels and figure out how they can use that in their particular life.
A little bit of a slide track here.
In support groups, if somebody is going to celebrate recovery or 12 step group, or even a depression or anxiety management group, I encourage them when they walk out of the group to be able to answer the question.
What was in that group for me? What can I take away from that now? It may be, I know what I don’t want to do, or it may be.
That was a great idea that so and so had, but I want them to answer that question every time, not just walk out of a group and go well.
That was a good group.
Why? Why was it a good group? What did you get out of it? Group therapy, as opposed to self-help groups and support groups, if you will have trained leaders, so you do have a lot more ability to facilitate what’s going on and kind of point people in directions that you want them to go.
Where support groups may have facilitators, but they don’t have the training that clinicians do and group therapy produces healing and recovery from substance abuse and mental health issues.
You see a lot of people gain.
Hope you see a lot of people gain optimism. You see a lot of people learn tools from one another and nobody can comic con.
If you will – and I had to figure out a way to say that a little bit nicer than the way I usually do.
But when people are in recovery and you can even think about it with your teenagers, if you’ve been around known more if you have them, teenagers hear what their parents say and they’re like yeah, okay, whatever old, fuddy-duddy, but when their Parents or when their peers say it, it carries a lot more weight, so sometimes the hope and faith and tools and stuff that they hear from their cohort has more impact than what we say.
If we’ve created a good supportive, healthy, nurturing environment, group therapy has a lot of power to it because it’s basically like having a bunch of code therapists and the ability to control it a little bit more than in group therapy.
You can address factors associated with addiction or these factors by themselves, such as depression, anxiety, anger, shame, temporary cognitive impairment, character, pathology, ie, personality disorders, medication management, and pain management.
So let’s go through these a little bit.
Depression groups are wonderful.
Now we’re going to talk about different types of groups and there’s everything from the traditional therapy group where people are sitting in a circle and or however, usually in a circle and sharing what’s going on in their particular situation.
To psycho-educational and skills groups, where we’re, providing them the tools to understand what’s going on and the tools to deal with what they’re experiencing, and you know with depression.
One of the groups I’m, going to do is depression. Well, any of these is to talk about what is it. What causes it? Where did it come from? How is it impacting you to have people start figuring out what that means to them, then we’re going to start talking, probably in the next group, about what are some ways we can start addressing this and what has worked for you. What what has worked in the past and what things might you want to do? Try? Temporary cognitive impairment can be addressed in the group in the sense that we can provide some life skills coaching.
We can provide for early recovery and substance abuse.
For example, a lot of people come to our groups, or at least where I used to work.
They would get out of detox and they weren’t fully detoxed.
Yet they had two days under them and the drug was out of their system.
For the most part, you know, except for like marijuana or benzos, but they were still not on their game so getting them to just get there on time, be prepared, pay attention, and process what’s going on was huge.
We didn’t expect to make huge therapeutic gains, but what I wanted was somebody to be able to dress up and show up.
If you will character, pathology can be addressed in groups, one of the basic reasons that Marsha Linehan created dialectically.
Behavior therapy was to address borderline personality disorder and DBT is very strong in skills groups.
Now it has individual components and coaching components as well, but she uses the skills groups to help people with character, pathologies, and borderline personality disorder, among other things, start learning about what are these symptoms. What do they mean? What does it look like and how can I deal with them and then they personalize it in their sessions? Medication management is huge for me, whether it’s, somebody who’s on antidepressants or somebody who’s on methadone. I don’t care, but I think it’s really important for people when they start taking medication, especially psychotropic medication, whether it’s, addiction or mental depression, or anxiety to be able to go into a group and talk with others who’ve Been on similar medications understand the side effects understand that gets better understand what they’ve done, that helped them deal with the side effects.
For example, a lot of my clients used to be on Seroquel and Seroquel is extremely sedating, so a lot of them found that they needed to take it at night.
But I had a small group of people who, when they took it at night, you know they would go to sleep at like 11, 00 get up at 6 30 and they were still groggy.
As I’ll get out from the Seroquel and among themselves, they started talking about okay, so I need to take it at 7, 00 every night for it to be out of my system.
So I can function the next morning they worked it out by talking about how long before it starts sedating you and how long the sedating effects last, but it helped clients stay more compliant with their medication because a lot of times and not knock Psychiatrists or doctors, but the ones that I’ve had experience with.
For the most part, I’ve had a couple of awesome: attendings they don’t have the patients they don’t have time in their schedule to hear all of the issues and help the client brainstorm, and a lot of times they don’t think to share with the patient.
These are the most common side effects that people tell me they experience.
Yes, they get the handout from the pharmacist.
There are like six pages, long and in eight-point font of all the potential side effects.
But what do people feel like when they start taking it? This Zoloft is another one. You know that’s, what one is commonly prescribed and a lot of patients feel kind of like they’ve got the flu.
They feel dizzy for the first two-to-three days and then that wears off, if they understand that, if they have a place where they can go and talk about the side effects and talk about how to deal with some of the side effects, it helps.
And this is also a place where they can talk about things like weight, gain and fatigue, and lethargy.
And how do you deal with this when you’re on this Giller medication, it doesn’t have to be facilitated by a nurse or a doctor.
That’s more helpful if it’s facilitated by a clinician.
What we want to do is encourage patients to become aware of what their potential obstacles are to be maintained to remain med, compliant, and identify some ways to address them.
Some intervention that might be effective and then go talk to their doctor, so they are armed with knowledge when they go see their psychiatrist and say I’m having these problems, it also gives them a chance to talk to other people and understand what it looks like if the medication is working for them and gives them hope if they have to change two three four times to find the right medication, so medication management obviously, is a group that I think is important.
If you’ve got clients that are medicated on pain, management,’s, pain can cause depression and anxiety.
Your body perceives pain as a stressor, so anybody who has pain may experience negative affect, especially if it goes on for a while, so helping them figure out ways to deal with the pain and ways to deal with breakthrough pain.
If you’re dealing with somebody who’s in recovery, then you’re also dealing with the issue of pain management without narcotics, so pain management groups can help teach stress management skills, progressive muscular relaxation, and sharing nonpharmacological interventions that they can discuss with their doctor, such as massage physical therapy, acupuncture yay, it also is a place that people get hope again. This is going to keep coming up with group therapy hope because they hear other people’s stories and yeah.
I hear that after John’s accident, he was in agony for six months and he was able to get through it, so they can share and support one another.
Another group provides positive peer support for abstinence from substances or addictive behaviors.
Remember we want to check our clients, and assess our clients to make sure they’re, not engaging in addictive behaviors like internet gaming, pornography, gambling, food-ish food, and eating addiction.
Anything like that, but it also provides positive peer support for positive action in any direction.
So if it’s growth goals, if it’s depression goals, the group is there to cheer you on.
They’re also there to notice when you’re starting to lose your motivation and point it out and help you increase that motivation groups reduce isolation.
So if you’re dealing with someone who’s got empty nest syndrome, someone who’s got depression, someone who’s got it up an addiction.
It helps them understand that they’re, not the only one dealing with that and they can share and support, enabling the members to witness the recovery or transformation of their fellow group members and see how other people deal with similar problems, because we all I mean There’s what twelve people in class today.
So if I throw out any problem, I’m probably going to get at least eight or nine different suggestions for how to deal with it and that’s cool, but that’s. The awesome part about group two because they can share.
What do you do when you can’t get to sleep at night? What do you do when the anxiety is so oppressive that you feel like you can’t breathe, rich, and provide information to clients who are new to the recovery process? So they know what to expect they’re not going to be giddy as all get out.
Twenty-four hours, seven days a week, 365 days a year, probably ever that’s not reality, but it helps them learn what the recovery trajectory looks like helps.
They accept the fact that they’re going to be bad days and it helps them see how they can be empowered in the process.
It provides feedback on group members, values, and abilities.
They’re going to hone in on their values, and you know I encourage them in my groups and obviously from a multicultural perspective.
I think it’s vital that we encourage members to explore their values and accept or reject them as they are and do not meet them.
For me to say whether your values are right or wrong, I want you to know what your values are and make sure that they’re.
Yours, not something that came from the media or something that just kind of popped into your head.
You don’t know where it came from that you, don’t agree with, and sometimes that will come up, especially as it pertains to medication, use or controlled drinking, or anything like that. But it also provides feedback on their abilities, and this is where I focus more than values.
What is it that you have done already? What are your strengths if you went three hours yesterday without being depressed and crying that is awesome? What did you do? How did you do it? How are you able to do that, I want to highlight that ability, so we can build on it. We want to highlight the exceptions to the problems and offer the sort of family-like experience where people get a sense of belonging and support when groups are run well, even if their skills are psycho-educational groups when a group member leaves drops out relapses, whatever happens, They just if they suddenly leave.
It affects the entire group.
When you’ve got a well-run group and a group member graduates or completes treatment, there’s still a whole process and sort of a grieving process, as that person leaves the family and launches out of the nest.
Whatever you want to say, we the way I’ve always run groups and what the way I was taught was.
We always celebrate that at the end of somebody,’s treatment, or experience after the last group that that person attends we have a little bit of a little pizza party or something to celebrate.
Let people say their goodbyes and have a good sense of closure.
A lot of our clients did not have good family experiences, so we want them to have the experience of being supported, being able to have different opinions and disagree with others, but being respected and being able to care about groups encouraged coach support and reinforce What they’re doing? Well, we don’t have to focus on what they’re doing wrong.
You know, we can talk about that.
An individual – or you know it may become germane to the group, but what we want to do is reinforce what they’re doing. Right from a management perspective groups allows a single treatment professional to help several clients.
At the same time, as I said, there are a core set of groups – educational modules, if you will that, I think all clients need to be exposed to so group is a great way to do it instead of saying the same thing six times a day to Each one of your clients having a group available with the advent of media and Internet, just like we’re doing right now.
Web chat web groups.
You can do some skills-based groups, you know if they’re, not treatment.
You don’t have as many issues with confidentiality, but you can also have videos online that you have them watch, learn from complete a worksheet and then come and participate in a one-hour group, instead of maybe having to sit through the whole lesson, which is An hour or so and then participate in the group, so there are a lot of different things that you can do using group techniques to reach a bunch of people in with one treatment provider.
In the same hour.
Groups add needed structure and discipline because, generally the group leader has a certain goal for the group or has a certain style of managing the group, so it can help sort of add a rhythm.
If you will to the group process.
Now we’re talking about traditional therapy groups.
You’re going to be sort of like the parent that controls the rhythm of the family. If you’re talking skills or psycho, read groups, you’re going to be setting more of a tone like a teacher and creating a learning experience, but it adds structure, so people feel safe.
They know what they can share, what they’re.
What’s too much sharing or what’s inappropriate sharing and it helps people also learn to bite their tongue, wait their turn all those other things that can be helpful in life.
They instill hope in a sense that, if that person can make it so can I so they see people doing a little bit better yeah.
They also see some people doing a little bit worse, sometimes, but that’s an opportunity for them to be able to reach out and provide support, and that helps the person providing support as much as it helps the person receiving it.
I truly believe that most people get a sense of contentment if you will, by being able and being able to reach out and help someone that they are concerned about, it provides support and encouragement to one another outside the group setting now this gets a little dicey Depending on your groups and your agency philosophy in reality, in substance abuse groups, the people that are in your group are probably going to be going to the same support group meetings so telling them not to ever contact each other outside of the group is unrealistic.
They’re going to see each other in the community, so it’s important to help them understand how to set boundaries and what’s? Okay, behavior, and what’s? Not okay, behavior between group members, other groups, other facilities are less stringent on that and encourage the clients to reach out to one another outside of the group setting.
So, depending on the group, the issue, your agency, all that kind of stuff there’s going to be more or less sharing.
What I want to see, especially, is, if you have, for example, in IOPS three hours here and have three groups with breaks.
I want to see people talking outside a group. I want to see people sharing, not just all sitting in there going when do we get out of here?
I want them to develop relationships and learn how to effectively communicate so group therapy is not individual therapy done with an audience.
It is not a mutual support group.
It’s designed to help people develop and practice knowledge and skills in a microcosm.
You’re, creating a mini family or a mini-community.
It aids patients in learning how to develop healthy, supportive relationships and also how to terminate relationships, because sometimes when people graduate they move on it, which doesn’t necessarily mean that they’re going to continue to interact with the clients in the group.
Alright.
So the second half of this class, we’re, going to look at the group therapy models used in treatment, explain the stages of change, and discuss three specialized group therapy modules that may be used for the stages of change.
I’ve gone over this before for new people.
I’ll go over it again, real quick think about getting into a pool in the summer. It’s hot it’s like 90 degrees.
You are sweating bullets, pre-contemplation, and you’re still laying on the lawn chair going.
I ain’t hot.
Yet no, I’m not anywhere near hot enough to go near that pool contemplation you’re starting to get hot and sweaty, and you’re looking at the pool going.
You know that might be a nice change in preparation.
You move to the side of the pool and you’re dangling your feet in the water trying to figure out.
If you’re ready to take the plunge because it’s cold, I mean compared to the 90 92 5 degrees C is outside and you know your 98 6 body temperature water is cold, so you’re preparing action is when you jump in you. ‘re, like I, can’t take it anymore.
I’m too hot to jump in the pool.
Now, if that pool is too cold, if it’s too painful to stay in there because you’re just like a ho ho, you may jump back out again and back into preparation or further back.
If you get in there and get moving – and you know, get your body temperature back up that’s – sort of basically like treatment – and you’re getting the swing of things, then you just want to maintain. So you don’t get cold again and recurrence is when you get out you get hot again and go through this process again so pre-contemplation, I ain’t got a problem.
Contemplation yeah, I’m a little uncomfortable, but I’m not ready to do anything yet preparation.
I’m starting to get ready to make a change because this is uncomfortable, but I’m not very it action I’m on it, and maintenance is keeping your gains and maintaining a steady state, so variable factors for groups, the group leader group or Leader of focus, so if you’re focusing on a part of it, is your training.
You know if you are more Rogerian client-centered in your training versus cognitive, behavioral versus DBT versus AC T, whatever your theoretical underpinnings are and what you choose to focus on.
In that particular group, there’s a lot of stuff.
We can focus on whether it’s cognitive, physical, or emotional.
We want to another thing that affects it is the specificity of the group agenda.
If you’re going to have a group and it’s on self-esteem, well that’s not specific, so we could go sixteen different ways till Sunday if you’re looking at self-esteem and disarming the internal critic.
Now that’s much more specific for that group, so that’s going to affect what that group looks like for that session or that says sessions how similar or different your group members are.
If they have a lot of different experiences, you’re going to have a different experience as a group leader. Then, if you have a lot of people who have the same experiences, open, ended or determinant duration of treatment, if you’ve got a group that somebody can join and if they want to stay for 104 weeks, they can stay for 104 weeks.
That’s up to them versus a group that is 16 weeks long that’s also going to affect how your group goes.
What do you cover, how connected do group members become? I use 104 weeks just to sort of overemphasize.
I hope nobody stays in the group for 104 weeks, but the level of leader activity is.
I have seen groups where its leaders will throw out a discussion and are like okay topic for today is what do you think about it, and let the group facilitator with a little bit of nudging here and there versus other groups where the leader is very involved In goes around goes okay, Sam.
What do you think about this sally? What do you think about it and that affect how people react and what they expect it? Doesn’t necessarily affect what they get out of it, but these are variables that could affect how someone meshes with the group.
Not everybody is going to like a real open, ended, a loosey-goosey group I don’t.
You know I’m structured.
So I prefer to be in groups where I know what the agenda is, and what we’re going to do.
In my groups, start with a review from the last group that’s the first five minutes, and check in with everybody. Next, in five minutes we do a 15 to 20-minute psycho, ed piece, and then the last.
You know 30 minutes of group.
I spend going around the room and having people tell me, what is it that you got out of this? What do you think you could use this next week etc and apply it to what they know that’s how my groups go, so they’re, really very structured.
You’ve got to be able to drop back and punt.
If a client is in crisis or something strikes a nerve with them, you know you might have to change up a little bit.
But overall you’re sort of setting the tone for what’s going to happen in the group, the duration of treatment, and the length of each session.
You’re going to cover a lot more in a 3 hour of IOP session.
That and treatment is five days.
A week for 12 weeks, then you’re going to cover in a treatment program that’s one hour a week for eight weeks, just knowing what you’re going to try to cover will affect the depth or the breadth of what you go through.
The arrangement of the room also affects how the people interact. If you have them set up in theatre, style, or classroom style.
People interact differently than if they’re all sitting around in a circle, and if you ever want to experiment with that, it is interesting to notice how much differently people interact and how much more they seem to participate when they’re sitting sort of in A circle versus when they’re in theater style and I feel like they can hide and the characteristics of the individuals.
Sometimes you’re, going to have people who are enthusiastic and chatting.
Sometimes you’re going to have people who are not, and it could be for a whole host of reasons.
It could be a bad fit, it could be their involuntary, or it could be they just got out of detox.
It could be that they’re.
All are just at that level of clinical depression that they’re having a hard time staying with the group and it’s up to us to adjust to try to meet the needs of as many people in a group as possible.
Now, while I’m saying this, they didn’t say to size of the group.
Here, the recommended size of the group is 8 to 12 people.
If you’re dealing with adolescents or people with severe and assistant Mental Illness, it’s more along the lines of 812. For your average group 15 for psycho-educational and skills groups any more than 15.
You’re doing a class and not a group.
Psycho-egg groups assist individuals in every stage of change, pre-contemplation contemplation, yay.
It helps clients, learn about their disorders, their treatment or intervention options, and other resources that might be available to them, such as assistance with prescriptions or physical therapy, or whatever other wraparound services.
We often call it might be available.
They can also be used to provide family members with an understanding of the person in recovery, so family egg groups can be awesome because then you get to understand and hear what the family thinks is going on and expects is going to happen in treatment and What they’re seeing and hearing, and you can normalize for them what’s going on with the client, so somebody recovering from clinical depression or somebody with bipolar disorder.
You know this is what recovery looks like this is what living with the disorder looks like.
This is what being on this medication looks like, I, ‘ve had a lot of patients because I deal with mainly co-occurring.
I’ve had a lot of patients who have bipolar disorder, and you know some sort of substance abuse issue.
They start taking. Seroquel, because that seemed to be the drug of choice for our prescribing at that particular time and they would start acting all groggy and family would freak out going you’re using again, and so Family Education groups were a great time for us to educate.
Not only about the disorder but also about treatment, medication, side effects, and how to interact with the loved one to be as most supportive as possible.
So ad groups educate about a disorder or teach a skill or tool and work to engage the clients in the discussion.
I don’t want to stand up there in the lecture.
I want them to be able to throw out ideas.
So if I say you know what is it that you do when you’re struggling with somebody, because they just great on your every last nerve, what are some things you do to solve that problem or to deal with it? I don’t want to just tell them everything I want to do something more Socratic and encourage them to tell me how they work with it, and if they come up with something that’s, not quite on point.
As far as being the most effective or healthiest approach, then we’ll talk about it and we’ll say well.
I’m sure that’s worked for you.
I’m wondering you know if there’s a kinder gentler way to do it, or you know you kind of massage it a little bit to morph it into something useful.
We want to prompt clients to relate what they learn to their issues, including their disorders. You know how you, how this relates to your depression, but also your goals, your challenges, and your successes?
Psycho-ed groups are highly structured and follow a manual or curriculum, and it doesn’t have to be a manualized curriculum that you buy from somewhere.
You can create your curriculum, but you teach the same thing and it’s sequential and it follows a teach, apply practice method.
So you teach a skill, you have them talk about how they would apply it, how that might apply to them, and then you have them practice it in role plays or imagine how they might use it.
Next week, basic teaching skills are required for psycho-ed groups, though, which requires that you understand the basic components of learning, and I call these the three C’s capture, which is how you get the knowledge I mean you got to get it into your brain.
Somehow I am a visual kinesthetic learner.
I learned virtually nothing from sitting in lecture classes.
I’m off in la la land in about 30 seconds.
I know this about myself, so I need to have material that I and see, which is why I do powerpoints here some of y’all may not might not even be looking at the screen.
You may be often doing something else and listening to me more power to you. However, you get the information in your brain is great.
Global and sequential.
Some people are global.
They need the big picture when they’re doing a puzzle.
They want to see the box first to do the frame and then fit all the pieces in sequential people.
Don’t want the box that’s cheating they look for pieces and put them together and then try to figure out how all the pieces go together to make a hole and then their wall out as a whole.
To appeal to both of those at the beginning of the group give an overview of what you’re going to cover in the group, and if you can sort of a written agenda it’s, not always practical.
I always tried to put it up on the whiteboard.
We always had issues with how many copies we were allowed to make and stuff.
So in the interest of saving trees, try to give them some sort of an agenda, so they know what the progress is or what they can expect from group talk about it, so people can hear it and apply it through role plays having them apply it to themselves. Make them manipulate that information in their mind and provide visual representations like bullet points of what you’re going over. If you can’t, if copies again are an issue, have them bring a notebook and write on a whiteboard, so they can see it.
So you’re presenting information in as many ways as possible.
Conceptualization is relating the information to building blocks.
So if you’re teaching a unit on cognitive distortions, then you’re going to talk about maybe using extreme words or nothing talk.
So I might say tell me about a time that you’ve said something like you always do this and then what we’re going to talk about, how to change that and how you know.
Thinking about things that way might be contributing to some of their distress and then caring.
This is the biggest one which is again why I have clients when they leave a group, ask themselves: what could I get out of that? Why was that important to me if they’re not motivated to remember it, they’re not going to think back to high school biology or college humanities archaeology?
101.
For me, I learned what I needed to learn for as long as I need to learn.
It’s to pass the test, and then I forgot it all because I didn’t care about it, so we want them to care or they’re not going to remember so get it in their heads and help them relate it to something they know and make Them care about it, make them figure out why it’s important to them, foster an environment, to support participation, encourage participants to take responsibility for their learning, use a variety of learning methods that require sensory experiences, which means talking about it. You know talking about it listening to it and maybe drawing art therapy try to incorporate as many senses as possible.
I always find that role plays are a big hit.
You can also break up concepts and have to break up your group into smaller groups and have each of the smaller groups reteach a concept to make sure that they understand it and be mindful of cognitive impairments.
So if you’ve got someone who is impaired in some way, make sure that you have some sort of method to ensure that that person is keeping up with the rest of the group.
If it’s a diverse group skills development cultivates the necessary skills to prevent a relapse, depression, anxiety, and addiction and achieve an acceptable quality of life.
Part of the skills groups assumes that the clients lack needed skills such as coping skills, interpersonal skills, and communication skills, hence the term skills group.
So we want to allow clients to practice skills in groups.
Psycho-ed groups provide the knowledge and, if you remember basic treatment, planning, and knowledge skills and abilities, so you know it, you learn how to use the skill and then the ability is a put those skills into practice.
So we want them to be able to practice.
These skills in a safe microcosm, you want to focus on skills, directly related to recovery and those to thrive in general. Think about Maslow’s hierarchy.
They need to get those biological needs met, they need food, shelter, medication, pain management, health, safety and safety from themselves and love and belonging.
So we want to help them make sure they’re getting those not just focusing specifically on depression or anxiety skills development groups have a limited number of sessions and a limited number of participants.
So everybody can practice.
We don’t want a big auditorium.
We want that 8 to 15 number ideally, and there used to strengthen behavioral and cognitive resources.
Skills groups focus on developing an information base on which decisions can be made and actions can be taken.
So when they’re thinking when they practice the pause and they’re trying to decide okay, what is the best reaction to this current situation that’s when skills kick in and they’ve got a menu of skills to choose from cognitive, behavioral Groups, conceptualize dependence on substances as a learned, behavior that subjects to modifications through various interventions, which is a bunch of garbage garbled a for CBT groups, really look at using as a triggered behavior in response to pain.
You want the pain to go away and your drug of choice does that.
The same is true for self-injury or a variety of other symptoms that we see in our patients. So we want to look at what’s triggering those and how can we. What are they trying to meet? What need are they trying to meet with that behavior and how can we help them meet that? Otherwise, sorry, my nose is itchy today, work to change, my learned, behavior by changing my thinking, patterns, beliefs, and perceptions and include psychological elements like thoughts, beliefs, decisions, opinions, and assumptions.
Cbt groups develop social networks that support abstinence, so the person with dependence becomes aware of behaviors that may lead to relapse and develop strategies to continue in recovery.
Now that’s for addictions, groups for anxiety and depression, the same is true.
We want them to have social networks with other people who experience the same diagnosis.
If you will so, they can become aware of relapse.
Warning signs when are starting to become impatient.
They’re not sleeping as much, whatever their relapse warning signs are for their condition, disorder, whatever you want to call it, so they can develop.
Strategies to stay, happy and healthy educational devices are used in CBT groups including worksheets role plays, and videos that encompass a variety of proof, and approaches that focus on changing the way we think and the behavior that flows from it.
I cannot stand feeling this way can be changed too.
I don’t like feeling this way, but I know it will change. In the next moment.
Cbt techniques teach group members about self-destructive, behavior and thinking that lead to maladaptive behavior.
We look at those unhelpful, cognitions and their effects of them.
How does that impact you in your relationships? The way you perceive the world and your general sense of empowerment and happiness? They focus on problem-solving and short and long-term goal-setting which a lot of people don’t know how to do.
Imagine how much better people and more empowered people feel when they figure out hey.
I know how to do that.
I know how to see a problem, develop a plan and solve the problem and they help clients, monitor feelings and behavior, particularly those associated with their diagnosis.
Support groups are useful for apprehensive clients who are looking for a safe environment and they boast remembers efforts to develop and strengthen their ability to manage thinking and emotions and interpersonal skills support groups.
Don’t have a trained facilitator necessarily, so they’re.
Not necessarily. How do I want to say this? They’re only as effective as the effectiveness of the group leader and the health of the group leader, support groups, address pragmatic concerns, and generally improve members, self-esteem and self-confidence they’re.
Often open-ended with changing members, encourage discussion about members, current situations, and recent problems.
So we’re less focused on education and skill building and more focused on what’s going on with you today, and they provide peer feedback and require members are accountable to one.
Other support groups vary with group goals and member needs and include facilitating desilting discussion among members while maintaining appropriate group boundaries, which can be a little difficult, especially with untrained if there are no trained facilitators there.
These groups can help the group the whole group work through obstacles and conflicts.
So if you’ve got people that are arguing within the group remember, this is a microcosm.
This is a little family, whether it’s a support group or any other kind of group.
These people meet every week and there are going to be conflicts, so we want to help people work through these and develop acceptance and regard for one another support groups ensure that interpersonal struggles among group members do not hinder group development.
So if you’ve got a relationship budding between two people, not unheard of, or if you’ve, got a huge conflict, getting ready to happen between two people.
You want to make sure that doesn’t interfere with the group process, so you may need to handle that outside of the group, or you know, figure out how to address it. Interpersonal process groups recognized conflicting forces in the mind, some of which may be outside of one’s.
Awareness determines a person’s behavior, whether it’s helpful or unhelpful.
So interpersonal process groups help people identify the developmental influences and other things that have gotten them to where they are, that influence, how they act and react the way they do currently, and bring a lot of stuff into awareness.
Oh, that makes sense that I react that way because that’s how my mom used to react or when I did that when I was a kid I got in trouble for it whatever the case may be interpersonal process groups delve into major developmental issues.
Searching for patterns that contribute to the problem or interfere with recovery abandonment issues is one that comes up a lot looking at the family of origin and their coping skills.
We want to learn.
What did you learn when you were growing up that is? You are using now and how effective is that for you, these groups use psycho dynamics or the way people function psychologically to promote change and healing and rely on the here-and-now interactions of members.
So we’re focusing on all this stuff.
That made you who you are and gave you the tools that you have right now, how’s that working for you?
So there are multiple types of groups that are available to assist clients in achieving their goals. We view current coping skills as creative adaptations to what they’ve learned and ways to get their needs met.
They may not be the healthiest coping skills, but they are serving a purpose.
So we want to look at the way.
Clients are coping acting interacting.
Just look at their behaviors and ask ourselves what’s the benefit to that? What’s motivating is that, because we always choose the behavior.
That seems – and I emphasize the word seems to have the most reward to it, based on reward and effort groups, help strengthen the healthy skills, but they also help point out some of the unhealthy ones, and again a lot of times it has more to it.
If it comes from a peer, as opposed to, if it comes from a therapist skills required to facilitate groups, overlap significantly a lot of my psycho, groups are also kind of skills groups.
I kind of do a psycho, ed skills blend when I do groups that are, my style though, and the group facilitator needs to figure out his or her style because you’re going to set the tone for your group.
Not everybody is going to thrive in your group.
Just like not everybody is going to mesh with you as an individual therapist, knowing your style and being confident is one of the first steps to having a really strong group experience. Types of groups include psychoeducational, which provides your knowledge, and classroom-type format.
Skills development provides takes the information that knowledge and helps people translate it into skills.
Okay.
Now I know what an unhelpful thought or a cognitive distortion is.
What do I do about it? Skills group is the: what do I do about it and let’s practice it.
So when I have this thought, what can I do? Cognitive behavioral groups kind of integrate those but focus strongly on what’s going on with the individual and the thoughts if you think, of the ABCs, the automatic beliefs that may be perpetuating or maintaining the unpleasant consequences and support groups are those groups that Are not facilitated by a trained facilitator or by a clinical facilitator.
In some groups like smart recovery, the facilitators are trained, but they’re, not necessarily clinicians and group members are accountable to one another more so than accountable to a group leader who starts the group by telling people what they’re going to learn and do and why it’s useful to them make them care, give them that global perspective of what’s going to happen and then go through the information step by step or sequentially.
So all of your learners are getting as much as possible provide an overview of what you’re talking about have written material like I said, if copies are a big issue where you come from it’s, not unheard of, or if you just don’t like making lots of Xerox copies, write it on a whiteboard and encourage clients to bring a notebook and write it down.
Clients will remember things better if they have to write them down because they’re going.
To paraphrase it, which is a form of kinesthetic learning before they write it down most likely because they want to write down as little as possible, discuss the material and apply it ask for their input. How do you deal with this? What do you think about this option? How could you use this? How could you have used this last week and what do you think you might? How do you think you might use it next week and give me an example of what that would look like for you? Can also have them roleplay, maybe they’re having somebody in the group having a particular issue with a supervisor or roommate.
You may choose to roleplay that in a group and have them apply a skill that you’re talking about.
Have each group member close by identifying one thing they got at a group and how they are going to use it in their recovery plan. Again, it brings it back to caring, has the kind of tie it up into a neat bow, and is able to walk out with one tool.
Yep give them two too many tools in one group and they’re going to walk out, and none of them are going to get used.
You give them one tool and they walk out.
They may try to use it throughout the week and then next week in the group, you can ask them how’d it go.
If you enjoy this podcast, please like and subscribe either in your podcast player or on YouTube, you can attend and participate in our life.
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This month,
7 Signs You’re Depressed and Don’t Know It
– [Narrator] There’s been a huge decline in mental health around the world, which is why we’re so committed to creating more content
than we ever have. Thanks for being a part of our journey. Hey you, Psych2goer’s happy
Mental Health Awareness Month. It’s so important to
have a month dedicated to spreading awareness of medical conditions that can’t be seen. When you think of depression
what do you think of? Being sad? Thoughts related to death,
unanswered calls, or texts? These are all very common
and noticeable signs of depression, but did you know,
there are more subtle signs of depression that can
fly under the radar? Let’s check out seven signs of
depression that go unnoticed. Number one, you toggle between emotions depending on your surroundings. When we think of depression we often think of being sad all the time but did you know that that
isn’t always the case? A subtle sign of depression
is when an individual flips between sadness and happiness based on the scenario and setting.
For example, you might
be sad when you’re alone but happy when you’re
out with your friends. Having people around or
something to keep your mind off things allows for a bit of reprieve. This can also be something
called forced happiness, where the person feels inclined to put on a smile for others. A group of researchers found that potential depression
sufferers on Twitter change the way they use language and interact on social media. You may notice them sending
you more negative texts or posting darker posts on
their social media accounts. But when you hang out with them in person, they’re completely happy. This online persona allows them to be and say what they want. Number two, you notice
changes in your habits. There’s a certain stigma around
staying up late at night. When you see posts or texts from a friend in those early hours, you
may not think anything of it but when you notice it more consistently this could be cause for concern.
Other habits that can be
disrupted can be eating, bathing, getting dressed, and going to work school or other appointments. Ignoring these basic human needs
is not caring for yourself. Then it could be a sign that
there are more things at play than just being tired or feeling lazy. Number three, you start
blaming yourself for things even if it’s not your fault. When you’ve done something, it’s important to take
responsibility for it and hold yourself accountable. But do you notice someone
apologizing for everything, even for things they didn’t do? You say I spilled juice on my shirt. They say, sorry. You say it’s raining,
I wanted to go running. They say, sorry. They didn’t make you
spill juice on your shirt. They didn’t make it rain
and purposely ruin the day but they feel like it’s their fault. This can even manifest as remembering or reliving an embarrassing memory and not moving on from it. Even having a feeling of guilt can leave someone feeling depressed.
Number four, you’re not
doing what you used to do. Have you noticed a certain friend has declined a lot of your
invitations to hang out later? Did you notice they’re not going anywhere besides work or school? Maybe there’s a friend who
still shows up at their hobbies like sports practice or music rehearsal but has lost all enjoyment. These are all signs of
potential depression. When you’re depressed, activities that used to produce dopamine, the feel-good hormone,
don’t react the same way causing you to not feel that same joy. This is another sign that can be paired with toggling mentioned
in the first point. The individual may feel
like they need to match their previous high spirits and hide their new emotions so they don’t bring the mood down. Number five, you have
difficulty making decisions. When you ask your
significant other to hang out it’s nice to get some
input on what they wanna do or even leave the decision up to them. Someone who may have depression may not have any opinions on anything. It can be as small as
what to eat for dinner or more difficult as what to major in or deciding your budget.
This can mean the
individual doesn’t feel like they’re good or smart enough
to make the right decision. Pushing away from making
decisions can be a good indicator of possible depression. Number six, you’re always on edge. Irritability is a common symptom of mental health conditions. But how can you tell the difference? Let’s say you’re crushing on someone and your friend knows it. If your friend starts
flirting with your crush in front of you, this is a situation where being irritable is a valid
and reasonable response but say you have a
roommate and one shared TV.
You wanna watch a movie after
work, but when you come home your roommate is already
watching something which causes you to blow
up at your roommate. The reaction is out of
proportion to the situation. Sure, it’s annoying that
someone’s watching TV but it’s something a simple
conversation can solve. You can ask your roommate
if they would mind you watching a movie
after they’ve finished. That knee-jerk reaction
to get angry can be a sign of other mental health
issues like depression. And number seven, you feel physical pain. Have you ever felt pain like
muscle ache or headache? And you have no idea where it came from? When you feel physical pains regularly, it’s always a good idea to
consult a medical professional to determine if there are any
underlying reasons for them. If nothing is found, it
may be a good next step to contact a trusted
mental health provider. So did any of these signs surprise you? Have you noticed these other signs of depression in yourself or a loved one? Let us know in the comments below.
If you are someone you know is concerned that they may be showing
signs of depression, please consult a mental
health professional. And if you found this video helpful please share it with others. The references and studies used are listed in the description below. Until next time, take
care and see you soon.
8 Signs You Might Have Social Anxiety
Hey, Psych2Goers! And welcome back to another Psych2Go video. Do you find it hard to socialize with other people? Do you feel overwhelmed at the thought of going to a social event? It can be very easy to confuse social anxiety and shyness.. ..since they share many of the same characteristics. While shyness is a personality trait.. ..social anxiety is a mental illness. Before we begin we’d like to mention that this video is created for educational purposes only.. ..and is not intended to substitute a professional diagnosis. With that being said, here are eight signs you might have social anxiety. #1 You’re always self-conscious. One aspect of social anxiety is the extreme fear of being judged. According to Kocovski and Endler if you have social anxiety; You’ll constantly worry about the way you look or act and what others think of you. Your greatest fear is of embarrassing yourself in front of others. A shy person, on the other hand, will only worry about being judged in certain situations.. ..like in public speaking or when meeting someone new. #2 Your anxiety feels out of hand. There are times when it’s normal to feel shy or nervous around other people.
..for example when you move to a new school or have to perform in front of an audience. But social anxiety is irrational and unwarranted. You may feel distressed about things as simple as making eye contact with someone,.. ..using public transportation, or eating in front of other people. The fear is always there. The fear is always there. #3 It interferes with your performance. Have you ever called in sick to work when your anxiety became too overwhelming? ..or have you kept quiet when you were having trouble in class? Social anxiety can impact your performance in many ways.. ..with the constant fear of people’s judgment You may even be afraid to do well to avoid drawing attention.
You don’t pitch ideas at meetings.. ..raise your hand in class… or join clubs because of how much anxiety it creates. #4 It affects your relationships. While it’s hard to make friends when you’re shy.. ..it can feel almost impossible when you have social anxiety. For a shy person, it’s usually about breaking the ice.. ..and going through the initial awkwardness of meeting each other. But having social anxiety can complicate your relationships. You feel tense and uneasy around people.
..no matter how close you are or how long you’ve known them. #5 It doesn’t go away with familiarity. It’s normal to feel shy at the beginning of a new relationship. But as you get to know each other the tension will start to subside. This isn’t the case if you have social anxiety. Instead, you always experience fear distress, and embarrassment whenever you’re around other people. Doesn’t matter if it’s your parent’s siblings or best friend.. ..you always feel uneasy and stressed unless you’re alone. #6 You overanalyze everything. Have you ever said things to yourself like; “I took too long to reply and now she doesn’t like me ..” or “He didn’t say hello this morning because he’s upset with me ..” Social anxiety can make you obsess over your social interactions. You may spend a lot of time and energy.. ..analyzing other people’s facial expressions.. ..body language and tone of voice.. ..to see if they mean what they’re saying or not. #7 You avoid social situations. Are you often absent or very late to social gatherings? It’s a serious matter if your social anxiety leads you to avoid social situations altogether.
You decline invitations, refuse to speak in front of people, ..and would rather sit in the corner.. ..to avoid being noticed and mingle with anyone else. It doesn’t matter if it’s a normal day at work or school.. ..your birthday party, or even your wedding day. And #8 You have physical symptoms. Do you feel nausea? dizziness or chest palpitations when you’re in social situations? Just like most anxiety disorders.. ..social anxiety is often accompanied by physical symptoms. Some common ones are sweaty palms, shortness of breath.. lightheadedness, and trembling. While these are also the same signs of someone having a panic attack. You’ll be able to tell the difference if you only show these symptoms.. ..when anticipating or being out in a social setting. Do you relate to any of these symptoms above? Let us know in the comments below.
If you do, you’re not alone…nor are you bad for feeling this way. The references and studies used in this video are added in the description below. If you find this video helpful, be sure to like, subscribe…and share this video with those who might benefit from it as well! Thanks for watching and we’ll see you in the next video!
6 Physical Symptoms that Might Be Anxiety
– [Presenter] Have you ever
experienced physical symptoms and not known why? It could be that you’re
experiencing anxiety without realizing it. So what exactly is anxiety? Experiencing occasional
moments of anxiety is normal, such as when facing a problem at work or before taking an
exam where you may feel your heart beating rapidly
sweaty palms, or have nausea. But these symptoms of
nervousness dissolve over time. While you may have experienced
these symptoms at some point, anxiety is more than
temporary worrying or stress. Worries and stress arise
from external triggers such as an upcoming deadline or an argument with a loved one.
Anxiety on the other hand is persistent worry in the absence of stressors. The American Psychology
The association defines it as an emotion characterized by apprehension and somatic symptoms of tensions in which an individual
anticipates impending danger, catastrophe, or misfortune. Aside from its mental symptoms, anxiety also produces a
roster of physical symptoms such as insomnia, fatigue, and muscle tension. Most people pay more attention
to the physical symptoms as they’re easy to identify, and as a result, tend to treat the symptoms rather than the underlying cause. So with that said, here
are six symptoms of anxiety that can help you discern if
it’s an illness or anxiety.
Number one is irritability. Yes, this symptom may seem vague
because when you’re unwell, who wouldn’t be a bit irritated? However, if you find
yourself getting worked up over the slightest things, that
could be a sign of anxiety. Anxiety triggers our fight-flight or freezes response. It also makes you believe that
you’re constantly in danger which reduces your tolerance to stress. As your stress tolerance decreases you become more susceptible
to snapping at someone. According to statistics, only
a small percentage of you who watch our videos
are subscribed. If you’re not subscribed yet
and you enjoy what you see do consider hitting the subscribe button. This encourages your hoops algorithm in promoting more of our
mental health content to more people out there. Number two is depersonalization
or derealization. Another sign that your
physiological symptoms are the result of anxiety
and not a sickness is if you experience frequent
bouts of derealization or depersonalization. Both symptoms disrupt
how you perceive yourself and the world. Derealization is a sensation
of being outside of your body and is a frightening thing to experience.
One minute you can be
walking down the street and suddenly everything feels
two-dimensional or unreal. Depersonalization is usually described as an out-of-body experience. Most times you feel like you’re watching and hearing yourself in real-time, but your actions feel distant like you’re not the person doing them and your limbs or body
can appear distorted and foreign to you. Reports show that stress and
anxiety are the primary causes of derealization and depersonalization because your fight or flight
response to stress floods your brain with adrenaline
which redirects blood from the brain to the larger
muscle groups and core. Because your brain has less blood you may feel more lightheaded, and as a result, you may
experience derealization and depersonalization. If this happens to you,
it helps to breathe. The adrenaline usually
takes two to three minutes to metabolize but you may take 20 minutes to calm down physically and mentally. Number three is phobias
and coping mechanisms. Another sign that you’re
experiencing anxiety and not a physical
illness is if you notice that you’ve developed new
and unexplainable phobias.
We all have phobias whether
they developed during childhood or are the result of a bad experience. Phobias are our brain’s way of
trying to keep us from harm. However, some phobias are
the results of anxiety and can become obstacles
in your daily life. Technically phobias are
categorized as anxiety disorders and fall into two groups;
specific and complex. Specific phobias usually
stem from a bad experience, but complex phobias stem from
mental or emotional distress. Specific phobias usually
don’t need treatment but complex phobias, like agoraphobia, the fear of being in busy
places, and social phobia do. These phobic opioids can
make you feel more alone and can also affect your self-esteem. Number four, attacks, trouble breathing.
A telltale sign of anxiety is
experiencing a panic attack or anxiety attack. Though both terms are
used interchangeably, they’re different. A panic attack is a sudden
overwhelming surge of emotion such as fear and discomfort. You may feel your chest tighten as your breathing has stopped. You may also feel dizzy or lightheaded. While anxiety attacks
have similar symptoms, they’re a bit different as
they’re the result of symptoms that have been gradually building up. Number five is gastrointestinal disruptions. Gastrointestinal issues
are another sign of anxiety but can also arise independently
of your mental health. While anxiety and gastro
illnesses are mutually exclusive, there is research supporting the theory that anxiety causes
gastrointestinal disorders such as irritable bowel syndrome and studies have shown the comorbidity between anxiety and
irritable bowel syndrome. There’s lots of research that treatment for some gastrointestinal
disorders may involve therapy.
And number six, physiological strangeness. A final sign that you’re
experiencing anxiety is if you feel tingling or numbness usually in your face and limbs, which is the feeling of blood
rushing to your extremities as your fight or flight response kicks in. While blood rushes to our extremities, other areas of your body can feel weak. Tingling and numbing can also
be caused by hyperventilation which indirectly happens
when you’re anxious. Along with the symptoms
listed in this article, there are other ways
anxiety can manifest itself.
Despite its symptoms,
anxiety is manageable. Please reach out to a
medical health professional or a therapist for help. Do you recognize any of
these symptoms in yourself? Let us know when the comments are below. And remember to like and share this video with those who might benefit. As always, the references and studies used are listed in the description below. Take care and thanks for watching. See you next time.
10 Ways to Deal with Social Anxiety
Welcome to happiness isn’t brain surgery
with Dr. Snipes. This podcast was created to provide you
the information and tools Doc Snipes gives her clients so that you too can
start living happier. Our website DocSnipes.com has even more resources
videos and handouts and even interactive sessions with Doc Snipes to help you
apply what you learn. Go to DocSnipes.com to learn more. Hey everybody and
Welcome to happiness isn’t brain surgery with Doc Snipes: Practical tools to
improve your mood and quality of life. Tonight we’re talking about 10 ways to
deal with social anxiety a lot of people have social anxiety and that’s basically
having unreasonable fears that you know are kind of excessive when it comes to
being in any kind of social situation some people have only social anxiety
when they’ve got to do things like perform or public speaking or something
like that other people have social anxiety when they have to go to work
when they have to be in crowds they don’t like going to the shopping center
or the mall where there are a lot of people around so depending on your level
of social anxiety, some of these things may be helpful to help you work through
and deal with your social anxiety the first is to minimize stimulants
stimulants Reb you up anxiety Rebs you up when you take stimulants if
you drink too much coffee you may feel anxious so if you’re drinking stimulants
before you go into an anxiety-provoking situation you may miss attributing your
anxiety about the social situation when in actuality it was the caffeine or the
nicotine the other thing that you want to do is pay attention when you’re at
some of these events that you’re minimizing your stimulants the other
thing and I’ll you know this is not stimulant alcohol is technically a
depressant but when alcohol starts to wear off about it 30 minutes after you
drink your drink it starts to wear off and there’s an anxiety rebound with
alcohol so if you have high anxiety if you have social anxiety drinking to
quell that anxiety is probably not your best
bet because in the end it’s gonna kind of backfire and bite you in the ass know
your temperament not everybody likes being around big groups of people
I draw energy from being around people so I love being around
groups but my daughter on the other hand is much more of an introvert and she
would prefer to be around you know two or three people at a time she gets
exhausted when she has to be in big groups of people it doesn’t mean
she’s got social anxiety so know what your preference is for being around
people so when you’re developing your self-confidence when you’re developing
your skills when you’re working through social anxiety you’re not putting
yourself in situations that would stress you out anyway so know your temperament
if you’re an introvert when you’re making your exposure hierarchy which
we’re going to talk about it in a minute you’re gonna start with something like
going out for coffee with a friend to Starbucks or maybe even having a friend
over for coffee in your house depending on how bad your social anxiety is and
then you’re gonna work up from there but if you are an introvert you’re never
gonna be relaxed in a group of a large group of people so I just
understanding the difference between being anxious and feeling like
you’re gonna crawl out of your skin and be uncomfortable or have it be very
draining to be in a large group of people who understand your temperament
that’s part of it so you can say you know this is normal I am not the type of
a person who likes to be in a large group of people so it’s going to take some
preparation and it’s going to take a lot of energy but I can do it knowing your
triggers different things trigger anxiety for different people some people
have anxiety when they feel like they’re going to be evaluated so if they’re
doing a presentation for their colleagues or their peers they’re more
likely to be more anxious than if they’re say hanging out with five other parents at a
kid’s play date or something some people have one of their triggers is
authority figures I know whenever I had to present in front of the CEO or in
front of my department chair or whoever gave me more anxiety than
presenting even in front of a class of a hundred and fifty students so it’s kind
of all about what your particular triggers are if the other trigger you
might want to consider the situation you know if you feel like you are on
stage if you feel like you are the center and everybody’s looking at you
that’s probably going to be a lot more anxiety-provoking than if you are mixing
and mingling with other people at a party so know what triggers your anxiety
so thinking about how your social anxiety impacts your life what kinds of
things can you not do or what kinds of things do you find are just terrifying
to keep a list of all of those things starting with the things that only make
you a little bit nervous about things that you would rather you know pull your
eyebrows out then do and start at the beginning start with the things that
only cause you a little bit of anxiety imagine them rehearsing and doing them
in your mind see yourself going through them successfully for example a job
interview or a first date imagine what it’s going to be like what the other
a person is going to say how you’re going to respond and how it’s all going to go
well just keep imagining that until you can imagine it or think about it and you
don’t feel stressed than when you go in to do it it’s going to be a lot easier
once you get past that first thing move on to the next thing that causes a
little bit more anxiety all right start at the beginning again imagine doing it
see yourself going all the way through maybe it’s doing a public speech see
yourself getting dressed for it getting ready for walking out on stage and
delivering the speech and seeing it go well you’re not going to see yourself
tripping and falling you’re not going to see yourself stuttering and stammering
or dropping all your note cards or anything those are the things the cat
strophic thoughts that you have that are likely not going to happen I want you to
imagine it going perfectly rehearse it in your mind until you can do it
literally with your eyes closed then when you go out to do it, it’s going to
be that much easier because you’ve already done it 20 times in your own
head and been successful at it so just do it like you practiced keep a rational
outlook a lot of times social anxiety is caused by catastrophic self-statements
things that you tell yourself people are judging me they’re laughing at me
people are gonna think I’m an idiot um whatever your thoughts are so keep a
list what those thoughts are and write counter thoughts to the people
are judging me well they may be but do you care so if people are judging me
that’s on them if people are laughing at me well at least they’re laughing but in
reality what other reasons could the people have had to be laughing what are
three other explanations for why they might be laughing besides laughing at
you so look at your catastrophic self
statements like I told you before imagining that you’re going to go
out on stage and you’re gonna walk out there you’re gonna trip over your own
two feet and you’re gonna wipe out on the way to do this presentation and
humiliate yourself well that’s pretty darn catastrophic so think about exactly
what is going to happen what are you going to do and how rational how
realistic how likely is it that all these things are gonna happen and you
know if that is one of your fears watch the movie Miss Congeniality because she
is going at as Miss America I think is who she’s trying to portray and she
falls flat on her face and she just picks herself right back up and walks on
and nobody thinks anything of it after that it’s not like a week later or 20
minutes later in the movie, people are still talking about her falling she
did she over it and you know move past it when
you make a big deal out of it when people start to think about it a little
bit more practice breathing when we get stressed we tend to breathe more
shallowly and more rapidly when you breathe slowly and deeply you’re
triggering the relaxation response in your body it doesn’t mean you have to
take those big giant deep breaths as you do at the doctor’s office or
anything that’s overly dramas is it but focus on your breathing if you start
feeling yourself getting an anxious breath in for a count of three hold for a count
of three and breathe out for a count of three and you know again it doesn’t have
to be noticeable that you’re doing it you can do it in a meeting and nobody
will even know but if you can slow your breathing you’ll slow your heart rate
and you’ll trigger the relaxation response to help you deal with your
anxiety sometimes we’ve just got to suck it up and go through things that create
a lot of anxiety for us I remember one place I worked once a month we would
have to get up in front of all of our colleagues and all of the executives and
give a report on how our department was doing I hated doing that I hated being
up there giving this report not because of the content of the report I just
hated being up there in front of everybody and it was no big deal
but it would cause me a little bit of anxiety if I had to do it
so distress tolerance techniques were always useful because it was an
eight-hour meeting so it might be four hours of me sitting there anticipating
going up and having to give my speech so what would I do during the four hours
while I was waiting I would do activities I would listen to what other
people were saying I would make notes I would sometimes go through clinical
charts and sign off on documentation and not pay attention but you know I digress
contributing so if you’re at a party you can’t do it in a meeting but if
you’re at a party for example and used feeling anxious get up maybe help the
hostess out or the host out in the kitchen go around pick up glasses pick
up trash throw things away do something to be helpful to contribute so you’re
not feeling like you’re having to sit there and be on the spot comparisons can
help too you can just kind of blend back into the wall a little bit and compare
how you’re doing to how other people are doing or how you’re doing to how you’ve
done in the past because you’re probably doing better now than you did then
trigger opposite emotions is another way of dealing with distress if you’re
feeling anxious you know bring out the opposite tell a joke find something
funny find a video or something that makes you laugh and share it with other
people because that’ll make you start laughing and feel more relaxed and
release endorphins you can also just push away some of those thoughts that
keep coming into your head I’m gonna make a mistake I’m gonna say something
stupid they’re judging me it’s gonna be awful just push those thoughts away and
Do you know what no I can do this and I’m going to push through the final
the thing you can do in this particular set of distress tolerance techniques is
sensations focus on sensations some people have a rubber band that they snap
on their wrists to kind of help them focus on something else
some people wring their hands I don’t recommend that because you know that
just kind of shows you’re anxious and keeps your anxiety going listening to
loud music you can go into the bathroom and splash cold water on your face
unless it’ll make your mascara run there are a variety of things you can do that you
can also find go and find some coffee because coffee is hot and that focus on
how the coffee feels in your hands when you’re holding the cup focus on the
taste of the coffee that hot sensation will kind of distract you from other
things that are going on so focus and we’re going to talk about one thing at a
time in a minute another set of distress tolerance techniques that can help our
imagery and we’ve talked about rehearsing it before you go to the party
imagine what you’re going to do before you go to the mixer or your in-laws
or wherever it is you’re going that’s potentially going to cause you anxiety
imagine going through it and doing it successfully to find meaning in what you’re
doing so sometimes you know maybe you’re going to your spouse’s holiday Christmas
party and it’s like the last thing you want to do because you don’t like big
crowds like that you don’t know anybody but find meaning in it why are you doing
this is because it’s helpful to your spouse you’re providing support and you know
maybe you can find somebody that has similar hobbies or something before you
go if you’re going to your spouse’s Christmas party for example try to find
out who might be at the party that shares similar hobbies and stuff I know
my husband works with people who do organic gardening and who are kind of
health-conscious I won’t say fanatical but health-conscious like I am and we
like to use a lot of lentils and beans and cook in health healthy ways so
identifying those people I can’t talk about what they do at work because
that’s just way out of my wheelhouse and over my head but I can talk with them
about these other things so I’m not just standing there looking around and feeling
like I’m out of place so find meaning in what you’re doing and try to find
connections and commonalities with other people before you go and then you know I
can have I would have my spouse introduce me to one of the people that
does organic gardening for example and then we could start talking once you get
more comfortable then you’re going to feel more at ease walking up to people
and going hey you know and striking up a conversation and finding out
commonalities if you’ve got children a lot of other people have children so
you can talk about your kids or if you’ve got pets you can talk about your
pets your dog’s people love their dog’s prayer can help sometimes you
just got to take a breath and say a prayer before you walk into that
situation to kind of get you through and get you going
practice relaxation if you’re feeling stressed just again don’t
have to get out of your chair you don’t have to go anywhere but practice tensing
and releasing your muscles clenching your fists and releasing your hands and feel
the difference between tense and released and then tense kind of your
whole upper body and you don’t have to do it like this because that’s obvious
but you can kind of tense up a little bit and relax and feel the difference
between stressed and relaxed and then when you do it one more time you tense
and when you relaxed you feel all the stress just draining out of your body
out of your fingertips so that’s a kind of guided relaxation to help you when
you’re kind of on the spot one thing at a time when you’re in a
the social situation there is a lot of input there is a lot of stimulus going around
a lot of people focus on one thing at a time if you start getting overwhelmed if
you’re at a party maybe you can go over and get something to eat and focus on
talking to one person at a time or focusing on what you’re eating or you know find
something that you can focus on so you’re not trying to keep up with
everything that’s going on takes a mental vacation or a physical vacation
sometimes you just got to excuse yourself and go to the bathroom and hide
out for five minutes and that’s okay you know sometimes you need to go somewhere
where you know nobody’s watching and you can take those good deep breaths and go
you know I got this it’s gonna be okay I’m doing fine give yourself a pep talk
look realistically over how the night’s gone and the majority of it has gone
okay yeah they’re probably going to be some hiccups and Pho paws here and there
and if there are that’s okay it happens to everybody nobody is perfect at their
social interactions all the time and that’s okay
but look over it realistically to realize that tonight is going
okay it may not be going the way you had hoped it would but it’s going okay
there’s nothing catastrophic ly wrong and remember that we are a lot more
important in our minds than we are in anybody else’s mind so when we make a
the mistake we will remember it for six months but other people probably forget
it’s about sixty minutes later it’s just you know even if it’s something like you
walked out of the bathroom and you had your dress tucked in the back your
panties did that before trusting me not something I want to repeat
but I would bet if I asked any of my staff now yes I did it at work about
that incident they’d look at me and go no I don’t remember that I remember it
because it was mortifying but nobody else cared they were passed it by
the next day nobody thought anything about it so remember that a lot
of stuff that seems huge and glaring to you is only because it happened to you
and other people are so involved in their own life they probably didn’t
notice or won’t remember that fear is an acronym standing for false
evidence appearing real so always examine the evidence if
something happens and you think it is the absolute worst thing in the world
and you’re just gonna die how likely is it that that’s true is it the worst
the thing in the world is people judging you so look at the evidence how do you
know this is going on for certain and what are other explanations for what
might be going on mentally rehearsing those stressful social situations get
ready for it the job interview the first date and for some people even going to
the doctor can be a stressful social situation because they get kind of a
white coat syndrome where they don’t they’re afraid to speak up to their
doctor, I found that if there is a certain set of things that you need to
say like if you’re going in to talk to your boss or you’re going in to talk to
your doctor sometimes it’s helpful to write down a list of the points that you
want to cover with them or the symptoms that you’re having
so you can go over it and make sure you get everything said and you don’t end up
kind of getting shut down when I used to go have supervision with my boss you
know I only got supervision for one hour once a week and that was if I was lucky
so I would go in with a whole laundry list of things and it could be the stuff
that I was upset about or having difficulty with and I could have a
laundry list and just go through it and mark it off so I would make sure that I
got everything said and I covered and we were on the same page by the end of the
the meeting finally practice mindfulness and focus on your surroundings to know how you
feel if you start feeling anxious a step back and ask yourself why am I anxious
what do I need right now to feel calmer try to do this periodically
so you don’t wait until your anxiety is off-the-charts focus on your
surroundings look around to find places and little niches that you might feel
comfortable maybe there’s somebody else sitting over in the corner and you can
go sit down with them and chat maybe there’s an empty seat somewhere that you
can just go sit down and take a breath or go out on if it’s a patio or a party
maybe you can go out on the patio for a few minutes oftentimes there’s somebody
sitting out on the patio trying to get a little peace so you
can find a situation that’s less anxiety-provoking two little bonus things I’m
going to tell you with social anxiety a lot of times people are afraid that
they’re going to offend someone and these days it is so easy to offend
people so what I tell my clients and my kids and what I try to remember myself
is before I speak or when I’m talking to people if what I’m saying is true
helpful important necessary and kind then you know
there’s probably a good chance I won’t offend them look on your social media
look at the comments people leave on other people’s posts and stuff and see
if they meet these criteria true helpful important necessary and kind 90% of the
time the answer is no well I won’t say that much about 50% of the time the
the answer is no there are a lot of times people will just say nasty stuff that
didn’t need to be said and that can be offensive but if you practice and
focus on making sure what you say is true helpful important necessary and
kind and if you’re following me that spells out think then the chances that you’re going to
offend somebody are greatly reduced if the person still gets offended it’s
probably more about them because you aren’t trying to offend them you weren’t
trying to be hurtful you are trying to be helpful and kind therefore it may be
more about their stuff whether they have an issue with you or they have an issue
with something else that’s going on and you just happen to be kind of in the way
it’s more about them you can’t control how they react to things it’s their
responsibility if you’re being nice and they take it the wrong way and they get
offended that’s their perception and they need to work on that the other
bonus that I’ll tell you to take away is something I got from dr.
Seuss and I
love something he says about the judgment of those whose minds don’t matter and those
who matter don’t mind so the people who matter in your life they’re going to be
people judge you all the time that’s just the way humans are but those who
mind what you do those who get offended those who judge you all the time they
don’t matter the people who matter to you don’t mind if you make a mistake
don’t mind if you’re not perfect they probably embrace all of your
imperfections so before you approach a social situation remember not
everybody’s gonna like you that’s just it’s not possible to have everybody like
you so remember the wise words of dr. Seuss those whose minds don’t matter and
those who matter don’t mind if you like this podcast subscribe to your favorite
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