Understanding Anxiety – A Psychiatrist Explains Symptoms, Medication Options and Therapy

Fear is something that everybody experiences. We all have fear, and fear is a normal response to a threat. The difference with anxiety is that anxiety is more diffuse. It’s not specific to a threat. It’s more global and it’s more vague and general. A fear of elevators could be rational if you know that the elevator reached the maximum capacity or you know for sure that it’s been failing or is shaking strangely, that’s rational, and avoiding that is normal. But anxiety would be for someone to be afraid of elevators, even though it’s a perfectly functioning elevator you know has been recently installed and checked and technically is flawless, and you still have anxiety about that.Anxiety disorders are a large family with several individual disorders, but it’s important to know that sometimes they happen together or you may have one and a little bit of another one. But the most common are panic disorder, social anxiety disorder, we have also generalized anxiety disorder, separation anxiety disorder, and the last one is selective mutism. It’s a rare disorder that is mostly seen in children. In psychiatry, probably the most successful group of illnesses or disorders that we can treat successfully are anxiety disorders. The treatment of choice is therapy. Multiple therapies are validated by research that can be effective. In addition to that, we can use medications that are just as needed, for example, panic attacks.Many people use a type of medication called benzodiazepine. There’s a family of anti-anxiety medications. They can work for someone who has only sporadic attacks, but not for someone who has chronic, what is called generalized anxiety disorder, because it’s easy to become dependent on those medications. The other mainstay type of treatment in terms of medications is antidepressants, specifically the so-called serotonergic antidepressants. Some of them, for example, are sertraline or paroxetine and these medications increase the transmission of serotonin in the brain and can alleviate some of the symptoms of anxiety. When we are thinking of treatment for anxiety disorders without medication, we have therapy, but also we have self-help. So we can do a lot with self-help. Probably the most effective are all kinds of activities that tend to reduce the activation of the stress response system in the body. So the stress response system releases several chemicals, like cortisol and adrenaline, but also changes the heart rate, breathing, and so forth. And so there are many activities, including meditation, yoga, tai chi, and sports in general, aerobic exercise, that can down-regulate the activation of the stress response system.In addition to self-help, another type of non-medication, non-pharmacological treatment for anxiety disorders is therapy. Counseling. And several types are specific for anxiety and they’re being developed through research and they are highly effective. One of the most common and most well-known is cognitive behavioral therapy, which is a systematic training of the patient to identify certain thoughts and beliefs that can be challenged, and the challenging of switching reframing, and changing those thoughts can alleviate anxiety. The main coping skill for anxiety is avoidance. Unfortunately, avoidance is the worst thing that we can do because it will perpetrate and make it chronic.The more we avoid something, the more powerful that fear becomes, or that anxiety. Therefore, one of the treatments for anxiety is to try not to avoid the triggers, is to expose ourselves as much as we can tolerate that. For example, if public speaking is a source of anxiety, some of us can get trained and go to Toastmasters, and go to a setting where we feel safer and slowly and progressively expose ourselves. Because the brain learns not to react. With more practice, we lose that fear. If you believe that you have an anxiety disorder, I would say the first thing to do could be a screening for that. That could be done by your primary care physician or yourself. One of the most common tools to screen for anxiety disorder is called General Anxiety Disorder-7.GAD-7. And that’s widely available in the public domain on the Internet. And if you have a suspicion of an anxiety disorder, I would go to your primary care doctor. Alternatively, you can go to a therapist because this, can be very effective and the therapist would be prepared to tell you, “I think you need medication in addition to therapy.”.

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Understanding Anxiety – A Psychiatrist Explains Symptoms, Medication Options and Therapy

Fear is something that everybody experiences. We all have fear, and fear is a normal response to a threat. The difference with anxiety is that anxiety is more diffuse. It’s not specific to a threat. It’s more global and it’s more vague and general. A fear of elevators could be rational if you know that the elevator reached the maximum capacity or you know for sure that it’s been failing or is shaking strangely, that’s rational, and avoiding that is normal. But anxiety would be for someone to be afraid of elevators, even though it’s a perfectly functioning elevator you know has been recently installed and checked and technically is flawless, and you still have anxiety about that. Anxiety disorders are a large family with several individual disorders, but it’s important to know that sometimes they happen together or you may have one and a little bit of another one.But the most common are panic disorder, social anxiety disorder, we have also generalized anxiety disorder, separation anxiety disorder, and the last one is selective mutism. It’s a rare disorder that is mostly seen in children. In psychiatry, probably the most successful group of illnesses or disorders that we can treat successfully are anxiety disorders. The treatment of choice is therapy. Multiple therapies are validated by research that can be effective. In addition to that, we can use medications that are just as needed, for example, panic attacks. Many people use a type of medication called benzodiazepine. There’s a family of anti-anxiety medications. They can work for someone who has only sporadic attacks, but not for someone who has chronic, what is called generalized anxiety disorder, because it’s easy to become dependent on those medications. The other mainstay type of treatment in terms of medications is antidepressants, specifically the so-called serotonergic antidepressants.Some of them, for example, are sertraline or paroxetine and these medications increase the transmission of serotonin in the brain and can alleviate some of the symptoms of anxiety. When we are thinking of treatment for anxiety disorders without medication, we have therapy, but also we have self-help. So we can do a lot with self-help. Probably the most effective are all kinds of activities that tend to reduce the activation of the stress response system in the body. So the stress response system releases several chemicals, like cortisol and adrenaline, but also changes the heart rate, breathing, and so forth. And so there are many activities, including meditation, yoga, tai chi, and sports in general, aerobic exercise, that can down-regulate the activation of the stress response system. In addition to self-help, another type of non-medication, non-pharmacological treatment for anxiety disorders is therapy. Counseling. And several types are specific for anxiety and they’re being developed through research and they are highly effective.One of the most common and most well-known is cognitive behavioral therapy, which is a systematic training of the patient to identify certain thoughts and beliefs that can be challenged, and the challenge of switching reframing, and changing those thoughts can alleviate anxiety. The main coping skill for anxiety is avoidance. Unfortunately, avoidance is the worst thing that we can do because it will perpetrate and make it chronic. The more we avoid something, the more powerful that fear becomes, or that anxiety. Therefore, one of the treatments for anxiety is to try not to avoid the triggers, is to expose ourselves as much as we can tolerate that. For example, if public speaking is a source of anxiety, some of us can get trained and go to Toastmasters, and go to a setting where we feel safer and slowly and progressively expose ourselves.Because the brain learns not to react. With more practice, we lose that fear. If you believe that you have an anxiety disorder, I would say the first thing to do could be a screening for that. That could be done by your primary care physician or yourself. One of the most common tools to screen for anxiety disorder is called General Anxiety Disorder-7. GAD-7. And that’s widely available in the public domain on the Internet.And if you have a suspicion of an anxiety disorder, I would go to your primary care doctor. Alternatively, you can go to a therapist because this, can be very effective and the therapist would be prepared to tell you, “I think you need medication in addition to therapy.”.
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Cognitive Behavioral Therapy (CBT) Skills and Counseling Techniques with Dr. Dawn-Elise “Doc” Snipes

 CEUs are available for this presentation at AllCEUs.com/CBT-CEU Hi everybody and welcome to today’s presentation on cognitive behavioral therapy skills. Like the other The presentation we did on assert not assertive community treatment acceptance and commitment therapy, which is also based on providing information about skills that can be used not providing an evidence-based practice We couldn’t cover that in a full hour or just an hour so over the next hour we’re going to define cognitive behavioral therapy and its basic principles a lot of us are familiar with this but it’s going to be a good review and it also may highlight some nuances that you didn’t know about will identify factors impacting people’s choice of behaviors explore causes and impact of thinking errors and identify common thinking errors and their relationships to cognitive distortions so why do we care well as therapists we want to help people figure out the best way to live a happy healthy meaningful goals-driven life for some people that’s going to mean using some cognitive behavioral interventions that can be in addition to mindfulness that can be in addition to a lot of other things but it’s important to help people understand that the way we believe things to be the way we interpret things is going to affect our reactions so for example think about a situation you know you’ve walked into and maybe you walked into it with a small child and it was a different situation it was a new situation but you know it was no big deal you walked in it was not a threatening situation to you because you were like hey I got this the little kid walks in and goes oh wow there are a lot of people walking around here, this is really scary same situation as two different perceptions you probably didn’t have much of a stress reaction going on whereas the little child probably had this fight-or-flight thing going on grabbing onto your hand like please don’t let go Atlanta Airport is a perfect example if you’ve ever taken a little kid through Atlanta Airport it gives you an idea about how People can perceive things differently and when you enact that fight-or-flight reaction you’re going to have all those stress hormones you’re going to have all either anxiety or anger or whatever that goes with it it may serve to exhaust the person and leave them feeling hopeless and helpless so what we want to do is help people see that but we also want to help them see that when They’re depressed when they’re tired when they’re sick things are going to seem a lot worse a lot of times because they don’t have the energy to perceive it differently I mean when you’re sick it’s overwhelming to think of going through Atlanta Airport so this is what we want to help people start understanding is it’s two sides of the same coin they interact if one is you know kind of going wonky is going to affect the other one the good thing is If one’s going really well the other one’s going to go well if you’re Having positive thoughts you’re probably going to feel pretty good there’s an activity and I think we’re going to talk about it later it’s called the coin flip activity and I asked client clients to flip a coin in the morning and in the morning if it turns heads then they have to be the most positive Pollyanna all day long look for the silver lining and everything smile walk with their head up hold those nonverbals up and see how they feel at the end of the day besides a little sore because there are muscles they’re using they haven’t been used in a while if it lands on tails they can just be their normal selves which generally if they’re seeing me means that they are depressed anxious stressed out angry about something in the negative realm then we Talk about how things seemed different on the days when you were feeling better when you were walking taller when you were smiling even our nonverbals it doesn’t even have to be sickness it can be our nonverbals that can make us feel or make our body feel heavy and tired and make it seem like it’s a whole lot harder to deal with life as a person who perceives the world generally good and believe they can deal with challenges as they arise that good old self-efficacy will be able to allow their stress response system to function normally so if they’re like you know what I can deal with whatever life throws at me I’ve got it and maybe I need help with it maybe I’ll need to ask for support but I’ve got it it’s not going to completely overwhelm me with people who see the world as hostile unsafe and unpredictable You know for a variety of reasons whatever happened to make their scheme as such that they don’t believe that people or the world is trustworthy are predictable They are always on guard they’re always kind of like a hamster in a cage that has Have you ever had a hamster hamsters doesn’t recognize you and goes Hey that’s my own Or human contact score hamsters go run under their little house And you just kind of open the cage and stick your hand in there and flip over their house and you’re like come here and give me cuddles and you’re like you know 200 times bigger than they are so the little hamster is like freaking out this is what it’s like for people and obviously, I’m exaggerating but this is what it’s like for people who have a negative perspective a negative view or a hostile view of the world so kind of keep that little hamster in your mind cognitive behavioral therapy we have core beliefs those things that are in our hearts when I talk with my clients about honesty step one and that’s what they’ve got to do to start recovery is get honest with themselves first and then other people we talk about head heart and gut honesty do you think it’s right does it seem like the right thing to do does it feel right in your heart you know does it make you happy it doesn’t make you feel good and then the Spidey senses is your gut saying and or Is your gut fine if one of those is saying this might not be the right choice and we need to think about what’s going on so we have those core beliefs and I put them in the heart just because that’s the middle of the head heart and gut but you have core beliefs about yourself whether you’re good with You’re bad whether you’re effective at certain things yadda You have core beliefs about other people same thing good bad effective predictable and you have core beliefs about the future and a lot of that goes with locus of control but also your past experiences if the world in the past is seemed unfriendly and uncontrollable and you’ve perceived it that way then you’re going to expect the future to be uncontrollable so what we want to do is help people look at their schemas and their core beliefs about themselves others in the future and figure out kind of what they want it to look like these schemas are going to affect your behavior your thoughts and your feelings and you know you can pick wherever you want to start it doesn’t matter because all three interfaces with one another so if you haven’t let’s Start with negative thoughts If you have negative thoughts then you might feel anxious angry stressed dysphoric which will affect the behavior you’re going to do different things than if you have positive thoughts about something you feel excited and energized you’re going to have different behavior the best thing example I can give you is if you’ve ever done public speaking or had to present something Some people detest public speaking it’s just terrifying for them to get up in front of a group of people so their thoughts are I’m going to trip up I’m going to forget what I’m going to say I’m going to make a fool of myself I’m going to you know it can go on forever that when you get on a roll you can get on a negative roll and go on forever or positive hopefully get on that roll with those thoughts you start holding onto Those thoughts remember as we talked about in a CT the other day when you hold those thoughts and you kind of mush them around in your mind and you come to believe them that you’re going to make a fool of yourself and it’s going to be awful you’re going to start feeling terrified which is going to likely affect your behavior if you go out on the stage and you’re terrified You’re going to probably stutter you’re probably going to get foggy-headed You’re going to have that fight-or-flight reaction so there’s an adrenaline rush and you start sweating and you can’t focus and you can’t concentrate you want to away as opposed to somebody like me who loves public speaking and I’m just like cool I get to go out there and try to engage however many people are in the audience it’s a game for me because when I can see your faces I enjoy trying to figure out and make eye contact with people and figure out what it is that they’re there for what is it that’s going to make them tick what resonates with them so my behavior as You can kind of see right now when I go out there I’m excited and I want to engage people and it’s a fun experience for me again just like the airport the same experience for two different people and two very different interpretations and reactions to it so what effects I don’t like the term rational but when We’re talking about CBT irrationally comes up a lot I like to replace it with helpful because every behavior in its weird sort of way is or probably was rational at one time that being said we’re going to get back to that stress affects our behavioral choices if we’re under stress we can have negative emotions negative emotions will affect our thoughts if we’re feeling sad we’re probably going to look at the dark side if we feel sad we’re going to look at the bottom falling out if we’re happy we’re probably going to look for that silver lining physical factors if you’re in pain sick sleep-deprived poorly nourished so your body can’t produce the neurotransmitters it needs to or heaven forbid intoxicated you’re probably not going to make the same decisions as you would if you were comfortable healthy well-rested nourished and not Intoxicated any of those things can impact how you perceive a situation or how you react in a situation, especially the intoxication whereas in your intoxicated State in your sober state, you may think that you want to do something but then you’ve got that filter that does not not a good idea in an intoxicated State or even in a manic state if you’re you know if you have somebody with bipolar that filter kind of goes away so the behaviors that someone may normally not do because they have a rational filter That goes you know punching this guy out is probably not the best idea right Now the filter goes away when you’re sleep-deprived you’re less generally People are less patient generally people don’t have as much of a filter thing about watching your children if you have children or your grandchildren or even yourself I know myself when I’m sleepy I am giddy as all get-out and things I wouldn’t normally say because they’re you know stupid I’ll just come out and say anyway and my kids just roll their eyes or the mom you’re overtired could go to bed, uh but that’s okay You know I’m okay with that In that situation now if I acted that way at work it would be a worse thing environmentally if you’re introduced to a new or unique situation and you perceive it as stressful because the unknown we know can be stressful then you may not make as rational of a choice or as helpful of a choice because you Maybe trying to escape the same thing as exposure to UNPROFOR bellowing for a word here but UNPROFOR ball is the best I could come up with we all prefer certain situations some people like I said would rather do just about anything then get up in front of a lecture hall of a hundred and fifty people and talk but if they have to do it then they’re going to be under stress which may affect how they do things so we want people to understand that their perception and their feelings are affected by a lot of other things not Just you know an emotion here or a particular memory there’s a lot that goes into it and social if peers your family convey irrational thoughts as necessary very standards for social acceptance people may tend to cling more to it to those unhelpful thoughts and unhelpful behaviors you know in CBT they say irrational because quote nobody wants to associate with those people you know who are those people and why can’t we associate with them there are a lot of things if you think back think high School you know high school is pretty rough if we’re going to talk about having irrational thoughts and cognitions if you have to be part of this particular group to be accepted you have to do this you have to do that but do you do you do those kinds of all-or-nothing statements are cognitive distortions and while they may have served a purpose in some way shape or form in the past we need to encourage our clients to take a look at them now and go are they still helpful ways of thinking is it still helpful for me to think that I am only successful if I live in a million-dollar house in a gated community and do this that and the other or can I be can I define success as a different way or do I define success differently and lack supportive peers to buffer stress so we had those peers who caused stress by talking about the half dues and categorizing and lots of attributions but then there’s Also not having somebody to go you know does this make any sense because sometimes we are our own worst enemies and if we go to a friend and we go you know this is what I’m thinking and I think I have to do this in order to be acceptable to be loved or you know whatever the case may be Most people are not going to use those exact phrases A good friend is probably going to listen and go yeah you’re right or no that’s way off so supportive peers are essential to reminding us to consciously regularly check in with our cognitions to make sure that they are hopeful and rational so a note about irrationality and this is mine this is not from CBT the origins of most beliefs for rational and helpful given the information the person had at the time and their cognitive development their ability to process that information so concepts schemas and core beliefs that people formed when they were five are probably going to be very egocentric you know the person is going to feel like everybody sees it my way because this is how I see it you know just like A five-year-old does A five-year-old doesn’t think Well you know let me take Johnny’s perspective is no he assumes that Johnny sees it the same way so it’s going to be egocentric It’s probably going to be focused on only one aspect of the situation because small children can’t focus on multiple aspects and it’s probably going to be dichotomous it’s all-or-nothing Mommy loves me mommy hates me and it could be personalized you know Everything a lot of kids think that everything has to do with them so if something happens something bad happens many times Children will take it personally or be afraid it’s going to happen to them Again you know if Hurricane Katrina hurricane Andrew those sorts of things you know we saw a lot of trauma in children and they developed very real fears about thunderstorms and hurricane season And if you’ve watched Florida hasn’t had a notable hurricane in years now but There’s a lot of stuff that goes into that but young people During some of those really bad hurricane seasons perceive those situations differently okay so we need to help people understand that if we especially if we use the term irrational those thoughts you form when you are knee-high to a grasshopper and they made perfect sense to you back then but now that you’re an adult you’ve got more experience and you’re able to take different perspectives your brain is more developed Let’s take a look at it and see if you can look at different perspectives and Come up with something a little more helpful maybe a different way of perceiving this situation the irrational irrationality or unhelpful Nosov Fox comes when those beliefs are perpetuated without examination so something a the belief that you formed when you’re five you’re still holding when you’re 35 and you’ve never questioned it you’ve never gone you know does this make sense is This is helpful to getting me toward where I want to be Most of us don’t know We form these attitudes and beliefs when we’re you know growing up when we’re in elementary school middle school high school from watching TV to being around our peers from being around our family in our community and we get all This input of the way things should be and a lot of times people don’t stop to question and go and go Well does this make me happy Is this really what I want and they can be irrational if they continue to be held despite causing harm to the person so the person continues to hold this belief even though it is causing them general emotional cognitive harm is making them miserable we need to look at what’s motivating them to hold on to that belief why is that belief so important and how can we make it so they can live a happy values-driven life with an emphasis on the harness and how can we make it less harmful sometimes it’s more productive for clients to think of these thoughts as unhelpful or helpful instead of irrational sometimes when I say irrational to clients and you know I’m the same way if somebody says you’re being irrational I’m like oh I’m not it elicits this instantaneous defensive reaction it’s like when you tell them they’re being resistant they’re like I am NOT resistant so helpful or unhelpful and then we talk about why it is unhelpful in getting them toward their goals basic principles of cognitive behavioral therapy we teach or help clients learn to distinguish between thoughts and feelings I can think something is scary I’ll probably feel it but if I have an automatic you know feeling I walk into Atlanta Airport and I see yeah I went to an airport in New York I can’t even remember which one it was because my plane was diverted and I got off and I walked out there and I have never seen so many people packed in his place like sardines before in my life I was just completely overwhelmed that was kind of an automatic feeling now that was a feeling based on you know who knows it was overwhelming to be surrounded by that many people so then I had to separate the thoughts and go Okay what am I thinking that’s making me feel so overwhelmed and at that point you know I didn’t know how to get to my gate and all that other sort of stuff with traveling I don’t travel well but encouraging clients to stop and go okay why am I feeling this way what are my What thoughts am I having that are contributing to these dysphoric feelings CBT helps people become aware of how thoughts can influence feelings in ways that are sometimes not helpful We have hecklers in our gallery the automatic tapes that we plaything memories that we have whatever you want to call them when you try something When you are just going through daily life you hear these voices in the back of your head and not real voices but that is saying you’re never going to make this or if you would have just blah blah blah then you’d be a better person helping clients become aware of those thoughts and how they’re Negatively influencing their feelings and keeping them kind of stuck is a huge part of CBT we help them learn about thoughts that seem to occur automatically without even realizing how they may affect emotions again those thoughts from the they’re saying you’re not good enough You’re not smart enough and nobody’s going to like you Where did that come from and do you believe it you know maybe it came from somebody When you were in high school so was that a valid was that a valid source Maybe it came from somebody yesterday on Facebook was that a valid source taking in those thoughts and then figuring out is something I’m going to hold because it makes me happy or is this something that I’ve got to deal with because I’m having a negative reaction constructively evaluate whether these automatic thoughts and assumptions are accurate or perhaps biased the other thing to remember is a lot of our clients not all of them but a lot of them hold themselves to a standard there’s like up here and they hold everybody else to a standard that’s down here so they are a failure if they don’t achieve this but Everybody else is successful as long as they achieve this so encouraging them to take a look at how accurate and biased or unbiased are the thoughts and like I said they may be their thoughts they may be telling themselves these things evaluate whether the current reactions are helpful and a good use of energy or unhelpful and a waste of energy that could be used to move toward those people and things important not impotent important to the person road-rage you’re In the car you’re driving somebody cuts you off Okay natural reaction fight or flight reaction you’re just like slam on the brakes and do whatever you got to do aversive maneuvers you’re good so you could let it go at that point ago got Lucky on that one and keep driving most people not all but most found that 80% of drivers have reported incidences of road rage which is a high number but most people will start getting all fired up and irritated and grumpy and we and just rageful and so my question would be I hear that and I hear that it made you angry In retrospect did screaming at the person as you pass them at sixty miles An hour in your car with the windows rolled up does any good Did it Did any good at all what else could you have done with that energy if you wouldn’t have expended it all yesterday we had to wait for the vet to come by and my daughter just completely wore herself out worrying about when the vet was going to get there what he was going to say about her donkeys and was beside herself so by the time it got to evening and it was time for her to go to her martial arts class she didn’t have the energy to go she’s like um wiped out I just want to go to bed in retrospect we’re looking back and saying okay now Tell me what it was that you were so stressed out about and let’s talk about whether that was a realistic and helpful line of thought to perseverate on all day long and what could you have done differently because she didn’t bother to mention any of that to me yesterday and then developed the skills to notice interrupt and correct these biased thoughts independently causes of these thinking errors information processing shortcuts when we form schemas and we encounter a situation that reminds us of something in the past like when I go to my grandmother’s house I have a schema I have a belief system I have you know stuff that I know about my grandmother’s house so when I go to my grandmother’s house it’s kind of a shortcut to knowing what to expect when I walk in and how to behave how to do different things and it helps me plan and predict if you’re Using outdated or dichotomous all-or-nothing schemas may cause thinking errors because you may be now incorrectly processing current events mental noise some of us have it a lot of us have it Not everybody thinks about trying to focus and study for a final exam in the middle of a really busy sports bar okay this is a cause of thinking or you’re going to miss important things you’re not going to be able to focus you’re not going to necessarily attend to the correct things because there’s just so much else going on your attention is drawn in 17 different directions and or the brain’s limited information processing capacity due to age we talked about that before young kids think all or nothing they think dichotomously egocentric ly middle school-aged kids and older start developing the ability for abstract thinking, by the time we get older, you know as adults theoretically We’re able to you know think pretty well and think pretty clinically about different events but if we’re in crisis when someone is in crisis it could be like what we think of clinically as a crisis or it could be they’re just completely overwhelmed and burned out and have been burning the candle at both ends for three months they’re not going to process information quite as well They’re not going to take in all this stuff because they’re just like shell-shocked have you ever seen teachers in the hallway of like an elementary school Oh at the end of the second nine weeks they just kind of stand there with this blank look on their face they’re not processing as much as they were the first day of school and you know God loved them they have a lot to deal with but we need to help our clients understand that there are some times that they are going to have to really stop and focus write things down so they can remember or they can make decisions A little more my guess is most of us have times in our lives when we’ve been able to think through complex problems but then there are other times where you just can’t keep it all in your head and you’ve got to put it on a Whiteboard maybe that’s just me but we want clients to understand that they are not broken they’re not faulty they’re doing the best they can with the tools they have and the knowledge they have and our job is to help them see where some of this might have gone a little awry other causes of thinking errors and emotional motivations I feel bad therefore whatever I’m thinking must be bad if I’m scared that means whatever it’s coming on the other end of the phone is bad news moral motivations I did it because it was the right thing to do and that can be an excuse for doing wrong behaviors as well it can also be you know you can argue on The moral one social influence well everyone else is doing it so it must not be bad set that again a lot of times and this is where the frames approaching the Motivational interviewing is helpful It stands for feedback about the reality of what’s going on is everybody doing it let’s look at statistics you know not subjective information let’s look at objective information so the impact of these thinking errors makes people want to fight or flee when they get upset and we use upset as a kind of this all-encompassing garbage term emotionally they get depressed or anxious we don’t want to feel that way Anxiety and anger are flee or fight fight or flee it’s our body saying there’s a threat you got to do something depression is your body going I give up I just don’t I don’t even have the energy to do it anymore behaviorally some people withdraw because they Shut down We all know people get frustrated when they get overwhelmed When they start feeling hopeless or helpless they just kind of withdraw from Everything and everyone’s addictions numb that out so they don’t have to feel the dysphoria sleeping problem and changes when we start being on that constant fight-or-flight hyper-vigilant sort of thing going on in the body is always sort of turned on which means you’re not going to sleep as well then The circadian rhythms get messed up which starts causing exhaustion and lethargy and then everything seems harder because you’re sleep-deprived and then you start thinking more negatively and more hopelessly you see where this is going it’s a downward spiral and eating changes some people eat a lot more because they’re eating comfort foods some people eat a lot less because Their stomach is so torn up from the stress they can’t even think about holding anything down physical stress-related illnesses fibromyalgia gastrointestinal problems headaches neck aches backaches you know the whole the gamut of it when you start feeling bad when you start hurting generally it gets frustrating after a while and that frustration makes it kind of raises the bar brings you up a little bit so you’re That thatch closer to kind of just kind of being overwhelmed as you do You have as much of a cushion as you would if you were happy healthy well nourished not in pain and socially a lot of times we will get irritable or impatient with other people or withdrawal when we’re having these negative cognitions these thinking errors that are keeping us in a dysphoric state these effects of thinking errors contribute to fatigue a sense of hopelessness and helplessness which intensifies thinking errors This is an important concept that I want my clients to understand and I want to drive home in this presentation so thinking errors what are they emotional reasoning feelings are not facts and we want to help people learn to identify feelings and separate them from facts so if somebody says I’m terrified okay that is a feeling what are the facts supporting that feeling why are you are terrified what is the evidence that you are in some sort of danger Right now you know that danger may not be the right word for your client at that a particular point in time but what’s the evidence that there’s a threat in what ways is this similar to other situations maybe it’s triggering something from the past that was scary or you know you were too little to be able to handle it but you can handle it now and how if you dealt with similar situations Like in the past, we wanted people to just step back and get some distance between their feelings and their thoughts and try to figure out you know which thoughts are helpful and productive and even if a sought makes people anxious or angry it can be helpful it may be telling them hey dude you need to get your butt up and get out of there if it’s helpful it means it’s moving them toward where they want to be happy healthy safe and values-driven life so happy and helpful developed a stress tolerance skills when people use emotional reasoning they feel emotions which then they start attributing finding the facts to support those emotions instead of looking at all the facts we want to help them learn to tolerate their distress so they can kind of let that subside for a second they can accept their feeling they can name them They say I’m scared I’m stressed I’m angry and whatever but they don’t have to act on it right then they can tolerate the distress for a minute without having to try to make it go away and emotional regulation skills they can feel a feeling without having to make it go from zero to 120 You know if they feel sad they go I feel kind of sad instead of grabbing onto it and going I wonder what I feel sad about I must feel sad about all these sad things now I’m going to be sad and devastated so we want to help people learn how to regulate their emotions identify them accept them Whatever word you want to use tolerate them because feelings are there for a reason they’re there to tell you your brain thinks something’s going now thankfully we have that higher-order cognition stuff going on so We can contradict our brain and we can go you know maybe that’s not true in this situation cognitive bias negativity mental filter whatever you want to call it people who focus on the negative they walk in they get up in the morning and They look outside and it’s partly cloudy They get to work and they say instead of saying there was it was very light traffic they said there was a fair amount of traffic everything is always the flip side of what somebody who’s optimistic would say so asking them what’s the benefit to focusing on the negative in what ways is this helpful to you know some people say Well it keeps me from getting disappointed because I know It’s going to end up negative anyway so we can trap challenges that know that whatever it is they think they know and see if there have been exceptions when It hasn’t turned out that way What are the positives to this situation I give the example a lot of you know I wash my car or it rains and maybe I wanted to go out on a run that day but I can perceive it I can look at the positives you know the rain washed my car for me so I don’t have to do it now score it watered my garden all the better it knocked down some of the pollen out of there even better I can find and I can encourage people to find positives in a situation yes there are negatives there are negatives to every situation if you want to find them you’re going to find them but if you want to find the positives you can too which takes us down to what are all the facts there’s the positive and the negative and the neutral I told you Earlier about the coin toss activity having people toss a coin on the heads days they act like it is just the greatest day to be alive and see how Things are different when they do their journal because you know I have my clients do I’m sort of a mindfulness check-in in the morning and in the evening and preferably at lunchtime how are they feeling what’s their emotional state what’s their energy level on the happy days a lot of times it can be less and sometimes they need a little coaching throughout because some of those old patterns kick in but I want them to start challenging some of their automatic thoughts that we’re going to talk about in a minute disqualifying or minimizing the positive most of us can probably say we’ve had a bunch of clients that do this they are more than happy to tell you about all the things that they mess up but then when they do something right they minimize it encouraging people to hold themselves to the same standard they would hold everyone else to and I know I talked about that earlier ask them things like would it minimum would you minimize this.If it was your best friend’s experience your best friend came to you and said I just got into such-and-such college would you say awesome or would you say anybody can get in there how would that go ask them what is scary about accepting these positive things that you might have had an accomplishment for some people it means that it might mean other people expect more of them for other people they just don’t know how to accept the positive They don’t know how to accept compliments they don’t know how to be the center of attention and they don’t like it and then we want to look at why that is sometimes we disqualify the positive because it fails to meet someone else’s standards so as people might that be true here you know I know When I was growing up and going through college and going through school and everything got my doctorate but I will always not being not a real doctor because a Ph.D. is not an MD and I’m like really So is it somebody else’s standards or can I feel good about having a Ph.D. egocentrism My perspective is the only perspective I’ll being egocentric but it doesn’t work most of the time so encouraging people to take alternate perspectives Maybe you’re texting with someone and they say something that is not what you interpret as not the nicest thing and this happens in text messages a lot and they get upset now an egocentric thinking error would say that purse is just grumpy today Someone who’s taking other perspectives would stop and go back and read the text and go I wonder if maybe this could have been taken some other another you know obvious reaction is not what I intended So egocentrism if you hold on to that I don’t understand anybody else because You know I don’t see a problem with anything personalizing and mind-reading This is when you assume that everybody’s frowning because of something you did your boss walks down the hallway and looks at you and grimaces and continues to walk on oh I must have done something wrong No maybe he just got out of his senior management meeting that was five hours long and he’s got to go to the bathroom you know there could be a hundred different explanations for why that happened so encourage clients to ask themselves what some alternate explanations for this event that are doesn’t involve me you know why this might have happened if they hold on to that, I must have done something wrong but as soon as their boss calls them up and goes hey can you come to my office for a second you know where their thoughts are going to go I’m getting fired I’m going to get laid off I don’t know what it was that I did wrong but he walked by me two weeks ago in the hallway and grimaced and I’m just I’m the worst person in the whole world But where did that come from so encouraging people to not necessarily assume they know what’s going on in someone else’s mind and not automatically attributing every person’s negative behavior to something they did How often and then ask them how often has it been about you now think about the last 10 times you’ve taken something personally how many of Those 10 times has it been about something you did versus something with the other person then the availability heuristic remembering what’s most prominent in your mind so asking clients what the facts ah the most obvious One that we talk about is plane crashes You know it is very dangerous to fly on a plane because you hear about all those plane crashes well yeah you hear about the airlines crashes but don’t hear about the 20,000 every day that land safely so you remember it and it seems more dangerous because that’s what is in your mind that’s what is available to you that’s what you’ve based your thought processes on because maybe you didn’t know that 20,000 planes or more fly and land just perfectly every day this can also be true with people remembering what’s most prominent in your mind sometimes and this can be very very true in domestically violent relationships if somebody falls in love with someone and that person is just the greatest person since sliced bread for the first four months and then the cycle starts and there’s this little tiny a sliver of the honeymoon period after the battering cycle and the person’s like That’s the person I fell in love with that’s what I remember and they try to focus on that that’s most prominent in their mind and they ignore the rest of the stuff so we need to encourage people to look objectively at the facts magnifying high and low probability outcomes what are the chances that this is going to happen how Many clients have worked with have gone to the doctor and gotten into a physical or get a test run and then the doctor had to call them back and This could be true for you too and the doctor had to call them back two or Three days later when the tests came back from the lab and that whole three days they were just in a panic because they were afraid they were going to get some terminal diagnosis so thinking about high and low probability outcomes another instance or example of magnification is somebody that thinks this is the end of the world whatever it I think I’ve told you before my little story about um tripping when I was walking down the hall at work and falling and yeah it was embarrassing my folders went everywhere and yeah but in that big scheme of things will it matter That much from now you know are people going to think Oh she is such a clutch she must be a ditz too no I mean they may have thought that at that time I don’t know but you know in six months nobody’s going to remember and then ask them in the past when something like this has happened when you’ve had to get a test done and you’ve had to wait on results or if you’ve done something that was embarrassing and you didn’t think you thought everybody was going to remember it forever how did you tolerate it how did you learn to deal with it building on those strengths that they already have all-or-nothing thinking errors These are things like love versus hate I love them or I hate them it’s all or Nothing she does this all the time or she never does it if I’m going to do it I’m going to do it perfectly or I’m not going to do it at all thank you all good intentions or all bad intentions you know sometimes we do things with good intentions that have some bad repercussions so did we do it with all Bad intentions are all good intentions and the answer is neither most of the time life is kind of in that middle-ground gray area encouraging clients to Look and find examples where something hasn’t been one of the polls when have they done something that they’re proud of that wasn’t perfect or when again When has somebody else done something that they were proud of that wasn’t perfect remembering that with availability heuristic remembering how often something happens and how long it’s been since you’ve seen that behavior and remember that sometimes good times are amazing but how frequent are they compared with the bad times another thinking error is a belief in a just world or a fallacy of fairness I just asked clients to identify for good people you know who’ve had bad things happen and in in reality we all have bad things happen good people do bad people do in between people do attributional errors and this is a pet of mine you know labeling yourself is not a behavior so global versus specific and I am stupid versus I’m stupid at math I don’t have good math skills it’s not about me it’s about the skills I can change skills stable I am and I always will be versus it’s something I can change it’s something I can learn internally It’s about me as a person versus it’s about a skill deficit or something I could learn or change and there’s you know lots of information on attributions out there on the internet if you need a refresher on it but we find that a lot of people who have dysphoria have negative global stable internal attributions so questions for clients remember the beliefs equal thoughts and facts plus personal interpretation another way of saying it is reality is 10% perception is 10% reality and 90% interpretation so what are the facts for and against my belief is the belief based on facts or Feelings Does the belief focus on one aspect or the whole situation Does the belief seem to use any thinking errors what are alternate explanations what Would you tell your child or best friend if they had this belief how would you want someone to tell what would you want someone to tell you about this belief so If you’re telling somebody about this what are you hoping they’re going to say in return and finally, how is this belief moving you toward what and who is important to you or moving you away from what or who is important to you now they can do a worksheet and have all of these or you can pick one or two of these questions that are most salient for your clients but they can have kind of at their fingertips so as they’re going through the day and something happens They can ask themselves ok what’s an alternate explanation Or you know Whatever it is this salient for that client’s irrational thoughts how do these thoughts impact the client’s emotions health relationships and perceptions of the world you know this is what we want to ask them How is this thought impacting you globally how may this thought have been helpful in the past Where did it come from How does it make sense from when you formed it in the past when you’re dealing with it ask the person if the thought is bringing you closer to those that are important Are there any examples of this thought or belief not being true and how can the statement be made less global less all-encompassing so it’s about a specific incident a specific situation less stable which means you can change it and less internal which means it’s not about who you are as a person but maybe something that you do or a skill that you have so we’re going to go through some of these thoughts real Quickly here mistakes are never acceptable and if I make one it means that I’m incompetent well never is kind of stable and I am incompetent is kind of global, that’s also that extreme all-or-nothing thinking so you can see where these cognitive distortions end up leading to unhelpful beliefs When somebody disagrees with me it’s a personal attack Well there’s Personalization If I ever heard it before maybe it’s not about you may be They’re having a bad day and you just happen to be the unlucky target or maybe they’re disagreeing with you because they have a different point of view and It’s not a personal attack it’s just their point of view If someone criticizes or rejects me there must be something wrong with me personalization all-or-nothing thinking global stable and internal something wrong with me as a person to feel good about myself others must approve of me Now this is one we’ve talked about external validation before and we can’t control other people to feel good about yourself how can you do that Besides necessarily requiring other people to approve of you to be content in life I must be liked by all people Wow I’ve never met anybody who’s liked by all people I’ve never even met anybody who’s been hated by all people but it’s important to help clients see how this is dramatic to say all people and for them to be content everybody has to like them I mean I like to be liked but if everybody doesn’t like me you know That’s pretty understandable My true value as an individual depends on what others think of me I would challenge this one this is all you know Also very personally I would challenge people to look at and say it so your child’s value as an individual depends on what other people think of Most people would say no but the perspective thing nothing ever turns out the way you want it to okay all-or-nothing thinking and probably availability heuristic if something bad just happened then they may be focusing on that which causes them to focus on all the other bad things in the past that have happened not to focus on that is okay you know bad thing happen but look at all these good things I won’t try anything new unless I will be good at it this fear of failure fear of rejection It just really paralyzes a lot of people when they get stuck with that thinking the area that they have to be perfect I am in total control of anything bad that happens is my fault well that’s egocentric and personal if They think they’re in total control that’s their perception of how the world Do they think if they’ve got everybody on marionette strings anything bad in the world that happens is their fault how powerful are they I feel happy about uh if I feel happy about life something will go wrong It happens sometimes but let’s look at times when you’ve been happy that something hasn’t gone wrong you know let’s get rid of that all-or-nothing thinking it’s not my fault my life didn’t go the way I wanted could be true but it seems like that’s making you unhappy so what do we do about that if I’m not in an intimate relationship I’m alone No, again that’s pretty extreme I’m either in an intimate relationship or I am alone and a loner and you know it’s just me and my 17 cats which follows with there’s no gray area so encouraging people to look at what these beliefs are saying important thoughts impact behaviors and emotional and Physical reactions emotional and physical reactions impact thoughts and interpretations of events so if you do something and it’s pleasurable and you have a great physical reaction you know let’s take bungee jumping or Skydiving if you go out there and it’s scary but you do it and you’re just like Whoa what a rush Your interpretation of that is probably going to be good which means you’ll probably do it again if you go out there and it’s just the most horrible experience you’ve ever had you’re probably not going to do it again and your interpretation of it is going to be not good which is going to make it hard to understand why other people would do it irrational thinking patterns are often caused by cognitive distortions so let’s just look back at some of those because there are a lot fewer cognitive distortions or general ways of thinking about the world then there are thinking errors because There are lots and lots of thinking errors Cognitive distortions are often schemas which were formed based on faulty inaccurate or immature knowledge or understanding and by identifying the thoughts of the hecklers you know the automatic tapes that maintain our unhappiness the person can choose whether to accept those thoughts or change them.As found on YouTubeNatural Synergy $47.⁰⁰ 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Best Practices for Anxiety Treatment | Cognitive Behavioral Therapy

 This episode was pre-recorded As part of a live continuing   education webinar on-demand CEUs are still available for this presentation   AllCEUs.com/Anxiety-CEU I’d like to welcome everybody to today’s presentation on best practices for the   treatment of anxiety I am your host, Dr. Dawn Elise Snipes now not too long ago we did a presentation on strengths-based biopsychosocial   approaches to addressing anxiety while Those are wonderful you know I thought maybe   we ought to look at you know what’s some of the current research so I went into PubMed which is   I don’t know it’s a playground for me it’s where You find a lot of journal articles and you   can sort I sorted by articles that were done and meta-analyses that were done within   the past five years so that gives us an idea About current research I mean there’s a lot   of stuff that is still the same like some of The medications that were known to work ten   years ago are still known to be you know good first-line treatments but there are also some   newcomers that we’ll talk about and there are also some changes that we’re going to talk about so we’re going to explore some common causes for anxiety symptoms in order to treat it, we   really need to and of course, this does play into the biopsychosocial aspect we really need to   understand kind of what causes it because anxiety that’s caused by for example somebody having a   racing heart may be different than anxiety that’s caused for somebody who has abandonment issues so we’re… …It can be incorporated in a lot of various places   again where they’re not applying it or ingesting it in any way all they’re doing is smelling it   they’ve used it in defusing aromatherapy in hospital emergency rooms and they found that it   reduces stress and irritability the people in emergency rooms and I’ve been to enough emergency   rooms over the course of the years to know that People who are in emergency rooms typically are not in the   best mood so if it can help those people then It’s probably going to have some sort of an   effect so psychologically helping clients realize that their body thinks there’s a threat for some   reason that’s why it triggered the threat response system which is what they call anxiety, so they   need to figure out why is there really a threat You know sometimes it’s like the fire alarm going   off in my house it just means that the windows are open and there’s a strong breeze there is no fire   there is no problem there’s just a malfunction It’s a false alarm A lot of times clients get this threat reaction they get this stress reaction and it’s not a big deal right now so they   can start modifying what their brain responds to and again, those basic fears that a lot of people   worry about failure rejection loss of control the unknown and death and loss distress tolerance is   one of those cognitive interventions that has taken center stage in anxiety research and   it isn’t about controlling your anxiety you know helping people recognize their anxiety acknowledge   it and say okay I’m anxious it is what it is How can I improve the next moment instead of   saying I’m anxious I shouldn’t be anxious I hate being anxious and slang with that anxiety let it   go just accept it is what it is have the client learn to start saying I am feeling anxious okay so distracted don’t react because I explain to them The whole notion of feelings comes in crest and go out   in about 20 minutes It’s like a wave so once they acknowledge their feeling if they can distract   themselves for twenty or thirty minutes you know Obviously, they figured out there’s no real threat if they can distract themselves for twenty or thirty minutes those emotions can go down and then   they can deal with it in their wise mind and encourage them to use distancing techniques instead of   saying I am anxious, or I am terrified or whatever Have them say I am having the thought that this   is the worst thing in the world I am having the thought that I could not handle this because thoughts   come and go and that comes from acceptance and commitment therapy functional analysis makes it   possible to specify where and when with what frequency with what intensity and under what circumstances   the anxious response is triggered so it’s important that we help clients develop the   ability to do functional analyses on their own so when they start feeling anxious, they can stop and   say okay where am I what’s going on how intense Is it what are the circumstances, and they start   really trying to figure out what causes this for them so they can identify any common themes from   their psychoeducation about cognitive distortions and techniques to prevent those circumstances or   mitigate them can be provided so if the client knows that they get anxious before they go into   a meeting with their boss and it’s usually a high intensity of anxiety okay so we can educate them and help them identify what fears that may be related to techniques to slow their breathing calm   their stress reaction and help them figure out times in the past when they’ve handled going in   and talking to their boss and it really wasn’t the end of the world you know there’s lots of   different things we can do there for them there but the first key and it gives them a lot of   a huge sense of empowerment to start becoming detectives in their own life and going okay now   under what situations does this happen positive Writing this was another really cool study each   day for 30 days the experimental group and this was high school-aged youth in China but you know   the experimental group engaged in 20 minutes of writing about positive emotions they felt that   day so they’re writing about anything positive that make them happy that made them enthusiastic give them hope whatever long-term expressive writing positive emotions so after 30 days it   appeared to help reduce test anxiety by helping them develop insight and use positive emotion   words so it got them out of the habit of using the destruction and doom words and encouraged them   to get in the habit of looking at the positive things and being more optimistic it’s a really cool activity that clients can try it’s…The Market WeekSign Up For The Free Newsletter No nonsense, no spam, unsubscribe anytime You can unsubscribe at any time. Read our privacy policy. Financial disclaimer: The Market Week is a general interest newsletter that is not liable for the suitability or future investment performance of any securities or strategies discussed. Readers are advised that the material contained herein should be used solely for informational purposes. As a financial newsletter publisher of general and regular circulation, we cannot tender individual investment advice. Read our full disclaimer. https://is.gd/mycbgenie_The_Market_Week As found on YouTubeAFFILIATE MASTERY BONUS: 6-Week LIVE Series Has Begun! FunnelMates $46.⁹⁵ Replays are Instantly Available. Want A Profitable Mailing List But Not Sure Where To Begin? We’ll Guide You, Equip You, and even PAY You Cash To Do It! OIP-2 ☃in 5-10 Minutes A Day Using Automation Software and our Time-Tested Strategy See How Your New Site Can Be Live In Just 27 Seconds From Now!

Best Practices for Anxiety Treatment | Cognitive Behavioral Therapy

 this episode was pre-recorded as part of a live continuing   education webinar on-demand CEUs are still available for this presentation   AllCEUs.com/Anxiety-CEU I’d like to welcome everybody to today’s presentation on best practices for the   treatment of anxiety I am your host, Dr. Dawn Elise Snipes now not too long ago we did a presentation on strengths-based biopsychosocial   approaches to addressing anxiety while those are wonderful you know I thought maybe   we ought to look at you know what’s some of the current research so I went into PubMed which is   I don’t know it’s a playground for me it’s where you find a lot of journal articles and you   can sort I sorted by articles that were done and meta-analyses that were done within   the past five years so that gives us an idea about current research I mean there’s a lot   of stuff that is still the same like some of the medications that were known to work ten   years ago are still known to be you know good first-line treatments but there are also some   newcomers that we’ll talk about and there are also some changes that we’re going to talk about so we’re going to explore some common causes for anxiety symptoms to treat, we need to and of course, this does play into the biopsychosocial aspect we need to   understand kind of what causes it because anxiety that’s caused by for example somebody having a   racing heart may be different than anxiety that’s caused for somebody who has abandonment issues so   we’re gonna treat the two things differently so we want to look at some of the common causes we’re   gonna look at some common triggers for anxiety Do you know what are some of these common themes that   we see in practice I will ask you to share some of the themes that you see that underline   or underlie a lot of your client’s anxiety and identify current best practices for anxiety   management including counseling interventions medications physical interventions and supportive   treatments so we care because anxiety can be debilitating and a lot of our clients   have anxiety a lot of our clients have anxiety comorbid with depression and they’re looking at   us going how can I feel anxious and stressed out and like I can’t sit still and be depressed at the   same time you know when you’re depressed you’re supposed to want to sleep well a lot of times   people who have both issues want to sleep but they can’t so I want to help clients   understand that also sometimes anxiety when people are anxious for long enough the body   starts kind of holding on to the cortisol the body recognizes at a certain point this is a   losing battle I’m not going to put energy into this anymore so it starts withdrawing some of   its excitatory neurotransmitters so to speak and people will start to feel depressed the   brain has already said this is hopeless this is you’re helpless to change the situation so   then people start feeling hopeless and helpless which is sort of the definition if you will of   depression low-grade chronic stress and anxiety arose energy and people’s ability to concentrate   so if we’re going to help them become their uber selves we need to help them figure out how to   address anxiety not just generalized overwhelming debilitating anxiety but also panic social anxiety   and those minor anxiety triggers that come along that may not meet the threshold for diagnosis   anxiety is a major trigger for addiction relapse if you have a client who is self-medicated before   or had an addiction for some reason anxiety is a major trigger increased physical pain when anxiety   goes up people tend to tense their muscles when they tense their muscles they tend to feel more   pain I mean think about when you’re stressed you tend to have more pain like in your neck your   back and things that already hurt may hurt more why because serotonin which is one of our major   anti-anxiety neurotransmitters is also one of our major pain modulators so when serotonin levels are   too low because anxiety is high then our pain perception is going to be more acute and people   can have sleep problems if they’re stressed out your body thinks there’s a threat you’re not   going to be able to get into that deep restful sleep you may have you may sleep you may sleep   a lot but it’s probably not quality sleep which means your neurotransmitters may get out of whack   your hormones make it out of whack and your body is going to start perceiving yourself in a   persistent state of stress when you’re exhausted the body knows that we may be the weakest link   in the herd so it continues to secrete cortisol to keep you on alert a little bit so you   may again you may be resting kind of like when you have a new baby at home those first couple   of months that my children were home from the hospital I slept but I didn’t sleep well I mean   the slightest little noise and I was awake and I was looking around and you know I felt it I felt   exhausted and a lot of new parents do so triggers for anxiety abandonment and rejection and we’re   going to talk about ways we might want to deal with these things but some of the underlying   themes that I’ve seen in a lot of clients and when I do the research and a lot of what themes that   come out include low self-esteem if someone has low self-esteem they’re looking to be externally   validated oftentimes they’re looking for somebody else to tell them you’re lovable you’re okay so   that can lead to anxiety about not having people to tell them you’re okay which makes   their relationships tenuous and can make them dysfunctional irrational thoughts and cognitive   distortions may lead people to believe that if I’m not perfect for example I am not lovable so we’re   going to look at some irrational thoughts and cognitive distortions unhealthy social supports   and relationships when you’re in a relationship it takes two to tango and even if your client is   relatively mentally and physically healthy if they are in a dysfunctional relationship they can fear   abandonment and rejection if that other person is always saying if you don’t do X I’m going   to leave you or if that other person is always cheating on them or whatever so relationships   can trigger abandonment anxiety and ineffective interpersonal skills can lead to relationship   turmoil and social exile if our clients are in relationships even if they’re not completely   dysfunctional if our clients are not able to ask for what they need and set appropriate boundaries   and manage conflict effectively because conflict happens in every relationship then they may start   to argue more which may lead to fearing may lead to relationships ending in the past and them going   well every relationship I get into ends which means I must not be lovable so they start fearing   abandonment and rejection these are four areas that we can look at one more assessing clients   another issue is the unknown and loss of control a lot of times negative self-talk and cognitive   distortions can contribute to that if I don’t have control of everything then it’s all going to be a   disaster negative others when clients hang out or when people hang out with negative people it   kind of wears on you after a while you notice that people who tend to be more negative   pessimistic conspiracy-minded tend to hang out with people who are also negatively pessimistic and   conspiracy-minded so if you’re hanging out with somebody who tends to be anxious then the anxiety   can be palpable and it can kind of permeate physical complaints can lead people to be   anxious because they don’t know what’s causing it like I said earlier sometimes if your heart starts   to race if you don’t know what’s causing it you can start thinking I’m having a heart attack or   I’m gonna die when people have panic attacks for the example they truly think they’re having a heart   attack and it’s I’ve had them they are very very unpleasant experiences but when people   start having physical complaints and it can be you know they have a weird rash that they can’t get to   go away or whatever but when they don’t know what it is and they can’t control it they can’t   make it go away they start thinking about all the worst-case scenarios and going online and   getting on WebMD which usually gives you all the worst-case scenarios um so physical complaints   are important we need to normalize the fact that nobody’s pain-free all the time and you know the   fact that you may have an ache or a pain or a lump or a bump or you know a cough most likely you know   when we look at probability the probability of it being something significant is pretty small now   do you want to get it checked out probably but you know the probability that is anything to be   worried about is relatively small and a sense of powerlessness can trigger fear of the unknown   and loss of control for somebody who doesn’t feel like they have any agency in their life   if they have an external locus of control or if they felt victimized all of their life then   they may fear not being in control they may be holding on and saying okay this is the one area   of my life I can control when I grew up you know I grew up in a very chaotic environment I had no   control I was bounced around in the foster system yadda yadda yadda now that I’m an adult you know I   can control these things and I am going to hold on with white knuckles and if I can’t control   everything then that terrifies me to death and loss are other triggers for anxiety and it can   be people or pets and pets are important I don’t want to minimize pets because you know they are   little parts of a lot of our families so making sure we check that my daughter’s dog for example   is it’s getting old she’s getting older she’s 14 now I think and you know she’s in decent health   we took her to the vet and the vet said yeah she’s got a little heart murmur but that’s expected for   a 14-year-old dog and but when she goes out if she doesn’t come back when I call her I have this rush   of anxiety for a second oh my gosh I hope this wasn’t the day so anxious around losing people   and you know if she when she crosses the bridge she will and you know I’m okay with that I’m   I have a harder time dealing with my daughter’s emotional turmoil when that happens and because   she’s grown up with this dog so you know those are the types of things that we want to talk about   with our clients what things are weighing on you that you may not even be thinking about because I   know in the back of my mind there’s always that worry about one of our donkeys and her dog jobs   and promotions can trigger anxiety if people are afraid they’re gonna lose their job if they’re   always afraid that you know they’re gonna walk in and get a pink slip or get fired you know we want   to help them look at how realistic they are you doing what you need to do to achieve   and keep your job and sometimes it’s not easy to answer I mean the first thought that a lot of us   have is well you know if you’re doing the right thing so just do it but there are those bosses   out there and I’ve had some amazing bosses a lot of them and I’ve had two horrendous   bosses and those two bosses I could never I never felt like I was able to do anything right   and so going to those jobs there was always this anxiety about what I’m what am I going to get in   trouble for today so you want to talk with people about does your job cause anxiety what can you   do to moderate that anxiety the same thing with promotions people may get anxious about whether   they’re going to get promoted to safety and security you know when you lose safety and security you can   feel anxious so if there’s a break-in at the house next door or shooting down the road   or you start watching the news you can feel very unsafe and insecure quickly so we want to   help people figure out how safe and secure are you really and a lot of it goes back to really looking   at facts when people lose their dreams and hopes or fear that they’re going to lose their dreams   and hopes they can start to get anxious you know they have this dream that they’re going to be   a doctor or I just finished the presentation on helping high school students transition to college   and a lot of high school students for example start college with these wide eyes and hopes   to save the world and they want to be doctors and engineers and this and that and they get   into it and they realize that it’s a lot harder then they thought or they realize that you know   what I don’t like this but I’ve already committed to it so what do I do I want to help   people but I can’t I can’t cut it doing this you know for me I figured out in my second year that   I wasn’t going to medical school because I wasn’t going to pass calculus and that caused a lot of   anxiety it was like okay what am I gonna do now Do you know what career should I choose to help people figure out do they have dreams that have maybe kind of crashed and burned and you have to   find new ones you know okay that one we’ve got to accept it figure out that it’s not going to be and   what can you do now people may also have dreams about relationships, they get into relationships   and see themselves with this person forever and then this relationship ends and or starts to   get rocky and they’re like but that’s my dream what happens if that’s got to happen because   it’s my dream I don’t know how to function if that goes away we want to help people be able to   rewrite their narrative and then sickness spiders and other phobias kind of go in with death a lot   of times when people get sick they start getting anxious that oh my gosh what if this is terminal   oh my gosh what if this is you know incurable if I get bit by a spider it’s gonna kill me and   which is rare you know there are very few spiders that is that poisonous same thing with   snakes going over bridges I’ve shared with you all that is not one of my irrational fears you know I   am just terrified that you know something’s going to happen and I’m going to get pushed off the side   of the bridge which is completely irrational but we need to help people look at those and identify   the thoughts that they’re telling themself about those phobias and dealing with that anxiety failure   is another trigger for anxiety especially in this culture our culture American culture is   in large part puts a high premium on success and perfectionism so when people realize that   they’re not perfect they may start to get anxious because they feel like if I’m not perfect then I’m   a failure you know those cognitive distortions of all-or-nothing thinking and they start with that   negative self-talk you know you can’t do anything right so those are some of the issues that you   know we often see in counseling sessions so what do we do you know somebody comes in and is like   I can’t live this way doc anxiety depression and substance disorders as well as a range of physical   disorders are often comorbid so this is the first the thing we need to realize is that   we’re very rarely dealing with a very simple diagnosis you know when somebody comes in we need   to figure out you know if they come in and they’re presenting with depression all right let’s talk   about that and then we start realizing that there depression started to occur after a long period   of being anxious okay so we need to deal with that but we also need to help them   with their sense of hopelessness and helplessness we need to develop that sense of empowerment and   then substance disorders we know that substance use is often a way of self-medicating but we also   know that it monkeys with the neurochemicals in the brain and can contribute to anxiety and   depression the same thing to physical issues pain from physical disorders anxiety about having   physical disorders medications you’re taking for physical disorders can all contribute to anxiety   so we need to look at the person as a whole and go what are all the things that are contributing to   the anxiety and what are all the things that the anxiety is contributing to so we have started having this big list of stuff that needs to be addressed and then we can start figuring out okay   where we start so knowing that these things are comorbid helps researchers explore pathways   to mental disorders so they can start figuring out you know what little string can we pull to   unravel this blanket of anxiety so it doesn’t suffocate somebody and for us as clinicians it   provides us key opportunities to intervene in you know sometimes clients will come in and start talking about their anxiety and their physical issues you   know maybe their anxieties about you know heart palpitations and because that’s a common one we   may want to encourage them to go see the doctor to get that ruled out you know rule out anything that   has to do with hormone imbalances or you know heart conditions or anything else that might be   contributing to it which can help them address it and if they do have physical disorders let’s   go with hormone imbalances that are contributing to the heart palpitations then they can start to   treat that if they don’t start to treat that then no amount of talk therapy we do is going to get   them to the quality of life that they’re looking for because they’re still gonna feel those so   we want to make sure that we’re addressing them holistically anxiety disorders should be treated   with psychological therapy pharmacy therapy or a combination of both and what they found and this   is no surprise this is kind of old news is that counseling Plus pharmacotherapy tends to have the   best outcomes but separating the two have similar outcomes in many cases but that’s just   looking at and I hate to call it simple anxiety but we’re just looking at anxiety symptoms here   we’re not looking at the full quality of life and we want to make sure that we’re also including any   medical issues behavioral therapy is regarded as the psychotherapy with the highest level   of evidence, there are a variety of cognitive behavioral approaches ranging from acceptance   and commitment therapy to dialectical behavior therapy to CBT to debt you know any of those that   deal with the thoughts and the cognitions that fall in that realm and it is effective in the current conceptualization of the etiology of anxiety disorders includes an interaction of   psychosocial factors such as childhood adversity or stressful events and a genetic vulnerability   so the psychosocial factors and these are other things when we do our assessment we want to pay   attention to because our approach to treatment is going to be different for people for example   who have trauma-related brain changes maybe then for somebody who doesn’t so, we want to   look at childhood adversity and stressful events that it may have caused basically what I tell clients is like rewiring of the brain there are trauma-related brain changes in soldiers and   especially in children or in people who’ve been exposed to extreme trauma that is designed to   protect them but it also can cause complications kind of later on in dealing with anxiety coping   skills that were learned that are ineffective you know sometimes people grow up in a household or an   environment or a situation where they don’t learn effective coping skills so we need to kind of help   them unlearn those and learn new ones build on their strengths and trauma issues that may still   need to be dealt with such as domestic violence you know if they grew up a lot around a lot of   domestic violence they may think you know I’m out of that situation it’s over I don’t want to   think about it it’s not bothering me anymore or a parental absence and I put absence because it can   be death it can be a parent that just packed up and left it could be a child that got put up for   adoption whatever put the child in a position of feeling like they were rejected by a parent can   be very traumatic and bullying among other things but there are a lot of trauma issues that people   once they’re out of that situation often say you know I’m out of it it’s not a big deal I dealt   with it let’s move on and they don’t realize the full ramifications and how that’s contributing to   their current anxiety and their current self-talk and cognitions of current stressors if somebody has   a lot of current stressors that’s also going to impact whether they develop generalized anxiety   you know we’re kind of stacking the deck here and the current availability of social support if they   don’t have effective current social support then they’re gonna have difficulty bearing the weight   of everything on their shoulders so we want to look at all these psychosocial factors when   we do our assessment now going back to the trauma issues if you’ve taken the trauma courses at   all CEUs you know that some people are not ready to acknowledge that the trauma is still bothering   them or work on the trauma and that’s okay we can educate them that it might be an issue and   then let them choose how to address it but we want to bear in mind the fact that you   know this could be sort of an underlying force motivating some of the current cognitions and genetic vulnerability so you take any three people and you put them or 300 people and you   put them through roughly the same psychosocial situations they’re all probably going to react   a little bit differently based on their prior experiences but also because of their genetic   makeup there are certain permutations and they found four we’ll talk about later that make the   brain more or less responsive to stress and more or less responsive to serotonin which   is your calming chemical so brains that are less responsive to serotonin isn’t going to you know   send out as much or send out serotonin as easily so people can stay kind of tensed and wired that’s an oversimplified explanation but that’s all you need for right now so genetic   vulnerability impacts people’s susceptibility to the effects and development of dependence   on certain substances which can increase anxiety when people are detoxing from alcohol when they’re   detoxing from benzos when they’re detoxing from opiates they can feel high levels of anxiety when   they take opiates some people find that opiates have wonderful anti-anxiety properties not that   I am advocating for the use of opiates I’m just client experiences have shown that that   can be true so some people are going to be more susceptible to the anti-anxiety effects   of certain substances and some people are going to be Cerrone to become dependent on substances   where others may not and that part of that is genetic vulnerability and they estimate about   30% the predictability of the development of anxiety disorders is genetic and genetics   also impact which medications are effective if you have genetic makeup then SSRIs might   be helpful then atypical antipsychotics may be more effective   and SSRIs might not do anything which is why a lot of our clients get so frustrated because they know there’s no way to figure out exactly what I guess there is now that there’s genetic testing   out there but up until then it was harder to figure out which medications to start with and   most physicians matter of fact I don’t know of a single physician that starts by   saying well let’s do a genetic profile to see what med to start you out with most we’ll start with events as with an SSRI or some other anti-anxiety medication some sort of Benzo that’s been my experience so we may want to encourage clients to consider genetic   testing if they’re having difficulty finding a medication regime that works for them and they   are feeling like they have to have medication genetic vulnerability also affects what’s going   to make somebody more vulnerable now than all of you in class today you know thinking about sleep you   know sleep may not be a big deal for some of you I know people who can go days or weeks with four   or five hours of sleep and they feel fine it’s not a big deal, not me I need eight or nine hours   of sleep so genetically for whatever reason I am programmed to need a lot of sleep so when I don’t   get that much sleep I tend to be it tends to be harder for me to deal with life on life’s terms   and I know that that makes me more vulnerable to being irritable so genetic vulnerability affects   who can become addicted and affects what medications work best and affects what situations are going   to tend to make somebody more vulnerable to anxiety so our medications and I know the type   on here is small but we’re going to go through the first-line drugs are the SSRIs selective   serotonin reuptake inhibitors and SNRs is selective norepinephrine reuptake inhibitors   now the names are a little bit deceptive because selective norepinephrine reuptake inhibitors also   increase available serotonin but the mechanism of action is different the mechanism of action   for each SSRI is a little bit different as well which is why you can put somebody on Prozac and   they have an awful experience and you can put them on Zoloft and they have a much better experience like I said earlier a lot of the research pre five years ago had been done on medications and Zoloft paxil luvox lexapro celexa and their generics have all been found to be effective   at treating anxiety in certain people no one medication works for everybody in the last five   years effexor has come on the radar and it has been found effective according to the Hamilton rating scale for anxiety so that’s another one to consider if clients are not successful or getting   the treatment effect that they need for on some of the other medications obviously, none of us   probably are prescribers but we do need to educate clients about why the first drug or even the third   drug that the doc tries may not work so they don’t start feeling helpless and hopeless like   I said earlier there are at least four different genetic variations which are correlated with the   development of generalized anxiety disorder and different medications are more or less effective   depending on the genetic makeup of the person there’s a high mortality rate moving on to two   benzos the recommendation has switched to back off from the use of benzos now for   some doctors will prescribe an SSRI and for the first, four weeks while the SSRI is building up   in the system they will also prescribe a Benzo to be taken as needed to moderate the   anxiety and you know you could argue on either side of that, if somebody has a history of substance   use or substance dependence benzos are really a bad idea because they do have a high rate of   dependence but the other reasons that they are now cautioning against the use of benzodiazepines is   that there’s a higher mortality rate among benzo users compared with non-users there’s an increased   risk for dependence with use for more than six months and that’s a long time to be using Benzo and when we’re talking about dependence and six months we’re talking about somebody who uses it   like every four hours or every eight hours depending on your Benzo every single day, not   a PRN user if somebody’s using it at night to help them go to sleep or you know three or four   times a week when the anxiety gets high the risk of dependence is relatively low but a   lot of people with anxiety because if they find the right Benzo makes them feel so much better   they may not want to be off of it and for a lot of people when that benzo reaches its half-life and   starts getting out of the system even more their anxiety spikes you know they have rebound anxiety   which they want to medicate with more benzos that’s gonna be an issue for them to discuss   with their doctor there’s also an increased risk of dementia identified in long-term benzodiazepine   users again this is for the people who use you know throughout the day every day for six months   or relatively every day for six months or more and it doesn’t matter if it’s you know we’re   talking about somebody who’s 65 or somebody who’s 35 who’s been using Benzos for you know   six months a year two years the risk of later life dementia is greatly increased according   to the research benzodiazepines also don’t treat depression okay so if you’ve got somebody who has   concurrent anxiety and depression there’s a much higher suicide risk if they’re on benzodiazepines   so being aware and generally that suicide risk comes from overdosing on benzodiazepines but   not always other treatment options you know if the benzos aren’t something that people want to touch   you know they scare the living daylights out of I SSRIs and SNRIs don’t seem to be working   then tricyclic antidepressants can be tried on those your older generation antidepressant seroquel   is used a lot and there are some there’s some research that shows it can be effective   with anxiety like some of the antidepressants and depending on the person the benzos seroquel can   make people very very very sleepy so you know it may not be the side effects of the Seroquel   the weight gain and the fatigue and you know sleepiness may be an unacceptable side effect for   some clients and boosts perón is the third option boost Barone works more like an anti-depressive   serotonin reuptake inhibitor and that it takes you know four weeks or so to kind of build up in   the system studies have shown that there’s really no long-term benefit to taking it but after six months   to eighteen months of use it has been shown to be effective in talking with clients a lot of   clients report that boost bar when they take it doesn’t necessarily help them stop being anxious   like a benzodiazepine does but it helps them not go from zero to 200 in 2.3 seconds it kind of you   know keeps them from having this gush of a freak out reaction every time something goes wrong which   a lot of clients report helps because they feel more stable throughout the day after remission   medication should be continued for six to twelve months and during that last six months first six   months keep it as is last six months you know they say that tapering is best it’s best not   to stop somebody cold turkey on any of these but it’s important for people once they’re   in remission to not just suddenly go okay I feel better I don’t need any of this anymore they need   to work into it and make sure they’ve developed the skills and tools that they need to deal with some of the anxiety that is going to happen in life so physical signs and symptoms   of anxiety may include fatigue irritability muscle tension or muscle aches try laying feeling twitchy   being easily startled trouble sleeping nausea diarrhea irritable bowel syndrome headaches so the   first thing we want to do with clients when we’re talking to them well second thing first thing is   say get a physical let’s rule out physiological causes of this but we can also help clients   look at you know what might be causing these things that you can do to mitigate it what might   be contributing to your fatigue what might be contributing to your irritability and your muscle   tension or your muscle aches I mean let’s look at economics did you recently get a new bed or do you   need to get a new bed what about your desk chair I know you know I get more muscle tension and muscle   achy when I do a lot of mousing because I have deplorable posture being becoming aware of that   helps and then I’m like okay well I know it caused unfortunately, it’s unpleasant but it’s not a   big deal trembling or feeling twitchy you know that can be caused by low blood sugar that can   be caused anxiety that can also be caused by early onset Parkinson’s symptoms you know   there’s you know it can be worst case scenario or it can be something benign so we want   to have people figure out you know when you start trembling or feeling twitchy is there something   that it’s related to you know I know when my son gets excited he’s he just sits there   and you can see him almost shake because he’s so excited about something so we want to have people prevent misidentification we don’t want them to jump to that worst-case scenario we don’t   want them to go onto WebMD and go oh my gosh I’ve got cancer I’ve got this debilitating disease and   I’m going to die in six months probabilistic Lee speaking it’s not gonna happen yes get a doctor’s   opinion I’m certainly not going to tell them it’s all in your head I want them to get an   evaluation but I do want to in the meantime help them think about how likely is   this and other things for headaches and this is one another one of those that can be frustrating   as we get older our eyesight starts to go and you know there was a period there I did fine   and then after I hit 45 my eyesight just started to like steadily and kind of rapidly in my mind   decline so I have to get my eyeglass prescription changed every couple of years and that can cause   headaches so instead of starting to worry about oh my gosh I’ve got a headache all the time   maybe I’ve got a brain tumor you know I know that it’s probably my glasses or I’m grinding my   teeth so other biological interventions that have been evaluated there’s something called   the floatation rest system that reduced environmental stimulation therapy reduces sensory input into   the nervous system through the act of floating supine which is on your back in a pool of water   saturated with Epsom salt you know I’m looking at this going sounds good and you can’t   quite get the same experience in a bathtub because you’re not floating you’ve got pressure points and   you’re still hearing stuff clients can sort of simulate it with you know earplugs or whatever   but it’s if they can access this it’s been shown to be effective the float experience is   calibrated so that sensory signals from visual auditory olfactory gustatory thermal tactile or   tactile vestibular gravitational and preceptive channels are minimized which means you don’t see   here taste touch smell feel anything as is most movement and speech so you want people to lay just   like completely motionless and not talk which can be hard for some people with anxiety in the study   the study I looked at fifty participants reported significant reductions in stress muscle   tension pain depression and negative effects and it was accompanied by significant improvement in mood   characterized by increases in relaxation happiness and well-being I read the study I’m like where can   I sign up you know it sounds in looking at some of the research this was more effective for   addressing anxiety than something like a massage Tai Chi also produced significant reductions in   anxiety there was approximately a 20% treatment effect 25% treatment effect in patients with   anxiety and fibromyalgia who practiced twice a week for a year now you know we want to look at   the confounding things here is it the Tai Chi itself or is it learning to control the muscles   and becoming more in tune with your body and learning to control your breathing helps   people reduce their anxiety either way you know Tai Chi helps people do that and it was shown that   after a year after the first six months, there was a significant treatment effect but after a year   you know it kept growing and after a year it was about 25% so Tai Chi can be effective acupuncture at the HT 7 median Meridian can attenuate anxiety-like behavior induced by   withdrawal from chronic morphine treatment through the meditation of the GABA receptor system   what does that mean that means if you if the acupuncture is done in very certain places the anxiety behavior the GABA a receptor system GABA is your main calming relaxation   neurochemical that is triggered and causes your body to sort of flood that receptor system and   this research was done on people who were detoxing from morphine treatment but we can look at   generalizing the results and I would be interested to see further studies on it pain other things we   need to do to help people with anxiety when people are in chronic pain they often have anxiety that   oh my gosh this is getting worse or It’s never gonna get better or I just can’t take this pain   anymore or they may get anxious that they’re going to be rejected because they can’t do some of the   things they used to do because they’re in so much pain so there’s a lot of guilt and anxiety that   can kind of revolve around pain what can we do to help clients guided imagery is generally very   helpful if we can help them imagine you know if that pain in their shoulder imagine the pain is   like the color red flowing out of their arm or other focus mindfulness so you know when you   think about something you know when you get a shot if I don’t think about it it doesn’t hurt near as   much as if the nurse says okay now one two three and you know she’s counting down and I’m getting   prepared and I’m focused on it I had another nurse one time who she was just talking   to me and you know put the alcohol on my arm and just kept on talking and didn’t tell me she was   getting ready to give me a shot and before I knew it she had given me a shot and she was like okay   we’re done I’m like you didn’t give me a shot yet she said yes I did it’s like oh so not focusing   on it and next time you have an itch for example if you’ve ever been driving on the interstate and   you can reach on your foot I get those on the bottom of my foot sometimes and I’m like okay   I’m not going to pull over to each my foot if you focus on something besides the itch eventually, it   goes away I’m not saying the pain is gonna completely go away but the more people focus on it the more   it hurts physical therapy can help so encourage them to get a referral and encourage them to do a   self-evaluation if nothing else of ergonomics in their car at work where they watch TV and spend   most of their time at home and they’re sleeping so those are the four places that they spend most   of their time what do their ergonomics look like and that can help a lot of people mitigate   a lot of pain hormones are another thing that we need to look at imbalances of estrogen and   testosterone can contribute to anxiety symptoms heart palpitations fatigue irritability having   people get a physical we can’t as clinicians do anything about it but doctors can rapid heart   weight rate sweating palpitations are not uncommon in women in perimenopause or menopause so a lot   of women start feeling like they’re developing generalized anxiety and/or something’s going wrong   when they start reaching that mid-40s to mid-50s area and they start having some of these symptoms   again we’re not going to diagnose it but we do want them to recognize that it may not be anything   you know is catastrophic this is something that a a lot of women experience and help them figure out   how to deal with that supportive care biologically now you know this isn’t gonna treat anything but   we can help them minimize their vulnerabilities help them create a sleep routine so their brain   and body can rebalance this can help repair any adrenal issues that may be going on and improve   energy levels people with anxiety don’t sleep well so helping them figure out how to get some quality   sleep is important nutrition minimizing caffeine and other stimulants are going to be a big help   because those make people feel anxious and encourage them to work with a nutritionist to try to prevent   spikes and drops in blood sugar which can trigger the stress response when your blood sugar goes way   up or way down you can start getting kind of shaky and feel weird and that can cause people anxiety   because they might think oh my gosh I’m having a stroke or a heart attack or you know I don’t know   what these tremors are so it’s important that they don’t miss identify symptoms and encourage   them to drink enough water dehydration can lead to toxic Ardea which is increased heart rate   sunlight vitamin D deficiency is implicated in both depression and anxiety mood issues   vitamin D has been found in those main areas where serotonin receptors are found vitamin D receptors   are found so we know the serotonin and vitamin D have something going on sunlight prompts the skin   to tell the brain to produce neurotransmitters and set circadian rhythms which impact the release of   serotonin your calming neurochemical melatonin which is made from breaking down serotonin and helps you sleep and gaba so sunlight actually helps increase the release of GABA when it’s   time to start calming down and going to sleep exercise studies have shown that exercise can   have a relaxing effect and encourage clients to start slowly there’s not a whole lot of new research   on exercise and anxiety aromatherapy has been used a lot, especially in other countries in   the treatment of people with anxiety people with hospital anxiety people women who are giving birth   and they have some birth anxiety there they’ve been found to be effective in a lot of   those studies essential oils for anxiety include lavender rose Bedevere ylang ylang bergamot   chamomile frankincense and Clary sage encourage clients to just go to a health food store and   you know sniff some of these and see if it makes them feel happy and calm and content the aromatherapy   molecules enter the nasal membranes and they will start triggering neurochemical reactions   and so you don’t need to apply it you don’t need to ingest it all you need to do is so encourage   clients if they’re open to it to think about this because aromatherapy can be integrated into their bedroom for example with an atomizer or a Mr. It can be incorporated in a lot of different places   again where they’re not applying it or ingesting it in any way all they’re doing is smelling it   they’ve used it in defusing aromatherapy in hospital emergency rooms and they found that it   reduces stress and irritability the people in emergency rooms and I’ve been to enough emergency   rooms over the years to know that people who are in ers typically are not in the   best mood so if it can help those people then it’s probably going to have some sort of an   effect so psychologically helping clients realize that their body thinks there’s a threat for some   reason that’s why it triggered the threat response system which is what they call anxiety so they   need to figure out why is there a threat you know sometimes it’s like the fire alarm going   off in my house it just means that the windows are open and there’s a strong breeze there is no fire   there is no problem there’s just a malfunction it’s a false alarm a lot of times clients get this threat reaction they get this stress reaction and it’s not a big deal right now so they   can start modifying what their brain responds to and again those basic fears that a lot of people   worry about failure rejection loss of control the unknown and death and loss distress tolerance is   one of those cognitive interventions that have taken center stage in anxiety research and   it isn’t about controlling your anxiety you know helping people recognize their anxiety acknowledge   it and say okay I’m anxious it is what it is how can I improve the next moment instead of   saying I’m anxious I shouldn’t be anxious I hate being anxious and slang with that anxiety let it   go just accept it is what it is have the client learn to start saying I am feeling anxious okay so distracted don’t react because I explain to them the whole notion of feelings comes in the crest and goes out   in about 20 minutes it’s like a wave so once they acknowledge their feeling if they can distract   themselves for twenty or thirty minutes you know they figured out there was no real threat if they can distract themselves for twenty or thirty minutes those emotions can go down and then   they can deal with it in their wise mind and encourage them to use distancing techniques instead of   saying I am anxious or I am terrified or whatever have them say I am having the thought that this   is the worst thing in the world I am having the thought that I cannot handle this because thoughts   come and go and that comes from acceptance and commitment therapy functional analysis makes it   possible to specify where and when with what frequency with what intensity and under what circumstances   the anxious response is triggered so it’s important that we help clients develop the   ability to do functional analyses on their own so when they start feeling anxious they can stop and   say okay where am I what’s going on how intense is it what are the circumstances and they start trying to figure out what causes this for them so they can identify any common themes from   their psychoeducation about cognitive distortions and techniques to prevent those circumstances or   mitigate them can be provided so if the client knows that they get anxious before they go into   a meeting with their boss and it’s usually a high the intensity of anxiety okay so we can educate them and help them identify what fears that may be related to techniques to slow their breathing and calm   their stress reaction and help them figure out times in the past when they’ve handled going in   and talking to their boss and it wasn’t the end of the world you know there’s lots of   different things we can do there for them there but the first key and it gives them a lot of   a huge sense of empowerment to start becoming detectives in their own life and going okay now   under what situations does this happen positive writing this was another cool study each   day for 30 days the experimental group and this was high school-aged youth in China but you know   the experimental group engaged in 20 minutes of writing about positive emotions they felt that   day so they’re writing about anything positive that make them happy that made them enthusiastic gave them hope whatever long-term expressive writing positive emotions so after 30 days it   appeared to help reduce test anxiety by helping them develop insight and use positive emotion   words so it got them out of the habit of using the destruction and doom words and encouraged them   to get in the habit of looking at the positive things and being more optimistic it’s a cool activity that clients can try it’s not gonna hurt anything if you have them journal each day   for 30 days mindfulness also came up in the research and was shown to be effective in   a meta-analysis of six articles about mindfulness based stress reduction four about mindfulness-based cognitive therapy and three about fear of negative appraisal and emotion regulation were   reviewed all of these showed that mindfulness was an effective strategy for the treatment of   mood and anxiety disorders and is an effective in therapy protocols with different structures   including virtual modalities so you know if you’re doing it via teleconference mindfulness can still   be helpful mindfulness helps people start learning how to observe what’s going on and become aware of   what’s going on more aware of those circumstances which will help them complete their functional   analysis but it also helps them become aware of vulnerabilities and head off things in the past   and if they’re taking better care of themselves that they’re living more mindfully then they may   not experience as many situations that trigger their anxiety mindfulness also encourages clients   to learn acceptance that radical acceptance of it is what it is I’m not gonna fight it I’m angry   right now I am anxious right now however I’m feeling right now is how I feel and that’s okay it’s hard for clients to get to that but once they get a hold of that and they truly believe it   and they can say all right it’s fine I’m not gonna feel this way forever I’m gonna do something else   until the feeling passes it helps and that’s where the labeling and letting go comes in mindfulness   can also help them identify trigger thoughts what thought were you having right before you   started feeling anxious if people are mindful or let’s start back when people are not mindful they   often notice or don’t notice that they’re getting anxious until they’re like super anxious   when people are mindful they become more aware of subtle cues address unhelpful thoughts when they   say or believe it’s a dire necessity for adults to be loved by significant others for almost   everything they do always running gonna happen why is it a necessity what we can encourage them   to do is concentrate on their self-respect on winning approval for practical purposes you   know for promotions or whatever but it’s not about me being lovable it’s about me getting a promotion   and making more money and focusing on loving rather than being loved because when we give   love we generally get love back with unhelpful thought number two people feel they aren’t able to stand   it if things are not the way they want them to be or are not in their control so encourage clients   to focus on the parts that are in their control and other things in life which are going well and   to which they’re committed number three misery is invariably externally caused and is forced   on us by outside people and events just by reading that makes me feel disempowered so encouraging   clients to focus on the fact that reactions such as misery or happiness are largely caused by the   view that people take of the conditions so if you see it as a tragedy and devastating then   it’s probably going to produce misery if you see it as an opportunity and a challenge it’s   probably going to produce a different emotional reaction if something is or may be dangerous or   fearsome people should be upset and endlessly upset about obsessing about it a lot of   people with anxiety get stuck on this you know if I feel like it’s fearsome I need to worry about   it getting on a plane for example if I fear that that’s dangerous that I need to think about it   and worry about it that’s not going to do any good so encourage clients to figure out how to   face it and render it harmless if possible and when that’s not possible accept the inevitable   so looking at airplanes you know facing it means researching to figure out how dangerous   is it really and realizing that it’s not that dangerous so that helps render it a little   bit harmless in their mind it proves to them that it’s not as dangerous as it could be and when   it’s not possible accepting the inevitable you know you got a fly so getting on there figuring   out how you’re gonna get through it hurricanes are the same way people especially in places   like Texas Louisiana Florida may obsess as soon as it starts coming to hurricane season or if a   hurricane is spotted out in the Atlantic somewhere they start checking the weather every hour or more   wondering what the path is going to be and you know what there’s you can’t change the path of the   hurricane so all you can do is board up your house evacuate if necessary and deal with the fallout child driving is just another example I’ll give you know my children are learning how to drive and   that’s kind of scary and fearsome you know what’s gonna happen when they’re out there you know you   see crashes all the time well render it harmless by making sure they’ve got good training on how   to drive make sure they’re good drivers and then accepting that some things are just not within   my control it’s easier to avoid than face life difficulties and responsibilities Well running   from fear is usually much harder in the long run so encourage clients to look back at times when they’ve avoided difficulties and responsibilities and the eventual outcome you know what happened   there people believe they should be thoroughly competent in achieving in all possible respects   or they will be isolated rejected and failures we need to encourage clients to accept themselves as   imperfect with human limitations and flaws and focus on what makes them loveable human being   what qualities like courage and intelligence and creativity and those things that can’t be taken   away what inherent qualities do they have that make them awesome people because something once   strongly affected people’s lives they should indefinitely fear it if you got lost you know   when little kids get lost it’s terrifying when you’re grown up if you get lost you turn on the   GPS and you figure out your way but some people still, you know freaked out about getting lost if   they got lost once so we want to help people look back at past episodes that may be contributing to   the current anxiety and compare the situation’s you know are you the same person or is this not   a big deal now that you’re older wiser stronger encourage them to learn from past experiences   but not be overly attached to or prejudiced by them yeah you could have maybe got lost in the   past and it was a horrible experience well you were six I can see where that would be terrifying   and a horrible experience but it doesn’t have to continue to impact you that way now when you’re   you know 26 getting lost you know could be an opportunity to try a new restaurant or something   people must have complete control over things well this doesn’t happen so encourage clients   to remember that the past and the future are uncontrollable we can’t change the past it is what   it is we can learn from it so it doesn’t repeat but we can’t change it and the future is largely   uncontrollable I mean there are a lot of things I can do to stay moving toward a rich and meaningful   life but life is going to throw me curveballs sometimes and there’s nothing I can do to plan for   or control that we can control our actions in the present to stay on our preferred path and general   develop general skills to deal with adversity should it arise so we want to help clients   develop those general problem-solving skills and the general support system so when they are thrown   a curveball you know it doesn’t knock them upside the head people have virtually no control over   their emotions and cannot help feeling disturbed by things well encourage them to think about the   fact that they have real control over destructive emotions if they choose to work at improving the   next moment and changing inaccurate thoughts then they’re not going to experience the destructive   emotions as intensely or as frequently when you feel an emotion you feel how you feel but again   you don’t have to wrestle with it fight it and nurture it you can say this is how I feel how   do I improve the next moment when it comes to cognitive distortions encourage them to find   alternatives when they start to personalize things if somebody laughs when you walk out of the room   then the and the person starts getting anxious thinking oh they were making fun of me I wonder   what they thought I wonder if I had something stuck to the back of my dress and they start   getting all panicked about it that doesn’t do any good encouraging them to think you know what   our three alternate explanations that hadn’t but had nothing to do with you for why they laughed   magnification of the worst thing you know taking something and saying if this happens then it’s   going to be a catastrophe and minimization going along with that a lot of times when people magnify   and see a catastrophe they minimize not only their strengths and resources but all the   other stuff that they’ve got going for them all they’re seeing is this catastrophe so encouraging   them to focus on the facts of what is actually happening and what is the high probability   event and encourage them to get information and look at the broader picture you know yes you   got into a car crash and your car is totaled and that is unfortunate you know it sucks but   you know that is not going to cause you to lose your job and then become homeless and penniless   and yadda-yadda it might cause your insurance to go up but okay so you don’t have a car but what   are the resources that you have who can Who do you work with that might be able to give you a   ride to work you know let’s look at the resources you have and work around so problem-solving helps   with magnification and also focusing on you know let’s be grateful for what didn’t happen you know   you could have been killed but you weren’t the car was totaled it’s replaceable all or nothing   thinking again have them think about what else could have been happening like Brittney suggested   finding the exceptions instead of saying she always does this look for exceptions when has   she not done that what else has she done instead of this selective abstraction and filtering is   when people look for the good the bad and the ugly a selective abstraction means you kind of   see what you expect to see so if you expect something to be devastating you see only the   devastating aspects of it which kind of goes with the magnification and minimization you filter out   the stuff a lot of times when people are in a bad mood or are anxious they see the negative because   that’s the state of mind they’re in so encouraging people to complete the picture alright there’s   all this bad stuff now what’s the good stuff you know to encourage them to look at the good the bad   and the ugly so they get a wide view of exactly what’s going on and encourage them to remember   that hindsight is twenty-twenty when people have something embarrassing happens or they get anxious   about something that happened they look back and they go I should have or I could have or Oh I   wish I wouldn’t have when you were in that situation you did what you did and you know   maybe you may have had a reason for it or you know you may have not had other options or it may have   just been a bonehead thing to do but okay so you made one mistake hindsight is 2020 that’s gonna   that mistake is gonna stand out just like the great big letter on the eye chart because you’re   thinking back and you’re looking at it and that’s all you see but encouraging clients to remember   that other people are too busy worrying about themselves to remember what they did jumping   to conclusions encourages clients to remember to get all the data if your significant other male   significant other comes home and is smelling like perfume don’t just jump to the conclusion that he   was cheating on you maybe he went to the mall to get a new tie and walked through the   perfume area and got spritzed or bought you some perfume or who knows maybe the person sitting next   to him at work sprayed her perfume on the desk and some of it filtered on there are all different   reasons that that might happen so encourage people to get all the data mind reading we can’t do it   you know you can’t read somebody’s mind you don’t know what they’re thinking so ask them what you think about this don’t assume anything and emotional reasoning encourages people to step back   from a situation and ask themselves am I feeling anxious about this because I’m feeling anxious and   I’m looking for reasons that it should be scary or am I feeling anxious about this because it’s   really scary for some reason there are facts support my anxiety a lot of times when we go into   new situations we may feel anxious because it’s a new situation but when we step back we say you   know what there’s nothing to be worried about here you know no big deal I got this and   move on so instead of rolling with it and trying to figure out okay I feel anxious so there must   be a reason not necessarily very likely a false alarm other psychological interventions relaxation   skills encourage people to learn how to relax not only physically but mentally diaphragmatic   breathing helps encourage them to breathe through their stomach and put their hand on their   belly and feel their belly expand and contract slows breathing down which triggers the rest and digestion reaction in the brain which is calming meditation can be helpful for some people some   people find trying to quiet their minds too frustrating because they’ve got too much   monkey mind going on that can be later or maybe never for some people we don’t want to increase   their anxiety with interventions cute progressive muscular relaxation also has a lot of research   support and remembers with cute progressive muscular relaxation we’re Sakura getting them   to attach a cue AK you word like relax or breathe with the relaxation response so they tense their   muscles and then relax their muscles and as they relax their muscles they say their “querk”-word   like relaxed and they work from head to toe or from toe to head tensing and relaxing different   muscle groups so they become more aware of what a tense muscle feels like versus a reactive relaxed   muscle there are great scripts that are online that people have already recorded that can walk   people walk clients through CPM are I highly encourage it because once they get used to it   then they can just think that cue they can think relax and as they exhale they will start to feel   their entire body kind of relaxing because it’s trained when it hears that just like when you hear   the word pop quiz when you were in high school you had a stress reaction well we want to use   it in reverse and train the body so that when it hears a cue word relaxes helps them develop   self-esteem because fear of failure and rejection a lot of times come from needing other people’s   approval to help them develop a rational idea of their real self develops compassion self-talk   instead of saying I’m an idiot or I’m stupid or I’ll never measure up to anything encourage them   to talk to themself like they would talk to their child or hopefully their best friend and encourage   them to spotlight strengths whenever they feel like they’ve got an imperfection to identify these   three strengths that they have so they’re you know balancing out the imperfections and the strengths of cognitive restructuring reframes challenges in terms of current strengths, not past weaknesses   so if you’re going to give a presentation in front of 60 people and you hate public speaking instead   of thinking about you know this is terrifying because the last time I went up in front of people   I forgot everything I was going to say and drop my note cards well that’s a past weakness what   is your current strength you’re prepared you know the material you Jabba-dada so encourages people   to look at all the strengths and resources they currently have them develop an attitude of   gratitude and optimism because like I said with that the positive writing exercise when people   are in a grateful optimistic frame of mind they tend to see more of the good stuff they see the   bad stuff too but they can also see more of the good stuff and some of the bad stuff they see   opportunistically instead of as a devastation acceptance and commitment therapy says that some of the reasons that we’re miserable are fear we get fused with our thoughts we think I   am terrified well if I am terrified then I can’t I mean if I am I can’t get rid of anything I am   if I’m having the thought that I’m terrified well I can get rid of a thought I can forget   things easily encourage people to evaluate their experience and empower them to look at things as   challenges and opportunities instead of hardships encourage them not to avoid their experiences so   things that are scary gradual exposure and finding exceptions like for me bridges you   know I love public speaking so that’s not a thing but when I go to a bridge you know when   I Drive to the bridge you know when I’m on the bridge somebody else is driving I get used to   doing that when I Drive over a bridge than when I Drive over one of those bridges that opens up   I hate those bridges um I know y’all are just like oh my gosh yeah it’s an irrational fear I realize   that but instead of going straight for the bridge that opens up going for the little bridges first   and then thinking back over times that I’ve gone over bridges and there’s been no problem you know there are exceptions nothing happened it wasn’t a big deal Sometimes I didn’t even notice it until   somebody pointed out hey look down there at that pretty water and I’m like oh we’re on a bridge so   encourage people to not avoid their experiences get used to them embrace them and learn that they   have the power to deal with them and stop reason giving for behavior you know use the challenging   questions if something is fearsome let’s look for at the evidence for and against it instead   of you know making excuses for social interventions improve their relationship with their self which   goes with self-esteem improvement people are going to feel less anxious about getting their needs and   wants to be met if they know what their needs and wants are so part of that is becoming mindful cuz a lot   of our clients don’t know what they need and want they just want to feel better but they don’t   know how they don’t know what they need to feel better so helping them identify their needs and   wants to encourage them to be their own best friend you know when they get a promotion take themselves   out to dinner pat themselves on the back whatever it is don’t rely onother people to do it because   other people it’s not that they don’t care but other people are often very involved in thinking   about their stuff and they may not notice encourage them to develop a method of internal   validation so they can feel like they are all that ‘no bag of chips and they realize why they   are lovable human beings and they accept the the fact that everybody is not going to like them   and nobody is gonna like them all the time and that’s okay you know my kids don’t like me all   the time my husband doesn’t like me all the time I’m okay with that I know I can be challenging but   you know most of the time you know they like me and that’s okay and there are some people you   know who don’t like me at all and okay there’s nothing I can do about that helping our clients   develop an okayness with that helps relieve a lot of anxiety because a lot of people feel like they   have to be liked by everybody and if somebody doesn’t like them it’s like what did I do wrong   oh my gosh encourage them to develop healthy supportive relationships with good boundaries   develop assertiveness skills so they can ask for help when they need it anxiety a lot of times you   know that’s the body saying there’s a threat well if there’s a threat maybe you need some help you   know dealing with it so people need to be willing and able to ask for help and not feel like that’s   going to lead them to be rejected and allow them a certify this will allow them to say no to requests   again without feeling like that’s going to result in them being fully rejected describe the ideal   healthy supportive relationship and encourage them to separate the ideals from the reals you   know let’s look at if you had the best relationship what would it look like okay you know Warden June   Cleaver we got that now how realistic is that you know let’s look at you know rephrasing this   a little bit so it’s less extreme you know warden June Cleaver never fought their kids were perfect   you know all those extreme words let’s look at what’s real what happens in real relationships encourages people to identify who would be a good partner in supportive relationships   I’m not meaning necessarily romantic I’m meaning friends and where they can be found you know where   would you find people that you could be friends with and encourage them to play through what it means when gaming cuz a lot of times again this goes with my reading you know what it means when your friend doesn’t return your text right away what does it mean when your friend cancels   dinner on Friday night what does it mean when you see where I’m going with this and a lot of   times clients with anxiety and rejection issues and low self-esteem will go to the worst-case   scenario so encourage them to go back to finding the exceptions what else could have been happening   what else could it be that caused this and it’s not about you so anxiety is a natural emotion that   serves a survival function excessive anxiety can develop from lack of sleep nutritional problems   neurochemical imbalances failure to develop adequate coping skills cognitive distortions low   self-esteem and a variety of other stuff recovery Ambala involves improving health behaviors making sure your body’s functioning and making the neurotransmitters it needs and you know release   them as needed to identify and build on current coping strategies address cognitive distortions   and develop a healthy supportive relationship with self and others if you enjoy this podcast please   like and subscribe either in your podcast player or on youtube, you can attend and participate in our live webinars with Dr.  Snipes by subscribing at all CEUs comm slash counselor toolbox, this   episode has been brought to you in part by all CEUs calmly provide 24/7 multimedia continuing   education and pre-certification training to counselors therapists and nurses since 2006 have used coupon code consular toolbox to get a 20% discount on your order this month.As found on YouTubeBrain Booster | Blue Heron Health News ⇝ I was losing my memory, focus – and mind! And then… I got it all back again. Case study: OIP-73 Brian Thompson There’s nothing more terrifying than watching your brain health fail. You can feel it… but you can’t stop it. Over and over I asked myself, where is this going to end? What am I going to end up like? And nobody could tell me. Doesn’t matter now. I’m over it. Completely well. This is how I did it!

Addressing Negative Thoughts | Cognitive Behavioral Therapy with Dawn Elise Snipes

 CEUs are available at AllCEUs.com/CBT-CEU This episode was pre-recorded as part of a live continuing education webinar. On demand CEUs are still available for this presentation through ALLCEUs. ALLCEUs.com/CBT-CEU I’d like to welcome everybody today to cognitive behavioral therapy addressing negative thoughts. Now a lot of us took courses and cognitive behavioral therapy we’ve worked with CBP for many many years so some of the this is just going to be a refresher and others you know you may pick up a few new tips or tools as we go along so we’re going to define cognitive behavioral therapy and its basic principles just get a really basic refresher on what was that original CDP about well identify factors impacting people’s choices behaviors because you know they always have a choice we’ll explore causes and the impact of thinking errors whether you call them cognitive distortions irrational thoughts or when I work with my clients I try to call them unhelpful beliefs or unhelpful thoughts because distortions and irrational seems sort of pejorative to me so I try to avoid those words as much as possible and help clients see them as not incorrect necessarily but unhelpful and then we’ll identify some common thinking errors and their relationship to cognitive distortions and some of our just very basic fears why do we care well because cognitive distortions or irrational thoughts or unhelpful thoughts whatever you want to say really impacts people on a physical level a mental level and an emotional level a person who perceives the world is hostile unsafe and unpredictable will tend to be more hyper vigilant until they exhaust the stress response system so think about you know a bottle ship and you’ve got a bunch of new people on this battleship and all the sailors every time there’s the least little thing they send off the all-hands-on-deck so a big bird flies over and I mean literally a bird and they freak out found me all hands on deck and this goes on for a week or two or six months you know let’s think about our clients they don’t usually come in right away where everything is set to OFF that startle response everything sets off that fight-or-flight response the staff starts to get exhausted all the rest of the sailors that have to drop everything and run to their battle stations after a little while they’re like really no no we just we can’t even do this and it also reminds me of the boy who cried wolf anyhow I digress sticking with the battleship metaphor so eventually the captain says you know what let’s retrain on what is worth setting off the all hands on deck because everybody here is exhausted and nobody’s even really responding anymore when they come to their battle stations they’re just kind of dragging their butts in like whatever it’s probably another false alarm the same sort of thing is true with us when we’re on on high alert for too long our brain says you know what we got to conserve some energy in case some really really big threat comes along so it turns down what I call the stress response system it turns down the sensitivity so you don’t get alerted for every little thing that would cause you stress but you also don’t get alerted for those little things that would cause you happiness either anything that would cause the excitatory neurotransmitters to be secreted you’re just not getting those anymore which a lot of people kind of refer to as depression it’s just kind of like the F whatever and only the biggest most notable things actually cause an emotional effect we don’t want people to get to that point that’s no way to live so we need to help them learn how to sort of retrain their spotters to figure out what is actually stressful a person who perceives the world is generally good and believe they have the ability to deal with challenges as they arise will be able to allow their stress response system to function normally there are going to be times you have all hands on deck whether it’s a real emergency or whether it’s just a drill but it will happen and they can go they can you know do what they’re going to do they have that adrenaline rush they have the energy and the focus to do their jobs and when it’s over they go back to their quarters they can relax refresh you know just kind of chill for a while and then there’s a low where their body rebalances before the next one and this is kind of what we want in life I mean ideally we wouldn’t have super high peaks very often but we want to make sure we give our body time to rebalance after there’s a stressor and not have to stand on on edge not be hyper vigilant constantly just waiting for the next one to come along so what is the impact of these thinking errors well whenever we have that stress response system activated the body is saying we either need to fight or we need to flee so you’re dumping all kinds of adrenaline and other neuro chemicals so there’s anxiety there can be stress when people start having this reaction you know they start having muscle tension sweating heart rate increases breathing increases people will call that anxiety some will label that as anger either way they’re both sides of the same coin they need to do something but if it lasts too long then we start moving into depression and they just they don’t have to get up and go anymore there’s just not any excitatory neurotransmitters really left they need some time to rest and rebalance behaviorally think about it if you go somewhere and you are just constantly on guard are you going to keep going there or are you going to withdraw so people who have a lot of thinking errors unhelpful thoughts tend to withdraw more they may turn to addictions to kind of numb or blunt some of the inputs sleep problems and changes when you are hyper vigilant when you have this stress response going even if it’s not a full-bore if it’s still there somewhat if you’re stressed out you’re not going to sleep as well you’re going to maintain higher levels of cortisol so you’re not going to get that restful rejuvenating sleep you may kind of goes on and off eating changes you know depending on the person some people eat the self food that some people can’t eat it all but we do see that the hormones Guerlain and lets them get all out of whack not under stress but also when sleep gets out of whack when your circadian rhythms get out of whack so we’re starting to see the Cascade effect where it’s emotional and behavioral physical you’ve got stress-related illnesses that start coming up if you’re on that lunch you’ve got muscle tension for that long it starts to hurt I mean you start to get migraines your back starts to hurt wherever you store your stress so to speak it starts to come out and most people when they’re under a lot of stress for an extended period you know a day is not a big deal for most people but for an extended period become more susceptible to illnesses they start getting sick easier headaches GI distress you know some people store their stress right in their gut socially think about the last time you were stressed were you patient and tolerant and just a pleasure to be around you may have tried to be but you’re more prone to irritability and impatience and again wanting to withdraw all of these affects contribute to fatigue and a sense of hopelessness and helplessness which often intensifies thinking errors so you’ll see this negative reciprocal interaction if somebody feels stressed out and overwhelmed and that they withdrawal then they may start feeling like they have no support and they don’t and they lose all their social buffers to the stress so they feel even more stressed so they want to withdrawal even more so we’re going to talk about how to prevent that now I like this little diagram maybe because it’s got a heart in the center I don’t know but behavior feelings and thoughts this is the outside of the circle all three of these impact diecuts each other when you do something it often impacts your feelings and your thoughts about a situation when you when you’re thinking if you think positively you’re probably going to choose more positive behaviors and more have more positive feelings you’re thinking negatively obviously you may choose more of an escape behavior Protection behavior and may have more feelings of anger anxiety depression etc so these things are going on and they’re all interacting the one really cool thing is if you break this chain somewhere or this circuit then you can stop that reciprocal negative downward spiral so cognitive behavioral helps people who are willing to show up or who are willing to address their thoughts not everybody is willing to start addressing their thoughts right away maybe they want to start addressing their sleep problems in their eating problems or something that’s more physical okay that’s fine because anywhere we interrupt this circuit is going to have positive effects assuming the intervention is positive it’s going to have positive effects on the other ones so what about the triangle well yourself so you’re feeling thoughts and behavior impact you it impacts how you feel and you’re like well yeah okay just stay with me but the way you feel think and act impacts your future and it also impacts how you interact with others so you know that kind of affects things because remember social support is a big buffer for us now core beliefs and you can do this inward to outward or outward to inward but either way it comes down to core beliefs if you have positive thoughts and positive feelings and you generally engage in positive behaviors to keep that cycle going you will probably feel pretty good about yourself have good relationships have a somewhat optimistic feeling about the future and your core beliefs may be more like people are generally good I can do this you know very self affirming and other affirming positive core beliefs about yourself in the world now if your thoughts or feelings are negative then you have this negative outer circle you don’t feel so good you start questioning the goodness and Trust ability and dependable of other people you have more of a bleak look in the future so what do you think is going to happen to the core beliefs the core beliefs may change too if someone doesn’t love me I am completely unloveable they may change to being more extreme more negative and more difficult to rectify if you want to have somebody who’s happy I mean you’re not going to have somebody who’s happy who thinks the world is an unkind unpredictable scary place going it’s just wonderful roses today so we have to help people try to adjust eventually start adjusting those core beliefs and when we get into causing that behavior remember the ABCs your automatic but well your automatic thought then your and beliefs are what happened as soon as that event occurs and those you don’t think about that’s why they’re called automatic so when you have the ABCs these core beliefs are those things that pop up that we need to address so what factors affect this and whoops you know there’s a lot of stuff right here and EBP they call them vulnerabilities you know we’re just going to talk about in general different factors that affect the choices our clients make in terms of behaviors so negative emotions if they are not if they’re feeling angry if they’re feeling anxious they’re feeling depressed they’re probably not going to be really motivated to get up and engage in a whole lot of self affirming activities they’re not probably not going to be having a lot of positive self affirming thoughts they’re going to be focused on whatever is causing that distress and maybe escaping from that physically pain and illness when you don’t feel well it’s harder to be Susie sunshine I don’t think many of us are just a barrel of monkeys when we don’t feel well so if our clients have pain this is one of those if you want to put it in behaviors behavioral areas physical areas we can address and have them go see their physician have them go see their physical therapist and get recommendations so they aren’t feeling physically painful physically and distress all the time because physical distress and emotional distress both mess with sleep unfortunately sleep is the first thing to usually go and I’m not talking about quantity I know a lot of clients who when they get depressed they’re in in bed for you know days they’ll get up they’ll maybe shower and you know go back to bed and they’re sleeping a lot but it doesn’t mean it’s quality sleep so what we need to look at is what is the quality of their sleep are they getting that rejuvenation the time for their brain and neural chemicals to rebalance so they can feel happy so they can have that nice balance of all the the neurotransmitters they need to feel happy poor nutrition well no matter how much sleep they get if they don’t have the building blocks to make the neurotransmitters and the hormones that are needed to prompt the feelings the physiological sensations that we’ve labeled happiness or excitement or you know even depression and anxiety those are all caused by different neurotransmitters being secreted in different combinations if your body doesn’t have the building blocks to make those then it doesn’t matter how much sleep you get you’re not going to get any benefit from it an intoxication and this can be uppers downers anything that is psychoactive if you are messing with that neurotransmitter balance you’re going to get it out of whack and you may either use up too much of the excitatory or cause us a lot of it or you may use up too much of the depressant either way there’s usually a rebound effect which we call withdrawal so you’re not going to be in a good space either during the intoxication sometimes but definitely when you’re sobering up there’s a period where there’s going to be negative emotions negative feelings environmentally yeah your environment can even make you grumpy introduction of a new or unique situation some people love new challenges love going to new places other people not so much depending on the person taking on going somewhere new may be really stressful for them so if they’ve already got de-stress going on because of having to go to this new situation then their thoughts may be a little bit more on the anxious side about a lot of things and they may have less patience and tolerance to deal with other stuff that comes their way because they’re already kind of on edge and exposure to unpress you know going places that you just really don’t want to go maybe and one of the places I used to work we had this meeting once a month and it was literally an eight-hour meeting and we would all sit in there for eight hours and one person at a time would get up and give their staff reports or whatever but it tended to be a relatively dreadful sort of environment or eight hours and we all knew we had to be there and that was fine but it was an unprecedented were grumbling on the way in they were getting their coffee and going well I better do this because I’m not getting out for another eight hours we need to help our clients obsess what is it in your environment if anything that is making you already feel grumpy or not as happy and likewise what can you put in your environment to make you feel happier you know I keep pictures of my kids and my animals on my phone that way if I’m having a moment or not sometimes I just like looking at them I can take a look at it it makes me smile and I’m like okay life is good you know this moment may not be so wonderful but it’s just this moment then we move on to stress of a social nature peers or family who convey irrational thoughts as necessary standards for social acceptance nobody wants to associate with those people or nobody’s going to like you when you’re like this or you read if you really want to be successful then you need to change fill in the blank it’s always a something needs to change you are not okay for who you are how you are and a lack of supportive peers to buffer stress because we all have negative people in our life it happens but if you have negative supportive peers that you can call afterwards and go yeah I had just had to meet with someone so for an hour and it was just dreadful and that person can go well I’m sorry or be there make you laugh or whatever they do it helps buffer the stress if you don’t have those positive social supports then you’re left walking out of it you’re kind of feeling shell-shocked and then you also at the same time have to figure out for yourself all right what do I do next now it doesn’t mean you can’t do it you know people do it all the time but it is good it is awesome to have supportive peers to buffer your stress so when cognitive therapy clients learn to distinguish between thoughts and feelings realizing that thoughts will trigger feelings but they don’t have to cause continual feelings and behaviors and feelings can cause certain thoughts but they don’t have to you can unhook from them and you can just say this is how I’m feeling right now now where am I going to go from here and we talked about that on Tuesday with unhooking from unhooking from your thoughts and stepping back and going what is the next logical action to get me to where I want to go become aware of the ways in which the thoughts can influence feelings in ways that are sometimes not helpful being critical being jealous envious maybe you just don’t like somebody and you know there’s a whole lot of reasons for that but you don’t like everybody most people don’t like everyone and so it’s you know that’s okay but recognize how that affects your interactions with that person and your thoughts about that person learn how thoughts that seem to occur automatically affect emotions so recognize start getting down to what are these core beliefs that happen every time it’s a negative incident that make me feel angry or anxious constructively evaluate whether these automatic thoughts and assumptions are accurate or perhaps biased evaluate whether the current reactions are helpful and a good use of energy or unhelpful and a waste of energy that could be used to move toward those people and things important to the person so again back kind of to that ACP sort of thing is this a good use of your energy to help you achieve your goals and be the person you want to be and develop the skills to notice interrupt and correct these biased thoughts independently like I said you don’t always have to call somebody you can do it on your own but sometimes it’s nice to have that buffer in that middle moment so what causes these thinking errors how can we even start helping people address their thoughts and until we start thinking about well what caused them information processing shortcuts as we grow up we learn things you know when you were knee-high to a grasshopper you didn’t have a lot of experience so you learned things but things you learned when you were a kid unfortunately because you were cognitively a child are either our dichotomies they’re all or nothing it’s either this way or no way at all so things that you have things that you learn back when you were a child may not have been challenged if you heard something from your parent maybe your parents said you’re a bad girl or you’re a bad boy it’s all or nothing well I am a bad girl so I guess that means I’m not okay and if I’m not okay right now I’m never okay that can stick with a person so these outdated amis schemas can really trip somebody up once the person gets into you know middle schoolish the thoughts aren’t nearly as dichotomous there’s a lot more formal operational thought if you will but up until then I mean you’ve got a child who’s experiencing a lot of stuff and taking in like a sponge everything they hear and it gets sorted into a yes or a No pile there’s there’s no kind of middle pile that there’s no yes and so what we want to do is help people look at those thoughts now and say okay if they’re all or nothing is there a way to find both and so for example we’ll take that exam scenario I gave you earlier if a child hears you’re a bad girl when they’re young they take that to mean always everything about me is bad I’m unlovable so what is the both and compromise as an adult we can look back and go you know I’m a good person I may not make may make poor choices sometimes I may make bad choices but I’m a good person so there’s that both and you know I’m not perfect but I’m good so that it’s not all or nothing and I encourage my clients to really always look for that middle ground how can it be both or does it have to even be that negative one but most of the time there’s a little bit of something on both sides the brain’s limited information processing capacity and limited responses when children are young you know they hear something you know mom comes in and says you’re a bad girl and child hears I’m totally unlovable and it just crushes the child they don’t have experiences to go moms having a bad day she kind of tends to say things she doesn’t mean when she’s having a bad day it’s just it’s devastating to that child when you’re older if somebody says something that’s not necessarily tactful you know you can look at it and go yeah that really wasn’t nice but that person probably did not intend to be hurtful they may have something else going on children have fewer experiences so what was devastating or overwhelming as a child may not still have have to feel that way when you’re a child if your best friend moved away oh that was devastating it was the end of the world now as an adult you can go visit them you can call them and with the internet and everything you can email them you can still stay in touch so there are ways to do it yeah you can’t go out and swing swing on swings together all the time but it doesn’t have to mean the end of the end of time things will change and there’s a little process of grieving that has to go along with that but to an adult a friend moving away is less devastating than say to a six-year-old your parent being angry with you if you grew up in an alcoholic or addicted household you learn don’t talk don’t trust don’t feel when the parent came in if the parent was angry with you you could have been in a lot of hurt you know there could have been some actual danger to your physical or emotional person so it was scary as a 26 year old or however old your client is is it that threatening you know if your parent gets angry with you you don’t depend on them for food and shelter anymore you don’t have to be an inner household if they were violent towards you so is it as terrifying when your parent gets angry yes there’s lots of issues with wanting acceptance from your parents that’s over here there’s a whole nother issue but when your parent is angry do you have to have that person’s approval when we’re in crisis we don’t process much when you’re in crisis your body is worried about surviving if you’ve been in a car wreck if somebody has gone to the hospital whatever the case is you’re not processing all of the data in order to make it in for decision you’re processing what’s right in front of you because when we’re in crisis we generally have tunnel vision and really crappy memory so if something happened when someone was in crisis that hurt their feelings made them angry you know fill in the blank some sort of dysphoric emotion we want to say well let’s look back at that and see if there’s a pose and let’s look back at that and see if there was something that you missed that might help you understand why this person reacted that way but understanding that in crisis we just generally don’t make the most informed decisions so emotional reasoning helping clients understand that feeling or not facts and helping them learn to identify feelings and separate them from facts so if they say I’m terrified all right so you’re terrified got that about what are you terrified you know tell me what are these things that make you feel like the world is such a scary place and let’s list them on the whiteboard or a flip chart what is the evidence that those are present dangers right now that they’re actually impending threats so tell me about what the evidence is in what ways is this similar to other situations where you felt terrified and how did you deal with those situations I have a friend who actually went this morning on an airplane flight and she hates flying totally terrified of it so what is the evidence that this plane is going to crash you know what is the evidence that it is likely that this plane will crash and there really she’s flying on an american-based commercial airliner there really isn’t any when you look at the proportions so okay there’s there have been a couple of crashes over the past 20 years and in a couple of those there were some fatalities no doubt but looking at the proportions and running the numbers what’s the likelihood in what ways this is similar to other situations that you have felt terrified you know maybe there haven’t been any other situations where she’s flown and gotten through it and been like score I did that but what other situations have you had to get through that you were terrified and how did you deal with those help people develop distress tolerance skills one of the things I told her was when you’re sitting on the airplane and you know the airplane starts up don’t wait til you start getting really stressed necessarily but when we were little on the car when we’re in the car we used to find things on the drive find something that starts with a and everybody would find something that started with a and then find something that starts with B and you know so on and if you couldn’t find something that started with that letter you were out so I mean she’s going on this trip with her kids and I’m like why don’t you try doing that because there are some letters that you’re going to have to work really hard and it’s kind of like the game apples to apples you end up finding something really inane in order to get that letter and you laugh and you’re so busy focusing on that you’re not focusing on all of the things that could possibly maybe go wrong other distress tolerance skills you know you can go through the whole DBT curriculum and learn some of those the biggest thing is if you have to face the terror if you have to go through it figure out a way to not have to focus on it and fight it and go I shouldn’t be afraid I shouldn’t be because that doesn’t work if it worked we wouldn’t be talking about it and develop emotional regulation skills so prevent those vulnerabilities set yourself up so you are as prepared as you can to not feel stressed to not feel anxious she has her spouse with her who can help diffuse some of it she’s got her kids with her she downloaded some movies she’s prepared to endure the distress she’s you know trying to go into it with a positive mindset as much as possible and focusing on the destination which you know is ultimately the reason she’s getting on the plane social causes of stress and thinking errors everybody’s doing it well that’s not true there’s very real that everybody does so correcting misinformation how the client gather objective information about you know if they say well everybody else that I know has succeeded okay well let’s gather objective information about that who do you know and tell me if they’ve succeeded if I want to be liked I must do it this need for approval or low self-esteem can cause a lot of problems in thinking errors and fears of rejection so we say okay let’s look at developing some self-esteem so you don’t need to worry about if somebody likes you what would it be like if you woke up in the morning and you didn’t care if so-and-so liked you I mean we all want to have friends don’t get me wrong I’m not saying you want to be her moving out in the woods but if we’re talking about a particular so-and-so what would it be like in the morning to get up and go you know what if that person messages me today or call us me today that’s great and if not I’m okay with that how liberating would that be to get your power back and how people develop social supports that share their same values and goals at least mostly or at least can respect yours so for example when you know I work with people with co-occurring disorders and they don’t drink and they don’t use drugs so they may be around people family friends who drink if you’re going to be in that situation do you have to drink and can you be around do you have social supports that can be supportive of your choice to not drink doesn’t necessarily mean they’re it’s not going to not going to not drink in front of you but at least they’re not trying to get you to drink so the social causes of irrational thoughts if I want to be liked I must do this why can’t you be like for who you are cognitive bias negativity mental filter focus on the negatives and worry about the future most of us know some people like that most of us have had a moment where we felt like this we’ve just gotten ourselves in a tizzy and spun out of control but you can bring it back so you want to ask yourself or have your clients ask themselves what’s the benefit to focusing on the negative if you know that this is going to go south really fast what’s the benefit to just focusing on that could you focus on alternatives or Plan B’s what are the positives to the situation most people who have mood issues who present to us in counseling don’t focus on both sides yes every side you know has a little bit of negative to it if you really want to look hard enough but every side also has a silver lining if you really want to look hard enough so we need to balance the the positives and the negatives so encourage people to look for the positives in the situation yeah this really sucked but and what are all the facts what are all the things going into it sometimes people will go to work and not know or wonder if they’re going to get laid off because you know you’re not necessarily always guaranteed a job anywhere there can be layoffs but if somebody is going to work every day worried about this focusing on the negative up yep I’m definitely going to be the one that’s going to get the pink slip and they go to their mailbox each time looking for that pink slip expecting it to be there how is that going to affect their mood as opposed to alright there may be layoffs coming what can I do to make myself really valuable or and what are my options if I do get laid off let’s make a plan B and C so I don’t just feel like the rug was pulled out from under me coin toss activity if somebody tends to be stuck in negativity have them flip a coin every morning if it lands on heads they can just see their normal selves to their heart’s content if it lands on tails they need to act as if they are a happy positive optimistic maybe even a noxious ly optimistic person for the entire day you know we want them to be farting rainbows and when I say that they usually look at me and laugh and but that’s okay I’m like every time you start having a negative thought I want you to see a unicorn farting rainbows and take it from there and then have them process how they felt at the end of the day if they weren’t constantly focused on negativity and worrying and only seeing the bad stuff disqualifying or minimizing the positive if something happens when somebody says well I just got that promotion because they didn’t have anybody else to give it to okay if your best friend just got a promotion would you say that to them what is scary about accepting the positive about accepting the fact that maybe you got the promotion because you’re awesome sometimes we disqualify the positive because it fails to meet someone else’s standards so might that be true here you know maybe you got this promotion and you’re actually down deep down inside kind of proud of it but you know that your mother had always wanted you to be this over here and you’re never going to meet that expectation so you minimize it that way nobody else could say well you know better than nothing and take away your thunder egocentrism my perspective is the only perspective take different perspectives I always say three if something happens and you know maybe somebody was rude to you anyone they were rude to me okay they were rude to you what are three reasons what are some alternate perspectives why that person might have been rude maybe what you did something that triggers them maybe they were having a bad day and it’s got nothing at all to do with you you know there are options that we can look at personalization and mind-reading what are some alternate explanations for the event that didn’t involve you if you think well that person that person just really doesn’t like me and you know I’ve got to work with them every day and they hate me my question to my client would be what what’s the evidence for that and what are some alternative explanations for why that person may be behaving that way I had a staff member that a lot of my other staff members had difficulty getting along with and ultimately you know we had to sit down and look when I had some different staff meetings with people and say you know what gives you the idea that she doesn’t like you what gives you the idea that it’s about you and you know they cited all kinds of behaviors and I had to come back to well what are some alternate reasons why somebody anybody not just her might be expressing those behaviors could it be something besides you and of course they came back – yeah availability heuristic remembering what’s prominent in your mind if somebody was if you’re a supervisor for example and you’re doing evaluation for the year what are you really remembering when you’re doing that evaluation the whole year or the last three months and that’s the event fail ability heuristic so when you’re talking to somebody about their relationship with their best friend or their spouse or their kids and if somebody says well that that child has always been a problem okay let’s look at that you know the child is 18 and you’ve had a lot of problems with him lately but what about three years ago so was he always a problem or is this something that’s relatively new that something might have changed magnification people getting stuck on fearing the absolute worst so you want to ask them is this a high probability or low probability outcome if they’re magnifying something that happened like oh my gosh that is the worst thing in the world is this going to matter six months from now maybe you totaled your car and yeah that is a huge bummer and you’re safe in six months is this really going to matter that much you know there are going to be some bills and everything but the big scheme of things is at the end of the world what have you done in the past to tolerate events like these when something really really unpleasant has happened and then if they’re looking at dichotomous ways of thinking which a lot of our clients still do they’re like someone so it always does this or never does this have them look at the differences between love versus hate perfection versus failure and all good intentions versus all bad intentions because a lot of our dichotomies fall in one of these three categories this person always does this or Never or does it intentionally or you know just doesn’t care belief in a just world the fallacy of fairness encourage people to look for for good people they know that have had bad things happen attributional bearers are labeling yourself not a behavior such as saying I am stupid instead of I don’t have good math skills I am is difficult to get rid of I can’t get rid of stupidity if it’s part of me but if it’s a thought or a skill I can either get rid of it or improve it stable I am means I am right now and I probably always will be stupid verses I can change this thought or skill I can learn math and internal attributions mean it’s about me as a person versus about a skill or skill deficit or something completely unrelated so when somebody makes a global internal negative statement we want to help them challenge that global internal positive statements I’m all about but the negative ones I want to say let’s take a look at that is that true that this is about you all of the time and it means that there’s something wrong with you so we want to ask them how are these thoughts how are these ways of thinking impacting your emotions health relationships and perceptions of the world we want to increase motivation to start looking at these spanking errors because it’s a lot of work to start changing the way you automatically think because you’ve got to stop you’ve got to become mindful and then you’ve got to decide well what are the alternative thoughts because this is what I thought for so long how may have this thought has been helpful in the past most of the time thoughts we have came from somewhere and whether it was a thought we had when we were a child something we learned when we were a child that is dichotomous and not quite applicable anymore it may have been helpful in the past to help you navigate situations doesn’t mean it was wrong it means it’s not helpful in the present asking them to always ask themselves is this thought or feeling bringing you the client closer to those people and things that are important to you it’s hanging on to this negativity bringing you closer and and I like the energy philosophy if you will when you are unhappy you are letting this person have your power you are letting this person make you angry when you decide you are not going to give them your power then you may start feeling happier and I don’t always use that with clients but sometimes the power metaphor help when we talk about thinking Ayers asked them are there examples of this not being true and and or how can a statement be made less global stable and internal is it about you or is it about what you do at work is it about you or is it about your relationship with this particular person so the last couple of slides focusing on some of the irrational thoughts or unhelpful beliefs our basic fears are rejection and isolation failure loss of control the unknown and death generally the things that cause people to have this fight-or-flight reaction fall into one of those categories so some of the unhelpful beliefs that we hear a lot coming up when we do the ABCs is that mistakes are never acceptable so if I make one I am incompetent so we’ve got dichotomous thinking and we’ve got a lot of internal global labeling here rejection and isolation when somebody disagrees with me it’s a personal attack against me well sometimes it is what does that mean it’s about you we’re helping them address the rejection and isolation fears we want to ask them you know if they disagree with you were they attacking you and saying you were stupid or were they attack attacking you want to use that word or were they attacking the thought and saying they disagreed with the thought there’s a little bit of a difference it’s somewhat semantics but it’s a difference because they may have a lot of respect for you but they may disagree with what you just said if someone criticizes or rejects me there must be something wrong with me again that’s one of those internal global negative statements to feel good about myself others must approve of me we want to make sure our clients can self validate and they don’t rely on external validation because they’re setting themselves up for a world of hurt if they are not their own best friend to be content in life I must be liked by all people and thanks for a second are you liked by everybody I know I’m not liked by everybody so does that mean that I should not be content in life and what does it say to give people that power to say if you don’t like me that I can’t be content because I’ve got to be liked by everybody sometimes with clients I’ll help them look at what may be going on with the other person why that person might like them because a lot of times other people’s reactions towards you are more about their stuff than about you and helping them see how that might be true my true value as an individual depends on what others think of me so these other unhelpful beliefs pertain to those thoughts of failure and loss of control none of us likes to fail don’t get me wrong it’s not pleasant but it happens and there is a saying out there that says if you haven’t failed you haven’t tried which means we need to get beyond our safety envelope we need to push ourselves behind beyond our boundaries and when we do sometimes we’re going to stumble and fall and we pick ourselves up and we learn from it but to expect to never fail at anything is not realistic so nothing ever turns out the way you want it to how many times have you heard that from your clients I won’t try anything new unless I know I’ll be good at it I’m in total control and anything bad that happens is my fault so let’s look at this locus let’s control thing here you’re in total control so you can make it rain you know it was unpleasant today because I had to come to work and it was raining outside so that was bad it happened was it your fault pointing out and depending on your relationship for your client you’re probably going to be more or less snarky when you present some of these but a lot of times I have a semi joking relationship if you will with my clients and they’re like yeah I see your point that kind of didn’t make a lot of since other times you know if they’re more serious I’ll ask them to identify things that happened that were bad that they had nothing to do with if I feel happy about life something will go wrong or I’m always waiting for the other shoe to drop helping people stay focused in the moment with mindfulness and something’s going to go wrong down the road somewhere sometimes yeah it’s true this will happen let’s enjoy what we’ve got for right now the past always repeats itself it was if it was true then it’s true now so what was true when you were ten is true now that you’re forty always is that true it’s not my fault my life didn’t go the way I wanted everybody conspired against me and there’s no gray area so for people who feel the need to hold on to control its dichotomous it is or it isn’t it’s got to be that way there’s no gray area and it can make life be seem very uncomfortable because they’ve got to put things in one of two buckets and sometimes things don’t fit nicely in buckets what happens if we add a third bucket that both an bucket so a quick note about irrationality the origins of most beliefs were rational and helpful given the information the person had at the time and their ability to process that information because of their cognitive development so things that we identify as unhelpful or automatic beliefs now came from somewhere and they made perfect sense whenever they were formed they may not be healthy or helpful now which is why we want to look at them and either adjust them or just throw them out the door but when they were formed they were on point irrationality or unhelpful nasaw thoughts comes when those beliefs are perpetuated without examination so again we need to look at them continually look at what you’re telling yourself and go is this still accurate and continue to be held despite causing harm to the person sometimes you’re going to look at a thought an automatic thought and you’re going to go yeah that is still spot-on now is holding on to this helping me achieve my goals you know yet the world right now is kind of a scary place is holding on to this fear and terror helping me and be a happy productive yada-yada whatever kind of person you want to be or is it causing me to feel anxious and angry and scared sometimes it’s more productive for clients to think of thoughts as unhelpful instead of irrational because like I said I feel like irrationality and distortions seem very pejorative to a lot of clients so questions clients can ask themselves when they are faced with a situation what are the facts for and against this belief is this belief based on facts or feelings just because you feel scared is it a scary situation does the belief focus on just one aspect or the whole situation does the belief seem to use any of those thinking errors we talked about and if so you know what do I need to do about it what are some alternate explanations for this belief what else could have caused this to happen besides whatever I’m afraid of what would you tell your child or your best friend if they had this belief what would you took what would you want someone to tell you about this belief you could have somebody tell you something that would make you feel okay what would you want them to tell you and how is this belief moving you toward what and who is important to you remembering that beliefs are a combination of thought and fact and personal interpretation of those thoughts and facts I tend to when I talk you know you see me I kind of I’m all over the place with my arms I am a animated talker now if you are seeing me from a hundred feet away and you are seeing me talk might think I was angry because I make a lot of really big gestures because if you had grown up in a situation where there was domestic violence or something but if you had grown up in a household like I did where you had a first generation Italian first generations of ten Italian Americans talk big they talk real big with lots of gestures and sometimes loud and that doesn’t necessarily mean any anger a lot of times it’s just pure excitement so understanding that there’s thoughts in facts you know you see this going on but your personal interpretation can really affect what you get out of it or what you perceive that situation to be so we need to look at how is your personal interpretation maybe adding a negative bias and what what do we do about that it may be 100 percent accurate what do we do about it so it doesn’t keep you miserable thoughts impact behaviors and emotional and physical reactions emotional physical reactions impact thoughts and your interpretation of events irrational or unhelpful thinking patterns are often caused by cognitive distortions my two favorite words in that same sentence cognitive distortions are schemas or shortcut ideas or memories if you will which were formed based on faulty inaccurate or immature knowledge or understanding of the event you know little kids may not have quite understood what was going on they just understood that mommy and daddy were screaming identifying the thoughts the hecklers I call them those negative voices inside your head that are maintaining unhappiness helps people choose whether to accept the thoughts and say yeah you know that’s right I really am not good at that or whatever the negative thought is and change it or let the thought go are there any questions you you thank you miss Benson well thank you all if you come up with any questions you know you’re mulling it over later and you think you know that yet I’ve worked with a client and with something similar and I did this or you know you have a question about something I said feel free to email me the easiest one to remember is support at all CEUs com there’s only two others in the office so either my husband gets it err I do so it’ll get to me and I guess that’s it so I will see you all on Tuesday if you have any types of courses that you want to see added to the list please let me know I’m always interested in doing what you want to learn about not necessarily just where I pull out on my rabbit hat yes you can print the slides in the golly golly golly when you go into the class there’s a link that has a PDF of the slides that you can print if you want to print go ahead and print those out the video version of this will be up on YouTube by tomorrow morning maybe later this afternoon you okay everybody have an absolutely amazing rest of your day and weekend if you enjoy this podcast please like and subscribe either in your podcast player or on YouTube you can attend and participate in our live webinars with dr. Schneider by subscribing at all CEUs calm / counselor toolbox this episode has been brought to you in part by all CEUs calm providing 24/7 multimedia continuing education and pre certification training to counselors therapists and nurses since 2006 use coupon code consular toolbox to get a 20% discount off your order this month.As found on YouTubeSeanCooper🗯 The Shyness & Social Guy ⇝ The 3 WORST Mistakes You Must AVOID If You Want To Overcome Shyness (PLUS: 1 weird trick that targets the root biological cause of shyness so you can stop being nervous, awkward, and quiet around people…) By Sean Cooper, The Shyness & Social Anxiety Guy. The fact that you’re reading this article tells me you may have already reached a point where you feel your shyness is NOT going away on its own… 732d01adf780998f105af3460737a431 or you fear it’s getting worse and worse. And I don’t want you to waste one more day living a life where you feel left out, bored, or depressed because you don’t have the relationships which would make you happy. That’s why I’ve put together this page to help you avoid the worst mistakes that keep many people stuck with shyness for years… often giving up hope of ever improving as you watch other people have interesting “normal” lives without you. Yet this doesn’t have to happen.

Cognitive Behavioral Therapy (CBT) Skills and Counseling Techniques with Dr. Dawn-Elise “Doc” Snipes

 CEUs are available for this presentation at AllCEUs.com/CBT-CEU Hi everybody and welcome to today’s presentation on cognitive behavioral therapy skills. Like the other the presentation we did on assert not assertive community treatment acceptance and commitment therapy, which is also based on just providing information about skills that can be used not providing an evidence-based practice we couldn’t cover that in a full hour or just an hour so over the next hour we’re going to define cognitive behavioral therapy and its basic principles a lot of us are familiar with this but it’s going to be a good review and it also may highlight some nuances that you didn’t know about will identify factors impacting people’s choice of behaviors explore causes and impact of thinking errors and identify common thinking errors and their relationships to cognitive distortions so why do we care well as therapists we want to help people figure out the best way to live a happy healthy meaningful goals-driven life for some people that’s going to mean using some cognitive behavioral interventions that can be in addition to mindfulness that can be in addition to a lot of other things but it’s important to help people understand that the way we believe things to be the way we interpret things is going to affect our reactions so for example think about a situation you know you’ve walked into and maybe you walked into it with a small child and it was a different situation it was a new situation but you know it was no big deal you walked in it was not a threatening situation to you because you were like hey I got this the little kid walks in and goes oh wow there are a lot of people walking around here, this is the really scary same situation as two different perceptions you probably didn’t have much of a stress reaction going on whereas the little child probably had this fight-or-flight thing going on grabbing onto your hand like please don’t let go Atlanta Airport is a perfect example if you’ve ever taken a little kid through Atlanta Airport it gives you an idea about how people can perceive things differently and when you enact that fight-or-flight reaction you’re going to have all those stress hormones you’re going to have all either anxiety or anger or whatever that goes with it it may serve to exhaust the person and leave them feeling hopeless and helpless so what we want to do is help people see that but we also want to help them see that when they’re depressed when they’re tired when they’re sick things are going to seem a lot worse a lot of times because they don’t have the energy to perceive it differently I mean when you’re sick it’s overwhelming to think of going through Atlanta Airport so this is what we want to help people start understanding is it’s two sides of the same coin they interact if one is you know kind of going wonky is going to affect the other one the good thing is if one’s going really good the other one’s going to go good if you’re having positive thoughts you’re probably going to feel pretty good there’s an activity and I think we’re going to talk about it later it’s called the coin flip activity and I asked client clients to flip a coin in the morning and in the morning if it turns heads then they have to be the most positive Pollyanna all day long look for the silver lining and everything smile walk with their head up hold those nonverbals up and see how they feel at the end of the day besides a little sore because there are muscles they’re using they haven’t been used in a while if it lands on tails they can just be their normal selves which generally if they’re seeing me means that they are depressed anxious stressed out angry about something in the negative realm then we talk about how did things seem different on the days when you were feeling better when you were walking taller when you were smiling even our nonverbals it doesn’t even have to be sickness it can be our nonverbals that can make us feel or make our body feel heavy and tired and make it seem like it’s a whole lot harder to deal with life as a person who perceives the world generally good and believes they can deal with challenges as they arise that good old self-efficacy will be able to allow their stress response system to function normally so if they’re like you know what I can deal with whatever life throws at me I’ve got it and maybe I need help with it maybe I’ll need to ask for support but I’ve got it it’s not going to completely overwhelm me with people who see the world as hostile unsafe and unpredictable you know for a variety of reasons whatever happened to make their scheme as such that they don’t believe that people or the world is trustworthy are predictable they are always on guard they’re always kind of like a hamster in a cage that has Have you ever had a hamster hamsters don’t recognize you and go hey that’s my own or human contact score hamsters go run under their little house and you just kind of open the cage and stick your hand in there and flip over their house and you’re like come here and give me cuddles and you’re like you know 200 times bigger than they are so the little hamster is like freaking out this is what it’s like for people and obviously, I’m exaggerating but this is what it’s like for people who have a negative perspective a negative view or a hostile view of the world so kind of keep that little hamster in your mind cognitive behavioral therapy we have core beliefs those things that are in our hearts when I talk with my clients about honesty step one and that’s what they’ve got to do to start recovery is get honest with themselves first and then other people we talk about head heart and gut honesty do you think it’s right does it seem like the right thing to do does it feel right in your heart you know does it make you happy it doesn’t make you feel good and then the spidey senses is your gut saying and or is your gut fine if one of those is saying this might not be the right choice and we need to think about what’s going on so we have those core beliefs and I put them in the heart just because that’s the middle of the head heart and gut but you have core beliefs about yourself whether you’re good with you’re bad whether you’re effective at certain things yada yada you have core beliefs about other people same thing good bad effective predictable and you have core beliefs about the future and a lot of that goes with the locus of control but also your past experiences if the world in the past is seemed unfriendly and uncontrollable and you’ve perceived it that way then you’re going to expect the future to be uncontrollable so what we want to do is help people look at their schemas and their core beliefs about themselves others in the future and figure out kind of what they want it to look like these schemas are going to affect your behavior and your thoughts and your feelings and you know you can pick wherever you want to start it doesn’t matter because all three inter interface with one another so if you haven’t let’s start with negative thoughts if you have negative thoughts then you might feel anxious angry stressed dysphoric which will affect the behavior you’re going to do different things than if you have positive thoughts about something you feel excited and energized you’re going to have different behavior the best thing example I can give you is if you’ve ever done public speaking or had to present something some people detest public speaking it’s just terrifying for them to get up in front of a group of people so their thoughts am I going to trip up I going to forget what I’m going to say I’m going to make a fool of myself I’m going to you know it can go on forever that when you get on a roll you can get on a negative roll and go on forever or positive hopefully get on that roll with those thoughts you start holding onto those thoughts remember as we talked about in a CT the other day when you hold those thoughts and you kind of mush them around in your mind and you come to believe them that you’re going to make a fool of yourself and it’s going to be awful you’re going to start feeling terrified likely which is going to likely affect your behavior if you go out on the stage and you’re terrified you’re going to probably stutter you’re probably going to get foggy-headed you’re going to have that fight-or-flight reaction so there’s an the adrenaline rush and you start sweating and you can’t focus and you can’t concentrate you want to away as opposed to somebody like me who loves public speaking and I’m just like cool I get to go out there and try to engage however many people are in the audience it’s a game for me because when I can see your faces I enjoy trying to figure out and make eye contact with people and figure out what it is that they’re there for what is it that’s going to make them tick what resonates with them so my behavior as you can kind of see right now when I go out there I’m excited and I want to engage people and it’s a fun experience for me again just like the airport the same experience for two different people and two very different interpretations and reactions to it so what effects I don’t like the term rational but when we’re talking about CBT irrationally comes up a lot I like to replace it with helpful because every behavior in its weird sort of way is or probably was rational at one time that being said we’re going to get back to that stress affects our behavioral choices if we’re under stress we can have negative emotions negative emotions will affect our thoughts if we’re feeling sad we’re probably going to look at the dark side if we feel sad we’re going to look at the bottom falling out if we’re happy we’re probably going to look for that silver lining physical factors if you’re in pain sick sleep-deprived poorly nourished so your body can’t produce the neurotransmitters it needs to or heaven forbid intoxicated you’re probably not going to make the same decisions as you would if you were comfortable healthy well-rested nourished and not intoxicated any of those things can go impact how you perceive a situation or how you react in a situation, especially the intoxication whereas in your non intoxicated State in your sober state, you may think that you want to do something but then you’ve got that filter that goes not not a good idea in an intoxicated State or even in a manic state if you’re you know if you have somebody with bipolar that filter kind of goes away so the behaviors that someone may normally not do because they have a rational filter that goes you know punching this guy outs probably not the best idea right now the filter goes away when you’re sleep-deprived you’re less generally people are less patient generally people don’t have as much of a filter thing about watching your children if you have children or your grandchildren or even yourself I know myself when I’m sleepy I am giddy as all get-out and things I wouldn’t normally say because they’re you know stupid I’ll just come out and say anyway and my kids just roll their eyes or the mom you’re overtired could go to bed, uh but that’s okay you know I’m okay with that in that situation now if I acted that way at work it would be a worse thing environmentally if you’re introduced to a new or unique situation and you perceive it as stressful because the unknown we know can be stressful then you may not make as rational of a choice or as helpful of a choice because you maybe trying to escape the same thing as exposure to UNPROFOR bellowing for a the word here but UNPROFOR ball is the best I could come up with we all prefer certain situations some people as I said would rather do just about anything then get up in front of a lecture hall of a hundred and fifty people and talk but if they have to do it then they’re going to be under stress which may affect how they do things so we want people to understand that their perception and their feelings are affected by a lot of other things not just you know an emotion here or a particular memory there’s a lot that goes into it and social if peers your family convey irrational thoughts as necessary very standards for social acceptance people may tend to cling more to it to those unhelpful thoughts and unhelpful behaviors you know in CBT they say irrational because quote nobody wants to associate with those people you know who are those people and why can’t we associate with them there are a lot of things if you think back think high school you know high school is pretty rough if we’re going to talk about having irrational thoughts and cognitions if you have to be part of this particular group to be accepted you have to do this you have to do that but do you do those kinds of all-or-nothing statements are cognitive distortions and while they may have served a purpose in some way shape or form in the past we need to encourage our clients to take a look at them now and go are they still helpful ways of thinking is it still helpful for me to think that I am only successful if I live in a million-dollar house in a gated community and do this that and the other or can I be can I define success a different way or do I define success differently and lack supportive peers to buffer stress so we had those peers that caused stress by talking about the half dues and categorizing and lots of attributions but then there’s also not having somebody to go you know does this make any sense because sometimes we are our own worst enemies and if we go to a friend and we go you know this is what I’m thinking and I think I have to do this in order to be acceptable to be loved or you know whatever the case may be most people are not going to use those exact phrases a good friend is probably going to listen and go yeah you’re right or no no that’s way off so supportive peers are essential to reminding us to consciously regularly check in with our cognitions to make sure that they are hopeful and rational so a note about irrationality and this is mine this is not from CBT the origins of most beliefs for rational and helpful given the information, the person had at the time and their cognitive development their ability to process that information so concepts and schemas and core beliefs that people formed when they were five are probably going to be very egocentric you know the person is going to feel like everybody sees it my way because this is how I see it you know just like a five-year-old does a five-year-old doesn’t think well you know let me take Johnny’s perspective is no he assumes that Johnny sees it the same way so it’s going to be egocentric it’s probably going to be focused on only one aspect of the situation because small children can’t focus on multiple aspects and it’s probably going to be dichotomous it’s all-or-nothing Mommy loves me mommy hates me and it could be personalized you know everything a lot of kids think that everything has to do with them so if something happens something bad happens many times children will take it personally or be afraid it’s going to happen to them again you know if hurricane katrina hurricane Andrew those sorts of things you know we saw a lot of trauma in children and they developed very real fears about thunderstorms and hurricane season and if you’ve watched Florida hasn’t had a notable hurricane in years now but there’s a lot of stuff that goes into that but young people during some of those really bad hurricane seasons perceive those situations differently okay so we need to help people understand that if we especially if we use the term irrational those thoughts you formed when you are knee-high to a grasshopper and they made perfect sense to you back then but now that you’re an adult you’ve got more experience and you’re able to take different perspectives your brain is more developed let’s take a look at it and see if you can look at different perspectives and come up with something a little more helpful maybe a different way of perceiving this situation the irrational irrationality or unhelpful Nosov Fox comes when those beliefs are perpetuated without examination so something a belief that you formed when you’re five you’re still holding when you’re 35 and you’ve never questioned it you’ve never gone you know does this make sense is this is helpful to get me to where I want to be most of us don’t know we form these attitudes and beliefs when we’re you know growing up when we’re in elementary school middle school high school from watching TV to being around our peers from being around our family in our community and we get all this input of the way things should be and a lot of times people don’t stop to question and go and go well does this make me happy is this really what I want and they can be irrational if they continue to be held despite causing harm to the person so the person continues to hold this belief even though it is causing them general emotional cognitive harm is making them miserable we need to look at why what’s motivating them to hold on to that belief why is that belief so important and how can we make it so they can live a happy values-driven life emphasis on the happy how can we make it less harmful sometimes it’s more productive for clients to think of these thoughts as unhelpful or helpful instead of irrational sometimes when I say irrational to clients and you know I’m the same way if somebody says you’re being irrational I’m like oh I’m not it elicits this instantaneous defensive reaction it’s like when you tell them they’re being resistant they’re like I am NOT rien resistant so helpful or unhelpful and then we talk about why it is unhelpful in getting them toward their goals basic principles of cognitive behavioral therapy we teach or help clients learn to distinguish between thoughts and feelings I can think something is scary I’ll probably feel it but if I have an automatic you know feeling I walk into Atlanta Airport and I see yeah I went to an airport in New York I can’t even remember which one it was because my plane was diverted and I got off and I walked out there and I have never seen so many people packed in his place like sardines before in my life I was just completely overwhelmed that was kind of an automatic feeling now that was a feeling based on you know who knows it was overwhelming to be surrounded by that many people so then I had to separate the thoughts and go okay what am I thinking that’s making me feel so overwhelmed and at that point you know I didn’t know how to get to my gate and all that other sort of stuff with traveling I don’t travel well but encouraging clients to stop and go okay why am I feeling this way what are my what thoughts am I having that are contributing to these dysphoric feelings CBT helps people become aware of how thoughts can influence feelings in ways that are sometimes not helpful we have hecklers in our gallery the automatic tapes that we plaything memories that we have whatever you want to call them that when you try something when you are just going through daily life you hear these voices in the back of your head and not real voices but that is saying you’re never going to make this or if you would have just blah blah blah then you’d be a the better person helping clients become aware of those thoughts and how they’re negatively influencing their feelings and keeping them kind of stuck is a huge part of CBT we help them learn about thoughts that seem to occur automatically without even realizing how they may affect emotions again those thoughts from they’re saying you’re not good enough you’re not smart enough and nobody’s gonna like you where did that come from and do you believe it you know maybe it came from somebody when you were in high school so was that a valid source maybe it came from somebody yesterday on Facebook was that a valid source taking in those thoughts and then figuring out is this something I’m going to hold because it makes me happy or is this something that I’ve got to deal with because I’m having a negative reaction constructively evaluate whether these automatic thoughts and assumptions are accurate or perhaps biased the other thing to remember is a lot of our clients not all of them but a lot of them hold themselves to a standard there’s like up here and they hold everybody else to a standard that’s down here so they are a failure if they don’t achieve this but everybody else is successful as long as they achieve this so encouraging them to take a look at how accurate and biased or unbiased are the thoughts and like I said they may be their thoughts they may be telling themselves these things evaluate whether the current reactions are a helpful and good use of energy or unhelpful and a waste of energy that could be used to move toward those people and things important not impotent important to the person road-rage you’re in the car you’re driving somebody cuts you off okay natural reaction fight or flight reaction you’re just like slam on the brakes and do whatever you got to do aversive maneuvers you’re good so you could let it go at that point ago got Lucky on that one and keep driving most people not all but most they found that 80% of drivers have reported incidences of road rage which is a high number but most people will start getting all fired up and irritated and grumpy and we and just rageful and so my question would be I hear that and I hear that it made you angry in retrospect did screaming at the person as you pass them at sixty miles an hour in your car with the windows rolled up does any good did it do any good at all what else could you have done with that energy if you wouldn’t have expended it all yesterday we had to wait for the vet to come by and my daughter just completely wore herself out worrying about when the vet was going to get there what he was going to say about her donkeys and was beside herself so by the time it got to evening and it was time for her to go to her martial arts class she didn’t have the energy to go she’s like um wiped out I just want to go to bed in retrospect we’re looking back and saying okay now tell me what it was that you were so stressed out about and let’s talk about whether that was a realistic and helpful line of thought to perseverate on all day long and what could you have done differently because she didn’t bother to mention any of that to me yesterday and then developed the skills to notice interrupt and correct these biased thoughts independently causes of these thinking errors information processing shortcuts when we form schemas and we encounter a situation that reminds us of something in the past like when I go to my grandmother’s house I have a schema I have a belief system I have you know stuff that I know about my grandmother’s house so when I go to my grandmother’s house it’s kind of a shortcut to knowing what to expect when I walk in and how to behave how to do different things and it helps me plan and predict if you’re using outdated or dichotomous all-or-nothing schemas it may cause thinking errors because you may be now incorrectly processing current events mental noise some of us have it a lot of us have it not everybody thinks about trying to focus and study for a final exam in the middle of a really busy sports bar okay this is a cause of thinking or you’re going to miss important things you’re not going to be able to focus you’re not going to necessarily attend to the correct things because there’s just so much else going on your attention is drawn in 17 different directions and or the brain’s limited information processing capacity due to age we talked about that before young kids think all or nothing they think dichotomously egocentric ly middle school-aged kids and older start developing the ability for abstract thinking, by the time we get older, you know as adults theoretically we’re able to you know think pretty well and think pretty clinically about different events but if we’re in crisis when someone is in crisis and it could be like what we think of clinically as a crisis or it could be they’re just completely overwhelmed and burned out and have been burning the candle at both ends for three months they’re not going to process information quite as well they’re not going to take in all this stuff because they’re just like shell-shocked have you ever seen teachers in the hallway of like an elementary school Oh at the end of the second nine weeks they just kind of stand there with this blank look on their face they’re not processing as much as they were the first day of school and you know God loved them they have a lot to deal with but we need to help our clients understand that there are some times that they are going to have to really stop and focus write things down so they can remember or they can make decisions a little more my guess is most of us have times in our life when we’ve been able to think through complex problems but then there are other times where you just can’t keep it all in your head and you’ve got to put it on a whiteboard maybe that’s just me but we want clients to understand that they are not broken they’re not faulty they’re doing the best they can with the tools they have and the knowledge they have and our job is to help them see where some of this might have gone a little awry other causes of thinking errors and emotional motivations I feel bad therefore whatever I’m thinking must be bad if I’m scared that means whatever it’s coming on the other end of the phone is bad news moral motivations I did it because it was the right thing to do and that can be an excuse for doing wrong behaviors as well it can also be you know you can argue on the moral one social influence well everyone else is doing it so it must not be bad set that again a lot of times and this is where the frames approaching the motivational interviewing is helpful f stands for feedback about the reality of what’s going on is everybody doing it let’s look at statistics you know not subjective information let’s look at objective information so the impact of these thinking errors makes people want to fight or flee when they get upset and we use upset as a kind of this all-encompassing garbage term emotionally they get depressed or anxious we don’t want to feel that way anxiety and anger are flee or fight fight or flee it’s our body saying there’s a threat you got to do something depression is your body going I give up I just don’t I don’t even have the energy to do it anymore behaviorally some people withdraw because they shut down we all know people who get frustrated when they get overwhelmed when they start feeling hopeless or helpless they just kind of withdraw from everything and everyone’s addictions numb that out so they don’t have to feel the dysphoria sleeping problem and changes when we start being on that constant fight-or-flight hyper-vigilant sort of thing going on in the body is always sort of turned on which means you’re not going to sleep as well then the circadian rhythms get messed up which starts causing exhaustion and lethargy and then everything seems harder because you’re sleep-deprived and then you start thinking more negatively and more hopelessly you see where this is going it’s a downward spiral and eating changes some people eat a lot more because they’re eating comfort foods some people eat a lot less because their stomach is so torn up from the stress they can’t even think about holding anything down physical stress-related illnesses fibromyalgia gastrointestinal problems headaches neck aches backache you know the whole the gamut of it when you start feeling bad when you start hurting generally it gets frustrating after a while and that frustration makes it kind of raises the the bar brings you up a little bit so you’re that is much closer to kind of just kind of being overwhelmed you don’t have as much of a cushion as you would if you were happy healthy well nourished not in pain and socially a lot of times we will get irritable or impatient with other people or withdrawal when we’re having these negative cognitions these thinking errors that are keeping us in a dysphoric state these effects of thinking errors contribute to fatigue and a sense of hopelessness and helplessness which intensifies thinking errors this is an important concept that I want my clients to understand and I want to drive home in this presentation so thinking errors what are they emotional reasoning feelings are not facts and we want to help people to learn to effectively identify feelings and separate them from facts so if somebody says I’m terrified okay that is a feeling what are the facts supporting that feeling why are you are terrified what is the evidence that you are in some sort of danger right now you know and danger may not be the right word for your client at that a particular point in time but what’s the evidence that there’s a threat in what ways is this similar to other situations maybe it’s triggering something from the past that was scary or you know you were too little to be able to handle it but you can handle it now and how if you dealt with similar situations like this, in the past, we want to help people just step back and get some distance between their feelings and their thoughts and try to figure out you know which thoughts are helpful and productive and even if a sought makes people anxious or angry it can be helpful it may be telling them hey dude you need to get your butt up and get out of there if it’s helpful it means it’s moving them toward where they want to be happy healthy safe and values-driven life so happy and helpful developed a stress tolerance skills when people use emotional reasoning they feel emotions which then they start attributing finding the facts to support those emotions instead of looking at all the facts we want to help them learn to tolerate their distress so they can kind of let that subside for a second they can accept their feeling they can name they can say I’m scared I’m stressed I’m angry and whatever but they don’t have to act on it right then they can tolerate the distress for a minute without having to try to make it go away and emotional regulation skills they can feel a feeling without having to make it go from zero to 120 you know if they feel sad they go I feel kind of sad instead of grabbing onto it and going I wonder what I feel sad about I must feel sad about all these sad things now I’m going to be sad and devastated so we want to help people learn how to regulate their emotions identify them accept them whatever word you want to use and tolerate them because feelings are there for a reason they’re there to tell you your brain thinks something’s going now thankfully we have that higher-order cognition stuff going on so we can contradict our brain and we can go you know maybe that’s not true in this situation cognitive bias negativity mental filter whatever you want to call it people who focus on the negative they walk in they get up in the morning and they look outside and it’s partly cloudy they get to work and they said instead of saying there was it was very light traffic they said there was a fair amount of traffic everything is always the flip side of what somebody who’s optimistic would say so asking them what’s the benefit to focusing on the negative in what ways is this helpful to you you know some people say well it keeps me from getting disappointed because I know it’s going to end up negative anyway so we can trap challenges that know that whatever it is they think they know and see if there have been exceptions when it hasn’t turned out that way what are the positives to this situation I give the example a lot of you know I wash my car or it rains and maybe I wanted to go out on a run that day but I can perceive it I can look at the positives you know the rain washed my car for me so I don’t have to do it now score it watered my garden all the better it knocked down some of the pollen out of there even better I can find and I can encourage people to find positives in a situation yes there are negatives there are negatives to every situation if you want to find them you’re going to find them but if you want to find the positives you can too which takes us down to what are all the facts there’s the positive and the negative and the neutral I told you earlier about the coin toss activity having people toss a coin on the heads days they act like it is just the greatest day to be alive and see how things are different when they do their journal because you know I have my clients do I’m sort of a mindfulness check-in in the morning and in the evening and preferably at lunchtime how are they feeling what’s their emotional state what’s their energy level on the happy days a lot of times it can be less and sometimes they need a little coaching throughout because some of those old patterns kick in but I want them to start challenging some of their automatic thoughts that we’re going to talk about in a minute disqualifying or minimizing the positive most of us can probably say we’ve had a bunch of clients that do this they are more than happy to tell you about all the things that they mess up but then when they do something right they minimize it encouraging people to hold themselves to the same standard they would hold everyone else to and I know I talked about that earlier ask them things like would it minimum would you minimize this if it was your best friend’s experience your best friend came to you and said I just got into such-and-such college would you say awesome or would you say anybody can get in there how would that go ask them what is scary about accepting these positive things that you might have had an accomplishment for some people it means that it might mean other people expect more of them for other people they just don’t know how to accept the positive they don’t know how to accept compliments they don’t know how to be the center of attention and they don’t like it and then we want to look at why that is sometimes we disqualify the positive because it fails to meet someone else’s standards so as people might that be true here you know I know when I was growing up and going through college and going through school and everything got my doctorate but I will always be ever and always being not a real doctor because a Ph.D. is not an MD and I’m like really so is it somebody else’s standards or can I feel good about having a Ph.D. egocentrism my perspective is the only perspective I’ll being egocentric but it doesn’t work most of the time so encouraging people to take alternate perspectives maybe you’re texting with someone and they say something that is not that you interpret as not the nicest thing and this happens in text messages a lot and they get upset now an egocentric thinking error would say that purse is just grumpy today someone that’s taking other perspectives would stop and go back and read the text and go I wonder if maybe this could have been taken some another way you know cuz their reaction is not what I intended so egocentrism if you hold on to that I don’t understand anybody else because you know I don’t see a problem with anything personalizing and mind-reading this is when you assume that everybody’s frowning because of something you did your boss walks down the hallway and looks at you and grimaces and continues to walk on oh I must have done something wrong no maybe he just got out of his senior management meeting that was five hours long and he’s got to go to the bathroom you know there could be a hundred different explanations for why that happened so encourage clients to ask themselves what are some alternate explanations for this event that doesn’t involve me you know why might this have happened if they hold on to that, I must have done something wrong but as soon as their boss calls them up and goes hey can you come to my office for a second you know where their thoughts are going to go I’m getting fired I’m going to get laid off I don’t know what it was that I did wrong but he walked by me two weeks ago in the hallway and grimaced and I’m just I’m the worst person in the whole world but where did that come from so encouraging people to not necessarily assume they know what’s going on in someone else’s mind and not automatically attributing every person’s negative behavior to something they did how often and then ask them how often has it been about you now think about the last 10 times you’ve taken something personally how many of those 10 times has it been about something you did versus something with the other person then the availability heuristic remembering what’s most prominent in your mind so asking clients what are the facts ah the most obvious one that we talk about is plane crashes you know it is way dangerous to fly on a plane because you hear about all those plane crashes well yeah you hear about A few planes crash but you don’t hear about the 20,000 every day that land safely so you remember it and it seems more dangerous because that’s what is in your mind that’s what is available to you that’s what you’ve based your thought processes on because maybe you didn’t know that 20,000 planes or more fly and land just perfectly every day this can also be true with people remembering what’s most prominent in your mind sometimes and this can be very very true in domestically violent relationships if somebody falls in love with someone and that person is just the greatest person since sliced bread for the first four months and then the cycle starts and there’s this little tiny a sliver of the honeymoon period after the battering cycle and the person’s like that’s the person I fell in love with that’s what I remember and they try to focus on that that’s most prominent in their mind and they ignore the rest of the stuff so we need to encourage people to look objectively at the facts magnification are you confusing high and low probability outcomes what are the chances that this is going to happen how many clients have we worked with that have gone to the doctor and gotten in a physical or get a test run and then the doctor had to call them back and this could be true for you too and the doctor had to call them back two or three days later when the tests came back from the lab and that whole three days they were just in a panic because they were afraid they were going to get some terminal diagnosis so thinking about high and low probability outcomes another instance or example of magnification is somebody that thinks this is the end of the world whatever it I think I’ve told you before my little story about um tripping when I was walking down the hall at work and falling and yeah it was embarrassing my folders went everywhere and yeah but in that big scheme of things will it matter that much from now you know are people gonna think oh she is such a clutch she must be a ditz too no I mean they may have thought that at that time I don’t know but you know in six months nobody’s going to remember and then ask them in the past when something like this has happened when you’ve had to get a test done and you’ve had to wait on results or if you’ve done something that was embarrassing and you didn’t think you thought everybody was going to remember it forever.

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How did you tolerate it how did you learn to deal with it building on those strengths that they already have all-or-nothing thinking errors these are things like love versus hate I love them or I hate them it’s all or nothing she does this all the time or she never does it if I’m going to do it I’m going to do it perfectly or I’m not going to do it at all thank you all good intentions or all bad intentions you know sometimes we do things with good intentions that have some bad repercussions so did we do it with all bad intentions are all good intentions and the answer is neither most of the time life is kind of in that middle-ground gray area encouraging clients to look and find examples where something hasn’t been one of the polls when having they do something that they’re proud of that wasn’t perfect or when again when has somebody else do something that they were proud of that wasn’t perfect remembering that with availability heuristic remembering how often something happens and how long it’s been since you’ve seen that behavior and remember that sometimes good times are amazing but how frequent are they compared with the bad times another thinking error is a belief in a just world or a fallacy of fairness I just asked clients to identify for good people you know who’ve had bad things happen and in reality we all have bad things happen good people do bad people do in between people do attributional errors and this is a pet of mine you know labeling yourself is not a behavior so global versus specific and I am stupid versus I’m stupid at math I don’t have good math skills it’s not about me it’s about the skills I can change skills stable I am and I always will be versus it’s something I can change it’s something I can learn internally it’s about me as a person versus it’s about a skill deficit or something I could learn or change and there’s you know lots of information on attributions out there on the internet if you need a refresher on it but we find that a lot of people who have dysphoria have negative global stable internal attributions so questions for clients remember the beliefs equal thoughts and facts plus personal interpretation another way of saying it is reality is 10% perception is 10% reality and 90% interpretation so what are the facts for and against my belief is the belief based on facts or feelings does the belief focus on one aspect or the whole situation does the belief seem to use any thinking errors what are alternate explanations what would you tell your child or best friend if they had this belief how would you want someone to tell what would you want someone to tell you about this belief so if you’re telling somebody about this what are you hoping they’re going to say in return and finally, how is this belief moving you toward what and who is important to you or moving you away from what or who is important to you now they can do a worksheet and have all of these or you can pick one or two of these questions that are most salient for your clients but they can have kind of at their fingertips so as they’re going through the day and something happens they can ask themselves ok what’s an alternate explanation or you know whatever it is this is salient for that client’s irrational thoughts about how to do these thoughts impact the client’s emotions health relationships and perceptions of the world you know this is what we want to ask them how is this thought impacting you globally how may this thought have been helpful in the past where did it come from how does it make sense from when you formed it in the past when you’re dealing with it ask the person if the thought is bringing you closer to those that are important are there any examples of this thought or belief not being true and how can the statement be made less global less all-encompassing so it’s about a specific incident a specific situation less stable which means you can change it and less internal which means it’s not about who you are as a person but maybe something that you do or a skill that you have so we’re going to go through some of these thoughts real quickly here mistakes are never acceptable and if I make one it means that I’m incompetent well never is kind of stable and I am incompetent is kind of global, that’s also that extreme all-or-nothing thinking so you can see where these cognitive distortions end up leading to unhelpful beliefs when somebody disagrees with me it’s a personal attack well there’s personalization if I ever heard it before maybe it’s not about you may be they’re having a bad day and you just happen to be the unlucky target or maybe they’re disagreeing with you because they have a different point of view and it’s not a personal attack it’s just their point of view if someone criticizes or rejects me there must be something wrong with me personalization all-or-nothing thinking global stable and internal something wrong with me as a person to feel good about myself others must approve of me now this is one we’ve talked about external validation before and we can’t control other people to feel good about yourself how can you do that besides necessarily requiring other people to approve of you to be content in life I must be liked by all people Wow I’ve never met anybody who’s liked by all people I’ve never even met anybody who’s been hated by all people but it’s important to help clients see how this is dramatic to say all people and for them to be content then everybody has to like them I mean I like to be liked but if everybody doesn’t like me you know that’s pretty understandable my true value as an individual depends on what others think of me I would challenge this one this is all you know also, very personally internally I would challenge people to look at and say it so your child’s value as an individual depends on what other people think of he or most people would say no but the perspective thing nothing ever turns out the way you want it to okay all-or-nothing thinking and probably availability heuristic if something bad just happened then they may be focusing on that which causes them to focus on all the other bad things in the past that have happened not to focus on that is okay you know bad thing happen but look at all these good things I won’t try anything new unless I will be good at it this fear of failure fear of rejection it just really paralyzes a lot of people when they get stuck with that thinking the area that they have to be perfect I am in total control of anything bad that happens is my fault well that’s egocentric and personal if they think they’re in total control that’s their perception of how the world are they think if they’ve got everybody on marionette strings anything bad in the world that happens is their fault how powerful are they I feel happy about uh if I feel happy about life something will go wrong it happens sometimes but let’s look at times when you’ve been happy that something hasn’t gone wrong you know let’s get rid of that all-or-nothing thinking it’s not my fault my life didn’t go the way I wanted could be true but it seems like that’s making you unhappy so what do we do about that if I’m not in an intimate relationship I’m alone no, again that’s pretty extreme I’m either in an intimate relationship, or I am alone and a loner and you know it’s just me and my 17 cats which follows with there’s no gray area so encouraging people to look at what these beliefs are saying important thoughts impact behaviors and emotional and physical reactions emotional and physical reactions impact thoughts and interpretations of events so if you do something and it’s pleasurable and you have a great physical reaction you know let’s take bungee jumping or skydiving if you go out there and it’s scary but you do it and you’re just like whoa what a rush your interpretation of that is probably going to be good which means you’ll probably do it again if you go out there and it’s just the most horrible experience you’ve ever had you’re probably not going to do it again and your interpretation of it is going to be not good which is going to make it hard to understand why other people would do it irrational thinking patterns are often caused by cognitive distortions so let’s just look back at some of those because there are a lot fewer cognitive distortions or general ways of thinking about the world then there are thinking errors because there are lots and lots of thinking errors cognitive distortions are often schemas which were formed based on faulty inaccurate or immature knowledge or understanding and by identifying the thoughts of the hecklers you know the automatic tapes that are maintaining our unhappiness the person can choose whether to accept those thoughts or change them As found on YouTubeThe Destroy Depression ꆛ System-Cure Depression Naturally YOUR DEPRESSION HAS BEEN IN CONTROL LONG ENOUGH. It’s Time to Fight Back ☂🗯 “Depression Sufferer Of Over 20 Years Reveals His Simple 7-Step System That Gives You The Power To Destroy Your Depression, End Your Feelings Of Sadness And Hopelessness, And Get Your Life Back.” “This didn’t just change my life, it saved my life.

How to Release Fears and Traumas with Hypnosis

 Alright, we are living. Welcome, guys. Welcome to the journey within It’s a journey of deconstruction and reconstruction of death and rebirth and today, I’ve got a very special hello hypnotist the founder of Twin Ravens Hypnotherapy and Research J Robert, Parker, In The House. Thanks for having me, man. Thank you. Thank you, dude. I think this will be a fun conversation cuz I mean, we. Absolutely. We both study hypnosis and I’d be very interested to get your perspective, you know, and how you got into this. So, um yeah, if you can share a little bit about who you are, how did you even get into this strange world of hypnosis? Uh, that’s an odd story. Um so, previously before the pandemic had been working as a chef uh that restaurant was actually where I met my partner. We did the stereotypical line cook ends up with the waitress thing. Interesting. And uh the the pandemic hit. And I had kinda seen the writing on the wall long before it had an effect. Long story short, you’ll say we both ended up out of jobs and it failed me to kinda pull something out of my bag of tricks to make money. I live in a very, very small town and there’s not a lot of ways to go about that. So, I ended up reading tarot cards professionally. And I was making a pretty good living doing that. And I noticed that I was reading people’s fortunes so to speak. And more using the archetypes of the tarot cards. Uh reframe their problems to them and help change their perspective And I got a lot of satisfaction out of that. And I started looking into what is a way that I can do only that. Uh and of course in an abnormal way. That I can do that cuz why not? And the Facebook algorithm. uh that one random point but HMI in front of me. previous to that, I hadn’t had any experience with hypnosis. I wasn’t even sure if it was real. I was in that camp And I talked to someone from admissions and they intrigued me. I figured why not give it a shot? This seems very interesting. And I think I was about two classes into 101 before I got my mind blown. The first time I saw the physiological responses of hypnosis. The things that can’t be faked. That is just reactionary. it just blew my mind. And then eventually I got to perform hypnosis and then, eventually, I got to experience it and that was a profound thing because uh going to that school, taught me a lot about myself and one of the things I came to learn is uh a lot of what I considered to be unusual behavior in myself. Uh wasn’t and a lot of what I consider to be unusual behavior in others, was it? I was just very extreme on one end of the suggestibility scale and I remember in class, they were explaining the traits of the intellectual suggestible of it’s like, oh, cool. That’s me and I took the suggestibility test and I scored like, eighty-two, my first time I wanna say. Jeez, man, that’s such an interesting thing because you’re, I mean you’re so rare and for you to be in hypnosis and experience hypnosis, uh I’m curious like who hypnotized you and how do they do it, right? Because you’re like the hard type. it was actually in a practice and it was with somebody I mean, I guess I should mention, this guy named Paul Villa Real and he’s since graduated, I believe. And uh, I told them what my suggestibility was and he said, cool. Can I try something? And he did what’s called an auto dual induction and that was the first time that it happened to me and that got me. It got me well enough that the next day, I wrote my custom version of that script uh based upon what worked for me and that was a very unusual thing because Previous to that, II did most of my experience with trance with self-hypnosis. Like, I can kinda help people along whenever they’re practicing on me because I was very aware of that state in myself and where I’d been there in the past, all that stuff. but in terms of outright just being hypnotized by somebody, uh that was the first time, and uh That was profound. Uh, the things that I learned and saw in that first time still kind of uh guide a lot of what I do for my clients. Because one of the things cuz I don’t remember too much of what was addressed. But one of the things that stands out to me as I was introduced to the future version of myself like 5 years in the future or so And that was profound to me. And that person that I saw kind of sticks out in my head and every day I think about what I can do to get to that point. And I have used that to a very great therapeutic effect with certain clients. Uh, I got the specialization in transgender hypnotherapy And one of the things I found with my transgender clients is that that class made me realize so much that it wasn’t just a psychological thing that it was a it was a physiological thing. And in that, that means that your brain is telling you that you look one way. And what you’re seeing in the mirror is telling you something very different. What if you were able to meet who you know you are? What if you were able to meet the person that looks how you know you’re supposed to look? And I find that having that, giving that to that person is substantial to their sense of self and their sense of well-being. Interesting. So, that does sound intriguing for so for someone who is, you know, they’re looking to meet their future, you know, 5 years from the future self. How how can we do that? Um, do you do that through self-hypnosis? Is this a visualization? Um. Um. Visualization. Visualization. I tend to use the LAL. Uh the uh for anyone listening that doesn’t know what that is. It’s a type of hypnotic induction or deepener where you start at a certain floor on an elevator and go down. The elevator opens and you meet this person and I make no attempt to describe this person. It is simply you in advance and II tell you to notice how this person looks, how they hold themselves, how they smell, like how, how they and depending on your suggestibility is kind of how profound that experience is. I um I don’t get hardly any visualization. Uh, I get weird flashes. Uh, I can’t smell anything. I don’t get anything auditory but I get a very heavy kinesthetic response. Uh. Interesting. Fuel things. Yeah. In imagination, right? In hypnosis. It’s not like you can’t smell things right now. Yeah. In the context of hypnosis. Right. Um. feel like if you tell me to walk downstairs, I will like to feel the stairs under my feet and things like that. That’s fascinating. Okay. So, uh for people who are listening, they’re like no idea like suggestibility type, intellectual, physical, you know, you know. Maybe like. Yeah, yeah. Yeah. Cuz like we know, we know exactly what we’re talking about cuz we’re from the same college but um I mean, you break that down and uh yeah. Yeah, just go from there. Okay. Well, you’re the host. Why don’t you explain suggestibility to your audience? I’m Good, man. I could, I could. So, I was like, yeah, why not and you can critique me. But I’m not the one So as you, like you were saying, right, we’re all, first of all, we all can go into hypnosis. That’s a very, very natural state. And um, we, but we’re just on this kind of this uh, scale of suggestibility and some people do better with certain suggestions. versus others, and I lean towards kinda where, where you’re at, where it’s like, we do the, the indirect stories, and then on the other side is the very more paternal, hey, you’re gonna feel this, this is gonna happen, you are now in hypnosis, X, Y, Z, right? And that still does, that can work for me and you know, for others, but, not honestly for you, right? Cuz you’re, you’re very objectively something. If you are literal with me, you just hit a brick wall. Yeah. So I mean like go ahead. Go ahead. I respond very well to stories and um that is so my entire life like I literally when I was a teenager my friends used to text me and just say tell me a story. I just make something up. And to this day if you tell me to make up a story, I can. Like, just off the top of my head. And I uh, a big revelation and it was initially thanks to the man that uh ended up being my mentor. uh, Joe Burns. Oh, dude. Yeah. Awesome. Yeah, and he told me, to throw the script away. Don’t work off script and I took that to heart because it’s much more intimate and so now, that’s what I do. I make up stories. Those same stories that I used to make up for my friends. I now just make up for clients that a lot of the paperwork that I have them do uh for their life history and the um the questions that I ask and the initial consultation and session are kinda getting to know like what story you wanna be told, how you want your story told, and for example, I have a client who recently came to me and this person is a software engineer. Uh a somnambulistic software engineer nonetheless and II just decided because this came at a time in my career I become very frustrated with pre-written scripts. Like I had thrown one away in the middle of a session. Hm. And those three sessions that I had that day I told myself like I’m not gonna prepare a script. I’m gonna figure out my inductions. I’m gonna ask some questions. And I’m just going to make myself go. And I did. And those were three of the best sessions I’ve done. And what I end up doing with the software engineer is I spoke to them with metaphors of code, visualizations of computers, and debugging. And um, Sure enough, that that that safe place in their head was represented as a computer bank. what the way they perceived that computer bank uh mandated where I took that therapy. Just to kind of adjust their visualization. And that’s had fantastic results. Right. So, it’s like when we tailor the therapy to the individual client who’s gonna have, you know, a different background. They’re gonna have different metaphors and um now, this is good cuz um the way I explain like the unconscious and the conscious is that the unconscious is just the realm of metaphors and emotions and it that that seems to be the reason why uh we humans love stories. It’s all. Yeah. Metaphors. Exactly and I ask people. One of the examples I give is, have you ever watched a movie and gotten angry or sad or happy? Uh based on what was on screen. Of course, the answer is inevitably yes. Yeah. So, yes, why? You consciously, logically know that you are watching a falsehood. You know these things aren’t happening. So, why do you feel these emotions? And the answer is that. Your subconscious does not differentiate fact and fiction. It’s a metaphor. It’s a and that’s all it sees that’s well, everyone but the high physicals. Uh, the high physicals don’t tend to dig the metaphor or anything like that. You just gotta tell them how they wanna be and it’s fine but uh for everyone else, it’s and at this point, because of this mentality I’ve taken with my I guess be hypnotic storytelling. Every time I watch a movie now or read a fiction book. I start noticing ways that I can retell that story for different applications or specific scenes. One of the most amazing movies I’ve seen recently is uh have you ever seen that Disney movie Inside Out? Yes. Yeah. Yeah. Uh. Yup. Have you seen it recently? No, that was like, wasn’t that like a decade ago? Yeah. You should rewatch that. Uh mental health professionals helped write that movie and it is still used in the mental. Well, that makes so much feel today. Yeah, that makes so much sense, dude. Yeah. When you rewatch it, with knowledge of the subconscious and metaphor It’s it blows your mind. So, okay. There’s that scene where they enter the subconscious and the critical mind is represented by those two idiot guards. And how do they pass by the critical mind? They confuse it. That’s my hat. No, that’s my hat. Wow. They do a confusion abduction to get rid of the gatekeeper of the subconscious. And more than, when they’re actually in the subconscious, and this speaks to a lot of what I say about fear. One of the first things they see is a giant vacuum cleaner. Um because the way that girl’s subconscious remembered that is because the way we remember our fears is in that moment in time. Frozen at that moment in time. So to that fear and that perception. That’s a giant vacuum cleaner because she was very small when she got that fear. And that has a lot to do with how I address fears and hypnotherapy. Because one of the things I stress is when we have a fear or a trauma which I argue is the same thing because we’re not afraid of something and we as we’re traumatized by it and if we’re traumatized by something, we have a fear. And what I it’s all where it happened at the time. For example, if you became afraid of a vacuum cleaner as a baby or a very small child, the vacuum cleaner would appear much larger because according to your memory and your perception, which cannot be changed until it’s addressed in hypnosis, that thing’s giant or maybe you were bitten by a dog when you were a child and you remember it as just Kujo, some giant, hell hound that almost tore your ankle off because it was so intense and traumatic. Where and hypnosis, maybe it’s just a Jack Russell Terrier that bit your ankle. Hm. When you were 6 years old and you had the emotional intelligence of a 6-year-old. So, you’re going to retain that memory as a 6-year-old until you readdress it and allow that person to uh gain a new subconscious understanding and association of that event. So, I’m gonna try to play advocate here and say, okay, I get it that, you know, when we were six, maybe we’re scared of a vacuum cleaner cuz it seemed very big or a dog or whatnot and we had to distort perception, right? But now that we’re adults and that we have developed our prefrontal cortex and our reasoning and now, we can go and we can experience that, you know, dogs are generally safe for the, for the most part, and happy and man’s best friend, or the vacuum cleaner, you know, it’s fairly harm is. Right and so uh why can’t we just maybe um do a little bit of exposure therapy, a little bit of cognitive behavioral therapy, and just say, hey, this is uh, this is false, this, you know, you can, sometimes. Um, and it depends on how traumatic the memory is. And really, a lot of the way that fears are addressed in hypnosis has to do with uh, desensitate, desensitization, that the same things you would do in the physical world you can do mentally. If you were afraid of dogs rather than go so far as to address that fear live and in person with the dog you could go through that same process of consciously and realize that you have control over that emotion. There’s uh as you know there’s something called circle therapy. Where in hypnosis you are presented with a fear or an anxiety and you are asked to recall that fear and the emotions associated with that fear. Consciously. So, you bring it up on purpose. And then it’s at the same time you tell them to bring it back down. And the purpose of this is for one, every time you tell them bring it back up. It’s a little less. But they gain the understanding that your emotion and your reaction is under your control. The way that you choose to react to this fear is 100% under your control. And once there is that realization, fear tends to fade. or it’s not yours. Uh, that’s an interesting thing I’ve encountered before. What do you mean? Oh, it’s not yours. just that. Um so, I did uh a podcast couple of months ago. Uh about fear. It was called fear. It’s run by two clowns and they were interviewing a German spy who had a fear of heights. And I uh and this is on my website by the way. Everything I’m about to say you can listen to this interview. But this person, this man, um not the shy away from it. He’s a government killer. Like he is what he did. He was in special operations. He went into places he couldn’t talk about and did things he couldn’t talk about. He was afraid of heights. As unusual as that is. And uh this was all done in about twenty minutes. I transit him. I took him back to that moment on the plane. Cuz he got that fear from his first training jump when he was seventeen. And in the process of just walking him through that moment. He realized something. That he had forgotten about until that moment in hypnosis obviously, this person was a very high physical. So, they said they could feel the vibration of the engines. They could smell the gas on the plane. They were there. Um, the kid that jumped before him screamed in terror and he went from being fine and calm to terrified. But he didn’t remember that. And so at this moment, he realized that this fear he had been carrying for decades wasn’t even his and I called him out of a trance, and within 5 minutes of that, he was hanging off the side of a balcony. Saying like, I don’t feel a thing. Huh. So, yeah. This is all in hypnosis. Yes. Um. And not the balcony thing. Yeah. That’s what’s interesting. So, he remembered in hypnosis the um. The other kind. Where’s my cause? Just got scared. And it wasn’t even his fear that that kid’s fear transferred to him and before he had time to process it, he was kicked out the door. So, this entire time, he’s been perceiving this event as his fear when as you know, if we’re around someone afraid or scared or happy, if but for a short moment, we feel that before we process it out as not ours but what if you didn’t get that chance? What if you feel that fear and before you could be like, man, that kid was scared. Somebody’s grabbing you by your collar being like, your turn. and he just perceived that as his fear. So, yeah, fear didn’t belong to him. Wow Yeah. So, I’d be curious um on your philosophy when it comes to trauma, right? So, for that particular case, I guess he just, he was able to kinda remember and and and bring up that unconscious material and then, oh, hey, this is not my fear. Um but do you think for trauma? Before we even get to that, what do you mean when you say trauma? Trauma is any event. leaves an impression later down the line. Usually negative. Uh, I guess it should be specifically negative. Um, something that leaves an imprint, something that uh like, okay, this would be just seen in the movie Inside Out. Trauma is when a negative memory becomes a core memory. that that it becomes a core memory is an aspect of your personality. So, it’s. Oh. Whenever something negative becomes a core aspect of your personality. Because of course, we all go through negative things but what if that negative thing is so extreme or its perception is so extreme that it formed every opinion and perception that you had after that event because it was a core part of your personality? Hm. That’s why that movie’s so good. Like, dude, I need to rewatch. You do. I took notes. I’ve got notes somewhere on that damn movie. Well, yeah. I feel like I’ve matured so much since then and then with the knowledge of hypnosis and now, parts therapy. So, I don’t know if you ever heard of uh internal family systems or any kind of parts therapy. I’m sure you, I mean, we, it’s, it’s been mentioned here and there in the college. Yeah. But um yeah, it’s so amazing now that I’m in like parts therapy and I’m sure it would, you know when you see all the different emotions like, oh, that makes so much sense. Like, yeah, we have all these different parts of us that sometimes different things and it gets into conflict, you know? So. One of the things that I’ve really kind of come to realize through doing this work and that I tell all of my clients is we are all at our core children. We are all scared eight-year-old kids. We’ve kind of got that cuz that’s when we form our core beliefs from zero to eight. So, by the time we’re eight, that’s our core self. Yeah. And that, that you, all exist and that what it means to be an adult is to learn how to parent yourself. How to parent your inner child. And that’s a perspective that I ask a lot of my clients to take. Because II asked them especially the ones that have children. Like the way, you talk to yourself. When you talk to your child like that. Yeah. But is that the way your parents talk to you? if you didn’t like that, why are you continuing to treat yourself like that? Why, why don’t you give yourself that same understanding? Because what, think about it. We all wanna stay up later than we should. We all wanna eat **** that we shouldn’t but we have that voice in our heads. Like, no, you have obligations in the morning. You have to get up or you know, that’s gonna upset your stomach or whatever have you and it’s the same things you tell a child but you have to tell yourselves. So, the way that you speak to yourself in that regard is very important. Yeah. Um what I’ve realized at least for myself, is that there’s even more than one inner child. Yeah. You know, there are lots of parts of us um that that have different goals and different perceptions and might get, you know, yeah, might get into fights or something. Um and so, it’s not even just the inner child but like, how do we parent all the different parts of us and realize that there is no bad part? You know, you wouldn’t call a child bad. You just would. Exactly. You know. Um, re-educate them. I heard something. I can’t remember if it was in class or in something I was watching. But it said that everyone has good intentions. Yeah. Everyone. No matter how evil or messed up. If anything there are always some manner of good intentions at their core. Yes. It could be wildly misperceived. It could be a mental illness. there are always even, even crimes of hate, even when somebody murders someone else, they’re trying to satisfy something in them. They’re trying to make something in them go away. So, they’re trying to take care of themselves. Yup. Or they feel some weird obligation to fulfill. It’s all manner of reasons but all all of these things boiled down to. They are for themselves or someone else or whatever have you. It’s good intentions. Just like your subconscious Yes. Always has your best intentions in mind. Even with traumatic things. Even with bad reactions. It is still just trying to protect you. Yeah. Just trying to preserve its homeostasis. It’s normal. yeah. Now, that’s powerful. And I think when we understand that, you know, I think sometimes we can like vilify the subconscious or vilify these different behaviors but they’re all serving some kind of purpose. So, you know, if you’re, if you’re traumatized, it’s trying not to get you into that painful situation. Yeah. Yeah. Yeah. So, if you have crippling anxiety, it’s you’re subconscious, it’s your mind trying to protect you. You just have this fear reaction that’s out of control. And It’s there’s a lot to be said in terms of healing just for the awareness of that. So much of my work and especially my breakthrough work with clients has been through subtle changes in perspective. And that’s it. It’s not much more than that. It’s sometimes there are some changes to behaviors or thoughts changes. But a lot of it has to do with um the way you look at a situation, how you perceive it, why you think this way, why you think this way about yourself Although it’s stereotypical in therapy, I find myself asking the question, why are you feel that way? Where does that come from? A lot. Right. And there’s always something. There’s always another layer deeper until you get to that aha moment. And you can tell whenever something has left their mouth that even they didn’t think of. They’d never even made that association before. And just by having that come into their conscious mind by being able to consider that logically. You’ve already gone so far in that healing. It’s like when we raise our awareness and take different perspectives, then, behaviors start to shift. Well, it’s like uh I’m not a big NLP guy but there are some aspects in neuro-linguistic programming that I like and one of those is the mindfulness aspect. The idea of being aware of what you’re thinking. Uh taking control over your thoughts. I thought Joe did a very good example when he talked about how he was crossing the road and he started getting this perception of these men in this car at this crosswalk about how they wanted to do him harm and he started getting anxious about this imagined situation and he stopped himself and he forced his thoughts to something ridiculous. I forgot what he said he pictured those guys in this car doing but immediately changed his thought pattern. Yeah. And he was able to just walk away and he looked back and he said, they’re just both on their phone doing nothing. And that’s right. He’s told me that story too. That’s right. Yeah. And II love that story. It’s hilarious But it’s a very good example. Because so so often we let our thoughts kinda run out of control. And it does us some good to stop and think like why do you think that? Why are you thinking that way? Why? Why do you believe like there’s something to be nervous about in this situation? Where is that coming from? Hm. All your trail back. Figure out why you’re nervous. So we’re so for somebody who likes you asked them that like oh why are you nervous? Why are you afraid? And they’re like I don’t know. No idea. Well. What? How did you ask? Mhm. What makes you nervous? How do you feel when you’re nervous or afraid? Um did you, were you always afraid of this? If you weren’t always afraid of this, when’s the last time you remember not being afraid of it? When is the first time you remember being afraid of it? most time in my experience, people haven’t taken that logical path back. They just stop with, I don’t know. They it’s that self-examination is difficult. Um, a good example of this is I had a client that said that They wish that they were able to perceive themselves as others perceive them, as strong as others perceive them and I said, well, why don’t you think you’re strong? got into a car wreck and I felt like I could have done better and I felt like I failed. Why do you feel like you failed? Well, because I couldn’t be there when my grandfather died. and there was just this dawning realization when they said that. And I was like, you never said that out loud, have you? No. There you go. So, that is currently on the table for the next time and uh it’s just a good example of just keep following the path back. If you do, there there’s always a reason for the behavior. It’s never an I don’t know. There’s an I don’t want to remember. There’s uh I choose not to know but. Yup. There’s not a mystery. There’s always a reason that Could be had through questioning, figuring out when and where, and all of that. Yeah. Yeah. So, I’m curious cuz there are different schools of thought and not even hypnosis but in therapy that maybe, hey, don’t go back to the cause.  You know, that’s just bringing up things that um that don’t necessarily need to be brought up or you can retraumatize people. X, Y, Z, focus on the solution, focus on the future, and more of like the positive thinking kind of approach. Um, I’m curious about what your thoughts on that are. It depends on the trauma Uh if it’s something like that they view as very grievous, it is something bad. I don’t ever ask people what their traumatic thing is. Like, you can just tell me that something bad happened in 2,000 seven. And that’s all I need to know. Uh, beyond that, all I, with, with that, I will, there’s a couple ways. But you, there’s no direct reexperience. You don’t take them back and make them live through it again. It’s antithetical to the goal. What you do is you take away that association. You make that not a core memory. They don’t focus on the events. They focus on the resolution. And the letting goes after that resolution. There’s a method that I very much enjoy that involves having them perceive this event on a screen. And they fast forward and rewind and fast forward and rewind until all that exists before the event and after the event. that that association is. And then after you establish that, you let them let go of that memory, of that association. And Trauma is very dependent on what happened. And uh sometimes it’s dependent upon um my referral. Because many times whenever it’s complex trauma uh I’m speaking to them on referrals from a mental health professional. Mhm. And a lot of it has to do with my communications with that mental health professionals. Whatever you learn. You know you’ve done. What do you need to be done? Um, it’s very important if you do find yourself working with uh medical doctor or mental health professional to get on the same page with them. Like involve yourself in that client and have them help you, help them, help that client. It’s a team effort at that point. It’s so dependent because II work with people with combat PTSD. I have uh postpartum depression. It’s just a matter of where this trauma and negative behavior come from. Often, uh with the combat PTSD, it’s always really heartbreaking to do those and I’m very happy that I get a chance to work with those men and women. there’s a lot that’s, for example, like what they’re not allowed to feel. Because you’re expected to, I literally soldier on. Hm. And there comes a time that that’s not a thing anymore. That you have to address what has happened to be able to heal. And I see a very similar thing in combat veterans that I see in people who suffer from trauma. they’ll go back to the closest safe save point in their head Uh it’s usually sometime when they’re a late teenager or soldier. It’s generally seventeen, or eighteen. And they’ll start adopting the traits that age. because they have all of these traumatic memories from older when they were older. So, it seems like psychologically, they just go back to the last time they were safe and untraumatized because it’s no longer safe to be an adult and I see that repeated time and time. Yeah, it’s. Wow. Interesting yeah, it must be very, very difficult to work with. Yeah, people who experience extreme, extreme trauma. Mm-hmm. So. I’m glad you are. But it’s one of those things like, once I realized what hypnosis was capable of and what it could do I kinda felt obligated to offer my services to them because it doesn’t matter what you think politically. It doesn’t matter what you think about war or the war or soldiers, the government, or anything like that. It has to do with these are deeply traumatized people who not getting the care and resolution that they need. I just feel obligated that if I have this toolset that allows me to give them that resolution, I should, that it doesn’t matter anything at all if I’m anti-war, pro-war, anti-government, pro-government, none of that. None of that matters. It’s just people. It’s just men and women who have seen things and done things that no one should be asked to see or do. And that’s it. That’s all it is. I’ve had a chance to see a wonderful change in those people because so much of it is it’s just difficult for them to deal with that, to face that. Whatever it is that they see. to do that is profound. To give them a safe place to do that. That is guided and secure. And it’s an interesting thing that for some reason people are hesitant to seek out psychotherapy. I have no problem with hypnotherapy. That. Really? Yeah, and I don’t know why that is. it’s fine and generally, I will encourage someone that if this isn’t something that they’ve seen a therapist for and they need to in the process of things, just be like, okay, now that we’ve kind of helped you through this, you need to consider bringing on someone else as well.

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And therapy isn’t the cure-all. It’s great for a bunch of things but sometimes you need other stuff. Yeah. Yeah. In fact, like, the way I see it is to attack it from every angle. Mm-hmm. Absolutely. Yeah. There’s no reason not to bring in everyone who could help. Yeah Perfect. So, uh I’m just going back to um you know, how you got into hypnosis and you talked about, you know, self-hypnosis and I’m sure that that has helped you and I mean, it’s helped me. I think it can help a lot of people where they can just utilize this modality, get over, get over some fears maybe, you know. Absolutely. I’m curious how, how you do self-hypnosis and what’s worked for you. So, that’s changed recently Longest time I did it as we were trained. And uh one of the things I’ve started to focus on recently. my self-hypnosis work and with my clients is nostalgia. This weird thing that exists in our minds seems to be separate from everything else. And what I do to self-hypnotize now is II focus on one of my far-off memories. Like one of my distant distant nostalgic childhood memories. Now form that as solidly as I can and just start doing breathing exercises. And focusing on that nostalgic moment and gets me right into a trance every time. Interesting. And do you think that would work with other intellectual suggestions? You know, high E note? Uh, I have clients that nostalgia has started to become a major part of our work. Because, um, I don’t even know how to define it. It doesn’t exist in a space like other memory. It’s it’s different. It’s more intense. It’s standard memory. It doesn’t have that feeling that’s associated with it. And I don’t know what that feeling is. Um actually, that’s one of the things that I want to focus on the most with research as that’s what nostalgia is and what its uses are about hypnosis. Yeah. Um and it’s, I’ve already started using it with a few clients, this notion of focusing on intense nostalgia to facilitate trance and I’ve had very good effects. Yeah. Well, that’s that reminds me of Erickson and I’m sure you know his story by the way, for people that are watching that and not familiar with Eric’s uh Milton Erickson, he was one of the greatest hypnotherapy of all time and did very indirect, artfully, vague, lots of metaphors and stories and god just brilliant results as a genius and um you know, when he was younger, he had polio, couldn’t move, thought about a memory of when he could and then all of a sudden 30 minutes later, he found himself Maybe. Well, that’s why a lot of the clients that I’m working with nostalgia are my clients that have self-perception issues and self-confidence issues Because nostalgia exists in a point of pure happiness. You don’t have negative nostalgic memories. Really? And yeah. This nostalgia by its very definition is positive. Huh, and it’s it may or may or may not be true because memory sucks but it doesn’t matter because your perception of that memory is nothing but positive. Nothing but happy. And so by recalling these memories, you’re able to recall this happiness. Uh, one of the more interesting bits of homework. That I’ve given my clients is uh sometime between now and our next session. Go on YouTube and look up an hour of old commercials or old cartoon intros from your childhood or something Like that. Um. Cartoon Network. Yeah. Something. I’ve uh I spent like 2 hours one night just watching intros to cartoons from the nineties. Like that’s it. And I’ve kind of become very focused on it. I very much love that sensation of nostalgia. I think it’s important therapeutically. That’s kind of why I put so much effort into exploring it myself. Yeah. Uh, Anytime I have like a nostalgic memory or thought, I kind of try to capture that and examine it and like figure out what I could do to bring myself back to that time and just that ponder ance alone has a hypnotic effect And I don’t know what it is about where nostalgia exists in the memory. it’s its present. there is an odd field of science. That’s kind of coming up now. That’s the quantum sciences. And there are some individuals doing work right now. or up to it including hypnosis that are fascinating. Um, the main person I’m speaking about is this guy named Doctor Dean Raiden who is the head of the Institute of Noetic Sciences. And yep I heard of them. Uh, he wrote a book called Real Magic. That is the scientific research and analysis behind certain processes. Like ESP whatever have you. Um, and it’s done strictly from the view of science and research. And These things are related to hypnosis because if the institute can be said to have any goal or direction, it’s consciousness research. Why? What are we? Why are we? I kind of think. Yeah. And the book doesn’t answer any of those questions but this book does provide uh an interesting indication of the direction of science and what we’re looking at in the next twenty years. One of the most fascinating things uh about living in this time certainly isn’t the plague or climate death but uh there is a concept called the singularity and there’s a version that exists in AI and there’s a version that just exists as humanity and the idea of the singularity in terms of humanity. Are that human technological eras exponential? That to get from the bronze age, the iron age was like two 2,000 years from the iron age to the industrial age like a thousand. Industrial age. It only lasts two hundred. Then, you get to the point now that the internet age only lasts twenty years. So. Oh, we’re not, are we, Oh yeah, you’re right. Uh-huh? I was just trying to think like, well, yeah. And. Previous to that, the computer age only lasted like fifty And so, now we are approaching this point in human evolution and development that um progress. The human era can no longer be measured. That each human technological era begins to overlap itself. And that progress became becomes foreseeable by the organic mind. we have a date for that. And it’s twenty-forty-five. Uh between twenty forty-five, 2055 is when the singularity is supposed to occur. And what? So what is that what is that mean exactly? That means human technological progress becomes infinitely fast. Every day there are new technological breakthroughs. Every day there is more progress. Um. How does even determine this state? Do you know? Well. I don’t know. Smarter men than me have done this math. Yeah. But it’s you see it evident in human evolution. These cuz there’s there were times in our history when thousands and thousands of years were spent the same. centuries were spent the same. There was no real development. It was just kind of an age. Living in the era that we live in now, it becomes very difficult to conceive of that. Because even if you’ve been around for twenty years, you’ve seen insane amounts of progress. And that simply just didn’t happen. Previously. Right. Ever since the industrial age for better or worse, we’ve sprinted towards this exponential progress, and as to what singularity looks like, oh no. Uh, I surely just hope it’s not a new iPhone a day. Uh, I’m hoping it’s not the AI, you know, um. Oh, god. Take me over the world and. The matrix. I uh. I’m kind of opposed to AI. Kinda not. Because to get AI, we have to first solve the consciousness problem, and we solve the consciousness problem. Good luck. That pretty much unlocked the singularity right there. But at the same time okay, let’s say if we unlock consciousness, let’s say we’ve created an artificial intelligence. We have created a thinking, feeling machine. The feeling of what? How do you know that consciousness implies emotion? What, how do you know what that emotion is? Right. Right. It’s defining consciousness. Mm-hmm. Which is the tricky part. So, and then one of the interesting questions I’ve, it’s been posed to me is does emotion evolve? Are we more emotionally intelligent now than we were 500 years ago? You gotta remember 500 years ago, what was considered fun was watching the local heretic gutted in the public square. So, I have to think that, yeah, we have grown. I, I do think we’ve owned in some ways, and at the same time, you know, there’s always going to be some kind of watching people get, you know, it’ll be a violent movie. Um. Yeah. Yeah. US, UFC, you know, we I mean II remember. Yeah. I don’t know how old you are but. I’m almost forty. There was a show on in the 90s called America’s Funniest Home Videos. That’s right. And it was hosted by Bob Saggett for some reason. And uh there used to be a rule. But it first came out. That no one could get hurt. And the video. It was an explicit rule. What? no1 could be injured. Yes. Well and then the dude getting hit in the nuts by a football One 3 years in a row. And they realized their entertainment value. Exactly. Cuz when I watched it, it was like 80% of people getting hurt. Yeah, absolutely. Yeah. And uh that’s an interesting aspect of humanity that to my knowledge, only the Germans have attempted to quantify. Uh, they have a word called uh Shodden Freuda. Which basically if I remember right, translates to the sad joy. And it is the pleasure that you get from other people’s pain. It is you who laugh at someone falling downstairs. It’s the reason you laugh at anything like that. Though the Germans have a word for it. It is Yeah. It exists Universally. And that is the very reason that um that that things like America’s funniest home videos or **** exist. Yeah. And it has to be II wonder really what is it psychologically that makes us like that? Is it a survival aspect of that ain’t me? Yeah. Yeah, I don’t know. Well because one of the weird questions I’ve never heard answered is uh why do we laugh? Like what even is laughter? Right. What is humor? Yeah. Uh-huh. and um because it wouldn’t exist for no reason. Laughter has to have a function the most interesting notion that I’ve heard is it was made as a diffused mechanism. The whole idea of why we find humor or awkwardness humorous. Because of like let’s say you were walking around the pack way back in the day. And you heard the Bush’s Russell. And everyone gets scared. You see the rabbit jumps out, so you laugh. And that signal which creates a neurological response in any human that hears it Is a way to signal the all clear. And maybe it’s a way to signal that hey that wasn’t me that just slammed into a **** curve on a bicycle or something like that. Like I don’t know what that is. I don’t define what humor is or why we laugh, to begin with. Right. Difficult question. And then you make it even more complex by the fact that some animals laugh. Really? Uh. Huh. Rats will laugh. Horses will laugh. Um, horses have displayed complex humor. Rats will laugh. Rats, you could tickle a rat. It’ll laugh. Giggle. That is so strange. Wow. They’re hyper-intelligent. Um, A horse. There’s some search horse prank on YouTube and you will get nothing but videos of horses taking revenge on people and laughing about it or playing a prank on their handler or something. it’s pretty. That’s always been the strangest thing to me because that implies very complex emotional intelligence to have humor. Yeah. Well, we’ve strayed. This is a very interesting topic for sure, man. Philosophical, psychological, like cultural, uh what’s called anthropology, anthropological questions. Um kinda tying it back to hypnosis. Well, I mean and you were talking about singularity and consciousness. Was that, were you going somewhere that in terms of hypnosis? Who knows? Um well, probably where I was going with that. Um if not, where I’m going now is that what we do is going if it’s not already it is going to become vital to consciousness research and what it means to have that type of increased development that we can analyze ourselves and others in ways that we haven’t been able to in the past. I’ve heard some theories that the notion of metaprogramming. Being able to actively change our thoughts and behaviors is uh an evolutionary step that is not something we’ve always had. That this ability to change everything about ourselves to suit our purposes is evolutionary. And I will take that one step further one of the things that I propose in many of my interviews is we don’t have free will. If everything of what we do is a product of association and learned behavior. How is that in any way an expression of choice? Now where free will comes in is when you choose to alter that behavior to suit your life when you choose how you want to view something. When you choose how you wanna act and react to something. Right, but aren’t those also dictated by past programming, by culture, um your knowns, so to speak? Yeah. You know. Could be. But it is the conscious choice of say if you have anxiety and you wish to resolve it. That is a conscious choice. Um. Right. Another example of a guess is if you don’t like a certain food, well, it stops. Like it. But you can’t. Okay, well, what if you could make that choice? What if you could just choose to make a certain food or like reading or like something in particular? What if your association was different? And that’s where the change comes in. That’s where the choice comes in. At least I think. That’s just uh the logical quandary that I like to present to people. Yeah. You know, this whole free-will discussion, man. That’s above my pay grade. I do mean on most days, I lean towards, you know, there probably is in free will but What I will say is I think it’s important for us to believe that there’s free will even if there’s not. Just to function in society and for mental health and yeah. Um, there are a lot of things like that that you don’t have time to get into today but it exists for you. You just have to play along to function. The biggest landmine in thought projects I could think of is simulation theory. Because you can neither prove it nor disprove it. So you could just continually fall that rabbit hole. So what is simulation The idea that we live in a simulation? Okay yeah, the matrix. Yeah. Yeah. Yeah yeah. There is no way to prove it. There’s no way to disprove it. Yup. And I have no couple of people that fell far down that hole. Yeah. So, now, this is not a lot of quantum physicists, okay? And obviously, I’m not anywhere near that realm and intelligence but from what I’ve heard and read and understand as a layman is that there is an interpretation that will lead to us being in a simulation, there are some quantum physicists who would say that, and um. Uh, who’s the deal? That it is. Yeah. Statistically more likely that we’re in a simulation than not. Is it? Yeah. Yeah. And it the singularity comes into that because it assumes that any civilization that gains enough technology to run a simulation will do so simply to gather information and that given our technological progress, it is more likely that we have reached that point and we are in a simulation, then, it is not. So, wait, maybe the similarities are just when our when our holes pop open and we all get to come to to play in the real world. You know what? I think this ties nicely into hypnosis. Yeah. Okay. Because our beliefs, our core beliefs, a lot of them, are just BS. Yeah. It’s all perception. Reality is perception and as hypnotists, we can help you change that perception. Yeah, I don’t know if you, if you’ve been part of like a stage hypnotist show, hypnosis show? No, I’m opposed to stage hypnosis. What? Uh. It’s something I’ve to develop and like, yeah, I get that reaction a lot but speaking to clients and speaking to podcasters doing interviews, Stage Hypnosis is responsible for 90% of the misconceptions and falsehoods about hypnosis. And I could say To me, hypnosis and hypnotherapy is a very, very, very powerful tool and it needs to be regarded as such and if we’re up on stage using what is supposed to be a powerful tool to make people stand on their head, that doesn’t allow people to view it with the, the gravity that they should because, to them, it becomes this, this parlor trick this and more than that, I’ve encountered people who’ve had negative experiences with stage hypnotists. Uh because of what they’ve experienced on stage, they would never get hypnotized again. I’ve thought about that a lot. Would I ever do stage work? And I think at this point, the answer is no. Uh, I would do parlor work within a small setting like Transing one person in front of a small group just as a demonstration. That’s fine but doing it as a spectacle in front of a crowd. I think personally, this is only my opinion that it robs hypnosis of some of the dignity that it deserves. Hm. And I understand why it exists cuz yeah, it’s a neat thing But like, given how important I feel that hypnosis is to, in the understanding of it is to our health. Did damages its capacity to do so, by it being a stage show. Here, here’s my kind of argument. Um, because if show somebody that, you know, hey, I can make you bark like a dog, cluck like a chicken, uh via the power of hypnosis. Imagine what it’ll do therapeutically. Imagine how easy it is for you to quit smoking or lose weight or you know. How many are to go to anxiety? Going to be convinced with that versus how many people are going to be convinced that it’s fake or that? Yeah, I know I get a process or that it’s mind control. Yeah. And that’s the contribution to the negativity that comes in. And the media doesn’t help because every time you see a movie where hypnosis is involved outside of uh black magic, that one movie from the forties. Um, it’s all **** Like it’s all just weird. if that’s not actually how that works. But it makes people believe it. That’s why you ask someone to imagine what a hypnotist is. The first thing they think is that. Yeah. I have one somewhere. Hey, it’s a legit induction man. It works. I know. That’s the whole reason I dug mine out is because like man if I’m a hypnotist I wanna trans someone with a pocket watch. Exactly. That’s why I got it too. Just for that. Yeah. Yeah. I got you. Oh, I feel like this might be a good stopping point, man. It’s been a fun conversation. I don’t know if there’s anything that you. Yeah, man. Thank you for coming on and um uh is there anything maybe you wanna end with before um you know, ask you how people can find you and work with you? Um well, one of the things I always like to end with, you’ve already mentioned that hypnosis is natural. It’s normal. It’s not a metaphysical thing that this is a natural function of the human mind and that there’s no reason not to utilize it for positive change. It’s there anyway. We’re not adding anything. So, it’s something that I believe anyone can benefit from But if anyone wants to get a hold of me, uh like I was so enthusiastically introduced, my name is Jay Robert Parker. I own Twin Ravens Hypnotherapy and Research LLC and you can get a hold of me through my website at WWW dot Ravens dot ORG. Very nice. And you are doing group hypnotherapy as well. Oh, yes. Um I, if you go to a meetup, uh meetup .com and search for twin ravens hypnotherapy. I have a bi-weekly group hypnosis that I’m starting up. Uh, just kind of as an experiment, see how well it catches on but it’s just uh every other week, just doing some general relaxation, motivation, just basic stuff, and way. Anyone that wants to be able to experience hypnosis gets the opportunity. It’s not the same as one-on-one but your results may vary. Some people get a very profound experience. Some people likely do but you always get something. You let them know what it is. Yeah. And awesome. Great talking to you man. Absolutely. And I just wanna vouch for Robert’s skill and his compassion and passion in this work cuz I’ve been in one of those group uh hypnotherapy sessions. And it was very powerful. So I recommend anyone who wants to experience the power of hypnosis, to change their lives, to go with, to with Robert and you’re in good hands. So, thank you, man. Thank you for coming on. Absolutely. Thanks for having me. Alright. Peace out, guys.As found on YouTubeHUMAN SYNTHESYS STUDIO 👀🗯 Attention: Have Real Human Spokespeople In Your Videos Saying Exactly What You Want In MINUTES! REAL Humans, REAL Voices, With A NEW Technology That Gives STUNNING Results Choose Your Human + Voice Type What You Want Them To Say Render your “Humatar” What You Are About To See Is Unbelievable…

Cognitive Behavioral Therapy (CBT) Skills and Counseling Techniques with Dr. Dawn-Elise “Doc” Snipes

 CEUs are available for this presentation at AllCEUs.com/CBT-CEU Hi everybody and welcome to today’s presentation on cognitive behavioral therapy skills. Like the other the presentation we did on assert not assertive community treatment acceptance and commitment therapy, which is also based on just providing information about skills that can be used not providing an evidence-based practice we couldn’t cover that in a full hour or just an hour so over the next hour we’re going to define cognitive behavioral therapy and its basic principles a lot of us are familiar with this but it’s going to be a good review and it also may highlight some nuances that you didn’t know about will identify factors impacting people’s choice of behaviors explore causes and impact of thinking errors and identify common thinking errors and their relationships to cognitive distortions so why do we care well as therapists we want to help people figure out the best way to live a happy healthy meaningful goals-driven life for some people that’s going to mean using some cognitive behavioral interventions that can be in addition to mindfulness that can be in addition to a lot of other things but it’s important to help people understand that the way we believe things to be the way we interpret things is going to affect our reactions so for example think about a situation you know you’ve walked into and maybe you walked into it with a small child and it was a different situation it was a new situation but you know it was no big deal you walked in it was not a threatening situation to you because you were like hey I got this the little kid walks in and goes oh wow there are a lot of people walking around here, this is the really scary same situation as two different perceptions you probably didn’t have much of a stress reaction going on whereas the little child probably had this fight-or-flight thing going on grabbing onto your hand like please don’t let go Atlanta Airport is a perfect example if you’ve ever taken a little kid through Atlanta Airport gives you an idea about how people can perceive things differently and when you enact that fight-or-flight the reaction you’re going to have all those stress hormones you’re going to have all either anxiety or anger or whatever that goes with it it may serve to exhaust the person and leave them feeling hopeless and helpless so what we want to do is help people see that but we also want to help them see that when they’re depressed when they’re tired when they’re sick things are going to seem a lot worse a lot of times because they don’t have the energy to perceive it differently I mean when you’re sick it’s overwhelming to think of going through Atlanta Airport so this is what we want to help people start understanding is it’s two sides of the same coin they interact if one is you know kind of going wonky is going to affect the other one the good thing is if one’s going well the other one’s going to go well if you’re having positive thoughts you’re probably going to feel pretty good there’s an activity and I think we’re going to talk about it later it’s called the coin flip activity and I asked client clients to flip a coin in the morning and in the morning if it turns heads then they have to be the most positive Pollyanna all day long look for the silver lining and everything smile walk with their head up hold those nonverbals up and see how they feel at the end of the day besides a little sore because there are muscles they’re using they haven’t used in a while if it lands on tails they can just be their normal selves which generally if they’re seeing me means that they are depressed anxious stressed out angry about something in the negative realm then we talk about how did things seem different on the days when you were feeling better when you were walking taller when you were smiling even our nonverbals it doesn’t even have to be sickness it can be our nonverbals that can make us feel or make our body feel heavy and tired and make it seem like it’s a whole lot harder to deal with life as a person who perceives the world generally good and believes they can deal with challenges as they arise that good old self-efficacy will be able to allow their stress response system to function normally so if they’re like you know what I can deal with whatever life throws at me I’ve got it and maybe I need help with it maybe I’ll need to ask for support but I’ve got it it’s not going to completely overwhelm me with people who see the world as hostile unsafe and unpredictable you know for a variety of reasons whatever happened to make their scheme as such that they don’t believe that people or the world is trustworthy are predictable they are always on guard they’re always kind of like a hamster in a cage that has Have you ever had hamster hamsters don’t recognize you and go hey that’s my own or human contact score hamsters go run under their little house and you just kind of open the cage and stick your hand in there and flip over their house and you’re like come here and give me cuddles and you’re like you know 200 times bigger than they are so the little hamster is like freaking out this is what it’s like for people and obviously, I’m exaggerating but this is what it’s like for people who have a negative perspective a negative view or a hostile view of the world so kind of keep that little hamster in your mind cognitive behavioral therapy we have core beliefs those things that are in our hearts when I talk with my clients about honesty step one and that’s what they’ve got to do to start recovery is get honest with themselves first and then other people we talk about head heart and gut honesty do you think it’s right does it seem like the right thing to do does it feel right in your heart you know does it make you happy it doesn’t make you feel good and then the spidey senses is your gut saying and or is your gut fine if one of those is saying this might not be the right choice and we need to think about what’s going on so we have those core beliefs and I put them in the heart just because that’s the middle of the head heart and gut but you have core beliefs about yourself whether you’re good with you’re bad whether you’re effective at certain things ya ya you have core beliefs about other people same thing good bad effective predictable and you have core beliefs about the future and a lot of that goes with the locus of control but also your past experiences if the world in the past is seemed unfriendly and uncontrollable and you’ve perceived it that way then you’re going to expect the future to be uncontrollable so what we want to do is help people look at their schemas and their core beliefs about themselves others in the future and figure out kind of what they want it to look like these schemas are going to affect your behavior and your thoughts and your feelings and you know you can pick wherever you want to start it doesn’t matter because all three inter interface with one another so if you haven’t let’s start with negative thoughts if you have negative thoughts then you might feel anxious angry stressed dysphoric which will affect the behavior you’re going to do different things than if you have positive thoughts about something you feel excited and energized you’re going to have different behavior the best thing example I can give you is if you’ve ever done public speaking or had to present something some people detest public speaking it’s just terrifying for them to get up in front of a group of people so their thoughts am I going to trip up I going to forget what I’m going to say I’m going to make a fool of myself I’m going to you know it can go on forever that when you get on a roll you can get on a negative roll and go on forever or positive hopefully get on that roll with those thoughts you start holding onto those thoughts remember as we talked about in a CT the other day when you hold those thoughts and you kind of mush them around in your mind and you come to believe them that you’re going to make a fool of yourself and it’s going to be awful you’re going to start feeling terrified likely which is going to likely affect your behavior if you go out on the stage and you’re terrified you’re going to probably stutter you’re probably going to get foggy-headed you’re going to have that fight-or-flight reaction so there’s an the adrenaline rush and you start sweating and you can’t focus and you can’t concentrate you want to away as opposed to somebody like me who loves public speaking and I’m just like cool I get to go out there and try to engage however many people are in the audience it’s a game for me because when I can see your faces I enjoy trying to figure out and make eye contact with people and figure out what it is that they’re there for what is it that’s going to make them tick what resonates with them so my behavior as you can kind of see right now when I go out there I’m excited and I want to engage people and it’s a fun experience for me again just like the airport the same experience for two different people and two very different interpretations and reactions to it so what effects I don’t like the term rational but when we’re talking about CBT irrationally comes up a lot I like to replace it with helpful because every behavior in its weird sort of way is or probably was rational at one time that being said we’re going to get back to that stress affects our behavioral choices if we’re under stress we can have negative emotions negative emotions will affect our thoughts if we’re feeling sad we’re probably going to look at the dark side if we feel sad we’re going to look at the bottom falling out if we’re happy we’re probably going to look for that silver lining physical factors if you’re in pain sick sleep-deprived poorly nourished so your body can’t produce the neurotransmitters it needs to or heaven forbid intoxicated you’re probably not going to make the same decisions as you would if you were comfortable healthy well-rested nourished and not intoxicated any of those things can go impact how you perceive a situation or how you react in a situation, especially the intoxication whereas in your non intoxicated State in your sober state, you may think that you want to do something but then you’ve got that filter that goes not not a good idea in an intoxicated State or even in a manic state if you’re you know if you have somebody with bipolar that filter kind of goes away so the behaviors that someone may normally not do because they have a rational filter that goes you know punching this guy outs probably not the best idea right now the filter goes away when you’re sleep-deprived you’re less generally people are less patient generally people don’t have as much of a filter thing about watching your children if you have children or your grandchildren or even yourself I know myself when I’m sleepy I am giddy as all get-out and things I wouldn’t normally say because they’re you know stupid I’ll just come out and say anyway and my kids just roll their eyes or mom you’re overtired could go to bed, uh but that’s okay you know I’m okay with that in that situation now if I acted that way at work it would be a worse thing environmentally if you’re introduced to a new or unique situation and you perceive it as stressful because the unknown we know can be stressful then you may not make as rational of a choice or as helpful of a choice because you maybe trying to escape the same thing as exposure to UNPROFOR bellowing for a the word here but UNPROFOR ball is the best I could come up with we all prefer certain situations some people as I said would rather do just about anything then get up in front of a lecture hall of a hundred and fifty people and talk but if they have to do it then they’re going to be under stress which may affect how they do things so we want people to understand that their perception and their feelings are affected by a lot of other things not just you know an emotion here or a particular memory there’s a lot that goes into it and social if peers your family convey irrational thoughts as necessary very standards for social acceptance people may tend to cling more to it to those unhelpful thoughts and unhelpful behaviors you know in CBT they say irrational because quote nobody wants to associate with those people you know who are those people and why can’t we associate with them there are a lot of things if you think back think high the school you know high school is pretty rough if we’re going to talk about having irrational thoughts and cognitions if you have to be part of this particular group to be accepted you have to do this you have to do that but do you really so those kinds of all-or-nothing statements are cognitive distortions and while they may have served a purpose in some way shape or form in the past we need to encourage our clients to take a look at them now and go are they still helpful ways of thinking is it still helpful for me to think that I am only successful if I live in a million-dollar house in a gated community and do this that and the other or can I be can I define success a different way or do I define success differently and lack supportive peers to buffer stress so we had those peers that caused stress by talking about the half dues and categorizing and lots of attributions but then there’s also not having somebody to go you know does this make any sense because sometimes we are our own worst enemies and if we go to a friend and we go you know this is what I’m thinking and I think I have to do this in order to be acceptable to be loved or you know whatever the case may be most people are not going to use those exact phrases a good friend is probably going to listen and go yeah you’re right or no no that’s way off so supportive peers are essential to reminding us to consciously regularly check in with our cognitions to make sure that they are hopeful and rational so a note about irrationality and this is mine this is not from CBT the origins of most beliefs for rational and helpful given the information the person had at the time and their cognitive development their ability to process that information so concepts and schemas and core beliefs that people formed when they were five are probably going to be very egocentric you know the person is going to feel like everybody sees it my way because this is how I see it you know just like a five-year-old does a five-year-old doesn’t think well you know let me take Johnny’s perspective is no he assumes that Johnny sees it the same way so it’s going to be egocentric it’s probably going to be focused on only one aspect of the situation because small children can’t focus on multiple aspects and it’s probably going to be dichotomous it’s all-or-nothing mommy loves me mommy hates me and it could be personalized you know everything a lot of kids think that everything has to do with them so if something happens something bad happens many times children will take it personally or be afraid it’s going to happen to them again you know if hurricane Katrina hurricane Andrew those sorts of things you know we saw a lot of trauma in children and they developed very real fears about thunderstorms and hurricane season and if you’ve watched Florida hasn’t had a notable hurricane in years now but there’s a lot of stuff that goes into that but young people during some of those really bad hurricane seasons perceive those situations differently okay so we need to help people understand that if we especially if we use the term irrational those thoughts you formed when you are knee-high to a grasshopper and they made perfect sense to you back then but now that you’re an adult you’ve got more experience and you’re able to take different perspectives your brain is more developed let’s take a look at it and see if you can look at different perspectives and come up with something a little more helpful maybe a different way of perceiving this situation the irrational irrationality or unhelpful Nosov Fox comes when those beliefs are perpetuated without an examination so something a the belief that you formed when you’re five you’re still holding when you’re 35 and you’ve never questioned it you’ve never gone you know does this make sense is this is helpful to get me to where I want to be most of us don’t know we form these attitudes and beliefs when we’re you know growing up when we’re in elementary school middle school high school from watching TV to being around our peers from being around our family in our community and we get all this input of the way things should be and a lot of times people don’t stop to question and go and go well does this make me happy is this really what I want and they can be irrational if they continue to be held despite causing harm to the person so the person continues to hold this belief even though it is causing them general emotional cognitive harm is making them miserable we need to look at why what’s motivating them to hold on to that belief why is that belief so important and how can we make it so they can live a happy values-driven life emphasis on the happy how can we make it less harmful sometimes it’s more productive for clients to think of these thoughts as unhelpful or helpful instead of irrational sometimes when I say irrational to clients and you know I’m the same way if somebody says you’re being irrational I’m like oh I’m not it elicits this instantaneous defensive the reaction’s like when you tell them they’re being resistant they’re like I am NOT being resistant so helpful or unhelpful and then we talk about why it is unhelpful in getting them toward their goals basic principles of cognitive behavioral therapy we teach or help clients learn to distinguish between thoughts and feelings I can think something is scary I’ll probably feel it but if I have an automatic you know feeling I walk into Atlanta Airport and I see yeah I went to an airport in New York I can’t even remember which one it was because my plane was diverted and I got off and I walked out there and I have never seen so many people packed in his place like sardines before in my life I was just completely overwhelmed that was kind of an automatic feeling now that was a feeling based on you know who knows it was overwhelming to be surrounded by that many people so then I had to separate the thoughts and go okay what am I thinking that’s making me feel so overwhelmed and at that point you know I didn’t know how to get to my gate and all that other sort of stuff with traveling I don’t travel well but encouraging clients to stop and go okay why am I feeling this way what are my what thoughts am I having that are contributing to these dysphoric feelings CBT helps people become aware of how thoughts can influence feelings in ways that are sometimes not helpful we have hecklers in our gallery the automatic tapes that we plaything memories that we have whatever you want to call them that when you try something when you are just going through daily life you hear these voices in the back of your head and not real voices but that is saying you’re never going to make this or if you would have just blah blah blah then you’d be a the better person helping clients become aware of those thoughts and how they’re negatively influencing their feelings and keeping them kind of stuck is a huge part of CBT we help them learn about thoughts that seem to occur automatically without even realizing how they may affect emotions again those thoughts from they’re saying you’re not good enough you’re not smart enough and nobody’s gonna like you where did that come from and do you believe it you know maybe it came from somebody when you were in high school so was that a valid source maybe it came from somebody yesterday on Facebook was that a valid source taking in those thoughts and then figuring out is this something I’m going to hold because it makes me happy or is this something that I’ve got to deal with because I’m having a negative reaction constructively evaluate whether these automatic thoughts and assumptions are accurate or perhaps biased the other thing to remember is a lot of our clients not all of them but a lot of them hold themselves to a standard there’s like up here and they hold everybody else to a standard that’s down here so they are a failure if they don’t achieve this but everybody else is successful as long as they achieve this so encouraging them to take a look at how accurate and biased or unbiased are the thoughts and like I said they may be their thoughts they may be telling themselves these things evaluate whether the current reactions are a helpful and good use of energy or unhelpful and a waste of energy that could be used to move toward those people and things important not impotent important to the person road-rage you’re in the car, you’re driving somebody cuts you off okay natural reaction fight or flight reaction you’re just like slam on the brakes and do whatever you got to do aversive maneuvers you’re good so you could let it go at that point ago got lucky on that one and keep driving most people not all but most they found that 80% of drivers have reported incidences of road rage which is a high number but most people will start getting all fired up and irritated and grumpy and we and just rageful and so my question would be I hear that and I hear that it made you angry in retrospect did screaming at the person as you pass them at sixty miles an hour in your car with the windows rolled up does any good did it do any good at all what else could you have done with that energy if you wouldn’t have expended it all yesterday we had to wait for the vet to come by and my daughter just completely wore herself out worrying about when the vet was going to get there what he was going to say about her donkeys and was beside herself so by the time it got to evening and it was time for her to go to her martial arts class she didn’t have the energy to go she’s like um wiped out I just want to go to bed in retrospect we’re looking back and saying okay now tell me what it was that you were so stressed out about and let’s talk about whether that was a realistic and helpful line of thought to perseverate on all day long and what could you have done differently because she didn’t bother to mention any of that to me yesterday and then developed the skills to notice interrupt and correct these biased thoughts independently causes of these thinking errors information processing shortcuts when we form schemas and we encounter a situation that reminds us of something in the past like when I go to my grandmother’s house I have a schema I have a belief system I have you know stuff that I know about my grandmother’s house so when I go to my grandmother’s house it’s kind of a shortcut to knowing what to expect when I walk in and how to behave how to do different things and it helps me plan and predict if you’re using outdated or dichotomous all-or-nothing schemas it may cause thinking errors because you may be now incorrectly processing current events mental noise some of us have it a lot of us have it not everybody thinks about trying to focus and study for a final exam in the middle of a really busy sports bar, okay this is a cause of thinking or you’re going to miss important things you’re not going to be able to focus you’re not going to necessarily attend to the correct things because there’s just so much else going on your attention is drawn in 17 different directions and or the brain’s limited information processing capacity due to age we talked about that before young kids think all or nothing they think dichotomously egocentric ly middle school-aged kids and older start developing the ability for abstract thinking by the time we get older, you know as adults theoretically we’re able to you know think pretty well and think pretty clinically about different events but if we’re in crisis when someone is in crisis and it could be like what we think of clinically as a crisis or it could be they’re just completely overwhelmed and burned out and have been burning the candle at both ends for three months they’re not going to process information quite as well they’re not going to take in all this stuff because they’re just like shell-shocked have you ever seen teachers in the hallway of like an elementary school Oh at the end of the second nine weeks they just kind of stand there with this blank look on their face they’re not processing as much as they were the first day of school and you know God loved them they have a lot to deal with but we need to help our clients understand that there are some times that they are going to have to really stop and focus write things down so they can remember or they can make decisions a little more my guess is most of us have times in our life when we’ve been able to think through complex problems but then there are other times where you just can’t keep it all in your head and you’ve got to put it on a whiteboard maybe that’s just me but we want clients to understand that they are not broken they’re not faulty they’re doing the best they can with the tools they have and the knowledge they have and our job is to help them see where some of this might have gone a little awry other causes of thinking errors and emotional motivations I feel bad therefore whatever I’m thinking must be bad if I’m scared that means whatever it’s coming on the other end of the phone is bad news moral motivations I did it because it was the right thing to do and that can be an excuse for doing wrong behaviors as well it can also be you know you can argue on the moral one social influence well everyone else is doing it so it must not be bad set that again a lot of times and this is where the frames approaching the motivational interviewing is helpful f stands for feedback about the reality of what’s going on is everybody doing it let’s look at statistics you know not subjective information let’s look at objective information so the impact of these thinking errors makes people want to fight or flee when they get upset and we use upset as a kind of this all-encompassing garbage term emotionally they get depressed or anxious we don’t want to feel that way anxiety and anger are flee or fight fight or flee it’s our body saying there’s a threat you got to do something depression is your body going I give up I just don’t I don’t even have the energy to do it anymore behaviorally some people withdraw they shut down we all know people who get frustrated when they get overwhelmed when they start feeling hopeless or helpless they just kind of withdraw from everything and everyone’s addictions numb that out so they don’t have to feel the dysphoria sleeping problem and changes when we start being on that constant fight-or-flight hyper-vigilant sort of thing going on in the body is always sort of turned on which means you’re not going to sleep as well then the circadian rhythms get messed up which starts causing exhaustion and lethargy and then everything seems harder because you’re sleep-deprived and then you start thinking more negatively and more hopelessly you see where this is going it’s a downward spiral and eating changes some people eat a lot more because they’re eating comfort foods some people eat a lot less because their stomach is so torn up from the stress they can’t even think about holding anything down physical stress-related illnesses fibromyalgia gastrointestinal problems headaches neck aches backaches you know the whole the gamut of it when you start feeling bad when you start hurting generally it gets frustrating after a while and that frustration makes it kind of raises the the bar brings you up a little bit so you’re that is much closer to kind of just kind of being overwhelmed you don’t have as much of a cushion as you would if you were happy healthy well nourished not in pain and socially a lot of times we will get irritable or impatient with other people or withdrawal when we’re having these negative cognitions these thinking errors that are keeping us in a dysphoric state these effects of thinking errors contribute to fatigue and a sense of hopelessness and helplessness which intensifies thinking errors this is an important concept that I want my clients to understand and I want to drive home in this presentation so thinking errors what are they emotional reasoning feelings are not facts and we want to help people to learn to effectively identify feelings and separate them from facts so if somebody says I’m terrified okay that is a feeling what are the facts supporting that feeling why are you are terrified what is the evidence that you are in some sort of danger right now you know and danger may not be the right word for your client at that a particular point in time but what’s the evidence that there’s a threat in what ways are this similar to other situations maybe it’s triggering something from the scary past or you know you were too little to be able to handle it but you can handle it now and how if you dealt with similar situations like this, in the past, we want to help people just step back and get some distance between their feelings and their thoughts and try to figure out you know which thoughts are helpful and productive and even if a sought makes people anxious or angry it can be helpful it may be telling them hey dude you need to get your butt up and get out of there if it’s helpful it means it’s moving them toward where they want to be happy healthy safe and values-driven life so happy and helpful developed a stress tolerance skills when people use emotional reasoning they feel emotions which then they start attributing finding the facts to support those emotions instead of looking at all the facts we want to help them learn to tolerate their distress so they can kind of let that subside for a second they can accept their feeling they can name they can say I’m scared I’m stressed I’m angry and whatever but they don’t have to act on it right then they can tolerate the distress for a minute without having to try to make it go away and emotional regulation skills they can feel a feeling without having to make it go from zero to 120 you know if they feel sad they go I feel kind of sad instead of grabbing onto it and going I wonder what I feel sad about I must feel sad about all these sad things now I’m going to be sad and devastated so we want to help people learn how to regulate their emotions identify them accept them whatever word you want to use and tolerate them because feelings are there for a reason, they’re to tell you your brain thinks something’s going now thankfully we have that higher-order cognition stuff going on so we can contradict our brain and we can go you know maybe that’s not true in this situation cognitive bias negativity mental filter whatever you want to call it people who focus on the negative they walk in they get up in the morning and they look outside and it’s partly cloudy they get to work and they said instead of saying there was it was very light traffic they said there was a fair amount of traffic everything is always the flip side of what somebody who’s optimistic would say so asking them what’s the benefit to focusing on the negative in what ways is this helpful to you you know some people say well it keeps me from getting disappointed because I know it’s going to end up negative anyway so we can trap challenges that know that whatever it is they think they know and see if there have been exceptions when it hasn’t turned out that way what are the positives to this situation I give the example a lot of you know I wash my car or it rains and maybe I wanted to go out on a run that day but I can perceive it I can look at the positives you know the rain washed my car for me so I don’t have to do it now score it watered my garden all the better it knocked down some of the pollen out of there even better I can find and I can encourage people to find positives in a situation yes there are negatives to every situation if you want to find them you’re going to find them but if you want to find the positives you can too which takes us down to what are all the facts there’s the positive and the negative and the neutral I told you earlier about the coin toss activity having people toss a coin on the heads days they act like it is just the greatest day to be alive and see how things are different when they do their journal because you know I have my clients do I’m sort of a mindfulness check-in in the morning and in the evening and preferably at lunchtime how are they feeling what’s their emotional state what’s their energy level on the happy days a lot of times it can be less and sometimes they need a little coaching throughout because some of those old patterns kick in but I want them to start challenging some of their automatic thoughts that we’re going to talk about in a minute disqualifying or minimizing the positive most of us can probably say we’ve had a bunch of clients that do this they are more than happy to tell you about all the things that they mess up but then when they do something right they minimize it encouraging people to hold themselves to the same standard they would hold everyone else to and I know I talked about that earlier ask them things like would it minimum would you minimize this if it was your best friend’s experience your best friend came to you and said I just got into such-and-such college would you say awesome or would you say anybody can get in there how would that go ask them what is scary about accepting these positive things that you might have had an accomplishment for some people it means that it might mean other people expect more of them for other people they just don’t know how to accept the positive they don’t know how to accept compliments they don’t know how to be the center of attention and they don’t like it and then we want to look at why that is sometimes we disqualify the positive because it fails to meet someone else’s standards so as people might that be true here you know I know when I was growing up and going through college and going through school and everything got my doctorate but I will always be ever and always being not a real doctor because a Ph.D. is not an MD and I’m like really so is it somebody else’s standards or can I feel good about having a Ph.D. egocentrism my perspective is the only perspective I’ll being egocentric but it doesn’t work most of the time so encouraging people to take alternate perspectives maybe you’re texting with someone and they say something that is not that you interpret as not the nicest thing and this happens in a text messages a lot and they get upset now an egocentric thinking error would say that purse is just grumpy today someone that’s taking other perspectives would stop and go back and read the text and go I wonder if maybe this could have been taken some another way you know cuz their reaction is not what I intended so egocentrism if you hold on to that I don’t understand anybody else because you know I don’t see a problem with anything personalizing and mind-reading this is when you assume that everybody’s frowning because of something you did your boss walks down the hallway and looks at you and grimaces and continues to walk on oh I must have done something wrong no maybe he just got out of his senior management meeting that was five hours long and he’s got to go to the bathroom you know there could be a hundred different explanations for why that happened so encourage clients to ask themselves what are some alternate explanations for this event that doesn’t involve me you know why might this have happened if they hold on to that, I must have done something wrong but as soon as their boss calls them up and goes hey can you come to my office for a second you know where their thoughts are going to go I’m getting fired I’m going to get laid off I don’t know what it was that I did wrong but he walked by me two weeks ago in the hallway and grimaced and I’m just I’m the worst person in the whole world but where did that come from so encouraging people to not necessarily assume they know what’s going on in someone else’s mind and not automatically attributing every person’s negative behavior to something they did how often and then ask them how often has it been about you now think about the last 10 times you’ve taken something personally how many of those 10 times has it been about something you did versus something with the other person then the availability heuristic remembering what’s most prominent in your mind so asking clients what are the facts ah the most obvious one that we talk about is plane crashes you know it is way dangerous to fly on a plane because you hear about all those plane crashes well yeah you hear about A few planes crash but you don’t hear about the 20,000 every day that land safely so you remember it and it seems more dangerous because that’s what is in your mind that’s what is available to you that’s what you’ve based your thought processes on because maybe you didn’t know that 20,000 planes or more fly and land just perfectly every day this can also be true with people remembering what’s most prominent in your mind sometimes and this can be very very true in domestically violent relationships if somebody falls in love with someone and that person is just the greatest person since sliced bread for the first four months and then the cycle starts and there’s this little tiny a sliver of the honeymoon period after the battering cycle and the person’s like that’s the person I fell in love with that’s what I remember and they try to focus on what’s most prominent in their mind and they ignore the rest of the stuff so we need to encourage people to look objectively at the facts magnification are you confusing high and low probability outcomes what are the chances that this is going to happen how many clients have we worked with that have gone to the doctor and gotten in a physical or get a test run and then the doctor had to call them back and this could be true for you too and the doctor had to call them back two or three days later when the tests came back from the lab and that whole three days they were just in a panic because they were afraid they were going to get some terminal diagnosis so thinking about high and low probability outcomes another instance or example of magnification is somebody that thinks this is the end of the world whatever it I think I’ve told you before my little story about um tripping when I was walking down the hall at work and falling and yeah it was embarrassing my folders went everywhere and yeah but in that big scheme of things will it matter that much from now you know are people gonna think oh she is such a clutch she must be a ditz too no I mean they may have thought that at that time I don’t know but you know in six months nobody’s going to remember and then ask them in the past when something like this has happened when you’ve had to get a test done and you’ve had to wait on results or if you’ve done something that was embarrassing and you didn’t think you thought everybody was going to remember it forever how did you tolerate it how did you learn to deal with it building on those strengths that they already have all-or-nothing thinking errors these are things like love versus hate I love them or I hate them it’s all or nothing she does this all the time or she never does it if I’m going to do it I’m going to do it perfectly or I’m not going to do it at all thank you all good intentions or all bad intentions you know sometimes we do things with good intentions that have some bad repercussions so did we do it with all bad intentions are all good intentions and the answer is neither most of the time life is kind of in that middle-ground gray area encouraging clients to look and find examples where something hasn’t been one of the polls when having they do something that they’re proud of that wasn’t perfect or when again when has somebody else done something that they were proud of that wasn’t perfect remembering that with availability heuristic remembering how often something really happens and how long it’s been since you’ve seen that behavior and remember that sometimes good times are amazing but how frequent are they compared with the bad times another thinking error is a belief in a just world or a fallacy of fairness I just asked clients to identify for good people you know who’ve had bad things happen and in reality we all have bad things happen good people do bad people do in between people do attributional errors and this is a pet of mine you know labeling yourself is not a behavior so global versus specific and I am stupid versus I’m stupid at math I don’t have good math skills it’s not about me it’s about the skills I can change skills stable I am and I always will be versus it’s something I can change it’s something I can learn internally it’s about me as a person versus it’s about a skill deficit or something I could learn or change and there’s you know lots of information on attributions out there on the internet if you need a refresher on it but we find that a lot of people who have dysphoria have negative global stable internal attributions so questions for clients remember the beliefs equal thoughts and facts plus personal interpretation another way of saying it is reality is 10% perception is 10% reality and 90% interpretation so what are the facts for and against my belief is the belief based on facts or feelings do the belief focus on one aspect or the whole situation does the belief seem to use any thinking errors what are alternate explanations what would you tell your child or best friend if they had this belief how would you want someone to tell what would you want someone to tell you about this belief so if you’re telling somebody about this what are you hoping they’re going to say in return and finally, how is this belief moving you toward what and who is important to you or moving you away from what or who is important to you now they can do a worksheet and have all of these or you can pick one or two of these questions that are most salient for your clients but they can have kind of at their fingertips so as they’re going through the day and something happens they can ask themselves ok what’s an alternate explanation or you know whatever it is this is salient for that client’s irrational thoughts about how to do these thoughts impact the client’s emotions health relationships and perceptions of the world you know this is what we want to ask them how is this thought impacting you globally how may this thought has been helpful in the past where did it come from how does it make sense from when you formed it in the past when you’re dealing with it ask the person if the thought is bringing you closer to those that are important are there any examples of this thought or belief not being true and how can the statement be made less global less all-encompassing so it’s about a specific incident a specific situation less stable which means you can change it and less internal which means it’s not about who you are as a person but maybe something that you do or a skill that you have so we’re going to go through some of these thoughts real quickly here mistakes are never acceptable and if I make one it means that I’m incompetent well never is kind of stable and I am incompetent is kind of global that’s also that extreme all-or-nothing thinking so you can see where these cognitive distortions end up leading to unhelpful beliefs when somebody disagrees with me it’s a personal attack well there’s personalization if I ever heard it before maybe it’s not about you may be they’re having a bad day and you just happen to be the unlucky target or maybe they’re disagreeing with you because they have a different point of view and it’s not a personal attack it’s just their point of view if someone criticizes or rejects me there must be something wrong with me personalization all-or-nothing thinking global stable and internal something wrong with me as a person to feel good about myself others must approve of me now this is one we’ve talked about external validation before and we can’t control other people to feel good about yourself how can you do that besides necessarily requiring other people to approve of you to be content in the life I must be liked by all people Wow I’ve never met anybody who’s liked by all people I’ve never even met anybody who’s been hated by all people but it’s important to help clients see how this is dramatic to say all people and for them to be content then everybody has to like them I mean I like to be liked but if everybody doesn’t like me you know that’s pretty understandable my true value as an individual depends on what others think of me I would challenge this one this is all you know also, very personal internal I would challenge people to look at and say it so your child’s value as an individual depends on what other people think of he or most people would say no but the perspective thing nothing ever turns out the way, you want it to okay all-or-nothing thinking and probably the availability heuristic if something bad just happened then they may be focusing on that which causes them to focus on all the other bad things in the past that have happened not to focus on that is okay you know bad thing happen but look at all these good things I won’t try anything new unless I will be good at it this fear of failure fear of rejection it just really paralyzes a lot of people when they get stuck with that thinking the area that they have to be perfect I am in total control of anything bad that happens is my fault well that’s egocentric and personal if they think they’re in total control that’s their perception of how the world are they think if they’ve got everybody on marionette strings anything bad in the world that happens is their fault how powerful are they I feel happy about uh if I feel happy about life something will go wrong it happens sometimes but let’s look at times when you’ve been happy that something hasn’t gone wrong you know let’s get rid of that all-or-nothing thinking it’s not my fault my life didn’t go the way I wanted could be true but it seems like that’s making you unhappy so what do we do about that if I’m not in an intimate relationship I’m alone no, again that’s pretty extreme I’m either in an intimate relationship, or I am alone and a loner and you know it’s just me and my 17 cats which follows with there’s no gray area so encouraging people to look at what these beliefs are saying important thoughts impacts behaviors and emotional and physical reactions emotional and physical reactions impact thoughts and interpretations of events so if you do something and it’s pleasurable and you have a great physical reaction you know let’s take bungee jumping or skydiving if you go out there and it’s scary but you do it and you’re just like whoa what a rush your interpretation of that is probably going to be good which means you’ll probably do it again if you go out there and it’s just the most horrible experience you’ve ever had you’re probably not going to do it again and your interpretation of it is going to be not good which is going to make it hard to understand why other people would do it irrational thinking patterns are often caused by cognitive distortions so let’s just look back at some of those because there are a lot fewer cognitive distortions or general ways of thinking about the world then there are thinking errors because there are lots and lots of thinking errors cognitive distortions are often schemas which were formed based on faulty inaccurate or immature knowledge or understanding and by identifying the thoughts of the hecklers you know the automatic tapes that are maintaining our unhappiness the person 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Best Practices for Anxiety Treatment | Cognitive Behavioral Therapy

this episode was pre-recorded as part of a live continuing   education webinar on-demand CEUs are still available for this presentation   AllCEUs.com/Anxiety-CEU I’d like to welcome everybody to today’s presentation on best practices for the   treatment of anxiety I am your host, Dr. Dawn Elise Snipes now not too long ago we did a presentation on strengths-based biopsychosocial   approaches to addressing anxiety while those are wonderful you know I thought maybe   we ought to look at you know what’re some of the current research so I went into PubMed which is   I don’t know it’s a playground for me it’s where you find a lot of journal articles and you   can sort I sorted by articles that were done and meta-analyses that were done within   the past five years so that gives us an idea about current research I mean there’s a lot   of stuff that is still the same like some of the medications that were known to work ten   years ago are still known to be you know good first-line treatments but there are also some   newcomers that we’ll talk about and there are also, some changes that we’re going to talk about so we’re going to explore some common causes for anxiety symptoms to treat, we need to and of course, this does play into the biopsychosocial aspect we need to   understand kind of what causes it because anxiety that’s caused by for example somebody having a   racing heart may be different than anxiety that’s caused for somebody who has abandonment issues so   we’re gonna treat the two things differently so we want to look at some of the common causes we’re   gonna look at some common triggers for anxiety Do you know what are some of these common themes that   we see in practice I will ask you to share some of the themes that you see that underline   or underlie a lot of your client’s anxiety and identify current best practices for anxiety   management including counseling interventions medications physical interventions and supportive   treatments so we care because anxiety can be debilitating and a lot of our clients   have anxiety a lot of our clients have anxiety comorbid with depression and they’re looking at   us going how can I feel anxious and stressed out and like I can’t sit still and be depressed at the   same time you know when you’re depressed you’re supposed to want to sleep well a lot of times   people who have both issues want to sleep but they can’t so I want to help clients   understand that also sometimes anxiety when people are anxious for long enough the body   starts kind of holding on to the cortisol the body recognizes at a certain point this is a   losing battle I’m not going to put energy into this anymore so it starts withdrawing some of   its excitatory neurotransmitters so to speak and people will start to feel depressed the   brain has already said this is hopeless this is you’re helpless to change the situation so   then people start feeling hopeless and helpless which is sort of the definition if you will of   depression low-grade chronic stress and anxiety arose energy and people’s ability to concentrate   so if we’re going to help them become their uber selves we need to help them figure out how to   address anxiety not just generalized overwhelming debilitating anxiety but also panic social anxiety   and those minor anxiety triggers that come along that may not meet the threshold for diagnosis   anxiety is a major trigger for addiction relapse if you have a client who is self-medicated before   or had an addiction for some reason anxiety is a major trigger increased physical pain when anxiety   goes up people tend to tense their muscles when they tense their muscles they tend to feel more   pain I mean think about when you’re stressed you tend to have more pain like in your neck your   back and things that already hurt may hurt more why because serotonin which is one of our major   anti-anxiety neurotransmitters is also one of our major pain modulators so when serotonin levels are   too low because anxiety is high then our pain perception is going to be more acute and people   can have sleep problems if they’re stressed out your body thinks there’s a threat you’re not   going to be able to get into that deep restful sleep you may have you may sleep a lot but it’s probably not quality sleep which means your neurotransmitters may get out of whack   your hormones make it out of whack and your body is going to start perceiving yourself in a   persistent state of stress when you’re exhausted the body knows that we may be the weakest link   in the herd so it continues to secrete cortisol to keep you on alert a little bit so you   may again you may be resting kind of like when you have a new baby at home those first couple   of months that my children were home from the the hospital I slept but I didn’t sleep well I mean   the slightest little noise and I was awake and I was looking around and you know I felt it I felt   exhausted and a lot of new parents do so triggers for anxiety abandonment and rejection and we’re   going to talk about ways we might want to deal with these things but some of the underlying   themes that I’ve seen in a lot of clients and when I do the research and a lot of what themes that   come out include low self-esteem if someone has low self-esteem they’re looking to be externally   validated oftentimes they’re looking for somebody else to tell them you’re lovable you’re okay so   that can lead to anxiety about not having people to tell them you’re okay which makes   their relationships tenuous and can make them dysfunctional irrational thoughts and cognitive   distortions may lead people to believe that if I’m not perfect for example I am not lovable so we’re   going to look at some irrational thoughts and cognitive distortions unhealthy social supports   and relationships when you’re in a relationship it takes two to tango and even if your client is   relatively mentally and physically healthy if they are in a dysfunctional relationship they can fear   abandonment and rejection if that other person is always saying if you don’t do X I’m going   to leave you or if that other person is always cheating on them or whatever so relationships   can trigger abandonment anxiety and ineffective interpersonal skills can lead to relationship   turmoil and social exile if our clients are in relationships even if they’re not completely   dysfunctional if our clients are not able to ask for what they need and set appropriate boundaries   and manage conflict effectively because conflict happens in every relationship then they may start   to argue more which may lead to fearing may lead to relationships ending in the past and them going   well every relationship I get into ends which means I must not be lovable so they start fearing   abandonment and rejection these are four areas that we can look at one more assessing clients   another issue is the unknown and loss of control a lot of times negative self-talk and cognitive   distortions can contribute to that if I don’t have control of everything then it’s all going to be a   disaster negative others when clients hang out or when people hang out with negative people it   kind of wears on you after a while you notice that people who tend to be more negative   pessimistic conspiracy-minded tend to hang out with people who are also negatively pessimistic and   conspiracy-minded so if you’re hanging out with somebody who tends to be anxious then the anxiety   can be palpable and it can kind of permeate physical complaints can lead people to be   anxious because they don’t know what’s causing it like I said earlier sometimes if your heart starts   to race if you don’t know what’s causing it for you can start thinking I’m having a heart attack or   I’m gonna die when people have panic attacks for the example they truly think they’re having a heart   attack and it’s I’ve had them they are very very unpleasant experiences but when people   start having physical complaints and it can be you know they have a weird rash that they can’t get to   go away or whatever but when they don’t know what it is and they can’t control it they can’t   make it go away they start thinking about all the worst-case scenarios and going online and   getting on WebMD which usually gives you all the worst-case scenarios um so physical complaints   are important we need to normalize the fact that nobody’s pain-free all the time and you know the   fact that you may have an ache or a pain or a lump or a bump or you know a cough most likely you know   when we look at probability the probability of it being something significant is pretty small now   do you want to get it checked out probably but you know the probability that is anything to be   worried about is relatively small and a sense of powerlessness can trigger fear of the unknown   and loss of control for somebody who doesn’t feel like they have any agency in their life   if they have an external locus of control or if they felt victimized all of their life then   they may fear not being in control they may be holding on and saying okay this is the one area   of my life I can control when I grew up you know I grew up in a very chaotic environment I had no   control I was bounced around in the foster system yadda yadda yadda now that I’m an adult you know I   can control these things and I am going to hold on with white knuckles and if I can’t control   everything then that terrifies me to death and loss are other triggers for anxiety and it can   be people or pets and pets are important I don’t want to minimize pets because you know they are   little parts of a lot of our families so making sure we check that my daughter’s dog for example   is it’s getting old she’s getting older she’s 14 now I think and you know she’s in decent health   we took her to the vet and the vet said yeah she’s got a little heart murmur but that’s expected for   a 14-year-old dog and but when she goes out if she doesn’t come back when I call her I have this rush   of anxiety for a second oh my gosh I hope this wasn’t the day so anxious around losing people   and you know if she when she crosses the bridge she will and you know I’m okay with that I’m   I have a harder time dealing with my daughter’s emotional turmoil when that happens and because   she’s grown up with this dog so you know those are the types of things that we want to talk about   with our clients what things are weighing on you that you may not even be thinking about because I   know in the back of my mind there’s always that worry about one of our donkeys and her dog jobs   and promotions can trigger anxiety if people are afraid they’re gonna lose their job if they’re   always afraid that you know they’re gonna walk in and get a pink slip or get fired you know we want   to help them look at how realistic they are you doing what you need to do to achieve   and keep your job and sometimes it’s not easy to the answer I mean the first thought that a lot of us   have is well you know if you’re doing the right a thing so just do it but there are those bosses   out there and I’ve had some amazing bosses a lot of them and I’ve had two horrendous   bosses and those two bosses I could never I never felt like I was able to do anything right   and so going to those jobs there was always this anxiety about what I’m what am I going to get in   trouble for today so you want to talk with people about does your job cause anxiety what can you   do to moderate that anxiety the same thing with promotions people may get anxious about whether   they’re going to get promoted to safety and security you know when you lose safety and security you can   feel anxious so if there’s a break-in at the house next door or shooting down the road   or you start watching the news you can feel very unsafe and insecure quickly so we want to   help people figure out how safe and secure are you really and a lot of it goes back to looking   at facts when people lose their dreams and hopes or fear that they’re going to lose their dreams   and hopes they can start to get anxious you know they have this dream that they’re going to be   a doctor or I just finished the presentation on helping high school students transition to college   and a lot of high school students for example start college with these wide eyes and hopes   to save the world and they want to be doctors and engineers and this and that and they get   into it and they realize that it’s a lot harder then they thought or they realize that you know   what I don’t like this but I’ve already committed to it so what do I do I want to help   people but I can’t I can’t cut it doing this you know for me I figured out in my second year that   I wasn’t going to medical school because I wasn’t going to pass calculus and that caused a lot of   anxiety it was like okay what am I gonna do now Do you know what career should I choose to help people figure out do they have dreams that have maybe kind of crashed and burned and you have to   find new ones you know okay that one we’ve got to accept it figure out that it’s not going to be and   what can you do now people may also have dreams about relationships they get into relationships   and see themselves with this person forever and then this relationship ends and or starts to   get rocky and they’re like but that’s my dream what happens if that’s got to happen because   it’s my dream I don’t know how to function if that goes away we want to help people be able to   rewrite their narrative and then sickness spiders and other phobias kind of go in with death a lot   of times when people get sick they start getting anxious that oh my gosh what if this is terminal   oh my gosh what if this is you know incurable if I get bit by a spider it’s gonna kill me and   which is rare you know there are very few spiders that is actually that poisonous same thing with   snakes going over bridges I’ve shared with you all that is not one of my irrational fears you know I   am just terrified that you know something’s going to happen and I’m going to get pushed off the side   of the bridge which is completely irrational but we need to help people look at those and identify   the thoughts that they’re telling themself about those phobias and dealing with that anxiety failure   is another –trigger for anxiety especially in this culture our culture American culture is large part puts a high premium on success and perfectionism so when people realize that   they’re not perfect they may start to get anxious because they feel like if I’m not perfect then I’m   a failure you know those cognitive distortions of all-or-nothing thinking and they start with that   negative self-talk you know you can’t do anything right so those are some of the issues that you   know we often see in counseling sessions so what do we do you know somebody comes in and is like   I can’t live this way doc anxiety depression and substance disorders as well as a range of physical   disorders are often comorbid so this is the first the thing we need to realize is that   we’re very rarely dealing with a very simple the diagnosis you know when somebody comes in we need   to figure out you know if they come in and they’re presenting with depression all right let’s talk   about that and then we start realizing that there depression started to occur after a long period   of being anxious okay so we need to deal with that but we also need to help them   with their sense of hopelessness and helplessness we need to develop that sense of empowerment and   then substance disorders we know that substance use is often a way of self-medicating but we also   know that it monkeys with the neurochemicals in the brain and can contribute to anxiety and   depression the same thing to physical issues pain from physical disorders anxiety about having   physical disorders medications you’re taking for physical disorders can all contribute to anxiety   so we need to look at the person as a whole and go what are all the things that are contributing to   the anxiety and what are all the things that the anxiety is contributing to so we have started having this big list of stuff that needs to be addressed and then we can start figuring out okay   where we start so knowing that these things are comorbid helps researchers explore pathways   to mental disorders so they can start figuring out you know what little string can we pull to   unravel this blanket of anxiety so it doesn’t suffocate somebody and for us, as clinicians, it   provides us key opportunities to intervene in you know sometimes clients will come in and start talking about their anxiety and their physical issues you   know maybe their anxieties about you know heart palpitations and because that’s a common one we   may want to encourage them to go see the doctor to get that ruled out you know rule out anything that   has to do with hormone imbalances or you know heart conditions or anything else that might be   contributing to it which can help them address it and if they do have physical disorders let’s   go with hormone imbalances that are contributing to the heart palpitations then they can start to   treat that if they don’t start to treat that then no amount of talk therapy we do is going to get   them to the quality of life that they’re looking for because they’re still gonna feel those so   we want to make sure that we’re addressing them holistically anxiety disorders should be treated   with psychological therapy pharmacy therapy or a combination of both and what they found and this   is no surprise this is kind of old news is that counseling Plus pharmacotherapy tends to have the   best outcomes but separating the two have similar outcomes in many cases but that’s just   looking at and I hate to call it simple anxiety but we’re just looking at anxiety symptoms here   we’re not looking at the full quality of life and we want to make sure that we’re also including any   medical issues behavioral therapy is regarded as the psychotherapy with the highest level   of evidence, there are a variety of cognitive behavioral approaches ranging from acceptance   and commitment therapy to dialectical behavior therapy to CBT to debt you know any of those that   deal with the thoughts and the cognitions that fall in that realm and it is effective in the current conceptualization of the etiology of anxiety disorders includes an interaction of   psychosocial factors such as childhood adversity or stressful events and a genetic vulnerability   so the psychosocial factors and these are other things when we do our assessment we want to pay   attention to because our approach to treatment is going to be different for people for example   who have trauma-related brain changes maybe then for somebody who doesn’t so, we want to   look at childhood adversity and stressful events that it may have caused basically what I tell clients is like rewiring of the brain there are trauma-related brain changes in soldiers and   especially in children or in people who’ve been exposed to extreme trauma that is designed to   protect them but it also can cause complications kind of later on in dealing with anxiety coping   skills that were learned that are ineffective you know sometimes people grow up in a household or an   environment or a situation where they don’t learn effective coping skills so we need to kind of help   them unlearn those and learn new ones build on their strengths and trauma issues that may still   need to be dealt with such as domestic violence you know if they grew up a lot around a lot of   domestic violence they may think you know I’m out of that situation it’s over I don’t want to   think about it it’s not bothering me anymore or a parental absence and I put absence because it can   be death it can be a parent that just packed up and left it could be a child that got put up for   adoption whatever put the child in a position of feeling like they were rejected by a parent can   be very traumatic and bullying among other things but there are a lot of trauma issues that people   once they’re out of that situation often say you know I’m out of it it’s not a big deal I dealt   with it let’s move on and they don’t realize the full ramifications and how that’s contributing to   their current anxiety and their current self-talk and cognitions of current stressors if somebody has   a lot of current stressors that are also going to impact whether they develop generalized anxiety   you know we’re kind of stacking the deck here and the current availability of social support if they   don’t have effective current social support then they’re gonna have difficulty bearing the weight   of everything on their shoulders so we want to look at all these psychosocial factors when   we do our assessment now going back to the trauma issues if you’ve taken the trauma courses at   all CEUs you know that some people are not ready to acknowledge that the trauma is still bothering   them or work on the trauma and that’s okay we can educate them that it might be an issue and   then let them choose how to address it but we want to bear in mind the fact that you   know this could be sort of an underlying force motivating some of the current cognitions and genetic vulnerability so you take any three people and you put them or 300 people and you   put them through roughly the same psychosocial situations they’re all probably going to react   a little bit differently based on their prior experiences but also because of their genetic   makeup there are certain permutations and they found four we’ll talk about later that make the   brain more or less responsive to stress and more or less responsive to serotonin which   is your calming chemical so brains that are less responsive to serotonin isn’t going to you know   send out as much or send out serotonin as easily so people can stay kind of tensed and wired that’s an oversimplified explanation but that’s all you need for right now so genetic   vulnerability impacts people’s susceptibility to the effects and development of dependence   on certain substances which can increase anxiety when people are detoxing from alcohol when they’re   detoxing from benzos when they’re detoxing from opiates they can feel high levels of anxiety when   they take opiates some people find that opiates have wonderful anti-anxiety properties not that   I am advocating for the use of opiates I’m just client experiences have shown that that   can be true so some people are going to be more susceptible to the anti-anxiety effects   of certain substances and some people are going to be Cerrone to become dependent on substances   where others may not and that part of that is genetic vulnerability and they estimate about   30% the predictability of the development of anxiety disorders is genetic and genetics   also impact which medications are effective if you have genetic makeup then SSRIs might   be helpful if you have genetic makeup be then atypical antipsychotics may be more effective   and SSRIs might not do anything which is why a lot of our clients get so frustrated because they know there’s no way to figure out exactly what I guess there is now that there’s genetic testing   out there but up until then it was harder to figure out which medications to start with and   most physicians matter of fact I don’t know of a single physician that starts by   saying well let’s do a genetic profile to see what med to start you out with most we’ll start with events as with an SSRI or some other anti-anxiety medication some sort of benzo   that’s been my experience so we may want to encourage clients to consider genetic   testing if they’re having difficulty finding a medication regime that works for them and they   are feeling like they have to have medication genetic vulnerability also affects what’s going   to make somebody more vulnerable now than all of you in class today you know thinking about sleep you   know sleep may not be a big deal for some of you I know people who can go days or weeks with four   or five hours of sleep and they feel fine it’s not a big deal, not me I need eight or nine hours   of sleep so genetically for whatever reason I am programmed to need a lot of sleep so when I don’t   get that much sleep I tend to be it tends to be harder for me to deal with life on life’s terms   and I know that that makes me more vulnerable to being irritable so genetic vulnerability affects   who can become addicted and affects what medications work best and affects what situations are going   to tend to make somebody more vulnerable to anxiety so our medications and I know the type   on here is small but we’re going to go through the first-line drugs are the SSRIs selective   serotonin reuptake inhibitors and SNRs is selective norepinephrine reuptake inhibitors   now the names are a little bit deceptive because selective norepinephrine reuptake inhibitors also   increase available serotonin but the mechanism of action is different the mechanism of action   for each SSRI is a little bit different as well which is why you can put somebody on Prozac and   they have an awful experience and you can put them on Zoloft and they have a much better experience like I said earlier a lot of the research pre five years ago had been done on medications and   Zoloft Paxil luvox Lexapro Celexa and their generics have all been found to be effective   at treating anxiety in certain people no one the medication works for everybody in the last five   years Effexor has come on the radar and it has been found effective according to the hamilton   rating scale for anxiety so that’s another one to consider if clients are not successful or getting   the treatment effect that they need for on some of the other medications obviously, none of us   probably are prescribers but we do need to educate clients about why the first drug or even the third   drug that the doc tries may not work so they don’t start feeling helpless and hopeless like   I said earlier there are at least four different genetic variations which are correlated with the   development of generalized anxiety disorder and different medications are more or less effective   depending on the genetic makeup of the person there’s a high mortality rate moving on to two   benzos the recommendation has switched to back off from the use of benzos now for   some doctors will prescribe an SSRI and for the first four weeks while the SSRI is building up   in the system they will also prescribe a benzo to be taken as needed to moderate the   anxiety and you know you could argue on either side of that, if somebody has a history of substance   use or substance dependence benzos are really a bad idea because they do have a high rate of   dependence but the other reasons that they are now cautioning against the use of benzodiazepines is   that there’s a higher mortality rate among benzo users compared with non-users there’s an increased   risk for dependence with use for more than six months and that’s a long time to be using benzo   and when we’re talking about dependence and six months we’re talking about somebody who uses it   like every four hours or every eight hours depending on your benzo every single day not   a PRN user if somebody’s using it at night to help them go to sleep or you know three or four   times a week when the anxiety gets high the risk of dependence is relatively low but a   lot of people with anxiety because if they find the right benzo makes them feel so much better   they may not want to be off of it and for a lot of people when that benzo reaches its half-life and   starts getting out of the system even more their anxiety spikes you know they have rebound anxiety   which they want to medicate with more benzos that’s gonna be an issue for them to discuss   with their doctor there’s also an increased risk of dementia identified in long-term benzodiazepine   users again this is for the people who use you know throughout the day every day for six months   or relatively every day for six months or more and it doesn’t matter if it’s you know we’re   talking about somebody who’s 65 or somebody who’s 35 who’s been using benzos for you know   six months a year two years the risk of later life dementia is greatly increased according   to the research benzodiazepines also don’t treat depression okay so if you’ve got somebody who has   concurrent anxiety and depression there’s a much higher suicide risk if they’re on benzodiazepines   so being aware and generally that suicide risk comes from overdosing on benzodiazepines but   not always other treatment options you know if the benzos aren’t something that people want to touch   you know they scare the living daylights out of me and SSRIs and SNRIs don’t seem to be working   then tricyclic antidepressants can be tried on those your older generation antidepressant Seroquel   is used a lot and there are some there’s some research that shows it can be effective   with anxiety like some of the antidepressants and depending on the person the benzos Seroquel can   make people very very very sleepy so you know it may not be the side effects of the Seroquel   the weight gain and the fatigue and you know sleepiness may be an unacceptable side effect for   some clients and boosts perón is the third option boost Barone works more like an anti-depressive   serotonin reuptake inhibitor and that it takes you know four weeks or so to kind of build up in   the system studies have shown that there’s really no long-term benefit to taking it but after six months   to eighteen months of use it has been shown to be effective in talking with clients a lot of   clients report that boost bar when they take it doesn’t necessarily help them stop being anxious   like a benzodiazepine does but it helps them not go from zero to 200 in 2.3 seconds it kind of you   know keeps them from having this gush of a freak out reaction every time something goes wrong which   a lot of clients report helps because they feel more stable throughout the day after remission   medication should be continued for six to twelve months and during that last six months first six   months keep it as is last six months you know they say that tapering is best it’s best not   to stop somebody cold turkey on any of these but it’s important for people once they’re   in remission to not just suddenly go okay I feel better I don’t need any of this anymore they need   to work into it and make sure they’ve developed the skills and tools that they need to deal with some of the anxiety that is going to happen in life so physical signs and symptoms   of anxiety may include fatigue irritability muscle tension or muscle aches try laying feeling twitchy   being easily startled trouble sleeping nausea diarrhea irritable bowel syndrome headaches so the   first thing we want to do with clients when we’re talking to them well second thing first thing is to say get a physical to let’s rule out physiological causes of this but we can also help clients   look at you know what might be causing these things that you can do to mitigate it what might   be contributing to your fatigue what might be contributing to your irritability and your muscle   tension or your muscle aches I mean let’s look at economics did you recently get a new bed or do you   need to get a new bed what about your desk chair I know you know I get more muscle tension and muscle   achy when I do a lot of mousing because I have deplorable posture being becoming aware of that   helps and then I’m like okay well I know it caused unfortunately, it’s unpleasant but it’s not a   big deal trembling or feeling twitchy you know that can be caused by low blood sugar that can   be caused anxiety that can also be caused by early onset Parkinson’s symptoms you know   there’s you know it can be worst case scenario or it can be something benign so we want   to have people figure out you know when you start trembling or feeling twitchy is there something   that it’s related to you know I know when my son gets excited he’s he just sits there   and you can see him almost shake because he’s so excited about something so we want to have people prevent misidentification we don’t want them to jump to that worst-case scenario we don’t   want them to go onto WebMD and go oh my gosh I’ve got cancer I’ve got this debilitating disease and   I’m going to die in six months probabilistic Lee speaking it’s not gonna happen yes get a doctor’s   opinion I’m certainly not going to tell them it’s all in your head I want them to get an   evaluation but I do want to in the meantime help them think about how likely is   this and other things for headaches and this is one another one of those that can be frustrating   as we get older our eyesight starts to go and you know there was a period there I did fine   and then after I hit 45 my eyesight just started to like steadily and kind of rapidly in my mind   decline so I have to get my eyeglass prescription changed every couple of years and that can cause   headaches so instead of starting to worry about oh my gosh I’ve got a headache all the time   maybe I’ve got a brain tumor you know I know that it’s probably my glasses or I’m grinding my   teeth so other biological interventions that have been evaluated there’s something called   the floatation rest system that reduced environmental stimulation therapy reduces sensory input into   the nervous system through the act of floating supine which is on your back in a pool of water   saturated with Epsom salt you know I’m looking at this going sounds good and you can’t   quite get the same experience in a bathtub because you’re not floating you’ve got pressure points and   you’re still hearing stuff clients can sort of simulate it with you know earplugs or whatever   but it’s if they can access this it’s been shown to be effective the float experience is   calibrated so that sensory signals from visual auditory olfactory gustatory thermal tactile or   tactile vestibular gravitational and preceptive channels are minimized which means you don’t see   here taste touch smell feel nothing as is most movement and speech so you want people to lay just   like completely motionless and not talk which can be hard for some people with anxiety in the study   the study I looked at fifty participants reported significant reductions in stress muscle   tension pain depression and negative effects and it was accompanied by significant improvement in mood   characterized by increases in relaxation happiness and well-being I read the study I’m like where can   I sign up you know it sounds in looking at some of the research this was more effective for   addressing anxiety than something like a massage Tai Chi also produced significant reductions in   anxiety there was approximately a 20% treatment effect 25% treatment effect in patients with   anxiety and fibromyalgia who practiced twice a week for a year now you know we want to look at   the confounding things here is it the Tai Chi itself or is it learning to control the muscles   and becoming more in tune with your body and learning to control your breathing helps   people reduce their anxiety either way you know Tai Chi helps people do that and it was shown that   after a year after the first six months, there was a significant treatment effect but after a year   you know it kept growing and after a year it was about 25% so Tai Chi can be effective acupuncture at the HT 7 median Meridian can attenuate anxiety-like behavior induced by   withdrawal from chronic morphine treatment through the meditation of the GABA receptor system   what does that mean that means if you if the acupuncture is done in very certain places the anxiety behavior the GABA a receptor system GABA is your main calming relaxation   neurochemical that is triggered and causes your body to sort of flood that receptor system and   this research was done on people who were detoxing from morphine treatment but we can look at   generalizing the results and I would be interested to see further studies on it pain other things we   need to do to help people with anxiety when people are in chronic pain they often have anxiety that   oh my gosh this is getting worse or it’s never gonna get better or I just can’t take this pain   anymore or they may get anxious that they’re going to be rejected because they can’t do some of the   things they used to do because they’re in so much pain so there’s a lot of guilt and anxiety that   can kind of revolve around pain what can we do to help clients guided imagery is generally very   helpful if we can help them imagine you know if that pain in their shoulder imagine the pain is   like the color red flowing out of their arm or other focus mindfulness so you know when you   think about something you know when you get a shot if I don’t think about it it doesn’t hurt near as   much as if the nurse says okay now one two three and you know she’s counting down and I’m getting   prepared and I’m focused on it I had another nurse one time who she was just talking   to me and you know put the alcohol on my arm and just kept on talking and didn’t tell me she was   getting ready to give me a shot and before I knew it she had given me a shot and she was like okay   we’re done I’m like you didn’t give me a shot yet she said yes I did it’s like oh so not focusing   on it and next time you have an itch for example if you’ve ever been driving on the interstate and   you can reach on your foot I get those on the bottom of my foot sometimes and I’m like okay   I’m not going to pull over to each my foot if you focus on something besides the itch eventually it   goes away I’m not saying the pain is gonna completely go away but the more people focus on it the more   it hurts physical therapy can help so encourage them to get a referral and encourage them to do a   self-evaluation if nothing else of ergonomics in their car at work where they watch TV and spend   most of their time at home and they’re sleeping so those are the four places that they spend most   of their time what do their ergonomics look like and that can help a lot of people mitigate   a lot of pain hormones are another thing that we need to look at imbalances of estrogen and   testosterone can contribute to anxiety symptoms heart palpitations fatigue irritability having   people get a physical we can’t as clinicians do anything about it but doctors can rapid heart   weight rate sweating palpitations are not uncommon in women in perimenopause or menopause so a lot   of women start feeling like they’re developing generalized anxiety and/or something’s going wrong   when they start reaching that mid-40s to mid-50s area and they start having some of these symptoms   again we’re not going to diagnose it but we do want them to recognize that it may not be anything   you know is catastrophic this is something that a a lot of women experience and help them figure out   how to deal with that supportive care biologically now you know this isn’t gonna treat anything but   we can help them minimize their vulnerabilities help them create a sleep routine so their brain   and body can rebalance this can help repair any adrenal issues that may be going on and improve   energy levels people with anxiety don’t sleep well so helping them figure out how to get some quality   sleep is important nutrition minimizing caffeine and other stimulants are going to be a big help   because those make people feel anxious and encourage them to work with a nutritionist to try to prevent   spikes and drops in blood sugar which can trigger the stress response when your blood sugar goes way   up or way down you can start getting kind of shaky and feel weird and that can cause people anxiety   because they might think oh my gosh I’m having a stroke or a heart attack or you know I don’t know   what these tremors are so it’s important that they don’t miss identify symptoms and encourage   them to drink enough water dehydration can lead to toxic Ardea which is increased heart rate   sunlight vitamin D deficiency is implicated in both depression and anxiety mood issues   vitamin D has been found in those main areas where serotonin receptors are found vitamin D receptors   are found so we know the serotonin and vitamin D have something going on sunlight prompts the skin   to tell the brain to produce neurotransmitters and set circadian rhythms which impact the release of   serotonin your calming neurochemical melatonin which is made from breaking down serotonin and helps you sleep and GABA so sunlight actually helps increase the release of GABA when it’s   time to start calming down and going to sleep exercise studies have shown that exercise can   have a relaxing effect and encourage clients to start slowly there’s not a whole lot of new research   on exercise and anxiety aromatherapy has been used a lot, especially in other countries in   the treatment of people with anxiety people with hospital anxiety people women who are giving birth   and they have some birth anxiety there they’ve been found to be effective in a lot of   those studies essential oils for anxiety include lavender rose Bedevere ylang ylang bergamot   chamomile frankincense and Clary sage encourage clients to just go to a health food store and   you know sniff some of these and see if it makes them feel happy and calm and content the aromatherapy   molecules enter the nasal membranes and they will start triggering neurochemical reactions   and so you don’t need to apply it you don’t need to ingest it all you need to do is so encourage   clients if they’re open to it to think about this because aromatherapy can be integrated into their bedroom for example with an atomizer or a Mr.It can be incorporated in a lot of different places   again where they’re not applying it or ingesting it in any way all they’re doing is smelling it   they’ve used it in defusing aromatherapy in hospital emergency rooms and they found that it   reduces stress and irritability the people in emergency rooms and I’ve been to enough emergency   rooms over the years to know that people who are in ers typically are not in the   best mood so if it can help those people then it’s probably going to have some sort of an   effect so psychologically helping clients realize that their body thinks there’s a threat for some   reason that’s why it triggered the threat response a system which is what they call anxiety so they   need to figure out why is there a threat you know sometimes it’s like the fire alarm going   off in my house it just means that the windows are open and there’s a strong breeze there is no fire   there is no problem there’s just a malfunction it’s a false alarm a lot of times clients get this threat reaction they get this stress reaction and it’s not a big deal right now so they   can start modifying what their brain responds to and again those basic fears that a lot of people   worry about failure rejection loss of control the unknown and death and loss distress tolerance is   one of those cognitive interventions that have taken center stage in anxiety research and   it isn’t about controlling your anxiety you know helping people recognize their anxiety acknowledge   it and say okay I’m anxious it is what it is how can I improve the next moment instead of   saying I’m anxious I shouldn’t be anxious I hate being anxious and slang with that anxiety let it   go just accept it is what it is have the client learn to start saying I am feeling anxious okay so   distract don’t react because I explain to them the whole notion of feelings comes in the crest and goes out   in about 20 minutes it’s like a wave so once they acknowledge their feeling if they can distract   themselves for twenty or thirty minutes you know they figured out there was no real threat if they can distract themselves for twenty or thirty minutes those emotions can go down and then   they can deal with it in their wise mind and encourage them to use distancing techniques instead of   saying I am anxious or I am terrified or whatever have them say I am having the thought that this   is the worst thing in the world I am having the thought that I cannot handle this because thoughts   come and go and that comes from acceptance and commitment therapy functional analysis makes it   possible to specify where and when with what frequency with what intensity and under what circumstances   the anxious response is triggered so it’s important that we help clients develop the   ability to do functional analyses on their own so when they start feeling anxious they can stop and   say okay where am I what’s going on how intense is it what are the circumstances and they start trying to figure out what causes this for them so they can identify any common themes from   their psychoeducation about cognitive distortions and techniques to prevent those circumstances or   mitigate them can be provided so if the client knows that they get anxious before they go into   a meeting with their boss and it’s usually a high the intensity of anxiety okay so we can educate them and help them identify what fears may be related to techniques to slow their breathing and calm   their stress reaction and help them figure out times in the past when they’ve handled going in   and talking to their boss and it wasn’t the end of the world you know there’s lots of   different things we can do there for them there but the first key and it gives them a lot of   a huge sense of empowerment to start becoming detectives in their own life and going okay now   under what situations does this happen positive writing this was another cool study each   day for 30 days the experimental group and this was high school-aged youth in China but you know   the experimental group engaged in 20 minutes of writing about positive emotions they felt that   day so they’re writing about anything positive that make them happy that made them enthusiastic gave them hope whatever long-term expressive writing positive emotions so after 30 days it   appeared to help reduce test anxiety by helping they develop insight and use positive emotional words so it got them out of the habit of using the destruction and doom words and encouraged them   to get in the habit of looking at the positive things and being more optimistic it’s a cool activity that clients can try it’s not gonna hurt anything if you have them journal each day   for 30 days mindfulness also came up in the research and was shown to be effective in   a meta-analysis of six articles about mindfulness based stress reduction four about mindfulness-based cognitive therapy and three about fear of negative appraisal and emotion regulation was reviewed all of these showed that mindfulness was an effective strategy for the treatment of   mood and anxiety disorders and is an effective in therapy protocols with different structures   including virtual modalities so you know if you’re doing it via teleconference mindfulness can still   be helpful mindfulness helps people start learning how to observe what’s going on and become aware of   what’s going on more aware of those circumstances which will help them complete their functional   analysis but it also helps them become aware of vulnerabilities and head off things in the past   and if they’re taking better care of themselves that they’re living more mindfully then they may   not experience as many situations that trigger their anxiety mindfulness also encourages clients   to learn acceptance that radical acceptance of it is what it is I’m not gonna fight it I’m angry   right now I am anxious right now however I’m feeling right now is how I feel and that’s okay it’s hard for clients to get to that but once they get a hold of that and they truly believe it   and they can say all right it’s fine I’m not gonna feel this way forever I’m gonna do something else   until the feeling passes it helps and that’s where the labeling and letting go comes in mindfulness   can also help them identify trigger thoughts what thought were you having right before you   started feeling anxious if people are mindful or let’s start back when people are not mindful they   often notice or don’t notice that they’re getting anxious until they’re like super anxious   when people are mindful they become more aware of subtle cues address unhelpful thoughts when they   say or believe it’s a dire necessity for adults to be loved by significant others for almost   everything they do always running gonna happen why is it a necessity what we can encourage them   to do is concentrate on their self-respect on winning approval for practical purposes you   know for promotions or whatever but it’s not about me being lovable it’s about me getting a promotion   and making more money and focusing on loving rather than being loved because when we give   love we generally get love back with unhelpful thought number two people feel they aren’t able to stand   it if things are not the way they want them to be or are not in their control so encourage clients   to focus on the parts that are in their control and other things in life which are going well and   to which they’re committed number three misery is invariably externally caused and is forced   on us by outside people and events just by reading that makes me feel disempowered so encouraging   clients to focus on the fact that reactions such as misery or happiness are largely caused by the   view that people take of the conditions so if you see it as a tragedy and devastating then   it’s probably going to produce misery if you see it as an opportunity and a challenge it’s   probably going to produce a different emotional reaction, if something is or may be dangerous or fearsome people, should be upset and endlessly upset about obsessing about it a lot of   people with anxiety get stuck on this you know if I feel like it’s fearsome I need to worry about   it getting on a plane for example if I fear that that’s dangerous that I need to think about it   and worry about it that’s not going to do any good so encourage clients to figure out how to   face it and render it harmless if possible and when that’s not possible accept the inevitable   so looking at airplanes you know facing it means researching to figure out how dangerous   is it really and realizing that it’s not that dangerous so that helps render it a little   bit harmless in their mind it proves to them that it’s not as dangerous as it could be and when   it’s not possible accepting the inevitable you know you got a fly so getting on there figuring   out how you’re gonna get through it hurricanes are the same way people especially in places   like Texas Louisiana Florida may obsess as soon as it starts coming to hurricane season or if a   hurricane is spotted out in the Atlantic somewhere they start checking the weather every hour or more   wondering what the path is going to be and you know what there’s you can’t change the path of the   hurricane so all you can do is board up your house evacuate if necessary and deal with the fallout child driving is just another example I’ll give you know my children are learning how to drive and   that’s kind of scary and fearsome you know what’s gonna happen when they’re out there you know you   see crashes all the time well render it harmless by making sure they’ve got good training on how   to drive make sure they’re good drivers and then accepting that some things are just not within   my control it’s easier to avoid than face life difficulties and responsibilities well running   from fear is usually much harder in the long run so encourage clients to look back at times when they’ve avoided difficulties and responsibilities and the eventual outcome you know what happened   there people believe they should be thoroughly competent in achieving in all possible respects   or they will be isolated rejected and failures we need to encourage clients to accept themselves as   imperfect with human limitations and flaws and focus on what makes them loveable human being   what qualities like courage and intelligence and creativity and those things that can’t be taken   away what inherent qualities do they have that make them awesome people because something once   strongly affected people’s lives they should indefinitely fear it if you got lost you know   when little kids get lost it’s terrifying when you’re grown up if you get lost you turn on the   GPS and you figure out your way but some people still, you know freaked out about getting lost if   they got lost once so we want to help people look back at past episodes that may be contributing to   the current anxiety and compare the situation’s you know are you the same person or is this not   a big deal now that you’re older wiser stronger encourage them to learn from past experiences   but not be overly attached to or prejudiced by them yeah you could have maybe got lost in the   past and it was a horrible experience well you were six I can see where that would be terrifying   and a horrible experience but it doesn’t have to continue to impact you that way now when you’re   you know 26 getting lost you know could be an opportunity to try a new restaurant or something   people must have complete control over things well this doesn’t happen so encourage clients   to remember that the past and the future are uncontrollable we can’t change the past it is what   it is we can learn from it so it doesn’t repeat but we can’t change it and the future is largely   uncontrollable I mean there are a lot of things I can do to stay moving toward a rich and meaningful   life but life is going to throw me curveballs sometimes and there’s nothing I can do to plan for   or control that we can control our actions in the present to stay on our preferred path and general   develop general skills to deal with adversity should it arise so we want to help clients   develop those general problem-solving skills and the general support system so when they are thrown   a curveball you know it doesn’t knock them upside the head people have virtually no control over   their emotions and cannot help feeling disturbed by things well encourage them to think about the   fact that they have real control over destructive emotions if they choose to work at improving the   next moment and changing inaccurate thoughts then they’re not going to experience the destructive   emotions as intensely or as frequently when you feel an emotion you feel how you feel but again   you don’t have to wrestle with it fight it and nurture it you can say this is how I feel how   do I improve the next moment when it comes to cognitive distortions encourage them to find   alternatives when they start to personalize things if somebody laughs when you walk out of the room   then the and the person starts getting anxious thinking oh they were making fun of me I wonder   what they thought I wonder if I had something stuck to the back of my dress and they start   getting all panicked about it that doesn’t do any good encouraging them to think you know what   our three alternate explanations that hadn’t but had nothing to do with you for why they laughed   magnification of the worst thing you know taking something and saying if this happens then it’s   going to be a catastrophe and minimization going along with that a lot of times when people magnify   and see a catastrophe they minimize not only their strengths and resources but all the   other stuff that they’ve got going for them all they’re seeing is this catastrophe so encouraging   them to focus on the facts of what is actually happening and what is the high probability   event and encourage them to get information and look at the broader picture you know yes you   got into a car crash and your car is totaled and that is unfortunate you know it sucks but   you know that is not going to cause you to lose your job and then become homeless and penniless   and yadda-yadda it might cause your insurance to go up but okay so you don’t have a car but what   are the resources that you have who can who do you work with that might be able to give you a   ride to work you know let’s look at the resources you have and work around so problem-solving helps   with magnification and also focusing on you know let’s be grateful for what didn’t happen you know   you could have been killed but you weren’t the car was totaled it’s replaceable all or nothing   thinking again have them think about what else could have been happening like Brittney suggested   finding the exceptions instead of saying she always does this look for exceptions when has   she not done that what else has she done instead of this selective abstraction and filtering is   when people look for the good the bad and the ugly a selective abstraction means you kind of   see what you expect to see so if you expect something to be devastating you see only the   devastating aspects of it which kind of goes with the magnification and minimization you filter out   the stuff a lot of times when people are in a bad mood or are anxious they see the negative because   that’s the state of mind they’re in so encouraging people to complete the picture alright there’s   all this bad stuff now what’s the good stuff you know to encourage them to look at the good the bad   and the ugly so they get a wide view of exactly what’s going on and encourage them to remember   that hindsight is twenty-twenty when people have something embarrassing happens or they get anxious   about something that happened they look back and they go I should have or I could have or oh I   wish I wouldn’t have when you were in that the situation you did what you did and you know   maybe you may have had a reason for it or you know you may have not had other options or it may have   just been a bonehead thing to do but okay so you made one mistake hindsight is 2020 that’s gonna   that mistake is gonna stand out just like the great big letter on the eye chart because you’re   thinking back and you’re looking at it and that’s all you see but encouraging clients to remember   that other people are too busy worrying about themselves to remember what they did jumping   to conclusions encourages clients to remember to get all the data if your significant other male   significant other comes home and is smelling like perfume don’t just jump to the conclusion that he   was cheating on you maybe he went to the mall to get a new tie and walked through the   perfume area and got spritzed or bought you some perfume or who knows maybe the person sitting next   to him at work sprayed her perfume on the desk and some of it filtered on there are all different   reasons that that might happen so encourage people to get all the data mind reading we can’t do it   you know you can’t read somebody’s mind you don’t know what they’re thinking so ask them what you think about this don’t assume anything and emotional reasoning encourages people to step back   from a situation and ask themselves am I feeling anxious about this because I’m feeling anxious and   I’m looking for reasons that it should be scary or am I feeling anxious about this because it’s   really scary for some reason there are facts support my anxiety a lot of times when we go into   new situations we may feel anxious because it’s a new situation but when we step back we say you   know what there’s nothing to be worried about here you know no big deal I got this and   move on so instead of rolling with it and trying to figure out okay I feel anxious so there must   be a reason not necessarily very likely a false alarm other psychological interventions relaxation   skills encourage people to learn how to relax not only physically but mentally diaphragmatic   breathing helps encourage them to breathe through their stomach and put their hand on their   belly and feel their belly expand and contract slows breathing down which triggers the rest and digestion reaction in the brain which is calming meditation can be helpful for some people some   people find trying to quiet their minds too frustrating because they’ve got too much   monkey mind going on that can be later or maybe never for some people, we don’t want to increase   their anxiety with interventions cute progressive muscular relaxation also has a lot of research   support and remembers with cute progressive muscular relaxation we’re Sakura get them   to attach a cue AK you word like relax or breathe with the relaxation response so they tense their   muscles and then relax their muscles and as they relax their muscles they say their “quack”-word   like relaxed and they work from head to toe or from toe to head tensing and relaxing different   muscle groups so they become more aware of what a tense muscle feels like versus a reactive relaxed   muscle there are great scripts that are online that people have already recorded that can walk   people walk clients through CPM are I highly encourage it because once they get used to it   then they can just think that cue they can think relax and as they exhale they will start to feel   their entire body kind of relaxing because it’s trained when it hears that just like when you hear   the word pop quiz when you were in high school you had a stress reaction well we want to use   it in reverse and train the body so that when it hears a cue word relaxes helps them develop   self-esteem because fear of failure and rejection a lot of times come from needing other people’s   approval to help them develop a rational idea of their real self develops compassion self-talk   instead of saying I’m an idiot or I’m stupid or I’ll never measure up to anything encourage them   to talk to themself like they would talk to their child or hopefully their best friend and encourage   them to spotlight strengths whenever they feel like they’ve got an imperfection to identify these   three strengths that they have so they’re you know balancing out the imperfections and the strengths of cognitive restructuring reframes challenges in terms of current strengths, not past weaknesses   so if you’re going to give a presentation in front of 60 people and you hate public speaking instead   of thinking about you know this is terrifying because the last time I went up in front of people   I forgot everything I was going to say and drop my note cards well that’s a past weakness what   is your current strength you’re prepared to know the material you ‘yoyo’ so encourage people   to look at all the strengths and resources they currently, have them develop an attitude of   gratitude and optimism because as I said with that the positive writing exercise when people   are in a grateful optimistic frame of mind they tend to see more of the good stuff they see the   bad stuff too but they can also see more of the good stuff and some of the bad stuff they see   opportunistically instead of as a devastation acceptance and commitment therapy says that some of the reasons that we’re miserable are fear we get fused with our thoughts we think I   am terrified well if I am terrified then I can’t I mean if I am I can’t get rid of anything I am   if I’m having the thought that I’m terrified well I can get rid of a thought I can forget   things easily encourage people to evaluate their experience and empower them to look at things as   challenges and opportunities instead of hardships encourage them not to avoid their experiences so   things that are scary gradual exposure and finding exceptions like for me bridges you   know I love public speaking so that’s not a thing but when I go to a bridge you know when   I Drive to the bridge you know when I’m on the bridge somebody else is driving I get used to   doing that when I Drive over a bridge than when I Drive over one of those bridges that open up   I hate those bridges um I know y’all are just like oh my gosh yeah it’s an irrational fear I realize   that but instead of going straight for the bridge that opens up going for the little bridges first   and then thinking back over times that I’ve gone over bridges and there’s been no problem you know there are exceptions nothing happened it wasn’t a big deal sometimes I didn’t even notice it until   somebody pointed out hey look down there at that pretty water and I’m like oh we’re on a bridge so   encourage people to not avoid their experiences get used to them embrace them and learn that they   have the power to deal with them and stop reason giving for the behavior you know use the challenging   questions if something is fearsome let’s look for at the evidence for and against it instead   of you know making excuses for social interventions improve their relationship with their self which   goes with self-esteem improvement people are going to feel less anxious about getting their needs and   wants to be met if they know what their needs and wants are so part of that is becoming mindful cuz a lot   of our clients don’t know what they need and want they just want to feel better but they don’t   know how they don’t know what they need to feel better so helping them identify their needs and   wants and encouraging them to be their own best friend you know when they get a promotion take themselves   out to dinner pat themselves on the back whatever it is don’t rely on other people to do it because   other people it’s not that they don’t care but other people are often very involved in thinking   about their stuff and they may not notice encourage them to develop a method of internal   validation so they can feel like they are all that ‘no bag of chips and they realize why they   are lovable human beings and they accept the the fact that everybody is not going to like them   and nobody is gonna like them all the time and that’s okay you know my kids don’t like me all   the time my husband doesn’t like me all the time I’m okay with that I know I can be challenging but   you know most of the time you know they like me and that’s okay and there are some people you   know who don’t like me at all and okay there’s nothing I can do about that helping our clients   develop an okayness with that helps relieve a lot of anxiety because a lot of people feel like they   have to be liked by everybody and if somebody doesn’t like them it’s like what did I do wrong   oh my gosh encourage them to develop healthily supportive relationships with good boundaries   develop assertiveness skills so they can ask for help when they need it anxiety a lot of times you   know that’s the body saying there’s a threat well if there’s a threat maybe you need some help you   know dealing with it so people need to be willing and able to ask for help and not feel like that’s   going to lead them to be rejected and allow them a certify this will allow them to say no to requests   again without feeling like that’s going to result in them being fully rejected describe the ideal   healthy supportive relationship and encourage them to separate the ideals from the reals you   know let’s look at if you had the best relationship what would it look like okay you know warden June   Cleaver we got that now how realistic is that you know let’s look at you know rephrasing this   a little bit so it’s less extreme you know warden June Cleaver never fought their kids were perfect   you know all those extreme words let’s look at what’s real what happens in real relationships encourages people to identify who would be a good partner in supportive relationships   I’m not meaning necessarily romantic I’m meaning friends and where they can be found you know where   would you find people that you could be friends with and encourage them to play through what it means when gaming cuz a lot of times again this goes with my reading you know what it means when your friend doesn’t return your text right away what does it mean when your friend cancels   dinner on Friday night what does it mean when you see where I’m going with this and a lot of   times clients with anxiety and rejection issues and low self-esteem will go to the worst-case   scenario so encourage them to go back to finding the exceptions what else could have been happening   what else could it be that caused this and it’s not about you so anxiety is a natural emotion that   serves a survival function excessive anxiety can develop from lack of sleep nutritional problems   neurochemical imbalances failure to develop adequate coping skills cognitive distortions low   self-esteem and a variety of another stuff recovery Ambala involves improving health behaviors making sure your body’s functioning and making the neurotransmitters it needs and you know release   them as needed to identify and build on current coping strategies address cognitive distortions   and develop a healthy supportive relationship with self and others if you enjoy this podcast please   like and subscribe either in your podcast player or on YouTube, you can attend and participate in our live webinars with dr.Snipes by subscribing at all CEUs comm slash counselor toolbox, this   episode has been brought to you in part by all CEUs calmly provide 24/7 multimedia continuing   education and pre-certification training to counselors therapists and nurses since 2006 have used coupon code consular toolbox to get a 20% discount on your order this month.As found on YouTubeAnimated Video Maker – Create Amazing Explainer Videos | VidToon™ #1 Top Video Animation Software To Make Explainer, Marketing, Animated Videos Online It’s EASIER, PRODUCTIVE, FASTER Get Commercial Rights INCLUDED when you act NOW Get Vidtoon™