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. 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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 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.

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™

How To Help Someone Struggling With Mental Health

Thank you so much to Kati Morton for coming on my channel and giving such amazing and helpful advice!Check out the video we did on Kati’s channel:
SUBSCRIBE AND FOLLOW KATI! YOUTUBE: http://www.youtube.com/KatiMorton TWITTER: http://www.twitter.com/KatiMorton INSTAGRAM: katimorton1SUBSCRIBE for new videos! http://www.youtube.com/subscription_center?add_user=eugeniacooneyMY SOCIAL MEDIA:Instagram: http://www.instagram.com/eugeniacooney Twitter: http://www.twitter.com/Eugenia_Cooney Facebook: http://www.facebook.com/eugeniacooneyy Twitch: http://www.twitch.tv/eugeniacooney Discord: https://discord.gg/eugeniacooneyEmail: eugeniascooney@gmail.com

EXTREME Makeover Transformation With Kati Morton!

Thank you so much to Kati for coming on my channel and letting me give her a makeover!!Go check out the video we did on Kati’s channel!
SUBSCRIBE AND FOLLOW KATI! YOUTUBE: http://www.youtube.com/KatiMorton TWITTER: http://www.twitter.com/KatiMorton INSTAGRAM: katimorton1SUBSCRIBE for new videos! http://www.youtube.com/subscription_center?add_user=eugeniacooneyMY SOCIAL MEDIA:Instagram: http://www.instagram.com/eugeniacooney Twitter: http://www.twitter.com/Eugenia_Cooney Facebook: http://www.facebook.com/eugeniacooneyy Twitch: http://www.twitch.tv/eugeniacooney Discord: https://discord.gg/eugeniacooneyEmail: eugeniascooney@gmail.com

How to Spot the Signs of Social Anxiety

Watch the rest of this series on anxiety with Dr. Ramani HERE: https://bit.ly/34QvlOTSocial anxiety is often misdiagnosed or mistaken for something else. With the right diagnosis, finding the right treatment and recovery is possible. Especially with an anxiety disorder ; anxiety is at the root of mental illness.In this interview, clinical psychologist Dr. Ramani and MedCircle host Kyle Kittleson break down how to spot the signs of social anxiety in a spouse, child, and in yourself. Discovering social anxiety symptoms is the first step in discovering how to cope with social anxiety and how to find the right social anxiety treatment & therapy . There is hope for overcoming social anxiety.For more on how to overcome social anxiety disorder & social phobia , how to deal with anxiety , and other videos on mental health, visit MedCircle: https://bit.ly/34QvlOT#SocialAnxiety #MentalHealth #MedCircle

Social Anxiety or Agoraphobia?


Hey everybody. Happy Thursday! And when it's Thursday … what is it? I'm doing an FAQ video or things in the media. There are a lot of things in the media. Many of you have commented. Don't think that I have missed it. But I had a couple of good questions today that I wanted to address. And I've been doing some thinking about videos, and I think I'm going to do my journal topics as separate videos.


I find many of you have let me know that you really like those short, clip videos, where it's just something inspirational to kind of help get you through your day. So instead of doing two videos a week, now I'll do three. And I'll do a, you know, journal topic inspiration. So share your ideas! If there's anything that you've read about, heard about, saw on Pinterest or something tweet it to me, leave it in the comments below. And I shall make a video about that. So today I have two questions, and both of these are really good. So let's get going. First question says, "Hey Kati. First of all very nice video." This person's referring to the agoraphobia video I put out on Monday. If you haven't checked it out, you should check it out.


"I have a question. Describing the disorder you really focused on embarrassment connected to the possibility of getting out of a stressful situation. Does this feeling have anything in common with social anxiety? And if so, what are the main differences?" Because if you remember correctly in my video I talk about agoraphobia being an anxiety disorder. Now the really awesome thing about the DSM … cause I have to put a different book under my thing, because I had to use this to reference … is that it shares with you differential diagnoses, which is really the way of saying how is this different from the other disorders. Because a lot of them seem very similar. How do we differentiate between the two? And it says, I'm gonna read this to you, 'cause I tend to blab so sometimes it's good if I just read you what it says.


So with reference to social anxiety disorder, or social phobia, it says "agoraphobia should be differentiated from social anxiety disorder based primarily on the situational clusters that trigger the fear, anxiety or avoidance, and the cognitive ideation." So in social anxiety disorder the focus is on the fear of being negatively evaluated. If you remember when I've talked about this in other videos, social anxiety is when we fear what other people are thinking of us, what they might say to others about us, that we could be negatively evaluated by them. Agoraphobia is more about trying to get out, having a panic attack, being embarrassed about trying to leave. Now I see how these kind of go together, but you can also see how they're separated. The social anxiety is more about how we're perceived by others, where as agoraphobia is just the fear, like it says the fear or anxiety or avoidance because we worry about how we'll get out if we have a panic attack.


Or that it could be really embarrassing, because we might stumble, like try to get out really quickly. I hope that that makes it clear. If you need more clarification feel free to re-ask the question and I can blab some more. Okay. Question number two, "Hey Kati my therapist told me she'd like me to see a dietician." Uhh, she didn't! "Only I'm not sure I really need it." You never think you do. Sorry I'll stop with my commentary. "I do some eating disorder behaviors, but I still eat enough most days. And the behaviors are only there for a few days, and then I have other behaviors. Different behaviors that switch off and on. And I've only seen my therapist for two times now. And I've only really told her what went wrong. I don't want to waste peoples' time going to a dietician when I don't really need it." This got so much chatter on the website.


Holy schmollies, you guys really had opinions about this. So I thought, let's talk about it. Now seeing a dietician is good. It's something that we can all, all of us who have any kind of eating disorder behaviors. I know you're thinking but I don't really think I have an eating disorder. I only purge sometimes or I only restrict, but it comes off and on. I have a video from like I don't know … any of my OG's out there? It's like two years ago, my original FAQ video. I'm wearing like a teal sweater. It says FAQ on the thumbnail so just search. Well no you can't, because all of my videos would come up. But anyway it says FAQs. One of them is If You Think You Have an Eating Disorder You Probably Do.


Just let that wash over you for a second. Because I know it's hard, and we always think "But it's not that bad. I don't do it all the time. It comes and goes." Eating disorders are sneaky. They like come in, I feel like they're like ink in water, where all of a sudden the water is turned a whole different color. But we're like but it only just started this little. It's crazy. It can get in there, morph, change. As soon as you think you understand where it comes from and what it's doing, it's already changing to something else. And so even when we feel like "it's not bad enough to get more help" we still need to get more help. Because the sooner we get the help, the better. And seeing a dietician, whether we binge, whether we purge, whether we binge and purge, whether we restrict, whether we over exercise.


It doesn't matter. We're using any kind of eating disorder behavior, a dietician can really help. They're not going to make you get fat. They're not gonna make you eat too much food. That's part of their job. They're going to work with you to put together a plan, set goals with you, and they're going to check in with you. And they're going to challenge you, but it's all part of the process. Just like with the therapist, I'm not going to make you go all the way at once. Like we're gonna go through this, just, you know, get through all this shit and move on. That's not how it works. It's a process, and they're going to work with you. And I encourage all of you, when you're therapist says you know you should probably see a dietician, do it. They are really helpful. They are amazing. They will definitely help you manage those symptoms. They'll ask you the hard questions about food and what you think about food.


Because we know it's not about the food, but we're using food to cope. And so they will work on that spot with you so your therapist can help you better manage the emotional stuff. Together you get the best results, so don't think you have to be on death's doorstep to get help. Don't think that you have to be really thick in your eating disorder to get a dietitian to help you.


You can all benefit. If you're struggling with any eating disorder behavior please see a dietitian as well as a therapist. It gives you the best outcome. Promise. Okay. I love you all. I will see you, I'm not sure when I'll put out the journal topic video. You'll just have to subscribe, so you don't miss it. And then I will see you all on Monday. And some of you I'll see in New York. Yea! Okay, bye! Subtitles by the Amara.org community.



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5 PANIC ATTACK MYTHS | Kati Morton


Hey everybody! Today we're gonna be talking about the five myths of panic attacks. So let's get into them. *intro music* Now the first myth is that they're caused by stress and anxiety. If you yourself have ever suffered with a panic attack you know that they come out of nowhere we don't even know what necessarily triggers us, something may not even trigger us. It's not necessarily something that environmental or something that's occurring right now. Panic attacks honestly happen because our system gets overwhelmed and overloaded and sends us into a fight or flight response, AKA, a panic! I also don't like this myth because it implies that we have control over it like we can stop our panic attacks if we just change our environment and the truth is the panic attacks will happen in a wide variety of places for a wide variety of reasons those of which we aren't even privy too.


We don't even know why they happen. And the second myth is that they're going to make us go crazy. Panic attacks, if they happen for too long we're just gonna go insane. I've heard a lot of my clients say this, that it feels like they're losing their mind and they wonder if it can cause other mental illnesses to occur and the truth is the panic attacks usually happen because we have some underlying mental illness, whether it be another anxiety disorder or depressive disorder, any kind of mood disorder can be a lot of different components that can lead us to having panic attacks and being more predisposed for panic.


The truth is that panic attacks in no way affect the functioning of our brain as a whole in the hormones, like dopamine, norepinephrine or any kind of neurotransmitter that could cause another mental illness or psychosis or quote, unquote, make us go crazy. The third myth about panic attacks is that having a severe one is going to cause us to go into cardiac arrest. I've heard from a lot of my clients that because a racing heart is one of the symptoms that they experience most with panic attacks, or even the build-up to a panic attack, they'll start feeling their heart race and they worry that if they're in a really extreme or intense panic attack for a sustained period of time, let's say for an hour, that they're going to go into cardiac arrest and this is going to be how they're going to die and it sends them into panic even more quickly and keeps them there longer.


But the truth is and this is something important to kind of note and to tell yourself, maybe when you're, you feel those symptoms happening is that our heart is extremely strong it can beat at over 200 beats per minute for days, if not weeks especially if we're young, it can be four weeks at that rate without sustaining any damage. I just want to take a second to let that sink in. We can essentially be in panic for a really really long period of time without our heart ever being hurt or even potentially considering it going into cardiac arrest or having any kind of malfunction.


Therefore on average, panic attacks last from three to ten minutes so a three to ten minute panic attack is not in any way going to harm your heart or cause a heart attack. The fourth myth is that they're used as a way to get out of something we just don't want to do. Uh, if we hear that one more time. Am I right? For those of you who don't understand what a panic attack is or what can cause a panic attack, like I stated earlier, they come out of nowhere. They are not triggered by our environment, it's not due to an over reaction by up if usually a result of another underlying mental illness and these feel like they come out of nowhere, happen quickly and can stay and they're extremely uncomfortable, so if you found yourself having these attacks anytime you went into the grocery store, then you would start to not want to go to the grocery store or whenever you're in a crowded place, like I've had a lot of clients are like, "If I'm ever in a busy thing like a club or a concert or even like a really busy day at the mall," they've had panic attacks, we don't really know why but they're then attaching busyness and a lot of people with panic attacks therefore if someone's going to call you, if a friends going to ask you to go out to a party, and you think it's going to be a small group you're like sure, then later you find out there's going to be like 50 people there, you're like I'm gonna have to say no.



But we need to understand that panic attacks and panic disorder is a real diagnosable mental illness and because we don't know what triggers them and they come out of nowhere we fear the next one may be just around the corner. So of course we're going to limit the amount of things that we do until we can get them more under control. And the fifth and final myth about panic attacks is that there is nothing that we can do to treat them. Meeh. That's wrong, there are a lot of things we can do to treat them. Yay! Number one, and something that I've been reading because if any of you follow me or have been on the live streams or follow me on snapchat or Instagram, I have been working very hard at your anxiety workbook and I'm super excited for it to come out, but the thing that I learned through all the research I've been doing, is that progressive relaxation, you know like clench your feet, relax your feet, clench your calves, relax your calves, that type of exercise, doing that 20 to 30 minutes a day can calm our system down to such an amount that those who struggle with panic disorder may rarely, if never again, if they continue to do the progressive relaxation each day, they may never have the symptoms again.


They're still doing more studies on it but progressive relaxation is, surprising to me, but it's so amazing and been so helpful and beneficial. And the other is that CBT, so cognitive behavioral therapy, is also helpful with panic disorder and those of us who struggle with panic attacks because a lot of times we build up the panic and our system's fight-or-flight response by worrying about all of those things like it's going to cause a heart attack, I'm going to be super embarrassed, I'm going to go crazy, I may fall over or faint, all those worries and kind of falsely held beliefs that we have, CBT can really help us challenge those.


Also medications have been shown to be extremely beneficial SSRIs, SNRIs, and benzodiazepine have been shown to be extremely helpful for those of us who struggle with panic disorder and I know that not all of you are interested in taking medication this is another option that's available and if you're out there and you're struggling with panic attacks and you feel like they're happening with more frequency, it's controlling the way you live your life please reach out, please talk to someone. There are different professionals and a ton of help available, we just have to ask for it and we just have to reach out and I know it's scary to do the first reach out, but know that we're used to managing it we can handle it. We are kind, calm, wonderful people and maybe bring an extra supportive person with you to that first appointment or maybe they make the call and set up the appointment for you.


Find ways, use your resources to get the support and help that you need. Please share this video, I think a lot of people talk poorly about panic attacks or don't understand and I also put some in here, if you didn't notice for those of us who struggle and the myths that we tell ourselves about panic attack because I think both are really important to note, and leave in the comments what are some myths that you've heard. What is the way that you talk back to that, so that we have as a community are raising the stigma associated with mental health. I love you all and I will see you next time. Bye!.



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5 Easy Tips to Beat Anxiety!

Hey everyone Today, I’m going to talk with you about five tips to beat anxiety, So stay tuned. So, like I said Today, I want to talk with you about five helpful tips to beat anxiety. I’ve heard from so many of you that you struggle with this, And there are so many ways that we can help ourselves, And this is only five. There are tons of ways, But these are just some helpful tips to get. You started Number one Keeping busy all day. I know that sounds really silly and simple, But often times our anxiety, loves and lives in the quiet When we have nothing to do And we are sitting at home And we are moping about It. Kind of takes a mole hill and turns it into a mountain When we have time to ruminate and think about things, It can make it so much worse. But if we are just going about our day, We’re doing things We’re making deals. We’re breaking hearts. We don’t have time to think about it. So I would encourage you if you are able plan your days out, Make sure you have things happening Back to back to back You,’re scooting on through The second helpful tip. Is what we call’feeling focusing 39, And this is something that we can do, no matter where we are, Which I love about tips, Because we never know when the anxiety may strike And feeling focusing is when we focus on the area in our body where We feel the anxiety For some of us. It might be our throat Our chest, Our stomach. It could be in our shoulders Wherever you feel it physically. I want you to focus on that spot And I want you to slowly breath into it And if you find your mind wandering Bring it back to that spot Keep breathing. Slowly – And I know this is just one of those things where you are like’Kati – that sounds really weird 39, But I promise you, by drawing your focus back to the area in your body. Back to that area Over and over Your anxiety will diminish It.’s because our mind can’t go out, searching for more things to worry us with It slowly, dissipates. The third helpful tip is exercise Now. Obviously I don’t want you to do anything to an extreme, But taking a thirty minute walk If you like to run and it’s not unhealthy, You go for a run. Maybe you jump some rope. Maybe you take your dog out. Maybe you walk with a friend, Maybe you do yoga Whatever it is. If you play tennis Play basketball There’s, so many things to do Just last week I went to Target and got Sean and I some tennis, rackets and basketballs. So we can play Anything. You can do to exert some physical energy Can help with anxiety, Often times when we have a lot of pent up. Energy Anxiety thrives So having an outlet for that. Even if it’s just nervous energy, Having an outlet like exercise Can really help bring it down. The fourth helpful tip is phoning a friend I feel like we are on Who Wants To Be a Millionaire, But it’s really important to contact people and to have people on what I always talk to my clients about on your’emergency call list’And this isn’t a real this isn’t like an emergency 39. I’m going to the ER I’m bleeding I broke a bone 39. This is 39. I’m feeling stressed I’m feeling overwhelmed. I don’t know what to do right now. 39. We need to have at least five people on this list. If you can, Because we never know who can pick up right, Some people might be in class. Some people might be asleep. Some people might be at work, We don’t know, But we want to make sure we have people that we can contact Even if it’s a text. I know now we text more than we actually call, But I want you to reach out to people Because having someone on the line Having someone talking to us, I think calling is the best Because hearing someone’s voice can be so soothing And sometimes when We feel like we are a ten on our anxiety scale. It can help bring us back down to maybe a six Or a five And the more we talk with them And the more we kind of vent to them about what’s going on with us. The better we will start to feel The fifth and final tip Is something that I don’t really talk that much about on my channel, And that is going to see a psychiatrist. And the reason that I wanted to put this in here Is because there are those of us who doing these things. This feeling focusing we’re exercising, We’re trying everything to help ourselves. We’re seeing our own therapist And nothing gives It’s not getting better, And sometimes it’s getting worse And seeing a psychiatrist. They can offer medications that can help with it. Now. Obviously, I’m a Licensed Marriage and Family Therapist. I’m, not a physician. I don’t prescribe medication, But it can be so helpful and so pivotal in your recovery And don’t be ashamed of it. Many people seek help from psychiatrists. How else would they even exist? They wouldn’t have a job or career People see them. When we can’t do enough ourselves, The medication can help us get there. I often tell my clients – and this still rings. True. All research shows that therapy and medication gives us the best possible outcome, Because sometimes our mind is running so quickly. Things are happening so fast That we can’t even think about doing anything to help ourselves. We’re just trying to stay afloat. It’s so overwhelming, And medication can help with that, Bring that anxiety level down enough That we can actually take action. We can start making steps towards our recovery, Putting things in place, Creating plans. It can give us that little bit of squish. We need to get started, So I would encourage you If you have tried a lot of things And that’s not helping Reach out to your psychiatrist Or your general practitioner doctor And let’s start working on recovery. As always, don’t forget to subscribe to my channel. I put out videos five days a week And you don’t want to miss them, And if you have any tips and tricks of your own That have helped with your anxiety. Can you let us know below, Because we’re a wonderful community Sharing in our experience And together we’re getting better And we are towards a healthy mind and a healthy body. Now don’t forget to like the video And if you click below there,’s a little share button. Don’t forget to share it on reddit. That will help more people, get the tips and tricks that we know about. It will help get that information out there And keep working with me Towards a healthy mind and a healthy body. The snaps don’t bug the Okay, I like to snap Subtitles by the Amara org community.