As found on YouTubeHuman Synthesys Studio It’s Never Been Easier To Create Human Spokesperson Videos. No Learning Curve, So Easy To UsePhysiology of Addiction and Mental Health Issues
this episode was pre-recorded as part
of a live continuing education webinar on-demand CEUs are still available
for this presentation through all CEUs register at allceus.com/counselortoolbox I’d like to welcome everybody to today’s
presentation of addiction and co-occurring disorders part two the physiology of addiction and mental
health issues over the next hour we’re going to discuss somewhat generally because there’s a
a lot of stuff to go over neurotransmitters which we’ve talked about some before but then we’re also
going to talk a little bit more today than we’ve talked in the past about sex hormones thyroid
hormones and stress hormones and how all of those interact in the body to increase or decrease the
availability of certain neurotransmitters we’re going to go on from learning about the different
hormones and neurotransmitters to discussing the physics all the physiology of emotion and
motivation and again we’ve kind of covered that but we’re going to go over it real quick again
we’ll talk about the physiology of sleep what happens during sleep and what happens to those
hormones or neurotransmitters when you don’t get enough sleep what happens when you eat why
is eating sometimes rewarding what happens when people take stimulants whether it’s caffeine or
methamphetamine what happens when we turn up the system and how does that affect the availability
of certain neurotransmitters and then we’ll talk about the physiology of depressants so we’re
looking in general at what these things do as far as the physiology of addiction we’re going
to talk generally about that right at the very end so your inhibitory neurotransmitters are
those brain chemicals turn down the system so instead of being hyped up and awake
and yadda-yadda your calm you are relaxed you are maybe even sleepy too drowsy so your inhibitory
neurotransmitters are the ones that kick in or counteract the excitatory ones serotonin
is your primary inhibitory neurotransmitter it’s broken down to make melatonin and help you sleep
okay so we know that it’s also responsible for a lot of our bowel function angle and also
for not it’s implicated in nausea and motion sickness and they found that there are a lot fewer
side effects to serotonin antagonists than there are to dopamine antagonists when we’re talking
about helping people who have motion sickness and nausea so anyway just a little aside there but
serotonin is 80 percent of it is actually in your GI tract and it is implicated in bowel function
so when we’re thinking about clients who may have an imbalance in serotonin and who may have greater
pain sensitivity we want to start thinking about you know how is their GI working and is are some
of their problems with you know stomach problems pain irritable bowel that kind of stuff is that
caused by a serotonin imbalance or is that causing a serotonin imbalance or maybe serotonin is not
implicated at all and it’s something completely different serotonin is also implicated in anxiety
and aggression if you don’t have enough of it you tend to be more anxious and aggressive because
you’re not having the turn down if you will low serotonin has also been implicated in poor impulse
control so we like serotonin but we found and we’re gonna talk about that throughout
this class of serotonin has often been given the go-ahead or been implicated for a whole lot of
things and we’ve said okay if this happens then it’s low serotonin if this happens then it’s low
serotonin and as it goes but no the research is finding that that’s rarely true that
most of our problems whether it be GI problems or mental health problems or addictive issues
don’t necessarily involve serotonin at all there is a subset of people for whom it does but the
majority of people which is why antidepressants are ineffective for about 70 percent of the
population for them shortie of the people it’s not serotonin so we do want to keep that in the back
of our mind yes serotonin is everywhere throughout the body 80% of it is in our gut and our gut is
not necessarily going to communicate directly with our brain we cannot measure neurotransmitter
levels effectively in a live human being just not how it works right now there are tests out there
that say they can measure your neurotransmitter levels and that’s true but it’s not telling you
how much of that neurotransmitter is in your gut or your muscles or wherever versus in your
brain so those tests for our purposes as mental health clinicians and people who come to us who
may want to know well what antidepressant should I be on they’re not all that effective
okay so depression has been debunked as being linked to serotonin in the majority of
cases serotonin is implicated as one of those neurotransmitters involved in pain control in people
with lower serotonin tend to have a lower pain threshold so it hurts more and that doesn’t mean
that they’re sissies or anything like that it just means that they are more reactive or they
feel more pain because they don’t have the same level of serotonin and maybe endogenous opioids
kind of coursing through their system serotonin is also like I said involved in sleep an interesting
fact is that alcohol impairs the body’s ability to convert tryptophan which is an amino acid
to serotonin so when you have somebody who’s an alcoholic let’s think about how this works
if they are drinking and maybe they’re eating a perfectly healthy diet and they just happen to
drink a lot if their body can’t convert tryptophan to serotonin then all of these problems up here
that may be implicated by low serotonin can start to rear their ugly head because the body can’t
To make serotonin out of anything else it has to make it from tryptophan and if it can’t make serotonin
then it can’t make melatonin which is involved in sleep and you’re gonna see how important all that
is later so the take-home message with that is that alcohol is something to be considered
for moderation especially if we have a client who is struggling with depression maybe they’re not an
alcoholic but they need to consider the long-term impact if they want to feel better is preventing
their body from making using the building blocks to make the neurotransmitters that they may need
is it worth that drink remember that serotonin has been found in research to be
implicated in low serotonin is implicated in people with generalized anxiety disorders so
it hasn’t been completely just been debunked for everything but researchers and clinicians
finally are starting to realize that there are a multitude of reasons that somebody could have
a mood issue that somebody could have even low serotonin okay if the person has low serotonin
alright that’s fine let’s address it but what is causing the low serotonin we’ll look at
that more in the next few slides GABA is your other major inhibitory neurotransmitter it has
sedative depressive and anti-anxiety properties to them the really interesting thing it’s and when
I say depressive I mean it slows down everything it’s not that it makes people depressed but it’s
your anti-anti-anxiety natural anti-anxiety neurotransmitter helps improve concentration by
filtering out background noise so you’re able to focus a little bit better when you’ve got normal
levels of gaba help with impulse control think about when you’re anxious when you’re a
little bit revved up when you’re stressed out and somebody scares you maybe you’re a little bit
more jumpy well think about if you have GABA at the right levels in your system and you’re not
stressed out and somebody scares you are you as jumpy are you as impulsive a lot of our impulses
are associated with wanting to make a threat or a pain go away so if you’re not perceiving as
many threats you’re probably not going to be as impulsive another little interesting side thing is
that glucose you know sugar is necessary for the formation of GABA so people with hypoglycemia
can have a reduction in GABA and an increase in anxiety so think about if your blood sugar
gets low even if you are not hypoglycemic but you know you got to work back-to-back patients
you didn’t take time for lunch yet back-to-back patients you’re on the drive home from the office
your blood Sugar’s low you are you more likely to respond with some anxiety or irritability to
things that happen versus when you are well nourished and your blood sugar is kind of stable
for most people, they’re gonna say yeah I tend to be a little bit cranky err when my blood sugar
is low and shake gear alright so those are our two inhibitory neurotransmitters glutamate is
generally acknowledged to be the most important neurotransmitter for brain functioning and
it’s excitatory it gets you up it gets you going it gives you energy and it’s responsible
for helping us learn and remember things so if you’ve got low levels of glutamate you know you
might have difficulty concentrating and learning now the interesting thing is that glutamine
which is an amino acid you eat glutamine is converted into glutamate all right well that
makes sense so you eat something it is turned into this neurotransmitter that’s excitatory the
interesting thing is gaba is made by the breakdown of glutamate so you have if you have glutamate
then you can have Gaba if you don’t have enough glutamate then you’re not going to have enough
GABA so it’s a balance like taking a warm bath and you know this is important to remember
simply because we want to know what’s rubbing us up and what’s slowing us down norepinephrine or
noradrenaline depending on where you are is what they call a catecholamine it increases arousal and
alertness promotes vigilance and focuses attention so you’re hearing a theme here about attention
and memory it enhances the formation and retrieval of memories so in your norepinephrine that’s your
motivation chemical is secreted it encourages you to pay attention to remember and to be able to go
and file things away and access them easily it can also promote restlessness and anxiety if
you have too much so it’s all about moderation when I talk about too much or too little of a
neurotransmitter everything is always about all of the other neurotransmitters and hormones
so we can’t just necessarily get a measurement and go well you’ve got too much of this well we have
to know what the levels of everything else are it would be kind of like making a marinara sauce and
saying you a teaspoon of garlic is how much you need but that teaspoon would be enough if you
were making maybe two quarts of marinara sauce but if you are making 4 gallons all of the
other spices and everything would be in much larger proportions so what a teaspoon be enough
so we need to know what proportions all the other chemicals are at in order to know how much we need
and since we can’t measure them we’re just kind of left guessing dopamine is another catecholamine
and it’s broken down to make norepinephrine now normally we think of dopamine as our pleasure
reward chemical which it is don’t get me wrong it’s that’s what is there for and it tells us
I want to do that again but it’s broken down to make our focus concentration motivation chemical
interesting so we need dopamine to make norepinephrine we need norepinephrine to want to
get up and go so if we are draining our dopamine system through addictive behaviors or some other
reason guess what we’re not going to be able to make enough nor epinephrine or those receptors
that usually receive the norepinephrine and the dopamine are going to be basically unresponsive
and you’re going to knock on the door and nobody’s going to open so dopamine is broken down to make
norepinephrine which is your motivation chemical high levels of dopamine in the brain generally
enhance mood and increase body movement too much dopamine may produce nervousness irritability
aggressiveness and paranoia so think about cocaine if somebody takes a whole lot of really good
cocaine this is probably what we’re going to see because the levels of dopamine in their brain
just skyrocketed and everything else didn’t catch up there was no signal to all the other chemicals
to go okay we’re gonna have a surge here so we have all of those neurotransmitters that are
responsible for helping us feel happy serotonin helps us feel theoretically calm and content
and focused gaba is an anti-anxiety medication or not medication but a neurotransmitter and then
dopamine glutamate and norepinephrine are all of our excitatory ones they’re the ones that get
us guess what excited happy excited mad excited whatever the excited is they Rev us up and that’s
what we label with our emotional feeling states so what is this HPA axis thing that I talk about
every once in a while in response to stress the level of various hormones change and reactions to
stress is associated with an enhanced secretion of several hormones including your gluta Co
corticoids which is cortisol your catecholamines to increase mobilization of energy sources
which is blah blah blah blah blah you get stressed your body sends out the message that
we need some energy we need some fuel for this fight-or-flight response cortisol is activated and
it’s a glue to co corticoid which tells your body we need to prepare we need to get some glucose
going so got energy for this fight-or-flight thing catecholamines adrenaline and dopamine are
released that’s your body going okay we have this energy now let’s get the team revved up the other
thing that happens though is jörgen a door opens are suppressed your body goes you know we don’t
really have time for sex right now so let’s not worry about it so your sex hormones tend to be
suppressed under high stress levels okay well who cares you’re gonna find out in a little while
but that’s kind of a big deal because there is a strong relationship between the amount of and the
balance of our sex hormones and the availability of serotonin-norepinephrine and dopamine in our
bodies oh well sweet this here we are androgen or testosterone what we want to look at is what does
it do it helps helps us with concentration mood and not enough of it can result in an increase in
belly fat they found that in men depending on the research that you look at somewhere between 30
and 40 years of age they start losing somewhere between 1% and 1.5 percent of their testosterone
each year and so you’re thinking well you know that’s not that much but you’ve also got to
remember that everything’s in a balance so they’re losing their testosterone but what else is
not decreasing estrogen so some articles have kind of termed it manopause if you will the increase
in estrogen can increase irritability difficulty concentrating and belly fat as well as Gyna
mastika or the development of excess fat in the breast area so something interesting to look
at if you’re dealing with patients male patients who are over the age of 40 who are having suddenly
if you will depression or anxiety issues or are talking about their midlife crisis that those
all of those things could be precipitated by in their neurochemistry because of a drop
in testosterone not necessarily but it’s one positive or one possible reason estrogen believe
it or not is a neuro stimulant estrogen revs us up receptors for estrogen are very abundant
in the emotional center of the brain called the amygdala and the hypothalamus which is involved
in what we just talked about the HPA axis which tells us to fight flea or freeze estrogen
increases serotonin receptor responsive ‘it increases the number of serotonin receptors
in the body and enhances serotonin transport and uptake so we might hypothesize and we don’t
know any of this for sure that if someone’s mood disorder started or fluctuates in response to
fluctuations in their estrogen then there might be a serotonin component to this mood disorder
because estrogen is so intimately connected with serotonin availability high levels of estrogen are
associated with anxiety one thing that they found in American culture and industrialized nations
but especially American culture is we have a lot of chemicals and stuff that we eat that tend
to and habits that we do that tend to increase our levels of estrogen creating something called
estrogen dominance but high levels of estrogen are associated with anxiety so one thing clients
may want to do especially female clients but you know if you have a male who is feeling like
estrogen may be increasing too much I have them look at what they’re doing as far as lifestyle
factors to see if there’s anything that might be increasing their estrogen levels low levels of
estrogen are associated with depression because there’s not enough serotonin going around but also
because estrogen is a neuro stimulant and if it’s not there then there’s no stimulation so alright
so now looking at first we started implicating just neurotransmitters and going well if you don’t
have enough of this or too much of this then you might be depressed well now we’ve added to the
mix and said well guess what these imbalances over here in the neurotransmitters may be caused
by something completely different such as sex hormones progesterone is another sex hormone an
imbalance in the ratio with estrogen is implicated in mood disorders so progesterone kind of calms
down estrogen they’re yin & yang if you will kind of like GABA and glutamate it’s referred to as the
relaxation hormone the interesting thing here is synthetic progesterone which is present in a lot
of birth control is associated with depression whereas naturally occurring progesterone levels
haven’t had that same associate association drawn in the research literature so another thing to
look at with our female clients is possibly to ask them have they and if they’re presenting with
depressive symptoms have they changed their birth control regimen or have they recently gotten
pregnant or had a baby or stopped nursing and that was one I learned you know when I stopped
nursing my first child was your body actually maintains different levels of hormones and makes
sense maintains different levels of hormones when you’re nursing so you’re producing milk and stuff
and then when you stop nursing there’s a whole different hormonal cascade that happens so there
are multiple different times that estrogen can change and progesterone levels can change ganado
trope ins hormones synthesized and released by the anterior pituitary promote the production of
sex hormones so remember earlier I said that when we’re under stress our body releases cortisol
and cortisol tells our body you know what we don’t need to produce those sex hormones right now
so let’s connect it all if you’re under a lot of stress you may not be producing enough estrogen
which is why a lot of women when they’re under a lot of stress tend to have more erratic cycles but
even in men when your sex hormones are not being produced because your body’s focused on fight
or flee it makes the availability of serotonin and norepinephrine and dopamine less available
so chronic stress can alter the availability of sex hormones which alter the availability of
neurotransmitters okay you wanted some good news we got some good news oxytocin is our bonding
hormone and they found that it can counteract cortisol and vice-versa it’s not just getting a
hug though so I mean hugs are great don’t get me wrong but a lot of research has indicated that
people who have companion animals and pet their companion animal it can be a horse it can be a
dog it can be a cat a bunny rabbit whatever it is that does it for you where you feel that
sensation of bonding 15 minutes of petting that animal raises oxytocin levels and which
counteracts cortisol sweet thyroid hormones yet a whole nother category so we’re moving off
of the sex hormones onto our thyroid you have two types of thyroid hormones thyroxine and
the other one that I can’t pronounce t4 and t3 t4 is broken down to make t3 they are always
in a balance they’re always in a ratio too much thyroid hormone which typically is t3 speeds
things up and too little slows things down so think about somebody who’s hypothyroid they have
symptoms of depression one of the things we want to rule out early on with our patients who present
with the pressive symptoms is thyroid problems the patients with too much thyroid hormone may
present with anxiety symptoms so again we want to look and say is there a physiological cause to
the neurotransmitter imbalance the pituitary gland hypothermic hypothalamic-pituitary-adrenal axis
so this is the middle of that stress axis here the pituitary gland releases thyroid stimulating
hormones to get the thyroid to release t4 and t3 majority of the thyroid hormones produced by the
thyroid are t4 but t3 is the most usable form so it sends out t4 which is kind of you know it’s
just kind of there it’s not a real hard worker at all but along the way it gets converted to 3
t3 which is a workhorse this conversion is the critical element because a lot of times doctors
will test thyroid secreting hormone and t4 alone and they’ll say well you’re secreting enough and
there’s plenty of t4 to be broken down to t3 so I don’t know why you have hypothyroid symptoms but
the piece that they’re missing is they may not be we may not be adequately converting t4 to active
t3 so it’s important if you think you have thyroid issues going on to work with an endocrinologist
who’s going to do more than just a superficial test or if you go to a GP you have and they do
just a TS h t4 test comes back normal but you’re like no something’s not right there are more tests
that can be done to be more specific about what’s available because if we’ve got a client who goes
to the doctor and says doc you know I feel awful I can’t wake up I’ve got no energy they run these
tests they say well there’s nothing wrong with you that just disempowers the client the clients
going well nothing’s wrong with me I don’t know why I feel this way I have no hope for getting
better because I don’t know what’s wrong so I want to make sure that we educate them about all
the possible things that they might be able to look into I don’t dump all this on my clients at
first you know when I go through the assessment I start listening for things and then I encourage
them to get a full blood panel done and then we talk about all that when they come back and
then narrow it down to other things that they may want to look at further testing for if the
general assessment didn’t come back with anything overactive thyroid produces anxiety feelings of
nervousness butterflies heart racing trembling irritability and sleep difficulties under activity
depressive symptoms the other interesting thing and I don’t know what other word to use is
if it’s either overactive or underactive the person can have mood swings and have sleeping
difficulties so we don’t want to just say well you’re having mood swings it must be hyper
we don’t know so we want to look at maybe the thyroid gland is sputtering and giving a little
bit and then not enough and then a little bit and then not enough it’s just important for
them to understand what the thyroid hormone does other cognitive issues difficulties with
concentration short-term memory lapses and lack of interest and mental alertness are also common
in hypothyroid but they’re also common in a whole bunch of other things I mean most of these
sound like what the criteria for depression so we’re trying to sort through and figure out
what may be going on with that particular client hypothyroidism led to a significant decrease of
responsiveness of the serotonin system so again here’s something else if you don’t have enough
estrogen or if you don’t have enough thyroid the serotonin system may be implicated and we know
that serotonin insufficiency is implicated in generalized anxiety disorder so one of those
little paths to kind of be aware of optimal thyroid function may be necessary for optimal
response to antidepressants antidepressants mean the serotonin is still there but if estrogen
and thyroid are responsible for transporting it around and making sure it gets taken up in
the right places then if those two systems aren’t working no matter how much serotonin
is in the system of it’s not getting to the right places it’s not do the job hypothyroidism
generally increases enzyme activities and GABA levels now you may go well sweet we want more
gaba but we don’t too much gaba has too much of a depressive effect so the person may not be
motivated may feel apathetic about things they can’t get excited about anything so there is such
a thing as being too chill thyroid hormone plays a role in the output of dopamine the precursor to
norepinephrine our motivation chemical not enough thyroid hormone not enough excretion of dopamine
not enough get up and go and norepinephrine has also insufficient norepinephrine has also
been implicated in depression so you know serotonin is not even in there we’re talking
about thyroid dopamine and norepinephrine stress hormones so we’ve moved on cortisol
it’s released from that HPA axis cortisol triggers a decrease in leptin and an increase in
gralen which increases appetite and food intake cortisol is telling you there is a threat we
need energy we need to mobilize the sugars because it’s a glucocorticoid but we also need to
get more sugars in here so we have energy for the fight-or-flight as long as it goes on which is why
a lot of people who are chronically stressed also feel like they’re chronically hungry they’re just
like I’m famished all the time and it may not be that their body needs all that energy all those
calories right now their body may be hoarding it because they think they’re going to have to it’s
gonna have to fight or flight flee for a long time cortisol also affects the endocrine system
including thyroids insulin regulating blood sugar and your sex hormones all right well that’s not
good so when people are stressed they maintain higher levels of cortisol when they maintain
higher levels of cortisol basically every bodily system and all the neurotransmitters are impacted
adrenaline is another stress hormone you know we think about it when somebody gets really upset or
excited or whatever they have a rush of adrenaline alright sigh Roxon is also released from the
kidneys and are from the thyroid and helps you get fatty acids which are long term long term
energy fat has nine calories per gram sugar has four calories per gram so fat is a much denser
source of energy effective chronically elevated cortisol includes impaired cognitive performance
you’re not thinking as well dampen thyroid function yep eventually the body goes there’s no
point the stress is not going to go away there’s no point in continuing to fight so I’m going to
turn down the sensitivity of the symptom blood sugar imbalances sleep disruption elevated blood
pressure lowered immune function and increased abdominal fat so if a client starts talking about
how they’re stressed they’re hungry all the time and they keep suddenly gaining all this weight
in their belly we might start looking at chronic stress and interventions that we might use for
chronic stress including mindfulness meditation exercise you know anything that we can throw
their way in addition to having them get a full physical to make sure there’s nothing else going
on like you know actual hyper hypothyroid caused by a physiological problem low levels of cortisol
brain fog cloudy headedness mild depression low thyroid function again blood sugar imbalances
such as hypoglycemia and remember when you’ve got blood sugar imbalances and not enough sugar
then your body cannot produce enough gaba which means you’re not going to have enough naturally
relaxing chemicals fatigue especially morning and mid-afternoon sleep disruption low blood pressure
lowered immune function and inflammation so these are all things that we can produce to work
our clients to say cortisol it’s not public enemy number one but it’s pretty close to it so
let’s look at how your cortisol levels how you’re sustained chronic stress might be impacting
your mood your health and your sleep and think about different ways we can reduce that because
that’s more tangible and cortisol is measurable obviously the doctor has to do that but it is
measurable in general when we feel emotions a stimulus is received by our peripheral peripheral
nervous system the brain responds by triggering the amygdala which is our emotion center and
the hypothalamus assesses if you will the need for fight or flee it goes there’s a threat or
there’s no emotional memory that helps the brain determine the types of neurochemicals to secrete
and in what amounts if the hypothalamus goes yeah no big deal then you’re going to have more
inhibitory neurotransmitters then if you have your hypothalamus going that’s a problem what we need
to look at and this adds another layer is when there is too much of a chemical or hypersensitive
receptors so hypersensitive receptors are like the person that you know that jumps when you tap them
on the shoulder somebody who’s hyper vigilant when they are activated they go from 0 to 100 and
it’s just like in sensitive receptors on the other hand when they’re activated they may not do
anything at all so you may have enough chemical in the system but if the receptors are not receptive
then the chemical can’t do its job so if serotonin is sitting outside the receptors door just kind
of knocking on it going let me in and that door never gets opened then it doesn’t matter how much
serotonin is sitting in the synapse it’s not going to do any good so as I said before all every
time I talk about too much and too little it’s always relative to the proportions of the other
hormones and neurotransmitters for that person anxiety irritability and anger our fight-or-flight
response can be caused by dot dot dot too little serotonin where you have anxiety coming
on because serotonin is not there to help the person calm too little GABA again not enough
calming too much norepinephrine too much estrogen too much testosterone or too much thyroid so
any of these too much is going to cause one symptom either anxiety or irritability or anger
and too little will probably produce something more on the depressive continuum now happiness and
excitements an interesting one because happiness and excitement are excitatory neurotransmitters
they’re going to get your heart rate going they’re gonna get your blood blood flowing they’re gonna
get your breathing a little bit faster think about Christmas Christmas morning when you run down the
stairs in order to see what’s under the Christmas tree or something else that is really exciting
your body is secreting dopamine norepinephrine glutamate and maybe a little bit of serotonin
in there but these are the same chemicals that are going out during a stress response it’s how
the amygdala processes everything so we still need these excitatory neurotransmitters we can’t
just shut them down and go well that’s causing too much problem let’s turn it down well if we turn it
down we’re also turning down the body’s ability to Spahn to happy stimuli and like I said depression
can be caused by serotonin insufficiency or excess and why is it excess when you have too much
serotonin or too little serotonin you can have high levels of anxiety they found and high
levels and anxiety trigger the stress response system after a certain period of time the stress
response system goes you know what I can’t stay this hyped up for this long I’ve got to turn down
my sensitivity I’ve just got a you know let it all go which starts leading to feelings of apathy and
depression it can be caused by nor norepinephrine insufficiency dopamine insufficiency thyroid
insufficiency or gain too much or too little estrogen the good thing is I Roy dand sex
hormones can be measured so we can easily or somewhat easily help the person rule those in
and/or rule those out as can cortisol so if they have chronically elevated or chronically low
levels of cortisol they’re going to have some mood symptoms but we can figure out that that’s
going on and we can help educate the patient to why they’re having the symptoms they are it’s
not all in their head the New England Journal of Medicine on major depression said numerous
studies of norepinephrine and serotonin in plasma urine and cerebrospinal fluid as well as
post mortem Studies on the brains of patients with depression so we’re talking about humans
not just rats studies have yet to identify the purported deficiency reliably so while we’re
talking about depression being caused by if you will norepinephrine or serotonin deficiency
there’s no real research that can reliably say yes this is it 100% of the time or even 95% of the
time it’s more like yeah 15 percent of the time so yes deficiencies in norepinephrine and and or
serotonin does cause depression in some people but that is a small subset and they found that there
are 20 or 30 small subsets of different causative factors estrogen and progesterone modulates sleep
and too much estrogen can cause insomnia so again if you have too much estrogen well you may have
plenty of serotonin going on you also may not be able to sleep sleep deficiency promotes elevated
cortisol and further disrupts our feeding hormones now for cortisol is elevated we’re not going
to get good restful sleep sleep deficiency is related to a 30% reduction in thyroid hormone
levels so again remember that the body finally after chronic stress will start turning down
the thyroid it’s just like there’s no need to exert any more effort because this is a losing
proposition with sleep deficiency the thyroid hormone levels go down cortisol levels go up
which is your stress chemical so everything’s starting to get out of whack when people eat
serotonin suppresses appetite and increases with feeding so as we eat our serotonin levels go
up especially for eating carbohydrate-rich foods but anytime we’re eating so if there’s not enough
serotonin people’s appetite suppression may be off but that’s also one of the reasons that people eat
for comfort is because serotonin helps them feel a little bit better so when they’re eating serotonin
goes up dopamine is associated with safety ATP handy which is great but if you don’t have enough
dopamine then you may never feel satisfied as we talked about before cortisol increases appetite
and neurons involved in the regulation of feeding are located in the hypothalamus so when you’ve
got that hypothalamus pituitary adrenal axis all activated all the time the HPA axis you’re
feeding is going to be probably way up here because the hypothalamus is going there’s a threat
we need food we need we need energy and all of these chemicals are involved in stress response
stimulants stimulants set off the stress response system by causing the body to kind of dump if
you will sigh roid hormones stress hormones and suppress sex hormones you know that HPA axis it’s
activated excitatory neurotransmitters dopamine and norepinephrine gets secreted so if you’ve got
a lot of pleasure reward focus and concentration going on and you’re just like woohoo yeah you’re
probably gonna want to do that again but when that wears off when stimulants wear off they wear
off a whole lot faster than what our normal neuro chemicals would normally do so when they wear off
there’s a sudden lack of stimulation pleasure and reward and there’s an excess of gaba and other
other neurochemicals when people drink alcohol initially gaba goes way up when they drink the
alcohol and they feel relaxed and disinhibited and all that kind of stuff the alcohol wears off and
all of a sudden in proportion to everything else there’s way not enough gaba so anxiety goes way up
so what we want to remember is when we’re taking substances or engaging it well taking substances
specifically they are going to impact and wear off in a much different rate than what would happen
from our body normally excreting or causing those neurochemicals to be excreted depressant
increase gaba and may increase serotonin so they found that alcohol may increase serotonin it also
increases gaba but again when it wears off you got a problem what there are other depressants out
there besides alcohol though so it’s important to know what are your clients taking what are they
using recreationally not to be judgmental you know if you have a couple drinks in the evening it is
what it is what other things are you taking are you using including looking herbs like valerian
Valerians are pretty powerful depressant so it’s important to know what what they’re taking so
they know what impact is having on their body there are a variety of neurotransmitters that
are implicated in moods sex stress and thyroid hormones among others modulate the secretion and
absorption that is modulate the availability of these neurotransmitters so if there’s a lack
or an insufficiency proportionally speaking of norepinephrine what we want to ask is not how do
we increase it but what’s causing it why is there an imbalance in norepinephrine in this particular
patient dysphoria is about having an imbalance not necessarily too much or too little you may have
too much X in relation to Y too much glutamate in relation to GABA so talking with your clients
if they start taking medications talk with them about how they feel and whether it’s getting worse
you’re getting better to help understand you know are we targeting the right things here sleep
deprivation directly contributes alterations in hormone and neurotransmitter levels and
excessive eating may be caused by high cortisol levels because the brain thinks it needs to store
energy for the long fight sex hormones impact the availability of serotonin but oxytocin has been
shown to inhibit cortisol so pet a dog get a hug do something to promote bonding it will help
with stress levels dysphoric moods are caused by a neurotransmitter imbalance but what causes
that imbalance in each person berries greatly and they found it even berries greatly among
people with PTSD so just like depression PTSD does not have one simple cause a cascade effect
can happen when any one of these systems goes offline so if the thyroid system goes offline has
a dysfunction for some reason it may negatively impact all the other symptoms because it’s
going to change the balance and the ratios of all the other hormones and chemicals involved
in those feedback loops so final thoughts chronic stress impairs sleep which causes imbalances
and hormones and neurotransmitters involved in eating sleeping mood attention motivation
and sex disruptions in nutrition can fail to provide the building blocks for the hormones and
neurotransmitters so it could be something as simple as you know eating junk food every day
sleep impairment is associated with decreases in thyroid hormones and increases in cortisol and
dysregulation of eating so if somebody’s hungry all the time but they’ve got a low mood and you
know they present with depressive symptoms we may want to look at what’s going on and could
it is a factor contributing to this is sleep um but any of these things could also contribute
to problems with sleep estrogen and testosterone, imbalances can cause depression or anxiety like
symptoms and thyroid hormone imbalances can also cause depression and anxiety-like symptoms so the
the take-home message is this stuff is stinkin complicated but what we know is everything
is intimately interconnected so we don’t want to just start by saying well it sounds like
you’ve got this and try to pigeonhole everybody into one particular causation we need to
understand what’s going on with them and since we can’t measure brain neurochemicals to figure
out exactly which one’s out of whack that’s where the part art comes into psychology as part art
and part science okay so are there any questions you I think you’re all probably feeling like me when
after I wrote this I worked on research for about 20 hours and I was all but drooling at myself
by the end I was like really I tackled a pretty deep subject for an hour and you may need to
go back and look at the presentation to kind of make all the connections and connect the
dots as it applies to your clients but let’s see thinking about autism symptoms and these
issues and body functions and hormones yeah I mean certainly autism is correlated and I’m
pretty ignorant as to the neurophysiology of autism but I would think that there’s a strong
correlation with the neurotransmitters so I would look at other systems to see if there are
something that’s going offline that may be contributing to the neuro neurotransmitter
imbalance when symptoms are exacerbated which makes me think you know again
I don’t know as much I don’t know much about autism but when a client begins
stemming I’m wondering if those impulsive behaviors mean there’s high
levels of anxiety at that point so I’m wondering what’s happening with the stress
response system in the GABA feedback loop I would love after you guys kind of
digest this and stuff if you have any thoughts reactions connections I would
love to hear back from you I’ll put my email and other than that have a wonderful
amazing weekend and I will see you on Tuesday if you enjoy this podcast please like and
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Etc sometimes you need to
delay joint sessions until the parent or caregiver can offer the child support and sometimes that
means not even starting treatment really until the parent and caregiver parent or caregiver
can be on board now you can get started with psychoeducation emotions identification feelings
identification and stress management and coping skills you know there were not really
poking a bunch of bears so you can probably safely get started on that if it’s sometimes it’s
court-ordered and they have to start treatment by April 1st or something so there are things you can
do but you may need to delay the actual beginning of the trauma narrative until the parent is
able to be available to educate everybody on how therapy works and instill in everyone not just
the parent optima optimist that well optimism about the child’s potential for recovery you
know sometimes they’ve been dealing with this child’s acting out behaviors for so long they’re
just like you know we’ve already been to three other therapists I don’t know what’s going to
fix it or I’ve done everything I know how to do good luck so we can talk about you know a
different approach or we can talk about what they’ve done that’s worked for a short period
of time and build on those strengths to instill optimism and hope and empowerment so
initially, when we talk about psycho-education it’s important to provide accurate information
about the trauma when children are traumatized they can be confused and not completely understand
what happened they may blame themselves and they may hold on to myths because they’ve been misled
and/or deliberately given incorrect information so one of the best ways we can help is to correct
that information provides information about how often this happens and whether you know it’s okay
to do this that or the other psychoeducation clarifies inappropriate information children may
have obtained directly from the perpetrator or on their own so the perpetrator may have told them
that this is how I express love or this is how you need to be disciplined because you don’t learn
this is how I was disciplined whatever it is or they could have gotten it on their own they could
have gotten it from school from the internet or just come up with it in their little heads trying
to make sense of what happened psychoeducation also helps them identify safety issues the
difference between safe situations and dangerous situations and as we get through this I really
want you to get away from the notion that TF CBT and childhood trauma are only physical and sexual
abuse there are so many other traumas as evidenced by the adverse childhood experiences survey that
I want you to wrap your head around that and there are things they didn’t cover in the aces such as
bullying and natural disasters so we want to help children whatever the trauma is the trauma made
they feel unsafe so we want to identify safety issues if the trauma was a hurricane then we want
to talk about what hurricanes are how often they hit what to safety plan etc so every time a
the thunderstorm comes they don’t freak out and we want to use psychoeducation to provide another
way to target faulty or maladaptive beliefs by helping to normalize thoughts and feelings about
the traumatic experience you know it makes sense that that was scary and makes sense that
you’re angry it makes sense that you feel this way and we can talk about why that makes
sense and why it makes you feel that way through cycle education you’re getting the child to start
talking about the specific trauma that he or she experienced in a less anxiety-provoking way by
talking in Jen wrong about the type of trauma so you’re talking about natural disasters you’re
talking about plane crashes you’re talking about domestic violence so they start learning about
it and then eventually you’re going to move down to their experience with it so like I said there
are a ton of different traumas and the ACE study even acknowledges that these are just the ten most
common ones that they heard however there are many many many different traumas and types of trauma
some of the biggest ones are physical and sexual abuse physical neglect emotional abuse
and neglect and the Aces identified mother treated violently I would say anyone in the household
treated violently it’s not just the mother’s substance misuse within the household and that
can be by the parents or by siblings household mental illness parental separation or divorce and
an incarcerated household member so those were aces but then like I said there’s also bullying
the death of a parent or sibling is extremely traumatic hurricane tornado natural disaster and
then I put the fire out separately because sometimes fire can be man-made sometimes it can be a wiring
problem but sometimes it can be Jr was playing with matches now even if jr. Accidentally started
the fire does that make it any less traumatic no it probably makes it more traumatic because then
there’s a whole sense of guilt and responsibility but it’s still a trauma that has to be dealt
with so I put a link to the adverse childhood experiences website if you want to go look more
about that but we’re going to move on psycho-education involves specific information about
the traumatic events the child has experienced not the child’s event we’re not going to go
into police records or something, we’re just going to talk about specific information about
domestic violence or whatever body awareness and sex education in cases of physical or sexual
maltreatment and there are caveats for getting parental consent and permission and all that other
stuff and Risk Reduction skills to decrease the risk of future traumatization now going back to
those other things it’s not just about physical or sexual abuse so we want to look at what was the
the risk created by you know how can you reduce your risk of being bullied how can you reduce your
risk of being traumatized in a tornado you know you can’t stop the tornado from coming
and they’re everywhere so what do you do and talk about a safety plan the same thing with fire
information needs to be tailored to fit a child’s particularly particular experiences and level
of knowledge obviously, you’re going to provide different information to a seven-year-old than
you are to a 17-year-old provide caregivers with handout materials to reinforce the information
discussed in session so this may help educate the parents about some of it but it lets them
know what you talked about and it gets us all on the literal same page you’re providing them a
handout of everything you went over with Junior and we want to encourage caregivers to discuss
this information at home reinforces accurate information about how safe or unsafe they
are and obviously, we’re going towards safe and reinforced accurate information and develop
a safety plan so they feel confident that at home they’re going to be taken care of when you
start psychoeducation you do want to get a sense of what the child already knows and you can use
a question-and-answer game format in which the child gets points for answering questions which I
love this suggestion so you can ask them if you know what is a hurricane or is a tornado and see
if they know and see if they know how much time and much-advanced warning we have for a tornado
versus a hurricane or you know whatever situation you’re talking about you see I did a lot of posts
Hurricane Katrina counseling in northern Florida so that’s one of those things that comes up for
I am talking with children about how likely is it that a category 5 hurricane is going to hit
again but encouraging them to give your aunt’s give answers and if they give the wrong answer you
know it’s great to try now you know try to coach them into a correct answer or provide them the correct
one but give them credit for at least making an effort sample questions might include what is
you know and put in the type of trauma what is bullying how often do you think bullying happens
and why does bullying happen you know those are some questions you can ask to just open a dialogue
about bullying, if this child has been a victim of bullying and is and is traumatized so cultural
considerations meet the child and family where they are by presenting information in a way which
they can relate it to their belief system and you may need to consult with their spiritual
guidance guides leaders whether it be a pastor or you know whatever to get some guidance
on how to handle certain aspects of whether it was the will of God and in the case of sexual abuse
how to handle the concept of virginity and how to handle the concept of bad things happening to bad
people and whatever else they think is coming from or their parents are instilling in them in a
belief system we want to make sure that we’re not necessarily contradicting it and going oh mom dad
and the church is wrong but we also want to help them try to integrate this in a way that can help
they have strong self-esteem so reaching out to those spiritual leaders and the family asking what
their belief system about certain things can be very helpful assess the general beliefs about
the trauma if something happened or when something happens ask the parent or the family that’s there
not necessarily the child but you want to get a sense of what the family stance is on why this
happened what it means how it’s going to impact life hence foreign henceforth and forever more
focus on the events they perceive as traumatic to the family but most especially the child if the
child’s going back to the Aces you know maybe the parents got divorced but the child doesn’t
see that as traumatic because there was domestic violence ahead of time the domestic violence was
traumatic the divorce was a relief so wherever the child is with each trauma we want to
be respectful of what they perceive is traumatic and tailor the information so the family can be
more receptive to it as supportive as possible and sometimes you need to make sure that the language
you know make sure the language is not jargony about general views of mental health and mental health
treatment should also be assessed and addressed in the psychoeducation piece not only with the child
but also with the family, if they are suspicious of it don’t understand it think that you’re just
going to magically fix Junior we want to demystify the process and talk about what is the purpose of
the assessment what is the purpose of each one of these activities and why am I doing this or why
are we doing this as a team and how can it help and then we also want to provide information to
D stigmatize and normalize mental health issues and seeking treatment some cultures are still
resistant to seeking treatment and I use the term cultures broadly because there’s
a stigma associated with it so normalizing for them how many people go to treatment how common
PTSD is or whatever the situation you’re dealing with it doesn’t mean they have to like it but at
At least it will give them a little bit of a nugget to understand that they’re not the only ones if
they are from a cultural group a minority cultural group of some sort you might want to provide
information about how common this particular issue is in their group I’ve done a lot of work
with law enforcement and emergency responders and they’re kind of their little group so
we talk about how common depression is among law enforcement and emergent emergency responders
specifically, because they face so much so many different stressors than you know Joe Schmo over
here so it D stigmatizes and normalizes a little bit now they still may not talk about it and
go well hey you know 37% of us have clinical depression no that’s probably not going to happen
but at least in the back of their mind, they can go you know what I’m looking around this room and
I can bet that at least one other person’s on antidepressants or something and feel a little
less unique and isolated in parent sessions you want to provide a rationale and overview of the
treatment model educates parents about the trauma and talks about the child’s trauma-related symptoms
so we’re going to go over what is hyper-vigilance what is the function it why people become
hypervigilant after trauma and what might it look like in a child because it presents very
differently for different children so we might want to give some ideas and say does this sound
like Johnny or does this sound like Johnny and help them understand why these behaviors may
be coming out we want to talk about how early treatment helps prevent long-term problems okay
maybe the trauma happened three years ago but still, it’s better than waiting ten more years and
you know Johnny’s still not having any Ellucian will want to talk about the importance of talking
directly about the trauma to help the children cope with their experiences and not hedging and
this will be on a case-by-case basis but the manual walks you through handling this discussion with
the parents about exactly how much detail do I go into if Johnny brings it up at home reassure
parents that children will first be taught skills to help them cope with their discomfort
and that talking about the trauma will be done slowly with a great deal of support so we’re not
just going to plop them down and go okay and tell me about the day that all this happened which
is what the child has experienced already if it was reported to law enforcement and/or the child
welfare they’ve probably had somebody sit down and say get right to the nitty-gritty at least
once or twice and it’s completely dehumanizing so we want to reassure parents that we’re not
going to do that to the child again will help the caregiver understand their role in the child’s
treatment since this modified since this model emphasizes working together as a team so I’m not
just going to be educating you it’s not going to be a parallel thing where I go in and I work with
Johnny and then I tell you what I did and then I work with Johnny I’m going to work with Johnny
and then we’re going to discuss what Johnny and I did in session and I’m going to get input from
you and we’re going to talk about how you feel about it and then I’m going to provide you with tools
so you can help Johnny outside of the session because you’re going to be with them for six-and-a-half
other days that I’m not and this can’t work if it’s just one hour once a week and we want to
elicit parent input questions and suggestions as much as possible because they’ve been living with
their kid for you know however many years so they probably have an idea about what works and what
doesn’t so we’ll start with both parents and children in their respective sessions helping
them understand what control breathing is and how it helps slow the heart rate and trigger the
wrist and digest sort of reaction in your body when your breathing slows your heart naturally
slows because the stress reaction tells your brain you’ve got to breathe fast and the heart
rates got to go fast well when you override that then you’re kind of overriding the whole system
and we’ll also talk about thought stopping and this is especially helpful if the trauma is recent
or and/or ever-present in the mind of the youth so they can say I am NOT going to talk about that right
now I’m not going to think about that right talk about distraction techniques go back to
your DBT stuff talks about improving the moment and accepts to help the child develop skills to
handle and work through when those thoughts pop up replace unthawed unwanted thoughts with
a pleasant one so talk about it in session when thoughts like that come up what would you
prefer to think about and then really get into the Nitty Gritty the five senses what do you see
smell hear taste you know help me get into that situation or that thought this teaches that
thoughts even unexpected and intrusive ones can be controlled so that gives them hope and again we’re
not exacerbating the thoughts right now we’re not bringing up their particular trauma and
having them get into detail we are just helping them deal with what’s happening normally on a
day-to-day basis so they feel like they have more control for the older kids you can have them
people log about when this technique is used what they were thinking about and how effective the
thought stopping was and then review it and help them tune it up if it’s not really effective and
give them praise for when they use it effectively relaxation training persons of Asian or Hispanic
origin tend to express stress in more somatic or physical terms so just be aware of that but that
doesn’t mean that Caucasians don’t relaxation training is good for anyone and the medical
school of South Carolina training recommended that relaxation is stress-free and
workbook by Davis Schulman and McKay so and it is still in publication when deciding how to
present relaxation techniques are creative have the child help you to integrate the elements
into the technique that makes it more relevant to them so, what are you thinking about when you
relax you know I know I like to go to the woods but maybe this kid likes to think about a video
game or play with their dog whatever it is but helps them make it relevant to them and then have
they identify other things they do to relax like drawing listening to music walking and making a
list of those things so they can refer to it when you’re teaching relaxation training especially if
you’re doing something like progressive muscular relaxation be sensitive to the child’s wishes if
they don’t wish to close their eyes or lie down which could trigger memories of the trauma we’re
not going there yet so if they feel vulnerable lying down or taking orders like that because
you can imagine how being told to lie down and close their eyes might be a trigger for certain
abuse survivors you know be cognizant of that and say you know get into a comfortable position
or how where would you like to sit while we talk about this like I said parents can often
benefit from the relaxation training as well so because they’re dealing with their issues
about the trauma but they’re also dealing with trying to figure out how to help Johnny and any
of them deal with any of Johnny’s misbehaviors or problematic behaviors then they move on to
feelings identification so it helps the therapist judge the child’s ability to articulate feelings
if you can tell me what makes you happy that’s great but if you can’t then you know we need to
work on figuring out what makes you happy you also want to help the child rate the intensity
of the emotion don’t let them stick with happy mad sad glad and afraid you know let’s talk about
different emotions and use the emotion chart with little faces on it or you can use the emotion
thermometer so is it a hot emotion or is it a cool emotion and helps the child
learn how to express feelings appropriately in different situations I mean sometimes they’re
going to be angry but it might not be appropriate to you know get up and stomp out of the room or
whatever however they communicate it so help them figure out how to articulate that so they can be
heard and supported some children have difficulty discussing or identifying their feelings so
you might try stepping back and discussing the feelings of other children or characters from
books or stories so you know think about Puff the Magic Dragon if they’ve read that you know
that dates me a little bit there but you know how did the little boy feel and talking about things
different characters and different stories where there are elements of anger and shame and loss and
all of that stuff helps children identify how they experience emotions if they seem detached
from the experience because sometimes they just they’ve shut it off it was just too overwhelming
so we want to talk about you know when you’re happy what does that feel like or when you’re
angry what happens what does your body feel like when you’re angry and they might be able
to tell you they hear their heartbeat in their ears or everything gets all fuzzy or whatever
but help them start tuning in to how they react and connecting that with an emotional word and then
after all, that’s done they can identify feelings they can identify feeling intensity now we want to
differentiate between thoughts and feelings many children describe thoughts when they’ve been
asked about a feeling so if you ask them how they feel they may say I want to run away so
you want to say okay well I hear that you want to run away so I’m wondering if you are bored and you
you’re bored and want to get away from it or if you’re scared can you tell me a little bit more
about what it means to you to want to run away during feelings identification the parent
sessions normalize what is going on with their child and help the parent understand that some
children may be seemingly in constant distress or detached from the trauma and that’s okay
we all react differently to traumas so again we’re going to share with the parents what we’re
Do let them know any specific difficulties if any juniors have encouraged the parent to praise
the child for appropriate management of difficult motions and I put in parenthesis successive
approximations because they’re not going to get it a hundred percent right every time so if they
try to effectively manage their emotions even a little bit let’s give them praise for that and
then help them figure out how to do it a little bit better the next time so instead of having a
complete meltdown maybe they got up and stomped out of the room well that’s an improvement so
then we want to talk about how to shape that behavior so it’s a more appropriate communication
if parents have difficulty identifying their own emotions provide them with examples so
continually ask them questions about how you feel when it’s a rainy day outside and how to do you
feel when somebody’s supposed to call you and they don’t how do you feel when and have about 15 or 20
examples and you can have them on a piece of paper and even give it to the parent to take home for
their homework if parents are overcome with their own emotions about the trauma validate
their feelings and explain how children need to see that their parents can handle talking
about the trauma so there the children need to see the strength and the parents which is what you’re
going to work on in parent sessions to make sure that the parents have the resolve and the skills
handle talking about this topic with junior TFC BT can be an effective intervention
for children or adolescents whose primary presenting issue is trauma-related emotional or
behavioral dysregulation TF CBT is not appropriate for clients who are actively suicidal and severely
depressed or currently abusing substances we want to make sure they’re clean
and sober as much as possible TF CBT starts with psychoeducation and then teaches stress
management and coping skills to aid in the management of distressing feelings psycho IDI
helps to clarify the inappropriate information children may have and start getting them a little
a bit more comfortable talking about the topic in general before we start going deeper and
feelings identification helps participants start effectively labeling and communicating their
feelings so they can receive the support and nurturance they need from their caregivers
and their support system 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 to all CEUs comm slash 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 on your order this month.