lmft – Page 2 – Effects of Anxiety

Group Counseling Modules 1 & 2 Based on SAMHSA TIP 41

This episode was pre-recorded as part of a live continuing education webinar on demand. Ceus are still available for this presentation through all CEUs registered at all, CEUs comm slash counselor toolbox. I’d like to welcome everybody to group therapy, which is a product of treatment improvement. Protocol 41. Today we’re going to be going over chapters 1 and 2 tips 41. They did make it into an in-service, which is what I loosely based. The next set of presentations on and we’re, going to talk about some of the different ways you can use group and make it beneficial and hopefully easier than some other ways of approaching treatment. So, in the first part of today’s presentation, the goal is to provide an overview of group therapy which is used in substance, abuse, and mental health treatment, and, as I said, I’m, loosely basing it on it, but a lot of times the groups That we’re doing in substance abuse are the same ones. We’re doing in mental health. We’re going to discuss the uses of group therapy in treatment, define five therapy models, explain the advantages of group therapy and modify group therapy to treat and address substance abuse issues. So group therapy is awesome because it supports members in times of pain and trouble. It’s something that we can make available to the community mental health center that I worked at before and if you’ve worked in community mental health or even private mental health. Maybe a lot of times. There are waiting lists to get into IOP to get into PHP to get into residential to get into detox. So one of the things that we started instituting was an intervention-level psycho-educational group, so we were able to sort of keep a tab on people who are on our waiting list. They got on the waiting list and they started coming to these groups that provided them with tools provided them skills. We weren’t treating any particular issue. We were focusing more on life skills, distress, tolerance, emotion, regulation, and all that other DPP kind of stuff. Helping them get through, was also enabling us to provide them with some hope and keep their motivation going. Group therapy can enrich members with insight and guidance. I found, and one of the reasons I love doing group so much is because you can ask a question to a group of 10 people and get 8 or 10 different answers to it, and the cool thing about that is that each person has their blind spots, so what they might not have thought about before might still be germane to them, and somebody else puts it out there. So when you start putting asking questions and putting the answers on the board or using the flip chart papers and having stations around the room that people go and contribute to the group process, you start getting a lot more feedback from individuals and they’re going To come up with ideas and suggestions and thoughts that not only each other had never had so they’re going to enrich each other’s lives, but they teach me something every single time. So I loved doing and still do love doing group and it’s. A natural ally with addiction, treatment or treatment in general group therapy enables us to provide a basic framework of information to people in a cost, effective manner. You know there are a lot of things like emotion, regulation, distress, tolerance, self, esteem, skills, effective interpersonal communication relationship skills, and self-esteem. I may have already said that we give to all of our clients whether it’s substance, abuse or mental health, and everybody who’s coming through the program. Has this curriculum? If you will go through now, it’s going to apply a little bit differently to each one and they’re going to take the stuff they get from those groups and they’re going to be able to take it back to their Therapists and say this is what I learned in group. If it is just a group process, then they’re going to be able to talk among each other and come up with their ideas, but IOP, PHP, and residential all have individual accounts. One component, if you’re doing an intervention level group 0 05 on the ACM. If you will, you may not have that individual therapy component. So you want to make sure that when you provide members with information – and you help them start gaining insight you tie it up in a nice little bow at the end and help them apply it. So what did you get out of today?’s group that could have been helpful last week and how could you have used it then go back around the room and say from whatever you got from today:’s group or what’s a morsel you got from today,’s, group that You’re going to use next week, and how do you expect to do that? So I encourage them to take one or two morsels and figure out how they can use that in their particular life. A little bit of a slide track here. In support groups, if somebody is going to celebrate recovery or 12 step group, or even a depression or anxiety management group, I encourage them when they walk out of the group to be able to answer the question. What was in that group for me? What can I take away from that now? It may be, I know what I don’t want to do, or it may be. That was a great idea that so and so had, but I want them to answer that question every time, not just walk out of a group and go well. That was a good group. Why? Why was it a good group? What did you get out of it? Group therapy, as opposed to self-help groups and support groups, if you will have trained leaders, so you do have a lot more ability to facilitate what’s going on and kind of point people in directions that you want them to go. Where support groups may have facilitators, but they don’t have the training that clinicians do and group therapy produces healing and recovery from substance abuse and mental health issues. You see a lot of people gain. Hope you see a lot of people gain optimism. You see a lot of people learn tools from one another and nobody can comic con. If you will – and I had to figure out a way to say that a little bit nicer than the way I usually do. But when people are in recovery and you can even think about it with your teenagers, if you’ve been around known more if you have them, teenagers hear what their parents say and they’re like yeah, okay, whatever old, fuddy-duddy, but when their Parents or when their peers say it, it carries a lot more weight, so sometimes the hope and faith and tools and stuff that they hear from their cohort has more impact than what we say. If we’ve created a good supportive, healthy, nurturing environment, group therapy has a lot of power to it because it’s basically like having a bunch of code therapists and the ability to control it a little bit more than in group therapy. You can address factors associated with addiction or these factors by themselves, such as depression, anxiety, anger, shame, temporary cognitive impairment, character, pathology, ie, personality disorders, medication management, and pain management. So let’s go through these a little bit. Depression groups are wonderful. Now we’re going to talk about different types of groups and there’s everything from the traditional therapy group where people are sitting in a circle and or however, usually in a circle and sharing what’s going on in their particular situation. To psycho-educational and skills groups, where we’re, providing them the tools to understand what’s going on and the tools to deal with what they’re experiencing, and you know with depression. One of the groups I’m, going to do is depression. Well, any of these is to talk about what is it. What causes it? Where did it come from? How is it impacting you to have people start figuring out what that means to them, then we’re going to start talking, probably in the next group, about what are some ways we can start addressing this and what has worked for you. What what has worked in the past and what things might you want to do? Try? Temporary cognitive impairment can be addressed in the group in the sense that we can provide some life skills coaching. We can provide for early recovery and substance abuse. For example, a lot of people come to our groups, or at least where I used to work. They would get out of detox and they weren’t fully detoxed. Yet they had two days under them and the drug was out of their system. For the most part, you know, except for like marijuana or benzos, but they were still not on their game so getting them to just get there on time, be prepared, pay attention, and process what’s going on was huge. We didn’t expect to make huge therapeutic gains, but what I wanted was somebody to be able to dress up and show up. If you will character, pathology can be addressed in groups, one of the basic reasons that Marsha Linehan created dialectically. Behavior therapy was to address borderline personality disorder and DBT is very strong in skills groups. Now it has individual components and coaching components as well, but she uses the skills groups to help people with character, pathologies, and borderline personality disorder, among other things, start learning about what are these symptoms. What do they mean? What does it look like and how can I deal with them and then they personalize it in their sessions? Medication management is huge for me, whether it’s, somebody who’s on antidepressants or somebody who’s on methadone. I don’t care, but I think it’s really important for people when they start taking medication, especially psychotropic medication, whether it’s, addiction or mental depression, or anxiety to be able to go into a group and talk with others who’ve Been on similar medications understand the side effects understand that gets better understand what they’ve done, that helped them deal with the side effects. For example, a lot of my clients used to be on Seroquel and Seroquel is extremely sedating, so a lot of them found that they needed to take it at night. But I had a small group of people who, when they took it at night, you know they would go to sleep at like 11, 00 get up at 6 30 and they were still groggy. As I’ll get out from the Seroquel and among themselves, they started talking about okay, so I need to take it at 7, 00 every night for it to be out of my system. So I can function the next morning they worked it out by talking about how long before it starts sedating you and how long the sedating effects last, but it helped clients stay more compliant with their medication because a lot of times and not knock Psychiatrists or doctors, but the ones that I’ve had experience with. For the most part, I’ve had a couple of awesome: attendings they don’t have the patients they don’t have time in their schedule to hear all of the issues and help the client brainstorm, and a lot of times they don’t think to share with the patient. These are the most common side effects that people tell me they experience. Yes, they get the handout from the pharmacist. There are like six pages, long and in eight-point font of all the potential side effects. But what do people feel like when they start taking it? This Zoloft is another one. You know that’s, what one is commonly prescribed and a lot of patients feel kind of like they’ve got the flu. They feel dizzy for the first two-to-three days and then that wears off, if they understand that, if they have a place where they can go and talk about the side effects and talk about how to deal with some of the side effects, it helps. And this is also a place where they can talk about things like weight, gain and fatigue, and lethargy. And how do you deal with this when you’re on this Giller medication, it doesn’t have to be facilitated by a nurse or a doctor. That’s more helpful if it’s facilitated by a clinician. What we want to do is encourage patients to become aware of what their potential obstacles are to be maintained to remain med, compliant, and identify some ways to address them. Some intervention that might be effective and then go talk to their doctor, so they are armed with knowledge when they go see their psychiatrist and say I’m having these problems, it also gives them a chance to talk to other people and understand what it looks like if the medication is working for them and gives them hope if they have to change two three four times to find the right medication, so medication management obviously, is a group that I think is important. If you’ve got clients that are medicated on pain, management,’s, pain can cause depression and anxiety. Your body perceives pain as a stressor, so anybody who has pain may experience negative affect, especially if it goes on for a while, so helping them figure out ways to deal with the pain and ways to deal with breakthrough pain. If you’re dealing with somebody who’s in recovery, then you’re also dealing with the issue of pain management without narcotics, so pain management groups can help teach stress management skills, progressive muscular relaxation, and sharing nonpharmacological interventions that they can discuss with their doctor, such as massage physical therapy, acupuncture yay, it also is a place that people get hope again. This is going to keep coming up with group therapy hope because they hear other people’s stories and yeah. I hear that after John’s accident, he was in agony for six months and he was able to get through it, so they can share and support one another. Another group provides positive peer support for abstinence from substances or addictive behaviors. Remember we want to check our clients, and assess our clients to make sure they’re, not engaging in addictive behaviors like internet gaming, pornography, gambling, food-ish food, and eating addiction. Anything like that, but it also provides positive peer support for positive action in any direction. So if it’s growth goals, if it’s depression goals, the group is there to cheer you on. They’re also there to notice when you’re starting to lose your motivation and point it out and help you increase that motivation groups reduce isolation. So if you’re dealing with someone who’s got empty nest syndrome, someone who’s got depression, someone who’s got it up an addiction. It helps them understand that they’re, not the only one dealing with that and they can share and support, enabling the members to witness the recovery or transformation of their fellow group members and see how other people deal with similar problems, because we all I mean There’s what twelve people in class today. So if I throw out any problem, I’m probably going to get at least eight or nine different suggestions for how to deal with it and that’s cool, but that’s. The awesome part about group two because they can share. What do you do when you can’t get to sleep at night? What do you do when the anxiety is so oppressive that you feel like you can’t breathe, rich, and provide information to clients who are new to the recovery process? So they know what to expect they’re not going to be giddy as all get out. Twenty-four hours, seven days a week, 365 days a year, probably ever that’s not reality, but it helps them learn what the recovery trajectory looks like helps. They accept the fact that they’re going to be bad days and it helps them see how they can be empowered in the process. It provides feedback on group members, values, and abilities. They’re going to hone in on their values, and you know I encourage them in my groups and obviously from a multicultural perspective. I think it’s vital that we encourage members to explore their values and accept or reject them as they are and do not meet them. For me to say whether your values are right or wrong, I want you to know what your values are and make sure that they’re. Yours, not something that came from the media or something that just kind of popped into your head. You don’t know where it came from that you, don’t agree with, and sometimes that will come up, especially as it pertains to medication, use or controlled drinking, or anything like that. But it also provides feedback on their abilities, and this is where I focus more than values. What is it that you have done already? What are your strengths if you went three hours yesterday without being depressed and crying that is awesome? What did you do? How did you do it? How are you able to do that, I want to highlight that ability, so we can build on it. We want to highlight the exceptions to the problems and offer the sort of family-like experience where people get a sense of belonging and support when groups are run well, even if their skills are psycho-educational groups when a group member leaves drops out relapses, whatever happens, They just if they suddenly leave. It affects the entire group. When you’ve got a well-run group and a group member graduates or completes treatment, there’s still a whole process and sort of a grieving process, as that person leaves the family and launches out of the nest. Whatever you want to say, we the way I’ve always run groups and what the way I was taught was. We always celebrate that at the end of somebody,’s treatment, or experience after the last group that that person attends we have a little bit of a little pizza party or something to celebrate. Let people say their goodbyes and have a good sense of closure. A lot of our clients did not have good family experiences, so we want them to have the experience of being supported, being able to have different opinions and disagree with others, but being respected and being able to care about groups encouraged coach support and reinforce What they’re doing? Well, we don’t have to focus on what they’re doing wrong. You know, we can talk about that. An individual – or you know it may become germane to the group, but what we want to do is reinforce what they’re doing. Right from a management perspective groups allows a single treatment professional to help several clients. At the same time, as I said, there are a core set of groups – educational modules, if you will that, I think all clients need to be exposed to so group is a great way to do it instead of saying the same thing six times a day to Each one of your clients having a group available with the advent of media and Internet, just like we’re doing right now. Web chat web groups. You can do some skills-based groups, you know if they’re, not treatment. You don’t have as many issues with confidentiality, but you can also have videos online that you have them watch, learn from complete a worksheet and then come and participate in a one-hour group, instead of maybe having to sit through the whole lesson, which is An hour or so and then participate in the group, so there are a lot of different things that you can do using group techniques to reach a bunch of people in with one treatment provider. In the same hour. Groups add needed structure and discipline because, generally the group leader has a certain goal for the group or has a certain style of managing the group, so it can help sort of add a rhythm. If you will to the group process. Now we’re talking about traditional therapy groups. You’re going to be sort of like the parent that controls the rhythm of the family. If you’re talking skills or psycho, read groups, you’re going to be setting more of a tone like a teacher and creating a learning experience, but it adds structure, so people feel safe. They know what they can share, what they’re. What’s too much sharing or what’s inappropriate sharing and it helps people also learn to bite their tongue, wait their turn all those other things that can be helpful in life. They instill hope in a sense that, if that person can make it so can I so they see people doing a little bit better yeah. They also see some people doing a little bit worse, sometimes, but that’s an opportunity for them to be able to reach out and provide support, and that helps the person providing support as much as it helps the person receiving it. I truly believe that most people get a sense of contentment if you will, by being able and being able to reach out and help someone that they are concerned about, it provides support and encouragement to one another outside the group setting now this gets a little dicey Depending on your groups and your agency philosophy in reality, in substance abuse groups, the people that are in your group are probably going to be going to the same support group meetings so telling them not to ever contact each other outside of the group is unrealistic. They’re going to see each other in the community, so it’s important to help them understand how to set boundaries and what’s? Okay, behavior, and what’s? Not okay, behavior between group members, other groups, other facilities are less stringent on that and encourage the clients to reach out to one another outside of the group setting. So, depending on the group, the issue, your agency, all that kind of stuff there’s going to be more or less sharing. What I want to see, especially, is, if you have, for example, in IOPS three hours here and have three groups with breaks. I want to see people talking outside a group. I want to see people sharing, not just all sitting in there going when do we get out of here? I want them to develop relationships and learn how to effectively communicate so group therapy is not individual therapy done with an audience. It is not a mutual support group. It’s designed to help people develop and practice knowledge and skills in a microcosm. You’re, creating a mini family or a mini-community. It aids patients in learning how to develop healthy, supportive relationships and also how to terminate relationships, because sometimes when people graduate they move on it, which doesn’t necessarily mean that they’re going to continue to interact with the clients in the group. Alright. So the second half of this class, we’re, going to look at the group therapy models used in treatment, explain the stages of change, and discuss three specialized group therapy modules that may be used for the stages of change. I’ve gone over this before for new people. I’ll go over it again, real quick think about getting into a pool in the summer. It’s hot it’s like 90 degrees. You are sweating bullets, pre-contemplation, and you’re still laying on the lawn chair going. I ain’t hot. Yet no, I’m not anywhere near hot enough to go near that pool contemplation you’re starting to get hot and sweaty, and you’re looking at the pool going. You know that might be a nice change in preparation. You move to the side of the pool and you’re dangling your feet in the water trying to figure out. If you’re ready to take the plunge because it’s cold, I mean compared to the 90 92 5 degrees C is outside and you know your 98 6 body temperature water is cold, so you’re preparing action is when you jump in you. ‘re, like I, can’t take it anymore. I’m too hot to jump in the pool. Now, if that pool is too cold, if it’s too painful to stay in there because you’re just like a ho ho, you may jump back out again and back into preparation or further back. If you get in there and get moving – and you know, get your body temperature back up that’s – sort of basically like treatment – and you’re getting the swing of things, then you just want to maintain. So you don’t get cold again and recurrence is when you get out you get hot again and go through this process again so pre-contemplation, I ain’t got a problem. Contemplation yeah, I’m a little uncomfortable, but I’m not ready to do anything yet preparation. I’m starting to get ready to make a change because this is uncomfortable, but I’m not very it action I’m on it, and maintenance is keeping your gains and maintaining a steady state, so variable factors for groups, the group leader group or Leader of focus, so if you’re focusing on a part of it, is your training. You know if you are more Rogerian client-centered in your training versus cognitive, behavioral versus DBT versus AC T, whatever your theoretical underpinnings are and what you choose to focus on. In that particular group, there’s a lot of stuff. We can focus on whether it’s cognitive, physical, or emotional. We want to another thing that affects it is the specificity of the group agenda. If you’re going to have a group and it’s on self-esteem, well that’s not specific, so we could go sixteen different ways till Sunday if you’re looking at self-esteem and disarming the internal critic. Now that’s much more specific for that group, so that’s going to affect what that group looks like for that session or that says sessions how similar or different your group members are. If they have a lot of different experiences, you’re going to have a different experience as a group leader. Then, if you have a lot of people who have the same experiences, open, ended or determinant duration of treatment, if you’ve got a group that somebody can join and if they want to stay for 104 weeks, they can stay for 104 weeks. That’s up to them versus a group that is 16 weeks long that’s also going to affect how your group goes. What do you cover, how connected do group members become? I use 104 weeks just to sort of overemphasize. I hope nobody stays in the group for 104 weeks, but the level of leader activity is. I have seen groups where its leaders will throw out a discussion and are like okay topic for today is what do you think about it, and let the group facilitator with a little bit of nudging here and there versus other groups where the leader is very involved In goes around goes okay, Sam.

What do you think about this sally? What do you think about it and that affect how people react and what they expect it? Doesn’t necessarily affect what they get out of it, but these are variables that could affect how someone meshes with the group. Not everybody is going to like a real open, ended, a loosey-goosey group I don’t. You know I’m structured. So I prefer to be in groups where I know what the agenda is, and what we’re going to do. In my groups, start with a review from the last group that’s the first five minutes, and check in with everybody. Next, in five minutes we do a 15 to 20-minute psycho, ed piece, and then the last. You know 30 minutes of group. I spend going around the room and having people tell me, what is it that you got out of this? What do you think you could use this next week etc and apply it to what they know that’s how my groups go, so they’re, really very structured. You’ve got to be able to drop back and punt. If a client is in crisis or something strikes a nerve with them, you know you might have to change up a little bit. But overall you’re sort of setting the tone for what’s going to happen in the group, the duration of treatment, and the length of each session. You’re going to cover a lot more in a 3 hour of IOP session. That and treatment is five days. A week for 12 weeks, then you’re going to cover in a treatment program that’s one hour a week for eight weeks, just knowing what you’re going to try to cover will affect the depth or the breadth of what you go through. The arrangement of the room also affects how the people interact. If you have them set up in theatre, style, or classroom style. People interact differently than if they’re all sitting around in a circle, and if you ever want to experiment with that, it is interesting to notice how much differently people interact and how much more they seem to participate when they’re sitting sort of in A circle versus when they’re in theater style and I feel like they can hide and the characteristics of the individuals. Sometimes you’re, going to have people who are enthusiastic and chatting. Sometimes you’re going to have people who are not, and it could be for a whole host of reasons. It could be a bad fit, it could be their involuntary, or it could be they just got out of detox. It could be that they’re. All are just at that level of clinical depression that they’re having a hard time staying with the group and it’s up to us to adjust to try to meet the needs of as many people in a group as possible. Now, while I’m saying this, they didn’t say to size of the group. Here, the recommended size of the group is 8 to 12 people. If you’re dealing with adolescents or people with severe and assistant Mental Illness, it’s more along the lines of 812. For your average group 15 for psycho-educational and skills groups any more than 15. You’re doing a class and not a group. Psycho-egg groups assist individuals in every stage of change, pre-contemplation contemplation, yay. It helps clients, learn about their disorders, their treatment or intervention options, and other resources that might be available to them, such as assistance with prescriptions or physical therapy, or whatever other wraparound services. We often call it might be available. They can also be used to provide family members with an understanding of the person in recovery, so family egg groups can be awesome because then you get to understand and hear what the family thinks is going on and expects is going to happen in treatment and What they’re seeing and hearing, and you can normalize for them what’s going on with the client, so somebody recovering from clinical depression or somebody with bipolar disorder. You know this is what recovery looks like this is what living with the disorder looks like. This is what being on this medication looks like, I, ‘ve had a lot of patients because I deal with mainly co-occurring. I’ve had a lot of patients who have bipolar disorder, and you know some sort of substance abuse issue. They start taking. Seroquel, because that seemed to be the drug of choice for our prescribing at that particular time and they would start acting all groggy and family would freak out going you’re using again, and so Family Education groups were a great time for us to educate. Not only about the disorder but also about treatment, medication, side effects, and how to interact with the loved one to be as most supportive as possible. So ad groups educate about a disorder or teach a skill or tool and work to engage the clients in the discussion. I don’t want to stand up there in the lecture. I want them to be able to throw out ideas. So if I say you know what is it that you do when you’re struggling with somebody, because they just great on your every last nerve, what are some things you do to solve that problem or to deal with it? I don’t want to just tell them everything I want to do something more Socratic and encourage them to tell me how they work with it, and if they come up with something that’s, not quite on point. As far as being the most effective or healthiest approach, then we’ll talk about it and we’ll say well. I’m sure that’s worked for you. I’m wondering you know if there’s a kinder gentler way to do it, or you know you kind of massage it a little bit to morph it into something useful. We want to prompt clients to relate what they learn to their issues, including their disorders. You know how you, how this relates to your depression, but also your goals, your challenges, and your successes? Psycho-ed groups are highly structured and follow a manual or curriculum, and it doesn’t have to be a manualized curriculum that you buy from somewhere. You can create your curriculum, but you teach the same thing and it’s sequential and it follows a teach, apply practice method. So you teach a skill, you have them talk about how they would apply it, how that might apply to them, and then you have them practice it in role plays or imagine how they might use it. Next week, basic teaching skills are required for psycho-ed groups, though, which requires that you understand the basic components of learning, and I call these the three C’s capture, which is how you get the knowledge I mean you got to get it into your brain. Somehow I am a visual kinesthetic learner. I learned virtually nothing from sitting in lecture classes. I’m off in la la land in about 30 seconds. I know this about myself, so I need to have material that I and see, which is why I do powerpoints here some of y’all may not might not even be looking at the screen. You may be often doing something else and listening to me more power to you. However, you get the information in your brain is great. Global and sequential. Some people are global. They need the big picture when they’re doing a puzzle. They want to see the box first to do the frame and then fit all the pieces in sequential people. Don’t want the box that’s cheating they look for pieces and put them together and then try to figure out how all the pieces go together to make a hole and then their wall out as a whole. To appeal to both of those at the beginning of the group give an overview of what you’re going to cover in the group, and if you can sort of a written agenda it’s, not always practical. I always tried to put it up on the whiteboard. We always had issues with how many copies we were allowed to make and stuff. So in the interest of saving trees, try to give them some sort of an agenda, so they know what the progress is or what they can expect from group talk about it, so people can hear it and apply it through role plays having them apply it to themselves. Make them manipulate that information in their mind and provide visual representations like bullet points of what you’re going over. If you can’t, if copies again are an issue, have them bring a notebook and write on a whiteboard, so they can see it. So you’re presenting information in as many ways as possible. Conceptualization is relating the information to building blocks. So if you’re teaching a unit on cognitive distortions, then you’re going to talk about maybe using extreme words or nothing talk. So I might say tell me about a time that you’ve said something like you always do this and then what we’re going to talk about, how to change that and how you know. Thinking about things that way might be contributing to some of their distress and then caring. This is the biggest one which is again why I have clients when they leave a group, ask themselves: what could I get out of that? Why was that important to me if they’re not motivated to remember it, they’re not going to think back to high school biology or college humanities archaeology? 101. For me, I learned what I needed to learn for as long as I need to learn. It’s to pass the test, and then I forgot it all because I didn’t care about it, so we want them to care or they’re not going to remember so get it in their heads and help them relate it to something they know and make Them care about it, make them figure out why it’s important to them, foster an environment, to support participation, encourage participants to take responsibility for their learning, use a variety of learning methods that require sensory experiences, which means talking about it. You know talking about it listening to it and maybe drawing art therapy try to incorporate as many senses as possible. I always find that role plays are a big hit. You can also break up concepts and have to break up your group into smaller groups and have each of the smaller groups reteach a concept to make sure that they understand it and be mindful of cognitive impairments. So if you’ve got someone who is impaired in some way, make sure that you have some sort of method to ensure that that person is keeping up with the rest of the group. If it’s a diverse group skills development cultivates the necessary skills to prevent a relapse, depression, anxiety, and addiction and achieve an acceptable quality of life. Part of the skills groups assumes that the clients lack needed skills such as coping skills, interpersonal skills, and communication skills, hence the term skills group. So we want to allow clients to practice skills in groups. Psycho-ed groups provide the knowledge and, if you remember basic treatment, planning, and knowledge skills and abilities, so you know it, you learn how to use the skill and then the ability is a put those skills into practice. So we want them to be able to practice. These skills in a safe microcosm, you want to focus on skills, directly related to recovery and those to thrive in general. Think about Maslow’s hierarchy. They need to get those biological needs met, they need food, shelter, medication, pain management, health, safety and safety from themselves and love and belonging. So we want to help them make sure they’re getting those not just focusing specifically on depression or anxiety skills development groups have a limited number of sessions and a limited number of participants. So everybody can practice. We don’t want a big auditorium. We want that 8 to 15 number ideally, and there used to strengthen behavioral and cognitive resources. Skills groups focus on developing an information base on which decisions can be made and actions can be taken. So when they’re thinking when they practice the pause and they’re trying to decide okay, what is the best reaction to this current situation that’s when skills kick in and they’ve got a menu of skills to choose from cognitive, behavioral Groups, conceptualize dependence on substances as a learned, behavior that subjects to modifications through various interventions, which is a bunch of garbage garbled a for CBT groups, really look at using as a triggered behavior in response to pain. You want the pain to go away and your drug of choice does that. The same is true for self-injury or a variety of other symptoms that we see in our patients. So we want to look at what’s triggering those and how can we. What are they trying to meet? What need are they trying to meet with that behavior and how can we help them meet that? Otherwise, sorry, my nose is itchy today, work to change, my learned, behavior by changing my thinking, patterns, beliefs, and perceptions and include psychological elements like thoughts, beliefs, decisions, opinions, and assumptions. Cbt groups develop social networks that support abstinence, so the person with dependence becomes aware of behaviors that may lead to relapse and develop strategies to continue in recovery. Now that’s for addictions, groups for anxiety and depression, the same is true. We want them to have social networks with other people who experience the same diagnosis. If you will so, they can become aware of relapse. Warning signs when are starting to become impatient. They’re not sleeping as much, whatever their relapse warning signs are for their condition, disorder, whatever you want to call it, so they can develop. Strategies to stay, happy and healthy educational devices are used in CBT groups including worksheets role plays, and videos that encompass a variety of proof, and approaches that focus on changing the way we think and the behavior that flows from it. I cannot stand feeling this way can be changed too. I don’t like feeling this way, but I know it will change. In the next moment. Cbt techniques teach group members about self-destructive, behavior and thinking that lead to maladaptive behavior. We look at those unhelpful, cognitions and their effects of them. How does that impact you in your relationships? The way you perceive the world and your general sense of empowerment and happiness? They focus on problem-solving and short and long-term goal-setting which a lot of people don’t know how to do. Imagine how much better people and more empowered people feel when they figure out hey. I know how to do that. I know how to see a problem, develop a plan and solve the problem and they help clients, monitor feelings and behavior, particularly those associated with their diagnosis. Support groups are useful for apprehensive clients who are looking for a safe environment and they boast remembers efforts to develop and strengthen their ability to manage thinking and emotions and interpersonal skills support groups. Don’t have a trained facilitator necessarily, so they’re. Not necessarily. How do I want to say this? They’re only as effective as the effectiveness of the group leader and the health of the group leader, support groups, address pragmatic concerns, and generally improve members, self-esteem and self-confidence they’re. Often open-ended with changing members, encourage discussion about members, current situations, and recent problems. So we’re less focused on education and skill building and more focused on what’s going on with you today, and they provide peer feedback and require members are accountable to one. Other support groups vary with group goals and member needs and include facilitating desilting discussion among members while maintaining appropriate group boundaries, which can be a little difficult, especially with untrained if there are no trained facilitators there. These groups can help the group the whole group work through obstacles and conflicts. So if you’ve got people that are arguing within the group remember, this is a microcosm. This is a little family, whether it’s a support group or any other kind of group. These people meet every week and there are going to be conflicts, so we want to help people work through these and develop acceptance and regard for one another support groups ensure that interpersonal struggles among group members do not hinder group development. So if you’ve got a relationship budding between two people, not unheard of, or if you’ve, got a huge conflict, getting ready to happen between two people. You want to make sure that doesn’t interfere with the group process, so you may need to handle that outside of the group, or you know, figure out how to address it. Interpersonal process groups recognized conflicting forces in the mind, some of which may be outside of one’s. Awareness determines a person’s behavior, whether it’s helpful or unhelpful. So interpersonal process groups help people identify the developmental influences and other things that have gotten them to where they are, that influence, how they act and react the way they do currently, and bring a lot of stuff into awareness. Oh, that makes sense that I react that way because that’s how my mom used to react or when I did that when I was a kid I got in trouble for it whatever the case may be interpersonal process groups delve into major developmental issues. Searching for patterns that contribute to the problem or interfere with recovery abandonment issues is one that comes up a lot looking at the family of origin and their coping skills. We want to learn. What did you learn when you were growing up that is? You are using now and how effective is that for you, these groups use psycho dynamics or the way people function psychologically to promote change and healing and rely on the here-and-now interactions of members. So we’re focusing on all this stuff. That made you who you are and gave you the tools that you have right now, how’s that working for you? So there are multiple types of groups that are available to assist clients in achieving their goals. We view current coping skills as creative adaptations to what they’ve learned and ways to get their needs met. They may not be the healthiest coping skills, but they are serving a purpose. So we want to look at the way. Clients are coping acting interacting. Just look at their behaviors and ask ourselves what’s the benefit to that? What’s motivating is that, because we always choose the behavior. That seems – and I emphasize the word seems to have the most reward to it, based on reward and effort groups, help strengthen the healthy skills, but they also help point out some of the unhealthy ones, and again a lot of times it has more to it. If it comes from a peer, as opposed to, if it comes from a therapist skills required to facilitate groups, overlap significantly a lot of my psycho, groups are also kind of skills groups. I kind of do a psycho, ed skills blend when I do groups that are, my style though, and the group facilitator needs to figure out his or her style because you’re going to set the tone for your group. Not everybody is going to thrive in your group. Just like not everybody is going to mesh with you as an individual therapist, knowing your style and being confident is one of the first steps to having a really strong group experience. Types of groups include psychoeducational, which provides your knowledge, and classroom-type format. Skills development provides takes the information that knowledge and helps people translate it into skills. Okay. Now I know what an unhelpful thought or a cognitive distortion is. What do I do about it? Skills group is the: what do I do about it and let’s practice it. So when I have this thought, what can I do? Cognitive behavioral groups kind of integrate those but focus strongly on what’s going on with the individual and the thoughts if you think, of the ABCs, the automatic beliefs that may be perpetuating or maintaining the unpleasant consequences and support groups are those groups that Are not facilitated by a trained facilitator or by a clinical facilitator. In some groups like smart recovery, the facilitators are trained, but they’re, not necessarily clinicians and group members are accountable to one another more so than accountable to a group leader who starts the group by telling people what they’re going to learn and do and why it’s useful to them make them care, give them that global perspective of what’s going to happen and then go through the information step by step or sequentially. So all of your learners are getting as much as possible provide an overview of what you’re talking about have written material like I said, if copies are a big issue where you come from it’s, not unheard of, or if you just don’t like making lots of Xerox copies, write it on a whiteboard and encourage clients to bring a notebook and write it down. Clients will remember things better if they have to write them down because they’re going. To paraphrase it, which is a form of kinesthetic learning before they write it down most likely because they want to write down as little as possible, discuss the material and apply it ask for their input. How do you deal with this? What do you think about this option? How could you use this? How could you have used this last week and what do you think you might? How do you think you might use it next week and give me an example of what that would look like for you? Can also have them roleplay, maybe they’re having somebody in the group having a particular issue with a supervisor or roommate. You may choose to roleplay that in a group and have them apply a skill that you’re talking about. Have each group member close by identifying one thing they got at a group and how they are going to use it in their recovery plan. Again, it brings it back to caring, has the kind of tie it up into a neat bow, and is able to walk out with one tool. Yep give them two too many tools in one group and they’re going to walk out, and none of them are going to get used. You give them one tool and they walk out. They may try to use it throughout the week and then next week in the group, you can ask them how’d it go. If you enjoy this podcast, please like and subscribe either in your podcast player or on YouTube, you can attend and participate in our life. Webinars with doctor Snipes by subscribing at all CEUs comm, slash counselor toolbox. This episode has been brought to you in part by all CEUs com providing 24 7 multimedia, continuing education, and pre-certification; training to counselors therapists, and nurses, since 2006 use the coupon code consular toolbox to get a 20 discount off your order. This month,As found on YouTube Hi, My name is James Gordon 👻🗯 I’m going to share with you the system I used to permanently cure the depression that I struggled with for over 20 years. My approach is going to teach you how to get to the root of your struggle with depression, with NO drugs and NO expensive and endless therapy sessions. If you’re ready to get on the path to finally overcome your depression, I invite you to keep reading…

10 Ways to Deal with Social Anxiety

Welcome to happiness isn’t brain surgery with Dr. Snipes. This podcast was created to provide you the information and tools Doc Snipes gives her clients so that you too can start living happier. Our website DocSnipes.com has even more resources videos and handouts and even interactive sessions with Doc Snipes to help you apply what you learn. Go to DocSnipes.com to learn more. Hey everybody and Welcome to happiness isn’t brain surgery with Doc Snipes: Practical tools to improve your mood and quality of life. Tonight we’re talking about 10 ways to deal with social anxiety a lot of people have social anxiety and that’s basically having unreasonable fears that you know are kind of excessive when it comes to being in any kind of social situation some people have only social anxiety when they’ve got to do things like perform or public speaking or something like that other people have social anxiety when they have to go to work when they have to be in crowds they don’t like going to the shopping center or the mall where there are a lot of people around so depending on your level of social anxiety, some of these things may be helpful to help you work through and deal with your social anxiety the first is to minimize stimulants stimulants Reb you up anxiety Rebs you up when you take stimulants if you drink too much coffee you may feel anxious so if you’re drinking stimulants before you go into an anxiety-provoking situation you may miss attributing your anxiety about the social situation when in actuality it was the caffeine or the nicotine the other thing that you want to do is pay attention when you’re at some of these events that you’re minimizing your stimulants the other thing and I’ll you know this is not stimulant alcohol is technically a depressant but when alcohol starts to wear off about it 30 minutes after you drink your drink it starts to wear off and there’s an anxiety rebound with alcohol so if you have high anxiety if you have social anxiety drinking to quell that anxiety is probably not your best bet because in the end it’s gonna kind of backfire and bite you in the ass know your temperament not everybody likes being around big groups of people I draw energy from being around people so I love being around groups but my daughter on the other hand is much more of an introvert and she would prefer to be around you know two or three people at a time she gets exhausted when she has to be in big groups of people it doesn’t mean she’s got social anxiety so know what your preference is for being around people so when you’re developing your self-confidence when you’re developing your skills when you’re working through social anxiety you’re not putting yourself in situations that would stress you out anyway so know your temperament if you’re an introvert when you’re making your exposure hierarchy which we’re going to talk about it in a minute you’re gonna start with something like going out for coffee with a friend to Starbucks or maybe even having a friend over for coffee in your house depending on how bad your social anxiety is and then you’re gonna work up from there but if you are an introvert you’re never gonna be relaxed in a group of a large group of people so I just understanding the difference between being anxious and feeling like you’re gonna crawl out of your skin and be uncomfortable or have it be very draining to be in a large group of people who understand your temperament that’s part of it so you can say you know this is normal I am not the type of a person who likes to be in a large group of people so it’s going to take some preparation and it’s going to take a lot of energy but I can do it knowing your triggers different things trigger anxiety for different people some people have anxiety when they feel like they’re going to be evaluated so if they’re doing a presentation for their colleagues or their peers they’re more likely to be more anxious than if they’re say hanging out with five other parents at a kid’s play date or something some people have one of their triggers is authority figures I know whenever I had to present in front of the CEO or in front of my department chair or whoever gave me more anxiety than presenting even in front of a class of a hundred and fifty students so it’s kind of all about what your particular triggers are if the other trigger you might want to consider the situation you know if you feel like you are on stage if you feel like you are the center and everybody’s looking at you that’s probably going to be a lot more anxiety-provoking than if you are mixing and mingling with other people at a party so know what triggers your anxiety so thinking about how your social anxiety impacts your life what kinds of things can you not do or what kinds of things do you find are just terrifying to keep a list of all of those things starting with the things that only make you a little bit nervous about things that you would rather you know pull your eyebrows out then do and start at the beginning start with the things that only cause you a little bit of anxiety imagine them rehearsing and doing them in your mind see yourself going through them successfully for example a job interview or a first date imagine what it’s going to be like what the other a person is going to say how you’re going to respond and how it’s all going to go well just keep imagining that until you can imagine it or think about it and you don’t feel stressed than when you go in to do it it’s going to be a lot easier once you get past that first thing move on to the next thing that causes a little bit more anxiety all right start at the beginning again imagine doing it see yourself going all the way through maybe it’s doing a public speech see yourself getting dressed for it getting ready for walking out on stage and delivering the speech and seeing it go well you’re not going to see yourself tripping and falling you’re not going to see yourself stuttering and stammering or dropping all your note cards or anything those are the things the cat strophic thoughts that you have that are likely not going to happen I want you to imagine it going perfectly rehearse it in your mind until you can do it literally with your eyes closed then when you go out to do it, it’s going to be that much easier because you’ve already done it 20 times in your own head and been successful at it so just do it like you practiced keep a rational outlook a lot of times social anxiety is caused by catastrophic self-statements things that you tell yourself people are judging me they’re laughing at me people are gonna think I’m an idiot um whatever your thoughts are so keep a list what those thoughts are and write counter thoughts to the people are judging me well they may be but do you care so if people are judging me that’s on them if people are laughing at me well at least they’re laughing but in reality what other reasons could the people have had to be laughing what are three other explanations for why they might be laughing besides laughing at you so look at your catastrophic self statements like I told you before imagining that you’re going to go out on stage and you’re gonna walk out there you’re gonna trip over your own two feet and you’re gonna wipe out on the way to do this presentation and humiliate yourself well that’s pretty darn catastrophic so think about exactly what is going to happen what are you going to do and how rational how realistic how likely is it that all these things are gonna happen and you know if that is one of your fears watch the movie Miss Congeniality because she is going at as Miss America I think is who she’s trying to portray and she falls flat on her face and she just picks herself right back up and walks on and nobody thinks anything of it after that it’s not like a week later or 20 minutes later in the movie, people are still talking about her falling she did she over it and you know move past it when you make a big deal out of it when people start to think about it a little bit more practice breathing when we get stressed we tend to breathe more shallowly and more rapidly when you breathe slowly and deeply you’re triggering the relaxation response in your body it doesn’t mean you have to take those big giant deep breaths as you do at the doctor’s office or anything that’s overly dramas is it but focus on your breathing if you start feeling yourself getting an anxious breath in for a count of three hold for a count of three and breathe out for a count of three and you know again it doesn’t have to be noticeable that you’re doing it you can do it in a meeting and nobody will even know but if you can slow your breathing you’ll slow your heart rate and you’ll trigger the relaxation response to help you deal with your anxiety sometimes we’ve just got to suck it up and go through things that create a lot of anxiety for us I remember one place I worked once a month we would have to get up in front of all of our colleagues and all of the executives and give a report on how our department was doing I hated doing that I hated being up there giving this report not because of the content of the report I just hated being up there in front of everybody and it was no big deal but it would cause me a little bit of anxiety if I had to do it so distress tolerance techniques were always useful because it was an eight-hour meeting so it might be four hours of me sitting there anticipating going up and having to give my speech so what would I do during the four hours while I was waiting I would do activities I would listen to what other people were saying I would make notes I would sometimes go through clinical charts and sign off on documentation and not pay attention but you know I digress contributing so if you’re at a party you can’t do it in a meeting but if you’re at a party for example and used feeling anxious get up maybe help the hostess out or the host out in the kitchen go around pick up glasses pick up trash throw things away do something to be helpful to contribute so you’re not feeling like you’re having to sit there and be on the spot comparisons can help too you can just kind of blend back into the wall a little bit and compare how you’re doing to how other people are doing or how you’re doing to how you’ve done in the past because you’re probably doing better now than you did then trigger opposite emotions is another way of dealing with distress if you’re feeling anxious you know bring out the opposite tell a joke find something funny find a video or something that makes you laugh and share it with other people because that’ll make you start laughing and feel more relaxed and release endorphins you can also just push away some of those thoughts that keep coming into your head I’m gonna make a mistake I’m gonna say something stupid they’re judging me it’s gonna be awful just push those thoughts away and Do you know what no I can do this and I’m going to push through the final the thing you can do in this particular set of distress tolerance techniques is sensations focus on sensations some people have a rubber band that they snap on their wrists to kind of help them focus on something else some people wring their hands I don’t recommend that because you know that just kind of shows you’re anxious and keeps your anxiety going listening to loud music you can go into the bathroom and splash cold water on your face unless it’ll make your mascara run there are a variety of things you can do that you can also find go and find some coffee because coffee is hot and that focus on how the coffee feels in your hands when you’re holding the cup focus on the taste of the coffee that hot sensation will kind of distract you from other things that are going on so focus and we’re going to talk about one thing at a time in a minute another set of distress tolerance techniques that can help our imagery and we’ve talked about rehearsing it before you go to the party imagine what you’re going to do before you go to the mixer or your in-laws or wherever it is you’re going that’s potentially going to cause you anxiety imagine going through it and doing it successfully to find meaning in what you’re doing so sometimes you know maybe you’re going to your spouse’s holiday Christmas party and it’s like the last thing you want to do because you don’t like big crowds like that you don’t know anybody but find meaning in it why are you doing this is because it’s helpful to your spouse you’re providing support and you know maybe you can find somebody that has similar hobbies or something before you go if you’re going to your spouse’s Christmas party for example try to find out who might be at the party that shares similar hobbies and stuff I know my husband works with people who do organic gardening and who are kind of health-conscious I won’t say fanatical but health-conscious like I am and we like to use a lot of lentils and beans and cook in health healthy ways so identifying those people I can’t talk about what they do at work because that’s just way out of my wheelhouse and over my head but I can talk with them about these other things so I’m not just standing there looking around and feeling like I’m out of place so find meaning in what you’re doing and try to find connections and commonalities with other people before you go and then you know I can have I would have my spouse introduce me to one of the people that does organic gardening for example and then we could start talking once you get more comfortable then you’re going to feel more at ease walking up to people and going hey you know and striking up a conversation and finding out commonalities if you’ve got children a lot of other people have children so you can talk about your kids or if you’ve got pets you can talk about your pets your dog’s people love their dog’s prayer can help sometimes you just got to take a breath and say a prayer before you walk into that situation to kind of get you through and get you going practice relaxation if you’re feeling stressed just again don’t have to get out of your chair you don’t have to go anywhere but practice tensing and releasing your muscles clenching your fists and releasing your hands and feel the difference between tense and released and then tense kind of your whole upper body and you don’t have to do it like this because that’s obvious but you can kind of tense up a little bit and relax and feel the difference between stressed and relaxed and then when you do it one more time you tense and when you relaxed you feel all the stress just draining out of your body out of your fingertips so that’s a kind of guided relaxation to help you when you’re kind of on the spot one thing at a time when you’re in a the social situation there is a lot of input there is a lot of stimulus going around a lot of people focus on one thing at a time if you start getting overwhelmed if you’re at a party maybe you can go over and get something to eat and focus on talking to one person at a time or focusing on what you’re eating or you know find something that you can focus on so you’re not trying to keep up with everything that’s going on takes a mental vacation or a physical vacation sometimes you just got to excuse yourself and go to the bathroom and hide out for five minutes and that’s okay you know sometimes you need to go somewhere where you know nobody’s watching and you can take those good deep breaths and go you know I got this it’s gonna be okay I’m doing fine give yourself a pep talk look realistically over how the night’s gone and the majority of it has gone okay yeah they’re probably going to be some hiccups and Pho paws here and there and if there are that’s okay it happens to everybody nobody is perfect at their social interactions all the time and that’s okay but look over it realistically to realize that tonight is going okay it may not be going the way you had hoped it would but it’s going okay there’s nothing catastrophic ly wrong and remember that we are a lot more important in our minds than we are in anybody else’s mind so when we make a the mistake we will remember it for six months but other people probably forget it’s about sixty minutes later it’s just you know even if it’s something like you walked out of the bathroom and you had your dress tucked in the back your panties did that before trusting me not something I want to repeat but I would bet if I asked any of my staff now yes I did it at work about that incident they’d look at me and go no I don’t remember that I remember it because it was mortifying but nobody else cared they were passed it by the next day nobody thought anything about it so remember that a lot of stuff that seems huge and glaring to you is only because it happened to you and other people are so involved in their own life they probably didn’t notice or won’t remember that fear is an acronym standing for false evidence appearing real so always examine the evidence if something happens and you think it is the absolute worst thing in the world and you’re just gonna die how likely is it that that’s true is it the worst the thing in the world is people judging you so look at the evidence how do you know this is going on for certain and what are other explanations for what might be going on mentally rehearsing those stressful social situations get ready for it the job interview the first date and for some people even going to the doctor can be a stressful social situation because they get kind of a white coat syndrome where they don’t they’re afraid to speak up to their doctor, I found that if there is a certain set of things that you need to say like if you’re going in to talk to your boss or you’re going in to talk to your doctor sometimes it’s helpful to write down a list of the points that you want to cover with them or the symptoms that you’re having so you can go over it and make sure you get everything said and you don’t end up kind of getting shut down when I used to go have supervision with my boss you know I only got supervision for one hour once a week and that was if I was lucky so I would go in with a whole laundry list of things and it could be the stuff that I was upset about or having difficulty with and I could have a laundry list and just go through it and mark it off so I would make sure that I got everything said and I covered and we were on the same page by the end of the the meeting finally practice mindfulness and focus on your surroundings to know how you feel if you start feeling anxious a step back and ask yourself why am I anxious what do I need right now to feel calmer try to do this periodically so you don’t wait until your anxiety is off-the-charts focus on your surroundings look around to find places and little niches that you might feel comfortable maybe there’s somebody else sitting over in the corner and you can go sit down with them and chat maybe there’s an empty seat somewhere that you can just go sit down and take a breath or go out on if it’s a patio or a party maybe you can go out on the patio for a few minutes oftentimes there’s somebody sitting out on the patio trying to get a little peace so you can find a situation that’s less anxiety-provoking two little bonus things I’m going to tell you with social anxiety a lot of times people are afraid that they’re going to offend someone and these days it is so easy to offend people so what I tell my clients and my kids and what I try to remember myself is before I speak or when I’m talking to people if what I’m saying is true helpful important necessary and kind then you know there’s probably a good chance I won’t offend them look on your social media look at the comments people leave on other people’s posts and stuff and see if they meet these criteria true helpful important necessary and kind 90% of the time the answer is no well I won’t say that much about 50% of the time the the answer is no there are a lot of times people will just say nasty stuff that didn’t need to be said and that can be offensive but if you practice and focus on making sure what you say is true helpful important necessary and kind and if you’re following me that spells out think then the chances that you’re going to offend somebody are greatly reduced if the person still gets offended it’s probably more about them because you aren’t trying to offend them you weren’t trying to be hurtful you are trying to be helpful and kind therefore it may be more about their stuff whether they have an issue with you or they have an issue with something else that’s going on and you just happen to be kind of in the way it’s more about them you can’t control how they react to things it’s their responsibility if you’re being nice and they take it the wrong way and they get offended that’s their perception and they need to work on that the other bonus that I’ll tell you to take away is something I got from dr.

Seuss and I love something he says about the judgment of those whose minds don’t matter and those who matter don’t mind so the people who matter in your life they’re going to be people judge you all the time that’s just the way humans are but those who mind what you do those who get offended those who judge you all the time they don’t matter the people who matter to you don’t mind if you make a mistake don’t mind if you’re not perfect they probably embrace all of your imperfections so before you approach a social situation remember not everybody’s gonna like you that’s just it’s not possible to have everybody like you so remember the wise words of dr. Seuss those whose minds don’t matter and those who matter don’t mind if you like this podcast subscribe to your favorite spot on your favorite podcast app join our Facebook group at docs nights comm / Facebook or join our community and access additional resources at Doc Snipes com you thanks for tuning in – happiness isn’t brain surgery with Doc’s knives our mission is to make practical tools for living the happiest life affordable and accessible to everyone we record the podcast during a Facebook live broadcast each week join us free at Doc’s 9.com slash Facebook or subscribe to the podcast on your favorite podcast player and remember Doc’s nights calm has even more resources Members Only videos handouts and workbooks to help you apply what you learn if you like this podcast and want to support the work we are doing for as little as 399 per month you can become a supporter at Doc’s nights comm slash join again thank you for joining us and let us know how we can help youAs found on YouTube Hi, My name is James Gordon 👻🗯 I’m going to share with you the system I used to permanently cure the depression that I struggled with for over 20 years. My approach is going to teach you how to get to the root of your struggle with depression, with NO drugs and NO expensive and endless therapy sessions. If you’re ready to get on the path to finally overcome your depression, I invite you to keep reading…

A Strengths Based Approach to Bipolar Disorder Treatment

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 all CEUs comm slash counselor toolbox I’d like to welcome everybody to today’s presentation on a strengths-based biopsychosocial approach to recovery from bipolar disorder so we’re going to talk a little bit about what bipolar is what causes it and how to mitigate it by helping people understand their own bipolar because what triggers it for John may not trigger it for James help them identify their warning signs because bipolar episodes just like depressive episodes and manic episodes often don’t come from completely out of the blue if we look backward we can see where the person was beginning to resume some unhealthy lifestyle habits that were making them more vulnerable well look at the symptoms of depression and mania and real quickly review bipolar one versus two and look at some co-occurring disorders and interventions another thing I added to this presentation was a little a short piece on differential diagnosis because I often see people who are diagnosed either only with bipolar when there’s also attention deficit disorder present or they’re diagnosed with anxiety when it’s bipolar disorder so we’re going to talk about how people might mistakenly diagnose one for the other and how to kind of try to ferret that out a little bit one way is using the online assessment measures there’s another measure we’re going to talk about in here too so we care because uncontrolled bipolar puts people at risk for suicide addiction and addiction relapse you know even if somebody doesn’t have an addiction when they are in a manic episode they can be more likely to engage in potentially self-injurious behaviors, not for self-injury but just because they’re looking for even more of a rush and when they’re in a depressive episode they can also be at risk for addictions because they’re looking to feel better in some sort of the way so a lot of it we’re talking about well with we’re talking about self-medication with mania we’re just talking about what they perceive as something exciting and people are often in manic episodes engage in extreme risk-taking behavior we don’t want our clients to go down any of these paths so we want to be aware of what might trigger it and I don’t think I talk about it anywhere else in the presentation, it’s important to be aware that for suicide when somebody is coming out of a depressive episode who somebody who’s bipolar well or unipolar depression but when they’re coming out of the depressive episode and they start having more energy is actually when they’re at greater risk of suicide than when they’re at their absolute bottom not saying they’re safe at their absolute bottom but we don’t want to get complacent when somebody starts feeling better and assume that they’re out of the woods with poorly controlled bipolar disorder can leave people feeling hopeless and helpless if they have bipolar one and they have at least a full-blown manic episode but maybe more they may not mind that they may because it disrupts their life the depressive episodes tend to be when patients usually present when they’ve got bipolar disorder so we want to look at what’s going on with them and help them see how the bipolar disorder disrupts their life because that can go a fair way to encouraging medication and treatment compliance well controlled bipolar like well-controlled addiction helps a person feel happy optimistic motivated and energized the key is helping them manage their vulnerabilities you now take care of their body so they have enough energy to do things but also make sure that they get their medications right some of the mood stabilizers can be flattened and make people feel more exhausted and it’s important it’s vital that they openly communicate with their psychiatrist or physician about the medications if they are if the side effects are so significant is impairing their quality of life which means they’re likely to be medication non-compliance so we want to make sure that if they’re feeling too flat that they talk it over with their medication provider bipolar disorder is a brain disorder you know sometimes with like depression we can look for situational causes for anxiety we can look for some situational causes we can look for some cognitive stuff we know in bipolar disorder something is going on in the brain that causes unusual shifts in mood energy activity levels and the ability to carry out day-to-day tasks many very successful let me go back to that so just to be clear and generalized anxiety panic disorder depression they also can have a brain organic component to them but not always sometimes you can have those from a situational cause whereas in bipolar disorder we know that there’s something that’s not quite right with the balance of the neurotransmitters for most people with bipolar okay so who has bipolar lots of people you’d be surprised Mel Gibson demi Lovato Axl Rose, Britney Spears Jean-Claude Van Damme Marc Vonnegut and Amy Winehouse to name just a few that I came across you know doing some internet research Lee Lee Thompson young and Robin Williams were also, both are quite successful and revered in their fields despite if you want to call it losing their battle with bipolar so why do I bring that up because a lot of times people when they are given a diagnosis of bipolar disorder feel very isolated feel very unique and I want them to realize that there are a lot of really successful awesome people who have bipolar disorder you know it once it’s managed then people can live a stereotypical life I work hard to avoid the word normal because what’s normal for one person may not be for another but we want to look at they can have a very high-quality active life bipolar disorder is caused by imbalances and neurochemicals especially dopamine serotonin and norepinephrine the imbalances could be genetic or triggered by sex hormone changes or stress hormone changes so they may be at you know steady state but when there’s a particular stressor some sort of change or you know other thing and it depends on the person, it can throw those neurotransmitters out of balance enough that it causes either a manic episode hypomanic episode or a depressive episode more than one in 50 adults are classified as having bipolar disorder in any 12 months so I encourage people when they’re walking around the store when they’re walking around the grocery store when they’re at church when they are sitting in a meeting at work with you know 50 other people at least one person in that group has bipolar disorder and or will be diagnosed with it in the year I want them to recognize how common it is I want them to start looking around and thinking when they’re driving down the road on rush-hour traffic you know every 50th car they pass somebody in those 50 cars probably had bipolar disorder to help them realize again it’s not us weird diagnosis is pretty doggone common among patients seen in primary care settings for depressive and/or anxiety symptoms twenty to thirty percent are estimated to have bipolar disorder a lot of times primary care physicians misdiagnosed bipolar disorder as either generalized anxiety or unipolar depression so it’s you know eighty percent of the time seventy eighty percent of the time they’re right but the other twenty to thirty percent you’ve got this person who is going to continue to struggle and get frustrated because the treatments for generalized anxiety and depression are generally, SSRIs and SSRIs can trigger mania so it can make the mood lability worse bipolar the disorder is still under-recognized primarily due to misdiagnosis as unipolar depression and that’s not just in primary care that’s also in you know our field because if we see somebody who has unipolar depression you know they may not have had a manic episode yet likely they have but they may not have had a manic episode yet or they may not report it or if it’s a hypomanic episode they may not note that as something problematic and yes diagnosis of mental health conditions is out of the scope for a lot of GPS and a lot of them will tell you that a lot of them will say If you’ve been diagnosed before I can help you continue your medication but there are so many nuances to psychological diagnosis I want you to get an evaluation from a psychiatrist in order to better make sure that we’re getting you started on the right path because nothing is more frustrating to somebody who is struggling and again generally they present in a depressive episode nobody is nothing is more troubling for somebody who’s presenting and struggling then getting on medication and not feeling like it’s working is one of the things they see and I’m jumping ahead of me is when somebody who has bipolar disorder is started on an SSRI one effect could be to set off a manic episode another effect could be to have rapid improvement and you know it takes four to six weeks for the SSRIs to get in there but they tend to have rapid improvement in days unfortunately that improvement doesn’t last and then they tend to go back into a depressive episode and they start to feel even more defeated I want clients to understand us if they start talking about that pattern where they’ve been on antidepressants and it works for a little while but then it doesn’t anymore you know that may just be the wrong medication for them, their case is not hopeless so we know the symptoms of depression apathy feeling down empty hopeless low energy decreased activity sleep changes worrying difficulty concentrating forgetting things a lot of changes in eating habits and feeling tired or slowed down how is this different than Low Energy I’ve had clients ask me this before and what I try to the way I try to differentiate is energy is your desire to get up and do things and feel like you can when people are feeling tired or slowed down it almost feels like they’ve got a 50-pound rucksack on their back or their arms and legs feel like they’re just lead and it is exhausting to even get up and walk across the room go to the kitchen go outside so there’s a difference there’s energy to do things and then there’s just feeling like you’re filled with cement mania people feel very up high or elated now after people come out of a depressive episode even unipolar depression there’s a period of mild very very mild euphoria and we don’t want to mistake that for hypomania or mania they’re just feeling good they’re like oh my gosh I see the Sun again I see colors how awesome is this and then you know it kind of levels out but you don’t have a crash it’s just kind of a good and then a-ok contentment people in a manic episode have a lot of energy and increased activity levels they often feel jumpy or wired you know like they can’t settle down they want to sometimes but they can’t they’re wide awake and they’re just looking for something to do they have trouble sleeping may talk fast about a lot of different things so they’re jumping around and when we talk about ADHD in a minute, we’re going to talk more about these symptoms they may agitate irritably or touchy not everybody who’s manic is in a good mood so they can be manic but agitated they feel like their thoughts are going fast and think they can do a lot of things at once people especially in a hypomanic episode often find themselves taking on three four five six projects and not being able to complete them you know when they come out of their hypomanic In the episode, they’re like oh my gosh what did I get myself into but there’s no sense of time in a manic or hypomanic episode and they can especially in a manic episode engage in risky and reckless behavior so mixed bipolar includes symptoms of both manic and depressive symptoms at the same time which can be confusing to clients they’re up they feel like they’re wired but they have no their flat they have apathy and just that lack of pleasure and anything they may feel very sad empty and hopeless and energized bipolar one now that big difference is bipolar one has at At least one full-blown manic episode if there hasn’t been one full-blown manic episode then we’re going to look for bipolar 2 where you have hypomania and major depressive disorder bipolar one can have either major depressive disorder or persistent depressive disorder so the big difference is if there’s a manic episode there they’re number one bipolar one patients experienced depressive symptoms more than three times as frequently as manic or hypomanic symptoms so yeah when they hit a manic or hypomanic period it’s not a wonder they feel pretty good and they don’t want it to go away if they experienced it three times more often bipolar 2 patients experience depressive symptoms approximately hold your horses 39 that’s not a mistake 39 times more often than hypomanic symptoms so people with bipolar 2 can have 39 depressives before a manic episode now unfortunately, the body is not that consistent where we can go okay 38 39 you’re due for a manic episode but we do know that both types of bipolar depression are experienced a lot more frequently than mania or hypomania so a common misdiagnosis is generalized anxiety disorder how do you differentiate because some people when they get anxious get revved up and they feel like they’re wired and they can’t sleep the goal-directed activity and generalized anxiety the disorder is often related to an anxiety theme like if they think that there’s a problem with their finances or if they’re you know whatever they’re worried about their activities and their thoughts generally race in that direction they’re not all over the place they’re pretty directed in more or less and their mood is often irritable and energetic versus elated now again just because somebody is irritable doesn’t mean it’s the anxiety we want to look specifically at what is causing the sleep disruption and what are the themes of the thoughts that the person is having the racing thoughts because if you know something’s going bad at work you hear there’s going to be layoffs somebody can get anxious and go well if I get laid off then I’m going to lose my job if If I lose my job then I’m not going to be able to pay the house payment and I’m dead a debt a debt it and go in this rapid cycle of catastrophe and get themselves all worked up and then not sleep then they start trying to figure out okay what I need to do to make sure I can pay the house payment what do I need to do to make sure I can do this so anxiety disorder pretty focused ADHD approximately 60 to 70 percent of people with bipolar disorder also have ADHD and 20% of people with ADHD have bipolar disorder so you can draw your own Venn diagram if you want the take-home message is we don’t want to assume that they’re mutually exclusive because if you’ve got somebody with bipolar disorder you can get that controlled but they’ve still got the ADHD symptoms going on over here they’re going to feel often feel frustrated now what’s the difference people with ADHD often have a hyper focus that’s one of the hallmarks this may happen on a deadline pressure or when wrapped up in a compelling book project or video game and so you can you can see where there’s a trigger for it hyper focus may cause a decreased need for sleep and look like increased goal-directed activity but is often short-lived in people with ADHD who feel exhausted when the hyper-focus fades so we want to look for number one was there something that triggered this hyper-focus could be a video game could be an awesome book or even a Netflix marathon whatever it is and once that hyper-focus faded did they feel exhausted if so we’re probably looking more towards ADHD than bipolar a manic episode is independent of external circumstances you know it’s not where somebody gets a project and it sends them into In a manic episode, there’s a lot less control and predictability in people with bipolar disorder and people with bipolar often want to go to sleep or relax but describe the feeling as if they can’t wind down which can go on for a week or more so we’re looking at duration we’re looking at what triggers it if they report let’s go back to here sometimes having manic episodes that there was no trigger and they lasted a long time but they also report manic goal-directed activity under deadline pressure or you know they can have all these symptoms which means you’re looking at ADHD and mania or bipolar disorder together potentially in ADHD people often interrupt or talk too much without noticing because they miss social cues or because they lose focus on the threads of a conversation because their minds going six ways till Sunday I had a friend of mine one time who had ADHD she was in graduate school with me and she gave a presentation on it one time and we were talking and she was presenting and as she was presenting somebody started flicking the lights on and off and all of us were looking around at each other going this is annoying and then a little while later you know 30 seconds or a minute later somebody turned on the radio not loud but low in the background and we’re all looking at each other and then she started doing something else after that oh she turned on a fan so the fan was oscillating and blowing in our faces and and finally, she’s like is this annoying and we were like yeah that’s annoying it’s hard to concentrate and she said this is what life is like for somebody with ADHD many times because we have difficulty filtering out what’s important to pay attention to and what’s not so we’re paying attention to everything so that made it a lot more understandable to me which was helpful later when my son was diagnosed with ADHD because you know it helped me tailor his learning environment so people with ADHD kind of get lost and they’re paying attention so much that they can miss the social cues people experiencing manic bipolar episodes are often very aware that they’re changing topics quickly and sometimes randomly but they feel powerless to stop or understand they’re quickly moving thoughts so they’re just trying to keep you in the loop in everything and they may notice that you’re getting uncomfortable or irritated or impatient but they don’t feel like they can stop racing thoughts you know all these kind of go together but kind of not people with ADHD report racing thoughts that they can grasp and appreciate but can’t necessarily express or record quickly enough think about the time you got excited about something and you just had all these ideas whenever we get a new grant that comes in I’m in charge of or I used to be in charge of writing the grant so I get the grant and I’d read through and I start identifying all the different things that we could do to you know get this grant and it would be hard for me to keep my pencil going fast enough to keep up with my ideas and you know I don’t have an and you know that was perfectly normal but I was excited and so my mind was racing people with ADHD can do this a lot you know not just because of a grant coming in people with mania the racing thoughts flash by like a flock of birds overtaking them so fast that their color and type are impossible to discern I loved this explanation because it’s just like you have this whole massive bird coming in and then going out and you didn’t have a chance to even notice what they were people with with mania often feels that way they don’t can’t grab any of those thoughts and hook on to them they’re just in and out so helping people differentiate to make sure that if they’ve got anxiety and bipolar if they’ve got anxiety and ADHD and bipolar bless their hearts that were attending to all of their presenting symptoms and issues so what do they do to treat bipolar well we’re going to get down into that in a minute sorry got ahead of myself things that can trigger a bipolar episode medications antidepressants as I said can propel a patient into mania captopril which is an ACE inhibitor something that’s used for high blood pressure can also trigger a bipolar episode corticosteroids certain immunosuppressant medications levodopa which increases dopamine you may see patients with schizophrenia or Parkinson’s taking web dopa and methylphenidate or dexmethylphenidate which are ADHD medications all of these different categories of medications can potentially trigger a bipolar so do they trigger it in every single person no so that makes it even more difficult but it is important to be aware if somebody has bipolar when they start taking medications that they need to be conscious and cognizant of their symptoms so they can you know identify early onset of a depressive or a manic episode circadian rhythm desynchronization can trigger or look like bipolar disorder hyperthyroidism can look like a manic episode that means too much thyroid you know a lot of times we talk about hypothyroidism and depression hyperthyroidism gets people to revved in children mania can be misdiagnosed or look like oppositional defiant disorder and substance use both intoxication and withdrawal but more specifically intoxication can also, look like mania or depression depending on whether they’re taking stimulants or depressants so it’s important to make sure that the person when they’re being assessed is substance-free Do you know what medications they’re on they’ve had a physical to rule out any hormone causes the thyroid is a hormone and looks at their circadian rhythms if they happen to be visually impaired that can cause problems in circadian rhythm if they are shift workers that can cause problems with circadian rhythm so let’s make sure we don’t label something as bipolar and start treating as such before we’ve ruled out everything else bipolar distinguishing factors and let’s see let me see if I can get that open for me right now well anyway spontaneous hypomania premorbid affective temperament particularly hyper thymic or cyclothymic so before somebody had an episode that they presented with do they have a history of remembering dysthymic is feeling blue low unhappy hyper thymic is more elated and cyclothymic is rapidly switching Moodle ability increased mental or physical energy even during depressions family you know you know we talked about the mixed episode if there’s a family history of bipolar disorder or a good response to lithium for unipolar depression or bipolar that’s a risk factor or a hallmark that you might be dealing with bipolar in this client if they have treatment-emergent hypomania mania or mixed States so as soon as they start medication treatment generally SSRIs they have an uncharacteristically rapid response followed by a crash again and or they have more than two failures on antidepressants now we want to look at what that means because antidepressants work differently for different people, somebody can be on and I’m going to use the trade names here just because I don’t have all of the generics memorized I’m not promoting any particular trade name but people could be on Lexapro or Paxil and feel like they can’t wake up people can be on Prozac and feel like they’ve got more energy some people are on Zoloft and don’t feel any energy change some people feel lousy but with antidepressants, we want to look at what failure means did it fail to improve the mood or were the side effects so bad that the person had to switch if this if it was the side effects that are not classified as a failure because the person wasn’t able to stay on it long enough for that antidepressant to get in their system now I do want you to see the mood disorders questionnaire, haha and that’s in this article here but there are three all of these questions that you can have people just complete at assessment and it helps you identify if they’ve had a manic or hypomanic episode so have there ever been a period of time when you are not your usual self and you felt so good or hyper that people thought you are not the normal self you were so irritable that you shouted at people or started fights you felt much more self-confident than usual you got less sleep than usual and found you didn’t miss it you were much more interested in sex than usual spending money got you or your family in trouble you know you can go through all the rest of the questions and they identify yes or no to each of these once they do that if they did check yes to more than one of the above have they ever happened during the same period if yes then again we’re probably looking at one of the bipolar and finally how much of a problem did any of these cause for you and if it’s a minor problem then we may want to look for other things this does not diagnose bipolar but it is an excellent screening instrument to give you an idea about whether you need to look in that direction have clients keep a life chart ideally for three to six months where they chart their sleep their dietary habits their exercise their life stressors hormones for women and any bipolar symptoms that they’re having now when I have clients chart this much I create a really simple fill in the blank a chart like for sleep number of hours did you feel rested yes or no dietary habits I have them keep on their mobile device for exercise did you exercise yes or no if so how much for how long you know really simple things so they can complete the chart in under five minutes otherwise, they’re not going to do it for the bipolar symptoms I have check blocks you know did you feel depressed did you have difficulty sleeping yada-yada so it’s easy it’s very very simple for them to fill out and it’s also simple for me to evaluate when I go through it encourages people to understand their bipolar because everybody’s presentation is going to be a little bit different have them identify you know their cognitive patterns and negative thinking patterns that contribute to their depression and if so how do they handle those in the past when they felt depressed how did they change their thinking or what they do to help themself be a little bit more optimistic and also looking cognitively what if they got going for them are they intelligent are they creative are they you know build on those if somebody is creative you know I’m not so I it’s wonderful to see creative people but for somebody who’s creating one of the greatest things they can do to work with their depression is art therapy you know it’s very therapeutic for a lot of people so find their strengths and use those to help them resolve their current presenting symptoms physically encourage them to get adequate sleep to avoid opiate and sedative medications alcohol and any sort of over-the-counter herbs including Jen Singh Sant Sami 5htp without talking to their the doctor first encourages them to eat a good diet they may already be doing some of this so how much they change at one time it is gonna vary between the person and what they’re motivated to change remind them not to change too much at once let’s just do one or two things right now and then you can work on two more things once you have those under underway situationally have them do a coping skills inventory to figure out how they cope when things get stressful and have them identify triggers for their bipolar that what types of situations make you feel depressed what types of situations have you noticed might seem to trigger a manic episode some people when they get stressed about something there’s that anxiety it can the stress of that and having the HPA axis activated can trigger a manic episode for them so encourage them to you know in their chart they’re going to be keeping track of what might be contributing to triggering and mitigating bipolar symptoms so if they’re getting good sleep and eating a decent diet their life stressors are pretty low and they’re not having any symptoms well we know what they can do interpersonally have them identify supportive friends to help them learn about interpersonal behaviors that trigger them and ways to deal with those interpersonal behaviors so if when somebody tends to be in a manic episode or even in a depressive episode if they tend to be irritable think about having them look at what behaviors trigger their irritability trigger their anger and figure out a plan to deal with it to minimize the impact that being on one end of the spectrum or the other mood wise might have on their relationships angers normal irritability is normal don’t get me wrong but when somebody is in a depressive episode or a manic episode that irritability can be intensified tenfold and people may be taken aback by it environmentally encourage clients to look around their environments and look at what they can do to make their environment cheerful calm and safe you know what that looks like for that particular person those are things that they can do because it’s you know when you felt calm and safe before what was different or what was the same what helps you feel cheerful we just recently had the inside of the house repainted because it was time but I’ve always felt more cheerful, especially during the winter and when there’s less sunlight when I have like a light yellow color on the walls like straw not bright yellow and that helps me feel a little bit more cheerful which is in contrast to all the black that I put in there but whatever it works for me and that’s how I feel comfortable in my environment to encourage clients especially you know when they’re feeling like they’re heading toward a depressive or manic episode to eliminate negativity from social media and television media you know if it stresses them out to watch the news do they have to watch the news you know what will happen if they go for a month without watching the news and in their real-life environment encourage them to try to eliminate as much negativity as possible and that can be altering how they deal with interpersonal relationships that can be looking around and finding things that stress them out and addressing there are a lot of different things but we want to look at it as biopsychosocial II Romania we still want to build on strengths and encourage them to become aware of any medications they’re taking and how those medications affect them this can include stimulants thyroid medications, Sammy and 5htp encourage them to avoid stimulants when possible and don’t combine them with caffeine if they put ephedra for example in combination with caffeine that used to be a common combination in pre-workout supplements that can get somebody revved up and so we want to make sure that they’re aware of the effect not only on their body but the likelihood that could also trigger a mood episode have them identify warning signs and interventions sometimes like I said that for people with bipolar disorder the depression and/or manic episode may seem like it comes out of the blue and sometimes it may but 99% of the time when I’ve traced it back with clients they weren’t taking good care of themselves they were either taking on too much at work or they weren’t getting enough sleep or they weren’t eating well or you know there had been something that had changed from when they were doing well and they felt good too when they started feeling like they were heading down towards an episode some patients may try to identify triggers for manic episodes to increase those we want to encourage them not to do that because that’s like driving your car with the RPMs up at five indefinitely that’s not good for your the car eventually something Bad’s gonna happen so we don’t want them to read themselves up that much we need to help them find that happy medium where they’re content there are three or four on a scale of 1 to 5 and they’re feeling good for some clients when they start feeling depressed they notice thinking changes and have difficulty concentrating this is a warning sign you know they may not feel completely depressed yet but they may be waking up in the morning going yeah not so sure I want to get out of it they may have low energy changes in sleeping or eating irritability sadness negativity resentment withdrawal and environmentally they may notice that they’re in the area becomes more disorganized or they may just not be caring as much about personal hygiene as these are all things that they can identify early on and say huh you know it looks like maybe I need to take a little bit better care of myself and it’s hard for clients it’s hard for a lot of us to listen to our body and go okay I wanted to do XYZ but my body is telling me that maybe I need to rest for mania warning signs can include racing thoughts heightened creativity that’s one that for people to be aware of especially if you’re dealing with somebody who’s naturally creative they may thrive during this period of heightened creativity and get upset when you start suggesting that they may need to temper that to stabilize their mood they’re gonna have to cut the top off the highs and raise the bottom on the lows physically they may have difficulty sleeping or sitting still maybe may feel elated excited irritable or thrill-seeking you may have some anger outbursts frustration with others and environmentally what I’ve seen with patients especially with full-blown mania, it varies on what they do sometimes they are cleaning like crazy and other times it looks like a whirlwind absolutely hit the room but so it’s usually extreme so treatment compliance we want to encourage clients to do a decisional balance back exercise and I broke it down so it’s shorter what are the benefits of eliminating depressive episodes if the person was no longer depressed how would they feel emotionally mentally physically and how would it impact their family and friends a lot of times that this one’s easy to fill out the drawbacks to eliminating depression are this can be harder to fill out because they’re like well I’ll see any drawbacks okay we can leave that for now sometimes patients come to the awareness that if they’re no longer depressed they may not get as much attention and people may expect more of them which is anxiety provoking but this area usually doesn’t have a whole bunch of stuff in it and then we want to ask them what are the benefits of eliminating the mania emotionally mentally physically and socially this one’s a little harder not as hard as the drawbacks to eliminating depression a lot of times clients can see the benefits of eliminating the manic episodes because they don’t have the periods I mean they have the highs and those are awesome but they don’t have the periods where they have the lows and they don’t feel like they can do as much they don’t have the loss of time they don’t kind of come out of it and realize that they’re completely overwhelmed because when they were in the manic episode they took on 17 things so there are a lot of things that clients may identify as benefits to eliminating the mania but we also want to talk about the drawbacks to eliminating it because like I said for some people that’s when they’re their most creative and if they’re a writer or an artist or a musician this may be the time when they are feeling like they’re uber selves so they don’t want to get rid of it and it’s terrifying to them to think that they might not be able to tap into what we can talk about ways to tap into their creativity when they’re not manic and you know there are techniques that they can use it to get that focus that they so desire but it depends on the person exactly what you’re going to use if we don’t address all of these concerns about eliminating their mania treatment compliance is going to be lower because people will just they’ll miss it they’ll miss it a lot and they’ll want to feel that high again so general techniques in clot ask clients how do you deal with it up until now when you felt depressed what have you done this helped you feel better even for 10 minutes or an hour or half a day you know maybe it didn’t work the whole time but or it helped you feel instead of feeling just devastated you felt sad you know it helps you feel a little bit less intensely depressed build on that ask them what they’re willing to do some clients are gonna look at you and go no I’m not gonna do that keep your journal no not gonna do that okay so what are you willing to do I tell my clients a lot of times I’m gonna suggest things that you may not think fit for you or work for you or you’re not going to do well I’d rather you tell me number one that you’re not going to do it and what I’m more concerned about is what you’re gonna do instead if you don’t want to keep the journal okay how are we going to be able to notice changes and find connections between your eating your sleeping your stress levels and your mood episodes you know help me let’s figure out a way that we can we can do this and they may come up with something you know I state what it is that I want to do or accomplish and why it’s important and I say is there another way we can accomplish this when I work with clients and recovery sometimes they don’t want to go to 12-step meetings okay if you’re not going to go then what are you gonna do instead because you need to have some social support you need to have something to do besides sitting alone in your apartment from the time you get off work until the time you go to work the next day because that’s a dangerous period encourage clients emotionally to practice mindfulness because it does prevent episodes from sneaking up if they start feeling run down or tired or off you know sometimes I hear that word I just feel off okay that’s when you need to stop and check in with yourself and go what’s going on how do I feel what do I need and mindfulness also encourages behaviors that prevent vulnerabilities when people check in with themselves they may say you know what I’m really tired today I need to rest and that’s a good thing because it keeps them from becoming vulnerable and potentially triggering an episode of stress reduction encourages clients to identify and eliminate or mitigate stressors so what stressors do you have and they can write them down on the list they can a lot of times if I’m doing an individual I’ll have somebody write down on our big whiteboard all of their stressors and then we go through on one by one and say okay can this one be eliminated if so how and the the client will start making a plan for how they’re going to start eliminating stressors if there’s a a stressor that can’t be eliminated maybe they don’t get along with their in-laws and periodically the in-laws come to visit or whatever okay well you can’t eliminate that so how are you going to mitigate that stressor before your in-laws come what can you do or may it be less stressful if you go to their house instead of them coming to yours so we talk about different things we talk about time management because in those manic and hypomanic episodes people can take on too much and then they feel a little overwhelmed when they’re steady-state and they feel overwhelmed if they’re in a depressive episode I do want to point out and I think most of us know this person don’t usually cycle from a manic to a depressive to a manic like that they can have a depressive episode and then be asymptomatic for anything for months and then have another depressive episode or a manic episode so it’s important to recognize that most people who are bipolar don’t rapidly cycle and there are periods of remission or symptomatology in between cognitive processing therapy can also help people mitigate stressors when they start feeling overwhelmed encouraging them to identify what thoughts they’re having that are contributing to them feeling stressed or overwhelmed and then looking for the facts for and against that thought if they’re feeling like they’ve got too much to do what are the facts for it what are the facts against it if they do have too much to do then they need to figure out how to address it but this helps keep people from getting stuck in emotional reasoning where every time they feel stressed or they feel depressed or they feel anxious they think there’s something to be dysphoric about encourage people to identify their anger management triggers they differ for everyone they need to develop a plan for de-escalation and begin addressing their anger triggers to maintain control of their energy they need to identify if driving in heavy traffic stresses you out and makes you irritable and angry well ok how can you address those triggers maybe driving a different way or maybe putting on your favorite music loud in the car or whatever it is that you can do to mitigate that anger anger takes a lot of energy everybody everybody’s energy is precious but people with bipolar disorder stress and excess energy drain can potentially trigger an episode so we want to help them conserve their energy so yeah they’re gonna get angry about some stuff but help them identify what’s worth getting angry about and using their anger energy for and how to deal with the rest of it so they have more energy to enjoy the life we’ve been talking about the negatives but let’s look at the positive they need to infuse happiness have them make a list of what makes them happy and do more of it or be around it more encourage them to schedule a belly laugh every day and there are Reddit forums there are YouTube videos there are places they can go to get a good old belly laugh but it helps release endorphins and release some of the calming neurotransmitters that have them keep a good things silver lining or gratitude journal and it doesn’t have to be prose you can have them identify at the end of the day three things three good things that happen that day or three things they’re grateful for or when things go bad they say I got demoted at my job today alright well what’s the silver lining to that you didn’t get fired and maybe have less responsibility now I don’t know but there are different ways you can approach it but encouraging people to be cognizant and try to embrace the dialectics there’s going to be bad in life but help them focus on the good to reduce dysphoria mentally address cognitive errors all Arnon thinking focusing on only the positive or negative using feelings as facts and focusing only on a small piece when something happens maybe you turned in a group project and your boss sent it back and said uh no try again some people will take it very personally and focus only on the fact that the boss sent it back with feedback instead okay it wasn’t just me participating in this project so you know all of us need to contribute to it again and you know yes it was given back to us but we get a second opportunity so it’s looking at a bigger piece of the puzzle encourage clients to develop their self-esteem and view failures as lessons applaud courage and creativity and nurture their inner child I have an inner the child my inner child comes out a lot more than some people would like to admit or really like to see but that’s okay you know on Saturday morning it is not uncommon for me to be watching cartoons in the living room my kids are teenagers I can’t say I’m watching it with them anymore I like Yogi Bear I’m sorry I’m weird that way but you know sometimes at the end of a long week of being serious and everything I just kind of need to regress for you know half an hour two hours no encourage people to nurture their inner child and don’t be afraid to be silly don’t be afraid to laugh or do something goofy physically increase clients to exercise class to increase exercise it increases serotonin levels reduces stress helps balance hormones and neurochemicals and may combat some medication side effects exercise is anything that moves the body gardening cleaning going to the gym of course walking the dog playing soccer with the kid anything like that so what is it that they like to do or at least they’re willing to do nutrition provides the building blocks for the neurochemicals so people need to have quality proteins and a nutritionist A friend of mine suggested always try to have three colors on your plate at every meal and use a salad plate that is smaller instead of a dinner plate because it tricks your brain into thinking that you’re getting more food as Americans we tend to eat way more than we need and try to avoid mindless or comfort eating when people start comfort eating a lot of times they’re not being mindful they’re eating to deal with stress instead of acknowledging the stress and dealing with it so yeah they’re infusing themselves with carbohydrates and fats and getting the serotonin and dopamine flowing but when all that goes away whatever was causing the stress is probably still there so they’re either gonna have to stress eat again or deal with it so encouraging people to be mindful of their eating sleep helps the body repair and rebalance and sleep deprivation is known to trigger both manic and depressive episodes too much sleep or sleeping at the wrong times can also mess up circadian rhythms so keeping naps to a minimum of 45 minutes one time a day, if the person has to take a nap, is important so they don’t get into that deep sleep and preferably try to avoid naps for most of a 15-minute power nap where you’re closing your eyes and you don’t ever completely drift off has been shown to increase focus in the afternoon but naps where you’re laying down and getting under the covers tend to mess up circadian rhythms, if people are on medication for their bipolar which they probably will be have them work with their doctor to adjust the dosages and dosage times to fit their schedule so if they have a medication that makes them feel sleepy maybe they take it right before dinner so it’s worn off completely by the time they get up in the morning and it’ll be up to the person to work with their doctor I had one client who took Seroquel and she ended up having to take it at 2:00 in the afternoon for it to be out of her system enough where she felt alert when she woke up at 6 o’clock the next morning so it’s gonna differ for different clients again encourage them to discuss any negative medication side effects with their doctor and not to expect a pill to do everything you know the pill can help stabilize the moods but if you’re taking this pill but then you’re still you know pulling the rug out from under it by not sleeping and using cocaine or or whatever it’s likely the pill is just not going to be able to do it all interpersonally support groups are really helpful to chat rooms if the person is either in a rural area working shift work can’t get to an appropriate support group not all communities have support groups that are embracing of all different types of people so it’s important to recognize that even though there may be a support group the person that you’re working with may not feel comfortable with the people that are in that the particular group so chat rooms can be helpful in the know family and friends and I say in the know these are people who have to understand or have to know that the person has bipolar disorder and be aware of their warning signs trigger their symptoms which helps so they can be supportive and facilitative environmental clients can explore things that improve their environment different pictures a temperature can also be a big thing if you’re too cold or too hot it can make people irritable certain essential oils can help increase energy such as peppermint rosemary or lemon calming essential oils if somebody tends to have some anxiety going on lavender chamomile valerian Valerians kind of they say woody some people think it stinks to high heaven some people love it catnip is the same way yes stuff you use for your cats you can get it in essential oil and it’s a sedative type essential oil for humans bergamot it’s a pretty mild smell rose is helpful rose geranium is a little bit less expensive and frankincense is all supposed to help with calming so he’s hypomanic having difficulty winding down anxious whatever some of these may help memory triggering include ginger cloves cinnamon orange and jasmine which works for one person is not necessarily going to work for another I mean there are studies out there that show certain essential oils have effectiveness at anxiety reduction and depression improvement but it’s going to be up to that person and I found that when a person smells something if it smells noxious to them then it’s probably not something that they need if they smell valerian and they’re like oh my gosh that stinks okay that’s not triggering what their brain needs their the brain knows what it needs I do the same thing with my rescue animals you know I let them take a a good whiff of it and if they like it they’ll stick around and they’ll sniff it some more if it’s not what they need then they’ll go somewhere else I tried fur for our donkeys when we first got them into rescue I tried lavender because I thought you know that’ll help them calm down they hated it they liked valerian so I learned that for them they preferred that particular essential oil for whatever way it works in the brain and encourage clients to visit a store that sells essential oils because they have testers and they can sniff them to see which ones work for they and essential oils also smell different from different manufacturers so it’s important again for them to figure out places that they can get their essential oils and try to stick with the same company once they find one that works organization can help another thing that’s important for people with Bipolar is to manage impulse items when they go into a manic or hypomanic episode especially and they’re prone to engage in risk-taking behavior or less restrained behavior car keys need to be somewhere where maybe they can’t access them if they’re known to go out and drag race or you know drive 100 miles an hour just to see how it feels credit cards that’s a big one credit cards need to be somewhere some of my clients will freeze their credit cards in a block of ice so they can’t get to them and they can’t see the numbers to read them and put them in on the phone this can help prevent unrestrained spending, especially at 2:00 a.m. or something when the infomercials are on porn sites if the client happens to have an attraction to porn sites having those blocked because it’s really easy to get sucked into that same thing with video games and alcohol and other drugs alcohol a lot of people have in their house so if this is a dangerous impulse item for somebody make sure they have it locked up somewhere so if they do and have a hypomanic or manic episode they can’t drink the same thing with certain medications especially the benzos and the opiates if you can keep it locked up somewhere all the better and during the day keep it light and bright try not to be in an office where it’s dark some people can’t help it I mean if you’re a nurse and you’re working in the neonatal intensive care unit it’s going to be dark most of the time and there’s nothing you can do about that but if you can help it keep the lights on if you don’t like fluorescent lights get lots of stand up lights that you can put around to keep it bright so your brain knows that it’s time to be awake co-occurring disorders depression can co-occur with bipolar I mean you can have part of bipolar is depression so when somebody is in depressive episode suicidality high-risk and addictive behaviors and self-medication we want to shout for it just like we would for unipolar depression with mania we want to help the person become aware and look out for explosive anger which can get them into legal trouble relationship issues etc heightened libido which also can get them into legal trouble and relationship issues etc and any other risk-taking that they do because when they’re in a manic episode is like they’re this is a bad idea filter is completely turned off or it’s switched on the other way and as the let’s try this filter so helping them understand that when they’re in that manic state it’s important to have safeguards so that when they come out of it they haven’t done something that they’re going to end up regretting or have to undo so bipolar is caused by neurochemical imbalances especially among serotonin dopamine and norepinephrine the symptoms and presentation varies widely depending on the person it’s more important to address each symptom then to address bipolar as a whole you know we want to look at what symptoms this person presenting with and how can we help them manage those the medication provider is going to be managing kind of the bipolar as a whole and trying to stabilize the mood but we want to help them start addressing their symptoms so they can feel as healthy happy healthy and productive as possible help them address each symptom identify warning signs and eliminate or mitigate triggers and vulnerabilities remember that treatment compliance is a huge issue because the mood stabilizers tend to flatten those highs and people miss the most dangerous times for suicidal ideation and people with bipolar disorder are when they’re coming out of a depressive episode or and I didn’t mention this before or during a mixed episode remember mixed they can be depressed and have high energy both at the same time ensure people with bipolar disorder have a crisis plan and people who interact with them daily who are aware of their warning signs and symptoms because sometimes they’re not being mindful and most of us are guilty of not being mindful all the time sometimes these symptoms can creep up so if they have people they interact with daily who are in the know and can say you know John it seems like you’re starting to destabilize a little bit then John can take a look at it people with co-occurring addictions also need to be aware that a bipolar episode can trigger an addiction relapse and vice versa so they need to be aware and have an extra-special relapse addiction relapse prevention plan for when their mood symptoms arise if you haven’t already signed up please remember that addiction and mental health counseling and Social Work continuing education credits are available for this presentation and are accepted in most US states Canadian provinces Great Britain Australia and South Africa go to all CEUs com counselor toolbox and click on the link counselor toolbox CEU spreadsheet to easily locate the course based on this presentation okay are there any questions now remember we’re not having class tomorrow but we’re having class on Thursday and that is just chock-full of stuff that I’ve never actually presented before so there is no repeat possible there oh and then next Tuesday we’re going to be talking about enhancing social justice and why that’s important for recovery you

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CEUs can be earned for this video at https://www.allceus.com/member/cart/index/product/id/629/c/ Director: Dawn-Elise SnipesA direct link to the CEU course is in the podcast show notes. https://www.allceus.com/feed/podcastAllCEUs provides #counseloreducation and CEUs for LPCs, LMHCs, LMFTs and LCSWs as well as #addiction counselor precertification training and continuing education. Live, Interactive Webinars ($5): https://www.allceus.com/live-interactive-webinars/ Unlimited Counseling CEs for $59 https://www.allceus.com/ #AddictionCounselor and #RecoveryCoach https://www.allceus.com/certificate-tracks/ Pinterest: drsnipes Podcast: https://www.allceus.com/counselortoolbox/Nurses, addiction and #mentalhealth #counselors, #socialworkers and marriage and family#therapists can earn #CEUs for this and other presentations at AllCEUs.com#AllCEUs courses are accepted in most states because we are approved as an education provider for NAADAC, the States of Florida and Texas Boards of Social Work and Mental Health/Professional Counseling, the California Consortium for Addiction Professionals and Professions.This was recorded as part of a live #webinar

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The ondemand continuing education course is available here https://www.allceus.com/member/cart/index/product/id/16/c/ AllCEUs provides #counseloreducation and CEUs for LPCs, LMHCs, LMFTs and LCSWs as well as #addiction counselor precertification training and continuing education. Live, Interactive Webinars ($5): https://www.allceus.com/live-interactive-webinars/ Unlimited Counseling CEs for $59 https://www.allceus.com/ #AddictionCounselor and #RecoveryCoach https://www.allceus.com/certificate-tracks/ Pinterest: drsnipes Podcast: https://www.allceus.com/counselortoolbox/Nurses, addiction and #mentalhealth #counselors, #socialworkers and marriage and family#therapists can earn #CEUs for this and other presentations at AllCEUs.com#AllCEUs courses are accepted in most states because we are approved as an education provider for NAADAC, the States of Florida and Texas Boards of Social Work and Mental Health/Professional Counseling, the California Consortium for Addiction Professionals and Professions.This was recorded as part of a live #webinar

22 Pharmacology Addiciton Counselor Exam Review

CEUs are available for this presentation at AllCEUs Want to listen to it as a podcast instead? Subscribe to Counselor Toolbox PodcastAlso check out our other podcasts, Happiness Isn’t Brain Surgery and Addiction Counselor Exam ReviewAllCEUs provides multimedia #counseloreducation and CEUs for LPCs, LMHCs, LMFTs and LCSWs as well as #addiction counselor precertification training and continuing education. Live, Interactive Webinars ($5) Unlimited Counseling CEs for $59 Specialty Certificates starting at $89 including #AddictionCounselor #RecoveryCoach #PeerSupportSpecialist #TraumaInformedCare #BehavioralHealthTechnician #Etherapy#addiction and #mentalhealth #counselors, #socialworkers and marriage and family therapists can earn #CEUs for this and other presentations at AllCEUs.com#AllCEUs courses are accepted in most states because we are approved as an education provider for NAADAC, the States of Florida and Texas Boards of Social Work and Mental Health/Professional Counseling, the California Consortium for Addiction Professionals and Professions.

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Want to listen to it as a podcast instead? Subscribe to Addiction Counselor Exam Review PodcastAlso check out our other podcasts, Happiness Isn’t Brain Surgery and Addiction Counselor Exam ReviewAllCEUs provides multimedia #counseloreducation and CEUs for LPCs, LMHCs, LMFTs and LCSWs as well as #addiction counselor precertification training and continuing education. Live, Interactive Webinars ($5) Unlimited Counseling CEs for $59 Specialty Certificates starting at $89 including #AddictionCounselor #RecoveryCoach #PeerSupportSpecialist #TraumaInformedCare #BehavioralHealthTechnician #Etherapy#addiction and #mentalhealth #counselors, #socialworkers and marriage and family therapists can earn #CEUs for this and other presentations at AllCEUs.com#AllCEUs courses are accepted in most states because we are approved as an education provider for NAADAC, the States of Florida and Texas Boards of Social Work and Mental Health/Professional Counseling, the California Consortium for Addiction Professionals and Professions.

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AllCEUs offers Addiction Counselor Certification Training packages for as low as $149 (everything is included). We also offer CEUs to help you keep your license current.AllCEUs provides #counseloreducation and CEUs for LPCs, LMHCs, LMFTs and LCSWs as well as #addiction counselor precertification training and continuing education. Live, Interactive Webinars ($5): https://www.allceus.com/live-interactive-webinars/ Unlimited Counseling CEs for $59 https://www.allceus.com/ #AddictionCounselor and #RecoveryCoach https://www.allceus.com/certificate-tracks/ Pinterest: drsnipes Podcast: https://www.allceus.com/counselortoolbox/Nurses, addiction and #mentalhealth #counselors, #socialworkers and marriage and family#therapists can earn #CEUs for this and other presentations at AllCEUs.com#AllCEUs courses are accepted in most states because we are approved as an education provider for NAADAC, the States of Florida and Texas Boards of Social Work and Mental Health/Professional Counseling, the California Consortium for Addiction Professionals and Professions.This was recorded as part of a live #webinar

Getting Rid of Anxiety & Stress | Kati Morton

JOURNAL CLUB! Every Tuesday & Friday I post a journal prompt to help keep you motivated and working on yourself! JOIN NOW: https://www.youtube.com/katimorton/join Today we are discussing Stress, Anxiety and treatment options. I called on Laura Rhodes-Levin, LMFT and founder of the Missing Peace Center for Anxiety. Together we discuss Anxiety, therapy options like art therapy, massage therapy, alpha-stimulation and neurofeedback. Laura’s clinic: https://missingpeace4anxiety.com/THE TEAM Producer: Sean St-Louis Writer: Kati Morton DP: Nick Davies Editor: Elijah Senn Animator: Jordan ComeauxOrder My Book Today! Are u ok? http://bit.ly/2s0mULyTry BetterHelp http://tryonlinetherapy.com/katimorton Plans start at $35 a week (billed monthly). Must be 18+ to sign up.PATREON Help us caption & translate this video!https://amara.org/v/o9pw/

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