mcap – Effects of Anxiety

Neurobiological Impact of Psychological Trauma on the HPA Axis

Unlimited CEUs for $59 are available at AllCEUs.com/Trauma-CEU this episode was pre-recorded as part of a live continuing education webinar. CEUs are still available at AllCEUs.com/Trauma-CEU welcome to today’s presentation on the neurobiological impact of psychological trauma on the HPA axis we’re going to define and explain the HPA axis which we’ve talked about before is a response system so it’s not anything to get to you know overly concerned about that it’s going to be super dry well identify the impact of trauma on this axis and on basically your whole nervous system in your brain identify the impact of chronic stress and cumulative trauma on the HPA axis because a lot of times when we talk about PTSD we think only about some particular acute event and that’s not necessarily true there are a lot of people with PTSD who have basically what I call cumulative trauma and they were exposed to extensive child neglect they were in domestically violent relationships they were in a situation where they were exposed to trauma over and above what a normal person would think lawfully think of law enforcement military personnel think first responders I mean they see stuff that no human should have to see and they see it not only once but you know once a week or once a month depending on kind of where you are so it’s important to understand well one thing may not be so traumatic to create post-traumatic stress we’re going to look at some of the reasons that PTSD symptoms may develop as a cumulative sort of thing which I found this to be interesting anyway we’ll identify symptoms of dysfunction and we’ll talk about some interventions that are useful for this population now my guess is none of you are prescribing physicians so when we’re going through this you’re going to be going yeah that’s all well and good what’s the exact point of thinking about exactly what this information is telling me on each slide show used to be the hat to help my clients who have been annoyed by trauma and have not yet developed any sort of PTSD symptoms or who have PTSD symptoms and how can I use this information to better tailor my treatment plan to help them become more effective in managing their symptoms this is kind of a unique presentation because it was based on only one article this was a meta-analysis so it’s a long article and it’s a really good article that I would strongly suggest looking at it in your resources section in the class it lays out the many changes and/or conditions that are seamed in the brain and nervous system of people with PTSD so they really looked at a lot of research longitudinally to see what we know and what we don’t know as clinicians awareness that these changes can help us educate patients about their symptoms why do you feel this way and find ways of adapting to improve quality of life so neurobiological abnormalities in PTSD overlap with features found in traumatic brain injury so that started making a lot of researchers go hmm you know traumatic brain injury there is something or again of course hurting part of the brain so why are the symptoms similar in PTSD you’re going to find out pretty soon is that PTSD does cause damage actual physical damage in the brain the response of an individual to trauma depends not only on the stressor characteristics but also on factors specific to the individual so somebody can see a trauma and not be as traumatized if you will as someone else and part of these factors and there was a study done by Pi Newson Nader back I believe the early 80s looked at triage factors for PTSD and some of the factors that they found why certain traumas may be more traumatic than certain people versus others have to do with this particular trauma, you’re experiencing it close to one of your safe zones where you live where you work somewhere where you’re not where you’re supposed to be feel safe and if so then it’s probably going to be perceived as more traumatic now again think about the survival capacity or the survival function of this behavior when your brain says this is supposed to be a safe zone and it’s not so I need to respond in kind you’re trying to protect yourself make sense the similarity to the victim if it could happen to her if it could happen to him they’re like me it could happen to me that makes me feel scared because we like to categorize the world in terms of using them bad things happen to those people not to us people but if you’re looking at a victim who’s liked you and you say well I am and us people then you’re going to have more difficulty separating it and feeling safe and going well that couldn’t happen to me and the degree of helplessness you know if you saw something and you were just like there was nothing I could do there’s a greater sense of helplessness and horror then if you didn’t have that necessarily that same experience so those are a couple of things as far as the prestress or perception that we want to consider when we’re talking to our patients even if you’re not a therapist that works with the trauma specifically some people refer out for that some people are working with an EMDR therapist and you know cool but as important to understand and if you happen to go down this road with your clients help them understand why they perceived that particular stressor so intensely versus some other stressor that they think may have good English there oh well sorry they think should have stretched them out more so their perception of the stressor prior traumatic experiences and we’re going to learn that prior traumas do cause changes in the brain to prepare you basically Therese bond more quickly when there’s a threat so prior traumatic experiences can send you from zero to 100 a lot faster which means it’s going to be or could be more traumatic the amount of stress in the preceding months if you’re already worn down and your body has already said I can’t fight anymore it’s not doing any good then when it encounters PTSD and when it encounters a trauma the body might be going I just can’t take another thing please just I can’t do it which is why we see in people with PTSD chronic stress burnout and chronic fatigue this inability to tolerate stress because the body’s just already waived them that white flag going I can’t do it current mental health or addiction issues again that’s your body’s way of saying something in the neurotransmitter something in the system is a little bit wonky and that means I’m not going to be able to respond a hundred percent healthy and functionally to whatever’s going on and the availability of social support now a lot of the research especially with emergency service personnel points to the availability of social support within 24 hours of the trauma so when there’s an officer-involved shooting when there’s something that they encounter on the duty that’s trauma the ability to have social support within that first 24 hours preferably first two-hour period to at least touch base with a social positive social support is vital to helping somebody process the memories instead of just kind of them disappearing into never-never land and getting solidified in an unhelpful way for the vast majority of the population though psychological trauma is limited to an acute transient disturbance you see something that’s traumatic you’re like oh my gosh Wow it is devastating and yeah is going to affect you for a little while but in a week or two you’re kind of feeling like you got your land legs again so there’s this subpopulation of the population there’s a small group that ends up developing PTSD the signs and symptoms of PTSD reflect a persistent adaptation of the neurobiological symptoms to witnessed trauma and I crossed out abnormal in the article it says abnormal and I look at it as a perfectly normal adaptation because the body is either going with the reserves I have right now I can’t deal or you know whatever it’s doing it’s trying to protect itself now it may not be helpful but from a survival perspective it generally makes sense so I try when I’m working with clients to help them see the functional nature of their symptoms given the knowledge they had or the state they were in at the time so now to the HPA axis the The hypothalamic-pituitary-adrenal axis aka your threat response system controls reactions to stress and regulates many body processes including digestion the immune system mood and emotions sexuality energy storage and expenditure so let’s think about this real quick when you’re under stress, your body feels threatened I needs to survive so it sends out excitatory neurotransmitters that get you wired up which kind of makes your digestion speed up it can cause some cramping in the abdominal area your immune system is not really important right now threat we’re not worried about the flu mood and emotions you tend to be hyper-vigilant and more easily startled threat means fight or flee which means anger or anxiety so you’ve got some stress emotions and I don’t want to say dysfunctional because they’re very functional your body perceives a threat and it’s saying you need to do something sexually well if there’s a threat this is no time to procreate so your body says let’s turn off those sex hormones right now, because we need to use us for fighting and fleeing not procreating which is all well and good but when we have reduced sex hormones it also reduces our serotonin availability which serotonin is one of those calming chemicals which help us calm down the excitatory neurons so without them, you stay revved up which brings us to energy storage and expenditure you’re revved up you’re on high alert you’re staying up here and your body says you know what if I’m going to survive this fight or flight I need fuel which means you need to eat preferably high-fat high-sugar foods that give us instant energy and sustained energy we want calorie defense stuff now thinking about it from that perspective you can see how when you’re under chronic stress or a big stressor you know some of your symptoms make sense why do you want to go eat chocolate or do whatever you do that’s my go-to pizza and chocolate when I’m stressed is generally what I crave not what I need but what I crave so we want to help people understand that there’s a reason it makes sense now we just have to figure out how to deal with it differently the ultimate result of HPA axis activation is to increase levels of cortisol in the blood during times of stress now cortisol is the hormone that goes out and sets off kind of this whole well there are a couple before it but it sets off this whole event cortisol is your stress hormone cortisol is the one who says no sex hormones right now you know and it monkeys with all your different hormones to make sure and your energy storage to make sure that you’re ready for this fight or flee its main role is to release glucose into the bloodstream in order to facilitate the fight or flight now glucose is sugar is raising your blood sugar so you’ve got energy now we’re going to talk regularly about glucocorticoids which are glucose hormones that make your body release glucose which is mainly cortisol and that term is going to become important later I’m just kind of throwing it out there right now cortisol also suppresses and modulates the immune system digestive system and reproductive system so again cortisol is saying we’ve got this energy we’ve got this threat let me figure out how to sort of dole out our resources right now for survival in the now it’s cortisol is very present focused it’s not looking at you know the long-term and going well this will pass cortisol is very right now HPA axis dysfunction the body reduces HPA axis activation when it appears further fight-or-flight may not be beneficial and they call this hypo cortisol ism so basically a threat response system is you know warning the alarm in my dorm when I was in college used to have these really annoying blinking lights I because why I do this all the time sorry the hypercritical ism is your body’s response to going if I keep fighting I am just throwing good energy after bad there is no sense in surrendering so it turns down the system and it stops producing as much cortisol that way it has cortisol your stress hormone for when there is a bigger more threatening threat well what does that mean well we need cortisol is what helps us get up in the morning our cortisol goes up and down throughout the day which helps us have the energy to get up go to work do those sorts of things it’s a normal hormone when it’s in the right balance hypo cortical cortisol ISM seen in stress-related disorders such as chronic fatigue syndrome burnout and PTSD is actually a protective mechanism designed to conserve energy during threats that are beyond the organism with us ability to cope so dysfunction in the axis causes abnormal immune system activation so you have increased inflammation and allergic reactions cortisol is also related to cortisone your body does not release its natural antihistamines when you are pardon me under stress which is why your allergies seem to bother you more which when your allergies bother you more you’re probably not sleeping as well at night and we know that not sleeping as well at night keeps your HPA axis activated so you’re fighting this battle you’re trying to squeeze blood out of a turnip basically because your body said we’re not releasing any more cortisol I don’t care what you say but everything else you’re not sleeping as well you’re still kind of revved up you’re fatigued and your body is going but there’s a threat and back in your brain they’re going yep but it’s not a big enough threat yet so you can see where this cascade you’re fighting inside your own body and all your systems are kind of arguing irritable bowel syndrome such as constipation and diarrhea because cortisol speeds things up and if you don’t have enough cortisol you know what might happen reduce tolerance to physical and mental stresses including pain remember I said that sex hormones go down which means that the availability of serotonin goes down we know that serotonin is not only involved somehow in mood it’s involved with some level of anxiety reduction but we also know it’s involved in pain perception so when serotonin goes down we perceive pain more acutely and altered levels of sex hormones so fatigue and you’re like where did that come from well the HPA axis is activated see how many times I can say that without tripping on my tongue when it’s activated it sends out these you know excitatory neurotransmitters when you’re excited for too long you get fatigued well interesting little caveat or thing here fatigue is actually an emotion generated in the brain you know we’ve learned to label it which prevents damage to the body when the brain perceives that further exertion could be harmful sounds similar to hypo cortisol ISM it is so what do we know from athletes we know that fatigue and sports is largely independent of the state of the muscles themselves so fatigued you know your muscles usually only work up to about 60% of their ability to work and then fatigue starts to set in so there was still a big margin that you could work before your muscles finally gave out and said hold no more I’ve got jelly legs but your muscles quit you start feeling tired you start feeling exhausted so this is a protective mechanism the body’s gone we need to conserve a little bit of energy because you have to get home and shower and you know prepare to run in case the tiger chases you but what factors is your body paying attention to but tells it OK whoa we need to stop so we’ve got enough reserve in the event of a problem core temperature, you’re working out your core temperature goes up at a certain point it goes that’s high enough your glycogen your blood sugar levels your oxygen levels in the brain how thirsty you are whether you’re sleep-deprived, to begin with, it’s going to mean that you fatigue a lot easier and the level of muscle soreness and fatigue going into that exercise session the brain kind of takes all these factors into effect and goes okay I can unless you work out this much and then I’m going to shut you down I’m wrong it’s off what they have found though is we can override this so when clients come into our office, they’re fatigued they are they’re off they’re just like I’m exhausted I’m agitated I’m irritable I’m not sleeping well I just uh okay so with athletes, we know that psychological factors can be used to reduce fatigue such as their emotional state if they go in in a positive emotional state or a hyped up energized emotional state if they’re listening to really energizing music it can help them push past that fatigue point a little bit if they know the endpoint maybe they know they’re doing three sets of ten reps they’re going to push through faster or more effectively than if they’re working with the coach and they have no idea how many sets they’ve got or how many reps they’ve got to do they’re just like are you going to make a stop to other competitors that service motivation they’re looking around they’re seeing other people doing it they’re going okay I got this and in the case of athletes visual feedback you know they’re seeing growth in their muscles they’re seeing positive changes so they can push through that fatigue a little bit more they’re like okay this is worth it so fatigue is one sign that the body is getting ready to down-regulate that HPA axis and go conservation in practice and counseling practice how can we help reduce mental fatigue and help clients restore their age PA access functioning and one of the things I would challenge you to think about is how can we increase their self-efficacy and their high ductless if you will in their the emotional state that a can-do attitude increases their hardiness and resilience you know we talk about those, a lot man make sure they know their endpoint where are they going what does their what do their symptoms look like what is it going to look like in three weeks in three months and what can we reasonably think will change you know let’s give them some tangible goals that they can look at other competitors or motivational group therapy can be very helpful in dealing with some of this stuff obviously, you’re not going to do a lot of trauma work in the group most of the time but having other people around knowing that there are other people who are dealing with PTSD and having support groups can be really helpful because they can cheer each other on and go come on John you got this you just need to push I know this is a really tough week for you and that can help people push through that fatigue and feedback now in the case of psychological issues we’re not talking about visual feedback but we’re talking about looking at that treatment plan or looking at their symptoms and being able to say you know what I have made progress I’m not having nightmares as much as I actually slept through the night last night who knew and finding those things that they can latch on to and go things are getting better you know they’re not going to get exponentially better overnight likely but they are getting better and I can see this incremental progress and in doing that we can help people get a sense increase that those dopamine levels increase that learning and go okay I can do this we want to make sure that we are considering their fatigue level though and not putting too much on them at once let’s look at really small steps and then solidifying those steps not taking one step after another but taking one step and then taking a breather for some of our clients helping them identify how they’re feeling and be aware of their own fatigue level low cortisol has been found to relate to more severe PTSD hyperarousal symptoms and you’re like yeah it took me quite a while to wrap my head around this whole concept but it makes sense now so when you have low cortisol your body is conserving all its energy can in case it needs to respond to an extreme threat the sensitized negative feedback loop in veterans diagnosed with PTSD have they’ve shown that they’ve got greater ludic corticoid responsiveness now remember I talked about cortisol being a glue to co-corticoids and there’s just no nice way to talk about this without using really obnoxiously clinical terms anyhow which means that the body is holding on and it’s going you’re not going to have cortisol to just get irritable or happy or excited about just anything but if there’s a threat I’ll let you have it unfortunately in patients with cortisol ISM when there’s a threat they have an exaggerated response thank hyper-vigilance and I call it the flatter the Furious so their mood is either kind of flat and they’re not really responsive too much but when there is something that startles them or their body perceives as a threat all of a sudden their body dumps cortisol and dumps glucose into the system which floods the system and if you’ve ever flooded your engine you know what happens doesn’t respond quite as well but there are even more problems with this so evidence says that the role of trauma experienced in sensitizing the HPA axis regulation is independent of PTSD development okay so what does that mean that means even if somebody doesn’t develop PTSD clinical diagnosis if they’ve had trauma HPA access is going to sensitize them a little bit and hold them back a little bit more cortisol and be a little bit more reactive when there is trauma which means successive traumas could produce success successively significant reactions in those with prior trauma maybe more at risk of PTSD for later traumas so again as a clinician what does this mean for me this means that if I’m working with a client who comes from a troubled childhood there were adverse childhood events or you know whatever you want to label it they had chronic stress they had trauma in their childhood even in the prenatal period they found I wanted to educate them about the the fact that they are at a greater risk of developing PTSD if they’re exposed to more trauma so they can learn how to keep their stress levels under control because it’s more important for them according to this research because of some persistent brain changes that we’re going to see core endocrine factors of PTSD include abnormal regulation of cortisol and thyroid hormones okay so we’ve already talked about cortisol our stress hormone and you’re probably familiar with thyroid hormones being sort of your metabolism hormone but what happens when cortisol goes down in the body starting to rein in the energy thyroid hormones also go down hypo cortisol ism and PTSD occurs due to increased negative feedback sensitivity of the HPA axis okay studies suggest that low cortisol levels at the time of exposure to trauma may predict the development of PTSD so if their cortisol levels were already low they were already suffering if you will from hypercortisolism and remember we’ve seen hypercortisolism in burnout and you know regular old burnout chronic fatigue syndrome as well as PTSD so we’re not just talking about veterans here if the cortisol levels are already abnormally low and the body’s already started conserving cortisol when they’re exposed to a trauma we can with more certainty predict which people are going to develop PTSD symptoms back to those gluteal corticoids they interfere with the retrieval of traumatic memories an effect that may independently prevent or reduce symptoms of PTSD so when cortisol is in the system and it’s causing all the blood sugar to develop we’re not forming lots of memories right now we’re just surviving which they hypothesize could prevent or reduce the symptoms if those memories aren’t consolidated and they go away, or it could contribute to difficulty in treating PTSD why well let’s think about it if people who’ve been exposed to trauma you know hypercortisolism they respond to threats by increasing the amount of cortisol and political corticoids exponentially have an exaggerated response than when they’re in our off and we’re talking to them about their trauma, and they start to get upset they start to get excited there the body’s going to start dumping all these gluten coke or turquoise and guess what it’s going to make it more difficult for them to retrieve those memories potentially so it’s kind of an interesting thing to look at because a lot of clients that I worked with PTSD have been like I can’t remember why can I not remember and my very general response because they don’t want to know about all this stuff generally is it’s your brain’s way of protecting you it’s your brain’s way of saying there’s a threat right now and you need to protect yourself from the threat we don’t need to be worrying about all those memories back there so we do some you know relaxation activities and those sorts of things to help them you know get back down to baseline so we’re not continuing to fight against those gluten Co corticoids and thus cortisol because when you fight with that what happens the client generally gets progressively frustrated progressively upset and progressively unable to think clearly and access those memories neurochemical factors corner or chemical factors of PTSD include abnormal regulation of catecholamines serotonin amino acid peptide and opioid neurotransmitters each of which is found in brain circuits that regulate and integrate the stress and fear response now again if you’re thinking I’m never going to remember this for the quiz don’t get too stressed out about it because I want you to take home the overarching concepts I’m not going to ask you really nitpicky questions about stuff that you have absolutely no control over or at least that’s what I tried to do that being said I want I think it’s important that you know that all of these neurochemicals including opioids are involved in the regulation and integration of stress and fear responses it’s not just serotonin or two dopamine the catecholamine family including dopamine and norepinephrine are derived from the amino acid tyrosine now it’s not really all that important but an interesting little aside is that norepinephrine is made from the breakdown of dopamine so your focus and get up and go chemical is made from your pleasure chemical interesting little concept there when a stressor is perceived the HPA axis releases corticotropin-releasing hormone which interacts with norepinephrine to increase fear conditioning and encoding of emotional memories enhance arousal and vigilant vigilance and increase endocrine and autonomic responses to stress so when the threat response system is turned on it releases cortisol which interacts with norepinephrine the stress hormone and they get up and go hormone say there’s some really bad mojo brewing here which increases fear conditioning because the heart rates go in and everything and the response is stress there’s an abundance of evidence that norepinephrine accounts for certain classic aspects of PTSD including hyperarousal heightened startle and increased encoding of fear memories so what about serotonin you know that’s supposed to be one of our calming chemicals it where did it go poor serotonin transmission and PTSD maybe may cause impulsivity hostility aggression depression and suicidality remember you’ve got the downregulation of the sex hormones so less availability of serotonin and there are other things that cause the serotonin to not be as available but they found that serotonin binding to 5h t1a receptors and this is just a little soapbox I’m going to go on don’t differ between patients with PTSD and controls so what does that tell us that’s the only way we can really To figure out what’s going on in the brain in a live subject look at PET scans what we have figured out or they’ve hypothesized is the fact that the serotonin may not transmit as effectively as it may be a really weak connection it’s connecting but it’s you know it’s kind of like having a rabbit ears you got to twist it to get the signal to come in correctly all right this is another one just a concept I want you to think about all they’re looking at in the research is the 5-hit 1a receptor there are a ton of 5-ht serotonin 5-ht receptors and each one of these receptors is involved in some aspect of addiction anxiety mood sexual behavior mood sleep so when we’re talking about why SSRIs don’t work well SSRIs only bind to certain receptors and if we’re not picking the right receptor if it is the serotonin at all then we’re probably barking up the wrong tree I educate my patients about this if they decide they need to go on antidepressants just so they don’t get frustrated as easily I mean it’s still frustrating but so they don’t feel hopeless if the first medication they start taking doesn’t seem to work or makes it worse we talked about why that might be because there are so many different receptors for each one of the neurotransmitters there is a really cool table if you’re into this stuff it’s actually on Wikipedia and it talks also about not only what these receptors do but also what chemicals and medicines act on these receptors and how Food for Thought GABA has profound anxiolytic effects in part by inhibiting the cortisol norepinephrine circuits so it turns down the excitatory circuits patients with PTSD exhibit decreased peripheral benzodiazepine binding sites well we know that when the body secretes a neurotransmitter goes to the other end and it binds like a lock-and-key if you will or it knocks on the door and the door gets opened and it goes through however you want to think about it basically what they found is in patients with PTSD the Kem GABA goes through and the GABA levels are okay but then it knocks on the door to get let in or it tries to put its key in the lock and there’s something wrong at the binding sites or the binding sites you know somebody’s super glued them shut and they’re just not there which is why patients with PTSD tend to have a harder time de-escalating when their anxiety and stuff gets up because the GABA is there but it’s got no doors to go through no locks to bind with however you want to whatever metaphor you want to use this may indicate the usefulness of emotion regulation and distress tolerance skills due to the potential emotional dysregulation of these clients so remember we talked about them having a more exaggerated get-up-and-go response to a perceived threat and they also have a harder time calming down which is basically one of your primary tenants of emotional dysregulation so one thing clinicians can do is help patients learn that okay their body responds differently to stress than other people at least for right now so it’s important for them to understand what emotional dysregulation is emotional regulation strategies as well as distress tolerance skills to help them until they can calm down to baseline because it sometimes takes them longer than other people as clinicians we also can help reduce excitotoxin in order to reduce stress improve stress tolerance and enable the acquisition of new skills when the brain gets really going when the cortisol is out there and the glucocorticoids are in there it’s actually toxic and starts causing neurons to disappear which we’re going to talk about in a second it’s kind of scary NMDA receptors have been implicated in synaptic plasticity.

Which means the brain’s ability to adjust and adapt as well as learning and memory so these are good receptors I like them glutamate binds with these receptors and high levels of glutamate are secreted during high levels of stress glutamate remember is what GABA is made from but high levels of glutamate it’s an excitatory neural net in the brain and overexposure of neurons to this glutamate can be excited toxic and may contribute to the loss of neurons in the hippocampus of patients with PTSD so we’re actually seeing brain volume decrease as a result of exposure to certain chemicals elevated gluten core glucocorticoid and yeah glucocorticoids increases the sensitivity of these receptors so you’ve got a bunch of glutamate being dumped and you’ve got a bunch of glucocorticoid you’ve got cortisol in there making these receptors more sensitive so it’s got they’re more sensitive and they’ve got more coming in which makes it a whole lot easier to become toxic and start causing neuronal degradation what does that mean why do we care it may take clients with PTSD more time to master new skills because of emotional reactivity but also because some of their synaptic plasticity may be damaged so it may take them a little bit longer to actually acquire and integrate these new skills it’s not saying they’re stupid they can remember it just fine however when they’re an emotionally charged state and helping their brain learn that okay this isn’t a threat that’s one of those sort of subconscious things that has to happen that can take longer if the brain becomes excited toxic during stress inhibited learning and memory then it becomes excited toxic during stress which inhibits learning and memory so it’s under stress things are excited toxic neurons are starting to disappear so I’m wondering and I’m just hypothesizing here I don’t know the answers obviously or I wouldn’t be practicing it but what happens during the exposure therapies because that’s exactly what we’re doing is we are flooding the brain with all of these chemicals and creating basically an excitotoxin now they found some evidence that exposure therapies can be helpful according to the DOJ website but or not the DOJ I can’t even think of it right now the VA website but you know I’m wondering long-term what the impact is endogenous opioids natural painkillers act upon the same receptors activated by exogenous opioids like morphine and heroin exerts an inhibitory influence on the HPA axis well we know that people take opiates and it has depressant effects on them it slows them down and calms them down alterations in our natural opioids may be involved in certain PTSD symptoms such as numbing stress-induced analgesia and dissociation again think of any clients you’ve had who have been abused or even taken and not like the side effects of opiates are what opiates do to some people make them feel more relaxed stress induced and analgesia they don’t have as much physical pain sometimes they just it’s there I don’t care pill another interesting factor is now truck zone which is used to oppose opiate appears to be effective in treating symptoms of dissociation flashbacks in traumatized persons so basically, they’re saying if we undo the endogenous opioids we can treat these symptoms it highlights the risk of opiate abuse for persons with PTSD though because if endogenous opioids produce some of these numbing symptoms and dissociative symptoms so they can get away from the pain and the flashbacks then if they add to that you know oral opioids it could prove to be a very tempting cocktail we do want to as clinicians figure out how we can assist them with their physical and emotional distress tolerance so they don’t feel the need to numb and escape and you know I can’t imagine what some people have seen have gone through and I’m not trying to take that away from them, I’m trying to help them figure out how they can stay present and learn to integrate it changes question marks in brain structure and one of the questions that’s come up in the research is because there aren’t any longitudinal studies that looked at it was the hippocampal volume as low to begin with which created a predisposition for PTSD or did PTSD create the smaller hippocampal volume interesting hippocampus is implicated in the control of stress responses memory and contextual aspects of fear conditioning so it helps you to find these triggers in the environment that help you become aware with your senses about when there might be a trauma prolonged exposure to stress and high levels of glucocorticoids damage the hippocampus we’ve talked about that hippocampal volume reduction in PTSD may reflect the accumulated toxic effects of repeated exposure to increased cortisol levels what I called earlier the flatter the Furious having you know your body holding on to cortisol for this extreme stress and then when it perceives stress it’s either nothing or it’s extreme there are no kind sort of mild stressors out there that decrease hippocampal volumes might also be a pre-existing vulnerability factor for developing PTSD the amygdala yet another brain structure is the Olympic structure involved in the emotional process and it’s critical for the acquisition of fear responses functional imaging of studies has revealed hyper responsiveness and PTSD during the presentation of stressful script cues or trauma reminders but also patients show increased amygdala responses to general emotional stimuli that are not trauma associated such as emotional faces so they show an increased responsivity to things they see on the TV that aren’t trauma-related to people crying to people showing anger’s going to have a stronger emotional amygdala response than people without PTSD so clients with PTSD may be more emotionally responsive across the board leading to more emotional dysregulation again an area that we can help provide them with tools for early adverse experiences including prenatal stress and stress throughout childhood has profound and long-lasting effects on the development of neurobiological symptoms the brain is developing and if is exposed to a lot of stress and some of these excited toxic situations how does that differ in the amount of damage caused versus a brain that’s already kind of pretty much-formed programming may change for subsequent stress reactivity and vulnerability to develop PTSD so if these happen during childhood or at any time the brain can basically reprogram and go that it’s a really dangerous place out there so I need to hold on to cortisol and I need to hold on to these stress hormones because every time I turn around it seems like there’s a threat so I am going to be hyper-vigilant and respond in an exaggerated way to protect you from the outside world adult women with childhood trauma histories have been shown to exhibit sensitization of both neuroendocrine and Audino stress responses so basically they’re showing hypo cortisol ISM a variety of changes take place in the brains and nervous systems of people with PTSD and we talked about a lot of those the key take-home point is stress can actually get toxic in the brain and cause physical changes not just thought changes in the brain preexisting issues causing hypo cortisol ism where the brain has already downregulated whether it’s due to chronic illness or chronic psychological stress increases the likelihood of the development of PTSD this points to the importance of prevention and early intervention of adverse childhood experiences we really need to get in there and help these people develop distress tolerance skills understanding of vulnerabilities so they’re not going from flat to furious all the time and so that they can understand why their body kind of responds and why they respond differently than others and you know as we talk about this and of course I’m regularly bringing up DBT buzzwords if you will think about your clients if you’ve worked with any who’ve had borderline personality disorder what kind of history do they have did they have just a great childhood no we know that people with BPD generally had pretty chaotic childhoods so this research is also kind of underscoring why they may react and act the way they do that flat to furious people with hypo cortical ism may or may not have PTSD so we don’t want to say well you’re fine if you don’t have PTSD symptoms we do know that every trauma potentially can cause the body to down-regulate and I kind of look at it as conserving a little bit more of the energy that it needs each time so instead of conserving 60% now it’s conserving 65 and 66 each time it encounters a stressor in order to prepare for potential ongoing threats in the environment hypercortisolism sets the stage for the flattened the furious leading to toxic levels of glutamate upon exposure to stressors which can cause the theorized reduction in hippocampal volume and persistent negative brain changes now I always say the brain can you know rebalance itself and all well that’s part of the plasticity that is the really cool thing about our brain however as far as regenerating those neurons I haven’t found any evidence in the research that we found a way to help people regenerate once we’ve already those neurons are gone they’ve been killed off the brain has to find a workaround so it does take time but I do believe people can minimize some of the impact of the trauma they may have experienced people with PTSD are more reactive to emotional stimuli even stimuli unrelated to trauma again think about some of your clients especially if you work in a residential situation where you’re around on 24/7, you know for 30 or 60 days, and you may see some clients that seem to get upset over everything and you’re like ah such a drama queen or such a drama king and to yourself not to anybody else but when you think about it from this perspective it gives you a different perspective and you might say oh maybe their body responds differently they’ve got more emotional dysregulation because of prior trauma they’re not trying to overreact this is their body’s response because it’s perceived threat so many times it gives me a different approach to working with that client hypercortisolism results when the brain perceives that continued effort is futile feelings of fatigue set in akin to reduced stress tolerance so think about you know when you’ve had a really long stressful period you know weeks or months maybe you’re dealing with an ailing family member or something it’s just a lot of stress and you start getting really tired and when you’re really tired and you’re worn down and somebody gives you one more thing it’s that one more thing normally wouldn’t bother you but right now you just can’t take it so we can see how there’s a reduced stress tolerance when somebody’s already at this stage reducing fatigue in our clients can be accomplished in part with psychological factors including motivation or knowledge of other people who are dealing with similar things support groups feedback about their and making sure they have frequent successes not once a week but I want to have them keep a journal every day of something good that happened or something positive that may indicate they’re moving forward in their treatment goals and knowledge of an endpoint.

Where are we going with this when is the treatment going to end I don’t want most clients don’t want to be with us forever no matter how lovable we are do you want to feel better and be done with us so having to help them see that there is an endpoint we’re going to accomplish this goal this month and then we can reassess 46% of people in the US are exposed to adverse childhood experiences so like I said this is a huge area for early intervention where we can prevent people from developing PTSD later in life how awesome would that be instruction and skills to handle emotional dysregulation including mindfulness vulnerability prevention and awareness emotion regulation distress tolerance and problem-solving could be wonderful additions to health curriculums anything any skills groups you do with children or adolescents or even adults I mean just because they’re adults doesn’t mean that they’re safe from PTSD or that they’ve crossed any threshold where they’re too old to learn we’re never too old to learn of those exposed to trauma education about and normalization of their heightened emotional reactivity and susceptibility to PTSD in the future may be helpful in increasing their motivation for their current treatment protocol whatever it is but it also just normalizes things so they don’t feel like they’re overreacting or they don’t feel guilty for being so tired or whatever they’re experiencing right now are there any questions I know I went through a lot of really complicated stuff but I thought it was really interesting not only the way our brain reacts in order to protect us but how cross-cutting a lot of this stuff was it not just PTSD we’re talking about necessarily but a lot of this information applies to our clients with chronic fatigue burnout and chronic stress and we can see that those people also are at risk at higher risk of PTSD should they be exposed to trauma and none of us is immune I mean there are tornadoes there are hurricanes there are you know things that happen that really stink so the more we can help clients be aware of things develop skills and tools to prevent as much harm as possible I think the more effective we are as clinicians depending on the client and I can do some more research on the VA website because they’re really into medications for PTSD I know ketamine which is a horse tranquilizer has been shown to be effective in people with PTSD and there have been some others that have kind of given me pause ketamine is a hypnotic you know most of the drugs they’re trying out right now are really in my opinion they’re powerful drugs but a lot of them all of them that I know of have pretty high addictive potentials too so they make me nervous but you know when you’re weighing the when you’re going from a harm reduction model that’s not necessarily not necessarily such the be-all-end-all I guess that’s interesting that you use ketamine in the ER it’s definitely powerful effective stuff and like I said earlier some of the stuff that some of my clients and some people have seen done experienced I couldn’t even imagine and you know sometimes for them to actually survive we may need to look at some of these more intense more powerful drugs PTSD and veteran trauma is not are not my focus right now and yes marijuana is being experimented with or looked at used whatever however you want to look at it for PTSD treatment with veterans there’s pretty much not a drug out there they haven’t tried to throw at it to see well what will this do I believe they were even using LSD experimentally for a little while too you the VA I mean if you’re interested in this topic let me see if I could pull that down into here, we go to the National Center for PTSD US Department of Veterans Affairs has a lot of information if you go for professionals, it has a ton more information if you can get on get some of your SI CEUs on demand they do have some free CEUs for PTSD here I’ve never taken any of them but what I’ve looked at when I’ve looked at like the PowerPoints the presentations and stuff I’m sure they’re good so if you’re you do focus a lot on PTSD and you can get on-demand CEUs then this might be a place to get some good free ones aside from DBT are there any other evidence-based practices for therapy that you’ve seen work best in combination with the medications cognitive processing therapy when you’re working specifically with veterans and there is a free course on that too and this one I have gone through and it’s really awesome CPT dot must seed and here I’ll just put it into that education and this is a free course oops and here’s the other one ah golly everyone and embryo does have a lot of research effectiveness with people with PTSD too so yes I would definitely encourage people to explore all options alrighty everybody I really appreciate you coming today and sticking with me through this topic and I will see you on Thursday if you have any questions please feel free to email me or you can always also send it to support that all CEUs com either way I get it and otherwise I will see you on Tuesday thanks a bunch if you enjoy this podcast please like and subscribe either in your podcast player or on YouTube you can attend and participate in our live webinars with 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 used coupon code consular toolbox to get a 20% discount on your order this month As found on YouTube 15 Modules Of Intimate Video Training With Dr. Joe Vitale – You’re getting simple and proven steps to unlock the Awakened Millionaire Mindset: giving you a path to MORE money, …

Addressing Negative Thoughts | Cognitive Behavioral Therapy with Dawn Elise Snipes

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

Schneider by subscribing at all CEUs calm / counselor toolbox this episode has been brought to you in part by all CEUs calm providing 24/7 multimedia continuing education and pre certification training to counselors therapists and nurses since 2006 use coupon code consular toolbox to get a 20% discount off your order this month. As found on YouTube SeanCooper🗯 The Shyness & Social Guy ⇝ The 3 WORST Mistakes You Must AVOID If You Want To Overcome Shyness (PLUS: 1 weird trick that targets the root biological cause of shyness so you can stop being nervous, awkward, and quiet around people…) By Sean Cooper, The Shyness & Social Anxiety Guy. The fact that you’re reading this article tells me you may have already reached a point where you feel your shyness is NOT going away on its own…

or you fear it’s getting worse and worse. And I don’t want you to waste one more day living a life where you feel left out, bored, or depressed because you don’t have the relationships which would make you happy. That’s why I’ve put together this page to help you avoid the worst mistakes that keep many people stuck with shyness for years… often giving up hope of ever improving as you watch other people have interesting “normal” lives without you. Yet this doesn’t have to happen.

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