Anxiety Disorders in the DSM 5 TR | Symptoms and Diagnosis

Hey there, everybody, and welcome to this presentation on diagnosing anxiety and panic in the DSM 5tr. I’m your host Dr. Donnelly Snipes in this presentation.Very briefly, we’re going to review the diagnostic criteria for anxiety disorders or at least most of them in the DSM 5 tr.So let’s talk a little bit about anxiety disorders in general, when we’re talking about anxiety disorders, we need to remember that fear and anxiety may be expressed as fighting agitation, tantrums fleeing freezing fawning clinging, or withdrawal, or what I call the final f, Which is um politely forget about it, because people, just don’t have any more energy left, so they kind of withdraw anxiety.Disorders differ from each other regarding the types of objects or situations that cause fear, anxiety, or avoidance behaviors and the associated beliefs.Anxiety disorders represent a response that is not developmentally culturally or, I also add, contextually normative in terms of intensity or duration.So when we’re looking at what somebody is anxious about, we want to examine, obviously culture and development, something that a five-year-old is afraid of is not necessarily going to be the same thing that a 25-year-old is afraid of.We also want to look at context, though, something that uh, you’re, afraid of in one context, you may not be afraid of in another like for children being around strangers may not be stressful for them when they are at home or when they’re.At school, somebody comes in to do a presentation versus when they are alone and they don’t have a caregiver around.Interestingly, from August 2020, through December 2020, the percentage of adults reporting symptoms of an anxiety disorder rose from 31 4 to 36 9.Now, when you go through the DSM and you start adding up the prevalence of these anxiety disorders, it is really hard to get to a number anywhere close to 36 9. So the numbers in the DSM and the numbers in the uh national health survey, don’t seem to jive very well.We also have to remember that during 2020 we were at the beginning of the pandemic, so there was more anxiety.You would expect that, but even the 31 percent that it was before 2020 seems to be higher than what is identified in the DSM.So I think that’s interesting the anxiety chapter in the DSM 5tr, just like in the DSM 5, is arranged in order of diagnosis which appears in children first, so separation, anxiety, and disorder appear first, and generalized anxiety.The disorder is down a little way, whereas you might expect some of the quote more common disorders to be first, but that’s not how the DSM is arranged.However, in this presentation, I did put generalized anxiety first, when we talk about generalized anxiety, we’re talking about excessive anxiety most days for six or more months, and the anxiety is about a variety of things.It’s not just about one particular thing like health or an individual or a phobia.It is about a variety of things.The worry, in addition to being excessive for the person’s developmental age, culture, and context.The worry is difficult to control the anxiety or the feeling of anxiety is associated with three or more symptoms in adults or one or more symptoms in children, feeling restless or feeling keyed up or on edge, easily fatigued difficulty concentrating, or mind going blank, irritability muscle, tension Or sleep disturbance, I want you to think about it. Anxiety is part of the fight or flight response, so we would expect somebody to experience anxiety.Would it be experiencing symptoms of hpa, axis activation, or activation of the threat, threat, response, or stress response? Whatever you want to call it, so we would expect all of these symptoms or any of these symptoms. When the fight or flight system is engaged, the body is not focused on higher order, processing, memory, or concentration it’s focused on self-preservation protection the person becomes more vigilant because they are trying to protect themselves from threats.They’re not able to relax enough to get good quality sleep because guess what they are keyed up.They’re scanning for those threats, muscle tension and I’ve mentioned in other videos.When I used to play tennis, my coach always used to say don’t stand flat-footed on the baseline, because it takes more time and it’s harder for you to run and spring into action to where that ball is going to be.Now.That is not a threat per se, but the same thing is true for people with anxiety disorders, when you are when you’ve got that muscle tension, it’s kind of like standing on your toes on the baseline.In tennis, you are primed and ready to go and it makes it easier to theoretically fight or flee.These symptoms have to cause clinically significant distress.People can have subclinical anxiety disorder where they have a lot of worry about a variety of things, but it is either not excessive for what they’re worried about, or it doesn’t cause them clinically significant distress. Overall, they report a decent quality of life.It doesn’t interfere with functioning in major areas of their life and generalized anxiety disorder, as well as all of the disorders, are not better explained by a medical, mental, or substance use disorder, and we’re going to talk in the end about differential diagnosis Of the anxiety disorders in general because there’s a lot of overlap between the symptoms, as well as the differential, diagnosis, and comorbidities for anxiety disorders.Remember the difference is often what the person experiences anxiety about and the cognitions associated with the diagnostic features of generalized anxiety disorder.Well, this section, as with most of the sections in the anxiety chapter, pretty much just recapitulated the diagnostic criteria and it elaborated a little bit.One interesting feature is that for generalized anxiety disorder, they noted that adults tend to worry about general life, things like paying bills and getting a promotion, or what’s going to happen with this or that or what’s going on in the world. Kids tend to worry about their competence like performing at school or their ability to be competent in relationships.Sometimes they worry about disaster now, with the coming of the pandemic.We can probably add that too, but other disasters like hurricanes and fires and floods and those sorts of things can prompt a lot of worry in children and punctuality.Interestingly enough, some children become very concerned about being punctual, and so it’s interesting to note that there is a difference in what they worry about, which makes sense, because adults have different responsibilities than kids do, and you notice that, except for disaster, a lot of these worries revolve around the primary life areas or functions of the person.You know: kids, are,  n’t worried about paying bills or or maintaining or parenting, or some of the things that that adults worry about associated symptoms.Well, let me talk about disaster. Quick, I’m trying not to go too far off the rails today, because we’ve got a lot to cover, but it’s important to recognize that children have a difficult time, understanding, the prevalence and likelihood of things.So when there is a disaster such as you know, we’ve had several in middle Tennessee over the past two years and a child watching the news or hearing about the news may not understand how close or far away that disaster was or the likelihood of It recurring adults are better able to understand.You know it’s a 100-year flood or there’s the chance of it happening again.Do you know whatever? The probability is depending on what you’re talking about children don’t understand that they see it on the news it feels like, since it’s on the news, it’s kind of in their house.So it feels like it’s right in their space and it’s hard to know when it’s going to end or when it’s going to happen again, which can prompt them to have a lot more worries about disasters.Parents can help by explaining some of the things to them and explaining to children the probability of another disaster occurring, and you know how they’re safe right now and the steps that they can take.It won’t do everything, but it is important again to recognize children’s different cognitive abilities compared to adults, associated symptoms with generalized anxiety, disorder, and other somatic symptoms that are not as intense as those seen in panic disorder.So we will also see potentially heart racing clammy, skin, rapid breathing other things, and an upset stomach that isn’t specifically indicated in diagnostic criteria, but we know it happens when that fight or flight response is kicked off the prevalence.Remember I said if you start adding up the prevalence of all these anxiety disorders.You’re going to be hard-pressed to get anywhere close to 31 percent and according to the DSM 5 tr between one percent of adolescents and three percent of adults in the? U s experience generalized anxiety disorder according to the National Center on Health Statistics in 2019. Now that was before the pandemic.15 6 of adults experienced symptoms of generalized anxiety disorder in the prior two weeks.The development, and course the mean onset, is rarely before adolescence, and is I’m? Sorry, the mean onset is 35 and rarely before adolescence.So this is one of the disorders that has a much later onset than other disorders, which I did find to be somewhat interesting.Now we’ll move on to separation.Anxiety, separation.Anxiety is the first disorder in the chapter because it tends to be the one that presents earliest and it can be diagnosed as early as preschool separation.Anxiety is characterized by developmentally inappropriate, excessive, recurrent anxiety about separation from major attachment figures.To be diagnosed, the person has to have three or more symptoms.It can be diagnosed in childhood. It can be diagnosed in adulthood if it’s diagnosed in adulthood.You do not have to have a childhood onset of separation anxiety.It actually can have an adult onset, so that is something to remember: symptoms, three or more distress due to or in anticipation of separation from home or from major attachment figures, anxiety about losing a major attachment figure, or possible harm to them.Anxiety about something bad happening to the person, the patient, which would cause them to be separated from an anxiety from an attachment figure.So they have fears about something happening to the attachment figure, causing separation, and fears about them, something bad happening to themselves, causing separation, a reluctance, a refusal to go out or away from home because of fear of separation.Now, generally, this is leaving home and separating from that attachment figure, but in some cases, it can include even being reluctant to leave the house to be cut with the attachment figure because they’re afraid that when they’re out there, they may get separated.Now think how this might occur if there was a child who happened to be at a carnival and got separated from their caregiver that might prompt future fears of separation when in public places, fear of or reluctance to be alone, or without major attachment figures.Refusal to go to sleep without being near a major attachment figure, nightmares about separation, or physical complaints in reaction to or in anticipation of separation.So they have those physiological symptoms of anxiety now note here they keep talking about major attachment figures because remember this can be diagnosed in adulthood.We’re not talking about the primary attachment from infancy. We’re talking about the person’s current major attachment figure, whether that be their significant other, their parent, or whomever that happens to be the fear, anxiety, or avoidance, is persistent, lasting at least four weeks in children and adolescents, and typically six months or more In adults – and you’ll find that’s a common theme where a lot of these situations or conditions have to last six months or more and be causing clinically significant distress for six months or more to rank a diagnosis.Although the symptoms often develop in childhood, they can be expressed throughout adulthood.It can be diagnosed in adults in the absence of a history of childhood separation, anxiety, or disorder, and, as I said, it causes clinically significant distress or impairment in one or more areas of functioning.The diagnostic features section repeats the diagnostic criteria with some elaboration and examples.It’s a pretty straightforward diagnosis in terms of development and, and course the onset of separation.Anxiety can be any time from preschool through adulthood, but generally before the age of 30.So you can have diagnoses of separation anxiety up through the 20s, there may be periods of exacerbation and remission, although most child onset cases do not experience ongoing, clinically significant impairment.I thought that was kind of an interesting associated feature.Now these are not diagnostic criteria.These are features that are associated with separation anxiety but didn’t rank in the diagnostic criteria, sadness or apathy. Well, if somebody is perpetually anxious that hpa axis is going to down-regulate some which may contribute to apathy, if they are perpetually anxious, they may also start feeling hopeless and hopeless, which is associated with feelings of sadness and depression.They may have difficulty concentrating well.The mind is not focused on concentration.If it’s in a perpetual state of fight or flee, there may be social withdrawal just stepping away from everything, because they don’t have the energy to engage with others.Because the anxiety is so pervasive in older children you may see homesickness or pining when they are away at camp or or something like that.Now.A lot of children who don’t have separation, anxiety, or disorder, experience homesickness when they’re away at camp.For the first time, however, this is also associated with separation, anxiety, the child migs or the person may exhibit anger or aggression towards separators.So anybody who’s causing a separation between the patient and their major attachment figures may provoke anxiety, anger, and perceptual disturbances.Now these are not hallucinations. These are when a person is alone, for example at night, and they feel like somebody’s watching them, or they think they see something moving in the shadows.It’s not there and by turning on the light.So there are no more shadows.You know that goes away.It’s, not a persistent uh hallucination that the person is experiencing, but perceptual disturbances are more common in children than they are in adults, and we want to make sure we don’t mislabel that as something related to a psychotic disorder, children with separation, Anxiety tends to be described as demanding intrusive and in need of constant attention.According to the DSM now, I would argue when we get down a little further that this may be true of all people with separation, and anxiety, adults may appear dependent and are likely to contact their major attachment figures throughout the day and track their whereabouts.They are also often overprotective as parents and pet owners.Interestingly enough, the DSM did mention pets where the person with separation anxiety may be excessively concerned about knowing where their pet is at all times.The prevalence of separation.Anxiety in children is approximately four percent, and in adolescents and adults, it ranges from one to two percent. In the culture section, the DSM talked about the importance of differentiating separation, and anxiety disorder from the high value, some cultural communities place on strong interdependence among family members.Specific phobias is the next in the line of disorders we’re going to talk about and a specific phobia is pretty straightforward.There’s a marked, fear or anxiety about an object or a situation about 75 percent of people that have one phobia have more than one phobia, and I think, if you think about it, even if it doesn’t rise to the level of being a Diagnosable phobia you can think about.If you have one what we’ll call irrational fear, you probably have a couple of others when I started to think about it.I’m, like yeah, i have i have a couple in there.The stimulus almost always produces an immediate fear response and is actively avoided.The fear is disproportionate to the threat that persists for guess what six months or more and causes clinically significant distress – and I have this bold and italicized because it’s important to remember that.Having a fear – and I’ve talked in other videos about my fear of bridges, I also have a fear of enclosed spaces.I hate you know those little water, tubes and tunnels and things that make me feel closed in.Does it cause me clinically significant distress or cause me to have to alter my life to get around it? No, so it doesn’t rise to the level of a specific phobia. A lot of people have fears that may not have a um basis or the fear may be disproportionate to the threat.In reality, we recognize it, but it doesn’t cause us clinically significant distress, so it would not be diagnosable as a specific phobia and the specific phobia is not better explained by another mental disorder and I’m thinking here more obsessive, compulsive disorder.But in the differential diagnosis list on the anxiety disorders, there were a lot, so we’re just going to go through all of those.In the end, the diagnostic features again for specific phobias were pretty much a restatement of the diagnostic criteria-associated features.Interestingly enough, some people are arousal.Well, that makes sense when the HPA axis kicks off.A lot of people have a um increased heart rate, sort of a panic sort of feeling about them, not to the level of a panic attack necessarily, but they have that aroused state in preparation for fight or flee.Other people may have what they call a vasovagal response in which their heart rate decelerates their blood pressure drops, and they may faint my grandmother used to do this.Oh my gosh, and it wasn’t necessarily hers.Wasn’t phobia-related, but when she would get startled she would fall out and for the longest time the doctors, couldn’t figure out exactly what was going on. But ultimately my guess would be.It re had something to do with with anxiety or generalized anxiety.The prevalence of phobias is between eight and twelve percent, it peaks in adolescence at sixteen percent.So sixty percent of adolescents have specific phobias.The development, in course usually develops before age, 10 or after a trauma, and the presence of phobias is a risk factor for neurocognitive disorders in older adults.Why is this? We’ve again, we’ve talked in other videos about how hyperactivation of that stress response system keeps levels of glutamate and norepinephrine and stuff high in the brain which causes neurodegeneration, which can lead to neurocognitive disorders additionally, because of social withdrawal and avoidance and restructuring Of their daily lives, to avoid the phobic stimulus, there tends to be less stimulation for the person with specific phobias, which may also lead to a decline in what they call cognitive reserve and social anxiety disorder in social anxiety disorder.There’s a marked fear of social situations when in which one might be judged.So you’ve got generalized anxiety, which is anxiety about a lot of things over at least six months.We have a specific phobia, which is something specific.Like enclosed spaces or spiders, or snakes, um separation, anxiety, which is anxiety or fear of being separated from an attachment figure, and then social anxiety, which is fear from being in situations in which one might be judged by children. The symptoms have to be present not only in relationships with adults but in relationships with their peers.It’s natural for children to be somewhat anxious if they’re interacting with adults if they’re having the same anxiety when they’re interacting with their peers, then that’s really what we’re going to look for for a trigger The person has an excessive fear of being embarrassed, rejected or offensive, and the offensive seems to be increasing in popularity or not popularity in commonality, um very quickly, with Twitter and Facebook and tick tock, and all these other things and trying to be politically correct.A lot of people have developed a level of social anxiety, maybe not to the level of being a disorder, but, a level of social anxiety, because they fear not saying the right thing because they fear being canceled.Social situations almost always trigger anxiety and social anxiety disorder.Social situations are actively avoided or endured with intense fear, and the level of fear is disproportionate to the potential consequences.People may have a high level of fear and anxiety uh before going out and giving a performance in front of 10,000 people the level of anxiety for that would probably be different than giving a speech in front of six classmates.You know you see the difference here, but a person with social anxiety disorder.They would have that same level of fear in front of six people.They knew as opposed to ten thousand, that they didn’t persist again for six months or more causing clinically significant distress and is not due to another medical, mental, health, or substance-related condition.There is a note that social anxiety disorder can be performance only and you do want to specify that if it only has to do with giving speeches performing sports music, or anything like that, the diagnostic criteria features section, gave further examples of the symptoms that were identified in The diagnostic criteria associated features with social anxiety. The person may be passive or shy.They may want to kind of blend into the wall.They may be somewhat withdrawn because they don’t want to be out there in the limelight.They don’t want to be in this position where they fear being judged.On the other end of the spectrum, though, there’s a proportion of people with a social anxiety disorder who are highly controlling of situations, and they may try to control the conversation and control other people in the situation to avoid feeling out of control.Use of substances, substance, use, misuse or abuse is often associated with people with social anxiety disorder, and I have parenthetically heard liquid courage is what we used to call it back in the day I don’t know if it’s what they still call it but using substances to help temporarily allay anxiety.Interestingly, as alcohol leaves, the body people tend to have an enhanced anxiety response.So using alcohol before a social situation may end up causing more problems for some people, but that’s that’s up to them.Additionally, you may see a worsening of physical illness symptoms such as tachycardia or increased tremor in people with social anxiety disorder, so if they already have something that causes a tremor or a tick that may get worse, if they already have something that causes tachycardia, that may Get worse in situations in which they fear being judged.Now I have here increased pain, a question mark that’s not identified in the DSM 5t. However, we know that hyperactivation of the hpa axis contributes to ultimately development of systemic inflammation and the worsening of autoimmune disorders.So I would be interested to see what the actual numbers are for that and no, I could not find any research that compared the rates of increased pain with social anxiety, specifically prevalence.Seven percent of people in the United States experience social anxiety, disorder now brace yourself.This is not a typo.2 3 percent of people in Europe can be diagnosed with social anxiety disorder.So what is that? A third? What’s different in the United States? That is contributing to significantly higher rates of social anxiety fear of being judged and fear of offending people.Just saying additionally, social anxiety disorder does tend to be highest in non-Hispanic whites.So what is unique about nonhispanic? Whites in us I’ll leave you to talk about that and panic disorder, people with panic, disorder, experience, recurrent unexpected surges of intense fear or discomfort that peak within minutes and has a and accompanying four-plus symptoms.Now I have bolded and italicized unexpected here there are expected panic attacks when you’re in a situation in which you’ve had a panic attack before when there is a known trigger for the panic attack that’s an expected panic attack that doesn’t count towards our diagnosis here, which I don’t know seems a little strange, but okay, the panic attacks have to be unexpected.That is, they come from out of the clear blue and the panic attacks need to be characterized by four or more of the following symptoms palpitations, which is when it feels like your heart, is like fluttering, pounding, heart or tachycardia, which is racing heart, sweating, trembling or Shaking a feeling of shortness of breath or smothering you just can’t don’t feel like you can breathe, feeling like you’re, choking chest pain or discomfort, nausea or abdominal distress, feeling dizzy, unsteady lightheaded or faint chills or heat, sensations, numbness or tingling. Derealization, in which things just don’t feel real.You feel like you’re kind of a dream or depersonalization.You don’t feel, like you, ‘re part of your own body, anymore, with fear of losing control or going crazy and fear of dying.Now I’ll mention it, even though it’s pretty obvious.Many of these symptoms are also symptoms of a heart attack.It is important if you are a clinician not to assume that somebody who is experiencing a panic attack it’s, it’s, just a panic attack and to dismiss it.It’s important to take every panic attack seriously when somebody’s experiencing it and work with their medical provider to help them differentiate between what’s a panic attack.How do I know when I’m having another panic attack versus how do I know when I need to go to the ER and their doctor will work with them on that culture? Specific symptoms of panic may include tinnitus or ringing in the ear and neck.Soreness headache, uncontrollable, screaming, or crying.Interestingly, even though these are culture-specific symptoms, the DSM said those don’t count toward the required four plus symptoms. Additionally, at least one of the attacks – unexpected attacks has been followed by one month or more of both of the following persistent concern or worry about additional panic attacks or their consequences and a significant maladaptive change in behavior related to the attack avoidance of situations where You think they might happen again or ritualized, or superstitious behavior or extreme behavior, like changing your diet completely or doing something extreme to try to prevent the attack, so the unexpected attack happens and then for the next month or more.Both of those persistent concerns about it happening again and significant maladaptive changes in behavior are occurring, it has to cause clinically significant distress and it’s not due to another mental medical or substance use disorder.Interestingly, for panic attacks, there were no specifiers, but in the diagnostic features, it did note that panic attacks can be full meaning four or more symptoms or limited symptoms, so it doesn’t meet all of them.Doesn’t meet four symptoms or more, but the person’s having a panic response.If the person has never had a full-blown panic attack, uh, four or more symptoms, then you would not diagnose panic.Disorder frequency can be relatively regular like one per week or it can come in bursts where they, where they have multiple, really close together, then they go weeks months, or even years without having them, and then they have another burst of panic attacks, and there could also Be instances where they just have a panic attack, and then they may go for a couple of years or more before they have another one.It still qualifies as panic disorder.There is no code for remission of panic disorder and the expectation is unfortunately that if somebody has had a panic disorder at some point, they probably will have another panic attack at another point.Remember that expected panic attacks occur with known triggers, and there are many culture-related diagnostic issues due to expected triggers.So if you read through the culture-related diagnostic issues, a section of the DSM 5tr, you will find they talk about a lot of culture-bound triggers that can cause a panic attack in people’s associated features. People who have panic attacks.Panic disorder may also cause intermittent anxiety about health or mental health.They tend to be more somatically sensitive.That means they’re more aware of what’s going on in their body.Well, that makes sense if you’ve already had your body kind of go haywire on you once makes sense that you would be a little bit more hypersensitive to it happening again.They may have increased anxiety about their ability to tolerate daily stress there.A lot of times this may stem from the fear that if they experience too much stress it, ‘ll trigger another panic attack and they may have more extreme behaviors to control panic.The prevalence of panic disorder is about the same two and two percent to three percent in both the: u s in europe and Europe, the only disorder that had a marked difference between the; u s and other countries.Interestingly enough was social anxiety, disorder.The development of panic disorder, the median age – is 20 to 24 in us and 32 worldwide. So that is a little bit divergent.You know the prevalence, and the number of people that experience it worldwide are pretty comparable, but the median age for panic disorder is much younger in us than in other countries.Additionally, they speculate that older adults may attribute symptoms to medical conditions, so they may be underrepresented in the prevalence rates because when they’re having these panic symptoms, they’re, attributing them to medication, side effects, or other health conditions that they already have.So let’s talk about some of the risk and prognostic factors for anxiety disorders in general.Anxiety disorders often develop afterlife stress.This could be a death, a severe illness, a disaster, a big move becoming a parent adverse childhood experiences, or aces that’s just to name a few that those aren’t all of the causes, but I think it’s interesting that becoming A parent was in there as a life stress that often triggers the development of anxiety disorders.I mean I’m a parent myself.I can see how that could happen, but it’s not something that I had considered in the past as a risk factor for the development of anxiety disorders.People who’ve been bullied have an increased risk of developing anxiety disorders.The heritability of anxiety disorders ranges between 30 and 75 percent. I found that interesting, but they didn’t explain in any of the diagnoses whether they were looking at twins that were raised in the same household or twins that were raised in different households.If they’re raised in different households, it gives more credence to a genetic component.If they’re raised in the same household, then they experience the same psychosocial, and environmental stressors.Both of them are so.I don’t know what the actual data is on that person with negative affectivity.They tend to be more brooding, more depressed, more irritable people who are more self-conscious.People who ruminate more also all of these kinds are combined often referred to as neuroticism.They are at higher risk for the development of anxiety disorders.Attentional bias to threat was noted in generalized anxiety disorder as being an associated feature, but research shows that people with any anxiety disorder tend to have a stronger attentional bias to threat, which means they tend to be more hyper-vigilant.They tend to be more aware when there are, threats in the environment, and anxiety disorders by and large – tend to be much more frequent in women than in men. Interesting, not sure.Why again, my assumption is this is people who are biologically female and it seems to be consistent across cultures.Therefore, I am wondering what the genetic predisposition might be that may cause this.It seems like it’s, less about environment and shaping and behavioral training and more about a physiological response.But additionally – and these last two were not in the DSM.However, I did a PubMed search for risk factors for anxiety disorders and those who have a more external locus of control.That means they believe that things happen in the world by fate.By chance, there’s not a they.Don’t have a whole lot of control or ability to change what’s going on destiny is preordained, etc.People with that outlook who have a more external locus of control, tend to have much higher rates of anxiety and depressive disorders, and again not in the DSM, but in the PubMed. In the literature.People who have a lack of emotional support also tend to be at greater risk for developing anxiety disorders seems pretty self-explanatory in terms of suicidal thoughts.Anxiety itself increases the risk of suicidal thoughts.All of your anxiety disorders carry with them an increased risk of suicidal thoughts.People with separation anxiety have that generalized anxiety, related to increased risk, but people with specific phobias, interestingly enough, have an increased transition from ideation to attempt in a study that was cited in the DS well mentioned in the DSM, but they didn’t say what the study Was they looked at adults and they found that up to 30 percent of people who had their first suicide attempt? It was related.They also had a specific phobia or it was related to that specific phobia so that’s 30 percent is a big number uh.When we’re, especially when we’re talking about suicide attempts and suicidal ideation, if you have somebody with a specific phobia, we often downplay that because we think it’s just a fear of this or a fear of that.But that fear can feel very, limiting and oppressive to a lot of people, and again 30 percent of them.Uh, 30 percent of people who have attempted suicide also had specific phobia functional consequences.Now I could go on a diatribe about the functional consequences of anxiety disorders. The DSM didn’t have much to say about it, so let’s talk about some of these limited independent activities.This is especially true in agoraphobia and separation, anxiety, people who are afraid of leaving the house for fear of being separated from their significant other or for fear of being separated from their safe place, and people who have social anxiety, who fear being in social situations, may Have a lot of restrictions on their life activities and limited activities that they feel safe or comfortable doing by themselves, not in the DSM 5 tr, but in the literature, also the functional consequences of impaired relationships.People with anxiety disorders may be because of their restrictions on life activities and their um potential need to know where people are and their separation, anxiety, etc.A lot of times, people with anxiety disorders struggle in their relationships, because it can feel overwhelming to the partners.As I mentioned earlier, people with anger, and anxiety disorders, have higher rates of autoimmune issues.Continuous or excessive levels of stress hormones contribute to systemic inflammation, which will trigger depression or is associated with triggering depression and associated with worsening of autoimmune conditions and obesity.I thought this one was interesting, but it makes sense when you look at it.People with anxiety disorders, who often are restricted in their life activities, may feel worn down and exhausted.From being stressed out, all the time may not have a lot of energy to do.Other stuff tends to be more prone to develop obesity so that’s an interesting functional consequence now differential diagnosis, I told you there was a laundry list of them. Generalized anxiety, a disorder in gad.Excessive anxiety is about a variety of things for at least six months.Separation, anxiety, the worry or the anxiety is about separation from the attachment figure.Okay, that’s pretty clear, agoraphobia.The fear is about being trapped or helpless in situations in which escape is difficult.The fear surrounds being away from their safe place, not being away from a person they want to be in a place where they feel safe, and it needs to be not specific to one setting so being trapped or helpless in a situation.I give the example of an MRI that closed MRIs.Oh my gosh, I can’t stand them.I’m terrified of them, but that is specific to one setting and I’m not afraid to leave the house for fear of being trapped or helpless in a situation, social anxiety, anxiety is about being judged negatively, and illness anxiety and this illness anxiety.Falls under somatic disorders but illness anxiety. The worry is about the illness, not separation, judgment, or being away from your safe place, so that’s a differential diagnosis of your basic anxiety disorders in terms of other disorders because there’s that criteria not better explained by another mental health or medical disorder.In psychotic disorders, people who have hallucinations and delusions may also have anxiety, but their worry or fear surrounds hallucinations or delusions and is not reversed by context or the presence of an attachment figure.So a person with psychotic disorders, if their major attachment figure shows up does.  n’t help them feel more comfortable if they turn on the light to eliminate the shadows that don’t make them feel more comfortable, and the hallucinations are not due to psychotic disorders.The hallucinations are not due to something present in eating disorders avoidance behavior is only related to food and food-related cues.According to the DSM, however, one of the main criteria for your eating disorders is an excessive fear about weight, shape, and size, and it’s important to recognize that, because people with eating disorders may avoid mirrors and scales and food, obviously certain foods, and that could All be related to their eating disorder, body, dysmorphic disorder.The fears are only related to people being offended by a particular perceived flaw in obsessive-compulsive disorder.The fear is an object or situation as a result of obsessions.So if they start thinking about germs on their hands – and they keep thinking about it, then they start developing a fear of getting germs on their hands, so the fear becomes the object of their obsessions.Their obsessions turn to cause what they’re.Thinking about becoming a fear in the autism spectrum, the person lacks sufficient age, appropriate relationships, and social communication capacity in anxiety disorders. The person often has sufficient age-appropriate relationships and can communicate socially, and socially understand others, just fine.What we’re, looking at in anxiety, is fear of being judged conduct.Disorder.School avoidance is a very common symptom of conduct disorder, but school avoidance is not due to worry or fear in conduct, disorder, school avoidance, and conduct disorder are due to not wanting to be told what to do.Thank you very much in oppositional defiant disorder, the oppositional behaviors occur in response to multiple situations, not just separation or situational anxiety, not just in response to an anxiety-provoking threat.So if somebody has separation anxiety, they may become oppositional about leaving their major attachment figure.If somebody has a social phobia, they may become oppositional about engaging in situations that would prompt that anxiety, or if they have a specific phobia, maybe they’re afraid of snakes.They may become oppositional about doing something like going hiking because they are actively avoiding that phobic stimulus if they are actively avoiding a phobic stimulus or an anxiety-provoking stimulus.It’s, probably not oppositional defiant.Now you can have both you can have them. Co occurs, but you do want to differentiate.What is the cause of the behavior? Prolonged grief is characterized by intense longing and yearning for the deceased, not fear of separation from them.Now you can have prolonged grief and separation.Anxiety, co occur, but you can’t.Have somebody who develops a fear of separation from others after a particularly particularly traumatic loss? That can happen, but you do want to differentiate and diagnose appropriately and in depression and bipolar.A lot of people who are in a major depressive episode may have reluctance to leave home, but this is due to a lack of motivation and energy to engage and apathy.It’s not due to fear of something out there.They just don’t care or they don’t have an energy personality.A person with a dependent personality relies too much on others.It’s not that they fear uh their safety or loss of attachment figures and avoidant personality disorder, broader avoidance patterns, and a pervasive negative self-concept, differentiate, avoidant, personality disorder from anxiety, and related disorders, not in the DSM I’m. Bringing up for differential diagnosis.Anxiety is related to apprehension and vigilance of physiological sensations and may have an onset after a concussion pots is a postural orthostatic tachycardia and when people have it, when they stand up, their heart rate will jump 30 or more beats just from when they move from sitting To standing and that can feel very scary, they can also get light headed they can.Faint hypoglycemia can also produce symptoms of anxiety sweating and agitation in people, so we want to differentially diagnose.I believe I read a study that more than 25 of Americans are pre-diabetic and don’t know it.Co-morbidity and anxiety disorders are comorbid with each other.So if you have one, you probably have some of its buddies.It’s also comorbid with depression.Bipolar PTSD, prolonged grief, obsessive-compulsive disorder, obsessive-compulsive personality disorder, somatic symptom, related disorders, so any of your physical symptom disorders, anti-social personality, specifically social anxiety, common commonly may co, occur with anti-social, oppositional, defiant disorder and substance use disorders.Physically autoimmune diseases may increase the risk of psychiatric disorders partially due to thyroid dysfunction when that hpa axis goes offline.It also affects the functioning of the thyroid cardiovascular issues like supraventricular tachycardia can also be misdiagnosed and is often misdiagnosed for panic disorder. Hormone level fluctuations, especially extreme hormone fluctuations, can contribute to anxiety, related symptoms, high levels of estrogen or testosterone, nutrient deficiencies, or toxicities.So too, much or too little of certain vitamins and minerals can also cause anxiety-like symptoms.Environmentally poverty is a high risk factor for the development of anxiety disorders, for obvious reasons and socially adverse childhood experiences that include abuse, neglect, abandonment, or mental illness in the household.Are all risk factors for the development of anxiety disorders later in life? Anxiety disorders represent an anxiety response that is developmentally culturally and contextually excessive it’s persistent or recurrent, and causes clinically significant distress, so that differentiates it from people’s run-of-the-mill anxiety.If you will multiple anxiety disorders are common.This presentation covered some of the more common anxiety disorders but did not cover selective mutism substance-induced anxiety or other specified and unspecified anxiety disorders.Finally, it is important to rule out or diagnose comorbidly any physiological causes of anxiety.Symptoms include cardiovascular issues, pots, or diabetes.
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Sociological Approach to Reducing Risk and Increasing Resilience Addiction Certification Exam Review

 This episode was pre-recorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through ALLCEUs. Register at ALLCEUs.com/CounselorToolbox. I’d like to welcome you to today’s presentation on the sociological approach to reducing risk and building resilience. As I was putting together This presentation it was kind of like right in the wake of when Harvey hit. And then you know recently we’ve had the shooting in Las Vegas, and some of the counselors, especially counselors in training that can’t be practiced independently yet that are in some of my social media groups and in my professional groups have been talking about how frustrating it is and even some of us who are licensed but just can’t wake up and go help the Red Cross right now about how frustrating it is not to be able to help and how much we want to help so what I usually do because you know I I’m generally not upwardly mobile where I can just drop everything and go to a crisis what I did after 9/11 was look at what things in that situation could I positively impact and how could I do it in a way that made sense but you know for my life because I can’t you know at that point I for 9/11 I had an infant at home and you know other stuff so we’re going to look when we’re talking about addressing issues like the opiate epidemic or the major problem of depression almost I guess anxiety almost one in four people has anxiety issues and we’re gonna look at some of that and try to figure out what can be done what can we do from where we are in a way that makes sense because yes we can influence politics and advocacy but what can we do with small chunks of time that are beneficial to helping the cause as well as you know could help the clients we have currently so we’ll define the socio-ecological not model which is Broth and Brenner’s model we’re going to apply it to addiction and mental health issues and explore different variables in this model and then discuss how this framework can be used in prevention and treatment of co-occurring or independently occurring disorders so we’re going to talk about how it may sense to conceptualize not only the development of addiction but also the development of things like eating disorders and mood disorders in terms of a socio-ecological model and even some things like bipolar and schizophrenia can be a person being genetically predisposed or whatever but there could be certain environmental factors that could you know trigger that first psychotic episodes so we want to look at what might be going on and how can we help prevent or treat now prevention can take the form of three different activities if you will prevent the problem so helping people not get depressed at all ever so starting to provide those skills and tools when people are knee-high to a grasshopper hopefully preventing worsening of the problem so people don’t get severely clinically depressed where they can’t get out of bed so the early intervention services and effective you know frontline resources and preventing associated fallout okay the person gets to press gets clinically depressed well let’s see if we can help them avoid losing their job because they can’t get out of bed to go to work develop additional health problems from being depressed or developing an addiction in order to self-medicate that depression so we’ve there are three different methods or avenues we can take in prevention and you know we want to look at them all because when you’ve got somebody who’s becoming clinically depressed you know they’re depressed you know situationally whatever something happened and it started to turn into something more than just a couple of days it’s going to start having associated fallout early and you know it’s not going to be huge they’re not going to lose a job right off they’re not going to start having major family problems right off but they are going to start having little hiccups because that depression causes an imbalance in their in their environment and we know environments like to maintain homeostasis and you know the kids are gonna be like well Mom why aren’t you getting up and doing these things and what’s going on and you know things are going to start changing and the person will need to be able to deal with that so the socio-ecological model explores and explains human behavior as the interaction between the individual and environmental systems there’s a fifth one that is more of your longitudinal but we’re going to talk about the four main ones today the micro the meso the EXO and the macro systems the microsystem involves well let’s start before that the individual if you look at the model is sort of the bull’s eye here and the individual is not considered a system but it involves all of the things about the individual including biology and personal learning that make people who they are okay so this person exists within a microsystem and that micro system is their family peers School Church synagogue whatever and health services things that they probably interface with regularly work should also be on that but it’s for some reason it’s not on this diagram anyway the mesosystem is the interconnection between microsystems so how do family and peers interact I don’t know about you thankfully my family might be very accepting of most of my peers but I know other friends of mine who brought home peers who were not as well accepted by their family so there was some conflict between the the family and the peers and we know how much peer pressure and peer relationships are important in an adolescents’ lives which creates conflict and consternation how does the family interface with school how does Pierce how does your peer group interact with school and do they see it as a good thing to do they see it as worthwhile you know etc so when we’re talking about the microsystem and the mesosystem we’re talking about things that people interface with daily so I want you to think about how the mesosystem and you can feel free to chime in on the chat room if you want how does the mesosystem family peer school church you know recreational activities health services impact the development of mental health or illness now you notice I’m trying to kind of switch ears for health because we want to promote health and we can look at the opposite for mental illness but you know if you have positive family peer interactions it’s probably going to support mental health it’s probably going to support decision-making in the adolescent it’s probably going to I mean and I’m thinking adults and adolescents here but family and friends you know if you want to think about you know how do you get along with your significant others peer groups and do they interface well or is it kind of like oil and water how does the how does your family interface with your work how do they deal with how many hours you have to work whether you’re getting called in at night or getting emails or text messages at 8 p.m. or you know what are their expectations and how does that influence if there’s a conflict you know if the family doesn’t like what’s going on at work or the fact that you know your boss is emailing you at 8 p.m. then it can create conflict within the environment which can lead to increased anxiety and depression and Yabadabadoo now how does mental health or illness impact the mesosystem so again thinking about how if someone is clinically depressed how does it impact their family how does it impact their peers and if you have a family member who has you know clinical depression or generalized anxiety how does it impact how your family interfaces with everything else because you know you end up having somebody or somebody in the family who may be caretaking for the person who has depression or anxiety or whatever the mental health issue is who’s not able to do the stuff that they were able to do so the rest of the families kind of pick slack so how does that affect how they interface you know the rest of the family members interface with school and work you know maybe they end up showing it more exhausted so it’s important to look at the mesosystem the exosystem involves links in a social setting in which the individual does not have a direct active role so for example how would I impact my spouse’s work and again if I am the identified patient and I’ve got clinical depression and I’m calling my spouse to come home because I just can’t be alone or my spouse is late to work or unproductive because he’s always exhausted when he gets to work because he has so much to do since I am you know not able to do as much right now then it could negatively impact his work and so we want to look at how that impacts how the home environment impacts work and how work impacts the home environment the macro system describes the culture socioeconomic status poverty ethnicity etc so what we’re looking at in the macro system is really the larger you know not just within your city maybe or even closer to your neighborhood we’re looking at what you see in the media what you see on national TV your your statewide elections your national elections your state laws and culture and what’s being communicated if you are a religious person what your religious culture communicates because you know religion generally is not just in one little area it’s international or national so what types of things does that communicate to to the person and how does that influence the development or not development if you will of depression anxiety or addiction so again think about how the exosystem of the social setting in which the individual doesn’t have a directive or an active role think about how much people were influenced after the elections I mean yeah we had a role if you went out and voted you had a role but you don’t decide the election so once that happens how do you know the exosystem impact you know your your emotions your other community events employment etc and how those things impact the family I know you know there was a lot of consternation and concern among some of my friends who are Jewish after the last election so their families experienced a high ink or a great increase in anxiety development of mental health or mental illness how does all this stuff that’s going on in the exosystem and stuff that you don’t have direct control over how does it impact the development of mental illness you know or mental health and we’re going to talk more specifically in a couple of minutes and again likewise how does mental illness or mental health impact the exosystem if you have a healthy workforce if you have healthy people who are actively participating in work and going to community activities voting to participate then you’re probably going to have a healthier outcome than if you have people who are not able I mean they’re so depressed they’re not able to even get out and participate so we want to look at the reciprocal nature it’s not one way the community doesn’t just affect us you know it may affect us but then how we react affects the community how does the attitude of the culture impact the community if you’ve got a a culture that is accepting of certain ideologies they’re accepting of LGBTQI they’re accepting of people who are Muslim in their religion they’re accepting of people who are Christian and their religion they’re accepting of you know fill in the blank if the culture is accepting of that how does that affect the community and those people within the community who might you know otherwise not have been accepting does it kind of pressure them in or does it cause anxiety and consternation in those people how does the attitude of the culture for example about premarital sex and marriage affect the family how does it affect the development of and again we’re thinking about anxiety depression and addiction so how does it affect the development of stress which may lead to mood disorders or problems and how did the community families and individuals with mental health or mental illness impacts the culture you know so we have an impact on our culture we get together we see you know we have Generation X Generation Y but the baby boomers all had their sort of or we all have our sort of unique cultures and things that we bring to the table and things you know that was given to us we said no we don’t want to thank you very much so there is a give-and-take among the individuals within the culture and that’s good because that means we can start small you know start in our locale and create this positive mesosystem and then build from there if If you have a positive community then that’s probably going to spread think about when a company goes and dumps fertilizer for example into a waterway it doesn’t just stay there over time that fertilizer bleeds out and you start having algae blooms everywhere things don’t stay I mean in our society things don’t stay in one place for very long they tend to move they tend to migrate so positive will migrate that’s awesome negative can also migrate so we want to look at how can we enhance the positive migration and keep down the negative if you will so now let’s start talking about what can we do and how can we operationalize all of this we realize that if we affect the individual it’ll have a positive effect on the meso system which can have a positive effect on the exosystem Yabadabadoo so great we also realize that one of the only things we have a lot of control over is the individual ourselves so a lot of people come to counseling individually score so this is where we’re going to start so what things contribute I start by listing risk factors for the development of mood disorders and addictions and then we talk about capital you know what you have in order to you need to have to prevent these things and then prevention strategies so that’s kind of how we’re going to go it’s not going to stay depressing individuals with chronic pain are at higher risk of mood disorders or addiction addiction because of the pain management you know drugs that are out there and you know once they start taking payment management drugs opiates a lot of times the brain quits producing endogenous opioids the natural painkillers so when they first come off the body doesn’t automatically pick up so it takes a little while for the person’s pain tolerance to build back up which keeps some people from wanting to get off the medication among other things but chronic pain can also be debilitating it can make people lose some abilities that they used to have or crush some dreams if you will you no, I think I’ve told you before that I have a bad shoulder and carpal tunnel so I can’t garden the way I used to you know I still go out and do it but I’ve got to pay attention and only be out there for an hour too instead of spending six hours out on the farm which is frustrating to me it was only mildly frustrating but my grandfather when he started developing Parkinson’s couldn’t make his miniatures anymore and he made gorgeous miniatures and I know that’s not chronic pain but it’s kind of the same thing if you’ve got rheumatoid arthritis he couldn’t make his miniatures and he became devastated and became withdrawn so understanding that pain has multiple influences that can cause depression that may trigger a grief reaction that we need to help people address now the things I put in bold are things that we as clinicians can easily help people prevent or/or address chronic pain we can help For people with low self-esteem that’s a no-brainer if people don’t feel good about themselves and they’re looking for external validation they’re going to be at a higher risk for anxiety fear of abandonment fear of not being good enough fear of failure and depression a sense of hopelessness and helplessness substance use especially early substance use can cause changes in the prefrontal cortex leading to problems with impulse control and decision-making but it can also disrupt the balance of neurochemicals leading to symptoms of depression and/or anxiety so it’s important to understand that especially the earlier the substance use starts the greater the chance that it’s going to cause some sort of brain changes and we’ve also found that a lot of people, not the majority but there is a percentage a significant percentage of people that when they start using early they kind of quit developing coping skills after that they find something that works they’re like oh I like this I think I’ll use that from now on when we start talking about people who started drinking or smoking marijuana when they were you know 9 10 11 12 you might see more mood issues or addiction issues in those people than people who didn’t start using mood-altering drugs as early as a history of abuse can contribute to the development of PTSD but not everybody who is abused develops PTSD but there can be episodes of anxiety and depression as well as it increases the chances of the development of addiction genetic vulnerability we know that mood disorders and addictions tend to run in families and they’ve done studies that have shown that there is a genetic component doesn’t mean it’s going to happen it just means you have this gene there that could be triggered so we don’t want we want to make sure that clients know that they are not just doomed you know they can prevent triggering that but they need to be aware that they may be more vulnerable inappropriate coping responses if we are not born with coping skills so if somebody doesn’t know how to cope with life on life’s terms because either because they’ve always been shielded or because they’ve never had anybody helped them maybe they were kind of on their own from the get-go so they learned to lash out and get angry or withdraw and get depressed but they never really learned how to deal with the stuff they’re gonna be at higher risk of mood and addictive disorders we can help people develop coping responses are one of the things you want to look at when people are using seemingly unhelpful behaviors is to remember to ask what is the cause of this so we want to look at what is the root cause of what is prompting this behavior and what is the benefit of the current behaviors and I’m going to keep reminding you of that as we go through this violence and aggression you know again what’s the cause of the violence and aggression did people do this person learn that’s how you cope with distress in their family of origin is it a protective mechanism because they’ve experienced situations where that has helped them deal with conflict before what prompts this and what the benefit to it when they act out when they’re violent and aggressive what is the benefit it gives them power it pushes people away they just enjoy hurting people hopefully that’s the minority but we want to ask that because we can’t figure out an alternative until we know what the function is same thing with risk-taking and impulsivity there are certain theories that says some people need more stimulation than others they get bored easily so they tend to be higher risk-takers and maybe more impulsive than you want to ask if this person doing this you know I have a friend who is an adrenaline junkie you know skydiving rock climbing you name it he’s done it and you know more power to him I don’t see a purpose of jumping out of a perfectly good airplane but he he thrives on that and when he can’t get out and do those sorts of things he feels good so what is it about this risk-taking and what kind of risk-taking it risk-taking as in holding a balloon liquor store or is it risk-taking as in doing something like skydiving which is theoretically safe and what’s the benefit it makes gives them a rush makes they feel good helps him you know escape or whatever great that’s fine the rebellious nests you know again what is and this is a key for adolescents especially but even if you’re a supervisor working with employees if they’re being rebellious you want to look and say what’s the point what’s the benefit to being rebellious what are they holding on to and refusing to let go of that you want them to let go of or what are they refusing to do that you want them to do and what’s the benefit to it if they are being rebellious and they’re staying like think again adolescents staying out all night OK well what’s a motivating factor is it to get under their parent’s skin probably not is it to conform to peer pressure you know oftentimes that’s maybe the case but you have to look at the individual and say ok how can you do this in a way that helps you move forward rejection of pro-social values if the people who espouse the pro-social values are the people that the person rejects then they’re probably going to reject those values so we want to look at you to know if you’re rejecting those what values are you espousing and why are those important to you and why are you rejecting these over here you know not saying it’s right or wrong I’m just trying to understand where you’re coming from and you know that’s something that we’ve got to be sensitive to and different people are going to hold different values lack peer refusal skills to stay out late to get into trouble to use drugs to have early sex whatever it is those things a lot of times indicate poor communication skills and low self-esteem need to be accepted you know all that stuff that’s challenging during during teen and early adolescent years those are things we can help with being bullied you know that’s a risk factor when people are bullied they tend to get depressed and when they’re bullied they may turn to substances to try to make themselves feel better to numb the pain they make self-injure there’s a lot of different things might happen we can help people develop skills to deal with being bullied since we don’t understand a hundred percent why people bully we need to help the victims become survivors we need to help them have the tools to be able to deal with it and understand why it happens without letting it hurt them early and persistent problem behaviors that’s just so broad but again look at why the person’s child acting out an early sexual activity could be a history of sexual abuse could be a dysfunctional family of origin and the child is trying to get out I worked with a 14-year-old who once told me she was gonna get pregnant as soon as she turned 15 because that’s when she could get into housing on her own so she was intentionally going to get pregnant at 15 and there was a reason for it she was very clear about her logic a lot of times it’s peer pressure and acceptance but uh asking what is that what is the cause and is this cause going to keep the person from developing healthy coping skills and being happy is potentially going to lead to depression peer rejection you know that hurts so helping people figure out how to navigate peer rejection because you’re not going to be liked by everybody academic failure we can help with now not necessarily as clinicians but we can advocate for the person we can help them find tutors resources etc lack of information on positive health behaviors put it out there most of the time youth these days have a pretty good idea of what’s healthy and what’s not they just aren’t motivated for it they’re motivated for something else when addictive behaviors are you used to cope with stress or unpleasant feelings I said coping skills may fail to develop or when they’re used to enhance self-confidence such as drinking before going to a party then they may start to develop anxiety and self-consciousness when they don’t have a drink on board so it may start prompting the development of some mood disorders in addition to the fact that repeated use especially in a young brain can cause some neurotransmitter imbalances using addictive behaviors also to enhance other experiences ties it to those experiences making them person more likely to use those and similar situations desensitizing the brain’s pleasure centers so what am I what do I mean I mean if you typically drink when you are watching football then you’re going to be more likely to drink every time you watch football it’s just one of those things you do when you watch football if you’re one of those people who eat when they watch TV then when you watch TV you’re more likely to eat when you go to the movies because that’s a similar situation you’re more likely to want to have popcorn or eat so it’s important to understand that with addictive behaviors if you have something that produces pleasure it can be triggered you know the person can start thinking about it in a similar situations using repeatedly can cause neurochemical imbalances in genetics you know you can’t be born with a neurochemical imbalance not enough serotonin too much whatever and poor health behaviors as I’ve talked about a bunch of times not enough sleep quality poor nutrition and high stress can also cause neurochemical imbalances so we can educate people about some of the things that can cause depression and anxiety so they can prevent it we can educate parents so they can start coaching their kids from the get-go so personal recovery capital to develop what we need to be happy and healthy human beings we have to have certain things to help us along the way we need to have the things to enable us for physical health think about Maslow’s pure hierarchy bottom level is all your health and biological needs we need to have our physical health and that includes nutrition Slee and you know not being in pain all the time sometimes you’re gonna feel pain that’s being human that’s being alive but we need to have our health for the the most part we need to have financial assets to get our basic needs met you now get that food keep clothing on our back transportation roof over our heads health insurance and access to medication and there are two different things health insurance covers theoretically going to the doctor and the mental health counselor etc access to medication is not covered under a lot of insurance so remember that most pharmaceutical companies have patient assistance programs that can help clients access their medication if they can’t afford it because some medication is a really expensive safe housing conduct that’s conducive to recovery and that’s not just addictions if you’ve got somebody who is clinically depressed or highly anxious living in a radically dysfunctional household where there’s lots of yelling or arguing or other people who are similarly dysfunctional it’s probably not going to prompt those positive cognitions and mindfulness and everything that we’re trying to establish doesn’t mean they can move unfortunately a lot of people can’t so we got to talk about how can you create an area in your housing environment that’s safe people need to have adequate clothing to stay warm to be able to dress for work and you know go to their job and be dressed appropriately and transportation to get their needs met most of us don’t live in a city where we can just walk but walking I guess is a form of transportation we need to be able to access the resources that are out there whether it be food or going to work so we can pay our light bill or whatever it is values awareness people need to know what’s important to them to figure out what they need to do to be happy a sense of purpose helps people keep going and we can help people with this I mean these are easy exercises when you give them a values activity worksheet you know what are your top five values when you look at the sense of purpose what is your purpose in life and a lot of us don’t know but we know what we want it to be or we can start theorizing about what is the purpose of what I do as a job on a day-to-day basis, what is the purpose of this activity that I’m doing so they can start to see some meaning in the stuff they do we can help people develop hope and optimism and we’ve talked about that one people need to have a perception of their past present and future they need to be able to look over the past and it may suck or it may be great but they need to be able to look back over it and go yep that’s it they need to be able to look at their present and realistically assess what they’ve got and maybe what they don’t have but realistically assess what they’ve got and look at their future and go where do I want to go from here because you’re here and you don’t want to stay here forever you can’t stay here forever because times gonna move on what next people need to be able to see but understand that they’re not necessarily controlled by their past or stuck in the present that they have the ability to make choices every single moment to work toward what they want for the future education training and job skills people need to be able to make a living that’s just the way it is you need to be able to feed yourself and put a roof over your head so we can make referrals to job training agencies we can make referrals to social service agencies problem-solving skills interpersonal skills and self-esteem are all things that we are super skilled at teaching and we can teach these in chunks they don’t have to be these long groups don’t have to be big drawn-out sessions we can provide people snippets you can provide somebody with the concept of distressed tolerance and the improve acronym in a handout and have them look at that or in an email you know if you email your clients once each day or on your blog there are a lot of different ways, you can just get that information out there and in front of people so I can look at it I call I tell my clients it’s bathroom reading you know I usually give them a handout or two and I just put it on the back of the toilet and when you’re in there you know take a look at it if it’s useful great if not bottle it up and throw it in the the trashcan I’m good with that but there’s no pressure and I’m not putting extra assignments on them I’m just providing information about a skill and then if they want to pursue it further when they come back to counseling we can talk about it so what can we do we can promote positive health and wellness behaviors by educating people about why they’re important and what to do and where to find more information you know because some of these things like nutrition we can’t be prescriptive but we can point people in the direction of where to get good advice and information and we can also model this you know in our treatment plan at least in mind I try to make sure that people are putting a print emphasizing getting enough quality sleep eating well and maybe exercising at least moving around if they don’t want to call it exercise but taking care of themselves and getting some relaxation and recreation in their bonding to a pro-social culture is difficult for us to do for people or do with people we can talk about what are your hobbies what are things that you enjoy doing and encourage people to try out volunteering or get involved in meetups to engage in activities with other people but that’s something that they’re going to have to do on their participation in extracurricular activities again kind of the same thing we can point them in the right direction of volunteerism meetups things through their through their church or their synagogue or their you know whatever clubs that they’re involved in positive relationships with adults now obviously this is more important if we’re working with children or teenagers we want to help children and teenagers kind of see where adults don’t have their head that far in the ground but we also want to help adults learn how to more effectively communicate with teenagers because a lot of adults lecture at and I know this and you’ll you’ll understand when you’re older and you know lots of that kind of stuff so things that we can do to enhance relationships with adults is to educate people about you know how to effectively communicate with teenagers for example who are trying to find their way and trying to assert independence and resisting some rules how do you deal with that how do you communicate with them in a way because a lot of parents have difficulty navigating that boundary between friend and parent so we can help with that active workshops in the community workshops you can do at churches at libraries those are things you can do there you can put them on for like an an hour once a month it’s good if you’re it’s free but it’s a good promotion for your practice if you know you go out and do it and people come to learn something from you, they’re like hey that might be helpful social competence it’s another one of those things that we can do in little snippets we can provide tips and tips and tools whether infographics on an Instagram page are really useful for a lot of teenagers they want something that’s you know in a picture and fast it’s a snapshot so social competence checklists are another really good thing if you’re teaching different types of skills for communication or how you’re supposed to use different forks I know the first time I went to a formal dinner I was looking at all the silverware going I have no idea what to do with this stuff the sense of well-being and self-confidence we can help people develop this by encouraging them to focus on what they do well we want to make sure they have plans well that means goal setting and since a lot of people don’t know how to goal-set they don’t have goals, so they’re just kind of floating out there not looking at the future we want to help people look at the future and figure out how they’re going to get there so they’re like wow this is doable this is attainable this is another thing you can put work put worksheets on your website you can do short workshops to help people figure out how to look at how to define or learn how to define a rich and meaningful life and figure out how they’re going to define their goals and achieve their knowledge about risks associated with addictive behaviors now a lot of kids you know think back to the old dare programs I had a lot of clients tell me that those programs only taught me how to you safely I was like well that’s not what they were intended for but we do want to educate youth about you know still about the risks of some of those drugs and even adults not just youth educate people about how dangerous or how potentially addictive opiates for example can be after three to five days your body has already started to build up a tolerance that’s kind of scary so helping people understand that but also addictive behaviors like pornography a lot of teens don’t think about it a lot of adults don’t think about it until they’re stuck in it or online gambling you know those are some things that can kind of catch people unawares because they didn’t think about it wasn’t a substance we typically think of addictions as substances since it’s not a substance they didn’t think about the effect that the pleasure from those activities were going to have on our neurochemicals and create a a situation where they didn’t feel okay they didn’t feel normal they didn’t feel happy without having that in their life because their dopamine receptors had been blunted individual prevention strategies the big summary is we want to promote attitudes beliefs and behaviors that ultimately provide the person with healthy coping skills whether it’s through health class whether it’s through workshops I know at organizations I’ve worked at before the Jaypee would come in and do periodic workshops that’s a great way to connect with people and reduce utilization if you do psycho-educational prevention group because an ounce of prevention is worth a pound of cure we want to make sure that they’re aware of positive health behaviors and how to access those resources in Gainesville I don’t know about up here but I know in Gainesville the mall used to open at six o’clock in the morning so people could walk inside in a safe place and you know be out of the elements and yadda-yadda so just letting people know that that existed was a big step because they were like well I don’t want to join a gym and go to the mall with effective interpersonal skills we want to make sure people know how to effectively communicate set boundaries all that stuff that we talked about this can be taught it’s nice if your local news is willing to use you to do you know wellness minute I find one of the best places to do that is either right before or right after the weather because most everybody Tunes in for the weather, I may not stick around for the animal of the day or whatever well I always do but I’m always tuned in for the weather so if you get either right before or right after that you tend to get higher viewership and reach more people and a minute gives somebody a chunk of something that they can use today-specific approaches may include education and life skills training in schools you know is provided to the kids and have them share it with their parents through the media and community center or library workshops those are all great ways to get stuff out I encourage you if you want to get into providing prevention and helping to help your community helping people to prevent getting depressed or anxious or developing other problems to look at doing some of these very time-limited things because you don’t want to lose a lot of billable hours but we still want to be able to do more than we’re doing at least that’s what a lot of a lot of us tend to feel like the mesosystem so we’ve been talking about the individuals so far because that’s where we can have the greatest effect the mesosystem examines close relationships that may increase the risk of experimenting with high-risk behaviors or developing mood disorders people’s closest circle of peers partners and family members influence their behavior and contribute to their range of experience if you’ve got a child that grows up in a household where the parent or parents are clinically depressed they’re not able to model effective coping skills where they model cognitive distortions guess what jr. Is gonna pick up if you are in a household where you know you’re in college and you’ve got four other roommates and all of your your other roommates tend to be negative and naysayers you’re either probably going to move or you may that might start wearing off on you a little bit likewise if they are you know all kinds of go-getters that can wear off on you too so you know there’s going to be an impact risk factor is peer and family reinforcement of negative or unhealthy norms and expectations so if your family says you know people suck they’re always going to take advantage of you what are you going to take away from that and is that going to contribute to you probably having difficulties with trusting and maybe developing depression possibly so we want to look at what kind of messages is the peer group or family sending to the individual that may contribute to the development of mood or anxiety disorders early sexual activity among peers could communicate that well this is the norm so everybody’s doing it ties to deviant peers and gang involvement you know especially at that particular group there’s a lot of pressure to conform or there’s a negative consequences family members who don’t spend much time together and this could be because parents work a lot this could be because everybody’s you know involved in all kinds of other stuff but they found that when families are disengaged the parents tend to miss out on subtle cues when families are disengaged even if they don’t have children in the mix that there tends to be a weakening of those bonds supportive bonds so people are at higher risk for development of depression and anxiety because they don’t have that you know everybody’s behind me sort of feeling parents who have trouble keeping track of youth can indicate that the youth may be at risk for developing substance or more mood disorders lack of clear rules and consequences you think about even just being at work when there’s a lack of clear rules and consequences you don’t exactly know what you’re supposed to do I know for me that creates doodles of anxiety I like manuals and to date pretty much every job I’ve ever taken I’ve walked in and there hasn’t been a manual and I’ve been like okay there must be a manual written and that’s been my first thing now I’m kind of on the structured side so I don’t expect everybody is that way but most of us tend to experience a little bit of anxiety about failure about acceptance if we don’t know what’s expected so it’s important whether it’s a family or a job situation to make sure there’s clear rules and consequences you know what’s expected and what’s going to happen if you mess up or if you don’t meet this expectation there also needs to be consistent expectations and limits you know when people especially children but a lot of us tested our limits when we were kids and even as adults you know I know you know going back to working in organizations I would have staff who would test limits and see how long they could go without turning in a progress note before I’d be knocking on their door going paperwork it’s natural for people to kind of test limits especially with stuff they don’t want to do stuff that’s not rewarding family conflict and abuse can cause a high risk of depression and anxiety whether adults or children I mean if there’s a a lot of conflict and chaos it’s exhausting and it can cause a lot of dysphoric emotions and loss of employment that’s kind of self-explanatory protective factors close family relationships so as clinicians we can encourage people to identify who they consider their family it may not be their blood relatives or their family who are there for them who can they call it 2:00 in the morning and how can they nurture those relationships encourage people to develop relationships with peers that are involved in pro-social activities like hiking or volunteering in the community consistency of parenting is important in terms of producing children who are who are stronger healthier more resilient encouraging education and parents who are actively involved can help prevent future depression because they’re creating children who can join the workforce and have that individual capital to prevent depression and anxiety and cope with stress positively and this is a family protective factor and a peer for protective factor why because we learn from observation so if our peers cope with stress positively by prayer or exercise or whatever it is they do and our family has other positive ways of coping with stress and we’re going to have a greater venue of stuff to choose from supportive relationships with caring for adults beyond the immediate family is encouraged so we want children to grow up being able to interact with teachers coaches with you know Scout leaders whomever and start seeing that people outside of the nuclear family are trustworthy sharing and family responsibilities including chores and decision making and that’s true for children teenagers and even adults you know if you’re living in the same household it important that everybody feels like they have a say in what’s happening and participates in the upkeep of the family environment and family members are nurturing and support each other and this is one where I tend to stop and I do a love languages little mini class to help people remember that we don’t always experience nurturance in the same way so understanding one another’s love language is really important to be able to nurture in a way that’s meaningful to that other person peer and family interventions are designed to identify norms goals and expectations in the family foster family problem-solving skills so there’s not just one person always fixing it develop structure and consistency within the family unit promote healthy relationships and engage peers and family of choice in the recovery process so if somebody’s already depressed we need to be able to hopefully engage everybody that’s involved in this person’s immediate environment in helping them move towards recovery and you know preferably not dragging them back down so we want to engage them and make sure that people have a supportive others school and work risk factors lack of clear expectations both academic or performance-wise and behavioral lack of commitment or sense of belonging at school or at work if you just kind of go and you feel like a number you punch in punch out that may not make you feel appreciated which can contribute to depression and you know just bad feelings high numbers of students failing academically at school and work translates to high amounts of turnover if you never know who’s going to get laid off it increases stress and anxiety and parents and community members who are not actively involved in keeping kids in school and helping make sure that the workforce workforce is strong but we want to make sure that people have access to how when it’s needed we want to make sure that people have access to tutoring in school if they need it to prevent failing school they have access to transportation to get to work now those are things those are meta concepts that are more on the community level but it’s important that as a community member you know we look at different things that we may be able to participate in advocacy and say you know it’s really important to get a bus system going I live out about 30 miles east of Nashville and we must have the the train that goes from my city out to Nashville so people have access to more jobs so that was important for us to get past the City Commission protective factors school and work positive attitudes gotta find a reason why you’re doing this you know and sometimes it’s hard to find a reason for algebra but we need to help kids find a reason for that we need to help adults find a reason for why they’re going to work why are they doing what they’re doing regular attendance shows you know it is associated with higher mood less less risk of mood or addictive disorders because you’re able to get up and do it and interface with people and get that social support hopefully from your colleague’s high expectations are communicated effectively in setting and positive social development is encouraged you know whether it’s at work or at school, there are goals there are things you’ve got to accomplish there are performance objectives but we also want to encourage morale and positive social bonding whatever the setting having a positive instructional climate again whether at work or school, I know we learn things when we’re on the job we learn things and I don’t want people to feel like they’re having difficulty like they’re stupid I want people to feel like anything that we teach them as a challenge and something that may be beneficial down the road leadership and decision-making opportunities are really important again for students or employees to prevent burnout keep morale up reduce anxiety and increase a sense of personal empower and connection and active involvement for everybody is fostered and the school or organization is responsive to the student’s needs making sure that in school in the case of school they have access to tutoring resources it’s a safe environment for them to be in and the children that are going to that school have enough food in their bellies you know they can’t learn if they’re hungry all the time workplace is a little bit different but we still need to be responsive to people’s needs in terms of you know family requirements whether they need to if they’re going back to school shifting schedules a little bit we need to try to work with people instead of being completely rigid and it’s my way or the highway when possible to promote the best mental health characteristics of settings in which relationships are often associated with the development of mood disorders and addictive behaviors so we want to look at the characteristics of schools that are they safe are they positive environments are they cheering squads or are they places where people know they’re gonna go and get thrown under the bus same thing with workplaces you know when you walk into a place you get most of we get a sense and you’re either like oh this is a cool place to work or oh I can’t wait til I can get out of here you know we want to go toward the other end and neighborhoods when you go into a neighborhood – people take care of their environment do they or do they have trash strewn all over their lawn all of these things communicate how people feel about their environment and generally how they feel about themselves and whether they have the energy to take care of stuff or they just feel completely disenfranchised and don’t care more about community risk factors no sense of connection to the community neighborhood disorganization rapid changes high unemployment a lack of strong social institutions lack of monitoring of youths activities imbalanced media portrayals of safety health and appropriate behavior misleading advertising and alcohol or drugs readily available a lot of stuff we do we’re not going to be able to affect on the community level so much but we’re gonna hit them real quick we want to improve the climate process and policies within community schools and workplaces to make it safe and promote positive health behaviors prevention strategies are designed to reduce social isolation reduce and address stigma increase awareness of local recovery models you know who’s out there that has recovered and can serve as a role model improve economic and housing opportunities so people have a house a safe roof over their head and they can you know earn money and feel good about themselves increasing the accuracy and improving the positivity of media messages and increasing physical and financial ability availability of recovery so like I said I live in a little town so it’s nice that we have a community mental health center here so people don’t have to rely on going into Nashville but also making sure that services are financially available whether you have a free clinic once a month or you know make sure you’ll you take Medicaid but there are still a lot of people who have no insurance so where do they go the socio-ecological model identifies how the end the individual impacts and is impacted by not only his own characteristics but also those of family peers community and culture prevention takes the form of preventing the problem preventing the worsening of the problem and preventing associated fallout like I said as clinicians a lot of what we’re going to do is target the individual providing them with resiliency skills to deal with some of this adversity that might be around them and to help them sort through some of those media messages and go yeah that’s not even true you know if I drink this vodka I’m not suddenly going to have 14 supermodels hanging on me or whatever it is that’s being communicated so encouraging people to be informed and Wylie consumers any change in the the system will affect other parts of this system so if it’s a positive change is probably going to have positive changes negative has negative changes addressing addictive and mood disorder behaviors require a the multi-pronged approach we need to look at the individual and you know provide provide as many skills as possible there because that’s where we’re going to have a lot of our impact especially in prevention but we also need to realize that this person resides within a family you know whether they live alone which sometimes is less problematic or they live in a household with other people, we need to make sure that where they lay their heads at night where they spend their non-working hours feel safe and is conducive to recovery where they work or go to school also needs to feel safe and be conducive to recovery and that’s part of the community so we need to kind of look at these areas and if they aren’t safe or they don’t feel safe or aren’t conducive to recovery, we need to help people how to figure out how they can fix that or address it like I said they may not be able to move so what can you do to set some boundaries to create as much safety as you can how can you do this and there are a lot of different techniques that I’m sure you already have that you used to help people but it’s important again not to just focus on the individual because they don’t live in a bubble we need to look at everything right and are Are there any questions now we have or I have added a Wednesday class, so you don’t don’t have to come but if you have unlimited membership same time same station Wednesday so Tuesday Wednesday and Thursday we have a class from noon. CST 1 p.m. EST 2 for an hour all righty I will talk to y’all maybe tomorrow maybe on Thursday have a great day 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 use coupon code consular toolbox to get a 20% discount off your order this month.As found on YouTubeI thought my anxiety disorder was for life… $49.⁰⁰ But I Discovered How Hundreds Of Former Anxiety Sufferers Melted Away Their Anxiety And Now Live Relaxed, Happy Lives – With No Trace Of Anxiety Or Depression At All! http://flywait.anxiety4.hop.clickbank.net We’ve seen so many people go anxiety-free that we have no hesitation in guaranteeing this program. 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Addressing Vulnerabilities to Prevent Anxiety, Depression and Pain

 This episode was pre-recorded As part of a live continuing   education webinar on-demand CEUs are still available for this presentation   through all CEUs registered at all CEUs.com/counselor toolbox I’d like to welcome everybody to today’s presentation we’re going to return to   talking about vulnerabilities and this is a topic We’ve covered it before, but you know I don’t seem to   be able to say enough about it so we’re going to talk some more about it we’re going to define   what vulnerabilities are and you know I expand the definition more than what occurred in   dialectical behavior therapy because I think there are a lot of other resources or vulnerabilities   out there sorry I’m trying to read two things at Once anyhow we’re going to identify some of the   most common vulnerabilities as I define them so We’re going to go beyond sleep in nutrition and we’re going to look at environmental vulnerabilities…
 
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Dr. Dawn-Elise Snipes is a Licensed Professional Counselor and Qualified Clinical Supervisor. She received her PhD in Mental Health Counseling from the University of Florida in 2002. In addition to being a practicing clinician, she has provided training to counselors, social workers, nurses, and case managers internationally since 2006 through AllCEUs.com A direct link to the CEU course is https://www.allceus.com/member/cart/i…
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Best Practices for Anxiety Treatment | Cognitive Behavioral Therapy

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

 This episode was pre-recorded as part of a live continuing   education webinar on-demand CEUs are still available for this presentation   through all CEUs registered at all CEUs comm slash counselor toolbox I’d like to welcome everybody today to the presentation love me doesn’t leave me addressing   fears of abandonment the purpose of this presentation is really to help us help clients   increase their awareness of their story including beliefs about behavioral reactions to situations   that trigger their fear of abandonment so how do we do that well the first thing we need to   figure out is what fear of abandonment is and how can we identify it in a clinical set setting then   we’re going to explore the concept of schemas or core beliefs and these are things that are formed   in early childhood you know if you remember prior classes we’ve talked about early childhood   cognition is generally very dichotomous in children Young children can’t look at   that gray area so these schemas if they’ve gone unchecked can lead to some very extreme belief   patterns which lead us into common traps in thinking reacting and relationships if your   schemas are based on all-or-nothing you either love me or you’re going to leave me hence the   name of the book then your reactions are going to tend to be more extreme and more all-or-nothing   which increases anxiety because then anytime a person who perceives any amount of disapproval is going to go to that extreme so we want to talk about bringing it more toward the   middle line and helping people learn to appreciate and love themselves for themselves while they may   not approve of the behaviors of other people they can still love other people so just because somebody   doesn’t approve of your behavior doesn’t mean necessarily that they’re going to abandon you so   we’re going to talk about that and then we’ll learn skills necessary to help people accept   their past as part of their story maybe they do have a lot of abandonment issues and you know   some people do and it is painful it cuts to the core especially when those abandonment   issues occur in early childhood when kids going what that does so we’re going to talk about that   and help people learn how to integrate it into their present and we’ll learn the skills necessary   to acknowledge that their past does not have to continue to negatively impact them in the present   so if they were abandoned when they were a child you know we need to deal with that however if they   continue to expect that every significant person in their life will abandon them notice I use the   word every because we’re still in those extremes then they’re going to think that the past is negatively   impacting them in the present so we’ll talk about how to sort of moderate those belief systems how   does this impact recovery whether you’re talking about addiction or mental health issues connection   is a basic human need we are not meant for the most part to be Hermits in the middle of the   woods there are introverts and in my husband’s an introvert he has a couple of excellent friends   he needs quiet time each day he doesn’t need to be surrounded by people and he’s fine but I mean   we’ve got human connection he’s not going to be one that’s just going to you know move out to the   middle of nowhere I’m an extrovert on the other hand and I tend to have a lot of acquaintances   and a lot of friends I draw energy from being around other people so just because   someone doesn’t have 150 acquaintances doesn’t necessarily mean they don’t need connections so   we want to recognize that connection is a basic human need when infants are born they are put   on their mother’s chest when we embrace each other whether it’s mother and child or friends   or whatever a chemical called oxytocin is released and it’s our bonding chemical we are programmed we   are hardwired for connection and oxytocin is a very rewarding chemical so we want to recognize   this that if people are so afraid of abandonment that they push everybody away what are they losing   as far as quality of life as infants and children survival is dependent upon the relationship with   the primary caregiver so if mom or dad wasn’t happy if mom or dad was rejecting the young   child was pretty much helpless to think about a child who’s growing up in a family that’s just riddled   with addiction and mental health issues and the primary caregiver or caregivers are completely   emotionally unavailable they may be physically there but they may be so high or so depressed or   so psychotic that they cannot attend to the child’s needs what does that communicate to   the child the child feels abandoned the child feels a sense of neglect for people’s beliefs about   other people and relationships were formed largely based on their interactions with their caregivers   so if this child was going Mom I’m hungry and nothing happened or worse yet child was going Mom I’m terrified and nothing happened or they were just given a pacifier and told to shut up   then that is they were told they were communicated to that, their beliefs their feelings their wants, and their needs were not important so they were being rejected healthy relationships serve up as   a buffer against stress so even if they had all these negative experiences in early childhood teenage years you know maybe up until they walked into your office it doesn’t mean it   has to continue and how much can they gain from having healthy relationships with a lot of clients   that I work with who have pretty significant abandonment issues can’t even fathom trusting   someone enough to be in a healthy relationship so we’re going to talk about how to sort of ease into   that because you’re not going to say don’t let your past influence your future and we’ll wave   a magic wand and they’re ready to trust people even once you point out that what happened in   the past was largely not their fault or maybe not even if their fault at they they’re still going   to have difficulty not accepting responsibility and going everybody leaves me so what talk about   that addressing beliefs that formed as a result of these relationships the past dysfunctional   relationships we can help people create a new understanding of events was mom or dad or   caregiver being rejecting were you being abandoned emotionally and physically because of   you or because mom or dad just was able to do what they needed to do to be a caregiver then they were doing the best they could with the tools they had but it wasn’t enough to meet   your needs so we want to talk about alternate explanations for why parents and caregivers may have   behaved in that way if you have a young child well an adult now but who was put up for adoption or   abandoned by their caregivers at a young age the a young child was probably very confused because   one moment their caregiver was there in the next moment they were in the system so they were   trying to figure out what did they do wrong and why doesn’t that person love me anymore it must be   me because children really can’t see well you know mom is not able to function as a parent   right now or dad is having difficulty coping we want to help people better understand themselves   in their reactions so that when they start getting this urge to just cut all ties and be like you   know what fine you know I’ll take my ball and go home no problem what does that mean at there’s a   certain point in all relationships in all healthy relationships that you know sometimes people have   to distance themselves from one another because it’s becoming dysfunctional but for the most part, people will in relationships encounter hiccups will encounter disagreements but in   healthy relationships, they can work through them in relationships with people who fear   abandonment there are going to be two extremes there’s going to be complete compliance and   please don’t leave me or complete disengagement and whatever I don’t care the final thing we want   to do is help make people more conscious of what they’re doing so they can make healthy   decisions in their current relationships so when they get that urge to either comply or disengage   is that a healthy normative reaction right now or are you reacting out of your past experiences the abandonment experience in childhood survival depends on caregivers a four-year-old left alone   for five days is not going to do so well you know they may be able to scavenge food but   once the food runs out where do they get it you know there’s only so much that a child   can do an infant can’t even get food so survival depends on their caregivers and if   their caregivers fail to meet those needs there are high levels of anxiety and I will refer regularly   to emotionally unavailable caregivers and emotionally absent in addition to physically   unavailable or absent because some parents and I worked in the field of co-occurring disorders for   over two decades and some parents just they are so overwhelmed and so paralyzed by life itself they   can’t even attend to anything else that’s going on they’re doing good just to be breathing but   if they have a child and that child’s needs are getting neglected and fear of abandonment is a natural   survival response when your food source goes away what happens you start to freak the freak out so   this is normal we look at this and say that that’s that’s natural if a child thinks about the first   time you take a child to kindergarten or pre-k or daycare or whatever it is and you drop the   child off even if they’re securely attached what do they cry because they’re afraid that   mom or dad won’t come back and they’re afraid of this new situation that’s changed securely attached   children will you know to adjust and then be happy to see mom or dad when they come back but the point   is there’s that initial oh crap reaction meeting biological needs and safety are key triggers for   anxiety at any age so we’re talking about housing we’re talking about safety we’re thinking about   Maslow’s hierarchy if somebody is not meeting the child’s needs or if the person is not getting   their needs met then they may have high levels of anxiety and I add to the safety concept not   only physical safety but also emotional safety people need to feel safe in their heads and   they need to be free from emotional abuse when focused on survival people can’t focus elsewhere   so if they’re not getting their physical needs met guess what you know if you take somebody who   is in pain who is sick who is hungry and who is homeless are they going to work on self-esteem   are they going to work on relationship skills no, they’re focused on survival they need to have   those basic needs met they need to have a certain sense of security if they are in a situation that   is dangerous physically obviously they’re not going to be focusing on how I can better myself   when they’re worried about somebody coming in and hurting them physically likewise, it’s hard to   focus on how can I better myself when everywhere they turn they perceive someone telling us you’re   not okay you’re stupid you’re lazy you’re bad you were the worst decision I ever made in my   life they can’t focus on personal growth when all they’re getting is these verbal beatdowns all the time so people need to have acceptance if they don’t have acceptance kind the opposite of   acceptance is abandonment two kinds of extremes again we’ll bring it back to the middle every   stressful situation becomes a crisis the in securely attached child now you can go back to   and read Bowlby’s work on secure and all that kind of stuff great reading but for the short version   of this presentation remember that certs securely attached children feel anxiety when their parents   leave but then they can adjust and they’re happy to see the parents return in securely attached   children feel a great amount of anxiety when their parents leave and are terrified that mom or   dad won’t come back and then when mom or dad does come back it’s your very very clingy or very very   rejecting so with this child that’s in securely attached it’s just like one to a hundred as soon   as something happens that they think they may be abandoned you see this pattern again in adults who   are still struggling with these abandonment issues that schema that they’ve formed and I’m getting a   little ahead of myself that schema that they form says if you let this person at your site or if   this person disagrees with you or if this person criticizes you they’re rejecting you and they’re   going to abandon you so we want to you know check in with those cognitions and look for trying to   make those thoughts a little bit more helpful in infancy or early childhood if caregivers were away   for long periods because of work because of the military if they were in jail if they just   chose to be away or if they passed away children may experience some abandonment issues now if   the parents are away because a parent is a way because of work or military or even jail and the   other parent can help the child work through it there’s much less drama if you will there’s much   less issue with abandonment issues in totality now if it’s whatever parent it is if the pay   if the father happened to be the one went away that person may have some residual issues with   adult figures in their life that they need to deal with but they may not know I’m not saying that   every child of a soldier or a service person is going to have abandonment issues that are so   not true however if the experiences of the time apart was not handled in a way where the child   felt secure then it could have consequences that are going into the present day if in early childhood   caregivers were consistently or unpredictably physically or emotionally present so think about   a parent who has major recurrent major depressive disorder addiction or is just ill-equipped to deal   with a child when I was working at the treatment center in Florida I had 14 15 16 year old young   women coming in and having babies and you know what does a 14-year-old know about giving birth   and raising a child it’s not that they weren’t necessarily trying you know they didn’t have great   role models raising them in most cases and so they don’t have anything to work with they don’t know   how to be a parent they’ve never been taught so it’s not always I don’t want to pathologize or   make the parents look like bad people because I believe that people do the best they can with   the tools they have at any given time parents don’t choose to be sucky parents sometimes it   happens but I don’t believe they choose to anyhow off my soapbox in later childhood as the   child becomes elementary school middle school age if they’re a poor family fit or they feel   like they’re the black sheep they just don’t have the same beliefs that the other people do   they don’t seem to have the same interest that their family does they may not feel accepted   especially if the family’s going no that’s wrong to believe and invalidate them so going back to   that psychological safety if they’re constantly being told their ideas are stupid they’re wrong   they have the wrong point of view and they can feel very isolated something can happen that   ruptures the relationship with the primary care giver whether it’s abuse or you know some other trauma and introduction of a new less emotionally or physically safe caregiver can also   lead to abandonment if the child feels like the biological caregiver chose a new spouse over him   or her say if you see where I’m going with that because if this new person comes in and is less   safe is abusive in some way emotionally physically sexually it doesn’t matter the child is going to   feel like they didn’t have a voice the child is going to feel like the biological caregiver   didn’t care and brought this other person in any way which leads to feelings of rejection   and abandonment so what are the reactions fight-or-flight whenever there’s a threat we   fall back to fight or flight or freeze but we’ll talk about that when there’s a threat our anxiety   goes up and we say in the past in these kinds of situations, if I fought, did I succeed if so then   we’ve got fights in the past did I succeed, and if the answer’s no then the response is to flee pretty simply so anger towards someone unavailable if they got angry and felt like it got them   some sort of acceptance from somewhere that might be the prevailing reaction sadness when someone   goes away a sense of helplessness this person just left me shame or self-anger about feeling   needy or about pushing someone away with fears related to rejection and isolation, nobody will ever love my loss of control or the unknown everybody always leaves see how I’m using these extreme   words again and fear of failure I can’t maintain a relationship nobody wants to be with me because   I’m not good enough so the questions for clients in these situations what caused these fears as a   child so when someone starts to have these fears about a relationship, if the relationship starts   to get rocking first question is what is it that you’re afraid of in this situation if you stay   together what is it that you’re afraid of if this the person leaves what is it you’re afraid of and how   likely is it that this person is going to leave based on whatever is going on right now so let’s   get some objective evidence here and another the tool you can use is the challenging questions   worksheet in cognitive processing therapy if you google it challenging questions worksheet   CPT or cognitive processing therapy helps people walk through the logic in some of their   cognitions and identify some known as unhelpful distortions so then after you figure out kind of   what the fear is then we say what caused that as a child in the past when you felt like this what   caused that and how was this reasonable or helpful you know in the past when you felt like this and   you reacted in anger what was the outcome and how was it helpful in some sort of way you know   did it get somebody to pay attention to you did it gets somebody to come to comfort you, okay so you   were identifying the function of the current behaviors and then we want to say what causes   these fears now a lot of times it’s the same symp or similar stuff but we could say how are these   reactions now unhelpful because as independent you know adult-type people we can fend for ourselves   we can put food on the table we can go to work we can do we can function independently whereas this   is a child we couldn’t you know there were just some barriers to that does that mean again that   we should live in isolation and say well I don’t need anybody no that’s not what I’m   saying what I’m saying is is these fears that are overwhelming about abandonment that causes   people to push others away or cling on like you know whatever clings on uh are these reactions   helpful in the present day you know do you still need to hold on to people like there’s no tomorrow temperament based on their temperament children need different types and amounts of caregiver   interaction um some children are wide open and easily overstimulated you know my son was that   way when he was born well to this very day um when he’s awake he is like the Energizer Bunny   on methamphetamine I’m he’s just going going going and talking and talking to himself and   he needed a lot of structure and he would get overstimulated easily but we were able to help   him figure out how to handle that instead of getting mad at him for what seemed to be acting   out we were able to help him channel and figure out when he needed to take a break the introvert   may not need as much one-on-one attention with the caregiver may need a comforting word   here and there but they may not need the amount of the attention that an extrovert may need an extrovert   tends to need more interaction with parents with family with other people because they draw energy   and they think while they talk and they think while they talk with other people so they feel   a lot more isolated if they are isolated so we want to understand the person’s temperament and   how they may or may not have gotten their needs met how they may have been told they were wrong   and invalidated when they were younger and you can hear some of this is kind of going towards   Linda hands DBT environment um but what we want to look at what you need now how can we create   an environment that’s accepting and welcoming to you now based on their needs and caregivers’ reactions children form schemas or core beliefs about the world and others so if they state their   opinion and it’s squashed or it’s ridiculed then they’re going to form this core belief that it   is not safe ever to share my opinions because I am always wrong now we’re talking about children here   but a lot of times think back for yourself there I think most of us have at least some all-or-nothing   dichotomous thoughts that come in every once in a while and you know we can catch them but if   these dichotomies go unaddressed the person starts feeling very lost and very abandoned because it’s all-or-nothing important points about children under 7 from 8 to 12 children are developing   alternative cognitive skills they’re starting to be able to think abstractly they’re   starting to be able to see the gray area and alternate explanations but even you know during   that period so zero to 12 children are having difficulty envisioning all the possibilities   so anything that happens before that we want to encourage them to look at the schemas that were   formed and challenge them to examine whether they are currently accurate and helpful children think   dichotomously when they’re that young it’s all or nothing it’s good or bad it’s not kind of sort   of something it is what it is I mean even think about thinking back to grades that we would get   it was satisfactory or unsatisfactory there was no ABCD F when we were in elementary school and   I don’t remember middle school then it was a dichotomous grading scale you either did it or you   didn’t children are egocentric so whatever happens they say what was it about me that made this   happen if mom’s in a bad mood what did I do if you know Mom is rejecting stupid well I’m   stupid children are very egocentric so you take all or nothing combined with all about me and you   can see we’re creating the perfect storm of children can only focus on one aspect at a time when I work   with adult clients you know they come in and they tell me that they had an interaction with their   boss he was walking down the hall and he was in a bad mood and I just knew I did something and so   we talked about that and I’m like how do you know that because he had it he had an angry look on his   face okay what are some other possibilities what else might have been going on with him then and a lot of times we can brainstorm ideas about a call he just got or where they just   left a meeting that didn’t go so well or who knows what else in this day and time when we’ve   got our cell phones and PDAs and everything there are a lot of things that can trigger a   mood besides just whoever you pass in the hallway children can’t think about those other things that   might have triggered the mood they see somebody unhappy and they’re like I’m sorry um so we want   to encourage as adults we want to encourage them to say all right what are the other possibilities even as children I try to work with my kids to encourage them to look at alternate reasons   why somebody may be acting a certain way children can’t think abstractly and consider those possible   options um even with kids you know knee-high to a grasshopper if you’re in a situation and   maybe in a store and somebody behaves not kindly to you, you can talk about that later with the kids   and say you know that was kind of unpleasant to go through what you think might have caused that   and brainstorm three ideas my favorite number is three I don’t know why but brainstorm three ideas   for alternate explanations for why that person may have been in an unpleasant mood if children   learn to do this when they’re younger it’s a a lot easier to transition to as adults schemas   are a broad way of perceiving things based on memories feelings and thoughts it’s   our go-to perception of what something’s going to be like we have schemas about everything if   you go to church you have a schema about what’s going to happen when you go to your mother’s   house you have a schema about how mom’s going to behave and what’s going to happen we form these   it’s our brain’s short shortcut instead of having to analyze every situation it says oh I remember   this been here before it’s probably going to be like X Y Z unfortunately sometimes things change   and one of the things we see in addictions treatment as is as caregivers into recovery and get a hold on it and start working that a new way of life and sobriety and all that stuff   old family members or family members still expect that old behavior they have that schema that when   Jane comes in this is what’s going to happen because they’re remembering how she behaved and   acted in her addictive self so we want to help people identify their schemas and check them   sometimes they’re still accurate sometimes not so much schemas that trigger abandonment fear center   around the cell acceptability is this person going to like me which is one of the reasons we do a lot   of self-esteem work in reducing abandonment fears because we want to reduce the need for people to   solicit external validation we want them to say I’m all that and a bag of chips and I would love   to play with you but if you don’t want to play I’m okay with that love ability if they were   told they were unlovable if they perceived they were unlovable then in the present, they   may fear isolation they may fear that they’re not lovable so they will try to do whatever they can   or likewise they will build a lead wall that is 5 feet thick around them so nobody can   hurt them they may have fears about their own competence you know thinking back to Erikson   you never thought some of these theorists from the past would keep coming up even in current practice   but they do if a child going through that period of industry versus inferiority Erik Erikson’s   stages of psychosocial development and they felt like a failure all the time or they were never   good enough the parents never recognized their positive achievements then they may question their competence and feel like a failure if they feel like a failure they may feel they may believe   that nobody wants to be around them so they will leave so if I fail they will leave and fears may   center around adaptability some people are not able to tolerate any loss of control they’re just   like that they’re holding on with a death grip to the relationship to anything that’s going on and   it starts to go wonky they are going to freak out so we want to look at what does it mean if you’re   not in control of everything what does it mean if you trust that this person is going to do the   next right thing if you are doing the next right thing as well schemas that trigger abandonment   fears can also be sent around center around others if someone is rejecting distant cold or is unable to   handle the person’s needs then the person may not feel acceptable so if they are in relationships   with people like this then we need to look at is Is it you who’s not acceptable or is something else   going on with that person that may be making them unable to deal with anybody else’s stuff   right now the person may feel isolated if other people are absent if people fail to keep promises   they may feel like nobody’s ever there for them competence if other people are always critical   then the person will question their competence and if others are unpredictable a lot of the time   when people who have anxiety about abandonment they come from situations where other people have   not been predictable or if they were they were unpredictably absent and relationship of self to   others if they are afraid about their ability to relate with others if they’re afraid of rejection   if they’re afraid that if they start to love they will be rejected and then they will be isolated   forever if they are afraid of the unknown and they I just want consistency more than anything and   as soon as consistency starts to waver a little bit because as we grow things change and people   with abandonment issues don’t like things to change because that’s not predictable and that’s   not consistent so they may have difficulty if one the person starts to change what they do I see this   a lot not saying that it’s an abandonment issue necessarily but when law enforcement officers   retire you know because they can retire after 20 years so they may start a new career and   that causes a lot of change schedule changes they’re not law enforcement anymore and the   spouse sometimes has culty adjusting to it as does the retired officer but controllability   if the person holds on to relationships and everything in their life with white knuckles   because they’re so afraid if they let go of control that they are going to disappear or   disintegrate then if something seems like it’s not in their control, it’s going to be a catastrophe so attachment Styles secure if there’s an emotionally available caregiver the child   will seek the caregiver for comfort and guess what the caregiver will be there and will more   often than not meet the need for comfort with the the correct type of comfort so hungry cold scared kind   of following the child’s upset when the caregiver leaves especially in new situations but the child   gets over it it’s not a child that’s going to sit there and cry for eight hours and then the child’s   happy when the caregiver returns in this kind of attachment the child learns to trust others will   be responsive to their needs and validate their needs a child learns to be self-reliant and try   new things but if they fail they know they can return to the home base they can go out and go well   that didn’t go as planned and the caregiver will be there to say alright let’s figure out what to do   next not You are such a failure the child learns to adapt to a variety of situations because when   they’ve been faced with something that’s a little scary caregivers have been there to kind of coach them   on and go you got this it’s scary I got it but you can do it the child learns to deal with   stress because the caregivers are there to coach them or to process it with them afterward because the   caregiver is not always physically there but if you’ve got children you know sometimes they’ll   come home from school and they’ve had a really bad day and you’d pull them aside and go you know   what’s going on let’s talk about it so in this way the child learns to deal with stress and the child   learns to have accurate expectations of others in the secure attachment, emotionally available   situation remember children are egocentric so if mom’s upset the child goes what did I do or Oh my gosh I hope mom’s not going to leave in a secure situation sometimes the parent has to   say something like Mommy had a really bad day at work today has nothing to do with you I need to go   take a timeout that helps a child understand that you know what it’s not all about me and   I can understand that sometimes moms upset for something besides me and I can understand that   if moms Up said it doesn’t mean she’s going to leave so obviously, this is the ideal situation   avoidant attachment styles the rejecting or harsh caregiver the person depends less on the caregiver   for security because every time they go saying mom Mom I had a nightmare can I come into bed with you   they’re met with going back to your bed and the caregiver rolls over it’s not oh I’m sorry you had   a nightmare let me walk you back to your room when the child is separated from the caregiver   there’s little response when the caregiver leaves or returns because the kids like what uses that   person to me the child learns not to depend on a caregiver for comfort connection or security   now imagine yourself a four-year-old child or a six-year-old child thinking I can’t count on my   caregivers for comfort connection or security that must be a terrifying place to be and I   can see why you would develop some pretty strong defense mechanisms the ambivalent relationship between the   cave caregiver is inconsistent or can bow can’t talk caregiver is inconsistent or chaotic this   is true in a lot of homes where there are at least one parent who is battling some sort of   addiction or mental health issue so the parent may or may not be available you don’t know what   the good days are going to be you don’t know what the bad days are going to be so the child may be   anxious and afraid to try new things or explore because they’re like things are going good right   now I don’t want to top will be an applecart just going to sit here and ride it out a child may be   clinging and demanding trying to elicit a response remembering negative attention is better than no   attention at all and the child is upset when the caregiver leaves but also inconsolable when the   caregiver returns because you know I was upset I was scared you went away but you came back and   that’s good but I don’t know when you’re going to go away again and if you’re going to come   back so it’s this constant anxiety of abandonment core abandonment beliefs all people leave so we   want to challenge that by identifying exceptions mistrust people will hurt reject take advantage   of me or just not be there when I need them you know what that’s true sometimes because people   have their stuff so when this happens let’s look at whether it’s happening all the time and/or   let’s also look at what else might be going on with that person that caused them to hurt reject   take advantage or not be there when you needed the emotional deprivation I never get the love I   need nobody understands me cares about me or even ever tries to meet my needs here how dramatic and   extreme that is so one of the things as clinicians we can do is say if you are getting the   love you needed what would it look like what would be different what is it that you need   that you’re not getting once we identify then we can create a plan to get it but a lot   of times other people don’t understand or may not be able to interpret what you need so let’s help   let’s try to figure out how to make this happen nobody understands me alright let’s talk about   why that might be and you know let’s look at some people who’ve kind of gotten a grasp sometimes   with clients with abandonment beliefs nobody understands me translates to I don’t give a buddy   a chance and I cut them off as soon as they become confused and because they associate confusion with rejection so we might talk about communication skills we might work on what it is that people   don’t understand and how to better communicate that and where to find people who have similar   interests nobody ever even tries to meet my needs you know where I would look for exceptions   but I would also challenge the person and I would say when do you meet your needs what do you do   to take care of yourself a lot of times clients with abandonment beliefs are so freaked   out and afraid of being abandoned that they’re not taking care of themselves either they’re   just living and paralyzed going back to fight flee or freeze they’re living a paralyzed state   of I want to be loved but if I love I’m gonna get hurt and I don’t know what to do they don’t even   love themselves so we want to start talking about if you had your best friend you know create this   best friend persona what would he or she say to you what would he or she do right now let’s try to   help you understand yourself with mindfulness exercises are good here because a lot of times these   clients don’t understand themselves they’ve got so much anxiety they’re so afraid and they don’t   know where it’s coming from because a lot of it has been going on for so long defectiveness   if people knew me they would reject me you know not everybody’s going to like you why do you need   everybody to like you why is it important that everybody likes you and failure I don’t measure   up and I’m not able to succeed I usually put pull out the obnoxious quote that if you haven’t failed   you haven’t tried and we talked about what it means to get outside your comfort zone and you’re   not going to be perfect at everything you’re not going to be Michael Phelps you’re not going to be   the president of the United States that doesn’t mean that you’re a failure that doesn’t mean you’re a failure so what things are you good at what can you and have you succeeded at and   go back and look over things like you graduated high school not everybody does that you know   raised a family, not everybody does that so we want to challenge all nothing’ languages we   want to look for exceptions and we want to look for in what ways can you provide yourself the   validation so you don’t fear abandonment you don’t need other people to tell you you’re okay because   guess what you’re telling yourself I’m okay and before I go on to unhelpful reactions I do want   to point out that if we tell people to tell themselves you know I’m okay that sounds great   but if they don’t believe it if it’s not supported with evidence, it’s probably going to slow   their growth because they’re sitting there going telling themselves I’m okay and in the back of   their head going you know you’re not so we need to get that internal critical voice to kind of   hush up by providing the person with the objective evidence of why they’re okay why they’re good   enough and that’s a slow process it’s not going to happen overnight but encourage people to figure   out why they believe what they believe and then you can work from there okay unhelpful reactions   fighting with someone you don’t want to leave me because so the person may engage in a dominant   sort of posturing behavior aggression hostility blaming and criticizing trying to tear down the   other person to say you know what I don’t care and it would help if you were grateful that I’m in your life recognizing and seeking to get attention and validation or approval so if they feel something’s going   wrong in a relationship they may start trying to do something to gain recognition to prove that   they’re worthy of a relationship for what they do versus who they are manipulation and exploitation   said lying justifying I did this because you made me so sometimes we all occasionally do things that   aren’t the nicest people who fear abandonment have difficulty saying you know what I screwed   up and they’re more likely to go you made me do I wouldn’t have done it if you would have X   Y & Z people again who are worried about a relationship is going to fall apart and may also make excuses for   other people’s inappropriate behavior it’s like you know I hate what this person does but   if I don’t make excuses for it if I condemn it then this person is going to leave in counseling   we can talk about the difference between loving a person and loving a person’s behavior you know I   love my kids to death there is no question about that but some of their behavior makes me want to   climb a wall I’m very clear to separate from them the difference between the behavior that I dislike   and them because you know like I said I love them to pieces and we want to help people start making   this differentiation if they don’t do it already and clinging and chasing is the other fight   reaction stalking and messaging somebody 47 times on Facebook in an hour all these kinds of behaviors   and even online bullying those sorts of things can be fight reactions in response to feeling like   there’s a threat of abandonment flight is more of the I don’t care if you leave so the person   will withdraw physically and emotionally and maybe even numb themselves with some sort of   addictive behavior or distract themselves with something completely different or find a new   person just proof that you know what I didn’t need you because I’ve got this new person now questions for clients about core beliefs all people leave okay so what does it look   like if somebody’s available to you if they don’t abandon you who in your past left you   or was unavailable emotionally now a lot of I find it helpful for mental health   and addiction clients to have them write an autobiography because then we can go back   and kind of review it and identify the core people at certain stages in a person’s life what did the person who left you do to make you feel rejected or abandoned in retrospect   you know it was hard to see the difference what was going on back then because you were a kid in   retrospect what are the alternate explanations for why this may have happened was it you or was it more about them who in your past has been available to you emotionally most of   the time people can point to one maybe two people who have generally been there it’s unreasonable to   expect someone always to be there who in your present is available to you emotionally you   know maybe they’ve only been in your life for six months or a year but they are available and I say   emotionally because you know not everybody can be available physically all the time we’ve got   jobs kids all that kind of stuff but can you pick up the phone and call them or text them and say   hey you know what I’m struggling right now what do you do in your current relationships that cause people to leave do you push them away if so how what are alternatives to pushing them away cutting all ties and just saying fine be that way I wipe my hands off you if you cling how do you do   this in what ways do you perceive yourself as being clinging and what are some alternatives   to holding on with all desperation and mistrust people will hurt reject or take advantage of me or just   not be there when I need them so again what does it looks like when somebody’s or what does it feel   like when someone is trustworthy and safe who in your past was untrustworthy or unsafe what do they   do they taught you this and what are alternate explanations who in your past has been trustworthy   and safe who in your present is available and trustworthy What do you do to yourself that   is unsafe or dishonest that’s one of those tricky questions you’re there talking about other people   other people then it’s like what do you do to yourself how do you lie to your   self or how are you mean and hateful to yourself how does your distrust of other people or even   yourself impact your current relationships some people distrust their internal intuition so   much that they don’t want to make friends with other people, they’re like I can’t tell who’s   going to hurt me and who won’t so just yeah I’m going to wipe my hands of it all what could you   do differently what do you think you could do to start building trust and what does   it look like to build trust because Trust doesn’t just appear it builds gradually emotional deaths   deprivation I don’t get the love I need nobody understands me so again what does it look like   when somebody understands you and meets your needs who in the past failed to meet your needs   emotionally and how can you deal with that now you know it may have been mom it may have been   ex-husband it may have been you know who knows how can you deal with it now yourself so you can   put it to rest who in your past is understood you who in your present understands you how   can you start again better understanding yourself because it’s hard for other people to understand   us when we don’t even understand ourselves and what can you do to start getting your needs met one of the things was starting to get your own needs met is to figure out what your needs are and   this is one of the exercises I have people do as a homework assignment they keep track of what is   it they want daily keep a log and then let’s talk about what common themes were seeing   if people knew me they would reject me okay so how do you know when you’re accepted or acceptable to   someone who when you’re past may make you feel defective are there alternate explanations and   how can you silence those old tapes because that person that statement stays as a heckler   in the gallery we need to hush the heckler what can you do part of it could be talking back and   saying you know what I’m not going to listen or I don’t have time for this right now who’s   been accepting and supportive who is in your life that’s accepting and supportive and how can you   start accepting yourself and being compassionate so some compassion focus training mindfulness work   to help people understand themselves and start being compassionate with themselves understanding   their vulnerabilities and cutting themselves some slack I don’t measure up I’m not able to succeed   okay that’s a pretty big success you know what is what success means success means different   things to different people so what does it look like to you to be successful let’s kind of hammer   that out what is it if you are successful what would be different what in your past has made   you feel like a failure what are some alternate ways of viewing it such as a learning experience   or something I had to go through to grow or you know brainstorming alternate explanations for   why people fail they don’t have a response to sometimes I ask them to kind of take on   a flip role and say pretend you’re a parent and your child comes home and they’ve tried out for   the football team and they didn’t make the team they failed what are you going to tell on what   have you succeeded at doing in the past what are you good at in the present and we want to   pay attention to minimization here because a a lot of our clients are not good at identifying   their strengths what does being successful mean in terms of your relationship with others do you have   to be successful to be loved and be a good relationship you know you’re going   to be successful in a relationship if you’re but do you have to be financially successful and powerful whatever you define success as in order to be in healthy relationships who are   three successful people you know and what makes them successful in your eyes does success equal   happiness you can do a whole group on that and what do your kids need to do to be successful   in life you know we want our kids to succeed we want our kids to be happy so what is it that I   envision my child’s life to be 10 to 15 years from now triggering relationships the abandoner is   unpredictable unstable and unavailable the abusive relationship is untrustworthy and   unsafe the deprived err depriving relationship the a person is detached or withholding the Devastator   is always judgmental rejecting and critical and the critic is critical and narcissistic usually   a lot of times people replay their past to try to kind of get it right the second time so we want   to look at do you have a habit of getting into relationships with people who are not safe we can   also ask them how do you exhibit these behaviors in what ways are these behaviors present your   current relationships and in what ways were these present and your primary caregiver relationships behavioral triggers abandonment and mistrust if somebody starts acting differently they change   their behavior in some way a person who fears abandonment goes oh that’s not good if they’re   not getting constant reassurance that’s that external validation can trigger   abandonment fears so again we want to work on internal validation and why is it that you   feel you need constant reassurance from the other person’s relationships feel threatening so   work relationships those sorts of things the a person who has abandonment issues won’t want   their significant other around other people and they become hyper-vigilant to rejection   and disconnection even if it’s just somebody going I had a really bad day I need 20 minutes   and go into the room and shut the door the person with abandonment issues will likely   have a high level of anxiety so we want to ask how these behaviors have threatened them in the   past what are alternate explanations for why this is happening with this person right now and what   would be a helpful reaction to these behaviors now so this is happening what would be a helpful   reaction instead of assuming that the sky is going to fall defectiveness and failure so if   somebody is critical if they have unexplained time apart there’s absent or inconsistent reassurance   or if the person tells them they’re a failure these or they fail at something these could   all be behavioral triggers they could be like I failed at something I’m not getting reassurance   this relationship is fixin’ to end questions how is this threatened you in the past alternate   explanations and what would be a helpful reaction to this particular situation right now envisioning activity what does a healthy the relationship looks like presence versus abandonment   acceptance versus rejection emotional support versus emotional unavailability trustworthy   versus untrustworthy and safe versus harmful these are extremes what does it look like to   be a middle ground there are going to be exceptions you know things are going to happen so what does   a healthy relationship look like and how do you deal with exceptions if somebody’s not always   present how can you create this relationship with yourself that’s the big one and then how can you   create this relationship with others’ mindfulness questions what am I feeling what’s triggering it   am I safe right now and if not what do I need to is this bringing up something from the past if   so how is this different how am I different then I was when I was six or four and how   can I silence my inner critic and finally what would be a helpful reaction that would move me   more toward my goals and a positive emotional experience summary core beliefs   about the self and others are formed in early life due to children’s lack of knowledge of other   experiences and primitive cognitive abilities these core beliefs are often very dichotomous   core beliefs can be formed around events or experiences outside of the conscious memory   identifying and being mindful of abandonment triggers in the present can help people choose   alternate more helpful ways of responding in the present in Secure and Loved loved me   don’t leave me are two excellent books there are Google previews if you want to look   at them to see if it’s something that you like but they do take what we talked about in this   presentation and expand upon it a whole bunch more 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 provides 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 off your order this month you As found on YouTubeSeanCooper🗯 The Shyness & Social Guy ⇝ The 3 WORST Mistakes You Must AVOID If You Want To Overcome Shyness (PLUS: 1 weird trick that targets the root biological cause of shyness so you can stop being nervous, awkward, and quiet around people…) http://flywait.darekw.hop.clickbank.net/ 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.732d01adf780998f105af3460737a431

Best Practices for Anxiety Treatment | Cognitive Behavioral Therapy

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

Abandonment Anxiety– Video corrupted See https://www.youtube.com/watch?v=XQWUYWeiHB0

 
 this episode was pre-recorded as part of a live continuing   education webinar on-demand CEUs are still available for this presentation   through all CEUs registered at all CEUs comm slash counselor toolbox I’d like to welcome everybody today to the presentation love me doesn’t leave me addressing   fears of abandonment the purpose of this presentation is really to help us help clients   increase their awareness of their story including beliefs about behavioral reactions to situations   that trigger their fear of abandonment so how do we do that well the first thing we need to   figure out is what fear of abandonment is and how can we identify it in a clinical set setting then   we’re going to explore the concept of schemas or core beliefs and these are things that are formed   in early childhood you know if you remember prior classes we’ve talked about early childhood   cognition is generally very dichotomous in children young children don’t have the ability to look at   that gray area so these schemas if they’ve gone unchecked can lead to some very extreme belief   patterns which lead us into common traps in thinking reacting and relationships if your   schemas are based on all-or-nothing you either love me or you’re going to leave me hence the   name of the book then your reactions are going to tend to be more extreme and more all-or-nothing   which increases anxiety because then anytime a person who perceives any amount of disapproval   obviously is going to go to that extreme so we want to talk about bringing it more toward the   middle line and helping people learn to appreciate and love themselves for themselves while they may   not approve of the behaviors of other people they can still love other people so just because somebody   doesn’t approve of your behavior doesn’t mean necessarily that they’re going to abandon you so   we’re going to talk about that and then we’ll learn skills necessary to help people accept   their past as part of their story maybe they do have a lot of abandonment issues and you know   some people do and it really is painful it cuts to the core especially when those abandonment   issues occur in early childhood when kids going what that does so we’re going to talk about that   and help people learn how to integrate it into their present and we’ll learn the skills necessary   to acknowledge that their past does not have to continue to negatively impact them in the present   so if they were abandoned when they were a child you know we need to deal with that however if they   continue to expect that every significant person in their life will abandon them notice I use the   word every because we’re still in those extremes then they’re going that the past is negatively   impacting them in the present so we’ll talk about how to sort of moderate those belief systems how   does this impact recovery whether you’re talking about addiction or mental health issues connection   is a basic human need we are not meant for the most part to be Hermits in the middle of the   woods there are introverts and in my husband’s an introvert he has a couple of really good friends   he needs quiet time each day he doesn’t need to be surrounded by people and he’s fine but I mean   we’ve got human connection he’s not going to be one that’s just going to you know move out to the   middle of nowhere I’m an extrovert on the other hand and I tend to have a lot of acquaintances   and a lot of friends I draw energy from being around other people so just because   someone doesn’t have 150 acquaintances doesn’t necessarily mean they don’t need connections so   we want to recognize that connection is a basic human need when infants are born they are put   on their mother’s chest when we embrace each other whether it’s mother and child or friends   or whatever a chemical called oxytocin is released and it’s our bonding chemical we are programmed we   are hardwired for connection and oxytocin is a very rewarding chemical so we want to recognize   this that if people are so afraid of abandonment that they push everybody away what are they losing   as far as quality of life as infants and children survival is dependent upon the relationship with   the primary caregiver so if mom or dad wasn’t happy if mom or dad was rejecting the young   child was pretty much helpless to think about a child who’s growing up in a family that’s just riddled   with addiction and mental health issues and the primary caregiver or caregivers are completely   emotionally unavailable they may be physically there but they may be so high or so depressed or   so psychotic that they cannot attend to the children’s need what does that communicate to   the child feels abandoned the child feels a sense of neglect for people’s beliefs about   other people and relationships were formed largely based on their interactions with their caregivers   so if this child was going mom I’m hungry and nothing happened or worse yet child was going   mom I’m terrified and nothing happened or they were just given a pacifier and told to shut up   then that is they were told they were communicated to that their beliefs their feelings their wants   and their needs were not important so they were being rejected healthy relationships serve up as   a buffer against stress so even if they had all these negative experiences in early childhood teenage years you know maybe up until they walked into your office it doesn’t mean it   has to continue and how much can they gain from having healthy relationships with a lot of clients   that I work with who have pretty significant abandonment issues can’t even fathom trusting   someone enough to be in a healthy relationship so we’re going to talk about how to sort of ease into   that because you’re not going to say don’t let your past influence your future and we’ll wave   a magic wand and they’re ready to trust people even once you point out that what happened in   the past was largely not their fault or maybe not even their fault at all they’re still going   to have difficulty not accepting responsibility and going everybody leaves me so what talk about   that addressing beliefs that formed as a result of these relationships the past dysfunctional   relationships we can help people create a new understanding of events was mom or dad or   caregiver really being rejecting were you being abandoned emotionally and physically because of   you or because mom or dad just was able to do what they needed to do to be a caregiver at that point   in time they were doing the best they could with the tools they had but it wasn’t enough to meet   your needs so we want to talk about alternate explanations for why parents and caregivers may have   behaved in that way if you have a young child well an adult now but who was put up for adoption or   abandoned by their caregivers at a young age the a young child was probably very confused because   one moment their caregiver was there in the next moment they were in the system so they were   trying to figure out what did they do wrong and why doesn’t that person love me anymore it must be   me because children really can’t see well you know mom is not able to function as a parent   right now or dad is having difficulty coping we want to help people better understand themselves   in their reactions so that when they start getting this urge to just cut all ties and be like you   know what fine you know I’ll take my ball and go home no problem what does that mean at there’s a   certain point in all relationships in all healthy relationships that you know sometimes people have   to distance themselves from one another because it’s becoming dysfunctional but for the most part, people will in relationships encounter hiccups will encounter disagreements but in   healthy relationships, they can work through them in relationships with people who fear   abandonment there are going to be two extremes there’s going to be complete compliance and   please don’t leave me or complete disengagement and whatever I don’t care the final thing we want   to do is help make people more conscious of what they’re doing so they can make healthy   decisions in their current relationships so when they get that urge to either comply or disengage   is that a healthy normative reaction right now or are you reacting out of your past experiences the abandonment experience in childhood survival depends on caregivers a four-year-old left alone   for five days is not going to do so well you know they may be able to scavenge food but   once the food runs out where do they get it you know there’s only so much that a child   can do an infant can’t even get their own food so survival depends on their caregivers and if   their caregivers fail to meet those needs there are high levels of anxiety and I will refer regularly   to caregivers who are emotionally unavailable and emotionally absent in addition to physically   unavailable or absent because some parents and I worked in the field of co-occurring disorders for   over two decades and some parents just they are so overwhelmed and so paralyzed by life itself they   can’t even attend to anything else that’s going on they’re doing good just to be breathing but   if they have a child and that child’s needs are getting neglected and fear of abandonment is a natural   survival response when your food source goes away what happens you start to freak the freak out so   this is normal we look at this and say that that’s that’s natural if a child thinks about the first   time you take a child to kindergarten or pre-k or daycare or whatever it is and you drop the   child off even if they’re securely attached what do they cry because they’re afraid that   mom or dad won’t come back and they’re afraid of this new situation that’s changed securely attached   children will you know adjust and then be happy to see mom or dad when they come back but the point   is there’s that initial oh crap reaction meeting biological needs and safety are key triggers for   anxiety at any age so we’re talking about housing we’re talking about safety we’re thinking about   Maslow’s hierarchy if somebody is not meeting the child’s needs or if the person is not getting   their needs met then they may have high levels of anxiety and I add to the safety concept not   only physical safety but also emotional safety people need to feel safe in their own heads and   they need to be free from emotional abuse when focused on survival people can’t focus elsewhere   so if they’re not getting their physical needs met guess what you know if you take somebody who   is in pain who is sick who is hungry and who is homeless are they going to work on self-esteem   are they going to work on relationship skills no, they’re focused on survival they need to have   those basic needs met they need to have a certain sense of security if they are in a situation that   is dangerous physically obviously they’re not going to be focusing on how can I better myself   when they’re worried about somebody coming in and hurting them physically likewise it’s hard to   focus on how can I better myself when everywhere they turn they perceive someone telling us you’re   not okay you’re stupid you’re lazy you’re bad you were the worst decision I ever made in my   life they can’t focus on personal growth when all they’re getting is these verbal beatdowns all the time so people need to have acceptance if they don’t have acceptance kind of the opposite of   acceptance is abandonment two kinds of extremes again we’ll bring it back to the middle every   stressful situation becomes a crisis the in securely attached child now you can go back to   and read Bowlby’s work on secure and all that kind of stuff great reading but for the short version   of this presentation remember that certs securely attached children feel anxiety when their parents   leave but then they can adjust and they’re happy to see the parents return in securely attached   children feel a great amount of anxiety when their parents leave and are terrified that mom or   dad won’t come back and then when mom or dad does come back it’s your very very clingy or very very   rejecting so with this child that’s in securely attached it’s just like one to a hundred as soon   as something happens that they think they may be abandoned you see this pattern again in adults who   are still struggling with these abandonment issues that schema that they’ve formed and I’m getting a   little ahead of myself that schema that they form says if you let this person at your site or if   this person disagrees with you or if this person criticizes you they’re rejecting you and they’re   going to abandon you so we want to you know check in with those cognitions and look for trying to   make those thoughts a little bit more helpful in infancy or early childhood if caregivers were away   for long periods of time because of work because of military, if they were in jail if they just   chose to be away or if they passed away children may experience some abandonment issues now if   the parents are away because a parent is a way because of work or military or even jail and the   other parent can help the child work through it there’s much less drama if you will there’s much   less issue with abandonment issues in totality now if it’s whatever parent it is if the pay, if the father happened to be the one, went away that person may have some residual issues with   adult figures in their life that they need to deal with but they may not know I’m not saying that   every child of a soldier or a service person is going to have abandonment issues that are so   not true however if the experiences of the time apart was not handled in a way where the child   felt secure then it could have consequences that are going into present-day if in early childhood   caregivers were inconsistently or unpredictably physically or emotionally present so think about   a parent who has major recurrent major depressive disorder addiction or is just ill-equipped to deal   with a child when I was working at the treatment center in Florida I had 14 15 16-year-old young   women coming in and having babies and you know what does a 14-year-old know about giving birth   and raising a child so it’s not that they weren’t necessarily trying you know they didn’t have great   role models raising them in most cases and so they don’t have anything to work with they don’t know   how to be a parent they’ve never been taught so it’s not always I don’t want to pathologize or   make the parents look like bad people because I believe that people do the best they can with   the tools they have at any given time parents don’t choose to be sucky parents sometimes it   happens but I really don’t believe they choose to anyhow off my soapbox in later childhood as the   child becomes elementary school middle school age if they’re a poor family fit or they feel   like they’re the black sheep they just don’t have the same beliefs that the other people do   they don’t seem to have the same interest that their family does they may not feel accepted   especially if the family’s going no that’s wrong to believe and invalidate them so going back to   that psychological safety if they’re constantly being told their ideas are stupid they’re wrong   they have the wrong point of view and they can feel very isolated something can happen that   ruptures the relationship with the primary care giver whether it’s abuse or you know some kind   of other trauma and introduction of a new less an emotionally or physically safe caregiver can also   lead to abandonment if the child feels like the biological caregiver chose a new spouse over him   or her say if you see where I’m going with that because if this new person comes in and is less   safe is abusive in some way emotionally physically sexually it doesn’t matter the child is going to   feel like they didn’t have a voice the child is going to feel like the biological caregiver   didn’t care and brought this other person in any way which leads to feelings of rejection   and abandonment so what are the reactions fight-or-flight whenever there’s a threat we   fall back to fight or flight or freeze but we’ll talk about that when there’s a threat our anxiety   goes up and we say in the past in these kinds of situations, if I fought, did I succeed if so then   we’ve got fights in the past did I succeed and if the answer’s no then the response is to flee pretty simply so anger towards someone who’s unavailable if they got angry and felt like it got them   some sort of acceptance from somewhere that might be the prevailing reaction sadness when someone   goes away a sense of helplessness this person just left me shame or self-anger about feeling   needy or about pushing someone away fears related to rejection and isolation, nobody will ever love my loss of control or the unknown everybody always leaves see how I’m using these extreme   words again and fear of failure I can’t maintain a relationship nobody wants to be with me because   I’m not good enough so the questions for clients in these situations what caused these fears as a   child so when someone starts to have these fears about a relationship if the relationship starts   to get rocking first question is what is it that you’re afraid of in this situation if you stay   together what is it that you’re afraid of if this the person leaves what is it you’re afraid of and how   likely is it that this person is going to leave based on whatever is going on right now so let’s   get some objective evidence here and another the tool you can use is the challenging questions   worksheet in cognitive processing therapy if you google it challenging questions worksheet   CPT or cognitive processing therapy really helps people walk through the logic in some of their   cognitions and identify some know unhelpful distortions so then after you figure out kind of   what the fear is then we say what caused that as a child in the past when you felt like this what   caused that and how was this reasonable or helpful you know in the past when you felt like this and   you reacted in anger what was the outcome and how was it helpful in some sort of way you know   did it get somebody to pay attention to you did it gets somebody to come comfort you, okay so you   were identifying the function of the current behaviors and then we want to say what causes   these fears now a lot of times it’s the same symp or similar stuff but we could say how are these   reactions now unhelpful because as independent you know adult-type people we can fend for ourselves   we can put food on the table we can go to work we can do we can function independently whereas this   is a child we couldn’t you know there were just some barriers to that does that mean again that   we should live in isolation and say well I don’t need anybody no that’s not what I’m   saying what I’m saying is is these fears that are overwhelming about abandonment that causes   people to push others away or cling on like you know whatever clings on uh are these reactions   helpful in the present day you know do you still need to hold on to people like there’s no tomorrow temperament based on their temperament children need different types and amounts of caregiver   interaction um some children are wide open and easily overstimulated you know my son was that   way when he was born well to this very day um when he’s awake he is like the Energizer Bunny   on methamphetamine I’m he’s just going going going and talking and talking to himself and   he needed a lot of structure and he would get overstimulated easily but we were able to help   him figure out how to handle that instead of getting mad at him for what seemed to be acting   out we were able to help him channel and figure out when he needed to take a break the introvert   may not need as much one-on-one attention with the caregiver may need a comforting word   here and there but they may not need the amount of the attention that an extrovert may need an extrovert   tends to need more interaction with parents with family with other people because they draw energy   and they think while they talk and they think while they talk with other people so they feel   a lot more isolated if they are isolated so we want to understand the person’s temperament and   how they may or may not have gotten their needs met how they may have been told they were wrong   and invalidated when they were younger and you can hear some of this is kind of going towards   Linda hands DBT environment um but what we want to look at what do you need now how can we create   an environment that’s accepting and welcoming to you now based on their needs and caregivers’ reactions children form schemas or core beliefs about the world and others so if they state their   opinion and it’s squashed or it’s ridiculed then they’re going to form this core belief that it   is not safe ever to share my opinions because I am always wrong now we’re talking about children here   but a lot of times think back for yourself there I think most of us have at least some all-or-nothing   dichotomous thoughts that come in every once in a while and you know we can catch them but if   these dichotomies go unaddressed the person starts feeling very lost and very abandoned because it’s all-or-nothing important points about children under 7 from 8 to 12 children are developing   alternative cognitive skills they’re starting to be able to think abstractly they’re   starting to be able to see the gray area and alternate explanations but even you know during   that period so zero to 12 children are having difficulty envisioning all the possibilities   so anything that happens before that we want to encourage them to look at the schemas that were   formed and challenge them to examine whether they are currently accurate and helpful children think   dichotomously when they’re that young it’s all or nothing it’s good or bad it’s not kind of sort   of something it is what it is I mean even think about thinking back to grades that we would get   it was satisfactory or unsatisfactory there was no ABCD F when we were in elementary school and   I don’t remember middle school then it was a dichotomous grading scale you either did it or you   didn’t children are egocentric so whatever happens they say what was it about me that made this   happen if mom’s in a bad mood what did I do if you know Mom is rejecting well that was stupid I’m   stupid children are very egocentric so you take all or nothing combined with all about me and you   can see we’re creating the perfect storm of children can only focus on one aspect at a time when I work   with adult clients you know they come in and they tell me that they had an interaction with their   boss he was walking down the hall and he was in a bad mood and I just knew I did something and so   we talked about that and I’m like how do you know that because he had it he had angry look on his   face okay what are some other possibilities what else might have been going on with him at that   point in time and a lot of times we can brainstorm ideas about a call he just got or where they just   left a meeting that didn’t go so well or who knows what else in this day and time when we’ve   got our cell phones and PDAs and everything there are a lot of things that can trigger a   mood besides just whoever you pass in the hallway children can’t think about those other things that   might have triggered the mood they see somebody unhappy and they’re like I’m sorry um so we want   to encourage as adults we want to encourage them to say all right what are the other possibilities even as children I try to work with my kids to encourage them to look at alternate reasons   why somebody may be acting a certain way children can’t think abstractly and consider those possible   options um even with kids you know knee-high to a grasshopper, if you’re in a situation and   maybe in a store and somebody behaves not kindly to you, you can talk about that later with the kids   and say you know that was kind of unpleasant to go through what you think might have caused that   and brainstorm three ideas my favorite number is three I don’t know why but brainstorm three ideas   for alternate explanations for why that person may have been in an unpleasant mood if children   learn to do this when they’re younger it’s a a lot easier to transition to as adults schemas   are a broad way of perceiving things based on memories feelings and thoughts basically it’s   our go-to perception of what something’s going to be like we have schemas about everything if   you go to church you have a schema about what’s going to happen when you go to your mother’s   house you have a schema about how mom’s going to behave and what’s going to happen we form these   it’s our brain’s short shortcut instead of having to analyze every situation it says oh I remember   this been here before it’s probably going to be like X Y Z unfortunately sometimes things change   and one of the things we see in addictions treatment as is as caregivers into recovery and   really get a hold on it and start working that a new way of life and sobriety and all that stuff   old family members or family members still expect that old behavior they have that schema that when   Jane comes in this is what’s going to happen because they’re remembering how she behaved and   acted in her addictive self so we want to help people identify their schemas and check them   sometimes they’re still accurate sometimes not so much schemas that trigger abandonment fear center   around the cell acceptability is this person going to like me which is one of the reasons we do a lot   of self-esteem work in reducing abandonment fears because we want to reduce the need for people to   solicit external validation we want them to say I’m all that and a bag of chips and I would love   to play with you but if you don’t want to play I’m okay with that love ability if they were   told they were unlovable if they perceived they were unlovable then in the present they   may fear isolation they may fear that they’re not lovable so they will try to do whatever they can   or likewise they will build a lead wall that is 5 feet thick all the way around them so nobody can   hurt them they may have fears about their own the competence you know thinking back to Erikson   you never thought some of these theorists from the past would keep coming up even in current practice   but they do if a child going through that period of industry versus inferiority Erik Erikson’s   stages of psychosocial development and they felt like a failure, all the time or they were never   good enough the parents never recognized their positive achievements then they may question their   own competence and feel like a failure if they feel like a failure they may feel they may believe   that nobody wants to be around them so they will leave so if I fail they will leave and fears may   center around adaptability some people are not able to tolerate any loss of control they’re just   like that they’re holding on with a death grip to the relationship to anything that’s going on and   it starts to go wonky they are going to freak out so we want to look at what it means if you’re   not in control of everything what does it mean if you trust that this person is going to do the   next right thing if you are doing the next right thing as well schemas that trigger abandonment   fears can also be sent around center around others if someone is rejecting distant cold or is unable to   handle the person’s needs then the person may not feel acceptable so if they are in relationships   with people like this then we need to look at is Is it you who’s not acceptable or is something else   going on with that person that may be making them unable to deal with anybody else’s stuff   right now the person may feel isolated if other people are absent if people fail to keep promises   they may feel like nobody’s ever there for them competence if other people are always critical   then the person will question their own competence and if others are unpredictable a lot of the time   when people who have anxiety about abandonment they come from situations where other people have   not been predictable or if they were they were unpredictably absent and relationship of self to   others if they are afraid about their ability to relate with others if they’re afraid of rejection   if they’re afraid that if they start to love they will be rejected and then they will be isolated   forever if they are afraid of the unknown and they I just want consistency more than anything and   as soon as consistency starts to waver a little a bit because as we grow things change and people   with abandonment issues don’t like things to change because that’s not predictable and that’s   not consistent so they may have difficulty if one the person starts to change what they do I see this   a lot not saying that it’s an abandonment issue necessarily but when law enforcement officers   retire you know because they can retire after 20 years so they may start a new career and   that causes a lot of change schedule changes they’re not law enforcement anymore and the   spouse sometimes has culty adjusting to it as does the retired officer but controllability   if the person holds on to relationships and everything in their life with white knuckles   because they’re so afraid if they let go of control that they are going to disappear or   disintegrate then if something seems like it’s not in their control, it’s going to be a catastrophe so attachment Styles secure if there’s an emotionally available caregiver the child   will seek the caregiver for comfort and guess what the caregiver will be there and will more   often than not meet the need for comfort with the the correct type of comfort so hungry cold scared kind   of following the child’s upset when the caregiver leaves especially in new situations but the child   gets over it it’s not a child that’s going to sit there and cry for eight hours and then the child’s   happy when the caregiver returns in this kind of attachment the child learns to trust others will   be responsive to their needs and validate their needs a child learns to be self-reliant and try   new things but if they fail they know they can return to the home base they can go out and go well   that didn’t go as planned and the caregiver will be there to say alright let’s figure out what to do   next not you are such a failure the child learns to adapt to a variety of situations because when   they’ve been faced with something that’s a little scary caregivers been there to kind of coach them   on and go you got this it’s scary I got it but you can do it the child learns to deal with   stress because the caregivers are there to coach them or to process it with them afterward because the   caregiver is not always physically there but if you’ve got children you know sometimes they’ll   come home from school and they’ve had a really bad day and you’d pull them aside and go you know   what’s going on let’s talk about it so in this way the child learns to deal with stress and the child   learns to have accurate expectations of others in the secure attachment, emotionally available   situation remember children are egocentric so if mom’s upset the child goes what did I do or   oh my gosh I hope mom’s not going to leave in a secure situation sometimes the parent has to   say something like mommy had a really bad day at work today has nothing to do with you I need to go   take a timeout that helps a child understand that you know what it’s not all about me and   I can understand that sometimes moms upset for something besides me and I can understand that   if moms up said it doesn’t mean she’s going to leave so obviously this is the ideal situation   avoidant attachment styles the rejecting or harsh caregiver the person depends less on the caregiver   for security because every time they go saying, mom mom, I had a nightmare can I come into bed with you   they’re met with going back to your own bed and the caregiver rolls over it’s not oh I’m sorry you had   a nightmare let me walk you back to your room when the child is separated from the caregiver   there’s little response when the caregiver leaves or returns because the kids like what uses that   person to me the child learns not to depend on a caregiver for comfort connection or security   now imagine yourself a four-year-old child or a six-year-old child thinking I can’t count on my   caregivers for comfort connection or security that must be a terrifying place to be and I   can see why you would develop some pretty strong defense mechanisms the ambivalent relationship between the   cave caregiver is inconsistent or can bow can’t talk caregiver is inconsistent or chaotic this   is really true in a lot of homes where there are at least one parent who is battling some sort of   addiction or mental health issue so the parent may or may not be available you don’t know what   the good days are going to be you don’t know what the bad days are going to be so the child may be   anxious and afraid to try new things or explore because they’re like things are going good right   now I don’t want to top will be an applecart just going to sit here and ride it out a child may be   clinging and demanding trying to elicit a response remembering negative attention is better than no   attention at all and the child is upset when the caregiver leaves but also inconsolable when the   caregiver returns because you know I was upset I was scared you went away but you came back and   that’s good but I don’t know when you’re going to go away again and if you’re going to come   back so it’s this constant anxiety of abandonment core abandonment beliefs all people leave so we   want to challenge that by identifying exceptions mistrust people will hurt reject take advantage   of me or just not be there when I need them you know what that’s true sometimes because people   have their own stuff so when this happens let’s look at whether it’s happening all the time and/or   let’s also look at what else might be going on with that person that caused them to hurt reject   take advantage or not be there when you needed the emotional deprivation I never get the love I   need nobody understands me cares about me or even ever tries to meet my needs here how dramatic and   extreme that is so one of the things as clinicians we can do is say if you are getting the   love you needed what would it look like what would be different what is it that you need   that you’re not getting once we identify then we can create a plan to get it but a lot   of times other people don’t understand or may not be able to interpret what you need so let’s help   let’s try to figure out how to make this happen nobody understands me alright let’s talk about   why that might be and you know let’s look at some people who’ve kind of gotten a grasp sometimes   with clients with abandonment beliefs nobody understands me translates to I don’t give a buddy   a chance and I cut them off as soon as they become confused and because they associate confusion with the rejection so we might talk about communication skills we might work on what it is that people   don’t understand and how to better communicate that and where to find people who have similar   interests nobody ever even tries to meet my needs you know here I would really look for exceptions   but I would also challenge the person and I would say when do you meet your needs what do you do   to take care of yourself a lot of times clients with abandonment beliefs are so freaked   out and afraid of being abandoned that they’re not taking care of themselves either they’re   just living and are paralyzed going back to fight flee or freeze they’re living a paralyzed state   of I want to be loved but if I love I’m gonna get hurt and I don’t know what to do they don’t even   love themselves so we want to start talking about if you had your best friend you know create this   best friend persona what would he or she say to you what would he or she do right now let’s try to   help you understand yourself with mindfulness exercises are really good here because a lot of times these   clients don’t understand themselves they’ve got so much anxiety they’re so afraid and they don’t   know where it’s coming from because a lot of it has been going on for so long defectiveness   if people knew me they would reject me you know not everybody’s going to like you why do you need   everybody to like you why is it important that everybody likes you and failure I don’t measure   up and I’m not able to succeed I usually put pull out the obnoxious quote that if you haven’t failed   you haven’t tried and we talked about what it means to get outside your comfort zone and you’re   not going to be perfect at everything you’re not going to be Michael Phelps you’re not going to be   the president of the United States that doesn’t mean that you’re a failure that definitely   doesn’t mean you’re a failure so what things are you good at what can you and have you succeeded at and   go back and look over things like you graduated high school, not everybody does that you know   raised a family not everybody does that so we want to challenge all nothing’ languages we   want to look for exceptions and we want to look for in what ways can you provide yourself the   validation so you don’t fear abandonment you don’t need other people to tell you you’re okay because   guess what you’re telling yourself I’m okay and before I go on to unhelpful reactions I do want   to point out that if we tell people to tell themselves you know I’m okay that sounds great   but if they don’t believe it if it’s not supported with evidence, it’s actually probably going to slow   their growth because they’re sitting there going telling themselves I’m okay and in the back of   their head going you know you’re not so we need to get that internal critical voice to kind of   hush up by providing the person with the objective evidence of why they’re okay why they’re good   enough and that’s a slow process it’s not going to happen overnight but encourage people to figure   out why they believe what they believe and then you can work from there okay unhelpful reactions   fighting with someone you don’t want to leave me because so the person may engage in dominant   sort of posturing behavior aggression hostility blaming and criticizing trying to tear down the   other person to say you know what I don’t care and you should be grateful that I’m in your life recognition seeking to get attention validation or approval so if they feel something’s going   wrong in a relationship they may start trying to do something to gain recognition to prove that   they’re worthy of a relationship for what they do versus who they are manipulation and exploitation   said lying justifying I did this because you made me so sometimes we all occasionally do things that   aren’t the nicest people who fear abandonment have difficulty saying you know what I screwed   up and they’re more likely to go you made me do I wouldn’t have done it if you would have X   Y & Z people again who are worried about a relationship is going to fall apart and may also make excuses for   other people’s inappropriate behavior it’s like you know I really hate what this person does but   if I don’t make excuses for it if I condemn it then this person is going to leave in counseling   we can talk about the difference between loving a person and loving a person’s behavior you know I   love my kids to death there is no question about that but some of their behavior makes me want to   climb a wall I’m very clear to separate from them the difference between the behavior that I dislike   and them because you know like I said I love them to pieces and we want to help people start making   this differentiation if they don’t do it already and clinging and chasing is the other fight   reaction stalking and messaging somebody 47 times on Facebook in an hour all these kinds of behaviors   and even online bullying those sorts of things can be fight reactions in response to feeling like   there’s a threat of abandonment flight is more of the I don’t care if you leave so the person   will withdraw physically and emotionally and maybe even numb themselves with some sort of   addictive behavior or distract themselves with something completely different or find a new   person just proof that you know what I didn’t need you because I’ve got this new person now questions for clients about core beliefs all people leave okay so what does it look   like if somebody’s available to you if they don’t abandon you who in your past left you   or was unavailable emotionally now a lot of I find it helpful for mental health   and addiction clients to have them write an autobiography because then we can go back   and kind of review it and identify the core people at certain stages in a person’s life what did the person who left you do to make you feel rejected or abandoned in retrospect   you know it was hard to see the difference what was going on back then because you were a kid in   retrospect what are the alternate explanations for why this may have happened was it really   you or was it more about them who in your past has been available to you emotionally most of   the time people can point to one maybe two people who have generally been there it’s unreasonable to   expect someone to always be there who in your present is available to you emotionally you   know maybe they’ve only been in your life for six months or a year but they are available and I say   emotionally because you know not everybody can be available physically all the time we’ve got   jobs kids all that kind of stuff but can you pick up the phone and call them or text them and say   hey you know what I’m really struggling right now what do you do in your current relationships that cause people to leave do you push them away if so how what are alternatives to pushing them away cutting all ties and just saying fine be that way I wipe my hands off you if you cling how do you do  this in what ways do you perceive yourself as being clinging and what are some alternatives   to holding on with all desperation and mistrust people will hurt reject or take advantage of me or just   not be there when I need them so again what does it looks like when somebody’s or what does it feel   like when someone is trustworthy and safe who in your past was untrustworthy or unsafe what do they   do they taught you this and what are alternate explanations who in your past has been trustworthy  and safe who in your present is available and trustworthy what do you do to yourself that   is unsafe or dishonest that’s one of those tricky questions you’re there talking about other people   other people then it’s like what do you do to yourself how do you lie to your  self or how are you mean and hateful to yourself how does your distrust of other people or even  yourself impact your current relationships some people distrust their own internal intuition so  much that they don’t want to make friends with other people they’re like I can’t tell who’s  going to hurt me and who won’t so just yeah I’m going to wipe my hands of it all what could you  do differently what do you think you could do in order to start building trust and what does  it look like to build trust because Trust doesn’t just appear it builds gradually emotional deaths  deprivation I don’t get the love I need nobody understands me so again what does it look like  when somebody understands you and meets your needs who in the past failed to meet your needs  emotionally and how can you deal with that now you know it may have been mom it may have been   ex-husband it may have been you know who knows how can you deal with it now yourself so you can   put it to rest who in your past is understood you who in your present understands you how   can you start again better understanding yourself because it’s hard for other people to understand   us when we don’t even understand ourselves and what can you do to start getting your needs met you one of the things was starting to get your own needs met is to figure out what your needs are and   this is one of the exercises I have people do as a homework assignment they keep track of what is   it they want on a daily basis keep a log and then let’s talk about what common themes were seeing   if people knew me they would reject me okay so how do you know when you’re accepted or acceptable to   someone who when you’re past may make you feel defective are there alternate explanations and   how can you silence those old tapes because that person that statement stays as a heckler   in the gallery we need to hush the heckler what can you do part of it could be talking back and   saying you know what I’m not going to listen or I don’t have time for this right now who’s   been accepting and supportive who is in your life that’s accepting and supportive and how can you   start accepting yourself and being compassionate so some compassion focus training mindfulness work   to help people understand themselves and start being compassionate with themselves understanding   their vulnerabilities and cutting themselves some slack I don’t measure up I’m not able to succeed   okay that’s a pretty big success you know what is what success means success means different   things to different people so what does it look like to you to be successful let’s kind of hammer  that out what is it if you are successful what would be different what in your past has made  you feel like a failure what are some alternate ways of viewing it such as a learning experience  or something I had to go through to grow or you know brainstorming alternate explanations for   why people fail they don’t have a response to sometimes I ask them to kind of take on   a flip role and say pretend you’re a parent and your child comes home and they’ve tried out for   the football team and they didn’t make the team they failed what are you going to tell on what   have you succeeded at doing in the past what are you good at in the present and we really want to   pay attention to minimization here because a a lot of our clients are not good at identifying   their strengths what does being successful mean in terms of your relationship with others do you have   to be successful in order to be loved and be a the good relationship you know obviously you’re going   to be successful in a relationship if you’re but do you have to be financially successful and powerful all whatever you define success as in order to be in healthy relationships who are   three successful people you know and what makes them successful in your eyes does success equal  happiness you can do a whole group on that and what do your kids need to do to be successful  in life you know we want our kids to succeed in us want our kids to be happy so what is it that I  envision my child’s life to be 10 to 15 years from now triggering relationships the abandoner is  unpredictable unstable and unavailable the an abusive relationship is untrustworthy and  unsafe the deprived err depriving relationship the a person is detached or withholding the Devastator  is always judgmental rejecting and critical and the critic is critical and narcissistic usually   a lot of times people replay their past to try to kind of get it right the second time so we want   to look at do you have a habit of getting into relationships with people who are not safe we can   also ask them how do you exhibit these behaviors in what ways are these behaviors present your   current relationships and in what ways were these present and your primary caregiver relationships behavioral triggers abandonment and mistrust if somebody starts acting differently they change  their behavior in some way a person who fears abandonment goes oh that’s not good if they’re   not getting constant reassurance that’s that external validation can trigger   abandonment fears so again we want to work on internal validation and why is it that you   feel you need constant reassurance from the other person’s relationships feel threatening so   work relationships those sorts of things the a person who has abandonment issues won’t want   their significant other around other people and they become hyper-vigilant to rejection   and disconnection even if it’s just somebody going I had a really bad day I need 20 minutes  and go into the room and shut the door the person with abandonment issues will likely   have a high level of anxiety so we want to ask how these behaviors have threatened them in the   past what are alternate explanations for why this is happening with this person right now and what   would be a helpful reaction to these behaviors now so this is happening what would be a helpful   reaction instead of assuming that the sky is going to fall defectiveness and failure so if   somebody is critical if they have unexplained time apart there’s absent or inconsistent reassurance   or if the person tells them they’re a failure these or they fail at something these could   all be behavioral triggers they could be like I failed at something I’m not getting reassurance that this relationship fixing to end question how is this threatened you in the past alternate   explanations and what would be a helpful reaction to this particular situation right now envisioning activity what does a healthy the relationship looks like presence versus abandonment   acceptance versus rejection emotional support versus emotional unavailability trustworthy   versus untrustworthy and safe versus harmful these are extremes what does it look like to   be a middle ground there are going to be exceptions you know things are going to happen so what does   a healthy relationship look like and how to do you deal with exceptions if somebody’s not always   present how can you create this relationship with yourself that’s the big one and then how can you   create this relationship with others’ mindfulness questions what am I feeling what’s triggering it   am I safe right now and if not what do I need to is this bringing up something from the past if   so how is this different how am I different then I was when I was six or four and how   can I silence my inner critic finally what would be a helpful reaction that would move me  more toward my goals and toward a positive emotional experience summary core beliefs  about the self and others are formed in early life due to children’s lack of knowledge of other  experiences and primitive cognitive abilities these core beliefs are often very dichotomous   core beliefs can be formed around events or experiences outside of the conscious memory   identifying and being mindful of abandonment triggers in the present can help people choose   alternate more helpful ways of responding in the present in secure and loved me   don’t leave me are two really excellent books there are google previews if you want to look   at them to see if it’s something that you like but they do take what we talked about in this   presentation and expand upon it a whole bunch more 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 provides 24/7 multimedia continuing   education and pre-certification training to counselors 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Common Co Occurring Issues in Addiction | Addiction Counselor Exam Review

this episode was pre-recorded as part of a live continuing   education webinar on-demand CEUs are still available for this presentation   through all CEUs registered at all CEUs comm slash counselor toolbox I’d like to welcome everybody to today’s presentation on common co-occurring issues   exploring the interaction between mental health physical health and addiction so we’re kind of   putting together the stuff that we’ve been talking about for a couple of sessions now   we’re going to start by talking about some questions and then reviewing what a healthy   person needs and then going through and talking about how different addictions may cause or be   caused by mood disorders and physical health issues and we’re going to talk about things   that you may see in private practice or the a facility that you’re working in just real quickly   for those of you who are here how many people if you would just type in the chat window if you’re   a mental health counselor type mhm if you are a addictions counselor type SI or whatever so just   kind of so and know who I’m talking to you okay so mostly mental health ok cool so what we’re going to look at is what you may see in private practice or a mental health   setting because these clients a lot of clients that have substance abuse or addiction issues   and I use the term addiction because we’re talking about behavioral addictions too many   times they don’t meet the criteria for admission for substance abuse because they don’t meet that   threshold of a substance use disorder tolerance withdrawal yay yay so substance abuse agencies   can’t get funding to provide the treatment so they end up in a mental health facility or a   mental health counselor’s office and they may be dealing with some of these addiction issues   and wanting to address them or they may not be but those issues are out there and exist so   we want to know how they interact so told you we’re gonna have a couple of questions to think   about and I’m just asking you to ponder these for right now and you can add throughout the class if   you want but we’re gonna talk about it more at the end how can we and why is it important   to address chronic illness and disabilities that result from or that cause mood disorders   or addictions so thinking about you know like HIV or hepatitis are two of the big one’s cirrhosis of the liver chronic obstructive pulmonary disease from smoking so these are   things that can result from addiction why or how is it important for us as clinicians mental health   clinicians mainly to think about addressing these how can we address depression and/or anxiety kind   of our mood disorder genre and hopelessness that results from or causes depression and anxiety so   we know that thinking back affects acceptance and commitment therapy there’s clean discomfort   which is what he calls your initial emotion when you feel something if you feel depressed   if you feel anxious that’s how you feel and it’s uncomfortable but it’s clean it is it is   what it is and then he calls dirty discomfort the feelings that we have about those feelings   so we can get angry that we are depressed we can get depressed that we’re still depressed and he   calls that dirty discomfort because we’re kind of layering on and piling in think about just kind of   throwing somebody into a hole and piling more dirt on top of them so we want to think about   how can we address these issues that result from depression or anxiety or sleeping eating or energy   changes so if you’ve got somebody who is dealing with a chronic illness or something else has   happened or they’re they’ve got some sort of an addiction and they are not eating well not   sleeping well it could trigger depression or anxiety so we’re going to talk about that how   can we address sleeping eating and energy changes seems like we’re getting repetitive we’re looking   at how each one interface and how can we address these things that are caused by or cause mood   disorders or addictions because we know when we look at the diagnostic criteria for depression   for example sleeping eating and energy changes primary in there and how can we address guilt   and regret which may accompany addiction recovery or the diagnosis of the disease as the result of   addiction such as lung cancer or HIV or cirrhosis of the liver and people who have liver disorders   cirrhosis of the liver and hepatitis are at a greater risk of liver cancer so that can they   can have some additional anxiety that is related to that so they may look back and go I wish I   hadn’t well you have so how can we help you deal with that and come to some level of acceptance so   my little editorialized soapbox when we’re talking about addictions I mean sometimes we don’t want to   think that they exist we want to pretend that our clients are coming in their mental health clients   otherwise their perfectly healthy things are going great well that may not be the trick the   case a lot of people begin to use and I mean think about ourselves when we’re when we were   in high school and college or you know even later some people use it for recreation you know they want   to go out have a few beers do whatever cool you know that’s fine some people drink or use it for   relaxation my son has a love of we will use that word videogames and he will get on his videogames   and we’ll kind of get lost in it it helps him escape from you know life as we know it for a   little bit of time some people use because of peer pressure you know it’s everybody’s   doing it or you know you’re at a football party or something and everybody’s having a beer and   somebody offers you one and you don’t want to be rude things like that can happen and some people   begin to use straight up for self-medication they’re like I feel crappy I need something to   help me feel better or numb the pain so there’s a lot of reasons people begin to use so then you   might say well why don’t they just say no because it’s easy to say no well it’s not some   people start to use it because they’re bored and they want something to bring some excitement some   euphoria to their life and we’re talking about everything from sex addiction to internet addiction to cocaine use I mean we’re running the gamut here they may lack the awareness of the dangers or how   quickly you can become addicted I know when I was working in the facility in Florida there was the   sort of knowledge if you will and knowledge is not the right word rule I guess that with crack   cocaine for some people, it was a one-hit wonder you did it once and you were hooked and several drugs can be highly addicting quickly especially if they’re taken either   through injection or inhalation but we’ve talked before about the fact that our bodies can start   developing tolerance to opiates within 3 to 5 days so you know people may not a lot of people   don’t realize when they go in and their doctor writes him a script for two weeks of opiates and   they take it as prescribed that they’re actually becoming somewhat addicted to those opiates if   they take the whole prescription so they may not understand that some people don’t say no because   they have low self-esteem so they’re looking for comfort to help them relax to help them loosen   up so they can be more fun at the party and or to peer pressure somebody tells them why don’t use or why don’t come out and go drinking with us or whatever the case may be so to fit in   they may try to use it to fit in to feel part of a crowd and part of it can also be you   know with that peer pressure just generally the culture promoting this kind of behavior going   it’s ok I think I’ve shared with you before at At the beginning of some of the original Beverly   Hillbillies episodes they still advertised Winston cigarettes, like they are the greatest thing and cool people, have them and that’s the thing to do so if that message gets out people may start   believing it and not do their research so to speak on what the true problems or risks may be and then again self-medication some people may be struggling just to get by from day to day and   this helps them survive the best they can with the tools they have until we give them some new tools   so just saying you know I had I grown up during the era of Nancy Reagan and you know God loves her she was trying to help and for a certain small percentage she probably did but for a larger   percentage just saying no is not that easy we need to give people the tools so they can say no so   they don’t so they aren’t relying on these drugs for some reason because when people start using it for recreation and relaxation some people may not have a big big issue with it other people may   start throwing their neurotransmitters kind of out of whack depending on how much how often they use   what combinations if they’re on any medication so people may inadvertently start messing with their   neurotransmitters and creating and we’ll talk about this creating depression or anxiety   that they end up trying to self-medicate so that that is my soapbox for it is not that easy to just   say no we as a culture not just as clinicians have some work to do so what do we need to do to help people be able to just say no they need to have access to healthy nutrition   and knowledge of what that means my son and it’s still like drawing fingernails on a blackboard   to me today this week, I told his sister that you no, he didn’t understand why she was so concerned   with the nutrition he’s a guy he doesn’t need to pay attention to nutrition it’s just whatever and I   was just like oh my gosh you know everything I’ve said has fallen on deaf ears but okay we’ll back   up and figure out a way they need access to it and then they also need to eat it you know if   we have healthy foods available but people are still eating peanut butter and jelly sandwiches   for every single meal it’s not going to help so we need to make sure people understand what a healthy   diet looks like and how to do it in a way that’s not painful you know we’re not asking you to just eat   rabbit food as my daddy used to say but so what does it look like to eat a diet or nutrition that   makes you feel good that’s happy that makes you feel happily fulfilled you like it tastes good   whatever you want to say but that’s also healthy you know it’s not just pizza or just   peanut butter we need to educate people and a lot of adults that I work with have no clue about   sleep hygiene you know they know they’re supposed to try to go to sleep but they don’t know anything   about turning off the blue turning on blue light filters so the blue lights are not keeping them   up so we need to do some education here ideally in elementary schools but if we can get it out to the   community so they can pass it on to their little minions we’ll be on a good path to pain control we   need people to start having pain control but we need to also have them have alternatives to   pain control besides opiates and there are a lot of them out there again people don’t know about   so we must educate and we’re not prescribing pain control that’s not our job but   if we have a client who’s in chronic pain we can suggest that they work with their doctor that they   look into options for pain control you can google it and find a lot of different alternatives now   if they don’t want to go to the doctor but you know there are a lot of different things from   acupressure it attends units to things that are nonpharmacological that can help people manage   their pain so they can sleep which will help the rest and rebalance to deal with fatigue and   be able to deal with life kind of on life’s terms because they won’t be in this constant state of   stress people need access to regular medical care to prevent problems so you know we want to prevent   this thing on your face from becoming skin cancer we want to prevent anything else that that might   trigger problems and early intervention so like with Lyme disease, if people get early intervention   mentioned they don’t end up with the chronic problems with HIV the earlier the intervention   the better same thing with hepatitis you know the list goes on so we want to make sure that if   people have some sort of issue that’s disrupting their ability to get enough sleep process   nutrition go to work do any of these things that they have access to some method whatever method   they need to address it so sometimes it’s medical sometimes it’s mental health it’s social   services they need safe housing so we’re on to social services now and that includes a roof   over their head that they’re not worried when they go to sleep at night but also being safe   from domestic violence and things like that safety and this kind of goes with safe housing and I put   internal and external because you know the first part is external safety we want to be able to know   that our patients can relax wherever they’re at they have enough money to keep a roof over their   head in a safe place and you know typically that’s not something that we think about as mental health   counselors we think about helping them deal with their anxiety but if they can’t get enough sleep   and they never feel safe when they’re at home they’re not going to be able to rest and they’re   at best their recovery is going to be impeded at worst you know it’s going to contribute to the   issue that they’re seeing us for so safe housing is important we’re not going to get it for them   but we can point them in the right direction your local United Way which is 2-1-1 and most places   generally has a listing of different resources for accessing safe housing if you don’t work   in a facility that’s used to dealing with that and then internal safety that’s shutting up that   internal critic that’s being able to go through a day without being derogatory to yourself and that’s something that we definitely can help with we can help people shut down that   internal critic or that internal person that is always calling gloom and doom and you know   waiting for the other shoe to drop or whatever the case maybe we can help clients change their   cognitions so it’s safe inside their head and then people need love and acceptance and   this should sound pretty familiar are you know Maslow’s hierarchy here kind of in Reverse   but people need love and acceptance but in order for love to have love and acceptance in many cases   they also need to love and accept themselves so we’re gonna work on self-esteem we’re gonna help   people develop relationship skills hopefully there are some people in their life that have provided   some level of love and acceptance maybe not the unconditional positive regard we’ve hoped for but   they’re there so these are things that the healthy happy person needs and these are things in large   part we can do through education referral and direct services help people get so why do we care about   co-occurring issues as mental health counselors well 35 percent of people with anxiety disorders   have according to one of these studies abused opiates so that’s a lot if you’ve got somebody   with an anxiety disorder this isn’t just panic this isn’t just something you know severe   this is you know any of your anxiety disorders one in three roughly have abused opiates they’ve   used some sort of opiate drug to help them kind of chill out of opiate or alcohol dependent patients   20% have major depressive disorder so of that 35% you know there’s going to be a percentage   of them who may be opiate or alcohol dependent and there are a lot of our clients that we see in   mental health treatment who are not willing to be truthful about how much they really drink or how   often they drink because they might be suspecting it’s a little bit of a problem but   they’re not wanting to go there yet they’re in what we call pre-contemplation okay so let’s   just go with this in mind that there may be some underlying other stuff that they haven’t told us   about opiate or alcohol-dependent patients 20% have major depressive disorder so you know we’re   taking them and we may be seeing them in the clinic for depression and we do want to be suspect of   whether there’s either some opiate or alcohol issues there depression and opioid-dependent patients including pain management patients so those who are opiate-dependent by prescription have been associated with poorer physical health decreased quality of life increased risk-taking behaviors and suicidality am I saying that pain management clinics are bad no but what I’m saying   is those who are in pain management clinics for a variety of reasons are at a high in a higher risk   category I mean think about it if your pain is bad enough that you need to be going to a pain   management clinic think about how much that must hurt think about how much that must impair your   daily life think about the impact of the drugs that you’re taking on your mood your energy levels   and the stigma in some cases associated with it some people here suboxone and they’re like yeah   whatever my neighbor takes that other person here suboxone and they’re like ah you can’t be taking   that so there is still a lot of social stigmas that goes along with medication-assisted therapies so there are a lot of things that may contribute to depression in opioid-dependent patients   the prevalence and severity of depression tend to decline within the first few weeks after treatment   initiation so if they are trying to get off of you know ideally their detox and they’re   trying to you know remain sober the prevalence and the severity of depression tends to decline so we   need to get them off of it first and get them through that acute withdrawal from a depressant   including alcohol and I know this slide is boring but we’re gonna be through in a second withdrawal   from depressants including alcohol opioids and even stimulants invariably include potent anxiety   symptoms so it’s important to pay attention and withdrawal from stimulants can also include potent   depressive symptoms if they’ve been on a crack binge for you know five days that won’t sleep for   a while many people with substance use disorders may exhibit symptoms of depression that fade over   time and are related to acute with drawl well we talk about acute withdrawal we’re talking about   the first three months we’re not talking about the detox period which is generally three days so   encourage people who’ve gone through detox and maybe they’re seeing you on an outpatient basis   encourage people to you know be patient and work with the treatment team if they need to but the first   three months is always the hardest so chicken or the egg you know did the person start using and become   depressed or was the person depressed so they self medicated does it matter depression and anxiety   are associated with addiction because because if you have stimulant withdrawal or recovery   that period after you quit using that’s maybe a week maybe two weeks where your body is going   whew that was a run people may feel depressed fatigued have difficulty concentrating which can   impact how well they eat it’ll impact their sleep they’re gonna sleep a lot more but the   quality of sleep may be poor so they can mess up their circadian rhythms and you know they   may not have access to the social support that they wanted they may but really with stimulant   withdrawal we’re looking at nutrition and sleep so we want to educate patients if they   decide to stop taking stimulants what they need to look at stimulant use can also be associated   with depression and anxiety because many people not you know the majority but a lot of people   out there will self-medicate depression with stimulants from anything from caffeine which   you know maybe like mild dysthymia but if you abuse enough caffeine you know it starts getting   into your system you become dependent on it but if you start combining caffeine and nicotine plus oh   let’s add in some workout supplements or you know the occasional Ritalin or something not suggesting   it then it’s these things can wear the body down which can lead to additional depression but people   may use these things to try to feel better because think depression is related for some people   they may not feel like they can wake up they’re fatigued they’re lethargic all the time and   they’re feeling blue so if they take stimulants they get that dopamine rush they’re starting   to feel good and they’re awake stimulant use can cause anxiety well the so if you’ve got   somebody who already has maybe they are depressed but they’ve also got some anxiety and they start   using stimulants which may make the anxiety way worse alcohol or opiate use some people use these things   to numb or to forget and that’s just your the standard used the depressant some people will   use either one of these but especially opiates to deal with physical pain to medicate depression or   anxiety remember there are a lot of trials not several trials right now that are looking at   using opiates to treat intractable depression but a lot of people also use opiates off-label illegally to address anxiety so if you’ve got a client with depression or anxiety just kind of   be alert for how they’re behaving if they’ve got pinpoint pupils or if they’re itching and   picking all the time I mean not the occasional are winter and the heat just turned on I’ve got   dry skin itch but constantly itching and picking and you know where you’re like please just settle   down detox from opiates can all often produce depression produces a lot of flu-like symptoms   which can make people feel crappy and the flu-like symptoms I won’t get graphic impaired   nutrient absorption impaired sleep you know they’re sleeping a lot because they feel like   crap but they’re also having to get up every 10 minutes to go to the bathroom sometimes so   this first week or so during the initial if they go cold turkey so to speak can be rough   detox from alcohol as I’ve talked about before can produce anxiety symptoms so understanding   that when people are going through detox whether they are alcohol dependent and have been drinking   a whole lot which needs to be medically monitored I can’t say this enough and I’ll say it a lot more   tomorrow when we talk about where Nikki Korsakoff syndrome but people who are detoxing from alcohol   will have anxiety symptoms and a period of high blood pressure and sometimes depression and anxiety are associated with addiction just because they sober up one morning and they look at their life   and they’re like what the hell have I done so you know and you’re looking at them going yeah   I don’t blame you for feeling that way now let’s see what we can do to improve the next moment   so make sure that we understand that these things are going to go hand in hand and to be   on the lookout because like I said a lot of people aren’t forthcoming even about alcohol use which is   legal but if they’re using something illegally or using maybe their kid’s Ritalin or something   they’re pretty much almost guaranteed not to tell you so we want to be on the lookout for signs and   symptoms bipolar disorder can be triggered by drug use so we just know that we can the person could   get worn down mess with the neurotransmitters enough they’re not exactly sure how it happens   but we have seen the initial acute episode of bipolar disorder-triggered mania triggered by   drug use it is more common for people with bipolar to use stimulants when they’re depressed and just   about anything when they’re manic now if you’re working with somebody with bipolar you know   you’re probably already having these discussions about how you stay safe when you’re in a manic   episode people with ADHD may use to self-medicate and we’re talking cannabis is a big one for ADHD   to help people feel like they’ve got more focus and not feel like they’ve got so much coming in   and so much stimulation all the time which can be exhausting and after the use of any of the substances   of abuse the disruption and neurotransmitters can make people feel like they’ve got ADHD-type symptoms faculty concentrating difficulty following through with things etc so understanding   that even if things don’t meet the threshold for DSM-5 diagnosis we want to look at what symptoms   are there and how can we help people manage them so they’re getting adequate sleep nutrition pain   control social support and safety borderline and antisocial personality just kind of threw those   in there because we see those a lot when we’re working in dual diagnosis facilities more people   are more likely to use addictions to cope with a lack of sense of self and their emotional lability   if they’re borderline so I mean their world is so chaotic many people with borderline personality   disorder are likely to use to try to get some calm in the storm now I will put out my other soapbox   here with both of these personality disorders when you see somebody in active addiction or early recovery they probably have symptoms that would meet diagnosis you know their symptoms   are pervasive in multiple areas of life their symptoms would meet the diagnosis for one of these   two personality disorders during this period but it resolves as recovery becomes the norm   as the neurotransmitter stabilizes they develop interpersonal skills so you know giving people   a little bit of time before we say it’s borderline personality disorder versus borderline personality   characteristics if you will be helpful because both of these diagnoses can block people from   getting into certain treatment centers and getting some of the services they need okay so we’re going   to move on to some of our more common addictions alcoholism is associated with eating disorders   there’s a really strong Association and it usually flip-flops between bulimia and alcoholism so if   somebody’s symptomatic for bulimia they may not be drinking a lot of alcohol but they may during   periods of remission from the bulimia drink a lot more alcohol become alcohol dependent so there’s   a lot of research out there that shows there’s a strong correlation between these two things and   it’s also associated with binge eating disorder but especially bulimia nutritional deficiencies   from alcoholism can cause mood disorders so even if somebody is not and I use the term   I should have put alcohol instead of alcoholism because even the term heavy use without physical   dependence can cause nutritional deficiencies that can cause ulcers it can cause physical problems   physical exhaustion which can disrupt sleep alcohol impairs sleep quality alcohol makes   apnea worse so if you’ve got a client who has sleep apnea they’re drinking they’re probably   gonna sleep even worse than they normally do depression is the result of using well alcohol as a depressant so what do people expect well most people expect to relax they don’t think about the   rest of the stuff that’s going on in neurochemical imbalances because the alcohol exits our system a   lot faster than our brain can catch up and go okay it’s not in there anymore so I need to adjust the   temperature and in sleep disruption anxiety can also, be triggered as a result of use I’ve said   before say it again after that initial period where people feel the depressant or relaxing   effects of alcohol there is an upsurge in anxiety so a lot of people have another drink to kind of   quell that anxiety feeling but you know people with anxiety disorders are gonna feel it more   prominently and the neurochemical imbalances that alcohol use causes can worsen pre-existing   anxiety conditions or trigger anxiety conditions nicotine is another one that we see a lot even   in just straight-up mental health clinics not co-occurring so what effect does nicotine have   well anxiety and depression are 70% more likely in smokers so that’s one of those statistics we want   to look at nicotine triggers dopamine release okay so nicotine is one of the most addictive drugs on   the planet and you’re thinking I thought that was opiates well opiates are in there but nicotine   not only is nicotine legal but it’s also one of the most addictive drugs on the planet so that’s   another important point to think about people are using their trigger and dopamine release their   brain gets used to being flooded with dopamine so their receptors on the other end start sensitizing   so we’re creating an artificial environment basically when people are smoking blood vessel   changes when people smoke it causes blood vessel changes that can cause high blood pressure as well   as depression and fatigue and confusion in the blood vessels narrow and get stiffer so the oxygenated   blood has a harder time getting to where it needs to be so people start feeling blah and that can   cause them to think that they’re starting to feel depressed can also cause those cause loss of   energy people with severe and persistent mental illnesses are two to three times more likely than   the general population to use nicotine so that’s just an interesting little fact to have out there   if you work with people with SP MI and people with ADHD may smoke because it increases their   concentration and attention for about five minutes literally, for about five minutes but during that   five minutes they’re like oh my gosh it’s a relief I can like focus for half a second so we   want to look at what else is going on whether the a person has adult ADHD for example physical health   mental nicotine is linked with COPD and emphysema and lung cancer so you know all kinds of lung   and cardiopulmonary stuff well when that happens you know we have less oxygenated blood efficient   efficiently getting through the system we’re going to have increased fatigue increased confusion some   grief that may go along with that especially if people are starting to have to carry an oxygen   tank around with them or something you know we may have to help them deal with disability acceptance   and depression and stroke because smoking like I said increases blood pressure and reduces   circulation so cutting off or greatly reducing circulation to the brain they have shown that   people who smoke especially heavy smokers are at a much greater risk of stroke and addiction nicotine   is strongly correlated with other addictions a a lot of people when they’re in the bar well not   so much anymore since smoking is not allowed in public places but used to be when they were in   the bar they would also be smoking but a lot of people associate alcohol and nicotine or nicotine   and other drugs so if somebody is using other drugs likely they’re smoking now it doesn’t work   the other way around just because they’re smoking doesn’t mean they’re likely using other drugs the   reason this is more important is that people who continue to smoke after they have gone into   recovery for their drug of choice have a relapse rates as high as 68 percent higher than for people   who quit smoking so we start thinking about that and we say well why is that well because nicotine is a mood-altering substance you know we don’t think of it as such because it’s not a   woohoo it’s Marva hey okay it’s not as prominent of interaction as maybe cocaine or something   but it does change the balance and people still do use smoking to cope with life when things get   stressful they smoke well if things get stressful and you know they’re too stressed for smoking to   handle then they may start going back to what else can I take use or do that will make this   feeling go away right now we know also that was smoking and that repeated release of dopamine   they’re messing with the neurochemical balances in their brain, so it makes sense that eventually   just like tolerance to other drugs happens it may not be enough at a certain point and they may fall   back into other habits nicotine has been known to suppress appetite and but whether it keeps weight   off or not they haven’t shown alcohol and nicotine both are appetite suppressants which   is another reason people with bulimia tend to drink and one of the reasons why people quit   smoking they tend to be hungrier so helping them get through that period now whether it   helps them keep weight off the party that deals with the reason that they eat it’s not really that it’s   suppressing their or increasing their metabolism so much its nicotine suppresses the anxiety   and sometimes the desire the hunger but if people are still eating out of anxiety if they’re still   eating under stress eating then you know when they stop smoking and they don’t have a cigarette to put   in their mouth when they’re stressed they tend to go for other things and so we need to help people   figure out when they stop smoking are you eating because you’re hungry or are you eating   because you’re stressed if they’re eating because they’re hungry and they’re getting heavier   than they want to be they need to talk with their doctor about you know thyroid tests and also let   their doctor educate them on biological setpoint theory of you know not everybody’s going to be   a zero so you know that may be something we can help them deal with body acceptance issues if   you know maybe they’re programmed genetically to be you know a size X whatever that is and they’re   not happy because they want to be a zero which our culture does tell us to do as clinicians   we can help them look at you know the costs and benefits of continuing to smoke and what being   you know a size zero means for them to opiate abuse there’s a lot of physical stuff and we’re   just gonna run through it real quick because you’re not as concerned with it the physical   stuff the doctors are gonna see but we need to be aware of from a clinical point because it can keep   people from getting their basic needs met blood and injection site infections you know that’s   probably going to lay them up for a while but if they have repeated infections and are repeatedly   out of work they can lose their job they can lose their housing they can you know get some sort   of MRSA or something else which can be really expensive it can be life-threatening ya-ya   collapsed veins and this is more common obviously this is only for injection drug users but   collapsed veins just as you would expect keep the oxygenated blood from getting where it needs to be   so people are more likely to experience strokes and may have certain forms of vascular dementia   because of the strokes dementia we’re familiar with endocarditis is the inflammation around   the heart so again this is only for needle drug users but if you’ve got a client who is using   needles to inject any kind of drug be aware of that and what they get and what they inject is   rarely pure so knowing what else they’re injecting into their system if they’re you know crushing   pills from the pharmacy you’re a little bit more sure about what they’re getting as opposed to if   it’s from the corner dealer and sometimes they’re cut with really nasty things like   you know comic bathroom cleaner and stuff HIV if people get HIV from injection or some other risky   behavior they’re probably going to experience some depression and a lot of times HIV from   opiate abuse they’re gonna experience depression remorse regret all that kind of stuff anxiety   about how long they’re going to live what’s going to happen and oh those medication side   effects those the antiretroviral medications that they have to take are doozies I’ve seen people go   through the induction weeks on their medications and it is a rough time so helping people   get through it so they are medication compliance so they can continue to live we need to help them   maintain hope and self-efficacy and all that kind of stuff to maintain that forward movement to get   through the induction period liver damage from acetaminophen can set people up for you know   physical pain among other things and it decreased pain tolerance now this generally the decreased   pain tolerance goes away after the the body starts producing its endorphins and   natural painkillers again but that initial period Stevie-Wright-rare-interview if somebody quits using and maybe you know you are seeing them as a mental health client and they had an accident or had surgery or something   they started using pills they got a couple of refills then the doctor said no I’m cutting you   off and now they’re going through a detox period detox from opiates is unpleasant but it is rarely   life-threatening unless somebody becomes their electrolytes get imbalanced because of the flu   symptoms but we still may see this in private practice in mental health practice because   of the scenario I just told you people can start taking painkillers as prescribed for something   they may get addicted you know take them for a month or so then when they get off of them   not only do they feel like you know really bad but their pain is also back and it may be they   had their wisdom teeth out that pain may be gone but other aches and pains and everything you feel is probably going to be intensified until the body kicks back in so educating clients about   this is what happens you know it’s not uncommon if you think it’s too bad go see your   doctor helping them make sure they’re getting good nutrition you know it’s hard if you’ve got   flu symptoms to feel like you want to eat or hold anything down so what can you do to make   sure your body has the building blocks to make the stuff that it needs to help you feel better what   can you do to improve your sleep and a lot of our clients and you know where I used to work we   had a methadone clinic and we also had a mother baby unit and as soon as the mothers would give   birth then the doctor would start them on their detox from methadone and he didn’t believe   in the kinder gentler taper he was just like okay baby’s gone threats gone because you can’t detox   from somebody from opiates when they are pregnant because it can cause the baby to die anyway   so as soon as they would stop or as soon as they weren’t pregnant anymore he would just   D see them and they would feel really bad I mean not only did they just push an 8-pound something   out of their body but they also are experiencing a decreased pain tolerance because they’re not   on the opiates anymore and all they want to do is sleep it’s just like please so understanding that   is important in helping people get through that period even though they may want to sleep   all the time helping them understand that it’s important to maintain their circadian rhythms   if they have to take two or three ten-minute power naps throughout the day to get through   the day you know more power to them but if they can practice good sleep hygiene they’re gonna   be way better off in the long run OPD opiate abuse is also or opiate use is also associated   with the treatment of depression but it can cause depressive symptoms due to its pharmacological   properties I mean it slows everything down from you’re gastrointestinal to your heart rate to your   respiration you’re not breathing as much you’re not getting as much oxygen in you’re gonna have   more fatigue you’re gonna have more confusion you’re going to have more of those symptoms of   depression for some people they find it is and certain opiates they find it is a powerful way   to reduce anxiety it makes them feel like they’ve got a ton of energy because they’re not stressed   out anymore and this last one is one of the The main reason that I find people don’t want to give   up opiates is that they finally feel better when they’re on the eating disorders commonly a coat   co-occur with depression and anxiety which can be caused by nutritional deficiencies you know   you’re not giving your body the building blocks so it can’t make the neurotransmitters it needs   and it also probably disrupts your sleep some and depression anxiety can cause or trigger or   whatever you want to say eating disorders because people with eating disorders may fear becoming fat   have low self-esteem have a sense of lack of self-control or have body dysmorphic disorder   so we also want to be aware that there are mental health stuff that can trigger dysfunctional eating   patterns there’s about a 24% prevalence of PTSD among people with eating disorders so if you’ve   got a client with eating disorders especially bulimia be on the lookout for depression anxiety   body dysmorphic disorder alcoholism and PTSD they maybe smoking too but of the things, I just listed   that’s probably the least of their worries it’s all eating disorders are also associated with   alcoholism and smoking I said physical health issues now you’re seeing somebody with an eating   disorder it’s a mild eating disorder you’re seeing them once a week outpatient so you’re not and you   have you know you have training and working with eating disorders or maybe it’s   mild enough that you’re just getting supervision on treating this issue whatever being aware that   people with eating disorders anorexia or bulimia can have irregular heartbeats and cardiac arrest   due to potassium imbalances and electrolyte imbalances so if they’re not eating or if   they are binging and purging in some way shape or form and that includes excessive exercise which can   trigger a lot of heart problems they may have loss of bone mass and osteoporosis so they may   break bones a little bit easier going back up to the heartbeat not to belabor the point but again   heart problems mean a lack of available oxygen mean confusion fatigue potential difficulty   sleeping depressive symptoms and you know cardiac arrest in and of itself is bad kidney damage from   Doretta caboose and low potassium can also potentially drain damaged the adrenals which   are on the kidneys and so it’s important to be aware of what people are using a lot of people   with eating disorders are going to creatively use stimulants to suppress their appetite think   about any of your diet drugs your enter mean I think it’s one of them the ones they give to help   people lose weight they’re stimulants they’re intense stimulants so people who are   struggling with eating disorders are likely to go towards abusing stimulants or at least using them   which can drain the adrenals it can in some cases have been linked to the development of   Addison’s disease liver damage from not eating or binging and purging causing toxin buildup   and possibly pain we can help people deal with it as much as we can anemia which can cause symptoms   of depression in and of itself so goes back to that nutrition making sure they’re getting enough infertility which in and of itself can be devastating for young women if they can’t   have children anymore or can’t have children ever that may be a grief issue that we need to   help them deal with cathartic: and this is an important one to be aware of because you   don’t have to have somebody who uses laxatives all the time but people who regularly use or   abuse laxatives can become dependent on them so when they don’t use them they have a feeling of   bloating feeling full and abdominal pain which especially in people with eating disorders or   body morphic disorders surrounding just general body fit bad back body fat can greatly increase   anxiety depression hopelessness and in some cases of suicidality so again educating people   is the first step to helping them understand what’s going on and how dangerous laxatives can be but   also if somebody is trying to cut back on their use of laxatives or just recently stopped using   laxatives like when people stopped using opiates it takes the body a while to get back   online but for most people it eventually does people with eating disorders also have chronic   ulcers which are painful and can keep you up at night As you know gastric reflux and pancreatitis   which can flare up at a moment’s notice will is extraordinarily painful and can cause people to   lose time from school or work social activities feel bad about themselves and also   pancreatitis causes a lot of bloating which in eating disorders is a huge trigger   for anxiety and depression pathological gambling is associated with stimulant abuse especially   cocaine methamphetamine and Ritalin to stay focused disrupted sleep and rebound depression   when they quit taking that stuff they wake up and they’re like oh wow what did I just do alcoholism   is also associated with pathological gambling some people drink to calm their nerves some   people drink because it’s the culture if you go to any of the casinos you know their hand-and-out drinks, they’re trying to get you drunk so you keep gambling more and there’s as we spoke about   earlier rebound depression or anxiety smoking may help people increase their focus or make   them think they can increase their focus so if you can’t smoke in public places this is more of   an issue if you have somebody who does a lot of online gambling or they gamble at their friend’s   house or somebody’s house where there’s poker games and stuff smoking has some anti-anxiety   anti-anxiety properties and may be part of the the culture I know when my daddy used to have his   poker games everybody would smoke cigars and even the one woman who went there would be smoking a   cigar with everybody else and it was just the culture of being there so there are a lot of   different reasons that people may use substances in addition to gambling mental health issues from   gambling anxiety from the stimulant use or from the tension and release of am I going to you know   I’m down $20,000 am I going to make it back ADHD is also strongly associated with pathological   gambling bipolar disorder, especially during manic phases are associated with pathological gambling   generally you see them co-occurring it’s not like gambling causes it it’s you will see co-occur depression can occur due to losses and gambling can start because somebody’s depressed   because of their financial situation and their trying to figure out a way to you know borrow from   Peter to pay Paul and get ahead you also see pathological gambling is more strongly associated   with people who have obsessive-compulsive disorder if you’ve got clients with these   diagnoses just kind of you know be attentive to the fact that they are more likely to engage in   pathological gambling or if they start gambling it’s more likely to become a problem than for   people who don’t have these issues internet an addiction that is diagnoseable so   you know I’m not just making something up depending on your resource affects eight   point two percent to thirty-eight percent of the general population now obviously we were looking   at you know like games versus you know games plus Facebook plus shopping or something so depending   on the study you looked at their parameters were a little bit different but either way up   to 38 percent of the population has sacrificed significant personal recreational activities to engage in some sort of internet behavior Internet addiction can cause anxiety or   depression due to eyestrain and chronic headaches you know if you’re hurting all the time it can   make you feel wonky it can also interrupt your sleep can cause circadian rhythm disorder which   can trigger depression fatigue reduced stress tolerance this is a condition when your body   doesn’t know whether it’s supposed to be awake or asleep because a lot of people who engage in internet-addictive behaviors do so in the dark or you know they don’t pay attention to whether the   lights are on or not they may just sit there kind of in their cave carpal tunnel contributes to pain   and sleep disruption because carpal tunnel does wake you up at night back ache again may disrupt   your sleep and can cause chronic pain during the a day which can interrupt your daily activities poor   nutrition I know a lot of gamers that will sit there for an entire weekend and not get up to go   eat so if it’s not brought to them they don’t eat they’ll even wear adult diapers so they don’t have   to get up to go to the bathroom reduced immunity due to exhaustion from not sleeping and job or   relationship problems I know uh several people whose marriages ended over a world of warcraft’   so internet addiction is a real thing and it’s something that we need to be cognizant of because   it does cause a lot of problems and a lot of relationships and it may be one of many problems   but it’s something to look at sex addiction can cause hepatitis and a variety of different STDs   which if not treated can cause systemic problems it’s related to anxiety and depression because sex   addiction may begin in order because somebody wants to feel loved or connected maybe after   a breakup or because they never felt loved you’re connected and then they feel that rush and they’re   like oh I like that I want to do that again part of it could be engaging in that behavior which is   so thrilling you know depends on the person psychological withdrawal from sex addiction   people who have been engaging in sex addiction type behaviors and I include pornography addiction   in it for this presentation if they’re not able to access that may start feeling anxious or depressed   they can’t get to that they can’t get to the the thing that’s gonna cause the dopamine rush and   reflection on behaviors that they’ve engaged in as a part of their sex addiction can also prompt   anxiety about a spouse finding out you know am I going to develop an STD and am I you know how I feel about what I’ve been doing so as clinicians if we’re working with somebody who has compulsive   sexual behaviors even if you know anywhere about that the spectrum we need to be aware that these things may   exist and figure out or help them figure out how they feel about it and what they need to   do to make sure that they’re getting good sleep that they’re dealing with their depression and   their anxiety so that they can have a safe internal and external environment so back to that global   perspective how can we and why is it important to address chronic illness and disabilities   that result from or cause mood disorders or addictions how can we address depression anxiety   and hopelessness that results from or causes depression anxiety or physical problems how can   we address physical problems that are caused by mood or addictions and how can we address   guilt or regret which may accompany addiction recovery or the realization of a diagnosis of a   disease caused by the addiction so while you kind of ponder those there was a question that came in so question what about robbing Peter to pay Paul in association with trauma specifically childhood trauma so if you could clarify that for me a little bit I had mentioned robbing Peter   to pay Paul in terms of gambling so I’m just so mental health issues can be caused by or trigger   addictions or physical health issues addictions can cause or trigger mental health issues or   physical health issues that can be caused by addictions or mental health issues   so again chicken-or-egg we don’t necessarily know which one came first when you have any one of   these it’s probably going to or likely impact each other person or each other area common   issues are seen in all three changes in sleeping changes in nutrition fatigue and grief effective   treatment requires addressing the underlying causes as well as the ripple effects you know so yes after childhood trauma or trauma of any sort, some people may spend a lot   of time feeding the addiction as you put it or engaging in addictive behaviors to avoid some   of the PTSD symptoms to avoid thinking about it to deal with the grief to deal with the shame so   they may engage in something that makes them feel better or helps them forget to cope with the trauma that happened until they have other tools so they can come to   some sort of terms with it and you know as I say close that chapter in their book already   if there are no other questions tomorrow’s the presentation I learned a lot creating is   on alcohol-related dementia and vascular dementia and fetal alcohol spectrum disorders all three of   which are issues that are caused by substance use and specifically alcoholism and then I’ll   give you a hint about where an acute Korsakoff a a lot of clients who abuse alcohol but they’re not   alcohol dependent who decide to stop drinking can trigger where Nikki Korsakoff syndrome   and causes alcohol-related dementia-type symptoms so again in mental health, we need to be on the   lookout for it if we hear that our clients are trying to cut down on their alcohol use   alrighty everybody and so tomorrow is that presentation and then Thursday we’re going to   look at different models of new bottles of treatment 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 com VirtualBox this   episode has been brought to you in part by all CEUs calmly provide 24/7 multimedia continuing   education and pre-certification training to counselors therapists and nurses since 2006 used coupon code consular toolbox to get a 20% discount on your order this month  As found on YouTubeAnimated Video Maker – Create Amazing Explainer Videos | VidToon™ #1 Top Video Animation Software To Make Explainer, Marketing, Animated Videos Online It’s EASIER, PRODUCTIVE, FASTER Get Commercial Rights INCLUDED when you act NOW Get Vidtoon™

Emotional Eating Signs and 7 Tips Cope | Making Peace with Food | Counseling Techniques

This episode was pre-recorded as part of a live continuing education webinar on demand. Ceus are still available for this presentation through all CEUs registered at allies com, counselor toolbox, hi everybody, and welcome to today’s presentation on emotional eating and making peace with food during the next hour.So we’re going to define emotional eating and differentiate it really from eating when to celebrate and when it’s a problem and also differentiate, differentiating it from eating disorders will explore emotional eating in terms of its, beneficial functions and rewards and discuss.Why restrictive diets, don’t resolve emotional eating a lot of times? People will say you know, I have been on this diet forever and it doesn’t seem to be working or I can’t seem to stick to any diet that I try and we’re going to look at different reasons why this might Be what is emotional eating and it’s exactly what it sounds like it:’s eating in response to emotions and feelings other than hunger.So if you’re eating, because you’re bored, if you’re eating at someone and sometimes especially if you are angry at someone or disappointed in someone, you may eat and sort of be eating and thinking you made me do this so eating At someone eating to forget or distract yourself eating, to feel better because when you eat, regardless of what you’re eating, but especially if you eat high sugar high-fat foods, you’re going to release serotonin and dopamine eating out of boredom.You know hand to mouth bang, eating out of habit and, as I said a few minutes ago, not all emotional eaters have an eating disorder um and we want to differentiate that.Does it mean that their eating is not problematic to them? No, not at all.OIP-28If they’re telling you it’s a problem, then it’s a problem.They may not meet the criteria for binge eating disorder or bulimia, but it’s important to address it because they understand that they’re eating for a reason.Other than hunger, they want to stop because they want to eat, for hunger, but not otherwise, and for us as clinicians.The first thing we need to do is understand: why is it that they’re eating? Is it boredom? Is it a habit, so they need to keep a food log or a food journal for over a week or two weeks, and sometimes when people come in for an assessment, especially if that’s one of their main presenting issues? I’ll start by just doing a retrospective of the last three days to get an idea of what may be triggering some of their eating episodes.And then we can look at some of the habits or bad habits, maybe that they’ve gotten into, and start talking about ways to address those remembering that Rome wasn’t built in a day this isn’t going to go away overnight.But a lot of times, if you give people some tips, tricks, and tools to think about implementing when they walk out of your office after the assessment before the first official session, it provides them some hope and gets the momentum going and again you don’t Have to binge to be an emotional eater, some people graze all day long.Some people will eat and it’s not what would be considered technically a binge, but it’s more than they had anticipated.Maybe they go back for second helpings or third helpings when they weren’t hungry, but it was good.So why is eating so soothing? There are a lot of reasons.Now there’s obvious it’s, tastes good, so that’s.You know the big obvious bonus, but thinking about the function eating serves, we have to eat to survive.When you were an infant, it eating involved a closeness with your parental unit, which could release oxytocin, and I say, parental unit because even if it was dad feeding the baby a bottle there was that connection.There was that contact that caused the infant and the parent to release oxytocin. This is our bonding chemical, so eating was associated early on with bonding food may also have been associated with sleep.If the infant or child was given a bottle every night to go to sleep, then they may start thinking or they may be in the habit of eating to wind down or calm down, and we need to help them figure out different ways to do That as a toddler, what eating mean think about when you went from well, we probably don’t, remember that, but think about when your kids went from eating.You know food out of a jar to even their first Cheerios.That was a huge figure out.How to pick up that little cheerio and get it in their mouth and it involved exploration and mastery.They were discovering all different types of textures and tastes and figuring out what smell went with what taste, and it was a cool and exciting time for kids, and I mean think about it.They’re like a year old, so it doesn’t take much to amuse them, but this was the rewarding reward.Equals dopamine equals let’s do that again.It involved power and control of the child.At this point was starting to be able to feed himself or herself and was starting to be able to be somewhat independent of the parent when it came to the basic physiological function of eating. So eating itself had its rewards and it was self-esteem building because the child started learning.You know how to feed yourself and how to ask for what he or she wanted, at least in terms of food.There are formations of memories around foods, even as early as toddlerhood.You know we have celebrations, we have birthdays, we have different things and most children have certain foods that they like, and it could be because the first time that ate that food was a really happy experience or it could be just that’s, their favorite Food and that’s all they want to eat, but they remember that food and they remember when they ate it, they felt good.They felt happy so as an adult there,’s a part of their brain going chicken nuggets.Make me happy now that’s, how the toddler thought as an adult.We can understand that chicken nuggets themselves, aren’t making you happy, but you see the connections that we’re making.Here there’s been an association between happiness and chicken nuggets unhealthy foods, especially for children when, as adults, we’re still able to control what they eat.Your sugary foods and your unhealthy foods are usually reserved for treats or rewards.So when you’re feeling like you need to be rewarded when you’re feeling like you want to feel good, sometimes you’ll resort to those things. When you were a kid that made, you feel good like chocolate, chip, cookies, Haagen Dazs, or whatever it was for you.We’ve talked in the past, about associations and conditioning, and this is all coming back kind of full circle now because we need to understand that our brain has associated pleasure and reward with food for a lot of different reasons.Not just because of nourishment looking at the reasons why your patient eats is going to help you understand what underlying issues you may need to address in treatment.Culturally, we associate eating with caring and celebration and think about birthdays and holidays.What do we get together? We have buffets, we have pot Luck,’s.When someone passes away.What do you bring food over when somebody’s sick? What do you bring food over to in our culture? There is a lot of emphasis put on eating and nourishing, and that’s, true of a lot of different cultures.Low blood sugar can cause feelings of depression and anxiety which are quelled by food.So if somebody typically doesn’t eat well during the day, you know they go long periods without eating or if they have blood sugar issues, to begin with, and then they eat they feel better.So when they start feeling not so good, what do you think their first reaction is, let me eat and see if that helps evolution, predisposes the human body to crave high sugar, high fat, high-calorie foods for quick energy and to prepare for a famine. Our bodies are cool and frustrating at the same time because you know your body takes in this these foods and it says we’re going to secrete, the most amount of dopamine and the most amount of reward for these high-calorie foods because We want to make sure we’re prepared in case there’s a famine back.You know in the day many many many years ago, hundreds of years ago we couldn’t guarantee.We would have a meal every day, let alone three meals every day.So the body prepared – and it said alright – we need to get whatever we can when we can.So we’re going to make this higher fat higher calorie food more rewarding.Now I said it:’s also can be a blessing and a curse.Today, there’s still a little part of our primordial brain.That says, if it thinks there’s a famine, it will slow down your base metabolic rate, which causes people to gain weight.We see this a lot in people with eating disorders, who tend to not take in very many calories, or if they take them in they purge them.So the body goes well. I can’t guarantee I’m gon to get enough food.I’m going to get enough energy to survive.So I’m just going to turn down the thermostat a little bit and turn down the base metabolic rate, which compounds the problem for the person with the eating disorder.So it’s important to understand that the brain is somewhat active in what’s going on.So I keep saying we need to figure out what’s behind or underlying the craving.First, we need to rule out physical causes for some people.It’s as simple as this.If they’ve got low blood sugar because they’re not eating too often and obviously as counselors, we’re not going to diagnose this their doctor or their nutritionist will, but we can start exploring and go.It sounds like you might need to look at having your blood sugar checked or talk to your doctor about how frequently you need to eat because some people – and I know I’m – are very guilty of it.If I get into it into a groove doing something I’ll eat breakfast and then I’ll get into a groove and before I know it, it’s 3 00 in the afternoon and I haven’t eaten for like a whole bunch of Hours I’m not doing math today and my blood Sugar’s low and I’m starting to get foggy, headed and irritable and tired. So it’s a real, simple fix there in our society we are so driven and we are so.We get so caught up in things because that’s such a fast pace that it’s easy to forget to eat or is easy to avoid eating so that’s.The first thing we want to rule out.Are you eating in response to low blood sugar, which is making eating, seem more rewarding when you eat in response to low blood sugar a lot of times, people who do that end up eating more than they normally would because they start eating fast.It’s like I’m going to shovel, in as much as I can.Your brain doesn’t register you’re eating for 20 minutes or so so, before their brain, even registers.What’s gone on and gets the blood sugar back up? They’ve already eaten a whole ton of food.Why is this under-emotional eating? Well because generally, when they go in to just start eating, yes, they’re hungry, but they’re, also cranky and irritable, and most of the time they’re.Not thinking about I’m eating for the nourishment it’s, I’m eating, feel better lack of sleep, and this is so true for shift workers as well.As you know, new parents and college students, and anybody who’s not getting enough sleep. If we are surviving on sugar and stimulants, we’re going Peak and Lower Valley, Peak, and Lower Valley, and you just keep going up and down until you just crash, because every time you crash you crash a little bit lower.So if somebody’s on that roller coaster, they’re going to feel worse between you know: eating episodes they’re going to feel tired.They’re going to feel a flood of sluggish irritable fatigued and, to a certain extent, maybe depression, and they may be missing attribute those feeling, those emotional feelings to emotions versus physical causes, and likewise we also want to make sure that you know we’re addressing The emotional causes because there’s probably stuff there too, but if they’re not getting enough sleep and they’re living on sugar and stimulants their body is kind of in a state of hyper-vigilance, a lot of times it’s exhausted.So they’re going to be tired and cranky.So those are a couple of things that we want to look at.Those are relatively easy fixes or at least relatively easy things to point out and go let’s think about this.One of the things that I suggest for a lot of my clients is just to take a week and mindfully and it is difficult but try to eat healthfully.You know try to eat a few times a day.You know try to eat like three meals a day and get enough water and try to get enough sleep and try not to overdo it.On the stimulants at the, beginning I, 39, am not going to say cut out anything because that 39, is not, realistic and it’s not fair, and they 39, are probably already struggling if they’re coming in to see me, so if I go hey Let’s just turn your world upside down and guess what you’re not going to drink any caffeine anymore. It’s not going to create a happy person, so I asked them to try to make some small changes and see if that starts, to help dehydration causes fogginess and symptoms of depressionWe want to make sure that they rule that out and too many stimulantsAlso causes dehydration, so you know we’re looking at some of the physical causes of irritability and fatigue and cravings because again we’re going back to when I felt this way before not looking at it.Why I felt this way.But when I felt irritable depressed cranky, what made me feel better and generally food, and generally it’s, not good food.For me, it’s M Ms.I love my M Ms, especially the ones with almonds, but I digress.Nutritional causes of cravings, high carbohydrate, and high starch foods caused a greater release of serotonin and endorphins.So if you’ve got somebody who’s depressed for whatever reason that they may crave these kinds of foods to increase their serotonin level or increase the endorphins, their energy levels, chocolate people who crave chocolate may be low in magnesium.It also um the level of magnesium affects how much serotonin is available again. Just I keep saying this just for legal reasons.We want to make sure their doctor or nutritionist goes in and makes this diagnosis, but if there are particular foods that they do crave, they need to bring that up with their medical provider if they’re craving fatty foods.Now again, fatty foods are just good.I love fried foods, but it also could mean that they’re not getting enough Omega threes, Americans, typically don’t and interestingly, if they crave soda, they may be calcium deficient, who knew so?These are things to take a look at to ask people.You know if they’re craving soda, maybe cutting back on their soda a little bit and seeing what happens and or getting blood work done.R-1Once we’ve ruled out the obvious physical causes.They’ve gone to the doctor.Gotten blood work done everything I’m coming back happy.They’re getting enough sleep, but they’re still eating when they’re, not hungry, we need to rule out habits. Is there a particular time or activity that makes you crave this food? When I was growing up, I would go to the grocery store with my mother, and on the way back home from the grocery store.She would always we would always get junk food and she would get a bag of chips and put them in the front seat.It was like a 20-minute drive from the grocery store to our house and by the time we would get back to the house.We would have put a good dent in those potato chips.That being said, I got into the habit of whenever I went to the grocery store.I would get something out of the bag and put it in the front seat and eat on the way home.Now am I paying attention to what I’m eating? No likely am I eating, because I was hungry, probably not so.We want to look at habits.A lot of people will eat when they are watching TV.It’s a huge one. So we want to not do that or if you’re going to eat when you’re watching TV make sure you sit at the table.At least that makes you a little bit more mindful so think about whether are there particular times or activities that you eat and you’re just not hungry.Are there particular times that you mindlessly eat, like, like, I said when you’re driving or when you’re watching television? Those are both habits and can be mindless because you’re not paying attention to how much is going in your mouth.You’re not probably paying attention to the taste and you’re not paying attention to whether you’re full or not.So if you’re mindlessly eating, then there’s going to be a lot more calorie consumption.In addition to the fact that you’re not eating because you’re hungry, you’re just eating to eat, are you going too long between meals than needing a sugar boost which leads to a sugar crash? So again that’s a physical cause? But we want to rule it out.These are bad habits that we can tend to get into other things that can be construed as bad habits are eating without putting food on a plate.If you eat straight out of the bag, you’re going to eat.More than if you put it on a plate, so put it on a plate, sit down, try not to watch TV, all the things that your grandmother would have told you.So what do we do about it? Emotional eating interventions? I talked earlier about the food diary. Do a retrospective during the assessment if they want to get a jumpstart on things, but have them keep a food diary, preferably for the duration of treatment, but at least for a week.What time did they eat? Were they craving just any old food or something salty, something that was sweet, something that was sour? This will give you a general idea and can give their medical provider a general idea if there are any nutritional imbalances or if there are particular associations.What emotion or state were you in, I say state because being exhausted is not necessarily really an emotion.Were you happy sad, mad glad exhausted drained whatever state feels like it would work, and then, because of why were you feeling this way it doesn’t have to be a dissertation? It can be short and sweet, but I encourage clients to write down everything.They eat before they eat it during the first week, or you know, like I said, preferably throughout the entire course of treatment why, before they eat it because it’s a stop, remember we’ve talked before about how we have an urge.We have a craving, we have an urge and then we engage in the behavior oftentimes without stopping mindfully.Think is this what we want to do this provides that stop.It says: okay, I’ve got it to write down the time, and then I’ve got to think about why I’m eating, and honestly a lot of clients notice, a reduction and their habit of eating when they have to do this, just because they don’t want to record-keeping that up for a month or two months helps break some of the habits, eating that they might do like.I said before when they’re eating, I encourage them to use a plate.Sit down. Don’t walk around don’t stand at the counter, eliminate distractions as much as possible and focus on the food you’re eating that goes with mindfully eating.What does it taste like? Is it good to take small bites when my son was young, I think I’ve shared this before he had gastric reflux and we would sit down at the table and I would shovel in food as fast as I could get it in my mouth because He couldn’t be put down for too long before he would start to get fussy, at least until we figured out that he had gastric reflux and Zantac was just a lifesaver.I developed that habit when he was little and I kept it up for a while.It took a while to learn for me to learn to go back to take.You know reasonable bites and tasting my food, and even today, if I’m not paying attention too much, I’ll eat my dinner fast and then I’ll sit there and I’ll be like well.Yes, I’ll taste that a little bit later, because I didn’t taste it when I ate it encourage clients to be aware of their eating habits, and try to avoid setting up a binge by restricting certain foods.Now.Does that mean you have to have cakes and candy and whatever your trigger foods are in your house all the time and in your face? No, I would encourage people not to do that, but to say you know, I said for me M Ms, is one of my favorite reward foods.If you will, I don’t keep them in the house, but I will allow myself occasionally to buy a small snack-size pack of M Ms, when I’m out or I will get a regular-size pack and I’ll share it with my daughter, so I’m not restricting it.I’m not saying I can never M. Ms again, I’m just not making it available to myself when I might have some unrestricted time, try to avoid buying a bunch of comfort foods and keeping them around the house, and when you’ve got kids when you’ve got family, it’s not entirely possible, usually to not have some of that stuff around but try to avoid having the things that you particularly used for comfort, because if it’s not readily available, then you’ve got to focus on guess what dealing with the emotions.Instead of stuffing them with food, try not to go too long without eating.Like I said earlier, if you go too long, then by the time you get to the food, your blood, Sugar,’s low and you’re just shoveling it as fast as you can initially distract.If you know that you’re getting you’re eating and you’re, like I’m – really not hungry, but I want to eat, take a bath, take a walk, call a friend, heaven forbid get on Facebook.Whatever it is, you can do to distract yourself for 10 or 15 minutes if, after 10 or 15 minutes, you’re still going, I want whatever it is, then you can decide what to do about it.Then, most of the time when people stop and go, I’m not hungry.Let me distract myself.They get caught up in that distraction and before they know it, they’ve forgotten about the craving, and identify the emotions.If you know that you’re not hungry, but you want to eat, then say: okay, what’s going on what’s going on with me? It doesn’t mean that the person is never going to eat when, when they’re upset, because a lot of people do, and is it the end of the world, probably not necessary if they can start reducing the frequency of times that they eat.In response to emotional distress that’s, what we want, we want to progress, not perfect if it’s, depression, what’s causing them to feel hopeless or helpless right now, if it’s, stress, anxiety, or anger, remember our big kind of lump together stuff. What are they stressing out about? Do they feel like they’re overwhelmed? Are they afraid of failure, rejection, and loss of control of the unknown? We’ve gone through those things.We want them to identify what’s going on with them, and then they can make better choices about how to deal with it.So general coping helps them develop, alternate ways of coping with distress.Distract we’ve, already kind of gone over that one.I encourage people – and you know it’s – one of those DBT things – that a lot of therapists encourage their clients to keep a list of things.They can do to distract themselves because it’s not always practical to get up and go on a walk.If you’re at work or it’s, you know two in the morning.So what else can you do to distract yourself? Talk it out with a friend with yourself with your dog? Sometimes you just got to get it out.People who are more auditory will prefer talking it out as opposed to journaling it now.If they talk it out with themselves, they can record it if they want to, or sometimes it’s just better to have a dialogue with themself. If it worked for Freud, it can work for other people journaling.If your clients are inclined to journal, encourage them to write it down.Sometimes just getting stuff out of your head and onto paper will help the feelings dissipate a little bit.So you’re not mulling them over and obsessing over them and getting stuck in those thoughts and feelings.Additionally, while you’re distracted talking it out or journaling, this is also your break.Your stop between the urge and the behavior make a pro and con list of the de-stress, not the eating whatever it is, that’s stressing you out and how can you fix it or what are the pros of this situation and what are the downsides To this situation, encourage them to focus on the positive.You know.If something stressing you out at work, you know you’ve got a big meeting coming up or something you don’t want to do or what it is.You can get stuck on focusing on that or you can focus on the positive that you do have a job.That meeting only comes around once a month. You can it’s time you don’t have to be doing paperwork whatever the pros are for that person encourage them to focus on the positive.If you’re distressed because of some kind of a failure or perceived failure, figure out what you learned from it, whether it was a relationship failure, or maybe you learned what not to do in a relationship anymore. Maybe you learned things that you may have ignored.Maybe you learned what you should have done instead, but how can it be a learning opportunity, instead of somewhere to stay stuck and finally, if something’s making you upset if something’s causing anxiety, depression, hopelessness, helplessness, whatever the negative feeling figure out.If it’s worth your energy to get stuck here, is it worth the turmoil? Is it worth you know having to pacify yourself with food or whatever? It is a lot of times people say you know what now it’s, just it’s, not even worth my effort.It’s not worth moving me away from my goals, because my goal is to stop emotional eating.My goal is to eat for hunger, so I can go to dinner with people and feel comfortable.I can be at a party where there’s a buffet and not feel stressed out that I’m going to go and eat half the stuff on the buffet that’s my goal so is holding on to whatever this de-stress is getting me Closer to being able to do those things and generally the answer:’s no develop alternate ways of coping with the stress the ABCs, the a is the activating event.What is stressing you out and what’s causing the de-stress C is the emotional reaction.Angry depressed stressed, whatever be: are your behaviors? What behaviors or B are your beliefs? Sorry, what are the beliefs that are in there that may need to be addressed? What kind of things are you telling yourself, and, and how can you counter them? Cognitively eliminate your vulnerabilities.You knew we couldn’t get through a presentation without talking about vulnerabilities. If someone is well-rested.Well, the fed has a good social support network, not stretch timewise.Then it will be easier to deal with stress or stressors when they come your way.You’ll have more energy to deal with it, so there won’t be this overwhelming feeling of I just want to bury my head in a jar of peanut butter, be compassionate with yourself.Some days, you know you’re, just going to feel anxious.You’re going to feel depressed.You’re going to get angry.You can beat yourself up over it and you know a lot of people do.Is that the best use of your energy or can you be compassionate? Can you learn from it? Can you give yourself a break and go? You know what I’m having a bad day today and that’s okay, I’m not going to unpack and stay here, but I’m not going to fight.It either helps clients learn how to urge surf help. They understand that, just like a panic attack just like a wave just like a lot of other things in life, it will come, it will crest and it will go out again, so they can sort of identify where they are on the energy of that Urge other tools people can use close the kitchen once I have the kitchen cleaned and you know all the dishes are done and it looks pretty.I hate going in there and finding dishes in the sink again now I’ve got teenagers, so we always have dishes in the sink.But before I had children, you know at seven o’clock.I finished all the dishes and closed the kitchen, and that would be enough motivation for me to not go in there and at least not use plates and stuff to eat.So if we’re saying that we’re going to only eat using utensils plates and sitting and all that stuff that we already talked about, then once you close the kitchen, you’re not going back in, there turn off the light.That also helps so you’re not being attracted to the pretty lights, and you know all the goodies that are in the kitchen to brush your teeth.This is something my grandmother used to do and it works.There’s some research behind it.Minty flavors reduce our appetite.So if you brush your teeth, you get all the other flavors out of your mouth and it reduces your urges to eat because it again it’s clean and fresh. And do you really want to brush your teeth again, and meditate, sometimes just getting in a space where you’re, not obsessing about anything, can help people get past that urge to self-soothe by eating a CT for emotional eating.What am I feeling or thinking about what’s going on with me right now? What is important to me? So if I am thinking I want to eat, I want to you know just dive into this jar of peanut butter, and then I think about what’s important to me.Is it important to me to get control of this? Is it important to me to you know, be able to fit into my clothes in six months or not? So what is it in? What way is controlling my eating habits and eliminating emotional eating important to me, and how does that get me closer to other things that are important to me, and what other things could I do? That would get me closer to my goals.So if the goal is to have improved relationships, be able to feel more comfortable around food reduce the stress around going out to eat, and just around food in general, what else can you do when you are stressed out? Somebody also suggested that adding a blue light in the refrigerator decreases the appeal of foods, which is interesting because yellow red and orange, and browns, I think Pizza Hut – are all foods that increase people’s, hunger and desire to eat.But blue is just a completely different primary color, and adding a blue hue seems like that would be effective, so cool thanks for that.Little tidbit there holiday help, and you know we’re coming into the holidays.So I’ve got to bring that up at every single glass and choose lower-calorie foods.If you tend to get stressed out or caught up or mindlessly eat when you are at family gatherings.Okay, you know cut yourself a break, know that that’s, probably going to happen, and fill up on the lower-calorie foods.The carrot sticks the broccoli, the white meat, turkey, anything that’s available, that’s, not like sweet potato pie or brownies, keep water or low-calorie beverage. In your hand, if you’ve got your hand full, you can’t eat at the same time.So you know if you walk around with a cup in your hand, it helps talk to people.Hopefully, you don’t talk with your mouth open or talk with food in your mouth.So if you’re talking to people, you’re not going to be as inclined to go and get something to eat because you’re wanting to stay engaged in that conversation.Stay away from the buffet, especially if you know that it could get stressful, or maybe you know for me, I turn into a pumpkin at like 7 30 at night.I get up at 4 00, but I turn into a pumpkin at 7, 30 and a lot of times holiday parties and those sorts of things are at eight, nine, o’clock at night, and you know I’ve already turned into a pumpkin.So I know that if I go to those I’m going to be more likely to eat just to kind of stay away because I’m tired and it’s a bad habit.It’s not because I’m hungry.So I know I need to stay away from the buffet during those times we rehearse refusal skills.If somebody says. Oh, you, I’ve got to try it by two.This figure out how you’re going to address that ahead of time, because there’s generally probably a lot of really good foods, and you may really want to taste some, but sometimes people who emotionally eat know if they start eating.If they start eating high-fat high calorie foods, they’re going to want to eat everything.So if I start with one bite of a brownie, I’m going to want to eat every suit that’s on the table.If they know that, then they may want to choose to not even go down that road at that juncture, encourage people to stay mindful of their distress meter before they go back for another helping and ask themselves, am I hungry? Am I just wanting to taste what’s here and how do I feel about that? Or am I eating just because I don’t want to be here and I’m bored and I want to fill the time? Have people keep an index card with their coping mantra and two reasons they don’t want to emotionally eat, so I need to be here.I can do this whatever the mantra is that’s going to get them through the night, whatever they’re.Telling themselves that it’s going to help them plow through and make the right choices, but also two reasons that they don’t want to eat, or they’re going to get around it.Maybe they’ve got something at home that they can eat when they get home eating before they go to.The party may also help prevent some grazing holidays, bringing out a lot of emotions in people.Some people struggle with depression, anxiety, jealousy, grief, and anger. You know the whole gamut during this time and during this time there’s food everywhere I mean starting at Halloween when your kids bring home the Halloween candy, which usually lasts about a week in our house baby.Oh, Halloween candy followed by getting ready for Thanksgiving, followed by doing all the baking or whatever you do, and the holiday parties coming up on the December holiday season.There’s just food everywhere, so it’s really easy to cope.If you will, with stress being overwhelmed with being tired by not eating enough healthy food by binging on unhealthy and soothing food if you will so it’s, encouraged it’s important to encourage people to stay.Mindful of why they’re eating what they’re eating, when constantly bombarded with high-fat high carbohydrate foods, people are tempted to eat to feel calm yeah.I challenge anybody to say that they’ve never eaten and go okay.You know I’m.Just focused on this right now I’m not thinking about everything out here and it feels good um.I’m good now, good, probably not the word I should use, but it does help people distract themselves sometimes when they eat, especially those high-intensity foods.You feel happier serotonins are released. Dopamine is released.You’re, like oh, that’s good.I want to do that again or you just feel numb.You can get into a zone where you’re just eating and not caring about it’s.Not that you’re feeling calm, you’re just not feeling anything, and a lot of times when people get into that zone.They’re not tasting the food either.They’re just kind of on autopilot for emotional eating, like most other escape behaviors.Never addresses the underlying emotions and their causes, so we need to look at them.Are you feeling anxious? Are you feeling jittery? Are you feeling depressed because your blood Sugar’s low, because you’re nutritionally deficient because you’re not getting enough sleep or because there’s something cognitive going on, or all of the above emotional eating, often results in physical issues like weight gain Poor sleep and reduced energy weight gain, are you know in and of itself a few pounds here and they’re not a big deal, but some people can start emotionally eating to feel better.They gained a lot of weight. Then they start feeling less energetic.It starts being harder to move around.They get to the point where they are clinically obese.Then they’re going.I’m never going to take all this weight off.They feel hopeless and helpless.You see where this is going, so they eat some more.Can cause poor sleep apnea, it’s hard to get it’s also hard to get comfortable.Sometimes, if you’ve eaten a whole bunch of food right before you go to bed, you know your bellies are all full, and little you wake up.The next morning and your belly are still awful, which means you probably didn’t, sleep very well the night before and emotional eating often results in reduced energy because the foods we binge on the foods we eat for self-soothing often end up causing a sugar Crash some people try to undo emotional eating by restricting other calories which can lead to nutritional deficits and more cravings. I had a girlfriend when I was in high school and you know think back to I don’t know if they still do it, but when we were in high school there was always some kind of candy sale going on and she would always forgo all Other food, so she could have two chocolate bars each day and you know we’re not going to get into the all the other issues surrounding only eating two chocolate bars.But the point I’m making it right now is the fact she wasn’t getting protein.She wasn’t getting it.You know most of her vitamins and minerals and stuff that her body needed to make the neurotransmitter.So she could feel happy and she was contributing to a sugar crash, but I also know that it’s common around the holidays for people to do this.They’ll let go all day without eating because they know they’re going to a party tonight and there’s going to be a lot of really good food doing that once in a while.Not a big deal doing that 10 or 15 times in a month could start to have problems.Emotional eaters need to first find a way to stop before they eat, so, whether it’s writing in a journal or adding.There are a lot of apps on your phone that you can put your food in, even if you’re, not writing about your emotions and your cravings and all that kind of stuff.Sometimes it’s enough to make people stop before they reach. For the food – or you know, kind of an extreme way to go is to not keep pre-processed or prepackaged foods in the house.So anything that you’re going to eat you’ve got to make second identify the underlying reason for your eating figure out.Do I generally eat in response to and then address the thoughts and emotions leading to the urges?So if you figure out the underlying emotions for your eating or your depression, then what thoughts are maintaining that depression? And how can you address it once you address the underlying issues, some of the emotional eating will go away, but some of its habits?We’re going to have to break that habit and, throughout you know, the past couple of decades of working with people.My experience has been the majority of the time people don’t want to hear.Well, once you deal with your emotional issues, the emotional eating will go away now.They’re there because they want to stop that behavior right now.So, yes, we need to work on all the underlying issues but give them a tip or a trick or a tool whatever you want to call it to use before they walk out of your office after every single session.That way, they have something else they can put in their toolbox and feel more empowered to have control over what’s going on with them. And what’s coming their way, having the knowledge of what and why is 80 of helping them get to the recovery point now, if there’s co-occurring or if the eating issues are more than just emotional eating, if there’s, the person meets The criteria for binge eating disorder, bulimia or anorexia.There are a lot of other underlying issues they’re going to have to be dealt with.So I don’t want to trivialize that, but I do want people to feel like they’ve got some hope over what’s going on.Are there any questions? 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 use coupon code consular toolbox to get a 20 discount off your order.This month,As found on YouTubeAnimated Video Maker – Create Amazing Explainer Videos | VidToon™ #1 Top Video Animation Software To Make Explainer, Marketing, Animated Videos Online It’s EASIER, PRODUCTIVE, FASTER Get Commercial Rights INCLUDED when you act NOW Get Vidtoon™

Emotional Eating Signs and 7 Tips Cope | Making Peace with Food | Counseling Techniques

this episode was pre-recorded as part of a live continuing   education webinar on-demand CEUs are still available for this presentation   through all CEUs register at allceus.com/counselortoolbox hi everybody and welcome to today’s presentation on emotional eating making peace with food during   the next hour so we’re going to define emotional eating and differentiate it really from eating   when to celebrate and when it’s a problem and also differentiate differentiating it from   eating disorders will explore emotional eating in terms of its beneficial functions and rewards and   discuss why restrictive diets don’t resolve emotional eating a lot of times people will   say you know I have been on this diet forever and it doesn’t seem to be working or I can’t seem   to stick to any diet that I try and we’re going to look at different reasons why this might be   what is emotional eating and it’s exactly what it sounds like it’s eating in response to emotions   and feelings other than hunger so if you’re eating because you’re bored if you’re eating at someone   and sometimes, especially if you are angry at someone or disappointed in someone you may   eat and sort of be eating and thinking you made I do this so eating at someone eating to forget   or distract myself from eating to feel better because when you eat regardless of what you’re eating but   especially if you eat high-sugar high-fat foods you’re going to release serotonin and dopamine   eating out of boredom you know hand-to-mouth bang eating out of habit and like I said a few minutes   ago not all emotional eaters have an eating disorder um and we want to differentiate that it means that their eating is not problematic to them no not at all if they’re telling you   it’s a problem then it’s a problem they may not meet the criteria for binge eating disorder or   bulimia but it’s important to address it because they understand that they’re eating for a reason   other than hunger and they want to stop because they want to eat for hunger but not otherwise and   for us as clinicians the first thing we need to do is understand why is it that they’re eating is   it boredom is it a habit so they need to keep a food log or a food journal over a week or   two weeks and sometimes when people come in for an assessment especially if that’s one of their main   presenting issues I’ll start just doing a retrospective of the last three days to get   an idea of what may be triggering some of their eating episodes and then we can look at some of   the habits or bad habits may be that they’ve gotten into and start talking about ways to address those remember that Rome wasn’t built in a day this isn’t going to go away overnight but a lot   of times if you give people some tips tricks and tools to think about implementing when they walk   out of your office after the assessment before the first official session it provides them some hope   and gets the momentum going and again you don’t have to binge to be an emotional eater some people   graze all day long some people will eat and it’s not what would be considered technically a binge   but it’s more than they had anticipated maybe they go back for second helpings or third helpings when   they weren’t hungry but it was good so why is eating so soothing there are a lot of reasons   now there’s obvious it tastes good so that’s you know the big obvious bonus but thinking about   the function the eating serves we have to eat in order to survive when you were an infant it eating   involved a closeness with your parental unit which could release oxytocin I say parental   unit because even if it was dad feeding the baby a bottle there was that connection there was that   contact which caused the infant and the parent to release oxytocin this is our bonding chemical so   eating was associated early on with bonding food may also have been associated with sleep if the   infant or child was given a bottle every night to go to sleep then they may start thinking or they   may be in the habit of eating to wind down or calm down and we need to help them figure   out different ways to do that as a toddler what an eating means to think about when you went from well we   probably don’t remember that but think about when your kids went from eating you know food   out of a jar to even their first Cheerios that was huge figuring out how to pick up that little   cheerio and get it in their mouth and it involved exploration and mastery they were discovering   all different types of textures and tastes and figuring out what smell went with what taste and   it was a cool and exciting time for kids and I mean think about it they’re like a year old   so it doesn’t take much to amuse them but this was the rewarding reward equals dopamine equals let’s do   that again it involved power and control of the child at this point was starting to be able to feed him   or herself was starting to be able to be somewhat independent from the parent when it came to the basic physiological function of eating so eating itself had its rewards and it was self-esteem   building because the child started learning you know how to feed himself and how to ask for what   he or she wanted at least in terms of food there are formations of memories around foods even as   early as toddlerhood you know we have celebrations we have birthdays we have different things and most   children have certain foods that they really like and it could be because the first time   that ate that food was a really happy experience or it could be just that’s their favorite food   and that’s all they want to eat but they remember that food and they remember when they ate it they   felt good they felt happy so as an adult there’s a part of their brain going chicken nuggets make me happy now that’s how the toddler thought as an adult we can understand that chicken   nuggets themselves aren’t making you happy but you see the connections that we’re making here there’s   been an association between happiness and chicken nuggets unhealthy foods especially for children   when as adults we’re still able to control what they eat your sugary foods your unhealthy foods   are usually reserved for treats or rewards so when you’re feeling like you need to be rewarded   when you’re feeling like you want to feel good sometimes you’ll resort to those things when you   were a kid that made you feel good like chocolate chip cookies or Haagen-Dazs or whatever it was for   you we’ve talked in the past about associations and conditioning and this is all coming back kind   of full circle now because we need to understand that our brain has associated pleasure and reward   with food for a lot of different reasons not just because of nourishment looking at the reasons why   your patient eats is going to help you understand what underlying issues you may need to address in treatment culturally we associate eating with caring and celebrating think about birthdays and holidays what do we do we get together we have buffets we have pot Luck’s when someone passes   away what do you do you bring food over when somebody’s sick what do you bring food   over so in our culture there is a lot of emphases put on eating and nourishing and that’s true of a   lot of different cultures with low blood sugar can cause feelings of depression and anxiety which   are quelled by food so if somebody typically doesn’t eat well during the day you know they   go long periods without eating or if they have blood sugar issues to begin with and then they   eat they feel better so when they start feeling not so good what do you think their first reaction   is let me eat and see if that helps evolution predisposes the human body to crave high sugar high-fat high calorie foods for quick energy and to prepare for a famine our bodies are cool   and frustrated at the same time because you know your body takes in these foods and   it says we’re gonna secrete the most amount of dopamine and the most amount of reward for these high-calorie foods because we want to make sure we’re prepared in case there’s a famine back   you know in the day many many many years ago hundreds of years ago we couldn’t guarantee we   would have a meal every day let alone three meals every day so the body prepared and it   said alright we need to get whatever we can when we can so we’re going to make this a higher fat   higher calorie food more rewarding now I said it’s also can be a blessing and a curse today   there’s still a little part of our primordial a brain that says if it thinks there’s a famine   it will slow down your base metabolic rate which causes people to gain weight we see this a lot   in people with eating disorders who tend to not take in very many calories or if they take them   in they purge them so the body goes well I can’t guarantee I’m gonna get enough food I’m gonna get   enough energy to survive so I’m just gonna turn down the thermostat a little bit to turn down the   base metabolic rate which compounds the problem for the person with an eating disorder so it’s   important to understand that the brain is somewhat active to what’s going on so I keep saying we   need to figure out what’s behind or underlying the craving first we need to rule out physical   causes for some people it’s as simple as this if they’ve got low blood sugar because they’re not   eating too often and obviously as counselors we’re not going to diagnose this their doctor or their   nutritionist will but we can start exploring and go it sounds like you might need to look at having   your blood sugar checked or talk to your doctor about how frequently you need to eat because some   people and I know I’m very guilty of it if I get into it into a groove doing something I’ll   eat breakfast and then I’ll get into a groove and before I know it it’s 3:00 in the afternoon and I   haven’t eaten for like a whole bunch of hours I’m not doing math today and my blood Sugar’s low and   I’m starting to get foggy-headed and irritable and tired so it’s a real simple fix there in   our society we are so driven and we are so we get so caught up in things because that’s such a fast   pace that it’s easy to forget to eat or easy to avoid eating so that’s the first thing we want to   rule out are you eating in response to low blood sugar which is making eating seem more rewarding   and when you eat in response to low blood sugar a lot of times people who do that end up eating   more than they normally would because they start eating fast it’s like I’m gonna shovel in   as much as I can your brain doesn’t register you’re eating for 20 minutes or so so before your brain even registers what’s gone on and gets the blood sugar back up they’ve already eaten a   whole ton of food why is this under emotional eating well because generally when they go in   to just start eating yes they’re hungry but they’re also cranky and irritable and most   of the time they’re not thinking about what I’m eating for the nourishment it’s I’m eating feel better after lack   of sleep and this is so true for shift workers as well as you know new parents and college students   and anybody who’s not getting enough sleep if we are surviving on sugar and stimulants we’re going   Peak and Lower Valley Peak and Lower Valley and you just keep going up and down until you just   crash because every time you crash you crash a a little bit lower so if somebody’s on that roller   coaster they’re going to feel worse between you know eating episodes they’re going to feel tired   they’re going to feel a flood of sluggish irritable fatigued and to a certain extent maybe depressed   and they may be missing attributing those feeling those emotional feelings to emotions versus   physical causes and likewise we also want to make sure that you know we’re addressing the emotional   causes because there’s probably stuff there too but if they’re not getting enough sleep   and they’re living on sugar and stimulants their the body is kind of in a state of hyper-vigilance a   lot of times it’s exhausted so they’re going to be tired and cranky so those are a couple of things that we want to look at those are relatively easy fixes or at least relatively easy   things to point out and go let’s think about this one of the things that I suggest for a lot of my   clients is just to take a week and mindfully and it is difficult but try to eat healthfully you know   try to eat a few times a day you know try to eat like three meals a day and getting enough water and trying to get enough sleep and try not to overdo it on the stimulants at the beginning I’m not   going to say cut out anything because that’s not realistic and it’s not fair and they’re probably   already struggling if they’re coming in to see me so if I go hey let’s just turn your world upside   down and guess what you’re not going to drink any caffeine anymore it’s not going to create a happy   person so I asked them to try to make some small changes and see if that starts to help dehydration   causes fogginess and symptoms of depression we want to make sure that they rule that out and   too many stimulants also causes dehydration so you know we’re looking at some of the physical causes   of irritability and fatigue and cravings because again we’re going back to when I felt this way   before not looking at why I felt this way but when I felt irritable depressed cranky what has made me   feel better and generally food and generally it’s not good food for me it’s M&Ms I love my M&Ms, especially the ones with almonds but I digress nutritional causes of cravings high carbohydrate   and high starch foods caused a greater release of serotonin and endorphins so if you’ve got   somebody who’s depressed for whatever reason that they may crave these kinds of foods to increase their serotonin level or increase the endorphins in their energy levels chocolate people   who crave chocolate may be low in magnesium it also um the level of magnesium affects how   much serotonin is available again just keep saying this just for legal reasons we want to   make sure their doctor or nutritionist goes in and makes this diagnosis but if there are particular   foods that they do crave it’s important for them to bring that up with their medical provider if   they’re craving fatty foods now again fatty foods are just good I love fried foods but it also could   mean that they’re not getting enough Omega threes Americans typically don’t and interestingly if   they crave soda they may be calcium deficient who knew so these are things to take a look   at to ask people you know if they’re craving soda maybe cutting back on their soda a little bit and   see what happens and or getting blood work done once we’ve ruled out the obvious physical causes   they’ve gone to the doctor gotten blood work done everything I’m comes back happy they’re getting   enough sleep but they’re still eating when they’re not hungry we need to rule out habits is there a   particular time or activity that makes you crave this food when I was growing up I would go to the   grocery store with my mother and on the way back home from the grocery store she would always we   would always get junk food and she would get a bag of chips and put them in the front seat it   was like a 20-minute drive from the grocery store to our house and by the time we would get back to   the house we would have put a good dent in those potato chips that being said I got into the habit   of whenever I went to the grocery store I would get something out of the bag and put it in the   front seat and eat on the way home now am I paying attention to what I’m eating no likely am I eating   because I was hungry probably not so we want to look at habits a lot of people will eat when   they are watching TV it’s a huge one so we want to not do that or if you’re going to eat when   you’re watching TV make sure you sit at the table at least that makes you a little bit more mindful so think about their particular times or activities that you eat and you’re just not   hungry are their particular times that you mindlessly eat like like I said when you’re   driving or when you’re watching television those are both habits and can be mindless because you’re   not paying attention to how much is going on in your the mouth you’re not probably paying attention to the   taste and you’re not paying attention to whether you’re full or not so if you’re mindlessly eating   then there’s going to be a lot more calorie consumption in addition to the fact that you’re   not eating because you’re hungry you’re just eating to eat are you going too long between   meals than needing a sugar boost which leads to a sugar crash so again that’s a physical cause but   we want to rule out these bad habits that we can tend to get into other things that can   be construed as bad habits are eating without putting food on a plate if you eat straight   out of the bag you’re gonna eat more than if you put it on a plate so put it on a plate sit   down try not to watch TV all the things that your grandmother would have told you so what do we do   about it emotional eating interventions I talked earlier about the food diary do a retrospective   during the assessment if they want to get a jumpstart on things but have them keep a food   diary preferably for the duration of treatment but at least for a week what time did they eat   were they craving just any old food or something that was salty sweet sour this will give you a general idea and can give their medical provider a general   idea if there are any nutritional imbalances or if there are particular associations with what emotion or   state were you in and I say state because being exhausted is not necessarily really an emotion where you are happy sad mad glad exhausted drained whatever state feels like it would work and   then because of why were you feeling this way it doesn’t have to be a dissertation it can be short and sweet but I encourage clients to write down everything they eat before they   eat it during the first week or you know like I said preferably throughout the entire course of   treatment why before they eat it because it’s a stop remembering we’ve talked before about how we   have an urge we have a craving we have an urge and then we engage in the behavior oftentimes without   stopping to mindfully think is this what we want to do this provides that stop it says okay I’ve   got it to write down the time and then I’ve got to think about why I’m eating and honestly, a lot of   clients notice a reduction and their habit of eating when they have to do this just because they don’t   want to record-keeping that up for the period of a a month or two months helps break some of the habits eating that they might do like I said before when they’re eating I encourage them to use a plate sit   down don’t walk around don’t stand at the counter eliminate distractions as much as possible and   focus on the food you’re eating that goes with mindfully eating what does it taste like is it   good take small bites when my son was young and I think I’ve shared this before he had gastric   reflux and we would sit down at the table and I would shovel in food as fast as I could get   it in my mouth because he couldn’t be put down for too long before he would start to get fussy   at least until we figured out that he had gastric reflux and Zantac was just a lifesaver I developed   that habit when he was little and I kept it up for a while, it took a while to learn for me to   learn to go back to take you to know reasonable bites and tasting my food and even today if I’m   not paying attention too much I’ll eat my dinner rest and then I’ll sit there and I’ll be   like well yes I’ll taste that a little bit later because I didn’t taste it when I ate it encouraging   clients to be aware of their eating habits and try to avoid setting up a binge by restricting certain   foods now does that mean you have to have cakes and candy and whatever your trigger foods are   in your house all the time and in your face no I would encourage people not to do that but to say   you know I said for me M&Ms is one of my favorites reward foods if you will I don’t keep them in the   house but I will allow myself occasionally to buy a small snack-size pack of M&Ms when I’m out or   I will get a regular-size pack and I’ll share it with my daughter so I’m not restricting it   I’m not saying I can never M&Ms again I’m just not making it available to myself when I might   have some unrestricted time to try to avoid buying a bunch of comfort foods and keeping them around   the house and when you’ve got kids when you’ve got family, it’s not entirely possible usually to not   have some of that stuff around but try to avoid having the things that you particularly used for   comfort because if it’s not readily available then you’ve got to focus on guess what dealing   with the emotions instead of stuffing them with food try not to go too long without eating as I said earlier if you go too long then by the the time you get to the food your blood Sugar’s low   and you’re just shoveling it as fast as you can initially distract if you know that you’re   getting you’re eating and you’re like I’m really not hungry but I want to eat take a bath take a   walk call a friend heaven forbid get on Facebook whatever it is you can do to distract yourself   for 10 or 15 minutes if after 10 or 15 minutes you’re still going I rant whatever it is   then you can decide what to do about it then most of the time when people stop and go I’m not hungry let me distract myself they get caught up in that distraction and before they know   it they’ve forgotten about the craving to identify the emotions if you know that you’re not hungry   but you want to eat then say okay what’s going on what’s going on with me it doesn’t mean that   the person is never going to eat when they’re upset because a lot of people do and is it the end   of the world probably not necessary if they can start reducing the frequency of times that they   eat in response to emotional distress that’s what we want to progress, not perfect if it’s   depression that’s causing them to feel hopeless or helpless right now if it’s stress anxiety   or anger remember our big kind of lump together stuff what are they stressing out about do they   feel like they’re overwhelmed are they afraid of failure rejection loss of control of the unknown   we’ve gone through those things we want them to identify what’s going on with them and then they   can make better choices about how to deal with it so general coping helps them develop alternate ways   of coping with distress distract we’ve already kind of go over that one I encourage people   and you know it’s one of those DBT things that a lot of therapists encourage their clients to   keep a list of things they can do to distract themselves because it’s not always practical to   get up and go on a walk if you’re at work or it’s you know two in the morning so what else can you   do to distract yourself talk it out with a friend with yourself with your dog sometimes you just got   to get it out people who are more auditory will prefer talking it out as opposed to journaling   it now if they talk it out with themselves they can record it if they want to or sometimes it’s   just better to have a dialogue with themself if it worked for Freud it can work for other people journaling if your clients are inclined to journal encourage them to write it down sometimes just   getting stuff out of their head and onto paper will help the feelings dissipate a little bit   so you’re not mulling them over and obsessing on them and getting stuck in those thoughts and   feelings additionally while you’re distracting talking it out or journaling is also your   break stop between the urge and the behavior make a pro and con list of the de-stress, not the   eating whatever it is that’s stressing you out and how can you fix it or what are the pros of   this situation and what are the downsides to this situation encourages them to focus on the   positive you know if something stressing you out at work you know you’ve got a big meeting   coming up or something you don’t want to do or what it is you can get stuck on focusing   on that or you can focus on the positive that you do have a job that meeting only comes around once   a month you can it’s time you don’t have to be doing paperwork whatever the pros are for that   person encourage them to focus on the positive if you’re distressed because of some kind of a   failure or perceived failure figure out what you learned from it whether it was a relationship   failure maybe you learned what not to do in a relationship anymore maybe you learned things   that you may have ignored maybe you learned what you should have done instead but how can it be a   learning opportunity instead of somewhere to stay stuck and finally if something’s making you upset if something’s causing anxiety depression hopelessness helplessness whatever the negative   feeling figure out if it’s worth your energy to get stuck here is it worth the turmoil is   it worth you know having to pacify yourself with food whatever it is a lot of times people say you   know what now it’s just it’s not even worth my effort is not worth moving me away from   my goals because my goal is to stop emotional eating my goal is to eat for hunger so I can   go to dinner with people and feel comfortable I can be at a party where there’s a buffet and   not feel stressed out that I’m gonna go and eat half the stuff on the buffet that’s my goal so is   holding on to whatever this de-stress is getting me closer to being able to do those things and   generally, the answer’s no develop alternate ways of coping with the stress the ABCs the a is the   activating event that is stressing you out what’s causing the de-stress C is the emotional reaction   angry depressed stressed whatever we are your behaviors what behaviors or B are your beliefs   sorry what are the beliefs that are in there that may need to be addressed what kind of things are   you telling yourself and how can you counter them cognitively eliminate your vulnerabilities   you knew we couldn’t get through a presentation without talking about vulnerabilities if someone   is well-rested well-fed has a good social support the network does not overstretch timewise then it will be   easier to deal with stress or stressors when they come your way you’ll have more energy to deal with   it so there won’t be this overwhelming feeling of I just want to bury my head in a jar of peanut   butter be compassionate with yourself some days are you know you’re just gonna feel anxious you’re   gonna feel depressed you’re gonna get angry you can beat yourself up over it and you know a lot   of people do is that the best use of your energy or can you be compassionate can you learn from it   can you give yourself a break and go you know what I’m having a bad day today and that’s okay I’m not   gonna unpack and stay here but I’m not gonna fight it either help clients learn how to urge   surf helps them understand that just like a panic the attack is just like a wave just like a lot of other   things in life it will come it will crest and it will go out again so they can sort of identify   where they are on the energy of that urge Panic-loop-3 other tools people can use close the kitchen once   I have the kitchen cleaned and you know all the dishes are done and it looks pretty I hate going   in there and finding dishes in the sink again now I’ve got teenagers so we always have dishes in   the sink but before I had children you know at seven o’clock I finished all the dishes and closed   the kitchen and that would be enough motivation for me to not go in there and at least not use   plates and stuff to eat so if we’re saying that we’re going to only eat using utensils plates and   sitting and all that stuff that we already talked about then once you close the kitchen you’re not   going back in there turn off the light that also helps so you’re not being attracted to the pretty lights and you know all the goodies that are in the kitchen brush   your teeth this is something my grandmother used to do and it works there’s some research   behind it minty flavors reduce our appetite so if you brush your teeth you get all the other   flavors out of your mouth and it reduces your urges to eat because it again it’s clean and   fresh and do you want to brush your teeth again meditate sometimes just getting in a space   where you’re not obsessing about anything can help people get past that urge to self-soothe   with eating a CT for emotional eating what am I feeling or thinking about what’s going on with me right   now and what is important to me so if I am thinking I want to eat I want to you know just dive into   this jar of peanut butter and then I think about what’s important to me is it important to me to   get control of this is it important to me to you know to be able to fit in my clothes in six months or   not so what is in what way is controlling my eating habits and eliminating emotional   eating important to me and how does that get me closer to other things that are important to   me and what other things could I do that would get me closer to my goals so if the goal is to   have improved relationships and be able to feel more Being comfortable around food reduces the stress around   going out to eat and just around food in general what else can you do when you are stressed out somebody also suggested adding a blue light in the refrigerator decreases the appeal of foods   which is interesting because yellow red and orange and browns I think Pizza Hut are all foods   that increase people’s hunger and desire to eat but blue is just a completely different   primary color and adding a blue hue seems like that would be effective so cool   thanks for that little tidbit their holiday help and you know we’re coming into the holidays so   I’ve got to bring that up at every single glass choose lower-calorie foods if you tend to get   stressed out or caught up or mindlessly eat when you are at family gatherings, okay you know cut   yourself a break know that that’s probably gonna happen to fill up on the lower calorie foods the   carrot sticks broccoli the white meat turkey anything available that’s not like sweet   potato pie or brownies keeps water or low calorie beverage in your hand if you’ve got your hand full   you can’t eat at the same time so you know if you walk around with a cup in your hand it helps   talk to people hopefully you don’t talk with your mouth open or talk with food in your mouth so if   you’re talking to people you’re not going to be as inclined to go get something to eat because you’re   wanting to stay engaged in that conversation stay away from the buffet especially if you know that   it could get stressful or maybe you know for me I turn into a pumpkin at like 7:30 at night I get up   at 4:00 but I turn into a pumpkin at 7:30 and a a lot of times holiday parties and those sorts of   things are at eight nine o’clock at night and you know I’ve already turned into a pumpkin so   I know that if I go to those I’m gonna be more likely to eat just to kind of stay away because   I’m tired and it’s a bad habit it’s not because I’m hungry so I know I need to stay away from   the buffet during those times we rehearse refusal skills if somebody says oh you’ve got to try it by   two this figure out how you’re going to address that ahead of time because there’s generally   probably a lot of really good foods and you may want to taste some but sometimes people who   emotionally eat know if they start eating if they start eating high-fat high calorie foods they’re   gonna want to eat everything so if I start with one bite of a brownie I’m gonna want to eat every   suite that’s on the table if they know that then they may want to choose to not even go down that   road at that juncture and encourage people to stay mindful of their distress meter before they go   back for another helping and ask themselves am i hungry am I just wanting to taste what’s here   and how do I feel about that or am I eating just because I don’t want to be here and I’m   bored and I want to fill the time have people keep an index card with their coping mantra   and two reasons they don’t want to emotionally eat so I need to be here I can do this whatever   the mantra is that’s gonna get them through the night whatever they’re telling themselves that   it’s gonna help them plow through and make the right choices but also two reasons that they   don’t want to eat or they’re going to get around maybe they’ve got something at home that they   can eat when they get home eating before they go to the party may also help prevent some grazing   holidays bring out a lot of emotions in people some people struggle with depression anxiety   jealousy grief anger you know the whole gamut during this time and during this time there’s   food everywhere I mean starting at Halloween when your kids bring home the Halloween candy which   usually lasts about a week in our house baby Oh Halloween candy followed by getting ready   for Thanksgiving followed by doing all the baking or whatever you do and the holiday parties coming   up on the December holiday season there’s just food everywhere so it’s really easy to cope if you   will with stress being overwhelmed by being tired by not eating enough healthy food by binging   on unhealthy and soothing food if you will so it’s encouraged it’s important to encourage people to   stay mindful of why they’re eating what they’re eating when constantly bombarded with high-fat high carbohydrate foods people are tempted to eat to feel calm yeah I challenge anybody to say that   they’ve never eaten and go okay you know I’m just focused on this right now I’m not thinking about   everything out here and it feels good um I’m good now goods are probably not the word I should use but   it does help people distract themselves sometimes when you eat especially those high-intensity foods   you feel happier serotonins release dopamine is released you’re like oh that’s good   I want to do that again or you just feel numb you can get into a zone where you’re just eating and   not caring it’s not that you’re feeling calm you’re just not feeling anything and a lot   of times when people get into that zone they’re not tasting the food either they’re just kind of on an autopilot emotional eating like most other escape behaviors never address the underlying   emotions and their causes so we need to look at it are you feeling anxious are you feeling   jittery are you feeling depressed because your blood Sugar’s low because you’re nutritionally   deficient because you’re not getting enough sleep or because there’s something cognitive going on or   all of the above emotional eating often results in physical issues like weight gain poor sleep   and reduced energy weight gain is you know in and of itself, a few pounds here and they’re not a big   deal but some people can start emotionally eating to feel better they gained a lot of weight then   they start feeling less energetic it starts being harder to move around they get to the point where   they are clinically obese then they’re going I’m never going to take all this weight off they feel   hopeless and helpless you see where this is going so they eat some more can cause poor sleep apnea it’s hard to get it’s also hard to get comfortable sometimes if you’ve eaten a whole   bunch of food right before you go to bed you know your bellies all full and little you wake up the   next morning and your belly still awful which means you probably didn’t sleep very well the   night before and emotional eating often results in reduced energy because the foods we binge on   the foods we eat for self-soothing often end up causing a sugar crash some people try to undo   emotional eating by restricting other calories which can lead to nutritional deficits and more   cravings I had a girlfriend when I was in high school and you know think back to I don’t know if   they still do it but when we were in high school there was always some kind of candy sale going on   and she would always forgo all other food so she could have two chocolate bars each day and you   know we’re not going to get into the all the other issues surrounding only eating two chocolate bars   but the point I’m making it right now is the fact she wasn’t getting protein she wasn’t getting you to know most of her vitamins and minerals and stuff that her body needed to make the neurotransmitter   so she could feel happy and she was contributing to a sugar crash but I also know that it’s common   around the holidays for people to do this they’ll let go all day without eating because they know   they’re going to a party tonight and there’s going to be a lot of really good food doing that once in   a while is not a big deal doing that 10 or 15 times in a month could start to have problems emotional   eaters need to first find a way to stop before they eat so whether it’s writing in a journal   or adding there are a lot of apps on your phone that you can put your food in even if you’re   not writing about your emotions and your cravings and all that kind of stuff sometimes it’s enough   to make people stop before they each for the food or you know kind of an extreme way   to go is to not keep pre-processed or prepackaged foods in the house so anything that you’re going   to eat you’ve got to make a second identity the underlying reason for your eating figure   out do I generally eat in response to and then address the thoughts and emotions leading to the   urges so if you figure out that the underlying emotions for your eating or your depression then   what thoughts are maintaining that depression and how can you address it once you address the   underlying issues of some of the emotional eating will go away some of its habits we’re going to   have to break that habits and over the course of you know past couple of decades of working with   people my experience has been the majority of the time people don’t want to hear well once you deal   with your emotional issues the emotional eating will go away now they’re there because they want   to stop that behavior right now so yes we need to work on all the underlying issues but give them   a tip or a trick or a tool whatever you want to call it to use before they walk out of your office   after every single session that way they have something else they can put in their toolbox and   feel more empowered to have control over what’s going on with them and what’s coming their way knowing what and why is 80% of helping them get to the recovery   point now if there’s co-occurring or if the eating issues are more than just emotional   eating if there’s the person meets the criteria for binge eating disorder bulimia   or anorexia there are a lot of other underlying issues they’re gonna   have to be dealt with so I don’t want to trivialize that but I do want people   to feel like they’ve got some hope over what’s going on are there any questions 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 monthAs found on YouTubeHuman Synthesys Studio It’s Never Been Easier To Create Human Spokesperson Videos. 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