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
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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. So… If at any time within 60 days of you purchasing ‘Overthrowing Anxiety’, your anxiety hasn’t completely evaporated then you can have all your money back. No questions asked! You can do this for yourself today. You can start making a difference in your life right now. Click on the button below and you’ll receive your copy of Overthrowing Anxiety in just a few minutes. It’ll be one of the best decisions you’ve ever made – guaranteed! http://flywait.anxiety4.hop.clickbank.net
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…
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…
Nurses, addiction and #mentalhealth#counselors, #socialworkers, and marriage and family therapists can earn #CEUs for this and other presentations at AllCEUs.com #AllCEUs courses are accepted in most states because we are approved as an education provider for NAADAC, the States of Florida and Texas Boards of Social Work and Mental Health/Professional Counseling, the California Consortium for Addiction Professionals and Professions.
As found on YouTubeAFFILIATE MASTERY BONUS: 6-Week LIVE Series Has Begun! FunnelMates $46.⁹⁵ Replays are Instantly Available. Want A Profitable Mailing List But Not Sure Where To Begin? We’ll Guide You, Equip You, and even PAY You Cash To Do It! ☃in 5-10 Minutes A Day Using Automation Software and our Time-Tested Strategy See How Your New Site Can Be Live In Just 27 Seconds From Now!
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. As a financial newsletter publisher of general and regular circulation, we cannot tender individual investment advice. Read our full disclaimer. https://is.gd/mycbgenie_The_Market_Week
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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
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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: 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!
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.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, 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.Once 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™
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 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
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for this presentation through all CEUs register at allceus.com/counselortoolbox I’d like to welcome everybody to today’s
presentation of addiction and co-occurring disorders part two the physiology of addiction and mental
health issues over the next hour we’re going to discuss somewhat generally because there’s a
a lot of stuff to go over neurotransmitters which we’ve talked about some before but then we’re also
going to talk a little bit more today than we’ve talked in the past about sex hormones thyroid
hormones and stress hormones and how all of those interact in the body to increase or decrease the
availability of certain neurotransmitters we’re going to go on from learning about the different
hormones and neurotransmitters to discussing the physics all the physiology of emotion and
motivation and again we’ve kind of covered that but we’re going to go over it real quick again
we’ll talk about the physiology of sleep what happens during sleep and what happens to those
hormones or neurotransmitters when you don’t get enough sleep what happens when you eat why
is eating sometimes rewarding what happens when people take stimulants whether it’s caffeine or
methamphetamine what happens when we turn up the system and how does that affect the availability
of certain neurotransmitters and then we’ll talk about the physiology of depressants so we’re
looking in general at what these things do as far as the physiology of addiction we’re going
to talk generally about that right at the very end so your inhibitory neurotransmitters are
those brain chemicals turn down the system so instead of being hyped up and awake
and yadda-yadda your calm you are relaxed you are maybe even sleepy too drowsy so your inhibitory
neurotransmitters are the ones that kick in or counteract the excitatory ones serotonin
is your primary inhibitory neurotransmitter it’s broken down to make melatonin and help you sleep
okay so we know that it’s also responsible for a lot of our bowel function angle and also
for not it’s implicated in nausea and motion sickness and they found that there are a lot fewer
side effects to serotonin antagonists than there are to dopamine antagonists when we’re talking
about helping people who have motion sickness and nausea so anyway just a little aside there but
serotonin is 80 percent of it is actually in your GI tract and it is implicated in bowel function
so when we’re thinking about clients who may have an imbalance in serotonin and who may have greater
pain sensitivity we want to start thinking about you know how is their GI working and is are some
of their problems with you know stomach problems pain irritable bowel that kind of stuff is that
caused by a serotonin imbalance or is that causing a serotonin imbalance or maybe serotonin is not
implicated at all and it’s something completely different serotonin is also implicated in anxiety
and aggression if you don’t have enough of it you tend to be more anxious and aggressive because
you’re not having the turn down if you will low serotonin has also been implicated in poor impulse
control so we like serotonin but we found and we’re gonna talk about that throughout
this class of serotonin has often been given the go-ahead or been implicated for a whole lot of
things and we’ve said okay if this happens then it’s low serotonin if this happens then it’s low
serotonin and as it goes but no the research is finding that that’s rarely true that
most of our problems whether it be GI problems or mental health problems or addictive issues
don’t necessarily involve serotonin at all there is a subset of people for whom it does but the
majority of people which is why antidepressants are ineffective for about 70 percent of the
population for them shortie of the people it’s not serotonin so we do want to keep that in the back
of our mind yes serotonin is everywhere throughout the body 80% of it is in our gut and our gut is
not necessarily going to communicate directly with our brain we cannot measure neurotransmitter
levels effectively in a live human being just not how it works right now there are tests out there
that say they can measure your neurotransmitter levels and that’s true but it’s not telling you
how much of that neurotransmitter is in your gut or your muscles or wherever versus in your
brain so those tests for our purposes as mental health clinicians and people who come to us who
may want to know well what antidepressant should I be on they’re not all that effective
okay so depression has been debunked as being linked to serotonin in the majority of
cases serotonin is implicated as one of those neurotransmitters involved in pain control in people
with lower serotonin tend to have a lower pain threshold so it hurts more and that doesn’t mean
that they’re sissies or anything like that it just means that they are more reactive or they
feel more pain because they don’t have the same level of serotonin and maybe endogenous opioids
kind of coursing through their system serotonin is also like I said involved in sleep an interesting
fact is that alcohol impairs the body’s ability to convert tryptophan which is an amino acid
to serotonin so when you have somebody who’s an alcoholic let’s think about how this works
if they are drinking and maybe they’re eating a perfectly healthy diet and they just happen to
drink a lot if their body can’t convert tryptophan to serotonin then all of these problems up here
that may be implicated by low serotonin can start to rear their ugly head because the body can’t
To make serotonin out of anything else it has to make it from tryptophan and if it can’t make serotonin
then it can’t make melatonin which is involved in sleep and you’re gonna see how important all that
is later so the take-home message with that is that alcohol is something to be considered
for moderation especially if we have a client who is struggling with depression maybe they’re not an
alcoholic but they need to consider the long-term impact if they want to feel better is preventing
their body from making using the building blocks to make the neurotransmitters that they may need
is it worth that drink remember that serotonin has been found in research to be
implicated in low serotonin is implicated in people with generalized anxiety disorders so
it hasn’t been completely just been debunked for everything but researchers and clinicians
finally are starting to realize that there are a multitude of reasons that somebody could have
a mood issue that somebody could have even low serotonin okay if the person has low serotonin
alright that’s fine let’s address it but what is causing the low serotonin we’ll look at
that more in the next few slides GABA is your other major inhibitory neurotransmitter it has
sedative depressive and anti-anxiety properties to them the really interesting thing it’s and when
I say depressive I mean it slows down everything it’s not that it makes people depressed but it’s
your anti-anti-anxiety natural anti-anxiety neurotransmitter helps improve concentration by
filtering out background noise so you’re able to focus a little bit better when you’ve got normal
levels of gaba help with impulse control think about when you’re anxious when you’re a
little bit revved up when you’re stressed out and somebody scares you maybe you’re a little bit
more jumpy well think about if you have GABA at the right levels in your system and you’re not
stressed out and somebody scares you are you as jumpy are you as impulsive a lot of our impulses
are associated with wanting to make a threat or a pain go away so if you’re not perceiving as
many threats you’re probably not going to be as impulsive another little interesting side thing is
that glucose you know sugar is necessary for the formation of GABA so people with hypoglycemia
can have a reduction in GABA and an increase in anxiety so think about if your blood sugar
gets low even if you are not hypoglycemic but you know you got to work back-to-back patients
you didn’t take time for lunch yet back-to-back patients you’re on the drive home from the office
your blood Sugar’s low you are you more likely to respond with some anxiety or irritability to
things that happen versus when you are well nourished and your blood sugar is kind of stable
for most people, they’re gonna say yeah I tend to be a little bit cranky err when my blood sugar
is low and shake gear alright so those are our two inhibitory neurotransmitters glutamate is
generally acknowledged to be the most important neurotransmitter for brain functioning and
it’s excitatory it gets you up it gets you going it gives you energy and it’s responsible
for helping us learn and remember things so if you’ve got low levels of glutamate you know you
might have difficulty concentrating and learning now the interesting thing is that glutamine
which is an amino acid you eat glutamine is converted into glutamate all right well that
makes sense so you eat something it is turned into this neurotransmitter that’s excitatory the
interesting thing is gaba is made by the breakdown of glutamate so you have if you have glutamate
then you can have Gaba if you don’t have enough glutamate then you’re not going to have enough
GABA so it’s a balance like taking a warm bath and you know this is important to remember
simply because we want to know what’s rubbing us up and what’s slowing us down norepinephrine or
noradrenaline depending on where you are is what they call a catecholamine it increases arousal and
alertness promotes vigilance and focuses attention so you’re hearing a theme here about attention
and memory it enhances the formation and retrieval of memories so in your norepinephrine that’s your
motivation chemical is secreted it encourages you to pay attention to remember and to be able to go
and file things away and access them easily it can also promote restlessness and anxiety if
you have too much so it’s all about moderation when I talk about too much or too little of a
neurotransmitter everything is always about all of the other neurotransmitters and hormones
so we can’t just necessarily get a measurement and go well you’ve got too much of this well we have
to know what the levels of everything else are it would be kind of like making a marinara sauce and
saying you a teaspoon of garlic is how much you need but that teaspoon would be enough if you
were making maybe two quarts of marinara sauce but if you are making 4 gallons all of the
other spices and everything would be in much larger proportions so what a teaspoon be enough
so we need to know what proportions all the other chemicals are at in order to know how much we need
and since we can’t measure them we’re just kind of left guessing dopamine is another catecholamine
and it’s broken down to make norepinephrine now normally we think of dopamine as our pleasure
reward chemical which it is don’t get me wrong it’s that’s what is there for and it tells us
I want to do that again but it’s broken down to make our focus concentration motivation chemical
interesting so we need dopamine to make norepinephrine we need norepinephrine to want to
get up and go so if we are draining our dopamine system through addictive behaviors or some other
reason guess what we’re not going to be able to make enough nor epinephrine or those receptors
that usually receive the norepinephrine and the dopamine are going to be basically unresponsive
and you’re going to knock on the door and nobody’s going to open so dopamine is broken down to make
norepinephrine which is your motivation chemical high levels of dopamine in the brain generally
enhance mood and increase body movement too much dopamine may produce nervousness irritability
aggressiveness and paranoia so think about cocaine if somebody takes a whole lot of really good
cocaine this is probably what we’re going to see because the levels of dopamine in their brain
just skyrocketed and everything else didn’t catch up there was no signal to all the other chemicals
to go okay we’re gonna have a surge here so we have all of those neurotransmitters that are
responsible for helping us feel happy serotonin helps us feel theoretically calm and content
and focused gaba is an anti-anxiety medication or not medication but a neurotransmitter and then
dopamine glutamate and norepinephrine are all of our excitatory ones they’re the ones that get
us guess what excited happy excited mad excited whatever the excited is they Rev us up and that’s
what we label with our emotional feeling states so what is this HPA axis thing that I talk about
every once in a while in response to stress the level of various hormones change and reactions to
stress is associated with an enhanced secretion of several hormones including your gluta Co
corticoids which is cortisol your catecholamines to increase mobilization of energy sources
which is blah blah blah blah blah you get stressed your body sends out the message that
we need some energy we need some fuel for this fight-or-flight response cortisol is activated and
it’s a glue to co corticoid which tells your body we need to prepare we need to get some glucose
going so got energy for this fight-or-flight thing catecholamines adrenaline and dopamine are
released that’s your body going okay we have this energy now let’s get the team revved up the other
thing that happens though is jörgen a door opens are suppressed your body goes you know we don’t
really have time for sex right now so let’s not worry about it so your sex hormones tend to be
suppressed under high stress levels okay well who cares you’re gonna find out in a little while
but that’s kind of a big deal because there is a strong relationship between the amount of and the
balance of our sex hormones and the availability of serotonin-norepinephrine and dopamine in our
bodies oh well sweet this here we are androgen or testosterone what we want to look at is what does
it do it helps helps us with concentration mood and not enough of it can result in an increase in
belly fat they found that in men depending on the research that you look at somewhere between 30
and 40 years of age they start losing somewhere between 1% and 1.5 percent of their testosterone
each year and so you’re thinking well you know that’s not that much but you’ve also got to
remember that everything’s in a balance so they’re losing their testosterone but what else is
not decreasing estrogen so some articles have kind of termed it manopause if you will the increase
in estrogen can increase irritability difficulty concentrating and belly fat as well as Gyna
mastika or the development of excess fat in the breast area so something interesting to look
at if you’re dealing with patients male patients who are over the age of 40 who are having suddenly
if you will depression or anxiety issues or are talking about their midlife crisis that those
all of those things could be precipitated by in their neurochemistry because of a drop
in testosterone not necessarily but it’s one positive or one possible reason estrogen believe
it or not is a neuro stimulant estrogen revs us up receptors for estrogen are very abundant
in the emotional center of the brain called the amygdala and the hypothalamus which is involved
in what we just talked about the HPA axis which tells us to fight flea or freeze estrogen
increases serotonin receptor responsive ‘it increases the number of serotonin receptors
in the body and enhances serotonin transport and uptake so we might hypothesize and we don’t
know any of this for sure that if someone’s mood disorder started or fluctuates in response to
fluctuations in their estrogen then there might be a serotonin component to this mood disorder
because estrogen is so intimately connected with serotonin availability high levels of estrogen are
associated with anxiety one thing that they found in American culture and industrialized nations
but especially American culture is we have a lot of chemicals and stuff that we eat that tend
to and habits that we do that tend to increase our levels of estrogen creating something called
estrogen dominance but high levels of estrogen are associated with anxiety so one thing clients
may want to do especially female clients but you know if you have a male who is feeling like
estrogen may be increasing too much I have them look at what they’re doing as far as lifestyle
factors to see if there’s anything that might be increasing their estrogen levels low levels of
estrogen are associated with depression because there’s not enough serotonin going around but also
because estrogen is a neuro stimulant and if it’s not there then there’s no stimulation so alright
so now looking at first we started implicating just neurotransmitters and going well if you don’t
have enough of this or too much of this then you might be depressed well now we’ve added to the
mix and said well guess what these imbalances over here in the neurotransmitters may be caused
by something completely different such as sex hormones progesterone is another sex hormone an
imbalance in the ratio with estrogen is implicated in mood disorders so progesterone kind of calms
down estrogen they’re yin & yang if you will kind of like GABA and glutamate it’s referred to as the
relaxation hormone the interesting thing here is synthetic progesterone which is present in a lot
of birth control is associated with depression whereas naturally occurring progesterone levels
haven’t had that same associate association drawn in the research literature so another thing to
look at with our female clients is possibly to ask them have they and if they’re presenting with
depressive symptoms have they changed their birth control regimen or have they recently gotten
pregnant or had a baby or stopped nursing and that was one I learned you know when I stopped
nursing my first child was your body actually maintains different levels of hormones and makes
sense maintains different levels of hormones when you’re nursing so you’re producing milk and stuff
and then when you stop nursing there’s a whole different hormonal cascade that happens so there
are multiple different times that estrogen can change and progesterone levels can change ganado
trope ins hormones synthesized and released by the anterior pituitary promote the production of
sex hormones so remember earlier I said that when we’re under stress our body releases cortisol
and cortisol tells our body you know what we don’t need to produce those sex hormones right now
so let’s connect it all if you’re under a lot of stress you may not be producing enough estrogen
which is why a lot of women when they’re under a lot of stress tend to have more erratic cycles but
even in men when your sex hormones are not being produced because your body’s focused on fight
or flee it makes the availability of serotonin and norepinephrine and dopamine less available
so chronic stress can alter the availability of sex hormones which alter the availability of
neurotransmitters okay you wanted some good news we got some good news oxytocin is our bonding
hormone and they found that it can counteract cortisol and vice-versa it’s not just getting a
hug though so I mean hugs are great don’t get me wrong but a lot of research has indicated that
people who have companion animals and pet their companion animal it can be a horse it can be a
dog it can be a cat a bunny rabbit whatever it is that does it for you where you feel that
sensation of bonding 15 minutes of petting that animal raises oxytocin levels and which
counteracts cortisol sweet thyroid hormones yet a whole nother category so we’re moving off
of the sex hormones onto our thyroid you have two types of thyroid hormones thyroxine and
the other one that I can’t pronounce t4 and t3 t4 is broken down to make t3 they are always
in a balance they’re always in a ratio too much thyroid hormone which typically is t3 speeds
things up and too little slows things down so think about somebody who’s hypothyroid they have
symptoms of depression one of the things we want to rule out early on with our patients who present
with the pressive symptoms is thyroid problems the patients with too much thyroid hormone may
present with anxiety symptoms so again we want to look and say is there a physiological cause to
the neurotransmitter imbalance the pituitary gland hypothermic hypothalamic-pituitary-adrenal axis
so this is the middle of that stress axis here the pituitary gland releases thyroid stimulating
hormones to get the thyroid to release t4 and t3 majority of the thyroid hormones produced by the
thyroid are t4 but t3 is the most usable form so it sends out t4 which is kind of you know it’s
just kind of there it’s not a real hard worker at all but along the way it gets converted to 3
t3 which is a workhorse this conversion is the critical element because a lot of times doctors
will test thyroid secreting hormone and t4 alone and they’ll say well you’re secreting enough and
there’s plenty of t4 to be broken down to t3 so I don’t know why you have hypothyroid symptoms but
the piece that they’re missing is they may not be we may not be adequately converting t4 to active
t3 so it’s important if you think you have thyroid issues going on to work with an endocrinologist
who’s going to do more than just a superficial test or if you go to a GP you have and they do
just a TS h t4 test comes back normal but you’re like no something’s not right there are more tests
that can be done to be more specific about what’s available because if we’ve got a client who goes
to the doctor and says doc you know I feel awful I can’t wake up I’ve got no energy they run these
tests they say well there’s nothing wrong with you that just disempowers the client the clients
going well nothing’s wrong with me I don’t know why I feel this way I have no hope for getting
better because I don’t know what’s wrong so I want to make sure that we educate them about all
the possible things that they might be able to look into I don’t dump all this on my clients at
first you know when I go through the assessment I start listening for things and then I encourage
them to get a full blood panel done and then we talk about all that when they come back and
then narrow it down to other things that they may want to look at further testing for if the
general assessment didn’t come back with anything overactive thyroid produces anxiety feelings of
nervousness butterflies heart racing trembling irritability and sleep difficulties under activity
depressive symptoms the other interesting thing and I don’t know what other word to use is
if it’s either overactive or underactive the person can have mood swings and have sleeping
difficulties so we don’t want to just say well you’re having mood swings it must be hyper
we don’t know so we want to look at maybe the thyroid gland is sputtering and giving a little
bit and then not enough and then a little bit and then not enough it’s just important for
them to understand what the thyroid hormone does other cognitive issues difficulties with
concentration short-term memory lapses and lack of interest and mental alertness are also common
in hypothyroid but they’re also common in a whole bunch of other things I mean most of these
sound like what the criteria for depression so we’re trying to sort through and figure out
what may be going on with that particular client hypothyroidism led to a significant decrease of
responsiveness of the serotonin system so again here’s something else if you don’t have enough
estrogen or if you don’t have enough thyroid the serotonin system may be implicated and we know
that serotonin insufficiency is implicated in generalized anxiety disorder so one of those
little paths to kind of be aware of optimal thyroid function may be necessary for optimal
response to antidepressants antidepressants mean the serotonin is still there but if estrogen
and thyroid are responsible for transporting it around and making sure it gets taken up in
the right places then if those two systems aren’t working no matter how much serotonin
is in the system of it’s not getting to the right places it’s not do the job hypothyroidism
generally increases enzyme activities and GABA levels now you may go well sweet we want more
gaba but we don’t too much gaba has too much of a depressive effect so the person may not be
motivated may feel apathetic about things they can’t get excited about anything so there is such
a thing as being too chill thyroid hormone plays a role in the output of dopamine the precursor to
norepinephrine our motivation chemical not enough thyroid hormone not enough excretion of dopamine
not enough get up and go and norepinephrine has also insufficient norepinephrine has also
been implicated in depression so you know serotonin is not even in there we’re talking
about thyroid dopamine and norepinephrine stress hormones so we’ve moved on cortisol
it’s released from that HPA axis cortisol triggers a decrease in leptin and an increase in
gralen which increases appetite and food intake cortisol is telling you there is a threat we
need energy we need to mobilize the sugars because it’s a glucocorticoid but we also need to
get more sugars in here so we have energy for the fight-or-flight as long as it goes on which is why
a lot of people who are chronically stressed also feel like they’re chronically hungry they’re just
like I’m famished all the time and it may not be that their body needs all that energy all those
calories right now their body may be hoarding it because they think they’re going to have to it’s
gonna have to fight or flight flee for a long time cortisol also affects the endocrine system
including thyroids insulin regulating blood sugar and your sex hormones all right well that’s not
good so when people are stressed they maintain higher levels of cortisol when they maintain
higher levels of cortisol basically every bodily system and all the neurotransmitters are impacted
adrenaline is another stress hormone you know we think about it when somebody gets really upset or
excited or whatever they have a rush of adrenaline alright sigh Roxon is also released from the
kidneys and are from the thyroid and helps you get fatty acids which are long term long term
energy fat has nine calories per gram sugar has four calories per gram so fat is a much denser
source of energy effective chronically elevated cortisol includes impaired cognitive performance
you’re not thinking as well dampen thyroid function yep eventually the body goes there’s no
point the stress is not going to go away there’s no point in continuing to fight so I’m going to
turn down the sensitivity of the symptom blood sugar imbalances sleep disruption elevated blood
pressure lowered immune function and increased abdominal fat so if a client starts talking about
how they’re stressed they’re hungry all the time and they keep suddenly gaining all this weight
in their belly we might start looking at chronic stress and interventions that we might use for
chronic stress including mindfulness meditation exercise you know anything that we can throw
their way in addition to having them get a full physical to make sure there’s nothing else going
on like you know actual hyper hypothyroid caused by a physiological problem low levels of cortisol
brain fog cloudy headedness mild depression low thyroid function again blood sugar imbalances
such as hypoglycemia and remember when you’ve got blood sugar imbalances and not enough sugar
then your body cannot produce enough gaba which means you’re not going to have enough naturally
relaxing chemicals fatigue especially morning and mid-afternoon sleep disruption low blood pressure
lowered immune function and inflammation so these are all things that we can produce to work
our clients to say cortisol it’s not public enemy number one but it’s pretty close to it so
let’s look at how your cortisol levels how you’re sustained chronic stress might be impacting
your mood your health and your sleep and think about different ways we can reduce that because
that’s more tangible and cortisol is measurable obviously the doctor has to do that but it is
measurable in general when we feel emotions a stimulus is received by our peripheral peripheral
nervous system the brain responds by triggering the amygdala which is our emotion center and
the hypothalamus assesses if you will the need for fight or flee it goes there’s a threat or
there’s no emotional memory that helps the brain determine the types of neurochemicals to secrete
and in what amounts if the hypothalamus goes yeah no big deal then you’re going to have more
inhibitory neurotransmitters then if you have your hypothalamus going that’s a problem what we need
to look at and this adds another layer is when there is too much of a chemical or hypersensitive
receptors so hypersensitive receptors are like the person that you know that jumps when you tap them
on the shoulder somebody who’s hyper vigilant when they are activated they go from 0 to 100 and
it’s just like in sensitive receptors on the other hand when they’re activated they may not do
anything at all so you may have enough chemical in the system but if the receptors are not receptive
then the chemical can’t do its job so if serotonin is sitting outside the receptors door just kind
of knocking on it going let me in and that door never gets opened then it doesn’t matter how much
serotonin is sitting in the synapse it’s not going to do any good so as I said before all every
time I talk about too much and too little it’s always relative to the proportions of the other
hormones and neurotransmitters for that person anxiety irritability and anger our fight-or-flight
response can be caused by dot dot dot too little serotonin where you have anxiety coming
on because serotonin is not there to help the person calm too little GABA again not enough
calming too much norepinephrine too much estrogen too much testosterone or too much thyroid so
any of these too much is going to cause one symptom either anxiety or irritability or anger
and too little will probably produce something more on the depressive continuum now happiness and
excitements an interesting one because happiness and excitement are excitatory neurotransmitters
they’re going to get your heart rate going they’re gonna get your blood blood flowing they’re gonna
get your breathing a little bit faster think about Christmas Christmas morning when you run down the
stairs in order to see what’s under the Christmas tree or something else that is really exciting
your body is secreting dopamine norepinephrine glutamate and maybe a little bit of serotonin
in there but these are the same chemicals that are going out during a stress response it’s how
the amygdala processes everything so we still need these excitatory neurotransmitters we can’t
just shut them down and go well that’s causing too much problem let’s turn it down well if we turn it
down we’re also turning down the body’s ability to Spahn to happy stimuli and like I said depression
can be caused by serotonin insufficiency or excess and why is it excess when you have too much
serotonin or too little serotonin you can have high levels of anxiety they found and high
levels and anxiety trigger the stress response system after a certain period of time the stress
response system goes you know what I can’t stay this hyped up for this long I’ve got to turn down
my sensitivity I’ve just got a you know let it all go which starts leading to feelings of apathy and
depression it can be caused by nor norepinephrine insufficiency dopamine insufficiency thyroid
insufficiency or gain too much or too little estrogen the good thing is I Roy dand sex
hormones can be measured so we can easily or somewhat easily help the person rule those in
and/or rule those out as can cortisol so if they have chronically elevated or chronically low
levels of cortisol they’re going to have some mood symptoms but we can figure out that that’s
going on and we can help educate the patient to why they’re having the symptoms they are it’s
not all in their head the New England Journal of Medicine on major depression said numerous
studies of norepinephrine and serotonin in plasma urine and cerebrospinal fluid as well as
post mortem Studies on the brains of patients with depression so we’re talking about humans
not just rats studies have yet to identify the purported deficiency reliably so while we’re
talking about depression being caused by if you will norepinephrine or serotonin deficiency
there’s no real research that can reliably say yes this is it 100% of the time or even 95% of the
time it’s more like yeah 15 percent of the time so yes deficiencies in norepinephrine and and or
serotonin does cause depression in some people but that is a small subset and they found that there
are 20 or 30 small subsets of different causative factors estrogen and progesterone modulates sleep
and too much estrogen can cause insomnia so again if you have too much estrogen well you may have
plenty of serotonin going on you also may not be able to sleep sleep deficiency promotes elevated
cortisol and further disrupts our feeding hormones now for cortisol is elevated we’re not going
to get good restful sleep sleep deficiency is related to a 30% reduction in thyroid hormone
levels so again remember that the body finally after chronic stress will start turning down
the thyroid it’s just like there’s no need to exert any more effort because this is a losing
proposition with sleep deficiency the thyroid hormone levels go down cortisol levels go up
which is your stress chemical so everything’s starting to get out of whack when people eat
serotonin suppresses appetite and increases with feeding so as we eat our serotonin levels go
up especially for eating carbohydrate-rich foods but anytime we’re eating so if there’s not enough
serotonin people’s appetite suppression may be off but that’s also one of the reasons that people eat
for comfort is because serotonin helps them feel a little bit better so when they’re eating serotonin
goes up dopamine is associated with safety ATP handy which is great but if you don’t have enough
dopamine then you may never feel satisfied as we talked about before cortisol increases appetite
and neurons involved in the regulation of feeding are located in the hypothalamus so when you’ve
got that hypothalamus pituitary adrenal axis all activated all the time the HPA axis you’re
feeding is going to be probably way up here because the hypothalamus is going there’s a threat
we need food we need we need energy and all of these chemicals are involved in stress response
stimulants stimulants set off the stress response system by causing the body to kind of dump if
you will sigh roid hormones stress hormones and suppress sex hormones you know that HPA axis it’s
activated excitatory neurotransmitters dopamine and norepinephrine gets secreted so if you’ve got
a lot of pleasure reward focus and concentration going on and you’re just like woohoo yeah you’re
probably gonna want to do that again but when that wears off when stimulants wear off they wear
off a whole lot faster than what our normal neuro chemicals would normally do so when they wear off
there’s a sudden lack of stimulation pleasure and reward and there’s an excess of gaba and other
other neurochemicals when people drink alcohol initially gaba goes way up when they drink the
alcohol and they feel relaxed and disinhibited and all that kind of stuff the alcohol wears off and
all of a sudden in proportion to everything else there’s way not enough gaba so anxiety goes way up
so what we want to remember is when we’re taking substances or engaging it well taking substances
specifically they are going to impact and wear off in a much different rate than what would happen
from our body normally excreting or causing those neurochemicals to be excreted depressant
increase gaba and may increase serotonin so they found that alcohol may increase serotonin it also
increases gaba but again when it wears off you got a problem what there are other depressants out
there besides alcohol though so it’s important to know what are your clients taking what are they
using recreationally not to be judgmental you know if you have a couple drinks in the evening it is
what it is what other things are you taking are you using including looking herbs like valerian
Valerians are pretty powerful depressant so it’s important to know what what they’re taking so
they know what impact is having on their body there are a variety of neurotransmitters that
are implicated in moods sex stress and thyroid hormones among others modulate the secretion and
absorption that is modulate the availability of these neurotransmitters so if there’s a lack
or an insufficiency proportionally speaking of norepinephrine what we want to ask is not how do
we increase it but what’s causing it why is there an imbalance in norepinephrine in this particular
patient dysphoria is about having an imbalance not necessarily too much or too little you may have
too much X in relation to Y too much glutamate in relation to GABA so talking with your clients
if they start taking medications talk with them about how they feel and whether it’s getting worse
you’re getting better to help understand you know are we targeting the right things here sleep
deprivation directly contributes alterations in hormone and neurotransmitter levels and
excessive eating may be caused by high cortisol levels because the brain thinks it needs to store
energy for the long fight sex hormones impact the availability of serotonin but oxytocin has been
shown to inhibit cortisol so pet a dog get a hug do something to promote bonding it will help
with stress levels dysphoric moods are caused by a neurotransmitter imbalance but what causes
that imbalance in each person berries greatly and they found it even berries greatly among
people with PTSD so just like depression PTSD does not have one simple cause a cascade effect
can happen when any one of these systems goes offline so if the thyroid system goes offline has
a dysfunction for some reason it may negatively impact all the other symptoms because it’s
going to change the balance and the ratios of all the other hormones and chemicals involved
in those feedback loops so final thoughts chronic stress impairs sleep which causes imbalances
and hormones and neurotransmitters involved in eating sleeping mood attention motivation
and sex disruptions in nutrition can fail to provide the building blocks for the hormones and
neurotransmitters so it could be something as simple as you know eating junk food every day
sleep impairment is associated with decreases in thyroid hormones and increases in cortisol and
dysregulation of eating so if somebody’s hungry all the time but they’ve got a low mood and you
know they present with depressive symptoms we may want to look at what’s going on and could
it is a factor contributing to this is sleep um but any of these things could also contribute
to problems with sleep estrogen and testosterone, imbalances can cause depression or anxiety like
symptoms and thyroid hormone imbalances can also cause depression and anxiety-like symptoms so the
the take-home message is this stuff is stinkin complicated but what we know is everything
is intimately interconnected so we don’t want to just start by saying well it sounds like
you’ve got this and try to pigeonhole everybody into one particular causation we need to
understand what’s going on with them and since we can’t measure brain neurochemicals to figure
out exactly which one’s out of whack that’s where the part art comes into psychology as part art
and part science okay so are there any questions you I think you’re all probably feeling like me when
after I wrote this I worked on research for about 20 hours and I was all but drooling at myself
by the end I was like really I tackled a pretty deep subject for an hour and you may need to
go back and look at the presentation to kind of make all the connections and connect the
dots as it applies to your clients but let’s see thinking about autism symptoms and these
issues and body functions and hormones yeah I mean certainly autism is correlated and I’m
pretty ignorant as to the neurophysiology of autism but I would think that there’s a strong
correlation with the neurotransmitters so I would look at other systems to see if there are
something that’s going offline that may be contributing to the neuro neurotransmitter
imbalance when symptoms are exacerbated which makes me think you know again
I don’t know as much I don’t know much about autism but when a client begins
stemming I’m wondering if those impulsive behaviors mean there’s high
levels of anxiety at that point so I’m wondering what’s happening with the stress
response system in the GABA feedback loop I would love after you guys kind of
digest this and stuff if you have any thoughts reactions connections I would
love to hear back from you I’ll put my email and other than that have a wonderful
amazing weekend and I will see you on Tuesday if you enjoy this podcast please like and
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this episode was pre-recorded
as part of a live continuing education webinar on-demand CEUs are
still available for this presentation AllCEUs.com/Anxiety-CEU I’d like to welcome everybody to today’s
presentation on best practices for the treatment of anxiety I am your host, Dr. Dawn Elise Snipes now not too long ago we did
a presentation on strengths-based biopsychosocial approaches to addressing anxiety while
those are wonderful you know I thought maybe we ought to look at you know what’re some of the
current research so I went into PubMed which is I don’t know it’s a playground for me it’s where
you find a lot of journal articles and you can sort I sorted by articles that were
done and meta-analyses that were done within the past five years so that gives us an idea
about current research I mean there’s a lot of stuff that is still the same like some of
the medications that were known to work ten years ago are still known to be you know good
first-line treatments but there are also some newcomers that we’ll talk about and there are
also, some changes that we’re going to talk about so we’re going to explore some common causes
for anxiety symptoms to treat, we need to and of course, this does play into
the biopsychosocial aspect we need to understand kind of what causes it because anxiety
that’s caused by for example somebody having a racing heart may be different than anxiety that’s
caused for somebody who has abandonment issues so we’re gonna treat the two things differently so
we want to look at some of the common causes we’re gonna look at some common triggers for anxiety
Do you know what are some of these common themes that we see in practice I will ask you to share
some of the themes that you see that underline or underlie a lot of your client’s anxiety and
identify current best practices for anxiety management including counseling interventions
medications physical interventions and supportive treatments so we care because anxiety can
be debilitating and a lot of our clients have anxiety a lot of our clients have anxiety
comorbid with depression and they’re looking at us going how can I feel anxious and stressed out
and like I can’t sit still and be depressed at the same time you know when you’re depressed you’re
supposed to want to sleep well a lot of times people who have both issues want to
sleep but they can’t so I want to help clients understand that also sometimes anxiety when
people are anxious for long enough the body starts kind of holding on to the cortisol the body
recognizes at a certain point this is a losing battle I’m not going to put energy into
this anymore so it starts withdrawing some of its excitatory neurotransmitters so to speak and
people will start to feel depressed the brain has already said this is hopeless this is
you’re helpless to change the situation so then people start feeling hopeless and helpless
which is sort of the definition if you will of depression low-grade chronic stress and anxiety
arose energy and people’s ability to concentrate so if we’re going to help them become their uber
selves we need to help them figure out how to address anxiety not just generalized overwhelming
debilitating anxiety but also panic social anxiety and those minor anxiety triggers that come along
that may not meet the threshold for diagnosis anxiety is a major trigger for addiction relapse
if you have a client who is self-medicated before or had an addiction for some reason anxiety is a
major trigger increased physical pain when anxiety goes up people tend to tense their muscles when
they tense their muscles they tend to feel more pain I mean think about when you’re stressed you
tend to have more pain like in your neck your back and things that already hurt may hurt more
why because serotonin which is one of our major anti-anxiety neurotransmitters is also one of our
major pain modulators so when serotonin levels are too low because anxiety is high then our pain
perception is going to be more acute and people can have sleep problems if they’re stressed out
your body thinks there’s a threat you’re not going to be able to get into that deep restful
sleep you may have you may sleep a lot but it’s probably not quality sleep which
means your neurotransmitters may get out of whack your hormones make it out of whack and your body
is going to start perceiving yourself in a persistent state of stress when you’re exhausted
the body knows that we may be the weakest link in the herd so it continues to secrete cortisol
to keep you on alert a little bit so you may again you may be resting kind of like when
you have a new baby at home those first couple of months that my children were home from the
the hospital I slept but I didn’t sleep well I mean the slightest little noise and I was awake and I
was looking around and you know I felt it I felt exhausted and a lot of new parents do so triggers
for anxiety abandonment and rejection and we’re going to talk about ways we might want to deal
with these things but some of the underlying themes that I’ve seen in a lot of clients and when
I do the research and a lot of what themes that come out include low self-esteem if someone has
low self-esteem they’re looking to be externally validated oftentimes they’re looking for somebody
else to tell them you’re lovable you’re okay so that can lead to anxiety about not having
people to tell them you’re okay which makes their relationships tenuous and can make them
dysfunctional irrational thoughts and cognitive distortions may lead people to believe that if I’m
not perfect for example I am not lovable so we’re going to look at some irrational thoughts and
cognitive distortions unhealthy social supports and relationships when you’re in a relationship
it takes two to tango and even if your client is relatively mentally and physically healthy if they
are in a dysfunctional relationship they can fear abandonment and rejection if that other person
is always saying if you don’t do X I’m going to leave you or if that other person is always
cheating on them or whatever so relationships can trigger abandonment anxiety and ineffective
interpersonal skills can lead to relationship turmoil and social exile if our clients are in
relationships even if they’re not completely dysfunctional if our clients are not able to ask
for what they need and set appropriate boundaries and manage conflict effectively because conflict
happens in every relationship then they may start to argue more which may lead to fearing may lead
to relationships ending in the past and them going well every relationship I get into ends which
means I must not be lovable so they start fearing abandonment and rejection these are four areas
that we can look at one more assessing clients another issue is the unknown and loss of control
a lot of times negative self-talk and cognitive distortions can contribute to that if I don’t have
control of everything then it’s all going to be a disaster negative others when clients hang out
or when people hang out with negative people it kind of wears on you after a while you notice
that people who tend to be more negative pessimistic conspiracy-minded tend to hang out
with people who are also negatively pessimistic and conspiracy-minded so if you’re hanging out with
somebody who tends to be anxious then the anxiety can be palpable and it can kind of permeate
physical complaints can lead people to be anxious because they don’t know what’s causing it
like I said earlier sometimes if your heart starts to race if you don’t know what’s causing it for you
can start thinking I’m having a heart attack or I’m gonna die when people have panic attacks for
the example they truly think they’re having a heart attack and it’s I’ve had them they are very
very unpleasant experiences but when people start having physical complaints and it can be you
know they have a weird rash that they can’t get to go away or whatever but when they don’t know
what it is and they can’t control it they can’t make it go away they start thinking about all
the worst-case scenarios and going online and getting on WebMD which usually gives you all the
worst-case scenarios um so physical complaints are important we need to normalize the fact that
nobody’s pain-free all the time and you know the fact that you may have an ache or a pain or a lump
or a bump or you know a cough most likely you know when we look at probability the probability of it
being something significant is pretty small now do you want to get it checked out probably but
you know the probability that is anything to be worried about is relatively small and a sense
of powerlessness can trigger fear of the unknown and loss of control for somebody who doesn’t
feel like they have any agency in their life if they have an external locus of control or
if they felt victimized all of their life then they may fear not being in control they may be
holding on and saying okay this is the one area of my life I can control when I grew up you know
I grew up in a very chaotic environment I had no control I was bounced around in the foster system
yadda yadda yadda now that I’m an adult you know I can control these things and I am going to hold
on with white knuckles and if I can’t control everything then that terrifies me to death and
loss are other triggers for anxiety and it can be people or pets and pets are important I don’t
want to minimize pets because you know they are little parts of a lot of our families so making
sure we check that my daughter’s dog for example is it’s getting old she’s getting older she’s 14
now I think and you know she’s in decent health we took her to the vet and the vet said yeah she’s
got a little heart murmur but that’s expected for a 14-year-old dog and but when she goes out if she
doesn’t come back when I call her I have this rush of anxiety for a second oh my gosh I hope this
wasn’t the day so anxious around losing people and you know if she when she crosses the bridge
she will and you know I’m okay with that I’m I have a harder time dealing with my daughter’s
emotional turmoil when that happens and because she’s grown up with this dog so you know those
are the types of things that we want to talk about with our clients what things are weighing on you
that you may not even be thinking about because I know in the back of my mind there’s always that
worry about one of our donkeys and her dog jobs and promotions can trigger anxiety if people are
afraid they’re gonna lose their job if they’re always afraid that you know they’re gonna walk in
and get a pink slip or get fired you know we want to help them look at how realistic they are
you doing what you need to do to achieve and keep your job and sometimes it’s not easy to
the answer I mean the first thought that a lot of us have is well you know if you’re doing the right
a thing so just do it but there are those bosses out there and I’ve had some amazing bosses
a lot of them and I’ve had two horrendous bosses and those two bosses I could never I
never felt like I was able to do anything right and so going to those jobs there was always this
anxiety about what I’m what am I going to get in trouble for today so you want to talk with people
about does your job cause anxiety what can you do to moderate that anxiety the same thing with
promotions people may get anxious about whether they’re going to get promoted to safety and security
you know when you lose safety and security you can feel anxious so if there’s a break-in at
the house next door or shooting down the road or you start watching the news you can feel very
unsafe and insecure quickly so we want to help people figure out how safe and secure are you
really and a lot of it goes back to looking at facts when people lose their dreams and hopes
or fear that they’re going to lose their dreams and hopes they can start to get anxious you know
they have this dream that they’re going to be a doctor or I just finished the presentation on
helping high school students transition to college and a lot of high school students for example
start college with these wide eyes and hopes to save the world and they want to be doctors
and engineers and this and that and they get into it and they realize that it’s a lot harder
then they thought or they realize that you know what I don’t like this but I’ve already
committed to it so what do I do I want to help people but I can’t I can’t cut it doing this you
know for me I figured out in my second year that I wasn’t going to medical school because I wasn’t
going to pass calculus and that caused a lot of anxiety it was like okay what am I gonna do now
Do you know what career should I choose to help people figure out do they have dreams that have
maybe kind of crashed and burned and you have to find new ones you know okay that one we’ve got to
accept it figure out that it’s not going to be and what can you do now people may also have dreams
about relationships they get into relationships and see themselves with this person forever
and then this relationship ends and or starts to get rocky and they’re like but that’s my dream
what happens if that’s got to happen because it’s my dream I don’t know how to function if
that goes away we want to help people be able to rewrite their narrative and then sickness spiders
and other phobias kind of go in with death a lot of times when people get sick they start getting
anxious that oh my gosh what if this is terminal oh my gosh what if this is you know incurable
if I get bit by a spider it’s gonna kill me and which is rare you know there are very few spiders
that is actually that poisonous same thing with snakes going over bridges I’ve shared with you all
that is not one of my irrational fears you know I am just terrified that you know something’s going
to happen and I’m going to get pushed off the side of the bridge which is completely irrational but
we need to help people look at those and identify the thoughts that they’re telling themself about
those phobias and dealing with that anxiety failure is another –trigger for anxiety especially in
this culture our culture American culture is large part puts a high premium on success
and perfectionism so when people realize that they’re not perfect they may start to get anxious
because they feel like if I’m not perfect then I’m a failure you know those cognitive distortions of
all-or-nothing thinking and they start with that negative self-talk you know you can’t do anything
right so those are some of the issues that you know we often see in counseling sessions so what
do we do you know somebody comes in and is like I can’t live this way doc anxiety depression and
substance disorders as well as a range of physical disorders are often comorbid so this is the first
the thing we need to realize is that we’re very rarely dealing with a very simple
the diagnosis you know when somebody comes in we need to figure out you know if they come in and they’re
presenting with depression all right let’s talk about that and then we start realizing that there
depression started to occur after a long period of being anxious okay so we need
to deal with that but we also need to help them with their sense of hopelessness and helplessness
we need to develop that sense of empowerment and then substance disorders we know that substance
use is often a way of self-medicating but we also know that it monkeys with the neurochemicals
in the brain and can contribute to anxiety and depression the same thing to physical issues pain
from physical disorders anxiety about having physical disorders medications you’re taking for
physical disorders can all contribute to anxiety so we need to look at the person as a whole and go
what are all the things that are contributing to the anxiety and what are all the things that the
anxiety is contributing to so we have started having this big list of stuff that needs to be
addressed and then we can start figuring out okay where we start so knowing that these things
are comorbid helps researchers explore pathways to mental disorders so they can start figuring
out you know what little string can we pull to unravel this blanket of anxiety so it doesn’t
suffocate somebody and for us, as clinicians, it provides us key opportunities to intervene in you
know sometimes clients will come in and start talking about their
anxiety and their physical issues you know maybe their anxieties about you know heart
palpitations and because that’s a common one we may want to encourage them to go see the doctor to
get that ruled out you know rule out anything that has to do with hormone imbalances or you know
heart conditions or anything else that might be contributing to it which can help them address
it and if they do have physical disorders let’s go with hormone imbalances that are contributing
to the heart palpitations then they can start to treat that if they don’t start to treat that then
no amount of talk therapy we do is going to get them to the quality of life that they’re looking
for because they’re still gonna feel those so we want to make sure that we’re addressing them
holistically anxiety disorders should be treated with psychological therapy pharmacy therapy or a
combination of both and what they found and this is no surprise this is kind of old news is that
counseling Plus pharmacotherapy tends to have the best outcomes but separating the two have
similar outcomes in many cases but that’s just looking at and I hate to call it simple anxiety
but we’re just looking at anxiety symptoms here we’re not looking at the full quality of life and we
want to make sure that we’re also including any medical issues behavioral therapy is regarded
as the psychotherapy with the highest level of evidence, there are a variety of cognitive
behavioral approaches ranging from acceptance and commitment therapy to dialectical behavior
therapy to CBT to debt you know any of those that deal with the thoughts and the cognitions that fall in
that realm and it is effective in the current conceptualization of the etiology
of anxiety disorders includes an interaction of psychosocial factors such as childhood adversity
or stressful events and a genetic vulnerability so the psychosocial factors and these are other
things when we do our assessment we want to pay attention to because our approach to treatment
is going to be different for people for example who have trauma-related brain changes maybe
then for somebody who doesn’t so, we want to look at childhood adversity and stressful events
that it may have caused basically what I tell clients is like rewiring of the brain there
are trauma-related brain changes in soldiers and especially in children or in people who’ve been
exposed to extreme trauma that is designed to protect them but it also can cause complications
kind of later on in dealing with anxiety coping skills that were learned that are ineffective you
know sometimes people grow up in a household or an environment or a situation where they don’t learn
effective coping skills so we need to kind of help them unlearn those and learn new ones build on
their strengths and trauma issues that may still need to be dealt with such as domestic violence
you know if they grew up a lot around a lot of domestic violence they may think you know I’m
out of that situation it’s over I don’t want to think about it it’s not bothering me anymore or a
parental absence and I put absence because it can be death it can be a parent that just packed up
and left it could be a child that got put up for adoption whatever put the child in a position of
feeling like they were rejected by a parent can be very traumatic and bullying among other things
but there are a lot of trauma issues that people once they’re out of that situation often say you
know I’m out of it it’s not a big deal I dealt with it let’s move on and they don’t realize the
full ramifications and how that’s contributing to their current anxiety and their current self-talk
and cognitions of current stressors if somebody has a lot of current stressors that are also going to
impact whether they develop generalized anxiety you know we’re kind of stacking the deck here and
the current availability of social support if they don’t have effective current social support then
they’re gonna have difficulty bearing the weight of everything on their shoulders so we want
to look at all these psychosocial factors when we do our assessment now going back to the trauma
issues if you’ve taken the trauma courses at all CEUs you know that some people are not ready
to acknowledge that the trauma is still bothering them or work on the trauma and that’s okay we
can educate them that it might be an issue and then let them choose how to address it but
we want to bear in mind the fact that you know this could be sort of an underlying force
motivating some of the current cognitions and genetic vulnerability so you take any three
people and you put them or 300 people and you put them through roughly the same psychosocial
situations they’re all probably going to react a little bit differently based on their prior
experiences but also because of their genetic makeup there are certain permutations and they
found four we’ll talk about later that make the brain more or less responsive to stress and
more or less responsive to serotonin which is your calming chemical so brains that are less
responsive to serotonin isn’t going to you know send out as much or send out serotonin as easily
so people can stay kind of tensed and wired that’s an oversimplified explanation but that’s
all you need for right now so genetic vulnerability impacts people’s susceptibility
to the effects and development of dependence on certain substances which can increase anxiety
when people are detoxing from alcohol when they’re detoxing from benzos when they’re detoxing from
opiates they can feel high levels of anxiety when they take opiates some people find that opiates
have wonderful anti-anxiety properties not that I am advocating for the use of opiates I’m
just client experiences have shown that that can be true so some people are going to be
more susceptible to the anti-anxiety effects of certain substances and some people are going
to be Cerrone to become dependent on substances where others may not and that part of that is
genetic vulnerability and they estimate about 30% the predictability of the development
of anxiety disorders is genetic and genetics also impact which medications are effective
if you have genetic makeup then SSRIs might be helpful if you have genetic makeup be then
atypical antipsychotics may be more effective and SSRIs might not do anything which is why
a lot of our clients get so frustrated because they know there’s no way to figure out exactly what I
guess there is now that there’s genetic testing out there but up until then it was harder to
figure out which medications to start with and most physicians matter of fact I don’t know of
a single physician that starts by saying well let’s do a genetic profile to see
what med to start you out with most we’ll start with events as with an SSRI or some other
anti-anxiety medication some sort of benzo that’s been my experience so we may want
to encourage clients to consider genetic testing if they’re having difficulty finding a
medication regime that works for them and they are feeling like they have to have medication
genetic vulnerability also affects what’s going to make somebody more vulnerable now than all of you
in class today you know thinking about sleep you know sleep may not be a big deal for some of you
I know people who can go days or weeks with four or five hours of sleep and they feel fine it’s
not a big deal, not me I need eight or nine hours of sleep so genetically for whatever reason I am
programmed to need a lot of sleep so when I don’t get that much sleep I tend to be it tends to be
harder for me to deal with life on life’s terms and I know that that makes me more vulnerable to
being irritable so genetic vulnerability affects who can become addicted and affects what medications
work best and affects what situations are going to tend to make somebody more vulnerable to
anxiety so our medications and I know the type on here is small but we’re going to go through
the first-line drugs are the SSRIs selective serotonin reuptake inhibitors and SNRs is
selective norepinephrine reuptake inhibitors now the names are a little bit deceptive because
selective norepinephrine reuptake inhibitors also increase available serotonin but the mechanism
of action is different the mechanism of action for each SSRI is a little bit different as well
which is why you can put somebody on Prozac and they have an awful experience and you can put them
on Zoloft and they have a much better experience like I said earlier a lot of the research pre
five years ago had been done on medications and Zoloft Paxil luvox Lexapro Celexa and their
generics have all been found to be effective at treating anxiety in certain people no one
the medication works for everybody in the last five years Effexor has come on the radar and it has
been found effective according to the hamilton rating scale for anxiety so that’s another one to
consider if clients are not successful or getting the treatment effect that they need for on some
of the other medications obviously, none of us probably are prescribers but we do need to educate
clients about why the first drug or even the third drug that the doc tries may not work so they
don’t start feeling helpless and hopeless like I said earlier there are at least four different
genetic variations which are correlated with the development of generalized anxiety disorder and
different medications are more or less effective depending on the genetic makeup of the person
there’s a high mortality rate moving on to two benzos the recommendation has switched
to back off from the use of benzos now for some doctors will prescribe an SSRI and for the
first four weeks while the SSRI is building up in the system they will also prescribe a benzo
to be taken as needed to moderate the anxiety and you know you could argue on either side
of that, if somebody has a history of substance use or substance dependence benzos are really
a bad idea because they do have a high rate of dependence but the other reasons that they are now
cautioning against the use of benzodiazepines is that there’s a higher mortality rate among benzo
users compared with non-users there’s an increased risk for dependence with use for more than six
months and that’s a long time to be using benzo and when we’re talking about dependence and six
months we’re talking about somebody who uses it like every four hours or every eight hours
depending on your benzo every single day not a PRN user if somebody’s using it at night to
help them go to sleep or you know three or four times a week when the anxiety gets high
the risk of dependence is relatively low but a lot of people with anxiety because if they find
the right benzo makes them feel so much better they may not want to be off of it and for a lot of
people when that benzo reaches its half-life and starts getting out of the system even more their
anxiety spikes you know they have rebound anxiety which they want to medicate with more benzos
that’s gonna be an issue for them to discuss with their doctor there’s also an increased risk
of dementia identified in long-term benzodiazepine users again this is for the people who use you
know throughout the day every day for six months or relatively every day for six months or more
and it doesn’t matter if it’s you know we’re talking about somebody who’s 65 or somebody
who’s 35 who’s been using benzos for you know six months a year two years the risk of later
life dementia is greatly increased according to the research benzodiazepines also don’t treat
depression okay so if you’ve got somebody who has concurrent anxiety and depression there’s a much
higher suicide risk if they’re on benzodiazepines so being aware and generally that suicide risk
comes from overdosing on benzodiazepines but not always other treatment options you know if the
benzos aren’t something that people want to touch you know they scare the living daylights out of
me and SSRIs and SNRIs don’t seem to be working then tricyclic antidepressants can be tried on those
your older generation antidepressant Seroquel is used a lot and there are some there’s some
research that shows it can be effective with anxiety like some of the antidepressants and
depending on the person the benzos Seroquel can make people very very very sleepy so you know
it may not be the side effects of the Seroquel the weight gain and the fatigue and you know
sleepiness may be an unacceptable side effect for some clients and boosts perón is the third option
boost Barone works more like an anti-depressive serotonin reuptake inhibitor and that it takes
you know four weeks or so to kind of build up in the system studies have shown that there’s really
no long-term benefit to taking it but after six months to eighteen months of use it has been shown to
be effective in talking with clients a lot of clients report that boost bar when they take it
doesn’t necessarily help them stop being anxious like a benzodiazepine does but it helps them not
go from zero to 200 in 2.3 seconds it kind of you know keeps them from having this gush of a freak
out reaction every time something goes wrong which a lot of clients report helps because they feel
more stable throughout the day after remission medication should be continued for six to twelve
months and during that last six months first six months keep it as is last six months you know
they say that tapering is best it’s best not to stop somebody cold turkey on any of these but
it’s important for people once they’re in remission to not just suddenly go okay I feel
better I don’t need any of this anymore they need to work into it and make sure they’ve developed
the skills and tools that they need to deal with some of the anxiety that is going to
happen in life so physical signs and symptoms of anxiety may include fatigue irritability muscle
tension or muscle aches try laying feeling twitchy being easily startled trouble sleeping nausea
diarrhea irritable bowel syndrome headaches so the first thing we want to do with clients when we’re
talking to them well second thing first thing is to say get a physical to let’s rule out physiological
causes of this but we can also help clients look at you know what might be causing these
things that you can do to mitigate it what might be contributing to your fatigue what might be
contributing to your irritability and your muscle tension or your muscle aches I mean let’s look at
economics did you recently get a new bed or do you need to get a new bed what about your desk chair I
know you know I get more muscle tension and muscle achy when I do a lot of mousing because I have
deplorable posture being becoming aware of that helps and then I’m like okay well I know it caused
unfortunately, it’s unpleasant but it’s not a big deal trembling or feeling twitchy you know
that can be caused by low blood sugar that can be caused anxiety that can also be caused
by early onset Parkinson’s symptoms you know there’s you know it can be worst case scenario
or it can be something benign so we want to have people figure out you know when you start
trembling or feeling twitchy is there something that it’s related to you know I know when my
son gets excited he’s he just sits there and you can see him almost shake because he’s so
excited about something so we want to have people prevent misidentification we don’t want them
to jump to that worst-case scenario we don’t want them to go onto WebMD and go oh my gosh I’ve
got cancer I’ve got this debilitating disease and I’m going to die in six months probabilistic Lee
speaking it’s not gonna happen yes get a doctor’s opinion I’m certainly not going to tell them it’s
all in your head I want them to get an evaluation but I do want to in the meantime
help them think about how likely is this and other things for headaches and this is
one another one of those that can be frustrating as we get older our eyesight starts to go and
you know there was a period there I did fine and then after I hit 45 my eyesight just started
to like steadily and kind of rapidly in my mind decline so I have to get my eyeglass prescription
changed every couple of years and that can cause headaches so instead of starting to worry
about oh my gosh I’ve got a headache all the time maybe I’ve got a brain tumor you know I know that
it’s probably my glasses or I’m grinding my teeth so other biological interventions that
have been evaluated there’s something called the floatation rest system that reduced environmental
stimulation therapy reduces sensory input into the nervous system through the act of floating
supine which is on your back in a pool of water saturated with Epsom salt you know I’m looking at
this going sounds good and you can’t quite get the same experience in a bathtub because
you’re not floating you’ve got pressure points and you’re still hearing stuff clients can sort of
simulate it with you know earplugs or whatever but it’s if they can access this it’s been shown
to be effective the float experience is calibrated so that sensory signals from visual
auditory olfactory gustatory thermal tactile or tactile vestibular gravitational and preceptive
channels are minimized which means you don’t see here taste touch smell feel nothing as is most
movement and speech so you want people to lay just like completely motionless and not talk which can
be hard for some people with anxiety in the study the study I looked at fifty participants
reported significant reductions in stress muscle tension pain depression and negative effects and it
was accompanied by significant improvement in mood characterized by increases in relaxation happiness
and well-being I read the study I’m like where can I sign up you know it sounds in looking at some of
the research this was more effective for addressing anxiety than something like a massage
Tai Chi also produced significant reductions in anxiety there was approximately a 20% treatment
effect 25% treatment effect in patients with anxiety and fibromyalgia who practiced twice a
week for a year now you know we want to look at the confounding things here is it the Tai Chi
itself or is it learning to control the muscles and becoming more in tune with your body and
learning to control your breathing helps people reduce their anxiety either way you know
Tai Chi helps people do that and it was shown that after a year after the first six months, there was
a significant treatment effect but after a year you know it kept growing and after a year it was
about 25% so Tai Chi can be effective acupuncture at the HT 7 median Meridian can
attenuate anxiety-like behavior induced by withdrawal from chronic morphine treatment through
the meditation of the GABA receptor system what does that mean that means if you if the
acupuncture is done in very certain places the anxiety behavior the GABA a receptor
system GABA is your main calming relaxation neurochemical that is triggered and causes your
body to sort of flood that receptor system and this research was done on people who were detoxing
from morphine treatment but we can look at generalizing the results and I would be interested
to see further studies on it pain other things we need to do to help people with anxiety when people
are in chronic pain they often have anxiety that oh my gosh this is getting worse or it’s never
gonna get better or I just can’t take this pain anymore or they may get anxious that they’re going
to be rejected because they can’t do some of the things they used to do because they’re in so much
pain so there’s a lot of guilt and anxiety that can kind of revolve around pain what can we do
to help clients guided imagery is generally very helpful if we can help them imagine you know if
that pain in their shoulder imagine the pain is like the color red flowing out of their arm
or other focus mindfulness so you know when you think about something you know when you get a shot
if I don’t think about it it doesn’t hurt near as much as if the nurse says okay now one two three
and you know she’s counting down and I’m getting prepared and I’m focused on it I had
another nurse one time who she was just talking to me and you know put the alcohol on my arm
and just kept on talking and didn’t tell me she was getting ready to give me a shot and before I knew
it she had given me a shot and she was like okay we’re done I’m like you didn’t give me a shot yet
she said yes I did it’s like oh so not focusing on it and next time you have an itch for example
if you’ve ever been driving on the interstate and you can reach on your foot I get those on
the bottom of my foot sometimes and I’m like okay I’m not going to pull over to each my foot if you
focus on something besides the itch eventually it goes away I’m not saying the pain is gonna completely
go away but the more people focus on it the more it hurts physical therapy can help so encourage
them to get a referral and encourage them to do a self-evaluation if nothing else of ergonomics in
their car at work where they watch TV and spend most of their time at home and they’re sleeping
so those are the four places that they spend most of their time what do their ergonomics look like
and that can help a lot of people mitigate a lot of pain hormones are another thing that
we need to look at imbalances of estrogen and testosterone can contribute to anxiety symptoms
heart palpitations fatigue irritability having people get a physical we can’t as clinicians do
anything about it but doctors can rapid heart weight rate sweating palpitations are not uncommon
in women in perimenopause or menopause so a lot of women start feeling like they’re developing
generalized anxiety and/or something’s going wrong when they start reaching that mid-40s to mid-50s
area and they start having some of these symptoms again we’re not going to diagnose it but we do
want them to recognize that it may not be anything you know is catastrophic this is something that a
a lot of women experience and help them figure out how to deal with that supportive care biologically
now you know this isn’t gonna treat anything but we can help them minimize their vulnerabilities
help them create a sleep routine so their brain and body can rebalance this can help repair any
adrenal issues that may be going on and improve energy levels people with anxiety don’t sleep well
so helping them figure out how to get some quality sleep is important nutrition minimizing caffeine
and other stimulants are going to be a big help because those make people feel anxious and encourage
them to work with a nutritionist to try to prevent spikes and drops in blood sugar which can trigger
the stress response when your blood sugar goes way up or way down you can start getting kind of shaky
and feel weird and that can cause people anxiety because they might think oh my gosh I’m having a
stroke or a heart attack or you know I don’t know what these tremors are so it’s important that
they don’t miss identify symptoms and encourage them to drink enough water dehydration can lead
to toxic Ardea which is increased heart rate sunlight vitamin D deficiency is implicated
in both depression and anxiety mood issues vitamin D has been found in those main areas where
serotonin receptors are found vitamin D receptors are found so we know the serotonin and vitamin D
have something going on sunlight prompts the skin to tell the brain to produce neurotransmitters and
set circadian rhythms which impact the release of serotonin your calming neurochemical melatonin
which is made from breaking down serotonin and helps you sleep and GABA so sunlight actually
helps increase the release of GABA when it’s time to start calming down and going to sleep
exercise studies have shown that exercise can have a relaxing effect and encourage clients to start
slowly there’s not a whole lot of new research on exercise and anxiety aromatherapy has been
used a lot, especially in other countries in the treatment of people with anxiety people with
hospital anxiety people women who are giving birth and they have some birth anxiety there they’ve
been found to be effective in a lot of those studies essential oils for anxiety include
lavender rose Bedevere ylang ylang bergamot chamomile frankincense and Clary sage encourage
clients to just go to a health food store and you know sniff some of these and see if it makes them
feel happy and calm and content the aromatherapy molecules enter the nasal membranes and they
will start triggering neurochemical reactions and so you don’t need to apply it you don’t need
to ingest it all you need to do is so encourage clients if they’re open to it to think about this
because aromatherapy can be integrated into their bedroom for example with an atomizer or a Mr.It
can be incorporated in a lot of different places again where they’re not applying it or ingesting
it in any way all they’re doing is smelling it they’ve used it in defusing aromatherapy in
hospital emergency rooms and they found that it reduces stress and irritability the people in
emergency rooms and I’ve been to enough emergency rooms over the years to know that
people who are in ers typically are not in the best mood so if it can help those people then
it’s probably going to have some sort of an effect so psychologically helping clients realize
that their body thinks there’s a threat for some reason that’s why it triggered the threat response
a system which is what they call anxiety so they need to figure out why is there a threat
you know sometimes it’s like the fire alarm going off in my house it just means that the windows are
open and there’s a strong breeze there is no fire there is no problem there’s just a malfunction
it’s a false alarm a lot of times clients get this threat reaction they get this stress
reaction and it’s not a big deal right now so they can start modifying what their brain responds to
and again those basic fears that a lot of people worry about failure rejection loss of control the
unknown and death and loss distress tolerance is one of those cognitive interventions that have
taken center stage in anxiety research and it isn’t about controlling your anxiety you know
helping people recognize their anxiety acknowledge it and say okay I’m anxious it is what it is
how can I improve the next moment instead of saying I’m anxious I shouldn’t be anxious I hate
being anxious and slang with that anxiety let it go just accept it is what it is have the client
learn to start saying I am feeling anxious okay so distract don’t react because I explain to them
the whole notion of feelings comes in the crest and goes out in about 20 minutes it’s like a wave so once they
acknowledge their feeling if they can distract themselves for twenty or thirty minutes you know
they figured out there was no real threat if they can distract themselves for twenty or
thirty minutes those emotions can go down and then they can deal with it in their wise mind and encourage
them to use distancing techniques instead of saying I am anxious or I am terrified or whatever
have them say I am having the thought that this is the worst thing in the world I am having the
thought that I cannot handle this because thoughts come and go and that comes from acceptance and
commitment therapy functional analysis makes it possible to specify where and when with what frequency
with what intensity and under what circumstances the anxious response is triggered so it’s
important that we help clients develop the ability to do functional analyses on their own so
when they start feeling anxious they can stop and say okay where am I what’s going on how intense
is it what are the circumstances and they start trying to figure out what causes this for
them so they can identify any common themes from their psychoeducation about cognitive distortions
and techniques to prevent those circumstances or mitigate them can be provided so if the client
knows that they get anxious before they go into a meeting with their boss and it’s usually a high
the intensity of anxiety okay so we can educate them and help them identify what fears may be related
to techniques to slow their breathing and calm their stress reaction and help them figure out
times in the past when they’ve handled going in and talking to their boss and it wasn’t
the end of the world you know there’s lots of different things we can do there for them there
but the first key and it gives them a lot of a huge sense of empowerment to start becoming
detectives in their own life and going okay now under what situations does this happen positive
writing this was another cool study each day for 30 days the experimental group and this
was high school-aged youth in China but you know the experimental group engaged in 20 minutes of
writing about positive emotions they felt that day so they’re writing about anything positive
that make them happy that made them enthusiastic gave them hope whatever long-term expressive
writing positive emotions so after 30 days it appeared to help reduce test anxiety by helping
they develop insight and use positive emotional words so it got them out of the habit of using
the destruction and doom words and encouraged them to get in the habit of looking at the positive
things and being more optimistic it’s a cool activity that clients can try it’s not gonna
hurt anything if you have them journal each day for 30 days mindfulness also came up in the
research and was shown to be effective in a meta-analysis of six articles about mindfulness
based stress reduction four about mindfulness-based cognitive therapy and three about fear of
negative appraisal and emotion regulation was reviewed all of these showed that mindfulness
was an effective strategy for the treatment of mood and anxiety disorders and is an effective
in therapy protocols with different structures including virtual modalities so you know if you’re
doing it via teleconference mindfulness can still be helpful mindfulness helps people start learning
how to observe what’s going on and become aware of what’s going on more aware of those circumstances
which will help them complete their functional analysis but it also helps them become aware of
vulnerabilities and head off things in the past and if they’re taking better care of themselves
that they’re living more mindfully then they may not experience as many situations that trigger
their anxiety mindfulness also encourages clients to learn acceptance that radical acceptance of
it is what it is I’m not gonna fight it I’m angry right now I am anxious right now however I’m
feeling right now is how I feel and that’s okay it’s hard for clients to get to that but once
they get a hold of that and they truly believe it and they can say all right it’s fine I’m not gonna
feel this way forever I’m gonna do something else until the feeling passes it helps and that’s where
the labeling and letting go comes in mindfulness can also help them identify trigger thoughts
what thought were you having right before you started feeling anxious if people are mindful or
let’s start back when people are not mindful they often notice or don’t notice that they’re getting
anxious until they’re like super anxious when people are mindful they become more aware of
subtle cues address unhelpful thoughts when they say or believe it’s a dire necessity for adults
to be loved by significant others for almost everything they do always running gonna happen
why is it a necessity what we can encourage them to do is concentrate on their self-respect
on winning approval for practical purposes you know for promotions or whatever but it’s not about
me being lovable it’s about me getting a promotion and making more money and focusing on loving
rather than being loved because when we give love we generally get love back with unhelpful thought
number two people feel they aren’t able to stand it if things are not the way they want them to be
or are not in their control so encourage clients to focus on the parts that are in their control
and other things in life which are going well and to which they’re committed number three misery
is invariably externally caused and is forced on us by outside people and events just by reading
that makes me feel disempowered so encouraging clients to focus on the fact that reactions such
as misery or happiness are largely caused by the view that people take of the conditions so if
you see it as a tragedy and devastating then it’s probably going to produce misery if you
see it as an opportunity and a challenge it’s probably going to produce a different emotional
reaction, if something is or may be dangerous or fearsome people, should be upset and
endlessly upset about obsessing about it a lot of people with anxiety get stuck on this you know
if I feel like it’s fearsome I need to worry about it getting on a plane for example if I fear that
that’s dangerous that I need to think about it and worry about it that’s not going to do any
good so encourage clients to figure out how to face it and render it harmless if possible and
when that’s not possible accept the inevitable so looking at airplanes you know facing it means
researching to figure out how dangerous is it really and realizing that it’s not
that dangerous so that helps render it a little bit harmless in their mind it proves to them
that it’s not as dangerous as it could be and when it’s not possible accepting the inevitable you
know you got a fly so getting on there figuring out how you’re gonna get through it hurricanes
are the same way people especially in places like Texas Louisiana Florida may obsess as soon
as it starts coming to hurricane season or if a hurricane is spotted out in the Atlantic somewhere
they start checking the weather every hour or more wondering what the path is going to be and you
know what there’s you can’t change the path of the hurricane so all you can do is board up your house
evacuate if necessary and deal with the fallout child driving is just another example I’ll give
you know my children are learning how to drive and that’s kind of scary and fearsome you know what’s
gonna happen when they’re out there you know you see crashes all the time well render it harmless
by making sure they’ve got good training on how to drive make sure they’re good drivers and then
accepting that some things are just not within my control it’s easier to avoid than face life
difficulties and responsibilities well running from fear is usually much harder in the long run
so encourage clients to look back at times when they’ve avoided difficulties and responsibilities
and the eventual outcome you know what happened there people believe they should be thoroughly
competent in achieving in all possible respects or they will be isolated rejected and failures we
need to encourage clients to accept themselves as imperfect with human limitations and flaws and
focus on what makes them loveable human being what qualities like courage and intelligence and
creativity and those things that can’t be taken away what inherent qualities do they have that
make them awesome people because something once strongly affected people’s lives they should
indefinitely fear it if you got lost you know when little kids get lost it’s terrifying when
you’re grown up if you get lost you turn on the GPS and you figure out your way but some people
still, you know freaked out about getting lost if they got lost once so we want to help people look
back at past episodes that may be contributing to the current anxiety and compare the situation’s
you know are you the same person or is this not a big deal now that you’re older wiser stronger
encourage them to learn from past experiences but not be overly attached to or prejudiced by
them yeah you could have maybe got lost in the past and it was a horrible experience well you
were six I can see where that would be terrifying and a horrible experience but it doesn’t have to
continue to impact you that way now when you’re you know 26 getting lost you know could be an
opportunity to try a new restaurant or something people must have complete control over things
well this doesn’t happen so encourage clients to remember that the past and the future are
uncontrollable we can’t change the past it is what it is we can learn from it so it doesn’t repeat
but we can’t change it and the future is largely uncontrollable I mean there are a lot of things I
can do to stay moving toward a rich and meaningful life but life is going to throw me curveballs
sometimes and there’s nothing I can do to plan for or control that we can control our actions in the
present to stay on our preferred path and general develop general skills to deal with adversity
should it arise so we want to help clients develop those general problem-solving skills and
the general support system so when they are thrown a curveball you know it doesn’t knock them upside
the head people have virtually no control over their emotions and cannot help feeling disturbed
by things well encourage them to think about the fact that they have real control over destructive
emotions if they choose to work at improving the next moment and changing inaccurate thoughts then
they’re not going to experience the destructive emotions as intensely or as frequently when you
feel an emotion you feel how you feel but again you don’t have to wrestle with it fight it and
nurture it you can say this is how I feel how do I improve the next moment when it comes to
cognitive distortions encourage them to find alternatives when they start to personalize things
if somebody laughs when you walk out of the room then the and the person starts getting anxious
thinking oh they were making fun of me I wonder what they thought I wonder if I had something
stuck to the back of my dress and they start getting all panicked about it that doesn’t do
any good encouraging them to think you know what our three alternate explanations that hadn’t but
had nothing to do with you for why they laughed magnification of the worst thing you know taking
something and saying if this happens then it’s going to be a catastrophe and minimization going
along with that a lot of times when people magnify and see a catastrophe they minimize not only
their strengths and resources but all the other stuff that they’ve got going for them all
they’re seeing is this catastrophe so encouraging them to focus on the facts of what is actually
happening and what is the high probability event and encourage them to get information
and look at the broader picture you know yes you got into a car crash and your car is totaled and
that is unfortunate you know it sucks but you know that is not going to cause you to lose
your job and then become homeless and penniless and yadda-yadda it might cause your insurance to
go up but okay so you don’t have a car but what are the resources that you have who can who do
you work with that might be able to give you a ride to work you know let’s look at the resources
you have and work around so problem-solving helps with magnification and also focusing on you know
let’s be grateful for what didn’t happen you know you could have been killed but you weren’t the
car was totaled it’s replaceable all or nothing thinking again have them think about what else
could have been happening like Brittney suggested finding the exceptions instead of saying she
always does this look for exceptions when has she not done that what else has she done instead
of this selective abstraction and filtering is when people look for the good the bad and the
ugly a selective abstraction means you kind of see what you expect to see so if you expect
something to be devastating you see only the devastating aspects of it which kind of goes with
the magnification and minimization you filter out the stuff a lot of times when people are in a bad
mood or are anxious they see the negative because that’s the state of mind they’re in so encouraging
people to complete the picture alright there’s all this bad stuff now what’s the good stuff you
know to encourage them to look at the good the bad and the ugly so they get a wide view of exactly
what’s going on and encourage them to remember that hindsight is twenty-twenty when people have
something embarrassing happens or they get anxious about something that happened they look back
and they go I should have or I could have or oh I wish I wouldn’t have when you were in that
the situation you did what you did and you know maybe you may have had a reason for it or you know
you may have not had other options or it may have just been a bonehead thing to do but okay so you
made one mistake hindsight is 2020 that’s gonna that mistake is gonna stand out just like the
great big letter on the eye chart because you’re thinking back and you’re looking at it and that’s
all you see but encouraging clients to remember that other people are too busy worrying about
themselves to remember what they did jumping to conclusions encourages clients to remember to
get all the data if your significant other male significant other comes home and is smelling like
perfume don’t just jump to the conclusion that he was cheating on you maybe he went to the
mall to get a new tie and walked through the perfume area and got spritzed or bought you some
perfume or who knows maybe the person sitting next to him at work sprayed her perfume on the desk
and some of it filtered on there are all different reasons that that might happen so encourage people
to get all the data mind reading we can’t do it you know you can’t read somebody’s mind you don’t
know what they’re thinking so ask them what you think about this don’t assume anything and
emotional reasoning encourages people to step back from a situation and ask themselves am I feeling
anxious about this because I’m feeling anxious and I’m looking for reasons that it should be scary
or am I feeling anxious about this because it’s really scary for some reason there are facts
support my anxiety a lot of times when we go into new situations we may feel anxious because it’s
a new situation but when we step back we say you know what there’s nothing to be worried
about here you know no big deal I got this and move on so instead of rolling with it and trying
to figure out okay I feel anxious so there must be a reason not necessarily very likely a false
alarm other psychological interventions relaxation skills encourage people to learn how to relax
not only physically but mentally diaphragmatic breathing helps encourage them to breathe
through their stomach and put their hand on their belly and feel their belly expand and contract
slows breathing down which triggers the rest and digestion reaction in the brain which is calming
meditation can be helpful for some people some people find trying to quiet their minds too
frustrating because they’ve got too much monkey mind going on that can be later or maybe
never for some people, we don’t want to increase their anxiety with interventions cute progressive
muscular relaxation also has a lot of research support and remembers with cute progressive
muscular relaxation we’re Sakura get them to attach a cue AK you word like relax or breathe
with the relaxation response so they tense their muscles and then relax their muscles and as
they relax their muscles they say their “quack”-word like relaxed and they work from head to toe or
from toe to head tensing and relaxing different muscle groups so they become more aware of what a
tense muscle feels like versus a reactive relaxed muscle there are great scripts that are online
that people have already recorded that can walk people walk clients through CPM are I highly
encourage it because once they get used to it then they can just think that cue they can think
relax and as they exhale they will start to feel their entire body kind of relaxing because it’s
trained when it hears that just like when you hear the word pop quiz when you were in high school
you had a stress reaction well we want to use it in reverse and train the body so that when
it hears a cue word relaxes helps them develop self-esteem because fear of failure and rejection
a lot of times come from needing other people’s approval to help them develop a rational idea of
their real self develops compassion self-talk instead of saying I’m an idiot or I’m stupid or
I’ll never measure up to anything encourage them to talk to themself like they would talk to their
child or hopefully their best friend and encourage them to spotlight strengths whenever they feel
like they’ve got an imperfection to identify these three strengths that they have so they’re you know
balancing out the imperfections and the strengths of cognitive restructuring reframes challenges in
terms of current strengths, not past weaknesses so if you’re going to give a presentation in front
of 60 people and you hate public speaking instead of thinking about you know this is terrifying
because the last time I went up in front of people I forgot everything I was going to say and drop
my note cards well that’s a past weakness what is your current strength you’re prepared to know
the material you ‘yoyo’ so encourage people to look at all the strengths and resources they
currently, have them develop an attitude of gratitude and optimism because as I said with
that the positive writing exercise when people are in a grateful optimistic frame of mind they
tend to see more of the good stuff they see the bad stuff too but they can also see more of the
good stuff and some of the bad stuff they see opportunistically instead of as a devastation
acceptance and commitment therapy says that some of the reasons that we’re miserable are
fear we get fused with our thoughts we think I am terrified well if I am terrified then I can’t
I mean if I am I can’t get rid of anything I am if I’m having the thought that I’m terrified
well I can get rid of a thought I can forget things easily encourage people to evaluate their
experience and empower them to look at things as challenges and opportunities instead of hardships
encourage them not to avoid their experiences so things that are scary gradual exposure and
finding exceptions like for me bridges you know I love public speaking so that’s not a
thing but when I go to a bridge you know when I Drive to the bridge you know when I’m on the
bridge somebody else is driving I get used to doing that when I Drive over a bridge than when
I Drive over one of those bridges that open up I hate those bridges um I know y’all are just like
oh my gosh yeah it’s an irrational fear I realize that but instead of going straight for the bridge
that opens up going for the little bridges first and then thinking back over times that I’ve gone
over bridges and there’s been no problem you know there are exceptions nothing happened it wasn’t a
big deal sometimes I didn’t even notice it until somebody pointed out hey look down there at that
pretty water and I’m like oh we’re on a bridge so encourage people to not avoid their experiences
get used to them embrace them and learn that they have the power to deal with them and stop reason
giving for the behavior you know use the challenging questions if something is fearsome let’s look for
at the evidence for and against it instead of you know making excuses for social interventions
improve their relationship with their self which goes with self-esteem improvement people are going
to feel less anxious about getting their needs and wants to be met if they know what their needs and wants
are so part of that is becoming mindful cuz a lot of our clients don’t know what they need and want
they just want to feel better but they don’t know how they don’t know what they need to feel
better so helping them identify their needs and wants and encouraging them to be their own best friend
you know when they get a promotion take themselves out to dinner pat themselves on the back whatever
it is don’t rely on other people to do it because other people it’s not that they don’t care but
other people are often very involved in thinking about their stuff and they may not notice
encourage them to develop a method of internal validation so they can feel like they are all
that ‘no bag of chips and they realize why they are lovable human beings and they accept the
the fact that everybody is not going to like them and nobody is gonna like them all the time and
that’s okay you know my kids don’t like me all the time my husband doesn’t like me all the time
I’m okay with that I know I can be challenging but you know most of the time you know they like me
and that’s okay and there are some people you know who don’t like me at all and okay there’s
nothing I can do about that helping our clients develop an okayness with that helps relieve a lot
of anxiety because a lot of people feel like they have to be liked by everybody and if somebody
doesn’t like them it’s like what did I do wrong oh my gosh encourage them to develop healthily
supportive relationships with good boundaries develop assertiveness skills so they can ask for
help when they need it anxiety a lot of times you know that’s the body saying there’s a threat well
if there’s a threat maybe you need some help you know dealing with it so people need to be willing
and able to ask for help and not feel like that’s going to lead them to be rejected and allow them a
certify this will allow them to say no to requests again without feeling like that’s going to result
in them being fully rejected describe the ideal healthy supportive relationship and encourage
them to separate the ideals from the reals you know let’s look at if you had the best relationship
what would it look like okay you know warden June Cleaver we got that now how realistic is that
you know let’s look at you know rephrasing this a little bit so it’s less extreme you know warden
June Cleaver never fought their kids were perfect you know all those extreme words let’s look at
what’s real what happens in real relationships encourages people to identify who would be
a good partner in supportive relationships I’m not meaning necessarily romantic I’m meaning
friends and where they can be found you know where would you find people that you could be friends
with and encourage them to play through what it means when gaming cuz a lot of times again this
goes with my reading you know what it means when your friend doesn’t return your text right
away what does it mean when your friend cancels dinner on Friday night what does it mean when
you see where I’m going with this and a lot of times clients with anxiety and rejection issues
and low self-esteem will go to the worst-case scenario so encourage them to go back to finding
the exceptions what else could have been happening what else could it be that caused this and it’s
not about you so anxiety is a natural emotion that serves a survival function excessive anxiety can
develop from lack of sleep nutritional problems neurochemical imbalances failure to develop
adequate coping skills cognitive distortions low self-esteem and a variety of another stuff recovery
Ambala involves improving health behaviors making sure your body’s functioning and making the
neurotransmitters it needs and you know release them as needed to identify and build on current
coping strategies address cognitive distortions and develop a healthy supportive relationship with
self and others if you enjoy this podcast please like and subscribe either in your podcast player
or on YouTube, you can attend and participate in our live webinars with dr.Snipes by subscribing
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Welcome to happiness isn’t brain surgery
with Dr. Snipes. This podcast was created to provide you
the information and tools Doc Snipes gives her clients so that you too can
start living happier. Our website DocSnipes.com has even more resources
videos and handouts and even interactive sessions with Doc Snipes to help you
apply what you learn. Go to DocSnipes.com to learn more. Hey everybody and
Welcome to happiness isn’t brain surgery with Doc Snipes: Practical tools to
improve your mood and quality of life. Tonight we’re talking about 10 ways to
deal with social anxiety a lot of people have social anxiety and that’s basically
having unreasonable fears that you know are kind of excessive when it comes to
being in any kind of social situation some people have only social anxiety
when they’ve got to do things like perform or public speaking or something
like that other people have social anxiety when they have to go to work
when they have to be in crowds they don’t like going to the shopping center
or the mall where there are a lot of people around so depending on your level
of social anxiety, some of these things may be helpful to help you work through
and deal with your social anxiety the first is to minimize stimulants
stimulants Reb you up anxiety Rebs you up when you take stimulants if
you drink too much coffee you may feel anxious so if you’re drinking stimulants
before you go into an anxiety-provoking situation you may miss attributing your
anxiety about the social situation when in actuality it was the caffeine or the
nicotine the other thing that you want to do is pay attention when you’re at
some of these events that you’re minimizing your stimulants the other
thing and I’ll you know this is not stimulant alcohol is technically a
depressant but when alcohol starts to wear off about it 30 minutes after you
drink your drink it starts to wear off and there’s an anxiety rebound with
alcohol so if you have high anxiety if you have social anxiety drinking to
quell that anxiety is probably not your best
bet because in the end it’s gonna kind of backfire and bite you in the ass know
your temperament not everybody likes being around big groups of people
I draw energy from being around people so I love being around
groups but my daughter on the other hand is much more of an introvert and she
would prefer to be around you know two or three people at a time she gets
exhausted when she has to be in big groups of people it doesn’t mean
she’s got social anxiety so know what your preference is for being around
people so when you’re developing your self-confidence when you’re developing
your skills when you’re working through social anxiety you’re not putting
yourself in situations that would stress you out anyway so know your temperament
if you’re an introvert when you’re making your exposure hierarchy which
we’re going to talk about it in a minute you’re gonna start with something like
going out for coffee with a friend to Starbucks or maybe even having a friend
over for coffee in your house depending on how bad your social anxiety is and
then you’re gonna work up from there but if you are an introvert you’re never
gonna be relaxed in a group of a large group of people so I just
understanding the difference between being anxious and feeling like
you’re gonna crawl out of your skin and be uncomfortable or have it be very
draining to be in a large group of people who understand your temperament
that’s part of it so you can say you know this is normal I am not the type of
a person who likes to be in a large group of people so it’s going to take some
preparation and it’s going to take a lot of energy but I can do it knowing your
triggers different things trigger anxiety for different people some people
have anxiety when they feel like they’re going to be evaluated so if they’re
doing a presentation for their colleagues or their peers they’re more
likely to be more anxious than if they’re say hanging out with five other parents at a
kid’s play date or something some people have one of their triggers is
authority figures I know whenever I had to present in front of the CEO or in
front of my department chair or whoever gave me more anxiety than
presenting even in front of a class of a hundred and fifty students so it’s kind
of all about what your particular triggers are if the other trigger you
might want to consider the situation you know if you feel like you are on
stage if you feel like you are the center and everybody’s looking at you
that’s probably going to be a lot more anxiety-provoking than if you are mixing
and mingling with other people at a party so know what triggers your anxiety
so thinking about how your social anxiety impacts your life what kinds of
things can you not do or what kinds of things do you find are just terrifying
to keep a list of all of those things starting with the things that only make
you a little bit nervous about things that you would rather you know pull your
eyebrows out then do and start at the beginning start with the things that
only cause you a little bit of anxiety imagine them rehearsing and doing them
in your mind see yourself going through them successfully for example a job
interview or a first date imagine what it’s going to be like what the other
a person is going to say how you’re going to respond and how it’s all going to go
well just keep imagining that until you can imagine it or think about it and you
don’t feel stressed than when you go in to do it it’s going to be a lot easier
once you get past that first thing move on to the next thing that causes a
little bit more anxiety all right start at the beginning again imagine doing it
see yourself going all the way through maybe it’s doing a public speech see
yourself getting dressed for it getting ready for walking out on stage and
delivering the speech and seeing it go well you’re not going to see yourself
tripping and falling you’re not going to see yourself stuttering and stammering
or dropping all your note cards or anything those are the things the cat
strophic thoughts that you have that are likely not going to happen I want you to
imagine it going perfectly rehearse it in your mind until you can do it
literally with your eyes closed then when you go out to do it, it’s going to
be that much easier because you’ve already done it 20 times in your own
head and been successful at it so just do it like you practiced keep a rational
outlook a lot of times social anxiety is caused by catastrophic self-statements
things that you tell yourself people are judging me they’re laughing at me
people are gonna think I’m an idiot um whatever your thoughts are so keep a
list what those thoughts are and write counter thoughts to the people
are judging me well they may be but do you care so if people are judging me
that’s on them if people are laughing at me well at least they’re laughing but in
reality what other reasons could the people have had to be laughing what are
three other explanations for why they might be laughing besides laughing at
you so look at your catastrophic self
statements like I told you before imagining that you’re going to go
out on stage and you’re gonna walk out there you’re gonna trip over your own
two feet and you’re gonna wipe out on the way to do this presentation and
humiliate yourself well that’s pretty darn catastrophic so think about exactly
what is going to happen what are you going to do and how rational how
realistic how likely is it that all these things are gonna happen and you
know if that is one of your fears watch the movie Miss Congeniality because she
is going at as Miss America I think is who she’s trying to portray and she
falls flat on her face and she just picks herself right back up and walks on
and nobody thinks anything of it after that it’s not like a week later or 20
minutes later in the movie, people are still talking about her falling she
did she over it and you know move past it when
you make a big deal out of it when people start to think about it a little
bit more practice breathing when we get stressed we tend to breathe more
shallowly and more rapidly when you breathe slowly and deeply you’re
triggering the relaxation response in your body it doesn’t mean you have to
take those big giant deep breaths as you do at the doctor’s office or
anything that’s overly dramas is it but focus on your breathing if you start
feeling yourself getting an anxious breath in for a count of three hold for a count
of three and breathe out for a count of three and you know again it doesn’t have
to be noticeable that you’re doing it you can do it in a meeting and nobody
will even know but if you can slow your breathing you’ll slow your heart rate
and you’ll trigger the relaxation response to help you deal with your
anxiety sometimes we’ve just got to suck it up and go through things that create
a lot of anxiety for us I remember one place I worked once a month we would
have to get up in front of all of our colleagues and all of the executives and
give a report on how our department was doing I hated doing that I hated being
up there giving this report not because of the content of the report I just
hated being up there in front of everybody and it was no big deal
but it would cause me a little bit of anxiety if I had to do it
so distress tolerance techniques were always useful because it was an
eight-hour meeting so it might be four hours of me sitting there anticipating
going up and having to give my speech so what would I do during the four hours
while I was waiting I would do activities I would listen to what other
people were saying I would make notes I would sometimes go through clinical
charts and sign off on documentation and not pay attention but you know I digress
contributing so if you’re at a party you can’t do it in a meeting but if
you’re at a party for example and used feeling anxious get up maybe help the
hostess out or the host out in the kitchen go around pick up glasses pick
up trash throw things away do something to be helpful to contribute so you’re
not feeling like you’re having to sit there and be on the spot comparisons can
help too you can just kind of blend back into the wall a little bit and compare
how you’re doing to how other people are doing or how you’re doing to how you’ve
done in the past because you’re probably doing better now than you did then
trigger opposite emotions is another way of dealing with distress if you’re
feeling anxious you know bring out the opposite tell a joke find something
funny find a video or something that makes you laugh and share it with other
people because that’ll make you start laughing and feel more relaxed and
release endorphins you can also just push away some of those thoughts that
keep coming into your head I’m gonna make a mistake I’m gonna say something
stupid they’re judging me it’s gonna be awful just push those thoughts away and
Do you know what no I can do this and I’m going to push through the final
the thing you can do in this particular set of distress tolerance techniques is
sensations focus on sensations some people have a rubber band that they snap
on their wrists to kind of help them focus on something else
some people wring their hands I don’t recommend that because you know that
just kind of shows you’re anxious and keeps your anxiety going listening to
loud music you can go into the bathroom and splash cold water on your face
unless it’ll make your mascara run there are a variety of things you can do that you
can also find go and find some coffee because coffee is hot and that focus on
how the coffee feels in your hands when you’re holding the cup focus on the
taste of the coffee that hot sensation will kind of distract you from other
things that are going on so focus and we’re going to talk about one thing at a
time in a minute another set of distress tolerance techniques that can help our
imagery and we’ve talked about rehearsing it before you go to the party
imagine what you’re going to do before you go to the mixer or your in-laws
or wherever it is you’re going that’s potentially going to cause you anxiety
imagine going through it and doing it successfully to find meaning in what you’re
doing so sometimes you know maybe you’re going to your spouse’s holiday Christmas
party and it’s like the last thing you want to do because you don’t like big
crowds like that you don’t know anybody but find meaning in it why are you doing
this is because it’s helpful to your spouse you’re providing support and you know
maybe you can find somebody that has similar hobbies or something before you
go if you’re going to your spouse’s Christmas party for example try to find
out who might be at the party that shares similar hobbies and stuff I know
my husband works with people who do organic gardening and who are kind of
health-conscious I won’t say fanatical but health-conscious like I am and we
like to use a lot of lentils and beans and cook in health healthy ways so
identifying those people I can’t talk about what they do at work because
that’s just way out of my wheelhouse and over my head but I can talk with them
about these other things so I’m not just standing there looking around and feeling
like I’m out of place so find meaning in what you’re doing and try to find
connections and commonalities with other people before you go and then you know I
can have I would have my spouse introduce me to one of the people that
does organic gardening for example and then we could start talking once you get
more comfortable then you’re going to feel more at ease walking up to people
and going hey you know and striking up a conversation and finding out
commonalities if you’ve got children a lot of other people have children so
you can talk about your kids or if you’ve got pets you can talk about your
pets your dog’s people love their dog’s prayer can help sometimes you
just got to take a breath and say a prayer before you walk into that
situation to kind of get you through and get you going
practice relaxation if you’re feeling stressed just again don’t
have to get out of your chair you don’t have to go anywhere but practice tensing
and releasing your muscles clenching your fists and releasing your hands and feel
the difference between tense and released and then tense kind of your
whole upper body and you don’t have to do it like this because that’s obvious
but you can kind of tense up a little bit and relax and feel the difference
between stressed and relaxed and then when you do it one more time you tense
and when you relaxed you feel all the stress just draining out of your body
out of your fingertips so that’s a kind of guided relaxation to help you when
you’re kind of on the spot one thing at a time when you’re in a
the social situation there is a lot of input there is a lot of stimulus going around
a lot of people focus on one thing at a time if you start getting overwhelmed if
you’re at a party maybe you can go over and get something to eat and focus on
talking to one person at a time or focusing on what you’re eating or you know find
something that you can focus on so you’re not trying to keep up with
everything that’s going on takes a mental vacation or a physical vacation
sometimes you just got to excuse yourself and go to the bathroom and hide
out for five minutes and that’s okay you know sometimes you need to go somewhere
where you know nobody’s watching and you can take those good deep breaths and go
you know I got this it’s gonna be okay I’m doing fine give yourself a pep talk
look realistically over how the night’s gone and the majority of it has gone
okay yeah they’re probably going to be some hiccups and Pho paws here and there
and if there are that’s okay it happens to everybody nobody is perfect at their
social interactions all the time and that’s okay
but look over it realistically to realize that tonight is going
okay it may not be going the way you had hoped it would but it’s going okay
there’s nothing catastrophic ly wrong and remember that we are a lot more
important in our minds than we are in anybody else’s mind so when we make a
the mistake we will remember it for six months but other people probably forget
it’s about sixty minutes later it’s just you know even if it’s something like you
walked out of the bathroom and you had your dress tucked in the back your
panties did that before trusting me not something I want to repeat
but I would bet if I asked any of my staff now yes I did it at work about
that incident they’d look at me and go no I don’t remember that I remember it
because it was mortifying but nobody else cared they were passed it by
the next day nobody thought anything about it so remember that a lot
of stuff that seems huge and glaring to you is only because it happened to you
and other people are so involved in their own life they probably didn’t
notice or won’t remember that fear is an acronym standing for false
evidence appearing real so always examine the evidence if
something happens and you think it is the absolute worst thing in the world
and you’re just gonna die how likely is it that that’s true is it the worst
the thing in the world is people judging you so look at the evidence how do you
know this is going on for certain and what are other explanations for what
might be going on mentally rehearsing those stressful social situations get
ready for it the job interview the first date and for some people even going to
the doctor can be a stressful social situation because they get kind of a
white coat syndrome where they don’t they’re afraid to speak up to their
doctor, I found that if there is a certain set of things that you need to
say like if you’re going in to talk to your boss or you’re going in to talk to
your doctor sometimes it’s helpful to write down a list of the points that you
want to cover with them or the symptoms that you’re having
so you can go over it and make sure you get everything said and you don’t end up
kind of getting shut down when I used to go have supervision with my boss you
know I only got supervision for one hour once a week and that was if I was lucky
so I would go in with a whole laundry list of things and it could be the stuff
that I was upset about or having difficulty with and I could have a
laundry list and just go through it and mark it off so I would make sure that I
got everything said and I covered and we were on the same page by the end of the
the meeting finally practice mindfulness and focus on your surroundings to know how you
feel if you start feeling anxious a step back and ask yourself why am I anxious
what do I need right now to feel calmer try to do this periodically
so you don’t wait until your anxiety is off-the-charts focus on your
surroundings look around to find places and little niches that you might feel
comfortable maybe there’s somebody else sitting over in the corner and you can
go sit down with them and chat maybe there’s an empty seat somewhere that you
can just go sit down and take a breath or go out on if it’s a patio or a party
maybe you can go out on the patio for a few minutes oftentimes there’s somebody
sitting out on the patio trying to get a little peace so you
can find a situation that’s less anxiety-provoking two little bonus things I’m
going to tell you with social anxiety a lot of times people are afraid that
they’re going to offend someone and these days it is so easy to offend
people so what I tell my clients and my kids and what I try to remember myself
is before I speak or when I’m talking to people if what I’m saying is true
helpful important necessary and kind then you know
there’s probably a good chance I won’t offend them look on your social media
look at the comments people leave on other people’s posts and stuff and see
if they meet these criteria true helpful important necessary and kind 90% of the
time the answer is no well I won’t say that much about 50% of the time the
the answer is no there are a lot of times people will just say nasty stuff that
didn’t need to be said and that can be offensive but if you practice and
focus on making sure what you say is true helpful important necessary and
kind and if you’re following me that spells out think then the chances that you’re going to
offend somebody are greatly reduced if the person still gets offended it’s
probably more about them because you aren’t trying to offend them you weren’t
trying to be hurtful you are trying to be helpful and kind therefore it may be
more about their stuff whether they have an issue with you or they have an issue
with something else that’s going on and you just happen to be kind of in the way
it’s more about them you can’t control how they react to things it’s their
responsibility if you’re being nice and they take it the wrong way and they get
offended that’s their perception and they need to work on that the other
bonus that I’ll tell you to take away is something I got from dr.Seuss and I
love something he says about the judgment of those whose minds don’t matter and those
who matter don’t mind so the people who matter in your life they’re going to be
people judge you all the time that’s just the way humans are but those who
mind what you do those who get offended those who judge you all the time they
don’t matter the people who matter to you don’t mind if you make a mistake
don’t mind if you’re not perfect they probably embrace all of your
imperfections so before you approach a social situation remember not
everybody’s gonna like you that’s just it’s not possible to have everybody like
you so remember the wise words of dr. Seuss those whose minds don’t matter and
those who matter don’t mind if you like this podcast subscribe to your favorite
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can become a supporter at Doc’s nights comm slash join again thank you for
joining us and let us know how we can help youAs found on YouTubeHi, My name is James Gordon 👻🗯 I’m going to share with you the system I used to permanently cure the depression that I struggled with for over 20 years. My approach is going to teach you how to get to the root of your struggle with depression, with NO drugs and NO expensive and endless therapy sessions. If you’re ready to get on the path to finally overcome your depression, I invite you to keep reading…
this episode was pre-recorded
as part of a live continuing education webinar on-demand, CEUs are
still available for this presentation through all CEUs register at all
CEUs comm slash counselor toolbox I’d like to welcome everybody to today’s
presentation on a strengths-based biopsychosocial approach to recovery from bipolar disorder
so we’re going to talk a little bit about what bipolar is what causes it and how to
mitigate it by helping people understand their own bipolar because what triggers it for John
may not trigger it for James help them identify their warning signs because bipolar episodes
just like depressive episodes and manic episodes often don’t come from completely out of the
blue if we look backward we can see where the person was beginning to resume some unhealthy
lifestyle habits that were making them more vulnerable well look at the symptoms
of depression and mania and real quickly review bipolar one versus two and look at some
co-occurring disorders and interventions another thing I added to this presentation was a little
a short piece on differential diagnosis because I often see people who are diagnosed either only
with bipolar when there’s also attention deficit disorder present or they’re diagnosed with anxiety
when it’s bipolar disorder so we’re going to talk about how people might mistakenly diagnose
one for the other and how to kind of try to ferret that out a little bit one way is using the online
assessment measures there’s another measure we’re going to talk about in here too so we care
because uncontrolled bipolar puts people at risk for suicide addiction and addiction relapse you
know even if somebody doesn’t have an addiction when they are in a manic episode they can be more
likely to engage in potentially self-injurious behaviors, not for self-injury but
just because they’re looking for even more of a rush and when they’re in a depressive episode
they can also be at risk for addictions because they’re looking to feel better in some sort
of the way so a lot of it we’re talking about well with we’re talking about self-medication with
mania we’re just talking about what they perceive as something exciting and people are often in manic
episodes engage in extreme risk-taking behavior we don’t want our clients to go down any of these
paths so we want to be aware of what might trigger it and I don’t think I talk about it anywhere
else in the presentation, it’s important to be aware that for suicide when somebody is coming
out of a depressive episode who somebody who’s bipolar well or unipolar depression but when
they’re coming out of the depressive episode and they start having more energy is actually
when they’re at greater risk of suicide than when they’re at their absolute bottom not saying
they’re safe at their absolute bottom but we don’t want to get complacent when somebody starts
feeling better and assume that they’re out of the woods with poorly controlled bipolar disorder
can leave people feeling hopeless and helpless if they have bipolar one and they have at least
a full-blown manic episode but maybe more they may not mind that they may because it disrupts
their life the depressive episodes tend to be when patients usually present when they’ve got
bipolar disorder so we want to look at what’s going on with them and help them see how the
bipolar disorder disrupts their life because that can go a fair way to encouraging medication
and treatment compliance well controlled bipolar like well-controlled addiction helps a person feel
happy optimistic motivated and energized the key is helping them manage their vulnerabilities you
now take care of their body so they have enough energy to do things but also make sure
that they get their medications right some of the mood stabilizers can be flattened and make
people feel more exhausted and it’s important it’s vital that they openly communicate with their
psychiatrist or physician about the medications if they are if the side effects are so significant
is impairing their quality of life which means they’re likely to be medication non-compliance so
we want to make sure that if they’re feeling too flat that they talk it over with their medication
provider bipolar disorder is a brain disorder you know sometimes with like depression we can look
for situational causes for anxiety we can look for some situational causes we can look for some
cognitive stuff we know in bipolar disorder something is going on in the brain that causes
unusual shifts in mood energy activity levels and the ability to carry out day-to-day tasks many
very successful let me go back to that so just to be clear and generalized anxiety panic disorder
depression they also can have a brain organic component to them but not always sometimes you
can have those from a situational cause whereas in bipolar disorder we know that there’s something
that’s not quite right with the balance of the neurotransmitters for most people with bipolar
okay so who has bipolar lots of people you’d be surprised Mel Gibson demi Lovato Axl Rose, Britney
Spears Jean-Claude Van Damme Marc Vonnegut and Amy Winehouse to name just a few that I came
across you know doing some internet research Lee Lee Thompson young and Robin Williams were
also, both are quite successful and revered in their fields despite if you want to call it losing
their battle with bipolar so why do I bring that up because a lot of times people when they
are given a diagnosis of bipolar disorder feel very isolated feel very unique and I want them to
realize that there are a lot of really successful awesome people who have bipolar disorder you
know it once it’s managed then people can live a stereotypical life I work hard to
avoid the word normal because what’s normal for one person may not be for another but we want
to look at they can have a very high-quality active life bipolar disorder is caused by imbalances and
neurochemicals especially dopamine serotonin and norepinephrine the imbalances could be genetic or
triggered by sex hormone changes or stress hormone changes so they may be at you know steady state
but when there’s a particular stressor some sort of change or you know other thing and it depends
on the person, it can throw those neurotransmitters out of balance enough that it causes either a
manic episode hypomanic episode or a depressive episode more than one in 50 adults are classified
as having bipolar disorder in any 12 months so I encourage people when they’re walking around
the store when they’re walking around the grocery store when they’re at church when they are sitting
in a meeting at work with you know 50 other people at least one person in that group has bipolar
disorder and or will be diagnosed with it in the year I want them to recognize how common
it is I want them to start looking around and thinking when they’re driving down the road on
rush-hour traffic you know every 50th car they pass somebody in those 50 cars probably had
bipolar disorder to help them realize again it’s not us weird diagnosis is pretty
doggone common among patients seen in primary care settings for depressive and/or anxiety
symptoms twenty to thirty percent are estimated to have bipolar disorder a lot of times primary
care physicians misdiagnosed bipolar disorder as either generalized anxiety or unipolar depression
so it’s you know eighty percent of the time seventy eighty percent of the time they’re right
but the other twenty to thirty percent you’ve got this person who is going to continue to struggle
and get frustrated because the treatments for generalized anxiety and depression are
generally, SSRIs and SSRIs can trigger mania so it can make the mood lability worse bipolar
the disorder is still under-recognized primarily due to misdiagnosis as unipolar depression and
that’s not just in primary care that’s also in you know our field because if we see somebody who
has unipolar depression you know they may not have had a manic episode yet likely they have but they
may not have had a manic episode yet or they may not report it or if it’s a hypomanic episode they
may not note that as something problematic and yes diagnosis of mental health conditions
is out of the scope for a lot of GPS and a lot of them will tell you that a lot of them will say
If you’ve been diagnosed before I can help you continue your medication but there are so many
nuances to psychological diagnosis I want you to get an evaluation from a psychiatrist in
order to better make sure that we’re getting you started on the right path because nothing is
more frustrating to somebody who is struggling and again generally they present in a depressive
episode nobody is nothing is more troubling for somebody who’s presenting and struggling then
getting on medication and not feeling like it’s working is one of the things they see and I’m jumping
ahead of me is when somebody who has bipolar disorder is started on an SSRI one effect could be
to set off a manic episode another effect could be to have rapid improvement and you know it
takes four to six weeks for the SSRIs to get in there but they tend to have rapid
improvement in days unfortunately that improvement doesn’t last and then they tend to go back into
a depressive episode and they start to feel even more defeated I want clients to understand us
if they start talking about that pattern where they’ve been on antidepressants and it works
for a little while but then it doesn’t anymore you know that may just be the wrong medication
for them, their case is not hopeless so we know the symptoms of depression apathy feeling down
empty hopeless low energy decreased activity sleep changes worrying difficulty concentrating
forgetting things a lot of changes in eating habits and feeling tired or slowed down how is this
different than Low Energy I’ve had clients ask me this before and what I try to the way I try to
differentiate is energy is your desire to get up and do things and feel like you can when people
are feeling tired or slowed down it almost feels like they’ve got a 50-pound rucksack on their back
or their arms and legs feel like they’re just lead and it is exhausting to even get up and walk
across the room go to the kitchen go outside so there’s a difference there’s energy to do things
and then there’s just feeling like you’re filled with cement mania people feel very up high or
elated now after people come out of a depressive episode even unipolar depression there’s a period
of mild very very mild euphoria and we don’t want to mistake that for hypomania or mania they’re
just feeling good they’re like oh my gosh I see the Sun again I see colors how awesome is this and
then you know it kind of levels out but you don’t have a crash it’s just kind of a good and
then a-ok contentment people in a manic episode have a lot of energy and increased activity levels
they often feel jumpy or wired you know like they can’t settle down they want to sometimes but they
can’t they’re wide awake and they’re just looking for something to do they have trouble sleeping
may talk fast about a lot of different things so they’re jumping around and when we talk
about ADHD in a minute, we’re going to talk more about these symptoms they may agitate irritably
or touchy not everybody who’s manic is in a good mood so they can be manic but agitated
they feel like their thoughts are going fast and think they can do a lot of things at
once people especially in a hypomanic episode often find themselves taking on three four five
six projects and not being able to complete them you know when they come out of their hypomanic
In the episode, they’re like oh my gosh what did I get myself into but there’s no sense of time in a
manic or hypomanic episode and they can especially in a manic episode engage in risky and reckless
behavior so mixed bipolar includes symptoms of both manic and depressive symptoms at the same
time which can be confusing to clients they’re up they feel like they’re wired but they
have no their flat they have apathy and just that lack of pleasure and anything they may feel
very sad empty and hopeless and energized bipolar one now that big difference is bipolar one has at
At least one full-blown manic episode if there hasn’t been one full-blown manic episode then we’re going
to look for bipolar 2 where you have hypomania and major depressive disorder bipolar one can have
either major depressive disorder or persistent depressive disorder so the big difference is if
there’s a manic episode there they’re number one bipolar one patients experienced depressive
symptoms more than three times as frequently as manic or hypomanic symptoms so yeah when they
hit a manic or hypomanic period it’s not a wonder they feel pretty good and they don’t want it to
go away if they experienced it three times more often bipolar 2 patients experience depressive
symptoms approximately hold your horses 39 that’s not a mistake 39 times more often than
hypomanic symptoms so people with bipolar 2 can have 39 depressives before a manic episode now
unfortunately, the body is not that consistent where we can go okay 38 39 you’re due for a manic
episode but we do know that both types of bipolar depression are experienced a lot more frequently
than mania or hypomania so a common misdiagnosis is generalized anxiety disorder how do you
differentiate because some people when they get anxious get revved up and they feel
like they’re wired and they can’t sleep the goal-directed activity and generalized anxiety
the disorder is often related to an anxiety theme like if they think that there’s a problem with
their finances or if they’re you know whatever they’re worried about their activities and their
thoughts generally race in that direction they’re not all over the place they’re pretty directed in
more or less and their mood is often irritable and energetic versus elated now again just because
somebody is irritable doesn’t mean it’s the anxiety we want to look specifically at what is causing
the sleep disruption and what are the themes of the thoughts that the person is having the racing
thoughts because if you know something’s going bad at work you hear there’s going to be layoffs
somebody can get anxious and go well if I get laid off then I’m going to lose my job if
If I lose my job then I’m not going to be able to pay the house payment and I’m dead a debt a debt
it and go in this rapid cycle of catastrophe and get themselves all worked up and then not sleep
then they start trying to figure out okay what I need to do to make sure I can pay
the house payment what do I need to do to make sure I can do this so anxiety disorder pretty
focused ADHD approximately 60 to 70 percent of people with bipolar disorder also have ADHD and
20% of people with ADHD have bipolar disorder so you can draw your own Venn diagram if you
want the take-home message is we don’t want to assume that they’re mutually exclusive because if
you’ve got somebody with bipolar disorder you can get that controlled but they’ve still got the ADHD
symptoms going on over here they’re going to feel often feel frustrated now what’s the difference
people with ADHD often have a hyper focus that’s one of the hallmarks this may happen on a deadline
pressure or when wrapped up in a compelling book project or video game and so you can you can
see where there’s a trigger for it hyper focus may cause a decreased need for sleep and look like
increased goal-directed activity but is often short-lived in people with ADHD who
feel exhausted when the hyper-focus fades so we want to look for number one was there something
that triggered this hyper-focus could be a video game could be an awesome book or even
a Netflix marathon whatever it is and once that hyper-focus faded did they feel exhausted
if so we’re probably looking more towards ADHD than bipolar a manic episode is independent of
external circumstances you know it’s not where somebody gets a project and it sends them into
In a manic episode, there’s a lot less control and predictability in people with bipolar disorder
and people with bipolar often want to go to sleep or relax but describe the feeling as if they can’t
wind down which can go on for a week or more so we’re looking at duration we’re looking at what
triggers it if they report let’s go back to here sometimes having manic episodes that there was
no trigger and they lasted a long time but they also report manic goal-directed activity under
deadline pressure or you know they can have all these symptoms which means you’re looking at ADHD
and mania or bipolar disorder together potentially in ADHD people often interrupt or talk too much
without noticing because they miss social cues or because they lose focus on the threads of
a conversation because their minds going six ways till Sunday I had a friend of mine one time
who had ADHD she was in graduate school with me and she gave a presentation on it one time and we
were talking and she was presenting and as she was presenting somebody started flicking the lights on
and off and all of us were looking around at each other going this is annoying and then a little
while later you know 30 seconds or a minute later somebody turned on the radio not loud but
low in the background and we’re all looking at each other and then she started doing something
else after that oh she turned on a fan so the fan was oscillating and blowing in our faces and and
finally, she’s like is this annoying and we were like yeah that’s annoying it’s hard
to concentrate and she said this is what life is like for somebody with ADHD many times because
we have difficulty filtering out what’s important to pay attention to and what’s not so we’re paying
attention to everything so that made it a lot more understandable to me which was helpful later when
my son was diagnosed with ADHD because you know it helped me tailor his learning environment
so people with ADHD kind of get lost and they’re paying attention so much that they
can miss the social cues people experiencing manic bipolar episodes are often very aware that they’re
changing topics quickly and sometimes randomly but they feel powerless to stop or understand they’re
quickly moving thoughts so they’re just trying to keep you in the loop in everything and they
may notice that you’re getting uncomfortable or irritated or impatient but they don’t feel like
they can stop racing thoughts you know all these kind of go together but kind of not people with
ADHD report racing thoughts that they can grasp and appreciate but can’t necessarily express
or record quickly enough think about the time you got excited about something and you just
had all these ideas whenever we get a new grant that comes in I’m in charge of or I used to be in
charge of writing the grant so I get the grant and I’d read through and I start identifying all the
different things that we could do to you know get this grant and it would be hard for me to
keep my pencil going fast enough to keep up with my ideas and you know I don’t have an and you
know that was perfectly normal but I was excited and so my mind was racing people with ADHD can do
this a lot you know not just because of a grant coming in people with mania the racing thoughts
flash by like a flock of birds overtaking them so fast that their color and type are impossible to
discern I loved this explanation because it’s just like you have this whole massive bird coming
in and then going out and you didn’t have a chance to even notice what they were people with with
mania often feels that way they don’t can’t grab any of those thoughts and hook on to them they’re
just in and out so helping people differentiate to make sure that if they’ve got anxiety and bipolar
if they’ve got anxiety and ADHD and bipolar bless their hearts that were attending to all of their
presenting symptoms and issues so what do they do to treat bipolar well we’re going to get down into
that in a minute sorry got ahead of myself things that can trigger a bipolar episode medications
antidepressants as I said can propel a patient into mania captopril which is an ACE inhibitor
something that’s used for high blood pressure can also trigger a bipolar episode corticosteroids
certain immunosuppressant medications levodopa which increases dopamine you may see patients
with schizophrenia or Parkinson’s taking web dopa and methylphenidate or dexmethylphenidate
which are ADHD medications all of these different categories of medications can potentially trigger
a bipolar so do they trigger it in every single person no so that makes it even more difficult
but it is important to be aware if somebody has bipolar when they start taking medications
that they need to be conscious and cognizant of their symptoms so they can you know identify
early onset of a depressive or a manic episode circadian rhythm desynchronization can trigger
or look like bipolar disorder hyperthyroidism can look like a manic episode that means too much
thyroid you know a lot of times we talk about hypothyroidism and depression hyperthyroidism
gets people to revved in children mania can be misdiagnosed or look like oppositional defiant
disorder and substance use both intoxication and withdrawal but more specifically intoxication can
also, look like mania or depression depending on whether they’re taking stimulants or depressants
so it’s important to make sure that the person when they’re being assessed is substance-free
Do you know what medications they’re on they’ve had a physical to rule out any hormone causes
the thyroid is a hormone and looks at their circadian rhythms if they happen to be visually impaired
that can cause problems in circadian rhythm if they are shift workers that can cause problems
with circadian rhythm so let’s make sure we don’t label something as bipolar and start treating
as such before we’ve ruled out everything else bipolar distinguishing factors and let’s see
let me see if I can get that open for me right now well anyway spontaneous hypomania premorbid
affective temperament particularly hyper thymic or cyclothymic so before somebody had an episode
that they presented with do they have a history of remembering dysthymic is feeling blue
low unhappy hyper thymic is more elated and cyclothymic is rapidly switching Moodle ability
increased mental or physical energy even during depressions family you know you know
we talked about the mixed episode if there’s a family history of bipolar disorder or a good
response to lithium for unipolar depression or bipolar that’s a risk factor or a hallmark
that you might be dealing with bipolar in this client if they have treatment-emergent hypomania
mania or mixed States so as soon as they start medication treatment generally SSRIs they have
an uncharacteristically rapid response followed by a crash again and or they have more than two
failures on antidepressants now we want to look at what that means because antidepressants work
differently for different people, somebody can be on and I’m going to use the trade names here just
because I don’t have all of the generics memorized I’m not promoting any particular trade name but
people could be on Lexapro or Paxil and feel like they can’t wake up people can be on Prozac and
feel like they’ve got more energy some people are on Zoloft and don’t feel any energy change some
people feel lousy but with antidepressants, we want to look at what failure means did it fail to
improve the mood or were the side effects so bad that the person had to switch if this if it was
the side effects that are not classified as a failure because the person wasn’t able to
stay on it long enough for that antidepressant to get in their system now I do want
you to see the mood disorders questionnaire, haha and that’s in this article here but there
are three all of these questions that you can have people just complete at assessment and
it helps you identify if they’ve had a manic or hypomanic episode so have there ever been
a period of time when you are not your usual self and you felt so good or hyper that people
thought you are not the normal self you were so irritable that you shouted at people or started
fights you felt much more self-confident than usual you got less sleep than usual and found
you didn’t miss it you were much more interested in sex than usual spending money got
you or your family in trouble you know you can go through all the rest of the questions and they
identify yes or no to each of these once they do that if they did check yes to more than one of the
above have they ever happened during the same period if yes then again we’re probably looking
at one of the bipolar and finally how much of a problem did any of these cause for you and if it’s
a minor problem then we may want to look for other things this does not diagnose bipolar but it is an
excellent screening instrument to give you an idea about whether you need to look in that direction
have clients keep a life chart ideally for three to six months where they chart their sleep their
dietary habits their exercise their life stressors hormones for women and any bipolar symptoms that
they’re having now when I have clients chart this much I create a really simple fill in the blank
a chart like for sleep number of hours did you feel rested yes or no dietary habits I have them
keep on their mobile device for exercise did you exercise yes or no if so how much for how long you
know really simple things so they can complete the chart in under five minutes otherwise, they’re
not going to do it for the bipolar symptoms I have check blocks you know did you feel depressed
did you have difficulty sleeping yada-yada so it’s easy it’s very very simple for them to fill
out and it’s also simple for me to evaluate when I go through it encourages people to understand
their bipolar because everybody’s presentation is going to be a little bit different have them
identify you know their cognitive patterns and negative thinking patterns that contribute to
their depression and if so how do they handle those in the past when they felt depressed how did
they change their thinking or what they do to help themself be a little bit more optimistic and
also looking cognitively what if they got going for them are they intelligent are they creative
are they you know build on those if somebody is creative you know I’m not so I it’s wonderful
to see creative people but for somebody who’s creating one of the greatest things they can do
to work with their depression is art therapy you know it’s very therapeutic for a lot of people
so find their strengths and use those to help them resolve their current presenting symptoms
physically encourage them to get adequate sleep to avoid opiate and sedative medications alcohol and
any sort of over-the-counter herbs including Jen Singh Sant Sami 5htp without talking to their
the doctor first encourages them to eat a good diet they may already be doing some of this so how much
they change at one time it is gonna vary between the person and what they’re motivated to change
remind them not to change too much at once let’s just do one or two things right now and then you
can work on two more things once you have those under underway situationally have them do
a coping skills inventory to figure out how they cope when things get stressful and have them
identify triggers for their bipolar that what types of situations make you feel depressed what
types of situations have you noticed might seem to trigger a manic episode some people when they
get stressed about something there’s that anxiety it can the stress of that and having the
HPA axis activated can trigger a manic episode for them so encourage them to you know in their chart
they’re going to be keeping track of what might be contributing to triggering and mitigating bipolar
symptoms so if they’re getting good sleep and eating a decent diet their life stressors are pretty
low and they’re not having any symptoms well we know what they can do interpersonally have them
identify supportive friends to help them learn about interpersonal behaviors that trigger them and ways
to deal with those interpersonal behaviors so if when somebody tends to be in a manic episode or
even in a depressive episode if they tend to be irritable think about having them look at what
behaviors trigger their irritability trigger their anger and figure out a plan to deal with
it to minimize the impact that being on one end of the spectrum or the other mood wise
might have on their relationships angers normal irritability is normal don’t get me wrong but when
somebody is in a depressive episode or a manic episode that irritability can be intensified
tenfold and people may be taken aback by it environmentally encourage clients to look around
their environments and look at what they can do to make their environment cheerful calm and safe you
know what that looks like for that particular person those are things that they can do because
it’s you know when you felt calm and safe before what was different or what was the same what helps
you feel cheerful we just recently had the inside of the house repainted because it was time but
I’ve always felt more cheerful, especially during the winter and when there’s less sunlight when I
have like a light yellow color on the walls like straw not bright yellow and that helps me feel
a little bit more cheerful which is in contrast to all the black that I put in there but whatever it
works for me and that’s how I feel comfortable in my environment to encourage clients especially
you know when they’re feeling like they’re heading toward a depressive or manic episode
to eliminate negativity from social media and television media you know if it stresses them out
to watch the news do they have to watch the news you know what will happen if they go for a month
without watching the news and in their real-life environment encourage them to try to eliminate
as much negativity as possible and that can be altering how they deal with interpersonal
relationships that can be looking around and finding things that stress them out and addressing
there are a lot of different things but we want to look at it as biopsychosocial II Romania
we still want to build on strengths and encourage them to become aware of any medications they’re
taking and how those medications affect them this can include stimulants thyroid medications, Sammy
and 5htp encourage them to avoid stimulants when possible and don’t combine them with caffeine
if they put ephedra for example in combination with caffeine that used to be a common
combination in pre-workout supplements that can get somebody revved up and so we want
to make sure that they’re aware of the effect not only on their body but the likelihood
that could also trigger a mood episode have them identify warning signs and
interventions sometimes like I said that for people with bipolar disorder the
depression and/or manic episode may seem like it comes out of the blue and sometimes
it may but 99% of the time when I’ve traced it back with clients they weren’t taking good
care of themselves they were either taking on too much at work or they weren’t getting
enough sleep or they weren’t eating well or you know there had been something that had
changed from when they were doing well and they felt good too when they started feeling
like they were heading down towards an episode some patients may try to identify triggers for
manic episodes to increase those we want to encourage them not to do that because
that’s like driving your car with the RPMs up at five indefinitely that’s not good for your
the car eventually something Bad’s gonna happen so we don’t want them to read themselves up that
much we need to help them find that happy medium where they’re content there are three or four
on a scale of 1 to 5 and they’re feeling good for some clients when they start feeling depressed
they notice thinking changes and have difficulty concentrating this is a warning sign you know they
may not feel completely depressed yet but they may be waking up in the morning going yeah not so sure
I want to get out of it they may have low energy changes in sleeping or eating irritability
sadness negativity resentment withdrawal and environmentally they may notice that they’re in
the area becomes more disorganized or they may just not be caring as much about personal hygiene as these
are all things that they can identify early on and say huh you know it looks like maybe I need to
take a little bit better care of myself and it’s hard for clients it’s hard for a lot of us to
listen to our body and go okay I wanted to do XYZ but my body is telling me that maybe I
need to rest for mania warning signs can include racing thoughts heightened creativity that’s
one that for people to be aware of especially if you’re dealing with somebody who’s naturally
creative they may thrive during this period of heightened creativity and get upset when
you start suggesting that they may need to temper that to stabilize their mood they’re
gonna have to cut the top off the highs and raise the bottom on the lows physically they may have
difficulty sleeping or sitting still maybe may feel elated excited irritable or thrill-seeking
you may have some anger outbursts frustration with others and environmentally what I’ve seen
with patients especially with full-blown mania, it varies on what they do sometimes they are
cleaning like crazy and other times it looks like a whirlwind absolutely hit the room but so it’s
usually extreme so treatment compliance we want to encourage clients to do a decisional balance
back exercise and I broke it down so it’s shorter what are the benefits of eliminating depressive
episodes if the person was no longer depressed how would they feel emotionally mentally physically
and how would it impact their family and friends a lot of times that this one’s easy to fill out
the drawbacks to eliminating depression are this can be harder to fill out because they’re like well
I’ll see any drawbacks okay we can leave that for now sometimes patients come to the awareness
that if they’re no longer depressed they may not get as much attention and people may expect more
of them which is anxiety provoking but this area usually doesn’t have a whole bunch of stuff
in it and then we want to ask them what are the benefits of eliminating the mania emotionally
mentally physically and socially this one’s a little harder not as hard as the drawbacks to
eliminating depression a lot of times clients can see the benefits of eliminating the manic
episodes because they don’t have the periods I mean they have the highs and those are awesome
but they don’t have the periods where they have the lows and they don’t feel like they can do as
much they don’t have the loss of time they don’t kind of come out of it and realize that they’re
completely overwhelmed because when they were in the manic episode they took on 17 things so there
are a lot of things that clients may identify as benefits to eliminating the mania but we also
want to talk about the drawbacks to eliminating it because like I said for some people that’s
when they’re their most creative and if they’re a writer or an artist or a musician this may be
the time when they are feeling like they’re uber selves so they don’t want to get rid of it and
it’s terrifying to them to think that they might not be able to tap into what we can talk about
ways to tap into their creativity when they’re not manic and you know there are techniques that
they can use it to get that focus that they so desire but it depends on the person exactly
what you’re going to use if we don’t address all of these concerns about eliminating their
mania treatment compliance is going to be lower because people will just they’ll miss it they’ll
miss it a lot and they’ll want to feel that high again so general techniques in clot ask
clients how do you deal with it up until now when you felt depressed what have you done this helped
you feel better even for 10 minutes or an hour or half a day you know maybe it didn’t work the whole
time but or it helped you feel instead of feeling just devastated you felt sad you know it helps
you feel a little bit less intensely depressed build on that ask them what they’re willing to do
some clients are gonna look at you and go no I’m not gonna do that keep your
journal no not gonna do that okay so what are you willing to do I tell my clients a lot of times I’m
gonna suggest things that you may not think fit for you or work for you or you’re not going to do
well I’d rather you tell me number one that you’re not going to do it and what I’m more
concerned about is what you’re gonna do instead if you don’t want to keep the journal okay how are
we going to be able to notice changes and find connections between your eating your sleeping your
stress levels and your mood episodes you know help me let’s figure out a way that we can we can
do this and they may come up with something you know I state what it is that I want to
do or accomplish and why it’s important and I say is there another way we can accomplish this
when I work with clients and recovery sometimes they don’t want to go to 12-step meetings okay
if you’re not going to go then what are you gonna do instead because you need to have some social
support you need to have something to do besides sitting alone in your apartment from the time you get
off work until the time you go to work the next day because that’s a dangerous period encourage
clients emotionally to practice mindfulness because it does prevent episodes from sneaking up
if they start feeling run down or tired or off you know sometimes I hear that word I just feel off
okay that’s when you need to stop and check in with yourself and go what’s going on how do I feel
what do I need and mindfulness also encourages behaviors that prevent vulnerabilities when people
check in with themselves they may say you know what I’m really tired today I need to rest and
that’s a good thing because it keeps them from becoming vulnerable and potentially triggering
an episode of stress reduction encourages clients to identify and eliminate or mitigate stressors
so what stressors do you have and they can write them down on the list they can a lot of times if
I’m doing an individual I’ll have somebody write down on our big whiteboard all of their stressors
and then we go through on one by one and say okay can this one be eliminated if so how and the
the client will start making a plan for how they’re going to start eliminating stressors if there’s a
a stressor that can’t be eliminated maybe they don’t get along with their in-laws and periodically
the in-laws come to visit or whatever okay well you can’t eliminate that so how are you going
to mitigate that stressor before your in-laws come what can you do or may it be less stressful
if you go to their house instead of them coming to yours so we talk about different things we talk
about time management because in those manic and hypomanic episodes people can take on too much and
then they feel a little overwhelmed when they’re steady-state and they feel overwhelmed
if they’re in a depressive episode I do want to point out and I think most of us know this person
don’t usually cycle from a manic to a depressive to a manic like that they can have a depressive
episode and then be asymptomatic for anything for months and then have another depressive episode
or a manic episode so it’s important to recognize that most people who are bipolar don’t rapidly
cycle and there are periods of remission or symptomatology in between cognitive processing
therapy can also help people mitigate stressors when they start feeling overwhelmed encouraging
them to identify what thoughts they’re having that are contributing to them feeling stressed
or overwhelmed and then looking for the facts for and against that thought if they’re feeling
like they’ve got too much to do what are the facts for it what are the facts against it if
they do have too much to do then they need to figure out how to address it but this helps keep
people from getting stuck in emotional reasoning where every time they feel stressed or they feel
depressed or they feel anxious they think there’s something to be dysphoric about encourage people
to identify their anger management triggers they differ for everyone they need to develop a plan
for de-escalation and begin addressing their anger triggers to maintain control of their energy
they need to identify if driving in heavy traffic stresses you out and makes you irritable and angry
well ok how can you address those triggers maybe driving a different way or maybe putting on your
favorite music loud in the car or whatever it is that you can do to mitigate that anger anger
takes a lot of energy everybody everybody’s energy is precious but people with bipolar disorder
stress and excess energy drain can potentially trigger an episode so we want to help them
conserve their energy so yeah they’re gonna get angry about some stuff but help them identify
what’s worth getting angry about and using their anger energy for and how to deal with the
rest of it so they have more energy to enjoy the life we’ve been talking about the negatives but let’s
look at the positive they need to infuse happiness have them make a list of what makes them happy and
do more of it or be around it more encourage them to schedule a belly laugh every day and there are
Reddit forums there are YouTube videos there are places they can go to get a good old belly laugh
but it helps release endorphins and release some of the calming neurotransmitters that have them keep
a good things silver lining or gratitude journal and it doesn’t have to be prose you can have them
identify at the end of the day three things three good things that happen that day or three things
they’re grateful for or when things go bad they say I got demoted at my job today alright well
what’s the silver lining to that you didn’t get fired and maybe have less responsibility now I
don’t know but there are different ways you can approach it but encouraging people to be cognizant
and try to embrace the dialectics there’s going to be bad in life but help them focus on the good to
reduce dysphoria mentally address cognitive errors all Arnon thinking focusing on only the positive
or negative using feelings as facts and focusing only on a small piece when something happens maybe
you turned in a group project and your boss sent it back and said uh no try again some people will
take it very personally and focus only on the fact that the boss sent it back with feedback instead
okay it wasn’t just me participating in this project so you know all of us need to contribute
to it again and you know yes it was given back to us but we get a second opportunity so it’s looking
at a bigger piece of the puzzle encourage clients to develop their self-esteem and view failures
as lessons applaud courage and creativity and nurture their inner child I have an inner
the child my inner child comes out a lot more than some people would like to admit or really
like to see but that’s okay you know on Saturday morning it is not uncommon for me to be watching
cartoons in the living room my kids are teenagers I can’t say I’m watching it with them anymore I
like Yogi Bear I’m sorry I’m weird that way but you know sometimes at the end of a long week of
being serious and everything I just kind of need to regress for you know half an hour two hours no
encourage people to nurture their inner child and don’t be afraid to be silly don’t be afraid to
laugh or do something goofy physically increase clients to exercise class to increase exercise
it increases serotonin levels reduces stress helps balance hormones and neurochemicals and
may combat some medication side effects exercise is anything that moves the body gardening cleaning
going to the gym of course walking the dog playing soccer with the kid anything like that so what
is it that they like to do or at least they’re willing to do nutrition provides the building
blocks for the neurochemicals so people need to have quality proteins and a nutritionist
A friend of mine suggested always try to have three colors on your plate at every meal and use
a salad plate that is smaller instead of a dinner plate because it tricks your brain into thinking
that you’re getting more food as Americans we tend to eat way more than we need and try
to avoid mindless or comfort eating when people start comfort eating a lot of times they’re not
being mindful they’re eating to deal with stress instead of acknowledging the stress and dealing
with it so yeah they’re infusing themselves with carbohydrates and fats and getting the serotonin
and dopamine flowing but when all that goes away whatever was causing the stress is probably
still there so they’re either gonna have to stress eat again or deal with it so encouraging
people to be mindful of their eating sleep helps the body repair and rebalance and sleep
deprivation is known to trigger both manic and depressive episodes too much sleep or sleeping
at the wrong times can also mess up circadian rhythms so keeping naps to a minimum of 45 minutes
one time a day, if the person has to take a nap, is important so they don’t get into that deep
sleep and preferably try to avoid naps for most of a 15-minute power nap where you’re
closing your eyes and you don’t ever completely drift off has been shown to increase focus in
the afternoon but naps where you’re laying down and getting under the covers tend to mess
up circadian rhythms, if people are on medication for their bipolar which they probably will be
have them work with their doctor to adjust the dosages and dosage times to fit their schedule so
if they have a medication that makes them feel sleepy maybe they take it right before
dinner so it’s worn off completely by the time they get up in the morning and it’ll be up to the
person to work with their doctor I had one client who took Seroquel and she ended up having to take
it at 2:00 in the afternoon for it to be out of her system enough where she felt alert
when she woke up at 6 o’clock the next morning so it’s gonna differ for different clients again
encourage them to discuss any negative medication side effects with their doctor and not to expect
a pill to do everything you know the pill can help stabilize the moods but if you’re taking this pill
but then you’re still you know pulling the rug out from under it by not sleeping and using cocaine or
or whatever it’s likely the pill is just not going to be able to do it all interpersonally support
groups are really helpful to chat rooms if the person is either in a rural area working shift work can’t
get to an appropriate support group not all communities have support groups that are embracing
of all different types of people so it’s important to recognize that even though there may be a support
group the person that you’re working with may not feel comfortable with the people that are in that
the particular group so chat rooms can be helpful in the know family and friends and I say in the know
these are people who have to understand or have to know that the person has bipolar disorder and be
aware of their warning signs trigger their symptoms which helps so they can be supportive
and facilitative environmental clients can explore things that improve their environment
different pictures a temperature can also be a big thing if you’re too cold or too hot it can
make people irritable certain essential oils can help increase energy such as peppermint rosemary
or lemon calming essential oils if somebody tends to have some anxiety going on lavender chamomile
valerian Valerians kind of they say woody some people think it stinks to high heaven some people
love it catnip is the same way yes stuff you use for your cats you can get it in essential oil
and it’s a sedative type essential oil for humans bergamot it’s a pretty mild smell
rose is helpful rose geranium is a little bit less expensive and frankincense is all supposed
to help with calming so he’s hypomanic having difficulty winding down anxious whatever some of
these may help memory triggering include ginger cloves cinnamon orange and jasmine which works for
one person is not necessarily going to work for another I mean there are studies out there that
show certain essential oils have effectiveness at anxiety reduction and depression improvement but
it’s going to be up to that person and I found that when a person smells something if it
smells noxious to them then it’s probably not something that they need if they smell valerian
and they’re like oh my gosh that stinks okay that’s not triggering what their brain needs their
the brain knows what it needs I do the same thing with my rescue animals you know I let them take a
a good whiff of it and if they like it they’ll stick around and they’ll sniff it some more if
it’s not what they need then they’ll go somewhere else I tried fur for our donkeys when we first
got them into rescue I tried lavender because I thought you know that’ll help them calm down they
hated it they liked valerian so I learned that for them they preferred that particular
essential oil for whatever way it works in the brain and encourage clients to visit a store that
sells essential oils because they have testers and they can sniff them to see which ones work for
they and essential oils also smell different from different manufacturers so it’s important
again for them to figure out places that they can get their essential oils and try to stick with
the same company once they find one that works organization can help another thing that’s
important for people with Bipolar is to manage impulse items when they go into a manic or
hypomanic episode especially and they’re prone to engage in risk-taking behavior or less restrained
behavior car keys need to be somewhere where maybe they can’t access them if they’re known to go out
and drag race or you know drive 100 miles an hour just to see how it feels credit cards that’s a
big one credit cards need to be somewhere some of my clients will freeze their credit cards in
a block of ice so they can’t get to them and they can’t see the numbers to read them and
put them in on the phone this can help prevent unrestrained spending, especially at 2:00 a.m.
or something when the infomercials are on porn sites if the client happens to have an attraction
to porn sites having those blocked because it’s really easy to get sucked into that same thing
with video games and alcohol and other drugs alcohol a lot of people have in their house so
if this is a dangerous impulse item for somebody make sure they have it locked up somewhere so if
they do and have a hypomanic or manic episode they can’t drink the same thing with certain medications
especially the benzos and the opiates if you can keep it locked up somewhere all the better and
during the day keep it light and bright try not to be in an office where it’s dark
some people can’t help it I mean if you’re a nurse and you’re working in the neonatal intensive
care unit it’s going to be dark most of the time and there’s nothing you can do about that
but if you can help it keep the lights on if you don’t like fluorescent lights get lots of stand up
lights that you can put around to keep it bright so your brain knows that it’s time to be awake
co-occurring disorders depression can co-occur with bipolar I mean you can have part
of bipolar is depression so when somebody is in depressive episode suicidality high-risk and
addictive behaviors and self-medication we want to shout for it just like we would for unipolar
depression with mania we want to help the person become aware and look out for explosive anger
which can get them into legal trouble relationship issues etc heightened libido which also can get
them into legal trouble and relationship issues etc and any other risk-taking that they do because
when they’re in a manic episode is like they’re this is a bad idea filter is completely turned off
or it’s switched on the other way and as the let’s try this filter so helping them understand that
when they’re in that manic state it’s important to have safeguards so that when they come out of it they
haven’t done something that they’re going to end up regretting or have to undo so bipolar is caused
by neurochemical imbalances especially among serotonin dopamine and norepinephrine the symptoms
and presentation varies widely depending on the person it’s more important to address each symptom
then to address bipolar as a whole you know we want to look at what symptoms this person
presenting with and how can we help them manage those the medication provider is going to be
managing kind of the bipolar as a whole and trying to stabilize the mood but we want to help them
start addressing their symptoms so they can feel as healthy happy healthy and productive as
possible help them address each symptom identify warning signs and eliminate or mitigate
triggers and vulnerabilities remember that treatment compliance is a huge issue because the mood
stabilizers tend to flatten those highs and people miss the most dangerous times for suicidal
ideation and people with bipolar disorder are when they’re coming out of a depressive episode
or and I didn’t mention this before or during a mixed episode remember mixed they can be depressed
and have high energy both at the same time ensure people with bipolar disorder have a crisis plan
and people who interact with them daily who are aware of their warning signs and symptoms because
sometimes they’re not being mindful and most of us are guilty of not being mindful all the time
sometimes these symptoms can creep up so if they have people they interact with daily
who are in the know and can say you know John it seems like you’re starting to destabilize a
little bit then John can take a look at it people with co-occurring addictions also need to be aware
that a bipolar episode can trigger an addiction relapse and vice versa so they need to be aware
and have an extra-special relapse addiction relapse prevention plan for when their mood
symptoms arise if you haven’t already signed up please remember that addiction and mental health
counseling and Social Work continuing education credits are available for this presentation and
are accepted in most US states Canadian provinces Great Britain Australia and South Africa go to all
CEUs com counselor toolbox and click on the link counselor toolbox CEU spreadsheet to easily
locate the course based on this presentation okay are there any questions now remember we’re not having class
tomorrow but we’re having class on Thursday and that is just chock-full of
stuff that I’ve never actually presented before so there is no repeat possible there
oh and then next Tuesday we’re going to be talking about enhancing social justice
and why that’s important for recovery you As found on YouTubeAlzheimer’s Dementia Brain Health ➫➬ ꆛシ➫ I was losing my memory, focus – and my mind! And then… I got it all back again. Case study: Brian Thompson There’s nothing more terrifying than watching your brain health fail. You can feel it… but you can’t stop it.
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
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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? 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