{"id":150215,"date":"2023-01-17T04:18:51","date_gmt":"2023-01-17T09:18:51","guid":{"rendered":"https:\/\/effectsofanxiety.net\/?p=150215"},"modified":"2023-01-17T17:06:56","modified_gmt":"2023-01-17T22:06:56","slug":"physiology-of-addiction-and-mental-health-issues","status":"publish","type":"post","link":"https:\/\/effectsofanxiety.net\/archives\/150215","title":{"rendered":"Physiology of Addiction and Mental Health Issues"},"content":{"rendered":"<div class=\"jetpack-video-wrapper\"><iframe loading=\"lazy\" title=\"Physiology of Addiction and Mental Health Issues\" width=\"660\" height=\"371\" src=\"https:\/\/www.youtube.com\/embed\/8FKCuq4beNU?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe><\/div>\r\n\r\nthis episode was pre-recorded as part\r\nof a live continuing education webinar\u00a0\u00a0 on-demand CEUs are still available\r\nfor this presentation through all\u00a0\u00a0 CEUs register at allceus.com\/counselortoolbox I’d like to welcome everybody to today’s\r\npresentation of addiction and co-occurring disorders\u00a0\u00a0 part two the physiology of addiction and mental\r\nhealth issues over the next hour we’re going to\u00a0\u00a0 discuss somewhat generally because there’s a\r\na lot of stuff to go over neurotransmitters which\u00a0\u00a0 we’ve talked about some before but then we’re also\r\ngoing to talk a little bit more today than we’ve\u00a0\u00a0 talked in the past about sex hormones thyroid\r\nhormones and stress hormones and how all of those\u00a0\u00a0 interact in the body to increase or decrease the\r\navailability of certain neurotransmitters we’re\u00a0\u00a0 going to go on from learning about the different\r\nhormones and neurotransmitters to discussing\u00a0\u00a0 the physics all the physiology of emotion and\r\nmotivation and again we’ve kind of covered that\u00a0\u00a0 but we’re going to go over it real quick again\r\nwe’ll talk about the physiology of sleep what\u00a0\u00a0 happens during sleep and what happens to those\r\nhormones or neurotransmitters when you don’t\u00a0\u00a0 get enough sleep what happens when you eat why\r\nis eating sometimes rewarding what happens when\u00a0\u00a0 people take stimulants whether it’s caffeine or\r\nmethamphetamine what happens when we turn up the\u00a0\u00a0 system and how does that affect the availability\r\nof certain neurotransmitters and then we’ll talk\u00a0\u00a0 about the physiology of depressants so we’re\r\nlooking in general at what these things do as\u00a0\u00a0 far as the physiology of addiction we’re going\r\nto talk generally about that right at the very\u00a0\u00a0 end so your inhibitory neurotransmitters are\r\nthose brain chemicals turn down\u00a0\u00a0 the system so instead of being hyped up and awake\r\nand yadda-yadda your calm you are relaxed you are\u00a0\u00a0 maybe even sleepy too drowsy so your inhibitory\r\nneurotransmitters are the ones that kick\u00a0\u00a0 in or counteract the excitatory ones serotonin\r\nis your primary inhibitory neurotransmitter it’s\u00a0\u00a0 broken down to make melatonin and help you sleep\r\nokay so we know that it’s also responsible\u00a0\u00a0 for a lot of our bowel function angle and also\r\nfor not it’s implicated in nausea and motion\u00a0\u00a0 sickness and they found that there are a lot fewer\r\nside effects to serotonin antagonists than there\u00a0\u00a0 are to dopamine antagonists when we’re talking\r\nabout helping people who have motion sickness\u00a0\u00a0 and nausea so anyway just a little aside there but\r\nserotonin is 80 percent of it is actually in your\u00a0\u00a0 GI tract and it is implicated in bowel function\r\nso when we’re thinking about clients who may have\u00a0\u00a0 an imbalance in serotonin and who may have greater\r\npain sensitivity we want to start thinking about\u00a0\u00a0 you know how is their GI working and is are some\r\nof their problems with you know stomach problems\u00a0\u00a0 pain irritable bowel that kind of stuff is that\r\ncaused by a serotonin imbalance or is that causing\u00a0\u00a0 a serotonin imbalance or maybe serotonin is not\r\nimplicated at all and it’s something completely\u00a0\u00a0 different serotonin is also implicated in anxiety\r\nand aggression if you don’t have enough of it you\u00a0\u00a0 tend to be more anxious and aggressive because\r\nyou’re not having the turn down if you will low\u00a0\u00a0 serotonin has also been implicated in poor impulse\r\ncontrol so we like serotonin but we\u00a0\u00a0 found and we’re gonna talk about that throughout\r\nthis class of serotonin has often been given the\u00a0\u00a0 go-ahead or been implicated for a whole lot of\r\nthings and we’ve said okay if this happens then\u00a0\u00a0 it’s low serotonin if this happens then it’s low\r\nserotonin and as it goes but no the research is finding that that’s rarely true that\r\nmost of our problems whether it be GI problems\u00a0\u00a0 or mental health problems or addictive issues\r\ndon’t necessarily involve serotonin at all there\u00a0\u00a0 is a subset of people for whom it does but the\r\nmajority of people which is why antidepressants\u00a0\u00a0 are ineffective for about 70 percent of the\r\npopulation for them shortie of the people it’s not\u00a0\u00a0 serotonin so we do want to keep that in the back\r\nof our mind yes serotonin is everywhere throughout\u00a0\u00a0 the body 80% of it is in our gut and our gut is\r\nnot necessarily going to communicate directly\u00a0\u00a0 with our brain we cannot measure neurotransmitter\r\nlevels effectively in a live human being just not\u00a0\u00a0 how it works right now there are tests out there\r\nthat say they can measure your neurotransmitter\u00a0\u00a0 levels and that’s true but it’s not telling you\r\nhow much of that neurotransmitter is in your gut\u00a0\u00a0 or your muscles or wherever versus in your\r\nbrain so those tests for our purposes as mental\u00a0\u00a0 health clinicians and people who come to us who\r\nmay want to know well what antidepressant should\u00a0\u00a0 I be on they’re not all that effective\r\nokay so depression has been debunked as\u00a0\u00a0 being linked to serotonin in the majority of\r\ncases serotonin is implicated as one of those\u00a0\u00a0 neurotransmitters involved in pain control in people\r\nwith lower serotonin tend to have a lower pain\u00a0\u00a0 threshold so it hurts more and that doesn’t mean\r\nthat they’re sissies or anything like that\u00a0\u00a0 it just means that they are more reactive or they\r\nfeel more pain because they don’t have the same\u00a0\u00a0 level of serotonin and maybe endogenous opioids\r\nkind of coursing through their system serotonin is\u00a0\u00a0 also like I said involved in sleep an interesting\r\nfact is that alcohol impairs the body’s ability\u00a0\u00a0 to convert tryptophan which is an amino acid\r\nto serotonin so when you have somebody who’s\u00a0\u00a0 an alcoholic let’s think about how this works\r\nif they are drinking and maybe they’re eating\u00a0\u00a0 a perfectly healthy diet and they just happen to\r\ndrink a lot if their body can’t convert tryptophan\u00a0\u00a0 to serotonin then all of these problems up here\r\nthat may be implicated by low serotonin can start\u00a0\u00a0 to rear their ugly head because the body can’t\r\nTo make serotonin out of anything else it has to make\u00a0\u00a0 it from tryptophan and if it can’t make serotonin\r\nthen it can’t make melatonin which is involved in\u00a0\u00a0 sleep and you’re gonna see how important all that\r\nis later so the take-home message with that is\u00a0\u00a0 that alcohol is something to be considered\r\nfor moderation especially if we have a client who\u00a0\u00a0 is struggling with depression maybe they’re not an\r\nalcoholic but they need to consider the long-term\u00a0\u00a0 impact if they want to feel better is preventing\r\ntheir body from making using the building blocks\u00a0\u00a0 to make the neurotransmitters that they may need\r\nis it worth that drink remember that serotonin has been found in research to be\r\nimplicated in low serotonin is implicated in\u00a0\u00a0 people with generalized anxiety disorders so\r\nit hasn’t been completely just been debunked\u00a0\u00a0 for everything but researchers and clinicians\r\nfinally are starting to realize that there are\u00a0\u00a0 a multitude of reasons that somebody could have\r\na mood issue that somebody could have even low\u00a0\u00a0 serotonin okay if the person has low serotonin\r\nalright that’s fine let’s address it but what\u00a0\u00a0 is causing the low serotonin we’ll look at\r\nthat more in the next few slides GABA is your\u00a0\u00a0 other major inhibitory neurotransmitter it has\r\nsedative depressive and anti-anxiety properties\u00a0\u00a0 to them the really interesting thing it’s and when\r\nI say depressive I mean it slows down everything\u00a0\u00a0 it’s not that it makes people depressed but it’s\r\nyour anti-anti-anxiety natural anti-anxiety\u00a0\u00a0 neurotransmitter helps improve concentration by\r\nfiltering out background noise so you’re able to\u00a0\u00a0 focus a little bit better when you’ve got normal\r\nlevels of gaba help with impulse control\u00a0\u00a0 think about when you’re anxious when you’re a\r\nlittle bit revved up when you’re stressed out\u00a0\u00a0 and somebody scares you maybe you’re a little bit\r\nmore jumpy well think about if you have GABA at\u00a0\u00a0 the right levels in your system and you’re not\r\nstressed out and somebody scares you are you as\u00a0\u00a0 jumpy are you as impulsive a lot of our impulses\r\nare associated with wanting to make a threat or\u00a0\u00a0 a pain go away so if you’re not perceiving as\r\nmany threats you’re probably not going to be as\u00a0\u00a0 impulsive another little interesting side thing is\r\nthat glucose you know sugar is necessary for the\u00a0\u00a0 formation of GABA so people with hypoglycemia\r\ncan have a reduction in GABA and an increase\u00a0\u00a0 in anxiety so think about if your blood sugar\r\ngets low even if you are not hypoglycemic but\u00a0\u00a0 you know you got to work back-to-back patients\r\nyou didn’t take time for lunch yet back-to-back\u00a0\u00a0 patients you’re on the drive home from the office\r\nyour blood Sugar’s low you are you more likely to\u00a0\u00a0 respond with some anxiety or irritability to\r\nthings that happen versus when you are well\u00a0\u00a0 nourished and your blood sugar is kind of stable\r\nfor most people, they’re gonna say yeah I tend to\u00a0\u00a0 be a little bit cranky err when my blood sugar\r\nis low and shake gear alright so those are our\u00a0\u00a0 two inhibitory neurotransmitters glutamate is\r\ngenerally acknowledged to be the most important\u00a0\u00a0 neurotransmitter for brain functioning and\r\nit’s excitatory it gets you up it gets you\u00a0\u00a0 going it gives you energy and it’s responsible\r\nfor helping us learn and remember things so if\u00a0\u00a0 you’ve got low levels of glutamate you know you\r\nmight have difficulty concentrating and learning\u00a0\u00a0 now the interesting thing is that glutamine\r\nwhich is an amino acid you eat glutamine\u00a0\u00a0 is converted into glutamate all right well that\r\nmakes sense so you eat something it is turned\u00a0\u00a0 into this neurotransmitter that’s excitatory the\r\ninteresting thing is gaba is made by the breakdown\u00a0\u00a0 of glutamate so you have if you have glutamate\r\nthen you can have Gaba if you don’t have enough\u00a0\u00a0 glutamate then you’re not going to have enough\r\nGABA so it’s a balance like taking a warm bath\u00a0\u00a0 and you know this is important to remember\r\nsimply because we want to know what’s rubbing\u00a0\u00a0 us up and what’s slowing us down norepinephrine or\r\nnoradrenaline depending on where you are is what\u00a0\u00a0 they call a catecholamine it increases arousal and\r\nalertness promotes vigilance and focuses attention\u00a0\u00a0 so you’re hearing a theme here about attention\r\nand memory it enhances the formation and retrieval\u00a0\u00a0 of memories so in your norepinephrine that’s your\r\nmotivation chemical is secreted it encourages you\u00a0\u00a0 to pay attention to remember and to be able to go\r\nand file things away and access them easily it can also promote restlessness and anxiety if\r\nyou have too much so it’s all about moderation\u00a0\u00a0 when I talk about too much or too little of a\r\nneurotransmitter everything is always about all of the other neurotransmitters and hormones\r\nso we can’t just necessarily get a measurement and\u00a0\u00a0 go well you’ve got too much of this well we have\r\nto know what the levels of everything else are it\u00a0\u00a0 would be kind of like making a marinara sauce and\r\nsaying you a teaspoon of garlic is how much you\u00a0\u00a0 need but that teaspoon would be enough if you\r\nwere making maybe two quarts of marinara sauce\u00a0\u00a0 but if you are making 4 gallons all of the\r\nother spices and everything would be in much\u00a0\u00a0 larger proportions so what a teaspoon be enough\r\nso we need to know what proportions all the other\u00a0\u00a0 chemicals are at in order to know how much we need\r\nand since we can’t measure them we’re just kind of\u00a0\u00a0 left guessing dopamine is another catecholamine\r\nand it’s broken down to make norepinephrine now\u00a0\u00a0 normally we think of dopamine as our pleasure\r\nreward chemical which it is don’t get me wrong\u00a0\u00a0 it’s that’s what is there for and it tells us\r\nI want to do that again but it’s broken down to\u00a0\u00a0 make our focus concentration motivation chemical\r\ninteresting so we need dopamine to make\u00a0\u00a0 norepinephrine we need norepinephrine to want to\r\nget up and go so if we are draining our dopamine\u00a0\u00a0 system through addictive behaviors or some other\r\nreason guess what we’re not going to be able to\u00a0\u00a0 make enough nor epinephrine or those receptors\r\nthat usually receive the norepinephrine and the\u00a0\u00a0 dopamine are going to be basically unresponsive\r\nand you’re going to knock on the door and nobody’s\u00a0\u00a0 going to open so dopamine is broken down to make\r\nnorepinephrine which is your motivation chemical\u00a0\u00a0 high levels of dopamine in the brain generally\r\nenhance mood and increase body movement too\u00a0\u00a0 much dopamine may produce nervousness irritability\r\naggressiveness and paranoia so think about cocaine\u00a0\u00a0 if somebody takes a whole lot of really good\r\ncocaine this is probably what we’re going to\u00a0\u00a0 see because the levels of dopamine in their brain\r\njust skyrocketed and everything else didn’t catch\u00a0\u00a0 up there was no signal to all the other chemicals\r\nto go okay we’re gonna have a surge here so we\u00a0\u00a0 have all of those neurotransmitters that are\r\nresponsible for helping us feel happy serotonin\u00a0\u00a0 helps us feel theoretically calm and content\r\nand focused gaba is an anti-anxiety medication\u00a0\u00a0 or not medication but a neurotransmitter and then\r\ndopamine glutamate and norepinephrine are all\u00a0\u00a0 of our excitatory ones they’re the ones that get\r\nus guess what excited happy excited mad excited\u00a0\u00a0 whatever the excited is they Rev us up and that’s\r\nwhat we label with our emotional feeling states\u00a0\u00a0 so what is this HPA axis thing that I talk about\r\nevery once in a while in response to stress the\u00a0\u00a0 level of various hormones change and reactions to\r\nstress is associated with an enhanced secretion\u00a0\u00a0 of several hormones including your gluta Co\r\ncorticoids which is cortisol your catecholamines\u00a0\u00a0 to increase mobilization of energy sources\r\nwhich is blah blah blah blah blah you get\u00a0\u00a0 stressed your body sends out the message that\r\nwe need some energy we need some fuel for this\u00a0\u00a0 fight-or-flight response cortisol is activated and\r\nit’s a glue to co corticoid which tells your body\u00a0\u00a0 we need to prepare we need to get some glucose\r\ngoing so got energy for this fight-or-flight\u00a0\u00a0 thing catecholamines adrenaline and dopamine are\r\nreleased that’s your body going okay we have this\u00a0\u00a0 energy now let’s get the team revved up the other\r\nthing that happens though is j\u00f6rgen a door opens\u00a0\u00a0 are suppressed your body goes you know we don’t\r\nreally have time for sex right now so let’s not\u00a0\u00a0 worry about it so your sex hormones tend to be\r\nsuppressed under high stress levels okay well\u00a0\u00a0 who cares you’re gonna find out in a little while\r\nbut that’s kind of a big deal because there is a\u00a0\u00a0 strong relationship between the amount of and the\r\nbalance of our sex hormones and the availability\u00a0\u00a0 of serotonin-norepinephrine and dopamine in our\r\nbodies oh well sweet this here we are androgen or\u00a0\u00a0 testosterone what we want to look at is what does\r\nit do it helps helps us with concentration mood\u00a0\u00a0 and not enough of it can result in an increase in\r\nbelly fat they found that in men depending on the\u00a0\u00a0 research that you look at somewhere between 30\r\nand 40 years of age they start losing somewhere\u00a0\u00a0 between 1% and 1.5 percent of their testosterone\r\neach year and so you’re thinking well you know\u00a0\u00a0 that’s not that much but you’ve also got to\r\nremember that everything’s in a balance so\u00a0\u00a0 they’re losing their testosterone but what else is\r\nnot decreasing estrogen so some articles have kind\u00a0\u00a0 of termed it manopause if you will the increase\r\nin estrogen can increase irritability difficulty\u00a0\u00a0 concentrating and belly fat as well as Gyna\r\nmastika or the development of excess fat in\u00a0\u00a0 the breast area so something interesting to look\r\nat if you’re dealing with patients male patients\u00a0\u00a0 who are over the age of 40 who are having suddenly\r\nif you will depression or anxiety issues or are\u00a0\u00a0 talking about their midlife crisis that those\r\nall of those things could be precipitated by in their neurochemistry because of a drop\r\nin testosterone not necessarily but it’s one\u00a0\u00a0 positive or one possible reason estrogen believe\r\nit or not is a neuro stimulant estrogen revs us\u00a0\u00a0 up receptors for estrogen are very abundant\r\nin the emotional center of the brain called the\u00a0\u00a0 amygdala and the hypothalamus which is involved\r\nin what we just talked about the HPA axis which\u00a0\u00a0 tells us to fight flea or freeze estrogen\r\nincreases serotonin receptor responsive ‘it\u00a0\u00a0 increases the number of serotonin receptors\r\nin the body and enhances serotonin transport\u00a0\u00a0 and uptake so we might hypothesize and we don’t\r\nknow any of this for sure that if someone’s mood\u00a0\u00a0 disorder started or fluctuates in response to\r\nfluctuations in their estrogen then there might\u00a0\u00a0 be a serotonin component to this mood disorder\r\nbecause estrogen is so intimately connected with\u00a0\u00a0 serotonin availability high levels of estrogen are\r\nassociated with anxiety one thing that they found\u00a0\u00a0 in American culture and industrialized nations\r\nbut especially American culture is we have a\u00a0\u00a0 lot of chemicals and stuff that we eat that tend\r\nto and habits that we do that tend to increase\u00a0\u00a0 our levels of estrogen creating something called\r\nestrogen dominance but high levels of estrogen are\u00a0\u00a0 associated with anxiety so one thing clients\r\nmay want to do especially female clients but\u00a0\u00a0 you know if you have a male who is feeling like\r\nestrogen may be increasing too much I have them\u00a0\u00a0 look at what they’re doing as far as lifestyle\r\nfactors to see if there’s anything that might be\u00a0\u00a0 increasing their estrogen levels low levels of\r\nestrogen are associated with depression because\u00a0\u00a0 there’s not enough serotonin going around but also\r\nbecause estrogen is a neuro stimulant and if it’s\u00a0\u00a0 not there then there’s no stimulation so alright\r\nso now looking at first we started implicating\u00a0\u00a0 just neurotransmitters and going well if you don’t\r\nhave enough of this or too much of this then you\u00a0\u00a0 might be depressed well now we’ve added to the\r\nmix and said well guess what these imbalances\u00a0\u00a0 over here in the neurotransmitters may be caused\r\nby something completely different such as sex\u00a0\u00a0 hormones progesterone is another sex hormone an\r\nimbalance in the ratio with estrogen is implicated\u00a0\u00a0 in mood disorders so progesterone kind of calms\r\ndown estrogen they’re yin &amp; yang if you will kind\u00a0\u00a0 of like GABA and glutamate it’s referred to as the\r\nrelaxation hormone the interesting thing here is\u00a0\u00a0 synthetic progesterone which is present in a lot\r\nof birth control is associated with depression\u00a0\u00a0 whereas naturally occurring progesterone levels\r\nhaven’t had that same associate association drawn\u00a0\u00a0 in the research literature so another thing to\r\nlook at with our female clients is possibly to\u00a0\u00a0 ask them have they and if they’re presenting with\r\ndepressive symptoms have they changed their birth\u00a0\u00a0 control regimen or have they recently gotten\r\npregnant or had a baby or stopped nursing and\u00a0\u00a0 that was one I learned you know when I stopped\r\nnursing my first child was your body actually\u00a0\u00a0 maintains different levels of hormones and makes\r\nsense maintains different levels of hormones when\u00a0\u00a0 you’re nursing so you’re producing milk and stuff\r\nand then when you stop nursing there’s a whole\u00a0\u00a0 different hormonal cascade that happens so there\r\nare multiple different times that estrogen can\u00a0\u00a0 change and progesterone levels can change ganado\r\ntrope ins hormones synthesized and released by\u00a0\u00a0 the anterior pituitary promote the production of\r\nsex hormones so remember earlier I said that when\u00a0\u00a0 we’re under stress our body releases cortisol\r\nand cortisol tells our body you know what we\u00a0\u00a0 don’t need to produce those sex hormones right now\r\nso let’s connect it all if you’re under a lot of\u00a0\u00a0 stress you may not be producing enough estrogen\r\nwhich is why a lot of women when they’re under a\u00a0\u00a0 lot of stress tend to have more erratic cycles but\r\neven in men when your sex hormones are not being\u00a0\u00a0 produced because your body’s focused on fight\r\nor flee it makes the availability of serotonin\u00a0\u00a0 and norepinephrine and dopamine less available\r\nso chronic stress can alter the availability\u00a0\u00a0 of sex hormones which alter the availability of\r\nneurotransmitters okay you wanted some good news\u00a0\u00a0 we got some good news oxytocin is our bonding\r\nhormone and they found that it can counteract\u00a0\u00a0 cortisol and vice-versa it’s not just getting a\r\nhug though so I mean hugs are great don’t get me\u00a0\u00a0 wrong but a lot of research has indicated that\r\npeople who have companion animals and pet their\u00a0\u00a0 companion animal it can be a horse it can be a\r\ndog it can be a cat a bunny rabbit whatever it\u00a0\u00a0 is that does it for you where you feel that\r\nsensation of bonding 15 minutes of petting\u00a0\u00a0 that animal raises oxytocin levels and which\r\ncounteracts cortisol sweet thyroid hormones\u00a0\u00a0 yet a whole nother category so we’re moving off\r\nof the sex hormones onto our thyroid you have\u00a0\u00a0 two types of thyroid hormones thyroxine and\r\nthe other one that I can’t pronounce t4 and\u00a0\u00a0 t3 t4 is broken down to make t3 they are always\r\nin a balance they’re always in a ratio too much\u00a0\u00a0 thyroid hormone which typically is t3 speeds\r\nthings up and too little slows things down so\u00a0\u00a0 think about somebody who’s hypothyroid they have\r\nsymptoms of depression one of the things we want\u00a0\u00a0 to rule out early on with our patients who present\r\nwith the pressive symptoms is thyroid problems\u00a0\u00a0 the patients with too much thyroid hormone may\r\npresent with anxiety symptoms so again we want\u00a0\u00a0 to look and say is there a physiological cause to\r\nthe neurotransmitter imbalance the pituitary gland\u00a0\u00a0 hypothermic hypothalamic-pituitary-adrenal axis\r\nso this is the middle of that stress axis here\u00a0\u00a0 the pituitary gland releases thyroid stimulating\r\nhormones to get the thyroid to release t4 and t3\u00a0\u00a0 majority of the thyroid hormones produced by the\r\nthyroid are t4 but t3 is the most usable form so\u00a0\u00a0 it sends out t4 which is kind of you know it’s\r\njust kind of there it’s not a real hard worker\u00a0\u00a0 at all but along the way it gets converted to 3\r\nt3 which is a workhorse this conversion is the\u00a0\u00a0 critical element because a lot of times doctors\r\nwill test thyroid secreting hormone and t4 alone\u00a0\u00a0 and they’ll say well you’re secreting enough and\r\nthere’s plenty of t4 to be broken down to t3 so I\u00a0\u00a0 don’t know why you have hypothyroid symptoms but\r\nthe piece that they’re missing is they may not be\u00a0\u00a0 we may not be adequately converting t4 to active\r\nt3 so it’s important if you think you have thyroid\u00a0\u00a0 issues going on to work with an endocrinologist\r\nwho’s going to do more than just a superficial\u00a0\u00a0 test or if you go to a GP you have and they do\r\njust a TS h t4 test comes back normal but you’re\u00a0\u00a0 like no something’s not right there are more tests\r\nthat can be done to be more specific about what’s\u00a0\u00a0 available because if we’ve got a client who goes\r\nto the doctor and says doc you know I feel awful I\u00a0\u00a0 can’t wake up I’ve got no energy they run these\r\ntests they say well there’s nothing wrong with\u00a0\u00a0 you that just disempowers the client the clients\r\ngoing well nothing’s wrong with me I don’t know\u00a0\u00a0 why I feel this way I have no hope for getting\r\nbetter because I don’t know what’s wrong so I\u00a0\u00a0 want to make sure that we educate them about all\r\nthe possible things that they might be able to\u00a0\u00a0 look into I don’t dump all this on my clients at\r\nfirst you know when I go through the assessment I\u00a0\u00a0 start listening for things and then I encourage\r\nthem to get a full blood panel done and then we\u00a0\u00a0 talk about all that when they come back and\r\nthen narrow it down to other things that they\u00a0\u00a0 may want to look at further testing for if the\r\ngeneral assessment didn’t come back with anything overactive thyroid produces anxiety feelings of\r\nnervousness butterflies heart racing trembling\u00a0\u00a0 irritability and sleep difficulties under activity\r\ndepressive symptoms the other interesting thing\u00a0\u00a0 and I don’t know what other word to use is\r\nif it’s either overactive or underactive the\u00a0\u00a0 person can have mood swings and have sleeping\r\ndifficulties so we don’t want to just say well\u00a0\u00a0 you’re having mood swings it must be hyper\r\nwe don’t know so we want to look at maybe the\u00a0\u00a0 thyroid gland is sputtering and giving a little\r\nbit and then not enough and then a little bit\u00a0\u00a0 and then not enough it’s just important for\r\nthem to understand what the thyroid hormone\u00a0\u00a0 does other cognitive issues difficulties with\r\nconcentration short-term memory lapses and lack\u00a0\u00a0 of interest and mental alertness are also common\r\nin hypothyroid but they’re also common in a whole\u00a0\u00a0 bunch of other things I mean most of these\r\nsound like what the criteria for depression\u00a0\u00a0 so we’re trying to sort through and figure out\r\nwhat may be going on with that particular client hypothyroidism led to a significant decrease of\r\nresponsiveness of the serotonin system so again\u00a0\u00a0 here’s something else if you don’t have enough\r\nestrogen or if you don’t have enough thyroid the\u00a0\u00a0 serotonin system may be implicated and we know\r\nthat serotonin insufficiency is implicated in\u00a0\u00a0 generalized anxiety disorder so one of those\r\nlittle paths to kind of be aware of optimal\u00a0\u00a0 thyroid function may be necessary for optimal\r\nresponse to antidepressants antidepressants\u00a0\u00a0 mean the serotonin is still there but if estrogen\r\nand thyroid are responsible for transporting it\u00a0\u00a0 around and making sure it gets taken up in\r\nthe right places then if those two systems\u00a0\u00a0 aren’t working no matter how much serotonin\r\nis in the system of it’s not getting to the\u00a0\u00a0 right places it’s not do the job hypothyroidism\r\ngenerally increases enzyme activities and GABA\u00a0\u00a0 levels now you may go well sweet we want more\r\ngaba but we don’t too much gaba has too much\u00a0\u00a0 of a depressive effect so the person may not be\r\nmotivated may feel apathetic about things they\u00a0\u00a0 can’t get excited about anything so there is such\r\na thing as being too chill thyroid hormone plays\u00a0\u00a0 a role in the output of dopamine the precursor to\r\nnorepinephrine our motivation chemical not enough\u00a0\u00a0 thyroid hormone not enough excretion of dopamine\r\nnot enough get up and go and norepinephrine has\u00a0\u00a0 also insufficient norepinephrine has also\r\nbeen implicated in depression so you know\u00a0\u00a0 serotonin is not even in there we’re talking\r\nabout thyroid dopamine and norepinephrine stress hormones so we’ve moved on cortisol\r\nit’s released from that HPA axis cortisol\u00a0\u00a0 triggers a decrease in leptin and an increase in\r\ngralen which increases appetite and food intake\u00a0\u00a0 cortisol is telling you there is a threat we\r\nneed energy we need to mobilize the sugars\u00a0\u00a0 because it’s a glucocorticoid but we also need to\r\nget more sugars in here so we have energy for the\u00a0\u00a0 fight-or-flight as long as it goes on which is why\r\na lot of people who are chronically stressed also\u00a0\u00a0 feel like they’re chronically hungry they’re just\r\nlike I’m famished all the time and it may not be\u00a0\u00a0 that their body needs all that energy all those\r\ncalories right now their body may be hoarding it\u00a0\u00a0 because they think they’re going to have to it’s\r\ngonna have to fight or flight flee for a long\u00a0\u00a0 time cortisol also affects the endocrine system\r\nincluding thyroids insulin regulating blood sugar\u00a0\u00a0 and your sex hormones all right well that’s not\r\ngood so when people are stressed they maintain\u00a0\u00a0 higher levels of cortisol when they maintain\r\nhigher levels of cortisol basically every bodily\u00a0\u00a0 system and all the neurotransmitters are impacted\r\nadrenaline is another stress hormone you know we\u00a0\u00a0 think about it when somebody gets really upset or\r\nexcited or whatever they have a rush of adrenaline\u00a0\u00a0 alright sigh Roxon is also released from the\r\nkidneys and are from the thyroid and helps you\u00a0\u00a0 get fatty acids which are long term long term\r\nenergy fat has nine calories per gram sugar has\u00a0\u00a0 four calories per gram so fat is a much denser\r\nsource of energy effective chronically elevated\u00a0\u00a0 cortisol includes impaired cognitive performance\r\nyou’re not thinking as well dampen thyroid\u00a0\u00a0 function yep eventually the body goes there’s no\r\npoint the stress is not going to go away there’s\u00a0\u00a0 no point in continuing to fight so I’m going to\r\nturn down the sensitivity of the symptom blood\u00a0\u00a0 sugar imbalances sleep disruption elevated blood\r\npressure lowered immune function and increased\u00a0\u00a0 abdominal fat so if a client starts talking about\r\nhow they’re stressed they’re hungry all the time\u00a0\u00a0 and they keep suddenly gaining all this weight\r\nin their belly we might start looking at chronic\u00a0\u00a0 stress and interventions that we might use for\r\nchronic stress including mindfulness meditation\u00a0\u00a0 exercise you know anything that we can throw\r\ntheir way in addition to having them get a full\u00a0\u00a0 physical to make sure there’s nothing else going\r\non like you know actual hyper hypothyroid caused\u00a0\u00a0 by a physiological problem low levels of cortisol\r\nbrain fog cloudy headedness mild depression low\u00a0\u00a0 thyroid function again blood sugar imbalances\r\nsuch as hypoglycemia and remember when you’ve\u00a0\u00a0 got blood sugar imbalances and not enough sugar\r\nthen your body cannot produce enough gaba which\u00a0\u00a0 means you’re not going to have enough naturally\r\nrelaxing chemicals fatigue especially morning and\u00a0\u00a0 mid-afternoon sleep disruption low blood pressure\r\nlowered immune function and inflammation so these\u00a0\u00a0 are all things that we can produce to work\r\nour clients to say cortisol it’s not public\u00a0\u00a0 enemy number one but it’s pretty close to it so\r\nlet’s look at how your cortisol levels how you’re\u00a0\u00a0 sustained chronic stress might be impacting\r\nyour mood your health and your sleep and think\u00a0\u00a0 about different ways we can reduce that because\r\nthat’s more tangible and cortisol is measurable\u00a0\u00a0 obviously the doctor has to do that but it is\r\nmeasurable in general when we feel emotions a\u00a0\u00a0 stimulus is received by our peripheral peripheral\r\nnervous system the brain responds by triggering\u00a0\u00a0 the amygdala which is our emotion center and\r\nthe hypothalamus assesses if you will the need\u00a0\u00a0 for fight or flee it goes there’s a threat or\r\nthere’s no emotional memory that helps the brain\u00a0\u00a0 determine the types of neurochemicals to secrete\r\nand in what amounts if the hypothalamus goes\u00a0\u00a0 yeah no big deal then you’re going to have more\r\ninhibitory neurotransmitters then if you have your\u00a0\u00a0 hypothalamus going that’s a problem what we need\r\nto look at and this adds another layer is when\u00a0\u00a0 there is too much of a chemical or hypersensitive\r\nreceptors so hypersensitive receptors are like the\u00a0\u00a0 person that you know that jumps when you tap them\r\non the shoulder somebody who’s hyper vigilant when\u00a0\u00a0 they are activated they go from 0 to 100 and\r\nit’s just like in sensitive receptors on the\u00a0\u00a0 other hand when they’re activated they may not do\r\nanything at all so you may have enough chemical in\u00a0\u00a0 the system but if the receptors are not receptive\r\nthen the chemical can’t do its job so if serotonin\u00a0\u00a0 is sitting outside the receptors door just kind\r\nof knocking on it going let me in and that door\u00a0\u00a0 never gets opened then it doesn’t matter how much\r\nserotonin is sitting in the synapse it’s not going\u00a0\u00a0 to do any good so as I said before all every\r\ntime I talk about too much and too little it’s\u00a0\u00a0 always relative to the proportions of the other\r\nhormones and neurotransmitters for that person anxiety irritability and anger our fight-or-flight\r\nresponse can be caused by dot dot dot too little\u00a0\u00a0 serotonin where you have anxiety coming\r\non because serotonin is not there to help\u00a0\u00a0 the person calm too little GABA again not enough\r\ncalming too much norepinephrine too much estrogen\u00a0\u00a0 too much testosterone or too much thyroid so\r\nany of these too much is going to cause one\u00a0\u00a0 symptom either anxiety or irritability or anger\r\nand too little will probably produce something\u00a0\u00a0 more on the depressive continuum now happiness and\r\nexcitements an interesting one because happiness\u00a0\u00a0 and excitement are excitatory neurotransmitters\r\nthey’re going to get your heart rate going they’re\u00a0\u00a0 gonna get your blood blood flowing they’re gonna\r\nget your breathing a little bit faster think about\u00a0\u00a0 Christmas Christmas morning when you run down the\r\nstairs in order to see what’s under the Christmas\u00a0\u00a0 tree or something else that is really exciting\r\nyour body is secreting dopamine norepinephrine\u00a0\u00a0 glutamate and maybe a little bit of serotonin\r\nin there but these are the same chemicals that\u00a0\u00a0 are going out during a stress response it’s how\r\nthe amygdala processes everything so we still\u00a0\u00a0 need these excitatory neurotransmitters we can’t\r\njust shut them down and go well that’s causing too\u00a0\u00a0 much problem let’s turn it down well if we turn it\r\ndown we’re also turning down the body’s ability to\u00a0\u00a0 Spahn to happy stimuli and like I said depression\r\ncan be caused by serotonin insufficiency or excess\u00a0\u00a0 and why is it excess when you have too much\r\nserotonin or too little serotonin you can\u00a0\u00a0 have high levels of anxiety they found and high\r\nlevels and anxiety trigger the stress response\u00a0\u00a0 system after a certain period of time the stress\r\nresponse system goes you know what I can’t stay\u00a0\u00a0 this hyped up for this long I’ve got to turn down\r\nmy sensitivity I’ve just got a you know let it all\u00a0\u00a0 go which starts leading to feelings of apathy and\r\ndepression it can be caused by nor norepinephrine\u00a0\u00a0 insufficiency dopamine insufficiency thyroid\r\ninsufficiency or gain too much or too little\u00a0\u00a0 estrogen the good thing is I Roy dand sex\r\nhormones can be measured so we can easily\u00a0\u00a0 or somewhat easily help the person rule those in\r\nand\/or rule those out as can cortisol so if they\u00a0\u00a0 have chronically elevated or chronically low\r\nlevels of cortisol they’re going to have some\u00a0\u00a0 mood symptoms but we can figure out that that’s\r\ngoing on and we can help educate the patient to\u00a0\u00a0 why they’re having the symptoms they are it’s\r\nnot all in their head the New England Journal\u00a0\u00a0 of Medicine on major depression said numerous\r\nstudies of norepinephrine and serotonin in\u00a0\u00a0 plasma urine and cerebrospinal fluid as well as\r\npost mortem Studies on the brains of patients\u00a0\u00a0 with depression so we’re talking about humans\r\nnot just rats studies have yet to identify the\u00a0\u00a0 purported deficiency reliably so while we’re\r\ntalking about depression being caused by if\u00a0\u00a0 you will norepinephrine or serotonin deficiency\r\nthere’s no real research that can reliably say\u00a0\u00a0 yes this is it 100% of the time or even 95% of the\r\ntime it’s more like yeah 15 percent of the time\u00a0\u00a0 so yes deficiencies in norepinephrine and and or\r\nserotonin does cause depression in some people but\u00a0\u00a0 that is a small subset and they found that there\r\nare 20 or 30 small subsets of different causative\u00a0\u00a0 factors estrogen and progesterone modulates sleep\r\nand too much estrogen can cause insomnia so again\u00a0\u00a0 if you have too much estrogen well you may have\r\nplenty of serotonin going on you also may not be\u00a0\u00a0 able to sleep sleep deficiency promotes elevated\r\ncortisol and further disrupts our feeding hormones\u00a0\u00a0 now for cortisol is elevated we’re not going\r\nto get good restful sleep sleep deficiency is\u00a0\u00a0 related to a 30% reduction in thyroid hormone\r\nlevels so again remember that the body finally\u00a0\u00a0 after chronic stress will start turning down\r\nthe thyroid it’s just like there’s no need to\u00a0\u00a0 exert any more effort because this is a losing\r\nproposition with sleep deficiency the thyroid\u00a0\u00a0 hormone levels go down cortisol levels go up\r\nwhich is your stress chemical so everything’s\u00a0\u00a0 starting to get out of whack when people eat\r\nserotonin suppresses appetite and increases\u00a0\u00a0 with feeding so as we eat our serotonin levels go\r\nup especially for eating carbohydrate-rich foods\u00a0\u00a0 but anytime we’re eating so if there’s not enough\r\nserotonin people’s appetite suppression may be off\u00a0\u00a0 but that’s also one of the reasons that people eat\r\nfor comfort is because serotonin helps them feel a\u00a0\u00a0 little bit better so when they’re eating serotonin\r\ngoes up dopamine is associated with safety ATP\u00a0\u00a0 handy which is great but if you don’t have enough\r\ndopamine then you may never feel satisfied as we\u00a0\u00a0 talked about before cortisol increases appetite\r\nand neurons involved in the regulation of feeding\u00a0\u00a0 are located in the hypothalamus so when you’ve\r\ngot that hypothalamus pituitary adrenal axis all\u00a0\u00a0 activated all the time the HPA axis you’re\r\nfeeding is going to be probably way up here\u00a0\u00a0 because the hypothalamus is going there’s a threat\r\nwe need food we need we need energy and all of\u00a0\u00a0 these chemicals are involved in stress response\r\nstimulants stimulants set off the stress response\u00a0\u00a0 system by causing the body to kind of dump if\r\nyou will sigh roid hormones stress hormones and\u00a0\u00a0 suppress sex hormones you know that HPA axis it’s\r\nactivated excitatory neurotransmitters dopamine\u00a0\u00a0 and norepinephrine gets secreted so if you’ve got\r\na lot of pleasure reward focus and concentration\u00a0\u00a0 going on and you’re just like woohoo yeah you’re\r\nprobably gonna want to do that again but when\u00a0\u00a0 that wears off when stimulants wear off they wear\r\noff a whole lot faster than what our normal neuro\u00a0\u00a0 chemicals would normally do so when they wear off\r\nthere’s a sudden lack of stimulation pleasure and\u00a0\u00a0 reward and there’s an excess of gaba and other\r\nother neurochemicals when people drink alcohol\u00a0\u00a0 initially gaba goes way up when they drink the\r\nalcohol and they feel relaxed and disinhibited and\u00a0\u00a0 all that kind of stuff the alcohol wears off and\r\nall of a sudden in proportion to everything else\u00a0\u00a0 there’s way not enough gaba so anxiety goes way up\r\nso what we want to remember is when we’re taking\u00a0\u00a0 substances or engaging it well taking substances\r\nspecifically they are going to impact and wear off\u00a0\u00a0 in a much different rate than what would happen\r\nfrom our body normally excreting or causing\u00a0\u00a0 those neurochemicals to be excreted depressant\r\nincrease gaba and may increase serotonin so they\u00a0\u00a0 found that alcohol may increase serotonin it also\r\nincreases gaba but again when it wears off you got\u00a0\u00a0 a problem what there are other depressants out\r\nthere besides alcohol though so it’s important\u00a0\u00a0 to know what are your clients taking what are they\r\nusing recreationally not to be judgmental you know\u00a0\u00a0 if you have a couple drinks in the evening it is\r\nwhat it is what other things are you taking are\u00a0\u00a0 you using including looking herbs like valerian\r\nValerians are pretty powerful depressant so it’s\u00a0\u00a0 important to know what what they’re taking so\r\nthey know what impact is having on their body\u00a0\u00a0 there are a variety of neurotransmitters that\r\nare implicated in moods sex stress and thyroid\u00a0\u00a0 hormones among others modulate the secretion and\r\nabsorption that is modulate the availability of\u00a0\u00a0 these neurotransmitters so if there’s a lack\r\nor an insufficiency proportionally speaking of\u00a0\u00a0 norepinephrine what we want to ask is not how do\r\nwe increase it but what’s causing it why is there\u00a0\u00a0 an imbalance in norepinephrine in this particular\r\npatient dysphoria is about having an imbalance not\u00a0\u00a0 necessarily too much or too little you may have\r\ntoo much X in relation to Y too much glutamate\u00a0\u00a0 in relation to GABA so talking with your clients\r\nif they start taking medications talk with them\u00a0\u00a0 about how they feel and whether it’s getting worse\r\nyou’re getting better to help understand you know\u00a0\u00a0 are we targeting the right things here sleep\r\ndeprivation directly contributes alterations\u00a0\u00a0 in hormone and neurotransmitter levels and\r\nexcessive eating may be caused by high cortisol\u00a0\u00a0 levels because the brain thinks it needs to store\r\nenergy for the long fight sex hormones impact the\u00a0\u00a0 availability of serotonin but oxytocin has been\r\nshown to inhibit cortisol so pet a dog get a hug\u00a0\u00a0 do something to promote bonding it will help\r\nwith stress levels dysphoric moods are caused\u00a0\u00a0 by a neurotransmitter imbalance but what causes\r\nthat imbalance in each person berries greatly\u00a0\u00a0 and they found it even berries greatly among\r\npeople with PTSD so just like depression PTSD\u00a0\u00a0 does not have one simple cause a cascade effect\r\ncan happen when any one of these systems goes\u00a0\u00a0 offline so if the thyroid system goes offline has\r\na dysfunction for some reason it may negatively\u00a0\u00a0 impact all the other symptoms because it’s\r\ngoing to change the balance and the ratios\u00a0\u00a0 of all the other hormones and chemicals involved\r\nin those feedback loops so final thoughts chronic\u00a0\u00a0 stress impairs sleep which causes imbalances\r\nand hormones and neurotransmitters involved\u00a0\u00a0 in eating sleeping mood attention motivation\r\nand sex disruptions in nutrition can fail to\u00a0\u00a0 provide the building blocks for the hormones and\r\nneurotransmitters so it could be something as\u00a0\u00a0 simple as you know eating junk food every day\r\nsleep impairment is associated with decreases\u00a0\u00a0 in thyroid hormones and increases in cortisol and\r\ndysregulation of eating so if somebody’s hungry\u00a0\u00a0 all the time but they’ve got a low mood and you\r\nknow they present with depressive symptoms we\u00a0\u00a0 may want to look at what’s going on and could\r\nit is a factor contributing to this is sleep\u00a0\u00a0 um but any of these things could also contribute\r\nto problems with sleep estrogen and testosterone, imbalances can cause depression or anxiety like\r\nsymptoms and thyroid hormone imbalances can also\u00a0\u00a0 cause depression and anxiety-like symptoms so the\r\nthe take-home message is this stuff is stinkin\u00a0\u00a0 complicated but what we know is everything\r\nis intimately interconnected so we don’t\u00a0\u00a0 want to just start by saying well it sounds like\r\nyou’ve got this and try to pigeonhole everybody\u00a0\u00a0 into one particular causation we need to\r\nunderstand what’s going on with them and since\u00a0\u00a0 we can’t measure brain neurochemicals to figure\r\nout exactly which one’s out of whack that’s where\u00a0\u00a0 the part art comes into psychology as part art\r\nand part science okay so are there any questions you I think you’re all probably feeling like me when\r\nafter I wrote this I worked on research for about\u00a0\u00a0 20 hours and I was all but drooling at myself\r\nby the end I was like really I tackled a pretty\u00a0\u00a0 deep subject for an hour and you may need to\r\ngo back and look at the presentation to kind\u00a0\u00a0 of make all the connections and connect the\r\ndots as it applies to your clients but let’s\u00a0\u00a0 see thinking about autism symptoms and these\r\nissues and body functions and hormones yeah\u00a0\u00a0 I mean certainly autism is correlated and I’m\r\npretty ignorant as to the neurophysiology of\u00a0\u00a0 autism but I would think that there’s a strong\r\ncorrelation with the neurotransmitters so I\u00a0\u00a0 would look at other systems to see if there are\r\nsomething that’s going offline that may be\u00a0\u00a0 contributing to the neuro neurotransmitter\r\nimbalance when symptoms are exacerbated which makes me think you know again\r\nI don’t know as much I don’t know\u00a0\u00a0 much about autism but when a client begins\r\nstemming I’m wondering if those impulsive\u00a0\u00a0 behaviors mean there’s high\r\nlevels of anxiety at that point so I’m\u00a0\u00a0 wondering what’s happening with the stress\r\nresponse system in the GABA feedback loop I would love after you guys kind of\r\ndigest this and stuff if you have any\u00a0\u00a0 thoughts reactions connections I would\r\nlove to hear back from you I’ll put\u00a0\u00a0 my email and other than that have a wonderful\r\namazing weekend and I will see you on Tuesday if you enjoy this podcast please like and\r\nsubscribe either in your podcast player or\u00a0\u00a0 on YouTube you can attend and participate\r\nin our live webinars with doctor Snipes by\u00a0\u00a0 subscribing at all CEUs comm slash\r\ncounselor toolbox this episode has\u00a0\u00a0 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No Learning Curve, So Easy To Use<\/a>","protected":false},"excerpt":{"rendered":"<p>this episode was pre-recorded as part of a live continuing education webinar\u00a0\u00a0 on-demand CEUs are still available for this presentation through all\u00a0\u00a0 CEUs register at allceus.com\/counselortoolbox I’d like to welcome everybody to today’s presentation of addiction and co-occurring disorders\u00a0\u00a0 part two the physiology of addiction and mental health issues over the next hour we’re going &hellip; <a href=\"https:\/\/effectsofanxiety.net\/archives\/150215\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Physiology of Addiction and Mental Health Issues<\/span><\/a><\/p>\n","protected":false},"author":3,"featured_media":150212,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[409],"tags":[38507,34232,38512,37897,37895,38513,38514,38515,37905,38531,38510,38518,38505,36289,37878,38508,38509,59870,59845,1629,38533,38520,37893,37894,38517,38521,36776,38522,38523,38524,37876,34002,38529,38525,38526,59865,38532,38527,37906,38528,38530,35373,7139,38506,38511],"class_list":["post-150215","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health","tag-adacb","tag-addiction","tag-alcohol-and-drug","tag-cadc","tag-cap","tag-ccapp","tag-ccdc","tag-ce","tag-ce4less","tag-cebynet","tag-certification","tag-certification-board","tag-cheap-ce","tag-coaching","tag-counseling","tag-counselling","tag-counsellor","tag-counselor-exam-review","tag-exam-review","tag-florida","tag-homestudy","tag-ladac","tag-ladc","tag-lcdc","tag-lcsw","tag-licensed-counselor","tag-lmft","tag-lmhc","tag-lpc","tag-lpc-ce","tag-lpc-ceus","tag-mindfulness","tag-motivational-interviewing","tag-naadac","tag-nbcc","tag-ncmhce","tag-online-ceu","tag-online-training","tag-quantum-units","tag-relapse-prevention","tag-sex-addiction","tag-studies","tag-training","tag-unlimited-ce","tag-worker"],"jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/effectsofanxiety.net\/wp-content\/uploads\/2023\/01\/htmlF_IMG_63c590d131e0d.jpg","_links":{"self":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/150215","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/comments?post=150215"}],"version-history":[{"count":4,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/150215\/revisions"}],"predecessor-version":[{"id":150247,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/150215\/revisions\/150247"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/media\/150212"}],"wp:attachment":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/media?parent=150215"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/categories?post=150215"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/tags?post=150215"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}