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Jun 27
ScienceCasts: Solar Minimum is Coming
High up in the clear blue noontime sky, the sun appears to be much the same day-in, day-out, year after year. But astronomers have long known that this is not true. The sun does change. Properly-filtered telescopes reveal a fiery disk often speckled with dark sunspots. that illuminate Earth with flashes of X-rays and extreme ultraviolet radiation. The sun is a seething mass of activity. Until it’s not.
Jun 20
Public Lecture: Reconstructing ancient human history from DNA
Thank you all for coming out tonight and giving me the opportunity to talk to a somewhat different group of people from the people I normally talk to our scientific results of talk to about our scientific results so I wanted to start by as Bruce mentioned in his introduction by talking a little bit about the New York Times those of you who read the New York Times science page or the Washington Post or The Guardian or look at National Geographic or any of these other publications will have seen headlines like this it’s a very nice article that came out about a year ago by one of the best science writers in the area of evolution Carl Zimmer about reconstructing the Tree of Life and if you were to click through and look at that article you would see an image that looks like this showing the evolutionary relationships among 3,000 different species sampled from across the globe and if you look closely at this picture you’ll see that most of this tree is made up of single-celled organisms bacteria and primitive single celled organisms called archaea and the organisms that we know best including animals, plants and fungi are all down in this little tiny corner here and the animals that we identify with the most such as vertebrates and mammals are so small that they don’t even get a label on this graph so some of these pictures are quite remarkable you can see from this picture that everything traces back to a single universal ancestor of all living things that would have lived about 3.
Jun 13
Welcome to Your Kaiser Permanente Surgical Experience - Richmond Medical Center | Kaiser Permanente
[music] Hello, I’m Dr. Judy Park. I’m a surgeon and the Physician-in-Chief. 00:19 - It’s my pleasure to welcome you to the Kaiser Permanente Richmond Medical Center. 00:25 - As the Physician-in-Chief, I’m responsible for the medical care delivered in this hospital. 00:31 - Here in our state-of-the-art facility, we perform over 6000 surgical procedures per year. 00:38 - It’s our goal to make certain each of our surgical patients and their loved ones feel comfortable, informed and well taken care of.
May 5
How to check for accessible colors -- A11ycasts #17
Hey everybody, what’s up? It’s Rob Dodson, welcome back to the A11ycasts show. 00:08 - Today we’re going to be talking about color contrast. 00:11 - So, in a nutshell, contrast is really the difference between two colors. 00:15 - You know, if you imagine a color wheel, and you have two colors that are far apart on the color wheel, or polar opposites on the color wheel, those colors are going to have a lot of contrast because they’re really really different.
Apr 26
Introducing the Kaiser Permanente San Diego Medical Center | Kaiser Permanente
- [Narrator] Introducing Kaiser Permanente’s beautiful new state-of-the-art San Diego Medical Center, a world-class addition to our integrated health care system that includes the Kaiser Permanente Zion Medical Center, the Palomar Medical Center in Escondido, and 24 medical offices throughout San Diego County. 00:19 - More than 617,000 square feet in size, the San Diego Medical Center is centrally located in the Kearny Mesa area with easy access to major freeways.
Feb 9
Cognitive Behavioral Therapy Addressing Negative Thoughts with Dr. Dawn-Elise Snipes
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. 00:27 - I’d like to welcome everybody today to cognitive behavioral therapy addressing negative thoughts. Now a lot of us took courses and cognitive behavioral therapy we’ve worked with CBP for many many years so some of the this is just going to be a refresher and others you know you may pick up a few new tips or tools as we go along so we’re going to define cognitive behavioral therapy and its basic principles just get a really basic refresher on what was that original CDP about well identify factors impacting people’s choices behaviors because you know they always have a choice we’ll explore causes and the impact of thinking errors whether you call them cognitive distortions irrational thoughts or when I work with my clients I try to call them unhelpful beliefs or unhelpful thoughts because distortions and irrational seems sort of pejorative to me so I try to avoid those words as much as possible and help clients see them as not incorrect necessarily but unhelpful and then we’ll identify some common thinking errors and their relationship to cognitive distortions and some of our just very basic fears why do we care well because cognitive distortions or irrational thoughts or unhelpful thoughts whatever you want to say really impacts people on a physical level a mental level and an emotional level a person who perceives the world is hostile unsafe and unpredictable will tend to be more hyper vigilant until they exhaust the stress response system so think about you know a bottle ship and you’ve got a bunch of new people on this battleship and all the sailors every time there’s the least little thing they send off the all-hands-on-deck so a big bird flies over and I mean literally a bird and they freak out found me all hands on deck and this goes on for a week or two or six months you know let’s think about our clients they don’t usually come in right away where everything is set to OFF that startle response everything sets off that fight-or-flight response the staff starts to get exhausted all the rest of the sailors that have to drop everything and run to their battle stations after a little while they’re like really no no we just we can’t even do this and it also reminds me of the boy who cried wolf anyhow I digress sticking with the battleship metaphor so eventually the captain says you know what let’s retrain on what is worth setting off the all hands on deck because everybody here is exhausted and nobody’s even really responding anymore when they come to their battle stations they’re just kind of dragging their butts in like whatever it’s probably another false alarm the same sort of thing is true with us when we’re on on high alert for too long our brain says you know what we got to conserve some energy in case some really really big threat comes along so it turns down what I call the stress response system it turns down the sensitivity so you don’t get alerted for every little thing that would cause you stress but you also don’t get alerted for those little things that would cause you happiness either anything that would cause the excitatory neurotransmitters to be secreted you’re just not getting those anymore which a lot of people kind of refer to as depression it’s just kind of like the F whatever and only the biggest most notable things actually cause an emotional effect we don’t want people to get to that point that’s no way to live so we need to help them learn how to sort of retrain their spotters to figure out what is actually stressful a person who perceives the world is generally good and believe they have the ability to deal with challenges as they arise will be able to allow their stress response system to function normally there are going to be times you have all hands on deck whether it’s a real emergency or whether it’s just a drill but it will happen and they can go they can you know do what they’re going to do they have that adrenaline rush they have the energy and the focus to do their jobs and when it’s over they go back to their quarters they can relax refresh you know just kind of chill for a while and then there’s a low where their body rebalances before the next one and this is kind of what we want in life I mean ideally we wouldn’t have super high peaks very often but we want to make sure we give our body time to rebalance after there’s a stressor and not have to stand on on edge not be hyper vigilant constantly just waiting for the next one to come along so what is the impact of these thinking errors well whenever we have that stress response system activated the body is saying we either need to fight or we need to flee so you’re dumping all kinds of adrenaline and other neuro chemicals so there’s anxiety there can be stress when people start having this reaction you know they start having muscle tension sweating heart rate increases breathing increases people will call that anxiety some will label that as anger either way they’re both sides of the same coin they need to do something but if it lasts too long then we start moving into depression and they just they don’t have to get up and go anymore there’s just not any excitatory neurotransmitters really left they need some time to rest and rebalance behaviorally think about it if you go somewhere and you are just constantly on guard are you going to keep going there or are you going to withdraw so people who have a lot of thinking errors unhelpful thoughts tend to withdraw more they may turn to addictions to kind of numb or blunt some of the inputs sleep problems and changes when you are hyper vigilant when you have this stress response going even if it’s not a full-bore if it’s still there somewhat if you’re stressed out you’re not going to sleep as well you’re going to maintain higher levels of cortisol so you’re not going to get that restful rejuvenating sleep you may kind of goes on and off eating changes you know depending on the person some people eat the self food that some people can’t eat it all but we do see that the hormones Guerlain and lets them get all out of whack not under stress but also when sleep gets out of whack when your circadian rhythms get out of whack so we’re starting to see the Cascade effect where it’s emotional and behavioral physical you’ve got stress-related illnesses that start coming up if you’re on that lunch you’ve got muscle tension for that long it starts to hurt I mean you start to get migraines your back starts to hurt wherever you store your stress so to speak it starts to come out and most people when they’re under a lot of stress for an extended period you know a day is not a big deal for most people but for an extended period become more susceptible to illnesses they start getting sick easier headaches GI distress you know some people store their stress right in their gut socially think about the last time you were stressed were you patient and tolerant and just a pleasure to be around you may have tried to be but you’re more prone to irritability and impatience and again wanting to withdraw all of these affects contribute to fatigue and a sense of hopelessness and helplessness which often intensifies thinking errors so you’ll see this negative reciprocal interaction if somebody feels stressed out and overwhelmed and that they withdrawal then they may start feeling like they have no support and they don’t and they lose all their social buffers to the stress so they feel even more stressed so they want to withdrawal even more so we’re going to talk about how to prevent that now I like this little diagram maybe because it’s got a heart in the center I don’t know but behavior feelings and thoughts this is the outside of the circle all three of these impact diecuts each other when you do something it often impacts your feelings and your thoughts about a situation when you when you’re thinking if you think positively you’re probably going to choose more positive behaviors and more have more positive feelings you’re thinking negatively obviously you may choose more of an escape behavior Protection behavior and may have more feelings of anger anxiety depression etc so these things are going on and they’re all interacting the one really cool thing is if you break this chain somewhere or this circuit then you can stop that reciprocal negative downward spiral so cognitive behavioral helps people who are willing to show up or who are willing to address their thoughts not everybody is willing to start addressing their thoughts right away maybe they want to start addressing their sleep problems in their eating problems or something that’s more physical okay that’s fine because anywhere we interrupt this circuit is going to have positive effects assuming the intervention is positive it’s going to have positive effects on the other ones so what about the triangle well yourself so you’re feeling thoughts and behavior impact you it impacts how you feel and you’re like well yeah okay just stay with me but the way you feel think and act impacts your future and it also impacts how you interact with others so you know that kind of affects things because remember social support is a big buffer for us now core beliefs and you can do this inward to outward or outward to inward but either way it comes down to core beliefs if you have positive thoughts and positive feelings and you generally engage in positive behaviors to keep that cycle going you will probably feel pretty good about yourself have good relationships have a somewhat optimistic feeling about the future and your core beliefs may be more like people are generally good I can do this you know very self affirming and other affirming positive core beliefs about yourself in the world now if your thoughts or feelings are negative then you have this negative outer circle you don’t feel so good you start questioning the goodness and Trust ability and dependable of other people you have more of a bleak look in the future so what do you think is going to happen to the core beliefs the core beliefs may change too if someone doesn’t love me I am completely unloveable they may change to being more extreme more negative and more difficult to rectify if you want to have somebody who’s happy I mean you’re not going to have somebody who’s happy who thinks the world is an unkind unpredictable scary place going it’s just wonderful roses today so we have to help people try to adjust eventually start adjusting those core beliefs and when we get into causing that behavior remember the ABCs your automatic but well your automatic thought then your and beliefs are what happened as soon as that event occurs and those you don’t think about that’s why they’re called automatic so when you have the ABCs these core beliefs are those things that pop up that we need to address so what factors affect this and whoops you know there’s a lot of stuff right here and EBP they call them vulnerabilities you know we’re just going to talk about in general different factors that affect the choices our clients make in terms of behaviors so negative emotions if they are not if they’re feeling angry if they’re feeling anxious they’re feeling depressed they’re probably not going to be really motivated to get up and engage in a whole lot of self affirming activities they’re not probably not going to be having a lot of positive self affirming thoughts they’re going to be focused on whatever is causing that distress and maybe escaping from that physically pain and illness when you don’t feel well it’s harder to be Susie sunshine I don’t think many of us are just a barrel of monkeys when we don’t feel well so if our clients have pain this is one of those if you want to put it in behaviors behavioral areas physical areas we can address and have them go see their physician have them go see their physical therapist and get recommendations so they aren’t feeling physically painful physically and distress all the time because physical distress and emotional distress both mess with sleep unfortunately sleep is the first thing to usually go and I’m not talking about quantity I know a lot of clients who when they get depressed they’re in in bed for you know days they’ll get up they’ll maybe shower and you know go back to bed and they’re sleeping a lot but it doesn’t mean it’s quality sleep so what we need to look at is what is the quality of their sleep are they getting that rejuvenation the time for their brain and neural chemicals to rebalance so they can feel happy so they can have that nice balance of all the the neurotransmitters they need to feel happy poor nutrition well no matter how much sleep they get if they don’t have the building blocks to make the neurotransmitters and the hormones that are needed to prompt the feelings the physiological sensations that we’ve labeled happiness or excitement or you know even depression and anxiety those are all caused by different neurotransmitters being secreted in different combinations if your body doesn’t have the building blocks to make those then it doesn’t matter how much sleep you get you’re not going to get any benefit from it an intoxication and this can be uppers downers anything that is psychoactive if you are messing with that neurotransmitter balance you’re going to get it out of whack and you may either use up too much of the excitatory or cause us a lot of it or you may use up too much of the depressant either way there’s usually a rebound effect which we call withdrawal so you’re not going to be in a good space either during the intoxication sometimes but definitely when you’re sobering up there’s a period where there’s going to be negative emotions negative feelings environmentally yeah your environment can even make you grumpy introduction of a new or unique situation some people love new challenges love going to new places other people not so much depending on the person taking on going somewhere new may be really stressful for them so if they’ve already got de-stress going on because of having to go to this new situation then their thoughts may be a little bit more on the anxious side about a lot of things and they may have less patience and tolerance to deal with other stuff that comes their way because they’re already kind of on edge and exposure to unpress you know going places that you just really don’t want to go maybe and one of the places I used to work we had this meeting once a month and it was literally an eight-hour meeting and we would all sit in there for eight hours and one person at a time would get up and give their staff reports or whatever but it tended to be a relatively dreadful sort of environment or eight hours and we all knew we had to be there and that was fine but it was an unprecedented were grumbling on the way in they were getting their coffee and going well I better do this because I’m not getting out for another eight hours we need to help our clients obsess what is it in your environment if anything that is making you already feel grumpy or not as happy and likewise what can you put in your environment to make you feel happier you know I keep pictures of my kids and my animals on my phone that way if I’m having a moment or not sometimes I just like looking at them I can take a look at it it makes me smile and I’m like okay life is good you know this moment may not be so wonderful but it’s just this moment then we move on to stress of a social nature peers or family who convey irrational thoughts as necessary standards for social acceptance nobody wants to associate with those people or nobody’s going to like you when you’re like this or you read if you really want to be successful then you need to change fill in the blank it’s always a something needs to change you are not okay for who you are how you are and a lack of supportive peers to buffer stress because we all have negative people in our life it happens but if you have negative supportive peers that you can call afterwards and go yeah I had just had to meet with someone so for an hour and it was just dreadful and that person can go well I’m sorry or be there make you laugh or whatever they do it helps buffer the stress if you don’t have those positive social supports then you’re left walking out of it you’re kind of feeling shell-shocked and then you also at the same time have to figure out for yourself all right what do I do next now it doesn’t mean you can’t do it you know people do it all the time but it is good it is awesome to have supportive peers to buffer your stress so when cognitive therapy clients learn to distinguish between thoughts and feelings realizing that thoughts will trigger feelings but they don’t have to cause continual feelings and behaviors and feelings can cause certain thoughts but they don’t have to you can unhook from them and you can just say this is how I’m feeling right now now where am I going to go from here and we talked about that on Tuesday with unhooking from unhooking from your thoughts and stepping back and going what is the next logical action to get me to where I want to go become aware of the ways in which the thoughts can influence feelings in ways that are sometimes not helpful being critical being jealous envious maybe you just don’t like somebody and you know there’s a whole lot of reasons for that but you don’t like everybody most people don’t like everyone and so it’s you know that’s okay but recognize how that affects your interactions with that person and your thoughts about that person learn how thoughts that seem to occur automatically affect emotions so recognize start getting down to what are these core beliefs that happen every time it’s a negative incident that make me feel angry or anxious constructively evaluate whether these automatic thoughts and assumptions are accurate or perhaps biased evaluate whether the current reactions are helpful and a good use of energy or unhelpful and a waste of energy that could be used to move toward those people and things important to the person so again back kind of to that ACP sort of thing is this a good use of your energy to help you achieve your goals and be the person you want to be and develop the skills to notice interrupt and correct these biased thoughts independently like I said you don’t always have to call somebody you can do it on your own but sometimes it’s nice to have that buffer in that middle moment so what causes these thinking errors how can we even start helping people address their thoughts and until we start thinking about well what caused them information processing shortcuts as we grow up we learn things you know when you were knee-high to a grasshopper you didn’t have a lot of experience so you learned things but things you learned when you were a kid unfortunately because you were cognitively a child are either our dichotomies they’re all or nothing it’s either this way or no way at all so things that you have things that you learn back when you were a child may not have been challenged if you heard something from your parent maybe your parents said you’re a bad girl or you’re a bad boy it’s all or nothing well I am a bad girl so I guess that means I’m not okay and if I’m not okay right now I’m never okay that can stick with a person so these outdated amis schemas can really trip somebody up once the person gets into you know middle school ish the thoughts aren’t nearly as dichotomous there’s a lot more formal operational thought if you will but up until then I mean you’ve got a child who’s experiencing a lot of stuff and taking in like a sponge everything they hear and it gets sorted into a yes or a No pile there’s there’s no kind of middle pile that there’s no yes and so what we want to do is help people look at those thoughts now and say okay if they’re all or nothing is there a way to find both and so for example we’ll take that exam scenario I gave you earlier if a child hears you’re a bad girl when they’re young they take that to mean always everything about me is bad I’m unlovable so what is the both and compromise as an adult we can look back and go you know I’m a good person I may not make may make poor choices sometimes I may make bad choices but I’m a good person so there’s that both and you know I’m not perfect but I’m good so that it’s not all or nothing and I encourage my clients to really always look for that middle ground how can it be both or does it have to even be that negative one but most of the time there’s a little bit of something on both sides the brain’s limited information processing capacity and limited responses when children are young you know they hear something you know mom comes in and says you’re a bad girl and child hears I’m totally unlovable and it just crushes the child they don’t have experiences to go moms having a bad day she kind of tends to say things she doesn’t mean when she’s having a bad day it’s just it’s devastating to that child when you’re older if somebody says something that’s not necessarily tactful you know you can look at it and go yeah that really wasn’t nice but that person probably did not intend to be hurtful they may have something else going on children have fewer experiences so what was devastating or overwhelming as a child may not still have have to feel that way when you’re a child if your best friend moved away oh that was devastating it was the end of the world now as an adult you can go visit them you can call them and with the internet and everything you can email them you can still stay in touch so there are ways to do it yeah you can’t go out and swing swing on swings together all the time but it doesn’t have to mean the end of the end of time things will change and there’s a little process of grieving that has to go along with that but to an adult a friend moving away is less devastating than say to a six-year-old your parent being angry with you if you grew up in an alcoholic or addicted household you learn don’t talk don’t trust don’t feel when the parent came in if the parent was angry with you you could have been in a lot of hurt you know there could have been some actual danger to your physical or emotional person so it was scary as a 26 year old or however old your client is is it that threatening you know if your parent gets angry with you you don’t depend on them for food and shelter anymore you don’t have to be an inner household if they were violent towards you so is it as terrifying when your parent gets angry yes there’s lots of issues with wanting acceptance from your parents that’s over here there’s a whole nother issue but when your parent is angry do you have to have that person’s approval when we’re in crisis we don’t process much when you’re in crisis your body is worried about surviving if you’ve been in a car wreck if somebody has gone to the hospital whatever the case is you’re not processing all of the data in order to make it in for decision you’re processing what’s right in front of you because when we’re in crisis we generally have tunnel vision and really crappy memory so if something happened when someone was in crisis that hurt their feelings made them angry you know fill in the blank some sort of dysphoric emotion we want to say well let’s look back at that and see if there’s a pose and let’s look back at that and see if there was something that you missed that might help you understand why this person reacted that way but understanding that in crisis we just generally don’t make the most informed decisions so emotional reasoning helping clients understand that feeling or not facts and helping them learn to identify feelings and separate them from facts so if they say I’m terrified all right so you’re terrified got that about what are you terrified you know tell me what are these things that make you feel like the world is such a scary place and let’s list them on the whiteboard or a flip chart what is the evidence that those are present dangers right now that they’re actually impending threats so tell me about what the evidence is in what ways is this similar to other situations where you felt terrified and how did you deal with those situations I have a friend who actually went this morning on an airplane flight and she hates flying totally terrified of it so what is the evidence that this plane is going to crash you know what is the evidence that it is likely that this plane will crash and there really she’s flying on an american-based commercial airliner there really isn’t any when you look at the proportions so okay there’s there have been a couple of crashes over the past 20 years and in a couple of those there were some fatalities no doubt but looking at the proportions and running the numbers what’s the likelihood in what ways this is similar to other situations that you have felt terrified you know maybe there haven’t been any other situations where she’s flown and gotten through it and been like score I did that but what other situations have you had to get through that you were terrified and how did you deal with those help people develop distress tolerance skills one of the things I told her was when you’re sitting on the airplane and you know the airplane starts up don’t wait til you start getting really stressed necessarily but when we were little on the car when we’re in the car we used to find things on the drive find something that starts with a and everybody would find something that started with a and then find something that starts with B and you know so on and if you couldn’t find something that started with that letter you were out so I mean she’s going on this trip with her kids and I’m like why don’t you try doing that because there are some letters that you’re going to have to work really hard and it’s kind of like the game apples to apples you end up finding something really inane in order to get that letter and you laugh and you’re so busy focusing on that you’re not focusing on all of the things that could possibly maybe go wrong other distress tolerance skills you know you can go through the whole DBT curriculum and learn some of those the biggest thing is if you have to face the terror if you have to go through it figure out a way to not have to focus on it and fight it and go I shouldn’t be afraid I shouldn’t be because that doesn’t work if it worked we wouldn’t be talking about it and develop emotional regulation skills so prevent those vulnerabilities set yourself up so you are as prepared as you can to not feel stressed to not feel anxious she has her spouse with her who can help diffuse some of it she’s got her kids with her she downloaded some movies she’s prepared to endure the distress she’s you know trying to go into it with a positive mindset as much as possible and focusing on the destination which you know is ultimately the reason she’s getting on the plane social causes of stress and thinking errors everybody’s doing it well that’s not true there’s very real that everybody does so correcting misinformation how the client gather objective information about you know if they say well everybody else that I know has succeeded okay well let’s gather objective information about that who do you know and tell me if they’ve succeeded if I want to be liked I must do it this need for approval or low self-esteem can cause a lot of problems in thinking errors and fears of rejection so we say okay let’s look at developing some self-esteem so you don’t need to worry about if somebody likes you what would it be like if you woke up in the morning and you didn’t care if so-and-so liked you I mean we all want to have friends don’t get me wrong I’m not saying you want to be her moving out in the woods but if we’re talking about a particular so-and-so what would it be like in the morning to get up and go you know what if that person messages me today or call us me today that’s great and if not I’m okay with that how liberating would that be to get your power back and how people develop social supports that share their same values and goals at least mostly or at least can respect yours so for example when you know I work with people with co-occurring disorders and they don’t drink and they don’t use drugs so they may be around people family friends who drink if you’re going to be in that situation do you have to drink and can you be around do you have social supports that can be supportive of your choice to not drink doesn’t necessarily mean they’re it’s not going to not going to not drink in front of you but at least they’re not trying to get you to drink so the social causes of irrational thoughts if I want to be liked I must do this why can’t you be like for who you are cognitive bias negativity mental filter focus on the negatives and worry about the future most of us know some people like that most of us have had a moment where we felt like this we’ve just gotten ourselves in a tizzy and spun out of control but you can bring it back so you want to ask yourself or have your clients ask themselves what’s the benefit to focusing on the negative if you know that this is going to go south really fast what’s the benefit to just focusing on that could you focus on alternatives or Plan B’s what are the positives to the situation most people who have mood issues who present to us in counseling don’t focus on both sides yes every side you know has a little bit of negative to it if you really want to look hard enough but every side also has a silver lining if you really want to look hard enough so we need to balance the the positives and the negatives so encourage people to look for the positives in the situation yeah this really sucked but and what are all the facts what are all the things going into it sometimes people will go to work and not know or wonder if they’re going to get laid off because you know you’re not necessarily always guaranteed a job anywhere there can be layoffs but if somebody is going to work every day worried about this focusing on the negative up yep I’m definitely going to be the one that’s going to get the pink slip and they go to their mailbox each time looking for that pink slip expecting it to be there how is that going to affect their mood as opposed to alright there may be layoffs coming what can I do to make myself really valuable or and what are my options if I do get laid off let’s make a plan B and C so I don’t just feel like the rug was pulled out from under me coin toss activity if somebody tends to be stuck in negativity have them flip a coin every morning if it lands on heads they can just see their normal selves to their heart’s content if it lands on tails they need to act as if they are a happy positive optimistic maybe even a noxious ly optimistic person for the entire day you know we want them to be farting rainbows and when I say that they usually look at me and laugh and but that’s okay I’m like every time you start having a negative thought I want you to see a unicorn farting rainbows and take it from there and then have them process how they felt at the end of the day if they weren’t constantly focused on negativity and worrying and only seeing the bad stuff disqualifying or minimizing the positive if something happens when somebody says well I just got that promotion because they didn’t have anybody else to give it to okay if your best friend just got a promotion would you say that to them what is scary about accepting the positive about accepting the fact that maybe you got the promotion because you’re awesome sometimes we disqualify the positive because it fails to meet someone else’s standards so might that be true here you know maybe you got this promotion and you’re actually down deep down inside kind of proud of it but you know that your mother had always wanted you to be this over here and you’re never going to meet that expectation so you minimize it that way nobody else could say well you know better than nothing and take away your thunder egocentrism my perspective is the only perspective take different perspectives I always say three if something happens and you know maybe somebody was rude to you anyone they were rude to me okay they were rude to you what are three reasons what are some alternate perspectives why that person might have been rude maybe what you did something that triggers them maybe they were having a bad day and it’s got nothing at all to do with you you know there are options that we can look at personalization and mind-reading what are some alternate explanations for the event that didn’t involve you if you think well that person that person just really doesn’t like me and you know I’ve got to work with them every day and they hate me my question to my client would be what what’s the evidence for that and what are some alternative explanations for why that person may be behaving that way I had a staff member that a lot of my other staff members had difficulty getting along with and ultimately you know we had to sit down and look when I had some different staff meetings with people and say you know what gives you the idea that she doesn’t like you what gives you the idea that it’s about you and you know they cited all kinds of behaviors and I had to come back to well what are some alternate reasons why somebody anybody not just her might be expressing those behaviors could it be something besides you and of course they came back - yeah availability heuristic remembering what’s prominent in your mind if somebody was if you’re a supervisor for example and you’re doing evaluation for the year what are you really remembering when you’re doing that evaluation the whole year or the last three months and that’s the event fail ability heuristic so when you’re talking to somebody about their relationship with their best friend or their spouse or their kids and if somebody says well that that child has always been a problem okay let’s look at that you know the child is 18 and you’ve had a lot of problems with him lately but what about three years ago so was he always a problem or is this something that’s relatively new that something might have changed magnification people getting stuck on fearing the absolute worst so you want to ask them is this a high probability or low probability outcome if they’re magnifying something that happened like oh my gosh that is the worst thing in the world is this going to matter six months from now maybe you totaled your car and yeah that is a huge bummer and you’re safe in six months is this really going to matter that much you know there are going to be some bills and everything but the big scheme of things is at the end of the world what have you done in the past to tolerate events like these when something really really unpleasant has happened and then if they’re looking at dichotomous ways of thinking which a lot of our clients still do they’re like someone so it always does this or never does this have them look at the differences between love versus hate perfection versus failure and all good intentions versus all bad intentions because a lot of our dichotomies fall in one of these three categories this person always does this or Never or does it intentionally or you know just doesn’t care belief in a just world the fallacy of fairness encourage people to look for for good people they know that have had bad things happen attributional bearers are labeling yourself not a behavior such as saying I am stupid instead of I don’t have good math skills I am is difficult to get rid of I can’t get rid of stupidity if it’s part of me but if it’s a thought or a skill I can either get rid of it or improve it stable I am means I am right now and I probably always will be stupid verses I can change this thought or skill I can learn math and internal attributions mean it’s about me as a person versus about a skill or skill deficit or something completely unrelated so when somebody makes a global internal negative statement we want to help them challenge that global internal positive statements I’m all about but the negative ones I want to say let’s take a look at that is that true that this is about you all of the time and it means that there’s something wrong with you so we want to ask them how are these thoughts how are these ways of thinking impacting your emotions health relationships and perceptions of the world we want to increase motivation to start looking at these spanking errors because it’s a lot of work to start changing the way you automatically think because you’ve got to stop you’ve got to become mindful and then you’ve got to decide well what are the alternative thoughts because this is what I thought for so long how may have this thought has been helpful in the past most of the time thoughts we have came from somewhere and whether it was a thought we had when we were a child something we learned when we were a child that is dichotomous and not quite applicable anymore it may have been helpful in the past to help you navigate situations doesn’t mean it was wrong it means it’s not helpful in the present asking them to always ask themselves is this thought or feeling bringing you the client closer to those people and things that are important to you it’s hanging on to this negativity bringing you closer and and I like the energy philosophy if you will when you are unhappy you are letting this person have your power you are letting this person make you angry when you decide you are not going to give them your power then you may start feeling happier and I don’t always use that with clients but sometimes the power metaphor help when we talk about thinking Ayers asked them are there examples of this not being true and and or how can a statement be made less global stable and internal is it about you or is it about what you do at work is it about you or is it about your relationship with this particular person so the last couple of slides focusing on some of the irrational thoughts or unhelpful beliefs our basic fears are rejection and isolation failure loss of control the unknown and death generally the things that cause people to have this fight-or-flight reaction fall into one of those categories so some of the unhelpful beliefs that we hear a lot coming up when we do the ABCs is that mistakes are never acceptable so if I make one I am incompetent so we’ve got dichotomous thinking and we’ve got a lot of internal global labeling here rejection and isolation when somebody disagrees with me it’s a personal attack against me well sometimes it is what does that mean it’s about you we’re helping them address the rejection and isolation fears we want to ask them you know if they disagree with you were they attacking you and saying you were stupid or were they attack attacking you want to use that word or were they attacking the thought and saying they disagreed with the thought there’s a little bit of a difference it’s somewhat semantics but it’s a difference because they may have a lot of respect for you but they may disagree with what you just said if someone criticizes or rejects me there must be something wrong with me again that’s one of those internal global negative statements to feel good about myself others must approve of me we want to make sure our clients can self validate and they don’t rely on external validation because they’re setting themselves up for a world of hurt if they are not their own best friend to be content in life I must be liked by all people and thanks for a second are you liked by everybody I know I’m not liked by everybody so does that mean that I should not be content in life and what does it say to give people that power to say if you don’t like me that I can’t be content because I’ve got to be liked by everybody sometimes with clients I’ll help them look at what may be going on with the other person why that person might like them because a lot of times other people’s reactions towards you are more about their stuff than about you and helping them see how that might be true my true value as an individual depends on what others think of me so these other unhelpful beliefs pertain to those thoughts of failure and loss of control none of us likes to fail don’t get me wrong it’s not pleasant but it happens and there is a saying out there that says if you haven’t failed you haven’t tried which means we need to get beyond our safety envelope we need to push ourselves behind beyond our boundaries and when we do sometimes we’re going to stumble and fall and we pick ourselves up and we learn from it but to expect to never fail at anything is not realistic so nothing ever turns out the way you want it to how many times have you heard that from your clients I won’t try anything new unless I know I’ll be good at it I’m in total control and anything bad that happens is my fault so let’s look at this locus let’s control thing here you’re in total control so you can make it rain you know it was unpleasant today because I had to come to work and it was raining outside so that was bad it happened was it your fault pointing out and depending on your relationship for your client you’re probably going to be more or less snarky when you present some of these but a lot of times I have a semi joking relationship if you will with my clients and they’re like yeah I see your point that kind of didn’t make a lot of since other times you know if they’re more serious I’ll ask them to identify things that happened that were bad that they had nothing to do with if I feel happy about life something will go wrong or I’m always waiting for the other shoe to drop helping people stay focused in the moment with mindfulness and something’s going to go wrong down the road somewhere sometimes yeah it’s true this will happen let’s enjoy what we’ve got for right now the past always repeats itself it was if it was true then it’s true now so what was true when you were ten is true now that you’re forty always is that true it’s not my fault my life didn’t go the way I wanted everybody conspired against me and there’s no gray area so for people who feel the need to hold on to control its dichotomous it is or it isn’t it’s got to be that way there’s no gray area and it can make life be seem very uncomfortable because they’ve got to put things in one of two buckets and sometimes things don’t fit nicely in buckets what happens if we add a third bucket that both an bucket so a quick note about irrationality the origins of most beliefs were rational and helpful given the information the person had at the time and their ability to process that information because of their cognitive development so things that we identify as unhelpful or automatic beliefs now came from somewhere and they made perfect sense whenever they were formed they may not be healthy or helpful now which is why we want to look at them and either adjust them or just throw them out the door but when they were formed they were on point irrationality or unhelpful nasaw thoughts comes when those beliefs are perpetuated without examination so again we need to look at them continually look at what you’re telling yourself and go is this still accurate and continue to be held despite causing harm to the person sometimes you’re going to look at a thought an automatic thought and you’re going to go yeah that is still spot-on now is holding on to this helping me achieve my goals you know yet the world right now is kind of a scary place is holding on to this fear and terror helping me and be a happy productive yada-yada whatever kind of person you want to be or is it causing me to feel anxious and angry and scared sometimes it’s more productive for clients to think of thoughts as unhelpful instead of irrational because like I said I feel like irrationality and distortions seem very pejorative to a lot of clients so questions clients can ask themselves when they are faced with a situation what are the facts for and against this belief is this belief based on facts or feelings just because you feel scared is it a scary situation does the belief focus on just one aspect or the whole situation does the belief seem to use any of those thinking errors we talked about and if so you know what do I need to do about it what are some alternate explanations for this belief what else could have caused this to happen besides whatever I’m afraid of what would you tell your child or your best friend if they had this belief what would you took what would you want someone to tell you about this belief you could have somebody tell you something that would make you feel okay what would you want them to tell you and how is this belief moving you toward what and who is important to you remembering that beliefs are a combination of thought and fact and personal interpretation of those thoughts and facts I tend to when I talk you know you see me I kind of I’m all over the place with my arms I am a animated talker now if you are seeing me from a hundred feet away and you are seeing me talk might think I was angry because I make a lot of really big gestures because if you had grown up in a situation where there was domestic violence or something but if you had grown up in a household like I did where you had a first generation Italian first generations of ten Italian Americans talk big they talk real big with lots of gestures and sometimes loud and that doesn’t necessarily mean any anger a lot of times it’s just pure excitement so understanding that there’s thoughts in facts you know you see this going on but your personal interpretation can really affect what you get out of it or what you perceive that situation to be so we need to look at how is your personal interpretation maybe adding a negative bias and what what do we do about that it may be 100 percent accurate what do we do about it so it doesn’t keep you miserable thoughts impact behaviors and emotional and physical reactions emotional physical reactions impact thoughts and your interpretation of events irrational or unhelpful thinking patterns are often caused by cognitive distortions my two favorite words in that same sentence cognitive distortions are schemas or shortcut ideas or memories if you will which were formed based on faulty inaccurate or immature knowledge or understanding of the event you know little kids may not have quite understood what was going on they just understood that mommy and daddy were screaming identifying the thoughts the hecklers I call them those negative voices inside your head that are maintaining unhappiness helps people choose whether to accept the thoughts and say yeah you know that’s right I really am not good at that or whatever the negative thought is and change it or let the thought go are there any questions you you thank you miss Benson well thank you all if you come up with any questions you know you’re mulling it over later and you think you know that yet I’ve worked with a client and with something similar and I did this or you know you have a question about something I said feel free to email me the easiest one to remember is support at all CEUs com there’s only two others in the office so either my husband gets it err I do so it’ll get to me and I guess that’s it so I will see you all on Tuesday if you have any types of courses that you want to see added to the list please let me know I’m always interested in doing what you want to learn about not necessarily just where I pull out on my rabbit hat yes you can print the slides in the golly golly golly when you go into the class there’s a link that has a PDF of the slides that you can print if you want to print go ahead and print those out the video version of this will be up on YouTube by tomorrow morning maybe later this afternoon you okay everybody have an absolutely amazing rest of your day and weekend if you enjoy this podcast please like and subscribe either in your podcast player or on YouTube you can attend and participate in our live webinars with dr.
Dec 26
Mystery Box #031
Pat: Who are these people? Woolie: I- that is not the foursome that I was expecting. 00:32 - Pat: Who is that black guy? Woolie: Why is there a black guy, who is that? Woolie: Was that Cindy on the side? Pat: OK I have played a little bit of 15, I have not seen a black guy Woolie: I don’t know anything about what was happening there!
Nov 8
The Habits of Effective Artists
Hello! Last year I made a $1,000 bet with my younger cousin. Normally when siblings make bets it’s over something fun like doing a backflip on a motorcycle or something crazy like that. But mine was purely artistic. So the bet was: I had to get 1,000 likes on ArtStation, within six months for something that I’m terrible at which is 2D painting and drawing. And to make things more interesting, if I actually succeded, I would actually get nothing.
Nov 7
Dialectical Behavior Therapy DBT Made Simple: Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes
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/Counselor Toolbox. I want to welcome everybody to today’s presentation on DBT or dialectical behavior therapy made simple. This presentation was actually based off the book by the same name dialectical behavior therapy made simple move bad graphics there and I really like this book because it presents DBT skills in a very usable format there are a lot of us who aren’t ready to launch into being a formal DBT practitioner but we are intrigued by how DBT works and some of the skills and all that kind of stuff this is a great introduction if you’re not if you haven’t really studied DBT and you want to figure out how you might be able to use it with your current client base great place to start especially if you’re working with clients who aren’t at the level that Marsha Linehan was working with when she developed DBT where there’s a lot of self-injury I personally like to err on the side of being conservative when I’m starting with new techniques and you know I use newer things that until I get a good feeling for how they work and what the outcomes going to be I use those newer things with less acute clients and I use my old tried-and-true with clients that may be struggling a bit more and I want to make sure that when I put something out there it usually hits the mark not to say that I do it every time so we’re going to go over the basics of DBT will review the B and DBT what you need to know about behavior there is a ton of stuff I got my minor in behaviorism I took class is in behaviorism 416 college credit hours so there’s a ton of stuff we could go over and we’re not going to cover anywhere near that right now and most people don’t want to cover anywhere near that at all so understanding and DBT there’s a few things you need to know but it’s not crucial to be a behaviorist we’re going to talk about mindfulness again and it is really unimportant and interesting to me that over the past few years how much mindfulness has been incorporated in most every new sort of mainstream therapy now it’s not exclusively the therapy but there is a core element of mindfulness that we’re talking about and I think prior to the emergence of the term mindfulness we talked about it but we didn’t have a label to put on it and mindfulness with the label gives us the ability to have some skills groups that are specifically tailored around mindfulness which from a therapeutic perspective is wonderful and from a business perspective can also be wonderful we’ll talk about reducing emotional reactivity developing distress tolerance skills what clients need to know about emotions including regulating the painful ones and increasing the positive you know I harp on that concept of you can’t just eliminate bad you have to add positive otherwise you’re going to have a person who’s just kind of sitting there going well I can’t do what I what I used to do but I don’t have any other tools and we want to help clients become more effective in relationships we find that a lot of the traumas that people experience especially people with high emotional reactivity can go wet way back and to where they were knee-high to a grasshopper and they were expressing how they felt they were expressing their heightened sensitivity and they were being invalidated they were being told this you need to suck it up this isn’t that bad so from the get-go they had difficulty expressing how they were feeling what was going on with them and they were in an environment that was invalidating so there’s a lot of relation ship stuff that people need to look at in terms of their anxiety and frustration levels I mean when you keep getting told you’re wrong you feel some particular way and you tell someone this is how I’m feeling and they tell you no you shouldn’t feel that way yeah it’s going to increase anger and frustration and your sense of isolation and helplessness so with DBT we help people examine some of these things provide self validation but also develop tools for handling this emotionality so the clients that we’re working with are typically clients with a higher amount of emotional vulnerability they react to things others wouldn’t react to and their reaction is more intense than others so instead of being you know a 2 on a scale of 1 to 10 their reaction is more like a 4 or 5 sometimes that’s because they have a whole bunch of pent-up stuff that they’re trying to keep bottled up and then this is sort of the straw that broke the camel’s back but more often than not they are just highly sensitive and their recovery time is longer than others which makes sense if you get more reactive if you get more of an adrenaline rush it’s going to take longer to come back to baseline than a person who only had half the adrenaline rush totally makes sense however if the person is in an environment where other people don’t share these same characteristics they’re going I don’t fit in everybody else is fine and I’m still feeling not fine they have an inability to regulate emotion again because when they were growing up they didn’t develop that emotional vocabulary that ability to communicate to others what was going on and the validation that okay this is how you feel let’s figure out how to deal with it many times this particular set of clients was told you need to suck it up get over it if not that bad so they didn’t learn the tools to tolerate distress they didn’t learn the tools to handle their emotions we want to help them understand why they feel the way they feel if they get upset about something okay let’s look at why because there’s a lot more to feelings than just that surface level and these particular clients typically have difficulty expressing expressing the emotion in an effective way so it comes out as either gushing or passive-aggressive or angry because when they’ve tried to express it the only way they know how they’ve been shut down sometimes they will bottle it up because people keep telling them they’re wrong so they’re like well I’m in excruciating agony but nobody understands so I am just going to go drink myself into a stupor not the healthiest way to handle things so this is the clients that we’re dealing with they’re highly sensitive which means that they get really revved up and it takes a while for them to calm down and they need to help figuring out how to navigate in a world where other people may not get as revved up or may be able to calm down more quickly one of the underpinnings of DP DBT is dialectical therapy for dialectical theory sorry everything is interconnected there’s an action and there’s a reaction if I scream at someone I’m probably pushing them away they’re probably going to be like oh I don’t want a piece of that so if I scream at somebody I push them away but what else goes along with that then I’m more isolated I have fewer social supports which means I may feel more stressed because I can’t spread it out and get support which may increase the frequency and/or the intensity with which I scream at people to push them away so it’s a sort of self-perpetuating cycle if you will some of the examples of action and reaction addiction if someone uses drugs if someone engages in a behavioral addiction there is an epinephrine rush there’s a dopamine rush there is a lot of excitatory stuff going on in the brain and the person goes that felt good I want to do that again but the brain has said we’re not equipped to handle that level of stimulus so we’re going to shut down some of the gates turning it down to protect itself the brain does the person uses again they don’t get quite the same rush when they sober up some of those doors some of those gates are shut so it takes more for them to feel happy than it did before they started using so now they’ve created a situation where when they sober up they’re still feeling pretty crappy so they use again so there’s an action reaction now likewise when they stop using as the brain recovers the action of stopping using in the brain recovering produces the reaction of getting more positive neurotransmitter secretions and actually seeing color in the world if you will I already gave you the example of anger when people are really angry it pushes everyone away most people don’t want to hang around with somebody who’s just angry all the time it’s exhausting so being angry all the time pushes people away people who tend to be angry all the time part of what I hear from from them is nobody wants to be my friend I’m all alone nobody gets it well let’s look at how you got to be all alone so you push these people away and now you’re feeling frustration how can we deal with that depression when someone’s depressed sometimes they’ll stay in bed all day what does that do that messes up their circadian rhythms so then they don’t know when they’re supposed to sleep they don’t know when they’re supposed to be awake when they do sleep with not quality sleep so they get more fatigued so they want to sleep more and then they can’t seem to wake up and it intensifies their feelings of helplessness and hopelessness and then finally social interactions for our final example when you have a positive social interaction with someone what comes back you want to hang out with them again when you give out positive vibes if you will positively gets positive most time I mean as clinicians we see someone hurting and most of us are more than more than likely to run over and go how can I help but after we get past that when we’re talking about just social life when you put out positive you get positive in return when you put out negative you may be surrounded by other negative people or you may be all by yourself so let’s look at what the action reaction was reality is in a constant process of change so helping clients remember how they perceive something now may be different than how they perceive it in an hour if you get an evaluation and it is not a good evaluation and it’s just devastating you know it hurts you’re dealing with that right now but in an hour when the adrenaline has a chance to go away when you’ve had a chance to you know lick your proverbial wounds in an hour how do you feel is it the end of the world still or have you kind of adjusted most of us have learned how to tolerate de-stress ride the wave whatever you want to call it and an hour later we’re like okay that really sucked but it’s not the end of the world some of the things we can ask clients to do is look at what things change their perception between you know something happens and they feel one way and an hour later or a day later or six months later they’re like that wasn’t that big of a deal what changed their perception was it just time or how do they change their perception another thing we can ask them to do is figure out what when they’re in a crisis when they’re upset what is their emotional mind saying what is their heart saying if their heart could talk what is their reasonable mind or their detectives saying taking the two of those and this is the dialect the heart in the head and combining them and going alright now what can I get out of that I may not be able to do exactly what my heart wants I may not be able or I may not want to do exactly what my head says I should do so how can I find a compromise where can I find that middle ground finally the truth is always evolving and can be found by integrating multiple perspectives and tolerating the two opposite things may coexist two opposite things may coexist let’s talk about these perspectives simultaneous if you go to a crime scene and you ask five people who saw it take place what happened you don’t get the same response you’re going to get five different reports now there’s going to be some overlap but there’s also going to be some interpretation of what happened based on their prior learning experiences doesn’t mean they’re wrong no that’s their reality so if you take five different realities and merge them all together hopefully you get something closer to an objective reality when there’s an interpersonal disagreement and I was watching gaali The Daily Show the other day and Trevor Noah was talking about how in this particular election if you’re a Hillary supporter and something comes out about Hillary you can get frustrated that the news is focusing on this and not focusing on all the Donald Trump stuff if you are a Trump supporter and something bad comes out about Hillary you can get excited that they’re not focusing on the bad stuff about Trump and they are focusing on the bad stuff about Hillary so its perspective is it a good thing or a bad thing that something’s coming out and how are you interpreting it what is meaningful to you longitudinally means thinking about things from you know what was meaningful when I was six versus what is meaningful when I’m 26 one example would be what if a child says you know my mom had no use for us and and that’s why she left and a lot of kids feel that way or a lot of kids don’t understand why mommy or daddy chooses alcohol and drugs over them because that’s their exception as they grow up and gain more knowledge learn more about addiction hopefully sooner rather than later they start to understand that yes the parent left yes the parent chose alcohol and drug addiction however does that mean that the parent loves you any less so we need to talk about what that means another example is in abusive situations where a parent is supposed to love the child but the parent also beats the child so the child’s going well if mommy loves me but mommy beats me then I must be bad it has to be something with me because mommy tells me she loves me and but then I don’t get it helping the child or the adult the adolescent kind of rectify those two things that they can they can coexist your parent can love you but they can also do things that are harmful and hurtful at the same time does it mean that you are bad what other things could it mean so one of the things that is interesting in DBT is the fact that there are skills training groups and in individual sessions a lot of clients with high emotional reactivity really want to deal with whatever their present crisis is they really want to deal with them so it’s not a time to start teaching a whole lot of skills in skills training groups clients are able in a relatively neutral environment to learn some basic skills and then we can take from those training groups and apply them in individual sessions in a more heated situation where the person is telling you about their current crisis so your main skills include core mindfulness which is increasing self-awareness of thoughts feelings and urges when you have an emotion anger what thoughts are you having what feelings physical feelings are you having you’ve already labeled the emotion as anger so what physical feelings are you having what secondary emotions are you having oh we don’t ask that a lot so there’s anger but there’s also probably other stuff in there guilt resentment jealousy what’s going on and what urges are you having when you have these thoughts when you have these physical feelings and reactions what is your desire what is your behavioral urge this helps people start to understand what’s going on with them and go okay I see how the dots are connecting and the cool thing is that you only have to kind of break one of the links in the chain to interrupt this behavior so if they feel an adrenaline rush coming on you know they know they’re anxious they can feel their blood pressure coming up if they’re mindful and aware of that happening then they can intervene earlier than if they wait until they’re in full-out thought feeling urge I’ve got to make it stop mode core mindfulness also helps clients develop an understanding of their emotions as things that don’t have to be acted on and this is a new concept this is a really new concept for a lot of people and you know it’s interesting because my daughter is 12 almost 13 and I was typing a response to something on Facebook the other day and I was pretty passionate about it and we were getting ready to go out and put the chickens up or something I’m like hang on a second let me just finish this post that I’m doing and she looked at me she’s like you’re going off on somebody about something aren’t you I’m like well and she’s like you don’t need to let them get you that upset I’m like really my 12 year old is telling me this so I finished my post it was polite but it was to the point and you know we went on and did that but her awareness of the fact that you can get angry you can get sad you can get whatever it is but you don’t have to follow through with a particular behavior I thought was pretty good for 12 interpersonal effectiveness helps people develop assertiveness skills so they can say this is how I feel you don’t have to feel that way and you don’t have even have to agree that I should should feel this way but it’s how I feel it is what it is and we also help people identify the goals of their relationships and skills and activities needed to achieve those goals so how do you effectively communicate how do you create a win-win situation how do you negotiate and compromise instead of thinking of things in terms of black and white emotion regulation skills is your third group of skills that you’re going to deal with helps people label and effectively communicate feeling States if you’re telling someone that you’re angry and you use and when I was in counseling 101 our first counseling class we were told we were not allowed to use the words happy mad sad glad or afraid we had to find some sin on him but we were not allowed to use those five words in class because she wanted us to develop a deeper repertoire of emotion words so we developed an understanding of irritated and enraged and those sorts of things you can do a lot of really cool activities with not charades you put 15 or 20 different emotions in a hat on little pieces of paper people draw them draw them from the hat and then they’ve got to act out that emotion so they get a sense of what it might feel like what it might look like and then you can talk about what types of thoughts might go through your head when you’re feeling like that emotion regulation helps us understand the function of emotions and why we don’t want to eliminate them is anger a functional emotion heck yeah anger and fear tell you there’s a threat there is something you either need to defeat or get the heck away from now does nurturing it and holding on to it and whatever we do with it is that functional that’s generally not as helpful anger and fear are our body’s way our minds way of saying you need to do something and that’s it then you get up and you do something you either let it go you fix it or you get away from it happiness is an emotion we don’t want to get rid of that that one either because it says I want to do it again and thinking about kids when they’re little some of the things they want to do we were talking yesterday about peekaboo and I was sharing with my daughter that small children are so thrilled I mean they can be amused for 20 minutes or more if you just cover your eyes there you go peekaboo and you do it again and again and they laugh every time and you’re just sitting there looking at them going how can you find this amusing this helps children laughter is cathartic laughter is helpful anything we do that makes us laugh that makes us happy it’s something we want to do again now whether the child really finds it all that confusing or they just think it’s fun to watch us make complete fools of ourselves which i think is probably more it it’s providing joy to that child learning the connection between thoughts feelings and behaviors and how to break the chain as people start labeling their feelings they can say when I get angry this is what I first notice when I get angry my thoughts my feelings my behavioral urges are so they can figure out what can they do a lot of times the first intervention focuses on those behavioral urges we don’t want you to go out and use we don’t want you to go out and cut we don’t want you to do something that’s self harming so when you feel this emotion what else could you do and then we start talking about distress tolerance and how to get through those periods where emotions feel overwhelmed and your distress tolerance skills are really just your survival skills and alternatives to self-harm it’s saying I met a lot of distress right now however I’m making the choice not to engage in an unhelpful behavior so some of the assumptions in DBT are that clients are doing the best they can with the tools they have at this point in time nobody gets up in the morning and says I want to be miserable so I’m going to half-ass it today you know we really we get up and we go I want to have a good day and if people don’t end up having a good day you know life happens so you’re doing your best and you’re surviving the best way they can clients want to get better if the situation they’re in is causing them distress they generally don’t want to keep doing it do you want to keep banging your head into the wall no you know so the old adage goes why does Johnny keep banging his head into the wall because it feels so good when he stops so we want to say all right you’re doing this behavior and it ends up having a bad consequence let’s take addiction for example you get under a lot of stress you get angry you go out you drink you pass out you wake up the next morning during that short period where you were drinking you’re inebriated and you are unconscious you didn’t hurt that is the reward that we’re looking at it’s not that they didn’t want to get better it’s not that they were choosing alcohol it was that they were choosing to survive so we need to figure out how to help them work harder and smarter so what are you going to do instead let’s give you some more tools to work with it is hard changing from that knee-jerk reaction that has worked most of the time to changing to something else which is a new skill or a new tool that’s exhausting that’s hard it is hard work therapy’s hard work but we’re going to provide you some tools so you can do it efficiently and we’ll be there to support you and help you figure out how to you know tweak how your using that tool to make it more efficient for you this helps them stay motivated clients need to remember that even if they didn’t create their problems they gotta fix them sometimes stuff happens and it is out of that person’s control but they’ve got to figure out how they’re going to live with that if someone in their family some of their clothes - passes away yet they’re going to feel grief they’re going to go through all those stages and it really stinks they didn’t create that they didn’t you know cause the person to die but they have to figure out how they’re going to live with it so it’s not their problem anymore so they don’t stay grieving for 5 10 15 years clients need to learn to act skillfully in every area of their lives and one thing that is pointed out in the book is the fact that there are a lot of people with high emotional reactivity who are very successful in one or two areas of their life you know they may be you know very very successful at work but their home life is a shambles or they may be you know really good at home but interpersonally you know in social situations and at work not so much so we need to help clients learn how to generalize these skills and use them in every area of their life and finally and one of the most important in my opinion is clients cannot fail in therapy if we give them the tools and they’re doing their best and we’re working with them then we need to stop back and look and say okay how did the techniques how did your knowledge or what we’ve been parted to you not meet the standards that it needed to how did we fail how did the therapeutic process fail not the client the client is doing the best they can the therapeutic process may not have been as effective treatment priorities obviously the first priority if somebody is suicidal or engaging in self-harming behaviors including addiction that’s our primary thing then we look at behaviors that interfere with therapy calling in not showing up to appointment showing up late and this includes the clinician and obviously we’re not going to discuss that with the client but we need to be cognizant of things that we may do that interfere with therapy and we’ve all had clients before that have been more challenging than others and you’re like okay you know so-and-so is coming today and you know that they’re trying to work you know they’re trying to do their best however you’re just really struggling at that point in time because it’s exhausting and this is when DBT therapists or therapists in general need some support then we want to identify suicidal or self-harm ideation and misery so we’re not talking about the behaviors we’ve gotten down to the point where the person just thinks about cutting or thinks about committing suicide or thinks about using how do we deal with those obsessions or ideation if you will once we have eliminated the self-harming behaviors they’re engaged in therapy they’re not idealizing they’re not thinking constantly about self-harming behaviors they’ve made a lot of progress and we’re going to focus on treatment gains so let’s keep this going you know you don’t want to hurt yourself look how far you’ve come and what are some other goals that have been identified by the client now in each one of these places we need to interject mindfulness emotion regulation interpersonal effectiveness and distress tolerance so if you’re working with someone who is actively suicidal or engaging in self-harming behaviors obviously make sure they’re safe if they need to be in a facility so they are safe then that’s a whole nother step but you get to the point where you’re working with the person and you have them start becoming mindful of what triggers their suicidal impulses you start addressing the emotions that just flare up and feel like a tsunami as opposed to a ripple start looking at that emotion regulation start looking at interpersonal effectiveness when you start feeling this way how can you assertively communicate this and to whom can you assertively communicate this and finally when you start feeling feeling this way before you engage in self-harming behaviors what distress tolerance techniques might be available now remember somebody at this level at level one suicidal self-harming behaviors when they have an emotion when they get overwhelmed it’s not just a little overwhelmed it’s drowning in a tsunami overwhelmed so they’re not going to go well waiting my therapists say all of these things need to be written down they need to have them somewhere accessible that they keep with them at all times so they can look back on it and go okay this is what I need to do and it may be as simple as a phone number of someone they need to call now if you’re familiar with the DBT theory and the DBT structure a lot of you know doing true dialectical behavior therapy involves phone consultations with the clinician between appointments and a whole lot of other stuff not just skills groups and individual therapy for the purposes of this particular presentation we’re just going to focus on the skills that one would use in the dialectical behavior therapy skills that one could use in traditional therapy taking it to that next level developing a consultation group all that other stuff is a huge undertaking and a whole nother task it’s wonderful but it’s more than we can cover right here and then we move down once we’ve got got it to the point where the person is not actively trying to harm themselves and again I say suicide cutting addictive behaviors because all of those have the potential for self harm or maybe even accidental suicide address those first then we move down to behaviors that interfere with therapy and we go through the list again when you’re engaging in these behaviors maybe you’re coming late to de sessions you know let’s talk about mindfulness what is it that’s motivating that or why does therapy feel like it’s something you don’t want to come to start talking about what feelings and what thoughts surround therapy as far as a priority what’s changed move down to emotion regulation sometimes coming to therapy and talking about emotions all the time is just exhausting so how can we deal with that draining factor one mistake I find that a lot of my patients make when they start therapy is thinking that therapy’s easy you know I’ll just go to therapy an hour a week and everything will be fine and I’ll get better and I’m like no no that’s that’s not it I’m sorry you need to plan for therapy to be a part time job for the next eight to ten weeks because it’s going to take a lot of energy even if it doesn’t take a lot of time between sessions it’s going to take a lot of energy you’re going to be drained so you need to figure out how you can prepare for that and prevent it from interfering with your life which will potentially make you want to drop out of therapy suicidal or self-harm ideation and misery again go through the list maintaining treatment gains and then clients generally have their own goals so sometimes you work on that at the end sometimes you can work on a goal concurrently with some of these other priorities and it’s sort of the carrot at the end of the stick it’s something the client wants to work on it’s a positive behavior we’re increasing in addition to addressing eliminating the negative behaviors stages of treatment attaining basic capacities identify behaviors that pose a direct threat to clients or other people safety monitor the frequency intensity of behaviors using a behavior tracking form she gives you examples of a lot of these forms and a lot of these protocols in the book you can also go to DBT self-help links calm and there are a lot there’s a lot of the stuff just on general DBT there we want to address suicidal behaviors behaviors to interfere with therapy general misery maintaining playing games and client initiated goals in stage one we want to get the ball rolling in stage two the person has kind of gotten control of their emotions they can label them they feel when they’re coming on they have some interventions that work they’re feeling stable they’re not feeling great but they’re feeling stable so in stage two we want to go on to reducing traumatic stress and the traumatic stress can come from negative relationship experiences related to emotional dysregulation those invalidating environments that i talked about earlier and lack of interpersonal skills so they feel rejected all the time their self esteems low so they have a hard time validating themselves they’ve always kind of been told that they’re wrong or they’re overreacting or they’re this or they’re that so they don’t feel good about themselves and then they have a hard time getting validation from anyone else so they’re pretty lonely they’re pretty isolated so we want to reduce some of this and help them feel validated and help them feel good about themselves which takes us to stage three of increasing self-respect and achieving in dual individual goals teaching them how to set boundaries teaching them how to be assertive the B and DBT benefits we want to look at the positive and negative reinforcement when somebody does something you know I gave the example earlier of drinking if an alcoholic relapses and drinks again what were the positive benefits of that it numb the pain the negative well I kind of mixed up my reinforcements here but the negative reinforcement was it made the pain go away the positive reinforcement was it made him feel good so not only did it make the go away but it had the additional increasing serotonin making them feel good making them feel generally more sociable we also want to look at the punishment what were the consequences of using you know if you woke up and you had 500 less dollars that’s that’s punishing if you woke up and you’ve realized that you had relapsed and you felt guilty about it that’s that’s also punishing that’s adding a negative feeling on top of it so we want to look at the consequences of the behavior and we have to look all along the behavior not just when the person used or when the person cut but what was the end goal of that behavior and what were the rewards we want to talk about intermittent reinforcement think about the kid in the candy store who or even in the grocery store we were in Publix one time my son was about four and he was hungry and he did the thing that all little kids do at some point or another and he wanted candy and you don’t have to have the candy right next to the checkout aisle and I I said no it’s about time for dinner and he’s pleased I was like no it’s about time for dinner and he looks at me with no volume control whatsoever and says well so much for Publix where shopping is a pleasure I was mortified but I didn’t give in when you give in at a certain point then the child or the animal or whomever learns that hey this is where I’ve got to start this is where the the threshold is so if I just start acting like this I will get my own way and we also need to model effective coping effective emotion regulation we don’t want to be screaming at our clients or screaming at our staff that’s kind of not what we want them to learn from us remember that reinforcers increase the likelihood of a behavior and punishments reduce it you don’t do things if there’s it’s more punishing than reinforcing vulnerabilities increase the likelihood of a fight-or-flight response so if you wake up in the morning and you’re tired and you’re sick and you’ve got six million things that you’ve got to get done that day you’re already vulnerable because you’ve got stress going on which means you have less energy to deal with whatever is thrown your way when you get to the office and finally we want to look in order to understand some of this for people we do backward chaining so client a has an outburst we said okay that’s what happened it’s not what you wanted to have happen let’s look at how we got there coworker said something and sensitive okay and that led to the outburst I think there’s more to it than that because co-workers have said things that were insensitive before and you haven’t had an outburst so what else happened well let’s go back a little bit farther when you woke up you felt drained already you didn’t feel like you slept well and you knew you had a lot going on and you were just like coffee okay was that enough have there been times who felt drained and people were rude but you didn’t have an outburst yes okay so let’s go back a little bit further you had to put your cat down the day before that was a traumatic draining event so all these things added together you see where there was a major stressor and you got the message from your brain by waking up the next morning that you’re drained you don’t have the happy chemicals you don’t have as much energy so you need to kind of play it close to the best however that person came in and said something insensitive and you didn’t have the energy reserves to deal with it which led to the outburst so what could we do differently next time remember that triggers or stimuli whatever you want to call them caused a reaction they remind a person of a prior situation in which a behavior was either rewarded so if they lashed out and they got controlled guess what they’re probably going to do again in a similar situation lash out or it was punished they lashed out it did no good and the client felt an increasing sense of helplessness so in a similar situation lashing out may or may not be repeated based on whether it was rewarded or punished so they need to look back at prior instances of that behavior and when was it rewarded and what about alternate behaviors were they ever rewarded or were they ever even tried triggers may communicate to the person that there’s a threat it says warning you need to do something ok so if somebody’s already a little hyper vigilant a little hyped up they may react extremely but triggers could also prompt feelings of well-being if you’ve ever opened your phone and there’s been a picture your kid on there and you’re just like ah that was a trigger to triggers aren’t always bad and we want to increase positive triggers and decrease negative triggers shaping and I know I’m going a little bit fast but I got behind shaping means rewarding successive approximations so for example if you’re dealing with somebody who has anger issues level one is not throwing things or being physically aggressive maybe they get in fights with their spouse but they’re not throwing things or being physically aggressive awesome progress not perfection level two now we want to say not only are you not going to throw things or be physically aggressive but you’re going to try to disengage until that urge subsides until the adrenaline and the norepinephrine subsides enough and you feel like ok we can have a calm discussion level 3 would be taking it the next step and saying ok I didn’t throw anything i disengaged I calm down now I can actually come back and have a calm discussion these levels progress over time level 1 it may take a month before the person gets to that point but I hope not but it may level 2 it may take a month or more for person to remember I need to just walk away I need to disengage I need to go to the bathroom whatever it takes for that person to let the adrenaline rush go away once they’ve mastered those skills then they can work on calmly discussing the issues and if they start to get upset again disengaging and coming back addiction or self-harm I have two levels here level one is engaging in a secondary coping behavior I’m not going to be real particular about what that is if you are not cutting or using drugs illegal drugs then you know let’s go with it right now we’re talking about harm reduction so even if it is smoking which is a drug I realize walking eating which again is not the healthiest reaction but it’s a whole lot better than using crack or cutting yourself so once the person gets used to not engaging in that primary urge to what if that they had then we say level two let’s take a mindfulness minute to evaluate the situation and then choose a behavior consistent with your goals so you take a timeout you’ve got that secondary coping behavior going on now let’s take a look at what’s happening instead of just trying to shove it down and forget about it mindfulness means developing an in-the-moment awareness of how you are emotionally mentally and physically and exploring the interconnection of thoughts feelings and physical sensations remember that distress in one of those areas leads to distress in others if you’re sad you may have a foggy head and you may have aches and pains you may just feel lethargic if you are sick or in pain you may be grumpier and you may have a harder time focusing because the pain is distracting you so remember that they’re all interconnected and we want people to become aware of the emotional wave so when they get upset they can say okay this wave is a tidal wave and I am you know down here I’m not even finished right or I’m at the top and I’m coming down reminding them that most emotions will dissipate within 5 to 15 minutes if we don’t stoke the fires we want to reduce emotional reactivity and one of the acronyms is please PL means treat physical illnesses be healthy remember not feeling good not going to help your mood eat a nutritious diet don’t use mine or mood altering drugs and less prescribed by a doctor get plenty of sleep and exercise exercise releases serotonin can do a whole lot to help people deal with pent up stress if you will build positive experiences it’s not just about eliminating miserable stuff you want to have fun things each day even if it’s five minutes what was one positive thing you did for yourself today and be mindful of your current emotion if you’re angry you’re angry don’t tell yourself you shouldn’t be just say I am and then you can move on from there distress tolerance another acronym accepts activities so do hobbies watch a video go for a walk if you’re feeling really upset try to do something to distract yourself contribute do volunteer work compare yourself to people who are coping either the same as or less well than you and go okay other people can do this I got this two emotions try to distract with the opposite if you’re feeling really down try to watch a comedy push away a distressing situation by leaving it mentally for a while which kind of goes back to distracting you’re just pushing that out of your head going I’m not going to think about that right now and you can even tell yourself those exact words thoughts think about something else so get engaged in puzzles or a book or something to distract you for me it’s cartoons you know I don’t know why and sensations if you distract with intense sensations you’re focused on that if you’re holding ice cubes you’re going to focus on after about three or four minutes trust me so what a clients need to know about emotions and there’s a whole chapter on that but basically like I said earlier we want to decrease the negative emotions they’re there for a reason but we want to decrease the intensity and develop an understanding of what causes depression anxiety anger envy frustration irritation whole lists whatever it is for the person in that person and what are the ones we can eliminate what are the unnecessary irritants we can just get rid of because there are some things that you know we should get upset about but there are some things that we can eliminate we don’t have to bother ourselves with and increasing the positive what are some positive things that you can do you can’t be happy and depressed at the same time so how can you increase the positive keep a list of positive things things that make you smile things that make you happy some days it’ll feel like you need a crowbar to get you out the door to do them but getting out and doing them makes you feel that much better interpersonal effectiveness teaching assertiveness distress tolerance emotion identification and communication so if the person can assertively say this is how I feel and this is what I really need or want in order for it to be resolved it’ll be a whole lot more effective than throwing a tantrum or acting out or walking away or being passive-aggressive in order to be interpersonally effective people need to understand their own needs you know that’s you know obvious but also the needs of others what is it then another person needs the whole empathy thing what do they need in order to support you what do they need in order to want to support you and then we want to help people explore situations to using dialectical theory so taking multiple perspectives in an argument or in a interpersonal situation to try to imagine what was the other person thinking or feeling dear man is your acronym here describe the situation objectively express why this is an issue or a need and how you feel about it assert sharing clearly what your being what you’re feeling and asking directly for what you want need not passive-aggressively not going well I wish there was something that could be done well if there’s something you want done say what it is reinforce what you want done and why it’s a good thing by offering a positive outcome or a win-win be mindful focusing on what you’re requesting and not getting distracted by all this other stuff appear confident and be willing to negotiate you know my kids want pizza a lot because they’re kids they want pizza and I have to negotiate that but sometimes they will come to me and they will make a case for why they deserve pizza and create a win-win situation they’re like hey and by the way mom you won’t have to clean up or cook dinner so there you go and I’m like okay find whatever you win now obviously our clients are dealing with a whole lot more than pizza but you can apply this in non-threatening situations to help people master it before you start applying it to the more emotionally Laden stuff so DBT is a great tool to help clients become more aware of their emotions identify the thoughts feelings and urges associated with those emotions develop a greater sense of self-awareness regarding the whys of emotion why do I feel this way why do I act this way when I feel this way they develop an awareness of their vulnerabilities which make them more likely to be emotionally reactive or sensitive most of the time when you say you know when you don’t feel well you tend to be grumpier people are like yeah you know you’re right but I’d never thought of that so helping people understand that mind-body connection and DBT provides an awesome framework for teaching skills groups that benefit an array of clients who have difficulty with emotionality and I can’t remember exactly when in the next couple of weeks there’s a class that we’re going to do on DBT and mindfulness skills for adolescents and if you work with adolescents or you just remember being an adolescent adolescence is a time of high emotionality I don’t care who you are so DBT skills can be really useful for that particular group like I said this book was this presentation was based on a book by Cheri Van Dyke DBT made simple you can get it at new Harbinger publications if you want to I will be putting out a I believe I figured out it was a 10 hour on demand class if you want to learn more and really get all the tips tools and tricks that she has in that book that will be available probably in two weeks but if you want to just peruse it in the library I’m pretty sure I’ve seen it at like borders and Barnes & Noble too so you can look at a copy and see if that’s something that interests you 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.
Oct 4
Drowzees and Masterpieces: Thoughts from London
Good morning, Hank, it’s Tuesday. I woke up in London a little bit jetlagged. All right, let’s go. The east end was also sleepy. Tattoo parlors were shuttered, the streets almost empty. On the walk to the tube, there was lots of graffiti to enjoy. I made it to the station, stood on the right for a very fast escalator ride, which turned out to be timed perfectly because there was the train, and then boom we were in Trafalgar Square.