291 -Transtheoretical and Transdiagnostic Approaches to Recovery | Journey to Recovery 2nd Edition
Counselor Toolbox

 
 
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This podcast episode is based on Journey to Recovery: A Comprehensive Guide to Recovery from Mental Health and Addiction Issues 2nd Edition by Dr. Dawn-Elise Snipes

Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs
Podcast Host: Counselor Toolbox & Happiness isn’t Brain Surgery
Author: Journey to Recovery (2015) & Happiness Isn’t Brain Surgery (2017)

To get on the pre-release list for Journey to Recovery 2nd Edition and a 50% discount on the digital version, please email support@allceus.com. Publication is expected at the end of October.

Objectives
~ Identify the common symptoms for anxiety and depression-based disorders
~ Learn how a positive change in one area or symptom can have positive effects on all symptoms or areas.
~ Explore
~ The function of each of those symptoms
~ The potential causes of each of those symptoms
~ Interventions for each of those symptoms

Review
~ Everything you feel, sense, think and do is caused by communication between your nerves with the help of chemical messengers called neurotransmitters.
~ “Higher order” thinking is able to over-ride sensory input and tell us there is a threat when none exists, or that there isn’t a threat when there really is.
~ Think of your brain as a computer processor. It simply does what it is told, based on the information that it has.

What are symptoms
~ Symptoms are your physical and emotional reactions to a threat.
~ Symptoms are designed to protect you.
~ They are not bad or good. They just are.
~ Instead of trying to make the symptom go away, it may help to:
~ Understand the function of them
~ Identify alternate, more helpful, ways to deal with the threat
Transtheoretical and Transdiagnostic
~ Transtheoretical means approaching a person’s presenting issues/symptoms and considering emotional, cognitive, physical, interpersonal and environmental explanations for it.
~ Transdiagnostic means that many symptoms are common to multiple issues such as sleep changes, appetite changes, irritability, fatigue and lack of pleasure.
~ By examining the WHOLE person and not getting stuck on treating a particular diagnosis we are freed up to really address the individual’s issues
Case
~ Sally is a 27 year old mother of 2 and presenting with
~ Lack of pleasure/apathy “blah”
~ Fatigue
~ Irritability
~ Weight gain
~ Sleeping difficulties (waking up a lot)
~ Feelings of guilt
~ Inability to concentrate and indecisiveness
~ Diagnosis Possibilities (some)
~ Depression
~ Anxiety
~ PTSD
~ PCOS
~ Hypothyroid
~ “Stress” (relationship or job)

Lack of Pleasure
~ Form/Symptom
~ Lack of pleasure in most things, most days for a period of at least 2 weeks.
~ Cause
~ Neurochemical imbalance (insufficient dopamine, norepinephrine?) caused by:
~ Lack of sleep
~ Excessive stress
~ Drug or medication use
~ Hormone imbalances including thyroid problems
Lack of Pleasure
~ Causes
~ HPA-Axis
~ Cortisol
~ Increased norepinepherine and glutamate
~ Reductions in
~ Estrogen
~ Testosterone
~ Serotonin
~ Increased anxiety and depression
~ Reduced melatonin
~ Impaired sleep

Lack of Pleasure
~ Function
~ This is your body's way of
~ Signaling that there may be a problem
~ Conserving excitatory neurotransmitters for a “real” crisis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182008/pdf/DialoguesClinNeurosci-13-263.pdf Post-traumatic stress disorder: the neurobiological impact of psychological trauma
~ Forcing you to address it. After all, nobody wants to be depressed for very long.

Lack of Pleasure
~ How You Cope
~ Think back over a few times when you have been depressed, even if it was just for a few hours.
~ What did you do to help yourself feel better?
~ What makes the depression/lack of pleasure worse?
~ What can you do to prevent triggering your depression/lack of pleasure?
~ What changed this time that triggered the depression?

Lack of Pleasure
~ Simple-ish Interventions
~ Don’t expect exhilaration, but try to do some things that make you mildly happy.
~ Get plenty of quality sleep to stabilize circadian (sleep-wake-eat) rhythms.
~ Improve nutrition. Search online for “nutrition for depression.”
~ Remember that depression is a natural part of the grief process and also very normal after a trauma. Be compassionate
~ Address unhelpful thoughts that are keeping you stuck
~ Add in visual and auditory triggers for happiness

Eating Behaviors
~ Form
~ Eating too much or loss of appetite
~ Cause
~ Imbalance in the brain chemicals that help you feel motivated to eat, such a norepinepherine and serotonin.
~ There are five primary causes of over-eating:
~ Poor nutrition
~ Low serotonin (stress/organic)
~ Circadian rhythms are out of whack
~ Habit/self soothing (stress)
~ Thyroid Issues
Eating Behaviors
~ How You Cope
~ In the past when you have just not had an appetite or have been eating to self-soothe, how did you deal with it?
~ How can you make sure you are eating a generally healthy diet, and making sure that your body has the building blocks it needs?
~ How is your environment contributing to your eating behaviors?
~ What can you do to ensure you are eating due to hunger and not distress?
~ What foods do you generally eat to self-soothe?
~ What can you do to prevent non-hunger eating?
~ What can you do besides eating to distract yourself or self-soothe?

Eating Behaviors
~ Some simple-ish interventions
~ Get enough sleep so you are not eating to stay awake.
~ Stop consuming caffeine at least 8 hours before bed.
~ Drink enough water (even if it is sparkling water or Powerade).
~ Have 3 colors on your plate at every meal.
~ Eat foods you enjoy, but in moderation
~ Use a plate. Don’t eat out of the bag
~ Experiment with essential oils. Some will increase appetite. Some will decrease stress and cravings.
~ If you just cannot stomach eating, ask your doctor about a meal replacement like Ensure. This should not be done for a long period, but as a stop-gap, it usually is fine.

Sleeping Behaviors
~ Form
~ Sleeping too much or having insomnia
~ Cause
~ Sleeping too much can indicate poor quality sleep due to:
~ Stress
~ Poor sleep habits
~ Pain
~ Hormone or neurochemical imbalances
~ Allergies/Apnea
~ Poor nutrition
Sleeping Behaviors
~ Cause
~ Insomnia can indicate:
~ An inability to relax
~ Pain making it difficult to sleep
~ Insufficient serotonin/melatonin (also implicated in depression)

Sleeping Behaviors
~ Function
~ When you are not getting enough sleep, you cannot recharge as efficiently, so you are more tired.
~ When you are getting too much sleep your body doesn’t secrete melatonin at the right times leading to poor quality sleep and feeling exhausted all the time.
~ When you cannot sleep it typically indicates that your HPA-Axis/Threat Responses System is activated so you are not vulnerable.
Sleeping Behaviors
~ How You Can Cope
~ What do you usually do to help yourself
~ Get to sleep when you can’t sleep
~ Wake up when you have been sleeping too much?
~ Create a good sleep routine that involves the same two or three activities.
~ Identify & address anything waking you up in the night.
~ Dogs
~ Coughing/allergies
~ Snoring spouse
~ Sleep apnea
~ Stress
~ Pain

Sleeping Behaviors
~ Simple-Ish Interventions
~ Get a physical to rule out any medical issues especially
~ Thyroid and other hormone imbalances
~ Chronic pain
~ Apnea
~ Reduce or eliminate caffeine at least 10 hours before bed.
~ Keep a notepad by your bed to write down things you need to remember instead of tossing them around in your head all night.
~ Use progressive muscle relaxation, to help your body relax.
~ Develop a stress management and relaxation plan.

Low Energy
~ Form
~ Lack of energy and/or fatigue.
~ Cause
~ Insufficient or excessive sleep
~ Lack of motivation and reward
~ Lack of movement
~ Fear of failure or rejection
~ Poor nutrition
~ Thyroid or hormone imbalances
~ Function
~ The body is devoting scarce resources to rebuilding and functioning. (Ain’t got enough gas)

Low Energy
~ How you cope
~ What (besides caffeine) helps you get energy?
~ What drains your energy?
~ Emotional
~ Mental
~ Physical
~ Social
~ Environmental
~ When you have felt lethargic in the past, how did you help yourself feel better?

Low Energy
~ Simple-ish Interventions
~ Get up and move around. Try doing 15.
~ Stay hydrated
~ Increase the motivating chemicals by having some successes.
~ Get an accountability buddy.
~ Identify any fear or depressive thoughts that may be dampening your motivation, and think the opposite.
~ How do you get energy/motivation when you don’t have any?
~ How do you get started on a task when you don’t want to?

Irritability
~ Form
~ Being restless or quick tempered during the day.
~ Cause
~ High levels of anxiety
~ Stimulants
~ Unstable blood sugar/poor nutrition
~ Depression
~ PTSD

Irritability
~ Function
~ When you are irritable, your body is likely detecting a threat (real or chemically induced).
~ How You Cope
~ When you feel driven and/or irritable, how have you been able to get it under control?
~ What can you do to be kind to yourself?
~ What thoughts make your irritability worse?

Simple-ish Interventions
~ Reduce irritability by:
~ Addressing unhelpful thoughts that are stressing you out
~ Using distress tolerance skills to feel the feeling and let it pass
~ Practicing good time management so you don’t feel pressured.
~ Be compassionate with yourself if things are taking a bit longer
~ Pay attention and reduce how many stimulants you are taking including caffeine, nicotine, diet pills, and decongestants. These can all cause you to feel revved up.
~ Unstable blood sugar/poor nutrition can make you feel jittery, so try to eat healthfully and regularly.

Concentration
~ Form
~ Trouble concentrating and/or making decisions
~ Cause
~ Neurotransmitter, hormone or blood sugar imbalances caused by lack of sleep, poor nutrition, excess stress
~ Feelings of helplessness causing you to second guess yourself
~ Function
~ Energy conservation. If your body is struggling to just keep going, it is not going to divert energy to higher order thought processes unless they have a direct impact on your survival.

Concentration
~ How You Cope
~ What helps you focus (small chunks, working in the morning..)
~ Simple-ish Interventions
~ How can you be kind to yourself?
~ Practice good nutrition
~ Make sure you are hydrated.
~ Get adequate, quality sleep
~ Take a powernap after lunch. Research shows that a nap after lunch increases “focus chemicals” up to 200%
~ Write things down. When you are stressed, your memory may suffer. It is easier to make sense of things when they are written down
~ Don’t overload.

Summary
~ The brain takes information that you already have and combines it with input from the current situation to “decide” if there is a threat
~ Higher order thinking is required to over-ride your threat response system
~ The HPA Axis (threat response system) triggers the release of cortisol and creates a cascade effect.
~ Interventions include:
~ Do things that make you happy
~ Improve sleep
~ Improve nutrition
~ Address pain issues
~ Address unhelpful thoughts contributing to emotional and physical distress
Summary
~ Every symptom has a function
~ Each symptom is usually caused by a neurotransmitter imbalanced due to:
~ Poor nutrition
~ Poor sleep
~ Negative thinking styles
~ Excessive stress
~ Thyroid/hormone issues
~ Addictive behaviors
~ Recovery involves identifying the function and:
~ Eliminating the problem
~ Finding a healthier alternative

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