Addiction Counselor Exam Review

By Dr. Dawn-Elise Snipes

Podcast review for persons preparing for the Addiction Counselor Certification Exam. To include: IC&RC, NCAC, MCAP, LADC, LADAC, CADC, LAC, CADAC exam reviews, exam preparation, addiction counselo... more

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April 15, 2017 121 -Trauma Focused Cognitive Behavioral Therapy Part 2
Trauma Focused CBT
Part 2
Treating Trauma and Traumatic Grief in Children & Adolescents
Objectives
~   Continue learning about TF-CBT
~   Explore
~   Cognitive Triangle
~   Creating the Trauma Narrative
~   Cognitive Processing
~   Behavior Management
~   Parent-Child Sessions
~   Explore ways to use TF-CBT with adult clients
Cognitive Coping
~   Recognize and understand the difference between
~   accurate and inaccurate cognitions
~   helpful and unhelpful cognitions
~   Recognize the distinction and relation among feelings, thoughts, and behavior
~   Generate alternative thoughts that are more accurate or more helpful
~   Attempt to change their feelings and behavior by thinking differently
Cognitive Triangle
Cognitive Triangle
~   Application
~   Differentiate between thoughts, feelings and behaviors
~   Generate scenarios to illustrate how thoughts impact feelings and behaviors
~   Explore how changing a thought impacts the feelings and behaviors
~   Apply the skill to real life
~   Not everyone will be able to differentiate between thoughts and feelings
~   Children under 8 will likely struggle identifying their personal thoughts. Ask what someone else might think
Parent Sessions During Cognitive Triangle
Common Thoughts
~   I can only be happy if my child is happy.
~   I can't trust anyone anymore.
~   Being strong for my child means I should never feel upset.
~   Good parents always know the right thing to say to their children
Alternate Thoughts
~   I can find things to be happy about, to show my child that happiness is possible
~   Most people are good at heart and many are trustworthy.
~   Being strong means doing what you have to do, and I am doing that.
~   Although we try our best, even the best parents sometimes don’t know the best thing to say.
Creating the Trauma Narrative
~   Purpose
~   Helping to control intrusive and upsetting trauma-related imagery
~   Helping to reduce avoidance of cues, situations, and feelings associated with trauma exposure
~   Identifying unhelpful cognitions about traumatic events
~   Helping the child recognize, anticipate, and prepare for reminders of the trauma.
~   Break apart thoughts, reminders, or discussions of the trauma from overwhelming negative emotions
Creating the Trauma Narrative
~   Legal issues
~   Encouraging discussion of the trauma may be perceived as “coaching,” “implanting memories,” or “tampering with testimony”
~   In TF-CBT, the therapist does not lead children by suggesting details or asking leading questions
Creating the Trauma Narrative
~   Decide on the best format (poem, book, pictures)
~   Start with a general introduction of the child/person
~   Next (3 Approaches)
~   start with what happened before the day of the trauma and work forward
~   start with the day of the trauma
~   start from the present and work backwards.
~   Encourage sharing of thoughts and feelings during the event
~   If feelings are overwhelming, start with thoughts and add emotions later
~   Present/read the narrative
~   Add the worst part of the traumatic event
Creating the Trauma Narrative
~   Reading through the trauma narrative several times
~   Identifying thoughts and feelings
~   Correcting cognitive distortions and errors
~   After several “exposures” the child will typically experience progressively less extreme emotional reactions and physiological reactivity.
~   It is important to help the child
~   Create a positive and optimistic ending to the narrative
~   Realiz
...more
58min
April 08, 2017 120 -Trauma Focused Cognitive Behavioral Therapy Part 1
Trauma Focused CBT Part 1 Treating Trauma and Traumatic Grief in Children & Adolescents
Objectives
~   Define Trauma Focused CBT
~   Explore the components of Trauma Focused CBT and their intended functions
~   Explore ways to use TF-CBT with adult clients
Facts about TF-CBT
~   Works for children who have experienced any trauma, including multiple traumas.
~   Is effective with children from diverse backgrounds.
~   Works in as few as 12 treatment sessions.
~   Has been used successfully in clinics, schools, homes, foster care, residential treatment facilities, and inpatient settings.
~   Works even if there is no parent or caregiver to participate in treatment.
Facts About Trauma
~   TF-CBT is intended for children with a trauma history whose primary symptoms or behavioral reactions are related to the trauma.
~   Traumatic stress reactions can be more than simply symptoms of PTSD and often present as difficulties with
~   Affect regulation
~   Relationships
~   Attention and consciousness
~   Somatization
~   Self-perception
~   Systems of meaning.
~   These effects can also interfere with adaptive functioning
Components of TF-CBT
~   Psychoeducation
~   Parenting skills
~   Relaxation and stress management skills
~   Affect expression and modulation
~   Cognitive coping and processing are enhanced by illustrating the relationships among thoughts, feelings and behaviors.
~   Trauma narration
~   In-vivo mastery of trauma reminders
~   Conjoint parent-child sessions
Effects of TF-CBT
~   Reduction in:
~   Intrusive and upsetting memories
~   Avoidance
~   Emotional numbing
~   Hyperarousal
~   Depression
~   Anxiety
~   Behavior problems
~   Sexualized behaviors
~   Trauma-related shame
~   Interpersonal distrust
~   Social skills deficits
Inappropriate Populations
~   Primary issue is defiant or conduct disordered
~   Child is suicidal or homicidal
~   Child is severely depressed
~   Child is actively abusing substances
~   When children remain in high-risk situations with a continuing possibility of harm, such as many cases of physical abuse or exposure to domestic violence, some aspects of TF-CBT may not be appropriate. For example, attempting to desensitize children to trauma memories is contraindicated when real danger is present.
Challenges
~   Potential barriers and obstacles may include the following: The parent caregiver…
~   Does not agree that the trauma occurred
~   Agrees that the trauma occurred but believes that it has not affected the child significantly or that addressing it directly will make matters worse.
~   Is overwhelmed or highly distressed by his or her own emotional reactions and is not available or able to attend to the child’s experience.
~   Is suspicious, distrustful, or does not believe in the value of therapy.
~   Is facing many concrete problems such as housing, that consume a great deal of energy.
~   Is not willing or prepared to change parenting practices even though this may be important for treatment to succeed.
Interventions to Strengthen Parental Alliance
~   Specific strategies that can be undertaken include:
~   Perseverance in establishing a therapeutic alliance
~   Exploring past negative interactions with social service agencies or therapy
~   Exploring the parent/caretaker’s potential concerns that may make them feel as if they are not being understood, accepted, believed, listened to, or respected
~   Exploring/helping to overcome barriers to participating in treatment
~   Emphasizing the centrality of the caregiver’s role in the child’s recov
...more
54min
April 06, 2017 119 -Addictions and Co-Occurring Disorders: Common Issues and Interventions
Common Issues & Interventions
in the Treatment of
Co-Occurring Disorders
Objectives
~ What are Co-occurring Disorders
~ Chicken and Egg Dilemma
~ Awareness and Mindfulness
~ Self-Esteem
~ Sleep
~ Nutrition
~ Depressed and/or Anxious Mood
What are Co-Occurring Disorders
~ Any physical or mental health disorder that
~ Occurs at the same time as an addiction
~ Can cause clinically significant impairment on its own
~ Creates a hurdle in the recovery process
Chicken and the Egg
~ Which to address first—Mental Health or Addiction
~ Both! (assuming motivation)
~ Addiction (Goal is progress not perfection)
~ What are your triggers for use?
~ What have you done in the past that has helped you not use?
~ What can you do to help yourself stay clean/not use now?
~ How can you do that? / How can I help?
~ Mental and/or Physical Health Issues
~ What MH/PH issues do you have that contribute to your use?
~ What can you do that helps make those things less distressing?
~ How can you do that? / How can I help?
Awareness
~ Most people in early recovery are on autopilot
~ The powerlessness to change the situation often prompts disconnection emotionally, mentally, physically and spiritually
~ Part of the definition of addiction is experiencing difficulties in multiple areas of life as a result of use which often results in guilt, resentment, depression, grief, negative self-image
~ Life is about survival  avoiding the intolerable pain
Awareness –Interventions
~ Turn off Autopilot
~ Mindfulness
~ How I feel right now
~ Meeting my needs
~ Thoughts Feelings, Urges and Behaviors that keep me unhappy
~ Thoughts Feelings, Urges and Behaviors that will help me start changing
Awareness –Interventions
~ Purposeful Action Continuum
Awareness –Interventions
~ Deal with thoughts and feelings that prevent self awareness
~ Guilt (I need to ignore my needs and make up for…)
~ Fear (If I tune in, I might get overwhelmed)
~ Apathy (What’s the point?)
~ Self-Hatred/Negative Internal Voice (Suck it up!)
Self-Esteem
~ Low Self Esteem
~ Powerless
~ Walk the middle path, identifying what you do and do not have control over
~ Learn from prior failures
~ Create a Success Mantra
Quotes About Success and Failure
~ “Failure isn't fatal, but failure to change might be” – John Wooden
~ “I have not failed. I've just found 10,000 ways that won't work.” – Thomas A. Edison
~ “Success is stumbling from failure to failure with no loss of enthusiasm.” – Winston Churchill
~ The only real mistake is the one from which we learn nothing.” – Henry Ford
~ “Success is the result of perfection, hard work, learning from failure, loyalty, and persistence.” Colin Powell
Self-Esteem
~ Low Self Esteem
~ If people do not feel worthy of recovery/happiness, they will not stay motivated for it
~ Change the Dialogue
~ Undeserving of happiness (refusal to forgive self)
~ What would it mean if you forgave yourself?
~ What are you afraid will happen?
~ What makes someone deserving of happiness?
Self-Esteem
~ Low Self Esteem
~ If people do not feel worthy of recovery/happiness, they will not stay motivated for it
~ Change the Dialogue
~ Unlovable or fallible?
~ What makes someone lovable?
~ Useless/purposeless or undirected?
~ What skills/qualities/attributes do you have?
~ How can you use those?
Sleep
~ Sleep is disrupted by
~ Addictions
~ Stress/Depression/Anxiety
~ Physical Pain
~ Poor Nutrition
~ Sufficient quality sleep improves
~ Focus/C
...more
57min
April 02, 2017 118 -Fetal Alcohol Spectrum Disorders in Mental Health
Fetal Alcohol Spectrum Disorders in Mental Health
and Criminal Justice
Instructor: Dr. Dawn-Elise Snipes
Executive Director AllCEUs.com, Counseling Continuing Education
Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery
CEUs are available for this podcast at https://www.allceus.com/member/cart/index/product/id/127/c/
Objectives
~   Where to begin…
~   Explore the scope of the problem
~   Identify the impact of the impairments across life domains
~   Discuss specific issues for adolescents
~ Identify special issues for suicide intervention
~ Explore techniques to modify the treatment environment to accommodate the needs of a person with an FASD
Stats
~   National Institute on Alcohol Abuse and Alcoholism, the prevalence of FAS in the general population ranges from 2% to 5% for the entire continuum of FASD.
~   94% of individuals with an FASD also have a mental illness
~   73-80% of children with full-blown FAS are in foster or adoptive placement
~   61% of adolescents with an FASD experienced significant school disruptions
Stats cont…
~   The prevalence of FASD in the child welfare system is approximately 17 to 19 times higher than that in the general population in North America (meta-analysis published online September 9 in Pediatrics).
~   12.8 is the average age children with an FASD begin having trouble with the law. (https://www.mofas.org/2014/05/fasd-and-the-criminal-justice-system/)
~   60% of people with an FASD have a history of trouble with the law
What is FASD
~   FASD is not a diagnostic term, but is an umbrella term encompassing four categorical diagnostic entities:
~   Fetal alcohol syndrome (FAS)
~   Partial FAS
~   Alcohol-related neurodevelopmental disorder
~   Alcohol-related birth defects
Impact of Functional Impairment
~   Problems in multiple domains interferes with treatment success, including inability to:
~   Remember program rules or follow multiple instructions.
~   Remember and keep appointments, or to get lost on the way there.
~   Independently make appropriate decisions about treatment needs/goals.
~   Appropriately interpret social cues
~   Observe appropriate boundaries, either with staff or other clients.
~   Attend to (and not disrupt) group activities.
~   Process information readily or accurately.
~   ‘Act one's age.’
~   When indicators occur in any these domains (and particularly when they occur across multiple domains), it is worthwhile to apply the FASD 4-Digit Code Caregiver Interview Checklist (Astley, 2004b)
Special Considerations for Adolescents
~   Evidence shows that adolescents will commonly exhibit learning and behavior challenges, especially in
~   Adaptive function/getting along from day to day
~   Remaining organized and regulated
~   Learning information slowly (especially what is said to them)
~   Tending to forget things they have recently learned
~   Making the same mistakes over and over.
~   Impulsivity/finding it hard to inhibit responses
~   Social communication (leaving out important details/being vague).
~   Suggestibility (and therefore easily influenced by others)
~   Immature social skills. (too friendly/trusting,/difficulty recognizing dangerous situations.
Differential Dx
~   There is some evidence for distinguishing between children with FASD and children with ADHD. Using the four-factor model of attention it has been shown that:
~   children with FASD have difficulties with encoding (taking in and processing information) and shift (shifting attention (hyperfocus))
~   children with ADHD have problems with focus a
...more
1h
April 01, 2017 117 -Motivational Enhancement
Screening and Motivational Enhancement
Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
CEUs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/40/c/
Objectives
~   Compare and contrast MET with other approaches to therapy
~   Briefly review the FRAMES approach
~   Describe the stages of change
~   Define EE-DD-AA-RR-SS
~   Define OARS
~   Explore strategies for increasing motivation
MET Unique Characteristics
~   Emphasis on personal choice regarding future behavior
~   Objective evaluation focused on eliciting the CLIENT’s OWN concerns
~   Resistance is an interpersonal behavior pattern indicating failure to accurately empathize
~   Resistance is met with reflection
Motivational Enhancement Therapists Do NOT
~   Argue with clients
~   Impose diagnostic labels
~   Tell clients what they “must” do
~   Seek to “break down” denial through direct confrontation
~   Imply client’s powerlessness
OARS
~   Open Ended Questions
~   Affirmations
~   Reflective Listening
~   Summaries
Stages of Change
~   Motivation needs to be enhanced and maintained in all stages of change
~   Stages
~   Precontemplation
~   Contemplation
~   Preparation
~   Action
~   Maintenance
Basic Principles: EE-DD-AA-RR-SS
~   Express Empathy
~   Reflective listening (accurate empathy) is a key skill
~   Develop Discrepancy
~   Perceive a discrepancy between where they are and where they want to be
~   Raise clients’ awareness of the personal consequences of their drinking in order to precipitate a crisis increasing motivation for change
~   Avoid Arguing
~   No attempt is made to have the client accept or “admit” a problem
Basic Principles cont…
~   Roll with resistance
~   New ways of thinking about problems are invited but not imposed.
~   Ambivalence is viewed as normal, not pathological, and is explored openly.
~   Solutions are usually evoked from the client rather than provided by the therapist
~   Support self-efficacy
~   People will not try to change unless they believe there is HOPE for success
Hardiness
~   Control
~   Self-efficacy
~   Hope and Faith
~   Commitment
~   Courage and Discipline
~   Challenge
CBT vs. MET
Cognitive Behavioral
~   Assumes client is motivated
~   Identify and modify maladaptive cognitions
~   Prescribes change strategies
Motivational Enhancement
~   Builds client motivation
~   Explores and reflects client perception without correcting
~   Elicits change strategies from the client
Nondirective vs. MET
Nondirective
~   Client determines content and direction
~   Avoids injecting counselor’s advice and feedback
~   Empathy is used noncontingently
MET
~   Directs client toward motivation
~   Offers advice and feedback
~   Empathic reflection used selectively to reinforce certain points
Building Motivation
~   Since you are here, I assume you have been having some concerns or difficulties related to your use. Tell me about them.
~   Tell me a little about your drinking. What do you like about it? What’s positive about drinking for you? And what’s the other side? What are your worries about drinking?
~   How has your drinking has changed over time? What things do you think could be problems, or might become problems?
~   What have others said about your drinking? What are they worried about?
~   What makes you think that perhaps you need to make a change in your drinking?
<
...more
56min
March 29, 2017 116 -Understanding Complex Trauma in Children and Adolescents
Complex Trauma in Children and Adolescents
CEUs can be earned for this presentation at https://www.allceus.com/member/cart/index/product/id/158/c/
Resources
~ This presentation is based, in part, upon
~ a white paper from the National Child Traumatic Stress Network: “Complex Trauma in Children and Adolescents” 2003
~ Child-Witnessed Domestic Violence and its Adverse Effects on Brain Development https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193214/
~ The Adverse Childhood Experiences Study https://www.cdc.gov/violenceprevention/acestudy/
Objectives
~ Define complex trauma
~ Define and explore Adverse Childhood Experiences
~ Highlight the cost of complex trauma
~ Examine the impact and diagnostic issues of complex trauma
What is Complex Trauma
~ Exposure to traumatic events plus the short and long term impact of exposure resulting in:
~ Emotional dysregulation
~ Loss of safety
~ Inability to detect or respond to danger cues
~ Inability to detect or respond to internal cues
~ Generalization of cues
More About Complex Trauma
~ Complex Trauma is most likely to develop if the danger is unpredictable and uncontrollable (p.8)
~ The greatest source of danger, unpredictability and uncontrollability is the absence of a caregiver who reliably and responsively nurtures and protects the child.
Adverse Childhood Experiences
~ ACEs measured in the study include:
~ Physical, sexual, emotional abuse
~ Physical or emotional neglect
~ Mother treated violently
~ Substance misuse within household
~ Household mental illness
~ Parental separation or divorce
~ Incarcerated household member
*Could happen anytime prior to 18th birthday
*Two thirds of the 17,000 people in the ACE Study had at least one ACE
Effects of ACEs
~ Psychosocially induced biological alterations (in the brain and the HPA-Axis) related to maladaptation (especially post-traumatic stress disorder) in the context of child-witnessed DV
~ Child-Witnessed Domestic Violence and its Adverse Effects on Brain Development https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193214/
Effects of ACEs
~ Nearly 60% of women and 35% of men with 4 or more ACEs reported chronic depression
~ The risk of perpetrating violence increased dramatically with the ACE score was over 5
~ Those with at least 4 ACEs had nearly double the chance of being raped later in life.
~ 18% of those with at least 4 ACEs attempted suicide.
National Incidence Study of Child Abuse and Neglect
~ NIS-3 (1996)
~ Harm Standard: 1,553,800
~ Endangerment Standard 2,815,600
~ Emotional (584,100)
~ NIS-4 (2006)
~ Harm Standard: 1,256,600 million (1:58)
~ Endangerment Standard: 2,905,800 (1:25)
~ Significant finding: Emotional (1,173,800)
7 Domains of Impairment
~ Attachment
~ Biology
~ Affect Regulation
~ Dissociation
~ Behavioral Regulation
~ Cognition
~ Self-Concept
As defined by the NCTSN Complex Trauma Taskforce
Attachment
~ Secure attachment
~ Internalize regulation strategies
~ Identify internal and external cues
~ Learn to use support systems in the face of overwhelming experience
Attachment
~ Insecure attachment (80% maltreated children)
~ 3 types
~ Avoidant
~ Rejecting caregiving—What does this look like
~ Disregard and distrust self and others
Attachment
~ Ambivalent
~ Parents alternate between validation and invalidation/detachment and enmeshment (Borderline-esque)
~ Children become hypersensitive to cues and overgeneralize
~
...more
1h 2min
March 26, 2017 115 -Relapse Prevention for Addiction and Mental Health Issues
Relapse Prevention
CEUs can be earned for this presentation at https://www.allceus.com/member/cart/index/product/id/574/c/
Dr. Dawn-Elise Snipes PhD, LMHC, LPC
Objectives
~   Define Relapse
~   Identify Relapse Warning Signs
~   Identify Strengths
~   Learn about how your issue developed
Relapse Definition
~   Relapse is the return to something that has been previously stopped
~   Relapse is multidimensional
~   Emotional
~   Mental
~   Physical
~   Social
~   A relapse is when you start returning to any of these people, places, things, behaviors or feeling states.
Activity: Distress vs. Happiness Worksheet
In your Unhappiness
~   Emotionally
~   Mentally
~   Physically
~   Socially
When you are Happy
~   Emotionally
~   Mentally
~   Physically
~   Socially
Triggers
~   Triggers are stimuli that set off an event.
~   Triggers can prompt positive or negative event as
~   Triggers can be
~   Visual
~   Auditory
~   Tactile
~   Olfactory
~   Cognitive
~   Temporal (Time or location)
Emotional Relapse
~   In emotional relapse, your emotions and behaviors become negative and unpleasant.
~   You start finding it difficult to experience pleasure
~   What triggers your negative emotions (Anger/resentment/jealousy/guilt; anxiety/fear/stress; depression)
~   Things/Media
~   People
~   Places
~   Events
Emotional Relapse
~   Negative emotions make us uncomfortable
~   Identify the emotion, explore why you are feeling that way and take steps to fix the problem
~   You can become stuck in the emotion, sometimes
~   Nurturing and blowing it out of proportion
~   Compounding it with other emotions like anger and guilt
~   Personalizing it
~   Trying to escape from it
~   Remember that emotions are just cues like a stoplight.
~   You feel how you feel in the moment
~   You can choose to change or improve the next moment
Preventing Emotional Relapse
~   Practice mindfulness
~   Increase positive experiences (real and guided imagery)
~   Keep a gratitude journal
~   Avoid personalizing something that may not be about you
~   Remember that…
~   Negative emotions are the mind’s way of telling us to get off our butts and do something—Like our car’s idiot light or hunger pangs
~   Dwelling on, nurturing, avoiding or hiding from negative emotions never makes anything better
~   You can *choose* to feel and fix, or relapse and repeat
~   Identify and put in place triggers for positive emotions
Activity
~   List 10 things that you chose to get anxious or angry about over the last week
~   Why did you get upset? (What was your mind telling you needed to be fixed)
~   Did holding on to the upsetness do any good?
~   What was your initial reaction, and was it helpful?
~   What could you do differently next time to either
~   Change/fix the situation (Improve the next moment)
~   Change how you feel about the situation (Walk the middle path)
~   Let it go (Radical Acceptance)
Mental Relapse
~   In mental relapse there's a war going on in your mind.
~   Part of you wants to stay positive, but part of you is struggling with tolerating the distress.
~   The signs of mental relapse are:
~   Focusing on the negative
~   Having a pessimistic/helpless/hopeless attitude
~   If you had an addiction, you may also be:
~   Thinking about people, places, and things you used with
~   Glamorizing your past use
~   Lying
...more
59min
March 25, 2017 114 -PTSD: Understanding the Functional Nature of Symptoms
PTSD
Exploring the Functional Nature of Symptoms
Instructor: Dr. Dawn-Elise Snipes LPC-MHSP, LMHC, CCDRC
Executive Director: AllCEUs
Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Podcasts
Continuing education Credits for this podcast are available at https://www.allceus.com/member/cart/index/product/id/59/c/
Objectives
~   Review PTSD Symptoms and explore their functional nature
Purpose
~   By understanding the function of symptoms we can
~   Normalize the behavior
~   Identify alternate ways to meet that same need or address the issue
~   Re-Experiencing
~   Trying to replay it to figure out how to integrate into your schema (like fitting a puzzle piece)
~   Reminding the person of similar situations to “protect” them
Purpose
~   Avoidance
~   The system is already over taxed. Avoiding upsetting stimuli by blocking out most stimuli, memories of the event.
~   Avoiding unnecessary use of energy by not getting “excited.”
~   Changes in Beliefs
~   Protects against future “surprises”
~   Tries to assimilate the experience into schema
~   Increased Arousal
~   Protects the individual
Re-Experiencing
~   You re-experience things every day
~   Access schema that guide your actions
~   When you go to work
~   When you encounter a particularly volatile client
~   When you approach a stop light
~   Re-Experiencing in PTSD
~   The context is often overgeneralized
~   The precipitating factors are often unknown
~   In many cases the resolution was not one of empowerment, resulting in trying to continually figure out how to not be disempowered
Re-Experiencing: Assimilation or Accommodation
~   Intrusive distressing memories of the traumatic events
~   In children repetitive play may occur in which themes or aspects of the traumatic events are expressed.
~   Recurrent distressing dreams in which the content or feeling of the dream is related to the events
~   In children there may be frightening dreams without recognizable content.
~   Flashbacks or other dissociative reactions in which the individual feels or acts as if the traumatic events are recurring
~   In children trauma-specific reenactment may occur in play.
Re-Experiencing
~   Intense or prolonged psychological or physiological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic events
~   The event represents a time in which the person experienced or witnessed something horrifying
~   The brain is trying to help the client
~   Avoid future similar situations
~   Learn how to protect during future similar situations
Avoidance
~   Purpose: Avoidance of Recurrence of Pain or Arousal of Stress Response System
~   Emotional numbness and avoidance of places, people, and activities that are reminders of the trauma.
~   Inability to remember an important aspect of the traumatic events (not due to head injury, alcohol, or drugs)
~   Purpose: An exhausted system conserves energy in case there is another threat
~   Markedly diminished interest or participation in significant activities
~   Feelings of detachment or estrangement from others
~   Persistent inability to experience positive emotions
Hypocortisolism
~   Cortisol is the stress chemical
~   After extreme stress and/or under chronic stress the brain may reduce the responsiveness of the stress response system by reducing the cortisol
~   This is protective, it keeps the organism from using precious resources by getting “excited” about anything (including pleasure)
~   Due to fear conditioning
...more
57min
March 22, 2017 113 -Medication Assisted Therapies: A Primer for Mental Health Clinicians
Medication-Assisted Therapies for Addiction
Presented by: Dr. Dawn-Elise Snipes, Ph.D, LMHC, LPC-MHSP
Executive Director of AllCEUs.com
An on-demand course based on this product is available for CEUs at https://www.allceus.com/member/cart/index/product/id/16/c/
Objectives
~   Discuss the purpose of long-term pharmacotherapy
~   Identify pharmacotherapies for
~   Smoking
~   Alcohol
~   Opioids
~   Methadone
~   Buprenorphine
~   Cases
Why Medication Assisted Therapy
~   Early Recovery
~   Reduces cravings
~   Provides increased self-efficacy and a greater sense of control
~   Anxiety Reduction due to:
~   May alleviate some of the anxiety/fear about relapsing
~   Pharmacological effects of certain MATs
~   May improve depressive symptoms by
~   Enhancing hope and an sense of empowerment
~   Pharmacological effects of certain MATs
What is our Goal in Early Recovery
~   Reduce Co-Occurring issues
~   Identify and address vulnerabilities
~   Improve overall health
~   Sleep
~   Nutrition
~   Energy (exercise)
~   Maintain abstinence
~   Increase time to relapse
~   Reduce intensity of binge if relapse occurs
Clinical Use of Pharmacotherapy
~   Part of comprehensive plan that addresses the following issues or problems:
~   Emotional
~   Cognitive
~   Physical
~   Social
~   Occupational
~   Environmental
~   Not a substitute for counseling
~   Works best in combination with psychosocial support
Co-Occurring Model of Addiction
~   Co-Occurring Disorders are the Expectation
~   Mood issues must be addressed to prevent relapse
~   Relapse begins when thoughts/urges or behaviors return to “addicted” mindset
~   Addictive behaviors were “learned” as a way to stop distress.
~   Learned behaviors cannot be unlearned.
~   Alternate behaviors and their consequences must be more rewarding than addictive behaviors and the consequences. (LT vs. ST)
Drugs or No Drugs
   No pharmacotherapy for most abused drugs
◦   Stimulants
◦   Hallucinogens (LSD, PCP, Ketamine, Dextromethorphan, Benadryl, Dramamine)
◦   Inhalants
◦   Marijuana
   What is the function of…
◦   Stimulants
◦   Hallucinogens
◦   Psychedelics (5HT2A); “state of empathetic wellbeing”
◦   Dissociatives (reduces glutamate); altered pain perception, depressant; Ketamine, Dextromethorphan
◦   Deliriants (reduces acetylcholine) Benadryl, Dramamine
◦   Inhalants (Depressants)
◦   Marijuana (increases dopamine); generally “relaxing,” pain relieving
Drugs or No Drugs
   Factors to consider
◦   Cost
◦   Availability
◦   Side effects
◦   Barriers
   Workplace drug testing
   Other meds taken
   Incarceration
◦   Motivation
Barriers
~   Stimatization
~   Science vs. dogma
~   Evidence-based treatment vs. “drugs for drug addicts”
~   12-Step groups
~   Becoming more progressive
~   Methadone Anonymous is alternative
~   Counselors
~   Different experiences and biases
~   Payors
~   Most payors require medication assisted therapy be “considered when available.”
What is the endpoint?
~   Duration of most pharmacotherapy is not indefinite
~   Months to years
~   Goal is stabilization
~   Flexibility
~   Individualized
~   Allow for relapse
Smoking Cessation Pharmacotherapy
~   Replacement
~   nicotine patches
~   nicotine gum
~   nicotine lozenges
~   nic
...more
59min
March 19, 2017 112 -The Neurobiological Impact of Psychological Trauma: The HPA-Axis
The Neurobiological Impact of Psychological Trauma:
The HPA-Axis
An on-demand course based on this product is available for CEUs at https://www.allceus.com/member/cart/index/product/id/650/c/
Objectives
~   Define and explain the HPA-Axis
~   Identify the impact of trauma on the HPA Axis
~   Identify the impact of chronic stress/cumulative trauma on the HPA-Axis
~   Identify symptoms of HPA-Axis dysfunction
~   Identify interventions useful for this population
Based on
~   Post-traumatic stress disorder: the neurobiological impact of psychological trauma
Dialogues Clin Neurosci. 2011 Sep; 13(3): 263–278.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182008/
~   This article lays out the many changes and/or conditions seen in the brain of people with PTSD.
~   As clinicians, awareness of these changes can help us educate patients about their symptoms and find ways of adapting to improve quality of life.
Introduction
~   Neurobiological abnormalities in PTSD overlap with features found in traumatic brain injury
~   The response of an individual to trauma depends not only on stressor characteristics, but also on factors specific to the individual.
~   Perception of stressor
~   Proximity to safe zones
~   Similarity to victim
~   Degree of helplessness
~   Prior traumatic experiences
~   Amount of stress in the preceding months
~   Current mental health or addiction issues
~   Availability of social support
Introduction
~   For the vast majority of the population, the psychological trauma is limited to an acute, transient disturbance.
~   The signs and symptoms of PTSD reflect a persistent, abnormal adaptation of neurobiological systems to the witnessed trauma.
What is the HPA Axis
~   Hypothalamic-Pituitary-Adrenal Axis AKA the Threat Response System
~   Controls reactions to stress and regulates many body processes, including digestion, the immune system, mood and emotions, sexuality, and energy storage and expenditure
~   The ultimate result of the HPA axis activation is to increase levels of cortisol in the blood during times of stress.
~   Cortisol's main role is in releasing glucose into the bloodstream in order to facilitate the “flight or fight” response. It also suppresses and modulates the immune system, digestive system and reproductive system.
HPA-Axis Dysfunction
~   The body reduces its HPA axis activation when it appears that further fight/flight may not be beneficial. (Hypocortisolism)
~   Hypocortisolism seen in stress-related disorders such as CFS, burnout and PTSD is actually a protective mechanism designed to conserve energy during threats that are beyond the organism's ability to cope.
~   Dysfunctional HPA axis activation will result in
~   Abnormal immune system activation
~   Increased inflammation and allergic reactions
~   IBS symptoms such as constipation and diarrhea,
~   Reduced tolerance to physical and mental stresses (including pain)
~   Altered levels of sex hormones
Fatigue
~   Fatigue is actually an emotion generated in the brain, which prevents damage to the body when the brain perceives that further exertion could be harmful.
~   Fatigue in sports is largely independent of the state of the muscles themselves and is more related to:
~   Physical factors
~   Core temperature
~   Glycogen levels
~   Oxygen levels in the brain
~   Thirst
~   Sleep deprivation
~   Levels of muscle soreness/fatigue
Fatigue
~   Fatigue cont…
~   Psychological factors reducing fatigue
~   Emotional state
~   Knowledge of the endpoint
~   Oth
...more
58min

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