438 Depression Case Study

Using the PACER Method

Counselor Toolbox Podcast Episode 438

Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC

Executive Director, AllCEUs.com

Podcast Host: Counselor Toolbox and Case Management Toolbox

Objectives

- Review a case study using the transdiagnostic, transtheoretical PACER approach

- As they say on Law and Order…

- The following story is fictional and does not depict any actual person or event.”

Case

- Tom is a 36 year old male and has been struggling with depression on and off for years, but the past 2 months it has gotten intolerable. He recently lost 85 pounds to try to help get his diabetes under control and improve his sleep apnea and blood pressure. He was thrilled with his weight loss progress, but he hit a plateau and feels like he is going backwards.

Physical

- Sleep

- On an average night how much sleep do you get- REM _1__ Deep _.5__ Light _6___

- On an average night how many times do you wake up- __3-4 but has sleep apnea___ Has not been waking up as much since he lost weight and started on the CPAP

- After an average night’s sleep how do you feel- Tired _x__ Okay ___ Energetic ____

- When you wake up feeling refreshed, how much sleep do you get- REM __3_ Deep __2+_ Light __3+__

- Sleep hygiene self assessment.

Physical

- Nutrition

- Using a free app like SparkPeople, track your nutrition for a week.

- Which nutrients do you get less than 75% the full RDA- Zinc

- Which nutrients do you get less than 25% of the RDA- None

- When was the last time you had a full panel blood test to examine your kidney and liver function, thyroid and vitamin D levels- 6 months

- Describe your eating habits: I have been eating healthier on my diet and try not to get too crazy because of diabetes

- Do you eat due to stress or for comfort when you are upset- yes

- Do you drink at least 64 ounces of noncaffeinated, nonalcoholic beverages each day- yes

- How much caffeine do you have on an average day- (100-150 mg/8oz of regular coffee; 35-50 mg/8oz of soda) ~600mg

Physical

- Nutrition

- How much nicotine do you have on an average day- (1mg/1 cigarette; 6-24mg/vaping cartridges) __0___

- Are you currently over or under fat- (Note: People can have a lot of muscle and not be unhealthy) _no____

- Have you recently had any problems with excessive thirst or hunger- __no

- Do you have problems with hypoglycemia (your blood sugar dropping)- _yes (diabetic)

- Have you recently gained or lost a lot of weight- Yes

- Has your doctor tested your blood sugar lately (fasting blood test)- __yes

- Do you mainly gain weight around your belly- __yes__

- Referral to PCP

Physical

- Pain

- Do you have any chronic pain- __Yes__

- If so what causes it-__bad knees___ How long have you had it- _since college___

- What makes it worse- __standing, walking_________

- What makes it better- _heat, ice, elevation

- How has it impacted your mood/relationships/energy/sleep/self-esteem- Knee pain is annoying and keeps me from playing tennis with my daughter

Physical

- Exercise/sedentariness

- Do you exercise- ____not anymore ______ If yes, how often and for how long- ____daily 45 minutes_____

- How is your energy, mood and appetite after you exercise- ___I’m exhausted________________

- Do you sleep better on days you exercise- __-___ Does muscle soreness make it harder to sleep- __No___

Physical

- Energy

- Which best describes your average energy level Low__x_ I can get through the day___ Great! ___

- Have you had your thyroid levels tested lately- __N__ If so were they in normal range- __-__

- Using a pulse ox monitor: What is your resting heart rate- __85_ What is your O2 saturation- __98___

- Do you have high blood pressure- _Y__ (managed with medication) Heart conditions- _N____ if so, what

Physical

- Libido/Sex hormones

- How is your sex drive- Low __x___ Good _____ Incredible______

- Has there been any c

437 -Social Work Considerations for Addressing Chronic Conditions Dr. Dawn-Elise Snipes Counselor Toolbox Podcast CEUs can be earned for this presentation at https://allceus.com/member/cart/index/product/id/1078/c/ ~ Chronic conditions such as diabetes, arthritis, chron’s disease, and depression Introduction ~ 60% of people in the US have a chronic illness ~ Many serious illnesses have a much longer course […]

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437 -Social Work Considerations for Addressing Chronic Conditions

Dr. Dawn-Elise Snipes

Counselor Toolbox Podcast

CEUs can be earned for this presentation at https://allceus.com/member/cart/index/product/id/1078/c/

~ Chronic conditions such as diabetes, arthritis, chron's disease, and depression

Introduction

~ 60% of people in the US have a chronic illness

~ Many serious illnesses have a much longer course with episodes of exacerbations and remissions

~ Chronic Illness can be highly stressful for patients and families

~ Care for people with chronic illnesses is increasingly done by family in the home.

~ Untreated mood disorders in individuals with co-morbid chronic health conditions increases morbidity and mortality rates and reduces the capacity for self-management

Biopsychosocial Impact of Chronic Conditions

~ Sleep

~ Pain

~ Medication side effects

~ Fatigue

~ Circadian rhythm disruption

~ Physical changes (weight changes, ports, pumps, hair loss)

~ Loss of mobility

~ Depression

~ Anxiety

~ Anger

~ Grief/Adjustment

~ Jealousy or resentment

~ Irritability

~ Withdrawal

~ Self Esteem changes

~ Loss of social support

~ Smothering social support

~ Inability to engage in prior important activities

~ Loss of independence

~ Vocational problems

~ Financial hardships (Medical expenses, job loss, environmental modifications)

~ Access to nutritious food

~ Physical, sexual and emotional relationship problems

Goals of Chronic Care Models

~ Shift from acute, episodic treatment to one of ongoing proactive care

~ Emphasizes

~ Prevention (getting worse, developing other conditions)

~ Patient’s role in managing health with mutual goal setting and action planning (self-management)

~ The goal of self-management interventions are to:

~ Improve knowledge about the condition and intervention options

~ Increase confidence in the ability to change

~ Leverage what he or she can do to promote personal health (prevention)

Goals of Chronic Care Models

~ The goal of self-management interventions are to

~ Improve motivation and problem solving rather than simple compliance with a caregiver’s advice

~ Help the participants’ master six fundamental self-management tasks:

~ Solving problems

~ Making decisions

~ Using resources

~ Forming a patient -provider partnership

~ Making action plans for health behavior change

~ Self-tailoring

Categories of Interventions (FRAMES)

~ Self Management Support

~ Feedback

~ Develop collaborative relationships

~ Use an ask-tell-ask framework with clients and caregivers

~ Responsibility

~ Ability and motivation for self-management fluctuates. Tailor interventions appropriately (symptom exacerbations, med changes, life changes…)

~ Advice

~ Use education and scaffolding to empower clients to adjust their behaviors and take control of health self-management

~ Menu of Options depends on individual circumstances, and resource availability

~ Empathy and Encouragement

~ Self-Efficacy

“5 A’s” of Behavioral Change

~ Assess

~ Advise/engage

~ Agree/collaborate

~ Assist/identify obstacles and interventions (treatment)

~ Arrange for follow up (evaluate/review)

Categories of Interventions

~ Assess

~ Regular assessment and enhancement of motivation and readiness for self-management

~ Ongoing Biopsychosocial Assessment (including quality of life and a Health Risk Appraisal (HRA)

~ An HRA is a systematic approach to

~ Collecting information about risk factors

~ Providing individualized feedback

~ Linking the person with at least one intervention to promote health, sustain function and/or prevent disease

Categories of Interventions

~ Advise:

~ Multimodal education about the condition and treatment options

~ Teach self-monitoring for clients and caregivers

~ Families and clients are educated about

~ The illness

~ What to expect from a family member who has the illness

~ How they can best help

~ How to take care of themselves

Categories of In

436- Anxiety Case Study Using the PACER Method Counselor Toolbox Podcast Episode 436 Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs.com Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free weeks of TherapyNotes with coupon code “CEU” Podcast Host: Counselor Toolbox and Case Management Toolbox Objectives – Review a case study using […]

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436- Anxiety Case Study Using the PACER Method Counselor Toolbox Podcast Episode 436 Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs.com Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free weeks of TherapyNotes with coupon code “CEU” Podcast Host: Counselor Toolbox and Case Management Toolbox Objectives – Review a case study using […]

435 – Biopsychosocial Impact and Strategies for Prevention and Intervention Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Podcast Host: Counselor Toolbox and Case Management Toolbox Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free weeks of TherapyNotes with coupon code “CEU” Objectives – Review the following effects of pain – Depression […]

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435 – Biopsychosocial Impact and Strategies for Prevention and Intervention Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Podcast Host: Counselor Toolbox and Case Management Toolbox Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free weeks of TherapyNotes with coupon code “CEU” Objectives – Review the following effects of pain – Depression […]

434- Impact of Social Media on Mental Health Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs.com Podcast Host: Counselor Toolbox Podcast, Case Management Toolbox Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free weeks of TherapyNotes with coupon code “CEU” Objectives – Examine the extent of social media use – Explore the […]

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434- Impact of Social Media on Mental Health

Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC

Executive Director: AllCEUs.com

Podcast Host: Counselor Toolbox Podcast, Case Management Toolbox

Sponsored by TherapyNotes.com

Manage your practice securely and efficiently. Two free weeks of TherapyNotes with coupon code “CEU”

Objectives

- Examine the extent of social media use

- Explore the positive and negative impacts of social media on mental and physical health

- Identify resiliency factors

What Research Tells Us

- The number of social media accounts is moderately correlated inattention, hyperactivity/impulsivity, ODD, anxiety, and depressive symptoms, as well as fear of missing out (FoMO) and loneliness.

- Chicken/Egg-

What Research Tells Us

- Internet use in general significantly affects participation in IRL experiences.

- Increased time spent online is related to

- A decline in communication with family members (or inadequate support to begin with)

- Reduction of the internet user's social circle

- Reduction in sleep

- Increased feelings of depression and loneliness

- Chicken or egg

- Internet cause or ancillary behaviors cause-

What Research Tells Us

- People spend the majority of their time on SNS looking at peers’ profiles and photos, rather than posting or updating their own profiles

- Computer-mediated communication may lead to the mistaken impressions about physical appearance, educational level, success, intelligence, moral integrity, and happiness of other people, thus increasing depression.

- Constant self-evaluation and competition with other users, incorrectly perceiving characteristics of others and feelings of jealousy may positively or negatively influence self-esteem.

What Research Tells Us

- Technology-based Social Comparison and Feedback-Seeking (SCFS) was found to be associated with depressive symptoms when comparing people with similar levels of overall frequencies of technology use, offline Excessive Reassurance-Seeking (ERS), and prior depressive symptoms

- Stronger associations between technology-based SCFS and depressive symptoms for unpopular individuals

- May increase FoMo

- Allows for unhealthy perseveration

What Research Tells Us

- Higher psychological distress was associated with displaying depression language on Facebook and with less satisfaction with friend’s responses

- Depression was negatively correlated with how much social support participants thought they received from their Facebook networks

- Sudden cessation of online social networking (i.e., lack of Internet connection) may in some chronic users cause signs and symptoms of psychological withdrawal

- Some researchers identify that due to the wide array of activities available on SNS, it is difficult to conclude which parts contribute to preoccupation and withdrawal (gaming, FoMo, attention etc…)

Benefits

- Easily reach millions of people with information to improve their health literacy

- Increase health-related behaviors through gamification and social support (Garmin, Bodybuilding.com, SparkPeople)

- Allows for potential screening and early identification of problems #bigbrother

- May bring to light conversations and behaviors that existed all along IRL

- Increases communication with IRL friends at a distance

Resiliency Factors

- IRL support

- Self esteem

- A sense of belonging

- Self-awareness

- Effective communication skills

- Psychological flexibility

- Alternate sources of validation

- Understanding of the algorithms on SNS

- Fewer stranger connections

Question

- What social media factors influence depression/anxiety in people

- Number of likes

- Whether it appears other people are happier, more successful or more popular

- Check-ins during extended absences

- Comments (support, flaming, disinhibition)

- Public presentation vs. reality

- Other factors contributing factors

- Pre-existing mood disorders

- Insufficient/ineffective IRL supports

Summary

- So

Mind-Body Connection: How Health, Thoughts, Feelings and Behaviors Interact Counselor Toolbox Podcast Episode 433 Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs.com Podcast Host: Counselor Toolbox, Case Management Toolbox Sponsored by TherapyNotes.com Manage your practice securely and efficiently. Two free weeks of TherapyNotes with coupon code “CEU” Objectives – A healthy body is essential […]

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