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35 Cognitive Behavioral Therapy Tools | Trauma Informed Counseling Skills

35 Cognitive Behavioral Therapy Tools | Trauma Informed Counseling Skills
everybody and welcome to this video  on 35

trauma

-

informed

cognitive

  

behavioral

therapy

techniques  i'm your host dr donnelly snipes as the title implies in this video we're going to  review 35

cognitive

behavioral

therapy

tools

that   can be used to help people feel safer and more  empowered now if you're looking for a specific   tool there are time stamps down in the video  notes just fyi because 35 is a lot of

tools

   so that can help you jump around  a little bit more if you need to in terms of the principles  of

trauma

-

informed

cognitive

  

behavioral

therapy

the goal is to use people's  strengths build on what they're already doing   help people recognize that they are the experts on  their own lives and

tools

and strategies they've   developed in order to cope with stress  cope with life until now may not be the   most effective may not necessarily be the most  helpful like in the case of addictions but they   were developed to help that person survive  help them see the survivor in themselves   we want to help them identify secondary  effects of

trauma

like depression   anxiety poor communication

skills

abandonment  anxiety you know there's a whole host of things   help them see how that's maybe related to

trauma

  and promote self-care help them develop

tools

   so they can start moving toward the rich  and meaningful life that they envision the first and most basic tool is a

behavioral

  one...
35 cognitive behavioral therapy tools trauma informed counseling skills
and that is to create safety we need to   help people feel like they are safe so their  hpa access or their threat response system can   take a break we don't want to have them feeling  constantly hyper vigilant constantly being   on guard and have an exaggerated startle response  so if we can help them feel safer and at home   in the car anywhere else they spend a fair amount  of time it's going to reduce the intensity and   maybe even the frequency that that stress response  system is activated it's going to help their body   start to recalibrate and that is wonderful when  they start feeling empowered when they start   looking at environments at places and saying  you know what there are things that i can do   to help myself feel safe that is huge now  there's a lot of types of safety though and   we need to help them create a sense of physical  safety from self and others now physical safety   from others is pretty obvious we want them to not  be afraid that they're going to be assaulted or   hurt in some way physically by another person but  safety from self is also important we want them to   feel like they have

tools

to deal with  overwhelming emotions so they don't engage in   self-injurious behavior or addictive behaviors  or other behaviors that could potentially be   destructive affective or emotional and

cognitive

  safety from self and others is another type of   safety we need to help them...
35 cognitive behavioral therapy tools trauma informed counseling skills
develop recognizing  that that inner critic in their head can feel   very threatening can feel very intimidating  a lot of times and can intensify

trauma

   helping them figure out how to deal with that  inner critic is another aspect of creating safety   as well as helping them develop safety from  others emotionally and

cognitive

ly being able to   set those boundaries and say this is how i feel  these are my thoughts you don't have to agree   but you can't i'm not going to let you  take them from me i'm not going to let you   invalidate my thoughts or feelings and then  environmental safety from self and others   or from others and environmental safety  is different than physical safety physical   safety has to do with my body and not letting  people injure myself environmental safety means   creating an environment in which people don't  have to fear for the things that they cherish   their belongings they don't have to worry that  somebody's going to encroach on their environment   that somebody's going to take their environment  from them maybe kick them out on the street for   example so we need to help them look at all  aspects of safety and do as much as they can   to reduce their feeling of threat and increase  their feeling of safety and empowerment i believe it's also important that people create  a rescue pack to have with them this safety rescue   pack can help people feel grounded...
35 cognitive behavioral therapy tools trauma informed counseling skills
safer more  empowered in a variety of situations because   you can't possibly plan for every situation  and how you're going to feel safer in you   know every single situation so a rescue pack  can be helpful in that rescue pack i encourage   them to create a thought list that has distress  tolerant mantras such as i can get through this   this will this too shall pass i have friends  that can help me whatever distress tolerance   thoughts that they find helpful usually somewhere  between three and ten thoughts that they can have   that they can just read over when they're  feeling distressed can be very very helpful   activities is something else they can do to  trigger that vagus nerve trigger that relaxation   response or sometimes just help them stay grounded  or turn their attention completely from whatever   is making them feel nervous breathing slow  diaphragmatic breathing will help trigger   the vagus nerve bubble stuff blowing bubbles  blowing up balloons or blowing bubble gum also   has the same effect because it slows breathing  down and can help trigger the relaxation response   keeping a phone with them which most people have  now so that's not too outlandish is also important   so they have the ability to reach out to a friend  to reach out to someone who can listen who can   provide support who can help them feel safer in  the event that they don't have anybody then making   sure they have the...
number of the local crisis line  so they have somebody that they can reach out to   and narration is another activity that can  be really helpful when people are feeling   unsafe if they narrate what they're doing it  can help them stay grounded avoid dissociating   and be more aware of what's going on and how  they are safe in the moment and sensations   essential oils or wax tarts are wonderful because  sometimes just smelling something that promotes a   sensation of relaxation or brings back a positive  memory can help trigger that relaxation response   and that can be really helpful likewise having  something that they can smell that can displace a  

trauma

trigger a smell that triggers their 

trauma

can also be helpful so if there's a   particular cologne that triggers memories  of their

trauma

when they're in the store   if somebody walks by they have that cologne on  then the person can reach into their rescue pack   and get one of those essential oils or wax tarts  or whatever out and smell that so it displaces   that it turns their attention to something  else if they want to for people who have a lot   of especially olfactory sensory triggers they  may consider using something like fix vaporub   or some other type of rub that lotion or  something that is scented and rubbing it right   below their nose so they are smelling that  pleasant scent the whole time and they're not   waiting until they might be...
triggered keeping an  anchoring object with them something they can hold   something they can feel whether it's a you  know those little tiny um stuffed animals i   don't know what to call them that kids used to  attach to their backpacks when i was in school   those can be helpful because you can  stick those in a purse or something   a worry stone or prayer beads or something  else that the person can hold they can feel   that helps them feel anchored can be very very  helpful sometimes jolting yourself if you will   out of a particular memory is can be really  helpful you can splash cold water on your face   now i wear makeup so i am not inclined to go into  the bathroom when i'm feeling stressed and throw   cold water on my face because that's going to make  my mascara run that's not a good thing ice packs   can be helpful and this was one that you probably  aren't going to use a whole lot because they're   not reusable but the instant ice packs can be  used if you can't access cold water to put on   your wrists on your neck or splash on your face  to help jolt you out of a particular distress   spiral some people have particular music that they  like to listen to or playlists that they listen to   that help them feel empowered that help them feel  safer that help them calm down whatever feeling   they're looking for and on the other end of the  spectrum sometimes noise-canceling headphones  ...
can be really helpful if for example one  of their triggers is the sound of ambulance   sirens you can't make ambulances not run therefore  if they are feeling particularly stressed   having noise cancelling headphones can be helpful  to block out the sound of that particular trigger   i know the other morning something was going on  in our town and it was early morning so sound   was traveling but no joke for 30 minutes  it was just siren after siren after siren   and for somebody who's triggered by sirens that  would have been pretty pretty intense for them the next

cognitive

behavioral

technique is  distress tolerance and if you're familiar   with dialectical behavior

therapy

you're  probably familiar with distress tolerance   i have distilled the stress tolerance activities  down from accepts and improves which is what   linehan uses and they're wonderful but i've  simplified it because a lot of people have   difficulty remembering all of those tags thoughts  distress tolerant thoughts we've already talked   about those and having people develop a list of  distress tolerant thoughts that can help them feel   safer and more empowered activities to reset  the hpa axis and improve vagal tone that is   to trigger the rest and digest to trigger the  relaxation response that can be that diaphragmatic   breathing that you do just breathing or  blowing bubbles or blowing up balloons   it can be through a vagus...
nerve massage where  you're massaging one finger behind the ear   one finger right on the tragus the little flippy  flop thing on the ear and just gently massaging   yawning is another thing and now that i  rubbed my tragus i'm getting ready to yawn   yawning is another activity that stimulates  deep breathing but it also triggers the   relaxation response guided imagery is  another tool in the distress tolerance toolbox if you will and you notice on the recovery  pack that we just talked about on the rescue pack   i had thoughts activities and sensations but i  didn't have guided imagery because when people are   feeling threatened when they're needing  that rescue pack they're not wanting to   check out they're not wanting to use guided  imagery they're not going to feel safe enough   to transport themselves somewhere else a lot  of times however when they are in a safe place   if they're having flashbacks if they're having  intrusive feelings sometimes it's not even a   memory it's this feeling that comes from out of  nowhere guided imagery can be helpful and that   guided imagery can take the form of a mental  vacation going to their favorite vacation spot   and identifying five things that they see when  they get to that spot four things they hear   three things they smell two things they  can feel that can really help people   turn their attention to something that  promotes dopamine...
and relaxation chemicals   being released which can help down regulate that  stress response which is what we're doing with   the stress tolerance we're not trying to avoid it  we're trying to down regulate the stress response   so the person can get in their wise mind another  image people can use is one i just call it safety   whatever that looks like to them for some  people they envision a force field around   themselves for other people they have an angel on  their shoulder for other people they have their   god carrying them like you hear in the poem  footprints in the sand whatever they envision   that helps them feel safer and the moment can  be incredibly empowering and if they're hurt   in some way distress tolerance can be helpful  if they're feeling pain especially physical pain   they can envision healing whether it's  you know nanobots or their immune cells   knitting together or healing the injured part  they've actually done studies on people with   hiv and aids and found that guided imagery  that focuses on the immune system actually does   increase the the number of t helper cells  which i thought was kind of cool and sensory   we talked about that briefly here and we're  going to talk about it some more because   distress tolerance is sort of woven throughout 

cognitive

behavioral

therapy

but sensory

tools

   can help people trigger that relaxation response  so that can be smells...
that help them feel relaxed   it doesn't have to be essential oils it can  be anything that triggers a positive memory   or a positive feeling like coffee for me if  i smell good coffee that's just absolutely   amazing and it triggers that little bit of an  endorphin rush and that relaxation response   sites whether it's pictures of their kids or of  their dog or of a beautiful landscape what is it   that they can look at that may help them feel  calmer or more more safer in the moment sights   smells sounds what can they listen to that might  help turn their attention away from their distress   for a moment we're not ignoring it we are turning  our attention away from it we're taking a break   until the stress response can be dampened some so  the person can address it through their wise mind breath work i already mentioned this a little  bit but breath work is so incredibly important   in

therapy

and

cognitive

behavior

behavioral

 

therapy

in just everything well we need   breathing we need oxygen to live  but slow deep breathing especially   diaphragmatic breathing or belly breathing  actually can help trigger the vagus nerve   they call it respiratory vagus nerve stimulation  or rvns so square breathing we've talked about   in multiple other videos is when you breathe in  for four you hold for four you exhale for four   and you hold for four and then you repeat that  a couple of times when you slow your...
breathing   it automatically triggers your heart rate to slow  down when your breathing and your heart rate slow   down your stress response system says oh guess i  don't need to be freaking out right now so you're   manually overriding by slowing your breathing  you're manually overriding your stress response   now obviously if there is an impending threat  right before you no matter how slowly you breathe   you're going to be getting other feedback that is  going to keep you from becoming completely relaxed   but even in the face of stress slowing your breathing can help mitigate  that stress response so you can maintain   your quote wits about you um a little  bit more effectively so square breathing   is ultimately the foundation of what we're  talking about but there's a lot of ways to   slow your breathing down some people feel like the  square breathing or taking a few deep breaths is   corny or they don't feel comfortable doing it  whatever okay fine as i mentioned yawning is   a wonderful way to slow your breathing and  you can force yourself to yawn you can also   massage your vagus nerve and that may encourage  a yawn you can do different vagus nerve   stimulation exercises that can trigger yawning  laughter when we laugh especially again belly   a good old belly laugh you're going to take a  deep breath in and then you go fall until you   have exhaled so you're doing a slower exhale...
you  just don't really pay attention to it i encourage   people to create a playlist on youtube or i don't  know if you can do playlists on tick tock or not   but create a playlist that stimulates that guffaw  that stimulates that good belly laughter that they   can turn to when they need to um trigger their  relaxation response i mentioned already bubble   gum when you blow a bubble you're going to  blow slowly so it doesn't pop in your face   bubble stuff and you can get the little tiny uh  bubble stuff containers that they use for parties   you can get that at target or walmart or online  i'm sure and you can carry that with you and   so you can just pull it out and blow bubbles  whenever now being 50 years old people look at me   like i'm a little odd if i pull bubbles out in the  middle of the parking lot and start blowing them   but you know if you don't care then no big deal  balloons are another thing and you can do this in   your car or so if you're having a bad moment maybe  you can go to your car you've got a balloon there   you can blow it up again to blow up  a balloon you're going to inhale big   and there then you're going to blow blow  blow so you're slowing your breathing   and those are things you can keep with  yourself party noise makers and i don't   know what else to call them they're the  little noise makers that you blow on and   they make that horrible...
screeching sound  or whatever however you characterize it   kids especially love those because they're loud  and annoying but that can be one other option   or dragon breathers and that's what i have  a picture of here you can use a toilet paper   roll or you can use one of those plastic cups  a red solo cup or something and then you cut   strips of tissue paper and glue it to one end  and you cut out the other end so it's a tube   if you're using a cup and then when the  child is distressed they can take a big   breath and then they can blow and let all  that anger out through the dragon breather   and last but not least fitness trackers  fitness trackers monitor your heart rate   so instead of thinking about breathing if  you're thinking about lowering your heart rate   well you've got to slow your breathing in order  to lower lower your heart rate so some people   will use their fitness tracker and they will  just sit back for a minute and then they will   intentionally slow their breathing so  they can reduce their heart rate when your   relaxation response is triggered  your heart rate is going to go down   so that is a clear indication that you  have manually overridden that hpa axis another one of my favorite techniques is defining  your rich and meaningful life for people to figure   out you know where am i going how should i use  my energy what's important for me to focus on   ultimately...
it's important to know where they're  going or know where they want to go so what does   that rich and meaningful look life look like for  them and this is just an example of a vision board   that i created you only have so much time and  energy how are you going to use yours what people   are important in your rich and meaningful life  how are you going to use your energy to nurture   those relationships what things like health are  important in your rich and meaningful life and how   how much energy are you going to use to nurture  that career is another one i've got on mine   how much energy am i going to use to nurture  that and what does that look like in my rich   and meaningful life and then again this is mine  so all my critters and my farm are on here too   but this gives people something  to look at and they can start   every day looking at this and saying all  right these are the things that are important   and this is how i'm going to allocate this is how  i'm going to spend my energy today or this week   so it helps get them focused and then if they  have to make a decision if something comes up   during the day they have the ability to reflect  look at this again and they can just take a   picture and keep it on their mobile device they  can look at that picture again and ask themself   all right is devoting energy to  whatever this is that's come up   helping me move toward my rich and...
meaningful life   or is it stealing energy from the things that  are important in my rich and meaningful life   so i really love this vision board as  a tool not only to have on the wall   but also to have on the mobile device to help  people regroup and refocus throughout the day once they've defined their  rich and meaningful life   then we move on to what haze in acceptance  and commitment

therapy

calls purposeful action   mindfully acknowledging the present this is  where i am right now this is what's going on   it's not good it's not bad it just is and then how  should i use my energy right now given my context   what is the most effective way to use my  energy to deal with the current situation   that will help me move toward the things that are  important in my rich and meaningful life do i need   to address it is it something that is in my way  is it something that i need to do something about   okay if so then let's make a plan is it something  that really doesn't matter i'm just getting all   tied up about it but in the big scheme of  things it doesn't keep me it's not blocking me   from moving toward my rich and meaningful  life i've just got gotten distracted by it   or should i change my reaction to the situation  moving from anger for example to compassion   maybe somebody does something in my life that  triggers my anger is holding on to that anger   is continuing to be angry...
at them helping  me move towards my rich and meaningful life   or is it stealing energy that i could be using  spending on nurturing other relationships   or even having compassion for them purposeful  action is another tool of empowerment   because it helps people recognize that  they have options and that is so important now symptom locks bear with me with the symptom logs because i'm  going to show you a few different ways to do   it however you know i got some of my foundation  knowledge i got my minor in behavior modification   so that gave me just enough knowledge to be  dangerous sometimes but symptom logs were one   of the big takeaways that i got from that  and symptom logs are important because you   know for example when you're on a diet or if  you've got small children or a puppy at home   when you are seeing that thing every day when  you're interacting with that thing every day   whether it's yourself your kid your puppy you  may not notice incremental changes and then all   of a sudden one day you're like whoa you've grown  up or whoa you've mastered the piano or something   um but so the same thing is true with  mental health symptoms when people are   dealing with it day in and day out they  may not notice the incremental changes   so symptom logs can be really really helpful  not only for documenting those baby steps   toward their rich and meaningful life but  also to help people...
see how far they've come   every couple of weeks you can look at it and say  okay let's look at the how far you've come and   it gives you the ability to look for trends you  can look for triggers for particular symptoms   you can look for vulnerabilities what things  or situations make a person more vulnerable   to reacting to situations with anger you know  sometimes it something may happen and it may not   bother them at all they get cut off in traffic for  example other times they get cut off in traffic   and they just fly into a rage what's different  why were they more vulnerable the second time   so symptom logs can provide us a lot of  information because it gives us a better peek   into what happened in dialectical behavior 

therapy

linehan talks about backward chaining   ideally the person completes the symptom log when  it happens but you can do it at the end of the day   symptom logs need to at the very least include  the date it happens the time is it eight in the   morning because some people are more irritable  or in a better mood first thing in the morning   versus late at night and vice versa so what  date does it occur what time does it occur   what triggered the symptom if known or if there  were distressful thoughts what was the theme   what was the intensity of the experience if  they're having a flashback or if they're having   an anxiety attack was it a one i noticed  it but wasn't...
a big deal was it a two   i noticed it it was uncomfortable but i managed  to get through it was it a three it was really   difficult to keep moving forward while i was  having this symptom or was it a four and in a   four the symptom is just all-encompassing  and they can't continue doing what they were   it kind of shuts them down for a minute  how long did it last was it five minutes   or five hours how did it impact their energy  mood productivity relationships said another   another way how did it impact those things that  are important in their rich and meaningful life   what vulnerabilities and this goes to that  backward chaining what vulnerabilities were   present if they had an anxiety reaction were they  over caffeinated or dehydrated or was their blood   sugar low or were they in a particular environment  that they tend to find stressful anyway   what did they do to cope was it effective  and what do they want to try to do the next   time maybe they want to do the same thing  the next time because it was effective   great if it wasn't effective they may  choose to try to do something else   if the symptom seems ever-present like anxiety  some people feel anxious quote all the time okay   have them complete the log every hour  that they're awake now i know that seems   like a lot and if they're working full time  that might not be practical if they're not   working it's definitely doable if...
they're in  residential treatment it's definitely doable   so you can adjust how often they do their  check-ins but definitely every couple of hours once they get this information once they've  got the data then it's going to be important   to review the logs for themes in triggers and  vulnerabilities i encourage people to make a   pictograph of the frequency intensity and duration  of their symptom so they can get an idea of   how often is this happening and kind of how bad  is it in this one you can see from 8 am to 9 am   the person was having an anxiety  attack it lasted for a whole hour   which is why it's as wide as it is and the entire  time they were having it it was at a level of a   three so it felt pretty damn overpowering they  still kept moving but it was really overpowering   and then at nine o'clock or 9 15 that went  away and then at 10 30 they had another little   anxiety attack but that only was a one  and it only lasted for about 30 minutes   and then at 12 30 12 45 whatever they had  another one that was a big one i mean it was   all-encompassing full-out panic attack  and that lasted for almost 30 minutes   so then when somebody brings this in  i would talk with them and i would say   you know what were the triggers and maybe at  8 a.m the person's anxiety ramped up because   they knew they had to go to work and work is just  really really a huge source of stress right now   or...
they knew they had to go to work and they were  going to have to ride the subway and the subway   is one of their triggers from their

trauma

  so their anxiety went up really really high   but then they got to work at nine o'clock  everything was okay they de-escalated sweet   and then at 10 30 they had to go to a meeting  with their boss and that was a little stressful   they got along with their boss fine so it's not a  big deal but it was a little bit stressful having   to do that and then at 12 30 that was after  lunch was over and they were getting ready to   go back to work and they got cut off in traffic  and it triggered an anxiety attack that lasted   20 or 30 minutes okay so by looking at this we  can see how long they're lasting and then we   can more granularly look back and go okay what's  triggering and see if there are themes that are   triggering anxiety at particular times of day or  in particular places because that can help the   person gain more awareness and be better able to  prepare or adjust in order to reduce their stress now you have a lot of these charts laying around  that's great you may be able to look at them   but it's hard to really get see incremental  progress when you're still looking at four   or five episodes a day and they're all  still pretty high it's hard to know   are we making progress are we reducing the  frequency intensity or duration and you know  ...
sometimes it may be obvious but sometimes it  may not be i use a mathematical formula so   here the first block is 1.25 hours so for an  hour and 25 minutes she was feeling you know huge   amounts of anxiety the intensity was at a level of  a three so you can see 1.25 hours level of a three   and then the next one was at 10 30 that lasted  half an hour it was an intensity of a one and   then we had this other one over here that was a  half an hour that was in an intensity of a four   in order to take into account the frequency  intensity and duration because we're looking   for an overall improvement it doesn't matter  whether it's frequency intensity or duration   i multiply the number of hours by the intensity  and add it all up then their average anxiety   is the number of total hours  they were feeling anxious   divided by the total intensity so the mathematical  formula here was a 0.36 so if we had to   average out her anxiety over the entire day um  what we would be looking at is a .36 remember one   is they're they're feeling it and ideally we  don't want people feeling anxious all day every   day so i'd like to see that a lot closer to a 0.0  than a 0.3 but next week we would go through and   add up the data and do this again now for some  people this could be too data-driven and i get   that so you can skip the mathematical formula if  it's not for you but i think the charts are at the  ...
very least very helpful because people can really  get a quick vision of do we see things going down now an alternative log if somebody feels like  they are anxious all the time they've got   generalized anxiety then there's not going  to be any particular time that they have a   symptom or they have an episode it's just kind  of all the time so remember i said assessing it   on an hourly basis and this is a chart on an  hourly basis if you do it every two hours then   it would adjust accordingly so each  hour the person asks themselves   how am i feeling on a scale of one to four  and we have three hours that it was a three   we have one hour that it was a three  and a half and then you can see   that towards the evening towards the end  of the day it actually went down to a one   we want to ask the person you know what  was different at 3 pm then at 8 am what   was triggering your anxiety throughout the day  and why did it go down at 3 pm but also why was   it still present at all at 3 pm what else  is contributing or maintaining your anxiety   and maybe it's just ruminating or anticipating  having to go to work the next day i don't know you can do the same mathematical formula here  and for this person based on that chart their   average anxiety over the course of the day was a  1.88 so they're still feeling some pretty intense   anxiety and we would look for that number to  gradually decrease over the...
course of treatment the next technique we're going to talk about  is systematic desensitization and ownership and   these are similar or similarly related techniques  they're not exactly the same but i lumped them   together systematic desensitization and ownership  helps the person alter their reaction to triggers   or stimuli in the environment think about it  like an allergy shot for

cognitive

allergens   it creates an environment of safety and  empowerment when they start realizing   that things do not have to control them  then they can start feeling more empowered   they mastered the ability to use breathing  relaxation and distress tolerance

skills

to   down regulate their stress response when they  feel triggered just because i smell this smell   just because i see this thing it may trigger a 

trauma

feeling but i d it doesn't have to consume   me i can address it i can help myself feel  safe and i can get control of that situation so the example i use for systematic  desensitization is snakes because a lot of people   have a fear of snakes but it can be anything the  first step is to learn about the trigger learn   about whatever it is whether it's snakes or flying  or in the case of

trauma

triggers like the smell   of a particular cologne you may not have to learn  a lot about that but you recognize that oh okay   the smell of this cologne triggers a

trauma

  memory all right now what do i do about it   well...
we're going to take away the power of  that trigger we're going to take away the   power of that stimulus so we have the person think  about the stimulus and so think about the snake   or think about what that's smelling that cologne  and their anxiety is going to go up their stress   response is going to go up and then they're  going to use distress tolerance

skills

to trigger   the relaxation response to dampen that stress  response so they can get into their wise mind   once they're in their wise mind then they can  effectively address the facts of the situation   in this situation at this time  am i safe i smelled that smell   triggered my stress response all right i'm going  to push down my stress reaction i'm going to   dampen my stress reaction get into my wise mind  in this situation at this time does that smell   represent a threat to me or is it just  somebody that walked past me in the store   the important thing is helping people  get into their wise minds so they can   effectively evaluate the facts in the current  context once they can think about a snake and   it doesn't trigger that stress response they've  been able to decouple that stress so just thinking   about it doesn't trigger that response anymore  then think about being in a room with a caged   snake so it's not just some snake somewhere it's  a snake in the same room with you it's in a cage   but it's...
in the room and they go through the  same process practicing imagining that and   down regulating their stress response until  thinking about being in a room with a caged   snake doesn't trigger that response think  about being in a room with someone else holding   a snake so now the snake's not even in a  cage but somebody else is holding on to it   thinking about that we're not nowhere  near being in the same room with a snake   yet we're just helping the person envision  imagine these situations and learn how to   down regulate the stress response  to their cognitions to their beliefs   think about petting a snake someone else  is holding and then think about holding a   snake once a person can move through all  of these things and it doesn't trigger   their anxiety response it doesn't trigger their  stress response anymore then you can move toward   you know maybe going to a pet store where  you're in an environment with a caged snake   and again there would be more steps to  desensitizing to that particular stressor   but it can be really helpful not again not only  for snakes or spiders or planes or phobias but   also for other triggers so people can think about  smelling that smell and then they can get to the   point where they can actually smell the smell and  it doesn't trigger that stress response for them in terms of ownership or immersion when  you're regularly exposed to...
something   and able to manage your response  it loses much of its power   now this isn't something that i recommend  i don't recommend flooding for people to do   on their own but it is a technique that people  can use especially with what i call annoyance   triggers it's not a trigger that triggers  this cascade this flood of stress chemicals   but it's enough to trigger a stress response  it triggers their resentment their irritability if it is a smell or a saying  sometimes people have have   success making it their own making it  theirs to control so they start wearing   that particular perfume or they start using that  particular scent to as a fragrance in their house   i had a client one time who had a significant  other that had a particular saying   and every time he heard that saying after they  broke up it just brought back a flood of memories   and just triggered his anger he's like oh when  people say that it makes me want to climb the wall   so i encouraged him for the next week  to use it himself you start saying that   whenever you can you start saying that make it  your own so it's no longer associated with her   it's something that you do and then if you don't  want to say it anymore after that that's fine   associated with positive things like smells  activities or holidays if something triggers a   stress response try to pair it with something else  positive as much as...
possible and regularly expose   yourself to it while regulating your stress  response and this is one i use for bridges   because i can't get away from bridges where  i live but i don't like bridges however i've   gotten to the point where i can drive over them  and they don't really bother me that much anymore systematic desensitization  should be undertaken with   care to prevent moving forward too quickly  and causing additional anxiety or trump   re-

trauma

tizing yourself it always starts with  ensuring you feel safe and empowered and every   scenario needs to end with the person feeling  safe and empowered so they feel safe and empowered   they imagine the stressful  situation and then they de-escalate   before beginning any type of exposure  even imaginary exposure it is essential   to have mastered the

skills

of distress  tolerance and emotion regulation mindfulness is another wonderful 

cognitive

behavioral

tool   mindfulness means turning off autopilot  and being non-judgmentally aware   of your thoughts feelings needs and behaviors  in the present moment it helps connect thoughts   feelings and behaviors and promotes prevention  and early intervention of distress think about   how operating on autopilot may contribute to  sickness anger outbursts or relapses of depression so there are a lot of different kinds of  mindfulness and the first one we're going   to talk about is personal mindfulness start...
with  being as being mindful as soon as you wake up in   the morning at each meal and before going to  bed and for a lot of people that i work with   i encourage them to set push notifications to  remind them to check in and be mindful i know   you need reminders to be mindful but  each time they check in with themselves   throughout the day they ask themselves how do i  feel physically how do i feel emotionally and why   what do i need right now to continue feeling great  if they're feeling awesome great keep it going   or improve the next moment if they're  feeling tired hungry run down anxious   checking in with themselves and figuring out what  is it that i need to do to improve the next moment grounding can be thought of as another kind  of mindfulness and it's a technique to help   people feel connected to the present moment  and not swept up by emotions or thoughts two   of the most common grounding activities  are the 54321 and the describe an object   in 54321 when the person starts feeling stressed  they identify five things they see four things   they hear three things they smell two things  they feel and if possible one thing they taste describing an object can mean holding an object  it can be your phone it can be your purse it can   be your grounding object and just describing it  to yourself is it cold is it hot is it soft is   it bumpy whatever sensations you get from it but  that encourages the brain to...
stay anchored in the   present moment which can help with dissociation  it can help with anxiety and it can help with   triggering that relaxation response as  people turn their attention away from the   anxiety provoking stimulus to what is helping them   stay relaxed in the moment i find the describing  object is really helpful when i go in to get shots   because to this day i am terrified of needles  but that helps me a lot i'll be holding   a grounding object and thinking about  what it feels like and all those things   so when i get the shot i'm not thinking about that  i'm not anticipating it hurting i'm not tensing up general mindful awareness uh encourages  people to be aware of the moment not just   themselves but the moment in general become more  mindful in your actions as you're doing them   what do you see what do you hear what do you smell  when you're out on a walk have that open awareness   where you're just noticing anything that's there  it's not necessarily good or bad you're just   noticing it you'll be surprised at all the  things that you typically probably overlook and mindful reflection is an activity in which   people reflect on their activities at  the end of the day by asking themselves   what did i do and for each of each thing that they  did throughout the day was doing this an effective   use of my energy to move toward the things that  are important in my rich...
and meaningful life   or was doing this whatever it was what a  happy healthy successful person would do   some people like the rich and meaningful life  you know does it help me move toward my goals   other people want to act as if fake it till  you make it as they say so they ask themselves   was i acting like a person who was happy  healthy and successful would have acted examples   you know when you're reflecting on the  day if you got sucked into video games   for three or four hours it's easy to do asking  yourself was this an effective use of my time   to move me toward my rich and meaningful life if  you were playing video games with your best friend   and it was good bonding time well then maybe it  was if not maybe it wasn't you know it's up to   each individual to decide was this important  is this something that you really like doing   is it a hobby does it promote relaxation well  then maybe it was an effective use of energy   you can do the same thing for dwelling  on resentments or eating unhealthfully   was it effective at helping  you move towards your goals   was it something that a happy healthy  successful person would typically do an ounce of prevention is worth a pound of  cure mindfulness is essential to health and   well-being because it can help you become your  own consistently empathetic responsive best friend   it can help you become more aware of the situation  and notice the good and...
the beauty in in life   in addition to the stressors and also become  more aware of how how you're using your energy   and whether it is moving you  forward or keeping you stuck authenticity is the next tool we're going to  talk about and i love authenticity it means being   true to yourself people often become inauthentic  because they're trying to get approval from others   their self-esteem is low so they're looking  for somebody else to tell them they're okay   they may be inauthentic because they're afraid  of being rejected abandoned or in today's society   cancelled or they may be inauthentic because  they're just operating on autopilot they're not   acting mindfully they have always just kind of  done whatever happens and hadn't haven't really   stopped to think about is this me is this me  being authentic or is this me just being impulsive i use the metaphor for chocolate  chip cookies when i talk about   relationships and when i talk about authenticity   when you have chocolate chip cookies you've got  sugar cookies and you've got chocolate chips   both of them are just fine on their own thank  you very much one doesn't pretend to be the other   they are authentic in who they are now if you  put them together in relationships when you   have two authentic people that join together you  can get something that is potentially infinitely   better than either one of those...
things all  by themselves because they enhance each other   they don't complete each other they're already  complete by themselves they enhance one another when you're practicing on authenticity it's  important to become mindful of your thoughts   feelings and needs and act in accordance with them  instead of being a chameleon so mindfulness is a   precursor to authenticity it's also important to  help people separate approval or disapproval of   behaviors from themselves not everybody's going to  like what you do if you're behaving authentically   not everybody may like your choices but does that  mean they dislike you or they dislike your choice it's important for people to ex explore and  address their fears related to being authentic and   a lot of people have fears about being authentic  for very legit reasons these days unfortunately   and if it is an office because of that radical  authenticity or being yourself a hundred percent   of the time may not be safe for everybody in every  situation so it's important that they practice   being assertive and authentic sharing themselves  with safe other people first and then deciding   is it important for me to be authentic here is it  important for me to be authentic on social media   is it important for me to be a hundred percent  authentic at work and only the individual can   figure that out and if they can't  be a hundred percent authentic  ...
is that an environment that's  healthy for them to be in   and again only they can decide but that's part of  the empowerment of

cognitive

behavioral

therapy

   helping people recognize that they are  good enough they are deserving of love   they are in a position they are empowered to help  keep themselves safe and that also means safe from   harm from others and safe from others being   mean to them if you will if they're authentic  from taking away their authentic selves authenticity means moving from what moving from  being aware of thoughts wants and needs to acting   in a way that's in accordance with them so if you  know that you like italian over mexican food or   that's what you want an authentic person would  be mindful they would recognize hey i want to go   for italian food and they would tell people that  they would assert that if you're being inauthentic   then you may know that you have a craving for  italian food but you know what no i don't care   where we go i don't have any preference well  that's inauthentic yes you do have a preference   being authentic can be scary at first and is  often advisable to not advisable to suddenly   start practicing what i call radical authenticity  which can make the person feel really vulnerable   not suddenly deciding that okay starting today  i am going to be a hundred percent authentic   all the time that is a radical shift not only  for the...
individual but for everybody around   them and it could upset the apple cart  so to speak it may take people a minute   to get used to someone suddenly becoming  authentic so which can set them up   for not so great reactions from significant others  but also when you're authentic you're putting   your true self out there you're making yourself  vulnerable and making yourself vulnerable can   be extremely scary especially for people with  a history of abandonment rejection or

trauma

   so it is important to use this with care  yes it's great when people feel like they   can be authentic but it's something that  a lot of times people need to build up to as people become more authentic have them notice  how it impacts their mental and physical health thought stopping is the next tool thought  stopping helps us redirect our brain and we can   engage in thought stopping by simply telling  ourself no not now not thinking about it   sometimes that helps sometimes people need to  replace the thought with a mantra a prayer or   grounding activities to sort of drown out whatever  that thought is to turn their attention if the   thought keeps coming back okay then ask yourself  what's the benefit to ruminating on this thought   why does it keep coming back why do i keep feeling  like i need to think about this is there anything   that the person can do to address the thought and  improve the issue at this moment so for...
example if   you're waiting on test results from the doctor  that aren't going to be in for another six days   what's the benefit to ruminating on that why  does it keep coming back is there anything you   can addre do to address the thought in the moment  and the answer is no you just gotta wait and be   patient so sometimes people will write it down and  put it into their thought box a lot of times it   can be helpful for people who have um persistent  thoughts ruminations whatever you want to call   call it they write these things down and then they  schedule 30 minutes a day that's their worry time   so these thoughts pop up and instead of saying  no i'm not going to think about it ever it's   no i'm not going to think about that right now  i will think about it this afternoon during my   worry period encourage people to start small  try to stop having the thought for five minutes   and if they make it to five minutes then great   thought may come back let's try 10 minutes now  see if you can make it 10 minutes without thinking   about it and it can be empowering to the person to  recognize that they are getting better at learning   how to stop some of those annoying thoughts  or those annoying voices that want to chime in perspective taking is another tool look  perspective taking means looking at the   bigger picture to understand the reactions of  other people as sometimes as well as yourself...
you   know stepping back and trying to get a different  perspective there are four p's in perspective   taking predisposing what were the background  factors that contributed to the behavior whether   it's another person or yours if the client has a  history of

trauma

that's one of those predisposing   factors that may contribute to them reacting with  fear or anger in particular situations for example   precipitating factors so  you have somebody who's been   exposed to

trauma

somebody who's endured

trauma

  and so they already have an hpa axis that's   you know turned on they already  tend to be more hyper vigilant   precipitating factors are vulnerabilities and  contextual factors that precipitate their reaction   they have this history and then they're in a  situation in which they feel somewhat unsafe   they're in this situation where there's lots of  hustle and bustle maybe they're at the airport   and there's just lots of people going around  and bumping into one another and they start   feeling really stressed out because it is feels  like an unsafe environment they feel vulnerable   provocations what provoked or triggered that  behavior and if you're talking about trying to   understand somebody else's reaction then looking  at your own behavior and saying in what way might   i have inadvertently provoked that behavior  and i say inadvertently because a lot of times   we...
may trigger somebody's anger and we didn't even  mean to we didn't maybe we didn't think clearly   before we said something or maybe we have no idea  what we did to trigger that person's behavior   but recognizing um that there  may be something that we did okay   doesn't mean we meant to and plans if you  reacted with anger or anxiety and you regret it   recognizing where that came from and asking  yourself well did i have good intentions did   i go into this situation saying yeah i'm  just going to be kind of nasty about this   or did i have good intentions but the  predisposing precipitating and provoking factors   led me in a different way same thing with  when you're dealing with somebody else   if you're interacting with them and they react  strongly to something that you say it's important   to ask yourself you know why are they perceiving  it differently than i am what predisposing factors   what historical or experiences might they  have had that caused them to interpret this   situation differently in what way might have  i have inadvertently provoked the behavior   and did the person really  ultimately have good intentions   they may have not intended to get into an  argument with you but it just it ended up there self forgiveness is the next tool we're going  to talk about remember that forgiveness does not   mean that you agree or condone the situation  or what happened but...
you're choosing to stop   using your energy to beat yourself up the  four r's of self forgiveness responsibility   yeah you need to take responsibility for  the aspects that you're responsible for   but that's it only take responsibility for the  aspects that you're responsible for if something   happened between you and someone else as they say  it takes two to tango there are probably a lot of   other factors that were out of your control take  responsibility for what you're responsible for   the second r is remorse well if you're work  working on forgiveness then you do feel remorseful   you feel guilty but just feeling guilty keeps  you beating yourself up guilt is self-anger so   feeling remorse is your body's way of saying okay  here's some energy now you can use this energy   to learn from this situation so you can stay safe  in the future or you can fix the mistake you made   which takes us to rectifying or making  amends what do you need to do to   fix this situation make amends or just learn from  it sometimes you can't fix it and the final r   is releasing past hurt and accepting  imperfection forgiving yourself and   saying all right you screwed up it doesn't  make you less lovable it just means you're   human you're fallible you're imperfect and  you forgive yourself you're going to choose   to not continue using energy beating yourself  up for something that...
you have rectified and taken responsibility for forgiving others is very similar forgiveness  still means choosing to stop giving energy   to that person or memory  that is causing you distress   forgiveness can involve recalling the betrayal  recal recalling what happened that is causing   you to feel angry or resentful explore why  you might be afraid to forgive them why are   you wanting to hold on to this energy why  are you afraid to learn and let go altruism   visualize forgiving this person as a gift to  yourself and your significant others i'm forgiving   this person over here so i'm not tying all my  energy up in it anymore which is great because now   i have all this energy freed up that i can give to  myself and my significant others learn from it and   adjust your expectations sometimes people ain't  gonna change therefore recalling the betrayal   what happened and what do you need to  learn so you don't get hurt in the future living in the and is another tool  that can be helpful for forgiving   you can have a rich and meaningful life   and not be able to trust this person anymore  if that's what has to happen it doesn't mean   you're going to continue to be angry at them you  you've just learned that they're not trustworthy   so living in the and means you can have a rich  and meaningful life and forgive other people sometimes it's easier to  forgive smaller things first it can help...
to empathize without minimizing  you can empathize and try to understand   why somebody did what they did maybe  even have compassion or pity for them   but not minimize it you're not saying oh i  have pity for you i understand why it happened   and you know i guess it wasn't really that bad no   i i can empathize with what you were going through  and maybe why you reacted with such anger however   this is how it impacted me and i am not  going to diminish the impact it had on me   just because you were going through a bad thing  so i'm going to empathize without minimizing safely share your feelings this isn't always  possible but sometimes it can be helpful to safely   share your feelings with that person or maybe  even with your higher power or just your journal   but sometimes you need to get them out sometimes  there are things that quote need to be said that   are going to keep bouncing around in your head  until you can say them so say them in a safe way   and then practice thought stopping even  after you've chosen to forgive somebody   every once in a while that resentment or that  anger is going to creep back up and you're   going to remember what happened and that's when  thought stopping comes in handy and you can say   nope handled that already not going to revisit it and then the abcdes of cbt a and if  you remember back to basic

cognitive

  

behavioral

therapy

this is one of your basic 

tools

...
a is the activating event what happened   c is the consequences of the activating event  and we want to consider all of the consequences   not just your emotional reaction but your physical  reaction your

cognitive

reaction how did it change   the way you think about people and the world your  relationship reaction how did it change the way   you feel about your ability or the trustworthiness  of people in the world so the activating event and   the consequences but between the time that  something happens and you get angry or that   hpa axis that stress response gets triggered you  have a litany of automatic beliefs that come from   schema come from past experiences your brain's  going okay let me tell you how to interpret this   a lot of times these beliefs because they're  based on past experiences may not be a hundred   percent accurate in the present context which  is why we go down to d after you've identified   what those beliefs are then you dispute each  one of them based on the facts in the current   context is this belief still a hundred percent  accurate based on the facts in the current context once you've identified what is actually true  in the current context then you can evaluate   the effectiveness of your reactions for helping  you use your energy and time to move toward your   rich and meaningful life so okay maybe something  happens it triggers rage in you you get really   angry that somebody did...
something you go  through your beliefs and you dispute them and   you determine yeah you know they betrayed me it  was a big hurt okay so evaluate the effectiveness   of your reaction is holding on to anger is  dwelling and stewing on anger and holding   on to this resentment is that an effective  use of your time and energy to help you move   towards your rich and meaningful life or would  something like forgiveness be a more helpful tool

cognitive

distortions is another  basic

cognitive

behavioral

therapy

   tool that we look at and there are five maybe six  uh big ones that frequently come up when i work   with people and all or none thinking this person  always does this or this person never does this   i encourage people to pay attention to their 

cognitive

distortions to their um extreme   language and if they say always or never to  reframe that and start saying sometimes or often   look for exceptions if you say that  jane never calls when she's going to   be late look back are there exceptions  are there times when jane did call   personalization means taking what somebody  else does personally it's my fault   or they looked at me with this horrible  look they must be angry at me what are   three alternatives that have nothing to do with  you magnification or catastrophing which means   making a mountain out of a molehill or assuming  that the worst case scenario is going to happen   look at the facts in the...
situation based  on the facts how accurate is your belief   minimization is the same way and sometimes  people will minimize the impact of drinking   for example and that can be faulty if they are  having if they're in recovery for alcoholism   they may also minimize their strength  and their power and their ability to   move towards their goals they may  minimize their own effectiveness   and so it's important to look at the facts is  it true that you are powerless in this situation and then assuming can be broken down into  mind reading and jumping to conclusions   a lot of times when people grew up in  dysfunctional environments they learn   to try to anticipate other people's needs in  order to get approval and prevent punishment   and they carry that with them into adulthood  unfortunately it's not common to be able to   effectively read other people's minds open  communication is a whole lot more effective   so if you are mind reading if you're assuming  that you know what somebody is thinking   or wanting check it out what are the facts what  do you actually know versus what are you assuming   related is jumping to conclusions maybe your  best friend doesn't text you back or stands you   up for lunch a lunch date that you made three  weeks ago you jumped to the conclusion that um   something terrible happened and she's as my mother  would always say lying dead in a ditch somewhere   um...
that's jumping to conclusions so  look at the facts based on what you know   you don't know why they didn't  show up for your lunch date when i'm working with clients  i have a

cognitive

distortions   worksheet that i give them and i encourage  them to go through it when they have   stress when they feel anxious when they feel angry  when they feel distressed they write down what the   activating event was what the trigger was and then  b is the beliefs they write down those beliefs   and then they evaluate each one of  those beliefs for

cognitive

distortions alternate problem formulation is another cool  one or i think it is and i use the mnemonic   peace corps for this and this kind of puts  together a lot of what we've been talking about   so the person identifies the problem they identify  early experiences they've had that may impact how   they perceive the situation so maybe they have  their um anxious around authority figures that's   the problem early experiences we look back  at early experiences with authority figures   well not so good so yeah it makes sense why this  person might have anxiety around authority figures   a stands for assumptions rules and attitudes  what are your assumptions about people who   are in authority positions based on your early  experiences so you're seeing how this is all   starting to connect our past helps us try to  interpret the present but it's not always...
a   hundred percent accurate so we need to understand  why am i assuming this to be true c is core   beliefs what are your core beliefs about people  if you have core beliefs that people are only   out for themselves and they'll throw you under the  bus any chance they get then you're going to feel   less trusting and probably be more apprehensive  than if you think that people are altruistic e stands for effectiveness of  assumptions core beliefs and reactions   based on all this stuff in the current  context how effective are my assumptions and   core beliefs at helping me function and then  the core part is looking at that context in   with the facts that i have in this context at this  time what are my options to handle the situation   what resources do i have to  help me handle the situation   if i do the things that are within my control  that i have options and resources for what's   the probability that things are going  to go well and where can i find support another technique that i really like is tragic  optimism and this can be you um summarized in   the mnemonic crab grass and i like crabgrass  because it is an example of tragic optimism   i don't know if it grows in the northern states  but in the southern states we have this weed   that we call crabgrass and it will take over your  lawn it is just a bugger and a half to get rid of   but it tends to be very resistant to heat and  weather and it stays...
green for a really long time   so if your goal is to have a green lawn crab grass  can be really freaking awesome if your goal is to   have this perfect fescue or bermuda grass lawn  then yeah crabgrass is not your friend but so   tragic optimism means embracing the good with the  bad recognizing the current situation and saying   all right it is what it is what do i  want is there hope that it can get better   and um so you start out by creating a vision what  is your vision of your rich and meaningful life   tragic optimism doesn't mean ignoring the  bad it means acknowledging the bad saying   okay this happened this sucks maybe in my rich  and meaningful life i would be able to work   on the farm until i was 80 years old but  hey i had to have both knees replaced   okay so my vision of being able to  work on the farm until i'm 80 years old   may not be doable anymore so radically acceptance  right radically accepting what's going on   all right i had to have my knees replaced  it is what it is therefore uh how can i   have a rich and meaningful life and have  some knees that don't work as well anymore   and that is the our part of crabgrass so i see  what i want i recognize what is and then i try to   figure out okay how can i mesh these two together  how can i still have a rich and meaningful life   and accept this adversity a stands for anticipate  the positive a lot of times we can get stuck in   the...
negative anticipating the positive means  trying to find hope trying to find compromise   in what's going on instead of anticipating the  worst b stands for be present be aware be mindful   of what's going on how you feel in the moment  and then address it if like the example i gave   your vision for your rich and meaningful  life suddenly took a hard left turn okay   well acknowledging that and radically accepting it  living in the end that's all well and good but you   may also have some grief that you've got to deal  with so being present helps you identify and say i hear all that i see all that is logical but i  also need to acknowledge how i'm feeling right now g stands for growth and learning this is  an unfortunate experience how can i use it   as a growth experience what can i learn  from it in order to improve my life   r is realistic goals and expectations okay well  maybe i can't work independently on the farm until   i'm 80 years old but what can i do i can still  have chickens i may not be riding horses anymore   but i can still have chickens i can still do  some gardening so those are realistic goals   based on the new reality radical  acceptance of the new reality   a stands for affirm yourself one step  at a time when something bad happens   we want it to go away we want to feel better but  we generally don't go from misery to exhilaration   like that so affirming yourself recognizes um ...
and acknowledges the positive steps you're taking   toward adjusting to this new situation s is find  solutions to the problem any problems that come up   because you're having to make some adjustments and  then the final s is in serenity accepting what can   and cannot be changed you know in the example i'm  using you can't get back your 20 year old knees   so if you don't have that you can't get that  back you have to accept that that cannot be   changed and potentially again process it  through grief for whatever you need to do challenging questions face palm when we start to  feel distressed when we start to feel overwhelmed   it's important to evaluate our beliefs what  are the facts for and against your belief   not your assumptions not emotional reasoning  what are the facts for and against your belief   what additional factors need to be considered  like the context like the other people that   were there like whatever what else contributed to  the situation and how it turned out what is the   context of the situation and are you using extreme  language are you using all or nothing words p stands for probability or likelihood  if you're having this belief that's   catastrophic that's stressful in nature  what is the probability or likelihood   that the worst case scenario is going to  play out a stands for alternate explanations   what are some alternate explanations for why this  might...
be happening or what might have happened   because sometimes we assume we know what happened  and why it happened and that's not it i mean think   about a car you can take it into a mechanic and he  says oh it's the compressor and he changes out the   compressor and the air conditioner still doesn't  work and he's like oh well what are some alternate   explanations learn from it and move forward and  moving forward can be really difficult because whatever triggered that feeling triggered that  stress response and it's important to learn   how you're safe learn what you have power over  and recognize that you do have the power to   move forward it may come back and visit you  occasionally but you can stop those thoughts radical acceptance and i love  the mnemonic well i created it so   uh face it um f stands for fact for and against  your belief radical acceptance means accepting   the moment as it is it is what it is and if  that phrase bugs you you know you may want to   look at why but a lot of times that phrase bugs  people because they don't like accepting things   they don't like not having complete  control over things but sometimes you don't   it is what it is okay so what are the facts for  and against your belief what is going on right now   a is acceptance that radical acceptance  embracing the present and acknowledging   that it is what it is and you don't have to  like it but you may...
not be able to change it   by recognizing this you eliminate should you  eliminate saying well it shouldn't be this   way or it should be this way it's not it just is  which also helps you reduce the amount of energy   wasted being angry over something that you don't  like in the moment and you have no control over c stands for control once you've identified  the facts and accepted them then you can   identify which aspects of the situation  you can control which ones you can't   and the best way to use your  energy to cope with the situation   continue to worry stay angry miserable is  that helpful what aspects can you control   how can you change your situation or the  way you feel about the situation and then e   stands for evaluate the effectiveness  of your choices so you're facing it successive approximations and scaffolding is  another tool that i have used a lot and i really   love successive approximations means striving  to get a little bit better or closer to the goal   every single time so maybe if you're learning how  to shoot free throws you know the first time you   shoot the ball and it just whiffs completely  misses the backboard the rim everything all   together all right well then you practice and  the next time you get the ball up there and   it grazes the rim that's better it's closer the  next time it hits the backboard but bounces off   okay and then the fourth time you hit...
it up  there and it actually sinks in the bucket   now for most people it's not going to be a 1 2  3 4 like that but you get the analogy that i'm   making successive approximations means looking  for a little bit of improvement every single time   scaffolding goes along with  successive approximations   and means letting somebody do something up until  the point they need help the goal is to prompt   successive approximations so they get a little bit  better and need a little less help each time think   if you've ever tried to teach your kid to tie  their shoes you know tying shoes can be difficult   so the first you want to get them so they  can slide the shoe on their foot that's the   first step and then it's crisscrossing the laces  and pulling them tight and then making the bow   and then the rabbit goes around the tree and  then pulling the ear through you know how it   goes when you're trying to teach children to  tie their shoes there's a lot of steps in it   but you want to let them do as much as they  can because that helps them feel empowered   that helps them feel more capable and that  helps them learn how to do it and then once   they get to the point where they're stuck then  you can either talk them through it or take over   and then the next time hopefully  they'll get a little bit further   but this can be applied to things like tying shoes  washing clothes learning a computer...
program school   work folding a fitted sheet one of the banes of  my existence or even things like anger management heartiness is represented by commitment control  and challenge and this is a concept that was   proposed way back in 1978 but it's still true  and useful today commitment means identifying   all of the things in your rich and meaningful  life to which you are committed that you are   that are important to you that you  want to devote your time and energy to   looking at that so you may have your house you  may have your garden you may have your animals and   your kids and your friends and your job and you  know all these things out here well that's great   at any one point in time it's likely that every  single one of them is probably not going perfectly   but heartiness encourages us instead of focusing  on the one sliver of the pie that's going bad   to acknowledge the part of the pie that's going  bad and recognize everything that's going well   which helps buffer so we don't feel hopeless  overwhelmed dejected sometimes people   will do this can chart this out using a  pie chart where each part of their life   that's going good is shaded in green and each  part that's not going well is shaded in red   other times people have used green and red  solo cups you know the little plastic cups   and they've put marbles or rocks representing  each thing that's important to...
them   in the cups accordingly and hopefully the  green solo cup ends up with filled up more   with a lot more rocks than the red solo cup so  people have a visual representation of hey you   know yes this stuff over here is going crappy  but look at all this stuff that's going well c stands for control of those things the ones  that are going crappy as well as the ones that   are going well what aspects can you control the  things that are going well how can you continue   to use your energy to keep those things going  well the things that are going crappy how can   you use your energy to help them improve if at all  and challenge instead of seeing it as a barrier   that keeps you from moving toward your rich and  meaningful life seeing things that are not going   so well as a challenge recognizing the ways that  you've endured difficult situations in the past   and then like an athlete constantly strives  to get stronger better or faster how can this   experience be seen as a challenge to help you  strengthen the

skills

that you already have   to get around or over or under this  particular obstacle that's in your path playing the tape through is another one that  i really like too often we make decisions or   assumptions based on emotions we feel angry  we feel anxious we want to fight or flee   so we do things out of anger or anxiety  instead of instead of our wise mind playing   the tape through means considering...
all  the factors and options both in the short   and the long term so it's kind of like  playing a game of chess with in life it's important to beta test  before acting or reacting for example quitting a job maybe you hate  your job and you want to quit your job and   in the short term oh my gosh that would  be such a relief that's that's true but   play the tape through what are the long-term  consequences of quitting your job right now   or maybe you have difficulty being around people  places or things that are triggering or you you   choose to be around people places or things that  are triggering maybe you're somebody who's in   recovery from alcoholism and you start minimizing  and say and rationalizing and saying oh you know i   haven't had a drink in two years so i can go meet  my friends at a bar and i'll just have club soda   that's rationalizing you want to play the tape  through you think you can but in the long run   how likely is that to happen what are the  potential consequences of taking that risk decisional balance activities are it's  a chart that is proposed and used a lot   in motivational interviewing and when you  practice decisional balance you encourage   people to look at the benefits and the drawbacks  not only to change but also to staying the same   the benefits to change well helping them figure  out why is it that they want to change that one   seems pretty obvious...
you know how is it going to  help them feel better physically get more sleep be   healthier have more energy feel happier improve  their relationships improve their finances you   know okay all those things so that one may seem  pretty obvious but then we want to talk about what   are the drawbacks to change and sometimes people  look at me like i'm crazy when i ask them that   but the goal is to try to figure out what things  might get in their way what might prevent them   from changing what might make them decide you  know what it's not worth all this effort so what   are the drawbacks and we go again through what  emotionally how are you going to feel what are   what's scary or anxiety provoking about change  physically when we're talking about addiction   one of the drawbacks to change physically  is the withdrawal symptoms okay well how   can we mitigate those so they're not quite as  intense so they don't make you as miserable   interpersonally what are the drawbacks to  change sometimes when people change it means   they lose some friends or change their social  circle and that can be really intimidating   financially what are the drawbacks to change  well we're talking about addiction for example   residential treatment can be really expensive in  the short term but in the long term um maybe not   and then legally if there  are any legal consequences   and then you do the same thing for staying...
the  same what are the benefits to staying the same   what do you like about what you're doing now and  then what are the drawbacks to staying the same   and by going through all four of these  quadrants by breaking it down very granularly   you can help people identify  their motivations for change   and then areas that you need to address  that might serve as obstacles to change dialectics radical acceptance and

cognitive

  restructuring means embracing the positive   and negative aspects of a situation dog hair  and sometimes i've mentioned in other videos   that around my house it feels like i'm trying  to brush my teeth and eat oreos at the same time   because we have three dogs and four cats and two  teenagers and so our house is always needing to   be dusted which drives me crazy i i don't like  dust and and dog hair and everything all around   but i love my animals more and if i have a  completely sterile house that would be beautiful   but i wouldn't have my animals and that would  break my heart i can't imagine living without   animals so yeah the dog hair not  ideal but the love of my animals   is much more important feeling vulnerable in  a relationship well when you start to care   about somebody you're going to often feel more  vulnerable and that can be anxiety provoking   but feeling vulnerable and that little bit of  anxiety also means that you care about somebody so   embracing the good...
with the bad and recognizing  you can't have one without having the other   or feeling anxiety or distress when  doing particular

therapy

activities  

therapy

recovery treatment whatever  you want to call it often involves debriding at least old wounds opening  up old wounds and doing it carefully   obviously is important but i've never worked  with somebody in the 20 some odd years that   i've been practicing that the entire time  we've worked together it's been a cakewalk   if we did i wouldn't be  doing my job the whole goal   is to process those issues and those

trauma

s  that bring up sadness or fear or even anger   and work through them so yeah it's uncomfortable  to feel some of those feelings sometimes   but once you process them then you're able to move  forward so you can't have one without the other and autobiography can be really helpful and you  can do autobiographies a lot of different ways   from the adult self assuming  you're working with an adult   they write their autobiography that's the way we  usually do it i've also had people write their   autobiography from someone else's perspective  if have write your autobiography as if your   mother or your grandmother or your best friend  were telling me all about you so it's writing your   biography so to speak or they can write their  autobiography autobiography from their child   self perspective and obviously...
this just goes up  through a certain period of time but going back   to maybe when that

trauma

happened or before  that

trauma

happened having them write their   autobiography from the perspective of that five or  six year old you know what were they seeing what   were they feeling what were they experiencing and  then seeing how that changes as the child grows you can also engage in letter writing and i use  the term letters but in this day and age you can   write old-fashioned letters by hand you can type  them you can do videos or you can even practice   what we call a gestalt

therapy

empty chair  technique any of these what you're doing is   you're getting words and thoughts out of your  head and putting them out here you can write   letters to your future self to your past self  or to other people from your past maybe they   were really important to you or maybe they were  really

trauma

tizing to you but you got something   to say to them you can write these letters to any  of these people in the voice of your past self so   maybe the six-year-old that was neglected  needs to write a letter to their caregiver   you can write it in the voice of your present  self so as a 26 year old you can write a letter   uh in the voice of your present self telling  your past person what happened or telling your   past self what happened you know you're in  the present writing a letter to your past   self or writing a letter to your...
child self  or even your future self or you can write   it in the voice of your future self you can  imagine yourself as being happy healthy and   in that rich and meaningful life writing a letter  to your present self about the things that you   learned or the changes that you made so how are  you different in your rich and meaningful life   there's a lot of different permutations of  this and i encourage you to get creative journaling kind of similar you can journal by  just doing a daily reflection like writing a diary   you can keep symptom logs some people  aren't into the whole prose thing   you can practice mindful journaling so sitting  down in the moment and spending 10 15 minutes   writing what you're thinking  seeing hearing feeling   you can journal about a particular feeling  happiness so you're going to write about the   things that make you happy or the things that  make you angry you can keep a gratitude journal   or journal from the perspective of the inner  child the manager or the firefighter and these are   archetypes if you will from internal family  systems theory the inner child is the part of   you that may have experienced

trauma

and is still  scared and is still sort of huddling back in the   corner so that child may come out and journal and  talk about what it feels like for them right now   the manager is the part of you that just tries to  get things done and they tend to be less...
emotional   and more practical and putting one foot in front  of the other but they can get frustrated by the   inner child that is you know fussing and anxious  and needy and the firefighter who is the emotion   response who's constantly trying to just make  it stop hurting and you know throw water on it   or you can write it from the perspective  of the firefighter that gets exhausted by   getting called out all the time you can do  journals in text or in video or audio format   you can change if you're writing it you can  change your writing utensils you can use a   pen or a pencil or a crayon or even  charcoal you can make your journals   verbal where you're writing words or graphic  where you're scrapbooking or drawing things guided imagery is one of the final  techniques we're going to talk about   but guided imagery can be used for emotional or  physical pain people can be helped to envision   a dial like a knob on the television i guess  we don't have those anymore but you understand   um on the stove we still have knobs on a lot  of stoves where they're turning it down they   actually turn down the intensity the  volume of their emotional or physical pain   they can envision their emotion or their physical  pain as a color and maybe it starts out as red   and then it turns to blue or it starts out as  completely opaque and you just can't even see   the thing that's hurting and if...
it's  your elbow it's your elbow if it's an   emotion maybe it's your heart it's red and  opaque and you can't see anything and then   as the pain goes away it becomes more and  more transparent until it goes away completely nanobots you can tell i watch science fiction but  or or your helper t cells or your immune system   you can envision your body healing itself  or sometimes you can envision like if you're   having anxiety you can envision a wave coming  over you and just whooshing it away sometimes   it can be helpful to be sitting under a fan  when you do that but guided imagery can take   just about any form somebody wants it to take  how would you see this getting better and then   encouraging them helping them actually  see it getting better envisioning it   you can use guided imagery for anticipatory  anxiety too if somebody has to do a speech   or they're anticipating something that's stressful  or they're anticipating heaven forbid the death   of a loved one you can help them use guided  imagery to envision themselves successfully   navigating that situation it may not be you  know all ribbons and roses and butterflies   but they can start to feel more empowered  feel more capable of handling that situation you can use guided imagery for growth you can  right before you go to sleep you can envision   what you want to do better or how you want  to be tomorrow you can start...
reprogramming   your subconscious right before you  go to sleep and then when you wake up   theoretically that has been imp imprinted on your  subconscious a little bit now it's not going to do   things like overnight but they have done  a lot of research that has shown that   meditating or using guided imagery  to change your subconscious is most   effective if done right before sleep and  then guided imagery for sleep and the old   counting sheep thing that most of us told our kids  to do is an example of guided imagery the person   is closing their eyes and they're envisioning  they're seeing this image of sheep jumping over   a fence and that guided imagery can help them  trigger their relaxation response and focus their   attention on a pleasant safe empowering scene  instead of going all over the place and thinking   about the meeting they've got tomorrow and what  happened today and this that and the other thing and health literacy can't end something on with 

cognitive

behavioral

therapy

without talking about   education and cognitions part of

cognitive

 

behavioral

therapy

is helping people understand   the connection between their mind and their  body or their thoughts and their symptoms   helping them understand the  connection between their thoughts   their feelings how they perceive the world  and how they react and helping them learn   and understand the connection between their  past experiences...
and their present reactions it's also important for a lot of people especially  those who encounter

trauma

early on to understand   to be educated about the impact of

cognitive

  development on their perceptions children think   differently than adults children tend to think  in all or nothing terms and very personally very   egocentrically so whatever happened the  way i perceive it must be the way it is   whatever happened is all my fault and it's all or  nothing so if people's perceptions when they were   children were formed that way and formed that way  around

trauma

then in the present they may still   perceive things in very um extreme terms so we  need to help them understand that those schema   that were formed when you were going through that 

trauma

when you were developing were very normal   because that's how a nine-year-old that's how  an eight-year-old thinks in the present you have   different abilities your brain actually changes  as you get older so maybe we can re revisit that

cognitive

behavioral

therapy

is not appropriate  for everybody but for many

trauma

survivors it   can be helpful to have practical

tools

to better  understand address and respond to their thoughts   feelings and behaviors in context so they don't  feel like these flashbacks and feelings come out   from out of nowhere and they're powerless against  them

trauma

-

informed

cognitive

behavioral

therapy

   always empowers the...
person to learn about the  tool decide whether it's one that they want to use   and arrive at their own conclusions when  evaluating thoughts beliefs and perceptions