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Best Practices for Anxiety Treatment | Dr. Dawn Elise Snipes

May 31, 2021
This episode is pre-recorded as part of a live, on-demand continuing education webinar. CEUs are still available for this presentation by registering all CEUs at I am your host dr. Dawn Elise Snipes, we did a presentation not long ago on strengths-based biopsychosocial approaches to addressing


, and while that's great, I thought maybe we should look at you, which we know from current research, so I went to PubMed. I don't know if this is a playground for me; that's where you find a lot of journal articles, and you can categorize them and I categorized them by articles that were done and meta-analyses that were done in the last five years, so it gives us an idea about current research, I mean there's a lot of things which are still the same as some of the drugs that were known to work ten years ago are still known to be good first-hand


s, but there are also some newcomers that we'll talk about, and there are also some changes that we're going to talk about, so we're going to explore some common causes of


symptoms to treat them, we really need to do that and of course it plays a role in the biopsychosocial aspect, we really need to understand what causes it because anxiety is caused by someone.
best practices for anxiety treatment dr dawn elise snipes
Having a racing heart, for example, may be different than the anxiety caused by someone who has abandonment issues. We're going to treat the two things differently, so we want to look at some of the common causes. We look at some common causes of anxiety. You know what these common themes are in practice and I would ask you to share some of the themes you see underlying or underlying the anxiety of many of your clients and identify current



for anxiety management, including interventions counselling, medicine, physical interventions and therapeutic


s so we care because anxiety can be crippling and a large proportion of our clients have anxiety a large proportion of our clients have anxiety comorbid with depression and are looking come on how can I feel anxious and stressed and since i can't sit still and at the same time at the same time you know when you're depressed you often want to sleep people who have both problems really want to sleep but can't so i want to help clients understand that anxiety sometimes too if people are anxious enough, the body begins to retain the co rtisol which the body recognizes at a certain point is a losing battle im not going to put any more energy into it so it starts by drawing some of your neurotransmitter upwi so to speak and people start to feel depressed the brain already He has said that he has no remedy; it's that you are powerless to change the situation, and then people start to feel hopeless and powerless.
best practices for anxiety treatment dr dawn elise snipes

More Interesting Facts About,

best practices for anxiety treatment dr dawn elise snipes...

It's kind of the definition, if you will, of depression, low-grade chronic stress and anxiety increased people's energy and ability to focus, so if we're going to help them become themselves, we need to help them to discover how to overcome anxiety, addressing not only overwhelming generalized debilitating anxiety, but also panic in social anxiety and the minor anxieties that occur, which may not reach the threshold for a diagnosis: anxiety is a major cause of relapse in addiction if you have a client who has previously self-medicated or had an addiction for some reason anxiety is a major cause of increased physical pain when anxiety increases people tend to tense their muscles when they tense their muscles they tend to feel more pain your back and things that already hurt can hurt more because serotonin, one of our most important anti-anxiety neurotransmitters, it is also one of our most important pain modulators. serotonin levels are too low because anxiety is high then our perception of pain will be more acute and people may have trouble sleeping if you are feeling stressed and your body thinks there is a threat that you cannot go as deep if you have a If you're getting restful sleep, you may be getting plenty of sleep, but it's probably not quality sleep, which means your neurotransmitters can leak out of your body and your body will start to look like it's in a constant state of stress when we're exhausted. , the body knows that we are possibly the weakest link in the pack so it continues to secrete cortisol to keep you a little alert so that you can rest again like when you have a new baby at home the first months my children's house was asleep since the hospital but I didn't sleep well I mean the slightest noise and I was awake and I look around and you know I felt it I was exhausted and very new even And it causes anxiety abandonment and rejection, and we're going to talk about manners how we want to deal with these things But some of the underlying issues that I've seen with many clients and when I do research, a lot of the issues that come up include low self esteem if someone has low self esteem. esteem they look outward are often validated they are looking for another person to tell them you love them you are okay which can lead to anxiety that people don't have to tell them they are okay which can make their relationships weak and dysfunctional irrational thoughts and cognitive distortions that make people believe that if I'm not perfect, I'm not nice, for example. looking at some irrational thoughts and cognitive distortions, social support and unhealthy relationships if you are in a relationship it takes two to tango, and even if your client is relatively healthy mentally and physically if not functional you cannot be in a relationship they fear the abandonment and rejection if the other person always says yes I'm going to leave you or if the other person is always cheating on them, or whatever, relationships can cause abandonment anxiety and ineffective interpersonal skills to create confusion in the relationship and social exile lead if our clients are in relationships, even if they are not completely dysfunctional, if our clients are unable to ask for what they need and set appropriate boundaries and manage conflict effectively because conflict occurs in every relationship they may start arguing more, which can lead to fear, which can lead to relationships ending in the past, and they are fine, every r The relationship I have ends which means not being loved so they start to fear abandonment and rejection so these are four areas we can do look at another one that clients judge another issue is the unknown and the loss of control, many times negative self-talk and cognitive distortion can be a contribution. to the fact that if I don't have control over everything, everything will be a disaster -negative, other than hanging around as clients or hanging around negative people, wears you down a bit, when you notice that people who tend to be more negative, pessimistic conspiracists tend to hang out with people who are also negative pessimists and conspiracy theorists, so if you're with someone who tends to be anxious, the anxiety can be palpable and can cause pervasive physical discomfort that can make people anxious that they aren't they know what's causing it, like I said before, if your heart starts racing, if you don't know what's causing it, you can start thinking I'm having a heart attack or I'm going to die if people have panic attacks. rbeeld supplement, they really think they are having a heart attack, and i have had one, but these are very unpleasant experiences, but if people start to have physical discomfort, it may be that you know they have a strange rash that they don't have. it can't go away, or whatever, but if they don't know what it is and can't control it, they can't make it go away, they start thinking worst case scenarios and they go online and on WebMD for go, which usually gives you the worst Of the cases, so the physical complaints are important, we have to normalize the fact that no one is pain free all the time and you know that you may have pain or an ache or a lump or a lump or if you know a cough, probably know that if we look at the probability, the probability that it's something significant is pretty small, you probably want to get it checked out, but you know that the probability that it's something to worry about, is relatively small and a feeling of helplessness can the fear of UN known and causes loss of control for someone who doesn't feel they have agency in their life, if you have an external locus of control or feel like a victim all your life, then you may fear not being in control, you may hold on and ok this is the only area of ​​my life i can control growing up you know i grew up in a very chaotic environment i have no control i got sent to the foster care system yadda yadda yadda now that i am an adult i know i can control these things, and I'm left white-knuckled, and if I can't control everything, it's terrifying death and loss, and causes other anxiety.
best practices for anxiety treatment dr dawn elise snipes
They can be people or pets and pets are important. I don't want to belittle pets because they know they are small parts of many of our families. now i think and you know she is healthy we took her to the vet and the vet said yes she has a little heart murmur but that is to be expected of a 14 year old bitch but if she comes out if she doesn't come back when i call her i had this anxiety for a bit oh my g oh i hope it wasn't the day so anxious to lose people and you know when she crosses the bridge and you know i'm cool with it i have a harder time dealing with my daughter's emotional turmoil when this happens and because she grew up with this dog, so you know these are the kinds of things that we want to talk about with our clients what things are weighing you down, that you might not even think about, because I know in back of my mind there's always worry about one of our donkeys and his dogs - work and promotions can cause anxiety when people are afraid of losing their jobs when they're always afraid you'll know they're going to break in and get a grade pink or get fired or, you know we want to help them see what it's really like: you do what you have to do to get and keep your job, and sometimes it's not easy to answer, I mean, the first thought a lot of us have is good, you know if you do the right thing, do it, so I don't, but there are the bosses, and I've had a lot of amazing bosses, and I've had two terrible bosses, and I could never get the feeling that I could do anything right and there.
best practices for anxiety treatment dr dawn elise snipes
It was always an anxiety because of who I am, because of what today I am going to get into trouble, that's why you want to talk to people, your work causes you anxiety, what can you do to moderate the anxiety anyway? Promotions can make people anxious or they promote safety and security which you know if you lose safety and security you can feel very anxious so if they break into the house next door or there's a shooting in the road or if you go to watch the news can make you feel insecure and insecure very quickly so we want to help people find out how safe and secure you are and a lot of that goes back to the facts when people lose their dreams and hopes or fears that they will leave. lose their dreams and hope that they can start to get anxious, they know they have this dream of being a doctor, or I just finished the presentation on helping high school students go to college, and a lot of things High school students, For example, they start college with these big eyes and they hope to save the world, and they want to be doctors and engineers and this and that, and they get involved and realize it's a lot harder than they thought. or they realize you know what i don't really do like that but i already committed, what should i do, or i want to help people but i can't do it? going to med school because i wouldn't pass calculus and it caused me a lot of anxiety was like what am i going to do now do you know what major i should choose so that people help you figure out if you have dreams that maybe crashed? and burnt out and you have to find new ones that you know well one that we have to accept we have to find out that it's not going to happen and what can you do now people can also have dreams about relationships they have in relationships going on and be they see themselves forever with this person, and then this relationship ends or it starts to get difficult and they say, but this is my dream that happens when it has to happen because this is my dream, not knowing how it doesn't work, if it goes away we want to help people to rewrite their history and then disease spiders and other phobias often go with death many times when people get sick they start to get anxious oh when it's finally what would it be you know it's incurable if I turn through a spider being bitten would kill me, and what's weird, you know there are very few spiders that are actually as venomous as the snakes that cross the bridges I shared with you, that's not one of the d e my irrational fears you know i'm just afraid you know something's going on h Appen and i'm going to get rid of pushing from the side of the bridge which is completely irrational but we need to help people look towards the door e identify the thoughts you now tell yourself about these phobias and deal with what anxiety failure is another trigger foranxiety especially in this culture our culture in american culture places a great deal of importance on success and perfectionism and if people realize they are not perfect they are not then they can get anxious because they feel like i am not perfect , then I can be a failure, you know the cognitive distortions of all or nothing thinking and negative self-talk starts, you know you can't do anything right, so these are some of the problems we often see in coaching sessions counseling, so what do we do?
You know someone comes along and it's like they can't live like that, but anxiety, depression, and substance use disorders, as well as a variety of physical disorders, often coexist, so that's the first thing we need to realize. If we realize that very rarely we're faced with a very simple diagnosis, you'll know that if someone comes in, we have to figure out that you know if they come in and they're depressed, let's talk about it, and then we start to realize that their depression started to show up after a long period where they were really anxious so we have to deal with that but we also have to help them with their sense of hopelessness and helplessness we need to develop the sense of empowerment and then substance disorders know that the use Substance use is often a form of self-medication, but we also know that they are monkeys with neurochemicals in the brain, and can contribute to anxiety and depression, as well as physical problems, due to physical disorders, anxiety for having physical disorders.
If you look at physical disorders they can all contribute to anxiety so we have to look at the person as a whole and do everything that contributes to anxiety and what are all the things that contribute to anxiety so we start with a big list of things that need to be addressed, and then we can start to figure out where we start from, so we can know that these things are comorbid, and that helps researchers investigate pathways to mental disorders, so they can start to figuring out, you know, what string we can pull to unravel this cloak of anxiety so that it doesn't suffocate someone and for us as clinicians it gives us important opportunities to intervene, you know, sometimes clients come in and they start talking, they start talking about your anxiety and physical problems.
You may know of their anxiety from their palpitations, and because they are frequent, we may want to encourage them to see their doctor to rule out anything to do with hormonal imbalances or if they know of heart conditions or anything else that could be contributing to that which could help. they address it and if that's the case If you have physical disorders we go with hormonal imbalances that contribute to palpitations then they can start treating that if they don't start they don't get treated the amount of talk therapy we do will not bring them to the quality of life they seek because they will continue to feel it, so we want to make sure we approach them holistically: anxiety disorders must be treated with psychological therapy, pharmacotherapy or a combination of both and what they found, and it's no surprise, it's old news that counseling plus pharmacotherapy tends to have the


results but in two cases h and have similar results but it's just looking and i hate to call it simple anxiety but we're only looking at the symptoms of anxiety here we're not looking at the full quality of life and we want to make sure we include medical issues as well. , that behavior therapy is considered the psychotherapy with the most evidence because there are a variety of cognitive behavioral approaches, ranging from acceptance and commitment therapy to dialectical behavior therapy and CBT, to know that anyone dealing with thoughts, and the Conceptualization of the etiology of anxiety disorders includes an interaction between psychosocial factors such as childhood adversity or stressful events, and a genetic vulnerability, so that psychosocial factors, and that there are other things when we make our assessment, which we want to pay attention to, because our approach to treatment is different for people byvo image trauma-related brain changes, maybe then for someone who doesn't like that, we want to look at childhood adversity and stressful events what caused it basically what i tell clients is like rewiring the brain ro, are there brain changes related to trauma? soldiers and especially in children or in people who have been exposed to extreme trauma that is intended to protect them, but can also cause complications later in managing anxiety. or a growth environment or in a situation where they don't learn effective coping skills, so we need to help them learn them and learn new ones to build on their strengths and trauma issues they may still be dealing with need to become, as domestic violence, you know if they have grown very domestic violence, they might think that you know I'm out of the situation, it's over, I don't want to, don't think about it, it doesn't bother me anymore, or I'm absent because of the father, and I put absence , because it can be death, it can be a parent that can only be a child that can be adopted , regardless of what the child has in a position to feel that they have been rejected by a parent can be very traumatic and intimidating, but there is a lot of traumatized people that if they're out of it, they often say they know I'm out of it is, it's no big deal, let's just move on, and they don't realize all the consequences and how with It contributes to your current anxiety and your current self-talk and current stressful cognitions if someone has a large amount of current stress. stressors, which will also affect whether they develop generalized anxiety, you know we're stacking the deck here and the current availability of social support if they don't If they have effective current social support, they're going to have trouble carrying everything on their own shoulders, so we want to look at all these psychosocial factors see if we do our assessment and now come back to the trauma issues if you've taken the trauma courses With all the CEUs you know that some people are not ready to admit that trauma still bothers them or to work on the trauma and that's good we can teach them that this can be a problem and then let them choose how to approach it, but we want to keep in mind that they know that it may be some kind of underlying force that drives some of the current cognitions and genetic vulnerability, so take three people and put them in or 300 people and put them through roughly the same psychosocial situations, it's probably They may react a little differently based on their past experiences, but also because of their genetic makeup there are certain permutations and they found four that we'll talk about later that make the brain more or less responsive to stress and more or less responsive to serotonin, which is your calming chemical, so brains are less responsive to serotonin and I don't know, send as much or send serotonin so easily that people can stay tense and wired.
It's a very simplified explanation, but that's all you really need for now. substances that can increase anxiety when people detox from alcohol when detox from benzodiazepines when detox from opiates may feel high levels of anxiety when taking opiates some find opiates to have wonderful anti-anxiety properties not that i am defending the use of opioids. I have only shown client experiences that this may be true, such that some people will be more susceptible to the anti-anxiety effects of certain substances, and that some Cerrone people will become dependent on substances where others cannot and that part is genetic. vulnerability and they estimate that about 30% of the predictability of developing anxiety disorders is genetic and genetics also affects which medications are effective if you have a genetic makeup then SSRIs may be helpful if you have a genetic makeup then atypical antipsychotics may be more effective and SSRIs can't do anything, that's why so many of our clients have done it.
I'm so frustrated because you know there's no way to find out exactly. I think there is genetic testing now, but until then it was harder to figure out which drug to start with, and most doctors don't really know of a single doctor that actually starts out by saying well, let's do a genetic profile to see what drugs you can start on the most. , we start events, such as an SSRI or other anti-anxiety medication, a type of benzo that my experience, so possibly we want to encourage clients to consider genetic testing if they are having trouble finding a medication regimen that works for them and they feel they must have a genetic vulnerability also plays into what will make someone more vulnerable.
Of all of you in class today, you know what to think about sleep, but sleep isn't a big deal for some of you; I know people who can get through days or weeks on four or five hours of sleep, not a big deal, I need eight or nine hours of sleep, so genetically, for whatever reason, I'm programmed to sleep a lot, so if I don't . I don't sleep as much, I tend to have more difficulties. facing life on life's terms, and I know this makes me more vulnerable to irritability, so genetic vulnerability affects who can become addicted, what drugs work best, and what situations tend to make someone more vulnerable to anxiety so our medication and I know the guy here is small but let's see him.
The first line drugs are the selective serotonin reuptake inhibitors SSRIs and the SNRs are selective norepinephrine reuptake inhibitors, now the names are a bit misleading because the selective norepinephrine reuptake inhibitors also increase the available serotonin but the Mechanism of action is different, the mechanism of action for each SSRI is also 'a little bit different, so you can put someone on Prozac and they have a terrible experience, and you can put them on zoloft, and they have a much better experience, like I said before there was a lot of research done five years ago with drugs and zoloft paxil luvox lexapro celexa and their generics have been shown to be effective in treating anxiety in certain people that no drug works for everyone in the last five years but effexor has come up in the radar, and is effective according to the Hamilton Rating Scale for Anxiety. clients are not having success, or not getting the treatment effect they need with some of the other drugs, but probably none of us are prescribers, but we need to educate clients why the first drug or even the third drug the doctor tries it does not work.
It doesn't work so they don't start feeling helpless and hopeless, as I said before, there are at least four different genetic variations associated with the development of general and anxiety disorder and different medications are more or less effective depending on genetic makeup. of the person there is a high mortality rate after two benzos the recommendation has actually moved to the use of benzos because some doctors prescribe an SSRI and for the first four weeks as the SSRI builds up in the system they also prescribe a benzo to be taken as needed to moderate anxiety and you know you can discuss either side of that if someone has had any substance use or substance dependency benzodiazepines are really a bad idea because they are highly dependent but the other reasons they are now warning against the use of benzodiazepines is that there is a higher mortality rate among benzodiazepine users compared to non-users. risk of dependency if you use it for more than six months, and that's a long time to be on a benzo and when we talk about dependency and six months, we're talking about someone who uses it every four hours or every eight hours, depending on your benzo every day. days, not a PRN user, if someone uses it at night to help them sleep or if they know three or four times a week when anxiety really kicks in, the risk of dependency is relatively low, but many people with anxiety, because when they find the right benzo they feel so much better they don't want to quit and for a lot of people when the benzo hits the middle of their life and even more starts coming out of the system their anxiety spikes you know they have anxiety that they want to cure with more benzodiazepines, which will be an issue for you to discuss with your doctor.
There's also an increased risk of dementia: benzodiazepine users again, this is for people you use, every day for six months or relatively every day for six months or more, and it doesn't matter if you know we're talking about someone. not who is 65 or someone who is 35 who uses benzodiazepines because he knows six months a year two years the risk of dementia in old age is greatly increased according to research benzodiazepines also do not treat depression so if someone has co - Al anxiety and depression can occur, there is a much higher risk of suicide if they use benzodiazepines,so if you know that suicide risk is the result of benzodiazepine overdose but not always other treatment options you know benzodiazepines are not something people want to touch you you know they scare the hell out of me and SSRIs and SNRIs don't seem to work so you can try tricyclic antidepressants the old generation antidepressants seroquel wor d a lot of use and there is research showing that it can really be as effective with anxiety as some of the antidepressants and depending on the person the benzos seroquel can make people very sleepy so you know it doesn't have the side effects of seroquel weight gain and fatigue and you know drowsiness can be an unacceptable side effect for some clients and increase fibula, the third option, boost barone works more like a serotonin reuptake inhibitor antidepressant and you should know that four weeks or so, to some degree of accumulation. ation in studies of the system, have shown no long-term benefit, but six months to eighteen months of use is effective in talking to clients, and many clients believe it increases If they take it, it doesn't necessarily help them be anxious as a benzodiazepine, but it helps them not go from zero to 200 in 2.3 seconds, but they know they can't freak out every time something goes wrong, which helps a lot of clients because they feel more stable for the next day. remission - the medication has to be continued for six to twelve months and for the last six months the first six months lasts like the last six months, you know they say taper off is best; it's best not to stop cold turkey, but it's definitely important for people once they're in remission, to not just suddenly feel better, I feel better.
You no longer need it; they need to work on it and make sure they have developed the skills and tools they need to deal with the anxiety that will happen in life, so physical signs and symptoms of anxiety can include fatigue, irritability, muscle tension or soreness, trying to keep feeling nervous startle easily difficulty sleeping nausea diarrhea irritable bowel syndrome headache the first thing we want to do with clients when we talk to them nicely the second thing first is to say get a physical we are going to rule out the physiological causes of this but we can also help the customers to look for Do you know what could be causing these things that you can do to mitigate it?
What could be contributing to your fatigue? What could be contributing to your irritability and muscle tension or muscle aches? I mean, let's look at the economy. new bed or you need to get a new bed what about your desk chair? I know you know I get more muscle tension and muscle pain when I move my mouse a lot because I have a lousy posture, becoming aware of that helps and then I'm like okay well I know what caused it is unfortunate it's unpleasant but it's not a big deal shaking or feeling nervous you know it can be caused by low blood sugar which can be caused by anxiety which can also be caused by early onset Parkinson's symptoms you know it can be the worst case scenario or it can be something really benign, so we want people to realize that you know when to start shaking or feeling nervous is there something that relates to you?
I know when my son gets really excited, he just sits there and you can almost see him shake because he's so excited about something, so we want people to avoid misidentification. We don't want them to jump to the worst case scenario, we don't want them to go on WebMD and say, oh my gosh, I have cancer, I have this debilitating disease, and I'm going to die in six probabilistic months. Lee speaking, it's not going to happen, yes, get a doctor's opinion. I'm certainly not going to tell you that it's all in your head. I definitely want you to get an evaluation but in the meantime I want to help you really think about how likely this and other things are for headaches and this is another one of those that can be frustrating as we get older our eyesight starts to fail and you know there was a period where i did well and then after i hit 45 my eyesight started to improve steadily and kinda quick in my mind it falters so i have to change my glasses prescription every two years old and that can cause headaches so instead of starting to worry about oh my gosh I have a headache all the time maybe I have I have a brain tumor you know I know it's probably my glasses or am I grinding my glasses teeth, so other biologic interventions have been evaluated, there's something called the floatation rest system, reduced environmental stimulation therapy, reduces the senses. input into the nervous system through the act of floating supine lying on your back in a pool of water saturated with Epsom salt you know I'm looking at this that sounds great and you can't get the same experience in a bathtub because you don't you're floating you've got pressure points and you're still hearing things that clients can simulate with earplugs or whatever but if they can access this it's been shown to be really effective the experience of floating is calibrated so that the sensory signals from the preceptive and gravitational channels vestibular tactile thermal tactile auditory visual olfactory are reduced to a minimum, which means that you do not see here taste, touch, smell, you do not feel anything, like most movements and speech, so you want people to kind of stay completely still and not talk, which can be difficult for some people with anxiety in the study, the study that I looked at with fifty participants reported significant reductions in stress, muscle tension, pain, depression. sion and negative effect, and was accompanied by a significant improvement in mood characterized by increases in relaxation, happiness, and well-being.
I read the study. I would like to know where I can register. more effective in addressing anxiety than something like massage Tai Chi also produced significant reductions in anxiety there was approximately a 20% treatment effect 25% treatment effect in patients with anxiety and fibromyalgia who practiced twice a week for a year now you know we want to look at the confusing things here is it Tai Chi itself or is it learning to control your muscles and being more in tune with your body and learning to control your breathing that helps people reduce their anxiety ? that and it was shown that after a year after the first six months there was a significant treatment effect, but after a year it was still growing and after a year it was around 25%, so Tai Chi can really be cash.
An acupuncture on the HT 7 middle meridian can attenuate anxiety-like behavior induced by withdrawal from chronic morphine treatment through meditation of the GABA receptor system. acupuncture is done in very specific places anxiety behavior the GABA receptor system a GABA is your main calming relaxation neurochemical that kicks in and causes your body to flood that receptor system and this research was done on people who were detoxing from morphine treatment but we can look at the generalizability of the results and I would be interested to see more studies on pain other things we need to do to help people with anxiety when people have chronic pain they often have anxiety that oh my gosh this it's getting worse or it's never going to get better or they just can't take this pain anymore or they may get anxious that they're going to be rejected because they can't do some of the things they used to do because they're in so much pain so there's a lot of guilt and anxiety that they can revolve around pain.
What can we do to help customers? Guided imagery is usually very helpful if we can help them imagine it. know if that pain in your shoulder imagine the pain is like the color red and it's coming out of your arm or another focus mindfulness so you know when you think about something you know when I get a shot if I don't think about it it doesn't hurt nearly as much as if the nurse says okay now one two three and you know she's counting down and I'm getting ready and I'm really focused on it. I had another nurse one time she was just talking to me and with you I know she put the alcohol on my arm and kept talking she didn't tell me she was getting ready to give me an injection and before I knew it she had given me an injection and she said that okay we're done i'm like you still didn't give me a chance she said yeah i did it's like oh so don't focus on that and the next time you do it itch like yeah have you ever been driving on the interstate and can each one on your foot sometimes i get those on the bottom of my foot and i'm like okay i'm not going to stop each one my foot if you focus on something besides the itching eventually goes away.
I'm not saying the pain will go away completely, but the more people focus on it, the more it hurts. Physical therapy can help, so encourage them to get a referral and encourage them. do a self-assessment, at least, of the ergonomics in your car at work where you watch tv and spend most of your time at home and you're sleeping so those are the four places where you spend most of your time what do with its ergonomics and that can help many people to mitigate a lot of pain. Hormones are another thing we need to look at.
Estrogen and testosterone imbalances can contribute to anxiety symptoms. Heart palpitations. Fatigue. Irritability. doctors do anything ing about it, but doctors can have a fast heart rate, palpitations, sweating, these are not uncommon in women in perimenopause or menopause, so many women start to feel like they are developing generalized anxiety and/or that something is wrong when they start to hit their mid- or mid-40s. area of ​​50 and they start to have some of these symptoms again we're not going to diagnose it but we want them to recognize that it may not be anything catastrophic you know this is something a lot of women experience and help them figure out how to deal with that care biologically supportive now that you know this isn't going to treat anything but we can help them minimize their vulnerabilities help them create a sleep routine so their brain and body can rebalance this can help repair any adrenal issues they may be going through increase and improve energy level People with anxiety don't sleep well, so it's important to help them figure out how to get quality sleep.
Nutrition minimizes caffeine and other stimulants. It's going to be a big help because that makes people anxious, encourage them to work with a nutritionist to try to prevent the spikes and dips in blood sugar that can trigger the stress response when your blood sugar is low. in the blood it goes up or down it can start to be kind or shaky and it feels weird and that can cause people anxiety because they may think oh my god I'm having a stroke or a heart attack or you know I don't know what it's these tremors, so it's important that they don't lose identification. symptoms and encourage them to drink enough water dehydration can lead to toxic ardea which is an increased heart rate sunlight vitamin D deficiency is implicated in both depression and anxiety mood problems vitamin D is has been found in the main areas where the serotonin receptors are located the vitamin D receptors are found so we know that serotonin and vitamin D have something going on sunlight causes the skin to tell the brain to make neurotransmitters and establish circadian rhythms which impact the release of serotonin your calming neurochemical melatonin which is produced by breaking down serotonin and helps you sleep and gaba so sunlight actually helps increase gaba release when it's time to sleep start to calm down and lie down.
Exercise studies have shown that exercise can have a relaxing effect. encourages clients to start slowly there is not much new research on exercise and anxiety aromatherapy has been used extensively, especially in other countries, in the treatment of people with anxiety people with hospital anxiety women who are giving birth and have some birth anxiety there have been found to be really effective in many of those studies essential oils for anxiety include rose lavender bedevere ylang and lang bergamot chamomile frankincense and clary sage encourage customers to go to a health food store and already know how to smell a little bit of these see if it makes them feel happy and calm and content the aromatherapy molecules get into the nasal membranes and will stay It doesn't trigger neurochemical reactions and so you don't need to apply it, you don't need to ingest it, all you need to do is encourage clients if they are open to thinking about this because aromatherapy can be integrated into their d bedroom, for example, with an atomizer or a mr. it can be incorporated back into many different places where they don't apply it or ingest it in any way, all they do issmell it, they used it to deactivate aromatherapy in hospital emergency rooms and found that it reduces stress and irritability for people in emergency rooms and I've been in enough emergency rooms over the years to know that people who are in ers are usually not in the best of moods, so if you can help those people, you'll probably leave. have some kind of effect to psychologically help clients realize that their body believes there is a threat for some reason, so it activated the threat response system, which is what they call anxiety, so they need find out why a threat really exists. sometimes it's like the fire alarm goes off in my house it just means the windows are open and there's a strong breeze there's no fire there's no problem there's just a malfunction many times it's a false alarm for customers they have this threat reaction , they have this stress reaction and it's not a big problem right now, so they can start to modify what their brain responds to and again those basic fears that many people worry about failure, rejection, loss of control , the unknown, and Distress Tolerance for Death and Loss is one of those cognitive interventions that has taken center stage in anxiety research and it's not about managing your anxiety, you know, helping people to acknowledge your anxiety, acknowledge it and say, okay, I'm anxious, it is what it is.
How can I improve the next moment instead of saying that I am anxious? You shouldn't be anxious. I hate being anxious and colloquy with that anxiety. Let it roll. Just accept it. Have the client learn to start saying I'm anxious. Okay, distract yourself, don't react because I explain the whole notion that feelings come and go in about 20 minutes, it's like a wave, so once you acknowledge your feelings, if you can distract yourself. s for twenty or thirty minutes, they obviously realized that there is no real threat to them if they can distract themselves for twenty or thirty minutes, those emotions can subside and then they can handle them in their wise mind.
Encourage them to use distancing techniques instead of saying I'm anxious or terrified or whatever. Have them say that I am thinking that this is the worst thing in the world is that I have the thought that I can't handle this because the thoughts come and go and that comes from acceptance and commitment therapy functional analysis allows you to pinpoint where when how often with how intensely and under what circumstances the anxious response is triggered, so it is important that we help clients develop the ability to do functional analysis for themselves, so that when they start to feel anxious they can stop and say, okay , where am I, what is happening, how intense is it, what are the circumstances and do they really start? trying to figure out what causes this for them so they can identify any common themes from their psychoeducation on cognitive distortions and techniques for those circumstances can be prevented or mitigated so if the client knows they get anxious before going to a meeting with their boss and it's usually high intensity anxiety, that's okay, so we can educate you and help you identify what fears may be related. to techniques to slow their breathing and calm their stress reaction and help them discover times in the past when they managed to come in and talk to their boss and it really wasn't the end of the world you know there's a lot of different things we can do there for them there but the first key gives them a great sense of empowerment to start becoming a detective in their own life and to be okay now in what situations this happens. positive writing.
This was another really cool study each. day for 30 days the experimental group and these were high school age youth in China, but the experimental group engaged in 20 minutes of writing about the positive emotions they felt that day, so they're writing about anything positive that makes them happy, excited, hopeful, anything expressive in the long term, write down positive emotions so after 30 days it seemed to help reduce test anxiety by helping them develop insight and use positive emotion words as well who got them out of the habit of using the words destruction and doom and encouraged them to get into the habit of looking at the positive things and being more optimistic is a really cool activity that clients can try it won't hurt a thing if you have them in a journal every day For 30 days, mindfulness was also mentioned in research and was shown to be really effective in a meta-analysis. these showed that mindfulness was an effective strategy for the treatment of mood and anxiety disorders and is an effective therapy protocols with different structures including virtual modalities so you know if you are doing it through a teleconference the attention mindfulness can still be helpful mindfulness helps people begin to learn to observe what is happening and to be aware of what is happening more aware of the circumstances that will help them complete their functional analysis, but it also helps them to become aware of the vulnerabilities and avoidance in the past and if they are taking better care of themselves and living more mindfully, they may not experience as many situations that trigger their anxiety. also encourages clients to learn to accept that radical acceptance is what it is I'm not going to fight it I'm angry right now I'm anxious right now However I feel right now This is how I feel and it's okay and It's hard for clients to get to that, but once they understand it and really believe it and can say it's okay, it's okay, I won't feel like this forever. doing something else until the feeling passes helps and that's where labeling and letting go comes in in mindfulness it can also help you identify the triggering thoughts what thought you were having just before you started feeling anxious if people are mindful or let's start over when people are unaware they often notice or don't notice they are getting anxious until they are super super anxious when people are aware they become more aware of subtle cues address unhelpful thoughts when they say or believe it is a compelling need that adults are loved by their loved ones for almost everything they do, it's always going to happen because it's a necessity, what we can encourage them to do is focus on their own respect for approval for practical purposes, you know, for promotions or whatever, but it's not about me. being nice is about me getting promoted and making more money and concentrating on loving instead of being loved because when we give love we usually don't return love Useless thought number two People feel like they can't stand it if things don't go the way they want that are or are not in your control, so encourage clients to focus on the parts that are in their control and other things. in life they are doing well and committed to number three misery is invariably externally caused and forced upon us by external people and events just reading about it makes me feel powerless so i encourage clients to focus on the fact that reactions like misery or happiness are largely caused by how people view conditions, so if you see it as tragic and devastating then it will probably produce misery, if you see it as opportunity and challenge then it will probably produce a different emotional reaction. if something is or could be dangerous or scary people should be terribly annoyed and annoyed endlessly to obsess over it, a lot of people with anxiety get stuck on this, you know if i feel like it's scary i have to worry about getting on a plane For example, if I'm afraid that it's dangerous, I need to think about it and worry about it, that won't do any good, so encourage clients to figure out how to deal with it and resolve it. harmless if possible and when that's not possible accept the inevitable so looking at planes you know how to deal with means doing your research to find out how dangerous it really is and realizing it's really not that dangerous which helps make it a bit harmless in its in its own mind it shows them it's not as dangerous as it could be and when you can't accept the inevitable you know you've got a fly so keep figuring out how you're going to get through it, hurricanes are the same way especially people in places like texas, louisiana, florida can become obsessed as soon as hurricane season starts or if a hurricane is detected in the atlantic somewhere they start checking the weather every hour or so wondering what the way is going to be and you know what's out there you can't change the path of the hurricane so all you can do is board up your house evacuate if you must and deal with the consequences child driving is just another example I will.
I want you to know that my kids are learning to drive and that is kind of scary and scary. You know what's going to happen when they're out there. how to drive make sure they are good drivers and then accept that some things are just not in my control is easier to avoid than to cope well with life's difficulties and responsibilities running from fear is often much more difficult in the long run so encourage clients to look back at times that they have avoided difficulties and responsibilities and the end result you know what happened there people believe they must be fully competent in achieving in every way possible or they will be isolated rejection and failures we need to encourage clients to accept themselves as imperfect, with limitations and human flaws, and to focus on what makes them a lovable human being, what qualities like courage, intelligence, creativity and those things that are not they can be removed, what inherent qualities they have. having that makes them amazing people because something that once strongly affected people's lives they should fear indefinitely if you get lost you know when little kids get lost it's scary as an adult if you get lost you turn on the GPS and figure it out in your own way , but some people you still know freaked out about getting lost if they got lost once, so we want to help people look back on past episodes that may be contributing to current anxiety and compare the situations you know , are you the same person or is this not a big deal now that you are older, wiser, stronger, encourage them to learn from past experiences but don't get too attached or judgmental about them, yes you could have. you got lost in the past and it was a horrible experience well you were six I can see that would be scary and a horrible experience but it doesn't have to keep impacting you like that now that you're 26 years lost you know it could be an opportunity to trying a new restaurant or something people should have full control over things ok this doesn't happen so encourage customers to remember the past and future are uncontrollable we can't change the past it is what it is that we can learn from it so that it does not repeat itself, but we cannot change it and the future is largely uncontrollable.
I mean, there are many things I can do to keep moving toward a rich and meaningful life, but life is going to throw curveballs at me sometimes and there is nothing I can do to plan or control that we can control our actions in the present to stay on our preferred path and generally build general skills to deal with adversity should it arise, so we want to help clients develop those general Problem Solving Skills and general support system so that when thrown at a curveball, you know you don't hit them over the head. People have virtually no control over their emotions and can't help but feel disturbed by things.
Encourage them to think about the fact. that you have real control over the destructive emotions if you choose to work to improve the next moment and change the wrong thoughts then you are not going to experience the destructive emotions as intensely or as frequently when you feel an emotion you feel how you feel but again you don't have to wrestle with it wrestle and nurture it you can say this is how i feel how i can improve in the next moment when it comes to cognitive distortions encourage them to find alternatives when they start to personalize things if someone laughs when you leave the room and then the person starts to get anxious thinking oh, they were making fun of me.
I wonder what they thought. I wonder if I had something stuck. or the back of my dress and they start to panic because that's no use encouraging them to think they know what our three alternative explanations are that they didn't but had nothing to do with you why they laughed the worst you know It's taking something and saying if this happens then it's going to be a catastrophe and minimization goes along with that many times when people magnify and see a catastrophe they minimize not only their own strengths and resources but all the other things around them. please all you are seeing is thiscatastrophe, so encourage them to focus on the facts, what's really happening and what the high probability event is, and encourage them to get information and look at the bigger picture, you know, yeah. you were in a car accident and your car was totaled and that's unfortunate you know it really sucks but you know that won't cause you to lose your job and then be homeless and penniless and ya dda-yadda it might make your insurance get on but ok so you don't have a car but what are the resources you have who can who works with you that could drive you to work? look at the resources you have and work around them for problem solving to help with magnification and also focus on you know let's be thankful that it didn't happen you know you could have been killed but it didn't the car was totaled is it replaceable all or nothing thinking again ask them to think of what else might have been happening as Brittney suggested finding the exceptions instead of saying she always does this find exceptions when she hasn't done that what else has she done instead part of this selective abstraction and filtering is when people look for the good, the bad and the ugly a selective abstraction means you see what you expect to see so if you expect something to be devastating you only see the devastating aspects that go with it amplification and minimization filters things out a lot of times when people are in a bad mood or anxious, they see the negative because that's the state of mind they're in, so I encourage people to complete the picture, okay, now there's all this bad stuff.
What's the good thing you know? Encourage them to look at the good, the bad, and the ugly so they have a broad view of exactly what is going on, and encourage them to remember that hindsight is twenty-twenty when something embarrassing happens to people or they get anxious. about something that happened they look back and say I should have or could have or I wish I hadn't when you were in that situation you did what you did and you know you might have had a reason for it or you know you might not have had no other options or it was just stupid but ok you made a mix up, in hindsight it's 2020 that mistake will stand out like the big big letter on the eye chart. be because he's remembering and he's looking at it and that's all he sees, but it encourages clients to remember that other people are too busy worrying about themselves to really remember what you did jumping to conclusions encouraging clients to remember to get all the data if your partner comes home and smells perfume do not jump to the conclusion that maybe he was cheating on you he went to the mall to buy himself a new tie and he walked through the perfume area and sprayed himself or bought you a perfume or who knows , maybe the person sitting next to you at work sprayed your perfume on the desk and some of it leaked out.
There are many different reasons why that could happen, so encourage people to get all the facts. Read mind. We can not do it. You know you can't read someone's mind. You don't know what they're thinking. you think about this, don't assume anything, and emotional reasoning encourages people to take a step back from a situation and ask themselves if I'm feeling anxious about this because I feel anxious and I'm looking for reasons why it should be scary. Am I feeling anxious about this because it's really scary for some reason? There are real facts that support my anxiety many times when we are faced with new situations, we can feel anxious because it is a new situation, but when we take a step back we say you know what's up. there's really nothing to worry about here you know it's not a big deal I got this and move on so instead of accepting it and trying to figure it out I feel anxious so there must be a reason not necessarily very likely a false alarm , other psychological interventions, relaxation.
The skills encourage people to learn to relax not only physically but also mentally. Diaphragmatic breathing is helpful to encourage them to breathe through their stomach and put their hand on their belly and feel their belly expand and contract. Slows down breathing, which triggers the rest-and-digest reaction in the brain which is calming meditation can be helpful for some people some people find trying to quiet their mind too frustrating because they have too much m on their mind is happening that can be later or maybe never for some people we don't want to increase their anxiety with interventions cute progressive muscle relaxation also has a lot of research support and remember with cute progressive muscle relaxation we are directing you to sakura attach an AK sign you say relax or breathe with the relaxation response so they tense their muscles and then relax their muscles and as they relax their muscles say their word q'' as relaxed and work from head to toe or head to toe tensing and relaxing different muscle groups so they are more aware of how a tense muscle feels compared to a relaxed muscle reactive either. encourage it because once they get used to it then they can think of that cue, they can think of relaxing and as they exhale they will start to feel their whole body relax because yo is trained when you hear that just like when you hear the word pop quiz when you were in high school you had a stress reaction, well we want to use it in reverse and train, train the body so that when it hears a key word it relaxes, help them. develop self-esteem because fear of failure and rejection often comes from needing other people's approval help them develop a rational idea of ​​their true self develop compassion self-talk instead of saying I'm an idiot or stupid or I'll never measure up nothing, encourage them to talk to themselves like they would talk to your child or hopefully their best friend, and encourage them to highlight their strengths whenever they feel they have a flaw identify these three strengths they have so they can do you know how to balance the imperfections and the strengths?
Cognitive restructuring reframes challenges in terms of current strengths and not past weaknesses, so if you're giving a presentation in front of 60 people and you hate pubs. lic talking instead of thinking about you you know this is scary because the last time i stood in front of people i forgot everything i was going to say and i dropped my grades well that's a past weakness what is your current strength are you ready Know your material, yada-yada, so encourage people to look at all the strengths and resources that they currently have, ask them to develop an attitude of gratitude and optimism because as I said with that, the positive writing exercise when people are in a grateful and optimistic state of mind.
They tend to see more good things. They also see bad things, but they can also see more of the good things and some of the bad things. They see it opportunistically rather than as devastation. Acceptance and commitment therapy says that we are some of the reasons we are miserable is fear we merge with our thoughts we think I'm terrified well if I'm terrified then I can't I mean if I am I can't get rid of anything I'm if I am having a thought that I am terrified, well I can get rid of a thought, I can easily forget things, encourage people to evaluate their experience and empower them to see things as challenges and opportunities rather than difficulties, encourage them not to Avoid your experiences, so do the scary things. gradual exposure and finding exceptions like for me bridges you know I love public speaking so that's not a problem but when I go to a bridge you know when I drive to the bridge you know when I'm on the bridge someone more is driving. i used to do that when i drive over a bridge and then when i drive over one of those bridges that open up i hate those bridges um i know everyone is like oh my god yeah it's an irrational fear i realize that but instead of going straight on the bridge which is opened by first going over the little bridges and then remembering the times when I've crossed bridges and there hasn't been a problem you know there are exceptions nothing happened it wasn't a big deal sometimes I didn't even notice it until someone pointed out: "Hey, look at that beautiful water and I was like, oh, we're on a bridge, so encourage people not to avoid their experiences, get used to it, embrace it, and learn that they have the power to cope." with them and stop giving reasons for behavior that you know use challenging questions if something is scary let's look for evidence for and against instead of making excuses social interventions improve their relationship with themselves what goes with improving self self esteem people will feel less anxious about getting their needs and wants met if they know what their needs and wants are, so part of that is becoming aware because many of our clients don't know what they need and want. feel better, but they don't know how they don't know what they need to feel better, so help them identify their needs and wants, encourage them to be their best friend. they themselves go out to dinner pat themselves on the back whatever it is don't trust other people to do it because other people it's not that they don't care but other people are often very involved in thinking about their own stuff and you may not encourage them to develop a method of internal validation so they can feel like they are all that, not a bag of chips and realize why they are lovable human beings and accept the fact that they won't be liked by others. everyone and no one.
I like them all the time and that's okay you know my kids don't like me all the time my husband doesn't like me all the time I'm okay with that I know I can be challenging but you know most some of the time you know they like me and that's okay and there are some people you know who don't like me at all and that's okay there's nothing I can do to help our clients develop and being okay with that helps relieve a lot of anxiety because a lot of people feel like they have to be liked by everyone and if someone doesn't like them it's like what did I do wrong oh my gosh encourage them to develop healthy supportive relationships with good boundaries build assertiveness skills to that they can ask for help when they need it, anxiety a lot of times, you know, that's the body says there's a threat, well, if there's a threat, maybe you need help, you know how to deal with it, so people need to be willing and able of asking for help and not feeling that it will lead to rejection and allowing them a certif this will allow them to say no to requests again without feeling that it will result in outright rejection describe the ideal healthy support relationship and encourage them to separate ideals from the real ones you know let's see if you had a better relationship what would it look like?
Okay, you know, Warden June Cleaver, we've got it now, how realistic is that? aver never fought their kids were perfect you know all those extreme words let's see what's real what happens in real relationships encourage people to identify who would make a good partner in supportive relationships i don't necessarily mean romantic i mean friends and where do they they can find, you know where you would find people you could be friends with and encourage them to play, what does it mean when the game? I'm not texting you back right away. What does it mean when your friend cancels dinner on Friday night?
What does it mean when you see where I'm going with this and many times clients with anxiety and rejection issues and low self esteem go to the worst so encourage them to go back to find the exceptions what else could have happened what else could have caused this and it is not about you, so anxiety is a natural emotion that has a survival function Excessive anxiety can develop due to lack of sleep Nutritional problems Neurochemical imbalances Failure to develop adequate coping skills Distortions Low self-esteem and a variety of other things Ambala recovery involves improving health behaviors Making sure your body is working and producing the neurotransmitters it needs and knows to release them as needed Identify and develop current coping strategies Address cognitive distortions and develop rapport healthy supportive of self and others participate in our live webinars with dr.
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