12 Strategies for Mindfulness and Self Awareness in Contextual Cognitive Behavioral Therapy

Foreign I'd like to welcome everybody to Today's presentation of 12 strategies for mindfulness and self awareness using contextual cognitive behavioral therapy. I'm your host, Dr. Donnelly Snipes. In this presentation, we're going to define and review the content concepts of contextual cognitive behavioral therapy, explore the impact of context on people's phenomenological reality or their personal reality. We'll explore how addiction and mental health issues can be influenced by context and explore how acceptance, awareness, mindfulness and psychological flexibility can all be used to address issues including mental health issues, addiction issues, and physical health issues, which is what we call trans diagnostically. So why is context important? Well, addiction and mental health issues are often intergenerational and they are strongly correlated with each other. Adverse childhood experiences, impaired occupational and social functioning, and health problems in general. But it's important for people to develop an awareness of their current context because if they grew up in an environment with adverse childhood experiences or ACEs, then they may be expecting the world to still operate in that function. They may still be operating based on schema they formed in an unsafe environment, when in the current context they're actually much safer. They may be forming schema or may have formed schema based in the past when they were clinically depressed, whereas in the current situation they are asymptomatic or in remission or whatever you want to call it. So the context is very important. Contextual approaches encourage mindfulness in the present moment. Context when we are mindful, we are aware of what is going on in the present moment in ourselves as well as in our environment. In our context. Contextual approaches accept each person's truth is constructed from their schema and the resulting interpretation of the current moment. And that's what we call phenomenological reality. Every person can experience a situation differently based on their prior experiences. Their prior experiences shade or impact how they interpret things. For example, some people interpret very large hand gestures and a lot of gesticulating, as they say, as being threatening because that's associated with arguing and violence. Other people associate that with people that are happy and be just being simply emotive. So two different people can see the same thing happening and have two very different assumptions or interpretations of the situation. Neither person's truth is necessarily wrong. Their truth is based in that moment is saying, okay, based on my past experiences, this is a threat or this is not a threat, that's their truth in that moment. Contextual CBT says, okay, let's acknowledge that that is your truth in that moment. Then let's explore it a little bit further. Let's explore the current context and see if that truth still is accurate. The goal is to consider the context and function of the past and present issue and empower the person to make conscious choices toward their valued goals, to examine their their truths, to examine their interpretations and say, okay, I can understand how I might have this interpretation based on my past. However, is this the interpretation or is this the reaction that is currently what I want to use? Remember that the prefix re means to do again. If we repeat something, we're doing it again. If we redo it, we're doing it again. If we regress, we're going to an earlier age. If we relapse, we're doing something that we had stopped doing and we're starting to do it again. And if we react, we are acting the same way that we've acted in the past. And I know you were like, what? What did those first ones have anything to do? I want you to get to the re point for reaction. Reactions are often based in our default mode network are often based in autopilot and contextual. Cognitive behavioral therapy says, all right, let's start empowering people to choose the their action to be proactive instead of reactive. The family context can be a preventative or a risk factor for the development of mental health and addiction issues. If the child grew up in an environment where there was secure attachment and high emotional intelligence and, you know, all kinds of good stuff, they had a very healthy chance childhood, then they form their schema based on that. And the schema that they use based on that context, they carry forward into the present, which generally doesn't lead to a lot of problems. Children who grew up in adverse environments form their schema and they grow up and ex continue to expect people to be un, untrustworthy, uncaring, abusive, neglectful, whatever. So it's important to recognize that the context in which the original schema were formed is really important, but it's also important to empower people to recognize their current context. When you were eight, you couldn't do anything about it. You had to rely on your caregivers, as crappy as that situation was. Now that you're 28, how is this context different? Children develop schema about themselves, others, and the world through these early interactions. In later life, people continue to develop their schema that is influenced by their past learning what they're saying there is. Unless we stop and actually intentionally evaluate our schema, then we are making forming future schema based on past assumptions, whether or not those assumptions are accurate in the present context. So it contextual CBT really says we need to get into our wise mind, turn off that default mode network, turn off that autopilot and get into that wise mind. Now we've talked about this before, but it's important to recognize that at the heart of a lot of mental health and addiction and even physical health issues is attachment trauma. And people need secure attachment in order to feel safe. They need consistency in their caregivers or in their loved ones if they're older. They need people who are responsive and they need to be responsive to their own needs. And consistency and responsiveness are things that people start to develop when they become more mindful. When people are not mindful, then they only pay attention to what they need, kind of sort of some of the time, if ever at all. Consistency means the person is regularly mindful, regularly checking in with themselves, regularly compassionately responding to themselves and addressing their needs in the best way that they know how. Responsiveness in others kind of goes along the same way. Caregiver responsiveness. It's important to recognize that some caregivers just didn't have the skills. If they didn't have emotional intelligence, they can't respond with it and they certainly can't teach it. If they didn't understand age appropriate communication or age appropriate intervention. They may have been trying to respond to the child, but they were responding to this 5 or 6 year old like they were 25. They were talking to them like they were adults and not understanding that children actually think completely differently. Attention is also important. Whether it is mindful attention to yourself, paying attention to yourself, spending time with yourself, figuring out what you like, what you need, or attention from others. Where people are proactively spending time with you, they're not doing it to help you feel better. It's not a reaction to distress, but they're proactively saying, hey, I want to spend time with you, see what, what's in what you are interested in. Validation is another important concept. And this goes along with understanding that phenomenological reality. Children's perspectives are very different than adults perspectives. What a child or a tween may think is the complete end of the world is a non issue for adults. Because we've been through so many more things and we've experienced so much more. We can look at, look at that particular issue and go, oh, in 10 years you won't even think about that anymore. But that's invalidating the child at that point in time. That is a huge big deal for them compared to other things they've gone through in that context for that child based on their reality, their phenomenological reality and their limited experiences, it's a big freaking deal. So validating that it's a big deal for them is important. Instead of invalidating and telling them to get over it or oh, you just, it won't be a big deal later. Providing encouragement is also important for the self. You know, if we're being mindful, if we're engaging in self awareness and self acceptance, encouraging ourselves to step outside of that comfort zone, step, step outside of that safety area to try new things, but recognize we can come back to that safe home base and receive unconditional love. Now, hopefully the person can provide unconditional love to themselves, recognizing that, hey, I'm not perfect, I'll make mistakes, but I'm still a good person, I'm still lovable. And hopefully they have other people in their environment to whom they have or with whom they have secure attachment that can provide that same thing. But it's important to recognize if people were in an environment, were in a context that did not have these things that promoted insecure attachment or neglect or abuse, then they often don't have the skills and don't know how to do these things to create secure attachment. Think about what it's like for a child growing up in a house in which one or both caregivers has either an addiction or a mental health issue. Now, these are only two of the identified, quote, adverse childhood experiences. But if you think about it, a lot of the other adverse childhood experiences like abandonment and violence and neglect and abuse, caregivers who are engaging in those types of things often have an addiction or mental health issue. You're not going to have a mentally healthy, physically healthy caregiver that in chooses abuse or neglect. You know, that's, you know, if we're talking about mentally healthy, that means non narcissistic, of course. So think about what it's like because caregivers with addictions or mental health issues are doing their darn best most of the time or a lot of the time to put one foot in front of the other and take care of themselves. Now when I'm saying these things, when what I'm talking about is an uncontrolled addiction or mental health issue, people who have been diagnosed in the past with depression or addiction or something else, and they're in remission, if you will, that's not what we're talking about. What we're talking about is caregivers that have active issues going on, common characteristics in the addictive household. Don't talk, don't trust, don't feel. So what the child learns, and I want you to think about it, pick one of these, because in an hour we don't have enough time to go through each one. But think about it, maybe from the toddler's perspective or the elementary school child's perspective. If the caregivers are having difficulty dealing with life on life's terms, then they certainly can't teach that to the child. So how does the child feel when they're seeing their caregiver struggling and they're not getting the skills and tools they need? That has to be terrifying. Difficulty dealing with distress, poor coping skills. Well, for the child, they see the emotions overwhelming their caregivers, and again, they're looking to their caregivers for structure, for stability, for safety. And if their caregivers are being overwhelmed by emotion, then that's got to be pretty scary. And it's also interesting in these households to examine how the child reacts to these things. What do they do in response? Because sometimes children will act out and develop behavioral problems in order to sometimes say, hey, look at me, focus on me. Then you won't have to focus on this other stuff. Other times, children become what we call the hero. They decide that they are going to be the absolute very best, so they don't add any more stress. And so maybe they can help their caregiver feel happy. So there's lots of different ways that children respond to this, which is why it's important to use context. Thinking about the environment they grew up in and the behaviors that they have, how did those behaviors make sense in that context? Back to the addicted household. There is impulsivity, lack of patience, and distress tolerance. People with addictions often are struggling with impulse control, struggling with emotional disregulation. There can be neglectfulness not only of the child, but also the caregiver is maybe neglectful of themselves. If they are clinically depressed, if they have you another mental health issue or addiction, they may not be showering every day. They may not be getting out of bed to feed themselves, let alone take care of the child. There can be hostility and defensiveness, blaming or manipulation. When there is someone with an addiction, there's often a someone else who is enabling that addiction. And there's a tension dynamic between the two of them. The enabler is trying to fix or control the person with the addiction. The person with the addiction is trying to cope with life on life's terms the best they can because they are completely overwhelmed. So there can be a lot of hostility. A lot of people with addictions become terrified at the threat of recovery because none of that other crap's ever worked before. And sorry, I called it crap, I did. But that is what I hear from people when they are considering early recovery. They're like, I've tried that stuff stuff before and it hasn't worked. And my emotions are overwhelming, my thoughts are overwhelming, life is overwhelming. And the addiction is the only thing that has helped me survive until now. So the thought of giving that up is terrifying. So I'm going to defend it as much as I can. There can be withdrawal from others leading to disconnectedness or just withdrawal because there's no pleasure in other activities. Justification, minimization, denial, low self esteem, guilt, shame. You know, there's a lot of stuff that happens in the addicted household. And it's also important to recognize that most people with addictions also have co occurring mental health issues. You know, you start messing with those neurotransmitters, it's going to have an effect on mood, it's going to have an effect on the stress response system. But I digress. So thinking about what it's like for a child to grow up in an environment where their caregivers are evidencing, are showing these behaviors, it's got to be scary. At this point. The caregivers probably are oblivious at least part of the time to the child's needs because they're having so, so much difficulty taking care of themselves. So the what does the child learn? I can't trust anybody. I can't rely on anybody but myself. I have to figure this out. Common characteristics in households where somebody has a uncontrolled mental health issue. Again, difficulty dealing with life on life's terms. Difficulty with coping, impulsivity, distress, intolerance, neglectfulness, hostility, irritability, withdrawal, low self esteem, guilt and shame. Remember that people who have anxiety, anger, depression, obsessive compulsive disorder, ADHD in many, many times they recognize that their behaviors or the disorder, however you want to phrase it, is causing distress in other people is keeping them or from doing what they want to do is keeping them from being the person they want to be, which can impact their self esteem. And they can feel guilty and ashamed of the fact that they can't do that right now. And there can be a sense of hopelessness and helplessness. The end product. People's reactions. Remember they're repeating actions from the past. People's reactions in the present, their autopilot in the present is based on prior learning plus the present moment. So something in the present moment triggers those schema from the past and their brain says, oh, this is how we react. We're not safe. This is what we need to do. And it's important to help people develop the skills to be able to, as Linehan would say, get into their wise mind so they can evaluate the accuracy of the their schema and the effectiveness of their old reactions in the present context. Is my schema accurate? And if it is, okay, fine. If it isn't, that's fine too. And is my current reaction the one that I want to use in order to use my energy to move toward my rich and meaningful life? Stress. When people grew up in a chaotic, stressful environment, they may not know how to let, you know, let things go. They may not know how to experience calm or contentment when people's self esteem was damaged when they were growing up. Then they may react from a place of feeling bad about themselves, even if objectively they may say, okay, I'm a pretty good person that sometimes we talk about inner child. And that's kind of what we're talking about with some of the schema is, are the schema from the past effective in the present? Mindful self awareness with contextual CBT So now we're getting down into the nitty gritty and the 12 or so techniques that can help people start becoming more mindful, aware in the moment and aware of the context so they can more effectively implement cognitive behavioral strategies. Develop mindfulness well, that's kind of a no brainer there given the title of the presentation. Mindfulness improves people's ability to be present in the present. It encourages people to shift from automatically reacting to thoughts and feelings based on their schema to being aware of experiences in the present moment in order to get more flexibility. Observing and describing what's going on without reacting in the present moment. It is what it is and I'm going to say that a couple times today and if it, you know, gets under your skin, I'm sorry about that. But radical acceptance and, and mindfulness starts out with accepting the present moment for what it is. How you act in response to it is changeable, but the moment is what it is. And every time you observe a moment, as soon as you've observed it, the next moment is happening and then the next moment is happening. Change is constant, which is really awesome, especially when people start feeling like they are agents of change. When people start feeling like they can say, all right, I identify what's going on here. I don't like the way I'm feeling right now, or I don't like what I'm doing right now, and I can improve the next moment. I don't have to stay on autopilot. So general awareness, encouraging people to reflect on what are they feeling physically? And this can be stressful for people with a trauma history. So go start easy with it. Don't start diving into super deep sensations. Maybe just, you know, am I hungry? Am I sleepy? Am know. Start with those. You don't need to get down into deep sensations like in your gut right away, especially if you have a history of trauma. But what am I feeling physically? What am I feeling emotionally? What am I thinking right now? What thoughts are going through my head? Whether they're ruminations or, you know, all kinds of different thoughts or nothing at all. And what are my urges? You know, that's very general mindfulness, general awareness of the present moment for the person. How has this been helpful or protective in the past? So how is this feeling or these thoughts or these urges, how have they been protective or helpful in the past? What's their function? Once you identify their function, then you can say, all right, I see that this behavior was designed to protect me. However, it's not producing the results that I want in my rich and meaningful life. So what are my other options? You know, what is the function and what are other options to achieve that same end? What is similar in this situation to the past? Recognizing what I'm feeling physically or emotionally or thinking or my urges. What's similar in this situation? What called forth that schema? What triggered it, so to speak. And what is different in this situation than in the past? You know, you may be engaging in an discussion with somebody that becomes somewhat heated, and you've engaged in those types of discussions in the past, and it ended badly. It was not a safe situation. Okay, that is extremely unfortunate in the present situation. What is similar is there is tension or anger in this discussion. What's different? Well, hopefully the person you're having this discussion with is a safe person. They're not going to hurt you. They're not going to belittle you. However, they are passionate about whatever they're talking about. We also need to accept our, quote, internal experiences radically accept our feelings, thoughts, and urges without having to act on them. I can accept that I'm anxious. I can accept that I had this fleeting thought, or maybe I'm ruminating on something right now. Okay, I'm having this repeating thought that is just driving me bonkers. All right? I'm having it. I'm not going to struggle with it. I'm having this urge. I want to have a cigarette. I want to drink alcohol. I want to punch a wall. I want to do something. All right? I can have that urge. It doesn't mean I have to do. Means I'm having that urge and I need to be curious. Think of feelings, thoughts and urges like road signs. Take them under advisement and then decide what to do. So your speed limit, you know, remember, anger and anxiety are responses to a threat, and anger is the fight. Your body's dumping all kinds of energy to make you, to prepare you so you can fight or flee. All right? So you have all this energy. You have all this gas in your gas tank. You see this speed limit sign? The speed limit sign says, hey, let's go 120. Do you really need to go 120 right now or can you just keep plugging along at 45? Is there a need to ramp up? What's going on? Construction signs means you can't get through this way. So you see construction. Are you going to give up? Are you just going to turn around and go back home? Or are you going to find a way around it? Are you going to give up or are you going to persevere? No passing signs. That could be addiction. You start having this urge. You know, sometimes you get behind a really slow driver and you just have this urge. You're like, oh, my gosh, I need to get around this person. Do you have to do it? Or can you respect that? No passing zone and. And not pass. So you get. Get my analogy here. Accept thoughts and feelings without having to act on them by unhooking. We've talked about this in other presentations. Unhooking means recognizing that thoughts, feelings and urges are fleeting. They don't have to stay there. And unhooking. I always forget to have something to hold. Here, I'll hold my bubbles. Unhooking says, I'm having the urge to. Instead of I have to do this, saying I'm having the urge that I want to have more coffee. So I'm holding this urge about having more coffee, knowing good and well I probably shouldn't have more caffeine this late in the day. What am I going to do with that urge? I'm having the thought that I'm a horrible person. Okay, so I'm having that thought. What am I going to do with it? Do I want to hold it. Do I, do I want to keep it with me or do I want to change it? Do I want to, you know, morph it, like play DOH into something else, or do I want to just put it down? Same thing for feelings. And this is really helpful to unhook from feelings. Because we can feel anxious. It doesn't mean we have to hold on to that anxiety. Anger and anxiety are our body's way of saying, hey, there might be a threat, probably ought to check it out. But it's not meant to be stewed on. It's not meant to be held and nurtured. So put it down. I'm having the feeling that what am I going to do with it? Dialectics are another tool for accepting internal experiences. I can be a good person and take care of myself. So many times I hear people telling me if in order to be a good person, I have to be there for everybody all the time. And my response is usually, well, if you're there for everybody all the time, how does that impact you? How does it, does it wear you down? And if you get burned out, are you going, how is that going to impact your perception of yourself? So let's look at, can you be a good person and take care of yourself at the same time? Can you be grieving about something and happy about something else? You know, after you suffer a loss, you can, your heart can hurt for that, but then something else in your life can happen that you're happy about. Doesn't mean that you can't have both your kid graduates, even though or perfect example for me, my father died the day before I defended my dissertation. You know, I was sad and devastated when he passed away and I was. But I was still happy that I graduated, you know, so I was able to recognize the dialectics there. I can be sober and stressed. That's another one of those. Just because I'm stressed does not mean I have to use. Distress tolerance is another cognitive behavioral tool that is very helpful but recognizing context in contextual cbt distress tolerant thoughts in the present context. So I am safe in this context at this time. I can I have these options in this context at this time or with this particular issue. It will pass activities doing things that can help you use your energy to move toward the things that are important in your rich and meaningful life. In this context at this time, how can I use my energy to move towards the things that are important? Guided imagery is a little bit trickier in contextual cognitive behavioral therapy because you're wanting to Stay mindful. You're wanting to stay in the present moment, but in guided imagery, you can envision turning down the volume of the pain or of the stress. You can envision yourself, you can actually see yourself as being strong and capable and handling this. Or envisioning a guardian angel that is sitting on your shoulder in the present moment, recognizing your strengths. And then sensations in the present moment. Sensations are always in the present moment. What are you feeling right now? But distress tolerance can also encourage you to modify those sensations to help you tolerate the distress. Some people go with pleasant, you know, they want to smell something that makes them feel, have that awe moment. Other people go with noxious. They want to smell something like rotten eggs that's just going to jolt them out of it and they're going to be like, oh wow, whatever. Sensations are helpful, but the sensations are something that guess what you're focusing on and they're in the present moment. So how awesome is that? It's also important to address vulnerabilities. Remember, vulnerabilities are things that make you more likely to respond strongly and negatively to a situation or trigger context. When you are rested, nourished, happy, clear headed in a safe environment that's not stressful and have supportive people in that context, you're probably going to respond far differently to stuff that happens than if you are sick and in pain and exhausted and irritable and foggy headed and you know, you get my point. So you can encounter the same exact thing, thing in two different contexts and it will affect you in two different ways, which is why context is so, so important. If something bothers you, you can ask yourself, you know, why is this bothering me now in this situation? In the past it hasn't really bothered me. So why is this getting under my skin right now? I know there are times in, at our house where, you know, for me I'm pretty easy going and there are other times that everywhere I look there is dog hair or I see crumbs on the floor, or I see something that I just kind of go into this cleaning frenzy. The house doesn't change that much. It's not like suddenly we had a wild party and it got dirty. So context. What is different on the days that I don't pay as much attention to it, to the versus the days that, you know, every little thing seems to jump out at me and bug me. What is the difference in what are my vulnerabilities that are triggering me to react differently? What vulnerabilities do you have in this context? At this time. So that's something to regularly ask yourself. And I'll find for me when I'm going around and I'm bleaching baseboards. Yes, it's something that I do with frequency. I'll ask myself, what's going on? Why do I feel the need? Why do I feel the urge to do this right now? And why am I doing it? You know, remember, we don't have to act on it, but if I am acting on it, I want to say, all right, let's turn off autopilot and figure out, do I want to spend the rest of the day crawling around on my hands and knees with bleach? What vulnerabilities did you have in similar situations in the past that led to bad outcomes? So what things might be telling, Prompting the current behaviors? Another technique is to focus on adding. Instead of eliminating, an activity that I like to do with clients is we get a big box, and we have a variety of toys around, and we put. And you can do this with bricks or blocks or anything. You don't have to use toys. But for every stressor, for everything that they want to get rid of in treatment, I want to get rid of my anxiety. I want to get rid of my depression. I want to get rid of my resentment, of this, that, and the other. Okay, let's just start piling all those things in the box. That's great. Now what else do you have? You know, what else is going on? And it's important, because once you start taking those things out of the box, once you start addressing all those issues, then what's left? If you're not depressed, what are you? Happy, maybe. Okay, well, what does happy look like? And instead of trying to eliminate the depression, acknowledging it, changing your relationship with it, and saying, all right, what can I enhance that is not compatible with depression? What things can I add to my life that naturally bring happiness? So encouraging people to think, what do they do to eliminate depression? You know, if I do this to try to make my depression go away, okay, is that also making me happy? Addiction is the same thing. What things do you do to eliminate addiction? And some people will say, all right, I quit using. Well, that's great. That's wonderful. That's part of the journey. But the addiction served a purpose. So if you don't replace it with something that's going to fulfill that same function, guess what? It's. You're probably setting yourself up for relapse. So instead of eliminating using focus on what can I add. Instead of using. Changing your Relationship with your feelings, thoughts, and reactions. Curiosity. Instead of recognizing, hey, I'm feeling really anxious today and getting angry about it, you wake up in the morning and you're like, oh, all right, let's get curious. Why am I anxious today? Why am I having this feeling, thought, or urge at this time? In this context, what's going on? Once I understand, once I have a clue about why I'm feeling this way or having these thoughts, then I can objectively look at it and go, okay, what are my options? Sometimes you can recognize the feeling or the thought with gratitude. I know that sounds really weird. Thanking your body, your brain, for warning you. Remember anger and anxiety. They're your body smoke alarm that say, hey, there might be a threat. Okay? Instead of getting angry or frustrated that you're feeling angry or anxious, think to yourself, all right, brain, based on your limited knowledge, thanks for the heads up. Thanks for warning me that there might be a problem. Just like when the smoke alarm goes off at the house, you know, it's loud, it's annoying. You can get angry about it, or you can be grateful for it and think, well, I'm glad to know it works. And if there would have been a problem, I would have been able to react appropriately. Options. Recognizing feelings, thoughts, and urges as your body's way, your brain's way of telling you that something needs to be done, something you need to fight, you need to flee, you need to evaluate, something needs to be done, okay, I'm having this feeling. It doesn't mean I need to use my default option. I can, you know, my default options there, but what other options do I have? So the feeling, thought, or urge is there to tell you you probably need to make evaluate your options in this situation. Acceptance. Sometimes you'll have this thought, feeling, reaction, and it's just a matter of accepting it and saying, okay, well, that was really unpleasant or annoying or whatever the word you want to use, and then let it go. If you fight with it, then you're creating what Hayes calls dirty discomfort. Then you start getting angry about being angry or feeling guilty for being anxious or depressed. And that just burns up a whole lot more energy. Like you're fighting in quicksand. You're not moving forward. You're actually sinking deeper into feeling powerless and overwhelmed and exhausted and finally growth. All right, so I got angry. I had that feeling. But this is how I reacted this time, which is better than how I used to react. It's still not where I want to be, but my reaction was more in line with the Intensity of the situation or my reaction was more helpful to moving me toward my rich and meaningful life than other options I've chosen chosen in the past. So I had this feeling, thought or reaction. And it shows growth, it shows forward progress. Create a rich and meaningful life. And normally I just squish this down and say, what people, things, events and activities are important in your rich and meaningful life? You only have so much energy during the day, you only have so many hours during the day, and you need to think about that kind of like money in your bank account. It's not limitless. So how do you want to spend your energy credits? Do you want to spend them toiling on stress and resentment? Do you want to spend them bleaching baseboards, or do you want to spend them doing something else? So it is important to know what's important in your rich and meaningful life so you can objectively step back and go, okay, how do I want to use my energy credits today in this context, what is the best response that is going to help me move toward what's important? Motivational enhancement. And this is your typical decisional balance exercise. If you understand your motivation for making changes, if you understand your motivations for certain urges or thoughts, then it can be easier to change them. Motivation is at the heart of change. Whether you're trying to change your, the way you react or you're trying to change something completely different. But motivation is essential. You need to recognize, all right, obviously, what are the benefits to change and what are the drawbacks to staying the same? That's what most people look at. What they fail to consider is what are the benefits of staying the same? What you're doing right now is serving a purpose. What are the benefits to staying the same and what are the drawbacks to change? Change is hard. Change sometimes means you've got to give up things that you kind of like, you know. So examining those and figuring out how to minimize the negative impact of change and maximize the positive impact, Use what we call a broad functional approach. Remember I mentioned at the beginning trans diagnostic, that means across multiple diagnoses. There are a lot of interventions that we use that can improve symptoms of multiple different types of diagnoses. HPA axis. So if you talk about stress management, mindfulness, reducing the activity of the HPA axis so you're not constantly in that stress, in that fight or flight mode has multiple benefits and improves sleep, it improves immunity, it reduces pain, it changes or allows rebalancing of gonadal hormones. It allows rebalancing of Neurotransmitters when you're not in that fight orf flight state, it changes the gut microbiome, all of which can improve mood. And when people are not feeling stressed or anxious or depressed or some other dysphoric feeling, then they're a lot less likely to engage in addictive behaviors. So HPA access healing if you will, and stress management can be effective tools for addressing mental health, addiction and physical health issues. So sleep is another. Nutrition and pain are also things that we want to pay attention to. People who are not getting enough sleep are more likely to have more negative ruminations, which is going to contribute to depression, anxiety and potentially relapse in addiction. People who are not eating a healthy diet are not getting the basic building blocks. They need to make the hormones and neurochemicals necessary to keep their body factory going so they can feel happy and healthy and sleep and all that stuff. People who are in pain are often going to have difficulty sleeping, are often going to have more inflammation throughout their body, which is, can contribute to imbalances and neurotransmitters. I have including sensitivities here. It's important to recognize that people, people who are neuro atypical or who have sensory gating issues, like in people who are on the autism spectrum, people with ADHD or schizophrenia, to name a few, may have a different experience in a context than you're having. So it's important to recognize the importance of context and individualization or that phenomenological reality, what is overwhelmingly noisy to you may not be a big deal to other people, or vice versa. But that feeling overwhelmed because of the noise can make somebody feel more vulnerable. It can contribute to irritation, irritability, agitation, which will impact in that context how they react to stuff. When people start recognizing this, when people start recognizing, hey, when I'm in pain, when I am hungry, when I am sleep deprived, in that context I tend to react less favorably affectively. People who emotionally dysregulate, that often happens as a result of long standing stress. Whether it's CPTSD or just general ongoing stress, changes in the HPA axis may result in emotional dysregulation. So recognizing that for people who do emotionally dysregulate, situations that prompt anger or anxiety or emotional reactions can feel, feel a lot more overwhelming. Being compassionate with themselves, recognizing that when they get overwhelmed, when they have that tsunami of emotions, not only is it, you know, much more intense than for other people, but it, they stay there longer and it takes them longer to get back to Baseline recognizing that in that context. So if somebody has emotionally dysregulated, they know that they have a, you know, two, three hour recovery period where they may be more irritable and more prone to dysphoric or less than ideal reactions. Cognitively. Shoulds cognitive distortions or just simply a lack of information about skills and tools for health and happiness can contribute to mental illness. Low self esteem and addiction in the environment itself triggers sights, smells, sounds. Times of day can be more problematic for people. For example, people who are in the early stages and mid stages of dementia become much more agitated in the evening when the sun starts to go down. So it's important to recognize that and get curious. And by the way, when that happens, they have found that as we go in, get ready for our sleep cycle, as our cortisol goes down, dopamine's also going down. And that can contribute to agitation in people. So it's not just some random oh my gosh, it's getting dark. It's an actual change in their neurochemical balance as a result or in queue with their circadian rhythms. Relationally, if people have insecure attachment or are exposed to others who are abusive or neglectful, it's going to contribute to potentially mental illness, low self esteem or addiction. If people grew up in these environments where they were exposed to these things, then they may need to relearn them in the future. Psychological flexibility. Turn off the autopilot and address your rigid thinking. Psychological flexibility means a willingness to accept all aspects of your experience without unnecessary avoidance, recognizing that you can have a rich and meaningful life and experience the pain that's inevitable. And psychological flexibility means you have the ability to consider multiple possible actions and thoughts and consciously choose. You're not stuck on this one road. You can actually branch off. You can choose a workaround. Finally, difficulty with self esteem or self efficacy may cause or maintain problems. Many times people's narrative about themselves contributes to distress if they're overly attached to the conceptualized self. This is what how I see myself, how I think I quote should be, can prohibit flexibility and inhibit effective process problem solving. If somebody wants to see themselves as a good worker, but they just can't seem to, do they keep making mistakes in their current job doesn't mean they're a bad worker. It may mean they're a good worker in a job that's a bad fit. I'm dependable, but I set limits and boundaries. Or I can be depressed, but it doesn't mean I always have to be. Instead of saying I I am depressed or I am a fill in the blank with a diagnosis, recognizing that that is a component, but it doesn't necessarily always have to occur. And it's important to adopt the perspective of the self in the past. Who you were, what you experienced in the present, who you are now, what you're experiencing, and how the past is impacting you in the present and the future. Who do you want to be and how do you want all of these things to impact you? How do you want to use your energy, increasing your perspective, looking at your definition of a rich and meaningful life. What does your past self tell you about your current situation? What schema do you have in the past that are informing the current situation? Telling you it's not safe or you're going to fail or whatever it's telling you. What might your future self tell you about your current situation? The future self's looking back, going, I don't listen to them, you're doing good, you're making progress. What might you tell somebody else in a similar situation that can be a replacement for the future self? Other Tools Mindfulness journals or logs Cognitive behavioral therapy Exposure or noticing when you're angry and this is something to obviously be done with a therapist thinking of something that triggered your anger, that exposure and then noticing thinking of the the entire context, what was going on at that point in time that triggered that degree of reaction to that situation. Developing relapse prevention plans to handle internal processes and increase awareness of context. Relapse prevention plans can help you have a plan to handle anxiety anger when you notice mindful you become mindfully aware and accept accepting of the moment. This is how I feel and this is the situation. Great. All right. Then the relapse prevention plan comes in and says now what do you do with it? And encouraging people to make a committed action to working toward each thing that's important to them. So each thing that's important, put it on its own little sheet of paper and have a plan for what you're going to do to move toward that, how you're going to use your energy to move toward that thing or those things that are important. Contextual cognitive behavioral therapy involves understanding people's phenomenological truth. Problems can arise when people get stuck struggling with the notion that they are not who they should be or things are not as they should be, are unaware of their internal feelings, thoughts or urges are unaware of the motivation in context of their feelings, thoughts and urges or use rigid problem solving and conceptualization without considering context or perspective. It may have been one way back then, but it may not be that same way now. Contextual CPT uses awareness, mindfulness, radical acceptance, and psychological flexibility activities to help people act based on the current context and move toward a rich and meaningful life instead of trying to escape or avoid discomfort.