AllCEUs Live Webinar

So just kind of bearing that in mind, this should be one of those easier ones to follow, if you will. You can download the PDF of the PowerPoint. If some of these sound like good ideas that you might want to use in some of your groups, I'm also going to give you some ideas about how to use self help books, self help workbooks and create your own group activities. Because I found with my staff and with myself to a certain extent until I got really comfortable with groups, a lot of people get stuck and they're like, well, what am I going to do in group today? And it's really actually kind of easy or easier to find things to do in psychoed skills, even interpersonal groups. If you use self help workbooks because you can take the activities from in there and, and use them by either throwing the, taking one of those activities and posing the questions to the group and having a discussion about it, filling out the whiteboard as if someone would fill out a workbook or as you know, I like to do, I'd create stations. So if there's eight questions in an activity, we'd probably have four stations and go around twice. But I'd encourage people to go around in a cohort of four or five and complete each station so they could brainstorm. And then we would process everything together. And that gave people a chance to talk amongst one another, to form some bonds, to get feedback from one another. And it was less me directed. It also gave some of the shyer people a little more confidence to speak if they were talking to a cohort in a station instead of having to talk in front of the whole group. So anyway, that's my little introduction and let's go ahead and get started. I'd like to welcome everybody to today's presentation on using groups to address anger, anxiety, depression and addiction. And you might be thinking to yourself, why am I putting all of those together? Well, because you know what, a lot of these skills and tools are applicable to all four. They're trans diagnostic skills. And a lot of times you're going to be doing groups with people who have multiple diagnoses. So let's see how many birds we can kill with one stone. I need to find a different metaphor because I don't like killing birds, but you know, I'm weird that way. So we're going to review the benefits of the groups real quick, identify some modalities for group. Let's get creative here because it's cost effective, how can we make it benefit our client base, our population? We'll talk about goals for psychoeducational and skills groups addressing anger, anxiety, addiction and depression in each different activity and explore activities that can be used to enhance group engagement. Sitting down and going, all right, group, what do you want to talk about today? Not only is that unstructured, but a lot of times you're not going to get very far. So even if you can just provide one teaser to get the group discussion started, you may be able to run with a whole group from there. So groups are cost effective. You can have 15 people to one therapist and skills and psychoed groups can be done by unlicensed clinicians. So if you've got interns, if you've got master's level clinicians that haven't gotten their license yet, groups are perfect for them. But I mean, granted, they can do individual therapy too, but you have a lot more latitude in what you can do with those kinds of groups. Groups provide peer feedback and support. So it's not just me spouting out whatever. I think they're hearing it from their peers. And like we talked about before, kind of like teenagers hear stuff from their peers and take it to heart, whereas if mom and dad say it, they're like, whatever, eye roll. The same thing can kind of be true in treatment. So hearing stuff from their peers and hearing echoed from two or three peers can give it more oomph with your clients. It encourages people to develop interpersonal skills, become more confident in discussing and sharing opinions and all that stuff that a lot of our clients are not super good at doing. It reduces isolation and uniqueness because people are talking about the symptoms they've had or the experiences they've had. And other people are going, yeah, I've been there, done that, bought the T shirt and burned it. So people don't feel as much like I am like the only one in the world who feels this way. And it also provides you many observers when you're sitting there. And even if you are on your A game and you're doing your best to pay attention to your client in an individual session, you know there are things that you're going to miss when you've got 15 people paying attention to the one person speaking, you're going to get a little bit more. And when you're in group, they kind of self monitor each other so they may help you manage the group a little bit better as they start to norm and develop that relationship. So modalities, this is fun. Think of groups as something that's fun and can be creative, not something that you have to do face to face are traditional. Everybody come into a room and let's talk. And those are cool. You know, those are really effective. I enjoy doing them because I like the human contact. You can do web meeting type groups if you're doing psychoed or skills groups. I would really caution you about doing any sort of therapy groups online simply because HIPAA and Hitech and 42 CFR, your federal regulations for confidentiality all apply. Once you say I am so and so and I provide substance abuse or mental health treatment, then pretty much anything you do falls under the rubric of the higher level of confidentiality than someone who's just in an AA support group meeting. So if somebody is participating in a web meeting group especially, well, video or not, and they've got six other people in the room that you don't know about, you know, that obviously is a breach of confidentiality. You can't guarantee people are going to use the best judgment. So web meetings can be really helpful for skills groups and psychoed groups. I prefer to have them with video. That way I know that there's not six other people in the room. But that's your call, what you feel comfortable with. And again, it has to be encrypted and you have to have business associate agreements and all that other stuff. You can also do asynchronous groups where you have a psycho educational video like some of the counselor toolbox videos. People watch them and then they participate in a discussion forum and they answer five or six questions and they respond to one another. And this is all moderated by the therapist and the thera goes in and, you know, provides prompts and suggestions. So there are a lot of different ways depending on the material you're covering and obviously the sensitive nature of the topic. There are a lot of different ways you can get information out, but there are a lot of skills that we can teach to clients. I mean, think about DBT skills groups and stuff that don't require that high level of confidentiality. People aren't going to be sharing stuff that's super duper personal or they don't necessarily have to. So if you're in a rural area or if you're in an urban area and people are working all the time and getting schedules organized, it's not going to happen. Try to get creative, see what people are willing to do. And today's generation, and I date myself by saying that, but today's generation is so much more used to participating in things online, in chat rooms, etc. So there is less apprehension than, you know, from my day when it was kind of a big scary thing. So transdiagnostic groups. One of the first things I start out with when I do groups is to help clients learn about the general reason they're there, learn about anger, anxiety, depression and addiction and their symptoms. How are anger and anxiety related? Remember, they're both fight or fleet and so they're flip sides of the same threat coin. And depression usually occurs when there's been too much stress, the person has been stressed out, anxious, whatever, for too long, or there are some hormonal imbalances or something else going on. But a lot of people develop depression subsequent to having high levels of anxiety and or anger. And then addiction can develop as a way to try to cope with this distress that we're talking about. But addiction also monkeys with the neurochemicals and can cause anger, anxiety and depression. So helping them see the interrelationship between these things, that they're not unique things out here, but they're all symptoms of an underlying issue that, you know, poor coping skills or lack of effective coping skills, lack of effective social supports, too much stress, cognitive issues. And we're going to talk about a lot of those things as we go through this. Then we go on to I help them learn about the mind body connection. And this is still generally in the first group. And we talk about causes of symptoms. So what might be a cause of difficulty concentrating, what might be a cause of fatigue and lack of energy? You know, and I'm thinking let's rule out the big ones first. Thyroid issues, hormone issues, nutritional issues, sleep issues. And are big C with cognitive issues, and not necessarily cognitive dysfunction, but irrational thoughts, cognitive distortions, all those things which most of our clients have, Heck, most of us have. It's just a matter of how well you keep them in check. So we identify what the symptoms are. We brainstorm. It could be caused by a lot of different things. This gives hope to clients who've tried treatment before and it hasn't worked, or who've been on three different antidepressants and they still haven't worked. So we start talking about, let's figure out what worked for you. Instead of trying to fit you into a diagnostic label, let's figure out what your symptoms are and how to address them. We talk about the effects of symptoms because this helps people figure out which ones are bugging them the most. And I've said before that I don't do well if I don't have adequate quality sleep. You know, that's just one of my biggies. And now I know a lot of other people who can get three hours of sleep and just be grand. So if I am having difficulty sleeping because I've got a head cold or whatever, I know it's going to potentially trigger other symptoms that are going on. So that's one for me that is going to be important to address early. Whereas other people, there might be the sense of hopelessness and helplessness or persistent worry about a variety of things, they'll pick the one or two that are most problematic for them, and then we start talking about what are some interventions. So I have clients identify what causes or worsens the symptom for you. What makes it worse or better for me is different than for Jim and John and Jane. So I want to know what makes it worse or triggers it for them. We'll make a list of those things so they can figure out what they probably don't want to do or need to look at, changing how they've dealt with the symptom in the past. If they've done things and they've helped, even if for an hour, let's put those in the win category and we can start enhancing those skills, those strengths, and we talk about the impact of the symptom. Because I want people to maintain their motivation. If you know that sleep deprivation is bad for you and it just has a cascade of negative effects, then maintain that in the front of your mind because it'll be more important when you're making that decision about, well, do I go out and stay out till 2am Even though I got a meeting at 7, or do I really need to go home and go to bed? So encouraging clients to be aware of the significance of their choices on their mood. So that can be one or two groups, depending on how interactive your group is. Negative triggers is the next one. And this is usually group number three. And we talk about those things that cause or worsen the symptom. Remember, they identified those already, but I have them go a little bit deeper into it because a lot of times they identify two or three things that they know triggers it. Like for me, drinking coffee after two in the afternoon is destined to monkey with my sleep schedule. So. But that's me now going back through. We also want to look at what other things make. You know, let's stick with sleep and fatigue and exhaustion as a symptom. If I'm hungry, if I'm not getting good nutrition, if I'm angry, does that keep me up? Well, yeah, keeps My cortisol levels high. Loneliness? Maybe, maybe not. If I'm tired, does it impair my sleep? And we know those people who have been on bed rest or who've been clinically depressed who are sleeping all the time and they're always sleepy and they can't seem to get good sleep because their circadian rhythms are out of whack. So if you slept and took a nap during the day, it might impact you later. Fear False evidence appearing real. So how does fear impact your symptom? What people make the symptom worse or what relationships and social situations make the situation worse or trigger the symptom? You know, just going in to speak my. The place I used to work, the CEO intimidated the heck out of me. And I mean, she was a nice enough woman, but, you know, she just intimidated the bejesus out of me. So whenever I would have to go talk to her, my heart would start racing and my palms would start sweating, and I knew exactly what it was. And as soon as I finished talking to her, I felt fine again. But knowing that. Knowing that that was a trigger for an anxiety symptom helped me understand, you know, how to deal with things. What places make your symptoms worse? You know, for some people, they've had negative experiences in a hospital. So when they go to a hospital, it's oppressive in a courtroom, maybe at work. So thinking about what places you go that make the situation worse, because later we're going to talk about how to improve all of these things. What things make it worse, things that you do, things that you see, movies. And are there any times of day, anniversaries or holidays that make the symptom worse? So some people start to get really blue in the evening, you know, when they're winding down, getting ready for bed, and it starts to get quiet. Then they're alone with their own thoughts and it start. Anxiety or depression starts to get a lot. Feel a lot more oppressive. So having them be aware of those things so they can figure out what to do with them. And, you know, this is one I love to do in stations because it encourages people to talk about, and they start talking about interventions ahead of time, and that's cool. Then we move on to which ones can be avoided or prevented. You may not be able to avoid going to work, but what can you do to improve the situation at work and prevent things? And, you know, forgive me, I would try to avoid having to go over to the main building, which we lovingly refer to as the big house, whenever I could, because I Knew that was just gonna provoke anxiety. So I'd stay on my side of the campus and everything was grand. And then ideal. Identify three ways to deal with unavoidable negative triggers. You know, so when you have to go see that person, that scares you to death or triggers an anxiety reaction, if you want to put it a little nicer, how do you deal with that? You know, take a few deep breaths, positive mantras, whatever you want to do. Encourage people to figure out and have a game plan written down. And I'll say this over and over and over again, write it down. Because when you're stressed, you're not going to be thinking, what did we talk about in therapy? Have them write it down. Have them keep a notebook so they can refer to it, even if it's just one of those little tiny, you know, notepads that they can fit in their purse or something, that's a good thing. Then a whole different group is on positive triggers because too often we talk about negative triggers and things that cause things to get worse. So we want to talk about positive triggers. What can you put in your environment that reminds you what you're working towards, that helps you be happy, that triggers happy feelings and reminds you to do use your therapeutic tools. So, you know, think real basic at first. What sights, sounds, smells, and things can you put in your environment that make you walk in and go, I'm happy to be here. If you like fish, a fishbowl. If you. I always feel bad people have little betas in a fishbowl and I know they like to be alone. They fight if they're with another beta, but I always feel bad for them because they're all alone. So bettas aren't my number one choice, but some people love them because they're beautiful little fish to watch. But what is it that you like to have in your environment? Even if you can only create a small little microcosm that you can call yours, what can you do to make that more comfortable and positive and happy for you? And then things that can remind you to use your new tools. If you have a sponsor or a coach or a best friend that can periodically send you a text on a day that you know you're going to have a really stressful day, that's awesome. You know, they can send you a text saying, keep your head up. You can program it in. So you send yourself a text periodically, too. But you know, it's better to have the social involvement if you can. Smells are our greatest memory trigger. So ask people what Smells they like. And I'm not talking necessarily essential oils, I'm talking about what smells do you like? Jasmine sugar cookies? What is it for you? And figure out how to bring that into your current environment. They have the tarts out right now that can be put in the little warmers that are plugged into the wall because we can't use candles in most any agency I've ever worked at. But you can have the tarts there. So being aware of what smells make you happy can help improve your environment. You may not even know it because it'll kind of go back into the recesses of your mind. And sounds. Now some people like a lot of noise. Some people when it's too quiet they start getting stressed out. Some people like the sounds of birds, some people like music. Whatever it is that that person likes that can trigger happiness in them, encourage them to do that. I mean a lot of our white noise machines now I just got my daughter one and it has some wonderful babbling brook noises and those sorts of things. And I love thunderstorms. So it has a great thunderstorm track. But you can also go on YouTube if your agency hasn't blocked it. And there are YouTube tracks or videos or whatever you want to call them that are like eight hours long that are nothing but nature sounds. And you can choose the different nature sounds and have that open in a window in the background and playing while you're doing your work. So you know, there are things you can do to make your environment feel more welcoming. And I encourage clients to do this at home, at work and in the car. Some people get really stressed out when they're driving. So if driving is one of your stressors or traffic or you know, it's just that time that you're winding down after a long day or getting revved up to go in. What can make your environment in the car more pleasant? The next group we do is on vulnerabilities and you know, going back to basic dbt but and then some. We talk about how vulnerabilities are the things that make you, hey, more vulnerable, more likely to react strongly in a negative way to life when it hands you a curveball. So we talk about some of the most common vulnerabilities emotionally like guilt, envy, depression, anger and anxiety. We talk about when you're feeling that way, you wake up in the morning and you're depressed or you wake up and you're just in a God awful mood. How does that affect the rest of your day? How does that affect what you see what you pay attention to, how well you concentrate. So it's a vulnerability. There are going to be days that you wake up and you feel like that, and it is what it is. So then we start talking about how do you deal with it? If you wake up and that's your reality, how can you improve the next moment? Mental vulnerabilities can include just somebody who's a negative Nelly having unhelpful thoughts, you know, someone who is regularly using cognitive distortions that keeps them worried, anxious, depressed, yada yada. And for some of us, fogginess is a vulnerability. If I can't focus when I'm at work, when I'm trying to get something done, I get frustrated and then I get angry and, you know, I start getting all worked up and stressed out over the fact that I can't focus, which makes it harder to focus. So doesn't make a lot of sense. Physical vulnerabilities, pain, exhaustion, illness and medication effects and side effects. Socially, we talk about stressful people and environments and abandonment fears. If somebody has underlying abandonment fears, then it's going to impact most of their relationships wherever they are, on a regular daily basis. So how do you deal with relationships when you have those fears? Kind of right front and center. Because we're not going to fix all of these in two weeks or even 12 weeks. So how can you start dealing with them? So you mitigate the impact. And then environmental, like I talked about before, if it's too chaotic or quite too chaotic, stresses some people out and too quiet stresses other people out. For some of us, disorganization, big vulnerability, it's hard to focus, get frustrated because you can't find anything if it's too dark. Sometimes people get sleepy, start feeling depressed, their circadian rhythms get all wonky. So being aware of the environments that you're going into, you may be going into an environment that is sort of vulnerability prone. It's likely to trigger a stronger reaction. So it's not just how do I feel right now, but it's also when I go into this situation, what vulnerabilities are there that might trigger a stronger reaction. Which takes us to mindfulness because most of us aren't really aware of what triggers feelings and sensations. We just, you know, don't even really notice them and go about our business. So encouraging people to learn about the purpose of mindfulness and the benefits so they're not wasting their energy. They're able to identify their needs and wants in the moment and figure out how to best meet those needs instead of pushing them all down and then not feeling like they're getting their needs met, or worse yet, getting angry, anxious, or depressed. I start out in my groups with these three mindfulness exercises because I find they're relatively easy for most people. The anchored scan is the one that I've talked about in other groups or other classes. At every meal I have people go through and say, how do I feel emotionally? How do I feel mentally? Am I positive? Am I negative? Am I foggy headed? How do I feel physically? Energy, pain, Anything like that? Hunger? How am I feeling in terms of relationships? Am I feeling lonely, isolated, supported? What's going on? And you know, is this environment conducive to my needs or is there something I need to change? As it gets to be summer here, I have to turn down the air conditioning before I come in to teach because all of the electronics put off a ton of heat. So I know ahead of time that when I come in here, I'm gonna have to turn that down, otherwise I get hot and cranky. So encourage people to start doing that. If they do it at every meal, that's at least two to three times a day. They're checking in with themselves and going, what do I need? What are my potential vulnerabilities right now and how can I address them before they cause a problem? Three minute thoughts. For three minutes, clients will spend just writing down or tape recording. If they don't like to write everything they think. Just that random association that Freud used to talk about. Let them free associate for three minutes, they will be interested to see hopefully where their mind goes. And then you go back through and you review those thoughts in terms of how many were negative, how many were positive, how many were just neutral, you know, there's something on the floor, what were they thinking about? And this will help them figure out kind of where they are when they're not paying attention to their thoughts because they're thinking things a lot. And then three minute observations is when they walk into a room or walk out, you know, onto the patio, or they go somewhere and for three minutes they write down everything they see, sense, notice, and then they come back. I love doing this in group because you bring 15 people into a room and do this and then you start to process it. Nobody has all the same stuff. They've all seen something a little bit different or noticed something a little bit different. So it helps people realize how, how much they may be missing by not being mindful, by not being present in the moment. And then I differentiate it. I Do spend a little bit of time differentiating it from meditation because some people are freaked out by meditation for whatever reasons. And so we talk about how you can be mindful without having to meditate, but when you are meditating, you're also being mindful. So you can do these three activities without, you know, none of these are meditation activities, but they're helping you learn to be in the present moment aware of what you need and accepting them, what's going on, non judgmentally. And so we talk pretty extensively about awareness and nonjudgmental acceptance starting in this group. Then we start talking about interventions and developing a plan, a written one, to become more mindful of strengths and needs in order to prevent vulnerabilities and mitigate the ones they can't prevent at home, at work, and particularly in family and social gatherings because, you know, they may have a great family but get stressed out in social situations. A lot of our clients have issues with someone somewhere. So helping them figure out, when you're in these situations that are vulnerability prone, how can you prevent it from getting to you? You know, maybe instead of going over, you know, Aunt Sally always rubs you the wrong way. So how can you deal with that? And whether you want to call that prevention or mitigation, if you have to talk to Aunt Sally, how do you deal with it so it doesn't get to you and trigger you prevent unnecessary distress? So if clients know they're going to have to go in for a job interview, for example, and that's stressful to them, which is stressful to most people, what can they do ahead of time so they're best prepared and best energized for it? Plan what they're going to wear ahead of time, plan the route, how they're going to get there if they need to ride the bus, know where the bus stops are and get to the bus stop early. Have everything planned out ahead of time, maybe even rehearse it. I used to go find my classes the first day that before the first day of the semester. That way I knew where they all were so I wasn't stressed the first morning trying to figure out where my classes were on campus because I can't find my way out of a paper bag. It's just one of those things. And how do you mitigate unavoidable distress? You know, life's going to suck sometimes, so how do you deal with that? Do you call a friend? Do you pray to your higher power? Do you meditate? What do you do? Because sometimes you're Going to get those curveballs. And I encourage clients when they're trying to figure out things, to start with their strengths, what have they done in the past that's worked? So they're going to go back to that list of the vulnerabilities that they made. The things that they know make them more likely to react strongly in a negative way. They're going to figure out which ones can be prevented and how. They're going to figure out how to mitigate the other ones. You know, when, when they can't avoid them, how do they deal with it so it doesn't make them go off the chart in the other direction. And then what things can they do to prevent unnecessary distress? You know, sometimes it's a matter of planning ahead of time. You know, during flu season, wash your hands. It's going to help so you don't get sick, if getting sick is stressful, which I think it is to most people. And then goal identification. So they know their vulnerabilities, they have an idea what causes their issues. They're learning about this mind body connection. But where are we going with this? What's our destination? So encouraging them to brainstorm. What are five things that are important to you? And I like to do this one as a big group and they just shout things out and we put them up on a whiteboard. But clients can also do it on their own paper so they identify what things are important to you. Housing. You know, for some people, they may need a, you know, large house that they own on 5 or 10 acres of property or something, whereas other people are just happy if they have a roof over their head and, you know, electricity. So knowing what is important to you, are you going to work to have that big house on lots of acreage, or are you going to work to keep a roof over your head and divert your energy and resources to other things that are more important to you? And that, you know, really depends on the person, what is important to you. So things are those tangible things. Clothing. Do you need to have, you know, $250 Reeboks or are you happy going to Walmart and picking up a pair of Dr. Scholl's off the, off the shelf. It's going to be a big difference in how much time, effort, energy you have to exert to get that. And again, that depends on the person. So we're talking about tangibles here. Then we move on to relationships. And five is kind of an arbitrary number. What relationships are important to you and what do you want them to look like. I can say my relationships with my kids are important to me. Well, yeah, but what do I want that to look like? What does a good relationship with my teenage daughter look like? And I'll tell you when I figure it out. What types of things do you want to do with that person? What types of communication, Contact? What does that look like to you? And then what 5 personal growth goals are important Now? This could be career. This could be relaxation. This could be skills. This could be a bucket list. But we've got to narrow it down, because you can have a list that goes on forever, but there's too much to focus on there. So I want to know, after you make that huge bucket list, what are the top fives? Because that's what we're focusing on here. Those are the ones that are most important to you right now. Well, you have that, and I've got this beautiful picture painted of what my destination looks like. So what are my top five values that are going to help me achieve that? So going back to, you know, maybe one of my personal growth goals is being CEO of a company. So one of my values may be diligence and integrity at work or diligence and integrity. So you want to start identifying what values underscore the majority of your goals. You know, fidelity, you know, whatever it is. And you can go online and Google top 50 values and get values sheets that you can hand out to your clients so they can go through. I mean, there's all kinds of honesty, integrity, friendliness, compassion. There's 50 or more that you can easily list. So it can be a fun activity to do with clients. And you can also go through different values if you want to spend two groups on this and have them talk about, okay, what does compassion look like and how do you do that? What does loyalty look like, and how do you do that if that's important to you? And encourage them to talk about how to actually manifest these values. So distress tolerance, because clients with mood or addictive disorders tend to get stuck in their unpleasant emotion and impulsively may act to try to eliminate or escape from the distress by acting out, by eating, by sleeping, by doing something which doesn't usually solve the problem, it either makes it worse or it just kind of pushes it to the side for a moment, and then it comes back. Helping clients realize that urges come in waves. They don't have to be acted upon. I use the bee metaphor. If a bee lands on your arm, unless you're, like, deathly allergic, and even then you want to think about whether you want to swat it. But I can't speak for people with anaphylactic allergies, but if a bumblebee lands on your arm, big furry little teddy bear looking guy, your first urge may be to swat it off because a bee's landed on your arm. But generally, if you swat a bee, it's going to sting you. You know, that's just what happens. It's not actually going to have the outcome you intended. However, if you just wait, that bee is going to fly away. So urges don't have to be acted upon. You can see it's there and go, okay, nope, not going to do that. Don't want to get stung. You can tolerate the bee on your arm. So distress tolerance skills help clients practice the pause so they can stop and go, let me think about this. What is the best choice in this situation? So you know, if you're working with a group, you've probably heard distressful situations. Somebody's in a breakup, somebody has lost a job, somebody has relapsed, somebody's on probation and something happens and they have a choice between acting or acting on it in an impulsive way, or choosing to let it go, or choosing some other course of action. Distress tolerance skills help them get into that wise mind so they can take a breath and say, okay, you know, my near jerk reaction is to do this. And it would feel really good right now, but my long term goals are to get off probation. So, you know, putting my fist through this guy's head is probably not the best choice and moving on from there. So encouraging clients to use distress tolerance as a method of practicing the pause. It doesn't mean it fixes anything. It just helps you get into a place where you can think clearly about what's the best choice for me that will help me move towards my goals. You can address a lot of the distress intolerant thoughts using the ABCs, the activating event. So brainstorm triggers. You're at a restaurant, some guy looks cross eyed at your girlfriend, makes you angry. So what were the beliefs? You know, we usually do the activating event and then the consequences. And then we go back and talk about the automatic beliefs, the distress intolerant thoughts that made you think, I need to put my fist through this guy's head. So this is unbearable. I will lose control and go, don't. And I will lose control and go crazy if he doesn't stop looking at her like that. This is going to keep going on forever. How dare he. Whatever the thoughts are and then we can dispute them with alternate statements in terms of how can you get through this without having to react impulsively or aggressively? And then evaluate which outcome represents a more effective use of your energy to help you get closer to your goals. So if there is stress at work, the consequences, you're stressed, you hate your job, you don't want to go in. What are the beliefs? This is unbearable. I hate going to work. This is going to go on forever. I'm never going to be happy. So we want to go back and dispute those looking at what would make you happy at work and what can you do to improve your situation? And you know, maybe it's means looking for a different job, but we want to start looking at, instead of feeling like you're a victim that is stuck in this situation, we want to look at the beliefs and say, what can we do to improve the next moment? So your distress intolerant thoughts are over here. You can google those. DBT101. Talk about the wave metaphor, reminding clients that when we feel something, it comes in, it crests and it goes out in about 20 minutes. So if they can recognize that and be okay with that, figure out what to do. If they're really angry, know that that'll probably dissipate in about 20 minutes if they don't sit there and dwell on it and you know, just really nurture it. So what can they do to ride the wave? A cloud metaphor is another one people use. Just think about it as clouds going through the sky. You can't stop them. You just sit there and you watch them come in. You notice them, acknowledge the feeling and let it go out. Discuss the concept of radical acceptance, differentiating it from agreement or powerlessness. Accepting that something is, is not agreeing, that's the way it should be. It's not saying, I give up, I give in, I'm going to let the world walk on me. It's saying, this is how it is in this moment. Now I can choose to improve the next moment. I use the house metaphor for this. If your house, the contractor screwed up and they built it 10ft over the property line, well, you know what it is what it is. No amount of leaning against it with your shoulders going to push it onto your property and it sucks. It doesn't mean you think that's where it should be, but you've got to figure out, okay, now what do we do? How do we fix this situation or improve the next moment? Have clients brainstorm ways and create an action plan to improve the moment. And accept reality. So again, these are things you can Google. DBT101 improve stands for imagery, finding meaning, prayer, relaxation activities, focusing on one thing at a time, taking a mental vacation, and self encouragement. So break those up. One word at each station. What can you do for positive guided imagery? How can you use imagery to help you get through a particular situation? How can you find meaning in things? So when something bad happens, how can you find meaning in it? Or find the silver lining, you know, and so on for each. Each letter of the acronym ACCEPT stands for activities. Do something different. You know, get yourself involved in something that is pleasurable because you can't be miserable and content at the same time. I go out and pull leads, or if I'm really stressed out, I get out the power tools and I start doing the hedges. That makes me feel a little better. Contributing, volunteering, giving back, doing something that makes you feel good, comparing yourself with somebody who's doing less well, finding something that activates the opposite emotion, pushing away those thoughts, just telling the thoughts. Nope, not going there right now, not going to think about it, and actively thinking about something else. You all know I do the four, three, two, one. Four things you see, three things you hear, two things you smell, one thing you can feel. So I encourage clients, you know, if Nothing else, do 4, 3, 2, 1, because that'll take you out of the stressful mental situation until the adrenaline can bleed off. But have them develop a list of their own tools that they're going to use in order to find meaning or relax. Because just telling somebody, do relaxation skills, but what does that mean to John and what does that mean to Sally could be two different things. So I want to know what they do to relax. And it's written down. Cognitive distortions and irrational thoughts, they're biggies. So we've helped them figure out what their triggers are. They're starting to address some of the things they can easily, like nutrition and sleep and being more mindful of what they need. Help clients learn about what cognitive distortions are and brainstorm when they've had each one. Again, this is a great one to do on in stations or even as a group. Arbitrary influence, for example, means drawing conclusions without sufficient information. So my girlfriend didn't call me when she was supposed to. That must mean she's cheating on me. Really? Where did you come up with that? Where's the evidence for that? So arbitrary inference is something that some of our clients use. So we want to have them identify ways they've used it and the impact of Using that distortion, whichever one it was, or ones, and figuring out how to address them. So in the case of arbitrary inference, inference, they force themselves to stop and think about three other possibilities for why his girlfriend didn't call him. So you can go through each one of these with clients, talk about how they're used and ways you can, you can counter them. Irrational thoughts kind of follow with cognitive distortions. And I always do distortions first because most irrational thoughts have cognitive distortions embedded within them. So that's one of the first things we start identifying is do you see any distortions in these thoughts? You must have love and approval from others all the time. Well, there's some all or nothing and exaggerated thinking there. In order to be worthwhile, you must be competent at everything all the time. So I help them see how these are thoughts that we may hold, but they're also just laden with all kinds of cognitive distortions. So then we start looking at, where did you learn this from? Who said, who taught you that you have to be loved by others all the time? And why is that important to you right now? Because a lot of times we take on beliefs from. We learn things in our childhood. We never question them. And then if you start to really stop and think and question them and go, you know what? I have no idea why I think that. Because that's not realistic. People can start knocking off their own irrational thoughts. So you can go through these. These are the most common ones that you know. They're everywhere on the Internet. The challenging questions, worksheet or activity is one that I like to do with both cognitive distortions CD and irrational thoughts ir. So for each of them, when somebody uses it, I'll say, okay, tell me what your evidence is for and against this belief. I want to. I want to hear both sides, which encourages them to walk that middle path. You hear the dialectics in there. I encourage them to look and see, say, do they have the big picture or are they focusing on one aspect? So in the case of, you know, John's girlfriend didn't call him, so she must be cheating. You know, we want to ask John, what's the big picture? She didn't call you. That's true. That's one aspect. But what was going on with her? You know, did she get stuck in traffic? Did her phone die? Was she running late at work? What else was going on in her world that might have impacted the situation that you're not accounting for? How reliable is the source of the evidence? You know, if you're hearing it From a friend of a friend of a friend versus if you've seen it firsthand, are you using emotional reasoning? I feel anxious that she's going to abandon me, therefore she must be cheating on me. So we want to look at the reasons why you feel anxious that she's going to abandon you. But it may come down to emotional reasoning. There's no factual basis to it. You're just afraid. Does the belief contain all or none terms? If so, what are the exceptions? And are you confusing something that's possible with something that's likely? So again, this is really easy to take all of these questions and apply them to each one of these things and talk about ways to dispute irrational thoughts using challenging questions. But you can also talk about things that clients present with. Like everybody always leaves. What's your evidence? Do you have the big picture or are you focusing on one aspect? Maybe your girlfriends always leave, but you've got friends who hang around. Well, then we might want to work on your romantic relationships a little bit so you can walk through this locus of control. I explained to them the concept of internal versus external locus of control. Have them look at if they have an internal locus of control that they think they can control everything. How does that increase stress and how does that decrease stress? We do the same thing for external locus of control. If you're totally external, you believe that destiny controls everything. How does that increase and decrease stress? Because they both have positives and negatives. Then we talk about reality. What we want is something in the middle realizing that we can't control everything. Where I've worked, we use the Serenity Prayer, and I encourage clients to explore the stressors that are within and outside of their personal control. We talk about how it feels and what it means to not be able to control something. And clients often give examples of things they haven't been able to control, like when a loved one got cancer or when a spouse was using. We talk about what powerlessness represents in that person's life because sometimes people want to control everything because they are terrified of being powerless because of stuff that happened in the past. So that interpersonal skills group starting to come in a little bit. And then we talk about ways to cope with those things that are out of personal control. How do you deal with it when somebody doesn't like you? How do you deal with it when you fail at something? Because we all make mistakes and we all fail. How do you deal with it? And they share supportive techniques. We move on to attributions explaining what they are Internal versus external. So whatever happened was either about me as a person or about the environment. Stable. It's always forever true versus changeable, self explanatory, global. Meaning that it's about me as a whole person or the world as a whole. Or specific. It's about one person or one situation. So we talk about how changing attributions change how people feel about situations. And you know, I'll give you three examples here real quick. If I'm clumsy, I can either think I am a lumbering ox, which sometimes I feel like a bull in a china shop, or I can say, you know what, I was a klutz today. I tripped over my own shoelace. That means it was something external that happened today. It's changeable and it's very specific. I'm a failure at everything I do versus another person had skills that I need to develop changeable in order to get that type of a job. Specific. So encourage clients to reframe things in terms of internal, in terms of external, changeable and specific. Have them look at the purposeful action pathway. So they've got all these tools now. What do we do with them? Well, when something happens, you can either go towards your starting point, which is not what you want to do. Negative feelings, distress, intolerance, cognitive distortions, physical issues, relationship issues, self esteem issues. Or you can move towards happiness. What do we use? So when the present issue happens, you can use impulsive escape behaviors, distress, intolerant thoughts, and a need for external validation from other people. Or you can choose to use some of these new skills that we've been talking about in order to keep you moving toward your destination. Self esteem, your relationship with yourself. So I ask clients, what do you look for in a friend? And we're starting a self esteem group. They look at me like I'm crazy. And I'm just like, just tell me what do you look for in a friend? And then I go on to ask them, which of those qualities do you already have? And how can you be your own best friend? How can you be loyal and compassionate to yourself? How can you help yourself instead of holding yourself up to this unreasonable high standard that you don't hold anybody else to? Then I have them describe who they think they should be versus who they are right now. And we look at the similarities. So what have you already succeeded at? And then we look at the differences and have each person assess, are those differences important? If they are, then we need to develop a plan to help you start working on them. If they're not important. How can you let go of that idea that it's something you should be? Interpersonal effectiveness is being able to ask for what you need and get what you want. Creating win win situations. 80% of the time, nobody's going to get it all the time. Being able to set and maintain healthy boundaries, which is the whole situation of being able to ask for something and get your needs met, but also being able to say no when somebody asks you for something and not feel guilty about it. Being able to say, you know what, I can't do that right now, but I can, or, you know, whatever it is. And we've done other videos on all of these skills. So if you want to learn more in depth about any of these groups, we've already got some videos on them on the All CEU's education YouTube channel. And then being able to develop and maintain supportive relationships communication skills. So encouraging clients to learn how to be assertive, not passive, not aggressive. And it sounds like a simple group, but it's actually a pretty challenging group because it's challenging for clients to use assertiveness skills when they are under stress. Problem solving. So you take everything we done been talking about for the past 24 groups using all these skills when something happens. And I'll ask some people in class to say, who wants to volunteer something that happened this week that was really stressful and you know, by this point they've got some comfort with each other. Somebody volunteers and I say, okay, you had four choices. Stay miserable. If you would have done that, what would have been the effects? You could have tolerated the distress and just grit your teeth through it. What would have been the effects in this situation? You know, maybe they were getting a ticket or the other lights turned off or whatever, you know, tolerating the distress. If you got your lights turned off, not really going to help the situation. You need to improve the next moment. Change how you feel and think about the situation. Well, that has some positive effects. Or change the situation. You know, sometimes a situation just needs to be changed, sometimes it can't be changed. So they need to change how they feel and think about it by addressing those cognitive distortions, irrational thoughts, and being mindful of what they need. So groups are extremely cost effective. You can reach a lot of people, touch a lot of lives, provide a lot of really useful skills and actually practice them. It's not like we're doing in depth therapy where people are going to be exposing their souls, but we can do things where people can apply it to situations that happened last week or talk about how they might use it next week to deal with something and share with one another what's going on, how they might adjust the skill or the tool to work for them. This 24 groups that we just went through provides the foundation for clients to begin living a happier life. I mean, these are all pretty basic skills that people need to have in order to kind of deal with ever changing life. I recommend you use written and visual material for people to look at. You know, PowerPoint or whiteboard or handouts for your visual learners, lecture for your auditory learners, and interactive applications. So everybody is taking the information and connecting it with things, memories. They have things that are meaningful to them, so they're strengthening those memory pathways. When looking for group activities, consult self help workbooks. Use activities to launch discussion or create discussion stations around the room and then have somebody present from each station what's on the station and you can talk about it as a larger group. Excellent resources. The first three are new Harbinger books. You know, I'm a big fan of Matthew McKay's work. Self Esteem and the 30 Minute Therapy series are both his, but the one from Kimberly Roth on Surviving a Borderline Parent I have used dozens of times in group, and it is an amazing group for clients to use individually as well as to integrate into a group treatment setting. And then Journey to Recovery, which is available on Amazon, is the book that I wrote and it was actually created as a method of guiding residential group treatment. So, you know, a lot of the activities in there are designed to be used in a group situation. Do you have any questions? Oh, yes. Happy Mother's Day to y'. All. Oh, for those of you who are still here, I am. I got a video on. Oh golly, where's it at now? I got a video on my Facebook feed today that was just far too funny. I'll share it with you guys if I can figure out how to do it. If you're a doggy mom, you will probably relate to this. If you're not a doggy mom, you might just think we're weird. But it gave me a good laugh. So yes, everyone, have an amazing Mother's Day. Have a great weekend. Stay cool, warm, comfortable, whatever makes you happy. And I will see y' all on Tuesday.