Ask Me Anything About Mental Health and Wellness! Live Q&A October 28

Foreign. Hey there everybody and welcome to today's Live Ask me anything. I guess I'm not supposed to say Q A anymore. The new cool term is ask me anything. I see we have a couple people that are already here, so welcome and I'm sure we will get a few more. We're a couple minutes early today, but I'd rather be early than late. It is a beautiful 60 degrees sunny day here in Middle Tennessee and I'm grateful for that. It's good weather. If you haven't voted yet, please get out and vote. Good morning, Jaden. Good morning, Damon. Glad to have you both here. Do you have questions? I am here for the whole ask me anything. A lot of people are still dealing with a lot of anxiety about stuff and that seems to be. It doesn't matter what time of year it is. It's an undercurrent that we can't seem to get away from now. So one of the things that I encourage people do to do every day, ideally every morning, is to really reflect on their rich and meaningful life and what things in their rich and meaningful life are going well or at least okay, and what things aren't going well. So you can get a bigger picture and see how much of that pie is not going so well and how much of that pie is actually it's going okay. And then you can decide from there how to use your energy, whether it's to nurture the things that are already going well because you can't do a dagum thing about the thing that's not, or to use your energy to nurture and work on the thing that's not going well and some of it to nurture the good things. And, and it's really important to make that distinction. And in addiction recovery, Addiction recovery, we often talk about the Serenity Prayer. Grant me the serenity to accept the things I cannot change. So I'm not dumping a whole bunch of energy into it, the courage to change the things I can. So I'm going to use my energy there and the wisdom to know the difference. So welcome to Bless J. Senorita Aurora. Always happy to see you. And Jaden, Jaden, you already. I said hi to you, but hello again. Let me get to that first question from Seeking Harmony. I knew I missed one. Hello. Seeking harmony. Is Omega 3 good for addiction recovery? Yes. Yes, it is. That's the very short version. Obviously, with anything, especially if you're talking about supplements, it can be overdone and you don't want to overdo it. However, the American diet specifically is extremely imbalanced. Really high in omega sixes and nines and very low in omega 3s. And you really want a much better balance. Omega 3s have been shown to be neuroprotective. When that stress response ramps up, whether it's because of cognitive stress or because you are detoxing or because you're using whatever, the environment in the brain becomes neurotoxic. And omegas actually help protect against some of that neurotoxicity. Another thing I learned today when I was updating the presentation for Wednesday is that when we take Omega 3s, it actually ramps up our body's ability to manufacture enzymes that help produce antioxidants which are anti inflammatory. They're the garbage cleaners. They, they go through and they try to heal everything and, and help get rid of some of that, address that oxidative stress. So omega 3s have a lot of benefits and can be found in a lot of things. Obviously they're supp. They're really high in chia seeds and walnuts. Those are my two favorite sources to get them. They're also high in olive oil. Now, I'm not a huge fan of olive oil by itself. I'll use it when I cook, but you're not going to get enough omega 3s just through incidental use of olive oil. You really need to think about what foods can I eat that are actually higher in omega 3s and can I integrate them somehow into my diet in a way that's helpful and, or, and, and generally I am very anti supplement because it can throw the system out of whack so quickly. But in general, for again, again, for most people that are eating an American diet, you're getting very little in the way of Omega 3. So most of the time it's not harmful. And always check with your doctor or a registered dietitian before undergoing any nutritional changes. But that being said, you know, the legal stuff aside, I've seen no ill effects in myself or in other people who do take Omega 3 supplements in addition to their other multivitamin. So that's a great question, though. It is a great holistic way to help increase the body's ability to regenerate some of those brain cells, protect the brain cells that are currently there. One of the things we say in recovery is one of the greatest things about recovery is the ability to feel feelings again. And one of the worst things about recovery is the ability to feel feelings again because those feelings can sometimes be so intense and so overpowering and so you've got to imagine what's going on in your brain. Yes, we want to feel those emotions, but we bit of help and omegas help act as a buffer against that neurotoxic environment until we can learn to upregulate our vagus nerve and downregulate our stress response. Great question. Can less vitamin D in the body result in mood changes? Yes, we know that vitamin D is ass is an anti inflammatory. Too little vitamin D, we start seeing systemic inflammation. Too little vitamin D, we start seeing depression. Too little vitamin D, we start seeing cognitive changes. Too little vitamin D, we start seeing problems in the immune system. So vitamin D is really integral in a lot of things in our body. So people who have too little vitamin D can have a lot of side effects. Sleep changes, mood changes, immune system changes, as I mentioned again. Now vitamin D is one of those that can get toxic in your body. And it's important to talk with your doctor about whether you are vitamin D deficient and if you are, how much of a supplement you need to take. That being said, Especially in the winter, and I'm treading lightly here because remember I'm a, I'm a therapist, I am not a medical doctor nor am I a registered dietitian. So I'm not telling you how to treat or diagnose anything. We're just talking in general about vitamin D, but in general in vitamin in people who live north of Tennessee and sometimes they say Tennessee north, depending on what article you read about eight months out of the year, we don't get enough of the UV penetration to actually give us enough vitamin D just through natural means, just through going outside and getting sunlight. A lot of us still consume dairy products that are fortified with vitamin D. So a lot of us get vitamin D there. But if you're a vegan, you may not be getting that. And, or if you don't like milk and cheese, you may not be getting that. My husband doesn't like cheese at all, which is one of my favorite foods. But I digress. So you do want to consider, are you getting enough? Is it possible for you to get enough from the foods that you eat and from the sunlight? And the best way to determine that again is by getting a blood test to see what your body is registering. As we age, unfortunately, our skin thins and as our skin thins, it actually becomes less able to convert sunlight into vitamin D. Long process, short. So if you're older, even if you're eating the same thing as your younger counterpart and spending the same amount of of time outside as your younger counterpart and their vitamin D levels are fine, yours may not be. So yes, the short version, yes. Vitamin D definitely impacts mood and then you already heard the long version. And I would encourage you to get blood work done, get a blood test done to monitor that. I know my vitamin Ds. I fight with my vitamin D levels being low even though I work on a farm and I'm outside all the time now. I slather on sunscreen and I wear long sleeves whenever possible because skin cancer runs in my family so I don't get as much from the sun. However, I figured I was getting enough between my multivitamin and all of the milk and cheese I eat. Apparently not. My body wasn't producing or storing enough and so my doc, my doctor put me on or had me start taking a vitamin D supplement. There's some argument about how much to take and that's a decision that you need to make with your doctor. Okie dokie. I found journaling about stress, activating the CNS through physical activity and then practicing regulating has worked well. That's great. One of the best ways, and Jaden really makes a good point here, one of the best ways to strengthen vagal tone is to actually intentionally increase your stress or distress and then practice triggering that vagal tone and down regulating your autonomic nervous system. Yoga is great for doing that. But as I meant I've mentioned in other videos before, I'm not a big one on yoga, but I do when I get on the elliptical or when I get on the treadmill, I try to keep my heart rate between a very small range and when it goes over, instead of reducing the speed or the incline of the treadmill, for example, I will try to slow my breathing and get my autonomic nervous system to kick in. So I try to override that stress response. When I get stressed about something, I try to down regulate it. Now I typically, I'll admit I typically am not going to try to trigger emotional distress in order to intentionally so I can down practice downregulating. That's, I'm probably not going to do that. I'm chicken, whatever you want to call me, I'm good with it. But I do do it when I am experiencing physiological stress. And some people, I mean Jaden is pointing out that they journal about stress and journal, journal about stressful events and that may increase stress. I take that back. One way that I do intentionally increase distress is when I do systematic desensitization. And I, I usually Use the example of a spider, because there's lots of people out there that are afraid of spiders. So when you start thinking about spiders, you're like. And I say, okay, you know, just thinking about a spider triggers your stress response. And I have them rank it on a scale of 1 to 5. Where's it at? And then we practice down regulating and activating that vagus nerve until they feel like their stress level is back down at a one. Then we do it again. Imagine just think about a spider and it goes back up to a five. How long does it take for them to be able to take it back down to a one? We keep doing that until the person can think about spiders and their stress level may go to a 2. But then they can real quickly bring it back down to a one. Once they're able to do that, then we start thinking about being in a room with a spider and we do the same thing until they can think about being in a room with a spider. And it barely moves the needle on their stress response. And when it does trigger a little bit, they're able to bring it right back down to baseline. And we take gradual steps like that, exposing people and gradually exposing people to something that triggers their anxiety. You want to take very, very, very small steps so you don't overwhelm the person. But that is one way. And that's a great example about figuring out what stresses you out and then being able to down regulate. Why is downregulating so important? Well, number one, it reduces the amount of time that the environment in your brain is neurotoxic because it's too stressed out. And number two, when you're in fight or flight, you're not in think and plan. You're either executive functioning or fight or flee. You're generally not going to be in both at the same time. Now sometimes you're in a little bit of fight or flee and a fair amount of think about it, but you're still not completely focused if that fight or flight system is, is, is triggered. So, alrighty, what's the best way to combat low self worth? The first thing I would encourage someone to do is to consider and, and remember I'm cognitive behavioral to consider writing down all of the things you tell yourself that convince yourself that you're not worthwhile. Write down all of those things and examine the facts for and against those beliefs in the present. I would also encourage you to examine, you know, look back over your history and examine experiences you've had that you believe contribute to your Low self worth and reevaluate those with fresh eyes. When you're in the moment, whatever's going on feels overwhelming, feels embarrassing, feels something. And so your fight or flight, your stress response is triggered. You're not thinking clearly, you're not in your wise mind at that point, so you're probably using emotional reasoning. I feel stupid, therefore I must be stupid. Well, no, not necessarily. Actually, probably not. But when we're in that moment, we tend to, because we're in our emotional mind, we tend to reason in our emotional mind and remember in our emotional mind. And we can't restructure those beliefs about ourselves until we get into our wise mind and we look back and go, what else was going on? Examine the facts for and against your beliefs that you are not worthy. Examine traumatic events that may have led to your feelings of unworthiness and examine them with fresh eyes. If somebody else went through those events, would you consider them less worthy? Consider on number three. Consider what makes a person worthy, what makes a person a good person, worthwhile, lovable, whatever word you want to use. Or maybe make a list for each three, all three of them, if they're slightly different in your mind. And then think to yourself, which of these characteristics do I already have? Okay, and then number four is to identify or describe if you were worthy. If you were a worthy lovable person, which I believe you are right now. But if you were a worthy lovable person, what, what, how would you describe yourself? Not what would be different, not what would be the same, but just how would you describe yourself? And then go through and look and say, how many of those things do I already have? Maybe not completely, but I have some. Then you can work to grow those. And what things do I need to add? If you think there are things that characteristics about yourself that make you less than worthy, then those are things that you can address. And I do want to encourage you to separate behaviors from yourself. I can do something really bad. I can make a mistake or something. I can have a, you know, just wide open addiction. And I'm going to make some choices that in my sober mind I wouldn't have made those behaviors. I regret those behaviors. I feel guilty for those behaviors I need to make amends for. But it doesn't mean I'm not a worthy person. I'm worthy of love. Those behaviors are not worthy of love, but I am worthy of love. And I am capable of choosing different behaviors. And really getting down to who you are versus what you do can be the final step. And you don't have to do those in any particular order. You don't have to do all of them. But those are the things that I would suggest for self worth. Hello Lucretia, thank you for the question. Lori. Bless j asks, is cbt helpful in curing bpd? My gut response is yes. Now let me qualify that a little bit. Okay? Bpd, Borderline Personality Disorder is a set of behaviors that's developed in childhood or adolescence, usually in response to trauma. I've never met anybody with BPD that didn't also have CPTSD or ptsd. I just, I haven't. So as a way to survive, you developed or whomever developed behaviors to survive whatever that chaos was that they were experiencing. And those end up causing dysregulation in the autonomic nervous system. Those end up causing issues where people will be hyper vigilant to rejection. They have high rejection sensitivity, they tend to be very intense in their relationships, they're terrified of abandonment, so they cling on really fast, really tight. And if they perceive that you might be upset with them, they will go the opposite way and they will cut bait faster than you can say I don't know what. And it's that, that extreme, those extremes that can be very exhausting for the person with BPD as well as for the people around them. Because a lot of times the person with BPD is acting in their emotional mind. They never have regained a sense of safety and empowerment, and their behaviors are reactive behaviors that are taking place, if you will, through emotional reasoning in their emotional mind because they are terrified. And cognitive behavioral therapy and dialectical behavior therapy, which is a type of cbt, can help you learn how to down regulate and start healing that autonomic nervous system, healing that stress response so you can down regulate, tolerate that distress and get into your wise mind to better evaluate the situation. Is cognitive behavioral therapy going to completely address all those traumas? Not necessarily. Some people will also need something like EMDR to help them process those traumas. But CBT as well as dbt, Dialectical Behavior Therapy and Act Acceptance and commitment therapy, all of those are forms of cbt, but they can help you learn how to help to start down regulating your stress response, getting into your wise mind and then the cognitive part helps you evaluate those cognitions and those schema based on the facts in this context at this time. So that's the long version of yes, I believe some form of cognitive behavioral therapy is essential in addressing complex post traumatic stress or borderline personality, whatever you want to call it. I tend to believe they're the same thing. But however, CBT may not do absolutely everything. How do you deal with out of proportion fear to situations? It's a great question and it kind of builds on what we were talking about with that systematic desensitization earlier. Out of proportion fear of situations can have to do with your beliefs. And without knowing the situation. We already talked about specific phobias like out of proportion fear to spiders and exposing yourself to that. You can also write down a list of your beliefs that are triggering that sense of unsafeness. If you are afraid that your house is going to get hit by a tornado. I don't know, I'm just trying to pick something other than snakes or dogs. If you're concerned that your house is going to get hit by a tornado. So every time there's a thunderstorm you go into full panic mode and it's out of proportion to the probability that your house is actually going to get hit by a tornado. Then you want to start taking a look at that. You are the one. In your question, you said that the fear was disproportionate. And so that tells me there's a part of your brain that says your fear is disproportionate. What are your, what are the beliefs that you have that are fueling that fear? And what are the facts for and against each one of those beliefs in the current context? And what's the probability anything's possible? So I don't say what's the possibility it's going to happen. I say what's the probability? Is it 1 in 10 or 1 in 10,000 that your worst fear will happen? And that can really help people start objectively analyzing what's going on in the moment when it's happening. If you are, I'll use the example when I go to the doctor and I've got to be stuck with a needle either to draw blood or to get a shot. I have an irrational fear of, of needles. So I practice my distress tolerance skills. I start slowing my breathing so I can basically manually override my stress response and activate my, my vagus nerve and my parasympathetic nervous system and down regulate. I try to avoid using the word calm down because that those are trigger words for a lot of people. So I downregulate my stress response. I'm just turning it down going, we don't need that much fuel right now. There's nothing to run from. There's nothing to be afraid of. And I tell myself that that can be helpful if you are talking about somebody else who you perceive has an irrational or disproportionate fear of a situation, that's a horse of a different color, you don't know what experiences they've had that have shaped their expectations about something. Airplanes. If there are some people who are terrified of airplanes and a lot of people who, you know, whatever, I'll fly on. And yes, objectively, we can look at the facts in context and say flying is safer than driving. And what's the probability that an airplane's actually going to crash? We can look at that. But there's also a part of us, if we have this schema, if we've been telling ourselves for 20, 30, 40 years that flying is unsafe, it takes a minute to unwind all of that teaching because every time you tell yourself this is, this is threatening, it adds a string to that mental rope. So if you've told yourself something three times, then that mental rope isn't very strong, and you can probably break that cognitive chain pretty quickly. But if you've told yourself that for 50 years, that cognitive rope is really strong. And even if you recognize that the thoughts are no longer accurate, or maybe they never were, it's going to take a minute to unwind all of those strings. Recognize people react to situations based on their prior experiences and their interpretation of those experiences, and that shapes how you interpret the present, which is why two people can get ready to go on a roller coaster. One's terrified, one's exhilarated. There are a lot of things like that where you look and you're like, they're both getting ready to do the same thing. Why are they reacting differently based on their beliefs about the situation? Hello, Alec. Great question, Marco. Laura, I'm not sure exactly what you're referring to as far as the father wound. If you can elaborate on that, then I can certainly address that or try to address that a little bit more. Do I have advice on managing triggers when in a state of grief? Grief represents a trauma, okay? When you experience grief, you have lost something, and generally it's not something you wanted to lose, so it's. It temporarily leaves you feeling powerless and potentially unsafe, depending on what the loss was. Maybe you lost your dog, you know, maybe that your dog got hit by a car. I'm sorry if it did, you know, been there, done that, never want to experience it again. It was horrific. But when that grief happened, I felt powerless and I felt unsafe, and I very quickly got out of denial into anger, and I was angry at myself and I was angry at the driver and I was angry at the dog and there was a lot of anger to go around. And remember that anger and anxiety are our stress responses. Fear, fight or flee. And so when we experience a loss, it's traumatic and that trauma causes us to go into fight or flee. So we are already in that emotional reasoning state of mind trying to figure out how to regain our sense of safety and personal empowerment. Therefore, during the grief period, it's important to recognize that you're already stressed out. A lot of people think of grief as exhausted. And you will, you'll go, you'll go back and forth from anger to depression. And some, some days you'll feel them both at the same time. You're angry, but you just don't have the energy to get up and do anything about it. And that's okay. You're your autonomic nervous system, your stress response, your is in overdrive and sometimes it starts running out of gas and you start feeling helpless and hopeless. And then you start recharging a little bit, get some energy back and now you're ready to fight again, you're angry again and you may bounce back and forth there for a while. Now that has to do with the stressor. But I want you to recognize you only have so much energy. And when you're already feeling unsafe and powerless, anything else that comes your way can feel like it is the straw that broke the camel's back. It can feel 10 times more overwhelming, irritating, terrifying than it probably would if you weren't already stressed out. All that being said, when you are in a state of grief, acknowledge that you're stressed out. Acknowledge that you feel unsafe. Try to identify, you know, no, if you can ahead of time, if you know what things are going to stress you out ahead of time, you can make a plan. When my mother was in hospice care, I made a plan because I knew that, you know, going through the last few weeks with her and the period after that, which was who, who knows how long I was going to be more likely to be irritable, to be triggered, to be stressed out. And I relied heavily on my family. I relied heavily on strategies to help me down, regulate. I relied heavily on my plan to reduce my responsibilities. It wasn't time to start taking on more stress. It was time to allow myself to devote my energy to regaining a sense of personal power and regaining a sense of safety. After having experienced a situation where I felt totally powerless and when I would get irritable, when I'd get snippy, sometimes I'd apologize and recognize. But the people around me, because I was open with them, this is a tough time for me, so please give me. Give me a wide berth right now. And that helped a lot because the people around me that. That knew what I was going through were. Were able to say, all right, go back away now. And I found that to be helpful. Try to keep. I know it's hard. Try to keep a regular sleep schedule and maintain your circadian rhythms. That will help a lot with your stress response. And you may be saying, well, when I'm grieving, every time I lay down is when all those memories and everything start flooding back. Okay, well, then we need to address that. Some people, when they are going through a period, if they have, you know, thoughts that just rush through their head all the time, or when they're grieving, they start thinking about those things. For some people, it's constant. For some people, it has to do with a. A acute incident. It doesn't matter. Some people will listen to music as they try to go to sleep. Some people will listen to a book on tape as they try to go to sleep. Some people will use guided imagery, either listening to a tape that gives you guided imagery or in their mind, walking through a situation. For example, one of my favorite places is a cabin in the woods. I'll imagine myself driving up to the cabin in the woods and parking the car and getting out and feeling that cool breeze and hearing the leaves rustle. And I focus. I go back to that grounding exercise, focusing on five things I see four things I hear, three things I smell, two things I can feel. And I just notice the environment around me. And then in my. In my image, in my narration, I walk, Walk toward the cabin and step up on the creaky stairs. And I just keep going through that. And I will stop. Kind of like you're in a video game. Just periodically stop and look around and do the 5, 4, 3, 2. And to get grounded, to really use your senses. But your turn. You're occupying your brain and you're forcing it to use energy to think of something different than that stuff over here right now. Finally, progressive muscular relaxation works for some people. You start. I like to start at my head and work my way down, pushing the negative energy out through my toes. I don't like pushing negative energy out through my head. It just doesn't work for me. But you. So I start at the top of my head and I tense the muscles in my scalp. And when you do that, you can find kind of Feel your ears go up, hold that for three seconds and relax. And I notice the difference between tense and relaxed. Then I do it two or three more times and then I move down to the next muscle group, which is my face, and I'm not doing that on camera, but I do the same thing. I tense the muscles and I notice the difference between tense and relaxed. Then I go down to my neck muscles and I tense my neck muscles, do the same thing. So you're slowly working down the body, all the muscle groups. When you get to, like, your chest, you're going to do your chest and then you're going to do your back. So you're getting all the muscles, not just half the body, but you're focusing on the muscles, the sensations and the difference between tense and relaxed. You can imagine every time you tense your ball, you're grabbing that distressful energy in your body. And every time you relax, you're letting it go, you're letting it rush out, rush out. Your fingertips rush out, your toes rush out wherever most of the time. I used to do this with my class at uf and by the time I'd get finished with the entire body, by the time we were down to the feet, about 2/3 of my class was usually asleep. Most people find that they will drift off to sleep during that process. So those are some suggestions for helping you get to sleep. Pay attention to your sleep hygiene. If you're sleep deprived right now, then you may be kind of thriving on coffee, which is also throwing your circadian rhythms out of whack. Not saying quit the coffee, that's kind of cruel, especially when you're already stressed. But you may want to consider cutting back on it or switching to decaf after 2ish in the afternoon. Normally I say 12, but you know, we're making the best of a bad situation right now. Once your circadian rhythms get realigned and your sleep starts to improve a little bit, then you will likely rely less on caffeine and you can back, back it up even more. Let's see other things. You can check out the video I have on sleep hygiene. Create a sleep routine so you do the same three things every night before bed with your kids. They would come home from school, they would play, they would eat dinner, they take a bath, you'd read them a story, they go to sleep. So as soon as they came home, their body knew what was coming next and it helped them plan. Even though they weren't thinking about it neurologically, their brain knew. Okay, we have about this Much time before we need to start making melatonin. And that's really helpful for adults, too. You come home from work, you put your stuff down for me. I make dinner. After dinner, I do the dinner dishes, and then I usually start watching tv, but that's my routine. And then I go to sleep. And so my brain knows that once I start watching tv, it's about time that we can start getting sleepy. It sounds odd, but it really does impact your. Your circadian rhythms. Your circadian rhythms are controlled, if you remember, by not only light levels, but also temperature and activity. So cool the environment down, because we sleep better when it's cool. Turn down the lights, especially blue lights. If you have lights on, ideally make them as yellow as possible. In my bedroom, I actually have the little yellow lights that you normally put on your front porch that don't have any blue in them in order to prevent the bugs, but I use them inside in order to keep the blue light levels as low as possible in the evening. And I find that that's really helpful. So th. Those are the suggestions. I know I went way off on a tangent. Unfortunately, expecting yourself to not be triggered when you're already under stress and distress is probably not overly compassionate with yourself. Recognize you're going to be triggered and say, all right, when I'm triggered, how can I most compassionately respond to myself and to others? If there are triggers that you can minimize, great. But also, instead of getting upset about getting triggered, embrace it. All right, that's what happened. What am I going to do now to use my energy most effectively to move toward my rich and meaningful life? Oops, sorry, y'. All. If I go on too long and. And you are typing, which I love, getting messages from you, sometimes it jumps on me. And. How can I measure mental health so I have a baseline and know if my therapy is working. Excellent question, Mike. Identify the symptoms that you're trying to work on. If you are working on your mood, maybe you're in therapy for depression and you want to be happier. Okay, I will be happier at the end of the month, as evidenced by what are three observable. Observable things that you will notice when you're happier? Okay, so that's one way to do it. You can also keep a log each day on a scale. I try to make it an even number because if you use odd numbers on likert scales, it's. You're tempted to pick the middle one, which is fine. Okay, whatever. So I use. I typically use four. What's my mood today? Zero is awful or depressed, one is melancholy, blue, whatever, two. Two is I feel okay, and three is I feel happy. You can definitely determine which one of those you feel. It's not so granular that it's hard to tell which. That helps a lot with reliability. You're not probably really interested in testing statistical theory, but. So four anchored points and each day, rate your mood over the course of the day. Today I would say my mood was on average a, you know, a three. It was okay. I won't say it was great, but it was okay. All right, that's fine. That's a whole lot better than a zero at clinically depressed. So you can scale it that way and see, but there's more to evaluate than just mood. There's behaviors, there's thoughts, there's functioning. When people are clinically depressed, sometimes they're not. They don't even have the energy to bathe. So I will look at. You will show improvement in terms of improved energy, as evidenced by bathing every day, as evidenced by wearing clean clothes or even getting out of your night clothes, as evidenced by. And then we start looking at those. If you're not making progress, then you want to evaluate why. So the short version, write down three between. Between one and five symptoms that you're hoping to change in therapy and write down what it'll look like in a month and three months if you are making progress or you hope it's going to look like, and then use that as a. As an anchor. So for that Likert scale, you take the average and you say the first week, your average is a 0.5. You know, you average all the days together. You had a lot of zeros that first week. You weren't doing so well. The next week is a one. So, okay, you're still not in that good to happy range, but it's improving. And then the week after that and the week after that. Recognize incremental improvements are important and also recognize that backsliding is going to happen. Sometimes you will be. You'll have some momentum. You'll be going. Just like when you're rock climbing. You'll have some momentum. You'll be going and you'll grab, and it's not a solid grab, and the rocks will crumble or something, or you'll lose your grip and you may slide down a little bit. You're not going all the way back down to the bottom. You're just sliding down a little bit. And by noticing that, you can ask yourself what changed. What changed that today or over the past couple of days that is causing me to slip a little bit and what can I do to start moving forward again? Thank you. Mark. Yes, please give a like if this is helping or encouraging, please ask questions. I will continue to answer questions for about 20 more minutes, But that really helps. The more people that see this, the more people that see the channel, the more subscribers we have and the better we are able to continue producing content. So great. I. I'm bad about pushing the like and subscribe and share, but they are so important. Adriana usually does that for me but her son is sick today so I'm. I'm winging it. But thank you, Mark. Question Dacian thank you for being here. Question I often replay events from the past countless times in my head or memory, mostly my past deeds and speech. Only sometimes do I remember what others have said to me. Any advice? If you're replaying that I believe that your body, it's something that hasn't been filed. Your body hasn't figured out. Your brain hasn't figured out. What do I do with this? Do I put it in a that's a nothing file? Do I put that in Hey, I did a good job file? I don't know how to evaluate this for the things that you're replaying. Maybe you are replaying, for example, the Christmas party from last year, okay. What you did, what you said, how you interacted, whatever. And you know, obviously it's almost time for this year's Christmas party. And if you're still replaying that, I would call that a rumination. I would call that something that's sticking around for a little too long. And I would ask myself, okay, I keep remembering this. What about this incident is making me feel unsafe? What about this incident is making me worry that I'm going to be rejected, that I'm going to be criticized, that I'm going to be or that people were rejecting me and criticizing me behind my back. A lot of times, especially when we ruminate about interactions with others, it has to do with our fear of rejection and abandonment. Maybe there was some non verbal that you picked up from somebody, but you can't. Your brain doesn't really identify it, but in the moment you noticed it was there. And so you keep replaying it, thinking to yourself, oh, that person like cringed when I said that. I wonder if I said something wrong. I remember what I said, but I don't remember how anybody reacted. Okay, well that happened last Christmas. We're now in October of this year. Have you been rejected? Have you been treated differently since that point. Even if you can't remember how other people reacted, you can evaluate whether it had any positive or negative consequence. And if you think it had a negative consequence, then you can start kind of addressing and trying to figure out why. A lot of times when we're in situations and if we have some social anxiety and we may remember, like you said, everything that we said or did, and we don't really remember other people's reactions. Why? Because their reactions were very benign. It was our reactions to ourself, our inner critic that kept saying what you said. Oh my gosh, that was so stupid. So we're basically remembering the negative interaction between ourselves and our inner critic. And if that's the case, then, then again, you want to look at facts in context and evaluate what your inner critic had to say. Is what they had to say helpful or not? And is ruminating, is spending a whole lot of time even trying to figure it out and ruminating on it? Is that a good use of your energy to help you move toward your rich and meaningful life? Without knowing specific details of what's going on? It's really hard for me to address ruminations and intrusive thoughts, but those are my initial general thoughts about what's going on. If it has to do with a particular situation, you might also examine whether it reminded you of a traumatic situation from your past. And so it left you feeling unsettled when you left because you felt the same way you felt when you went to the homecoming dance your, your senior year or something. Hello, Lucretia. And yes, it does. The microbiota does affect mental health. There is absolutely no doubt about that. There's a lot of really fascinating research which you probably don't want to get into. A whole lot. I do have a video on the gut microbiome and, and mental health, if you kind of want to do, do a deep dive. And we talk about the different types of bacteria that are in the gut and what they're responsible for, how the MIC gut microbiome is responsible for helping to produce some of the stuff that we need as far as neurotransmitters, etc, and they're responsible also for maintaining other microbiome M microbes, e.g. e. Coli and Streptococcus. Those. Both of those are bacteria we have in our gut and we need in our gut because they help produce neurotransmitters like serotonin and dopamine. We don't want to completely get rid of them, but we need them in the right proportion, which is very, very small amounts. And we want them down in our gut, not in our upper GI system. So I'm, by no means am I saying ingest any of that because we do know that those things will make you sick, but when they're in the anaerobic environment of your gut, it's a different situation. And stress, illness. Anything you eat alters your gut microbiome, the stuff that you, you can eat stuff that's whole foods and high in fiber and all that kind of stuff which feeds your gut microbiome, microbiota. Or you can eat stuff that at best doesn't feed it and at worst kills it off alcohol, like, you know, beer, wine, liquor. Alcohol and antibiotics are both known for killing bacteria. What's an antibiotic? It's something that kills microbes and it's not selective. It doesn't go, oh, I'm going to kill the streptococcus. No, it goes in there and it either kills all the gram positive or all the gram negative or just all the bacteria, which means that your gut microbiome is out of balance for a long time after you take antibiotics. They've done studies that have found that treatment with specific strains of microbes like Bifidobacterium and certain types of Lactobacillus are associated with improved mood in people who are clinically depressed as well as people who are elderly. So, you know, that's an interesting, interesting thing. And different foods have different types of microbes in them. You have your not preserved, what's the word I'm looking for? Like sauerkraut and, and kefir that have certain microbes in them. You've got yogurt, you've got cheeses, Parmesan cheese actually has microbes in it. So there's a lot of food out there you can eat to help diversify the micro microbe population. My family thinks I'm struggling with an ed, but I don't feel that way. I'm recovered OCD and autistic, so I have a lot of weird food rules, but they don't cause me any distress and I'm fine. Okay, and this is an interesting point. What when we look objectively at criteria, one of the things we look at, for example for anorexia is a refusal to eat. But there has to be a fear of weight gain, there has to be a fear of getting fat. We, there can be as, as you pointed out, somebody who is neuro atypical may have food aversions that a neurotypical person doesn't understand. My son when he was little had some food aversions that he had difficulty with and somewhere along the way he got out of those. But food aversions are not uncommon in children and they're not uncommon in people who are neuro. Atypical. Examining what specifically are they concerned about, what behaviors are you doing or what about you specifically makes them think that you've got an eating disorder. And then you can address those sorts of things. If you are, for example, exercising two hours per day and eating 600 calories, okay, we may want to look at that because that's physiologically unhealthy. If you are binging and purging, then we may want to look at that because that's a symptom. But binging and purging and food restriction alone do not qualify as an eating disorder. I would encourage you to go to, well, go online and you can ask any of the AIs now what the DSM 5 criteria are for anorexia, bulimia and binge eating disorder. I tend to think the way you're describing it, you're describing anorexia, but you can look at that. And with my patients, before I diagnose them, I go through the diagnostic criteria with them and I say, this is what I'm seeing. These are the criteria in this diagnosis that I think you meet. Do you agree? And they say yes or they say no. I don't want it to be a mystery where I came up with a diagnosis of xyz. And I think that can be helpful and potentially comforting to your parents if you can have an open discussion about their concerns and about what the diagnostic criteria are for the particular eating disorder. Some people are naturally thin. Some people may not have the same appetite as others. Some people may have anxiety induced loss of appetite where it's not an eating disorder, but it is a physiological reaction when the stress response kicks off. It says, we're not worried about rest and digest, we're worried about fight or flee. So obviously I'm not going to eat right now. Those would be my suggestions to try to open a dialogue with your parents. I would also encourage you, Eliza, to consult with your doctor the next time you go in for your physical about any concerns your parents are having. If they think you're underweight or you're not eating enough or you're malnourished or whatever, consult with your doctor about their opinion. Because again, people can be malnourished, people can be not eating enough, but it may not be an Eating disorder, it may be something completely different. And with the OCD as well as the autism, there are sensations and experiences and motivations for eating or not eating. Certain things that your parents may not completely understand yet. I don't know. But that would be where what I would start thinking about. Can functional neurologic disorder appear as a result of undiagnosed high functioning ADHD or asd? I do not know because I don't know what the diagnostic criteria are for functional neurologic disorder. OCD and hoarding are can both be considered anxiety related behavioral reactions, if you will. And that greatly oversimplifies it. But when you look at the underlying cause, people with ocd, they have this obsession that if they don't do something then bad things are going to happen. So then they do the something. That's the compulsion. So that's anxiety. I have this fear. Now we need to examine where that fear came from. Sorry y', all, I don't know why my nose is so itchy today. The hoarding is another manifestation in most people consider of an anxiety disorder. I need to keep all this because I'm afraid if I let it go something bad will happen. I'll need it. Something bad will happen. I will. If I get rid of this photo album then the memories that are associated with it will also go away. There are thoughts that are saying, telling you or telling your. You're telling yourself with those thoughts. And I have to keep this exploring and I know I keep going back to this exploring the thoughts that you're having that are promoting the hoarding can be helpful. What, in what way is hoarding helping you feel safer and more empowered and what alternatives do you have? Same thing with the ocd. With people with ocd. Mild to moderate OCD is what I work with somebody who has severe ocd, I typically refer to a specialist. But mild to moderate ocd, we often work with systematic desensitization. The person has the belief that they need to do this or something bad will happen. And we pre prevent them from doing the compulsive behavior and help them down regulate their stress when they're not able to fulfill that behavior and then process what happens afterwards when their fear, whatever their feared outcome was doesn't happen. We process all of those things. But that's obviously something that's important to do with a therapist who can help monitor your level of distress because you don't want to, you know, try it at home and increase your level of distress too high because that just reinforces the fearsome nature of not completing the compulsive behavior. You're right, John Halt is a mnemonic that we have in addiction. Hungry, angry, Lonely, and tired. And I have a video on it. I know there's a surprise. Think broadly about Halt. Hungry is not just physically hungry. It's hunger for. Do I have a hunger for being around somebody? Do I have a hunger for what I lost? Am I angry or anxious? Well, if you're angry or anxious, then you're in fight or flight. You're not in your wise mind, so you probably want to try to avoid making any snap decisions or making any, you know, jumping to any impulsive behaviors. If you're lonely, it can be really tempting to try to engage with others. But then if you're grieving especially, you can get overwhelmed really fast and start getting irritable, and then you feel guilty because you got irritable, and it's just this whole mess. If you're lonely, that's okay. If you're lonely, acknowledge that you're lonely and have a plan to deal with that. When I'm lonely, I can. It doesn't mean you can't call a friend, spend time with people, go do something. But recognizing how much you can handle. When I'm grieving or when I'm stressed out and I also start feeling lonely, I know that, you know, I can probably tolerate hanging out with a friend of mine, but going to a mixer for work is probably way too much. And so pacing myself and then tired. As I mentioned, when you're tired, when. When you're grieving, you're expending a whole lot of energy. You're probably not sleeping very well, so you're probably tired. And acknowledging that. Acknowledging that you are going to. When you're grieving, you're going to likely feel more impulsive, and that's okay. That's your body going, I'm trying to protect myself. Get away. Every time something comes close, get away because I can't take anymore. And understanding your behavior as communication can be really liberating. Understanding your behavior as your body's way of trying to protect you and have compassion for yourself. Say, oh, guess I'm not ready for that. Okay, I'm not ready for that yet. Abeka, I would encourage you to watch the video I have on sleep hygiene. I have a couple of videos out there, actually, that take you through about 16 different points to consider for improving sleep. Thank you, Polo, for being here. Visiting somebody that you love who's in hospice or palliative care is heart Wrenching. You are totally right. That's a great tip. Polo. When you're grieving, like I said, you're tired. It can be helpful. We call it behavioral activation. It can be helpful to sort of force yourself to engage in hobbies or pleasurable activities. Even for just 15, you can combine the Do15 and a hobby because sometimes that can help release some of those pleasure chemicals, some of those happy chemicals in your body. You may not feel it, you may not feel happy, but it's kind of like adding a little bit of cold water to the hot water. You may not notice a huge change, but it makes it a little bit more tolerable. In general, when we're Talking about medications, SSRIs or benzodiazepines or any other, any of our psychotropic medications, what they are doing is assisting our nervous system. They're not healing anything, they're supplementing it. So for example, SSRIs prevent the serotonin and the synapse from being absorbed as quickly and from being broken down and absorbed as quickly. So if you quit taking the ssri, then the serotonin is going to go back to being absorbed really quickly. All you're doing by taking that medication, it's not healing the condition. It is helping your body work despite the condition, so to speak. You are quite welcome, Mark. I really do enjoy doing my My Monday Lives. I wish we could do them more. I'm a counseling student wanting to go into private practice once I graduate in 2025. What should my job look like after graduation? Well, Ty, I'm going to assume that you're in one of the 50 states besides Florida, so I'm going to speak to those first. Florida is the only state in the union that I know of that will allow a postmaster's pre licensed individual to open a private practice. Okay. Therefore, While you're getting your 3, 000 hours of Postmaster's supervised clinical experience, you're going to want to find a setting that you enjoy working in. It could be a group practice where one of the licensed providers takes you takes you in and you're able to bill under that person's number. Or maybe you are able to do private pay because you can't get on insurance panels until after your until after you're licensed. With the exception if you go to work for a community behavioral health center that takes Medicaid master's level. Pre licensed people can bill for most things that a licensed person could bill for through Medicaid. That being said, your first two to three years post Masters. You're going to want a setting that gives you plenty of clinical hours. Shoot for between 20 and 30 contact hours per week and provides you supervision, ideally as part of your contract and in a setting that you think you want to work in. Because this is really when you're honing your skills under the tutelage of somebody who's been working in that environment. I worked in addiction and co incurring disorders and I learned a lot. I learned way more during my postmasters internship residency period than I did during graduate school, I'll be brutally honest, because I was working with people who had spent their entire lives, 20, 30 years working with people with co occurring disorders prior to licensure. You're not going to be able to get credentialed with insurance companies, so I wouldn't even really worry about that yet. Be very careful. Read your state statutes very carefully about what is an acceptable clinical site and how many supervision hours you need to have for every contact client contact hour you have and whether your supervisor needs to be physically on site or like in the building where you're working. Or you can do virtual supervision. A lot of places have eased up and you can do virtual supervision, but some places say that the provider has to be on site because if you're seeing a patient and they start to decompensate and heaven forbid you should need to baker act then having that licensed clinician there who's able to help you with that process is really important and they can't do that through zoom or some other telehealth thing. But welcome to the field. Roller girl. Welcome and thank you so much as always for your I'm not even sure what they call those. Super thanks or but for your donation that every little bit helps and it is really helpful when people can donate if they do in order to keep everything rolling forward. And Mr. Leslie, Chuck is right. Generally boards will frown on more than eight CEUs in a day. How There are some caveats, but it's always important to be careful. For example, at all CEU's we have a couple of classes that are 30 hour classes, for example, and people will take tests throughout the course and and so we can prove that they didn't sign up on Monday morning and take the test on Monday evening and try to get credit for 30 hours. We can prove by the duration of how long that they're enrolled in the class and when they took their various quizzes that they actually were active in the class over a period of time. I know a Lot of them are refreshers like ethics and medical errors and those sorts of things. However, it's also important to remember that most states and most boards will not allow you to take the same exact course two years in a row. So, for example, if we had a course at all CEU called Ethics 101, you could take that this year, but then in two years when you renew, you wouldn't be able to take that same exact course again and get credit for it. In terms of medication for post acute withdrawal symptoms syndrome, most of it has to do with helping the person cope with the symptoms until their nervous system can heal, until their HPA axis can rebalance itself, which can take up to two years. There is a significant portion of people who go on a low dose of antidepressant, for example, to help them make it through that really tough, as one of my clients called it, gray period, where there's no, there's no color, it's there. It's just blah all the time. And it was really hard for him to stay sober when he started taking a low dose antidepressant. It helped him get through that pause period and then he tapered off after about a year and felt a lot better. It doesn't work for everybody, but it's certainly something to consider. I would certainly caution you and encourage you to talk very frankly with your doctor about anything that has any short acting effects. Like, I can't even think of a doctor that would prescribe a benzodiazepine for somebody in recovery. But heaven forbid if they tried to give you something like Valium, making sure that they knew that you were in recovery and that wasn't going to work. So those are certainly some things to consider in post acute withdrawal from benzos and opioids. A lot of times one of the most effective things is doing a very slow taper so the body has time to adjust to the altered levels of opioid and GABA activation. So you don't have a lot of pain or a lot of anxiety in that early post acute phase. Call me glitter. I am not seeing your question, Mela. I did miss your question as well. Trichtillomania is a disorder where people, especially when they're stressed, pull out their hair. And a lot of times it will be hair on the arms, hair on the eyebrows, or even the eyelashes. Hello. Come here. You want to say hi to the people? Yeah, the boo boo says hi. Okay. All right. That's plenty. Suresh. A social relapse, as I define it, is going back to Hanging out with those people that you hung out with in your addiction, hanging out with people who co sign on your, forgive my French your and going back to interacting with yourself in a way that is dehumanizing and promotes self criticism and self rejection and and causes you to feel rejected and unsafe in your own head. What, what are my thoughts on beta blockers? Well, beta blockers are typically used to address cardiac issues and they do have an anti anxiety sedating effect but for most people they are like ultra sedating. My daughter had was on them for a while for her pots and yes, it slowed down the tachycardia, but when she wasn't tachycardic she was almost comatose. Like she was zombified. She wasn't literally almost comatose. So it depends on the person what's causing your anxiety, what other symptoms you're having, what cardiovascular complications you may have with it. But do recognize that beta blockers have their own set of side effects that may or may not be tolerable for some people. Great question. In terms of mi, mixing beta blockers with alcohol. Yeah, I would say that's dangerous. Beta blockers are going to slow you down. Alcohol is going to slow you down. You add the two, it is problematic. Advocating for yourself in treatment. One of my favorite topics, I guess because I think a lot of doctors and therapists don't listen. I know we're supposed to listen, but we don't. When you have an issue, the DSM 5tr for psychology and the ICD 11 for medical stuff, go online, ask one of the AIs what the diagnostic criteria are for XYZ diagnosis, write it down. And then for each symptom of that diagnosis you think you have, write as evidenced by when my son, when I was trying to get him diagnosed with adhd, instead of trying to fight with the doctors about whether he had it or not, he was still pretty young. I printed it out and next to each symptom that he had, I did that difficulty completing tasks, as evidenced by and I'd give an example of two or three things that he did regularly that demonstrated he couldn't finish a task to save his life. Easily distractible, as evidenced by and by giving those real world explanations or those real world examples, it helps the doctor and a lot of times they're able to take that if they agree with it and just slap it into your file, which they love because it's less work for them, or they're able to look at it and go, wow, okay. But these, all these symptoms you've identified are also common to this over here. So let's look at both things and see which one you think fits best. Doctors are not mind readers. They're not omniscient. They are the experts on disease or disorders. They're not the experts on you. You are the expert on you. And any doctor who tells you otherwise is full of himself. And I think it's important for people to feel confident, not like, oh, well, I'm talking to this doctor. They went to school for like a million years. Yeah, they went to school for like a million years. You've been living in your body for twice that long. And so recognizing. Yes, they may know all the diagnoses in the ICD9 or the DC DSM5. Okay, fine. If they do, great. That doesn't mean that they know your issue specifically. And that's why it's so important for them to do a effective assessment and intake. Because, for example, and we're going to talk about this on Wednesday. Sorry. Boo. The symptoms of ADHD and trauma and borderline personality disorder, among others, overlap almost in undiscernably, indiscernibly. So it's really important to get a good history to figure out if you're dealing with somebody who has trauma or who has ADHD and trauma or something else. And you know, there's autism spectrum disorders and other. Some other things that can be in there when they just jump to a. The easiest explanation. Oh, you're feeling tired and lethargic and you know, you're sad all the time. Sounds like depression. Here's an antidepressant. Go away. Oh, makes me so angry because it could be. I know, I know, it makes me angry, doesn't it, Boo? It could be a thyroid problem. It could be a vitamin D deficiency, it could be iron deficiency, it could be sleep apnea. There are so many things that present like depression that just making an assumption without doing a thorough clinical history is, in my mind, pretty darn close to malpractice. But so the short version, to advocate for yourself, find the criteria for the diagnosis you think you have or you think you don't have online. Sorry, this dog is really warm. And print it out. And if you think you have it right next to each symptom you think you have, as evidenced by. And then give examples. If you don't think you have it, then next to each of the symptoms for the disorder that you don't think you have. Right. Why you don't think that applies to you. And then go in and present it to your doctor. You know, here is something written. For some reason, when you give them something written, they seem to pay more attention, and that can be really helpful. I did that a lot with my. With my kids in particular. Okay, one more question. Okay. There's beta blockers. I like that. Mr. Leslie. Yeah, poo Poo's been kissed a lot. But he's also 11 years old. Low GABA levels can be associated with depression because when GABA levels are low, anxiety is high, and when anxiety stays too high, it. Too high for too long. Yes, baby, I need you to get down right there. When Kappa levels stay too high for too long, then we start getting that dysregulation that leads to the flat and the furious. People who have depression that starts after a period of anxiety may have some low GABA levels because their neurotransmitters are out of balance as a result of that dysregulation in the autonomic nervous system. Okay, Well, we have actually been going for almost an hour and a half. Well, actually right at an hour and a half now. So I need to go because I've got to start prepping for class on this Wednesday and next Wednesday. But we will be back here next week, next Wednesday, same time, same station, and I will try to answer more of your questions at that point in time. Everybody, have a wonderful rest of your week.