Must-Have Tools to Reduce Negative Triggers and Increase Positive Ones

I'd like to welcome everybody. Today's presentation triggers out with the bad.

And in with the good. And I am your host, Dr. Donnelly Snipes.

We are going to, in the course.

Of this presentation, identify the physical, affective, cognitive, and environmental and relationship triggers for stress and relapse. And when I'm talking about relapse, I'm talking about major depressive disorder, anxiety, addiction, bipolar disorder. You know, anything that you can relapse, because remember, relapse is returning to a prior state.

So we're going to look at triggers.

That may be going on during this crisis that might trigger relapse, ways to.

Prevent and mitigate them, and things that.

People can do to remind themselves to do those prevention activities. And that'll seem clearer once we get there.

Then we're going to finish up by.

Switching focus from eliminating unpleasant triggers for addiction or mental health issues and adding triggers for health and recovery.

Triggers are sites including people, places and.

Things, sounds, smells, and situations that make you think about doing something or bring up a particular memory or emotion. Now, that can be good or it can be bad.

Triggers can be positive.

They may remind you to do things that are good for you or make you happy. You know, puppies, I love seeing puppies. They make me happy. They are triggers for happiness for me. You can also have push notifications to remind you to go to a meeting, go to counseling, do a mindfulness check, drink your water, whatever it is. I have one of those nutritional apps on my mobile device and it annoyingly reminds me, have you consumed your water today? Because I forget to go in and put in when I drink my water. So there are different apps for just about anything. If you want to get a lot of push notifications, triggers can also be negative. They make you think about or want to do things that are not helpful for recovery, happiness, wellness. They can cause cravings and bring up memories of things from the past that are unpleasant. For people who are substance users, alcohol in the house, for example, can be a negative trigger. Knowing it's there can prompt thoughts and feelings and cravings for anxiety, for depression, and for addiction. Stress in and of itself can be a trigger.

And we're really going to focus today.

On triggers for stress and anxiety, recognizing that when we are anxious for too long, when we are revved up in that fight or flight place for too long, we can experience.

A sense of.

Being overwhelmed and helplessness. It's like this is never going to end, which can start manifesting as symptoms of depression. So anxiety and stress can trigger depression. It can Trigger additional anxiety, it can trigger anger, it can trigger depression, addiction. You know, there's a lot of stuff. So we're just gonna try to deal with that little bugger today.

During a crisis like the one we're.

Going through right now, people are at.

Risk for the development or resurgence of.

Mental health issues because there are so many things that can trigger anxiety, anger, hopelessness, or helplessness.

And we really want to help people.

Dig down and recognize what's going on. And in true fashion, I created some more acronyms, mnemonic devices, whatever you want to call them, for you to, you know, use to help your clients remember things that they can do to help themselves stay as healthy and happy as possible given the current circumstance.

And this is one of those beautiful.

Examples, and I'm getting off on a tangent, I apologize, but it's one of those beautiful examples of what Hayes talks about in terms of living in the and in acceptance and commitment therapy. Hayes talks about the fact that we can't avoid pain. It's going to happen sometimes, but we can have a rich and meaningful life and experience problems at the same time. We can have anxiety and have a rich and meaningful life. That's really what we're going to be talking about a lot today is living in the and embracing the fact that.

There are some things that we have.

No control over right now, but there are other things that we can put our energy into in order to have the best possible quality of life that we can.

The emotional valence can refer to the.

Strength of a trigger.

And research has shown that negative triggers.

And events are about five times stronger or have about five times more valence than positive ones.

Well, think about it. If you are just be bopping along.

Out there in the wilderness and you don't pay attention to or, you know, whatever, you don't notice a threat that could really be a problem for your survival. If you don't notice a bunny rabbit, you know, that doesn't affect you at all.

So in terms of a survival perspective.

It'S definitely more important that we notice the threats that are out there. So our body, our brain does assign more weight to those things, more gravity to them, which means we have to.

Work a little bit harder when there.

Are stressful things, when there are negative triggers to balance them out, and also notice the positive. You know, I can hear the coyotes baying in the distance, but I can also notice the little bats flying above, and I think bats are cool. So the little bats flying above and the bunny rabbits and the fireflies and whatever Else that's going out, going on, on a typical summer evening on my farm. So it's important to recognize that we can live in the.

And we are going to go through.

The physical, affective, cognitive, environmental and relationship triggers for distress that can be mitigated.

And for the ones for happiness that can be enhanced. Now you're never going to be able.

To eliminate all unpleasant triggers.

That's just not realistic.

There are, they are going to be there occasionally, they are going to happen sometimes. Recognizing that and knowing how to deal with it is really important.

For example, if you have somebody who.

Is in recovery, they're, they're working on their PTSD because they have rape trauma from their history, okay, they're, they're working through some stuff. They're working through that trauma.

You know, they're feeling pretty good. And then they turn on the TV.

And there is a advertisement for a movie that is very triggering. You know, unless they don't ever turn on the tv, there is always the chance that a trigger is going to pop up. So if it does, making sure that people have a set of resources handy that they can use to tolerate that distress and to deal with that trigger.

I did promise in the advertisement for.

This class that we would talk about individual and group activities.

Now with individual, you can talk about.

Things one on one and just kind of do the same old, you know, back and forth discussion. You can in game, in groups. I like to use games because I find people get very bored. I know I would get very bored just sitting there listening to somebody.

So we've talked in the past before.

About the ABCs going around the room and using the Alphabet. The first person says something that starts with A. The next person says something that starts with B. So if you're talking about happiness triggers, what things can you do? Can you add. Can trigger happiness for you? So you go, you know, apples, butterflies, cats, dogs, you know, around the room like that. Whatever it is that triggers it for them, that can be something you can do. It's really easy. You don't need any materials at all. Even adults can get into it if, if they want to. If you're doing it with kids, you can do the clapping game where they clap, clap, snap, clap, clap, snap. And they go around and say something rhythmically so it doesn't necessarily have to follow the Alphabet. But each person in the, in the series has to say something when you get to the snap. So they don't have a lot of time to think, which can be fun.

I haven't had that go over as.

A big hit with adults, but kids tend to like it a lot.

Pictionary, you know, that is another easy one.

If you've got a whiteboard, if you've got a chalkboard, if you've got paper, you can do Pictionary.

And even if you've got certain markers.

If you've just got like a big glass window, you can do it and you can just wipe it off the window.

But it's easy to do Pictionary.

And you can use Pictionary to have people act out, you know, different triggers, different things that would trigger their anxiety, or different things that they could do to deal with their anxiety. Taboo is the same way. And for those of you who are not familiar, that's an older game, so I figured I'd put a link up to it here, here, here.

In Taboo, it gives you a word.

That you're supposed to have your partner guess, and then it tells you all.

Of the words that you cannot use.

As clues to get that person to guess your word.

For a lot of these games, you.

Have to create your own card decks. So that does require a little bit of advanced planning.

However, you know, you might have some.

Extra time on your hands right now. And this is a good thing that you can do to create resources to use with your clients. So it might count as a work hour for you. Who knows?

Acronym maker.

Well, just because I like to make acronyms, you know, you can give people suggestions, you can break people up in groups and say, I want you to create a five letter acronym that represents things that you can do to be happy. Or a five letter acronym that identifies warning signs that you're getting anxious.

And you can take your group of.

12 and break them into four groups of three, and they can work on it together. It's something that they can talk about, something that they can have fun.

And they're going to go through a.

Lot of different words in order to find the words that have the right letters to actually make something that spells something.

So it can be fun.

It actually is a relatively educational experience because it does call on them to think about all of the things that they could possibly use and then choose from that to make the acronym Trivial Pursuit.

If you just hijack a Trivial Pursuit.

Board and the little pieces from your house, from your kids, whatever, you can repurpose the different sections instead of being biology and art and whatever else they are, they can be physical, affective, cognitive, environmental, relationships, and spirituality. So those, instead of using the six categories that are currently on this trivial Pursuit board. You can make your own six categories.

You play it just the same.

Again, you have to create your own.

Card deck, but a lot of times it's not.

You know, it. It takes a week or so. Writing. Writing cards while you're watching TV at night or something. It's not overly taxing.

Flip charts, I've talked about a lot before.

You can use flip chart paper and put it in the corners of the room. I like the corners. That way people aren't talking over one another. But have people go and create something on one corner, and then they go and answer questions in the other corner on the next page and go around the room.

That encourages people to think.

They get in little clusters or cohorts, and they tend to travel together so they'll talk about things. They see what other people are putting up there.

It's not that much different than you.

Standing up there writing on the whiteboard, but it adds a certain amount of movement to it and encourages people to participate. More so than they do. If they're all sitting in a group and you ask a question and it's just. You hear the crickets chirping when they're moving around the room, they feel obligated to add something to every piece of paper.

A beach ball. That's another one that's really fun. You can get them for really cheap.

Offline, since we can't go shopping right now. And then on each. Well, you can do it on each color and. But that only gives you a few things. But you can write things on the beach ball and you toss it to somebody in your group, and they grab it and they look down, and whatever they see, whatever's facing up, is a question they've got to answer.

Small group activities, you can break people.

Up and you can ask them, for example, what are. I want you to teach the rest of the group about what physical triggers for anxiety are or about what distress tolerance activities are. And then you have another group teach. Teach the larger group about what mindfulness techniques are.

And you can just pick different subtopics.

Of the day's groups and parcel it out. Give the small groups handouts so they've got material to work with, and they can take that handout and they can create their own presentation, and they can teach it to the group.

A lot of times we don't really.

Know what we don't know until we try to teach it, unfortunately.

So having people teach it makes them.

Paraphrase it and manipulate it in their own minds, which solidifies some of those memory Pathways people often have a lot of fun teaching. So that can be a really cool thing to do.

Family Feud.

If you've ever played or watched Family Feud on TV and there are variations of it, you know the person, I guess it's Steve Harvey now, I don't know who's doing it now. Will call people up and they will say we ask a hundred people what.

Their top five physical triggers for depression.

Were and what are the top five answers. And people buzz in and try to guess what the answers are. You can do that for this stuff. Again, having to create a list of questions ahead of time and create a list of answers.

You can do.

You can, you can use a poster board and cut out the little slots like they have on the Family Feud board, whatever you want to call it, and have other poster boards, you slide behind it that have the answers on them. If you want to do it, you know, kind of all gee whiz, it can be something of an art project. If you've got older kids at home, this can be a fun family activity to help you prepare resources for group.

And finally Jeopardy. The same way you can do it.

You know, with little sticky notes as flaps covering the answers. Or you can get real fancy with it.

But you can play Jeopardy.

For example, under physical you might have a good pillow can help with this. And you know, the answer would be, well, it could be sleep or pain. I really didn't think that one through that well. So you might be need to take more than one answer. But.

So those are the things that I.

Typically use in group activities to make things more fun, to help people learn. One of the cool things about gamification is people don't aren't focused on learning as much. They are focused on playing. People's competitive spirit makes them pay more attention. So that's another good thing. The competition gets their norepinephrine flowing, which helps them focus and concentrate and actually gets those learning juices going in their brain, which is another benefit.

And they found that when people are.

Happy, when they're comfortable, they actually learn better. And you know, doing something that's fun, generally people are going to internalize it. They may not even really know they're learning, but then, you know, lo and behold, they remember it a week later.

So those things are cool. If you have other ways that you.

Gamify things in group, please share. You know, I.

There are some art therapy stuff or.

Artistic sort of things that I do sometimes. But as far as games, these are really the only ones I've thought of I do use Jenga. Sometimes you can use Jenga blocks. And I usually either get a set that's plain and I paint them four or five different colors, or I get a Jenga set that has multiple colors and then each color corresponds with a card deck. And when somebody pulls like a green block, then they've got to answer something out of the green card deck. And when they pull a red block, they've got to answer something out of the red card deck. You know, whatever you want to do. The Jenga is really fun for individual counseling. That's one way you can kind of gamify in in individual counseling.

So moving on. Physical triggers I want you to think about how each of the following things.

Can be a trigger for depression, anxiety, or addiction during a crisis.

What might cause it, and how can.

You prevent or minimize each one? Before I finish with physical triggers, Janie suggested Wheel of Fortune is another one. Come up with positive phrases and let the participants in the group try to guess what phrase it is or so. So that can be a fun thing to do. Awesome. Thank you for sharing.

So physical triggers Pain and inflammation Think about during a crisis, think about during.

Quarantine and self isolating what might be causing pain right now. And I can tell you that when I spend a lot of time at home, you know, I work in an office by myself, so, so I'm still able to come to work.

But when I do spend a lot.

Of time at home, like when we've had a snowstorm in Tennessee, that means getting half an inch. But I digress.

Sometimes we're, we're stuck in the house.

For like a week before our road.

Gets, our road gets cleared. And if I spend a lot of.

Time indoors, especially binge watching tv, which I'll admit, I do it and I'm sitting in a, on the couch and I'm sitting with my neck kinked or something. Or people who are playing a lot of video games right now because they can, they may have really poor ergonomics and may be experiencing neck pain or back pain or other sorts of pains.

When we're under stress.

People also tend to have an upset stomach, which can cause, you know, gastric upset, which can be painful. It can also trigger autoimmune issues which trigger inflammation. Think about when you get stressed. Where do you feel pain? Do you get headaches? Do you get tmj? Do you get, you know, a sour stomach? All of the above.

So it can be anything from physiological.

Reactions to stress to, you know, poor ergonomics from, you know, not doing the same things that you usually do. Helping people recognize that pain can lead to frustration and can keep them from sleeping as well as they need to sleep, which can alter their circadian rhythms. We'll get down there in a minute. All of those things can contribute to anxiety and depression. There's a lot of research out there that has correlated. The people's levels of depressive symptoms increase in. Not in direct proportion, but they increase as their inflammation increases. As we have more systemic inflammation, we tend to have more depressive symptoms.

Fatigue. When we are in a crisis, a.

Lot of times our HPA axis is ramped up, and I'm going to bring hormones into this, too. When our HPA axis is activated, cortisol is being secreted to prepare us for the fight or flee. Adrenaline's being dumped. Blood glucose is being dumped. Our hormones are being altered because our body says now is not the time to procreate. So it's altering our levels of estrogen and testosterone, etc.

There's lots of stuff, stuff going on when we're stressed.

And all of that can make us feel exhausted because we're sort. It's sort of like sitting in a car and revving the engine. You know, just like the engine gets hot if it runs, if it keeps running or, you know, you start burning up the gas, you're burning up your own gas. By being anxious and stressed out.

Now, I'm not saying you're going to.

Be able to study, stop being anxious and stressed out. You know, that that would be ideal. But a lot of times that's not totally realistic. But what we can do is address our fatigue and recognize that we may not. We may get fatigued easier right now because we are already somewhat exhausted. When our HPA axis is activated, when our body perceives a threat, which it does right now, our brains are saying, you know, there's some really bad mojo going on.

Then we're also probably not sleeping as.

Well, which means we're not getting that restorative sleep. Our brain is not clearing out the adenosine. So when we wake up, we still feel sleepy, or as they call it, sleep pressure, which I think is quite the little euphemism.

We feel exhausted and you kind of.

Drag your happy butt out of bed and go, oh, I'm really not ready to be up.

Recognizing that, thinking about what you can do.

And we're going to go back over it in a second and talk about what we can do.

Hunger can be a trigger for depression or anxiety. And specifically, if we're not eating the.

Right types of foods.

If we are not eating a healthy.

Diet, our body may not be getting the building blocks it needs to build the neurotransmitters and the hormones necessary for happiness and relaxation. Does that mean we can't have one of those off days? Of course not.

But if you're going the next 30.

Days and you're eating like crap, then.

You'Re probably going to feel like crap. Your hormones, like I said, when the HPA axis is activated, are going to.

Be altered, and that is going to affect the levels of your libido, but it's also going to affect the levels of your energy, your serotonin and thyroid hormones. So all of that can contribute to feelings of apathy and frustration. But we also have on top of that continued input that there's a threat. So that HPA axis stays activated, which means we're continually dumping more cortisol. So we feel anxious and exhausted at the same time. And it feels like a no win situation.

Sickness. Oh my gosh.

I saw an article this morning when I woke up and I recognize that it's out there and, and that it's, you know, potentially a true article, that one of the first signs for people who get COVID 19 is diarrhea.

Well, one of the first signs of.

People being stressed out is diarrhea. You know, so we've got millions of people right now who are stressed out, experience experiencing GI distress. They read this article and they're like, oh my gosh, you know, so being aware that certain symptoms, you know, you can have a sore throat, you can have a runny nose, you can have.

A fever, there are a lot of.

Things you can have and still not necessarily have COVID 19. And that's one of those things that's going to be important to help point out to people.

Substance use can also trigger anxiety and depression. When we drink, for example, initially it.

Has a depressant effect, but as the alcohol leaves the body, it leaves the body faster than your brain can balance out with its own gaba. So a lot of times when people start sobering up, they have feelings of anxiety or even panic and sleeping too.

Much and altered circadian rhythms. We are supposed to have a spike.

In our cortisol first thing in the morning. That gets us excited to get out of bed, supposedly, and then it gradually declines through the rest of the day.

But if we are sleeping at weird.

Times, sleep, taking naps during the day, our body doesn't know when it's supposed to ramp up the cortisol and when it's supposed to let it go down so we can have even more difficulty getting good quality sleep, which, guess what, Sleep deprivation increases your HPA axis activation, your stress response. So it's working against us.

So what can we do to deal with these things? And if you're working with clients, encouraging.

Them for each one of these things.

To go through and identify three things they can do for. For pain.

You know, we are not physicians. Obviously, if they think it's something a doctor needs to see, then they need to see a doctor.

But, you know, reminding them to pay.

Attention to their ergonomics, where they're sitting, pay attention to if they're tensing up. You know, a lot of people when they're stressed, tense up. I notice that I will grind my teeth, you know, sometimes even when I'm, like, working on the computer. And I have to be aware of that and intentionally relax. So teaching them to do systematic relaxation can be helpful. So relaxation techniques, being aware, stretching, good ergonomics, all of those things can help.

And when we're at home, when we're.

Out of our element. I talked to somebody today who was telling me that, you know, they just started working from home, and she's like, yeah, I'm sitting on my couch and I've got my keyboard on my lap and I've got my papers on the sofa, and I don't have a desk to work at, so I'm trying to do everything, and things keep falling on the floor. And it's just so exasperating.

I get that. I can.

I can understand where that might be. So looking at, you know, what ways can you reduce your. Reduce your stress? How can you address things that may cause pain? What can you do to improve your sleep? What can you do to reduce your fatigue that's caused by anxiety, that's caused by being revved up too much? What can you do to ensure that you're eating a healthy diet? Plenty of water. Water's really important. And making sure that it's not caffeinated. So because caffeine is a diuretic.

Plenty of water to keep your body.

Hydrated, because almost every chemical reaction in your body takes place in a fluid state. So if you don't have enough water, then, you know, things don't connect quite right. Helping people be alert to changes and recognize what's going on. If they start feeling ill, have them identify, you know, three reasons that might be going on.

Obviously, if it comes out of nowhere.

And, you know, it's severe stuff, okay. Or if they suddenly spike a fever, you know, that's one we've been talking about. But being realistic and recognizing this is one of the peak allergy seasons for me. So I've had like a runny nose and a sore throat for days now. No fever or anything. But when you do have that dry cough, even if you know it's allergies, you still have that thought for a little half a second.

If substances are a problem, making sure.

To get them out of the house and finding other things to do besides, you know, drink or use.

And that's really important if some, even if somebody is not.

Using substances problematically right now.

We do know from prior.

Episodes, you know, when they had SARS and mers, that especially healthcare workers showed a great increase in substance misuse and addiction six to nine months after the crisis was over. So, you know, they were looking back and they were finding that even six to nine months after the crisis was over, people were still experiencing problems with substance use.

Have people think about things they can.

Do, put in their environment to remind them to, you know, sit up straight. When I am doing a lot of work at the computer, I will set a timer on my, on my mobile device that reminds me periodically that I need to stretch. Otherwise I end up like hunched over and, you know, kinked up. And by the end of the day I'm in agony. So it reminds me to check my posture, to stretch, to get up and move around at least once an hour. You can also have that on your. If you have a fitness tracker. A lot of those remind you to get up at least once an hour. Reminding yourself to go to bed on time. Have setting a sleep timer or a push notification to remind you to start getting ready for bed.

Because it's really easy to lose track.

Of time right now, especially if you are not going, going to work. You know, if you're out of your routine, I have a hard time remembering what day it is right now. I'm just like, it kind of all blends together and it's easy to get caught up. You know, binge watching a series on tv and then you look down and it's like an hour and a half past when you wanted to go to bed. Setting those alarms to remind yourself can be helpful.

Affective triggers during a crisis. There are a lot of unpleasant emotions.

That people can experience.

Anger.

You know, there's anger at, you know, the powers that be. There's anger at, you know, whoever caused the virus. There's anger at not being able to leave our house. There's anger from people who've got gotten furloughed. There's anger at their bosses or whatever.

There's a lot of anger.

Anger is a normal response. It's part of fight or flee, and it is a normal response. When we perceive a threat, that's a protective response. What we do with it can be helpful or harmful. We do need to help people identify their anger and figure out, okay, that's taking a lot of your energy. What can you do with that? That is going to help you live in the. And that is going to help you have a rich and meaningful life and be on quarantine.

Loneliness.

People who don't have a family that they're living with right now, or, heaven forbid, you know, people like my stepfather who just recently lost their spouse of many years and are living alone, they may experience a lot of loneliness, feeling like they're rattling around in their apartment or their house.

Even those of us who are in.

A house with a bunch of other people may experience some loneliness because we're.

Not connecting in the same way with.

People like we normally do. If you're an extrovert and you have a lot of friends at work and, you know, friends at the gym and this, that and the other, and then all of a sudden it's just you.

And your kids, you know, you'll love them to death. But, you know, there is something to.

Be said for missing quality time with your friends.

Now, there are a lot of watch parties.

There are a lot of ways to FaceTime right now. There are a lot of ways to, you know, virtually connect. In our area, we're still allowed to go out. You know, they closed all the city and county parks, but we're still allowed to, like, go out and jog and stuff as long as you keep effective social distancing. So, you know, that's something if you just want to have some sort of proximity, it's not. It's not true in every area, but.

Figuring out what you can do.

Anger is a response to powerlessness, to threat, to loss of control.

Helping people focus on, all right, what.

Do I have control over? What is the opposite of anger? Anger is a threat. The opposite is safety, contentment. So what can I do to help me feel safe and in control?

Loneliness.

You know, we talked about what can I do to help myself feel connected?

There are a lot of animal shelters.

Right now that are having to close their doors because the work, they aren't considered essential. So the workers aren't going in and they need somewhere to go. So there are tons of rescues. If you go on Pet Finder, you can find rescues in your local area. There are tons of rescues that have taken on tons of extra dogs and cats and sometimes even birds and guinea pigs that are needing foster homes right now.

If you are lonely and you love the little critters, that's something you might.

Be able to do. So figuring out ways to feel connected, ways to feel useful, ways to feel helpful. If you are able to go up and pick up groceries for your elderly neighbor or something, even though you're not connecting, you know, you're not going to get within 6 or 20ft of each other or whatever that may help you feel a little bit more connected because you're reaching out and sharing that human.

Kindness, hopelessness and helplessness.

Oh, my gosh.

If you go online, and unfortunately right.

Now I found that Fox News is one of the worst offenders.

But if you go online and you.

Are just bombarded with, you know, death tolls and horrific images and this and that, and, you know, there's no happiness there, it is extremely disempowering because you're like, well, what can I do? I don't feel empowered.

Well, kind of goes along with anger.

Helping people identify where there's hope. Recognizing the fact, you know, in this particular case that they do have some treatments that, that they are studying very closely, that they're having really good results with right now. Finding things to have hope about is also important. And in, in terms of helplessness, identifying things that they do have control over.

To keep themselves safe, yes, but also to help themselves be happy. There's more than just staying safe.

There is more to life than just surviving this crisis.

We want to enjoy it.

We want to be able to look at the end of the day and.

Go, hey, that was a decent day. Depression, you know, is characterized by hopeless.

And hopelessness and helplessness. That apathy, that bleh, you know, same thing.

Help people figure out, you know, what is causing them to feel hopeless and.

Helpless and depressed and what can they do about it? How can you minimize those things?

For example, turn off the news or.

Only go to certain news channels that are less. Sky is falling.

Make sure that you limit your news.

Time, that you limit your media time to maybe 30 minutes a day so you're not bombarded with it all day long.

Find different ways that you can meet your needs.

If you feel like you need to have the news every day. Okay, you know, I get it. My mother was a reporter.

But, you know, limit it so you.

Don'T get sucked into it.

Identify other things that may trigger your depression. Staying inside in the dark and that.

Kind of goes back up with the physical and the circadian rhythms, but that can trigger your depression.

Helping people figure out, what can I.

Do that's going to help me feel more energized, more and more empowered.

Envy and jealousy can happen. Some places are still able to go.

Out and do things because they don't have stay at home orders. Some groups of people are at lower risk and so they theoretically are able to do a little bit more or at least are a lot less risk so they don't have to worry as much.

So some people are envious or jealous.

Of those people who are in those low risk groups that, you know, aren't worried as much.

Some people are envious or jealous of.

People who still have jobs, who aren't worried about how they're going to make their house payment. All of those are very realistic triggers right now.

Helping people identify, okay, what can I.

Do to address this? Being angry at John because he still has a job isn't doing anything for me but reducing my immune system. When that HPA axis is elevated, our immune system is suppressed. So being anxious is doing nothing but putting me at greater risk.

Guilt and grief are often also there.

Some people may feel guilty that maybe they did something that put their family at risk or heaven forbid, they brought corona virus into their house.

Some people may be experiencing grief right.

Now because loved ones have died, because people they know have died, or just because people are dying.

Some people may feel guilty because people.

Are dying and they're not and they're sitting at home.

Well, yes, we're sitting at home because.

We'Ve got stay at home orders. You know, there are only certain people that are supposed to be going out.

But sometimes it's hard to deal with.

That guilt and helping people recognize realistically, and we're going to get to those thoughts in a minute, what they can do about it.

Dealing with affective triggers a lot of.

Times goes boils down to distress tolerance skills like Linehan identified encouraging them to get involved in activities, to push away negative thoughts, to create the opposite emotion, to use sensations in order to shock themselves for a second, you know, splash cold water on your face in order to, you know, get out of that emotion stew and more into your logical mind.

Encourage people, you know, if they're feeling lonely, what can they do? Can they call a friend?

Can they do FaceTime? Can they text with somebody? Can.

What is it that they can do if they are Feeling depressed and hopeless. Have them identify five things that they are hopeful about or five things that they are currently grateful for as a in.

In proportion to, to one trigger so they can start balancing those things out.

Cognitively. There are a lot of thoughts that.

We'Re having right now, especially because the news keeps changing and we don't have all the answers right now. And so many people are feeling completely powerless. They're thinking they can control nothing, reminding them to take stock of what they do, have control over what can they control right now?

And all or nothing.

Thinking everybody is going to get. This for example, is an example of all thinking. Have them find exceptions or everybody who gets this dies. I just read an article earlier today. There's been 103 year old person and 105 year old person I think that have both gotten COVID 19 and survived. So even being over a hundred, they.

Were able to survive. And that's, that's a pretty high risk group there. So there is no everybody in this.

Group or nobody in this group because we've also seen younger people succumb to the illness. It's important to recognize the exceptions.

Personalization. Sometimes we take it personally.

You know, I'll use that illness example again. We went out grocery shopping because it was time, you know, we were out of the perishables. And you know, it was shortly after that that we started feeling like we had a scratchy throat. My husband and I both went together.

And both of us knew that this.

Is allergy season for us. So we were pretty sure that it was allergies.

But there was that initial, you know.

Personalization and feeling of guilt, like oh my gosh, I hope I didn't bring this home. This would be my fault and I would feel terrible. And you know, you can go down to, you know, catastrophizing really easily right now.

Look for other explanations. For us, it was easy to go.

Oh, you know, it is elm pollen season. Lucky for us.

But that is important. Emotional reasoning is important to help people find the facts.

Just because they are scared right now, just because they are terrified does not necessarily mean that they are in extreme danger. And I know you're going but, but.

Okay, so if they go out and.

If they are not practicing social distancing and if they are breaking all the rules, yeah, they're in danger.

But if they're following the rules, if.

They haven't been out of their house in two weeks and everybody in the.

House is healthy, they're probably pretty dagum safe from the virus Now Financially, that could be another issue.

And if they're terrified about that, again, encouraging them to look at the resources, look at the stimulus packages that have been, you know, pushed through, look at the options, talk to their creditors. A lot of businesses are working with people right now.

So encourage people to find the facts.

Not just go with, I'm terrified. So it must mean that the world is ending and negative perceptions. It is easy to get into a funk right now and just see the negative in everything.

I challenge myself just because I don't.

Know I want to.

But when I start getting in this.

Negative mindset, forcing myself to find, you know, three to five positives and turning my mind, as Linahan would say, to focus on the dialectics. Yes, there's bad, but there's also good going on in the world. There are people who are surviving, there are people who are getting healthy.

So here's my wonderful mnemonic device for you.

Aren't you excited?

So it is reap reward.

You know that saying you re, you can reap your rewards or reap the rewards?

Well, reap stands for reasoning. Encourage people to look at facts versus emotions.

Are they reasoning? Do they have the facts or are they just going on their gut and saying, I'm scared, therefore it must be, you know, world ending extremes in thought.

Are they using all or nothing, Thinking all aspects? Are they considering all aspects of the situation? Like I said earlier, yes, if you're.

Breaking all the rules right now, you could be in danger. But if you're looking at all aspects and recognizing that, hey, I'm at home, we haven't been out for two weeks, nobody's symptomatic. You know, that's different. You've got to consider the context of the situation.

And P stands for probabilities. High versus low. What is the probability that you are.

Going to get it and it's going to be severe and you are going to die from it, you know, those.

Are, those are three different, qualitatively different things. There are more than 80% of people who get it.

The symptoms are mild and they recover. Then there's 20% who get it and have significant symptoms. But the last chart I looked at indicated only about 5% of the people in the US who are getting it are developing extreme problems from it. And most of those people, not all of them, but most of those people have either underlying health conditions or they're much older.

Excuse me, that doesn't apply for everybody.

I'm not saying that's true for everybody, but I'm saying when we look at pro probabilities, the probability of you getting sick based on your current behaviors, your current age, your current health conditions.

You need to look at that and consider it. It's probably different for you than it.

Is for, you know, an 80 year old man who's been smoking for the past 60 years of his life and has COPD.

Reward stands for recognize your reactions.

How are you feeling?

If you are anxious, okay, accept without.

Judgment how you feel and then decide what you are going to do with that energy to improve the next moment.

Anger and anxiety.

Is your body revving up that engine.

Dumping energy so you got it there to spare?

What are you going to do with that energy to improve your life, to feel better, to address the situation? And why are you feeling that way?

And this is one we haven't talked about a whole lot.

But the why is really important.

Some people are reacting out of the.

Present situation because it is terrifying.

Don't get me wrong, some people may.

Be reacting out of some traumas from their past when their movement has been restricted, when something like this has happened. You know, I don't think there's many people, if anybody, still alive that were in concentration camps back in the world wars, but this could be devastating and terrifying for them because, you know, being forced to stay in our house could trigger those kinds of memories. And you know, so there are a lot of things we want to consider. Why are you having the reaction you're having to the degree that you're having right now? How does it make sense? It's not wrong, it's your reaction. How does it make sense? What are you reacting to? And that's important for people to take a look at.

E stands for examine your options and resources to improve the next moment. How can you use this pool of.

Energy that's been dumped into your system to improve the situation, to deal with your anxiety or your anger? W stands for welcome the challenge. And that is embracing it instead of fighting against it, saying this can't be, this, this won't be.

Embrace it and go, all right, it is what it is. Accept the things you cannot change. You know, some things we have no.

Control over right now, unfortunately, the fact that we have no vaccination for it, the facts that we don't have all the answers, we cannot change those things. If we stay angry about the fact that, that they're not getting answers fast enough. All we are doing is dumping energy, reducing our immune system and putting ourselves at risk. You know, that's not something I want to do. So that's how I keep thinking of it is the more stressed out I am, the lower my immune system is, and that's not where I want to be right now.

R stands for reach out, for support and help others. When you reach out to others, you.

Don'T have to do it physically. You can call them, you can text them, you can FaceTime them.

And you know, as I said earlier, there are some people who are at.

A much higher risk than you are, or maybe at a higher risk than you are.

And they may appreciate if when you.

Picked up your groceries from the grocery store, you also picked up their groceries for them and then dropped them off on their front porch.

Likewise, if you are not able to.

Go out because you're in high risk.

A lot of people, it makes their heart feel good to be able to help. They want to help.

They just don't know what to do.

So ask. A lot of times people are grateful.

For the opportunity to help people.

And D stands for determine the best use of your energy. You look at your resources, you look.

At your options, and you decide on something to do. And you may change up along the way, but you decide on something to do in order to.

Best try to.

Improve the next moment. You know, you don't want to sit there in this pit of despair and just stewing in it, sinking in that quicksand that doesn't feel good, that feels oppressive. So what can you do in order to rise up?

One of the things that is interesting.

I read about quicksand, interestingly enough, is.

If you relax, the more you fight.

The deeper you're going to sink into the quicksand. But if you relax, then somehow you can eventually, like, start to float up to the top. And I don't know if that's actually.

True or not, but it was kind.

Of interesting to think about because in the pool, it's the same thing. If you're fighting and thrashing and everything, you can't float. You have to relax in order to be able to float.

Well, same sort of thing. If we're fighting with our emotions, we.

We're not going to be able to, you know, use that energy to float to the top, to move on. We're going to stay stuck.

Environmental triggers. How can each of the following be a trigger for stress during a crisis?

Well, places can be a trigger. Right now, if you're seeing those same four walls that you've been seeing for the past two weeks, you may want.

To start climbing them.

I know for me, I am starting to notice every dust bunny and every smear on the wall because it's been raining here a lot. And our puppy loves to go out and roll in mud and then come in and walk along the wall leaving a nice little streak which, oh, drives me crazy. So, you know, there are a lot.

Of stress triggers for me just because.

I tend to be a little OCD sometimes that in, in places. And I have to recognize right now that trying to keep my house clean with a puppy and mud and quarantine is like trying to brush my teeth and eat Oreos at the same time. It's a losing battle.

People being around people that are coughing or sneezing can be really stressful. You go to the grocery store and.

You walk past somebody and all of.

A sudden they sneeze or cough and you're just like.

I noticed when I went what? Whatever it was last week, it subconsciously when I would walk past someone, I was holding my breath and I'm really not all that stressed out about it. So I can only imagine people who are super stressed out or who, who are at high risk what they're feeling like. But people can be triggers for anxiety.

Remembering that sometimes a cough is just a cough. Sights can trigger peer fear and panic and anxiety.

If you see more and more people walking around with masks, if you turn on the media, looking at billboards, watching commercials or you see a hearse go by, any of those things, I'm sure there's lots of others can trigger anxiety because it makes you think about how bad it could possibly get.

I couldn't think of any smells that might be triggering during this crisis.

I'm sure there are some sounds are another one sirens. If you hear, you know, ambulance sirens, it can make you think that, oh my gosh, somebody else may have gotten Covid or a lot of the news stations now are playing this ominous music before they, you know, start their broadcast or whatever. And I just hate that I'm like.

You know, I, I don't like watching.

Horror movies to begin with. I don't need to see this stuff.

And relationship triggers, thinking about how low self esteem, rejection, isolation, friends and family.

Who are not with you and friends and family who are with you could trigger anxiety.

So we're just going to kind of.

Go through these real quickly because I know we're running short on time.

Low self esteem. If you don't feel good about yourself.

And you're needing other people's approval. A lot of people, not everybody, but a lot of people are stuck in their own head right now. So they are not thinking about saying please and thank you. They are not thinking about giving kudos or gratitude. They may not be thinking about giving approval.

And since a lot of us, you.

Know, if you're at home with the same people day in and day out.

May be getting a little bit edgy.

So there may be more irritability, which some people with low self esteem can feel that as rejection and that can trigger a lot of anxiety which goes along with those, those abandonment fears where you may fear that people are going to get angry with you or they're. Whatever.

Isolation. Some, some people may feel like they're.

Completely isolated right now and the people that they love are not going to come back and they're stuck in the moment that they're in.

For other people, isolation and having being.

Home a lot can also be a huge trigger because they don't have much to do, so they have more time to think. And the more they think, the more they get into their own head and the more they overthink and they start having paranoid thoughts, they start, you know, questioning everything or they start having thoughts about things that they try to avoid, which is why they stay busy so much. So there's a lot that happens when people slow down.

Some of us are worried about friends and family that are not with us.

Right now because, you know, we're concerned. We know that if they were in the same household, we might be able to exert more influence to get them to stay home or not wash their, or wash their hands more or whatever. But since they are where they are.

You know, we're worried.

We've got family down in one of the areas of South Florida that is hardest hit and I worry about them. There's nothing I can do about it besides, you know, call or text, but I worry.

And then there are triggers for anxiety and depression and anger among the friends and family that are with you. No matter how well adjusted you are.

Being in close quarters with one another in highly stressful situations and can, you know, make you start grading on each other's nerves. And it's important to recognize what you need. If you need quiet time, if you need space, find a place to get space if you need to. I remember when my kids were little, I would just go into the bathroom and I would shut the door. I'm like, okay, you know, mommy's on the potty. And, you know, then they would sit and wait if I was in the bath. That was, you know, they didn't really care much about that, but they wouldn't come in when I was on the potty. So that was my key key for getting some quiet time. Probably shouldn't have told you guys that, but whatever.

We need to remember to practice gratitude.

And take a breath and remember that everybody in our family is, you know, kind of on their very last nerve right now potentially, and that the little kids are picking it up for from us if we are stressed out, they're picking up that something's wrong, so they feel stressed out. So they may be acting out more. And on my Facebook page, I shared some really great guidelines from the World Health Organization for families to help people deal with. To help people deal with quarantine during COVID 19.

So we are out of time.

So I'm not going to go through the last half of the presentation.

But that's okay.

You have plenty to pass your quiz. It's not that hard. And I will see you guys.

Gosh, on Tuesday. It's Thursday.

I told you the days were blending together. I would never pass the mental status exam right now.

Oh yeah, the little fingers sticking under.

The door, I remember that are the ones you can see that they're down there and they're looking under the door with, you know, that one eye.

And do remind people to go online and, you know, look for those of you who are in the US Go.

Online and look for things like rental assistance, credit card, debt forgiveness, COVID 19 resources there are a lot of things out there that are available to help people deal with their financial concerns right now as well as their mental health concerns.

So everybody stay well, stay safe. You know, maybe take this time to develop some of those card decks so.

You'Ve got some fun activities to do when you do. Go back to Face to Face work and I will see you on Tuesday.

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