Reducing Vulnerabilities and Relapse Triggers Quickstart Guide

Foreign. I'd like to welcome everybody to today's presentation on vulnerabilities, what they are and what we can do about them. I am your host, Dr. Donnelly Snipes. We're going to define vulnerabilities, identify some of the most common ones, their effects and ways to prevent them. So this is really a big over. If you go to the YouTube channel, all CEU's education, you can find full length videos on each and every vulnerability. But we're really just hitting the highlights for people who aren't interested in getting down into the, into the nitty gritty, just to help you understand and help you explain to your clients or remind your clients about the importance of taking care of more than just that presenting issue. Vulnerabilities are situations or things that make it more difficult to deal with life on life's terms, leading to depression, anxiety, stress, irritability, whatever you want to call it. People don't feel happy. And I want you to think more broadly in terms of vulnerabilities, anything that is going to make you potentially more irritable. For me, for example, if I am too hot, I don't do well being well, cold either, but especially hot. If I am too hot, I get super cranky and I tend to be more short tempered, which is one of the reasons I don't live in Florida anymore. But it's important to know for you what things make you more short tempered. I'm another one of those people who I run early. If I'm supposed to be somewhere at 1 o' clock and I get there at 12:50, I feel like I'm late. So when I start running behind, if I'm actually going to get there on time, I get really stressed. So I am more vulnerable to getting irritable with people who are driving slowly in traffic or anything else that might kind of get in my way. So I know that that's a vulnerability. I get very high strung or stressed out when I am, when I'm running behind. So time management is an issue that I have to manage. And it's important for each and every person to think about what things in my life, what situations make me more likely to be short tempered, less patient, more irritable. Depression occurs when people feel helpless and hopeless, or if they've just felt too stressed out for too long and they're just like, you know what, forget it, I can't, I just, I can't anymore. Anxiety occurs if you feel powerless or out of control. And a lot of times anxiety occurs before depression, people Start feeling powerless, they start to try affecting things, they start to start trying to make changes, and they may not feel that it's making that much of a difference. And then they start getting frustrated and overwhelmed and give up. Addictive behaviors also increase when people feel a need to escape because of stress, anxiety, depression or pain. And it's important to recognize the influence of substances on our brain once we start engaging and even addictive behaviors. Once we start engaging in addictive behaviors, anything that causes that extreme dopamine rush with regularity, then we are going to likely prompt changes in the circuitry in our brain, which will lead to tolerance symptoms, withdrawal symptoms. But more than that, it will also lead to feelings of anxiety or depression when we're not using because our brain starts to expect us to flood it with those neurochemicals. So addictive behaviors in and of themselves can be a vulnerability for some people, even things that are exhilarating. You know, if you think about when you go on vacation, you know, hopefully it's a wonderful vacation. It's awesome. You are just, you know, full bore, gung ho, having a blast the whole time and you come back and how do you feel? I think most of us, while we may not be more vulnerable, so to speak, we are exhausted because it takes a lot of energy and our brain is recuperating from having all those happy chemicals just pumping through the system so much. We'll start out with physical vulnerabilities. Pain is a big one. There are a lot of people and you know, I dare say the majority of people struggle with some sort of pain on a semi regular basis. If you are a fitness person and you have a really good workout, you may love the fact that you had a really good workout, but you may also experience pain. I know days well when the gym's open and I can have a really good lift that night, or heaven forbid, the night after my muscles are so sore sometimes it's difficult to lay in bed because, you know, my quadriceps are just absolutely killing me. And that obviously is going to be something that might disrupt sleep. We want to pay attention to pain. And don't get me wrong, I'm not saying don't work out, but I'm saying recognize the impact of pain on your attitude, on your ability to get quality sleep, on your ability to concentrate. When I have a kink in my neck, and I know other people are the same way, Think about when you have had a kink in your neck and you've been at work and you've been Trying to focus and you can't turn your head, it makes it a little bit more difficult to concentrate. Not only because you're in pain and you're constantly rubbing it, trying to make it feel better, but also just because you feel like you're less aware of what's going on because you're less mobile. So pain can also make us more irritable. I know when I am in pain for a while, like when my arthritis is acting up or something, I hate saying that, but whatever, I can get a little bit testy. I get frustrated that my body is not cooperating with me. I get frustrated of feeling pain, and so that can lead to irritability. So I might already be somewhat frustrated and angry. Then something else happens and I may react with an exaggerated response to that. Remember, pain also turns on that threat response system, our HPA axis. Because when we have pain, that's our body saying something's broken, something's wrong. And it may be something's just a little bit wrong, like a kink in your neck, or it may be something big is wrong, but something is wrong. So the threat response system is kicked off, which we know reduces serotonin, increases norepinephrine and reduces sleep quality. Pain is a big thing we need to help people address. We also know that ways that we can address pain include stress management. Because if other things are causing that HPA axis to be activated, then we're already experiencing reductions in our pain threshold because of that lower serotonin level. We're already experiencing, experiencing potentially more pain because of muscle tension and other things in our body. So it's important to recognize for you what does pain do? How does pain impact you and what can you do about it? You know, talk with your doctor, obviously, make sure it's not anything that's a big deal, and then explore non pharmacological interventions. Ice is one of my favorite. Heat, ice, tens units, yoga, stretching, massage, There are a lot. Acupressure, acupuncture, There are a lot of different things that people can use. They've actually even found that some essential oils, like essential oil of bergamot, reduces people's perception of pain. Now, whether that works for you, you have to try it out yourself. But there have been some studies and you can go to PubMed and just look at essential oils. You know, use the keywords essential oils and pain tolerance or pain, and you'll find a lot of different articles where they have started exploring this experimentally. Poor nutrition is another one. Your body needs the building blocks I know I say this just about every single class, which should highlight why it's so important. Food. Provide your body the building blocks to make the neurotransmitters to help you feel happy, to help you deal with stress, to help you reregulate when you get dysregulated, to send out those endorphins, those natural pain fighters. Your body makes all of those chemicals from the foods you eat. So it's vital that we eat good foods. Your nutrition will also help you keep from getting sick, which is another thing that, you know, right now is super important. But most of us tend to be less pleasant to be around, to be nice when we are sick. I know when I have a stuffy head and a runny nose and a cough and I'm not number one, I'm not sleeping well. But I tend to be more, at least apathetic, if not more irritable with those around me. So it's important to know again for you what things impair your ability to tolerate life on life's terms. Things clients can do that are not going to be contraindicated. You know, we can talk with them about the importance of having at least 60 to 64 ounces of water per day. And that's water reminding them that caffeine and other stimulants like decongestants will actually be diuretic. They'll cause you to lose more water, so you need to drink more water when you're consuming those things. And it's a balance. If you like your coffee, especially if you like caffeinated coffee, balancing those things out can be a little bit of a challenge. But it is important to make sure you get water. Most of your body's chemical reactions take place in a fluid environment. Without fluid, then you don't have the conductivity that you need to make things happen effectively and efficiently. Have three colors on your plate at every meal. Condiments and skittles do not count, unfortunately. But it is important to try to eat colorfully. A lot of people aren't into following a food journal or following a menu or anything. They want to eat what they want to eat. They don't want to have to count calories or macros. And no, unfortunately, I'm sorry, Wendy M. And Ms. Don't count either. But a lot of people aren't into being super attentive to what they're eating. But most people can look at a plate and go, yes, there are three colors on this plate, and it's actually a little bit of a Challenge sometimes at first, when you're trying to eat more colorfully, to figure out, especially green, how to get green in there at breakfast can be a little bit of a challenge, with the exception of, like, honeydew melon or something. But apples, you know, you have green apples that you can eat. Green grapes, there are greens that you can include in breakfast, but have. Having three colors on your plate at every meal ensures that you're getting a wide variety of micronutrients as well as eating relatively healthfully. And try to eat smaller meals. Now, some dietitians will argue with this if you've got an underlying health condition. You know, obviously people are supposed to follow their medical doctor or registered dietitian's recommendations with this, but a lot of people do better if they eat smaller meals every few hours. With intermittent fasting, some people are getting away from that. And if you can do intermittent fasting, more power to you. But it is important to maintain your blood sugar. My husband is hypoglycemic. So if he goes too long without eating, his blood sugar starts to crash and he gets irritable. When he was in law enforcement, when he was on patrol, pretty much every single time, and we traced it back, we looked at vulnerabilities. Every single time he would get a complaint, would be a time when his blood sugar was low, and we'd be out shopping or whatever. We've been married for, like, 25 years, and I can tell when his blood sugar is getting low because he starts getting very impatient and testy and irritable. So. So it's important for him to recognize when he needs to eat, but also to do things like keeping food with him when he's going out, whether it's some sort of Nutri grain bar or something, whatever it is that can keep him, as Barrett says, from getting hangry is really, really important. But for some of us, we may not get to the point of being hangry, but we may have more difficulty concentrating when our blood sugar gets low or start feeling like we are really, really sleepy. Know how your body reacts and know what's important and when you need to eat. Being mindful of when you have those cravings for food to check in and say, you know, am I hungry or am I wanting to eat for some other reason? And the more mindful we are, the more we get in tune with our body. And yes, kids go through growth spurts and, oh, my gosh, if you remember back to when you had kids around the house, or maybe you do now, I know mine are older teenagers, so they are mainly through this area. But when they would go through a growth spurt, my fridge would empty like gangbusters. When you eat mindfully, then you are eating when you are hungry, but whoops, sorry. When kids are younger and going through those growth spurts, then they need to eat, they often need to eat more and more often in order to stabilize their blood sugar. Another interesting point is that our brain is one of the biggest users of blood glucose. So when you're at school, if you're using a lot of cognitive energy, when you're at work, if you're using a lot of cognitive energy, you may actually feel hungry more so than you do on other days, like when you're out in the garden or something because your, your body is using more blood sugar. They also found that with children who are gifted, and, you know, maybe other children too, but the particular experiment was done on children who were gifted, that their blood sugar tends to drop a lot more precipitously throughout the day. So it's more, even more vital for them to make sure that they have a really good balanced lunch and maybe even a snack in between in order to keep their blood sugar up and reduce acting out behaviors and other things that might be problematic during the pandemic. A lot of people are eating more partly because they are stressed. And when we eat especially high sugar, high fat foods, it causes our body to release dopamine and serotonin. So sometimes we eat because it's soothing, it distracts us. It's something that we can focus on besides the news, besides the fact that we can't leave the house. And sometimes we are hungrier or we feel hungrier more often because we've gotten our circadian rhythms out of whack. And your circadian rhythms are set by when you go to sleep and when you wake up. But they help control the excretion of your hunger and your satiation hormones. And so if your, your schedule has changed or if it's kind of loosey goosey, then you may find that your body doesn't know when it's supposed to eat and when it's supposed to not. And finally, sometimes we just eat because we're bored and it's there and you're, you're not busy with other things. So you're sitting there doing your crossword puzzle or whatever and you're like, hmm, Oreos. Those sound good. And we need to pay attention when we're eating or before we eat, actually, whether we're eating for hunger or some Other reason, lack of sufficient quality sleep is also a vulnerability. I know when I don't get enough sleep, I am a great big old cranky pants. I do not do well with sleep deprivation. So I was a deer to be around when I had infants at home. Let me tell you, drug and alcohol induced sleep is rarely good quality. Alcohol, for example, helps you fall asleep faster and the first two to three hours may be a little bit better. But then as the alcohol exits your system, your body can't balance out the neurochemicals quickly enough. So the last two thirds to half of your sleep at night is going to be much more disrupted and much less quality. If you have sleep apnea, it's a double whammy because alcohol actually exacerbates sleep apnea in the first part of the night and then you get crappy quality sleep the rest of the night. So alcohol and sleep really don't mix. If you're going to drink alcohol, making sure that your blood alcohol level is somewhere around 00 before you go to sleep is helpful. Did you know that you can order little breathalyzers that you can keep on your keychain? They're not expensive, they are not obviously state trooper quality, but it'll give you a regular kind of general idea about where you're at. It's something that I strongly recommend with any of my clients who consume alcohol. So when they go out to happy hour or out to dinner and have a couple of glasses of wine that they can give themselves, you know, go to the bathroom or whatever and give themselves a little private breathalyzer test before they leave the restaurant to make sure that their alcohol level is below the legal limit. But you can also use it at home to make sure that your blood alcohol level is zero before you go to bed. Lack of sleep contributes to fogginess and difficulty concentrating. We've talked about this in other classes. We, when we think, we create something called adenosine. It's a byproduct of thinking. For lack of a more in depth explanation. As adenosine builds up in your brain, it causes what they call sleep pressure, which as adenosine builds up, we get sleepier. When we reach this maximum threshold of adenosine, it's, you know, you're sitting in bed and you're like, oh, I can't even focus anymore, it's time for me to go to sleep. That is kind of you reaching your max level of adenosine. When you are asleep, your brain clears it out, but you have to be in deep sleep. So if you're getting crappy sleep, the adenosine is not getting cleared out, or at least not effectively cleared out. So you're going to be foggy, have difficulty concentrating the next day. When a lot of people, when we are foggy and have difficulty concentrating, aside from the hunger and satiation hormones, we, we tend to try to eat to stay awake. We think, oh, well, maybe if I have a little sugar or a little caffeine, it'll wake me up. And you keep trying to sort of self medicate with food and drink throughout the day, which is not good for your HPA axis. And it's really probably not effective. We can become irritable when we don't have enough sleep. A lot of people do. They've shown that sleep deprivation, and that doesn't mean hours necessarily, but, but lack of quality sleep actually ramps up, that threat response system ramps up the HPA axis, ramps up our cortisol levels and we start to feel more irritable because we are in a little mini fight or flight sort of thing in the morning. Our cortisol level is highest. You know, our body secretes the cortisol and it says, all right, you know, stress hormone, time to get up. We need a little bit of stress to function, so that's not a bad thing. But when we are excessively sleepy, then our body is regularly pumping out that cortisol to cause us to dump blood glucose to try to keep us awake. Our body's trying to keep us going, but it's running the tank dry if you want to think about it that way, which also makes us susceptible to overeating. We already talked about the fact that if you're not getting quality sleep, your ghrelin and leptin, and that's spelled G, H, R, E, L, I, N. And leptin is easy, but the H is important in ghrelin. Ghrelin and leptin. Those are your hunger and satiation. Hormones are regulated by your circadian rhythms. And if you're not getting good sleep, then that's probably going to be out of whack. When Chuck was on midnight shift, he ate constantly because he didn't know if he was hungry or sleepy. And it's really hard for our body to differentiate between the two sometimes. Or thirsty, that's another one. So a lot of times when we don't get enough sleep, not only because our hormones are out of whack, but also because we're trying to self medicate to try to help us stay awake, we may overeat Interventions. There are a lot of interventions for sleep hygiene. Like I said, there are other videos on the YouTube channel specifically devoted to sleep. You can also go to the Sleep foundation website. I think it's sleepfoundation.org Basically, develop a sleep routine. Roughly the same three things you do every night. Just like with a kid, they come home from school, they play, they eat, they bathe, they read a story, they go to sleep or whatever it is in your world. That's what our world looks like for the first, for the last 15 years. But that's helpful for us too. If we come home from work, we relax for a little bit, we make dinner, we eat, we take a bath. Unless you bathe in the morning, read a book or do whatever it is you do to relax and then go to bed. That helps cue your body in that it's time to start making that melatonin so we can go to sleep. You also want to turn down those lights. Get rid of the blue lights. Get a blue light filter on your mobile devices, for your television, for your computer. And also try to have lights wherever you're sitting to wind down that are either adjustable so you can turn down the blue intensity or that they're different lights. The room we sit in at night, I have the yellow bulbs, so they don't have any blue in them at all. I don't remember where they are on the spectrum. I think it's like 2500 Kelvin is where the yellow is. And it's a little challenging to find bulbs with virtually no blue in it, but it is helpful and keep it dim. When your environment is dim and there is little or no blue light coming in, it cues your body through your eyes that it is time to start secreting melatonin. Likewise, during the day, it is vitally important that you are exposed to blue light that you're getting outside, that you're by a sunny window. In order to tell your brain that it's time to wake up so your body recognizes through those, through the light levels, that it's time to be awake or time to sleep, cut back on caffeine and other stimulants 6 to 12 hours before bed. I know that sounds ridiculously hard, and I'm not saying do it necessarily right away, but it is important to remember that caffeine stays in your system for up to 12 hours. So what you're drinking at noon may still be impacting your sleep at 10 or 11 o' clock at night. Nicotine and decongestants, and some of those Other stimulants are shorter, acting in your system, being aware of the stimulants that you take in. When we take in stimulants, what does it do? It ramps up that HPA axis, turns on that threat response system, which in and of themselves makes us more edgy. If you've ever. I can't hardly drink even, you know, decaf Starbucks anymore because there's so much caffeine in it. But I remember the last time I drank caffeinated Starbucks, I felt like Beavis and Butthead doing the sugar video that they did. And if you haven't ever seen it, you can look, look for it on YouTube later. But I felt like a little Chihuahua or squirrel or something on cocaine. I swear I was just gonna crawl out of my skin. And when you're revved up that much, when your HPA axis is secreting that much norepinephrine, it's more difficult to think clearly and it's more difficult to deal with life on life's terms because a lot of times you tend to be more impatient. You're wanting to go faster and faster and faster. Illness is another vulnerability. We talked about it a little bit earlier when we are sick, and they've actually done studies that found people with seasonal rhinosinusitis, which, you know, allergies, had higher levels of cortisol and were sleeping, their sleep was disrupted and they had higher levels of cortisol than other people, which indicated that the allergies disrupting the sleep and also the post nasal drip and everything that goes along with it turned up that threat response system. I thought that was an interesting little thing. Exhaustion happens when we're sick. Our body is devoting energy to try to help us repair and get back to normal. So it's diverting energy from other things. We're not supposed to feel super energetic. It always bewildered me how my toddler was able to be playing like nothing was wrong when he would have a double ear infection. I was just like, oh, my gosh, foggy head, difficulty concentrating when you're not getting enough sleep, and especially if you're sick, a lot of times you're stuffy, so you're not oxygenating enough. One of the main reasons that we yawn is not because we're actually sleepy, not because we've got too much adenosine, but because we're not getting enough oxygen. So if you notice you're yawning or feeling like you need to yawn, it may be because you're not belly breathing. So practicing some belly Breathing can help, but when you're sick, you know, it is important to do as much as you can to help clear your head. You're not sleeping well. Your adenosine is not getting cleared out. Your body's not really focused on learning right now. It's focused on healing. So recognizing all that's going on, all that your body is trying to do and being compassionate and going, you know what? Thank you for trying to get me better. Let me see if I can give you a little space to do your work instead of nagging at you that I want to go to the gym and do these other things. So be compassionate with yourself and have good nutrition. Good nutrition helps your body maintain your immune system. It helps your body repair. You know, it's a good thing. Brain changes can be hereditary from an accident, the result of addictive behaviors. But some people, because of organic changes in their brain, you know, they're actually. Changes in the brain tend to be more vulnerable to distress. There are some people, because of the way they are now wired, dysregulate emotionally more than others. If that's you, that's you. Okay, that's just the way you're wired right now. What can you do? Changes in the structure of the brain have all kinds of effects, including impacting your memory, your concentration, your mood, your stress tolerance. For people who've had an accident or who are recovering from addictive behaviors, or even people who have a hereditary imbalance in their neurochemicals. We've looked back in generation after generation after generation has had, you know, major depressive disorder that has responded to medication. There's probably some cognitive and environmental stuff in there, too. I'm not saying that it's all brain, but it is important to recognize that eating a good diet, getting quality rest and medication when needed can be helpful for some people to help their body balance or create a new balance of neurotransmitters that is more functional or helpful to them. You know, if their body just naturally has problems, a breakdown somewhere in the dopamine system or the serotonin system, they may need a little assistance rebalancing that and resetting the balance of their neurotransmitters to somewhere where they can feel what they consider to be happy. Remember that medication only works for about 30% of people, so it's not a panacea by any means. But there is a significant minority of people who do benefit from pharmacological intervention in addition to lifestyle changes and those sorts of things. Anger, anxiety, depression, grief, guilt, jealousy, Resentment and inability to self soothe are all vulnerabilities that we experience. We talked about being hangry earlier and it's important to recognize and as David points out, there are some acronyms and you can develop as many acronyms as you know you want to identify your personal vulnerabilities. In substance recovery, we talk about halt, hungry, angry, lonely and tired. And it is important to recognize that hungry is your physical, angry is emotional, lonely is interpersonal, and tired is also physical. So we need to look at the person as a whole, not just their emotions, not just their thoughts, not just their physical health. Recognizing what triggers dysphoric emotions for you and you know, any of these things right here is important. Recognizing that anger can be disguised. Or versions of anger include guilt, that's anger at yourself, resentment, anger at somebody else, jealousy, anger at someone else for having something that you want. Grief has an anger component to it. Depression sometimes starts out with somebody being very angry. And remember, anger is part of that fight or flee. It happens when we feel threatened. At a certain point, they may feel like they have no control. They get angry, but they feel like they have no control over whatever it is that's making them angry, so they eventually become depressed. Anger and anxiety underpin a lot of things. Anxiety can be thought of as stress, worry, fear, any of those things, but any of our dysphoric emotions that we have, we need to be able to self soothe. It's important to be able to use those distress tolerance skills in order to help people get into their wise mind so they can figure out, all right, you know, I'm going to accept unconditionally, without judgment that I am really ticked off right now? It is what it is. What are my options right now to deal with this situation in a way that makes sense to improve the next moment so I don't have to stay here stuck in this, in this mud. When people are feeling negative emotions, it causes the brain to keep the fight or flight reaction going, which takes energy. As long as you're feeding that anger, you're pumping out that serotonin, you're pumping out that norepinephinephrine, you're keeping that adrenaline high, you're keeping your blood pressure high. All of that is exhausting. After a while. It's like sitting in a car or driving a car with the gas pedal all the way down and not letting up. The engine starts to get hot after a while. It lacks or prevents the happy, calming neurotransmitters from being excreted. When we are you know, holding on to those negative emotions. Sometimes there are things we can do to resolve the situation that can help us feel better. Sometimes there aren't. And in recovery, we talk about the serenity prayer. Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference. Part of distress tolerance skills and part of recovery also means people have the ability to know what helps them feel happy, what they can do to help get their body to secrete some of those happy chemicals. Encourage people to develop coping skills that work for them to deal with whatever is causing their distress. Ask them in the past when you have dealt with this or in the past, what have you done that's helped you deal with situations like this? You know, build on their strengths, no problem in that, and work from there. Encourage them to keep a list of coping skills that work. So when they're in distress and that norepinephrine is flowing and they've got a little bit of tunnel vision because of all the adrenaline, they can look at the list and go, okay, this is what I need to do. I am a huge fan of having posters or pictures or things around that can prompt us visually for what we need to do when we're in distress. Encourage people to insert positive and rewarding experiences throughout the day. We've talked before about emotions and neurotransmitters kind of being like a warm bath. And when we are too angry or too anxious, that is like cranking up that hot water and it gets so hot that it can burn you. If you crank in a little bit of cold water, even if you are having a bad day, if you put in a little cold water, sometimes it evens it out a little bit. Get plenty of rest, eat a healthy diet and exercise. Exercise has been shown to help secrete serotonin as well as endorphins. And if you exercise at a low intensity, 50% below your target heart rate or below 50% of your target heart rate max, then it also helps reduce cortisol. And you can go online and find calculators that can help you look at what you need to be at for under 50% of your target heart rate, pretty much if you're moving around, if you're cleaning house or gently walking around the neighborhood, you're probably there. Cognitive situations that make us more vulnerable include global, internal, stable attributional styles, which you'll hear a lot of cognitive distortions as I go through this. Global means everything. Stable means always. So when everything is Always bad. It adds extra stress. And we know people, and we've probably worked with clients who have a global negative attributional style, Global stable attributional style. When anything happens that reflects on them as a person, it adds extra stress. So if they fail a test, instead of seeing it as a failure at a particular test or not being good in a particular subject, they see it as all encompassing. I am stupid or I am useless. And it's important to help people start looking at situations as specific and alterable. You know, yes, you failed that test. That's unfortunate. That's unpleasant. There's a lot of stuff to deal with there. But does that mean that you as a person are a failure? And encouraging them to challenge their cognitions, challenge those global stable attributions that they say are about, especially about them, that are negative? We want them to be able to see things as potentially changeable. Not everything is changeable, and not every, in every situation is changeable. So part of intervening here is helping people identify. What parts of this situation do you have control over? What parts of this can you change? Encourage people to identify what is good about them as a person and explore the difference between what makes them a good person versus their skills. And I encourage them to look at things like compassion and creativity and loyalty. You know, those values that we talk about that are inherent in us as what makes them a good person versus their skills. Can they make a souffle or whatever it is they're trying to do? Just because somebody can't make a souffle or whatever doesn't mean they're necessarily. It doesn't mean they're a bad person. And helping them see the difference between, you know, not being good at something that's a skill versus not being a good person. An extremely internal or external locus of control can add stress. If you think that nothing is in your control, you have an external locus of control. It's just all fate. Nothing you do makes a difference that's stressful because you feel like you are kind of a prisoner to the whim of whatever is going on. If you have an extremely internal locus of control, then you think you can control everything. And we all know that that's just not reasonable or accurate either. We want people to be somewhere in the middle, recognizing there are some things they can and some things they can't control. And in different situations, there may be parts that they can and can't control. Encourage people when they're struggling or they're working with moderating their locus of Control to identify what aspects of situations that they can control and how they can use their energy to achieve the desired outcome. Another thing they need to do is figure out how they're going to cope with the things they can't control. And a lot of times we want to be able to control other people. We want to be able to control certain things, and we cannot. And a lot of us are struggling with that right now. Developing a strategy for figuring out, okay, there are these things going on right now that are out of my control. So how can I deal with them in a way that doesn't just exhaust me, in a way that I'm not sitting in the mud and spinning my wheels and just getting more and more stuck? Self esteem is how you feel about who you are compared with who you think you should be. And I hate that word, should. Low self esteem causes people to feel helpless, not deserving of love or success. Encourage them to explore the characteristics they think they should have, but don't. One of my favorite activities, and one of the activities that most of my clients like when we do self esteem, is to create a description of what they look for in a best friend. What qualities do they look for in a best friend? I have them do that. I don't tell them what it's for. They come in for the next session or the next group. And then we go through it and we talk about each one of those characteristics and why it's important. And then I ask them, okay, let's look at each one of these individually. Which ones do you have already and which ones might you need to work on? And a lot of times they recognize that they have a lot more good qualities about themselves than they really realized or gave themselves credit for. For things that are left on the list that they don't have. Deciding whether that's really important to them to feel like a good person, and if it's if, so, what to do about it. For example, I've shared with you guys before, patience is not my strong suit. Do I think that's an important characteristic to have? Yes. Would I like to be more patient? Certainly. Is that something that I'm working on? Yes. So I've decided that that's important enough to put some energy into because I think that that's important. When people have higher self esteem, they don't rely on others for external validation. They don't need other people to tell them they're okay, which makes life a lot less stressful. If they can look in the mirror and tell themselves, you know, I am awesome. I am worth a worthwhile person. And they don't need other people to tell them that. Then they're not so worried all the time about what other people think. They're not feeling like they've got to be a chameleon, which makes them much less vulnerable to distress because they're not having to constantly try to read everyone and please everyone. They're worried about being the best version of them that they can be. Negative Perceptions and cognitive Style when people see the world as negative, depressing, out of control, scary, terrifying, life is more stressful. I mean, think about what it's like to be in that person's head and everywhere you look you see the sky falling, you see death and destruction. It is exhausting when people see most everything as negative or not rewarding. A lot of times they don't want to do anything. They feel powerless. They say, what's the point? If I do this, there's not going to be any benefit. Encourage people to look for the silver lining. When they start to think about something as negative, they need to find the positive. Some people talk about this as embracing the dialectics, looking for the good and the bad, and recognizing that they balance each other. And encourage people to look for exceptions to what's going on. Maybe this particular test you failed, but look at all of the other classes that you've passed and things that you've succeeded at. There are a lot of different ways to challenge negative perceptions. But remember that negative thoughts and things that we notice that are threatening or upsetting in some way have a stronger emotional valence than positive thoughts. For every negative thought that we have, you want to try to have three to five positive thoughts and that can be really challenging. I'm happy when people start out just trying to do a one to one, like it's raining outside. It's frustrating that I'm frustrated that it's raining outside, but hey, that means I don't have to wash my car this weekend because, you know, after it gets wet I can just run a towel over it and get the dust off. That's what what I do. But trying to look at the positive of something that you know, isn't what I had ideally hoped for. Poor organization and time management can lead people to being over committed. If they're the yes person that agrees to do everything, then they can feel really stressed and they can get frustrated. If I promised my friend Bob that I was going to help him move in the morning and then I promised my friend Jane that I was going to Go to her baby shower at one o' clock, and I get to Bob's and he's not quite ready to start moving yet. I can start getting irritable because I packed my day too tightly and this situation is making me feel stressed. So likely I'm going to be more testy in response to anything that is not going as I had foreseen it. The more stressed we get, the more controlling a lot of us tend to be. And when things go against our control, we tend to be more irritable. Poor time management can cause people to feel rushed or harried or forget to do things leading to conflict. My son, bless his heart, you know, time management is not his strong suit. He's gotten a lot better as he's gotten older. But for example, he was. I was supposed to take him to the, to the dentist and I showed up and got out of the car and I'm like, okay, Shawn, you know, get in, get in the car. It's time to go. He wasn't ready yet. Still had to put on his shoes. Okay, So I was a little frustrated, but he got his shoes on. We get almost all the way to the dentist and he's like, I forgot my retainer at home. Which caused a little bit of frustration on my part because that meant that we were probably going to be late for the dental appointment. And remember, I don't do well being late. So that just kind of compounded things. Recognizing how poor time management affects your work quality, quality, your patience levels and your relationships is really important. Have people make a list of must dos at the beginning of every week. These are the things that I gotta get done this week. I've got to pay bills, I've got to go to the grocery, I've got to yada yada. Encourage them to use that as their priority list. And sometimes I know I do a must do list every single day. So I start out the morning, I'm writing down the things that I have to get done that day. Then anything else that comes along, I consult my list and I'm like, can I fit that in with everything else I've got to do today? So I am constantly checking back and being mindful of the fact that there are only so many hours in the day and encourage people to identify and address. Time sucks. Mobile devices, the news, the Internet can be huge. Time sucks. I will start drinking my coffee in the morning and reading the news, and before I know it, an hour has gone by and I'm like, crap, I'm going to be late for the gym. So it's important to know where your time sucks are. And poor organization can also cause a lot of lost time. Like if you spend 15 minutes before you leave the house trying to find where you left your dagum keys. Recognizing that not only did that probably raise your stress levels looking for your keys, but it also caused you to start running behind, putting your time out of whack, causing you to feel more rushed, making you more vulnerable to distress. Poor communication skills impede people from being able to state their needs. And when our needs aren't getting met, we tend to be more irritable. We tend to have more difficulty dealing with life on life's terms because we don't feel like the world understands. We don't feel like we're getting our needs met. Poor communication skills can cause misunderstandings and can hurt your relationships. Don't expect people to read your mind. If you need something, tell them. Most people are not good at picking up on hints. And if you're sitting there going, well, this person should know that I expect them to do this, that, and the other. That's setting yourself up for disappointment and failure. It's important to tell people what you want of them. Tell people what your expectations are, what you need of them, so they can have the option of saying sure and doing it, or, you know, not. But then you're not sitting there in limbo going, well, they should know that they're supposed to pick me up for work today. Well, did you tell them that for communication skills, people need to learn about effective verbal and nonverbal communication, making sure that they understand not only how to use the words, but also how to use the nonverbal so it doesn't come off as aggressive or passive. I mean, if I say, yeah, well, kind of, sort of, maybe I'm not going to be taken nearly as seriously as if I make direct eye contact and say, yes, that's exactly what I want. Don't assume you understand what the other person is talking about. And this is where paraphrasing comes in so helpful. When you are talking with people, make sure you paraphrase. When my kids were younger, I used to have them repeat back to me what I said in order to make sure that they understood and heard what I had been asking them to do. Now, obviously, with adults, that's patronizing and condescending to say. Now repeat back to me what I just said. But we do want to get in the habit of paraphrasing what we hear somebody else say so they can Confirm that we heard correctly or not and correct any misconceptions. Weak emotional boundaries may keep people feeling more vulnerable because they're not able to feel happy unless the people around them are happy. And we've all had this experience before when we've been in some sort of situation where other people were grumpy or one other person was grumpy, and we kind of felt guilty for feeling happy. It's important to recognize that it is okay to feel happy. I've been talking with people recently who feel guilty for not feeling stressed about everything that's going on with coronavirus and everything else. And my response is, why do you need to feel stressed? If you don't feel stressed, you don't feel stressed. And, you know, kudos to you because you're not wearing down your immune system. Helping people accept and validate their own emotions as okay is important. Even if everybody else in your house is stressed, it doesn't mean you have to be stressed if you're not. People with weak emotional boundaries also may take everyone else's bad mood personally. You know, if they're in a bad mood, it's like, I can't be in a good mood because everybody else is in a bad mood, so that puts me in a bad mood. Well, why. Why does. Why does other people's bad mood have to put you in a bad mood? Have people examine why it's not safe to feel how they feel and encourage them to start paying attention to their wants, needs, and feelings. Once they are more mindful of what they want and need and how they feel, and they're aware of why they think it might not be safe to feel how they feel, then they can start confronting those cognitions. Is it really unsafe? If they grew up in an addicted household, then likely they were taught that it was not safe to talk, to trust, or to feel. So now, as an adult, they may have to learn how to that it is okay to have their feelings. It's okay to be happy even if somebody else is in a bad mood. It doesn't necessarily mean you flaunt it in their face, but it is okay to have your own feelings, to have your own opinions, and to have your own wants and needs. We talked a little bit earlier about external validation, which means not feeling okay unless you're constantly surrounded by people who tell you you're okay. They're telling you that you are good enough and smart enough and all that stuff. You look in the mirror and you're like, is it okay for me to breathe the air. And that leaves you in the situation where you're depending on other people to get out of their own heads and to provide you constant validation. It's like they're constantly pumping you with fuel. You're not able to fuel yourself. You require other people to fill you up all the time. And sometimes that just doesn't happen. People are just too caught in their own stuff. It's not that they don't love you, it's not that you don't deserve validation and love. It's there in their own stuff right now. If you're able to provide your own validation, then you don't rely on those other people to fuel you up. Help people identify why they are okay, why they are awesome, and that is self esteem building 101 and examine why they feel they need other people to validate them. Why is it that you need other people to tell you you're okay? Why is it that it is so devastating to you when people are not fawning over themselves to get to you? It's important to recognize a lot of it goes back to basic abandonment issues. But until you deal with those, a lot of times you are going to be stressed because you're going to be craving that external validation. You're going to need that external input. Addressing vulnerabilities frees up energy so you can deal with other stuff that comes your way. If you're not worried about what other people are thinking about you, if you're not worried about whether you're going to get somewhere on time, if you're not stressed about this, that or the other, then all that energy is just kind of sitting in a reservoir waiting to be used for something fun, something that's going to help you create that rich and meaningful life. Eliminating vulnerabilities can help you feel less stressed, exhausted and overwhelmed. Persistent vulnerabilities are the first relapse warning sign and this is true for depression, anxiety, bipolar disorder or addiction or anything else. Remember, it goes with that acronym, Hungry, angry, lonely and tired. Being mindful of when you are vulnerable and taking positive steps to address it are crucial to recovery and to preventing relapse. Thank you for being with me everybody today. Everybody. Are there any questions? I am so hoping it is a beautiful day wherever you are. Even if it's snowing, hopefully at least it's sunny and you can enjoy your weekend. And you know, I hope all of you are staying safe and strong and I will see you on Tuesday. Between writing notes, filing insurance claims and scheduling with clients, it can be hard to stay organized. That's why I recommend TherapyNotes. Their easy to use platform lets you manage your practice securely and efficiently. Visit therapynotes.com to get two free months of therapy notes by just using the promo code CEU when you sign up for a free trial at therapynotes.com. If this podcast helps you help your clients or yourself, please support us by purchasing your ceus@allce.com or getting your agency to sponsor an episode. A direct link to the on demand CEUs for this podcast is@allce.com podcastceus that's allceus.com podcastceus to sponsor an episode of Counselor Toolbox and reach over 50,000 clinicians per week, go to allceus.com Sponsor thank you.