Secrets to Better Mental Health: Live Q&A with Doc Snipes
Dr. Dawn-Elise Snipes answers questions on anxiety, depression, OCD, trauma, and addiction relapse prevention. She covers whether telehealth or in-person therapy works better, how to build distress tolerance, and what attachment looks like in parenting.
Chapters
Foreign. Hey. Hey, everybody, and welcome to today's new or live Q A. I know we're not actually supposed to be started yet, so we'll give people a few minutes to log in. But I did want to say hi to Adriana and Chuck and Himanshu. Welcome. All right. Coffee's a little hot. The these live Q&As we used to do quite frequently and I love doing them. However, we weren't getting a lot of attendance and they just weren't making any money. And let's be honest, part of what we got to do today or on the channel is to increase subscribers, increase views, and hopefully generate some revenue in order to keep the channel going. So we're gonna give it another try, especially now that summer's over and people are starting to wind in for their winter hibernation. I am hopingly, hopingly, gosh, I am hoping that these start becoming more popular. And if we get good attendance and participation, I am certainly open to doing them multiple times a week. Hello, Spiritual Disco. Welcome. I will also be adding to the Doc Snipes website probably today, some support groups that I will be adding, and those will be paid support groups that you can participate in. If, you know, some people don't feel comfortable sharing their stuff here or they want a little bit more one on one attention or individualized attention, then you can get when there's 76 people in a chat room. So I will have those coming available. We will be starting those in October. Hello, Dye Studio. I'm glad you enjoy the videos and the real world examples, and I apologize to y' all if I mispronounce your name. I do the very best I can. Unfortunately, we don't have the phonetic spelling out to the side for some of them. And I know there was somebody the other day who had a relatively common name, but it's one of those that can be pronounced two or three different ways, depending on where you put the emphasis. So I'm not sure if I ever pronounced her name right or not, but I tried. Now that we've got 31 people in here, you're here to hear about mental health. You're here to ask questions. This isn't ask me anything. I didn't prepare anything. But I will do my very best to answer your questions. So ask your questions. If you didn't know September used to be recovery month and SAMSA would really highlight recovery month. This year they decided to do recovery month and Suicide prevention month all in the same month, which I was a little frustrated about because I think each one of those things deserves its own month. But hey, they didn't ask me. So we're just gonna run with it. What do I do in this psychoed groups like I am going to be offering? Good question, Chuck. Generally we start out with, you know, it's a support group. I can't do counseling with people except for those that are currently living in Tennessee or Florida. So what we're going to be offering is a support group and a skills group. What we will do is start out the group by doing a check in everybody talk about how they're doing, what their hurdle was potentially with that particular issue like anxiety or addiction or codependency over the past week. And then I will try to help provide some tools that might be useful to address those issues. And the group will also be able to support one another. This is not one of those groups where everybody sits and one person shares, where it's like individual therapy with nine people watching. That's not how I run group. I want everybody to be interactive. We when I provide you skills, I'm going to ask you how might you have applied that in the past week? I'm going to ask you based on the hurdle or the problem that you presented this week, you know, the challenge that you faced in the past week, how might you use this tool or how. How might you might you have used this tool to address that? And so we can learn, we can actually practice applying it. The groups will be not on YouTube. They will be through our learning management system. So you will have the opportunity to use audio and video and we can actually have a. Oh my gosh, brace yourself here. A discussion. You don't have to use video. Some people aren't comfortable with that. But it will be much more interactive. So here we go. Let's see. Rajni asks, I have some confusion. As some people have. I have conducted some tests and found some may score high on anxiety and depression. In that case, what can we do? Anxiety and depression are kind of. They're two. Those turn that those terms are too general. We need to hone in on what symptoms of anxiety does the person have, what symptoms of depression does the person have and what might be causing those symptoms. A lot of times people who have high anxiety will also eventually start to develop depression. They start feeling hopeless and helpless to change the situation. And part of that we know is the result of autonomic nervous system dysregulation, dysregulation of that HPA axis that we've talked about before. So we need to assess from a biopsychosocial perspective, are they having symptoms caused by physiological issues? When our HPA axis gets out of whack, it negatively impacts the functioning of the hpg, your hypothalamic pituitary, gonadal axis, and your thyroid axis. So we may start seeing symptoms of depression or increased pain in people as a result of that dysregulation of that system. So that's one thing we want to consider. We also want to evaluate when the symptoms started. And was there something that preceded that? Was there a change in their life? Was there a death? Was there a trauma? What happened that preceded that? We want to look at what their thoughts are that are maintaining their beliefs that they are unsafe and powerless and whatever things they see as hopeless and helpless. What beliefs do they have that are making them perceive life as being totally hopeless and helpless? And of course, we want to help them define their rich and meaningful life. If your anxiety improved, if your depression improved, what, what would you see your life being like? What's important in your rich and meaningful life? Because then we have targets for their energy and we can help them evaluate in the moment. Is worrying about this thing that I objectively cannot control, Is this a good use of my energy, or is it stealing energy from things that are important in my rich and meaningful life? And when we help people view it as stealing energy from things that are important, it's a bit of a different perspective. And then they're empowered to choose whether to continue to worry about that thing they have no control over or take steps to tolerate the distress and to redirect their energy toward positive activities. I mean, there are a host of issue or things that you can do. And like I said, it's important to really do a comprehensive biopsychosocial assessment that includes their hormones, it includes their nutrition, it includes their sleep, it includes their trauma history, their support systems. Think of Maslow's hierarchy. We need to know that they're biologically or physiologically stable. We need to know that they can access medication and that they're not dealing with unpleasant medication side effects. We need to know that they feel safe. And that's generally the first place to start with a lot of people is to help them figure out how to feel safe and empowered in their skin. In this context, at this time, true. A week ago, a year ago, 10 years ago, whenever you may not have been power powerful, you may have been unsafe, you may have been powerless. However, is that true now? And choosing to process what happened in the past in the context of the present, I can grieve that loss, I can process that trauma and I can recognize that I'm a different person now. I'm in a different situation now. I am safe and empowered now, so I can move forward. And then I would ask about, you know, what kind of goals they want to set and help them learn how to set small, specific, achievable s. Small, small, specific, measurable, achievable, relevant and time limited goals. Your smart goals. Great question. Do I know if anyone in the mental health sector following a trend of the impact of gangstalking on a victim even when there is no physical or sexual abuse, there is a lot of information out there about stalking. And if you go to PubMed for example, or the crime victim. Hang on, let me look that up for you. Office for victims of crime. Here you go, here's a link to that. And then you can also let me see what we've got on PubMed. And here's another one that here an article that talks about the psychological impact of stalking. Now obviously that's not specifically being stalked by a gang, but that does start giving you some insight in terms of gang stalking. Ah, here we go. There was an article done on it in 2020. So see I learned something today. And I try to give you article y' all articles that are free full text so you can read the whole thing, not just the abstract and get a little bit more depth. And. So that was a great question. And I don't have a lot of additional information that I can volunteer because I haven't done a deep dive on gang stalking. And when we talk about gang stalking, from what I gleaned really quickly, it's not just gangs as you might think of, you know, the Bloods and the Crips or whatever. It is a group of people stalking an individual like we sometimes see allegedly in certain cults where if somebody leaves a cult, they are stalked by the members of the cult. So how do I compare psychotherapy via telehealth versus traditional in person? Personally, I prefer traditional in person because there tends to be better non verbals. There tends to be better eye contact because when I'm watching somebody on video, I'm watching them on the screen, which is not looking into the camera, which means it looks like I'm not looking at them. And so they've actually found that our oxytocin receptors are less stimulated when doing video chats, zoom meetings and even teletherapy. That being said, that's the biggest downside in My opinion, the research has shown that for many people, it allows them to access services when they wouldn't normally have been able to because they needed child care, because they couldn't fit it into their schedule, because they were too embarrassed or culturally inhibited from going to see a therapist and fear of being seen. There's a lot of reasons why telehealth is beneficial. The younger generation has grown up on their mobile devices and many young people, Gen X and younger, have identified that they may feel more comfortable on telehealth platforms than in person. So that that's an interesting switch. And again, since the quarantines, got to be careful what words I use on YouTube. Since the quarantines, a lot of people have developed more social anxiety and felt more comfortable seeing someone virtually. Especially if when it comes to going to a, quote, doctor's office where they fear that there might be physically sick people. How do I stop from being too hard on myself? Due to a previous gambling addiction which left me with around $200,000 in debt. I'm working on never falling back into it. How can I make sure I never gamble again? Okay, there's multiple questions there. Great questions, great questions. How do I stop from being so hard on myself? I'm not sure what approach you're using to recovery, whether you're using a 12 step model or a smart recovery model, but you are taking steps to change. You can't change the past. You can learn from the past. You learn what your triggers were. You can learn what your vulnerabilities were. You can learn what prompted you to start using our gambling in this case and process those things. You will need to go through the grieving process. What I'm hearing being too hard on ourselves is often regret and regret is anger at ourselves and for something that we did that we shouldn't have done or didn't do that we should have done. In your case, it's something you did that you shouldn't have done. Okay, so we feel regret about that and we need to grieve the things that we lost or you need to grieve the things that you lost as a result of that. For example, you probably never envisioned yourself being, becoming a problem gambler. And so your conceptualization of yourself is different now than it used to be. Before the gambling problem. You may have experienced a variety of losses, not just financial, as a result of the gambling. You lost time, you lost friends, possibly you'll need to grieve each one of those things, giving yourself credit, acknowledging, yeah, yeah, you Screwed up. Okay? But that's in the past. Acknowledging what you're doing right today is important. Acknowledging the path forward is important. Getting support to help you recognize the path forward and, dare I say the F word, getting to the place. And it's going to take some time where you can accept what has happened and forgive yourself. Now, it doesn't mean you're saying those behaviors were okay. You're saying, you know, I made a mistake, I did some really bad behaviors, but I'm a good person and I'm trying to do better. You can consider comparing yourself to other people. And I think you'll find that it's really hard to find people out there who are perfect. And there are people out there who've made some real doozies in terms of financial mistakes or life mistakes. It doesn't mean they're bad people. It means they made a really bad choice. I have a just dear, dear friend of mine who got into a DUI and accidentally killed somebody. Does he regret that? Yes. But he recognizes that if he holds on to that, that is a pathway back to relapse. He recognizes that he's a good person and he screwed up and he is living the best life he can in order to try to be the person that he knows he always could have been. Okay, so that's recognizing the good with the bad. Recognizing why you continue to beat yourself up. That's another aspect that's really important. Some people are afraid that if I. If I quit beating myself up, then I'm going to relapse. Give me the facts for and against that. Show me somebody who started being kind to themsel and mindful and meeting their needs that relapsed. True. You don't want to say no big deal and fall back into old habits. You need to learn to be mindful. You need to learn how to prevent that again. So use your energy to move forward. Recognize other things that you're telling yourself when you try to stop beating yourself up. What are you telling yourself? And, and again, unhooking the behavior from the person, the behavior not so good, the person deserving of love. I believe that now. Not you believe whatever you're going to believe, but I believe that human beings by and large are deserving of love. And the fact that you feel regret for what you did shows that you've got a heart. Shows that you, you know, recognize your mistake. And that takes a lot of courage to admit your mistake and to try to start rebuilding after that, because that's. Wow, that's an exhausting prospect. Thinking about rebuilding what was, what was lost. But it's possible it will just take time. How can I make sure I never gamble again? Mindfulness, checking in with yourself in the morning and the evening. At the very least, becoming mindful of your thoughts, wants and needs. Becoming mindful of your relapse traps and addressing them or preventing them whenever possible. Developing skills and tools to deal with your triggers for gambling is going to be important. Gambling was a tool that you use to cope with distress of some sort of for a period of time. And yeah, ultimately it was not a good tool and it led to some very painful consequences. But unless you figure out what prompted the use of that, what function was gambling serving for you, you're going to be at risk of relapse. It could be you were feeling bored and disconnected and just stuck in life and you needed the adrenaline. It could be you were feeling stressed about money and you thought, hey, I can triple that. It may be that you were having other stress in your life that you were just trying to escape from. It could be that the rest of the world felt totally out of control and you had convinced yourself that you could control what was going on in the gambling if it was poker or whatever method you were using. And there could be other reasons, but those are some of the more common reasons people engage in gambling. It's an escape behavior that helps numb pain or helps make them feel okay for a second. And processing those things, figuring out how to deal with those things without gambling is going to be what's most important to your sustained recovery. I have one person that I work with, worked with many, many, many years ago and his biggest relapse trap is abandonment. Lots of low self esteem, fears of abandonment, etc and when he starts feeling like he's being abandoned, feeling like he is not good enough, he relapses. And it used to be that he would go for six months or a year or 18 months and he'd be able to stay clean and sober. But he was still hadn't addressed those abandonment issues and he was not being mindful. So then he'd get into a relationship, he'd start fearing that he was going to be abandoned and, and then all of a sudden the drugs and alcohol would bite him in the butt again. It's like, I don't know how I started using. He finally figured this out and started understanding what was going on and became more mindful of these feelings that he had when and became more aware of when he feared being abandoned, became more aware of when he was telling himself he wasn't worthy of love and would take positive steps, calling a sponsor, going to meetings, going to therapy, whatever it took, depending on the situation. And that was really important for him to achieve sustained sobriety. And you know, he has 10 years, a little more than 10 years of sustained sobriety right now. It is possible. It's a matter of. And again, it's so crucial to be mindful of how you're feeling so that relapse doesn't come out of the blue. Because relapses actually never come out of the blue. Relapses just seem like they do because we weren't paying attention, we were ignoring it, we were trying to numb it, we were trying to avoid it. Let's see, is there a method to initiate dissociation as a way to deal with emotional pain? Typically, dissociation wouldn't be recommended as a way to deal with emotional pain because then it can become habitual. Distress tolerance is what we would typically talk about. Learning how to surf the urge, sit through the pain, recognize, recognizing the urges go up and then they go out. Learning how to tolerate pain when it's not something you can change. Tolerating distress when it's not something you can change. Knowing that eventually it will change. You'll. You're doing something. For example, if you've got a sprained knee and you're in physical therapy for it, and physical therapy is painful, I don't care what anybody says. The first time I went to physical therapy, I thought I was supposed to walk out of there first day. Feeling better now. No, it was about six weeks into it before I started feeling any better because I had to strengthen those muscles again. It was painful. I'd wake up, my knee would still hurt. It was painful. But I knew that the pain would subside because I was taking steps to address that pain. Now, I'm talking in really general terms right now about pain. There's grief. That's a whole different issue when we're talking about dealing with the pain of a loss. There's physical pain, there is pain. There's a lot of different things that can cause us distress. And understanding what's causing your distress and developing those distress tolerance skills is really important. And I've got several videos on the channel on distress tolerance skills. Some of them are just down regulating your stress response so you're not adding to the pain. Others of them can include distracting yourself and doing something that you enjoy instead of focusing on the pain. There's guided imagery or meditation that can help you turn your attention to something else. You're not dissociating, you're not essentially leaving your body checking out, but you are turning your attention to something that is less painful. And I also have some videos on mindfulness and meditation. So distress tolerance, mindfulness and meditation. Do I think teaching parents how to love, nurture and care for their children would be a good idea? Of course. It could create a healthier society and healthier adults. Yes. A lot of our adverse childhood experiences that we're seeing today are the result of caregivers who were exposed to adverse childhood experiences by caregivers who were exposed to adverse childhood experiences. And so we're seeing intergenerational trauma. We've got to break the trauma cycle. When we have adverse childhood experiences, we often don't develop secure attachments. When we don't develop secure attachments, we don't develop emotional awareness, we don't develop communication skills. We have difficulty developing empathy, we have difficulty developing self esteem. So somebody who is in a chaotic environment where they're exposed to adverse childhood experiences does not have a caregiver that helps them feel safe. As a result, they stay in basically perpetual fight or flee. And they're not developing new skills to figure out how to deal with it. They are simply doing the best they can with the albeit primitive tools that they have. And if we did a better job of teaching people, and I think we should start teaching this in like middle school and high school, it's not something where somebody has a child and we say, okay, now you need to learn how to be, be a parent. That's condescending, paternalistic, all kinds of wrong. If they want help, that's great. But I think it's something that should be integrated into our curriculum early on. Helping people in health class, in biology learn about developmental stages, how to communicate with a child, how to communicate with one another. You know, there's a lot of skills and tools that we may or may not have ever learned. So yes, I think making this available would be wonderful. I think having it available to people now, like through videos like on, on my channel, on YouTube, is one way to help people gain the knowledge if they're ready, willing and devote the time to watch those things. Not everybody wants to be told how to parent or learn parenting skills or whatever we call it. And that's the other thing. We need to be very sensitive in how we communicate these things. Culturally, parenting differs very greatly between different cultures. And we need to be culturally sensitive and we need to help. There are certain Things that are are the same across cultures because we're all human. We all desire attachment. We're wired for it. How can we help par parents and caregivers create that secure attachment? All right. Sorry, it jumped on me. Good afternoon, Se cog. All you've got to do is go to all ceus.com and you can un enroll in the unlimited CEUs. You are quite welcome. Rajni. How do you get interested in talking to people instead of doing introverted activities at home? When I try to talk to people, all I think is myself, my life, my problems. One of the things is to recognize what your comfort level is. Some introverts, well, introverts themselves tend to be more internally focused and it takes a lot of energy for, for introverts to focus on what's going on around them. They're more aware of what's going on inside them. Introverts tend to like to do deep dives on things and they don't have much time or patience for small talk in general. And so when you're with other people, I would reflect on the last few times you were with other people trying to do social things and examine were you doing social things that you had an interest in? You know, just going out to be around other people doesn't necessarily take your mind off stuff. And if you're going out to spend time with people, were you doing something that you enjoyed? Maybe you wanted to go to the, to the museum or to the library or to some art show or a car show or I don't know, whatever you're interested in. But it sounds like when you get go out to do things with people, it may be that what you're doing is not enticing enough to pull yourself out of your own head. Now, I'm, I'm just guessing here. Obviously I'm going off just what you said. And so it's important to recognize what you want to do and with whom you want to do it. If you're struggling with things in your life and if you're struggling with your problems, then it can feel hard to turn your attention to that. One thing that I encourage people to do, if they're trying to get out and meet new people and do new things and break out of a rut, but they keep ruminating on their own problems is I encourage them just to be aware of what they're thinking. And when they notice that they're thinking about their problems, when they notice they're ruminating, say, okay, there's a time and a place for that, and that's not now. So I'm going to put that on the table over here and I'm going to focus on what I'm doing right now. I encourage them, especially people who have a lot of anxiety, I encourage them to set aside worry time each day. There's 30 minutes or an hour, preferably 30 minutes, but some people need an hour where they can just go through their worries and they can evaluate all of their worries, the facts in context, and start processing them. But they know that there's a time. Just like there's a time to take a shower and a time to eat lunch. There's a time to process all the things that are in your worry inbox. And a lot of people say that that helps free them up because they know that they're going to address it. They're not going to forget to worry about it, but they're not going to have to worry about it constantly. Write it down. That's another thing that can be helpful. If your thoughts are ruminative and intrusive, try writing them down and putting them in a folder or a notebook or something that you can look at during your ruminating time or worry time or whatever you want to call it. That can be helpful. Does anybody else have suggestions? I forgot to ask that earlier. But if you have suggestions for some of these things based on your own experiences, please feel free to share. Another thing. DYI Studio is identifying things again that you're interested in. It's hard to get interested in talking to people about stuff you don't care about. If you don't care about cars or whatever, it's hard to get interested in it. And I'll. I'll share a little anecdote. When my son was very little. And those of you who've watched my My channel have heard this story three or four times, probably. When my son was very little, he was about two, I wanted to be a good mom and I wanted to play with him. And he loved playing with his little Matchbox cars. And I just didn't get it. I was just like, okay, vroom, vroom, vroom. What now? But I would try, you know, I would get down there and I would try to play with them. And as soon as I'd sit down, we'd play for about two or three minutes. And about the time I was getting bored, he was getting bored. And he'd get up and toddle off like. But you left. Anyway, long story short, I had his teacher come over because she was just, you know, she's awesome with kids. And I said, jessica, what am I doing wrong? And she said, show me what you're doing. And so we went through this thing again. She stopped me after about a minute and a half. She said, I see what's wrong. You're boring. What? I'm boring? I was trying to get interested in something that I wasn't interested in. And he could tell it. He's like, yeah, my. Your heart's not in it. So we started doing things together that we were both interested in, like creating a certified wildlife habitat or going bird watching or there were things that we did share, things that we did enjoy doing. And I told him, you know, I love watching you play, but mommy just doesn't know how to play cars. And he was fine with that. He recognized that we're not all going to like the same things. And I say that story because it's probably harder if you're not engaged in something, if you're not getting interested in it, then the people that you're with probably sense that, and then that may compound that distress. Joining groups. I don't know if meetup is even a thing anymore that do things that. Where everybody shares the same interest can be another helpful strategy. I have one more question. Some children are not safe in their homes and their parents are not going to give them any conducive environment. They cannot leave them. How can we counsel them? That's a bugger. That is a really challenging situation. And I'm not sure where you're at if you're in the US or somewhere else in the U. S, depending on the status of the environment. If it's abusive or neglectful, then we're required to report that to Department of Children and Families, who will then step in and try to monitor and adjust family behaviors. But for DCF to get involved, it has to be pretty severe. There are lots and lots and lots of children, unfortunately, who are in environments where it's not enough. It's not bad enough for DCF to get involved, but it's clearly harmful to the child. The child is clearly experiencing those adverse childhood experiences. And the best thing that we can do is be empathetic, be consistent for the child, make sure that the child knows that we're there. And if they need us to do something to help them get safe, we can. But a lot of times we're working with really young children. We can counsel the parents on strategies that may help. Because a lot of times we're seeing junior, because junior's the identified patient, Juniors acting Out, Junior skipping school, juniors biting people, juniors doing it, whatever. Well, Junior is communicating. Junior's telling us something through their behavior. And that something is, I don't feel safe. That something is, I don't know how to deal with my feelings. And through that we can say, all right, so here are some things I'd like you to do with Junior over the next week. And we can give the family homework assignments. Instead of saying, parent, you need to change this because this is not helpful, we can say, parent, here are some activities I'd like you to do to help junior change his behavior. So you're kind of backdooring it, but a lot of caregivers respond a lot more effectively if we help them address what they see as the problem. So we're both working on the same issue, the chaos at home. We both have the united goal of improving juniors mental health and behavioral health and figuring out how to do that in the most effective possible way. What are some ways to start allowing yourself to remove walls you built from previous hurt from others? Recognizing your walls is the first step for different people, walls look different. And knowing what your walls look like are really important. And I've used the analogy of a house when I talk about boundaries and when I talk about walls. And there are people that you don't know, you've never met, and you're certainly not going to let into your home. All right, so fine, those people stay on the outside of the wall. Then there are people, maybe the Amazon guy who comes and delivers your packages every week. You get to know him, you recognize him. All right, fine, it's a rainy day. Why don't you step inside, step into the foyer for a second, whatever. I feel comfortable letting you come into the foyer. I'm not afraid of letting you come into the foyer. I'm not going to invite you in to have coffee, but I'm not afraid to open the door and actually let you step into my house a little bit. And then maybe you get to know them a little bit better or somebody like your neighbor that over time you start knowing a little bit better and you say, okay, maybe I'll try inviting my neighbor over for, for coffee. All right, so coffee is pretty non threatening. And inviting them over for coffee, they're still, you know, talking about boundaries. You would expect somebody who's never been in your house before who you don't know really well. They'd come come to your house for coffee, but they would be respectful of your boundaries. They wouldn't start going through your medicine cabinet but, or wandering into your bedroom or whatever, you know, they're going to respect your environment, they're going to respect your stuff. And then you get to the point with your neighbor that you've been neighbors for two years, you're kind of BFFs and you have them house sit. You're like, hey, you can come into the house. Here's a key. I trust you, you know, do, do whatever needs to be done because you trust them not to rifle through your stuff unnecessarily. You trust them to be respectful. And that's the step that we need to take. When we've been hurt before, you know, we put up that wall, we say, not sure if I want to let people in again. Eventually we need to get to the point where we're willing to let somebody into our foyer. Instead of keeping them out here not sharing anything, not willing to trust them, invite them into the foyer, say, okay, you know, let's go out for coffee, you know, because you're not inviting them into your home. You're not, you know, making yourself vulnerable at all. Or maybe you say, hey, let's go out to lunch. Pretty non committal if that feels comfortable. Maybe you do that a couple more times. And then if it seems like that person respects you as a person, if it seems like that person respects your feelings and, and your thoughts, they may not agree with them, but they respect them. They say, hey, you have a right to your feelings and thoughts, and I'm not going to judge you based on any differences that we have, then you start feeling a little bit safer. If they're keeping promises, if they're being honest, and this is a, this takes time. It's not something you're going to do in like three weeks. If they're doing the things that you expect them to do and not doing the things that the person who hurt you did, then at some point you're going to say, all right, you actually seem pretty safe. Let me let you in a little bit more. But it's important to make it a gradual process. You don't go from going on a couple of dates to suddenly moving somebody in. No. Or all but moving somebody in. You know, giving somebody a drawer, that's. That takes a process. In the trust arena, trust grows. Trust grows with time. And just like a plant, you plant that seed and you water it and it germinates and then it starts to grow and you keep watering it and eventually you'll be able to harvest fruit from. Does take time. The other thing I would encourage you to do is when you start feeling like this person's hurting me, this person is going to abandon me. This, you know, you start having those hurt feelings again like you did with that past relationship. Stop. Take inventory. Recognize. Is this person actually dangerous? Is this person actually getting ready to abandon me or hurting me or lying to me? Or am I just projecting? Am I expecting they're doing it because so and so did in my last relationship? We really need to keep a handle on our baggage and make sure that we're not punishing people or accusing people of doing things that they haven't done. Other people did, but they haven't done. Any advice for those of us whose cognitive issues make it hard to reap the benefits of therapy? I. E. Unable to use thought diffusion due to ocd, mind being overwhelmed and too much. Trying to think of the best way to answer that. Thought diffusion and your mind racing everywhere can be difficult, whether it's ocd, adhd, bipolar disorder, even schizophrenia. So it's important for you to work with your therapist and acknowledge what's going on. Acknowledge the persistent loud, over overbearing obsessions and thoughts and how they're preventing you from hearing or moving forward. When you're having an OCD obsessive compulsive disorder, the obsession is this thought that you're having that if I don't do this thing, something bad's gonna happen. And so when we're starting to think that way, we put ourself into fight or flight. We know we cannot think clearly when we're in fight or flight. The remedy to the obsession is to do that thing. So if I'm afraid that if I don't wash my hands I'm going to get sick, then I'm going to keep thinking about that. Because now I'm like, okay, I don't want to get sick. Sick, I'm afraid until I wash my hands. And then for some people, as soon as they wash their hands, they're afraid, oh, I've got germs on my hands now. And it starts the process over again. So the first step for somebody with ocd, for example, would be to start to develop tools to manage the obsessions and not processing a whole bunch of other stuff, but really talk about, all right, what are your thoughts? What are you thinking right now? That is promoting those that desire. What are your obsessive thoughts? Writing them down, let's not avoid them, let's not ignore them, let's put them out there and let's talk about them. And it's A gradual process of turning down the volume of those thoughts until you get to the point where you can think about something else. So that would be one strategy I would try doing with somebody who has ocd. I've worked with people with ADHD and bipolar disorder before, especially in the manic episodes where it's very helpful for them because their mind is going six ways till Sunday. As we talk, they write things down that are important and they write things that pop into their mind. And we stay focused on one thing and they're writing down all those other thoughts that pop up. And I'm like, okay, write it down. We'll get back to it. Let's go back and refocus on this one thing here. So that's a tool for somebody who's mind is more scattered than focused on obsessive ruminations. Does any of that sound like it might be helpful? Richard, I'm going to answer another question while I'm waiting for, for a response. How to overcome social anxiety. It's reached the point where I'm unable to interact with people. Going back to those thoughts, identify kind of where it began and identify the thoughts you're having that are telling you people are dangerous, people are going to humiliate me, people are going to reject me, people are whatever you're telling yourself, start writing down those thoughts and then for each thought, examine the facts in this context at this time. Time in On My Channel, we use the mnemonic fit cat facts in this context at this time to start taking the power away from those thoughts. As you examine them and you examine the facts for and against that belief, you start seeing, okay, well, I'm feeling anxious, but there's not logical evidence that I need to be anxious. Right now I'm feeling afraid or feeling like somebody's going to reject me. But I don't have any evidence that that's true. It's just a feeling. A lot of social anxiety starts from somebody having a trauma of some sort, whether it's attachment trauma and childhood or a really humiliating event and they felt embarrassed. And then that just gets generalized every time they think about, let's use the example of a speech. Maybe they were in high school and they were giving a speech and in the middle of the speech they just let out a belch to top all belches. The whole school start busted out laughing, well, yeah, you're going to. And especially high school kids, they're mean. So then the person is humiliated. They're like, I can't face people at school again. And they go back to school the next day and people are pointing and you know, being high school people and so they feel embarrassed, they feel ashamed, they don't want to be around others. Time passes, everybody's at school's forgotten about it. But. But now every time that person has to get up in front of the class or get up and make a speech or get up at work in front of people, those feelings come back. It's like that one time I did this, it was absolutely traumatic. And I start feeling terrified again. I start feeling anxious again. Do I need to be anxious? What are the facts in this context at this time? And as with everything else we've talked about today, it doesn't go away overnight. It is a process of regularly. As soon as you start feeling that anxiety, acknowledge it. Okay, I'm feeling anxious. I'm feeling anxious that people are going to. Okay, it is what it is. You have your feeling. Now let's examine the facts for and against that feeling. Let's examine the beliefs that you're having that are promoting that feeling and whether those beliefs are accurate in this context at this time, Is real change from childhood trauma possible? Yes. I've had counseling on and off for over 25 years and still suffer from anxiety, etc. It's improved a bit, but I feel we still haven't gotten the answers. It is possible to process trauma. It is possible to heal your mind and body a great extent after trauma. Now, some traumas, you're not going to be able to totally heal your body, but people can make some significant forward progress from dealing from experiencing adverse childhood experiences and, and trauma in childhood. That being said, it's a matter of feeling safe and empowered in your current person and being able to process those traumas that you went through, grieve those losses, and help that inner child feel safe. A lot of people who've experienced childhood trauma, they have the memories of being terrified, they have the memories of being hurt and memories, unfortunately, we can't just erase them that we can put them on a shelf somewhere. We can recognize that we're safe now, but we can't just erase them. So when those feelings come up, it's important to acknowledge that that's that inner child, that's that part of you that was, was hurt and help that child feel safe and empowered and under. Recognize that you're in charge now. You're there, you got this and they're not going to be hurt like that again. All of those things are really important. Being kind to yourself. I experienced trauma when I was a child. And to this day, I occasionally have flashbacks, and they are extremely rare anymore, but they occasionally happen. And it's important for me to acknowledge, hey, I remember that feeling, and it really sucks. And this is not the same situation. This is not. I am safe. I am powerful. Yes, I remember those things. And I say, you know what? This is what I do may not work for you. I tell myself, yes, this reminds me of that situation. And you know what, self, we're not going to dwell on that right now, because that's in the past, and I can't change that. And look at how far I've come. That's what I say to myself. What you say to yourself is. Is going to vary based on what your trauma was, based on how safe you feel in the present moment. I feel like it's difficult to follow advice on OCD intrusive thoughts because I do not have ocd, but persistent intrusive thoughts. And working with persistent intrusive thoughts involves multiple things. Number one, you know, I. When I work with people who have a lot of intrusive thoughts and ruminations, one of the first things I look at is their sleep. We know research has shown that quantitatively, people who don't get quality sleep have significantly more intrusive thoughts and have significantly more difficulty controlling their thoughts. I would examine what those intrusive thoughts are, if they are different, you know, I just write them all down, and I would examine where they came from. Your brain is trying to tell you something. It says, I still have this issue that you haven't dealt with yet or you haven't taken care of yet, and I need you to address. And it's important to understand that because your brain is going to keep tapping you on the shoulder and go, hey, what about that? Hey, what about that? So that would be another step towards addressing those intrusive thoughts, is figuring out where they came from and how you're going to integrate those thoughts. So if you have this intrusive thought that all people are going to abandon you. Okay, you know, that's one of those devastating thoughts. Where did it come from? Where did you get this belief? What experiences did you have that taught you this? Are those experiences accurate in the present moment based on the facts in this context at this time? That would be. Those would be the early steps to addressing persistent intrusive thoughts. Okay, Sorry, y'. All. It, like, jumped way up on me. I'm trying to get back to where I was. Okay, there's walls. Childhood trauma sh. If certain core wound triggers only come up in romantic relationships. Do you have techniques for finding those triggers out when one isn't dating or in a relationship? I would suggest looking back and learning from your prior relationships. When I was in this relationship with so and so, this is what happened. This is what triggered this core wound. And you know what? Apparently you know what your core wounds are and identifying what is it that that person does or says. Or maybe it's a point in your relationship where you start feeling like you've let down your walls and you're vulnerable and identifying from past relationships when you start to react to those core wounds. Doing more work on processing those core wounds so you don't. So you're not still afraid that every person is going to do those things. Those would be things. Being mindful in the present moment of people in your life and who is safe can be another strategy. You know, if you're not dating and. And that's great. Some people need to take a break from dating to figure out themselves. Until those core wounds are healed in some way, until you've moved through the grief process to some level of acceptance, it's going to be real difficult not to have those wounds triggered. Well, Gary, I'm glad the videos have been helpful for your pain management. I'm an amft. I'm struggling to ask my clients questions that will help the light bulbs go off for them. Be curious. And I'm assuming wherever you're at, AMFT is the level prior to getting full licensure, which indicates to me that you're relatively new in the field and that's okay. Don't expect fireworks and light bulbs in every session. Just be curious. Try to make connections. And it may be helpful for you to review sessions if your clients will allow you to videotape them. Some won't, but if the ones who will review your sessions and see if you can come up with the light bulb moment questions when you're not on the spot. If they won't let you videotape, audio tape works well too. That's one of the things that we used to do in supervision and is play the. Literally play the tape. And then I would stop the tape and I would ask the supervisee, what else could you have asked them at this point? Or what. What were you trying to get them to realize at this point? And how. How might you have gone about it more effectively, for example? So it takes time. Remember that they say 80 to 85% of people's progress in therapy is a result of the relationship, not necessarily any Particular technique. That being said, there's that, you know, 10, 15%, that's techniques try to focus on improving one thing. If you're having difficulty having them self reflect, for example, then you may spend some time thinking about what are some questions, you know, just ahead of time think about what are some questions that I might be able to use that might help people have that moment of clarity. Summarization can also be helpful. We've been talking about this topic and you've said this, this, and this. And I'm wondering, you know, how you see those pieces fitting together. That can be another thing that encourages the client to interpret what they're hearing or what they're seeing. Hello, Sam. My son is going through that, so. Oh, I wish. Well, sorry. Alexandrew, at this point, my understanding is the American Psychological association has absolutely no intention of even considering CPTSD for the DSM 5, whatever the next revision is, or the DSM 6. They're not even putting that out there for conditions for future consideration. So the only way somebody can get a CPTSD diagnosis in the foreseeable future is through an ICD11 diagnosis. Great questions, everybody. Are there any other questions? We've been going for about an hour, so that's probably about it for today. And John Jones is right. We put up walls for a reason. They're there to protect us. And just like the walls in our house and the doors and windows and the locks we have on them, they're there to protect us. We choose when to unlock the door and open it. We choose when to let people walk through it. And we can choose when to push people out of it, too. The doors, not the windows. Let's see. Kartik, I can empathize with where you're at in that situation, and it will take time. And unfortunately, there is no guarantee that it won't happen again. However, the probability that it happens again is much, much lower. So we need to also consider anything can happen. But what is the probability that something like that is going to happen again? Using the example of. Of the speech in the belch? Well, okay, if that happened, fine. I just make sure I don't eat beans or drink a whole bunch of soda before I do public speaking anymore. And that can be a proactive step. So what is the likelihood that if I haven't intentionally done something to get air into my system, what is the likelihood that I'm going to belch next time I have a. Next time I give a public presentation? I'm sorry that happened for you, though, because I know those memories stick with you. And it takes a while to develop enough new memories to kind of drown them out. New successful memories. When it didn't happen. How many times have you gotten up in front of people to speak and you didn't have a problem? You weren't humiliated compared with the couple of times that you did. And it's not a one for one. The time that you were embarrassed or humiliated was intensely traumatic. It was intensely distressful. So one good speech isn't going to negate that. It's going to take four or five experiences that are positive to help you not think so strongly about the one that was negative. Yes, I will try to do some more videos on ADHD and autism. How do I get somebody to stop bullying me to do their work? For example, they don't want to wash the cat, so they start yelling and getting upset about it, and I end up doing it, so they stop. Unfortunately, you're rewarding their behavior when you give in to their tantrum. Number one, you got to stay safe. So if the person is unsafe to be around, then you may need to take steps to get yourself into a safer place. Now, if they're just being a bully, but they're not actually, you know, threatening or dangerous, letting them know that you don't appreciate when they scream at you is important. Letting them, Letting them know that that's not okay. Letting them know that if you're going to be willing to wash their cat, what needs to happen? You know, okay, if you want me to wash your cat, then I need you to, you know, ask me nicely to do it, and if I have time, I will. Or if you just don't want to wash their cat, then you need to say, it's your cat, and I am more than happy to help you out with other things, but taking care of your cat is not my responsibility, and they're not going to like it. They're going to throw a temper tantrum because in the past when they've thrown a temper tantrum, you've given in. And so it will take some time and figuring out what's going to happen. So if they start getting loud about washing their cat, if you can excuse yourself from the situation and say, I've already explained to you that yelling at me about this is not okay. So I'm gonna give you, give you a chance to cool down and then leaving, leaving the situation so they can't continue to bully you or try to manipulate you. And over time, they'll figure out that you mean business. And again, if you're willing to wash their cat, you need to tell them under what conditions. If you're not willing to do it, you need to tell them. That's your responsibility, not mine. I have my things that I need to do. 14142 I am not sure what sibo is. Congratulations on your new job, Sidra. I didn't see that up here, but. Oh, there we go. Congratulations. And let us know or let yeah, let us know if there are any topics that might be helpful. You can also go to all ceu.com/doc snipes to parse my videos if there's, you know, just a question that you have and you're not sure which video it would be answered in. I'm glad you caught us too, Senorita Aurora. ERP can be a approach, but there are multiple approaches for OCD and obsessive thoughts. So it's important to recognize that no one person is going, no one treatment is going to work for every single person. And it's important to explore what options and alternatives are available for you and explore it with your therapist. How about the best way to help clients when they're shut down from an ongoing traumatic event that they're stuck in, not able to engage in life? ADL's are sporadic and home life doesn't change. If they are stuck. In a traumatic event is going to be a step would be to try to help them figure out what they can do to stay safe. It's going to be important to help them figure out what they can do to tolerate the distress if they can't literally can't get out of it. For example, if you've, if somebody has a young child that's born with a heart valve defect and they have 14 surgeries in the first six months of life or something. I mean, that is an ongoing trauma that is devastating and the caregivers are exhausted, they're fraught with grief and anxiety and all this other stuff. And yeah, ADL's are probably going to be pretty sporadic because they're so worried about that child. In that case, I typically help people focus on what they can do for their child and what their child needs them to do. For example, your child needs you to be around, your child needs you to stay healthy, which means your child needs you to eat, your child needs you to get some sleep. Now how can you accomplish that in a way that feels okay to you? When my children were in the neonatal intensive care unit, the hospital was wonderful about letting me with my son I was able to stay there for, I think almost two weeks after I gave birth. Maybe it was only one week, but I was able to stay there because I certainly didn't want to leave him. And then after I left the hospital, my husband and I would take shifts. So somebody was pretty much always there with him at the hospital, but the other person was able to get some sleep. And that's what worked for us in order to maintain our own sanity and jobs as well as feel like we weren't abandoning, abandoning our child in, in the nicu. So that is important. When people are undergoing trauma, what do we know? They feel unsafe and powerless. Okay, what can you do to feel safer? What can you do to feel like you've got some sort of power in this situation? What do you have control over and how can you use your energy to focus it on the things that are important in your rich and meaningful life? I Homeschool. My 5 year old gives up quickly when making mistakes. I had this issue with my firstborn. How do I encourage her already? Well, I hear frustration tolerance or dis intolerance. So the first thing I would do with that is and recognize that it could be a sign of adhd. It may not be, but a lot of people with ADHD have low frustration tolerance and when they start getting upset, they kick right into fight orf flight and they can't think clearly anymore and they're just like, well, forget it. Helping your child when they start getting frustrated, acknowledge it, recognize it and then take a break. Take, take a minute to breathe, to blow bubbles, to do something, say, okay, you know, you're not in your wise mind right now. Let's take a second to get to regroup and then let's approach it again and then use scaffolding. When you go back to the problem, have them walk you through it. You were doing this and you did this step, great job. You did this step, great job and you got here and then you got stuck. I'm wondering what you think the next step should be. And if they just sit there and they ah, then give them some prompts. You know what if you tried doing this and scaffolding is really helpful. I generally use the example of tying your shoes when you teach a child to tie their shoes a lot of times I know my, my son, he just wanted the Velcro. He didn't want to have to mess with that whole laces thing. And I was like, no, you're going to learn how to tie your shoes. And he would get frustrated. He'd do the crisscross and maybe even get to the bunny ear. But then he'd forget what to do after that. And it took some time. He'd get to the bunny ear and I'd go, okay, what do you do next? I don't know. And I, I'd be like, go around. Oh, around the tree and giving him little hints like that and to prod him along when he would get stuck. Eventually, with practice, he got through it and he figured out that he could focus on what the child is doing right, not only what the child is doing wrong. Yes, when you homeschool. I homeschooled both my kids. We have to focus on, on or pay attention to what the child is not learning. But we also want to really make sure that they know how proud we are of the things they are learning and how well they're doing in these other things. Remembering too, that a lot of children learn sporadically. That is, they may two or three months, they may be in their English brain and they are learning languages and all that language oriented stuff and their math skills either are stagnant or almost seem to be regressing some. And you're like, you knew how to do rounding last week. What happened? Well, that's their brain switching gears. Eventually that English brain or verbal brain will get quiet and then the math brain may surge or the science brain may surge. And not criticizing children when they forget stuff because it's like, okay, the brain's making all this room for all these language things right now. And some of the math stuff that wasn't put on a shelf solidly gets pushed out. Okay, well, when you start doing math stuff again, some of the stuff that you're learning in the language part may get pushed out a little bit. And it's a, it's an ebb and flow for a lot of children when they learn. And too often we forget that. So, so and assessing what else may be contributing to their frustration tolerant intolerance. Are they hungry? Are they, is it the wrong time of day for them? Are they getting too distracted? What other things might be adding to it that is making it more difficult for them? And I mean, there are some things that we just don't like doing. Some people don't like math, some people don't like writing. Breaking it into small chunks so it doesn't feel so overwhelming can also be helpful. Going out on your own in into private practice is terrifying. First, get credentialed, do your CAQH paperwork, get on as many provider panels as you can. Put the word out that you're accepting, have a marketing plan. Know where you're going to get your referrals from. Most of the clinicians I work with have overflow. They, they have a waiting list for people to get appointments so you can take people's overflow. You can let treatment centers in your area know that you're accepting people so when they discharge from residential that they can transfer directly to you. Those are the biggest things. While you're waiting, while you're getting all your ducks in a row, make sure you've got your paperwork put together, your HIPAA notices, your informed consent, your billing agreements, make sure that you know how you're going to take payment. All those administrative things that can be kind of daunting. It's important to have those, have those ready. Know whether you're going to use an electronic medical record or you're going to go, but use the old paper pencil method. If you're looking to do telehealth, then there are a lot of options out there for telehealth platforms. And you can also get set up with some of the other telehealth agencies potentially to work with them in addition to bringing in your own clients. Now, I've heard a lot of mixed reviews on that. You can also figure out if you're going to do telehealth, how are you, how you're going to do your scheduling, are you going to have online scheduling and which system that you're going to use. If you're going to do face to face, figuring out where your office is going to be, whether you're going to rent an office in a suite with somebody or whether you're going to sign up for something like Regis offices where you can just get an, get a face to face office when you need it. Let United Way information and referral in your area know that you're available if you're willing to take low cost payments. When I used to do it back many, many years ago, it was $30 per session. I think it may be up to $45 a session now, but I could be wrong. So you have to be willing to take no more than that per session. But I would offer, when I, when I was seeing people in Gainesville, I would offer a sliding scale in order to accommodate because 30 bucks back then or 45 bucks now is still a whole lot of stinking money to a lot of people. And it's better to make some money during an hour than be twiddling my thumbs making no money at all. Was always my thought. Alrighty, I'm gonna do a couple more questions and then I am going to have to call it for today. Michelle Andrews, I think I missed the first half of your question or statement. It's very common for people to store trauma in their body. Bessel Vander Kolk wrote a book called the Body Keeps the Score. And I would not recommend reading it if you are still processing trauma because it can be extremely triggering. It's a great book, but it can be extremely triggering. So, you know, take that for what it's worth. The zoning out, constant fatigue. What I'm would speculate or evaluate is your circadian rhythms and your, your HPA axis, your stress response. It sounds like those have become sort of mis calibrated. And your thyroid, your adrenals, everything are just kind of out of whack. And so when you're on, you're wide open. But then as soon as you stop, you crash and burn and it's. And it takes a long time to recoup and then you sprint and then you crash and burn again. And that's a common dysregulation we see in people who are burned out, who have experienced ongoing chronic stress. And like I said, their HPA axis, their autonomic nervous system is just not doing it right. Now in terms of addressing the physiological trauma, that would be something you might want to discuss with a physiotherapist to see if there are any techniques for releasing the trauma from that particular part part of your body. Certainly you can do pro bono work through the United Way. The United Way is a great organization. Just reach out. We. One thing I learned not too long ago is that each United Way is its own independent organization. So if you see United Way, it doesn't mean there's not one big United Way organization that has tentacles in all of our communities. There are individual organizations and communities that have aligned with United Way and. And so there is a little bit of a difference. Make sure you connect with your local United Way. But if you are planning on doing something like telehealth, you may want to consider reaching out to all of the United Ways in your state or in the state that you are states that you are licensed in. Alrighty everybody. Thank you for being here today. I enjoyed our time together. Please remember to like and share share the channel. This will go. This will be available only to members in. In replay. But I'm hoping, crossing my fingers, I'm hoping that if we keep doing this with regularity, we will be able to get a get our attendance up, and it will help the channel grow because the channel's been kind of stagnant for a little while. So let's hope for that. And I will see you definitely. We'll be doing the live on Wednesday. Take care.
