Set Great Goals Based on Your Readiness for Change

Foreign like to welcome everybody to today's presentation on goal setting, behavior modification, and readiness for change. I'm your host, Dr. Donnelly Snipes. Today we're going to talk about smart goal setting, define some very basic behavior modification terms, explore how behavior mod can be useful in practice, and try to apply it to to helping people set smart goals that are based on their readiness for change. Last week we talked a lot about readiness for change. And we recognize that what people are going to be motivated to do at any one time is going to be based in part on their readiness for change. Change means doing something different or modifying a response. That response can be a neurochemical one. Modifying your stress response so you don't get quite as excited or stressed out over something or an overt behavioral response. Smoking or eating when you're stressed. Behavior modification principles will help people understand some of the reasons they act or react the way they do. Once they start understanding, hey, now I see. I'm choosing this because it benefits me in this way, or I'm choosing this because the alternative just doesn't seem very rewarding. By understanding what causes and motivates people's behavior, we can better address their issues. The focus in behavior modification is on the observable measurable conditions to the exclusion of cognitive interpretation. But I think it's important that we recognize behavior modification was started way, way back and we actually can measure hormone levels now. We can measure a whole lot of things that we weren't able to measure before. So there are a lot more observable, measurable things. When you do neuropsychology, when you do neurofeedback, you're actually watching how your neurons are lighting up and you can manage your stress and control to a certain extent which areas of your brain are lighting up and how much. So let's talk about readiness to change and defining smart goals. Now, smart goals, for those of you who haven't heard of this before, they're specific, measurable, achievable, relevant to what is important to the person and time limited. Now, time limited is really important because a lot of people set goals that are way too big, which means they almost never get to that reward at the end. They start feeling defeated and then it impairs their self efficacy. So we want to be specific. What exactly is it that you want somebody to change? If you say, john, you're rude, well, okay, that, that's. I'm sorry that you feel I'm rude, but what does that mean? What's specifically am I doing that you Perceive as rude. That way the person can change their behavior. You don't listen. Okay, what. What is it that I do that makes you think I don't listen? What I hate to say, what evidence do you have? But specifically, what is telling you that I'm not listening? The goals need to be measurable. So the person goes from saying things that are perceived as being rude and they're defined. We're not going to go into all that right now, but saying those things six times a day to saying them once a week. Okay, so that we want to see a measurable change in that identified behavior. When somebody is. When. When my son would clean his room, you know, that's a very ambiguous thing. So we started defining, you need to make your bed, you need to dust your shelves, you need to put your toys away. And we went from that almost never getting done to having that get done nearly seven days a week. So it was observable and measurable. And I could, since I broke it down into three specific tasks, I could say, well, this one got done every single day. This one got done five out of seven days. So we can see the progress. It has to be achievable. If you're asking somebody to do something that is too big, too involved, out of their scope, then they're setting themselves up for failure. If I wanted to go back to medical school now, you know, I don't think that's really achievable. Now for some people it may be, but I don't have it in me to do a residency. I need my sleep. Too bad. And from a health perspective, I don't think I could do it. And honestly, by the time I finished my residency, I'd be retirement age. So, you know, is it achievable? So that goal for me, probably not. That would not be a good goal. Asking somebody who has ADHD to focus for a super extended period of time on something they're not motivated to focus on, that's not achievable. You're setting them up for failure or having them try to focus when they are in a room that is like a bullpen at work, when there's all kinds of noise and chaos and activity, that's not achievable. So the goals need to be specific, measurable, achievable, relevant to what is important to the person. If you are, sorry, my nose itches today. If you are trying to get people to make a change, or if you're trying to get yourself to make a change, that change has to be relevant. To something that's important. If keeping my room clean is not important to me, then I'm probably not going to be motivated to do it now, by extension, for my son, keeping his room clean wasn't really important for him. But keeping mama happy and keeping his privileges, that was important. So keeping his room clean became relevant to him because it led to other things that were important and time limited. Try to keep change as small as can. You can break it into chunks. So it's a daily goal. A weekly goal. Yes, you may build on those. So your weekly goals become monthly goals, become six month goals. But you want to have things to accomplish. When you start the semester at school, you get your syllabus and well, when you start school, you have to finish four years, you have to graduate. That's a big goal. And that's way long out of the way. So then you break it down. I need to finish this semester. Well, that's a big goal too. I need to finish this course. Okay, well, that's still a big goal. I need to finish this paper that is due next week for this course. Okay. That is a specific, measurable, achievable, relevant and extremely time limited goal. So you want to break it down into as small of a component part as possible. So let's go over to readiness. Readiness for change. Remember, pre contemplation. I ain't got a problem. You can't tell me I do. Contemplation, I may have a problem, but it ain't that big of a deal. Preparation, I've got a problem. I may need some help. Not quite ready to do anything, but I'm going to get my ducks in a row. Action. I'm taking action. Maintenance. I've made the change and I'm maintaining it. And then relapse, which occurs to a greater or lesser degree for most people will have these little lapses. And that indicates something about these new behaviors is not as rewarding as these alternate behaviors. When somebody is in pre contemplation, they don't think they've got a problem and they're being forced to be there. So the specific goals, when I was working with people in, in criminal justice, they didn't have a problem. I couldn't tell them they had a problem. So the specific goal was you want to get off papers, you want to get off probation. And that means you've got to complete this 10 week course of treatment. So that's the specific goal. And my goal is to help you get as much out of that 10 weeks as possible. The Individual's goal was very specific. I want to get done with this. I want to, you know, get it past me. So that was it. Was it measurable 10 weeks? Yes. Was it achievable? Yes, I was very clear. You come, you stay awake, you participate. You'll be done with me in 10 weeks. Relevant to what is important to the person, which again, was getting off probation and time limited back to 10 weeks. So readiness really depends on the person. And if they're being forced into something, then generally their motivation is going to be to get their power back. In contemplation, the person's considering that they may have a problem, but they're not ready to ask for help. They're not ready to turn over their power. And in contemplation, we want to, again, be specific about what is it that I can help you do? What is it that steps are. That. What steps are you going to make to move toward your rich and meaningful life? Most of the time, I'm not going to say all the time, because I'm sure there's an exception. But most of the time, if somebody is working toward their rich and meaningful life, it means getting rid of problematic behaviors. Ultimately, it means having to change problematic behaviors. That's fine if you don't want to give up drinking, if you don't want to give up smoking, if you. Whatever. We don't have to focus on that. We have to focus on what you want. But in the meantime, we'll also look at how drinking or smoking or whatever else it is is keeping you from achieving those goals. In preparation, again, we want to be specific about what are you preparing to do? What do you need to do in order to prepare? Let's look at your life and figure out where your ducks are and how. Which ones need to be put in a row. It needs to be measurable. You need to do this, this, this, and this before you begin treatment. Achievable. Obviously relevant to what is important. Making sure that if they're motivated for treatment, then they're going to want to get these ducks in a row. They're going to want to start this process, maybe so they can be finished with the process. But they. They're going to want to be getting started, and it's time limited. So I generally encourage people when they're in preparation. All right, over the next two weeks, these are the things that you need to get done in order to be ready to get on the wait list. And we're going to talk more about each of these as we go through. But ultimately I want you to recognize that each level of readiness for change has different goals and the person has different goals. Pre contemplation, I want to get, get you off my back. Contemplation. I want to feel better, but I don't want to give up my power yet. I want to try to figure out how to do it on my own. Preparation. I'm getting ready for change and I need some help preparing action. Well, actions that therapy. Behavior modification is necessary for maintaining targeted behaviors and reducing unwanted behaviors. We know we start doing something, maybe you're deciding that you're going to eat healthier and it's great. You're, you're doing fine. You start feel, feeling better, you're less foggy, it's great. But then all of a sudden you go to Christmas dinner or Thanksgiving dinner and there's all these high sugar, high fat, nummy nummy foods and you have them. And then after that it's harder to not crave them again. So there's a little bit of a relapse because your brain is starting to say, you can just have a little, little smidgen of that. That's your brain saying, trying to minimize the harm it could do or trying to minimize what it wants you to do. In its truest form, behavior modification is concerned only with observable, measurable behaviors. Stimuli, reinforcement and punishment. Emotions, interpretations and mental processes have no bearing. For some people who really don't like talking about feelings, this can actually be liberating because they can see how this trigger this, this whatever stimuli triggers this behavior in them. And they can see that it's a. Almost a mathematical process. However, we need to recognize that experiences we have create beliefs and expectations when those expectations are triggered. We have neurochemical changes when we're exposed to those stimuli which produce feelings. So you have a traumatic event with a dog when you are a small child, you become develop these beliefs that dogs are dangerous, dogs are scary. So when you see dogs in the future, you expect that that dog is going to be dangerous or scary. Based on your past experiences, your amygdala kicks in and it goes, I remember that. I know what we need to do. We need to get the heck out of here. And you trigger that fight or flight response. You have those neuroco neurochemical changes which lead to feelings of fear. So it makes sense what's going on. And we can see this mathematical process because our body ultimately wants us to survive. Traditional behavior modification can be quite useful in simplifying a stimulus reaction makes Sense why you got upset in that situation. That situation reminded you of a time in your past when you felt powerless, which led to you feeling anxious, which led to you feeling angry. Totally makes sense. Stimulus reaction Exploring the cognitive interpretations or labels that we put on things can help people identify and address what is causing their distress. We want to use another mnemonic. It's been a while since I've added a new one. This one is called Feel. When we are evaluating our beliefs, we want to look at the facts in this context at this time. Exceptions to when this happens. Very rarely do things happen always or never. Alternate explanations for why this may be happening besides worst case scenario or besides me and the likelihood that the worst case scenario is going to actually happen. We've talked before about possibility versus probability. So when people are experiencing distress after they downregulate, they can think about the automatic beliefs they had and evaluate those beliefs based on the facts, exceptions, explanations and likelihood. Understanding what triggers feelings and urges and motivates behavior can also give people a greater sense of empowerment. It starts to become clear, oh my gosh, it makes so much sense now why this bugs me. The brain receives signals and based on prior learning or conditioning, responds with either fight, anger, flee or fear. So you have the fight or flight response or it doesn't react. It says ah, this is a nothing burger, not even going to pay attention to it. Or it responds with I want to do that again. So we have three very different reactions and those three very different reactions are associated with three different chemical cocktails, if you will. In our brain, fight or flight is associated with adrenaline, cortisol, norepinephrine, oxytocin. The pleasure response is associated with dopamine, norepinephrine, serotonin and gaba. So we have stimulating in the fight or flight and we have relaxing and pleasure in the pleasure response. And the no reaction neutral typically just doesn't trigger much of anything. The brain just filters it out. It says, not worth even paying attention to. Humans label these different chemical responses with feeling words. The same response can be labeled differently by two different people. Fear versus accelerate, Exhilaration. Roller coasters. I'm terrified of them. My primitive brain says you are not supposed to be going that fast in something that doesn't have a a roof on it at the very least. And probably not supposed to be going that fast down downwards anyway and definite upside down. But that's what my brain tells me. I have friends who love roller coasters and it, it's exhilarating for them. Are we Both getting an adrenaline rush? Yes. Are we both getting a lot of excitatory chemicals? Yes. They happen to be perceiving it as exhilarating. So they're having more dopamine and more norepinephrine and more endogenous opioids just flood their system. Me, I'm hanging on for dear life going, how can I get out of here? We're doing the same thing, having the same experience, having similar chemical reactions, but the balance of the different neurochemicals is somewhat different for pleasure versus fear. So let's think about the fears and rewards of someone who is in different stages of readiness for change. Let's talk about anxiety first, since that's first on the list. In pre contemplation, if somebody has a lot of generalized anxiety, maybe their boss noticed that they were stressed out all the time and referred them to the eap. They don't want to be there. They say, I, I don't have that much anxiety. It's not that big of a deal. I don't need your help. I don't like therapists. Whatever. Okay, you know, that's fine. Let's talk about what your fears are. For one, the person may have fear because they feel like they're being forced to be there. They're having their power taken away from them. They may be afraid that if they get started, they're not going to benefit or they're going to fail at recovery. They may be afraid if they get started, they're going to open Pandora's box and not be able to put a lid back on it. It's a lot of reasons people may be afraid. We want to hear. We want to listen for what is punishing. And I don't like that word, but that's what we use in behavior mod. What is punishing? Their desire to get better, to feel what is holding them back. What did. What do they think is going to be painful or stressful or dangerous if they admit that there's a problem in contemplation, the person recognizes that they're stressed out and they need to change, but they're not ready to give that power up. And it could be prior experiences with therapists or authority figures. It could be that they're afraid that their boss is going to find out and they're going to be sidelined. There are a lot of reasons, but we need to listen. They're contemplating change. They're recognizing there might be a problem. So we want to explore what are they doing that works? What have they tried that didn't work. In what ways might somebody be able to help them with this? You know, making sure they recognize the power is in, in their court, in contemplation. There's going to be potentially activities that they experiment with outside of therapy. And if they're willing to do that, that's great. But we have to tie it back to make it meaningful and relevant to them. Why am I going to do this? Why am I going to do this homework? Okay, well, the homework is specific, it's measurable. You're going to do it or you're not. It's achievable. Not going to give you anything that's too big. How is it relevant to helping you meet your goals, Feeling better, getting out of therapy, whatever your goals are, and time limited. Typically we give homework assignments that are on a week to week basis in preparation. The person may be saying, I need help to change. And this is their fear. Their fear fear that once they start trying to change, they're not going to be able to do it all by themselves. Remember, trauma goes back to a loss of power and control and a sense of feeling unsafe. And when people enter therapy, if they don't establish a good rapport with their therapist, a lot of times they feel very anxious about telling this person what's going on. They feel they fear being judged, they fear losing control. They. There's a lot of things they may fear and those fears are going to punish movement toward change. They're going to inhibit the person's progress toward the goals that you want them to achieve. So we need to go back to that decisional balance and we need to be very authentic about the benefits of the current behavior, the drawbacks to change, and address all of those things in the change plan. The person who has anxiety is taking steps to change when they're in action. But it can get overwhelming really fast. And I have countless times worked with people who've entered treatment and they've been in that action stage. They're ready to start. They stop being sick and tired. They're sick and tired of being sick and tired. Okay, great. They get into it and then it starts hurting. Whether it's physical hurt because of the detox or emotional hurt, their heart hurts, they feel overwhelmed. They start uncovering a lot of guilt and shame. Whatever it is, it gets unpleasant really fast and they want to start backing out. It's like, okay, maybe I didn't have that big of a problem. And they'll minimize what's going on in the action stage of change. It is so important that one of their goals is to make sure that they have an adequate foundation to help them cope with stress and manage distress before you start opening that box. If you open that box and they don't have the tools to deal with it, they are probably going to feel unsafe and powerless. And in outpatient therapy, it's even more important to do this because they're with you for one hour a week. They have six days and 23 hours left in the week that you're not there to walk them through a coping skill. So they need to be able to default to something. They need to know that during those other six days and 24 hours that they're not going to feel overwhelmed or consumed by these memories or traumas they've opened up or, or whatever's going on. In maintenance, the person has found their new normal and that's great. What are their fears? A lot of times one of the biggest fears is relapse. I found this. It feels good. I want to keep going, but every time I've tried before I've relapsed, or whenever I've made a change before I made a New Year's resolution, I've kept it going for two months and then I've let it go. So what's to say that this is going to be any different? We need to help them set goals in maintenance to monitor their progress. We need to help them set goals in maintenance to increase mindfulness and to take action when they notice they're starting to lose motivation. You don't have to have an all out relapse before you make a change. If you're being mindful, then you can be aware of your waning motivation, which means that those old rewarding behaviors are starting to kind of push through and go, you want to come back here, don't you? This was a lot of fun. Think about some of the things that we have people do. What are some of the fears or punishments and rewards for someone in each stage for the following behaviors? And we're not going to go through this super granularly just for the sake of brevity, but defining their rich and meaningful life. For some people, they may feel that their life is already half over, so what's the point? And it may trigger grief or anxiety, or they may be afraid that if they define this life that they're going to realize that they can never achieve it and then that'll be devastating to them. Most people, when they resist defining their life, what they want, what would make them happy, they're afraid of disappointment. I have a friend of mine who to this day says that happiness is just that ship is sailed and they will never, ever feel happy. The best they'll get to is content. And I'm not their therapist, so I'm not going to challenge that. But it breaks my heart to hear that they don't even want to try to figure out what happy would look like or feel like for them. When we have people monitor and restructure their thoughts, they're having to examine the automatic beliefs that they're telling themselves that are that's leading to the anxiety or the depression or the anger. And they may start encountering some things like they start paying attention to it, and they're like, yeah, I remember my mom always used to say that. And then they start feeling anger at their mother because they're just hearing that negative, critical voice in their head all the time. So they may be afraid that they're going to discover things about themselves or about others that they don't know how to handle. Forgiving. Oh, this is a big one. Some people are afraid if they forgive others, that they're basically becoming walking targets and they make themselves vulnerable. I like to look at forgiveness as choosing not to give that person your energy anymore. Because you can't change the past. You can learn from it, use your energy to learn from it so it don't happen again, but you can't change the past. And a lot of times people are afraid to forgive themselves because they're afraid if they do, they're going to do it again. Once again. You can use that energy instead of just nurturing that guilt. You can use that energy to learn why you did it and how to avoid doing it again and work to use that energy to be a better version of yourself today than you were yesterday. Getting a physical, terrifying for people. And it's one of the things that I almost always strongly encourage people to do because there are so many things like vitamin D deficiency, hypothyroid hormone insufficiencies that can lead to symptoms of anxiety or depression. That and brain fog. That I want people to rule out some of the easy fixes. Let's make sure that everything's working okay under the hood. Improving sleep. Some people are afraid that if they set the goal of improving sleep that they're going to miss out. They've got fomo, they want to do all this stuff and they don't know how to set boundaries and manage time effectively enough to get sleep in there. They're working 12, 14 hour days. But then they want to play for three or four hours after they get out of work. You don't have eight hours left to sleep. So it's important that we help them figure out how can you do the things you enjoy and improve your sleep and keep your job? And a lot of times it's a matter of recognizing balance and choosing to set some work life boundaries. Improving nutrition, it's a great thing. It can help you feel better. But you know what? You can't have all the yummy food all the time. You can't have the brownies and the ho hos and the whatever else it is that you eat. If you're going all the time, if you're going to improve nutrition, it's important that people make small changes. Back to smart. If they are contemplating improving their nutrition, have them make a small change. Start drinking more water, reduce junk food to one serving a day. Making those small observable changes or one at a time and let them build on each other is going to be a lot more effective than turning somebody's entire nutritional thing over on its head and saying, okay, you're going to just completely change how and what you eat. Their gut is probably not going to like it if you do that, and their brain is not going to like it either because they are going to miss those highly rewarding, highly palatable foods. So we want to set small goals. A lot of people are afraid that if they talk to a nutritionist or something, the nutritionist is going to say, you can't have this anymore. You can't have this anymore. You can't have this anymore. I worked with a dietitian who was very against that. She said the fastest way to get somebody to binge on a food is to tell them they can't ever have it again. And in a lot of ways that's true. She would help them figure out, how can you have this in moderation? And that goes back to modifying behavior. I love chocolate. I love M M's, the peanut M M's. And when I was in school, they were. We had a vending machine in our dorm and it was just too easy to get to all the time. When I moved out of the dorm, I chose to not have M M's in the house. Instead, when I would go to work, I would allow myself one individual sized pack of M M's each day. Now some of you may be going, that's a lot of chocolate. Well, yeah, but it was a compromise. And that was one step that I made when I started trying to change my diet to eat healthier. I now I have M M's maybe once every four or six months, but I had to gradually get there. A lot of times I ask people to complete an autobiography and, and it's true. With all of these things, which I should have mentioned earlier, we need to help people see how it's relevant to their goals. Remember, smart, measurable, achievable, relevant. Why is improving nutrition relevant to helping me feel better and manage my depression or my anxiety? Well, let me tell you. Your food is broken down to make neurotransmitters, which is what helps fuel your mood. So crappy nutrition is going to lead to crappy feeling. Making sure that we always tie it back to their main goal is important. Completing an autobiography. What's the point? A lot of times we react in the present based on our expectations that were created as a result of prior experiences going back to that scary dog. If somebody met a scary dog when they were a kid, then they may still get freaked out around dogs or just not like them. They may not get frustrated freaked out, but they see dogs and they're like, I don't like dogs. They may not remember that initial event. So by writing an autobiography, they may be able to start pinpointing, oh, I stopped liking dogs at this age, or my, my family was always against dogs. They didn't like having dogs in the house, they didn't like dogs. So I developed this belief that dogs were dogs were bad or scary. But the autobiography can help give them clues about their prior experiences that they may not even remember that are triggered in the present and trigger feelings of anxiety or depression or longing or anger. And seeking support is yet another goal that I have on. All of these are things that I have on pretty much every treatment plan that I do. And seeking support is important. If you're seeing me for individual therapy, that's wonderful. You know, I'm glad. I want to help you, I want to be there for you. But I'm only there for you one hour a week, 26 days and 23 hours of the rest of the week. You need to have somebody else that you can confide in. And I've said this before, and I'll say it again, I am adamantly opposed in 99.9% of situations to have people as clients for more than six months to a year at most. People may need episodic treatment. They meet, may need to come back periodically because things in their life change or they need a tune up or something that's fine. But when people are in therapy for years on end, it creates a dependency where they start believing that they need the therapist. They don't rely on the their own skills that they're developing, and they're not encouraged or forced to start developing social supports out outside of the therapeutic environment. And so those other six days and 23 hours, they're kind of like a fish flapping in the breeze. It just doesn't work. So we want to make sure that we're encouraging people to learn how to live instead of feeling like they need to be meeting with us every single week for the rest of their life. Behavior modification. Basic terms, unconditioned stimulus and response. This is something that evokes an unconditioned automatic response in an infant as well as an adult. Loud noises. No matter how old a baby is, it can be one minute old. If you make a really loud noise, it's going to startle pain. Well, we all know that everybody responds to pain, excessive cold or heat. Our body knows what temperature we need to be at. We're going to respond interestingly. Heights, which I always found to be fascinating. But if you put babies on a clear tabletop, they will not crawl over where they don't, where they can't see the bottom. So they've done experiments where they've had a glass plant, paint, glass pane that covered a table, and then it extended out several feet and the baby would crawl to the edge of the table. But then when it looked like they were going to fall off the cliff, they stopped. The baby didn't have any way of knowing that that would hurt if they fell. But there's something programmed in our brain that says you don't want to do that. And contact, pleasurable or painful contact. When you feel pain, you can be, you know, you have an automatic response. They found that kangaroo care is super important for infants to help them bond with their caregiver, especially premature infants. And that contact helps the child regulate their breathing and their responses. But even as we get older, if you are in contact, close contact with somebody, you tend to sink your heart rate and your breathing a lot more. Now, a conditioned stimulus is something that in its of itself has no meaning to the person until they have experiences with it. A yellow light. An infant or a toddler has no clue what a yellow light means. It's just, yeah, it's yellow. Treatment or therapy. If you've never had experience with it, you don't have any opinion about it. If you've had experience with it, then you have an opinion. So it's been conditioned that you either think it's a good thing or you think it's a bad thing. Doctors, you know, once you have experiences with them, it's conditioned that it's going to be a good experience or it's going to be a bad experience. We just start expecting it. Our reaction to that stimulus is a conditioned response. So if somebody was trained when they see a yellow light to floor it, to get through, then that's what they're going to do. Other people are trained to slow down and stop so they don't accidentally run a red light based on your prior experiences, treatment, or therapy. Some people embrace it. Some people become defensive. Doctors, some people, when they go to see a doctor, they're just going to, like, you know, word vomit, confiding in about everything. For others, they're going to clam up. They have what we call white coat syndrome. They start to get stressed and. And they expect to be invalidated. They expect to be talked down to. They expect to be ignored. So their response a lot of times is just to clam up and not even to try to share. We want to help people recognize when you experience a stimulus in your environment that triggers your anxiety, if they're in treatment for anxiety. All right, where did. Where did you first learn about that? What do you know about that? And smoke alarms. You know, a lot of us, we hear a smoke alarm and we get up and we look around to see if there's smoke. Well, that's a conditioned stimulus. We had to learn what that sound was, what it meant, and what to do. It was all very conditioned. When somebody hears a smoke alarm, if they've been in a fire before, it may trigger their anxiety response. When. And I know y' all get tired hearing me share about tornadoes here, but when we have a bad thunderstorm and I hear this, the wind starting to pick up, I get anxious because I've been through some pretty ugly tornado seasons in Tennessee, and I know that's my conditioned response. When I was in Florida, I used to open the blinds and sit there and watch the thunderstorms and just marvel at the lightning. Not anymore. Conditioned stimuli and responses can almost always be traced back to survival. The fight, flee, fawn, freeze, or flop response. And we want to look at. I respond this way, like dogs. I love dogs. I will walk up to a dog that's like foaming at the mouth and look like Cujo. I'm exaggerating, but I'll be like, oh, here, puppy, come here. Because my Experience with dogs has always been very positive, but other people have not. And their expected, their conditioned response for survival is to stay away from something that's threatening. The discriminative stimulus is the stimulus that triggers the reaction. This includes your vulnerabilities. So, for example, if you're sick and you wake up, you know you're sick, your body says, hey, you're vulnerable right now. Which means you're, you're vulnerable to threats in the environment. So you're going to be more likely to respond with anger or anxiety to things. You're going to probably be more irritable. If you have a racing heart, that's a stimulus, what does that. What reaction are you experiencing? Some people when they have a racing heart, they're going to look around. If I just ran a marathon, then I'm going to know that was the stimulus that triggered my racing heart. If I'm just sitting still and all of a sudden it just starts going out of going crazy, I'm not going to know what triggered that reaction. And that's going to trigger an anxiety response, recognizing when my heart starts beating faster. Unless I can trace it back to something that makes sense, I'm probably going to get anxious because there's no overt explanation. The smell of smoke. If you've been in a fire, you're going to have a different response than somebody who has been camping all of, all of their life. And they think they smell smoke, they think campfire, they think s'. Mores, It's a great thing. You smell smoke, you're like, no, I need to get out of here. Learned helplessness is the flop response. It's a response that occurs when people have tried and failed to escape the threats. They just, they give up. It's like, screw it, nothing I do is making any difference. Or I, I don't even have energy to deal with this because I've been dealing with too much else. Screw it, I'm just going to lay back down. We want to think about and ask our clients, what do you already have a sense of helplessness about? What do you already feel powerless to control? And let's take a look at that and in what ways that might keep you from moving toward your rich and meaningful life. How can we help people see observable differences between then and now, facts in this context at this time? Then we'll stick with the dog for a minute. You experience, you experienced this dog that was, you know, by all my, by all rights, aggressive. We'll say maybe it really was aggressive. And it was terrifying. No doubt. This dog is not aggressive in the least. They are very passive. They're just sitting there. How is the situation different? Number one, you're bigger. You were a little kid back then and that was very overpowering and overwhelming. You're a bigger person now so you can defend yourself better. Even if this dog did go all Cujo on you back then, that was a different dog. That was a crazy ass dog, sorry, crazy dog. This dog is just sitting there looking at you, wagging its tail. What does it, what do its non verbals tell you about the situation? So having people look at the difference between the situation then and now and between them, themselves them and now you're stronger now you're more empowered now you're smarter now you have different tools now you're safer now. In terms of measurable responses, we have excitatory responses where we get the adrenaline, norepinephrine, glutamate, cortisol. These come out when we have fight or flee. And recognizing our basic feelings as being a neurochemical response to a stimulus, that's all it is. It's a neurochemical response to a stimulus that we interpret based on our prior experiences, based on our prior learning. Even Pavlov's dog was exposed to meat and you know, that was an unconditioned stimulus and he started salivating and they'd ring the bell and then eventually based on his prior experiences he learned that when that bell rang, meat was going to come so they could ring the bell and he'd start double drooling based on his prior experiences. Neutral in action. A person has learned helplessness sometimes. It's not that they don't, not that they're ignoring it or saying ah, not a big deal, they just, they ain't got it. They don't have any motivation to actually respond. Now again, sometimes it's just not motivating in any direction so it's, they just let it go. But other times they just can't. They just can't. And then the positive response is when we have serotonin and gaba. GABA is our relaxation, it's our pleasure chemical along with your endorphins and dopamine is your motivation chemical. And that comes out when we feel safe, when we feel empowered, when we feel happy. Stimuli that present a threat of loss, pain or vulnerability can trigger the fight or flight response. Situations that the person perceives to present a threat of loss, pain or vulnerability can trigger the fight orf flight response. What are we asking people to do? In therapy we're asking them to be vulnerable. It's terrifying on some level. And that can trigger anxiety, it can trigger the fight orf flight response. It can trigger a push away from change because change feels too threatening. And when we see that we need to slow down, slow down and figure out, okay, what feels threatening, what can we do so you feel safe, so you feel empowered again. Through experiences, people learn what threats they can defeat which result in fight or anger. If I can defeat it, then I'm going to come after it, or which threats will defeat them. And those are the things that I'm going to run like heck from. A useful intervention is to help people identify the threat. What's going on right now, that is trigger triggering your sense of anxiety, that's triggering your anger, that's triggering your sense of hopelessness and helplessness. What's the threat? Why was it labeled? Why did you label it as a threat? That it was something you needed to fight or flee or you just couldn't fix at all. What experiences have you had that led you to have that belief and then break down parts of the situation into the controllable and into the uncontrollable. Because in any situation there are things that you can control and things that you can't. The dog, you can't control the dog, you can't, you know, alter its mind and make it all of a sudden behave or all of a sudden become aggressive. The dog is the dog and it's going to respond to its own stimuli. But controllable. You can avoid making fast movements, you can avoid pulling its tail or doing something that would cause it pain or to feel vulnerable. So when you're around a dog, you know, these are safety measures we take in terms of threats. Fight or flea helps us survive. And we have basic fears and we need to consider these basic fears when we're asking people to do things. And depending on what level of change they're at, loss of control underscores most fears. Fighting or fleeing actually provides us with control. It helps us protect ourselves. We have a fear of isolation or rejection. As humans, we are not meant to be hermits. We have an entire hormone, oxytocin, dedicated to bonding and survival. Primitively, when we are isolated or rejected, we are more vulnerable to death. We are un less safe and we can't procreate, which isn't good for the species. So we don't want to be isolated and rejected. Isolation and rejection can be examined and counter conditioned. This thing that you're afraid of because you're afraid that if people find out, they will reject you or, or they will abandon you in some way. Is this really going to lead to rejection or failure? Rejection or abandonment? And is this thing, even if you are rejected by this person or you're abandoned by this person, which no doubt would be horrible and agonizing, but is it really going to kill you? And, and is everybody going to reject or abandon you or is it just one or two people? And why are their opinions important to your survival? Examine the exceptions. Is everybody going to reject you or is it going to be a few people? And what are the alternate explanations? If something happens and you are rejected by somebody, is it you or is it them? You know, we all have stuff, we all have baggage. And for a lot of people, they may get into a relationship and they start feeling vulnerable and they hightail it. That had nothing to do with you. They actually thought you were the cat's meow. But they started feeling scared so they left. We all fear the unknown to a greater or lesser extent. When we don't know what's coming up, we're vulnerable to death and pain. It's like walking around in complete darkness. You don't know when you're going to run into the furniture. It can be examined and counter conditioned. What is the probability that if I do this it will end in death or pain? What's controllable about this? For example, if I'm walking around, the power went out, I'm walking around in the dark. I'm not going to be walking around really fast and running. I'm going to be shuffling my feet and feeling around ahead of me in order to anticipate what's ahead so I don't stub my toe on the table and experience pain. How many other times have you confronted an unknown and the outcome was positive or neutral? And this is very general. How many other times in your life have you confronted something that was unknown and it turned out okay? It's important for people to recognize because we remember. We have emotional salience for the things that turned out badly. We tend to forget or discount the things that were neutral or positive. It's like, yeah, okay, that happened, whatever. Oh, this, this thing over here. This was horrible. We need to help people look at the totality of their experiences with the unknown. We fear failure in reality. This protects us because if we fail at protecting ourself from the hungry lion, we may die. We protects us from rejection. We need to look at the probability that if I fail it will result in rejection Death or pain? And to what extent? If I fail at recovery, if I'm in addiction recovery and I fail and I relapse, what is the probability that it will result in rejection, death or pain? Will some people reject me? Probably. Will everybody reject me? Probably not. But I can't answer that for people. They have to figure that out for themselves. Will it result in death? Possibly. You know, what's the probability there? And will it result in pain? Probably. And understanding that is important that. So if somebody is entering treatment, we recognize that part of the reason they may be apprehensive about making a change is because they're afraid of failure and the resulting rejection, death or pain. If I fail, is that pain related to the fear of rejection or loss of control? And what are the facts in this context at this time? If I fail, is it actually going to harm me in some way? Or is it triggering my fear of rejection and loss of control? And what are the facts? What do I still have control over? Who still accepts me? How many other times have I tried and failed and the outcome was at least neutral? And how can I make failure? This is where we counter, condition or restructure. How can I make failure into a positive or a neutral hint? Failure can be perceived as a learning experience. Rewards must be frequent and rewarding to the individual. And what I call the net rewards for a behavior must outweigh its alternatives. When I work with people in addiction, they say, you know, recovery, you tell me how great it's going to be. There's no way that the high of recovery can match the high of, you know, fill in the blank with whatever drug. And I'm like, well, in the very short term, in the immediate reaction, probably not. However, in totality, when you're looking at your reduced stress, your improved health, your ability to have the things that are important in your rich and meaningful life. How, how rewarding is that compared to 30 minutes of being high? Encourage people to use discriminative stimuli in their environment to increase targeted behaviors. These are reminders of what they want to do and that they're safe and empowered to do it. To increase a feeling of control and self efficacy. This will help address the loss of fear of loss of control and fear of the unknown. Help them put things in their environment that remind them what they are in control over and what they do know. Have them put things in the environment to increase their self esteem, to help buffer against fears of rejection. Maybe they can put pictures of their best friends who they know will always be by their side. Or their best friends who are there that keep them from feeling isolated and have them put discriminative stimuli in the environment that remind them of how competent they are. If it's awards, if it's kudos, if it's cards, whatever it is that reminds them that, you know, you can do this. Life is hard and you're going to make mistakes, but you can do this. Help people figure out how to use discriminative stimuli in the environment to manage their angry responses. What can they have around them that reminds them to downregulate? What can they have around them that reminds them that getting angry over this is not a good use of their energy to help them move toward their rich and meaningful life? Behavior modification is concerned with the stimuli in the environment that evoke a response. Unconditioned stimuli evoke a response based on survival needs. Conditioned stimuli have no meaning to the person initially, but through experience, just like the dog and the bell become associated with pleasure or pain, the excitatory response, anger and fear, serve to protect the person from what they have in the past experienced as producing pain or being threatening. Stimuli can be reconditioned in order to change the biochemical response and increase motivation to change behavior. But we need to remember, when we're helping people set goals, we have to remember that they're setting goals based on what they want. But we also have to identify what fears might keep you from moving forward. What fears might tell you, hey, maybe this isn't worth all the effort to go this far. People with a logical, experimental mindset often respond well to behavior modification. It's imperative to help them identify alternate responses to their behaviors. You can't just say, okay, when you get angry. You can't scream anymore. We're going to eliminate that behavior. Well, what am I going to do instead? We need to make sure that when we're helping people set goals for change, we're not just eliminating a behavior, but we're adding one in its place.