Doc Snipes
Mental Health Awareness and DeEscalation: PACER Integrative Behavioral Health
Dr. Dawn-Elise Snipes is a Licensed Professional Counselor and Qualified Clinical Supervisor. She received her PhD in Mental Health Counseling from the University of Florida in 2002. In addition to being a practicing clinician, she has provided training to counselors, social workers, nurses and case managers internationally since 2006 through AllCEUs.com Want to chat with me? Join me at https://members.docsnipes.com/ For $10/month you get access to my daily tips for health and wellness and you can text chat with me privately.
Video by Dr. Dawn Elise Snipes on integrative behavioral health approaches including counseling techniques and skills for improving mental health and reducing mental illness.
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#mentalhealthmatters #mentalhealthawareness #deescalation
Signs of distress
Anger/Irritability
Fear
Depression –Hopelessness & Helplessness
Guilt
Difficulty concentrating
Insomnia
Recognize dysphoric symptoms represent an emotional reaction to
A threat (loss of a sense of safety and control– unsafe, disempowered)
Loss of something that was important
What not to say (most of the time)
I understand
Calm down
Overt invalidation (If you can talk, you can breathe)
What to say to someone who is in distress … Empathize and validate with their current thoughts and feelings (even if you do not agree)
I can see that you are feeling…
This situation feels very terrifying
I can imagine how scary it feels to not have control
Dr Dawn Elise Snipes provides training through AllCEUs.com that are helpful for LPC CEUs LMHC CEUs LCPC CEUs LSW CEUs LCSW CEUs LMFTCEUs CRC CEUs LADC CEUs CADC CEUs MAC CEUs MCAP CEUs NCC CEUS LCDC CEUs CPRS CEUs CTRS CEUs and HPCSA ACA #NBCC counsellors needing counselling continuing education counseling continuing education ceus for social workers social work ceus addiction counselor training counseling ceus continuing education training
NCMHCE addiction treatment, addiction recover,y mental health, anxiety relief, depression, motivation, mental health awareness, addiction awareness and integrated behavioral health approaches to treatment CEbroker CE broker @cebroker lpc ceus lmhc ceus lcsw ceus mental health mental illness
i'd like to welcome everybody to today's episode of integrated behavioral health today we're talking about mental health awareness and de-escalation and then at the end we're going to talk some about mental health hygiene i am your host dr dawn elise snipes now this presentation is really designed for the average person for non-clinicians if you're a clinician it you know hopefully will be old hat review but a lot of people interact with loved ones or even people that they work with um who are in crisis or who are starting to develop some level of mental health issue so let's talk first about some signs of distress and these are not going to be surprising to you anger and irritability fear depression a sense of hopelessness and helplessness guilt grief i don't even have that one on here difficulty concentrating and insomnia if you are dealing with somebody who is what we will call dysphoric they are not in a happy place then it's important to be aware that they may have something situational going on that's contributing to their anger or their irritability or their depression however there are steps that we can take to help them feel acknowledged and accepted and validated and supported and when people feel that way it often helps them to start improving the next moment we need to recognize that dysphoric symptoms your unpleasant symptoms represent an emotional reaction to a threat you know these symptoms are our body's way of saying hey something is not right in the hen house here so we need to take a look at what's going on and as i've talked before many times about this system that we have our hpa axis mainly um is not a hundred percent accurate it's like a smoke alarm that goes off when you know it thinks there might be a fire it doesn't necessarily mean there is a fire it could be that you know you put something on the on the stovetop and it's not catching fire it's just smoldering a little bit and getting getting smokey or in our house for some reason when there are really really strong winds our fire alarms go off i don't know why but when that happens it's important to check that alarm is an indication not necessarily that there is for a fact always a problem but it's an indication that there might be a problem and you need to check it out either way when people are dysphoric their hpa axis their fight or flight response is activated and it's important to recognize that that activates in response to a perceived threat when we feel threatened we often feel a loss of a sense of safety and control we feel unsafe disempowered maybe unsupported so you know those are things that we really need to recognize maslow abraham maslow many many many many years ago created this hierarchy of needs and the base of the pyramid is our biological needs we need food we need water we need medical care the next level is safety if we are hungry if we are sick if we are in pain if we are not getting enough sleep um and we don't feel safe guess what working on things like relationships and self-esteem and all that kind of stuff that's kind of unimportant so those the things in the base level of maslow's hierarchy are really important and when people feel a threat a lot of times that threat is to at least that safety level people feel unsafe for some reason another reason people can feel dysphoric unhappy is because of a loss of something that was important when we feel depression when we feel grief sometimes that's our body saying hey that thing was really important and you're sad it's not here anymore you know it's not something that we can go go get or go do anymore so that is an emotional reaction to a loss of control and a loss of something that was important to you what we're really talking about today is the best way to try to interact with people who are in crisis or who are in a uh unpleasant state of mind if somebody is irritable and you go at them and you tell them how they should feel and what they should do or just to let it go or whatever it's probably going to make them feel more out of control and it's probably going to contribute to increased irritability so some key phrases that can trigger people to be feel less supported and feel more threatened include things like i understand when somebody is really upset and you tell them i understand a lot of times their response is you have no idea or my least favorite is calm down when someone is upset and they're in that fight-or-flight mode they're in their emotional mind they want to calm down if they could calm down they would at that point in time they are feeling oftentimes very powerless very threatened and very hyper vigilant because that threat is right there it's important to help them figure out how to calm down recognize that they're safe and then overt invalidation when i was giving birth to my son he was a micro preemie so you know we were rushed into the hospital we were rushed into labor and i i'm sitting there you know trying to give birth and i'm telling the doc i can't breathe and his response to me was if you can talk you can breathe just push and i was just like oh no you didn't um but of course i wasn't in a position to fight at that point in time but my son is now 21 years old and that is still something that is right in the forefront of my mind because that was so incredibly invalidating at that point in time when people are in distress we want to help them regain a sense of safety that's the first thing help them get a safe sense of safety and that may mean also mean helping them feel empowered to do things to get themselves safe helping them figure out what they can do to de-escalate at that point in time instead of telling somebody you need to calm down talking with them and saying i i can see that you are really upset right now and you know you're breathing so fast i'm you know i'm afraid that you're gonna get dizzy i'm afraid you're gonna pass out you know can we sit down or would it help if you took a deep breath tell explaining to them even that when you breathe deeply and in for four hold for four out for four it helps trigger a relaxation response so they can catch their breath you want them to breathe you're not telling them that they're hyperventilating is irrational you're telling them you're worried about what's going on with them you want to empathize and validate their current thoughts and feelings even if you don't agree they are in crisis that is their reality at the moment and coming in and telling them that their reality is wrong is only going to make them feel more attacked more edgy so it's important to empathize and validate with what they're going through right now what it must be like for them and so they can feel supported once they a lot of times once people feel like you understand and you've got a clear picture of what's going on they feel like you've joined with them against this threat or that you can be more supportive so you can say things like i can see that you are feeling angry i can see that you are depressed grieving you know i see it it doesn't mean i feel it um but when i say that i can see that then i am validating i am telling you i'm being responsive and saying i'm noticing how you feel and the person will say yes or they may say you know if you say it seems like you're kind of upset and they may say well i'm way past kind of upset okay well at least that's opened a door and they're you know communicating to try to welcome you in to help them and to support them you can say things like this situation feels very terrifying or must feel very terrifying i remember you know with my son the one time one and only time i've ridden in an ambulance it was from one hospital to another because they had since he was so preemie they had to transfer me to a hospital that had a higher level neonatal intensive care unit so in this 10 minute ride between hospitals i was absolutely terrified uh about what was going on and everything else uh so just saying to somebody you know this must feel very terrifying or it feels very terrifying for you validates how they're feeling even if you're the paramedic sitting there going we got this covered the patient probably has never been through that before you may have been through it 50 times and you're like yeah no biggie but the patient's never been through it before so they may be feeling very terrified and it's important instead of explaining to them how they should feel and it's not a big deal to paraphrase how they feel and ask them what can i do to best support you you can also say things like i can imagine how scary it feels to not have control in this situation if you're dealing with a parent for example who has a child that was diagnosed with cancer or even a person who was diagnosed with cancer you know one of the things there may feel is a lot of rage at what's going on because they may feel like they don't have control over what's going on with them i've created y'all know i love my acronyms or mnemonics the mnemonic craves when you're dealing with somebody who is in crisis calmness is very helpful and i'm not sure if that's even actually a word but it worked here um being calm if you get upset then they're gonna pick up on that even if you're trying to hide it if you get upset they're gonna pick up on it and go oh there must be something to this and they may escalate further so being calm is essential being responsive to them if they are in crisis they may be getting cold they may be hot they may want to move around not have to sit still just asking them what can i do to best assist you to best support you right now a stands for acceptance accepting their thoughts and feelings and experiences as they're experiencing them you may have a very different perception of what's going on but if they're terrified right now then we need to kind of join with them and and try to understand what it's like in their head we're not going to stay here forever but in order to develop that connection and develop some rapport the first thing is to help the person feel accepted and have their feelings validated you know i can imagine how terrifying it must be to you know one of my friends a few years ago used to race motocross and he took a jump too high and fell and or crashed or whatever you call it and he had compound fractures of both legs both tibias both fibulas in both legs and you know they didn't know if he'd ever walk again and it was absolutely terrifying for him and his wife and it and it's important to to validate that you know i accept how you're feeling right now and you know i don't blame you i can imagine how scary this must be e stands for empowerment once you've kind of joined and the person says feels like okay this person understands what i'm going through or has a better inkling of what i'm going through then moving to empowerment and i kind of put empowerment and safety together remember one of the first things we want to do with people um or help people do when they are in crisis is help them establish a sense of safety now the first steps that you did the responsiveness and acceptance and all that that helped establish emotional safety and cognitive safety because you're not afraid you're not being put off by their anger you're not being freaked out by their depression you are sitting there with them you're not invalidating them so that gives them a sense of emotional and cognitive safety that you're not going to tell them how they're wrong and you're going to be there to kind of empathize and support them then we move to physical safety and it's important to help people figure out you know sometimes all right what is the next thing that you need to do for you in this situation and and how can i assist with that so you know for example when i was in the in the ambulance on the way to the hospital the paramedic was very good about you know reminding me when i would have a contraction to breathe it was one of those things i was kind of forgetting at that point in time and he was very calm the whole time i was like totally freaking out but he was calm and and uh empowering he was reassuring about you know the and he would tell me he'd give me updates periodically we're almost to the hospital it's only a couple more minutes so i felt like there was a light at the end of the tunnel so that was that was really good when people are in distress let's just say in distress because it's not necessarily in crisis helping them feel a sense of safety and personal power often helps get them unstuck so they can get out of their emotional mind get out of their reactive mind and start thinking more broadly about okay what are what's the next thing what are the next things i need to do in order to improve the next moment this moment sucks i don't want to continue to have this moment over and over again so what can i do to improve the next moment and it is important to when you're talking with them and you're being responsive if you're saying something and they're starting to get more agitated acknowledge that it seems like what i'm saying is upsetting to you or it doesn't seem like you're feeling comforted or whatever is appropriate to say at that moment that's fine to say and the person can say yeah that you're darn tootin and then you can respond by what is it that i can do to best help you at this point in time and if they don't know that's okay try to have a couple tools in your tool kit specifically the slow breathing can be very helpful for some people they may want to hold your hand other people won't want to be touched ask permission before touching they are already on on edge so it's important to kind of step back and put them in the driver's seat and and ask them sometimes is it okay if i touch your hand or you know would you like to hold my hand um would you like a hug not everybody wants a hug some people do and and go from there and their responses are perfectly what they need at that point in time and you can tell you can get a feeling from their especially from their nonverbals about whether they are calming down and de-escalating or they're not and if they're not de-escalating you can ask them questions like what is it that you are most fearful of right now so that helps you understand exactly what they're focusing on paramedics can do that after a crisis after a disaster when first responders are on scene after a tornado or something you know asking people what is it that i can best do for you asking them you know for example what are you most afraid of right now but also using your knowledge first responders know that people who've had an extreme trauma are likely in a kind of a shocky hazy sort of thing so it's important to help them stay safe and you know get them get them blankets and make sure that they're drinking water or what have you so those are things that you can also remember a lot of people who are who are first responders you know you don't get a lot of training on this but it is helpful to know that you know you're in a position to be able to lead the person you don't want to do things to them if you can help it you want to lead them and say would you be willing to can i help you buy do you think it would help if we got up and walked around for a minute those are all things that allow the person to feel empowered and give them choice and that is the next step they need after they feel safe then they need to feel like there's some level of choice now i see a few questions have come in oh and mental hygiene i did promise we would talk about that mental hygiene is a way of or a strategy for maintaining and promoting mental health and it's important to recognize we talk about hardiness a lot recognizing you know in the big scheme of things all of the things that you have right now that are that you're committed to that make your life rich and meaningful so being grateful for what you've got even the stuff that's going crappy but recognizing that most of the time your entire life is not going crappy there are parts of it recognizing what you can control what aspects of the situation you can control to nurture the good and to address the bad and viewing challenges viewing problems as challenges instead of barriers can also be very helpful heartiness was something that kobasa proposed back in i think it was 1978 if you're interested in looking at the wiki on it um so that's one step but it's also really important and i am doing a whole series on integrative behavioral health right now but it is really important to make sure that our body factory is functioning optimally because when our body is physically under stress it contributes to distress and low mood low energy difficulty concentrating lots of things that are symptoms of anxiety disorders mood disorders or even cognitive decline so we do need to pay attention to that on an affective note we need to add in the positive think about life if you will as a box because we all you know want to get out of our box sometimes but think about life like a box and if you have in that box a bunch of unpleasant stuff you know broken toys and you want to get all those broken things out all that unpleasantness out well that's great but if all you do is eliminate the bad take out the broken stuff and you don't put in the good then when you finish eliminating the bad you're left with an empty box and you're like what what's this so it's important to add in positive so when you get to the bottom there are some not broken toys there are some really awesome things there the other analogy i make uh about mental hygiene and affect is thinking about life thinking about health like a bath and anxiety distress anger those things are hot and and when our cortisol levels are up that's like hot when we are doing things that we enjoy things that make us happy things that help us relax those are like cold you don't want to be in a bath that is too incredibly hot because it would burn you and in life it's just very unlikely that you're going to have a bath that's completely cold so what you're trying to do most of the time is regulate the temperature so it doesn't get too hot in acceptance and commitment therapy hayes talks about the fact that it is unreasonable to expect life to not have pain pain is an essential part of life cognitive pain you know we lose things that are important to us we may feel distressed we may have physical pain sometimes and that's just reality it's not reasonable to expect we will have a life without pain but it is reasonable to consider the fact that you might be able to have pain and a rich and meaningful life people who have rheumatoid arthritis for example can have rheumatoid arthritis and still do a lot of things they can address that as well as possible so they can have a rich and meaningful life they have to live life a little bit differently in order to you know keep the arthritis from flaring up but they still can have a rich and meaningful life so that's affectively we want to do things that encourage us to feel happy that encourage the dopamine and the serotonin cognitively we want to address our thoughts and this is where mindfulness can come in really really handy a lot of times we automatically fall back on negative thinking styles cognitive distortions whatever you want to call them and that puts us in a negative frame of mind if we're always scanning for the negative for the threats then guess what we miss the positive so part of mental hygiene can be being mindful of our thought patterns and practicing radical acceptance when you see a negative in something also trying to find you know the positive it may not be in that exact same thing but like a few few years ago it got really snowy here which you know i love snow so that was awesome uh but we couldn't get out of our neighborhood for almost a week and the kids and the animals and everybody were all kind of trapped at the house and that felt a little um suffocating at times but it was also a really amazing time because we got to go out and snowboard down the hill in the backyard and do some other things so recognizing would i like to be able to go to the gym right now and get to the office and do those sorts of things well heck yeah however i can't what what is the good i can get out of this so that can be um they sometimes people call it cognitive restructuring sometimes they call it radical acceptance whatever you want to call it trying to focus turn your attention to what is going well in your life what is right about this situation instead of looking at all the things that are wrong about it another thing with mental hygiene and we talked about this in the episode on dementia is to make sure that you're working your brain it's not really a muscle but it is important to continue to regularly work your brain to develop cognitive resources think about it as just like a pantry that you would stack up and make sure that you had plenty of food reserves in the event of a hurricane or a blizzard or something like that the same sort of thing is true with your brain if you build up some of those cognitive reserves then they hypothesize that activating more aspects more areas of your brain provides you more flexibility when you do start aging and evidencing you know inevitable cognitive decline you can stave it off if you've got more resources you don't start starving as quickly if you've got plenty in the pantry environmentally mental hygiene is it's important to evaluate your environment to make sure that it is as relaxing and as safe feeling as possible you know no sense having extra distress around and then interpersonally focusing on developing a few healthy supportive relationships not everybody is going to be healthy and supportive but especially in this time of high stress you know it's important to think about things and ask yourself is what i'm doing now helping me feel happier and have a more rich and meaningful life or is it contributing to my distress i was flipping through channels the other night and it occurs to me how um awful it is for for a lot of people right now that you know generally on the holidays some of those hallmark christmas movies can be painful anyway because people see this hallmark christmas and they're like i never had that and then they start feeling like they missed out on something like everybody else has this and i don't so that contributes to feelings of resentment and depression and grief when in reality you know the number of people that actually have those hallmark christmases is probably pretty small those are idealized but it increases people's distress and during this particular holiday season when there's a lot of travel restrictions and there have been a lot of people that have gotten sick and died there's even more distress out there so having all of those um glorified uh holiday movies on can be really challenging so the question is if somebody turns it on is watching this going to help me go to a happy place and imagine what life could be like and increase my pleasure or is watching this going to make me feel grief stricken and depressed and if it's the second turning it off making sure you do things for your mental fitness as well as your physical fitness because if your body is out of sync if your body is sick in some way then your emotions are probably going to follow not too far behind but by the same token if your body is healthy that hpa axis hpg axis hpt axis if all that stuff is healthy or healthy-ish then your mood is probably going to follow not too far behind with the exception of when there is some sort of situational thing that comes up you experience a loss in your life you experience something stressful well okay when that happens if your body is your body factory is functioning at optimal levels then it's cranking out those hormones and neurotransmitters and everything like it needs to so you have the resources to deal with distress when it happens you have the extra in the bank so to speak whereas if you weren't practicing mental hygiene if you weren't taking care of your mental health leading up to it then your pantry was empty and a lot of times you don't have the resources to cope as well and you're right nick many um helping professionals do lack a bedside manner especially um well i'm not going to call out particular professions but there are some professions and in the helping field that tend to be more uh tend to be less focused on the warm and fuzzy and more focused on the facts so it is important to recognize how important and how that can really help with understanding what's going on with the person and this is true not just of health professionals but of firefighters of paramedics of law enforcement it doesn't take a lot of time but a lot of times it actually speeds up the process if you can go in there and quickly establish rapport if you spend the first 10 minutes kind of struggling to see who's going to have power in the relationship uh you're wasting a lot of time if you get in there and you know help the person feel heard and understood and safe you're going to be able to gain a whole lot more traction more quickly regardless of what your profession is or where you're at and this is true for supervisors too this isn't just first responders if you've got a staff member who is starting to show signs of dysphoria you know it's not just today john is in a bad mood but for the last three weeks john has been you know on a tear then these skills can also be super helpful to initiating a discussion that may end up in for example a referral to the employee assistance program and it is important you're right nick to try to be as careful as possible responding to people based on their age their gender their cognitive ability their culture they may respond differently to to different people and to different situations so you can't assume that any two people are going to respond exactly the same way and and that's a really good point that you want to just let them come in some people may come in like like my friend who had the two broken legs some people may come in and you know they've broken lots of bones before and this isn't a huge big deal i mean it's stressful don't get me wrong but they're not like super freaked out about it um other people may come in with something that seems pretty minor and they are in terror about it for example my mother um unfortunately had uh kidney we're not sure where it started but kidney cancer and you know she had low back pain and that was the first sign that she had kidney cancer she put off going to the doctor because she thought she just heard herself working out low and behold she goes in she's stage four so what do you think my reaction was for the first year after mother got her diagnosis whenever i would get low back pain you know my first thought would be oh my gosh and then i would have to kind of talk myself down and be like okay realistically you were you know squatting with 150 pounds yesterday so not surprising your low back sore today and it was important for me to be able to back up and look at that but having a professional a caregiver um of some sort of doctor say oh you know there is no chance that you have this and and dismissing my concerns uh could have been very invalidating and not comforting at all if i didn't feel like i was taken seriously and yes i would love to do a future lecture on the effects cognitive effects on the hippocampus and amygdala due to abuse and chronic stress if you have not read it already um the body keeps the score by uh bessel van der kulk is a is an amazing book um i believe it's by bessel vander kulk um let me see if i can pull it up here for you guys um yep uh so evidently it's on audible on amazon but the body keeps the score is one of those foundational readings if you deal with people who experience trauma and i have another article that i can share with you guys i will put it in the comments section after we finish today's presentation that you can look at if you're interested in some of the wide-ranging changes that occur as the result of ptsd and trauma in the brain in the body so it's it's not just a thinking thing there are a lot of physiological alterations that happen as a result of trauma so i'll pull up that article it's one of my favorites and i can share that with you you can also actually find it i've done a couple of videos on the youtube channel on the neurological impact of trauma are there any other questions as i said i've been working on a series on integrative behavioral health and i'm just learning so much about how things like testosterone levels and estrogen levels impact thyroid levels and neurotransmitters and how sleep and nutrition and you know actually lack of enough fat or lack of enough carbohydrates can add stress to the body and you know obviously the the the whole gut brain axis thing and talking about leaky gut and how an unhealthy gut can also contribute to distress and how distress how cognitive distress and emotional distress and unhelpful thinking styles can trigger that hpa axis and actually make the body sick so you know i think it's a really fascinating system that our body has although imperfect alrighty everybody thank you so much for being here with me today i appreciate you taking time out of your day to join me as always if you have further questions after i sign off the chat quits pretty quickly so i can't respond to a whole bunch of stuff so if i haven't responded to something that you've put in the live chat after i end the stream you can also put comments below the video and we do respond to those comments as quickly as we can so thank you for being here i look forward to seeing you on monday have a fabulous weekend figure out some awesome things to put in that box not just unpleasant things to take out
#Mental #Health #Awareness #DeEscalation #PACER #Integrative #Behavioral #Health
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Thanks!
The Body Keeps the Score by Dr. K has lots of great resources but I thought I'd mention that a lot of people who have read it found it very triggering and actually retraumatized them instead of helping them. It can be male-gazey in the gruesome and graphic way that he describes his female patient's experiences. The Body Never Lies by Alice Miller is far more gentle and easier to read with the same kind of information in it and the information is a bit easier to understand since there's not as much neuroscience in it. Thank you so so much for this incredible presentation and sharing your personal stories! I appreciate this resource and your effort!
I'm aware of it 24/7 365 unfortunately. It won't let me be.
Fear Depression Guilt Hopelessness
Very informative. Thank youuu
Thank you so much 🙏🙏🙏
Does adrenal fatigue also cause difficulty in coping with body temperature rise esp if needing paroxetine and carbamazepine.sometimes often i cant get my meal plan to move down and together i feel hot and i feel a swing in my brain i cant read a line.