 This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through all CEUs. Register at allceus.com slash counselor toolbox. I'd like to welcome everybody to today's presentation, Happiness Isn't Brain Surgery, Understanding Symptoms. Over the next 45 minutes or so, we're going to identify the common symptoms for anxiety and depression-based disorders. So, you know, if you are familiar with diagnosis, you know that there are some very similar symptoms between anxiety and depression. And some people may have both. Some people may have variants of depression, if you will. And we'll talk a little bit about atypical depression in today's presentation, but more so in the nutrition presentation coming up in a few presentations. Anyway, we'll learn how a positive change in one area or symptom can have positive effects on all symptoms or areas. So, think about it. If one of your symptoms is the fact that you are not able to sleep, you know, you have wicked insomnia, or on the other hand, you are just tired all the time and you're sleeping all the time. If that starts to improve, what is the effect on everything else in your life as far as your mood and your motivation and your social relationships and all that other stuff? So, sometimes a positive change in one area. While it's not going to fix all the stuff you're stressing about and it may not fix all of the other depressive symptoms, it may go a long way to giving people a little bit of hope that things can get better with some small changes and that they can get a lot better if they keep working on their treatment plan. We'll explore the function of each symptom that we're talking about, the potential causes of each of those symptoms, and we can't cover all of them. We're going to cover some of the more likely causes. And we will look at some interventions that people may choose to use. And in this presentation, I call them simple-ish interventions because when you're really depressed or you're really, really anxious, things that may seem simple when you're feeling good may seem a lot harder in those particular times. So, I don't want people to think that, oh, this is a really easy way to just do it. When you're in recovery, when you're trying to start being happier, living healthier, nothing is super simple. So, we want people to choose what they're motivated to work on and what they think might be most helpful because as they experience successes in those small changes, they're going to have more momentum going and more motivation to continue on the path, if you will, of recovery and health and wellness. So, remember that everything you feel, sense, think, and do is caused by communication between your nerves with the help of chemical messengers called neurotransmitters. So, when we get information into our brain that says there's a threat, then our brain sends out the fight-or-flight neurochemicals. You have a dump of glutamate nor epinephrine. It's time to get up and do something. These are your excitatory neurotransmitters. When the information comes in that the threat is gone or there's no threat at all, then we have more of our calming neurotransmitters, which are GABA, serotonin. So, when that stimulus comes in, there's an automatic change. This is important to know and we'll talk about that in a little while. Higher order thinking is able to override sensory input and tell us there's a threat when none exists. So, if you have learned and the example that I usually use is the dog charging down the fence at you. If a dog charges down the fence at you and is baring its teeth and barking and just going all kinds of crazy, you know, initially that might initiate a startle reaction. Now, you have the ability to go, you know what, I've seen dogs do that before. Chances of him jumping the fence are like slim to none. So, it's not a big deal. It just kind of startles you for a second. But if you have a negative history with dogs, then your higher order thinking may go, oh, yeah, there's a threat. So, you're able to perceive a threat and then use our rational minds, if you will, to decide whether one really exists or not. And that impacts which neurotransmitters your brain is kind of dumping. And so, if you can tell it there's no threat, then great. Think of your brain as a computer processor and it simply does what it's told to do based on the information that it has. And I talked last week about the fact that this is not an exactly accurate metaphor, but it's the most accurate one we have right now. So, what are symptoms? Symptoms are your physical and emotional reactions to a threat. When that dog comes charging at you, you get scared or startled. Well, how do you know that? That is a verbal label we've put on something that is characterized by increased heart rate, maybe sweaty palms, increased respiration. That's what we call scared. Symptoms are designed to protect you. It's your body's way of saying fight or flee. There's something wrong. We need to do something about it. And they're not bad or good. They just are. It's your body saying, hello, you need to do something. And think about it as a stoplight. It's either red or green. Instead of trying to make the symptom go away, it may help to understand the function of them. When I've worked with patients who have PTSD, for example, a lot of the symptoms of PTSD can seem very, very frustrating. And once a lot of my patients understand, okay, I can see where this might kind of make sense from a survival perspective. It doesn't mean they're okay with the symptom, but it gives them a better understanding so they know the adversary they're fighting against, if you will. So we want to help people understand the function of the symptom and identify alternate, more helpful ways to deal with the threat. So the first symptom, lack of pleasure in most things for a period of at least two weeks. Now, most people call this depression. And when you ask them if they're depressed, this is what they're referring to. They have no greater concept of the criteria for depression to include sleep disturbances and eating disturbances and all that other stuff that we lump in when we're trying to diagnose someone. If you ask somebody if they're depressed, they're talking about lack of pleasure and maybe apathy, not having the motivation to get off the couch, just not having any get up and go. This can be caused by a neurochemical imbalance, insufficient dopamine. That's your reward chemical. If you're not getting rewards for anything, then it can feel really draining over time. So there may not be a desire to get up and go. Insufficient norepinephrine. Norepinephrine is your get up and go. It's the one that helps you get excited and get the energy to do the next thing. And there's glutamate and other imbalances, but just understand that there may be a neurochemical imbalance. But what causes that? Why did somebody suddenly, if you will, start having a lack of pleasure, lack of sleep? This is the first one we're going to look at. Because when people sleep, especially in deep sleep, this is the brain's downtime. It's the time the brain rests and rebalances, if you will. So when you're not getting enough sleep, the brain doesn't have time to rest and rebalance. Think about when it's been really busy at work and there's just, you don't have any breaks. You don't even get time to take lunch. By the end of the day, you're just like, well, if that happened, and maybe you worked a double, think about how totally exhausted you would be. So, you know, expand that exponentially. When people don't get quality sleep, which means they're not getting that deep sleep, it can start to cause neurochemical imbalances. Excessive stress. When we're under a lot of stress, the body knows it can't stay in the all hands on deck state forever. It can't stay in the alarm stage forever. So eventually it starts saying, well, you're telling me there's always threats. And I don't have that much norepinephrine. I don't have that much glutamate. I can't keep you running this high, running this hypervigilant for this long. So the body kind of turns down, if you will, the sensitivity so you don't get stressed about as much stuff. But that also means because norepinephrine is your motivation chemical. It's not just your stress chemical. It's your chemical that says, I really want to get up and go to the gym, or I really want to get up and go to the park, or, wow, gee, this would be really fun. So not only are things that would kind of normally stress you out, you just don't care about them, but things that would normally make you happy. You just don't care about them. So then you've got that apathy again. The good news is once you give your body a break and you're not under constant chronic stress, it rebalances. Drug or medication use, same thing. If you are flooding the system and the system wants to maintain a balance. How much goes in, how much comes out, how much is used up, the balance between the excitatory and the inhibitory neurochemicals. And if you're flooding the system and upsetting the apple cart, if you will, the brain wants to restore balance, restore homeostasis. So it's going to kind of turn down some chemicals, which generally, if you're using drugs or even some medications, a lot of those are either stimulants or flood the system with dopamine. So motivation and reward. When the body turns those down, what happens? We don't feel so good. Hormone imbalances, including thyroid problems. There are a lot of hormones, not just your sex hormones, there's stress hormones, there's thyroid hormones. But when these get out of whack, you can feel irritable, you can feel tired, and it can cause a lack of accessibility of serotonin. So understanding that there's a lot more to lack of pleasure than just maybe negative cognitions. This is your body's way of signaling that there's a problem. You know, I'm not going to get upset, but I'm not going to get happy about anything. It's conserving the excitatory neurotransmitters for a real crisis when there is a true threat. You know, the house is on fire or, you know, the dog starts absolutely going eight bananas over something. Then you might get excited enough to get up and take a look at what's going on or get out because you want to survive. This lack of pleasure, lack of motivation, eventually, most people don't want to feel that way for very long. I don't know anybody who does. So it forces us to address the problem and figure out, you know, what's going on and why is my body sort of down-regulating everything. What we want to do is encourage people to think back over a few times when they've been depressed, you know, not felt any sense of pleasure, even if it was just for a few hours. Maybe somebody hasn't had a depressive episode prior to this, but most likely people have had, you know, a few hours where they were really depressed. What did they do to help themselves feel better? What makes the depression or lack of pleasure worse? You know, sometimes dwelling on it makes it worse. Sometimes, you know, just brainstorm what makes it worse because we don't want to do that. And what can you do to prevent triggering depression or lack of pleasure? Some of us know that we have certain vulnerabilities that will trigger this sort of symptom. I tend to get a lot crankier, you know, I said sleep. I don't do well on insufficient sleep for a long period of time or even multiple days. So it's important that I get quality sleep, even if it's not as much as I want. For other people, there may be different things that trigger their depression or their apathy or their lack of motivation. But a lot of people know what it is. Another one for me can be watching the news, depending on kind of what's going on, or those ASPCA commercials. Oh, those can make me depressed in a heartbeat. So I avoid watching them. I'm just like not going to go there. I encourage people to identify what triggers their depression or apathy and try to figure out ways around it. So I said simple-ish interventions. Don't expect exhilaration, but try to do some things that make you mildly happy. So encouraging people to, you know, watch a comedian, watch a comedy, go to the park and watch the dogs play, whatever it is that, you know, isn't horrible. That's what we're going for right now. I'm not looking for somebody to be rolling on the floor and just in hysterics. I want someone to crack a smile to feel content. Get plenty of quality sleep to stabilize your circadian rhythms. This is your sleep, wake, eat cycle, if you will. When these get out of whack, you don't know when you're supposed to sleep. You don't know when you're supposed to be awake. You may not be sure when you're supposed to eat. What does that mean? When your circadian rhythms get out of whack, then you're not secreting serotonin, which is broken down to make melatonin, which helps you sleep during the right periods of time. So you may not be getting that deep sleep. Improve nutrition. You can search online for nutrition for depression. There are some handouts from WebMD that you can print out. Obviously, not being physicians, we can't prescribe nutritional changes for people, but we can educate them about the importance of good nutrition and how to figure out what good nutrition is. Encourage people to think about the last time they didn't feel this way. What was different? What changed that caused them to start feeling depressed? Because a lot of times you can kind of go back and go, okay, this is when it's set in. Many times people can identify, yeah, I just woke up this morning and I was just like, no. Or maybe there was a trauma. Depression is a natural part of the grief process and it's very normal after some kind of a loss or a trauma. So it's important that we encourage people to be compassionate with themselves. They may have to work through the depression for a little while. It's not abnormal to feel grief, to feel a deep sense of depression. And it can be a loss because of a death. It can be a loss of a job. It can be any kind of losses or traumas. If somebody is victimized, for example, there's some losses there, like a loss of sense of security. There's a whole sense of not understanding how the world goes. There may be some loss of a violation of person. But their brain dumped a whole bunch of those excitatory neurotransmitters and they're trying to kind of put the pieces back and figure out how everything fits after that trauma or after that loss. And that's what, you know, in counseling we can help them with. But it's also possible that people can do it on their own depending on the trauma and how deep their depression is. Eating behaviors is another one that comes up a lot with both anxiety and depression. Eating too much or loss of appetite. Some people when they get really stressed just can't stomach anything. Their stomachs tore up if they will. And okay, I get that. There are also people who, when they get stressed or when they get depressed, eat a lot and eat a lot more out of stress. So what causes that? Well, we'll get down to that. Inbalancing brain chemicals that help you feel motivated to eat such as norepinephrine and serotonin. So you've got to have the motivation to eat if you're going to get up and do it. There's a lot of serotonin in our gut. Like 80% of our serotonin is in our gut and digestive system. So if serotonin gets out of whack, it's probably going to affect your appetite. There are three and actually four now added one primary causes of overeating. Your body needs the building blocks to make the neurotransmitters. Okay. So when we eat, we're taking in proteins like tryptophan. Tryptophan is broken down to help make serotonin. So it's important that people are getting a relatively healthy diet. You know, it's not, you don't have to eat, you know, like crazy healthy, but relatively healthy, which low serotonin is the one I added. Because sometimes it's not because your body doesn't have the building blocks. It's for some other reason that you don't have enough serotonin. So it's important for your body to have the adequate balance. When acetylcholine goes up, for example, which is another neurotransmitter, serotonin goes down. But once acetylcholine goes down, serotonin goes up. Interesting relationship. If your circadian rhythms are out of whack, yet we're going to keep talking about sleep. I'm sorry, it is important. There are two hormones, garyllin and leptin, that help us feel full and help us know when it's time to eat, when it's time to stop eating. And those get all wonky when people are sleep deprived. And again, sleep deprived doesn't necessarily mean not enough hours in bed, but it means not enough quality sleep. So when your circadian rhythms are out of whack, you may not know when you're hungry. I've worked with a lot of law enforcement officers who switched shifts a lot. And they just ate, you know, they ate at eight o'clock because it's that's one breakfast time is I don't know if I'm hungry, I can't remember the last time I was actually hungry. But then they also graze throughout the day, they eat to stay awake, but they also eat to help calm themselves down to get sleeping. So there's a lot that can happen when our sleep gets wonky and habit self soothing. Think about when you were a kid, you went to the doctor, got a shot, or something else unpleasant happened. What happened? A lot of us had parents that would either take us out to eat, or we would get a cookie or we would get a lollipop or something. When something good happened like a birthday, it's a celebratory thing. What do we do? We eat. When something bad happens like a funeral, what do we do? People bring over food and we eat. So in our culture, food is associated with trying to make people feel better. So when people feel bad, what do you think they're kind of natural responses? Well, this has worked in the past, or I think it's worked in the past. So I'm going to eat. Most of us don't think it through that much. It's just when we start to feel bad, we head for the kitchen. What can I do to make myself feel better? Eating behavior functions. If the nutritional building blocks aren't there, the body will go into overdrive trying to rebalance the system. It needs the raw materials. It needs the proteins. It needs the vitamins, which may cause people to crave certain foods. In the nutrition presentation we've got coming up, we talk about how important magnesium B6 and B12 are, in addition to calcium and one other that's escaping me right now, at keeping the system running because vitamins kind of serve as spark plugs to help the body process the proteins to make the neurotransmitters that help us feel calm or energized. Disruption is circadian rhythms. When you don't sleep at all or sleep all hours of the day, the brain just doesn't get that normal ebb and flow of serotonin. Tryptophan is broken down to make serotonin. Serotonin is broken down to make melatonin. It's a process. But if the body is not queued into that process, then you may not have enough melatonin to get the good sleep and you may not have the serotonin being made in preparation for sleep. Self-soothing. Certain foods actually raise the levels of pleasure chemicals in your body, not for long. But we know that high carbohydrate foods tend to lead to a, and high fat foods tend to lead to a dump of dopamine. They hypothesized that this goes back to our ancestors who needed to have food and, you know, food wasn't nearly as available. Maybe not as far back as cavemen, but they needed to have enough energy and it wasn't as easy to come by as it is today. They didn't have grocery stores. So it was important that they ate calorie dense foods. So when they got those, the brain dumped dopamine to say, do that again. That's important. And yes, vitamin D is very important as one of those vitamins that is implicated in depression. So, you know, we'll talk about that a lot more in the next presentation, but I learned a lot about how important vitamin D is. How you cope? I'm looking at how people cope with erratic eating behaviors. And I just used the term erratic, so I don't have to keep saying not eating enough or eating too much. In the past, when you have not had an appetite or been eating to self-soothe, how did you deal with it? You know, we really want to use a strengths-based approach. People are not probably very motivated to start reinventing the wheel right now when they don't have hardly any energy to get up and go. So what did you do in the past that worked? Even if it was only for a little while, we can build on that. How can you make sure you're eating a generally healthy diet and making sure that your body has the building blocks it needs? I suggest to my patients to download an app on their iPad, iPhone. Most people have some sort of mobile device that they can record what they eat and get an idea of how complete their nutrition is at the end of the day. Spark People and MyFitnessPal are two really easy ones. They're free. But people have whatever works for them that gives you a breakdown of the vitamins and minerals you're getting at the end of the day. We can also say, what are you doing to ensure that you're eating due to hunger and not distress? So mindful eating is huge on there to stop before you eat and go, you know, hey, am I really hungry? Knowing what foods you generally gravitate toward to self suit is another thing people need to be aware of. If you don't normally eat chicken breast when you're trying to self suit, then if you're craving chicken breast or you're making it, probably not self soothing. If you gravitate toward peanut butter when you're stressed, then if your first instinct is to go into the kitchen and get a big old tub of peanut butter, that's a clue. What can you do besides eating to distract yourself from your distress or self soothe? So if somebody is distressed and they want to eat to self soothe, you know, and that's possible and we're not going to make that go away overnight. But what do we ask them? We say, what else can you do? Can you drink a glass of water? That's usually not a real appealing solution. I encourage people to get a bottle of water and go out on a walk because most of the time if you have a bottle of water in your hand, you're going to sip on it. But going out on a walk gets you away from the kitchen so you're not just sitting there watching the cabinets going, okay, I've got to wait 10 minutes before I can eat anything. Encourage them to go out, walk around for 10 minutes, come back in and then reassess the situation. Simple-ish interventions. Stop consuming caffeine at least eight hours before bed. Drink enough water. Have three colors on your plate at every meal. This is a simple-ish nutrition hack. If you have multiple colors, you're probably going to get a reasonably thorough representation of vitamins and minerals over the course of the day. Eat foods you enjoy but in moderation. This was a tip that was told to me by a nutritionist friend of mine who was very adamant about not writing off or prohibiting any particular food unless there was a medical reason. Because it just, in many cases, it makes you crave it even more. You start thinking about what you can't have. But encourage people to do it in moderation. So if chocolate is something that they really like, maybe that's not the best thing to keep around the house. But when they go out or, you know, somewhere else, they can have a chocolate dessert or they can have a package of M&Ms, not a whole bag. Use a plate. Don't eat out of the bag. When we're stressed, we tend to just keep doing this and not be mindful of our sense of satiation. Get enough sleep so you're not eating to stay awake. Take a multivitamin. This will help with any cravings that you might be having. And of course, make sure it's okay with your doctor, but most doctors are okay with a multivitamin. I typically take mine after dinner because they upset my stomach. But again, that's something people can talk about with their docs. Experiment with essential oils. Some will increase appetite. Some will decrease stress and cravings. So if you are of the mindset that essential oils can be therapeutic, then encourage people, you know, look at different essential oils that you might inhale. We're not talking about ingesting them. We're not even talking about rubbing them on. We're just talking about inhalation. If you can't stomach eating because you're stressed, explore a meal replacement like insure. It should not be done for a long period, but as a stop gap, it's usually fine, obviously. Again, ask the doctor before implementing this. But some people, if they're really stressed and their stomach is just tore up, physicians will often be okay with them, you know, at least getting calories and protein in through a meal replacement shake for a little while. Sleeping behaviors. Sleeping too much or having insomnia. Sleeping too much can indicate poor quality sleep due to stress. If you're stressed, your body is staying on some level of high alert. It's saying there's a threat somewhere. It may be a cognitive threat. It may be I've got too much to do threat. It whatever, but you've maintained higher levels of excitatory neurotransmitters because you're remembering all the stuff that you got to do. So stress keeps us from getting into that deep sleep or can keep you. Poor sleep habits can also cause you to have poor sleep if you get really, really exhausted and you're wanting to sleep all of the time. Many times that means your circadian rhythms are out of whack. Pain. And this can be chronic pain. This can be muscle pain. After my lifting days, some days it's really hard for me to sleep. And I know this the next morning because I wake up and I'm like, oh, I feel like I got hit by a truck because my muscles are so sore, they wake me up every time I move. So encouraging people to identify if there are if there is some type of pain that's waking them up. I also grind my teeth at night. And so if I'm grinding my teeth a lot and getting my jaw sore, that can wake me up. I tend to share these with my clients when we're talking just to kind of normalize the fact that everybody has pain. Pain is not necessarily a sign that something huge is wrong. It can just be your body going, yeah, we may need to change something. Hormone or neurochemical imbalances can make people want to sleep more or make their sleep quality poor if it's causing them to have stomach cramps, if it's causing agitation. If testosterone or estrogen are low, then oftentimes that's related to low serotonin because whole different lecture. But if those two things, one or either one of those are low, it can cause low serotonin. And if you need serotonin to make melatonin, then guess what? Sleep may be impaired. Allergies. If you wake up coughing or even if it doesn't wake you up, if you're coughing all night long or snoring and waking yourself up or you have sleep apnea, all of these things can cause poor sleep and poor nutrition, not giving yourself the building blocks to make the serotonin, which makes the melatonin. The cause. Insomnia can indicate an inability to relax, pain making it difficult to sleep or insufficient neurotransmitters. One thing I suggest with people who have difficulty relaxing, who tend to be type A, who have a lot of things going through their mind. If you don't get it out of your mind, it's going to keep running around like a racetrack in there. So I encourage them to have a red light, preferably so they don't disturb their melatonin and all that. But have a little red light headlamp or a little red light flashlight and a notepad by their bed and write down anything that comes into their mind. That way they're not thinking, I've got to remember to get milk at the store tomorrow. I've got to remember to do this and pondering and pontificating. When you're not getting enough sleep, you can't recharge as efficiently. So we want to encourage people to identify why they're not sleeping well and rule out the easy things. Love my dogs, love them to death, but my 85 pound boxer sometimes does not like to stay on his side of the bed. And when that happens, I don't sleep well. So I've had to start putting him out of the room so I can get a decent night's sleep. Hate to do it, but you got to make some concessions somewhere. So ruling out the easy things. I'm also allergic to his fur, so I was coughing. If you have other things going on in your room that are irritating allergies, if you have a spouse that snores so loud that it's pulling paint off the walls, you may need to look at figuring out how to work around that earplugs. That's one way. Create a good sleep routine that involves the same two or three activities starting about an hour and a half before bedtime. You don't have to go to bed at the same exact time, but if you have a sleep routine just like you did with your kids when they were younger, you know, you would eat dinner, they would take a bath, you would read a story that go to bed and they would zonk right out. At least you hope so. We need to do the same thing for ourselves. It helps cue our body in. That is almost time for bed. For me, I have these little games on my iPad. It's either checkers or scrabble that I play. And as soon as I start playing them, I can almost start feeling myself get tired within 20 or 30 minutes. And that's part of my wind down routine. Eliminate caffeine at least six hours before bed. Caffeine has a 12 hour life, a six hour half life. So if you drink caffeine at noon, it isn't fully out of your system until midnight. And I don't know about you, but I go to bed at like 830. So if I am have a lot of caffeine at three or four in the afternoon, then when I'm getting up at 430 in the morning, it is just then starting to get out of my system. So encourage people to look at how much caffeine they take in and at what time they start cutting it down or cutting it out. Identify anything that wakes you up in the night and try to figure out how to work around it. Get a physical to rule out any medical issues, especially thyroid and other hormone imbalances, which may be keeping you too revved up or maybe contributing to a serotonin deficiency and anything that might be causing chronic pain. Keep a note pad by your bed. Use progressive muscular relaxation to help your body relax. And there are a lot of scripts online. If you just Google it that you can download MP3 scripts that can walk you through progressive muscular relaxation or guided imagery that can help people relax and focus on something besides the anxiety that's out here. And develop a stress management and relaxation plan. Like I said, it's a simple ish intervention. If that was easy, everybody'd have one. Energy lack of energy or fatigue can be caused by too little sleep lack of motivation and reward. If you try something and there's no reward, you might try something else again. But if you keep trying things and you just never get any rewards for it, how motivated are you to keep trying different things? Eventually you're just like, whatever, I'm going to sit on the couch. And that's normal is normal behavior. We need to have some kind of reward for what we're doing. So this can increase our lack of energy or fatigue or lack of motivation. A lack of movement. If you've ever been on bed rest, I never knew how tired you could get by being in bed all day until I was on bed rest. It's exhausting lack of movement, your joints start to get stiff and it just feels like you're moving the entire world with you when you get out of bed. So, you know, the physics rule that says a body in motion tends to stay in motion and a body at rest tends to stay at rest kind of applies here and I don't remember what commercial stole that but I'm stealing it back. And yes, a sound machine can be a good tool for sleep for some people, especially if they live in an apartment complex where there's a lot of ambient noise or they live in the city. I live out in the country. So except for my rooster waking up at four o'clock in the morning, there's not a whole lot that I hear in the middle of the night. A lack of fear of failure or rejection. And that can cause a lack of energy and fatigue because if you're constantly stressed that people are going to reject you or you're going to fail, then there's that constant chronic stress going on, which is exhausting. I mean, you can only stay wound up for so long. I keep talking if you kind of want to try out a little example, try tensing either your back muscles or making a fist and holding it for a while and just keep holding it. And that's kind of what we're doing when we're stressed all the time. We're prepared for fight or flight and we're not giving our body a chance to relax and eventually we start to get tired. The body's devoting scarce resources to rebuilding and functioning. So if it's not getting the resources it needs for one reason or another, then it may kind of turn down those excitatory neurotransmitters so it can have time to not focus on anything else except for rebuilding and functioning. If there is a partner who is disrupting your sleep, or if there's a partner who is have sleep apnea or, you know, bad allergies or whatever the case may be. It's always obviously we want everybody in our family to sleep well as well. So it's always advisable to encourage people to go to the doctor, get a sleep study done, rule out any sleep apnea, rule out any allergies, you know, anything that might have a relatively easy fix. So whoever it is can get a better night's sleep if it is not you having the problems with snoring or sleep apnea or sleep disruption. Figure out what you need to do so you can deal with it from and like I said, I was kind of not justing when I said earplugs can work if it's a sound thing. If a partner gets up seven times during the night to go to the bathroom, then you might want to look at getting one of the mattresses that doesn't transmit as much vibration when somebody else gets up and down. It is about figuring out what is going to work in that particular situation. We want to encourage people to figure out what helps them get energy besides caffeine. One of the things that's getting up and moving around. I know if I am kind of having a blood day and I get up and I go outside into the garden or even just go outside with the dogs for a little while. It helps make it a little bit of energy. On these days where I'm at right now it's been really cloudy for a really long time, and it's starting to get really draining. People have that a lot like over on the West Coast. There are times when it rains more often than not. So encouraging people when there is sun to get out and get some bright light. Identify anything that drains your energy. Things that you can figure out what you can let go because there are generally things that are draining your energy that you can let go. And adjustments that you can make. Maybe you typically make a bunch of food for every meal. I'm not going to say five course because I don't think anybody does five course anymore. But you make really detailed meals at every single meal. Well that takes a lot of time and energy. When you don't have a lot of time and energy, what shortcuts can you use in order to free up some energy so you can rest and rebalance. And as always look back into things that have helped in the past. Encourage people to do 15 and this is something I learned when I was working on my dissertation. Because I would get awful writer's block and I'd sit down and I just kind of stare at the computer. Or it would be hard for me to get, even sit down. And my committee chair said try doing 15. Sit down, work on it for 15 minutes. If after 15 minutes you were just still hating it, then stop and do something else. But about 85% of the time, maybe even more than that, once I got in and started doing it, it really wasn't so bad. And before I knew it, an hour or two hours would have passed. The same thing is true for movement. If somebody is really lethargic, just it feels like they're toting around the weight of the world. If they can get up and go outside and walk around even for 15 minutes. And then after 15 minutes, if they're still miserable and they want to sit back down, cool. But generally, once you get started, it's not as bad as you thought it was going to be. Make sure to increase motivating chemicals by having some successes. Don't just focus on all the failures. Focus on whatever successes there were that day and create things that are successes. Get an accountability buddy. Sometimes we need somebody to call us and go, you need to get up and come to the gym or you need to get up and let's go shopping today and get you out of the house. Get you out of your PJs. Identify any fear or depressive thoughts that may be dampening your motivation and try thinking the opposite. Or looking for the silver lining. And it can feel really obnoxious when you first start doing it. But that's okay. You know, that's if you are doing something that's not your normal way of doing things, then it's probably going to feel weird. But encourage people to try it. Try it a few times. If it doesn't work, no harm, no foul. But a lot of times people will find if they look for the silver lining or force themselves to think the opposite, then they're able to reduce some of that fight-or-flight reaction. Ask people when they've been stuck before, unmotivated, how did they get started on a task when they didn't want to? And sometimes people will just kind of look at you with this blank look on their face. So I encourage people to ask other people when you don't feel like doing something, how do you get motivated? What helps you? Agitation or slowing, being sped up or slowed down during the day. Calls can be high levels of anxiety, stimulants, unstable blood sugar, or poor nutrition, and again poor sleep. So nutrition and sleep keep coming back up. And I'm harping on this because I want us as clinicians and anybody else who listens to this presentation to understand that it's not always about negative thoughts. I mean, negative thoughts tend to creep in when you start feeling really depressed and apathetic. And sometimes it starts with negative thoughts, but everything seems to get wonky when one part of the system goes wonky. And that's my clinical term that I always use, so whatever. Function, when you're sped up, your body's likely detecting a threat, whether it's real or chemically induced. If you've ever had too much caffeine, you know, I'm pretty sensitive to caffeine. If I go to Starbucks and I even get a small, whatever they call it, by the end of that cup, I feel like a little chihuahua and I'm ready to run around and I'm really wired. And so that can cause agitation. If you're drinking caffeine in order to combat fatigue and slowing, then you're kind of just forcing your body to dump chemicals. If you're slowed down, you're likely out of gas. Your body is not letting so much norepinephrine through and glutamate through either because there's not enough or your body's decided you've been too stressed for too long. So it's important to look at what you might be doing that's either putting a drain on your gas mileage or caused you to run out of gas. Ask people that when they feel driven or anxious, how have they been able to get it under control? Because even if you're depressed, you're probably going to have periods of anxiety or drivenness, if that's a word. How do you get that under control? How do you calm down so you don't feel so wired and edgy? And just generally, how can you be kind to yourself if you're feeling really slowed down? And I use E.O.R. a lot as an example. But if you're feeling kind of E.O.R.-ish, how can you be kind to yourself? A lot of people beat themselves up and say, I shouldn't feel this way. I should get all this stuff done. Should, should, should, should. Well, it's not going to happen. So when you're feeding yourself all those shoulds, you're just increasing your anxiety and negative stuff, which compounds the problem. So asking people, what can they do to be kind to themselves? If they still have problems coming up with it? I said, what would you do if your kid was, you know, just exhausted and couldn't get going? And it was something more than just staying up too late watching YouTube videos or something. What do you do to help them cope? Because we tend to be a lot nicer to other people than we are to ourselves. Concentration goes with both anxiety and depression. So what causes trouble with concentration? Neurotransmitter imbalances. You know, we need them in order to help us focus. Norepinephrine is one of our key concentration hormones. Hormone or blood sugar imbalances, which can be caused by lack of sleep, poor nutrition, or excess stress. Because it throws all of those other neurotransmitters at a whack. And feelings of helplessness causing you to second guess yourself. So every time you start to make a decision, you're like, well, you know, there's this other option and there's this other option here. And then you get stuck in looking at all of the options and you're not concentrating on making a decision. So why do we have trouble concentrating? A lot of times it's energy conservation. If your body's struggling to keep going, it's not going to divert energy to higher order thought processes. Think about sometime when you've been really sick. You know, your body was trying to get better or after surgery. Your body was trying to get better. So did you think that clearly even when you weren't in a medication induced fog? Most of us don't. I know when I have a head cold and everything, I just kind of assume everything and there's all clogged up because I can't think clearly. Help people understand that your body only has so much energy is trying to survive and cut yourself some slack. If you are not, not everybody is on their A game every single day. So what can you do to give yourself a little compassion? What helps you focus if you're having difficulty focusing? Some people do better doing things in small chunks like 15 minutes and then taking a break. My son's got a head cold right now. And with him, you know, when he gets the ability to, he reads for 10 or 15 minutes or whenever he has to blow his nose again, and then he takes a break. And then he comes back and he studies some more. Some of us have much better focus and concentration at a certain time of day. For me, it's before two o'clock. After two o'clock, I'm kind of drooling on myself. So working in the morning is much better for me if it's something that I've really got to concentrate on. And, you know, sometimes eliminating background noise. For me, at least I have difficulty filtering out all that stuff. So if it's quiet, I focus better. Some people do better with instrumental music on whatever it works for them. What helps you concentrate? Stephen Covey talks about sharpening the saw. He said, if you've got to cut a piece of wood, you can do it with a dull saw, but it's going to take a long time. Or, you know, say it's going to take an hour. Or you can rest for 30 or 45 minutes and sharpen the saw for five minutes and get the job done in 10 minutes. You still spent the hour, but which one was more efficient? Sharpening the saw, resting and rebalancing, sharpening the saw and then getting it done with a sharp saw. Or, trying to do it with the same dull saw. And I know we've all felt like a dull saw some days. Make sure you're eating healthfully and frequently to keep your blood sugar stable and give your body the building blocks it needs. Stay hydrated. One of the overlooked things with nutrition and depression. Did you know that dehydration can cause some symptoms of depression, including foggy head and fatigue? So encourage people to make sure they stay hydrated. And that doesn't mean drinking caffeinated beverages. Those are dehydrating. Caffeine is a deretic. So encouraging people to drink ideally water, but if not, some sort of decaffeinated fluid. Get sleep. And they found recently that taking a power nap after lunch can increase focus chemicals, mainly norepinephrine up to 200%. And it's not when you want to talking a power nap, we're talking something between 10 and 40 minutes, not any longer. But they have found that that does help increase focus in the afternoon. And hopelessness and helplessness. I can't go on like this and nothing I do ever seems to work. Again, thank if you're tired, it's going to be harder. Everything's going to feel like drudgery. If you can't focus and you're tired, you're probably going to make more mistakes. When we're sick, tired and in pain, you know, think of Maslow's pyramid when those biological needs aren't getting met. It's really hard to get enthusiastic and feel optimistic sometimes. So we want to ensure that people are getting their brain chemicals imbalance with nutrition, sleep, addressing any negative thinking patterns that are keeping them stuck. And we're going to talk about that in simplest interventions and chronic pain, which can really be a drag. If you've ever had something that hurt, and many of us don't have chronic pain that goes on for months or years. But we can have something that hurts for weeks. If you've sprained your ankle or broken your foot or something like that. And when you wake up and you hurt and you go all day and you hurt and you go to sleep and you hurt, it can be really frustrating. And it can make you feel hopeless and helpless because nothing seems to make the pain go away. People who have chronic migraines also may feel this sense of hopelessness and helplessness, not being able to control when they happen. These emotions are a signal that something's wrong and we need some kind of help. We need to do something a little bit differently. So what helps you feel empowered? Empowerment is the opposite of helplessness. So what do you have control over? And you're not going to have control over everything. What are you hopeful about? Most people are hopeful that they'll feel better. They're hopeful about something in the future. They have some kind of future goals. I don't harp on this one a lot because sometimes when people are in seeing a clinician for the first time, they're not feeling real hopeful about anything. But we can talk about what are your goals? Because behind the scenes, I'm going, well, if you have goals, it's something you hope to achieve where there's the hope. And we can help set goals that are achievable, small, reasonable, measurable goals. So people can start getting that reward going, that motivation when they achieve small steps in their goal. Ask people what are three things you can do today to start making things better? If you feel hopeless and helpless about all this stuff, what are three things you can do today that might start helping you feel either more empowered or more hopeful? And what are three things that have gone well in the recent past? And it may not be huge stuff. It may be you got to your appointment on time and didn't hit any traffic. We'll score. You know, that's a positive. Encourage people to look at some of the more mundane successes and positive things. Too often, we're looking for that exhilaration and we don't take advantage of all the really good things that happen every day. Help people identify things that give them hope or make them happy and do one each day. It can be watching YouTube videos of babies giggling or listening to a comedy skit or painting or whatever it is that makes you at least a little bit mildly happy. Identify the things you do have control over. Watch a video or read a book that makes you laugh. Get adequate sleep, sensing a trend. Get at least eight glasses of water and eat a relatively healthy diet. Talk with a friend and create a plan to get unstuck. If you're feeling hopeless, if you're feeling disempowered, sometimes it helps to have a battle buddy that's going to say, okay, what are we doing today? What's the next step we need to do? And keep you going until you can start getting your own momentum. Excessive worry and fear can also be caused by neurotransmitter imbalances, negative thinking patterns, use of stimulant drugs, and physical issues, especially hyperthyroid and any sort of heart conditions. So really important to rule those out with a physician. Fight or flight is a basic survival reaction. Something is going on that's telling the body there might be a threat. And it's up to us to help people figure out whether there is a threat or not, if there is how to respond, and if there's not how to decompress. We want to help people develop distress tolerance skills and identify things that make their worry or anxiety worse or better. You know, sometimes journaling helps, sometimes distress tolerance skills. It depends on the person, but what have they done in the past? We can help people understand that fear is a protective reaction. And the first step is just understanding that your body is trying to protect you. Then identify, what are you afraid of and why is it scary to you right now? Minimize stimulants that intensify anxiety reactions and learn your stress worry or fear triggers. Identify ways you've dealt with them in the past, or you could deal with them. We all have different triggers based on our own personal stuff that we carry. So it's important to have people keep a log of what triggers their anxiety over the week. And hyper vigilance are being easily startled. Cause can be excessive worry or fear. If you're stressed out and you're already kind of wound up, then it's easier to get startled. And stimulant overuse can cause people to be more easily startled and again, more high strong. There's also trauma and all that other stuff, but we're kind of lumping things together. Hyper vigilance keeps you on high alert for a perceived threat. It's your body going, we're not going to do that again. I need to protect you. So you need to stay, you need to stay alert. Well, that's fine, but you can't stay alert 24, 7, 365. So how do people cope? They help themselves stays, feel safe at home, locking the doors, pulling the blinds, having a dog turning on the alarm system. What is it they do to feel safe at work? You know, for some people, they need to be able to face the door in public. How do you stay feeling safe? Because when you're walking through the mall, there's always people around you. What do you do to help you feel safe in that environment? So those are some of the most polished interventions of what being startled. That's easier said than done. Knowing what startles you. You know, when my dogs start to bark, like crazy, crazy little animals. It can startle me if I'm in the middle of working on something. If my kids make a loud noise. So if I'm getting ready to do something that is cognitively intensive. I generally tell my kids, mom, he's getting ready to work. You know, it's not to make really loud bangs or jump down the stairs. Create a safe environment and feng shui is one technique that you can use that talks about always making sure you're aware of your surroundings through effective placement of chairs, not having your backs to doors, etc. That could be a whole class and avoid stimulants because that just makes you jump beer racing thoughts. If you set the brain wants to find out how to stop it. Makes sense. Oftentimes people will run through the things in their head that are causing stress. But until they can identify the threat is like playing pin the tail on the donkey just blindfolded spinning around going is that what was causing me stress is that what's causing me stress. Which can feel very frustrating and overwhelming. I encourage people to write everything down on a piece of paper or or a whiteboard. There are other things that are stressing them out big stresses little stresses any stresses, and then try to decipher what it is that's causing them stress at that moment, or what they're focused on when your thoughts are racing. It's also helpful to get them out so you can see them and encourage people to avoid taking on anything extra that they'll need to balance their thoughts are already racing and then they're going to add something else think about juggling. They got eight balls in the air and somebody throws in four more and you're just can't do it. So every symptom has a function, whether we like it or not, our body wants to protect us and it wants to help us survive. Each symptom is usually caused by a neurotransmitter imbalance due to poor nutrition, poor sleep, negative thinking styles, excessive stress. Thyroid or hormone issues, cardiovascular issues or addictive behaviors. Recovery involves identifying the function and what's the function of the symptom, and then we got to figure out what's causing it. So we got to eliminate the problem, but in order to eliminate the problem, we generally have to find a healthier alternative to what we're doing now. So it's a process, but find one thing that you can work on each week and over time, you'll start feeling a lot more positive and optimistic and energetic. Okay, another question came in talking about how do you help a or motivate a hoarder who uses fatigue lack of motivation energy as reasons not to do something about the hoarding. Yeah, that could be a pretty lengthy topic, I guess. My first thought would be why are they hoarding and generally hoarding involves some sort of anxiety is an anxiety coping mechanism. So what does the hoarding do for them? What function is the hoarding serving and how can we help them meet that need? Because if they're hoarding in order to protect themselves from this overwhelming anxiety, then again, they're on 24 seven high alert, which could be exhausting and causing a lot of fatigue and lack of motivation and energy. And if the hoarding is what is helping them feel safe, then I can see where they wouldn't be motivated to want to stop hoarding because that's what's working for them right now. It's like, you know, we can go in a whole different scenario there, but it's serving a function. It's helping them right now. So until they have an equally effective alternate, it's going to be really hard for them to give it up. If you think about you can Google Decisional Balance Exercises and you can do a chart and on here across the top, you say hoarding versus either not hoarding or whatever the alternative behavior. I like the alternative behavior better than just the absence of. And then the positives and the negatives. So look at what are the positives of hoarding? What does it do for you? Look at the negatives of hoarding. You know, what are all the drawbacks to this? Why are you in treatment right now? On the other side for this new behavior, what are the benefits to the new behavior? Because there are probably some that are different than things we've already noticed. And then what are the drawbacks to the new behavior? These are the things that make the person not motivated to engage in the new behavior. A lot of times it will come back to whatever this new behavior is, they're fearful. It won't serve the same function as the old behavior. So tip 35 go into SAMHSA, S-A-M-H-S-A dot gov. And tip T-I-P 35 is their tip on motivational interviewing and it goes in depth into Decisional Balance Exercises. That's probably where I might start on that. As far as boosters or natural things that people can do to improve besides nutrition and sleep for improving neurotransmitters, obviously your SSRIs, there's a lot of pharmaceutical interventions that people can do. Sunlight has been found to regulate vitamin D, which they found a lot of vitamin D receptors in the brain. And they're not exactly sure, and specifically the brain, areas of the brain that are responsible for mood. And they're not exactly sure what vitamin D does yet, but since the receptors are there, they're figuring it has some sort of function in the prevention of depression. Other natural things, I encourage mindfulness, I encourage guided imagery, I encourage exercise. We know exercise releases endorphins and some serotonin. So those would be if you want to go natural. Obviously anything that involves the physical body, I encourage clients to talk it over with their doctor, make sure they're cleared before they start an exercise regime or changing their nutrition or anything like that. But there are a lot of things people can do naturally that can help them start balancing their neurotransmitters. It may not happen as quickly as it does with pharmaceuticals. And we know that with SSRIs, it takes four to six weeks to feel the effects from those. So if that's quick, then we know the natural things are probably going to take a little bit longer. With most people who have these symptoms, there's a certain amount of negative cognition that's going on and helping them address the critical inner voice, the negative cognitions using dbt skills and and or cognitive behavioral skills can also help turn down or override. If you will, the body's threat response system and help them say, you know, there's really not a threat here or this isn't worth my energy. I know some of you need to go and that that's totally fine. I'm just going to keep staying here and answering questions as long as people have questions, but I really appreciate you coming today. And I am more than happy to answer any questions or research anything that you want to know that I didn't cover. If you enjoy this podcast, please like and subscribe either in your podcast player or on YouTube. You can attend and participate in our live webinars with Dr. Snipes by subscribing at allceus.com slash counselor toolbox. This episode has been brought to you in part by allceus.com providing 24 seven multimedia continuing education and pre certification training to counselors, therapists and nurses since 2006. Use coupon code counselor toolbox to get a 20% discount off your order this month.