The Many Pathways to Healing Conference BC

presented by

Sponsored by

The Many Pathways to Healing Conference Trauma, Addictions & Related Disorders

Live In-Person & Live Stream Conference

November 25–27, 2024

Richmond, BC

Monday to Wednesday 8:30am to 4:00pm

Executive Hotel Vancouver Airport 7311 Westminster Hwy

A Conference Tailored to Mental health Professionals at all levels and any Profession that applies Behavioural and developmental science to Practice • An Integrated Approach to Trauma Treatment •Stress and Trauma •A Mind-Body Approach to Address Chronic Pain and Co-Existing Disorders • Conquering Anxiety • Proven Interventions for Complex PTSD • Effective and Strategic Intervention Plans to Reduce Relapse Episodes

• Motivational Interviewing Techniques •Art Therapy Interventions for Anxiety, Chronic Pain, Addictions, Grief and Loss • Couples Therapy to Transform Your Practice • Acceptance and Commitment Therapy • MDMA-Assisted Psychotherapy for PTSD & Improving Social Connectedness

JACKHIROSE.COM | 1.800.456.5424

THE MANY PATHWAYS TO HEALING CONFERENCE: TRAUMA, ADDICTIONS & RELATED DISORDERS Presented by Jack Hirose & Associates. Sponsored by Sunshine Coast Health Centre and Georgia Strait Women’s Clinic If you have any questions, please contact your on-site coordinator.

PLEASE REMEMBER: • Wear your name badge every day.

• Turn off your cell phone.

• If you have pre-purchased lunch your tickets are in your name badge, please treat your tickets like cash.

EVALUATION FORM: •

Complete your evaluation form each day using the QR code below.

SCHEDULE: This schedule may vary depending on the flow of the presentation and participant questions 7:30am – 8:30am 8:30am – 10:00am 10:00am – 10:15am 10:15am – 11:45pm 11:45pm – 12:45pm 12:45pm – 2:15pm 2:15pm – 2:30pm 2:45pm – 4:00pm 4:00pm

Sign-In Morning Workshops Begin Mid-Morning Break (Refreshments Provided) Workshop in Session Lunch Break Sign-In (CPA Members Only) Afternoon Sessions Begin Mid-Afternoon Break (Refreshments Provided) Workshop in Session Complete Evaluation Forms (Use QR Code Above) & Sign-Out (CPA Members Only)

CERTIFICATES: • Digital certificates are available for download on the final day for multi-day attendees at: http://registration.jackhirose.com/certificates CPA MEMBERS • A new policy requires you to request a form from your on-site coordinator, which must be submitted directly to the association.

• Please sign in after lunch and sign out at the end of the day. Early departures result in the loss of CPA credits.

• Certificates will be updated with CPA credits after form verification (allow 2-4 weeks).

11/22/24

Meaning-Based Therapy in the Treatment of Trauma, Addiction, Anxiety & Depression Dr. Carissa Muth, Psy.D.

Treatment Resistance

Chapman, C., Mills, K., Slade, T., McFarlane, A. C., Bryant, R. A., Creamer, M., … Teesson, M. (2012). Remission from posttraumatic stress disorder in the general population. Psychological Medicine, 42(8), 1695–1703. doi:10.1017/S0033291711002856

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Schlaepfer, Thomas & Ågren, Hans & Monteleone, Palmiero & Gastó, Cristobal & Pitchot, William & Rouillon, Frederick & Nutt, David & Kasper, Siegfried. (2012). The hidden third: Improving outcome in treatment-resistant depression. Journal of psychopharmacology (Oxford, England). 26. 587-602. 10.1177/0269881111431748.

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Effective Psychotherapy

Medical Model- characterized by insistence on the correct explanation of a disorder and adoption of the concomitant therapeutic actions that are responsible for the patient benefits Common factors- aspects of therapy that are common to most psychotherapies, such as hope, expectation, relationship with the therapist, belief and corrective experience Common factors model understands the therapist as an agent of change and that outcomes are linked to the therapist’s characteristics and relationship with the client

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Therapist Effects • Preponderance of evidence indicates that there are important therapist effects (3-7% of variability) • Therapist effects general exceed treatment effects • What are the characteristics and actions of effective therapists?

• Empathy • Authenticity (real relationship) • Ability to form strong alliances across the range of clients • Interpersonal skills (Higher linked to better client outcomes) • Verbal fluency • Interpersonal perception • Affective modulation and expressiveness • Warmth and Acceptance • Empathy • Focus on other • Reflective about practice

General Effects • Working alliance • Healthy, affectionate, and trusting feelings toward the therapist without transference • Agreement about the goals of therapy • Agreement about the tasks of therapy • Bond • Early symptom change may increase rates of alliance • Placebo/ Expectation (Hope) • Desire to feel relief • Induction of an expectation that treatment can accomplish goal • Presence of emotional arousal • Attribution • Client attributes changes to their own efforts (Self- efficacy increase) • Acquisition of the belief that one’s efforts are responsible for improvement

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Resistance

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Models of Wellbeing What makes for a Good Life?

• Aristippus (435- 356 BCE)- Goal of life is to experience the maximum amount of pleasure and happiness consists of the totality of hedonic moments • Epicurus (34 BCE)- Goal of life is to obtain a happy, tranquil life, one characterized by peace and freedom from fear and pain • Aristotle- Goal of life is to achieve “eudaimonia,” which is the pursuit of highest virtue

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Hedonic Wellbeing • 1960s- Life satisfaction and happiness was considered key components of well being • Wellbeing determined by life satisfaction, positive affect and negative affect

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Hedonic Wellbeing • Factors impacting hedonic wellbeing • Age (U- shaped trend) • Satisfaction reaches its lowest point at midlife between ages 30 and 60 and then peaks in older adulthood • Higher income • Higher education

Eudaimonic Wellbeing • Wellbeing determined by the presence of particular factors rather than by the absence of illness • Internal rather than external factors • Self acceptance • Positive relationships with others • Environmental mastery • Autonomy • Purpose in life • Personal growth

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Dr. Corey Keyes

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Ryff, C.D (2014). Psychological well-being revisited: Advances in the science and practice of Eudaimonia

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Positive Relationships • Sense of belonging • Depth of emotional ties • Warm, satisfying trusting relationships with others; is concerned about the welfare of others; capable of strong empathy, affection and intimacy; understands give and take of human relationships

Purpose in Life • Has goals in life and a sense of direction; feels there is meaning to present and past life; holds beliefs that give life and purpose; has aims and objectives to living • “A human being, by the very attitude he chooses, is capable of finding and fulfilling meaning in even a hopeless situation.” (Frankl) • Principal ways to find meaning (Frankl) • What they gives to the world in terms of creations • What they take from the world in terms of encounters and experiences • The stand they take to their predicament in case they must face a fate which they cannot change

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Motivation • “Pleasure cannot be attained by directly intending it. But as we now notice, it may well be obtained by a biochemical medium” (Frankl) • Fulfillment is contingent to the extent to which an individual finds a unique sense of meaning • “Man is pushed by drives but pulled by meaning” (Frankl) • “The man who regards his life as meaningless is not merely unhappy but hardly fit for life” (Albert Einstein)

Pain and Suffering “As soon as a painful fate cannot be changed, it not only must be accepted but may be transmuted into something meaningful, into an achievement” (Frankl)

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Dr. Carol Dweck

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Frankl – The Will To Meaning

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Dr. Paul T. Wong

Dr. Paul T. Wong

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Dr. Paul T. Wong

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• Difficulties with emotional regulation • Difficulties with meaning attribution

WHAT CREATES PROBLEMS?

• Difficulties with taking responsibility for one's wellbeing and future • Difficulties with relationship skills • Difficulties with coping resources and skills • Difficulties with endurance and tolerance of suffering • Difficulties with life intelligence or existential intelligence

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CREATING CHANGE Meaning Therapy assumes that desirable changes depend on: • Understanding and accepting the true meaning of one’s life situation • Self and social validation of personal existence as being meaningful and worthwhile • Pursuit and actualization of valuable life goals

HOW DO YOU FIND MEANING? • Activity ⚬ Activities that are intrinsically valuable and interesting ⚬ Activities that are instrumental in attaining significant goals ⚬ Activities that are self- transcended and directed at serving others • Experience- beauty, truth and love joy and wonder • Attitude- acceptance in suffering

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Discovering Meaning Three types of values whereby one can discover meaning: • ·Creative- what the person gives to the world • ·Experiential- what the person receives from the world • ·Attitudinal- adopting the right attitude of acceptance and taking a stand towards unavoidable suffering

MT GOALS Develop a deeper understanding of cause- Not just symptoms Develop a set of positive meanings as foundation upon which to build a fulfilling and productive life Learn how to overcome internal and external obstacles to attain meaningful life goals Learn to live productively in spite of certain unchangeable realities of life, such as suffering, aloneness, and anxiety Improve relationship skills and connection with others

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Thanks!

Questions? carissam@schc.ca

22

Stress & Trauma

an a%achment-based developmental perspec3ve

Gordon Neufeld, Ph.D.

Clinical & Developmental Psychologist Founder of the Neufeld Institute Vancouver, Canada

A JACK HIROSE SEMINAR

Healing & Trea,ng Trauma Wounds Richmond, B.C. November 25, 2024

Copyright 2024 Gordon Neufeld, Ph.D. All rights reserved.

The handout is intended for registered par?cipants of this seminar only.

Please do notduplicate this document without permission.For more informa?on regarding the Neufeld Ins?tute or Dr. Neufeld and his work, please consult the website.

www. neufeldins,tute.org

Stress & Trauma - Dr. Gordon Neufeld

Hirose Seminars - Richmond - Nov 25, 2024

Stress & Trauma an a$achment-based developmental perspec3ve

Gordon Neufeld, Ph.D.

Developmental & Clinical Psychologist Vancouver, Canada

sense of safety

role of relationship grieving

tears of futility & sadness

stress Response

play & playfulness fight or flight

impact of experience & exposure

optimal functioning

emotional defense

sense of strength

vulnerable feelings

TRAUMA

nature of emotion

role of adaptation

recovery and healing

neural plasticity antecedents to bouncing back vasovagal

rest and restfulness

response

Stress & Trauma Chapter One

Chapter 1

The WISDOM ! of the !

Stress Response

THE THREAT: an evolution in understanding

Copyright 2024 Gordon Neufeld PhD

1

Stress & Trauma - Dr. Gordon Neufeld

Hirose Seminars - Richmond - Nov 25, 2024

WALTER CANNON’S FIGHT-FLIGHT RESPONSE TO THREAT • Harvard medical professor who studied the effects of physical danger on lab animals and formed his thesis in 1915, published in 1932 in the book “The Wisdom of the Body” • his focus was on the situaQonal response to a threat to survival but made the mistake of isolaQng animals from their own species • studied the role of adrenalin and the sympatheQc nervous system in responding to threats to physical survival

THREAT to survival FIGHT

FlIGHT

HANS SELYE’S STRESS RESPONSE (1940’S)

• was seeking a common physiological response that could account for the behaviours that Cannon had observed as a response to threat • assumed that the FEAR system was the physiological pathway for stress, thus making the mistake that aggression came from fear • assumed that harm or survival was the essence of threat • since modified to include a third opQon – FREEZE (immobilizaQon or shutdown mediated by the vagus nerve) if flight or fight are not opQons

STRESs FlIGHT

FIGHT

about Hans Selye and the construct of STRESS • Selye was a Hungarian-Canadian endrocrinologist who worked at McGill in the 30’s and 40’s and later at the University of Montreal • popularized the construct of stress (word originates from ‘distress’ meaning coming apart) as a term for the generalized effect of threat on the body • the term was borrowed from physics and engineering where it was used to describe the force exerted on a physical enQty (like a bridge) that would cause it to snap or come apart • the term became immediately and immensely popular, influencing the vocabulary and thus thinking in many languages • the term unfortunately gave the impression that stress was bad, leading to breakdown, something Selye tried in vain to correct

Copyright 2024 Gordon Neufeld PhD

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Stress & Trauma - Dr. Gordon Neufeld

Hirose Seminars - Richmond - Nov 25, 2024

NEGLECT losing face both me n paren tio ts wo bedti a rking liz ta personal injury pi s failure ho e

ol dis scho ab loneliness ilit y isola tion ATH g DE facin

STRESs

threats to iden tity

on adopQ

sec rets

ar yc a d e ve loss of lo d on

mov ing

ling er sib h t o n a ST LO ng bei resi d sch enQal ool

DIVORCE

E NT US RETIREME AB

CHANGE

Adversive Childhood Experiences Emotional abuse

pHysical abuse emotional neglect Mental illness of household member

sexual abuse

physical neglect

substance abuse in household

STRESs divorce incarcerated relative

mother treated violently

REDUCE DISTRESSING EVENTS

if THREAT = STRESS LOAD nd drugs aSon medica

t parariggerin sym g a resp pathe ons Sc e n ita5o d e m deep breathing g nut ni n & exeri5on l to rcise a vag

MANAGE IMPACT OF STRESS

Self-care is the logical deduction of this understanding

Copyright 2024 Gordon Neufeld PhD

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Stress & Trauma - Dr. Gordon Neufeld

Hirose Seminars - Richmond - Nov 25, 2024

1. When kids pracQce self-care they learn to idenQfy their physical and emoQonal needs and can begin to take care of those needs.

2. PracQcing self-care at a young age allows kids to create a foundaQon that will benefit them as adults.

3. PracQcing self-care allows your child to develop healthy habits that they can benefit from in the future.

4. Your child will be able to become more independent and understand how to take care of themselves.

5. They will develop the skills necessary to keep themselves healthy mentally, physically and emoQonally.

Copyright 2024 Gordon Neufeld PhD

4

Stress & Trauma - Dr. Gordon Neufeld

Hirose Seminars - Richmond - Nov 25, 2024

THREAT FACING SEPARATION

= experience of separaSon

SEPARATION

is thus the greatest threat

ATTACHMENT = SURVIVAL and is thus our preeminent drive

of .. lacknging losing face with . can’t NEGLECTED . be w o .. bel ith ... ct by cQon ne reje

n not important to ... tood co n’t feel s a ing c er fe unlo eli not ma nd ved ng ferin u b y ... t dif g to . fe .. no re

d by ... not recognize

n

t isola tion g ngin belo n ot

ced repla

by ...

ed loneliness nt d i sc threats . a .. to o t id ou n entity ecial tw ted n o t sp no by . n .. old o BETRAY ..

ED can’t hn apart BY .

O e T h w ON HELD NOT LIKED BY ...

NOT

Adversive Childhood Experiences pHysical abuse

Emotional abuse

physical neglect

emotional neglect Mental illness of household member

substance abuse in household divorce incarcerated relative

Togetherness is threatened

sexual abuse

SPECTRUM OF TRAUMA

Copyright 2024 Gordon Neufeld PhD

mother treated violently Togetherness IS the threat

5

Stress & Trauma - Dr. Gordon Neufeld

Hirose Seminars - Richmond - Nov 25, 2024

THREAT – an evolution in understanding

threat is to

SURVIVAL

SEPARATION

STRESS

is the threat

itself is the threat

• address issues • reduce distressing of safety, food, events health, & shelter • manage the impact of stress

REDUCE SEPARATION via naturally developing ... ... ways to hold on when apart ... viability as a separate being ... resilience in the face of separa3on faced

If FACING SEPARATION is the THREAT, togetherness is our answer!

-

and thus CASCADING CARE in the context of togetherness should become our ultimate focus

Stress & Trauma

The WISDOM ! of the !

Stress Response Chapter 1 The WISDOM Chapter Two

of the stress response

Copyright 2024 Gordon Neufeld PhD

6

Stress & Trauma - Dr. Gordon Neufeld

Hirose Seminars - Richmond - Nov 25, 2024

THE STRESS RESPONSE ACTIVATES PRIMAL EMOTIONS closure separa3on-triggered

PURSUIT

ALARM

FRUSTRATION change

cau3on

Attachment’s Emergency First Aid Team

M

R LA

-

-P

-A

UR SU IT -

- FRUSTRATION -

se on sp Re

Re Sc

EM RE OTI

Sc

Sy mp at he

e th pa ym ras Pa

sp on se

OUR MOTTO - “We promise to get emo5onal when holes appear in the fabric of your togetherness”

SP ON ON A SE L

Copyright 2024 Gordon Neufeld PhD

7

Re Sc

Sc

Sy mp at he

Hirose Seminars - Richmond - Nov 25, 2024

e th pa ym ras Pa

sp on se

Stress & Trauma - Dr. Gordon Neufeld

Re se on sp

EM RE OTI

SP ON ON A SE L

Re

as a last resort , the parasympatheQc system can be deployed as a DEFENSIVE RESPONSE to stress

SP ON ON A SE L

se on sp

EM RE OTI

Re

Sy mp at he

Sc

Sc

e th pa ym ras Pa

sp on se

first response

e ez d re gue l F or aQ eju int y, F rg Fa ogg , Fo F ble e Fe if trapped or thwarted, can trigger if trapped or thwarted, can trigger

a reverse thependulum pendulum a reverseswing swing of of the

The Stress Response - a two-pronged approach al rimons p S TE oS n IVA em raQo ACTraSon, frust it) a u sep, alarm purs e (i and

de em f e n oS siv ( ie ona ely , fe l f e eli ed ng ba s) c k

- via the command centre (amygala) of limbic system

- via the brain’s sensory gaQng sytem

- to situaQonally address the separaQon problem

- to reduce felt suffering and improve abillty to funcQon in distressing circumstances

Copyright 2024 Gordon Neufeld PhD

8

Stress & Trauma - Dr. Gordon Neufeld

Hirose Seminars - Richmond - Nov 25, 2024

The Stress Response

animates and armours the heart al • gives the STRENGTH and primons TOUGHNESS needed to S E S T o funcQon or perform in A IV n em T stressful or wounding C o IT A U S S R • ara circumstances PU p N e s ALARM TIO A TR US FR

• while a Sme, INHt the same that wou IBITS FEELINGS performinld interfere with in stressfu g or funcQoning l circumst ances

STRESS RESPONSE = MORE EMOTION BUT LESS FEELING

• instantly CHANGES one to be able to COPE with adversity & SURVIVE distressing circumstances

• taps all available resources to enable one to PERSEVERE in the face of distress and OVERCOME stressful circumstances

LOCK, OLLOW, FAWN, IND, ANCY (family, friends, fame, fortune) devolving into

Fixes closure Fixations separa3ontriggered

PURSUIT

ALARM

FRUSTRATION

FIGHT

FlIGHT

The stress response in the ‘key’ of

impulses to

ATTACH separa3ontriggered

PURSUIT

ALARM

FRUSTRATION

impulses to

impulses to

Avoid

Attack

The stress response in the ‘key’ of

Copyright 2024 Gordon Neufeld PhD

9

Stress & Trauma - Dr. Gordon Neufeld

Hirose Seminars - Richmond - Nov 25, 2024

Stress & Trauma

The WISDOM ! of the !

Chapter Three Stress Response

Chapter 1

TRAUMA REDEFINED

The Stress Response

h, lt ea l h l ia al na ent • gives the and io STRENGTH rimons t t p o po TOUGHNESS needed to S oS E m T f e funcQon or perform in o VA m n to ostressful or wounding C TI n e ti RSUIT • A araSo circumstances U P a z p i N y l se ALARteM alIO reAT u ol heTR s • while a tS b • instantly CHANGES Sme, IN t the same re a anFdRU one to be able to COPE that wouHIBITS FEELINa GnSg, with adversity & SURVIVE ni distressing circumstances performinld interfere iw g or func ct o ith in stressfu Q o n n in g l c:ircum u M l f stances LE ma • taps all available resources to B i O pt enable one to PERSEVERE in the o PR RESPONSE STRESS = MORE face of distress and OVERCOME EMOTION BUT LESS FEELING stressful circumstances

animates and armours the heart

Stress Response acQvaQon of

ATTACHMENT’S EMERGENCY RESPONSE TEAM (alarm, frustraQon & pursuit) FEELINGS that would interfere with performing or funcQoning in stressful circumstances are INHIBITED

Resilience Response Feelings that have been inhibited BOUNCE BACK to enable opQmal funcQoning and the full realizaQon of potenQal

SAFETY

Copyright 2024 Gordon Neufeld PhD

10

Stress & Trauma - Dr. Gordon Neufeld

THREAT

Hirose Seminars - Richmond - Nov 25, 2024

STRESS RESPONSE

SE F A PA C I RA N G TI ON

The brain’s naturally evolved emo3onal intelligence

THREAT

STRESS RESPONSE

REMOVAL OF THREAT

S E F P A A C R I A N T G I O N

RESILIENCE RESPONSE

Recovery of feelings

The brain’s naturally evolved emo3onal intelligence

THREAT S E F P A A C R I A N T G I O N

STRESS RESPONSE

Is NOT a funcSon of reality NOR is it

REMOVAL RESILIENCE raSonal in any way; OF THREAT RESPONSE doesn’t even have

S A F E T Y

to be a conscious feeling.

Recovery of feelings

in a ain lay i ^ac depn trushing brhe pode end Sng t m enc e

The brain’s naturally evolved emo3onal intelligence

Copyright 2024 Gordon Neufeld PhD

11

Stress & Trauma - Dr. Gordon Neufeld

THREAT

STRESS RESPONSE

S E > >> F P A A C R I A N T G I O N

Hirose Seminars - Richmond - Nov 25, 2024

REMOVAL OF THREAT

RESILIENCE RESPONSE

S A F E T Y

Recovery of feelings felt >>> futility

in a ain lay i ^ac depn trushing brhe pode end Sng t m enc e

The brain’s naturally evolved emo3onal intelligence

Attachment’s Emergency First Aid Team

OUR MOTTO - “We promise to get emo5onal when holes appear in the fabric of your togetherness” “We also promise to hang around un5l fu5lity is felt”

When the fixes are fuQle, they need to be FELT as such.

RS

PU

M AR AL FRUSTRATION

UI T

L ST E WA R E N RE Y VER O C RE RESILIENCE as an afribute

Copyright 2024 Gordon Neufeld PhD

12

Stress & Trauma - Dr. Gordon Neufeld

Hirose Seminars - Richmond - Nov 25, 2024

D OWN

BOUN

LET

CE B AC K

SADNESS brings RECOVERY

SADNESS brings RECOVERY

HELP THAT IS

HELPFUL!!

• keeping or restoring perspective • right thinking / being positive • pursuing happiness • resisting the ‘let-down’ • acquiring the ‘skills’ of resilience • pursuing calmness & tranquility

Copyright 2024 Gordon Neufeld PhD

13

Stress & Trauma - Dr. Gordon Neufeld

Hirose Seminars - Richmond - Nov 25, 2024

loss of job ne’s way losing facMORTA NEGLECT e LITY loss go n of p a ln atio e z i l g g a rent n t ibli ospi n ot s tragedy f o rejecQh s s o l on t loss of child threats y nes BUSE to iden tity di empt A ffe re nt ne ss

a traum ed ov l n isolatio u n NT TH E ME EA lo RETIR D ne NG lin ACI es F s

the nadir

Strength of DEFENSE

vs

Strength of BECOMING - meant to be characteris5c -

- meant to be situa5onal found needed strength

OVERCAME

potenQal sQll unfolding

persisted despite distress

PERSEVERED

growth force persists

came through distress seemingly ‘unscathed’

SURVIVED

heart was mended and spirits were revived

changed to withstand or cope with adversive or distressing condiQons

RESILIENT

feelings recover quickly aner Qmes of stress

ADAPTIVE

transformed from inside out by adversity

can funcQon or perform in highly stressful or wounding circumstances

HARDY

doesn’t need to be sheltered from stress to preserve growth potenQal

Strength of DEFENSE

vs

Strength of BECOMING - meant to be characteris5c potenQal sQll unfolding

persisted despite distress

PERSEVERED

growth force persists

came through distress seemingly ‘unscathed’

SURVIVED

heart was mended and spirits were revived

changed to withstand or cope with adversive or distressing condiQons

RESILIENT

feelings recover quickly aner Qmes of stress

ADAPTIVE

transformed from inside out by adversity

HARDY

doesn’t need to be sheltered from stress to preserve growth potenQal

fee

en de r

a ro m

f of

ee

g lin

su lts f

a

re

m ro

can funcQon or perform in highly stressful or wounding circumstances

f lts su

lin g

found needed strength

re

OVERCAME

of t

- meant to be situa5onal -

Copyright 2024 Gordon Neufeld PhD

14

Stress & Trauma - Dr. Gordon Neufeld

Stress Response acQvaQon of

ATTACHMENT’S EMERGENCY RESPONSE TEAM (alarm, frustraQon & pursuit) FEELINGS that would interfere with performing or funcQoning in stressful circumstances are INHIBITED

Hirose Seminars - Richmond - Nov 25, 2024

Resilience Response Feelings that have been inhibited BOUNCE BACK to enable opQmal funcQoning and the full realizaQon of potenQal

SAFETY

as judged by the brain’s innate intelligence

sadness

ie, feelings of fuQlity re brain’s emoQonal ‘fixes’

Stress Response acQvaQon of

ATTACHMENT’S EMERGENCY RESPONSE TEAM (alarm, frustraQon & pursuit) FEELINGS that would interfere with performing or funcQoning in stressful circumstances are INHIBITED

Resilience TRAUMAResponse is NOT

what happens to us Feelings but what fails to happen that have been within us in response, ie, inhibited BOUNCE the lack of a opQmal follow-up BACK to enable funcQoningresponse and the that resilience full realizaQon potenQal includesofSADNESS

SAFETY

mveantss u rotaancek strese Tsadness

as judged by the brain’s t innate intelligence bu

on stueofspfuQlity iie,s nfeelings a r re brain’s emoQonal ‘fixes’

THREAT S E FP AA CR IA NT I GO N

STUCK

STRESS RESPONSE

TRAUMA

DEFENSIVELY

DEPRESS

DEFENSIVELY

DETACH

BRAIN’S INTERNAL BACKUP DEFENSES

The brain’s naturally evolved emo3onal intelligence

Copyright 2024 Gordon Neufeld PhD

15

Stress & Trauma - Dr. Gordon Neufeld

Hirose Seminars - Richmond - Nov 25, 2024

Stress & Trauma

The WISDOM ! of the !

Chapter Four Stress Response

Chapter 1

Signs of a Stuck Stress Response (ie, trauma)

Missing Key Feelings Brain’s Backup Defenses

THREAT S E F P A A C R I A N T G I O N

FIVE POINT ASSESSMENT of a STUCK STRESS RESPONSE

Resilience Response is Lacking

Stuck Primal Emo3on

Stuck Stress Response

STRESS RESPONSE

REMOVAL OF THREAT

RESILIENCE RESPONSE

S A F E T Y

Recovery of feelings felt >>> futility

DEFENSIVELY

DEPRESS

DEFENSIVELY

DETACH

1

in a ain lay i ^ac depn trushing brhe pode end Sng t m enc e

BRAIN’S INTERNAL BACKUP DEFENSES

Copyright 2024 Gordon Neufeld PhD

16

Stress & Trauma - Dr. Gordon Neufeld

fe lt p lay

REST

est lt r fe

- stuck in the WORK MODE - lacking emergent or venturing forth energy - lacking curiosity

Hirose Seminars - Richmond - Nov 25, 2024

LESS NES S

the vital signs of well-being felt futility

- past history of ungrieved losses

eg, sadness, sorrow, disappointment, grief

- stuck in fuQle endeavours /unable to let go / brain unable to find work-arounds for impediments

eg, cared for, cared about, caring deeply about, etc feelings re CARE eg, sorry, remorseful, guilty about, bad about feelings of DEPENDENCE feeling eg, needy, trusjul RESPONSIBLE FEELINGS of vulnerable ATTACHMENT N IO T A that may go IT G A feelings feeling MISSING of ANGER IA ALARMED ... when personally NO A ... when facing R mistreated PA separaQon feeling FULL ADREN or EMPTY ALIN-S EEKING eg, fulfilled, saQated, missing, longing, afachment ‘holes’

D BORE

OM

What BOREDOM is about

When the ‘holes’ in togetherness are NOT sufficiently FELT, it is experienced as BOREDOM.

Copyright 2024 Gordon Neufeld PhD

17

Stress & Trauma - Dr. Gordon Neufeld

Hirose Seminars - Richmond - Nov 25, 2024

Boredom-a natural barometer for deficits of feeling - can’t feel the true nature or shape of the hole that exists within -

acSv ity

food nt me n i rta

ns scree

sSm

al s git it di rsu pu

te en delin quen cy

ula So n

videog

ames

G& TIN ING T U C URN B sensing PAIN

SIGHT & HEARING

TOUCH & SMELL

3 STRESS RESPONSE

THREAT S E F P A A C R I A N T G I O N

DEFENSIVELY

DEPRESS

DEFENSIVELY

DETACH

sensing COLD

feelings of SENSATIONS that may be restricted

sensing BLADDER/BOWEL

W & ETT PRESSURE SO IN ILI G NG

REMOVAL OF THREAT

2 RESILIENCE RESPONSE

S A F E T Y

Recovery of feelings felt >>> futility

1

in a ain lay i ^ac depn trushing brhe pode end Sng t m enc e

BRAIN’S INTERNAL BACKUP DEFENSES

Copyright 2024 Gordon Neufeld PhD

18

Stress & Trauma - Dr. Gordon Neufeld

Hirose Seminars - Richmond - Nov 25, 2024

Impact of the STress Response - a loss of tender feeling -

insidious long-term impact

CONFUSING SIGNS OF A WORKING STRESS RESPONSE the loss of so-called ‘nega3ve’ feelings is typically misinterpreted posi3vely

no longer talks about what distresses or hurt feelings no longer feels unsafe or alarmed no longer reads rejecSon or feels its sSng no longer given to sadness and disappointment no longer feels as needy, empty, lonely or dependent no longer is as visibly affected by loss and lack be^er able to funcSon or perform under duress

3 STRESS RESPONSE

THREAT S E F P A A C R I A N T G I O N

4

DEFENSIVELY

DEPRESS

DEFENSIVELY

DETACH

REMOVAL OF THREAT

2 RESILIENCE RESPONSE

S A F E T Y

Recovery of feelings felt >>> futility

1

in a ain lay i ^ac depn trushing brhe pode end Sng t m enc e

BRAIN’S INTERNAL BACKUP DEFENSES

Copyright 2024 Gordon Neufeld PhD

19

Stress & Trauma - Dr. Gordon Neufeld

Hirose Seminars - Richmond - Nov 25, 2024

SIGNS OF AN ACUTE STRESS RESPONSE AFTER A DISTRESSING EVENT

lin e e f

g

- typically referred to in the ‘disorder approach’ as a post-traumaQc stress syndrome or disorder Blinded by:

ess SIVENESS l ut IMPUL b ALARM ion FRUSTRATION t mo e re o m PURSUIT

• diagnoses • ‘empathy’ • ‘dysregulaSon’

- elevated startle response - flashbacks and nightmares - avoidance of whatever alarms - intrusive thoughts & memories - unable to focus and concentrate - hyper-arousal and hyper-vigilence

- irritability and impaQence

- erupQons of afacking energy

- self-afack and suicidal impulses

SIGNS OF STUCK PRIMAL SEPARATION EMOTIONS

in l e fe

g

- clutching, clinging, possessing, hoarding, acquiring, impressing, pleasing, etc - fragmented fixes & fixaQons with pursuit as the theme – winning, placing, hunQng, chasing, afracQng, demanding, reducing, seeking, enhancing, etc - preoccupaQons with altering - preoccupaQons with concealing PURSUIT oneself in pursuit of belonging, self in pursuit of belonging, love or significance love or significance

s s e tl u n b FRUSTRATION ALARM o i ot m ee r mo

- anxiety - irraQonal obsessions - irraQonal avoidance - anxiety reducing behaviour - an afracQon to what alarms - inability to stay out of trouble - recklessness and carelessness - afenQon deficits around alarm - chronic agitaQon and restlessness

- fits & tantrums - hilng and fighQng - obsessions with change - aggression and violence - rudeness and meanness - irritability and impaQence - erupQons of afacking energy - self-afack and suicidal impulses

THE SEPARATION COMPLEX – A LEGACY OF TRAUMA

- the telltale - the telltale (but reversable) marks of marks trauma of trauma on personality on personality -

stuck

stuck in defensive detaching and transference

stuck

ALARM

PURSUIT

stuck in defensive alpha or over-dependence

stuck

FRUSTRATION

stuck in a defensive flight from feeling & vulnerability (ie, a stuck stress response)

Copyright 2024 Gordon Neufeld PhD

20

Stress & Trauma - Dr. Gordon Neufeld

3 STRESS RESPONSE

THREAT S E F P A A C R I A N T G I O N

Hirose Seminars - Richmond - Nov 25, 2024

REMOVAL OF THREAT

2 RESILIENCE RESPONSE

S A F E T Y

Recovery of feelings felt >>> futility

4

1

in a ain lay i ^ac depn trushing brhe pode end Sng t m enc e

DEFENSIVELY

DEPRESS

DEFENSIVELY

DETACH

5 BRAIN’S INTERNAL BACKUP DEFENSES

4

emo

tio

in

FEELINGS

bra nal

prefrontal cortex sensory gating system

2

3

emotions stir us up & move us

internal feedback from the body

1

Feelings are the mind’s READINGS of emoQonal feedback

sensing outside world

4

REVERSE ATTACHMENT DEPRESS EMOTION

emo

tio

FEELINGS

in

bra nal

prefrontal cortex DE

MO STRESS

2

3

more emotion

more feedback from the body

1 sensing trouble

Copyright 2024 Gordon Neufeld PhD

21

Stress & Trauma - Dr. Gordon Neufeld

Hirose Seminars - Richmond - Nov 25, 2024

depresssion = fla^ened affect

threat to attachment can trigger a defensive depressing of emotion

e m

ot i o n

about defensive detaching If the separaSon faced is deemed unbearable, the brain can reverse direcSon of the pursuit in an automated a^empt to reduce the threat.

The a^achment drive itself cannot be reversed since it is the default and preeminent drive and only increases under threat.

• can be situaQonal or pervasive, physical or emoQonal, parQal or complete • can involve DEFENSIVE TRANSFERENCE to other persons such as one’s peers and famous figures (includes fantasy afachments) • can involve the DEPERSONALIZATION of afachment (ie, detaching from persons and afaching instead to pets, groups, objects, naQons, race, ideas, possessions, poliQcs, etc, etc, etc) • depersonalizaQon can also result in fragmented pursuit – FIXES & FIXATIONS – which are highly addicQng because they cannot fulfill or deliver care

Copyright 2024 Gordon Neufeld PhD

22

Stress & Trauma - Dr. Gordon Neufeld

Hirose Seminars - Richmond - Nov 25, 2024

g in ng cli

Some common a^achment-driven where the pursuit is divorced from its relaSonal context: goin g scor g fo sin r hu ing ses PURSUING PRAISE gs/s s o mile p hoarding s T G H IN N T IN W G E N N I e T s FI U AC lau ND ATTR EH app seeking g TH FIXES & collec si n afenQon Qng FIXATIONS chaseekin g statu s clutching THE CHASE eness m g a in s ir g acqu chasing marks pursuin G PLE AM ASI ING NG x e s r fo g chasin unQng evin h i g h c a pprov a PORNOGRAPHY al placing

Stress & Trauma The WISDOM ! of the !

Chapter Five Stress Response

Chapter 1

The RECOVERY of FEELINGS

More Wounding in today’s world teach less

empathy

SAFETY

stop more bullying

reduce increased percepSons of threat

reduce more

social interacSon

increase less scripSng & supervision

Copyright 2024 Gordon Neufeld PhD

23

Stress & Trauma - Dr. Gordon Neufeld

Resilience Response

Stress Response

Feelings that have been inhibited bounce back to enable opQmal funcQoning and the realizaQon of full potenQal

acQvaQon of

ATTACHMENT’S EMERGENCY RESPONSE TEAM alarm, frustraQon & pursuit FEELINGS that would interfere with performing or funcQoning in stressful circumstances are inhibited

Hirose Seminars - Richmond - Nov 25, 2024

Provide SAFETY through

• RELATIONSHIP • PLAY

RECOVERING FEELINGS Where the helper can be ANYONE but preferably a caring adult to whom the child or adult is a^ached or will a^ach

helper

- making it safe to feel -

P HI NS

PL

AY

RE

O TI LA

- parent - grandparent - relaSve - teacher - coach - expert - counsellor - therapist - caregiver - case worker - volunteer

applying relaSonal and emoSonal first-aid

ADULT

T R U - wounding S by others T - losses and I lacks N - neglect and G

(eg, parent, teacher, therapist)

We must HAVE their hearts before we can protect their hearts

rejection

CHILD

D E P E N - shaming or D put-downs abuses and E - violations N distress and C - adversity E

(or client)

Copyright 2024 Gordon Neufeld PhD

24

ng hi c at th

nu rt ur e

Hirose Seminars - Richmond - Nov 25, 2024

yt an

at ta ch m en t

Stress & Trauma - Dr. Gordon Neufeld

an d

ld ou

to

e id

en ga ge

v di

to caring adults and emotional playgrounds

Helping via Relationship • convey a strong CARING ALPHA presence to inspire dependence

• BRIDGE problems and all separaQons

• COLLECT to engage and invite dependence • COME ALONGSIDE emoQonal experience

RELATIONSHIP

• support EXISTING ATTACHMENTS with caring adults

Copyright 2024 Gordon Neufeld PhD

25

Stress & Trauma - Dr. Gordon Neufeld

Hirose Seminars - Richmond - Nov 25, 2024

Helping via Relationship • convey a strong CARING ALPHA presence to inspire dependence

• BRIDGE problems and all separaQons • convey TRUST in their strength to cope (vs over-protecQon)

• COLLECT to engage and invite dependence • COME ALONGSIDE emoQonal experience

• provide CARE (including food) in the context of connecQon

RELATIONSHIP

• support EXISTING ATTACHMENTS with caring adults

• matchmake to embed in CASCADING CARE

We are meant to fit together in hierarchical attachment arrangements of CASCADING CARE as opposed to contrived arrangements based on social roles, gender stereotypes, prevailing assumpQons of equality, or parQcular dynamics between parents and children or between partners of a couple or in friendship

a NATURAL arrangement in harmony with the dynamics of afachment and the principles of development

Our objective should be to embed in CASCADING CARE as opposed to pushing for independence or promoQng self-care

Helping via Relationship • convey a strong CARING ALPHA presence to inspire dependence

• BRIDGE problems and all separaQons • convey TRUST in their strength to cope (vs over-protecQon)

• COLLECT to engage and invite dependence • COME ALONGSIDE emoQonal experience

• provide CARE (including food) in the context of connecQon

RELATIONSHIP

• support EXISTING ATTACHMENTS with caring adults

• matchmake to embed in CASCADING CARE

• create SAFE SPACES for feelings to bounce back

Copyright 2024 Gordon Neufeld PhD

26

Stress & Trauma - Dr. Gordon Neufeld

SPACE FREE :

T wounding R U teaching S T problemI solving N screens & distractions G

ADULT

(eg, parent, teacher, therapist)

CHILD

Hirose Seminars - Richmond - Nov 25, 2024

FREE D SPACE : E P be upset E N D feel sad E N C E

(or client)

Create timely spaces for feelings to bounce back • AFTER times of stress including separation, school, strained interactions, discipline, special performances, wounding, loss, etc • ideally BEFORE sleep or the passing of time interferes with the ability of the thinking brain to interpret emotional feedback and link to the situations that stirred one up • FREE of digital pursuit (social or videogames) and other competing activities • FREE of problem solving, judgment, correction or teaching • through RITUALS involving safe relationships and/or emotional playgrounds

Through another’s attachment to us, we can BE their ANSWER even when there are no answers: • BE their HOME

• BE their place of REST • BE their sanctuary of SAFETY • BE their SHIELD in a wounding world • BE their REASON for holding on • BE their source of WELL-BEING The answer is in BEING - not in DOING or SAYING or KNOWING the right things – when empowered by the other’s attachment to us.

Copyright 2024 Gordon Neufeld PhD

27

Stress & Trauma - Dr. Gordon Neufeld

Hirose Seminars - Richmond - Nov 25, 2024

RECOVERING FEELINGS Where the helper can be ANYONE but preferably a caring adult to whom the child or adult is a^ached or will a^ach

helper

- making it safe to feel -

PL

AY

L RE

AT

P HI NS O I

- parent - grandparent - relaSve - teacher - coach - expert - counsellor - therapist - caregiver - case worker - volunteer

l rea

PLAY

for

NO T

T NO

wo rk

applying relaSonal and emoSonal first-aid

expressive

Copyright 2024 Gordon Neufeld PhD

28

Stress & Trauma - Dr. Gordon Neufeld

Hirose Seminars - Richmond - Nov 25, 2024

Harness the Power of Play • to safely engage and DISTRACT in alarming situaQons

• to provide a bubble of SAFETY in a • to LIGHTEN the distressing Qmes emoQonal load • to aid the RECOVERY of feelings so that the stress response does not get stuck

• to give the brain a chance to REST and RECOVER PLAY • to provide for SAFE EXPRESSION of primal emoQon

• to set the stage to access SADNESS when emoQonally ready

When drawing into play, we are transferring into the arms of NATURE itself so it can gently and wisely restore lost feelings

EmoSons are easier to feel when one step removed from real life

EmoSons are not at work, so the inhibiSon of feelings is reversed Play is safe so feelings won’t get hurt

Words or their lack, do not get in the way

EmoSons are freer to move and so more likely to be felt and idenSfied

Feelings of fuSlity are much easier to access

Feelings are recovered when emotions are at play

ENCOUNTERS WITH FUTILITY

Copyright 2024 Gordon Neufeld PhD

29

Stress & Trauma - Dr. Gordon Neufeld

Hirose Seminars - Richmond - Nov 25, 2024

Suggestions for Harnessing Play • engage in play by giving PLAY SIGNALS, like a bit of silliness, singing, wearing a playful cape • playfully ENGAGE in games, puzzles, stories, music, movement, drama, theatre, etc • provide MATERIALS to draw, paint, construct, make crans, make music, priming the acQvity where necessary

• set the stage for made-up STORIES, so their emoQons can drive something other than nightmares • sing or hum LULLABYtype songs if possible, to harness their emoQonal and connecQve power

PLAY

• if defended against closeness, engage in PLAYFUL CONNECTION, providing brief ‘accidental’ experiences of contact that are able to disarm

• engage in the CULTURAL PLAY, ie, the dances, music, art, of their culture of origin

Inviting Instincts & Emotions to Play • provide opportuniQes to play out ALARM as well as alarming scenarios, while safely in the context of play where it is one step removed and doesn’t count for real

• give SEPARATIONTRIGGERED-PURSUIT safe expression through games or acQviQes characterized by the hunt, the chase, or the find • provide plenty of opportunity for PRETENDING to be someone or something else

• give residual FRUSTRATION some playful expression via games of construcQon and/or destrucQon

PLAY

• give ALPHA insQncts safe expression through playing the leader, the boss, the superhero, the rescuer, the one in charge, the one giving the orders

• give DEPENDENT insQncts safe expression through playing the baby, the pet, the sick, the wounded, the one in need of care

Copyright 2024 Gordon Neufeld PhD

30

Stress & Trauma - Dr. Gordon Neufeld

Hirose Seminars - Richmond - Nov 25, 2024

... in our pursuit of happiness PRESS PAUSE

... in avoiding negaQve thoughts ... in afempQng not to be upset ... in trying to stay in perspecQve ... in afempQng to stay opQmisQc ... in trying to cheer each other up ... in pulng limits on grief and sorrow ... in denying that the glass is half empty ... in trying to change the Eeyores into Tiggers

PLAY

l rea

y ap r e th

for

NO T

T NO

wo rk

into the SADNESS whose task it is to facilitate needed endings, strengthen as required, and deliver us back to what happiness exists

expressive

Copyright 2024 Gordon Neufeld PhD

31

Stress & Trauma - Dr. Gordon Neufeld

Hirose Seminars - Richmond - Nov 25, 2024

RECOVERING FEELINGS

helper

- making it safe to feel -

PL

AY

L RE

AT

P HI NS O I

RECOVERING FEELINGS - making it safe to feel -

vs adult therapeuSc techniques & methods

vs treaSng children directly

vs teaching emoSonal management vs cogniSve and raSonal approaches

vs promoSng ‘posiSve feelings’

helper

vs promoSng selfcare and stress management

P HI NS

PL

AY

RE

O TI LA

vs trauma debriefing & correcSng percepSons

applying relaSonal and emoSonal first-aid

Copyright 2024 Gordon Neufeld PhD

32

Conquering Anxiety

Strategies for Helping Your Anxious Students Dr. Caroline Buzanko, R. Psychologist www.drcarolinebuzanko.com info@korupsychology.ca

Anxiety is the most common mental health problem in kids K-12… & the leading reason for children’s emergency room visits and hospitalizations

2

Untreated anxiety is the leading predictor of depression in teens & young adults

drcarolinebuzanko.com

1

70% of all mental health problems begin in childhood and adolescence

Anxiety has tripled since COVID

Anxiety Impairs Daily Functioning • Sleep!!!

• Academics • Social interactions • Happiness and outlook • Family relationships • Doing things/going places • Nutrition • Self-care • Independence 5

ADULTS to Understand

drcarolinebuzanko.com

2

What is anxiety?

7

Run!

Fear and worries are here to stay • Normal, protective feeling • Necessary for survival • Its ok!

• Temporary in the moment • Not dangerous • Not to be eliminated or avoided • Can help motivate & energize us 9

drcarolinebuzanko.com

3

The brain was built to protect us…

However, while society has changed so much even in the past two decades, our brain has not changed in hundreds of thousands of years…

10

Society is now created in a way that makes that brain meant to protect us to actually harm us

11

Worries to be expected Developmentally appropriate fears • Survival: separation, danger

Life transitions • New school or job, new relationships, teenage years, transition to adulthood

Stressful experiences • New or unfamiliar situations 12

drcarolinebuzanko.com

4

Worries to be expected Infant/ Toddlers

• Separation • Novelty • Loud noises • Shyness, fear of strangers • Santa

Preschool

Early Childhood

• Animals, dark, thunder, fire • Nightmares • Monsters & shadows • Novelty

• Fear of death or ghosts • Separation • Dark • Getting lost • Thunder

Elementary

• Changes • Performance • Getting sick or hurt • Animals, monsters, ghosts • Natural disasters

PreAdolescence

• Home alone • Family or pets • Rejection • Mortality, health

Adolescence

• Social • What others think • Family getting sick • School performance • World events • After high school!!!!

Normal Worries

TEMPORARY

DO NOT INTERFERE WITH FUNCTIONING

STILL SUCCESSFUL IN ACHIEVING GOALS

14

BEGINNING

MIDDLE

END 15

drcarolinebuzanko.com

5

16

Common Vulnerabilities Among all Emotional Challenges

High levels of negative affect Tend to view their emotional experiences as negative Aversive reactions that lead to efforts to avoid and suppress them.

17

What’s going on for Suzie?

(What can’t she handle?)

drcarolinebuzanko.com

6

Common Vulnerabilities Among all Emotional Challenges

High levels of negative affect Tend to view their emotional experiences as negative Aversive reactions that lead to efforts to avoid and suppress them.

19

High levels of negative affect • Constant worries impairing daily functioning • Frequent panic attacks

20

Views emotional experiences as negative • Why can’t I be like everyone else?

• I am deficient • Worries and panic are awful When they evaluate the emotion: Snowball effect – the more she thinks about everything, the more panic symptoms intensify

drcarolinebuzanko.com

7

Aversive reactions that lead to efforts to avoid and suppress them.

• Reassurance seeking • Avoidance

22

Different parts of the brain that activates worries need different strategies

Amygdala Pathway: Physiological

• Oldest, quickest, strongest • Talking will escalate the problem 24

drcarolinebuzanko.com

8

Amygdala Based Memories: Emotional Memories • Out of awareness • Remembered very differently from conscious memories

25

Might not have no clue why

26

Cortex Pathway: Thinking

drcarolinebuzanko.com

9

Ruminate Talk to self Try to problem solve

Visual images Imaginative worries

The brain cannot tell the difference between what it actually sees and what it imagines

29

Expecting something bad to happen Kids continue to worry themselves with their own thoughts

30

drcarolinebuzanko.com

10

Anxiety-Based Schemas The world is a scary place and I am vulnerable

Everyone is predisposed to anxiety.

drcarolinebuzanko.com

11

Anxiety is all in how we respond • Based on how we perceive the demands of the situation.

• Anxiety makes the demands feel way bigger than what they believe they can manage.

34

Social disconnection and loneliness Local and world news

Current State of the world

Social media

Far more:

Identity and body Issues

Worthlessness

• Depression • Self-harm • Suicide

Multiple pressures and high expectations

Helplessness

Major Psychological Risk Factor

Loneliness Poor School performance

Screen time

Self-esteem

• Impairs resilience • Contributes to everything we worry about as parents

Depression

Disordered eating

Withdrawal

Anxiety

Suicidal planning Suicidal ideation

drcarolinebuzanko.com

12

Self-esteem False messages to avoid rejection • So happy!

• So beautiful!

“Likes” worsens self-esteem • Others won’t like the “real” them.

Massive-Scale Emotional contagion We begin to experience the same emotions as others without our awareness • Long-lasting moods (e.g., depression) can be transferred through social networks

Disrupts connections.

Especially family connections.

drcarolinebuzanko.com

13

Disrupted Attachment

Family is the most important relationship overall development.

Important for discovering: • Self • Values • Personality • World

Bullying doesn’t happen privately anymore  

        





  

Sending unsolicited and/or threatening e-mail.

Encouraging others to send e-mail or to overwhelm the victim Posting/spreading rumours.

Making defamatory comments online Sending negative messages Sexual remarks Posting the victim’s personal information Hate speech Impersonating the victim online Harassing the victim Leaving abusive messages online, including social media sites Sending the victim pornography or other graphic material that is knowingly offensive Creating online content that depicts the victim in negative ways Trolling Cyberstalking Hate raids

41

Violent Images

HIGH LEVELS OF DISTRESS

drcarolinebuzanko.com

DISORIENTATION

FAULTY INFORMATIONPROCESSING

14

• Weaken kids’ ability to manage emotions

Exposure

• Contributes to anxiety

Frontal Lobes

Poor self-regulation because resources used up • Poor emotion regulation • Increased emotional reactivity • Proactive aggression • Anti-social behaviours

Maturity

Capacity to focus & self-regulate diminishes Emotion Regulation and Impulse Control

Stunted growth of cognitive skills

Exert control over the amygdala and emotional responses

Immature brain & delay in maturity

Critical for focus, regulating behaviour, and decision-making:

drcarolinebuzanko.com

15

Technostress • Hard to detach = chronic stress • Don’t receive an immediate reply to a text = anxiety and isolation • Technology-related anxiety (e.g., pressure to respond immediately) • Shame & stigma if not connected • Validation through social media

46

Digital Immigrants vs.

Digital Natives • Hard to detach = chronic stress • Shame & stigma If not connected • No issue big enough to risk being disconnected

Anxiety Intervention is about…

Breaking the cycle that fuels anxiety

drcarolinebuzanko.com

16

Kids learn anxious behaviours from adults in their lives 49

Overly self-critical models

50

Overly Critical, Impatient, or Hostile People

drcarolinebuzanko.com

17

Over-Nagging and Unrealistic Demands • We place more demands on children than adults • Constant correction and nagging can erode relationships and discourage autonomy • Would we treat our coworkers or friends the same way?

Unhelpful Interactions can Create Loneliness • Adding stress • Failing to meet their needs • Unwittingly responding in punishing ways, even when trying to be supportive

Talking too much or asking lots of questions

drcarolinebuzanko.com

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Unsolicited Support vs.

Perceived Support • Swooping in can: • Undermine the equity in the relationship • Create a sense of obligation • Independence and self-esteem threatened • Feel invalidating • Seem unsympathetic • Shut down communication

Medications 57

drcarolinebuzanko.com

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58

Enabling Accommodations

Accommodation Behaviours Participation

• Assist in checking behaviours • Assist in avoidance • Reassure

Modification

• Prevent anxiety provoking situations 60

drcarolinebuzanko.com

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Accommodation Accommodation

Accommodations worsens anxiety long-term

Accommodation

Anxiety more impairing and severe with poorer treatment outcomes 61

Accommodations are reactive. They take away kids’ ability to self-soothe and problem solve.

Avoid anxiety situations Adjusting routines Allow them to be excused; slow-re-entry Distract them or stop thoughts Alternative place for lunch Fixed schedules and transition warning Stress balls Minimize anxious feelings Breaks/office visits

62

Get stuck in constant need for reassurance

Reassurance

No skills developed Minimizing 63

drcarolinebuzanko.com

21

Brain in high stress state = amygdala kicks in and becomes a stop sign for information and any rational thinking

64

Anxiety…

• Wants certainty • Wants predictability • Wants comfort

Avoid traps • Others jumping in to help or continuously avoiding : • Changes brain & ingrains anxiety • Makes individuals even more vulnerable: Confidence and resilience stunted • No opportunities to experience success managing emotions and situations • No opportunities to learn (e.g., that anxiety is not dangerous)

drcarolinebuzanko.com

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Physically

AnxietyDriven, Maladaptive Response

Cognitively

Behaviourally 67

Maladaptive coping strategies Anything to avoid or reduce emotions develop and maintain challenges

68

Accommodations & Maladaptive Coping Strategies Become Safety Behaviours!

(Used to attempt to minimize or prevent something bad from happening)

AVOIDANCE

EXCESSIVE CHECKING

RITUALS

SEEKING REASSURANCE

SAFETY AIDS

69

drcarolinebuzanko.com

23

Others

Breaking the Cycle: Everything that Maintains Anxiety

Negative thought patterns Inability to manage emotions effectively

Maladaptive Coping

70

May as well figure out how to navigate them

71

Remember: How we respond to emotional experiences develop and maintain challenges.

Thus, the goal is to: • Change responses to emotional experiences • Create new pathways in the brain – new learning and memories • Target the problematic emotion regulation strategies people use

NOT to eliminate or reduce the intensity of emotional experiences – Impossible!

72

drcarolinebuzanko.com

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The # 1 thing they need to learn?

73

How to effectively experience anxiety (with less distress and avoidance) 74

Mindful emotion awareness Increasing awareness and tolerance of physical sensations

Core skills

Challenging automatic thoughts and increasing cognitive flexibility.

Identifying and modifying problematic emotional behaviours.

Integration of above skills through emotion exposure to master adaptive responses

drcarolinebuzanko.com

25

Connect

Adult perceptions

Worries & Stress are contagious

drcarolinebuzanko.com

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Good Role Models: No one is immune • Empowering • Promotes bravery, confidence, & resilience

Good Role Models • Being scared & doing it anyway • Display vulnerability & cope out loud • Model effective coping • Seek and receive help • Recognize own unhelpful thoughts and behaviours

Buy-in & Tolerance • Education (especially outcomes of traps) • Awareness of traps • Pros & cons of traps • Values • Desired outcomes

drcarolinebuzanko.com

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27

Reassuring Suzie in the morning Pros

Cons

82

Expectations

Self-fulfilling prophecy

83

drcarolinebuzanko.com

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Emotion Coach

Use mirror neurons Brain can’t tell the difference

86

We show confidence = They FEEL confidence

drcarolinebuzanko.com

29

Emotion coach Coaches avoid traps: • Reassuring • Answering questions • Reviewing the schedule excessively • Answering every phone call or text message • Checking

Emotion coach Coaches • Validate • Show confidence with open-ended questions.

• What are you going to do?

• How are you going to figure that out?

Coaching Cues • Show confidence: They can figure it out • Collaborate ideas re: how they can figure it out • Help them make predictions • Focus on learning • How did you do?

• What went well?

• What did you learn?

• What will you do differently next time?

drcarolinebuzanko.com

30

Confident

Supportive

Effective Response

Talking will only escalate the problem 92

Give space for regulation

drcarolinebuzanko.com

31

Effective Communication Tips

Talk less listen more

Focus on connection & safety • Empathy & Physical safety • Validate & acknowledge • How they are feeling • How they perceive the situation • Be present with the situation yourself • Being present is better than words

Effective Emotion Coaches

Be prepared!

Better yet, ADJECTIVE!!!

Let me see if I got that. You said…

Did I get it?

Is there more?

That makes sense…

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Suzie’s Mom Learned reasonable vs. excessive Modelled her own emotion regulation Practiced validation • Acknowledging fear • Acknowledging the physical sensations Collaboratively created a plan on new ways for mom to respond • Asking open-ended question in response to Suzie’s questions (e.g., what do you think?)

• Responding to one call or text a day when there are no classes • Specific guidelines when a doctor’s visit is warranted • Do opposite of what anxiety wants!

97

Buy-in & Tolerance • Education (especially outcomes of her traps) • Awareness of her traps • Pros & cons of her traps • Values in her role • Desired outcomes for Suzie

98

Biggest Barrier to Success?

Motivation for Change

Inspire

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Inspire

101

Otherwise, you get resistance

• Emotional distress directly related with hesitancy towards engaging in the work.

• We MUST identify what is more important to them than feeling uncomfortable

102

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Suzie’s Cost Benefit Analysis Benefit of anxiety Protection – alert to potential dangers Makes me feel safer and more prepared Better liked Prevent judgment Responsible & taking good care of my health Easier & more comfortable

Cost of anxiety Too upset and reactive Social isolation Personal relationships affected Academics affected No time for hobbies and self-care Time consuming!

Not sustainable Chronic physical symptoms Loss of self Effortful to feel overwhelm No joy in life

What is Important And how is anxiety getting in the way?

104

• Why they want to control their own life • How exhausting anxiety is • How life will be different • What they are missing out on

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Letter to your future self For when your future self gets nervous

106

Collaboratively Create Clear Goals How do emotional experiences cause problems in your life

What needs to change?

All the things anxiety makes you avoid • Seeing friends • Sleepovers • Birthday parties • School • Tryouts for sports (and therefore sport teams) • Sleeping in own bed • Making new friends

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Goals that promote self-efficacy – I can do it!

• • • •

Boost rationale Connects strategies to what’s important to them Gives us focus Track progress 109

Clarify expectations

What’s the problem with this goal:

To be less anxious 110

Clarify expectations • We are human!

• We cannot eliminate emotions & the discomfort • We cannot change our thoughts

111

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SMART GOALS

112

Key Concern

Unable to leave the house without very specific criteria being met.

Leads to everyone arguing, feeling overwhelmed, and late.

Concrete Goal 1

Specific: By October 22, Suzie will leave the house on her own. She will use her skills instead of asking for reassurance.

Leaving the house despite the unknown. Measurable: Track the number of times Suzie asks for reassurance. Track her use of strategies.

Achievable: Identify realistic and feasible strategies that will work for Suzie’s personal needs and leave enough time to get ready.

Relevant: Learning to cope is crucial to break the dependency traps that are maintaining anxiety. This will improve Suzie’s emotional well-being – (the primary concerns), as well as her relationship with her mother and morning.

Time bound: Implement strategies immediately and continue to monitor until our next appointment.

Necessary Steps to Achieve Goals Identify and create a plan to address all maintaining variables Define & set clear boundaries and expectations  If Reassurance shows up, Mom will point to the plan  Write & post boundaries and expectations Implement

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Necessary Steps to Achieve Goals Skill building:  Awareness  Acceptance (of discomfort)  Detach Practice  Leaning in

Monitor  Effectiveness of the established plan  Obstacles  Adjust as needed

Address barriers to success Individual Barriers

• Willingness, commitment, and consistency • Irrational thoughts and negative mindset • Self-concept and self-efficacy • Avoidance

Familial Barriers

• Mother's Anxiety • Unintentionally reinforcing avoidance behaviours • Poor modelling • Codependency • Family beliefs and attitudes • Parenting style

External Barriers

• Social pressures and dynamics • School stressors • Social media influences • Time constraints • Therapeutic alliance

Externalize & Expose

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Emotions can be helpful

But sometimes they can be a sneaky trickster trying to make you think there is something wrong….

119

Mishmash of a Brain Pieced together over millenia • No one CEO. Lots of sub selves.

• Different parts of the brain can communicate and work together easily • Others only have indirect contact • Can hold contradicting information in different parts of the brain

120

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Subselves argue & fight for control

The Best Equipped Takes over

• A lot of back and forth • Integrative – working through a scenario • Confrontational – competing to win • Different parts of the brain activated depending on the selftalk • How we talk to ourselves influences our behaviours

Expose it • Understand emotions and how they work to take control • Yep, there’s Bob, that’s what it does.

• Wow, it is really working hard to make me think the worst today!

• Yeah, we knew it’d show up now. It doesn’t want me to do this presentation.

• It wants me to avoid new things.

• It really knows how to try to stress people out.

121

Catastrophizin gCatastrophizing Carl Carl

Mindreading Mandy

Humiliating Hannah

Perfectionist Paula

Overestimating Oscar

Rigid Richard

Avoiding Alison

Permanent Pete

Fortune Telling Fran

Scarcity Sam

All-or-nothing Al

Grumpy McGrumperson

Self-critical Carla

Mindreading Mandy

Negative Ned

NOVEMBER

Rigid Rick All-or-nothing Allie Avoidant Alison

Missing out on • Seeing friends • Learning opportunities • Wasting time that could be doing other things

Self-Critical Carla Catastrophic Cam Perfectionist Pete Fortunetelling Fran Mind reading Mandy Negative Nellie

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KIDS to Understand

Anger • Alerts us to threats or injustices • Protect our well-being

Emotions Are Adaptive!

Fear • Alerts us to danger • Protects us from harm Joy • Positive reinforcement for doing things that promote our wellbeing and survival Shame • Prompts self-reflection, processing, and change • Maintains social harmony

Tell us something about reality

Sadness • Alerts us to loss, separation, or unmet needs and allows us to process the event • Promotes personal growth and deeper social connections Excitement • Propels resilience and growth • Fosters curiosity, creativity, learning, and adaptability

125

Emotions Help Us Navigate Situations Keep us safe or move us towards goals

No Anger

No Fear

Picked on

No Disgust

Eat pooh

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Get eaten

No sadness

No Misery

No future motivation

Unable to process loss

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Teach the connection!

• All are just as strong and important

Feelings

• All influence each other and re-trigger emotions

Emotions

Behaviours

Thoughts

Change Relationship with Emotions From judgmental and critical stance in which they try to avoid, minimize, or eliminate

Curiosity is a key response to emotional experiences Becoming an Emotion Detective 129

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Core Skill: Mindful Awareness of Emotion

Establish a Framework

Physical Feelings • Prepares to take action

AnxietyDriven, Maladaptive Response

Emotion

Behaviours

Thoughts

• Nonverbals • Compelled to take action

• Focus on perceived threats 130

131

Raise Awareness: Mindfulness Build awareness of: • What is happening in the world around us • What the feeling is • What is happening in the body • What is happening in our mind • How all of these relates to each other, and to our behaviours 132

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Mindfulness is Key

NOT ABOUT RELAXING

NOT ABOUT CHANGING EMOTIONAL EXPERIENCES

NOT ABOUT FIGHTING OR IGNORING THEM

133

Worry Likes to Keep us Stuck!

Negatively influences affect, thoughts, behaviours

Thoughts of Past or Future

Keeping thinking of past or future

Negatively influences affect, thoughts, behaviours

At the expense of valuable information now

134

• Need to stay here and attend to the current context • To keep prefrontal cortex online • To attend to corrective information • To learn!

Versus getting sucked into worries, which intensifies the emotional experience and keeps us stuck

135

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Mindfulness

IT’S ABOUT LEANING INTO THEM & GIVING THEM SPACE 136

Stress is inevitable so need to learn to go with the flow, stay mindful, & accept what we can’t change

Acceptance Welcoming anxiety and all it brings.

And living life anyway.

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Anxiety/Emotion Dial

0

100

Acceptance Dial

0

100

Understand Anxiety & What it does….

Emotions (Anxiety) Manifests

Physically

140

Physiological

Emotion

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• Most powerful • Usually shows up first • Triggers emotional response before we even realize it • Helps us to prepare to react to the situation

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Understand Anxiety & What it does….

•

When the alarm goes off, the body gets ready to fight or run

Even when it is a false alarm!

The brain (and body) cannot tell the difference.

Our body is going to respond based on its best guess

143

Our brain isn’t going to wait around

144

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Our brain doesn’t care if its hazardous or not Our brain will respond based on what we need to survive

145

…What it feels like…

146

• Released hormones • Increase heart rate • Increase blood pressure • Increase energy • Increase alertness • Slows other processes (to fight or run away) • Secretes acid into the stomach to empty it

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They start to worry about the physical feelings, which are distressing, which they will do anything to stop Become reactive Misinterpret as dangerous and leads to more fear, more sensations…

Feelings Subject to Distortion • Wrong context • Need to learn to correctly interpret our interoceptive signals • Better able to interpret signals • Can make more adaptive decisions • Boost resilience • Better emotion regulation and overall emotional functioning

149

Feel More but can’t interpret what the feelings mean Do whatever they can to get rid of them…

150

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… Or control what they can in their external world

151

Of course you feel that way!

Validate & Normalize Feelings

No wonder - your adrenal glands sent out all that stuff that’s really uncomfortable.

Quick Tip 153

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Understanding the FUNCTION of emotions also critical to accept & tolerate them!

154

Anger • Alerts us to threats or injustices • Protect our well-being Fear • Alerts us to danger • Protects us from harm

Emotions Are Adaptive!

Joy • Positive reinforcement for doing things that promote our well-being and survival Shame • Prompts self-reflection, processing, and change • Maintains social harmony

Tell us something about reality

Sadness • Alerts us to loss, separation, or unmet needs and allows us to process the event • Promotes personal growth and deeper social connections Excitement • Propels resilience and growth • Fosters curiosity, creativity, learning, and adaptability

155

Emotions Help Us Navigate Situations Keep us safe or move us towards goals

No Anger

No Fear

Picked on

No Disgust

Eat pooh

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Get eaten

No sadness

No Misery

Glutton for punishment with unattainable goals

No future motivation

Unable to process loss

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Understand Function of Emotions

Disappointment

MUST have physical reactions to alert us to what is happening • Cannot change reactions without this understanding

Hurt

Fear 157

158

Understand the truths!

 Our bodies are intuitive and designed to protect us.  It doesn’t make sense if our body was doing something to harm us.  Trust the body to do it’s thing and get out of its way. We don’t need to add commentary.

Hearts can beat hard all day long and stay healthy

Understand the truths!

We’d be extinct if we always fainted in danger.

• Fainting happens with LOW blood pressure.

• When anxious, lots of blood is flowing!

Forcing ourselves to swallow won’t help us swallow • Hum or sing

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Our body will always compensate for breathing

Tension builds when we are not doing anything with the energy • Get moving: Shake!

Emotions come and, more importantly, they go

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This is normal!!!

And NOT dangerous!

160

Understand how stress shows up = Adaptive thinking

Of course, I feel uncomfortable!

I know what my body is doing.

I can handle this.

The mystery is gone BONUS: Expecting physical sensations helps reduce signals to amygdala

I understand what my body is doing I can handle what my body does

Self-Coach

I can handle discomfort I know what I can do now

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Essential to Reconnect Physiologically Diz z y

Racing

Tens ion

Achy

Sore

H ot

Cold

Tingly

Relaxed

Trembling

N umb

Sharp

N aus ea

Breathles s

Shivering

Sweating

163

Trouble s wallowing

Tired

Dizzy

Shivers

Racing

Increased heart rate

Tension

Weak legs Ringing ears

Achy

Identify& describe TWO places anxiety shows up.

Stronger on left or right?

Sore Hot Cold Tingly Numb

Blurred vision Muscle tension Shaking Trembling Chest pain

Sharp

Headaches

Breathless

Burning skin/sweating

Shivering

Blushing

Sweating

Changes in breathing

Trouble swallowing

Stomach-ache/ Nausea

Tired

Relaxed

164

When we label the different parts of emotions and our experiences, we: • Change our interpretation of them • Change how our body responds • Dampen amygdala’s false alarm • Turn on prefrontal cortex • Make adaptive decisions • Learn that we have control over our responses • I know what you are & I know how to handle you

• Avoid getting sucked in – it’s just a piece of information 165

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Can’t just talk about it.

Practicing Emotional Awareness Key! 166

167

Mindful Mood Induction

168

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Mood Induction Practice • Observe reactions, whatever comes up physiologically, in an objective and nonjudgmental way • Third party reporter • It makes sense I feel______________________ • Focus on the PRESENT MOMENT • Grounding techniques

• Debrief at the end about all the reactions that happened, in an objective and nonjudgmental way

169

Emotions are simply emotions!

They will take over if we aren’t self-aware in the moment.

Use them as a learning opportunity, get curious!

170

Practicing Emotional Awareness with UNCOMFORTABLE Feelings is Key! 171

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Nonjudgmental Awareness of the NOW is Foundational

• Without mindful awareness and acceptance of emotions, can’t move on with any of the other work to strengthen more adaptive responses • Therefore, need LOTS of practice and experiences with uncomfortable feelings

172

Focus on Physical Sensations Be with it • Observe it vs. think about it • Breathe into it • Expand it • Allow it to be there Sensations might change but they might not. It doesn’t matter!

173

Learning?

• It might change • It’s temporary if you sit long enough with it • Staying curious keeps our prefrontal cortex on

174

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Anxiety is not in the situation but the feelings we have and

How we perceive those feelings Same mindful acceptance applies with thoughts

Cognitive

Emotion

176

The brain cannot tell the difference between what it actually sees and what it imagines

& will react as truth 177

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Mindful Awareness & Acceptance of Thoughts • Infinite amount of thoughts • (4.617 x 10^61 potential thoughts= four hundred sixty-one duodecillion and seven hundred decillion)

178

• Constant stream • Unaware of most of them • Even when they affect how we feel • Easy to get stuck on one • If sensitive, the bizarre ones will always stand out

We can't control our thoughts – only our response to them Be aware and accept it for what it is: A random thought

180

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Success at controlling obsessions _________________________________ 1 10 Effort in trying to control obsessions _________________________________ 1 10 Back & forth battle where obsessions typically always win…

Core skill Mindful Awareness & Acceptance of Emotion:

Thoughts

Sit with, accept, & acknowledge worries

Focus on raising awareness to thoughts Recognizing them

Acknowledging them

Disentangling from them

Accepting them

vs. trying to change thoughts

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Defusion

•Noticing thoughts vs. getting caught in thoughts

Past

Future Present

Emotions are simply emotions!

We can experience different emotions despite the exact same circumstances.

How we interpret them causes suffering.

They will take over if we aren’t self-aware in the moment.

Use them as a learning opportunity, get curious!

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Remember!

It’s NOT about the trigger…

187

Anxiety is not in the situation but the feelings we have and how we perceive those feelings

Did you know?

Fear and excitement feel the same in the body?

But how we think about it makes all the difference in the world….

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Threat vs. Challenge Response Not good or bad, different purposes Threat response: Goal is survival in situations we aren’t equipped to handle • Rush of cortisol to defend and protect Challenge response: Opportunity for growth where we tackle hard but manageable situations • More testosterone and adrenaline to help us achieve our goal

190

Our thoughts are not always trustworthy!

191

Stretch Make a list of things you or others have believed that you do not believe anymore

192

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Information from our eyes and ears only loosely connected to what we experience Mechanics of vision: The eye is like a camera • Light bounces off objects • Enters our eyes • Focused on the retina by the lens • Retinal image (2-D)

193

Knowledge Influences Sensory Information (e.g., all faces are always convex) Our knowledge/ experience misleads us into seeing the mask as convex

194

Bottom-up sensory information is overridden by topdown knowledge We interpret the information to create meaningful PERCEPTIONS of the world

195

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Automatic Negative Thoughts (ANTS)

Ghost Burglar

Scratch at the door Monster

Kidnapper

The first draft

These are only guesses!!

Wrong 99% of the time 197

Not about the trigger… …It’s just an Illusion

198

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Brain Shortcuts With these shortcuts it is really easy to get stuck with ONE interpretation (the automatic conspiracy END OF THE WORLD)

• Cuts out information to maximize brain resources • Helpful at times (e.g., repetitive stimuli) • Unhelpful when emotions kick in: Miss other possibilities • Become rigid and stuck

199

Cognitive Flexibility

But first, need to get unstuck

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Zoom Out! • When we are too close, we get drawn into the emotions of the experience and spiral to the easy way out.

• When we can create space, we can respond in helpful ways

202

Detach & Enhance

Get Unstuck: Detach Distancing • “___ is noticing ____ is having the thought that….”

• Use third person language Train, balloons, bubbles clouds, or leaves on the river Thank them Objectify

• What colour? How big? What shape? What texture? How would it move if it could?

Name that Story

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Detach

•Noticing thoughts vs. getting caught in thoughts

Make fun of worried thoughts Sing it Draw cartoons Literalization Mute it Say it really fast Say it in slow motion Mimic it Exaggerate it 206

Dismiss Worried Thoughts Dismiss Worried Thoughts

Demand more from worried thoughts

Roll my eyes

You’re so boring!

Is that all you got?

Is that the best you can come up with?

Big deal

So what?

Don’t you have something scarier?

Can’t you give me more?

207

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• Yep, that’s your story you’re trying to tell.

• Nice first draft. Nice conspiracy.

• This is normal.

• This is not an emergency.

• You’re annoying.

208

Create a Bingo Card of Strategies Past/Present/Future

Distancing

Train, balloons, bubbles clouds, or leaves on the river

Thank them

War of the Worlds

Objectify

Name that Story

Repetition

Humour

Paradox

Body Scan

Literalization 209

Remember!

Thinking flexibly is to be done PROACTIVELY Don’t try to change their mind!!!

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Ghost Burglar

These are only guesses!!!!

Scratch at the door

(Based on unhelpful trickster assumptions)

Monster

Kidnapper

Overestimation

ANTS Involve:

• Believe something bad is for sure going to happen Catastrophizing • Worse case scenario • Completely awful • Completely unmanageable

Overestimation

NOT good or bad BUT they

DO limit our flexibility

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• Believe something bad is for sure going to happen Catastrophizing • Worse case scenario • Completely awful • Completely unmanageable

71

Overestimation • About the likelihood of something happening Catastrophizing • About the importance of the event

Lead to spiralling

I made a mistake

They realize I am incompetent

I am going to be fired

My family is going to reject me

Homeless

Cognitive Flexibility • Lean into strong emotions • Keep our prefrontal cortex online by GETTING CURIOUS • Break anxiety maintaining cycles: Change relationship and response to emotion-provoking situations

216

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Cognitive Flexibility: Get Unstuck from Thinking Traps Goal is to increase flexibility in appraising situations  NOT to eliminate, replace, or fix thinking – this IS one possible way to look at the situation

• Respond in adaptive ways •

217

Ghost Dog

Acknowledge.

Detach.

Edit the first draft.

Burglar Sister

Scratch at the door

What are other possibilities?

Something fell in the Monster hall Kidnapper MOM

Possibility 1

Possibility 4

Situation

Possibility 2

Possibility 3

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Cognitive Flexibility: Co-Existence Important! (with other possibilities based on the NOW)

Burglar

Sister Dog

Kidnapper

Something fell 220

Unexpected event of the day & how you handled it 221

What are all the ways you could use a… Pen?

222

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Enhance Cognitive Flexibility with Helpful Open-Ended Questions Create a checklist • To generate alternative explanations

Alternative explanations

How would my friend interpret this? Grandma? Pet? Is there any shred of usefulness in this thought?

What would I get for buying into this story?

Am I going to follow my thoughts or my experience?

What advice would I give to someone else?

What have I not considered?

What evidence is there for and against this thought?

How much do I believe this is true? What do I know for sure?

If I were in a sitcom, what would be funny about this situation?

Ability to cope

• To acknowledge their ability to cope

What little change will help?

How would my successful future self-handle this situation?

What is going positively in my life that will help me cope?

How have I coped with emotional experienced in the past?

What aspect of this situation is easy to target?

If this was true, would I still survive?

If this was true, what are five possibilities re: where I will be in a year from now?

If this was true, what have I learned?

223

Be Creative!

MIXING UP THE DAY

FIND THREE WAYS TO LEARN ABOUT A TOPIC

FIND THREE WAYS TO SHOW WHAT YOU KNOW ABOUT A TOPIC 224

Chain of flexibility

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Columbo Approach • Guide them to create discrepancies • Can you read everyone’s minds?

• All the time?

• With everything? Or certain things?

• Examples?

Practice Cognitive Flexibility • Yes, And • Story re-write • Can try visualization • Externalization of voices • Problem-solving • Play devil’s advocate • Counterarguments

227

Hypothesis Testing Lots of experiments and experiences needed!

• What do I think will happen?

• How sure? (1-10)?

• Was the hypothesis right?

• What did I learn?

228

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Help them be thinkers Independent problem solvers to figure things out Without calls or texts Without fake crutches

229

(We can’t know, so avoid reassurance.)

Let’s figure that out.

What could you do?

230

What I know • • • • •

Where we’re going What time we’re leaving What I will eat for lunch Who is in my group Who our group leader is

What I don’t know • • • • • • • • • • • •

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Where I will sit Who I’ll sit with Weather?

What time we’ll get back Where the bathrooms are Bugs?

How much walking?

Allergic reaction Snack breaks If the bus will be on time How busy it’ll be How loud it’ll be

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Create opportunities

Modelling • I feel frustrated. I need to take a minute to think what to do next.

• Can you help me brainstorm ideas?

• That’s a tight timeline. I am going to plan this out.

• I am a little nervous; I have no idea what will happen. Let’s figure this out.

233

Perfectionist Paula Gets in the Way of Life

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Perfectionism is the most serious thinking trap & root of depression Focus on core concepts • Unrealistic expectations • Rumination • Need for approval • Concern about mistakes • Doubts about actions • Additional traps like circumstantial thinking , quality/quantity

235

Break into Parts

Helpful parts of perfectionism

Unhelpful parts of perfectionism

Helps us prepare

Become paralyzed

Helps us strive for excellence

Procrastinate & create more stress Stifles learning and growth Narrows our world Makes us perform worse

Perfectionism likes to work with Pals

• You never do anything right • No one likes you • Everything you do sucks • You always fail and will continue to fail

Break into parts • Good and not so good • This part is hard • I will focus on one step at a time

Henchmen Guesses

237

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All or nothing: I can’t do anything I can’t write I can brainstorm

I can follow a template

Math is easy

I can edit

Reading: Easy

Gym: easy 238

Build Procedural Thinking!

• Strive for excellence, but address unrealistic standards • Emotions related to expectations • Focus on what’s next (vs. circumstances, rumination, should’s)

What’s next?

What’s next?

What’s next?

The Importance of Mistakes  Talk about your own mistakes  Talk about others’ experiences

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Embracing mistakes: Mistake of the Day! What was this experience like?

What did you learn from this mistake What will you do the next time you are in this situation?

What advice can you tell others based on this?

Forging ahead • Avoid getting stuck • No need to ask why, lecture, or explain the problem • Have THEM think of the hows • How will they fix this mistake?

• How will they move on?

• How will they handle ______________?

Practice!

• Start with emotion free problems • Move toward emotionally charged problems

243

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Core Skill: Mindful Awareness of Emotion: Behaviours

Awareness& & Awareness Modification Modification Reaction ofof Reaction

Awareness of Interpretation & Flexibility

Situation

Awareness of & Awareness Acceptance Feelings of Physical Feelings

Core skills  Identifying and modifying unhelpful emotion-driven behaviours

Emotion

Body language 246

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What it looks like • Our body communicates how we are feeling • How would others know when I am feeling anxious by looking at me?

Motivational (behavioural response)

Emotion

Remember, emotions lead to behavioural responses to respond quickly to our environment

Anger

Assert, Flee, ThoughtsFear about the situation defend freeze

Shame

Avoid

& their belief of how they can manage also lead to patterns of behaviours

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Sadness

Support, withdrawal

Joy

Excitement

Connect, engage

Attend, explore

83

Behaviours: Internalizing • Withdrawn/isolated • Shy • Sad/irritable • Head/stomach-aches • Eating issues (under- or over-eating; food intolerances) • Sleep problems/Fatigue • Low self-esteem and confidence • Rejection • Repetitive behaviours/obsession • Difficulties concentrating, fidgety • Avoidance • Disorganized • Cry

• Easily triggered • Disrespectful

Behaviours: Externalizing

• Oppositional and defiant • Difficulty transitioning • Aggression/intimidation • Difficulties concentrating • Lies or steals • Temper outbursts • Restless/fidgety • Interrupts/Intrudes • Impulsive • Give up easily • Argumentative • Yell • Repetitive questions • Seek constant approval • Substance use

251

When someone avoids things they don’t feel comfortable with, they lose the chance to practice and grow

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Thoughts & Feelings lead to (avoidant) behaviours People will think I’m stupid

• I avoid speaking up in meetings

I feel like I will vomit

• I avoid going out

Everything must be done perfectly

• I avoid doing anything I can’t do perfectly

I am going to be in a car accident

• I avoid driving

People will think I am boring • I avoid hanging out with friends 253

With avoidance, they never learn!

Biased Thoughts

Safety behaviours

Never learn thoughts are biased and bad things might not happen or be as bad as thought.

Never learn they can cope on their own

Anxiety strengthened Worried thoughts seem believable

Hinders their ability to face challenges

254

Emotional (Avoidant) Behaviours Function: To reduce the intensity of the emotion

Overt Avoidance

Avoid situations, people, things

Subtle Avoidance

Avoid full experience of emotions

Cognitive Avoidance

Avoid distressing thoughts

Safety Behaviours/signals

Used to feel as safe as possible 255

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Emotional Discomfort

Brain is rewarded

Important!

Avoid

Feel better in the moment

MUST understand how their behaviours are maintaining, or even worsening, their emotional discomfort  The behaviour is reinforced in the moment, increasing the likelihood of using this strategy again in the future

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Remember! Short- and long-term outcomes of maladaptive vs. adaptive coping strategies Maladaptive Coping

Feel better in the moment

Worsens anxiety in the long run

Ingrains anxiety pathways

Adaptive Coping

Feel distressing in the moment

Tolerate & manage anxiety in the long run

Create new healthy pathways

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• But I end up missing school I ensure I look perfect to feel safe • But I fight with my mom against potential embarrassment.

I skip social functions to avoid rejection

• But I miss out seeing my friends and nurturing those relationships

I constantly check • But I miss out on things my health to stay in • Time consuming control and catch • Always worried and no anything early time for hobbies

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I fail school Homelife is tense

I will lose relationships and become isolated.

I disrupt relationships, lose self, become depressed

86

90% of what people learn is from what they experience

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Don’t underestimate the power of the anxious emotional brain!

• Change is neurological – we need to change the brain • Behaviours affect emotions more effectively than thought or talking • Brain is changed through EXPERIENCES • Can’t think or talk our way to change • Focus on strength (behaviours) rather than weakness (thoughts)!

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MUST DO THINGS DIFFERENTLY! Emotions become a disorder when we do what anxiety wants (i.e., feel better in the moment)

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Speed of recovery directly relates to your willingness to feel anxiety

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Resilience Ability to adapt well to adversity, trauma, tragedy, threats, or even significant sources of stress.

Suzie WHAT IS THE PROBLEM?

WHAT OUTCOME DO I WANT?

WHAT DOES ANXIETY WANT US TO DO?

• Need to make sure I look perfect in the morning • Need to make sure I am healthy

To go to school without • Guarantee worrying about how I perfection look or what others • Discuss colour will think wheel • Analyze every inch To get through a day • Reassure without worrying I am • See the doctor going to die. (Caroline every week to change: Still doing ensure I am healthy what I need to do • Check health status when I have a worried daily thought about dying)

WHAT NEEDS TO CHANGE? (& WHAT IS THE OPPOSITE?)

WHAT ACTIONS ARE NEEDED?

Control for certainty needs to change.

Therefore, • Go to school without checking • Doctor schedule and as needed based on specific guidelines

• Acknowledge henchmen • Drop into the body • Talk back (whatever) • Say goodbye to mom (without asking about how I look and without her telling me) • Write my symptoms if needed for next regular doctor appointment 264

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What am I going to do next?

(The Opposite of What Anxiety Wants)

Avoid judgment

Avoid rejection

Ensure Healthy

• Harassing mom to ensure I look perfect

Face uncertainty of possible judgment

• Leave without asking mom

• Skip social functions

Face uncertainty of possible rejection

• Go to social functions

• Waste time constantly checking • Fighting with mom

Face uncertainty of my health status

• Paint instead of checking Dr. Google

Suzie’s Homework • Going to school without reassurance • Tolerating uncertainty of whether she is sick • Making her own appointments • Filling up the car with gas • Going through her morning routine without consulting Dr. Google • Handing in work without mom checking it 266

Core skills Integration of all the skills through emotion exposure to

master adaptive responses

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Dare & Defy

Integrate Skills through Emotion Exposure Integrate skills to master adaptive responses • Talking not enough to change the brain!

• Doing makes stronger memories • Doing gives us experience • Quicker progress • Provoke STRONG EMOTIONS - MUST show up for learning to happen

Worry is…

Emotional exposures because the primary focus is not the specific situation, image, or activity but the emotion itself.

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Emotion Exposures Interoceptive

• Elicit distressing physical sensations

situations that provoke Situational-based • Face intense emotional reactions

Imaginal

• Confront distressing thoughts or emotions.

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Emotion Exposures Interoceptive

• Elicit distressing physical sensations

Situationalbased

• Face situations that provoke intense emotional reactions

Imaginal

• Confront distressing thoughts or emotions.

Combine for maximal benefits

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Goals for ALL Exposures PROCESS vs. OUTCOME • Based on something actionable • Targets distress

• Ensures they learn something new firsthand vs. anxiety reduction

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Exposure to LEARN

Anxiety is safe, tolerable, & temporary • Safety behaviours are not needed to tolerate anxiety or to stay safe • The amygdala will learn: This is not dangerous! (And stops sending the false alarm.)

Exposure to LEARN

Despite feeling anxious, I still did it • And… I can still live life and do anything, even while feeling anxious!

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Exposure TO LEARN • Something about the specific issue (based on their prediction) • Did the feared outcome happen?

• No • Less likely • Less severe and/or • Not as dangerous as I thought • Yes…

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Exposure to LEARN Despite feeling anxious, I still did it And… I can still live life and do anything, even while feeling anxious!

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Getting unstuck

Face Fear

Without the worst thing happening

Without safety behaviours

Or, if it does, they can handle It

Physical Symptoms are a Natural Response

• But often misinterpreted as dangerous, which creates a positive feedback loop • Often motivated to avoid these

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Interoceptive Exposure: Lean Into Discomfort!

• Confront worrisome body sensations • Evoke things they worry about

Ultimate goal: Tolerate the physical sensations • Without being scared of them (and therefore making them worse) • Without needing to engage in emotion-driven behaviours to reduce, avoid, or eliminate the feelings

Interoceptive Exposure Learning: The uncomfortable physical sensations are tolerable, temporary, and not dangerous.

• I am not • Having a heart attack • Losing complete control • Suffocating • Dying

Interoceptive Exposure Be prepared!

• We need their confidence in this process so we need to be confident ourselves

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Be Prepared!

Hyperventilate/fast breathing (dizziness)

Breathe through a straw really fast (breathlessness) • Hold your nose!

Jumping jacks, run on the spot or up and down stairs (increased heart rate)

Spin in place (dizziness, nausea)

Shake head side to side or draw a circle with your nose (dizziness)

Stare at hands for 2-3 min. (unreality)

Wear something tight around neck (tightness in throat)

Stare at ceiling light for 1 min. and then try to read something (blurred vision)

Get them to do whatever causes the feelings

Collaboratively choose a moderate & distressing exercise • Repeat it • Evoke sensations as intensely as possible • Sustain sensations beyond feared outcome limits • Repeat – especially with any “yeah but’s” • No distraction nor avoidance

• Record • Length of time & number of repetitions • Physical sensations • Intensity of sensations • Level of distress

• Assign for homework!

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Tolerating Uncertainty • Life is full of uncertainty: we can never know what is going to happen from one moment to the next • Brain will do whatever it can to avoid uncertainty • Build tolerance by going into the unknown!

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Become so good at managing ANY emotion that comes up.

Learn to respond differently through LOTS OF EXPERIENCES Anxiety Shame Guilt Rejection Disappointment Frustration Self-doubt

Being Ridiculous

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Rejection Practice Ask a store to stay open an extra 30 minutes for me Ask a stranger to take a selfie with me Ask for a bite of a stranger’s food at a restaurant Ask to make an announcement over the loudspeaker at a grocery store Ask a stranger for $50 Ask someone for their car Ask for a 50% discount at a store 288

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Setting up Exposure Set up the situation & collaborate a specific plan Address obstacles Address safety behaviours Honesty & Remind them how anxiety works Rationale and buy-in Test it out!

Validate & normalize Debrief & Evaluate Reinforce Keep going

Setting up Exposure

Set up the situation: COLLABORATIVELY Create a Menu of Feared Situations & Internal/External Stimuli Have a variety and match situations, thoughts, and physiological experiences Make it worthwhile: Include the hardest, scariest things they think are valid and need to be avoided

What do they have to learn?

What do they have to do to learn?

No more than 10

Remember: Focus on PROCESS vs. trigger or outcome, LEARNING vs. anxiety reduction

Reasonable Risk

Not absolutely risk-free but something people do everyday • Say something stupid • Do something embarrassing • Make a mistake • Sweat in front of others • Wear something atrocious • Ask someone out • Forget to lock the door • Go to the toilet in public

• Walk outside on a really windy day 291

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Feared Situations & Internal/External Stimuli Antecedents (Triggers to anxiety) Snakes Feeling nausea Trying something new Initiating an interaction Presentations Being with unfamiliar people Intrusive thoughts re: break-ins Intrusive thoughts re: house setting on fire

You are the expert and I need your expertise!

We will put our expert heads together to figure out the best plan.

Rate it Antecedents (Triggers to anxiety)

Predicted Awfulness

Walking by the snake cage

50

Standing by the snake cage for 30 seconds

70

Standing by the snake cage for 2 minutes

70

Opening the snake cage

80

Putting my hand in the snake cage for 30 seconds

100

Holding my hand in the snake cage for 2 minutes

100

Touching the snake

100

Holding the snake for 30 seconds

100

Holding the snake for 5 minutes

100

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Actual Awfulness

Later

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Collaborate

They get to choose what they want to do Several things can make it easier or harder (e.g., distance, time, people) Does NOT need to be easiest first MUST surpass the identified point at which the feared outcome is expected

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Setting up Exposure:

Collaborate a specific plan

Step-by-step plan On Monday morning at 10:00, I will: • Mindfully walk (focusing on my feet movement) in the direction of M’s desk.

• I will maintain a natural pace and posture with my eyes up • When I reach the intersection of desk, I will look at M and smile • As I reach the corner of M’s desk, I will say “Hi” clearly and audibly • I will continue walking past the desk to the photocopier to photocopy a document • I will return to my desk to note how I felt before, during, and after the exposure and rate the awfulness.

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Intense Anxiety or Panic Before the Attempt

Setting up Exposure:

Address Obstacles

• Drop into the body and review my goal and coping cards • Identify the first step and go anyway M is not at their desk • Practice walking past the desk • Try again when M is back • Do the exposure at the next alternate time I get called into a meeting • Do the exposure at the next alternate time

No Safety Behaviours Allowed!

(It’s only an illusion of safety anyway)

The Problem with Safety Behaviours Habits that maintain & worsens anxiety • No learning happens: believe the behaviour prevented catastrophe • Still trying to control anxiety (so never confront fears) • Effortful and exhausting (which causes more anxiety and dysregulation)

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Safety Behaviours

Any strategy to control, avoid, or reduce anxiety Sitting strategically (e.g., near exits)

Having someone with you

Carrying a safety object

Never letting heart rate get too high

Having phone charged and on at all times

Medications

Reassurance seeking

Checking google all the time

Having water available at all times

Not eating before leaving the house

Not going to work or school

Asking forgiveness

Praying

301

AVOID False Fear Blockers Anything to make them feel better in the moment • Taking deep breaths • Relaxation • Distraction

302

What to do instead…

Calming strategies

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Stay present with what is, tolerate, and notice what happens.

Amygdala learns by feeling the discomfort and seeing that nothing needs to happen for it to go away (and can handle it).

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Predictions are important for learning!

Set up as experiments to ensure learning

304

Predict to Maximize Learning!

Antecedents (Triggers to anxiety)

Predicted Awfulness

Walking by M’s desk and saying Hi

90

I predict this will happen

Actual Awfulness

Later

What really happened?

I will turn bright red I will stare like a deer in headlights I will say something nonsensical or stupid

Need to disconfirm their fear story to the fullest extent possible

M will look at me in disgust Everyone will hate me I will die from embarrassment

Setting up Exposure

Honesty!

You’re going to feel uncomfortable Anxiety will be at its highest when you do something different the first time without safety behaviours

306

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Setting up Exposure

You’re going to feel uncomfortable MUST Activate to generate

Develop new, competing brain circuits

Setting up Exposure: Remind how anxiety works Anxiety is • Uncomfortable & this is what it does…

• Normal (of course you are going to be scared!)

• Safe (it’s meant to protect you!)

• Temporary (let’s see how long this feeling lasts)

Setting up Exposure:

Honesty!

• We have no idea what is going to happen • I know you will handle it

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We can never make anyone do anything – especially distressing things - if they don’t want to do

Setting up Exposure Rationale & Buy-In Collaborate

• What is important to them • Why are we doing this? How will it be helpful for you?

• How does worry get in the way of your life?

• New learning • To manage emotions • I can handle it!

BUT…Fake it ‘til you make it doesn’t work (Masking is exhausting and too hard in the face of a real challenge) 312

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Real Bravery is NOT Fearlessness.

Bravery is acknowledging when something is hard (not pretending it isn’t) • With an honest appraisal, we can respond productively

313

Remember!

Speed of recovery directly relates to your willingness to feel anxiety

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If I am uncomfortable Then I know I am on the right track

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Setting up Exposure:

Test it out

This is the only way to create new experiences that contradict with old worries

Anxiety wants comfort & certainty

Do the opposite of what it wants!

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When the gremlin shows up, it is going to:

I am going to:

Tell me

Say

Make me feel

Notice

Want me to

Do

For Suzie’s mom:

Reassure

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Support Confidence

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Suzie’s Flowchart

Acknowledge & Name it

Where & how does it show up

What story is it telling

Whatever

Thank it

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Setting up Exposure:

Validate & Normalize No matter what!

• Stick to the plan until you surpass the feared outcome handle ANYTHING • Must learn they can go further than the worry made them believe they can

Setting up Exposure: Debrief & Evaluate

Learning happens here to disconfirm conspiracy 321

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Evaluate to Maximize Learning!

Antecedents (Triggers to anxiety)

Predicted Awfulness

Walking by M’s desk and saying Hi

90

I predict this will happen

What really happened?

I will turn bright red

Feel like I turned red (but don’t know for sure)

I will stare like a deer in headlights

I smiled

I will say something nonsensical or stupid

I said Hi

M will look at me in disgust

M smiled and said hi back

Everyone will hate me

No one has treated me any differently

I will die from embarrassment

I am still alive

Actual Awfulness

Later 0

70

Disconfirm their fear story to the fullest extent possible but,

No matter how awful or what happened, it passed &

I HANDLED IT!!!!

An environment which emphasizes safety, trust, and belonging while showing confidence

Important Foundations

Integrate all the skills to handle challenges

Set goals – what am I going to do and why is it important?

Get curious and keep the prefrontal cortex online

Recognize and name their emotions

Understand and identify what is happening in the body and mind

Accept and tolerate the discomfort in the body and mind

Detach, boss back, and problem solve 323

Ending Exposure Session Did you survive?

Yes How manageable was it?

Did the feared outcome happen?

No

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How tolerable was the distress waiting for It to happen?

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When exposure is done • Lots of opportunities • Can do it on their own without safety behaviours • NOT about their subjective distress!!!!

Willingness to face anxiety provoking experiences!!!

Recovery is when: You’re not worried about worries

END

Thrive

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Life is About Ups and Downs (and downs help us learn & get stronger)

328

Create new ingrained habits

Even the most skilled of us revert to old ingrained habits when the situation is new and/or overwhelming 329

Worry makes us forget

330

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Keeping track is essential to create memory bridges

Hard

Working on It

Success!

Keep Going!

What can we do to tweak the exposure to be even more effective & next targets

333

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What I couldn’t do because of worry:

Moving on

What I can do now: Where I am going next:

Lifestyle Focus Opportunists: Choosing to be anxious now for more success later

Missions for Self-Exposure

You’re only limited by your own creativity!

Create themes for the week • Imperfection • Make a guess when don’t know • Focus on quantity vs. quality in a timed task • Fast decision making • Independence • Book own appointments • Buy things on their own • Order the family’s pizza

• Talking to people • Ask stranger for time or directions • Ask someone to play • Compliment someone

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Challenges are part of life. Need to be challenged to gain direct experience working through it and learn they can handle it.

Do something hard & take risks!

Every day.

Adults Being Helpful • Encourage kids to try new things, even when scared • Teach kids to be comfortable in the world • There is no certainty

Goal:

Willingness Action Plan

Big why:

The steps I need to take are:

The discomfort I am willing to have to achieve this goal:

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I will take the first step on (date) at (time)

Thoughts Feelings Sensations Urges I can remind myself that:

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BONUS Common Obstacles: • Lack of understanding about anxiety and what maintains it • Unclear rationale • Rationale irrelevant or weak • Fusion to unhelpful thoughts (e.g., justifications) • Excessive (e.g., too big, skills or resources lacking) • Individual is not involved in selecting and planning • Exposures aren’t worrying – too easy • Something still makes them feel safe (yeah but…)

• Practice sessions too narrow

Common Obstacles: • Implemented incorrectly • Focus too much on convincing or reframing • No learning happening • Poor therapeutic relationship • Depression • Failing to address others’ accommodations • Failing to address safety behaviours • Unintentionally reassuring or accommodating ourselves • Working harder than the individual • Stuck in trying to convince them

Us! We need to get over our own discomfort They MUST get uncomfortable

342

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Focusing on Habituation Sending the wrong messages • Anxiety is bad (because it must be reduced) • Something is wrong with me (because the only way I will be fixed is if I don’t feel anxious) • Misinterpret inevitable and normal unexpected anxiety becomes signs of failure • Hopelessness • Anxiety is controllable • Exposure can become another safety signal

What to do instead…

Habituation

Focus on learning: Feared outcome beliefs contradicted ? Did you handle it?

What to do instead…

Eliminate anxiety & fearful associations

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Create new learning patterns that compete with old ones

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What to do instead…

Conditional Safety Learning

https://parentsoftheyear.buzzsprout.com/

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Learn non-danger-based associations across contexts with different people and everywhere anxiety can show up

https://bit.ly/overpoweringemotionspodcast

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ART THERAPY FOR KIDS AND TEENS Presented by

Pamela Hayes Malkoff

An artist can color the sky red, because they know it is blue. Those of us who are not artist, must color things as they really are, or people might think we are stupid.

-Jules Fieffer, Cartoonist, Phantom Toolbooth

Board Certified Art Therapist Licensed Marriage Family Therapist - CA Licensed Professional Counselor -GA Licensed Mental Health Counselor - RI

HayesArtTherapy.com HayesArtTherapy@gmail.com

Understanding t h e Art Materials

1.

2.

3.

4.

5.

6.

7.

1. Each person relates differently to different materials 2. Allow them to explore 3. Some materials allow for more control 4. Some materials force you to let go of control 5. Force them out of their comfort zone 6. May bring up memories 7. Help to create rituals*

Fear and Anxiety stored in the Amygdala Eric Kandel, "In Search of Memory"

Containment of overwhelming feeling Gives a voice where it is too scary to speak

● ● ● ● ● ● ● ●

Provides another language to tell their story Can project feelings outside of themselves Can be more objective and safe Containment of overwhelming feeling Gives a voice where it is too scary to speak Learn to tolerate frustration Try new things/ experiences

We all begin with the same starting points We all are given the same directives We all hear and interpret things differently Things may get miscommunicated Things may get misunderstood When expectations are too high we may be disappointed Opportunity to think creatively Observe how others interpret the world, without judgement

W h e n it c o m e s t o y o u r children, W h a t a r e you m o s t c o n c e r n e d about?

Behaviors Health Relationships Grades

❖ Instability ❖ Divorce, a d o p t i o n , s e p a r a t i o n o r c h a n g e of caregivers ❖ Moving ❖ Unclear e x p e c t a t i o n s ❖ Premature or late development ❖ N e u r o d e v e l o p m e n t a l Disorders ❖ Disability ❖ Financial Difficulties ❖ Caregivers’ m e n t a l illness, drug/alcohol dependence ❖ Minority p o p u l a t i o n ❖ First Generation ❖ C h a n g e s i n religious affiliations ❖ Life t r a n s i t i o n s

Flight Tight jaw or grinding of the teeth Urge to punch someone or something Feeling intense anger or killing someone, even yourself Desire to stomp or kick Crying Glaring at people, conserving angrily Upset stomach, feels like knots or burning

Excessively exercising Feeling fidgety or tense or trapped Constantly moving legs, feet, and arms Restless body that will not stop moving Sensation of numbness in extremities Dilated eyes, darting eyes

Attacking the source of the danger

Fawn Freeze Fight

Flight

Freeze

Fawn Pale skin Sense of dread

The stress response occurs when the demands of the environment are greater than our perceived ability to cope with them

Feeling stiff, heavy, cold, numb Loud, pounding heart Decreasing in heart rate Sensing tolerated stress

the only hope of survival would probably be agreement and helpfulness You are more concerned with making them happy than taking care of yourself Fear of Rejection..

Has the potential to negatively impact all aspects of life, including social relationships, academic performance, emotional wellbeing, and future work

Social Anxiety

opportunities

Academic Anxiety

1. Social Media Binging can lead to lower self-esteem and fatigue

Testing Anxiety

2. Social Change 3. Constant notifications, comparisons to others, pictures of events they weren’t invited to, pressure to get comments and “likes” 4. Warning signs: avoiding school, avoiding eye contact, overly critical, fidgety. mumbling, etc.

5. Parents support - empathetic support, structure, reassurance, and boundaries

Academic anxiety refers to the feelings of worry, tension, or dread that are associated with academic settings or tasks.

Shortness of breath Heaviness in their body/muscle fatigue Dry m o u t h Clammy hands

1.

The Generation of Testers

2.

Students are overwhelmed by the pressures to succeed

3.

What are the Signs? Anxious students may express their fears by: a. crying or throwing tantrums, seek constant approval or reassurance from

4.

“In the Pew survey of teens, academic pressure tops their list of stressors: 61 percent

others, headaches, stomachaches, racing heartbeat, or difficulty breathing. say they face a lot of pressure to get good grades.”

5.

SINCE COVID - 19 shown an increase in general anxiety in children under 17

And more!

Case study: Phoebe 9 Years Old You cannot put your seatbelt on in the middle of a car accident

Mother died from drug overdose History Of Physical And Sexual Abuse Living in a Residential Group Home (No father involved)

1.

Deep b r e a t h i n g exercises: Bubble Breaths

2.

The p o w e r of positive s e lf- t a l k & Affirmations: “ I c a n d o h a r d things!”

3.

Healthy Nutrition & Sleep Schedule

4.

Activity focusing o n bodily regulation - - yoga is a g r e a t place t o s t a r t , look i n t o Somatic practices.

5.

U n d e r s t a n d , d o n ’ t invalidate.

6.

Positive Interactions

7.

Play!

8.

Take t h e p r e s s u r e off!

9.

C o - Regulation Rituals: family d i n n e r s , t e a time,

10.

P a r e n t Groups/Sessions

11.

F a m i l y / P a r e n t Meetings

12.

Modeling self-c a r e , b o u n d a r i e s , assertive c o m m u n i c a t i o n a n d self-efficacy

13.

Provide Safe Spaces

14.

Tools t o use: a.

Fidgets

b.

Therapy :)

c.

Normalize asking for s u p p o r t a n d recognizing “ a n x i e t y tics”

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Don’t try t o eliminate their anxiety Don’t avoid t h i n g s just because they m a k e your child anxious Express positive - but realistic - expectations Respect their feelings, but don’t e m pow e r t h e m Don’t ask leading questions Don’t reinforce your child’s fear Be encouraging Keep the anticipatory period short Think t h i n g s through together Model healthy ways o f handling anxiety

Draw w h a t s c a r e s you Draw w h a t m a k e s you feel brave

● ● ● ● ● ● ●

DO Limit n e w s a n d i m a g e s Be h o n e s t But r e a s s u r i n g Say “ I t will be OK” Validate t h e i r feelings Talk a b o u t anxiety Talk a b o u t o t h e r feelings Seek p r o f e s s i o n a l help, if needed

DON’T ● Avoid t h e scary t h i n g s ● M i ni m i ze t h e i r feelings ● Excessively discuss y o u r o w n fears

Case study: Rebecca 8 years old:

Safe Place drawing 1. W h a t c a n you see?

2. W h a t c a n you hear?

1. W h a t feelings d o you h a v e a b o u t (given situation)?

3. W h a t c a n you smell?

1. W h a t color is t h a t feeling?

4.

1. W h a t s h a p e is it?

W h a t c a n you taste?

5. W h a t c a n you feel?

1. Where i n y o u r b o d y d o y o u feel it?

1. Does it m o v e a r o u n d o r s t a y in o n e place?

1. Does t h a t feeling m a k e you do a n y t h i n g ?

1.

2.

3.

5.

4.

Draw a H e a r t Tu r n t h e p a p e r over t o back List 5 - 7 feeling Choose a color for e a c h feeling Flip p a p e r back over t o t h e h e a r t Draw h o w m u c h of e a c h feeling y o u h a v e r i g h t n o w

1. Draw t h e Yucky

1.

Deep b r e a t h i n g exercises

1. Draw t h e o p p o s i t e of t h e Yucky

2.

T h e p o w e r of positive s e l f - t a l k & affirmations

3.

Healthy n u t r i t i o n & sleep a n d daily schedule

4.

Activity focusing o n bodily regulation

1. I m a g i n e t h a t s o m e t h i n g m a g i c a l could c o m e a l o n g a n d c h a n g e t h e fi r s t d r a w i n g i n t o t h e s e c o n d drawi ng . W h a t w o u l d y o u r m a g i c look like?

a.

Yoga

b.

Somatic practices

5.

Listen, d o n ’t invalidate.

6.

FOSTER RESILIENCE

S t a r t early Be c o n s i s t e n t M a k e it p a r t of y o u r routine

Let t h e m Fail Self Regulation Self Care Service t o Others Ask for Help Act C o n fi d e n t

●

Positive physical d e v e l o p m e n t

●

Academic a c h i e v e m e n t / i n t e l l e c t u a l development

● ●

Good coping skills a n d p r o b l e m - s o l v i n g skills E n g a g e m e n t a n d c o n n e c t i o n s in t w o o r m o r e

1.

of t h e following co nte xts: school, w i t h p e e r s , in

2.

athletics, e m p l o y m e n t , religion, culture ●

High s e lf - e s t e e m

●

Clear a n d stable expectations

●

Self Efficacy

●

E m o t io n a l self-r e g u l a t i o n

Stick Person Drawing

3.

4.

5.

6.

7.

8.

Holding s o m e t h i n g Standing on something We a r i n g s o m e t h i n g S o m e t h i n g beside Dropping something We a r i n g s o m e t h i n g else S o m e t h i n g above Anything else

To Reduce Tantrum Frequency Practice P r e v e n t i o n

Case Study: Kenji 11 years old Oppositional Lying Stealing Acting o u t

Reduce F r u s t r a t i o n Don’t give in t o D e m a n d s

M o t h e r died of cancer w h e n h e w a s 5 - living in Japan

Stay Calm

Moved in w i t h m a t e r n a l a u n t , a n d s h e dies of c a n c e r w h e n h e w a s 7yo

H u m o r a n d / o r Distraction Don’t t a k e it Personally

Moved t o US t o live w i t h m a t e r n a l Uncle a n d Aunt

Differentiate Model between appropriate Establish feelings a n d anger a n g e r r u les behaviors management

Be consistent

Teach healthy c o p i n g skills

Consequences when necessary

3.

4.

5.

6.

Draw y o u r yucky feeling Use colors, s h a p e s , lines …..

C r u m p l e it u p Open it - Say s o m e t h i n g t o it Rip a n d t e a r it u p T h r o w half away

7.

Write t h e o p p o s i t e feeling o n t h e colored p a p e r -

8.

9.

10.

t e a r i n t o 3 equal p a r t s Give a w a y y o u r o p p o s i t e feelings Take a w a y s o m e o n e else’s yucky Collage t h e p a r t s back t o g e t h e r

1.

2.

Help c h i l d r e n t o b e i n c o n t r o l Play “Freeze!Focus!”

M a k e M e m o r y Musical M a k e t h e Day a Story

Watercolor P a i n t s , blow w i t h s t r a w s Control B r e a t h e Be i n t e n t i o n a l Have f u n

P u zz l e s a n d Play L e a r n t o delay g r a t i fi c a t i o n - “ m a k e f u t u r e m e h a p p y ”

● ● ● ● ● ●

F r e q u e n t worrying Trouble c o n c e n t r a t i n g Skipping activities t h e y u s e d t o enjoy Difficulty w i t h sleep Clinging t o caregivers E x t r e m e focus o n safety a n d h e a l t h

●

Irritability o r e d g i n e s s

● ●

Shutting down Repetitive behaviors

1.

N a m e t h e i r feelings

1.

Talk a b o u t t h e feeling

1.

Identify w h e r e i n t h e b o d y t h o s e feelings m a n i f e s t a n d live

1.

Recognize t h e c o n n e c t i o n b e t w e e n t h o u g h t s a n d feelings

1.

L e a r n t o s e p a r a t e t h o u g h t s , feelings a n d behaviors

● ● ● ● ● ● ● ● ●

F r e q u e n t worrying Trouble c o n c e n t r a t i n g Skipping activities t h e y u s e d t o enjoy Difficulty w i t h sleep Clinging t o caregivers E x t r e m e focus o n safety a n d h e a l t h Irritability o r e d g i n e s s Shutting down Repetitive behaviors

● ● ● ● ●

Delayed Gratification Self R e s t r a i n t Tr u s t i n g t h e Process E n c o u r a g e s Creativity I n c r e a s e d Self-E s t e e m

“ Ar t, like m o r a l i t y, c o n s i s t s of d r a w i n g a line s o m e w h e r e ”

The Current Crisis of WellBeing what is happening to our kids?

- an a%achment-based developmental approach -

Gordon Neufeld, Ph.D.

Clinical & Developmental Psychologist Founder of the Neufeld Institute Vancouver, Canada

A JACK HIROSE SEMINAR Richmond, B.C. November 26, 2024

Copyright 2024 Gordon Neufeld, Ph.D. All rights reserved.

The handout is intended for registered par?cipants of this seminar only.

Please do notduplicate this document without permission.For more informa?on regarding the Neufeld Ins?tute or Dr. Neufeld and his work, please consult the website.

www. neufeldins,tute.org

Crisis of Well-Being - Dr. Gordon Neufeld

Hirose Seminars - Vancouver - Nov 26, 2024

The Current Crisis of WellBeing what is happening to our kids? an a$achment-based developmental perspec3ve

Gordon Neufeld, Ph.D.

Developmental & Clinical Psychologist

The current Crisis of WellBeing - some facts and figures -

• school-aged children suffered an approximate 40% increase in depression, anxiety, irritability and aLenMon problems over the span of the pandemic. Studies indicate these problems are not abaMng. • during the pandemic, adolescent psych wards were filled, children’s help lines were overwhelmed, and self-reports of anxiety and depression were unprecedented • suicides and cuTng were increasing before the pandemic, conMnued to do so through the pandemic, and are sMll on the rise • some studies reported that up to 70% of children experienced harm to their mental health when isolated from their peers (in contrast to about 20% who thrived when sent home from school) • most experts assumed that being socially isolated from peers must be bad for the mental health of children and so prescribed more peer interacMon as a result

making sense of the

Current Crisis of WellBeing

Copyright 2024 Gordon Neufeld PhD

1

Crisis of Well-Being - Dr. Gordon Neufeld

Hirose Seminars - Vancouver - Nov 26, 2024

well-being well-being

Attachment ARGUMENT for WELL-BEING being ROOTED in ATTACHMENT THEORY: • togetherness is our preeminent drive and as such, has the most profound and widespread impact on emoMonal, mental and developmental processes and dynamics • togetherness replaces survival as a drive in evoluMon, as survival becomes a natural outcome of togetherness • the ‘trouble spots’ in our brain have evolved from emoMon extending the reach of insMnct - aLachment being our primary drive

ARGUMENT for WELL-BEING being ROOTED in ATTACHMENT SOME OF THE EVIDENCE: • longitudinal study of adolescent health and well-being • loneliness research which reveals togetherness as the answer to well-being • happiness research which reveals the key factor as being embedded in caring relaMonships • marriage research that reveals longevity, health, and well-being as resulMng from being in caring relaMonship • famous Harvard 2023 study revealing that being embedded in caring relaMonships is the #1 factor in well-being

The most consistent and widespread finding is that those embedded in a context of CARING ATTACHMENTS are found to be less at risk for mental health issues and problems

Copyright 2024 Gordon Neufeld PhD

2

Crisis of Well-Being - Dr. Gordon Neufeld

Hirose Seminars - Vancouver - Nov 26, 2024

well-being

Attachment

NATURE’S TEMPLATE FOR GIVING AND RECEIVING ... ... signals

... care

Attachments are specifically structured for giving & receiving CARE

Copyright 2024 Gordon Neufeld PhD

3

Crisis of Well-Being - Dr. Gordon Neufeld

Hirose Seminars - Vancouver - Nov 26, 2024

PROVIDING CARE

SEEKING CARE

dependent insMncts dependent instincts • for an invitation to exist

alpha instincts

• for contact and connection • for sameness & belonging

• for warmth & love • for recognition • for significance

seeking

• to get one’s bearings

PROVID

ING

• for safety and comfort

• for understanding • for a relational ‘home’ • for a sense of togetherness

We are meant to fit together in hierarchical attachment arrangements of CASCADING CARE

a NATURAL arrangement in harmony with the dynamics of aLachment and the principles of development

as opposed to contrived arrangements based on social roles, gender stereotypes, prevailing assumpMons of equality, or parMcular dynamics between parents and children or between partners of a couple or in friendship

Our objective should be to embed in CASCADING CARE as opposed to pushing for independence or promoMng self-care

mental health

Attachment Copyright 2024 Gordon Neufeld PhD

4

Crisis of Well-Being - Dr. Gordon Neufeld

Hirose Seminars - Vancouver - Nov 26, 2024

making sense of the

Current Crisis of WellBeing

NEGLECT losing face both me n paren tio ts wo bedti a rking liz ta personal injury pi s failure ho e

ol dis scho ab loneliness ilit y isola tion ATH g DE facin threats to iden tity

sec rets

adopM

on

mov ing

ar

e loss of loved on

er anoth

DIVORCE

E NT US RETIREME AB

CHANGE

yc da

g siblin

ST LO ng i e b resi d sch enMal ool

of .. lacknging losing face with . can’t NEGLECTED . be w .. belo ith ... ct by cMon ne reje

n not important to ... tood co ’t f n s eeli a c ng u er fe nlov eli not ma nd ed b ng Lerin u y ... t dif g to . fe .. no re n

t isola tion g ngin belo n ot

d by ... not recognize

ced repla

by ...

ed nt d i sc threats a loneliness to iden ou n ... t w tity ted ial to no by . t spec o n on .. hold BETRAY can’ten apart Y ...

B E O D wh ON T HELD NOT LIKED BY ...

NOT

Copyright 2024 Gordon Neufeld PhD

5

Crisis of Well-Being - Dr. Gordon Neufeld

Hirose Seminars - Vancouver - Nov 26, 2024

closure separa$on-triggered

PURSUIT

ALARM

FRUSTRATION change

cau$on

Stress Response

PRIMAL SEPARATION EMOTIONS ARE ACTIVATED FEELINGS that would interfere with performing or funcMoning in stressful circumstances are inhibited

Resilience Response Feelings that have been inhibited bounce back to enable opMmal funcMoning and the realizaMon of full potenMal

the recovery of feelings requires a sense of SAFETY

TIME (ideally the end of the day or end of the week at most)

mental health

Attachment Copyright 2024 Gordon Neufeld PhD

6

Crisis of Well-Being - Dr. Gordon Neufeld

Hirose Seminars - Vancouver - Nov 26, 2024

EMOTION IS AT THE HEART OF THE MATTER • emoMon is in charge of managing the brain, including development, prioriMes, aLenMon, and memory • the stress response is emoMonal in nature • emoMonal processes precede and undergird mental processes – in evoluMon, in development, and in everyday funcMoning

• most problems in learning, aLenMon, and maturaMon are rooted in emoMon

EMOTION NEEDS TO MATTER TO US

• adaptaMon (including healing & recovery) is an emoMonal process • mental processes are primarily derivaMves of emoMon, rather than the other way around

• almost all troubled thinking and • emoMons need to be resolved to behaviour (including diagnoses) reduce symptoms as well as to are found to have roots in emoMon effect deep and lasMng change

EMOTION IS STILL & EMATTER IS AT ISCOUNTED CLIPSED EMOTION HEART THE D OF THE W D& ON • SmostOproblems ISREA ED of managing • emoMon TILL MEN & in learning, EAS ILL Mis inPRcharge ET development, STbrain, C IL BLA and TO R the including R aLenMon, E R T MED HmaturaMon DRE IO TOare MISIN aLenMon,INand N prioriMes, FER memory F R emoMon O Erooted MO Oin RED TION BEING E D I S AL N O • theILstress L C response is • adaptaMon (including ST emoMonalDIC MB EMOTION an ATIONS NUEMOTION WITH is healing &ED recovery) MOST ME process M FRO T ERN C an emoMonal process ’ N WITH LITTLE PROTES O NEEDS TOMORE C ING DOWN M • emoMonal processes SO-CALLED EXPERTS OO LM R A G ‘C MATTER IN precede and undergird UP’ are •Nmental MAK processes MOR E CO–NC mental processes in ERNED WTO IRRED THAprimarily ITH US MAN E ‘ST derivaMves of B ING EMOTIO O evoluMon, inAG development, T emoMon, rather than the NS THAN UNDERS and in everyday funcMoning TANDING TH wayBY around STILL other ECLIPSED EM THEIR EFFECTS ON • almost all troubled thinking COGNITION & to be resolved to S STILL • emoMons need SEand IAGNO MOTION reduce symptoms behaviour E(including as well as to BEHAVIOUR E DICAL D diagnoses) F O M E L are found to Ehave RO in emoMon effect deep and lasMng change THEroots ECLIPS

KEY INSIGHTS REGARDING E M O T I O N • there is PURPOSE to emoMon it is Nature’s way of moving us and taking care of us • each emoMon has specific WORK to do (ie, emoMons are Nature’s workforce) • emoMons need sufficient REST in order to do be effecMve in their work • emoMons seek RELIEF through expression but this will be thwarted if working aLachments are threatened

• emoMons need to be RESOLVED in some way or another or they will get stuck • the emoMonal system needs to DEVELOP for opMmal funcMoning but can only do so if condiMons are conducive • the emoMonal system begins in the ‘EITHER OR’ mode and is meant to mature into ‘THIS AND’ funcMoning where inner conflict is felt • emoMons need to be FELT for opMmal funcMoning and for children to flourish

Copyright 2024 Gordon Neufeld PhD

7

Crisis of Well-Being - Dr. Gordon Neufeld

Stress Response

Hirose Seminars - Vancouver - Nov 26, 2024

is

s Resilience Response lem b ro hp

IN EL

lt aFeelings he have been lthat

SF S E

E

G

tainhibited bounce

n eback PRIMAL SEPARATION to enable opMmal g m funcMoning and the n EMOTIONS ARE i y l r realizaMon of full potenMal ACTIVATED de n nu

o FEELINGS that wouldi3interfere d with performing on or c l in stressful funcMoning na circumstances 3o o m are inhibited ec Th

or

ee

M EE

IO OT

N

TL U B

the recovery of feelings requires a sense of SAFETY

R O M TIME (ideally the end of the day or end of the week at most)

The Continuum of ALARM Problems alarm is dysfunc;onal

alarm is perverted

ANXIETY problems (obsessions & compulsions)

AGITATION, ATTENTION, & DISCIPLINE problems

ADRENALIN SEEKING problems

feel unsafe but alarm not linked to the separa$on faced

driven by alarm that is not felt

devoid of feelings of alarm, fu$lity & vulnerability

alarm is displaced

including cuVng & burning ••• • •

• • HIGHLY ALARMED

•• •• •

The Continuum of Aggression Problems

EXISTENCE of attacking impulses

ERUPTIONS of attacking energy

not feeling the fu$lity of changing the frustra$ng circumstances including suicidal impulses ••• • •

VIOLATING aggression problems

devoid of feelings of alarm, fu$lity & vulnerability

• • HIGHLY FRUSTRATED • • • •

Copyright 2024 Gordon Neufeld PhD

••

8

Crisis of Well-Being - Dr. Gordon Neufeld

Stress Response

PRIMAL SEPARATION EMOTIONS ARE ACTIVATED FEELINGS that would interfere with performing or funcMoning in stressful circumstances are inhibited

Hirose Seminars - Vancouver - Nov 26, 2024

Resilience Response Feelings that have been inhibited bounce back to enable opMmal funcMoning and the realizaMon of full potenMal

the recovery of feelings requires a sense of

SAFETY

TIME (ideally the end of the day or end of the week at most)

More Wounding in today’s world teach less

empathy

reduce more

social

SAFETY interac3on

increase less scrip3ng & supervision

stop more bullying

The experience of SAFETY required for the recovery of feelings is ... ... NOT a func3on of reality, percep3on or cogni3on ... an inherent wired-in state of the brain when in one of two basic modes 1. the a$achment drive in the dependent mode where closeness is experienced and seems secure attachment-based safety

2. the play drive where emoMons are at play play-based safety

Copyright 2024 Gordon Neufeld PhD

9

Crisis of Well-Being - Dr. Gordon Neufeld

ADULT T R U less S empathy T I more N bullying G CHILD

ADULT T R U less S empathy T I more N bullying G

We must HAVE their hearts before we can protect their hearts

CHILD

ADULT T R U less S empathy T I N more bullying G

We must MATTER MORE than those who are wounding the child

CHILD

Copyright 2024 Gordon Neufeld PhD

Hirose Seminars - Vancouver - Nov 26, 2024

D E P E more N social D interac3on E less N scrip3ng & C supervision E

D E P E more N social D interac3on E less N scrip3ng & C supervision E

D E P E more N social D interac3on E less N scrip3ng & C supervision E

10

l rea

PLAY

for

NO T

Hirose Seminars - Vancouver - Nov 26, 2024

T NO

wo rk

Crisis of Well-Being - Dr. Gordon Neufeld

expressive

Feelings are recovered when emotions are at play!

The current Crisis of WellBeing what is happening to our kids?

Why are today’s kids not receiving the CARE they need, nor experiencing the SAFETY they require for the spontaneous recovery of their feelings?

1. They are NOT depending upon the adults who care.

2. The proximity in their aLachments is constantly threatened, depriving them of the SAFETY required to recover their feelings.

3. They are NOT engaging in the kind of play that provides the SAFETY required to recover their feelings.

Copyright 2024 Gordon Neufeld PhD

11

Crisis of Well-Being - Dr. Gordon Neufeld

Hirose Seminars - Vancouver - Nov 26, 2024

Our children are losing their play, especially their emo$onal play: • although play is a natural insMnct & primary drive, it is not demanding and so requires space, as well as protecMon from compeMng acMviMes • SPORTS PLAY has become organized and outcome-based, compeMng with ‘play for play’s sake’ • creators of DIGITAL SCREEN GAMES primarily harness the more robust aLachment drive (eg, winning, dominaMng, placing) which is outcome-based, highly addicMve in this depersonalized form, and takes the place of the kind of play that children truly need • ENTERTAINMENT has become universally accessible, replacing and suffocaMng the more fragile expressive play children require • PARENTS now seek acMviMes to help their children ‘GET AHEAD’, at the expense of the play children need to get ahead developmentally • SCHOOLS are becoming more OUTCOME DRIVEN, reducing the playful acMviMes that are required for healthy development to occur

The current Crisis of WellBeing what is happening to our kids?

Why are today’s kids not receiving the CARE they need, nor experiencing the SAFETY they require for the spontaneous recovery of their feelings?

Because they are NOT depending upon the adults who care, their aCachments are con;nually threatened, and they are NOT engaged in true play.

WHY is this so?

mental health ar S T

eir Th

AT

HM C TA

T EN

W eA

RY

C TIN PEER ORIENTATION S IN ALPHA COMPLEX

DEPERSONALIZATION

Attachment

Copyright 2024 Gordon Neufeld PhD

12

Crisis of Well-Being - Dr. Gordon Neufeld

Hirose Seminars - Vancouver - Nov 26, 2024

PEER ORIENTATION

Children taking their cues from each other as to how to act, what to do, how to talk, what to wear, how to express oneself, what is valued, what is expected, what is right and what is wrong

The compe3ng nature of most peer a$achments today (ie, can’t be close to both peers and adults simultaneously) pulls children out of orbit from around the adults responsible for them.

THE PROBLEMS WITH PEER ORIENTATION • does NOT serve survival as children were not meant to take care of each other

• breeds ALPHA children and fosters DEPERSONALIZATION

• destroys the natural context for raising & educaMng children

• fuels a preoccupaMon with digital devices and social media, which further compete with family

• robs adults of the power they need to parent, teach and treat

• is not conducive to feeling, as the vulnerability is too much to bear

• the more peers maLer, the more separaMon to be faced, resulMng in escalaMng emo3onal distress • robs children of the shielding and protecMon they need to live in an wounding world

positive polarity seeks to be with makes contact endears looks up to a$ends & listens to imitates & emulates possesses is loyal to holds dear a$empts to find favour makes things work for seeks to ma$er to seeks to please befriends loves shares secrets with or keeps the secrets of

• can result in chaoMc polarizaMon & tribaliza3on which in turn can create a ‘lord of the flies’ scenario

negative polarity shies away from resists contact alienates looks down upon ignores & disregards mocks & mimics disowns opposes & betrays holds in contempt ridicules and derides spoils things for discounts as not ma$ering annoys and irritates eschews loathes keeps secrets from or creates secrets about

Copyright 2024 Gordon Neufeld PhD

13

Crisis of Well-Being - Dr. Gordon Neufeld

society is not structured to facilitate peer togetherness

The PEER-ORIENTED ...

SUFFER more WOUNDING ... eleva3ng the separa3on-triggered emo3ons of alarm, frustra3on and pursuit ...

Hirose Seminars - Vancouver - Nov 26, 2024

children are not meant to take care of each other increasing tribalizaMon renders peer interacMon unsafe

while losing the very feelings that would lead to their resolu3on.

The peer oriented are less inclined to play for play’s sake, or take their emoMons to play: • peer-oriented children are stuck in a relentless pursuit of proximity which interferes with the condiMons leading to emergent and expressive play • children take their cues from their peers as to the acMviMes and entertainment to engage in, again interfering with emergent and expressive play • the peer-based pop cultures have not inherited the classic emoMonal playgrounds of older cultures (expressive wriMng, drawing, dance and composing)

INSIDIOUS IMPACT OF PEER ORIENTATION • loss of safety and thus increased wounding & defendedness

• elevated & unresolved alarm, frustraMon, and pursuit, manifesMng in countless syndromes associated with mental illness • aLachment tribalizaMon, polarizaMon, depersonalizaMon hypersexualizaMon, and resulMng obsessions & addicMons

• loss of feeling and thus true growth, adaptaMon, and well-being

• lack of received care resulMng in increased distress and restlessness including boredom

• stuck in the aLachment drive resulMng in developmental arrest and loss of playfulness

Copyright 2024 Gordon Neufeld PhD

14

Crisis of Well-Being - Dr. Gordon Neufeld

Hirose Seminars - Vancouver - Nov 26, 2024

INSIDIOUS IMPACT OF PEER ORIENTATION • loss of safety and thus increased wounding & defendedness

• elevated & unresolved alarm, frustraMon, and pursuit, manifesMng in countless syndromes associated with mental illness • aLachment tribalizaMon, polarizaMon depersonalizaMon hypersexualizaMon, and resulMng obsessions & addicMons

• loss of feeling and thus true growth, adaptaMon, and well-being

• lack of received care resulMng in increased distress and restlessness including boredom

• stuck in the aLachment drive resulMng in developmental arrest and loss of playfulness

INSIDIOUS IMPACT OF PEER ORIENTATION • loss of safety and thus increased wounding & defendedness

• elevated & unresolved alarm, frustraMon, and pursuit, manifesMng in countless syndromes associated with mental illness • aLachment tribalizaMon, polarizaMon depersonalizaMon hypersexualizaMon, and resulMng obsessions & addicMons

• loss of feeling and thus true growth, adaptaMon, and well-being

• lack of received care resulMng in increased distress and restlessness including boredom

• stuck in the aLachment drive resulMng in developmental arrest and loss of playfulness

INSIDIOUS IMPACT OF PEER ORIENTATION • loss of safety and thus increased wounding & defendedness

• elevated & unresolved alarm, frustraMon, and pursuit, manifesMng in countless syndromes associated with mental illness • aLachment tribalizaMon, polarizaMon depersonalizaMon hypersexualizaMon, and resulMng obsessions & addicMons

• loss of feeling and thus true growth, adaptaMon, and well-being

• lack of received care resulMng in increased distress and restlessness including boredom

• stuck in the aLachment drive resulMng in developmental arrest and loss of playfulness

Copyright 2024 Gordon Neufeld PhD

15

Crisis of Well-Being - Dr. Gordon Neufeld

attaching to

PARENTS

and other adults responsible for the child

emergence into

PERSONHOOD

Hirose Seminars - Vancouver - Nov 26, 2024

able to relate to

PEERS

without loss of individuality or loss of adult attachment

The current Crisis of WellBeing - some facts and figures -

• school-aged children suffered an approximate 40% increase in depression, anxiety, irritability and aLenMon problems over the span of the pandemic. Studies indicate these problems are not abaMng. • during the pandemic, adolescent psych wards were filled, children’s help lines were overwhelmed, and self-reports of anxiety and depression were unprecedented • suicides and cuTng were increasing before the pandemic, conMnued to do so through the pandemic, and are sMll on the rise • some studies reported that up to 70% of children experienced harm to their mental health when isolated from their peers (in contrast to about 20% who thrived when sent home from school) • most experts assumed that being socially isolated from peers must be bad for the mental health of children and so prescribed more peer interacMon as a result

Reversing peer orientation should be a top priority in the support of our children’s well-being

Copyright 2024 Gordon Neufeld PhD

16

Crisis of Well-Being - Dr. Gordon Neufeld

- by giving something of ours to hold on to

to

e id

v di

en ga ge

ld ou

at ta ch m en ti

- all problems as well as differences

c at th

th e

- all separaMons, including the night

ng hi

- use play and playfulness to engage

ns t

- collect before any other interacMon

yt an

in ct

s

- collect the eyes, some smiles and some nods

Hirose Seminars - Vancouver - Nov 26, 2024

- to embed in cascading care - to emotional playgrounds that engage

Assume the role of being their ANSWER • a COMPASS POINT to orient by (regarding what’s happening but especially regarding their strengths, uniqueness & contribuMons) • a HOME BASE, GUIDE or COMFORTER if needed • for NURTURANCE – offering a ‘TOUCH OF PROXIMITY’ to hold on to - a sign of belonging, or something special that belongs to us - a likeness or similarity, something held in common - a touch of loyalty – that we will come to their side and alongside - a sign of significance, something beyond the role expectaMons - a touch of warmth or delight, something that suggests liking - a sign that we truly get them or understand them - some sign of being welcomed and invited into our presence

Three Common ATtachment Disorders ... and how they impact received care and recovered feelings

1. PEER ORIENTATION 2. ALPHA COMPLEX 3. DEPERSONALIZED ATTACHMENT

Copyright 2024 Gordon Neufeld PhD

17

Crisis of Well-Being - Dr. Gordon Neufeld

Hirose Seminars - Vancouver - Nov 26, 2024

Typical manifesta;ons of alpha children ing roll ontnding c , sy a bos r dem o

com over opelled to ta r take k chargee

obsessed with winning or being seen as the best

top e on ge to bont sta s k e r se take f or

ca to n b sho dome drive w s inat n upe e o rior r ity

driven to trump interacMon, to have the last word ma the y need k as a now / to be kno can in w-it act - al l

ith or yw n e ult recMostanc c diffing di assi r i taking fo k s a

Typical manifesta;ons of alpha childrene

iz m ter he ac foonr ttope r a e g cshto bre nt sta seteesktaokecafro u h r rib sow ca to dn be d e aQ ult d s o s r how min hiveen a com sup natte oith driven to trump over opelled to ta r take ke interacMon, to heeirpios rwit r charge w y have the last word e d o n sh m r $ o a ma ith or s f rel the y need y w n eha ir kn t ult recMostalenxc the c a s a kow / co be in diffing di assmi p or now an a r co ity i o k i f t-al ct ta ing a al l h ask alp rson e n a ir p e th ing roll ontnding c , sy a bos r dem o

obsessed with winning or being seen as the best

- is part of the ATTACHMENT drive which is Nature’s answer to SURVIVAL for birds and mammals

- it’s ulMmate purpose is to take CHARGE of the CARE of one’s dependents

- is meant to create a LEAD in the aCachment dance, inspiring trust and dependence in response

- should never be characterisMc of an individual, only an aLachment DANCE with a ‘dependent’ in need

- requires extensive taming and development to turn the raw displacement insMncts into an effecMve ALPHA CARING RESPONSE

- successful development requires ample PRACTICE in a context rich with FEELING,

- if characterisMc of a child, can seriously INTERFERE with development and being taken care of, including being parented or taught

Copyright 2024 Gordon Neufeld PhD

18

Crisis of Well-Being - Dr. Gordon Neufeld

Hirose Seminars - Vancouver - Nov 26, 2024

RE SP O

gC lin

fee

lin gs

ED

of C

AR

IN G

ICT FL ON

&

- develops the capacity for CONSIDERATION - necessary to make caring effec;ve (can begin between 5-7 years but only if condi;ons are conducive)

fee

- unites primi;ve displacement ins;ncts with their ul;mate care-taking PURPOSE

NS IBI LIT

Y

FEELINGS convert raw displacement into ALPHA CARING

feeling the FUTILITY of controlling & domina3ng - soHens and prunes displacement ins;ncts to where they become sensi;ve to context and in the service of caring and community

DEVELOPING THE CARING ALPHA RESPONSE

Ca rin

g

“neurons that FIRE together WIRE together”

DIVERSE MANIFESTATIONS of UNTAMED ALPHA unrelen Mn domina g drive to te & dis place

moved to exploit the vulnerable & needy (the bully response)

narcissism chron ic or opp resistance osiMo nality ority r superi drive fo premacy and su obsessed with winning, placing, status, coming out on top

the n be o to enM n L e a v dri re of t cen comp e spous Mng with e or c hil for ca dren re

unable to depend, submit or take direcMon fuels th e to ‘lor impulse d it ov er’

Copyright 2024 Gordon Neufeld PhD

m, anis itari ialism, r o h aut imper m lis m, racis colonia and

19

Crisis of Well-Being - Dr. Gordon Neufeld

Hirose Seminars - Vancouver - Nov 26, 2024

The Continuum of Troubling Alpha Behaviour •••

perversion of • • • • • • alpha ins;ncts

••• • • •

co pro mpl ble ian ms ce hig de hly ma nd ing ea pro 3ng ble ms bo ssi ne ss

ob wit sess h w ed inn ing ob s wit ess h d ed om ina nce nar cis sism BU LL YI NG

common alpha syndromes

lacking feelings of dependence and neediness

devoid of feelings of caring and responsibility

• • •HIGHLY MOVED TO DISPLACE

•••

HOW ELEVATED DISPLACEMENT INSTINCTS IMPACT LEARNING AND THE CLASSROOM - CANNOT COMMAND their aLenMon or orchestrate their behaviour - they do not accept their teachers as authoriMes and are NOT RECEPTIVE to instrucMon - their peer relaMonships are oqen fraught with CONFLICT, or they can develop significant followings that draw students away from their teachers

- tend to be fraught with ALARM problems (eg, anxietybased, agitaMon-based and adrenalin-based) - tend to be fraught with FRUSTRATION problems (aLacking energy, impulses & behaviour) - tend to be fraught with ADAPTATION problems as not able to feel the fuMlity encountered (eg, sadness & grief)

ALPHA CHILDREN ARE MORE PRONE TO ...

ALARM-BASED PROBLEMS - anxiety, agitaMon, & adrenalin seeking (cannot make oneself feel safe) ATTENTION ISSUES - cannot command their aLenMon / elevated alarm scaLers aLenMon / must be the centre of aLenMon FRUSTRATION ISSUES - aggression, violence and self-aLack including suicide EATING ISSUES - anorexia & food issues of all kinds

Copyright 2024 Gordon Neufeld PhD

LEARNING PROBLEMS - literacy problems, dysfuncMon due to learning disabiliMes, difficulMes with seeking assistance COMPLIANCE ISSUES - resistance & opposiMonality ENTITLEMENT ISSUES - self-evident to them that they are most important PEER ISSUES - conflict, bullying, dominance, and supremacy issues

20

Crisis of Well-Being - Dr. Gordon Neufeld

Hirose Seminars - Vancouver - Nov 26, 2024

the making of the bully response

highly moved to displace

Lacking feelings of caring & responsibility

the BULLY response to perceived vulnerability, neediness, threat or weakness

- to assert dominance by exploiting vulnerability -

Renders today’s children increasingly UNSAFE and highly ALARMED, whether peer-oriented or not

ALPHA CHILDREN ARE MORE PRONE TO ...

ALARM-BASED PROBLEMS LEARNING PROBLEMS - anxiety, agitaMon, - literacy problems, & adrenalin seeking dysfuncMon due to The alpha problem has learning disabiliMes, (cannot make oneself feel safe) been totally ECLIPSED by difficulMes with seeking assistance misinterpreMng alpha as ATTENTION ISSUES ‘independence’, by our - cannot command COMPLIANCE their aLenMon / aversion to the construct of ISSUES elevated alarm - resistance & ‘hierarchy’, by our lack of scaLers aLenMon / opposiMonality must be the centre understanding of the nature of aLenMon & purpose of aLachment, ENTITLEMENT ISSUES and by the lack of any FRUSTRATION ISSUES self-evident to supporMng language – - aggression, violence them that they are and self-aLack rendering the symptoms most important including suicide unexplained and resul$ng PEER ISSUES in a fu$le baQle against them - conflict, bullying, EATING ISSUES dominance, and - anorexia & food supremacy issues issues of all kinds

FACTORS CONTRIBUTING TO BEGETTING ALPHA CHILDREN - schools tend to generate PEER ORIENTATION which, in turn begets alpha children

- today’s adults use behaviour management methods that make it UNSAFE TO DEPEND, evoking alpha by defense - today’s adults are increasingly seeking answers as to HOW TO parent and teach, puTng them in the ‘dependent’ mode

- many parents and teachers think they are being forward thinking

by PUTTING CHILDREN IN THE LEAD

- parents have LOST THEIR CONFIDENCE in being their children’s ‘answer’, presenMng as weak or inadequate, and thus evoking alpha by default

- decades of veneraMng independence has made us BLIND to the problems of children who resist dependence because of being stuck in the alpha mode

Copyright 2024 Gordon Neufeld PhD

21

Crisis of Well-Being - Dr. Gordon Neufeld

Hirose Seminars - Vancouver - Nov 26, 2024

PEER ORIENTATION, the ALPHA COMPLEX and MENTAL HEALTH

- the perfect storm peer orientaMon creates CONTRIVED hierarchies devoid of care and safety

DEPENDENT peer-oriented children, having lost their adult shields, suffer significant WOUNDING at the hands of their peers

increasing numbers of ALPHA peer-oriented kids who are devoid of taming feelings, evolve into BULLIES who make life unsafe for EVERYONE

the lack of received care and recovered feelings results in escalaMng and pervasive MENTAL HEALTH PROBLEMS

Reversing runaway alpha should be a top priority in the support of our children’s well-being!

Children need to be deeply & personally attached in the dependent mode to the adults responsible for them ... for the delivery of care to shield from wounding to make flourishing possible for the transmission of culture for the regular recovery of feelings to support wellness & mental health for the unfolding of human potential to activate caring and develop empathy to empower the adults to fulfill their roles to activate and direct their desire to be good to properly purpose their shyness & counterwill

Copyright 2024 Gordon Neufeld PhD

22

Crisis of Well-Being - Dr. Gordon Neufeld

Hirose Seminars - Vancouver - Nov 26, 2024

Take ALPHA INSTINCTS to PLAY • use controlled games of compeMMon and conquest to safely vent the quest for dominance and supremacy • use stories, imaginaMon, drama, role play and theatre to invent or idenMfy with alpha characters who always come out on top • provide playful acMviMes where there is plenty of opportunity for leading, direcMng, or orchestraMng • use playful games and acMviMes where children and students get to displace the adults in charge – eg, being the boss, having the last word, giving the orders, making the demands, making up the rules • encourage or support alpha caring play, where alpha insMncts are used to take care of others • provide ample access to emoMonal playgrounds where there is more chance for the alpha insMncts to awaken the impulse to care

School-Based Practice – developing the vertical dimension

STUDENT-TEACHER EMOTIONAL CASCADING CARE FAMILY RELATIONSHIPS PLAYGROUNDS RELATIONSHIPS RELATIONSHIPS

Embed in CASCADING CARE • our aim should be to shield students at risk by fostering an aLachment with a safe caring adult who is willing to serve that role

• matchmake by presenMng one as the ANSWER to the other

• use playful acMviMes to matchmake students to teachers and across the grades and the ages

• our aim should also be to matchmake students hierarchically so that every student experiences being both cared for and in charge of taking care of • matchmake the more mature students with those in need, to serve as HOME BASE as needed • uMlize the ‘house system’ if possible, to foster cascading care across the grades and ages

Copyright 2024 Gordon Neufeld PhD

23

Crisis of Well-Being - Dr. Gordon Neufeld

Hirose Seminars - Vancouver - Nov 26, 2024

Assume a caring alpha lead in order to ...

1. INSPIRE the DEPENDENCE necessary in order to fulfill one’s responsibiliMes and to foster healthy development 2. Render students RECEPTIVE to your instrucMon and MOTIVATED to be good for you, thus OPTIMIZING their learning as well as their behaviour 3. Possess the POWER to SCRIPT the behaviour of the immature 4. Serve as the ATTACHMENT IN COMMON in one’s class in order to keep children from revolving around each other and maLering too much to each other 5. FuncMon as a SHIELDING aLachment as needed (for wounding that may come from others including peers, siblings, parents or other adults) 6. Bring the followers of charismaMc ALPHA STUDENTS under your control and influence

Mastering the Lead in the dance of attachment • assume the posture and demeanor of the ALPHA in charge, concealing one’s own needs and insecuriMes

• seize the lead by ANTIPICATING ‘demands’ and geTng there first • READ the needs & take the lead (don’t ask too many quesMons)

• perceive the student(s) as being IN NEED of you, as an ANSWER to their aLachment needs

• WIN the alpha baLles you can, but avoid the rest

• INVITE dependence and make it SAFE to depend

• invite the INEVITABLE to preserve one’s alpha and convey that the relaMonship can take the weight

• convey CARING and find a way to get the message across that you will take care of them

• ARRANGE scenarios where there is no choice but to depend upon you

• be GENEROUS - providing more than is pursued

PROVIDING CARE

SEEKING CARE

dependent insMncts dependent instincts • for an invitation to exist

alpha instincts • INSPIRE dependence by taking a strong caring alpha LEAD

• for contact and connection • for sameness & belonging

• INVITE dependence by gestures of CARE

• for warmth & love • for recognition • for significance

seeking

• to get one’s bearings

• for understanding • for a relational ‘home’ • for a sense of togetherness

PROVID

ING

• for safety and comfort

• make it SAFE to depend, never using their rela$onal needs against them • be GENEROUS with one’s care, providing more than is pursued • DON’T BE FOOLED by the myriad illusions of independence

Copyright 2024 Gordon Neufeld PhD

24

Crisis of Well-Being - Dr. Gordon Neufeld

Hirose Seminars - Vancouver - Nov 26, 2024

Three Common ATtachment Disorders ... and how they impact received care and recovered feelings

1. PEER ORIENTATION 2. ALPHA COMPLEX in a dependant 3. DEPERSONALIZED ATTACHMENT

about the defensive DEPERSONALIZATION of a$achment If a$aching is sensed as leading inevitably to unbearable separa3on or wounding, the a$achment brain can reverse the direc3on of the pursuit to reduce the vulnerability involved.

The a$achment drive itself cannot be reversed since it is the preeminent/default drive and only increases under threat.

- depersonalized aLachment cannot fulfill so the drive remains unabated and any experienced proximity becomes addicMve - depersonalized aLachment cannot deliver care or safety, but competes with personal aLachments that could - can involve the defensive transference to non-personal enMMes: objects, pets, groups, categories, ideas, religion, race, poliMcs, naMons, etc (fuels racism, sports obsessions, and all the ...ISMs)

The Depersonaliza3on & Fragmenta3on of Pursuit the DEPERSONALIZATION of attachment the PURSUIT of PROXIMITY with a PERSON

WINNING

the

APPROVAL

of

Sarah Matthew

MEASURING UP

to be

VALUED

by

Genevieve

DEMANDING

to be

SPECIAL

to

Rorie

IMPRESSING

to be

ESTEEMED

by

ATTRACTING

the

ATTENTION

of

Scott Ms.Kerr

HELPING

to be

IMPORTANT

to

BEING NICE

to be

LIKED

by

Kendall

BEING CHARMING

to be

LOVED

by

Sherry

RECOGNIZED

by

Uncle Jack

SEEKING STATUS to be

Copyright 2024 Gordon Neufeld PhD

25

Crisis of Well-Being - Dr. Gordon Neufeld

Hirose Seminars - Vancouver - Nov 26, 2024

The Depersonaliza3on & Fragmenta3on of Pursuit the DEPERSONALIZATION of attachment the PURSUIT of PROXIMITY with a PERSON

WINNING

the

APPROVAL

of

Sarah Matthew

MEASURING UP

to be

VALUED

by

Genevieve

DEMANDING

to be

SPECIAL

to

Rorie

IMPRESSING

to be

ESTEEMED

by

HELPING

to be

IMPORTANT

to

BEING NICE

to be

LIKED

by

Kendall

LOVED

by

Sherry

RECOGNIZED

by

Uncle Jack

ATTRACTING

BEING CHARMING

the

ATTENTION

to be

SEEKING STATUS to be

of

Scott Ms.Kerr

P

The depersonaliza3on and fragmenta3on of a$achment-based pursuit U in the face of threatened M connec3on

I

O X T

U I

at of thre separ a3on

PURSUIT of PROXIMITY T

I

S

R

P R of

g in ng cli

Some common a$achment-driven where the pursuit is divorced from its rela3onal context: goin scor ng g fo ssi r hu ing e s gs/s s PURSUING PRAISE o mile p hoarding s T G H IN N T IN W G E N N se FI U ACTI lau ND ATTR EH pp seeking a H g T collec FIXES & si n aLenMon Mng FIXATIONS chaseekin g statu s clutching THE CHASE ess n e m g a in gs acquir chasing marks pursuin G PLE AM ASI ING NG r sex fo g g c n n h i M asing hun v e i h appro ac PORNOGRAPHY val placing

Copyright 2024 Gordon Neufeld PhD

26

Crisis of Well-Being - Dr. Gordon Neufeld

Hirose Seminars - Vancouver - Nov 26, 2024

Reversing defensive depersonalization should be a top priority in the support of our children’s well-being

mental health

SAFE SANCTUARY

CASCADING CARE vs ROLE-based, including expertbased care vs SELF-care

- trus$ng dependence - end-ofday rituals

Right Relationships & Emotional Playgrounds

SPACE FREE :

T R U teaching S T problemsolving I N screens & distractions G

ADULT

wounding

We must MATTER MORE than those who are wounding the child

CHILD

Copyright 2024 Gordon Neufeld PhD

FREE D SPACE : E P be upset E N D feel sad E N C E

27

Crisis of Well-Being - Dr. Gordon Neufeld

ENCOUNTERS WITH FUTILITY

HELP THAT IS

Hirose Seminars - Vancouver - Nov 26, 2024

ST AL RE EW N RE Y VER O C E R RESILIENCE

HELPFUL!!

• keeping or restoring perspective • right thinking / being positive • pursuing happiness • resisting the ‘let-down’ • acquiring the ‘skills’ of resilience • pursuing calmness & tranquility

Do NOT allow the popular construct of ‘mental health’, thrice removed from a working reality a) a euphemised spin on mental illness which is b) itself an instrumental analogy vs evidence-based reality, and c) an indirect ‘fruit’ versus useful point of intervenMon to thus ECLIPSE its developmental ROOTS in ATTACHMENT and EMOTION

MISDIRECTING and thus EXHAUSTING our valuable resources and energy with regards to the emo;onal well-being of our beloved children and youth.

Copyright 2024 Gordon Neufeld PhD

28

Crisis of Well-Being - Dr. Gordon Neufeld

Hirose Seminars - Vancouver - Nov 26, 2024

Cutivating the Diagnosing syndromes and vs Conditions for Well-Being Battling against Symptoms - crusades against bullying, meanness, discriminaMon, violence, RIGHT RELATIONSHIPS insensiMvity, injusMce, intolerance WITH CARING ADULTS - prosocial programs aimed at ... that can deliver CARE and children being nice and kind provide safe sanctuary for FEELING - discipline approaches aimed at teaching a lesson, socializa3on approaches aimed at declaring PLAYGROUNDS for hurrul interacMon unacceptable, EMOTION and legal approaches punishing the violators ... so that emo;on can find REST, - skill-based programs aLempMng working aCachments can be PROTECTED, vulnerable feelings to teach empathy, self-control, can be RECOVERED, and the emoMonal literacy, graMtude, etc CARE that has been delivered via - mental health advocacy and trus;ng dependence to caring literacy programs as well as selfadults can be FELT care programs

Through a child’s attachment to us, we can BE their ANSWER even when there are no answers: • BE their HOME

• BE their place of REST • BE their sanctuary of SAFETY • BE their SHIELD in a wounding world • BE their REASON for holding on • BE their source of WELL-BEING The answer is in BEING - not in DOING or SAYING or KNOWING the right things – when empowered by the other’s attachment to us.

The Current Crisis of WellBeing what is happening to our kids? an a$achment-based developmental perspec3ve

Gordon Neufeld, Ph.D.

Developmental & Clinical Psychologist

Copyright 2024 Gordon Neufeld PhD

29

10/19/2024

Acceptance and Commitment Therapy: Transcending Traditional Approaches

Jennifer L. Patterson, Psy.D., LCPC Chicago, IL

1

Objectives Day One • To explain the underlying theoretical and philosophical principles of the model • Discuss the six basic tenets of ACT • To layout the general clinical approach • To give examples of the experiential techniques and concepts to gain some skill in using them • To encourage you to explore this model experientially

2

Informed Consent • At times, this workshop will ask for your willingness to engage in experiential exercises • Your privacy will never be violated, but you will be invited to take a few risks • For that reason, we must agree to confidentiality • You may choose to decline participation

3

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10/19/2024

The Ubiquity of Human Suffering

The assumption of “Healthy Normality” is a myth

4

Alternative Assumption: Destructive Normality Normal language and cognitive processes often are destructive and can amplify or exacerbate normal processes into pathological suffering.

5

Question: If that is true, why don’t we all struggle with anxiety, depressed moods, insecurities, fears, etc….?

6

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10/19/2024

What is "third wave" therapy • First wave: behavioral therapy • Second wave: cognitive behavioral therapy • Third wave: acceptance-based behavioral therapy

7

All third-wave therapies are…

Grounded in an empirical, principlefocused approach, the third wave of behavioral and cognitive therapy is particularly sensitive to the context and functions of psychological phenomena, not just their form. Thus, it tends to emphasize contextual and experiential change strategies in addition to more direct and didactic ones (Hayes, 2004).

8

The third-wave therapies • Dialectical behavioral therapy (DBT) • Acceptance and commitment therapy (ACT) • Mindfulness-based cognitive therapy (MBCT) • Functional analytic psychotherapy (FAP)

9

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10/19/2024

Third-wave therapies are…

• More contextual and experiential, less didactic, and more focused on function over form • Unlike CBT, there is little emphasis on changing the content of thoughts; instead, the emphasis is on changing awareness of and relationship to thoughts • Help improve outcomes • Help improve understanding of human behavior

10

All third-wave therapies include: • Acceptance and mindfulness • Spirituality • Values • Emotional deepening • Genuineness, intimacy • The present moment

11

The third-wave approach COGNITIVE

BEHAVIOURAL

• Develop awareness of getting hooked to negative thoughts and thinking patterns

• Clarifying what and who is important in life

• Develop balanced thinking by looking at the function of “buying into” negative thinking vs. learning to just “notice” thoughts

• Commit to engaging in valuebased behaviours.

• Learn new skills i.e. acceptance, defusion, self-compassion, mindfulness

12

4

10/19/2024

Acceptance and Commitment Therapy (ACT) • A form of third-wave experiential behavioral psychotherapy • based on a relational frame approach to human language, • and a resulting perspective on psychopathology

13

Acceptance and Commitment Therapy (ACT) • Pronounced as one word ACT not “A-C-T” • Emphasis on acceptance-willingness to have • Approach to cognition • Not disputing “negative thoughts” • Not trying to change thoughts (though change sometimes happens) (Hayes et al., 1989)

14

ACT… • very experiential • use of metaphors • perception of both therapist and client as people struggling with what life offers • ACT focuses on the individual’s behavior and the context in which it occurs.

• Treatment success is the “successful working” of an individual’s behavior according to that person’s values and desired outcomes.

15

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10/19/2024

ACT suggests…

• psychological pain is normal • cannot get rid of it • pain is different from suffering • accepting your pain reduces suffering (Hayes and Smith, 2005)

16

ACT from the Beginning • In the late 1970s / early 1980s, Steven Hayes et al. began to develop a view based on the behavioral literature on rule governance that psychopathology was often an issue of cognitive rigidity • Hayes et al. developed and borrowed procedures to undermine attachment to verbal rules and to focus on behavior change instead • They called it “Comprehensive Distancing” • And they tested it

17

First Clinical ACT Study • Very small (N = 18) randomized pilot with depressed subjects comparing Beck’s CT and ACT in a 12-week study (3-month follow-up) • Done at Beck’s Center for Cognitive Therapy by a Beck-trained cognitive therapist • With process measures

18

6

10/19/2024

Difference in Outcome 20 15

CT

10 5 0

ACT

HRS-D

Pre

Post

Follow up

19

With Different Change Processes CT

ACT

CT

0% 10 %

ACT

Reductions in the Believability of Depressive Thoughts (Frequency was not different)

20 % 30 % 40 % 50 % 60 %

Pre to Post

Pre to Follow up

20

First ACT Component Study Acceptance and defusion practice CBT practice Information about pain 32 subjects Cold pressor task (up to 5 minutes) (Hayes et al., Psych Record, 1999)

21

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10/19/2024

Results – Seconds of Pain Tolerance 250

200 ACT 150

Traditonal CBT

Cohen’s d at post = .5 (CBT) and .97 (AP)

Information 100

50 Pre

Post

22

Results – Believability of Emotional and Cognitive Reasons 85 80 ACT

75

Traditonal CBT 70

Cohen’s d at post = .89 (CBT) and .91 (AP)

Information

65 60 Pre

Post

23

Then they did something strange…

• Hayes et al. stopped doing ACT research for nearly 15 years and in fact, did not even publish the pain study until 15 years later • During that time, they worked on the philosophy of science – coming up with functional contextualism • And they worked on a basic theory of language and cognition

24

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10/19/2024

As of mid-2024, there are nearly 1,050 ACT randomized controlled trials.

Details of each of these studies, along with links to the original research articles, can be found on: https://contextualscience.org/ACT_Randomized_Controlled_Trials

25

American Psychological Association, Society of Clinical Psychology (Div. 12), Research Supported Psychological Treatments: • Chronic Pain - Strong Research Support • Depression - Modest Research Support • Mixed anxiety - Modest Research Support • Obsessive-Compulsive Disorder - Modest Research Support • Psychosis - Modest Research Support

26

Book reviewing ACT Research Hooper, N., & Larsson, A. (2015) The research Journey of Acceptance and Commitment Therapy (ACT). London: Palgrave Macmillan http://www.palgrave.com/gp/book/9781137440150#otherversion=97811374401 67

27

9

10/19/2024

Limitations of Research Limitations of the Research and Potential Risks • Acute, florid hallucinations • Catatonic depression • Individuals with an adverse reaction to mindfulness exercises

28

ACT: The Foundation Philosophy and Theory

-Functional Contextualism (FC) -Relational Frame Theory (RFT)

29

Why Learn Functional Contextualism and RFT? • Understand how language is the source of our suffering • Use language as an intervention • Helps to become a more competent ACT clinician!

30

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10/19/2024

What is Functional Contextualism?

A modern philosophy of science rooted in philosophical pragmatism and contextualism. It is most actively developed in behavioral science in general and the field of behavior analysis and contextual behavioral science.

31

In other words, 1.Context Matters: Imagine you’re solving a puzzle. Instead of examining individual pieces, functional contextualism encourages you to consider the whole picture—the context. It’s like understanding a word by examining its sentence.

2.Useful Insights: Functional contextualism focuses on valuable insights. It’s not about being perfectly accurate; it’s about what helps you take effective action. Think of it as finding practical solutions rather than just theoretical answers.

3.Behavior and Language: This idea is used in psychology and therapy. Therapy is about understanding how our thoughts and feelings affect our actions. It’s like figuring out how words (language) impact our behavior.

32

Functional Contextualism • Functional Contextualism is the underlying philosophy of ACT • What is the “function” of any particular behavior?

• Core focus of Act becomes “workability”

33

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10/19/2024

Context • Anything that influences behavior • Can be anything that precedes behavior (Antecedent) • Can be anything that comes after behavior (Consequence)

34

ALWAYS ASK YOURSELF WTF?!

(What the function)

35

What are the Functions of Human Behavior?

• Escape/Avoidance – escaping or avoiding pain or a demand situation.

• Attention – a behavior done to gain the attention of others.

• Access – a behavior to access a tangible object or situation.

• Sensory – a behavior that is self-stimulatory to feel good.

36

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10/19/2024

Example: Eating a piece of candy (Behavior) Can be influences by being hungry (Antecedent) AND Can be influenced by the taste of candy in the mouth (Consequence)

37

What Contexts Exist?

• Situational • Physiological • Genetic • Epigenetic • Cognitive • Social Cultural • Emotional • Interpersonal • Development and learning history

38

Example: • Situational – Place where the behavior of eating candy is influenced Trick-or-Treating Birthday Party • Interpersonal – Thoughts and emotions that may influence the behavior of eating candy I want candy too!

I’m bored

39

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10/19/2024

IF our behaviors are influenced by the context…

THEN we can change the context to change our behaviors

40

Two Main Ways of Changing the Context Concrete AKA Direct

Symbolically

41

Relational Frame Theory: The Role of Language Language is a double edge sword Light and dark side of human language Language is the reason for the ascendance of species AND the primary cause of our suffering

42

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10/19/2024

43

44

Receptive language - the understanding that words have meaning Expressive language - the ability to say words with meaning As we develop, we start to understand that sounds become words and words are given meaning.

45

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10/19/2024

Learning through language and cognition is secondary to learning through experience.

46

We learn through arbitrary and non-arbitrary means Non-Arbitrary

Arbitrary

Repulsed Disgusted Queasy Nauseated

47

Non-Arbitrary

Arbitrary

Yummy Sweet Good Delicious

48

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10/19/2024

Function of Behavior Aversive Stimulus

Appetitive Stimulus

49

Foundation of Language

50

51

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10/19/2024

=

“Pacifier”

“Pacifier”

=

52

RFT Model of Psychopathology Thought“What if something bad happens!”

I need to escape from my thoughts by drinking alcohol

TransformsInto anxiety

Arbitrary Applicability“Thoughts about anxiety are bad!

Aversive Stimulus Control Avoidance

Ironic Processes“Don’t think about my anxiety”

53

Ironic Processes The more you scratch the more you itch!

Trying not to think about X… Tends to evoke X

54

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10/19/2024

In summary…

• When people feel bad, they carry around verbal descriptions of the hurt • These descriptions keep the person in contact with the hurt • People don’t like hurting • They want to avoid the hurt • They try to control their thinking about the hurt

55

ACT tries to undermine ...

• The domination of literal, evaluative, and temporal language • Connect instead with our values • Behave more flexibly and effectively, focused on our values, not our fear

56

ACT Stance on Disorders • Attempts to “get rid of” painful private experiences can be the underpinning of mental health issues…

• “Painful” thoughts and emotions do not produce mental disorders in and of themselves.

57

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10/19/2024

Psychological Inflexibility • Clients need to get rid of negative private experiences • This is best achieved by experiential avoidance • Experiential avoidance is the core problem most clients face

58

Psychological Inflexibility “Inflexahex”

59

Ruminating/Forecasting Experiential Avoidance

Unclear Values

Psychological Inflexibility Hooks/Fusion

Unworkable Action Lost in the Narrative

60

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10/19/2024

The six core processes are interconnected and maintain psychological inflexibility

61

Transdiagnostic Approach • Transdiagnostic approaches that target underlying psychological processes (rather than symptom constellations) are increasingly becoming the new gold standard of evidencebased treatment.

• Process-based treatment bridges clinical science and practice, can target a broader range of problems than diagnosis-based protocols, and is more easily individualized and administered to the client.

62

Assessment phase • Transdiagnostic Approach • Using the ACT conceptualization model – Inflexahex • Target core processes regardless of symptoms and co-morbidity

63

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10/19/2024

Experiential Avoidance

Lost in the Narrative

64

Experiential Avoidance

65

Experiential Avoidance • Individuals often try to decrease negative private experiences through “experiential avoidant” behaviors, which can be overt or covert.

• This is a common occurrence in all of us… ignoring, distracting, forgetting, etc.

66

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10/19/2024

Higher Avoidance Scores Are… • Associated with: • Distress intolerance • Higher anxiety • Substance abuse • More Depression • More overall pathology • Poorer work performance • Inability to learn • Lower quality of life

• History of sexual abuse • High-risk sexual behavior • BPD symptomatology and depression • Thought suppression • Alexithymia • Anxiety sensitivity • Long term disability • PTSD following trauma

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Common overt avoidant behaviors • Excessive use of alcohol • Substance abuse • Excessive sleeping • Zoning out in front of the TV • Excessive Videogaming • Compulsive Shopping • Sleeping too much

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Avoidance is also experiential…

• Attempting to change emotions' form, frequency, or situational sensitivity, especially those that are universal and contextually appropriate.

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Experiential avoidance is…

Cognitive modification - Excessively trying to control or change thoughts and emotions Cognitive reappraisal - Trying to see things in a positive light Suppression – trying to suppress thoughts and emotions = Elimination Agenda!

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“The single most remarkable fact about human existence is how hard it is for humans to be happy.”

(Hayes, Strosahl, & Wilson, 1999)

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What Exactly is “Happiness”?

“Happiness” has two very different meanings 1. The common meaning – is to “feel good.”

Feeling a sense of pleasure, gladness, or gratification. However, like all human emotions, feelings of happiness don’t last.

(Harris, 2008)

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2. Far less common meaning – is “living a rich, full, and meaningful life.”

When we take action on the things that truly matter deep in our hearts, move in directions that we consider valuable and worthy, clarify what we stand for in life, and act accordingly…

Then, our lives become rich and meaningful, and we experience a powerful sense of vitality.

(Harris, 2008)

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Four Myths of Happiness 1. Happiness is THE natural state for ALL human beings 2. If you’re not happy, you’re defective 3. To create a better life, we MUST get rid of negative feelings 4. You SHOULD be able to CONTROL what you think and feel (Harris, 2008)

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Avoidance = Suffering

Primary Pain (PP)

Avoidance Of PP (due to evaluations, verbal entanglement)

Secondary Pain

Suffering

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Primary Pain vs. Secondary Pain • Lost job due to economy = sadness, frustration, and irritability “How am I going to feed my family?”(Primary) • Negative evaluation of the primary pain “I’m a loser,” “I’ll never find a job” “I can’t handle this!” = and leads to Avoidant behavior (e.g., Drinking excessively) • Which can then lead to further problems = guilt over avoidant behavior, family members upset, etc.

(Secondary)

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“Suffering usually relates to wanting things to

be different than they are.” ~Allan Lokos

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Fusion AKA Getting Hooked

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Fusion • Inflexible behavior influenced more by verbal networks.

• Thoughts, feelings, judgments and memories have more influence over responding than direct experience with the world.

• Most clients believe what their mind is telling them, not what their experience has been.

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Fusion • Look for instances where responding is guided by evaluations and inflexible rules.

• This will look like ‘cognitive distortions’ in CBT.

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Clinical Examples • “I’m such an idiot” • “Nothing will EVER change” • “I’m unlovable” • “I am broken” • “I will ALWAYS screw up”

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Experiential Avoidance and Fusion • Experiential avoidance increases the impact and even frequency of avoided thoughts, feelings, and sensations • Cognitive fusion increases the impact and even the frequency of entangling, negative thoughts

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Fusion measures • Automatic Thoughts-Believability (ATQ-B) • Believability of Anxious Feelings and Thoughts Questionnaire (BAFT) • Cognitive Fusion Questionnaire • Stigmatizing Attitudes–Believability (SAB)

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Attachment to conceptualized self AKA Lost in the Narrative

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Three Senses of Self • Conceptualized Self • Self-as-Context • Self-as-process

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The conceptualized self • The conceptualized self is the same thing as self-ascontent and attachment to the conceptualized self is usually related to fusion with content.

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Pros A conceptualized self is useful It allows us to participate in a verbal social community and answer questions such as: • What is your name?

• What do you do for a living?

• Where do you live?

• Is that your son?

• How old are you?

• Tell me about your hobbies?

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Attachment to the conceptualized self During case conceptualization, look for statements such as: • I am too…

• If only I did…(or didn’t…) then I would • My problem is that I… • I am a (failure, loser, wimp, druggie, etc.)

• I am not (smart, pretty, strong) enough • I can’t…

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Core Belief Chart

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Example “I was traumatized” (historical fact) gets used in a cause-andeffect relationship like “My trauma causes me to not be safe in the world” and serves as an explanation for current behavior: “So, because I can’t trust, I can’t live my life.”

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Dominating Concept of the Past and Feared Future, AKA Ruminating/Forecasting

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Dominating concept of the past and/or feared future • Fusion with the verbally constructed past or future means that one is not in contact with the present moment • Words pull us into the past and future • Rumination about the past or feared future • Anticipatory anxiety and avoidance

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Mindfulness Measures • Five Facet Mindfulness Questionnaire (FFMQ) • Freiburg Mindfulness Inventory • Mindful Attention Awareness Scale (MAAS)

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About 47% of waking hours is spent thinking about what isn’t going on

(Killingsworth and Gilbert, 2010)

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Lack of Values Clarity AKA Unclear Values

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Lack of values clarity • The client may describe a general lack of vitality and be vague about values and goals.

• The client may misunderstand the difference between values and goals.

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Listen for…

What’s the point?

Nothing matters.

I don’t know where I’m going.

I don’t know what to do.

What should I do with my life?

Everything seems meaningless…I feel disillusioned.

Ever since (my divorce, my illness, I started using drugs, etc), my life has been going nowhere.

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• Personal Values Questionnaire • The Survey of Guiding Principles questionnaire and card sort • VLQ - Valued Living Questionnaire • Values Bull's Eye • Values Compass pictures • Valuing Questionnaire (VQ)

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The ACT Clinical Interview • The client’s presenting concerns • Past experiences that have shaped the client’s current behavior • Current context/experiences that maintain the client’s clinical issues

(Patterson & Rowland 2016)

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Experiential Avoidance – (administer the AAQ) • What have you been doing to cope with your (anxiety, depression, clinical issues)?

Listen for avoidant, compulsive behaviors (Excessive use of alcohol, substance abuse, excessive sleeping, zoning out in front of the TV, etc.)

• What have you done internally to control unwanted thoughts, memories, images, and emotions?

Listen for instances of suppression, minimization, distraction, ignoring, etc.

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• What unwanted thoughts, memories, images, and emotions are most present for you daily?

• How much time and energy do you spend trying not to think of painful thoughts, memories, images, or emotions?

• Give me an example of something painful you have recently experienced and how you respond to it. Cope with it?

Listen for workable and unworkable strategies.

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Fusion – (administer the CFQ) • Do you believe your unwanted thoughts to be true? Especially the ones that are self-critical, judgmental, and evaluative.

Listen for ‘I am’ statements, irrational beliefs, cognitive distortions, etc.

• When you believe your thoughts, do you act on them?

• How workable is your behavior when you act on negative thoughts?

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Dominating Concept of Past and Fear Future – (follow up with administering the MAAS) • How often do you find yourself thinking about the past?

What do you think about the past?

• How often do you think about the future? What do you think will happen in the future?

Listen for excessive rumination and or anticipatory anxiety ‘what if” statements.

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Lack of Values Clarity – (follow up with administering a values assessment; VLQ,) • What are some things that are important to you? What gives your life meaning and vitality?

• What do you value?

Listen for statements What’s the point? I have no idea, Nothing really…

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Experiential Avoidance

Lost in the Narrative

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Case Conceptualization Rick, 29 single Caucasian male, lives alone in a two-bedroom condo.

He works as an engineer and is dissatisfied with his career path but loves and is good at programming History of social anxiety – smokes marijuana Adopted at age three (father is deceased, mother is in a nursing home) Presenting complaints – The reason I need counseling is pretty apparent. I hate my job and get paid squat, but at the same time, I won't quit, ask for a raise, or pitch my ideas. It’s the same with getting high. I don’t even enjoy it. I do it to take the edge off. I don’t have any friends, nor a girlfriend. The future is bleak. I’m fucking loser with no end in sight!

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Rick: I got stoned last night after staying clean for four days. We had a staff meeting, and I wanted to suggest that new product again; I’ve been thinking about it for a year and can’t get up the balls to talk about it….But then, when I thought about speaking up, my hands started to shake, my face got hot, and my mind started blank. I knew I wouldn’t be able to say anything without looking like an asshole, so I just kept my mouth shut. And then, while I was thinking about this stuff, I didn’t hear the boss ask me a question, and suddenly, everyone was staring at me, waiting for me to say something. I know I turned all red, and I heard someone snickering when I had to ask the boss to repeat the question. And then I just mumbled something stupid. I wanted to disappear. And then the real kicker ---Adam suggested the product I was going to suggest, and everyone said what a great idea it is. Now he, as usual, gets all the kudos while I’m the one who looks like a loser. I was driving home just thinking, “I’m such an asshole; nothing is ever going to change. And I couldn’t stop thinking about that damn meeting. And then, when some neighborhood kid asked if I wanted to score some good weed, I was like, “What the hell? Nothing’s ever going to change.” So I bought a half-ounce and got stoned. It felt great until I woke up the next day, and now it’s still like, “Nothing is ever going to change! I’m always going to screw up. What’s the point in staying off of the marijuana?” It’s, like, the only thing worthwhile in my life. Why should I quit it just because some shrink thinks I should? No one else cares if I smoke the shit or not. Why should I care?

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This then is the overall ACT model

Contact with the Present Moment

Acceptance

Values

Defusion

Committed Action

Self as Context

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Acceptance and Mindfulness Processes

Contact with the Present Moment

You can chunk them into two larger groups

Acceptance

Values

Defusion

Committed Action

Self as Context

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and

Contact with the Present Moment

Commitment and Behavior Change Processes

Acceptance

Values

Defusion

Committed Action

Thus the name “Acceptance and Commitment Therapy”

Self as Context

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The Essence of ACT Work

Contact with the Present Moment

Acceptance

Values

is this psychological space

Defusion

and what it is, is the answer to this central ...

Committed Action

Self as Context

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ACT Question

Contact with the Present Moment

(6) at this time, in this situation?

(2) are you willing to have that stuff, fully and without defense Acceptance

If the answer is “yes,” that is what builds...

Values (5) of your chosen values

Psychological Flexibility (4) AND do what takes you in the direction Committed Action

Defusion

(3) as it is, and not as what it says it is, Self as Context

(1) Given a distinction between you and the stuff you are struggling with and trying to change

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Psychological flexibility is:

…contacting the present moment fully …as a conscious, historical human being, …and based on what the situation affords …changing or persisting in behavior …in the service of chosen values.

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The psychological flexibility processes SYSTEM

PSYCHOLOGICAL FLEXIBILITY PROCESS

Affective

Acceptance

Cognitive

Defusion

Attentional

Present moment

Self

Transcendent self

Motivational

Values

Overt behavioral

Committed action

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Informed Consent 1) Address alternative therapies 2) Address risks and benefits 3) Propose a specific time frame 4) Orient person to therapist, client roles 5) Give general descriptions of operating principles https://contextualscience.org/informed_consent_for_act

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ACT in Action Typically, you do not ‘teach’ ACT. 1. Give clients an experience of the ACT processes.

2. In session, you model the ACT processes.

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The Therapeutic Relationship •The six core ACT flexibility processes (transcendent self, defusion, acceptance, present moment, values, and committed action) are central to the therapeutic relationship.

•If we model psychological flexibility in the therapy room, clients internalize it, just as you internalize it.

•The betweenness of the therapist and client interactions is central.

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Therapeutic Relationship: EXTREMELY IMPORTANT 1. Needs to be safe and supportive 2. Give lots of positive support and feedback 3. Lots of validation of pain 4. Lots of validation of difficulty in making changes 5. Self–disclosure in the interest of validation 6. Explain the rationale behind techniques.

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Sessions should follow the following format: • Brief Update and Mood Check • Bridge from Previous Session • Set Agenda • Review Homework • Potential supporting exercises (see below) • Final Summary • Assign Homework • Feedback

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“We can shift our work from something that looks more like fixing a problem to something that looks more like building a life.” ~ Steve Hayes

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Acceptance

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Actively contacting psychological experiences directly, fully, and without needless defense while behaving effectively.

Hayes, Wilson, Gifford, Follette, & Strosahl, 1996, p. 1163

Colloquially, Acceptance is a willingness to have the capacity to feel so that you can learn from your experiences.

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ACCEPTANCE is not: • Tolerating, putting up with • Resignation • Defeat, a “less than” alternative • Passive

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What helps willingness to accept?

• Creative Hopelessness” —engendering a posture of giving up strategies when giving up is what is called for in service of larger goals.

• We help clients understand that the alternative to control is willingness.

• “Are you willing to have what shows up?”

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Creative Hopelessness • Making the client aware of an ‘unworkable’ change agenda.

• Workability = the extent to which a behavior ‘works’ in the long term to create a rich, full, meaningful life.

• The client is trying to improve their life by using emotional control strategies in contexts where they don’t work and/or reduce their quality of life.

• Q: What have you tried? How has it worked in the long term? What has it cost?

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Building Willingness • Explore how the steps the client took have worked or not • Don’t imply their coping strategies were wrong • VALIDATE whatever the client did to survive.

• VALIDATE that these control strategies are often helpful in the short term.

• GENTLY, COMPASSIONATELY get the client in touch with the reality that these strategies are NOT HELPFUL in the long term.

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Learning to Say “Yes” In ACT work, we encourage clients to deliberately seek out or imagine situations they avoid and change their relationship to the thoughts, feelings, and memories that arise.

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The Miracle Question What would you do if a miracle happened and all the things you are struggling with were instantly solved?

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Creative Hopelessness Metaphors • Quicksand • Person in the hole • Tug-of-war with a Monster • The Struggle switch

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Willingness Exercises • Ball-in-a-Pool • Unwelcomed Party Guest • Finger Trap • Holding the Cactus Lightly • Turn up the Willingness knob

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Goals for Clinicians Help clients let go of the agenda of control as applied to internal experiences. Help clients see experiential willingness as an alternative to experiential control. Help clients come into contact with willingness as a choice, not a desire. Help clients to understand willingness as a process, not an outcome.

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DeFusion AKA Unhooked

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We are NOT our Thoughts…

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How to help clients Use defusion exercises in session such as: • Deliteralizing language • Lemon…Lemon…Lemon • Another Voice

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Focus on functionality • “And what is that story in the service of?”

• “Is this helpful, or is this what your mind does to you?”

• “What’s useful about believing this thought?”

• Buying a thought vs. Having a thought • Thank your mind for that thought.

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“How old is that thought?”

“If that thought had a voice, how would it sound?”

“What does that thought remind you of?”

“Just say that thought again slowly and let’s watch what shows up.”

“In a normal mode of mind, what does that thought usually pull from you?”

“Can we distill that thought down to its simplest form or theme? The core theme of that thought is ______________?”

“If that thought were an object, how big would it be?”

“What other thoughts do you have in association with that thought

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Metaphors/analogies

•Clouds in the sky • Leaves on a stream •Sushi Train

•Passengers on the bus

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Defusion Exercises • Thoughts on Post-It notes • Defusing Storytelling

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SELF AS CONTEXT AKA FLUID SELF

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Self-as-Context It is experienced when we notice our own private or public experience in the present moment • I feel sad (or hungry, tired, anxious, happy) • I am thinking about what to have for dinner • I am walking to the coffee shop • I am typing an email message to my boss • I am having the thought, “I don’t want to go.”

• I am having a panic attack • I am obsessing about germs

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How to help clients • Discuss evaluations vs descriptions • Good Cup Bad Cup • Looking at thoughts as just thoughts • “I am having the thought, “I’m a bad person” vs “I’m a bad person” • Metaphors

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The sense of self is a consistent perspective from which to observe and accept all changing experiences.

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Activities • Touch your nose, your toes, your clothes…

• You as a baby, as a little kid, you as you are NOW • Your box of stuff • Chessboard metaphor

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Contacting the Present Moment

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Mindfulness: …is much easier learned by experience …involves: paying attention in a particular way; on purpose, in the present moment, and nonjudgmentally -Jon Kabat-Zinn

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Why do we teach clients to be in contact with the present moment?

To help clients…

• discover that life is happening right now • to return to “now” from a conceptualized past or future…whether it be filled with sorrow or happiness • to notice what is happening in their relationships now • To accept moment-to-moment emotional experiences

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Mindfulness The official ACT definition of mindfulness is: As a conscious human being, defused, accepting, and open contact with the present moment and the private events it contains is experientially distinct from the content being noticed.

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It also helps to undermine avoidance and struggle…

If we are presently focused, we usually have nothing against which to fight; we only have what is present.

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Goals of Mindfulness Come into contact with the present moment willingly, in the services of greater vitality and psychological flexibility. Establish observation and awareness skills. Continue practicing these skills so they are honed. Contact the present moment in the presence of an aversive experience that constricts behavior.

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How Do We Teach Clients To be Mindful?

• As clinicians, we need to encourage clients to observe and notice what is present in their environment and their private experience.

• Clinicians should encourage their clients to label and describe what is present without excessive judgment or evaluation.

Linehan, 1993

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Observe and notice + label and describe = “Mindfulness”

Linehan, 1993

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It is an active process of moment-to-moment awareness of your: Surroundings “I am here in this room listening to Jennifer talk about Mindfulness.”

AND Private Events “I am bored, I feel tired, I need more coffee…”

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Obstacles in trying to teach mindfulness Clients and clinicians can misunderstand the goal of mindfulness.

• Mindfulness is NOT a technique to diminish an undesirable feeling such as anxiety.

• MINDFULNESS and RELAXATION are not the same.

They are separate techniques with separate goals.

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Best Mindfulness Apps • Headspace • Smiling Mind • Insight Timer • Mindfulness Daily • Calm • ACT coach • Stop, Breathe & Think Information from: Mani M, Kavanagh DJ, Hides L, Stoyanov SR. Based on I Phone Apps. JMIR mHealth 2015; 3 (3): e82. Available at URL: http://mhealth.jmir.org/2015/3/e82

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Values Clarification

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VALUES ASSESSMENT: DIRECT MEANS • Personal Values Questionnaire (Blackledge & Ciarrochi, 2005) • Valued Living Questionnaire (Wilson & Groom, 2002)

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Intimate relationships Family relations Social relations Employment Education and training Recreation Spirituality Citizenship Health/physical well-being 159

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Values Questions Start with what they care most about  If they say, “to feel better,” I ask, “If you felt better, what would life look like for you?” “If I had a magic wand…”

• Other ways to start  Say, “For me to help, I need your help first. I want to know what it is like to be you and walk around in your shoes.” “In a world where you could choose any direction, what would you want your life to stand for? And are you doing that now? “Are you willing to do whatever needs to be done to move in that direction?”

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Values activities • The Dash Poem • Epitaph exercise • Eulogy exercise

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Committed Action

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Committed Action • Committed action is a step-by-step process of acting to create a whole life, a life of integrity, true to one’s deepest wishes and longings.

• Commitment involves both persistence and change – whichever is called for in living one’s values.

• Committed action is inherently responsible – based on the view that there is always an ability to respond in any situation.

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How to help clients…

• Stick with ESTs • In session committed action • Homework between sessions

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Contact with the Present Moment

Acceptance

Values

Defusion

Committed Action

Self as Context

Habit Reversal Social Skills Training Behavioral Activation ERP Role Play Systematic Desensitization

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Committed Action • Specific and measurable in some way • Practical and within the client’s abilities • Avoid “dead men’s goals” • Linked to their values

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Committed Action • Lots of contracts (for home, for work, with the therapist) • Practice doing things when mad, sad, hyper, as well as happy (sometimes had to “pretend” felt specific ways, and other times this naturally occurred) • Talk about how it feels either easier or more challenging – noting consequences in the short- and long-term either way

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ACT Question

Contact with the Present Moment

(2) are you willing to have that stuff, fully and without defense Acceptance

(6) at this time, in this situation?

Values

(5) of your chosen values

If the answer is “yes,” that is what builds...

Defusion

Psychological Flexibility (4) AND do what takes you in the direction Committed Action

(3) as it is, and not as what it says it is, Self as Context (1) Given a distinction between you and the stuff you are struggling with and trying to change

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ACT Apps

- ACT-companion (iOS & Android), http://www.actcompanion.com/ - ACT Coach (iOS & Android), https://itunes.apple.com/us/app/actcoach/id804247934?mt=8 - ACT Mindfully (Android), https://play.google.com/store/apps/details?id=it.marcot uri.actmindfully - ACTive: Value-based living (iOS), https://itunes.apple.com/us/app/active-value-basedliving/id1343994479 - Blue Life Coach (iOS & Android) http://bluelifecoach.com - I Here Now (iOS), https://itunes.apple.com/se/app/iherenow/id872764840?mt =8 - Learn2ACT (iOS & Android), http://www.learn2act.net - The Sleep School App (iOS & Android), https://my.thesleepschool.org/category/insomnia/ - 2Morrow Health (suite of ACT-based apps for various health issues), https://www.2morrowinc.com/2morrow-health/

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Questions?

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Thank you!

PattersonJennifer@comcast.net

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Useful Resources • Drjenniferlpatterson.com • Patterson-jennifer@comcast.net • Association for Contextual Behavioral Sciences www.contextualscience.org • https://www.praxiscet.com/ • https://contextualscience.org/ACTinPractice

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References • Bach, P., & Moran, D. (2008). ACT in practice: Case conceptualization in Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.

• Bullis, J. R., Boettcher, H., Sauer‐Zavala, S., Farchione, T. J., & Barlow, D. H. (2019). What is an emotional disorder? A transdiagnostic mechanistic definition with implications for assessment, treatment, and prevention.

Clinical Psychology: Science and Practice, 26(2), e12278.

• Eifert, G.H.; Forsyth, J.P. (2005). ACT for Anxiety Disorders. Oakland, CA: New Harbinger Publications, Inc. • Eifert, G. H., Forsyth, J. P., Arch, J., Espejo, N., Keller, M., & Langer, D. (2009). Acceptance and Commitment Therapy for anxiety disorders: Three case studies exemplifying a unified treatment protocol. Cognitive and Behavioral Practice, 16, 368–385.

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• Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and Commitment Therapy: An experiential approach to behavior change. New York: Guilford Press.

• Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006).

Acceptance and commitment therapy: Model, processes and outcome.

Behaviour Research and Therapy, 44, 1-25.

• Hayes, S.C.; Smith, S. (2005). Get Out of Your Mind and Into Your Life. Oakland, CA: New Harbinger Publications, Inc. • Harris, R. (2008). The Happiness Trap. Boston, MA: Trumpeter Books.

• Killingsworth, M.A, Gilbert, D.T. (2010). A wandering mind is an unhappy mind.

Science, volume 330, Issue 6006, pp. 932 DOI: 10.1126/science.1192439 • Linehan, M. (1993) Skills Training Manual for Treating Borderline Personality Disorder. New York, NY: The Guilford Press.

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• McKay, M; Lev, A; Skeen, M. (2012). Acceptance and Commitment Therapy for Interpersonal Problems. Oakland, CA: New Harbinger Publications, Inc. • McKay, M.; Fanning, P.; Lev, A., Skeen, M. (2013). The Interpersonal Problems Workbook. Oakland, CA: New Harbinger Publications, Inc. • Neff, K. (2011). Self-Compassion: The Power of Being Kind to Yourself.

New York, NY: HarperCollins Publishers.

• Neff, K. (2016) The Self-Compassion Scale is a valid and theoretically coherent measure of self-compassion. Mindfulness. 7 (1), 264-274.

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• Stahl, B.; Goldstein, E. (2010). A Mindfulness-Based Stress Reduction Workbook. Oakland, CA: New Harbinger, Inc. • Stoddard, J.A.; Afari, N. (2014). The Big Book of ACT Metaphors. Oakland, CA: New Harbinger, Inc. • Zettle, R.D. (2007). ACT for Depression. Oakland, CA: New Harbinger Publications, Inc. • Zettle, R. D., Rains, J. C., & Hayes, S. C. (2011). Processes of change in acceptance and commitment therapy and cognitive therapy for depression: A mediation reanalysis of Zettle and Rains. Behavior Modification, 35, 263-283.

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