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Behavior Modification, Goal Setting and Avoiding Common Traps
Presented by: Dr. Dawn-Elise Snipes
Executive Director, AllCEUs
Host: Counselor Toolbox

A direct link to the CEU course is
~    Define behavior modification
~    Explore how behavior modification can be useful in practice
~    Learn basic behavior modification terms:
~    Unconditioned stimulus and response
~    Conditioned stimulus and response
~    Discriminitive stimuli
~    Learned helplessness

Why Do I Care
~    Change means doing something different or modifying a response
~    That response can be a neurochemical one (stress response) or an overt behavioral one (smoking)
~    Behavior modification principles will help you understand some of the reasons people act/react the way they do
~    By understanding what causes and motivates people’s behavior we can better address their issues
~    The focus on observable, measurable conditions to the exclusion of cognitive interpretation underscores the mind-body connection
~    Behavior modification in its truest form is concerned only with observable, measurable behaviors, stimuli and reinforcement
~    Emotions, interpretations and mental processes have no bearing

How can this be useful in practice
~    Traditional (strict) behavior modification can be quite useful in simplifying stimulus/reaction
~¬†¬† ¬†Integrating the cognitive interpretations (labels) can help people in identifying and addressing what is causing their ‚Äúdistress‚ÄĚ (Behaviorists would refer to excitatory response)
~    Understanding what causes feelings can also give people a greater sense of empowerment.
~    Puppies learn appropriate behavior through reinforcement and correction
~    Puppy 1 tackles puppy 2  threat
~    Puppy 2 responds by tackling puppy 1  counter threat
~    Both puppies get a surge of adrenaline
~¬†¬† ¬†The puppy that dominates receives a dopamine surge that reinforces the prior behaviors — do that again.

~    If Puppy 1 plays too rough, then puppy 2 will either become more aggressive or leave.
~    Either way, puppy 1s behavior is punished.
Example 2
~    Humans have learned to label certain internal experiences with feeling words (angry, scared, happy)
~    Sally goes to a pet store
~    A puppy comes out, sits in her lap and puts is head on her leg
~¬†¬† ¬†This contact (we know from studies) usually causes the release of dopamine and oxytocin ‚Äďboth reward chemicals
~¬†¬† ¬†Sally calls this ‚Äúhappy‚ÄĚ

~¬†¬† ¬†If Sally had previously had a threatening experience with a dog, when she saw it, her body would likely respond by secreting adrenaline, kicking off the fight or flight reaction.¬† Sally would label this as ‚Äúfear‚ÄĚ
~    The brain receives signals and, based on prior learning (conditioning), responds with either:
~    Fight/Anger or Flee/Fear (adrenaline/norepinepherine)
~    No reaction/neutral
~    Pleasure/Happy/Do this again (Dopamine/norepinephrine/Serotonin/GABA/Oxytocin?)
~    Humans label these different chemical responses with feeling words.
~    The same response can be labeled differently by two different people (fear vs. exhilaration)
~    People with anxiety, anger or resultant depression may need to:
~    Recondition  X is not actually a threat (anymore)
~    Relabel
~    Excited vs. terrified
~    Stressed vs. hungry
~    Helpless/anxious vs. fat
~¬†¬† ¬†ACT approach‚Äď X is causing me to have the feeling that‚Ķ
~    In American culture we often use nonfeeling words to describe emotional states.
~    Part of recovery is identifying the physiological response to the stimulus and labeling it with a feeling word
Basic Terms
~    Unconditioned stimulus and response
~    Something that evokes an unconditioned/automatic response in an infant and adult
~    Loud noises
~    Pain
~    Excessive cold/heat
~    Contact
Basic Terms
~    Conditioned Stimulus
~    Something that in itself has no meaning to the person (yellow light)
~    Conditioned Response
~    The person’s reaction to the stimulus (slow down or floor it)
~    Conditioned stimuli and responses can be traced back to survival Fight-Flee-Forget-Repeat
Basic Terms
~    Discriminitive stimulus
~    All things being equal, the stimulus which triggers the reaction. (Includes vulnerabilities)
~    Going to work
~    Good day
~    Bad day
~    Learned Helplessness
~    A response which occurs when people have tried and failed to either fight or flee.  Giving up.

Measurable Responses  Basic Feelings
~    Excitatory (Adrenaline, norepinephrine, Glutamate)
~    Fight  Anger, rage, resentment, jealousy, envy, regret, stress
~    Flee  Fear, anxious, nervous, apprehensive, timid
~    Neutral
~    Learned Helplessness  Depression
~    Inhibitory (Serotonin, GABA, Dopamine)
~    Repeat  Happy, elated, victorious, successful, competent

Fight or Flee
~    Stimuli that present a threat of pain or death can trigger the excitatory fight or flight response
~    Through experiences (conditioning) people learn what threats
~    They can defeat (fight/anger)
~    Will defeat them (flee/anxiety)
~    A useful intervention is to identify
~    The threat
~    Why is was labeled fight/anger/controllable or flee/fear/uncontrollable
~    Break down parts of the situation into controllable and uncontrollable
A Note About Threats
~    Fight or Flee (survival)
~    Basic Fears
~    Loss of Control
~    Underscores most fears
~    Fighting or fleeing provides control
~    Isolation & rejection
~    Primitive: Death/inability to procreate
~    Can be examined and counter conditioned
~    Is this really going to kill you?
~    Examine the exceptions
~    Examine alternate explanations

A Note About Threats
~    Fight or Flee (survival)
~    Basic Fears
~    The unknown
~    Primitive: Death/pain
~    Can be examined or counter conditioned
~    What is the probability this will end in death or pain?
~    How many other times have you confronted an unknown and the outcome was positive or neutral?

A Note About Threats
~    Fight or Flee (survival)
~    Basic Fears
~    Failure
~    Primitive: Death/pain
~    Can be examined or counter conditioned
~    What is the probability that if I fail it will result in death or pain?
~    If I fail, is that pain related to fear of rejection and/or loss of control?
~    How many other times have you tried and failed and the outcome was at least neutral?
~    How can you make failure into a positive or neutral (Hint: Learning experience)

~    Some stimuli elicit little or no response and are often ignored
~    MindLESSness can cause people to fail to identify
~¬†¬† ¬†Positive stimuli ÔɆ dopamine ÔɆ ‚Äúhappy‚ÄĚ
~    Negative stimuli  adrenaline  fight or flee
~    Little things build up and lead to a big reaction.  (Water and the dam)
~    Negative stimuli can be reconditioned as neutral
~    Find the positive (snowy day)
~    Not worth the energy (rainy day)
~    Adding and noticing positive stimuli in the environment is vital
~    Grouchy day
~    Happy day
~    Positive stimuli in the environment can include
~    Smells (pumpkin spice…lol)
~    Sights (wildlife, my kids)
~    Sounds (babbling brook)
~    Feel (crisp autumn breeze)

Putting It Together
~    Humans label physiological reactions with feeling words.
~    What do you experience when you are scared?
~    What do you experience when you are angry?
~    How do you differentiate?  (Hint: Prior experience)
~    What do you experience when you are happy?

Putting it Together
~    How can you use discriminative stimuli to
~    Increase happy responses
~¬†¬† ¬†Increase a feeling of control and ‚Äúself-efficacy‚ÄĚ
~    Loss of control
~    The Unknown
~¬†¬† ¬†Increase ‚Äúself-esteem‚ÄĚ
~    Rejection
~    Isolation
~¬†¬† ¬†Increase feelings of ‚Äúcompetence‚ÄĚ
~    Failure

Putting it Together
~    How can you use discriminative stimuli to:
~    Decrease angry responses
~    Decrease anxious/fearful responses
~    Decrease learned helplessness

~    Behavior modification is concerned with the stimuli in the environment that evoke a response
~    Unconditioned stimuli evoke a response based upon survival needs
~    Conditioned stimuli have no meaning to the person, but, through experience, become associated with pleasure or pain/threat
~    The excitatory responses, anger and fear serve to protect the person from what they have in the past experienced as producing pain/being threatening.

~    Stimuli can be reconditioned in order to change the biochemical response (feeling)
~    People with a logical/experimental mindset often respond well to behavior modification techniques
~    It is imperative to include alternate responses.
~    In the next segment we will discuss
~    Reinforcement
~    Punishment

Nashville Counseling Un-Conference
A grass-roots conference put together by clinicians for clinicians.
Up to 20 CEUs from a NAADAC approved provider are available for addiction and mental health counselors and people seeking certification as addiction counselors
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~    WHEN: February 23-25, 2018
~    WHERE: Nashville Metro (exact site TBD)
~¬†¬† ¬†The main speaker each hour will also be simulcast online.¬† Virtual attendance is possible for those who do not need ‚Äúface-to-face‚ÄĚ hours.
~    COST:
~    Whole conference (20 CEUs): $99 in advance;  $149 at the door
~    One Day (8 CEUs): $45 in advance; $65 at the door
~    Registration will open in October 2017
Nashville Counseling Un-Conference
Call for Papers

~    Theme: Addressing the Growing Problem of Co-Occurring Disorders.
~    Suggested Topics:
~    Techniques and Effectiveness of Technology Assisted Therapy (e-therapy, text-based coaching, apps, online support and educational programs etc.)
~    Special Needs of Rural Populations
~    Transdiagnostic Approaches to Treatment
~    Relapse Prevention for Co-Occurring Disorders
~    Multidisciplinary Approaches to Treatment
~    Prevention and Early Intervention Strategies for Co-Occurring Disorders
~    Developing Self-Esteem and Emotion Regulation Skills in Youth
~¬†¬† ¬†Case Management is not a counselor's job, but…It is
~    Exploring pharmacotherapy in the treatment of co-occurring disorders (SSRIs and their impact on compulsive behaviors for example)
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