Strategic Self Regulation Program May 19-21, 2010 Dr. Elia Vecchione

DAY 1

What do you want to learn?

Treatment with the Brain in Mind.

Interaction: The Effects of Our Behavior

The Bi-Partisan Brain:

Cognition & Emotion

DAY 2

Attachment

Trauma

Learned Helplessness

Putting an End to an Emotional Reaction:

De-Escalation

“The Tools”

DAY 3

Talking Through an Emotional Reaction

“Building Emotional Alliances”

Helping People Understand Themselves, Their

Perceptions, Thoughts, Emotions, and Behavior

“The Map”

1. He makes me laugh.

2. He looks me in the eyes when he talks to me.

3. He talks to me about things I’m interested in.

4. Sometimes he just sits and listens and smiles.

Molly’s Rules:

He Makes Me Feel Good Because:

HOPE

ATTACHMENT

FEELING AND THINKING

VERBAL & NON VERBALDE-ESCALATION

MAPPING

Strategic Self Regulation Program

Strategic Self Regulation TherapyState-Stage Model: Regulation, Targets, Treatments, & Outcomes

STATE-STAGEMODEL ->>

I.Wrap the WorldAround Them

II.Help Them Understand

Themselves & the World

III.Wrap Them Around

the World

I. Attachment /RelationshipDependence

Self – Regulation withSignificant Others

Self – Regulation with Guidanceand Assistance

Self – RegulationIndependently

II. TARGETS Emotions / Arousal Thinking / Understanding

Compliance withReasonable Rules and

Regulations

III. TREATMENTS De – Escalation Tools Mapping / Negotiation Presenting the World as it is

IV. OUTCOMES Arousal Regulation Understanding / Problem SolvingAdaptive and Pro-Social

Behavior

Verbal Interaction

EVENTLimbic System:Emotions, “Feeling”

Frontal Lobes:Thinking &

Impulse Control“Stop”

Danger!

Survival Behaviors:1) Escape2) Fight 3) Freeze

Thoughtful Behaviors:

Future based Problem Solving

“Choices”

(Confabulation)(Confabulation)$@#&!!!$@#&!!!

THE BODY

Then: Now:

How History Effects Behavior:

TimeTraumaNormal Stressor

Locked in the Body

NecessarySurvival Response

Excessive SurvivalResponse

Survival Responses of the Nervous System*Survival Responses of the Nervous System*

Fight, flight and freeze are automatic survival actions. They are similar to reflexes, but are much more complex.

If the perception of the limbic system is that there is not time to flee, then the body will fight.

If the limbic perception is that there is not enough time to flee, but there is adequate strength to fight, then the body will fight.

If the limbic system perceives there is neither time nor strength for fight or flight it will freeze.

It is important to understand that these limbic system ANS responses are instantaneous, instinctive responses to a perceived THREAT.

*“The Body Remembers: The Psychopathology of Trauma and Trauma Treatment” Babette Rothschild

The De-Escalation Tools

Building Emotional Alliances

Step 1: Manage Yourself, Model Reasonable Behavior, and Make a Plan

Step 2: Agree, Acknowledge, and Listen

Step 3: Navigate the Thoughts and Perceptions

Step 4: Aid in Generating Solutions and Solving the Problem

Step 5: Generate Reasonable Consequences and Take Personal Responsibility

Step 6: End by Repairing Relationships

II. Non-Verbal De-Escalation Tools

1. Arousal Regulation

2. Engagement/Disengagement

3. Distraction/Redirection

4. Limit Setting

II. Non-Verbal De-Escalation Tools1. Arousal Regulation

• Escape• Humor• Choice• Control• Movement• Manage the Context

– People & Places

II. Non-Verbal De-Escalation Tools2. Engagement and Disengagement

• Posture

• Tone

• Distance

• Engage/Disengage Verbally

• Engage/Disengage Physically

• Replacement with Significant Other

II. Non-Verbal De-Escalation Tools3. Distraction and Redirection

• Distraction - Change Thoughts

• Redirection - Change Behavior

II. Non-Verbal De-Escalation Tools4. Limit Setting

• Safety

• Limits Around Self

• Limits Around Others

The Strategic Self-Regulation Program

BackgroundNoise

FeelingGradient

De-escalation ProblemSolving

Behavior

(-)

Consequences

(+)

Pro-ActiveStrategies

Thoughts

Context

Perception ofEvent

Health & Wellness

Guidelines:

Diet:Eat a plate that is 1/2 vegetables and fruits, 1/4 lean protein, and 1/4 UNREFINED carbohydrates.

Follow the Paleo Pyramid: Eat Whole, Unprocessed Foods

Make olive oil your main source of added fat.

Avoid saturated fats (butter, palm oil), trans fats (margarine and hydrogenated oils) and omega 6 oils (corn and soy bean oils).

NEVER GO HUNGRY – Eat all the fresh fruit and vegetables that you want!

Paleo Pyramid: Eat Like Your Ancestors

Refined, Processed foods.“Anything in a box, bag, or can”

Foods in their natural,Unprocessed state

Fruits And

Vegetables

AnythingFresh or Frozen(not potatoes)

Lean Protein

Complex Carbohydrates

Turkey BreastLean Pork

ChickenEggsFishTofu

PastaBarley

Basmati RiceWhole Grain Bread

Boiled New Potatoes

The Health and Wellness Guide to Eating

Multi Vitamins:

Take a daily Multi-Vitamin that delivers at least 100% of the recommended daily allowances (RDA).

The best choices are Centrum Performance or generic equivalent. I like Kirkland brand “High Performance” at Costco or ideally the Enzymatic Therapies product “From Fit to Fantastic”

available at www.endfatigue.com

B Complex

Take a B complex daily that delivers at least 100% of the RDA of each of the B vitamins.

The best choices are Kirkland brand “B-50” at Costco of equivalent. If ordering multi-vitamins from Enigmatic Therapies separate B complex is

included at no extra cost.

Vitamin D

Take 4000 IU’s of Vitamin D3.

The best choices are GNC or equivalent, 2000 IU’s per tablet,

NOT with calcium OR vitamin A.

Omega 3 Fatty AcidIn order to promote physical and mental health in reasonably healthy people 1200 mgs of EPA & DHA in a ratio of 2:1 with greater than 50% of capsule

content DHA & EPA.

Best choices are pharmaceutical grade Omega’s as they have the least contaminants and the highest grade fish oil. They include “Omega Brite” (available at www.omegabrite.com) and Zone omega’s (available at www.zonediet.com). Costco has a Kirkland brand “Fish Oil Omega 3: One Per Day”

Item # 240669, just make sure you take 2 capsules per day.

Exercise:

Enjoy some from of exercise almost daily, aerobic if possible, for 30-45 minutes, as close as is

comfortable to 75% of maximum heart rate.

Start SLOW, increase SLOWLY, and ENJOY it!

Sleep:Get 7-9 Hours of sleep per night.

If you cannot get 7-9 hours, sleep too much, awake still tired, or cannot get to and stay asleep, take 1 mg of melatonin 1 hour before bed and DO LIGHT THERAPY.

Expose yourself to 10,000 lumens of bright white light (NOT full spectrum) for at least a half hour at the prescribed distance.

If sleep is still a problem, practice good sleep hygiene and have a quick course of sleep oriented cognitive behavior therapy before taking medication.