Transtheoretical and Transdiagnostic Approaches to Symptom Assessment and Change

Journey to Recovery Series
Transtheoretical and Transdiagnostic
Approaches to Assessment and Change
Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs
Podcast Host: Counselor Toolbox & Happiness isn’t Brain Surgery
(C) Counselor Toolbox 2018 All Rights Reserved. For CEUs go to AllCEUs.com.

Objectives
 Identify the common symptoms for anxiety
and depression-based disorders
 Learn how a positive change in one area or
symptom can have positive effects on all
symptoms or areas.
 Explore
 The function of each of those symptoms
 The potential causes of each of those symptoms
 Interventions for each of those symptoms

Review
 Everything you feel, sense, think and do is caused
by communication between your nerves with the
help of chemical messengers called
neurotransmitters.
 “Higher order” thinking is able to over-ride sensory
input and tell us there is a threat when none exists,
or that there isn’t a threat when there really is.
 Think of your brain as a computer processor. It
simply does what it is told, based on the
information that it has.

What are symptoms
 Symptoms are your physical and emotional
reactions to a threat.
 Symptoms are designed to protect you.
 They are not bad or good. They just are.
 Instead of trying to make the symptom go
away, it may help to:
 Understand the function of them
 Identify alternate, more helpful, ways to deal
with the threat

Transtheoretical and
Transdiagnostic
 Transtheoretical means approaching a person’s
presenting issues/symptoms and considering
emotional, cognitive, physical, interpersonal and
environmental explanations for it.
 Transdiagnostic means that many symptoms are
common to multiple issues such as sleep changes,
appetite changes, irritability, fatigue and lack of
pleasure.
 By examining the WHOLE person and not getting
stuck on treating a particular diagnosis we are
freed up to really address the individual’s issues

Case
 Sally is a 27 year old
mother of 2 and
presenting with
 Lack of pleasure/apathy
“blah”
 Fatigue
 Irritability
 Weight gain
 Sleeping difficulties
(waking up a lot)
 Feelings of guilt
 Inability to concentrate
and indecisiveness
 Diagnosis Possibilities
(some)
 Depression
 Anxiety
 PTSD
 PCOS
 Hypothyroid
 “Stress” (relationship or
job)

Lack of Pleasure
 Form/Symptom
 Lack of pleasure in most things, most days for a
period of at least 2 weeks.
 Cause
 Neurochemical imbalance (insufficient dopamine,
norepinephrine?) caused by:
Lack of sleep
Excessive stress
Drug or medication use
Hormone imbalances including thyroid problems

Lack of Pleasure
 Causes
 HPA-Axis
Cortisol
Increased norepinepherine and glutamate
Reductions in
Estrogen
Testosterone
 Serotonin
 Increased anxiety and depression
 Reduced melatonin
 Impaired sleep

Lack of Pleasure
 Function
 This is your body's way of
Signaling that there may be a problem
Conserving excitatory neurotransmitters for a “real”
crisis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182008/pdf/DialoguesClinNeurosci-13-
263.pdf Post-traumatic stress disorder: the neurobiological impact of psychological trauma
Forcing you to address it. After all, nobody wants to
be depressed for very long.

Lack of Pleasure
 How You Cope
 Think back over a few times when you have been
depressed, even if it was just for a few hours.
What did you do to help yourself feel better?
What makes the depression/lack of pleasure worse?
What can you do to prevent triggering your
depression/lack of pleasure?
What changed this time that triggered the
depression?

Lack of Pleasure
 Simple-ish Interventions
 Don’t expect exhilaration, but try to do some things
that make you mildly happy.
 Get plenty of quality sleep to stabilize circadian
(sleep-wake-eat) rhythms.
 Improve nutrition. Search online for “nutrition for
depression.”
 Remember that depression is a natural part of the
grief process and also very normal after a trauma.
Be compassionate
 Address unhelpful thoughts that are keeping you
stuck
 Add in visual and auditory triggers for happiness

Eating Behaviors
 Form
 Eating too much or loss of appetite
 Cause
 Imbalance in the brain chemicals that help you feel
motivated to eat, such a norepinepherine and
serotonin.
 There are five primary causes of over-eating:
Poor nutrition
Low serotonin (stress/organic)
Circadian rhythms are out of whack
Habit/self soothing (stress)
Thyroid Issues

Eating Behaviors
 How You Cope
 In the past when you have just not had an appetite or have
been eating to self-soothe, how did you deal with it?
 How can you make sure you are eating a generally healthy
diet, and making sure that your body has the building blocks
it needs?
 How is your environment contributing to your eating
behaviors?
 What can you do to ensure you are eating due to hunger and
not distress?
 What foods do you generally eat to self-soothe?
 What can you do to prevent non-hunger eating?
 What can you do besides eating to distract yourself or self-soothe?

Eating Behaviors
 Some simple-ish interventions
 Get enough sleep so you are not eating to stay awake.
 Stop consuming caffeine at least 8 hours before bed.
 Drink enough water (even if it is sparkling water or
Powerade).
 Have 3 colors on your plate at every meal.
 Eat foods you enjoy, but in moderation
 Use a plate. Don’t eat out of the bag
 Experiment with essential oils. Some will increase
appetite. Some will decrease stress and cravings.
 If you just cannot stomach eating, ask your doctor about
a meal replacement like Ensure. This should not be done
for a long period, but as a stop-gap, it usually is fine.

Sleeping Behaviors
 Form
 Sleeping too much or having insomnia
 Cause
 Sleeping too much can indicate poor quality sleep due to:
 Stress
 Poor sleep habits
 Pain
 Hormone or neurochemical imbalances
 Allergies/Apnea
 Poor nutrition

Sleeping Behaviors
 Cause
 Insomnia can indicate:
An inability to relax
Pain making it difficult to sleep
Insufficient serotonin/melatonin (also implicated in
depression)

Sleeping Behaviors
 Function
 When you are not getting enough sleep, you cannot
recharge as efficiently, so you are more tired.
 When you are getting too much sleep your body
doesn’t secrete melatonin at the right times leading
to poor quality sleep and feeling exhausted all the
time.
 When you cannot sleep it typically indicates that
your HPA-Axis/Threat Responses System is activated
so you are not vulnerable.

Sleeping Behaviors
 How You Can Cope
 What do you usually do to help yourself
 Get to sleep when you can’t sleep
 Wake up when you have been sleeping too much?
 Create a good sleep routine that involves the same two or three
activities.
 Identify & address anything waking you up in the night.
 Dogs
 Coughing/allergies
 Snoring spouse
 Sleep apnea
 Stress
 Pain

Sleeping Behaviors
 Simple-Ish Interventions
 Get a physical to rule out any medical issues especially
 Thyroid and other hormone imbalances
 Chronic pain
 Apnea
 Reduce or eliminate caffeine at least 10 hours before
bed.
 Keep a notepad by your bed to write down things you
need to remember instead of tossing them around in your
head all night.
 Use progressive muscle relaxation, to help your body
relax.
 Develop a stress management and relaxation plan.

Low Energy
 Form
 Lack of energy and/or fatigue.
 Cause
 Insufficient or excessive sleep
 Lack of motivation and reward
 Lack of movement
 Fear of failure or rejection
 Poor nutrition
 Thyroid or hormone imbalances
 Function
 The body is devoting scarce resources to rebuilding and
functioning. (Ain’t got enough gas)

Low Energy
 How you cope
 What (besides caffeine) helps you get energy?
 What drains your energy?
Emotional
Mental
Physical
Social
Environmental
 When you have felt lethargic in the past, how did
you help yourself feel better?(C) Counselor Toolbox 2018 All Rights Reserved. For CEUs go to AllCEUs.com.

Low Energy
 Get up and move around. Try doing 15.
 Stay hydrated
 Increase the motivating chemicals by having some successes.
 Get an accountability buddy.
 Identify any fear or depressive thoughts that may be
dampening your motivation, and think the opposite.
 How do you get energy/motivation when you don’t have any?
 How do you get started on a task when you don’t want to?

Irritability
 Form
 Being restless or quick tempered during the day.
 Cause
 High levels of anxiety
 Stimulants
 Unstable blood sugar/poor nutrition
 Depression
 PTSD

Irritability
 Function
 When you are irritable, your body is likely
detecting a threat (real or chemically induced).
 How You Cope
 When you feel driven and/or irritable, how have
you been able to get it under control?
 What can you do to be kind to yourself?
 What thoughts make your irritability worse?

Simple-ish Interventions
 Reduce irritability by:
 Addressing unhelpful thoughts that are stressing you out
 Using distress tolerance skills to feel the feeling and let it pass
 Practicing good time management so you don’t feel pressured.
 Be compassionate with yourself if things are taking a bit longer
 Pay attention and reduce how many stimulants you are taking
including caffeine, nicotine, diet pills, and decongestants.
These can all cause you to feel revved up.
 Unstable blood sugar/poor nutrition can make you feel jittery,
so try to eat healthfully and regularly.

Concentration
 Form
 Trouble concentrating and/or making decisions
 Cause
 Neurotransmitter, hormone or blood sugar imbalances
caused by lack of sleep, poor nutrition, excess stress
 Feelings of helplessness causing you to second guess
yourself
 Function
 Energy conservation. If your body is struggling to just
keep going, it is not going to divert energy to higher order
thought processes unless they have a direct impact on
your survival.

Concentration
 How You Cope
 What helps you focus (small chunks, working in the morning..)
 How can you be kind to yourself?
 Practice good nutrition
 Make sure you are hydrated.
 Get adequate, quality sleep
 Take a powernap after lunch. Research shows that a nap after lunch
increases “focus chemicals” up to 200%
 Write things down. When you are stressed, your memory may suffer.
It is easier to make sense of things when they are written down
 Don’t overload.

Summary
 The brain takes information that you already have and
combines it with input from the current situation to “decide” if
there is a threat
 Higher order thinking is required to over-ride your threat
response system
 The HPA Axis (threat response system) triggers the release of
cortisol and creates a cascade effect.
 Interventions include:
 Do things that make you happy
 Improve sleep
 Improve nutrition
 Address pain issues
 Address unhelpful thoughts contributing to emotional and physical
distress

Summary
 Every symptom has a function
 Each symptom is usually caused by a neurotransmitter
imbalanced due to:
 Poor nutrition
 Poor sleep
 Negative thinking styles
 Excessive stress
 Thyroid/hormone issues
 Addictive behaviors
 Recovery involves identifying the function and:
 Eliminating the problem
 Finding a healthier alternative

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