The document provides an agenda for a training session on anxiety, trauma, and stress for practitioners working with clients with co-occurring disorders. The agenda includes: a check-in, a review of a stress video and discussion, a presentation on signs and symptoms of anxiety disorders and how stress relates, a discussion on trauma experienced by clients and practitioners, a preview of the next session, and a question period. The document also includes supplementary materials on anxiety disorders, trauma-informed practices, secondary trauma, and self-care strategies.

1. Christina Boyd, LSCSW, LCAC
Co-Occurring Disorders EPL

2. Week #3
Anxiety and Trauma

3. • Welcome and Check in
• Review Learning Activity-Stress Video and
Discussion
Welcome
• Signs and Symptoms of Anxiety Disorders
• Trauma of clients and practitioners
• How stress relates to all of this
Presentation
• Preview of next week
• Assign Learning Activity
• Questions
Summary
Agenda

4. • What has been
helpful so far in
the series?
• What would be
helpful as we
move forward?
How are we doing?

5. How are you managing the stress and trauma from your work?
Learning Activity

6. • Was there anything in the video that was new
information to you? Surprising? Hard to believe?
• How could this information be helpful for those that
you are here to help? How could this information
help you with your stress levels?
• Is stress an issue with the people that are coming
to seek services? In what way is it affecting their
treatment outcomes?
• Does your agency do anything to monitor or deal
with the stress of the people seeking your
services?
• Does your agency do anything to assist you as an
employee with your stress levels?
• What is the most important thing that you took
away from watching this video?
Let’s Talk!

7. ANXIETY Disorders

8. Did You Know?
•Anxiety disorders are the most common mental illness in the U.S., affecting 40
million adults in the United States age 18 and older, or 18.1% of the population
every year.
•Anxiety disorders are highly treatable, yet only 36.9% of those suffering
receive treatment.
•People with an anxiety disorder are three to five times more likely to go to the
doctor and six times more likely to be hospitalized for psychiatric disorders than
those who do not suffer from anxiety disorders.
•Anxiety disorders develop from a complex set of risk factors, including
genetics, brain chemistry, personality, and life events.
Anxiety & Depression

9.  The five major types of anxiety
disorders are:
Generalized Anxiety Disorder
Obsessive-Compulsive Disorder (OCD)
Panic Disorder
Post-Traumatic Stress Disorder (PTSD)
Social Phobia (or Social Anxiety Disorder)
US Dept. of Health and Human Services

10. Generalized Anxiety
Disorder, GAD, is an
anxiety disorder
characterized by
chronic anxiety,
exaggerated worry and
tension, even when
there is little or nothing
to provoke it-(hhs.gov)
Generalized
Anxiety Disorder

11. Obsessive-Compulsive
Disorder, OCD, is an anxiety
disorder and is characterized by
recurrent, unwanted thoughts
(obsessions) and/or repetitive
behaviors (compulsions).
Repetitive behaviors such as
hand washing, counting,
checking, or cleaning are often
performed with the hope of
preventing obsessive thoughts
or making them go away.
Performing these so-called
"rituals," however, provides only
temporary relief, and not
performing them markedly
increases anxiety-(hhs.gov)
Obsessive-Compulsive
Disorder (OCD)

12. Panic disorder is an anxiety
disorder and is
characterized by
unexpected and repeated
episodes of intense fear
accompanied by physical
symptoms that may include
chest pain, heart
palpitations, shortness of
breath, dizziness, or
abdominal distress.-
(hhs.gov)
Panic Disorder

13. Social Phobia, or Social
Anxiety Disorder, is an
anxiety disorder
characterized by
overwhelming anxiety and
excessive self-
consciousness in everyday
social situations. Social
phobia can be limited to only
one type of situation - such
as a fear of speaking in
formal or informal situations,
or eating or drinking in front
of others - or, in its most
severe form, may be so
broad that a person
experiences symptoms
almost anytime they are
around other people-
(hhs.gov)
Social Phobia (or Social
Anxiety Disorder)

14. Post-Traumatic Stress
Disorder, PTSD, is an
anxiety disorder that can
develop after exposure to a
terrifying event or ordeal in
which grave physical harm
occurred or was threatened.
Traumatic events that may
trigger PTSD include violent
personal assaults, natural or
human-caused disasters,
accidents, or military
combat.
Post-Traumatic Stress
Disorder (PTSD)

15. • Why is it important to understand anxiety
when treating those with SUDs?
• Is anxiety something that you see often in
your practice?
• How do you or your agency refer or assist
those in your services with these
disorders? How are they recognized? How
are they addressed?
Questions to Ponder…

16. • Are they severe enough to warrant specific
mental health treatment, even if symptoms are
caused by substance use?
• Is the patient able to manage the activities of
daily living?
• Can he or she cope with any emotional,
behavioral or cognitive problems?-(ASAM 2013)
Consider how depressive
disorders or suicidal ideation
can affect this dimension.
ASAM-Dimension 3 Continued

17. SAMHSA
https://www.integration.samhsa.g
ov/clinical-practice/screening-
tools#anxiety
Anxiety and Depression
Association of America
• https://adaa.org/living-with-
anxiety/ask-and-
learn/screenings
Screens

18. Trauma

19. • APA.ORG
• Mirror neurons are a type of brain cell that respond equally when we perform
an action and when we witness someone else perform the same action.
• They were first discovered in the early 1990s, when a team of Italian
researchers were observing monkeys.-(Mirror 2012)
Mirror Neurons

20. We Experience
trauma together

21. Tip 57-SAMHSA
A GREAT
Resource!

22. • Safety -Throughout the organization, staff and the people they serve feel physically and psychologically safe.
• Trustworthiness and transparency -Organizational operations and decisions are
conducted with transparency and the goal of building and maintaining trust among staff, clients, and family members
of those receiving services.
• Peer support and mutual self-help-These are integral to the organizational and
service delivery approach and are understood as a key vehicle for building trust, establishing safety, and
empowerment.
• Collaboration and mutuality - There is true partnering and leveling of power differences
between staff and clients and among organizational staff from direct care staff to administrators. There is recognition
that healing happens in relationships and in the meaningful sharing of power and decision-making. The organization
recognizes that everyone has a role to play in a trauma-informed approach. One does not have to be a therapist to be
therapeutic.
• Empowerment, voice, and choice-Throughout the organization and among the
clients served, individuals' strengths are recognized, built on, and validated and new skills developed as necessary.
The organization aims to strengthen the staff's, clients', and family members' experience of choice and recognize that
every person's experience is unique and requires an individualized approach. This includes a belief in resilience and
in the ability of individuals, organizations, and communities to heal and promote recovery from trauma. This builds on
what clients, staff, and communities have to offer, rather than responding to perceived deficits.
• Cultural, historical, and gender issues -The organization actively moves past
cultural stereotypes and biases (e.g., based on race, ethnicity, sexual orientation, age, geography), offers gender
responsive services, leverages the healing value of traditional cultural connections, and recognizes and addresses
historical trauma.
Trauma Informed Practice(TIP 57)

23. • 1. What kinds of trauma are
people that seek your services
dealing with?
• 2. How common is this in your
setting? Are some populations
affected by this more?
• 3. What are ways that we could
be addressing this in a more
productive way?
• 4. What are things that we are
already doing that help address
this in productive ways?
GROUP DISCUSSION

24. • Building a trauma-informed workforce that
includes in-depth training to enhance
understanding of the impact of trauma on
individuals and among providers
(i.e., secondary traumatization); screening,
assessment, and referral processes; and
other trauma-specific counselor
competencies and ethics
One Main Concept-Tip 57

25. • -SAMHSA (Tip
57)
15.2 % reported secondary trauma as a result of indirect
exposure to trauma material Then meeting the diagnostic
criteria for PTSD.
This rate is almost 2x the rate of PTSD in the general
population.
In a study LMSW’s

26. -SAMHSA (TIP 57)
• Psychological distress
• Somatic issues
• Cognitive shifts
• Relational disturbances
• Changes in Frames of reference
Signs of Secondary Trauma

27. -SAMHSA (TIP 57)
• Peer support
• Supervision and consultation
• Training
• Personal counseling
• Maintaining balance in one’s life
• Engaging in spiritual activities that provide meaning and perspective
Prevention of Secondary Trauma

28. Break into groups of 3-4
Discuss the following questions:
1. What kinds of trauma are you experiencing at
work?
2. What are ways that we could be addressing
this in a more productive way?
3. What are things that we are already doing
that help address this in productive ways?
4. What are ways that trauma, anxiety and
stress affect the populations that you serve?
SMALL GROUP
DISCUSSION

29. Self-Care

30. HOW
Do you
SPEND
Your TIME?
Introvert VS Extrovert

31. Some hints….

32. Are you doing things that
charge you up or drain you?
Pick Activities that
RECHARGE
your batteries

33. How Would you define
STRESS?
What about
STRESS?

34. Where is your STRESS level set?
Monitoring Stress

35. Beyond Blue
https://www.beyondblue.org.au
/get-support/online-
forums/anxiety
Anxiety Network
https://anxietynetwork.com/
TRAUMA SURVIVORS
NETWORK
https://www.traumasurvivorsnetwork.org/pages/home
On-Line Support

36. Sneak Peek at
next week ….
Personality
Disorders

37. Watch Videos and Consider Questions
-View Video “Personality Disorders Crash Course Psychology#34”
http://www.youtube.com/watch?v=4E1JiDFxFGk
-Watch the video “Dilectic Behavioral Therapy (DBT) Simply Explained”
https://www.youtube.com/watch?v=wRBw_Iti3Ww
Be prepared to Discuss Next Week!
Learning Activity-Week #3

38. Questions

39. https://www.youtube.com/wa
tch?v=aX7jnVXXG5o
Crash Course on
Anxiety

40. Anxiety and Depression Association of America, https://adaa.org/about-adaa/press-room/facts-
statistics
CDC-https://www.cdc.gov/violenceprevention/acestudy/index.html
Center for Substance Abuse Treatment. Managing Depressive Symptoms in Substance Abuse
Clients During Early Recovery. Treatment Improvement Protocol (TIP) Series, No. 48. HHS
Publication No. (SMA) 13-4353. Rockville, MD: Substance Abuse and Mental Health Services
Administration, 2008.
Substance Abuse and Mental Health Services Administration. Trauma-Informed Care in Behavioral
Health Services. Treatment Improvement Protocol (TIP) Series 57. HHS Publication No. (SMA) 13-
4801. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
http://www.apa.org/monitor/oct05/mirror.aspx
Mirror neurons: Enigma of the metaphysical modular brain
Sourya Acharya, Samarth Shukla
J Nat Sci Biol Med. 2012 Jul-Dec; 3(2): 118–124. doi: 10.4103/0976-9668.101878
US Dept. of Health-https://www.hhs.gov/answers/mental-health-and-substance-abuse/what-are-the-
five-major-types-of-anxiety-disorders/index.html
References: