Category Archives: Handout

Setting boundaries

20 Wednesday Aug 2025

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Setting boundaries is an essential skill in life, especially for people in recovery. Addicts often grow up in dysfunctional homes, where boundaries were either too rigid (leading to suppressed emotions or distant relationships) or too enmeshed (depriving them of a sense of personal identity). Later in life, their interpersonal relationships may continue to be defined by old roles and patterns, increasing the risk of depression, anxiety and addictive or compulsive behaviors. f-145

As part of recovery, addicts learn how to set boundaries and to respect other people’s boundaries in return. In the addiction field, treatment providers often refer to this process as embracing the authentic self. While it may sound like psychobabble, it is really a process of discovering who you want to be, how you want to interact with other people, and taking responsibility for the consequences of your choices.

Why are boundaries important? They keep you safe from being manipulated, abused or taken advantage of, while also protecting other people from harm you may consciously or unconsciously inflict. They prevent both parties in a relationship from blurring the lines between self and others, which can lead to enmeshment and codependency. With healthy boundaries in place, you can begin to tune in to your inner voice and trust your own thoughts and feelings, and then communicate those to other people.

Distinguishing Healthy and Unhealthy Boundaries

Without a healthy role model, it can be difficult to know what healthy boundaries look like. First, let’s cover what healthy boundaries are not. They are not threats or attempts to control or manipulate others into doing what you want. They are not rigid rules or “walls” designed to keep people out or shield you from expressing your emotions.

Healthy boundaries are simply a delineation of what type of treatment is acceptable to you, and what consequences will result from violating a boundary. People with healthy boundaries share their thoughts and feelings, take care of their own needs, and are able to say no when necessary.

merge-signBy contrast, people with weak boundaries often:

• Sacrifice their personal values, plans or goals to please others

• Allow others to define who they are and make decisions for them

• Expect others to fulfill all their needs

• Feel guilty when they say no

• Hesitate to share their opinions or assert themselves if they are being treated unfairly

• Frequently feel used, threatened, victimized or mistreated by others

• Frequently offer unsolicited advice, or feel pressured to follow someone else’s advice

• Take responsibility for other people’s feelings

• Tell others how to think, feel or act

A Boundary-Setting Roadmap

Every individual is called upon to set their own boundaries. What works for some may seem either too intrusive or too distant to others. When laying out your boundaries, work through the following steps:

Create a Personal Bill of Rights. Before you can start setting boundaries, you have to recognize your right to have your own feelings, values and beliefs and to express to others how you want to be treated. For some, this requires a colossal leap in self-worth.

Identify Your Emotions. Our parents always admonish us to “think before you act.” When you have a strong response, take a time-out to identify the underlying emotion and figure out what you want to convey. Doing so allows you to interact with other people in an honest, direct way rather than blaming or lashing out.

Set Limits. Once you have a few guidelines in place for how you expect to be treated, practice setting limits with people in a clear, direct way. Examples of healthy boundaries are: “I choose to be around sober people” or “I’ll be happy to talk with you when your voice is calm.”

Assert Your Needs. If you feel that your boundaries are being violated, speak up. This doesn’t mean lashing out or blaming others, but rather assertively communicating your needs. Ask for what you want and say no, politely yet firmly, if something isn’t right for you.

Listen to Your Instincts. If a situation feels uncomfortable or inappropriate, chances are a boundary is being pushed. By tuning into your instincts, you’re more likely to respond in ways that are true to your authentic self.

Defend Your Boundaries. Once you set boundaries, expect that they will be tested. Before this happens, set consequences that you are willing and able to enforce (e.g., “If you continue this behavior, I will…”). Know that by setting limits, you may disappoint the other person, especially if they have weak boundaries themselves. While you should always act with dignity and respect, you can’t control other people’s feelings and behaviors.

If someone continually violates your boundaries, you may need to minimize contact with them, or if they are toxic to your recovery, cut ties altogether. By choosing not to let people violate your boundaries, you stop being the victim, stop blaming others and start reclaiming responsibility for your own life.

Respect Other People’s Boundaries. Just as important as honoring your own boundaries is respecting other people’s, even if they are different from yours. If they don’t have defined boundaries, show them the respect you know they deserve anyway.

Handout: Anger Words

03 Wednesday Jul 2024

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Anger groups are usually straight forward …. OK, no group is like that. They each have their own dynamics which are dependent on many factors.

I used to work as a float at a hospital and would walk onto a unit to facilitate a group of (usually) adults with a mix of diagnoses none of whom I had ever met before. In those situations I usually keep it very basic and thus very safe.

The list of words below was generated over a few years of asking folks in groups,’what are your angry words’. I have not included the usual assortment of curse words but there were quite a few favorites in the uncensored list.

If a group is not very talkative, this list is a good way to start the conversation. I might ask folks to circle 6 words that most express their typical (or specific) anger. We then share, or if in a larger group have folks share with a partner.


ANGER WORDS
anger disgust grumpiness rage
aggravation dislike hate resentment


agitation envy hostility revulsion
annoyance exasperation irritation scorn
bitterness ferocity jealousy spite
contempt frustration loathing torment


cruelty fury mean-spiritedness vengefulness
destructiveness grouchiness outrage wrath
add your own …..

angry

Stress management strategy #6

26 Wednesday Apr 2023

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Adopt a healthy lifestyle

Adopt a healthy lifestyle

You can increase your resistance to stress by strengthening your physical health. 

  • Exercise regularly. Physical activity plays a key role in reducing and preventing the effects of stress. Make time for at least 30 minutes of exercise, three times per week. Nothing beats aerobic exercise for releasing pent-up stress and tension.
  • Eat a healthy diet. Well-nourished bodies are better prepared to cope with stress, so be mindful of what you eat. Start your day right with breakfast, and keep your energy up and your mind clear with balanced, nutritious meals throughout the day.
  • Reduce caffeine and sugar. The temporary “highs” caffeine and sugar provide often end in with a crash in mood and energy. By reducing the amount of coffee, soft drinks, chocolate, and sugar snacks in your diet, you’ll feel more relaxed and you’ll sleep better.
  • Avoid alcohol, cigarettes, and drugs. Self-medicating with alcohol or drugs may provide an easy escape from stress, but the relief is only temporary. Don’t avoid or mask the issue at hand; deal with problems head on and with a clear mind.
  • Get enough sleep. Adequate sleep fuels your mind, as well as your body. Feeling tired will increase your stress because it may cause you to think irrationally.

There as many ways to reduce stress as there are stars. I use and recommend that people engage a variety of healthy coping and preemptive stress reducing techniques.

Stress Management Strategy #5

19 Wednesday Apr 2023

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Make time for fun and relaxation

Beyond a take-charge approach and a positive attitude, you can reduce stress in your life by nurturing yourself. If you regularly make time for fun and relaxation, you’ll be in a better place to handle life’s stressors when they inevitably come.

Don’t get so caught up in the hustle and bustle of life that you forget to take care of your own needs. Nurturing yourself is a necessity, not a luxury.

  • Set aside relaxation time. Include rest and relaxation in your daily schedule. Don’t allow other obligations to encroach. This is your time to take a break from all responsibilities and recharge your batteries.
  • Connect with others. Spend time with positive people who enhance your life. A strong support system will buffer you from the negative effects of stress.
  • Do something you enjoy every day. Make time for leisure activities that bring you joy, whether it be stargazing, playing the piano, or working on your bike.
  • Keep your sense of humor. This includes the ability to laugh at yourself. The act of laughing helps your body fight stress in a number of ways.

Learn the relaxation response

You can control your stress levels with relaxation techniques that evoke the body’s relaxation response, a state of restfulness that is the opposite of the stress response. Regularly practicing these techniques will build your physical and emotional resilience, heal your body, and boost your overall feelings of joy and equanimity.

There as many ways to reduce stress as there are stars. I use and recommend that people engage a variety of healthy coping and preemptive stress reducing techniques.

Stress management strategy #4

05 Wednesday Apr 2023

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Accept the things you can’t change

Some sources of stress are unavoidable. You can’t prevent or change stressors such as the death of a loved one, a serious illness, or a national recession. In such cases, the best way to cope with stress is to accept things as they are. Acceptance may be difficult, but in the long run, it’s easier than railing against a situation you can’t change.

  • Don’t try to control the uncontrollable. Many things in life are beyond our control— particularly the behavior of other people. Rather than stressing out over them, focus on the things you can control such as the way you choose to react to problems.
  • Look for the upside. As the saying goes, “What doesn’t kill us makes us stronger.” When facing major challenges, try to look at them as opportunities for personal growth. If your own poor choices contributed to a stressful situation, reflect on them and learn from your mistakes.
  • Share your feelings. Talk to a trusted friend or make an appointment with a therapist. Expressing what you’re going through can be very cathartic, even if there’s nothing you can do to alter the stressful situation.
  • Learn to forgive. Accept the fact that we live in an imperfect world and that people make mistakes. Let go of anger and resentments. Free yourself from negative energy by forgiving and moving on.

There as many ways to reduce stress as there are stars. I use and recommend that people engage a variety of healthy coping and preemptive stress reducing techniques.

Stress management strategy #3

29 Wednesday Mar 2023

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Adapt to the stressor

If you can’t change the stressor, change yourself. You can adapt to stressful situations and regain your sense of control by changing your expectations and attitude.

  • Reframe problems. Try to view stressful situations from a more positive perspective. Rather than fuming about a traffic jam, look at it as an opportunity to pause and regroup, listen to your favorite radio station, or enjoy some alone time.
  • Look at the big picture. Take perspective of the stressful situation. Ask yourself how important it will be in the long run. Will it matter in a month? A year? Is it really worth getting upset over? If the answer is no, focus your time and energy elsewhere.
  • Adjust your standards. Perfectionism is a major source of avoidable stress. Stop setting yourself up for failure by demanding perfection. Set reasonable standards for yourself and others, and learn to be okay with “good enough.”
  • Focus on the positive. When stress is getting you down, take a moment to reflect on all the things you appreciate in your life, including your own positive qualities and gifts. This simple strategy can help you keep things in perspective.

There as many ways to reduce stress as there are stars. I use and recommend that people engage a variety of healthy coping and preemptive stress reducing techniques.

Anger Management

22 Wednesday Mar 2023

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Over the years I have facilitated anger management groups. I use a variety of handouts and activities to have a process oriented group interaction. One of the hand outs I use is below. I use it in 1 of 2 ways. I have folks fill it out first and then we discuss or we go through it together and discuss. We explore as a group, learning from each other. anger-management.jpg
ANGER WORDS
anger disgust grumpiness rage  aggravation dislike hate resentment  agitation envy hostility revulsion  annoyance exasperation irritation scorn  bitterness ferocity jealousy spite  contempt frustration loathing torment  cruelty fury mean-spiritedness vengefulness  destructiveness grouchiness outrage wrath
Other:_________________________
Prompting Events for Feeling Anger
Losing power.
Losing status.
Losing respect.
Being insulted.
Not having things turn out the way you expected.
Experiencing physical pain.
Experiencing emotional pain.
Being threatened with physical or emotional pain by someone or something.
Having an important or pleasurable activity interrupted, postponed, or stopped.
Not obtaining something you want (which another person has).
Other:_______________________________
Interpretations That Prompt Feelings of Anger
Expecting pain.
Feeling that you have been treated unfairly.
Believing that things should be different.
Rigidly thinking “I’m right.”
Judging that the situation is illegitimate, wrong, or unfair.
Ruminating about the event that set off the anger in the first place, or in the past.
Other:____________________________
Experiencing the Emotion of Anger
Feeling incoherent.
Feeling out of control.
Feeling extremely emotional.
Feeling tightness or rigidity in your body.
Feeling your face flush or get hot.
Feeling nervous tension, anxiety or discomfort.
Feeling like you are going to explode.
Muscles tightening. .
Teeth clamping together, mouth tightening.
Crying; being unable to stop tears.
Wanting to hit, bang the wall, throw something, blow up.
Other:__________________________
Expressing and Acting on Anger
Frowning or not smiling; mean or unpleasant facial expression.
Gritting or showing your teeth in an unfriendly manner.
Grinning.
A red or flushed face.
Verbally attacking the cause of your anger; criticizing.
Physically attacking the cause of your anger.
Using obscenities or cursing.
U sing a loud voice, yelling, screaming, or shouting.
Complaining or bitching; talking about how lousy things are.
Clenching your hands or fists.
Making aggressive or threatening gestures.
Pounding on something, throwing things, breaking things.
Walking heavily or stomping; slamming doors, walking out.
Brooding or withdrawing from contract with others.
Other:_____________________
Aftereffects of Anger
Narrowing of attention.
Attending only to the situation making you angry.
Ruminating about the situation making you angry and not being able to think of anything else.
Remembering and ruminating about other situations that have made you angry in the past.
Imagining future situations that will make you angry.
Depersonalization, dissociative experience, numbness.
Intense shame, fear, or other negative emotions.
Other:______________________

Men & recovery

15 Wednesday Mar 2023

Posted by in Handout, Mental Health, Psychoeducation, recovery

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I often do men’s groups and have worked with men in recovery from intoxicant use. Below is a handout I sometimes use to facilitate discussion.

1. SAMHSA studies (1996 and 2000) have found that the vast majority of American men over 12 years of age (82.6%) had used alcohol at least once in their lifetime. The data indicate that 9% of men reported heavy alcohol use (five or more drinks at one time in the previous month), compared to 2% of women. Approximately 34% of the sample reported using illicit drugs.

2. Men are more than twice as likely to develop substance use disorders as women. Men begin using substances earlier than women and have more opportunity to try drugs. Men become intoxicated twice as often as women and are 3-4 times more likely to experience problem drinking and alcoholism. These patterns cross all demographic lines of race, income, education, marital status, and geographic location.

3. Men suffer far more adverse consequences of substance abuse than women. Clearly, the social construction of masculinity plays a significant role in these statistics.

4. Men’s attitudes toward alcohol and drugs tend to be generally less negative than women’s attitudes. The use of substances is not viewed as a problem for men but rather as a rite of passage, a sign of true manliness. By contrast, substance use is more likely to be viewed as something for women to avoid due to increased sexual vulnerability. Moreover, such behavior is viewed as incompatible with female roles, including family and relationship expectations.

5. Co-occurring psychiatric disorders occur commonly among men. One study found that 55% of the men identified as having a substance abuse problem also experienced mental health problems. Men often suffer from depression in conjunction with a substance abuse problem. On the other hand, men are not as likely as women to express their feelings of guilt, sadness, or worthlessness (all signs of depression) and may engage in reckless behavior as a way to deal with their depression. Men are also at greater risk of depression when they have experienced a trauma such as combat, an accident, or physical violence.

6. Men are also at greater risk for co-occurring medical problems, such as disorders of the liver, pancreas, and the neurological and gastrointestinal systems. Heavy alcohol use correlates with greater risk of prostate cancer and lower amounts of testosterone. Men who abuse alcohol are more likely to engage in unprotected sex and are at greater risk of contracting HIV, hepatitis, and other STDs.

7. Violence is closely associated with substance use and abuse among men. The relationship between early childhood sexual trauma and substance abuse in men has been well documented. Substance using and abusing men also show high rates of violence.

8. Men who use and abuse substances also tend to have higher rates of problems related to fatherhood and families. They are twice as likely not to pay child support as those without

Mens_Recovery

alcohol and drug problems. Substance abuse and violence may also be a factor in separating men from their families. The results of this alienation are dramatic: when men are not in relationships or do not have children they are less likely to complete treatment.

Honesty handout

08 Wednesday Mar 2023

Posted by in Handout, Honesty, Uncategorized

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  1. Figure out why you lie and who you lie to. We’ve all lied at one time or another, to different people, to ourselves, and for different reasons. But coming up with a systematic plan for becoming more honest will be difficult unless you try to define those reasons and those people for yourself.Transformation.jpg
    • Lies to make ourselves look better might include exaggerations, embellishments, and flat-out tall-tales we tell to others, and ourselves, to make ourselves feel better about our inadequacies. When you’re unhappy about something, it’s much easier to fill it in with lies than tell the truth.
    • We lie to peers we think are better than us, because we want them to respect us as we respect them. Unfortunately, being dishonest is disrespectful in the long run. Give people more credit for their ability to empathize and understand you on a deeper level.
    • Lies that avoid embarrassment might include lies told to cover up bad behaviors, transgressions, or any activity we’re not proud of. If your mom found a pack of cigarettes in your jacket, you might lie and say that they’re your friend’s to avoid punishment.
    • We lie to authoritative figures to avoid embarrassment and punishment, including ourselves. When we’ve done something we feel guilty about, lies are told to eliminate the guilt, avoid the punishments, and get back to the objectionable behavior we’re forced to lie about. It’s a vicious cycle.
  1. Anticipate behaviors that will make you feel guilty. To break the chain of embarrassment and lying, it’s important to learn to anticipate things that you’ll likely feel guilty about in the future, and avoid those behaviors. When you lie, you’re covering up some uncomfortable truth that’s more easily couched in a lie. You can either get comfortable with the truth, or abandon the behavior that makes you embarrassed.
    • If you smoke cigarettes, you won’t have to lie if everyone knows it’s true. Own up to it. If a behavior is un-own-upable, it’s probably best to avoid it. It would be humiliating for your wife to find out that you had an inappropriate relationship with a coworker, but you won’t have to lie if you don’t do it.
  1. Avoid situations in which you’ll have to lie for others. Be wary when someone tells you something in confidence that you know that you should share with someone else (e.g., knowledge of a crime, a lie, or a harmful act against another). Hearing such information puts you in a difficult position, especially when the truth eventually emerges and reveals to the affected person that you knew all along.
    • If someone begins a sentence with “Don’t tell so-and-so about this, okay?” be prepared to offer your own disclaimer: “If it’s something that I’d want to know about were I them, then please don’t tell me. I don’t want to be responsible for anyone’s secrets but my own.”

Stress management strategy #2

22 Wednesday Feb 2023

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Alter the situation

If you can’t avoid a stressful situation, try to alter it. Figure out what you can do to change things so the problem doesn’t present itself in the future. Often, this involves changing the way you communicate and operate in your daily life.

  • Express your feelings instead of bottling them up. If something or someone is bothering you, communicate your concerns in an open and respectful way. If you don’t voice your feelings, resentment will build and the situation will likely remain the same.
  • Be willing to compromise. When you ask someone to change their behavior, be willing to do the same. If you both are willing to bend at least a little, you’ll have a good chance of finding a happy middle ground.
  • Be more assertive. Don’t take a backseat in your own life. Deal with problems head on, doing your best to anticipate and prevent them. If you’ve got an exam to study for and your chatty roommate just got home, say up front that you only have five minutes to talk.
  • Manage your time better. Poor time management can cause a lot of stress. When you’re stretched too thin and running behind, it’s hard to stay calm and focused. But if you plan ahead and make sure you don’t overextend yourself, you can alter the amount of stress you’re under.

There as many ways to reduce stress as there are stars. I use and recommend that people engage a variety of healthy coping and preemptive stress reducing techniques.

Stress management strategy #1

15 Wednesday Feb 2023

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Avoid unnecessary stress

Not all stress can be avoided, and it’s not healthy to avoid a situation that needs to be addressed. You may be surprised, however, by the number of stressors in your life that you can eliminate.

  • Learn how to say “no” – Know your limits and stick to them. Whether in your personal or professional life, refuse to accept added responsibilities when you’re close to reaching them. Taking on more than you can handle is a surefire recipe for stress.
  • Avoid people who stress you out – If someone consistently causes stress in your life and you can’t turn the relationship around, limit the amount of time you spend with that person or end the relationship entirely. 
  • Take control of your environment – If the evening news makes you anxious, turn the TV off. If traffic’s got you tense, take a longer but less-traveled route. If going to the market is an unpleasant chore, do your grocery shopping online.
  • Avoid hot-button topics – If you get upset over religion or politics, cross them off your conversation list. If you repeatedly argue about the same subject with the same people, stop bringing it up or excuse yourself when it’s the topic of discussion.
  • Pare down your to-do list – Analyze your schedule, responsibilities, and daily tasks. If you’ve got too much on your plate, distinguish between the “shoulds” and the “musts.” Drop tasks that aren’t truly necessary to the bottom of the list or eliminate them entirely.

There as many ways to reduce stress as there are stars. I use and recommend that people engage a variety of healthy coping and preemptive stress reducing techniques.

Positive Statements about you

08 Wednesday Feb 2023

Posted by in Handout, Mental Health, Self Esteem

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I am a group therapist who generally works with adults. I facilitate groups using creative arts, processing oriented, or psycho-education. Sometimes I actually sort of combine these in to a psycho-educational process oriented creative group. I provide info (psycho-educational, we talk about it from a personal perspective, and than create something out of the discussion.

Man Laughing

One thing I have notice over the decades is that when people are stressed or overwhelmed about events in their life they tend towards a negative self perception. Below is a handout that I often use. One way of using this is to start out discussing what is positive self esteem, how you get it, maintain it, and why bother with it. I than pass out the hand out and folks write and than we share it in the group or in groups of 2 or 3 folks.

Positive Statements about you

  1. I like myself because:
  1. I’m an expert at:
  1. I feel good about:
  1. My friends would tell you I have a great:
  1. My favorite place is:
  1. I’m loved by:
  1. People say I am a good:
  1. I’ve been told I have:

 

Cognitive Distortions

18 Wednesday Jan 2023

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A basic handout I have used with groups. Ideally I use handouts only to get a conversation going. The handout becomes a frame work for people to open up and start sharing.

Cognitive Distortions and Strategies to dispute them

  • Personalizing: When you blame yourself entirely as the cause of something or blame someone else as the sole reason why something happens . “It’s my fault ” “It’s his/her fault.”
    Strategy: Don’t look for blame. Find other causes. List other possibilities.
  • All or nothing/black and white thinking: When you use extreme terms, “all”, “never”, “none”, “everybody”, “no one”. Also watch for “can’t”.
    Strategy: Look for gray areas. Modify your language by substituting less extreme terms such as “some”, “often”, “most”.
  • Catastrophizing: When you predict or expect the worst will happen.
    Strategy: Expect more positive outcomes and possibilities.
  • Should-ing: When you refer to (or rely on) your list of inflexible rules of acceptable behavior and believe you’re guilty or unworthy if you violate the rules. Or, when you get angry with others if they break the (your) rules. This results in “always having to be right “, or being “super human” or “perfect”.
    Strategy: Change your language: “I should/must” to “I’d prefer” or “I’d rather”.
  • Over-generalizing: When you make an overall assessment based on one example or incident.
    Strategy: Remember that no one situation can exactly predict future outcomes. Look for individuality in each case. Remember that possibilities may exist that have not existed before by recognizing that you have the ability to change, and that things are always changing.
  • Fallacy of fairness: When you expect things to work out based on some unseen system of “karma”, balance, morality, payback, justice, or what “should be fair”.
    Strategy: Change your expectations. There is no inherent system of fairness. Things can happen for no apparent reason.
  • Labeling/Name calling: When you attach powerful words or labels to yourself or others as if those words describe you, or them, or the situation completely. “This day is terrible”, or I’m stupid”.
    Strategy: Define the term, see if it is really accurate. Use only accurate terms. Avoid intense labeling and name-calling. Use less weighted, destructive or inflammatory words. Are you using a double standard? Are you judging yourself more harshly than others would judge you or than you would judge others?
  • Emotional reasoning: When you use your emotions or feelings as proof of how things are. “I feel so sad; things must be hopeless”.
    Strategy: Evaluate the evidence objectively. Feelings are not proof of how things are or will be. Recognize that emotions change.
  • Mind-reading: When you know what others are thinking and why they act the way they do. Particularly, you “know” how people think and feel about you.
    Strategy: Seek other explanations for why people behave the way they do. Don’t assume. Check it out. Ask for their thoughts, opinions and feedback. Remind yourself that you don’t know what they are thinking.
  • Disqualifying the positive: When you devalue anything “good” in a particular situation in light of the “bad”.
    Strategy: Make an accurate assessment. See that “negatives” or “shortcomings” don’t erase strengths and assets, but that these can co-exist.
  • Comparing: When you measure yourself against others, focusing on their accomplishments and attributes, or when you compare yourself to your own ideal.
    Strategy: One can’t compare apples and oranges. We’re all different with different qualities. We can usually find somebody who may be “better” in some way. So what? That doesn’t help. Focus on your own inherent worth and aspirations instead.

Anger Group

11 Wednesday Jan 2023

Posted by in Anger, Anxiety, emotions, Handout, Mental Health

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feelings-07Once a week I facilitate a anger management group. I use a variety of handouts and activities to have a process oriented group interaction. One of the hand outs I use is below. I use it in 1 of 2 ways. I have folks fill it out first and then we discuss or we go through it together and discuss. We explore as a group, learning from each other.

ANGER WORDS

anger disgust grumpiness rage  aggravation dislike hate resentment  agitation envy hostility revulsion  annoyance exasperation irritation scorn  bitterness ferocity jealousy spite  contempt frustration loathing torment  cruelty fury mean-spiritedness vengefulness  destructiveness grouchiness outrage wrath

Other:_________________________

Prompting Events for Feeling Anger

Losing power.

Losing status.

Losing respect.

Being insulted.

Not having things turn out the way you expected.

Experiencing physical pain.

Experiencing emotional pain.

Being threatened with physical or emotional pain by someone or something.

Having an important or pleasurable activity interrupted, postponed, or stopped.

Not obtaining something you want (which another person has).

Other:_______________________________

Interpretations That Prompt Feelings of Anger

Expecting pain.

Feeling that you have been treated unfairly.

Believing that things should be different.

Rigidly thinking “I’m right.”

Judging that the situation is illegitimate, wrong, or unfair.

Ruminating about the event that set off the anger in the first place, or in the past.

Other:____________________________

Experiencing the Emotion of Anger

Feeling incoherent.

Feeling out of control.

Feeling extremely emotional.

Feeling tightness or rigidity in your body.

Feeling your face flush or get hot.

Feeling nervous tension, anxiety or discomfort.

Feeling like you are going to explode.

Muscles tightening. .

Teeth clamping together, mouth tightening.

Crying; being unable to stop tears.

Wanting to hit, bang the wall, throw something, blow up.

Other:__________________________

Expressing and Acting on Anger

Frowning or not smiling; mean or unpleasant facial expression.

Gritting or showing your teeth in an unfriendly manner.

Grinning.

A red or flushed face.

Verbally attacking the cause of your anger; criticizing.

Physically attacking the cause of your anger.

Using obscenities or cursing.

U sing a loud voice, yelling, screaming, or shouting.

Complaining or bitching; talking about how lousy things are.

Clenching your hands or fists.

Making aggressive or threatening gestures.

Pounding on something, throwing things, breaking things.

Walking heavily or stomping; slamming doors, walking out.

Brooding or withdrawing from contract with others.

Other:_____________________

Aftereffects of Anger

Narrowing of attention.

Attending only to the situation making you angry.

Ruminating about the situation making you angry and not being able to think of anything else.

Remembering and ruminating about other situations that have made you angry in the past.

Imagining future situations that will make you angry.

Depersonalization, dissociative experience, numbness.

Intense shame, fear, or other negative emotions.

Other:______________________

Secondhand Marijuana Smoke and Drug Tests

04 Wednesday Jan 2023

Posted by in Addiction, Drug Tests, Handout, Marijuana

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People who are exposed to secondhand marijuana smoke may feel a bit of the “high” that comes with using the drug, a study finds. They may also feel unable to think clearly, and they may even have detectable levels of the drug in their urine or blood. But all of this happens only if they are exposed to marijuana smoke under severely unventilated conditions, the study found.

“If you’re going to breathe in enough passive cannabis smoke to feel high and potentially be slightly impaired, you could fail a drug test,” said Evan S. Herrmann, the study’s lead author and postdoctoral fellow in psychiatry and behavioral sciences at Johns Hopkins School of Medicine. “But this only happens under a very extreme situation.”

Cannabis is the world’s most commonly used illicit drug. It is often smoked in small, enclosed spaces with poor ventilation, according to the study.

Studies in the 1980s showed that such “social exposure” to pot smoke could trigger positive drug tests for cannabis’ main psychoactive ingredient, tetrahydrocannabinol (THC). But such studies had several limitations. They used marijuana that had much lower potency than that available today and they failed to account for normal levels of ventilation in rooms. They also did not examine how people may feel or behave after such exposures.

“This study probes a question people have been wondering forever,” said Ziva Cooper, an assistant professor of clinical neurobiology at Columbia University, who was not involved in this research. “Do people actually get high from these ‘hot box’ effects? And if so, does it change your capabilities or cause you to fail a drug test?”

In the first study of its kind, Herrmann’s team recruited about 20 healthy people between the ages of 18 and 45, including some who smoked marijuana and some who didn’t use the drug. The researchers tested the participants’ blood, saliva, urine and hair samples for cannabis biomarkers, and then asked six smokers and six nonsmokers to relax in a Plexiglas and aluminum smoke chamber about the size of a dorm room. Participants underwent two separate sessions, each an hour long.

The researchers gave each of the six smokers 10 marijuana cigarettes, each containing 1 gram of high-potency weed, and instructed them to smoke at their leisure for the hour while the six non-smokers sat by their side in the chamber.

During one test session, the room’s ventilation system was switched on, allowing air to flow in and out at a standard office-building rate. In the other session, the researchers restricted the airflow in the chamber. After the 60 minutes, each participant completed a series of biological, cognitive and subjective surveys and tasks at regular intervals for up to 34 hours after exposure.

“Our results are pretty consistent with what we expected,” Herrmann said. The new findings confirm “it’s really hard to get a positive [drug test result] from passive smoke unless you’re in an extreme scenario,” he said.

Under the unventilated, “hot box” condition, the nonsmokers showed slight impairments on cognitive tests, reported feeling high, and had detectable levels of THC in their blood and urine for up to 22 hours post-exposure. Those in the ventilated condition had much lower levels of THC in their blood, did not feel impaired or high, and did not test positive for THC in their urine.

But the unventilated room is not representative of most real-life situations, the researchers said. “We modeled the worst-case scenario,” Herrmann said. “You are in an enclosed room for an hour with 15 grams of cannabis being smoked.”

Ideally, the study would have had a placebo group, in which nonsmokers were exposed to smoke without THC. This would have helped the researchers determine whether the feeling of being high was due to the marijuana or simply a placebo effect, from being exposed to smoke.

Still, “this study is really important because it adds to our limited knowledge of the direct effects of cannabis smoking and the potential dangers of second-hand smoke,” Cooper said.

Men and Depression

21 Wednesday Dec 2022

Posted by in Depression, Handout, men

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In my years of facilitating groups I have on occasion facilitated men only groups. One issue that comes up is depression. We all have bouts of sadness now and then and when those bouts of sadness interfere with our daily lives than we need to take a step in the direction of change. Below is part of a handout I often use, particularly with dual diagnosed men.  

Symptoms of Depression

Not everyone who is depressed or manic experiences every symptom. Some people experience only a few; some people suffer many. The severity of symptoms varies among individuals and also over time.

· Persistent sad, anxious, or “empty” mood.

· Feelings of hopelessness or pessimism.

· Feelings of guilt, worthlessness, or helplessness.

· Loss of interest or pleasure in hobbies and activities that were once enjoyable

· Decreased energy, fatigue; feeling “slowed down.”

· Difficulty concentrating, remembering, or making decisions.

· Trouble sleeping, early-morning awakening, or oversleeping.

· Changes in appetite and/or weight.

· Thoughts of death or suicide, or suicide attempts.

· Restlessness or irritability.

· Persistent physical symptoms, such as headaches, digestive disorders, and chronic pain that do not respond to routine treatment.

Co-Occurrence of Depression with Other Illnesses

Depression can coexist with other illnesses. In such cases, it is important that the depression and each co-occurring illness be appropriately diagnosed and treated. Research has shown that anxiety disorders which include post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, panic disorder, social phobia, and generalized anxiety disorder commonly accompany depression.

Substance use disorders (abuse or dependence) also frequently co-occur with depressive disorders. Research has revealed that people with drug and/or alcohol addiction are almost twice as likely to experience depression.

Depression has been found to occur at a higher rate among people who have other serious illnesses such as heart disease, stroke, cancer, HIV, diabetes, and Parkinson’s.

Causes of Depression

Very often, a combination of cognitive, genetic, and environmental factors is involved in the onset of depression. Modern brain-imaging technologies reveal that, in depression, neural circuits responsible for the regulation of moods, thinking, sleep, appetite, and behavior fail to function properly.

In some families, depressive disorders seem to occur generation after generation; however, they can also occur in people with no family history of these illnesses. Genetics research indicates that risk for depression results from the influence of specific multiple genes acting together with non-genetic factors.

Environmental factors such as trauma, loss of a loved one, a difficult relationship, financial problem, or any stressful change in life patterns, whether the change is unwelcome or desired, can trigger a depressive episode in vulnerable individuals. Once someone experiences a bout of depression later episodes of depression may occur without an obvious cause.

Men and Depression

Men are more likely than women to report alcohol and drug abuse or dependence in their lifetime; however, there is debate among researchers as to whether substance use is a “symptom” of underlying depression in men or a co-occurring condition that more commonly develops in men. Nevertheless, substance use can mask depression, making it harder to recognize depression as a separate illness that needs treatment.

Instead of acknowledging their feelings, asking for help, or seeking appropriate treatment, men may turn to alcohol or drugs when they are depressed, or become frustrated, discouraged, angry, irritable, and, sometimes, violently abusive. Some men deal with depression by throwing themselves compulsively into their work, attempting to hide their depression from themselves, family, and friends. Other men may respond to depression by engaging in reckless behavior, taking risks, and putting themselves in harm’s way.

Positive Traits Handout

23 Wednesday Nov 2022

Posted by in Addiction, Creative Therapy Tools, groups, Handout, positive

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This handout is a quick way to start the conversation in groups. I have folks circle the 10 traits that they (think/feel) have. Than I ask them to put them in a numbered order (1 to 10), best to worst. One day someone suggested that they had way more negative traits so…. I started asking folks (after they shared the positive traits) to write their negative traits on the back and share.

Most of the people that I worked with for the last 10 years were men between 20 and 35. Most had started using intoxicants as teens with cannabis and moved onto oxie and later stronger opioids and/or fentanyl. Most had felony possession charges and/or were on probation.

I kept a lose record of what people chose as their top 3 positive traits: 1. Hardworking, 2. Reliable, 3. Strong. One last thing, I usually asked folks at the end of group would their loved ones and/or family (however they chose to define that) agree with their list of positive traits. Most said (hell) no.

Anxiety Handout

26 Wednesday Oct 2022

Posted by in Coping Skills, Handout

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We all know the uncomfortable feeling of anxiety. Our hearts race, our fingers sweat, and our breathing gets shallow and labored. We experience racing thoughts about a perceived threat we fear will be too much to handle. That’s because our “fight or flight” response has kicked in, resulting in sympathetic arousal and a narrowing of attention and focus on avoiding the threat. We seem to be locked in that state, unable to focus on our daily chores or longer-term goals. Below are six strategies that you can use to help relieve your everyday anxiety:

  • Reevaluate the probability of the threatening event actually happening.

Anxiety makes us feel that a threat is imminent, yet most of the time what we worry most about never happens. By recording our worries—and how few actually came true—we can notice how much we overestimate the prospect of negative events.

  • De-catastrophize.

Even if a bad event happened, we may still be able to handle it by using  coping skills and problem-solving abilities or by enlisting others to help. Although not pleasant, we could still survive encountering a spider, having a panic attack, or losing money. It’s important to realize that very few things are the end of the world.

  • Use deep breathing and relaxation.

By deliberately relaxing our muscles we begin to calm down so we can think clearly. If you practice this at first without a threat present, it can start to become automatic and will be easier to use in the moment when you face a threat. Deep breathing engages the parasympathetic nervous system to put the brakes on sympathetic arousal.

  • Become mindful of your own physical and mental reactions.

The skill of mindfulness involves calmly observing our own reactions, including fear, without panic or feeling compelled to act. It can be taught in therapy and improves with practice.

  • Accept fear and commit to living a life based on core values.

Acceptance and Commitment Therapy (ACT) is an approach that encourages people to accept the inevitability of negative thoughts and feelings and not try to repress or control them. By directing attention away from the fear and back onto life tasks and valued goals, we can live a full life despite the fear.

  • Exposure.

Exposure is the most powerful technique for anxiety and it involves facing what we fear and staying in the situation long enough for the fear to habituate or go down, as it naturally does. Fear makes us avoid or run away, so our minds and bodies never learn that much of what we fear is not truly dangerous.

Anger Handout

12 Wednesday Oct 2022

Posted by in Coping Skills, Handout

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I often work with groups I have never met before. When I walk into group I start to evaluate and access right away. For psych-educational groups I mostly focus on do I need to pull out a handout or not. That decision depends on the openness of the folks. Do they greet me verbally, with postures and/or gestures, eye contact, expressions of thoughts/feelings, where and how they are sitting.

In most places I have worked I would facilitate an anger management group. I used a variety of handouts and activities to have a process oriented group interaction. One of the handouts I use is below. I use it in 1 of 2 ways. I have folks fill it out first and then we discuss or we discuss while filling it out. Both ways we explore as a group, learning from each other.

ANGER WORDS

anger disgust grumpiness rage  aggravation dislike hate resentment  agitation envy hostility revulsion  annoyance exasperation irritation scorn  bitterness ferocity jealousy spite  contempt frustration loathing torment  cruelty fury mean-spiritedness vengefulness  destructiveness grouchiness outrage wrath

Other:_________________________

Prompting Events for Feeling Anger

Losing power.

Losing status.

Losing respect.

Being insulted.

Not having things turn out the way you expected.

Experiencing physical pain.

Experiencing emotional pain.

Being threatened with physical or emotional pain by someone or something.

Having an important or pleasurable activity interrupted, postponed, or stopped.

Not obtaining something you want (which another person has).

Other:_______________________________

Interpretations That Prompt Feelings of Anger

Expecting pain.

Feeling that you have been treated unfairly.

Believing that things should be different.

Rigidly thinking “I’m right.”

Judging that the situation is illegitimate, wrong, or unfair.

Ruminating about the event that set off the anger in the first place, or in the past.

Other:____________________________

Experiencing the Emotion of Anger

Feeling incoherent.

Feeling out of control.

Feeling extremely emotional.

Feeling tightness or rigidity in your body.

Feeling your face flush or get hot.

Feeling nervous tension, anxiety or discomfort.

Feeling like you are going to explode.

Muscles tightening. .

Teeth clamping together, mouth tightening.

Crying; being unable to stop tears.

Wanting to hit, bang the wall, throw something, blow up.

Other:__________________________

Expressing and Acting on Anger

Frowning or not smiling; mean or unpleasant facial expression.

Gritting or showing your teeth in an unfriendly manner.

Grinning.

A red or flushed face.

Verbally attacking the cause of your anger; criticizing.

Physically attacking the cause of your anger.

Using obscenities or cursing.

U sing a loud voice, yelling, screaming, or shouting.

Complaining or bitching; talking about how lousy things are.

Clenching your hands or fists.

Making aggressive or threatening gestures.

Pounding on something, throwing things, breaking things.

Walking heavily or stomping; slamming doors, walking out.

Brooding or withdrawing from contract with others.

Other:_____________________

After effects of Anger

Narrowing of attention.

Attending only to the situation making you angry.

Ruminating about the situation making you angry and not being able to think of anything else.

Remembering and ruminating about other situations that have made you angry in the past.

Imagining future situations that will make you angry.

Depersonalization, dissociative experience, numbness.

Intense shame, fear, or other negative emotions.

Other:______________________