Category Archives: Handout

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

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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

Posted by in Coping Skills, Handout, Stress

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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

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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.