10 Ways to Help Stuck Clients Move Forward

Our emotional brains are primed to override the rational mind with patterns that persist until we intervene with something this feeling brain can understand: a compelling emotional experience that completely changes how we feel, not just how we think. Orchestrating such felt experiences with your clients is easier than you think. Here are 10 strategies…

“I know it’s irrational, but I can’t stop the extreme anxiety I feel around people because I’m a 6’3” tall woman and fear they’ll think I’m a freak,” said Natalie, a 35-year old nurse. Though she was comfortable working with patients, was happily married, and had two very close friends, she couldn’t shake the anxiety she felt around colleagues and large groups of people.

“My last therapist taught me relaxation exercises, how to talk back to my negative thoughts, and encouraged me to get out socially with small groups,” Natalie added. “But none of that seems to work. The anxiety just hijacks my brain.”

She’s right. Sometimes, no matter how we try to outsmart it, our emotional brains are primed to override the rational mind with patterns that persist until we intervene with something this feeling brain can understand: a compelling emotional experience that completely changes how we feel, not just how we think.

Orchestrating such felt experiences with your clients is easier than you think. In this post, I’ll share 10 strategies from my book, “The Therapeutic ‘Aha!’” that you can use to engage the emotional brain and help stuck clients move forward.

Strategy #1: Align, Lift, and Lead

Most of us were taught to validate our client’s feelings. However, if you spend too long merely validating your client’s pain, it can amplify negative feelings in the emotional brain. To help your client access positive states of mind, you have to find a way to lift and lead them emotionally. To make this transition, I recommend a language pattern that I call “Align, Lift, and Lead.”

You align with the client by reflecting your understanding of the problem, and then you lift the client by affirming her strengths, and lead her by suggesting her desired response to the situation. Here is how I used this language pattern with Natalie:

 “Natalie, I understand that you’ve had these experiences where you’ve not felt comfortable around large groups of people because you’ve not been sure how they would react to your height. Being a nurse, you’re obviously an empathic person and are probably pretty good at helping people feel at ease. I’m seeing you using these people skills in other social situations, too, realizing that a person’s reaction just tells you something about them, and you can sense how to put them at ease.”

Reframing her problem in this way helped Natalie feel more socially competent and encouraged.

Strategy #2: Visualize the Desired Response

Because the emotional brain learns better through metaphor and imagery than it does through words, another strategy you can use is to have your client visualize her desired response. I suggested Natalie visualize herself successfully navigating a social situation and imagine feeling curious, secure, and calm. Then, I asked her to imagine something in nature that could represent her mind working this way. Natalie smiled and said, “Muir Woods with the redwood trees.” Visualizing the peacefulness of the tall trees in this forest helped her feel calmer and gave her a sense of belonging.

Strategy #3: Identify Inspiring Goals

Instead of setting dry, lifeless goals like, “Client will practice relaxation skills and talk to two new people per week,” explore potential goals that have real value and meaning for your client.

When I explored inspiring goals with Natalie, she began talking about her desire to have lunch with a group of colleagues. They’d been inviting her to lunch for several weeks, and she liked the idea of connecting with fellow nurses. Targeting a small group of people she wanted to be around felt more intriguing and doable to her and less like a task.

Strategy #4: Locate the Root of an Emotional Conflict

Even though Natalie felt encouraged by this goal, she still felt a knot in her stomach at the thought of going out to lunch with these colleagues. I asked Natalie to follow the sensations in her stomach back to the first time she could remember having a similar feeling. Her eyes widened as she recalled being teased during lunchtime in middle school by a group of kids who called her names like “Amazon” and “Sasquatch.”

She had coped by avoiding the school cafeteria and doing her homework in the library during lunch. As a result, she avoided her bullying classmates and was praised by her teachers for being studious. Natalie gasped as she realized she was doing the same thing at her job­—skipping lunch with peers to avoid fears of being ridiculed and getting praised by her boss for being so dedicated.

Once Natalie made this connection, she understood her emotional brain had simply continued the pattern because it had been adaptive for her in the past.

Strategy #5: Reverse Traumatic Memories

Natalie was excited to have made this connection, but just having cognitive insight into the cause of her social anxiety didn’t change it. In fact, recent neuroscience discoveries have shown us that in order for the emotional brain to change a response that was once adaptive, we have to recall the old memory while eliciting a new experience that invalidates the beliefs that got attached to the disturbing memory.

Strategy #6: Change Beliefs With Imagery and Metaphor

To change Natalie’s negative self-concept, we revisited her imagery of the redwood tree­—tall, beautiful, and majestic. I suggested she imagine the smaller trees laughing at the redwoods for being so tall and see the absurdity of it. Imagining this scene made Natalie laugh and realize every tree had its natural place in the world, and so did she.

Strategy # 7: Conjure Up Compelling Stories

Another way you can reverse the meaning of a traumatic event is to have your client finish her story with a new ending. For instance, she can finish it with a later moment in her life when she was out of danger, in a better situation, or felt competent or empowered.

The first time Natalie told her story about being bullied at school, she ended the story with an incident where a boy asked her to dance, then brought out a chair to the dance floor and stood on it so he could be as tall as she was. Everyone laughed, which made Natalie cry.

When I prompted her to consider a new ending to this story, she said, “Well I’ve been happily married for 15 years, and my husband said he was attracted to me because I was tall. He thought I looked like a graceful dancer.” She smiled and realized that ending her story this way suddenly caused the experiences she had with the boys in her youth to seem trivial.

Strategy #8: Prime With Play and Humor

Using play and humor are also great ways to dissipate anxiety and trigger new perspectives on events. Natalie and I acted out a role-play in which I let her play a woman with a snobby attitude teasing her while I played Natalie. She began the role-play by wrinkling her nose and saying,

“Who invited you to lunch with us, Amazon lady?”

I answered by simply saying, “Linda invited me.”

“Well I hope you don’t think I can be seen walking next to you, Sasquatch,” Natalie continued. And you should really consider doing something different with your hair.”

I smiled and replied, “Oh, what a shame. I fixed my hair this way just for you.”

Natalie laughed and we continued the role-play for a few more minutes. Letting Natalie play the character she feared reduced her anxiety because she realized how insecure a person would have to be to make such insensitive comments.

Strategy #9: Rouse With Rhythm and Music

Music can influence mood and neurochemistry, and it can entrain the brain to calmer states. One activity many clients enjoy is creating a playlist of tunes that evoke desired responses. Natalie started her playlist with “Creep” by Radiohead, which reflected her fears of being a social reject. Then we added “Everyday People,” by Sly and the Family Stone, which was more upbeat and affirmed that humans come in different colors, shapes, and sizes. Natalie ended her playlist with “Can’t Keep a Good Woman Down,” by Mary J. Blige, which helped her feel empowered.

Strategy #10: Integrate Mindful Movement

Movement can also engender desired states of mind. Dancing to her playlist helped Natalie shake off anticipatory anxiety, but I also suggested she could place her hand on her abdomen to calm her stomach and invoke a sense of self-compassion. She practiced this gesture while she slowed her breathing and imagined the beautiful redwood trees. Over the next several weeks, Natalie reported that her anxiety completely dissipated and she was able to comfortably enjoy lunch with her co-workers and other social situations.

Closing Thoughts

Neuroscience is now suggesting that in order to change recurring emotional and behavioral patterns, we can’t just talk about change at the cognitive level, we have to evoke an emotional experience that changes patterns in the emotional regions of the brain. Creating these emotional experiences not only triggers profound transformation, but it can also be fun and uplifting for both you and your clients.

I hope this post has given you ideas for new techniques you can use, and that it leads to many “Aha!” moments for you and your clients.


Join Courtney Armstrong, LPC, MHSP, for the transformational workshop “The Therapeutic ‘Aha!’: 10 Brain-Based Strategies to Transform Your Clients and Your Practice Seminar.”


Courtney Armstrong, LPC, MHSP, is a licensed professional counselor in Chattanooga, Tenn., and the author of “The Therapeutic ‘Aha!’: 10 Strategies for Getting Your Clients Unstuck.” She also offers training and free resources for therapists at her website: www.courtneyarmstrong.net.

10 Questions to Ask Your Client About Social Media Use

The cyber age has provided a breeding ground for bullying, and our clients can be bombarded daily with negative comments, images or untruths about themselves. Understanding how your clients use social media can be key to successful sessions.

Bullying has become a major factor among school-age children and has been linked to increased diagnoses of depression, social anxiety, generalized anxiety, eating disorders, body image problems, low self-esteem and feelings of low self-worth.

The harmful effects of bullying outlast childhood, and many adults continue to manage the damaging and devastating consequences of this behavior. In particular, female bullying is much different and unique when compared to their male counterparts.

Female Relational Aggression, also known as covert aggression or covert bullying, is a type of aggression in which harm is caused to another by damaging their relationships or social status. It has long-lasting effects on relationships, self-esteem, self-worth, and the ability to navigate healthy relationships with others.

The peak of this type of bullying typically occurs during a sensitive period when intimate and close relationships involving trust, bonding, and self-image are forming.

Relational aggression can involve:

  • Being unexpectedly ousted from a “friend group”
  • Being ignored by a group of friends
  • Not being invited to a party that everyone else is attending
  • Having rumors spread about you
  • Someone posting derogatory images of you online
  • No one liking your pictures on Instagram
  • Having someone post negative or demeaning comments about you on a social media outlet

The cyber age has provided a breeding ground for this type of aggression, and our clients can be bombarded daily with negative comments, images or untruths about themselves.

For example, since being ostracized from her “friend group,” a teenage client has been addicted to Instagram. She stated, “I know it’s not good for me to look at it, but I can’t help it. I can at least see what they are doing, and I can at least know if they are having fun or not. I look to make sure other people don’t “like” their pics on there. I feel like if people don’t like their pictures, it will make me feel better. And that’s all I want; to feel better about what they did to me.”

Another client taught me that her self-worth was associated to her “likes” on her Facebook page. She reported that her moods were contingent on these “likes,” and she would even inquire when a post is not liked to make changes to her image or how she may word a comment.

Because this type of aggression is covert, others may be oblivious that it is happening. Some children may even deny being victimized due to embarrassment, their desire to preserve their friendship with the aggressor, or fear of reprisal.

This is not a “coming of age” or “initiation” into adolescence. This is a serious problem that needs to be addressed, and as clinicians, we have a duty to our clients to educate and promote awareness.

Navigating this issue to help preserve a sense of self-worth, self-love, and self-image is key to providing adequate care to our clients. There are several social media forums which promote this type of relational aggression.

It’s important to understand how your client is using social media. You can explore your clients social media behaviors by using the worksheet: 10 Questions to Ask Your Client About Social Media Use.

It is key to educate ourselves on the existence of social media sites used for bullying, and how to use this technology to assist our clients in healing and moving forward to establish healthier and productive relationships with others.


 

Download: 10 Questions to Ask Your Client About Social Media Use


 

This post was contributed by PESI speaker Meagan Houston, Ph.D., SAP. Meagan specializes in providing suicide treatment in a wide variety of settings and populations. She has experience in high-risk settings where the application of suicide prevention, assessment and intervention occurs daily.

Learn more from Meagan Houston, Ph.D., SAP, in her CE Seminar on DVD:

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Can You Hear Me Now: When to stop fixing and just listen

When a client comes to you in emotional distress and you sense that childhood wounds are the cause, your instinct is to spring into action. We want to stitch them up and slap on a new metaphorical bandage.

But you can’t fix them. And here’s why…

When a client comes to you in emotional distress and you sense that childhood wounds are the cause, your instinct is to spring into action. I’ve spent my career working as a marriage and family therapist, so I understand this instinct. We want to stitch them up and slap on a new metaphorical bandage.

You Can’t Fix Them

We think, understandably, that because of years of education and training, we can fix them. We can’t. At least not yet.

Here’s why:

If something happened to your client as a child, and they’ve been carrying the experience around silently for decades, the act of putting voice to their story and having someone listen and really, truly hear them, can feel groundbreaking to them. In the beginning of your journey with them into their past, that’s all they need from you.

Don’t Offer Solutions

As your client opens up to you about their past, one of the worst things you can do is to try to offer solutions too soon. While you may have had a dozen clients who experienced similar trauma, and you have a dozen ways to heal their wounds, if you immediately jump to fix-it mode, the message you send your client is, “Your experience isn’t unique.”

Your client doesn’t want to feel like they are one of many with similar stories, and when you rush in with solutions, they may feel ashamed they couldn’t solve it themselves. Instead, when you sit with your client in silence and hear them tell their story—in their way, at their pace—you are able to offer them the validation they have wanted their whole life and haven’t received.

Your client needs to know that their experience is as unique and as important to you as it is to them.

Being heard brings the realization that we are not alone, that people care about our feelings. As a family therapist, I’ve seen how important silent listening is. When you listen, you let your client know that they are not alone and never have to suffer in silence again. The end goal is to heal the wounds, but the first step is to just let the wound breath.


This blog was contributed by PESI speaker Andrea Brandt, Ph.D., MFT. Brandt brings over 30 years of clinical experience to her work as a renowned psychotherapist, speaker, and author. A pioneer in the field of treating anger issues, she also works with a full range of emotional concerns: anxiety, aggression, aging, workplace, women’s issues, and relationship dynamics. Her wisdom, warmth, and humor have made her a frequently featured media expert, appearing on numerous television and radio shows and interviewed in the Los Angeles Times, ehow.com, and Parenting Magazine. She is also the author of Mindful Anger: A Pathway to Emotional HealingFor additional information, visit www.abrandtherapy.com


Join Andrea live in Anaheim, Sherman Oaks, or Pasedena, Cali. for the CE Seminar: The Art of Mindful Anger: Transforming a Difficult Emotion into a Powerful Therapeutic Device.

Not in an area near you? Purchase the DVDand earn CE from the comfort of your home.

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Changing the Way We Handle Infant Loss

Recognizing a need to change the way we care for families dealing with infant loss, Megan made the decision to complete her certification to become a bereavement Doula. Since her certification, Megan has become focused on changing the program and procedures at her facility to better care for families experiencing the loss of an infant. That means not just adjusting policies in labor and delivery, but training NICU and PICU staff on how to help a family say hello to their child before saying goodbye.

Mandy Maneval faced infertility for years. Finally, three years ago, she became pregnant with twins. At a routine ultra sound, she was faced with the news that Aaron was lost at 20 weeks. Her little girl, Abigail (Abby), was healthy.

At 30 weeks, Mandy went into labor. She called her sister, Megan Shellenberger, a nurse at Penn State Milton S. Hershey Medical Center, located in Hershey, Pennsylvania. Megan spends most of her time working in labor and delivery, and she was quick to reassure Mandy that everything would be O.K.

Suspecting that baby Abigail had a heart defect, Mandy came to Penn State Milton S. Hershey Medical Center, the home of a leading neonatal cardiologist. The physicians were able to stop Mandy’s labor, but she would remain an inpatient until delivering Abby at 35 weeks.

Abby was born with two very complex heart defects. So rare, that her doctors described it as being struck by lightning twice. Born on a Saturday, she had open heart surgery four days later. She made it through with limited complications, but shortly after her urine output declined, and she began to look dusky.

On Saturday morning, just one week after she was born, Mandy called her sister. “Abby went with the angels. What do I do, Meg?”

Megan was familiar with the tragic loss of infants. She joined her sister in the hospital where they bathed and dressed Abby. She carefully made hand and foot molds of her niece, and a priest came in. Then they left: Mandy carrying a white plastic bag labeled “personal belongings” filled with Abigail’s few possessions she ever touched.

“On the day of Abby’s funeral, I had to dress my sister,” said Megan. “For a year I took care of her, helped her get into therapy, and when I felt confident that she was healing I knew it was time to do something different for myself, my career, and my medical facility.”

Recognizing a need to care for families differently, Megan made the decision to complete her certification to become a bereavement Doula.

Since becoming certified, Megan has become focused on changing the program and procedures at her facility to better care for families experiencing the loss of an infant. That means not just adjusting policies in labor and delivery, but training NICU and PICU staff on how to help a family say hello to their child before saying goodbye.

Megan stressed,“These babies are important, and we should show parents that they’re important to us as a medical facility too. And that means not sending them home with a plastic bag of belongings, but instead allowing them time to slow down, create some memories and have the opportunity to process what is happening.”

Megan worked with Sweet Grace Ministries, a support organization for families who’ve lost infants, to purchase a CuddleCot™ for Penn State Milton S. Hershey Medical Center. CuddleCot™ is a small cooling system that helps a family dealing with bereavement have additional time with their child.

“Families usually have one, two or four hours to spend with their infant after a loss. That’s nothing compared to the time they anticipated spending with their child. Using the CuddleCot™ we can extend the time to one, two or even four days. During that extra time, we create a lot of memories. We place a bear next to the baby and take photos, we make hand and foot molds, and we have mementos for the family to take home with them. It’s all about taking the time to say hello to their child before saying goodbye,” said Megan.

Megan notes that there are easy steps every medical facility can take to help families dealing with infant loss grieve.

If it is safe for the mother, facilities need to encourage time for the parents to process what has happened.

“Many families find out that their baby’s heart has stopped during routine ultra sounds. After hearing the news, they go straight to labor and delivery. Sometimes these families have nurseries ready and waiting at home, and they have no time to go home, pick out an outfit, or plan with their family. When we slow everything down, these families can grieve this devastating loss in a way that’s right for them.”

By allowing families time to prepare for a stillbirth, facilities can provide entire families with the opportunity to make memories. Groups such as Now I Lay Me Down to Sleep are available to take photographs of mom, dad, siblings, and all of the extended family who are deeply in love with the child.

Creating hand and foot molds of the baby are invaluable for families.

Megan recalls making the molds for her niece. “My sister was devastated because we had to hold Abby to complete the hand and foot molds. Later, when we brought the molds to my sister she cried. She told me she didn’t realize that they were going to be so wonderful. They’re her favorite thing of Abby’s.”

If the facility knows the family will be having a stillborn child, make the delivery room more comfortable.

“Remove the equipment that isn’t needed. If the comforter on the bed is white, change it to something with a color. The baby will photograph against a colored blanket much better. Even little touches like filming when the family comes in can be helpful. It’s priceless to have the moment on film when a grandmother says ‘Oh, he looks just like his Dad.’”

Megan’s role as a bereavement doula can be a wonderful resource for families struggling with infant loss. She’ll join families in the hospital and help them understand that it’s O.K. to take pictures, and it’s O.K. to hold their baby. Megan says, “there is a feeling that it’s morbid to hold a baby that has passed on. But we need to change our thinking.”

Not every facility is fortunate enough to have a bereavement doula on staff. Families can find bereavement doulas through online listings, and are encouraged to reach out and contact a doula. Many bereavement doulas are open to traveling and visiting medical facilities to help families grieve their infant.

“Abigail and my sister are the reasons why I’ve done bereavement. Our medical facilities can do better helping families grieve. For my own facility, I’m passionate about getting the perinatal bereavement program up and running. I want parents who know they’re going to have a baby who won’t make it be able to start planning right away.”

Megan stressed the importance of reaching out and remembering these families after their baby has passed. “Right after Abigail passed, I went back to work and had a mom come in who was losing her twins. She gave me an ornament with two little hearts that had their names on the back. It hangs on my tree every year. And every year I take a picture of it and send it to her, and I tell that I remember.”


NurseOfMonthMeg

Megan Shellenberger, BSN, has been a nurse for 11 years. She honors Abby by caring for mothers experiencing a loss. PESI is proud to share Megan’s story in memory of Abigail. For Megan’s role in changing her facility’s practices for handling infant loss, she has been awarded the PESI Nurse of the Month.


For more resources on infant loss, please visit the following:

The Smallest Gift – a resource available to any nurse or family dealing with infant loss. This volunteer run organization will pack and ship boxes at no charge to families experiencing loss. Included are self help books, a blanket with the baby’s name, a weighted heart pillow made to the exact birth weight of the baby.

Babies Remembered – A bereavement doula certification group.


Do you know a nurse who deserves recognition for going above and beyond the call of care? Tell us about it.


Get a free hour of CE when you watch Mastering the Neurological Assessment with Cyndi Zarbano.

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Integrating Tonic Labyrinthine Reflex: An exercise for children with learning disabilities

Do you work with clients struggling with learning disabilities? It could be from a retained reflex.

Do you have students who….

  • Are very disorganized?
  • Can’t tell a good story from beginning to end?
  • Can’t read an old fashioned clock?
  • Mix up words related to time like yesterday and tomorrow?
  • Have skinny arms and legs?
  • Have no muscle tone and are weak in their upper body?
  • Find it most comfortable to slouch in their chair?
  • Hate to lie on their tummies to read or watch TV?

If you responded yes to several of the above questions, the child may have a retained Tonic Labyrinthine Reflex (TLR).

What is Tonic Labyrinthine Reflex?

TLR is a primitive reflex in newborns. Normally, a baby spends time on their tummy with head and arms up and out. While doing this, a baby develops the muscles in their neck, shoulders, and back. These muscles are necessary for later stages of development. If a child has a retained TLR, they may have passed too quickly through this stage of development in infancy and retained the TLR.

What does this mean?

During the time TLR is developing, other areas in the body are also growing and maturing, including:

  • The vision system for convergence – the ability to refocus near to far and back again easily
  • The ability to use the entire foot for walking (instead of toe-walking)

A later stage of development, Asymmetrical Tonic Neck Reflex (ATNR), is integrated by doing combat crawl. In order to do this, the baby needs to have developed strong muscles during the TLR stage to be able to pull herself across the floor. Crawling requires even more muscles as the arms must be able to hold up the weight of the body.

In order to have healthy and complete development, the stages must be adequately entered and worked through. When TLR is retained and the muscles haven’t properly developed, a child may appear uncoordinated in their movement, have a tendency to walk on their toes, and hang their head forward while sitting (making concentration difficult and uncomfortable for a learning child).

TLR and Brain Development

During TLR, the connections to the temporal lobe are starting to be developed, setting up the brain to be able to sequence. We use sequencing for reading (keeping sounds in order), writing (keeping letters, words, and thoughts in order) and math (step-by-step directions, counting, telling time).

A retained TLR can lead to difficulties learning reading, writing and math.

What to do?

By replicating the stage of development and completing easy, daily exercises, we can train our body to work through the retained TLR. While 30 days of exercise may be enough to make changes in a child’s sequencing ability, it may take up to six months of daily exercise to fully develop the muscles.

Here’s one daily exercise to help integrate TLR:

Simple Fly to the Moon exercise to integrate Tonic Labyrinthine Reflex

  1. Every day, have the student lie on their stomach, up on their elbows. Hold for 30 seconds at a time, working up to 3 minutes a day.
  2. In order to isolate the muscles in the upper body, the legs and buttocks should be resting. It may be very difficult at first—have the child do this at their own capability, but each day challenging for more.
  3. This must be done at least 5 days a week in order to make real changes in the brain and the body.
  4. When the child is ready, have them see if they can hold both elbows up off the floor, causing the entire upper body to be off the floor.
  5. Start with however long they can accomplish this—even if only 10 seconds. Challenge each day to go a little longer.

The goal is to be able to sequence well, and most children achieve this in 30 days. Physically, the goal of being able to hold up the upper body without pain for 3 minutes may take longer, as much as 6 months.


Dyslexia, Dyscalculia and Dysgraphia: An Integrated Approach

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This blog was brought to life by PESI speaker Kathy Johnson, MS Ed.

Kathy Johnson, author of The Roadmap From Learning Disabilities To Success, is a nationally recognized expert in multiple therapy methods including: Primitive Reflex Training, Therapeutic Listening, Samonas Listening, PACE, Phono-Graphix, Irlen Syndrome, Brain Gym 101, and An Introduction to Rhythmic Movement.

Kathy started The Hunter School of Ballston Spa where struggling third through eighth grade students received required academics along with intensive therapy. She is also the owner of an educational consulting business to screen and remediate student struggles individually. Kathy earned her Master’s degree from the State University of New York at Albany where she instructed faculty and staff, was an adjunct professor at Schenectady County Community College, and taught at The Adirondack School of Northeastern New York.

PESI Participates in 4th Annual Joining Forces Wellness Week

In recognition of Veterans Day, PESI is proud to participate in the 4th Annual Joining Forces Wellness Week in conjunction with the Office of the First Lady of the United States, Center for Deployment Psychology at the Uniformed Services University of the Health Sciences (USUHS), and the Association of American Medical Colleges (AAMC). Join us Nov. 9-13, 2015, and earn free CE when you join any of the five free webinars focused on the health needs of veterans and their families.

In recognition of Veterans Day, PESI is proud to participate in the 4th Annual Joining Forces Wellness Week in conjunction with the Office of the First Lady of the United States, Center for Deployment Psychology at the Uniformed Services University of the Health Sciences (USUHS), and the Association of American Medical Colleges (AAMC).

Joining Forces Wellness Week is designed to heighten awareness about the health needs of the nation’s veterans, service members, and families, and elevate the role that medical schools and teaching hospitals play in serving this community.

The week-long initiative will take place November 9-13, 2015, and will feature a webinar series hosted by our friends at the Center for Deployment Psychology. Registration is now open. Sign up today and earn one free CE hour per webinar!

All sessions in the webinar series will be hosted from 12 PM to 1 PM (EST) and include the following:

  • November 9 – Service Culture of the Military and Implications for Health Care Providers
  • November 10 – Generational Differences of Veterans and Service Members and Impact on Health and Wellness
  • November 11 – Incorporating Veteran and Military Health Curricula into Health Professions Education
  • November 12 – Military and Veteran Families – Service and Resilience
  • November 13 – Guard & Reserve: Insights and Resources

CLICK HERE for more information and to register!


About Joining Forces

First Lady Michelle Obama and Dr. Jill Biden created Joining Forces to bring Americans together to recognize, honor, and take action to support service members, veterans and their families during their service to our country and throughout their lives. The initiative aims to educate, challenge, and spark action from all sectors of society to support veterans and active military.

6 Questions to Test Your Diabetes IQ

Every patient you see is unique, and so is their diabetes treatment plan. Diabetes care is constantly evolving as we continue to learn more about the disease and the way it affects the body. Are you up to date with the most current diabetes knowledge? See if you can answer the 6 questions listed here.

Every patient you see is unique, and so is their diabetes treatment plan. Diabetes care is constantly evolving as we continue to learn more about the disease and the way it affects the body. Are you up to date with the most current diabetes knowledge? See if you can answer the 6 questions below.

Q: What new medications are available for Diabetes Mellitus?

There are now 8 classes of medications available to treat Type 1 diabetes (T1DM) and Type 2 diabetes (T2DM) respectively. They include:

  • Sulfonylureas
  • Biguanides
  • Meglitinides
  • Thiazolidinediones
  • DPP-4 inhibitors
  • SGLT2 Inhibitors
  • Alpha-glucosidase inhibitors
  • Bile Acid Sequestrants

Q: What are the differences between T1DM and T2DM?

T1DM is absolute insulin deficiency caused by an autoimmune response, which attacks the beta cells of the pancreas and represents less than 10% of all cases of diabetes. It generally occurs in children and in the past was called Juvenile diabetes.

T2DM is a relative insulin deficiency and insulin resistance and represents 90% of all people with diabetes. Often 75% of those are overweight or obese, thus the name “diabesity” has been coined representing the obesity and diabetes epidemic in the United States.

Q: Have you wondered what LADA and MODY mean?

LADA stands for Latent Autoimmune Diabetes of the Adult and has been termed “Diabetes 1.5” as it manifests clinically as T1DM but occurs in an adult who requires insulin management.

MODY stands for Mature Onset Diabetes of the Young and manifests clinically as T2DM with overweight or obesity but in children.

Q: Do you know what MDI and CGM are?

MDI is an acronym for Multiple Daily Injections and means a person is receiving several injections of insulin each day. CGM stands for Continuous Glucose Monitoring and is a monitor applied below the skin for generally 7 days to read changing blood glucose levels throughout the day minute by minute instead of just one data point after a finger stick sugar reading.

Q: Did you know that inhaled insulin is now available again?

Afrezza by Sanofi is inhaled fast acting insulin and given generally before meals to help with post prandial (after meal) high blood sugar levels. After nasal insulin was recalled by the FDA for too many respiratory complications several years ago, the new Afrezza offers insulin without injection and hope for many people with diabetes.

Q: Are you aware of current research on the artificial pancreas technology?

The artificial pancreas is the use of technology that combines the continuous subcutaneous insulin infusion (CSII) “insulin pump” and continuous glucose monitor (CGM). They work together to measure blood glucose levels in real time and automatically deliver the required insulin. Several companies are racing to provide the method to truly respond how the natural pancreas works within us and will revolutionize the management of diabetes mellitus.


If diabetes mellitus isn’t a “sweet topic” to you because you’re not up to date, then fear no more! Taking an online course where you learn at your own pace can provide you with a strong foundation for understanding the basics and beyond about diabetes mellitus. Learn more about the new diabetes online course on sale from $220 to $174.99


This blog was brought to life by PESI speaker Tracey Long, PHD (C), RN, BSN, MS, MSN, CDE, CNE, CHUC, CCRN. Long has over 28 years of nursing experience working in critical care & cardiology. She developed Spanish programs in health education and diabetes for local hospitals in Las Vegas, and currently, she is faculty of nursing at the College of Southern Nevada. With a passion for active learning, and as an international speaker and award winning educator, Tracey helps students not just memorize, but truly learn the content material needed to successfully master skills and learning.