Rewire Your Nervous System for Optimal Mental Health

Rewire Your Nervous System for Optimal Mental Health

Unlimited CEUs $59 @ALLCEUS I’d like to welcome everybody to today’s 
presentation on the autonomic nervous system, the biological key to functional health and mental 
health. This is part of the pieces method series and I am your host Dr. Donnisee Snipes. Today 
we’re going to review briefly what the ANS does and why it matters for mental health. We’re not 
going to hit epigenetics nearly as hard today. We’re going to kind of get back to basics, 
if you will. We’re going to explore issues caused or worsened by ANS imbalance. Why? Because 
a lot of people who present in counseling because their ANS is imbalanced, they have co-occurring 
issues that really need to be addressed. And then we will explore functional mental health 
strategies to integrate into your assessment and the treatment plan. So the autonomic nervous 
system our ANS regulates the automatic functions in the body to maintain homeostasis and to adapt 
to changes or alostostasis as they call it. So why do I have autonomic and automatic bolded? 
Because that’s how I remember it. Both of them are auto. So your ANS is responsible for all 
of those things that you don’t think about. The ANS is regulated in part 
by circadian rhythms. Okay,   that was new. I did not realize that. With 
parasympathetic and sympathetic activity fluctuating predictably across the day and night, 
contributing to daily v variations in heart rate, blood pressure and metabolism. Makes sense when 
you think about it. Remember cortisol is high first thing in the morning and that is cortisol 
is secreted by the autonomic nervous system and it lowers throughout the day and so the body can make 
serotonin or convert serotonin to melatonin in the in the evening. That is an ANS function that 
is regulated in part by our circadian rhythms. major branches of the autonomic nervous system. 
Two of these we’ve talked about a lot. Your sympathetic, which is your stress, your fight 
orflight. So, your body has sympathy for the fact that there is a threat to you, and it triggers 
that fight orflight reaction. And I know it’s more than fight or flight. Fight, flee, freeze, 
fawn, or flop. Those are the five Fs in the stress response. But it too much to say all five of those 
every time. The parasympathetic nervous system is your brake pedal and it promotes rest, digest and 
repair. Those are the things that we need. And when we are not rested, when we don’t adequately 
digest our food and when we don’t repair damage that’s been done, guess what? We get inflammation. 
And we know that inflammation triggers epigenetic changes, reduces uh the body’s ability to heal, 
triggers inflammation, and creates a cascade effect. The third one that we really haven’t 
talked about a lot is the entic system, which runs the digestive tract. Think about aspirin. You can 
get intericcoated aspirin. Well, that means it’s aspirin that’s coated so it doesn’t irritate your 
digestive tract at least as much. So the entic system runs the digestive tract and communicates 
with the gut and the brain which contributes to the gut brain connection. And I’ve done a video 
before on the gut brain axis and I’ll be doing one I think in January on it. But our gut brain 
axis is very important and it’s regulated in large part through communication via the vagus nerve. 
Um little side note um they did an experiment on mice, sorry Mr. mice, uh and they found that when 
probiotics were given to intact mice that mood and social behavior was altered when they had a 
proper probiotic or um microbiome balance. when they gave the same um when they gave mice the same 
probiotics but they had cut the vagus nerve there was no change in their behavior. So they disrupted 
that signaling by cutting the vagus nerve. How many of our clients really struggle with veagal 
tone? Really struggle with getting signals to tra traverse that vagus nerve. a lot of them probably 
the autonomic nervous system doesn’t just respond to stress. It helps create our sense of safety or 
danger by controlling selective attention by and by modulating arousal levels and preparing 
the brain to focus on behaviorally relevant stimuli which is a gobbleygook way of saying what 
we’ve said so many times before. When we are in fight or flight, we are paying attention to the 
threats. We are not noticing the bunny rabbits   and the happy things. We are not thinking about 
when we’re feeling stressed, when we’re feeling um overwhelmed. We’re not thinking about all 
the things that are going well in our life.   We’re thinking about this threat that feels like 
it’s looming. Which is one of the reasons that widening our attention to notice the good and 
the bad is so important because it really helps um not only turn our attention away from the 
threat for half a second, but it also helps balance that autonomic nervous system because 
the body is starting to get signals that okay,   some things are okay. Maybe not great, but they’re 
okay. And this crap show over here is just part of life right now. When the parasympathetic nervous 
system is engaged, our rest and digest, the brain can engaged in focused flexible attention and 
social engagement. We talked about this in the past couple of sessions that when our sympathetic 
nervous system fight orflight is engaged, we actually disengage the prefrontal cortex area. 
you know, it’s not time to think, focus, you know, problem solve, do all that kind of stuff. It’s 
time to get the heck out of there or fight to   stay alive. So, it’s important that we help people 
be able to activate their relaxation response, their parasympathetic nervous system, so they can 
get into their wise mind and make mindful choices. The sympathetic nervous system stress heightens 
alertness to immediate dangers, increasing distractability or hypervigilance. If you are 
walking through the forest, you’re on a hike, you’re having a great day, then all of a sudden a 
poisonous snake, a cotton mouth, slithers across in front of you, or worse yet, towards you because 
they’re aggressive little suckers. you you go on high alert for the next period of time, whether 
it’s the whole rest of the hike or the next five minutes, depending on the person, you are probably 
hypervigilant to every sound that sounds like another snake rustling in the leaves off the side 
of the path. And it’s important to recognize that people who have a trauma history who have never 
resolved whatever it h whatever happened in a way that they felt safe and empowered again. They are 
always listening for those rustling leaves. It’s hard for them to focus. It’s hard for them to 
relax because they don’t feel safe. That’s like telling a soldier in a foxhole, “Hey, just chill 
out for a while.” it ain’t going to happen. They can to tone it down a little bit, but they’re 
never going to be able to truly relax because   in the back of their mind, they feel or know 
depending on the situation that they’re not safe. Physiological processes regulated by the 
autonomic nervous system. Again, these are all the things we don’t think about. our heart rate, our 
breathing, our digestion, our immune responses, and our energy use and availability. So, let’s 
go through each of those. Our heart rate. Now, so many times we’ve talked about square breathing 
or um whatever you want to call it, slowing our breathing to slow our heart rate. And yes, we 
can do that. But if we’re not thinking about, okay, heart beat, beat, beat, we don’t have 
to think about it to get our heart to beat, like we have to think about bending our arm 
to drink or something. It’s like, I want this   drink. I’m going to do it. Heart rate is one of 
those things. Breathing is another. When we start to get stressed, we tend to breathe faster and 
often more shallowly. When we are more relaxed, we’re breathing more slowly and more deeply. When 
we are breathing more slowly and more deeply, that sends the signal to the brain that, hey, 
maybe there’s not a stressor. Um, digestion, we don’t think about it. That’s just not one 
of those things. But when we’re under stress, our microbiome changes and our digestion changes. 
Our immune responses including in inflammation are regulated by the autonomic nervous system and 
then energy use. Your brain doesn’t say okay you know I’m going to allocate I’m going to tell 
you how to use your energy right now. But we all know it when we are under a lot of stress or when 
we’re recovering from an illness we get tired more easily. Why? Because the brain is redirecting 
energy to repairing. It’s like screw you. I’ve got to take care of this. So, you’re not going 
to have energy to go to the gym or clean the   house or whatever it is you want or don’t want to 
do. So, the brain will automatically reallocate energy as it sees necessary in order to protect 
the organism. Which takes us down to homeostasis. And this is the state we want to be in. that 
constant state of balance, not too stressed, not too relaxed, just right. We want to be balanced 
when we are stressed because every once in a while it happens. That’s okay. But we want to be able 
to bring it back into balance when when necessary. Just like in anything we do, we have times 
where more energy is required, but then we have times when we rest and recover from that energy 
expenditure. Allasis is the process of changing and adapting to stress. Any kind of stress in any 
piece of life, physical, interpersonal, emotional, cognitive or environmental. When something is 
causing stress on the body, including thoughts and feelings, the body adapts. That’s why we have 
the ANS and the PNS. Um, chronic overactivation of the autonomic nervous system, particularly the 
sympathetic nervous system, leads to allic load or wear and tear on the body and mind. Um, and why 
I said ANS in this, think about it. When if you go out and you do sprints, it takes a whole lot of 
energy. You sprint and then you rest and then you sprint and then you rest. It’s still exhausting. 
It takes a lot of energy. or if you’re driving, maybe this is a better example, we use a 
whole lot more gas when we are stop and start, when you’re driving in the city, when there’s 
stop lights and stuff than we do if we’re consistently going. But if the parasympathetic 
nervous system is activated for too long that also take causes wear and tear on the system and 
that sympathetic nervous system becomes dominant in terms of the gut brain connection and we’re 
not going to go down a deep rabbit hole on this   today but understanding that stress directly 
alters the composition of the microbiome. gut microbes and and a lot of people say, “How 
does the gut communicate with the brain through   the vagus nerve?” Well, uh, that still doesn’t 
answer my question. We’re going to answer that question now. Gut microbes produce chemicals, 
you know, so all those little microbes are producing byproducts. They’re the bacteria 
are gobbling up what you eat and, you know, producing byproducts that trigger signals 
that travel up the vagus nerve to the brain. So kind of like the telephone um the chemical 
signals are being sent trigger the the vagus nerve to send a message to the brain. So that’s how it 
communicates. Interestingly it doesn’t work both ways. The vagus nerve doesn’t communicate 
from the brain to the gut. Under stress, hormones like cortisol bind to the receptors on 
the gut cells, changing the environment in which the microbes live, reducing microbial diversity. 
This is bad. Certain microbes have been associated with pro-social behavior. Certain microbes have 
been associated with mood changes and emotional dysregulation. So when we start developing either 
an unhealthy microbial um colony or a lack of microbial diversity which is usually dominated 
by the problematic microbes then we start seeing a lot of symptoms. So under stress the brain re 
triggers the sympathetic nervous system red ah wow releases cortisol and that cortisol binds to the 
gut receptor. So it’s bypassing the vagus nerve and it’s just going directly to the gut. When we 
see changes stress induced changes in the gut we see a reduction in beneficial bacteria such as 
lactobacillus and bytoacterium. These are a group of bacteria. There are thousands of them and each 
of them are listed by like buffto bacterium. Then it has another name and then it has a number. 
So you have you know different strains of these bacteria and they are there’s thousands of them 
but we see a reduction in those because they have difficulty living in the environment which often 
becomes more acidic when we’re stressed. Likewise, we see the proliferation of other bacteria which 
you can recognize as bugaboos. Um, streptoccus, ecoli, salmonila, and h pylori. I think most 
people can look at those and go, “Yeah, I don’t want those flourishing in my gut.” We need some of 
them. Okay, we do need a certain amount of each of these things because they actually do help make 
neurotransmitters, but when they become dominant, then we start having a lot more problems and they 
will start attacking killing um the lactobacillus, the the phytoacterium, the environment becomes 
inhospitable for the positive gut bacteria. One of the things that we can encourage our people 
to do and this is why I talk about prebiotic and probiotic foods all the time because when we eat 
those our our uh probiotic foods like yogurt and sauerkraut uh keier are very rich in lactobacillus 
and bytoacterium strains and that can help give sort of a um extra dose of those microbes to 
the gut and yeah a lot of them don’t survive especially if the gut is inhospitable but some of 
them will so increasing that a little bit you can overdo it you actually can eat too much yogurt 
and drink too much kefir and then you end up with other digestive issues uh but that is one 
of the things that we want to inc en encourage people to do especially under stress stress. Your 
prebiotics are your fiber richch foods that when they are digested feed those bacteria. That’s 
food for the bacteria and we want to help them uh or provide that in order to help 
create a hospitable environment. So the vagus nerve is in an environment that 
it is getting the chemical signals it can send up to the brain that says all clear 
here. We’ve got a good balance. Everybody   that we need for work is reporting to work. 
It’s all clear down here in this station. In terms of the connection between anxiety and 
depression, we’ve gone over this before, but for people who haven’t seen the other 17 videos, 
chronic stress causes glucocorticoid resistance, which means chronic stress means that our uh 
receptors for cortisol become less receptive. This causes high cortisol in the bloodstream because 
it’s not attaching to the receptors. it’s just floating around going hm nobody’s paying attention 
to me. High cortisol damages the preffrontal cortex and the hippocampus which regulate emotion 
modulation. So people who have chronic high stress and that’s anxiety is kind of general. It can be 
from PTSD. It can be from chronic um environmental stress. It can be from true anxiety. whatever 
is causing that uh sympathetic nervous system to stay active, they often have high cortisol levels 
which are damaging parts of the brain that help them regulate um and modulate their emotions. 
So, we see a lot more emotional dysregulation. High cortisol also triggers inflammatory 
responses that contribute to depressive   symptoms by interfering with neurotransmitter 
systems like dopamine, glutamate, and GABA. Glutamate is our main stress neurochemical 
and GABA is our main relaxation neurochemical. And if that system gets messed up, then a lot of 
times we have people that have low motivation and no energy because there’s just there’s not enough 
glutamate and there’s not enough GABA and they feel stressed out all the time. These disruptions 
lead to emot emotional dysregulation and what we’ve referred to in in my classes as the flat to 
the furious or the flat to the frantic. They just don’t feel much of anything until there’s enough 
of a stressor that triggers enough of a cortisol release to actually wake up those cortisol 
receptors and then oh my, it’s a tsunami. I mentioned at the beginning that a lot of 
the people who present for counseling have an imbalanced autonomic nervous system. If they 
present with depression, it could be unipolar, straight up depression. I have found in my 
practice over about 25 years that probably about 70% of the people that present with depressive 
symptoms have co-occurring or longstanding anxiety. So, they’ve gotten to this place where 
at when we talk about the stress response, fight, flee, freeze, fawn, or flop, they’re at flop. And 
they’re feeling exhausted. They don’t have the motivation. They don’t have the energy. And they 
also often have other issues that are being caused as a result of the cortisol resistance and the 
high stress. healing requires healing the whole person. If for example they developed insulin 
resistance as a result of chronic stress then that means that their their blood sugar is difficult 
to manage which means there’s another stressor on the body. And for that person to truly heal and be 
able to effectively manage their autonomic nervous system, that’s one of those stressors we want to 
look at because that’s one of those we may not be   able to fix it, but they may be able to work with 
their doctor to manage it better so there’s less stress on the body. when I was asked to start 
working on a suicide prevention program for um fire rescue and one of the things that we talk 
about is the fact that in fire rescue circadian rhythms not going to happen and when you’re 
off on their days off they can maintain their circadian rhythms but when they’re working their 
12 or 24hour shift depending on the state there are many many nights if not every night, they’re 
not going to sleep through the night. So, there is no way to regulate circadian rhythms as well as we 
would like. We have to mitigate it. We have to try to figure out what is the best we can do. The best 
we can do is maintain a consistent schedule on the days off and on the days they are working. Try to 
maintain that same schedule to the greatest extent possible. But recognize that you’re going to get 
call outs. That’s one of the stressors, one of their vulnerabilities for distress that we can’t 
completely eliminate and it’s part of the job. So accepting that is part of the treatment plan 
and and recognizing, okay, we can’t completely fix this. What other stressors might we be able to 
minimize or mitigate in order to bring the stress overall stress level on the body in every piece 
of life for that person bring it down? We’re not going to eliminate it, but what can we do to bring 
it down so it’s more manageable? We that was the long version of we need to screen people for some 
of these co-occurring issues and if they might have them make sure that they we are working in a 
multid-disciplinary team with their doctor andor their physical therapist. So diabetes and insulin 
resistance chronic sympathetic nervous system activation increases cortisol disrupting insulin 
and glucose metabolism. These stress hormones alter dopamine and serotonin signaling, worsening 
mood and motivation. So that stress that’s caused by the blood sugar disruption contributes to 
increased sympathetic nervous system activation and worsening of mood. We’ve all been in a place 
before where our blood sugar’s gotten too low. Not everybody’s had blood sugar too high, but when 
our blood sugar’s gotten too low and we’ve gotten freaking hangry, you know, our mood changes when 
our blood sugar is out of whack, even for a little bit. So for people who have difficulty regulating 
their blood sugar, think about how much stress their body is under. PCOS, polycystic ovarian 
syndrome for women. Elevated sympathetic nervous system activation increases testosterone and 
lowers estrogen in most areas of the body. Um, and impacts dopamine, serotonin, and other pathways 
regulating mood, impulse control, and contributing to anxiety and depression. Um, I’ve done several 
other videos and I’m going to be doing one on the hypothalamic pituitary gonatal axis in the next 
couple of weeks. And we’re going to talk about how stress alters our gonatal hormones and how 
altered gonatal hormones actually will affect the availability um of neurotransmitters which will 
directly impact our mood. This is not just because of emotional stress. It can be we see it in people 
who have eating disorders because of physical stress from malnutrition. We see it in people 
who are um alcoholic. We see it in people who um start taking and not necessarily PCOS, but 
we do see disruptions in neurotransmitters and alterations in mood in people who start taking 
uh hormonal birth control because all of a sudden what the body recognizes as homeostasis 
has been turned upside down on its head. Many many many people with stress, chronic stress, 
with depression also have hypothyroidism. An imbalance in the autonomic nervous system, 
sympathetic dominance reduces hormone, thyroid hormone release. The body says, “Okay, 
there’s a lot of stress and we need to conserve   energy.” I know it seems counterintuitive, but 
that’s what the body does. This in turn affects serotonin and dopamine metabolism. Remember 
your gonatal hormones, your thyroid hormones and your neurotransmitters all work in concert 
with one another. So when one gets out of whack, the whole system goes completely. This can cause 
fatigue and depressive symptoms. Additionally, as we get uh stressed, the not only do we have 
a reduction in thyroid hormone release, we have an increase in reverse T3. That’s the enzyme that 
breaks down T3. So, our body is breaking down the thyroid hormone that’s supposed to give us energy 
before our body can actually use it. And that’s again part of that conservation um mechanism if 
you will energy conservation mechanism. But it’s really frustrating because a lot of people and I’m 
one who has excessively high RT3 um when we have a lot of stress that RT3 stays up and it just breaks 
down the the T the free T3 as quickly as almost as quickly as it’s made. So, we need to figure out 
what’s causing the high RT3 and what can we do to reduce it. In many cases, it’s reducing stress. 
Easier said than done, but that is again reducing stress in any area of life. If cognitively you’ve 
got a bunch of crap hitting the fan right now, okay, well, what can we do in other areas of 
life to take some of the stress off the body? Chronic fatigue syndrome is also caused and 
or worsened by chronic stimulation of the stress response. Overactivity of the stress 
response depletes norepinephrine and dopamine reserves in brain areas controlling energy 
and motivation promoting fatigue and cognitive dysfunction. When norepinephrine is our focus 
neurochemical. It’s our attention neurochemical. When that gets depleted, guess what? We’re 
gonna have a hard time focusing. Dopamine is our motivation chemical. It’s the I want to do 
that again chemical. When we don’t have that,   guess what? Not only can we not focus, but we 
don’t want to focus. We have no motivation. It also adds to um fatigue and hence chronic fatigue 
syndrome. Remember I said the autonomic nervous system controls our energy utilization. And in 
people with um CFS, a lot of times they’ve got a lot of systemic inflammation. And as stress goes 
up, inflammation goes up. What’s the body going to do? It’s going to direct a lot of energy 
to try to figure out how to deal with that   inflammation. So you don’t have as much energy 
to like get out of bed. Cardiovascular issues can also be caused by an imbalance in the autonomic 
nervous system. And I will say that as we age, we see a lot more people uh we see people develop 
a lot more cardiovascular issues. As we age, we also see naturally because of the reduction 
of testosterone and estrogen as well as other physiological changes that represent stress on the 
body, most older adults are sympathetic dominant. And most older adults benefit from, even the 
ones that don’t have mood symptoms, most older adults benefit from activities that can help 
balance their autonomic uh their sympathetic and parasympathetic nervous system. It’ll help reduce 
inflammation. It slows the progression of a lot of diseases. Um, and it also, they’ve shown, can help 
with uh helping to clear brain fog. But I digress. When sustained uh increased stress and increased 
vasoc constriction caused by stress triggers the release of inflammatory cytoines leading to 
changes in neurotransmitters like serotonin and dopamine that regulate mood and thinking. 
So the common thread here, stress one way or another alters our neurotransmitters and we 
need to take a look at that that sympathetic nervous system when it’s engaged then it alters 
the availability of of um our neurotransmitters. Sleep apnea is another one that a lot of people 
have irrespective of weight. um trauma history and chronic stress are super strong indicators 
or correl things that are strongly correlated with sleep apnea. They believe that chronic stress 
keeps airway muscles tight increasing apnea risk. Apnea related oxygen drops throughout the night 
cause more stress and sleep fragmentation which causes even more stress and more inflammation. 
If they snore, have them have it. Encourage them to have it evaluated. And finally, bxism, 
tooth grinding. How many of you out there wear um I call it a bite plate. I think my my dentist 
calls it a splint, but I wear a splint at night because I grind my teeth like nobody’s business. 
Chronic stress disrupts dopamine pathways that control motor activity and amydala fear processing 
function causing increased jaw muscle clenching, jaw muscle tone and anxiety related muscle 
activity. So people when they’re stressed often will clench their teeth or grind their 
teeth a lot more. If they are going to sleep and not downregulating, they’re stressed when they’re 
sleeping. Guess what? they’re going to be grinding pain. A lot of people that we work with 
have chronic pain and you’re like, “Okay, well that causes stress.” Yes, it does. Uh but 
pain itself actually sensitizes or stress itself actually sensitizes pain pathways in the brain 
and serotonin deficits increase pain sensitivity which can worsen pain perception. So, not only do 
our pain pathways become more sensitive, more raw, if you will, but the reduction in serotonin makes 
us more sensit more aware of the rawness. So, it’s a double whammy when we’re under stress, 
when we’ve got a lot of glutamate coursing through our system over a long period of time. 
Helping people with chronic pain understand the connection between stress and increased pain 
perception can also be helpful. It we’re not saying it’s in your head. We’re not saying you’re 
imagining it or you’re just overreacting. That’s   not what we’re saying. We’re saying you actually 
are feeling more pain and you’re actually more aware of that pain when you’re under stress. which 
is why it’s important to engage in some of these stress reduction activities to lower glutamate 
which takes off which helps um desensitize some of those pain receptors. Think about it, you know, 
if you’ve ever rubbed your arm for a long enough time or you’ve had a little kid just sit there 
and mommy mommy mommy eventually it starts to   get a little irritated, you know, and that’s the 
glutamate. That’s the stress that’s being added. When we reduce our stress, either slowing 
down or eliminating the agitator completely, then those nerve endings, those pain pathways 
aren’t being stimulated and they get a chance to kind of breathe and become less sensitive. 
If you come back two seconds later, it’s still tender. It’s still sensitized. So, it’s going 
to become irritated more quickly. If you give it a complete chance to re um recover, then when 
you come back and if you start doing it again, it will take a while. I’m not sure if you followed 
that metaphor. In terms of the gut microbiome, the sympathetic nervous system or stress 
increases gut permeability. We’ve talked about leaky gut so many times. Leaky gut allows 
bacteria to leak into the system and trigger systemic inflammation. Stress triggered secretion 
of neurotransmitters also affect that microbial composition which produce neurotransmitters. So 
the microbes in your gut produce GABA, serotonin, dopamine and acetylcholine. If those microbes 
don’t report for work because it’s an inhospitable work environment, then your body is not going to 
be able to produce the neurotransmitters that you need, which influences systemic levels of these 
neurotransmitters contributing to cognitive, mood, and GI symptoms. Remember, neurotransmitters have 
receptors throughout the entire body, not just in the brain. So when your for example serotonin 
gets out of whack, you’re going to start seeing um changes in heart rhythm. You’re going to 
start seeing uh changes in pain perception. You’re going to start seeing a lot of uh somatic 
symptoms in addition to cognitive and emotional downstream impacts. Elevated norepinephrine and 
reduced GABA and serotonin due to stress amplify fear responses and hyperarousal. So when people 
are chronically stressed, you know, we’ve talked about stress being a bucket. Um, and when that 
bucket is constantly full, it doesn’t take much to get the bucket to start to overflow. And that’s 
where you see anger or anxiety start to come out. We want to help people reduce the level the the 
level of their bucket. It’s probably never going to be completely empty, but we want to reduce 
the level so every little tablespoon of water doesn’t cause it to overflow. In depression, we 
see elevated cortisol increasing the expression of serotonin transporters leading to increased 
re-uptake and reduced availability of serotonin. So cortisol actually reduces serotonin and you 
know that’s important to remember. We see the same thing at night. When cortisol stays high 
at night serotonin isn’t made available to be broken down to converted to melatonin. So seroton 
serotonin and cortisol are are kind of enemies. Cortisol releases uh increased monoamine oxidase 
or MAO activity which breaks down serotonin and dopamine further decreasing their levels. 
The oldfashioned anti-depressants were MAOIs, MAO inhibitors. The whole goal was to prevent 
serotonin and dopamine from being broken down as quickly. Cortisol acts to increase the break 
increase these uh MAO and the breakdown of serotonin and dopamine. So we have less and less 
available to even activate the receptors. Chronic stress and cortisol also reduce brain derived 
neutrophic factor BDNF. We’ve talked about this a lot before in terms of neurogenesis. Our brain 
can heal. Our brain can regenerate those neurons that are lost as a result of chronic stress. 
However, we have to have BDNF and when chronic stress and cortisol are just constantly there, 
BDNF is low. So, we don’t have an environment that supports neurogenesis. We don’t have 
an environment that supports brain healing. What do we do? This is this is the part you’ve 
been waiting for. Addressing mood symptoms with interpersonal like humanistic or cognitive 
behavioral therapy alone is like trying to fix a car by only changing the oil. You know, you 
got to look at the fluids. You got to look at the air pressure and the tires. You’ve got to look 
at other stuff, I’m sure. Um, but fan belts and alternators and I know there’s a lot of words I 
can throw out. Another metaphor, it’s like relying on the quarterback to carry the whole team to a 
winning season. Now, I know sometimes it happens. You know, at UF, we had Danny Worful for a while 
and um you know, he was a great quarterback, but he relied on his line. He relied on his receivers 
um in order to create a winning season. He couldn’t go out there and just do it by himself. 
It was a team effort. Our body is like I’ve always said, it’s like a factory and getting the factory 
to run well is a team effort. People who engage in counseling or exhibit mood or behavioral symptoms 
often have multiple other issues contributing to their distress, physical issues caused by or 
causing their distress, interpersonal, emotional, cognitive, and environmental. An empowering 
holistic multiddisciplinary approach will produce the most effective and efficient treatment if you 
identify okay here are all the places where there you’re experiencing stress in each piece of your 
life. Now we can’t tackle all of them at once. You know that that’s foolhardy but what are you most 
motivated to work on? What are you willing to do? And what areas can we start addressing to turn 
down some of the stress if you want to think of it like a knob or to empty out some of the stress 
if you’re talking about the bucket. In terms of comprehensive assessment and education when 
we do our assessment and throughout treatment we want to focus on a few areas. What is going 
well and what is not? We want to help them look at that big picture because that helps provide 
more balance to what’s going on. I don’t want to negate what’s not going well because that’s why 
they’re probably in my office, but I also want to make sure that they’re not completely missing the 
other parts. Which symptoms are most bothersome? These are the ones they’re going to be most 
motivated to work on. And it’s kind of like a   a woven blanket. distress any place you start 
unraveling that blanket eventually the whole thing is going to unravel. So you can start at any 
point. So tell me which symptom is most bothersome and what are you most motivated to change or to do 
to address that symptom. Additionally, instead of just telling people what to do, and I can’t tell 
you literally I don’t have the numbers. It’s an astronomical percentage. The the percentage 
of therapists that I’ve worked with that do an assessment for somebody, then they write a 
treatment plan and they tell the person what to do   without even asking some of these questions. And 
it’s just mind-boggling. We want to ask them what what they’ve tried because they have been trying 
things trying not to have to come to counseling most likely. Uh they’ve been trying things to 
feel better and it hasn’t worked. So tell me   what you’ve tried and what hasn’t worked for you, 
but also tell me what has worked for you even if just for 10 minutes or a day or a short period. 
That can help us figure out what types of tools will work better. It also again helps them look 
at the big picture. Yes, I’ve tried a bunch of things that have failed. They haven’t done the job 
and you know I felt powerless. I felt hopeless. But but there were some things that I tried that 
did work a little bit. There’s some hope there. If it worked for a little bit, we can tweak those 
things usually and help them work a lot of bit. What is different in your life when the symptoms 
or the symptom is decreased? And that’s another one of those solutionfocused questions that we 
often don’t ask. Tell me what’s different when you’re not having this problem and then let’s 
see how we can recreate that. Let’s let’s look at what’s what might be going on now that’s 
causing the problem that wasn’t going on then. And for each symptom you have I define at least 
five progress points. So I have we’ll say I I I’m coming to you because I’m feeling depressed. Okay. 
Now, depression, that’s that feeling of anhidonia, um the blues, however you’re defining it. That’s 
where you are right now. That is a zero. You want to get to a five. So, what is one thing you think 
you might be able to do over the next week or so to move you half a step forward? So, from a a zero 
to a 0.5 and then to a to a one or what is one thing you think you might be able to do over the 
next week that can help you move to a one and then talk about that. See if one week is realistic. 
It usually isn’t. And say, “Okay, let’s let’s do half of that. Let’s set a realistic goal that we 
know you can achieve um over the next week. What’s one thing you can do?” Those progress points are 
really important because we need to as humans, we need to be able to notice progress. Just like 
when you’re on a diet, you may not realize that you’re losing weight because it comes off kind of 
slowly. So, you don’t notice the quarter pound or half pound that you lost, which is why you weigh 
once once a week when you’re on a diet to see how much progress you’ve made. and that helps keep 
motivation up when you see your progress. Same thing with cognitive and behavioral changes 
in terms of the comprehensive assessment and education. And I’m not going into the education 
a lot here, but it’s important to provide the people that you’re working with a why. Why am I 
suggesting this? Not only it’s important that you do this, but why? So they have a reason, not just 
because my therapist said so. So physically we’ll look at diet, nutrition if they are presenting 
for example with um especially with depression but also with anxiety. uh blood test suggestions 
looking for anemia B12 which is now I read a study this morning they’re encouraging doctors 
to quit testing for B12 and instead test for homocyine levels because it’s a more accurate 
measure of what’s going on. So I there will be another video on that. But it’s important for the 
doctors to be able to assess people’s iron levels, their anemia levels, their uh vitamin D. When 
it comes to thyroid, TSH, free T3 and T4, and reverse T3, because reverse T3, remember, you can 
have perfectly normal levels of T3 and T4. But if your RT3 is way up here, then that t your free T3 
is getting broken down before it can actually do its job. A1C levels, your basically your ability 
to manage your insulin. Um, and insulin resistance and C reactive protein, that is an inflammatory 
marker. Um all of these uh your people’s insulin resistance their insulin sensitivity should 
improve as stress comes down their C reactive protein their systemic inflammation should improve 
as their stress comes down as there’s less stress as there’s less stuff triggering inflammation we 
should start seeing these changes they may also uh look at genetic testing for MTHFR are 
mutations. That’s one of those genes. Again, read another article by um from the Cleveland 
Clinic this morning. This morning was a great morning. Um that indicated that it’s less 
important to test for the MTHFR genetic mutation and more important to look for the symptoms. If 
you have the mutation, but your homoyines are in the right area, then you’re probably fine. Um, 
so you can have the mutation and have no symptoms and be fine and it’s not a big deal. So you’ve 
wasted 300 bucks getting the genetic test. Um, if your homocyine levels are elevated, then there 
are two or three things that could be indicated, but B12 um, deficiency is one of them. So that 
will guide your doctor’s treatment plan. So I thought that was really interesting. We want to 
have them do a sleep assessment. Now, I don’t mean going to the doctor. I mean just doing a 
worksheet that evaluates their sleep hygiene and trying to improve any problems they’re having 
with their getting to sleep, staying asleep, quality sleep. We want to help them reset their 
circadian rhythms. This is probably one of the best things you can do for somebody because 
that circadian clock when it gets out of whack, everybody’s reporting to work in the different 
body departments at the wrong time. Identify if they’ve got chronic pain. Develop strategies 
to address that because chronic pain increases stress, increases depression, increases 
anxiety, increases emotional dysregulation. address substance abuse and addictive behaviors. 
We’re g we’re doing an entire video on um addiction in the ANS next week or the week 
after because it is even behavioral addictions are so hard on the body and so stressful to the 
body. And have them take a look at medications, maybe medications they started taking and then 
started having symptoms. We’re not telling them to decrease them. We’re not telling them 
anything. We’re telling them if you started taking   this medication and you then you started having 
symptoms the next day or the next week, talk to your doctor. Anything that is outside of our lane, 
refer them back to their doctor. Interpersonally, we want to talk with them about their sense of 
self-esteem and self-efficacy, their attachment issues, help them heal their attachment style, if 
you will, um so they can start developing a secure attachment with self and a secure attachment with 
others. Now, obviously, we’re not doing all these things in a week or a month or necessarily even 
10 weeks. This is a progressive thing. um some of which they can work on on their own, but we want 
to figure out where the areas of stress are and then have them tell us what they’re willing to 
work on. What’s most important, what are the top three things they want to address first and then 
we can go from there. We want to evaluate trauma, especially as it relates to their ongoing sense 
of unsafess and powerlessness. Evaluate their communication skills. How effective are they 
at identifying and articulating their needs in a way that other people hear without becoming 
defensive? How effective are they at identifying, setting, and maintaining their boundaries? This 
is a huge one for a lot of people because they e their boundaries partly is because of attachment 
issues are either too rigid or too weak. Um which makes them feel unsafe. They either feel rejected 
when it’s too rigid or they feel um invaded when their boundaries are too weak. Emotionally start 
out simple emotion identification and labeling. What does this feeling look like to you? What does 
it feel like to you? Practice this week noticing and labeling when you feel angry. And that’s 
it. We’re not doing anything further. I just want you to start becoming more mindful of when 
you feel angry, when you feel happy, when you feel curious. Have them start identifying after 
they’re comfortable recognizing their emotions. start to look backwards and say what was the 
trigger for that emotion and what can I do about it and then move on to modulation and 
addressing dysregulation. Now you know what the feeling is you’re having. You know possibly 
what triggered it. Now what strategies are you going to take to downregulate and modulate 
that feeling so it doesn’t overwhelm you? Cognitively, have them look at distortions. 
A somewhat new pneummonic. I’ve used it a few times before. Feel. Have them look at the facts 
in this context at this time. What are the facts supporting their belief or their feeling? What 
are explanations? What are alternate explanations for what’s going on besides personalization 
or all or nothing thinking? exceptions. Are there any exceptions? Most things don’t happen 
all the time or never. So, what exceptions are there? And L stands for likelihood. What is 
the probability that this is actually going to happen? Is it possible that the sky could 
fall? Maybe. What is the probability that it’s going to happen especially in the next six months? 
Okay. So feel facts, explanations, exceptions, and likelihood. Evaluate their learning and memory. 
Are they having difficulty with these things? And a lot of that will improve as stress abades. 
But right now, if they’re struggling, help them develop tools to support themselves so that it’s 
not causing them extra stress. When they’re trying to learn something, what can they do to make 
it easier? taking notes, removing distractions, chunking it if they have difficulty focusing 
for long periods of time. Um, there are lots of different little hacks that they may be able 
to do so they don’t feel so frustrated every time they’ve got to try to learn something. Problem 
solving. If they’re stuck in a box and they can’t think of what to do next, okay, again, a lot of 
that will probably clear up as stress abates. So encourage them to identify supports for now. When 
you’re trying to solve a problem and you’re stuck, what can you do? Can you call a friend? Can you 
look it up online? What can you do to figure out what other people have done in similar situations? 
And brain fog is another one that’ll likely clear up for a lot of people as stress abates. But while 
you’ve got brain fog, it can be exasperating. taking notes. That’s the biggest thing I tell 
people. And being patient with themselves when you’ve got brain fog, it takes longer to find the 
words, to find the answer, to find the response that you want. Okay? So, instead of getting upset 
about it, accept it and say, “All right, this is where I’m at right now. I’m kind of navigating 
peace soup fog, just like you do when you’re   driving. You’re not driving at the speed limit. 
Hopefully, you’re slowing down so you can be safe. environmentally. Encourage them to evaluate 
positive triggers in the environment and add more of those and identify distress triggers in 
the environment and do what they can to either eliminate them or buffer against them. Um, I’ve 
shared with you before that Christmas trees were a huge trigger for my um stepfather. Now, he 
couldn’t get people to never put up a Christmas tree. What he did do was he avoided going to uh 
the the stores and stuff where there were a lot of Christmas trees and Christmy decorations and 
things. Um so he didn’t feel as triggered. Um he kept his house where there wasn’t a Christmas 
tree. Safety and stability. This means do you feel safe in your home and do you have a stable 
roof over your head? If you don’t, that’s the bottom of Maslo’s hierarchy. If your housing, 
food, and medical care are not taken care of, yeah, you’re going to be freaking stressed. So, 
we need to figure out how to address that. And   then address toxins and pollution as much 
as possible. Um, filtered water, good air, you know, have people define their rich and 
meaningful life. These are initial tools that they can potentially pluck from that helps them 
ask themselves before they do anything or when they’re having a moment and they’re angry, they 
can ask themselves, is staying angry about this or is making this choice helping me use my 
energy to move toward my rich and meaningful life or is it moving me away or using energy that 
moves me away from my rich and meaningful life? encourage them to do uh mindfulness morning 
and evening reflection. In the morning, how am I feeling? What are my needs? What are my goals 
for today? Kind of envisioning, walking through   the day. In the evening, how am I feeling? What 
am I needing? How did I how well did I do today? What did I succeed at? What did I not get done or 
not do so well? What can I learn from it? Okay, end of story. you know, you’re looking at what 
went well as well as what you can learn. Have them identify stressors that can be eliminated or 
mitigated. So, going back over that assessment, they can pick out things that can be tweaked a 
little bit. help them develop down regggulation skills uh in order to slow their heart rate 
whether it’s um blowing bubbles or square breathing or um going out on a walk, whatever 
it is that helps them. Encourage them to start practicing 20 minutes of positivity a day. That’s 
20 minutes of focusing on what went right. Not be not this weirdopium out there that maybe this will 
happen. know what actually factually did go right today. Begin completing cognitive distortion 
worksheets using that feelmonic to help them identify and restructure core beliefs contributing 
to their distress. Have them explore self-talk triggers where what the origins of that script is 
and the accuracy. Do they actually believe what they are telling themsel or is it something 
that their fourth grade teacher told them   and they’ve just held on to it for 20 years? 
And try using hardiness, commitment, control, and challenge. Looking at that rich and meaningful 
life, let me examine all of the things that I’m committed to in my rich and meaningful life. 
of the things that are going well. You know, what parts of those can I control? Of the things 
that are not going well, what parts of those can I control? And for the things, how can I view 
it as a challenge to use my energy to focus on the things that I can control, to nurture what’s 
going well, and to improve what’s not going well. The autonomic nervous system responds to promote 
survival of the organism. Anything a miss in any piece of life will trigger alostasis or 
adjustment. Emotional distress adds stress to every piece of our life. And rebalancing the 
autonomic nervous system requires more than meditation and breathing. It requires modulating 
each of the stressors in the person’s life. Are there any questions? Oh my gosh, Todd. It’s not something I came up 
with. It’s um something that’s evidently a a common saying in the in the crypto verse, crypto 
circles. And it’s one of those that irritates me now because I’m just like, I don’t want to hear 
aboutopium. I want to hear about facts. But um I agree, Robbie. Most doctors are not taught 
a lot about healthy nutrition. There’s a lot of research that’s coming out now that is 
showing that most people that live to be over a hundred actually have high cholesterol. 
Um their healthy cholesterol is really high, their unhealthy cholesterol is low. So, it’s all 
about that ratio. To somewhat oversimplify it, they’ve also shown that having 
higher healthy cholesterol   um actually buffers against cognitive decline in 
older adults. So, you know, that’s a lot of really interesting new research about cholesterol 
has been coming out over the past two years. Jesse, I’m glad you appreciate the thoroughess. 
I know some people after an hour, they’re well, after about 20 minutes, they’re like, “Oh, I 
can’t take anymore.” But I am sort of the deep   dive person. The beautiful thing about YouTube 
is people can pause it and go back and listen and even download the transcript if they don’t 
want to listen to me ramble. Um, so I’m glad you appreciate it. Um, I’m glad I love doing the deep 
dive. I like knowing the wise and the hows. So, okay, everybody have an amazing rest of 
your day and I will see you on Monday if you come to the AMA or next Wednesday 
for the next live CEU presentation.

The Autonomic Nervous System Functional Medicine and Optimal Mental Health
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Doc Snipes is a Licensed Professional Counselor and Qualified Clinical Supervisor focusing on providing evidence-based, strengths-based, trauma-informed cognitive behavioral therapy that helps people address the underlying causes of thier distress.
She discusses neurobiology, holistic approaches to mental health recovery, the impact of trauma on all PIECES of life: Physical Interpersonal, Emotional, Cognitive, Environmental, Spiritual. She received her PhD in Mental Health Counseling from the University of Florida in 2002. In addition to being a practicing clinician, she has been nationally and internationally accredited to provide certification and continuing education (CEU) training to counselors, social workers, nurses and case managers internationally since 2006 through AllCEUs.com

NOTE: ALL VIDEOS are for educational purposes only and are NOT a replacement for medical advice or counseling from a licensed professional.

Video by Dr. Dawn Elise Snipes on integrative behavioral health approaches including counseling techniques and skills for improving mental health and reducing mental illness.

AllCEUs.com provides multimedia counselor education and CEUs for LPCs, LMHCs, LMFTs and LCSWs as well as addiction counselor precertification training and continuing education on many of the videos on this channel. Unlike other providers like CE4Less, AllCEUs includes a weekly LIVE Stream Webinar with your unlimited continuing education and professional development membership.