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Category Archives: Mental Health

Holiday CE Sale!

Holiday CE Sale @pdresources.org

With only 10 days left in 2017, now is a great time to catch up on any remaining CE you still need, or stock up for 2018. Earn CE wherever YOU love to be and SAVE 20-30% on courses now @ PDR:

 

Holiday CE Sale

Your holiday savings will automatically apply at checkout based on order total, after coupons (yes, you can ALSO use a coupon! :).

20% Off orders $1 to $49

25% Off orders $50 to $99

30% Off orders $100 or more!

Courses must be purchased together (separate orders cannot be combined to receive a greater discount). Offer valid on future orders only. Hurry, sale ends Tuesday, December 26, 2017Shop now!

 APA-Approved Online CE for Psychologists
ASHA-Approved Online CEUs for SLPs

NBCC-Approved CE for Counselors & MFTs

AOTA-Approved Online CEUs for OTs

ASWB-Approved Online CE for Social Workers

CDR-Approved Online CEUs for Dietitians

APA-Sponsored Online CE for School Psychologists


Professional Development Resources is a nonprofit educational corporation 501(c)(3) organized in 1992. We are approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners; and are CE Broker compliant (all courses are reported within a few days of completion).

Target Audience: PsychologistsCounselorsSocial WorkersMarriage & Family Therapist (MFTs)Speech-Language Pathologists (SLPs)Occupational Therapists (OTs)Registered Dietitian Nutritionists (RDNs)School Psychologists, and Teachers

Earn CE Wherever YOU Love to Be!

 
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Posted by on December 21, 2017 in Mental Health

 

Does Gratitude Make Us Happier?

Course excerpt from Leveraging Adversity

 

Image result for images showing gratitude

 

“Gratitude is not only the greatest of virtues, but the parent of all others.” – Marcus Tullius Cicero

In his 2012 TED talk, Dan Gilbert, the author of Stumbling on Happiness, states, “A year after losing the use of their legs, and a year after winning the lotto, lottery winners and paraplegics are equally happy with their lives” (Gilbert, 2012).

For most people, this makes no sense. Why would it be that losing everything wouldn’t fundamentally change our happiness levels? This is, after all, what most of us believe. It’s why we try to avoid setbacks, mitigate losses, and improve our health. If having losses—and none might be so severe as the ones suffered by paraplegics—can mean that we arrive at the exact same place as when we win the lottery, why should we spend so much time trying to avoid them? Maybe we shouldn’t.

But we still need an answer. How is it possible that losing the use of limbs can lead to the same level of happiness as winning the lottery? And what does this mean about the way we look at setbacks? To answer these questions, we first have to consider two possibilities:

  • What we predict will make us happy doesn’t. That is, in considering what leads to happiness, and making decisions based on happiness, we choose wrongly.
  • Losing everything leads to a profound feeling of appreciation for what we have left, and this feeling of appreciation is highly linked to happiness.

Let’s consider the first possibility. Gilbert, and many others like him, have shown repeatedly that the attachments we make to certain outcomes—whether it is winning the lottery, having a child, getting a raise, or losing everything—are often wrong. And this may have a lot to do with our beliefs about happiness.

Happiness, for most people, is inextricably linked to beliefs about experiences (Gilbert, 2006). If we believe that earning a college degree will lead to happiness, we pursue that. And if we are raised in a family that values athletic achievement, we go after that.

We are also highly influenced by the environment. The fascinating research of Richard Thaler and Cass Sunstein, authors of Nudge: Improving Decisions about Health, Wealth, and Happiness, has shown that the environment influences us much more than we think, even in subtle ways. In one study, Thaler and Sunstein had subjects read a passage that was primed toward slowness (using words such as “old,” “tired,” “weak,” and “retirement”) or a passage that was primed toward speed (using words like “energetic,” “lively,” “young,” and “children”) and then measured the subjects’ walking speed down the hall as they exited the research lab. Without having any idea what was being measured or to which study group they had been assigned, the subjects showed something fascinating: the ones who had been primed to walk faster did just that, while participants who had read the passage primed for slowness did indeed walk slower (Thaler & Sunstein, 2009).

Neither group had been told anything about walking slower or faster; they had simply been exposed to it through verbal priming.

So we can be primed to act in certain ways that are presumed to lead to happiness. It’s why we go for the promotion. It’s why we want the big house on the nice street, the luxury vehicle in the garage, and the vacation home in Vail. And like it or not, we are constantly exposed to messages that tell us what will lead to happiness. We are told what to buy, what to wear, what to eat and when to eat it, and where to vacation. Yet we are also told that if we don’t jump on the opportunity now, the chance will be gone. The sale ends tonight, you have to buy now, and the sale only lasts so long. Making use of our fear of missing out, or what Gregg Easterbrook, author of The Progress Paradox: How Life Gets Better While People Feel Worse, calls “loss avoidance,” marketers not only prime us, they prod us (Easterbrook, 2004).

So what do many of us do? We pursue that esteemed position—the one with the hefty salary—so we can buy the nice house, the new car, and the fancy vacation home. And the zest with which we go after this American dream—the one that promises happiness—can only be equated to a disease called “affluenza,” according to John de Graaf, David Waan, Thomas Naylor, and David Horsey, authors of Affluenza: The All-Consuming Epidemic. What these authors cite is a multitude of unequivocal examples of all-out consumerism—in each of the past four years, more Americans declared personal bankruptcy than graduated from college, we have twice as many shopping centers as schools, and our annual production of solid waste would fill a convoy of garbage trucks stretching to the moon—that all lead to the same conclusion: we have been led to believe that all this spending will bring us happiness (de Graff et al., 2005).

Yet nothing could be further from the truth.

Consider the data presented by Easterbrook:

“The percentage of Americans who describe themselves as happy has not budged since the 1950s, though the typical person’s real income more than doubled during that period. Happiness has not increased in Japan or Western Europe in the past half-century either, though daily life in both of those places has grown fantastically better. Adjusting for population growth, unipolar depression, the condition in which a person simply feels blue, is ten times as prevalent as it was half a century ago” (Easterbrook, 2004).

Easterbrook goes on to make the case that the way we link material wealth to happiness is a “nature’s revenge law” where no matter how much money you have, there will always be something you can’t afford. And while you will never be materially satisfied, you will also have “reference anxiety” because you will be comparing yourself to those around you and worrying that you are not keeping up. You will always be expecting more, and regardless of how high your income is, the minute it plateaus, so will your happiness.

Because the truth is, as Easterbrook accounts, “Most of what people really want in life—love, friendship, respect, family, standing, fun—is not priced and does not pass through the market. If something isn’t priced, you can’t buy it, so possessing money doesn’t help much” (Easterbrook, 2004).

While this premise may seem obvious upon second glance, many of us fall for it. As one man described to me, “You just get stuck in a cycle where you know you are unhappy, but you can’t quite figure out why, and so you just keep buying things trying to make yourself feel better. But at the end of the day, you are still stuck with yourself—and a lot of stuff you don’t really need.”

In terms of predicting what makes us happy, we often pursue a set of false beliefs about happiness—that is, that the things we think will make us happy actually don’t. But when it comes to predicting our happiness, we also make another error: we miscalculate the impact that losses will have on us (Gilbert, 2006).

Pointing to what is called the impact bias, Gilbert explains that when considering the future, and the way we will feel about the future, we tend to overestimate the hedonic impact of future events. The flip side of this, as Gilbert also mentions, is that we also tend to overestimate the negative impact of bad events.

Making his point, Gilbert quotes Moreese Bickham, who spent thirty-seven years in the Louisiana State Penitentiary for a crime he didn’t commit. Upon being released, Bickham stated, “I don’t have one minute’s regret; it was a glorious experience” (Gilbert, 2012).

No one would consider that such a fundamental loss would lead to happiness, and certainly not a “glorious experience,” but the point to be made is that we make a profound miscalculation. And the miscalculation is not in whether or not losses will undermine our happiness—they will. The real miscalculation we make is in our ability to adapt. Perhaps it’s the unknown nature of losses that clouds our predictions, or perhaps it’s that we have an innate ability to take the events that happen to us and “find a way,” as Gilbert states. We don’t see our own ability.

Yet, here again, we might be more influenced by the environment than we would like to admit. Because while child psychologists tell us that all attempts to shape a child’s behavior should employ the use of a three-to-one ratio—three positive statements to one bid for change (criticism)—we expose ourselves to something entirely different. Ray Williams, the author of Breaking Bad Habits, reports that media studies show that bad news far outweighs good news by as much as seventeen negative news reports for every one good news report (Williams, 2011). The supposition that Williams makes is that the media exploits our own biological tendency to focus more—and be impacted more—by bad events than positive ones. And because, as we know from section one, we seek to elaborate negatively charged emotions more than positive ones, we will return to the negative news again and again.

But there might be another reason we are saturated by negative news. Negative news keeps us feeling bad, and as the story goes, the way to happiness is to spend. The supposition is that the worse we feel, the more we will spend. Making matters worse, an anxious, depressed state does not lead to wise spending decisions. And being made to feel negative—and primed to reach for a cure that cannot possibly make anyone feel better—in many ways, we are put into a state of learned helplessness. And while in this state, it’s not surprising that when bad events do give us a feeling of helpless in our own lives, we miscalculate the way in which we will respond to them.

Now let’s consider the second possibility. The idea that losing everything somehow leads to actually feeling more grateful seems entirely foreign to most people. But as we already know, we make some pretty big mistakes when it comes to predicting how we will feel. And losses have an undeniable effect on gratitude.

The reason they do is that, as Joseph and Linley (2005), two researchers who study losses and the processes we take to get through them, suggest, gratitude is an essential part of the recovery process. It appears that people’s recovery from the traumatic experience is influenced by the extent to which they are able to find some benefit in the experience (Joseph & Linley, 2004). And the kinds of benefits people report—living life to the fullest, a greater appreciation of family and friends, and valuing each day more – are what most people really want.

Whether it’s valuing each day more, living life more fully, or simply appreciating those “little moments,” gratitude has a remarkable effect on the way we get through any kind of adversity. Gratitude orients us toward noticing the positive aspects of our lives, which is especially helpful in light of losses.

In the words of one survivor, “even the smallest joys in life took on a special meaning” (Tedeschi & Calhoun, 2004). These little moments of joy—a child’s smile, spending time with loved ones, a beautiful sunset—add up to a profound appreciation for what we still have.

Gratitude, and especially the kind that comes from losses, changes our priorities. For many people who report severe life setbacks, the sense of being “so lucky” is not uncommon. And gratitude causes one to value what’s left—just as Amy Purdy, the world’s top-ranked Paralympic snowboarder, related after losing both legs to bacterial meningitis, “I almost lost my left hand and my nose—it could have been much worse” (Purdy, 2011).

To many of us, the story seems unbelievable. But Amy Purdy, in looking back upon her experience, “wouldn’t change it.” And Amy’s experience isn’t unique. Several trauma survivors also report “not wanting things to be different.” In the words of one survivor, “This was the one thing that happened in my life that I needed to have happen, it was probably the best thing that ever happened to me” (Tedeschi & Calhoun, 2004).

Losses, setbacks, and traumas put things in perspective. They cause us to take a look at how we were living—to acknowledge that life could have been lost—and to reconsider what is really important. This leads to a profound recalibration of values and a much more purposeful life. As one cancer survivor stated, “I don’t concern myself with life’s small inconveniences, and I don’t have the patience for chronic complainers. I am so grateful for having survived cancer…I’m living the best life I can, and I don’t take anything for granted” (Verona et al., 2009).

The connection between gratitude and a purposeful life may explain what many have found when studying Vietnam War veterans. Those who reported higher levels of gratitude had more positive daily functioning (irrespective of symptomatology). But this might also be why a second study found a positive relationship between posttraumatic growth and recovery from trauma (Joseph & Linley, 2004).

The idea postulated by those who study posttraumatic growth is that trauma can lead to profound growth. That in going through even horrific experiences, there can be growth that surpasses pre trauma functioning. And some of the most undeniable evidence for posttraumatic growth can be found when looking at the September 11 attacks in 2001. Peterson and Seligman (2002) measured people before and after the attacks on the VIA inventory of psychological strengths, which acts as a map of positive functioning (Wood et al., 2011; Seligman & Peterson, 2002). Astoundingly, gratitude was shown to increase over this period. And this was not the only study. Several subsequent studies showed that gratitude appeared to increase for both adults and children after the attacks (Seligman & Peterson, 2004). There is something about losses, even the most profound ones, that dramatically increases gratitude.

While gratitude may have evolved to make us more cooperative, trusting, and favorable toward others, the question remains: Does this improve happiness?

Gratitude has been repeatedly linked to eudemonic well-being—the kind of purposeful, authentic living reported by trauma survivors (Joseph & Linley, 2004). And eudemonic well-being is highly related to happiness – in a longitudinal cohort of over 5,500 people initially aged fifty-five to fifty-six years, Wood and Joseph showed that people low in eudemonic well-being were 7.16 times more likely to meet criteria for clinical depression ten years later (Joseph & Linley, 2004).

Gratitude also relates to willingness to forgive, which is associated with the absence of psychopathological traits and is integral to positive functioning. Gratitude is connected to low narcissism and appears to strengthen relationships and promote relationship formation and maintenance. Relationship connection and satisfaction also appear to be highly linked to gratitude, and experimental evidence suggests that gratitude may promote conflict resolution and increase reciprocally helpful behavior (Wood et al., 2010).

Gratitude appears to also have important health ramifications and is associated with a significantly lower risk of major depression, generalized anxiety disorder, phobia, nicotine dependence, alcohol dependence, and drug “abuse” or dependence. Additionally, feeling thankful has been related to a much lower risk of bulimia nervosa, which is not surprising given that interventions that increase gratitude appear to improve body image (Wood et al., 2010).

Looking at the role of gratitude in staving off posttraumatic stress disorder, researchers looked at a sample of Vietnam War veterans, including forty-two patients diagnosed with PTSD and a control group of thirty-five comparison veterans, to find that gratitude is “substantially lower in people with PTSD.” Further, gratitude was shown to relate to higher daily self-esteem and positive affect above the effects of symptomatology (Wood et al., 2011).

Gratitude also appears to improve sleep. Many studies have specifically examined the possible relationships between gratitude and sleep in a community sample of 401 people, 40 percent of whom had clinically impaired sleep. Gratitude was related to total sleep quality, sleep duration (including both insufficient and excessive sleep), sleep latency (abnormally high time taken to fall asleep), subjective sleep quality, and daytime dysfunction (arising from insufficient sleep). In each case, gratitude was related to sleep through the mechanism of pre-sleep cognitions. Negative thoughts prior to sleep are related to impaired sleep, whereas positive pre-sleep cognitions are related to improved sleep quality and quantity (Joseph & Linley, 2004).

And gratitude appears to offer a buffer against negative emotions. In three separate studies, it has been negatively correlated with depression (Joseph & Linley, 2004). This is also consistent with the life orientation approach to gratitude, as being oriented toward the positive seems to counteract the “negative triad” of beliefs about self, world, and future seen in depression (Joseph & Linley, 2004).

The single measure of gratitude appears to be linked to more independent traits of well-being than any other measure. It has been correlated with positive emotional functioning, lower dysfunction, and positive social relationships. Grateful people score as less angry and hostile, depressed, and emotionally vulnerable, and experience positive emotions more frequently. Gratitude has also been correlated with traits associated with positive social functioning, emotional warmth, gregariousness, activity seeking, trust, altruism, and tender-mindedness. Finally, grateful people had a higher openness to their feelings, ideas, and values, and greater competence, dutifulness, and achievement striving (Joseph & Linley, 2004; Achor, 2011).

When it comes to the way losses affect us, we make some pretty big miscalculations. Not only do we fail to consider that we are not the best predictors of our emotional states, but more importantly, we profoundly underestimate our ability to adapt. And when it comes to adapting—learning to leverage our losses in service of ultimate growth—we fail to see the advantage that gratitude offers.

What we should know by now is that gratitude orients us to notice the positives, alters our priorities, enhances our sense of purpose, and dramatically improves our happiness. We should also know that facing challenging setbacks, naturally engages our sense of gratitude, and that helps us cope.

Click here to learn more

Leveraging Adversity is a 6-Hour online continuing education course. This course gives clinicians the tools they need to help their clients face adversity from a growth perspective and learn how to use setbacks to spring forward and ignite growth. Packed with recent data on post-traumatic growth, behavioral economics, and evolutionary psychology, this course begins with a look at just what setbacks are and how they affect us. Clinicians are then introduced to the concept of “leveraging adversity,” that is, using it to make critical reconsiderations, align values with behavior, and face challenges with a growth mindset. The course then addresses the five core strengths of leveraging adversity – gratitude, openness, personal strength (growth mindset), connection, and belief – and provides numerous exercises and skills for clinicians to use with clients.

Course #61-03 | 2018 | 92 pages | 35 posttest questions

 

CE Credit: 6 Hours

Target Audience: Psychology CE | Counseling CE | Social Work CE | Occupational Therapy CEUs | Marriage & Family Therapy CE | School Psychology CE | Teaching CE

Learning Level: Intermediate

Course Type: Online

Professional Development Resources is a nonprofit educational corporation 501(c)(3) organized in 1992. We are approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners; and are CE Broker compliant (all courses are reported within a few days of completion).

 

Target Audience: PsychologistsCounselorsSocial WorkersMarriage & Family Therapist (MFTs)Occupational Therapists (OTs)Registered Dietitian Nutritionists (RDNs)School Psychologists, and Teachers

Earn CE Wherever YOU Love to Be!

 

 

 

 
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Posted by on December 19, 2017 in Mental Health

 

Friendships are Necessary for Happiness!

Course excerpt from Finding Happiness: Positive Interventions in Therapy

Danilo Garcia, a researcher in psychology at the Sahlgrenska Academy’s Centre for Ethics, Law and Mental Health,  highlights that close, warm relationships are in fact necessary for our happiness.

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Analyzing news articles published online by Swedish dailies during 2010, Garcia looked to see which words most often occurred in the same articles as the Swedish word for happiness. The analysis, which included more than one and a half million words, showed that words like “Prince Daniel,” “Zlatan,” “grandmother” and personal pronouns (such as you/me, us/them) often appear with the Swedish word for happiness. Words like “iPhone,” “millions” and “Google” on the other hand, almost never appeared with the word for happiness (Garcia, 2013).

“It’s relationships that are most important, not material things, and this is in line with other findings in happiness research” (Garcia, 2013).

A more recent study showed that relationships that foster happiness need not be with our family, especially as we age.

Recruiting 271,053 participants of all ages from nearly 100 countries, Michigan State University scholar, William Chopik analyzed survey information about relationships and self-rated health and happiness, along with data from 7,481 older adults in the United States about relationship support/strain and chronic illness.

Chopik uncovered two important findings: both family and friend relationships were linked to better health and happiness overall, but it was friendships that became a stronger predictor of health and happiness at advanced ages. And those friendships were very influential. When friends were the source of strain, participants reported more chronic illnesses. When friends were the source of support, participants were happier (Chopik, 2017).

Chopik contends that friendships predict day-to-day happiness and ultimately how long we will live, even more than spousal and family relationships (Chopik, 2017).

“Friendships become even more important as we age. Keeping a few really good friends around can make a world of difference for our health and well-being. So it’s smart to invest in the friendships that make you happiest” (Chopik, 2017).

Friendships, Chopik further notes, must survive the test of time. Unlike family relationships, we typically do not feel obligated to keep our friends, so the ones we do choose to keep are often the ones that make us feel good. Another study demonstrates that one important aspect of friendship and the close bonds we form is the sharing of good news, particularly in times of stress.

As part of a larger research project, the Study for Employment Retention of Veterans (SERVe), Sarah Arpin, a Gonzaga University social psychologist, examined 162 post 9/11 military couples and explored the connection between perceived responsiveness to capitalization (sharing good news), and the couples self-reported feelings of loneliness, intimacy, and sleep. To be included in the study couples had to have been living together for at least 6 months to participate, though the average length of relationship was 12 years.

Arpin’s results demonstrated an interesting connection: when partners responded positively to the sharing of good news, they felt less lonely, more intimate, and slept better (Arpin, 2017). Arpin explains, “When you share something good, and the recipient of the information is actively happy for you, it heightens the positive experience for both parties. However, when someone ‘rains on your parade’ that can have negative consequences” (Arpin, 2017).

According to research out of University of California at Santa Barbara, deep, meaningful relationships do not only contribute to our well-being in times of stress and over the course of our lives, they also help us thrive.

For their study, researchers Brooke Feeney of Carnegie Mellon University and Nancy Collins of University of California at Santa Barbara defined thriving in 5 components:

  1. Hedonic well-being (happiness, life satisfaction)
  2. Eudaimonic well-being (having purpose and meaning in life, progressing toward meaningful life goals)
  3. Psychological well-being (positive self-regard, absence of mental health symptoms/disorders)
  4. Social well-being (deep and meaningful human connections, faith in others and humanity, positive interpersonal expectancies)
  5. Physical well-being (healthy weight and activity levels, health status above expected baselines).

What Feeney and Collins found was that for thriving to occur, relationships must serve two important functions. First, they support thriving through adversity, not only by buffering individuals from negative effects of stress, but also by enabling them to flourish either because of or in spite of their circumstances.

Feeney explains, “Relationships serve an important function of not simply helping people return to baseline, but helping them to thrive by exceeding prior baseline levels of functioning” (Feeney & Collins, 2014).

The second important function of relationships is to support thriving in the absence of adversity by promoting full participation in life opportunities for exploration, growth, and personal achievement. Supportive relationships help people thrive in this way by enabling them to embrace and pursue opportunities that enhance positive well-being, broaden and build resources, and foster a sense of purpose and meaning in life.

This type of support is referred to as Relational Catalyst (RC) Support because support providers can serve as active catalysts for participating in enriching life opportunities (Feeney & Collins, 2014).

While it is not surprising that surrounding ourselves with those we feel close to and supported by is good for our happiness, it seems they also create some pretty powerful physiological effects, some say even better than drugs.

It has been well established that oxytocin, often called the “love hormone,” is associated with interpersonal bonding.

Daniele Piomelli, a researcher at the University of California at Irvine, and his colleagues wanted to know if there was a link between oxytocin and anandamide, which has been called the “bliss molecule” for its role in activating cannabinoid receptors in brain cells to heighten motivation and happiness.

Anandamide is among a class of naturally occurring chemicals in the body known as endocannabinoids that attach to the same brain cell receptors as does marijuana’s active ingredient, THC, with similar outcomes.

To test their hypothesis, Piomelli and his team first measured levels of this marijuana-like neurotransmitter in mice that had been either isolated or allowed to interact. Anandamide levels were shown to increase with social contact, which then triggered cannabinoid receptors to reinforce the pleasure of socialization. When cannabinoid receptors were blocked, this reinforcement disappeared.

Next, the researchers looked for a possible connection between anandamide and oxytocin. By stimulating a small number of neurons in the brain that make oxytocin and use it as a neurotransmitter, researchers were able to increase anandamide creation in the nucleus accumbens.

More importantly, they found that blocking anandamide’s effects also blocked the pro-social effects of oxytocin, which implies that oxytocin reinforces social ties by inducing anandamide formation. Moreover, when anandamide degradation was blocked – meaning more anandamide was made available in the brain for a longer period of time – the pleasure of social contact was enhanced (Wei et al., 2015).

Being around others, who support and care for us, makes us feel good, even blissful. These deep, meaningful relationships also sustain us powerfully through adversity and activate our efforts toward enriching life experiences. The net effect is a potent upward spiral of thriving.

Click Here to Learn More

Finiding Happiness: Positive Interventions in Therapy is a 4-hour online continuing education course. Drawing on the latest research, this course will explore the concept of happiness, from common myths to the overriding factors that directly increase our feelings of contentment. We will start with a discussion on why you, the clinician, need to know about happiness and how this information can help in your work with clients. We will then uncover mistakes we make when trying to attain happiness and look carefully at the actions we take and the beliefs that do not just obfuscate our happiness efforts, but often leave us less happy. Next, we will explore the ways in which our mindset influences our feelings of happiness and the many ways we can fundamentally change our levels of well- being, not just immediately, but for many years to come. The final section of this course contains exercises you can use with clients to cultivate and sustain a lifelong habit of happiness.

Course #40-45 | 2018 | 57 pages | 25 posttest questions

CE Credit: 3 Hours

Target Audience: Psychology CE | Counseling CE | Social Work CE | Occupational Therapy CEUs | Marriage & Family Therapy CE | Nutrition & Dietetics CE | School Psychology CE | Teaching CE

Learning Level: Intermediate

Course Type: Online

Professional Development Resources is a nonprofit educational corporation 501(c)(3) organized in 1992. We are approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners; and are CE Broker compliant (all courses are reported within a few days of completion).

 

Target Audience: PsychologistsCounselorsSocial WorkersMarriage & Family Therapist (MFTs)Occupational Therapists (OTs)Registered Dietitian Nutritionists (RDNs)School Psychologists, and Teachers

Earn CE Wherever YOU Love to Be!

 

 
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Posted by on December 15, 2017 in Mental Health

 

Eat a Rainbow Every Day!

Course excerpt from Nutrition and Depression

The Power of Fruits and Vegetables:
Image result for sharing fruit and veg
We have all been told that eating more fruits and vegetables is an important part of preserving our health, but can increased consumption of produce also improve mood?
Looking to answer just this question, Department of Psychology researcher Dr. Tamlin Conner, Dr.Caroline Horwath, and Bonnie White from Otago’s Department of Human Nutrition, recruited a total of 281 young adults (with a mean age of 20 years) to complete a questionnaire giving details of their age, gender, ethnicity, weight and height. Excluding those with a history of an eating disorder, participants were then asked to complete an internet-based daily food diary for 21 consecutive days. Every evening, for 21 days, participants logged into their diary and rated how they felt choosing from a list of eighteen positive and negative adjectives.
Then they answered five questions about what they had eaten that day. Specifically, participants were asked to report the number of servings eaten of fruit (excluding fruit juice and dried fruit), vegetables (excluding juices), and several categories of unhealthy foods like biscuits/cookies, potato crisps, and cakes/muffins.
And after 21 days, the results showed a strong day-to-day relationship between more positive mood and higher fruit and vegetable consumption, but not other foods.This result stood even after controlling for body mass index (BMI), or running additional analysis to ensure that a positive mood didn’t precede a higher intake of fruits and vegetables. In fact, what Dr. Conner and her team found was that eating fruits and vegetables predicted improvements in positive mood the next day, suggesting that healthy foods may improve mood (Conner et al.,2013).
“On days when people ate more fruits and vegetables, they reported feeling calmer, happier and more energetic than they normally did.” (Conner et al., 2013).
Conner cautions, however, that in order to notice a meaningful positive change, people would need to consume approximately seven to eight total servings of fruits and vegetables per day –essentially ensuring that half of your plate at each meal is comprised of fruits or vegetables (Conner et al., 2013).
A more recent study found similar results.
A collaboration between the University of Warwick, England and the University of Queensland, Australia, involved an examination of longitudinal food diaries of 12,385 randomly sampled Australian adults over 2007, 2009, and 2013 in the Household, Income, and Labour Dynamics in Australia Survey.
The authors adjusted the effects of incident changes in happiness and life satisfaction for people’s changing incomes and personal circumstances. As part of the study, subjects kept food diaries and had their psychological well-being measured at intervals throughout the course of the study.
Increased consumption of fruits and vegetables was found to improve well-being in the long term, and incrementally, as happiness benefits were detected for each extra daily portion of fruit and vegetables up to 8 portions per day. Incredibly, the researchers concluded that people who changed from almost no fruit and veg to eight portions of fruit and vegetables a day would experience an increase in life satisfaction equivalent to moving from unemployment to employment (Oswald et al.,2016).
Professor Andrew Oswald explains, “Eating fruit and vegetables apparently boosts our happiness far more quickly than it improves human health. People’s motivation to eat healthy food is weakened by the fact that physical-health benefits, such as protecting against cancer, accrue decades later. However, well-being improvements from increased consumption of fruit and vegetables are closer to immediate” (Oswald et al., 2016).
“Perhaps our results will be more effective than traditional messages in convincing people to have a healthy diet. There is a psychological payoff now from fruit and vegetables –not just a lower health risk decades later” (Mujcic, 2016).
While it has been well established that there is a link between antioxidant consumption and improved health, is there a link between increased anti-oxidants and optimism? From the results of studies like this, it is reasonable to think so. Most interesting, as Mujcic points out, the psychological payoff from fruits and vegetables occurs both immediately, and in better health down the road.
So what is the takeaway when it comes to fruits and vegetable and mood? Here are some guidelines to keep in mind:
  • Aim for at least eight servings of fruits and vegetable daily (excluding dried fruits and fruit and vegetable juices).
  • At each meal, fill your plate halfway with fruits and vegetables.
  • Use fruits and vegetable between meals as snacks.
  • Aim for a wide variety of fruit and vegetable sources.

Nutrition and Depression: Advanced Clinical Concepts is a 3-hour online continuing education (CE) course that examines how what we eat influences how we feel – and what we can do to improve both.

Depression is an increasingly common, complex, inflammatory condition that co-occurs with a host of other conditions. This course will examine how we can combat depression through nutrition, starting with an exploration of the etiology of depression – taking a look at the role of neurotransmitters, the HPA axis and cortisol, gene expression (epigenetics), upregulation and downregulation, and the connections between depression and immunity and depression and obesity. We will then turn our attention to macronutrients and investigate how factors such as regulating blood sugar, achieving amino acid balance, consuming the right fats, and eating fruits and vegetables can enhance mood, improve our decision-making, enhance cognitive processes, and reduce inflammation. From there, we will look at just how we go about the process of building a better brain – one neurotransmitter at a time. Exercises you can use with clients are included.

Course #31-02 | 2018 | 42 pages | 20 posttest questions

CE Credit: 4 Hours
Target Audience: Psychologists | Counselors | Social Workers | Occupational Therapists (OTs) | Marriage & Family Therapists | School Psychologists | Teachers
Learning Level: Introductory
Course Type: Online

Professional Development Resources is a nonprofit educational corporation 501(c)(3) organized in 1992. We are approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners; and are CE Broker compliant (all courses are reported within a few days of completion).

 

Target Audience: PsychologistsCounselorsSocial WorkersMarriage & Family Therapist (MFTs)Occupational Therapists (OTs)Registered Dietitian Nutritionists (RDNs)School Psychologists, and Teachers

Earn CE Wherever YOU Love to Be!

 
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Posted by on November 13, 2017 in Mental Health, Nutrition & Dietetics

 

Helping Children Find Their Strengths

Course excerpt from Motivating Children to Learn

The primary aim of this course is to illustrate strategies and activities that can help motivate children to learn by removing obstacles that are in their way. A good starting point in this process is to teach them that there are many ways to be “smart.” One way to help children learn and understand their strengths is to understand the concept of multiple intelligences. There are nine different categories of intelligence. These intelligences can assist clinicians, parents, and teachers with identifying the best way for students to learn.

Child Learning

Below is a list of the different intelligence areas and the child’s preferred method of learning.

  • Visual/Spatial: Prefers using pictures, images, and spatial understanding.
  • Verbal/Linguistic: Prefers using words, both in speech and writing.
  • Logical/Mathematical: Prefers using logic, reasoning, and systems.
  • Interpersonal: Prefers to learn in groups or with other people.
  • Intrapersonal: Prefers to work alone and use self-study.
  • Aural/Musical/Rhythmic: Prefers using sound and music.
  • Naturalist: Prefers working outdoors with animals and plants.
  • Existential: Prefers dealing with abstract theories.
  • Bodily/Kinesthetic: Prefers using your body, hands, and sense of touch.

Hunt (2015) explains it this way: How does this knowledge help children learn? For example, a student who is a naturalist in Multiple Intelligences might classify insects while working in the plant area. We have them at the level of analyzing and in an area that they feel comfortable in—the plant area. A student in a kindergarten classroom who is mathematical might be comparing five items from the kitchen area. For a middle school or high school linguistic student, we might be writing two paragraphs contrasting poets from the 19th century. For a musical student, we might have them outline a chapter on banking while listening to music. Maybe this would be distracting to some students so you might have students use earbuds, so those who like to listen to music wouldn’t disturb the ones who do not like to listen to music. If you are a visual learner, we might have you show comparisons using a Venn diagram. An interpersonal learner could classify rocks with a partner, while an intrapersonal learner might compare two features from their project individually. An elementary level example for a kinesthetic learner might be to stand at the back counter while separating fruit and vegetable pictures.

A child needs to understand that his or her identity is not defined by their learning disability. In order to do so, children require help to identify their strengths and weaknesses. It is even more critical for a child who struggles in school to verbalize and recognize what they are good at. Most children with learning disabilities are told what their deficits are, and what areas they need to work on; however, few are told what their strengths are.

As parents and clinicians, we need to seek and cultivate our children’s innate gifts and strengths. This may require some detective work toward an appreciation of each child not just for what is acceptable and culturally valued in our society, but for their actual abilities. We need to ask ourselves the following questions:

  • What does my child/student/client enjoy doing?
  • What comes to him/her naturally?

When people align with their strengths they feel as if they come alive.

Examples of strengths include:

  • Works well/gets along well in groups
  • Is able to organize items and thoughts
  • Shows empathy and sensitivity to others
  • Accepts personal responsibility for actions (good and bad)
  • Participates in discussions at home, school and with friends
  • Uses inflection and expression when speaking
  • Figures out new words by looking at the context or by asking questions
  • Makes connections between reading material and personal experiences
  • Observes and understands patterns in nature and in numbers
  • Thinks logically

Knowing about strengths and weaknesses is helpful to children, but it has to be taken a few steps further in order to be useful to them. How can we help children use their personal strengths to build self-confidence and a positive attitude? Part of this depends on the child’s age. Young children love to tell you about themselves and are open to telling you what they like to learn. In contrast, older children and teens may have a hard time opening up. We need to point out their strengths:

  • “I noticed you love basketball, you seem so comfortable holding and dribbling the ball.”
  • “I noticed that you love to figure out math problems in your head.”

However, according to Anjum et al. (2013), Some children and adolescents, especially those with behavioral concerns may be reluctant to explore or believe their strengths because they have been conditioned to associate negatives about themselves. In such cases, the professional may first work on building the self-efficacy of children and adolescents by using evidence-based strategies such as cognitive-behavioral programs that can help them to believe that they have the ability to change. Once they focus and spend more time on what they are capable off, they will automatically spend less time in thinking about their shortcomings.

To learn more about multiple intelligences, building on children’s strengths and practical techniques to support children in becoming more resilient learners, check out our new online CE course:

Motivating Children to Learn is a 4-hour online continuing education (CE/CEU) course that provides strategies and activities to help children overcome their academic and social challenges. This course describes the various challenges that can sidetrack children in their developmental and educational processes, leaving them with a sense of discouragement and helplessness. Such challenges include learning disabilities, autism spectrum disorder, ADHD, behavior disorders, and executive functioning deficits. Left unchecked, these difficulties can cause children to develop the idea that they are not capable of success in school, precipitating a downward spiral of poor self-esteem and – eventually – school failure. The good news is that much better outcomes can result when parents, teachers, and therapists engage children in strategies and activities that help them overcome their discouragement and develop their innate intelligence and strengths, resulting in a growth mindset and a love of learning. Detailed in this course are multiple strategies and techniques that can lead to these positive outcomes. Course #40-44 | 2018 | 77 pages | 25 posttest questions

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Professional Development Resources is a nonprofit educational corporation 501(c)(3) organized in 1992. We are approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners; and are CE Broker compliant (all courses are reported within a few days of completion).

Target Audience: PsychologistsCounselorsSocial WorkersMarriage & Family Therapist (MFTs)Speech-Language Pathologists (SLPs)Occupational Therapists (OTs)Registered Dietitian Nutritionists (RDNs)School Psychologists, and Teachers

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A Short Course on Encryption and Cloud Storage

Course excerpt from Ethics & Risk Management: Expert Tips 8

Encryption and cloud storage is a complicated area because it requires an analysis of the interplay of several variables, including confidentiality, encryption, cloud storage and HIPAA. Each of these variables is complex, but there are ways to make the situation more manageable.

Cloud storageEncryption and cloud storage. Let’s consider a few common questions:

“For the purposes of HIPAA, if you have adequately encrypted your data, does your cloud storage provider need to sign a Business Associate Agreement (BAA)?”

The bottom line is that there is no crystal-clear answer to this question. The Department of Health and Human Services (HHS) hasn’t specifically addressed this issue, so we are faced with the question of how to interpret the security rule.

There are two basic interpretations: “no,” and “yes.” Both have some support, and if you proceed with one interpretation you should consider the countervailing position.

First, the basics: HIPAA Covered Entities (CEs) who work with vendors are required to have their vendors sign BAAs. This is required because it allows the federal government to enforce the provisions of HIPAA on these third-party vendors.

The public policy at work is that CEs shouldn’t be allowed to offload their legal responsibilities to a third party that isn’t subject to regulatory oversight. BAAs are required whenever a third-party vendor has access to Protected Health Information (PHI).

Here’s where it gets complicated. PHI is identifiable data, but if the data are encrypted they are not identifiable. In such a case, why is a BAA necessary?

The interpretation against requiring a BAA for encrypted data finds some support in one of HIPAA’s safe harbor provisions, which states that losses of encrypted data do not trigger a breach notification (the letter CEs send out that apologetically admits to the disclosure of protected health information).

The reason why breach notifications is not required for encrypted data are that the data remain inaccessible if encrypted. The covered entity has essentially lost gibberish.

Thus, this interpretation goes, BAAs are also not required because the vendor does not have access to protected health information. That makes sense. However, it should be noted that this is a fairly permissive interpretation and HHS has declined to endorse this position.

The competing interpretation, which appears to be strongly supported by the official commentary on related regulations (especially the 2013 HITECH amendments to the HIPAA Privacy and Security Rules), is that BAAs are required even when the data are encrypted.

Support for this position includes: HHS has not made the criteria for breach notifications the same as the criteria for needing a BAA.

The statutory exceptions for BAAs, such as those with incidental access (e.g., a janitor or electrician) or those who are mere “conduits,” do not apply to cloud storage providers. HHS has indicated that a data storage company is not a conduit because of the “persistent nature” of its contact with the data. Thus, it is persistency, and not the degree of access, that HHS has specifically indicated warrants consideration for the purposes of BAAs.

Commentary prior to the adoption of the security rule asked whether or not BAAs could be something that CEs could address, and thus render unnecessary. In other words, the question was asked, “if we as CEs take adequate security measures to ensure the protection of PHI, can we make BAAs unnecessary?” HHS specifically declined to make BAAs an “addressable” requirement.

Besides the issue of protecting PHI, BAs have additional responsibilities. These responsibilities include accessibility, data integrity, etc. If encryption enabled vendors to escape “business associate” (BA) status, HHS would have no jurisdiction. (From a risk management perspective, the execution of a BAA is something that many CEs do to “distribute” the risk.)

The definition of BA isn’t explicitly restricted to those who have access to PHI. The definition also includes those who perform “any other function or activity regulated by this subchapter.” (See 45 CFR 160.103(1)(i)(B)) The amount of functions and activities that are regulated under HIPAA is huge.

I want to emphasize that I understand the argument that where vendors have absolutely no access to PHI because the data are encrypted, the vendor doesn’t have encryption keys, etc., then HIPAA is (theoretically) a non-issue. It makes a lot of sense. However, we just don’t know at this time if HHS agrees with that position and we have some strong evidence that casts this position as too narrow.

However, the ambiguity also applies to the other interpretation: We don’t know if HHS agrees with the position that the storage of encrypted PHI (where the vendor has zero access to the PHI) still requires a BAA.

I hope this helps or at least provides some things to consider.


By Adam Alban, PhD, JD

Adam Alban, PhD, JD, hosts a website of general information for mental health professionals in California. He has an M.A. and PhD in clinical psychology from Michigan State University and a JD from American University in Washington, D.C. He operates a law practice specializing in legal assistance to mental health practitioners and also has a clinical psychology practice, the Alban Psychology Group. He may be reached at: alban@clinicallawyer.com.


Ethics & Risk Management: Expert Tips 8 is a 3-hour online continuing education (CE) course that addresses a wide variety of ethics and risk management topics, written by experts in the field.

This online course provides instant access to the course materials (PDF download) and CE test. After enrolling, click on My Account and scroll down to My Active Courses. From here you’ll see links to download/print the course materials and take the CE test (you can print the test to mark your answers on it while reading the course document). Successful completion of the online CE test (80% required to pass, 3 chances to take) and course evaluation are required to earn a certificate of completion.

Professional Development Resources is approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB Provider #1046, ACE Program); the American Occupational Therapy Association (AOTA Provider #3159); the Commission on Dietetic Registration (CDR Provider #PR001); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy (#BAP346), Psychology & School Psychology (#50-1635), Dietetics & Nutrition (#50-1635), and Occupational Therapy Practice (#34); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).

 

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The Impact of Suicide

By Laura More, MSW, LCSW

Suicide PreventionThe health and economic consequences of suicide are substantial. Suicide and suicide attempts have far reaching consequences for individuals, families, and communities. In an early study, Crosby and Sacks (2002) estimated that 7% of the U.S. adult population, or 13.2 million adults, knew someone in the prior 12 months who had died by suicide. They also estimated that for each suicide, 425 adults were exposed, or knew about the death. In a more recent study in one state, researchers found that 48% of the population knew at least one person who died by suicide in their lifetime. Research also indicates that the impact of knowing someone who died by suicide and/or having lived experience (by personally having attempted suicide, having had suicidal thoughts, or having been impacted by suicidal loss) is much more extensive than injury and death. People with lived experience may suffer long-term health and mental health consequences ranging from anger, guilt, and physical impairment, depending on the means and severity of the attempt (Stone, Holland, Bartholow, et al., 2017).

The economic toll of suicide on society is immense as well. According to conservative estimates, in 2013, suicide cost $50.8 billion in estimated lifetime medical and work-loss costs alone (Florence, Simon, Haegerich, Luo & Zhou, 2015). Adjusting for potential under-reporting of suicide and drawing upon health expenditures per capita, gross domestic product per capita, and variability among states in per capita health care expenditures and income, another study estimated the total lifetime costs associated with nonfatal injuries and deaths caused by self-directed violence to be approximately $93.5 billion in 2013 (Shepard, Gurewich, Lwin, Reed & Silverman, 2016). The overwhelming burden of these costs were from lost productivity over the life course, with the average cost per suicide being over $1.3 million. The true economic costs are likely higher, as neither study included monetary figures related to other societal costs such as those associated with the pain and suffering of family or other impacts (Stone, Holland, Bartholow, et al., 2017).

Suicide Prevention: Evidence-Based StrategiesSuicide Prevention: Evidence-Based Strategies is a 3-hour online continuing education (CE) course that reviews evidence-based research and offers strategies for screening, assessment, treatment, and prevention of suicide in both adolescents and adults. Suicide is one of the leading causes of death in the United States. In 2015, 44,193 people killed themselves. The Centers for Disease Control and Prevention (CDC) notes, “Suicide is a serious but preventable public health problem that can have lasting harmful effects on individuals, families, and communities.” People who attempt suicide but do not die face potentially serious injury or disability, depending on the method used in the attempt. Depression and other mental health issues follow the suicide attempt. Family, friends, and coworkers are negatively affected by suicide. Shock, anger, guilt, and depression arise in the wake of this violent event. Even the community as a whole is affected by the loss of a productive member of society, lost wages not spent at local businesses, and medical costs. The CDC estimates that suicides result in over 44 billion dollars in work loss and medical costs. Prevention is key: reducing risk factors and promoting resilience. This course will provide a review of evidence-based studies on this complex subject for psychologists, marriage & family therapists, professional counselors, and social workers. Information from the suicide prevention technical package from the Centers for Disease Control and Prevention will be provided. Included also are strategies for screening and assessment, prevention considerations, methods of treatment, and resources for choosing evidence-based suicide prevention programs. Course #30-97 | 2017 | 60 pages | 20 posttest questions

This online course provides instant access to the course materials (PDF download) and CE test. After enrolling, click on My Account and scroll down to My Active Courses. From here you’ll see links to download/print the course materials and take the CE test (you can print the test to mark your answers on it while reading the course document). Successful completion of the online CE test (80% required to pass, 3 chances to take) and course evaluation are required to earn a certificate of completion. Click here to learn more.

About the Author:

Laura More, MSW, LCSW, is a healthcare author and licensed clinical social worker. Laura was one of the founding partners of Care2Learn, a provider of online continuing education courses for the post-acute healthcare industry. She now provides healthcare authoring services. She has authored over 120 online continuing education titles, co-authored evidence-based care assessment area resources and a book, The Licensed Practical Nurse in Long-term Care Field Guide. She is the recipient of the 2010 Education Award from the American College of Health Care Administrators.

CE Information:

Professional Development Resources is approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB Provider #1046, ACE Program); the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy (#BAP346), Psychology & School Psychology (#50-1635); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).

 

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