DiscoverCounselor Toolbox PodcastOverview of the PACER Method
Overview of the PACER Method

Overview of the PACER Method

Update: 2019-10-11
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Overview of the PACER Method and Transdiagnostic Assessment

Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC

Executive Director, AllCEUs.com

Podcast Host: Counselor Toolbox and Case Management Toolbox


Sponsored by TherapyNotes.com

Manage your practice securely and efficiently. Two free weeks of TherapyNotes with coupon code “CEU”


Objectives

– Define the PACER model

– Explore how PACER dimensions interact

– Examine the transdiagnostic assessment process

Why A New Approach-

– 10% of Americans are on antidepressants for anxiety or depressive issues

– Without medication 20-40% of people with clinical depression noticed symptom improvement in 6-8 weeks

– WITH antidepressants 40-60% of people with clinical depression noticed symptom improvement in 6-8 weeks

– That leaves as many as 40% of people still struggling with significant symptoms after 6-8 weeks.

– No high- or moderate-strength evidence for any intervention to effectively treat any phase of any type of BD versus placebo or an active comparator

Why A New Approach-

– Cognitive Behavioral Therapy appears to be effective in approximately 47% of cases

– Results are mixed regarding whether CBT + antidepressants can augment treatment response

– Cognitive behavioral interventions for depression and anxiety prevention showed a small effect for prevention of depression but not anxiety and no effect at 3-6 months and at 12 months follow-up

– In a study of over 33,000 patients, only patients who had 18 or 20 CBT sessions showed more improvement than generic counseling.

Why a New Approach

– Counseled patients are significantly more likely to have recovered than non-counseled patients

– Client outcomes are most often determined by client variables such as

– Chronicity and severity

– Complexity of symptoms

– Motivation

– Acceptance of responsibility for change

– Therapeutic change is less about talk-therapy interventions and more about the patient’s ability to maintain motivation and efficacy and clinician team’s ability to look multidimensionally at issues


PACER Method

– The PACER Method uses a transdiagnostic (many symptoms are common to multiple disorders) and transtheoretical (there are many ways to address each symptom) approach to recovery to assist people in optimizing their quality of life

– Physical

– Affective

– Cognitive

– Environmental

– Relationships

– The PACER method consistently looks at bidirectional interactions

PACER Method

– The PACER Method

– Counselor Functions

– Counseling and motivational enhancement

– Connecting with multidisciplinary referrals (MD, RD, PT etc.)

– Case Management (Integrating & monitoring tx plans)

– Improving Health and Mental Health Literacy

– Goal

– To address PACER issues which create or maintain imbalances in the nervous system that cause unnecessary dysphoria.


Physical

– Rule out organic dysfunction in the system

– If the body cannot make or balance the neurotransmitters due to health or behavioral issues, those must be addressed.

– There are over 30 hormones the body must construct to regulate neurotransmitters

– There are over 100 neurotransmitters the body must construct and balance to regulate attention, memory, sleep, feeding, heart rate, respiration, energy, motivation, mood and more.

– Up to 95% of some neurotransmitters and hormones are made in the gut (Setting concrete in the rain)

– The body requires vitamins, minerals and amino acids to make hormones and neurotransmitters


Physical

– Rule out dysfunction in the system

– If the body cannot produce or effectively regulate hormones and neurotransmitters, people will have “symptoms”

– Example: HPA axis dysfunction and exposure to stress are critical components that increase risk for developing addictions

– Some hormones and neurotransmitters increase the levels of certain H & NTs while simultaneously decreasing levels of other H & NTs

– Under stress cortisol increases norepinephrine, adrenaline, glutamate, estrogen and ghrelin and inhibits and availability of serotonin and the creation of T3

– During relaxation, DHEA, GABA and serotonin levels increase which reduces cortisol and norepinephrine, adrenaline, glutamate, estrogen and ghrelin


Physical Assessment

– Sleep

– Nutrition (app & blood test*)

– Weight (obesity, anorexia)

– Bariatric surgery

– Central weight gain

– Pain

– Exercise/sedentariness

– Energy (T, T3, Sleep, O2…)*

– Libido/Sex hormones*

– Blood sugar/hypoglycemia*


Physical Assessment

– Hypervigilance/startle (Hypo- or hyper-cortisolism)

– Autoimmune issues/inflammation (RA, IBD, Diabetes Type 1, psoriasis, chron’s)

– TBI

– Headaches (stress, migraines, BP)

– Medications (beta blockers (HBP), proton pump inhibitors (GERD), Corticosteroids (RA), Parkinson’s and Antipsychotic medications, hormone altering drugs (2), stimulants, anticonvulsants (bipolar, pain), statins (cholesterol), opioids, benzodiazepines (depression/rebound anxiety)

– Substance use and potentially addictive behaviors (sex/pornography, gambling, video games)


Affective Assessment

– Helps us get an understanding of HPA-Axis functioning

– Happiness

– Sadness/Depression

– Loneliness

– Grief

– “Stress”

– Anxiety

– Anger

– Resentment

– Guilt

– Jealousy

Affective Assessment

– Dysphoric emotions typically impair sleep quality, excite the HPA-Axis, reduce pain tolerance, prompt cravings for high carbohydrate foods

– Questions

– In an average week how much time is spent on each emotion (baseline charting is helpful)-

– What triggers each emotion-

– What stressors are currently present-

– What stressors have you experienced in the past 12 months-

– What is different when you are happy-

– How long does it take for you to calm down after you get upset-


Cognitive Assessment

– Dopamine, norepinephrine, serotonin, oxytocin, estrogen imbalances can all cause cognitive dysfunction

– Cognitions can cause biological, emotional and behavioral changes which throw hormones and neurotransmitters out of balance and impact the mind, body, relationships and environment

– Negative Ned

– Positive Pete


Cognitive Assessment

– Assess Functioning

– Attention/concentration

– Memory

– Problem solving

– Assess Cognitive HPA-Axis Triggers

– Negative Attitudes/Perceptions (Learned responses)

– Hardiness (Lack of)

– Locus of control

– Cognitive distortions

– Negative self-talk

– Time management


Environmental

– Safety

– Noise

– Light

– Darkness

– Blue-light

– Smells

– Noxious

– Triggering

– Assistive (insomnia, sleep, anxiety, pain , depression, cortisol)

– Air pollution

– Carbon dioxide & nitrous oxides, Carbon monoxide (home), Volatile Organic Compounds (VOCs), tobacco smoke

– Temperature


Relationships

– Self-esteem and self-efficacy

– Relationship with self as capable, lovable and deserving

– Attachment (oxytocin, serotonin, dopamine, endogenous opioids)

– Healthy attachment without abandonment fears

– Boundaries

– Ability to set and maintain healthy emotional and physical boundaries

– Communication skills

– Ability to identify and communicate feelings and thoughts and get needs met

– Social support system

– Accessible functional and emotional support and engagement

– Animals/Pets

– Relationship with support animals


Summary

– Our current uni- or bi-dimensional approach (medication, counseling or medication+counseling) to treatment does not work for the majority of people.

– There are a myriad of underlying “causes” of distress, and most people have multiple contributing factors. (More to come)

– If your air conditioning bill was suddenly ridiculously high would you pull down all of the blinds- What impact would that have- Would it solve the whole problem-

– Would you turn up the AC so it didn’t run as often and pull down the blinds- What impact would that have- Would it solve the whole problem-

– A transdiagnostic approach works to identify all of the causes of the symptoms, understand their interrelationship and causes and develop a multidimensional treatment plan based on what the client is most motivated to address.

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Overview of the PACER Method

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