1	Too Tired To Keep Juggling
2	Summary Teachers have always been jugglers. Many juggle too much for too long and get too tired. Some may eventually seek the help of a psychologist. They may present with tormenting fears, sickening depression, and relentless pains. I describe a two-phase “hot” cognitive-behavioural approach to these conditions that may include EMDR and biofeedback components.
3	Learning Objectives Can identify 3 reasons that teachers avoid psychological treatment Can identify 3 psychological conditions common to teachers Can briefly describe CBT Can describe 2 core approaches to stress
4	Juggling What? Covering curriculum Managing special needs in class Involvement on committees Extra-curricular activities Communication with parents
5	And That’s Not All … Budget cuts Greater teacher:student ratio Less teacher support for special needs students (e.g., TAs) Losing counsellor & library positions The downside of greater parent involvement in school-based decisions
6	And That’s Still Not All … Children at home? Elderly parents? Partner/Spouse? Other social commitments (friends)? Financial commitments?
7	What to Do? Change the Stressors Remove, postpone, delegate, alter the stressor Or Adjust to the Stressors RESPONSE-ability: if can’t change stressor, change personal response to it perceptual change (pain: from enemy that is fought to border that is lived around) behavioural change (pain: ergonomic changes)
8	What is done? Stop working (Absenteeism) Keep working (Presenteeism) Intermittent Working (Absent/Presenteeism?)
9	Get Help? Maybe Not It’s not that bad. I don’t have time. I’ll get over it (And other variations on denial) It’s not psychological … It’s me … I’m not good enough (And other variations on self-blame) What will others think? (stigma)
10	What Help? Implement anti-stress strategies Talk to a friend (on staff?) Get informed (workshops, books) Consult a physician? EAP provider? (the pros, cons)
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12	Tormenting Fears Generalized fears (GAD) Specific fears (Specific Phobia) Posttraumatic fears (PTSD) Obsessive fears (OCD) Somatoform fears (Hypochondriasis) Sheer panic (Panic Disorder; Agoraphobia)
13	Sickening Depression Mood vs. feelings Depressed mood Apathy or anhedonia Other signs & symptoms
14	Relentless Pains Persistent pain, often in several locations May seem disproportionate Lasts longer than is typical Does not respond to rehab. Caused and/or perpetuated by psychological factors (sleep, anxious/depressed mood, addictions, excessive protection & avoidance)
15	Full Meal Deal Pain – Anxiety - Depression Perverse synergy Poorer prognosis Good news
16	What do teachers want from a psychologist? Education Reassurance Coping Strategies An exit strategy Safe place to crash A care taker New hope/vision
17	Toffee
18	Treatment Phases Phase 1: Off-work tx towards sx improvement sufficient for RTW trial Phase 2: Testing tx gains in real work situation
19	Cognitive-Behavioural Therapy
20	What is CBT? A hybrid: Cognitive therapy + Behaviour therapy = CBT An attempt to increase BT success by modifying thoughts Assumption: modifying thoughts & behaviour changes feelings
21	What is CBT? Time limited (12 – 24 tx hours) Active (in session; homework) Present centred Goal oriented Equipping with knowledge & skills
22	Cognitive Interventions Mood monitoring Identifying cognitive distortions automatic thoughts (e.g., black/white) Choosing & testing alternative thinking in real life experiments
23	Hot CBT Using experiential strategies to access “hot” cognitions Expanding affect Working with metaphors
24	Behavioural Interventions Functional analysis What changed (increases, decreases) in your thoughts & activities since you last felt well as a teacher? What changed in your teaching environment? Other environments? (home, neighbourhood, province, country, world)
25	Behavioural Interventions Increase pleasant, social, & mastery activities Self-calming strategies (breathwork) Systematic desensitization Acceptance vs. change work
26	Relapse Prevention Normalize recurrence of some sx Anticipate triggers & stressors Develop social supports Review & rehearse adaptive coping
27	EMDR
28	EMDR Method Use of bilateral eye movements by following the therapist’s fingers back & forth. Common alternatives are bilateral clicks (finger snaps), tones and tapping (usually on the knees). There are also one-eye techniques and an EMDR variant called One Eye Integration.
29	Hooper
30	EMDR Rationale EMDR method as a form of Accelerated Information Processing Perhaps EMDR taps into the same mechanisms used in learning and memory identified with REM sleep. Perhaps EMDR initiates improved hemispheric communication. Perhaps EMDR causes an orienting reflex change in neurophysiological functioning.
31	EMDR Tx Phases Client History Preparation Assessment Desensitization Installation Body Scan Closure Re-evaluation
32	EMDR Distinctives Bilateral activation Less talk Re-exposure to trauma important Client-centred Somatic focus Change can be unexpected
33	Biofeedback Traditional Neurofeedback Hemoencephalography
34	Time for a Break
35	RTW Phase (2) Generalizability of treatment gains A graduated RTW (GRTW) The help of a mentor or colleague
36	Outcome Evaluation
37	CBT for Depression Strong support for CBT randomized controlled studies meta-analytic reviews Also support for: Cognitive Therapy Behaviour Therapy Interpersonal Therapy
38	Alternative Treatment (Depression) Combined psychosocial & medication Strongly supported by at least one major study SSRIs & several new compounds (Wellbutrin) Support from RCT with placebo controls
39	CBT for Pain Disorder CBT Individual or Group Reduces pain-related distress & disability (usually not pain) Several favourable RCTs
40	Alternative Treatment (Pain Disorder) Cognitive Therapy, Behaviour Therapy Some support Medications Antidepressants (numerous supportive RCTs); reduce pain and associated sleep & mood disturbance. E.g. large meta-analytic study of amitriptyline
41	CBT for Anxiety Exposure Therapy, Anxiety Management Therapy Strong support from good studies (RCT)
42	Alternative Treatment (Anxiety) EMDR Good support for PTSD treatment from studies of civilian trauma vs. controls Antidepressants Strong support (RCTs with placebo controls) Behaviour Therapy, SSRI Meds, EMDR Meta-analytic studies
43	Howard
44	The Happy Juggler
45	Learning Objective #1 Can identify 3 reasons that teachers avoid psychological treatment Denial Self-blame Stigma
46	Learning Objective #2 Can identify 3 psychological conditions common to teachers Pain Anxiety Depression
47	Learning Objective #3 Can briefly describe CBT A brief, active & goal-oriented therapy that uses cognitive and behavioural strategies to decrease abnormal emotional states.
48	Learning Objective #4 Can describe 2 core approaches to stress Change stressor (e.g., remove) Adjust to stressor
49	Thanks for the invitation!
50	What Do YOU Think? OPEN DISCUSSION
51	Remember …