Sunday, August 2, 2026

Adverse Childhood Experiences (ACES) Applied by Keith Torkelson, MS, BS

 

Contents – Adverse Childhood Experiences (ACES)

 

Requirements
Why Publish?
Causation
Results Up Front
Interpret an ACES score of 4.4
Assessment 17-Items
Cutoffs
Graph
Teen Warning Signs
ACE @ 13
Toxic Stress
Forgiveness V Reconciling
Grave Outcomes
Therapy
Growth
Sliding Doors
Boarding School
Near Death Experiences
Costs of Adverse Childhood Experiences (ACEs)
9-Item Screener
8-Item Screener
How is it Normal People?
Why Investigate?
Rough Childhood
Delinquency
Role Models
Berserks
Anger
The Block
ACES Assessment – Online
Original Errors in Childhood
Conflict @ Home
Stop the Cycle

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Losses Equal Gains

The premise that losses equal gains does not hold true in behavioral sciences; instead, research shows that losses have a much stronger psychological impact than equivalent gains. This phenomenon is known as loss aversion.

The Core Concept: Loss Aversion

Unequal weight:

Psychological studies demonstrate that the pain of a loss is roughly twice as intense as the pleasure of an equal gain.

Decision making:

People change their behavior more drastically to avoid losing something they have than to get the same thing.

Social context:

In sociology and social psychology, this framing affects choices like peer conformity, where individuals act to prevent a loss of social status rather than to gain new status.




That’s Keith on the Right with Candace on the Left

 

Aside - After Minnesota: 20220811-TH: For ASK

 

Why publish a paper on ACES?

Publishing research on Adverse Childhood Experiences (ACEs) is crucial for establishing the physiological link between early-life trauma and long-term health, shifting adversity from a purely social issue to a clinical priority.

Publishing allows researchers and clinicians to:

Establish the Dose-Response Curve:

Demonstrate how higher ACE scores statistically correlate with severe adult health risks, including cardiovascular disease, depression, and substance use.

Drive Policy Changes:

Provide actionable, evidence-based data that advocates and legislators use to fund trauma-informed care and preventative community programs.

Guide Clinical Best Practices:

Standardize how medical and educational systems screen for trauma and respond without re-traumatizing patients.

Explore Under-Researched Areas:

Identify how systemic factors like socioeconomic status, racial discrimination, or protective factors (Positive Childhood Experiences) alter individual outcomes.

 

Break Even - Costs of Adverse Childhood Events

Adverse Childhood Experiences (ACEs) impose a massive economic burden, estimated at $14.1 trillion annually in the U.S. due to direct medical spending and lost productivity. Affecting over 60% of adults, these experiences (abuse, neglect, household dysfunction) drive high costs through chronic illness, mental health conditions, and lower educational/employment attainment.


Why are cause analyses important?

Cause analysis is important because it prevents repeat issues, fixes real core problems instead of surface signs, and saves time and money.

Key Benefits

Stops repeats:

Keeps the same error from happening again by fixing the deep-down source.

Saves money:

Cuts out the high cost of doing quick, temporary fixes over and over.

Builds safety:

Lowers risk and stops accidents in high-risk jobs.

Makes work better:

Helps teams build stronger, faster, and cleaner daily work habits.


 

Results Up Front

By and For Keith “Buster” Torkelson, MS, BS

Low Scores are Favorable (LSF)



Interpret an ACES score of 4.4

An ACES (Adverse Childhood Experiences) score of 4.4 indicates that a person experienced multiple types of childhood trauma. In clinical contexts, it places the individual in a high-risk category for toxic stress, which can have long-lasting effects on both physical and mental well-being in adulthood.

The Breakdown

The original ACE questionnaire is a 10-point checklist evaluating traumatic events before the age of 18. Scores are generally whole numbers (e.g., 0 to 10) for the standard test, but some extended clinical evaluations average scores across multiple categories to arrive at a decimal figure.

An ACE score of 4 or higher is considered high cumulative risk.

Statistical Health Risks

Groundbreaking studies by the CDC and Kaiser Permanente demonstrated a strong, dose-response relationship between higher ACE scores and the statistical likelihood of negative life and health outcomes.  Adults with an ACE score of 4 or higher statistically face significantly elevated risks for:

Mental & Behavioral Challenges:

Heightened vulnerability to depression, severe anxiety, and substance use disorders.

Chronic Physical Disease:

Increased risk for autoimmune diseases, coronary heart disease, stroke, chronic pulmonary lung disease, and liver disease.

Toxic Stress Physiology:

Prolonged "fight-or-flight" stress during childhood can disrupt the development of the nervous, cardiovascular, and immune systems.

What the Score Doesn't Mean

Crucially, an ACE score is not a diagnosis or a destiny. It is simply a statistical tool used to assess risk. Having a score of 4.4 does not guarantee that an individual will develop these conditions. Many people with high ACE scores live healthy, fulfilling lives by building resilience through strong support networks, healthy lifestyle choices, and trauma-informed care.

 

AI - If you'd like to explore this topic further, I can help by:

Detailing the 10 standard categories used in the ACE assessment.

Discussing resilience-building strategies to mitigate the effects of toxic stress.

Providing resources to find trauma-informed care or licensed mental health professionals.

Would you like to focus on strategies for building resilience, or would you prefer to learn more about the 10 specific types of events the ACE questionnaire measures?


[TRANSFORMATION]

Question Starter: Before your 18th birthday…

Yields – Adverse Childhood Score





Aside - What is Librium used for?

Librium (chlordiazepoxide) is a prescription benzodiazepine primarily used for the short-term management of anxiety disorders and acute alcohol withdrawal symptoms. By enhancing the calming neurotransmitter GABA in the brain, it slows down the central nervous system to reduce agitation, relax muscles, prevent seizures, and ease pre-operative anxiety. Librium is highly effective for its approved indications, but it carries a significant risk of dependence, tolerance, and addiction. Because of this, it is typically prescribed for short-term use (generally under 4 months) and requires careful medical supervision.

 

Note – In the 1970s one or both of my parents were prescribed Librium.  We also had phenobarbital in the house and I never tried it.  Maybe I would have benefitted from Phenobarbital.


Cutoffs

Abnormal 18 year old

An "abnormal" behavior or trait in an 18-year-old typically refers to warning signs that deviate significantly from typical young adult development. While mood swings and boundary-testing are normal, red flags include prolonged social withdrawal, extreme aggression, self-harm, severe academic decline, or substance abuse. Because the human brain continues to develop until the mid-20s, early adulthood is a peak time for the onset of various mental health disorders.  Recognizing these issues early is critical, as conditions like depression, anxiety, or emerging personality disorders can severely impact a young adult's life.

 

Abnormal 16 year old

At 16, normal adolescent behavior can occasionally mimic "abnormal" signs, but distinguishing between typical teenage boundary-testing and true red flags is critical. Severe or prolonged changes in mood, extreme social withdrawal, dropping grades, self-harm, or substance use are primary indicators that your teen may need professional help. Recognizing whether a 16-year-old’s behavior requires professional intervention involves watching for specific warning signs and comparing them to expected developmental milestones.



Teen Warning Signs

Teen warning signs encompass persistent changes in mood, behavior, academics, or physical health. Red flags include social withdrawal, significant shifts in sleep or appetite, reckless behavior, and direct or indirect remarks about death. Always take suicidal ideation seriously. Recognizing the difference between typical adolescent growing pains and serious distress can be challenging, but understanding specific categories can help you spot when a teen needs intervention:

Emotional and Mental Signs

Extreme Mood Swings:

Frequent, intense irritability, anger, or sadness that seem disproportionate and last more than two weeks.

Persistent Hopelessness:

Expressing feelings of being worthless, trapped, or having "no reason to live".

Anxiety:

Excessive worrying, nervousness, or avoidance of certain social situations, accompanied by physical symptoms like recurring headaches or stomachaches.

Behavioral and Social Red Flags

Social Withdrawal:

Shutting down, refusing to attend school, or isolating from family, friends, and previously enjoyed activities.

Sudden Secrecy:

Uncharacteristic lying, hiding activities, or becoming defensive when asked simple questions.

Reckless Behavior:

Engaging in risky sexual activity, vandalism, shoplifting, or dangerous driving.

Substance Use:

Unexplained injuries, memory lapses, or finding substances/paraphernalia among their personal effects.

Physical and Academic Changes

Neglect of Self-Care:

Noticeable decline in personal hygiene, wearing the same clothes for days, or sudden drastic changes in weight.

Academic Decline:

Sudden drops in grades, missing classes, or a complete lack of enthusiasm for schoolwork.

Sleep and Energy Disruptions:

Persistent insomnia, severe fatigue, or sleeping excessively.

Immediate Crisis Indicators

Talking, writing, or joking about death or suicide.

Giving away possessions for no logical reason.

Writing goodbye notes or saying farewells.

If you are noticing these patterns, professional support can make a major difference. For a comprehensive overview, review the Mental Health Warning Signs in Teens guide from the Jed Foundation. To find local therapists or adolescent care programs in the Buena Park, CA area, consult the Psychology Today Therapist Finder.

 

Adverse Childhood Events and being 13 years old

Adverse Childhood Experiences (ACEs) are potentially traumatic events occurring before age 18. At age 13, the early teenage brain is undergoing rapid restructuring, making youth highly vulnerable to the "toxic stress" caused by ACEs, which include abuse, neglect, or household dysfunction.

ACEs at this developmental stage often result in severe immediate and long-term impacts:

Mental Health:

Thirteen-year-olds dealing with trauma are at a significantly higher risk of experiencing frequent anxiety, depression, and social isolation.

Behavioral Changes:

Trauma can trigger coping mechanisms such as self-harm, substance experimentation, or aggressive behaviors.

Physical Health:

Prolonged stress response can alter physical development, sometimes leading to sleep disruptions, headaches, or even elevated blood pressure.

Long-Term Risks:

Untreated trauma increases the likelihood of chronic health conditions (like heart disease or obesity) and socioeconomic challenges in adulthood.  Fortunately, the impacts of ACEs are not destiny. Having at least one stable, supportive relationship with a caregiver or adult can act as a powerful buffer against toxic stress. 

Toxic Stress

Toxic stress is the prolonged, excessive activation of the body's stress response system. It happens when an individual—especially a developing child—faces continuous hardship without the emotional support of a reliable caregiver to help them recover.

Why It's Harmful

Unlike normal or "tolerable" stress (which involves short bursts with time to recover), toxic stress triggers a constant flood of stress hormones like adrenaline and cortisol. Over time, this constant high alert changes the physical architecture of the brain, suppressing areas responsible for learning and memory while enlarging the brain's fear centers.

Causes and Symptoms

Toxic stress is most often caused by persistent adversity such as:

Physical or emotional abuse, and chronic neglect

Exposure to domestic violence, community crime, or war

Extreme poverty, homelessness, or severe food scarcity

Parental substance abuse or untreated mental health issues.

Symptoms in children can include extreme vigilance, withdrawal, behavioral regression, difficulty concentrating, and frequent physical complaints like stomach aches or headaches.
Symptoms in adults include memory struggles, chronic anxiety, and a feeling of being disconnected or detached from one's surroundings.

Long-Term Health Risks

If left unaddressed, the physiological toll of toxic stress increases the lifetime risk for numerous chronic conditions, including:

Anxiety and depression

Asthma, heart disease, and autoimmune disorders

Chronic pain and substance use disorders

How to Mitigate and Recover

The most effective buffer against toxic stress in childhood is the presence of at least one stable, caring, and responsive relationship with an adult. For adults experiencing or recovering from toxic stress, building strong support networks, seeking professional counseling (such as trauma-informed cognitive behavioral therapy), and practicing self-regulation techniques are highly recommended.

You can read more about how this stress impacts brain development on the Harvard Center on the Developing Child page, or access coping strategies through UNICEF Parenting.

Forgiveness versus reconciling

Forgiveness is a unilateral, inward process of letting go of resentment and the desire for revenge for your own peace of mind. Reconciliation is a two-way process that restores a broken relationship, requiring mutual trust, accountability, and changed behavior from the offending party. Understanding the distinction between these two concepts is crucial for emotional well-being and personal safety.




Grave Individual Health Outcomes

A "grave prognosis" indicates a medical condition with a high risk of mortality and minimal likelihood of meaningful recovery. It does not automatically mean a death sentence, but necessitates immediate, specialized medical intervention and comprehensive palliative care planning.

 

Factors Driving Grave Outcomes

Individual health outcomes are heavily influenced by the following factors:

Medical Adherence:

Managing chronic or life-threatening conditions requires rigorous medication or therapy compliance to delay disease progression.

Social Determinants of Health:

Factors like housing insecurity, unemployment, and material or psychological financial hardship are strong predictors of worse prognosis and higher all-cause mortality across all age groups.

Disparities in Access:

Restricted access to healthcare accounts for approximately 10% of premature deaths, while systemic socioeconomic disparities heavily impact access to high-quality palliative or end-of-life care.

Psychological and Traumatic Events:

Severe, sustained grief or highly stressful life events can predispose individuals to physical illnesses and are strongly associated with increased long-term healthcare utilization and excess mortality.


Therapy

Laura Adams’ Take

In 2004 I tallied my incidences of being a victim of abuse.  At the time our family was at war within.  I needed someone to validate my position.  I needed a break from my family in order to avoid long term institutionalization.  I signed up with Laura Adams for psychodynamic therapy.  I needed results in 3 sessions costing $60 each.  Laura Adams PhD, LMFT indicated that our abuse history was seriously problematic and remarkable.  She was not helpful and a year of institutionalization ensued till 2005. 

 

STAYED - Insert Inventory of Physical Abuse

Benefits of Adverse Childhood Events

Adverse Childhood Experiences (ACEs) are overwhelmingly associated with negative health and social outcomes; however, research in developmental psychopathology and psychology identifies certain ways individuals can adapt or grow from these experiences. The potential "benefits" are typically framed as post-traumatic growth or resilience-building rather than inherent advantages of the trauma itself:

 

Resilience Development:

Overcoming ACEs can lead to the development of resilience, defined as the ability to bounce back from challenges and adapt to future stressors.

 

Adaptive Coping Skills:

In some contexts, individuals with ACEs may develop adaptive coping strategies that provide temporary relief or survival in high-stress environments, though these can become detrimental if they persist into adulthood.

 

Strengthened Emotional Regulation:

Through therapeutic interventions like Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), survivors can develop advanced emotional regulation and mindfulness skills that may eventually surpass those of individuals who never faced such challenges.

 

Enhanced Compassion and Purpose:

Healing from ACEs often involves finding meaning and purpose by helping others, which can foster deep compassion and lead individuals to become positive forces in their communities.

 

Incentive for Positive Childhood Experiences (PCEs):

Awareness of ACEs has led to the prioritization of Positive Childhood Experiences (PCEs), which are proven to promote adult mental health, flourishing, and relational health.

 

Prevention

While these strengths can emerge, it is critical to note that preventing ACEs remains the primary goal due to their strong links to chronic health problems and mental illness.

Aside - Sliding Doors

When Helen (Gwyneth Paltrow), a London ad executive, is fired from her job and rushes out to catch a train, two scenarios take place. In one, she gets on the train and comes home to find her boyfriend, Gerry (John Lynch), in bed with another woman. In the second, she misses the train and arrives after the woman has left. In the first scenario, Helen dumps Gerry, finds a new man and gradually improves her life. In the second, she becomes suspicious of Gerry's fidelity and grows miserable.

 

Sliding Doors Release date: April 24, 1998 (USA)
Director: Peter Howitt - Screenplay: Peter Howitt
Box office: 67 million USD
Budget: 6 million USD

 

Boarding School our Sliding Door

My father used to tell me he should send me to boarding school.  Looking back I probably would have benefited from boarding school beginning eight grade.  Is wasn’t the school part I needed it was the social part studying with kids focused and on track to succeed in education and employment.  Yet in the boarding school scenario I would have likely not ended up at UC Davis.  I have great memories of UC Davis from 1982-1988.

Advantages of Boarding School

Boarding schools offer a transformative, immersive environment that builds early independence, resilience, and strong study habits. By living on campus, students benefit from small class sizes, 24/7 access to teachers, and a distraction-free setting that accelerates personal growth and college preparation.

Key advantages include:

Academic Excellence:

Schools often feature exceptionally small class sizes (often 6:1 or 7:1), specialized facilities, and faculty who live in dorms, providing mentorship well after the final bell rings.

Independence and Life Skills:

Living away from home forces students to manage their own schedules, do laundry, and resolve conflicts, making the transition to college seamless.

Structured Daily Life:

A predictable balance of classes, mandatory study hours, and extracurriculars builds time management and discipline.

Global Diversity:

Immersive dorm and campus life exposes students to diverse regional and international peers, fostering empathy and cross-cultural awareness.

Extensive Extracurriculars:

Without the need to commute, students have easy access to robust athletic, artistic, and debate programs right on campus.

College Prep:

Dedicated college counseling departments offer targeted application strategy, essay workshops, and interview prep.

Families can explore specific options and compare student-to-teacher ratios using resources like the Boarding School Review.

 

The kids that need to get out of town the most can’t afford it

This is a heartbreaking reality of the growing "summer opportunity gap," where lower-income children are priced out of nature, camp, and travel experiences. While affluent families enroll children in structured activities, more than half of working-class parents nationwide cannot afford summer programs. This leaves the youth who would benefit most from a change of scenery isolated in hot, under-resourced neighborhoods.

 

Aside - Serious Problems – Things could be worse

Accidental Manslaughter

Accidental manslaughter, legally termed involuntary manslaughter, is the unlawful, unintentional killing of a person resulting from criminal negligence or recklessness rather than malice. It occurs when someone acts with disregard for human life—such as drunk driving, mishandling a firearm, or extreme carelessness—leading to a death.

 

Stayed - Kyrule – Mistaken Belief

Costs of Adverse Childhood Experiences (ACEs)

Adverse Childhood Experiences (ACEs) impose a massive economic burden, estimated at $14.1 trillion annually in the U.S.. These costs include over $183 billion in direct medical spending and trillions in lost productivity. Nearly 63% of U.S. adults have at least one ACE, with costs rising significantly for those with two or more.

 

ACEs Increase Health Risks

According to the Adverse Childhood Experiences study, the rougher your childhood, the higher your score is likely to be and the higher your risk for various health problems later.

 

Outcomes & Prediction - 9-Item Screener

Adverse Childhood Experiences have been linked to

By and For Keith “Buster” Torkelson, MS








Note - 20220818-TH: Phone Interview with ASK

For determining in family cutoff score

“If you don’t feel comfortable you may opt out”

 


 

Interpretation of ACES scores

Adverse Childhood Experiences (ACEs) scores (0–10) measure childhood trauma, with higher scores strongly correlated to increased risks of chronic diseases, mental health issues, and social challenges in adulthood. A score of 4 or more is a high-risk indicator for severe health challenges, including addiction, heart disease, and reduced life expectancy.

 






Pending - Age 0 to 12 (ACES)

 

  • Physical Abuse
  • Emotional Abuse
  • Sexual Abuse
  • Physical Neglect
  • Emotional Neglect
  • Mental Illness
  • Incarcerated Relative
  • Mother Treated Violently
  • Divorce
  • Substance Abuse

 

Why is it hard to believe there are normal people?

It is hard to believe normal people exist because everyone hides their inner chaos behind a public mask, we judge others by their outer actions while judging ourselves by our hidden thoughts, and uniqueness is simply more common than a strict ideal of average.

The Hidden Self

The Mask: Most people act calm and put-together in public to fit in, hiding their true fears and quirks.

Private Chaos:

You know all your own messy thoughts and mistakes, but you only see the neat outward presentation of other people.

The Myth of Average:

"Normal" is just a statistical range, not an actual personality type where everyone thinks and feels the same way.

Why We Doubt Others?

The Comparison Trap:

We assume everyone else has life figured out because they do not broadcast their failures.

Focus on Flaws:

When someone does show a strange or difficult trait, it stands out strongly against the quiet background of everyday life.


Themes

Why investigate your childhood?

Investigating your childhood helps identify the root causes of current behavioral, emotional, and physical health issues by understanding how early experiences shaped your brain development, stress responses, and relationship patterns. It allows for healing trauma, reducing long-term health risks like heart disease, and breaking negative, subconscious cycles.

 

Sub-par Family Therapy

Sub-par family therapy often fails due to poor engagement, lack of clear goals, or addressing the wrong subsystems, leading to ineffective boundary restructuring. High-quality, specialized therapy should foster cohesion, while inadequate approaches may aggravate conflicts, ignore safety issues like abuse, or mismanage complex power imbalances within the family.

 

Role of Psychiatrist (Bera)

A psychiatrist is a medical doctor (MD or DO) who specializes in mental health, diagnosing and treating complex mental, emotional, and behavioral disorders. They evaluate both mental and physical symptoms to create comprehensive treatment plans, which commonly include prescribing medication, psychotherapy, and specialized treatments like TMS or ECT

 

Note - Friday’s with Joyce (JMB)

Promotion – Laura Adams

https://www.southoctherapist.com/

 

Need to Determine Score MAX

 

Judge Judy

“I protect those that cannot protect themselves”

 "I protect those that cannot protect themselves" is a common oath or motto emphasizing duty to defend the vulnerable, frequently appearing in fiction and RPG contexts. It is commonly associated with heroic archetypes like knights, paladins, or in the novel My Eternal Light.

 

Transparency in Behavioral Health

Transparency in behavioral health involves making data on treatment, funding, provider networks, and insurer compliance publicly available to improve accountability, access, and outcomes. Key initiatives include the Behavioral Health Coverage Transparency Act, which enforces mental health parity, and California's Proposition 1, which increases reporting on county expenditures and outcomes.

 

Accountability in Behavioral Health

Accountability in behavioral health ensures high-quality, equitable care by aligning provider actions with evidence-based practices, patient goals, and systemic standards. It involves tracking performance metrics, enforcing professional ethics, and implementing regulatory oversight, such as the California Mental Health Services Oversight and Accountability Commission. Effective accountability spans systemic, provider, and individual levels to improve patient outcomes, such as those overseen by the Mental Health Services Act.

 

FYI - BHSOAC

https://bhsoac.ca.gov/

BHSOAC stands for the Behavioral Health Services Oversight and Accountability Commission. It is a California state agency created by the Mental Health Services Act (Prop 63) to provide oversight, accountability, and leadership for the state's behavioral health systems.

 

Juvenile Delinquent

Juvenile delinquency refers to criminal acts or offenses committed by minors, typically under 18 years of age, ranging from status offenses (truancy, curfew violations) to serious violent crimes. It is rooted in factors like impulsive behavior, poor school performance, and unstable family environments, with the justice system focusing on rehabilitation over punishment.

 

McDaniel Delinquency – Rough Childhood

Cumulative Activities: 13 individuals: Drinking, smoking, shop-lifting, fighting, grand-theft auto, inappropriate sex, violence, DUI, burglary, stealing from parents, lying, street fighting, etc.

 

CET
KGT
LH
DH
DB
BR
JR
TA
RB
JPL
GEG
JR
SH (Female)

What are the four main types of juvenile delinquency?

AI Overview

The four main types of juvenile delinquency are individual, group-supported, organized, and situational delinquency. These categories help explain the social and personal settings behind unlawful acts done by minors.

Breakdown of the Four Types

Individual delinquency:

A single young person acts alone. The root cause usually comes from personal psychological problems or family trouble.

Group-supported delinquency:

Young people commit illegal acts with friends or peers. Peer pressure and the surrounding environment drive this behavior.

Organized delinquency:

Minors join formal, structured groups or gangs. These groups follow their own set of rules, roles, and criminal plans.

Situational delinquency:

A minor breaks a rule in a specific, sudden moment. It happens due to weak self-control or a tempting setting rather than a long-term habit.

Using Insane to Describe Something

"Insane" is an adjective used to describe something as irrational, foolish, or extremely intense, often functioning as slang for "crazy" or "wild". It can describe situations (e.g., "the traffic is insane"), ideas, or amounts, suggesting a lack of logic or extreme excess.

Genetics of Adverse Childhood Experiences

Adverse Childhood Experiences (ACEs) have a strong genetic component, acting through both inherited predispositions to risk and epigenetic modifications. Research shows that genetic factors can make individuals more sensitive to environmental stressors, and that ACEs can cause lasting, intergenerational epigenetic changes—specifically in DNA methylation—that affect how genes are expressed without altering the underlying DNA sequence.

 

Nurture and Adverse Childhood Experiences

Adverse Childhood Experiences (ACEs)—such as abuse, neglect, or household dysfunction—create toxic stress that disrupts brain development and causes long-term physical, mental, and social issues. Nurturing, stable, and safe relationships act as a vital buffer, fostering resilience and mitigating the lasting negative impacts of these traumatic experiences.

Milestones

Ages = 5 & 8 &10 &13 & 17

 

DTY = Died Too Young | RM = Role Model

Role Models




Berserkers

Berserkers were elite Norse warriors known for entering a frenzied, animalistic "battle rage" (berserkergang) during combat, fighting with uncontrollable strength and disregarding safety. Historically, they are linked to Odin, often wearing bear or wolf skins, and their name likely means "bear-shirt," originating from Old Norse ber (bear) and serkr (shirt).

 

Berserker Rage

Berserkers were elite Viking warriors known for fighting in a trance-like, uncontrollable fury called berserkergang, often wearing bear or wolf skins. This frenzy, likely induced by rituals, extreme self-hypnosis, or perhaps intoxicants, allowed them to fight with immense strength, ignore pain, and act with reckless savagery, often disregarding the safety of allies.

 

What is the difference between anger and rage?

Anger is a natural, manageable, and often rational emotion triggered by being wronged or threatened, aimed at setting boundaries. Rage is an extreme, uncontrollable, and destructive expression of anger, often stemming from suppressed emotions, which causes emotional damage and, in severe cases, is used as a tool to intimidate or harm, says BPDFamily.com.

 

Anger in proportion to the infraction/transgression

Anger proportional to a transgression—often termed "proportional" or "justifiable" anger—functions as a constructive response to injustice, boundary violations, or moral harm. It matches the severity of the offense, acts as a signaling mechanism for moral standards, and promotes boundary setting.

 

Family shot caller goes away to college

Sending the eldest child to college is a significant, emotional milestone that marks the start of a new family phase, characterized by immense pride mixed with profound sadness. Parents often experience "empty nest" feelings, needing to adjust to a quieter home, while supporting the student's independence through balanced, often weekly, communication.

This was Anger

Anger for the girls and rage for the boys

 



Cohorts

Matrix - Asocial Classification – “The Block” off The Block

Genetics – Phenotypes – Risk Factors

Date Scored: 20220304-F:




CoC = Co-conspirator | DTY = Died Too Young | RM = Role Model

 

Take the ACEs Assessment

Promotion - BraveBe

https://www.bravebe.org

Start with Self Awareness — Your story matters. Take the ACEs test to start healing your childhood trauma. Adverse childhood experiences (ACEs) shape your pain, but this test can help you heal. Free Assessment.

https://bravefaces.typeform.com/adult?typeform-source=www.bravebe.org

 

20260404-SA: Your ACEs Score: 5

Think of your ACEs score as a tool to understand childhood adversity and its potential effects on your health.With a score of 5, you are at high risk for long-term physical and mental health issues, including depression, anxiety, heart disease, and substance abuse. Getting trauma-informed support and resources can empower you to heal, grow, and build a brighter future.

 

For an in-depth look at each score category and to find resources, visit the Brave fACEs website.

 

Behavioral Risks

Behavioural risk refers to the potential for negative impacts on an organization or individual due to human actions, decisions, or cultural flaws, rather than just technical or systemic failures. In business, it involves poor culture, unethical conduct, and cognitive biases that threaten productivity, while in health, it refers to lifestyle factors like smoking or poor diet.

 

Physical Risks

Personal physical risks primarily stem from lifestyle factors, workplace hazards, and medical predispositions. The most common daily threats include cardiovascular disease, metabolic syndrome, and musculoskeletal issues exacerbated by prolonged sitting and physical inactivity. Managing these risks requires targeted preventative health measures and awareness

 

Protective Factors

Protective factors are characteristics, conditions, or behaviors—such as strong social connections, resilience, and nurturing parenting—that promote well-being, reduce the risk of adverse outcomes, and help individuals thrive despite adversity. They build resilience, act as a safety net in times of crisis, and can be developed at individual, family, and community levels.

 

Trauma Informed Support

What Is Trauma Informed Care? Why Do We Need It? Trauma-informed support is a framework focusing on safety, empowerment, and understanding, recognizing that trauma affects individuals' physical, emotional, and psychological well-being. It seeks to avoid re-traumatization by creating trusting environments, offering choice, and acknowledging the role of trauma in behavior. Key elements include recognizing symptoms, integrating knowledge into practice, and fostering collaboration.

 

Post-traumatic Growth

Post-traumatic growth (PTG) refers to the profound positive psychological transformation some individuals experience after navigating a major life crisis or trauma. Coined by psychologists Richard Tedeschi and Lawrence Calhoun in the 1990s, PTG does not mean the trauma is erased; rather, it means an individual uses the struggle to foster a deeper, more meaningful life.

The 5 Domains of PTG

Researchers generally measure post-traumatic growth across five specific areas:

Personal Strength:

Recognizing an inner resilience and realizing, "If I survived that, I can survive anything."

New Possibilities: Pursuing different paths, interests, or career changes that may not have been considered prior to the trauma.

Improved Relationships:

Forging deeper, more empathetic, and trusting connections with loved ones or others who have experienced similar struggles.

Greater Appreciation for Life:

Developing a heightened gratitude for everyday moments, shifting priorities to what truly matters.

Spiritual or Existential Growth:

Evolving philosophical, religious, or spiritual beliefs and experiencing a refined sense of life's purpose.

PTG vs. Resilience

While often confused, resilience and PTG describe different aspects of recovery. Resilience is the ability to endure a challenging event, bounce back, and maintain your prior state of functioning. Post-traumatic growth involves a shift in perspective where the individual does not simply return to "normal," but emerges fundamentally transformed and living life with a new worldview.

Coexistence with PTSD

PTG does not deny the severe distress, anxiety, or ongoing symptoms associated with trauma. In fact, mental health experts agree that PTG and Post-Traumatic Stress Disorder (PTSD) can coexist. It is a process that takes time; one cannot usually grow in the middle of an active crisis. It is the subsequent cognitive processing—making sense of what happened—that allows growth to take root.

For more information on the psychological framework and how people cultivate this growth, you can read the American Psychological Association Overview or explore the Psychology Today Basics on the topic.


Aside - Assessment Versions
10 Items
17 Items Here

 

Stayed - Personality Trait Outcomes - Big 5 (50 Items)

 

Original Errors in Childhood

Original errors in childhood often stem from immature cognitive processing, imaginative misunderstandings of the world, or emotional misconceptions. Common errors include false memories, overgeneralization in language (e.g., "tooths"), magical thinking, and the "4 mistaken goals" (attention, power, revenge, or assumed inadequacy). These errors are normal developmental steps, though they can sometimes form lasting, incorrect self-beliefs.

 

Original Sin

Original sin is the Christian doctrine that all humans inherit a sinful nature, guilt, and propensity toward disobedience from Adam and Eve's fall in the Garden of Eden. It signifies that humanity is born into a broken state separated from God, requiring redemption through Jesus Christ, rather than being personally guilty from birth.

 

Buying into other peoples’ problems

"Buying into other peoples’ problems" refers to the tendency to take emotional or practical ownership of issues that belong to others. This behavior often stems from high levels of empathy, a desire to be helpful, or a subconscious need to find self-worth through fixing others.

 

Who is at risk of abuse?

  • Be getting older
  • Have a physical or learning disability, or have trouble seeing or hearing
  • Not have enough support
  • Have mental health problems
  • Be socially isolated
  • Live in inappropriate accommodation
  • Misuse alcohol or drugs
  • Have financial circumstances which make them higher risk

 

Screen out false reports method

Screening out false reports involves a combination of automated data validation, AI-driven analysis, and structured human review to identify and discard inaccurate, misleading, or malicious information. Effective methods depend on the context, such as background checks, whistleblower reports, or AI monitoring.

 

ACES Sanctioned by the Centers for Disease Control

The CDC-Kaiser Permanente Adverse Childhood Experiences (ACEs) study is a landmark, CDC-sanctioned research project (1995–1997) that established a direct link between childhood trauma and adult health problems. It identifies 10 types of childhood trauma—including abuse, neglect, and household dysfunction—that increase risks for chronic disease, mental illness, and socioeconomic struggles.


Take The ACE Quiz - And Learn What It Does And Doesn't Mean - NPR

https://www.npr.org/sections/health-shots/2015/03/02/387007941/take-the-ace-quiz-and-learn-what-it-does-and-doesnt-mean

March 2, 2015·2:57 PM ET - Laura Starecheski

 

Results

An ACE score is a tally of different types of abuse, neglect, and other hallmarks of a rough childhood. According to the Adverse Childhood Experiences study, the rougher your childhood, the higher your score is likely to be and the higher your risk for later health problems. You can take the test below:




20180531-TH: Online Version (Date of Assessment)

 

Adverse Childhood Experiences (ACEs)

[20260719-SU-Link test fails]

https://www.cdc.gov/violenceprevention/acestudy/index.html


Take The ACE Quiz

And Learn What It Does And Doesn't Mean - NPR

https://www.npr.org/sections/health-shots/2015/03/02/387007941/take-the-ace-quiz-and-learn-what-it-does-and-doesnt-mean

 

20220304-F: Your ACE score is 6

Remember this, too: ACE scores don't tally the positive experiences in early life that can help build resilience and protect a child from the effects of trauma. Having a grandparent who loves you, a teacher who understands and believes in you, or a trusted friend you can confide in may mitigate the long-term effects of early trauma, psychologists say.

 

My ACE Score could be Worse

The ACE (Adverse Childhood Experiences) score is a broad screening tool, not a competition or a measure of "who had it worse." A lower score does not invalidate any real struggles you face.

The test is fundamentally limited:

Severity vs. Frequency: It asks if an event happened, not how often or how severely.

Missing Elements: It does not account for positive childhood experiences (which can act as buffers) or other significant traumas like bullying or community violence.

No Individual Prognosis: It is a population statistic. Everyone's nervous system responds uniquely to stress.

Many mental health professionals agree that your daily symptoms and current quality of life are far more important than a static number.

Would you like to explore resources for managing specific symptoms, or learn more about how positive childhood experiences can counterbalance the negative ones? Let me know how you'd like to proceed.

 

Finger points to conflict within our house

When a single finger is pointed in conflict, it usually assigns blame, which instinctively makes the receiving person defensive and closes the door on real resolution. The most effective path forward is to stop blaming and start sharing your own feelings, as this encourages the other person to understand your perspective.

Shift from "You" to "I" Statements

When you point fingers or use accusatory language, it quickly escalates tension. Instead of using "You" statements that assign fault, shift to "I" statements. This allows you to own your emotions, describe the specific problem, and explain exactly how an action or situation impacts you.

 

Stop the Cycle

The Stop the Cycle (STC) program is a free prevention and early intervention service provided by the Orange County Health Care Agency (OCHCA) designed to support parents and siblings of youth involved or at risk of involvement with the juvenile justice system.

Program Overview and Goals

Target Audience: Parents, caregivers, and siblings (children and teens) of youth connected to the juvenile justice system.

Core Purpose: To build family resiliency, improve parenting skills, and prevent the progression of mental health or substance abuse issues in other family members.

Cost: Completely free of charge.

Services Provided

12-Week Parenting Groups: Weekly sessions focused on positive discipline, supervision, structuring the home environment, and strengthening protective factors.

Concurrent Youth Groups: Age-appropriate educational sessions for children and adolescents to build life skills, coping mechanisms, and personal resilience.

Family Sessions & Booster Meetings: Individual family meetings with program facilitators and periodic follow-up booster sessions to reinforce acquired skills.

Community Linkages: Referrals to additional local behavioral health and social support networks.

How to Contact / Access

Countywide Information Line: Call (714) 480-4678 for enrollment, schedules, and site locations.

General OCHCA Behavioral Health Support: For broad assistance or mental health navigation in Orange County, contact the 24/7 OC Links service at (855) 625-4657.

 





Saturday, August 1, 2026

Applied Crisis Intervention Management – Mechanisms – by Keith Torkelson, MS, BS

 

Contents

 

Requirements
Promotion – Kristi Kanel
Results Up Front
Ways of Coping
High Weight Crises
Book – A Guide to Crisis Intervention
Form – The ABC Model
Healthy Normal Mode
Steps to close out a crisis
Prevent Helper Burnout
Predisposition for MH Challenges
Anxiety V Mania
Onset of Mania
Testosterone
Anxiety and Mania – Co-occurring
Time Line
Risk Factor – Housing
Risk Factor – Child Abuse
Insecurity
Prevention and Protective Factors
Host Stress
Triggers, stressors and situations
Thinking
Emotions
Hurdles
Ways of Coping
Projected Losses
Seek Professional Input
Reasons to Live
Scenario
Precipitating Events
Subjective Units of Distress
Challenge
How can I stop complaining?



Promotion – Person of Interest - Kristi Kanel

About the author (2019)

Kristi Kanel (Ph.D., University of Southern California) is a Full Professor at California State University, Fullerton in the Department of Human Services where she has been teaching for over 31 years. She is the author of A GUIDE TO CRISIS INTERVENTION, 5th Edition; HUMAN SERVICE DELIVERY TO LATINOS, 2nd Edition; and AN OVERVIEW OF THE HUMAN SERVICES, 2nd Edition (with Melanie Horn-Mallers). Dr. Kanel was a practicing psychotherapist for over 25 years. Her experience as a counselor includes working at two non-profit agencies (the Anaheim Free Clinic and a battered woman's shelter), a public agency, a managed care organization, and in private practice where she worked with a multitude of client populations, specializing in trauma. Her most recent research has focused on the mental health needs and interventions for the veterans of the Iraq and Afghanistan wars. Other research includes mental health needs of Latinos and crisis intervention practices.

 

Kristi Kanel ABC Crisis Worksheet [Included later on]

Results Up Front

Applied CIM - Kristi Kanel – Model for Crisis Intervention

The DAR Mismatch

 

Crisis = Danger + Opportunity (Incidence when I get to ask for help

Name of Hurdle – Doug Allen Rochwell Cough and Moan - Mismatch

 

Date: July 10, 2026 (F)




CIM > Predict > Prevent > Prepare > Perform > Post Action


Applied CIM - Kristi Kanel – Model for Crisis Intervention

Advanced Planning

Crisis = Danger + Opportunity (Incidence when I get to ask for help)

Name of Hurdle – The Adverse Reactions to Medications & QOL

 

Date: July 10, 2026 (F)




CIM > Predict (Scenarios) > Prevent > Prepare > Perform > Post Action


Ways of Coping Questionnaire (WOCQ-66 item)


The Ways of Coping Questionnaire is a 66-item self-report tool created by Susan Folkman and Richard Lazarus in 1985 to measure cognitive and behavioral coping strategies used in specific stressful events. It uses a 4-point Likert scale (0 to 3) and features core subscales like confrontive coping, distancing, and planful problem-solving.

Structure and Scoring

Format:

66 total items, which include 50 coping items and 16 filler items not scored in the primary scales.

Scale:

Ranks items from 0 ("does not apply or not used") to 3 ("used a great deal") based on a specific stressful encounter chosen by the person.

Process Focus:

Measures situational coping rather than fixed personality traits, allowing repeated use over time.

Coping Subscales

Confrontive Coping:

Aggressive or risky efforts to change the situation.

Distancing:

Cognitive efforts to detach and minimize the event's importance.

Self-Controlling:

Efforts to regulate one's own feelings and actions.

Seeking Social Support:

Efforts to seek informational, tangible, or emotional help.

Accepting Responsibility:

Acknowledging one's own role in the problem.

Escape-Avoidance:

Wishful thinking and avoidance behaviors.

Planful Problem-Solving:

Deliberate, problem-focused efforts to alter the situation.

Positive Reappraisal:

Creating positive meaning and personal growth.

 

Related to - Crisis Prevention

Systems and training programs used to recognize, de-escalate, and manage aggressive or high-risk behavior before it leads to violence. The leading global provider for this training is the Crisis Prevention Institute, which specializes in fields like healthcare, education, and human services.

 


 

Ways of Coping

Coping strategies are tools you use to manage stress and big feelings. The main types are problem-focused coping, emotion-focused coping, and seeking social support.

Problem-Focused Strategies

Make a plan:

Fix the root cause or take step-by-step action.

Manage time:

Set clear goals and boundaries to reduce the load.

Ask for help:

Talk to someone who can fix or change the issue.

Emotion-Focused Strategies

Breathe deep:

Slow your breathing to calm your body.

Distract yourself:

Read a book, play a game, or do a hobby.

Move your body:

Go for a walk, run, or stretch.

Reframe thoughts:

Look at the bright side or change negative thoughts.

 

 

High Weight Crises (Sample)

 

  • Can’t access storage – Can’t work keypad due to shaking hand
  • Can’t reduce storage
  • Driving & Car Related
  • Hospitalization - Mental
  • Hospitalization – Physical
  • Housing
  • Loss of Freedom
  • Medication
  • Peace Chronically Disturbed – Especially in room
  • Sleep – Medication
  • Sleep - Actual
  • Tremors
  • Walking – Cane – Walker – Wheelchair - Bedridden

 

Promotion - Kristi Kanel – A Guide to Crisis Intervention, 4th Edition

Purchased in 2011











Develop a healthy Normal Mode

Developing a "healthy normal mode" means building a balanced, sustainable routine. The most effective approach focuses on small, consistent habits spanning four key pillars: nutrition, movement, sleep, and mental recovery. A simple blueprint can transition your default setting from surviving to thriving.

The 4 Pillars of a Healthy Default Mode

Nutrition (The 3-3-3 Rule):

Focus on a dietary pattern rich in whole foods.

3 Balanced Meals:

Base these around lean proteins, fiber, and healthy fats.

Hydration:

Drink at least one extra glass of water as soon as you wake up.

Fueling:

Avoid skipping meals, as it leads to energy crashes and cravings.

Movement (30-Minute Baseline):

Being active doesn't mean punishing yourself at the gym. Aim for at least 30 minutes of moderate physical activity daily (e.g., walking, yoga, or stretching). Break up long periods of sitting with micro-wins like stretching, taking the stairs, or taking a 10-minute walk after lunch.

Sleep Hygiene:

Quality rest is the cornerstone of a healthy lifestyle. Aim for 7 to 9 hours of uninterrupted sleep per night. Set a consistent sleep schedule and limit screen time 45 minutes before bed.

Mental Recovery:

Dedicate 3 minutes throughout the day to a digital detox or mental reset. Try box breathing, a quick meditation, or a short mindfulness practice to manage stress and lower cortisol levels.

How to Build Momentum

Start Small:

Choose just one small goal per week to work on. It could be taking the stairs instead of the elevator or swapping your afternoon soda for carbonated mineral water.

Embrace Consistency over Perfection:

You won't operate at 100% every day. Some days, your energy might only be 30%, but showing up in any capacity builds the habit of a healthy normal.

Track Your Progress:

Log how you feel as you build new habits. You can use health and wellness resources from trusted organizations like the American Heart Association or the Centers for Disease Control and Prevention to track and adjust your lifestyle goals.

 

Steps to close out a crisis

Closing out a crisis—whether personal, operational, or organizational—requires systematically transitioning from active containment to recovery, evaluation, and future preparedness. The process guarantees you are not just returning to normal, but actively building resilience.

A structured, 5-step closeout process establishes long-term stability:

1. Conduct a Post-Mortem Analysis

Review the entire lifecycle of the crisis to understand what transpired and evaluate how the team responded.

Document the timeline:

Track exactly how the crisis started, escalated, and resolved.

Evaluate response effectiveness:

Identify which decisions minimized damage and which were less effective.

Identify root causes:

Determine the underlying failures or triggers that led to the event.

2. Implement Recovery & Corrective Actions

Transition from damage control to fixing the structural vulnerabilities that the crisis exposed.

Address immediate fallout:

Ensure all pending tasks, pending repairs, or lingering issues are formally resolved.

Prioritize improvements:

Allocate resources to fix flaws so the exact same problem does not happen again.

3. Provide Closure to Stakeholders

Communicate transparently with everyone involved to formally mark the end of the crisis and rebuild trust.

Issue a final statement:

Clearly communicate that the immediate threat has passed, detailing the steps taken to resolve it.

Check on affected individuals:

Offer support mechanisms such as counseling, wellness check-ins, or stress management resources.

4. Update and Upgrade Plans

Update your internal response plans to reflect the insights gained from the recent event.

Revise the crisis manual:

Update your standard operating procedures or crisis protocols.

Run simulations:

Practice the updated protocols through tabletop drills to ensure the team is prepared if another issue arises.

5. Transition to a "New Normal"

Recognize that after a major disruption, returning to the exact prior state is rarely possible.

Normalize new operations:

Integrate any temporary fixes that worked well into permanent daily operations.

Celebrate resilience:

Acknowledge the hard work and dedication of the team that managed the crisis.

 

 

Giving your helpers a break to prevent burnout

Preventing burnout in your helpers requires a structured approach. Implement regular micro-breaks throughout their shift to reduce stress. Utilize short-term coverage or structured respite care to give them uninterrupted time to recharge. Prioritize open communication so they feel comfortable setting boundaries without guilt. Maintaining long-term stamina for those who carry the weight of care-giving or intensive tasks involves specific actions:

Micro-rests:

Encourage 2-to-5-minute pauses for breathwork, stretching, or brief walks to lower heart rates and restore focus.

Shift Transitions:

Create a definitive "shutdown" ritual (e.g., organizing notes, walking away) to help helpers mentally detach from their duties.

Delegation and Respite:

Arrange professional respite or involve other family and team members so your primary helper can take a true day off or a weekend getaway.

Clear Boundaries:

Support them in learning to say "no" to extra tasks and ensure they have a safe space to vent or process their emotional labor.

 


Predisposition for Mental Health Challenges

A genetic predisposition for mental health problems means you inherit a higher risk for conditions like depression, anxiety, or bipolar disorder from your family. This risk comes from a mix of your DNA and life triggers, such as stress or trauma.

How Genetics and Environment Work Together

Shared Genes:

Having a parent or sibling with a mental health condition increases your baseline risk, though it does not guarantee you will get it.

Life Triggers:

Stressful events, grief, or abuse often activate these underlying genetic risks.

Epigenetics:

Your daily habits and environment can turn specific genes "on" or "off" over time.

Protective Steps You Can Take

Manage Stress:

Build daily routines that lower mental pressure and anxiety.

Healthy Habits:

Get regular sleep, eat well, and exercise.

Seek Support:

Talk to a professional early if you notice persistent changes in your mood or thinking.

 

Lived Experience – Behavioral Health - Brief

Back in the 1970s I discovered that one or both of my parents had been prescribed Librium.  Some family members believed that my mother suffered depression.  Especially after my brother died in 1969.  When it came to dealing with my older brothers and somewhat my older sisters my father demonstrated intense anger boardering on rage.  In hindsight I could have benefitted in the 1970s from being prescribed Clozapine (wasn’t approved until 1989).  I also should have prioritized sleep and remaing substance free.  During the 1970s the only persona in the house that was safe and stable was our family dog, Lady.  My oldest sister left the house in 1965 to go to UC Berkeley.

 

Differentiating Anxiety from Mania

Differentiating anxiety from mania involves recognizing distinct differences in core emotional tone, sleep patterns, and behavioral drive, even though both conditions share overlapping signs like racing thoughts, restlessness, and irritability. Anxiety stems from fear, dread, and a negative anticipation of future threats, whereas mania functions as a state of high physical and mental arousal driven by elevated, expansive, or irritable moods.

Core Emotional Experience and Energy

Anxiety:

Feels heavy, tense, and jumpy. It involves a focus on worst-case scenarios, tightening in the chest or stomach, and a paralyzing or exhausting sense of distress.

Mania:

Often begins with feeling remarkably good, powerful, or euphoric, bringing an unstoppable internal drive. Energy expands outward rather than collapsing inward into fear, and grandiosity or inflated self-esteem may occur.

Sleep Patterns

Anxiety:

You desperately want to sleep, but racing worries, physical tension, and a racing heart keep you awake or disrupt rest, leaving you exhausted.

Mania:

You feel you do not need sleep. Individuals can sleep for only two or three hours and wake up feeling fully charged and energetic.

Thought and Speech Patterns

Anxiety:

Thoughts tend to loop or converge tightly around a single, fearful worry or threat.

Mania:

Thoughts race rapidly while jumping quickly from one unrelated topic to another. Speech becomes fast, pressured, and difficult to interrupt.

Behavior and Risk-Taking

Anxiety:

Leads to avoidance, caution, and a desire for things to stand still so you can feel safe.

Mania:

Leads to high impulsivity, rapid project-switching, overspending, or risky behaviors without regard for consequences.

 


Delaying the onset of mania

Delaying or preventing the onset of mania involves maintaining strict daily routines, protecting consistent sleep patterns, and adhering to prescribed medical treatments. Key strategies focus on stabilizing your circadian rhythm, avoiding stimulants, and recognizing early warning signs.

Daily Routines and Sleep

Keep fixed hours:

Go to sleep and wake up at the exact same time every day to protect your internal body clock.

Maintain steady schedules:

Eat meals and plan daily activities at consistent, predictable times.

Protect rest: Avoid late-night overstimulation, bright screens, and irregular napping that can disrupt night-time rest.

Medical and Behavioral Management

Take prescribed medication:

Continue taking mood stabilizers or other medications exactly as directed by your healthcare provider, and consult them immediately before making any changes.

Avoid substances: Stay away from alcohol, recreational drugs, and excess caffeine, which can trigger or worsen high-energy episodes.

Reduce environmental stress:

Step back from loud, bright, or chaotic environments and postpone major life or financial decisions if you feel your mood start to climb.

Recognizing Early Signs

Track subtle shifts:

Monitor early indicators like needing less sleep, racing thoughts, talking faster than usual, or heightened irritability.

Engage professional support:

Reach out to a doctor or mental health counselor at the very first sign of a shifting mood pattern.

 

Is elevated testosterone associated with mania

Yes, elevated testosterone is associated with mania, clinical research showing connections between high hormone levels, exogenous testosterone use, and manic or hypomanic symptoms.

Clinical Associations

Exogenous Testosterone:

High doses of testosterone or anabolic steroids can trigger manic episodes, irritability, agitation, and psychosis.

Bipolar Disorder Correlation:

Studies note that higher natural testosterone levels can positively correlate with a greater frequency of manic episodes.

Episode-Specific Shifts:

Biochemical markers during active manic episodes often reveal significantly higher testosterone levels compared to depressive phases.

 

Co-occurring anxiety and mania

Co-occurring anxiety and mania involve experiencing high anxiety and high manic energy at the same time, which can lead to severe distress, racing thoughts, and increased behavioral agitation. This combination often makes both conditions harder to treat and requires careful professional medical care.

Symptoms and Overlap

Racing thoughts:

Both mania and anxiety cause fast, spiraling thoughts that are hard to stop.

Restlessness:

High physical energy and a constant feeling of being "on edge" or keyed up.

Distractibility:

Trouble focusing on tasks because the mind is moving too fast.

Sleep changes:

A very low need for sleep during mania combined with worry or panic keeping the body awake.

Treatment and Management

Mood Stabilizers:

Doctors often use core medications like lithium or valproate to help control the underlying manic state.

Anxiety Management:

Specific non-addictive medications or short-term options (such as specific anti-anxiety agents) may be used to target high panic and agitation safely without worsening mood cycles.

Talk Therapy:

Structured therapy helps identify triggers and build coping tools for emotional control.

 

Timeline – Lived Experience



Risk Factors for Mental Health Problems (Especially Housing)

Housing-related risk factors for mental health problems include housing instability, severe affordability stress, and poor physical housing quality. These conditions trigger chronic stress, anxiety, depression, and severe psychological distress.

Housing Instability and Insecurity

Frequent moves and forced relocations:

Constantly changing homes disrupts social networks, causing anxiety and depressive symptoms.

Eviction and threat of eviction:

The trauma and financial shock of forced eviction significantly raise the risk of emergency room visits and hospitalizations for mental health conditions.

Homelessness:

Complete loss of shelter leads to extreme survival stress, exposure to violence, and higher rates of severe mental illness.

Affordability and Cost Burdens

High rent-to-income ratios:

Spending most of your money on rent leaves little for food or health care, generating relentless worry and hopelessness.

Financial strain:

The constant fear of not paying rent next month causes chronic fatigue and an inability to focus.

Substandard Housing Quality

Environmental toxins:

In-home exposure to lead damages neurological function, causing behavioral and cognitive issues.

Physical deterioration:

Living with mold, leaks, pests, and broken ventilation increases distress, depression, and anxiety symptoms.

Crowding:

Overcrowded living spaces destroy personal privacy and heighten psychological friction.

 

 

Is Child Abuse a Risk Factor for Mental Health Problems?

Yes, child abuse is a major and well-established risk factor for mental health problems. It causes toxic stress that can harm brain development, leading to conditions like:

Depression and anxiety

Post-traumatic stress disorder (PTSD)

Substance use disorders

Common Mental Health Impacts

Emotional struggles:

Survivors often face deep shame, guilt, and ongoing fear.

Behavioral changes:

People may isolate themselves or turn to drugs and alcohol to cope with pain.

Long-term risk:

The trauma raises the long-term chance of self-harm and suicide attempts.

The Centers for Disease Control and Prevention classify abuse as an Adverse Childhood Experience (ACE) tied to lifelong health challenges. Support and counseling can help survivors heal.


 

Insecurity

Insecurity is a feeling of inadequacy, self-doubt, and a lack of confidence in one's own abilities, worth, or relationships. Everyone experiences it at times, often stemming from personal fears or past events.

Common Signs

Constant self-doubt:

Second-guessing your choices, looks, or value.

Negative self-talk:

Focusing heavily on personal flaws or mistakes.

Excessive comparison:

Measuring your worth against the achievements or traits of others.

Approval seeking:

Relying on validation from others to feel accepted.

Potential Causes

Early upbringing:

Lack of support or unconditional love from early caregivers.

Past rejection:

Experiencing bullying, failure, or painful social situations.

Social pressures:

Internalizing unrealistic cultural standards regarding appearance or success.

 

Prevent mental health problems with Protective Factors

Protective factors are inner strengths, positive relationships, and safe environments that help prevent mental health problems, build resilience, and reduce the impact of stress. Key protective factors include strong social connections, healthy coping and problem-solving skills, and safe, stable living conditions.

Personal and Emotional Skills

Coping skills:

Knowing how to calm down, solve problems, and reframe negative thoughts into positive ones.

Emotional control:

Managing big feelings without acting out or hurting yourself.

Self-worth:

Having high self-esteem and hope for a good future.

Family and Social Relationships

Supportive connections:

Having close friends, trusted family members, or mentors who listen and care.

Nurturing home life:

Growing up or living with clear expectations, steady routines, and open communication.

Community ties:

Belonging to positive groups, clubs, or spiritual and cultural communities that encourage support.

Physical Health and Environment

Healthy habits:

Eating nutritious foods and staying physically active to support brain health.

Safe spaces:

Living in stable housing and safe neighborhoods free from violence.

Access to care:

Having easy access to medical and mental health services when needed.


 

Aside - Ambulatory Balance issues from medication

With blood pressure drugs, sedatives, and pain relievers being frequent culprits. These drugs affect stability by causing dizziness, low blood pressure when standing, or slowed reaction times.

Certain medications may cause side effects, such as dizziness or drowsiness, that impair balance and coordination. Additionally, conditions causing severe wasting, like cachexia in advanced illnesses, lead to rapid muscle loss, severely limiting mobility.

 

Environment and Mental Health Problems

The physical and social environment heavily influences mental well-being, with key factors including air pollution and toxins, chronic environmental noise, and a lack of access to green natural spaces. These external stressors can physically change neural pathways in the brain, triggering anxiety, chronic stress, and depression.

 

Host Stress (Stress symptoms & life change units)

Holmes-Rahe Life Stress Inventory, which assigns point values to major life events to predict the risk of future illness. Cumulative scores indicate risk levels: under 150 points means low risk (30% chance of illness), 150–299 points means moderate risk (50% chance), and 300+ points indicates severe risk (80% chance).

 

Crisis Triggers, Stressors, & Situations

A stressor is any event or situation that puts physical or mental demand on you. A crisis happens when stressors become so big that your normal problem-solving skills fail. When a crisis hits, intense anxiety and a loss of control take over, making it hard to think clearly or function normally.

1. Types of Stressors

Stressors fall into four main categories:

Catastrophic events:

Sudden, major traumas like natural disasters or violence.

Significant life changes:

Big transitions, like a new job, marriage, or losing a loved one.

Daily hassles:

Small, ongoing annoyances like heavy traffic, money problems, or work pressure.

Ambient stress:

Unconscious, continuous background stress like neighborhood noise or pollution.

2. Common Crisis Triggers

When stressors pile up too high or one sudden event occurs, they can trigger a crisis state. Common triggers include:

Financial disruption:

Job loss, eviction, or sudden debt.

Health crises:

A new, severe diagnosis or untreated chronic illness.

Trauma and abuse: Past or recent experiences with violence or harm.

Major loss:

Death of a loved one or a major relationship breakup.

Acute mental health changes:

Sudden spikes in severe depression, panic attacks, or psychotic episodes.

3. Signs of a Crisis

In a crisis, a person is overwhelmed and their usual way of coping stops working. Key signs include:

Emotional:

Extreme anger, panic, sadness, or hopelessness.

Behavioral:

Withdrawal from normal activities, neglecting basic hygiene, or self-harm.

Cognitive:

Confusion, difficulty concentrating, or feeling disconnected from reality.

Physical:

Inability to sleep, exhaustion, or rapid heart rate.

4. How to Manage and Cope

To manage a crisis, you must reduce immediate stress and restore balance.

Focus on the basics:

Ensure the immediate physical environment is safe. Get water, food, and sleep.

Ask for support:

Talk to trusted friends, family, or reach out to local mental health professionals.

Use positive coping:

Practice breathing exercises, listen to music, or take a short walk

Thinking

Thinking is the active mental process of using the mind to consider information, solve problems, and form ideas, encompassing core forms like reasoning, remembering, and judging.

Key Types of Thinking

Analytical:

Breaking down complex problems using logic and evidence.

Creative:

Generating novel ideas, art, or imaginative possibilities.

Critical:

Evaluating information objectively to make sound judgments.

Core Functions of the Mind

Problem Solving:

Finding solutions by drawing on past experiences.

Memory Retrieval:

Accessing stored information to guide current actions.

Inner Speech:

Using an internal dialogue of words or symbols to process meaning.

If you would like to explore this further, let me know if you want to discuss:

Metacognition (thinking about your own thinking)

Specific problem-solving strategies

How the brain creates thoughts

 

Negative Thinking

Negative thinking is a normal brain habit that includes all-or-nothing thinking, overgeneralization, and mental filtering. It happens because our minds try to spot danger, but it can lead to stress and sadness.

Common Types

All-or-nothing:

Seeing things as only totally good or totally bad.

Catastrophizing:

Expecting the worst possible thing to happen.

Mental filtering:

Focusing only on the bad parts and ignoring the good.

Simple Ways to Stop

Pause:

Stop for a moment and use your five senses to feel the real world right now.

Label your thoughts:

Say to yourself, "I am having the thought that..." instead of treating the thought as a hard fact.

Choose your next step:

Decide not to fight the thought, and instead do a small, helpful action.


Emotions

Emotions are physical and mental states brought on by neurophysiological and neuropsychological changes, variously associated with thoughts, feelings, behavioral responses, and a degree of pleasure or displeasure. There is no scientific consensus on a definition.

Negative Emotions

Negative emotions are natural, uncomfortable feelings like anger, fear, and sadness that act as signals for unmet needs. While they feel bad, they provide vital information to help you spot problems and protect your well-being.

Common Types

Anger:

Signals a broken boundary or unfairness.

Fear or Anxiety:

Warns you of danger and prepares you to react.

Sadness or Grief:

Helps you process a loss or failure.

Guilt or Shame:

Points out actions that go against your personal values.

Why They Matter

Information:

They tell you when something in your life needs to change.

Action:

Fear keeps you safe, and anger gives you energy to fix a problem.

Balance:

Feeling low sometimes makes it possible to truly appreciate feeling good later.

Healthy Ways to Cope

Accept them: Do not judge yourself for feeling upset; let the feeling exist.

Name the need:

Ask yourself what you need right now (like rest, safety, or respect).

Move your body:

Take a walk or do light exercise to release heavy stress.

Talk it out:

Share your thoughts calmly with a trusted friend instead of keeping them bottled up.

E.G. Anger

 

Thinking-Planning - Coping Challenge (Hurdle)

 

  • Coping Skills (Sample)
  • Adapt and Adjust
  • Avoid Problematic Behaviors
  • Clear Thinking
  • Cognitive Behavioral Therapy (CBT)
  • Communication
  • Education – Self-help - Bibliotherapy
  • Increase Functioning
  • Needs Assessment
  • Skills for Managing Stress
  • Thrive (Kaiser)

 


 

Ways of Coping

From: Ways of Coping Questionnaire (WOCQ)

 

Approach

Confrontive Coping

Distancing

Self-Controlling

Seeking Social Support

Accepting Responsibility

Escape-Avoidance

Planful Problem Solving

Positive Reappraisal

Seek professional input/intervention

 

Transfer to Coping Index




Projected Losses

Bed
Car
Driving
Exercise
Family
Freedom
Friends
Life
Peace
Seeing my Family
Sleep
Support
Walking

 

Confrontive Coping

A behavioral response to stress defined by aggressive efforts, hostility, and risk-taking to change a difficult situation. It is one of the core coping styles identified in stress psychology research, sitting alongside methods like avoidance and planned problem-solving.

 

Distancing

Distancing is the act of keeping space between yourself and others, and it has main meanings in public health and psychology. It involves physical separation to stop sickness or mental separation to manage thoughts

 

Self-Controlling - Psychological Meaning

Executive Function:

Managed by the prefrontal cortex to help humans plan, evaluate actions, and delay short-term gratification for long-term rewards.

Emotional Regulation:

Often fails not from a lack of strict discipline, but due to stress and overwhelming emotions activating survival brain responses.

Practical Tips:

Improving outcomes involves avoiding direct triggers, altering your environment, and managing internal stress rather than relying purely on willpower.

 

Seeking Social Support

Seeking social support involves reaching out for emotional comfort, advice, or practical help. You can connect with others through trusted friends, local community groups, or professional resources like the 988 Suicide & Crisis Lifeline.

Types of Support

Emotional:

Sharing feelings with a friend or listener for comfort.

Informational:

Asking for advice or guidance on a problem.

Tangible:

Receiving concrete help like assistance with daily tasks

 

Accepting Responsibility

Accepting responsibility means acknowledging your mistakes, owning the outcomes of your choices, and choosing not to blame others. Key parts include:

Core Steps

Acknowledge:

See what happened and admit your part in it without making excuses.

Communicate:

Speak clearly and directly about the error.

Fix it:

Offer solutions to make things right and prevent future issues

 

Escape-Avoidance

Escape and avoidance are behavioral coping mechanisms where an individual takes action to terminate or prevent an unpleasant stimulus. Escape ends an ongoing aversive experience (e.g., leaving a loud room), while avoidance prevents it before it starts (e.g., putting on noise-canceling headphones before entering).

Chronic Avoidance

In psychological and behavioral sciences, these responses are often a normal part of survival, but chronic avoidance can severely limit personal growth and exacerbate anxiety. Breaking free from these patterns involves structured, evidence-based methods:

 

Planful Problem Solving

Planful problem solving is a constructive coping method that relies on a logical, step-by-step approach to handle stress and challenges. The main steps include defining the problem, generating alternative solutions, and making decisions.

 

Positive Reappraisal

Positive reappraisal is a coping strategy where you reframe a stressful or negative situation to find a helpful meaning, a silver lining, or a lesson. It helps reduce stress, improve mental health, and build personal strength.

How It Works

Change the meaning:

You shift your view of an event from something purely harmful to something manageable, valuable, or productive.

Stay grounded:

It is based on reality and realistic facts, not false hope or ignoring the truth.

Lower stress:

Changing how you think calms your body's panic and stress responses.

Practical Examples

Making a mistake:

Instead of feeling defeated, you view the error as a valuable lesson on how to do better next time.

Facing a major delay:

Instead of getting angry, you treat the extra time as a chance to rest or listen to an audiobook.

Experiencing a loss or breakup:

Instead of just feeling empty, you recognize personal growth and the chance to meet new people.

 

Seek professional input/intervention

Seeking professional input or intervention is essential when dealing with complex addictions, dual diagnoses, or high-conflict situations. Key steps include consulting a licensed interventionist, organizing a support team, and preparing a structured treatment plan.

Why Involve a Professional

Neutral Guidance:

A trained specialist provides an objective, third-party view during emotional family talks.

Safety & Boundaries:

Experts help loved ones set firm limits and manage unexpected reactions.

Tailored Treatment:

Professionals diagnose the core issue to match the correct level of care, whether detox or therapy.

Steps to Take

Initial Consultation:

Speak confidentially with a licensed counselor or intervention service to assess the severity.

Team Preparation:

Gather calm family members or friends to align on what to say using supportive "I" statements.

Arranging Care:

Line up an admission slot or evaluation at a verified treatment center before the meeting takes place.

 


Behaviors I Do – Reasons to Live (*)

 

Advanced Planning
Attend Appointments
Avoid Buying Alcohol
Budget Money
Content Warning
Drive
Eat
Exercise
How is it no working?
Improve Objectivity
Make & Attend Appointments
Material Disposition
Meditate
Pray
Read
Research
Self-assessment
Sing & Karaoke
Sleep
Smoke Cigarettes
Surrender to side effects
Take Clozapine & Other Meds
Use, maintain, and repair Computers
Visit and gift the kids
Volunteer (Advanced Planning Advocate)
Watch Media
Walk
Write & Publish – Share my Legacy

 


http://docsdrive.com/images/academicjournals/rjbm/2009/fig1-2k8-6441.gif

 

Iterative Anxiety

A repetitive, compounding cycle of worry that builds through a sequence of repeated thoughts, checks, or medical and life follow-ups. It is not a formal clinical diagnosis, but rather a descriptive term used when anxiety reactivates across consecutive stages or feedback loops.

 


 

Developing Scenarios



Scenarios

09_EOL_Scenarios_26070701_Notes

 

20260627

SA

Onset of serious weak legs & numb right foot

911 Scare

 

Wake > RX > Thrive & Peaceful > Engage & Productive > RX > Sleep > Repeat

 

Wake > Can’t walk > Walker > Temporary > Balance testing > RX > Sleep > Resume normal

 

Car disposition

 

Wake > Can’t drive (AMB intervention) > Ponder no drive life > address transportation > No drive > Repeat

 

Wake > Can’t walk or use walker (Risk of fall) > Call family > Call 911

Crisis Precipitating Events - Crisis Management

The 5 P's of crisis management form a strategic framework used by organizations to navigate emergencies: Predict, Prevent, Prepare, Perform, and Post-Action. This lifecycle approach minimizes damage by proactively identifying threats, outlining step-by-step response protocols, and facilitating continuous improvement after the event.

 

Crisis Subjective Distress

A crisis involves an overwhelming event and how you perceive it. If your usual coping skills fail, the result is subjective distress—an intense, personal feeling of mental pain, panic, or confusion.

 

Key Facts about Subjective Distress:

It is personal

The same event impacts people differently. Your feelings depend on your past and your support system.

It affects the brain

Extreme distress changes how you think. It makes it hard to solve problems or make good choices.

It is measured

Doctors use the SUDS Scale (Subjective Units of Distress Scale) to measure your feelings from 0 to 10.

Common Signs of Distress:

Emotional:

Feeling panic, helplessness, or extreme anger.

Physical:

A fast heart rate, shaking, or stomach pain.

Behavioral:

Pacing, acting without thinking, or crying.

How to Manage Distress:

Use the TIP skill (Temperature, Intense exercise, Paced breathing).Put an ice pack on your face for 30 seconds. This slows your heart rate and resets your brain. Take slow, deep breaths. Breathe in for 4 seconds, hold for 4, and breathe out for 6.

 

Subjective Units of Distress

20260710-F-Pertains to DAR roommate mismatch

Making uncontrollable noise = Loud Moaning

20260731-F-DAR is not living with us anymore yet still moaning

 

https://www.thepsychcollective.com/blog/what-are-subjective-units-of-distress





Crisis Prevention Strategies

Crisis prevention relies on early intervention, clear communication, and emotional regulation to de-escalate distress before it becomes an emergency. By using calm body language, active listening, and simple choices, you help people feel safe and in control, which stops extreme reactions.

Crisis Coping Challenge

A crisis is a sudden event that overwhelms your usual coping skills. The biggest challenge is that stress hormones block clear thinking. Your brain shifts into survival mode. You can regain control by focusing on small actions you can control. Try grounding exercises to calm your body.

 

The Challenges

When a crisis hits, you face a few main hurdles:

Overwhelming Emotions:

Fear, anger, or sadness flood the brain.

Loss of Routine:

Disruptions to your daily schedule destroy your sense of normalcy.

Information Overload:

Constant news creates feelings of helplessness.

Social Isolation:

Pulling away from friends makes problems feel much bigger.

How to Cope

You can overcome these challenges with a few simple steps:

Stick to a Schedule:

Eat and sleep at the same time every day. Routine brings calm.

Control What You Can:

Focus on one small task at a time. Ignore the rest for now.

Take a News Break:

Turn off your TV or phone. Limit your news updates to once a day.

Talk to Someone:

Call a friend or family member. Do not carry the burden alone.

 

How can I stop complaining?

To stop complaining, you can build awareness, switch to problem-solving, and practice gratitude. Breaking this habit takes time, but small daily shifts help your mind stay positive.

Notice the Habit

Catch yourself right when a negative thought or complaint starts to form in your mind.

Name the feeling out loud or in your head without blaming anyone else.

Track your triggers to see what times of day or situations make you want to vent the most.

Take Action

Fix what you can by turning your complaint into a clear plan or action step.

Let go of things you cannot change and refuse to dwell on them.

Set a timer if you truly need to vent, and move on to something else once the time is up.

Shift Your Mindset

Practice gratitude by naming positive things in your life when you feel a complaint coming.

Reframe the story to look for a helpful or neutral way to view an annoying situation.

Change your opening line in conversations so you do not start talks with a negative comment.

For tips on how to get the mindset and daily practice just right: