"The lesson is not

how strong we
may have been in
the past; it is about
how strong we are
right now. This is
our unmeasured
strength. This is the
power we have
inside us, to
persevere and
prevail,"

uren M an ni n g
-La
(9-11 Sur viv or)
HANDOUT Taking Good care of Yourself
Self-Care Questionnaire

* Answer each question below 'yes" or "no"; if a question does not apply, leave it blank.
Do you ...
• Associate only with safe people who do not abuse or hurt you? Yes_ No
•Get annual medical check-ups with a:
• Doctor? Yes No • Dentist? Yes No
• Eye doctor? Yes_ No_ • Gynecologist (women only)? Yes_ No_
• Eat a healthful diet (healthful foods and not under- or overeating)? Yes_ No
• Have safe sex 7 Yes No
• Travel in safe areas, avoiding risky situations (e.g., being alone in deserted areas)? Yes_ No
•Get enough sleep? Yes_ No
• Keep up with daily hygiene (clean clothes, showers, brushing teeth, etc.)? Yes_ No
•Get adequate exercise (not too much or too little)? Yes_ No
•Take all medications as prescribed? Yes _ No
• Maintain your car so it is not in danger of breaking down 7 Yes_ No
• Avoid walking or jogging alone at night? Yes_ No
• Spend within your financial means? Yes_ No
• Pay your bills on time? Yes_ No
• Know whom to call if you are facing domestic violence? Yes_ No
• Have safe housing? Yes_ No
• Always drive substance-free? Yes_ No
• Drive safely (within 5 miles of the speed limit)? Yes_ No
• Refrain from bringing strangers home to your place? Yes_ No
• Carry cash, ID, and a health insurance card in case of danger? Yes_ No
• Currently have at least two drug-free friendships? Yes_ No
• Have health insurance? Yes No
•Go to the doctor/dentist for problems that need medical attention? Yes_ No
• Avoid hiking or biking alone in deserted areas? Yes_ No
• Use drugs or alcohol in moderation or not at all? Yes_ No
• Not smoke cigarettes? Yes_ No
• Limit caffeine to fewer than 4 cups of coffee per day or 7 colas? Yes_ No
• Have at least 1 hour of free time to yourself per day? Yes_ No
• Do something pleasurable every day (e.g., go for a walk)? Yes_ No
• Have at least three recreational activities that you enjoy (e.g., sports, hobbies-but not substance use!)?
Yes No
• Take vitamins daily? Yes_ No
• Have at least one person in your life that you can truly talk to (therapist, friend, sponsor, spouse)?
Yes No
• Use contraceptives as needed? Yes_ No
• Have at least one social contact every week? Yes_ No
HANDOUT (page 2 of 2) Taking Good care of Yourself

• Attend treatment regularly (e.g., therapy, group, self-help groups)? Yes_ No

• Have at least 10 hours per week of structured time? Yes_ No
• Have a daily schedule and "to do" list to help you stay organized? Yes_ No
• Attend religious services (if you like them)? Yes_ No_ N/A_
• Other: _____________ Yes No
Your score: (total number of No's):_

NOTES ON SELF-CARE
Self-care and PTSD. People with PTSD often need to learn to take good care of themselves. For example, if you
think about suicide a lot, you may not feel that it's worthwhile to take good care of yourself and may need to make
special efforts to do so. If you were abused as a child, you got the message that your needs were not important. You
may think, "If no one else cares about me, why should I?" Now is the time to start treating yourself with respect and
dignity.

Self-care and substance abuse. Excessive substance use is one of the most extreme forms of self-neglect be­
cause it directly harms your body. And the more you abuse substances, the more you are likely to neglect yourself in
other ways too (e.g., poor diet, lack of sleep).

Try to do a little more self-care each day. No one is perfect in doing everything on the questionnaire at all
times. However, the goal is to take care of the most urgent priorities first, and to work on improving your self-care
through daily efforts. "Progress, not perfection."
 Taking Good care of Yourself

Ideas for a Commitment

Commit to one action that will move your life forward I
It can be anything you feel will help you, or you can try one of the ideas below.
Keeping your commitment is a way of respecting, honoring, and caring for yourself.
+ Option 1: Identify one self-care problem from the Self-Care Questionnaire (one "no" answer) that you want
to work on. Before the next session, make that "no" into a "yes"-solve that self-care problem. If you want
to, write out how it went: How did it feel to do it? Was it successful? Any next steps you'd like to take?
+ Option 2: Take any four of the following words and write a page on how your life could be improved by at­
tending to them (be creative-there's no right or wrong answer to this):

Self-Care Dignity Body Attention Love Effort

Knowledge Respect Safety Physical
+ Option 3: Find someone in your life who takes very good care of her- or himself. Interview this person, asking
everything you can about how the person does it, how it feels, and how the person learned it.
+ Option 4: Fill out the Safe Coping Sheet. (See below for an example applied to this topic.)

EXAMPLE OF THE SAFE COPING SHEET APPLIED TO THIS TOPIC

Old Way New Way

Situation I have a bad toothache. I have a bad toothache.

* Your Coeing * Not doing anything about it. Call dentist immediately. Say
Just trying to put it out of to myself, "Even though I
mind. wasn't taken good care of
when I was growing up, I
need to do things better
now."

Consequence It keeps getting worse. I This feels strange-I'm used

feel miserable. to waiting until everything
is in crisis. But I know
this was the best way to
handle it.

How safe is your old way of coping? __ How safe is your new way of coping? __

Rate from O (not at all safe) to 10 (totally safe)

HANDOUT 1 Self-Nurturing

Safe and unsafe Self-Nurturing

❖ Safe self-nurturing means seeking fun, joy, and pleasure in healthy ways and without excess.
+ Unsafe self-nurturing means seeking pleasure in an activity that causes you harm (legal, financial, social, per­
sonal, or physical) and/or doing the activity to excess.

EXAMPLES OF SAFE SELF-NURTURING

* (a) Circle any that you currently do. (b) Check(✓) any that you'd like to add to your life.
❖ Taking walks ❖ Socializing with safe friends ❖ Reading ❖ Travel
❖ Movies ❖ Crafts or hobbies (e.g., painting, woodworking, puzzles) ❖ Sports
❖ Enjoying pets ❖ Participating in a club or organization ❖ Music ❖ Exercise
❖ Eating out ❖ Local trips (day trips, weekends away) ❖ Baking or cooking
❖ Dance ❖ Visiting museums ❖ Playing games ❖ Taking an interesting class
❖ Volunteering ❖ Learning a new skill ❖ Enjoying the outdoors ❖ Writing
❖ Religious services ❖ Meditation ❖ Enjoying computers ❖ Warm baths
❖ Playing with children ❖ Going to events (concerts, comedy clubs, lectures, etc.)
❖ Others: __________________________________

EXAMPLES OF ACTIVITIES THAT MAY BE UNSAFE FOR SOME PEOPLE (WHEN EXCESSIVE)
* Circle any that are unsafe for you.

+ Shopping + Food + Watching TV + Gambling + Partying + Work

+ Pornography + Exercise + Video or computer games + Internet + Sex
+ Others: __________________________________

HOW DO PTSD AND SUBSTANCE ABUSE RELATE TO PROBLEMS IN SELF-NURTURING?

PTSD. You may be more familiar with pain than with pleasure. You may feel guilty about nurturing yourself (es­
pecially if you grew up without much love). To cope with trauma, you may have turned to unhealthy addictions
rather than healthy activities to feel better.
Substance abuse. Substance abuse and other addictions are "cheap thrills." They may work in the short run,
but in the long run they cause tragedy. They are misguided attempts to give yourself pleasure, and they keep you
from finding healthy ways to feel good.

From Seeking Safety by Lisa M. Najavits (2002}. Copyright by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only (see copyright page for details}.
HANDOUT 2 Self-Nurturing

A Gift to Yourself

❖ Give yourself a gift by ... increasing safe self-nurturing.

+ Give yourself a gift by ... decreasing unsafe self-nurturing.

Some ways to do this:

• Replace unsafe activities with safe activities.
• Set a structure (e.g., at least 2 hours a day of safe self-nurturing).
• "Play around"-try a variety of safe new activities to see what you like.
• Work on it in therapy or with someone else who can help.
• Write yourself a letter giving yourself "permission" to improve self-nurturing.
• Explore the emotions that arise when you change your self-nurturing.
• Listen to your deepest needs.
• Get back to activities that you enjoyed "way back when" but gave up along the way.

YOUR SELF-NURTURING PLAN

* Create your plan below, focusing on the week ahead. Be very specific to really make it work! Include any details
that are important for you-for example, what activities, how often, during what time frame, how you will make it
happen, who you will get help from, how you will remember to do it, and how you will feel if you do it. Continue on
the back of the page if you need more space.

My "gift to myself" to increase safe self-nurturing activities:

My gift to myself'' to decrease unsafe self-nurturing activities:

11

From Seeking Safety by Lisa M. Najavits (2002). Copyright by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only (see copyright page for details).
 Self-Nurturing

Ideas for a commitment

Commit to one action that will move your life forward!

It can be anything you feel will help you, or you can try one of the ideas below.
Keeping your commitment is a way of respecting, honoring, and caring for yourself.

+ Option 1: Carry out the "gift to yourself" plan that you wrote in today's session.
+ Option 2: Try one new self-nurturing activity before the next session.
+ Option 3: Make a life plan: What self-nurturing activities do you want to do every day? Every week? Every
year? What would it take for you to give yourself these?
+ Option 4: Write a letter giving yourself permission for self-nurturing activities.
+ Option 5: Remember yourself as a child: What activities did you used to enjoy that you've lost along the
way? Can you get back to any of those activities now?
+ Option 6: Fill out the Safe Coping Sheet. (See below for an example applied to this topic.)

EXAMPLE OF THE SAFE COPING SHEET APPLIED TO THIS TOPIC

Old Way New Way

Situation Had a conflict with my boss Had a conflict with my boss
today at work. today at work.

* Your Coeing * Went home, felt depressed. Get a video to take my mind
My thoughts were "Why can't off work, make myself a nice
I function like everyone dinner, and take my dog out
else? This is my third job for a run (all self-
in 2 years. I can't keep my nurturing activities).
mouth shut, and I get mad at
the slightest thing." I
smoked some pot.

Consequence Went to sleep early. Woke up Feel calmer; have more

the next day and felt worse. perspective.

How safe is your old way of coping? __ How safe is your new way of coping? __

Rate from O (not at all safe) to 10 (totally safe)

From Seeking Safety by Lisa M. Najavits (2002). Copyright by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only (see copyright page for details).
Who Am I?
identity exploration exercise

Identity is how you think about, describe, and present yourself. It can be made up of different roles, traits, or experiences. For example, an identity
may include parent, survivor, dog owner, chronic illness sufferer, and kind person. A strong sense of identity can give meaning and direction in life.

Instructions: Name the parts of your identity and describe what they mean to you. Then, rate how much you identify with each part (1 = very little,
10 = very strongly). Note: You do not have to use all the boxes.

What it means to me: What it means to me:

What it means to me: What it means to me:

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Who Am I?
identity exploration exercise

What it means to me: What it means to me:

What it means to me: What it means to me:

Reflect on the most important aspects of who you are, then write a title or nickname for your identity. For example: The Poetry-Loving
Energetic Engineer or Silly Cat Mom with Tattoos. Be as creative as you like!

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Letter to My Past Self
reflection exercise

Letter
Dear Past Seif,

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Letter to My Past Self
reflection exercise

Process
Describe any insights you had while completing this activity:

Describe ways you can grow from your experience:

Additional comments (optional):

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Letter to My Past Self
reflection exercise

Examples
The following examples show how two people approached this exercise. Use these to reflect on ways
to write your letter while staying true to your own situation and personality.

Example 1
Dear Past Seif,

You were just 13 when you got caught up with the wrong group at school and started bullying others.
Even after 20 years, I can still remember how scared and helpless the kids you bullied looked! Man, the
guilt and shame I have over that still hurts so much!! I know you felt this at the time, but you ignored it
because you were so desperate to fit in.

I've learned the hard way that it takes mad courage to hold true to your values, especially when others are
putting pressure on you. I've a/so learned that popularity is meaningless! It took a lot of time before I
finally accepted myself enough to stop trying to make everyone like me. I wish you could have had that
courage at 13, but I feel proud of the person I have become.

Past self, I forgive you for what you did to those other kids. It was wrong then, and it still feels wrong
now. But I know how lonely you felt at that time and how you were willing to do almost anything not to
feel that way. I want to let go of the guilt I've been carrying over this. I wish peace to you, to my present
self, and to those who were harmed by what I did.

Example2
Dear Past Seif,

Decades later, I still remember the brutal grief you felt after mom died when you were just 20. You hadn't
spoken to her for months because of an argument that now seems pointless. You thought you had all the
time in the world to patch things up. You had only just left home and had no clue about how uncertain life
can be. I cringe when I think of the intense grief and guilt you felt at that time.

Never again have I taken the presence of my friends and loved ones for granted!! Every day. I remind
myself how fragile life is, how things can be taken away without warning. Mom's death motivates me to
be more present to my loved ones - to cherish every conversation, every moment spent together.

Past self, I send you all my love and compassion for what you went through. Stop blaming yourself for
your argument with mom - you were doing the best you could! You know deep down that both of you
never stopped loving one another. Mom wants you to be happy and free. You owe it to her to stop beating
yourself up! We can honor her memory by sharing love with others and living a full life.

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Everyone has problems, both big and small. To better solve your big problems, it
helps to learn how your thoughts, feelings, and actions are connected.
Imagine you have an upcoming test, and you think ''I'm going to fail". Because of
this thought, you start to worry. You are so worried that you feel sick just thinking
about the test. Because it's so uncomfortable, you decide not to study.
The thought (''I'm going to fail") led to a feeling (worry), which led to an action (not
studying). What might have changed if you had a different thought?

0
Thoughts are the words that run through your mind. They're the things
you tell yourself about what's going on around you. There are many
0 different thoughts you could have about a single situation.

Feelings come and go as different things happen to you. You might feel
happy, angry, and sad, all in one day. Some feelings are uncomfortable,
but they are not bad. Everyone has these feelings from time-to-time.

0
Actions are the things you do, or the way you behave. Your thoughts and
feelings have a big impact on how you act. If you feel happy, you are likely
to do nice things. But if you feel angry, you might want to act mean.

© 2018 Therapist Aid LLC Provided by TherapistAid.com

 What happened?
My friend Emma hasn't spoken to me as much as usual over
the past week.

0
0 My Thoughts
I thought: "Emma hasn't talked
to me much this week. She
must be mad at me."

Because I was upset I

ignored Emma and avoided I felt sad and hurt.
her at school.

0 MyActions 9 My Feelings
Just because you have a thought doesn't mean it's true. Your thoughts are
guesses about why something happened, or about something that might happen.
Coming up with new thoughts will help you see a situation differently.

0
0
A.
V
New Thoughts New Feelings New Actions

"Emma might be upset Concerned that Emma Ask Emma if she is

1 with me, but maybe might be upset, but I'm mad at me, or if she
not. I don't know." not as sad as I was. has another problem.
"Emma has probably Disappointed I haven't I'll stay friendly with
been busy with school talked to Emma, but Emma, as usual. I'll be
or something else." understanding. sure to say "hi" anyway.
"Maybe Emma is upset Worried about how Ask Emma what's
3 about something Emma is feeling. going on, and if she
unrelated to me." needs help.

© 2018 Therapist Aid LLC Provided by TherapistAid.com

 1ffu®®@lliU§ •�1 �ffi@
What happened?

0
0 My Thoughts

0 My Actions My Feelings

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 1ffu®m@llifi§ •�1 �ffi@
0
0 •
New Thoughts New Feelings New Actions

© 2018 Therapist Aid LLC Provided by TherapistAid.com

Jealousy
Related Emotions --- Signs & Behaviors --------------
Bitter Acting Possessive Frustration
Contempt Controlling Insecurity
Envious Distrust Making Hurtful Comments
Spiteful Fear of Abandonment Making Threats
Feelings of Inadequacy Negative Thinking

Love
Related Emotions ---- Signs & Behaviors ---------------
Affection Caring for Another Person Feeling Vulnerable
Attachment Commitment Gestures of Appreciation
Closeness Desire for Connection Kindness
Compassion Drive to Protect Physical Affection
Desire Empathy Selflessness
Endearment Enjoying Time Together Thinking Often of the Subject
Fondness
Tenderness

Sadness
Related Emotions --- Signs & Behaviors ---------------
Depressed Apathy Negative Thoughts
Despair Changes in Eating Neglecting Self-Care
Disappointment Crying Poor Self-Esteem
Down Difficulty Concentrating Rumination
Emptiness Fatigue Sleep Problems
Grief Inactivity Sluggishness
Guilt Irritability Social Isolation
Hopelessness Loss of Interest in Activities
Lonely
Shame

© 2019 Therapist Aid LLC Provided by TherapistAid.com

HANDOUT 1 Healing from Anger

Exploring Anger
DO YOU HAVE A PROBLEM WITH ANGER?
Do you think you have a problem with anger? Yes/ No/ Unsure
* If you circled "Yes," you may want to go directly to the next section. If you are unsure, check (✓) below any that
are true for you-these are typical signs of an anger problem.

□ You "blow up" at others. □ You hate yourself.

□ You often criticize others. □ You often isolate.
□ You feel anger but can't express it. □ You feel bitter.
□ You have impulses to harm others. □ You have impulses to harm yourself.
□ You "never feel angry." □ Others have said you have an anger problem.

TWO TYPES OF ANGER

It is important to know that anger is not bad or wrong. Rather, it is information that can be used either to help or to
harm your recovery. It can be used constructively to help you heal, to be honest with others, to face your pain. Or it
can be used destructively to act out against yourself or others, to give up, to become bitter.Anger itself is not a prob­
lem-it's all in what you do with it.

Constructive Anger: Anger that Heals

"Constructive anger" means anger that is . . .

• Moderate or lower (e.g., up to 5 on a 0-1 0 scale, where 0 :;;: no anger and 10 = intense anger).
• Explored to understand yourself and others better.
• Conscious (you are aware of it).
• Handled well (e.g., not acted out in dangerous behavior).
• Respectful of your own and others' needs.
For example, if you go out on a date and the other person acts selfish, you may rightly feel angry.If you listen
to your anger, you can use it as a sign to protect yourself; perhaps you can talk to the person about what bothers
you, or you can calmly end the date early. You can feel good about using your anger constructively.
There are great benefits to constructive anger. It can help protect you from danger . . . convey insights
about yourself and others ... give you real power. *
Any other benefits you notice?

Destructive Anger: Anger that Harms

"Destructive anger" means anger that is .. .

• Acted out in dangerous behavior (hurting yourself or others).
• Too intense and/or frequent (e.g., often above a 5 on a 0-10 scale).
• "Underground" (quietly seething or feeling bitter).
• Unconscious.

(cont.)
From Seeking Safety by Lisa M. Najavits (2002). Copyright by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only (see copyright page for details).
HANDOUT 1 (page 2 of 2) Healing from Anger

*
There are great costs to destructive anger. It can destroy your relationships ... cause physical harm ...
weaken you ... become an addiction. Any other costs you notice?
Destructive anger can be directed toward yourself and/or directed toward others. Both represent a lack
of balance between your own and others' needs. For some people, both are present.
Destructive anger toward self (e.g., self-harm, suicidal feelings): Putting others' needs too much
ahead of yours.
Destructive anger toward others (e.g., verbal abuse, assault): Putting your needs too much ahead of
others'.
With destructive anger toward yourself, you may not be aware of anger. For example, if you physically
hurt yourself you may not notice anger at the time.However, such acting out does indeed represent anger-typically
anger toward others that you have difficulty "owning."

* How do you tend to handle anger? Circle one: Constructively / Destructively / Both
Circle one: Toward self / Toward others / Both

DID YOU KNOW ... 1

* Check ( ) any points below that you understand. Circle any that you have questions about.
✓

Anger is normal in recovery from PTSD and substance abuse. If you have been through the terrible experi­
ences of trauma and substance abuse, anger is inevitable.You may feel angry at people who hurt you, at the world,
at God, at yourself, at life, at treaters, at family, at strangers. Your anger is valid and real. In recovery, the goal is to
use your anger as a way to learn about yourself and grow. The task is to face your anger without letting it destroy
you or others.
Behind all anger are unmet needs. Anger is a signal that something is wrong. It may mean that you are not
taking enough care of yourself, or that you have a lot of sadness to work through, or that you are in a harmful rela­
tionship. Listening to your anger and caring for the underlying needs can resolve anger.
Constructive anger can be learned. It is never too late, no matter how long you've had a problem with an­
ger. Mainly, it requires really listening to others' feedback about your anger, "owning" your feelings rather than act­
ing them out, expressing anger in healthy ways, and learning to tolerate the painful feelings behind the anger.
Destructive anger can become an addiction. Can you see similarities between destructive anger and sub­
stance abuse? For example, the more you engage in it, the more it increases. Also, with destructive anger you may
feel "high" on it in the moment. Have you "hit bottom" with destructive anger-has it caused serious problems in
your life?
Venting anger does not work. An old-style view of anger was the idea of venting-that the solution to anger
is to "get it out" (e.g., punch a pillow, write an angry letter, throw rocks at a tree). However, these actually tend to in­
crease rather than decrease anger.Currently, it is understood that anger needs to be handled constructively, not sim­
ply vented.
Destructive anger never works in the long term. You may get results in the short term. People may do what
you want; you may feel powerful in the moment. It is only later that you can see that these are an illusion. Destruc­
tive anger spins you out of control and weakens your bonds with others.
HANDOUT 2 Healing from Anger

Understanding Anger
Notice how each constructive view on the right side of the list below softens the anger. Destructive anger is rigid and
harsh. You may want to think of it as ice that needs to melt. The goal is to keep perspective, balance your own and
others' needs, and understand yourself better. Also, don't feel you have to agree with each view below-just use the
ones that work for you.
* Check(✓) any below that might help you.
Anger toward Others

Destructive View Constructive View

"Others should put my needs first." "Among adults, one's ultimate duty in life is to put
one's own growth first."
"If I yell at people, they'll treat me better." "Yelling alienates people and makes them dislike me. I
need to ask for what I want in calm ways."
"I know what's right." "There are many perspectives on truth. I need to listen
fully before I judge a situation."
"The only way people hear me is if I yell." "People will want to help me more if I talk to them
respectfully."
"Other people screw up." "If other people make mistakes, I need to gently guide
them. And I make mistakes too."
"Anger shows how strong I am." "Strong anger makes me weak. I become out of
control."
"Others have to make my life better." "It's up to me, more than anyone else, to make my
life better."
"I can only deal with anger by acting out." "Everyone can learn to deal with anger safely."
"I'm right to be angry." "I have a right to be angry, but how I express it is
what counts."
"I'm better than other people." "Everyone in life has a purpose, even if I can't see it.
Respect is the basis of all relationships."
"I know I need to stop blowing up, but I can't." "I need to listen to my emotional pain-that's what's
behind my anger."
"If others threaten me, I have to hurt them." "In a case of serious physical danger, self-defense is
appropriate. Other than that, violence is
unacceptable."

(cont.)
From Seeking Safety by Lisa M. Najavits (2002). Copyright by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only (see copyright page for details).
HANDOUT 2 (page 2 of 2) Healing from Anger

Anger toward Self

Destructive View Constructive View

"I should put others' needs ahead of mine." "My needs are just as important as anyone else's. It's
time for me to treat myself well."
"I should never get angry." "It is normal to get angry at times. I need to listen to
my anger and respond to it safely."
"If I hurt myself, I'll feel better." "I need to find long-term solutions to my pain."
"I'm a failure." "Deep inside, I know that life is about personal
progress-not about 'winning' and 'losing.' "
"I can't say what I really think." "It's how I say it that matters."
"I need to be punished." "That is a PTSD thought. It reflects my inner pain, but
it's not true."
"I want to die." "I'm in a lot of distress. But I deserve to live."
"This will show people how I feel." "I need to put it in words, not action."
HANDOUT 3 Healing from Anger

Before, During, and After: Three Ways to Heal Anger

To transform anger from destruction to healing, three key strategies are helpful: "Motivate," "Contain, and "Listen."
These correspond, generally, to "before," "during," and "after" destructive anger episodes. If you want, you can re­
member the acronym "MCL" or "More .haring 1ife" to represent the idea that handling anger well can help you take
better care of yourself and others.
* Note: If you tend to harm yourself, you may not be aware of your anger. In reading the material below, you can
substitute the term Rself-harm" where it says "anger."

BEFORE ANGER EPISODES ... MOTIVATE

"Motivate" means searching your heart for compelling reasons to stop destructive anger. This can free you to handle
the anger constructively. Prepare now, before the next anger episode.
Why? When you are in the midst of destructive anger, it may feel "right" to do something you will later regret.
Whether it's hurting yourself or someone else, the feelings are so strong that you may feel you have no choice ex­
cept to go with them. They are like a tidal wave. Think of all the times you've sworn "things will be different next
time"-but then they aren't. The only way to make them different is to establish strong motivation and then work at
it. It will not happen on its own. A key question: Why is it in your best interest to solve your anger problem?
How? * Check off any ideas below that might help you.
■ Observe the cost of your anger. Has it isolated you? Kept you from feeling at peace? Hurt your job perfor­
mance? Left scars on your body (from self-harm)?
■ Get feedback about your anger. Hearing how others view your anger problem can give you important in­
formation. Becoming defensive or dismissing feedback keeps you stuck. You do not have to agree with others, but
listen very carefully before you decide what's true.
■ Feel the impact of anger on your body. People who get angry a lot are more likely to have physical prob­
lems and to die younger. Do you notice the intense stress that anger puts on your body? Can you feel the tension it
creates?
■ Notice whom your anger has hurt. Yourself? Your partner? Your children 7 Your therapy relationship 7 An­
ger scares people, even if they cannot tell you that. See the other's pain-the hurt look on a child's face, the partner
who becomes quiet. If you are feeling empathy for someone, you cannot simultaneously harm that person. (That in­
cludes yourself too!) Remember that you cannot "unstab" someone once the damage is done.
■ Develop a policy on anger. Make a commitment to yourself (and your therapist or sponsor) that no matter
what happens, you will not act on your anger. Handout 4 is a Safety Contract you can fill out.
■ Imagine how it would feel to control your anger. Picture how extraordinary it would be-freeing, truthful
at the deepest level, caring, in control. In the long run, it will feel like a new life. It is "intoxicating" in the best sense.
■ Learn more about anger. This is one of the best ways to motivate yourself. Take a class on anger manage­
ment or assertiveness-local adult education programs and/or mental health clinics offer such courses. Or read a
book on it (two are listed in Handout 5). Learn when and how to express anger, and what to do if the other person
does not respond well. You can also ask others how they handle angry situations. Find out what is realistic to expect
from people and from yourself (often your anger derives from unrealistic expectations).

(cont.)
From Seeking Safety by Lisa M. Najavits (2002). Copyright by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only (see copyright page for details).
HANDOUT 3 (page 2 of 5) Healing from Anger

■ Create an image to help you. A horse being reined in? A child being raised? An athlete in training? Really
picture the process that's required to learn how to control your anger-the ups and downs.
■ Carry an anger reminder. Carry a physical reminder of how destructive your anger can be-for example,
11 1
'

a photo of someone you've hurt with your anger, or a list of the hospitalizations you've had for suicidal behavior.
■ Get rid of weapons until you are safe to keep them. Keeping weapons that can be used against oneself
or others is dangerous (e.g., guns, ropes). Until you can express anger in constructive ways without acting out, it is
essential to keep your environment as free as possible of weapons. They are disasters waiting to happen.

* On the back of the page, write out your motivation for working on anger. Make it clear, compelling, and realistic.
"Own your anger!"

DURING ANGER EPISODES ... CONTAIN

Once destructive anger has begun, the only goal is to bring it back to the "safe zone" -aware of it, but keeping it
within a manageable level (no higher than a 5 on a 0-10 scale).
Why? Destructive anger can blind you. It makes you unable to get perspective or improve the situation. Only
once you are in control of anger can you put it to positive use. Thus, when you are feeling the impulse to act on an­
ger-to say something you'll later regret, to hurt someone-the only priority is to regain safety. Do not try to explore
the anger, understand it, or express it (all that's for later). Think of an "emergency response system" or "damage con­
trol." For example, when there is a toxic industrial spill, the goal is to contain it, get people to safety, clear the area,
and only figure out why later on. Remember that controlling your anger does not mean your anger is wrong. Your
anger is a valid, important feeling that comes from somewhere important. But how it gets addressed-not hurting
yourself or others-is just as important. Each time you are able to contain your anger, you are building strength. It will
get easier over time!
How? * Check off any ideas below that might help you.
• Delay or time out. This is one of the most effective strategies. No matter what, force yourself to delay
11 11

any anger expression or action until you're back in the safe zone. Delay for at least a half hour-it has been found
that it takes the body at least 20-30 minutes to return to normal once anger has been activated.
• Do soothing activities. These might be music, meditation, relaxation, sports, reading, TV, praying, ground­
ing, sex, or hobbies.
• Do activities that help you feel in control. These counteract the out-of-control feeling of destructive an­
ger. They include cleaning your room, writing a list of things to do, going shopping, searching the Web, or any other
productive activity that is not too stressful for you.
• Notice what you're grateful for. Notice what you do have in life, and what others have done for you. For
example, think, "I have a job, a car, my health." Or "I am lucky I have enough to eat every day." Or "I am seeing im­
provements in my life, such as more days clean."
• Apply the twelve steps of AA to your destructive anger. Give yourself up to your Higher Power for help.
Think of destructive anger as an addiction.
• Remember clear thinking." Clear thinking means saying statements to yourself that remind you to keep
11

perspective. See Understanding Anger (Handout 2).

•See the good in people. For anger toward others: Try to identify-right now-anything you can that is good
about the person you are angry at; if you can do this, notice whether your anger goes down a little. For anger to­
ward yourself: Try to identify anything that is good about you.

(cont.)
HANDOUT 3 (page 3 of 5) Healing from Anger

• Ask for help. Try to identify someone you can call when you feel like hurting yourself or others. It may take
others' help before you can stop yourself, once the feeling builds (just as with cravings for substances}. If you have
no one to call, try using a hotline.
• If you are unaware of your anger, try to become conscious. Sometimes people physically hurt them­
selves but are not aware of any anger. It has gone "underground." Your goal in such situations is to notice your an­
ger. This too is a form of containment- conscious anger is much safer than unconscious anger. Ways to do this in­
clude, Ask yourself, "Who am I angry with?" and "What am I afraid will happen if I express anger?"
• Remember the bottom line: It is not okay to act out anger. It is never okay to physically hurt someone
(unless you or others are in life-threatening danger}. Never attack someone weaker than yourself (e.g., a child, an an­
imal, an elderly person}. No matter what someone says or does to you, it is your responsibility to manage your anger.
Do not justify angry outbursts-they harm others and degrade you. And never leave a trail of anger, such as an angry
voice mail or an angry letter. Wait until you're calmer to express your anger (see the next section, "Listen"}.
• Remember your rights. You have a right to feel angry, but you do not have a right to abuse others or your­
self. You have a right to leave a relationship, but you do not have a right to stay and hurt someone. If you cannot ac­
cept the other person, consider detaching from the relationship.
• Stay humble. Much of what fuels anger is a feeling of righteousness. Notice that everyone, including you,
makes mistakes in life. Make a list of the mistakes you've made toward others, and read it the next time you feel like
blowing up at someone.

* On the back of the page, write out your plan for containing destructive anger. Make sure it fits who you are and
what most helps you.

AFTER ANGER EPISODES ... LISTEN

The next major step in healing from anger is listening to it. This means respecting that your anger comes from some­
where important; it signifies a message that needs to be heard.
Why? Behind all anger are unmet needs. Hear the "whisper" behind the anger. If you try to push it away with­
out looking at it, it will keep coming back. Note that listening is meant broadly; it means both listening to yourself
and getting others to listen to you. The key step is for you to hear it clearly-if you can hear it, you can learn to ex­
press it clearly to others too. And if you can hear it clearly, you can then work to get your needs met in effective
ways.
How? * Check off any ideas below that might help you.
♦ Listen to the most vulnerable sides of yourself. Destructive anger is like a small child throwing a tan­
trum-a vulnerable child who feels scared, sad, alone, guilty or powerless, for example. Indeed, it is said that anger is
often a defense against feelings that are more painful. An essential task of recovery is to respect these feelings and
soothe yourself through them.
♦ Listen to your anger messages. Some typical messages that anger conveys include, "Others are not hear­
ing me," "I have suffered too much," "I want the world to be a better place," "I don't have enough support," "I feel
hopeless," "I feel like a failure," "Other people have it easier."
♦ Notice patterns. Does your anger occur when you feel hurt? When you are tired or hungry? When others
are incompetent? When you have been working too hard? When you feel rejected? When others place demands on
you? Some people keep an anger journal to better identify their patterns. For self-harm, too, it is important to notice
what triggers you.

(cont.)
HANDOUT 3 (page 4 of 5) Healing from Anger

• Express your anger calmly. Be gentle, centered, caring. Get others to listen to your anger by expressing it
in appropriate ways. Always try to express anger face to face and really "see" the other person. Also, get help from
others before expressing it: Ask your therapist, friend, or sponsor how to express the anger. If you start to escalate
(yelling, anger above a 5 on a 0-10 scale), leave until you can come back and try again calmly
• Strive to get your needs met through your own efforts. Once you have heard your needs, you can take
care of them. If you are tired or hungry, get sleep or something to eat. If you feel disappointed that your partner doesn't
want to spend more time with you, consider couple therapy or find other people to do more activities with. Remember
that ultimately you are responsible for your own happiness. There are always ways to improve your situation.
♦ Explore how anger relates to your PTSD and substance abuse. How did each of these contribute to
your anger?
♦ If you want to change others, use methods that work. Anger and criticism never change people in the
long run. People just feel afraid of you and avoid you. Methods that do work include negotiation, empathy, praise,
and teaching.
♦ Take good care of yourself. People who hurt others are typically not getting their needs met in healthy
ways. People who harm themselves typically put others' needs before theirs too much. If you hear the needs behind
your anger you may notice, for example, "I need someone to listen to me," "I need to say 'no,' " "I need to take
more time for myself."
♦ Change shoulds" to "wants." All anger has a "should" statement in it-for example, "My partner should do
11

what I ask." A very helpful strategy is to change the "should" statement to a statement beginning with "I want": "I want
my partner to do what I ask." Do you notice your feelings shift when you do this? Usually it makes you aware of limita­
tions that are important to accept. Much anger is a way to gain control in situations where you do not have it.
♦ Create win-win" solutions. Take into account both your needs and the other person's. Take turns mak­
11

ing decisions. Take turns listening and speaking.

♦ Notice why you did what you did. Much anger (especially self-harm) comes from self-criticism. If you be­
come angry with yourself because of something you did or didn't do, try to see why you made that choice. Being
compassionate allows you to take responsibility for your actions and move forward.
♦ Notice low-level anger. People who act out anger often have trouble expressing it as it builds up. They bot­
tle it up and then blow up, often triggered by some small event. Notice your anger in its low-level forms (e.g., annoy­
ance, irritation), and try to get your needs met then so it won't build up.
♦ Protect yourself from angry influences. Observe how you are affected by violent movies, watching televi­
sion news, or being around angry people. There is often a connection between larger cultural forces and your anger.
But remember that anger is a habit that you can change.
• Notice how anger gets misdirected. Anger often gets directed at people who do not deserve it or who do
not deserve it so intensely. For example, perhaps you get very angry over some "small" thing-such as a clerk at a
store who gives you wrong information. You might say to yourself, "I'm furious, but it doesn't make sense to be so
angry about this. I think I'm really angry, deep down, about feeling like no one ever helps me out. I need to start get­
ting more support, rather than blowing up at a store clerk."
♦ Notice whose point of view is being neglected. If you are angry at others, try to listen to others' point of
view more. If you are angry at yourself, try to listen to your point of view (or the various sides of yourself) more. The
goal is to hear both your own and others' point of view at the same time.
♦ Apologize to people you've hurt with your anger. This does not fully take it away, but it may help. If
you can, try to explain the painful feelings that drive your anger.
♦ Recognize that you may need to mourn things you cannot change. Ultimately, after doing whatever
you can to get your needs met, there may be some that can never be fulfilled. Perhaps you have a medical illness that
will never go away. Perhaps you are too old to have a child or to have the career you want. Perhaps your partner can­
not be the person you want. With situations that you cannot change, you will need to mourn and accept them. This
is emotional work that you can and should do, but that may need a therapist's help.
(cont.)
HANDOUT 1 (page 2 of 2) Recovery Thinking

PTSD THOUGHTS
* Compare the thoughts associated with PTSD (left column) to the thoughts associated with recovery (right
column).

PTSD Thoughts versus Recovery Thoughts

''I'm worthless" versus "I did that well"
(Beats self up) (Builds self up)

"I want to cut my arm" versus "I want to solve the problem"
(Self-destructive) (Constructive)

"I don't matter" versus "I need to attend to my needs"

(Neglects self) ( Takes care of self)

"There's no point" versus "Life is what I make it"

(Chooses to die) (Chooses to live)

"I'll always be alone" versus "I can connect"

(Isolates) (Reaches out)

"I am my abuse" versus "I am a human being"

(Narrow identity) (Broad identity)

"Nothing will change" versus "I can grow"

(Rigid) (Flexible)

"I need to drink" versus "I can work on it"

(Seeks escape) (Confronts problems)

"I'm nothing" versus "I'm a decent person"

(Devaluing) (Affirming)

"I'm bad" versus "I'm good"

(Hates self) (Loves self)

"Bad relationships are all I can get" versus "I can find good people"
(Stays with unsafe people) (Seeks safe people)

"I can't cope" versus "I can try"

(Gives up) (Seeks solutions)

"Suffering is all there is" versus "Life is a mix"

(Sees only pain) (Sees pleasure and pain)
HANDOUT 2 Recovery Thinking

Rethinking Tools

Try the following tools to change your thinking.

* List Your Options *

In any situation, you have choices, and it helps to identify them. For example, David was living with his parents and
feeling "pathetic, like a loser." Instead of continuing to put himself down, he sat down and made a list of what he
could do: ( 1) Go to job counseling, get a job, and earn money to move out; (2) See if I can live with a friend; (3) Ap­
ply for disability and move out; (4) Stay with my parents but spend more time on my own. He began to see that he
had choices and that it was up to him to decide among them, rather than just feeling bad about the situation.

* Notice the Source *

Who's telling you something? Can this person be believed? What are that person's flaws? This strategy is especially
important when you are being criticized or given advice that you disagree with. For example, Judy's aunt kept telling
her she was fat. Judy would get depressed and eat more, until she began to see that being talked to like that was
"not okay-it was disrespectful." She began to see that her aunt was a very unhappy person who took out her pain
on the people around her.

* Imagine *
Create a mental picture that helps you feel better. For example, Allan imagined his "heart exploding" when he
had a panic attack, and this would make him feel more anxious. He changed the image to his heart as a "com­
puter," hard-wired and solid-computers don't just blow up and explode. You can create any image you want, as
long as you can picture it: Imagine yourself as a coach encouraging yourself, or an explorer embarking on a
search, or an artist playing with possibilities. You can also use your imagination to "invent a possible world"­
imagine how you want the future to be, and then move toward that (as in sports training, when an athlete imag­
ines a move before doing it).

* Praise Yourself *
Notice what you did right. Decades of research show that the most powerful method of growth is positive reinforce­
ment. This is the opposite of "beating yourself up" or "putting yourself down"-neither of which works to make you
better. Find every opportunity for praise, no matter how small. And be generous-there's no such thing as overdoing
it when it's well earned.

* Learn from Ex perience *

Find a meaningful lesson that can help you next time. For example, Doug asked his roommate to take his marijuana
plants out of the house, but the roommate refused. The lesson he learned was, "My roommate is not really there for
me. I need to either move out or find a new roommate who is less selfish and won't drag down my recovery."

(cont.)
From Seeking Safety by Lisa M. Najavits (2002). Copyright by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only (see copyright page for details).
HANDOUT 2 (page 2 of 3) Recovery Thinking

* Create a New Story *

Tell "what happened" in a way that is respectful of yourself. For example, Jennifer used to think of herself as "dam­
aged goods." Eventually she rewrote the story: "Now I think of myself as a walking miracle, and feel a sense of es­
teem when I realize how far I've come, and how I'm really a good and decent human being."

* Think of the Consequences *

Evaluate the pros and cons over the long term. You feel like having a hit of cocaine. It may feel great for 15 minutes.
But in the long term? You've wasted money; your body will feel worn out; you may dislike yourself more; your family
may be disappointed.

* Examine the Evidence *

Like a scientist or detective, strive to look at the facts objectively. Notice both sides, pro and con. For example, Jack
said, "I can't get off drugs." To examine the evidence, he wrote down two lists, Pro (e.g., "I've been using marijuana
every day for 3 months") and Con (e.g., "I was able to quit for 6 months 4 years ago"). Notice that the lists include
only facts, not opinions. When Jack looked at the lists, he realized that he had had some past success with recovery
and felt a little more motivated to try again.

* Brainstorm *
Try to think of as many interpretations of a negative situation as possible. For example, if someone cuts you off in
driving, you could leap to "What a jerk! No one cares about anyone else." Or you could generate other interpreta­
tions: "Maybe he just found out his wife has gone into labor," "Maybe he's a doctor rushing to the hospital to do sur­
gery." This strategy is especially important for situations where you don't know the truth and can't find out. In this
situation, you can't stop the other person's car and ask why you were cut off on the road. In short, if you can't know
for sure, you might as well go with an interpretation that makes you feel better.

* What's the Real Impact? *

Sometimes it helps to ask, "What is the real impact on my life?" If you apply for a job and don't get it, you may feel
depressed and say to yourself, ''I'm incompetent; I really blew the interview. This is terrible." But if you ask yourself,
"What is the real impact?", you might think "That was just one interview. There are many jobs out there, and I can
keep applying, or maybe get new training, job counseling, practice interviewing, or read a book on how to get a job.
This is not the end of the world." In fact, most situations are not life-or-death.

* Make a Decision *
If you're stuck, try just picking an imperfect road (as long as it's safe). Sometimes people get caught up in so many
possibilities or the attempt to find a "perfect" solution that they feel paralyzed, stuck, or confused. When you get
this way, it's actually better just to go ahead and make a decision for now, even though it may not be perfect. Down
the line you can reevaluate your decision, but for now, "Do something, anything" (as long as it's safe!) is better than
feeling paralyzed and doing nothing.

(cont.)
HANDOUT 2 (page 3 of 3) Recovery Thinking

* Remember a Better Time *

Get perspective by noticing good times. Sometimes when you're caught in a negative feeling, it seems as though it
has always been this way in the past and will always be this way in the future. Try to remember better times (e.g.,
"Last month I was able to keep myself from bingeing on food for an entire week," or "Three years ago I was able to
hold a job"). Both PTSD and substance abuse are disorders that may be different at different times. Stacy wrote, "I
used to be Stacy, full of life and vigor, and smart. Now I don't know me. Will I come out of this? I am a good person,
and the 'old me' wants back in. Can the 'old me' live with how I act when I'm sick? I have to remember it's not me
now, it's an illness."

* Discover Rules to Live By *

Identify principles that keep you focused on recovery-for example, "Take good care of myself," or "When in doubt,
do what's hardest."
HANDOUT 3 Recovery Thinking

About Rethinking

• Everyone is thinking, all the time, even when one is not aware of it. While awake, we are always in a
"conversation" with ourselves (sometimes called "self-talk"). It ranges from the trivial ("What should I have for
lunch?") to the profound ("Why should I go on with life?"). Much of this thinking is automatic-it just happens. In re­
thinking, the idea is to become aware of this internal dialogue and to choose thinking that helps you feel better. For
example, saying to yourself, "I'm no good," would be depressing; saying to yourself, "I've had a hard life but that's
not my fault," might feel a little better.
• Notice how thinking impacts your life. Thinking affects how you feel and act. For example, imagine that
you are home alone at night and drifting off into sleep. Suddenly you hear a sound at the window. If you think, "It's
the wind rustling a tree branch against the window," you are likely to feel fine and go back to sleep. But if you think,
"It's a robber trying to break in," you are likely to feel anxious and call the police. The same situation occurs-hearing
a sound at the window-but how you feel and act depends on what you think.
• Rethinking does not mean "positive thinking"-it means realistic thinking. For example, if you think,
"I'm a bad person," just flipping this around to "I'm a good person" does not work. The goal is not just to reverse
negative thoughts into positive ones, but to evaluate them realistically. Various ways to evaluate your thoughts are
described in Handout 2. But it is important to emphasize that rethinking does not mean "the power of positive think­
ing," but rather, the power of actually exploring the way you look at the world, the meanings you create, and the re­
alities of your experience.
• Rethinking is a profound emotional experience. People sometimes believe that "rethinking" is dry, intel­
lectual, boring, or schoolish. When you learn to do it well, it is a deep experience that helps you truly feel better. It is
not about repeating to yourself things you don't really believe, or just saying what you think you ought to say. It is
about discovering who you are and choosing how you want to approach your life. Some keys to make it work at this
powerful level include the following:
• Identify "hot" thoughts. These are thoughts that are connected to your feelings, that matter to you right
now.
• Stay specific. If you have a general thought such as "My life is hopeless," try to break it down into what
specific and recent real-life experience set off that thought. For example, it might help to identify when
you most recently thought this (e.g., yesterday evening when you were home alone) and what it was
connected to (e.g., you had been drinking). Then you can work on changing it more easily (e.g., "I no­
tice that I feel more hopeless when I drink," or "If I spend time with people in the evenings, I might not
feel so down"). It takes practice, but it really can help.
• Your thoughts are not wrong or bad. Some people assume, "If I need to rethink, it means my thoughts
are bad." This is especially true for people with PTSD and substance abuse, who may already feel bad about them­
selves. But everyone has a variety of thoughts, some of which are negative. Remember that there are good reasons
why you developed the thoughts you have-they come from your life experiences. For example, if you lived through
combat during war, you may have begun to believe that "People are vicious and out for themselves." Or if you were
repeatedly told certain things when you were a child (e.g., "You'll never amount to anything"), after a while you be­
gan to believe it. You may notice too that how you talk to yourself resembles how people in your life have talked to
you.

(cont.)
From Seeking Safety by Lisa M. Najavits (2002}. Copyright by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only {see copyright page for details}.
HANDOUT 3 (page 2 of 2) Recovery Thinking

• Rethinking takes active practice. Rethinking needs to be learned just like anything else. Remember when
you learned to tie your shoes or ride a bike? You had to practice and make mistakes along the way. You can definitely
learn rethinking-anyone can. It took a long time to develop your current way of thinking, and it may take a while to
change it. The more actively you work on it, the better you'll get, and the quicker the results will be. When you no­
tice destructive thinking, stop yourself at that moment and ask yourself, "How can I rethink this to feel better?" You
need to make this sort of active effort for a while until a healthier way of thinking becomes automatic. It's like build­
ing a house: Each brick adds to the strength of the building; it does not happen all at once. Just keep trying!
• Learn more about rethinking. Browse in a library or bookstore or on the Internet; there are many different
resources available under the term "cognitive therapy." For example, there are books by Aaron T. Beck, the main
founder of cognitive therapy. Also, David Burns's Feeling Good: The New Mood Therapy is an inexpensive, popular
paperback. Call the Institute for Cognitive Therapy to locate a cognitive therapist in your area (610-664-3020).
• Try SMART Recovery or Rational Recovery. SMART Recovery and Rational Recovery are substance abuse
self-help groups like AA, except that they focus on rethinking, do not have a spiritual component, and do not view
addiction as a lifelong disease.

Acknowledgments: Cognitive therapy was originally developed by Aaron T. Beck, MD, and Albert Ellis, PhD. The substance abuse section of Hand­
out 1 is based in part on Beck and colleagues (1993) and DuWors (1992). The idea of listing rethinking methods in Handout 2 is based on Burns
(1990), and the handout contains two methods taken directly from that book. Ask your therapist for guidance if you would like to locate any of
these sources.
Grief Myths

Myth: Grief follows distinct stages.

Reality: Despite the popular belief that grief has five distinct stages, research does not back this up.
You might skip stages or go through them in reverse order. Or they may not apply at all.

Feel free to refer to stage models if they are helpful, but follow your intuition above all else. No matter
how it looks, your grief is real, valid, and meaningful. There is no one map for the grief journey.

Myth: Grief is experienced in the same way across all cultures.

Reality: Culture strongly shapes the grief experience. Some cultures see grief as private and personal,
while others approach it as a communal phenomenon.

Even within the same culture, individuals may grieve very differently based on factors such as age,
religion, personality, family situation, and past experiences.

Myth: Grief is just an intense form of sadness.

Reality: Grief includes sadness, but it can also include many other emotions, such as guilt, anger, and
jealousy. Even positive emotions-such as joy, gratitude, and hope--may be part of the grief experience.

You may have a rollercoaster of emotions around grief, particularly when a loss is recent. Then again,
you may find that your emotions are consistent and predictable. Experiences vary widely.

Myth: Moving on is a betrayal of the deceased.

Reality: After a loss, some feel they can't allow themselves to be happy, enter a new relationship, or
move forward in life.

Going on with life and seeking happiness does not mean that you have forgotten or stopped loving the
person you lost. It's okay to move forward at the speed that feels right to you.

Myth: Advice is the best way to help someone who is grieving.

Reality: The temptation to give advice can be hard to resist. While your intentions may be good, advice
can come across as impersonal or even judgmental.

Your presence is often the best thing you can offer the bereaved. Allow yourself to be affected by their
pain, remind them how much you care, and be sensitive to their needs and wishes.

Provided by TherapistAid.com © 2022 Therapist Aid LLC

 Asking for Help

Ideas for a Commitment

Commit to one action that will move your life forward!

It can be anything you feel will help you, or you can try one of the ideas below.
Keeping your commitment is a way of respecting, honoring, and caring for yourself.
+ Option 1: Write a list of people you can call when you are having problems (e.g., wanting to talk, feeling
afraid, drug cravings, needing a ride, etc.). Include friends, family members, self-help sponsors, treaters, hot­
lines, drop-in centers, and anyone else you can think of (see example below).

List of people to call for help

1. My friend Martha: 466-4215 or 252-7655
2. My therapist (Dr. Klein): 855-1111 or can page at 855-1000
3. My AA sponsor (Barbara): 731-1502

+ Option 2: Go for it! Fill out the Approach Sheet.

APPROACH SHEET-EXAMPLE

Fill in the first three parts now. Later, after you've approached the person, fill in the last part.
(1} Who will you talk to?

My friend Elizabeth.

(2) What will you say?

"Please help m e not drink at the party tonight-you can help

by not offering m e any alcohol and checking in with me
at tim es during the party to see if I'm okay."

(3) What do you predict will happen?

She won't want to help m e. She'll think I'm pathetic.

(4) What did happen in reality?

I called Elizabeth. She was very willing to watch out for me

at the party, and also gave m e the phone number for a good AA group
in town. She didn't convey any judgm ent or negative views of me.

From Seeking Safety by Lisa M. Najavits (2002). Copyright by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only (see copyright page for details).
HANDOUT 2 Asking for Help

Approach Sheet
* Fill in the first three parts now. Later, after you've approached the person, fill in the last part.
(1) Who will you talk to?

{2) What will you say?

{3) What do you predict will happen?

(4) What did happen in reality?

* You may want to ask yourself:

• What did you learn from trying this?
• Did you get what you wanted, or at least part of what you wanted?
♦ Is there anything you might do differently next time?
• How do you feel about your experience?
• How difficult was it?
From Seeking Safety by Lisa M. Najavits (2002}. Copyright by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only (see copyright page for details}.
 Chapters of My Life
Chapter 1:
I walked down the sidewalk and fell into a deep hole. I
couldn't get out and I couldn't figure out why. It
wasn't my fault. It took a long time to get out.

Chapter 2:
I walked down the sidewalk and fell into the same hole
again. I couldn't understand. It wasn't my fault. I
really had to struggle to get out.

Chapter 3:
I walked down the sidewalk and fell into the same hole
again. This time I understood why and it was my
fault. This time it was easier to get out.

Chapter 4:
I walked down the sidewalk and saw the same big hole.
I walked around it. I didn't fall into that hole.

Chapter 5:
I chose another sidewalk.

-Portia Nelson
(20th-century American writer)
HANDOUT 1 Red and Green Flags

Signs of Danger versus Safety

Listen to the messages your behavior is sending you/
* What are your red and green flags? Check off below:

g Red Flags g 03 Green Flags 03

Danger Safety
Isolation Spending time with supportive people.
Not taking care of my body (food, sleep) Taking care of my body
Fights with people Able to get along
Too much free time Structured schedule
Destructive behavior Behavior under control
Feel stuck Feel I'm moving forward
Lying Honesty
Negative feelings acted out Negative feelings expressed in words
Canceling treatment sessions Attending all treatment regularly
Stop taking medications as prescribed (either too Taking medications as prescribed
much or too little)
Passive ("Why bother?") Active coping
Cynical/negative Rea Iistic/positive
Not fighting PTSD symptoms (e.g., dissociation, self- Fighting PTSD symptoms (e.g., grounding, rethinking,
cutting) etc.)
Not learning new coping skills Learning new coping skills
Become physically sick Stay physically healthy
Believe treatment is unnecessary Believe treatment is necessary
Spend time with people who use Spend time with "clean" people
Cannot hear feedback Listen to feedback
Too much responsibility Appropriate responsibility
Think people are trying to make me look and feel bad Feel okay around people
Stop caring; stop trying Care and try
Arrogant euphoria Realistic concern
Absent from work or school Attend work or school
(cont.)
From Seeking Safety by Lisa M. Najavits (2002). Copyright by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only (see copyrig ht page for details).
HANDOUT 1 (page 2 of 2) Red and Green Flags

* What are your additional red flags 7 * What are your additional green flags 7
HANDOUT 3 Red and Green Flags

Key Points about Red and Green Flags

'9o Red flags are messages of distress. Just as a fever is a sign that you must rest your body, the red flags are
signs that you are in emotional distress. With PTSD and substance abuse, the tendency is to push them out of mind,
unconscious, not seeing the signs as they occur. But it is essential to notice the red flags and to validate that they are
there for a reason; they are not signs of weakness or failure, but messages to attend to yourself.
'9o Remember "budding." Some people are helped by the acronym "BUD"-"ftuilding !J.p to Qrinking." You
could also use "ftuilding !.!P to Qanger." The list of red flags in Handouts 1 and 2 can be a sign that you are gearing
up to act destructively. There is a window of opportunity during which you can stop yourself from sliding downhill if
you can see the warning signs and actively try to cope with them. Thus dangerous times in both PTSD and substance
abuse are not all-or-none events, but rather gradual buildups that allow time to save yourself.
'9o Help from others is essential as danger escalates. As red flags increase, the need to reach out for help
from safe people increases too. One of the most difficult aspects of PTSD and substance abuse is isolation. As symp­
toms increase, the tendency is to hide away. That's why it is necessary to plan in advance whom you will call and to
prepare that person for how to help you through a dangerous time. Rehearse what you will say to each other.
'9o Listen to the "whispers" before they become ''screams." A safety plan identifies your warning signs
and ways to respond to them. The safety plan in Handout 2 has three levels so that you can attend to mild danger
signs (level 1) before they become an emergency (level 3). The earlier in the process you take action, the better.
'P- As danger increases, so does acting out rather than talking. Notice that many of the danger signs are
behaviors. As distress increases, it is essential to keep talking about your feelings; otherwise you'll likely find yourself
"acting them out" in your behavior. Think of a small child who feels hurt and starts punching a wall. When the child
cannot express the feelings directly, they get acted out.
'I>- Most substance abuse relapses occur within 90 days of abstinence. Research shows the first 90 days to
be a vulnerable time, across various substances of abuse (heroin, smoking, alcohol). Thus knowing your danger signs
is especially important in early recovery.
'9o Notice spiraling. In recovery, there is a process of "spiraling" or "snowballing" that can occur in both posi­
tive and negative directions. A downward spiral occurs when symptoms start to pick up speed and get worse and
worse, often rapidly. An upward spiral occurs when your recovery efforts are so persistent that good things begin to
happen. For example, you get a job, and are therefore able to get an apartment in a safer area, where you can make
friends with healthier people, and so on ...

Acknowledgments: The concept of relapse warning signs is described in detail in Marlatt and Gordon (1985). The term "red flag" is from Trotter
(1992). The safety plan (Handout 2) is derived from a form used in the Mclean Hospital Women's Day Treatment Program, author unknown. Ask
your therapist for guidance if you would like to locate any of these sources.

From Seeking Safety by Lisa M. Najavits (2002). Copyright by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only (see copyright pa ge for details).
HANDOUT 2 Red and Green Flags

create a Safety Plan

* Fill in the safety plan using the following as an example:
Mild Danger {star ting to show distress) What I Will Do to Stay Safe
• Eating poorly • Increase AA to three times a week
• Missing occasional treatment sessions • Tell therapist what I'm feeling
• Getting cynical and negative • Call my friend Pat and talk with her

Id Red Flags Id <'.13 Safety Plan <'.13

Mild Danger What I Will Do to Stay Safe
(Starting to show distress)

Moderate Danger What I Will Do to Stay Safe

(Getting serious-watch out)

Serious Danger What I Will Do to Stay Safe

(Emergency!!)

From Seeking Safety by Lisa M. Najavits (2002). Copyright by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use onl y (see copyright page for details).
HANDOUT 1 Recovery Thinking

Notice What You Say to Yourself!

Recovery thinking means talking to yourself with respect and support.

SUBSTANCE ABUSE THOUGHTS

* Compare the thoughts associated with substance use (left column) to the thoughts associated with recovery
(right column).

Substance Abuse Thoughts versus Recovery Thoughts

"I need it now" versus "I can wait"
(Wants instant satisfaction) (Self-contro�

"I don't care about the future" versus "How will I feel later?"
(Unable to plan) {Able to plan)

"Things should always go smoothly" versus "Sometimes things go wrong"

(Can't tolerate frustration) (Can tolerate frustration)

"I can do what I want" versus "If I use, I'll hurt my kids"
(Focused only on self) (Focused on self and others)

"I need drugs to numb the pain" versus "I can tolerate feeling down"
(Can't tolerate bad moods) (Can tolerate bad moods)

"Abstinence will be boring" versus "I can try new things"

(Afraid of boredom) (Locates exciting activities)

"I'll never get over this" versus "Take it a step at a time"

(Overreacts) (Balanced)

"I might as well use-my life's a mess" versus "I matter"

(Doesn't care) (Cares)

"I'll only have one drink" versus "I know I can't use"
(Unrealistic) (Realistic)

"I have no self-discipline" versus "I can learn self-discipline"

(Stuck) (Seeks to grow)
(cont.)
From Seeking Safety by Lisa M. Najavits (2002). Copyright by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only (see copyri ght page for details}.
HANDOUT 1 Safety

Safety Is the Most Important Priority Right Now!

This entire treatment revolves around one central idea: You need to stay safe. The good news is that you can learn to
cope safely, no matter what negative life events come your way. Nothing has to make you use substances or engage
in any other high-risk behavior.

EXAMPLES
Life situation. You lose your job; your mother criticizes you; you wake up depressed; someone offers you co­
caine; your dog dies; you dissociate; your partner gives you a hard time; you have no money; you find out you have a
tumor; you have a flashback; you can't sleep.
Your coping. This is everything! No matter what happens in your life, you can cope safely.

Unsafe Coping versus Safe Coping

Use substances versus Ask for help
Hurt yourself (e.g., cutting, burning) versus Take good care of your body
Let someone harm you versus Set a boundary in a relationship
Act on impulse versus Rethink the situation

The goal of this treatment is to help you become more aware of how you are coping and to teach you how to cope
more safely. That's it!

STAGES OF HEALING FROM PTSD AND SUBSTANCE ABUSE

For both PTSD and substance abuse, safety is the first stage in healing, according to a great deal of research and clin­
ical wisdom. The stages are as follows:

1. Safety. This is the phase you are in now. The goals are to free yourself from substance abuse, stay alive,
build healthy relationships, gain control over your feelings, learn to cope with day-to-day problems, protect your­
self from destructive people and situations, not hurt yourself or others, increase your functioning, and attain sta­
bility.

2. Mourning. Once you are more safe, you may need to grieve about the past-about what your trauma and
substance abuse did to you. You may need to cry deeply to get over the losses and pain you experienced: loss of in­
nocence, loss of trust, loss of time.
3. Reconnection. After letting yourself experience mourning, you will find yourself more willing and able to re­
connect with the world in joyful ways: thriving, enjoying life, able to work and relate well to others. You will get to
this stage if you can establish safety now!

(cont.)
From Seeking Safety by Lisa M. Najavits (2002). Copyright by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only (see copyright page for details).
HANDOUT 1 (page 2 of 3) Safety

It is important to know that you can heal from PTSD and substance abuse; many people do. It does not mean that
you forget about the past. Rather, it means that it no longer holds such destructive power over your life. (Note that
some people use the term "recovery"; others do not like to use it for PTSD, substance abuse, or both. Whatever
wording you prefer is okay.)

SIGNS OF RECOVERY
"Recovery" means that you .. .

* Can talk about the trauma without feeling either very upset or numb.
* Can function well in daily life (such as holding a job).
* Are safe (e.g., not suicidal or abusing substances).
* Are able to be in healthy relationships without feeling completely vulnerable or isolated.
* Are able to take pleasure in life.
* Take good care of your body (e.g., eating, sleeping, exercising).
* Can rely on yourself and others.
* Can control your most overwhelming symptoms.
* Believe that you deserve to take good care of yourself.
* Have confidence that you can protect yourself.

WHAT IS SAFETY TO YOU?

Describe what safety means to you. Write out who you feel safe with, what activities you feel safe doing, and where
you feel safe. You might also want to describe in detail a safe place that helps you feel calm and connected, such as
a room, the beach, your therapist's office, or another place that brings you back to a feeling of inner peace. You can
add drawings, quotations, or anything else that you like, to better express what safety is for you. Continue on the
back of this page if you need more space.
 Protective Factors

� Protective factors are things that contribute to mental health, and allow a person to be
� resilient in the face of challenges. Someone with a lot of protective factors-such as strong
relationships and healthy coping skills-will be better equipped to overcome life's obstacles.

Many protective factors are out of your control. For example, genetics, the neighborhood where you
grew up, and family cannot be changed. However, plenty of factors can be controlled. You choose the
people in your life, how to cope with problems, and how you'll spend each day.

By focusing on what you can control, and building upon those protective factors, you will improve
your ability to cope with many of life's challenges.

'1 My Protective Factors

Instructions: Review each of the following protective factors, and mark the scales to indicate
how well you are performing in each area.

Social Support Coping Skills

• ability to talk about problems • ability to manage uncomfortable emotions in
• people to ask for practical help (e.g. a ride if a healthy way
car breaks down) • awareness of one's own emotions, and
• feelings of love, intimacy, or friendship recognition of how they influence behavior

Weak Moderate Strong Weak Moderate Strong

Physical Health Sense of Purpose

• adequate exercise or physical activity • meaningful involvement in work, education, or
• a balanced and healthy diet other roles (e.g. parenting)
• medical compliance (e.g. taking medications • understanding of personal values, and living in
as prescribed} accordance with those values

Weak Moderate Strong Weak Moderate Strong

Self-Esteem Healthy Thinking

• belief that one's self has value • does not ruminate on mistakes, personal
• acceptance of personal flaws, weaknesses, flaws, or problems
and mistakes • ability to consider personal strengths and
• belief in ability to overcome challenges weaknesses rationally

Weak Moderate Strong Weak Moderate Strong

© 2017 Therapist Aid LLC Provided by TherapistAid.com

 Protective Factors
Instructions: Refer to the protective factors on the previous page to answer the following questions.

Which protective factor has been the most valuable to you during difficult times?

Specifically, how have you used this protective factor to your advantage in the past?

What are two protective factors that you would like to improve?

Describe how things might be different if you were able to improve these protective factors.

List specific steps or actions that might help to make these goals a reality.

© 2017 Therapist Aid LLC Provided by TherapistAid.com

 Triggers
Trigger: A stimulus-such as a person, place, situation, or thing-that contributes
to an unwanted emotional or behavioral response.

The Problem
Describe the problem your triggers are contributing to. What's the worst-case scenario, if you are
exposed to your triggers?

1-------- -----··....................................._ ................................................ _ ...........__ ,

Trigger Categories
Just about anything can be a trigger. To begin exploring your own triggers, think about each of
the categories listed below. Is there a specific emotion that acts as a trigger for you? How about
a person or place? List your responses in the provided spaces.

Emotional State
____ ................................. __ __ ......................... ___.............................
People
, ______ ............................ ______ ___ .............................

Places
---····..·······················-------····················································--···--···············
Things
•---------.......................--.................................. ______ ,
Thoughts
----...................... ____ ____ , ..............................
Activities / Situations

Tips for Dealing with Triggers

• Oftentimes, the best way to deal with a trigger is to avoid it. This might mean making
changes to your lifestyle, relationships, or daily routine.

• Create a strategy to deal with your triggers head on, just in case. Your strategy might
include coping skills, a list of trusted people you can talk to, or rehearsed phrases to
help you get out of a troublesome situation.

• Don't wait until the heat of the moment to test your coping strategy. Practice!

© 2017 Therapist Aid LLC Provided by TherapistAid.com

 Triggers
� In this section, you will develop a plan for dealing with your three biggest
I=� triggers. Review your plan regularly, and practice each of the strategies.

Describe your three biggest triggers, in detail.

..
CP
#1
............................·---····..·······.........................----······················..·····......................�-------
g
i!:
#2
........................... --.......................................... ____ ..................................................................... --........................................
#3

Describe your strategy for avoiding or reducing exposure to each trigger.

#1 ............................................................................................____..............................................................................___ ............................

CP
0)
0) #2 .............................................................................................---..................................................___
·c
�

#3 •-------····..··............................................... __________

Describe your strategy for dealing with each trigger head on, when they cannot be avoided.

#1 ......................................-�--

..
CP
g #2 ............................................................................................·----·--..············..............................................................................--,
i!:
#3 .............................. ___ ----·····························----

© 2017 Therapist Aid LLC Provided by TherapistAid.com

HANDOUT coping with Triggers

Coping with Triggers

FIGHT THE GOOD FIGHT-COPE WITH TRIGGERS

♦ A trigger is anything that sets off PTSD symptoms or substance use: seeing a crack vial, hearing sad
music, having money, hearing a sudden noise. Just about anything can be a trigger. The more you learn to actively
avoid and fight them, the stronger you'll be.
• What are the most common triggers? For substance abuse, one major study found that the most com­
mon triggers were negative emotions (35%), social pressure (20%), relationship conflicts (16%), urges and tempta­
tions (9%), positive emotions with others (8%), testing personal control (5%), positive emotions alone (4%), and
negative physical states (3%).
♦ Stay far away from triggers. The safest plan is to stay away from triggers whenever possible. Don't watch
the upsetting TV show; don't go near the bar. Avoid "avoidable suffering" by protecting yourself from triggers ahead
of time.
♦ Never "test" yourself" with triggers. This is a mistake some people make in early recovery. They may
think, "I'll go to a party tonight to see if I'm strong enough to tolerate drug triggers." Don't do it! Just as you would
not test yourself by getting into a new trauma, never test yourself to see whether you can tolerate triggers. It is hard
enough to recover without setting yourself up.
♦ Triggers are part of life-but you can "fight the good fight." Even if you do everything you can to avoid
triggers (and hopefully you will!), some will occur just because it is impossible to live "in a bubble." As you go
through your day, you will be faced with triggers at times. The main point is to cope heroically when they do occur.
Fight them; resist them; do not give in to them.
• Strive for balance. With PTSD you may feel too much at times (e.g., overwhelming, intense emotions) and
too little at other times (e.g., numbness, dissociation). With substance abuse you may also feel too much (e.g., in­
tense cravings) or too little (e.g., the "pink cloud" in which you feel you'll never be tempted to use again). To best
fight triggers, the goal is balance: being aware, conscious, and in touch with reality so that triggers will not control
you.
♦ Cope with triggers before, during, or aher they occur. The best way is to cope before by preparing in
advance, but you can cope well at any time in the process. Never give up!
♦ Triggers can be very sudden. That's what makes them so dangerous. They may appear when you least ex­
pect them.

CHANGING WHO, WHAT, AND WHERE TO COPE WITH TRIGGERS

You can get to safety by changing who, what, and where.

Who Are You With?

Detach from unsafe people (dealers, users, abusers). Move toward safe, positive people. Call your sponsor, or a
safe friend or family member. Call before, during, or after a trigger occurs (preferably before!). You can talk about
(cont.)
From Seeking Safety by Lisa M. Najavits (2002). Copyright by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only (see copyright page for details}.
HANDOUT (page 2 of 2) Coping with Triggers

how you are feeling, or just discuss "light" topics such as movies or sports to distract yourself. Also, stay connected
with important people in your life by carrying photographs of them. If you get triggered, pull out the photos and ask
yourself, "What do I need to do right now? How will my substance use affect them?"

What Are You Doing?

Switch to safe activities. Try reading, TV, calming music, exercise, taking a walk, or doing a craft or hobby. Keep
busy in general by having a structured schedule that focuses your attention away from triggers.

Where Are You?

Change your environment. If you feel triggered, find a safe place by leaving the room, the area, or the neighbor­
hood; taking a drive or a walk; throwing out the drug accessories; or changing the TV channel.

In short, put as much space between you and the trigger as possible.
Create a safety zone by changing who, what, and where.

Acknowledgments. This topic and the major study mentioned in the handout are drawn from Marlatt and Gordon (1985). The concept of who,
what, and where is similar to the phrase "Change people, places, and things" in the AA literature. Ask your therapist for guidance if you would
like to locate either of these sources.
 Taking Good care of Yourself

Ideas for a Commitment

Commit to one action that will move your life forward I

It can be anything you feel will help you, or you can try one of the ideas below.
Keeping your commitment is a way of respecting, honoring, and caring for yourself.
+ Option 1: Identify one self-care problem from the Self-Care Questionnaire (one "no" answer) that you want
to work on. Before the next session, make that "no" into a "yes"-solve that self<are problem. If you want
to, write out how it went: How did it feel to do it? Was it successful? Any next steps you'd like to take?
+ Option 2: Take any four of the following words and write a page on how your life could be improved by at­
tending to them (be creative-there's no right or wrong answer to this):

Self-Care Dignity Body Attention Love Effort

Knowledge Respect Safety Physical

+ Option 3: Find someone in your life who takes very good care of her- or himself. Interview this person, asking
everything you can about how the person does it, how it feels, and how the person learned it.
+ Option 4: Fill out the Safe Coping Sheet. (See below for an example applied to this topic.)

EXAMPLE OF THE SAFE COPING SHEET APPLIED TO THIS TOPIC

Old Way New Way

Situation I have a bad toothache. I have a bad toothache.

* Your Coeing * Not doing anything about it. Call dentist immediately. Say
Just trying to put it out of to myself, "Even though I
mind. wasn't taken good care of
when I was growing up, I
need to do things better
now."

Consequence It keeps getting worse. I This feels strange-I'm used

feel miserable. to waiting until everything
is in crisis. But I know
this was the best way to
handle it.

How safe is your old way of coping? __ How safe is your new way of coping? __

Rate from O (not at all safe) to 10 (totally safe)

From Seeking Safety by Lisa M. Najavits {2002). Copyright by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only (see copyright page for details).
IMPROVE the Moment
distress tolerance skills

Instructions: Choose a specific situation you find distressful, or that you found distressful in the past.
Reflect on how you can apply each of the IMPROVE skills to help you cope.

Imagery: Imagine and describe what it's like to be in a beautiful place where you're at peace.

Meaning: Describe the meaning you can find or create in your uncomfortable situation.

Prayer: Describe a prayer or meditation you can practice in this moment.

Relaxation: List relaxation strategies to try, such as breathing deeply or listening to music.

One thing in the moment: What is a simple but engaging activity you can focus on?

Vacation: List two ways you can take a break from your worries.

Encouragement: Select an affirmation, write it here, and then repeat it to yourself several times.

"" �

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HANDOUT 1 (page 2 of 3) safety

It is important to know that you can heal from PTSD and substance abuse; many people do. It does not mean that
you forget about the past. Rather, it means that it no longer holds such destructive power over your life. (Note that
some people use the term "recovery"; others do not like to use it for PTSD, substance abuse, or both. Whatever
wording you prefer is okay.)

SIGNS OF RECOVERY
"Recovery" means that you ...

* Can talk about the trauma without feeling either very upset or numb.
* Can function well in daily life (such as holding a job).
* Are safe (e.g., not suicidal or abusing substances).
* Are able to be in healthy relationships without feeling completely vulnerable or isolated.
* Are able to take pleasure in life.
* Take good care of your body (e.g., eating, sleeping, exercising).
* Can rely on yourself and others.
* Can control your most overwhelming symptoms.
* Believe that you deserve to take good care of yourself.
• Have confidence that you can protect yourself.

WHAT IS SAFETY TO YOU?

Describe what safety means to you. Write out who you feel safe with, what activities you feel safe doing, and where
you feel safe. You might also want to describe in detail a safe place that helps you feel calm and connected, such as
a room, the beach, your therapist's office, or another place that brings you back to a feeling of inner peace. You can
add drawings, quotations, or anything else that you like, to better express what safety is for you. Continue on the
back of this page if you need more space.
HANDOUT 2 Safety

Safe Coping Skills

mi" Ask for help Reach out to someone safe I

� Inspire yourself Carry something positive (e.g., poem), or negative (e.g., photo of friend who overdosed)

� Leave a bad scene When things go wrong, get out

� Persist Never, never, never, never, never, never, never, never give up

� Honesty Secrets and lying are at the core of PTSD and substance abuse; honesty heals them

� Cry Let yourself cry; it will not last forever

� Choose self-respect Choose whatever will make you like yourself tomorrow

q- Take good care of your body Healthy eating, exercise, safe sex

� List your options In any situation, you have choices

� Create meaning Remind yourself what you are living for: your children? love? truth? justice? God?

� Do the best you can with what you have Make the most of available opportunities

q- Set a boundary Say "no" to protect yourself

Q" Compassion Listen to yourself with respect and care

� When in doubt, do what's hardest The most difficult path is invariably the right one

(cont.)
From Seeking Safety by Lisa M. Najavits (2002). Copyright by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only (see copyright page for details).
HANDOUT 2 (page 2 of 6) Safety

� Talk yourself through it Self-talk helps in difficult times

� Imagine Create a mental picture that helps you to feel different (e.g., remember a safe place)

� Notice the choice point In slow motion, notice the exact moment when you chose a substance

aw Pace yourself If overwhelmed, go slower; if stagnant, go faster

� Stay safe Do whatever you need to do to put your safety above all

aw Seek understanding, not blame Listen to your behavior; blaming prevents growth

q- If one way doesn't work, try another As if in a maze, turn a corner and try a new path

� Link PTSD and substance abuse Recognize substances as an attempt to self-medicate

q- Alone is better than a bad relationship If only treaters are safe for now, that's okay

q- Create a new story You are the author of your life: be the hero who overcomes adversity

aai" Avoid avoidable suf fering Prevent bad situations in advance

� Ask others Ask others if your belief is accurate

� Get organized You'll feel more in control with "to-do" lists and a clean house

� Watch for danger signs Face a problem before it becomes huge; notice red flags

� Healing above all Focus on what matters

(cont.)
HANDOUT 2 (page 3 of 6) Safety

� Try something, anything A good plan today is better than a perfect one tomorrow

� Discovery Find out whether your assumption is true, rather than staying "in your head"

� Attend treatment AA, self-help, therapy, medications, groups-anything that keeps you going

I& Create a buffer Put something between you and danger (e.g., time, distance)

� Say what you really think You'll feel closer to others (but only do this with safe people)

� Listen to your needs No more neglect-really hear what you need

� Move toward your opposite For example, if you are too dependent, try being more independent

� Replay the scene Review a negative event: What can you do differently next time?

� Notice the cost What is the price of substance abuse in your life?

� Structure your day A productive schedule keeps you on track and connected to the world

� Set an action plan Be specific, set a deadline, and let others know about it

� Protect yourself Put up a shield against destructive people, bad environments, and substances

� Soothing talk Talk to yourself very gently (as if to a friend or small child)

� Think of the consequences Really see the impact for tomorrow, next week, next year

� Trust the process Just keep moving forward; the only way out is through

(cont.)
HANDOUT 2 (page 4 of 6) Safety

� Work the material The more you practice and participate, the quicker the healing

� Integrate the split self Accept all sides of yourself; they are there for a reason

� Expect growth to feel uncomfortable If it feels awkward or difficult, you're doing it right

� Replace destructive activities Eat candy instead of getting high

� Pretend you like yourself See how different the day feels

� Focus on now Do what you can to make today better; don't get overwhelmed by the past or future

� Praise yourself Notice what you did right; this is the most powerful method of growth

� Observe repeating patterns Try to notice and understand your reenactments

� Self-nurture Do something that you enjoy (e.g., take a walk, see a movie)

EF Practice delay If you can't totally prevent a self-destructive act, at least delay it as long as possible

� Let go of destructive relationships If it can't be fixed, detach

EF Take responsibility Take an active, not a passive approach

� Set a deadline Make it happen by setting a date

� Make a commitment Promise yourself to do what's right to help your recovery

� Rethink Think in a way that helps you feel better

(cont.)
HANDOUT 2 (page 5 of 6) Safety

� Detach from emotional pain (grounding) Distract, walk away, change the channel

� Learn from experience Seek wisdom that can help you next time

1W Solve the problem Don't take it personally when things go wrong-try just to seek a solution

1W Use kinder language Make your language less harsh

1W Examine the evidence Evaluate both sides of the picture

1W Plan it out Take the time to think ahead-it's the opposite of impulsivity

Kar Identify the belief Examples: shoulds, deprivation reasoning

� Reward yourself Find a healthy way to celebrate anything you do right

� Create new "tapes" Literally! Take a tape recorder and record a new way of thinking to play back

� Find rules to live by Remember a phrase that works for you (e.g., "Stay real")

1W Setbacks are not failures A setback is just a setback, nothing more

1W Tolerate the feeling "No feeling is final"; just get through it safely

1W Actions first, and feelings will follow Don't wait until you feel motivated; just start now

1W Create positive addictions Examples: sports, hobbies, AA ...

1W When in doubt, don't If you suspect danger, stay away

(cont.)
HANDOUT 2 {page 6 of 6) safety

1& Fight the trigger Take an active approach to protect yourself

1& Notice the source Before you accept criticism or advice, notice who's telling it to you

� Make a decision If you're stuck, try choosing the best solution you can right now; don't wait

Lai" Do the right thing Do what you know will help you, even if you don't feel like it

� Go to a meeting Feet first; just get there and let the rest happen

Lai" Protect your body from HIV This is truly a life-or-death issue

I& Prioritize healing Make healing your most urgent and important goal, above all else

I& Reach for community resources Lean on them! They can be a source of great support

KrF Get others to support your recovery Tell people what you need

� Notice what you can control List the aspects of your life you do control (e.g., job, friends ... )

Acknowledgments: The "signs of recovery" in Handout 1 are based in part on Harvey (1990). Some of the safe coping skills in Handout 2 are from
Marlatt and Gordon (1985) (e.g., "Setbacks are not failures" and "Create positive addictions"); some are related to AA (e.g., "Work the material"
and "Go to a meeting"); "No feeling is final" is from Rilke (1996); and many are drawn from professional books and articles on cognitive­
behavioral therapy and relapse prevention. Ask your therapist for guidance if you would like to locate any of these sources.
 Coping Skills
Addictions
Building New Habits
Most addictions require a lot of time. Thinking about, acquiring, and indulging an addiction can fill
most of a day. When you quit, one of your greatest new resources is time. However, if your newfound
time isn't filled with healthy activities, it will pose a risk for falling back into old habits.

Building new habits is different than diversion because of the focus on long-term or permanent life
changes. This isn't about riding out a craving-this is about building a better life for yourself.

• Join a casual sports league.

Foster New • Attend a local meetup for one of your interests or hobbies.
Relationships • Get involved in your community by volunteering or supporting a cause you
care about.

• Return to school to pursue a subject you are interested in.

Develop New
• Find a full-time job, or seek a new career that you enjoy.
Professional
• Build new skills on your own using free online resources, or practice your
Skills
existing skills.

• Build a routine around socializing with friends and family. For example,
Refocus on
have Sunday dinners with family, and evening walks with a friend.
Existing
• Be proactive-don't wait for others to reach out to you.
Relationships
• Say "yes" to every social invitation that will not put you at risk of relapse.

Prevention

Avoid Triggers/ Risky Situations

Don't wait until you're in a bad situation to figure out how to escape it. Instead, avoid those
situations altogether. Create a list of the people, places, and things that will likely lead to relapse,
and come up with a plan to avoid them in the future. Sometimes this is as simple as taking a
different route home from work, and other times it might mean a significant lifestyle change.

Healthy Lifestyle
A healthy lifestyle will make you more resilient when faced with obstacles. Many unhealthy
habits, such as insufficient sleep and exercise, have been closely linked to many forms of mental
illness. Focus on creating a routine that accounts for the following aspects of a healthy lifestyle:

• Sleep
• Exercise
• Medical Compliance (e.g. taking medications as prescribed and attending appointments)
• Healthy Diet

© 2017 Therapist Aid LLC Provided by TherapistAid.com

 Coping Skills
Addictions
Managing Emotions/ Relaxation
Most addictions serve as an escape from uncomfortable emotions such as stress, anxiety, and
anger. When the crutch of addiction is taken away, you may need to re-learn how to manage your
emotions. If you don't learn how to relax, tension will build and build, until it leads to relapse. These
techniques, when practiced regularly, will help you manage your emotions in a healthy way.

Deep Breathing
Deep breathing is a simple technique that's excellent for managing emotions. Sit comfortably
and place one hand on your abdomen. Breath in deeply enough that your hand begins to rise
and fall. Imagine you are trying to completely fill your lungs with air. Time the inhalation (4s),
pause (4s), and exhalation (6s) during every breath. Practice for 3 to 5 minutes at a time.

4s 4s"\;J 6s
Inhale Hold� Exhale

Journaling
Writing about personal experiences gives your brain the opportunity to process information
and organize it into manageable chunks. Some of the many benefits of journaling include
improved mental wellbeing, and the reduction of uncomfortable emotions. As you journal, be
sure to describe your feelings alongside the facts of your experiences.

Feel free to journal however you like. However, if you feel stuck, try these prompts:

• Daily Log: Jot a few notes about each day. Whatever comes to mind is fine.
• Letter: Write a letter to someone with whom you would like to tell something. Remember
to describe your feelings. Do not send the letter!
• Gratitude: Describe three good things from your day, no matter how minor they seem.

Imagery
Your brain has the power to turn thoughts into real emotions, and physical responses. Think
about it: Your mouth waters at the thought of your favorite food, and a happy memory can
make you laugh. With the imagery technique, you will use this power to your advantage.

Take a moment to think of a relaxing location or situation. This could be a memory, or

something entirely made up. Maybe you're on a warm beach, alone at the top of a mountain, or
at dinner with close friends. Next, imagine this scene through each of your senses. Don't just
think about each detail for a second and move on-really imagine them. What do you see?
What sounds do you hear? What do you feel? What smells are around you?

Use imagery for at least 5 minutes whenever you need a quick escape.

© 2017 Therapist Aid LLC Provided by TherapistAid.com

 Coping Skills
Anxiety
Challenging Irrational Thoughts
Anxiety can be magnified by irrational thoughts. For example, the thoughts that "something bad will
happen" or "I will make a mistake" might lack evidence, but still have an impact on how you feel. By
examining the evidence and challenging these thoughts, you can reduce anxiety.

Put thoughts on trial. Choose a thought that has contributed to your anxiety. Gather evidence in
support of your thought (verifiable facts only), and against your thought. Compare the evidence
and determine whether your thought is accurate or not.

Use Socratic questioning. Question the thoughts that contribute to your anxiety. Ask yourself:

"Is my thought based on facts or feelings?"

"How would my best friend see this situation?"
"How likely is it that my fear will come true?"
"What's most likely to happen?"
"If my fear comes true, will it still matter in a week? A month? A year?"

Imagery
Your thoughts have the power to change how you feel. If you think of something sad, it's likely you'll
start to feel sad. The opposite is also true: When you think of something positive and calming, you
feel relaxed. The imagery technique harnesses this power to reduce anxiety.

Think of a place that you find comforting. It could be a secluded beach, your bedroom, a quiet
mountaintop, or even a loud concert. For 5 to 10 minutes, use all your senses to imagine this
setting in great detail. Don't just think fleetingly about this place-really imagine it.

What do you see around you? What do you notice in the distance? Look all around
to take in all your surroundings. Look for small details you would usually miss.
What sounds can you hear? Are they soft or loud? Listen closely to everything
around you. Keep listening to see if you notice any distant sounds.
Are you eating or drinking something enjoyable? What is the flavor like? How does
0 it taste? Savor all the tastes of the food or drink.
What can you feel? What is the temperature like? Think of how the air feels on
your skin, and how your clothes feel on your body. Soak in all these sensations.
What scents are present? Are they strong or faint? What does the air smell like?
Take some time to appreciate the scents.

© 2018 Therapist Aid LLC Provided by TherapistAid.com

HANDOUT Detaching rrom Emotional Pain (Grounding)

Using Grounding to Detach from Emotional Pain

WHAT IS GROUNDING?

Grounding is a set of simple strategies to detach from emotional pain {e.g., drug cravings, self-harm impulses, anger,
sadness). Distraction works by focusing outward on the external world, rather than inward toward the self. You can
also think of it as "distraction," "centering," "a safe place," "looking outward," or "healthy detachment."

WHY DO GROUNDING?
When you are overwhelmed with emotional pain, you need a way to detach so that you can gain control over your
feelings and stay safe. As long as you are grounding, you cannot possibly use substances or hurt yourself! Grounding
"anchors" you to the present and to reality.
Many people with PTSD and substance abuse struggle with feeling either too much {overwhelming emotions
and memories) or too little {numbing and dissociation). In grounding, you attain a balance between the two: con­
scious of reality and able to tolerate it. Remember that pain is a feeling; it is not who you are. When you get caught
up in it, it feels like you are your pain, and that is all that exists. But it is only one part of your experience-the others
are just hidden and can be found again through grounding.

Guidelines
♦ Grounding can be done any time, any place, anywhere, and no one has to know.
♦ Use grounding when you are faced with a trigger, enraged, dissociating, having a substance craving,
or whenever your emotional pain goes above 6 (on a 0-10 scale). Grounding puts healthy distance between
you and these negative feelings.
♦ Keep your eyes open, scan the room, and turn the light on to stay in touch with the present.
♦ Rate your mood before and after grounding, to test whether it worked. Before grounding, rate your
level of emotional pain (0-10, where 10 means "extreme pain"). Then rerate it afterward. Has it gone down?
♦ No talking about negative feelings or journal writing-you want to distract away from negative feel­
ings, not get in touch with them.
♦ Stay neutral-avoid judgments of "good" and "bad." For example, instead of "The walls are blue; I dislike
blue because it reminds me of depression," simply say "The walls are blue" and move on.
♦ Focus on the present, not the past or future.
♦ Note that grounding is not the same as relaxation training. Grounding is much more active, focuses on
distraction strategies, and is intended to help extreme negative feelings. It is believed to be more effective than relax­
ation training for PTSD.

WAYS OF GROUNDING
Three major ways of grounding are described below-mental, physical, and soothing. "Mental" means focusing your
mind; "physical" means focusing on your senses (e.g., touch, hearing); and "soothing" means talking to yourself in a
very kind way. You may find that one type works better for you, or all types may be helpful.

(cont.)
From Seeking Safety by Lisa M. Najavits (2002). Copyright by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only (see copyright page for details).
HANDOUT (page 2 of 3) Detaching from Emotional Pain (Grounding)

Mental Grounding
w Describe your environment in detail, using all your senses-for example, "The walls are white; there are
five pink chairs; there is a wooden bookshelf against the wall ..." Describe objects, sounds, textures, colors, smells,
shapes, numbers, and temperature.You can do this anywhere.For example, on the subway: "I'm on the subway. I'll
see the river soon.Those are the windows.This is the bench. The metal bar is silver.The subway map has four col­
ors."
w Play a ''categories" game with yourself. Try to think of "types of dogs," "jazz musicians," "states that be­
gin with 'A' ," "cars," "TV shows," "writers," "sports," "songs," or "cities."
w Do an age progression. If you have regressed to a younger age (e.g., 8 years old), you can slowly work your
way back up (e.g., "I'm now 9; I'm now 1 O; I'm now 11 .. . ") until you are back to your current age.
w Describe an everyday activity in great detail. For example, describe a meal that you cook (e.g., "First I
peel the potatoes and cut them into quarters; then I boil the water; then I make an herb marinade of oregano, basil,
garlic, and olive oil ... ").
w Imagine. Use an image: Glide along on skates away from your pain; change the TV channel to get to a
better show; think of a wall as a buffer between you and your pain.
w Say a safety statement. "My name is · I am safe right now. I am in the present, not the past.I am
located in · the date is ___
w Read something, saying each word to yourself. Or read each letter backward so that you focus on the
letters and not on the meaning of words.
w Use humor. Think of something funny to jolt yourself out of your mood.
w Count to 10 or say the alphabet, very s ... I ... o ... w ... I ... y.

Physical Grounding

* Run cool or warm water over your hands.

* Grab tightly onto your chair as hard as you can.
* Touch various objects around you: a pen, keys, your clothing, the table, the walls. Notice textures, colors,
materials, weight, temperature. Compare objects you touch: Is one colder? Lighter?
* Dig your heels into the floor-literally "grounding" them! Notice the tension centered in your heels as you
do this. Remind yourself that you are connected to the ground.
* Carry a grounding object in your pocket-a small object (a small rock, clay, a ring, a piece of cloth or yarn)
that you can touch whenever you feel triggered.
* Jump up and down.
* Notice your body: the weight of your body in the chair; wiggling your toes in your socks; the feel of your
back against the chair. You are connected to the world.
* Stretch. Extend your fingers, arms, or legs as far as you can; roll your head around.
* Clench and release your fists.
* Walk slowly, noticing each footstep, saying "left" or "right" with each step.
* Eat something, describing the flavors in detail to yourself.
* Focus on your breathing, noticing each inhale and exhale. Repeat a pleasant word to yourself on each in­
hale (e.g., a favorite color, or a soothing word such as "safe" or "easy").

Soothing Grounding

+ Say kind statements, as if you were talking to a small child-for example, "You are a good person going
through a hard time. You'll get through this."
+ Think of favorites. Think of your favorite color, animal, season, food, time of day, TV show.
(cont.)
HANDOUT (page 3 of 3) Detaching from Emotional Pain (Grounding)

+ Picture people you care about (e.g., your children), and look at photographs of them.
+ Remember the words to an inspiring song, quotation, or poem that makes you feel better (e.g., the
AA Serenity Prayer).
+ Remember a safe place. Describe a place that you find very soothing (perhaps the beach or mountains, or
a favorite room); focus on everything about that place-the sounds, colors, shapes, objects, textures.
+ Say a coping statement: "I can handle this," "This feeling will pass."
+ Plan a safe treat for yourself, such as a piece of candy, a nice dinner, or a warm bath.
+ Think of things you are looking forward to in the next week-perhaps time with a friend, going to a
movie, or going on a hike.

WHAT IF GROUNDING DOES NOT WORK1

Grounding does work! But, like any other skill, you need to practice to make it as powerful as possible. Below are
suggestions to help make it work for you.
* Practice as often as possible, even when you don't need it, so that you'll know it by heart.
* Practice faster. Speeding up the pace gets you focused on the outside world quickly.
* Try grounding for a looooooonnnnngggg time (20-30 minutes). And repeat, repeat, repeat.
* Try to notice which methods you like best-physical, mental, or soothing grounding methods, or some
* Create your own methods of grounding. Any method you make up may be worth much more than those
combination.

* Start grounding early in a negative mood cycle. Start when a substance craving just starts or when you
you read here, because it isyours.

* Make up an index card on which you list your best grounding methods and how long to use them.
have just started having a flashback. Start before anger gets out of control.

* Have others assist you in grounding. Teach friends or family about grounding, so that they can help
* Prepare in advance. Locate places at home, in your car, and at work where you have materials and remind­
guide you with it if you become overwhelmed.

ers for grounding.

* Create a cassette tape of a grounding message that you can play when needed. Consider asking your
* Think about why grounding works. Why might it be that by focusing on the external world, you become
therapist or someone close to you to record it if you want to hear someone else's voice.

more aware of an inner peacefulness? Notice the methods that work for you-why might those be more powerful

*
for you than other methods?
Don't give up!
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Provided by TherapistAid.com © 2023 Therapist Aid LLC

 Mental Health Maintenance Plan
Much like your body requires a balanced diet and exercise to maintain its health, your mental health also
needs attention. Maintaining your mental health involves practicing self-care, using coping strategies, and
knowing when to seek professional help. Use this worksheet to review your mental health needs and the
strategies you can use to maintain wellness.

Spotting Mental Health Risks

Triggers
A trigger is anything that can bring back mental health issues. Triggers can be activities, thoughts, people,
places, or things. Once you know your triggers, they can be avoided or managed. List 4 of your triggers.
Tip: In order to avoid triggers, you may need to make changes to your habits, lifestyle, and relationships.

Warning Signs
Warning signs are symptoms-such as thoughts, feelings, and behaviors-that indicate your mental health
might be at risk. Examples include sleep issues, social isolation, and stress. List 4 of your warning signs.
Tip: Knowing your warning signs allows you to begin managing symptoms � they become too severe.

© 2018 Therapist Aid LLC Provided by TherapistAid.com

 Mental Health Maintenance Plan
Preventing and Dealing with Problems
Self-Care
Self-care activities are the things you do regularly to maintain your mental health. Examples include eating
well, exercising, socializing, and engaging in hobbies. List 3 self-care activities you can practice regularly.
Tip: A healthy lifestyle will make you more resilient to stress. Choose self-care activities that can become
habits, and a regular part of your day.

Coping Strategies
Coping strategies are skills that help you manage problems or symptoms when they arise. Examples
include relaxation, communication, and anger management skills. List 3 coping strategies you can use.
Tip: Practice your coping strategies regularly so you are prepared to use them in an emergency.

Returning to Therapy
It's normal to experience problems or uncomfortable emotions, such as sadness, anger, or anxiety.
However, when your problems become too intense, or last for too long, you may need professional help.
How will you know if you should return to therapy?

© 2018 Therapist Aid LLC Provided by TherapistAid.com

HANDOUT 1 community Resources

National Resources
The following are all free, nonprofit, national resources dedicated to helping people. Included are advocacy organiza­
tions, self-help groups, and newsletters.

SUBSTANCE ABUSE/ ADDICTIONS

Al-Anon (for relatives and friends of alcoholics) 800-344-2666

Al-Anon Family Group Headquarters 800-356-9996
Alateen (for teen relatives and friends of alcoholics) 800-344-2666
Alcohol and Drug Healthline 800-821-4357
Alcoholics Anonymous (World Service) 212-870-3400
American Council for Drug Education 800-488-DRUG
American Council on Alcoholism 800-527-5344
Center for Substance Abuse Treatment: National Drug Information, Treatment 800-662-HELP
and Referral Hotline
Cocaine Anonymous (World Service) 310-559-5833
Co-Dependents Anonymous (addictive relationships) 602-277-7991
Division on Addiction-Harvard Medical School 617-432-0058
Families Anonymous (for families with substance abuse) 800-736-9805
Gamblers Anonymous (GA) 213-386-8789
Harm Reduction Coalition 212-213-6376
Join Together (for communities working to reduce substance abuse) 617-437-1500
Narcotics Anonymous (World Service) 818-773-9999
National Clearinghouse for Alcohol and Drug Information 800-729-6686
National Council on Alcoholism Information Line 800-NCA-CALL
National Institute on Drug Abuse Info-Fax Service 888-NIH-NIDA
Rational Recovery (main office) 530-621-437 4
Secular Organization for Sobriety/Save Our Selves (SOS) 310-821-8430
SMART Recovery (national office) 440-951-5357
Sexaholics Anonymous (national office) 615-331-6230

(cont.)
From Seeking Safety by Lisa M. Najavits (2002). Copyright by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only (see copyright page for details).
HANDOUT 1 (page 2 of 5) community Resources

TRAUMA/PTSD/ ANXIETY DISORDERS

Anxiety Disorders Association of America 301-231-8368

Cavalcade Videos (on trauma, for patients and therapists) 800-345-5530
The Healing Woman (trauma survivor newsletter) P. 0. Box 28040
San Jose, CA 95159
www.healingwoman.org
International Society for Traumatic Stress Studies 847-480-9028
Many Voices (trauma survivors newsletter) 513-751-8020
National Center for PTSD and PILOTS Database (extensive literature on PTSD) 802-296-5132;
www.ncptsd.org
National Institute of Mental Health Information Line 800-647-2642
National Victim Center lnfolink 800-FYI-CALL
PTSD Research Quarterly (summary of new research) 202-512-1800
Sidran Traumatic Stress Foundation (trauma information, support) 888-825-8249

DOMESTIC VIOLENCE

National Domestic Violence Hotline 800-799-7233

National Resource Center on Domestic Violence 800-537-2238

MENTAL HEALTH

Depression Awareness, Recognition and Treatment 800-421-4211

Grief Recovery Helpline 800-445-4808
National Alliance for the Mentally Ill 800-950-6264
National Foundation for Depressive Illness 800-248-4344
National Mental Health Association 800-969-6642

HIV/AIDS/SEXUALLY TRANSMITTED DISEASES (STDS)

AIDS Hotline 800-235-2331

American Social Health Association (sexually transmitted diseases) 919-361-8422
Centers for Disease Control National AIDS Clearinghouse 800-458-5231

(cont.)
HANDOUT 1 (page 3 of 5) community Resources

Centers for Disease Control National AIDS Hotline 800-342-2437

Gay Men's Health Crisis Hotline 212-807-6655
Planned Parenthood 800-230-7526

PARENTING/RELATIONSHIPS

American Academy of Husband-Coached Childbirth 800-4A-BI RTH

Child Abuse Prevention Center 888-273-0071
International Childbirth Association 800-624-4934
National Adoption Center 800-TO-ADOPT
National Resource Center 800-367-6724
Parents Helping Parents (free self-help support groups} 800-882-1250

NUTRITION

American Dietetic Association Consumer Nutrition Hotline 800-366-1655

Food Safety Information Line 800-535-4555

MEDICAL PROBLEMS

24-Hour Poison Control Hotline 800-682-9211

Alzheimer's Association 800-272-3900
Alzheimer's Disease Education and Referral Center 800-438-4380
American Cancer Society 800-ACS-2345
American Diabetes Association 800-232-3472
American Heart Association 800-242-8721
American Heart Association-Stroke Information 800-553-6321
American Kidney Fund 800-638-8299
American Liver Foundation 800-223-0179
American Lung Association 800-586-4872
American Optometric Association 314-991-4100
American Paralysis Association 800-225-0292

(cont.)
HANDOUT 1 (page 4 of 5) Community Resources

American Parkinson Disease Association 800-223-2732

American Red Cross 800-737-8300
Asthma and Allergy Foundation 800-7-ASTHMA
Asthma Information Line 800-822-2762
Brain Injury Association Helpline 800-444-6443
Breast Cancer Hotline 800-877-8077
Cancer Care 212-302-2400
Crohn's and Colitis Foundation 800-932-2423
Cystic Fibrosis Foundation 800-FIGHT-CF
Dial-a-Hearing Screening 800-222-3277
Endometriosis Foundation 800-992-3636
Guillain-Barre Syndrome Foundation International 610-667-0131
Huntington's Disease Society 800-345-HDSA
Impotence Information Center 800-843-4315
Juvenile Diabetes Association 800-533-2873
Lupus Foundation of America 301-670-9292
March of Dimes Birth Defects Foundation 888-MO-DIMES
Myasthenia Gravis Foundation 800-541-5454
National Cancer Institute (information about all forms of cancer) 800-4-CANCER
National Council on Aging Information Center 800-222-2225
National Down Syndrome Society 800-221-4602
National Easter Seal Society 312-726-6200
National Hemophilia Foundation 800-42-HANDI
National Kidney Foundation 800-622-9010
National Marrow Donor Program 800-MARROW-2
National Multiple Sclerosis Society 800-FIGHT-MS
National Neurofibromatosis Foundation 800-323-7938
National Organization for Rare Disorders 800-999-NORD
National Psoriasis Foundation 503-297-1545
National Stroke Association 800-STROKES

(cont.)
HANDOUT 1 (page 5 of 5) community Resources

Prevent Blindness 800-331-2020

RP Foundation Fighting Blindness 800-683-5555
Spina Bifida Association of America 800-621-3141
Stuttering Foundation of America 800-992-9392
Sudden Infant Death Syndrome Alliance 800-221-7437
Tourette Syndrome Association 800-237-0717
United Ostomy Association 800-826-0826

WOMEN'S HEALTH

National Women's Health Information Center 800-994-WOMAN

 Resources
Nusaiba Publishing. (2022). Say no to suicide adult coloring book [ Say no to suicide
adult coloring book].

Therapy worksheets, tools, and handouts. (n.d.). Therapist Aid.

http://therapistaid.com

Najavits, L. M. (2002). Seeking Safety. Guilford Publications.