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1. Determine the neurophysiology of the stress response, including the roles of the amygdala, hypothalamus, sympathetic and parasympathetic nervous systems, and the effects of cortisol and adrenaline.
2. Discriminate among acute stress, major life events and chronic stressors, and the longer-term effects of chronic stress on mind and body.
3. Implement grounding strategies to help clients who experience "freeze" states or dissociative symptoms.
4. Communicate the concept of mindfulness, how it affects the brain, and how to use mindfulness-based interventions in therapy.
5. Critique the concept of self-compassion and research on its benefits.
6. Design practical exercises to increase self-compassion in clients facing stress.
7. Analyze the importance of perceived control to the impact of stressors and learn how to help clients differentiate controllable and uncontrollable aspects of stressors.
8. Explore how stress and anxiety narrow cognitive focus and create thinking traps and learn techniques to help clients be more cognitively flexible in the face of stress.
9. Evaluate the research suggesting that positive emotions can undo the physiological effects of negative emotions.
10. Investigate how rumination exacerbates the effects of stress and how to help clients curtail ruminative cycles and de-fuse from negative thinking.
11. Appraise how a growth mindset differs from a fixed mindset and how to help clients adopt a growth mindset and a gritty attitude towards their stressors.
12. Assess the application of a brain-based, neuroscience approach to treating clinical disorders like GAD and PTSD.

Using Neuroscience in Treatment of Stress and Trauma

• Positives:
  • Science gives authority, evidence, de-stigmatizes mental health problems
  • Increased motivation and hope for change
• Concerns:
  • Oversimplification, unrealistic expectations, changing state of science, see self as damaged or different

The Promise of Neuroplasticity

• Describe neuroplasticity in everyday language
• Therapy is about creating a new, more resilient brain
• We are changing beings - don't have to be stuck in rigid views of self
• Teach brain to be less reactive to stress and triggers
• "Rewiring" as a metaphor for change
• Changing "raw," unprocessed memories to organized narratives

The Brain's Stress Response

• Historical view - Hans Selye
• The brain's stress response "fight, flight, freeze"
• The triune brain - reptilian, mammalian, human
• The amygdala and the prefrontal cortex
• How the amygdala "hijacks" the brain into emergency mode

How the Stress Response is Spread Throughout the Body

• Neurotransmitters - Epinephrine, norepinephrine and cortisol
• The HPA axis and role of cortisol
• The sympathetic and parasympathetic nervous systems
• The dorsovagal "freeze" response to unavoidable threat

The Upside and Downside of Stress

• Increased motivation and engagement - "flow" state
• Can create mental toughness and resilience to future stressors
• Inflammatory response to chronic stress
• Stress and health risk behaviors (excess alcohol use, smoking, overeating etc)
• Stress and cellular aging (telomeres)

Traumas - Effects on the Brain

• Cortisol attacks the hippocampus - center of narrative memory
• Amygdala response increases in strength
• Impaired anterior cingulate cortex (ACC) and prefrontal cortical function
• Cortisol halts production of BDNF - fewer new brain cells formed
• Link to depression, anxiety disorders, PTSD
• Cognitive rigidity and inability to take in new information
• Changes in sense of self and dissociation

Long-Term Impact of Adverse Childhood Experiences (ACEs)

• The ACE Study (Kaiser and the CDC)
• Addictive and unhealthy ways of managing anxiety & negative emotions
• Disease, mental health issues, behavioral problems, PTSD

Explaining Neuroscience Concepts to Clients

• Use drawings and images
• Individualize to the type of difficulty (e.g., disengaged vs reactive - different brain areas)
• Redirect vs eliminate
• Help client label & recognize when happening (e.g., freeze, flooding, negative thinking, rigidity, impulsivity)
• Find coping strategies for each type of brain difficulty

Stress-Proofing the Brain - Overview

• Calming the amygdala - Grounding, mindfulness, self-compassion, perceiving control
• Moving forward with the prefrontal cortex - Cognitive reappraisal, priming positive mindsets and, growth focus, health psychology tools

Grounding Strategies for Clients with Trauma or Attachment Injuries

• Yoga, relaxation, breathing, present-moment focus, soothing with the senses, pets, drawing, gardening, walking
• Mental imagery - safe place, boundaries, energetic, times they felt strong/competent
• Left-brain strategies - task focus and engagement

Mindfulness Strategies

• Qualities of mindfulness states - open, nonjudgmental, fluid, deliberate,
• Observing and accepting inner experience (thoughts, feelings, sensations)
• Using the senses to self-regulate
• De-fusing from negative thoughts and self-images
• How mindfulness changes the brain
• Mindfulness practices - breathing, watching thoughts, urge surfing, open awareness
• Application to anxiety, depression, addictions, PTSD

Self-Compassion Strategies

• Self-kindness, common humanity, focus on unmet needs
• Application to depression, anxiety, stress-management, trauma, insecure attachment
• Link to Schema Therapy - healthy adult mode
• Practices - Metta meditation, soften, soothe and allow, dialogues with inner critic

Cognitive Strategies

• How stress and anxiety narrow attention, create cognitive rigidity
• Depression and negative thinking
• PTSD and internalized negative appraisals (helpless, unworthy, unsafe etc.)
• Worry and rumination cycles - link to prefrontal cortex and default mode network
• Why thought suppression doesn't work
• De-catastrophizing and probability estimation
• Exposure and tolerating negative thoughts
• Using metaphors (monsters on the boat, bouncy ball underwater)

Creating Positive States of Mind to Counter Stress

• How our brains are wired to the negative
• Positive emotions can promote physiological recovery from anxiety and fear
• Reappraising anxiety as excitement
• Gratitude diaries
• Commitment, control, and challenge; growth mindset

Living Healthy in the Face of Stress

• Sleep disturbance - behavioral strategies
• Healthy coping strategies - exercise, meditation, yoga
• Dealing with emotional eating

Melanie Greenberg, PhD, is a practicing psychologist, author, speaker, and executive coach with more than 20 years of professional experience. She has an active practice in Mill Valley, CA where she sees individuals and couples, teens and adults. Originally from South Africa, Melanie has a passion for psychological growth and healing. She loves to challenge, inspire and motivate. Melanie is the author of The Stress-Proof Brain (New Harbinger, 2017) – an Amazon bestseller in neuropsychology, stress-management, and health. She writes the popular Mindful Self-Express blog for Psychology Today (8 million page views) and has a substantial social media following. Melanie is a former professor in the clinical psychology Doctoral Program at Alliant International University, San Diego. She has delivered talks and workshops to national and international audiences, businesses, nonprofits, and professional organizations, including The American Psychological Association, Wisconsin Psychological Association, Society of Behavioral Medicine, and The Bay Club. She has also published more than 50 research articles and scholarly products. A popular media expert, she has been featured on CNN, Forbes, Inc., Business Insider, BBC radio, ABC News, Yahoo, AOL, and Lifehacker, as well as in Self, Redbook, Women’s Health, Men’s Health, Fitness Magazine and the Huffington Post. She has also been featured on radio shows and numerous podcasts. With almost 50,000 followers, she was named one of the Top Psychologists to follow on Twitter by The British Psychological Society. www.drmelaniegreenberg.com

Speaker Disclosures:

Financial: Melanie Greenberg is in private practice. She is an author for New Harbinger Publications and Psychology Today and receives royalties. Dr. Greenberg receives a honorarium from the Community Institute for Psychotherapy and National Charity League. She receives a speaking honorarium from PESI, Inc. She has no relevant financial relationships with ineligible organizations.

Non-financial: Melanie Greenberg is a member of the American Psychological Association; and California Psychological Association.

Save time and $10 off the price of other submission methods – purchase & take the CE test online for $19.99 USD per participant. Additional processing fees apply for other submission methods (i.e. mail, fax, etc.). Please contact our Customer Service at 1-800-844-8260 for more details.

Listed below are the continuing education credit(s) currently available for this non-interactive self-study package. Please note, your state licensing board dictates whether self study is an acceptable form of continuing education. Please refer to your state rules and regulations.

Certificates of Successful Completion are available for email, download and/or printing from your online account immediately following the successful completion of the post-test/evaluation.

**Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of mental health professionals. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your professions standards.

All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners. For speaker disclosures, please see the faculty biography.

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Addiction Counselors
This self-study activity consists of 12.5 clock hours of continuing education instruction. Credit requirements and approvals vary per state board regulations. Please save the course outline, the certificate of completion you receive from the activity and contact your state board or organization to determine specific filing requirements.

California Alcoholism & Drug Abuse Counselors (CADTP): PESI, Inc. is an approved provider by the CADTP, Provider #: 201. This Category H activity meets the qualifications for 12.5 CEU's (continuing education hours).

Connecticut Addiction Counselors: Provider #120924. This course has been approved as a CCB approved training and has been awarded 12.5 hours by the Connecticut Certification Board.

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Chaplains/Clergy
This self-study program is designed to qualify for 12.5 continuing education hours.

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Counselors
This intermediate self-study activity consists of 12.5 clock hours of continuing education instruction. Credit requirements and approvals vary per state board regulations. Please save the course outline, the certificate of completion you receive from the activity and contact your state board or organization to determine specific filing requirements.

California Counselors: The California Board of Behavioral Sciences accepts CE programs that are approved by other approval agencies, including several that approve PESI and its programs. A full list of approval agencies accepted by the BBS can be found at www.bbs.ca.gov/licensees/cont_ed.html under “Where to find CE Courses.” This Intermediate level self-study activity consists of 12.0 clock hours of continuing education instruction.

Florida Social Mental Health Counselors: PESI, Inc. is an approved provider with the Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling. Provider Number 50-399. This self-study course qualifies for 12.5 continuing education credits.

Missouri Counselors: CE credit is available. This self-study course consists of 12.5 continuing education clock hours for Missouri Counselors. The Missouri Committee for Professional Counselors accepts continuing education programs relevant to counseling that are provided by organizations recognized by national social worker associations. PESI, Inc. is recognized by a national social worker association. Please see social work approvals for this program.

Montana Counselors: The Montana Board of Behavioral Health no longer pre-approves any courses or sponsors. Each licensee is responsible for taking courses which contribute to their competence and directly relate to their scope of practice as defined in board statute (MAR 24-219-32). Licensees must keep CE documentation for three years in case of an audit. This intermediate level self-study activity consists of 12.5 clock hours of instruction.

New York Counselors: PESI, Inc. is recognized by the New York State Education Department's (NYSED) State Board for Mental Health Practitioners as an approved provider of continuing education for Licensed Mental Health Counselors. #MHC-0033. This self-study activity will qualify for 15.0 contact hours. Full attendance is required; no partial credits will be offered for partial attendance.

Pennsylvania Counselors: The Pennsylvania State Board of Social Workers, Marriage and Family Therapists and Professional Counselors accepts many national association CE approvals, several of which PESI offers. For a full list, please see your State Board regulations at https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/. This intermediate self-study activity consists of 12.5 clock hours of continuing education instruction.

South Carolina Counselors: This self-study program has been approved for 12.5 continuing education hours by the South Carolina Board of Examiners for Licensure of Professional Counselors, Marriage and Family Therapists, and Psycho-Educational Specialists. Provider #4540.

Texas Counselors: This self-study activity consists of 12.5 clock hours of continuing education instruction. Texas State Board of Examiners of Professional Counselors no longer approves programs or providers. PESI activities meet the continuing education requirements as listed in Title 22 Texas Administrative Code, Chapter 681, Subchapter J, Section 681.142 Acceptable Continuing Education. Please retain the certificate of completion that you receive and use as proof of completion when required.

Ohio Counselors: PESI, Inc. is an approved provider with the State of Ohio Counselor, Social Worker and Marriage & Family Therapist Board. Provider approval #:RCST071001. Full attendance at this course meets the qualifications for 12.5 clock hours of continuing education credit. TBD

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Marriage & Family Therapists
This self-study activity consists of 12.5 clock hours of continuing education instruction. Credit requirements and approvals vary per state board regulations. Please save the course outline, the certificate of completion you receive from this self-study activity and contact your state board or organization to determine specific filing requirements.

California Marriage & Family Therapists: The California Board of Behavioral Sciences accepts CE programs that are approved by other approval agencies, including several that approve PESI and its programs. A full list of approval agencies accepted by the BBS can be found at www.bbs.ca.gov/licensees/cont_ed.html under “Where to find CE Courses.” This Intermediate level self-study activity consists of 12.0 clock hours of continuing education instruction.

Florida Marriage & Family Therapists: PESI, Inc. is an approved provider with the Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling. Provider Number 50-399. This self-study course qualifies for 12.5 continuing education credits.

Illinois Marriage & Family Therapists: PESI, Inc. has been approved as a provider of continuing education by the State of Illinois, Department of Financial and Professional Regulation, Division of Professional Regulation. Provider #: 168-000156. Full attendance at this self-study activity qualifies for 12.5 credits.

Montana Marriage & Family Therapists: The Montana Board of Behavioral Health no longer pre-approves any courses or sponsors. Each licensee is responsible for taking courses which contribute to their competence and directly relate to their scope of practice as defined in board statute (MAR 24-219-32). Licensees must keep CE documentation for three years in case of an audit. This intermediate level self-study activity consists of 12.5 clock hours of instruction.

New York Marriage & Family Therapists: PESI, Inc. is recognized by the New York State Education Department's (NYSED) State Board for Mental Health Practitioners as an approved provider of continuing education for Licensed Marriage and Family Therapists. #MFT-0024. This self-study activity will qualify for 15.0 contact hours. Full attendance is required; no partial credits will be offered for partial attendance.

Pennsylvania Marriage & Family Therapists: The Pennsylvania State Board of Social Workers, Marriage and Family Therapists and Professional Counselors accepts many national association CE approvals, several of which PESI offers. For a full list, please see your State Board regulations at https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/. This Intermediate self-study activity consists of 12.5 clock hours of continuing education instruction.

South Carolina Marriage & Family Therapists: This self-study program has been approved for 12.5 continuing education hours by the South Carolina Board of Examiners for Licensure of Professional Counselors, Marriage and Family Therapists, and Psycho-Educational Specialists. Provider #4540.

Texas Marriage & Family Therapists: This self-study activity consists of 12.5 clock hours of continuing education instruction. Texas State Board of Examiners of Marriage and Family Therapists no longer approves programs or providers. PESI activities meet the continuing education requirements as listed in Title 22 of the Texas Administrative Code, Chapter 801, Subchapter K, Section 801.264 Types of Acceptable Continuing Education. Please retain the certificate of completion that you receive and use as proof of completion when required.

Ohio Marriage & Family Therapists: PESI, Inc. is an approved provider with the State of Ohio Counselor, Social Worker and Marriage & Family Therapist Board. Provider approval #:RCST071001. Full attendance at this course meets the qualifications for 12.5 clock hours of continuing education credit. TBD

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Nurses, Nurse Practitioners, and Clinical Nurse Specialists
This self-study activity consists of 12.5 clock hours of continuing education instruction. Credit requirements and approvals vary per state board regulations. Please save the course outline, the certificate of completion you receive from this self-study activity and contact your state board or organization to determine specific filing requirements.

California Nurses: PESI, Inc. is a provider approved by the California Board of Registered Nursing, Provider #:17118 for 12.5 self-study contact hours.

You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

Florida Nurses: PESI, Inc. is an approved provider by the Florida Board of Nursing. Provider #: FBN2858. These materials qualify for 12.5 self-study contact hours.

Iowa Nurses: PESI, Inc. is an approved provider by the Iowa Board of Nursing. Provider #: 346. Nurses successfully completing these self-study materials will earn 12.6 self-study contact hours.

Copies of the evaluation may be sent to the IBON. You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

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Psychologists & Physicians

Physicians
PESI, Inc. is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. PESI, Inc. designates this enduring material for a maximum of 12.5 AMA PRA Category 1 Credit(s)™. This activity was originally recorded on 12/14/2017. It was last reviewed on 08/11/2021 and is valid until 6/27/2024.

Physicians should only claim credit commensurate with the extent of their participation in the activity.

Psychologists
The following state psychologist boards recognize activities sponsored by PESI, Inc. as an approved ACCME provider: Alaska, Arkansas, California, Colorado, Georgia, Illinois, Indiana, Kentucky, Maine, Maryland, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, Oklahoma, Pennsylvania, South Carolina and Wisconsin. This activity consists of 12.5 clock hours of continuing education instruction. You are required to successfully complete and submit a post-test prior to receiving a certificate of completion.

California Psychologists: CE credit is available. This self-study course consists of 12.5 continuing education credit hours for California Psychologists. The California Board of Psychology recognizes and accepts for continuing education credit courses that are specifically applicable and pertinent to the practice of psychology and by entities approved by the ACCME (Accreditation Council for Continuing Medical Education). This enduring material is certified for a maximum of 12.5 AMA PRA Category 1 Credits™ by PESI as an accredited ACCME provider authorized to award credit by the AMA. PESI, Inc. is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Canadian Psychologists: PESI, Inc. is approved by the Canadian Psychological Association to offer continuing education for psychologists. PESI, Inc. maintains responsibility for the program. This program is approved for 12.5 self-study continuing education hours. Full credit statement at: https://catalog.pesi.com/page/ceinformation#psychologists

Florida Psychologists: PESI, Inc., is an approved provider with the Florida Board of Psychology. Provider Number 50-399. This product qualifies for 12.6 self-study continuing education credits. Please make sure to bring your license number to the seminar so that we can report your attendance to CE Brokers.

Illinois Psychologists: PESI, Inc is an approved provider with the State of Illinois, Department of Financial and Professional Regulation, Division of Professional Regulation. License #: 268.000102. Full attendance at this course qualifies for 12.5 self-study contact hours.

Kentucky Psychologists: PESI, Inc. is approved by the Kentucky Board of Examiners of Psychology to offer continuing education for psychologists, approved provider #202312H. PESI maintains responsibility for this program and its content. This self-study activity will qualify for 12.5 contact hours.

Indiana Psychologists: PESI, Inc is an approved provider with the Indiana Board of Psychology. Certificate #: 98000998A - Category I. PESI maintains full responsibility for this program and its contents. Full attendance at this self-study course qualifies for 12.5 contact hours.

Ohio Psychologist: PESI, Inc. is approved by the Ohio Psychological Association, Provider #263896894, to sponsor continuing education for psychologists. PESI, Inc. maintains responsibility for this program and its content. PESI is offering this self-study activity for 12.5 Standard hours of continuing education credit.

Pennsylvania Psychologists: PESI, Inc. is approved by the Pennsylvania State Board of Psychology to offer continuing education for psychologists. Provider #PSY000211. PESI maintains responsibility for the program(s). This self-study program qualifies for 12.5 continuing education hours.

South Carolina Psycho-Educational Specialists: This self-study program has been approved for 12.5 continuing education hours by the South Carolina Board of Examiners for Licensure of Professional Counselors, Marriage and Family Therapists, and Psycho-Educational Specialists. Provider #4540.

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Social Workers - National ASWB ACE
PESI, Inc., #1062, is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved as ACE providers. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. PESI, Inc. maintains responsibility for this course. ACE provider approval period: January 27, 2023 - January 27, 2026. Social workers completing this course receive 12.5 Clinical continuing education credits.

Course Level: Intermediate Format: Recorded asynchronous distance. Full attendance is required; no partial credits will be offered for partial attendance.

Canadian Social Workers: Canadian provinces may accept activities approved by the ASWB for ongoing professional development.

California Licensed Educational Psychologists: The California Board of Behavioral Sciences accepts CE programs that are approved by other approval agencies, including several that approve PESI and its programs. A full list of approval agencies accepted by the BBS can be found at www.bbs.ca.gov/licensees/cont_ed.html under “Where to find CE Courses.” This Intermediate level self-study activity consists of 12.0 clock hours of continuing education instruction.

California Social Workers: The California Board of Behavioral Sciences accepts CE programs that are approved by other approval agencies, including several that approve PESI and its programs. A full list of approval agencies accepted by the BBS can be found at www.bbs.ca.gov/licensees/cont_ed.html under “Where to find CE Courses.” This Intermediate level self-study activity consists of 12.0 clock hours of continuing education instruction.

Colorado Social Workers: PESI, Inc. is an approved provider with the Colorado Chapter of the National Association of Social Workers. Provider #1413. This course has been approved for 12.6 continuing education hours.

Florida Social Workers: PESI, Inc. is an approved provider with the Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling. Provider Number 50-399. This self-study course qualifies for 12.5 continuing education credits.

Illinois Social Workers: PESI, Inc. is an approved provider with the State of Illinois, Department of Financial and Professional Regulation, Division of Professional Regulation. License #: 159-000154. Successful completion of this self-study activity qualifies for 12.5 contact hours.

Kansas Social Workers: PESI, Inc. is an approved provider with the Kansas Behavioral Sciences Regulatory Board. Provider #14-006. This self-study course has been approved for 12.5 continuing education hours.

Minnesota Social Workers: PESI, Inc. is an approved provider with the State of Minnesota, Board of Social Work. Provider #: CEP-140. This self-study course has been approved for 12.5 continuing education hours. A certificate will be issued upon successful completion of a post-test.

Montana Social Workers: The Montana Board of Behavioral Health no longer pre-approves any courses or sponsors. Each licensee is responsible for taking courses which contribute to their competence and directly relate to their scope of practice as defined in board statute (MAR 24-219-32). Licensees must keep CE documentation for three years in case of an audit. This intermediate level self-study activity consists of 12.5 clock hours of instruction.

New York Social Workers: PESI, Inc. is recognized by the New York State Education Department's (NYSED) State Board for Social Work as an approved provider of continuing education for licensed social workers #SW-0008. This self-study activity will qualify for 15.0 contact hours. Full attendance is required; no partial credits will be offered for partial attendance.

Pennsylvania Social Workers: The Pennsylvania State Board of Social Workers, Marriage and Family Therapists and Professional Counselors accepts many national association CE approvals, several of which PESI offers. For a full list, please see your State Board regulations at https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/. This intermediate self-study activity consists of 12.5 clock hours of continuing education instruction.

Ohio Social Workers: PESI, Inc. is an approved provider with the State of Ohio Counselor, Social Worker and Marriage & Family Therapist Board. Provider approval #:RCST071001. Full attendance at this course meets the qualifications for 12.5 clock hours of continuing education credit. TBD

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Other Professions
This self-study activity qualifies for 12.5 clock hours of instructional content as required by many national, state and local licensing boards and professional organizations. Retain your certificate of completion and contact your board or organization for specific filing requirements.

Disclaimer: **Information obtained in this course should be used within your scope of practice.
**It is your ethical responsibility to report accurate hours to your licensing board.
**All self-study participants must complete and pass (80% or better) a post-test and evaluation prior to receiving a certificate of completion. If you require a copy of the test/evaluation for CE purposes, please print at the time you take the test. Or you may call our customer service department and a copy of your test/evaluation will be emailed to you. Please allow 30-45 days.

Addiction Counselors, Case Managers, Chaplains/Clergy, Counselors, Marriage & Family Therapists, Nurses, Psychologists, Social Workers, and other Mental Health Professionals