Mood and Anxiety Disorders

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  DBT was first developed by Marsha Linehan, PhD, ABPP to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD), It has now become the go to therapy for Borderline, but its usefulness does not end there.  Research has shown that it is effective in treating a wide range of other disorders such as substance dependence, depression, post-traumatic stress disorder (PTSD), and eating disorders. 

So what is DBT? It is focused on learning and applying skills in four main areas.  Those areas are mindfulness, Interpersonal effectiveness skills, emotional regulation, and distress tolerance skills.  Mindfulness helps us learn how to be in the present and to become more aware of our thoughts and emotions.  Interpersonal effectiveness skills helps us to help healthy relationships with realistic expectations and healthy boundaries.  Emotional regulation skills provides ways to handle our emotions and understand them.  Finally distress tolerance skills gives tools to  manage crisis without making them worse.  In reality these are all skills each of us could use.

I have used DBT with several of my clients, especially teenagers.  I have seen how it has helped my clients regulate their emotions, become more effective in their relationships, be able to handle hard situations in a healthy manner, and not be controlled by their pain and hurts anymore.  If you are struggling with managing your emotions, relationships, being overwhelmed with your past, or struggling with trauma DBT could be the answer.

Cognitive-Behavioral Therapy (CBT) is a widely practiced and evidence-based therapeutic approach that focuses on the connection between thoughts, feelings, and behaviors. It is commonly used to treat a variety of mental health issues, including anxiety, depression, phobias, and stress-related disorders.

Key principles of CBT include:

1. Cognitive Restructuring: Identifying and challenging negative thought patterns and beliefs that contribute to emotional distress. This process involves replacing irrational or unhelpful thoughts with more realistic and balanced ones.
2. Behavioral Activation: Encouraging individuals to engage in positive behaviors and activities that bring a sense of achievement and pleasure. This helps disrupt cycles of avoidance and withdrawal.
3. Exposure Therapy: Gradual and controlled exposure to feared or avoided situations to reduce anxiety and desensitize individuals to triggers.
4. Problem-Solving: Teaching individuals effective problem-solving skills to cope with challenges and stressors in their lives.
5. Mindfulness: Integrating mindfulness techniques to enhance present-moment awareness and acceptance, reducing the impact of negative thoughts.
6. Collaborative Approach: CBT is typically a collaborative effort between the therapist and the individual. Therapists work with clients to set goals, track progress, and develop coping strategies.
7. Homework Assignments: Assigning tasks or exercises for individuals to complete between sessions, reinforcing and applying therapeutic concepts in real-life situations.

Exposure Response Prevention (ERP) is a therapeutic technique commonly used in the treatment of obsessive-compulsive disorder (OCD). It involves exposing individuals to anxiety-provoking situations or thoughts (exposure) while preventing the accompanying compulsive rituals or behaviors (response prevention). The goal is to break the cycle of obsessions and compulsions, gradually reducing anxiety and allowing individuals to develop healthier coping mechanisms.

In ERP, clients work collaboratively with therapists to identify and confront their fears in a controlled and systematic way. Through repeated exposure to anxiety triggers without engaging in compulsive behaviors, individuals can learn to tolerate and manage their anxiety more effectively. Over time, this process helps to diminish the power of obsessive thoughts and reduces the need for compulsive actions.

ERP is rooted in the principles of cognitive-behavioral therapy (CBT) and has shown effectiveness in treating various forms of OCD. It empowers individuals to confront and overcome their fears, promoting long-lasting symptom relief and improved quality of life. It is crucial for ERP to be tailored to each individual's specific fears and triggers to ensure its effectiveness in addressing their unique challenges.

TRIP  is specifically designed to interrupt the fear, terror, and helplessness of traumatic memories.  This process will begin the separation of emotion from the trauma and start the memory reconsolidation process during the sleep and the REM cycle. This process will shut off the brain's fight or flight mechanism, allowing for the symptoms associated with PTSD to stop.

When dealing with trauma, or acute or post-traumatic stress,  the reactions occur through no fault of our own.  The brain hijacks the event and believes you need to preserve yourself through a fight or flight response.  Self-preservation is the primary responsibility of the brain through a brain organ called the amygdala.  This is an essential function of the brain and essential for human survival as a species.  When a traumatic memory doesn't process appropriately with adequate sleep, you will retain immediate access to the event's emotions in the amygdala.  Causing the fight or flight response to engage oftentimes in inappropriate settings.  Then the feeling and memory are readily available like a thumb drive for easy access.  Nightmares, triggers, intrusive thoughts bombard the brain, causing a problem with normal functioning.  Maybe the individual will isolate, self-medicate or worse, resort to suicide as a prolonged situation drags out.

The Trauma Recovery Intervention Protocol (TRIP) interrupts this pattern of behavior.  It allows the memory to be viewed in a dissociated fashion, removing color, speeding up or slowing down, integrating smells, tastes, rewinds, etc., to stop the event's intensity.  In the rewind part of the process, the brain says, "Time-out," releases the memory's emotion because it runs the event backward.  It thinks the event is ending on the positive before the trauma occurred, therefore lets go of the feeling because subconsciously, the brain recognizes it's violating the self-preservation rule. Memory reconsolidation then occurs as sleep patterns are restored, and the body comes back to a sense of homeostasis. 

TBRI® is an attachment-based, trauma-informed intervention that is designed to meet the complex needs of vulnerable children. TBRI® uses Empowering Principles to address physical needs, Connecting Principles for attachment needs, and Correcting Principles to disarm fear-based behaviors. While the intervention is based on years of attachment, sensory processing, and neuroscience research, the heartbeat of TBRI® is connection.

Key components of TBRI include:

1. Empowerment: TBRI focuses on empowering caregivers to meet the physical, emotional, and psychological needs of children who have experienced trauma. Caregivers are equipped with tools to create a safe and nurturing environment.
2. Connection: Building strong connections between caregivers and children is central to TBRI. Establishing trust and attachment helps children feel secure and supported.
3. Sensory Integration: Recognizing the impact of sensory experiences on behavior, TBRI incorporates strategies to address sensory needs and promote self-regulation.
4. Correcting Principles: TBRI emphasizes proactive strategies to prevent and address challenging behaviors. Instead of punitive measures, the focus is on teaching appropriate behavior and providing a supportive environment.
5. Life Values: Instilling positive values and beliefs in children, helping them develop a sense of worth and purpose.

I provide the following items to my supervisees 

1. Clinical Guidance: Offer expertise in clinical assessment, diagnosis, and treatment planning. Provide guidance on evidence-based interventions and help supervisees develop their clinical skills.
2. Case Review: Regularly review cases to ensure the ethical and effective practice of the supervisee. Discuss assessment strategies, treatment plans, and interventions, offering constructive feedback.
3. Professional Development: Support ongoing professional growth by recommending relevant training, workshops, and continuing education opportunities. Encourage the development of specialized skills or areas of interest.
4. Ethical Considerations: Discuss and navigate ethical dilemmas that may arise in clinical practice. Reinforce adherence to ethical standards and legal requirements in the field.
5. Cultural Competence: Promote cultural competence by addressing issues related to diversity, equity, and inclusion. Help supervisees understand and navigate cultural differences in therapeutic relationships.
6. Supervision Structure: Clearly outline the structure of supervision, including the frequency and format of sessions. Ensure that supervision meets state licensing board requirements.
7. Feedback: Provide timely and constructive feedback on clinical skills, interpersonal interactions, and professional demeanor. Encourage a reflective practice to enhance self-awareness.
8. Licensure Support: Guide supervisees through the licensure process, ensuring they are meeting all requirements for independent practice. Assist with any paperwork or documentation needed for licensure.
9. Self-Care: Emphasize the importance of self-care and well-being. Help supervisees recognize signs of burnout and develop strategies for maintaining their own mental health.
10. Supportive Environment: Create a safe and supportive space for open communication. Encourage supervisees to express concerns, ask questions, and seek guidance without fear of judgment.
11. Documentation: Keep thorough documentation of supervision sessions, including topics discussed, feedback provided, and any agreements made. This documentation may be required for licensure purposes.