What is DBT

DBT combines both cognitive-behavioral therapy (Western principles and practices) and mindfulness approaches (Eastern principles and practices) to help people understand – accept and change – patterns of living that are causing suffering.

Dialectical Behavioral Therapy (DBT) is a therapeutic treatment modality that stems from Cognitive Behavioral therapy (CBT). DBT helps alleviate problems with regulating emotions, thinking patterns, and behaviors that cause misery and distress.

DBT has been shown to:

  • Enhance motivation and desire to live fully in your life
  • Improve overall quality of life and create a life worth living
  • Improve emotion management
  • Improve interpersonal relating and communicating
  • Decrease self-destructive behaviors
  • Enhance your ability to get through crises
  • Decrease inpatient hospitalizations

Who Benefits?

DBT may be for you if you experience any of the following symptoms:

Emotions

  • Heightened emotional sensitivity
  • Quick and intense emotional reactions
  • Slow return to normal mood
  • Chronic problems with depression, anxiety, anger or anger expression

Behavior

  • Repeated suicide threats or attempts
  • Self-harm behavior such as cutting and burning
  • Relationship difficulties including hypersensitivity to criticism, disapproval, intimacy or fear abandonment
  • Impulsive and potentially self-destructive behavior in areas such as binge eating and purging, alcohol or drug abuse, sexual promiscuity, and gambling or spending sprees

Thinking

  • Extreme (black or white) thinking
  • Difficulty with problem-solving and decision making
  • Unstable self-image or sense of self
  • “Detached” thinking, ranging from mild problems with inattention to episodes of complete dissociation

What We Offer

Overall we offer psychotherapy for adults and adolescents. We also provide consultation for other professionals and other agencies in the field.

We provide assessment, diagnosis and treatment for a wide variety of mental health issues which include but are not limited to:

  • Borderline Personality Disorder
  • Bipolar Disorder
  • Anxiety
  • Depression
  • Addiction
  • Post Traumatic Stress Disorder
  • Eating Disorders
  • Body Dysmorphic Disorder
Borderline Personality Disorder

A “personality” disorder is defined by a set of symptoms. A personality disorder is present, by definition, when individuals have long standing problems with their sense of ‘self’, which involves how they think of themselves, their self-esteem, their impulse control and such, and/or their relationships.

The term ‘personality disorder’ is a descriptive label for those long standing patterns of behaving, thinking and feeling. Although these patterns often are persistent, research shows that these patterns of behaviors and the way one thinks about and experiences(feels) self and others can certainly change and one’s quality of life can be enhanced significantly.

Borderline Personality Disordaer Diagnosis: DSM IV Diagnostic Criteria

A pervasive pattern of instability of interpersonal relationships, self image and affects, and marked impulsivity present in a variety of contexts, as indicated by five (or more) of the following:

  • Frantic efforts to avoid real or imagined abandonment.
  • A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
  • Identity disturbance: markedly and persistently unstable self-image or sense of self.
  • Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).
  • Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior*.
  • Affective [mood] instability.
  • Chronic feelings of emptiness.
  • Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
  • Transient, stress-related paranoid ideation or severe dissociative symptoms. 


Dr. Marsha Linehan (the founder of DBT) once likened a person with BPD to that of someone with 3rd degree “emotional burns.”

*The preferred term is self-harm or self-injury

Anxiety

Most to all know what anticipation, restlessness feels like. Your heart pounds before a big presentation or engagement. You get butterflies in your stomach during a blind date. You worry and fret over family problems or feel jittery at the prospect of asking someone for a need to be met. These are all natural reactions.

However, in today’s busy world, many of us often feel anxious and unsettled outside of these challenging situations as well. If worries, fears, or anxiety attacks seem overwhelming and are impacting your daily life, you may be suffering from an anxiety disorder. Fortunately, in addition to anxiety treatments, there are plenty of things you can do to help yourself and reduce your anxiety symptoms, control and manage anxiety attacks, and regain control of your life.

Here are three parts to anxiety: physical symptoms (how our body responds), thoughts (what we say to ourselves), and behaviors (what we do or our actions). Learning to recognize these signs of anxiety can help you to be less afraid of it.

  • Thoughts, What if ?
  • Behaviors, find a barrier to not engage due to worry
  • Physical Symptoms, stomach ache, cold sweat, heart racing


More information: http://www.goodtherapy.org/therapy-for-anxiety.html

Bipolar Disorder

The exact symptoms of bipolar disorder vary from person to person. For some people, depression causes the most problems; for other people, manic symptoms are the main concern. Symptoms of depression and symptoms of mania or hypomania may also occur together. This is known as a mixed episode.

  • Bipolar I disorder. Mood swings with bipolar I cause significant difficulty in your job, school or relationships. Manic episodes can be severe and dangerous.
  • Bipolar II disorder. Bipolar II is less severe than bipolar I. You may have an elevated mood, irritability and some changes in your functioning, but generally you can carry on with your normal daily routine. Instead of full-blown mania, you have hypomania — a less severe form of mania. In bipolar II, periods of depression typically last longer than periods of hypomania.
  • Cyclothymic disorder. Cyclothymic disorder, also known as cyclothymia, is a mild form of bipolar disorder. With cyclothymia, hypomania and depression can be disruptive, but the highs and lows are not as severe as they are with other types of bipolar disorder.


Manic phase of bipolar disorder

Signs and symptoms of the manic or hypomanic phase of bipolar disorder can include:

  • Euphoria
  • Inflated self-esteem
  • Poor judgment
  • Rapid speech
  • Racing thoughts
  • Aggressive behavior
  • Agitation or irritation
  • Increased physical activity
  • Risky behavior
  • Spending sprees or unwise financial choices
  • Increased drive to perform or achieve goals
  • Increased sex drive
  • Decreased need for sleep
  • Easily distracted
  • Careless or dangerous use of drugs or alcohol
  • Frequent absences from work or school
  • Delusions or a break from reality (psychosis)
  • Poor performance at work or school


Depressive phase of bipolar disorder

Signs and symptoms of the depressive phase of bipolar disorder can include:

  • Sadness
  • Hopelessness
  • Suicidal thoughts or behavior
  • Anxiety
  • Guilt
  • Sleep problems
  • Low appetite or increased appetite
  • Fatigue
  • Loss of interest in activities once considered enjoyable
  • Problems concentrating
  • Irritability
  • Chronic pain without a known cause
  • Frequent absences from work or school
  • Poor performance at work or school


Other signs and symptoms of bipolar disorder

Signs and symptoms of bipolar disorder can also include:

  • Seasonal changes in mood. As with seasonal affective disorder (SAD), some people with bipolar disorder have moods that change with the seasons. Some people become manic or hypomanic in the spring or summer and then become depressed in the fall or winter. For other people, this cycle is reversed — they become depressed in the spring or summer and manic or hypomanic in the fall or winter.
  • Rapid cycling bipolar disorder. Some people with bipolar disorder have rapid mood shifts. This is defined as having four or more mood swings within a single year. However, in some people mood shifts occur much more quickly, sometimes within just hours.
  • Psychosis. Severe episodes of either mania or depression may result in psychosis, a detachment from reality. Symptoms of psychosis may include false but strongly held beliefs (delusions) and hearing or seeing things that aren’t there (hallucinations).
Borderline Personality Disorder

Depression varies from person to person, but there are some common signs and symptoms. It’s important to remember that these symptoms can be part of life’s normal lows. But the more symptoms you have, the stronger they are, and the longer they’ve lasted—the more likely it is that you’re dealing with depression. When these symptoms are overwhelming and disabling, that’s when it’s time to seek help.

Are you depressed?

If you identify with several of the following signs and symptoms, and they just won’t go away, you may be suffering from clinical depression.

  • You can’t sleep or you sleep too much
  • You can’t concentrate or find that previously easy tasks are now difficult
  • You feel hopeless and helpless
  • You can’t control your negative thoughts, no matter how much you try
  • You have lost your appetite or you can’t stop eating
  • You are much more irritable, short-tempered, or aggressive than usual
  • You’re consuming more alcohol than normal or engaging in other reckless behavior
  • You have thoughts that life is not worth living (seek help immediately if this is the case)/li>


“What does depression feel like?” They ask me quietly, “It feels like your waking up in a dream, you can see people living in an amazing world but yet your sitting there frozen in an unbearable or numb pain” I answered. Depression is not “just a bad mood or a bad day”. The difference between having a bad mood/day and clinical depression is:

  • How intense the mood is: Depression is more intense than a bad mood.
  • How long it lasts: A bad mood is usually gone in a few days, but clinical depression lasts two weeks and or often longer.
  • How much it interferes with your life: A bad mood does not keep you from showing up to life and engaging with others. Clinical depression can keep you from doing these things, including getting out of bed.


Sadness or downswings in mood are normal reactions to life’s struggles, setbacks, and disappointments. Many people use the word “depression” to explain these kinds of feelings, but depression is much more than just sadness.

Some people describe depression as “living in a black hole” or having a feeling of impending doom. However, some depressed people don’t feel sad at all — they may feel lifeless, empty, and apathetic, or possibly feeling angry, aggressive, and restless.

Whatever the symptoms, depression is different from normal sadness in that it engulfs your day-to-day life, interfering with your ability to work, study, eat, sleep, and have fun. The feelings of helplessness, hopelessness, and worthlessness are intense and unrelenting, with little, if any, relief.

Borderline Personality Disorder

The Symptoms of PTSD

The DSM-IV criteria for identifying PTSD require that symptoms must be active for more than one month after the trauma and associated with a decline in social, occupational or other important areas of functioning. The three broad symptom clusters can be summarized as follows:

1. Persistent Re-experiencing

A person experiences one or more of the following:

  • recurrent nightmares or flashbacks;
  • recurrent images or memories of the event — these images or memories often occur without actively thinking about the event;
  • intense distress of reminders of the trauma; and/or
  • physical reactions to triggers that symbolize or resemble the event.

2. Avoidant / Numbness Responses

A person experiences three or more of the following:

  • efforts to avoid feelings or triggers associated with the trauma;
  • avoidance of activities, places or people that remind the person of the trauma;
  • inability to recall an important aspect of the trauma;
  • markedly diminished interest in activities;
  • feelings of detachment or estrangement from others;
  • restricted range of feelings; and/or
  • difficulty thinking about the long-term future — sometimes this expresses itself by a failure to plan for the future or taking risks because the person does not fully believe or consider the possibility that they will be alive for a normal lifespan.

3. Increased Arousal

A person experiences two or more of the following:

  • difficulty falling asleep or staying asleep;
  • outbursts of anger/irritability;
  • difficulty concentrating;
  • increased vigilance that may be maladaptive; and/ or
  • exaggerated startle response


Patterns of Trauma Response

There are various ways in which PTSD can be exhibited:

  • Acute Stress Disorder is diagnosed when responses to a traumatic event occur and last for less than a month. For many people, these acute symptoms resolve over time, often with the help of a support system or treatment.
  • PTSD is identified when disabling symptoms persist for months or years after the traumatic event(s). These symptoms interfere with daily functioning and meet specific diagnostic criteria.
  • Acute PTSD is diagnosed when an individual has symptoms for less than three months.
  • Chronic PTSD is diagnosed when someone has symptoms for more than three months.
  • Delayed-onset PTSD appears months – sometimes more than year – after the initial trauma. In many cases, the individual may have had some symptoms before, just not enough to meet the diagnostic criteria. Many people with delayed-onset PTSD demonstrate dissociation to suppress their reactions and avoid thoughts of the event. Numbing and/or avoiding symptoms are associated with a worse prognosis in the long run for many people.


Individuals that suffer from trauma can exhibit a variety of symptoms, including depression, anxiety, flashbacks, avoidance behavior, sleep disturbance and/or nightmares, disrupted eating patterns, abuse of substances, intrusive thoughts or images, and disrupted interpersonal relationships.

One of the main objectives of DBT is to help individuals learn skills that will decrease emotion dysregulation, self-destructive behaviors and other ineffective coping mechanisms. And teaches individuals the skills to identify their emotional experiences and manage them through skills. DBT teaches skills that regulate emotions or symptoms of PTSD through mindfulness concepts, emotional regulation, interpersonal effectiveness skills and distress-tolerance skills.

Borderline Personality Disorder

An eating disorder is an unhealthy relationship with food and weight that interferes with many areas of a person’s life. One’s thoughts become preoccupied with food, weight or exercise. A person who struggles with an eating disorder can have unrealistic self-critical thoughts about body image, and his or her eating habits may begin to disrupt normal body functions and affect daily activities. Eating disorders are not just about food and weight. People begin to use food as a coping mechanism to deal with uncomfortable or painful emotions or to help them feel more in control when feelings or situations seem over-whelming. The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) recognizes Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and OSFED (Other Specified Feeding or Eating Disorder).

Anorexia Nervosa – A person with anorexia may have an intense fear of gaining weight or becoming fat. Someone with anorexia may practice unhealthy behaviors such as: restricting calories, only eating specific foods or skipping meals frequently.

Bulimia Nervosa – A person with bulimia may also be intensely afraid of becoming fat or gaining weight. Someone with bulimia may eat large amounts of food in a short period of time (binge) and then eliminate the food and calories (purge). One may induce vomiting, exercise excessively, or use laxatives, diuretics, or diet pills to purge weight or calories.

Binge Eating Disorder – This disorder involves eating very large amounts of food rapidly (to the point of feeling sick or uncomfortable). These episodes of bingeing occur frequently. When binge eating, a person feels like they cannot stop eating or control what or how much is eaten.

OSFED (Other Specified Feeding or Eating Disorder) – OSFED is a feeding or eating disorder that causes significant distress or impairment, but does not meet the criteria for another feeding or eating disorder.

CAUSES

There isn’t one conclusive cause of eating disorders. Multiple factors are involved, such as genetics and metabolism; psychological issues – such as control, coping skills, trauma, personality factors, family issues; and social issues, such as a culture that promotes thinness and media that transmits this message.

Borderline Personality Disorder

Most of us have something we don't like about our appearance — a crooked nose, an uneven smile, or eyes that are too large or too small. And though we may fret about our imperfections, they don’t interfere with our daily lives.

But people who have body dysmorphic disorder (BDD) think about their real or perceived flaws for hours each day.

They can't control their negative thoughts and don't believe people who tell them that they look fine. Their thoughts may cause severe emotional distress and interfere with their daily functioning. They may miss work or school, avoid social situations and isolate themselves, even from family and friends, because they fear others will notice their flaws.

They may even undergo unnecessary plastic surgeries to correct perceived imperfections, never finding satisfaction with the results.

Characteristics of BDD

BDD is a body-image disorder characterized by persistent and intrusive preoccupations with an imagined or slight defect in one's appearance.

People with BDD can dislike any part of their body, although they often find fault with their hair, skin, nose, chest, or stomach. In reality, a perceived defect may be only a slight imperfection or nonexistent. But for someone with BDD, the flaw is significant and prominent, often causing severe emotional distress and difficulties in daily functioning.

BDD most often develops in adolescents and teens, and research shows that it affects men and women almost equally. About one percent of the U.S. population has BDD.

The causes of BDD are unclear, but certain biological and environmental factors may contribute to its development, including genetic predisposition, neurobiological factors such as malfunctioning of serotonin in the brain, personality traits, and life experiences.

Symptoms

People with BDD suffer from obsessions about their appearance that can last for hours or up to an entire day. Hard to resist or control, these obsessions make it difficult for people with BDD to focus on anything but their imperfections. This can lead to low self-esteem, avoidance of social situations, and problems at work or school.

People with severe BDD may avoid leaving their homes altogether and may even have thoughts of suicide or make a suicide attempt.

BDD sufferers may perform some type of compulsive or repetitive behavior to try to hide or improve their flaws although these behaviors usually give only temporary relief. Examples are listed below:

  • camouflaging (with body position, clothing, makeup, hair, hats, etc.)
  • comparing body part to others' appearance
  • seeking surgery
  • checking in a mirror
  • avoiding mirrors
  • skin picking
  • excessive grooming
  • excessive exercise
  • changing clothes excessively

BDD and Other Mental Health Disorders

People with BDD commonly also suffer from the anxiety disorders obsessive-compulsive disorder (OCD) or social anxiety disorder, as well as depression and eating disorders.

BDD can also be misdiagnosed as one of these disorders because they share similar symptoms. The intrusive thoughts and repetitive behaviors exhibited in BDD are similar to the obsessions and compulsions of OCD. And avoiding social situations is similar to the behavior of some people with social anxiety disorder.

Diagnosis and Treatment

To get an accurate diagnosis and appropriate treatment, people must mention specifically their concerns with their appearance when they talk to a doctor or mental health professional. A trained clinician should diagnose BDD.

However, you can take a self-test that can help suggest if BDD is present, but it will not offer a definitive diagnosis.

  • Self-test for adults
  • Self-test for adolescents

If your child is preoccupied with appearance so that it interferes with concentration in school or if behaviors listed above appear, talk to a mental health professional.

Effective treatments are available to help BDD sufferers live full, productive lives.

  • Cognitive-behavioral therapy (CBT) teaches patients to recognize irrational thoughts and change negative thinking patterns. Patients learn to identify unhealthy ways of thinking and behaving and replace them with positive ones. Find out about ACT with CBT.
  • Antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs), can help relieve the obsessive and compulsive symptoms of BDD.

Treatment is tailored to each patient so it is important to talk with a doctor to determine the best individual approach. Many doctors recommend using a combination of treatments for best results.

Borderline Personality Disorder

The signs and symptoms of substance dependence vary according to the individual, the substance they are addicted to, their family history (genetics), and personal circumstances.

  • The person takes the substance and cannot stop - in many cases, such as nicotine, alcohol or drug dependence, at least one serious attempt was made to give up, but unsuccessfully.
  • Withdrawal symptoms - when body levels of that substance go below a certain level the patient has physical and mood-related symptoms. There are cravings, bouts of moodiness, bad temper, poor focus, a feeling of being depressed and empty, frustration, anger, bitterness and resentment.
  • There may suddenly be increased appetite. Insomnia is a common symptom of withdrawal. In some cases the individual may have constipation or diarrhea. With some substances, withdrawal can trigger violence, trembling, seizures, hallucinations, and sweats.
  • Addiction continues despite health problem awareness - the individual continues taking the substance regularly, even though they have developed illnesses linked to it. For example, a smoker may continue smoking even after a lung or heart condition develops.
  • Social and/or recreational sacrifices - some activities are given up because of an addiction to something. For example, an alcoholic may turn down an invitation to go camping or spend a day out on a boat if no alcohol is available, a smoker may decide not to meet up with friends in a smoke-free pub or restaurant.
  • Maintaining a good supply - people who are addicted to a substance will always make sure they have a good supply of it, even if they do not have much money. Sacrifices may be made in the house budget to make sure the substance is as plentiful as possible.
  • Taking risks (1) - in some cases the addicted individual make take risks to make sure he/she can obtain his/her substance, such as stealing or trading sex for money/drugs.
  • Taking risks (2) - while under the influence of some substances the addict may engage in risky activities, such as driving fast.
  • Dealing with problems - an addicted person commonly feels they need their drug to deal with their problems.
  • Obsession - an addicted person may spend more and more time and energy focusing on ways of getting hold of their substance, and in some cases how to use it.
  • Secrecy and solitude - in many cases the addict may take their substance alone, and even in secret.
  • Denial - a significant number of people who are addicted to a substance are in denial. They are not aware (or refuse to acknowledge) that they have a problem.
  • Excess consumption - in some addictions, such as alcohol, some drugs and even nicotine, the individual consumes it to excess. The consequence can be blackouts (cannot remember chunks of time) or physical symptoms, such as a sore throat and bad persistent cough (heavy smokers).
  • Dropping hobbies and activities - as the addiction progresses the individual may stop doing things he/she used to enjoy a lot. This may even be the case with smokers who find they cannot physically cope with taking part in their favorite sport.
  • Having stashes - the addicted individual may have small stocks of their substance hidden away in different parts of the house or car; often in unlikely places.
  • Taking an initial large dose - this is common with alcoholism. The individual may gulp drinks down in order to get drunk and then feel good.
  • Having problems with the law - this is more a characteristic of some drug and alcohol addictions (not nicotine, for example). This may be either because the substance impairs judgment and the individual takes risks they would not take if they were sober, or in order to get hold of the substance they break the law.
  • Financial difficulties - if the substance is expensive the addicted individual may sacrifice a lot to make sure its supply is secured. Even cigarettes, which in some countries, such as the UK, parts of Europe and the USA cost over $11 dollars for a packet of twenty - a 40-a-day smoker in such an area will need to put aside $660 per month, nearly $8,000 per year.
  • Relationship problems - these are more common in drug/alcohol addiction

DBT Treatment of Addiction

DBT treatment can include homework ( diary cards), phone coaching and both group and individual sessions, and it can aid in reshaping ineffective or maladaptive thoughts in various potential ways including the following:

  • Explore basic emotional needs that are unmet and may fuel ineffective thought patterns that increase cravings.
  • Assist the individual in learning how to validate their own experiences and provide new ways through skills training to relate and tolerate those experiences more effective and objectively
  • Provide specific skills to tolerate the feelings and delay immediate gratification of the familiar and increase new distress tolerance coping mechanisms.
  • Identify issues related to negative self-talk, minimizing positives, amplifying negatives and over-generalizations.
  • Create plans of skillful actions that incorporate activities into the patients’ daily routines that assist in creating a life that is worth living.
  • Teach and implement the practice of awareness (mindfulness) and quieting the mind.