Category: Mental Health

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Radically Open Dialectical Behavioral Therapy (RO DBT) is a treatment developed by Thomas Lynch for those who develop disorders associated with an overcontrolled (OC) personality.  OC individuals are often described as reserved and cautious, not very expressive with their emotions, and great at delaying gratification. OC individuals tend to be strong rule followers and feel a high sense of obligation in their lives (i.e., go to a birthday party because they feel they have to rather than wanting to do so). However, at times, they may experience “emotional leakage,” or emotionally breaking down once they are in private after holding it all together all day in public. An OC personality can be really helpful in some ways. These are the people that get their work done no matter what, show up to work on time every day, work through all the nitty, gritty details of a project, and follow through on their word. They can be very organized and methodical, and they are great at planning for long-term gains (i.e., saving to buy a house). However, they can be rigid and inflexible at time (i.e., get very upset if a restaurant lost a dinner reservation and struggle with figuring out where else to go to eat) and may have difficulty receiving feedback. Patients that may benefit from this treatment include those with chronic depression and anxiety, autism spectrum disorders, Obsessive-Compulsive Personality Disorder, and Anorexia Nervosa.

Radically Open Dialectical Behavior Therapy for Overcontrolled Personality

The biosocial theory behind RO DBT explains that OC individuals have brains that zoom in on the negative or threatening aspects of a situation before seeing the positives. This predisposition interacts with being raised in an environment that encourages or praises high levels of self-control in one’s life (i.e., doing homework without one’s parents needing to remind them to do so), performing at a high level (i.e., getting good grades, doing well in sports, receiving accolades), and avoiding making errors. These individuals end up avoiding uncertain situations, hold back their emotions out of fear that others may see them as being out of control, and become guarded in social situations, appearing to others as withdrawn.  Their lack of vulnerability and difficulty expressing what they are really feeling leads others to struggle to relate to them, so they end up feeling lonely and isolated.  Thus, RO DBT operates under the assumption that increasing connectedness to others can improve psychological functioning, thus targeting emotional expression. Additionally, RO DBT encourages being open to hearing other points of view so that one can learn as well as learning to be flexible in responding to varying situations.

Thomas Lynch describes that the five main behavioral targets of RO DBT include 1) being socially distant or reserved, 2) inflexible, rule-governed behaviors, 3) focusing on the details rather than the big picture of a situation and being overly cautious, 4) demonstrating emotional expressions that are inconsistent with how one is really feeling, and 5) comparing oneself to others, leading to resentment and envy. In RO DBT, patients work with their therapists on identifying personal goals consistent with these behavioral targets, connecting these goals to the problems that brought them into treatment. For instance, a patient may bring up that he/she would like to deepen relationships with others, be more flexible when things don’t go according to plan, or let go of past grudges to help fight depression and anxiety.

Radically Open DBT vs DBT

Many incorrectly assume that RO DBT and Dialectical Behavior Therapy (DBT) are the same thing. While RO DBT has some similarities with DBT, these are two very different treatments. DBT primarily benefits those who have an undercontrolled (UC) personality. UC traits include being impulsive, sensation-seeking, wearing one’s heart on one’s sleeve, and acting in the here and now.  Thus, DBT can be helpful for those that have impulsive control problems, such as those with borderline personality disorder, bulimia nervosa, binge eating disorder, and substance abuse disorders. Both RO DBT and DBT combine individual therapy with skills training classes, involve tracking emotions and behaviors via diary cards, allow for telephone consultation with the individual therapist, and involve consultation teams for the group and individual therapists. However, DBT has a stronger focus on self-regulation to target emotion dysregulation whereas RO DBT is much more focused on helping individuals address social signaling and connectedness with others.

For more information see our Comprehensive Guide to RO-DBT.

References:

Lynch, T. R. (2018). Radically Open Dialectical Behavior Therapy. New Harbinger Publications.

Lynch, T. R. (2018). The Skills Training Manual for Radically Open Dialectical Behavior Therapy. New Harbinger Publications.

Elizabeth Mariutto, PsyD

Lindner Center of HOPE, Psychologist and Clinical Director of Partial Hospitalization/Intensive Outpatient Adult Eating Disorder Services

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By Jennifer Farley, PsyD,
Lindner Center of HOPE, Staff Psychologist

There are a number of reasons someone may undergo a psychological evaluation or assessment. The type of testing that is done depends on the individual’s functioning and the setting in which testing may be pursued. This article will look at the different settings of mental health assessments.

Types of Mental Health Assessment Settings

  • Outpatient
  • Inpatient
  • Residential
  • Children’s Assessments

Psychological Assessment in an Outpatient Setting

Testing from a clinical psychologist in a clinical outpatient setting can be pursued on their own or they may be referred from another clinician (such as a primary care physician or psychiatrist). This type of assessment is for patients with non-immediate mental health concerns. In this case, testing is pursued with the referral question in mind (such as whether someone has Attention Deficit/Hyperactivity Disorder, depression, anxiety, a learning disorder, dementia, cognitive problems due to a medical condition, etc). The psychologist tailors the tests to help determine the person’s functioning in the areas that could be affected by a cognitive or emotional disorder. Tests can range from intellectual assessments to personality measures to behavioral questionnaires (which can be completed by the patient themselves, parents, and/or teachers) to academic achievement measures. Clinicians such as neuropsychologists and developmental psychologists can do all these tests and then add additional measures specific to their specialization (such as when documenting problems related to a head injury or when evaluating for Autism Spectrum Disorder). The psychologist can use this information to make a diagnosis and provide recommendations for treatment of the condition. Often, such as for school-age or college-age patients, recommendations for academic accommodations are also provided.

Psychological Assessment In An Acute Inpatient Unit

Sometimes, psychological testing is completed for patients during an acute inpatient psychiatric hospitalization (when the patient is in a mentally unstable condition). In these cases, testing is often used for diagnostic elucidation to help guide decisions about types of medication to use. Recommendations may also be made about additional assessments or resources to pursue following one’s discharge from the hospital. The clinical psychologist completes these evaluations within a short time, since these acute hospitalizations last (on average) about 7 days, and there are usually just a few measures that are administered. Tests are specific to the question about the individual’s diagnosis and may only include emotional/personality measures.

Psychological Assessment in a Residential Setting

Another setting in which psychological testing may occur is within a residential psychiatric setting. This setting is for patients who are experiencing psychological distress that is not severe enough to warrant an acute inpatient hospitalization. Length of stay in a residential setting can vary from 10 days to several months, depending on the purpose of the stay (i.e., evaluation and/or treatment). The purpose of testing in a residential setting is to help comprehensively understand – by way of several different measures – one’s personality functioning, cognitive functioning (which can include neurocognitive skills such as attention, memory, and executive functioning), and other factors (such as external stressors, substance use, medical conditions, etc.) that have contributed to the patient’s condition(s). The patient’s internal strengths and weaknesses are explored, with the intention of making recommendations for how treatment can be tailored to work with the patient’s strengths to compensate for their weaknesses. The clinical psychologist works closely with the other members of the treatment team (such as the psychiatrist, social worker, and the therapists) to understand the patient, develop a treatment plan, and (if a longer stay) to begin implementing the recommendations. The patient’s progress is then monitored and, if needed, further testing can be done to help assess changes in the patient’s functioning as a result of the treatment.

Psychological Assessment in Childhood

In childhood, early observations of potential problems may come from teachers. Teachers may observe struggles in behavior such as impulsivity, talking or interrupting others during times when there is an age-appropriate expectation of silence, and/or oppositional behaviors towards others. Teachers may also be the first to wonder if a child has an underlying learning or attention disorder. If the teacher’s attempts to help the child are unsuccessful, the teacher may recommend testing in the form of a Multi-Factored Evaluation (MFE). Psychological testing may be part of this evaluation and can include intellectual testing and academic achievement testing by a school psychologist. Parent and teacher questionnaires may also be included in the MFE. Depending on the nature of the child’s observed difficulties, others (such as speech and language therapists and physical therapists) may do their own screening. If findings reveal that the student experiences problems that would make learning difficult, accommodations are then recommended and interventions and/or accommodations are then put in place through a 504 Plan or an Individualized Education Plan. It is noteworthy that clinical diagnoses are NOT made from this type of evaluation and findings and recommendations are specific to helping the child learn better.

Prior to any psychological testing, the patient (and/or his/ her family) should understand the purpose of psychological assessment and how it can be useful for guiding treatment and other recommendations.

Find out more information on what psychological assessment is here and why it is a critical step of the process towards finding a diagnosis and treatment plan.

Finding Help and HOPE

If you, or someone you know, is experiencing a mental health crisis, there is help available. The first step would be to consult with a health care provider or mental health care specialist. To see how Lindner Center of HOPE can help you decide on the best mental health assessment setting, reach out to us today. We can help you take the next steps. 

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Self-Discipline, by definition, is the ability to listen and to act based on your inner voice, regardless of how you feel, other influences, or the temptations you face. Discipline is the key to self-mastery. So why is this so hard?

So many people struggle with maintaining healthy choices and keeping to their goals. We have misperceptions that we are supposed to be excited and want to be engaged in these wellness practices. The truth is… discipline is hard. It’s rarely anything that we love to do or get super excited about. It’s often something we internally combat and make excuses for. We will find 100 reasons why we should not deliver or more importantly not show up for ourselves. Breaking into a better emotional and behavioral state is work, hard work. We need to accept that this will always be hard work and something that you must employ, daily or regularly, if you want to feel better and be better!

Research shows that people who have a good sense of discipline are less likely to suffer from major mental health issues and more likely to experience overall increased wellness. Some mental health benefits of being disciplined are it increases depressed moods, it creates less anxiety or stress, it combats drugs or alcohol abuse, it decreases potential for develop eating disorders, and it helps manage obsessive compulsive disorders.

Often mental health practitioners will say, “the key to real therapeutic change is when someone finally figures out how to show up for themselves.” It’s the improved habits and disciplines they enforce on themselves that creates positive change. They learn to be healthier and show up successfully.

The benefit of any discipline consistently comes later. It’s not always in the moment of but the sooner or later future. It will show up in the long term and create a new fondness of self. It’s choosing what I want the most. It will get you to the transformative self. Self- discipline creates confidence and motivation. Confidence being the internal stability of self-worth and motivation being the momentum. Momentum will keep the motivation alive. It will increase your focus making you work harder. Discipline creates a drive to succeed and find joy in the success. By being disciplined you will gain tolerance, patience, and a better sense of self-control. All key traits needed for an overall healthy, happy person to be present every day.

Easy steps to create a discipline:

  1. Set clear goals. Clearly outline what your goal means to you and how you intend to achieve it. Meaning is necessary for a discipline to be initiated.
  1. Make a commitment to yourself. You must have meaning and purpose in this. Knowing you are worth the effort and wanting to get back the control of your life.
  1. Make it apart of your daily routine. It is critical to make time each day and figure out where the discipline will fit into your day. Make a place for it, be consistent. Establishing an autopilot routine is essential for the discipline to occur.

Keeping distractions and temptations away will help you to commit and focus on your goals. Being mindful or purposeful of your attention about what your goals are and when your discipline should take place will help you stay on track. Persevering, staying steadfast through hard times will keep you motivated and keep you from self-sabotaging. Executing or carrying the discipline through will keep you in alignment of success and build the journey of your productive self.

Self-discipline is a practice. It is something that you must demonstrate everyday even if you fail or falter. You must put exertion at it and be available to it. You must practice repeatedly until it becomes an automatic behavior and/or thought. Find the courage to put the work in, be patient, and wait with hope.

By: Kristina Tracy, LISW-S

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Lindner Center of HOPE’s Premiere Assessment Residential Programs have a private entrance to welcome patients and families. Both programs operate as private-pay programs.

If you or a loved one is suffering from mental illness or addiction, contact us for information on our residential treatment programs for mental health in adults.

One in four individuals are living with a mental illness, according to the 2012 National Survey on Drug Use and Health: Mental Health Findings1 conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA). It is a leading health problem in the United States, with approximately 61.5 million adults, or one in four, experiencing a mental illness in a given year.

Among adolescents, the same study found an estimated 20 percent of teens ages 13 to 18, and 13 percent of youth ages 8 to 15, experience a severe mental disorder in a given year.

Another major public health problem, according to the National Institute on Drug Abuse, is drug and alcohol abuse. The Closing the Addiction Treatment Gap (CATG) initiative2, created by the Open Society Institute, reports that 23.5 million Americans, or one in every 10 individuals over the age of 12, are addicted to drugs and/or alcohol.

The statistics bring to the forefront the importance of residential mental health facilities focused on comprehensive assessment and intensive treatment in a residential setting, as one effective tool in treating mental health conditions and addiction, including non-substance addictions like gambling.

But for most people, recognizing a mental illness or an addiction, finding the best help to treat it, and knowing what to expect from a residential treatment center can be an uncertain road without the proper guidance.

Click here for more information.

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Anna I. Guerdjikova, PhD, LISW, CCRC
Director of Administrative Services, Harold C. Schott Foundation Eating Disorders Program
Lindner Center of HOPE

 

 

 

 

Emotion regulation refers to the process of generating and maintaining an emotion, as well as the ability to modulate its’ intensity and frequency in order to achieve socioemotional competence and sustain mental health. In modern society, from early age, we learn inhibition to downregulate our emotions (for example, to not cry in public or to not say anything when angry) which often results in emotional restraint. True emotional regulation is reached through focused monitoring, evaluating, and modifying of our emotional reactions and depends on the person’s age, temperamental characteristics and environmental circumstances. Some examples of successfully practicing emotional regulation include being able to calm self-down after something exciting or upsetting happens, sustaining focus on repetitive tasks, refocusing attention on a new task and controlling impulsive behaviors. The skill to emotionally regulate depends significantly on the persons’ age and brain maturity and thus understanding that some of the time the individual is not difficult or spoiled, but developmentally or circumstantially unable to control their emotions can help build empathy and strengthen family systems and relationships.

DOs in Emotional regulation

  • Do create safe space for all emotions- the good, the bad and the ugly. Being happy should be equally accepted in the family as being angry or sad.
  • Do model emotional regulation for your children and peers every time you can. Work on naming your emotion (ex.” I am very upset with you now..”), the reasons for it/ the trigger, if you know it (..”because you hit your sister..”) and the solution you have (..”so I will take a moment to regroup and then we will talk about how I am feeling and what helps me go through it”)
  • Do practice awareness of your reaction to the emotional dysregulation in others. The goal it to learn to respond to their outburst (observe, acknowledge, empathize and work through it) rather than react (yell back or slam the door and leave).
  • Do prepare and reflect. When a challenging situation lays ahead, take the time to prepare yourself and the child for it and afterwards reflect on how preparation and having a rescue plan had helped to minimize emotional outbursts.

DON’Ts in Emotional regulation

  • Don’t expect emotional regulation if the person is hungry, thirsty, tired, lonely or in other way physically unsettled. Emotions are felt in the body and learning how the body reacts to them is a crucial step in recognizing and further regulating them.
  • Don’t ignore or minimize kids’ emotions. They might see overly dramatic, or unnecessary, or inconvenient (airport tantrums, anyone?) but for the child they are real and often intense. Work on acceptance that even if we don’t get it, it is real for them and our job is to validate their struggle/excitement and teach them how to better self-regulate.
  • Don’t pretend you “feel it for them” if you do not. It is ok to state that “I don’t know what you are going through but I am here for you and I am willing to help you out in any way I can”.
  • Don’t try to “fix it” or make it go away or focus on it for too long. Emotions are fleeting, they can feel very intense when they occur, but most of them resolve or lose their overpowering force if the person “stays with it” (recognizes it, tolerates the distress for negative emotions and responds, rather than reacts) for long enough. Learning this skill early on can be truly helpful in adulthood

Practical skills to help with emotional regulation

Mindfulness techniques. There are many ways to focus on the “now” to help tame an emotional outburst. A simple example is the 5-4-3-2-1 Grounding Exercise. It can distract from the anxiety trigger, focus the person on the present moment, and help them relax in their body. Ask the person to : name 5 things they can SEE in the room (have them list them out loud) ; name 4 things they can FEEL (sock on my feet, knots in my belly) ; name 3 things they can HEAR (my voice, radio); name 2 things they can SMELL right now (my coffee) ; name 1 thing they can TASTE (if not in the moment, what did they taste last night) . This can be shortened to 4-3-2-1 or even 3-2-1, depending on the circumstances.

Relaxation techniques– teach yourself and your young ones deep breathing. Yoga Dragon breath and the Camel pose can be a fun quick way to release tension.  Explode like a volcano/ Balloon technique can be practiced anywhere and most children under 10 years of age find is helpful (pretend you explode like a volcano/popped balloon- you can jump up and model the eruption with your hands and make a lot of loud dramatic volcano sounds). Using movement, music and sensory activities can help further relax and refocus one’s brain.

Diligent self-care – emotional regulation is impossible in a body with unmet basic needs, namely being tired, hungry, thirsty, lonely or sick. Daily self-care, particularly getting enough rest depending on the person’s age, should be encouraged and taught by parents, especially to teens and young adults who have more autonomy and can make the connection between being overly tired and overly emotional and further

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For many families, the start of the school year means the start of activities, socialization, and helpful structure. For others, it signals the start of anxiety – anxiety about grades, socializing, separation from loved ones, and the like. Anxiety is very common in childhood and adolescence and often does not require mental health intervention.

Common childhood fears include:

  • loud noises
  • costume characters
  • the dark
  • separation from parents
  • social anxiety

However, some children may develop clinical levels of anxiety, warranting attention from a mental health provider. It is estimated that 9% of youth ages 3-17 have had an anxiety disorder. The prevalence rises as children move into adolescence.

If mild anxiety is normal and expected, how do you know when it is a problem?

It might be a problem if anxiety is…

…getting in the way of school.

…getting in the way of friendships or personal goals.

…negatively impacting their mood.

…causing significant strain on the family.

So, what can I do as a parent?

It can be highly distressing to witness a child suffering. Parents may also find it frustrating if their child cannot or will not engage in developmentally appropriate activities due to anxiety (e.g., go to school, complete chores, sit at the dinner table). This can make it hard to know what to do to help

First, identify whether the fear is based on a true threat. Use your judgment here, but if there is clearly a threat or the anxiety is in proportion to the situation, validate and support your child. And just because a fear is valid, it is not always solvable or preventable. Encourage your child to tolerate the anxiety and convey your confidence in their ability to cope.

For anxiety that seems out of proportion to the actual threat, it can be helpful to educate your child. Many young children are still learning about what is dangerous and what isn’t. However, if your child comes to you repeatedly to get reminded or reassured that they are okay, this may no longer be helpful.

Encourage approach coping. Research tells us that overtime, with repeated exposure to feared situations, anxiety will reduce. Avoidance can reinforce anxiety in the long run. Try encouraging your child to engage in activities that they are avoiding. Don’t allow them to avoid doing what is expected in your house or given their developmental level.

This may involve facing your own distress. When you see your child in distress repeatedly, it is normal to become overprotective. You may start anticipating what they fearand protect them. Parents do this because seeing your child in distress is HARD, and it can feel cruel to maintain expectations (e.g., child to sleep alone in their own bedroom) when they are visibly upset.

Just remember that overprotectiveness is NOT helpful because:

  • it can promote avoidance
  • it reinforces the belief that the world is dangerous
  • it reinforces the belief that your child is not capable of managing distress

Positive reinforcement. Acknowledge how difficult it is to be brave and praise your child when they go outside of their comfort zone. Implementing tangible rewards can also be helpful in motivating children to face their fears.

Differential attention. Sometimes, families can get into a pattern where the anxious child gets more attention when fearful. This can inadvertently reinforce anxiety and dependency. By providing relatively more attention when children are engaging in brave or expected behavior, you can help to reverse this pattern.

Modeling. Children learn by watching you, so keep an eye on what you are teaching them through your actions. When you can, demonstrate bravery and willingness to mess up.

Scaffolding. Scaffolding can be a very useful technique when the behavior change needed is too challenging to be expected all at once. It involves providing enough support for your child to engage in a desired behavior (e.g., school) and then slowly reducing that support overtime.

If you think your child may have an anxiety disorder, talk to your pediatrician or a mental health provider. And if you need extra help, seek advice from a professional. Many providers also offer tailored education and parenting support.

 

Lindsey Collins, Lindner Center of Hope new studio portraits. UC/ Joseph Fuqua IIBy: Lindsey Collins Conover, PhD
Lindner Center of HOPE, Staff Psychologist

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By: Laurie Little, PsyD 

Lindner Center of HOPE, Staff Psychologist

Plants that have psychedelic properties have been used across all continents for centuries to aid in rituals, recreation and in healing. Over time, researchers have found that psychedelic medicines can also be profoundly effective in treating mental illnesses such as depression and anxiety and in ameliorating the effects of trauma.

Although a psychedelic medicine can be derived from a plant or created in a lab, the user will experience what can be described Laurie Little, PsyD as non-ordinary or altered states of consciousness. These states may include hallucinations, unusual perceptual or sensory experiences or an altered sense of space and time. Many users of psychedelic medicines also report profound experiences of inner peace, compassion towards themselves and others and deeply meaningful spiritual realizations. When combined with psychotherapy, psychedelic medicines have the potential to heal in ways often not seen with traditional therapies.

The psychedelic medicines that are most often being studied with mental health conditions are psilocybin (derived from mushrooms), LSD, Ketamine, Ayahuasca and MDMA. There have been numerous studies showing the effectiveness of psychedelic medicines on treatment resistant depression, end of life anxiety, Obsessive Compulsive Disorder, eating disorders and substance use disorders.

One of the most rigorously studied medicine is MDMA for the treatment of Post-Traumatic Stress Disorder (PTSD). In studies conducted by the Multidisciplinary Association for Psychedelic Studies (MAPS), 88% of participants with severe PTSD experienced a significant reduction in their symptoms and 67% no longer met criteria for PTSD only two months after their treatment.

The question remains, why is the treatment so effective? What is it about the combination of psychedelic medicine and psychotherapy that is so profoundly healing?

One possible theory is that psychedelic medicines offer the user an opportunity to look at difficult or traumatic experiences through a new lens that they have never had before. A psychedelic experience can potentially slow down the experience of time, engender feelings of safety and compassion, provide profound experiences of meaning and purpose and foster or deepen a connection to a higher power. Many of these experiences when applied to processing an old wound or trauma can have a profoundly healing impact.

Case Vignette:

John Doe is a veteran who has seen horrors that most of us cannot imagine. He has spent the better part of his adult years struggling with recurring nightmares, intrusive thoughts and strong feelings of survivor guilt and shame. He lives alone, avoids most people when he can and spends most of his time ruminating about what he should have done differently in his life.

At the behest of his family, John has tried traditional psychotherapy, but has gotten so overwhelmed by symptoms of panic and flashbacks, that he quits. It is too painful to talk about and he assumes it won’t help.

However, when John was given the opportunity to participate in an MDMA assisted therapy session, he was intrigued. He had been hearing more and more about how psychedelics could help with trauma but was afraid to feel hopeful. He had been resigned to feeling this way for so long. He agreed to give it a try.

While taking MDMA, John felt an alert state of consciousness, yet he felt calm and safe in a way that he had not felt for years. He felt at peace and relaxed. When he was gently guided to recall aspects of his past, he did not resist or feel panic like he had before. He was able to recall the events with a certain kind of distance. He could understand now that he was just doing what he could to survive. He could see now for the first time in his life that his so called “enemies” were also doing what they could to survive. He began to realize how true that was for all of the world. After that initial session of MDMA assisted therapy, John was then able to engage in traditional therapy in a way he never could before.

Although many researchers and therapists are aware of how profoundly helpful these medicines can be, there is still a great deal of stigma associated with these medicines. Because these medicines are still illegal in the United States, desperate patients are either travelling to other countries or are finding therapists who are privately using these medicines through “word of mouth”.

The Food and Drug Administration gave approval for certain psychedelic medicines to be researched, as long as they were held to the same standards as other pharmaceutical medications. This has led to a resurgence of new studies showing the safety and efficacy of psychedelic medicines for a multitude of mental health conditions. It is projected that several psychedelic medicines (including psilocybin and MDMA) will become legal and available for therapeutic use within the next one to two years.

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Kristy L. Hardwick, EdD, LPCC-S Lindner Center of HOPE, Outpatient Therapist

 

 

 

 

 

 

 

 

The sun is shining; the days are longer. Summer is approaching. For some, summer is a break from study or work. For others, it may be an opportunity to take a week of vacation to relax and rejuvenate. Whether it is a two-to-three-month break, or simply more time in the evening to enjoy the sunshine, it is a time for which most look forward. It is often a time of joy, laughter, and reprieve. Summer is associated with rest and play, all of which can promote positive well-being. And I embrace all of it.

However, I am also keenly aware of the various tragedies we have collectively experienced over the recent months. With the “last day of school” and the “first vacation of the summer” pictures also come news of mass shootings, war, and other difficult events. There is exposure to pain and suffering on multiple levels, whether indirectly or directly.

Thus, I get the sense “the sun is shining, but it is also dark!” I find it necessary to acknowledge the current conflicting duality of our reality and the distress which many are experiencing, while sharing a few reminders to help us navigate through.

First, during times like this, it is crucial to recognize it is normal to have a plethora of intense thoughts and feelings, as well as an urge to act. It is also expected there will be differing viewpoints and ways these events affect individuals based on a variety of factors.

Second, it is important to highlight there are times when words are insufficient to convey the depth and intensity of feelings or to comfort adequately. Perhaps we don’t know anyone personally who has been directly affected by one of the current tragedies. Yet, we have been impacted. We may find ourselves juggling varying thoughts and feelings and struggling to put these into words. I would invite us to lean into what we are experiencing in our bodies. Accept there may not be “right words.” However, we can give space for our thoughts and feelings, accepting them as we experience them.  Sitting in silence might be necessary. It might also be helpful to focus on possible actions. For example, if we are feeling helpless, we might brainstorm a way we can make a difference or identify an area where we do have control. We can also find ways to show care, concern, support, and express meaningful presence with others amid the current tragedies.

Perhaps we do know someone who has been directly affected by one of the various tragedies or observe others being more deeply impacted by our current shared experiences. Again, we may not know the “right words” to say to those who have suffered directly from a tragedy or are in more distress. That is okay. There is a reason why words fall short; it is because ultimately, they often do. Thus, instead of getting caught up in “saying the right words,” we can focus on embracing being a meaningful presence. We offer authentic support through honest connection. Even saying, “I don’t know what to say; however, I am here for you,” or “I don’t understand or know the solution, but I am here to listen.” Offering just to be with someone is powerful.

Next, we may experience discomfort when we feel “caught in the middle” of opposing circumstances or even opposing feelings. On the one hand, it is summer. We have plans to relax, find joy, rejuvenate. Yet, we find ourselves surrounded by various tragedies. The degree of impact may vary. We are both impacted and aware of the suffering; yet also are navigating daily lives. We are both excited about summer plans, but also angry and sad about world events. Or we may be struggling with different stressors or difficult life circumstances, but also must continue to function. In these situations, it can be powerful to embrace “both/and.” Often we are influenced to exist in an “either/or” mindset. Either we are happy, or we are sad. Either we are fulfilled, or we are discontent. Yet this negates the complexity of both the outer world, and our inner worlds. Joy and pain can coexist; celebration and grief may show up hand in hand. Vacations are happening in the middle of world conflict. We are both celebrating our young adults graduating college and mourning for those killed in a mass shooting. Embrace and hold space for “both/and.” Multiple, often conflicting, thoughts and feelings can be true at the same time. It is necessary to accept all of them.

Lastly, we can utilize healthy coping skills to navigate these “distressing-at-a-loss-for-words-embracing-both-and” times. Consider strategies which have been helpful in the past, as well as those we may not have utilized previously.

Find ways to express our thoughts and feelings, giving ourselves permission to hold several thoughts and feelings simultaneously, while also releasing them. (Allow time for “both/and.”) Resist the urge to hold them in. Even if we have moments of “no words,” we must find ways to release them in nonverbal ways and then be willing to let words flow when they do come, without judgment. Releasing feelings is an important skill to practice.

Get moving, be active. We cannot separate the various parts of our bodies; they are all interconnected. Moving is good for all areas of our health, increasing endorphins. Research also supports various activities such as yoga, which activates the parasympathetic nervous system, decreasing stress and muscle tension. We can engage in physical activities we love, whether it be swimming, kayaking, or biking.

Be creative. Engaging in novel and creative activities increases dopamine. Make art; write, create music. Simply listening to music has been found to decrease anxiety and stress. (We can even combine the coping skill of releasing and expressing feelings with this one!)

Seek social support. Make connections. We increase the oxytocin (the “love hormone”) in our brains by spending time with family, friends, and pets. We are inherently built to be in relationship with others.

Stick to routine; take the vacations we have planned. Routine helps us stay motivated and organized.

Maintain healthy habits. Sleep/rest. Eat well, hydrate.

Limit social media/news exposure when current events become too distressing.

Seek ways to advocate and get involved in organizations created to assist survivors of events or those which support issues we find important.

And lastly, let us not hesitate in seeking professional help if levels of distress increase, we are unable to function or fulfil roles, unhealthy coping has increased (drug/alcohol use), there is difficulty sleeping or change in appetite, and if experiencing severe hopelessness and suicidal thoughts. We are here to help when the sun is shining but it is also dark.

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By: Jennifer B. Wilcox, PsyD
Staff Psychologist, OCD and Anxiety Disorders Program

 

 

 

 

What is compulsive hoarding?

Hoarding Disorder is a psychiatric illness and is considered to be a subtype of Obsessive-Compulsive and Related Disorders. The Diagnostic and Statistical Manual of Mental Disorders – 5th Edition (DSM-5) defines Hoarding Disorder (HD) as:

Persistent difficulty discarding or parting with possessions, regardless of their actual value. This difficulty is due to a perceived need to save the items and to the distress associated with discarding them.

The difficulty of discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use.

The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).

The hoarding is not attributable to another medical condition and is not better explained by another mental disorder.

 

 

 

 

 

 

How is compulsive hoarding different from normal clutter or collections?

It is not uncommon for people to acquire a few extra possessions from time to time, resulting in occasional clutter. However, while normal clutter or collecting doesn’t usually interfere with a person’s daily functioning, compulsive hoarding often does. Compulsive hoarding also differs from normal clutter or collecting as it tends to become unmanageable, overwhelming, and causes significant distress or family discord. Though collections usually bring people joy and fill them with pride, hoarding often comes with shame and embarrassment.

Why do people hoard things?

Compulsive hoarding is thought to result from a combination of factors including genetics, environmental factors, life experiences, and learned behaviors. The reason one person hoards may not be the same as the reason someone else hoards. Some people who hoard are compulsive shoppers and acquire more things than they need or have room to accommodate. Others may have difficulty categorizing or making decisions about what to do with particular items. Sometimes they can’t remember what they own or where it is, leading to the purchase of duplicate items. Other times people hold on to possessions for emotional or sentimental reasons or get anxious when they discard things. Some people believe that the hoarded items may be useful someday and keep the items despite not needing them currently. The level of insight a person has about their struggles in these areas can vary widely from completely absent insight to good insight.

What types of things do people hoard?

The types of items a person hoards vary based on factors such as the reason they are hoarding and how severe their hoarding issues have become. Some commonly hoarded items include books, newspapers, magazines, boxes, bottles, clothes, food, items purchased in bulk, collectibles or vintage items, furniture, animals, or digital media.

How many people suffer from Hoarding Disorder and who does it affect?

While the exact prevalence of people who suffer from Hoarding Disorder is not certain, it is estimated that it affects approximately 2.5% of the general population. Studies have shown that prevalence rates in men and women are nearly equal and appear to be consistent across developed countries. Most studies report onset between 15 and 19 years of age and show a chronic course over the lifespan.

What is the treatment for Hoarding Disorder?

Hoarding Disorder is treated using Cognitive-Behavioral Therapy (CBT), a type of therapy that allows someone to work with a therapist to shift their thinking patterns and change their behavioral patterns to healthier ones. Randomized controlled trials have shown this to be an effective treatment for hoarding. While the data on the efficacy of medication for Hoarding Disorder is limited, there is some evidence to support the use of medication in the treatment of this disorder. For those hoarders who have limited insight, a Motivational Interviewing (MI) approach can help to foster their motivation and confidence. Finally, working on skills that improve the hoarder’s ability to maintain attention and focus, categorize items, and decision-making can be beneficial in treating Hoarding Disorder.

What can I do to help a loved one who seems to have issues with compulsive hoarding?

It is generally not recommended for family and friends to discard hoarded items without the hoarder’s permission. This can be extremely distressing for a compulsive hoarder and tends to make them upset, anxious, or angry. Instead, it is recommended that friends and family talk to their loved ones about their concerns and help them to seek professional treatment. Additional resources are available at the International Obsessive-Compulsive Disorder Foundation (IOCDF) and the Anxiety and Depression Association of America (ADAA).

Resources:

American Psychiatric Association, 2013. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. American Psychiatric Association Publishing, Arlington, VA.

Treatment of Hoarding Disorder

https://instituteofliving.org/programs-services/anxiety-disorders-center/what-we-treat-at-the-adc/compulsive-hoarding

https://www.psychiatry.org/patients-families/hoarding-disorder/what-is-hoarding-disorder

Postlethwaite, A., Kellett, S., Mataix-Cols, D., 2019. Prevalence of Hoarding Disorder: A systematic review and meta-analysis. Journal of Affective Disorders 256, 309-316.

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The Difference Between CBT and DBT (Cognitive and Dialectical Behavioral Therapies)

Stacey L. Spencer, Ed.D.
Clinical Neuropsychologist, Lindner Center of HOPE
EMDR Trained therapist
Assistant Professor, Department of Psychiatry & Behavioral Neuroscience

 

There are many, many possible types of psychotherapy. Psychotherapy is an optimal treatment method for mental illnesses.  Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) are among the most common psychotherapies.

CBT vs DBT

What is Cognitive Behavioral Therapy?

One that has been in the public sector for decades, and that you’ve likely heard of, is Cognitive Behavioral Therapy (CBT). If you’ve ever gone to therapy, it’s very likely that the therapist you saw practiced CBT. This therapy, also called talk therapy, helps people better understand how thoughts influence our feelings. The goal of CBT is to talk through problems and help frame thoughts differently. CBT is typically time-limited and there are specific goals and homework provided. You might start out with a situation that troubles you, or one you may find troubling. With the guidance of the therapist, you identify the thoughts around the situation and work on finding alternatives and ultimately changing the behaviors in order to feel better. So, it’s thought-feeling-action-focused. Some mental flexibility is involved given that most of these thoughts are automatic and can become engrained.

Cognitive Distortions are often discussed in CBT.  CBT helps us to break up negative thought patterns or “thought traps” that can lead to feelings of anxiety, depression and cause us to avoid. A technique to help one move away from this type of thinking and often employed in CBT is “cognitive shifting”. With the help of awareness in what a person focuses on (in this case, often the negative cognition/thought/belief) the idea is that this helps us learn to shift our focus to something more helpful or innovative. There are many Cognitive Distortions under this umbrella. Examples of catastrophizing could be magnifying or minimizing. I read a good description once of this being a “billowing cloud of everything can go wrong” and believing it inevitably will.  Or in Minimizing when we downplay our successes.

A CBT-oriented therapist might give someone who tends to catastrophize events in their lives, leading to anxiety, for instance, a worksheet and walk through the process with them. This is hypothesized to have evolved as a way to help us survive during the immediate crisis. Now that we have developed higher-level reasoning skills, this can turn against us, as these negative thoughts can turn sticky.

One way to start is to help the client identify what they are currently most worried/anxious about. The client might start by specifying what they imagine will occur without using “what if” statements. Instead, the focus is on the client’s own predictions, e.g., “ I will fail the exam and get kicked out of school.” You ask the client to rate how much they believe this to be true from 0-100%. Next, the client is asked to take a step back and consider the likelihood of the catastrophe to occur. By helping the client to take a step back and assess the fear from a different perspective and re-interpret their concerns, this is called “reframing”.

Working on ways to cope with and manage these fears/anxieties by not diving into them is a strategy that CBT therapists employ. It takes practice and yet studies have shown that finding more balanced ways of managing these types of thoughts can lead to better mental and physical health outcomes. By helping the client to explore the underlying thoughts, emotions and beliefs and problematic thinking, they can work towards a more balanced view of themselves. The hope is that by helping the client change their perception to support more positive thinking, they will reduce distress and suffering and lead a more fulfilling life.

To recap, CBT features the following:

  • Treats emotional response
  • Is time-limited
  • Works best with solid therapist-patient relationship
  • Relies on the application of logic and reason
  • Employs structure to guide tailored treatment

What is Dialectical Behavioral Therapy?

Dialectical Behavioral Therapy (DBT) comes from dialectical theory and is actually a type of CBT.  DBT posits balance; not leaning too hard in one direction or another. This modality was originally created by Dr. Marsha Linehan in her work with people with chronic life-interfering behaviors, like self-harm and chronic suicidal thoughts. It has expanded to help with many other issues. Dialectical Behavioral Therapy techniques utilize individual therapy, group skills class and coaching. Groups emphasize learning specific DBT coping skills and there is homework given in-between to reinforce what was learned.

DBT Coping Skills

The four pillars of DBT coping skills include:

Mindfulness

Emotion Regulation

Distress Tolerance

Interpersonal Effectiveness

Mindfulness is a DBT coping skill that involves living with intentional awareness of the present moment. This includes not trying to push away or reject the moment but to notice it and not attach ourselves to it. As Dr. Linehan describes, this is by “Attending to the experience of each new moment, rather than ignoring the present by clinging to the past or grabbing for the future.” This takes practice and patience and can take many forms. Some examples of mindfulness include meditation in the form of noticing by either opening or focusing the mind. Contemplative prayer (in any spiritual form) is another mindfulness practice along with mindful movement such as yoga, martial arts, hiking, tai chi.

Emotion Regulation involves understanding and naming one’s emotions. By helping to learn to identify emotions, one can hope to gain an understanding of what they do for us. Goals of this are to decrease the frequency of unwanted emotions, the vulnerability to them and decrease emotional suffering.

Distress Tolerance are DBT coping skills for when involved in a crisis situation and the goal is to not make the crisis worse. By utilizing skills of Radical Acceptance, one can achieve freedom from suffering and being “stuck”. This can help by reducing acting on intense emotions and tolerating painful events. These are only utilized in a crisis situation, where the event or experience is highly stressful and short-term.

Lastly, Interpersonal Effectiveness skills are to help assist with either strengthening current relationships or end destructive ones, to learn to say yes/no effectively, resolve conflicts before they get overwhelming and create and maintain balance in relationships.

The Difference Between CBT vs DBT in Treating Certain Illnesses

Not all mental illnesses respond to treatment in the same way.  The difference between CBT and DBT must be taken into consideration when determining the optimal treatment method for an individual. CBT has been shown to be effective when treating depression, anxiety, obsessive compulsive disorder (OCD), phobias, panic disorder and post-traumatic stress disorder. DBT was created to help people who might be easily dysregulated and tend benefit from learning ways to self-soothe, communicate more effectively with others and find ways to reduce significant distress.

The Difference Between CBT and DBT Treatment Methods

The difference between CBT and DBT are defined. CBT focuses on the connection between thoughts, feelings and behaviors and how they influence each other. DBT emphasizes regulating emotions, being mindful and tolerating the uncomfortable. CBT guides patients to recognize troubling thoughts and redirect them, while DBT helps patients accept themselves, feel safe and manage emotions to avoid harmful behaviors.

When comparing CBT vs DBT, both therapies have aspects of how our thinking influences our emotions and behaviors but are different in their approaches and structure of the therapeutic process. Both modalities are evidenced-based, that is, much research has gone into showing whether they are effective.  When choosing a therapist, as important as it is to find someone in-network or with openings, it’s equally so to know what treatments are most effective for the reasons you’re seeking therapy in the first place. Therefore, asking about CBT vs DBT and which one might work best for you, would be an important next step in this process.  This is the best way to determine if CBT vs DBT are right for you.

Knowing your diagnosis is key to determining what therapy will be most effective for you. However, many people have more than one diagnosis, and sometimes people use a blend of therapy elements to best manage symptoms.

It can be confusing to know what techniques will best help you. CBT and DBT are some of the more common therapy practices, and have been shown to help individuals suffering from a number of mental illnesses.

Choosing to take care of your mental health is just as important as your physical health and finding providers that utilize evidence-based practices will provide you with the best outcomes possible.

For more information about DBT skills group at Lindner Center of HOPE.