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Dialectical Behavior Therapy (DBT): a Cognitive Behavioral Approach

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Dialectical Behavior Therapy (DBT): a Cognitive Behavioral Approach

By: Jasmyn Cuate

Dialectical behavior therapy (DBT) is a combination of cognitive and behavior therapy, supported by empirical-based evidence that teaches patients skills to cope with and change unhealthy behaviors. The main goals of DBT are to teach people how to live in the moment, develop healthy ways to cope with stress, regulate their emotions, and improve their relationships with others.

DBT focuses on four key areas in therapeutic skills:

  • Mindfulness: focuses on improving your ability to accept and be present in the current moment, helping you use healthy coping skills instead of using negative impulsive behaviors
  • Distress tolerance: teaches you how to feel intense emotions without reacting impulsively or using self-injury or substance abuse to escape from it. Helping you prepare for intense emotions and cope with a more positive long-term outlook
  • Emotion regulation: teaches you how to identify, label, and change your emotions without judging them– learning how your emotions shape your behavior and what obstacles prevent you from managing your emotions, reducing your emotional vulnerability and helps you have more positive emotional experiences
  • Interpersonal effectiveness: allows you to communicate more effectively with others, become more assertive, maintain self-respect and respect for others, while keeping a relationship positive and healthy

DBT goes through a multistage approach where the therapist first treats the patient’s most self-destructive behavior followed by the therapist addressing quality-of-life skills, then focus on improving the patient’s relationships and self-esteem, with the last stage focusing on promoting more joy and relationship connections. Standard comprehensive DBT is often used in the following settings:

  • Individual therapy: with a trained professional, you learn how to apply DBT skills to specific challenges and situations in your life­– patients agree to do homework to practice new skills and fill out diary cards which are completed daily to keep track of their emotions, urges, behaviors, and skills used throughout the week and brought to weekly sessions for the therapist and client to discuss and see if there’s progress being made. Diary cards are designed to record instances of target behaviors, thoughts and urges, and the use of behavioral skills client’s applied to cope with the problem
  • Group skills training: patients have the opportunity to role-play new behavioral skills and interact with others
  • Phone coaching: with DBT, your therapist is available by the phone for in-the-moment support between sessions if you’re in a difficult situation and need guidance

While your therapist works with you through the DBT approach, it can be challenging to stay motivated. Therefore, therapists have consultation groups,which are a group of professionals who met regularly helping one another to navigate potential stressors, monitor their devotion to treatment, develop and increase their skills, and sustain their motivation to work with high-risk, difficult-to-treat clients.

DBT was developed by Marsha Linehan, originally intended to treat borderline personality disorder (BPD) and suicidal behaviors but has been modified to treat other mental health conditions and have been effective in treating:

  • Borderline personality disorder (BPD)
  • Bipolar disorder
  • Substance use or impulsive behaviors
  • Eating disorders
  • Depression
  • Post-traumatic stress disorder (PTSD)
  • Non-suicidal self-injury (NSSI) or suicidal behavior
  • Generalized anxiety disorder (GAD)
  • Attention-deficit/hyperactivity disorder (ADHD)

Overall, DBT offers validation for patients, helping them understand their actions within the context of their personal experiences without necessarily agreeing that their actions are the best approach to solving a problem. This helps patients become more likely to cooperate and work towards self-acceptance and change. The best way to find out if DBT is right for you is to talk with a professional. They will evaluate your symptoms, treatment history, and therapy goals to see if DBT is the best treatment option for you.

If you or someone you know is seeking for dialectical behavior therapy, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources: https://www.webmd.com/mental-health/dialectical-behavioral-therapy https://www.psychologytoday.com/us/therapy-types/dialectical-behavior-therapy

https://www.verywellmind.com/dialectical-behavior-therapy-1067402

https://psychcentral.com/lib/an-overview-of-dialectical-behavior-therapy

Laziness: The Harmful Effects of the Term “Lazy” on Mental Health

GalleryJudy Gurfein Leave a comment

By: Rebecca Fernandez

               “Lazy” is a common uncomplimentary term in modern vocabulary for when someone is unproductive. Think back to a time a group member failed to pull their weight in a group project, or a time someone procrastinated severely, leaving everything for the last minute and creating a poor final product. Consider even a time where you witnessed someone who, by early afternoon, was seemingly unable to bring themselves to get out of bed to start the day.

Whether it was yourself or someone else that you imagined, it’s easy to write off everyone in those examples as lazy. However, there’s a major issue with doing that – “laziness” is often not the cause of these situations. Rather, many mental health conditions can create issues that simulate behaviors identical to laziness.

Take, for example, disorders such as attention deficit hyperactivity disorder (ADHD), depression and other mood disorders, insomnia and other sleep disorders, and anxiety disorders including obsessive compulsive disorder (OCD) and generalized anxiety disorder (GAD). Each of these conditions can negatively impact a person’s ability to be productive, making them appear lazy. People with ADHD can often find themselves imagining all of the tasks they could be engaging in at once and becoming so overwhelmed they feel almost paralyzed. People with depression and other mood disorders often lack the mental energy to accomplish anything. Similarly, people with insomnia and other sleep disorders often lack the physical energy to accomplish anything. People with GAD may have a crippling fear that they won’t be good enough at something, preventing them from attempting to do the task in question. People with OCD may have a crippling (rational or irrational) fear that something bad will happen if they do specific things, preventing them from doing those things.

               All of these explanations are generalized and therefore may not apply to everyone with each listed disorder, or be the only applicable factor for each disorder’s effect on laziness. However, if you or someone you know has been consistently labeled as lazy, remember that “laziness” is often more than how it appears on the surface, and that actively struggling with mental health does not make a person a failure.

If you or someone you know is exhibiting signs of “laziness” as described above that are getting in the way of day-to-day life, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

https://over-coming-ocd.com/2020/07/20/laziness-does-not-exist-10-reasons-why-we-procrastinate/

https://www.psychologytoday.com/us/blog/hide-and-seek/201410/the-psychology-laziness

Borderline Personality Disorder and Bipolar Disorder; Distinguishing Between the Two

GalleryJudy Gurfein Leave a comment

Borderline Personality Disorder and Bipolar Disorder; Distinguishing Between the Two

By: Stacey Rodriguez

Borderline Personality Disorder (BPD) and Bipolar Disorder (BD) have many overlapping symptoms, causing them to manifest similarly. BPD is characterized by a pattern of unstable emotion, behavior and self-image. Similarly, BD is marked by unusual and extreme shifts in energy and mood.

Mood swings in the context of BPD are more frequent, shorter lived, and triggered by situational factors; they are largely a product of a distorted perception of reality fueled by dysfunctional core beliefs. Contrastingly, manic and depressive episodes experienced by those with BD are not directly induced by external stimuli, but rather a result of chemical imbalances. These episodes last for a minimum of 7 days and can be intersected by symptom free periods. While impulsivity is a key marker in both, it is important to note that in bipolar disorder it occurs most frequently during periods of mania, whereas it is unrelated to mania in BPD.

A common correlation between the two disorders is family history. Though, history of trauma seems to be a distinguishing factor as it is most particular to BPD, whereas genetics seem to play a larger part in BP.

Though BPD and BD are distinctly separate, in some cases, they can co-occur. While being informed on the nature of these two disorders is beneficial, it is essential for an individual to seek help from a mental health specialist if either seem to be present.

If you or someone you know is seeking therapy for Bipolar Disorder or Borderline Personality Disorder, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources: https://www.nami.org/Blogs/NAMI-Blog/June-2017/Borderline-Personality-Disorder-and-Bipolar-Disord

https://www.medicalnewstoday.com/articles/324375#diagnosis

Image Source: https://ibpf.org/how-to-know-if-you-have-bipolar-disorder-adhd-or-borderline-personality-disorder/

Borderline Personality Disorder (BPD): Understanding BPD and how to Appropriately Respond to Provocations as a Loved One

GalleryJudy Gurfein Leave a comment
By: Abby Erasmus

Living with Borderline Personality Disorder (BPD) not only affects the individual, but those with whom they have formed a relationship. Relationships are present and strong, but experience more turbulence due to key symptoms of BPD such as: intense reactions, self- doubt, extreme idolization or devaluation, fear of abandonment, mood swings, risky behaviors, etc. There is no one “cause” of a personality disorder like BPD, but studies show that patients with BPD come from families of severe pathology leading to their provocative behavior patterns.

People with BPD engage in provocative behaviors like making wild accusations, over- the- top demands, threatening suicide, etc., all with the intention of being invalidated by their counterparts as they have been their whole life. They feel invalidated (which fuels self- doubts) when they evoke one of three reactions from their counterpart: anxious helplessness, anxious guilt, or overt hostility. If these reactions are displayed, their poor behavior is rewarded and will continue, and feelings of self- doubt are reaffirmed.

When someone with BPD makes a wild accusation, resist invalidating them while disagreeing with the accusation. If they say, for example, “I can tell you hate me,” you can reply with, “I’m sorry you feel that way. I wish there was something I could do that would convince you I love you.” Here, you are disagreeing with the accusation while validating their feelings, and not showing one of the craved reactions. Their poor behaviors are thus not rewarded and feelings of self- doubt are not reaffirmed. Further, simply listen and be attentive. People with BPD most likely grew up being invalidated so they want to feel cared about. When talking to someone with BPD, incorporate the counseling technique “reflection of feelings”. This is defined by interpreting one’s feelings based on their verbal and nonverbal cues. When you’re able to interpret someone’s feelings, it demonstrates that you are paying attention and care, which is of utmost importance to someone with BPD.

If you or someone you know is seeking therapy for a codependent relationship, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources:

https://www.nami.org/Personal-Stories/What-Is-BPD

https://www.psycom.net/personality-disorders/bpd-and-relationships/

https://www.psychologytoday.com/us/blog/matter-personality/201401/responding-borderline-provocations-part-iii

https://www.psychologytoday.com/us/blog/matter-personality/201403/responding-borderline-provocations-part-iv

https://www.psychologytoday.com/us/blog/matter-personality/201403/responding-borderline-provocations-part-v

https://www.psychologytoday.com/us/blog/matter-personality/201405/responding-borderline-provocations-part-vi

Bipolar Disorder: How to Support a Spouse with Bipolar Disorder

GalleryJudy Gurfein 2 Comments

    Bipolar Disorder: How to Support a Spouse with Bipolar Disorder

    By: Isabelle Siegel

    Bipolar Disorder is characterized by alternating manic (“elevated, expansive, or irritable mood”) and depressive (“depressed mood or loss of interest or pleasure in life”) episodes. The disorder causes significant suffering for the individual diagnosed, as well as his/her loved ones. It can be extremely difficult to support a partner or spouse with Bipolar Disorder, but it is possible with the right mindset and preemptive actions.

    Develop an understanding of Bipolar Disorder and how it manifests in your partner/spouse. Psych Central suggests creating a list of warning signs that your partner/spouse starts to exhibit before or while entering a manic or depressive episode. This will help you to better understand your partner/spouse, as well as enable you to interpret his/her behaviors in the context of the disorder.

    Learn what helps (and what does not help) when your partner/spouse is in a manic or depressive episode. When your partner/spouse is stable, work together to create a list of actions you can take to alleviate symptoms when he/she is in a manic or depressive episode.

    Communicate. As cliche as it sounds, open communication is integral to maintaining a relationship with someone who has Bipolar Disorder. It is important that each partner/spouse feels heard and validated at all times.

    During manic or depressive episodes, understand your partner’s/spouse’s behavior in the context of the disorder. During episodes, it is important to view your partner’s/spouse’s actions and words as symptoms of a disorder rather than as reflective of his/her true feelings. If your partner/spouse says something hurtful, for example, try to understand the role that the disorder is playing in causing this behavior.

    Allow yourself to feel frustration, upset, or any other emotion. Understand that Bipolar Disorder is an illness and that it is normal for difficult or conflicting emotions to arise. Do not feel guilty for feeling frustrated, upset, angry, resentful, or even for wanting to leave your partner/spouse at times. All of these feelings are normal.

    Most importantly, take care of yourself and seek therapy. Understand that your partner/spouse is not the only one who needs support and never feel guilty for prioritizing your own needs. It can be beneficial to seek therapy or other support in order to take care of your own mental health and to work through difficult emotions.

    If you or a loved one needs support and help understanding yourself and/or a family member, the licensed psychologists, psychiatrists, psychiatric nurse practitioners, and psychotherapists at Arista Counseling & Psychotherapy can assist you. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, visit http://www.counselingpsychotherapynjny.com/

    Sources:
    https://psychcentral.com/blog/helping-your-partner-manage-bipolar-disorder/
    https://www.nami.org/personal-stories/living-with-someone-with-bipolar-disorder
    https://www.healthline.com/health/bipolar-disorder/relationship-guide
    https://www.psycom.net/bipolar-definition-dsm-5/

    Image Source:
    https://medium.com/@christinacare/a-guide-to-supporting-a-partner-in-therapy-f0d64575558

    Depression: Difference between Unipolar and Bipolar Depression

    GalleryJudy Gurfein 1 Comment

    By Gabriella Phillip

    Eliciting a history of brief periods of improved mood is the key to differentiating between unipolar and bipolar depression. Bipolar spectrum disorders typically begin earlier in life than unipolar depression; the usual sign of bipolar disorder in young children could be depression and/or a combination of depression and states of mania/hypomania. It’s significant to ask the patient how old they were when they first experienced a depressive episode. Men have a higher rate of bipolar disorder than women, but the rates for unipolar depression in men and women are more equal.

    Some patients with bipolar spectrum disorder can go from normal to severely depressed technically overnight whereas unipolar depressive episodes tend to occur more gradually. Patients with bipolar spectrum depression tend to experience weight gain and crave carbs, while those with unipolar depression usually experience weight loss or loss of appetite. Patients suffering from bipolar depression tend to show irregular responses to antidepressant monotherapy, including switching into mania. Bipolar spectrum disorder is an inheritable mental illness, so it’s vital to take family history into consideration. While patients diagnosed with unipolar depression usually note that their symptoms fluctuate in a more stable, regular pattern, those with bipolar depression have moods that can vary unpredictably, usually with no cause.

    When treating bipolar depression, antidepressants are used in combination with some sort of mood stabilizer. Treatment for unipolar depression can include medication like SSRIs and antidepressants, often in combination with cognitive behavioral therapy (CBT) and psychotherapy. Screening instruments including the Bipolar Spectrum Diagnostic Scale and the Mood Disorders Questionnaire can be effective and helpful tools in differentiating unipolar from bipolar depression.

    If you or someone you know is struggling with Bipolar Disorder or Unipolar Depression, Arista Counseling and Psychotherapy can help. Please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/ .

    Sources

    https://www.psychiatrictimes.com/special-reports/major-depressive-episode-it-bipolar-i-or-unipolar-depression

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2850601/

    https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/unipolar-and-bipolar-depression-different-or-the-same/AE364DFBFFBAF1F66A9294A55120C64E/core-reader

     

     

    Bipolar Disorder: Cognitive Deficits of Which You May Not Be Aware

    GalleryJudy Gurfein Leave a comment

    By Samantha Glosser

    When you hear the term “bipolar disorder” your first thoughts are most likely about the cycle of elevated and depressed moods, of extreme highs and extreme lows. This is to be expected, as these states of mania and depression are hallmark features of bipolar disorder, and they are typically the symptoms highlighted by mainstream media. In mania, individuals exhibit symptoms of high energy, decreased need for sleep, feelings of euphoria, extreme irritability, and impulsivity. In a depressive state, individuals display symptoms of low energy, feelings of helplessness and hopelessness, avolition, and suicidal ideation.

    Sometimes there can be more to bipolar disorder than just these symptoms. For some, after the onset of bipolar disorder symptoms, there is a marked decrease in cognitive capacity across a few different areas. Typical cognitive deficits reported with bipolar disorder include the following: difficulties with working memory, such as word retrieval, and executive functioning, such as problems with planning, prioritizing, and organizing behavior. Individuals also experience difficulties retaining information that was just presented to them and can even experience slowed thought processes. These adverse cognitive impacts appear at both polarities of mood. It is also important to distinguish between two types of cognitive deficits: mood-phase specific and enduring. Mood-phase specific cognitive deficits are typical to most individuals diagnosed with bipolar disorder, as these symptoms are only present during periods of mood intensity. Enduring deficits, on the other hand, will remain present even when an individual has sustained a period of partial remission or is at a baseline level of functioning (i.e., they are not experiencing mania or depression). Not everyone diagnosed with bipolar disorder experiences enduring cognitive deficits. Individuals with a history of higher acuity symptoms, as well as individuals with a history of treatment resistant symptoms, treatment non-compliance, and/or unhealthy lifestyle choices are more likely to suffer from enduring cognitive deficits.

    If you or someone you know appears to be suffering from bipolar disorder, the licensed psychologists, psychiatrists, psychiatric nurse practitioners, and psychotherapists at Arista Counseling & Psychotherapy can assist you. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, visit http://www.counselingpsychotherapynjny.com/

    Source: https://www.psychologytoday.com/us/blog/bipolar-you/201412/cognitive-deficit-in-bipolar-disorder

    Bipolar Disorder: What Is It and What Treatments Are Available

    GalleryJudy Gurfein 2 Comments

    By Stephanie Osuba

    Bipolar disorder is classified as a mood disorder with cycling emotions of highs (mania) and lows (depression) by the Diagnostics and Statistical Manual of Mental Disorders (DSM-5). Periods of mania can last for as little as two days and as long as fourteen days at a time. It is this period of elevated mood and heightened irritability that sets bipolar disorder apart from the diagnosis of clinical depression. During a manic episode, people experience elevated moods of extreme happiness, decreased need for sleep, hyperactivity, and racing thoughts which manifest in pressured speech. Because mania makes people feel like they are on top of the world, people also tend to engage in risky behavior of sexual nature or even substance abuse to maintain the high. Manic episodes can also bring on an intense and easily irritable mood, which can also lead to a risk of violence. Besides one manic episode, in order to be diagnosed with bipolar disorder one must have had a depressive episode as well. This period can last from a few days to even months and is characterized by extreme sadness, disinterest in pleasurable activities, lack of energy, and feelings of helplessness and hopelessness.

    There are two kinds of bipolar disorder, one being more manic and the other being more depressive. Bipolar I is characterized by one fully manic episode, that must last at least a week, and a depressive episode. Bipolar II is characterized by a period of depression and a period of hypomania. Hypomania has all the symptoms of a manic episode; however it usually doesn’t last as long, only about a few days. The speed at which people cycle through emotions largely depends on the person. Treatment for this disorder can either psychotherapy or medication. Most people seem to benefit greatly from a combined treatment of both. A common medication prescribed for this disorder is a mood stabilizer and even sometimes an antidepressant or other psychotropic medication. It’s best to talk to a professional in order to find the best individual treatment plan.

    Source: Grohol, J. M., Psy. D. (2018, May 18). Bipolar Disorder – What is it? Can it be treated? Retrieved from https://psychcentral.com/disorders/bipolar/ 

    If you or someone you know is struggling with bipolar disorder, the licensed psychologists, psychiatrists, psychiatric nurse practitioners, and psychotherapists at Arista Counseling & Psychotherapy can assist you. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, visit http://www.counselingpsychotherapynjny.com/