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Cognitive Behavioral Therapy (CBT)

The Many Benefits of Cognitive Behavioral Therapy

Cognitive-behavioral therapy is one of the most popular and well-known types of talk therapy applied in modern-day psychiatry. It is the evolution of decades of psychotherapy and psychoanalysis, with roots dating back over a century. But what is cognitive behavioral therapy, really? And how does it work? 

Understanding how CBT can affect patients with different mental health disorders and psychological states can help individuals get a better sense of how therapy can treat psychological disorders, as well as the role of therapy in the long term. 

What Is Cognitive Behavioral Therapy? 

Cognitive behavioral therapy has two important elements: the cognitive, and the behavioral. Both were developed individually at first and came together over the years through integrative treatment. 

On a cognitive level, CBT establishes the idea that a person’s symptoms and problems are based in part on faulty or irrational thinking. It aims to help patients discover, recognize, and understand these irrationalities, and separate them from logical reality. 

On a behavioral level, CBT aims to help patients recognize and overcome their own patterns of unhelpful behavior. We each fall into a cycle of self-destructive habits when struggling with mental health problems – recognizing the urge to stick to the formula, and learning to avoid it, is an important part of the healing process.  

Put together, CBT aims to help people isolate and identify problematic thoughts and actions, emphasize healthier thinking based on reality, and develop strong coping mechanisms for themselves. It’s important to remember that cognitive behavioral therapy is a greater sum of its two parts, and not just two different therapeutic theories brought together. 

A Brief History on CBT

On that note, cognitive behavioral therapy has a long and complex history. It did not spring from nothing but was instead developed as a culmination of decades of work in behavioral analysis and an amalgamation of different therapeutic practices. 

The earliest instance of the kind of framework on which today’s cognitive behavioral therapy was built on can be found in the 1960s, when it was predominantly used to analyze and treat behavioral dysfunction in children. It wasn’t until the 70s that behavioral therapies were developed for older, higher functioning clients. 

Over the years, cognitive and behavioral theories melded into a framework that centered around self-talk – that is, internal thought processes – as a central mechanism of change for anxiety disorders, then mood disorders, post-traumatic stress, and more. 

Today, cognitive-behavioral therapy is one of the most prominent first line treatments in a number of common mental health disorders, playing an important role alongside disorder-specific medication. 

How Cognitive Behavioral Therapy Works

Cognitive behavioral therapy takes two parties: the therapist and the patient. Little more is involved, and in many cases, CBT can be applied efficaciously via telehealth and online resources – meaning physical contact isn’t necessary. 

A lot of CBT boils down to talking. A therapist will work with a patient to help them identify and understand thought processes that play a vital role in shaping their emotions and behavior yet have little to no foundation in reality. These irrationalities often lay at the center of our anxieties and can help deepen depression

CBT also often incorporates elements of mindfulness training (breathing exercises, meditation, focus, and more) and utilizes roleplay and imaginative thinking to explore anxieties, identify problems, and come up with healthy solutions. 

While CBT may not help someone completely think their way out of a mental disorder, it can lessen their symptoms, lead to powerful coping skills, and can help motivate patients to affect positive changes in their daily lives – creating a positive cycle. 

Cognitive behavioral therapy also ultimately helps people become their own therapists by arming them with the tools needed to continue treatment indefinitely. That being said, patients are always encouraged to seek out professional help whenever they need it, no matter what. 

Learning Mindfulness with CBT

Mindfulness is an important element of cognitive behavioral therapy because it emphasizes taking a step back to self-analyze and identify problematic thinking in the here and now. The two are intrinsically linked because both require analysis and awareness. 

Mindfulness can be better characterized as a healthy self-awareness – one that isn’t overly self-critical but aims to be objective. That means recognizing wanted and unwanted thoughts and acknowledging and separating our biases from reality. Affirmations can play an important but separate role in mindfulness, by shifting our perspective from a negative one, to one focused on gratitude. 

For people with depressive and anxious symptoms in particular, making a point of recognizing the present rather than viewing life through a negative lens informed by the past can make a big difference. 

This is often the first step towards establishing a healthier mental framework on which to build important coping skills. 

CBT for Depression

Mood conditions like major depressive disorder are characterized by a persistent low mood or prevailing sadness that won’t go away. Some cases of depression are also underlined by anhedonia (inability to experience joy) in addition to dysphoria.

Cognitive behavioral therapy helps patients with depressive symptoms develop mental arguments for a more positive, healthier outlook, which can have a marked impact on mood and mental health. 

The effects of CBT on any given patient with depression largely depends on the source of their depression, as well. Sometimes, biological factors such as chronic illness or thyroid disease can cause or exacerbate depressive symptoms. 

CBT for Anxiety

Anxiety is characterized as an irrational level or kind of fear. Phobias, for example, describe a form of fear that is nearly constant, persisting even when there is no threat. 

Conditions like social anxiety disorder can lead to dysfunctional behavior and are debilitating. Generalized anxiety disorder can lead to long-term fatigue and depression, as a person remains on edge and worried in nearly every waking moment. CBT aims to help people with anxiety disorders recognize the irrationality of their thoughts and emotions, and find ways to counter, reject, and overcome them. 

CBT and Other Treatment Modalities

CBT is an effective treatment method but is often used in conjunction with other case-specific treatments. 

Conditions like bipolar disorder rely on mood stabilizers like lithium to reduce the severity of certain symptoms. Depression in a neurological sense can be an expression of a neurotransmitter dysfunction, so drugs like SSRIs can help combat this dysfunction. Anti-anxiety medication can help reduce the likelihood of panic attacks, and so on. 

Aside from psychotherapy and medication, common mental health treatment modalities include lifestyle changes, such as exercise and diet, to improve mood and self-esteem. But in any and all cases, one of the most important elements in mental health treatment is a strong support system.

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Cognitive Behavioral Therapy (CBT) Trauma

What Is Trauma-Focused Cognitive Behavioral Therapy?

Trauma-focused cognitive behavioral therapy (TF-CBT) is a form of cognitive-behavioral therapy (CBT) designed to assist in the treatment of families, children, and teens who have survived a traumatic event. Therapists trained in trauma-focused cognitive behavioral therapy have had greater success in treating children and teens with trauma-related mental health issues, from induced anxiety and clinical depression to post-traumatic stress disorder.

Understanding Trauma-Focused Cognitive Behavioral Therapy

Trauma-focused cognitive behavioral therapy is a short-term treatment option that usually lasts about 16 sessions or less. Over 80 percent of teens treated via trauma-focused CBT see notable improvements in symptoms within this period. This form of therapy is also used to help families navigate post-traumatic stress and the symptoms that follow, particularly by arming them with the necessary tools to manage stress, anxiety, and depressive symptoms better through healthier coping mechanisms, thought experiments, and self-reflective methods. Individuals treated through trauma-focused cognitive therapy learn to identify and differentiate errant and intrusive thoughts, disarm them more effectively, and develop the tools to improve their perspective. Some of the most crucial elements explored through trauma-focused cognitive behavioral therapy through its program include:

  • A safe and stable treatment environment. Outpatient or residential treatment establishes an environment that assures the patient that they are safe and taken care of.
  • Affect regulation. Taking charge of your own emotional state.
  • Cognitive trauma processing and trauma narrative. Working through the events of what happened, while providing therapeutic exposure to traumatic memories, and recontextualizing them into tools to overcome trauma.
  • Child-parent sessions. Helping parents better understand what their child is going through while demonstrating how trauma-focused therapy works and helping them arm themselves with the tools to help support their loved one in the long term after therapy.
  • Focusing on future development. Because this therapy is often short-term, a large focus is placed on the effectiveness of future treatment options, and the transition towards long-term treatment via an established support system continued therapeutic support and other mental health resources.

A Short History of Trauma-Focused Cognitive Behavioral Therapy

Trauma-focused cognitive behavioral therapy was developed through the clinical work of Anthony Mannarino, Judith Cohen, Esther Deblinger, and other researchers. They worked together to establish a form of cognitive-behavioral therapy that centered on the treatment of traumatized children and adolescents, by incorporating family therapy and centering on specific core elements of cognitive-behavioral therapy that were most effective for children and teens. Once the basic framework for trauma-focused cognitive behavioral therapy was established, it was followed by five different randomized controlled trials, the golden standard of scientific testing. The result was an explicitly proven efficacy for children and teens with traumatic experiences, proven again multiple times by other researchers.

How Does TF-CBT Differentiate Itself From CBT?

The main differences in trauma-focused cognitive behavioral therapy versus traditional cognitive behavioral therapy include:

  • A focus on establishing a safe day-to-day environment for the treated child or teen.
  • Revisiting their trauma in treatment.
  • Incorporating family therapy to ensure their continued safe development.
  • Centering on treatment elements that resonated best with children and teens.

What Does TF-CBT Treat?

Trauma-focused cognitive behavioral therapy is most often used for the treatment of post-traumatic stress disorder in children and teens. Children and teens experience and display signs of PTSD differently from adults. Children re-experience trauma more often through play, while teens are far more likely to struggle with irritability and outbursts of rage following a traumatic experience. TF-CBT helps them avoid destructive behaviors, identify, and push back against intrusive thoughts, and overcome trauma. TF-CBT is specifically used to treat individuals between ages 3-18, for both single traumatic events and recurring trauma. TF-CBT has also been used in the treatment of teens with complicated grief, as well as stress-induced anxiety and depression.

Should I Speak to My Therapist About TF-CBT?

It’s never a bad thing to express an interest in a certain treatment method or modality. If you are interested in exploring the applications of trauma-focused cognitive behavioral therapy in your own treatment, it isn’t a bad idea to talk about it with your therapist. Ultimately, your mental healthcare provider is the best person to advise you on any treatment you should or shouldn’t try, as well as where or when to try them. Treating individual cases of a mental health issue is vastly different from reading about them, or providing textbook examples of illnesses and treatments.

Case-by-case details greatly affect how efficacious any given treatment might be, and you should always defer to a professional who has spent time working with you and your issues and knows best how you process certain activities and modalities. It also helps to understand that there are distinct limitations in both the application and usefulness of trauma-focused cognitive behavioral therapy. For example, this form of therapy may not be suitable for children or teens who have had severe conduct or behavioral problems before their trauma. Their therapist might instead focus on helping them overcome these conduct issues before addressing their trauma.

Both substance use and suicidal ideation might be contraindicative of trauma-focused therapy as well. The keyword here, however, it might. Because such a core tenet to trauma-focused cognitive behavioral therapy is gradual and frequent exposure, both suicidal ideation and drug addiction can be amplified by this type of treatment. But by modifying exposure frequency and taking a dialectical approach to address factors such as suicidal ideation and self-harm, trauma-focused cognitive behavioral therapy can still be a useful modality in cases with these issues. Otherwise, teens with these issues may be better served with a different treatment approach that tackles both their addiction or severe depression and trauma appropriately, and effectively.

If you have questions about the treatment options offered to you by your therapist or mental health professional, be sure to ask as many of them as possible. It’s important to be on the same page with your treatment provider and to understand how and why certain treatment modalities might work better for you than others. Patients are encouraged to be involved with their treatment, always – and to have a better understanding of both how their condition is affecting them, and how their treatment is helping them overcome that.

Categories
Adolescence Cognitive Behavioral Therapy (CBT) Dialectical Behavioral Therapy (DBT) Mental Health Recovery Spirituality Therapy Treatment

Recovery: Redefining Normal

(Photo credit: Wikipedia)

Stepping onto a path of recovery and beginning the removal of toxicity from one’s life is an arduous, often painful, but beautiful process. But I like to believe that some of our greatest lessons come from our difficulties. Those are the times that provide us with the most insight into what is actually going on with us. Take for instance your relationships with others. Is there a pattern? Have you continued to add links to an unhealthy chain be it consciously or subconsciously? Are you happy?

When there is a history of toxicity in one’s life, particularly when it’s introduced at an early age, what is considered “normal” tends to become skewed. For example, someone raised in a home with an abusive parent may inadvertently seek out relationships with similar personality types. This isn’t a conscious act but rather a direct result of being taught how to be in this world through violence (emotional, physical, visual, etc.). It feels familiar and therefore “normal” to be around toxicity. The question is, how do you break the chain? How do you make new, better choices that are healthy and nurturing?  How do you place yourself in environments that celebrate you for who you are instead of those that persistently denigrate you?

The 12 steps are a brilliant start. They allow us to begin the process of unpeeling the layers of the onion by asking us to turn our eyes inward and check out what’s going on in our minds and in our hearts. That oft-dreaded fourth step tends to help identify a pattern, particularly if we are honest with ourselves when we write it.  Personally, I’ve always liked that process because it feels like I’m stripping the layers of emotional dirt off of me. It’s uncomfortable, but it’s worth it. Frankly, it hurts like hell to look at ourselves and at our lives with a magnifying glass, but dang it, it’s liberating. You just don’t need to carry that stuff around anymore. Twelve-step work is just the start. If it were only that easy, right?

Taking a clinical approach is incredibly beneficial, especially when dealing with trauma, addiction, and mental-health issues.  Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT), to name a few, are invaluable tools to help identify the psychological triggers and hooks we have embedded within us.

But you know what really seals the deal for me? Creating space for Spirituality. I can’t emphasize enough how invaluable it is to develop a spiritual practice. It is the very thing that will feed your soul. No, I’m not selling you religion or a canon of idealized thought. I am, however, urging you to find the calm in your breath, the grounding notion of having your feet planted to the earth, and the healing weight of your hand on your heart. You can break the chain of abuse. You can shut out the tapes that play in your mind, telling you you’re a piece of crap, a failure, not enough, stupid, fat, ugly, useless. You can take your power back. It takes work, but it’s worth all the sweat and tears. Trust me. Be patient. Understand that this process of recovery takes time. Nothing and no one is perfect.

I’ll leave you with this. I was involved in a series of abusive relationships growing up. I was doing the same thing, expecting different results. I eventually discovered I was continuing the pattern of emotional denigration established in my childhood and nurtured in my adolescence. When I finally smashed through that chain several years into my recovery and only after working tirelessly with a therapist, meditation, yoga, 12 steps, I was free. This doesn’t mean the trauma or triggers went away. It means I finally learned to identify them, and have garnered tools to help me respond to them differently. When I met my husband, I quickly discovered he was different. For one thing, he showed me unconditional support, which I hesitated to believe was true. It took me almost two years to accept the fact that I had, in fact, broken that chain and was capable of having relationships that were built on trust and respect. I realized I could believe someone; something this traumatized gal was never able to do. This was proof that I had redefined my “normal” and surrounded myself with a healthy, loving new family. In fact, I redefined my response to the world and its triggers, not just within my family, but also in my life. Ultimately, I took my power back. You can too.  You just have to do the work!

Categories
Cognitive Behavioral Therapy (CBT) Dialectical Behavioral Therapy (DBT) Mental Health Obsessive-Compulsive Disorder (OCD) Recovery Therapy

Body-Focused Repetitive Disorders

Trichotillomania (TTM) is a type of body-focused repetitive behavior (BFRB) specifically characterized by impulsive pulling out of one’s hair from the scalp, eyebrows, eyelashes, or elsewhere on the body. According to the DSM-IV of the American Psychiatric Association, TTM must meet the following five criteria:

  1. Repetitive pulling of one’s own hair that results in noticeable hair loss.
  2. A feeling of tension prior to pulling or when trying to resist the behavior.
  3. Pleasure, gratification, or relief while engaging in the behavior.
  4. The behavior is not accounted for by another medical (or dermatological) or psychiatric problem (such as schizophrenia).
  5. Hair pulling leads to significant distress or impairment in one or more areas of the person’s life (social, occupational, or work).

Though this criteria is useful, there is some debate within the clinical and scientific communities about whether or not all five of these criteria are present in every case. Since there are many who suffer from debilitating hair pulling behaviors but don’t meet all of these criteria, efficient and effective treatment is still paramount to one’s health and well-being.

Signs and symptoms of Trichotillomania often include:

  • Repeatedly pulling your hair out, typically from your scalp, eyebrows or eyelashes, but it can be from other body areas as well;
  • A strong urge to pull hair, followed by feelings of relief after the hair is pulled;
  • Patchy bald areas on the scalp or other areas of your body;
  • Sparse or missing eyelashes or eyebrows;
  • Chewing or eating pulled-out hair;
  • Playing with pulled-out hair;
  • Rubbing pulled-out hair across your lips or face.

Onychophagia (nail-biting) and Dermatillomania (skin-picking) are other BFRBs but are characterized by compulsive skin picking and nail biting. Nail-biting is the most common of “nervous habit.” I’m not talking about the occasional cuticle or hangnail, or the occasional blemish that someone may pick or squeeze. Instead, someone who suffers from onychophagia picks or bites their nails or skin until they bleed, finding themselves using Band-Aids like accessories. As those suffering from TTM will wear hats to cover bald spots and the like, nail-biters will keep their hands in their pockets, sit on them, wear gloves or those Band-Aids I mentioned. Those who excessively pick at the skin on their faces will try to cover up with makeup or when things get really bad, go so far as to stay inside and isolate. I mention these two together, because they often make intermittent appearances in the same individual.

Nail-biting (onychophagia) facts include:

  • Common in individuals of all ages.
  • Up to 33% of children ages 7-10 bite their nails.
  • Nail-biting can be triggered by stress, boredom, or nervousness.
  • About half of all children between the ages of 10 and 18 bite their nails at one time or another. Nail-biting occurs most often during puberty.
  • Some young adults, ages 18 to 22 years, bite their nails.
  • Only a small number of other adults bite their nails. Most people stop biting their nails on their own by age 30.
  • Boys bite their nails more often than girls after age 10

Chronic skin picking (dermatillomania)is characterized by:

  • Inability to resist urges to pick at real or perceived blemishes in one’s skin
  • For some, mounting tension before one picks
  • For some, gratification and relaxation while picking
  • Noticeable sores or scarring on the skin
  • Increased distress and/or interference with daily life

BFRBs have been linked to obsessive-compulsive disorder (OCD). They can sometimes be linked to a sign of emotional or psychological disorders. They are all compulsive disorders, but their manifestations have varying presentations: For some, the picking or pulling will occur during sedentary activities like watching TV, reading, driving or being a passenger in a car, talking on the phone, sitting in class, or sitting at a computer or a desk. At times, there might be focused intent which drives the behavior–for example, planning on picking or pulling at an area as soon as one arrives home. At other times, it’s happens without conscious awareness, and the individual only realizes they’ve picked or pulled when they see the resulting pile of hair, open scabs or bleeding fingers.

This can feel overwhelming, but there is help. For starters, you have to say something to someone and let them know you’re suffering.  Your doctor and/or therapist will then work with you and help you redirect the negative behaviors and create new, innocuous behaviors.

The following therapeutic modalities are typically used to treat BFRB:

(Sometimes, elements from some or all of the aforementioned modalities are used to meet the BFRB client’s needs.):

Alternative therapies are also used, but are not as researched or predictable in terms of their success.

Support groups can provide a wonderful place for fellowship and to create positive social reinforcements.

Keep in mind, What works for one person may not work for another. The key will be in finding the treatments that do work and committing to them. Nothing is impossible, but everything takes effort. Feeling better is worth your treatment endeavors.

 

For more info, check out:

https://www.trich.org/

Mayo Clinic

https://www.trich.org/dnld/ExpertGuidelines_000.pdf

Categories
Cognitive Behavioral Therapy (CBT) Dialectical Behavioral Therapy (DBT) Mental Health Personality Disorder Therapy

Personality Disorders: Finding Solace in Therapeutic Care

According to the DSM-IV, “Personality Disorders are mental illnesses that share several unique qualities.  They contain symptoms that are enduring and play a major role in most, if not all, aspects of the person’s life.  While many disorders vacillate in terms of symptom presence and intensity, personality disorders typically remain relatively constant.” Further, the DSM-IV says that in order to be diagnosed, the following criteria must be met:

  • Symptoms have been present for an extended period of time, are inflexible and pervasive, and are not a result of alcohol or drugs or another psychiatric disorder. The history of symptoms can be traced back to adolescence or at least early childhood.
  • The symptoms have caused and continue to cause significant distress or negative consequences in different aspects of the person’s life.
  • The symptoms are seen in at least two of the following areas
    • Thoughts (ways of looking at the world, thinking about self or others, and interacting)
    • Emotions (appropriateness, intensity, and range of emotional functioning)
    • Interpersonal Functioning (relationships and interpersonal skills)
    • Impulse Control 1

In layman’s terms, someone suffering from a personality disorder often views the world in their own way. Because the perceptions of those around them are often skewed to meet a reality only they see, the subsequent social issues stemming from the inability to interact with others appropriately is troubling–both for the one afflicted and those on the receiving end of the negative behaviors and perceptions. For the Borderline Personality Disorder (BDP), the major symptoms revolve around interpersonal interactions, negative sense of self, significant mood swings, and impulsivity. Where Narcissistic Personality disorder presents itself as grandiose and uncaring yet hungry for recognition, Borderline Personality Disorders can often be summed up like this: “I hate you…don’t leave me.”

Unfortunately, personality disorders are sometimes used as a quick label for a difficult client. However, the criteria are pretty significant and the diagnosis itself should be made after significant assessment by a qualified professional. Those ensconced in the emotional turmoil of a legitimate personality disorder need be able to find some solace in their psychiatric care and trust in the individuals providing care, especially since treatment for personality disorders are long term. The type of therapeutic treatment used depends upon the type of personality disorder being treated. The various types of therapy used to treat personality disorders may include:

  • Cognitive Behavioral Therapy (CBT)
  • Dialectical Behavioral Therapy (DBT)
  • Psychodynamic psychotherapy
  • Psychoeducation

Personality disorders are tricky and can be hard to address. Applying DBT, for example, has shown positive results in the treatment of BPD–recent studies have shown lower suicide rates, less self-harming incidents, and less self-removal from treatment. We must remember that psychiatry is a relatively young science, so the growth and change is happening quickly as practitioners eagerly seek resolution to some of the most challenging psychological quandaries. A therapist once said to me, “If someone were to observe a given client in a single session, they could come up with a variety of diagnoses, when the fact is, that client could have just been having a bad day.” So, whether a client is simply having that bad day or truly struggling with a bona fide disorder, it’s befitting to remember the words of Hippocrates as we unravel the mysteries of mental illness: “Cure sometimes, treat often, comfort always.”

1 https://allpsych.com/disorders/personality/index.html

Additional articles of interest:

 

Personality Disorder – What Is it, and What Does Diagnosis Mean?

With Mental Illness, “Serious” is a Slippery Term

Categories
Bipolar Disorder Cognitive Behavioral Therapy (CBT) Dialectical Behavioral Therapy (DBT) Mental Health Therapy

DBT, Mental Health & Addiction

Image by kenleyneufeld via Flickr

Sometimes someone comes into contact with treatment because their drug use got out of control only to discover their problem isn’t actually addiction, but rather, an untreated mental health issue. Often times the misuse of drugs and alcohol is an ardent attempt to quell the feelings of anxiety or lift the fog of depression. Sometimes it’s a way to disengage from the flashbacks of trauma. Sometimes it’s a way to close the door on a panic attack. However, many times, these modes of self-treatment go too far, and the claws of addiction sink in, creating another layer to uncover and treat. Still, once the addiction piece of the puzzle is treated, therein lies the deeper, more complicated issue of mental illness. What then?

At Visions, we have embraced the mental health component of treatment and are adding a mental health track to our existing treatment plan. We are utilizing a wider range of treatment methodologies and branching into the area of Dialectical Behavioral Training (DBT). DBT is a “comprehensive cognitive behavioral treatment developed by Marsha M. Linehan over the last 25 years,”[i] and has primarily been used to treat patients struggling with suicidal ideation, suicide attempts, a desire to self-harm, and self-mutilation. After discovering numerous problems with the traditional use of cognitive behavioral therapy (CBT) in treating this particular clientele, Linehan began to integrate validation strategies (also known as acceptance-based interventions) into her treatment methodology.  By integrating these validation strategies, Linehan inevitably began empowering her clientele and creating an environment of acceptance, while also encouraging them to begin to recognize the need to consciously change negative behaviors. DBT has also become one of the more successful treatments for patients suffering from borderline personality disorder (BPD), a group typically resistant to the traditional use of CBT.

To illustrate some of the problems Marsha Linehan and her team encountered, here are the three issues they found to be the most troublesome with traditional CBT:

  1. Clients receiving CBT found the unrelenting focus on change inherent to CBT invalidating. Clients responded by withdrawing from treatment, by becoming angry, or by vacillating between the two. This resulted in a high drop out rate. And, obviously, if clients do not attend treatment, they cannot benefit from treatment.
  2. Clients unintentionally positively reinforced their therapists for ineffective treatment while punishing their therapists for effective therapy. In other words, therapists were unwittingly under the control of consequences outside their awareness, just as all humans are. For example, the research team noticed through its review of audio taped sessions that therapists would “back off” pushing for change of behavior when the client’s response was one of anger, or emotional withdrawal, or shame, or threatened self-harm. Similarly, clients would reward the therapist with interpersonal warmth or engagement if the therapist allowed them to change the topic of the session from one they didn’t want to discuss to one they did want to discuss.
  3. The sheer volume and severity of problems presented by clients made it impossible to use the standard CBT format. Individual therapists simply did not have time to both address the problems presented by clients – suicide attempts, urges to self-harm, urges to quit treatment, noncompliance with homework assignments, untreated depression, anxiety disorders, etc, AND have session time devoted to helping the client learn and apply more adaptive skills.[ii]

In addition to utilizing validation strategies, DBT also employs the use of mindfulness as one of the core concepts behind this therapy. Mindfulness is beneficial in the treatment of addiction and mental illness: it introduces the concept of non-judgmental observation, where we can observe our own actions and behaviors without criticism; Being mindful requires that we are engaged in present-time awareness: the here and now. This is where mindfulness is truly invaluable. If we are aware of our actions in the here and now, we are less likely to get caught in the destructive patterns of “what if? and “remember when?” In the practice of meditation, the act of “coming back to the breath” helps one stay in the present. Learning how to label emotions and feelings that may present themselves can help sufferers from getting lost in negative thought patterns. For example, if we are feeling scared or triggered, paranoid or angry, naming that emotion with non-judgmental observation will help us retain our present-time awareness.

In time, hopefully, the implementation of treatments such as DBT and mindfulness will help provide sufferers with some valuable tools for regulating emotion, distress tolerance and managing interpersonal relationships.


For more detailed information on DBT, please visit these sites: