Monthly Archives: March 2020

Eating Disorders and DBT

Posted March 12, 2020

Eating Disorders and DBT

The Core Components of DBT

Dialectical Behavior Therapy (DBT) is one type of cognitive-behavioral therapy. It has demonstrated effectiveness with a variety of mental health issues such as post-traumatic stress disorder (PTSD), depression, and anxiety. Though it was developed in the 1980s by Marsha Linehan, Ph.D., as a therapy for suicidal thinking and self-harm, DBT has found applications for many more substance abuse disorders as well as mental health diagnoses.

 

How Can Dialectical Behavioral Therapy Help With Eating Disorders?

DBT focuses on the fluid nature of acceptance and change, two concepts that may seem mutually exclusive. Practitioners believe that people need to learn new behaviors to find satisfaction in their lives. Supporting and validating clients helps them to gain the motivation to learn and practice new things. DBT demonstrates effectiveness in addressing eating disorders using the five components of the treatment.

  • DBT skills training: Usually offered in a weekly group format, these sessions are like a class where participants learn behavioral skills and complete assigned homework. The tasks provide clients with opportunities to try out their new skills in the real world. Skills training takes 24 weeks to complete the four modules of the curriculum.
    • Mindfulness is the practice of staying in the moment and fully aware with a focus on making decisions with one’s “wise mind.” The wise mind uses both emotional and rational inputs to contribute to decision making to avoid emotional eating.
    • Distress tolerance is one’s ability to cope with feelings that cause distress. This skill is critical for dealing with crises, identification of emotions, and reducing vulnerability to emotional extremes.
    • Interpersonal effectiveness is the way that a person expresses needs and sets boundaries to establish and grow healthy relationships. This concept includes acquiring assertiveness skills, learning to ask for help, and saying “no” to others.
    • Emotional regulation is the process of changing emotions that you want to change.
  • Individual therapy: DBT focuses on growing the client’s motivation to make changes and then assisting through the application of those skills to real life. Therapy sessions are usually once a week for as long as necessary, running concurrently with the DBT skills training sessions.
  • Coaching to ensure the generalization of skills: DBT uses coaching sessions over the phone to provide support at the moment when clients are struggling. The goal is to teach clients how to use DBT skills when challenging situations arise in day to day life.
  • Structure the environment with case management: With the assistance of case management, clients learn how to manage their own lives in their usual physical and social circles.
  • DBT consultation team to support the therapist: The DBT treatment team offers support to the professionals providing the various services, including therapists, case managers, group leaders, and others.

 

Common Desired Outcomes of DBT

Cognitive-behavioral therapies such as CBT are the preferred method of treatment for eating disorders as it appears to slow or stop the unhealthy behaviors present in the condition. DBT is often offered alongside other types of service in residential treatment programs for eating disorders. Other clients receive DBT services in an outpatient setting. Sessions may be in a group format or one-on-one with a trained therapist. Individual sessions allow the client to practice what they are learning in a group so that the best approach may be a combination of the two.
Clients report multiple positive outcomes with DBT services.

      • Leaving sessions with concrete skills to apply to real-world experiences
      • Gaining knowledge of how to make decisions in stressful situations
      • Successful avoidance of behaviors such as binging and purging through improved coping skills

 

Case Studies and Research About the Effectiveness of DBT and Eating Disorders

The body of research on DBT and eating disorders is still evolving. However, the current prominent perspective is that DBT is most helpful for clients with bulimia nervosa or binge eating disorder. It is most likely to be successful with clients who have Borderline Personality Disorder and intense emotions along with the eating disorder. For clients who have not found success with traditional CBT or other forms of individual psychotherapy, DBT may produce better results. Mindful eating, trigger identification, and healthy responses to stressors are a few of the skills that DBT teaches these clients to use.

Here are a few of the relevant studies into the use of DBT with eating disordered clients.

  • 2001: Participants with a binge eating disorder receiving DBT experienced a decrease in symptoms. A surprising 89% were symptom-free at the end of the study, and 56% maintained that status six months later. Similar studies with participants diagnosed with bulimia found symptom reduction after DBT as well.
  • 2014: A study of clients with anorexia nervosa receiving DBT found improved body mass indexes (BMIs) at six and 12 months after services. Another study involving women with anorexia nervosa or bulimia nervosa found improved emotion regulation and a reduction in symptoms with DBT.
  • 2015: A study found that a combination of DBT and Family-Based Treatment (FBT) led to a reduction in binging and purging episodes in teens with bulimia nervosa.

Along with the research studies, case studies exist demonstrating the effective use of DBT for clients with eating disorders. A 23-year-old female diagnosed with anorexia nervosa, binge-eating/purging subtype, received six months of residential treatment. She found DBT helped her learn the skill of “Opposite to Emotion” or “Opposite Action,” which means acting in a way that is opposite or different from what your emotions would typically demand. Rather than reacting with food restriction when offered meals, she chose to practice gratitude for the meal and for the chance to practice her new skills.

This client also used the concept of “Radical Acceptance” as her weight began to restore to a healthy level. Instead of attacking herself, she instead committed to love and accept everything about herself throughout the growth process. Over time, her inner dialogue changed for the better.

 

Dialectical Behavioral Therapy at MHS

The Minnesota Department of Human Services certifies Mental Health Systems as an accredited provider of DBT for adults and adolescents, including those with developmental disabilities. Contact us today to set up an appointment for evaluation if you or someone you love is struggling with an eating disorder.

Image Credit: Shutterstock / Photographee.eu

DBT and Borderline Personality Disorder

Posted March 12, 2020

DBT and Borderline Personality Disorder

What Is Borderline Personality Disorder (BPD)?

Borderline Personality Disorder (BPD) is a mental health diagnosis that involves difficulty regulating emotions. When someone with BPD experiences intense stress over an extended period, it can be tough for that person to de-escalate to a “normal” level of functioning. This feeling may express itself as self-harm, unhealthy relationships, and impulsivity. Individuals diagnosed with BPD are 75% female, though professionals suspect that men are often misdiagnosed.

What Are the Symptoms of Borderline Personality Disorder?

Characteristics of borderline personality disorder vary by the individual, but some are more usual than others, according to the Diagnostic and Statistical Manual (DSM). Here are some of the most common symptoms of BPD:

  • Extreme mood swings
  • Feelings of instability and insecurity
  • Desperation to avoid abandonment, either real or imagined
  • Unstable relationships that alternate between intense feelings of love and hatred
  • Distorted and unstable self-image
  • Impulsive and dangerous behaviors

What Are the Causes of Borderline Personality Disorder?

The definitive causes of BPD are not thoroughly understood, but experts agree that it’s probably multifactorial. Genetics likely play a role, as those with a close relative with BPD are more likely to be diagnosed themselves. Environmental factors, especially childhood trauma and being raised in an invalidating environment, seem to contribute to the development of BPD. Individuals with BPD may have neurological differences in the parts of the brain that control emotional regulation.

Because of the multiple factors that contribute to BPD, there is no single test to diagnose it or one single indicative symptom. Mental health professionals use a comprehensive assessment that includes a complete history of symptoms and functioning across areas.

How Can Dialectical Behavioral Therapy Help BPD?

Dialectical Behavior Therapy (DBT) is a type of cognitive-behavioral treatment initially designed to treat those diagnosed with borderline personality disorder (BPD). It focuses on thoughts, beliefs, behaviors, and actions to reduce symptoms and enhance life functioning. DBT was the first form of psychotherapy that has demonstrated effectiveness in treating BPD through controlled clinical trials. It is now the preferred first-line treatment for this disorder with a broad base of evidence and documented success rates in reducing adverse outcomes such as these:

  • Psychiatric hospitalizations
  • Hospital stays
  • Substance abuse
  • Self-injury
  • Suicidal behavior
  • Severity of symptoms

While DBT cannot cure BPD, it is proven effective for reducing symptoms and helping with the management of them. Research finds that up to 77% of people no longer met the criteria for BPD after one year of treatment with DBT.

What Can I Expect from DBT?

DBT usually involves a combination of group and individual sessions, classroom training, and phone coaching. Patients track symptoms and the use of their new skills daily while receiving services.

The skills training portion of DBT includes four types of skills.

  • Mindfulness skills focus on keeping a person fully present in the moment. Observation, description, and participation in daily experiences are all part of this learning. Patients learn to process thoughts, emotions, external responses to the environment, and sensations without deeming them either good or bad. These skills are needed to implement more advanced DBT skills successfully.
  • Interpersonal effectiveness skills are those that help an individual assert his or her needs and manage relationship conflicts.
  • Distress tolerance skills teach individuals to cope with stress without exacerbating it through negative means such as self-injury, impulsivity, and risky behaviors.
  • Emotion regulation involves helping a person learn to identify and manage feelings and reactions to them.

Where Can I Learn More About DBT as a Treatment for BPD?

DBT can help clients with BPD reach positive long-term functioning. The best results involve a combination of psychotherapy, family and peer support, and medications. Reach out to Mental Health Systems (MHS) to schedule an evaluation to see if DBT can help you or someone you love.

Image Credit: Shutterstock /pathdoc

Super-users in Health Care. MHS’ Dr. Mark Carlson Leads Training on Clients with Chronic Conditions

Posted March 3, 2020
Did you know that 5% of the general population accounts for about 50% of health care costs?  Coined super-users, these clients struggle to engage, burn out providers, and often have poor outcomes.  For many of these clients, traditional therapy techniques are either ineffective, or make the situation worse.  “Therapists and health care providers often haven’t seen the research and don’t know the strategies that work with these clients”, says Dr. Mark Carlson, who has spoken nationally on super-users.  “Fortunately, there are clear strategies that work across approaches that help engage clients, improve outcomes, and lead to therapists and care providers feeling better about their work with high need clients”, Dr. Carlson continued.
Held on March 6th, click here for more information and to register for this event.

Parasympathetic Nervous System and Trauma

Posted March 2, 2020

What Is the Parasympathetic Nervous System?

The parasympathetic nervous system (PSNS), sometimes called the feed-and-breed or rest-and-digest system, is part of the autonomic nervous system, along with the sympathetic nervous system. Located between the brain and spinal cord, the PSNS is tasked with saving the body’s energy by slowing the heart rate and increasing the activity of the intestines and glands during periods of rest. It also relaxes the sphincter muscles in the gastrointestinal system.

Here are some of the body functions stimulated through the parasympathetic nervous system. The PSNS uses acetylcholine as its primary neurotransmitter, but other peptides may act on the PSNS as well.

  • Sexual arousal
  • Lacrimation (crying or shedding tears)
  • Digestion: The PSNS dilates the blood vessels of the GI system to allow for greater blood flow.
  • Salivation: The PSNS stimulates the salivary glands and speeds up peristalsis.
  • Urination and defecation

The PSNS also constricts air passageways when the body needs less oxygen, such as during rest periods. It also constricts the pupils when closer vision is required. These functions complement those of the sympathetic nervous system, which is best known for stimulating the fight or flight response when the body perceives a threat.

 

When Is the Parasympathetic Nervous System Activated?

During times of stress, your body’s sympathetic nervous system activates your fight or flight response. It happens quickly so that the body is almost instantly ready to run or defend itself. In contrast, the parasympathetic nervous system’s job is to relax the body and use hormones to slow down those frantic responses once the threat is gone. The PSNS gives the body a calm and relaxed feeling over a period of time. The changes don’t happen as quickly as those of the sympathetic nervous system.

 

How Does Trauma Affect the Nervous System?

In periods of stress, the body’s fight or flight response activates. A normally regulated nervous system experiences the stress but returns to normal when the threat has passed. This period during which you have the ability to self regulate is called the window of tolerance, and most people move through several of these cycles daily. One example is rushing to get somewhere and running late but relaxing once you reach your destination on time. However, the system works very differently when the body experiences trauma.

Traumatic events push the nervous system outside its ability to regulate itself. For some, the system gets stuck in the “on” position, and the person is overstimulated and unable to calm. Anxiety, anger, restlessness, panic, and hyperactivity can all result when you stay in this ready-to-react mode. This physical state of hyperarousal is stressful for every system in the body. In other people, the nervous system is stuck in the “off” position, resulting in depression, disconnection, fatigue, and lethargy. People can alternate between these highs and lows.

In cases of extreme and chronic stress, such as ongoing trauma, complex PTSD may result. One example is children who are raised in abusive homes. Another is a soldier returning from combat. The nervous system becomes conditioned to exist in a state of fear. That state can continue into adulthood, triggered by things that would seem utterly unrelated to the childhood trauma. For example, the soldier may react to the backfiring of a car as if the sound is gunfire because he or she is in a constant state of fear, ready to react to the firing of a bullet.

 

How Do You Calm Down the Parasympathetic Nervous System?

A competent and trained therapist can help clients learn to activate the PSNS to control feelings of stress and anxiety, improve mood, boost the immune system, and reduce blood pressure. Many activities can help trigger this calming response in the body:

  • Meditation and progressive relaxation
  • Identifying and focusing on a word that you find peaceful or calming
  • Exercise, yoga, tai chi, and similar activities
  • Spending time in a serene natural place
  • Deep breathing
  • Playing with small children and pets

Other ways to activate the PSNS include getting a massage, repeating a calming chant or prayer, and participating in hobbies. Anything that you find calming, reassuring, and relaxing can be a way to wake up your parasympathetic nervous system.

Some of the techniques to activate the PSNS may come as a surprise. They focus on connecting your brain to the physical activity you are involved in, removing it from the “stuck” stage. Here are some examples:

  • Gently touching your lips with two fingers can activate the PSNS because the lips are rich with parasympathetic fibers.
  • Focusing on one thing at a time and avoiding the temptation to multitask can maximize the benefits of activating the PSNS.
  • Visualization and imagery and picturing yourself in a peaceful place that you love can activate the calming actions of the PSNS.

 

Self Care and PTSD

Practicing self-care can help those who have PTSD learn to release stress and pull the nervous system back into regulation. These tips can help.

  • Choose relationships that are safe. People who calm you and make you feel secure can help you activate your PSNS. People are social by nature and find comfort in connection with others. Isolation and superficial relationships can even aggravate mental health challenges.
  • Take mindful breaths to connect your breathing to your conscious thoughts rather than to automatic panic responses.
  • Connect with a trauma-focused therapist who understands these concepts and can help you recognize the signs of a dysregulated nervous system. A trained professional can help you identify what’s calming for you, and this may be different from person to person. For example, one person may find it soothing to sit still while others need the motion to feel at peace.

 

Does DBT Work for PTSD?

Dialectical Behavior Therapy (DBT) is a form of Cognitive Behavioral Therapy (CBT) intended to treat patients with the symptoms of Borderline Personality Disorder (BPD). However, since many of these patients also have Post-Traumatic Stress Disorder (PTSD) and vice versa, DBT can be useful in helping with both diagnoses. BPD and PTSD are both characterized by difficulty in controlling emotions, impulsive behaviors, and problems managing interpersonal relationships.

DBT was developed in the 1980s by Dr. Marsha Linehan. Like CBT, DBT emphasizes controlling thoughts and behaviors in a way that reduces symptoms. However, DBT also focuses on the acceptance of emotions and thoughts through the use of mindfulness skills. Researchers in a German study found that treating people with PTSD using DBT reduced the symptoms, such as depression and anxiety, and led to improvement that continued weeks after the therapy ended. Research continues into this promising use of DBT.

 

Contact MHS for Help Today

MHS offers DBT for adults and adolescents as young as 12, including those with co-occurring disorders, to help them reduce symptoms and improve quality of life. The Adherent DBT program at the Woodbury, Edina, Plymouth, and Roseville locations is closely modeled after the curriculum developed by Dr. Marsha Linehan. It is nationally accredited and certified by the Minnesota Mental Health Division Department of Human Services.

At MHS, DBT combines different techniques such as mindfulness, emotional regulations, interpersonal skills, and distress tolerance to effect lasting change. Clients identify personal goals, and MHS provides support to help them reach those targets. Therapists help clients get motivated and practice what they learn in therapy.

To learn more about how this intensive outpatient approach can help you, contact us today.

Image Credit: Shutterstock / GBALLGIGGSPHOTO