Norman

Borderline personality disorder (BPD) is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a mental disorder. As defined by the National Institute of Mental Health (NIH), borderline personality disorder is an illness characterized by an ongoing pattern of varying moods, behavior, and self-image. The combination of these symptoms often results in difficulty maintaining relationships. It is highly common for an individual diagnosed with borderline personality disorder to have a deep-seated fear of abandonment making it difficult to tolerate being alone. This paired with intense, sometimes irrational, expressions of emotional instability often push others away making it exceeding difficult for an individual with borderline personality disorder to foster and maintain meaningful, lasting relationships. The scientific reason as to why an individual develops borderline personality disorder remains unknown. The onset of BPD typically occurs in early adulthood. The symptoms of borderline personality disorder are usually worse in young adults, and although the condition may gradually improve with age, BPD is a lifelong condition. 

Treatment

The first step in the treatment process is to obtain an accurate diagnosis from a qualified mental healthcare provider. Borderline personality disorder is notoriously known as an illness that is exceedingly difficult to diagnose. However, a thorough psychological evaluation can provide the most detailed diagnosis, which in turn will greatly inform treatment recommendations. The treatment plan for a person diagnosed with BPD will be a unique to the individual. In order to accommodate all the needs of an individual diagnosed with borderline personality disorder, a treatment plan could include and/ or emphasize any combination of the following options: 

• Individual psychotherapy, also known as “talk therapy,” some of which can include any of the following:
  • Dialectical behavior therapy (DBT): is a form of cognitive behavior therapy (CBT) that focuses on how one’s thoughts and beliefs can lead to actions and behaviors. This skills-based approach teaches how to manage emotions, tolerate distress and improve relationships though group and individual therapy sessions. 
  • Schema-focused therapy: incorporates aspects of CBT and psychoanalytic theories. It helps to identify unmet needs that have led to unhealthy ways of thinking about the world. Conducted in an individual setting or group setting, schema-focused therapy challenges maladaptive beliefs and behaviors and focuses on promoting positive life patterns. 
  • Mentalization-based therapy (MBT): emphasizes thinking before reacting. This is accomplished through helping an individual identify his or her own thoughts and feelings and creating an alternate perspective on the situation.
  • Transference-focused psychotherapy (TFP): helps an individual understand and process his or her emotions and interpersonal difficulties through the developing relationship between the individual and his or her therapist. 

• Encouraging healthy and frequent self-care practices
  • Eating nutritiously
  • Establishing good sleep habits 
  • Regular exercise
  • Remaining hydrated
  • Practicing calming techniques (i.e. meditation, yoga, journaling, etc.)

• Medication: The Food and Drug Administration (FDA) has yet to approve a medication specifically designed to treat borderline personality disorder. There are, however, certain medications that can help to alleviate and/ or reduce some of the symptoms arising from BPD or co-occurring disorders (i.e. depression, anxiety, etc.). Common examples of types of medication prescribed as a component of one’s BPD treatment plan include: 
  • Antidepressants
    • Celexa (citalopram)
    • Prozac (fluoxetine)
  • Anticonvulsants/ mood stabilizers 
    • Topamax (topiramate)
    • Lamictal (lamotrigine)
  • Anti-anxiety medications/ anxiolytics
    • Lexapro (escitalopram)
    • Zoloft (sertraline)
  • Antipsychotics
    • Rexulti (brexpiprazole)

Customized treatment plans that comprise of a variety of different therapeutic modalities, and are used when treating borderline personality disorder, so as to ensure that the individual’s nuanced needs are appropriately addressed. Every person is different and each will require a distinct combination of the various treatment options when it comes to learning effective coping mechanisms and implementing emotional regulation techniques needed to effectively manage borderline personality disorder, long-term.

The National Institute of Mental Health (NIH) defines eating disorders as “serious medical illnesses marked by severe disturbances to a person’s eating behavior.” Though there are several different types of eating disorders included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the three most commonly diagnosed types include anorexia nervosa, bulimia nervosa, and binge eating disorder. According to the Mayo Clinic, anorexia nervosa is characterized by abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight. Johns Hopkins defines bulimia nervosa as uncontrolled episodes of overeating (binging) following by purging (i.e. vomiting, abusing laxatives, excessively exercising, etc.). The NIH characterizes binge eating disorder as repeated episodes of uncontrolled intake of exceedingly large amounts of food in a short period of time. While there is significant overlap, each type of eating disorder comes with its own set of signs and symptoms, short and long-term effects, and treatment methods. 

Causes and Risk Factors

There is no single, identifiable cause as to why someone develops an eating disorder. Research has, however, indicated certain biological, psychological, interpersonal and social risk factors that have been noted to increase one’s susceptibility for developing an eating disorder, which can include the following, as provided by the National Eating Disorders Association (NEDA):

• Biological risk factors: 
  • Scientists continue to research the biochemical and biological causes of eating disorders
  • In some individuals with eating disorders “certain chemicals in the brain that control hunger, appetite and digestion have been found to be unbalanced” 
  • Eating disorders tend to run in families indicating a significant genetic contribution to eating disorders
• Psychological risk factors
  • Feelings of inadequacy
  • Low self-esteem
  • Ineffective coping strategies
  • Depression
  • Anxiety
  • Impulsive behaviors
  • Anger 
• Interpersonal risk factors
  • Overly concerned with other’s opinions
  • Excessively competitive
  • Troubled personal relationships
  • Difficulty expressing emotions
  • History of sexual and/ or physical abuse
  • History of being ridiculed and/ or teased based on size and/ or weight
• Social risk factors
  • Pressure to achieve and succeed 
  • Valuing individuals based solely on their physical appearance
  • Stress related to ethnic, racial, size/ weight-related or other forms of discrimination or prejudice
  • Cultural emphasis placed on thinness as an inextricable part of beauty
  • Media and pop culture’s unrealistic portrayal of people’s bodies and shapes

Constantly engaging in weight loss and diets that involve severely restricting food intake to the point of continued hunger can contribute to the development of an eating disorder. This way of eating can not only cause adverse affects to one’s energy levels, but it can also impact one’s physical health as it prohibits one’s ability to extract and absorb the needed vitamins, minerals, and nutrients that are innately sourced from consuming food. 

Signs, Symptoms, and Treatment

Every person is different and will likely exhibit a somewhat unique set of signs and symptoms as they relate to the presence of an eating disorder. Furthermore, the type of eating disorder an individual struggles with will influence the signs and symptoms experienced. The Mayo Clinic provides a list of examples of behaviors that could be indicative of an eating disorder, some of which include the following: 

• Obsessively focusing on healthy eating
• Skipping meals 
• Withdrawing form social activities
• Making excuses for not eating
• Adhering to an overly restrictive diet 
• Preparing separate meals when eating in a group instead of eating what everyone else is eating
• Excessive exercise
• Constantly checking the mirror and/ or pointing out perceived flaws
• Using laxatives, herbal weight loss products, and/ or dietary supplements
• Regularly excusing oneself during meals to use the restroom
• Eating in secret
• Expressing disgust, shame, and/ or guilt about one’s eating habits

The severity and duration of symptoms will fully depend on the individual. There are a variety of treatment options available to an individual struggling with an eating disorder. If left untreated, continued malnutrition that occurs with an untreated eating disorder can lead to severe short and long-term consequences. Eating disorders are serious mental health illnesses and the sooner one obtains treatment the sooner he or she can begin the recovery process and go on to live a healthy and fulfilling life.

Marriage counseling is a type of psychotherapy that is used to help couples improve their relationship. Marriage counseling provides a couple with an emotionally safe environment to make thoughtful decisions surrounding the status of the relationship, whether or not both parties authentically wish to work towards rebuilding and strengthening the relationship or work towards separating amicably. Through marriage counseling, a mental health clinician works to help couples recognize and resolve conflicts by teaching and facilitating healthy methods of communication and conflict resolution tactics, whether they opt to remain together or not. The saying “you get out of it what you put into it” can be applied to many areas and situations encountered in one’s life, including marriage counseling. 

The Format

A licensed marriage and family therapist typically facilitates marriage counseling sessions. A commonly held credential for mental health clinicians that offer marriage counseling services is obtained through the American Association for Marriage and Family Therapy (AAMFT). While one partner may decide to work with a therapist separately, marriage counseling is usually conducted with both partners present. The specific treatment plan and areas of focus will be wholly dependent upon the unique needs of the couple. Marriage counseling is generally a relatively short-term process lasting between twelve to twenty sessions, and in some cases longer. Most marriage counseling sessions last approximately fifty minutes long. The time between sessions will depend both on the availability of the mental health provider as well as the wants and needs of the couple.  

What Specifically Can Marriage Counseling Help With?

The reasons why a couple decides to go to marriage counseling are wide-ranging. Psychology Today provide the following potential reasons why a couple may seek marriage counseling:

• Poor and/ or lack of communication
• Trust has been broken
• Feelings of unease in the relationship (i.e. being aware that something is wrong but being unable to pinpoint the issue) 
• Diminished emotional intimacy 
• Diminished sexual intimacy 
• Conflicts regarding child rearing and/ or blended families
• Infidelity 
• Consistently becoming dysfunctional during conflict (one or both members)
• Feeling stuck in unhealthy and/ or undesirable patterns
• Addressing and/ or sharing difficult to talk about information with the partner
• Processing situational circumstances that have devastated the relationship (i.e. loss of a child, prolonged unemployment, being diagnosed with a long-term illness, etc.)

Some couples attend marriage counseling as a means to gain better understanding of their partner. Aside from the above, there are many nuanced reasons why a couple may decide to go to marriage counseling. 

What To Expect?

The work that occurs during marriage counseling sessions is guided by the needs of the couple. By nature of participating in marriage counseling both partners engage in shared emotional experiences via the therapy sessions, which can help to foster aligned relationship goals. The work that occurs during marriage counseling can be emotionally charged, elicit difficult to face feelings and seem arduously trying. However, the skills, tools and emotional awareness that can come from actively participating in marriage counseling can be both empowering and insightful. The American Association for Marriage and Family Therapy (AAMFT) reported the findings of a study that indicate, “of couples who try marriage counseling, 90% feel that their emotional health improves, and two-thirds report improvements in their physical health.” The reason behind why a couple elects to participate in marriage counseling will affect its outcome and success.

Dissociative identity disorder (DID) was formerly referred to as multiple personality disorder until 1994, when the name changed to denote a clearer understanding of the disorder. It is currently listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as dissociative identity disorder and is described as a disruption of identity that is characterized by two or more distinct personality states or an experience of possession. Psychology Today defines dissociative identity disorder as a “rare condition in which two or more distinct identities, or personality states, are present in—and alternately take control of—an individual.” An individual that has been diagnosed with DID has essentially failed to integrate various aspects of his or her identity, memory and/ or consciousness into a single multidimensional self. The DSM-5 has reported over seventy percent of individuals diagnosed with DID have attempted suicide at least once in their life, and self-harming behavior is highly common among individuals with DID.

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is a specific type of cognitive-behavioral therapy (CBT) that places significant emphasis on the psychosocial aspects of treatment. Psychologist Marsha M. Linehan developed DBT in the late 1980s to better treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). DBT is currently not only the most heavily relied upon method of treatment for individuals diagnosed with BPD, but has also proven to be effective in treating other mental health disorders such as depression, post-traumatic stress disorder (PTSD), eating disorders, anxiety, substance use disorder (SUD) and more. Dialectical behavior therapy focuses on providing therapeutic skills in the following four modules:

• Mindfulness: the practice of being wholly aware in the present moment
• Distress Tolerance: learning strategies to tolerate pain in difficult situations instead of trying to change and/ or avoid it
• Interpersonal effectiveness: focuses on skills that enable an individual the ability to communicate with others in a way that is assertive, maintains self-respect and simultaneously strengthens his or her relationships
• Emotion regulation: learning how techniques to shift and change unwanted emotions

DBT is comprised of two therapeutic formats: individual psychotherapy sessions and DBT skills group sessions. Individual therapy sessions provide one-on-one therapeutic attention to provide customized treatment and focus in the nuanced mental health needs of the individual. They are also a place for individuals to further process and practice implementing the skills learned during the DBT skill group sessions. Individual therapy sessions are often held once a week for the duration of the DBT program. A trained mental health provider holds the DBT skills group sessions once a week. The leader teaches the DBT skills, facilities group exercises and assigns homework to be completed outside of the group sessions. Participants are often encouraged to share their experiences and provide mutual support to the other group members. The DBT skills group sessions offer participants the ability to learn and practice new skills alongside other individuals that are working on similar issues.

Can DBT Treat Dissociative Identity Disorder?

Every individual is different and will respond distinctly to the variety of mental health treatment options available. The first step in securing mental health treatment is to be properly diagnosed by a qualified mental health provider. It is imperative to obtain an accurate diagnosis when it comes to mental health illnesses, as one’s diagnosis greatly informs his or her methods for treatment. An individual diagnosed with DID should seek immediate mental health treatment to assist in managing its symptoms. Many individuals will require tailored treatment plans that incorporate a variety of therapeutic modalities when it comes to DID. This helps to ensure all nuanced mental health needs of the individual are fully addressed. For example, it is not uncommon for an individual with DID to experience the feeling of becoming suddenly detached from his or her body, speech and/ or actions. 

Research has noted that the distress tolerance and emotion regulation skills can reduce impulsive behaviors that occur from DID. Additionally, due to the fact that suicidal ideation and self-harming behaviors are so widely spread in the DID population, often certain components of dialectical behavior therapy are frequently integrated into treatment plans that are developed by a mental health clinician working with an individual diagnosed with DID. However, traditional DBT focuses on treating the whole person as a single individual and does not recognize nor acknowledge the presence of dissociative identities. Although this aspect of DBT can be harmful to one’s treatment process, the ultimate goal of DBT is to shift negative thinking patterns and destructive behaviors into positive outcomes.

Asperger’s syndrome is a developmental disorder that affects an individual’s ability to effectively socialize and communicate with others. According to the Mayo Clinic, Asperger’s syndrome is a condition that is on the autism spectrum, leaning towards the higher functioning end (mild end) of the spectrum. Asperger’s syndrome was previously listed as a stand alone disorder in earlier publications of the Diagnostic and Statistical Manual of Mental Disorders, but is currently listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) under the umbrella diagnosis known as “autism spectrum disorder.” There are a variety of treatment options available to individuals struggling with Asperger’s syndrome, many of which involve fostering improved behavior, social and communication skills. Depending on the specific needs of the individual, medications, speech therapy, occupational therapy and more may be integrated into his or her treatment plan. 

Dialectical Behavior Therapy

Psychologist Marsha M. Linehan developed dialectical Behavior Therapy (DBT) in the late 1980s. It was originally developed to help treat individuals diagnosed with borderline personality disorder (BPD) experiencing pervasive suicidal thoughts and/ or attempts. DBT is a specialized form of cognitive behavioral therapy (CBT) that places great emphasis on the psychosocial aspects of treatment. DBT continues to be considered the primary and most effective form of treatment for individuals diagnosed with BPD. Furthermore, continued research on its applicability in the treatment of other mental health ailments has indicated that it has become increasingly effective in treating mental health illnesses such as eating disorders, post-traumatic stress disorder (PTSD), substance use disorder (SUD), anxiety, depression, and more. 

Dialectical behavior therapy is comprised of two main components: individual therapy sessions and DBT skills group sessions. The individual therapy component consists of one-on-one contact with a mental health practitioner to ensure all therapeutic needs are being addressed and met. One-on-one therapy provides an individual in treatment with a consistent outlet to discuss obstacles that may manifest throughout the duration of the program, as well as a safe emotional environment to begin to practice implementing the skills learned in the DBT skills group sessions. Individual therapy can provide insight into areas that may need to be further addressed, shed light on therapeutic successes, and help to motivate the individual to remain committed to the DBT process. Individual therapy sessions are often held once a week for the duration of the DBT program.

DBT skills group sessions are intended to enhance a participant’s capabilities by teaching useful and applicable behavioral skills. The Linehan Institute asserts the four primary areas of therapeutic skills that are focused on in DBT include:

1. Mindfulness: focuses on the practice of being fully aware and completely present in the moment
2. Distress Tolerance: focuses on learning techniques to effectively tolerate pain that arises in difficult situations, instead of attempting to avoid and/ or change it
3. Interpersonal Effectiveness: focuses on utilizing assertive communication methods that allows the individual to effectively express his or her wants, while simultaneously maintaining self-respect and strengthening relationships
4. Emotion Regulation: focuses on learning strategies to change unwanted emotions

In the DBT skills group sessions, participants are taught the DBT skills by a qualified mental health professional. The leader will facilitate relevant exercises during the group sessions, as well as assign homework to be completed outside of the group sessions. Participants are encouraged to share their experiences during the group sessions as well as provide feedback and support to their peers. The DBT skills group sessions typically last between two to two and a half hours long, and are held once a week for the twenty-four week program. Mastering each of these skills can be invaluable to an individual diagnosed with Asperger’s syndrome. 

Asperger’s Syndrome and DBT

Every individual is different and will have a unique set of needs when it comes to the treatment of a mental health condition. Many mental health practitioners develop tailored treatment plans that cater to the nuanced needs of the individual. The development of DBT was intended to assist individuals diagnosed with BPD in managing emotional challenges and social difficulties. Traits such as emotional dysregulation and social struggles are noted as common side effects of both Asperger’s syndrome and borderline personality disorder. Increased tendencies towards suicidal ideation and/ or self-harm thoughts and/ or behaviors are also common side effects of both BPD as well as Asperger’s syndrome. With these overlaps, and the fact that DBT was specifically developed to address these issues, it often serves as an effective treatment method for individuals with Asperger’s syndrome.

Binge eating disorder (BED) is listed in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) as a severe, life-threatening eating disorder. According to National Eating Disorder Association (NEDA), it is characterized by “recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating.” Binge eating disorder is currently known to be the most common eating disorder in the United States. 

How Is It Diagnosed?

According to the DSM-5, in order to be diagnosed with binge eating disorder, an individual must meet the following diagnostic criteria for BED:

• Recurrent episodes of binge eating, as characterized by both:
  • Eating discretely (within any two hour period) an amount of food that exceeds what most people would eat in the same amount of time under similar circumstances
  • Experience a lack of control over eating during the episode (i.e. feeling unable to stop eating and/ or an inability to control the amount of food one consumes)
• Binge eating episodes are associated with three or more of the following:
  • Eating until feeling uncomfortably full
  • Eating faster than normal
  • Eating excessive amounts of food when not physically hungry
  • Eating alone due to embarrassment of the quantity of food being consumed
  • Feelings of disgust, guilt, depression after an episode
• Binge eating episodes occur (on average) at least once a week for a minimum of three months
• The binge eating episodes are not associated with the recurrent use of inappropriate compensatory behaviors (i.e. purging, abuse of diuretics, excessive exercise, etc.)

Obtaining an accurate mental health diagnosis is imperative to one’s treatment process. Specifically as it relates to binge eating disorder, it is important to note, that BED is a relatively new type of eating disorder recognized in the DSM-5. Due to its new status, without a proper DSM diagnosis, some insurance companies may not provide coverage for its treatment. 

Treatment and DBT

Every individual is different and will require a customized treatment plan when it comes to struggling with binge eating disorder. Many individuals struggling with binge eating disorder are likely to have dialectical behavior therapy (DBT) incorporated into their treatment plan. Although DBT was originally developed to help better treat individuals diagnosed with borderline personality disorder (BPD), it has since become increasing effective for the treatment of additional mental health illnesses such as depression, anxiety, post-traumatic stress disorder (PTSD), substance use disorder, and eating disorders, including BED. More specifically, DBT helps individuals establish coping mechanisms to reduce anxiety in situations and environments that elicit the stress response associated with food. 

Dialectical behavior therapy is comprised of individual psychotherapy sessions and DBT skills group sessions. Each component is essential to the efficacy of DBT. The individual therapy sessions provide the individual in treatment for binge eating disorder the ability co create behavioral plans and goals surrounding mindful eating with his or her mental health clinician. One-on-one therapy sessions are also used to help empower the formation of a positive self-identity, which helps to foster acceptance, an increased sense of self-worth, and self-compassion. They are also a space to process the information learned in the DBT skills group sessions, address any challenges that arose from the previous week and reinforce the practice of implementing the DBT skills learned. 

The DBT skills group sessions are conducted by a qualified mental health professional and he or she teaches therapeutic skills in direct relation to the following four main areas, as described by the Linehan Institute:

1. Mindfulness: the practice of being wholly aware and present in the given moment
2. Distress Tolerance: skills to learn how to tolerate pain in difficult situations instead of attempting to change or avoid it
3. Interpersonal Effectiveness: techniques that enable an individual to communicate with others in an assertive manner, while simultaneously maintaining self-respect and strengthening relationships
4. Emotional Regulation: learning effective methods to adjust, shift, and/ or change unwanted emotions

After each DBT skills group session the facilitator will assign homework to encourage the participants to continue practicing the skills taught in the session. Participants are encouraged to share their experiences during the group sessions and provide supportive feedback to the peers in the group. Both one-on-one therapy sessions and DBT skills group sessions are usually held once a week and the entire program generally takes twenty-four weeks to complete.

While seeking professional help for mental health ailments was once greatly stigmatized in America, society has come a long way in its understanding of mental illness. Nowadays, not only has treatment for mental health issues become mainstream but also seeing a therapist seems to be the norm rather than the exception in the United States. There are a plethora of recognized mental health illnesses that are currently listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). As the list of mental health illnesses increased so too have the therapeutic modalities. There are countless mental health professionals in America with a wide variety of specialties. Hence, the idea of beginning the search for a therapist in Los Angeles can seem like an incredibly overwhelming feat, even with the set geographic limitation. Below are some helpful considerations that may make the process a bit easier. 

• Ask for referrals: delve into your network of trusted friends and family for referrals. Even in situations where the therapist you are referred to is unable to take you on as a client, he or she will likely be able to provide you with professional alternatives.

• Accreditations: note the accreditations of the mental health provider you are considering. While many mental healthcare workers are required to hold degrees in higher education, they are also obliged to pass certain certification tests and many hold relevant mental health accreditations. Certifications are earned through programs or service that may be based within or associated with a healthcare organization. An individual must earn a passing score on the National Clinical Mental Health Counseling Examination (NCMHCE) to become certified in mental health. Accreditations can be earned by an entire health care organization (i.e. hospitals, nursing homes, etc.). Both certification and accreditation require an evaluation by The Joint Commission.

• Be aware of the different therapeutic modalities offered: According to Psychology Today, there are over sixty-five different types of therapeutic modalities currently offered in the mental health field. Most mental health professionals will incorporate a variety of different therapy methods into their treatment plans. Some of types of therapy listed by Psychology Today include the following:

• • Cognitive Behavioral Therapy (CBT)

• • Emotionally Focused Therapy

• • Experiential Therapy

• • Dialectical Behavior Therapy (DBT)

• • Integrative Therapy

• • Psychodynamic Therapy

• Plan an initial meeting with several therapists: although it may seem time consuming, planning on and meeting with more than one therapist can help you make an informed decision. Sometimes it takes sitting with someone to really understand if they resonate with you. If you have several first therapy sessions lined up with different clinicians, you can give yourself the chance to experience different styles and delineate which feels like the best fit. It can also help to alleviate any undue pressure you may inadvertently put on a first therapy session when you feel you only have one option. 

• Know your out-of-pocket cost: every mental health provider will charge a fee for his or her services. Some will accept insurance, and some will not. Insurance companies are different, as are their respective tiered insurance plans they offer to members. Insurance companies are required to provide full or partial coverage when it comes to the treatment of mental health conditions; however, the exact amount is variable. Some insurance plans provide extensive in-network and out-of-network mental health coverage with little to no out-of-pocket cost to members, while others may only offer specified coverage for services rendered by in-network providers only. Depending on the health insurance plan, there may be a cap placed on the amount of money a plan will cover and/ or the frequency of sessions allotted for the treatment of mental health illness. It is essential to know how much therapy your insurance plan will cover, both cost and frequency.  

 

Each individual is different and as such will likely require a tailored treatment plan when it comes to treatment for mental health disorders. As unique as each individual is, so too are mental health therapists. Every mental health clinician will have his or her own method for developing treatment plans for his or her patients, hold different certifications, as well as rely on a distinctive subset of therapeutic modalities. When searching for a therapist it is imperative have patience and bear in mind that not all therapists will be a perfect fit immediately. Furthermore, in order for therapy to yield the most successful results, an individual must feel comfortable with his or her therapist. If a therapist does not feel like a good fit, make an appointment with another one.

Psychologist Marsha M. Linehan developed dialectical Behavior Therapy (DBT) in the late 1980s. It was initially intended to help better treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). It is a specific type of cognitive-behavioral therapy (CBT) that prioritizes the psychosocial aspects of treatment. Since its development, DBT has proven to be an effective treatment method for other kinds of mental health disorders, such as substance use disorder (SUD), depression, post-traumatic stress disorder (PTSD), anxiety, eating disorders, and more. DBT works by providing individuals with new skills to manage painful emotions and reduce relationship conflicts. When regularly applied, the DBT skills can help an individual improve his or her ability to regulate emotions, learn to better tolerate distress and negative emotions, remain mindful and present in the moment, and learn to communicate and interact more effectively with others. 

Anxiety

While it is normal for an individual to experience bouts of anxiety at various time throughout his or her life, if the worry becomes debilitating it may be indicative of a clinical mental health disorder. Anxiety is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), as Generalized Anxiety Disorder (GAD). According to the Anxiety and Depression Association of America (AADA), in order to be clinically diagnosed with GAD an individual must experience severe difficulty controlling his or her worry on more days than not for at least six months and present with at least three or more of following signs and symptoms:

• Nervousness
• Edginess 
• Irritability
• Having a sense of impending danger, panic and/ or doom
• Increased heart rate
• Difficulty sleeping (due to trouble falling asleep and/ or staying asleep, restlessness at night, and/ or unsatisfying sleep)
• Hyperventilation (breathing rapidly)
• Excessive sweating
• Trembling
• Feeling weak and/ or tired
• Impaired concentration and/ or feeling as though the mind goes blank
• Increased muscle aches and/ or soreness
• Gastrointestinal (GI) problems (i.e. nausea, diarrhea, vomiting…etc.)

The above criteria differentiate GAD from normal bouts of anxiety and/ or worry that may manifest from a specific set of stressors or for a more limited period of time. An individual that struggles with GAD will likely experience a large percentage of his or her waking hours excessively worrying about something, even when there is no specific threat present. Reports have noted that GAD affects nearly 6.8 million adults, which makes up over 3% of the population in America.

DBT Overview

DBT is comprised of individual therapy sessions and DBT skills group sessions. One-on-one therapy sessions allow the providing mental health clinician the ability to focus on the nuanced mental health needs of the individual in treatment. The individual therapy sessions are also a place for the individual to process any challenges that may arise during the week and practice applying and integrating the DBT skills learned into his or her daily life. A qualified mental health clinician conducts the DBT skills group sessions. DBT focuses on providing therapeutic skills in four fundamental areas, which include the following (as provided by the Linehan Institute):

1. Mindfulness: focuses on improving an individual’s ability to accept and be present in the current moment
2. Distress Tolerance: focuses on increasing an individual’s ability to tolerate pain that may arise from difficult situations, as opposed to trying to change and/ or escape it
3. Interpersonal Effectiveness: focuses on teaching techniques that enable a person to communicate with others in a way that is assertive, maintains self-respect, and simultaneously strengthens relationships
4. Emotion Regulation: focuses on methods to successfully change unwanted emotions

The participants of the group are encouraged to share their experience and provide mutual support. After each DBT skills group session the facilitator will assign homework to reinforce actively practicing the material taught in the session. The DBT skills group sessions are typically held on a weekly basis and meet for around six months, though the timeframe can vary depending on the specific needs of the group members. The individual therapy sessions are often held once a week in conjunction with the DBT skills group sessions, though frequency of one-on-one sessions can be increased or reduced based on the individual’s needs. Every individual is different and when in treatment for a mental health illness, such as anxiety, will likely respond best to a tailored treatment plan. DBT offers both the ability to provide customized therapeutic support through the individual therapy sessions, as well as peer support though the DBT skills group sessions.  Depending on the individual’s specific needs, DBT may be a suitable treatment option for an individual struggling with anxiety.

Dialectical Behavior Therapy, DBT, is a type of cognitive-behavioral psychotherapy. DBT was originally developed to help better treat individuals with suicidal behaviors and borderline personality disorder (BPD). DBT is a modification of standard cognitive behavioral therapy (CBT). DBT utilizes a cognitive-behavioral approach while placing greater emphasis on the psychosocial aspects of treatment. A psychologist named, Marsha M. Linehan, developed DBT in the late 1980s after the result of her own transformation that occurred in 1967, according to Psych Central. Interestingly, at the time of its development, Linehan was a suicide researcher, with negligible knowledge of borderline personality disorder. Although DBT was initially developed as a means to be used primarily in the treatment of individuals with BPD, it is now recognized as an effective treatment method for individuals diagnosed with a variety of mental health illnesses, particularly those that involve serious emotion dysregulation such as depression, eating disorders, post traumatic stress disorder (PTSD), substance use disorder (SUD), and more. Furthermore, DBT has been evaluated and found to be effective among individuals from diverse backgrounds.

Marsha M. Linehan

Marsha M. Linehan is a pioneer in the treatment of mental health ailments, with extensive notoriety. She retired from serving as a Professor Emeritus of Psychology in the Department of Psychology at the University of Washington in 2019. She served as president of both the Association for the Advancement of Behavior Therapy and the Society of Clinical Psychology, Division 12, American Psychology Association. Linehan was also a fellow of the American Psychological Association and the American Psychopathological Association and was a diplomat of the American Board of Behavioral Psychology. Linehan has written the following four books, including two manuals:

• Cognitive-Behavioral Treatment for Borderline Personality Disorder 
• Skills Training Manual for Treating Borderline Personality Disorder
• DBT Skills Training
• Building a Life Worth Living: A Memoir

Additionally, Linehan has published extensively in scientific journals, as well as served on a plethora of editorial boards. Some of the many awards Linehan received recognizing her clinical and research contributions to the study and treatment of suicidal behaviors include the following:

• The Distinguished Research in Suicide Award (American Foundation of Suicide Prevention
• The Louis I. Dublin Award for Lifetime Achievement in the Field of Suicide
• The creation of the Marsha Linehan Award for Outstanding Research in the Treatment of Suicidal Behavior established by the American Association of Suicidology
• The Distinguished Scientist Award from the Society for a Science of Clinical Psychology

She is the co-founder of DBT-Linehan Board of Certification (DBT-LBC), which is an organization that identifies providers and programs that offer reliable DBT services, which conform to the evidence-based research for treatment. Linehan is the founder of Behavioral Tech LLC, which is an origination that provides DBT training to mental health professionals and healthcare systems. 

DBT Basics

Dialectical behavior therapy is comprised of one-on-one psychotherapeutic sessions and DBT skills group training sessions. The individual therapy sessions are used to assure the individual in treatment can focus on all of his or her nuanced mental health needs, as well as to provide support and encouragement to integrate the skills learned in group sessions into his or her daily life. One-on-one therapy sessions emphasize problem-solving behaviors, and provide the individual with an emotionally safe environment to process and address any problems that arise in the individual’s life. The DBT skills group sessions are conducted by a qualified mental health professional that teaches the DBT skills as well as provides relevant exercises for participants to practice the skills learned. DBT specifically focuses on providing therapeutic skills in the following four key areas, as provided by the Linehan Institute:

1. Mindfulness: integrating the practice of being fully aware and present in the moment
2. Distress Tolerance: learning how to tolerate pain in difficult situation instead of attempting to change it
3. Interpersonal Effectiveness: learning how to advocate for and assert one’s wants, including the ability to say no, while simultaneously maintaining self-respect and relationships with others
4. Emotion regulation: learning how to change unwanted emotions. 

DBT skills group sessions generally last about two hours, and are often held on a weekly basis. After each DBT skills group session the facilitator will assign homework to the participants to help reinforce the information taught during the session. The combination of one-on-one therapy sessions and the DBT skills group sessions help an individual in treatment learn, apply and master the DBT skills. DBT usually lasts about six months long, though depending on the needs of the participants the process can last a shorter or longer length of time.