More About Our Treatment Approaches

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DBT

Dialectical Behavior Therapy (DBT) is an intensive treatment originally developed by Dr. Marsha Linehan to treat suicidal clients who meet criteria for Borderline Personality Disorder, and those struggling with other mood-related problems, self-injurious behavior, and frequent hospitalization. DBT is often the treatment of choice for emotion regulation, eating disorders, family/relationship problems, anger, depression, substance abuse and trauma. DBT integrates Eastern Mindfulness and Buddhist Zen techniques with cognitive behavioral therapy approaches.

 

The goal of DBT is to help clients create a life worth living by:

• Enhancing behavioral skills and capabilities

• Generating and improving motivation to engage in more skillful behavior

• Generalizing the gains made in sessions to the natural environment

• Helping to structure their environment so that it helps to reinforce more functional behavior

 

In order to accomplish these goals, the therapist and client work to:

• ​Reduce/eliminate life-threatening and dangerous behavior

• Reduce behaviors that interfere with the client receiving effective treatment

• Reduce other dangerous, severe, or destabilizing behaviors

• Increase behaviors and approaches to living that enhance one’s quality of life

  

How does DBT accomplish these goals?

• Individual Therapy: Individual therapy in DBT focuses on generating and strengthening clients’ motivation to remain alive, motivation to participate in treatment, and motivation to create a life worth living. The treatment is organized according to a treatment hierarchy which places suicidal behavior and self-injury as the highest priority in any interaction. Behavior that impacts a client’s ability to benefit from therapy, including issues relating to the therapeutic relationship and behaviors that interfere with a client’s ability to receive effective treatment, are considered the second-highest priority. Behaviors that impact a client’s quality of life, such as problems related to an eating disorder, substance use, problems with anxiety, depression, adjustment, problems with interpersonal relationships, or problems with employment, etc., are addressed after safety concerns and issues pertaining to delivering effective therapy have been controlled for. Individual sessions in DBT generally occur at least once per week, with the frequency of individual therapeutic contact determined based on the therapist’s evaluation and clinical judgement in collaboration with the client.

 

• DBT Adult and Multi-Family Groups: Often conducted in a group format, clients learn mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness skills. In addition, “Walking the Middle Path Skills,” originally created by, Dr. Jill Rathus (Dr. Schlager’s clinical mentor), target teenager and family challenges, address problems related to extreme thinking, feeling, and acting; absence of flexibility; difficulty navigating family conflict or effectively influencing others’ behaviors).

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• DBT Phone Coaching:

  • Enhance generalization of DBT skills and problem solving strategies to natural environment.

  • Decrease Stage 1 target behaviors (suicidal, self-injurious, crisis-related, specified target, behaviors).

  • Serve as contingency method for praising client’s positive efforts.

  • Decrease sense of distance between client and therapist.

 

• DBT Consultation Team:

  • Provides support for therapists

  • Maintains dialectical balance between clients and therapists

  • Keeps therapists adherent to the treatment model.

  • Peer Group Therapy for the Therapists

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• Parenting/Family Sessions (as needed)

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CBT

Cognitive Behavioral Therapy (CBT) is a collaborative and practical therapeutic approach that has been effective in hundreds of clinical trials for treating a variety of disorders, including anxiety, depression, and adjustment-related problems. CBT adopts a present-oriented and structured approach to therapy, which focuses on the relationship between a person’s thoughts (or cognitions), emotions, and behaviors, and the way in which they influence one another.

 

In addition, the therapist and client work together to define problems, discover the origins of these problems, clarify factors that contribute to and maintain the problems, and design effective strategies to address them. In this treatment, the therapist and client work collaboratively to create a treatment plan, which involves active efforts, both within and outside of sessions, as well as applying strategies and skills to solve problems and improve quality of life.

 

Consistent with an approach that focuses on the manner in which one’s thoughts, emotions, and behaviors influence one another, some of these strategies and skills focus on increasing or decreasing certain behaviors, identifying thinking patterns that are distorted or maladaptive, modifying beliefs, learning to mindfully identify cognitions and emotions, and learning methods to increase one’s ability to tolerate uncomfortable emotions and distress.

 

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Exposure Based Therapy

Exposure therapy is a psychological treatment that was developed to help people confront their fears. When people are fearful of something, they tend to avoid the feared objects, activities or situations. Although this avoidance might help reduce feelings of fear in the short term, over the long term it can make the fear become even worse. In such situations, a psychologist might recommend a program of exposure therapy in order to help break the pattern of avoidance and fear. In this form of therapy, psychologists create a safe environment in which to “expose” individuals to the things they fear and avoid. The exposure to the feared objects, activities or situations in a safe environment helps reduce fear and decrease avoidance.

 

Exposure therapy has been scientifically demonstrated to be a helpful treatment or treatment component for a range of problems, including: Phobias, Panic Disorder, Social Anxiety Disorder, Obsessive-Compulsive Disorder, Posttraumatic Stress Disorder, Generalized Anxiety Disorder

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There are several variations of exposure therapy. Your psychologist can help you determine which strategy is best for you. These include:

• In vivo exposure: Directly facing a feared object, situation or activity in real life. For example, someone with a fear of snakes might be instructed to handle a snake, or someone with social anxiety might be instructed to give a speech in front of an audience.

• Imaginal exposure: Vividly imagining the feared object, situation or activity. For example, someone with Posttraumatic Stress Disorder might be asked to recall and describe his or her traumatic experience in order to reduce feelings of fear.

• Interoceptive exposure: Deliberately bringing on physical sensations that are harmless, yet feared. For example, someone with Panic Disorder might be instructed to run in place in order to make his or her heart speed up, and therefore learn that this sensation is not dangerous.

 

Exposure therapy is thought to help in several ways, including:

• Graded exposure: The psychologist helps the client construct an exposure fear hierarchy, in which feared objects, activities or situations are ranked according to difficulty. They begin with mildly or moderately difficult exposures, then progress to harder ones.

• Flooding: Using the exposure fear hierarchy to begin exposure with the most difficult tasks.

• Systematic desensitization: In some cases, exposure can be combined with relaxation exercises to make them feel more manageable and to associate the feared objects, activities or situations with relaxation.​​

• Habituation: Over time, people find that their reactions to feared objects or situations decrease.

• Extinction: Exposure can help weaken previously learned associations between feared objects, activities or situations and bad outcomes. 

• Self-efficacy: Exposure can help show the client that he/she is capable of confronting his/her fears and can manage the feelings of anxiety.

• Emotional processing: During exposure, the client can learn to attach new, more realistic beliefs about feared objects, activities or situations, and can become more comfortable with the experience of fear.

 

Source: APA Div. 12 (Society of Clinical Psychology)