Does DBT work?

The short answer is YES, the long answer can be found below...

Effectiveness of Dialectic Behavioral Therapy

Dialectic behavioral therapy is recognized as the top treatment choice for symptoms associated with the borderline personality disorder including suicidal ideations, self harm, emotional dysregulation, impulsivity and interpersonal conflicts. Often associated with the treatment of choice for borderline personality disorder (BPD), DBT has been proven useful in the treatment of other disorders. 

Now for the research:

Cochrane review is a database of systematic peer reviews and meta-analysis which summarizes medical research. The Cochrane library contains resources for evidence based practices in medicine including areas in mental health. Cochrane review has declared DBT the most effective treatment for symptoms often classified as BPD (Source: http://summaries.cochrane.org/CD005652/psychological-therapies-for-borderline-personality-disorder), however, the symptoms listed above are universal and can meet requirements for other diagnostic criteria.

To date, Dialectic Behavioral Therapy is the only treatment for the symptoms of BPD that has enough outcome data and improvement rates to enable a Meta analysis. A meta-analysis uses statistical data from individual studies, looking at research as a whole (Source: http://www.cochrane-net.org/openlearning/html/mod12-2.htm).

Eighteen randomized controlled trials have been published demonstrating the effectiveness of DBT in populations with complex problems and disorders. Some examples of past research include: In 1991, Linehan, Arm-strong, Suarez, Allmon, and Heard conducted research using 18-45 year olds in an outpatient setting. Subjects participated in 150 minute skills group including homework for 12 months. The 1991 research study showed that parasuicidal behaviors were more likely to start treatment, 83% completed treatment, and 60% maintained lower parasuicidal behaviors (self harm) a year after treatment. (Source: http://behavioraltech.org/downloads/Research-on-DBT_Summary-of-Data-to-Date.pdf)

In 2011, Hirvikoski, Waaler, Alfredsson, Pihlgren, Johnson, Ruck,and Nordstrom used 51 year olds diagnosed with ADHD in a Swedish outpatient psychiatric unit. Two hours of DBT skills groups were the only course of treatment (without individual or phone coaching) for 24 sessions and still participants showed less symptoms of ADHD. (Source: http://behavioraltech.org/downloads/Research-on-DBT_Summary-of-Data-to-Date.pdf)

In 2010, Kroger, Schweiger, Sipos, Kliem, Arnold, Schunert and Reinecker used 24 to 31 year old with Anorexia and Bulimia in addition to Borderline Personality Disorder. Participants competed three months of inpatient DBT program including Weekly 1 hr individual therapy, 100

Minutes of skills group 3 times per week, and weekly consultation. At the 15 month follow up, participants showed reduction in anorexia and bulimia symptoms (Source: http://behavioraltech.org/downloads/Research-on-DBT_Summary-of-Data-to-Date.pdf).

The National Registry of Evidence-Based Programs and Practices published a summary of all evidence based practices and outcomes since 2006. In 2009, the American Recovery and Reinvestment Act (ARRA) created the Federal Coordinating Council for Comparative  Effectiveness research to provide the most recent health care information by comparing different approaches to managing health issues (including mental health). The purpose of National registry of evidence based programs is to inform and educate and bring evidence based awareness. DBT was mentioned as evidence for treatment of symptoms associated with borderline personality disorder (Stoffers, Völlm at al. 2013).

References

Stoffers, Völlm at al.(2013), Psychological therapies for borderline personality disorder, Cochrane Summary, Retrieved: http://summaries.cochrane.org/CD005652/psychological-therapies-for-borderline-personality-disorder),

Dialectic Behavioral Therapy Skills

Dialectic Behavioral Therapy Skills

There are four main therapy modules which compose the skeleton of the dialectic behavioral theory.  The four main therapy modules are:

Core Mindfulness

Being present in the moment and not ruminating on the past or worrying about the future. Mindfulness suggests awareness of what is. “Observe, discribe and participate” encourages being an active participants in the present moment. “Non judgmentally, one mindfully” suggest engaging in one activity or thought at a time.

Emotion Regulation

Learning how to balance your emotions by separating yourself from the emotional experience.

Interpersonal Effectiveness Skills

Learning skills to effectively communicate and relate to others as well as getting your needs met. This skill is frequently used in any assertive communication problem solving lessons: the lessons include saying no/boundary setting, assertively asking for what one needs and conflict resolving.

Distress Tolerance

Specific tools to help cope during a distressing moment or personal crisis. An appropriate alternative to self harming behaviors such as substance use, cutting, etc.

What is Art Therapy?

Art Therapy is a mental health modality which integrates elements of psychotherapy with the creative process of art making to facilitate dialogue, relieve stress, explore emotions, modify behavior, reconcile emotional and interpersonal conflict, increase self esteem and bring overall well-being. Art therapy is very effective in expressing elements of our lives and ourselves which are not easily formulated with words (i.e. falling in love, emotional pain, loneliness, sadness, feeling empty, trauma, etc.) An art therapist has knowledge of visual arts including drawing, painting, sculpting, etc and comprehension of human behavior, psychology and counseling techniques. An art therapy session is an integration of psychotherapy (“talk therapy”) with art making, therefore, utilizes Cognitive Behavioral Therapy and Dialectic Behavioral Therapy. I myself am an artist so have had training in art making.  For more information on Art Therapy, please visit the American Art Therapy Association: http://www.arttherapy.org/

What is Dialectic Behavioral Therapy?

I will write a lot more about Dialect Behavioral Therapy skills in greater detail but wanted to begin by explaining DBT. Dialectic Behavioral Therapy (DBT) had originated in the 1980’s by Dr. Marsha Linehan. Dialectic Behavioral Therapy is a cognitive behavioral based treatment which incorporates elements from Zen practices of mindfulness, with skills training (coping skills).  Dialectic Behavioral Therapy is constructed of weekly individual sessions and weekly group sessions with an emphasis on a psychoeducational (teaching) framework. The desired outcome and goals include distress tolerance, emotional regulation, and overall pleasure and enjoyment in life (Hayes, Linehan, et al. 2004).  Dialectic Behavioral Therapy Skills There are four main therapy modules which compose the skeleton of the dialectic behavioral theory.  These skills are taught to clients. The four main therapy modules are: Core Mindfulness Being present in the moment and not ruminating on the past or worrying about the future. Mindfulness suggests awareness of what is. “Observe, discribe and participate” encourages being an active participants in the present moment. “Non judgmentally, one mindfully” suggest engaging in one activity or thought at a time. Emotion Regulation Learning how to balance your emotions by separating yourself from the emotional experience. Interpersonal Effectiveness Skills Learning skills to effectively communicate and relate to others as well as getting your needs met. This skill is frequently used in any assertive communication problem solving lessons: the lessons include saying no/boundary setting, assertively asking for what one needs and conflict resolving. Distress Tolerance Specific tools to help cope during a distressing moment or personal crisis. An appropriate alternative to self harming behaviors such as substance use, cutting, etc.  The Dialectic Behavioral Program Individual DBT: Individual DBT is a crucial factor in a comprehensive DBT program. Trained DBT therapists work collaboratively with clients, tailoring treatment to specific individual needs. Therapy will address issues that interfere with an individual’s quality of life, and help individuals take steps toward building a better life while encouraging self-acceptance. Sessions are generally once a week. Clients are required to be in individual therapy in order to participate in the DBT group. DBT Groups: Groups are generally from 2-2.5 hours and on a weekly basis. Group focuses on skills from the four modules: Mindfulness, emotional regulation, interpersonal, and distress tolerance. A trained DBT therapist runs groups. Phone consultation: In the event of acute distress, DBT therapists have to be available to their clients over the phone 24 hours. Phone conversations are brief; therapists assess risk factors and review appropriate DBT skills that would help improve the moment.

What is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy was first introduced by Aaron Beck in the early 1960’s. Cognitive Behavioral Therapy (CBT) is an evidence based, short term, goal oriented, approach.  Homework assignments are often given at the end of most sessions in order to practice the skills between sessions. Change is dependent on behavioral modification, cognitive formulation, and psychoeducation. Disorders are viewed as a result of dysfunctional thinking, which in turn affects mood and behavior. Improvement is conditional upon changing or modifying distorted thinking to achieve more realistic and adaptive thought patterns. (Beck 2011). The Cognitive behavioral approach attempts to interpret an individual’s processing of information and assumptions i.e. cognition (your thoughts!). In other words, what an individual thinks and perception influence behavior and emotions. The idiosyncratic rules and assumptions become cognitive distortions or automatic thoughts which appear spontaneously but are mood dependent. What does all of this mean? Our thoughts are what drives behavior and influences how we feel. Therefore, examining thought patterns with a skilled CBT therapist, can change behavior and improve mood. Cognitive Behavioral Therapy is a very effective treatment and supported by research.  Please feel free to contact me with any questions about Cognitive Behavioral Therapy! I will write more later on CBT!

Website is up! Would you like a free newsletter?

Hello readers,

My website is finally up!

If you would like to get in touch or/and sign up for a free newsletter, feel free to go to my website and fill in your information on the first page!.

I look forward to connecting and hearing from you!
http://www.lizamordkovich.com/

All about perspective

For many, happiness (or a state of happiness) is a desirable goal. We seek out and build relationships, purchase glittery, extravagant jewelry, go on vacation, eat out at restaurants, shopping therapy, food therapy, movie therapy, (hopefiully, eventually psychotherapy!)... all with the ultimate hope that we may just find our happiness in the stuff or the place or the people.

External items create a sense of instant reward which feels gratifying in the moment, however, fleeting. In some ways (for some people), making something or someone else responsible for our happiness generates blame when rewards are scarce or non existent. After all, it's "easier" to finger-point at someone/something  than taking ownership of our lives. An excuse for a dysfunctional relationships may be the OTHER persons anger issues or being broke because of our irresponsible government, sick because of horrible healthcare (although illness can be out of our control), overweight because it's winter--- does any of this ring a bell??

So, where are the origins of happiness? What is the secret to complete state of joy and appreciation for our lives? How do we make all our problems go away?

Let me answer the last question first: our problems will NEVER all go away.

Let's divide our population into two categories A. Happy people B. Not happy people. The difference between group A and group B isn't that group A has no problems in life; Group A has realized that happiness is a mindset. Certainly, certain concerns are more severe and sitautional grief, depression, stress is a normal human reaction. Even in circumstances which are beyond our control such as loss of a loved one or illness, perspective (and acceptance!) is key. We can hate and feel anger at our chronic pain or we can incorporate mindfulness based approaches and work with a pain specialist. We can curse the universe for taking our loved one and ask "why me?" OR establish and utilize skills to endure grief. Even though emotions can be warranted; emotions can still prevent us from moving forward. Asking "why me?" will not bring the person back. Blame, excuses, dysfunctional, unrealistic perspective is what MAKES misery.

In other words, happiness is found internally not externally.

Cognitive behavioral therapy examines our thought pattern and its influence on emotions and behavior. Dysfunctional thoughts influence maladaptive behavior which influences how we feel. An example: if an individual believes "I am worthless and unloved" than even the most unconditional of relational love will never seem enough. If the underlining belief is "I will fail at everything I try" than any measurable success or achievement will be minimal and internally scrutinized. It's all about perspective. By replacing dysfunctional or unrealistic thoughts with something else (with the help of a skilled CBT Therapist!) , our mood will improve.

Our "self talk" (internal dialogue) is what determines how we experience life. The good news is Cognitive behavioral therapy can help reexamine what thoughts just aren't working for you and help change them! Imagine that!

 In my own practice, I have found how successful CBT really, and truly is! After all, we all deserve a life worth living!

Artists and ADD/ADHD: What came first the chicken or the egg?

Artists and ADD/ADHD: What came first the chicken or the egg?

I’ve known many creative folks in my lifetime. Having attended an art high school (where about 2/3 of the students were popping Ritalin like vitamins!), later double majoring in art and psychology in my undergraduate studies, having artists friends and personally being interested in the arts. I can safely say, I have been around enough artists and aspiring artist to observe certain “trends”: Artists have similar symptoms to ADD/ ADHD.

I’ve known artists who easily can transform a thrown out, broken stereo into a sophisticated and truly beautiful creation, belonging in a museum, however, won’t remember to pay rent on time or get too distracted when paying cable online. A certain artist friend of mine, has a difficult time reading and following directions and therefore “can’t” put Ikea furniture together or follow complex cooking recipes (though she cooks well!). My friend is a brilliant painter and photographer but has a hard time concentrating on things that are “boring”, mundane, the everydays.. She can be tangential in conversation and overly impulsive but impulsive (bold!) decisions has contributed to her mindblowing art!

I always wonder, what came first the chicken or the egg. In other words, does a creative, artistic mind contribute to ADD/ADHD symptoms OR are some (DISCLAIMER: CERTAINLY NOT ALL) individuals with ADD/ADHD just creative, artistic, different thinkers? Is what the psychology community labels as ADD/ADHD really just an “artist brain” which is imaginative, innovative, explorative, emotional, passionate, talented (*inserts many other positive adjectives*)? Do artists process information and manage their lives differently? Is it talent and perhaps the idiot savants of our society that just don’t have the room in their brain for the commonplace, inconsequential, one-at-a-time slow paced activities, because they are unique and gifted? Are we mental health providers (pointing my finger here!) more obsessed with stamping the ADD/ADHD diagnosis rather than truly understanding the interworking of an artist mind?

ADD/ADHD has several classifications/symptoms:

• ADD (Also may be known as ADHD inattentive subtype): Attention Deficit disorder is categorized as poor concentration (zoning out in the middle of reading a sentence or conversation, for example.
• Extreme distractibility
• Difficulty completing tasks
• Poor listening skills
• Tendency to overlook important details, being late with deadlines, difficulty starting and finishing projects, etc WITHOUT the hyperactive component
• Other symptoms may include poor self esteem, anxiety/depression

ADHD: Attention deficit hyperactivity disorder

• Same as ADD BUT with added hyperactivity/ impulsivity which creates a higher than normal activity level making it difficult to sit still and very fidgety.

There is another subtype that is the OVERFOCUED subtype which gives artist the ability to obsess and obsess and obsess and over-concentrate in their art. Hyperactivity is just the energy necessary to work hard in art making. The creative process is gratifying; full of instant rewards, cathartic releases and perhaps praise.

Many artists I know, may work throughout the night claiming to be more inspired at night and therefore lethargic and in a brain fog during daytime hours, perhaps exacerbating or contributing to the commonplace-related boredom (art process IS more stimulating!).

So, what really IS the artist brain composed of?

And if you are one of those brilliant visual expressers who I lost after the first paragraph, perhaps this entry was written about you!!! But I have to say, THANK YOU for making the world more colorful  :)

#ADHD #Mentalhealth #Artist #Creativity #Iloveartists #Artmakestheworldgoround #Iamatherapist

Anxiety disorders and Exposure Therapy

Exposure therapy is the most effective form of treatment for anxiety disorders. Exposure therapy is exactly what it sounds like: gradually EXPOSING the individual to the feared stimulus resulting in desensitization. And what happens next? No more panic!

I have worked with anxiety disorders of different types ranging from OCD, Social phobias, Agoraphobia, Panic Disorder. Treatment usually begins in my office where we discuss thought pattern and behaviors associated with the disorder. Together, we practice relaxation techniques and other coping strategies proven very effective. Homework often follows sessions. When ready, exposure work consists of myself accompanying the individual to the location that triggers anxiety. I go to clients homes, accompany an individual to a restaurant, subway, car ride… in vivo exposure suggests in real life exposure to the feared stimulus.

#ExposureTherapy #AnxietyDisorders #AnxietydisordertreatmentNYC

What is mental health and why is it important?

We hear terms like “taking a mental health day” or having a “nervous breakdown” and may wonder what it means to have or not have our mental health. In our yoga addicted, acupuncture going, green tea drinking , namaste society, being “unbalanced” is something serious which requires immediate attention…. but what is being unbalanced, really? The answer lies in an explanation of mental health. 

So, what is mental health anyways?

Mental Health Gov defines mental health as a system involving our emotional, psychological and social well being, affecting thinking, behavior and overall feelings across the lifespan. Mental illness is a medical condition which happens when our thinking, behavior and/or how we feel becomes disrupted. The National Alliance of Mental Illness (NAMI) discusses how the disruption can affect quality of life, ability to relate to others and ability to cope with day to day functions.

The DIagnostic Statistical Manual (DSM) currently in fifth edition, is a manual of disorders and their symptoms. The DSM discusses the criteria for disorders, duration of symptoms, and distinction between disorders. Basically, the DSM makes it possible to label the symptoms.

Disorders include anxiety disorders, mood disorders, autistic spectrum disorders, ADHD/ADD, schizophrenia, schizoaffective disorder, etc. Conditions resulting from disorders include insomnia, racing thoughts, hallucinations, general uneasiness, isolation, suicidal thoughts or ideations, substance use, difficulty sustaining healthy relationships and/or employment, etc…. 

In a nutshell, mental health ensures that other systems or components in our lives run smoothly and our ability to handle hurdles is strong. When faced with a mental health illness, situations may seem overwhelming and intolerable: our ability to handle stressful situations at a job, on the subway, waiting in line at a grocery store, in marriage, at Thanksgiving dinner becomes negatively affected leading to horrible, debilitating thoughts and just feeling very, very bad.  

Our mental health IS important.