An Introduction to Dialectical Behavior Therapy: 1. Mindfulness

Dialectical Behavior Therapy (DBT) is an evidenced-based type of psychotherapy developed to help individuals manage emotions and symptoms of mental illness. It includes four different modules that will be explained in a series starting with Mindfulness in this article.

Mindfulness has become a buzz word in recent years, and for good reason. Being mindful is increasingly challenging as our lives become more focused on technology, and most of us are running on auto-pilot to manage our packed schedules. Mindfulness is simply paying attention to the present without judgment, being aware of what is happening in your mind, in your body, and in your surroundings. It is easy enough to see how detached we can become from the present when we think of an activity like driving. Do you have full awareness of your actions every time you use your blinker or look in the mirror? Something we tend to do so often becomes automatic, to the point we might not even fully remember getting from one point to another!

While this lack of awareness has become the norm, it can cause problems with our mental health. When we go through the motions without checking in with ourselves to notice how we are feeling and responding to things, we become ungrounded and detached from ourselves and our experiences.

Learning to become more mindful in our everyday lives is a process that takes time, but even starting with small practices can help. Mindfulness is the foundation for being able to improve our emotional experience and mental health.

DBT teaches the following ideas for mindfulness:

Here are some ways to build mindfulness skills:

If you feel you need more guidance to incorporate mindfulness skills and improve your mental health, a licensed mental health professional can help.

-Laura Gross, LMSW

Marsh Psychology Group

248-860-2024

Linehan, M. M. (2014). DBT Skills Training Handouts and Worksheets. New York: Guildford Press

It is incredibly common to struggle with the process of setting and accomplishing goals.  And due to this difficult process, many of us end up feeling defeated or as if we have some sort of character flaw.  This way of thinking can not only keep us from practicing goal setting but can have negative impacts on our overall self-esteem.  The process of setting and accomplishing goals is a vital component to our overall mental health and emotional wellbeing; therefore, it is extremely important that we do not abandon the practice of goal setting and goal accomplishment.

Below are some tips to assist you in successfully setting and accomplishing your goals:

1. Keep your goals simple and specific.  Many of us set goals that are simply too large and/or not clearly defined.  This can lead us to feel overwhelmed and/or inadequate if we do not accomplish our goal, when in reality the goal as we defined it was just not feasible. Examples include the following:

2. Make sure your goals are realistic. Identify potential barriers to accomplishing your identified goals and modify your goals accordingly.  For example, if you set a goal to go to sleep each night at 10 pm but you have a favorite show conflicting with that time, consider altering your chosen bedtime for that evening, or recording the show to watch it at a time not conflicting with your chosen bedtime.

3. Identify and challenge “all-or-nothing” thinking. “All-or-nothing” thinking is a pattern of thinking in “extremes” or “absolutes.”  When we apply this inaccurate and often-negative method of thinking to goal setting, we can become very easily frustrated or feel as if we have failed.  It is therefore vital that we are able to identify and challenge “all-or-nothing” thinking as it applies to goal setting and completion.  The following is an example of “all-or-nothing” thinking in relation to goal setting and completion:

4. Set up cues or prompts to remind you of your goal and/or to assist in making your goal more attainable. An example of this would be keeping a pair of walking shoes near your door if your goal is to begin an outdoor walking regimen.

1. Be mindful of your self-talk.  It is not easy to develop a new habit.  It is not easy to set goals and accomplish them.  Be kind to yourself.  Remind yourself that this is a new process, and it is completely normal to struggle when we are learning something new.  If you find it hard to be compassionate with yourself, think of what you might say to a close friend or even to a child who is learning a new skill and/or attempting to develop a new habit.

1. Provide yourself with positive reinforcement for accomplishing your goals.  As stated above, this is not an easy process.  Reward yourself for setting and accomplishing a goal.  This is a way to show yourself encouragement and compassion, and it is also a technique to make habits you are trying to develop more likely to continue.

If you are finding any of the concepts and/or techniques described in this blog particularly difficult, it may be helpful to seek the guidance of a mental health professional.

-Sierra Shapiro, MS, LPC

When Spring Comes and Depression Stays

Oftentimes, people struggling with depression look forward to springtime and the hope that warmer weather and longer days will bring some relief to their symptoms.  Unfortunately, that is not always the case and hopelessness can set in.  This year especially, with the pandemic seeming to be never-ending, people are dealing with the loss of the ability to find pleasure in activities.

The number of people experiencing burnout, stress, and depression has increased as the pandemic continues.  During long periods of unpredictability, like what has been happening over the past 13 months, it can be easy to become lethargic and lose any kind of pleasure in what would normally feel good to us.  And the hobbies that may have been taken up time in the beginning of the pandemic, may have lost their luster.  People are losing motivation to do much of anything.

Connection with other continues to be extremely important during this time.  As the weather warms, it provides us the opportunity to meet up with people safely outside.  But if that is not an option for you, reach out through video chat or phone calls.  Let people know you are struggling so they can support you.

Other options include spending time in nature, connecting to a spiritual practice, or exercise.  When not much seems to be working, be patient with yourself and remember this too shall pass.  And of course, seek out professional help and support when you need to.  Working with a mental health professional can help you to begin to climb out of your depressive mood.

-Julie Lublin, MA

Julie Lublin, MA, PLC is a staff psychotherapist at Marsh Psychology Group.  She can be reached at jlublin@marshpsychologygroup.com or 248-860-2024.

Resilience

With the pandemic continuing into 2021, stress levels are at an all time high.  Most people have been challenged in unimaginable ways.  Whether it be isolation and loneliness from sheltering in place, loss of income, or even loss of a loved one due to Covid 19, we ,as a nation, have been pushed to the limits.  

However in times of stress, one’s resilience comes to the forefront.  In focusing on self care and self exploration , it is the rule rather than exception, that struggles, anxiety, grief, and trauma can provide an opportunity for growth.  To be clear, this is not to dismiss pain,anguish, and struggle. Rather, we can use these difficulties as a springboard for growth.

What is Resilience?

Resilience is defined as the capacity to respond to pressures and tragedies quickly, adaptively and effectively(Graham,2013). It is our ability to both “go with the flow” and learn from our difficult experience, resulting, in time, a better understanding of self, increased confidence, and functioning.  But it begs the question, why are some folks more resilient than others, and can resilience be taught?

The truth is some folks are more resilient than others.  Some of this stems from a having a strong support system and a healthy development prior to the difficult event.  That being said, even the most resilient person will struggle with traumatic event, like a pandemic.  So if even the most resilient struggles, is it possible to learn to be  more resilient? The answer is yes.

Neurons that Fire Together, Wire Together

Neuroplasticity is the brain’s ability to form new pathways and grow. Studies on neuroplasticity(Siegel,2007)repeatedly show the brain’s ability to re-wire, grow and change in response to new experiences, both joyful and traumatic.  This means that when we are faced with a new challenge, our brains are primed to learn new ways to cope.  Similarly, when we try new healthful ways  of coping in the face of struggle, our brains are ready to develop new pathways, becoming stronger and more resilient. Further, the window of opportunity for  increasing resilience does not have an expiration date.  The brain continues to create neural pathways throughout our lives.  

Ways to Increase Emotional Resilience

Practice daily self care: good nutrition, sleep, and exercise increases our general sense of well being and provides a sense of stability in the face of negative events.

Journaling: Writing about your struggles allows increased self reflection and emotional attunement.  This creates new understandings of our inner voice and increases resilience.  Focus on what things are particularly challenging as well as the ways you cope.  Thinking  about what lessons may be learned,  and how you would like to be different, stimulates the brain.

Mindfulness:  Become aware and curious about your thoughts and feelings in response to challenge.  Focus simply on noticing rather than judging.  This is a powerful data collector for our brains, providing new material to link/ wire for growth.

Practice Self-compassion: cut yourself a break when shame/guilt/self deprecating thoughts come up.  This practice is a very powerful fuel for resilience.

Psychotherapy: Psychotherapy can be a powerful catalyst for resilience.  New insights, coping techniques, and emotional attunement help fuel resilience.  In some instances of trauma or enduring depression/anxiety, working with a trained psychotherapist is needed to create new coping skills and insights.  Having a mental health professional serve as shepherd, witness, and support while working through intense trauma and emotional strife is a powerful tool for change.

Resilience is a constant and enduring quality that we all can cultivate.  Here’s to finding our strongest inner selves.

Be well,

Dr. Marsh

Pamela Warner Marsh, Psy.D., is a licensed clinical psychologist at Marsh Psychology Group.  Contact her at 248-860-2024 or pmarsh@marshpsychologygroup.com

Resources and Citations:

https://www.apa.org/topics/resilience

https://www.mayoclinic.org/tests-procedures/resilience-training/in-depth/resilience/art-20046311

Graham, Linda. Bouncing Back: Rewiring Your Brain for Maximum Resilience and Well-Being. New World Library, 2013.

Siegel, Daniel (2007). The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being (Illustrated ed.). W. W. Norton & Company.

What to Expect in Your First Psychotherapy Session

Although seeking help for mental health struggles is becoming more accepted and de-stigmatised, even the most accepting people may wonder what exactly to expect in the first meeting with a therapist. In general, here are 3 things every first psychotherapy session should include:

• A discussion of what you would like to change:  This discussion usually begins with the question: what made you reach out for help? For some it might be a specific event, like a fight with a family member , a panic attack, or break up with a significant other.  For others, counseling may be something they have been contemplating for a while.  Often folks call in after one too many days of  battling their depression or anxiety.  It is likely that your therapist will spend some time exploring how the presenting issue developed and any other key stressors in your life.

•  Taking your mental health temperature: Your therapist should also spend some time assessing how you are functioning in your daily life , given the problems you presented. They will likely ask about:     Sleep, eating/appetite, attention/concentration,  exercise habits, current coping skills, support system, caffeine intake, alcohol intake, recreational drug use, family history of mental illness, current medications.

•   An assessment of their understanding of your issues and how they might help you. You should leave the session with an idea of what the therapist thinks is causing your current struggles and how they propose to help.  This assessment may vary depending on how the therapist practices and conceptualized treatment.  Some therapists may focus on exploring your thought patterns and irrational beliefs.  Some might focus on your emotional experiences and ways to understand and control your feelings.  Others might look at your relationship patterns and how this fuels difficulties.  Another therapist might propose to improve your coping skill through teaching stress management techniques.  Most modern therapists will use a combination of these interventions.  What is most important, is that you leave the office with an idea of how the therapist can help you.                                                             

I hope this helps demystify the first session. Here are some links to further explore starting psychotherapy and  different types of treatment :

https://www.npr.org/2019/12/11/787058888/how-to-start-therapy

https://www.apa.org/topics/psychotherapy/approaches

https://www.goodtherapy.org/learn-about-therapy/types

Be well,

Dr. Marsh

Pamela Warner Marsh, Psy.D. is a fully licensed clinical psychologist and Director of Marsh Psychology Group.  She can be reached at pmarsh@marshpsychologygroup.com or 248-860-2024

Tips for Parents/Guardians: Dealing with a “Difficult” Teenager

Many parents/guardians of a teenage child find this complex period of development confusing, highly stressful, and even exhausting. Due to your teenage child’s significant changes in brain structure, hormonal regulation, and increased exposure to peer influence and media suggestion, this period is often extremely difficult to navigate for both the parent(s)/guardian(s) and the teenage child experiencing these changes.
Below are some tips that may assist you in guiding your teenager through this often-difficult developmental period, while minimizing your personal stress in the process:

1. Don’t take it personally. Autonomy-seeking is a normal and necessary part of brain development during adolescence; therefore, resistance to structure and rules is a normal and overwhelmingly common behavior in adolescence. It is also important to remember that your teenage child does not yet have the vocabulary or emotional regulatory skills to appropriately communicate their feelings. For example, a frustrated adolescent may yell, “You’re the worst parent ever!” to simply convey feelings of annoyance or frustration. With this in mind, it can be easier to remain objective and not allow your own negative emotions to control your reaction when addressing problematic behaviors from your teenage child.

2. Be willing to compromise. Many parents/guardians have difficulty with this due to fear of losing control within the parent-child dynamic and/or “giving in” to the child. If you find yourself resisting compromise with your teenager, I invite you to ask yourself this question: “Do I want to be right and spend six hours arguing with an angry 14-year-old, or do I want to compromise and have a calmer and more relaxing evening?” If you choose the latter, brainstorm options either alone or with your partner (if applicable) and present them to your teenage child. This allows your teenage child to exercise autonomy while you as the parent/guardian maintain overall authority within the parent-child dynamic. For example, “You cannot stay out past your curfew on a school night to go to out with friends; so, you can either extend your curfew by half-an-hour this Saturday, or I will pick you up this evening instead of you being driven home by friends so you are home by your curfew.”

3. Validate your teen’s feelings and experiences. “Teenage drama” may seem extremely minor and/or silly to you, but peer-related events that happen during this critical developmental period are extremely important to your teenage child. Your child’s ability to navigate these situations in a healthy way is critical to their psychological development. Validating your teenager’s feelings and providing authentic support and guidance through difficult situations they will face is extremely beneficial to their overall emotional wellbeing.

4. Monitor your own behaviors. Unfortunately, “Do as I say and not as I do” is not an effective strategy at promoting positive behavioral changes. As humans, our primary
learning strategy is through mimicking the behaviors we are most frequently exposed to, and, in most cases, this is through a child’s parent(s)/guardian(s). It is therefore critical for you to examine your own behaviors if they are similar to ones you wish for your child to change. For example, if you swear often but wish for your child to stop this behavior, the most effective strategy is to attempt to control this behavior in front of your child (as opposed to continuing to swear in front of your child but then disciplining the child for mimicking this behavior).

5. Create clear structure and boundaries for your teenage child. Remember that during this period of development, your adolescent’s primary goal is autonomy and separation from their caregivers; therefore, they do not yet have the ability to create structure and boundaries for themselves and they rely on fully emotionally-developed adults to create this for them. Remember that resistance from your adolescent to this is completely normal and expected, and the tips mentioned above can assist you in addressing this resistance and successfully creating structure and household regulations (or enforcing established ones).

6. Be realistic in your expectations. Adolescents do not have a fully-developed brain during this period of development. Until your teenage child reaches their mid-twenties, the part of their brain responsible for time management, impulse control, and appropriate judgment (i.e., the frontal lobe) is not yet fully developed. This is in no way meant to “make excuses” for your teenage child if they are exhibiting problematic behaviors; however, it is important to keep this limitation in mind when you and/or your partner (if applicable) attempt to formulate realistic expectations and household regulations for your adolescent.

7. Check in regularly with your adolescent. This period of development is difficult for parents/guardians because it is extremely difficult for the adolescent experiencing it. Your adolescent is experiencing extremely strong emotions with a highly limited ability to regulate these internally. This can be an extremely intense experience for many adolescents and it is important that you make yourself available to them as a known primary support figure, even if they do not always choose to take you up on it.

If you are finding the above techniques particularly difficult to implement, or your adolescent is experiencing significant emotional distress during this period of development, it may be helpful to seek the services of a mental health professional to assist and support you and/or your teenage child during this process.

-Sierra Shapiro, MS, LPC, is a staff psychotherapist at Marsh Psychology Group.  She can be reached at 248-860-2024 or at sshapiro@marshpsychologygroup.com.

As we grow up we develop thought patterns, or ways to synthesis information, to make sense of the world.  Unfortunately, this can lead to cognitive distortion, or ways we twist information (mental gymnastics) to fit into these preferred ways of thinking. This results can lead to depression, anxiety, and relationship issues.

Common Cognitive Distortions

Cognitive distortions happen automatically – we don’t mean to think inaccurately – but unless we learn to notice them, they can have powerful yet invisible effects upon our moods and our lives. Most of us have used cognitive distortions at one point or another. To avoid negative feelings caused by these thinking errors, it is important that we learn to identify and modify or correct these faulty patterns of thinking.

The term, “cognitive distortions” is used to describe irrational, inflated thoughts or beliefs that distort a person’s perception of reality, usually in a negative way.

Cognitive distortions can take a serious toll on one’s mental health, leading to increased stress, depression, and anxiety

The terms below were conceptualized by Dr. David Burns. Much of his work is based on Dr. Aaron Beck’s research who was the first to reveal the potential impacts of distorted thinking.

Filtering

A person engaging in filter (or “mental filtering) takes the negative details and magnifies

those details while filtering out all positive aspects of a situation. For instance, a person may pick out a single, unpleasant detail and dwell on it exclusively so that their vision of reality becomes darkened or distorted. When a cognitive filter is applied, the person sees only the negative and ignores anything positive.

Polarized Thinking (or “Black and White” Thinking)

In polarized thinking, things are either “black-or-white” — all or nothing. We must be perfect or we are a complete and abject failure — there is no middle ground. A person with polarized thinking places people or situations in “either/or” categories, with no shades of gray or allowing for the complexity of most people and most situations.

Overgeneralization

In this cognitive distortion, a person comes to a general conclusion based on a single incident or a single piece of evidence. If something bad happens just once, they expect it to happen repeatedly.

Catastrophizing

When a person engages in catastrophizing, they expect disaster to strike, no matter what. This is also referred to as magnifying, and can also come out in its opposite behavior, minimizing. In this distortion, a person hears about a problem and uses what if questions (e.g., “What if tragedy strikes?” “What if it happens to me?”) to imagine the absolute worst occurring.

Personalization

Personalization is a distortion where a person believes that everything others do or say is direct, personal reaction to them. They literally take virtually everything personally, even when something is not meant in that way.

Blaming

When a person engages in blaming, they hold other people responsible for their emotional pain. They may also take the opposite track and instead blame themselves for every problem — even those clearly outside their own control.

SHOULD STATEMENTS

Thoughts that include “should,” “ought,” or “must” are almost always related to a cognitive distortion. For example: “I should have arrived at the meeting earlier,” or, “I must lose weight to be more attractive.” This type of thinking may induce feelings of guilt or shame.

Here are some ways to begin challenging cognitive distortions.

1.Identify Our Cognitive Distortion: We need to create a list of our troublesome thoughts and examine them later for matches with a list of cognitive distortions. An examination of our cognitive distortions allows us to see which distortions we prefer. Additionally, this process will allow us to think about our problem or predicament in more natural and realistic ways.

2. Examine the Evidence: A thorough examination of an experience allows us to identify the basis for our distorted thoughts. If we are quite self-critical, then, we should identify several experiences and situations where we had success.
3. Double Standard Method: An alternative to “self-talk” that is harsh, and demeaning is to talk to ourselves in the same compassionate and caring way that we would talk with a friend in a similar situation.
4. Thinking in Shades of Gray: Instead of thinking about our problem or predicament in an either-or polarity, evaluate things on a scale of 0-100. When a plan or goal is not fully realized, think about, and evaluate the experience as a partial success, again, on a scale of 0-100.

Here are some questions to ask yourself if you think you might be engaging in cognitive distortions.

Am I confusing a thought with a fact?

Am I jumping to conclusions?

Am I assuming my view of things is the only one possible?

What are the advantages and disadvantages of thinking this way?

Am I thinking in all-or-nothing terms?

Am I condemning myself as a total person based on a single event?

Am I concentrating on my weakness and forgetting my strengths?

Am I taking something personally which has little or nothing to do with me?

Am I expecting myself to be perfect?

Am I assuming I can do nothing to change my situation?

If you feel that one or more of the above cognitive distortions are contributing to feelings of anxiety, depression, or other mental health issues, consider finding a qualified therapist you trust who can help transform your negative thoughts and beliefs into empowering, realistic thoughts that inspire and uplift you.

Carol Van Kampen, LMSW

Carol Van Kampen, LMSW is an individual private practice psychotherapist who specializes in anxiety, depression, grief, and trauma treatment at Marsh Psychology Group. Carol is EMDR trained. Contact her at marshpsychologygroup.com

cvankampen@marshpsychologygroup.com

https://marshpsychologygroup.com/carol-van-kampen-lmsw/