Dialectical Behavior Therapy

Dialectical Behavior Therapy (DBT) is a unique, specialized form of cognitive-behavioral therapy that was originally developed to treat adults who were chronically suicidal, self-injuring, and exhibiting symptoms of borderline personality disorder. DBT is now also being utilized for treatment of adolescents who engage in impulsive, self-injuring, or suicidal behavior.

Our clients often experience:

• Problems with anger
• Chaotic relationships
• Frequent mood swings
• Intense fears of abandonment
• Impulsive behavior
• Inadequate sense of self
• Recurrent suicidal or self-injurious behavior
• Family problems or conflicts

As a comprehensive treatment, DBT has the following goals:

• Decreasing life-threatening (e.g., suicidal attempts, suicidal threats, suicidal thoughts) and self-injurious behaviors
• Decreasing therapy-interfering behaviors (e.g., missing or coming late to sessions, remaining silent in sessions)
• Decreasing quality-of-life interfering behaviors (e.g., fighting with people, substance abuse, trouble in school)
• Increasing coping skills (e.g., learning to deal with conflict, learning to cope with painful emotions, improving positive self-care)

About the DBT Program at the Center for Cognitive and Dialectical Behavior Therapy

At CCDBT, standard outpatient DBT involves:

Skills Group Training

DBT Skills Group Training focuses on helping patients develop the coping skills they need to solve their own problems and achieve their desired goals. In our DBT Adolescent and Family program, parents attend all DBT Skills groups with their teens to help parents communicate more effectively with their teens, to learn how to coach their teens in using skills when problems arise, and to develop their own coping skills.

Five skills training modules are taught in DBT:

• Core mindfulness skills
• Distress tolerance skills
• Emotion regulation skills
• Interpersonal effectiveness skills
• Middle Path – Skills for Families

Individual/ Family Psychotherapy

Participants in CCDBT’s DBT Programs are required to be in individual therapy while they are in skills group.

DBT Trained therapists will provide individual DBT psychotherapy. Individual therapists will help motivate clients to stay in treatment and will help clients apply DBT skills to their personal lives.

Commitment

To participate in CCDBT’s Dialectical Behavior Therapy Programs, participants are asked to commit to:

• Weekly individual therapy sessions
• Weekly 90-minute DBT Skills Groups (in Family Program this group is for adolescent and parent/caregiver)
• Medication management services as needed
• Participants are asked to commit to a six month treatment contract with an understanding that failure to attend sessions can be the basis for being discharged from the program

Appointments

If you would like to participate in one of CCDBT’s DBT Programs, please call our Intake Coordinator. For programs on Long Island, please call 516.390.3525 extension 1.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is a psychotherapy that targets unhelpful or destructive thoughts and behaviors that interact together to cause distress and problems. CBT works to replace these unhelpful thoughts and behaviors with more positive and realistic ones in order to improve an individual’s quality of life.

Appointments

If you would like to participate in any of the psychotherapy programs at CCDBT, please call our Intake Coordinator at (516) 390-3525 extension 1.

Mindfulness-Based Stress Reduction

The internationally successful Mindfulness-Based Stress Reduction (MBSR) program has been offered at CCDBT for a while now. It has motivated hundreds of people to reach out to CCDBT to attend our program. Based on Mindfulness Meditation, this program has had a positive impact on:

• People having difficult emotional experiences such as insomnia, depression, and anxiety.
• People struggling with skin disorders, GI distress, asthma, fibromyalgia, and other complicated medical issues.
• People struggling with infertility.
• People fighting cancer.
• Heart disease and high blood pressure patients.
• People having trouble coping with chronic pain and illness.
• Decreasing the effect of stress in people’s lives caused by feeling out of control, grief, aging, financial issues, family, school, or work problems.

This treatment is greatly respected by medical experts. It is typically offered as an adjunct to medical treatment instead of replacing it. It is a complementary therapy that improves the effect of the primary medical treatment.

Initially developed by Dr. Jon Kabat-Zinn, the Mindfulness-Based Stress Reduction (MBSR) program offered at CCDBT offers an 8-week 2-hour class. You can reach out to our Intake Coordinator, for more information at (516) 390-3525 (extension 1).

Trauma Therapy

Unfortunately, many people will experience a significant traumatic event during their lifetime. Traumatic events include, but are not limited to, experiences such as accidents, physical, sexual, or emotional abuse, diagnosis of a serious medical condition, the death or loss of a close friend or family member, or witnessing catastrophic events during combat or in first responding situations.

Symptoms of PTSD include:

1. Re-experiencing – such as nightmares, intrusive thoughts or memories, flashbacks;
2. Avoidance of trauma-related reminders – not talking about what happened, not going to places that resemble the trauma situation;
3. Negative changes in thought patterns and mood – detachment from others, self-blame, difficulties trusting others; and
4. Changes in reactivity – being easily startled, impaired sleep, inability to concentrate.

The Trauma Treatment Program is designed to help clients overcome these symptoms of PTSD and re-engage in life without debilitating fear and anxiety. The appropriate course of treatment is designed based on the individual’s specific symptoms and needs to ensure the greatest likelihood of improvement.

Treatments offered are evidence-based, and cognitive-behavioral in nature. They have been shown to be effective treatments for PTSD as well as other comorbid conditions. The research has indicated that with such interventions, these symptoms diminish over time and one’s overall quality of life improves. Treatment is available for clients of all ages.

Treatments Offered at CCDBT:

• TF-CBT– for children and adolescents
• Prolonged Exposure (PE)– for adolescents and adults
• DBT-PE– for adolescents and adults who need both Dialectical Behavior Therapy and Prolonged Exposure
• Cognitive Processing Therapy (CPT)– for adults

Prolonged Exposure (PE)

Prolonged exposure is an evidence-based treatment for Posttraumatic Stress Disorder (PTSD) that usually takes between 10 and 15 weeks to complete. It encompasses both exposure therapy and emotional processing to help clients overcome the re-experiencing and arousal symptoms of PTSD, such as nightmares, flashbacks, and hypervigilance. During exposure therapy, clients are helped to confront anxiety-evoking situations to overcome their fears and to confront situations that are safe but that feel dangerous to the client because of what happened to them. Emotional processing is used to help process and digest the traumatic memory. Through this repeated exposure, one can process the trauma in new ways, and reduce the power it has over one’s life. In this way, the treatment helps clients regain a sense of control over their emotions and fully participate in their lives again.

Components of PE Treatment

Prolonged exposure is an intense, time-limited treatment comprised of three main components: Psychoeducation, In-Vivo Exposures, and Imaginal Exposures.

• Psychoeducation involves teaching the client about the common responses to trauma and helping them understand how their avoidance is maintaining PTSD symptoms.
• In-Vivo Exposures are homework exercises that are completed between sessions to help clients confront situations that they have been avoiding, but that are actually safe. Much care and thought is involved in creating these assignments to ensure success and to build confidence in one’s ability to perform the tasks.
• Imaginal Exposures are completed in the therapy sessions and involve telling the trauma narrative to allow for confrontation and processing of the images and emotions related to the event. These sessions are recorded and the client listens to them between sessions.

Who Is Appropriate for PE?

Individuals who have experienced a traumatic event and are experiencing symptoms of PTSD such as nightmares or sleep disturbances, flashbacks, intrusive thoughts of the event, avoidance of situations and reminders of what happened, hyperarousal when reminded of the situation, and impairment in functioning due to the traumatic event that last for more than one month following the trauma. The individual must remember aspects of the traumatic situation and cannot be engaging in life-threatening behaviors at the present time. If you struggle with interpersonal or emotion regulation difficulties in addition to the trauma symptoms, the combined Dialectical Behavior Therapy and Prolonged Exposure (DBT-PE) approach may be a good fit.

What Will the Treatment Be Like?

PE usually consists of 10-15 weekly individual psychotherapy sessions. These sessions are 90 minutes in length. Besides the weekly individual PE sessions, clients will have homework exercises to listen to the recorded exposures from the session and to complete their in-vivo exposure exercises. Symptoms will be assessed and monitored throughout the treatment to ensure that clients are getting better and progressing as expected.

Benefits of Doing PE Treatment

Prolonged exposure has shown to be a very effective treatment for PTSD. In addition to reducing these symptoms, PE treatment helps to decrease depression, anxiety, anger and irritability, and to increase satisfaction and engagement in one’s life.

Dialectical Behavior Therapy and Prolonged Exposure (DBT-PE)

DBT-PE is an evidence-based protocol that is effective with both male and female adults and adolescents. It was developed to treat PTSD in clients with complex emotional issues and high-risk behaviors (e.g., suicidal ideation, self-harm, substance use, severe dissociation, personality disorders). DBT-PE is a one-year program that integrates Prolonged Exposure (PE) with adherent, standard DBT. It includes adaptations to the standard PE approach to more effectively address complex needs of these clients and to help build a “life worth living” while also promoting trauma recovery.

Stages of Treatment

Treatment occurs in three stages. Stage 1 is akin to standard DBT, and includes weekly individual therapy, group skills training, and phone coaching. The goal of Stage 1 is to achieve stabilization and enhance one’s ability to identify and tolerate intense emotions. Individuals must be free from self-harm or life-threatening behaviors for at least 2 months prior to beginning the Prolonged Exposure (PE) stage of treatment. Stage 2 involves directly targeting trauma symptoms. During this stage of treatment, the client continues to engage in individual and group DBT while also incorporating an additional individual session per week of PE. In Stage 3, DBT is used to address any residual problems, such as enhancing relationships and further building one’s “life worth living.”

Benefit of DBT-PE

Research indicates that the treatment is both safe and effective in reducing PTSD symptoms, as well as suicidal and self-injurious behavior, dissociation, shame, guilt, depression, and relationship problems. It has been demonstrated to be more effective than DBT or PE alone in individuals with trauma and emotion regulation issues.

Cognitive Processing Therapy (CPT)

CPT is an evidence-based therapy for PTSD. Studies have demonstrated that CPT significantly reduces symptoms of PTSD as well as other comorbid symptoms, such as depression, anxiety, and anger. Traumatic experiences, as well as the way we have thought about or made sense of the experiences and how others have reacted to our experiences, can lead us to develop negative thoughts that interfere with our lives and damage our relationships.

These damaging and likely inaccurate thoughts might sound like:

• “I could’ve prevented it – it’s all my fault”
• “The world is a dangerous place”
• “I cannot trust other people”
• “My gut is all wrong about people or situations”

Even though these thoughts make sense given the experience, they may be interfering with your ability to function in your life. CPT helps to identify and shift these thoughts that cause distress or keep you “stuck.” This process can help change how you feel and act, make sense of the trauma, and decrease avoidance of trauma-related thoughts, feelings, or reminders that may be negatively impacting you.

What Will Treatment Look Like?

Treatment involves exploring your trauma-related symptoms and how they impact your life; building awareness of your thoughts and feelings; learning skills to help you challenge, question, or balance your thoughts; and identifying how trauma has affected your beliefs about safety, trust, control, self-esteem, and relationships. There are two versions of CPT; one involves writing a narrative of the trauma, and the other does not. Research has shown that both versions are effective. CPT generally consists of twelve 50-minute sessions, though can be extended as needed. Partners or loved ones may be integrated into treatment depending on the situation.

Trauma-Focused Cognitive Behavior Therapy (TF-CBT)

TF-CBT consists of several core treatment components that are designed to be provided in a flexible and developmentally appropriate manner to address the unique needs of each child and family who have experienced traumatic events. It is a short-term, evidence-based treatment protocol that has been well-researched and shown to be effective in treating posttraumatic stress disorder (PTSD), depression, and behavioral problems (including sexual behavior problems) in children exposed to traumatic events. Research suggests the treatment may work in as few as 12 sessions. Of course, treatment may be provided for longer periods depending on the individual and family needs. Individual sessions for the child and for the parents, as well as joint parent-child sessions address the following topic areas:

• Providing psychoeducation to children and caregivers about the impact of trauma on children and common reactions to traumatic events
• Helping to identify and cope with a range of emotions
• Teaching and practicing coping skills
• Learning how to recognize the connections between one’s thoughts, feelings and behaviors, and how these may have been impacted by the trauma
• Encouraging children to share their traumatic experiences verbally, in writing, or in other developmentally appropriate ways
• Helping children and parents talk with each other about the traumatic event(s)
• Modifying inaccurate or unhealthy trauma-related thoughts or associations
• Helping caregivers develop skills for optimizing a child’s emotional and behavioral functioning

Family Therapy

Family therapy is a branch of psychotherapy that works with families on fostering strengths in family relationships and changing maladaptive communication patterns. The therapy views the family system as the unit of change rather than the individual. The family therapist facilitates interactions in a way that emphasizes the abilities, wisdom, and support of the wider system.

Couple’s therapy involves counseling the parties in a relationship in an effort to identify patterns of distress, manage differences, and improve communication. Short-term couples therapy may be between 1 to 3 sessions whereas long-term couples therapy may run from 12 to 24 sessions.

If you would like to participate in one of CCDBT’s Programs, please call our Intake Coordinator at 516.390.3525 extension 1.

Parent Coaching

CCDBT is now offering a time-limited intervention for parents of teens or young adults with emotional and behavioral difficulties. In this intervention, a Parent Coach will work with parents through several sessions to generate a customized behavior plan based on in-depth assessment of parent and family needs. The intervention will include optional access to Parent Coach by phone to help parents effectively manage emerging crises.

CCDBT also offers a Parent Skills and Support Group. Please see the News item and attached flyer for more information.

If you would like to participate in one of CCDBT’s Programs, please call our Intake Coordinator at 516.390.3525 extension 1.