Westside DBT – Building Lives Worth Living!

 

Sasha Ginsburg, LCSW

~ the executive director and founder of WestsideDBT  talks about dialectical behavioral therapy, its applications and the programs offered by WestsideDBT.com. Learn more about these powerful tools to enhance emotional, interpersonal and behavioral regulation...

 

 

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How it started

The Westside DBT center was founded by friends and colleagues License Clinical Social Workers  Sasha Ginsberg and Erin Lotz.  Their doors opened almost 6 years ago.  They were initially a small clinic set up to treat those people suffering from interpersonal and behavioral dysregulation as well as people with chronic and persistent suicidal thoughts or behaviors.  They have grown in size expanding their practice to 2 locations and now treat all people ages 13 and up in need of emotional support, skills training to manage their emotions and cognitive support to help retrain the persons self-perception.  Sasha says they help people "build lives worth living". 

What is Dialectical Behavioral Therapy (DBT)?

DBT is a therapeutic approach designed in the mid-1980's by psychologist Marsh Linehan.  It was initially designed to treat people with Borderline Personality Disorder.  Borderline Personality Disorder is marked by a sabotaging pattern of behaviors often stemming from an extreme or unrealistic fear of abandonment, born out of an "attachment break" early in one's emotional life.  The DBT skills training approach allows these people to learn to manage the extremes of their emotions and implements mindfulness and self-soothing techniques in order to allow them to live lives with more emotional stability and emotionally healthier interpersonal relationships. For as much as DBT is still the "go-to" method for helping people with Borderline Personality Disorder, it has been demonstrated to be helpful to people with less clinically significant symptoms, allowing more people to access the method to reap the benefits of the skills training to help manage life's problems and relationship discord.

Dialectical Behavioral Therapy originated in Cognitive Behavioral therapy (CBT). It helps alleviate problems with regulating emotions, thinking patterns, and behaviors that cause misery and distress.  DBT combines both cognitive-behavioral therapy (Western principles and practices) and mindfulness approaches (Eastern principles and practices) to help people understand ,accept and change, patterns of living that are causing them suffering.  In understanding this approach one can see how many people can benefit from these skills.

Who Benefits from DBT?

(From the Westside DBT website)

DBT may help if you are experiencing the following symptoms:

Emotions

  • Heightened emotional sensitivity
  • Quick and intense emotional reactions
  • Slow return to normal mood
  • Chronic problems with depression, anxiety, anger or anger expression

Behavior

  • Repeated suicide threats or attempts
  • Self-harm behavior such as cutting and burning
  • Relationship difficulties including hypersensitivity to criticism, disapproval, intimacy or fear abandonment
  • Impulsive and potentially self-destructive behavior in areas such as binge eating and purging, alcohol or drug abuse, sexual promiscuity, and gambling or spending sprees

Thinking

  • Extreme (black or white) thinking
  • Difficulty with problem-solving and decision making
  • Unstable self-image or sense of self
  • “Detached” thinking, ranging from mild problems with inattention to episodes of complete dissociation

4 Modules of Dialectical Behavioral Therapy

DBT is designed to teach

1. Mindfulness Skills

2. Interpersonal Effectiveness

3. Distress Tolerance

4. Emotion Regulation

 

How is the therapy implemented?

Dialectical Behavioral Therapy is implemented through a combination of group and individual sessions over a set number of weeks.  A person can extend their treatment if necessary, but it is best effective when a person initially participates for the designated weeks of both individual and group sessions.

How to connect with the Westside DBT Team

Email: info@westsidedbt.com

Call: (310) 772-8118

website: westsidedbt.com

Suicide Prevention is Necessary

 

Julie Goldstein Grumet, Phd

~ Director of Prevention and Practice at the Suicide Prevention Resource Center speaks about the many programs and resources available via SPRC.org
The Suicide Prevention Lifeline is available 24/7 at 1-800-273-8255 (suicidepreventionlifeline.org)
The Veterans Crisis Line is also available 24/7  at     1-800-273-8255 Press 1 (veteranscrisisline.net)

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September is Suicide Prevention Month

Suicide is the 10th leading cause of death in the United States – AND it is preventable. September is suicide prevention month.  The International Association for Suicide Prevention (IASP), collaborates with the World Health Organization (WHO) and the World Federation for Mental Health, to host World Suicide Prevention Day on Sept. 10, 2015. ‘Preventing Suicide: Reaching Out and Saving Lives’ is the theme of the 2015 World Suicide Prevention Day (WSPD). This year’s theme is designed to encourage all of us to consider the role that offering support may play in combating suicide.

Suicide touched my own life in a profound way when my youngest brother, Scott, took his own life on July 1, 2007. I witnessed his struggle for many years. I talk more about this experience and how my family grieved in the accompanying episode of The Coaching Through Chaos Podcast, but for this post, I'm going to stick to facts that I want to share. As most of this information is cut and pasted from relevant sites dedicated to suicide prevention and research, credit is given accordingly.

Why do we Need Suicide Prevention Education & Resources?

General Statistics (as posted by save.org)
• Suicide is the 10th leading cause of death in the US for all ages. (CDC)
• The suicide rates decreased from 1990-2000 from 12.5 suicides per 100,000 to 10.4 per 100,000. Over the past decade, however, the rate has again increased to 12.1 per 100,000. Every day, approximately 105 Americans die by suicide. (CDC)
• There is one death by suicide in the US every 13 minutes. (CDC)
• Depression affects 20-25% of Americans ages 18+ in a given year. (CDC)
• Suicide takes the lives of over 38,000 Americans every year. (CDC)
• Only half of all Americans experiencing an episode of major depression receive treatment. (NAMI)
• 80% -90% of people that seek treatment for depression are treated successfully using therapy and/or medication. (TAPS study)
• An estimated quarter million people each year become suicide survivors (AAS).
• There is one suicide for every estimated 25 suicide attempts. (CDC)
• There is one suicide for every estimated 4 suicide attempts in the elderly. (CDC)

The Suicide Prevention Resource Center (SPRC.org)

If you knew someone who was suicidal, or you work in a community where there were no active suicide prevention programs, would you know where to turn? Today’s episode features Julie Goldstein Grumet, Ph.D., who is the Director of Prevention and Practice at the Suicide Prevention Resource Center (SPRC.org). The SPRC is the nation’s only federally supported resource center devoted to advancing the National Strategy for Suicide Prevention. They provide technical assistance, training, and materials to increase the knowledge and expertise of suicide prevention practitioners and other professionals serving people at risk for suicide. They also promote collaboration among a variety of organizations that play a role in developing the field of suicide prevention.

Who does SPRC.org serve?

The SPRC website can be a reference guide for both Professionals in the community (teachers, care givers, therapists, first responders, etc.) and individuals (teens, parents, survivors of suicide, etc.). There is even state-specific information on programs and community resources. From their website they specifically serve:
• Suicide prevention grantees: Garrett Lee Smith Suicide Prevention Grantees funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) to support suicide prevention work in Campus, State, and Tribal communities.
• State suicide prevention coordinators and initiatives: individuals and groups in the state with the lead for statewide suicide prevention.
• College and university staff involved with suicide prevention efforts on campus.
• American Indian/ Alaska Native communities: Individuals working with native populations to support suicide prevention and mental health promotion.
• Health and behavioral health care providers who play a role in identifying and helping individuals at risk for suicide.
• Professionals providing social services in their community and organizations that can help reduce suicide rates among the populations they serve.
• Members of the National Action Alliance for Suicide Prevention, the public-private partnership dedicated to advancing the National Strategy for Suicide Prevention

Risk Factors for Suicide (as posted by SuicidePreventionLifeline.org)

• Mental disorders, particularly mood disorders, schizophrenia, anxiety disorders and certain personality disorders
• Alcohol and other substance use disorders
• Hopelessness
• Impulsive and/or aggressive tendencies
• History of trauma or abuse
• Major physical illnesses
• Previous suicide attempt
• Family history of suicide
• Job or financial loss
• Loss of relationship
• Easy access to lethal means
• Local clusters of suicide
• Lack of social support and sense of isolation
• Stigma associated with asking for help
• Lack of health care, especially mental health and substance abuse treatment
• Cultural and religious beliefs, such as the belief that suicide is a noble resolution of a personal dilemma
• Exposure to others who have died by suicide (in real life or via the media and Internet)

The Suicide Prevention Lifeline and SPRC feature the following as Warning Signs of Suicide:

The following signs may mean someone is at risk for suicide. The risk of suicide is greater if a behavior is new or has increased and if it seems related to a painful event, loss, or change. If you or someone you know exhibits any of these signs, seek help as soon as possible by calling the Lifeline at 1-800-273-TALK (8255).

• Talking about wanting to die or to kill themselves.
• Looking for a way to kill themselves, such as searching online or buying a gun
• Talking about feeling hopeless or having no reason to live.
• Talking about feeling trapped or in unbearable pain.
• Talking about being a burden to others.
• Increasing the use of alcohol or drugs.
• Acting anxious or agitated; behaving recklessly.
• Sleeping too little or too much.
• Withdrawing or isolating themselves.
• Showing rage or talking about seeking revenge.
• Displaying extreme mood swings.

What should everyone know?

- Suicide is preventable. Recent research is beginning to show a correlation between suicide prevention programs and decreases in suicides in those areas.
- Most people that are thinking about suicide absolutely feel hopeless and wish for feeling better, not necessarily to die. The wish to die often is born out of the despair and hopelessness.
- If someone verbalizes a suicidal thought, you should absolutely take it seriously. It’s imperative to share that thought with someone who can intervene and assess futher. You might feel uncomfortable about that, or your friend may ask you not to tell anyone, but jeopardizing your relationship is much wiser than pleasing them in that moment.
- Talking about suicide, or asking someone if they are suicidal will not cause them to become suicidal. There are some people that “just get depressed”. While that may hinder their life and their well-being, they don’t move into a suicidal state. On the other hand, there are other people who may not even present as outwardly depressed but have suicidal thoughts when problems develop in their life. If you are concerned about someone you know, ask them if they have suicidal thoughts. Whatever answer you get will be better than never having asked.

 

 
VeteransCrisisLineLogoNational Suicide Prevention Lifeline

Be part of the conversation - show your support on social media!

The people at Suicide Prevention Lifeline ask that when sharing about suicide prevention to use the following tags to support their campaign to raise awareness for suicide prevention: #BeThe1To (help someone else)

and for Veterans: #JoinThePowerof1

Resources

The National Suicide Prevention Lifeline: 1-800-273-TALK (8255): You can call this number 24/7 to speak to someone about how you are feeling or to get help for yourself or someone you care about.

The Suicide Prevention Resource Center - SPRC.org : The nation’s only federally supported resource center devoted to advancing the National Strategy for Suicide Prevention. They provide technical assistance, training, and materials to increase the knowledge and expertise of suicide prevention practitioners and other professionals serving people at risk for suicide. They also promote collaboration among a variety of organizations that play a role in developing the field of suicide prevention.

SuicidePreventionLifeline.org: Not only can you call them at 1-800-TALK, but you can life chat with someone online, get information specific to helping young adults and veterans as well. They also provide resources on bullying, how to get help in your area and have other information you may need when feeling suicidal.  Their online resources are also provided in Spanish.

Save.org : The mission of SAVE is to prevent suicide through pubic awareness and education, reduce stigma and serve as a resource for those touched by suicide.

Zero Suicide Program - zerosuicide.sprc.org : This is an SPRC program designed and committed to preventing suicide in health and behavioral healthcare systems. The approach of Zero Suicide is based on the realization that suicidal individuals often fall through cracks in a fragmented, and sometimes distracted, health care system. To do this, Zero Suicide requires a system-wide approach to improve outcomes and close gaps in the systems for better preventative care.

The National Strategy for Suicide PreventionA Report of the U.S. Surgeon General and of the National Action Alliance for Suicide Prevention

The National Action Alliance for Suicide Prevention - The public-private partnership advancing the National Strategy for Suicide Prevention

 

 

 

The Warning Signs of Depression

chart of warning signs of depression
The above graphic was adapted for US conditions, the original comes from UK based StudentsAgainstDepression.org
It is available  on a dark blue background (as seen above) or on a white background.

Students Against Depression: A website by students for students

One in four of us will experience some kind of mental health problem in our lifetime. One in 10 will experience depression or anxiety with depression in any one year. This statistic holds true for students and young people. Depression is one of the biggest dangers facing young people today – suicide is the biggest killer of young men under 35 in the UK.

The StudentsAgainstDepression.org  website offers advice, information, guidance and resources to those affected by low mood, depression and suicidal thinking. Alongside clinically-validated information and resources it presents the experiences, strategies and advice of students themselves. Students, after all,  are the best placed to speak to their peers about how depression can be overcome.

Know the Warning Signs of Depression

  • Feelings of hopelessness and pessimism,
  • Feelings of worthlessness, guilt and helplessness,
  • Thoughts of death or suicide,
  • Restlessness,
  • Irregular sleep,
  • Decreased energy,
  • Changes in mood,
  • Insomnia,
  • Difficulty making decisions,
  • Appetite and weight loss,
  • Persistent sad, anxious or empty mood,
  • Tearfulness.

 

The iconography of despair

Being UK based, the original graphic uses European warning roadsigns as an iconography of  the symptoms of depression.  Because this image is so striking, we translated the iconography to reflect North American roadsigns in order to help spread the message of  Students Against Depression to a broader audience.  In reflecting upon the challenges of dealing with depression, the message goes much deeper than the chosen iconographic representation; whilst we may speak similar or even different languages and use different symbolic representations, the underlying concepts are the same, the core problems are the same. All people suffering from depression, students and young people in particular, need to know that help is at hand.
You are not alone.

 

Resources for U.S. Students

The following Q&A section comes from the National Institute of Mental Health website

www.nimh.nih.gov/health/publications/depression-and-college-students

 

Q. If I think I may have depression, where can I get help?

A. Most colleges provide mental health services through counseling centers, student health centers, or both.1 Check out your college website for information.

  • Counseling centers offer students free or very low-cost mental health services. Some counseling centers provide short-term or long-term counseling or psychotherapy, also called talk therapy. These centers may also refer you to mental health care providers in the community for additional services.
  • Student health centers provide basic health care services to students at little or no cost. A doctor or health care provider may be able to diagnose and treat depression or refer you to other mental health services.

If your college does not provide all of the mental health care you need, your insurance may cover additional mental health services. Many college students have insurance through their colleges, parents, or employers.
1 If you are insured, contact your insurance company to find out about your mental health care coverage.

Q. How can I help myself if I am depressed?

A. If you have depression, you may feel exhausted, helpless, and hopeless. But it is important to realize that these feelings are part of the illness. Treatment can help you feel better.

To help yourself feel better:

  • Try to see a professional as soon as possible—research shows that getting treatment sooner rather than later can relieve symptoms quicker and reduce the length of time treatment is needed
  • Give treatment a fair chance—attend sessions and follow your doctor’s or therapist’s advice, including advice about specific exercises or “homework” to try between appointments
  • Break up large tasks into small ones, and do what you can as you can; try not to do too many things at once
  • Spend time with other people and talk to a friend or relative about your feelings
  • Do not make important decisions until you feel better; talk about decisions with others whom you trust and who know you well
  • Engage in mild physical activity or exercise
  • Participate in activities that you used to enjoy
  • Expect your mood to improve gradually with treatment
  • Remember that positive thinking will replace negative thoughts as your depression responds to treatment.

Q. How can I help a friend who is depressed?

A. If you suspect a friend may have depression, you can help him or her get diagnosed and treated. You may need to help your friend find a doctor, mental health care provider, or mental health services on your college campus. If your friend seems unable or unwilling to seek help, offer to go with him or her, and tell your friend that his or her health and safety are important to you.

You can also:

  • Offer support, understanding, patience, and encouragement
  • Talk to your friend and listen carefully
  • Never ignore comments about suicide, and report them to your friend’s therapist or doctor
  • Invite your friend out for walks, outings, and other activities. If they refuse keep trying, but don’t push
  • Ensure that your friend gets to doctor’s appointments and encourage him or her to report any concerns about medications to their health care professional
  • Remind your friend that with time and professional treatment, the depression will lift

Q. What if I or someone I know is in crisis?

A. If you are thinking about harming yourself or having thoughts of suicide, or if you know someone who is, seek help right away

  • Call your doctor or mental health care provider
  • Call 911 or go to a hospital emergency room to get immediate help, or ask a friend or family member to help you do these things
  • Call your campus suicide or crisis hotline
  • Call the National Suicide Prevention Lifeline’s toll-free, 24-hour hotline at 1-800-273-TALK (1-800-273-8255) or TTY: 1-800-799-4TTY (1-800-799-4889) to talk to a trained counselor
  • Call your college counseling center or student health services
  • If you are in crisis, make sure you are not left alone
  • If someone else is in crisis, make sure he or she is not left alone.

 


Depression

What is depression?

We all go through “emotional rough patches” in life. Sometimes it’s a full depressive episode and sometimes its’ not. We usually distinguish one from the other by the length of time the emotional state lasts. People with depression usually feel:

  • lack of energy,
  • sadness – many times for no reason,
  • difficulty concentrating,
  • apathy,
  • they sometimes stop participating in daily self-care like showers, eating, exercising,
  • they often sleep too much,
  • there can be thoughts of suicide,
  • avoid social situations they would normally attend,
  • lack of appetite, or over-eating (some people “stuff” their emotions, some people starve them),
  • physical pain that has no physical origin,
  • easily angered or irritable,
  • lack of sexual desire,
  • feelings of low self-worth

I think many people can relate to having felt some cluster of those symptoms at different times in their lives. There are both biological and situational causes for depression. Situational or “environmental” causes for depressive symptoms can be things like: relationship or job stress, financial pressures, feeling stuck when you want to make changes.
Whether due to biology or environmental factors, if the symptoms are left untreated, they can get worse over time and it can feel overwhelming to try to overcome them.

 Depression is a prison where you are both the suffering prisoner and the cruel jailer.
-Dorothy Rowe

What does depression feel like?

When depression hits, it can feel like nothing matters anymore. You might feel like you don’t want to get out of bed, you might lose your appetite (or conversely, you may begin to overeat) and you may feel like you are “faking” your emotional engagement with others. Depressive episodes can last a few days to a few months. More severe cases of depression, especially recurrent and without any obvious environmental trigger may be helped with medication management in addition to talk therapy.

 

Who gets depression?

There’s been a long-standing statistic that 1 in 4 women  and 1 in 5 men go through a depressive episode at least one time in their lives. That doesn’t sound all too different and it’s not, but depression can present itself differently between men and women.

How is it depression treated?

Depression can be treated in many ways. Talk therapy is one of the most effective strategies for treating depression.
Focusing in on what the triggers (or predictors) are and how you react to them is usually where we will get started in our work together.
We utilize strategies that pull from several known effective theories for treating depression. Depression is usually helped through building or strengthening coping skills, expanding our support network  and emotional work that leads to behavioral changes.
We use Cognitive behavioral therapy, Strategic interventions, Mindfulness practices and Solution-Focused perspectives to help you move towards an emotional place of well-being. We can help you learn ways to retrain your brain to combat your depressive or negative thoughts and get moving towards the life you want to live.
We recognize that people have a wide range of opinions as to whether or not to also seek anti-depressant medication treatment in addition to their talk therapy. We are focused on helping you best help your depression in a way that is in line with your beliefs. If that includes medication management, we can coordinate care with your psychiatrist and/or help facilitate a referral.

Anxiety

What is anxiety?

Anxiety is a physiological reaction to stressors in our environment.  
Certain stressors or traumas can result in an anxiety- based condition in a person who may have other factors influencing the occurrence, such as family genetics or consistent environmental stressors. 
Anxiety can manifest itself in many ways (see what does anxiety feel like?).
Research has demonstrated that severe or long-lasting stress can change the way nerve cells in the brain transmit information from one region of the brain to another, triggering one of several “anxiety disorders”.  People with certain anxiety disorders such as Post Traumatic Stress Disorder may  suffer changes in certain brain structures that control memories linked with strong emotions.
Anxiety disorders can run in families, which means that a person can inherit it from either one or both parents.

man with anxiety

What does anxiety feel like? 

Anxiety can manifest itself differently depending on the condition. 

  • Panic Attacks (Anxiety Attacks):  A person can experience rapid heart beat, sweating, chest pains, nervousness, upset stomach, shaking hands, panic-stricken thoughts.

     

  • Generalized Anxiety Disorder (GAD): A person with GAD may be thought of as “high strung” and have a hard time “shutting off their thoughts”.  They may experience a general feeling of malaise or dread. It is more worry-based than a person with depression and not  as immediate as a Panic Attack and the thoughts are not usually as obsessive as the person who has Obsessive Compulsive Disorder
  •  

  • Obsessive Compulsive Disorder (OCD):  OCD actually has several presentations.  It can look like the stereotypical “checking” type of behavior (i.e. having to check that the stove is off 5 times before leaving the house or turning light switches off 5 times before leaving). It can also be occurring in the person who has pretty consistent “ruminating thoughts” – they can’t turn their mind off and the thoughts are repetitive and relentless.  It can also present itself in ways that leave a person isolated from others (germ phobic, fearful of trusting others in clinically significantly, anxiety-driven ways).

     

  • Hoarding:  This condition is marked by an obsession with holding on to items- this can range from obsessive collecting to the point where there is nothing other than the collected items int eh home, to be ing unable to part with items that had sentimental value at some point in time (i.e. clothes from a certain time in one’s life, or invitations or birthday cards that are cluttering storage space).  However, hoarding becomes a problem when the person becomes unable to part with things such as garbage, random papers, food, newspapers or other possessions to the point in which their home or property becomes over-loaded, often causing health or fire hazards. 
    Hoarding is a condition that usually needs the assistance of a professional trained in  interventions specifically for this behavior.

     

  • Posttraumatic Stress Disorder (PTSD): refer to PTSD section.

 Who gets anxiety?

According to the Anxiety and Depression Association of America (ADAA):

  • Anxiety disorders are the most common mental illness in the U.S.,
  • Anxiety disorders affect 40 million adults in the United States age 18 and older, or 18% of the population.
    (Source: National Institute of Mental Health)
  • Anxiety disorders are highly treatable, yet only about one-third of those suffering receive treatment.
  • Anxiety disorders cost the U.S. more than $42 billion a year, almost one-third of the country’s $148 billion total mental health bill, according to “The Economic Burden of Anxiety Disorders,” a study commissioned by ADAA (The Journal of Clinical Psychiatry, 60(7), July 1999).
    • More than $22.84 billion of those costs are associated with the repeated use of health care services; people with anxiety disorders seek relief for symptoms that mimic physical illnesses.
  • Anxiety disorders develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events.

What is the treatment for anxiety?

Treatment fort anxiety ranges from traditional psychotherapy (talk therapy), behavior therapy, medications, or a combination thereof.  Certain anxiety disorders can have quick responses to therapy, while others may be more difficult to treat.  Panic attacks can be treated with behavioral interventions interspersed with talk therapy.  If you think you may be dealing with OCD or Hoarding Disorder, please seek out a therapist who has special training in treating these disorders.