Category: Depression

Teen Mental Health: What Dialectical Behavior Therapy (DBT) Can Offer

By Thanos Nioplias, MA

Anxiety and depression are clearly on the rise among teenagers. And it’s not only psychologists and educators who are concerned. Everyday conversations among teens focus on how stressed and anxious they feel, and the press has recently written extensively about mental health struggles that young people face. Time magazine, citing compelling clinical research and personal accounts, recently described the modern teenager as “fragile, less resilient and overwhelmed”.

What is wrong with our teens?

The modern teenager has been impacted by technological advances unlike any previous generations. At any given time, our teenagers are glued to their screens. As a result, they are exposed to plenty of negative information, some of which is genuinely terrifying and even horrifying. They are also constantly comparing themselves to others on social media where they are exposed to images of idealized bodies and lifestyles, which leave them feeling excluded, lonely, and dissatisfied with their own abilities and accomplishments. But perhaps the most insidious negative impact of screen-time is that teens are less focused and less present-minded than ever. As a result, they are less likely to naturally recognize and regulate their basic needs and emotions. All the bright lights and limitless scrolling are so distracting that many have no clue what they need themselves to maintain emotional wellness. The worst part about the above is that it has become completely normal for kids to use technology for hours on end each day.

As a result, we have a serious crisis. It is almost expected that teens today are moody, lacking in confidence, insecure about their appearance, filled with worry and concern about their future, and that they have been exposed one way or another to alcohol and illicit substances when interacting with peers. It is also very common for teenagers today to experience significant depressive symptoms including pervasive sadness, apathy, complaining about life being “hard and overwhelming” and even thoughts about suicide. Equally common are bouts of anger, which are frequently followed by apathy and seclusion, as well as failure to complete academic work and/or maintaining meaningful hobbies and interests (aside from scrolling on their phones). Also common are possession and frequent use of alcohol and drugs, and frequenting places where these substances can pose a threat to wellbeing. Worse, a staggering number of teenagers engage in self-injury and have significant, active suicidal ideation. The majority of the above symptoms – while common – are clear red flags that warrant professional intervention and care.

Can therapy help our teenagers become more resilient?

Dialectical behavior therapy (DBT) is a comprehensive, evidence-based psychotherapy originally developed to treat self-injury, suicidality and other high-risk behaviors among individuals with Borderline Personality Disorder. More recently, DBT skills groups have been modified to help troubled teenagers reduce depression, irritability, anger, impulsivity, self esteem issues and overall social adjustment, in addition to self harm and suicidal ideation. A DBT skills group is like a classroom. Teenagers (or adults) come to a 90-minute session each week for approximately six months to learn and practice skills in four core areas.

First, DBT participants learn how to practice Mindfulness, which helps them to slow down, be present in the moment, and simply identify and be aware of their thoughts, emotions, and urges.

Second, they focus on Emotion Regulation, which involves learning how to change their feelings such as anxiety, depression, anger, etc.

Third, they learn Distress Tolerance skills to manage impulsive and other problematic behaviors that can be damaging to themselves and others.

And finally, they learn strategies to build and maintain Interpersonal Effectiveness in order to improve and enhance social relationships through assertiveness and reducing hostility.

For teens, a fifth component of treatment focuses on Middle Path skills to let go of “black-and-white” thinking and embrace a balanced perspective in their relationships and in their life.

Among other therapies that have been showed to effectively improve teenagers’ mental health, DBT is especially promising in keeping teenagers safe and helping them build a life worth living. Even in our fast-paced and uncertain times, we have evidence to believe that our troubled teenagers can learn life skills, get better, and thrive in their lives.

The iPhone Setting That Could Save Your Mental Health

By Aliza Dinerstein, LMSW

With mental health awareness on the rise, many individuals are beginning to become more mindful of their internal experiences in day to day life, and the number of adults recognizing feelings of anxiety and depression has reached an all-time high. According to the National Institute of Mental Health 18.1% of the American population suffers from anxiety, and 6.7% of adults in the United States face depression. Even though these statistics are high, there is an even greater number of people with no formal diagnosis or professional treatment who are actually experiencing their own volumes of anxiety and depression every single day.

Multiple theories have been hypothesized as to why today’s society engenders such pathological responses to reality, some suggesting that the bombardment of social media, constant connection to technology, and a fast-paced culture are the antecedents that cause people to respond to life with overwhelming feelings of anxiety and/or depression. These theories may give us a glimpse into certain contributing factors, but no single explanation seems to be leading us directly toward a direct cure. Thus, the question must begin to shift from what has happened in the past to understand what is happening in the present; and from why we became a culture with so much anxiety and depression to how we will begin to fix it.

In psychology, there is a common understanding that thoughts, feelings, and actions make up an interrelated triad of human experience. This notion has led cognitive and behavioral therapists to treat psychological disorders by targeting one specific area, such as a series of thoughts or a pattern of behavior as a means of activating positive change in all other areas of the individual as well. One such technique used in behavioral therapy is called behavioral activation or self-activation and is a highly effective method of treating depression. Simply put, behavioral activation is based on the premise that in order to improve one’s mood and recover from depressive symptoms, one must take active steps, no matter how small, to slowly re-engage in his or her own life. The model of self-activation proposes that when one succeeds in activating or changing a small behavior that allows him to re-enter his own world in a meaningful way, eventually the rest of his thoughts and feelings will begin transforming as well.

So although the aforementioned theories about our present-day society cannot give us direct causational reasoning for the pervasive mental health challenges of today, they all have a very relevant commonality: a root that lies in the engagement with others and disengagement from the self. Perhaps our connection to media, ever-present technology, and our rapid culture is not the issue; rather the problem lies in our inability to turn off the externalities and re-engage with ourselves, even for a few moments a day.

In 2017, the idea of completely rendering one’s self-unavailable to the public for the sake of engaging in his or her own world seems nearly impossible. Rarely any pockets of time remain when it is socially acceptable to be completely offline and unresponsive to the barrage of social media, colleagues, and even friends. With internet connection on almost every street, aircraft, and even subway, there is no longer a feeling of sweet escape when boarding a plane or getting onto the train for work, knowing that when internet service disappears, there is every excuse to take a breath and shut off the outside world for a while.

This brings me to my favorite smartphone feature. Sometimes it only takes one button to trigger a pattern that will re-engage a person in his or her own life, and there’s an app for that. The tiny little switch on my iPhone labeled ‘airplane mode’ has been my ticket to self-activation (and perhaps sanity), every single day for the past two years.  It takes a lot of courage to tell the entire universe that you need some time to shut off their requests, opinions, and stresses in order to focus on the area of life that tends to become the most neglected: the self. The theory of self-activation states that it is disengagement from one’s life that perpetuates negative emotional states and the way to remedy these very feelings is to take the tiniest step towards deactivating the world around and reactivating the world within. The choice to deem one’s self-unavailable (even for 10 minutes at a time) may seem insignificant, but it could actually spark the chain reaction that may be the best therapy you’ve ever had.

How to Conquer Difficult Emotions with Dialectical Behavior Therapy

By Aliza Dinerstein, LMSW

Throughout life individuals encounter a kaleidoscope of experiences,
each one eliciting a specific emotional reaction ranging from joy,
love and hope, to anxiety, anger, or fear. Although one instinctively
strives to increase positive feelings and decrease negative ones, it
is important to remember that, at times, encountering painful emotions
is an inevitable part of life. Dialectical Behavior Therapy (DBT), a
composite of therapeutic interventions geared toward helping
individuals build a life worth living, focuses on the science of
‘emotion regulation,’ i.e., one’s capacity to work through difficult
emotions in an effective way. DBT provides concrete, empirically based
practices such as building awareness, mindfulness skills, and specific
behavioral change that can be utilized in day to day life, helping
individuals approach challenging emotions in constructive and
rewarding ways.

The first step is to increase emotional awareness. Oftentimes, strong
emotional reactions occur and individuals are unable to identify their
own emotions or recognize their impact on thoughts and actions.
Therefore, one of the most fundamental tools in responding effectively
to difficult feelings is learning to identify and label present
emotions as they arise, while gaining an understanding of how those
feelings work in conjunction with one’s thoughts and behaviors.
Emotional awareness is developed through monitoring five specific
elements: 1) events that trigger emotional responses, 2) one’s
thoughts and cognitive interpretations of these event, 3)
physiological reactions and bodily sensations, 4) behavioral response
(i.e., actions), and 5) most important, the outcome of one’s
emotional, cognitive and behavioral responses – also known as
“effectiveness”. Building emotional awareness is a skill that takes
time and practice to acquire through the use of daily monitoring. But
this is the foundation of DBT, as it enables us to develop emotional
mastery and regulation.

Another core concept in DBT is to grant yourself the freedom to feel.
Usually, people try to avoid painful feelings such as anger, sadness,
fear and anxiety. However, inhibiting these emotions does not make
them disappear and in fact it usually makes them worse. Thus, DBT
emphasizes the importance of “mindfulness” which involves truly
experiencing emotions instead of blocking, suppressing, or avoiding
them. In mindfulness practice, emotions are understood as waves that
naturally rise and fall. When we allow our emotions to operate
naturally, the intensity of the feelings are minimized and we can move
through strong emotional responses in a more healthy and integrative
way. A related DBT concept is that one should aim to radically accept
each emotion without judgement. Mindful awareness is a key element for
truly allowing one’s self to feel, and mindfulness practice enables
us to work through emotions with mindfulness, presence, and
acceptance.

A third key DBT principal is learning to take care of the body in
order to take of the mind. Our capacity to cope with challenges in
moments of adversity is impacted not only by one’s emotional health,
but also by the condition of one’s physical wellbeing. DBT’s  emotion
regulation ‘PLEASE’ skill encapsulates these very dimensions of
physiology, which include 1) treating any existing Physical iLlness,
2) maintaining balanced Eating, 3) avoiding mood Altering drugs, 4)
creating healthy Sleep habits, and 5) engaging in regular Exercise.
Although these targets may seem simplistic, research shows that the
more one decreases physical and environmental stressors, the less
prone to emotional reactivity one becomes.

Although experiencing painful emotions is unavoidable over the course
of life, it does not mean that anyone must suffer through them. These
and other principals of DBT explain that one can change maladaptive
behavioral, emotional, and cognitive responses while mindfully
experiencing life in the present and accepting reality as it is. This
understanding, coupled with the skills that DBT provides, can help us
cultivate awareness, acceptance, resilience, and growth.