Borderline Personality Disorder

The treatment for Borderline Personality Disorder (BPD) is Dialectical Behavior Therapy (DBT). Comprehensive DBT is the gold standard to treat BPD, suicide and self-harm concerns, and overall dysregulation in mood, emotions, and tolerating stress.

What is comprehensive DBT: This includes individual therapy (weekly or bi-weekly), skills training (weekly), phone coaching (as needed), and consultation team for the therapist.

Symptoms of BPD:

Emotions	Highly sensitive and reactive responses with difficulty returning to baseline or settling down once the emotion has been set off.
Relationships	Intense, chaotic and unstable relationships or absence of relationships, fears of abandonment, feelings of emptiness.
Self-Image	Unclear on one’s preferences, goals, and values. Difficulty sticking to one’s sense of self, having a wavering presence, a lack of self confidence.
Behaviors	Impulsive reactions that are often due to either difficulty regulating emotions or as an attempt to regulate the high emotion (life threatening behavior, eating, spending, addictions).
Thoughts	Extreme and inflexible thinking, difficulty finding a middle ground, and generating non-judgmental interpretations.

Post-Traumatic Stress Disorder

How does PTSD develop?: Not everyone who witnesses or experiences a traumatic event develops PTSD. Anyone at any age can have PTSD. Avoidance of the trauma reminders (people, places, memories, thoughts, and feelings) is a key factor in developing PTSD. Avoidance leads to negative beliefs about others, oneself, emotions, and the world because the person isn’t facing fears and learning that either their fearful predictions may not be likely to happen or they can in fact tolerate the discomfort.

Symptoms of PTSD:

Re-experiencing	Repeated, intrusive, and unwanted memories, nightmares, flashbacks
Avoidance	Persistently staying clear of trauma memories and reminders – people, places, sights, smells, sounds, music
Changes in thinking or emotions	Overly negative beliefs about self, others, world, exaggerated blame of self or others, difficulty experiencing positive mood
Changes in arousal or reactivity	Overly alert, easily startled, on guard, difficulty concentrating or sleeping, irritability or aggression, risky behavior

The treatment for PTSD is a type of Cognitive Behavior Treatment called Prolonged Exposure (PE). PE is the the most research based treatment for trauma. DBT-PE is adapted from PE and used to treat trauma in combination with suicidal/self-harming symptoms and multiple diagnoses (i.e., PTSD and BPD).

The treatment includes in-vivo (real life) exposure to help clients approach trauma reminders that they want to stop avoiding. Imaginal exposure is used to revisit the trauma story in a safe way. These exposures are highly effective in breaking the cycle of avoidance that maintains PTSD by teaching people to cope with the trauma reminders, feel in control of emotions, and reduce problem thoughts.

Obsessive Compulsive Disorder

OCD is an anxiety disorder that includes cycles of obsessions and compulsions. An assessment by a trained clinical is important, as there are many themes or ways OCD can present.

Obsessions are repetitive unwanted and uncontrollable thoughts, images, or urges that trigger anxiety.

Compulsions are the behaviors people engage in to reduce their discomfort and anxiety.

The treatment for OCD is a type of cognitive behavior therapy (CBT) called exposure response prevention (ERP). In ERP, the person intentionally faces fears associated with the obsessions while avoiding the compulsions. OCD is known as the “Doubting Disorder.” The goal of ERP is to learn to tolerate uncertainty, live with the doubt, and develop new ways of coping with anxiety.

Panic Disorder

A panic attack is an experience of intense fear and abrupt, short lasting physical reactions in. one’s body. Panic attacks can last on average 5-20 minutes and generally less than an hour.

Panic disorder occurs when one has repeated panic attacks and can lead to Agoraphobia, which is either extreme dread or complete avoidance of situations that an escape is either difficult or unavailable.

The treatment for panic disorder is a type of cognitive behavior therapy called exposure therapy. This includes in-vivo exposure (facing cues in the environment that cause panic) and interoceptive exposure (facing body cues that are similar to panic). Breathing and thinking skills are taught to use during and after exposure situations.

Body Dysmorphic Disorder

BDD is considered an OCD spectrum disorder.

Obsessions in BDD are related to one’s perceived or actual body flaws.

Compulsions in BDD are frequently related to mirrors (avoiding mirrors and/or repeatedly checking mirrors, binocular like focus when looking in the mirror). Other compulsions can include covering up the flaws, attempting to appear more muscular, rituals with clothing (avoiding, frequently changing) and assurance seeking related to appearance.

The treatment for BDD is cognitive behavior therapy (CBT) including the following components: exposure to the situations that trigger the obsessions while refraining from compulsions (ERP treatment), developing new thoughts related to body image (challenge old ones, mindfulness to thoughts), and learning to expand attention to one’s whole self rather than only the flaws.

General Anxiety Disorder

GAD is a condition of persistent, unrealistic, and excessive worry about everyday situations (future, school, work, money, and others). The worry is often related to a realistic problem but is experienced in an extreme way.

GAD often co-occurs with other anxiety disorders.

The treatment for GAD is cognitive behavior therapy including the following components: relaxation and thinking skills, imaginal exposure (deliberately focusing on negative images related to worry thoughts) and in-vivo exposure (approaching real life avoided situations).

SAD includes worry related to being around others. There are often extreme fears of embarrassment or humiliation around others that often lead to avoiding social situations, including eye contact, initiating or maintaining conversation, and joining in overall. There is typically unrealistic worry about being judged and an over focus on perceptions of others.

Treatment for SAD is cognitive behavior therapy that teaches thinking skills and exposure to avoided social situations.

Perfectionism

Defined by setting unrealistic goals across areas of life, ongoing pursuit of standards, fears of failing, and extreme mood and behaviors when not meeting their expectations.

Treatments for perfectionism include the following:

Cognitive behavior therapy: the goal is to decrease the chronic frustration one experiences with maladaptive perfectionism and to accept high achieving and less than perfect behaviors. To learn how to challenge self-criticisms, increase flexibility and compassion, and to increase tolerance to imperfection with exposure to situations that may not go perfectly.

Self-compassion therapy: teaches mindfulness in the self-critical moments, how to increase self-validation while also hold oneself accountable to realistic goals.

Mood Disorders

The treatment for depression is a type of Cognitive Behavior Therapy called Behavior Activation (BA). BA focuses on improving mood by changing ineffective behaviors people engage in when depressed. The goals are to get active, engage in pleasant events, maintain both a routine and a values-driven lifestyle.

Types of Mood Disorders:

Persistent Depressive Disorder:	Ongoing low level of depression that can include the following symptoms: hopelessness, worthlessness, negative thoughts, low energy, loss of interest, isolation, and changes in sleep or appetite.
Major Depressive Disorder:	Severe depressive symptoms that occur nearly every day for at least two weeks.
Bipolar	Extreme mood swings of emotional highs (mania or hypomania) and lows (depression). Mood swings interfere with sleep, energy, thoughts, judgment, and activities.
Disruptive Mood Dysregulation Disorder:	For children up to 18 years old who experience extreme irritability, anger, and frequent outbursts.