Cognitive Behavioral Therapy

What is DBT?

DBT is a type of cognitive behavioral therapy (CBT) originally developed by Marsha Linehan. DBT is useful for someone having difficulty regulating emotions or challenged by depression, bipolar disorders and other mood disorders, and eating disorders.

How does DBT work?

Staff help patients learn how to accept uncomfortable or opposing thoughts and emotions, but also help patients realize where they have room for change.

DBT-informed skills you may develop in treatment include:

•  Mindfulness, or being present in your body and mind
•  Interpersonal effectiveness
•  Distress tolerance, or reacting in a wise manner, even if in distress
•  Emotion regulation to reduce or improve self-defeating or self-harming behaviors 

DBT helps patients increase compassionate, non-judgmental acceptance of themselves while learning how to do better in managing their life. It helps patients react in a wiser, more effective manner, even if feeling distressed.

DBT and DBT-informed skills are part of an increasing number of programs at Rogers, with a high level of fidelity, or compliance, being demonstrated in programs like our Nashotah Center for DBT Female Adolescent residential care.

What is behavioral activation?

As a treatment for depression and other mood disorders, behavioral activation is based on the theory that, as someone becomes depressed, you tend to increase avoidance and isolation, which serves to maintain or worsen your symptoms.

How does behavioral activation work?

Our goal is to gradually decrease a patient's avoidance and isolation and increase their engagement in activities which improve mood. This can include activities enjoyed before becoming depressed, activities related to a person's values or even everyday items that get pushed aside such as:

•     Exercising 
•     Going out to dinner 
•     Improving relationships with family members 
•     Working toward specific work-related goals 
•     Learning new skills and activities 
•     Showering regularly 
•     Completing household chores

This therapy often includes keeping a record of activities to better understand patterns and identify behaviors that help improve mood.

Additional strategies may help to gain the necessary skills to do various tasks and work toward goals while also managing uncomfortable emotions that may arise during activities when feeling depressed. Patients move on to increasingly challenging activities as they experience improvements in mood. We also work with to improve sleep and diet patterns which are often impacted by periods of depression.

What is Exposure and Response Prevention?

Exposure and response prevention (ERP) is is type of cognitive behavior therapy (CBT) and is the “treatment of choice” for obsessive-compulsive disorder (OCD). It involves gradually exposing someone to their obsessions and fears, while also preventing them from engaging in rituals that decrease anxiety in the short term but keep OCD symptoms present in the long term.  

Similar to ERP but slightly different, exposure-based CBT is used to treat anxiety disorders such as social anxiety, panic disorder, generalized anxiety disorder, and specific phobias.

How does ERP work?

Someone suffering from OCD experiences obsessions and compulsions. An obsession refers to a feared, oftentimes unrealistic situation that causes anxiety. Compulsions are repetitive behaviors used to reduce the anxiety brought on by the obsession. ERP helps you gradually face obsessions without engaging in compulsions or rituals using:

1. Exposure: gradual and repetitive exposure to a feared situation
2. Response prevention: avoiding the impulse to use a compulsive behavior

The goal of ERP is to be exposed to a feared situation while avoiding the compulsive behavior long enough that the anxiety decreases. For example, if you have to get out of your car every time you run over a pothole because you’re afraid you’ve hit someone, the treatment team may ask you drive down bumpy roads for longer and longer intervals each time, without checking your car. Over time, you realize you can drive safely and the likelihood that you’ve hit someone is very slim.

The process of anxiety reducing due to nothing but the passing of time is called habituation. Habituation is important because it helps patients learn that they can tolerate anxiety and do not need to complete their OCD rituals.

What is prolonged exposure?

Prolonged exposure is a type of cognitive behavioral therapy (CBT) which helps people with trauma (posttraumatic stress disorder) process single or multiple traumas or continuous trauma and reduce symptoms. The technique is also useful for decreasing depression, anger, and general anxiety.

How does prolonged exposure work?

After experiencing a traumatic event, a person's brain goes into a survival mode and tries to protect them by recognizing possible threats related to the trauma, ensuring the trauma won’t occur again. These threats may include people, places or anything else that reminds the person of the trauma-inducing event. 

Through individual therapy and assignments, prolonged exposure helps patients realize they can encounter stimuli that reminds them of the traumatic accident, assault, natural disaster or other event without fear. It also allows them to change their experiences with the event and find safety in their environment.

With prolonged exposure, patients learn:

• About common reactions to trauma and possible causes of your difficulties (psychoeducation)
• To re-visit or re-tell the traumatic memory (imaginal exposure)
• To gradually approach trauma reminders, such as feared situations or objects patients avoid, despite being safe. 

Patients manage the pace of their treatment and gradually take the steps they're ready to make. Many people who participate in prolonged exposure treatment show significant symptom reduction.