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, eating disorders and more.

How does DBT work?

Staff help you learn how to accept uncomfortable or opposing thoughts and emotions, but also help you realize where you 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 you increase your compassionate, non-judgmental acceptance of yourself while learning how to do better in managing your life. It helps you react in a wiser, more effective manner, even if feeling distressed.  While in treatment, you may record your DBT skills development or complete another form of homework between sessions.

DBT and DBT-informed skills are part of more and more treatment at Rogers, with a high level of fidelity, or compliance, being demonstrated in treatments like our    Nashotah Center for DBT Female Adolescent Residential Care.

What exactly 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 your avoidance and isolation and increase your engagement in activities which improve mood. This can include activities you enjoyed before becoming depressed, activities related to your 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 your mood.

Additional strategies may help you remember to complete assignments, gain the necessary skills to do various tasks and work toward your goals, while at the same time managing uncomfortable emotions that may arise during activities when you feel depressed. You move on to increasingly challenging activities as you experience improvements in mood. We also work with you to improve sleep and diet patterns which are often impacted by periods of depression.

What exactly is ERP?

ERP is a component of cognitive behavioral therapy (CBT) and considered the “treatment of choice” for obsessive-compulsive disorder (OCD). Also useful for treating other mental health conditions, such as phobias, panic disorders, generalized anxiety disorders and social anxieties, ERP is also becoming a key component of care for eating disorders at Rogers. This method gradually exposes a patient to feared thoughts, images or impulses and outcome studies show its effectiveness in reducing anxiety and distress over time.

How does ERP work?

If you or someone you know has OCD, you experience 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 confront obsessions and compulsions 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 expose yourself to your feared situation while you avoid your compulsive behavior long enough that your 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, your treatment team may ask that 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.

This way of reducing anxiety is called habituation. Habituation is important because it’s the point at which you no longer need your impulsive behavior to reduce your anxiety. You know that if you sit with your anxiety long enough, it will decrease on its own.

What exactly 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, your brain goes into a survival mode and tries to protect you by recognizing possible threats related to your trauma, ensuring the trauma won’t occur again. These threats may include people, places or anything else that reminds you of your trauma-inducing event. 

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

With prolonged exposure, you learn:

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

You manage the pace of your treatment and gradually take the steps you’re ready to make. Many people who participate in prolonged exposure treatment show significant symptom reduction.