James Donaldson on Mental Health - DBT: What Is Dialectical Behavior Therapy?

A treatment for children and teenagers with trouble managing emotions

Writer: Juliann Garey

Clinical Experts: Jill Emanuele, PhD , David Friedlander, PsyD , Lauren Allerhand, PsyD

https://www.youtube.com/watch?v=kJP-Kf6IhDQ&ab_channel=ChildMindInstitute

What You'll Learn

- What is DBT?
- How does DBT work?
- What is DBT used for?
- Quick Read
- Full Article
- Who is DBT for?
- Why is it called ‘dialectical’?
- A brief history of DBT
- How does DBT work?
- What are DBT skills?
- Why does DBT include phone coaching?
- Structured therapy sessions
- DBT, DMDD, and young children
- What happens after DBT?

DBT stands for dialectical behavior therapy. It’s an intensive, structured treatment for children and teens who have trouble handling their strong emotions. Being overwhelmed with emotion can cause a lot of problem behaviors,  including outbursts, aggression, self-harm, substance abuse, and suicidal thoughts.

DBT was first created to treat a condition called borderline personality disorder, but now it’s widely used to help kids with lots of issues that stem from having overwhelming and painful feelings — anxiety, depression, bipolar disorder, eating disorders, and drug abuse, among other diagnoses.

DBT works by combining two sets of skills. The first, called mindfulness, helps kids understand and accept difficult feelings without judgment. The second, a treatment called CBT (cognitive behavioral therapy), teaches them coping strategies to change unhelpful feelings and thought patterns.

DBT is often helpful for kids who have tried other forms of therapy, but need something more intensive, without being in-patient.

In DBT, patients participate in three things: one-on-one therapy, group skills training, and phone coaching from their therapist available 24/7 to help them handle difficult situations without self-destructive behaviors. Parents are taught the same skills the kids learn, so they can help their kids use them outside of  therapy sessions.

If you have a child with emotional or behavior problems, there’s a good chance you’ve heard of mindfulness or cognitive behavioral therapy (CBT), two different approaches to helping kids with anxiety and mood disorders. But there’s another very popular therapy that combines elements of both: DBT, or dialectical behavior therapy. DBT is an intensive, highly structured program that’s been adapted for children and adolescents with serious emotional instability, including self-harm and suicidal ideation.

Who is DBT for?

“DBT is best suited for people who have a core challenge with highly sensitive emotions, and it’s impairing their functioning,” explains Lauren Allerhand, PsyD, co-director of DBT programs at the Child Mind Institute. “The extreme emotions can cause a wide range of symptoms.”

Those symptoms might include explosive anger or outbursts, intense mood swings, physical aggression, conflict with parents and siblings, or impulsive behaviors like self-harm, substance abuse, or risky sex. “Many of these challenges can be viewed as the downstream effect of emotion dysregulation.”

While DBT was first developed to treat people diagnosed with borderline personality disorder, it is now being used to help kids with a wide range of diagnoses, including depression, anxiety, bipolar disorder, eating disorders, substance use disorders, and disruptive behavior disorders.  “Since there are many ways emotional dysregulation can present, DBT is a transdiagnostic treatment,” Dr. Allerhand says.

Why is it called ‘dialectical’?

DBT is “dialectical” because it works by simultaneously addressing two things that might seem contradictory: acceptance of feelings (mindfulness) and learning to use coping strategies to change unhelpful feelings and thought patterns (CBT). It’s basically “‘I’m doing the best I can’ on the one hand, and ‘I need to do better,’” notes Alec Miller, PsyD, a professor in the Department of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine.  “That’s a dialectical truth.”

A brief history of DBT

Dialectical behavior therapy was developed by Marsha Linehan, PhD, in the 1970s to treat adult borderline personality disorder — a disorder with symptoms that include emotional volatility, trouble with relationships, self-destructive behaviors and  suicidal thoughts. These patients were typically thought of as “difficult,” if not impossible, to treat. Dr. Linehan redefined the disorder, reframing it as a specific problem of the emotion regulation system that can be addressed with a structured intervention.

People with borderline personality disorder have trouble regulating their moods, which leads to impulsivity and conflict in interpersonal relationships. That, in turn, often leaves them feeling misunderstood by others around them. First, Dr. Linehan tried traditional CBT, which emphasizes using conscious thoughts to confront and change overwhelming emotions. She was unsuccessful with her patients. So she then tried an acceptance-based approach that came out of her meditation and mindfulness practice. This, too, failed.

“So then she had this brilliant epiphany,” says Dr. Miller. “Blending the acceptance strategies of mindfulness with the change technologies of CBT to create this dialectical behavior therapy.”

How does DBT work?

A comprehensive DBT program involves four components:

- Individual therapy
- Group skills training for managing intense emotions
- 24/7 access to phone coaching from the therapist to help kids and parents manage difficult situations using their skills
- Weekly team meetings for therapists to support each other and consult on their cases

For children and adolescents, parents are involved in skills training so they can encourage their child to use the skills they are learning in real-life situations. “The feedback from parents is, ‘Where have these skills been all my life? I need these skills too,’ ” says Jill Emanuele, PhD, a clinical psychologist who specializes in mood disorders.

The highly structured nature of DBT, combined with the therapists’ stance of acceptance, can make it especially helpful for some kids who have tried other treatment without success and need a higher level of intervention. “A comprehensive DBT program, while still at the outpatient level, is a step up, a more intensive treatment from your standard CBT, which might be a once-a-week therapy,” Dr. Allerhand notes. For some children, DBT offers an alternative to a residential program. Treatment usually lasts from 6 months to a year.

What are DBT skills?

DBT skills training is very structured. For adolescents and children, it consists of five modules:

- Mindfulness skills: Being present, accepting, and non-judgmental in the moment and understanding the signs of unregulated emotions.
- Emotion regulation skills: Coping with difficult situations by building pleasant, self-soothing experiences to protect from emotional extremes. “Especially with teenagers,” says Dr. Emanuele, “there’s a big focus on the physical body: eating properly, getting enough sleep, taking their medicine, and avoiding drug use.”
- Interpersonal effectiveness skills: “It’s often interactions with others that are the negative triggers for impulsive behaviors,” Dr. Emanuele says. The purpose is to teach adolescents how to interact more effectively with other people and enable them to feel more supported by others.
- Distress tolerance skills: “It’s being able to recognize urges to do things that would be ineffective, such as hurting themselves or trying to kill themselves” and consciously controlling them, says Dr. Emanuele. These skills are the crisis survival tools for the most challenging moments.
- Walking-the-middle-path skill: Kids and parents learn how to validate one another, how to compromise and negotiate, and how to see the other person’s side of things. “It has to do with acknowledging multiple truths in the teenagers’ and the parents’ worldview as opposed to ‘I’m right and you’re wrong,’” explains Dr. Miller.

Some clinicians who do individual therapy, but are not part of a comprehensive DBT program, use DBT principles and introduce DBT skills — what’s often called DBT-informed treatment. “That would probably look more like CBT with mindfulness and acceptance-based strategies woven in,” notes Dr. Allerhand, “and it would be probably once a week.”

Why does DBT include phone coaching?

One of the most unusual elements of DBT programs, phone coaching, is designed to support patients’ efforts to apply DBT skills in their lives outside the therapy session, something therapists call “skills generalization.”

As Dr. Allerhand puts it, “How do we actually help people to do the things that we talked about in session when they are in the moments of crisis?” Ideally, the patient calls the therapist when they are tempted to do something self-destructive, to get support in using their DBT skills instead. Emotion dysregulation also leads to ineffective problem solving, and phone coaching can help kids and parents utilize more constructive problem solving skills rather than falling into old, unhelpful patterns.

Structured therapy sessions

Therapy sessions in comprehensive DBT don’t hew to a step-by-step manual, but they do follow structured principles, Dr. Allerhand says.

Each individual therapy session is structured around a diary card that the patient brings to the session, which is like a weekly tracker of their emotions and their urges to engage in whatever their problematic behaviors are.

There is a hierarchy of behaviors: Target 1 are life-threatening behaviors. Target 2, therapy-interfering behaviors.  And Target 3, quality-of-life-interfering behaviors.

The therapist makes it a priority to focus on Target 1 behaviors, giving them the most time in a session. “The point is that you can’t ignore if they’re thinking about hurting or killing themselves,” Dr. Allerhand explains, “and talk about, the test that they got a B- on.”

DBT, DMDD, and young children

DBT programs treat kids as young as 6. Dr. Allerhand says that the younger kids they see include those diagnosed with disruptive mood dysregulation disorder (DMDD).DMDD is a relatively new diagnosis for children who have explosive tantrums — big and emotional responses that are out of proportion to the events that triggered them — and in between outbursts they usually continue to be irritable.

Some of these young kids have behaviors that we usually associate with teenagers — hurting themselves, talking about killing themselves, or trying to kill themselves. “Recent CDC data actually showed that there’s been an increase in suicide attempts and completed suicides for younger kids,“ she notes.

Referrals to a DBT-C program (one structured specifically for children ages 6-12) often happen, she adds, “when the behavior has become so problematic that parents are worried for the safety of the child or other members of the family, or school placement is in jeopardy.”

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

www.celebratingyourgiftoflife.com

Link for 40 Habits Signup
bit.ly/40HabitsofMentalHealth

If you'd like to follow and receive my daily blog in to your inbox, just click on it with Follow It. Here's the link https://follow.it/james-donaldson-s-standing-above-the-crowd-s-blog-a-view-from-above-on-things-that-make-the-world-go-round?action=followPub

What happens after DBT?

After the 6-12 months of the comprehensive DBT program, most patients continue with individual or family therapy.

“Once they’ve gained control over the behaviors that were really making their life worse, the dangerous behaviors,” Dr. Allerhand explains, “most people still have lots of other goals that they need to work on to truly make their life feel fulfilling rather than just tolerable.” Many continue to do the diary cards, and they are able to focus in therapy on the continuing barriers to them having the things that they want in their life.

Dr. Allerhand notes that, as that Marsha Linehan famously said, “DBT is not a suicide prevention program. It’s a life-worth-living treatment program.  The idea is that people who have the life that they want, the things that they want in their life, and the relationships they want, are much less likely to hurt themselves or kill themselves.”

Frequently Asked Questions

What does DBT stand for?

How does DBT work?

DBT works by combining two sets of skills. The first, called mindfulness, helps kids understand and accept difficult feelings. The second, a treatment called CBT (cognitive behavioral therapy), teaches them how to change their feelings and behavior.

What is DBT used to treat?

https://standingabovethecrowd.com/james-donaldson-on-mental-health-dbt-what-is-dialectical-behavior-therapy/

A treatment for children and teenagers with trouble managing emotions

Writer: Juliann Garey

Clinical Experts: Jill Emanuele, PhD , David Friedlander, PsyD , Lauren Allerhand, PsyD

https://www.youtube.com/watch?v=kJP-Kf6IhDQ&ab_channel=ChildMindInstitute

What You'll Learn

- What is DBT?

- How does DBT work?

- What is DBT used for?

- Quick Read

- Full Article

- Who is DBT for?

- Why is it called ‘dialectical’?

- A brief history of DBT

- How does DBT work?

- What are DBT skills?

- Why does DBT include phone coaching?

- Structured therapy sessions

- DBT, DMDD, and young children

- What happens after DBT?

DBT stands for dialectical behavior therapy. It’s an intensive, structured treatment for children and teens who have trouble handling their strong emotions. Being overwhelmed with emotion can cause a lot of problem behaviors,  including outbursts, aggression, self-harm, substance abuse, and suicidal thoughts.

DBT was first created to treat a condition called borderline personality disorder, but now it’s widely used to help kids with lots of issues that stem from having overwhelming and painful feelings — anxiety, depression, bipolar disorder, eating disorders, and drug abuse, among other diagnoses.

DBT works by combining two sets of skills. The first, called mindfulness, helps kids understand and accept difficult feelings without judgment. The second, a treatment called CBT (cognitive behavioral therapy), teaches them coping strategies to change unhelpful feelings and thought patterns.

DBT is often helpful for kids who have tried other forms of therapy, but need something more intensive, without being in-patient.

In DBT, patients participate in three things: one-on-one therapy, group skills training, and phone coaching from their therapist available 24/7 to help them handle difficult situations without self-destructive behaviors. Parents are taught the same skills the kids learn, so they can help their kids use them outside of  therapy sessions.

If you have a child with emotional or behavior problems, there’s a good chance you’ve heard of mindfulness or cognitive behavioral therapy (CBT), two different approaches to helping kids with anxiety and mood disorders. But there’s another very popular therapy that combines elements of both: DBT, or dialectical behavior therapy. DBT is an intensive, highly structured program that’s been adapted for children and adolescents with serious emotional instability, including self-harm and suicidal ideation.

Who is DBT for?

“DBT is best suited for people who have a core challenge with highly sensitive emotions, and it’s impairing their functioning,” explains Lauren Allerhand, PsyD, co-director of DBT programs at the Child Mind Institute. “The extreme emotions can cause a wide range of symptoms.”

Those symptoms might include explosive anger or outbursts, intense mood swings, physical aggression, conflict with parents and siblings, or impulsive behaviors like self-harm, substance abuse, or risky sex. “Many of these challenges can be viewed as the downstream effect of emotion dysregulation.”

While DBT was first developed to treat people diagnosed with borderline personality disorder, it is now being used to help kids with a wide range of diagnoses, including depression, anxiety, bipolar disorder, eating disorders, substance use disorders, and disruptive behavior disorders.  “Since there are many ways emotional dysregulation can present, DBT is a transdiagnostic treatment,” Dr. Allerhand says.

Why is it called ‘dialectical’?

DBT is “dialectical” because it works by simultaneously addressing two things that might seem contradictory: acceptance of feelings (mindfulness) and learning to use coping strategies to change unhelpful feelings and thought patterns (CBT). It’s basically “‘I’m doing the best I can’ on the one hand, and ‘I need to do better,’” notes Alec Miller, PsyD, a professor in the Department of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine.  “That’s a dialectical truth.”

A brief history of DBT

Dialectical behavior therapy was developed by Marsha Linehan, PhD, in the 1970s to treat adult borderline personality disorder — a disorder with symptoms that include emotional volatility, trouble with relationships, self-destructive behaviors and  suicidal thoughts. These patients were typically thought of as “difficult,” if not impossible, to treat. Dr. Linehan redefined the disorder, reframing it as a specific problem of the emotion regulation system that can be addressed with a structured intervention.

People with borderline personality disorder have trouble regulating their moods, which leads to impulsivity and conflict in interpersonal relationships. That, in turn, often leaves them feeling misunderstood by others around them. First, Dr. Linehan tried traditional CBT, which emphasizes using conscious thoughts to confront and change overwhelming emotions. She was unsuccessful with her patients. So she then tried an acceptance-based approach that came out of her meditation and mindfulness practice. This, too, failed.

“So then she had this brilliant epiphany,” says Dr. Miller. “Blending the acceptance strategies of mindfulness with the change technologies of CBT to create this dialectical behavior therapy.”

How does DBT work?

A comprehensive DBT program involves four components:

- Individual therapy

- Group skills training for managing intense emotions

- 24/7 access to phone coaching from the therapist to help kids and parents manage difficult situations using their skills

- Weekly team meetings for therapists to support each other and consult on their cases

For children and adolescents, parents are involved in skills training so they can encourage their child to use the skills they are learning in real-life situations. “The feedback from parents is, ‘Where have these skills been all my life? I need these skills too,’ ” says Jill Emanuele, PhD, a clinical psychologist who specializes in mood disorders.

The highly structured nature of DBT, combined with the therapists’ stance of acceptance, can make it especially helpful for some kids who have tried other treatment without success and need a higher level of intervention. “A comprehensive DBT program, while still at the outpatient level, is a step up, a more intensive treatment from your standard CBT, which might be a once-a-week therapy,” Dr. Allerhand notes. For some children, DBT offers an alternative to a residential program. Treatment usually lasts from 6 months to a year.

What are DBT skills?

DBT skills training is very structured. For adolescents and children, it consists of five modules:

- Mindfulness skills: Being present, accepting, and non-judgmental in the moment and understanding the signs of unregulated emotions.

- Emotion regulation skills: Coping with difficult situations by building pleasant, self-soothing experiences to protect from emotional extremes. “Especially with teenagers,” says Dr. Emanuele, “there’s a big focus on the physical body: eating properly, getting enough sleep, taking their medicine, and avoiding drug use.”

- Interpersonal effectiveness skills: “It’s often interactions with others that are the negative triggers for impulsive behaviors,” Dr. Emanuele says. The purpose is to teach adolescents how to interact more effectively with other people and enable them to feel more supported by others.

- Distress tolerance skills: “It’s being able to recognize urges to do things that would be ineffective, such as hurting themselves or trying to kill themselves” and consciously controlling them, says Dr. Emanuele. These skills are the crisis survival tools for the most challenging moments.

- Walking-the-middle-path skill: Kids and parents learn how to validate one another, how to compromise and negotiate, and how to see the other person’s side of things. “It has to do with acknowledging multiple truths in the teenagers’ and the parents’ worldview as opposed to ‘I’m right and you’re wrong,’” explains Dr. Miller.

Some clinicians who do individual therapy, but are not part of a comprehensive DBT program, use DBT principles and introduce DBT skills — what’s often called DBT-informed treatment. “That would probably look more like CBT with mindfulness and acceptance-based strategies woven in,” notes Dr. Allerhand, “and it would be probably once a week.”

Why does DBT include phone coaching?

One of the most unusual elements of DBT programs, phone coaching, is designed to support patients’ efforts to apply DBT skills in their lives outside the therapy session, something therapists call “skills generalization.”

As Dr. Allerhand puts it, “How do we actually help people to do the things that we talked about in session when they are in the moments of crisis?” Ideally, the patient calls the therapist when they are tempted to do something self-destructive, to get support in using their DBT skills instead. Emotion dysregulation also leads to ineffective problem solving, and phone coaching can help kids and parents utilize more constructive problem solving skills rather than falling into old, unhelpful patterns.

Structured therapy sessions

Therapy sessions in comprehensive DBT don’t hew to a step-by-step manual, but they do follow structured principles, Dr. Allerhand says.

Each individual therapy session is structured around a diary card that the patient brings to the session, which is like a weekly tracker of their emotions and their urges to engage in whatever their problematic behaviors are.

There is a hierarchy of behaviors: Target 1 are life-threatening behaviors. Target 2, therapy-interfering behaviors.  And Target 3, quality-of-life-interfering behaviors.

The therapist makes it a priority to focus on Target 1 behaviors, giving them the most time in a session. “The point is that you can’t ignore if they’re thinking about hurting or killing themselves,” Dr. Allerhand explains, “and talk about, the test that they got a B- on.”

DBT, DMDD, and young children

DBT programs treat kids as young as 6. Dr. Allerhand says that the younger kids they see include those diagnosed with disruptive mood dysregulation disorder (DMDD).DMDD is a relatively new diagnosis for children who have explosive tantrums — big and emotional responses that are out of proportion to the events that triggered them — and in between outbursts they usually continue to be irritable.

Some of these young kids have behaviors that we usually associate with teenagers — hurting themselves, talking about killing themselves, or trying to kill themselves. “Recent CDC data actually showed that there’s been an increase in suicide attempts and completed suicides for younger kids,“ she notes.

Referrals to a DBT-C program (one structured specifically for children ages 6-12) often happen, she adds, “when the behavior has become so problematic that parents are worried for the safety of the child or other members of the family, or school placement is in jeopardy.”

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

www.celebratingyourgiftoflife.com

Link for 40 Habits Signupbit.ly/40HabitsofMentalHealth

If you'd like to follow and receive my daily blog in to your inbox, just click on it with Follow It. Here's the link https://follow.it/james-donaldson-s-standing-above-the-crowd-s-blog-a-view-from-above-on-things-that-make-the-world-go-round?action=followPub

What happens after DBT?

After the 6-12 months of the comprehensive DBT program, most patients continue with individual or family therapy.

“Once they’ve gained control over the behaviors that were really making their life worse, the dangerous behaviors,” Dr. Allerhand explains, “most people still have lots of other goals that they need to work on to truly make their life feel fulfilling rather than just tolerable.” Many continue to do the diary cards, and they are able to focus in therapy on the continuing barriers to them having the things that they want in their life.

Dr. Allerhand notes that, as that Marsha Linehan famously said, “DBT is not a suicide prevention program. It’s a life-worth-living treatment program.  The idea is that people who have the life that they want, the things that they want in their life, and the relationships they want, are much less likely to hurt themselves or kill themselves.”

Frequently Asked Questions

What does DBT stand for?

How does DBT work?

DBT works by combining two sets of skills. The first, called mindfulness, helps kids understand and accept difficult feelings. The second, a treatment called CBT (cognitive behavioral therapy), teaches them how to change their feelings and behavior.

What is DBT used to treat? https://standingabovethecrowd.com/james-donaldson-on-mental-health-dbt-what-is-dialectical-behavior-therapy/

A treatment for children and teenagers with trouble managing emotions

Writer: Juliann Garey

Clinical Experts: Jill Emanuele, PhD , David Friedlander, PsyD , Lauren Allerhand, PsyD

https://www.youtube.com/watch?v=kJP-Kf6IhDQ&ab_channel=ChildMindInstitute

What You'll Learn

- What is DBT?

- How does DBT work?

- What is DBT used for?

- Quick Read

- Full Article

- Who is DBT for?

- Why is it called ‘dialectical’?

- A brief history of DBT

- How does DBT work?

- What are DBT skills?

- Why does DBT include phone coaching?

- Structured therapy sessions

- DBT, DMDD, and young children

- What happens after DBT?

DBT stands for dialectical behavior therapy. It’s an intensive, structured treatment for children and teens who have trouble handling their strong emotions. Being overwhelmed with emotion can cause a lot of problem behaviors,  including outbursts, aggression, self-harm, substance abuse, and suicidal thoughts.

DBT was first created to treat a condition called borderline personality disorder, but now it’s widely used to help kids with lots of issues that stem from having overwhelming and painful feelings — anxiety, depression, bipolar disorder, eating disorders, and drug abuse, among other diagnoses.

DBT works by combining two sets of skills. The first, called mindfulness, helps kids understand and accept difficult feelings without judgment. The second, a treatment called CBT (cognitive behavioral therapy), teaches them coping strategies to change unhelpful feelings and thought patterns.

DBT is often helpful for kids who have tried other forms of therapy, but need something more intensive, without being in-patient.

In DBT, patients participate in three things: one-on-one therapy, group skills training, and phone coaching from their therapist available 24/7 to help them handle difficult situations without self-destructive behaviors. Parents are taught the same skills the kids learn, so they can help their kids use them outside of  therapy sessions.

If you have a child with emotional or behavior problems, there’s a good chance you’ve heard of mindfulness or cognitive behavioral therapy (CBT), two different approaches to helping kids with anxiety and mood disorders. But there’s another very popular therapy that combines elements of both: DBT, or dialectical behavior therapy. DBT is an intensive, highly structured program that’s been adapted for children and adolescents with serious emotional instability, including self-harm and suicidal ideation.

Who is DBT for?

“DBT is best suited for people who have a core challenge with highly sensitive emotions, and it’s impairing their functioning,” explains Lauren Allerhand, PsyD, co-director of DBT programs at the Child Mind Institute. “The extreme emotions can cause a wide range of symptoms.”

Those symptoms might include explosive anger or outbursts, intense mood swings, physical aggression, conflict with parents and siblings, or impulsive behaviors like self-harm, substance abuse, or risky sex. “Many of these challenges can be viewed as the downstream effect of emotion dysregulation.”

While DBT was first developed to treat people diagnosed with borderline personality disorder, it is now being used to help kids with a wide range of diagnoses, including depression, anxiety, bipolar disorder, eating disorders, substance use disorders, and disruptive behavior disorders.  “Since there are many ways emotional dysregulation can present, DBT is a transdiagnostic treatment,” Dr. Allerhand says.

Why is it called ‘dialectical’?

DBT is “dialectical” because it works by simultaneously addressing two things that might seem contradictory: acceptance of feelings (mindfulness) and learning to use coping strategies to change unhelpful feelings and thought patterns (CBT). It’s basically “‘I’m doing the best I can’ on the one hand, and ‘I need to do better,’” notes Alec Miller, PsyD, a professor in the Department of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine.  “That’s a dialectical truth.”

A brief history of DBT

Dialectical behavior therapy was developed by Marsha Linehan, PhD, in the 1970s to treat adult borderline personality disorder — a disorder with symptoms that include emotional volatility, trouble with relationships, self-destructive behaviors and  suicidal thoughts. These patients were typically thought of as “difficult,” if not impossible, to treat. Dr. Linehan redefined the disorder, reframing it as a specific problem of the emotion regulation system that can be addressed with a structured intervention.

People with borderline personality disorder have trouble regulating their moods, which leads to impulsivity and conflict in interpersonal relationships. That, in turn, often leaves them feeling misunderstood by others around them. First, Dr. Linehan tried traditional CBT, which emphasizes using conscious thoughts to confront and change overwhelming emotions. She was unsuccessful with her patients. So she then tried an acceptance-based approach that came out of her meditation and mindfulness practice. This, too, failed.

“So then she had this brilliant epiphany,” says Dr. Miller. “Blending the acceptance strategies of mindfulness with the change technologies of CBT to create this dialectical behavior therapy.”

How does DBT work?

A comprehensive DBT program involves four components:

- Individual therapy

- Group skills training for managing intense emotions

- 24/7 access to phone coaching from the therapist to help kids and parents manage difficult situations using their skills

- Weekly team meetings for therapists to support each other and consult on their cases

For children and adolescents, parents are involved in skills training so they can encourage their child to use the skills they are learning in real-life situations. “The feedback from parents is, ‘Where have these skills been all my life? I need these skills too,’ ” says Jill Emanuele, PhD, a clinical psychologist who specializes in mood disorders.

The highly structured nature of DBT, combined with the therapists’ stance of acceptance, can make it especially helpful for some kids who have tried other treatment without success and need a higher level of intervention. “A comprehensive DBT program, while still at the outpatient level, is a step up, a more intensive treatment from your standard CBT, which might be a once-a-week therapy,” Dr. Allerhand notes. For some children, DBT offers an alternative to a residential program. Treatment usually lasts from 6 months to a year.

What are DBT skills?

DBT skills training is very structured. For adolescents and children, it consists of five modules:

- Mindfulness skills: Being present, accepting, and non-judgmental in the moment and understanding the signs of unregulated emotions.

- Emotion regulation skills: Coping with difficult situations by building pleasant, self-soothing experiences to protect from emotional extremes. “Especially with teenagers,” says Dr. Emanuele, “there’s a big focus on the physical body: eating properly, getting enough sleep, taking their medicine, and avoiding drug use.”

- Interpersonal effectiveness skills: “It’s often interactions with others that are the negative triggers for impulsive behaviors,” Dr. Emanuele says. The purpose is to teach adolescents how to interact more effectively with other people and enable them to feel more supported by others.

- Distress tolerance skills: “It’s being able to recognize urges to do things that would be ineffective, such as hurting themselves or trying to kill themselves” and consciously controlling them, says Dr. Emanuele. These skills are the crisis survival tools for the most challenging moments.

- Walking-the-middle-path skill: Kids and parents learn how to validate one another, how to compromise and negotiate, and how to see the other person’s side of things. “It has to do with acknowledging multiple truths in the teenagers’ and the parents’ worldview as opposed to ‘I’m right and you’re wrong,’” explains Dr. Miller.

Some clinicians who do individual therapy, but are not part of a comprehensive DBT program, use DBT principles and introduce DBT skills — what’s often called DBT-informed treatment. “That would probably look more like CBT with mindfulness and acceptance-based strategies woven in,” notes Dr. Allerhand, “and it would be probably once a week.”

Why does DBT include phone coaching?

One of the most unusual elements of DBT programs, phone coaching, is designed to support patients’ efforts to apply DBT skills in their lives outside the therapy session, something therapists call “skills generalization.”

As Dr. Allerhand puts it, “How do we actually help people to do the things that we talked about in session when they are in the moments of crisis?” Ideally, the patient calls the therapist when they are tempted to do something self-destructive, to get support in using their DBT skills instead. Emotion dysregulation also leads to ineffective problem solving, and phone coaching can help kids and parents utilize more constructive problem solving skills rather than falling into old, unhelpful patterns.

Structured therapy sessions

Therapy sessions in comprehensive DBT don’t hew to a step-by-step manual, but they do follow structured principles, Dr. Allerhand says.

Each individual therapy session is structured around a diary card that the patient brings to the session, which is like a weekly tracker of their emotions and their urges to engage in whatever their problematic behaviors are.

There is a hierarchy of behaviors: Target 1 are life-threatening behaviors. Target 2, therapy-interfering behaviors.  And Target 3, quality-of-life-interfering behaviors.

The therapist makes it a priority to focus on Target 1 behaviors, giving them the most time in a session. “The point is that you can’t ignore if they’re thinking about hurting or killing themselves,” Dr. Allerhand explains, “and talk about, the test that they got a B- on.”

DBT, DMDD, and young children

DBT programs treat kids as young as 6. Dr. Allerhand says that the younger kids they see include those diagnosed with disruptive mood dysregulation disorder (DMDD).DMDD is a relatively new diagnosis for children who have explosive tantrums — big and emotional responses that are out of proportion to the events that triggered them — and in between outbursts they usually continue to be irritable.

Some of these young kids have behaviors that we usually associate with teenagers — hurting themselves, talking about killing themselves, or trying to kill themselves. “Recent CDC data actually showed that there’s been an increase in suicide attempts and completed suicides for younger kids,“ she notes.

Referrals to a DBT-C program (one structured specifically for children ages 6-12) often happen, she adds, “when the behavior has become so problematic that parents are worried for the safety of the child or other members of the family, or school placement is in jeopardy.”

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

www.celebratingyourgiftoflife.com

Link for 40 Habits Signupbit.ly/40HabitsofMentalHealth

If you'd like to follow and receive my daily blog in to your inbox, just click on it with Follow It. Here's the link https://follow.it/james-donaldson-s-standing-above-the-crowd-s-blog-a-view-from-above-on-things-that-make-the-world-go-round?action=followPub

What happens after DBT?

After the 6-12 months of the comprehensive DBT program, most patients continue with individual or family therapy.

“Once they’ve gained control over the behaviors that were really making their life worse, the dangerous behaviors,” Dr. Allerhand explains, “most people still have lots of other goals that they need to work on to truly make their life feel fulfilling rather than just tolerable.” Many continue to do the diary cards, and they are able to focus in therapy on the continuing barriers to them having the things that they want in their life.

Dr. Allerhand notes that, as that Marsha Linehan famously said, “DBT is not a suicide prevention program. It’s a life-worth-living treatment program.  The idea is that people who have the life that they want, the things that they want in their life, and the relationships they want, are much less likely to hurt themselves or kill themselves.”

Frequently Asked Questions

What does DBT stand for?

How does DBT work?

DBT works by combining two sets of skills. The first, called mindfulness, helps kids understand and accept difficult feelings. The second, a treatment called CBT (cognitive behavioral therapy), teaches them how to change their feelings and behavior.

What is DBT used to treat? https://standingabovethecrowd.com/?p=13658

James Donaldson on Mental Health - Anxiety and Being Kind to Yourself

How self-compassion can help parents (and anyone else) manage anxiety

This is an excerpt from The Anxiety Sisters Survival Guide: How You Can Become More Hopeful, Connected, and Happy, by Abbe Greenberg and Maggie Sarachek. 

When we say, “Be kind,” we’re not talking about being nice to others (although that’s always a good idea); we’re talking about being kind to yourself. This is no easy task — we are often much quicker to be kind to everyone else but ourselves. Recognizing this, Kristin Neff, a researcher and professor at the University of Texas at Austin (and with whom we were fortunate enough to have trained), developed the concept of self-compassion, which is giving ourselves the same kindness and understanding we would offer a friend who is experiencing difficulty.

Typically, when we’re having a hard time, we tend to beat ourselves up about it. Our inner critics are all too eager to remind us how we’ve failed (once again):

I feel like a terrible person because I always blow up at my kids when I’m anxious. I let the worst parts of me take over. (Gillian, age 44)

I really want to visit my son, but I am too afraid to make the drive. I feel like such a failure. (Reyna, age 55)

Self-compassion is all about turning our inner critics into our inner advocates. Instead of reprimanding ourselves, self-compassion suggests we offer ourselves unconditional acceptance and supportive self- talk. For example, we can practice self- compassion by saying something like: “Anxiety is a real struggle for me, and this has been really painful.” 

Self-compassion, as conceptualized by Dr. Neff, comprises three components: (1) self- kindness, (2) common humanity, and (3) mindfulness. We’ve already covered self-kindness, which is all about treating yourself gently and compassionately, as you would a good friend. Common humanity is the understanding that we all struggle with challenges and that none of us live a life without pain. Suffering is part of what it means to be human — nobody gets out unscathed. When we truly accept our common humanity, we realize how connected we all are. Our trials are not unique, and we are not alone.

Self-compassion, then, allows us to transform a sense of isolation into connectedness when we are suffering. Common humanity is such a valuable notion because we all know how lonely it is to live with an anxiety disorder.

I thought I was the only one who had trouble leaving the house. I was so embarrassed about it — I wouldn’t talk about my anxiety with anyone. When I learned that agoraphobia was an actual thing, and that other people had it too, it was like the weight of the world was lifted off me. (Natalie, age 63)

The root of self-compassion is mindfulness, which is defined as being completely open to whatever it is you are feeling or thinking in a given moment. Many of us are uncomfortable sitting with our emotions because we are scared they will swallow us whole. Mindfulness teaches us not to push away or try to suppress our emotions. 

Another aspect of mindfulness is recognizing that your thoughts and feelings are not a permanent state — that they too will pass. Understanding the transient nature of thoughts and emotions helps us stay off the hamster wheel of exaggeration — when your mind goes right to “This is the worst thing ever” or “I’ll never feel better.” If we believe that no emotional state lasts forever, then we are better able to tolerate pain and suffering. Once we can tolerate our pain and suffering (by using self-compassion), we can proceed to soothe ourselves.

Self-compassion is not only about making yourself feel better. It’s also about empowering yourself to take action. When we aren’t caught up in the denial spiral or stuck on the exaggeration hamster wheel, we free up our rational brain to help us problem-solve. For science wonks, the limbic system is calmed, the prefrontal cortex can be engaged.

In terms of motivation to change behavior, self-compassion is a far better choice than self-criticism, which releases stress hormones and lowers resilience. How has berating yourself helped you manage your anxiety? We’re guessing not so well. Self-compassion allows you to be less afraid of failure and judgment, which results in your being better able to take risks.

Studies show that self-compassion makes us less self-indulgent, more accountable, and more likely to change our behavior. It also makes us more resilient. But most important for us, research shows that self-compassion is correlated with decreased anxiety and depression.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Link for 40 Habits Signup
bit.ly/40HabitsofMentalHealth

If you'd like to follow and receive my daily blog in to your inbox, just click on it with Follow It. Here's the link https://follow.it/james-donaldson-s-standing-above-the-crowd-s-blog-a-view-from-above-on-things-that-make-the-world-go-round?action=followPub

So how can we use self-compassion to manage our anxiety? As we said earlier, we start by talking very gently to ourselves and disengaging our inner critics. If you catch yourself thinking, “I’m a total mess,” try: “Anxiety is part of the human experience, and sometimes it feels messy.” Replace “Things will never get better” with: “I’m suffering right now, but I won’t always feel this way.”

After you have silenced your inner critic and given yourself some compassion, you can then ask yourself, “What do I need right now?” In other words, do you need to be alone? With others? An action plan? A hug? A bath? A walk? Do you need to enlist other resources, like a therapist or the advice of a close friend?

Finally, remind yourself that everyone experiences suffering — that what you are going through is valid and very human. Give yourself permission to feel anxious, because all humans feel anxious sometimes; then, with the love and compassion you absolutely deserve, tell yourself you will be okay.

https://standingabovethecrowd.com/james-donaldson-on-mental-health-anxiety-and-being-kind-to-yourself/

How self-compassion can help parents (and anyone else) manage anxiety

This is an excerpt from The Anxiety Sisters Survival Guide: How You Can Become More Hopeful, Connected, and Happy, by Abbe Greenberg and Maggie Sarachek. 

When we say, “Be kind,” we’re not talking about being nice to others (although that’s always a good idea); we’re talking about being kind to yourself. This is no easy task — we are often much quicker to be kind to everyone else but ourselves. Recognizing this, Kristin Neff, a researcher and professor at the University of Texas at Austin (and with whom we were fortunate enough to have trained), developed the concept of self-compassion, which is giving ourselves the same kindness and understanding we would offer a friend who is experiencing difficulty.

Typically, when we’re having a hard time, we tend to beat ourselves up about it. Our inner critics are all too eager to remind us how we’ve failed (once again):

I feel like a terrible person because I always blow up at my kids when I’m anxious. I let the worst parts of me take over. (Gillian, age 44)

I really want to visit my son, but I am too afraid to make the drive. I feel like such a failure. (Reyna, age 55)

Self-compassion is all about turning our inner critics into our inner advocates. Instead of reprimanding ourselves, self-compassion suggests we offer ourselves unconditional acceptance and supportive self- talk. For example, we can practice self- compassion by saying something like: “Anxiety is a real struggle for me, and this has been really painful.” 

Self-compassion, as conceptualized by Dr. Neff, comprises three components: (1) self- kindness, (2) common humanity, and (3) mindfulness. We’ve already covered self-kindness, which is all about treating yourself gently and compassionately, as you would a good friend. Common humanity is the understanding that we all struggle with challenges and that none of us live a life without pain. Suffering is part of what it means to be human — nobody gets out unscathed. When we truly accept our common humanity, we realize how connected we all are. Our trials are not unique, and we are not alone.

Self-compassion, then, allows us to transform a sense of isolation into connectedness when we are suffering. Common humanity is such a valuable notion because we all know how lonely it is to live with an anxiety disorder.

I thought I was the only one who had trouble leaving the house. I was so embarrassed about it — I wouldn’t talk about my anxiety with anyone. When I learned that agoraphobia was an actual thing, and that other people had it too, it was like the weight of the world was lifted off me. (Natalie, age 63)

The root of self-compassion is mindfulness, which is defined as being completely open to whatever it is you are feeling or thinking in a given moment. Many of us are uncomfortable sitting with our emotions because we are scared they will swallow us whole. Mindfulness teaches us not to push away or try to suppress our emotions. 

Another aspect of mindfulness is recognizing that your thoughts and feelings are not a permanent state — that they too will pass. Understanding the transient nature of thoughts and emotions helps us stay off the hamster wheel of exaggeration — when your mind goes right to “This is the worst thing ever” or “I’ll never feel better.” If we believe that no emotional state lasts forever, then we are better able to tolerate pain and suffering. Once we can tolerate our pain and suffering (by using self-compassion), we can proceed to soothe ourselves.

Self-compassion is not only about making yourself feel better. It’s also about empowering yourself to take action. When we aren’t caught up in the denial spiral or stuck on the exaggeration hamster wheel, we free up our rational brain to help us problem-solve. For science wonks, the limbic system is calmed, the prefrontal cortex can be engaged.

In terms of motivation to change behavior, self-compassion is a far better choice than self-criticism, which releases stress hormones and lowers resilience. How has berating yourself helped you manage your anxiety? We’re guessing not so well. Self-compassion allows you to be less afraid of failure and judgment, which results in your being better able to take risks.

Studies show that self-compassion makes us less self-indulgent, more accountable, and more likely to change our behavior. It also makes us more resilient. But most important for us, research shows that self-compassion is correlated with decreased anxiety and depression.

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Link for 40 Habits Signupbit.ly/40HabitsofMentalHealth

If you'd like to follow and receive my daily blog in to your inbox, just click on it with Follow It. Here's the link https://follow.it/james-donaldson-s-standing-above-the-crowd-s-blog-a-view-from-above-on-things-that-make-the-world-go-round?action=followPub

So how can we use self-compassion to manage our anxiety? As we said earlier, we start by talking very gently to ourselves and disengaging our inner critics. If you catch yourself thinking, “I’m a total mess,” try: “Anxiety is part of the human experience, and sometimes it feels messy.” Replace “Things will never get better” with: “I’m suffering right now, but I won’t always feel this way.”

After you have silenced your inner critic and given yourself some compassion, you can then ask yourself, “What do I need right now?” In other words, do you need to be alone? With others? An action plan? A hug? A bath? A walk? Do you need to enlist other resources, like a therapist or the advice of a close friend?

Finally, remind yourself that everyone experiences suffering — that what you are going through is valid and very human. Give yourself permission to feel anxious, because all humans feel anxious sometimes; then, with the love and compassion you absolutely deserve, tell yourself you will be okay. https://standingabovethecrowd.com/?p=13716

James Donaldson on Mental Health - The Art and Science of Mindfulness

How and why it helps us feel better and be mentally healthier

Clinical Experts: Allison Baker, MD , Cameron Craddock, PhD

- What is mindfulness?
- How is mindful meditation different from other kinds of meditation?
- Mindfulness: Exercise for your brain
- How is mindfulness used clinically?
- How does mindfulness change your brain?
- How being mindful can change your life

There is nothing touchy-feely or New Age-y about Dan Harris, an ABC News correspondent and Nightline anchor who has covered mass shootings, natural disasters and the war in Iraq. But an on-camera panic attack 10 years ago led Harris to discover mindfulness. Specifically mindful meditation. And now he’s a convert.

Harris wrote a book called 10% Happier. And in case that sounds too touchy-feely he subtitled it: How I Tamed the Voice in My Head, Reduced Stress Without Losing My Edge and Found Self-Help That Really Works—a True Story. He now travels the globe extoling the virtues of mindfulness meditation. He says it changed his life and claims mindfulness can change your life and the lives of your kids, too.

What is mindfulness?

Mindfulness as we know it — and it’s being tried out by everyone from elite athletes to corporate executives — was conceived as a therapeutic practice over 30 years ago by a scientist named Jon Kabat-Zinn. He defines mindfulness simply as “paying attention in a particular way: on purpose, in the present moment and non-judgmentally.”

That’s the short version. To expand on that just a little, mindfulness is a meditation practice that begins with paying attention to breathing in order to focus on the here and now — not what might have been or what you’re worried could be. The ultimate goal is to give you enough distance from disturbing thoughts and emotions to be able to observe them without immediately reacting to them.

Harris has an appealingly pragmatic way of explaining mindfulness. “Mindfulness is the ability to see what’s going in your head,” Harris says, “combined with the ability to not get carried away with it.”

In the last few years mindfulness has emerged as a way of treating children and adolescents with conditions ranging from ADHD to anxiety, autism spectrum disorders, depression and stress. Dr. Allison Baker, a child and adolescent psychiatrist, says that mindfulness can play a significant role in managing anxious or negative thoughts. “It helps you step back and look at that thought as just a thought, as opposed to a reality,” she says. “That in turn allows you to have a little distance and not necessarily engage in that thought and get agitated about it, or have your sleep disrupted because of it.”

Adolescents who practice mindfulness regularly develop that ability to self-regulate and put distance between the intensity of their emotions and the way in which they react to them — in particular how they engage in or react to negative, difficult or stressful thoughts. Acquiring that sense of self-control in itself is empowering, and it can help kids avoid unhealthy or dangerous responses.

How is mindful meditation different from other kinds of meditation?

The word “meditation” describes a wide variety of activities, many of which have little in common. “It’s kind of like the using the term ‘sports,’” says Harris. “Badminton and water polo have nothing to do with each other. Meditation describes a whole range of activities, some of which are designed to boost your mindfulness muscle and others are not.”

Mindfulness involves paying close attention to whatever you are doing in the present moment — breathing, eating, brushing your teeth, feeling your feet on the ground and smelling the air if you’re outside taking a walk. Mindfulness, Harris says, can be achieved through meditation and it can be achieved by paying close attention to daily activities. “But in my opinion, meditation is the best way to get there,” he says.

Mindfulness: Exercise for your brain

Harris doesn’t pretend that meditation is the magic bullet that will solve all your problems. But there’s a lot it can help with and it doesn’t require a huge time commitment.

In fact, Harris says, you can derive most of the benefits of mindfulness just by sitting quietly for even five to ten minutes a day, paying attention to your breathing and noticing the thoughts and feelings you experience. As your mind wanders — and you can expect your mind to wander constantly — you bring it back to the breath. That is what you’re practicing. Mindfulness, Harris explains, “is mental exercise. You’re trying to focus on one thing at a time — usually your breath. Then you get lost and you start over. And every time you start over, that is a bicep curl for your brain.”

How is mindfulness used clinically?

Dr. Baker has increasingly incorporated mindfulness into her clinical practice for kids and adolescents with a variety of psychiatric diagnoses. It gives kids and parents the opportunity to put time and space between their emotions and their thoughts — between feeling and reacting. Dr. Baker says mindfulness can be used for a whole host of challenges, including attention and impulsivity issues, anxiety, depression, and PTSD, among others.

The whole point of mindfulness is not to do away with particular thoughts, including negative ones, but to develop a different, non-judgmental relationship to them — to understand that they are feelings but they are not you. In Dr. Baker’s experience, parents and kids who practice mindfulness derive benefits regardless of their diagnosis. “Over time,” Dr. Baker says, “it means that they then have choices about how they want to engage with or react to that thought and that’s very powerful clinically because they actually feel that they have control. It really has incredible benefits in terms of their happiness, their ability to get a better night’s sleep, their ability to not sweat a test. It’s really powerful.”

How does mindfulness change your brain?

Dr. Cameron Craddock, the Child Mind Institute’s director of imaging, says studies on mindfulness have increased substantially in the last few years. “There’s still a lot that we don’t know about how it works, but what my research is showing is that there is a brain network, we call it the default network, that is constantly active when we have these ruminative or perseverative thoughts, thoughts that can be very deleterious.”

Rumination means compulsively focusing on bad feelings and experiences. And perseveration means repeating the same response over and over. Both of them are common symptoms of depression and anxiety among other psychiatric diagnoses.

“This default network,” Dr. Craddock notes, “is typically turned off when we are performing an external, goal-driven task. For example if you asked someone to do calculus, that network would turn off — hopefully. And what we’ve shown is that if that network doesn’t stay off during the performance of that task you can’t perform that task as well.”

Dr. Craddock says that when they first began to see this phenomenon, they thought of it as an attentional deficit. “Initially,” he says, “it showed up a lot in ADHD and was attributed to attention. Now we’re seeing it in major depression, we’re seeing it in anxiety, in social anxiety, with PTSD, over and over again.”

It turns out that these intrusive, repetitive thoughts are looking more and more like an inability to regulate this default network in the brain. People who practice mindfulness regularly develop the ability to turn it off when they want to and turn it back on when they need to perform the tasks that require using it. “The key,” he says, “is to be able to maintain the balance, and we’re proving that mindfulness allows us to do that.”

Or as Dan Harris likes to put it, “Another way to think about it is getting out of your own way. It’s hard to open a jar when every muscle in your arm is tight, and we are constantly doing the mental equivalent of that. We are constantly getting in our own way, tripping ourselves up with these thoughts.”

With mindfulness, he says, “They’re going to continue to come, but you can develop a different relationship to them.”

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Link for 40 Habits Signup
bit.ly/40HabitsofMentalHealth

If you'd like to follow and receive my daily blog in to your inbox, just click on it with Follow It. Here's the link https://follow.it/james-donaldson-s-standing-above-the-crowd-s-blog-a-view-from-above-on-things-that-make-the-world-go-round?action=followPub

How being mindful can change your life

Why practice mindfulness? Aside from the fact that if you’re anxious or depressed, it’s likely to make you less so, Harris says, “the reason to do it, for a beginner, is that most of the things that you’re embarrassed by in your life are done out of mindlessness.” Harris says mindlessness for him meant, “Going to war zones, coming home and getting depressed, not even knowing I was depressed, and then mindlessly self-medicating.”

For other people it may be starting arguments without thinking, constantly checking your phone when you should be paying attention to your kid or eating while watching TV. “What mindfulness does is act as kind of kryptonite for these impulses,” Harris says. “So most of the time we’re unaware of this nonstop conversation we’re having with ourselves. And as a consequence, we’re yanked around by it. Mindfulness, is just the ability to see what’s going on in your head without getting carried away by it.”

Interestingly, Harris admits that mindfulness has also made him feel his feelings more acutely — even the negative ones. But he says that’s not necessarily a bad thing.

“There’s a reason that they call feelings, feelings,” he says. And that includes his initial response to things like anger. “You might notice that your chest is buzzing, your ears are turning red or whatever. And so for me in those moments of annoyance or anger the initial moment of suffering is actually more acute because I’m right there with it. But it’s a good early warning system. I’m aware of what’s happening and therefor there’s a buffer between the immediate stimulus and my blind reaction to it.”

And that is the ultimate goal of mindfulness. To provide you with a psychological and emotional buffer where previously there was none. As always, Harris avoids getting too warm and fuzzy about the subject but he will say this: “Most mediation clichés make me want to put a pencil through my eye, but there is one cliché that I like, which is that mindfulness teaches you how to respond wisely instead of reacting blindly. That is a super power. It changes the whole game.”

https://standingabovethecrowd.com/james-donaldson-on-mental-health-the-art-and-science-of-mindfulness/

How and why it helps us feel better and be mentally healthier

Clinical Experts: Allison Baker, MD , Cameron Craddock, PhD

- What is mindfulness?

- How is mindful meditation different from other kinds of meditation?

- Mindfulness: Exercise for your brain

- How is mindfulness used clinically?

- How does mindfulness change your brain?

- How being mindful can change your life

There is nothing touchy-feely or New Age-y about Dan Harris, an ABC News correspondent and Nightline anchor who has covered mass shootings, natural disasters and the war in Iraq. But an on-camera panic attack 10 years ago led Harris to discover mindfulness. Specifically mindful meditation. And now he’s a convert.

Harris wrote a book called 10% Happier. And in case that sounds too touchy-feely he subtitled it: How I Tamed the Voice in My Head, Reduced Stress Without Losing My Edge and Found Self-Help That Really Works—a True Story. He now travels the globe extoling the virtues of mindfulness meditation. He says it changed his life and claims mindfulness can change your life and the lives of your kids, too.

What is mindfulness?

Mindfulness as we know it — and it’s being tried out by everyone from elite athletes to corporate executives — was conceived as a therapeutic practice over 30 years ago by a scientist named Jon Kabat-Zinn. He defines mindfulness simply as “paying attention in a particular way: on purpose, in the present moment and non-judgmentally.”

That’s the short version. To expand on that just a little, mindfulness is a meditation practice that begins with paying attention to breathing in order to focus on the here and now — not what might have been or what you’re worried could be. The ultimate goal is to give you enough distance from disturbing thoughts and emotions to be able to observe them without immediately reacting to them.

Harris has an appealingly pragmatic way of explaining mindfulness. “Mindfulness is the ability to see what’s going in your head,” Harris says, “combined with the ability to not get carried away with it.”

In the last few years mindfulness has emerged as a way of treating children and adolescents with conditions ranging from ADHD to anxiety, autism spectrum disorders, depression and stress. Dr. Allison Baker, a child and adolescent psychiatrist, says that mindfulness can play a significant role in managing anxious or negative thoughts. “It helps you step back and look at that thought as just a thought, as opposed to a reality,” she says. “That in turn allows you to have a little distance and not necessarily engage in that thought and get agitated about it, or have your sleep disrupted because of it.”

Adolescents who practice mindfulness regularly develop that ability to self-regulate and put distance between the intensity of their emotions and the way in which they react to them — in particular how they engage in or react to negative, difficult or stressful thoughts. Acquiring that sense of self-control in itself is empowering, and it can help kids avoid unhealthy or dangerous responses.

How is mindful meditation different from other kinds of meditation?

The word “meditation” describes a wide variety of activities, many of which have little in common. “It’s kind of like the using the term ‘sports,’” says Harris. “Badminton and water polo have nothing to do with each other. Meditation describes a whole range of activities, some of which are designed to boost your mindfulness muscle and others are not.”

Mindfulness involves paying close attention to whatever you are doing in the present moment — breathing, eating, brushing your teeth, feeling your feet on the ground and smelling the air if you’re outside taking a walk. Mindfulness, Harris says, can be achieved through meditation and it can be achieved by paying close attention to daily activities. “But in my opinion, meditation is the best way to get there,” he says.

Mindfulness: Exercise for your brain

Harris doesn’t pretend that meditation is the magic bullet that will solve all your problems. But there’s a lot it can help with and it doesn’t require a huge time commitment.

In fact, Harris says, you can derive most of the benefits of mindfulness just by sitting quietly for even five to ten minutes a day, paying attention to your breathing and noticing the thoughts and feelings you experience. As your mind wanders — and you can expect your mind to wander constantly — you bring it back to the breath. That is what you’re practicing. Mindfulness, Harris explains, “is mental exercise. You’re trying to focus on one thing at a time — usually your breath. Then you get lost and you start over. And every time you start over, that is a bicep curl for your brain.”

How is mindfulness used clinically?

Dr. Baker has increasingly incorporated mindfulness into her clinical practice for kids and adolescents with a variety of psychiatric diagnoses. It gives kids and parents the opportunity to put time and space between their emotions and their thoughts — between feeling and reacting. Dr. Baker says mindfulness can be used for a whole host of challenges, including attention and impulsivity issues, anxiety, depression, and PTSD, among others.

The whole point of mindfulness is not to do away with particular thoughts, including negative ones, but to develop a different, non-judgmental relationship to them — to understand that they are feelings but they are not you. In Dr. Baker’s experience, parents and kids who practice mindfulness derive benefits regardless of their diagnosis. “Over time,” Dr. Baker says, “it means that they then have choices about how they want to engage with or react to that thought and that’s very powerful clinically because they actually feel that they have control. It really has incredible benefits in terms of their happiness, their ability to get a better night’s sleep, their ability to not sweat a test. It’s really powerful.”

How does mindfulness change your brain?

Dr. Cameron Craddock, the Child Mind Institute’s director of imaging, says studies on mindfulness have increased substantially in the last few years. “There’s still a lot that we don’t know about how it works, but what my research is showing is that there is a brain network, we call it the default network, that is constantly active when we have these ruminative or perseverative thoughts, thoughts that can be very deleterious.”

Rumination means compulsively focusing on bad feelings and experiences. And perseveration means repeating the same response over and over. Both of them are common symptoms of depression and anxiety among other psychiatric diagnoses.

“This default network,” Dr. Craddock notes, “is typically turned off when we are performing an external, goal-driven task. For example if you asked someone to do calculus, that network would turn off — hopefully. And what we’ve shown is that if that network doesn’t stay off during the performance of that task you can’t perform that task as well.”

Dr. Craddock says that when they first began to see this phenomenon, they thought of it as an attentional deficit. “Initially,” he says, “it showed up a lot in ADHD and was attributed to attention. Now we’re seeing it in major depression, we’re seeing it in anxiety, in social anxiety, with PTSD, over and over again.”

It turns out that these intrusive, repetitive thoughts are looking more and more like an inability to regulate this default network in the brain. People who practice mindfulness regularly develop the ability to turn it off when they want to and turn it back on when they need to perform the tasks that require using it. “The key,” he says, “is to be able to maintain the balance, and we’re proving that mindfulness allows us to do that.”

Or as Dan Harris likes to put it, “Another way to think about it is getting out of your own way. It’s hard to open a jar when every muscle in your arm is tight, and we are constantly doing the mental equivalent of that. We are constantly getting in our own way, tripping ourselves up with these thoughts.”

With mindfulness, he says, “They’re going to continue to come, but you can develop a different relationship to them.”

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Link for 40 Habits Signupbit.ly/40HabitsofMentalHealth

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How being mindful can change your life

Why practice mindfulness? Aside from the fact that if you’re anxious or depressed, it’s likely to make you less so, Harris says, “the reason to do it, for a beginner, is that most of the things that you’re embarrassed by in your life are done out of mindlessness.” Harris says mindlessness for him meant, “Going to war zones, coming home and getting depressed, not even knowing I was depressed, and then mindlessly self-medicating.”

For other people it may be starting arguments without thinking, constantly checking your phone when you should be paying attention to your kid or eating while watching TV. “What mindfulness does is act as kind of kryptonite for these impulses,” Harris says. “So most of the time we’re unaware of this nonstop conversation we’re having with ourselves. And as a consequence, we’re yanked around by it. Mindfulness, is just the ability to see what’s going on in your head without getting carried away by it.”

Interestingly, Harris admits that mindfulness has also made him feel his feelings more acutely — even the negative ones. But he says that’s not necessarily a bad thing.

“There’s a reason that they call feelings, feelings,” he says. And that includes his initial response to things like anger. “You might notice that your chest is buzzing, your ears are turning red or whatever. And so for me in those moments of annoyance or anger the initial moment of suffering is actually more acute because I’m right there with it. But it’s a good early warning system. I’m aware of what’s happening and therefor there’s a buffer between the immediate stimulus and my blind reaction to it.”

And that is the ultimate goal of mindfulness. To provide you with a psychological and emotional buffer where previously there was none. As always, Harris avoids getting too warm and fuzzy about the subject but he will say this: “Most mediation clichés make me want to put a pencil through my eye, but there is one cliché that I like, which is that mindfulness teaches you how to respond wisely instead of reacting blindly. That is a super power. It changes the whole game.” https://standingabovethecrowd.com/james-donaldson-on-mental-health-the-art-and-science-of-mindfulness/

Authors

- Marcos del Pozo Banos Senior Research Data Analyst, Swansea University

- Ann John Clinical Professor of Public Health and Psychiatry, Swansea University

- Tania Gergel Honorary Senior Research Fellow, Division of Psychiatry and Director of Research at Bipolar UK, UCL

Disclosure statement

Marcos del Pozo Banos research is funded by UKRI – Medical Research Council through the DATAMIND Hub (MRC reference: MR/W014386/1), and the Wolfson Centre for Young People's Mental Health (established with support from the Wolfson Foundation).

Ann John receives funding from Health and Care Research Wales, NIHR, Wolfson Foundation and MRC (DATAMIND).

Tania Gergel works for Bipolar UK as the Director of Research. She receives research funding from National Institute of Health Research, the Medical Research Council and King's College London. She is also on the Board of the National Centre for Mental Health in Wales, and is an Honorary Visiting Professor at Cardiff University and Honorary Senior Research Fellow in the Division of Psychiatry at University College London.

Heston Blumenthal, the celebrity chef known for his experimental cuisine, recently shared his experience of being sectioned under the UK’s Mental Health Act, saying it was “the best thing” that could have happened to him. His openness about living with bipolar disorder highlights the little-discussed fact that people with this condition face one of the highest suicide risks of any mental illness.

Bipolar disorder is a severe mental illness characterized by episodes of mania (high energy, impulsivity) and depression (hopelessness, fatigue). Suicidal thoughts and behavior are a core feature of the disorder, with fluctuating risk that can persist over long periods.

Although bipolar disorder affects around 2% of the population, studies suggest that up to 50% of people with the condition attempt suicide at least once, and 15-20% die by suicide – a rate much higher than in the general population. Unlike global suicide rates, suicide deaths in bipolar disorder have not declined.

Understanding why suicide is so common in people with this disorder is difficult. But one major factor is mood instability. Rapid shifts between emotional highs and lows, as well as mixed states where symptoms of mania (impulsivity) and depression (despair) occur together, can be particularly dangerous.

Social and economic factors also play a role. Research we conducted at Swansea University shows that the population suffering from bipolar disorder has become poorer over the last two decades. Financial strain, social isolation and poorer access to healthcare all lead to worse outcomes. Beyond suicide, people with the condition die up to 20 years earlier than the general population, often from preventable health problems such as heart disease.

While bipolar disorder cannot be cured, it can be managed. The most commonly used drug, lithium, has been found to reduce suicide risk significantly in some patients. However, people with the condition struggle to take it regularly.

The drug’s side-effects can affect the kidneys, thyroid, metabolism, cognition and cardiovascular health. Managing these side-effects requires regular blood tests and continuous monitoring, making long-term treatment difficult.

Many people stop taking their medication during manic phases, believing they are cured.

Other treatments, such as antipsychotics, mood stabilizers and electroconvulsive therapy (where electric currents are passed through the brain while the patient is under anesthesia), can also be effective in some types and phases of bipolar – for example, in states of mixed mania and depression where there is a high risk of suicide – but they come with their own harms and limitations.

Some psychiatrists now question whether continuous lifelong treatment is necessary for all patients.

Even when people seek help, healthcare systems often fail to intervene effectively. Suicide risk is highest in the days following discharge from a psychiatric hospital. Many people who later die by suicide have recently visited emergency rooms after hurting themselves, but the help they received was either delayed or not enough to prevent further harm.

Existing tools to identify and measure suicide risk, such as checklists, questionnaires and structured interviews, are ineffective. Many people with bipolar disorder who die by suicide are assessed as “low risk” shortly beforehand, exposing a crucial gap between doctor and patient perceptions. This is in great part because these tools rely too heavily on past factors such as suicide attempts (which may not be disclosed), rather than dynamic, real-time distress or mood instability.

Despite the significant effect that bipolar disorder has on individuals, families and society, the development of new drugs has been frustratingly slow. Lithium, first used in the 1940s, remains the go-to treatment, while most other drugs were originally designed to treat schizophrenia. No truly new treatments have emerged in decades.

Not a single disorder

One difficulty is that bipolar is not a single disorder but a spectrum of conditions, rendering the one-size-fits-all approach inadequate — lithium is effective in only about one in three patients.

Drug development for bipolar disorder is particularly challenging. The complexity of bipolar disorder calls for equally complex trials that need to consider patient variability, ethical concerns and strict safety requirements. New treatments also face strict approval hurdles because lithium – despite its limitations – is highly effective for some patients. This results in slow treatment development, leaving patients with limited options.

Lithium only works for about one in three people with bipolar disorder

Research is also slowed by concerns about whether it’s ethical to involve patients in trials. But it’s important to include people with the disorder who have experienced suicidal thoughts and behavior, to better understand their mindset and decision-making.

However, new approaches offer hope. Several research projects, such as Datamind, are developing artificial intelligence platforms to help find new drugs quicker and to personalize treatments based on patients’ genetic and clinical profiles. AI could lead to faster, more effective therapies tailored to individual needs.

Blumenthal’s story highlights that being sectioned, while traumatic, can save lives and keep people safe. Yet the stigma around psychiatric hospitalization prevents many from seeking care. There is a widespread belief that hospitalization should be avoided at all costs – but for some, it can be the difference between life and death.

However, hospitalization alone is not enough. The mental health system must do better to ensure that people with bipolar disorder receive long-term care, particularly during high-risk periods like hospital discharge. To prevent suicide, we need to rethink how risk is assessed, improve follow-up care, and reduce barriers to treatment.

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

www.celebratingyourgiftoflife.com

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While the statistics on bipolar are alarming, the message should be one of hope. The condition is treatable and suicide is preventable, but only if we commit to improving access to care, reducing stigma and advancing research.

- Mental health

- Bipolar disorder

- Psychiatric conditions

- Heston Blumenthal

- Give me perspective

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