Common Treatment Modalities

Acceptance and Commitment Therapy (ACT) is a type of psychotherapy that helps you accept the difficulties that come with life. ACT has been around for a long time, but seems to be gaining media attention lately. Categorically speaking, ACT is a form of mindfulness based therapy, theorizing that greater well-being can be attained by overcoming negative thoughts and feelings. Essentially, ACT looks at your character traits and behaviors to assist you in reducing avoidant coping styles. ACT also addresses your commitment to making changes, and what to do about it when you can’t stick to your goals.Acceptance principals can be useful in dealing with situations you cannot control, a personality trait that is hard to change or an emotion that overwhelms, accepting it can allow you to move forward. Obsessing, worrying and playing things over and over keep you stuck. In this sense, asking why can leave you helpless. ACT invites you to accept the reality and work with what you have. Some acceptance strategies including:

• Letting feelings or thoughts happen without the impulse to act on them.
• Observe your weaknesses but take note of your strengths.
• Give yourself permission to not be good at everything.
• Acknowledge the difficulty in your life without escaping from it or avoiding it.
• Realize that you can be in control of how you react, think and feel.
• Defusion principals are another aspect of ACT which help people learn how to cognitively defuse psychologically heightened experiences. Defusion involves realizing thoughts and feelings for what they really are, like passing sensations or irrational things that we tell ourselves – instead of what we think they are like feelings that will never end or factual truths. The goal of defusion is not to help you avoid the experience, but to make it more manageable for you. Some defusion strategies include:
  • Observe what you are feeling. What are the physical sensation.
  • Notice the way you are talking to yourself as these feelings are experienced.
  • What interpretations are you making about your experience? Are they based in reality?
  • Grab onto the strands of your negative self-talk and counter them with realistic ones.
  • Re-evaluate your experience with your new-found outlook

Summary: Acceptance and Commitment Therapy is not a long term treatment. The ACT experience of reworking your verbal connections to thoughts and feelings, known as comprehensive distancing, can be extremely helpful in the treatment of depression, anxiety and many other psychological disorders. For a good reference on ACT, link here.

Art therapy is a mental health profession in which clients, facilitated by the art therapist, use art media, the creative process, and the resulting artwork to explore their feelings, reconcile emotional conflicts, foster self awareness, manage behavior and addictions, develop social skills, improve reality orientation, reduce anxiety, and increase self-esteem.

A goal in art therapy is to improve or restore a client’s functioning and his or her sense of personal well-being. Art therapy practice requires knowledge of visual art (drawing, painting, sculpture, and other art forms) and the creative process, as well as of human development, psychological, and counseling theories and techniques. Today art therapy is widely practiced in a wide variety of settings including hospitals, psychiatric and rehabilitation facilities, wellness centers, forensic institutions, schools, crisis centers, senior communities, private practice, and other clinical and community settings.

During individual and/or group sessions art therapists elicit their clients’ inherent capacity for art making to enhance their physical, mental, and emotional well-being. Research supports the use of art therapy within a professional relationship for the therapeutic benefits gained through artistic self-expression and reflection for individuals who experience illness, trauma, and mental health problems and those seeking personal growth

Cognitive behavioral therapy is a evidence-based approach to treatment using cognitive behavioral therapy. Patients work with a mental health counselor (psychotherapist or therapist) in a structured way, attending a limited number of sessions. Cognitive behavioral therapy helps you become aware of inaccurate or negative thinking, so you can view challenging situations more clearly and respond to them in a more effective way.

Cognitive behavioral therapy can be a very helpful tool in treating mental disorders or illnesses, such as anxiety or depression. But not everyone who benefits from cognitive behavioral therapy has a mental health condition. It can be an effective tool to help anyone learn how to better manage stressful life situations.

Based on the empirically supported premise that the body, mind and spirit are interconnected, the American Dance Therapy Association defines dance/movement therapy as the psychotherapeutic use of movement to further the emotional, cognitive, physical and social integration of the individual.

Dance/movement therapy is:

• Focused on movement behavior as it emerges in the therapeutic relationship. Expressive, communicative, and adaptive behaviors are all considered for group and individual treatment. Body movement, as the core component of dance, simultaneously provides the means of assessment and the mode of intervention for dance/movement therapy.
• Is practiced in mental health, rehabilitation, medical, educational and forensic settings, and in nursing homes, day care centers, disease prevention, health promotion programs and in private practice.
• Is effective for individuals with developmental, medical, social, physical and psychological impairments.
• Is used with people of all ages, races and ethnic backgrounds in individual, couples, family and group therapy formats.

Dialectical behavior therapy (DBT) is a evidence-based approach to treatment is a cognitive-behavioral approach that emphasizes the psychosocial aspects of treatment. The theory behind the approach is that some people are prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations, primarily those found in romantic, family and friend relationships. DBT theory suggests that some people’s arousal levels in such situations can increase far more quickly than the average person’s, attain a higher level of emotional stimulation, and take a significant amount of time to return to baseline arousal levels.

People who are sometimes diagnosed with borderline personality disorder experience extreme swings in their emotions, see the world in black-and-white shades, and seem to always be jumping from one crisis to another. Because few people understand such reactions — most of all their own family and a childhood that emphasized invalidation — they don’t have any methods for coping with these sudden, intense surges of emotion. DBT is a method for teaching skills that will help in this task.

Characteristics of DBT

• Support-oriented: It helps a person identify their strengths and builds on them so that the person can feel better about him/herself and their life.

• Cognitive-based: DBT helps identify thoughts, beliefs, and assumptions that make life harder: “I have to be perfect at everything.” “If I get angry, I’m a terrible person” & helps people to learn different ways of thinking that will make life more bearable: “I don’t need to be perfect at things for people to care about me”, “Everyone gets angry, it’s a normal emotion.

• Collaborative: It requires constant attention to relationships between clients and staff. In DBT people are encouraged to work out problems in their relationships with their therapist and the therapists to do the same with them. DBT asks people to complete homework assignments, to role-play new ways of interacting with others, and to practice skills such as soothing yourself when upset. These skills, a crucial part of DBT, are taught in weekly lectures, reviewed in weekly homework groups, and referred to in nearly every group. The individual therapist helps the person to learn, apply and master the DBT skills.

• Generally, dialectical behavior therapy (DBT) may be seen as having two main components

Individual weekly psychotherapy sessions that emphasize problem-solving behavior for the past week’s issues and troubles that arose in the person’s life. Self-injurious and suicidal behaviors take first priority, followed by behaviors that may interfere with the therapy process. Quality of life issues and working toward improving life in general may also be discussed. Individual sessions in DBT also focus on decreasing and dealing with post-traumatic stress responses (from previous trauma in the person’s life) and helping enhance their own self-respect and self-image.

During individual therapy sessions, the therapist and client work toward learning and improving many basic social skills.

Weekly group therapy sessions, generally 2 1/2 hours a session and led by a trained DBT therapist, where people learn skills from one of four different modules: interpersonal effectiveness, distress tolerance/reality acceptance skills, emotion regulation, and mindfulness skills are taught.

The Four Modules of Dialectical Behavior Therapy)

• Mindfulness
  • The essential part of all skills taught in skills group are the core mindfulness skills. Observe, Describe, and Participate are the core mindfulness “what” skills. They answer the question, “What do I do to practice core mindfulness skills?” Non-judgmentally, One-mindfully, and Effectively are the “how” skills and answer the question, “How do I practice core mindfulness skills?”

• Interpersonal Effectiveness
  
  • Interpersonal response patterns taught in DBT skills training are very similar to those taught in many assertiveness and interpersonal problem-solving classes. They include effective strategies for asking for what one needs, saying no, and coping with interpersonal conflict. Borderline individuals frequently possess good interpersonal skills in a general sense.
  • The problems arise in the application of these skills to specific situations. An individual may be able to describe effective behavioral sequences when discussing another person encountering a problematic situation, but may be completely incapable of generating or carrying out a similar behavioral sequence when analyzing her own situation.
  • This module focuses on situations where the objective is to change something (e.g., requesting someone to do something) or to resist changes someone else is trying to make (e.g., saying no). The skills taught are intended to maximize the chances that a person’s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person’s self-respect.

• Distress Tolerance
  • Most approaches to mental health treatment focus on changing distressing events and circumstances. They have paid little attention to accepting, finding meaning for, and tolerating distress. This task has generally been tackled by religious and spiritual communities and leaders. Dialectical behavior therapy emphasizes learning to bear pain skillfully.
  • Distress tolerance skills constitute a natural development from mindfulness skills. They have to do with the ability to accept, in a non-evaluative and nonjudgmental fashion, both oneself and the current situation. Although the stance advocated here is a nonjudgmental one, this does not mean that it is one of approval: acceptance of reality is not approval of reality.
  • Distress tolerance behaviors are concerned with tolerating and surviving crises and with accepting life as it is in the moment. Four sets of crisis survival strategies are taught: distracting, self-soothing, improving the moment, and thinking of pros and cons. Acceptance skills include radical acceptance, turning the mind toward acceptance, and willingness versus willfulness.

• Emotion Regulation
  • Borderline and suicidal individuals are emotionally intense and labile – frequently angry, intensely frustrated, depressed, and anxious. This suggests that borderline clients might benefit from help in learning to regulate their emotions. Dialectical behavior therapy skills for emotion regulation include:
    • Identifying and labeling emotions
    • Identifying obstacles to changing emotions
    • Reducing vulnerability to “emotion mind”
    • Increasing positive emotional events
    • Applying distress tolerance techniques
    • Increasing mindfulness to current emotion

Equine-assisted psychotherapy (EAP), an increasingly popular experiential treatment where individuals interact with horses in a variety of activities, including grooming, feeding, walking and equine games, for improving their psychological health. Both a licensed therapist and horse professional conduct EAP.

Exposure therapy is a method in behavior therapy purposed for treating anxiety disorders. This involves the exposure of the man or woman to the feared object or circumstance in the absence of danger as an approach of overcoming their anxiety. Exposure and Response Therapy (ERP) was essentially designed to desensitize one to their fears and distresses. As the commonly co-occur, ERP has proven to be a useful tool in treating eating disorders and anxiety together.

Prior to beginning ERP treatment, patients detail a hierarchy of situations that trigger obsessive fears. Treatment would begin with exposure to circumstances that create mild to moderate anxiety. As the individual adjusts to various situations, they are gradually able to work up to predicaments that influence increased levels of anxiety or fear. The time period of progression in treatment is dependent of the patient’s capacity to withstand anxiety and to resist engaging in compulsive behaviors. Exposure tasks are generally executed primarily with a professional therapist assisting. Sessions can usually be expected to last between 45 minutes to three hours.

Participants are directed to practice additional exposure tasks between sessions for up to two to three hours per day. In specific instances, direct exposure to the feared object or circumstance is practiced in “imagined” exposure, which involves exposing an individual to instances or situations that trigger obsessions by imagining various scenarios. The primary goal during exposure sessions is for the individual to remain connected with the trigger without using ritualistic behaviors. To record progress during exposure trials with a therapist, patients are guided to rate their anxiety levels. Typically, an ERP treatment runs over a course of 14-16 weeks.

Types of Exposure Response Therapy

• Exposure therapy Post Traumatic Stress Disorder (PTSD): The use of exposure therapy targeted at healing from events that may have caused PTSD.
• Gradual Exposure Therapy: Involving the slow increase of exposure to stimuli during therapy
• Prolonged Exposure Therapy: Involving extended periods of sustained exposure to stimuli during treatment
• Exposure Therapy Social Anxiety: Targeting anxiety created by social events or activities.

Family Therapy has proven to be an important element in the treatment of patients with eating disorders. For adolescent patients, getting the family involved with therapy is considered essential, and family therapy can be equally important for adults. Family sessions for adults can include family of origin, current family, or members of a close support network.

Through therapy, families come to discover how changes in the way they communicate, manage conflict, or tolerate negative emotions can aid in their loved one’s recovery. Specifically for children and adolescents, family therapy emphasizes a strong parental alliance, resolution of family difficulties and support for the adolescent’s developing independence. Family therapy also helps support people understand the role the eating disorder has played within their family, what factors may be maintaining the disorder, and how to differentiate between their family member and their family member’s illness.

Family Based Treatment/The Maudsley Method is a evidence-based approach to treatment for some adolescents and young adults where parents play an active and positive role in order to: Help restore their child’s weight to normal levels expected given their age and height then hand the control over eating back to the child, and; encourage normal development through an in-depth discussion of these crucial developmental issues as they pertain to their child.

Many proponents of this approach consider ‘family problems’ as part of the problem contributing to the child’s eating disorder.

This Approach opposes the notion that families are pathological or should be blamed for the development of the child’s eating disorder, instead it is believed that the parents as a resource and essential in successful treatment of their child’s eating disorder.

The approach proceeds through three clearly defined phases, and is usually conducted within 15-20 treatment sessions over a period of about 12 months.

• Phase I: Weight restoration: Treatment focuses on severe malnutrition and medical stabilization associated with the eating disorder and assisting parents in re-feeding their daughter or son.
• Phase II: Returning control over eating to the adolescent: Treatment focuses on encouraging the parents to help their child to take more control over eating once again.
• Phase III: Establishing healthy identity: Treatment focuses on shifting from an “eating disordered identity” to a “healthy identity”.

Interpersonal Psychotherapy (IPT) is an empirically validated treatment for a variety of psychiatric disorders. The evidence for IPT supports its use for a variety of affective disorders, anxiety disorders, and eating disorders, and for a wide range of patients from children and adolescents to the elderly. The evidence base for IPT supports its use from age 9 to 99+.

IPT is a time-limited psychotherapy that focuses on interpersonal issues, which are understood to be a factor in the genesis and maintenance of psychological distress. The targets of IPT are symptom resolution, improved interpersonal functioning, and increased social support. Typical courses of IPT range from 6-20 sessions with provision for maintenance treatment as necessary.

The Defining Elements of IPT can best be understood by describing framework for its delivery. This framework can be divided into the theories supporting IPT; the targets of IPT; the tactics of IPT (i.e., the concepts applied in the treatment); and the techniques of IPT (i.e., what the therapist says or does in the treatment). Though individual elements in each of these categories may be shared with other psychotherapeutic approaches, their unique combination defines IPT.

Trauma-focused therapy uses a range of techniques for the purpose of dissipating the difficult feelings experienced by a trauma victim through a change in his thoughts, beliefs and behavior. The principal techniques in trauma-focused therapy are exposure, cognitive restructuring and learning methods for emotional and physical adjustment.

Exposure

• Using exposure techniques, the therapist helps the patient cope with traumatic memories, as well as situations, people and objects that have become connected to the trauma and now arouse a strong physical or emotional response that is disconnected from reality. For example, anxiety causes people to avoid situations that frighten them or stimulate troubling thoughts and memories. Trauma victims feel that if they do not immediately escape a frightening situation something bad will happen to them – they will go crazy, have a heart attack or lose control. The exposure technique helps the victim to deal with the frightening situation so that it will possible for him to relearn that fears need not come true – he will not die or go crazy and will be able to maintain control.

Cognitive Restructuring

• In cognitive treatment, the therapist helps the trauma victim to identify and change those negative thoughts and beliefs that cause him unpleasant feelings and difficulties functioning. The therapy focuses on how the victim translates a situation that is part of daily life in a manner that intensifies the danger and threat inherent in it. The danger originates in the way that the victim initially translated the trauma and what occurred as a result. For example, some victims experience feelings of guilt and embarrassment related to the trauma: a combat soldier might feel that a good friend was killed because of his actions; a victim of terrorism might feel embarrassed about his weakness or inability to cope. Others tend to exaggerate the level of danger that they encounter in their daily lives or extent to which their symptoms affect their sanity.

The therapist and patient discuss the way in which the victim translates the event that he experienced. The victim looks at how these translations create prophecies and, with the assistance of the therapist, tests these prophecies, draws conclusions and finds solutions that correspond more closely to reality. In addition, the therapist encourages the patient to relinquish behaviors and thoughts that reinforce catastrophic translations (for example, unceasing thoughts about what he could have done differently during the traumatic event or constantly being on watch lest another trauma occur).