Waiting room in an officeThere are many different types of residential treatment centers (RTCs) that offer therapeutic care for a wide variety of behavioral and mental health issues. Choosing a center that is suited to your personal needs is important; however, with many options available, making a decision may be difficult. How can you decide which RTC is right for you? Consider these answers to ten frequently asked questions about RTCs, as well as insight from Darren Haber, MA, MFT, an expert on addictions and compulsions.

1. What is a residential treatment center?

A residential treatment center is a health care facility that helps people experiencing various substance dependency and behavioral issues. For some inpatient treatments, residents may be required to live at the facility for a period of time. Some facilities also offer outpatient treatment to help former residents avoid relapse and to provide options for people who cannot commit to living at the facility temporarily. In most cases, treatment lasts for one to three months.

“[The] average stays tend to be 30 days, but some stay longer, and some shorter. Thirty days seems to be the industry norm,” Haber said.

2. What are the most important things to look for in an RTC?

Check and confirm that the RTC and any programs you wish to attend are accredited and the treatment programs are being administered by licensed, qualified mental health professionals. Ask if the program has a clinical director and about his or her credentials. Learn as much as you can about the treatment center you’re considering through third parties such as the Better Business Bureau, online reviews, and any local consumer protection agencies. If you need it, ensure that an active aftercare program is in place to help prevent relapse.

3. What type of issues do residential treatment centers treat?

Because different RTCs specialize in treating different health issues, the structure, routines, and therapeutic methods used will vary from facility to facility. Some centers take a “lock-down” approach where residents are secured within the facility’s premises and their movements inside the center are restricted. Other RTCs may take an unlocked approach and allow residents to traverse the premises with some degree of freedom; however, residents may only be permitted to leave the center if certain conditions are met.

In recent years, the residential treatment field has expanded. At some centers, everything from substance abuse to sex addiction to codependence may be treated. There are also centers that focus solely on substance abuse or eating disorders, for example.

Issues treated at an RTC may include:

It should be noted, too, that some RTCs specializing in mental health treatment may not provide therapeutic care for substance dependency issues.

4. Why do people go to residential treatment centers?

“Usually because their condition or problem has reached the point where it needs containment—that is, 24-hour medical or psychological monitoring due to harmful behaviors or medical problems—and has become so acute that it requires an acute, sustained focus,” Haber said.

5. What kinds of services are provided by RTCs?

Residential treatment centers offer a variety of services, which may include 24-hour supervision, intensive recovery programs, individual counseling, group counseling, structured activities, educational services, social skills training, vocational training, and relapse prevention services.

6. What are the benefits of a RTC over other forms of treatment?

The environment in a residential treatment center is usually more comfortable than the sterile, functional setting of a hospital. The residents are able to focus solely on their healing and recovery programs as they are removed from the stresses of daily life.

Some treatments, such as chemical detoxification, may be life threatening. For those cases, RTCs provide trained medical personal to keep residents safe during such treatments. Residents also have the opportunity to explore the emotional and psychological underpinnings for their behaviors in counseling sessions with a qualified mental health professional.

“Some people also go for legal reasons, such as being ordered by a judge after a DUI or DWI, for example. Usually one goes to an RTC because living life day-to-day has become unmanageable or to the point where one’s well-being, job, or close relationships are threatened,” Haber said.

7. What is the experience of being a resident at a residential treatment center like?

“It’s really what the client or patient makes of it. Anyone who participates to the best of his or her ability can potentially gain much and grow and learn tools for lifelong use. If one has been forced in by family but doesn’t believe, for instance, that one truly has an issue with alcohol or addiction, it can feel almost like jail,” Haber said.

8. How can families or friends keep in touch with residents?

“It depends on the policy of the residential treatment center. Some encourage family contact and some don’t. Some RTCs prefer those in treatment wait until their detox is over, or that the person in treatment only meet family members with counselors present. I believe this is a crucial part of treatment that can easily be overlooked, since dysfunctional family systems often play a crucial role in the formation of the illness or addiction,” Haber said.

9. Are there any RTCs in my area?

With the number of treatment facilities currently providing care across the country, chances are there is a residential treatment center nearby. However, it is important to remember that your chances of recovery may be better if the chosen facility is well suited to your personal preferences and specific health condition.

10. How much does treatment at a residential treatment center cost?

“Some people also go for legal reasons, such as being ordered by a judge after a DUI or DWI, for example. Usually one goes to an RTC because living life day-to-day has become unmanageable or to the point where one’s well-being, job, or close relationships are threatened.”The cost of treatment at a residential treatment center will vary based on the condition being treated, services provided, length of treatment, and the location of the center. For example, The Betty Ford Center, one of the most well-known rehab programs, charges approximately $1,217 per day for inpatient alcohol addiction treatment at their Rancho Mirage, CA location. Other locations may charge more or less, and some may not offer a per-day rate. Most locations develop a program based on a person’s individual needs, which can drastically affect the cost depending on medication or other requirements.

Some facilities may be able to offer a sliding fee based on a person’s income, while some may be low or no cost. Others may offer luxurious settings and amenities. The types and costs of RTCs simply vary. If your personal health insurance covers residential care, even the more costly facilities may become affordable. Call your insurance company for more information regarding your covered benefits if you are in need of inpatient treatment.

References:

  1. The Addiction Recovery Guide. (2015). Drug and alcohol addiction recovery. Retrieved from http://www.addictionrecoveryguide.org/treatment/residential
  2. The American Residential Treatment Association. (n.d.). Types of programs. Retrieved from http://artausa.org/type_programs.html
  3. Federal Trade Commission. (n.d.) Residential treatment programs for teens. Retrieved from http://www.consumer.ftc.gov/articles/0185-residential-treatment-programs-teens
  4. Hazelden Betty Ford Foundation. (n.d.) Addiction treatment specialties. Retrieved from http://www.hazeldenbettyford.org/treatment/locations/betty-ford-center-rancho-mirage
  5. Mental Health America. (n.d.). In patient care. Retrieved from http://www.mentalhealthamerica.net/patient-care
  6. National Institute on Drug Abuse. (n.d.) Principles of drug addiction treatment: a research based guide. Retrieved from http://www.consumer.ftc.gov/articles/0185-residential-treatment-programs-teens
  7. Smith, M., & Segal, J. (2015). Choosing a drug treatment program: What to look for in substance abuse rehab. Retrieved from http://www.helpguide.org/articles/addiction/choosing-a-drug-treatment-program.htm

Girl stood looking towards the distant seaIf her heart is broken, maybe it’s because her father broke it first. Her inability to accept herself is probably because he told her that she would never be good enough for anyone or anything.

I am a young lady that grew up without a father. I would watch enviously as friends celebrated father’s day, wishing I could do the same. I remember spending hours imagining my father coming back and telling me how he has missed me in his life. I imagined conversations and holidays that I knew would never happen. I could not fathom why I was never good enough for him to call daughter. If I am not good enough for my father, how will I be good enough for anyone else?

[fat_widget_right]This began my journey to self-loathing. As an eight-year-old, I would spend hours drawing circles around the areas I wanted to change. As more and more people around me commented about my weight and unattractive features, I began to obsess about my image. I moved from dreaming about plastic surgery to experimenting with ways to lose weight. People around me were too busy to realize that I had begun experimenting with diet pills, binging and purging, and starving myself for days on end. All I could think about was being skinny. Maybe if I was smaller, I would be sexier. Maybe if I was skinnier, more people would love me. Maybe if I was skinnier, my father would come back…

My strong desire to be loved strained my relationship with food, and began to take a toll on my mind. I would find myself crying for hours on end, not even sure what I was crying about. I began hiding from the world, thinking of ways to give myself an early exit. At that moment I did not realize that I was suffering from depression. In all honesty, I thought that’s how life worked: some people deserved happiness, and some didn’t. I was one of those that didn’t deserve it. I was not popular, and I didn’t fit in with anyone in my family. I was a constant outcast, and this pushed me into further isolation.

My isolation made me desperate. I wanted someone, anyone to love me. I wanted to feel like I belonged somewhere. So I clung on to the first sign of love that presented itself to me. It always came in the form of an abusive relationship, but that didn’t matter to me. I allowed people to cheat, because at least they would come back to me. I justified the physical abuse, blaming myself for saying or doing the wrong thing. I endured the emotional and psychological torture, because at least I was not alone. Any attention I received was better than nothing at all. I would run away from any “good guy” because someone like me didn’t deserve anything good.

Today, I’m a work in progress. I still have food issues that make me border on an eating disorder. After six different combinations, I have found antidepressants that are helping to pull me out of the dark shadows of my mind. I still find myself afraid of relationships, scared that I might end up in more abusive relationships. I try to keep my mind occupied with small happy thoughts, which will one day lead me to some form of happiness.

ros limbo share your storyI was first diagnosed with depression in my last year of university. From that day on, my life changed. I have tried over four combinations of medication over the last two years. I try to focus on the positive: my love for God, writing, and yoga. I am lucky to have family and friends that support me even when they don’t understand my struggle.  

Ros keeps a blog at memoirsofavirginprostitute.blogspot.com.

man silhouette in the fogMany people struggle with addictions in today’s stressful society. Drinking and/or using drugs, overeating, sexual compulsions, and gambling are all ways in which individuals attempt to self-soothe and forget about their problems. These misguided methods all have one thing in common—they enable the individual to temporarily attain a different state of consciousness in order to avoid looking at painful emotions they may be feeling.

Alcohol and drugs obviously create altered states of mind, but overeating, gambling, or having a sex addiction do as well. For those who overindulge, food typically brings up early memories of comfort and is used to fill up an inner sense of emptiness. Many who gamble tend to forget or overlook everything except the thrill and excitement of the potential win. For many individuals with a sex addiction, there is an attempt to seek connectedness through the sexual act, without having to connect on an emotional level.

So what are some ways that individuals can learn to cope with their emotions in a healthier way? The following steps can be taken to help overcome an addiction:

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  1. Join a support group. There are many different peer-led support groups available that can be very helpful when trying to overcome any kind of addiction. Alcoholics Anonymous, Narcotics Anonymous, Overeaters Anonymous, Sex Addicts Anonymous, or Gamblers Anonymous, for example, are all groups where people can relate to others who are dealing with the same types of issues. Individuals hold each other accountable and are often inspired by others’ success stories.
  2. Explore issues that the addiction may be covering up. Often, people resort to unhealthy coping mechanisms because they are struggling with painful emotions and/or traumatic situations that have not been integrated. Seeking out a qualified therapist can be helpful in working through past trauma and learning healthier ways to cope.
  3. Keep track of your triggers. By noting the times you feel tempted to indulge in an addiction, you can begin to bring more awareness to the situation. For example, do you start drinking after work every time your boss criticizes you? Do you binge on fast food whenever your self-esteem is at a low point?
  4. Look for the purpose your addiction may be serving. Many people struggling with addictions have difficulties with relationships. The addiction becomes their relationship of choice, and the individual may spend much of his or her time thinking about ways to indulge in it, rather than examining underlying issues related to connecting with others.
  5. Learn to experience emotions rather than avoid them. Addictions are often an easy way to escape from feeling painful emotions, but this is only a temporary solution and ends up making the problem much worse. Try to spend five to 10 minutes a day just sitting with your eyes closed and focusing on the sensations in your body. Painful emotions tend to be held in the body and are typically experienced as a tightness or constriction. Practice mindfully sitting with the sensations, honoring and welcoming them, rather than trying to push them away. Remember to breathe in and out deeply when doing this exercise.
  6. Journal about your feelings. Journaling is a helpful tool to get uncomfortable emotions off your chest. Whenever you feel triggered to indulge in your addiction, try to write about the thoughts and feelings that you are experiencing instead. This technique can also be useful right before going to bed, especially if you tend to toss and turn and ruminate over stressful issues.

Overcoming an addiction can be extremely challenging, but using some or all of the techniques above can be a great starting point. If you have a severe drinking or drug problem, you may need to start off with residential treatment in order to be surrounded by individuals who support you on your healing journey.

The first step can feel like the most difficult one, but recovery from any type of addiction is absolutely possible for anyone willing to reach out for help.

Body-ImageBody image, your internalized sense of your physical shape and appearance, isn’t just about confidence, nor is it an issue reserved exclusively for teenagers. Negative body image affects people of all ages, genders, and races, and is intricately linked to a host of mental health concerns, including eating disorders, low self-esteem, shame, isolation, anxiety, and depression.

Although it’s quite normal to feel some dissatisfaction regarding aspects of your body or appearance, if such self-criticism dominates your thoughts, limits your overall life satisfaction, or otherwise affects your school, work, relationships, or ability to function in a healthy way on a day-to-day basis, seeking help is imperative. Persistent negative body image can set the stage for serious mental and physical health complications, including body dysmorphia (sometimes referred to as “imagined ugliness”), compulsions and avoidance behaviors, and even suicidal ideation.

Eating disorders are of particular concern among people with body image issues, as they can be life threatening if left untreated. Anorexia nervosa, in fact, has the highest mortality rate of any psychiatric condition. Widely misunderstood and mischaracterized as a phase or lifestyle choice, eating disorders—also including bulimia nervosa and binging and purging—are strongly linked to body dissatisfaction.

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When it comes to body image, the elephants in the room, of course, are the unavoidable media and advertising messages that permeate our culture. Television, movies, magazines, websites, and other forms of media peddle unrealistic and often unhealthy standards, and younger people can be especially susceptible to the suggestion that these images reflect an ideal. In one study, 69% of American elementary school girls who look at magazines said the images they contained influenced their concept of the ideal body, and 47% said the images made them want to lose weight.

Addressing body image issues is complicated, but seeking the help of a qualified therapist is a highly recommended step. For our part, we’ve compiled a list of the 10 best online resources for body image issues and support—GoodTherapy.org excluded—in 2014. Our selections are based on quality and depth of content, presentation, and functionality.

Have a website you would like to see in our Top 10? Recommend it here.

References:

  1. Body Dysmorphic Disorder. (n.d.). Retrieved from http://teenshealth.org/teen/your_mind/body_image/body_image_problem.html
  2. Get the Facts on Eating Disorders. (n.d.). Retrieved from https://www.nationaleatingdisorders.org/get-facts-eating-disorders
  3. Martin, J. B. (2010). The Development of Ideal Body Image Perceptions in the United States. Nutrition Today, 45(3), 98-100. Retrieved from http://www.nursingcenter.com/pdf.asp?AID=1023485
  4. Stice, E. (2002). Risk and maintenance factors for eating pathology: A meta-analytic review. Psychological Bulletin, 128, 825-848.

Bulimia nervosa is an eating issue that can be assessed using a variety of diagnostic tools. Because there are many different measures to evaluate bulimia, some researchers believe that overestimation or underestimation of bulimia exists. To cloud the issue further, a large majority of people who have symptoms of bulimia often have comorbid psychological conditions, including mood problems, anxiety, depression, and drug or alcohol use.

Less than half of the individuals who demonstrate bulimic symptoms seek treatment for them. Although many do enter treatment for comorbid issues, the bulimia is often discovered secondarily and does not always receive the attention it deserves. Bulimia can lead to serious negative health outcomes and even suicide. For clinicians to identify those most at risk and intervene at the earliest point possible, it is imperative that consistency in symptom assessment and diagnosis be achieved.

Katie Sandberg of the Department of Education Specialties at Loyola University in Maryland wanted to test the reliability, consistency and validity of the six most commonly used tools for assessing bulimia. She conducted an analysis of existing research involving studies using the Eating Disorder Examination (EDE), the Eating Attitudes Test (EAT), the Eating Disorder Inventory-3 (EDI-3), the Body Shape Questionnaire (BSQ), the Bulimic Investigatory Test, Edinburgh (BITE), and the Three-Factor Eating Questionnaire (TFEQ).

Sandberg found that all six measures were able to assess bulimic symptoms with relative accuracy, but in unique ways. Based on symptoms of purging, binging, laxative use, and overall body dissatisfaction, she found that the EDI and the EAT were the most reliable at assessing bulimia. When she looked at body dissatisfaction, the BSQ and the EDE emerged as the most reliable tools.

In sum, Sandberg believes these findings show the importance of utilizing multiple screening tools when evaluating clients for bulimia. She said, “The best way for clinicians and researchers to document treatment effects is to use a multitude of high-quality instruments to achieve triangulation.” Further, she believes implementing screening tools before and during treatment can provide clinicians with accurate measures of progress and can help clients and clinicians identify persistent symptoms that need further attention.

Reference:
Sandberg, Katie, and Bradley T. Erford. “Choosing Assessment Instruments for Bulimia Practice and Outcome Research.” Journal of Counseling and Development : JCD 91.3 (2013): 367-79. ProQuest. Web. 26 July 2013.

photoshopped-advertisement-of-woman-modelWomen face overwhelming pressure to meet an often unrealizable “beauty” ideal. The result is that 80% of women report being unhappy with their appearance, and three-quarters of all women engage in some form of disordered eating such as crash dieting or skipping meals. Many companies have capitalized on this trend, offering a veritable cornucopia of products designed to “fix” women’s perceived flaws.

The advertisements for these products, however, frequently leave women feeling bad about themselves, particularly when images in these ads contain unrealistically “perfect” women. The overwhelming majority of cosmetic and clothing advertisements are digitally enhanced. Even Beyoncé fell victim to this practice, often called photoshopping, getting into a public dispute with H&M in early 2013 when the clothing retailer altered images of her modeling swimwear. But women are increasingly aware of the effects of digitally manipulated advertisements, and some retailers are abandoning the practice of presenting women with unrealistic images.

Photoshopping and Other Tricks

Although women continue to be bombarded with unrealistic—and perhaps even fake—images of models, the tide is slowly turning against photoshopping. Debenhams, a major British department store, recently announced that it will no longer manipulate images, even releasing photos demonstrating the “before” and “after” effects its previous photoshopping efforts had on models’ appearance. The National Advertising Division, an organization that makes recommendations for advertisers, has advocated for an outright ban on photoshopping in cosmetic advertisements.

Advertising tricks aren’t limited to photoshopping, though. The right lighting, heavy makeup, and clever clothing placement can leave models looking very different from how they look in real life. Some tricks mislead women about the effects of products featured in advertisements. Mascara manufacturers, for example, may resort to the use of false lashes or lash extensions to make the product look much more effective than it actually is. Women who buy the product are then left feeling like there’s something wrong with them because they can’t look like the model in the advertisement.

The Effects of Advertisements

Numerous studies have documented the negative effects that advertisements have on women, even when women know the ads have been altered. Women feel worse about themselves, for example, after reading advertisement-laden fashion magazines. Some women even resort to cutting out photos of extremely thin models as “thinspiration” for crash diets. According to research by sociologist Jean Kilbourne, regular exposure to advertisements can contribute to internalized sexism. Women may begin to see their appearance as the primary source of their worth, neglecting other interests in favor of the perpetual pursuit of aesthetic perfection.

Keeping Self-Esteem Intact

Even if photoshopping is banned, women will be exposed to images of models who have been heavily made up, who benefit from excellent lighting, and whose appearance differs substantially from the average woman. Although this practice can feel unfair and even overwhelming, women can take steps to empower themselves and avoid the self-esteem-crushing effects of unrealistic ideals. These include:

References:

  1. Edwards, J. (2011, December 16). US moves toward banning photoshop in cosmetics ads. Business Insider. Retrieved from http://www.businessinsider.com/us-moves-toward-banning-use-of-photoshop-in-cosmetics-ads-2011-12
  2. ExtremeTech. (2011, December 16). US Watchdog Bans Photoshopping in Cosmetic Ads. Retrieved from http://www.extremetech.com/extreme/109375-us-bans-photoshop-use-in-cosmetics-ads
  3. Grey, J. (2013, May 30). Beyonce outraged that H&M intended to photoshop her bootyliciousness. Business Insider. Retrieved from http://www.businessinsider.com/beyonc-outraged-at-hm-photoshop-2013-5
  4. Helping your daughter see through advertising. (n.d.). Discover Your Daughter. Retrieved from http://www.discoveryourdaughter.com/for-your-daughter/self-esteem/helping-your-daughter-see-through-advertising
  5. Kilbourne, J. (2000). Can’t buy my love: How advertising changes the way we think and feel. New York, NY: Simon & Schuster.
  6. Ross, C. C., MD. (n.d.). Why do women hate their bodies? Psych Central.com. Retrieved from http://psychcentral.com/blog/archives/2012/06/02/why-do-women-hate-their-bodies/
  7. Three out of four American women have disordered eating, survey suggests. (2008, April 23). ScienceDaily. Retrieved from http://www.sciencedaily.com/releases/2008/04/080422202514.htm
  8. Women’s magazines and the cult of hypocrisy. (2012, July 5). Women’s Media Center. Retrieved from http://www.womensmediacenter.com/feature/entry/womens-magazines-and-the-cult-of-hypocrisy

GoodTherapy | Scared to Eat: Conquering Anxiety Around Food AllergiesEating brings pleasure, energy, and well-being to our lives. A disruption of this simple, often mindless, but important activity could lead to stress and anxiety.

People who have food allergies have to be extra careful about what they eat. A simple ingredient such as eggs or nuts could ruin a meal by causing hives or wheezing, and, in extreme cases, cause a reaction so severe that an epinephrine injection is needed to save the person from a life-threatening condition.

Food intolerances, or adverse reactions to specific foods, can also cause harm to a person, but generally lead to minor symptoms such as diarrhea or stomach cramps, according to the National Center for Biotechnology Information website. Celiac disease, for example, is not a food allergy but rather an autoimmune issue. People with celiac disease who eat gluten experience health problems as a result.

Elika Kormeili, a therapist specializing in food-allergy issues and founder of the Center for Healthy and Happy Living, says that she has suffered from food allergies and knows the stress and anxiety they can cause. She says certain social situations that involve food, such as birthday celebrations or work lunches, can be so stressful that people with food allergies might avoid them entirely.

“Sometimes children with severe food allergies (life-threatening) are so scared of being exposed to an allergen that it impacts their ability to participate at school,” Kormeili said. She goes on to say that “Food is a huge part of our socialization and when you are limited in what you can eat, it definitely causes anxiety.”

[fat_widget_left]Food allergies may lead to anxiety, but anxiety may or may not lead to issues with food allergies. Kormeili said stress and anxiety can weaken the immune system to the point of aggravating food allergies. People with food allergies might also experience changes in mood and behavior. Sometimes just getting on a diet to eliminate allergens improves mood, decreases irritability, and allows for better concentration.

She has the following tips for coping with food allergies and the anxiety that sometimes follows:

Stacey Antine, a registered dietician and author of Appetite for Life: The Thumbs-Up, No-Yucks Guide to Getting Your Kid to Be a Great Eater, says that the most important part of alleviating anxiety associated with food allergies is having direct control over the food you’re eating. She encourages growing, harvesting, and cooking your own food. She is the founder of HealthBarn USA, which hosts workshops and other programs on a family farm to help kids and adults understand the importance of natural, healthy food.

She suggests cooking your own food, talking to servers at restaurants to get more information about the preparation and ingredients included in foods, carrying safe snacks to eat just in case, and informing others of your diet restrictions in advance so they can accommodate you. “Cook your own food and rely less on packaged foods. It’s better for your overall health…Also, yoga and at least 20 minutes of meditation daily will help reduce anxiety,” Antine said.

Laurinda Kwan, a naturopathic physician at Arizona Natural Health Care, says that she decided to focus on treating seasonal, environmental, and food allergies because of her own suffering from food allergies and eczema. “If you repeatedly have adverse reactions to your food, just like Pavlov’s dogs, you develop a learned response,” says Kwan. She goes on to say, “We are not born having anxiety to foods. However, over time, if eating food consistently produces unfavorable feedback (e.g., hives, itching, stomach pain), your learned response is going to be that of fear or anxiety to foods.”

She believes that in some cases anxiety itself could create food-intolerance issues. For example, when a person experiences anxiety, sometimes he or she also has gastrointestinal problems such as bloating, abdominal pain, and diarrhea. “If the gastrointestinal tract is compromised, this could lead to intestinal permeability (or ‘leaky gut syndrome’). When the intestinal lining is compromised, substances pass through the lining of the small intestine that normally should not pass into the blood stream, and your body creates an immune response,” Kwan said. She said to keep in mind that there is some debate about leaky gut syndrome, and more information needs to be gathered.

Kwan’s suggestions for alleviating anxiety associated with food allergies include talking to a homeopathic doctor who can treat the whole person, not just immediate physical symptoms. She also said it’s necessary to pay attention to food labels to avoid allergens.

Anxiety is not the only mental health issue associated with food allergies. Kwan said depression could develop as a result of living a restricted lifestyle. Also, because people with food allergies have a tendency to focus on what they do or don’t eat, in some cases eating disorders can develop.

Woman looking out train window

Dialectical behavior therapy (DBT) is a comprehensive, evidence-based treatment approach used to treat individuals with a wide variety of issues, including relationship conflict, anxiety, depression, bipolar, self-injury, eating issues, and substance abuse. Developed in the 1980s by psychologist Marsha M. Linehan for the treatment of borderline personality disorder and chronic suicidality, this method has since been adapted and utilized to help clients with much less severe issues. The therapy can help clients who exhibit extreme emotional reactions, helping them develop self-acceptance while also learning coping skills to better regulate their emotions and handle distress. DBT uses both individual therapy sessions and group skills training, as well as telephone coaching between sessions.

The DBT model combines a behavioral therapy approach with eastern mindfulness practices. In one sense, the term dialectical refers to the goal of synthesizing the extreme opposites inherent in the rigid “black and white” thinking of many clients who have trouble regulating their emotions. “Dialectical” also applies to the core DBT principle of practicing acceptance strategies while implementing change strategies, in the process of reducing and modifying self-destructive behaviors.

This type of therapy is very support-oriented; it helps clients identify their strengths, build new skills, and increase their self-esteem. DBT focuses on cognitive issues by indentifying destructive thought patterns and replacing them with more neutral and accepting internal dialogues. It is designed to be a nonjudgmental collaboration, with the therapist and client working together to increase emotional awareness and understanding, minimize negative thought patterns and behaviors, and develop new coping and problem-solving skills.

The four modules of dialectical behavior therapy:

In the case of adolescent treatment, Dr. Alec Miller has adapted Dr. Linehan’s model to incorporate parents attending skills training groups with their teens. There is an additional module, “walking the middle path,” which focuses on helping parents and their children understand each other’s viewpoints and reduce conflict and invalidation.

The five functions:

Dialectical behavioral therapy was designed to fulfill five primary functions:

Stages of treatment:

The course of DBT generally flows through three stages:

Who can benefit:

Though DBT originally was developed to treat more severe issues, such as borderline personality disorder, suicidal behaviors, and self-harm, the treatment has become a widely respected method for treating clients who exhibit the following, much milder traits and issues:

Dialectical behavior therapy has proven to be a very effective tool to help people manage intense emotions, change negative thought patterns, and decrease self-destructive behaviors. Individual therapy sessions focus on current detrimental behaviors in the client’s life, while group sessions involve learning skills from the four modules: mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation.

Adolescent girls are among the most vulnerable for issues that relate to body image. They are assaulted with unrealistic images and unachievable ideals from virtually every media outlet. Teen girls struggle to find their identity at a time when appearance often determines their social circle and affects their self-esteem. In fact, research shows that teen girls worry more about their bodies than they do about academics, family life, or any other stressors. Young women who develop unhealthy eating behaviors can find themselves in a lifelong battle of physical and mental distress. Eating and food issues can lead to other negative psychological problems such as depression, anxiety, or even suicidal ideation.

Kathryn E. Rayner of the Centre for Emotional Health of the Department of Psychology at Macquarie University in Australia recently led a study to explore how peer relationships affect eating and body image issues in young women. Social acceptance is critical to teens, so Rayner theorized that perhaps young women select their friends based on eating and body image similarities, or perhaps they shape their own perceptions and behaviors based on the friends in their social circle. Rayner examined selection versus socialization in a sample of 1,197 teen girls from nine separate high schools in Australia. The adolescents were assessed for bulimic and dieting patterns, body satisfaction, and peer relations over a period of three years.

The results of the study revealed some interesting trends. First, the participants tended to choose friends with similar body satisfaction/dissatisfaction levels and bulimic behaviors. However, they did not choose girls with similar dieting and eating patterns. The girls also chose to engage in friendships that were bidirectional and avoided one-sided friendships. Rayner discovered that the girls who dieted the least had more people who wanted to befriend them, while those with more depressed mood and overt dieting behaviors had fewer peers soliciting their friendship. Additionally, the girls in the study, although they selected girls with dissimilar behaviors from their own, did not change their own actions to model those of their friends. Rayner believes the results of her study shed new light on some of the factors that influence eating, dieting, and body image in girls at risk. She added, “These findings represent important building blocks in facilitating the formation of more effective prevention and intervention strategies.”

Reference:
Rayner, K. E., Schniering, C. A., Rapee, R. M., Taylor, A., Hutchinson, D. M. (2012). Adolescent girls’ friendship networks, body dissatisfaction, and disordered eating: Examining selection and socialization processes. Journal of Abnormal Psychology. Advance online publication. doi: 10.1037/a0029304

A client that drops out of therapy is one who does not complete the recommended course of treatment. Many therapeutic approaches, such as cognitive behavioral therapy, do not have a specific treatment deadline, and clients are considered dropouts when they have voluntarily stopped therapy prior to resolving the issues and symptoms that brought them there to begin with. Dropout is a serious concern for the medical community and the general population. Individuals who drop out of therapy are more likely to have future psychological complications and seek services multiple times, which places an economic burden on society. Because they do not learn adaptive coping strategies and fail to address the issues that plague them most seriously, they are likely to be less than productive in their careers, families, and communities. Additionally, therapists who experience client dropout may begin to question their ability to help clients and their own adequacy.

Understanding the factors that contribute to dropout can provide clinicians with the information they need to address the problem. Joshua K. Swift of the Department of Psychology at the University of Alaska in Anchorage wanted to explore this problem further and made it the focus of his most recent study. Swift analyzed over 650 studies that included more than 83,000 clients and looked at factors such as client age, therapy setting, therapist experience, type of therapy, issues addressed in therapy, and clinician definition of dropout.

Swift found that nearly 20% of all the clients in the studies ended their treatment early. He found that some variables, such as therapy setting, influenced the rates of dropout. He also discovered that rates of dropout were highest among the youngest participants and those seeking treatment for personality or eating problems. Swift believes that more work is needed to determine specific nuances that effect retention. He hopes efforts will be aimed at isolating psychological issues, such as anxiety or depression, and approaches, such as psychodynamic or behavioral therapy, in order to get a clearer idea of the different dimensions affecting treatment completion. Swift said, “By paying attention to these variables and making adaptations where needed, clinicians may be able to reduce rates of premature discontinuation in their work with clients.”

Reference:
Swift, J. K., Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology80.4: 547-559.

Women have been stereotypically defined as being more emotional than men. In popular culture, women are depicted as being more emotionally volatile, often erupting into fits of sadness, anger, despair or jealousy much more frequently than their male counterparts. But is this portrayal scientifically accurate? Research has shown that there are differences in how men and women emotionally respond to situations. However, little research has addressed the core self-conscious emotions (SCE) of men and women and how they differ. Nicole M. Else-Quest of the Department of Psychology at the University of Maryland in Baltimore sought to debunk the myth that women have less emotional regulation than men. She recently conducted a study that compared male and female levels of embarrassment, shame, guilt, and pride in data gathered from over 300 studies.

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Existing research has shown that women and men differ in their risks for some mental health issues such as depression, food and eating issues, anxiety, and self-worth. How men and women experience SCEs has a direct influence on their likelihood of developing these and other psychological problems. Else-Quest analyzed over 200,000 self-reports and found that for the most part, women and men had similar levels of SCEs. The results revealed slightly higher levels of guilt and shame in the women, but minimal differences in pride and embarrassment. Else-Quest also looked at age as a factor because men and women tend to exhibit the first signs of depression, anxiety, and low self-esteem at different ages. She found that although there were relatively few differences in SCEs in early childhood, women reported higher levels of SCEs, primarily shame and guilt, during adolescence.

Overall, Else-Quest discovered that women experienced the highest levels of guilt and shame when they were asked about sex, food and eating, body image, or the environment. Although the rates of SCEs in these areas were only slightly higher for women than men, these results support existing research regarding women’s emotional perceptions about sex, body image, and eating problems. Else-Quest concluded by saying that even though women had minimally elevated levels of guilt and shame, the men and women reported levels of pride and embarrassment that were virtually identical. She added, “These findings contribute to the literature demonstrating that blanket stereotypes about women’s greater emotionality are inaccurate.”

Reference:
Else-Quest, N. M., Higgins, A., Allison, C., Morton, L. C. (2012). Gender differences in self-conscious emotional experience: A meta-analysis. Psychological Bulletin. Advance online publication. doi: 10.1037/a0027930

Two young girls pose for each otherResearch has determined that eating disorders are caused by a confluence of factors. No one single factor is enough to cause someone to develop an eating disorder, but certain factors set the stage for a person to be vulnerable to developing an eating disorder. When it comes to eating disorders, the age-old question of nature versus nurture is answered simply: it’s a mixture of both.

An article published in Focus magazine states that, “In recent decades, researchers have increasingly appreciated the multifaceted contributions to the etiology and pathogenesis of eating disorders, including genetic, familial, developmental, and psychosocial influences” (Yager, et al., 2005).

Are eating disorders biologically based? In the sense that certain genetic traits must be present in order to render a person vulnerable to developing an eating disorder, yes. In the sense that, if the various genetic markers are present then the person in question will develop an eating disorder regardless of any other factor, no. Recent research on the genetic factors that contribute to the formation of an eating disorder reveals that, while genes are indeed a factor, they alone cannot cause an eating disorder. Cynthia Bulik, Director of the UNC Eating Disorders Program at the University of North Carolina at Chapel Hill School of Medicine, states that, “Genetics loads the gun, but environment pulls the trigger.” In other words, the genetic vulnerabilities must be there, but an eating disorder won’t emerge unless the right environmental conditions are present.

In an article co-written by Bulik and Suzanne Mazzeo, Associate Professor of Counseling Psychology at Virginia Commonwealth University the authors posit that, “Ultimately, the elucidation of causal models for eating disorders will no doubt include various types of genetic and environmental interplay…Clinicians and researchers must become educated in the nuances of GxE (genetic and environmental) interplay and avoid perpetuating purely environmental or purely genetic conceptualizations of eating disorder etiology” (2009).

[fat_widget_left]This speaks to the role of the family system, as one of several environmental factors, in potentially providing an eating-disorder-friendly habitat, so to speak, for a child whose genetic makeup renders her vulnerable to developing an eating disorder. Mazzeo and Bulik note that, “For decades, parenting styles have been unrightfully blamed for causing eating disorders. Considerable care must be taken when discussing GxE interplay not to convey the message that somehow parenting is to blame for these pernicious illnesses. Conversely, a purely genetic explanation should not be taken to mean that parents need not examine their parenting style and the influence it might have on children” (2009). They go on to say that the child’s genetically influenced constitution also shapes how that child will react to a particular parenting style. For example, a child with the genetic constitution for developing an eating disorder might be much more aware of physical appearance than his/her differently gened siblings. The child may ask for more feedback about his/her appearance, thus generating more comments about appearance from his/her parents (and others) than the other siblings receive.

So the interplay of genetics and environment is complex, and begins early on with environmental factors, such as parenting. Other environmental factors include life events and media influence. Authors John Briere and Catherine Scott report on how “Research suggests that individuals with eating disorders (EDs) are relatively likely to have been abused or neglected as children, or to have been victimized in adolescence or adulthood. These experiences, in turn, are often associated with a range of psychological symptoms, as well as, in some cases, a more severe or complex ED presentation” (2007).

It’s important to recognize that difficult life events, from a major move to physical or sexual abuse (which have been shown to be risk factors for bulimia), are experienced differently by a person who tolerates distress poorly, and a person who tolerates distress well. The ability to tolerate distress is, in part, genetically influenced, but also has to do with how distress tolerance was modeled and taught in the person’s family.

With regard to cultural notions about ideal body size and shape, everyone is exposed to media images of ultra-thin ideals, but not everyone develops an eating disorder. These things will affect someone with the “right” genetic markers differently from someone who does not have them. But how parents and other elder family members handle the media imagery, and whether they share the idealization of ultra-thin bodies, also influences the child.

Suffice it to say, eating disorders are complex, and their causes are equally complex. No one factor accounts for the formation of an eating disorder. Eating disorders are best understood via a biopsychosocial model, which takes into account genetics, our personal selves (thoughts, feelings and behaviors) and the familial and social contexts in which we grow up and live. When it comes to treating disordered eating, the latter two must be addressed. We can’t change our genetic makeup, but we can change the way we think, the way we manage our emotions, the way we behave, and, in adulthood, the circumstances in which we live. And we can avail ourselves of therapies that focus on healing the damage done by earlier experiences.

References

  1. Briere, John and Scott, Catherine. (July, 2007). Eating Disorders: The Journal of Treatment and Prevention. “Assessment of Trauma Symptoms in eating Disordered Populations.” Vol. 15. No. 4.
  2. Bulik, Cynthia M. and Mazzeo, Suzanne E. (January 2009). Child and Adolescent Psychiatric Clinics of North America. Vol. 18. No. 1.
  3. Yager, Joel; Devlin, Michael J; Helmi, Katherine A; Herzog, David B; Mitchell, James E; Powers, Pauline S; and Zerbe, Kathryn J. (Fall, 2005). Focus. “Eating Disorders.”
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