CITICARE

Dialectical Behaviour Therapy

Dialectical Behaviour Therapy (DBT) was established for individuals who deal with distressing emotions and experiences by using unhealthy self-destructive behaviours such as self-harm, substance misuse and eating disorders. DBT is an effective, evidence-based treatment to support people who experience some of the following difficulties:

• People who feel isolated and lonely when in their own company.
• People who feel intense emotional pain and a sense of emptiness.
• People who feel depressed or anxious.
• People who find it difficult to build trust and maintain relationships with others.
• People who experience a chaotic painful life.
• People who feel uncomfortable in a close relationship, or that people are trying to control them.
• People who cannot cope well when people leave them.

Exposure and Response Prevention Therapy

ERP is a type of behavioral therapy that exposes people to situations that provoke their obsessions and the resulting distress while helping them prevent their compulsive responses. The ultimate goal of ERP is to free people from the cycle of obsessions and compulsions so they can live better.

Response prevention is key, because anything that gets rid of distress makes it impossible for us to get used to it. When people don’t turn to compulsions, they learn how to accept their obsessions instead of acting desperately to neutralize them. The thoughts are still difficult sometimes, but they no longer seem like a huge problem.

Exposure Therapy: The effectiveness of exposure therapy relies upon a behavioral principle called habituation. Habituation is the process by which a person's behavioral and sensory response diminishes over time, after repeated exposure to a particular stimulus. We all have experienced habituation. Have you ever jumped into an ice cold swimming pool, only to feel comfortable after a few minutes? That's habituation at work. Perhaps you have friends who live nearby an airport, busy highway, or a train station. Have you wondered how they could possibly concentrate or sleep with all that noise? Your friends may have felt the same way when they first moved in. Now, after living there for a while, their sensory neurons just stopped reacting to the noise. They will probably tell you that they are so accustomed to the noise they no longer even hear it anymore. They've become habituated to it.

Exposure therapy takes advantage of this principle of habituation. In the context of treatment, it means allowing repeated exposure to the feared object or situation, so that habituation can occur.

Response Prevention: Exposure therapy is usually coupled with response prevention. This is also known as "ritual prevention." This component of treatment is particularly important for people who have developed ritualized, repetitive behaviors such as compulsions. The compulsive behavior serves to "undo" or neutralize the anxiety that occurs when faced with an anxiety-provoking situation. Since compulsive behaviors serve to reduce or eliminate anxiety they are intrinsically rewarding. Therefore, they are repeated.

Response prevention is based on a principle of learning theory (specifically, operant conditioning). According to this principle, when a behavior is no longer rewarded (reinforced) it becomes extinct. This means the behavior gradually fades away. For instance, washing hands after contact with a doorknob serves to "undo," or negate the anxiety that occurs after touching a doorknob. Response prevention eliminates the rewarding effect of hand washing. As such, compulsive hand washing will gradually become extinct.

Cognitive Processing Therapy

Cognitive processing therapy (CPT) is a specific type of cognitive behavioral therapy that has been effective in reducing symptoms of PTSD that have developed after experiencing a variety of traumatic events including child abuse, combat, rape and natural disasters.

CPT is generally delivered in different sessions and helps patients learn how to challenge and modify unhelpful beliefs related to the trauma. In so doing, the patient creates a new understanding and conceptualization of the traumatic event so that it reduces its ongoing negative effects on current life.

What CPT Can Help With?

• Depression
• Cognitive distortions
• Psychological distress
• Anxiety
• Sleep disturbances
• Dissociation
• Anger
• Problems coping

Eye Movement Desensitization Reprocessing

Eye Movement Desensitisation and Reprocessing (EMDR) is a distinct treatment approach which uses bilateral stimulation to support the processing of distressing information that remain “frozen” in the brain or being unprocessed due to their overwhelming nature (e.g., in trauma). EMDR has been initially developed in order to successfully treat Post-traumatic Stress Disorder and this is where the bulk of its evidence-base presently lies, although EMDR is increasingly being used to treated other conditions in which disturbing memories play a part.

EMDR therapy focuses to past or present disturbing memories, experiences and related events. Eye movements (or other bilateral stimulation) are used during sessions. Once a memory or experience is agreed upon the therapist will ask the client to hold diverse facets of that event or thought in mind and to use his eyes to track the therapist’s hand as it moves back and forth across the client’s field of vision. Whilst this occurs, it is suggested that inner associations arise and the client begins to process the memory and distressing feelings. In successful EMDR therapy, the meaning of painful events is changed and integrated on an emotional level.

What can I expect if I receive EMDR?

• You and your therapist will agree on key traumatic memories that you want to work on.
• There will be some repetition of this process in the room which is part of the reprocessing experience.
• Your therapist will continue to work with you and focus on specific memories until the intense affect associated with them has decreased.
• EMDR can be delivered as a therapy in its own right or sometimes you might receive it in conjunction with another therapeutic approach as an adjunctive intervention.

Habit Reversal Therapy

Habit reversal training (HRT) is an evidence-based highly effective behavioral therapy for people with unwanted repetitive behaviors or habits. HRT works on behaviors such as: tics, hair pulling, nail biting, and skin picking to name a few, and is appropriate for people at any age.

Often we don’t really understand what is driving our behaviors (like relief from urges or feelings) until we look for them with the help of a professional.

Habit Reversal Training is made up of five parts:

• Awareness training: brings attention to the behavior so the person can gain better self-control and awareness. In this stage you will work to notice when you are performing the behavior, identify the earliest warning that a behavior is about to take place, and identify the situations where the behavior occurs.
• Competing response training: you will work with your therapist to come up with a different behavior to replace the old unwanted behavior and practice performing this new behavior.
• Motivation and compliance: you may make a list of all the problems that were caused by the behavior to remind you of the importance of sticking with it. Parents and friends may be asked to offer praise and encouragement for the person’s progress, support of family and friends can increase your chances of kicking an unwanted behavior.
• Relaxation training: habits or tics can be common when a person is under stress, it can be helpful to learn relaxation skills such as deep breathing, mental imaging, mindfulness, and progressive muscle relaxation to keep urges at bay.
• Generalization training: you will practice your new skills in a number of different situations so the new behavior becomes automatic.