Treatments

Individual Therapy

I'm not entirely sure how exactly the various therapists I've worked with define their therapeutic style. I would say it's probably a little bit of a combination of different styles... however because modern day therapy is based on Freudian "talk therapy" and has it's origins in psychodynamic psychotherapy I'm just going to give a little bit of information on that and some brief history of developments in psychotherapy that got us to present day therapies. The goal of psychodynamic therapy is to increase awareness of how unconscious processes affect daily functioning and gain insight in order to effect changes.1 The idea is to figure out how past experiences affect your current functioning and learn how distorted thought processes may be influencing your behaviors. This type of therapy can last years and it's eventual result is to integrate conflicting parts of the self in order to heal. Therapy nowadays though, tends to be a little more warm than what psychoanalysis was (and still is). The development of humanistic therapy followed pyshodynamic therapy, and it places more emphasis on the importance of the client in their own healing and was the start of the therapist being more than just a quiet interpreter. The therapist has empathy, unconditional positive regard and is genuine. Following that, therapies started to look at changing behaviors and then included changing cognition. There are so many different types of therapies now that it's impossible to talk about all of them. A majority of therapists describe themselves as eclectic, meaning that they use the style that they think will work best for the particular client.

My personal experience with individual therapy has been, overall, incredibly positive. I have become more aware of my emotions and more willing to allow them into my consciousness. I don't dissociate so much from the feelings that are associated with certain experiences. This has, in the short term, made me experience more pain, but it is necessary in order to integrate all parts of myself and become a "whole" person. Therapy has also allowed me to learn how certain relationships affect my thinking and behavior and I have learned how to have more positive connections with others. I've had to take a close look at how the trauma has affected my feelings of self-worth. How my family has affected how I think about things. How my behaviors affect my state of mind and vice versa. It's taught me so many things about my experiences and about myself and has been extremely helpful to me.

Psychopharmacology

Psychopharmacology uses medications to affect brain functions and regulate moods and emotions. It is usually recommended that medications be used as an adjunct to some other form of therapy.

Mood disorders, such as depression, can be caused by or cause chemical imbalances of the brain. These imbalances can be treated with drugs that may affect serotonin, norepinephrine and dopamine levels in the brain.1 Some common drugs that may be used as antidepressants include monamine oxidase inhibitors such as  Nardil and Parnate, tricyclic antidepressants such as Tofranil and Aventil, and selective serotonin reuptake inhibitors (SSRIs) such as Prozac and Zoloft.2 Anxiety may be treated with drugs that target GABA, an inhibitory neurotransmitter. These drugs can help relax highly anxious people.1 Drugs that may used include benzodiazepines, such as Xanax or Klonipin, antidepressants, or buspirone (BuSpar).2 Problems with sleep are a common symptom of PTSD and drugs may be used to help with sleep. A wide variety of medications may be used to treat sleep disturbances including benzodiazepines and barbiturates.2 Other drugs that have drowsiness as a side effect may be used to help with sleep.

PTSD is hard to treat with medications because of it's wide variety of opposing symptoms. I have had varying amounts of success using medications. I have found that treating the depression has been very difficult and I haven't had much success. I have found that medications have been able to help treat my anxiety, however occasionally the tranquilizing side effects of these drugs can worsen the depressive symptoms, so it is a difficult balance to find. Medications, combined with sleep hygiene, have helped my sleep. I have no trouble falling asleep anymore though it hasn't been perfect. A side effect of some of the medications is vivid dreams, which can sometimes leave me feeling unrested. 

Unfortunately finding the right medications can be a very long process. Everybody's chemistry is different so it can take a while to find a medication that works for someone. I guess I'm one of those people that it's going to take a while for...

Dialectical Behavior Therapy (DBT)

DBT was created by Marsha Linehan as a treatment for people with chronic suicide attempts or suicidal ideation and urges to self harm. She found that CBT was not adequately treating many people with these problems so she built on the CBT model, adding validation and dialectics - balancing acceptance and change.3 It is the best known treatment for people diagnosed with Borderline Personality Disorder (BPD) but has also been shown to be effective in treating people with PTSD.

Stage 1 of DBT treatment is getting behavioral dysregulation under control. This includes reducing behaviors that threaten the life of the patient, reducing the likelihood that the patient will terminate therapy, and replacing ineffective skills with better coping skills. Stage 2 of treatment is moving the patient from a state of silent suffering to one of experiencing emotions and talking about them. This is the stage when PTSD is treated. Stage 3 of treatment is to create a life of balance, with the normal ups and downs of day to day life.3

DBT is made up of four modules: emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness.4

Emotion regulation uses the acronym of PLEASE MASTER in order to remember to: treat PhysicaL illness, balance Eating, avoid mood-Altering drugs, get Exercise, and build MASTERy of skills. Doing these things helps balance unbalanced emotions.4

Distress tolerance teaches skills to deal with intense emotions to replace negative coping skills. This module teaches distraction techniques, ways to self-soothe and improve the moment, and making pros and cons lists for tolerating the moment.4

Interpersonal effectiveness is about attending to relationships, balancing priorities, and balancing "shoulds". One must balance priorities when trying to ask for something or when faced with responding to a request. This involves looking at how important it is to obtain the objective, maintain the relationship, and maintain self-respect.4

Mindfulness is staying in the present by observing, describing, participating, and being nonjudgmental. One must find a balance of the rational mind and emotional mind to find the wise mind.4

I have DBT to be very helpful in my treatment. I was first exposed to DBT after my first hospitalization in September 2011. I learned a lot of the skills but was not effectively implementing them into my life. However, once I figured out that I could get better and that I had to work to do that, I started using DBT and it has been really helping me deal with behavioral and emotional dysregulation. I'm very hopeful that it will continue to improve my life.

Cognitive Bahavior Therapy (CBT)

Coming Soon!


Group Therapy

Coming Soon!


References 

1. Gazzaniga, M.S. & Heatherton, T.F. (2006). Psychological Science (2nd ed.). New York: W.W. Norton & Company.
2. Meyer, J.S. & Quenzer, L.F. (2005). Psychopharmacology: Drugs, the Brain, and Behavior. Sunderland: Sinauer Associates, Inc.
3. http://behavioraltech.org/resources/whatisdbt.cfm 
4. Linehan, M. M. (1993). Cognitive Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press.

2 comments:

  1. I'm glad that in describing the therapy models and medication, you provided us with both the "objective," definitional viewpoint and also your "subjective," personal experience. As someone who had experienced years on the wrong medications (i.e., antidepressants instead of mood stabilizer + anxiety medication,) I appreciated your sharing that it has been a rather long (and likely frustrating?) experience for you to first be over-medicated and now have the support of a competent and caring nurse yet still have some symptoms persisting despite medication. I share your hopefulness that over time the medication mix will be improved for each of us to minimize or even eliminate persistent symptoms. Thanks for sharing :-)
    -Patrice

    ReplyDelete
    Replies
    1. Hi Patrice!

      Thanks for your comment! I'm happy to hear that you enjoyed both the objective and subjective viewpoints. I worried while I was writing these that I was being a little preachy.

      Medication treatment for me has been a very frustrating experience. Knowing that medications were making me feel worse for a while makes me angry with the whole process, but I'm also very glad to have a nurse practitioner now who doesn't try to throw medication at every problem I talk about. I am hopeful that medications can be very helpful and, though there are definitely hiccups in the path to finding the right combination, it's worthwhile once you find what's right for you.

      Thanks for reading!
      Kate

      Delete