World Suicide Prevention Day

Dear BHBA community:

I have the honor of promoting a tremendous learning opportunity (CE credit available) that is not to be missed! Dr. David Jobes, Ph.D., ABPP, (click here for his bio) is a renowned clinician, professor, suicidologist and the creator of the evidence-based treatment Collaborative Assessment and Management of Suicidality (click here to read about CAMS). He has partnered with the DBT-Linehan Board of Certification (DBT-LBC) to livestream his timely and critical presentation "A Crash Course on Suicide and Suicide Prevention.” The presentation will air on September 10th, 2021 from 12-1pm Eastern Standard Time. September 10th, 2021 is World Suicide Prevention Day (click here to read more about this day from the International Association for Suicide Prevention and how they promote awareness worldwide).

This partnership between Dr. Jobes and DBT-LBC is unprecedented and inspired by the growing and alarming rates of suicide behavior and completion in the United States. Sadly, suicide is already a leading cause of death in the US. This is of grave concern, prompting the National Institute of Mental Health (NIMH) to publish a recent article entitled “The dual pandemic of suicide and COVID-19” (click here for the full article from the NIMH). The NIMH emphasizes that suicide can be treated and is preventable, with early detection. Increased awareness can lead to early detection, so we are doing our part here at BHBA by posting a series of newsletters on suicide and the treatment for suicide in and around the month of September and have the honor of promoting this webinar to anyone who is interested.

A newsletter will come soon with information on how you can register and how to obtain a CE credit for this course if you qualify. Please note that 100% of your registration cost ($30) will be directed to support DBT-LBC, a non-profit and mostly volunteer agency, whose members tirelessly work to educate, promote awareness of standardized DBT treatment for suicide, and increase affordability and availability of standardized DBT, including trying to make inroads at the state legislative level. DBT-LBC also provides scholarships to clinicians, agencies and programs needing help with certification costs. I have the honor and privilege of being a volunteer for this organization and can attest to how value and mission-driven they are.

As you all know, there are decades of research proving DBT as a gold standard treatment for those struggling with chronic suicidal thoughts, feelings and behaviors for all ages. Still, affordable and standardized DBT is hard to find. The sad reality is that there are not enough therapists providing comprehensive and standardized DBT. DBT-LBC, the certifying body, exists for this purpose. Please click here to see their website to learn more about DBT-LBC.

As always, please email me with any thoughts and questions to drbellet@bhbehavioralassociates.com.

Introducing Gabrielle DiBenedetto, LMSW!

Please give a warm welcome to Gabrielle DiBenedetto, LMSW who joined our cognitive-behavioral therapy (CBT) team in July! You can see her full and impressive bio by clicking here!

Gabrielle is a child and adolescent psychotherapist and, as all incoming therapists at BHBA, is engaged in weekly didactics with curriculum from the Beck Institute for CBT. She is in intensive training for exposure and response prevention (ExRP) for OCD with a developer for ExRP from the University of Pennsylvania Center for the Treatment and Study of Anxiety, along with other members of the BHBA team.

During graduate school at NYU Silver School of Social Work, Gabrielle was drawn to trauma-informed interventions for children and trained in CBT-FT (trauma focused), as well as Group Attachment-Based Intervention (GABI) at the Center for Babies, Toddlers, and Families (CBTF) at the Albert Einstein College of Medicine. GABI focuses on fostering secure attachment within the care-giver/child dyad, in order to circumvent transmission of intergenerational trauma. Through GABI, she developed a love for play therapy, and frequently uses toys, games, and art to build therapeutic bonds and facilitate healthy emotional expression. She also brings to bear her passions and degrees in both theater and early education to enhance her therapeutic skills.

Gabrielle has experience with youth of all ages, from infants to young adults, with a variety of challenges, in a variety of settings, including special ed and main stream schools, clinics, and New York city family shelters.

Please email intakes@bhbehavioralassociates.com to inquire!

CBT for Trauma, by Brianna Sculley, LCSW

Most people who are familiar with Cognitive Behavior Therapy (CBT) likely associate it with treating anxiety. However, CBT techniques help with a variety of mental health symptoms, including those related to trauma!

If you are suffering from past traumas, then working with a CBT therapist can assist and change problematic thought patterns, which can lead to an increased feeling of safety in your daily life. With a therapist's support, you will eventually reflect on what occurred without being constantly triggered.

Let’s explore how CBT helps people who are dealing with trauma.

Address Catastrophizing

A person with PTSD can fear that many situations will have a catastrophic outcome. After living through a traumatic experience, this is certainly understandable. However, if you catastrophize often, it will hold you back from trying new things. It could even prevent you from staying in touch or socializing with your loved ones. Through CBT, your therapist can help you envision realistic outcomes for different situations, which will ultimately help you avoid jumping to the worst-case scenario and allowing for more freedom in your life.

Re-evaluate Negative Thoughts

If you live with PTSD, you may find yourself trapped in the same negative thought cycles over and over again. Unfortunately, simply telling yourself to “think positive” isn’t going to be effective. Instead, you can re-evaluate these negative thoughts and address the cognitive distortions. You’ll start to see how certain thought patterns don’t serve you and why you adopted them out of a self-protective urge in the first place.

Gathering Evidence

After going through a traumatic experience, it can be hard to clearly see a situation due to increased fear and expectations based on past events that cloud the present reality. You may be triggered by things that wouldn’t seem threatening to others, or you might feel unsafe in situations that remind you of your trauma, even if you are “technically” safe.
It can take time for your brain and body to register that you truly are okay in a given situation. Your therapist will teach you how to gather evidence and focus on increasing feelings of safety. This will help ground your perspective in evidence, which is an essential part of CBT.

Establish New Thought Patterns

Your CBT therapist will also help you build new thought patterns to boost your mood, alleviate your PTSD symptoms, and navigate challenging situations with confidence.
In therapy, you’ll focus on creating new ways of thinking by using affirmations you can refer to whenever you feel overwhelmed. It can be hard to rewrite beliefs that you developed due to a traumatic experience, but your perspective will shift over time.

Form Positive Associations

Through CBT, you can begin to form new, positive or neutral associations with things that may have reminded you of trauma in the past. Yes, this process takes time, but your therapist will cultivate a safe environment where you can analyze your trauma without feeling like you are reliving the experience. As time goes on, you’ll begin to focus on new associations, reducing the effects of former triggers. Always reach out if you would like assistance as PTSD can be highly challenging to face on your own.

CBT for OCD, by Brianna Sculley, LCSW

Cognitive Behavioral Therapy (CBT) can be an effective treatment for Obsessive-Compulsive Disorder (OCD) by targeting irrational and obsessive thought patterns. At times, these distressing thought patterns lead people to engage in compulsions that provide temporary relief and temporary feelings of safety, but they are only temporary and can play tricks on us!

Exposure and Response Prevention Therapy

A therapist working with a client with OCD can provide a safe environment to expose to stress-inducing scenarios. Exposure therapy should proceed at a comfortable pace for the patient. During exposure therapy, the client will not be able to engage in compulsive behaviors for anxiety relief. Instead, they face their fear and allow the anxiety to gradually fade away. This desensitizes the client to these scenarios over time resulting in them happening less frequently.

Types of Exposure

How does a therapist expose their client to stressful scenarios? They can use a few different methods. First, they might proceed with real-life exposure and supervise the client in an anxiety-inducing scenario for a period of time. Alternatively, they might use imaginal exposure, in which the client visualizes the stimulus they are afraid of to reduce their fears and distress. In addition to these forms of exposure, a key aspect of exposure therapy is response, or in this case, ritual, prevention. It can be difficult for OCD sufferers to let go of their powerful urges. However, through exposure therapy, it is highly possible to experience long-term relief.

Grounding and Deep Breathing Exercises

In CBT for OCD, a therapist will likely work with their client on grounding and deep breathing exercises. These skills are very helpful for reducing anxiety without turning to their go-to ritual behaviors. While they are not “quick fixes” for OCD, clients can often experience relief with these coping mechanisms. Through deep breathing and grounding, clients can learn to slow their breathing and get their heart rate under control for an overall calming effect.

Progressive Muscle Relaxation

Many people who struggle with OCD also carry tension in the body. After all, stress doesn’t just affect the mind. A person with OCD may feel their muscles tense up when they are anxious. This is because the fight or flight response kicks in. Progressive muscle relaxation techniques are another aspect of CBT for people with OCD. This helps people to disengage from the automatic fight or flight response and see the situation more clearly.

Cognitive Restructuring

CBT for OCD includes a focus on cognitive restructuring. A therapist will help their client to challenge irrational thoughts that are not necessarily based on facts. Basically, CBT for OCD involves using logic to critique thought patterns that result from emotional responses rather than factual evidence.

And after a therapist guides their client through these exercises, the client will begin working to establish new thought patterns by analyzing the evidence for their new beliefs. This does not happen overnight, but it becomes easier for people who struggle with OCD to focus on more rational thought patterns over time. This makes it possible to avoid engaging in compulsive behaviors. Essentially, clients learn to become their own exposure therapists!

Are you curious about the benefits of CBT for OCD? Consider working with a therapist. Reach out to us today to discuss options for scheduling your first session - it will be so worth it.

CBT for Social Anxiety, by Brianna Sculley, LCSW

Living with social anxiety can be exhausting! You may lose touch with family and friends because you are hesitant to attend social gatherings or connect with them. Maybe you tend to replay past social interactions over and over in your head, wondering if you said or did anything wrong. You might hold back from applying for jobs because the thought of going to an interview leaves you panicked. Perhaps even picking up the phone or answering the front door is nerve-wracking.

A therapeutic approach that includes Cognitive-Behavioral Therapy tailored for social anxiety can help you find your confidence again.

Here’s how CBT for social anxiety works and how it can benefit you.

Determine Your Goals!

Before you start processing your social anxiety with CBT techniques, outline your goals. This might include addressing a low sense of self-worth or letting go of your guilt for past social faux-pas. It could also involve learning to be more assertive and confident in social situations. Other goals may include being more proactive about accepting invitations to social events, striking up conversations, or easing up on your self-judgment.

Identify Negative Thoughts!

Next, you’ll be ready to identify automatic negative thoughts that crop up when you are in a social situation. For instance, if you have to give a public speaking presentation, you might think, “If I mess up, no one will let me forget it.” Or if your friend asks you to tag along to a party, you might assume, “No one will want me there.” If you frequently dwell on negative thoughts like this, the most important first step is noticing them and potentially what situations trigger them to happen.

Change Your Thought Patterns!

How do you go about changing your thought patterns? You can start by coming up with realistic replacements. For example, instead of thinking, “No one will want me there” before attending an event, you could focus on thinking, “Maybe I’ll meet some nice people.”

Your new thought patterns don’t have to be dramatic declarations. Simply start from a place of quiet confidence. This is a step in the right direction. It can take some time to internalize these new thought patterns, but you will get there with repetition.

Gradual Exposure!

CBT for social anxiety also involves gradual exposure, known as “systematic desensitization.” This might sound intimidating, but all that is required is practicing small tasks that help you develop confidence. For instance, if you have performance anxiety, you could give a “presentation” to a close friend or family member as a behavioral rehearsal. Give yourself every opportunity to practice and see it as an opportunity to expose yourself to your fears.

The Real Thing!

Finally, you will be ready to practice in real social situations. As you approach these situations, your predictable negative thoughts may crop up. Take a moment to remember and practice the new ones that you developed. Remember, you will likely not feel super confident overnight. However, by consciously choosing new thought patterns, you can begin to engage in socializing and possibly even looking forward to meeting new people! As always, CBT therapists are available if you need additional help and never be afraid to ask!

CBT for Anxiety, by Brianna Sculley, LCSW

Brianna Sculley, LCSW, our resident Cognitive Behavioral Therapy (CBT) expert, developed a 4-part series on CBT interventions! In this first installment, learn how CBT helps with anxiety, a very common psychological problem that gets exacerbated in times of stress.

Brianna writes, "If you struggle more than you think you should with worry and anxiety, you might be wondering how CBT can help you. People with anxiety often ruminate on negative thoughts that aren’t likely rooted in the present and may not even be rooted in facts. Then, it can affect your mood and behavior in ways that do not line up with the facts. The cycle can feel extremely frustrating and hard to manage.

CBT tackles these kinds of thinking problems and analyzes the way they negatively affect emotions and behavior. Then new thoughts based on facts are incorporated to help change our thinking, feelings, and behaviors.

When anxiety is high, our perceptions are naturally distorted as our neurological arousal system, specifically the sympathetic nervous system, is set off and produces rapid changes in our body to gear us up for fight or flight. Our brain is certain there is a threat. Trying to talk ourselves out of our beliefs or "get perspective" in these moments can truly feel impossible!

Thankfully, CBT strategies can help to alleviate these distressing thoughts, and with enough time and practice, you can develop and use these truly effective techniques strategically and on your own.

Let's take an example. Say you text a friend and they do not send a text in return, triggering thoughts that they do not like you, or "I am unlikeable". You may also notice that this is a common assumption and one you make with multiple friends and colleagues. This thought naturally increases worry and distress, and if the thought occurs frequently, you are likely to be in a lot of anguish. Unchallenged, these thoughts may lead you to erroneously conclude your worst fears, making you feel even more miserable AND you may even act on your conclusions by withdrawing from your friends (flight) and unnecessarily isolating yourself, or confronting your friends for rejecting you (fight) and causing unneeded relationship trouble.

Use these 4 CBT steps to help you:

Step 1 - Identify Your Negative Thoughts
Take the time to identify negative thoughts that you dwell on. These beliefs might make you feel insecure, unworthy, or fearful. Think about the origins of these thoughts. Did you receive a lot of criticism or rejection as a child, or did you suffer a significant loss or abandonment? In the example above, the frequent thought is "I am unlikeable," or "people don't like me".

Step 2 - Challenge Cognitive Distortions
Come up with a list of examples from the past that confirm or debunk this thought. Chances are you have many more examples in your life proving your fear is wrong. A majority of these thoughts that are exacerbating your anxiety do not pass the reality test. A CBT therapist can walk you through “reality testing” if you need extra help.

Step 3 - Replace Problematic Thoughts with New Ones
You have figured out which thoughts are rooted in anxiety. You have determined that many of them are not based on any real evidence, and now you are ready to establish healthier thought patterns. With the above example, replace "People do not like me" with “I am a good friend and have a good time when I'm with friends. I feel liked in their presence and they show interest in me. People often get busy and overlook texts. I have even overlooked texts from time to time with good friends." These new thoughts likely won't sink in right away – but as you focus and commit to adopting new beliefs that align more closely with reality, you’ll find relief from your anxiety.

Step 4 - Generalize by Practicing Reinforcing & Encouraging
Like learning any new behavior, you must practice in order to achieve mastery. Use these techniques often. Don't forget to reward yourself for your efforts and apply good old reinforcement to give your efforts an extra boost. Keep encouraging yourself along the way! You can do this! In time, you will become a thoughts and emotions master. And as always, we believe in you!”