Motivation: Start Lifting Yourself Up and Stop Beating Yourself Down

Motivation, non-judgment, authentic life
Listen to the Audio Version of Dr. Bando’s Article.
Often, clients or prospective clients approach me for help with motivation. We all want to live vibrant lives and maybe increase exercise, change the foods we eat, stop eating late at night, make that health care appointment, or countless other important things. Today passes, then tomorrow, then a week goes by, and we realize we haven’t made that change we wanted at all. We can’t seem to find that Motivation, so we get frustrated and feel defeated. Our self-talk becomes harsh: “Ugh, I am so bad at this!” “Why can’t I just do what I’m supposed to?! It should be easy!” “I’m hopeless.” “I’m an idiot!” We give up for the moment and throw in the towel, abandon our goals, and try to accept things as they are, giving up hope that we will ever make that change.

Finally Fed Up?

Maybe we finally decide to get serious. We are disgusted enough with ourselves that we make a strict plan to ensure we adhere to the behaviors we “should” be doing. Then one day passes, then another, then a week, and then here we are: still stuck, still without change.

Perhaps we even make the change for a brief time. Maybe we start eating in a way that makes us feel nourished and energized while helping to reach a target weight. Then, time goes by, and we are sick of being restrictive and “depriving” ourselves, so we give in and “indulge,” feeling stuck in old behaviors, staying unmotivated, and continuing the cycle.

It’s Time to Get Motivated!

MOTIVATION happens when our goals align with our values, then the behaviors we take to move toward our goals link closely to our values, and we reinforce those behaviors. I know from personal experience that the key factors in staying Motivated are reinforcement, which inspires and ignites Motivation, and punishment, which extinguishes Motivation. When we narrow it down to these two simple principles, we begin to realize how straightforward it is to start down a path to lasting change. By reinforcing yourself with simple things like clear goals, being in tune with what is truly important to you, and staying passionate (by focusing on what works and reinforcing the hell out of it), you are guaranteed to break yourself free from that cycle.

Audio Meditation for Motivation:

Listen to Dr. Bando’s Audio Meditation
To stay motivated and moving toward goals that you value, you must build the muscle of Reinforcement. Finding what you are already doing that is working, or taking very small steps forward, and then rewarding those actions creates sustainable motivation for change. Think of it this way: punishment extinguishes motivation and reinforcement creates, ignites, awakens and maintains motivation. Where you have reinforcement, you can create motivation.

Let’s practice building this muscle:

Start with noticing your breathing. You do not have to change or alter your breath. Simply notice that you are inhaling and exhaling. Pay attention to where in your physical body you feel your breath.

Now, for the next three to five breaths, pay attention to where you feel your breath in your physical body and when your mind wanders away or zones out, gently bring your attention back to your breath.

When you notice yourself wander and bring you attention back to your breath, you can think of this as a weight lifting rep, or an exercise to build your ability to put your attention where you want it.

Now, let’s go further. Using this idea of placing the mind where you want it to be in the moment, recall one thing you did in the past day that was effective. Unless you achieved a huge goal in the past day, this exercise requires you to let go of judgments and find where you were effective. Do not dismiss anything for not being “good” enough or “big” enough. If you were tired and you got up on time, that is an accomplishment. If you felt depressed and did not want to get out of bed but you took a shower, perhaps that was effective. It does not matter how big or small you think this action was, take a moment and pick one effective action you engaged in over the past day.

When you have that behavior in mind, reinforce it. You can reinforce this behavior a number of ways: you can reinforce with self-talk, such as, “Good job,” or “I did it,” or “Nice!” Remember, your focus is on what you did well and reinforcing it. If your mind wanders to telling you that it wasn’t good enough, your practice is to gently bring your focus back to what you did well and reinforce it. You may also reinforce your behavior through soothing touch. Maybe if feels soothing to place your hands over your heart center and notice the warmth, or one hand over the other hand, or gently cup your face with both hands. This is touch that feels loving and sweet. Again, when your mind wanders to you or your behavior not being good enough, gently bring your attention back to what you did well and reinforce it.

This is the practice of increasing your motivation in a way that is sustainable and reliable. You can practice this every day – find one thing you did well and practice turning your mind toward noticing what you accomplished and reinforcing it. When your mind goes toward judgments about you or your behavior not measuring up, this is punishment. It will extinguish your motivation and ability to move forward. It’s not wrong, this is just what minds do, they wander, and they come up with judgments. Your task is to calmly notice when this happens and bring your attention back to reinforcing your accomplishment. Practice, practice, practice this and you will notice your motivation grow and your ability to take more steps toward your goals increase.


4 Tips for Returning to Therapy

For an audio recording of this post, visit here: Dr. Bando on Soundcloud 

When you make the investment of time, energy and money in therapy, you want to experience progress and change. If you’ve been in therapy before but haven’t achieved the results you want, you may be wondering what you can do to make those changes. Talk therapy can feel helpful, allowing you to have some real ‘aha’ moments and gain insight into the cause of your problems. However, talk or what’s called “supportive” therapy often does not help you change and meet your goal. Often, what is needed is to learn practical, concrete skills that will help you foster lasting change and healing. This can be achieved through treatment with a results-oriented therapist.

If you’re thinking about returning to therapy and want to create more effective change, here’s what to do:

Four things to keep in mind.

1st- Know That Returning to Therapy Takes Readiness and Commitment

If you have decided on returning to therapy, that’s a great sign that usually indicates you have some readiness and commitment to do what is needed to make changes. The most important first step is finding a therapist who aligns with your goals and who you feel comfortable working with. This can help you stay committed and focused.

Many clients prefer a results-oriented therapist who will work with them to make specific changes toward goals, rather than attending therapy indefinitely. The right therapist can help you identify and build upon your goals from the start and keep you motivated to do what is needed for lasting change.

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2nd- Develop A Plan

While the idea of planning your therapy might seem strange, having a goal and a plan in place makes it much more likely you will succeed in making changes. Sometimes people attend therapy to just talk or vent, but to transform your life you need to work systematically to plan and implement change.

The therapist you choose to work with should develop a case formulation within your first few sessions. This formulation offers expert reflections and additional insight on your current situation. A skilled therapist will indicate a thorough understanding of your unique situation and collaborate with you to make sure this formulation is on target. By the third or fourth session, you and your therapist should have treatment goals and a treatment plan that will guide your future sessions, help you better understand what to expect out of therapy and ensure you both keep your eyes on the prize and moving toward your goals.

 3rd- Take What You Learn in Therapy Outside the Session

One benefit of therapy can be receiving support from your therapist and leaving sessions feeling relieved or empowered. Keep in mind, this is not enough. If you are working to make changes, then you must take the work done in therapy with you, outside of the session, and into your day-to-day actions. A therapist focused on getting you the results that you want will probably ask you to do “homework” or to practice new skills throughout the week. It is essential to follow the recommendations of your therapist and do your assigned practices so that you can reap the benefits of therapy and translate them into your daily life. Practice in between sessions is imperative to change. It also arms you with information about what happened when you tried these new skills, and you and your therapist can troubleshoot and hone the skills in your next session. Your practice and feedback are invaluable in helping you and your therapist stay on track with moving toward your goals.

Depending on your therapist’s style and theoretical orientation, they may be able to implement additional ways to help you achieve change. For example, therapists that have been trained in Dialectical Behavior Therapy (DBT) might ask you to complete weekly Diary Cards, so you can plan to try out and practice newly learned skills and then keep track of what happened and have a straightforward way of reporting this in your next session.

4th- Discuss Problems with Your Therapist

 Therapy does not always happen on a linear path without hiccups. At times, problems may arise. Whether you felt misunderstood by your therapist, your homework did not seem to hit the mark, or you are not making the changes you expected as quickly as you wanted, it is important to talk about this honestly with your therapist. This can be an excellent time for you and your therapist to revisit your identified goals, refine your treatment plan, and figure out any adjustments that need to be made. Although it might seem like a challenging conversation, talking with your therapist about what is not working may help you discover some factors that are holding you back or halting change, making this a valuable part of your treatment. Do not underestimate the value of the feedback you give to your therapist. Once your therapist knows your experience, thoughts, and feelings, he or she has the opportunity to respond effectively, make any necessary adjustments, and this ensures you can get the quality care you want and need.

With the right approach, you can make effective and lasting changes when returning to therapy, learning new and valuable skills that lead to a more rewarding and satisfying way of life.

Remember, life is too short to just survive, that’s why I help people thrive. I’m Dr. Amanda Gale-Bando, licensed psychologist. Thank you for reading and best wishes to you in making the lasting changes you want.

 


What Happens When You Stop Depressant or Anxiety Medications?

Anti-depressant and anti-anxiety medications work to alter your brain chemistry and support a more balanced mood state. Since psychotropic medication changes your brain chemistry and may also come with side effects, deciding to take medication should not to be made lightly.  It’s helpful to understand how the medication you are prescribed works and what to expect when discontinuing it before deciding to stop. It’s always advised to be under the supervision of a doctor who can ensure your safety and help minimize any side effects before discontinuing psychotropic meds.

(Please skip to the last section of this article if you would like to consider alternatives to psychotropic medication and discuss your options with your prescribing doctor and other healthcare professionals.)

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Why Take Psychotropic Medications?

If you are struggling with depression or anxiety in a way that is significantly affecting your life, your doctor may recommend anti-depressant or anti-anxiety medications. Medications are also sometimes prescribed to alleviate symptoms, making therapy more helpful and useful. When feeling burdened by emotional overwhelm, at times it can be impossible to participate in your therapy in a way that promotes the change you need or motivate yourself to follow up on homework in-between sessions. When this is the case, your doctor may recommend psychotropic medication to help you engage in therapy in the way that you need to give you some relief from the symptoms you are experiencing.

Current-day research supports the use of both psychotropic medication and Cognitive Behavior Therapy (CBT) to treat diagnoses associated with depression. Medication may help you be fully involved and benefit from therapy. CBT will help you make the chemical changes in your brain for the long-term so that if you decide to taper off your medication at some point, you can maintain the brain changes you have worked to achieve in therapy.

In other cases, psychotropic medications may be prescribed to address chronic forms of depression and anxiety. Some people suffer from depression and/or anxiety for years. Despite trying many approaches, they struggle with symptoms on a daily basis. In these cases, medication may be a helpful option. Some people choose to maintain their medication regimen for a lifetime because when the medication is withdrawn, symptoms quickly return. Sometimes, even when engaging in all the behaviors necessary to support your health, the chemical components of the disorder you suffer from are just too strong, and medication is an essential part of your health routine. Each person is unique, as are the type, dosage and length of time prescribed medication works best.

It is very important to note that psychotropic medications may be contraindicated for some anxiety disorders and interfere with treatment and prognosis. Evidence-based treatments for anxiety require that you are able to experience the anxiety to its fullest extent in therapy in order for the treatment to be effective. If you are taking medication to decrease your experience of anxiety, in some case, this may interfere with your therapy. Talk to your treatment provider so that you can collaborate about the most effective treatment for you.

 

How Do Psychotropic Medications Work?

Different anti-depressant and anti-anxiety medication work in distinctive ways. Some medications stimulate the brain to produce more neurotransmitters (chemicals in the brain that regulate mood and other processes). Some help the brain by blocking the effects of neurotransmitters. Others, affect the brain by encouraging it to hold onto extra neurotransmitters. Because it takes some time for these medications to affect and balance the neurotransmitters in the brain, anti-depressant and anti-anxiety medications need to be taken for a minimum period of time before results are noticed. Your prescribing doctor can advise you the time needed to experience the affects from your medication.

 

Why Stop Taking Psychotropic Medications?

People often decide to stop using their medications once they start to feel better. This can be a mistake. It is important to carefully consider this decision and preferably, discuss your desire to discontinue medication with your healthcare professional. Often, it’s wise to wait a while after feeling better before discontinuing your prescription. When people quit taking their medication too soon, symptoms can return and sometimes the medication does not have the same effect or potency on mood symptoms the next time around. It is often preferable to wait until you have made changes in your health behaviors and maintained them for long enough where they have become habits. Once you have made the changes needed to support your sustained mental health, you’ll want to make sure they are engrained and part of your life so that you will continue to be supported in this way after your medication has stopped. Other times, people may find the medication they are taking no longer works and they may need to stop one type of medication to start another. Additionally, people may need to discontinue using their medication due to some other health concern (possible side effects, drug interactions, or in cases of pregnancy).

 

What Happens When You Stop Anti-Depressant or Anti-Anxiety Medications?

If you are taking an anti-depressant medication and suddenly stop, it can cause unpleasant symptoms including nausea, vomiting, headaches, dizziness, nightmares, and paresthesia (unpleasant sensations in the skin). If you are taking an anti-anxiety medication (or anxiolytic) and suddenly stop, symptoms could include nausea, vomiting, seizures, sweating, weight loss, heart palpitations, migraines, muscle pain, insomnia, and even suicidal thoughts. Specific side effects are unique to the medication and the person who is taking it. In either case, you may experience a rebound of psychological symptoms.

Because suddenly stopping anti-depressant or anxiety medication can cause unpleasant side effects, it is very important to consult with a doctor before you stop taking prescribed medications. A doctor can help to assess whether this is the right choice. They will also help you slowly reduce your dosage so that you are weaned off the medication safely, which helps to prevent uncomfortable side effects.

When you start or stop medications, it can be helpful to also seek the services of a qualified therapist who can help you address thoughts, feelings and emotions that may be affecting your mental health. A Dialectical Behavior Therapist (DBT) can provide specific education and skills to help you naturally cope with life’s ups and downs, without medication in some cases. A frequently used DBT slogan is, “Skills over pills.” This means that with learning and practice of DBT skills, often people can reduce or eliminate medication and lean on the DBT strategies they have learned to help them function effectively. The most important thing is to work together with your doctor and therapist to find the healthiest and most effective treatment solution for you.

 

Alternatives to Psychotropic Medications

Taking any type of prescribed medication is a personal choice. While doctors can advise you and make recommendations, ultimately, the decision whether to take psychotropic medication is up to you. Many times, making lifestyle changes can significantly impact your mood and decrease the need for prescription use. However, making these changes can be difficult and requires work. Only you and your wisdom can decide whether you are in a position and have access to the support needed to make these changes, or if now is not the time and medication is a worthwhile option.

If you are interested in making changes to your health behaviors to support a more balanced and stable mood, consider consulting with a Health Psychologist, such as Dr Bando. Health Psychologists are trained to understand all the factors maintaining the ineffective behaviors you are engaging in and help you directly target and change those behaviors to better support you. A good therapist can take out the guesswork and help you move toward your health goals with ease and precision.

Whatever your choice, please consult your wisdom and be gentle with yourself. In a time of difficulty (like experiencing depression or anxiety), increased self-compassion is needed.

Take action today and start shifting from surviving to THRIVING!


How To Prevent Seasonal Depression This Winter

seasonal depression, seasonal affective disorder, SAD

 

Many people find it hard to get going on a gloomy day. The covers feel extra cozy and that cup of hot coffee or tea, extra warm and inviting. The urge to stay in your pajamas and curl up indoors beckons you.

You may notice the weather can influence your mood. You might feel more tired or even down and blue. It might be hard to motivate yourself to get much done. Feeling subdued is nothing to concern yourself with if it happens for a day or two. Relax and put your feet up (as much as your schedule allows) and give yourself permission to chill out and indulge. The key is to soak up the laziness and enjoy, without shirking your responsibilities or feeling pulled farther and farther into hibernation.

This may be easier said than done. For some, seasonal depression is an experience that lasts all winter long.

What is Seasonal Depression?

Seasonal Depression is sometimes called “the winter blues” and psychologists give it the more formal title of Seasonal Affective Disorder (SAD). It is a set of depressive symptoms that occur with a seasonal pattern, typically emerging in the Fall, when the weather gets colder, and remitting in the Spring, with the more frequent sunshine. Occasionally, people experience the opposite, with symptoms during Spring and Summer.

Typical symptoms include having low energy, feeling tired, sad and sluggish, losing interest in activities, difficulty concentrating, and sleep/appetite changes. Additionally, with seasonal depression, you may experience irritability, agitation, anxiety, hypersensitivity, and conflict in getting along with others. Frequently, symptoms start out mild and can become more severe.

What causes Seasonal Depression?

A major cause of seasonally-based depression is biology. Your biological clock (or circadian rhythm) may be partly to blame.  Changing patterns of sunlight and less daylight affect your biological clock. Reduced sunlight can also cause decreases in serotonin, a neurotransmitter (chemical in the brain) which affects and regulates mood. Finally, the body’s balance of melatonin may be disrupted, which also affects mood and sleep.

Another cause of seasonal depression is vulnerability factors. In Dialectical Behavior Therapy (DBT), vulnerability factors are described as circumstances that make you more vulnerable to experiencing intense, unpleasant emotions. These factors may include environmental stress, a diet that isn’t supporting your needs, sleep irregularities (lack of or too much sleep), lack of exercise (or too much or the wrong kind for you), and physical illness. During Winter, as the weather and winter colds and flu make you feel tired, worn down, and depressed, you may become even more vulnerable, less equipped to handle stressors and feel greater amounts of unpleasant emotions more frequently.  When vulnerability factors are high, intense emotions can follow, making you even more vulnerable.

How to prevent Seasonal Depression?

A gold-standard and evidence-based treatment (research shows it works) for any cause of depression is called Behavioral Activation. In short, this means that as soon as you suspect depression may be on its way (or has arrived), you make a plan to get active. In DBT, this is called Opposite Action.

Specifically, identify all of the depressive behaviors you might want to engage in (e.g., call in sick to work, stay in all weekend without socializing, watch more television). Then, identify their opposites (e.g., show up early to work, make plans ahead of time with friends and keep them, have your shoes and jacket by the door ready to go for a walk after work). Next, get busy doing the opposite behaviors that you feel like doing when you are depressed.

The key is to be clear and specific about what Opposite Action you are going to take (make plans with Joe to see a movie on Sunday afternoon, not vaguely: make plans this weekend), and then throw yourself in all-the-way. Don’t expect it to be easy. Combating depression is exactly that, combat. And, do not be discouraged. It is a battle you can win with persistence and encouragement.

When engaging in Opposite Action, do not suppress how you are feeling or your desire to stay home and put your head under the covers. Instead, allow yourself to feel how you feel AND, at the same time, throw yourself all-the-way into the Opposite Action you have identified and let the skill do the work. (Do not wait until you feel like doing Opposite Action. That day may never come, and it allows Depression to take even more of a hold.) Then, do it again and again until you have gone through your list of Opposite Action tasks and Depression has been sent on his not-so-merry way. If you find it hard to get started, pick one very small step you can take, and take it! Last (and definitely not least), remember to reinforce yourself for taking each step. Reinforcement is a powerful change agent. The more you use it immediately after engaging in desired behaviors, the easier those behaviors will become.

Another way to prevent seasonal depression is by managing your vulnerability factors. Identify what is making you more vulnerable to intense, unpleasant emotions. Although this step may seem obvious, we often do not realize the number of stressors present until we say it out loud to someone else or give it some intentional thought. Once you’ve identified your vulnerability factors (e.g., not sleeping well, feeling under the weather, nutrition has been off the past week), you can brainstorm some ways to attend to them and give yourself really good cold-weather care. For example, if you know that you need extra sleep during the winter and without it, you become quite irritable, see if you can brainstorm some ways to get even just a little bit more sleep each night. Your body and emotions will thank you.

Other treatments for seasonally-based depression address the physical causes. To help combat decreases in natural light, you might use Light Therapy. This works with specially designed light therapy boxes, and research shows it can help. Some people also elect to try vitamins and supplements (in consultation with their health provider) as an alternative to psychotropic medications, such as anti-depressants.

If you have noticed that your mood shifts as the season changes, you may find it helpful to seek out therapeutic support in learning to manage it. Therapists can teach you how to send depression into remission, and then prevent or drastically reduce the likelihood of a relapse. Dialectical Behavior Therapy (DBT) is one helpful approach. DBT offers techniques to help you identify your unique vulnerability factors, engage in self-care to reduce and manage them, and notice earlier when they may be affecting you so that you can take steps to mitigate depression. If you think DBT may help you, contact a qualified therapist and start shifting from surviving to thriving today!

 


How To Get The Most Out Of Your Therapy Session

If you are seeking a therapy session, it is likely because you want something in your life to change and you would like expert support and guidance through the process. You want a skilled professional to help take out the guesswork and help get you to your goals.

In the past, this has meant that on top of the stress or problem(s) for which you are seeking help, you must find the time, during business hours, to leave your home or office and make it to a weekly therapy session. Packed schedules, work requirements, and congested commutes present valid obstacles to taking over an hour out of your day every week to drive to your therapist’s office. Not to mention the trouble if the expert you’d like help from lives far away from you. In today’s busy world, many people are turning to TeleHealth or TeleTherapy sessions. These video therapy sessions use HIPAA-secure formats that function similar to Skype or Facetime to make therapy more accessible.

Whatever format you select for your therapy session, your success depends largely upon the work you put in, not just on the effort of the therapist. When attending therapy, your active participation in the process will help you to get the most out of your therapy appointments and ultimately, achieve the results you want.

Treat Therapy As A Collaborative Process

We often view therapists as the expert in the room. Therapists do bring a great deal of knowledge about psychology and new ideas for how to help you. However, you are also an expert in the room. You know best about your history, what you have tried in the past, and what is happening in your present.

A therapy session will be most successful if you work collaboratively and come prepared with what you want to work on in each session. Then, work with your therapist to set goals, explore information, make discoveries, and learn how to apply new skills to your life. Ultimately, you decide what to take away from the therapy session.

 

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Apply What You Learn Outside Of Session

As you and your therapist work together, you will understand yourself better and identify new, more effective ways of behaving. It is essential to apply these new skills outside of session. Whenever possible, ask for homework and then do it. If it is too challenging (usually this is the case when you find yourself not doing the homework), ask your therapist for help. It is your therapist’s job to help you generalize the skills that you learn in the therapy office to making real-time changes in your life. This means the therapist must use their expertise to assign homework in a way that not only challenges you but also is likely that you will engage with and complete the practice(s) they’ve suggested.

Remember to communicate with your therapist about any barriers you face putting the new skills into action. Trying a new skill once and never again will not help you get to that point of lasting change. Every new skill takes practice to become a new habit, and you are paying with your time and money to get help. Use it to your advantage!

Talk To Your Therapist About Your Therapy

When people go to therapy, it is often because they want to address some concern or problem in their life. You may be focused on discussing that problem and finding solutions, which makes sense. In addition, therapy works best when you also talk to your therapist about your therapy.

This means you can reflect on what is working and share those thoughts with your therapist. If you like a new skill, let your provider know. If you are unhappy about something, talk to your therapist about it and see how the two of you can navigate this situation. Giving your therapist this feedback allows them to respond by adjusting their interventions to be more appealing to you or more relevant to your treatment goals.

Find Therapy That Fits Your Lifestyle

Nowadays, most people don’t want to travel to get to therapy appointments or lie on a couch in the room with a therapist. And you don’t have to do these things to get results. With TeleHealth therapy, you can benefit from the skilled, focused attention of a therapist when and where you need it. Even within the comfort of your home, you can access professional therapy with TeleTherapy services via video calls. Making therapy easier to access means you are more likely to stay engaged and on track with your goals.

Once you have started therapy, use these tips to get the most out of your sessions, get the results you want, and start shifting from surviving to THRIVING.


What is DBT and How Can It Help Me?

Seeking help and going to therapy can be stressful. Choosing the right approach can ensure you get the care you need to make the changes you want. In this article, I’m going to give you introduction to Dialectical Behavior Therapy (DBT), a treatment that may be helpful if you want more balance in your emotional life. DBT has become a popular technique used to help individuals cope with the stressful challenges life throws their way, and the intense emotions that can follow. The scientific research for this treatment is strong. Individuals often report huge, impactful, positive life change as a result of DBT. DBT focuses on helping people change their reactions and behaviors to create more resilience in life. Understanding what Dialectical Behavior Therapy is and how it works can help you decide if it is the right approach for you.

What Is Dialectical Behavior Therapy?

Dialectical Behavior Therapy is a form of Cognitive Behavioral Therapy (CBT) that was initially developed for people suffering from chronic suicidal thoughts and behaviors, and those diagnosed with Borderline Personality Disorder. However, implementing DBT revealed that it is helpful for people in a range of situations having difficulties managing emotions, and can help to reduce anxiety and improve coping mechanisms under stressful circumstances. DBT teaches you coping techniques and strategies to deal with difficult emotions without being caught up and swept away in them.

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What Does Dialectical Behavior Therapy Involve?

DBT is best administered by an experienced therapist, with a history of training and supervision in DBT by experts in the field. Full program DBT involves weekly individual therapy in addition to attending a weekly DBT Skills Group. Treatment length varies by person and treatment goals.

DBT includes –

  • Collaboration – working with a skilled therapist can help you identify what you want out of life and obstacles getting in your way. Bringing awareness to both your goals and challenges in a specific, systemized way is a key step toward making the changes you want.
  • Learning skills – one of the most important aspects of DBT is learning specific skills to incorporate into your everyday routine for growth, happiness, and fulfillment.
  • Practice – DBT is a behavioral therapy. This means that new behaviors must be practiced for change to occur. Practice, practice, practice, and then some more practice, is a common mantra in DBT.

The Four Modules Of DBT Skills

The four areas of skills learned in DBT are designed to help you better understand your thoughts and feelings, and change your behaviors to better achieve and support the life that you want. These modules include:

  1. Mindfulness
  2. Distress Tolerance
  3. Interpersonal Effectiveness
  4. Emotional Regulation

Who Can Benefit From DBT?

DBT has been shown to be successful in a number of different areas and for those suffering a range of issues including:

  • Relationship problems
  • Low self-esteem or shame
  • Weight management
  • Eating disorders
  • Anxiety
  • Depression
  • Borderline Personality Disorder

DBT can also be used in many other situations, even where a specific diagnosis may not be defined. Under the guidance of an experienced and well-trained DBT therapist, you can learn life-changing skills to make a profound impact on your well-being.

DBT is an inspiring treatment method that can help change your life for the better. Talking with a DBT therapist can help you determine whether DBT is the right therapy approach for you. Contact me today if you may be interested in finding out more about DBT and shifting your life from surviving to thriving!


4 New Perspectives To Free You From The Guilt And Shame Drain

Guilt and shame can hold you back from the happiness and freedom you desire, draining your energy and burning you out. Sometimes it can feel like shame is eating away at you from the inside, and you can’t even bear to face family and friends.

Fortunately, there are steps you can take to be free from the guilt and shame drain, starting today. Working one on one with a skilled Dialectical Behavior Therapist is a key way to begin letting go of these painful emotions to live a happier, more fulfilling life. As a part of DBT, you will learn specific techniques to shift your perspectives and see things in new light.

  1. Recognizing Guilt and Shame is the First Step

If you recognize your feelings and are able to label them as guilt or shame, you’ve already begun the journey to cope skillfully with these emotions. Just bringing attention and mindfulness to when you are feeling guilt or shame is a powerful step. When you realize that guilt or shame is what you are feeling, gently label and make a note of it internally, without trying to change or modify it. This act of mindfulness and recognition of emotions works into the further stages of DBT where you can learn to welcome pain and skillfully cope with it, rather than pushing it away, which often increases emotional distress.

  1. Your View May Not Be What Others See

One of the tricks that guilt and shame play on your mind is creating thoughts that things are all your fault or that everyone is blaming you. One of the first steps DBT teaches is to recognize and unglue from your thoughts. This step involves working with a DBT therapist to carefully review how you may be automatically coming to conclusions about situations and staying stuck in a rut. When you are feeling guilt and shame, take a closer look at your thoughts and interpretation of the situation that brought up these painful feelings. Recognizing these biases in interpretation is a first step to using DBT to tap into your wisdom and let go of worry thoughts.

  1. Take A Short Break From Your Feelings

When you are feeling guilt and shame, it can be easy to get stuck in a cycle of self-blame and anger. It is important to give yourself permission to give yourself a break from what can be an endless cycle. Do this intentionally, not to avoid the problem-solving process, rather, just to give yourself a break so you can come back to solve the problem at a different time. Take time off to do an activity you enjoy, to help others, or to just do or think about something else for a while. Taking a break from the intensity of emotions can give you the chance to refresh and gain a new perspective on the situation.

  1. Remember That Emotions Are Temporary

Always remember that “this too shall pass” and nothing lasts forever. Mind states and emotions – no matter how powerful – are  temporary and we can ride them out. (If emotions feel never-ending and do not feel temporary to you, a DBT therapist can help with that!) This doesn’t mean you should avoid problem-solving when necessary. Still, you may not need to treat every thought and emotion as though it is very serious and must be solved immediately. Training the mind is a process. The mind is always changing, and we can learn to let thoughts and emotions come and go gracefully.

An experienced DBT therapist can equip you with essential skills and techniques so you can learn to be free from the guilt and shame drain. Contact me today to work with me on creating a happier and more fulfilling life.


Name that Emotion

We’ve all got things to do and people to see. Who needs unwanted emotions slowing us down? Just ignore them, and maybe they’ll go away. Right?

Here’s the hitch: emotions are hard-wired into our human experience. In other words, emotions are part of us and the more we push them away, the louder they become. When we deny and try to block out emotions, we starve them until the emotional hunger pains are so strong, we become overwhelmed with unruly, overbearing, unable-to-control feelings.  You know, that moment someone asks you something harmless like to pass the salt, and you completely lose your cool? When we suppress or don’t acknowledge emotions, they bubble up, and like water boiling in a covered pot with the burner on high, eventually they’re going to blow.

The solution? Don’t ignore the monster!

Emotions grow to become monsters when we ignore them, push through them, judge them and just plain do whatever it takes to try not to feel them. There is a better way! The next time you feel an unpleasant emotion, try noticing it and putting a name to it.

Scientists call this affect labeling. It goes something like this:

  • I am noticing a feeling of butterflies in my stomach. I’m nervous.
  • I feel a lifting, light feeling in my chest and shoulders. I’m happy.
  • I feel like it’s hard to move. I notice that I’m slumped and don’t feel like doing anything. I’m sad.
  • I can’t believe that guy just cut me off. I’m irritated.

When we give our emotion a name, it starts the process of calming it down. Instead of pushing the feelings away, we pay attention and engage our intellect to give it a name. Once emotions are acknowledged and paid attention to, they start to digest and let go of their grip. Relief can get his foot in the door, and we initiate the process of regulating emotions and feeling more in control.

 

Brain imaging studies explain the science behind affect labeling: When we experience an emotion, a part of our brain called the amygdala, gets activated. When our amygdala is very active and fired up, it is hard to access the reasoning part of our brain, the frontal lobes.

How to become Happy, Breaking through an Obstacle, Orinda Psychologist, Lafayette Psychologist, Berkeley Psychologist, Oakland Psychologist, Moraga, Alamo

 

When we use techniques like affect labeling, we begin to activate our frontal lobes (the organizing, planning, thinking-through part of the brain) and de-activate the amygdala (the “OMG!” emotional part of the brain).

 

How to become Happy, Breaking through an Obstacle, Orinda Psychologist, Lafayette Psychologist, Berkeley Psychologist, Oakland Psychologist, Moraga, Alamo

 

PRACTICE:

The next time you are “freaking out” or “stressed” or just “feeling off,” try getting specific. What emotion are you feeling? Can you put a label on it?

How to become Happy, Breaking through an Obstacle, Orinda Psychologist, Lafayette Psychologist, Berkeley Psychologist, Oakland Psychologist, Moraga, Alamo

Now, reinforce yourself by checking out the Reinforcement Practice Sheet and get some suggestions on how to reinforce yourself. You’ve just taken the first step toward processing and letting go of that unpleasant emotion.

LIFE’S TOO SHORT JUST TO SURVIVE. THAT’S WHY I HELP PEOPLE THRIVE!


HOW TO FIND A RESULTS-ORIENTED THERAPIST

Maybe you have never been in therapy. Perhaps you have been in therapy, and it hasn’t gotten you the results you’d hoped.  This time, you want to try something a little bit different. You may even have a particular goal(s) and know what it is that you want to change. Now come the questions, “How do I get the results I want?” and, “Who is the best person to help me?” Despite the consumer-savvy world we live in, there is little information on how to find a therapist, let alone how to find a therapist who will truly help you achieve real results and change your life in the way that you want.

Here, you will find a five-step process to help you find a therapist who will help you achieve the goals you want to reach. Stop wasting time, money and effort with treatment that doesn’t work. Set yourself on the path to success today!

 

  1. Get COMFORTABLE. – Going to therapy can be a hard process, requiring courage to step outside of your comfort zone and ask for help. At times, therapy asks you to be quite vulnerable, talking with another person about your deepest, most private experiences. Treatment often requires you to be super uncomfortable, and even want to temporarily squirm out of your skin or run for the door. After all, you are in therapy to get help with areas that are likely challenging and possibly, quite painful. To venture to feel this awkward and uneasy, you must first be comfortable! It is so important that you are at ease in the presence of your new therapist and feel understood and not at all judged. In other words, think about whether this is a person to whom you would want to open up.
    • Ask for a PHONE CONSULTATION to get a feel for the therapist. Most therapists will agree to talk to you for a free, 10-15 minute phone consultation. During this meeting, you can give the therapist an idea of what you want help with and hear his or her response. It is important to ask questions and leave time for the therapist to talk so that you can start to assess your feel for this clinician’s competency and ability to help you. Trust your instincts. The therapist should give you a choice (or you can ask) whether you want to schedule an in-person appointment right then and there, want time to think about it, or do not believe that this therapist is a good fit for you.
    • MEET IN PERSON with the idea that you are still evaluating whether this professional is a good fit for your needs. During the first session, the therapist will likely ask you questions about why you are seeking therapy and many other detailed questions about yourself and your treatment goals. The more open you are will help you to experience how the clinician responds to you and gives you the opportunity to evaluate your comfort level with this person. Their response will provide valuable information about whether you would like to proceed or seek another’s help instead.

 

  1. Ask for a CASE FORMULATION. – A results-oriented therapist will be able to discuss their conceptualization of your problem(s) and what is currently missing for you to reach your goals. Likely, this won’t be obvious information that you already know. Rather, it should add more information to your understanding of your stuck point(s) and show you that this person has the education and experience to understand your particular problem area(s) expertly. Think of the analogy of visiting a medical doctor (M.D.). You may report your symptoms (e.g., poor digestion, feeling light-headed) and the doctor will not simply repeat your symptoms back to you: “You have poor digestion and feel light headed. That must be hard.” They will tell you, based on their evaluation (e.g., examining your vitals, blood tests), what is wrong (e.g., “You have high blood sugar.” “Your thyroid is malfunctioning.”). You can expect this same kind of expert information regarding your psychological and emotional health as well. A results-oriented mental health professional will not only repeat your complaints back to you; they will add information to fully conceptualize what is contributing to the problem and why you need help in solving it. For example, you may report repeated over-eating and sudden emotional outbursts. The results-oriented clinician may suggest after their assessment (e.g., conversation with you, standardized questionnaires), they believe these problems come from deficits in understanding how to change behaviors and regulate emotions successfully.1 The results-oriented therapist will explain this to you in detail and discuss precisely how this affects you. This explanation will be in language you understand, and the conceptualization should make sense to you. If you think the therapist is off-base, does not accurately comprehend your problem, or cannot communicate in a way that you understand and agree with, openly discuss this with him or her. If you still cannot come to an agreement, it may be time to interview another therapist for your treatment needs.

 

  1. Ask for a TREATMENT PLAN, including TREATMENT GOALS, prognosis, and length of therapy. – Just as your general medical practitioner will give you an idea of your treatment options, likely results, rate of recovery, and time needed to achieve these results, you can also expect this from a results-oriented therapist. For example, a clinician may tell you that in the first three sessions2, the two of you will collaborate to reach a case formulation. At that point (by the third session) the therapist will make a treatment recommendation. They will talk with you in detail about how the treatment he/she is recommending addresses your particular problem(s), will help you reach your goals, and the time you should expect to devote to attain this outcome, including frequency and length of sessions, and expected length of time in therapy. Alternatively, at the third session, the therapist may refer you to another professional with the expertise to help you meet your goals if you and the clinician have determined that is what is needed. Again, think of the M.D. If blood tests reveal you have a thyroid problem that is relatively simple and straightforward, the doctor may express this to you and lay out a treatment plan. If, however, the problem seems more complicated, the M.D. may then refer you to an endocrinologist or another specialist to help you achieve your health goals. Defining treatment goals in therapy is important because these goals will help you know if you are making progress and whether the therapy is working.

 

  1. Understand how you and your therapist will MONITOR TREATMENT PROGRESS and ask for HOMEWORK. – How will you know whether you are moving toward your treatment goals and making progress? This is a question a results-oriented therapist will be able to answer with clarity.
  • Together, you and your therapist may choose to use standardized measures of symptoms or progress and chart them on a graph, making sure your symptoms are decreasing, and skills needed are increasing. You may also choose to track behavioral markers, such as how often per week you are engaging in a particular behavior or have the urge to do so. Successful treatment would show a decrease in those behaviors (and possibly urges) the therapist has agreed to help you decrease (e.g., over-eating). You will also see an increase in the behaviors moving you toward your treatment goals (e.g., taking three breaths before a meal, stopping eating your meal when you experience a feeling of satiation regardless of the quantity of food left). Your therapist may ask you to chart each time you have the urge to or actually engage in these behaviors in between sessions to track your progress.
  • PRACTICE, PRACTICE, PRACTICE, and then, you guessed it, more PRACTICE is needed to make changes and reach your goals. Homework will always be present in results-oriented therapy. Homework doesn’t mean that you will be sent off to write a 5-page paper about what you learned. Rather, therapy homework is a way for you to put into practice what you are learning in therapy. Typically, therapy sessions last about 50 minutes once per week. What about the other six days of the week and 24 hours each day? 50 minutes is not going to change your life in the way that you want. A results oriented therapist will send you home with something to practice (e.g., filling out a worksheet about a skill you learned at your session, practice saying “no” and noticing in detail the thoughts that come into your head or sensations in your body). If you want results, you must practice. Change does not happen in our thinking. Change happens when we do things differently over and over and over again. If you want results, ask for homework!

 

  1. CONTINUE TO EVALUATE, on an on-going basis, whether your treatment is helping you move toward your goals and achieve the results you want. A results-oriented therapist will regularly review treatment progress with you using the techniques described in Step 4. Therapy is not meant to be life-long. Remember, you are hiring a professional to help you reach specifically-defined treatment goals. At some point, if therapy is working (as you are carefully monitoring), you will have achieved those goals and will either want to develop new treatment goals or decrease the frequency of your contact with this clinician or terminate your treatment.

 

Therapy can be an enriching, life-changing experience if you choose an effective treatment. Use the five steps above to help you get the help you need and deserve, and start shifting from surviving to thriving today!

 

NOTES

 

  1. This is provided as an example only and does not imply that all causes of over-eating or emotional lability come from the same source. These statements are meant to clarify the topics addressed in this article, not to assess or diagnose.

 

  1. Not all clinicians assess within one to three sessions. This is meant as an example only. Please check with the therapist you plan to see about their individual policy and of course, ensure that it makes sense and is reasonable to you.

Frequently Asked Questions:

  • What is the difference between a Ph.D., Psy.D., LMFT, LCSW, MFTi, etc., and will it affect the quality of my treatment?

A Ph.D. and Psy.D. both have doctorate degrees in psychology. LMFTs and LCSWs have a  master’s degree. A Psychological Assistant (someone with a doctorate who is not yet licensed) and MFTi (Marriage and Family Therapist intern) indicate this person is still in training and under supervision before they can become licensed. While the degree itself may show different types of training and specialties, what is usually more informative is how the therapist works with their clients. I have results-oriented colleagues with LMFT and LCSW licenses who work similarly to myself and other contemporaries who have doctorate-level training. I also have met professionals with doctorates who are not results-oriented and do more of a supportive-type therapy. In my opinion, if you follow the five steps laid out in this article, you will significantly increase the likelihood that you will work with a therapist who will help get the results you want, regardless of their type of license. Trainees can also be good options. I personally would choose to work with a Psychological Assistant or MFTi if they met all of my requirements in the 5-steps to finding a results-oriented therapist. The quality of work a therapist demonstrates to me is more important than where they are in their education and whether they have a master’s or doctorate degree. One caveat: if your problem is quite complicated and you have been to several clinicians before who haven’t helped, you may need a skilled and seasoned eye and choose a therapist who has some years of experience under his/her belt.

 

  • Should I look for a therapist with a particular theoretical orientation?

Some of my results-oriented colleagues may argue that it is imperative to receive treatment from someone doing “evidence-based therapy,” such as cognitive-behavior therapy (CBT). I like to be careful about making this generalization. There are certainly CBT practitioners who are results-oriented, and there are those who are not. Because someone professes to work under a particular modality is not an assurance that they do. More relevant is whether the therapist helps you develop treatment goals, assigns homework, monitors your progress, etc. I am less inclined to be concerned about the modality and more interested that the therapist can give you evidence that their treatment recommendation(s) works (has been researched to be effective) and the way the therapist is applying the treatment to your problem makes logical sense to you.

 

  • What if my therapist tells me that being uncomfortable with him/her or wanting to leave therapy is as a result of my problem(s) and I should not act on this?

This answer is not a straightforward “stay” or “leave.” Rather, it is a more nuanced answer: Use your WISDOM. On the one hand, if this is a new therapist, it is important to be comfortable and feel at ease in his or her presence right away. (See Step 1.) You will already be challenging yourself to grow in various ways throughout your treatment; no need to do this with the relationship with your therapist. I have talked to countless people who have stayed with a therapist they didn’t like or felt uneasy around because they assumed they (the client) were at fault and there was something wrong with them that they felt this way. I previously had a personal experience visiting a therapist with whom I was uncomfortable. I told her so, and she stated that she thought this meant I had significant problems with intimacy and needed to sit physically closer to her than I was comfortable with and work through the problems in my relationship with her. At that moment, I felt ashamed and unsure of myself. After leaving the session, and discussing it with a loved one, I determined that the only relationship in my life that I was having a significant problem with and wanted to get out of was the one with my therapist. I left, found a new therapist who I was immediately comfortable with, and therapy was successful. I have heard some version of this story from many clients about their past therapy, and often, once they remove themselves from that clinician, they find much success moving toward their goals with much more ease. On the other hand, it could be useful to ask yourself if your therapist has a point. Does this reaction toward your therapist happen in many other relationships? After visiting a few therapists, do you feel this same way about each of them? If so, you may want to consider whether this is something you want to target (work on) in therapy and may decide to stick with this therapist. You may want to consult with a trusted loved one and get some help tuning into your WISDOM to make this decision. Also, remember Step 5 and to continuously evaluate whether this treatment is helping you.


© 2017 Amanda Gale Bando Phd · Designed and Developed by D-Kode Technology

Dr. Amanda Gale-Bando

Dr. Amanda Gale-Bando