Anxiety

All people experience anxiety, but if the anxiety is so strong or persistent that it’s interfering with quality of life, counseling can help. Common symptoms of anxiety include ongoing worry, trouble concentrating, sleep disturbance, muscle tension, restlessness, and fatigue. Some people may also experience panic attacks.

Common examples of anxiety disorders include:

• generalized anxiety disorder – a lingering anxiety about a wide variety of things
• social anxiety disorder – anxiety about being around/interacting with others
• specific phobia – anxiety triggered by a specific thing, such as heights, spiders, medical procedures, etc.
• agoraphobia – anxiety around leaving the house and being out in public
• panic disorder – recurrent panic attacks

Depression

Depression is commonly thought of “sadness”. While sadness can be a part of it, depression is much more. Clinical depression can keep a person trapped. Common symptoms include depressed mood, inability to feel joy (giving up activities that were once enjoyable), too much or too little sleep, too much or too little appetite, low motivation/energy, feelings of worthlessness or guilt, trouble concentrating, and thoughts of suicide. Irritability is also common, especially in children and adolescents.

Common examples of depressive disorders include:

• major depressive disorder – significant, long-lasting periods of depression, typically occurring in multiple episodes
• persistent depressive disorder – “low grade” depression lasting multiple years
• disruptive mood dysregulation disorder – specific to children and adolescents, this shows as frequent irritable outbursts and persistent angry mood
• premenstrual dysphoric disorder – specific to women, this shows as significant depression, irritability, and/or anxiety just prior to the start of the menstrual cycle

Bipolar

Bipolar disorder is often confused with “moodiness”. True bipolar disorder generally shows up as distinct periods of depression (lasting multiple days) followed by distinct periods of mania (lasting multiple days). Mania is a state of increased energy or agitation. Common symptoms of mania are inflated sense of self-esteem, impulsivity or engaging in reckless behaviors, increased talkativeness, racing thoughts, increase in goal-directed activities, descreased need for sleep, and increased distractibility. In severe cases, mania can also include psychotic symptoms such as hallucinations or delusions.

Common examples of bipolar disorders include:

• bipolar I – at least one instance of a manic episode (which was severe enough to cause noticeable problems for the person), often followed by a period of depression
• bipolar II – experiences of more mild manic episodes called hypomania, followed by a period of major depression
• cyclothymic disorder – frequent shifts between periods of hypomania and more mild states of depression

Borderline Personality Disorder

Borderline personality disorder (BPD) is a common, yet often misunderstood diagnosis. It is believed that BPD is caused by certain genetic vulnerabilities combined with being raised in invalidating environments. There is often an influence of childhood trauma. Common symptoms of BPD include feeling emotions intensely, fear of abandoment, impulsive/reckless behaviors, inclination for self-injury/suicidal behaviors, periods of dissociation, polarized or “black-and-white” thinking, feelings of emptiness, unstable sense of identity, and instability in interpersonal relationships. Unfortunately, the BPD diagnosis often carries stigma. However, once one understands their diagnosis and how to treat it, recovery can be very promising. The gold standard for treatment of BPD is dialectical behavior therapy (DBT).

Substance Use

Substance use disorders are one of the most common mental health disorders. It is estimated that nearly 1 in 10 people meet the criteria for a substance use disorder. Substance use becomes a disorder when the use of the substance is causing significant distress in the person’s life. This can occur with alcohol, THC, prescribed/over-the-counter meditations, and street drugs. There are several symptoms to consider, but the most common are an inability to cut-down/stop using, experiencing cravings for the substance, increased amount of use over time, experiencing withdrawal symptoms upon stopping, giving up important activities because of the substance, and experiencing health problems as a result of the substance. The severity of a substance use disorder can be considered mild, moderate, or severe. There are a wide range of methods for recovering from a substance use disorder

Addiction is a brain disease that results in compulsive, persistent use of a substance or behavior despite ongoing negative consequences. Some substance use disorders evolve into addictions. Certain behaviors can be considered addictions as well, such as gambling, sex, video games, work, and more.

Trauma

Trauma is a broard term. We might consider it as an injury to the psyche, either by one major incident or several smaller incidents. When we find we can’t live a full quality of life because of something bad that happened to us, this might fit the criteria for a trauma disorder. Common symptoms of trauma include emotional distress (e.g. depression, anxiety), flashbacks or intrusive thoughts, nightmares, difficulty connecting with others, negative views of the self, feeling “on guard” or hypervigilant, being easily startled, and more. The most commonly recognized type of trauma is post-traumatic stress disorder (PTSD), which can be caused by many different things. However, PTSD is not the only type of trauma-related disorder. Trauma can impact a person in many different ways.

Common examples of trauma and related disorders include:

• post-traumatic stress disorder – when a life- or safety-threatening event causes long-term, persistent trauma symptoms
• acute stress disorder – trauma symptoms that occur immediately after a traumatic incident, then resolve within about one month
• prolonged grief disorder – also know as complex grief, when a loss causes significant emotional distress that doesn’t resolve overtime (beyond what would be normally expected of the grieving process)
• adjustment disorder – a very common ailment when a life stressor causes significant distress, such as strong anxiety, depression, or behavioral problems

Approaches to Treatment

Dialectical Behavior Therapy (DBT)

Dialectical behavior therapy (DBT) is a type of behavioral therapy that is built on principles of mindfulness and acceptance. It was developed to treat borderline personality disorder (BPD), and has since been found useful for other conditions such as bipolar disorder, depression, anxiety, and substance use disorders. DBT is flexible in that it can be used at many different levels, from one-on-one therapy to 24/7 residential treatment. What might be called “standard DBT” consists of a skills education group, individual therapy, and phone coaching. Because I do not offer skills education groups, my approach relies only on individual therapy and phone coaching when needed. Depending on your needs, this may or may not be sufficient to help you reach your goals. After our first meeting, I will be able to make a recommendation on whether or not individual therapy alone would likely meet your needs and provide referrals to more intensive DBT programs if necessary.

The core skill areas of DBT include:

• distress tolerance skills – for coping through difficult or uncomfortable experiences
• emotion regulation skills – for finding and maintaining more balanced emotional states
• mindfulness skills – for maintaining more connection and acceptance with the present moment
• interpersonal effectiveness skills – for improving relationships with others and with ourselves

Acceptance and Commitment Therapy (ACT)

Acceptance and commitment therapy (ACT) aims to help us increase “psychology flexibility”. It helps us to think and respond to things in a more fluid and effective way. This is a very experiential therapy; we will find more success by really practicing the concepts it offers, not just talking about them. ACT can help us let go of unhelpful thoughts and ideas about ourselves, break out of cycles of unhelpful behaviors, better understand our values and the quality of life we want to live, and build patterns of healthier and more fulfilling behaviors.

Internal Family Systems (IFS)

Internal family systems (IFS) believes that people are composed of many different “parts”. These parts serve various roles for us to help us navigate life. We have a part that tells us when we’re hungry. We have a part that tells us when we’re afraid of something. We have a part that tells us we like ice cream; we may also have a part that feels guilty about eating that ice cream. When we’re dealing with trauma or mental health issues, our parts tend to go into “overdrive”. IFS helps us get to know the various parts that makeup our inner system and find balance with them. It is particularly helpful in addressing past traumas.