Neuroworks offers group and individual psychotherapy. Our individual psychotheraphy services include PTSD, anxiety, depression, loss, stress, fatigue, pain management, sleep hygiene. Group focuses can include family and survivor counseling; and psychotherapy for families and individuals.
NEUROWORKS uses a number of therapeutic approaches in our psychotherapy work with individuals:
1. Acceptance and Commitment Therapy (ACT)
Often, individuals with a neurodevelopmental disorder or an ABI struggle with changes in emotions, difficulty regulating emotions, difficulty organizing thoughts, lack of motivation, and difficulty organizing and taking action towards goals.
Fortunately, ACT addresses all of these challenges through a process of mindfulness practice, targeted behavioral goal setting, and acceptance building. For example, a therapist might help a client increase awareness of his or her emotions by encouraging specific directed mindful attention towards physiological sensations in the body associated with a feeling, or by deeper exploration of an emotion and the related thoughts, memories, and cognitions. The goal is always to move toward, not away, from the emotion, to help individuals develop acceptance, while at the same time noticing that emotions come and go and can change quickly. Taking a mindful, nonjudgmental stance toward one’s emotions allows individuals to not become overwhelmed by them, even when the emotions are changing quickly or feel out of control.
Also, executive functioning may be impaired, which is why mindfulness, awareness, and attention training can be so helpful in allowing the individual to regain some control over his or her mind. Simply put, mindfulness is intentional, open, focused attention and awareness in the present moment.This practice has been proven to improve cognitive and executive functioning.
Furthermore, these same strategies can be modified or tailored to address PTSD, depression, anxiety, stress, chronic pain, headaches and other mental health issues that may be related to a TBI.
Individuals can learn to focus their attention on what matters to them while creating space for the physical and emotional pain they are experiencing. This will often involve noticing emotional triggers in the environment, slowing down the process, and not immediately responding before making a conscious choice about how to act in the situation.
This can be especially important for those individuals who may feel they have a shorter temper, are prone to anger or sudden mood swings, or are now hyper-vigilant and constantly reacting to stressful and anxiety-provoking cues in the environment.
2. Cognitive Processing Therapy (CPT)
Cognitive Processing Therapy (CPT), is an evidence-based treatment specifically designed for people with Post-Traumatic Stress Disorder (PTSD). It has been found to be particularly effective for individuals who have experienced sexual assault, interpersonal violence, traumatic military experiences and other traumatic events. CPT utilizes the cognitive-behavioral model of CBT to address negative thoughts and behaviors associated with PTSD, which often include hypervigilance, anxiety, avoidance, re-experiencing, nightmares and especially feelings of guilt and shame. Although this treatment is designed for PTSD symptoms specifically, most people find the skills they learn useful for all aspects of life and coping. Primary interventions include:
Relaxation Exercises; People with PTSD are often anxious and on “high alert” for potentially dangerous or problematic situations. Relaxation exercises help lower hyper-arousal, including techniques like Progressive Muscle Relaxation, safe-place imagery and deep breathing. Grounding techniques may also help reduce flashbacks and improve sleep quality.
Natural Exposure to the Trauma; Most people want to avoid thinking about their trauma at all. However, this leads to a maladaptive cycle of anxiety and avoidance. CPT utilizes gentle and safe exposure to the natural emotions experienced after a trauma. When a person is able to properly feel, process and categorize these emotions, the memory of the trauma ceases to have power over the individual.
Cognitive Restructuring; Traumatic events disrupt the way people think about the world, their safety and self-worth and the intentions of other people. CPT centers on cognitive restructuring to change maladaptive thinking to a more update, realistic and logical way of viewing the world and traumatic event itself.
Behavioral Activation; Avoiding activities of daily life or pleasurable activities is common to PTSD. Patients are asked to begin to ‘test’ their skills at home by trying activities they may avoid or introduce safe and pleasurable leisure activities.
CPT is a 12-14 week manualized treatment, although actual treatment time may vary depending on patient motivation, skill and severity of PTSD symptoms. Sometimes patients find Cognitive-Behavioral Therapy (CBT) or other psychotherapy helpful following a course of CPT, especially if there is a history of mood difficulties prior to the traumatic event.
3. Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral therapy (CBT) is a widely used and evidence-based treatment for a variety of difficulties, including depression, anxiety, behavioral dysregulation, anger management, insomnia and negative thinking for people of all ages. The core of CBT includes the exploration and modification of negative and maladaptive thoughts to more realistic, logical and adaptive ways of thinking. CBT utilizes a variety of techniques including:
Relaxation Exercises: These may include deep breathing, meditation, imagery and progressive muscle relaxation designed to lower symptoms of anxiety/hyperarousal and foster present moment awareness.
Behavioral Activation: People with depression and anxiety tend to avoid social interaction and engage in less leisure and pleasurable activities. Increasing engagement in the community or with leisure activities like exercise can help increase mood and overall well-being.
Cognitive Interventions: In particular, focus is placed on ‘core beliefs’, which are deeply held beliefs about the world, one’s self and other people. Many people with depression and anxiety tend to have very negative core beliefs, which can be thought of as the ‘lense’ that people use to interpret their world. CBT is problem-focused and action-oriented; that is, specific difficulties are targeted and modified through real world engagement.
Real World Experience: A large part of CBT is generalizing skills introduced and learned in session in the real world. After each session, clients are asked to engage in various activities, which may include tracking thoughts, feelings and behaviors or modifying daily routines (including sleep, eating habits, etc.).
CBT is typically a 10-20 session treatment with exact treatment length highly dependent on patient motivation, skill and the severity of the symptoms being treated.
4. Dialectical Behavior Therapy (DBT)
Dialectical behavior therapy (or DBT) is a type of cognitive behavioral therapy designed to help people increase their emotional and cognitive regulation. DBT focuses on teaching clients four main sets of behavior skills they can utilize in order to enact changes in their behavior, emotions, and thinking. These skill sets include:
Mindfulness: the practice of being fully aware and present in this one moment
Distress Tolerance: how to tolerate pain in difficult situations, not change it
Emotion Regulation: how to understand and change emotions that you want to change
Interpersonal Effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others
These skills are designed to help individuals gain a sense of control over overwhelming feelings, thoughts, and reactions. Furthermore, research has shown that mindfulness techniques can help to improve cognitive difficulties, such as attention, concentration, and fatigue. For these reasons, DBT is shown to be an effective treatment option for individuals struggling with symptoms of post-traumatic stress disorder and traumatic brain injury.
The term “dialectical” means a synthesis or integration of opposites. The primary dialectic within DBT is between the seemingly opposite strategies of acceptance and change. All of the skills and strategies taught in DBT are balanced in terms of acceptance and change. For example, the four skill sets include two acceptance-oriented skills (mindfulness and distress tolerance) and two change-oriented skills (emotion regulation and interpersonal effectiveness). Additionally, DBT therapists accept clients as they are while also acknowledging that they need to change in order to reach their goals.
More on Mindfulness
Mindfulness is not a skill to be mastered and then dismissed, but rather it is a lifelong practice to improve awareness and attention, and foster acceptance of ourselves and all of the thoughts, feelings, memories, and sensations we experience on a continual basis.