Month: August 2016

Young woman sitting in a dark room, wearing a one-piece jumpsuit, obsessing over her weight with a measuring tape in hand.

Eating Disorder Treatment Based on Attachment Theory

According to the National Eating Disorders Association, “eating disorders are real, complex, and devastating conditions that can have serious consequences for health, productivity, and relationships.” Claiming that eating disorders are a fad, or merely a poor lifestyle choice is harmful to the millions of people who struggle with them. Eating disorders are serious and potentially life-threatening. This mental health disorder can impact a person’s health both physically and emotionally.

Better Understanding Eating Disorders

The NEDA reports that “in the United States, 20 million women and 10 million men suffer from a clinically significant eating disorder at some time in their life, including anorexia nervosa, bulimia nervosa, binge eating disorder, or EDNOS.” However, they also acknowledge that a large number of cases go unreported. But why? There are many reasons why a person may choose not to divulge their eating disorder, but most signs point to the personal nature of the condition. In fact, the majority of individuals who struggle with an eating disorder also experience body dissatisfaction and disordered eating attitudes and behaviors. All of these issues relate back to our self-image and self-esteem, which can be difficult (though necessary) topics to talk about.

It is possible to overcome an eating disorder. Studies show that success rates for treatment are largely dependent on whether or not the individual chooses to seek help early on. The earlier treatment is initiated, the more likely it is to be successful. The longer a person waits to seek treatment, the more time and opportunity the eating disorder has to become an ingrained aspect of daily lives and routines. This means that it can be harder to break and overcome (though still not entirely impossible.)

Eating Disorder Treatment

What also matters is how one approaches the treatment of the disorder. For example, some clinicians and researchers believe that how a patient developed their eating disorder doesn’t really matter for treatment. Many therapists argue that treatment should be based on what is necessary for patients to recover. Other professionals like Dr. Judy Scheel, President of Cedar Associates Foundation, disagree on this topic. The mission of the Cedar Associates Foundation, a non-profit organization, is to assist in the prevention, education, and research of eating disorders. In her line of work, which spans 20 years, Dr. Scheel has found reason for her belief that “uncovering causation enables the individual to understand motivations (what purposes the eating disorder and its symptoms serve in someone’s life.)   Knowing the factors driving the proverbial bus can support informed decisions about what is necessary in maintaining recovery and long term health and well-being.”

Dr. Scheel notes that patients diagnosed with eating disorders have been shown to also have profound interpersonal and psychological issues. Because of this, treatment and the recovery process can be long and challenging. According to Dr. Scheel, “research repeatedly affirms that pre or co-existing anxiety and/or depression co-occur with eating disorders.” These co-existing conditions are what make people with eating disorders particularly susceptible to criticism, shame, and fear, especially with regards to behaving in a manner that they consider to be imperfect. Many researchers are now beginning to find that perhaps these qualities stem from childhood attachment issues.

Dr. Scheel explains that “Many in the psychodynamic and psychoanalytic camps would agree that these fragile interpersonal qualities are the outcrop of childhood attachment experiences and their intensity is compounded as a child grows throughout life.” Thus, she concludes that “eating disorders therefore are ‘natural’ consequences as they attempt on the one hand to correct the vulnerable states  through perfection and fitting into the culture as well as are the means in which to punish the individual for being imperfect i.e. having vulnerabilities.”

The Attachment Theory

Attachment theory is a psychological model that attempts to describe the dynamics of long-term and short-term interpersonal relationships between humans. This method has been invaluable to the study and treatment of eating disorders. The Attachment Theory respects the relationship between the therapist and patient as a significant vehicle for recovery. The role of the therapist is to create a safe and understanding environment for the patient. This environment allows for the development of trust. It is through that trust that an opportunity unfolds where patients may be able to deal with their negative emotions and confront their behaviors. Patients can discuss their self-destructive impulses and conflicted relationships within the trusting environment constructed by the therapist. As Dr. Scheeler puts it: “compassion, forgiveness and empathy therefore have an opportunity to be experienced and shared. Attachment Theory provides a natural framework in the relationship between therapist and patient.”

Dr. Scheeler does advise, however, that the Attachment Theory approach doesn’t work for the therapist who is uncomfortable with a more intense relationship with their patients. Practicing Attachment Theory requires a high level of control over one’s own emotional responses. The therapist must be comfortable with discussing various topics of an emotional and psychologically impactful nature. Dr. Scheel explains that “if a therapist is uncomfortable with feelings of anger, or cannot tolerate their patients’ dependency, or is uncomfortable with discussing sex and sexuality, then Attachment Theory is not likely a comfortable lens from which to practice.  If a therapist has not confronted their own competitive issues or lacks compassion and empathy creating a safe place for the truth to be told is hampered.”

Assuming that the therapist is able to practice it, the Attachment Theory provides a useful technique for dealing with conditions such as eating disorders. In fact, there are  researchers who suggest that the emotional, intuitive impact of therapists may be more influential than the cognitive or behavioral suggestions. Or, as Dr. Scheel says: “the relationship between patient and therapist are paramount in treatment and recovery as the attachment patterns developed in childhood are contemporarily unavoidable and necessary to be played out in psychotherapy.” In this way, Attachment Theory enlists the therapist’s creativity, as well as their knowledge about their patient’s disorder and related issues. Through this unique method, they can provide a healing opportunity for their patient that is incomparable to any other existing form of treatment.


Two teenage girls consoling each other during a difficult time.

Five Steps for Dealing with Difficult Life Events

It has been said that life is a journey. The only way to progress through this journey is to take steps forward. Throughout our lives we will encounter a number of twists and turns, perhaps even a few pitfalls. Obstacles make life challenging. It is important to remember that it is important to continuing moving forward even when life is difficult. Depression and anxiety can make moving forward seem impossible. Sometimes, overcoming life’s challenges starts as simply as putting one foot in front of the other. Learning and practicing small daily strategies to deal with difficult times will help ease the overwhelming negative feelings. This is a difficult thing to do. Especially when we find ourselves in the midst of a difficult crossroads, or a path that seemingly leads to nowhere.

Five Tips for Dealing with Difficult Times

Below are a few ideas on how to take the next necessary steps forward even when life gives you lemons.

1. Don’t Give Up

 First and perhaps most importantly – don’t give up! Just because an obstacle emerges, no matter what size, does not mean that the journey is over. Dr. Barton Goldsmith, a multi-award winning psychotherapist, explains that “once you quit, it is never quite the same. Whether it’s a relationship, a job, or your life, you are in charge of your choices. Giving up may enter your mind, but find some way to keep going, even if you have to do things a little differently.” So when the going gets tough, don’t be afraid to find another path, or, to find a way to overcome the obstacle obstructing your way. The journey continues from there.

2. Stay Positive

 In this day and age, it may seem a bit cliche to say that positivity is key, but the truth is often worth repeating. A positive mindset can make all the difference when it comes to progressing through life’s challenges. It is important to remember that the world is not our enemy. True, we will all face our own shares of ups and downs, but when we are confronted by the “downs”, we must remember that they don’t happen because the universe hates us or that we are the victims of some sort of terrible cosmic vendetta. Rather, by adopting the perception that the world around us exists to do us good, we can learn to see the opportunities that surround. In this way, we open ourselves up to the possibility to flourish, and learn not to assume failure.

3. Take Things One Day at a Time

 A simple yet effective piece of advice is also to take things one day – or one step – at a time. Trying to tackle problems head on all at once is the easiest way to get overwhelmed. Instead, it helps to learn to tackle things one at a time. For example, if we’re having problems within a relationship, attempting to fix all of them at once can seem not only difficult but outright impossible. By approaching our problems one step at a time, we can improve this relationship by strengthening the parts that comprise it. To begin with, we might start by improving communication. Then, maybe we schedule more dates or quality time. One-by-one, we take on the things that were causing us to feel upset and stressed. By doing so we not only improve the health of our relationship, but our own personal health as well. We don’t need to do everything at once in order to see progress.

4. Go at Your Own Pace

 Life is not a race. There is no need to rush progress. Dr. Goldsmith states that “you may have been beaten down, but you are not broken. Even if you have suffered and lived through a life-altering trauma, if you still have a beating heart and air in your lungs, you can get back on your feet.” The key is doing what we can, when we can, and taking breaks when we need to. These periods of rest can be what we need in order to get the energy to continue forward. However, we must remember that taking breaks should not be the same thing as stopping entirely. We must continue on the journey. There is nothing wrong with taking time every now and then to collect ourselves and refocus on what we really want in life.

5. Don’t Be Afraid of Disappointment

 Unfortunately, disappointment as natural to life as as breathing. People from all walks of life experience disappointment. Disappointment should never stop us from moving forward. There is nothing wrong with feeling disappointed from time-to-time. Disappointment is not an excuse to give up or stop trying to accomplish what we want. No matter what, we must keep going. After all, we have a lot to see and do before our journey end. So why stop here?

If you are feeling overwhelmed with life, speaking with a therapist can help. Call our office @ 800-378-9354 to check appointment availability.
People using various exercise stations on a Florida Beach.

Exercise Emerges as New Way to Treat PTSD

PTSD is one of the most commonly misunderstood mental health disorders. According to statistics from the National Institutes of Health, Sidran Institute, and the Department of Veteran Affairs, collected by PTSD United, the socioeconomic impact of PTSD is quite heavy. In fact, it is reported that “the annual cost to society of anxiety disorders is estimated to be significantly over $42.3 billion, often due to misdiagnosis and under treatment. This includes psychiatric and non-psychiatric medical treatment costs, indirect workplace costs, mortality costs, and prescription drug costs.” With such high expense, it’s not surprising that anxiety disorders, especially PTSD, have some of the highest rates of healthcare service use. Luckily, this means that there are a wide array of treatment options for those struggling with PTSD and similar anxiety disorders.

A New Form of Treatment for PTSD

The most common and successful form of treatment for PTSD is a combination of therapy and carefully prescribed medication. Among the most frequently administered forms of therapy are what is known as Cognitive Processing Therapy and Prolonged Exposure Therapy. The former, also known as CPT, consists of the therapist and the patient working together to devise new ways to cope with distressing thoughts and events.

Through CPT, the patient learns to identify the ways in which experiencing trauma has impacted the way they perceive the world around them. After all, it is this perception that alters how we think, feel, and act, especially around others. Conversely, Prolonged Exposure Therapy involves helping the patient approach their trauma-related thoughts, feelings, and situations that they may have been avoiding as a result of the traumatic experience itself. This practice stems from the idea that repeated exposure to these things in varying intervals can ultimately make them less distressing and thus less influential.

However, researchers are now discovering the ways in which we can treat and reduce symptoms of PTSD on a far more regular basis than a weekly meeting with a therapist. As it turns out, something as seemingly small as daily exercise can assist individuals struggling with PTSD, though it cannot replace therapeutic intervention. That being said, more than just a good way to maintain one’s overall health, exercise is become a viable alternative physical remedy for PTSD. In fact, Dr. Robert Muller, Harvard graduate and a Fellow of the International Society of Trauma and Dissociation (ISSTD), reveals that “those who exercise regularly are less likely to suffer from anxiety and depression.”

Exercise for a Healthy Body and Mind

Research conducted by Mathew Fetzner and Gordon Asmundson at the University of Regina confirms this claim with their finding that just two weeks of stationary biking can effectively reduce symptoms of PTSD and improve one’s mood. These results are compounded by further study conducted at Loughborough University where it was discovered that physical activity enhances the well-being of veterans with PTSD. According to their research, through exercise the veterans were able to reduce their symptoms as well as improve their coping strategies. Explaining these findings, Dr. Muller states that “symptom reduction in these studies seems to occur through a renewed sense of determination and hope, increased quality of life, and the cultivation of positive self-identity.” According to the researchers, short physical activities can help these veterans as well as other individuals with PTSD feel a sense of achievement.

Exercise has also been shown to increase what is known as respiratory sinus arrhythmia. This is a naturally occurring variation in heart rate which is linked to higher levels of emotion-focused coping. In other words, heart rate variation can help with coping with difficult emotions, which is why individuals with PTSD often lack this necessary arrhythmia.

How to Benefit from Exercise With Limited Ability

That being said, the researchers note that it may only be combat veterans who benefit so strongly from regular exercise, at least, according to present findings. Further studies are needed to determine the impact of exercise on non-military individuals struggling with PTSD, but these current results seem promising. The primary requirement for this remedy is the physical ability to participate. The most successful form of exercise to reduce symptoms, particularly of depression, seems to be aerobic exercise. However, the researchers note that this form of exercise may not be accessible to everyone, especially veterans who have been physically impaired from combat.

For these persons as well as others who are unable to do more physically demanding exercises, Dr. Muller suggests that “less physically demanding exercise may be an option.” He adds that “recent research shows that yoga, for example, may help individuals with PTSD focus on the present, reduce rumination, and combat negative thinking patterns.” Because of the recorded positive effects of exercise and physiotherapy on patients with PTSD, Dr. Muller advises that both medical researchers and clinicians alike should take note of this and similar alternative treatment methods for PTSD. In doing so we can aim to provide the greatest array of options to those affected by the otherwise debilitating condition.

Fill out a contact form or call 800-378-9354 to schedule an appointment with one of our Boca Raton Therapists.
A silver figurine in a sitting position, alone in a room with wood floors and large windows.

Finding the Right Therapist to Treat Anxiety and Depression

With so much misinformation out there, unfortunately a good therapist can be hard to find. Everyone has needs which are unique to them as an individual, and it is the goal of therapy to address and cater to those needs. However, due to the diverse array of unique problems patients can present, there’s a likelihood that patients and therapists can be mismatched. Furthermore, just as in any profession, there are certain individuals who are more qualified for their position than others. The key is not to give up on seeking help if you need it, but to find the therapist that is best equipped to address your needs.

There are many reasons why someone would look towards therapy for help. For some, it may be as simple as needing extra support. Perhaps they feel as though the support system in their own lives is lacking in some respects, and that’s where a therapist can come in to help. Weekly check-ins can be just what the patient needs to feel fulfilled and secure in their lives. For others, the necessity of a therapist can be more acute. These situations likely need more intensive methods than the aforementioned weekly check-in. Research Assistant Professor at Boston University, Dr. Shannon Sauer-Zavala, explains that “If you are experiencing symptoms of anxietyand/or depression that are interfering with your daily life, recounting the events your week may feel validating in the moment, but is unlikely to lead to lasting relief.” Dr. Sauer-Zavala points to the effectiveness of methods such as CBT (Cognitive Behavioral Therapy) in such instances.

Because CBT is one of the most well known and successful therapeutic treatment methods for dealing with symptoms of anxiety and depression, many therapists claim it as one of their services offered. However, this information isn’t always accurate. According to Dr. Sauer-Zavala: “Many therapists list CBT on their websites as a service they provide, but actually fall back on more supportive (How was your week?) techniques in practice. As a result, people seeking a therapist need to be savvy consumers who ask the right questions to make sure they’re getting their money’s worth.” Because of this, she, and many other healthcare professionals are advising patients to ask important questions when seeking out help from a therapist. Doing so will ensure that the therapists in question are providing evidence-based strategies to help with anxiety and depression, not just empty promises.

What to Look For in Therapist to Treat Anxiety and Depression

It’s no secret that anxiety and depression can color our perspectives and alter our views of ourselves and the world around us. As such, those of us struggling with either disorder have a tendency to view things from a negative point of view. In CBT, the cognitive aspect refers to the practice of questioning these initial thoughts in order to achieve a more realistic and balanced perspective. In other words, rather than just jumping into negative assumptions, we are encouraged to recognize all aspects of a given situation in order to better understand it. For example, if a friend doesn’t message us back, it doesn’t necessarily mean that they hate us, but rather, they may have been busy or not had their phone on their person in order to immediately respond to the message. Dr. Sauer-Zavala explains: “Challenging negative thoughts is a hallmark of CBT!” As such, she advises patients to “ask a potential new therapist if he/she teaches cognitive restructuring, which is CBT-lingo for challenging our negative first impressions. Also ask if he/she uses a thought record, a standard practice form that facilitates learning how to challenge thoughts.” Therapists who are familiar with utilizing this technique will likely have a greater chance of success in treating patients struggling with depression and anxiety.

Avoidance Isn’t the Answer

People with anxiety and depression have a tendency to avoid situations or activities which may trigger negative emotions in an effort to self-treat their symptoms. These methods may work in the short-term, they almost never have any lasting success. This is where legitimate CBT is especially useful. Dr. Sauer-Zavala puts it thusly: “The more you struggle against negative emotions, the more limited your life becomes (e.g., avoiding going to a party means you won’t feel anxious but it also means you won’t expand your social circle).” In CBT, the behavioral treatment involves encouraging individuals to engage in situations that are relevant to their life goals. A good CBT therapist will encourage their patients to pursue the paths that will ultimately allow them to move forward in their lives, even if these paths present emotional challenges along the way. After all, it is necessary to face these situations which provoke such strong emotions, also known as “exposures,” in order to improve one’s quality of life.

Modern CBT: Mindfulness Over Matter

Modern CBT methods have begun to include meditation and similar mindfulness techniques aimed at restoring a balance between the body and mind. The goal of these practices is to ground oneself in the present in a nonjudgmental fashion. This is aimed at combating the self-destructive thoughts and feelings people struggling with anxiety and depression may experience at any given moment. The most likely reason for these recurring thoughts, according to Dr. Sauer-Zavala is that “Often people with anxiety and depression are hard on themselves for the thoughts and feelings they experience…They mistakenly believe that beating themselves up for feeling anxious or down will make them less likely to feel that way in the future.” But research reveals that the opposite is actually true. Judging oneself for having feelings will actually do more harm than good. As a result, many therapists these days incorporate mindfulness techniques into their treatments to help their patients think and act without harsh judgment and/or criticism. Thus, for patients with anxiety or depression, it is good to ask any potential therapist who claims to specialize in CBT whether or not they also advocate mindfulness or related techniques.

Of course, the effectiveness of any treatment, CBT included, is entirely dependent on how often it is practiced. The teachings learned in therapy are only as effective as the patient’s commitment to them. This can really make a difference in whether or not the therapy itself is successful. That being said, the therapist also makes a large difference. Patients must look for a therapist qualified to treat their unique needs. This will require research, inquiries, and investigation, but will be well worth it. Matched with a compatible treatment program, patients with anxiety or depression can improve their conditions and significant reduce, if not eliminate, the symptoms of their condition.

Schedule an appointment to begin treating anxiety and depression with our Boca Raton Therapists @ 800-378-9354.
Peaceful picture of a small, white Buddha figurine with pretty rocks laying on ground.

Five Common Misconceptions About Practicing Mindfulness

In previous posts, we’ve discussed the many and varied benefits of mindfulness, particularly for those struggling with anxiety and depression. Mindfulness has been shown to assist in improving one’s mental and physical health. In fact, according to survey results from a 2011 research article titled “Doing and Being: Mindfulness, Health, and Quiet Ego Characteristics Amongst Buddhist Practitioners,” published in the Journal of Happiness Studies, there are 5 key ways that mindfulness training can improve our overall wellbeing. 

  • Reducing stress – this can help lessen the symptoms of anxiety and depression, thereby allowing us to ultimately feel happier.
  • Improving our social relationships with others, including family, friends, and even strangers.
  • Strengthening our immune systems due to lessened physiological stress and negative emotional impact.
  • Increasing our self-awareness. Helping us become flexible, clear, and practical towards our realities. This also allows us to pay better attention to our consciousness in the present and address our needs as they arise.
  • Opening us up to new, diverse experiences. Mindfulness has been shown to reduce feelings of paranoia and neuroticism, thereby enabling us to try new things without feeling limited by fear or worry.

However, despite the multiple benefits of practicing mindfulness, there are a few misconceptions that seem to persist regarding the practice. These misconceptions can misrepresent what exactly mindfulness is as well as how it works. Thus, in order to better understand mindfulness and the subsequent practice of mindfulness therapy, we should learn to recognize and distinguish between the facts and myths associated with mindfulness.

Below are 5 of the most commonly held misconceptions about mindfulness and mindfulness-based treatments:

Mindfulness is a Fringe Practice 

Perhaps one of the most harmful myths is that mindfulness is a fringe practice, almost on par with cultish behavior. However, in the last couple of decades, mindfulness-based treatments have served as somewhat of a “third wave” in cognitive-behavioral treatment. As such, many practitioners, including Dr. Seth Gillihan, clinical professor of psychology at the University of Pennsylvania, are supporters of this method.

Despite its connections to the often decried “new age” spirituality that has been growing in popularity as of late, mindfulness remains its own distinct practice. That being said, many religions may incorporate mindfulness into their teachings and methods, but the act of being mindful is accessible to everyone, regardless of spirituality or lack thereof. As Dr. Gillihan explains : “mindfulness is available to everyone at every time, and is as normal as breathing.”

Mindfulness is Religious

Building off of our previous point, many individuals insist that mindfulness is strictly religious. However, this isn’t true. As we’ve discussed, many religions do incorporate mindfulness or some variation into their practices. This often leads to the assumption that one must be affiliated with a particular religion, or with religion in general, in order to benefit from mindfulness itself.

That being said, although many religions practice some form of mindfulness, the concept itself is not inherently biased towards any one religion. You do not have to follow any particular religion, nor do you have to be religious at all, to benefit from mindfulness or mindfulness-based treatments. Dr. Gillihan adds that “Whatever our beliefs and values, we can practice them more fully through a mindful approach.”

Practicing Mindfulness Means You Are Weak

Yet another toxic belief is that mindfulness, or similar methods that advocate mind-over-matter and/or the unification of the body and mind, are weak. For some, mindfulness represents failing to take a stance on an issue, thereby being too passive or “wishy-washy.” This argument comes from a perspective that equates strength with fighting, rather than with fortifying one’s own psychological resilience.

Recognizing this, it’s important to realize that mindfulness, despite any outward appearances of ease, can actually be a challenging process. This is because practicing mindfulness includes letting go of well-established habits, mindsets, and behaviors. This process of letting go can be especially hard. Learning to relinquish the past and focus our energies on improving our futures is anything but weak. In fact, by practicing mindfulness, we are directing our strength and resolve towards ways that serve us, rather than fighting without any direction.

Mindfulness Contradicts Science

Similar to the belief that mindfulness is inherently religious, there are some who may argue that mindfulness actually contradicts science. Luckily, this misunderstanding is one of the easiest to dispel. This is because a large number of studies, many of which were quite rigorous, have proven the effectiveness of mindfulness and mindfulness-based treatments. In essence, the scientific foundation for practicing mindfulness is very strong; certainly strong enough to prove that the practice itself has legitimate benefits rather than acting on a sort of placebo effect.

Mindfulness is just Meditation

This misconception is one of the more understandable: many people assume that mindfulness just means meditation. The reason for this is obvious – meditation is one of the most common forms of mindfulness practice. However, although meditation is, in fact, incredibly beneficial, any activity can prove to be mindful so long as the individual is able to be reflective and act mindfully during.

Activities like holding a child, going for a walk, hammering a nail, or talking with someone can all potentially be mindful depending on the individual and how they process their present state of mind and surroundings. Practices such as meditation are more formal and, while successful, are not the only way to train ourselves to be mindful. Growing research evidence supports the idea that learning to be mindful during our daily activities can be almost just as beneficial as taking the time to properly meditate.

Exposing Mindfulness Myths Removes an Obstacle

When we dispel harmful myths such as these we ultimately open ourselves up to a new opportunity to improve ourselves and our overall wellbeing. Mindfulness can be key to removing mental and emotional barriers which keep us from living our lives in a meaningful way. Being consistent about any form of treatment, including mindfulness, can be challenging at times, but the rewards make the practice itself worth it. Therefore we need not pay heed to any misgivings about the practice which, rather than serving a constructive purpose, only exist to make us doubt ourselves and our true potential.

Call our office to learn more about child, adolescent and family therapy in Boca Raton.
A male and female interlocking hands in what appears to be a strong, happy relationship.

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