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Frequency: Once a month for 12 months (in addition to standard weekly DBT groups) Schedule: Monthly Location: Anderson This group is for anyone currently in DBT or recently graduated (within the last year) who would benefit from learning additional DBT skills specific to changing behaviors that they do not feel in control over yet. These are additional skills that are covered more fully than in standard DBT. By the end of the group, clients will have learned specific skills to help them to decrease their problem behaviors. This group would be helpful for anyone currently in DBT who continues to struggle with controlling certain behaviors. The group would especially be helpful for those with: Problems over spending/ shopping Treatment Resistant Depression Eating Disorder behaviors Self-Harm behaviors Drinking and Drug use Gambling and other addictions. If interested, clients should speak to their Individual Therapist about a referral or discuss this in their DBT intake. Gregory Pratt, MSW, LISW-S has worked in the Mental Health Field in the Greater Cincinnati area for over eleven years. He graduated from Thomas More College with a BA in Psychology and from the University of Kentucky with a Master’s Degree in Social Work (MSW). He has worked with individuals and families struggling with a wide range of concerns and specific needs, including individuals with both mental health and substance use struggles... Continue Reading
 The practice of mindfulness dates back thousands of years to Eastern religion, where mindfulness and meditation have been demonstrated over these millennia to help people live in the present and be present in their own bodies. This state of mindfulness means minimizing drifting thoughts into the mind about the past and the future, where the study and practice of mindful breathing is essential. These practices are especially beneficial for people experiencing symptoms of a mental health condition that causes sleep issues. Until recently, it was thought that sleep deprivation can only be the cause of mental health conditions over time. Recent research now however shows that it can be the other way around, that mental health conditions can actually cause sleep deprivation, where sleep issues are more prevalent with people who already have mental health issues. Research shows that through the practice of mindfulness, sleep quality can be improved for those who experience sleep disturbance due to mental illness like depression, anxiety, ADHD, and bipolar disorder. More and more research is showing how mental health conditions can actually impact sleep. Harvard Medical School says that “chronic sleep problems affect 50% to 80% of patients in a typical psychiatric practice, compared with 10% to 18% of adults in the general U.S. population.” According to NAMI, sleep problems can be a sign of an impending illness like bipolar disorder, and certain mental health conditions can be worsened by lack of sleep. NAMI says that more than one half of insomnia cases are related to depression, anxiety, or psychological stress. OCD, PTSD, ADHD, Schizophrenia, as well as substance abuse disorders are also each specifically associated with poor sleep. Both Harvard Medical School and NAMI recommend relaxation techniques, including deep breathing, progressive muscle relaxation, and meditation to increase mindfulness. This mindfulness exercises reduce anxiety and help people feel aware and present in their bodies so they can sleep. There are a number of benefits to such relaxation techniques used to achieve mindfulness that aids sleep. Mindfulness and meditation help in three major ways with regard to sleep problems that can be caused by mental illness:
In combination with the relaxation techniques that NAMI and Harvard Medical School recommends to limit the effects on sleep caused by mental health conditions, consider your overall bedroom environment and how it contributes to mindfulness and serenity. Consider your sleep space as well, where you invest in the right bedding and mattress for you. Once your sleep space and environment are ideal, focus on one or more specific meditation techniques to practice before bed. It may take time for meditation to work, so be patient with yourself and remember that self compassion isn’t selfish! To learn more about mindfulness and the positive effects it can have on your body, join our Mindfulness Based Stress Reduction Group. The group will meet weekly for 9 weeks and include a time of teaching and a time of practicing techniques. There is daily homework that is essential to getting the most out of the group.
MBSR Group Cost: $240 Private Pay Meets weekly in Fairfield for 9 weeks from 4-6pm Each group is 2 hours long, There is also an 7 hour session between weeks 5 and 6 for a total of 25 hours Presenter: Charity Chaney  Anxiety comes in many forms, from the general worry that comes from everyday life to the intense fear caused by major psychiatric disorders. As debilitating as anxiety can be to our mental and physical health, it’s also corrosive to our quality of sleep—whether you’re a college student pulling an all-nighter or a veteran jolted awake from a nightmare caused by PTSD. This guide covers how anxiety and sleep are interrelated, change with age, and what you can do to improve both. Anxiety and Sleep Nearly 40 million people in the US experience an anxiety disorder in any given year. More than 40 million Americans also suffer from chronic, long-term sleep disorders. Those numbers aren’t a coincidence. Anxiety and sleep are intimately connected: The less sleep you get, the more anxious you feel. The more anxious you feel, the less sleep you get. It’s a cycle many insomnia and anxiety sufferers find hard to break. anxiety and sleep are intimately connected: the less sleep you get, the more anxious you feel. Common anxiety symptoms like restlessness, increased heart rate, rapid breathing, and gastrointestinal (GI) problems make it difficult to fall asleep. Because insomnia and anxiety are so closely linked, one of the first steps in treatment is to determine which is causing the other — that is, which is the primary cause and which is the secondary symptom. “Sometimes, insomnia is secondary,” says psychotherapist Brooke Sprowl, “in that it is caused by another primary disorder such as depression, anxiety, or a medical condition. In this case, usually treating the primary disorder [improves] the insomnia.” Whether insomnia is the primary or secondary cause, natural remedies like magnesium glycinate and melatonin have been shown to help with sleep, says Sprowl. Non-medication treatments like cognitive behavior therapy along with good sleep hygiene are also effective at combating insomnia and anxiety. Health Risks of Insomnia Insomnia affects cognitive functions and cripples school and work performance. According to one study, 70% of college students with lower GPAs also had difficulty falling asleep. Insomnia also slows reaction times, raising the risks of driving a car or operating heavy machinery. Sleep deprivation is also bad for your physical health, increasing your risk for developing high blood pressure and heart disease. And long-term sleep disruptions may even raise the risk of some forms of cancer. Common Sleep Disorders There are many forms of sleep disorder besides insomnia. All interrupt sleep, threaten our health, and increase nervousness and stress. Here are a few common ones: Delayed Sleep Phase SyndromeAnyone who has changed time zones or experienced “jet lag” understands the effects of delayed sleep phase syndrome (DSPS). When your sleep and wake cycles don’t align with the current time zone, you feel groggy when you shouldn’t. While these symptoms are temporary for most, people with DSPS stay out of sync for long stretches of time, negatively affecting their work and activities. Because people with DSPS are forced to conform to the external clock rather than their internal one, they suffer from lack of sleep and increased anxiety. Obstructive Sleep Apnea Obstructive sleep apnea is when a sleeper’s relaxed airways close and obstruct breathing. Interrupted breathing episodes occur numerous times during sleep and are usually accompanied by snoring. Obstructed airways result in lowered oxygen levels and increased carbon dioxide in the blood. Sufferers are often unaware they have the condition. Sleep apnea increases the risk of heart disease, stroke, diabetes, and cancer. Sleep studies are required to diagnose obstructive sleep apnea. Forms of Anxiety How do you know if you have garden-variety nervousness or a more serious anxiety disorder? Usually, the difference is how significantly your anxiety affects your life. For someone at a party who doesn’t know anyone, a certain level of anxiety is normal. However, if their anxiety is interfering with daily activities (e.g. making friends, school work, job performance), They may have a serious anxiety disorder.Whether social nervousness or a serious phobia, every form of anxiety will affect your quality of sleep if it goes on long enough. Below are descriptions of the five major anxiety disorders. If you think you may have one, consult your physician or therapist about diagnosis and treatment.  If you’re like many people, you spend a good deal of energy and time beating yourself up! You may frequently engage in an internal monologue about how lame it was for you to have said something or how you’re not successful enough, or not good looking enough. This toxic internal self-speak merely adds to your troubles. Self-compassion, on the other hand, helps us build resilience to difficulties that have the potential to sink us into a state of self-defeat. When we make mistakes or experience a rough day, having self-compassion allows us to get back in the game and try again, rather than being swallowed by a self-centered swamp of self-pity. What Exactly Is Self-Compassion? Self-compassion is the antidote to self-deprecation. Sadly, many people put themselves down with self-loathing comments. In the movie Annie Hall, Woody Allen plays a character named Alvy who says, “I would never want to belong to any club that would have someone like me for a member.” Some people think putting themselves down is cool, funny or charming. In Self Compassion: Stop Beating Yourself Up and Leave Insecurity Behind, renowned self-compassion advocate, psychologist, professor and speaker, Kristin Neff, Ph.D., promotes a very different message. Neff explains that self-compassion is a must in today’s day and age. She states that it is very different from selfishness. Neff says self-compassion is comprised of three distinct ingredients: mindfulness, empathy and connection. Mindfulness By now, you have likely heard the word Mindfulness a few hundred times. It is quite the buzzword these days! But what exactly does it mean to be mindful and how does mindfulness relate to self-compassion? Mindfulness means being aware of what is. It does not require changing anything. Rather, mindfulness means paying attention to or drawing our awareness to our own thoughts, feelings, reactions, emotions or surroundings, in the moment. Sounds simple, right? Well, not so much because we often go through life reacting without thinking. Have you ever driven to work and then wondered how you got there or not remembered anything about the drive itself? Often, we ruminate about something that occurred in the past or worry about something that could occur in the future, so much that we have little awareness of what is occurring right here and now, in front of us. Mindfulness draws us in to notice and become more aware of what is--a requirement of having self-compassion. You cannot have self-compassion if you are not mindful of what is. Empathy The second ingredient of self-compassion is empathy. When we have self-compassion, we treat ourselves with the same empathy that we would a good friend. Why must we be quick to forgive our friends when they make an honest mistake but we hold ourselves to such high demands that we cannot do the same for ourselves? We are only human, after all. We pride ourselves on being empathetic to others’ needs, treating others with kindness and love, just as we should. Yet, at the same time, when it comes to how we treat ourselves, we are downright relentless. What would happen if we gave ourselves the same sort of empathy that we provide so freely to others? How might that change the way we operate in our daily lives? I believe we would feel calmer, cared for, happier and more peaceful. Connection Neff describes the third and final ingredient of self-compassion as connection or connectedness to others. When we notice our connection with others and appreciate that we’re all human and “we’re all in this together,” it makes facing life’s challenges more tolerable. Conversely, when we believe that we are the only ones in the world with a particular difficulty, we become self-absorbed, we isolate ourselves further, and we pity ourselves. In effect, we become more selfish and self-centered. Whereas, when we feel a connection with those around us, we have confidence that everything will turn out ok—that others face this difficulty too and if we can’t tackle it by ourselves, we know people who have already faced a similar challenge who can help us. Take Care of Yourself So You Can Take Care of Others I attended a workshop about a year ago led by Neff who instructed participants to think of the video that airlines show passengers before taking flight on an airplane. The video instructs you to first place an oxygen mask on your own face before helping others with their oxygen masks because if you cannot breathe, you cannot possibly help anyone else. Similarly, when we practice self-compassion, we are better equipped to help those around us. Without adequate self-compassion, we sink into self-absorption, making it more difficult to support others. This is the distinction between self-compassion and selfishness. It is with mindfulness, empathy toward ourselves, and the recognition that we are all in this thing called life together, that we can practice self-compassion, and more effectively help ourselves and each other. This recipe can be difficult to follow but if you keep at it, the end result can bring you more satisfaction in life.
So, first things first, why expand “the talk” to your child beyond giving them a book, showing them a video, or describing anatomy without further explanation? As a sex therapist, the majority of my clients come in feeling embarrassed to talk about sex or have a lot of misconceptions about it as adults because no one ever talked to them about it. Many people were raised with the underlying message that sex is awkward, taboo, or shameful to talk about – some were fortunate enough to have parents that were a bit more open to talking about it, but may still have only learned about anatomy, and not much else otherwise. By closing off our kids from talking about sex, we’re modeling the notion that there’s something inherently wrong with sex – that it needs to be hidden and can only be discussed with our partner. The problem with this is that as adults, most people have no one to turn to when they’re experiencing sexual difficulties. Forget about talking to a friend, co-worker, spiritual leader, etc. – most people just avoid the topic. And if the doctor doesn’t bring it up (which they probably won’t since they too feel awkward talking about sex), who can one turn to for guidance and advice? Porn? The industry that takes sex and scripts and edits it to look more like a movie than real life? I don’t think so. While porn might teach a technique or two, it doesn’t address issues such as pain, dysfunction, lack of desire, etc. Therefore, by setting a new trend and talking to your child about sex, you’re setting them and society up for better sex education and therefore better sexual health. So, when is the best time to start talking to your child about sex? The reality is, as early as possible, so that it never becomes a taboo topic in your home. Teach your child from an early age to label their anatomy properly. Teach girls the difference between vulva and vagina and let boys know about their penis and how sometimes it might grow, and that’s normal! Also, teach your children from an early age about consent. Rather than forcing hugs, kisses, or tickles, ask them if it’s okay to give them a hug, or ask them if they’d like to give Grandma a kiss. Teaching them from an early age that it’s okay to say “no” will help give them a voice early on to advocate for their own rights when it comes to their bodies. This is important not only for lessening any potential shame around sex and our bodies, but it’s also very important in the court of law. There have been cases where a perpetrator did not receive a full conviction because the child didn’t know how to describe the assault that happened to them, since they didn’t know how to properly label their body parts. And while this is an extreme example, it highlights the importance of teaching children proper anatomy and consent. As children get older, continue to have the conversation about sex. Answer questions honestly and make yourself available as someone to talk to. If you catch your child self-pleasuring, rather than yelling, smacking hands, shaming, etc., provide a gentle tone and have a discussion with them in private and set the standard that you and your household value. If your values indicate that self-pleasure is not okay, calmly explain to your child why without including shame messages. If your values align more with self-pleasure being acceptable, try explaining to your child that it’s fine for them to do it, but in the privacy of their own room, etc. It’s natural for children to explore their bodies, including their genitals as they age. It’s very likely that at a young age, they will discover masturbation and experiment with it. However, by addressing it in a way that reduces shame through a gentle tone and explanation (rather than just telling them “no” or “don’t do that in public!” ), they are much more likely to be open to coming to you when sexual issues arise. In addition, shame around their body and their natural desires will be much lower. Into adolescent and teen years, continue having the conversation. Explain to them about puberty changes so it doesn’t come as a shock when their bodies begin to change. You can give them a “welcome to puberty” package (razor, shaving cream, deodorant, tampons, pads, etc.) and let them know they can come to you with any questions they have about these changes. Make sure you explain to your kids not only the physical repercussions of sex (some potential side effects such as pregnancy, STIs, potential physical enjoyment, etc.) but also the emotional side effects (potential feelings of joy, connectedness, sadness, shame, etc. depending on the outcome of their experience) and again, that they can come to you to process any of these feelings/outcomes. Check and see if your child has a mentor with whom they’re comfortable talking about sex in case they still feel awkward talking about it with you. While there is plenty of other information to be considered regarding the sex talk, the biggest highlights are these:
By being open with your kids about sex and their bodies, the hope is that in the future they will experience less shame and be more empowered with making their own decisions regarding their choices. No matter what phase of life they are in right now, it’s never too late to have the talk. You’ve got this!
What Is Seasonal Affective Disorder (SAD)? SAD or seasonal affective disorder is a depressive disorder that most often occurs in fall and winter. However, It is not to be confused with the common “winter blues” just described. Symptoms of SAD include fatigue (regardless of the amount of sleep one gets) and weight gain associated with overeating, particularly high-carb treats and sweets. It is associated with higher levels of distress and interference with daily functioning than what most experience in the darker, colder months. According to the American Psychiatric Association, SAD has been linked to a biochemical imbalance in the brain prompted by shorter daylight hours and less sunlight in winter. With seasonal changes, people’s biological clocks or circadian rhythms can fall out of step with their daily schedules. Symptoms of SAD may require the help of a mental health practitioner. Whether SAD or Just Blue, Take Action You (or anyone) can benefit by being proactive and taking steps now to improve your health and wellness so that you’re better prepared to deal effectively with the challenges of fall and winter. Following are tips to give you a better chance of preventing the winter doldrums:
If your depression is severe or if you have suicidal thoughts, please consult a doctor immediately, seek help at the closest emergency room or call the National Suicide Prevention Lifeline – 800-273-TALK (8255). REBECCA MORRA, MA, LPC
 Troubled sleep, insomnia, and oversleeping are classic symptoms of clinical depression. While not all depressed people have sleep disorders, many do. When evaluating patients for depression, doctors typically ask about sleep patterns as part of the diagnosis. Problematically, sleep problems worsen mood and can cause depression themselves, creating a vicious cycle. What is depression? The CDC estimates that just over 7% of Americans have moderate or severe depression. The severity and symptoms of depression vary, but the most common include:
As you can see, sleep problems are core symptoms of depression. Both depression and severe sleep problems are major risk factors for suicide and health problems like heart disease, other mental disorders, and smoking. People with depression have trouble being productive in work or school, which can impact their career and social life. The sleep issues are often one of the reasons depressed people seek out professional help. The symptoms of depression are persistent and pervade all aspects of an individual’s’ life, from work and play to basic needs like eating and sleeping. Within the larger category of depression, there are several different types of depression which come with their own sleep problems:
Anyone can become depressed, but it affects some people more than others, particularly women and adults in middle age. Coincidentally, these two groups are also more likely to have insomnia. The chart below from the CDC reveals the correlation between age and depression as well as the disproportionate prevalence between the genders:  The cyclical relationship between depression and sleep The sleep problems brought on by depression – or the ones that caused it in the first place – make it much more difficult to get better. Sleep deprived people have stronger emotional reactions in general, so it’s tougher to regulate the emotional volatility associated with depression. Abnormal sleep interferes with mood and energy levels during the day, so it’s difficult to stay motivated to engage with others, exercise, and even go to work. To cope, people who are depressed may self-isolate, which can lead to more sleep problems: loneliness itself is associated with fragmented sleep. The cause-and-effect runs both ways. Even if you’re not depressed, lack of sleep increases your chances of depression and other mental illnesses. Depression causes insomnia and hypersomnia. An article in the Journal Sleep reported that children with both insomnia and hypersomnia are more likely to be depressed, to be depressed for longer periods of time, and to experience additional problems such as weight loss. Particularly for young adults, there is a strong correlationbetween insomnia and major depressive disorder. Genes involved in the molecular clock and circadian cycle are known to be involved with bipolar disorder, although nobody exactly knows how. When scientists examine mice with mutations in the so-called CLOCK gene (important in the circadian cycle), they find the mice act like humans with mania. When the mice are given lithium (a treatment for bipolar disorder), their behavior reverts to normal. So it appears that this important part of the sleep control cycle is tied up with mood and mood disorders. Teens who don’t get enough sleep are at a significantly greater risk for depression and suicide. Treatment for depression-related sleep disorders The good news is that treating either depression or related sleep problems tends to improve the symptoms of the other. Getting good sleep is essential for overcoming depression. You may have seen stories of sleep deprivation as the new cure to depression, but be wary of these. Researchers have indeed found that a night of sleep deprivation reduces symptoms of depression the following day. However, they can experience a rebound effect (known as “residual insomnia”) the following day. Moreover, sleep deprivation on a long-term basis is simply impractical – and also dangerous, given the serious side effects for your mental, physical, and emotional health. Rather, the recommended treatment for depression typically combines psychotherapy and/or pharmacology. Psychotherapy One popular form of psychotherapy is cognitive-behavioral therapy (CBT). CBT focuses on helping the individual recognize the negative or destructive thoughts (the cognitive aspect) that make them feel depressed, and the behaviors they’ve become accustomed to responding with. Once they learn to recognize these thoughts and behaviors, they develop new ways of thinking or responding. A sub-type of CBT is CBT-I, which applies the same techniques to curing insomnia. Pharmacology Although both depression and insomnia can be treated without drugs, there are pharmacological interventions for both, and not coincidentally, both can be addressed with antidepressants. The most common antidepressant medications today are selective serotonin reuptake inhibitors (SSRIs). Those with insomnia who start taking one of those drugs often find relief for their sleeping problems. The pharmacological treatment for idiopathic hypersomnia is usually a stimulant – something that works opposite of sleeping pills. That’s why it is important for doctors to evaluate whether long-sleeping patients might have depression and be a better candidate for anti-depressant medication. Tips for getting better sleep with depression In addition to the therapies suggested above, the following advice can help you get better sleep while you’re getting treated for depression and related sleep problems. 1. Keep a sleep diary. If you believe you are suffering from depression and/or a comorbid sleep disorder, keep a sleep/mood diary for 2 weeks to share with your doctor. Note when you go to bed, how long it takes you to fall asleep, when you wake up, and how much time you spent asleep. Also note your level of fatigue or energy throughout the day, as well as any changes in mood, diet, libido, or thought patterns. 2. Turn your bedroom into a sleep haven. Use your bedroom exclusively for sleep and sex. Everything else, from watching television to working to socializing, should take place elsewhere. You want your mind to see your bedroom as a place of rest, not of worry, stress, or social activity. Keep your bedroom as cool and as dark as possible by removing electronics and using blackout curtains if necessary. Invest in a comfortable, supportive mattress that makes sleep come easier. 3. Stick to a regular sleep schedule. Go to bed and wake up at the same time every day, even weekends. Ensure you leave enough room for you to conceivably get at least 7 hours of sleep, but don’t worry about whether you spend all of that time asleep. Your only goal is to stick to the schedule; eventually your brain will catch up and train itself to sleep and wake at those times more naturally. Avoid napping if you can. If you’re absolutely exhausted, limit them to short power naps of 30 minutes or less. 4. Create a calming bedtime routine.Depression and anxiety-producing thoughts are a recipe for insomnia. Help ease your mind of worries with a calming bedtime routine. Try relaxation techniques, deep breathing exercises, or meditation. Take a warm bath or light some candles. If your mind continues to race at night, take time to write your thoughts down in a worry journal – getting them out of your head and onto the page will diminish their power. Relieve anxieties by listing out any remaining to-do items you can take care of tomorrow. 5. Get plenty of sunshine. Natural sunlight facilitates a healthy sleep-wake cycle. Aim to get plenty of sunshine, ideally by exercising outdoors in the morning or early part of the day. This will give you an energy boost that makes it easier to feel better and less fatigued during the day time. Then, as it gets dark, your brain will recognize it’s time to wind down and fall asleep. While you’re at work or school, sit by the windows to increase your amount of sunlight. 6. Eat well and avoid stimulating substances. Foods that are high in sugar or fats mess with your sleep, your health, and your mood. Instead, fill your diet with foods that promote healthy energy levels and sleep. Also take care to avoid any stimulating substances in the afternoon or evening that interfere with sleep, such as caffeine, alcohol, or nicotine. 7. Stay calm when you wake up. Unfortunately, retraining your body to sleep well is not an overnight process. Expect – and accept – that you’ll continue having disturbed sleep during this process. When you do wake up, practice your deep breathing or progressive muscle relaxation exercises. Meditate or visualize something that makes you feel happy or calm. Turn on a soft lamp and read a book. Stay calm and sleep will come.
General diary card instructions: Each night as you are winding down for the day, take a few moments to reflect on what your daily experiences were. We fill out the diary card left to right, one day at a time. The first thing you fill out is the day/date! If your session was on a Tuesday and the date was June 3rd, you would write 6/3 in the Tuesday box. Then move across as you would read a book. There is ample research that shows a strong correlation between tracking and improved outcomes. Whether you want to increase or decrease a behavior, tracking it will help. The first section asks you to rate your urges for use (drugs/alcohol), self-harm and suicide on an intensity scale from 0-5. This column does not indicate action, you could have an urge for alcohol at a 5 and not actually drink. 5 is very intense; 0 is non-existent. The second section is for emotions. You are asked to rank the highest intensity of each emotion that day. 5 is very intense; 0 is non-existent. The “P” stands for physical pain (which isn’t an emotion…it just fits there) and the “E” is for emotional pain (which many of my clients like to use as their general stress rating that day. The goal is NOT all zeros…the goal is not all 3s…the goal is that you are honest. Over time in DBT®, what I tend to see is that a person’s negative emotions will go down first, then their positive emotions will raise up (At about the same time that they start using skills). Having this sort of proof to look back on can be very helpful when you start to feel jaded or tired from the treatment. I have also found in this section that people tend to block feeling certain emotions; the diary card allows you and your therapist to find this out faster! The next big section is about drug/alcohol use (including legal prescriptions). We do need honesty here; your therapist is not going to use this information against you! This section allows us to discover trends much faster. For example, if you have anger outburst every day after a glass of wine…or if you have a depressive slump each time you miss a medication, then we can target that immediately! Some people also find that tracking their medication compliance helps them remember their medications more often. Next you will find a few blank columns. This is something for you and your therapist to decide on over time. Common things to track are: hours slept, bedtime, whether or not you exercised, eating disordered behaviors, etc. The last section is your actual actions. This section asks you to indicate (yes or no) whether or not you engaged in self-harm (intentional tissue damage), whether or not you lied (either big lies through the week or lying on the actual diary card) and whether or not you used skills (this is a 0-7 scale indicated on the bottom of the diary card). The furthest section to the right and smallest section by far is the reward column. In the column we are asking you to remember that humans rarely learn unless someone rewards a behavioral change; we are asking if you rewarded yourself for a job well done. This might mean that you had a 5 in anger and you coped well or that you made a choice to go out with friends resulting in a 4 of enjoyment. A reward could be as simple as positive self-talk/praise or as big as buying yourself a new item (perhaps new workout clothes for going to the gym 3x that week). A reward doesn’t have to cost anything! Upon entering session, you are supposed to hand your diary card to your therapist for them to review with you and lay the path for that session. The DBT® individual session is structured in the following way: 1. we address any life-threatening behavior (self-harm, suicide attempts) 2. we address any therapy-interfering behavior (not doing diary card, being late to class or session) 3. we address any quality-of-life interfering behavior (substance use, not rewarding self, lying, etc) Other helpful diary card hints: 1. Keep it where you will see it. Inside your planner, the front seat of your car, on your nightstand or where you eat breakfast. We don’t care what condition it’s in when we get it back…just that it’s filled out and that you bring it back! 2. Set a reminder alarm on your phone to complete it 3. Use diary card time as a reminder to do your DBT® homework and/or practice mindfulness ALEXANDRIA BERESFORD MSW, LISW-S, DBTC
Co-Occurring Disorders
A person with a co-occurring disorder has been diagnosed with a substance abuse disorder and another mental health disorder. Co-occurring disorders, sometimes called dual disorders, are best treated through integrated treatment that addresses both issues at the same time.
The brain is a complicated and delicate organ. It’s not surprising that alcohol and other drugs can cause symptoms of mental illness. The substances work by changing the way the brain operates. People who use drugs feel buzzed or high because the substances affect chemicals in the brain and the way brain cells communicate with one another.
In response to those changes, the brain adapts to the presence of alcohol and other drugs, increasing the chances that a person will develop a substance use disorder. Substance use disorders are types of mental health disorders that are more commonly called addiction. It’s possible to have more than one mental health disorder. Substance use disorders often co-occur alongside other mental illnesses. More than half of people with substance use disorders also have a mental illness. Sometimes the mental illness comes first. In other people, substance abuse occurs first. In both situations, each disorder amplifies the symptoms of the other. “A large number of people with substance use disorders also have some psychiatric disorders which may or may not be major,” Dr. Timothy Huckaby, medical director of Orlando Recovery Center, told DrugRehab.com. “A lot of people have underlying depression or underlying anxiety.” Other common co-occurring disorders include personality disorders, behavior disorders and psychotic disorders. With comprehensive treatment, individuals can recover from addiction and most co-occurring mental health disorders. But failing to address co-occurring disorders during addiction treatment increases the chances of relapse.
What Are Mental Health Disorders?
The phrases “mental illness,” “mental health disorder” and “mental health issue” are often used synonymously. In its diagnostics manual, the American Psychiatric Association uses the term mental disorder to define mental illnesses, but the organization also recommends using the term mental health challenge. The American Psychiatric Association defines a mental disorder as: “a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation or behavior that reflects a dysfunction in the psychological, biological or developmental processes underlying mental functioning.” 
Some mental disorders are more common than others. Conditions such as anxiety and depressive disorders, for example, occur more frequently than schizophrenia and psychosis. Each type of mental disorder can range in severity from mild to severe.
Developmental Disorders
Mental disorders are different from developmental disabilities. Developmental disorders, such as autism spectrum disorder and learning disabilities, impair social interaction, mobility, language and self-sufficiency. Substance use disorders and other mental health disorders can co-occur alongside developmental disorders. But the term co-occurring disorder most commonly refers to substance use disorders and mental disorders. Dual Diagnosis & Comorbidity Dual diagnosis is an outdated term for co-occurring disorders. Both of these terms are sometimes confused with comorbid disorders. Comorbidity is a broad term used to denote the existence of multiple physical or mental diseases or disorders. Co-occurring disorders and dual diagnosis are specific to substance use disorders and other mental health conditions.
Mental Disorders that Co-Occur with Substance Abuse
Any mental health disorder can co-occur alongside substance use disorders. The most common types of co-occurring disorders include mood, anxiety, psychotic, eating, personality and behavioral disorders. Each category includes numerous types of mental disorders that can range in severity. Symptoms of personality disorders vary widely based on the type and severity. Behavioral Disorders Behavioral disorders most commonly occur in children. Many healthy people exhibit behavior problems, such as inattention, defiance and hyperactivity. However, behavioral disorders are characterized by chronic behavior problems that last at least six months. Common behavioral disorders include:
Symptoms of Co-Occurring Disorders The physical and emotional symptoms of co-occurring disorders vary depending on your life circumstances, the type of substances you use and the type of mental illness you possess.
The symptoms of mental health disorders are similar to the side effects of addiction. Thus, it can be difficult to determine whether a mental illness is caused by substance abuse or vice versa. Reputable addiction treatment centers screen patients for mental illnesses and develop plans for treating co-occurring disorders simultaneously.
If watching the news is hard today, you are not alone.
On Thursday, Dr. Christine Blasey Ford and Judge Brett Kavanaugh testified in front of the Senate Judiciary Committee regarding Ford’s allegation that Kavanaugh sexually assaulted her 35 years ago. While this hearing is important, it can be hard to watch, especially if you’re a sexual assault survivor. If you’re feeling emotional, raw or triggered right now, we want you to know that support is out there. If listening to Ford or Kavanaugh’s testimony is triggering, turn it off, log out of social media and contact someone you trust. We’re sending hugs to anyone struggling today, and want you to remember these seven things if this news has been difficult for you. We’re here for you. We believe you, and we’re happy you’re part of our community. 
If you need support right now, here are some resources you can turn to:
Take care of yourselves today, 
While we cannot offer you a real or ghost hug, we can offer you an ear. We are hear to listen if you want to talk. Please call us at 513-939-0300 for an appointment today. You don't have to carry it all on your own.
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