Lara Effland:

Hello, and welcome to Insight Behavioral Health Center's Mood and Anxiety Family Days. Thank you so much for joining us. My name is Lara Effland. I'm the Regional Clinical Director in Washington, and I've also been a part of the Insight Behavioral Treatment team since its beginning. I just wanted to share an introduction and an overview.

One thing that I would just like to start off with is a piece of information in which when we came together as clinicians and providers, and really designed our mood and anxiety approach, what we felt was what's the most important thing that we're really trying to strive for for our patients? Ultimately it is emotion regulation.

There's, time and time again, research continues to show that the success, the ability to really thrive, to build resiliency, to feel connected to your life, to feel engaged with those around you and the world in which you're in, is to have the ability to emotionally regulate. To know what you're feeling, to know how to handle them and how to move forward? When to just tolerate them versus acting on them and how to allow for it to come and go, as emotions do? It really is the cornerstone of our mental health is our ability to emotionally regulate.

What is emotion regulation? Well, first and foremost, it's the awareness and understanding and acceptance of emotional experiences and that we really... once emotions start, you really don't have that control over the milliseconds in which it does. Instead, it's a split... It's a moment of reaction. It's a moment of our body telling us how we're reacting or how we're feeling about the world around us.

A lot of times we beat ourselves up and we feel as though if I only could get control of my emotions. If I only couldn't feel this way. Why do I feel this way? But really first we just have to be aware, unconditionally aware, and that all emotions are acceptable and then understand, well, what is the emotion? Is it a fear that something is happening that I don't know whether or not it is? A sense that something is about to occur or has occurred, and so I'm just processing that? Or is it actually this is a response to the event. This is I have fact that this happened, and this is my response to it. Then accepting that for what it is, whether whatever part of that emotion it may be.

The second piece is the ability to engage in goal directed behaviors and inhibit impulsive behaviors when experiencing negative emotions. We really do want to see the bigger picture. Where am I going with this? What's really the purpose? What's the drive? What's my overarching value? What's the most important thing to me? Is the relief in which I'm seeking and giving into this emotion will actually make it worse? Or, is it feeling this emotion, following through with this emotion?

For instance, when you feel guilt that encourages you and urges you to apologize, which can actually be very replenishing of a relationship. Reinforcing that the guilt had a purpose, and following through with that is important. Or anger or fear may sometimes actually mislead us to follow through with a particular behavior that wouldn't be so effective for us, such as avoiding, acting out, bursting, showing rage, showing a sense of emotion that is overwhelming for us and for others, and that actually causes more complications down the road.

The third piece is the flexible use of situationally appropriate strategies to modulate the intensity and/or duration of emotional responses. Recognizing that there's a lot of vulnerability factors that go into emotions. Did we sleep well? Have we eaten? What are the conditions of the day? What's been happening in our lives? Really, to think about the bigger context and then try to be flexible within that. Be kinder and more compassionate towards ourselves in more difficult situations. Also recognizing, and I may need to put more effort in, in order to really stabilize this.

The fourth piece and final is the willingness to experience negative emotions as part of pursuing meaningful activities in life. When we fall in love, when we go for a promotion, when we try to really build more opportunity in our lives, we actually are taking risks and there may be a downfall to that. We may not get what we want. We may be disappointed. We may find loss or sadness within that, but that doesn't take away from this, the point and the meaning of all these activities in our lives, and continue to strive for really important, meaningful things. Even though there is a risk of uncertainty of what outcome and the potential losses that you endure because of that.

The reason why I talk about these things is we actually cultivated a program really trying to strive to give our clientele this opportunity to grow, to take the steps towards emotional regulation. That is what recovery is from a mood and anxiety disorder or traumatic stress.

First and foremost, awareness and recognition. What's working, what's not in one's life and then finding effective regulation and activation, finding an opportunity to effectively regulate those emotions, finding an opportunity to effectively emotionally activate, which means finding meaning in your life, being guided more by values, being driven towards the things that are important to you and going for that.

Flexibility, adaptability and openness, recognizing that we have to learn how to roll with the punches, how to put ourselves in risky situations? How to put ourselves out there when it may actually feel really scary to do so? That values driven behavior, well, even though this is hard to do, even though I'm going to struggle through it, purpose of me doing this is because of my family, because of my self identity, because of my want to be authentic.

Connection and support, really regaining those bridges, building connection, building opportunity to have authentic relationships with those around you. It's such a critical piece in the time in which recovery is possible for our patients, but they can't do it alone. Even after treatment, they really can't do it alone. They need that support and connection. So, we show them the way while they're in the groups, and then we also want them to be using that and taking it to their community and their loved ones and families.

For our patients, for our adult program, we see 18 and up. For child and adolescent, it's between the ages of 12 and 18, as long as they are still in high school and recommended for a child and adolescent program. Those who are on the cusp of 17 or 18, what we want to ask you to think about is, is this individual learning and trying to strive towards independence from the family and gain more adult autonomy? Then that would be more of an adult program.

If they are 17 or 18 and they actually do need more family based connection, they do actually need those around them to support them through this and that the family dynamic is something that really does need repair, that would be more of a child and adolescent focused program. Where the family is very much still a part of the treatment that we're striving towards, building more honesty, connection in the family and that the family members are very involved in the treatment process.

Disorders that are commonly treated in Mood and Anxiety is major depression, bipolar, anxiety disorders, the full spectrum of obsessive-compulsive disorder, generalized anxiety disorder, panic, phobias, school refusal, personality disorders, trauma, post traumatic stress disorder, and attachment disorders, emerging psychotic symptoms.

So, for individuals who are around teenage to young adult years, they actually may start to show more thought disorders where it's very, very hard to follow their thinking. There may be some obsessions or compulsions attached to that. Really, what may be developing underneath that is the mind is building more of this representation or characteristic of psychosis. How do we support an individual to gain understanding and awareness and stability and a treatment plan?

Also, co-occurring substance use. Those who are struggling with a mood and anxiety or traumatic stress disorder and have co-occurring substance use, we can support them. If they have a primary substance use issue, we would actually refer them to a primary substance abuse program where they can actually focus and actively work on reducing those behaviors, which would then really enable them to be more effective in our mood and anxiety treatment.

We also are able to support those who may experience difficulty in connecting, such as antisocial behaviors. Over controlled, really clinging to the want of control themselves and others and the environment around them so much so that it actually causes more restriction and loss in one's life. Or, the autism spectrum disorder where an individual still is able to function within groups and milieus and connect in particular ways, but would like some support with emotion regulation, maybe interpersonal relationship skill building, and really does find that the skills and the groups are effective in helping them do so.

Our Insight philosophy focuses on evidence based treatments. For mood, we use dialectical behavior therapy, radically open-dialectical behavior therapy and CBT behavioral activation. For dialectical behavior therapy, it was founded by Marsha, Dr. Marsha Linehan here in Washington. It's actually an evidence based treatment for those who experience emotional dysregulation as a chronic issue. Along with that impulsivity are high risk behaviors, and so giving them skills and ways to actually build off of that.

There's four modules to the dialectical behavior therapy, which is mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. Then for radically open-dialectical behavior therapy that is more for the over controlled individuals that I was just speaking of, and they would actually experience pretty pervasive depression because of that social isolation that they experience of feeling as though the world is hard to control, so I need to reduce my connection to the world because I need to feel more in control.

When that happens, we really do need to help an individual find more flexibility, openness, and willingness to risk things, to show more of their authentic self, to have more emotional projection and ability to share what's going on internally. Which will help them feel more connected to those around them, which is also an evidence based treatment and something that we offer in groups.

Then for behavioral activation is for those who really experience pervasive depression. What happens over time is you actually have a loss of the things that are pleasurable for you. You may have learned that it may have had many, many different losses over your lifetime, which then has felt like it's not possible for you, such as relationships, work relationships, things around you that were really important to you. Striving, really, to get a particular level of promotion or grade or achievement and just not getting there.

How do you continue to build meaning? How do you continue to work towards something important to you that you may have experienced loss around in your life? Behavioral activation is that. It's also for those who have experienced depression, may also get into this pattern of feeling as though when they feel depressed, treating it as though it's like a flu. They feel like, if I just reduce my demand and I actually focus more on resting, doing less, sleeping more, the mind sometimes believes I will eventually feel better.

They're waiting to feel better until they actually will engage in an activity or do something positive for themselves. That, unfortunately, does cause that individual to feel more and more depressed, so the depression begets depression. We actually have to do opposite of that and not treat it like a flu or an illness. But instead, even though it feels incredibly hard to get up and do something, we do have to connect and activate with the world around us.

For anxiety, we also use dialectical behavior therapy and radically open dialectical behavior therapy, and we also use Exposure and Response Prevention. Facing the things in which we're avoiding because we're afraid or because we've had an adverse event in the past, and so we do not want that to happen again, so trying to go avoid the repetition of something negative.

Where exposures is really helping an individual start to build gradually towards facing the things that they're avoiding or that they fear. For some of our patients that actually could look like avoiding social environments, meeting new people, trying new things, going on dates, things like that. How do you start to build towards meaningful exposures that really do help you get back to the things that do enrich you in your life?

Exposures is not something that necessarily is meant to be used towards things that ultimately you want to be avoiding, such as dangerous situations or high risk situations. It's actually meant for things that are really low risk when it comes to danger or risk. But when you remove them from your life, they actually cause a lot of grief and a lot of suffering, and so we would want to get those back.

We also use acceptance and commitment therapy, which is ultimately helping our clientele accept the things that they cannot change by finding commitment to the values and the things that are overarching and really help them find the motivation and the energy to work towards those. Also, getting to know themselves, their thoughts, their reactions, their responses to the things in the world around them, and how they can be making decisions or making choices in the moment that help them go closer to their values versus further away or experiencing more avoidance and mindfulness?

Which is essentially being in this present moment, being centered within what is here and now, and not necessarily trying to attach meaning to it, or any sort of analysis. But instead, just allowing the present moment to be what it is. This in breath, this out breath is just one inhalation, one exhalation, and just being present with that.

Then for trauma, really an incredibly important component of that is recognizing that when we have experienced trauma that we do need to go through a series of... at what point has it gotten to the place in which we can no longer regulate our emotions? We're feeling incredibly overwhelmed. This is an opportunity for us to build skills, to work towards something where we can regain that grounding, that footing in our own body. Then start to work on what has happened in the world around us that has been traumatic.

How do we hold onto that? How do we process that? We do use exposure based therapies for trauma. Also using a CBT therapy informed trauma protocol to really help inspire the phases of change that go with healing from trauma. Then somatic experiencing informed content and education, which means getting back to the body, so learning how to calm the body when the body is really overwhelmed.

As you can imagine after a trauma, you're incredibly afraid, you're incredibly hyper vigilant of the negative things happening to you again. How do you really find grounding and safety in the world around you? It takes steps and you can get there.

Our outcomes, when we've looked into how our treatment approach has helped our clientele, it shows it's statistically and clinically significant reductions in depression, anxiety, dysfunctional attitudes, obsessive-compulsive disorder, and trauma. Most of the symptom reduction occurs within the first 11 days of treatment, which is called a rapid response, which is actually a wonderful quality of effective treatment.

What we're also noticing though, is that the familiarity and the skills use only grow stronger and increases steadily over those 34 days. We want to see this engagement and connection to the skills around us, and then also the ability to gather more understanding, comprehension and competence with the skills.

Statistically and clinically significant increases in accomplishment, positive emotions, relationship quality and meaning. They absolutely feel that their individual therapeutic alliance matters, and the most important thing was group. Having a place in which they no longer were alone with what was happening for them. So, really ultimately for us, that is connection is healing.

Our Exposure and Response Prevention engagement is most effective in promoting improvements. Really seeing our patients advancing, using evidence based treatments to help challenge avoidance and to really help somebody move towards the things that are important to them.

An 84% satisfaction rate in regards to patients feeling that their treatment was overall helpful. They really did feel that. 90% also stated that they were satisfied and they would also refer to either their loved ones or friends to Insight as well.

Our overall arching understanding of what is the prediction? The predictions for patient satisfaction, improved wellbeing, their length of stay, how long they were with us and improved trauma symptoms. Really ensuring that we are able to support our clientele in making those changes that they they've come to us for, and to see that they feel as though it's meeting what they're looking for as well.

Thank you so much for coming to our Insight Behavioral Health Center's Family Days, and we hope that this was informative and useful. Please do let us know if you have any questions or anything that you might need. This is just the beginning. It's an introduction and a welcoming, but thank you, much appreciated and be well.

Eating Recovery Center and Pathlight Mood and Anxiety Center are accredited through the Joint Commission. This organization seeks to enhance the lives of the persons served in healthcare settings through a consultative accreditation process emphasizing quality, value and optimal outcomes of services.

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