Specializing in Trauma, DBT, Substance Abuse, BPD, Depression & Anxiety and Relationship Issues. 

 
Trauma

Trauma is a word used quite liberally in everyday language, typically to identify a highly stressful event.  When we speak about trauma in the clinical sense, we are referring to an event that has completely overwhelmed an individual’s capacity to cope and this, of course, is entirely defined by the survivor. Two people can experience the same adverse event, one may be left severely psychologically traumatized and the other relatively unaffected. Several factors influence an individual’s response to trauma including previous trauma exposure, age, gender, family of origin environment, genetics and level of social support. Many different events can cause a post-traumatic stress response and various aspects of the event can exacerbate the impact of the trauma, including the duration and frequency as well as the nature of the event (e.g., man-made vs. natural). Generally speaking, traumatic experiences that are prolonged, repeated and purposely inflicted by people cause the most severe posttraumatic responses.  With regards to duration and frequency, the term Type I trauma is used to identify a single incident trauma whereas Type II trauma denotes a trauma that is prolonged and repeated. Furthermore, we use the term complex trauma to categorize prolonged and repeated trauma that only occurs in some type of captivity (not necessarily physical), where a person is subjected to systematic methods of coercive control by the perpetrator who wields substantially more power than the victim. Examples include domestic violence, concentration camps, cults, organized sexual exploitation and even childhood abuse.

The distinction between Type I and Type II trauma is essential as the type of trauma shapes clinical presentation, conceptualization and treatment approach. As trauma psychiatrist, Judith Herman, explains, post-trauma responses really should be understood as a spectrum of conditions rather than as a single disorder. The diagnosis of PTSD that is described in the DSM-V is more reflective of the post-traumatic response inflicted by Type I trauma whereas those that suffer from Type II trauma present with a much more complex myriad of symptoms and problems that may include dissociation, self-harm, addiction, paranoia as well as somatic preoccupations. Importantly, as clinical presentations differ significantly based on type of trauma, so does the appropriate treatment approach. Those that present with Type I trauma are most effectively treated with a more exposure based treatment, such as Prolonged Exposure, EMDR or Cognitive Processing Therapy.  Given the nature and frequency, and duration of Type II trauma, an individual’s basic functioning and fundamental capacities for coping are more significantly disrupted; therefore, an individual presenting with complex trauma or Type II will not benefit initially from exposure based therapies, and may even experience further decompensation.  These individuals are most effectively treated with a three phase approach that begins with interventions targeting safety, stabilization and improved functioning in day to day life. Once this is achieved, processing and exposure to trauma material may be introduced.  Unfortunately, many individuals suffering from Type II trauma or complex PTSD are often misdiagnosed, thus, do not receive effective and comprehensive treatment. This unfortunate trend points to the importance of seeking out a qualified trauma therapist who can accurately diagnose and conceptualize the continuum of post-traumatic stress responses.

 
DBT​​

Dialectical Behavior Therapy is a treatment approach established by Dr. Marsha Linehan. Originally developed for individuals with borderline personality disorder and/or chronic suicidality.  Through years of research, DBT is now considered an effective treatment for substance abuse, eating disorders, depression and anxiety , self-harm, impulsivity, trauma/PTSD, and bipolar disorder.  DBT targets emotion dysregulation which can lead to the following difficulties:

  • difficulty understanding or identifying emotions, emotional avoidance and/or overwhelm, not knowing what to do when experiencing emotions, mood-dependent behavior which interferes with accomplishing long term goals

  • chaotic, conflictual or intense relationships, frantic efforts to keep others from leaving, sabotaging behavior, avoidance of relationships or difficulty establishing or maintaining relationships

  • substance abuse, impulsivity, self-harm, suicide attempts, frequent thoughts of suicide, destructive/self-defeating behavior

  • disconnection with self, identity confusion, feelings of worthlessness

DBT aims to help individuals change problematic emotional, interpersonal, behavioral and thought patterns that are interfering with having a balanced life.  One major component of DBT is teaching skills to help individuals replace these maladaptive/ineffective patterns of responses with more skillful, effective ones. The skills are divided into 4 modules:

  • Mindfulness

    • Increase control of attention (what you pay attention to and for how long)​

    • Improve awareness of thoughts, emotions and urges without attachment or avoidance

    • Develop more flexible, balance thought patterns

  • Emotion Regulation​

    • Improve ability to identify and label and increase understanding of emotions experienced

    • Increase control over frequency, intensity and expression of emotions

  • Interpersonal Effectiveness​

    • Enhance ability to deal with conflicts effectively ​

    • Increase self-respect and assertiveness

    • Learn how to get wants and needs met in an effective way

    • Establish, maintain and strengthen relationships

  • Distress Tolerance​

    • Increase​ tolerance of distress/painful emotions without engaging in behavior that would make the situation worse

    • Reduce/eliminate destructive/harmful behavior and substance abuse

    • Learn how to accept reality as it is

Anyone can benefit from learning these skills and you can incorporate DBT into your therapy in many different ways including

  • Standard DBT- individual therapy, skills training (group or individual), phone coaching

  • DBT-informed individual therapy (incorporate DBT concepts and skills into individual therapy sessions)

  • Skills Training- learn the DBT skills via either individual skills training or group skills training

  • DBT Coaching- touch up on skills with focused coaching sessions.  

 
Substance Abuse

Substance abuse refers to a pattern of alcohol and/or drug use that causes significant disruption in several areas of life, including work, school, relationships, and health.  Despite these problematic consequences, individuals with substance use problems continue to repeatedly engage in use of the substance and may even find themselves using more and more of the substance over time.  This destructive cycle is often baffling to both the substance user and loved ones and can feed a deep well of shame and guilt that only serves to perpetuate the problem.  

Problematic  patterns of substance use often start as a solution to a problem.  People may turn to prescriptions, drugs and alcohol to reduce stress, avoid unpleasant emotions and/or cope with painful life events.  The effects of using a substance are typically immediate (e.g., euphoria, high, calmness, relief) as substances directly activate the brain's reward system, making the behavior highly reinforced.  As the person becomes more and more reliant on the substance to solve the problem and the brain continues to be rewarded, use may increase in quantity and frequency and begin to cause problems. These problems may include strain or conflict in relationships, difficulty keeping up with responsibilities at work or school, legal issues, and/or health related problems such as hangovers, injuries and exacerbation of pre-existing illnesses.  Despite these problematic consequences of using the substance, a person may continue to turn to that substance only creating more and more problems. They may begin try to reduce their use or stop altogether, only to find themselves unsuccessful time and time again. Psychological treatment is often necessary to help a person break out of this cycle and find more adaptive, healthy ways of coping. 

The term substance abuse used to be synonymous with addiction- a term that many associate with compulsive use of the substance, chronic relapsing and physical dependence. Moving away from a more black and white perspective, we now view substance abuse on a continuum, ranging from mild to severe.  For some, any use of substance results in out of control use/behavior and thus abstinence from any mood altering substance is the goal.  For others, gaining tools to curb use in order to reduce the negative consequences may be the focus of treatment. A thorough evaluation by a trained professional can provide information regarding the severity of a substance use problem and is used to develop a treatment plan to help a person successfully achieve their goals related to their substance use.  

 
Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a widely misunderstood disorder, often associated with grossly inaccurate depictions in the media and societal stigma.  Classified as a personality disorder, individuals with BPD struggle with a pattern of instability with relationships, emotions, sense of self/identity, and marked impulsivity.  From a Dialectical Behavior Therapy lens, BPD is thought of as an emotion dysregulation disorder, meaning the symptoms experienced by someone with BPD center around problems controlling or regulating emotions.  These problems with regulation are categorized into the following 5 symptom clusters:

  • Emotion Dsyregulation

    • rapid mood shifts

    • frequent emotions that are very intense and last a long time (hours to days)

    • particular difficulty regulating anger

    • predominantly sad mood

    • easily triggered emotions

    • heightened emotional sensitivity​

  • Cognitive (Thought) Dysregulation

    • pervasive negative thinking​

    • dissociation when highly stressed

    • suspiciousness, paranoid thinking (when highly stressed)

    • Rigid thinking

    • "black and white" thinking

  • Behavioral Dysregulation 

    • impulsivity​

    • reckless/destructive behavior

    • self-harm

    • suicidal thoughts, threats and/or behaviors

    • substance abuse

  • Interpersonal Dysregulation 

    • chaotic, unstable relationships​

    • fears of abandonment (intense panic that may be accompanied by behavior intended to avoid abandonment)

    • patterns of pushing others away and other times desperately clinging to others

    • avoidance of relationships

    • vacillating between idealizing others and rejecting/devaluing

  • Self Dysregulation

    • Chronic feelings of emptiness​

    • unstable sense of self

    • frequently changing appearance, mannerisms, preferences

    • distorted/negative view of self

    • extreme life changes

Borderline Personality Disorder was once thought of as a condition that was unresponsive to treatment; however, the past 20 years of research have resulted in significant empirical support for the effectiveness of Dialectical Behavior Therapy (DBT) in reducing or eliminating many of the problematic symptoms of BPD.  Please see above for a more information on DBT.

Due to the nature of the problems caused by this disorder, loved ones of those with BPD  often experience their own struggles. 

The challenges that come with being in a relationship with someone who has difficulty regulating their emotions are often taxing, confusing, and can cause a person to feel totally helpless in supporting their loved one.  Loved ones can benefit from working with a therapist to help them to better understand their loved one suffering from BPD, how to support them and interact with them more effectively. 

 
Depression & Anxiety
Depression

Differing from periodic sadness that everyone experiences, clinical depression is marked by experiencing at least 5 of the following 9 symptoms for a period of at least 2 weeks:

  • persistent feelings of sadness, hopelessness, emptiness

  • difficulty concentrating, indecisiveness 

  • feeling overly fatigued

  • observable changes in movement (restlessness or significant slowing)

  • lack of feelings of enjoyment 

  • significant weight gain or weight loss

  • insomnia or sleeping too much

  • feelings of worthlessness

  • thoughts of suicide

Clinical depression affects 1 in 4 Americans at some point in their lifetime. Some people experience depression only once in their life where others may be prone to recurrent episodes of depression. Despite the hopelessness that often accompanies depression, psychological treatment can be very effective in reducing the duration and intensity of a depressive episode. 

 

Anxiety

Anxiety is also another mental health condition that is commonly experienced.  While apprehension, nervousness, and worry are a normal aspect of the human experience, anxiety can be so intense or frequently experienced for some that it causes significant problems in a person's life.  Anxiety and fear are often used interchangeably; however they do have distinct differences. When experiencing fear, someone is perceiving a specific threat in the present moment whereas anxiety is anticipation of a future threat that is often more vague and difficult to pinpoint.  Some people experience anxiety only in certain situations or focused on around a specific object or situation.  

Those that suffer from chronic anxiety often learn to cope by avoiding or engaging in anxiety reducing behaviors that often cause additional problems. An example would be a person that when feeling anxious, feels an overwhelming need to control things around them.  While these solutions may work in the short term, they typically just maintain anxiety in the long-run.  

Cognitive Behavioral Therapy (CBT) has been supported by research to be effective at reducing or eliminating both depression and anxiety.  CBT targets both the thought and behavioral patterns that cause or maintain depression and anxiety.  The benefits of CBT extend beyond reduction of anxiety and depression as it provides skills and tools for coping with life in a more balanced and effective way.  

 
Relationship Issues

Relationships are incredibly complex, dynamic and often the source of intense pain, stress and dissatisfaction in life.  Many people find they struggle to have satisfying relationships in general and others experience difficulty with certain types of relationships (e.g., romantic, familial) or with specific loved ones in their life. Psychotherapy can help individuals that struggle with relationship issues in many different ways including: 

 

  • identifying and changing problematic attachment styles

  • improving communication skills

  • identifying and targeting barriers for the development of intimate connections with others

  • processing and healing from relational trauma 

  • learning or refining social skills

  • learning how to effectively resolve conflict

Contact Me

For any questions you have, you can reach me here:

Lyndsey Karns, Pys.D.

5301 N Federal Hwy, Suite 345

Boca Raton, FL 33487

(561) 210-5714

Dr.Lyndsey@Middlepathcounseling.org

Click on the map for directions

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