Treatment | Dr. Lyndsey Karns

Specializing in Trauma, DBT, EMDR, Depression, Anxiety and Relationship Issues.

Trauma

In contemporary discourse, the term “trauma” is often used to describe highly stressful events. However, in clinical settings, trauma refers to experiences that overwhelm an individual’s capacity to cope, and this is uniquely defined by the survivor. Trauma doesn’t follow a “one size fits all” pattern. Both pre-trauma factors (e.g., age, gender, genetics, family of origin, coping styles) and the nature, frequency and duration of the traumatic experience(s) shape post-trauma responses. As trauma psychiatrist, Judith Herman explains, post-trauma responses really should be understood as a spectrum of conditions, rather than a single disorder. Therefore, understanding the complexities of trauma is essential for effective treatment as different types of trauma and responses call for different treatment approaches. For instance, someone who suffers a horrific car accident may benefit from exposure-based interventions whereas someone looking to heal from years of childhood abuse and neglect will typically respond much more positively to a phase-oriented approach that prioritizes safety, stability and skill building before exposure based interventions are introduced.

Two subtypes of trauma that I specialized in treating include:

Complex Trauma- repeated, prolonged and systematic abuse that occurs in the context of a significant power differential between victim and abuser, in which the abuser has ability to control and coerce. Examples include domestic violence, cults, organized sexual exploitation, and childhood abuse.

Betrayal Trauma- abuse inflicted by trusted person with whom the victim has the expectation of safety.

Partners of sex/love/porn addicts

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:

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, weekly consultation meetings for therapists
- I do not provide standard/comprehensive DBT but I am always happy to help you find a group that does
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
- I currently only provide individual skills training
DBT Coaching- touch up on skills with focused coaching sessions.

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, balanced thought patterns

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

Emotion

Regulation

Improve ability to identify, label and understand emotions
Increase control over frequency, intensity and expression of emotions
Learn more effective ways of responding to emotions

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

EMDR

EMDR is a leading evidence-based treatment approach designed to help individuals process and heal from difficult life events. The underlying theory of EMDR suggests that, as humans, we are born with a hardwired psychological mechanism that enables us to move toward an adaptive emotional understanding in response to upsetting/traumatic experiences. This concept is not too different than our innate physical healing mechanisms that are reflexively activated when the body sustains physical injury. When we experience a traumatic or disturbing event, that internal mechanism can become blocked because the memory is improperly encoded into our memory storage system. The result is a raw, unprocessed memory that threatens to be “triggered” or re-activated.

EMDR is believed to help unblock our natural healing mechanism using bilateral stimulation- a technical word for using eye movements, touch, or sound in a left-right rhythm. By alternating left and right stimulation, the brain can integrate our logic and emotions, enabling us to better make sense of things, derive meaning from our experiences and helps us to correct faulty and incomplete information so that we can reorganize how we think and feel about the experience.

Anxiety

Dread, apprehension, and uneasiness are all examples of degrees of anxiety that threaten to distract, paralyze, and disrupt our ability to feel at ease in the world. While anxiety is normal part of the human experience; the intensity, frequency and impact can negatively affect our physical health, relationships, ability to function and overall wellbeing. Fortunately, there are many therapeutic interventions that can help you to better understand your anxiety and how to gain control over it.

In my approach to working with anxiety, I often emphasize education as the first initial treatment target. Being able to understand what anxiety is, what it’s trying to do for us and the tricks it tries to play on you, it loses some of its power- not unlike the unveiling of the “monster” at the end of a horror film. Next, I aim to arm my clients with tools and skills to help calm the nervous system, deflate catastrophic predictions, and improve ability to discern real threats from imaginary ones.

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.

Depression & Anxiety

Depression

Depression goes by many names- “the blues, “going into a funk” and affects 1 in 4 people at least once in their life. While many experience low mood periodically, clinical depression is a mental health disorder that significantly impacts a person’s ability to maintain their responsibilities, relationships and physical health. Symptoms can vary but many experience low mood, loss of interest and/or enjoyment, low energy, changes to sleep habits, appetite changes, difficulty concentrating and even feelings of worthlessness or shame. Often people struggling with depression describe feeling enveloped by a fog, weighed down, empty and like they are just going through the motions of life. For some, depression may present as an isolated episode while others are more prone to recurrent bouts of depression throughout their lifetime. Despite the hopelessness that often accompanies depression, psychological treatment can be very effective in reducing the duration and intensity of a depressive episode and even preventing future episodes.

While my approach is highly individualized, a typical treatment plan would include education, skill building, and behavioral interventions. Given my background and training with EMDR and trauma, I also tend to focus on problematic beliefs that tend to be shaped by painful, embarrassing and/or traumatic life experiences. Clinically, we refer to these beliefs as core beliefs and they can essentially create a “colored lens”, through which life is filtered, distorting our perception of ourselves, others and the world around us. Fortunately, we can work to understand the experiences that shaped these beliefs, disentangle reality from the “stories” and move toward a more balanced perspective.

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/betrayal trauma
learning or refining social skills
learning how to effectively resolve conflict