mental-illness – TRANSCENDENT MENTAL HEALTH

Part 1 of a Five-Part Series on DBT Skills

Dialectical Behavior Therapy, usually called DBT, is a form of therapy designed to help people manage difficult emotions, navigate relationships, cope with painful situations, and build lives that feel more meaningful and manageable.

Psychologist Marsha Linehan originally developed DBT to treat people experiencing chronic suicidal thoughts and borderline personality disorder. Over time, however, DBT and DBT-informed approaches have been used much more broadly. Its skills can be helpful for people struggling with anxiety, depression, trauma-related difficulties, impulsive behavior, relationship problems, anger, and overwhelming emotions. Many of its principles can also be useful to people who simply want better tools for dealing with the ordinary stresses of life.

At its heart, DBT asks an interesting question: How can we accept ourselves and our lives as they are while also working to change them?

What Does “Dialectical” Mean?

The word dialectical refers to the idea that two things that seem contradictory can both contain truth.

For example:

I am doing the best I can, and I need to do better.

Those statements may initially seem incompatible. If I am already doing my best, why should I need to do better? DBT asks us to consider that both can be true. Given your history, circumstances, knowledge, emotional state, and skills, you may genuinely be doing the best you can right now. At the same time, what you are doing may not be working. You may need to learn new skills, make different choices, or change your circumstances.

This balance between acceptance and change runs throughout DBT. Acceptance without change can leave us stuck. Change without acceptance can turn into constant self-criticism. DBT tries to hold both.

The Assumptions of DBT

DBT is built around several assumptions about people and behavior. Among the most important are:

People are doing the best they can.
People want to improve.
People need to do better, try harder, and become more motivated to change.
People may not have caused all of their problems, but they still have to solve them.
New behaviors have to be learned and practiced in the situations where they are needed.
People cannot fail at DBT. When treatment isn’t working, the task is to understand what isn’t working and make adjustments.

These assumptions reflect the dialectical nature of the treatment. DBT does not require us to decide whether someone is responsible or blameless, strong or weak, trying or not trying. Human behavior is usually more complicated than that.

You may not have chosen the circumstances that caused your pain. You may nevertheless be the person who has to figure out what to do about it.

What Is the Goal of DBT?

The broad goal of DBT is sometimes described as building a life worth living.

That will mean different things to different people. For one person, it might mean maintaining relationships without constantly fearing abandonment. For another, it might mean getting through intense emotions without using substances or self-destructive behaviors. Someone else might want to communicate more effectively, manage anger, tolerate uncertainty, or stop allowing anxiety to dictate everyday decisions.

DBT therefore isn’t simply about making unpleasant feelings disappear. Sometimes feelings provide useful information. Sometimes distress is an understandable response to genuinely difficult circumstances. And sometimes a painful situation cannot immediately be changed.

Instead, DBT teaches us to respond more effectively to whatever situation we are actually facing.

Four Ways to Respond to a Problem

One particularly useful DBT idea is that there are essentially four ways we can respond to a problem.

We can solve the problem—or leave the situation. If something can be changed, we can identify the problem and take practical steps to address it. Sometimes the solution is changing or leaving the situation itself.

We can feel better about the problem. A situation may remain the same while our emotional response to it changes. We can examine our interpretations, regulate emotions, practice acceptance, or find a different way of relating to what happened.

We can tolerate the problem. Some problems cannot be fixed right now. DBT teaches distress-tolerance skills for getting through painful situations without making them worse.

Or we can do nothing and stay miserable.

That last option may sound harsh, but it reflects an important point: doing nothing is still a choice. Sometimes we cannot control what happened to us, what another person does, or what life has placed in our path. We can still work on choosing our response.

The Four DBT Skill Groups

DBT organizes many of its practical tools into four major skill areas.

Mindfulness teaches us to pay attention to what is happening in the present moment without immediately judging it or reacting to it. It forms the foundation for many other DBT skills.

Emotion regulation helps us understand emotions, reduce emotional vulnerability, and respond to feelings in ways that fit the situation rather than simply acting on emotional impulses.

Distress tolerance focuses on surviving painful moments that we cannot immediately change. The goal isn’t to pretend that distress feels good. It is to get through it without turning a difficult situation into an even more difficult one.

Interpersonal effectiveness focuses on relationships: asking for what we need, saying no, setting boundaries, managing conflict, maintaining self-respect, and balancing our own needs with those of other people.

Together, these skills provide something like a toolbox. DBT isn’t about using every tool in every situation. It is about recognizing what kind of problem you’re facing and learning which tool is most likely to help.

In the next four parts of this series, we’ll look more closely at each of these skill areas, beginning with mindfulness—the foundation on which the rest of DBT is built.

If you live in Washington State, and would like to set up an appointment with Susan Reimers, LICSW at Transcendent Mental Health, please click here.

Green leafy tree branches framing a blue sky with white clouds

Therapy, Uncategorized

The Basics of Somatic Therapy

June 27, 2026May 26, 2026 S. Reimers, JD/LICSW

How Healing the Body Can Support Mental Health

Line art of two women, one looking down and the other tilting head back with hand in hair

Mental health treatment often focuses on thoughts, emotions, and behavior. While these are important, many people are surprised to learn that the body also plays a major role in emotional well-being. Stress, trauma, anxiety, and depression are not only experienced in the mind—they are also stored and expressed physically. This is where somatic therapy comes in.

Somatic therapy is a body-centered approach to mental health that helps people process emotions, reduce stress, and heal trauma by increasing awareness of bodily sensations. As interest in holistic wellness continues to grow, somatic therapy has become an increasingly popular treatment option for individuals seeking a deeper connection between mind and body.

In this article, we’ll explore the basics of somatic therapy, how it works, its benefits, and who may benefit from this therapeutic approach.

What Is Somatic Therapy?

Somatic therapy is a form of psychotherapy that combines traditional talk therapy with body awareness practices. The word “somatic” comes from the Greek word soma, meaning “the living body.” Rather than focusing only on thoughts and emotions, somatic therapy helps people notice how experiences are physically held in the body.

This approach is based on the understanding that emotional distress and trauma can become trapped in the nervous system. Over time, unresolved stress may appear as muscle tension, chronic pain, fatigue, digestive issues, panic attacks, or emotional numbness.

Somatic therapists guide clients in recognizing physical sensations connected to emotions and past experiences. Through gentle techniques, individuals learn how to release tension, regulate their nervous systems, and feel safer in their bodies.

How Somatic Therapy Works

Somatic therapy works by helping individuals become more aware of the connection between physical sensations and emotional experiences. During sessions, a therapist may encourage clients to notice:

Tightness in the chest
Muscle tension
Changes in breathing
Heart rate shifts
Tingling sensations
Posture or movement patterns

The goal is not to force emotional release but to create a safe environment where the body can process stress naturally.

Unlike some traditional therapies that rely heavily on verbal communication, somatic therapy recognizes that trauma is not always fully accessible through words. The body may remember experiences even when the conscious mind cannot clearly explain them.

By paying attention to bodily responses, clients can gradually release stored survival energy linked to trauma, fear, or chronic stress.

Common Techniques Used in Somatic Therapy

Somatic therapy includes a variety of techniques designed to calm the nervous system and increase body awareness. Different therapists may use different methods depending on the client’s needs.

Breathwork

Controlled breathing exercises can help regulate the nervous system and reduce anxiety. Deep, mindful breathing encourages relaxation and helps individuals reconnect with their bodies.

Grounding Exercises

Grounding techniques help people stay connected to the present moment. This may involve noticing physical contact with the floor, focusing on the senses, or using gentle movement.

Body Scanning

A body scan involves mentally checking in with different parts of the body to identify areas of tension, discomfort, or emotional holding.

Movement Therapy

Some somatic approaches incorporate stretching, shaking, yoga-inspired movement, or guided physical exercises to release stress and increase emotional expression.

Mindfulness Practices

Mindfulness helps individuals observe sensations and emotions without judgment. This can improve emotional regulation and self-awareness.

Touch Therapy

In some forms of somatic therapy, trained practitioners may use safe and consensual touch techniques to support nervous system regulation. However, not all somatic therapists include physical touch.

Benefits of Somatic Therapy

Somatic therapy offers a range of mental and physical health benefits. Because it focuses on the nervous system and body awareness, many individuals find it especially helpful when traditional talk therapy alone has not fully addressed their symptoms.

Reduced Anxiety and Stress

Somatic practices can calm the body’s stress response and reduce chronic tension. Clients often report feeling more grounded and emotionally balanced.

Trauma Healing

Somatic therapy is widely used for trauma recovery, including post-traumatic stress disorder (PTSD). It helps individuals safely process traumatic experiences without becoming overwhelmed.

Improved Emotional Awareness

Many people struggle to identify or express emotions. Somatic therapy strengthens the connection between physical sensations and emotional understanding.

Better Nervous System Regulation

Learning how the nervous system responds to stress can help individuals recognize triggers and recover more quickly from emotional distress.

Relief from Physical Symptoms

Since emotional stress often appears physically, some people experience improvements in headaches, digestive discomfort, fatigue, and chronic muscle tension.

Stronger Mind-Body Connection

Somatic therapy encourages people to feel more connected to themselves, increasing self-awareness and self-compassion.

Who Can Benefit from Somatic Therapy?

Somatic therapy may benefit people dealing with a wide range of mental health and stress-related conditions, including:

Anxiety disorders
Depression
PTSD and trauma
Chronic stress
Panic attacks
Burnout
Grief and loss
Emotional numbness
Relationship difficulties

It can also support individuals who feel disconnected from their bodies or struggle with emotional regulation.

Some people choose somatic therapy as a standalone treatment, while others combine it with cognitive behavioral therapy (CBT), medication, mindfulness practices, or other forms of mental health support.

What Happens During a Somatic Therapy Session?

A somatic therapy session usually begins with conversation, similar to traditional psychotherapy. The therapist may ask about emotional experiences, stress levels, or physical symptoms.

As the session continues, attention may shift toward bodily sensations. The therapist might ask questions such as:

“What do you notice in your body right now?”
“Where do you feel tension?”
“What happens when you focus on that sensation?”

Sessions often move slowly and gently to avoid overwhelming the nervous system. The emphasis is on safety, awareness, and gradual healing.

Every therapist has a different style, so sessions may vary depending on the therapeutic approach being used.

Is Somatic Therapy Evidence-Based?

Research on somatic therapy continues to grow, especially in the areas of trauma treatment and nervous system regulation. Studies suggest that body-centered therapies may help reduce symptoms of anxiety, PTSD, and chronic stress.

Many mental health professionals now recognize the importance of including the body in emotional healing. While somatic therapy may not replace all traditional mental health treatments, it can be a valuable complement to existing therapies.

Final Thoughts

Somatic therapy offers a unique and holistic approach to mental health by recognizing the powerful connection between mind and body. Instead of focusing only on thoughts and emotions, this therapy helps individuals tune into physical sensations, regulate the nervous system, and release stored stress and trauma.

For people seeking a deeper, body-centered path to emotional healing, somatic therapy may provide meaningful support. As awareness of trauma-informed care and holistic wellness grows, somatic therapy is becoming an important part of modern mental health treatment.

Understanding the basics of somatic therapy is the first step toward discovering how the body can become an active partner in healing, resilience, and emotional well-being.

Therapy

Cognitive Defusion: A Key to Psychological Flexibility

February 10, 2025January 27, 2025 S. Reimers, JD/LICSW

Part Two of a Six Part Series on the Core Principles of ACT Therapy

Changing Your Relationship with Thoughts

This post is the second in our series exploring the core principles of Acceptance and Commitment Therapy (ACT), an evidence-based approach designed to enhance psychological flexibility and promote a values-driven life. Following our discussion of Acceptance, we now turn to another foundational principle of the ACT hexaflex: Cognitive Defusion.

What Is Cognitive Defusion in ACT?

Cognitive defusion is the process of changing how we relate to our thoughts. In ACT, thoughts are not viewed as inherently good or bad, true or false. Instead, the focus is on how much power we give to these thoughts and whether they help us live according to our values. Cognitive defusion involves stepping back from thoughts, seeing them for what they are—simply words or images in our minds—rather than as literal truths that must dictate our actions or emotions.

When we become fused with our thoughts, we treat them as absolute facts and allow them to dominate our decisions and behaviors. Defusion helps us break free from this grip, enabling us to observe our thoughts with curiosity and perspective. By doing so, we can reduce their impact and influence, allowing us to act in alignment with our values rather than being controlled by unhelpful mental content.

Why Is Cognitive Defusion Important?

Cognitive defusion is crucial because it helps us disentangle from thought patterns that contribute to emotional distress and behavioral avoidance. Many psychological struggles, such as anxiety, depression, and low self-esteem, are fueled by unhelpful thinking. When we take our thoughts too seriously or treat them as ultimate truths, we can become stuck in patterns of rumination, worry, or self-criticism.

Defusion allows us to create distance from these thoughts, diminishing their power and influence. It helps us see that thoughts are not commands we must obey or obstacles we must eliminate. Instead, they are transient experiences that we can observe and let pass without getting caught up in their content. This shift empowers us to make choices based on our values rather than being driven by automatic thought patterns.

Cognitive Defusion in Action: A Metaphor

One of the most well-known metaphors for cognitive defusion is the “Passengers on the Bus” metaphor. Imagine you are driving a bus, and the passengers represent your thoughts. Some passengers are loud, critical, or demanding, while others are quiet or supportive. If you stop the bus every time a passenger yells at you, you won’t make much progress toward your destination. Cognitive defusion teaches you to keep driving the bus, acknowledging the passengers’ presence but not letting them dictate your journey.

Practical Strategies to Cultivate Cognitive Defusion

In ACT, cognitive defusion is a skill that can be practiced and developed. Here are some techniques to help you foster this skill:

Labeling Thoughts: Practice noticing your thoughts and labeling them as they arise. For example, instead of thinking, “I’m a failure,” you might say, “I’m having the thought that I’m a failure.” This simple shift creates distance and reminds you that thoughts are not facts.
Silly Voices Exercise: Repeat a troubling thought in a silly voice or imagine it being said by a cartoon character. This exercise highlights the arbitrary nature of thoughts and reduces their emotional impact.
Thought Clouds: Visualize your thoughts as clouds drifting across the sky. Notice them come and go without trying to hold onto or push them away. This imagery reinforces the idea that thoughts are temporary and not inherently powerful.
Leaves on a Stream: Imagine placing each thought on a leaf and letting it float down a stream. Watch as the leaf drifts away, carrying the thought with it. This technique helps you practice letting go of unhelpful thoughts.
Thank Your Mind: When your mind produces a particularly challenging thought, try saying, “Thank you, mind,” with a touch of humor or kindness. This response acknowledges the thought’s presence without becoming entangled in it.

Common Misconceptions About Cognitive Defusion

It is important to clarify what cognitive defusion is and what it is not:

Defusion Is Not Suppression: Defusion does not involve pushing thoughts away or trying to eliminate them. Instead, it involves changing your relationship with them.
Defusion Is Not Distraction: While defusion techniques may reduce the immediate impact of a thought, their primary goal is to foster awareness and perspective, not to avoid or distract from the thought.
Defusion Is Not About Truth: The goal is not to determine whether a thought is true or false but to assess whether it is helpful and aligned with your values.

The Role of Cognitive Defusion in the ACT Hexaflex

Cognitive defusion is closely connected to other principles of the ACT hexaflex, such as mindfulness and acceptance. Together, these principles create a flexible approach to managing difficult thoughts and emotions while pursuing a meaningful life. By practicing defusion, you can increase your ability to stay present, act intentionally, and focus on what matters most.

Final Thoughts

Cognitive defusion is a transformative skill that allows us to step back from our thoughts and see them for what they are: fleeting mental events rather than absolute truths. By cultivating this skill, we can reduce the power of unhelpful thinking and make choices that align with our values and goals.

In the next post in this series, we will explore the principle of Present Moment Awareness, which builds on the concepts of acceptance and defusion to help us engage more fully with life. For now, consider how cognitive defusion might apply to your own experiences. How might your life change if you could view your thoughts with greater curiosity and detachment? The journey to greater psychological flexibility starts with small steps like these.

If you live in Washington State, and you would like to make an appointment, please feel free to contact me here. I’m looking forward to hearing from you.

:), Susan Reimers, JD/LICSW

Therapy

Acceptance: Greeting Life Without Judgment

February 3, 2025January 27, 2025 S. Reimers, JD/LICSW

Part One in a Six Part Series on the Core Principles of ACT Therapy

Embracing Life as It Is

This post is the first in a series exploring the core principles of Acceptance and Commitment Therapy (ACT), an evidence-based approach designed to help individuals build a meaningful and values-driven life. ACT is structured around six interrelated principles, often visualized as a hexaflex. These principles work together to cultivate psychological flexibility, a key component of well-being. In this series, we begin with one of the foundational principles: Acceptance.

What Is Acceptance in ACT?

Acceptance in ACT is not about passive resignation or giving up. Rather, it is an active process of opening up to our inner experiences—thoughts, emotions, memories, and sensations—without judgment or attempts to avoid, suppress, or control them. It is the practice of making room for these experiences, even when they are uncomfortable, while continuing to engage with life in meaningful ways.

At its core, acceptance challenges the natural human tendency to fight against discomfort or unpleasant emotions. In modern society, we are often taught to “fix” problems, avoid pain, and pursue happiness at all costs. While this approach can be helpful in many contexts, it becomes problematic when applied to our internal world. Struggling against pain often amplifies suffering, creating a cycle of avoidance and distress that prevents us from living fully.

Why Is Acceptance Important?

Acceptance is vital because it frees us from the exhausting battle of trying to control what we cannot. Many psychological struggles stem from attempts to avoid difficult emotions or thoughts, a process known as experiential avoidance. While avoidance may bring short-term relief, it often leads to long-term problems, such as anxiety, depression, addiction, or a diminished sense of meaning in life.

When we practice acceptance, we learn to approach our internal experiences with curiosity and compassion rather than fear or aversion. This shift allows us to respond more effectively to life’s challenges, enabling us to focus our energy on what truly matters. Importantly, acceptance does not mean liking or approving of painful experiences. It simply means acknowledging their presence without allowing them to dominate our lives.

Acceptance in Action: A Metaphor

A powerful metaphor used in ACT to explain acceptance is the “struggle with quicksand.” Imagine you are trapped in quicksand. Your first instinct might be to struggle and thrash in an effort to escape. However, this reaction only causes you to sink deeper. The way out is counterintuitive: stop struggling, spread your weight evenly, and allow yourself to float. Similarly, acceptance involves letting go of the struggle with difficult emotions and thoughts, creating the space to move forward.

Practical Strategies to Cultivate Acceptance

In ACT, acceptance is not just a concept but a skill that can be developed through practice. Here are some strategies to help cultivate acceptance in daily life:

Mindful Observation: Practice noticing your thoughts and emotions as they arise, without labeling them as “good” or “bad.” For example, if you feel anxious, simply acknowledge, “I am noticing anxiety right now.” This nonjudgmental awareness helps create distance from the experience, reducing its intensity.
Allowing and Breathing: When faced with a challenging emotion, pause and take a few deep breaths. Visualize yourself creating space for the emotion, allowing it to be there without resistance. Remember that emotions, like waves, will naturally rise and fall if you let them.
Anchoring in the Present: Engage your senses to ground yourself in the present moment. Focus on the feel of the ground beneath your feet, the sound of birds chirping, or the sensation of your breath entering and leaving your body. This practice can help you stay present rather than getting caught up in avoidance.
Self-Compassion: Speak to yourself with kindness and understanding, especially during difficult times. Remind yourself that it’s okay to feel pain and that you are not alone in your struggles. Self-compassion can soften resistance and create a safe space for acceptance.
Acceptance Imagery: Imagine your thoughts and emotions as leaves floating down a stream or clouds passing across the sky. This imagery can help you see them as temporary and separate from your core self, reducing the urge to control or suppress them.

Common Misconceptions About Acceptance

It is important to address some common misunderstandings about acceptance:

Acceptance Is Not Endorsement: Accepting an experience does not mean you agree with it or want it to continue. It simply means you are choosing to stop fighting against its presence.
Acceptance Is Not Passive: Acceptance is an active stance. It requires courage and effort to turn toward discomfort and make space for it.
Acceptance Does Not Replace Action: Acceptance works hand-in-hand with committed action. While you make room for difficult experiences, you also take steps aligned with your values and goals.

The Role of Acceptance in the ACT Hexaflex

Acceptance is intricately linked with the other principles of the ACT hexaflex, such as mindfulness, cognitive defusion, and values-based action. Together, these principles create a framework for navigating life’s challenges with greater flexibility and resilience. By practicing acceptance, you lay the foundation for engaging more fully with the present moment and pursuing a meaningful life.

Final Thoughts

Learning to embrace acceptance is a transformative journey. It allows us to let go of the struggle with pain and focus on what truly matters: living in alignment with our values. In the next post in this series, we will delve into the principle of cognitive defusion, another essential component of the ACT model.

For now, consider how acceptance might play a role in your life. What would it feel like to stop fighting against difficult emotions or thoughts and instead make space for them? The path to greater well-being often begins with this simple yet profound shift.

If you live in Washington State, and you would like to make an appointment, please feel free to contact me here. I’m looking forward to hearing from you.

:), Susan Reimers, JD/LICSW

Therapy

Understanding Acceptance and Commitment Therapy

January 13, 2025January 27, 2025 S. Reimers, JD/LICSW

Embracing Life’s Challenges with Mindful, Values-Based Commitments

Acceptance and Commitment Therapy (ACT), pronounced as “act” rather than spelled out, represents a groundbreaking approach in the field of psychotherapy. Rooted in the principles of mindfulness, behavioral science, and acceptance, ACT encourages individuals to embrace life’s challenges rather than resist them. This philosophy aims to foster psychological flexibility, empowering people to live meaningful lives even in the face of adversity.

The Core Philosophy of ACT

ACT is grounded in the belief that psychological suffering arises from the human tendency to avoid or suppress difficult emotions, thoughts, and experiences. At its heart, ACT challenges the conventional goal of eliminating distress, arguing instead that it is our relationship with discomfort—not the discomfort itself—that determines our mental well-being.

The therapy is deeply influenced by Relational Frame Theory (RFT), a modern behavioral science framework that explores how language and cognition influence our behavior. RFT posits that humans are uniquely capable of forming complex associations through language, which, while advantageous, can also lead to cognitive traps such as self-criticism, worry, and avoidance.

ACT emphasizes six interconnected processes that form its therapeutic foundation, often visualized as the points of a hexagon, collectively referred to as the ACT Hexaflex. These processes work in harmony to cultivate psychological flexibility, the ability to stay present, open, and committed to value-driven action even when faced with challenging emotions or thoughts.

The Six Core Processes of ACT

1. Acceptance

Acceptance involves an active and open stance toward difficult thoughts, emotions, and sensations rather than attempting to suppress, control, or avoid them. ACT posits that fighting against unpleasant experiences often amplifies suffering. Instead, acceptance fosters a willingness to coexist with discomfort, recognizing it as a natural part of life.

For instance, rather than avoiding anxiety-provoking situations, an individual learns to acknowledge and make room for the anxiety, allowing them to engage more fully with life.

2. Cognitive Defusion

Cognitive defusion refers to the process of disentangling from unhelpful thoughts and seeing them for what they are—words and images—rather than absolute truths. This practice helps reduce the power and influence of negative thinking.

A common exercise involves imagining a distressing thought as a cloud floating across the sky or writing it on a leaf carried down a stream. These metaphors encourage clients to observe their thoughts from a distance rather than becoming entangled in them.

3. Present Moment Awareness

Mindfulness lies at the heart of ACT, emphasizing non-judgmental awareness of the present moment. This practice encourages individuals to fully experience their surroundings, sensations, and emotions without judgment or distraction.

Present moment awareness helps individuals break free from the grip of past regrets or future anxieties, grounding them in the here and now. Techniques such as mindful breathing, body scans, and sensory awareness exercises are commonly employed to cultivate this skill.

4. Self-as-Context

ACT introduces the concept of “self-as-context,” which differentiates between the “self” as a constant, observing entity and the transient thoughts, feelings, and roles we often associate with our identity. By recognizing that they are more than their thoughts or emotions, individuals can gain perspective and reduce the impact of self-limiting beliefs.

For example, instead of saying, “I am a failure,” an individual might reframe it as, “I notice that I am having the thought that I am a failure.” This subtle shift creates space for self-compassion and empowerment.

5. Values Clarification

ACT emphasizes the importance of identifying and living in alignment with one’s core values. Values are the guiding principles that give life meaning and purpose, such as kindness, creativity, or community involvement. Therapy often involves exercises to help individuals clarify what truly matters to them, serving as a compass for decision-making and goal-setting.

Rather than focusing on symptom reduction, ACT asks, “What do you want your life to stand for?” This shift encourages individuals to focus on what they can control: taking steps toward a fulfilling and values-driven life.

6. Committed Action

Once values are clarified, ACT encourages committed action—taking meaningful steps toward living those values, even in the face of obstacles. This process involves setting realistic goals, developing action plans, and building resilience to persist despite setbacks.

For instance, a person who values connection might commit to reaching out to a friend despite feelings of social anxiety. Over time, these actions build momentum, fostering a sense of agency and purpose.

The Unique Approach of ACT

What sets ACT apart from other therapeutic modalities is its emphasis on acceptance over avoidance and its integration of mindfulness into practical, action-oriented strategies. Unlike Cognitive Behavioral Therapy (CBT), which often focuses on challenging and changing unhelpful thoughts, ACT encourages clients to change their relationship with their thoughts. This distinction shifts the focus from controlling internal experiences to engaging meaningfully with external ones.

Another hallmark of ACT is its use of metaphors, experiential exercises, and storytelling to convey complex ideas. For example:

The Tug-of-War Metaphor: Imagine you’re in a tug-of-war with a monster (representing your struggles), and there’s a pit in the middle. The harder you pull, the more the monster pulls back. ACT suggests letting go of the rope—not to surrender but to stop exhausting yourself in a battle that keeps you stuck.
Passengers on the Bus: In this metaphor, you are the driver of a bus, and your thoughts, emotions, and fears are the passengers. While some passengers may be loud and unpleasant, they don’t control the direction of the bus—you do.

Evidence Base and Applications

ACT has been extensively researched and shown to be effective for a wide range of psychological and physical conditions, including:

Anxiety disorders
Depression
Chronic pain
Substance use disorders
PTSD
Obsessive-compulsive disorder (OCD)

Additionally, ACT is increasingly applied in workplace settings, coaching, and education, demonstrating its versatility and relevance.

Challenges and Critiques

While ACT has gained widespread acceptance, it is not without its critics. Some argue that its concepts can be abstract or difficult to grasp for clients who prefer structured, problem-solving approaches. Additionally, practitioners must strike a balance between acceptance and action, ensuring clients do not become passive in the face of challenges.

Conclusion

Acceptance and Commitment Therapy offers a transformative approach to psychological well-being by teaching individuals to embrace life’s inevitable challenges while staying true to their values. By fostering acceptance, mindfulness, and committed action, ACT helps people navigate their internal experiences with greater flexibility and resilience.

Ultimately, ACT is not about eliminating pain but about creating space for a rich, meaningful life—a life in which discomfort is not a barrier but a companion on the journey toward growth and fulfillment.

If you live in Washington State, and you would like to make an appointment, please feel free to contact me here. I’m looking forward to hearing from you.

:), Susan Reimers, JD/LICSW

Therapy

Overcoming Seasonal Affective Disorder (SAD) This Winter

December 29, 2024January 27, 2025 S. Reimers, JD/LICSW

Tips for Coping with a Case of the Winter Blues

As the vibrant colors of autumn fade into muted shades of gray and white, winter begins to assert itself, typically starting in late December and extending through late March. For those in the northern parts of the country, this season brings its unique challenges. The days grow alarmingly short, with the sun rising late and setting as early as mid-afternoon. Cold temperatures and icy conditions make outdoor activities less inviting, while snow-covered landscapes, though beautiful, can feel isolating. These seasonal changes often lead to a phenomenon many refer to as the “winter blues.”

The winter blues, also known as seasonal affective disorder (SAD) in its more severe forms, can leave you feeling lethargic, unmotivated, and even depressed. This is a widespread issue, with millions experiencing a dip in their mental health during these colder months. But understanding why this happens and exploring ways to counteract it can make winter a more manageable, even enjoyable, time of year.

Why Does Winter Impact Our Mood?

The primary culprit behind the winter blues is the lack of sunlight. Sunlight plays a crucial role in regulating our circadian rhythms, the internal clock that governs our sleep-wake cycle. Reduced exposure to daylight can disrupt this rhythm, leading to fatigue and difficulty concentrating. Additionally, limited sunlight can decrease serotonin levels—a neurotransmitter that contributes to feelings of well-being—and increase melatonin production, which can make us feel sleepy and sluggish.

Another contributing factor is the limited opportunity for outdoor activities and social connection. In warmer months, it’s easier to meet friends for a walk, enjoy a picnic, or take part in community events. But when temperatures plummet and sidewalks are slick with ice, many people opt to stay indoors, leading to feelings of isolation. The festive holiday season, while joyful for some, can exacerbate feelings of loneliness for others, especially once the celebrations are over and January’s stark reality sets in.

Fighting Back: Strategies to Beat the Winter Blues

Although winter’s challenges are real, there are numerous strategies you can employ to lift your spirits and maintain your mental health during the colder months. Here are some effective ways to combat the winter blues:

1. Maximize Sunlight Exposure

Whenever possible, try to get outside during daylight hours. Even a short walk during your lunch break can make a difference. If natural light is scarce, consider investing in a light therapy box. These devices mimic natural sunlight and can help regulate your circadian rhythms, boost serotonin levels, and improve your mood. Place the light box on your desk or dining table and use it for about 20-30 minutes each morning for optimal results.

2. Stay Active

Exercise is a powerful mood booster. While outdoor activities may be less accessible, there are plenty of ways to stay active indoors. Join a gym, try yoga or Pilates at home, or explore online workout classes. If you’re an outdoor enthusiast, consider winter-friendly activities like snowshoeing, cross-country skiing, or even brisk walks on clearer days. Physical activity releases endorphins, which are natural stress relievers and mood enhancers.

3. Prioritize Social Connections

Combat isolation by staying connected with friends and family. Schedule regular phone calls, video chats, or socially distanced meetups. If it’s safe and feasible, host small gatherings or join virtual communities and groups that share your interests. Social interaction is a cornerstone of mental well-being, and making an effort to connect can help you feel less alone.

4. Maintain a Healthy Routine

Establishing a consistent daily routine can provide structure and a sense of normalcy during the darker months. Aim to wake up and go to bed at the same time every day to support your circadian rhythm. Eat a balanced diet rich in whole foods, including fruits, vegetables, lean proteins, and whole grains. Foods rich in omega-3 fatty acids, like salmon and walnuts, as well as those high in vitamin D, can be particularly beneficial.

5. Practice Mindfulness and Gratitude

Mindfulness techniques, such as meditation and deep breathing, can help reduce stress and improve your overall mental state. Take a few minutes each day to sit quietly and focus on your breath or practice guided meditations. Gratitude journaling is another effective tool; write down three things you’re thankful for each day to shift your perspective and cultivate positivity.

6. Seek Professional Help if Needed

If your feelings of sadness or lethargy persist and interfere with your daily life, don’t hesitate to seek help from a mental health professional. Therapy, medication, or a combination of both can be highly effective for managing seasonal affective disorder. Remember, asking for help is a sign of strength, not weakness.

Embracing the Season

While winter may not be everyone’s favorite season, finding ways to embrace its unique offerings can make a significant difference. Cozy up with a good book by the fire, explore new indoor hobbies like painting or baking, or take time to reflect and plan for the year ahead. Viewing winter as an opportunity for rest and rejuvenation, rather than a burden, can shift your mindset and help you make the most of this quieter season.

Winter’s challenges are undeniable, but with intentional effort and a proactive approach, it’s possible to not just survive but thrive during these colder, darker months. By staying active, connected, and mindful, you can keep the winter blues at bay and emerge into spring feeling strong and refreshed.

If you live in Washington State, and you would like to make an appointment, please feel free to contact me here. I’m looking forward to hearing from you.

:), Susan Reimers, JD/LICSW

Climate, Therapy

Coping with Climate Anxiety: DBT Techniques for a Better Future

November 17, 2024November 19, 2024 S. Reimers, JD/LICSW

What Dialectical Behavioral Therapy Can Teach Us About Coping With an Uncertain Future

What is DBT?

Dialectical Behavioral Therapy (DBT) is an effective, evidence-based therapeutic tool that teaches practical skills in the areas of Mindfulness, Interpersonal Effectiveness, Emotional Regulation and Distress Tolerance. It is considered an important tool in the treatment of Borderline Personality Disorder and a host of other mental health conditions. As it happens, it’s also a good tool for combating the very real and very understandable issue of Climate Anxiety.

How Can DBT Help with Coping?

At the most basic level, DBT posits that any problem can be solved in four distinct ways. Reading through the list below, you’ll notice there are three active solutions, and one that requires no action at all:

You can actually SOLVE the problem.
You can FEEL BETTER about the problem.
You can ACCEPT/TOLERATE the problem.
You can DO NOTHING and stay miserable.

But what do these options mean exactly? Let’s take a moment to explore them one by one.

SOLVING Climate Change

Solving a problem is always the best solution, yet, it’s not always a realistic option. When it comes to climate change, no one person on the planet has the ability to completely resolve the issue of greenhouse gas emissions. That said, each of us has the ability to do what we can. This might mean living small, cutting back on beef consumption, living in a walkable/bikeable neighborhood, buying an electric vehicle next time you’re in the market for a car, cutting back on plane trips, or any number of other things. In addition, you have the option of voting for leaders who care about climate change, supporting the work of climate activists and communicators, or creating innovative ideas, products and services. You may not be able to end the global crisis, but you can solve the smaller issue of your personal contribution

It’s true, you’re only one person. The change you make is a tiny drop in a very large bucket. It’s also true that climate change cannot be solved without your contribution. That bucket needs every drip. A jigsaw puzzle remains unfinished without every single piece. When many people acknowledge their carbon footprint and make necessary adjustments, the aggregate effect is very significant. In fact, it’s the only path to a complete solution.

Don’t get caught in the bystander effect! Don’t assume someone else will solve the problem! Be the change you want to see!

FEELING BETTER about Climate Change

While it’s very understandable to harbor deep-seated concerns about the planet we live on, it is also easy to catastrophize and engage in mental-filtering or all-or-nothing thinking. When we concentrate on our failures, it’s easy to lose sight of hopeful developments and the significant progress we’ve already made. Clean energy production has become 99% cheaper to build and implement than old-fashioned coal-burning power plants. A global solar power boom is underway, changing the way human kind generates energy, heats water, and fuels their vehicles. Speaking of electrified transportation, EV sales are growing year after year. And while there has been negative press regarding the ethical and environmental costs of mining vital battery components, or the strain EVs will put on our current power grid, these problems can (and will) be solved. Oil, coal and gas production is rife with its own ethical and environmental costs, and our current fossil fuel infrastructure didn’t leap into existence overnight. We’re moving in the right direction, but change takes time.

When you find yourself falling into a pit of despair, start asking questions. “Are my thoughts balanced? Are they evidence-based?” Put your thoughts on trial. Fact check. It won’t hurt, and it just might help relieve some anxiety!

In addition, you might try “reframing”. For example, when you think about problems that exist on a global scale, they can seem utterly hopeless and overwhelming. This is because your frame might be too big. Global problems require global solutions, and last time I checked, no one person has that much power. Try a smaller frame. Focus on your personal realm of influence. At the national level, you can help select leadership, you can make consumer choices, and support non-profits and activism. You’ll have even more influence at the regional and local levels, where your unique voice is more likely to stand out. You have still more power in your home, family, and close-knit communities. You have a choice. Use a frame that feels hopeful and empowering!

ACCEPTING or TOLERATING Climate Change

Learning to tolerate the distress of a bad situation is not as ideal as solving the problem, or even feeling batter about it. That said, it can be a way to find relief from intense emotions. DBT offers an entire suite of Distress Tolerance Skills ranging from those designed for crisis experiences to practical, everyday strategies for tolerating mild distress. Here are a few examples:

The TIPP Skill (Temperature, Intense exercise, Paired muscle relaxation, Paced breathing) offers quick and effective ways to calm your body when anxiety runs high.

The ACCEPTS Skill (Activities, Contributions, Comparisons, Emotions, Pushing away, Thoughts and Sensations), on the other hand, offers practical methods to lower our distress on a day to day basis.

One important distress tolerance skill is Radical Acceptance. Often, we add an additional layer of distress/anxiety when we struggle to accept certain unpleasant realities. While the stressor (climate change) is painful enough all on its own, we can amplify that distress by believing that things “should” be different. Just as a person who has lost their life savings might struggle to accept their new circumstances- holding on to outdated notions of what resources they used to have- doing so may prevent that person from embracing life as it currently is. Accepting the fact that climate change is happening, that you cannot solve it alone, and that human beings are a complicated and frustrating lot can help you end your fight against reality. That doesn’t mean you suddenly feel like everything’s fine. Nor does it mean sacrificing your values.

That person who lost their life savings might begin to improve their financial health through budgeting, saving and investment, If they practice radical acceptance along the way, they can do so without the added distress of feeling or believing that life should be anything other than what it is. Settling that fight against reality leaves room for the present, for joy, and for undistracted time with our loved ones. How would radical acceptance improve your life? What kind of difference could it make?

DOING NOTHING and STAYING MISERABLE

This last “solution” is really just the status quo, isn’t it? Doing nothing really is an option. You’re reading this post because you are anxious about the present and future of our climate. Your anxiety is so significant that you’re looking for tools and perspectives to help. If you do nothing at all, you can remain in that distress. That’s a choice you have. Problem is, it’s not a solution. Not really. It won’t help you solve the problem (or contribute to mitigation. Doing nothing won’t help you feel better. It won’t even help you deal with your distress. It only helps maintain the status quo (your very understandable climate anxiety).

So, rather than doing nothing, what’s the harm in dabbling in the above three strategies?

MORE RESOURCES

If you’d like to learn more about Dialectical Behavioral Therapy, there are a number of searchable sites online (Google, Psychology Today and YouTube are good sources). Focus on the four major skill areas: Mindfulness, Emotional Regulation, Distress Tolerance, and Interpersonal Effectiveness.

If you’d like to make a therapy appointment, and you live in Washington State, you can do so by visiting my Psychology Today page and contacting me directly. I offer TeleHealth services statewide.

:), Susan Reimers, JD/LICSW

Therapy

Being Trans is Not a Mental Illness

November 11, 2024January 27, 2025 S. Reimers, JD/LICSW

Written and Published by Steven Novella under Culture and Society,Neuroscience Reprinted With Author’s Permission

On the current episode of the SGU (Skeptic’s Guide to the Universe podcast), because it is pride month, we expressed our general support for the LGBTQ community. I also opined about how important it is to respect individual liberty, the freedom to simply live your authentic life as you choose, and how ironic it is that often the people screaming the loudest about liberty seem the most willing to take it away from others. That was it – we didn’t get into any specific issues. And yet this discussion provoked several responses, filled with strawman accusations about things we never said, and weighed down with a typical list of tropes and canards. It would take many articles to address them all, so I will focus on just one here. One e-mailer claimed: “It is obvious to me that the 98% of trans people have a mental illness that should be treated like any other mental illnesses.”

Being trans itself is not considered a mental illness, but this deserves some extensive discussion. It’s important to first establish some basic principles, starting with – what is mental illness? This is a deceptively tricky question. The American Psychiatric Association provides this definition:

Mental illnesses are health conditions involving changes in emotion, thinking or behavior (or a combination of these). Mental illnesses can be associated with distress and/or problems functioning in social, work or family activities.

But this is not a technical or operational definition (something that requires book-length exploration to be thorough), but rather a quick summary for lay readers. In fact, there is no one generally accepted technical definition. There is some heterogeneity throughout the scientific literature, and it may vary from one illness to another and one institution to another. But there are some generally accepted key elements.

First, as the WHO states, “Mental disorders involve significant disturbances in thinking, emotional regulation, or behaviour.” But then we have to define “disorder”, which is typically defined as a lack or alternation in a function possessed by most healthy individuals that causes demonstrable harm. “Significant” is also a word that’s doing a lot of heavy lifting there. This is typically determined disorder by disorder, but usually includes elements of persistent duration for greater than some threshold, and some pragmatic measure of severity. For example, does the disorder prevent someone from participating in meaningful activity, productive work, or activities of daily living? Does it provoke other demonstrable harms, such as severe depression or anxiety? Does it entail increased risk of negative health or life outcomes?

Further, symptoms and outcomes need to be put into cultural context. Specifically, it has been increasingly recognized that negative outcomes do not qualify as mental illness if they are entirely due to outside factors, such as social norms and acceptance. If you are a rugged individualist living in a collectivist society, your individualism is not a mental illness simply because it puts you in conflict with the dominant cultural norm. In other words, mental illness must be a product of inherent brain function (although this can be in response to extreme stress or environmental conditions, such as PTSD), and not simply culture.

As psychiatry evolved and matured, and wrestled with many complex issues, it also became clear that a diagnosis of mental illness should not be used simply to enforce cultural norms, or as a value judgement to be imposed on individuals. Along those same lines, it has become increasingly recognized within biology, medicine, and neuroscience specifically that living things, including people, exhibit a lot of variation within very broad parameters that can be considered healthy. Also, evolution typically involves lots of trade-offs, and different trade-offs are often just different, not better or worse. This is why we no longer used value-laden terms like “normal”, “abnormal”, or “deviant”. Rather, it is more appropriate to use value-neutral terms such as typical and atypical. Not everyone who is atypical is abnormal or suffering from a disorder.

Grappling with these complex issues is extremely important, because they get right to the heart of the liberty question. Historically the designation of mental illness has been used as a tool of authoritarian governments to deprive citizens of liberty. Not cooperating with a collectivist ideology was considered a mental illness, and “treated” by confinement in reeducation camps. Anti-psychiatry organizations, like Scientologists, take this principle to an extreme, and deny the very existence of mental illness and portray all mental health treatment as political oppression. This is the other end of the spectrum, equally nonsense. An optimal approach is somewhere in the middle – recognizing the many abuses and pitfalls of giving someone a diagnosis of mental illness, the tremendous power this can give someone over someone else’s liberty, but retaining the ability to recognize genuine problems in order to give proper help to those who need it.

With this as background, let’s consider an historically relevant case – is homosexuality a mental illness? In the first DSM published in 1952, the manual of psychiatric diagnoses, it was considered a mental illness. This was based upon one competing theory of homosexuality that pathologized it. For example, psychiatrist and psychoanalyst Edmund Bergler wrote in a book for general audiences:

“I have no bias against homosexuals; for me they are sick people requiring medical help… Still, though I have no bias, I would say: Homosexuals are essentially disagreeable people, regardless of their pleasant or unpleasant outward manner… [their] shell is a mixture of superciliousness, fake aggression, and whimpering. Like all psychic masochists, they are subservient when confronted with a stronger person, merciless when in power, unscrupulous about trampling on a weaker person.”

This was closely tied to cultural normative value judgements, that anyone who did not conform to social norms around sexual behavior were “deviant”. In the second edition published in 1973, the competing theory that homosexuality was simply part of human variation prevailed, and homosexuality was removed as a mental illness. This was also based on an analysis following the principles I outlined above. Being homosexual does not seem to correlate with any pathology, mental deficiency, or inability to function – except to the degree that is being imposed from the outside by society. It is not a reaction to stress, bad parenting, or social contagion. People seem to be born gay, because that is how their brains developed, and it’s just part of variation that we see pretty much across the entire animal kingdom.

When it comes to individuals who identify as trans or non-binary, we see essentially the same story playing out. Accusations that being trans is a mental illness is being used to justify taking away their liberty, marginalizing them in society, and even depriving them of health care. But there is equally little reason to consider a trans identity a mental illness as being non-heterosexual. It is true that trans individual do have a higher risk of depression, anxiety, and suicidality. But again, this seems to result from acceptance in society, rather than an internal factor.

With respect to the DSM, the same evolution has occurred. The original designation was “gender identity disorder”, but after debate and review it was considered that this was just as much a bias as considering homosexuality deviant. The GID designation was removed, and replaced with “gender incongruence” as a descriptor under the sexual health section (The DSM also lists traits, personality types, and other things which are not considered disorders or illnesses). There is also a separate diagnosis of “gender dysphoria” which is a negative emotion that can (but does not always) arise from gender incongruence. For context it’s important to recognize that part of the purpose of the DSM is to give a label to anyone who might be seeking help, so that they can be treated and insurance can be billed. That’s why there are many conditions that are not considered a mental illness. For example, someone might seek mental health treatment because they are suffering from reactionary grief following the loss of a loved one. This is considered a healthy reaction to a life event, not a mental illness, but they still may benefit from intervention.

Critically, the consensus among mental health experts is that the trans identity itself is not a manifestation of some mental illness, but is simply part of the natural variation of a complex biological system. Some people are trans or non-binary. This may result in increased mental stress, but that is generally a societal issue, not an issue of brain health.

To be clear, and to head-off the likely strawmen arguments thrown my way, there is a meaningful discussion to be had about how to optimize health care for trans people, to balance concerns about outcome, risks vs benefits, maturity, and consent. But such a conversation should be had among experts, and free of misinformation, biases, bigotry, outdated notions of deviance, or the imposition of external cultural norms (no matter how well entrenched and firmly held they are).

Dismissing trans individuals as “98%” mentally ill is just misinformed bias, and a way to deprive a marginalized community of their humanity, dignity, rights, and liberty.

END OF REPOST

THERAPIST’S NOTE: I asked Dr. Novella for permission to reprint this article because it so thoroughly and effectively represents the views of myself and the staff at Transcendent Mental Health.If you live in Washington State, and you would like to make an appointment, please feel free to contact me here. I’m looking forward to hearing from you.

:), Susan Reimers, JD/LICSW