powerful wave
Adults, DBT

Is Remission In Mental Health Even Possible?

The Importance of Balancing Coping and Changing

I recently was interviewed for an article about the difference between coping and healing. I was asked if remission was even possible when it comes to mental health. The article SO beautifully summarized my thoughts on healing from mental health concerns. So I wanted to elaborate from the article with the in-depth details of our entire interview here! Enjoy.

For someone who experiences panic attacks specifically, can they expect therapy to alleviate panic attacks right away?

how to ride a wave of emotions

I like to conceptualize panic attacks as waves of unpleasant emotion that come and go. A true panic attack is the peak discomfort of that emotion wave. One goal of therapy can be to help you “ride a wave” more effectively without causing any harm to yourself, your relationships, your other goals etc. This happens by teaching the coping skills set. It’s quite difficult to even think about recent waves if they just bring on another new wave. So you must first learn those coping skills in order to be able to do deeper reflection. 

Another goal of therapy is to look at how we can make the waves happen fewer and farther between, and be less intense when they happen. These are the change oriented skills. They involve analyzing triggers, choosing different actions, and problem solving either situations or relationships to prevent prompting more waves.

It is pretty important to start with coping skills because without them, the process of analyzing and changing can just be retriggering over and over again. It is very ineffective to look back at what’s happening without being able to tolerate current emotions. At the same time if all one does is cope, they will likely become exhausted of constantly having to ride their waves with no breaks for rest. This can eventually lead someone to a breaking point. So really both the coping skills and the change skills are necessary for overall progress or remission.

Though everyone is different, learning to better cope seems like an important first step that comes before feeling better for a lot of people. Is that an accurate assessment? If so, how can people develop better coping skills and more resilience in general?

Yes, like I said before coping generally has to be learned before changing. Some great coping skills are physiological self soothing techniques like paced breathing, paired muscle contraction and relaxation, and ice packs on the face. Distractions can also be good for coping but they can’t last forever and you need to get back to your life responsibilities once the wave has passed. Once you learn that your emotions will pass on their own, it becomes much less scary to reach peak discomfort. 

Why might a person not necessarily feel better right away, even though they’re finally getting help? In what ways might they potentially feel worse at the start of therapy?

Oftentimes, short term distractions (video games, work, reading etc etc) make for great coping skills because you can ride out the wave of discomfort while focusing on something else non-destructive, possibly even productive. (Queue us workaholics!) The problem is you still need to be able to reflect back on that wave and analyze it. For folks who are not used to doing that, therapy will bring into focus plenty of uncomfortable circumstances and emotions that someone may have been blissfully (but ineffectively) ignoring.

This can be quite painful to notice triggers more often, to be aware of your emotions more often etc. Especially in the early phases of treatment. Talk with your therapist about this before deciding that therapy doesn’t work or is making things worse. With so many clients, the disruption of homeostasis DOES feel acutely worse. AND it is a necessary path towards alleviation of chronic misery. 

Is it possible a lot of people just stop at coping and never grow past that, and that’s why they don’t feel fully better?

You’ve got this 100% right. For people who first learn the coping skills and then think they are “done” with therapy because they feel better, what is likely to happen is that they will eventually become burnt out from constantly coping without actually preventing or changing the problem. These people who may leave therapy prematurely.

And unfortunately they may also have the distorted belief that this means therapy didn’t work and there’s no use in returning. The best case scenario is to talk with your therapist about your perception of being “done” and hear their take on if/what more you might still have to do for sustainable change and prevention.

What are some ways people might cope when they start to feel worse, or just don’t feel better and are disappointed?

Definitely social support. Talking with others who have similar experiences. This is where group therapy come in so much handy. It is so important to know that you are not alone in these experiences so you don’t feel a further sense of shame. Or wrongness for being  a “bad therapy patient”

I think also remembering that healing and recovery is a journey and you can only make progress at a realistic rate. You can’t force progress to happen faster. Doing so may lead to things feeling worse before you are equipped to handle that. Pace yourself. Everyone learns how to pump the brake before you learn how to hit the gas while driving; mental health processing is no different. 

What about medication for mental health remission?

cartoon of pills with text saying "there is no shame in taking medication for mental illness (whatever works for you)

Regarding medication, I am not a psychiatrist so I can’t speak directly to that but what I do know is that meds can make the skills more accessible. Like a step-stool to get to something that’s out of reach. For some people meds can help someone access/practice/habitualize the emotional skills for both coping and changing. And then once it’s more common practice they may not need the meds anymore.

For others with more biological origins or emotion dysregulation, meds might always be needed, kinda like insulin for a diabetic. But without a doubt all the research points to a combination of both therapy AND meds for the best results.  

Work towards mental health remission with MCCC

DBT is a really great therapy modality for hard to treat anxiety and depression. This is because in DBT we teach skills for both coping and changing. These skills can be taught in our DBT skills groups or just in individual therapy.

Learn how to ride your waves with Montgomery County Counseling Center! Contact Us Today to Get Started!

About the Author

Laura Goldstein, family therapist and DBT expert

Laura Goldstein, LCMFT is a Licensed Clinical Marriage and Family Therapist in Rockville Maryland and Founder of Montgomery County Counseling Center, LLC. Laura obtained her Bachelor’s degree in Neuroscience from Franklin and Marshall College in Lancaster, PA. She then went on to earn her Master’s degree in Family Therapy from Thomas Jefferson University in Philadelphia. Laura became intensively trained in Dialectical Behavioral Therapy (DBT) through Behavioral Tech Linehan Institute in 2015. She is also Level 1 Trained in Gottman Couples Therapy. After working in both substance use and failure to launch IOP programs, Laura now works in her private practice alongside her excellent associates! Montgomery County Counseling Center serves individuals, families, parents, and couples who are struggling with intense emotions, fraught relationships, and maladaptive coping behaviors.

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