17. dialectical behaviour therapy and its applications

Question 1

what is suicidality?

Answer 1

chronic suicidal ideation
chronic suicide attemps
always thinking about suicide as an option

Question 2

what is parasuicidality?

Answer 2

behaviours that are harmful but won’t lead to suicide
harder to work with

Question 3

what is DBT designed for?

Answer 3

• as a tx for people with chronic suicidality or parasuicidality who didn’t respond favourably to CBT or other txs
• recognition that px engage in behaviours that interfere with ther, and that clinicians experience burnout and negative reactions to these px

Question 4

fill in the blank

most patients with _ have _ but not all patients with _ have _

Answer 4

most patients with chronic suicidal behaviour have borderline personality disorder but not all patients with BPD have suicidal behaviour

Question 5

what is Linhan’s biosocial theory of BPD?

Answer 5

emotionally vulnerable person + an invalidating environment = problems with
1. ability to understand + label feelings
2. coping skills
3. emotion modulation (intensity of emotions)

Question 6

what’s the dialectical dilemma for the patient?

Answer 6

• emotional vulnerability vs. self-invalidation
• active passivity vs. apparent competence
• unrelenting crisis vs. inhibited grieving

Question 7

what’s the dialectical dilemma for the therapist?

Answer 7

• accepting client as they are, but encourage change
• centered and firm, but flexible when needed
• nurturing, but benevolently demanding

Question 8

dialectical dilemma in treating BPD

what is active passivity?

Answer 8

indifferent approach to life “i lack control”

Question 9

dialectical dilemma in treating BPD

what’s “unrelenting crisis”?

Answer 9

• can’t let go of specific events
• constantly bring up same challenges

Question 10

dialectical dilemma in treating BPD

what is inhibited grieving?

Answer 10

• normalizing
• minimalizing
• internalizing emotions

Question 11

what’s the DBT tx package?

Answer 11

• weekly individual ther session
• weekly group skills training session (application of specific skills)
• phone contact (need to be reachable when they feel like they might have debilitating thoughts)
• therapist consultation team meeting
• client must commit to all parts of tx package for at least 1 year (longer than other kinds of ther)

Question 12

5 functions of DBT

Answer 12

1. enhancing capabilities
2. generalizing capabilities
3. improving motivation + reducing dysfunctional behaviours
4. enhancing + maintaining therapist capabilities and motivation
5. structuring the environment

Question 13

5 functions of DBT

what are some components of stucturing the environment of tx of BPD?

Answer 13

• want to reinforce effective behaviour/progress, not reinforce maladaptive or problematic behaviour
• patients also need to modify their own environment

ex: if call before bad behav, good; can talk for a while. if call after bad behav, stop call quickly.

Question 14

DBT: individual therapy

hierarchy of therapy targets (behaviours)

Answer 14

• suicidal and parasuicidal (can’t do ther is not alive)
• therapy interfering behaviours
• behav interfering with qual of life
• behav related to PTS (not nec dx)
• improve self-esteem
• individual targets negotiated with client

Question 15

DBT: individual therapy

what’s a diary card, what’s it used for?

Answer 15

track behaviour like self harm, suicide attempts, emotional misery
used to prioritize session

Question 16

DBT: skills training

Answer 16

• mindfulness skills
• interpersonal effectiveness skills
• emotion regulation skills
• distress tolerance skills

Question 17

DBT skills training

what kind of mindfulness skills can you teach in DBT?

Answer 17

what skills: observe, describe, participate
how skills: non-judgementally, one-mindfully, effectively

Question 18

what kind of interpersonal skills can you teach in DBT?

Answer 18

• objective
• relationship (maintenance)
• self-respect effectiveness

Question 19

what kind of emotional regulation skills can you teach in DBT?

Answer 19

• identify + describe emotions (if you can name feeling, more likely to adopt a better coping strategy)
• riding wave of emotions (opposite of emotion action

Question 20

what’s the evidence for DBT?

Answer 20

• efficacious for self-harm, suicidal ideation, depressive sx for teens
• efficacy data for BN + BED, no evidence for superiority over cbt
• preliminary evidence that DBT skills can be used as stand-alone tx for variety of conditions