Behavioral - DBT

Question 1

Who developed DBT?

Answer 1

Marsha Linehan - U of Washington

Question 2

What is the goal of Dialectical Behavior Therapy?

Answer 2

Synthesis of “acceptance” and “change,” which is a process the develops over time in transactions
between people

Question 3

What is a Dialectical Worldview?

Answer 3

A synthesis sought between two
extreme viewpoints. A belief that no statement captures an absolute truth and people can validly disagree, so dialog is needed to forge understanding.

Question 4

How is Dialectical Behavioral Therapy a behavioral approach?

Answer 4

It focuses on present behavior and current factors which are controlling that behavior

Question 4

What are the main techniques in Dialectical Behavioral Therapy?

Answer 4

validation and problem solving

Question 5

How does Dialectical Behavioral Therapy conceptualize Borderline Personality Disorder?

Answer 5

BPD is a consequence of an emotionally vulnerable individual growing up within an
“Invalidating Environment”
- Personal experiences, emotions, and responses of child are disqualified and
“invalidated” by significant people
- Climate of high standards of self-control and self-reliance
- Prevents client from developing ability to label and understand emotions or trust own
responses or skills to manage them
- Extreme, oscillating behaviors are attempt to gain acceptance in order to have feelings
acknowledged
- Client’s autonomic nervous system reacts excessively to relatively low levels of stress and
takes longer than normal to return to baseline once the stress is removed

Question 6

How does the therapist seek to communicate with the client in Dialectical Behavioral Therapy?

Answer 6

• Reciprocal communication (responsiveness and warmth)
• Irreverent communication (confrontational and challenging)

The therapist is:
- Accepting of patient as she is but still encouraging of change
- Centered and firm, yet flexible when the circumstances require it
- Nurturing but benevolently demanding

Question 7

What is the therapist’s assumption about the client in DBT?

Answer 7

Patients cannot fail in DBT. If things are not improving, it is the treatment that is failing.

Question 8

What are the stages of treatment in Dialectical Behavioral Therapy (DBT)?

Answer 8

• Pretreatment Stage: assessment, commitment,
  and orientation to therapy
• Stage 1: Focuses on suicidal behaviors, therapy
  and quality of life interfering behaviors, and
  problem-solving skills
• Stage 2: Post-traumatic stress related problems
• Stage 3: Self-esteem and individual treatment
  goals

Question 9

What does Dialectical Behavioral Therapy require of clients?

Answer 9

Clients are required to:
1. Work in therapy for a specified period of time (usually 1 year) and to attend all sessions (within reason)
2. Agree to work on reducing suicidal behaviors or gestures, if present
3. Work on any behaviors that interfere with the course of therapy (“therapy interfering behaviors”)
4. Attend skills training

Question 10

What are the modes of Dialectical Behavioral Therapy treatment?

Answer 10

• Individual therapy
• Telephone contact
  ◦ Group skills training (4 modules of DBT)
• Therapist consultation

Question 11

What happens in Group Therapy in Dialectical Behavioral Therapy?

Answer 11

1. Core mindfulness skills
2. Interpersonal effectiveness skills: strategies for asking for what one needs, saying “no”, and
   coping with interpersonal conflict
3. Emotion modulation skills: tolerating and surviving crises and accepting life as it is in the
   moment
4. Distress tolerance skills: identify/increase mindfulness to emotions, reduce vulnerability to
   “emotion mind”; apply distress tolerance techniques