DBT

Question 1

what is Dialectical

Answer 1

A dialectic is a discussion intended to resolve differences between two views and reach an agreed truth.

Question 2

What are the advantages of dialectic and why is it important

Answer 2

It enables us to be clear that the patients emotions and behaviour are indeed valid.

It is important because in DBT it is hypothesised that a lack of validation (in particular during childhood) is partly the cause of the patients problems

Question 3

What are the ‘modes’ of DBT

Answer 3

skills development group: usually with 2 facilitators over a long time i.e. weekly for 1 year

Telephone consultations: help generalise skills to real life by crisis support and coaching

1:1 therapy: for problem-solving and overcoming motivational obstacles

Consultation team meetings: for individual therapist and skill group leaders to support each other and ensure they are all working to their best

Question 4

NICE evidence for DBT to treat. .

Answer 4

Boderline personality disorder (EUPD)
Self Harm
Binge Eating Disorder

Question 5

The Wise Mind

Answer 5

The Wise Mind is a rare psychological state that a person occupies in their day-to-day life. It is the quiet, optimal mode of acting/thinking that is flexible, adaptive, and holistic.

The Wise Mind sits in the middle of two extreme ends, the emotional mind on one end and the rational mind on the other. Most people find themselves on either end of the spectrum, being either overly emotional or overly rational in their decisions and behaviours.

Question 6

How is validation used in DBT

Answer 6

Problem solving and change strategies are balanced dialectically by the use of validation strategies - convey to patients that their thoughts and feelings are understandable even though they may be maladaptive or unhelpful

Question 7

What does the biopsychosocial theory suggest about EUPD

Answer 7

it’s a disorder of self-regulation, and particularly of emotional regulation, which results from biological irregularities combined with certain dysfunctional environments, as well as from their interaction and transaction over time

Question 8

Biological irregularities and dysfunctional environments mean a child may . .

Answer 8

• fail to label and regulate arousal
• fail to tolerate emotional distress
• fail to trust their own emotional responses as valid
• be unable to solve problems under high stress conditions
• fail to show a response to emotional stimuli
• fail to develop a stable sense of self

Question 9

A child experiencing biological irregularities and dysfunctional environments mean as an adult they may . .

Answer 9

• be unable to validate their own emotional experiences
• be unable to solve problems consistently
• be unable to reward or nurture themselves
• hate themselves when they fail to achieve goals
• be ashamed of being emotionally vulnerable

Question 10

3 types of invalidating families

Answer 10

Chaotic - main care providers are often absent and have problems in: drug/alcohol dependance, interpersonal, finance, housing. Basic needs to children in these families are often disregarded and so invalidated

Perfect - main care providers who can no tolerate negative emotional displays from their children. children are “required” to “control feelings”

Typical - Western Cultural phenomenon emphasising cognitive control of emotions with a focus on mastery and achievement in life as a criterion for success.

Question 11

Ways of Validating

Answer 11

• Listening in an accepting/ non-judgemental way
• Reflecting back what has been said in an un-surprised way
• Articulating thoughts and feelings that the patient has but has not been verbalised
• Explaining the patient’s present by linking it to the past

Question 12

Chain Analysis

Answer 12

In chain analysis a particular instance of behaviour is first clearly defined an then a ‘chain analysis’ is conducted, looking in detail at the sequence of events.

Factors that may be controlling the behaviour are analysed.

Other ways of dealing with the situation at each point in the chain are considered and evaluated.

A solution is chosen. Difficulties that may be encountered are considered and strategies for dealing with these can be worked out.

Question 13

Relentless Problem Solving

Answer 13

Is an attitude of the mind, yet the skill or problem solving is a good one to have: many issues can be boiled down to a problem.
- write down the problem
- write down all the options
- examine the options, deciding pros and cons
choose the option you like best or dislike least
act on your choice

Question 14

Contingency Management

Answer 14

• respond more when the person talks about changing in a direction that is helpful for them, than when they talk about staying as they are.
• similarly respond more to the person when they are doing things this will be helpful to them than the opposite
• try to set up contingencies so that the person is guided in a direction that is helpful to them (i.e. we are only allowed to keep you as long as you are making progress).

Question 15

Skills Training Groups

Answer 15

1. Core mindfulness skills
2. Interpersonal effectiveness skills
3. Emotion regulation skills
4. Distress Tolerance Skills
5. Walking the middle path

Question 16

Mindfulness

Answer 16

paying attention in highly specified ways to the entire landscape, inner and outer of one’s experiences including intense emotions. This includes suspending the impulse to characterise, evaluate and judge what one is experiencing.

Question 17

Benefits of mindfulness

Answer 17

• increased awareness results in being able to notice when they are about to undergo dangerous mood swings
• awareness itself takes up processing resources that maintain rumination and associated negative emotions /physical sensations.
• mindfulness is how negative thoughts and feelings are expressed through the body.
• it is non judgemental present moment focus provides the means to change mental gears.
• helps to balance the emotional mind with the reasonable mind to achieve the wise mind.

Question 18

Applications of Mindfulness

Answer 18

Pain, Depression, Anxiety, Personality Disorder, Anger and Violence, OCD

Question 19

Interpersonal Effectiveness

relationship effectiveness - GIVE

Answer 19

Creating relationships that are rewarding for all concerned (GIVE)
Gentle: no attacks, threats, judging
Interested: actively listen to the other person
Validate: show that you get their viewpoint with words and actions
Easy Manner: smile, be diplomatic, use of humour if appropriate

Question 20

Interpersonal Effectiveness

objective effectiveness - DEAR MAN

Answer 20

being effective in achieving things you want, rather like assertiveness (DEAR MAN)
Describe: the situation
Express: how you feel about it
Assert: your wishes
Reinforce: what is the payoff for everyone
Mindful: keep your focus on what you want
Appear Confident;
Negotiate: listen to the other person nd see if you can compromise

Question 21

Interpersonal Effectiveness

self-respect effectiveness

Answer 21

as in maintaining relationships that sustain our self- respect.
Fair: be fair to yourself
Apologise (don’t): don’t apologies when you don’t need to but (asking for something) apologise when you do (if you have done wrong by someone)
Stick to your values: don’t go against your values to get what you want in the short term
Truthful: be truthful and honest.

Question 22

Emotional Regulation

ABC PLEASE

Answer 22

A -accumulate positive emotions
B - build mastery so you feel competent and effective
C - cope ahead: develop a plan to cope with difficult situations

PhysicaL illness
Eat healthy
Altering mood substances - avoid
Sleep well
Exercise

Question 23

Distress Tolerance

Answer 23

ability to tolerate distress is a wonderful skill to have and liberates you to actively address your distress or to simply tolerate it and allow it to disparate of it’s own accord and in its own time.

Question 24

Distress Tolerance (techniques)

Answer 24

distraction 
self soothe
examine your options
accepting reality 
TIPP skills (temperature, intense exercise, paced treating, muscle relaxation)