DBT Flashcards
WHAT IS DBT:
the reduction of ineffective action tendencies linked with dysregulated emotions.
Combines CBT, Buddhism, Acceptance and Dialectics. Originally developed for highly suicidal individuals led to treatment of BPD. Efficacious treatment of BPD
addresses the core features of borderline personality disorder
What are the four Working Assumptions about the Client
1) Client wants to change. Despite what it may seem, they are trying their best. (change)
2) Behaviours are understandable given their historical background and present circumstances. (acceptance)
3) Nonetheless, they need to try harder if things are to improve. (change)
4) One cannot fail at DBT. (acceptance)
Development and Etiology of Borderline PD
Individuals with BPD are born with an emotional vulnerability»_space;> Biological pre-disposition
Invalidating Environments
» emotional struggles get ignored trivialised or rejected
» only extreme / drastic communication gets taken seriously
Overtime have learned to escalate behaviour to get needs met
Borderline Personality Disorder
Life-threatening Problems (NSSI, Suicidal, comorbidity, self-sabotage, maladaptive coping)
Therapy Interfering Behaviours (non compliance, drop out, reactive)
Pervasive disorder of Emotional Regulation (highly sensitive to rejection , emotional intensity, maladaptive strategies to regulate emotions)
Behavioural > self-harm > drugs and alcohol >over-eating
»> Avoidance and numbing.. interfere with a life worth living
The Dialectic – Balancing Acceptance and Change
BPD feel invalidated when others try to get them to change; Feel blamed and invalidated
Yet, need to change in order to build a life worth living and tolerate emotion.
Focussing only on acceptance / validation is not going to be beneficial
Focussing only on change is also going to fail
Style:
“Accepting client as they are while encouraging change”
“Centred and Firm, but flexible and validating”
“Nurturing but benevolent detaining”
Treatment Strategies Overview
Clinician: Validate, CBT
Skills: emotional regulation and acceptance
Support/Validation/Acceptance Cognitive restructuring Coping skills Exposure and opposite action Problem-solving Dialectical Strategies Reinforcement principles
What is Validation?
Understanding
that makes sense
you are capable of change
Modes of Treatment - Combination approach.
Individual therapy
Group therapy
Telephone contact
Team for therapists to consult
*** DBT explicitly helps therapists avoid becoming burned out, as often happens in the treatment of behaviors associated with BPD or multi-diagnostic cases
Hierarchy of Therapy Targets (7)
STAGE 1- eliminating the most severely disabling and dangerous behaviors.
- Decreasing suicidal behaviors.
- Decreasing therapy interfering behaviors.
- Decreasing behaviors that interfere with quality of life.
STAGE 2 - shifting from quiet desperation to emotional experiencing
- Increasing behavioral skills (4 stages)
- Decreasing behaviors related to post-traumatic stress.
- Improving self-esteem.
STAGE 3 - addresses problems in living, such as career problems, and marital problems.
STAGE 4 - develop the capacity for freedom and joy.
7.Individual targets negotiated with the client (integrate into life)
Skills Training - 4 Skills
Core mindfulness skills.
Interpersonal effectiveness.
Emotion modulation skills.
Distress tolerance skills.
Mindfulness Skills
Mindfulness ‘what’ skills»_space;> Observe, describe and participate
Mindfulness ‘how’ skills»_space;> Non-judgemental and accepting stance
Reasonable mind»_space;> Rational, logical, cool etc…
Emotion mind»_space;> Emotions in control, influence thinking and behaviour
Wise mind»_space;> Integration of reasonable and emotion mind
letting go of attachments
becoming one with current experience; without judgment or any effort to change (acceptance)
finding middle path between extremes or polarities.
Interpersonal Effectiveness Skills
Attending to relationships
Busting Relationship myths “I can’t stand it if someone gets upset with me”)
Enhancing interpersonal effectiveness -assertiveness (Getting objectives met in relationships ,Boundaries)
Identification of thoughts and emotions in interpersonal situations
Skills training for skills deficits
Skills practice (Asking for help, disagree with someone’s opinion)
Emotion Regulation Skills
Identifying and labelling emotions
Taking opposite action (Similar to behavioural activation)
Increasing positive emotional events
Distraction, particularly during crisis
Pleasant events scheduling
Distress Tolerance Skills / Crisis survival skills
Distract (Kindness, downward comparisons, time out, hobbies, hold ice in hand, squeeze rubber ball very hard, have a very hot shower etc…)
Self-soothe with five senses
Improve the moment (present moment awareness / mindfulness practice, devotion/gratitude)
Radical acceptance (Major focus of DBT)
Anger in session
Simply venting or letting the client have catharsis is rarely helpful.
Link behaviour to client goals
Examine the helpfulness of the emotion, and if it is not helpful, redirect efforts to a more useful focus
Validate client emotions
Apologise or repair rupture if you made a mistake
Don’t avoid issues that generate emotion if they are going to be useful to deal with and work on
