Intervention L3 - Personality Disorders Flashcards
What is DBT used for?
Dialectical behaviour therapy:
Developed for BORDERLINE PERSONALITY DISORDER - but now reformulated as a treatment for treatment0resistant populations.
for Very severe, high risk mental problems.
Eg. Addiction, impulse control difficulties, emotion/mood control difficulties, highly suicidal individuals.
Who is Marsha Linehan?
She developed DBT in 1993.
It combines CBT, Buddhism, Acceptance and Dialectics.
Who are similar to third-degree-burn patients?
- borderline individuals
- they simply have no emotional skin - even the slightest touch or movement can create immense suffering.
What are the working assumptions about the client in DBT?
1) Client wants to change. Despite what it may seem, they are trying their best.
2) Behaviours are understandable given their historical background and present circumstances.
3) Nonetheless, they need to try harder if things are to improve.
4) One cannot fail at DBT.
There is a balance between ACCEPTANCE (given their context, we understand why they turn to these behaviours) and CHANGE (they need to change because what’s happening isn’t working for them)
What does DBT stand for?
Dialectical behaviour therapy
What is the balance between acceptance and change in DBT?
There is a balance between ACCEPTANCE (given their context, we understand why they turn to these behaviours) and CHANGE (they need to change because what’s happening isn’t working for them).
We recognise that their behaviour is both functional and dysfunctional.
What is Linehan’s biosocial theory for borderline PD?
Emotional and behavioural dysreg due to transaction between invalidation rearing environemtn and bio tendency towards emotional vulnerability
- those with BPD are born with emotional vulnerability - eg. more impulsive, anxious, and emotional dysreg problems.
- invalidating environments - where emotional struggles get trivialised, ignored or rejected, and are only taken seriously in extreme circumstances - so they learn to eg. self harm.
- sexual abuse history very common
Describe some aspects of personality disorder.
- LIFE THREATENING PROBLEMS - eg. suicidal behaviour, self injury, comorbid diagnoses (PTSD, MDD), self sabotage
- THERAPY INTERFERING BEHAVIOURS - non-compliance, non-attendance, emotional reactions
- PERVASIVE DISORDER OF EMOTIONAL REGULATION - highly sensitive to rejection, easily triggered, high emotional intensity, maladaptive responses to emotion to attempt to regulate.
- PROBLEMATIC BEHAVIOURS relieve emotion temporarily but reinforce maladaptive behaviour - self harm, drugs and alcohol, over-eating.
Why is acceptance and change important for borderline individuals?
- We cannot focus on CHANGE because they will feel invalidated.
- We cannot just ACCEPT because they will not build a life worth living.
- need a balance of both!
What is the dialectical style?
Reciprocal communication vs. Irreverent communication:
- need to accept the client as they are, and encourage change.
- Centred and firm, but also flexible and validating
- nurturing but benevolently demanding.
- balance therapist strategies
- balance coping skills
so a balance between a person who is really warm and accepting, but also firm and assertive!!!!
How do we balance acceptance and change as therapists?
Balance therapist strategies:
- Validation and Rogerian counselling skills - do this genuinely by understanding their situation wholly.
- CBT - problem solving skills, exposure, cog restructuring, contingency management..
Balance coping Skills:
- skills to modify emotion
- acceptance skills
What are some ways to show validation?
Demonstrate understanding - PARAPHRASE
Describe how behaviours and emotions MAKE SENSE given history and are NORMAL - eg. its difficult you do this because its difficult to trust people.. (Validates)
Demonstrate that client is CAPABLE and don’t treat them as though they are too fragile.
What are some modes of treatment?
- individual therapy
- group skills training
- telephone contact - enhance generalisation to the natural enviro
- therapist consultation
Full on DBT program for people who are really struggling…
some people may not need all of this
What is the hierarchy of suicidal behaviours?
DBT works on a hierarchy
- Decreasing suicidal behaviors - giving them different skills.
- Decreasing therapy interfering behaviors - eg. drunkeness, missing sessions
- Decreasing behaviors that interfere with quality
of life. - eg. self harm, relationships - Increasing behavioral skills.
- Decreasing behaviors related to post-traumatic
stress. - Improving self-esteem.
- Individual targets negotiated with the client.
takes years :)
What are some skills training techniques in DBT?
- Core mindfulness skills.
- Interpersonal effectiveness.
- Emotion modulation skills.
- Distress tolerance skills.

What are some mindfulness skills?
Mindfulness ‘what’ skills - Observe, describe and participate
Mindfulness ‘how’ skills - Non-judgemental and accepting stance
Reasonable mind - Rational, logical, cool etc…
Emotion mind - Emotions in control, influence thinking and behaviour
Wise mind - Integration of reasonable and emotion mind
so..
radically accepting the moment
want to use both emotion and wise mind
What are some interpersonal effectiveness skills?
Attending to relationships
Relationship myths - “I can’t stand it if someone gets upset with me” - what would be the worse that could happen? help them tolerate bad feelings
Enhancing interpersonal effectiveness - ASSERTIVENESS - Getting objectives met in relationships - Saying no or setting limits – self rights
Identification of thoughts and emotions in interpersonal
situations - If you feel rejected, what would be a good way to cope with that without hurting yourself?
Skills training for skills deficits
Skills practice - Asking shop assistant for help, disagree with someone’s opinion, ask friend for help fixing something
What are some emotion regulation skills?
- Identifying and LABELLING emotions - labelling it can reduce emotional arousal. “I feel ashamed”.
- Taking OPPOSITE action - if you feel shame, then behaving in the opposite way (NOT withdrawing), will help you less shame. (similar to behav. activation)
- Increasing positive emotional events
- DISTRACTION particularly during crisis - how to get through a crisis without making it worse - Distraction is a bad long term solution, but it’s better than hurting yourself in the short term.
- Pleasant EVENTS SCHEDULING

Distress tolerance skills?
These are Crisis survival skills:
DISTRACT - Activities, contributing to someone or something, downward comparisons, leave the situation for a while, count to 10, watch TV, puzzles, read books, listen to music, hold ice in hand, squeeze rubber ball very hard, have a very hot shower etc…
SELF-SOOTHE with five senses- E.g., buy a flower, listen to what you can hear, scented candles,
favourite meal, special foods, bubble baths, pet a dog or cat etc…
IMPROVE MOMENT- Meditation, imagery, prayer, relaxation, present moment awareness /
mindfulness practice
RADICAL ACCEPTANCE - Major focus of DBT
Is anger in session helpful?
No.
We want to create a way that they can with hold and deal with the anger, rather than just venting.
Link behaviours 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 - always!!
Apologise or repair rupture if you made a mistake - important for those who are hypersensitive.
Don’t avoid issues that generate emotion if they are going to be useful to deal with and work on
Therapy Interfering Behaviours ?
- Late arrival to session, or early leaving
- Do not do activities
- Talks in group sessions / excessive talking in individual
sessions - Becomes angry in therapy, abusive
- Critical of therapist or other group members
- Presenting to therapy intoxicated
- Talks about their own self-harm to other group members
5 goals of DBT?
- enhance capabilities
- increase motivation
- enhance generalisation to natural enviro
- structure the enviro
- enhance therapist capabilities and motivation to treat effectively.
