L11: Dialectical Behaviour Therapy

Question 1

How did DBT originate?

Answer 1

• dev by Linehan in early 90s to treat pervasive & severe issues
• based on CBT, suicide prevention, and zen principles
• EBT dev for severely suicidal patients w or w/o self injury & later extended to addiction, EDs, trauma, depression, ASPD, forensic problems

Question 2

What is DBT effective for?

Answer 2

• sig reduces suicidial behaviours & self injury
• sig improvements in interpersonal functioning & emotional regulation

Question 3

What is the goal of DBT?

Answer 3

building a life worth living
ex: reducing (para) suicidal behaviour, therapy hindering behaviour, and other serious,d angerous, or destablizing behaviours that stand int he way of a valuable life
not a suicide prevention program!
1. enhance capabilities
2. improve motivation
3. generalaze to natural environment
4. support each other as therapists
5. structure environment

Question 4

What is the biosocial theory behind DBT?

Answer 4

as humans, if something happens, we take time to process it & we have a reaction
ex: some stressor happens (someone makes a comment about you), so your stress goes up, but then it goes down again
-> ppl w PD dont have sufficient and/or limited skills to regulate these emotional problems (or stressors)
-> DBT helps by strengthening these skills or learning new skills

Question 5

What theory is DBT based on?

Answer 5

biosocial theory

Question 6

What does DBT consist of?

Answer 6

3 main principles: mindfulness (zen), dialectics (seeing that 2 things are true), behaviourism (CBT)
1. setting goals in stages (commitment, behavioural control, nonanguished emotional experiencing, individual goals, freedom)
2. making agreements (w client, w team, w urself)
3. using strategies (include: problem solving, validation, dialectical strategies, need structure)
4. keep track of assumptions & fair expectations (on client, on therapist, on biosocial theory) so u can be understanding
5. keep track of main goals

Question 7

What does the practical side of DBT look like?

Answer 7

• contains self chose treatment goals based on a hierachy & agreemetns between patient, practitioner, and team
• treatment strategies based on CBT, ZEN and suicide prevention
• nr of assumptions to support the practtioners
• 4 components: weekly structure group training (practice & coaching), structured individual (motivating & analyse obstacles), telephone consultation (generalizing), and a consultation team (monitoring & improving qualities and keeping therapists healthy)

Question 8

What are the key assumptions in DBT?

Answer 8

1. Patient is Doing Their Best
2. Patient Wants to Improve
3. Patient Needs to do Better, Try Harder, and be More Motivated to Change
4. Patient May Not Have Caused All Their Problems, but They Have to Solve Them Anyway
5. The Lives of Suicidal Patients are Unbearable as They are Currently Being Lived
6. Patients Must Learn New Behaviors in All Relevant Contexts & Areas of life
7. Patients Cannot Fail in Therapy: therapy needs adjustment if its not working, its not the patient failing
8. Therapists Treating Borderline Patients Need Support

Question 9

What are the 3 key principles in DBT?

Answer 9

• dialectics: recognising the polarity in behaviour & importance of continuous change & coherance
• acceptance/mindfulness: observing w/o judgment
• change/behaviourism: behaviour shaping through repetition & operant conditioning

Question 10

What are the 4 main skill modules taught in DBT & what problem behaviour do they fix?

Answer 10

Mindfulness: addressing identity confusion and feelings of emptiness
Interpersonal effectiveness: managing unstable relationships and fear of abandonment.
Emotion regulation: controlling mood swings and intense anger
Frustration tolerance: reducing impulsive behavior and self-harm.

Question 11

What are the 3 central principles of dialectic philosophy?

Answer 11

• wholeness
• polarity
• continuous change

Question 12

What is the “house of DBT”?

Answer 12

an allegory used to teach clients about the 4 stages of DBT:
1. improving behavioural control & increasing skills use
2. improving emotional regulation & experiencing
3. bolstering overall quality of life through dev fulfilling relationships
4. improving capacity for joy

Question 13

What is chain analysis?

Answer 13

the primary insight tool of DBT
functions to slow down the events leading to a problematic behaviour so that the client can more clearly see their patterns of thinking, feeling, and actign

Question 14

What is solutions analysis?

Answer 14

teaches clients that when faced with a problem, they can either solve it, change their emotional response, tolerate or accept it, or do nothing and potentially make it worse