Lecture 10: Dialectical Behaviour Therapy Flashcards
on what 3 basic principles is DBT based
- CBT
- suicide prevention
- zen principles
what is the ultimate goal of DBT
building a life worth living
what are the 8 key assumptions of DBT
- The Patient is Doing Their Best: It is assumed that at any given moment, the patient is doing the best they can with the skills and resources they have. This helps to foster a non-judgmental and compassionate therapeutic environment.
- The Patient Wants to Improve: DBT operates on the belief that patients inherently desire to improve their lives and well-being. This encourages motivation and a forward-looking perspective in therapy.
- The Patient Needs to do Better, Try Harder, and be More Motivated to Change: Despite doing their best, patients must strive for improvement, increasing their efforts and motivation to achieve better outcomes.
- The Patient May Not Have Caused All Their Problems, but They Have to Solve Them Anyway: This emphasizes personal responsibility and empowerment, encouraging patients to take active steps towards resolving their issues, regardless of their origin.
- The Lives of Suicidal Patients are Unbearable as They are Currently Being Lived: Acknowledging the profound distress and pain in patients’ lives underscores the urgency and necessity of change and intervention.
- Patients Must Learn New Behaviors in All Relevant Contexts: For change to be effective and sustainable, patients must apply new skills across different areas of their lives, not just in therapy sessions.
- Patients Cannot Fail in Therapy: It is recognized that if the patient is not benefiting from therapy, it is the therapy or the therapeutic approach that needs adjustment, not the patient who is failing.
- Therapists Treating Borderline Patients Need Support: Therapists also need a supportive environment to deal with the challenges of treating complex cases, which is why DBT includes a consultation team for therapists.
explain the biosocial theory
perspective describes that people in childhood have a severe mismatch between their temperament and their environment which leads to them not having sufficient and/or limited skills to regulate emotional problems, DBT helps by strengthening these skills
The normal is that something happens that leads to emotions/stress, stress goes up and then after a while it goes down again
In DBT patients, they respond earlier to the event and every time something new happens so their stress builds and builds until it reaches a high point where they feel the only way out is to self-harm/try suicide
what are the 5 functions and modes of DBT
- individual therapy: improve the clients motivation to change; building a strong and genuine connection; replace problematic behaviours with effective ones; weekly diary card to track emotions/skills used/thoughts/behaviors etc
- skills training group: enhance clients capabilities to solve problems; mindfulness activity, review prior skills, learn new skills, homework
- phone coaching: facilitate generalisation of capabilities to natural environments (via message or call); most effective for specific reasons (eg. asking for validation, assistance with using skills)
- consultation team: enhance therapist motivation and capabilities to treat clients effectively; therapists support each other
- case management: help structure the environment to bolster client and therapist capabilities; managed by administrative support person who takes care of the practical details
what are 4 roles included in a consultation team
- team leader = the one that treats the client
- meeting leader = runs the agenda
- meeting observer = highlights when non-mindfulness/judgmental language is spoken
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note taker = keeps track of the conversation and what is said
–> these roles (except for the first one) rotate every time
what are 4 unique characteristics of consultation team
- community of therapists treating a community of clients
- focus on client and therapist behaviors
- focus of therapist vulnerability
- emphasis on dialectics
chain analysis
= helps client and therapist detect patterns/sequences that lead to problematic behaviours –> identifying what led to the problem behaviour (chain) and why each element of the chain led to the next (links)
what are the 4 stages of treatment
Stage 1: improve behavioural control and increase skills use: diary card; collaboratively establish agenda loosely following the structure of the treatment targets
Stage 2: improve emotional regulation and experiencing: can be sequentially or concurrently with stage 1
Stage 3 & 4: bolstering overall quality of life and improving capacity for yoy: learning more traditional CB and acceptance-based therapeutic skills for managing distress, cultivate regular mindfulness practice
what are the 5 treatment targets of DBT
- self-harm and life-threatening behaviors: highest priority; explain with warmth/honesty; talk about it, dont avoid, exposure with self-harm scars
- therapy-interfering behaviors: addressed openly and non-judgmentally; arriving late, not doing the homework, misusing phone coaching, etc
- quality-of-life interfering behaviors: limit motivation; mental health crisis (eg. depression, anxiety, ptsd), financial crisis, problems at home
- skills acquisition: mindfulness, interpersonal effectiveness, emotion-regulation, distress-tolerance techniques
- dialectics and dialectical dilemmas: reality is made up of polarising forces and change occurs through tension/synthesis of these polarities
what is the primary dialectic and what are 3 dialectics falling under that primary one
primary dialectic is between acceptance and change
3 additional dilemmas:
1. emotional vulnerability - self-invalidation: EV = slightest touch to emotions can cause pain, respond with anger/hopelessness/fragility; SI = intense self-loathing and unrealistic perfectionism –> hard to detect so more dangerous
2. active passivity - apparent competence: AP = demanding and willfull help-seeking + helplessness; AC = clients fear ridicule if they share so instead they pretend they’re fine –> internal experiences don’t match what they outwardly express (hard to detect for therapist)
3. unrelenting crisis - inhibited grieving: UC = may result from lack of support/resources, adverse events or crisis-generating behaviours (eg. impulsivity, self-injury, etc); IG = when clients avoid painful emotions related to trauma/loss
what are 3 principles to guide therapists through dilemmas
- dialectics: recognising the polarity in behaviour and the importance of continuous change and coherence
- acceptance (mindfulness): observing without judgment
- change (behaviourism): behaviour shaping through repetition and operant conditioning
what are 4 skill modules and what do they belong to
- Mindfulness = Addressing identity confusion and feelings of emptiness
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Frustration tolerance = Reducing impulsive behavior and self-harm
–> belongs to acceptance - Emotion regulation = Controlling mood swings and intense anger
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Interpersonal effectiveness = Managing unstable relationships and fear of abandonment
–> belongs to change
what are the 4 stages of the house of treatment
- Severe behavioural dyscontrol
- Quiet, Desperation
- Problems in living
- Incompleteness
