Lecture 11: Dialectical behaviour therapy

Question 1

What is DBT?

Answer 1

Based on CBT, suicide prevention and Zen principles. Significantly reduces suicidal behaviours and self-injury + significant improvements in interpersonal functioning and emotion regulation. Goal is to build a life worth-living through minimizing therapy-hindering behaviour and destabilizing behaviours which are obstacles in a valuable life. There is NO suicide prevention program

Question 2

Who is DBT developed for?

Answer 2

Evidence based Treatment program developed for severely suicidal patients with or
without automutilation and later extended to addiction, eating disorders, trauma,
depression, antisocial personality and forensic problems.

Question 3

What is the origin of DBT?

Answer 3

First used to treat troublesome patients like those with BPD who were seen as untreatable, manipulative and unmotivated. First developed for suicidal patients and based on her own experiences

Question 4

What is the biosocial theory?

Answer 4

Blue line: When something happens (incentive) it takes time to process, you process it (stress and arousal builds up) and eventually it goes down, then something else happens (second peak) but then it goes down again.

Red line: with BPD people are really sensitive, the arousal levels are already higher, when something happens, they respond really quick, the incentive reaction is steeper, and it takes more time to regulate. When a new incentive arises, there is a new peak, goes down a bit, again a peak, goes down a bit, and then there is a huge peak, and this is unbearable. The only thing to do to regulate this emotion is to kill yourself.

—> difference in temperament between ‘normal’ people and people with PD
Describes that patients do not have sufficient or limited skills to regulate emotional problems, helps to strengthen or learn new skills

Question 5

What are the assumptions for DBT?

Answer 5

These guide the treatment approach so the therapist and patient have a shared understanding and positive, collaborative framework.
Key Assumptions:
1. 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 he lps
to foster a non judgmental and compassionate therapeutic environment.
2. The Patient Wants to Improve:
DBT operates on the belief that patients inherently desire to improve their lives and well being. This encourages motivation an d a
forward looking perspective in therapy.
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
8.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.

Question 6

What does the treatment consist of?

Answer 6

• Self-chosen treatment goals based on a hierarchy and clear agreements between patient, practitioner and team.
• treatment strategies based on CBT, ZEN and suicide prevention
• 4 components of weekly structure group training (practice and coaching), structured individual (motivating and analyse obstacles) and telephone consultation (generalizing) and consultation team (monitor and improve qualities + therapist wellbeing)

Question 7

Which 3 principles guide therapist’s thought dilemmas?

Answer 7

• dialectics (recognize polarity in behaviour + continuous change and coherence)
• acceptance (mindfulness and observing without judgement)
• change (behaviourism= behaviour shaping through repetition and operant conditioning)

Question 8

What are the skills in DBT?

Answer 8

• mindfulness which is addressing identity confusion and feelings of emptiness
• interpersonal effectiveness which is managing unstable relationships and fear of abandonment
• emotion regulation is controlling mood swings and intense anger
• frustration tolerance is reducing impulsive behaviour and self harm

Question 9

What has been found about effectiveness in autism and suicidal ideation?

Answer 9

DBT is effective in reducing suicidal thoughts and attempts in adults in the short term but not significant at follow-up.

Question 10

How has DBT been adapted for adolescents?

Answer 10

Has been effective, showing outcomes in reducing self-harm behaviours and shows flexibility and effectiveness across different age groups and issues

Question 11

What is the general efficacy and safety of DBT?

Answer 11

1. DBT continues to be a well
   received and safe treatment option.
2. Studies report low attrition rates and no severe adverse events, indicating good patient tolerance (

Question 12

How does DBT treat emotion regulation disorders?

Answer 12

1. DBT emphasizes teaching skills to manage intense emotions, cope with challenging situations, and improve relationships.
2. The incorporation of mindfulness and acceptance techniques is crucial for emotional regulation and reducing problematic behaviors