Week 6 - DBT Flashcards
What are the key concepts of DBT?
-Borderline personality disorder
-Biosocial theory
-Emotional dysregulation and Emotional regulation
-Dialectical philosophy
-Behaviorism
-Zen Buddhism and Mindfulness
What are the seven basic assumptions of DBT?
- People are doing the best they can
- People want to improve
- Although people are doing the best they can, if they are suffering, they need to try harder and be even more motivated to change
- People may not have caused all of their own problems, but they have to solve them anyway
- New behavior has to be learned in all relevant contexts
- All behaviors (actions, thoughts, emotions) are caused
- Figuring out and changing the causes of behavior is a more effective way to change than judging and blaming.
What is DBT’s understanding of the person largely based on?
The biosocial model of personality formation, credited mostly to Theodore Millon.
What does the biosocial model of personality formation suggest?
Children are born with specific constitutional factors related to their physical ability, intellect, drive, energy and temperament.
A child’s emotional world can be impcated by how these factors are sharped through childhood experiences.
Childhood experiences that create a negative or invalidating environment can impact constitutional factors in a manner that lends the child and developing adult toward emotional volatility and dysregulation and associated behaviors, and it puts them at risk of developing BPD ore related mental disorders.
DBT is considered a type of BLANK therapy.
Third wave of cognitive-behavioral therapy.
DBT and other third wave approaches view personality formation as what?
A complex interaction between behavior, biology, and context (environment), and focus on a wide range of techniques to assist clients in accepting and changing their ways of being in the world.
True or False: DBT does not solely focus on changing specific behaviors as did first-wave cognitive-behavioral therapy.
True.
What do DBT and related third-wave approaches tend to emphasize?
Mindfulness, emotions, acceptance, relationships, values, goals, and meta-cognition along with a number of traditional behavioral techniques and modified cognitive techniques when working with clients.
How is DBT different than traditional cognitive therapy (second-wave CBT)?
DBT focuses on adopting an increasingly flexible and relativistic view of the world, so the person is not embedded in rigid ways of thinking, which tend to exasperate problems.
Recognizing that change is slow and difficult but possible for most clients, DBT suggests the importance of what?
Radically accepting clients and encouraging them to accept themselves.
Borrows skills from person-centered therapy such as building a strong therapeutic alliance through listening.
Also, other techniques borrowed from existential therapy and gestalt therapy are used to encourage clients to examine what is important in their lives and help them see the polarities in themselves.
What are the symptoms of BPD?
-Frantic efforts to avoid imagined abandonment
-Instability in interpersonal relationships
-Identity disturbance
-Impulsivity
-Suicidal behaviors
-Emotional instability
-Chronic feelings of emptiness
-Inappropriate or intense anger
-Stress-related paranoid ideation or dissociation
Linehan suggested that a BLANK environment from important caregivers can result in heightened emotional responses in some children, difficulty in regulating one’s emotional responses, and a slow rate of returning to normality—symptoms typical of individuals with BPD or related disorders.
Invalidating
Individuals with BPD and related disorders struggle with BLANK, which is the difficulty or inability to moderate one’s emotional experiences
Emotional dysregulation
What is another term for cognitive distortions?
Stuck thoughts.
Individuals who have difficulty regulating their emotions do what?
-Are run by their emotions
-Have difficulty processing information and cues from others
-Demonstrate impulsive behaviors
-Have difficulty processing information and cues form others
-Have difficulty making decisions
-Have behaviors that are dictated by cognitive distortions (all or nothing thinking, overgeneralizing, etc.)
True or False: DBT was originally used solely for people with BPD, but was expanded and used with a wider class of individuals seeking counseling.
True
What does dialectical philosophy suggest?
That reality is interrelated and connected, made of opposing force, and always changing.
Reality is grounded in polarities that are always in tension, within the client, within the counselor, and between the client and counselor.
In contrast with other forms of cognitive-behavioral treatments that focus on changing symptoms, Linehan suggested what?
A dialectical framework should be the foundational philosophy that grounds the change process.
What is the overarching dialectic of DBT?
Acceptance vs change.
Example: clients who experience themselves as failures need to envision their successes.
Helping clients accept their current state of being, while also helping them recognize the possibilities of change, is the hallmark of the work of DBT.
What are three common dialectical dilemmas of people with BPD due to emotional dysregulation?
-Active passivity vs. apparent competence
-Emotional vulnerability vs. self-invalidation
-Unrelenting crisis vs. inhibited grieving
The first 3 are biologically based, in which the person is underregulated or emotionally out of control and the second three (after the vs.) are socially based, in which the person is overregulated or attempts to control one’s emotions.
Neither are good.
What is active passivity?
When a person allows and even encourages others to determine their fate rather than taking an action oneself.
What is apparent competence?
The feigning of ability to the point that other people do not know, and cannot read, stressful situations a person may be going through.
What is inhibited grieving?
A state in which they avoid or negate their emotions.
What traditional behavioral principles are used in first-wave CBT?
Classical conditioning, operant conditioning, and modeling paradigms
What are second-wave CBT?
Rational-emotive behavior therapy and Aaron Beck’s CBT, which added an important component—the internal world of the client.
Both first and second wave CBT focused on what?
Problem-solving strategies, which Linehan soon realized that the constant focus on changing the problem was frustrating to most clients.
True or False: With DBT, counselors needed to accept that progress would be slow, that clients would have periodic setbacks and periodic gains, and when working with highly volatile clients, needed to be constantly cognizant of their risk for suicide and self-harm.
True
Most DBT counselors will complete a BLANK of the client’s situation, which examines how behaviors are linked to a person’s problems.
Functional behavior analysis
In the change process, DBT counselors will do what?
-Apply first-wave cognitive-behavioral techniques (operant conditioning, classical conditioning, and modeling)
-Help clients examine rigid beliefs (I am right, you are wrong)
-Suggest more flexible ways of thinking
-Use a wide range of other techniques to help clients integrate dialectical opposites and become less reactive to the world.
What are the four modes that occur concurrently during the DBT therapeutic process?
-Individual counseling
-Group skills training
-Consultation team meetings
-Between-session phone coaching
How long does DBT treatment typically last?
four to five hours per week for 6 months to a year
What are the four stages of individual therapy?
-Stage I: focus on safety and stabilization (behaviors that are life-threatening, interfere with therapy, decrease quality of life)
-Stage II: focus on behaviors that cause misery
-Stage III: a focus on behaviors that cause problems in everyday living
-Stage IV: Focus on finding deeper meaning, spiritual fulfillment, and ongoing capacity for joy
True or False: Structuring therapy is important.
True.
Example: greet the client, address the affective state of the client, conduct mindfulness, etc.
What is a diary card?
Helps clients focus on their emotions during the week, helpful to know if the client is suicidal.
What is chain analysis?
Detailed examination of a problematic behavior that needs to be addressed.
What are some of the most frequently used dialectical communication skills in DBT?
-Radical acceptance
-Reciprocal communication
-Irreverent communication
-Playing the devil’s advocate
-Using metaphors
-Making lemonade out of lemons
-The exception rule
-The wise mind
-Role reversal
-Understanding the three common dialects
Counselors who use DBT should be familiar with the basics of which behavioral techniques?
-operant conditioning
-classical conditioning
-modeling
-first-wave behavioral techniques
Whereas traditional cognitive therapies view thoughts as something that need to be replaced or disputed, in DBT thoughts are what?
One additional mechanism that can increase cognitive complexity and help a client consider other points of view.
How many cognitive distortions are there?
14, such as black and white thinking, regret orientation, overgeneralizing, selective information, etc.
What does group skills training consist of?
-mindfulness
-distress tolerance
-emotional regulation
-interpersonal effectiveness
*acceptance and change skills
DBT skills are taught in order and divided into which four sections?
- beginning ritual
- review of homework practice since the last session
- presentation of new material
- closing wind-down
Linehan created three hierarchical goals that are worked toward in skills training, which are?
- stopping behaviors that very likely will destroy therapy
- acquisition, strengthening, and globalization of skills
- reducing behaviors that interfere with therapy
Linehan describe the BLANK and BLANK skills of mindfulness
What skills: involve observing events, emotions, and behavioral responses without labeling or terminating them
How skills: describe the process of observing, describing, and participating in mindfulness.
What are the two overarching modules that DBT teaches?
-Crisis survival skills
-Reality accepting skills
What are crisis survival skills?
-Short-term solutions used to help tolerate painful situations and lessen the likelihood of a client acting impulsively.
-STOP skills
-Pros and cons
-TIP skills
-distracting with wise mind ACCEPTS
-self-sooth
-IMPROVE the moment
What are reality accepting skills?
-Reduce the suffering that is associated with crisis and increased freedom for individuals when painful situations can’t be changed.
-radical acceptance
-turning the mind
-willingness
-half-smiling and willing hands
-mindful of current thoughts
What are emotional regulation techniques?
-understanding and naming emotions
-changing unwanted emotions
-reducing vulnerability to the emotional mind
-managing extreme emotions
Through BLANK, a client learns how to strengthen and use interpersonal skills.
Group skills training
What are three kind of interpersonal effectiveness techniques?
-Obtaining objectives while maintaining relationships and self-respect
-Building relationships and ending destructive ones
-Walking the middle path
What do obtaining objectives while maintaining relationships and self-respect do?
These skills teach individuals how to get what one needs, how to say no, and how to effectively manage interpersonal conflicts.
What do building relationships and ending destructive ones do?
Focuses on developing and maintaining relationships and on ending relationships that may be damaging or destructive
What does walking the middle path do?
Teaching dialects, validation, and strategies for changing behavior
What are consultation team meetings?
Weekly meeting, lasting on average 60 to 90 minutes consisting of two to eight professionals.
Therapy for the counselor is important, as working with clients with BPD can be extremely taxing. Make sure there isn’t any consultation-interfering behavior and if the therapist continues to miss the meetings, the provider should no longer state they are a DBT counselor.
What is between-session coaching?
Usually happens by phone, time-limited, specific rules, must use it if they want to harm themselves
-Help build therapeutic alliance
-Help stop suicidal or self-harming behaviors
-Help reinforce skills learned
-Help in offering immediate help with a conflict arises
What are the five components of DBT?
-Pretreatment change
-Four stages of individual therapy
-Group skills training
-Consultation team meetings
-Between-session coaching
What happens during pre-treatment stage?
-orientation and commitment
-assessment
-psychoeducation
-explanation of the purpose and process
-boundaries of the relationship
-verbal or written agreement
What happens during individual therapy?
-Structuring therapy
-Diary card
-Chain analysis
-Dialectical communication skills
-Behavioral skills
-Cognitive skills
-Reinforcing group skills training
