1. 5200 SW Macadam Portland OR 97239 | (503) 290-3282
August 6, 2010
Dialectical Behavior Therapy: Evidence Based Treatment for Suicidal Individuals Jesse Homan, LPC Youth Suicide Prevention Conference September,
5200 SW Macadam Portland OR | (503)

2. Our Focus Together What is DBT?
August 6, 2010
Our Focus Together
What is DBT?
Which patients can most benefit from DBT?
How can you tell if it’s really DBT? (structure, modes, & functions)
What elements matter the most in DBT
What does DBT expect from clients before beginning DBT?
How do you make a referral to PDBTI?
At the end of the session, the learner is expected to be able to:
Gain an awareness of DBT components
Recognize which patients may benefit from a DBT program
Have an understanding of what agreements are made prior to entering a DBT program
Know where to look for additional training, including seminars, on-line and print resources
Agenda:
Overview of DBT Theory and Skills
Practical applications
Expectations for being in a DBT program, individual therapy and skills group
Additional resources
© 2013 Linda Dimeff, PhD & Portland DBT Institute. Please do not reproduce or distribute without permission.

3. What is DBT?
Dialectical behavior therapy (DBT) is a principle-driven, comprehensive, multi-modal treatment for severe, complex and multi-diagnostic patients whose problems are caused or controlled by pervasive emotion dysregulation.
DBT is an integration of three philosophies: cognitive-behavioral, acceptance, & dialectics.
DBT focuses on building a life worth living; it is not palliative care.
© 2013 Linda Dimeff, PhD & Portland DBT Institute. Please do not reproduce or distribute without permission.

4. Which Patients Can Benefit from DBT?
November 4-5, 2011
Which Patients Can Benefit from DBT?
Multiple diagnoses = multiple problems
confusing, crisis-oriented treatment
Poor client retention
inadequate treatment dose
High hospitalization rates & serious suicide risk
interrupted treatment, therapist stress
Relationship-relevant problems
empathy reducing effect, therapist burnout
Noncompliance
power struggles, feelings of helplessness 4

5. Clinical Populations for Whom DBT is Efficacious
November 4-5, 2011
Chronically suicidal individuals
Multi-diagnosed, difficult to treat clients
BPD
BPD + substance abuse
Non-suicidal self-injurious behaviors
Bulimia and binge eating
Depression in the elderly 5

6. DBT Outcomes at a Glance
4/10/2018
DBT Outcomes at a Glance
Reduces:
Suicidal behaviors
Non-suicidal self-injurious behaviors (NSSI)
Depression
Hopelessness
Anger
Eating disorders (binge eating, bulimia)
Substance dependence
Impulsiveness
STD/HIV high risk behaviors
Increases:
Adjustment (general & social)
Positive self-esteem
Treatment retention
© 2013 Linda Dimeff, PhD &Portland DBT Institute. Please do not reproduce or distribute without permission.
Copyright by Marsha M. Linehan

7. DBT and Suicidal Adolescents
August 6, 2010
DBT and Suicidal Adolescents
Mehlum et al,. (2014): RCT of DBT vs TAU DBT to be superior at reducing NSSI, suicidal ideation, and depression at 19 weeks and 1 year follow up.
Multiple non-randomized trials of DBT for adolescents have shown promising results for decreasing suicidal behaviors, NSSI, and increasing QOL.
Only six studies have demonstrated significant decreases in suicide attempts of adolescents, none of these have been replicated
Multi systemic therapy
Developmental group therapy
Mentalization based treatment
Integrated CBT
DBT
Parent only psychoeducation
© 2013 Linda Dimeff, PhD & Portland DBT Institute. Please do not reproduce or distribute without permission.

8. DBT and Suicidal Adolescents
DBT has been adapted for adolescents (Miller, Rathus, & Linehan, 2007).
2nd RCT of DBT for adolescents is underway in the United States, Collaborative Adolescent Research on Emotions and Suicide
© 2013 Linda Dimeff, PhD & Portland DBT Institute. Please do not reproduce or distribute without permission.

9. Is It Really DBT? (How can you tell?)
Look for highly structured integrated comprehensive DBT program (e.g., all modes and functions if outpatient).
Are clinicians intensively trained (5 to 10 days) by an expert?
© 2013 Linda Dimeff, PhD & Portland DBT Institute. Please do not reproduce or distribute without permission.

10. Standard DBT Modes Outpatient Individual Psychotherapy
Outpatient Group Skills Training
Telephone Consultation
Therapists’ Consultation Meeting
Uncontrolled Ancillary Treatments
Pharmacotherapy
Acute-Inpatient Psychiatric
© 2013 Linda Dimeff, PhD & Portland DBT Institute. Please do not reproduce or distribute without permission.

11. DBT Treatment Functions
1. Enhance capabilities
2. Improve motivational
factors
3. Assure generalization to natural environment
4. Structure the environment
5. Enhance therapist capabilities and motivation to treat effectively
© 2013 Linda Dimeff, PhD &Portland DBT Institute. Please do not reproduce or distribute without permission.

12. Stages of Treatment Pre-Treatment:
August 6, 2010
Stages of Treatment
Pre-Treatment:
Stage 1: Severe Behavioral Dyscontrol
Behavioral Control
Stage 2: Quiet Desperation
Emotional Experiencing
Stage 3: Problems in Living
Ordinary Happiness /Unhappiness
Stage 4: Incompleteness
Capacity for Joy and Freedom
Commitment & Agreement
© 2013 Linda Dimeff, PhD &Portland DBT Institute. Please do not reproduce or distribute without permission.

13. Stage 1 Primary Targets Dialectical Synthesis
August 6, 2010
Commitment & Agreement
Pre-Treatment:
Decrease
Life-threatening behaviors
Therapy-interfering behaviors
Quality-of-life interfering behaviors
Increase
Mindfulness
Distress Tolerance
Emotion Regulation
Interpersonal Effectiveness skills
© 2013 Linda Dimeff, PhD & Portland DBT Institute. Please do not reproduce or distribute without permission.

14. disorders, problematic behaviors Global Assessment of Functioning
4/10/2018
DBT Treatment Plan
Solves the problems that interfere with C having/keeping a LWL,
Works strategically & systematically to help C build a LWL.
Reduce
disorders, problematic behaviors
Increase
Global Assessment of Functioning
© 2013 Linda Dimeff, PhD. Please do not reproduce or distribute without permission.
Copyright by Marsha M. Linehan

15. What DBT Elements Matter the Most?
Highly structured, integrated treatment environment.
Empirically supported suicide risk assessment and management protocol.
DBT skills: acquisition, strengthening, and generalization to all relevant contexts.
© 2013 Linda Dimeff, PhD & Portland DBT Institute. Please do not reproduce or distribute without permission.

16. What Does DBT Expect From Clients at Start?
Willingness to give up suicidal and non-suicidal behaviors (if relevant) and/or other high-order target behavior (e.g., heroin use).
Willingness to commit to being in treatment for 12 months, to attend all modes of treatment, and work hard.
Willingness to talk with therapists about behaviors that are interfering with therapy including interpersonal problems between T and P.
© 2013 Linda Dimeff, PhD & Portland DBT Institute. Please do not reproduce or distribute without permission.

17. PDBTI Electronic Referral Form
© 2013 Linda Dimeff, PhD & Portland DBT Institute. Please do not reproduce or distribute without permission.

18. Referral Process: www.pdbti.org
© 2013 Linda Dimeff, PhD & Portland DBT Institute. Please do not reproduce or distribute without permission.

19. Portland DBT Institute Phone: 503.231.7854
August 6, 2010
For more information about us, please visit our website at:
Portland DBT Institute
Phone:
© 2013 Linda Dimeff, PhD &Portland DBT Institute. Please do not reproduce or distribute without permission.