1. Dialectical Behavior Therapy: DBT Primer Marci Martel, Ph.D. LCMHC
Real life
Therapy
November 2010

2. DIALECTICAL BEHAVIOR THERAPY (DBT)
aims to change
problem behavior
teach new skills
improve quality of life
help people learn to value themselves and each other

3. DBT Background
Developed by Marsha Linehan, Ph.D. as a therapy model that has been researched and validated.
Internal Distress
External Experiences
Dialectics are things that seem to be in conflict and yet they are both real or true.
Two major Philosophical points
Clients/Students are doing the best they can and need more skills to be effective.
Clients/Students have not caused all their problems but they have to solve them anyway.

4. DBT Assumptions Person is doing best they can.
Person wants to improve.
Person needs to do better, try harder, and be more motivated to change.
Person may not have caused all of their own problems, but she has to solve them anyway.
The lives of emotionally dysregulated individuals are unbearable as they are currently being lived.
People must learn new behaviors in all relevant contexts of their lives.
Person cannot fail in DBT.
Staff treating emotionally dysregulated persons need support.
Person is not fragile.

5. THE DBT MINDSET
Hold a balance of the student’s strengths and areas for growth
Have thorough knowledge of the skills
Plan for resistance
Role play skills
Assign skills as practice
Provide coaching for skill development
Empower students
Accept student “as is” or “in process”
Avoid negative talk or viewing the student negatively
Be centered and firm
Establish clear limits of acceptable behavior
Be non-defensive
Manage your own countertransference
Talk to peers/staff/supervision/therapy
Practice and know DBT skills yourself
Manage transition
Help student analyze behaviors that interfere
Practice good self-care
Keep balance in your relationship

6. EMOTIONAL DYSREGULATION
Affective Dysregulation
Problems with Anger
Interpersonal Dysregulation Chaotic Relationships
Fears of Abandonment
Self Dysregulation
Identity Disturbance/Difficulties with Sense of Self
Sense of Emptiness
Behavioral Dysregulation
Serious Behaviors/Threats
Impulsive Behaviors
Cognitive Dysregulation
November 2010

7. EMOTION VULNERABILITY
BECAUSE YOU FEEL EMOTIONS MORE INTENSLY THAN OTHERS YOU HAVE:
EMOTION VULNERABILITY
This means that you have…
A High sensitivity
Your feelings get hurt more easily
You often have an emotional reaction when others do not
A High reactivity
Your reactions are more extreme than others
When your emotions are so intense it becomes difficult for you to think clearly
It takes a long time for you to CALM yourself down and return to normal
Your reactions are long lasting
This makes you more vulnerable to the next situation
November 2010

8. Balance Skills Emotion Regulation Mindfulness Change Acceptance
Self-Regulation
Interpersonal
Effectiveness
Distress
Tolerance
November 2010

9. DBT’s aim in creating a validating environment is to teach the individual to trust and validate her own emotions, thoughts and activities.
The DBT Model suggests to focus on skills training and behavior change, as well as on the validation of the individual’s current capabilities and behaviors.

10. What Happens in DBT? Dialectical strategies Irreverence/warmth
Compassion and non-judgment
Hope
Responding differently than other person has
Exposure, response prevention, opposite action to urges
Person is able to tolerate aversive states
Commitment
Problem solving
Acceptance
Validation
Mindfulness, Interpersonal Effectiveness, Emotion Regulation, Distress tolerance skills
Insight
Cognitive modification

11. Mindfulness Is about being in the here and now most of the time.
It’s about doing one thing at a time.
When individuals use mindfulness in their lives, they are able to stay in balance, remain non-judgmental and be as effective as possible.

12. Distress Tolerance Is about learning tolerate frustration.
It’s about being able to deal with stress, drama and crises in skillful ways.

13. Emotional Regulation Is about learning impulse control.
This includes tolerating, managing and coping with emotions, impulses, urges and cravings while not acting automatically or without thinking it through.

14. Interpersonal Effectiveness
Is about being effective in relationships.
Here individuals balance investment in relationships, commitment to self, and the ability to communicate effectively.