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Dialectical Behavior Therapy: DBT Primer Marci Martel, Ph.D. LCMHC
Real life Therapy November 2010
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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
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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.
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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.
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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
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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
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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
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Balance Skills Emotion Regulation Mindfulness Change Acceptance
Self-Regulation Interpersonal Effectiveness Distress Tolerance November 2010
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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.
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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
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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.
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Distress Tolerance Is about learning tolerate frustration.
It’s about being able to deal with stress, drama and crises in skillful ways.
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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.
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Interpersonal Effectiveness
Is about being effective in relationships. Here individuals balance investment in relationships, commitment to self, and the ability to communicate effectively.
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