The Behavioral Technology Transfer Group 4556 University Way NE l Seattle WA 98105 Phone 2066758588 l Fax 2066758590 Web wwwbehavioraltechcom informationbehavioraltechcom ID: 535998
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Dialectical Behavior Therapy Presentation Materials
The Behavioral Technology Transfer Group
4556 University Way NE
l
Seattle, WA 98105
Phone
206/675-8588
l
Fax
206/675-8590
Web:
www.behavioraltech.com
information@behavioraltech.comSlide2
Theory of
Borderline
Personality Disorder
in DBTSlide3
BPD is a Pervasive Disorder of the Emotion Regulation System
BPD criterion behaviors function
to regulate emotions or
are a natural consequence of emotion dysregulation Slide4
Biosocial Theory of BPD
Pervasive Emotion Dysregulation
Biological Dysfunction in the Emotion Regulation System
Invalidating
EnvironmentSlide5
Emotion Dysregulation
Inability to
Modulate Emotions
Emotional VulnerabilitySlide6
Invalidating Environment
Pervasively
negates
or
dismisses behavior independent of the actual validity of the behaviorSlide7
Change
Core
Problem
Solving
Acceptance
V
alidation
Team
Consultation
Reciprocal
Environmental
Intervention
Consultation-
to-the-Patient
Case Management
Communication
DIALECTICAL
IrreverentSlide8
Balance Core Strategies
Dialectics
VALIDATION
PROBLEM
SOLVINGSlide9
Dialectics as Persuasion
A method of logic or argumentation by disclosing the contradictions
(antithesis)
in an opponent
’s argument (thesis) and overcoming them (synthesis).Slide10
Dialectics within therapy
Dialectics can be used within therapy to help clients start to think less in black and white and more in
“
gray
” (e.g., a person can be be “good” but still make a mistake) Slide11
Translating a Dialectical World View
into Treatment
Provides foundation of biosocial etiology
1. Transactional development and maintenance
2. Systemic disorderDialectically informs treatment strategies1. Balance of Acceptance vs. Change2. Search for "what is left out"3. Emphasis on speed, movement, flow
Dialectically informs treatment goals
1. Emotion regulation
2. Interpersonal effectiveness
3. Mindfulness
4. Distress toleranceSlide12
Goals of Treatment by Level of Disorder
Dialectical Synthesis
Level 1: Severe Behavioral Dyscontrol
Behavioral ControlLevel 2: Quiet Desperation Emotional Experiencing
Level 3: Problems in Living
Ordinary Happiness & Unhappiness
Level 4: Incompleteness
Capacity for Joy and Freedom
Slide13
Decrease
Life-threatening behaviors
Therapy-interfering behaviors
Quality-of-life interfering behaviors
Increase behavioral skills Core MindfulnessDistress ToleranceInterpersonal EffectivenessEmotion Regulation Self-Management
Stage 1 Primary Targets
Dialectical Synthesis
Severe Behavioral Dyscontrol
Behavioral Control Slide14
14
Structure
the Milieu and Modes
of Treatment
Standard DBT is Outpatient TreatmentSlide15
Standard DBT Modes
Outpatient Individual Psychotherapy
Outpatient Group Skills Training
Telephone Consultation
Therapists’ Consultation MeetingUncontrolled Ancillary Treatments Pharmacotherapy Acute-Inpatient PsychiatricSlide16
Five Functions of
Comprehensive Treatment
1.
Enhance capabilities2. Improve motivational factors3. Assure generalization to natural environment4. Enhance therapist capabilities and motivation to treat effectively
5.
Structure the environmentSlide17
The Overarching
DBT
Goal
is...A LIFEWorth LivingSlide18
Behaviors to increase
Behaviors to decrease
Mindfulness skills
Identity confusion
Emptiness
Cognitive dysregulation
Interpersonal skills
Interpersonal chaos
Fear of abandonment
Emotion regulation skills
Labile affect
Excessive anger
Distress tolerance skills
Impulsive behavior
Suicide threats
Parasuicide
Goals of skill training Slide19
Six month skills training cycle
Continuous loop
Interpersonal skills (6 weeks)
Mindfulness (2 weeks)
Emotional regulation (6 weeks) Mindfulness (2 weeks) Distress tolerance (6 weeks) Mindfulness (2 weeks) Slide20
Mindfulness Skills
Mindfulness is about learning to control one
’
s mind instead of letting the mind control you.
To a certain extent, learning to control the mind is learning to be in control of attentional processes. Inability to control attention can cause problems (inability to stop thinking about things). Western + eastern meditation practices, yoga are all practices that help control mind. They are hard and take practice. Slide21
Mindfulness Skills: Three types of mind
Rational Mind: rational, thinking, logical mind.
Emotional Mind: In emotional mind when your emotions are in control of thinking or behavior. Emotional mind is important.
Wise mind: integration of rational mind and emotional mind. Wise mind is that part of each person that can know and experience truth. It is the integration of many types of knowing, knowing by observing, analyzing, knowing by what we experience in our bodies. Slide22
Mindfulness: being a personal scientist: what skills
Observe: pay attention to current moment.
Step back and watch what
’
s happening inside of you and outside of you. Control attention but not content. Describe: Put words to experience. Just describe facts without your own theories.Feel the feelings -- Drop the story-line Participate- Enter completely into the moment.