Dialectical Behavior Therapy - PowerPoint Presentation

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Dialectical Behavior Therapy - PPT Presentation

Paulette Aasen PhD Director of Psychology Services West Central Human Service Center Bismarck ND 701 3288888 Badlands Human Service Center Dickinson ND 701 2277500 February 10 2014 ID: 264227

therapy dbt behavior clients dbt therapy clients behavior amp relationship dialectical skills behaviors therapist change disorder commitment environment linehan life personality www

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Slide1

Dialectical Behavior Therapy

Paulette Aasen, Ph.D

Director of Psychology Services

West Central Human Service Center

Bismarck, ND

(701) 328-8888

Badlands Human Service Center

Dickinson, ND

(701) 227-7500

February 10, 2014Slide2

Overview of DBT

Developed by Marsha

Linehan

, Ph.D., in 1993 as treatment for clients struggling with severe & persistent emotional, behavioral, & thought difficulties, especially those diagnosed with Borderline Personality Disorder.

Dr.

Linehan

recently shared that she struggles with Borderline Personality Disorder.

The Goal of DBT:

“Create a life worth living.”Slide3

Foundations of DBT

DBT is a synthesis of three paradigms:

Dialectics

Behaviorism

Mindfulness

Purpose:Reducing dysfunctional behaviorsIncreasing skillful behaviorsBuilding a life worth livingClient needs validating environment in which s/he is taught to regulate emotions, deal with interpersonal conflicts, tolerate distress, and find balance.

Swenson,

Witterholt

, &

Bohus

, 2007Slide4

Linehan

Diagnosis for

Borderline Personality Disorder

Emotion Dysregulation

Affective

labilityProblems with angerInterpersonal DysregulationChaotic relationships

Fears of abandonment

Self Dysregulation

Identity disturbance – difficulties with sense of selfSense of emptinessBehavioral DysregulationParasuicidal behaviorImpulsive behaviorCognitive DysregulationDissociation / paranoid ideation

(

Linehan

, 1993)Slide5

Bio-Social Model

Biological Sensitivity

AND

Invalidating Environment =

Dsyregulation

Disorder Symptoms

Invalidating

Environment

Biology

Invalidating

Environment

Invalidating

Environment

Biology

BiologySlide6

Bio-Social Model (cont.)

High Sensitivity

High Reactivity

Slow Return to Baseline

Often “Transactional” with the EnvironmentSlide7

Slow Return to Baseline

EmotionsSlide8

Dialectical Paradigm

Dialectics is the theory that opposites can co-exist.

Hegel

: “Process of change in which a concept or its realization passes over into and is preserved and fulfilled by its opposite.”

Bohr

: “The Universe is so constructed that the opposite of a true statement is a false statement, but the opposite of a profound truth is usually another profound truth.”Slide9

Dialectical Paradigm

From DBT Self Help at http://www.dbtselfhelp.comSlide10

Dialectics: A Model for Change

Movement Over Time

Thesis

Synthesis

AntithesisSlide11

Primary Dialectic in DBT

Acceptance

ChangeSlide12

Dialectical Dilemmas

Unrelenting Crisis

Social

Biological

Emotional Vulnerability

Apparent Competence

Active Passivity

Self-Invalidation

Inhibited ExperiencingSlide13
Slide14

Dialectical Strategies

Balance Treatment Strategies

Enter the paradox

Metaphor

Devil’s Advocate

ExtendingWise Mind“Lemonade out of lemons”Allowing natural changeDialectical AssessmentSlide15

Behaviorism Paradigm

From DBT Self Help at http://www.dbtselfhelp.comSlide16
Slide17

Behavior Therapy Basics

Behavioral Principles necessary to be effective

Behavior Therapy: a non-biological form of therapy that developed from learning theory. The purpose is to change maladaptive patterns of behavior.

Shaping: Divide a behavior to be learned into a series of steps.

DBT: Harm reduction model so shape clients toward thatSlide18

DBT Assumptions about Clients

Clients are doing the best they can.

Clients want to improve.

Clients need to do better, try harder, and be more motivated to change.

Clients may not have caused all of their own problems, AND they need to solve them anyway.Slide19

Assumptions about

Clients (cont.)

The lives of suicidal individuals with Borderline Personality Disorder are unbearable as they are currently being lived.

Clients must learn new behaviors in all relevant contexts.

Clients cannot fail in DBT.Slide20

Assumptions About Therapy

The most caring thing a therapist can do is help clients change in ways that bring them closer to

their own

ultimate goals.

Clarity, precision, and compassion are of utmost importance in conducting DBT.

The therapeutic relationship is a real relationship between equals.Slide21

Hierarchy of Targets

Individual Therapy

Life threatening behaviors

Therapy interfering behaviors

Quality of life interfering behaviors

Increasing behavioral skillsSlide22

Client Agreement

Client and Therapist BOTH sign the agreement to acknowledge what it is they are agreeing to in the therapy relationship.Slide23

Session Structure

Review Diary Card

Attention to Target Hierarchy

Chain Analysis on highest targeted behavior

Weave in Solution Analysis

Continue to move down hierarchy until able to discuss skills related to current life situations or session time endsSlide24

Commitment Strategies

Therapist discusses

PRO’s

and

CON’s

of commitment to changeUse the DEVIL’S ADVOCATE technique to strengthen commitment and build sense of controlHighlight PRIOR COMMITMENTS consumer has madePresent consumer with CHOICE stressing the freedom to choose while presenting the consequences of choices clearly and directlySlide25

Commitment Strategies (cont.)

Therapist uses principles of

SHAPING

to elicit commitment

Therapist generates hope by

CHEERLEADINGTherapist and client agree on HOMEWORKSlide26

Validation of Consumer

Stay Awake

Accurate Reflection

Articulating

unverbalized

emotions, thoughts, and behavior patternsValidation in terms of past learning or biological dysfunctionValidation in terms of current context or normative functioningRadical GenuinenessSlide27

Self-Verification Theory

Validation = Self-Verification

Invalidation of Self-Construct leads to

AROUSAL!!

! (Sense of out-of-control)

HIGH AROUSAL + OUT-OF-CONTROL leads to >>>>Failure to process New Information =NO NEW LEARNING!Slide28

Relationship Strategies

Accept the relationship as it is in the current moment, use the relationship as therapy –

YOU

are the Key

Use problem solving on the relationship

Attend directly to generalization of behaviors learned in the relationshipSlide29

Be honest about limits

Be consistently firm

Combine Soothing, Validating, & Problem Solving with Observing Limits

Warm Engagement:

Limits on Warmth

Coping with anger/rage at the consumerWarm engagement and touch in psychotherapyGenuinenessSlide30

DBT Skills

Group

Screening session

1-year commitment

Both client and therapist sign agreement

Agreement includes statements regarding homework completion and attendanceCo-facilitatorsSlide31

Hierarchy of Targets

DBT Skills Group

Therapy destroying behavior

Skills acquisition, strengthening, and generalization

Therapy interfering behaviorsSlide32

Zen Practice

Be Mindful to the current moment

See reality as it is without delusions

Accept reality without judgment

Focus on one’s own experiencing as a means of understanding the world

Let go of attachments that obstruct seeing and accepting reality as it isUse skillful meansFind the middle waySlide33

Mindfulness Paradigm

Mindfulness is at the core of

Emotion Regulation

(emotions, thoughts, and behaviors).

Distress Tolerance

(skills used to help us cope and survive during a crisis, distracting or soothing activities).Interpersonal Effectiveness (skills which help us to attend to relationships, balance priorities versus demands, balance the “wants” and the “shoulds,” and build a sense of mastery and self-respect.

From DBT Self Help at http://www.dbtselfhelp.comSlide34

Mindfulness

“Paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experiences moment by moment.”

(

Kabat-Zinn

, 2003, p. 145).

Non-JudgmentPatienceBeginner’s Mind or Child’s MindTrustNon-Striving

Acceptance

Letting Go

Kabat-Zinn, 1990Slide35

5 Stages of Accomplishment

Denial