Created by Marsha - PowerPoint Presentation

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Created by Marsha LinehanAli Gold

Dialectical Behavioral Therapy(DBT)Slide2

What is DBT?Marsha M.

Linehan developed DBT in 1993 when CBT and other therapies proved to be unsuccessful with a “specific type” of clientsThese clients were emotionally unstable, sometimes suicidal, and usually engaged

in self-destructive behaviors- typically diagnosed with borderline personality disorderDBT targets BPD and also other disorders such as depression, bipolar disorder, PTSD, anxiety, eating disorders, alcohol/drug abuse, and in any combination Slide3

The Human MindThe human mind is like a radio, it is hard wired differently each time. Some people are wired to experience frequent, stronger emotions than most.

Trauma can also create stronger specific emotions, as can a chemical imbalance left untreatedSlide4

BPD and DBT ClientsMany factors contribute to BPD and the DBT client but two stand out:

Emotional vulnerability- quick, intense, difficult to control emotions; like a rollercoasterInvalidating environment- the failing to treat a person in a manner conveying respect, attention, or understanding ex. A shy family member in an outgoing family being teased for his or her shynessSlide5

DBT TherapyIndividual therapy once or twice a week

Usually includes patient filling out a daily diary card: rates urges/thoughts/actions/emotions and records skill useGroup therapy once a week for at least 6 monthsPhone coaching- a client can call/text their therapist in order to receive skills coaching before engaging in a target behavior

Focuses on 4 modules: mindfulness, emotional regulation, interpersonal effectiveness, and distress toleranceSlide6
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Dialectics

You can’t walk in the same river twice.Slide8

Dialectics

You can AND can’t walk in the same river twice.This is a dialectical statement. A dialectic is an idea in which two seemingly opposite statements can be true. This component is crucial to DBT because it helps clients think in a more open and less judgmental way. The concept of dialectics helps balance the mind and find the middle path between two extremes.

Change is the only constant in life. With this idea,

we can more easily find acceptance.Slide9

MindfulnessGoals:Increase awareness of internal and external experiences as they occur

Learn how to non-judgmentally and effectively observe, describe, and participate in events and experiencesIncrease ability to focus attention on one thing in the momentLearn to be in control of your mind rather than your mind being in control of youSlide10

Mindfulness

Activities: meditating, prayer, yoga, walking, anything as long as you are being mindful and in the moment!Mindfulness aims to reduce suffering, increase happiness, and experience reality as it really isHelps us find wise mind-

both reason and emotion are integrated and find balance- the middle pathSlide11

MindfulnessExercise:

Hold a piece of wrapped gum, be in a quiet environment, focus solely on the gum and nothing else, let thoughts and judgments passObserve it: sight, smell, touch, (taste)Unwrap it and let it rest on your tongue without chewing, observe sensesTake ONE chew, observe senses

Chew and observe and discussCould you stay focused, one in the moment?Slide12

Emotion RegulationGoalsUnderstand emotions and how they function

Increase awareness of emotional experienceIncrease control over difficult emotionsIncrease positive experiences

Decrease emotional sufferingSlide13

Emotion Regulation: ABC PLEASEAccumulate positive experiences- do pleasant things, “build a life worth living”

Build mastery- do things that make you feel competent and effectiveCope ahead for emotional situations- rehearse/plan out in order to feel prepared to cope skillfully with stressful situationsSlide14

Emotion Regulation: ABC PLEASE

(treat) Physical illnessLather, rinse and repeatE

at (balanced and well)Avoid mood altering substances (alcohol, drugs, caffeine too!)Sleep (enough and not too much)

E

xercise

TAKE CARE OF YOUR MIND BY TAKING CARE OF YOUR BODY!Slide15

Emotion Regulation: examples of mind-body connection

Your body and mind are connected. Taking care of one is taking care of the other. Example of someone with depression: This person is depressed; they sleep all day and don’t have healthy eating habits. Without the proper nutrients or beneficial amount of sleep, this person will have even more difficulty managing emotions,

possibly making them more depressed.Another note: let’s say the once depressed person is recovering and doing well. Then, they get sick and as a result are more tired and begin to sleep more. Their body will associate sleeping more with being depressed, so that person will be apt to feeling low. How do we cure the low mood? Trick the body and do the opposite!! Eat well, balance the sleep, and get up and out! Even just smiling WILL lift the mood!Slide16

Interpersonal Effectiveness (IPE)GoalsBuild and maintain relationships

Learn how to set limits and boundariesEffectively asking for what you want and/ or needPrioritizing and organizing wants/needsBuilding mastery and preserving self-respectSlide17

IPE: DEARMAN- getting what you want or setting limitsD

escribe the current situationExpress your feelings and opinions about the situationAssert yourself by asking for what you want or saying “no” clearly

Reinforce or reward the person ahead of time by explaining consequences, good or bad(stay) Mindful, keep the focus on your objectives

A

ppear confident and effective

N

egotiate, be willing to give and getSlide18

IPE: FAST and GIVE

FAST: maintain self-respect and communicate personal limits(be) Fair- both to yourself and othersNo over A

pologizing- confident body languageStick to values- don’t sell out your own values and integrityBe T

ruthful-don’t lie, act helpless, or exaggerate

GIVE: Repair and/or build relationships that you care about

(be)

G

entle- be courteous, no attacks, no threats, no judging

(act)

I

nterested- actively listen, eye contact too!

V

alidate-acknowledge the other person’s feelings, wants and difficulties… “I can understand how you might feel”

(use an)

E

asy manner- a little humor never hurts, smile and ease the person alongSlide19

IPE: CONCEPT

“Do you want to be right,

OR BE

EFFECTIVE?”

~Michael Hollander, DBT SpecialistSlide20

Distress Tolerance (DT)Goals

Learn how to effectively tolerate painful experiencesIncrease awareness of how distress is represented in your lifeLearning how to decrease suffering through acceptance of reality

Increasing willingness over willfulnessSlide21

DT: Crisis Survival Strategies- TIPP

“TIPP” your body chemistry (great for anxiety and anger)

Temperature-submerge your body (face especially) in ice cold water, put an ice pack on your chestThis extreme cold enacts the divers reflex in your body (cheek bones/nose, chest, back of neck) which physiologically slows down your heart rate from 10-25%

I

ntense exercise- at least 20 minutes, get the heart rate up!

P

rogressive Muscle Relaxation (PMR)- clench and release each muscle one at a time

P

aced Breathing-focus on how long each breath in and out is, goal is to exhale longer than inhaleSlide22

DT: Crisis Survival Strategies- ACCEPTS

Distract yourself from painful emotions when things cannot get better right awayActivities- exercise, hobbies, cleaning, friendsContributing- volunteer, give gifts, be thoughtful

Comparisons- find reasons for appreciation(opposite) Emotions- emotional books, music, TV

P

ushing away- leave the situation, no ruminating

(other)

T

houghts- count things, puzzles, TV, read

(other)

s

ensations- hold ice, stress balls, showersSlide23

DT: Crisis Survival Strategies- self-soothe

Self-soothe with the five sensesVision- art museum, observe nature, photos

Hearing- music, nature, instruments, waves, rainSmell- lotions, candles, flowers, cookies, Taste

- yummy meal, tea, hot cocoa, gum, candy

Touch

- bath, pets, massage, comfy chair, hugsSlide24

DT: Crisis Survival Strategies- IMPROVE

IMPROVE the momentImagery- imagine relaxing scenes or views, let your mind lay open, beautiful, calming fantasy worlds

Meaning- create purpose, meaning or value in the pain, focus on positivesPrayer- God, a higher being, yourself, beliefsR

elaxation- PMR, hot tub, bath, breathe deeply

O

ne thing in the moment- focus/stay in the present, be fully aware

(brief)

V

acation- bundle up in a blanket, sit on a park bench for an afternoon, a one-hour breather

E

ncouragement- cheerlead yourself, “It won’t last forever,” “I can stand it,” etcSlide25

DT: Reality AcceptanceRadical Acceptance: Accepting what you cannot change in the moment; turning the mind over to acceptance- it is

your choice to accept or notWillingness: let go of judgments and do what is effectiveKeep

long term goals in mind!Make a pros and cons sheet of benefits and negatives of long term and short term actionsSlide26

Non-DBT Skills Taught With DBTConsulting to the Patient

CBTProblem SolvingMentalizingSlide27

Consulting to the Patient

Goal: To be effective in handling treatment/any medical issue…managing the systemInteract effectively with psychiatric/medical caregivers toGet emergency careGet meds added/changed/discontinued

Communicate needsUnderstanding the systemHow/why caregivers make decisionsUnderstand professionals are doing the best they can and are fallible

It’s about getting the patient involved and aware about medical specialists’ decisions on what goes into the patient’s body and why. It’s about honesty- as a patient you know your body best!Slide28

Cognitive Behavioral Therapy (CBT)

How thoughts affect our mood and behavior:Ex. A student studies hard and works hard to learn math concepts. He receives a 62% on his first big test. He feels discouraged and depressed and skips the next class, considers dropping the class altogether, and considers changing his career goals.

Usually this creates a pattern. A way to break the cycle is to change one of the steps. In this case, and CBT, we change the thought process. We can’t change what we think but we can change how we think. We can identify cognitive distortions.Slide29

CBT Cognitive Distortions

Cognitive Distortions are biases in information processing associated with our negative mood states. We do it all the time! It’s the way our mind makes sense of things in the blink of an eye. Remember,

thoughts aren’t facts!Ex. All or nothing thinking- everything is black and white, right and wrong, good and bad; if you fail one test you’re a total failure

Emotional Reasoning-

You assume your negative emotions reflect reality; I feel guilty, I must be a rotten person

Jumping to conclusions-

Mind Reading: without fact, you immediately assume someone is negatively reacting to you; you walk by a group of kids talking and “you know” they’re talking about you

Fortune Telling: You predict things will turn out badly; “you know” you’re going to flunk a test… before you take it! Or, if you’re depressed, “I’ll never get better.”Slide30

Ways to Approach a ProblemSolve the problemChange your relationship to the problem

Radically accept the problemStay MiserableMake the problem worse

Steps to Problem Solve

Observe/describe

the problem

Check the facts

(get rid of distortions)

Identify the goal

(what needs to happen to feel ok; keep it realistic)

Brainstorm solutions

(as many as you can!)

Choose a solution

likely to work (pick two, make a pros and cons to compare them, pick the best)

Put the solution into action

!

Did it work? If not, try a new solution.

Problem SolvingSlide31

Mentalizing

Mentalizing is a process by which you are able to represent and understand the thoughts, feelings, wishes, beliefs, and desires in yourself and in others. Mentalizing requires that you take a

curious and unattached stance about all situations. Imagine there’s a bubble around everyone’s head, and in that bubble lay thoughts, feelings, behaviors, etc. Mentalizing

is being curious and open and guessing what’s in your own and others’ bubbles. A further step may be guessing what’s in someone’s bubble and guessing how your own bubble impacts his or hers.Slide32

Failures to Mentalize

Mentalizing is like a muscle, with practice it gets stronger. Many times, we as humans fail to mentalize

.“Psychic equivalence”- if I feel it, then it must be true; “I feel unlikable therefore nobody likes me.”“Pretend Mode” or “Pseudo-

mentalizing

”-

It’s like you’re in autopilot. Instead of

mentalizing

and being present you just agree with others’ explanations about you. Perhaps someone assigns an explanation to one of your behaviors and it sounds kind of right, so you agree. Where’s the curiosity?

“Teleological Stance”-

when one feels that an internal experience is only real if there is evidence in the physical world. “If you loved me you would have given me flowers;” “I am only smart if my teachers

call

on me a lot in class.”Slide33

DBT

ABC’s of DBT:AcceptanceBalanceChange

Thank you for your patience and listening. If ever you find someone (a friend, OR YOURSELF!) who you think could benefit from DBT or worries you because they’ve been engaging in self-destructive behaviors, don’t be afraid to notify a trusted adult. It’s nothing to be embarrassed about, DBT truly changes and saves lives. If you have any questions about DBT or personal matters, don’t be afraid to find me. Thanks again!Slide34

CitationsA SPECIAL THANKS:Marsha

Linehan: many books and teachingsClip ArtMcLean adolescent DBT programshttp://www.google.com/imgres?q=a+diary+card+dbt&num=10&hl=en&biw=1024&bih=640&tbm=isch&tbnid=3EowpYOC9eCbjM:&imgrefurl=http://www.docstoc.com/docs/27242334/Mindfulness-Dialectical-Behavior-Therapy-DBT-Skills-Diary-Card&docid=unk-BJd_W4lJiM&imgurl=http://img.docstoccdn.com/thumb/orig/27242334.png&w=1275&h=1650&ei=EGYEUL-hAqrl0QGx-KHfBw&zoom=1&iact=hc&vpx=495&vpy=253&dur=1086&hovh=255&hovw=197&tx=107&ty=143&sig=113041524419178016048&page=1&tbnh=133&tbnw=103&start=0&ndsp=16&ved=1t:429,r:8,s:0,i:100

(diary card picture)