JFKU Mark Purcell PsyD amp Claire Coyne LMFT Different Types of Emotions Anger Sad LOVE Panic Guilt Calm Joy Pain Confused Worried Embarassed Estatic DBT Goals RADICAL ACCEPTANCE ID: 616338
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Dialectical Behavioral Therapy (DBT)JFKU
Mark Purcell,
PsyD
& Claire Coyne, LMFTSlide2
Different Types of Emotions
Anger
Sad
LOVE
Panic
Guilt
Calm
Joy
Pain
Confused
Worried
Embarassed
EstaticSlide3
DBT GoalsSlide4
RADICAL ACCEPTANCE
Grant me the serenity to ACCEPT the things I cannot change,
Courage to CHANGE the things I can,
And WISDOM to know the difference.
4Slide5
DBT Program OverviewSlide6
Dialectics Finding Balance
Dialectics Involves integrating seemingly opposing views
Similar to Eastern Concepts of Non-Duality
Use the word “And” instead of “But”
One Set of Needs or Wants
Opposing Needs or WantsAcceptanceChangeTrustSuspicionDependence
IndependenceCareful, Too FearfulImpulsive, RecklessSurrenderProtect/Fight
Focus on SelfFocus on OthersSlide7
Biosocial Theory
I am Stupid...
There’s something wrong with me
I don’t deserve to live
You’re so stupid!
I don’t understand why you’re so upset
I wish you were never bornConfusion about self; impulsivity; emotional instability; interpersonal problemsSlide8
Emotional Dysregulation
High Sensitivity
Immediate reactions
Reactions with only a little provocation
High ReactivityExtreme reactionsHigh arousal makes thinking clearly difficultSlow return to baselineLong-lasting reactionsHigher sensitivity to next emotional eventDifficulties with changing one’s own emotionsDifficulties with paying attention (e.g., in class) when emotions are feltDifficulty in stopping from acting right away when emotions are felt
Biological Vulnerability to Emotions (Sensitive Wiring)Low Emotional ModulationSlide9
Consequences of invalidating Environment
By not validating feelings, the environment does not teach the individual to:
Label feelings
Effectively regulate emotions
Trust feelingsBy making problem solving seem easier than it is, the environment does not teach the individual to:Effectively tolerate stressForm realistic goals and expectations When communication of anger or sadness is punished and/or when only intense anger or sadness are responded to, the environment teaches the individual to:Vary between having no emotions and having extreme emotions.Slide10
Types of Dysregulation
Emotional
Interpersonal
Self
BehavioralCognitiveSlide11
Dialectical Behavior Therapy
Problems
(Behaviors to Decrease)
Skills
(Behaviors to Increase)Confusion about your selfMindfulness
ImpulsivityDistress Tolerance Emotional InstabilityEmotional RegulationInterpersonal Problems
Interpersonal EffectivenessParent-Youth ProblemsMiddle PathSlide12
Validation
Validation communicates to another person that his/her feelings, thoughts, and actions make sense and are understandable to you in a particular situation.
Validation ≠ Agreement
WHAT should we validate?
Feelings, thoughts, and behaviors in:OurselvesOther People WHY should we validate?It improves relationships
Validation can show that:We are listeningWe understandWe are not being judgmentalWe care about the relationshipConflict is possible with decreased intensity and angerSlide13
Levels of Validation
Validation Level
Goal of Interaction
One
Listen Non-Judgmentally
TwoAccurate ReflectionThreeArticulate Unspoken Thoughts and FeelingsFour
Understanding Historical Background of BehaviorFiveConfirming Thoughts, Behaviors and Feelings Based on Current CircumstancesSixRadical Genuineness & AuthenticitySlide14
Interaction of Emotions, Thoughts
, &
BehaviorsSlide15
Matching Skills with Level of
Dysregulation
EMOTIONAL DYSREGULATIONSlide16
Commitment Strategies
Selling it, evaluating pros and cons
Devil’s advocate
Foot-in-the-door technique
Freedom to choose in absence of alternativesShapingSlide17
Orientation Strategies
Therapeutic Alliance
Connect problems to areas of
dysregulation
and skill developmentDefine problems as targetsLink long-term goals to targetsIntroduce biosocial theory
Introduce tx format/characteristicsIntroduce diary cardsReview agreementsUse commitment strategiesSlide18
Pre-Treatment Goals
Agreement on Goals
Commitment to change
Initial targets of treatment
Agreement to Recommended Tx. Client agreements Therapist agreementsAgreement to Therapist-Client RelationshipSlide19
Treatment Goals
Level 1: Severe Behavioral Dyscontrol
Level 2: Quiet Desperation
Level 3: Problems in Living
Level 4: IncompletenessSlide20
Stage 1 Targets
Decrease
Life-threatening/high-risk behaviors
Therapy-interfering behaviors
Quality of life interfering behaviorsIncrease behavioral skillsMindfullness, distress tolerance, interpersonal effectiveness, emotional regulationSlide21
Therapy-Interfering Behaviors
Client
Non-compliance
Non-collaborative
Non-attendingBehaviors that interfere with other clientsPushing therapists’ limitsReduce therapist’s motivation to treatSlide22
Therapy-Interfering Behavior
Therapist
Extreme acceptance or change
Extreme flexibility to rigidity
Extreme nurturing or withholdingExtreme vulnerability or irreverenceDisrespectful BehaviorsSlide23
Quality of Life Interfering Behaviors
Incapacitating DSM Disorder
High risk sexual behavior
Extreme financial difficulties
Criminal behaviors Severe interpersonal dysfuntionUnemployment, severe school problemsPhysical health, dysfunctional behaviors
Severe housing difficultiesSlide24
Adol. Secondary Targets
Excessive leniency vs. authoritarian control
Normalizing pathological behaviors vs. pathologizing normative behaviors
Forcing autonomy vs. fostering dependenceSlide25
Diary CardsTrack and observe behaviors in real time
Structure Session
Spring board to Chain and Solution Analysis
Integration of SkillsSlide26
Diary CardsSlide27
Chain Analysis
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VULNERABILIES
PROMTING EVENTS
PROBLEM BEHAVIOR
CONSEQUENCESSlide28
Solution Analysis
Identify goals, needs, desires
Generate solutions
Evaluate solutions
Choose a solution to implementTroubleshoot solutionSlide29
Responding to Problems
Solve the problem
Change emotional reaction to problem
Tolerate/accept the problem
Stay miserableSlide30
DBT Consultation Agreements
To accept a dialectical philosophy
To consult with patient on how to interact with other therapists
Consistency of therapists is not expected
Observe own limits, without judgmentSlide31
Consultation Agreements Con’t
Search for non-pejorative, empathic interpretation of client’s behavior
All therapists are fallibleSlide32
DBT Team Responsibilities
Plan and trouble shoot treatment
Monitoring adherence to DBT
Progress towards DBT competence
Consult to the therapistSupport to therapist and team members