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DBT and Social Work Practice

History of DBT, DBT Modules, DBT use in Practice
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Nicole Labonte

on 10 December 2012

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Transcript of DBT and Social Work Practice

Lindsay Baiko, Ali Knight, Nicole Labonte & Bethany Peterson Dialectical Behavior Therapy Issue Conclusion Module 1-Core Mindfulness Emotional Mind, Reasonable Mind and Wise Mind Module 1-Core Mindfulness Module Skills Module 1-Core Mindfulness What can we do? Mindfulness daily Module 2 -Interpersonal Effectiveness Priorities and Effectiveness Module 1 -Core Mindfulness Understanding Core Mindfulness requires us to first look at Marsha Linehan’s theory on Emotional Mind, Reasonable Mind
and Wise Mind.










The Emotional Mind is when our mind is being completely controlled by emotions. Sometimes when we are controlled by anger or fear, the emotion can so volatile, we have a hard time seeing reason. We are often most vulnerable in this state and can be easily swayed one way or another.

The Reasonable Mind is when we are thinking logically and are rational about what is actually happening. We look at things analytically in a calm fashion without being swayed by our emotions about the situation.

The Wise Mind is when the Emotional Mind and Reasonable Mind overlap. This is when our mind is both logical and emotional. We can tell we are using our Wise Mind when we get a sense of intuition, this is sometimes described as an “aha” moment. The mindfulness module involves learning 6 mindfulness skills. There are three "what" skills and three "how" skills. What does all this mindfulness mean and how do people use it? Actually, you or
anyone can incorporate these skills into daily life by attending to the following tasks daily.

•Focus and shift your attention between your thoughts, feelings, physical sensations, and actions in order to be mindful of your present-moment experience.
•Let go of distracting thoughts and judgments by allowing them to float past without getting stuck on them so that you don’t get distracted from what’s happening in the present moment.
•Use radical acceptance to remain nonjudgmental.
•Use wise mind to make healthy decisions about your life.
•Do what’s effective in order to accomplish your goals.

“Mindfulness is like a FLAME”
Focus and shift your attention to be mindful of the present moment.
Let go of distracting thoughts and judgments
Use radical Acceptance to remain nonjudgmental
Use wise Mind to make healthy decisions.
Do what’s Effective to accomplish your goals.

(McKay et al., 2007, p. 108)

Try a Core Mindfulness activity for yourself:
https://www.box.com/shared/694hcic0l2 Module 2-Interpersonal Effectiveness A variety of 'priorities' exist during any interpersonal encounter; how a person handles
these priorities dictates how he or she feels about how he/she managed the situation.
(Anestis, 2009) Objectiveness Effectiveness DEAR MAN is one way in which this skill is developed:

Describe
Express
Assert
Reinforce

Mindful
Appear confident
Negotiate Module 3-Emotion Regulation Emotions: The Basics Emotion regulation skills in DBT focus on reducing negative emotional stress by nonjudgementally acknowledging the primary emotion and engaging a learned set of specific skills.

Emotional dysregulation involves experiencing a level of emotional vulnerability and having an inadequate level of skills needed to regulate emotions.

Goals of Emotion Regulation:
Understand emotional experience
Reduce emotional vulnerability
Decrease emotional suffering Introduction to Dialectical Behavioral Therapy Module 3-Emotion Regulation Identifying Emotions Module 3-Emotion Regulation Module 3-Emotion Regulation "P.L.E.A.S.E. MASTER" Marsha Linehan suggests focusing on the “P.L.E.A.S.E. MASTER” acronym to help keep ourselves less vulnerable to the negative emotions that can control our thoughts. Module 4-Distress Tolerance What is Distress Tolerance? Distress Tolerance is defined as "the ability to effectively accept emotional pain in situations that cannot be changed" (Choate, 2012, p.66) Module 4-Distress Tolerance Accepting Reality Skills Skills include:
Observing ones breath
Half-smiling
Awareness

Three basic principles of accepting reality
Radical Acceptance
Turning the Mind
Willingness Module 4-Distress Tolerance Crisis Survival Skills Engaging in activities that help a client to function without resorting to behaviors that make things worse (Linehan, 1993)

Four Crisis Survival Strategies
Distract with “Wise Mind ACCEPTS”
“IMPROVE the Moment”
Pros and Cons
Self-Sooth Using the 5 Senses
(Choate, 2012, Linehan, 1993) Module 4-Distress Tolerance Strategy Measurement Tools References Why did we choose Dialectic Behavioral Therapy?
We chose to focus our project on Dialectical Behavioral Therapy (DBT) because it is a treatment modality we were all interested in learning more about because our group had varying levels of knowledge of DBT and how DBT works. We decided we wanted to learn about what DBT was and how it is can be implemented into the field. Our presentation goal is to share with you a general understanding of how DBT works and how it can be implemented into our field. Background Information Dialectical Behavioral Therapy was developed over 20 years ago by Marsha Linehan for the treatment of Borderline Personality Disorder (BPD). Linehan and her research team were trying to apply standard cognitive behavioral therapy to women whom had reoccurring suicide attempts, suicidal ideation and self-injurious behavior to create behavioral changes in their lives. The team discovered that due to the complex personality dynamics of the targeted treatment population, standard CBT needed some modification. People diagnosed with BPD can be extremely sensitive to anything they view as criticism, so Linehan created a treatment modality that centered around acceptance and positive change that clients could work towards (Corrado, 2009).

Please view the following video to hear Marsha Linehan (2009) talk about the development of DBT. DBT and Social Work Practice: Empowerment Course Connection: Mindfulness with clients Benefits of Distress Tolerance Helps a client distract and self-soothe
Prevents impulsive decisions or actions and helps to consider pros and con of actions
(Choate, 2012, Baer, 2006) Distress Tolerance Skills Build directly on mindfulness skills (Baer, 2006)
Two types of skills:
Skills for accepting reality
Skills for crisis survival
(Choate, 2012) What is it? “Mindfulness refers to the quality of attention or the quality of awareness or the quality of presence that you bring to every day life. It's a way of living your life awake. Which is to say, with your eyes open, instead of your eyes closed. You know most people live their lives as if their eyes were closed a good part of the time.”
Marsha Linehan
(Dietz, 2012) Help clients to accept life in the moment, even when the moment is painful or uncomfortable. Half-Smiling Slightly turning up your lips with a relaxed face to trigger positive emotions associated with a smile (as your body is one with your mind) Observing One's Breath Awareness Basic Principles of Accepting Reality -Radical Acceptance Basic Principles of Accepting Reality -Turning the Mind Basic Principles of Accepting Reality -Willingness Wise Mind A.C.C.E.P.T.S. I.M.P.R.O.V.E. the Moment Pros and Cons Self-soothe using the Five Senses Vision -Art, Nature

Hearing -Music

Smell- Aroma-therapy

Taste -Preferred foods

Touch -Preferred textures

(Choate, 2012) Introduction to DBT: The Basics Activities -Distract with healthy activities

Contributions -Help others when feeling distressed

Comparisons -Compare to how you were doing prior to treatment

Emotions -Engage in emotions opposite to current negative emotion

Pushing away -Exerting control over thoughts and disengaging from the immediate negative environment

Thoughts -Distract with neutral thoughts like counting the number of tiles in the room, reading the titles of all the books on your bookshelf, etc...

Sensations -Distract with physical sensations

(Anestis, 2009, Arnold, n.d., Linehan, 1993) Imagery -Imagery is used to shift from the current situation to soothe

Meaning -Making meaning out of difficult situations in order to accept the situation more readily

Prayer -Pray to be fully open in the moment (not praying to take away the suffering or ask why).

Relaxing -By de-stressing the body we can often experience less pain

One thing in the moment- Used to help focus on one thing in the moment in a crisis as not to get overwhelmed.

Vacation-Taking a mental break from a stressful situation

Encouragement -Talking to yourself gently and positively to help get through the situation


(Anestis, 2009, Arnold, n.d., Linehan, 1993) DBT in Action Interview with a DBT Facilitator Jennifer Appleby, Clinical Supervisor for the Spurwink Southern Region Residential Program, responded to the following questions regarding her experience with DBT and adolescents... Out of the four DBT modules (Mindfulness, Emotion Regulation, Interpersonal Effectiveness, Distress Tolerance), what would you consider the MOST DIFFICULT for clients to learn and achieve? Insight as to why? "I think it truly depends on the client as each person has a spectrum of challenges and strengths that are unique. That said, in some ways Mindfulness can be the most challenging for the following reasons:

1. It can be misunderstood as either simply relaxation or meditation. As opposed to the cultivated practice of being totally aware and immersed in each moment in a non judgmental and self-observing kind of way, thereby leading to a sense of calm and self-control.

2. Mindfulness asks us to be alert in a different way. Many times our kids feel more comfortable being active as activity helps people feel powerful or in control. Mindfulness can feel passive and therefore vulnerable. Our kids begin to feel anxious when they feel vulnerable, which of course then makes teaching mindfulness more challenging." Out of the four DBT modules (Mindfulness, Emotion Regulation, Interpersonal Effectiveness, Distress Tolerance), what would you consider the EASIEST for clients to learn and achieve? Insight as to why? "In some ways Interpersonal effectiveness can be the easiest to learn and achieve. Most kids are more in touch with their desire for friends and relationships than they may be for the benefits of tolerating distress or regulating their emotions. The rewards are more tangible. It also is a process that they do in tandem with someone else, which helps shift the focus from the work being something you do all by yourself to something you do with other people. I have also seen great success with D.E.A.R M.A.N. which kids seem to understand, and be able to successfully implement without the same level of practice as some of the skills in other modules." From your experience, what have clients identified as the most helpful aspect of DBT? "Many kids like that it is more like a class and less like a therapy group. i.e. it is about skills and not processing feelings. It feels hands-on and concrete. They can articulate what they are working on and learning, which is often challenging for the kids we serve." For a person newly facilitating a DBT group, what advice would you give them? 1. Meet with potential participants before they join the group to assess their commitment; and to review expectations. Buy-in is essential and even one or two participants who are not engaged can derail your group quickly.

2. Make it fun and interesting. The more fun it is, the more likely kids will want to keep returning and working.

3. Use different methods of getting your points across. Remember that in any group you have visual, auditory, kinesthetic and tactile learners.

4. Think about time of day….groups at day’s end, after school, can be hard to generate energy for (yours or theirs)

5. Find ways to celebrate their success and help them concretize their learning.

6. Use kids to teach other kids. Many times you can have a client who is very familiar with DBT who might be checking out. Pulling them into an assistant/mentor role can be effective for the other clients and the leader. Requires making a list of the pros and cons of tolerating the distress in the moment and not tolerating the distress in the moment while focusing on long term goals. (Linehan, 1993) Deep breathing
Counting your breath
Consciously following your breath (Linehan, 1993) Awareness...
of the position of the body
of connection to the universe
during everyday tasks
during meditation (Linehan, 1993) (Choate, 2012, Linehan, 1993) Linehan, M. (1993). Skills training manual for treating borderline personality disorder. New York, NY: Guilford Press (Linehan, 1993) Linehan, M. (1993). Skills training manual for treating borderline personality disorder. New York, NY: Guilford Press Linehan, M. (1993). Skills training manual for treating borderline personality disorder. New York, NY: Guilford Press Linehan, M. (1993). Skills training manual for treating borderline personality disorder. New York, NY: Guilford Press (J. Appleby, personal communication, December 4 2012) (J. Appleby, personal communication, December 4 2012) (J. Appleby, personal communication, December 4 2012) (J. Appleby, personal communication, December 4 2012) (J. Appleby, personal communication, December 4 2012) Module 2 - Interpersonal Effectiveness Example Situation: I share an office with two other people, one of whom calls a friend weekly to spend an hour, minimum, talking loudly about non-work related stuff...this drives me insane and I am becoming quite angry about it. Describe Express Assert Reinforce (stay) Mindful Appear Confident Negotiate I'm not sure if you noticed but Rachel (other office mate) and I have to either leave the room or put headphones on when you talk on the phone with Jan each week. It's really difficult to get any work done when you're talking so loudly with Jan about her love life and your lack of one... I have been feeling extremely frustrated with having to adjust what I'm doing so that you can continue to talk to Jan weekly during work hours. I would really like it if you would not call Jan while I am here working. I think there would be less tension in the office and our relationship would be better if you would respect my need for a quiet work environment The Functions of Emotions:
Communicate to and influence others
Organize and motivate action
Can be self-validating (positive or negative) Identifying emotions is a key component to ultimately understanding them and the responses that come from them. DBT focuses on being mindful and present with one’s emotions in order to appropriately identify them. The following questions help to identify emotions; think about each of them in the context of an emotional reaction you have had recently. • What was the prompting event? What prompted the emotion?
• What is your interpretation of the event? Often it is our interpretation of the event that makes the difference in the emotional response.
• What body changes do you notice? Listen to these body changes and take a deep breath if needed!
• What action urges do you recognize? How do you want to react to this emotion?
• Are you fully expressing/communicating your emotions?
• What after effects do you feel (physically, behaviorally) following your emotional reaction? 5 Subsystems in understanding (and later learning to regulate) emotions: • Emotional vulnerability to cues (triggers)
• Internal and/or external events that are emotional triggers and the evaluation of such
• Emotional responses (including physiological, cognitive, experiential and action urges)
• Verbal and nonverbal expressive responses and actions
• After effects of the initial emotion

(DiGregorio, 2011) [*Video (Penderson, 2012)] A technique for working to change one’s emotional reactions is “opposite to emotion action”. The idea is to help manage distressing emotions by engaging in a helpful action in attempt to counteract the negative emotion. It is important to not try to suppress the emotion, but recognize it, and engage in a positive action (taking a walk, talking to a friend, putting energy into something that will make one feel better) rather than the negative action that may be the initial response action.
(DiGregorio, 2011) Emotion regulation involves practice of previous skills along with focusing on maintaining mindfulness and compassion for the self. DBT clinicians suggest these reminders when practicing emotion regulation skills:

DON’T PANIC – don’t run away from your emotions and remember that you will not always feel like this.
Change your expectations of self, don’t expect to do what you were doing before.
Spend time on self comforting activities
Embrace your sensitivity – try not to judge your emotion, just recognize it.
Get plenty of rest and eat well
Be as gentle and compassionate with yourself as you can! Forgive yourself and see yourself as you would see other people that are hurting This is where I make sure to stay focused on the issue at hand, and avoid veering off on tangents initiated by my office mate. For example, if my office mate were to respond with 'well Rachel eats with her mouth open and that's disruptive too!' I might respond with something like 'I know, but right now we're talking about your calls to Jen' while remaining CALM. Who likes conflict?! Most people avoid confrontation like the plague. Try to think of a time when you felt very confident and reenact the body posture and facial expressions you communicated then. Whether negotiation applies or not depends on the situation and is up to YOU to decide. In this example, my goal is pretty straightforward - a (relatively) quiet work environment, so negotiation (unless that means calling Jen when I'm out of the office) isn't really an option. Module 4-Interpersonal Effectiveness 3 Types of Effectiveness Actions that work to diminish your sense of self-respect over time:

1. Giving in for the sake of approval
2. Lying to please others
3. Acting helpless DBT is a holistic, person centered approach An individual may have a good overall understanding of interpersonal skills but experience a break down in the actual application of these skills when in the midst of an interpersonal situation; this issue is often due to difficulty with emotional regulation, a history of invalidation of emotional responses from others and a lack of coping skills.
(Livesley, 2001) Issue "Individuals with any of the disorders DBT has been shown to treat effectively (BPD, bulimia, and binge eating disorder) are typically charaterized by a tendency to act impulsively when upset...as such, they often act without thinking about consequences due to an overpowering urge to reduce distress."

The result of this pattern of interaction is an increase in conflict with others and strained relationships.

The skills in this module support a person with thinking before acting.

(Anestis, 2009) Issues Continued If the priority is addressed effectively, the individual is likely to feel a sense of self efficacy afterward Relationship Effectiveness 1. Acting in a way that makes the other person want to give you what you are asking for

2. Acting in a way that makes the other person feel good about your saying no to their request

3. Balancing immediate (short-term) goals with what is good for the relationship GIVE is one way in which you can support this effectiveness:

Gentle
Interested
Validate
Easy manner (Dietz, 2012) 3 types of 'effectiveness' must be considered in an interpersonal interaction...
Objectiveness Effectiveness - prioritizing the accomplishment of goals
Relationship Effectiveness - prioritizing the maintenance of a conflict-free relationship
Self-respect Effectiveness - prioritizing your own values/principles Module 4-Interpersonal Effectiveness Effectiveness Skills FAST is a suggested method for developing self-respect effectiveness:

Fair
Apologies (NO apologies)
Stick to values
Truthful
(Dietz, 2012) Self-Respect Effectiveness DBT is a wide range, evidence based approach
DBT has demonstrated it's efficacy in the treatment of:

BPD (Linehan et al., 1999,)
(including BPD in women veterans)(Koons et al., 2001)
Drug dependence (Linehan et al., 1999)
Binge eating disorder (Linehan, Telch, & Agras, 2001)
Opioid dependent women (Linehan et al., 2002)
Depressed older adults (Lynch et al., 2003)

And has shown promise in treating suicidal behavior in adolescents (Miller, 1999), and other many other disorders. DBT considers the interrelationship between the individual and the environment
A continual balancing of treatment strategies occurs as the needs of the client shift
The dialectical theme of DBT removes the pressure to change; rather, it balances change with acceptance
DBT utilizes a multi-modal approach: group and individual sessions, in vivo practice, phone consultation, homework assignments
DBT recognizes the importance of spirituality and supports development of spirituality in clients whose problems stem from lack of this need

(Livesley, 2001; "DBT Resources", 2012) "An operational working definition of mindfulness is: the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgementally to the unfolding of experience moment by moment."
Jon Kabat-Zinn
(McKay et al., 2007, p. 63) DBT is a strengths based approach DBT seeks to build strong self belief and sense of self efficacy through changing exsiting damaging beliefs about the self (and others)

DBT's use of "radical genuineness" (where clinician communicates to the client naturally, rather than with prescribed language) validates client strengths and conveys belief in the client's ability to handle his/her problems, rather than coveying fragility

Client is an active participant in the treatment process from the get go, beginning with self monitoring outside of sessions with clinician

DBT focuses on adaptation and management of difficult situations rather than trying to removing the client from the crisis

Psychoeducation is provided to increase a client's self awareness of the biological basis of his or her problem


(Livesley, 2001) Implications for social work practice DBT’s dialectical emphasis on acceptance and change, along with its emphasis on mindful awareness of one’s body and mind, is a treatment approach that will likely continue to increase in popularity as the pace of environmental and technological change continues to increase - inevitably leading to an increase in stress related disorders, such as depression, anxiety and addiction.

Further research on DBT's efficacy in treating these disorders with different age groups, within this context of rapid change and ever increasing social and environmental disconnection, is needed. The "What" Skills Observe: The skill of observing is being able to look at things as a just an experience. We need to allow ourselves to focus solely on what is there.

Describe: The skill of describing is being able to put our experiences into words. We need to describe everything about the experience, even if it seems insignificant.

Participate: The skill of participating is when we are able to enter into our experience. Letting ourselves “get involved in the moment, letting go of ruminating. Become one with [our] experience, completely forgetting [ourselves]” (Young, 2010).

The information on this slide is combined from the following sources: ("Dialectical Behavior Therapy", 2010) & ("Learning Center", 2012). The "How" Skills P & L:
Treat Physical Illness What would it take for you to take care of your physical illness (if you have one)? E:
Balanced Eating Eat foods that are healthy and make you feel good. A:
Avoid Mood-Altering Drugs These can lower resistance to certain negative emotions; notice how they make you feel. S:
Balanced Sleep Plan your schedule so you get the sleep you need. E:
Get Exercise Regular exercise releases endorphins that are natural anti-depressants. MASTER:
Build Mastery Every day, do things that make you feel confident and challenge you to learn something new. It is important to work on one of these categories at a time. Non-Judgmentally: The skill of being non-judgmental is being able to separate our experience from our thoughts, judgments, opinions and feelings. To be non-judgmental, we need to look at the very basic experience. For example, if you think “a driver is honking behind me”, this is a fact. If you think “the driver behind me is mad at me for not going faster", this is a thought that includes judgments. We are merely assuming the driver is angry because he honked his horn, we don’t actually know that.

One-Mindfully: The skill of one-mindfully is basically doing one thing at a time. We want to be able to take in the present moment. If we are drinking juice, drink juice. If we are walking the dog, walk the dog. To be mindful, we need to live in the present moment concentrating on the one task we are doing.

Effectively : The skill of effectiveness is to be effective in daily life, which sounds obvious, but it is that basic. The idea is “to focus on doing what works, rather than what is "right" versus "wrong" or "fair" versus "unfair” (DBT Self Help, 2012). This skill also teaches us to look at our current situation in the moment, not decide on things based on resentments or past experiences.

The information on this slide is combined from the following sources: (Dietz, 2012) & ("Learning Center", 2012). Dialectical Behavioral Therapy is a form of treatment that combines cognitive behavioral techniques, relaxation and self-soothing techniques and self-awareness techniques. “Core treatment techniques are problem solving, exposure techniques, skills training, contingency management and cognitive modification.” (Linehan, 1993, p.19). This treatment modality emphasizes accepting clients as they are, “while encouraging them and teaching them tools which will enable them to make changes in their life” ("Dialectical Behavioral Therapy", 2010). How does DBT work?
There are four primary modes of treatment involved in DBT:
1.Individual Therapy: The majority of the treatment happens in individual sessions.
2.Group sessions: This is where the four modules are taught, this includes core mindfulness, interpersonal effectiveness; emotional modulation and distress tolerance.
3.Telephone contact: This gives clients the opportunity to contact the therapist by phone between sessions to help the client apply the skills they have learned to real life situations. This goal of this is for real life coaching, not in-depth psychotherapy.
4.Therapist consultation: This is a consultation group for the therapist, where they “work to remain dialectical in their interactions with each other, to avoid pejorative description of the client or therapist behavior, and to respect therapists’ individual limits”
("Dialectical Behavioral Therapy", 2010) What do clients have to commit to during DBT treatment?
At the beginning of DBT treatment, clients are asked to make a commitment to the following:
• attend therapy for at least one year;• attend all scheduled therapy
sessions;
• if suicidal or parasuicidal behaviors are present, the client must agree
to work on reducing these;
• to work on any behaviors that interfere with the course of therapy;
• to attend skills training.

("Dialectical Behavioral Therapy", 2010) Over the course of this semester, we have learned a lot about mindfulness. DBT includes a whole module in it's teachings on core mindfulness. One specific thing we have learned about mindfulness is how to be mindful while in session with our clients. One of the major components of Dialectical Behavioral Therapy is mindfulness for both the client and the therapist. As a social worker providing DBT therapy, we would have to accept where the client is at that moment. Marsha Linehan wanted a treatment modality for people that were being judged by therapists and being pushed from one therapist to the next because of the complexities of working with individuals with Borderline Personality Disorder ("Dialectical Behavior Therapy", 2007).

In the Hick chapters we read, it talked about how being present with clients allows us to realize how much our "inner talk" isn't accurate or helpful to the client. That in fact we can often make conclusions and judgments. Being mindful allows us to listen more deeply (Hick, 2009). Marsha Linehan wants DBT therapist to be mindful of the moment to avoid this judgments. DBT is designed to help therapist keep their judgments and conclusions in check and accept clients for where they are at that present moment ("Dialectical Behavior Therapy", 2007).
Empowerment can be seen as one of the major social work concepts at work during DBT practice. Empowerment-centered social workers respect clients as an active player in the therapeutic process. DBT focuses putting the power of treatment back into the hands of client by allowing the client to actively strive for healthy change on a daily basis with support from (both from a therapist and other DBT participants). DBT involves the concept empowerment because it supports clients where they are at that moment and believes in their ability to make positive change in their life. DBT also has a major component of self-empowerment, which includes encouraging clients to take life in their own hands and make positive changes, that appears throughout the modules. (Dietz, 2012) Module 3-Emotion Regulation Opposite to Emotion Action Clinician Suggestions Anestis, M. (2009). Dialectical behavior therapy skills part 4: Distress tolerance.
Psychotherapy Brown Bag. Retrieved December 2, 2012, from:
www.psychotherapybrownbag.com/psychotherapy_brown_bag_a/2009/04/dialectical- behavior-therapy-skills-part-4-distress-tolerance.html

Arnold, T. (n.d.). Dialectical behavior therapy: Distress tolerance overview. Psychotherapy
for eating disorders, substance abuse, anxiety, depression. Retrieved December 2, 2012, from http://taraarnoldinc.com/?p=432

Axelrod, S. (n.d.). Nonjudgmental stance handout and worksheet. Retrieved from
https://www.box.com/shared/694hcic0l2

Baer, R. A. (2006). Mindfulness-based treatment approaches: Clinician's guide to evidence
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Choate, L. H. (2012). Counseling adolescents who engage in nonsuicidal self-injury: A
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Corrado, B. (2009). Dialectical behavioral therapy: Brief background and introduction to
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Dialectical Behavioral Therapy. (2010). Retrieved December 1, 2012, from Community Resource Alliance website:
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Dialectical Behavior Therapy: Interview with Sabrina Heller, LSW. (2007, October 15). The Social Work Podcast.
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Dietz, L. (2012). Life skills for emotional help. DBT Self Help. Retrieved December 3, 2012, from
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www.youtube.com/watch?v=dUj9zKPMsO

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Kirby, J., Baucom, D. (2007). Treating emotion dysregulation in a couples context: A pilot study of a couples skills
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plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug and Alcohol Dependence, vol 67, 13 – 26.

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Full transcript