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DBT

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by

mira niklin

on 23 February 2014

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Transcript of DBT

Initially used BT and change strategies
Negative results
Populations
Difficulties with identity and
emotion regulation
Chronic
suicidal behaviour
Borderline Personality Disorder
BPD patients (suicidal behaviours)
1. Enhancing client capabilities

2. Enhancing client motivation

3. Ensuring generalization

4. Structuring the environment

5. Enhancing therapist capabilities

Current DBT involves strategies such as skills training, exposure therapy, contingency management and cognitive modification
Origins
DBT

Dialectics
Every argument has an assertion and opposition, and a synthesis of these two is a dialectic
i.e. suicidal behaviour
Originates from CBT
Main Aspects
Dialectics
Mindfulness
Acceptance
Duration
Usually 1 year
Goal of Therapy
To move beyond symptom reduction and help the client create a life worth living
Later Linehan emphasized acceptance in therapy
Heightened emotional response system leads to difficulties like:
problem solving
poor access to learnt coping strategies
limited capacity to consider consequences of actions
Maladaptive behaviour is maintained by interaction with biological and environmental factors
What is DBT?
What is BPD?
Assumptions
5 Essential functions with a DBT program
Role of therapist
Group Skills Training
Treatment Strategies
Treatment strategies con't
Client needs to change the way they're living
4 standard CBT interventions
skills training
exposure
contingency management
cognitive restructuring
What?
How?
Strategies for BPD
Video
MBCT
Benefits
Limitations
Pre-Commitment
Therapist takes a dialectical stance
Identify obstacles and target behaviours
Both agree on goals, target behaviours and treatment
Therapist explains treatment model and expectations
Stage 1
A. Reduce immediate life threatening behaviours and difficulties
Set a hierarchy of behavioural targets to keep client alive and safe
Stage 2
Stage 3 & 4
Modern therapy
The therapist will challenge the client's thinking

The client must first accept themselves and then change who they are

3 views of dialectics
Role of Client
Therapeutic Relationship
C. Address behaviours that compromise the client's quality of life (i.e. substance abuse, anxiety)
Structured for learning and rehearsing new skills along with individual therapy
Divided into 4 categories
mindfulness
distress tolerance
interpersonal effectiveness
emotional regulation
B. Target therapy interfering behaviours from both therapist and client
Psychoeducational
2. Problem solving/change strategies
Developed to treat relapse of depression in people who recovered from MDD
Employs mindfulness exercises to make client aware and less engaged in negative thoughts
Formal meditation
Integrates elements of CT and Mindfulness-Based Stress Reduction program
1. Most effective treatment for clients with BPD
2. Multiple populations
3. DBT can enhance other therapies when used simultaneously
4. DBT clients receive benefits from therapist
Dialectical Behaviour Therapy (DBT)
5. Increased commitment to therapy
substance and drug abuse
eating disorders
ADHD
suicidal behaviour in adolescents
1. People with BPD lack key interpersonal and self regulation skills


2. Personal and environmental factors frequently block or inhibit use of behavioural skills. They may also reinforce maladaptive actions
Self disclosure (personal and self-involving)

Radical genuineness
• Dialectical persuasion
Willing to change
Be mindful
Be non-judgemental
Necessary but not sufficient
Exposure stage
Client must experience intense emotions with decreased disturbance
• Increase client’s ability to experience a full range of emotions
Therapist must make sure that is is not an emotionally traumatizing experience
3.
Client must develop:
Self respect
Self efficacy sense (worth)
Sense of morality
An acceptable quality of life
4.
Complete resolution
Mindfulness
Focus on the "here" and "now"
Acceptance
• Z
en principles
- recognize the perfection of each moment as each moment is caused by what preceded it and therefore couldn’t be more perfect than it is
Radical Acceptance
Validation
Increase commitment to therapy
Problem solving strategies (change strategies)
chain analysis - past, present, future
Dialectical strategies
Validation strategies (acceptance strategies)

1. Cost and duration of therapy
2. Only beneficial for clients with high severity
3. Focus on women only
4. Little research on how DBT works with other therapies
5. Over-dependance on the therapist
Presentation by:
Léonie Hoveling & Tsvetomira Niklin
Full transcript