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DBT Study Guide

A form of Cognitive behavioral therapy that: Manages painful emotions Decreases conflict in relationships

Founded by: Marsha M Linehan, 1980

Key elements DBT to assist clients w/BPD: PTSD: SI include:

Emotional reactivity and sensitivity (hyperarousal) Hx of invalidation (common in childhood/sexual abuse) Dissociation (intrusive symptoms and flashbacks) Affective instability (negative mood and thought changes) Fundamental dialect is that of change and acceptance Uses persuasive dialogue

4 Modules of DBT:

1. Mindfulness 2. Interpersonal Effectiveness 3. Distress Tolerance 4. Emotional Regulation (Gleissner, 2018)

Functions of DBT:

Enhancing clients capabilities Motivating clients to use and expand their capabilities Ensuring that clients can generalize their capabilities beyond the therapeutic relationship Enhancing the therapists skills and motivations Structuring the environment for both the therapist and the client to aid therapeutic progress

Four essential elements:

Weekly individual therapy sessions for 1 hr. Weekly group skills training sessions for 2.5hrs Skills coaching via telephone or other electronic means as needed to manage vivo situations Team consultation to the therapist to maintain treatment fidelity and adherence

Stages of Treatment: 4 stages

1st stage: pretreatment: negotiate goals/commit to tx Focus: to address life threatening behaviors and therapy interfering behaviors Diary Card are used Behavioral chain analysis guides client to become mindful and use skills more effectively 2nd stage: addresses non traumatizing emotional experiences Brings together dialectics of emotional mindedness and rational mindedness into wise mindedness. Balances experience of and response to emotions (Chapman, 2006) 3rd stage: client integrates his or her skills, awareness of self and interpersonal responsiveness are used to begin to confront the trauma they experienced. Client re-experiences elements of the trauma in small doses using skills to regulate emotions behavior Once they are able to experience memory without overwhelming distress they can gain a sense of mastery and self-efficacy. Targeted behaviors may resurface in this stage. Therapist may need to coach effective skills to manage urges ie: self-harm, substance abuse. Stage 4: transcendent sense of self, they focus on self-efficacy, interdependence, and self-fulfillment. Client taught to be their own therapist. Therapist role maintain calmness w/o overreacting to clients behavior (chapman, 2006).

Treatment approaches: Requires a skilled therapist

Foundation of skills therapy is mindful meditation. Two components to core mindfulness: The what skills (observing, describing, participating) How skills (non-judgmental stance) one minded in the moment, and effectiveness Client learns then practices regularly and includes on their diary card. Group sessions begin w/mindfulness, team consultation and encouragement from all in the team to maintain mindfulness, and regulate emotions and behavior. The leader provides the background for the group activity, once everyone understands the therapy, and is in a comfortable position, the exercise can be cued by a Tibetan singing bowl or other gentle cue (Panos, 2013).

Skilled modules in DBT

Core mindfulness:     Mindful abdominal breathing exercises focus/observe/describe/Wise Mind/Judgement Judgement diffusion

Distress Tolerance:      Radical acceptance/distract/relaxation/self-soothing

Emotional regulation: Recognizing emotions/reducing vulnerabilities/ opposite action to emotion/problem solving

Interpersonal                Knowing what you want/making a request/ Effectiveness :               passive verses aggressive behavior/assertive listening/negotiating

Self-management:         Realistic goal setting/behavior analysis/contingency management Environmental control. (Wheeler, 2014).

Trauma focused therapy:

Must have a strong trusting relationship with therapist Two basic types of exposure therapy: Imagined and In vivo In vivo is limited to people, places, and situations not the actual trauma. For ex: If the client had been cheated on in the past, they would focus on the people, place and situation that occurred they would not re expose the patient to the actual event by having her/him be cheated on again. Preparatory work is needed: IE: identifying behaviors/emotions Begin by determining what situation elicits the unwanted emotional condition that influences the response Then establish the intensity of the emotion/before/after the exposure The therapist helps walk the client through the mindfulness exposure until the rating of their emotion decreases. Then stabilization and transition to termination of therapy as the event is no longer traumatic. (Wheeler, 2014).