Treatment Cont (again) - Lecture 19

Dialectical Behavior Therapy

• first developed for borderline personality disorder, self harm, etc

• created by Marsha Linehan

• Four key modules: mindfulness, emotional regulation, distress tolerance, interpersonal effectiveness

Dialectics

notion of two opposing things that seem contradictory co-existing

• two things may be true at once

Mindfulness

• observe, describe, participate skill

  • observe: simply notice what is happening; notice thoughts, emotions, and physical sensations

  • describe: put words on what you have observed

  • participate: fully participate in an experience; instead of becoming distracted/engaged in another activity, focus on the present

• non-judgmental stance

  • focus on observing specific feelings and thoughts instead of labeling things as “good” or “bad”

• wise mind

  • reasonable mind - facts and logic are in control without emotions, such as love

  • wise mind - knowledge, experience, common sense

  • emotion mind - emotions control thinking and behavior without reason

Distress Tolerance

• ability to manage emotional pain

• goal isn’t necessarily to fix any particular situation, rather to cope with the elicited emotions

• if you can get through a situation without making it worse, that’s effective distress

TIPP (Distress Tolerance)

• Temperature - change body temperature; ex. splash water on your face

• Intense Exercise - do intense exercise to match your intense emotions

• Paced Breathing - ex. doing box breathing

• Paired Muscle Relaxation - focus on one muscle group at a time; tighten muscles as much as possible for 5 secs

Self-Soothe with Senses (Distress Tolerance)

• find a pleasurable way to engage each of your five senses

• doing so will help soothe your negative emotions

Pros and cons list (Distress Tolerance)

• making a list of pros and cons of doing this action/versus not doing that action

Radical Acceptance (Distress Tolerance)

• when facing a problem out of your control, you can fall into thinking “this isn’t fair” or “this shouldn’t be happening,” which may exacerbate negative emotions

• recognizing the situation as it is, not fighting reality in that moment

• not the same thing as liking/condoning something

Interpersonal Effectiveness

• build and maintain healthy relationships, especially after trauma and any ongoing attachment issues

• G.I.V.E.

  • Gentle: don’t attack, threaten or express judgment during interactions; accept occasional “no” for your requests

  • Interested: show interest by listening to the other person without interrupting

  • Validate: be outwardly validating to the other person’s thoughts and feelings

  • Easy: have an easy attitude, try to smile and act lighthearted

• D.E.A.R.M.A.N.

  • Describe: describe the situation objectively; stick to the facts by avoiding opinion/interpretation

  • Express: let others now how a situation makes you feel by clearly expressing your feelings; don’t expect others to read your mind

  • Assert: say what you need to say

  • Reinforce: reward people who respond well and reinforce why desired outcome is positive; say thank you or smile

  • Mindful: don’t forget the object of the interaction

  • Appear: appear confident

  • Negotiate: no one can have everything that they want out of an interaction all the time; be open to negotiation

• F.A.S.T.

  • Fair: be fair, not only to others, but also to yourself

  • Apologies: don’t apologize unless it’s warranted; don’t apologize for making a request, having an opinion or disagreeing

  • Stick to values: don’t compromise your values just to be liked or to get what you want

  • Truthful: avoid dishonesty such as exaggeration, acting helpless as a form of manipulation, or outright lying