M26 DBT in Addiction Counselling

Flashcards related to Dialectical Behavior Therapy in Addiction Counselling lecture notes; this deck includes vocabulary, and facts about DBT, Mindfulness, Emotional Regulation, Interpersonal skills, distress tolerance, and additional concepts.

Dialectical behavior therapy (DBT)

A therapy designed to help people suffering from mood disorders as well as those who need to change patterns of behaviour that are not helpful, such as self-harm, suicidal ideation, and substance abuse. Works towards helping people increase their emotional and cognitive regulation.

DBT Assumptions

Assumes that people are doing their best but lack the skills needed to succeed, or are influenced by positive reinforcement or negative reinforcement that interferes with their ability to function appropriately.

DBT Combination

Combines standard cognitive behavioural techniques for emotion regulation and reality- testing with concepts of distress tolerance, acceptance, and mindful awareness largely derived from Buddhist meditative practice.

Meta-analysis of DBT

Moderate effects in individuals with borderline personality disorder.

DBT skills for substance abuse

Skills taught in DBT are being used to address issues of relapse, such as skills to identify triggers, controlling urges, and managing overwhelming emotions.

Three commitments for clients before beginning DBT treatment

To stay alive for one year, to work on behaviours that may interfere with therapy or treatment, and participate to the best of their ability in DBT skills.

Hierarchy of targeting behaviours as a treatment approach (Linehan)

Decrease behaviours that are life threatening; reduce behaviours that interfere with therapy (late, not attending, intoxicated); reduce behaviours with consequences that degrade the quality of life (homeless, probation, domestic violence); and increase behavioural skills.

Four treatment modalities in an outpatient treatment setting

Individual therapy, group skills training, telephone consultation, and therapy for the therapist

Distress Tolerance

Helps clients cope better with painful events without the need for substance use by building up their resiliency and provides new ways to soften the effects of upsetting circumstances.

Mindfulness

Teaches clients how to experience more fully the present moment while focusing less on painful experiences from the past or frightening possibilities in the future. Also provides tools to overcome habitual, negative judgments about self and others are considered one of the core skills of DBT.

Emotional Regulation

This skill helps an individual to recognize more clearly what they are feeling and then to observe each emotion without getting overwhelmed by it. The overall goal is to adjust your feelings without behaving in reactive, destructive ways based solely on your emotions.

Interpersonal Effectiveness

Is a tool designed to help a client express his or her beliefs and needs, set limits, and negotiate solutions to problems. By becoming more functional in their relationship clients may find less of a need for substance use. This is done all while protecting the person’s relationships and treating others with respect.

The Dialectical Approach to Abstinence

Pushing for immediate and permanent cessation of drug abuse (i.e., change), while also inculcating the fact that a relapse, should it occur, does not mean that the patient or the therapy cannot achieve the desired result (i.e., acceptance).

Establishing Abstinence Through Promoting Change

The therapist communicates the expectation of abstinence in the very first DBT session by asking the patient to commit to stop using drugs immediately.

Supporting Abstinence by Encouraging Acceptance

The therapist guides the patient in making a behavioural analysis of the events that led to and followed drug use, and gleaning all that can be learned and applied to future situations. Additionally, the therapist helps the patient make a quick recovery from the lapse.

DBT employs a number of strategies to engage treatment butterflies

Increase the positive valence of therapy and the therapist, re-engage “lost” patients, and prevent the deleterious consequences that commonly occur during periods when patients fall out of contact with their therapist.

Five essential functions of the treatment

Improving patient motivation to change, enhancing patient capabilities, generalizing new behaviours, structuring the environment, and enhancing therapist capability and motivation.

Four treatment modes

Individual therapy, group skills training, telephone consultation, and therapy for the therapist.

DBT target hierarchy

Decrease behaviours that are imminently life-threatening (e.g., suicidal or homicidal); reduce behaviours that interfere with therapy (e.g., arriving late or not attending therapy, being inattentive or intoxicated during the session, or dissociating during the session); reduce behaviours with consequences that degrade the quality of life (e.g., homelessness, probation, Axis I behavioural problems, or domestic violence); and increase behavioural skills.

“Dialectical”

Open-mind thinking. That 2 ideas can both be true at the same time.

Being dialectical

Letting go of self-righteous indignation, letting go of “black and white”, “all or nothing” ways of seeing a situation, looking for what is “left out” of your understanding of a situation, finding a way to validate the other person’s point of view, expanding your way of seeing things, getting “unstuck” from standoffs and conflicts, being more flexible and approachable, and avoiding assumptions and blaming.

4 main skills that are used in DBT

Emotion Regulation, Mindfulness, Distress Tolerance, and Interpersonal Effectiveness.

Basic principles of accepting life on life’s terms - Radical acceptance

Everything is as it should be, everything is as it is, and freedom from suffering requires ACCEPTANCE from deep within of what is.

Reality - Basic principles of accepting life on life’s terms

Acceptance is the only way out of hell, pain creates suffering only when you refuse to ACCEPT the pain, and deciding to tolerate (endure) the moment is ACCEPTANCE.

Emotional Regulation

Emotion regulation refers to the ability to control one’s emotions.

Acting when our emotions control us

When our emotions control us, we FEEL, ACT and only then THINK.

OBJECTIVES EFFECTIVENESS: DEAR MAN

Express feelings and opinions about the situation, assert yourself by asking for what you want or saying NO clearly, reinforce or reward the person ahead of time by explaining the CONSEQUENCES, be mindful, appear confident, and negotiate.

RELATIONSHIP EFFECTIVENESS: GIVE

Be gentle, act interested, validate the other person’s feelings, and use an easy manner.

SELF-RESPECT EFFECTIVENESS: FAST

Be fair to YOURSELF and to the OTHER person, no apologies, stick to YOUR OWN values, and be truthful.

Triggers for an action plan to be useful to aware of the distress

Situations, events, people, cues in the environment are external triggers vs certain thoughts, memories, images, bodily sensations are internal triggers.

Distress tolerance

Distress tolerance refers to a perceived inability to fully experience unpleasant, aversive or uncomfortable emotions, which is accompanied by a desperate need to escape the uncomfortable emotions.

Accepting Distress involves

Watch or observe, label or describe, and be curious and non-judgemental to Accepting Distress emotions.

DISTRACT with Wise Mind: ACCEPTS

Activities, contributing, comparisons, emotions, pushing away, thoughts and senses.

Observing your breath while effectively managing stress

Focus your attention on your breath and observe your breathing as a way to centre yourself in your Wise Mind to take hold of your mind, dropping off non-acceptance and stop fighting reality.

Half-Smile

Relax your face, neck and shoulder muscles and half-smile with your lips.

Mindfulness

Is the quality of attention or the quality of awareness or the quality of presence that you bring to everyday life; a way of living your life awake.

Mindfulness is the awareness that emerges if:

Pay attention on purpose, in the present moment, and Non-judgementally to things as they are.

Mindfulness practice is a core aspect of Dialectical Behavior Therapy (DBT)

Reflection of synthesized the central dialectic in DBT of acceptance and change, synthesizes an acceptance of one’s history, current thoughts, emotions, and sensations with change efforts directed at distress tolerance, emotion regulation, and relationship effectiveness.

Core Mindfulness – The “What” Skills

Describe, participate and observe.

Core Mindfulness – The ‘How’ Skills

Non-Judgmental Stance, Mindfully, and Effectively.

The 3 Minute Breathing Space involves

Acknowledging, gathering and expanding.