Psych 3501 Exam 3: Dialectical Behavior Therapy (DBT)

Historical Development of DBT

Developed by Marsha Linehan in 1970s-1980s

Originally created to treat individuals at high-risk for dying by suicide

- Borderline personality disorder

Heavily inspired by:

- Radical behaviorism: treats everything as a behavior

- Zen contemplative practices

- Personal experience

- Dialectics

What are dialectics?

a concept of synthesizing or integrating seemingly opposing truths or ideas to achieve a more balanced and nuanced understanding of oneself and the world

A closer look at dialectics

Walking the middle path

Typically, psychological well-being rarely exists when we exist rigidly at the extremes

Fundamental dialectical dilemma in DBT

Acceptance vs. change

Cognitive therapy (focuses on change): invalidating

Acceptance and commitment therapy: don’t have to change anything

Therapist at middle point too, ready to adjust depending on the circumstances

Who was DBT originally designed for? characteristics

Emotional vulnerability: Difficulties with emotion regulation

Self-invalidation: Intense shame, self-hate, self-directed anger

Unrelenting crises: Frequent negative environmental events

Inhibited grieving: Inhibit or overcontrol negative emotions (not showing)

Active passivity: Looking to environment for problem solving/emotion regulation

Apparent competence: Appear more competent at handling life stressors than one truly is; Difficulty with generalizing competencies to new situations

How do these behavioral patterns emerge?: Biosocial theory of emotions

Biological vulnerability to emotions:

1. Higher emotional sensitivity

2. Higher emotional reactivity

3. Slower than average return to emotional baseline

Along with Social environment with high

1. Invalidation of private experiences

2. Ignored or punished emotional displays

3. Oversimplification of emotions or experiences

What does DBT treatment look like? (four components)

Individual psychotherapy

Skills training

- Group or individual therapy

- Learn the skills to address each barrier

Phone coaching

- therapists providing brief, real-time guidance to clients via phone calls to help them apply skills learned in therapy to everyday situations

Therapist consultation team

These four components are necessary to consider the therapy full protocol

Primary goal of DBT

Goal: to identify and run towards life worth living

Identify barriers along the way

Teach skills to address each one

Skills training

Mindfulness

Distress tolerance

Emotion regulation

Interpersonal effectiveness

Mindfulness

Paying attention, on purpose, to the present moment without judgment

The core piece of DBT

Why:

- Slowing down

- Increase control of your mind

Emotion regulation: 3 categories

1. Skills for identifying and understanding emotions

2. Skills to decrease emotional sensitivity

3. Skills to decrease emotional suffering

Decreasing emotional sensitivity

We all have an emotional gas tank

When it is depleted, it can be difficult to manage what life throws at you

Can refill the tank in many different ways

Skills taught in DBT: Accumulating positives in the short- and long-term

Label and (actually) do things that help us recharge

Distress tolerance skills

Survive crisis situation without making them worse

Crisis situation = highly stressful situations

Crisis: High stress, possibility of very bad outcomes, short-term, strong urge for immediate resolution

How do you know they worked?

Helped you not make the situation worse

Only meant to get through the crisis

Temperature skill

Takes advantage of the body's dive reflex

Cover face in ice cold water for 30+ seconds

Reduces heart rate, helps get through anxious/fearful situations without acting on a urge

Distress tolerance vs. emotion regulation

Start: an event that triggers an emotional response

Rapidly go up on emotional intensity

To skill breakdown point: can't talk yourself out of it, hard to do emotion regulation skills (mindfulness, etc.)

After going down: go back to problem-solving and emotion regulation

Interpersonal effectiveness skills

Learn skills to be effective in interactions with others, so you are able to get what you want from these interactions

Effectiveness is "doing what works"

- Not getting caught up in what's "fair" or "right"

Balancing objective effectiveness, connection effectiveness, self respect effectiveness

DEAR MAN

Describe the situation without judgment

Express your feelings about the situation

Assert yourself by stating what you want or need

Reinforce the other person if they respond well

Mindful: keep your focus on what you want, don’t get sidetracked

Appear confident

Negotiate: open to negotiation

Individual therapy for DBT

Mindfulness

Diary card

Chain analysis

Solution analysis

Diary card

Develop priority list

Behaviorally specific

For clients to build awareness of their goals

Track behaviors, urges, emotions

Life threatening behaviors -> therapy interfering behaviors -> life barriers

Chain analysis

Used to figure out the "chain of events" that led to the target behavior

Vulnerability

Prompting event

Links

Problem behavior

Short-term consequence

Long-term consequence

Solution analysis

What skills can help reduce the likelihood of the target behavior?

Where in the chain can we intervene to reduce likelihood?

Pick solutions from

- Mindfulness

- Distress tolerance

- Emotion regulation

- Interpersonal effectiveness