psychotherapy - DBT

what was DBT designed for?

individuals with chronic suicidality or parasuicidality who didn’t respond favorably to other treatments

how is DBT tied to BPD?

most patients with chronic suicidal behavior have BPD but not all patients with BPD have suicidal behavior

what did DBT recognize?

patients engage in behaviors that interfere with therapy and clinicians experience burnout and negative reactions to these patients

what is DBT based on?

Marsha Linehan’s biosocial theory of BPD

what is Linehan’s biosocial theory of BPD?

putting an emotionally vulnerable person in an invalidating environment may lead to problems with ability to understand and label feelings, coping skills, and emotion modulation

what are the dialectical dilemmas for clients?

emotional vulnerability vs self-invalidation, active passivity vs apparent competence, unrelenting vs inhibited grieving

what is the therapist’s dialectical stance?

accept client as they are but encourage change, centered and firm but flexible when needed, nurturing but benevolently demanding

what is the therapist balancing?

change/problem solving and acceptance/validation

what are Linehan’s three minds?

rational mind, emotional mind, wise mind

what is the rational mind made up of?

past experiences, logic, research, and statistics

what is the emotional mind made up of?

feelings and emotions

what is the wise mind?

combining the rational and emotional minds to come to a balanced conclusion of how to move forward

what is the DBT treatment package?

weekly individual therapy sessions and group skills training session, telephone contact, and therapist consultation team meeting

how long must clients commit to all parts of the treatment package?

at least 1 year

what are the five functions of DBT?

enhancing and generalizing capabilities, improving motivation and reducing dysfunctional behaviors, enhancing therapist capabilities, structuring the environment

how does DBT enhance capabilities?

improve several life skills in weekly skills group session

how does DBT generalize capabilities?

homework assignments to practice skills in natural environment

how does DBT improve motivation and reduce dysfunctional behaviors?

primarily accomplished in individual therapy

how does DBT enhance and maintain therapist capabilities and motivation?

therapist consultation meetings provide support, validation, skill-building, and feedback

how does DBT structure the environment?

want to reinforce effective behavior/progress and not reinforce maladaptive or problematic behavior

what is the hierarchy of therapy targets?

suicidal and parasuicidal behaviors, therapy interfering behaviors, behaviors that interfere with quality of life, behaviors related to PTS, improve self-esteem, individual targets negotiated with client

why does the hierarchy of therapy targets exist?

if clients know that they will have less time to talk about what they want to talk about if they engage in problematic behavior, they are less likely to engage in it

what is the diary card used for in DBT?

track behaviors such as self-harm, suicide attempts, and emotional misery, used to prioritize session time

what are the four kinds of skills learned in DBT?

mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance

what are the mindfulness skills?

what skills and how skills

what are the what skills?

observe, describe, participate

what are the how skills?

non-judgmentally, one-mindfully, effectively

what are the interpersonal effectiveness skills?

identify and describe emotions, riding the wave of emotion, opposite to emotion action

what are the distress tolerance skills?

distraction, self-soothing, and radical acceptance

what kind of study was Linehan et al (2006)?

dismantling study to examine specific specific ingredients of DBT

what DBT non-specific factors needed to be controlled for in Linehan et al (2006)?

hours of therapy, availability of group consultation, etc

who were the participants in Linehan et al (2006)?

women with BPD with recent suicidal behavior (attempt or self-injury)

how were participants assigned to conditions in Linehan et al (2006)?

matched to treatment condition on 5 prognostic variables

who were the controls in Linehan et al (2006)?

community therapists nominated based on expertise treating difficult clients and identified as nonbehavioral or psychodynamic

what did Linehan et al (2006) find in favor of DBT?

DBT had less dropout and change in therapist, half the rate of suicide attempts, and less use of crisis services and hospital admissions

what did Linehan et al (2006) find was consistent between the treatments?

no difference in NSSI, depression, suicidal ideation, and reasons for living improved in both

what has shortened DBT been found to be efficacious for?

self-harm, suicidal ideation, and depressive symptoms for adolescents

which EDs does DBT have efficacy data for?

bulimia nervosa and binge eating disorder but no evidence of superiority over CBT

can DBT skills be used outside of the treatment package?

preliminary evidence says yes

what was the setup of Moore et al (2018)?

8 week skills group in jail setting for male inmates selected for emotional or behavioral problems

what did Moore et al (2018) find?

no statistically significant changes in coping skills or emotional/behavioral dysregulation, likely due to small sample size, but feedback generally positive