CBT and DBT
Cognitive Behavioral Therapy and Dialectical Behavioral Therapy
CBT - Anxiety
CBT focuses on targeting thoughts associated with emotional symptoms such as depression, anxiety, and anger.
Techniques in CBT help people detect, evaluate, and modify their inner thoughts.
Example activities in CBT include noticing body changes, identifying triggers, and tracking behaviors.
DBT - Trauma and BPD
DBT is used for people who have experienced trauma and have borderline personality disorder (BPD).
DBT focuses on emotional awareness, identifying triggers, and not reacting emotionally.
Overview and Objectives
The objective is to obtain an introductory understanding of CBT and DBT.
The process of therapy involves understanding the techniques and practicing them.
CBT - Doesn't deal with past events
CBT is structured and focused on the problems caused by the diagnosis.
It involves homework, worksheets, and progress reports to engage the individual.
CBT - The "C" in CBT
The "C" in CBT stands for cognitive.
Techniques in CBT help people detect, evaluate, and modify their inner thoughts.
Example activities in CBT include noticing body changes, identifying triggers, and tracking behaviors.
CBT - The "B" in CBT
The "B" in CBT stands for behavioral.
Actions are connected to the way we feel.
Example activities in CBT include tracking behaviors and measuring pleasure and accomplishment.
Unhelpful Thinking Styles in CBT
Unhelpful thinking styles include all-or-nothing thinking, overgeneralizing, and discounting the positive.
Automatic thoughts are thoughts that pop into one's head and are usually not even aware of.
Cognitive distortions include magnification, jumping to conclusions, and mind reading.
Core Beliefs in CBT
Core beliefs are global and absolute rules for interpreting information related to self-esteem.
Core beliefs are typically deduced rather than identified explicitly.
Examples of core beliefs include "I'm unlovable" and "People are untrustworthy."
Cognitive Restructuring in CBT
Cognitive restructuring involves identifying automatic thoughts and modifying negative automatic thoughts.
Adaptive patterns of thinking include thoughts like "No matter what happens, I can manage somehow."
Maladaptive patterns of thinking include thoughts like "I can never be comfortable around others."
Process of Therapy in CBT
The process of therapy involves identifying automatic thoughts, examining the evidence, and providing a rationale response.
Questions to identify thoughts include asking what was going through the individual's mind before feeling a certain way.
Example Statements in CBT
Example statements in CBT involve addressing childhood experiences and negative self-perceptions.
CBT aims to challenge negative beliefs and promote more adaptive thinking.
DBT - Emotional Awareness
DBT is less cognitive and more focused on emotional awareness.
It helps individuals identify triggers and learn to not react emotionally.
DBT Skills
DBT skills include mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.
Mindfulness involves being aware of the present moment without judgment.
Emotion regulation involves understanding and changing unwanted emotions.
Letting Go of Emotional Suffering in DBT
Mindfulness of current emotions helps individuals observe, describe, and participate in their emotions.
The goal is to accept emotions and take appropriate action.
Distress Tolerance Skills in DBT
Distress tolerance skills are used when individuals cannot leave or change a situation.
Skills include stopping, deep breathing, and self-soothing with the senses.
The ACCEPTS Skill in DBT
The ACCEPTS skill in DBT involves engaging in activities, comparing, contributing, emotions, pushing away, thoughts, and sensations.
It helps individuals cope with intense emotions and urges to engage in unskillful behavior.
Conclusion
CBT and DBT are therapeutic approaches used in the mental health community.
CBT focuses on targeting thoughts associated with emotional symptoms, while DBT focuses on emotional awareness and distress tolerance.
Both approaches aim to help individuals improve their mental well-being and cope with challenging situations.
Page 16:
Treat Physical Illness
Take care of your body, see a doctor
Emotional Regulation Skills
Balance Eating
Don't eat too much or too little, stay away from foods that make you feel
Often logic or cognitive based techniques emotional
Understand and change emotions
Avoid mood Altering Drugs
Non-prescribed drugs and ALCOHOL
Balance Sleep
Get the amount that makes you feel good
Get Exercise
Build up to 20 minutes a day
Act MASTERY
Do one thing at a time to make yourself confident and in control
Change Unwanted Emotions
Identify, label, functions of emotions
Mindful to emotions
Skill of Opposite Action: Check the facts of emotion responses
Behavior chain analysis
Problem solving
Identify an emotion that they would like to change
Pros and cons
Opposite action to emotion urges
Managing extreme emotions
Engage in the opposite of the urge in order to make a change
Page 17:
Interpersonal Effectiveness Skills
DEAR MAN - helping us gain our objective
Use clear and concrete terms to describe what you want
Express expressing your feelings
Assert
Don't beat around the bush-say what you need to say
No attacks, threats, or judgements
Reward people who respond well, and reinforce why your listen to the other person
Validate
Mindful
Appear confident
Be truthful
Negotiate
GIVE FAST
Let others know how a situation makes you feel by clearly expressing your feelings
Don't expect others to read your mind
Don't forget the objective of the interaction
Consider your posture, tone, eye contact, and body language
Use humor, smile, ease
No one can have everything they want out of an interaction all the time
Be open to negotiation
Page 18:
Other Techniques Strategies
Devil's advocate - Challenge the client
Making Lemonade from lemons
Cheerleading Statements
Assertiveness Statements
Page 19:
DBT - Acceptance/Change Techniques
Articulate the wisdom, correctness, or value in patients' emotions, cognitions, and behaviors
It is OK to feel this way
Being aware of the adversarial relationship that may develop
Assume that patients are doing their best rather than viewing patients as sabotaging therapy
Patients must also commit to attend all therapy sessions
The therapy will be terminated if patients do not make sufficient progress
Teaching patients to ask for help rather than act out, and ask in an appropriate rather than a demanding manner
Hospitalization is discouraged
Page 20:
DBT Example
Consistency is the key for all types of behavioral therapies
DBT Example Video #1 (20:08)
DBT Example Video #2 (25:38)
Page 21:
Lab Activities
Read the CBT Case Study Example for PTSD (under lab activities #2)
Identify 2 cognitive distortions in the scenario
Identify 2 possible core beliefs in the client
Identify 3 therapeutic communication strategies used
Identify the CBT strategies used by the therapist
Complete the Lab Role Play Case Studies for CBT and DBT - answer the questions
Look for things like core beliefs, automatic thoughts
See what kinds of strategies might be helpful for communication and to build coping
Take a look at the list of cognitive distortions
Self-reflect or discuss with your lab partners, have you noticed any of these in yourself, your friends/families?
How would you plan to "improve thinking" in yourself, in others?
Page 22:
Debrief CBT Case Study
Core Beliefs: Jocelyn: I'm the best, I'm smart, no one else knows better
Core Beliefs: Robert: I'll be alone forever, I'm unlovable, I'm a failure
Debrief DBT Case Study
Core Beliefs: Shae-Lynn: I fear being alone, I don't have value to others
Core Beliefs: Paul: I don't have intrinsic worth, I struggle with defining my identity
Page 23:
Debrief CBT Questions (Jocelyn) - Examples
Strategies: Journaling, cognitive restructuring, play the script until the end, PMR, breathing
Debrief CBT Questions (Robert) - Examples
Strategies: Journaling, goal setting, cognitive restructuring, possible interoceptive exposure if he has anxious aspects to his depression
Debrief DBT Questions (Shae-Lynn) - Examples
Strategies: TIPP, STOP, ACCEPTS - needs to develop value in herself and build her independence
Debrief DBT Questions (Paul) - Examples
Strategies: Reality acceptance skills; goal setting; behavior analysis, ABC PLEASE, DEAR MAN