Dialectical Behavior Therapy (DBT):

Dialectics

  • synthesis or integration of opposites; two opposing ideas being true at once

  • dialectical persuasion to hand contradictions

DBT: Major Skills Domain

  • ACCEPT:

    • Mindfulness: awareness and nonjudgmental observation of the present moment

    • Distress Tolerance: tolerance of negative emotion or experiences, getting through a crisis

  • CHANGE:

    • Emotion Regulation: identify, understand, manage, and reduce vulnerability to intense emotions

    • Interpersonal Effectiveness: communication that is assertive, respectful, and strengthens relationships

DBT-Enhanced CBT for Adolescent Trichotillomania: An Adolescent Case Study 

  • mental health disorder characterized by the recurrent irresistible urge to poull out one’s own hair, resulting in noticeable hair loss

  • feeling of tension or anxiety → relief or gratification after pulling hair

  • two types:

    • automatic: outside of awareness, often during sedentary, contemplative activities

    • focused: often cued by negative emotions, intense thoughts or urges, attempts to create symmetry

Session 1: Chain Analysis

  • behavior tool in which a problematic behavior is broken down into a sequence of events, from prompting triggers to consequences

Session 2: Habit Reversal and Stimulus (Change)

  • subbing in another habit for the bad habit

    • when you feel the urge to pull, squeeze a stress ball

  • stimulus control - manipulate the situation to make it harder to perform habit

    • bandage fingers, gloves, pull oil on fingers

Sessions 3-5: Mindfulness

  • awareness of breath

  • observations of thought

    • less about breathing but more about refocusing attention elsewhere

    • Molly:

      • notices hair pulling more and more “in the moment”

      • notices skin-picking behaviors she wasn’t aware of

      • helps her choose from many different strategies to reduce pulling (vs. relying on a single skill)

Sessions 6-8: Emotion Regulation

  • general emotion regulation

    • exercise, good social relationships, stress management, taking more breaks

  • emotion regulation in response to difficult events

    • A) Change = modify the emotion or the situation

    • B) Acceptance = allow the emotion without judgment or avoidance

Sessions 9-10: Distress Tolerance (Acceptance)

  • self-soothing

  • distraction

  • radical acceptance

Interpersonal Effectiveness

  • techniques that allow a person to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships