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What is DBT?

​DBT is a skills based treatment that looks to resolve symptoms that get in the way of a life worth living.

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Who can benefit?

People with undercontrol symptoms can benefit from DBT. Symptoms include:

• low inhibitory control--strong impulses,

• lack of control in emotional intensity

• lack of control in relationships--chaotic relationships

• instability in sense of self

• chaotic coping

• global focused processing,

• high reward sensitivity 

 

People with overcontrol symptoms can benefit from RO-DBT. Symptoms include:

• rigidity

• inability to connect

• too much self-control,

• inflexible behavioral repertoires,

• emotional suppression and inhibition,

• elevated distress tolerance,

• tendencies towards perfectionism,

• low reward responding and high threat responding,

• anxious apprehension, and

• high detail focused processing

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What will treatment look like, week to week?

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A.PRE-TREATMENT:  goals are assessment and commitment.

- agree to stay alive

- agree to stay in treatment

- agree to work towards no self-harm behaviors

- agree to build a life worth living, and a life worth sharing

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B.STAGE 1: Achieving Behavioral Control

 

WHAT will be targeted?  4 things:

1. Life-Threatening Behaviors

• Eliminate all self-harm

2. Therapy-Interfering Behaviors

• Remove avoidance and “I don’t know” responses

• Attend all sessions and classes as agreed, on time

• Complete homework, diary cards, BCA’s, and individual assignments

• Eliminate patterns that reduce therapist engagement or motivation

• No lying, withdrawing, or shutting down in sessions

• No ongoing crisis generation

• No panic attacks used to avoid sessions

• No use of hospitalization as avoidance

3. Quality-of-Life Interfering Behaviors

• Stabilize living conditions

• Reduce PTSD symptoms

• Eliminate high-risk sexual behavior

• Address financial instability impacting basic needs (e.g., nutrition)

• Improve overall safety and life stability

• Strengthen interpersonal effectiveness (reduce extreme dysfunction)

• Reduce behaviors interfering with employment or education

4. Skills Acquisition & Strengthening

• Mindfulness

• Interpersonal Effectiveness

• Emotion Regulation

• Distress Tolerance

• Radical Openness (RO-DBT

 

HOW will we attend to those targets? 3 ways: Individual, Class, and Coaching

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1. Individual Therapy—what will we do in session? 6 things:

   • Diary Card: track behavior. Set up reinforcement for wanted behavior. Set up treatment goals for the week.

   • BCA (Behavioral Chain Analysis): eliminate responses to one problem behavior or emotion or thought each week. Measurably.

   • Coping Ahead Solutions: practice skills that you may need ahead of time and to offer solutions to the BCA.

   • Role Play: skills learned to use in real time

   • Imaginal Practice:  rehearsal to remove obstacles and identify components needed to enact skills

   • Homework Application: real time application to current stressors.

2. Skills Classes: classes are grouped into 4 (four) 7-week modules. What will we learn in class? 6 Main Topics:

   • Mindfulness: focus and awareness of present moment to not “borrow” anxiety from the future or ‘punish’ the guilty anxiety of the past.

   • Interpersonal Effectiveness Module: focus on containment of chaos in relationships, asking for wants and needs to meet without sacrificing the relationship or self-respect.

   • Emotion Regulation Module: focuses on moment by moment anatomy and physiology of emotions and the ability to choose emotions, how long to apply them to a situation, how intensively to feel proportionate to said situation, and how to return to baseline functioning.

   • Distress Tolerance Module:  developing the ability to not explode externally or implode internally/shut down in the face of situations that are not amenable to change.

   • Radical Openness Module: skills on being able to overcome overcontrol disorders such as MMD, GAD, OCD, PTSD, anorexia, etc.…in order to surmount obstacles to new and different methods of functioning.

   • Walking the Middle Path Module:

     • Principles of behaviorism: shaping one’s and other’s behavior in the environment

     • Validation theory: the ability to validate to deescalate situations without agreement or the perception of ‘giving in’

3. Skills Coaching:  ask for skills coaching in a moment when urges are overriding wise mind functioning. Text/call….