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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:

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1. Eliminating life threatening behaviors:  no self-harm

2. Therapy interfering behaviors: what keeps therapy from working?  no “I don’t know”, no avoiding. Doing homework. Attending all sessions and classes as agreed in pre-treatment, on time. Doing individual therapy assignments. No creating continuous crisis. No lying or withdrawing in sessions. Not doing diary cards, and BCA’s. No reducing the therapist’s motivation to treat. No having panic attacks before session or in session to avoid. *No using hospitalization to avoid.*

3. Quality of life-threatening behaviors: Unstable living conditions; decrease PTSD; high risk sexual behavior; extreme financial issues that interfere with nutrition; safety or life stability; extreme dysfunctional IE skills; behaviors that interfere with employment/education

4. increasing behaviors skills in mindfulness, interpersonal effectiveness, emotion regulation, distress tolerance, and radical openness (see below under class)

 

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….