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DBT & MBT (Personality Disorders (Features (Cognitive perspectives…

- - - - Cluster A
        
        Paranoid
        
        Schizoid
        
        Schizotypal
      - Cluster B
        
        Antisocial
        
        Borderline
        
        Histrionic
        
        Narcissistic
      - Cluster C
        
        Avoidant
        
        Dependent
        
        Obsessive-compulsive
      - Problems with this approach
        
        Assumes a clear distinction between normal and PD.
        
        Large overlap between categories and with other mental disorders.
        
        Lacks empirical support.
    - - Step 1: Assess poor personality function defined based on identity, self-direction, and interpersonal relations.
      - Step 2: Specify the condition through ratings of pathological personality traits.
      - 25 traits are assessed. The main domains are:
        
        Negative affect
        
        Detachment
        
        Antagonism
        
        Disinhibition
        
        Psychoticism
      - This model incluesd ratings of 6 / 10 PD types from the categorical model. Other forms of PD are identified by applying a new diagnosis called "Personality Disorder Trait Specified".
  - - - Affiliation
      - Power
    - - Neurobiological basis of personality traits
    - - Disturbed self-image
      - Misinterpreting the intentions, motives or abilities of others
      - Difficulties regulating social distance
      - Difficulties with empathy
    - - Conflict
      - Aggression
    - - Suicide risk
      - Health risk
      - Disturbed schemas
  - - - People with PD don't have insight into their own problems.
      - They often have other comorbid illnesses.
      - They often have difficulties establishing and maintaining meaningful and stable relations that are required in psychotherapy.
    - - DBT
      - MBT
      - Transference-focused psychotherapy
      - Schema-focused psychotherapy
      - Psychodynamic psychotherapy
      - Medicine
    - - Strong therapeutic relation
      - Open / honest communication
      - Focus on concrete goals
      - Structured sessions
- - - - 3-8 patients per group. 1 session of 2 hours per week.
      - Attentional skills
        
        Mindfulness practice
      - Relational skills
        
        Role play
      - Emotion regulation skills
        
        Identify feelings
        
        Change negative feelings
      - Skills in enduring
        
        Endure and accept emotional pain.
        
        Strategies
        
        Distraction
        
        Self-care
        
        Improve the now
        
        Cost-benefit analysis
    - - Once a week.
      - Phase 1: Establish security and stability.
      - Phase 2: Process possible trauma / PTSD.
      - Phase 3 / 4: Build self-respect and a meaningful life.
      - Chain Analysis
        
        Triggering event
        
        Vulnerability factors
        
        Thought
        
        Feeling
        
        Behavior
        
        Feeling
        
        Thought
        
        Problematic behavior
        
        Consequences
        
        Thought
        
        Often applied for self-harm and suicidal behavior.
      - The therapist applies acceptance strategies
      - Reduction of therapy disturbing behaviors.
    - - The patient can contact the therapist outside working hours. The aim is to strengthen and generalize the skills learned during therapy in the specific situations in everyday life. The patient can call to prevent self-harm or suicidal behavior, but cannot contact the therapist in the first 24 hours following such behavior.
    - - Applied to examine together what the therapist can do to improve and maintain the motivation of the patient. Thus, it should prevent common pitfalls for the therapist.
  - - - Phase 1: Get in. Develop motivation and engagement. Chain analysis. Problem-goal list. Progress monitoring.
      - Phase 2: Get in control. Reduce the feelings and thoughts that were the reasons for hospitalization.
      - Phase 3: Get out. Develop a discharge plan, and how to cope outside in the real world.
      - Daily program often very structured.
  - - - Patient
        
        Agreement on 1-year course of treatment.
        
        Agreement on presence.
        
        Agreement regarding suicidal behavior.
        
        Agreement regarding therapy-disturbing behavior.
        
        Agreement regarding skill training.
      - Therapist
        
        Agreement on a reasonable attempt.
        
        Ethical agreement.
        
        Agreement on personal contact.
        
        Agreement on confidensiality.
      - Therapist consultation
        
        Dialectic approach.
        
        Consistency.
        
        Observe own limitations.
        
        Phenomenological empathy.
    - - Setting the stage: Agree on goals and determine sequence of treatment questions.
      - Establishment of the relation.
      - Remain dialectical
      - Validation
      - Problem-solving (Chain Analysis)
      - Balance communication styes: Irreverent and reciprocal
    - - Balance
        
        Acceptance vs. Change
        
        Nurturing vs. Benevolent Demanding
        
        Unwavering Centeredness vs. Compassionate Flexibility
    - - (1) The patients do as well as they can.
      - (2) The patients want to improve themselves.
      - (3) The patients must to better, try harder and be more motivated for change.
      - (4) The patients have maybe not cause all their problems, but they must solve them anyway.
      - (5) The lives of suicidal borderline patients are unbearable as they are right now.
      - (6) The patients must learn new behavior in all relevant contexts.
      - (7) The patients cannot fail in therapy.
      - (8) Therapists who treat BPD patients need support.
- - - - Hospitalization
      - Intensive outpatient team