Dialectical Behavior Therapy

Therapist's Characteristic

Patient and Therapist agreement

Treatment Strategies

Skills Training

Interpersonal Effectiveness Skills

Emotional Regulation Skills

Core Mindfulness Skills

Distress Tolerance Skills

b. Able to separate judgmental thoughts - fuels overwhelming emotions

c. Improve skill of wise mind - helps decisions of thoughts based on rational thoughts and emotions

a. Focusing on one task at a time - can sooth the
overwhelming emotions

.Voluntary. If involuntary treatment is required, the client must be allowed to choose a non-DBT treatment (as involuntary treatment is not allowed)
.Succession depends on the cooperation of the patient.
.Attention is given to orienting the patient to the nature of DBT and obtaining a commitment to undertake the work.



PATIENT


Required undertakings from a patient before DBT.


  1. Work in therapy for a specific period of time. (The patient should attend all scheduled sessions)
  2. If suicidal/parasuicidal, then he/she must agree to work on reducing the thoughts.
  3. Agree to work on the therapy interfering behaviours for the course of therapy.
  4. To attend skills training (Core mindfulness skills, interpersonal effectiveness skills, Emotion modulation skills, Distress tolerance skills)
  5. Client should use the skills on a daily basis and try to work hard as possible on target behaviours

THERAPIST


  1. Provide, respect, nonjudgment and validation towards the client.
  2. Assume that the client is doing the best they can in every moment and can also learn to do better by learning new skills.
  3. Make every reasonable effort to conduct DBT as competently as possible.
  4. Provide a dialectical stance, balancing the need for acceptance and change.
  5. Making an effort to start/end sessions on time
  6. Provide continuity of care along with the client's treatment team
  7. Obey ethical/professional guidelines
  1. Negotiating conflicting wants
  1. Getting information
  1. Asking for what you want
  1. Saying no, in a way that protect relationships
  1. Knowing what you want
  1. Acting according to values

Powerless Style

Aggressive Style

Assertive Style


Recognizing / Overcome / Increase - Emotions


Reducing Physical vulnerability Reducing Cognitive vulnerability
Being Mindful
Emotional Exposure

Coping Physical Pain

Managing Emotional Pain

Pretreatment stage

Stages of Treatment

it focuses on assessment, commitment and orientation of the therapy.

stage 2 :- It deals with post - traumatic stress related problems.

stage 3 :- Focuses on self- esteem and individual treatment goals.

stage 1 :- Focuses on suicidal behavior, therapy interfering behaviors and behaviors that interfere with quality of life.

Hierarchy targets

individual targets negotiated with the patient

Improving self - esteem

Decreasing behaviors related to post - traumatic stress

Decreasing behaviors that interfere with quality of life

Decreasing therapy interfering behaviors

Decreasing suicidal behaviors

increasing behavioral skills

Introduction

 also it’s been used to treat a variety of other mental health disorders.

 used to treat borderline personality disorder

 by psychologist Marsha M. Linehan

 developed in the late 1980s

 is a specific type of cognitive-behavioral psychotherapy

History

 dialectical behavior therapy based on the bio-social theory of borderline personality disorder.

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 An emotionally vulnerable child, according to Linehan, will not be allowed to adequately name and understand his feelings, nor will he learn to trust his reactions to events, nor will he be aided in coping with stressful and challenging situations.

 Disorder: is a result of an emotionally vulnerable child growing up in the Invalidating Environment.

Emotionally vulnerable child:
is someone whose autonomic nervous system overreacts to relatively low amounts of stress and takes longer than usual to return to baseline after the stress is eliminated.

Invalidating Environment:
refers to a condition in which the significant others in a child's life disqualify or "invalidate" her unique experiences and responses.


 Use specific techniques of acceptance and validation designed to counter the self-invalidation of the patient.

Modes of Treatment

Telephone Contact

Group Skills Training

Individual Therapy

Therapist Consultation

  • Follows a psycho-educational & structural format
  • Goal - develop/enhance client skills and capabilities
  • Four main modules
  • Core mindfulness skills
  • Interpersonal effectiveness skills
  • Emotion regulation skills
  • Distress tolerance skills
  • Follows clear structure and format
  • Goal – reduction of target behavior
  • Brief contact between sessions
  • Goal – to provide support in applying skills learned to real life situations; help find ways to avoid self-injury; for
    relationship repair between therapist & client.
  • Therapist set limits to the contact.
  • Benefits both therapist and client
  • Could consists of DBT therapists, social workers, psychologists, psychiatrists and others working with
    DBT clients.
    • Goals - provide support; continuous professional
      development; case discussion; adherence to DBT
      strategies

There is a clear and open emphasis on the limits of behaviour acceptable to the therapist, which are dealt with in a very direct way. The therapist should be clear from the start about their limits with patients

The success of treatment depends on the quality of the relationship between the patient and therapist.


  1. Accepting the patient as they are but encouraging change
    Validation, a key acceptance strategy in DBT, refers to therapist behaviors that communicate to the client that their emotions, responses, thoughts, and actions make sense and are understandable in their life context, without agreeing that the actions are the best approach to solving a problem.
  2. Being centred and firm yet flexible when the circumstances require - by maintaining necessary limits and adherence to the principles of DBT, but also allowing natural change to occur.
  3. Nurturing but benevolently demanding - a balance between providing support and teaching when needed without giving unnecessary help that might reinforce passive or dependent behaviors.

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✅ B