DBT

Question 1

Why was DBT developed?

Answer 1

Because individuals with BPD found change-oriented therapy invalidating, while validation-focussed therapy (counselling) was not effective

Question 2

What are 4 challenges in dealing with BPD?

Answer 2

1. Hard to form collaborative relationship
2. Need to focus on client safety
3. Keeping stable goals and priorities across sessions
4. Managing unrelenting crises

Question 3

What is the diagnostic description of BPD?

Answer 3

A pervasive pattern of instability of interpersonal relationships, self-image and affect, and marked impulsivity, beginning in early adulthood and present across contexts.

Question 4

What are the 9 diagnostic criteria for BPD?

Answer 4

1. Frantic efforts to avoid abandonment
2. Unstable relationships with idealization and devaluation
3. Identity disturbance
4. Impulsivity in >1 self-damaging areas
5. Recurrent suicidal or self-harm thoughts/actions
6. Affective instability, short-term dysphoria, anxiety etc.
7. Chronic emptiness
8. Inappropriate anger
9. Transient, stress-related paranoia or severe dissociation

Question 5

What are 4 components of DBT model?

Answer 5

1. Skills training group (2.5 hrs for 24 weeks)
2. Individual therapy
3. Telephone consultation
4. Consultation team

Question 6

What are the four modules in DBT skills training?

Answer 6

1. Core mindfulness skills
2. Interpersonal effectiveness skills
3. Emotion regulation skills
4. Distress tolerance skills

Question 7

How does individual therapy relate to group therapy?

Answer 7

Therapist helps client implement skills learned in group in their target areas

Question 8

What are the 5 functions of DBT?

Answer 8

1. Enhances client capabilities (e.g., learn skills)
2. Improve motivation to change (e.g., use therapy as reinforcer)
3. Generalise skills to environment (e.g., first be appropriate with therapist, then with colleagues)
4. Structures environment to support capabilities???
5. Enhances therapist capabilities and motivation to treat clients effectively

Question 9

“DBT is a ____ enhancement

program, not a _____ prevention program.” Linehan

Answer 9

“DBT is a life enhancement

program, not a suicide prevention program.” Linehan

Question 10

What is the main dialectic in DBT?

Answer 10

Between acceptance and change. Accepting client as they are and motivating to change self-destructive behaviours.

Question 11

How does dialectic manifest in behaviours such as self-harm and drug-taking?

Answer 11

Behaviour is functional – reduces distress – but also dysfunctional –creates distress.

Question 12

Three facets of emotional dysregulation in BPDs?

Answer 12

1. heightened emotional sensitivity
2. inability to regulate intense emotional responses
3. slow return to emotional baseline

Question 13

Where does emotional dysregulation come from, according to Linehan’s biosocial model?

Answer 13

Interaction between biological vulnerability and environmental influences.

Question 14

Emotional regulation skills assist people to… 4 things

Answer 14

1. Inhibit inappropriate behaviour
2. Act in way that is not mood-dependent
3. Self-soothe physiological arousal
4. Refocus attention

Question 15

How does emotional dysregulation lead to impulsive behaviours?

Answer 15

Impulsive behaviours are solutions to problem of uncontrollable affect

Question 16

DBT conceptualises the behaviours of the BPD diagnosis as either natural _________ of experiencing intense ______ ________ or as learned efforts to _____ these extremes.

Answer 16

DBT conceptualises the behaviours of the BPD diagnosis as either natural consequences of experiencing intense emotion dysregulation or as learned efforts to reduce these extremes.

Question 17

What happens in invalidating environment?

Answer 17

Child’s private experiences/emotions are denied/punished /trivialised –regarded as invalid response to circumstances.

Expectation that child should regulate emotions; gets invalidated when expresses.

Only gets response when escalates –teaching child to either suppress emotion or communicate in extreme ways.

Child not comforted when emotional; thus not taught how to regulate emotion by self-soothing.

Question 18

Three types of invalidating environment?

Answer 18

1. The poor fit
2. The abusive home
3. The chaotic home
4. The perfect home

Question 19

Adult BPDs adopt characteristics of invalidating environment by?

Answer 19

Invalidating own emotional experiences

Looking to others for accurate reflection of reality

which leads to oversimplified problem-solving and unrealisitic goals

Question 20

What is the link between emotion dysregulation and identity?

Answer 20

Sense of identity is formed through observation of self and others’ reactions. If these observations are erratic, because of instability of affect and feedback from world, sense of identity becomes confused. This can create overdependence on views of others.

Question 21

How does emotion dysregulation cause unstable relationships?

Answer 21

Stable relationships require stable sense of self and capacity for spontaneity of expression.

Also need to be able to regulate emotions such as anger, and to control impulsive behaviour.

Question 22

What DBT skill helps with confusion about self and cognitive dysregulation?

Answer 22

Mindfulness training

Question 23

What DBT skill helps with impulsiveness?

Answer 23

Distress tolerance

Question 24

What DBT skill helps with emotion dysregulation?

Answer 24

Emotion regulation

Question 25

What DBT skill helps with interpersonal chaos?

Answer 25

Interpersonal effectiveness

Question 26

What is overarching goal of DBT and why is it important?

Answer 26

Creating a life worth living Promise of such a life acts as an operant reinforcer in therapy

Question 27

What are the goals of treatment by level of disorder?

Answer 27

Level 1 – Severe behavioural dyscontrol – Behavioural control (not suiciding) Level 2 – Quiet desperation – Replace with non-traumatic emotional experiencing Level 3 – Problems in living – Achieve ordinary happiness and unhappiness Level 4 – Incompleteness – Achieve capacity for joy and freedom

Question 28

How does DBT view emotions, as opposed to cognitions, in the generation and maintenance of acute mental disorders?

Answer 28

Assume the primacy of emotions over cognitions. Cognitions are explanations for high emotion, i.e. "I must be unlovable since I feel that everyone rejects me".

Question 29

What are the 6 levels of validation?

Answer 29

1. Staying awake - unbiased active listening, observing. 2. Accurate reflection - Rogerian reflections of clients feelings, thoughts and behaviors. 3. Articulating unverbalised emotions, thoughts or behavior patterns - i.e. "that must've been upsetting". 4. Validating current experiences in terms of past learning/biological dysfuntion - i.e. "Given what you have gone through, it makes perfect sense that...". 5. Validation in terms of normative functioning - i.e. "anyone would feel upset if...". 6. Telling it like it is - i.e. "Man that must've sucked".

Question 30

Distress tolerance. What does the ACCEPTS acronym stand for i.e. 'Wise mind accepts'?

Answer 30

A - Activities i.e. hobbies, watching a movie etc.. C - Contributing C- Comparisons - comparing to individuals coping the same or less well than you, or your past self if you are now doing better. E - Emotions - this means doing 'opposite actions' i.e. listening to happy songs. P - Pushing away - physically leaving a situation or imagining a wall. T - Distract with other thoughts i.e. counting. S - Sensations - i.e. hold ice, rubber band etc.

Question 31

For examples of distress tolerance skills what does the acronym 'Improve' stand for in "Improve the moment".

Answer 31

I - Imagery i.e. create a "safe space" in your mind's eye. M - Meaning - Create some purpose, meaning or value in pain, make "lemonade". P - Prayer - i.e. the acceptance prayer. R - Relaxation i.e. PMR. O - One thing in the moment - mindful awareness. V - Vacation - take a break. E - Encouragement - "cheerlead" yourself.

Question 32

What sorts of things are recorded on a diary card?

Answer 32

Target behavior - strength of urge; whether they acted on urge. Emotions - Intensity of different emotions i.e. pain, sadness, joy. Skills - degree to which they considered using or used DBT skills across 4 domains. May also explicitly track explicitly use of drugs, alcohol, over the counter and prescription medications, suicidal ideation, self-harm behaviour, 'misery', May include ABC i.e. antecedents and consequences of engaging in target behaviors.

Question 33

Interpersonal effectiveness. What does the "Dear Man Give Fast" acronym stand for and what does it do?

Answer 33

``` Assists with assertiveness. D - Describe E - Express A - Assert R - Reinforce M - Mindful A - Appear confident N - Negotiate ``` G - Gentle (start) I - Interested (be curious) V - Validate E - Easy Manner F - Fair (be fair) A - Apologise S - Stick to values T - Truthful (be truthful) - 'Fast' is for 'self-respect effectiveness'.

Question 34

What are the basic principles of accepting reality taught in DBT?

Answer 34

1. Radical acceptance - let go of fighting reality. 2. Turning the mind - Turn the mind towards acceptance, 'try'. 3. Willing vs. Willful - notice willfulness, radical acceptance of willfulness and turn mind toward willingness.

Question 35

What are the "What" and "How" skills taught in DBT?

Answer 35

What skills: - Observing. - Describing - Participating. 'How' skills: - Taking a non-judgmental stance. - Focusing on "one thing" in the moment. - Being effective.

Question 36

Explain the 'Bio' in the Bio-social model of emotion dysregulation used in DBT.

Answer 36

Some people (approx 30%) are born with 'high emotional vulnerabilty', or dispositions that are precursors of emotion dysregulation. These include high sensitivity to emotion cues, negative affectivity, very intense response to emotional stimuli, emotions have a slow return to baseline once arousal has occurred and impulsivity. This may be due to hereditary, interuterine factors or brain injuries.

Question 37

Explain the 'Social' in the Bio-social model of emotion dysregulation used in DBT.

Answer 37

The early care-giving environment may contribute to the development of emotion regulation difficulties seen in BPD through: 1. a tendency to invalidate the infant or child's emotional experiences, 2. an inability to model appropriate expressions of emotions, 3. regular interactions with the child that inadverdantly reinforce their emotional arousal; 4. a poor fit in terms of the parenting style and the child's temperament.

Question 38

What are two aspects of conscious control and emotion regulation that DBT focuses on?

Answer 38

1. Increasing 'conscious control' i.e. through mindfulness. | 2. Overlearning emotion regulation skills so that they become automatic.

Question 39

What are 7 assumptions DBT therapists make about their clients?

Answer 39

1. They are doing the best that they can. 2. They want to improve. 3. They must learn new behaviors and in all relevant contexts. 4. Clients cannot fail in DBT. 5. Clients may not have caused all of their problems, but they have to solve them anyway. 6. Clients need to do better, try harder and/or be more motivated to change. 7. The lives of BPD individuals are unbearable as they are currently being lived.

Question 40

What is the DBT treatment hierarchy?

Answer 40

1. Decreasing life threatening behaviors (i.e. suicide, self-harm. 2. Decreasing therapy interfering behaviors. 3. Decreasing quality of life interfering behaviors (i.e. drinking). 4. Increasing behavioral skills. 5. Creating a life worth living.

Question 41

What are four characteristics of invalidating environments?

Answer 41

1. Personal responses and experiences of the child are invalidated by the significant others in her life. 2. The child’s personal communications are not accepted as an accurate indication of her true feelings. 3. It is implied, that if they were accurate, then such feelings would not be a valid response to circumstances. 4. Characterised by a tendency to place a high value on self-control and self-reliance.

Question 42

What are seven different ways DBT therapists validate?

Answer 42

(FECRAPS) ``` F - Focus on capabilities/strengths E - Encouragement (provide) C - Contradict external criticism R - Realistic (always be) A - Assume the best P - Provide praise/reassurance S - Staying near ```

Question 43

How does DBT conceptualise the behaviours of the BPD diagnosis? 2 options

Answer 43

1. Natural consequences of experiencing intense emotion dysregulation or 2. Learned efforts to reduce these extremes.

Question 44

What are reasonable, emotion and wise mind?

Answer 44

Reasonable – rational mode – asks what should I do? Emotion – visceral mode – asks what do I want? Wise mind – integrates reason and emotion – asks how can I be most effective?