How does DBT view emotions, as opposed to cognitions, in the generation and maintenance of acute mental disorders?
Assume the primacy of emotions over cognitions. Cognitions are explanations for emotions, i.e. “I must be unlovable since I feel that everyone rejects me”.
What are the 6 levels of validation?
- Staying awake - unbiased active listening, observing.
- Accurate reflection - Rogerian reflections of clients feelings, thoughts and behaviors.
- Articulating unverbalised emotions, thoughts or behavior patterns - i.e. “that must’ve been upsetting”.
- Validating current experiences in terms of past learning/biological dysfuntion - i.e. “Given what you have gone through, it makes perfect sense that…”.
- Validation in terms of normative functioning - i.e. “anyone would feel upset if…”.
- Telling it like it is - i.e. “Man that must’ve sucked”.
For examples of distress tolerance skills what does the ACCEPTS acronym stand for i.e. ‘Wise mind accepts’?
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.
For examples of distress tolerance skills what does the acronym ‘Improve’ stand for in “Improve the moment”.
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.
What sorts of things are recorded on a diary card?
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.
What does the “Dear Man Give Fast” acronym stand for and what type of DBT skill is it?
It is part of 'Interpersonal Effectiveness' & 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’.
What are the basic principles of accepting reality taught in DBT?
- Radical acceptance - let go of fighting reality.
- Turning the mind - Turn the mind towards acceptance, ‘try’.
- Willing vs. Willful - notice willfulness, radical acceptance of willfulness and turn mind toward willingness.
What are the “What” and “How” skills taught in DBT?
What skills:
- Observing.
- Describing
- Participating.
‘How’ skills:
- Taking a non-judgmental stance.
- Focusing on “one thing” in the moment.
- Being effective.
Explain the ‘Bio’ in the Bio-social model of emotion dysregulation used in DBT.
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.
Explain the ‘Social’ in the Bio-social model of emotion dysregulation used in DBT.
The early care-giving environment may contribute to the development of emotion regulation difficulties seen in BPD through:
- a tendency to invalidate the infant or child’s emotional experiences,
- an inability to model appropriate expressions of emotions,
- regular interactions with the child that inadverdantly reinforce their emotional arousal &
- a poor fit in terms of the parenting style and the child’s temperament.
What are two things that DBT focuses on?
- Increasing ‘conscious control’ i.e. through mindfulness.
2. Overlearning emotion regulation skills so that they become automatic.
What are 7 assumptions DBT therapists make about their clients?
- They are doing the best that they can.
- They want to improve.
- They must learn new behaviors and in all relevant contexts.
- Clients cannot fail in DBT.
- Clients may not have caused all of their problems, but they have to solve them anyway.
- Clients need to do better, try harder and/or be more motivated to change.
- The lives of BPD individuals are unbearable as they are currently being lived.
What is the DBT treatment heirarchy?
- Decreasing life threatening behaviors (i.e. suicide, self-harm.
- Decreasing therapy interfering behaviors.
- Decreasing quality of life interfering behaviors (i.e. drinking).
- Increasing behavioral skills.
- Creating a life worth living.
What is the first level of disorder?
Behavioral Dyscontrol: Failures in safety & survival. Severe disinhibition. Incapacitating disorder. Severe “externalising” disorders. Severe life interfering behaviors i.e. suicide attempt, homeless heroin addict, homicidal rage, catatonic depresison.
What is the second level of disorder?
Quiet Desperation: severe neuroticism. “Internalising” disorders. PTSD, maladaptive bereavement, BPD.
What is the third level of disorder?
Problems in living: uncomplicated axis 1 disorders or marital/career problems.
What is the fourth level of disorder?
Incompleteness: e.g. existential concerns, emptiness or loneliness.
What are four characteristics of invalidating environments?
- Personal responses and experiences of the child are invalidated by the significant others in her life.
- The child’s personal communications are not accepted as an accurate indication of her true feelings.
- It is implied, that if they were accurate, then such feelings would not be a valid response to circumstances.
- Characterised by a tendency to place a high value on self-control and self-reliance.
What are seven different ways DBT therapists validate?
(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
