what is DBT based on
CBT, zen principles and suicide prevention
what is DBT and for what patients is it useful
its an evidence based program developed for severely suicidal patients, the goal is to build a life worth living
- it started with suicide then BPD and its found useful for ASD as well
what is the biosocial theory
- emotion dysregulation arrises from the interplay between bilogical vulnerability and a chronicaly invalidating environment
The biosocial perspective describes that patients do not have sufficient and/or limited skills to regulate emotional problems. The DBT helps the patient by strengthening these skills or learning new skills.
what are the 4 components of DBT
structured group training - practice and coaching
structured individual - motivating and analysing obstacles
telephone consultation - generalizing
consultation team - monitoring and improving qualities and keeping therapist healthy
+ Case Management - Structure the environment
what are the 8 Key assumptions of DBT
- Patients is doing their best
- The patient wants to improve
- Patient needs to do better
- The patients may not have caused all their problems, but they can solve them
- The lives of suicidal patients are unbearable as they are currently being lived
- Patients must learn new behaviours in all relevant contexts - generalisation
- Patients cannot fail therapy
- Therapists need support
what are the 3 principles to guide therapist
- Dialectics - Recognizing the polarity in behavior and the importance of continuous change and coherence.
- Acceptance (Mindfulness) - Observing without judgment
- Change (Behaviorism)- Behavior shaping through repetition and operant conditioning.
house of cbt
pretreatment - commitment to DBT and foundation with the therapist
stage 1 -severe behavioral dyscontrol improve behavioral control focus on Life-Threatening Behaviors and Increase Skills (hiearchy)
step 2- quiet desperation - imrpove emotional regulation and experiencing
step 3 - problems in living - ordinary happines and unhappines, self respect individual problems in living
steo 4 - incompletness - capacity for sustained joy, expanded awarenes, peak experiences
skill modules of DBT
- Mindfulness - Addressing identity confusion and feelings of emptiness
- Interpersonal effectiveness - Managing unstable relationships and fear of abandonment.
- Emotion regulation - Controlling mood swings and intense anger
- Frustration tolerance - Reducing impulsive behavior and self harm.
there are five functions of comprehensive DBT:
(1) improve client motivation to change;
(2) enhance client capabilities;
(3) facilitate generalization of client capabilities to their natural environments;
(4) enhance therapist motivation and capabilities to treat clients effectively;
(5) help structure the environment to bolster client and therapist capabilities
DBT hiearchy - treatment targets
1) Self-harm and Life-threatening Behaviours:(SIBS)Highest priority, addressing suicidal ideation, attempts, and high-lethality behaviours like substance use or disordered eating.
2) Therapy-interfering Behaviours (TIBs) Behaviours that interfere with effective treatment, such as missing sessions, arriving late, or damaging the therapeutic relationship.
3) Quality-of-life Interfering Behaviours (QIBs): Behaviours that limit client motivation or quality of life, including mental health crises and financial or home problems.
4) Skills Acquisition: Developing skills to replace problematic behaviours, primarily taught in skills groups, including mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance.
what are the 3 central principles of DBT
- wholness
- polarity
- continous change
what is the primary dialectic in DBT
acceptance and change
name the 3 additional dialectical dilemas
- emotional vulnerability vs self invalidation
- active passivity vs apparent competence
- unrelenting crisis vs inhibited grieving
what are the 3 behavioruist techinques that DBT integrates
clasical conditioning
operant learning
modeling
describe the 4 steps of chain analyisis
goal identify and understand the sequence of events leading to a problem behavior
1. Identifying the Problem Behaviour: This could be any target behaviour, such as self-harm or heightened perfectionism.
2. Identifying Proximal Cues/Risk Factors: Understanding what triggered the problem behaviour.
3. Conducting a Functional Analysis: Diving into the details to understand the “links” in the chain that led to the problem behaviour.
4. Discuss Short- and long-term consequences
