DBT

DIALECTICAL BEHAVIOUR THERAPY
INTRODUCTION
BPD is a disorder that is severe, chronic, and persistent individuals meeting criteria for the disorder is aprox 11% BPD individuals describe chronic feelings of anger, emptiness, depressions and anxiety.
DIALECTICAL BEHAVIORAL THERAPY

Marsha Linehan (1991) pioneered this treatment Treatment goals were reducing Para suicidal (self-injuring) and life-threatening behaviors. reducing behaviors that interfered the therapy/treatment process finally reducing behaviors that reduced the client's quality of life.
THE TOP TARGETS AND GOALS OF TREATMENT IN DBT DBT organizes treatment into four stages Stage I: Moving from Being Out of Control of Ones Behavior to Being in Control Target 1: Reduce and then eliminate lifethreatening behaviors Target 2: Reduce and then eliminate behaviors that interfere with treatment Target 3: Decreasing behaviors that destroy the quality of life
CONTD..
Target 4: Learn skills that help people do the following Control their attention Start new relationships, improve current relationships, or end bad relationships Tolerate emotional pain without resorting to selfharm or self-destructive behaviors
Stage II. Moving from Being Emotionally Shut Down to Experiencing Emotions Fully Stage III. Building an Ordinary Life, Solving Ordinary Life Problems Stage IV. Moving from Incompleteness to Completeness/Connection
PHILOSOPHICAL UNDERPINNINGS
Biosocial theory BPD is seen as a biological disorder of emotional regulation. Characteristic behaviors and emotional experiences associated with BPD theoretically result from the expression of this biological dysfunction in a social environment experienced as invalidating by the borderline patient."
INVALIDATING ENVIRONMENT
The invalidating environment is broadly characterized by pervasive, criticizing, minimizing, punishing or or irratically reinforcing communication of internal experiences and over simplifying the ease of problem solving.
EMOTIONAL VULNERABILITY
The is characterized by heightened sensitivity to emotion, increased emotional intensity and a slow return to emotional baseline.
Emotional dysregulation
EMOTIONAL DYSREGULATION
Environmental invalidation Emotional vulnerability
COGNITIVE BEHAVIORAL THERAPY

It makes use of self-monitoring. emphasis on the here and now. include the style of open and explicit. collaboration between patient and therapist.
ZEN
DBT utilizes Zen concepts as a basis to encourage patients to be mindful in the current moment, see reality without delusion, and accept reality and themselves without judgment. This skill, which has its roots in Western contemplative and Eastern meditative practices, is called mindfulness.
THE DIALECTIC
The word dialectic is the Greek dialegein, which means to argue or converse."As a world view... dialectics anchors the treatment within other perspectives that emphasize: 1. the holistic, systemic and interrelated nature of human functioning and reality as a whole (asking always "what is being left out of our understanding here?"); 2. searching for synthesis and balance, (to replace the rigid, often extreme, and dichotomous responses characteristic of severely dysfunctional individuals); 3. enhancing comfort with ambiguity and change which are viewed as inevitable aspects of life.
GROUP SKILLS TRAINING

BPD lack many of the fundamental skills Groups have a didactic orientation and the entire sequence of weekly skills training takes approximately six months to complete. Patients typically go through the skills training at least twice. It includes four modules.
THE FOUR MODULES

Mindfulness Interpersonal effectiveness Distress tolerance Emotion regulation
HOW IT WORKS
Avoidance or escape
Problem behavior
cue
DBT teaches to tolerate distress
Teaches to stop this behaviour
Temporary relief
INDIVIDUAL THERAPY
Individual therapy involves weekly (or daily if inpatient) sessions in which problem behaviors (e.g., self-mutilation, therapy interfering behaviors, bingeing / purging, abuse of alcohol / drugs, etc.) are analyzed in great depth for both precipitants and consequences which elicit, lead to, maintain, or reinforce the behavior. Solutions are developed that address what gets in the way of skillful behavior by changing reinforcement patterns, overcoming inhibitions through exposure, cognitive modification, and directly teaching skills.
CONTD
Diary cards Behavior analysis Skill enhancement
VALIDATION
Validation in DBT involves five different levels This first two are similar to other psychotherapies The third step of validation is to articulate for the patient unverbalized emotions, thoughts, or behavior patterns. The fourth step is for the therapist to validate the person's present behavior based on their past learning history. Fifth, the therapist looks for and articulates the part of the patient's response that is valid and / or wise.
DIALECTICAL STRATEGIES
Acceptance & change focused interventions Nurturing the patient & demanding that he or she helps himself highlight patients strength & deficits being stable & persistent, as well as flexible point out paradoxes when present use metaphors help patient activate wise mindetc
TELEPHONE CONSULTATION
To enhance the generalization of skills, patients in DBT can contact their therapist for telephone consultation between sessions. However personal limits should be maintained making the calls to be brief & lasting approximately 10 minutes. It uses 24- hour rule which states that patient will not receive skills help from their individual therapists until 24 hours after any self injurious behavior. in all these calls the DBT therapist assesses for immediate danger & provide appropriate assistance.
CONSULTATION TEAM
Because working with borderline individuals can be very difficult and distressing, effective DBT treatment requires the formation of a consultation team. The goal of the consultation team is to provide feedback to therapists so that they keep the treatment balanced, to strategies treatment approaches which may be helpful to the patient, to look for what may be missing in any analysis or hypothesis, to help the therapists observe their own limits and values, to strive for phenomenological empathy, and to cheerlead when a therapist becomes demoralized.
EMPERICAL EVIDENCES
Less parasucidal behavior Decrease psychiatric hospitalization Decrease anger Decrease psychotropic medication use Increase social adjustment Retention in therapy Can also be applied in depression, PDs, affective dysregulation problem, substance use & eating disorder.
CONCLUSION
DBT combines Zen philosophy and practice with behavioral analysis and change procedures in the context of Rogerian unconditional regard, empathy, and genuineness. works better that way). What this means is that, at its best, DBT is not just a treatment but a way of living.

DBT

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DIALECTICAL BEHAVIOUR THERAPY

DIALECTICAL BEHAVIORAL THERAPY

COGNITIVE BEHAVIORAL THERAPY

GROUP SKILLS TRAINING

THE FOUR MODULES

DBT teaches to tolerate distress

Teaches to stop this behaviour

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