Dialectical Behavior Therapy: Paulette Aasen, PH.D
Dialectical Behavior Therapy: Paulette Aasen, PH.D
Dialectical Behavior Therapy: Paulette Aasen, PH.D
Therapy
Paulette Aasen, Ph.D.
Director of Psychology Services
West Central Human Service Center
Bismarck, ND
(701) 328-8888
Dickinson, ND
(701) 227-7500
Overview of DBT
Developed
Dr.
The
Foundations of DBT
DBT
Dialectics
Behaviorism
Mindfulness
Purpose:
Dysregulation
Affective lability
Problems with anger
Interpersonal
Dysregulation
Chaotic relationships
Fears of abandonment
Self
Dysregulation
Dysregulation
Parasuicidal behavior
Impulsive behavior
Cognitive
Dysregulation
Bio-Social Model
Biological Sensitivity
AND Invalidating Environment =
Dsyregulation Disorder Symptoms
Invalidati
ng
Environm
ent
Invalidati
ng
Environm
ent
Invalidati
ng
Environm
ent
Biology
Biology
Biology
Sensitivity
High Reactivity
Slow Return to Baseline
Often Transactional with the
Environment
Emotion
s
6
5
4
3
2
1
0
Average
Dysregulated
Threshold
Dialectical Paradigm
Dialectics is the theory that opposites can co-exist.
Dialectical Paradigm
Antithes
is
Synthesis
Acceptan
ce
Change
Dialectical Dilemmas
Unrelentin
g Crisis
Emotional
Vulnerabili
ty
Active
Passivity
Biological
Social
Apparent
Competen
ce
Inhibited
Experienci
ng
Self-Invalidation
Dialectical Strategies
Balance
Treatment
Strategies
Enter the paradox
Metaphor
Devils Advocate
Extending
Wise Mind
Lemonade out of lemons
Allowing natural change
Dialectical Assessment
Behaviorism Paradigm
Principles necessary to be
effective
Behavior Therapy: a non-biological form
of therapy that developed from learning
theory. The purpose is to change
maladaptive patterns of behavior.
Shaping: Divide a behavior to be
learned into a series of steps.
DBT: Harm reduction model so shape
clients toward that
can.
Clients want to improve.
Clients need to do better, try
harder, and be more motivated to
change.
Clients may not have caused all
of their own problems, AND they
need to solve them anyway.
Assumptions About
Therapy
The
Hierarchy of Targets
Individual
1.
2.
3.
4.
Therapy
Client Agreement
Client
Session Structure
Review
Diary Card
Attention to Target Hierarchy
Chain Analysis on highest
targeted behavior
Weave in Solution Analysis
Continue to move down hierarchy
until able to discuss skills related
to current life situations or
session time ends
Commitment Strategies
Therapist
Commitment Strategies
(cont.)
Therapist
uses principles of
SHAPING to elicit commitment
Therapist generates hope by
CHEERLEADING
Therapist and client agree on
HOMEWORK
Validation of Consumer
Stay
Awake
Accurate Reflection
Articulating unverbalized emotions,
thoughts, and behavior patterns
Validation in terms of past learning
or biological dysfunction
Validation in terms of current
context or normative functioning
Radical Genuineness
Self-Verification Theory
Validation
= Self-Verification
Invalidation of Self-Construct
leads to AROUSAL!!! (Sense of
out-of-control)
HIGH AROUSAL + OUT-OFCONTROL leads to >>>>
Failure to process New
Information =
NO NEW LEARNING!
Relationship Strategies
Accept
the relationship as it is in
the current moment, use the
relationship as therapy YOU are
the Key
Use problem solving on the
relationship
Attend directly to generalization
of behaviors learned in the
relationship
Be
session
1-year commitment
Both client and therapist sign
agreement
Agreement includes statements
regarding homework completion
and attendance
Co-facilitators
Hierarchy of Targets
DBT
Skills Group
Zen Practice
Be
Mindfulness Paradigm
Mindfulness
is at the core of
Mindfulness
Paying
Non-Judgment
Patience
Beginners
Trust
Non-Striving
Acceptance
Letting
Go
Kabat-Zinn, 1990
1.
2.
3.
4.
5 Stages of
Accomplishment
Denial
I cant
do it!
Maybe I
can do it!
Uncertainty
Resistance
Panic
Theres no
way I can
do it!
AAAARGH!
What if I
cant do it?!
5.
Acceptance
ALL RIGHT!
I DID IT!
LETS
PARTY!
CONGRATULATIONS!
References
DBT Associates
Christine