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Acceptance Based DBT for Emotion Regulation Sandra Georgescu, Psy. D. Paul Holmes, Psy.D.

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Presentation on theme: "Acceptance Based DBT for Emotion Regulation Sandra Georgescu, Psy. D. Paul Holmes, Psy.D."— Presentation transcript:

1 Acceptance Based DBT for Emotion Regulation Sandra Georgescu, Psy. D. Paul Holmes, Psy.D.

2 Introduction  DBT – one of the 1 st CBTs to integrate acceptance/mindfulness and behavior change strategies  DBT – one foot in the 2 nd & another in the 3 rd wave of behaviorism  DBT’s leap into the 3 rd wave

3 The Field’s Timeline 1st Wave S-R Behaviorism scientific principles Rigorous testing Reject anything vague First-order change 2nd Wave Cognitive Behavioral Same as above + role of cognition based on clinical samples 3rd wave Acceptance/Mindfulness experiential avoidance, cognitive defusion, relationship, values, contact with the present moment dialectics, contact with the present moment DBT Hayes, (2004)

4 DBT as Originally Packaged  Intensive Outpatient Treatment involving:  Individual Psychotherapy  Skills Training Group  Telephone Consultation  Therapists’ Consultation Group  Uncontrolled Ancillary Treatment  Pharmacotherapy  Acute Inpatient Psychiatric

5 DBT - Stages of Treatment Pre-treatment - Commitment, Orientation & Agreement on Goals Stage I - Stability, Connectedness & Safety Stage II - Exposure & Emotional Processing of the Past Stage III - Ordinary Happiness & Unhappiness Stage IV - Capacity for Sustained Joy

6 Stage I Targets Severe Behavioral Dyscontrol  Behavioral Control Decrease control of contrived private experience 1.Life threatening behaviors 2.Therapy interfering behaviors 3.Quality of life interfering behaviors Increase Behavioral Skills } Core Mindfulness } Distress tolerance } Emotion regulation } Interpersonal Effectiveness

7 Become more discriminating in our actions Relationship Between Knowledge & Action KnowledgeAction Contact with Consequences results in refined knowledge

8 Moving Forward  Meaningless Dialectic  Data on emotion and thought suppression  Relational Frame Theory (RFT) – provides us with a nominalist model for understanding mind from a behavioral perspective

9 Meaningless Dialectic in DBT ????? ????? Mindfulness Cognitive Restructuring Mindfulness Cognitive Restructuring (content is not the (content is the problem; problem, just notice) evaluate & change it) (content is not the (content is the problem; problem, just notice) evaluate & change it)

10 Avoidance of Private Experience  Escape from events & objects  Escape from private experience  Thought suppression (Marcks & Woods, 2005; Bower & Woody, 1996, Abramowitz, Tolin & Street, 2001 )  Emotion suppression (Gross & Johns, 2003; Gross, 1998; Gross & Levenson, 1997)  Experiential Avoidance (Feldner, Zvolensky, Eifert & Spira, 2003; Hayes, Strosahl, Wilson, et al. 2004; Chawla & Ostafin, 2007)

11 Relational Frame Theory (RFT)  Language about mind was avoided in the 1 st wave & mentallistic in the 2 nd wave  Rorty (1997) – when we’ve explained the use of language in society, we’ve made sense of the term “mind”  RFT may have provided us us with a functional conceptualization of mind  Mind is unidirectional – once you have it, you got it


13 Implications Individual Session Cognitive restructuring strategies are replaced by:  Mindfulness of thoughts, rules and stories – is this the 1 st time you’ve ever had that thought  Willingness to experience this thought as just that, a thought rather than whatever it may say it is (acceptance) – is it ok to have that thought given that it’s here?  Functional assessment of thoughts and stories is carried out in the context of their commitment to a valued direction in life  Workability of buying thoughts (short & long-term) is the measuring stick that helps inform choices

14 Private Experience Lots of questions about it…exposure Is it ok to have that thought…. As a thought not as what it says it is? If not, more questions…. About workability, about the thought(s) in a different context….but its always the SAME thought!

15 DBT & Values  In it’s original DBT proposes “life worth living” as a direction for movement…in treatment and in life… AND  No definition or process is identified for defining what “life worth living” means…

16 Values on an individual basis  Utilizing the Values Living Questionnaire, Values compass or Bulls eye to assess the direction that people want to give to their lives  An anchor for commitment: conversation to be had as part of pre-treatment; beginning to define the areas that are meaningful and the directions that people would like their lives to take

17 ACBS Values assessment tools Very close Developed by T. Lundgren &J.A. Dahl

18 ….and Skills Training  Skill training modules renamed to reflect an acceptance/ongoing life process instead of a if/then contingency  Cognitive restructuring strategies have been removed from all handouts & replaced with acceptance/mindfulness consistent interventions…  extended mindfulness practice  Valued Living has been added to Emotion Regulation Skill Area to help extend existing behavioral activation exercises and provide an anchor/purpose to skill use

19 Skills Training

20  Living in the Present (Mindfulness)  Goal - to develop an unattached awareness of experience. It is training in perspective-taking.  Participants are taught that one cannot control thoughts and feelings. They can only control what they attend to.  Learn to be open to all things and focus only on one thing.  Learn to differentiate between being lost in experience and being present in an experience.  Learn to recognize and practice choosing in the gap between an urge and the action typically associated with it.

21 Skills Training  Living with Distress (Distress Tolerance)  Considered more active forms of mindfulness.  The DT activity becomes the focus of attention.  Participants are taught to take their distressing thoughts and feelings with them as they engage in a DT skill.  Learn to re-contextualizing experience.  Learn to attend to the process of experiencing rather than continuously evaluating the experience.

22 Skills Training  Living with Emotions (Emotion Regulation)  Emotions are adaptive  Emotion is an early brain form of communication  Emotion is where your language and body meet  An emotion is an indicator of a specific way in which you need to take care of yourself  Skills emphasize practice identifying emotion and lesson it is attempting to convey  Identifying language that would help direct you towards actions that would make certain emotions more present e.g. meaning driven behavioral activation/exposure

23 Skills Training  Living with Others  To live meaningfully will involve other people  Practice observing your limits while honoring the limits of others  Being fully present non-judgmentally, validating one’s emotions and perceptions and communicating honestly  Practice making requests and saying “no”

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