Presentation on theme: "Acceptance Based DBT for Emotion Regulation"— Presentation transcript:
1Acceptance Based DBT for Emotion Regulation Sandra Georgescu, Psy. D.Paul Holmes, Psy.D.
2IntroductionDBT – one of the 1st CBTs to integrate acceptance/mindfulness and behavior change strategiesDBT – one foot in the 2nd & another in the 3rd wave of behaviorismDBT’s leap into the 3rd wave
3The Field’s Timeline S-R Behaviorism 1st Wave Acceptance/Mindfulness Reject anything vaguescientific principles1st WaveRigorous testingFirst-order changeThe Field’s Timelinedialectics, contact with the present momentexperiential avoidance, cognitiveAcceptance/Mindfulnessdefusion, relationship, values,3rd waveCognitive BehavioralSame as above + role ofcognition based on2nd Waveclinical samplesDBTHayes, (2004)
4DBT as Originally Packaged Intensive Outpatient Treatment involving:Individual PsychotherapySkills Training GroupTelephone ConsultationTherapists’ Consultation GroupUncontrolled Ancillary TreatmentPharmacotherapyAcute Inpatient Psychiatric
5DBT - Stages of Treatment Pre-treatment - Commitment, Orientation & Agreement on GoalsStage I - Stability, Connectedness & SafetyStage II - Exposure & Emotional Processing of the PastStage III - Ordinary Happiness & UnhappinessStage IV - Capacity for Sustained JoyTalk about dialectics! general
6Stage I Targets Decrease control of contrived private experience Severe Behavioral Dyscontrol Behavioral ControlDecrease control of contrived private experienceLife threatening behaviorsTherapy interfering behaviorsQuality of life interfering behaviorsIncrease Behavioral SkillsCore MindfulnessDistress toleranceEmotion regulationInterpersonal Effectiveness
7Knowledge Action Relationship Between Knowledge & Action Become more discriminating in our actionsKnowledge ActionContact with Consequences resultsin refined knowledge
8Moving Forward Meaningless Dialectic Data on emotion and thought suppressionRelational Frame Theory (RFT) – provides us with a nominalist model for understanding mind from a behavioral perspective
9Meaningless Dialectic in DBT ?????Mindfulness Cognitive Restructuring(content is not the (content is the problem; problem, just notice) evaluate & change it)
11Relational Frame Theory (RFT) Language about mind was avoided in the 1st wave & mentallistic in the 2nd waveRorty (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 mindMind is unidirectional – once you have it, you got ityou
12Acceptance Based DBT for Emotional Regulation “LIVING MEANINGFULLY”meACCEPTANCEBEHAV. CHANGEVALUESPRIVATE EXPERIENCE
13Implications Individual Session Cognitive restructuring strategies are replaced by:Mindfulness of thoughts, rules and stories – is this the 1st time you’ve ever had that thoughtWillingness 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 lifeWorkability of buying thoughts (short & long-term) is the measuring stick that helps inform choicesMe & you - perhaps you can even talk about your phallic drawing here….All jokes aside, I really like that diagram & remember that it was something that was brough up last year….
14Private 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!Me/you
15DBT & ValuesIn it’s original DBT proposes “life worth living” as a direction for movement…in treatment and in life…ANDNo definition or process is identified for defining what “life worth living” means…me
16Values 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 livesAn 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 takeSee what you think about where I placed it in the hierarchy….
17ACBS Values assessment tools Developed by T. Lundgren &J.A. Dahl
18….and Skills TrainingSkill training modules renamed to reflect an acceptance/ongoing life process instead of a if/then contingencyCognitive restructuring strategies have been removed from all handouts & replaced with acceptance/mindfulness consistent interventions…extended mindfulness practiceValued Living has been added to Emotion Regulation Skill Area to help extend existing behavioral activation exercises and provide an anchor/purpose to skill useme
20Skills Training 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.you
21Skills 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.
22Skills Training Living with Emotions (Emotion Regulation) Emotions are adaptiveEmotion is an early brain form of communicationEmotion is where your language and body meetAn emotion is an indicator of a specific way in which you need to take care of yourselfSkills emphasize practice identifying emotion and lesson it is attempting to conveyIdentifying language that would help direct you towards actions that would make certain emotions more present e.g. meaning driven behavioral activation/exposureYou
23Skills Training Living with Others To live meaningfully will involve other peoplePractice observing your limits while honoring the limits of othersBeing fully present non-judgmentally, validating one’s emotions and perceptions and communicating honestlyPractice making requests and saying “no”