DIALECTICAL BEHAVIOR THERAPY OVERVIEW OF BASIC PRINCIPLES AND TREATMENT STRATEGİES

Treatment Dialectical Behavioral Therapy (DBT) DBT is the combination of dialectical, cognitive behavioral and Zen approaches DBT is based on a biopsychosocial theory: A range of problems relating to emotion dysregulation, including substance use problems, eating disordered behavior, and anger-related problems naz

Obey standard ethical and professional guidelines Therapist Agreements Make every reasonable effort to conduct competent and effective therapy Obey standard ethical and professional guidelines Maintain confidentiality Be available to the patient for weekly therapy sessions and provide needed therapy back-up Obtain consent when needed naz

Therapist’s Role 1- Dialectical approach Opposites can coexist and be synthesized. Be dialectical, try to balance between acceptance and change. Be nonjudgemental Should tailor the therapy to clients’ needs Play the devil's advocate, activate wise mind, challenge her thoughts naz

Therapist’s Role 2- Cognitive behavioral/learning approach Attend to both the antecedents and the consequences that control a specific cognitive behavior. naz

Therapist’s Role 3- ZEN approach ``All beings are the truth, just as they are'' (Aitken, 1982, p. 6) The world is perfect in the sense that it is the best that it can be. It cannot be any different than it is because it is created or caused by what has preceded it naz

Four-Staged Treatment Plan 1st stage: Decreasing suicidal and self-harm behavior Decreasing behaviors that undermine or interfere with therapy Changing core beliefs Decreasing behaviors which interfere with her quality-of-life; often behavior which lead to crisis dila

Techniques to Modify Core Beliefs Developing a new core belief Motivating patients to modify beliefs Modifying negative core beliefs daily Reinforcing more realistic core belief daily Contrasting with more extreme negative role models Creating yardsticks of evaluation Devising behavioral experiments Acting “as if” Doing intellectual/emotional role-plays Metaphors Cognitive Continuum Historical Review of Evidence Restructuring the Meaning of Early Experiences through imagery dila

Four-Staged Treatment Plan 2nd stage: Increasing other required skills, like mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance Increasing respect for self naz

Required Skills Mindfulness skills: Psychological and behavioral versions of meditation skills. Three “what” skills (observing, describing, participating)& three “how” skills (taking a nonjudgmental stance, focusing on one thing at the moment, being effective) Distress tolerance: Ability to tolerate and accept distress. 4 sets of strategies: distracting (activities, other thoughts, etc.), self-soothing (vision, hearing ,smell, etc.), improving the moment (prayer, relaxation, etc.), and thinking of pros and cons naz

Required Skills Emotion regulation: borderline individuals are affectively intense and labile 1. Identifying and labeling affect: identify and label ongoing, current emotions 2. Identifying obstacles to changing emotions: identify functions and reinforces for particular emotional behaviors (if one hates another, this does not mean other is worthy of being hated) 3. Reducing vulnerability to emotion mind: balanced nutrition, eating habits, adequate exercise, sleep, etc. 4. Increasing positive emotional events: increasing number of positive events in one’s life 5. Increasing mindfulness to current emotion: experience emotions without judging them 6. Taking opposite action: acting in a way that is inconsistent with the emotion (approaching what she is afraid of) 7. Applying distress tolerance techniques naz

Required Skills Interpersonal effectiveness skills: effective strategies of asking for what one needs, saying no, coping with interpersonal conflict Self-management skills: Any attempt to control, manage or otherwise change one’s own behavior, thoughts or emotional responses naz

Four-Staged Treatment Plan Stage 1 and Stage 2 are not totally separate processes. Stage 1 and Stage 2 are applied simultaneously Move on to next stages when first two stages are successfully achieved naz

Four-Staged Treatment Plan 3rd Stage: Return to ordinary levels of happiness and unhappiness. Problems at this stage of treatment are of low to moderate severity and have only a moderate impact on clients' functioning, in comparison to Stage 1 and 2 problems Stage 3 problems may include marital, education or employment difficulties. dila

Four-Staged Treatment Plan 4th Stage: Aim to enhance her capacity for joy and focus on assisting clients through their insufficient ordinary happiness and unhappiness and feelings of meaninglessness or absence of connectedness. At this stage, long-term insight-oriented therapies and spiritual or religious practices. dila

Application of the Treatment Plan Individual therapy sessions twice a week and group sessions once a week Duration of the therapy is estimated to be around 15 weeks in the hospital (inpatient treatment) Daily Cards and review Brief weekly phone calls to ensure generalization of new skills (outpatient treatment) dila