1. DIALECTICAL BEHAVIOR THERAPY
OVERVIEW OF BASIC PRINCIPLES AND TREATMENT STRATEGİES

2. 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
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3. 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
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4. 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
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5. Therapist’s Role 2- Cognitive behavioral/learning approach
Attend to both the antecedents and the consequences that control a specific cognitive behavior.
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6. 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
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7. 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
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8. 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
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9. Four-Staged Treatment Plan
2nd stage:
Increasing other required skills, like mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance
Increasing respect for self
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10. 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
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11. 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
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12. 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
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13. 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
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14. 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.
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15. 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.
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16. 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)
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