1. Dialectical Behavior Therapy Presentation Materials
The Behavioral Technology Transfer Group
4556 University Way NE l Seattle, WA Phone 206/ l Fax 206/ Web:

2. Borderline Personality Disorder
Theory of
Borderline Personality Disorder
in DBT

3. BPD is a Pervasive Disorder of the Emotion Regulation System
BPD criterion behaviors function to regulate emotions or are a natural consequence of emotion dysregulation

4. Biosocial Theory of BPD
Biological Dysfunction in the Emotion Regulation System
Invalidating Environment
Pervasive Emotion Dysregulation

5. Emotion Dysregulation
Emotional Vulnerability
Inability to
Modulate Emotions

6. Invalidating Environment
Pervasively negates or dismisses behavior
independent of
the actual validity
of the behavior

7. Validation Case Management
DIALECTICAL
Communication
Change
Acceptance
Irreverent
Reciprocal
Problem
Solving
Validation
Core
Consultation-
to-the-Patient
Environmental
Intervention
Team
Consultation
Case Management

8. Balance Core Strategies
PROBLEM
SOLVING
VALIDATION
Dialectics

9. Dialectics as Persuasion
A method of logic or argumentation by disclosing the contradictions (antithesis) in an opponent’s argument (thesis) and overcoming them (synthesis).
This is why to use Rational Emotive Therapy (RET).
Therapist use of logic.
Cognitive modification.

10. Dialectics within therapy
Dialectics can be used within therapy to help clients start to think less in black and white and more in “gray” (e.g., a person can be be “good” but still make a mistake)

11. Translating a Dialectical World View into Treatment
Provides foundation of biosocial etiology
1. Transactional development and maintenance
2. Systemic disorder
Dialectically informs treatment strategies
1. Balance of Acceptance vs. Change
2. Search for "what is left out"
3. Emphasis on speed, movement, flow
Dialectically informs treatment goals
1. Emotion regulation
2. Interpersonal effectiveness
3. Mindfulness
4. Distress tolerance

12. Goals of Treatment by Level of Disorder
Dialectical Synthesis
Level 1: Severe Behavioral Dyscontrol
Behavioral Control
Level 2: Quiet Desperation
Emotional Experiencing
Level 3: Problems in Living
Ordinary Happiness & Unhappiness
Level 4: Incompleteness
Capacity for Joy and Freedom

13. Increase behavioral skills
Stage 1 Primary Targets Dialectical Synthesis Severe Behavioral Dyscontrol Behavioral Control
Decrease
Life-threatening behaviors
Therapy-interfering behaviors
Quality-of-life interfering behaviors
Increase behavioral skills
Core Mindfulness
Distress Tolerance
Interpersonal Effectiveness
Emotion Regulation
Self-Management

14. Structure the Milieu and Modes of Treatment
Standard DBT is Outpatient Treatment

15. Standard DBT Modes Pharmacotherapy Outpatient Individual Psychotherapy
Outpatient Group Skills Training
Telephone Consultation
Therapists’ Consultation Meeting
Uncontrolled Ancillary Treatments
Pharmacotherapy
Acute-Inpatient Psychiatric

16. Five Functions of Comprehensive Treatment
1. Enhance capabilities
2. Improve motivational factors
3. Assure generalization to natural environment
4. Enhance therapist capabilities and motivation to treat effectively
5. Structure the environment

17. The Overarching DBT Goal is...
A LIFE
Worth Living

18. Goals of skill training
Behaviors to increase
Behaviors to decrease
Mindfulness skills
Identity confusion
Emptiness
Cognitive dysregulation
Interpersonal skills
Interpersonal chaos
Fear of abandonment
Emotion regulation skills
Labile affect
Excessive anger
Distress tolerance skills
Impulsive behavior
Suicide threats
Parasuicide

19. Six month skills training cycle
Continuous loop
Interpersonal skills (6 weeks)
Mindfulness (2 weeks)
Emotional regulation (6 weeks)
Distress tolerance (6 weeks)

20. Mindfulness Skills
Mindfulness is about learning to control one’s mind instead of letting the mind control you.
To a certain extent, learning to control the mind is learning to be in control of attentional processes.
Inability to control attention can cause problems (inability to stop thinking about things).
Western + eastern meditation practices, yoga are all practices that help control mind. They are hard and take practice.

21. Mindfulness Skills: Three types of mind
Rational Mind: rational, thinking, logical mind.
Emotional Mind: In emotional mind when your emotions are in control of thinking or behavior. Emotional mind is important.
Wise mind: integration of rational mind and emotional mind. Wise mind is that part of each person that can know and experience truth. It is the integration of many types of knowing, knowing by observing, analyzing, knowing by what we experience in our bodies.

22. Mindfulness: being a personal scientist: what skills
Observe: pay attention to current moment.
Step back and watch what’s happening inside of you and outside of you.
Control attention but not content.
Describe: Put words to experience. Just describe facts without your own theories.
Feel the feelings -- Drop the story-line
Participate- Enter completely into the moment.