2. Rogers Memorial Hospital
Presented at the WSCA Annual Conference on February 22, 2017, Madison, Wisconsin
Introduction to Dialectical Behavior Therapy: Applying DBT Skills and Philosophy in the School Setting
Lisa Herpolsheimer, LCSW, DBTC
Rogers Memorial Hospital
Nashotah Program
Clinical Services Manager
Carissa Buchanan, M.S.
Rogers Memorial Hospital
Kenosha Campus
Clinical Services Manager
Psychological Assistant

3. Learning Objectives
Learn the definition of “Dialectical Behavior Therapy,” which was created by Marsha Linehan, PhD and her colleagues
Develop an increased awareness of how an individual struggling with intense emotions may present, and begin to consider how effective emotional and behavioral strategies can enhance students’ capabilities
Learn the key principles of DBT, including dialectics
Understand how teaching DBT skills for emotion regulation, mindfulness, distress tolerance, and interpersonal effectiveness can assist students in managing emotionally intense situations in the school setting and beyond

4. The Emotionally Sensitive Student….
MERGING behaviors with others alternate with cycles of rejection. Primary fear is that of ultimate abandonment, judgement.
Intense and longer lasting emotional responses were repeatedly met with an invalidating social environment. Principally this increases SHAME. Shame is “I AM A BAD” to wish to hide and disappear (vs Guilt, I did a bad thing to which I can repair).
They feel powerless, vulnerable; may use aggressive behavior to mask this; or “apparent competence” which is looking completely put together and capable but at drop of the next activating event they are suicidal.

5. DBT Philosophy
Dialectical…..To actively and on purpose seek a Synthesis. “Two Seemingly Opposites Can be Equally True and Valid at the Same Time.”

6. DBT Philosophy
Behavioral…..All behavior is caused; therefore it can be modified when:
1) behavior is accurately understood,
2) we effectively structure the environment to respond to behaviors to increase or decrease them, AND
3) we teach to overcome skills deficits so the person may learn and test out new behaviors (Think: “This is a road map for building a life worth living. DBT is LIVED not just passively learned or prescribed to someone).

7. DBT Philosophy : “EFFECTIVE COMPASSION,” Marsha Linehan, PhD.
Non-judgmental stance: To know the objective causes and functions of a behavior helps us to be more effective to change that behavior. Judging, blaming, or assuming another’s “intentions,” is not helpful and reduces the likelihood that our change interventions can be delivered or accepted.
Assumptions of DBT
At any given time we are all doing our best and can keep doing better
All people want to reduce their suffering and improve their lives

8. Dialectical Philosophy
DBT Philosophy
Zen / Contemplative Practice
Behavioral Science
ACCEPTANCE
CHANGE
Dialectical Philosophy
Slide Author: Carissa Buchanan, M.S.

9. DBT Philosophy : To intervene, use Acceptance Strategies before using any of the Change Strategies.
Core Mindfulness
Observe, Describe, STOP skill…what is my/our goal in the here and now? At this VERY moment?
Radical Acceptance
Lots of VALIDATION but don’t validate the invalid.
Listen for the EMOTION. This is NOT RESCUING, FRAGILIZING, Reassuring, problem solving or minimizing!
“Makes Sense” “Kernel of Truth”

10. DBT Philosophy CHANGE Skills Training + Environmental Structuring
Behavioral Chain Analysis (BCA).
Environmental Structuring: how we respond to increase or decrease targeted behaviors for change.
Activate change by assigning use of DBT skills by the learner: For example, Opposite Action.

11. DBT Skills

12. DBT Skills - Mindfulness
Definition
Being present in the moment
Purposely paying attention
Goals
Increase emotional stability
Learn how to control one’s attention
Practice being present in everyday activities
Requires daily practice

13. DBT Skills - Mindfulness
What are the benefits of engaging in mindfulness?
Helps focus on the present
Changes brain activity
Increases nonjudgmental perspective
Assists with thinking before acting
Improves ability to attend to a situation

14. DBT Skills - Mindfulness
Incorporate a brief activity daily
Have a bell or sound to cue the start of mindfulness
Encourage students to focus on themselves
Remind them why it is important to practice mindfulness
Discuss how they felt afterwards

15. DBT Skills - Mindfulness
Wise Mind
Emotion mind
Reasonable mind
Wise mind
“What” skills
Observe the experience
Describe with words
Participate in mindfulness
“How” skills
Non-judgmentally
One-mindfully
Effectively

16. DBT Skills – Wise Mind Skill
Emotion mind
Emotions dictate action
Little attention to thoughts and reason
Reasonable mind
Dealing with only facts
Focus on solving the problem
Wise mind
Integration of emotions and logic
Remaining mindful and nonjudgmental

17. DBT Skills – Distress Tolerance
Crisis survival strategies
Wise mind ACCEPTS
IMPROVE the moment
Pros and cons
STOP
TIP
Self-Soothing
Reality acceptance skills
Radical acceptance
Turning the mind
Willingness
Half-smiling and willing hands

18. DBT Skills – TIP Skill
Tip the temperature of your face with cold water
Physiologically cool your body
Intense exercise
Calm your body
Paced breathing
Slow your breathing
Paired muscle relaxation
Pairing deep breathing with relaxed muscles

19. DBT Skills – Emotion Regulation
Understanding emotions
Why emotions are important
Describing emotions
Decrease frequency of unwanted emotions
Check the facts
Use opposite action
Reduce emotional vulnerability
ABC PLEASE
Increase positive emotions
Decrease emotional suffering
Let go of painful emotions through mindfulness

20. DBT Skills – Wave Skill Experience your emotions like a wave
Don’t try to push away the emotions AND don’t try to hold on to them
Be mindful of body sensations
You are not your emotions
You don’t have to act on your emotions
Don’t judge your emotions
Radically accept your emotions

21. DBT Skills – Interpersonal Effectivenes
Be skillful in getting what you want and need from others
Objective effectiveness: DEAR MAN
Relationship effectiveness: GIVE
Self-respect effectiveness: FAST
Build healthy relationships and end
destructive ones
Walk the middle path
How to solve problems

22. DBT Skills – DEAR MAN Skill
How to assertively obtain what you want:
Describe
Express
Assert
Reinforce
Mindful
Appear confident
Negotiate

23. Rogers Memorial Hospital
Six Rogers Memorial Hospital Wisconsin locations:
Oconomowoc
Inpatient hospital
8 residential centers
Partial hospital (PHP) and intensive outpatient (IOP) programs
West Allis
PHPs and IOPs
Brown Deer
Madison
PHPs and IOPs
Kenosha
Appleton 

24. References
Christensen, K., Riddoch, G.N., Huber, J.E. (2009). Dialectical behavior therapy skills, 101 mindfulness exercises and other fun activities for children and adolescents: A learning supplement. Bloomington, IN: AuthorHouse
Dimeff, L.A. & Koerner, K. (Eds) (2007). Dialectical behavior therapy in clinical practice: Applications across disorders and settings. New York: Guilford Press.
Harvey, P. & Rathbone, B.H. (2013). Dialectical behavior therapy for at-risk adolescents: A practitioner’s guide to treating challenging behavior problems. Oakland, CA: New Harbinger Publications, Inc.
Koerner, K. (2012). Doing dialectical behavior therapy: A practical guide. New York: Guilford Press.
Linehan, M.M. (1993b). Skills training manual for treating borderline personality disorder. New York: Guilford Press.
Linehan, M.M. (2015). DBT skills training handouts and worksheets (2nd ed.). New York: Guilford Press.
Linehan, M.M. (2015). DBT skills training manual (2nd ed.). New York: Guilford Press.
Mazza, J.J., Dexter-Mazza, E.T., Miller, A.L., Rathus, J.H., & Murphy, H.E. (2016). DBT Skills in Schools: Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A). New York: Guilford Press.
Miller, A.L., Rathus, J.H., Linehan, M.M. (2007). Dialectical behavior therapy with suicidal adolescents. New York: Guilford Press.
Rathus, J.H. & Miller, A.L. (2015). DBT skills manual for adolescents. New York: Guilford Press.