1. Acceptance Based DBT for Emotion Regulation
Sandra Georgescu, Psy. D.
Paul Holmes, Psy.D.

2. Introduction
DBT – one of the 1st CBTs to integrate acceptance/mindfulness and behavior change strategies
DBT – one foot in the 2nd & another in the 3rd wave of behaviorism
DBT’s leap into the 3rd wave

3. The Field’s Timeline S-R Behaviorism 1st Wave Acceptance/Mindfulness
Reject anything vague
scientific principles
1st Wave
Rigorous testing
First-order change
The Field’s Timeline
dialectics, contact with the present moment
experiential avoidance, cognitive
Acceptance/Mindfulness
defusion, relationship, values,
3rd wave
Cognitive Behavioral
Same as above + role of
cognition based on
2nd Wave
clinical samples
DBT
Hayes, (2004)

4. DBT as Originally Packaged
Intensive Outpatient Treatment involving:
Individual Psychotherapy
Skills Training Group
Telephone Consultation
Therapists’ Consultation Group
Uncontrolled Ancillary Treatment
Pharmacotherapy
Acute Inpatient Psychiatric

5. DBT - Stages of Treatment
Pre-treatment - Commitment, Orientation & Agreement on Goals
Stage I - Stability, Connectedness & Safety
Stage II - Exposure & Emotional Processing of the Past
Stage III - Ordinary Happiness & Unhappiness
Stage IV - Capacity for Sustained Joy
Talk about dialectics! general

6. Stage I Targets Decrease control of contrived private experience
Severe Behavioral Dyscontrol  Behavioral Control
Decrease control of contrived private experience
Life threatening behaviors
Therapy interfering behaviors
Quality of life interfering behaviors
Increase Behavioral Skills
Core Mindfulness
Distress tolerance
Emotion regulation
Interpersonal Effectiveness

7. Knowledge Action Relationship Between Knowledge & Action
Become more discriminating in our actions
Knowledge Action
Contact with Consequences results
in refined knowledge

8. Moving Forward Meaningless Dialectic
Data on emotion and thought suppression
Relational Frame Theory (RFT) – provides us with a nominalist model for understanding mind from a behavioral perspective

9. Meaningless Dialectic in DBT
?????
Mindfulness Cognitive Restructuring
(content is not the (content is the problem; problem, just notice) evaluate & change it)

10. Avoidance of Private Experience
Escape from events & objects
Escape from private experience
Thought suppression (Marcks & Woods, 2005; Bower & Woody, 1996, Abramowitz, Tolin & Street, 2001 )
Emotion suppression (Gross & Johns, 2003; Gross, 1998; Gross & Levenson, 1997)
Experiential Avoidance (Feldner, Zvolensky, Eifert & Spira, 2003; Hayes, Strosahl, Wilson, et al. 2004; Chawla & Ostafin, 2007)
you

11. Relational Frame Theory (RFT)
Language about mind was avoided in the 1st wave & mentallistic in the 2nd wave
Rorty (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 mind
Mind is unidirectional – once you have it, you got it
you

12. Acceptance Based DBT for Emotional Regulation
“LIVING MEANINGFULLY” me
ACCEPTANCE
BEHAV. CHANGE
VALUES
PRIVATE EXPERIENCE

13. Implications Individual Session
Cognitive restructuring strategies are replaced by:
Mindfulness of thoughts, rules and stories – is this the 1st time you’ve ever had that thought
Willingness 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 life
Workability of buying thoughts (short & long-term) is the measuring stick that helps inform choices
Me & 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….

14. Private 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

15. DBT & Values
In it’s original DBT proposes “life worth living” as a direction for movement…in treatment and in life…
AND
No definition or process is identified for defining what “life worth living” means… me

16. Values 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 lives
An 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 take
See what you think about where I placed it in the hierarchy….

17. ACBS Values assessment tools
Developed by T. Lundgren &J.A. Dahl

18. ….and Skills Training
Skill training modules renamed to reflect an acceptance/ongoing life process instead of a if/then contingency
Cognitive restructuring strategies have been removed from all handouts & replaced with acceptance/mindfulness consistent interventions…
extended mindfulness practice
Valued Living has been added to Emotion Regulation Skill Area to help extend existing behavioral activation exercises and provide an anchor/purpose to skill use me

19. Skills Training

20. Skills 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

21. Skills 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.

22. Skills Training Living with Emotions (Emotion Regulation)
Emotions are adaptive
Emotion is an early brain form of communication
Emotion is where your language and body meet
An emotion is an indicator of a specific way in which you need to take care of yourself
Skills emphasize practice identifying emotion and lesson it is attempting to convey
Identifying language that would help direct you towards actions that would make certain emotions more present e.g. meaning driven behavioral activation/exposure
You

23. Skills Training Living with Others
To live meaningfully will involve other people
Practice observing your limits while honoring the limits of others
Being fully present non-judgmentally, validating one’s emotions and perceptions and communicating honestly
Practice making requests and saying “no”