Acceptance Based DBT
for Emotion Regulation
Sandra Georgescu, Psy. D.
Paul Holmes, Psy.D.
Introduction
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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
The Field’s Timeline
Hayes, (2004)
DBT as Originally Packaged
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Intensive Outpatient Treatment involving:
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Individual Psychotherapy
Skills Training Group
Telephone Consultation
Therapists’ Consultation Group
Uncontrolled Ancillary Treatment
 Pharmacotherapy
 Acute
Inpatient Psychiatric
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
Stage I Targets
Severe Behavioral Dyscontrol  Behavioral Control
Decrease control of contrived private
experience
1. Life threatening behaviors
2. Therapy interfering behaviors
3. Quality of life interfering behaviors
Increase Behavioral Skills
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Core Mindfulness
Distress tolerance
Emotion regulation
Interpersonal Effectiveness
Relationship Between Knowledge & Action
Become more discriminating in our actions
Knowledge
Action
Contact with Consequences results
in refined knowledge
Moving Forward
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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
Meaningless Dialectic in DBT
?????
Mindfulness
(content is not the
problem, just notice)
Cognitive Restructuring
(content is the problem;
evaluate & change it)
Avoidance of Private Experience
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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)
Relational Frame Theory (RFT)
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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
Acceptance Based DBT for
Emotional Regulation
“LIVING MEANINGFULLY”
ACCEPTANCE
PRIVATE EXPERIENCE
BEHAV. CHANGE
VALUES
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
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!
DBT & Values
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In it’s original DBT proposes “life worth
living” as a direction for movement…in
treatment and in life…
AND
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No definition or process is identified for
defining what “life worth living” means…
Values on an individual basis
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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
ACBS Values assessment tools
Bullsey
e
Very
Close close
In the
vicinity
Far
from
Developed by T. Lundgren &J.A. Dahl
….and Skills Training
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Skill training modules renamed to reflect an
acceptance/ongoing life process instead of a
if/then contingency
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Cognitive restructuring strategies have been
removed from all handouts & replaced with
acceptance/mindfulness consistent interventions…
 extended mindfulness practice
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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
Skills Training
Mindfulness
Distress Tolerance
Emotion Regulation
Interpersonal Effectiveness
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Acceptance
Skills
Change
Skills
Skills Training
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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.
Skills Training
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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.
Skills Training
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Living with Emotions (Emotion Regulation)
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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
Skills Training
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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”
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ACT-ifying DBT - Joanne Steinwachs, LCSW