*
Created by Marsha Linehan
Ali Gold
* Marsha M. Linehan developed DBT in 1993 when CBT
and other therapies proved to be unsuccessful with
a “specific type” of clients
* These clients were emotionally unstable, sometimes
suicidal, and usually engaged in self-destructive
behaviors- typically diagnosed with borderline
personality disorder
* DBT targets BPD and also other disorders such as
depression, bipolar disorder, PTSD, anxiety, eating
disorders, alcohol/drug abuse, and in any
combination
*
* The human mind is like a radio, it is hard wired
differently each time. Some people are wired
to experience frequent, stronger emotions than
most.
* Trauma can also create stronger specific
emotions, as can a chemical imbalance left
untreated
*
* Many factors contribute to BPD and the DBT
client but two stand out:
* Emotional vulnerability- quick, intense,
difficult to control emotions; like a
rollercoaster
* Invalidating environment- the failing to treat a
person in a manner conveying respect,
attention, or understanding
ex. A shy family member in an outgoing
family being teased for his or her shyness
*
* Individual therapy once or twice a week
* Usually includes patient filling out a daily diary
card: rates urges/thoughts/actions/emotions and
records skill use
* Group therapy once a week for at least 6 months
* Phone coaching- a client can call/text their
therapist in order to receive skills coaching before
engaging in a target behavior
* Focuses on 4 modules: mindfulness, emotional
regulation, interpersonal effectiveness, and distress
tolerance
*
You can’t walk
in the same
river twice.
*
*You can AND can’t walk in the
same river twice.
* This is a dialectical statement. A dialectic is
an idea in which two seemingly opposite
statements can be true. This component is
crucial to DBT because it helps clients think in
a more open and less judgmental way. The
concept of dialectics helps balance the mind
and find the middle path between two
extremes.
Change is the only constant in life.
With this idea,
we can more easily find acceptance.
*
* Goals:
* Increase awareness of internal and external
experiences as they occur
* Learn how to non-judgmentally and effectively
observe, describe, and participate in events and
experiences
* Increase ability to focus attention on one thing in
the moment
* Learn to be in control of your mind rather than
your mind being in control of you
*
*Activities: meditating, prayer, yoga,
walking, anything as long as you are
being mindful and in the moment!
*Mindfulness aims to reduce suffering,
increase happiness, and experience
reality as it really is
*Helps us find wise mind- both reason
and emotion are integrated and find
balance- the middle path
Rational Mind
*
Emotional Mind
Facts
Moods
Reason
Feelings
Logic
Urges to do or say something
* Exercise:
* Hold a piece of wrapped gum, be in a quiet
environment, focus solely on the gum and
nothing else, let thoughts and judgments pass
* Observe it: sight, smell, touch, (taste)
* Unwrap it and let it rest on your tongue without
chewing, observe senses
* Take ONE chew, observe senses
* Chew and observe and discuss
* Could you stay focused, one in the moment?
*
*Goals
*Understand emotions and how they
function
*Increase awareness of emotional
experience
*Increase control over difficult emotions
*Increase positive experiences
*Decrease emotional suffering
*
*Accumulate positive experiences- do pleasant
things, “build a life worth living”
*Build mastery- do things that make you feel
competent and effective
*Cope ahead for emotional situations-
rehearse/plan out in order to feel prepared to
cope skillfully with stressful situations
*
* (treat) Physical illness
*Lather, rinse and repeat
*Eat (balanced and well)
*Avoid mood altering substances (alcohol, drugs,
caffeine too!)
*Sleep (enough and not too much)
*Exercise
* TAKE CARE OF YOUR MIND BY TAKING CARE OF
*
YOUR BODY!
* Your body and mind are connected. Taking care of one is taking
care of the other. Example of someone with depression: This
person is depressed; they sleep all day and don’t have healthy
eating habits. Without the proper nutrients or beneficial amount
of sleep, this person will have even more difficulty managing
emotions, possibly making them more depressed.
* Another note: let’s say the once depressed person is recovering
and doing well. Then, they get sick and as a result are more
tired and begin to sleep more. Their body will associate sleeping
more with being depressed, so that person will be apt to feeling
low. How do we cure the low mood? Trick the body and do the
opposite!! Eat well, balance the sleep, and get up and out! Even
just smiling WILL lift the mood!
BREAK THE
CYCLE! Trick
the body
and follow
PLEASE!
*
Depressed
Emotionally
vulnerable
Sick
Sleeps more
* Goals
* Build and maintain relationships
* Learn how to set limits and boundaries
* Effectively asking for what you want and/ or
need
* Prioritizing and organizing wants/needs
* Building mastery and preserving self-respect
*
*Describe the current situation
*Express your feelings and opinions about the situation
*Assert yourself by asking for what you want or saying
“no” clearly
*Reinforce or reward the person ahead of time by
explaining consequences, good or bad
* (stay) Mindful, keep the focus on your objectives
*Appear confident and effective
*Negotiate, be willing to give and get
*
FAST: maintain self-respect and communicate personal limits
*
(be) Fair- both to yourself and others
*
No over Apologizing- confident body language
* Stick to values- don’t sell out your own values and integrity
*
Be Truthful-don’t lie, act helpless, or exaggerate
GIVE: Repair and/or build relationships that you care about
Gentle- be courteous, no attacks, no threats, no judging
*
(be)
*
(act) Interested- actively listen, eye contact too!
* Validate-acknowledge the other person’s feelings, wants and difficulties…
“I can understand how you might feel”
*
(use an) Easy manner- a little humor never hurts, smile and ease the
person along
*
“Do you
want to
be right,
OR
BE
EFFECTIVE?”
~Michael Hollander, DBT Specialist
*
*Goals
*Learn how to effectively tolerate painful
experiences
*Increase awareness of how distress is
represented in your life
*Learning how to decrease suffering
through acceptance of reality
*Increasing willingness over willfulness
*
* “TIPP” your body chemistry (great for anxiety and anger)
*Temperature-submerge your body (face especially)
in ice cold water, put an ice pack on your chest
* This extreme cold enacts the divers reflex in your body
(cheek bones/nose, chest, back of neck) which
physiologically slows down your heart rate from 10-25%
*Intense exercise- at least 20 minutes, get the heart
rate up!
*Progressive Muscle Relaxation (PMR)- clench and
release each muscle one at a time
*Paced Breathing-focus on how long each breath in
and out is, goal is to exhale longer than inhale
*
* Distract yourself from painful emotions when things
cannot get better right away
*Activities- exercise, hobbies, cleaning, friends
*Contributing- volunteer, give gifts, be thoughtful
*Comparisons- find reasons for appreciation
* (opposite) Emotions- emotional books, music, TV
*Pushing away- leave the situation, no ruminating
* (other) Thoughts- count things, puzzles, TV, read
* (other) sensations- hold ice, stress balls, showers
*
* Self-soothe with the five senses
* Vision- art museum, observe nature, photos
* Hearing- music, nature, instruments, waves,
rain
* Smell- lotions, candles, flowers, cookies,
* Taste- yummy meal, tea, hot cocoa, gum,
candy
* Touch- bath, pets, massage, comfy chair,
hugs
*
* IMPROVE the moment
*Imagery- imagine relaxing scenes or views, let your
mind lay open, beautiful, calming fantasy worlds
*Meaning- create purpose, meaning or value in the
pain, focus on positives
*Prayer- God, a higher being, yourself, beliefs
*Relaxation- PMR, hot tub, bath, breathe deeply
*One thing in the moment- focus/stay in the present,
be fully aware
* (brief) Vacation- bundle up in a blanket, sit on a park
bench for an afternoon, a one-hour breather
*Encouragement- cheerlead yourself, “It won’t last
forever,” “I can stand it,” etc
*
* Radical Acceptance: Accepting what you
cannot change in the moment; turning the
mind over to acceptance- it is your choice to
accept or not
* Willingness: let go of judgments and do what
is effective
* Keep long term goals in mind!
* Make a pros and cons sheet of benefits and
negatives of long term and short term actions
*
*Consulting to the Patient
*CBT
*Problem Solving
*Mentalizing
*
* Goal: To be effective in handling treatment/any medical
issue…managing the system
* Interact effectively with psychiatric/medical caregivers to
*
*
*
Get emergency care
Get meds added/changed/discontinued
Communicate needs
* Understanding the system
* How/why caregivers make decisions
* Understand professionals are doing the best they can and are
fallible
It’s about getting the patient involved and aware about
medical specialists’ decisions on what goes into the
patient’s body and why. It’s about honesty- as a patient
you know your body best!
*
* How thoughts affect our mood and behavior:
Ex. A student studies hard and works hard to learn math
concepts. He receives a 62% on his first big test. He feels
discouraged and depressed and skips the next class, considers
dropping the class altogether, and considers changing his
career goals.
Events/situation
Works hard/gets 62%
Thoughts
That’s a horrible score; I’m
stupid; I’m going to fail the
class, I can’t do math
Feelings/Behaviors
Depressed; avoids next
class; drop class? Change
career?
Usually this creates a pattern. A way to break the cycle is to
change one of the steps. In this case, and CBT, we change the
thought process. We can’t change what we think but we can
change how we think. We can identify cognitive distortions.
*
* Cognitive Distortions are biases in information processing
associated with our negative mood states. We do it all the
time! It’s the way our mind makes sense of things in the
blink of an eye. Remember, thoughts aren’t facts!
* Ex.
* All or nothing thinking- everything is black and white, right and
wrong, good and bad; if you fail one test you’re a total failure
* Emotional Reasoning- You assume your negative emotions reflect
reality; I feel guilty, I must be a rotten person
* Jumping to conclusions-
* Mind Reading: without fact, you immediately assume someone is
*
negatively reacting to you; you walk by a group of kids talking and
“you know” they’re talking about you
Fortune Telling: You predict things will turn out badly; “you know”
you’re going to flunk a test… before you take it! Or, if you’re
depressed, “I’ll never get better.”
*
* Solve the problem
* Change your relationship to
the problem
* Radically accept the
problem
* Stay Miserable
* Make the problem worse
*
* Observe/describe the
problem
* Check the facts (get rid of
distortions)
* Identify the goal (what needs
to happen to feel ok; keep it
realistic)
* Brainstorm solutions (as
many as you can!)
* Choose a solution likely to
work (pick two, make a pros
and cons to compare them,
pick the best)
* Put the solution into action!
* Did it work? If not, try a new
solution.
* Mentalizing is a process by which you are able to
represent and understand the thoughts, feelings,
wishes, beliefs, and desires in yourself and in
others. Mentalizing requires that you take a curious
and unattached stance about all situations. Imagine
there’s a bubble around everyone’s head, and in
that bubble lay thoughts, feelings, behaviors, etc.
Mentalizing is being curious and open and guessing
what’s in your own and others’ bubbles. A further
step may be guessing what’s in someone’s bubble
and guessing how your own bubble impacts his or
hers.
*
*Mentalizing is like a muscle, with practice
it gets stronger. Many times, we as
humans fail to mentalize.
* “Psychic equivalence”- if I feel it, then it must be
true; “I feel unlikable therefore nobody likes me.”
* “Pretend Mode” or “Pseudo-mentalizing”- It’s
like you’re in autopilot. Instead of mentalizing and
being present you just agree with others’
explanations about you. Perhaps someone assigns an
explanation to one of your behaviors and it sounds
kind of right, so you agree. Where’s the curiosity?
* “Teleological Stance”- when one feels that an
internal experience is only real if there is evidence
in the physical world. “If you loved me you would
have given me flowers;” “I am only smart if my
teachers call on me a lot in class.”
*
*ABC’s of DBT:
*Acceptance
*Balance
*Change
* Thank you for your patience and listening. If
ever you find someone (a friend, OR
YOURSELF!) who you think could benefit from
DBT or worries you because they’ve been
engaging in self-destructive behaviors, don’t
be afraid to notify a trusted adult. It’s nothing
to be embarrassed about, DBT truly changes
and saves lives. If you have any questions
about DBT or personal matters, don’t be afraid
to find me. Thanks again!
*
* A SPECIAL THANKS:
* Marsha Linehan: many books and teachings
* Clip Art
* McLean adolescent DBT programs
*
http://www.google.com/imgres?q=a+diary+card+dbt&num=10&hl=en&biw=1024&bih=640&tbm=isch&tbnid=3EowpYOC9eC
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* (diary card picture)
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