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Dialectical Behavior Therapy: A Treatment Option for Persons Living with Borderline Personality Disorder

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Dialectical Behavior Therapy: A Treatment Option for Persons Living with Borderline Personality Disorder. Presented by: Jennifer Baran-Prall, LCSW October 13, 2004. Goals of this presentation: . Present symptoms targeted with DBT Overview of DBT Theory Review DBT skills and modules

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Dialectical Behavior Therapy: A Treatment Option for Persons Living with Borderline Personality Disorder

Presented by:

Jennifer Baran-Prall, LCSW

October 13, 2004

goals of this presentation
Goals of this presentation:

Present symptoms targeted with DBT

Overview of DBT Theory

Review DBT skills and modules

Discuss resources for DBT treatment

dialectical behavior therapy
Dialectical Behavior Therapy

Developed by Marsha Linehan, Ph.D.

  • Skills Training Manual for Treating Borderline Personality Disorder
  • Cognitive-Behavioral Treatment of Borderline Personality Disorder
borderline personality disorder dsm iv tr
Borderline Personality DisorderDSM IV-TR
  • Frantic efforts to avoid real or imagined abandonment
  • Pattern of unstable and intense interpersonal relationships (valuing and devaluing)
  • Identity disturbance, unstable self image
  • Impulsivity that is self damaging
  • Recurrent suicidal behavior, gestures or threats, or self mutilating behavior
bpd cont
BPD cont.
  • Affective instability due to a marked reactivity of mood
  • Feelings of emptiness
  • Inappropriate, intense anger
  • Transient, stress-related paranoid ideation or severe dissociative symptoms
dbt is designed to treat
DBT is designed to treat:
  • Multi-diagnostic
  • Severe and chronic
  • Ineffective coping skills
why use dbt
Why use DBT?
  • Significantly reduced self-harm behaviors and self-harm urges
  • Fewer psychiatric hospitalizations
  • Decreased feelings of depression, hopelessness, anger
  • More likely to stay and complete treatment
a definition of dialectics
A Definition of Dialectics

“…debate intended to resolve a conflict between two contradictory or apparently contradictory ideas or elements logically, establishing truths on both sides rather than disproving one argument.”

Encarta World Dictionary, 1993-2003

dialectics as applied to behavior therapy
Dialectics as Applied to Behavior Therapy
  • Interrelatedness or wholeness of reality
  • Reality not seen as static but as comprised of internal opposing forces
  • The nature of reality is change and process rather than content or structure
  • “Another side to every story”
biosocial theory of borderline personality disorder
Biosocial Theory of Borderline Personality Disorder
  • Biological Sensitivity
  • Invalidating Environment
  • Emotion Dysregulation
dbt intervenes
DBT Intervenes

Balance of Acceptance and Change

  • Regulate emotions and reduce vulnerability to cues
  • Teach new skills and improve problem solving abilities
  • Tolerate distress
  • Avoid or distract in a healthy way
how is dbt different than cognitive behavioral therapy
How is DBT different than Cognitive Behavioral Therapy?
  • Focus on acceptance and validation
  • Emphasis on treating therapy interfering behaviors
  • Emphasis on the therapeutic relationship as essential to treatment
  • Focus on the dialectical processes
treatment program
Treatment Program
  • DBT Skills Training Group
  • Individual therapy
  • Phone coaching/consultation
  • Emphasis on ongoing assessment and data collection- Diary Cards
  • Clear and precise treatment goals
  • Collaborative working relationship between therapist and consumer
treatment program settings
Treatment Program Settings
  • Psychiatric In-patient groups
  • Consult Liaison- Emergency Department
dbt skills training group
DBT Skills Training Group
  • Group meets weekly
  • Structured like taking a class:

one hour devoted to reviewing homework

one hour focused on learning a new skill

  • Groups are no larger than 10 people
  • Six month treatment cycle
  • Two facilitators
targets for dbt skills group
Targets for DBT Skills Group
  • Teach skillful behavior to replace problem behavior

Behaviors to increase:

Interpersonal Skills

Emotion Regulation Skills

Distress Tolerance Skills

Core Mindfulness Skills

interpersonal effectiveness skills goals
Interpersonal Effectiveness SkillsGoals:
  • Getting your objectives or goals in a situation
  • Getting or keeping a good relationship
  • Keeping or improving self-respect and liking yourself
emotion regulation skills goals
Emotion Regulation SkillsGoals:
  • Understand emotions you experience
  • Reduce emotional vulnerability
  • Decrease emotional suffering
distress tolerance skills goals
Distress Tolerance SkillsGoals:
  • Crisis survival strategies
  • Guidelines for accepting reality
  • So as to reduce:

Impulsive behaviors

Suicide threats

Self harm

  • Learning to be in control of your own mind, instead of letting your mind be in control of you.

States of Mind:

Reasonable Mind

Emotional Mind

Wise Mind

mindfulness taking hold of your mind
“What” Skills




“How” Skills


One mindfully


Mindfulness:Taking hold of your mind
dbt resources
DBT Resources
  • The Behavioral Technology Transfer Group
  • Talk with your therapist or psychiatrist