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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


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Goals of this presentation:

Present symptoms targeted with DBT

Overview of DBT Theory

Review DBT skills and modules

Discuss resources for DBT treatment


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Dialectical Behavior Therapy

Developed by Marsha Linehan, Ph.D.

  • Skills Training Manual for Treating Borderline Personality Disorder

  • Cognitive-Behavioral Treatment of Borderline Personality Disorder


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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


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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


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DBT is designed to treat:

  • Multi-diagnostic

  • Severe and chronic

  • Ineffective coping skills


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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


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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


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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”


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Biosocial Theory of Borderline Personality Disorder

  • Biological Sensitivity

  • Invalidating Environment

  • Emotion Dysregulation


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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


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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


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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


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Treatment Program Settings

  • Psychiatric In-patient groups

  • Consult Liaison- Emergency Department


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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


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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


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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


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Emotion Regulation SkillsGoals:

  • Understand emotions you experience

  • Reduce emotional vulnerability

  • Decrease emotional suffering


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Distress Tolerance SkillsGoals:

  • Crisis survival strategies

  • Guidelines for accepting reality

  • So as to reduce:

    Impulsive behaviors

    Suicide threats

    Self harm


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Mindfulness

  • 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


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What” Skills

Observe

Describe

Participate

“How” Skills

Non-judgmentally

One mindfully

Effectively

Mindfulness:Taking hold of your mind


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DBT Resources

  • The Behavioral Technology Transfer Group www.behavioraltech.com

  • Talk with your therapist or psychiatrist


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