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Dialectical Behavior Therapy for People with ID/DD Presented by: APS Healthcare Southwestern PA Health Care Quality Unit (HCQU). December 2010 bjl. Disclaimer.

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Dialectical Behavior Therapy for People with ID/DDPresented by: APS HealthcareSouthwestern PA Health Care Quality Unit(HCQU)

December 2010 bjl


Information or education provided by the HCQU is not intended to replace medical advice from the consumer’s personal care physician, existing facility policy or federal, state and local regulations/codes within the agency jurisdiction. The information provided is not all inclusive of the topic presented.

Certificates for training hours will only be awarded to those who attend a training in its entirety. Attendees are responsible for submitting paperwork to their respective agencies.

note of clarification
Note of Clarification

While mental retardation (MR) is still recognized as a clinical diagnosis, in an effort to support the work of self-advocates, the APS SW PA HCQU will be using the terms intellectual and/or developmental disability (ID/DD) to replace mental retardation (MR) when feasible.


Define Dialectical Behavior Therapy (DBT)

Recall stages of DBT

Identify benefits and challenges of DBT for people with ID/DD

List DBT strategies for staff

what is dialectical behavior therapy
What is Dialectical Behavior Therapy?

Originally developed for borderline personality disorder

Can be applied to other mental health disorders

Aims to teach emotional regulation and stress tolerance skills

origins of dbt
Origins of DBT

Developed by Dr. Marsha Linehan in 1991

Designed to address ‘emotional dysregulation’

origins of dbt emotional dysregulation
Origins of DBT: Emotional Dysregulation

Biological causes


Intrauterine factors

Traumatic events in early brain development

origins of dbt emotional dysregulation1
Origins of DBT: Emotional Dysregulation

Environmental Factors

Invalidating environment

Feelings, responses, and experiences disqualified

Self-control and self-reliance highly valued

Genuine emotions/reactions seen as ‘untrue’ or ‘inaccurate’

origins of dbt1
Origins of DBT

Similar to Cognitive Behavioral Therapy

But with some differences

Teaches emotional regulation skills and stress tolerance

Emphasizes validation and change

dbt theory of borderline personality disorder
DBT Theory of Borderline Personality Disorder

People react abnormally to emotional stimulation

Emotional arousal increases faster, peaks higher, and takes longer to return to baseline

Invalidating environments hinder development of basic coping/regulation skills

main goals of dbt
Main Goals of DBT

Regulate extreme emotions

Individuals learn to trust emotions, thoughts, behaviors

Reduce negative behaviors

Help individuals create ‘lives worth living’

how dbt works
How DBT Works

Teaching new skills and improving existing skills

Increase use of healthy responses and techniques

Treatment organized into 4 stages

dbt stage one
DBT - Stage One

“Moving from being out of control of one’s behavior into being in control”

Targets/Goals for this stage:

Decreasing suicidal behaviors/thoughts

Decreasing behaviors that interfere with therapy

Decreasing behaviors that reduce quality of life

Learning new skills to deal with emotions and relationships

dbt stage two
DBT – Stage Two

“Moving from being emotionally shut down to experiencing emotions fully.”

Targets/Goals for this stage:

Learning healthy coping skills

Learning additional skills to deal with emotions

dbt stage three
DBT – Stage Three

“Building an ordinary life, solving life problems’

Targets/Goals include:

Working on ordinary problems (job/relationship issues, career goals, etc.)

Focusing on what makes a person’s life worth living

dbt stage four
DBT – Stage Four

“Moving from incompleteness to completeness / connection”

Targets/Goals include:

Seeking meaning in one’s life

Spiritual/religious fulfillment

Seeking new career paths/learning new skills/seeking new relationships

dbt and group therapy
DBT and Group Therapy

Group therapy important in DBT treatment

Weekly sessions to augment individual therapy

Offers individuals chance to practice skills with others

effectiveness of dbt
Effectiveness of DBT

Research shows effectiveness in reducing:

Self-injurious behaviors

In-patient psychiatric hospitalizations

Extreme and uncontrolled anger

other uses of dbt
Other Uses of DBT

Drug dependence

Male prison inmates

Binge eating disorder


In older adults

Also in teenagers

dbt for people with id dd
DBT for People with ID/DD

What makes DBT viable for those with ID/DD?

Biological vulnerability

Invalidating environments

benefits of dbt for people with id dd
Benefits of DBT for People with ID/DD

A ‘skills-based’ treatment

Does not label individuals

Teaches individuals to ‘self-advocate’

Based on concrete ideas / practices

challenges of dbt for people with id dd
Challenges of DBT for People with ID/DD

Cognitive-based treatment

Requires support from agency administration

Some individuals may not be ready for certain aspects of treatment

challenges of dbt for people with id dd1
Challenges of DBT for People with ID/DD

ISPs may become more difficult to create

Skills practice must take place in ‘real world’

benefits of dbt for treatment teams
Benefits of DBT for Treatment Teams

All staff members have input

Treatment is team oriented

Aids in problem-solving

Team members model behaviors for individuals

dbt strategies for staff
DBT Strategies for Staff


Acknowledge individual’s difficult times/experiences

Re-state things from individual’s viewpoint


Validate individual’s feelings and reinforce that harmful behavior is unacceptable

Acknowledge individual’s reality and reality of the ‘big picture’

dbt strategies for staff dialectics
DBT Strategies for Staff - Dialectics

Give praise/positive feedback for healthy behaviors

Remind individual that dangerous or disruptive behaviors will not help

Ask individual to come up with healthier ways of meeting needs

dbt strategies for staff1
DBT Strategies for Staff

Radical Acceptance

Helps foster empathy

Recognizing that things may be tough right now

Strategizing ways to get through hard times

dbt the last word
DBT – The Last Word

Why use DBT for those with ID/DD?

Ask instead “Why should anyone be denied a potentially helpful treatment?”

What use is it for staff?

DBT provides staff more tools to use

Has a broad range of applications

Works well with a Positive Approaches outlook

suggested trainings
Suggested Trainings

Borderline Personality Disorder


Behavioral Tech. (2010). Dbt resources: what is dbt? Retrieved from

Dykstra, E.J., & Charlton, M. (2003). Dialectical behavior therapy: a new direction in psychotherapy. Retrieved from

Huffman, J.C., Stern, T.A., Harley, R.M., & Lundy, N.A. (2003). The use of dbt skills in the treatment of difficult patients in the general hospital. Psychosomatics, 44 (5), 421-429.


Lew, M., Matta, C., Tripp-Tebo, C., & Watts, D. (2005). DBT for individuals with intellectual disabilities: a program description. Retrieved from

Linehan, M. (2003). Dialectical behavior therapy (dbt) for borderline personality disorder. Retrieved from


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