Dialectical Theory
Facilitator: Dr. Dawn-Elise Snipes
CEUs for this webcast can be earned through ondemand classes found at CEUs are available for this podcast at https://allceus.com/member/cart/index/product/id/665/c/
Objectives
~ The Basics of DBT
~ The B in DBT: What You Need to Know About Behavior
~ Mindfulness
~ Reducing Emotional Reactivity
~ Distress Tolerance Skills
~ What Clients Need to Know About Emotions
~ Regulating Painful
~ Increasing Positive
~ Helping Clients Become More Effective In Relationships
The Clients
~ Emotional Vulnerability
~ React to things others wouldn’t react to
~ Reaction is more intense than others
~ Recovery time is longer than for others
~ Inability to Regulate Emotion
~ Difficulty identifying/labeling emotions
~ Difficulty understanding why they feel that way
~ Difficulty expressing the emotion in an effective way
Dialectical Theory
~ Everything is interconnected (Action/reaction)
~ Examine examples of action/reaction
~ Addiction
~ Anger
~ Depression
~ Social Interactions
~ Reality is in a constant process of change
~ How you perceive something now may be different than how you perceive it in an hour?
~ What changes perceptions?
~ What does the emotional mind say? The reasonable mind? The wise mind?
Dialectical Theory
~ The truth (always evolving) can be found by integrating multiple perspectives, and tolerating that two opposite things may co-exist
~ Simultaneous (understanding things differently by taking multiple people’s perspectives of the same event)
~ Example: Crime scene
~ Example: Interpersonal disagreement
~ Longitudinal (understanding things differently as knowledge is gained)
~ Example: Mommy had no use for us and that is why she left.
~ Example: Mommy loves me, but she beats me, so I must be bad.
Skills Training Groups
~ Core Mindfulness
~ Increase self-awareness of thoughts, feelings and urges
~ Develop an understanding of emotions as things that do not have to be acted upon
~ Interpersonal Effectiveness
~ Develop assertiveness skills
~ Identify the goals of relationships and skills/activities needed to achieve those goals
Skills Training Groups
~ Emotion Regulation Skills
~ Label and effectively communicate feeling states
~ Understand the function of emotions and why we don’t want to eliminate them
~ Learn the connection between thoughts, feelings and behaviors and how to break the chain
~ Distress Tolerance Skills
~ Survival skills/alternatives to self-harm
DBT Assumptions
~ Clients are doing their best
~ They want to get better
~ They need to work harder/smarter and be more motivated
~ Even if clients didn’t create their problems, they have to fix them
~ Clients need to learn to act skillfully in EVERY area of their lives
~ Clients cannot fail in therapy
Treatment Priorities in DBT
~ Suicidal or self-harming behaviors
~ Behaviors that interfere with therapy (including clinician)
~ Suicidal or self-harm ideation and misery
~ Maintaining treatment gains
~ Other goals identified by the client
Mindfulness
Emotion Regulation
Interpersonal Effectiveness
Distress Tolerance
Stages of Treatment
~ Stage 1: Attaining Basic Capacities
~ Identify behaviors that pose a direct threat to the clients (or other’s) safety
~ Monitor the frequency, intensity of behaviors using a Behavior Tracking Form
~ Address
~ Suicidal/self-harming behaviors
~ Behaviors that interfere with therapy
~ Suicidal ideation and “misery”
~ Maintaining treatment gains
~ Client initiated goals
Stages cont…
~ Stage 2 Reducing Traumatic Stress
~ Subgoals
~ Negative relationships experiences related to emotional dysregulation
~ Lack of interpersonal skills
~ Stage 3 Increasing Self-Respect and Achieving Individual Goals
The “B” in DBT
~ Benefits–Positive and Negative Reinforcement
~ Punishment – Positive and Negative
~ Consequences
~ Negative
~ Positive
~ Neutral
~ Intermittent reinforcement (variable interval or ratio)
~ Modeling
The B In DBT
~ Reinforcers: Increase the likelihood of a behavior
~ Punishments: Reduce the likelihood of a behavior
~ Vulnerabilities: Increase the likelihood of fight or flight responding
~ Backward Chaining
~ Outburst Co-Worker said something insensitive Felt drained upon awakening Had to put cat down the day before
The B In DBT
~ Triggers (+/-)
~ Cause a reaction
~ Remind the person of a prior situation in which a behavior was:
~ Rewarded—Lashing out makes gave client control
~ Punished– Lashing out did no good increasing client’s sense of helplessness
~ Communicate to the person there is a threat
~ Prompt feelings of wellbeing
The “B” in DBT
~ Shaping
~ Rewarding/reinforcing “successive approximations”
~ Example: Anger
~ Level 1: Not throwing things or being physically aggressive
~ Level 2: Disengaging until the urge to be verbally or physically aggressive was gone
~ Level 3: Being able to calmly discuss issues/problems
The “B” in DBT
~ Shaping
~ Example: Addiction or other self-harm
~ Level 1: Engaging in secondary coping behavior (smoking, walking, eating, listening to music, drawing)
~ Level 2: Taking a mindfulness minute to evaluate the situation, then choosing a behavior consistent with goals
Mindfulness
~ Developing an in-the-moment awareness of how you are:
~ Emotionally
~ Mentally
~ Physically
~ Exploring the interconnection of thoughts, feelings and physical sensations
~ Distress in one leads to distress in others
~ Becoming aware of the emotional wave
Reducing Emotional Reactivity
~ Reduce Vulnerability: (Please)
~ P & L Treat Physical Illness
~ Eating
~ Altering Drugs
~ Sleep
~ Exercise
~ Build Positive experiences
~ Be mindful of current emotion
Distress Tolerance
~ Activities: Do hobbies, watch a video, go for a walk
~ Contribute. Do volunteer work
~ Compare yourself to people coping the same as or less well than you
~ Emotions. Distract with opposite (i.e. Comedy)
~ Push away a distressing situation by leaving it mentally for awhile.
~ Thoughts. Think about something else (Puzzles, book)
~ Sensations. Distract with intense sensations
What Clients Need To Know About Emotions
~ Increasing the Positive
~ Decreasing the Negative
Interpersonal Effectiveness
~ Assertiveness
~ Distress tolerance
~ Emotion identification and communication
~ Understanding
~ Your needs
~ The needs of others
~ Exploring situations using dialectical theory
Interpersonal Effectiveness
~ DEARMAN – Getting what we want/need:
~ Describe our situation.
~ Express why this is an issue or need and how we feel about it.
~ Assert: Sharing clearly what we feel and asking directly for what we want/need.
~ Reinforce our position by offering a positive outcome (win/win)
~ Mindful focusing on what we are requesting
~ Appear Confident
~ Negotiate
Summary
~ DBT is a great tool to help clients
~ Become more aware of emotions
~ Identify the thoughts, feelings and urges associated with emotions
~ Develop a greater sense of self-awareness regarding
~ The whys of emotions
~ Vulnerabilities which make them more likely to be emotionally reactive or sensitive
~ Provide a framework for teaching skills groups that benefit an array of clients who have difficulty with emotionality.