Introduction to the basic concepts of Dialectical Behavior Therapy (DBT). Continuing Education (CE) credits for addiction and mental health counselors, social workers and marriage and family therapists can be earned for this presentation at

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Assumptions about clients
Doing the best they can with the tools they have at any given time Want to improve Cannot fail in DBT Experience life as unbearable as it is currently being lived Must learn new behaviors in all relevant contexts May not have caused all of their problems, but have to resolve them Clients need to increase their motivation for change

Assumptions about therapists The most caring thing is to help a client change Clarity, compassion and precision are of the utmost importance The relationship between client and therapist is one between equals Therapists can fail to apply DBT effectively, and DBT can fail to achieve the desired outcome Therapists who treat patients with pervasive emotional dysregulation need support

Concepts of DBT
Dialectics—The possibility that two opposing viewpoints can co-occur and be equally valid
I want to live/I want to die I want to be clean/I want to use I love you/I hate you I love my family/I wish everybody would leave me alone Polarization is expected and the valid points of both poles must be considered.

Emotional Dysregulation
DBT is most appropriate for people who struggle with pervasive emotional dysregulation
Emotional dysregulation arises from the interplay of biological vulnerabilities and invalidating social environments
Linehan proposed three characteristics that may contribute to vulnerabilities
High Sensitivity/Low Threshold
High Reactivity/Intense Reactions
Long-Lasting Arousal/Slow Return to Baseline

Additional factors impacting vulnerabilities
Blood sugar
Prior trauma leading to hypervigilence (increased sensitivity)
Secondary Behavioral Patterns
Develop as a result of constant overregulating and underregulating emotional experiences.
3 primary patterns
Emotional Vulnerability and Self Invalidation
Highly sensitive followed by telling self that she should not feel that way.
Active Passivity and Apparent Competence
Responding to problems passively in the face of insufficient help while communicating in ways that will activate others
Due to emotions controlling behaviors, people may appear competent and capable at times and not at others.
Unrelenting Crises and Inhibited Grieving—Person creates and is controlled by incessant aversive events (Address a crisis with a dysfunctional behavior that leads to another crisis.)

Often patient’s have multiple inter-related problems and working on one may destabilize the rest.
Assess and prioritize problems based on patient safety.
Behavioral Regulation
Emotional Experiencing
Enhancing capabilities through skills training/psychoeducation, pharmacotherapy
Mindfulness (Reasonable, emotional, wise (HHG))
Distress Tolerance (Distract, self-soothe, radical acceptance)
Interpersonal effectiveness (Communication, interpretation)
Emotional Regulation (CBT, reduce vulnerability)
Improving self awareness through daily diary cards
Improving motivation by increasing awareness of connections between tasks and client goals
Reducing factors that inhibit progress and drawing connections between current behaviors and distress
Assisting the client in generalizing new skills to the natural environment
Role playing
Group process
Phone coaching
Enhancing therapist capabilities, insight and motivation through consultation and support
Structuring the environment to support client and therapist
Boundary and limit setting
Contingency management
Program development.
Problematic behavior may be a consequence of emotional dysregulation
Invalidation plays a role in maintenance of current difficulties
Common patterns develop as a person struggles to regulate emotion and deal with invalidation
People with emotional dysregulation often have multiple, interconnected “wicked problems”
Treatment begins with adding structure to the chaos and prioritizing based on the patient’s degree of dysfuction.