DBT & ACT

DBT: Dialectical Behavior Therapy

Developed by Marsha Lineham, who herself, had BPD. first created to treat chronic suicidality, but has been adapted to fit many presenting issues

Relies on the assumption that a balance exists between acceptance and change 

Structured, technique-heavy theory 

Key Concepts

• Dialectics: art of investigating the relative truth of principles, opinions, and guidelines

• DBT involves arriving at the truth by examining the argument and revolving the two into a rational synthesis 

• Dialectics has the beliefs that two opposing or contradictory things can work together 

• Use of dialectics helps clients to

Develop a broader perspective of their problem

Learn to look for the dialectic pole

Consider more options and possibilities

Get ‘unstuck’ and develop a sense of efficacy and competence 

• Common example: two married people have conflict on how to use their free time. The issue is of dependence and independence. If they realize this, they can begin to see the issue from the other perspective 

From a dialectical perspective, everyone is right and all behavior is functional and serve a purpose 

• Emotion Regulation: the ability to respond to emotions in healthy ways 

DBT assumes that strong, painful emotions and difficulties regulating them are the cause of psychopathology 

Emotions precede the development of thoughts

The Therapeutic Process

• Goal is to develop dialectical thinking and practice skills that result in emotional regulation, reduced suffering, and improved relationships

• Shows clients how their attempt to avoid emotions can actually intensify them 

• Empowers clients to increase their tolerance for stress 

Goals:

Teaching clients new skills 

Understanding and increasing client motivation

Helping clients accept what cannot be changed 

Real-world applications and functionality 

Stages:

1. Moving from being out of control of one's behavior to being in control

Reduce and eliminate behaviors that are life threatening, serve as barriers to counseling, or reduce quality of life 

2. Moving from being emotionally shut down to experiencing emotions fully

Experience emotions without allowing them to take over, without experiencing PTSD symptoms, and without avoiding them or shutting down

3. Building an ordinary life, solving ordinary problems 

Work to accomplish goals surrounding ordinary problems of living such as those at school or home, and continued use and engagement in treatment services 

4, Moving from incompleteness to completeness and connection 

Discover and engage in ways to feel complete by having meaningful interests or activities, meaningful groups that share interests, and through relationships with others 

Role of Therapist 

• Relationship between client and therapist is reciprocal and both will be changed as a result of the therapeutic relationship

• Collaborative, requires constant attention to the relationship

• Active; therapists provide psychoeducation, skills training, coaching, and group work

• Clients compete homework, role-play and practice new ways of interacting

• Intensive therapy model; 1 yr of 1 hr weekly sessions and 2 hr group sessions 

Therapeutic Techniques and Procedures 

• Emotion Regulation Skills: first and most critical task 

  • Important for several reasons, but importantly for reducing life-threatening behaviors including suicidality and self-injury 

  • Imperative that client develop an awareness of how their thought and body sensations are associated with their self-destructive behaviors 

  • ER interventions emphasize identifying, processing, and reducing clients vulnerability to distress including 

    • Negative automatic thinking patterns 

    • Highly reactions emotional responses to communication styles

    • Body sensations when strong emotions are felt 

    • Behaviors that contribute to dysfunctional behaviors like poor eating/sleeping, drug use, etc 

  • Worksheets, visual means, and using pre-existing coping skills 

Mindfulness:

• Rational Mind: logic, reason, planning, using information and problem solving effectively. Hindered without adequate sleep, food, movement, or use of substances 

• Emotional Mind: mood, sensations, impulsivity, reactivity. During distressing events, emotional mind can take over and prevent client from using the rational mind

• Wise Mind: integration of both rational and emotional mind. Clients operate from this mind when they are living mindful lives. They can effectively respond to distress in ways that they know and feel are right 

Distress Tolerance: self-soothing skills & distraction skills

• Self-soothing: combat intense emotions and physiological sensations, and assist clients with letting go of distress

• Distraction: quick, easy to use, and useful in preventing crisis and high-risk behavior

• The Wise Mind ACCEPTS to work throogh distress

  • Activities: engage in activities such as listening to music, going on a walk, exercising, painting, reading, talking to a friend etc. 

  • Contributing: enhance feelings of generosity and find ways to contribute to the environment. Write a letter to a friend, pick up some trash outside, volunteer at a pet rescue 

  • Comparisons: compare current situation to all the positive aspects of life that are going well

  • Emotions: remember that emotions are not permanent. Accept the present as the present 

  • Pushing away: if you are unable to accept or let go, it’s okay. Intentionally push away your current distress and solve the problem when you are feeling better

  • Thoughts: ask “are my thoughts controlling me or I am controlling my thoughts? “Am I using my wise mind or letting one overrule the other?” 

Sensations: do something to cool down, self-soother, or relax. Have a cold drink, eat something sweet 

IMPROVE 

• Imagery: imagine your happy place or a relaxing scene

• Meaning: identify meaningful things in your life. How might this experience cause you to grow in meaningful ways?

• Prayer: engage in prayer, introspection, or other spiritual practices

• Relaxation: engage in activities that are relaxing like yoga, stretching, deep breathing

• One things at a time: focus on the present moment, observe, and pratice non judgment, radical acceptance, and loving kindness

• Vacation: take a break from the dresses of daily time and disconnect from social media, email, texting, electronics for a day 

• Encouragement: use positive affirmations or scripts to encourage yourself and foster self-compassion

Interpersonal Effectiveness: 

• Many of those who benefit from DBT experience difficulties maintain stable relationships with others 

• Promote skills in 3 domains 

  • Objective effectiveness

  • Relationship effective 

  • Self-respective effectiveness 

• Skills necessary to help make appropriate requests or convey their wants to others, manage and resolve conflict, establish and maintain positive relationships, and maintain self-respect when interacting with others 

DEAR MAN GIVE FAST

• Describe what you want by stating info or facts

• Express your feelings and explain why you want what you’re requesting

• Assert and be specific in what you want. When others say no, use skills to effective cope

• Reinforce: provide evidence of past experiences that support your request
  
  

• Mindful: remain focused on what you want and don’t allow distractions 

• Appear confident: look at others in the eyes and convey your message in a clear manner

• Negotiate: remain willing to discuss alternative options to compromise what you want
  
  

• Gentle: maintain a nonjudgmental stance and don't make threats or attack others 

• Interested: be open when listening to others 

• Validate others by reflecting their feelings to show you’re listening 

• Easy manner: convey kindness, smile, keep the conversation light-hearted
  
  

•  Fair: work to maintain fairness for self and others 

• Apology free: do not apologize for asking for what you want

• Stick to your values: maintain integrity 

• Truthfulness: be honest and refrain from exaggerating the truth to get your way

Application & Current Use of DBT

Effective for BDP 

Decreases experiences of SI, hospitalization, anger, and increase social adjustment 

Appropriate for any client who experiences intense emotions, especially when they result in harmful behaviors