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Dialectical behavioral therapy
- 2. Introduction of DBT •DBT is a type of talking therapy which was originally developed by an American psychologist named Marsha linehan in 1993. • It is based on cognitive behavioral therapy (CBT) . • CBT tries to identify and change negative thinking patterns and pushes for positive behavioral changes.
- 3. What does’ dialectics’means ? • ‘’dialectics” means try to balance seemingly contradictory position .for example ,in DBT you will work with your therapist to find a good balance between : 1. Acceptance –acceptance yourself as you are. 2. Change - making positive changes in yourself
- 4. Dialectical behavioral therapy Definition: DBT is a broad based cognitive behavior treatment originally developed for chronically suicidal /individual diagnosed with BPD .
- 5. CBT VS DBT CBT •Wrong thinking • Therapeutic relationship needed to do work • Collaborative stance with willing client • change DBT • Dialectical thinking • Therapeutic relationship is essential • Working with commitment and therapy interfering behavior • Radical acceptance
- 6. Goal of DBTskill training • To help the individuals change behavior ,emotional thinking ,and interpersonal pattern associated with problem in living,
- 11. Symptoms of Borderlinepersonality disorder Behavioral symptoms: • Antisocial behavior • Compulsive behavior • Hostility • Impulsivity • Irritability • Self- distructive behavior • Social isolation • Self-harm
- 12. Mood: • anger • Anxiety •Guilt • Lonlinesss • Loss of interest or pleasure in activity • Mood swings or sadness
- 13. Psychological : • Depression •Distorted self image • Fear • Grandiosity Common: • Risky behavior • Thought of suicide
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- 17. Learning how tocontrol your mind/attention so it does not control you. MINDFULNESS
- 18. Getting through themoment without making matters worse. DISTRESS TOLERANCE
- 19. Not about changingor controlling our emotions- instead is about changing our reactions to emotions EMOTION REGULATION
- 20. Interpersonal Effectiveness • Describe •Express • Assert • Reinforce • Mindfully • Appear confident • Negotiate • Gentle • Interested • Validate • Easy manner • Fair • Apologies (no undue) • Stick to values • Truthful
- 21. Organizing DBT skilltraining 1. Form a team. 2.select skill training members of your team . • Skill training can be conducted by psychotherapist counselors, case manager ,social workers, milieu staff, and psychiatric nurse. • Skill training also can be conducted by any one trained in the principal of skill training. • They need to know and be able to use basic behavior technique such as (behavior analysis, solution analysis, management, exposure procedure and basis of skill building. • DBT treatment strategies such as(dialectical strategies ,validation and problem solving strategies reciprocal communication strategies consultation to the patients and environmental strategies.
- 22. 3 .select skillmodules and specific skill to teach. • Orientation +mindfulness module 2 week • Interpersonal effectiveness module 6 week • Orientation +mindfulness module 2 week • Emotional regulation module 6week • Orientation +mindfulness module 2 week • Distress tolerance module 6 week (24 week ,6 month )
- 24. • A standardDBT ,skill training is conducted in group of 6-8 ( 10 at the most) participant, plus 2group leader ,once a week for 2.5 hr. participant one full cycle of core skill through all the module in 6 month ,in a one year treatment programme participant then repeat the cycle for a total of 12 months.
- 25. Cont… 4.plan a skilltraining curriculum • Decide how many total weeks your skill training programme will last and how many long each session will be , it also depend on whether do or do not have mental disorder and severity of mental disorder. • Goal of treatment is (stabilization ,treatment ,skill building). • Decide which skill you definitely want to teach ,and content of skill should be based on the research data for the disorder/problem you re addressing it will guide you. • Decide which handout and worksheets you want to use don’t use them without reviewing.
- 26. 5.Decide on : •Individual vs group skill training • Open vs closed group • Heterogonous vs homogenous groups 6. 6.clarify the role of skill trainers ,individual therapist ,case managers, nurses and line staff and pharmacotherapist in a skill training program
- 28. commitment in dialecticalbehavior therapy • Patient agreement: Stay in therapy for the specified time period Attend scheduled therapy sessions Work toward reducing suicidal behaviors as a goal of therapy Work on problems that arise that interfere with the progress of therapy Participate in skills training for the specified period.
- 30. Cont.. Therapist agreement : Makeevery reasonable effort to conduct competent and effective therapy Obey standard ethical and professional guidelines Be available to the patient for weekly therapy sessions and provide needed therapy back- up Maintain confidentiality Obtain consent when needed.
- 32. Components of DBT Individualsessions • Individual sessions typically last for 45–60 minutes and occur weekly. The past week is reviewed using ‘diary cards’ that the patient has filled in. • There is a recommended structure to sessions that follows a hierarchy of topics. Life-threatening behaviors should be discussed and dealt with first. • Then come therapy-interfering behaviors, quality-of- life- interfering behaviors and attention to skills.
- 33. Skill training: • Skillstraining is conducted in a weekly group, which typically lasts for 2 or 2½ hours.. • The room may be arranged like a classroom. • The book also contains hand-outs for patients, which may be freely copied for the purpose. • Groups may include group exercises and role- play, and homework is suggested. • The content is divided into four modules, each of which is usually taught in blocks lasting a few weeks. Three modules are on topics – emotional regulation, distress tolerance and interpersonal effectiveness .
- 34. Out of hourtelephone contact: • Patients within a DBT programme may telephone their individual therapist between session. • The contact should be mainly about coaching the patient in the appropriate use of the skills that have been learned. • Typically a DBT telephone call is brief – perhaps 5 or 10 minutes – and should not in general be used as an extra therapy session. • It is mainly to try to help the patient avoid self-harm or sometimes to sustain or repair the therapeutic relationship. • The patient is banned from contacting the therapist for 24 hours after an act of self-harm. • The hours during which telephone contact is available are agreed between the therapist and the patient.
- 35. The consultation group •The fourth essential component of DBT does not involve the patient directly. • DBT is a team treatment and the consultation group is where the team – the individual therapists and skills trainers – meet to review the programme and their practice.
- 37. authors Subject/setting designAdherence to standard DBT Outcomes and comments Jame winmills et .al(2011) 25 adolescents(84%) female ,M age=15 yr )with a history of persistent self harm; community out patient treatment among teen in UK. This pre-post treatment study examined an adopted one year DBT programme for teen in a looked after care system participant assessed at pre- and post treatment Mode of treatment included weekly 2 hr DBT skills group ,telephone consultation,out reach,consultatio n team and weekly individual session no individual DBT Paired t –test :significant reduction in depression, hopelessness score and lowered frequency of self harm. no significant changes in automatic thought
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