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Dialectical Behavioral Therapy
- 1. Dialectical Behavioral Therapy By: Hannah Choi, Jessica Whittemore, Stacie Swartz
- 2. An Overview There are four modules of Dialectical Behavioral Therapy (DBT) Mindfulness Interpersonal Effectiveness Distress Tolerance Emotional Regulation Clients are taught to recognize specific states of mind Reasonable Mind Emotion Mind Wise Mind
- 3. Characteristics of DBT Collaborative Cognitive-Based Support- oriented
- 4. Beginning the Journey Individual Sessions Group sessions Who can benefit?
- 5. Effects of DBT on the neural correlates of affective hyper arousal in BPD This pilot study examined whether DBT improved regulation of affective arousal in BPD. Six females with BPD and free of medication for at least four weeks. They also took pre and post neuro-imaging studies of the prefrontal brain regions and anterior cingulategyrus. Patients participated in a 12-week DBT in-patient program made up of 10 group sessions per week and 1 session per week using stress tolerance, emotional modulation, mindfulness, and interpersonal behavior. Goal: reduction of self harming behavior, decrement of aversive mood swings, improvement of interpersonal functioning, reduction of conflicts and angry outbursts. Outcome: the study found that there was a significant reduction of activity in the caudal anterior cingulate cortex over time.
- 6. How stress effects the body. Fight/Flight response Muscles tense Heart and respiration rates increase Increase blood pressure Physiological systems become taxed Chronic stress or anxiety can lead to burnout, anger, irritability, and depression.
- 7. Dealing with stress using Mindfulness can… Improve quality of life. Control over moods Staying motivated Ability to make and maintain friendships
Editor's Notes
- Mindfulness - This is the practice of intentional awareness in the moment without placing judgment upon it, getting cut off by a driver exampleInterpersonal Effectiveness -A skill set designed to maximize the chances a person’s specific goals will be met without damage to their relationships or self esteem. Similar to assertiveness therapy. (Saying no.) *Think about the skills we learned in managementDistress Tolerance -Tied in with mindfulness in that it is geared towards tolerating and surviving crises and accepting life as it is in the moment. Four skills taught are distracting, self soothing, improving the moment*Cut off example again*, and thinking of pros and cons. *Class interaction here, have them give examples*Emotional Regulation – Learning how to identify, label, and increase mindfulness of emotions. Clients are taught to recognize obstacles to changing their emotions, increase positive emotional events, and reduce their vulnerability to the “emotional mind.” Reasonable mind- The “logical and rational” filter. This state does not necessarily include how we feel about things Emotional mind- The name sort of give it away, here, we are thinking with our feelings, we are vulnerable to outside influences in this state and can develop dysfunctional behaviors and coping mechanisms. Wise mind- This is the goal of mindfulness, and is a blend of the previous two states of mind. So, the client can identify their desires and preferences but not be solely guided by them or other outside influences.
- Collaborative– Going beyond therapy sessions, DBT encourages its participants to complete “homework assignments”, Role play related to social interactions and to practice the emotional regulation skills such as soothing, mentioned earlier. Clients will often participate in group therapy as well as individual therapy to practice the skills they are developing. A potential role for the psychiatric nurse would be to direct these groups.Cognitive based – Helps identify thoughts, beliefs and assumptions that impair relationships of clients e.g. “I need to be perfect” “if I get angry, I’m a horrible person.” These thoughts are modified through therapy to reduce the disruption caused by these destructive thought patterns. The homework a client is given will likely include identifying any maladaptive thought patterns to be discussed and modified in therapy or modified individually using the skills the client gains through treatment.Support-Oriented – Helps the client indentify personal strengths, and how to build on them to improve their self esteem and relationships
- Marsha M. Linehan developed this method of therapy in the late 1980’s to treat chronically suicidal individuals with borderline personality disorder, clients with BPD were historically resistant to therapies present at the time, DBT has since been adapted to diverse settings and populations but remains successful with the target population. Individual sessions – These tend to be weekly and last about an hour, and the amount depends upon the individual. Therapy can be initiated in an inpatient setting or and outpatient setting. The topics discussed usually pertain to quality of life and working towards improving the quality of life for the client. The emphasis is placed on problem solving for the past week’s issues and recent troubles in the client’s life. This differs from “traditional” psychoanalytic therapy which focuses on a clients childhood issues. While therapy does provide catharsis for the client, the focus of DBT is changing disruptive thought patterns and improving self esteem, quality of life, and interpersonal relationships through the development of specific skills. Group sessions – These sessions tend to be longer and can range up to 2.5 hours, and they are led by a person specially trained to lead groups from the DBT perspective. This can mean a master’s prepared nurse or a nurse who becomes certified in DBT. This is the place where clients learn the skills that fall under the four modules.Who can Benefit? – Though this therapy was developed for a specific population, research has shown that additional populations can benefit from DBT such as clients with eating disorders, and depression
- Caudal anterior cingulate cortex plays an important role in monitoring emotional salience and it is involved in the use of cognitive strategies to dampen negative feelings. Decreased posterior cingulate reactivity might be associated with an acquired ability to reduce stimuli processing at the level of retrieving maladaptive associated memories since this structure has been discussed as being linked to interaction between emotion and episodic memory.