Karen L. Morgan, LADAC II Jessica Cole, DPC LPC-S NCC. Elements Behavioral Health May 2018

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1 Karen L. Morgan, LADAC II Jessica Cole, DPC LPC-S NCC Elements Behavioral Health May 2018

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3 Be mindful of.

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9 Distract Create a new emotion

10 Evolved to help therapist in clients exactly like these circumstances. Marsha Linehan, 1993 (3) Randomized Clinical Trials (see review by Lynch,Trost, Salsman & Linehan, 2006) (4) SAHMSA (Substance Abuse Mental Health Services Administration) Comparative Effectiveness Research (CER) (5)

11 DBT - Research SAHMSA (Substance Abuse Mental Health Services Administration) Comparative Effectiveness Research (CER) The superiority of DBT over other commonly used approaches such as CBT, psychotherapy and group therapy have been found in several studies.

12 DBT -Research Reduction in suicidal attempts and non-suicidal self-injury Fewer psychiatric inpatient days and fewer emergency room visits Treatment completion Increases in binge abstinence and decreases in binge frequency Fewer dropouts from treatment Decreased depression and anxiety Decreased substance abuse

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14 Angry Manic Shame Hurt Anxious Sad Lonely Suicidal Disappointed Hate Love Energetic

15 E m o t i o n a l D y s-r e g u l a t i o n Biosocial Theory proposes that pervasive emotional dysregulation arises from the combination of vulnerable biology and invalidating social environments. (6) Crowell, Beauchaine & Linehan, 2009

16 E m o t i o n a l D y s-r e g u l a t i o n Koerner, People prone to emotion dysregulation react immediately and at low thresholds (high sensitivity). Second, they experience and express emotion intensely (high reactivity), and this high arousal dysregulates cognitive processes too. Third they experience long-lasting arousal (slow to return to baseline). Keorner 2012

17 Emotional Dysregulation.. High Sensitivity High Reactivity Slow to Return to Baseline

18 E m o t ii o n a l D y s-r e g u l a t ii o n Difficulties with dysregulation lead to maladaptive behaviors (e.g., suicidal behavior, purging, abusing substances because these behaviors function to regulate emotions or are a consequence of failed emotion regulation (7) Linehan, & Bohus & Lynch, 2007), (8) (Koerner, 2012)

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21 Dialectical Goal -??? Emotional Mind Rational Mind

22 Dialectical Goal - Balance Wise Mind Emotional Mind Rational Mind

23 Treatment Target Hierarchy Daily Diary Card Skills Group/Training Individual Therapy Skills Coaching Team Consultation

24 Treatment Hiearchy 1. Life Threatening Behaviors Suicidal, Para-suicidal, Self-harm 2. Therapy Interfering Behaviors: Non-compliance, Missing sessions, Not completing Diary Cards, etc. 3. Quality of Life Issues: Mood Disorders, Substance Abuse, Anxiety Disorders, Eating Disorders, Psychotic Disorders, Inability to Maintain Housing, etc.

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26 Distress Tolerance Skills 1. Distract with (ACCEPTS) Activities, Contribute to others, Compare (CAT Scale) Mon. Tues Wed. Thurs. Fri. Sat. Sun. Use emotions, Push away bad thoughts, Think and feel Sensations Mon. Tues Wed. Thurs. Fri. Sat. Sun. 2. Self-soothe with Vision, Touch, Hearing, Smell and Taste Mon. Tues Wed. Thurs. Fri. Sat. Sun. 3. Pro's and Con's Of using your skills Mon. Tues Wed. Thurs. Fri. Sat. Sun. 4. IMPROVE: Imagery, Meaning, Prayer, Relaxation, One crisis at a time, Vacation, Mon. Tues Wed. Thurs. Fri. Sat. Sun. Encouragement 5. Radical Acceptance: Freedom from suffering requires Mon. Tues Wed. Thurs. Fri. Sat. Sun. acceptance from deep within-doesn't mean approve Core Mindfulness Skills 6. Wise Mind: Reasonable (logical) Mind/Emotional Mind Mon. Tues Wed. Thurs. Fri. Sat. Sun. 7. Observe: Just notice, Have a teflon mind; Be alert to your Mon. Tues Wed. Thurs. Fri. Sat. Sun. thoughts & feelings without reacting on them 8. Describe: Put words on experiences; JUST THE FACTS! Mon. Tues Wed. Thurs. Fri. Sat. Sun. 9. Non-judgmental Stance: Don t judge others or yourself Mon. Tues Wed. Thurs. Fri. Sat. Sun. 10. One Mindful: THOUGHT DEFUSION; Stay focused; Let go of distractions Mon. Tues Wed. Thurs. Fri. Sat. Sun. Interpersonal Skills 11 Effectiveness: Do what works, play by rules, Let go of vengeance, anger, who is rt/wrong Mon. Tues Wed. Thurs. Fri. Sat. Sun. 12.Participate: Just do it; Throw yourself into something Mon. Tues Wed. Thurs. Fri. Sat. Sun. 13.Objective Effectiveness: DEAR MAN (Describe, Express feelings Mon. Tues Wed. Thurs. Fri. Sat. Sun. Assert, Reinforce, stay Mindful, Appear confident, Negotiate Emotion Regulation Skills 14.Keep Relationship: GIVE (be Gentle, act Interested, Validate, use an Easy manner Mon. Tues Wed. Thurs. Fri. Sat. Sun. 15.Self-Respect: FAST (be Fair, no Apologies, Stick to values, be Truthful Mon. Tues Wed. Thurs. Fri. Sat. Sun. 16.Reduce Vulnerability: PLEASE (treat Physical, Illness, balanced Eating, Avoid mood Mon. Tues Wed. Thurs. Fri. Sat. Sun. altering drugs, balance Sleep, Exercise 17.Build Mastery: Do something that makes you feel good about you Mon. Tues Wed. Thurs. Fri. Sat. Sun. 18.Opposite Action: Try things you are afraid of, get active when down Mon. Tues Wed. Thurs. Fri. Sat. Sun. 19.Cheerleading Statements for Worry Thoughts: "I can do this! This is temporary! Mon. Tues Wed. Thurs. Fri. Sat. Sun. 20.Working Toward Long-term Goals: Build a life worth living Mon. Tues Wed. Thurs. Fri. Sat. Sun. Middle Path Skills 21. Positive Reinforcement: Reward someone's action Mon. Tues Wed. Thurs. Fri. Sat. Sun. 22.Contact: call sponsor, therapist, friend, pastor, other) Mon. Tues Wed. Thurs. Fri. Sat. Sun. 23.Play the tape out: follow the end results of your choice all the way out Mon. Tues Wed. Thurs. Fri. Sat. Sun. 24.Willingness over Willfulness: Be willing to accept people where they are Mon. Tues Wed. Thurs. Fri. Sat. Sun. 25.Validate Someone Else: Show empathy; Actively listen; no judging Mon. Tues Wed. Thurs. Fri. Sat. Sun. 26.Think Dialectically (non black and white) Accept different opinions; don't have to agree Mon. Tues Wed. Thurs. Fri. Sat. Sun.

27 Did you fill out your diary card daily? Y or N Did you fill out your diary card just before session? Y or N Actions Urges Emotions Drugs Suicide Self-Harm Suicide Self-Harm Impulsive Behavior Quit Therapy Sadness Anger Anxieties Shame Joy Love Illicit Alcohol Prescrip. OTCM Y/N Y/N Y/N Specify Specify Y/N Specify Mon. Tues. Weds. Thurs. Fri. Sat. Sun. Mon. Rate Your Skills: Tues. Rating Scale: 0=Didn't help today Rate Your Skills: Weds. 1=Helped a little 2=Helped a lot Rate Your Skills: Thurs. Rate Your Skills: Fri. Rate Your Skills: Sat. Rate Your Skills: Sun. Rate Your Skills:

28 Distress Tolerance Core Mindfulness Interpersonal Emotional Regulation Middle Path

29 Distress tolerance.. Crisis survival and reality acceptance skills: Recognizing negative situation and their effects Managing extreme emotions and resisting urges to engage in dysfunctional coping Practicing accepting circumstances or situations that are painful or unwanted

30 A: ACTIVITIES C: CONTRIBUTE to Others C: COMPARE- CAT Scale E: Emotion Create a New EMOTION P: PUSH Away Bad Thoughts T: New THOUGHTS S: Create New SENSATIONS

31 Driving to location and not remembering the actual drive Speaking to someone and not remembering what they just said Taking a shower and then not remembering if you washed a body part Walking into a room and forgetting what you went in to get Reading a book and having to re-read because you don t remember what you just read Having sex with someone and thinking about something else

32 Core Mindfulness. Focusing skills: Mindfulness skills are specific behaviors that together make up the basics of focusing the mind in the present moment, without judgment and without attachment to the moment The Miracle of Mindfulness by Thich Nhat Hanh The Power of Now by Eckhart Tolle

33 Interpersonal Skills People Skills: Teaching communication strategies that include asking for what one needs, saying no, and coping with interpersonal conflict; building and maintaining relationships

34 D: DESCRIBE the behavior & situation E: EXPRESS the feelings in I Feel Statements A: ASSERT the behavior you prefer R: REINFORCE the reasons behind your objectives M: Stay MINDFUL A: APPEAR Confident N: Be willing to NEGOTIATE

35 De escalation skills: Learning to deal with emotions by identifying and labeling emotions, Reducing vulnerability, Increasing skills aimed at changing emotions checking the facts, opposite action, problem solving, building mastery, thinking or coping ahead, Increasing mindfulness to current emotions

36 Middle Path Skills..

37 DBT Addiction Skills Dialectical Abstinence Clear Mind Community Reinforcement Burning Bridges & Building New Ones Alternative Rebellion and Adaptive Denial Vimeo link: ills/

38 Individual Therapy Weekly Assess Treatment Goals and Hierarchy Diary Card Review Directive

39 Coaching Weekly Skills Coaching and Reinforcement Not Therapy Strict Boundaries Validation of Skills Usage

40 Team Consultation Team Purpose: to ensure that each team member has the motivation and skill needed Koerner p 188. To ensure the treating therapist is adhering to the DBT model 6-8 members who meet weekly/bi-weekly minutes Strengthen each others work

41 DBT Informed Therapy DBT Therapy Skill Training Only

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43 References Crowell, S. E., Beauchaine, T. P., & Linehan, M. (2009). Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to child abuse. Journal of Consulting and Clinical Psychology, 70, Koerner, Kelly (2012). Doing Dialectical Behavioral Therapy: A Practical Guide. New York: The Guilford Press. pp Linehan, M.M. (1993). Skills Training for Treating Borderline Personality Disorder. New York: Guilford Press. Linehan, M.M., Bohus M., & Lynch T. R. (2007). Dialectical Behavioral Therapy for Pervasive Emotional Dysregulation. In J. Cross (Ed.). Handbook of Emotional Regulation (pp ). New York: Guilford Press. Lynch, T. R., Torst, W. T., Salman, N., & Linehan, M.M. (2006). Dialectical Behavior Therapy for Borderline Personality Disorder. Annual Review of Clinical Psychology, 3, Substance Abuse and Mental Health Services Administration. (2006, October). Dialectical behavior therapy. Retrieved from the National Registry of Evidence-based Programs and Practices,

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