Advanced Topics in DBT: The Art of Moving from Conceptualization to Exposure for Emotional Avoidance

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1 Conceptualization to Exposure for Emotional Avoidance This 4-day course will include one day of advanced training on DBT case conceptualization and three days of training on exposure in DBT Stage 1 and Stage 2. Dates: Instructors: Hosted by: Location: April 11-14, 2018 (note this is Wedesday-Saturday) Shari Manning, Ph.D. Annie McCall, MA, LMHC Choices Counseling & Skills Center and the Institute for Girls Development Near Pasadena, CA COURSE DESCRIPTION Dialectical Behavior Therapy (DBT) was developed in the 1980 s and was published as a manualized evidence based treatment in 1993 (Linehan, Cognitive behavioral treatment of borderline personality disorder). Since it was originally tested at the University of Washington, 13 randomized trials and numerous non-randomized trials have demonstrated its efficacy at treating out-of-control behaviors, including suicide, self-harm, other behaviors requiring medical and/or psychiatric hospitalization, treatment drop-out, substance abuse, binge eating, binging and purging and significant isolation. Often, those behaviors (suicide, self-harm, substance abuse, etc.) are both a consequence of extreme emotion dysregulation and an attempt to avoid emotions. A primary strategy in DBT is emotional exposure (both informal and formal) to decrease emotional avoidance and increase emotional experiencing. In past studies of Prolonged Exposure (PE) for Post-Traumatic Stress Disorder, subjects with suicide and self-harm behaviors were excluded from treatment. Harned, et al. (2012) have developed the DBT Prolonged Exposure Protocol for Stage 2 DBT with clients who often engage in suicide and self-harm behaviors. When exposure is used in DBT it is dictated by the DBT case formulation. Informal exposure is used to treat in session avoidance in Stage 1. It is also the behavioral intervention that specifically targets emotional avoidance when identified through behavioral chain analysis as a controlling variable for problem behavior. Formal (Prolonged) Exposure is the primary treatment intervention for Stage 2 of DBT. This training will begin with one day of advanced training on DBT case conceptualization. Participants will be asked to complete a case conceptualization on an individual psychotherapy client prior to the training. Those case conceptualizations will be used as examples to identify stages and targets for their individual client. We will begin to formulate the exposure interventions as a part of Day 1 and will move into training on exposure in DBT Stage 1 and Stage 2 for days 2-4. This training is designed for people who have attended previous trainings in DBT and will further develop skills needed to provide effective treatment with Stage 1 and Stage 2 clients. This training assumes that participants have knowledge of the basic principles of DBT. An overview of the treatment and treatment strategies will not be presented. Conceptualization to Exposure for Emotional Avoidance Brochure :: TIC 2018 Page 1 of 6

2 In addition to the case conceptualization to be completed prior to the training, there will be daily homework and practices. Trainers will use PowerPoint, case examples, live demonstrations and practices to teach case conceptualization and exposure. This training will be helpful for therapists who are in the process of certification through the DBT- Linehan Board of Certification ( as well as those preparing for the certification process. It meets partial requirements for training and will be a valuable tool for applicants as they enter the work sample demonstration requirements (formal case conceptualization and adherence through recorded sessions). COURSE OBJECTIVES Following this training, participants will be able to: Formulate a DBT individual therapy case from pre-treatment through Stage 2 Explain the role of the biosocial theory in one of their individual therapy clients Create Life Worth Living Goals for a DBT client Translate a client s Life Worth Living Goals into behavioral defined specific problems Create a primary target list for a Stage 1 DBT client Conduct chain analysis of dysfunctional behavior Determine controlling variables for a client s target behaviors Formulate a solution analysis for the controlling variables of a client s behavior Explain the difference between informal and formal exposure Define readiness for Stage 2 DBT Create behavioral tests to determine client s readiness for Stage 2 DBT Define subjective units of distress/discomfort (SUDs) Write anchor points for a client s SUDS Explain the behavioral constructs of habituation and mastery as they pertain to exposure Describe the different types of exposure (in vivo, imaginal and interoceptive) Create an in vivo hierarchy for exposure Conduct an in vivo exposure for one point on the in vivo hierarchy Define imaginal exposure Conduct imaginal exposure on a traumatic memory Describe interoceptive exposure List ways of creating physical experiences for interoceptive exposure Identify avoidance behaviors when they show up in session Conduct informal exposure for an in-session behavior Orient a client to exposure Define traumatic invalidation Describe how exposure is conducted with traumatic invalidation Explain their own therapy interfering behaviors when providing exposure treatments Define the role of the consultation team in treating emotional avoidance of the therapist COURSE SCHEDULE Day 1 8:30-10:15 Introductions Orientation to the training Mindfulness Overview of case conceptualization Conceptualization to Exposure for Emotional Avoidance Brochure :: TIC 2018 Page 2 of 6

3 10:30-11:45 Formulating biosocial theory and its role in the clients treatment Creating Life Worth Living Goals Translating goals into behaviorally defined problems 11:45-1:00 Lunch 1:00-2:30 Secondary Targets Determining Controlling Variables 2:30-2:45 Break 2:45-4:15 Moving to Solutions (Problem Solving, Contingency Management, Cognitive Modification) 4:15-4:30 Q&A, Evaluations Day 2 8:30-10:15 Mindfulness Orientation to the Training Introduction to Exposure Exposure in DBT 10:30-11:45 How do I know that my client is ready for PTSD treatment Assessing PTSD Organizing Stage 1 DBT targets to get clients ready for PTSD treatment Creating behavioral tests for readiness 11:45-1:00 Lunch 1:00-2:30 Basic Principles of Exposure: SUDS Anchor Points Habituation v Mastery 2:30-2:45 Break 2:45-4:15 3 Types of Exposure 4:15-4:30 Q&A, Evaluations Day 3 8:30-10:15 Mindfulness Homework 3 Types of Exposure (continued) 10:30-11:45 3 Types of Exposure (continued) Troubleshooting/When it s not working Treating therapy interfering behavior during exposure 11:45-1:00 Lunch 1:00-2:30 Informal Exposure: Identifying avoidance as a link on the chain Finding in-session avoidance 2:30-2:45 Break 2:45-4:15 Informal Exposure Practice 4:15-4:30 Q&A, Evaluations Day 4 8:30-10:15 Mindfulness Homework Informal Exposure Practice 10:30-11:45 Treating Traumatic Invalidation and other types of emotional avoidance 11:45-12:30 Lunch 12:30-2:15 Therapist Mindfulness: Tolerating the trauma Using your team effectively when doing exposure 2:15-2:30 Q&A, Evaluations Conceptualization to Exposure for Emotional Avoidance Brochure :: TIC 2018 Page 3 of 6

4 Conceptualization to Exposure for Emotional Avoidance Brochure :: TIC 2018 Page 4 of 6

5 REGISTRATION All registrations are being handled by Choices Counseling & Skills Center. All questions should be sent to Early Bird Registration begins January 8, 2018 Rates from January 8, February 16, 2018: Individual: $ Group (3 or more): $ each Pre-licensed*: $ Standard Registration February 17, March 31, 2018 Individual: $ Group (3 or more): $ each Pre-licensed*: $ INSTRUCTORS Shari Manning, Ph.D. is the Chief Executive Officer and one of the three founders of TIC. She is also the founder of the South Carolina Center for Dialectical Behavior Therapy (now the SC Center for DBT, LLC), a private practice that offers standard outpatient and intensive DBT treatment for adults and adolescents. She has supervised therapists at the Behavioral Research and Therapy Clinics at the University of Washington and the University of South Carolina as well as training and supervising therapists and programs at the SC Department of Mental Health and SC Department of Corrections. Dr. Manning consults extensively to state and private mental health programs, domestically and internationally, at all levels of client care, including forensic and criminal justice settings. Her research includes investigations of the efficacy of DBT with incarcerated women with borderline personality disorder (BPD) and with adult women with co-morbid BPD and eating disorders. Dr. Manning has written several published chapters and articles on DBT and its implementation. Her book for family members, Loving Someone with Borderline Personality Disorder: How to Keep Out-of-Control Emotions from Destroying Your Relationship was published in 2011 by Guilford Press. Dr. Manning has been leading DBT consultation teams since 1993 and has been a member of the consultation teams at Linehan s Behavioral Research and Therapy Clinics. She is currently working with consultation teams around the world to strengthen their team process. For more information: Annie McCall Annie McCall began practicing DBT as a skills trainer in community mental health in She spent several years at the Behavioral Research and Therapy Clinics as a research therapist and skills co-leader on Marsha Linehan s team. In her private practice, Annie co-founded Youth and Family DBT in Seattle, and provided individual DBT therapy to adults and adolescents, as well as leading multi-family DBT skills groups and parent coaching workshops. Annie has been teaching DBT in professional settings since 2009, and has had the opportunity to consult with providers across the spectrum of treatment contexts: outpatient, inpatient, residential, forensic, day treatment, and schools. Annie s experiences as a high school teacher give her a unique perspective in the mental health field, particularly in coaching skills trainers how to manage group behavior and bring skills to life. Conceptualization to Exposure for Emotional Avoidance Brochure :: TIC 2018 Page 5 of 6

6 Annie is also a certified provider and supervisor of Prolonged Exposure treatment. She participated as a therapist in the development of DBT-PE, and has provided training with treatment developer Melanie Harned, PhD. Annie is a DBT- Linehan Board of Certification, Certified DBT Clinician, and volunteers for the certification board scoring work samples. For more information: Conceptualization to Exposure for Emotional Avoidance Brochure :: TIC 2018 Page 6 of 6

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