Emotional Vulnerability versus Self-Invalidation, Active Passivity versus Apparent Competence, Unrelenting Crises versus Inhibited Grieving

Transcription

1 Multiple Choice DBT. Match the phrase in blue with the best of the 4 choices. Please excuse the poor formatting, abbreviations and punctuation! Confirm all answers in Linehan text caveat emptor = let the test taker beware 36 Questions 3 Sets of Dialectical Dilemmas 1. Emotional Vulnerability versus Self-Invalidation, Active Passivity versus Apparent Competence, Unrelenting Crises versus Inhibited Grieving The most caring thing a therapist can do is help patients change in ways that bring them closer to their own ultimate goals Clarity, precision, and compassion are of the utmost importance in the conduct of DBT The therapeutic relationship is a real relationship between equals Principles of behavior are universal, affecting therapists no less than patients Therapists treating borderline patients need support DBT therapists can fail DBT can fail even when therapists do not Attend to small units of behavior (links of chain) Attend to defining chain's beginning (antecedent, prompting event, trigger) Attend to describing the problem instance itself Attend to end (consequences in terms of emotions, bodily sensations, thought and images, overt behaviors and/or environmental factors) Focus on observables Attend to vulnerability/contextual factors Providing opportunities for emotional expression Teaching emotion observation and labeling Reading emotions Communicating the validity of emotions Informal Exposure Steps 2. Emotional Vulnerability versus Self-Invalidation, Active Passivity versus Apparent Competence, Unrelenting Crises versus Inhibited Grieving high sensitivity (quick rxn, low emot. rxn threshold), hig reactivity (extreme rxn, high arousal dysregulates cog. processing, slow return to baseline (long-lasting rxns which can compound w successive emot. stimuli) C behs judged as wrong, C private experiences met with erratic, inappropriate, extreme responses, often punished or trivialized. Painful emotions and causal factors disregarded. 1. T EXPLICITLY EXPOSES C TO EMOTION CUES, 2. T BLOCKS ACTION TENDENCIES associated with C's problem emotions, 3. T ENHANCES C's SENSE OF CONTROL over adverse emotional situations. T exposes C to Emotion cues 3. imaginal exposure, engaging in behaviors known to elicit unjustified emotions, role-play, eliciting new behavior (opposite action) Teaching behavior observation and labeling Identifying the should Countering the should Accepting the should Moving to disappointment

2 a> T prevents C from engaging in emotional avoidance. b> T blocks C's tendency to escape/avoid when feeling afraid. b> T blocks C's tendency to escape/avoid when feeling afraid. c> T blocks C's tendency to hide or withdraw when feeling shame. d> T blocks C's tendency to repair or self-punish when feeling unjustified guilt. e> T blocks C's tendency to hostile and aggressive responses; f> T blocks active-passivity. inhibit maladaptive, mood-dependent actions, decrease (increase) physiological arousal ass'ed with emotion, reorient att'n away from emot. stimuli, organize beh toward non-mood dependent goals. And experience painful emotions without diss'n or escalating them. T BLOCKS ACTION TENDENCIES associated with C's problem emotions. 4. Clarify C's adaptive solutions Confront maladaptive solutions directly Focus on consequences, both short- and long-term of various solutions/action plans; predict consequences of action plans. Discuss with C problem solution criteria Do pros and cons with respect to solutions a> T prevents C from engaging in emotional avoidance. b> T blocks C's tendency to escape/avoid when feeling afraid. b> T blocks C's tendency to escape/avoid when feeling afraid. c> T blocks C's tendency to hide or withdraw when feeling shame. d> T blocks C's tendency to repair or self-punish when feeling unjustified guilt. e> T blocks C's tendency to hostile and aggressive responses; f> T blocks active-passivity. ~ behaviors related to hierarchy of targets ~ observable or public behaviors ~ present events and behaviors v. past Assuming the best Providing encouragement Focusing on capabilities Contradicting/modulating external criticism Providing praise and reassurance Being realistic and dealing with fears of insincerity Staying near In Contingency Management procedures, T REINFORCES target-relevant adaptive behaviors. (e.g., Praise, INCREASED warmth, responsiveness, communication of understanding, validation, control over session agenda, etc.) 5. high sensitivity (quick rxn, low emot. rxn threshold), hig reactivity (extreme rxn, high arousal dysregulates cog. processing, slow return to baseline (long-lasting rxns which can compound w successive emot. stimuli) evolves, develops, and constructed over time; neither abs or relative ~ behaviors related to hierarchy of targets ~ observable or public behaviors ~ present events and behaviors v. past 8 Specific dialectical strategies 6.

3 The most caring thing a therapist can do is help patients change in ways that bring them closer to their own ultimate goals Clarity, precision, and compassion are of the utmost importance in the conduct of DBT The therapeutic relationship is a real relationship between equals Principles of behavior are universal, affecting therapists no less than patients Therapists treating borderline patients need support DBT therapists can fail DBT can fail even when therapists do not 1. C wants to improve 2. C needs to try, do better and be more motivated to change 3. Cs must solve problems (even if didn't cause) 4. Lives of suicidal Cs are unbearable as currently lived 5. Cs must learn new behs in all relevant contexts 6. Cs cannot fail Tx 7. Ts treating BPD need support imaginal exposure, engaging in behaviors known to elicit unjustified emotions, role-play, eliciting new behavior (opposite action) Entering the paradox, Metaphor, Devil s advocate, Extending, Activating Wise Mind, Making lemonade out of lemons, Allowing natural change, Dialectical assessment Cheerleading strategies 7. Assuming the best Providing encouragement Focusing on capabilities Contradicting/modulating external criticism Providing praise and reassurance Being realistic and dealing with fears of insincerity Staying near ~ based on biosocial theory ~ using non-pejorative language ~ link current behaviors to current events Clarify C's adaptive solutions Confront maladaptive solutions directly Focus on consequences, both short- and long-term of various solutions/action plans; predict consequences of action plans. Discuss with C problem solution criteria Do pros and cons with respect to solutions Validation = Self-Verification INVALIDATION OF Self-Construct leads to high arousal and out-of-control leads to failure to process new info (=no new learning!) Emotional validation strategies 8. Providing opportunities for emotional expression Teaching emotion observation and labeling Reading emotions Communicating the validity of emotions The most caring thing a therapist can do is help patients change in ways that bring them closer to their own ultimate goals Clarity, precision, and compassion are of the utmost importance in the conduct of DBT The therapeutic relationship is a real relationship between equals Principles of behavior are universal, affecting therapists no less than patients Therapists treating borderline patients need support DBT therapists can fail DBT can fail even when therapists do not interactional model;env. stimuli reach threshold to trigger latent predisposition in person to develop do Validation = Self-Verification INVALIDATION OF Self-Construct leads to high arousal and out-of-control leads to failure to process new info (=no new learning!)

4 Behavioral validation strategies 9. For the Individual Therapist DECREASE suicide crises behaviors INCREASE generalization of DBT behavioral skills DECREASE sense of conflict, alienation, distance with therapist For the Skills Trainer DECREASE therapy destructive behaviors INCREASE immediate contacting of primary therapist high sensitivity (quick rxn, low emot. rxn threshold), hig reactivity (extreme rxn, high arousal dysregulates cog. processing, slow return to baseline (long-lasting rxns which can compound w successive emot. stimuli) mislabeling private experiences, not modulate emot. arousal, not resolve problems prompting arousal, inaccurate expectations cause poor tolerance of stress and unrealisitc goals, extreme emot. behs to provoke helpful response, and not trust child's own emot. and cog. responses Teaching behavior observation and labeling Identifying the should Countering the should Accepting the should Moving to disappointment Cognitive validation strategies 10. C behs judged as wrong, C private experiences met with erratic, inappropriate, extreme responses, often punished or trivialized. Painful emotions and causal factors disregarded. mislabeling private experiences, not modulate emot. arousal, not resolve problems prompting arousal, inaccurate expectations cause poor tolerance of stress and unrealisitc goals, extreme emot. behs to provoke helpful response, and not trust child's own emot. and cog. responses Eliciting and reflecting thoughts and assumptions Discriminating facts from interpretations Finding the kernel of truth Acknowledging Wise Mind Respecting different values Assuming the best Providing encouragement Focusing on capabilities Contradicting/modulating external criticism Providing praise and reassurance Being realistic and dealing with fears of insincerity Staying near Chain Analysis Checklist get ct's attn, 2. shift affective response, 3. see different view. Used when C or T are stuck in dysf emot, thought or beh pattern. "jump the track" to rebalance 1. Conduct behavioral chain analysis of problem behavior. 2. Summarize links in current chain 3. Analyze function of behavior not assume 4. Attend to dysfunctional links in chain 5. Target most relevant links in the chain 6. Work with behavioral analysis (BA) handout. 1. awake and alert to C small changes in beh and responding to C's questions/remarks

5 BCA - Problem Analysis 12. Providing opportunities for emotional expression Teaching emotion observation and labeling Reading emotions Communicating the validity of emotions Attend to small units of behavior (links of chain) Attend to defining chain's beginning (antecedent, prompting event, trigger) Attend to describing the problem instance itself Attend to end (consequences in terms of emotions, bodily sensations, thought and images, overt behaviors and/or environmental factors) Focus on observables Attend to vulnerability/contextual factors the change in associations between two stimuli via experience. A change in association between two stimuli ( S-S ) changes the meaning and valence of stimuli. A change in association between a response and stimuli ( S d-r-s r/a ) changes the probability of the response. Soluton Analysis Checklist Generate specific coping strategies and practices Ask C for possible solutions Generate possible solutions and new behaviors 2. Generate (or drag out) realistic solutions 3. Help C evaluate solutions generated during problem solving Suicidal,SH, Life-threatening behs, Tx-interfering behs, Life Qual Issues, Coping Skills, Resolving PTSD, Self-respect and other (pp 97-98) a> T prevents C from engaging in emotional avoidance. b> T blocks C's tendency to escape/avoid when feeling afraid. b> T blocks C's tendency to escape/avoid when feeling afraid. c> T blocks C's tendency to hide or withdraw when feeling shame. d> T blocks C's tendency to repair or self-punish when feeling unjustified guilt. e> T blocks C's tendency to hostile and aggressive responses; f> T blocks active-passivity. mislabeling private experiences, not modulate emot. arousal, not resolve problems prompting arousal, inaccurate expectations cause poor tolerance of stress and unrealisitc goals, extreme emot. behs to provoke helpful response, and not trust child's own emot. and cog. responses Step 2. Generate (or drag out) realistic solutions 14. Attend to small units of behavior (links of chain) Attend to defining chain's beginning (antecedent, prompting event, trigger) Attend to describing the problem instance itself Attend to end (consequences in terms of emotions, bodily sensations, thought and images, overt behaviors and/or environmental factors) Focus on observables Attend to vulnerability/contextual factors Teaching behavior observation and labeling Identifying the should Countering the should Accepting the should Moving to disappointment

6 Affect tolerance as a solution Solutions to stop eliciting events General coping behaviors Specific DBT skills as solutions to problems Crisis Survival Mindfulness/reality acceptance Emotion regulation skills Interpersonal effectiveness Clarify C's adaptive solutions Confront maladaptive solutions directly Focus on consequences, both short- and long-term of various solutions/action plans; predict consequences of action plans. Discuss with C problem solution criteria Do pros and cons with respect to solutions Step 3. Help C evaluate solutions generated during problem solving Conduct behavioral chain analysis of problem behavior. 2. Summarize links in current chain 3. Analyze function of behavior not assume 4. Attend to dysfunctional links in chain 5. Target most relevant links in the chain 6. Work with behavioral analysis (BA) handout. Clarify C's adaptive solutions Confront maladaptive solutions directly Focus on consequences, both short- and long-term of various solutions/action plans; predict consequences of action plans. Discuss with C problem solution criteria Do pros and cons with respect to solutions inhibit maladaptive, mood-dependent actions, decrease (increase) physiological arousal ass'ed with emotion, reorient att'n away from emot. stimuli, organize beh toward non-mood dependent goals. And experience painful emotions without diss'n or escalating them. 1. C wants to improve 2. C needs to try, do better and be more motivated to change 3. Cs must solve problems (even if didn't cause) 4. Lives of suicidal Cs are unbearable as currently lived 5. Cs must learn new behs in all relevant contexts 6. Cs cannot fail Tx 7. Ts treating BPD need support 9 Sx/criteria of BPD 16. Emotional instability and problems w anger (E D), Unstable Rel's and Efforts to avoid loss (I D), Suicide threats/sh and Impulsive behs (B D), Paranoid idn/severe diss sx (C D), Unstable self (image) and chronic emptiness (S D) imaginal exposure, engaging in behaviors known to elicit unjustified emotions, role-play, eliciting new behavior (opposite action) Entering the paradox, Metaphor, Devil s advocate, Extending, Activating Wise Mind, Making lemonade out of lemons, Allowing natural change, Dialectical assessment 1. Generate specific coping strategies and practices Ask C for possible solutions Generate possible solutions and new behaviors 2. Generate (or drag out) realistic solutions 3. Help C evaluate solutions generated during problem solving 7 Steps of 3 DBT Stages 17.

7 Suicidal,SH, Life-threatening behs, Tx-interfering behs, Life Qual Issues, Coping Skills, Resolving PTSD, Self-respect and other (pp 97-98) Eliciting and reflecting thoughts and assumptions Discriminating facts from interpretations Finding the kernel of truth Acknowledging Wise Mind Respecting different values 1. T EXPLICITLY EXPOSES C TO EMOTION CUES, 2. T BLOCKS ACTION TENDENCIES associated with C's problem emotions, 3. T ENHANCES C's SENSE OF CONTROL over adverse emotional situations. Entering the paradox, Metaphor, Devil s advocate, Extending, Activating Wise Mind, Making lemonade out of lemons, Allowing natural change, Dialectical assessment stress-diathesis model 18. high sensitivity (quick rxn, low emot. rxn threshold), hig reactivity (extreme rxn, high arousal dysregulates cog. processing, slow return to baseline (long-lasting rxns which can compound w successive emot. stimuli) interactional model;env. stimuli reach threshold to trigger latent predisposition in person to develop do reciprocal rel betw ind. and env. (mutually impact other) 1. awake and alert to C small changes in beh and responding to C's questions/remarks transactional model 19. Affect tolerance as a solution Solutions to stop eliciting events General coping behaviors Specific DBT skills as solutions to problems Crisis Survival Mindfulness/reality acceptance Emotion regulation skills Interpersonal effectiveness reciprocal rel betw ind. and env. (mutually impact other) Assuming the best Providing encouragement Focusing on capabilities Contradicting/modulating external criticism Providing praise and reassurance Being realistic and dealing with fears of insincerity Staying near irreverent comm'n used to: get ct's attn, 2. shift affective response, 3. see different view. Used when C or T are stuck in dysf emot, thought or beh pattern. "jump the track" to rebalance interactional model;env. stimuli reach threshold to trigger latent predisposition in person to develop do

8 Providing opportunities for emotional expression Teaching emotion observation and labeling Reading emotions Communicating the validity of emotions evolves, develops, and constructed over time; neither abs or relative truth pp Affect tolerance as a solution Solutions to stop eliciting events General coping behaviors Specific DBT skills as solutions to problems Crisis Survival Mindfulness/reality acceptance Emotion regulation skills Interpersonal effectiveness Knowledge of Principles of Behavior Change and Maintenance. Realistic Goal Setting. Environmental/Behavioral Analysis Skills. Contingency Management Skills. Environmental Control Techniques. Relapse Prevention Plans. Ability to Tolerate Limited Progress. p.144 evolves, develops, and constructed over time; neither abs or relative 1. get ct's attn, 2. shift affective response, 3. see different view. Used when C or T are stuck in dysf emot, thought or beh pattern. "jump the track" to rebalance responsiveness is reciprocal strategy of: 22. Attend to small units of behavior (links of chain) Attend to defining chain's beginning (antecedent, prompting event, trigger) Attend to describing the problem instance itself Attend to end (consequences in terms of emotions, bodily sensations, thought and images, overt behaviors and/or environmental factors) Focus on observables Attend to vulnerability/contextual factors Emotional Vulnerability versus Self-Invalidation, Active Passivity versus Apparent Competence, Unrelenting Crises versus Inhibited Grieving 1. T EXPLICITLY EXPOSES C TO EMOTION CUES, 2. T BLOCKS ACTION TENDENCIES associated with C's problem emotions, 3. T ENHANCES C's SENSE OF CONTROL over adverse emotional situations. 1. awake and alert to C small changes in beh and responding to C's questions/remarks DBT assumptions 23. Emotional Vulnerability versus Self-Invalidation, Active Passivity versus Apparent Competence, Unrelenting Crises versus Inhibited Grieving 1. C wants to improve 2. C needs to try, do better and be more motivated to change 3. Cs must solve problems (even if didn't cause) 4. Lives of suicidal Cs are unbearable as currently lived 5. Cs must learn new behs in all relevant contexts 6. Cs cannot fail Tx 7. Ts treating BPD need support

9 Suicidal,SH, Life-threatening behs, Tx-interfering behs, Life Qual Issues, Coping Skills, Resolving PTSD, Self-respect and other (pp 97-98) Invalidating environment= 24. C behs judged as wrong, C private experiences met with erratic, inappropriate, extreme responses, often punished or trivialized. Painful emotions and causal factors disregarded. Suicidal,SH, Life-threatening behs, Tx-interfering behs, Life Qual Issues, Coping Skills, Resolving PTSD, Self-respect and other (pp 97-98) interactional model;env. stimuli reach threshold to trigger latent predisposition in person to develop do inhibit maladaptive, mood-dependent actions, decrease (increase) physiological arousal ass'ed with emotion, reorient att'n away from emot. stimuli, organize beh toward non-mood dependent goals. And experience painful emotions without diss'n or escalating them. Invalidating environment lead to learning: 25. mislabeling private experiences, not modulate emot. arousal, not resolve problems prompting arousal, inaccurate expectations cause poor tolerance of stress and unrealisitc goals, extreme emot. behs to provoke helpful response, and not trust child's own emot. and cog. responses 1. get ct's attn, 2. shift affective response, 3. see different view. Used when C or T are stuck in dysf emot, thought or beh pattern. "jump the track" to rebalance 1. C wants to improve 2. C needs to try, do better and be more motivated to change 3. Cs must solve problems (even if didn't cause) 4. Lives of suicidal Cs are unbearable as currently lived 5. Cs must learn new behs in all relevant contexts 6. Cs cannot fail Tx 7. Ts treating BPD need support Providing opportunities for emotional expression Teaching emotion observation and labeling Reading emotions Communicating the validity of emotions High Emot. vulnerablity= 26. mislabeling private experiences, not modulate emot. arousal, not resolve problems prompting arousal, inaccurate expectations cause poor tolerance of stress and unrealisitc goals, extreme emot. behs to provoke helpful response, and not trust child's own emot. and cog. responses inhibit maladaptive, mood-dependent actions, decrease (increase) physiological arousal ass'ed with emotion, reorient att'n away from emot. stimuli, organize beh toward non-mood dependent goals. And experience painful emotions without diss'n or escalating them. high sensitivity (quick rxn, low emot. rxn threshold), hig reactivity (extreme rxn, high arousal dysregulates cog. processing, slow return to baseline (long-lasting rxns which can compound w successive emot. stimuli)

10 a> T prevents C from engaging in emotional avoidance. b> T blocks C's tendency to escape/avoid when feeling afraid. b> T blocks C's tendency to escape/avoid when feeling afraid. c> T blocks C's tendency to hide or withdraw when feeling shame. d> T blocks C's tendency to repair or self-punish when feeling unjustified guilt. e> T blocks C's tendency to hostile and aggressive responses; f> T blocks active-passivity. Emotion modulation/regulation skills 27. interactional model;env. stimuli reach threshold to trigger latent predisposition in person to develop do 1. Conduct behavioral chain analysis of problem behavior. 2. Summarize links in current chain 3. Analyze function of behavior not assume 4. Attend to dysfunctional links in chain 5. Target most relevant links in the chain 6. Work with behavioral analysis (BA) handout. ~ based on biosocial theory ~ using non-pejorative language ~ link current behaviors to current events inhibit maladaptive, mood-dependent actions, decrease (increase) physiological arousal ass'ed with emotion, reorient att'n away from emot. stimuli, organize beh toward non-mood dependent goals. And experience painful emotions without diss'n or escalating them. Self-Management Skills...the generic set of behavior capabuities that an individual needs in order to acquire further skills Generate specific coping strategies and practices Ask C for possible solutions Generate possible solutions and new behaviors 2. Generate (or drag out) realistic solutions 3. Help C evaluate solutions generated during problem solving Assuming the best Providing encouragement Focusing on capabilities Contradicting/modulating external criticism Providing praise and reassurance Being realistic and dealing with fears of insincerity Staying near Knowledge of Principles of Behavior Change and Maintenance. Realistic Goal Setting. Environmental/Behavioral Analysis Skills. Contingency Management Skills. Environmental Control Techniques. Relapse Prevention Plans. Ability to Tolerate Limited Progress. p.144 high sensitivity (quick rxn, low emot. rxn threshold), hig reactivity (extreme rxn, high arousal dysregulates cog. processing, slow return to baseline (long-lasting rxns which can compound w successive emot. stimuli) Self-verification theory 29. evolves, develops, and constructed over time; neither abs or relative 1. T EXPLICITLY EXPOSES C TO EMOTION CUES, 2. T BLOCKS ACTION TENDENCIES associated with C's problem emotions, 3. T ENHANCES C's SENSE OF CONTROL over adverse emotional situations.

11 Validation = Self-Verification INVALIDATION OF Self-Construct leads to high arousal and out-of-control leads to failure to process new info (=no new learning!) DBT Targets for Phone Calls Conduct behavioral chain analysis of problem behavior. 2. Summarize links in current chain 3. Analyze function of behavior not assume 4. Attend to dysfunctional links in chain 5. Target most relevant links in the chain 6. Work with behavioral analysis (BA) handout. Teaching behavior observation and labeling Identifying the should Countering the should Accepting the should Moving to disappointment For the Individual Therapist DECREASE suicide crises behaviors INCREASE generalization of DBT behavioral skills DECREASE sense of conflict, alienation, distance with therapist For the Skills Trainer DECREASE therapy destructive behaviors INCREASE immediate contacting of primary therapist C behs judged as wrong, C private experiences met with erratic, inappropriate, extreme responses, often punished or trivialized. Painful emotions and causal factors disregarded. DBT Assumptions about Patients 31. Patients are doing the best they can Patients want to improve Patients must learn new behaviors in all relevant contexts Patients cannot fail in DBT Patients may not have caused all of their own problems, but they have to solve them anyway * Patients need to do better, try harder, and/or be more motivated to change * The lives of suicidal, borderline individuals are unbearable as they are currently being lived Knowledge of Principles of Behavior Change and Maintenance. Realistic Goal Setting. Environmental/Behavioral Analysis Skills. Contingency Management Skills. Environmental Control Techniques. Relapse Prevention Plans. Ability to Tolerate Limited Progress. p awake and alert to C small changes in beh and responding to C's questions/remarks The most caring thing a therapist can do is help patients change in ways that bring them closer to their own ultimate goals Clarity, precision, and compassion are of the utmost importance in the conduct of DBT The therapeutic relationship is a real relationship between equals Principles of behavior are universal, affecting therapists no less than patients Therapists treating borderline patients need support DBT therapists can fail DBT can fail even when therapists do not DBT Assumptions about Therapy 32. For the Individual Therapist DECREASE suicide crises behaviors INCREASE generalization of DBT behavioral skills DECREASE sense of conflict, alienation, distance with therapist For the Skills Trainer DECREASE therapy destructive behaviors INCREASE immediate contacting of primary therapist

12 Suicidal,SH, Life-threatening behs, Tx-interfering behs, Life Qual Issues, Coping Skills, Resolving PTSD, Self-respect and other (pp 97-98) imaginal exposure, engaging in behaviors known to elicit unjustified emotions, role-play, eliciting new behavior (opposite action) The most caring thing a therapist can do is help patients change in ways that bring them closer to their own ultimate goals Clarity, precision, and compassion are of the utmost importance in the conduct of DBT The therapeutic relationship is a real relationship between equals Principles of behavior are universal, affecting therapists no less than patients Therapists treating borderline patients need support DBT therapists can fail DBT can fail even when therapists do not LEARNING is Emotional Vulnerability versus Self-Invalidation, Active Passivity versus Apparent Competence, Unrelenting Crises versus Inhibited Grieving 1. get ct's attn, 2. shift affective response, 3. see different view. Used when C or T are stuck in dysf emot, thought or beh pattern. "jump the track" to rebalance the change in associations between two stimuli via experience. A change in association between two stimuli ( S-S ) changes the meaning and valence of stimuli. A change in association between a response and stimuli ( S d-r-s r/a ) changes the probability of the response. Principles of Learning 34. Strengthen Behavior Add Reinforcer -Remove Aversive Weaken Behavior -Withhold Reinforcer - Maintain Aversive Suppress Behavior * -Add Aversive -Remove Positive For the Individual Therapist DECREASE suicide crises behaviors INCREASE generalization of DBT behavioral skills DECREASE sense of conflict, alienation, distance with therapist For the Skills Trainer DECREASE therapy destructive behaviors INCREASE immediate contacting of primary therapist Assuming the best Providing encouragement Focusing on capabilities Contradicting/modulating external criticism Providing praise and reassurance Being realistic and dealing with fears of insincerity Staying near Providing opportunities for emotional expression Teaching emotion observation and labeling Reading emotions Communicating the validity of emotions What do we interpret in Insight Strategies? 35.

13 ~ behaviors related to hierarchy of targets ~ observable or public behaviors ~ present events and behaviors v. past Affect tolerance as a solution Solutions to stop eliciting events General coping behaviors Specific DBT skills as solutions to problems Crisis Survival Mindfulness/reality acceptance Emotion regulation skills Interpersonal effectiveness Attend to small units of behavior (links of chain) Attend to defining chain's beginning (antecedent, prompting event, trigger) Attend to describing the problem instance itself Attend to end (consequences in terms of emotions, bodily sensations, thought and images, overt behaviors and/or environmental factors) Focus on observables Attend to vulnerability/contextual factors Entering the paradox, Metaphor, Devil s advocate, Extending, Activating Wise Mind, Making lemonade out of lemons, Allowing natural change, Dialectical assessment How do we interpret in Insight Strategies? 36. ~ based on biosocial theory ~ using non-pejorative language ~ link current behaviors to current events For the Individual Therapist DECREASE suicide crises behaviors INCREASE generalization of DBT behavioral skills DECREASE sense of conflict, alienation, distance with therapist For the Skills Trainer DECREASE therapy destructive behaviors INCREASE immediate contacting of primary therapist Attend to small units of behavior (links of chain) Attend to defining chain's beginning (antecedent, prompting event, trigger) Attend to describing the problem instance itself Attend to end (consequences in terms of emotions, bodily sensations, thought and images, overt behaviors and/or environmental factors) Focus on observables Attend to vulnerability/contextual factors C behs judged as wrong, C private experiences met with erratic, inappropriate, extreme responses, often punished or trivialized. Painful emotions and causal factors disregarded.