Adam C. Payne, PhD Center for Cognitive and Dialectical Behavior Therapy December 3, 2014
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1 Adam C. Payne, PhD Center for Cognitive and Dialectical Behavior Therapy December 3,
2 What is DBT? Why is DBT Important? Why is DBT Important for Transition Age Youth? DBT Implementation Q&A
3
4 Dialectical Behavior Therapy is a form of cognitive-behavioral therapy that was developed to treat adults exhibiting symptoms of borderline personality disorder, who were self-injuring and suicidal DBT has expanded to treat adolescents who engage in suicidal, impulsive, and selfinjurious behaviors DBT often combines a skills group component with individual psychotherapy (CCDBT, 2014)
5 How many of you are using DBT in your current work? A. Yes B. Somewhat C. No
6 Simon Sinek, Talk given at TED. How Great Leaders Inspire Action, May 2010
7
8 Emotions are not the enemy, and yet.
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10 Borderline Personality Disorder Suicide and Non-Suicidal Self- Injurious behavior Eating disorders Bulimia Binge Eating Substance use disorders
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12 Year Total 4.7% 1, % 1, % 1, % 7, % 7, % 8, % 10, % 10,18 5 Female 6.5% % % % 3, % 3, % 4, % 5, % 5,622 Male 2.8% 1, % % % 3, % 3, % 3, % 4, % 4,535 (during the 30 days before the survey) New York City, NY, High School Youth Risk Behavior Survey (YRBS)
13 Year Total 20.6% 1, % 1, % 1, % 7, % 7, % 8, % 11,214 Female 15.6% % % % 3, % 4, % 4, % 6,074 Male 25.6% 1, % % % 3, % 3, % 4, % 5,138 (during the year before the survey) New York City, NY, High School Youth Risk Behavior Survey (YRBS)
14 Marsha Linehan, Ph.D., ABPP Treatment developer of Dialectical Behavior Therapy (DBT) Professor at the University of Washington in Seattle New York Times article from 2011 details her own emotional struggles as an adolescent
15 Marv Goldfried, Ph.D. Professor of Clinical Psychology at Stony Brook University Worked with Marsha Linehan when Marsha did a post doc in behavior therapy Introduced Marsha to the seminal idea that psychologists could TEACH their clients, i.e., going beyond insight as the mechanism for change in therapy
16 DBT Individual Therapy = Brain DBT Phone Coaching = Blood DBT Consultation Team = Heart DBT Skills Class = Backbone
17 Multifamily skills group with six to eight families Alec Miller, Psy.D. & Jill Rathus, Ph.D. first developed family-based DBT Families members are considered equal in group and all learn and practice the skills, i.e., parent(s) and teen Conducted like a class, 90 minutes with a short break Six month curriculum, repeated, for one year total in DBT class. Feels more like a class than traditional group therapy. Skills can be taught in individual therapy. However, data from research is predominantly on DBT skills group.
18 PAUSE & REDUCE EMOTIONAL DISTRESS
19 Jon Kabat-Zinn s definition: Mindfulness means paying attention in a particular way; On purpose, in the present moment, and nonjudgmentally. Attending to the present moment, the here and now, not the past or the future Marsha Linehan s definition: Mindfulness in its totality has to do with the quality of awareness that a person brings to everyday living; learning to control your mind, rather than letting your mind control you. Mindfulness as a practice directs your attention to only one thing, and that one thing is the moment you are living in. 19
20 Reasonable Mind W WISE I I MIND S M N E D Emotional Mind
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22 100 0 ANGER SADNESS ANXIETY SHAME GUILT DISGUST NAME IT CLAIM IT TAME IT IN THE PRESENT MOMENT IN THE ZONE NOT THE PAST NOT THE FUTURE WITHOUT BEING SELF-CONSCIOUS OBSERVE DESCRIBE PARTICIPATE
23 PAUSE & REDUCE EMOTIONAL DISTRESS
24
25 Be prepared for emotions, problem solve emotions Be able to redirect attention away from emotional stimuli Be able to appraise situations accurately and then redirect away from extreme thoughts Be able to change the action tendencies that further increase emotion dysregulation Be able to use their physiology to their benefit in reducing emotion distress and intensity
26
27 THOUGHTS PROMPTING EVENT EMOTIONS ACTIONS BODY SENSATIONS
28 THOUGHTS PROMPTING EVENT EMOTIONS ACTIONS BODY SENSATIONS
29 1. the process of thought by which such contradictions are seen to merge themselves in a higher truth that comprehends them. Oxford English Dictionary, Second Ed., debate establishing truths on both sides rather than disproving one argument. Encarta World, English Dictionary, North American Edition.
30 I don t want to miss out. Wants to go to party until: Wants teen home at: Safety Will either person be satisfied with compromise position of 11:30PM? Dialectics helps because the solution honors the essence of both sides
31 Please chat in your suggestions for honoring both sides of teen and momma.
32 Go till 1AM, teen checks in with momma regularly Go till 1AM, have momma pick up Go till 1AM, take cab home Home at 10PM, invite best friends back too Parents says no entirely, helps arrange another time where teen can be with friends.
33 THOUGHTS PROMPTING EVENT EMOTIONS ACTIONS BODY SENSATIONS
34
35
36 EMOTION ACTION URGE OPPOSITE ACTION Anxiety / Fear Avoid Approach Sadness Withdraw Get Active Anger Attack Gently avoid, Empathy Shame Hide Be Open
37 THOUGHTS PROMPTING EVENT EMOTIONS ACTIONS BODY SENSATIONS
38 emperature, Change Body ntense exercise rogressive muscle relaxation aced breathing
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40 Not the same as diaphragmatic breathing Breath out to a longer count than you breath in That s it. (Pretty simple, huh?) Syncs breathing rate with heart rate and stimulates the parasympathetic nervous system
41 Resonance Frequency Breathing (from Milton Brown) Primarily the lower abdomen (diaphragm) Exhale longer than inhale (4 sec in, 6 sec out) Pursed lips to slow down the exhale Exhaling slows Heart Rate (and helps the vagal break where parasympathetic nervous system kicks on) Exhaling at Resonance Frequency pace activates most vagal break (a slow pace of about 5-6 breaths per minute) Visual feedback can maximize the Breathing - Heart Rate synchrony
42 12 breaths per minute
43 5 breaths per minute
44 THOUGHTS Dialectics Problem Solving PROMPTING EVENT ABC PLEASE EMOTIONS TO REGULATE EMOTIONS ACTIONS Opposite Action BODY SENSATIONS TIP Skills
45 DBT Individual Therapy = Brain DBT Phone Coaching = Blood DBT Consultation Team = Heart DBT Skills Class = Backbone
46 Distress Tolerance Skill Distract with ACCEPTS Furious Distress Tolerance Skill Pros & Cons Up all night studying Told that boyfriend was with another girl Felt worthless & betrayed Thoughts of wanting to be dead Cut arm & stomach Brought to ER, scars, parents upset
47
48 Materials owned by ICL, Licensed by CTAC
49 heet.pdf
50 December 17, :00pm-1:30pm Reimagining Children s Health Services Part II: Gearing up for Change January 12, :00am-12:00pm Adult Engagement Dissemination Project: Training for Supervisors January 14, :00-1:30pm Reimagining Children s Health Services Part III: Understanding the New Menu of Services February 2, :00pm-12:00pm Adult Engagement Dissemination Project: Training for Clinical Staff February 23, :00am-12:00pm Adult Engagement Dissemination Project: Training for Clinical Staff
51 Adam C. Payne, PhD Kara M. Dean-Assael Lydia Franco Jayson Jones 51
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