Adam C. Payne, PhD Center for Cognitive and Dialectical Behavior Therapy December 3, 2014 1
What is DBT? Why is DBT Important? Why is DBT Important for Transition Age Youth? DBT Implementation Q&A
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)
How many of you are using DBT in your current work? A. Yes B. Somewhat C. No
Simon Sinek, Talk given at TED. How Great Leaders Inspire Action, May 2010
Emotions are not the enemy, and yet.
Borderline Personality Disorder Suicide and Non-Suicidal Self- Injurious behavior Eating disorders Bulimia Binge Eating Substance use disorders
Year 1997 1999 2001 2003 2005 2007 2009 2011 Total 4.7% 1,991 4.0% 1,576 2.5% 1,596 4.0% 7,187 5.9% 7,447 5.1% 8,469 5.0% 10,177 5.0% 10,18 5 Female 6.5% 967 5.6% 784 3.5% 855 5.3% 3,677 6.7% 3,903 6.3% 4,506 5.1% 5,621 5.3% 5,622 Male 2.8% 1,021 2.3% 789 1.3% 734 2.6% 3,472 5.2% 3,527 3.6% 3,939 5.0% 4,554 4.5% 4,535 (during the 30 days before the survey) New York City, NY, High School Youth Risk Behavior Survey (YRBS)
Year 1997 1999 2001 2003 2005 2007 2009 Total 20.6% 1,998 20.9% 1,576 24.0% 1,603 21.9% 7,256 26.1% 7,863 23.3% 8,764 23.3% 11,214 Female 15.6% 970 18.6% 784 18.4% 860 17.8% 3,698 22.2% 4,057 21.5% 4,607 19.6% 6,074 Male 25.6% 1,025 23.3% 788 29.7% 736 25.8% 3,518 30.2% 3,788 25.2% 4,132 27.5% 5,138 (during the year before the survey) New York City, NY, High School Youth Risk Behavior Survey (YRBS)
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
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
DBT Individual Therapy = Brain DBT Phone Coaching = Blood DBT Consultation Team = Heart DBT Skills Class = Backbone
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.
PAUSE & REDUCE EMOTIONAL DISTRESS
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
Reasonable Mind W WISE I I MIND S M N E D Emotional Mind
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
PAUSE & REDUCE EMOTIONAL DISTRESS
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
THOUGHTS PROMPTING EVENT EMOTIONS ACTIONS BODY SENSATIONS
THOUGHTS PROMPTING EVENT EMOTIONS ACTIONS BODY SENSATIONS
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., 1989. 2. debate establishing truths on both sides rather than disproving one argument. Encarta World, English Dictionary, North American Edition.
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
Please chat in your suggestions for honoring both sides of teen and momma.
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.
THOUGHTS PROMPTING EVENT EMOTIONS ACTIONS BODY SENSATIONS
EMOTION ACTION URGE OPPOSITE ACTION Anxiety / Fear Avoid Approach Sadness Withdraw Get Active Anger Attack Gently avoid, Empathy Shame Hide Be Open
THOUGHTS PROMPTING EVENT EMOTIONS ACTIONS BODY SENSATIONS
emperature, Change Body ntense exercise rogressive muscle relaxation aced breathing
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
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
12 breaths per minute
5 breaths per minute
THOUGHTS Dialectics Problem Solving PROMPTING EVENT ABC PLEASE EMOTIONS TO REGULATE EMOTIONS ACTIONS Opposite Action BODY SENSATIONS TIP Skills
DBT Individual Therapy = Brain DBT Phone Coaching = Blood DBT Consultation Team = Heart DBT Skills Class = Backbone
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
Materials owned by ICL, Licensed by CTAC
http://www.ccdbt.com/ http://www.nami.org/factsheets/dbt_facts heet.pdf http://behavioraltech.org/resources/
December 17, 2014 12:00pm-1:30pm Reimagining Children s Health Services Part II: Gearing up for Change January 12, 2015 11:00am-12:00pm Adult Engagement Dissemination Project: Training for Supervisors January 14, 2015 12:00-1:30pm Reimagining Children s Health Services Part III: Understanding the New Menu of Services February 2, 2015 11:00pm-12:00pm Adult Engagement Dissemination Project: Training for Clinical Staff February 23, 2015 11:00am-12:00pm Adult Engagement Dissemination Project: Training for Clinical Staff
Adam C. Payne, PhD apayne@ccdbt.com Kara M. Dean-Assael kara.dean@nyu.edu Lydia Franco lydia.franco@nyu.edu Jayson Jones Jayson.jones@nyu.edu 51