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Acceptance Based DBT for Emotion Regulation. Sandra Georgescu, Psy. D. Paul Holmes, Psy.D. Introduction. DBT – one of the 1 st CBTs to integrate acceptance/mindfulness and behavior change strategies DBT – one foot in the 2 nd & another in the 3 rd wave of behaviorism
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Acceptance Based DBT for Emotion Regulation Sandra Georgescu, Psy. D. Paul Holmes, Psy.D.
Introduction • DBT – one of the 1st CBTs to integrate acceptance/mindfulness and behavior change strategies • DBT – one foot in the 2nd & another in the 3rd wave of behaviorism • DBT’s leap into the 3rd wave
1st Wave S-R Behaviorism scientific principles Rigorous testing Reject anything vague First-order change The Field’s Timeline 3rd wave Acceptance/Mindfulness experiential avoidance, cognitive defusion, relationship, values, dialectics, contact with the present moment 2nd Wave Cognitive Behavioral Same as above + role of cognition based on clinical samples DBT Hayes, (2004)
DBT as Originally Packaged • Intensive Outpatient Treatment involving: • Individual Psychotherapy • Skills Training Group • Telephone Consultation • Therapists’ Consultation Group • Uncontrolled Ancillary Treatment • Pharmacotherapy • Acute Inpatient Psychiatric
DBT - Stages of Treatment Pre-treatment - Commitment, Orientation & Agreement on Goals Stage I - Stability, Connectedness & Safety Stage II - Exposure & Emotional Processing of the Past Stage III - Ordinary Happiness & Unhappiness Stage IV - Capacity for Sustained Joy
Stage I Targets Severe Behavioral Dyscontrol Behavioral Control Decrease control of contrived private experience • Life threatening behaviors • Therapy interfering behaviors • Quality of life interfering behaviors Increase Behavioral Skills • Core Mindfulness • Distress tolerance • Emotion regulation • Interpersonal Effectiveness
Relationship Between Knowledge & Action Become more discriminating in our actions KnowledgeAction Contact with Consequences results in refined knowledge
Moving Forward • Meaningless Dialectic • Data on emotion and thought suppression • Relational Frame Theory (RFT) – provides us with a nominalist model for understanding mind from a behavioral perspective
Meaningless Dialectic in DBT ????? MindfulnessCognitive Restructuring (content is not the (content is the problem; problem, just notice) evaluate & change it)
Avoidance of Private Experience • Escape from events & objects • Escape from private experience • Thought suppression (Marcks & Woods, 2005; Bower & Woody, 1996, Abramowitz, Tolin & Street, 2001 ) • Emotion suppression (Gross & Johns, 2003; Gross, 1998; Gross & Levenson, 1997) • Experiential Avoidance (Feldner, Zvolensky, Eifert & Spira, 2003; Hayes, Strosahl, Wilson, et al. 2004; Chawla & Ostafin, 2007)
Relational Frame Theory (RFT) • Language about mind was avoided in the 1st wave & mentallistic in the 2nd wave • Rorty (1997) – when we’ve explained the use of language in society, we’ve made sense of the term “mind” • RFT may have provided us us with a functional conceptualization of mind • Mind is unidirectional – once you have it, you got it
Acceptance Based DBT for Emotional Regulation “LIVING MEANINGFULLY” ACCEPTANCE BEHAV. CHANGE VALUES PRIVATE EXPERIENCE
Implications Individual Session Cognitive restructuring strategies are replaced by: • Mindfulness of thoughts, rules and stories – is this the 1st time you’ve ever had that thought • Willingness to experience this thought as just that, a thought rather than whatever it may say it is (acceptance) – is it ok to have that thought given that it’s here? • Functional assessment of thoughts and stories is carried out in the context of their commitment to a valued direction in life • Workability of buying thoughts (short & long-term) is the measuring stick that helps inform choices
Private Experience Lots of questions about it…exposure Is it ok to have that thought…. As a thought not as what it says it is? If not, more questions…. About workability, about the thought(s) in a different context….but its always the SAME thought!
DBT & Values • In it’s original DBT proposes “life worth living” as a direction for movement…in treatment and in life… AND • No definition or process is identified for defining what “life worth living” means…
Values on an individual basis • Utilizing the Values Living Questionnaire, Values compass or Bulls eye to assess the direction that people want to give to their lives • An anchor for commitment: conversation to be had as part of pre-treatment; beginning to define the areas that are meaningful and the directions that people would like their lives to take
ACBS Values assessment tools Developed by T. Lundgren &J.A. Dahl
….and Skills Training • Skill training modules renamed to reflect an acceptance/ongoing life process instead of a if/then contingency • Cognitive restructuring strategies have been removed from all handouts & replaced with acceptance/mindfulness consistent interventions… • extended mindfulness practice • Valued Living has been added to Emotion Regulation Skill Area to help extend existing behavioral activation exercises and provide an anchor/purpose to skill use
Skills Training • Living in the Present (Mindfulness) • Goal - to develop an unattached awareness of experience. It is training in perspective-taking. • Participants are taught that one cannot control thoughts and feelings. They can only control what they attend to. • Learn to be open to all things and focus only on one thing. • Learn to differentiate between being lost in experience and being present in an experience. • Learn to recognize and practice choosing in the gap between an urge and the action typically associated with it.
Skills Training • Living with Distress (Distress Tolerance) • Considered more active forms of mindfulness. • The DT activity becomes the focus of attention. • Participants are taught to take their distressing thoughts and feelings with them as they engage in a DT skill. • Learn to re-contextualizing experience. • Learn to attend to the process of experiencing rather than continuously evaluating the experience.
Skills Training • Living with Emotions (Emotion Regulation) • Emotions are adaptive • Emotion is an early brain form of communication • Emotion is where your language and body meet • An emotion is an indicator of a specific way in which you need to take care of yourself • Skills emphasize practice identifying emotion and lesson it is attempting to convey • Identifying language that would help direct you towards actions that would make certain emotions more present e.g. meaning driven behavioral activation/exposure
Skills Training • Living with Others • To live meaningfully will involve other people • Practice observing your limits while honoring the limits of others • Being fully present non-judgmentally, validating one’s emotions and perceptions and communicating honestly • Practice making requests and saying “no”