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Dialectical Behavior Therapy: A Treatment Option for Persons Living with Borderline Personality Disorder

Dialectical Behavior Therapy: A Treatment Option for Persons Living with Borderline Personality Disorder. Presented by: Jennifer Baran-Prall, LCSW October 13, 2004. Goals of this presentation: . Present symptoms targeted with DBT Overview of DBT Theory Review DBT skills and modules

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Dialectical Behavior Therapy: A Treatment Option for Persons Living with Borderline Personality Disorder

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  1. Dialectical Behavior Therapy: A Treatment Option for Persons Living with Borderline Personality Disorder Presented by: Jennifer Baran-Prall, LCSW October 13, 2004

  2. Goals of this presentation: Present symptoms targeted with DBT Overview of DBT Theory Review DBT skills and modules Discuss resources for DBT treatment

  3. Dialectical Behavior Therapy Developed by Marsha Linehan, Ph.D. • Skills Training Manual for Treating Borderline Personality Disorder • Cognitive-Behavioral Treatment of Borderline Personality Disorder

  4. Borderline Personality DisorderDSM IV-TR • Frantic efforts to avoid real or imagined abandonment • Pattern of unstable and intense interpersonal relationships (valuing and devaluing) • Identity disturbance, unstable self image • Impulsivity that is self damaging • Recurrent suicidal behavior, gestures or threats, or self mutilating behavior

  5. BPD cont. • Affective instability due to a marked reactivity of mood • Feelings of emptiness • Inappropriate, intense anger • Transient, stress-related paranoid ideation or severe dissociative symptoms

  6. DBT is designed to treat: • Multi-diagnostic • Severe and chronic • Ineffective coping skills

  7. Why use DBT? • Significantly reduced self-harm behaviors and self-harm urges • Fewer psychiatric hospitalizations • Decreased feelings of depression, hopelessness, anger • More likely to stay and complete treatment

  8. A Definition of Dialectics “…debate intended to resolve a conflict between two contradictory or apparently contradictory ideas or elements logically, establishing truths on both sides rather than disproving one argument.” Encarta World Dictionary, 1993-2003

  9. Dialectics as Applied to Behavior Therapy • Interrelatedness or wholeness of reality • Reality not seen as static but as comprised of internal opposing forces • The nature of reality is change and process rather than content or structure • “Another side to every story”

  10. Biosocial Theory of Borderline Personality Disorder • Biological Sensitivity • Invalidating Environment • Emotion Dysregulation

  11. DBT Intervenes Balance of Acceptance and Change • Regulate emotions and reduce vulnerability to cues • Teach new skills and improve problem solving abilities • Tolerate distress • Avoid or distract in a healthy way

  12. How is DBT different than Cognitive Behavioral Therapy? • Focus on acceptance and validation • Emphasis on treating therapy interfering behaviors • Emphasis on the therapeutic relationship as essential to treatment • Focus on the dialectical processes

  13. Treatment Program • DBT Skills Training Group • Individual therapy • Phone coaching/consultation • Emphasis on ongoing assessment and data collection- Diary Cards • Clear and precise treatment goals • Collaborative working relationship between therapist and consumer

  14. Treatment Program Settings • Psychiatric In-patient groups • Consult Liaison- Emergency Department

  15. DBT Skills Training Group • Group meets weekly • Structured like taking a class: one hour devoted to reviewing homework one hour focused on learning a new skill • Groups are no larger than 10 people • Six month treatment cycle • Two facilitators

  16. Targets for DBT Skills Group • Teach skillful behavior to replace problem behavior Behaviors to increase: Interpersonal Skills Emotion Regulation Skills Distress Tolerance Skills Core Mindfulness Skills

  17. Interpersonal Effectiveness SkillsGoals: • Getting your objectives or goals in a situation • Getting or keeping a good relationship • Keeping or improving self-respect and liking yourself

  18. Emotion Regulation SkillsGoals: • Understand emotions you experience • Reduce emotional vulnerability • Decrease emotional suffering

  19. Distress Tolerance SkillsGoals: • Crisis survival strategies • Guidelines for accepting reality • So as to reduce: Impulsive behaviors Suicide threats Self harm

  20. Mindfulness • Learning to be in control of your own mind, instead of letting your mind be in control of you. States of Mind: Reasonable Mind Emotional Mind Wise Mind

  21. “What” Skills Observe Describe Participate “How” Skills Non-judgmentally One mindfully Effectively Mindfulness:Taking hold of your mind

  22. DBT Resources • The Behavioral Technology Transfer Group www.behavioraltech.com • Talk with your therapist or psychiatrist

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