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Dialectical Theory
Facilitator: Dr. Dawn-Elise Snipes

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~    The Basics of DBT
~    The B in DBT: What You Need to Know About Behavior
~    Mindfulness
~    Reducing Emotional Reactivity
~    Distress Tolerance Skills
~    What Clients Need to Know About Emotions
~    Regulating Painful
~    Increasing Positive
~    Helping Clients Become More Effective In Relationships
The Clients
~    Emotional Vulnerability
~    React to things others wouldn’t react to
~    Reaction is more intense than others
~    Recovery time is longer than for others
~    Inability to Regulate Emotion
~    Difficulty identifying/labeling emotions
~    Difficulty understanding why they feel that way
~    Difficulty expressing the emotion in an effective way
Dialectical Theory
~    Everything is interconnected (Action/reaction)
~    Examine examples of action/reaction
~    Addiction
~    Anger
~    Depression
~    Social Interactions
~    Reality is in a constant process of change
~    How you perceive something now may be different than how you perceive it in an hour?
~    What changes perceptions?
~    What does the emotional mind say? The reasonable mind? The wise mind?

Dialectical Theory
~    The truth (always evolving) can be found by integrating multiple perspectives, and tolerating that two opposite things may co-exist
~    Simultaneous (understanding things differently by taking multiple people’s perspectives of the same event)
~    Example: Crime scene
~    Example: Interpersonal disagreement
~    Longitudinal (understanding things differently as knowledge is gained)
~    Example:  Mommy had no use for us and that is why she left.
~    Example: Mommy loves me, but she beats me, so I must be bad.

Skills Training Groups
~    Core Mindfulness
~    Increase self-awareness of thoughts, feelings and urges
~    Develop an understanding of emotions as things that do not have to be acted upon
~    Interpersonal Effectiveness
~    Develop assertiveness skills
~    Identify the goals of relationships and skills/activities needed to achieve those goals
Skills Training Groups
~    Emotion Regulation Skills
~    Label and effectively communicate feeling states
~    Understand the function of emotions and why we don’t want to eliminate them
~    Learn the connection between thoughts, feelings and behaviors and how to break the chain
~    Distress Tolerance Skills
~    Survival skills/alternatives to self-harm

DBT Assumptions
~    Clients are doing their best
~    They want to get better
~    They need to work harder/smarter and be more motivated
~    Even if clients didn’t create their problems, they have to fix them
~    Clients need to learn to act skillfully in EVERY area of their lives
~    Clients cannot fail in therapy
Treatment Priorities in DBT
~    Suicidal or self-harming behaviors
~    Behaviors that interfere with therapy (including clinician)
~    Suicidal or self-harm ideation and misery
~    Maintaining treatment gains
~    Other goals identified by the client

Emotion Regulation
Interpersonal Effectiveness
Distress Tolerance
Stages of Treatment
~    Stage 1: Attaining Basic Capacities
~    Identify behaviors that pose a direct threat to the clients (or other’s) safety
~    Monitor the frequency, intensity of behaviors using a Behavior Tracking Form
~    Address
~    Suicidal/self-harming behaviors
~     Behaviors that interfere with therapy
~¬†¬† ¬†Suicidal ideation and ‚Äúmisery‚ÄĚ
~    Maintaining treatment gains
~    Client initiated goals
Stages cont…
~    Stage 2 Reducing Traumatic Stress
~    Subgoals
~    Negative relationships experiences related to emotional dysregulation
~    Lack of interpersonal skills
~    Stage 3 Increasing Self-Respect and Achieving Individual Goals
The ‚ÄúB‚ÄĚ in DBT
~¬†¬† ¬†Benefits–Positive and Negative Reinforcement
~¬†¬† ¬†Punishment ‚Äď Positive and Negative
~    Consequences
~    Negative
~    Positive
~    Neutral
~    Intermittent reinforcement (variable interval or ratio)
~    Modeling
The B In DBT
~    Reinforcers: Increase the likelihood of a behavior
~    Punishments: Reduce the likelihood of a behavior
~    Vulnerabilities: Increase the likelihood of fight or flight responding
~    Backward Chaining
~    Outburst Co-Worker said something insensitive  Felt drained upon awakening Had to put cat down the day before
The B In DBT
~    Triggers (+/-)
~    Cause a reaction
~    Remind the person of a prior situation in which a behavior was:
~¬†¬† ¬†Rewarded‚ÄĒLashing out makes gave client control
~¬†¬† ¬†Punished‚Äď Lashing out did no good increasing client‚Äôs sense of helplessness
~    Communicate to the person there is a threat
~    Prompt feelings of wellbeing

The ‚ÄúB‚ÄĚ in DBT
~    Shaping
~¬†¬† ¬†Rewarding/reinforcing ‚Äúsuccessive approximations‚ÄĚ
~    Example: Anger
~    Level 1: Not throwing things or being physically aggressive
~    Level 2: Disengaging until the urge to be verbally or physically aggressive was gone
~    Level 3: Being able to calmly discuss issues/problems

The ‚ÄúB‚ÄĚ in DBT
~    Shaping
~    Example: Addiction or other self-harm
~    Level 1: Engaging in secondary coping behavior (smoking, walking, eating, listening to music, drawing)
~    Level 2: Taking a mindfulness minute to evaluate the situation, then choosing a behavior consistent with goals

~    Developing an in-the-moment awareness of how you are:
~    Emotionally
~    Mentally
~    Physically
~    Exploring the interconnection of thoughts, feelings and physical sensations
~    Distress in one leads to distress in others
~    Becoming aware of the emotional wave

Reducing Emotional Reactivity
~    Reduce Vulnerability: (Please)
~    P & L Treat Physical Illness
~    Eating
~    Altering Drugs
~    Sleep
~    Exercise
~    Build Positive experiences
~    Be mindful of current emotion

Distress Tolerance
~    Activities: Do hobbies, watch a video, go for a walk
~    Contribute. Do volunteer work
~    Compare yourself to people coping the same as or less well than you
~    Emotions. Distract with opposite (i.e. Comedy)
~    Push away a distressing situation by leaving it mentally for awhile.
~    Thoughts. Think about something else (Puzzles, book)
~    Sensations. Distract with intense sensations

What Clients Need To Know About Emotions
~    Increasing the Positive
~    Decreasing the Negative
Interpersonal Effectiveness
~    Assertiveness
~    Distress tolerance
~    Emotion identification and communication
~    Understanding
~    Your needs
~    The needs of others
~    Exploring situations using dialectical theory

Interpersonal Effectiveness
~    DEARMAN РGetting what we want/need:
~    Describe our situation.
~    Express why this is an issue or need and how we feel about it.
~    Assert: Sharing clearly what we feel and asking directly for what we want/need.
~    Reinforce our position by offering a positive outcome (win/win)
~    Mindful focusing on what we are requesting
~    Appear Confident
~    Negotiate
~    DBT is a great tool to help clients
~    Become more aware of emotions
~    Identify the thoughts, feelings and urges associated with emotions
~    Develop a greater sense of self-awareness regarding
~    The whys of emotions
~    Vulnerabilities which make them more likely to be emotionally reactive or sensitive
~    Provide a framework for teaching skills groups that benefit an array of clients who have difficulty with emotionality.