NAMIIllinoisStateConference

October16,2009

FredaBFriedmanPhD,LCSW,RN,CS

o ComponentsofDBT
Developingtheabilitytothinkdialectically
Mindfulness
Skillstrainingindividuallyandingroups
Supportfortherapist,forfamily
o HelpingfamiliestoapplyDBTintheirinteractionswith

lovedones
o Currentresearchfindingsandapplications
o Resourcesforinformation,referralsandtraining

FundamentalsofDBT
DBTistargetedatclientswithemotionalvulnerability
andpoorabilitytomodulatestrongemotions.
Vulnerability:
a. Veryhighsensitivitytoemotionalstimuli
b. Veryintenseresponsetoemotionalstimuli
c. Aslowreturntoemotionalbaselinefollowing
emotionalarousal.

FundamentalsofDBT cont.
Emotionmodulation abilityto...
Inhibitinappropriatebehaviorrelatedtostrong
emotions[+or]
Organizeoneselfforcoordinatedactioninserviceof
anexternalgoal
Selfsoothephysiologicalarousal
Refocusattentioninthepresenceofstrongemotion

FundamentalsofDBT cont.
Fourareasareemphasized:
Acceptanceandvalidationofbehaviorasitisinthe
moment
Treatingtherapyinterferingbehaviorsofbothclient
andtherapist
Theassumptionthatthetherapeuticrelationshipis
essentialtothetreatment
Dialecticprocess[persuasivedialogue,focusonreality].

UnderstandingDialectics
ThetermDialecticsreferstoopposingforcesthat
createawholeorsynthesis.DBTfocusesonfindinga
balanceinopposingforces.
Opposingforcesneedingabalancecanbefoundin
manythingsallaroundus,forexample:
thesunandthemoon
theseasons

GoalsofDBT
Decrease
(and)blockdysfunctionalresponses[thatallowescape]
Reinforceoppositeaction[approach]
Increase
DBTskills
Secondarytargets
Qualityoflifebehaviors
Buildconfidence
Buildmotivationtocreatealifeworthliving

SomecoredifferencesbetweenDBTandCBT
CBT

DBT

Focusonchange

Dialecticofacceptanceand
change

Exposuretodistress

Exposuretodistresswith
acceptanceofdistress

Problemfocus:specific

Problemfocus:broad,
inclusiveanduseof
hierarchy

Dialecticsofcontinuouslybalancingandintegrating

AcceptanceandChange
Acceptancebasedstrategies:
Validation
DistressTolerance
Changebasedstrategies:
Oppositeaction
SomeDBTskills

ComponentsofDBTTreatment

Skillstrainingandapplicationinindividualtherapy
andingroups

Developingabilitytothinkdialectically

Mindfulness

Supportandconsultationforthetherapist,forthe
teamand[whenappropriate]forthefamily

SkillsTrainingModules
1.

CoreMindfulness[focusingskills]

2. DistressTolerance[crisissurvivalskills]
3. EmotionRegulation[deescalationskills]
4. InterpersonalEffectiveness[peopleskills]

Module1:Mindfulness
Mindfulness
...isnotamatterofexplainingandsolving,butof
experiencinganddescribing.

Everythingbeginswithlucidindifference.
AlbertCamus

Whatismindfulness?
AwarenessplusAcceptanceofthecurrentmoment
Focusingononething,inthatmoment,without

judgment
Theabilitytohaveawarenessofonessensoryand
cognitiveexperience
Theabilitytodiscernemotions,
verbaldescriptionsofevents,
appraisalsandjudgmentsofevents,
memories,perceptionsofeventsfromeachother

Andmore

Reasonable
Mind

Wise
Mind
Emotion
Mind

PracticingMindfulness
Observe[justnotice]
Describe[putwordstoanexperience]
Participate[beinvolvedinwhatyouredoing]
Learnhowtonoticewithoutnecessarilyreacting
Distinguishbetweenthoughtsandfacts
Bringnonjudgment[neithergoodnorbad]
Beonemindful[inthemoment]
Beeffective[focusonwhatworks]

MindfulnessSummary

Youcanusetheseskillsto
recenter,
calmyourself,
betterunderstandyouremotions,
reflect,ortrainyourbraintostayinthepresent.

MindfulnessSummary cont.
Youcansitwithyouranxietyinsteadofpushingit
away,and
observeyourthoughts;
listentoyourself;
acknowledgeyourfears,orapprehensions...

Inpracticingtheseskills,youcan
avoidgettingcaughtupinpowerstruggleswith
another
avoidtakingthingspersonally
listenmorefullyandunderstandothers...

DistressToleranceSkills
CrisisSurvivalStrategies
GuidelinesforAcceptingReality

CrisisSurvivalStrategies
DistractswithWiseMind ACCEPTS
Activities
Contributing
Comparisons
Emotions
Pushingaway
Thoughts
Sensations

SelfSooththeFIVESENSES
Vision
Hearing
Smell
Taste
Touch

ProsandConsofDistressTolerance
Tolerating

NotTolerating

Moreeffectiveinlongrun

Easierinshortrun

Harderinshortrun

Createsmoreproblemsin
longrun

GuidelinesforAcceptingReality
Observingyourbreath
Halfsmiling
Awareness
RadicalAcceptance
Turningthemind
Willingness

HowFamiliesCanHelp*
1.

2.
3.
4.
5.
6.
7.

Rememberthatchangeisdifficulttoachieveand
fraughtwithfears.Becautiousaboutsuggesting
thatgreatprogress hasbeenmade.
Progressevokesfearsofabandonment.
Loweryourexpectations
Setrealisticgoalsthatareattainable.
Workononethingatatime.
Keepthingscoolandcalm.
Expressappreciationandvalidation

HowFamiliesCanHelp cont.
8. Maintainfamilyroutines.Theresmoretolifethan
problems,sodontgiveupthegoodtimes.
9. Findtimetotalkaboutlightorneutralmatters.
10. Managingcrisis:Payattention,butstaycalm.
11. Selfdestructiveactsorthreatsrequireattention.
Dontignore.Dontpanic.
12. ALWAYSinvolvefamilymemberinproblem
solving.
13. Beconsistentenough.

HowFamiliesCanHelp cont.
14. Shareconcernsaboutmedicationsortherapist
interventions.Ifyouhavefinancialresponsibility,you
havetherighttoaddressyourconcernstotherapistor
doctor.
15. Setlimits,butbecarefulanddirect.
16. Donotprotectfamilymemberfromnatural
consequencesoftheiractions.
17. Donottolerateabusivetreatment.
18. Becautiousaboutthreatsandultimatums.Theyarea
lastresort.
*FromMultipleFamilyGroupProgram,McLeanHospital,Harvard
University:JohnGunderson,MDandCynthiaBerkowitz,MD.

ResearchonDBT

Controlledstudiesshowthat
ThecostofDBTisapproximately50%oftreatmentat
usual[TAU]
Significantlyfewerinpatientdays
Fewerandlesssevereselfharmbehaviors

ResearchonDBT cont.
Sevenwellcontrolledrandomizedclinicaltrialswith
varyingresearchteamshaveestablishedDBTasa
validandeffectivetreatmentforBorderline
PersonalityDisorder.
DBThashadseveralcontrolledstudiesshowing
effectivenessintreatmentof
Eatingdisorders
Substanceabusedisorders
Depressedolderadults
Otherpersonalitydisorders

ResourcesandReferences
TARANAPD(TreatmentandResearchAdvancementNational
AssociationforPersonalityDisorder). www.tara4bpd.org
NationalEducationAllianceforBPD(NEABPD)
www.borderlinepersonalitydisorder.com
BehavioralTechLLC www.behavioraltech.org
FrequentlyAskedQuestionsaboutDBT &DBTataGlance
www.BPDCentral.com
Mindfulness:www.dbtselfhelp.com