DBT Flashcards
1
Q
What is the BioSocial Model of BPD?
A
- Characterises BPD as a pervasive emotion dysregulation, characterised by high reactivity and slow return to baseline. Arising from the combination of:
-
Biological Vulnerability:
- Sensitivity to triggers
- Intensity of reactivity
- Slow return to baseline
-
Invalidating Environment:
- Intolerance of expression of private emotional experiences
- Intermittent reinforcement of extreme expressions of emotion
- Over-simplification of problems
2
Q
What is the Transactional Model of BPD?
A
3
Q
What are the four stages of the DBT house on fire?
A
-
Stabilisation:
- Problems: Severe behavioural dyscontrol, life-threatening or self-destructive behaviours.
- Treatment Goals: Shift behaviours to being under the client’s behavioural control using commitment and skills
-
Re-Processing:
- Problems: Sense of ‘quiet desperation’, ongoing suffering from past trauma and invalidation, moderate to severe axis 1 disorders, shame, anger, interpersonal deficits.
- Treatment Goals: shift client from emotion inhibition to non-anguished emotional experience. Exposure, PTSD work, cognitive restructuring, interpersonal skills.
-
Everyday Living
- Problems: General problems in everyday living, mild axis 1 disorders,
- Treatment Goals: Building sense of mastery, identifying and living by values, ordinary happiness and unhappiness.
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Finding Meaning
- Problems: Lack of deeper meaning, sense of incompleteness.
- Treatment Goals: Shift towards intergrated experience of self, experiencing ‘flow’ activities, capacity for joy and freedom
4
Q
What are the five main functions in a comprehensive DBT program?
A
5
Q
What is the dialectics skill?
A
- Problem: Clients often think by oscillating in mutually exclusive extremes (I am right, I can’t get anything right)
- Dialectic Skill = learning to use “and” rather than “but” (eg. I can have my opinion and still make mistakes)
- Learning goals:
- How to drop the rope (tug of war metaphor), get unstuck from conflict and standoffs
- There can be truth to both sides
- Developing flexibility, letting go of black and white thinking.
6
Q
What is Mindfulness in DBT?
A
- Mindfulness = the act of consciously focusing the mind in the present moment without judgement and without attachment to the moment.
-
Skills:
- Wise Mind: Sitting between the emotional mind and the reasonable/rational mind. The wise mind is a balance of intellectual decisions and respect/care for feelings.
- “What”: Observe (cultivate a teflon mind, control attention not content), Describe, Participate
- “How”: Non-judgementally (opinion vs fact), One Mindfully (one thing at a time), Effectively (focus on what works).
7
Q
What are the purposes of the DBT Diary Card?
A
- Track target behaviours that clients are trying to decrease
- Track skills that clients are trying to increase
- A reminder to practice skills already learned and not just new ones
- A reminder to practice skills everyday
- Increase ability to self-identify emotions and urges
- Exposure to sitting with and identifying emotions
- A way to track progress over time
8
Q
What are three key dialectical dilemmas in DBT?
A
9
Q
What are some explicit assumptions of DBT group?
A
- Client Assumptions
- Clients are doing the best they can but need to try harder and do better.
- Clients may not have caused their own problems but need to learn to solve their own problems.
- Understanding and changing the cause of any particular behavior works better than judging
and blaming. - The lives of clients are unbearable as they are currently being lived.
- Clients want to improve.
- Clients cannot fail DBT
- Therapist Assumptions
- The therapeutic relationship is a real and genuine relationship between equals.
- Principles of behavior are universal and affect therapists as well as clients.
- Clarity, precision, and compassion are of the utmost importance.
- Care is helping clients change in ways that bring them closer to their values and goals.
- DBT therapists can fail.
- DBT can fail even when therapists do not.
10
Q
What are the three goals of distress tolerance?
A
1) Survive a crisis without making it worse
2) Accept reality to reduce being ‘stuck’ and open to moving forward
3) Become free of acting unhelpfully on urges and intense emotions
11
Q
What are some DBT Crisis Survival Skills?
A
- STOP
- Pros and Cons
- TIPP: Temperature (cold to decrease heartrate, hot to increase), Intense exercise, Paced breathing, Progressive muscle relaxation
- Distract with ACCEPTS: Activities, Contribute, Comparison, Emotions, Push away, Thoughts, Sensations
- Self-soothe
- IMPROVE the moment
12
Q
What is radical acceptance?
A
- The concept that Suffering = Pain + Non-Acceptance
- Acceptance =
- Accepting reality how it is and letting go of “should be”
- Does not mean you need to approve of how things are
- Active and Effective, rather than resignation which is passive/noneffective
- Requires a choice and commitment to repeat acceptance again and again
13
Q
How would DBT go about chronic risk management?
A
-
Sequence/plot out the risk event
- Vulnerability –> Event –> Thought –> Emotion –> Urge –> Behaviour
- Repeat until end of sequence (short term consequence)
- Identify the problem the client is trying to solve
-
Collaboratively develop
- Antecedent strategies (prevent escalation of distress)
- Target Behaviour strategies (replace target behaviour)
- Contingency strategies (reinforce skill and extinguish old beh) Why would the client choose the new solution over the old one?
- Practice new skills in session, troubleshoot, and pair with a reminder cue
14
Q
What is the DBT model of emotions?
A
15
Q
What functions do emotions have in the DBT model?
A
(1) Emotion communicate to (and influence) others
(2) Emotions organise and motivate behaviour
(3) Emotions communicate to ourselves (and can be self validating)
e.g. sad –> urge to withdraw, connect, cry –> function to rest, heal, elicit re-connection
