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96074 exam > DBT > Flashcards

DBT Flashcards

1
Q

What are some of the biological vulnerabilities of BPD?

A
  • Higher emotional sensitivity to triggers
  • Higher intensity of emotional reactions
  • Slower return to baseline
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2
Q

What are the common aspects of an invalidating environment that contribute to BPD?

A
  • Telling the child their expressions aren’t true reflections of their emotions
  • Telling the child their expressions aren’t valid given the situation
  • Intermittent reinforcement of extreme emotional expressions
  • Over-simplification of problem-solving
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3
Q

What is the dialectical philosophy underpinning DBT?

A
  • Firstly, it refers to how we understand things by comprehending their polar opposites (e.g., when know light because of darkness)
  • Dialectics posits a worldview of wholeness. There’s not one single objective truth, but a piece of truth in each opposing force
  • DBT teaches clients to hold a point of tension between seemingly opposing views. E.g., “I need to learn to help myself” and “It’s okay to ask for help sometimes”, “My therapist accepts me” and “She is suggesting behaviours I might want to change”. This hopefully leads to a reduction in polarised thoughts and behaviours
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4
Q

What are the 4 stages of ‘phased treatment planning’ in DBT?

A
  1. Stabilisation - address high risk/life-threatening behaviours
  2. Re-processing - is there ‘quiet desperation’ due to past trauma. Shift from emotional inhibition to emotional experiencing.
  3. Everyday living - treat mild axis I disorders, increase mastery, live by values, increase quality of life
  4. Finding meaning - develop greater sense of meaning and purpose, more integrated self, increased capacity for joy and freedom
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5
Q

What are the 4 levels of the DBT house of treatment?

A

Level 1 - Getting in control (stabilisation)
Level 2 - Getting in touch (emotional experiencing, re-processing)
Level 3 - Getting a life (fixing problems in living)
Level 4 - Sustained joy, peak experiences, expand awareness, spiritual fulfilment

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6
Q

How are dialectical phrases typically constructed?

A

Replacing ‘but’ with ‘and’

E.g., “I can have my opinion and sometimes make mistakes”

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7
Q

What are the 4 groups of DBT skills?

A
  • Mindfulness
  • Distress tolerance
  • Emotion regulation
  • Interpersonal effectiveness
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8
Q

What are the 3 ‘how’ skills of DBT mindfulness?

A

1) Non-judgmentally
2) One-mindfully (one thing at a time, let go of distractions, focus on the mind)
3) Effectively (focus on what works, not doing it perfectly)

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9
Q

What are the 3 ‘what’ skills of DBT mindfulness?

A

1) Observe
2) Describe
3) Participate (throwing yourself in, letting go)

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10
Q

What are the 3 components of the wise mind exercise?

A
  • Rational mind
  • Emotional mind
  • Wise mind
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11
Q

What information is included in a DBT diary card?

A
  • Emotion rating
  • Target behaviours to reduce (urge to act 0-5, acted Y/N)
  • Skilfulness (used skills 0-5)
  • Urge to quit therapy
  • Urge to commit suicide
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12
Q

What are some of the reasons that motivated Linehan to create DBT?

A
  • She noticed emotion dysregulation was often at the core of various emotional difficulties
  • With CBT, clients often felt invalidated having their thoughts challenged
  • They also tended to have greater emotional vulnerability, reacted more strongly to stressors, and took longer to calm down
  • She wanted DBT to be more validating and accepting
  • The goal was to try and keep clients engaged in therapy while teaching them how to regulate their emotions
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13
Q

What are the 3 dialectical dilemmas in DBT?

A
  • Acceptance-based AND change-based
  • Suicidal behaviour is problem-solving AND a problem
  • BPD is an emotional regulation disorder AND BPD behaviours often function to regulate emotions
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14
Q

What are some explicit client assumptions of a DBT group?

A
  • Clients are doing the best they can
  • Clients need to try harder and do better
  • Clients may not have caused their own problems
  • Clients need to learn to solve their own problems
  • Understanding and changing the cause of a behaviour works better than judging and blaming
  • Client’s lives are unbearable as they’re currently being lived
  • Clients want to get better
  • Clients cannot fail DBT
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15
Q

What are some explicit assumptions about DBT therapists?

A
  • The therapeutic relationship is real and genuine between individuals
  • Behavioural principles are universal and apply to therapists as well as clients
  • Clarity, precision, and compassion are of the upmost importance
  • The best a DBT therapist can do is help clients change in ways that bring them more in line with their values and goals
  • DBT therapists can fail
  • DBT can fail even when therapists do not
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16
Q

What are the 3 goals of DBT 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

17
Q

What are the 3 distress tolerance skills covered in the lectures?

A

Crisis survival skills - TIPP and (distract with) ACCEPTS

Radical acceptance

18
Q

What is TIPP?

A

Temperature - when overwhelmed, cold temperature can decrease HR, dive reflex (e.g., splash cold water on face, cold shower). When depressed, hot temperature can increase HR (e.g., warm bath, walk in the sun)
Intense exercise - can expend energy from overwhelming emotions
Paced breathing - slower breathing decreases physiological arousal
PMR - release muscle tension, built-up energy, and decrease physiological arousal

19
Q

What is ACCEPTS?

A 
Activities
Contribute
Compassion
Emotions
Push away
Thoughts
Sensations
20
Q

Explain the difference between distress tolerance and avoidance

A
  • The individual needs to build their distress tolerance ability before they can address the true avoidance in their life
  • DT serves as an intermediary between a complete inability to tolerate emotions and being able to fully face them.
  • Avoidance would be completely running from the emotional experience altogether, or acting on it in a harmful way
21
Q

How might you respond to a client’s acute risk behaviour?

A
  • Engage crisis services
  • Contact next of kind
  • Refer to a Crisis Mental Health Team
  • Take the client to ED
  • Call ambulance
  • Call police
22
Q

When teaching (DBT) clients new skills, what things do you need to do?

A
  • Orient them to the skill
  • Practice in-session
  • Troubleshoot the skill together
  • Pair the skill with a reminder/cue
  • Link skill to long-term goals
  • Follow-up, monitor, review, further troubleshoot
23
Q

What are the emotion regulation skills covered in the DBT lectures?

A
  • Model of emotions
  • Function of emotions
  • Opposite-to-emotion action (+ levels of validation)
  • Chain analyses
24
Q

What are three functions of emotions?

A
  • Motivate behaviour (evolutionary advantage)
  • Communicate to others
  • Communicate with yourself
25
Q

Break down the ER skill ‘model of emotions’

A
  • Vulnerability factors
  • Prompting event
  • Internal/biological changes (physical sensations, feelings, urges)
  • External changes/expressions (face/body language, words, actions)
  • Emotion name
  • After effects (secondary emotions, further behaviour, consequences)
26
Q

When should a client try to use opposite-to-emotion action?

A

When the emotion doesn’t fit the facts (emphasis opposite action, not opposite emotion. It’s still okay to feel the emotion)

27
Q

What are the 6 levels of validation? Give examples

A

Level 1: Be present (be attentive, actively listen)
Level 2: Paraphrase accurately (“I’m hearing you say you’re anxious about your first day of work”)
Level 3: Guess at the emotion (“I imagine you felt hurt when your partner said that”)
Level 4: Validate based on past history (Given that your dad used to take off with no notice when you were young, I can understand why you started to feel anxious when you hadn’t heard from your boyfriend all morning”)
Level 5: Normalise (“I think anyone would feel afraid if they were threatened like that”)
Level 6: Radical genuineness - communicating as real, no therapist persona

28
Q

What are the rules when validating?

A
  • Try to use the highest level of validation you can, but never validate the invalid
  • Connect before you correct
29
Q

What are some tips for doing chain analyses?

A
  • Do one every time a high risk behaviour occurs
  • Break down the minutiae of the situation
  • Do it over and over again for the same situation if needed
  • Identify long-term consequences
  • Discuss options for reducing further vulnerability
  • Identify the different (DBT) skills they could have used in each part of the situation
  • Discuss whether there’s anything that can be done to repair the situation
30
Q

What is DBT consult team not?

A
  • Supervision
  • Case review
  • Optional
  • Hierarchical
31
Q

What are some of the purposes of DBT consult team?

A
  • Enhances therapists’ capabilities
  • Enhance therapists’ motivation
  • Putting yourself, rather than the client, on the table
  • Identifying your therapy-interfering behaviours
  • Offer support when a team member’s limits are stretched
  • Increase the team’s adherence to DBT principles
  • Monitor and address problems that arise in the course of treatment delivery
32
Q

What are some possible therapy-interfering behaviours on the part of the client?

A
  • Behaviours that interfere with receiving therapy - non-compliance, non-attendance, non-collaboration
  • Behaviours that interfere with other clients - prevent learning, encourage unskilfull behaviour
  • Behaviours that burn out the therapist - limit-testing, attacks
33
Q

What are some possible therapy-interfering behaviours on the part of the therapist?

A
  • Behaviours that interfere with therapy balance - non-dialectical stance on acceptance, change, rigidity, flexibility, vulnerability
34
Q

What the 3 goals of interpersonal effectiveness training (IE)?

A

1) Assertiveness skills - Ask skilfully for what I need, or say ‘no’ to a request
2) Relationship skills - Initiate and maintain good relationships
3) Self-respect skills

35
Q

Breakdown DEARMAN

A
  • Describe the situation using only the facts
  • Express how you feel using ‘I’ statements
  • Assert what you want
  • Reinforce the benefits for you and them
  • Stay Mindful
  • Act confident
  • Negotiate if necessary

96074 exam (6 decks)

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