DBT Made Simple Flashcards
(99 cards)
1
Q
The Reasoning Self
A
The part of ourselves that we use when we’re thinking logically or reasoning something out.
2
Q
Puppies
A
The client’s mind is the puppy, and mindfulness is how she will train her mind to sit and stay.
3
Q
Emotional Vulnerability
A
Refers to a biological predisposition or temperament where an individual is born more emotionally sensitive than most people. These individuals have a tendency to react emotionally to things that others wouldn’t typically react to.
4
Q
Distress Tolerance:
Reality Acceptance
A
Radical acceptance
- everything is as it should be. - acceptance is acknowledging what it is.
5
Q
Core Mindfulness Skills
A
The aim of mindfulness is to reduce confusion about the self, but mindfulness is also helpful in many other ways. Increasing self-awareness helps clients become aware of their thoughts, emotions, and urges and gradually learn to manage them more effectively.
6
Q
Distress Tolerance:
I.M.P.R.O.V.E. The moment
A
I - imagine very relaxing scenes M - find/create meaning in the pain P - open your heart to god R - muscle tension / relax then O - one thing in the moment —> mindfulness V - a brief vacation E - Encouragement —> cheer lead yourself
7
Q
Communication Styles
A
DBT makes use of two specific styles for communication:
- reciprocal
- irreverent
8
Q
Monkey Mind
A
The mind is often like a monkey: jumping around, constantly distracted and wandering, chattering about different things, and nearly impossible to quiet.
9
Q
Interpersonal Effectiveness:
D.E.A.R.M.A.N. Assertiveness
A
D - describe
E - express
A - assert
R - reinforce
M - mindful
A - appear confident
N - negotiate
10
Q
Contingency Management
A
Therapists must be aware of how their behavior is likely to affect specific clients so they don’t inadvertently reinforce unwanted behaviors or punish or neglect to reinforce desired behaviors.
11
Q
Core Mindfulness:
Non-judgmentally
A
- See, but DON’T EVALUATE
- unglue your opinions
12
Q
Self-involving self-disclosure
A
The therapist identifies her own internal reactions to the client, communicating them directly to the client.
13
Q
Solution Analysis
A
This form helps you and the client look at possible ways to prevent the behavior from happening again in the future.
14
Q
Stage 1: Attaining Basic Capacities
A
Focus on behaviors that are a threat to client’s safety and stability.
- behaviors that interfere with life.
- behaviors that interfere with therapy.
- behaviors that interfere with quality of life.
15
Q
Core Mindfulness:
Participate
A
Enter into your experiences
- become one with your experience, completely forgetting yourself.
16
Q
Selling Mindfulness to Client’s
A
- taking control of your mind
- improving emotional regulation
- increasing behavior control
- improving concentration and memory
- engaging in life
17
Q
Distress Tolerance:
Willing VS. Willful
A
Willingness is DOING JUST WHAT IS NEEDED.
Willingness is ALLOWING into awareness, your connection to the universe.
Willfulness is GIVING UP.
Willfulness is REFUSING TO TOLERATE the moment.
18
Q
DBT Stage One
A
Decreasing high-risk suicidal behaviors
19
Q
Observe
A
The goal of observing is to watch events, emotions, etc. without trying to rid yourself of pain or prolonging certain feelings.
20
Q
Distress Tolerance:
Turn the Mind
A
Acceptance of reality as it is requires an act of CHOICE.
21
Q
Six Different Levels or Validation
A
1) listening and observing
2) accurate reflection
3) articulating the unverbalized
4) validating in terms of sufficient causes
5) validating as reasonable in the moment
6) treating the person as valid-radical genuineness.
22
Q
Stage 3: Increasing Self-Respect and Achieving Individual Goals
A
The goal becomes helping clients work on trusting, valuing, and repeating themselves, as well as, continuing to work on generalizing the skills they’ve learned in therapy to the rest of life.
23
Q
Emotion Regulation:
P.L.E.A.S.E.
A
PL - treat physical illness E - balance eating —> don’t eat too much / little A - avoid mood altering drugs / alcohol S - balance sleep E - get exercise
24
Q
Dialectical Strategies
A
- Devil’s advocate
- use of metaphor
- making lemonade out of lemons
25
Invalidating Environment
As one in which there is a tendency to deny or respond unpredictably and inappropriately to the child’s private experiences, and especially to private experiences such as emotions, physical sensations, and thoughts, which aren’t accompanied by evidence to prove that this is, in fact, the child’s experience.
26
Examples of an Invalidating Environment
- the poor fit
- the chaotic home
- the abusive home
- other invalidating environment
27
Interpersonal Effectiveness:
| G.I.V.E. (how to keep relationships)
G - Gentle
I - Interested
V - Validate
E - Easy Manner
28
Interpersonal Effectiveness
- attending to relationships
- balance priorities VS. demands
- balance wants VS. shoulda
- build mastery and self-respect
- objective ness Effectiveness
- relationship Effectiveness
- self-respect Effectiveness
29
DBT Stage Two
Decreasing responses or behaviors (from the patient or therapist) that interfere with therapy.
30
Emotion Regulation ABC
A - accumulate positive emotions
B - Build Mastery
C - Cope ahead
31
Justified VS Unjustified Emotions
Justified - a reasonable or typical reaction
Unjustified - an over-reaction, misunderstanding
32
Transactional Model
It is important to emphasize that the biosocial theory is dialectical or transactional, meaning that interactions take place over time between the environment and the individual, gradually leading to their adaption to one another, and to the development of BPD.
33
DBT
Clients are taught to accept themselves as they are, and then they learn tools to help them change behaviors that are unhealthy or problematic in some way.
34
Intermittent Reinforcement
The positive or negative reinforcement occurs only occasionally, rather than every time the behavior takes place.
i.e. gambling
35
Consequences
Refers to the effect, result, or outcome of something that occurred earlier.
- negative consequences
- positive consequences
36
DBT Model
- core mindfulness skills
- interpersonal Effectiveness skills
- emotion regulation skills
- distress Tolerance skills
37
Positive Reinforcement
Something the person sees as positive that happens after he engages in a certain behavior.
- client wants 2x a week
—> you say no
- client attempts suicide
—> so you give in
38
9 Emotion Regulation Skills
1) recognizing emotions
2) overcoming barriers to healthy emotions
3) reducing physical vulnerability
4) reducing cognitive vulnerability
5) increasing your positive emotions
6) mindfulness of emotions
7) emotion exposure
8) opposite action
9) problem solving
39
Modeling
Demonstrating a behavior for someone else to imitate
40
Shaping
By reinforcing behaviors that are close to the desired behaviors, you can shape an individual’s behavior.
- angry punching stuff / people
—> punching bag
41
Emotion Regulation Skills
Self-validating is emphasized in this module, along with other skills to help clients manage their emotions more effectively. Clients are taught general information about emotions, such as why we need them and why we don’t want to get rid of them even though they can be quite painful at times.
42
What is the goal in DBT?
To create a life worth living.
43
Contingency
Refers to. Relationship between two events wherein if one event takes place, the other is more likely to occur.
44
Distress Tolerance:
| Self-soothe the 5 Senses
- vision
- hearing
- smell
- taste
- touch
45
DBT Stage Three
Decreasing behaviors that interfere with / reduce the quality of life
46
DBT Stage Four
Expanded awareness, enhancing respect for self, spiritual fulfillment, vision for life.
47
Emotion Regulation
Refers to the processes we use (unconsciously, consciously, or even perhaps with a tremendous amount of effort) to decrease, maintain, or increase an emotion or aspects of an emotion.
48
Distress Tolerance Skills
The goal is simply this: to help clients survive crises without making things worse by engaging in problem behaviors such as suicide attempts, self-harm, substance abuse, and so on. They help clients soothe and distract themselves from the problem rather than dwelling on it and eventually acting on the urges that accompany the painful emotions.
49
Core Mindfulness:
| Describe
- put words on the experience
| - put experiences into words
50
Reciprocal Communication
By definition, it is about sharing with the client: giving AND taking in the interaction, being warm and genuine, and treating the client as an equal.
51
What is mindfulness?
Doing one thing at a time, in the present moment, with your full attention, and with acceptance.
52
Reinforcement
- Positive reinforcement
- Negative reinforcement
- Intermittent reinforcement
53
Chain Analysis
The behavior analysis worksheet will help you and the client thoroughly analyze the problem behavior.
54
Pretreatment Stage: Orientation and Commitment
- willing to work together?
- modify beliefs or misconceptions about treatment
- completing an assessment
- obtain commitment
55
Emotion Regulation: Opposite Action
Opposite Action is acting opposite to your emotional urge.
56
Interpersonal Effectiveness Skills
Helps reduce the interpersonal chaos that is present in their lives. Clients are taught to think about what they most want to get out of an interaction and then are taught skills that will make it more likely for them to reach this goal.
57
Formal Mindfulness
Formal exercises help to become more aware of internal experiences, increasing self-awareness, and the ability to manage themselves more effectively.
58
Positive Reinforcement
Something the person sees as positive that happens after he engages in a certain behavior.
59
Core Mindfulness: Effectively
- focus on what works
- play by the rules
- act as SKILLFULLY as you can
- let go of vengeance
60
Participate
This means entering fully into an activity-staying in each moment without separating yourself from the events.
61
Stages of Treatment
- Pretreatment Stage: Orientation and Commitment
- Stage 1: Attaining Basic Capacity
- Stage 2: Reducing Post-Traumatic Stress
- Stage 3: Increasing Self-Respect and Achieving Individual Goals
62
Informal Mindfulness
Informal exercises help to live more mindfully and be in the present moment on a regular basis.
63
Stage 2: Reducing Post-Traumatic Stress
- The trauma becomes the focus and exposure therapy is used to emotionally process past traumas.
- Stage 2 may also focus on negative relationship experiences related to the client's emotional dysregulation and subsequent lack of interpersonal skills.
64
Emotion Dysregulation
Results from a combination of high emotional sensitivity or vulnerability and an inability to regulate or modulate one's emotions.
65
Distress Tolerance: Half-Smile
- Accept reality with your body
- by relaxing
- a half-smile is a relaxed smile.
66
DBT Assumptions
- clients are doing their best
- clients want to get better
- clients need to work harder and be motivated to make changes
- if clients didn't create their problems, they still have to solve them
- the lives of suicidal clients are unbearable
- clients need to act skillfully in all areas of their live
- clients cannot fail in psychotherapy
- therapists treating clients with emotional dysregulation need support too.
67
Negative Reinforcement
- Taking away something that the person finds aversive
- yells
- -> change subject
- they will yell again to get you to change the subject
68
T.I.P. Skills
T - Temperature --> Ice water & face, ice cube and hand
I - Intense --> exercise (20 minutes)
P - Progressive --> Relaxation (Squeeze muscles, and then relax)
69
Distress Tolerance: Wise Minds A.C.C.E.P.T.S.
A - Activities - exercise / hobbies
C - Contributing - contribute to something (volunteer)
C - Comparisons - Compare self to less fortunate
E - Emotions - read emotional books / stories
P - Pushing away - push the situation away
T - Thoughts - count to 10; puzzles
S - Sensations - hold ice, squeeze ball
70
The Dialectical Theory of DBT
- Note that thinking dialectically means looking at both perspectives in a situation and then working toward synthesizing these possibly opposing perspectives. Thinking dialectically means that we must practice acceptance while also continuing to work toward change. It also means recognizing that all points of view can have aspects that are both valid and incorrect.
71
Irreverent Communication
Irreverence is blunt and confrontational and makes use of honesty and an offbeat sense of humor at the same time.
72
Non-judgmentally
This means you do things without evaluating them
73
Validation
Communicating that the client's responses make sense and are understandable given what's currently taking place in their life.
74
Distress Tolerance: Observe the Breath
Focus attention on your breath, coming in and out. Observe your breathing as a way to center yourself in your wise mind, dropping off non-acceptance and fighting reality.
75
Interpersonal Effectiveness: F.A.S.T. (How to keep self-respect)
F - Fair
A - Apologies
S - Stick to values
T - Truthful
76
One-mindfully
This means learning to focus on the mind and awareness on the current moment
77
Core Mindfulness: One-Mindfully
- doing one thing at at time
| - concentrate on your mind
78
Basic Steps to Mindfulness
1) Choose an activity
2) Focus on activity moment non-judgmentally
3) Notice when your attention wanders
4) Bring your attention back
79
Three Styles of Thinking in DBT
1) the reasoning self
2) the emotional self
3) the wise self
80
The Reasoning Self
The part of ourselves that we use when we're thinking logically or reasoning something out.
- Organizing your day at work
- Leaving instructions for the baby sitter
- Deciding whether or not you should drive or take the subway to work
81
The Emotional Self
The part that often gets us into trouble, as our behaviors are controlled by the emotion we're feeling at the moment.
- "When you are angry at someone, and you lash out at them."
82
The Wise Self
The combination of the reasoning self, the emotional self, and intuition. In other words, we feel our emotions and are still able to think straight, and we weigh the consequences of our actions and choose to act in a way that's in our best interests in the long run, even if that means behaving in a way that's quite difficult.
- "It's 5:00pm, your partner's going to be home from work soon, and you promised you would cook dinner, but you're exhausted and don't feel like it. Yet you do it anyways. This is your wise self."
83
How to Access the Wise Self
- Mental Noting with Emotions
- Improving Self-Talk
- Just This Moment
84
Mental Noting with Emotions
Mentally noting your experience of the emotion helps you put a little distance between you and the emotion so you can watch the tornado from a safe distance, rather than getting sucked up into it.
85
Improving Self-Talk
Clients often beats up on themselves. Encourage them to think of someone they really care about and to speak to themselves the way they would to that person. This will help them be kinder to themselves, which will help them access their wise self.
86
Just This Moment
Focusing on the present moment and whatever they happen to find in the moment. By practicing mindfulness with whatever activity they are doing in the moment, they can distract themselves from painful emotions.
87
Addressing Lifestyle Issues that Affect Emotion Regulation
- Balancing Sleep
- Treating Physical Illness
- Reducing Use of Mood-Altering Substances
88
Identifying Problem Behavior Examples
- drinking or using drugs
- gambling
- self-harming behaviors
- threatening or attempting suicide
- lashing out at people who care about them
- shoplifting
- driving dangerously
- under- or overeating
- sleeping to avoid or escape life
89
Examining the Costs and Benefits of Problem Behaviors
The DBT skill of looking at the pros and cons is used when clients are ambivalent about giving up a behavior and need help seeing that the behavior has costs or negative consequences. Doing a cost-benefit analysis helps them come to terms with this so they can make a more conscious decision to either engage in the behavior or choose to act in another way.
- Use Cost-Benefit Analysis Worksheet
90
RESISTTING THE URGE
```
R - Reframe
E - Mindfully engage in an activity
S - Do something for someone else
I - Intense sensations
S - Shut it out
T - Think neutral thoughts
T - Take a break
```
91
R - Reframe
Reframing refers to changing one's perspective about something -- in other words, helping clients make lemons out of lemonade or helping them see the silver lining.
92
E - Mindfully Engage in an Activity
Getting one's mind off a painful situation and the emotions it's evoking is often helpful. Researchers have found that telling people to not think about an unwanted emotion actually increases the activation of that emotion, whereas providing them with something to think about in place of the emotion greatly increases their ability to not think about it.
93
S - Do Something for Someone Else
Sometimes, an effective way for clients to get their minds off their own problems is to do something for someone else. When clients are in a crisis, they might find it helpful to distract themselves by turning their attention to someone else, perhaps visiting a friend who's in the hospital or who can't get out of the house, spending a couple of hours baking a special treat for a family member, and so on.
94
I - Experience Intense Sensations
Sometimes generating intense physical sensations can distract the mind from painful emotions. This helps explain why many clients resort to cutting or hurting themselves in other ways: because it can help them feel better temporarily.
- take a hot or cold bath or shower
- keep a rubber band on one wrist and snap it - not so hard that it causes a lot of physical pain, but hard enough to generate a sensation that will temporarily occupy the mind.
- Chew on crushed ice or frozen fruit
- Go for a walk in cold or hot weather
- Lie in the hot sun
95
S - Shut It Out
Physically leaving the situation and going somewhere calm and quiet will make it more likely that they can use their skills, access their wise self, and manage their emotion. Sometimes, however, this isn't enough. Clients may continue to dwell on the problem even though they've left the situation physically. This is when the DBT skill known as PUSHING AWAY is helpful. With this skill, clients use their imagination to convince the mind tat the problem isn't something that can be worked on in the present moment.
96
T - Think Neutral Thoughts
Focusing attention on on neutral thoughts can provide distraction from emotions and urges, thereby reducing their intensity. Neutral thoughts can be anything that won't add to the distressing emotions.
- Saying a prayer
- Singing a favorite song or reciting a nursery rhyme or poem
- Saying the names of objects observed in the environment (e.g. desk, bed, dresser)
- Repeating a mantra, such as "it is what it is" or "peace and calm"
97
T - Take a Break
Taking a break in some way when emotions are high can also help clients get through a crisis without making it worse. Help them get creative with this. Taking a break might mean doing so literally - taking a "mental health day" from work as long as this won't have negative consequences.
98
Managing Urges
The handout STEPS TO MANAGING YOUR URGES outlines an approach that most people find helpful.
99
Coping Ahead
The final distress tolerance skill is the DBT skill called COPING AHEAD. When clients know that an upcoming situation will be emotionally difficult, it can be very helpful for them to rehearse their plan ahead of time so they're prepared to cope in a more skillful way.
