Dialectical behavior therapy

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Dialectical behavioral therapy ( DBT ) is evidence-based psychotherapy designed to help people with personality disorder thresholds. It has also been used to treat mood disorders as well as those who need to change unhelpful patterns of behavior, such as self-harm, suicidal ideas, and substance abuse. This approach works to help people improve their emotional and cognitive regulation by learning about triggers that lead to reactive states and help assess which coping skills are applied in sequences of events, thoughts, feelings, and behaviors to help avoid unwanted reactions. DBT assumes that people do best but lack the skills needed to succeed, or are affected by positive reinforcement or negative reinforcement that interferes with their ability to function appropriately.

A modified form of cognitive behavioral therapy (CBT), DBT was developed in the late 1980s by Marsha M. Linehan, a psychology researcher at the University of Washington, to treat people with borderline personality disorder (BPD) and those who want to commit suicide. Research on its effectiveness in treating other conditions has paid off; DBT is now used in a variety of psychological treatments including treatment for depression, substance use disorders, post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), eating disorder, and mood disorders. Research suggests that DBT may have some effects on patients presenting various symptoms and behaviors associated with mood spectrum disorders, including self-injury. The latest work also shows its effectiveness with victims of sexual abuse and chemical dependence.

DBT combines standard cognitive behavioral techniques for emotional regulation and reality testing with the concept of tolerance of dangers, acceptance, and awareness of consciousness largely derived from the practice of Buddhist meditation. DBT is based on biosocial theory and is the first treatment that has been experimentally proven to be generally effective in treating BPD. DBT's first randomized clinical trial showed a decrease in suicide rate, psychiatric hospitalization, and drop-out treatment when compared with usual treatment. A meta-analysis found that DBT achieved moderate effects in individuals with impaired personality thresholds.

Video Dialectical behavior therapy

Ikhtisar

Linehan observed "burn-out" in the therapist after addressing "non-motivated" patients who refused cooperation in successful care. His first core insight was to recognize that the chronic suicide patient he had studied had been raised in a very uncertain environment, and, therefore, requiring a rather unconditional climate of love and acceptance (not Rogers' positive humanist approach, but metaphysically Hanh was neutral ), in which to develop a successful therapeutic alliance. The second insight involves the need for a commensurate commitment from the patient, who needs to be willing to accept a terrible level of emotional dysfunction.

DBT seeks to have the view of therapist patients as an ally rather than an enemy in the treatment of psychological problems. Thus, the therapist aims to receive and validate the client's feelings at a certain time, while, nevertheless, tell the client that some feelings and behaviors are maladaptive, and show them a better alternative. DBT focuses on clients acquiring new skills and changing their behavior, with the ultimate goal of achieving "life worth living", as defined by the patient.

In DBT's biosocial theory of BPD, clients have a biological tendency to emotional dysregulation, and their social environment validates maladaptive behavior.

Linehan and others combine a commitment to the core conditions of acceptance and change through the principle of dialectics (where the antithesis thesis -> synthesis) and gathers various skills for emotional self-regulation taken from Western psychological traditions, such as cognitive behavior. therapy and interpersonal variants, "assertiveness training", and Eastern meditation traditions, such as Buddhist awareness meditation. One of his contributions is to change the nature of the hostility of the therapist-client relationship in favor of an alliance based on intersubjective love intact.

All DBT can be said to involve 4 components:

• Individual - The therapist and the patient discuss issues that appear during the week (recorded on the diary card) and follow the treatment target hierarchy. Behavior of self-injury and suicide, or life-threatening behavior, takes first priority. The second priority is a behavior which, although not directly harmful to oneself or others, interferes with the course of treatment. This behavior is known as behavior that interfere with therapy. The third priority is the quality of life and work to improve a person's life in general. During individual therapy, therapists and patients work to improve the skills used. Often, groups of skills are discussed and barriers to acting skillfully will be discussed.
Group
• - Groups usually meet once a week for two to two and a half hours and learn to use special skills broken down into four skill modules: core attention, interpersonal effectiveness, emotional regulation, and distress tolerance.
• Therapist Consulting Team - Therapist consultation team includes all therapists who provide DBT. The meeting takes place every week and serves to support the therapist in providing care.
• Telephone Training - Phone training is designed to help generalize skills into the daily life of the patient. Short and limited phone training to focus on skills.

No component is used by itself; individual components are deemed necessary to keep the suicidal impulses or emotional issues out of control of disturbed group sessions, while group sessions teach unique skills for DBT, and also provide practice by regulating emotions and behavior in a social context. DBT's own skills training is used to address treatment goals in some clinical settings, and the broader objectives of emotional regulation seen in DBT have enabled it to be used in new settings, for example, supportive care.

Maps Dialectical behavior therapy

Four modules

Mindfulness

Mindfulness is one of the core ideas behind all DBT elements. This is considered to be the foundation for other skills taught in DBT, as it helps individuals accept and tolerate the powerful emotions they may feel when challenging their habits or exposing themselves to irritating situations. The concept of awareness and meditation practice used to teach it comes from traditional Buddhist practice, although the version taught in DBT does not involve religious or metaphysical concepts. In DBT it is capacity to pay attention, not to judge, to date; about living at that moment, experiencing the emotions and feelings of a person completely, but with perspective. Practice attention can also be intended to make people more aware of their environment through their 5 senses: touch, smell, sight, taste, and sound.

"What" skills

Observe

This is used not to judge a person's environment inside or outside oneself. It helps in understanding what is going on in certain situations.

DBT recommends developing a "teflon mind", the ability to let feelings and experiences pass unattached to the mind.

Explain

This is used to express what has been observed with observing skills. It should be used without a judgmental statement. It helps by letting others know what has been observed. Once the environment or mind's state of mind has been observed with 5 senses, the individual can put words into observation and thus better understand the environment.

Participate

This is used to fully focus on, and engage in, the activities one undertakes.

"How" skills

How to do Mindful Meditation. There are many "script" musings available on YouTube; for example: 3 Minute Meditation; or The Body Scan. How to do it (The Body Scan): You listen to body scans and you allow the mind to focus on every aspect of your physique, usually starting from your toes and ending at the top of your head. When you listen to body scans and allow your mind to focus on the body, you will see the "busy mind" you will be aware of. You will notice that thoughts and feelings will try to distract you from focusing on every part of your body. You will notice that some thoughts and feelings may be troubling you. You may want to stop meditation because it may be very painful emotionally or physically or because you have negative or busy thoughts. Sometimes memories may arise and they may also be difficult to accept emotionally. How to do Mindful Meditation involves learning to acknowledge thoughts, feelings and memories without fighting them or driving them away. Paradox: If we try to fight them, they look bigger; but when we moved to reception, they seemed smaller. We entered the body of mindfulness meditation scanning, meditation 3 minutes or other meditation sessions without a goal and with non-striving attitude. Again, if we go in for the purpose of "fixing my problem by meditation," the purpose and pressure to fix something tends to make the problem bigger. To enter meditation with a non-goal/non-striving attitude, so hopeless, paradoxically, usually results in reducing stress, pain and other symptoms.

No rating

This is an act of describing facts, and not thinking in terms of "good" or "bad," "fair," or "unfair." This is an assessment, not a factual description. Being nonjudgment helps you convey your intent effectively without adding judgments that others may not like.

Consciously

This is used to focus on one thing. One-mind is very helpful in keeping one's mind from error into "emotion" by lack of focus.

Effectively

This just does what works. It is a very broad skill and can be applied to other skills to help become successful with word skills.

Distress Tolerance

Many of the current approaches to mental health care focus on changing events and sad situations such as dealing with the deaths of loved ones, loss of jobs, serious illness, terrorist attacks and other traumatic events. They do not pay much attention to receiving, finding meaning for, and tolerating distress. This task has generally been addressed by psychodynamic, psychoanalytic, gestalt, or narrative therapy, along with communities and religious and spiritual leaders. Behavioral therapy therapy emphasizes learning to bear pain with skill.

The skill of distress tolerance is a natural development of DBT awareness skills. They must do with the ability to accept, in a way that is neither evaluative nor judgmental, neither the self nor the present situation. Since this is a nonjudgmental attitude, this means that it is not one of consent or resignation. The goal is to be able to recognize negative situations and their effects calmly, rather than being overwhelmed or hiding from them. This allows the individual to make wise decisions about whether and how to take action, rather than falling into intense, desperate, and often damaging emotional reactions that are part of a personality threshold disorder.

Disrupt with ACCEPTS

This is a skill used to distract you temporarily from unpleasant emotions.

• Activities - Use positive activity you like.
• C ontribute - Help others or your community.
• C omparisons - Compare yourself to the less fortunate or how you used to be when you were in a worse condition.
Movement
• E (other) - make yourself feel something different by provoking a sense of humor or happiness with the appropriate activity.
• P ush away - Put your situation behind the burner for a while. Put something else for a while in your mind.
• T houghts (other) - Force your mind to think of something else.
• S work (other) - Do something that has intense feelings other than what you feel, like a cold shower or spicy candy.

Enough yourself

This is a skill in which a person behaves in a comfortable, friendly, kind, and gentle way to himself. You use it by doing something soothing for you. It is used in difficult times or agitation. The wide-ranging New York Jets recipient Brandon Marshall, who was diagnosed with BPD in 2011 and a strong supporter of DBT, cites activities such as prayer and listening to jazz as an instrument in his care.

INCREASE moments

This skill is used in difficult times to help a person relax.

• I magery - Imagine a casual scene, all going well, or anything else that pleases you.
• M eaning - Find some purpose or meaning in what you feel.
• P rayer - either pray for anyone you worship, or, if not religious, chant a personal spell.
• R relaxation - Relax your muscles, breathe deeply; use by calming down.
• O at this point - Focus all your attention on what you are doing right now. Stay in the present.
• V acation (short) - Take a break from it all for a short time.
• E ncouragement - Cheerlead itself. Tell yourself that you can solve it and overcome this because it will help your resilience and reduce your vulnerability.

Pros and cons

Think about the positive and negative things about not tolerating trouble.

Radical acceptance

Release the reality battle. Accept your situation as-is.

Reverse the mind

Turn your mind to acceptance. This should be used with radical acceptance.

Willingness vs. passion

Willing and open to do what is effective. Unleash an intentional attitude that conflicts with acceptance. Keep an eye on the goal in front of you.

Emotion settings

Individuals with impaired personality disorder and suicidal individuals are often emotionally intense and volatile. They can be angry, very frustrated, depressed, or anxious. This suggests that these clients may benefit from help in learning to manage their emotions. The skills of dialectical behavior therapy for emotional regulation include:

• Identify and label emotions
• Identify barriers to changing emotions
• Reduce vulnerability to emotional thoughts
• Increase positive emotional events
• Increase attention to the current emotion
• Take the opposite action
• Apply the distress tolerance technique

Emotional stories

This skill is used to understand what emotions a person feels.

1. Events suggest
2. Event interpretation
3. Body sensation
4. Body language
5. Urgent action
6. Action
7. The name of the emotion, based on the previous item on the list

PLEASE

This skill in terms of ineffective health habits can make a person more vulnerable to emotional thoughts. These skills are used to maintain a healthy body, so that a person is more likely to have healthy emotions.

P hysica L illness (treat) - If you are sick or injured, get the right treatment for it.

E ating (balanced) - Make sure you eat the right healthy food, and eat enough.

A cancel the mood-altering medication - Do not take any medications or other drugs that are not prescribed. They may be very harmful to your body, and can make your mood unpredictable.

S leep (balanced) - Do not sleep too much or too little. Eight hours of sleep is recommended per night for the average adult.

E xercise - Make sure you get an effective amount of exercise, as this will improve body image and release endorphins, making you happier.

Build mastery

Try doing one thing a day to help build competence and control.

Opposite action

This skill is used when you have an unjustified emotion, which is not included in the situation at hand. You use it by doing the opposite of your current impulse. It is a tool to get you out of unwanted or inappropriate emotions by replacing them with opposing emotions.

Troubleshooting

This is used to solve a problem when your emotions are justified. This is used in combination with other skills.

Release emotional suffering

Observe and feel your emotions, accept them, then release them.

Interpersonal effectiveness

The interpersonal response patterns taught in DBT skills training are very similar to those taught in many assertive and interpersonal classes. They include effective strategies for asking what one needs, saying no, and overcoming interpersonal conflict.

Individuals with impaired personality thresholds often have good interpersonal skills in the general sense. Problems arise in the application of these skills to a particular situation. An individual may be able to describe an effective sequence of behaviors when discussing others facing problematic situations, but may be incapable of generating or executing the same sequence of behaviors when analyzing their own situation.

The interpersonal effectiveness module focuses on situations where the goal is to change something (eg, ask someone to do something) or to reject changes made by others (eg, say no). The skills taught are meant to maximize the likelihood that a person's goals in a given situation will be met, while at the same time not damaging one's relationships or self-esteem.

DEEAR MAN - passing someone's needs to others

This acronym is used to help someone in getting what they want when asking.

• D write down a person's situation using a specific factual statement about the current situation.
• E xpress the emotions experienced when the situation occurs, why this is a problem and how people perceive it.
• E sympathy confesses what others are experiencing and their emotions
• A ssert yourself by asking clearly and specifically for what behavior the person is looking for.
• R strengthens a person's position by offering positive consequences if they want to get what they want.
• M depends on the situation by focusing on what is wanted and ignoring the distraction through validation/empathy and switching back to its core.
• A should be confident and assertive, even if one does not feel confident.
• N negotiate with a hesitant person and come to a comfortable compromise at someone's request.

GIVE - give something

These skills help a person maintain a person's relationship, whether they are with friends, co-workers, family, romantic couples, etc. This will be used in the conversation.

• G entle: Use appropriate language, no verbal or physical attacks, do not give up, avoid sarcasm unless someone is sure the person is okay with it, and be polite and not judge.
• I nterested: When the person who speaks talks about something, acts interested in what is being said. Keep eye contact, ask questions, etc. Avoid using the phone during in-person conversations.
• V alidate: Show the understanding and sympathy of a person's situation. Validation can be displayed through words, body language and/or facial expressions.
• E asy Manner: Quiet and comfortable during the conversation; use humor; smile.

FAST - keep your self-esteem

This is a skill to help a person maintain one's self-esteem. This should be used in combination with other interpersonal effectiveness skills.

• F air: Be fair to yourself and others.
• A pologies (less): Do not apologize more than once because what has been done is not effective or for something that is not effective.
• S mark to First Value: Stay true to what is believed and held firmly by it. Do not allow others to encourage action against their own values.
• T cruel: Do not lie. Lying can only accumulate and damage one's relationships and esteem.

This list does not include the "problem solving" module, the goal being to practice being a therapist on your own.

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Tools

Diary Card

Special cards are formatted to track behavior that interferes with the therapies that divert or impede the patient's progress. Daily cards can be filled daily, 2-3 times a day, or once a week.

Chain analysis

Chain analysis is a form of functional behavioral analysis but with an increased focus on the sequential events that make up the behavioral chain. It has strong roots in behavioral psychology especially the concept of behavioral analysis applied from chaining. More research supports the use of behavioral chain analysis with many populations.

Milieu

The environmental, or group culture involved, plays a key role in DBT effectiveness.

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Benefits

Borderline personality disorder

DBT is the most studied therapy for the treatment of personality disorder thresholds, and there has been considerable research done to conclude that DBT is helpful in treating personality threshold disorders. A 2009 Canadian study compared treatment of threshold personality disorder with dialectical behavioral therapy to general psychiatric management. A total of 180 adults, 90 in each group, were treated in the study and treated for an average of 41 weeks. Statistically significant decreases in suicide events and self-harmful events were seen overall (48% reduction, p = 0.03, and 77% reduction, p = 0.01, respectively). There was no statistically significant difference between the groups seen for this episode (p = 0.64). Emergency department visits decreased by 67% (p & lt; 0.0001) and 65% (p & lt; 0,0001) emergency room visits for suicide, but there were no statistically significant differences between groups.

Depression

Source of the article : Wikipedia