Module Madness
Name the four modules of DBT
What are: mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness
Define a dialectic
What is the concept that two seemingly opposing truths can be experienced simultaneously
The general format of a DBT group session
What is: completing diary cards, teaching the skill of the day, and processing/utilizing practice exercises
The value of group therapy for DBT over individual therapy alone
What is that:
Skills group allows the therapist: To manage interpersonal behaviors that arise in group dynamics
Skills group allows the clients: To learn from one another, to interact with peers, to receive validation and support from others, and to have a relatively non-threatening opportunity to learn how to be in a group
*Note: Research has found individual therapy to be an ineffective solo intervention for BPD
Name two common elements of a BPD diagnosis
What are mood instability, intense and unstable relationships, and maladaptive behaviors (e.g., SIB)
List the three "What" skills of mindfulness
What are observe, describe, and participate
Wise mind's two components
What are rational mind and emotional mind
The purpose of DBT coaching
What is to reinforce skill acquisition and help members apply the skills in their natural environment
These factors serve as barriers to maintaining consistency and expectations with P/S in a hospital setting (Name 3)
Changes in schedule demands, environmental limitations (e.g., bad weather)
Differences in staff expectations/responses
Inconsistency in reinforcement of behaviors (e.g., praising the positive, then giving additional attention to maladaptive)
Unrealistic expectations (e.g., I'll be back in 5 minutes)
DBT was created to treat BPD. These other treatment strategies are also effective (Name 2)
What are: medication, CBT, individual psychoanalytic/ psychodynamic therapy
The module defined by the ability to accept the present in a non-judgmental fashion
What is distress tolerance
Name the 4 components of true DBT treatment
What are individual therapy, skills group, DBT coaching and telephone consultations
For the therapists: Supervision group!
The limitations of DBT (Name 2)
What are: leading to therapist burnout, being emotionally and intellectually demanding, requiring awareness of and motivation to change their behavior, being difficult to find/implement locally
Ways that P/S often attempt to cross boundaries or engage in power strugges (Name 4)
What are: pushing back on time limits, pulling for extra 1:1 time, asking you personal questions, asking you for a contraband item, splitting staff, dictate what you are "allowed" to talk about in session, refusing to attend a group if a certain peer is invited, etc.
Name 3 common triggers for maladaptive behavior
What are: Believing someone is talking about them, disrespecting them, or rejecting them; Feeling like others are too physically close to them; Getting bad news or having a promise broken; and Being overwhelmed by overstimulation or feelings
The module that includes effective strategies for asking for what you need, saying no, and coping with interpersonal conflict
What is interpersonal effectiveness
Define radical acceptance
What is fully acknowledging and embracing the present moment, including its difficulties and discomforts, without trying to change or control it
Radical acceptance is about recognizing that some parts of life are beyond our control, and that struggling against them only leads to further suffering.
The basic assumptions of DBT (Name 3)
What are:
People are doing the best they can and want to improve
People need to do better, try harder, and be more motivated to change
People may not have caused all of their own problems, but they have to solve them anyway
New behaviors have to be learned in all relevant contexts
All behaviors (actions, thoughts, emotions) are caused
Figuring out and changing the causes of behavior is more effective than judging and blaming
The most effective approach for handling a group member leaving in the middle of the session
What is having one leader walk out to briefly assess for safety, encourage them to return, and escort them back to their unit (when needed)
Someone with BPD is likely to make sense of their emotions through the following tactics (Name 2)
What are: invalidating their emotional experience, improperly labeling and interpreting their emotions, looking to others to make sense of their experiences, and using their emotions in extreme form to get their needs met
The module that involves taking opposite action and applying distress tolerance techniques
What is emotion regulation
The reasons why DBT group benefits from having two leaders (Name 3)
What are: To reduce the impact of multiple relationships, To minimize therapist burn out, To enhance individual attention, and To provide dialectal balance and interpersonal support
Evidence-based adaptations to DBT for those with cognitive functioning difficulties (Name 4)
What are: repetition of material, simplification of language, longer time dedicated to one topic (.5 speed), pictorial handouts, smaller group size, and creativity/variety (e.g., increased role plays and practice, interactive learning)
The necessary steps to take when someone expresses suicidal ideation in group
What is: approach the P/S at the end of the group, determine any plan/intent, escort them back to the unit, assist them in informing unit staff, tell your supervisor, and email the treatment team
The Biosocial Theory states that dysfunction in the emotion regulation system arises from these factors (Name 3)
What are: discrepancies between environmental opportunity/ demand and capacity/characteristics of the child; consequences of invalidating environments; communication of private experiences being met by inappropriate and extreme responses; and Emotional vulnerability + inability to self-regulate