DBT Skills

Goals/Targets

100

True or False: DBT does not focus directly on traumatic stress until previous target behaviors are under control and, therefore, basically ignores the trauma when the client brings it up.

FALSE. Trauma is never ignored if brought up, however it is not a primary target of treatment until Stage 1 targets are resolved.

200

What are the goals/targets of the DBT pretreatment stage?

Orienting to treatment and commitment to participation (agreeing on goals). Also, start building the therapeutic relationship.

300

DBT is very specific on the order and importance of various treatment targets. List in order the seven steps or targets that therapists follow and indicate which go in Stage I, II, and III.

STAGE I: 1st = suicidal, intentional self-harm, and life-threatening behaviors. 2nd = behaviors that threaten the proces of the therapy. 3rd = quality of life issues. 4th = stabilization of coping skills. STAGE II: 5th = resolving post-traumatic stress. STAGE III: 6th = self-respect. 7th = other.

400

What are several important reasons for distinguishing among behavioral intent, consequences, and reinforcement when discussing client behaviors and targets in therapy?

(1) For individuals with diagnosed BPD, the intent of their behaviors is frequently unrelated to at lest some of the outcomes. Many consequences are unintended, but nonetheless serve to reinforce behavior. (2) Reinforcing consquences have physical effects on the brain independent of what a person may want, and thus are an important influence on behavior. (3) Because reinforcement can alter our behaviors beyond our conscious attention, it is important to be aware that there may be explanations for our behavior that do not refer to our preferences and desires. (4) Very importantly, insight into behavioral influences rely upon actively searching for causes which are beyond "feelings" or "beliefs."

500

CURVEBALL! (a) In DBT the core set of change strategies are _____. These strategies are balanced by ____. (b) What's an invalidating environment?

(a) Problem solving and validation. (b) Behaviors of the client are constantly being described as wrong, invalid, etc. Communication of private experience is met by erratic, inappropriate and extreme responses; they're often punished or trivialized. Experience of painful emotions and distress are disregarded.

The Lingo

100

Define reinforcement, punishment, extinction, behavioral (extinction) burst, and shaping.

REINFORCEMENT: all consequences or contingencies that increase or strengthen the probability of a given behavior occuring again. PUNISHMENT: all consequences or contingencies that decrease the probability of a given behavior occuring again. EXTINCTION: cessation of reinforcement for a behavior that was previously rinforced. BEHAVIORAL BURST: the temporary increase of the strength, frequency, and intensity of behavior near the beginning of extinction. SHAPING: gradual approximations of the target behaviors are reinforced.

200

What does the prase "looking for the nugget of gold in a cup of sand" refer to in DBT?

Seeking the wisdom, or the adaptive aspect of behavior in a dysfunctional or maladaptive action. It is the essence of validation.

300

One of the reciprocal communication styles is "responsiveness." What does that mean?

Responsiveness is the reciprocal strategy of staying awake and alert to small changes in client demeanor and/or behavior, and responding to the content of the client's remarks and questions (as opposed to interpreting or putting off questions).

400

The strategy "making lemonade out of lemons" requires the therapist to view everyday problems as _____.

Opportunities to practice skills.

500

DOUBLE WHAMMY! (1) Define "wise mind." (2) In teaching dialectical reasoning, the therapist helps the client move from "either-or" statements or thinking to "____-____" statements, thus communicating to the client that opposite statements are possible.

(1) Wise mind = the integration of "emotion mind" and "reasonable mind" (2) "both-and"

Emotions

100

What are 3 characteristics of 'high emotional vulnerability?'

(1) High sensitivity: reacts quickly, low threshold for emotional reaction. (2) High reactivity: extreme reactions, high arousal dysregulates cognitive processing. (3) Slow return to baseline: reactions are long-lasting, "additive" nature of emotional stimuli, which occur in rapid succession.

200

According to the basic research on emotions, what 5 capabilities (or skills) must a person develop to master emotion modulation?

(1) Experience painful emotions without dissociating or escalating them. (2) Inhibit maladaptive, mood-dependent actions. (3) Organize behavior in the service of external, non-mood dependent goals. (4) Reorient attention away from emotional stimuli. (5) Decrease (or increase) physiological arousal associated with emotion.

300

List several of the specific emotion regulation skills taught to borderline patients.

(1) Identifying and labeling affect. (2) Identifying obstacles to changing emotions. (3) Reducing vulnerability to "emotion mind." (4) Increasing positive emotional events. (5) Increasing mindfulness to current emotion. (6) Taking opposite action. (7) Applying distress tolerance techniques.

400

Imagine that you have a client with fear or sadness (two of the primary emotional responses). How would you utilize DBT's five skills of emotion modulation for that emotion?

FEAR: (1) Sit with the emotion. (2) Don't run away or quit. (3) Do feared action. (4) Count bricks on a wall. (5) Do slow breathing. SADNESS: (1) Let self grieve, cry. (2) don't crawl into bed or isolate self. (3) Get active, do chores. (4) Exercise and eat. (5) Think about pleasant events.

500

Imagine that you have a client with shame or anger (two of the primary emotional responses). How would you utilize DBT's five skills of emotion modulation for that emotion?

SHAME: (1) Sit with the emotion. (2) Don't hide. (3) Expose self, pursue goals which make you feel self-confident. (4) Go to an activity entirely removed from shameful activity. (5) Do slow breathing. ANGER: (1) Sit with the emotion. (2) Don't yell or fight. (3) Politely ask again for what you want, apologize. (4) Watch a comedy, leave the situation. (5) Count breaths. (6) Drik warm milk.

Skills

100

Skills training in DBT is designed to remediate behavioral skill defecits typical of individuals meeting criteria for BPD. What are the five broad categories of skills taught in DBT?

(1) Emotion regulation. (2) Interpersonal effectiveness. (3) Distress tolerance. (4) "Core" mindfulness. (5) Self-management.

200

"Core" mindfulness skills are divided into "what" skills and "how" skills. Briefly describe the goals of these skills.

"WHAT" skills aim to observe, describe and participate with awareness. The goal of the "HOW" skills is to take a non-judgmental stance, focus on one thing in the moment, and be effective.

300

What are the 4 crisis survival skills taught in tolerating distress?

(1) Distracting (2) Self-soothing (3) Improving the moment and (4) Thinking of pros and cons

400

Skills training procedures are necessary when a problem solution requires skills not currently in the individual's behavioral repertoire. Often an individual will have the separate components of a skill, but cannot put them together coherently when necessary. What are the three types of skills training procedures employed in DBT? Give two examples of each.

(1) Skills acquisition (instruction, modeling, bibliotherapy). (2) Skills strengthening (behavioral rehearsal, feedback, coaching). (3) Skill generalization (homework assignments, comparisons of situations, audiotaping of sessions).

500

As skills group leader, one of your group clients tells you in confidence that she is frustrated and upset with the interpersonal behavior of another group client. She wants to practice her new interpersonal skills (currently being taught in the interpersonal skills module) in giving feedback to this client during in-session practice of group skills. Do you let this client practice her interpersonal skills in giving feedback? Why or why not?

Borderline individuals generally cannot tolerate any negative feedback, especially in a group format. the group therapist should discourage the client from givin such feedback during session (thus avoiding proess in a skills training group) and encourage the client to practice her other skills that would not involve feedback (i.e. distress tolerance, mindfulness, etc.).

What's the Difference?

100

What's the difference between an interactional and transactional developmental model? Which model does DBT favor?

INTERACTIONAL model is where characteristics of the individual (fixed) interact with characteristics of the environment. (ex: stress-diathesis model, in which environmental stimuli cross a threshold of intensity, triggering a latent predispostion within the individual to develop a disorder) TRANSACTIONAL model is where the environment has an impact on the individual and at the same time the individual impacts the environment. It's a two-way street, reciprocal relationship. DBT favors this model.

200

What's the difference between a client's vacation from therapy and termination from therapy?

VACATION: kicking them out adn then pining for their return. TERMINATION: assisting clients to either find a new therapist with whom to continue treatment or to make the transition to living without regular treatment.

300

What is the difference between "masking emotions" and "changing emotional expressiveness?" Why is it important?

Masking usually involves the tensing of facial muscles. Expressing an opposite emotion, such as calmness in contrast to fear, requires the relaxation of those same muscles. The idea behind changing facial and postural expressions is that muscles send messages to the brain about what one is feeling. In DBT exposure-based procedures, the idea is to try to get the face and body to send a different message to the brain. Masking, in contrast, sends the message, "This is frightening and I can't show it."

400

What are limits and what's the difference between observing limits and setting limits?

Limits are boundary lines which the therapist draws. They're different for each therapist and intrisic to the therapist's continued willingness to serve and work with a client. OBSERVING = the mechanism which ensures that the contingencies operating in therapy do not punish the therapist's continued involvement. Important for 2 reasons, 1. enable client to be treated as an adult, capable of restraining her behavior and of working within an atmosphere of mutual respect (limits can't be arbitrary and must be communicated honestly) 2. enables the therapist to maintain motivation to work with a client. SETTING = associated with an arbitrary, fixed set of rules, often independent of client needs or therapist concerns.

500

What is the difference between the two main types of cognitive modification strategies utilized within DBT?

COGNITIVE RESTRUCTURING: aims to change the general or habitual content or form of the client's thinking, as well as the client's cognitive style. CONTINGENCY CLARIFICATION: focus is on modifying dysfunctional rules or "if-then" expectancies operating in specific instances.