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2. Objectives
The Basics of DBT
The B in DBT: What You Need to Know About Behavior
Mindfulness
Reducing Emotional Reactivity
Distress Tolerance Skills
What Clients Need to Know About Emotions
Regulating Painful
Increasing Positive
Helping Clients Become More Effective In
Relationships
3. The Clients
Emotional Vulnerability
React to things others wouldn’t react to
Reaction is more intense than others
Recovery time is longer than for others
Inability to Regulate Emotion
Difficulty identifying/labeling emotions
Difficulty understanding why they feel that way
Difficulty expressing the emotion in an effective way
4. Dialectical Theory
Everything is interconnected (Action/reaction)
Examine examples of action/reaction
Addiction
Anger
Depression
Social Interactions
Reality is in a constant process of change
How you perceive something now may be different than how
you perceive it in an hour?
What changes perceptions?
What does the emotional mind say? The reasonable mind?
The wise mind?
5. Dialectical Theory
The truth (always evolving) can be found by integrating
multiple perspectives, and tolerating that two opposite
things may co-exist
Simultaneous (understanding things differently by taking
multiple people’s perspectives of the same event)
Example: Crime scene
Example: Interpersonal disagreement
Longitudinal (understanding things differently as knowledge is
gained)
Example: Mommy had no use for us and that is why she left.
Example: Mommy loves me, but she beats me, so I must be bad.
6. Skills Training Groups
Core Mindfulness
Increase self-awareness of thoughts, feelings and urges
Develop an understanding of emotions as things that do
not have to be acted upon
Interpersonal Effectiveness
Develop assertiveness skills
Identify the goals of relationships and skills/activities
needed to achieve those goals
7. Skills Training Groups
Emotion Regulation Skills
Label and effectively communicate feeling states
Understand the function of emotions and why we don’t
want to eliminate them
Learn the connection between thoughts, feelings and
behaviors and how to break the chain
Distress Tolerance Skills
Survival skills/alternatives to self-harm
8. DBT Assumptions
Clients are doing their best
They want to get better
They need to work harder/smarter and be more
motivated
Even if clients didn’t create their problems, they
have to fix them
Clients need to learn to act skillfully in EVERY
area of their lives
Clients cannot fail in therapy
9. Treatment Priorities in DBT
Suicidal or self-harming behaviors
Behaviors that interfere with therapy (including
clinician)
Suicidal or self-harm ideation and misery
Maintaining treatment gains
Other goals identified by the client
Mindfulness
Emotion Regulation
Interpersonal Effectiveness
Distress Tolerance
10. Stages of Treatment
Stage 1: Attaining Basic Capacities
Identify behaviors that pose a direct threat to the clients (or
other’s) safety
Monitor the frequency, intensity of behaviors using a
Behavior Tracking Form
Address
Suicidal/self-harming behaviors
Behaviors that interfere with therapy
Suicidal ideation and “misery”
Maintaining treatment gains
Client initiated goals
11. Stages cont…
Stage 2 Reducing Traumatic Stress
Subgoals
Negative relationships experiences related to emotional
dysregulation
Lack of interpersonal skills
Stage 3 Increasing Self-Respect and Achieving
Individual Goals
12. The “B” in DBT
Benefits--Positive and Negative Reinforcement
Punishment – Positive and Negative
Consequences
Negative
Positive
Neutral
Intermittent reinforcement (variable interval or
ratio)
Modeling
13. The B In DBT
Reinforcers: Increase the likelihood of a behavior
Punishments: Reduce the likelihood of a behavior
Vulnerabilities: Increase the likelihood of fight or
flight responding
Backward Chaining
Outburst Co-Worker said something insensitive
Felt drained upon awakening Had to put cat down
the day before
14. The B In DBT
Triggers (+/-)
Cause a reaction
Remind the person of a prior situation in which a
behavior was:
Rewarded—Lashing out makes gave client control
Punished– Lashing out did no good increasing client’s
sense of helplessness
Communicate to the person there is a threat
Prompt feelings of wellbeing
15. The “B” in DBT
Shaping
Rewarding/reinforcing “successive approximations”
Example: Anger
Level 1: Not throwing things or being physically
aggressive
Level 2: Disengaging until the urge to be verbally or
physically aggressive was gone
Level 3: Being able to calmly discuss issues/problems
16. The “B” in DBT
Shaping
Example: Addiction or other self-harm
Level 1: Engaging in secondary coping behavior (smoking,
walking, eating, listening to music, drawing)
Level 2: Taking a mindfulness minute to evaluate the
situation, then choosing a behavior consistent with goals
17. Mindfulness
Developing an in-the-moment awareness of how
you are:
Emotionally
Mentally
Physically
Exploring the interconnection of thoughts,
feelings and physical sensations
Distress in one leads to distress in others
Becoming aware of the emotional wave
18. Reducing Emotional Reactivity
Reduce Vulnerability: (Please)
P & L Treat Physical Illness
Eating
Altering Drugs
Sleep
Exercise
Build Positive experiences
Be mindful of current emotion
19. Distress Tolerance
Activities: Do hobbies, watch a video, go for a walk
Contribute. Do volunteer work
Compare yourself to people coping the same as or
less well than you
Emotions. Distract with opposite (i.e. Comedy)
Push away a distressing situation by leaving it
mentally for awhile.
Thoughts. Think about something else (Puzzles, book)
Sensations. Distract with intense sensations
20. What Clients Need To Know About Emotions
Increasing the Positive
Decreasing the Negative
21. Interpersonal Effectiveness
Assertiveness
Distress tolerance
Emotion identification and communication
Understanding
Your needs
The needs of others
Exploring situations using dialectical theory
22. Interpersonal Effectiveness
DEARMAN - Getting what we want/need:
Describe our situation.
Express why this is an issue or need and how we feel about
it.
Assert: Sharing clearly what we feel and asking directly for
what we want/need.
Reinforce our position by offering a positive outcome
(win/win)
Mindful focusing on what we are requesting
Appear Confident
Negotiate
23. Summary
DBT is a great tool to help clients
Become more aware of emotions
Identify the thoughts, feelings and urges associated
with emotions
Develop a greater sense of self-awareness regarding
The whys of emotions
Vulnerabilities which make them more likely to be
emotionally reactive or sensitive
Provide a framework for teaching skills groups that
benefit an array of clients who have difficulty with
emotionality.
24. Available at New Harbinger Publications
(https://newharbinger.com).
Use Promocode 1168SNIPES to get 25%
off your entire order.
The book contains
• Step-by-step guide to DBT skills
• Excellent worksheet examples for
clinicians
• A user-friendly explanation of DBT
and how it works.