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2. Based in part on
Doing Dialectical Behavior Therapy: A Practical
Guide by Kelly Koerner (Guilford Press)
The Dialectical Behavior Therapy Skills Workbook
(New Harbinger Publications)
DBT Made Simple (New Harbinger Publications)
Use promocode 1168SNIPES at New Harbinger for 25%
off your entire order.
www.dbtselfhelp.com
DBT for Substance Abusers
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5
3. Objectives
Why was DBT created
Understanding Emotional Dysregulation
Identify DBT assumptions about clients and
therapists
Explore skills to help clients learn
Distress Tolerance
Emotional Regulation
Interpersonal Effectiveness
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5
4. Why I Care/How It Impacts Recovery
Many of our clients experience emotional
dysregulation
The inability to change or regulate emotional cues,
experiences and responses.
They have tried to change and failed, leaving
them feeling hopeless and helpless
(depressed/anxious)
Untenable emotional experiences lead to self
preservation behaviors such as addiction, non-
suicidal self-injury, even suicidality
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5
5. Why DBT Was Created
People with emotional dysregulation have:
High sensitivity
Hypervigilance
Overgeneralization
Easily thrown off kilter (vulnerabilities)
No “emotional skin”
High reactivity
Fight or Flight
Slow de-escalation (Persistent heightened awareness)
Invalidating environment
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5
6. The Emotional Reaction
Hyperawareness of stimuli (Perceptions)
Threat perceived (Cognitions)
All hands on deck response (Physiological
response—Fight or flight)
Actions (Survival)
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5
7. Primary Invalidation
Caregivers dismiss emotional reactions as invalid
Child is mocked, shamed for emotional response
Child is not taught
Self-soothing/de-escalation
Mindfulness
Effective cognitive processing
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5
8. Secondary Trauma/Invalidation
Coping skills can be overwhelmed by trauma or
intense stress leading to a high-alert “raw” status
Many people do not receive necessary support during
these times and may be shamed for being weak or
needy
Crisis is a normal response to an abnormal event
Most humans are not inherently prepared to deal with
crisis alone
What precipitates a crisis may vary between people
based on pre-existing stress or mental health issues
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5
9. Result
High sensitivity + high reactivity + invalidation =
Frantic efforts to numb/withdraw/protect
People learn that who they are and HOW they are
results in rejection
Avoidance of threats
Avoidance of thoughts, feelings, sensations that may
lead to invalidation
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5
10. Assumptions About Clients
Clients
Are doing the best they can
Want to improve
Cannot fail at DBT
Are existing in an unbearable state
Need to learn new behaviors in all contexts
Are not responsible for all of their own problems, but
are responsible for all of their own resolutions
Need to be motivated for change
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5
11. Assumptions About Therapists
Clarity, precision and compassion are of the
utmost importance
The therapeutic relationship is between equals
DBT or therapists can fail to achieve the desired
outcome
Therapists who treat patients with pervasive
emotional dysregulation need support
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5
12. Global—Core Mindfulness
Rational (Cognitive) Mind + Emotional (Feelings)
Mind + Wise Mind (Intuition and Interpretation)
Mindfulness—effective, nonjudgmental
observation and description of experiences
(thoughts, feelings)
What is the objective evidence for an against
What is all the evidence (the big picture)
What are my feelings about this event
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5
13. 4 Options
Tolerate the problem
Change your beliefs
Solve the problem/Change the situation
Stay miserable
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5
14. Distress Tolerance
TIP: Address physiological arousal
Temperature (ice/hot bath)
“…hold your breath and dunk your face and head in for as
long as you can hold your breath. Then come up, exhale,
inhale and dunk again. Repeat as many times as you
need to until you feel quite a bit calmer.”
Intense Exercise
Progressive Relaxation
All of these
Distract
“Explain” or reduce heart rate
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5
15. Distress Tolerance
Distract ACCEPTS
Activities
Contributing to the welfare of others
Comparisons to others or old self
Emotions (opposite)
Pushing Away
Build an imaginary wall between yourself and the situation.
Imagine yourself pushing it away with all your strength.
Block the situation in your mind. Each time it comes up, tell
it to go away,
Thoughts (counting, singing, the 10 game, 54321)
Sensations (cold, rubber band, smells---avoid taste)
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5
16. Distress Tolerance
IMPROVE the moment
Imagery—Happy place
Meaning– Make lemonade
Prayer– Radical Acceptance/It is what it is.
Relaxation
One thing at a time– Focus on one thing, like breathing
Vacation—Take a time out
Encouragement—Positive and calming self-talk
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5
17. Emotional Regulation
Goals
Identify, label and understand emotions
Decrease unwanted emotional responses
Decrease emotional vulnerabilities
Skills
Identify and label emotions and their functions
Improve self-awareness
Conduct behavior chain analysis
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5
18. Emotion Regulation
COP—Police your thoughts
Check the facts
Opposite actions
Problem solving
Reduce Vulnerability ABC-P
Accumulate positives
Build mastery
Cope ahead of time
Physical vulnerability prevention (health, sleep,
exercise)
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5
19. Emotional Regulation
Behavior Chain Analysis
Name the behavior/reaction
Identify the prompting event
Identify behavioral links (sensations, thoughts, events,
feelings)
Short term positive and negative effects
Long term positive and negative effects
Address the problematic links with skills
Sensations/Actions—Distress tolerance
Thoughts/feelings– Emotional regulation
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5
26. VITALS to Success
Validate
Imagine the possibilities
Take small steps
Applaud yourself
Lighten your load
Sweeten the pot (rewards)
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5
27. Apply It
Practice these skills yourself
Which skills have you used or would have been
helpful for you in the past week?
Which skills might have been helpful for a client in
the past week
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5
28. Summary
Many disorders involve some amount of emotional
dysregulation
That dysregulation can be caused by high
sensitivity and reactivity due to:
Innate characteristics and poor environmental fit
External traumas and lack of support
DBT seeks first to help the person replace self-
defeating behaviors with self-care behaviors
Emotional regulation and interpersonal
effectiveness are addressed in the second phase
of treatment
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5
29. Summary
A variety of tools are imparted to clients to help
them
Set SMART goals
Identify and understand emotions and their functions
Decrease unwanted emotional and behavioral
responses
Develop a more effective, compassionate and
supportive relationship with self and others
Not every tool will work for every person. It
takes some experimentation
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5