2. Things that are better after DBT
Behaviors typically under Emotions under better
control control
Self-harming is decreased Mood labiality decreased
Visits to the hospital Better understanding of
decreased emotions
Impulsive behaviors and Less likely to act in
anger outbursts decreased emotion mind
Suicide attempts decrease,
but suicidal ideation
typically remains the same
3. Things that still need work
Clients can stop unwanted Ability to apply skills to real-
emotions, but still reluctant to life situations
feel emotions and allow them Know skills, but not sure what
to return to baseline naturally to use when
Unresolved trauma
Clients have learned to NOT While clients may “act” better,
think about the trauma they do not “feel” better
Creating and fulfilling
personal accomplishments Inability to obtain happiness
10 year longitudinal study in life
shows that while service use
decreased, BPD patients are When clients say, “I can’t be
never regain functional happy,” they may be right.
abilities Biofeedback studies indicate
More likely to stay on disability that BPD struggle to feel
Less likely to return to positive emotions
workforce, school or other
“productive” activities
4. Current aftercare programs
Very little available
Linehan addresses issue, stating that the current manual only
addresses Stage I
She recommends that for Stage II treatment, providers use
Exposure Therapy as developed by Edna Foa (manual
available)
However, may not be appropriate for all clients
Only addresses PTSD/trauma
Does not Stage III or Stage IV
5. Current aftercare programs
DBT ACES
(Accepting challenges of exiting the system)
Used in community mental health setting
Focused primarily on discontinuing treatment and reliance on
mh center
Secondary focus on employment/vocational rehabilitation
Little to no emotional regulation component
Only aftercare program to date with specific evidence
supporting effectiveness
6. Pilot studies
Multiple pilot studies about continuing DBT
Self-esteem focus
Assertiveness training focus
“Booster” sessions helpful at decreasing relapse
Adolescent graduate group model
Small scale study, little evidence behind it
For information on actual articles, please see Amy for the references
7. Creating a DBT graduate group
Areas of focus:
Emotional experiencing
Getting beyond stopping emotions, allowing self to feel
Unresolved trauma (better done in individual or trauma specific
treatment)
Generalizing and strengthening skills
Knowing what skill to use, when to use it and being able to apply it to
day to day problems
Building a life worth living
Developing and following through on goals that will make life better
Transitioning out of treatment
Providing a slow transition out of treatment
Helping to find supports outside the mh center
8. Emotional Experiencing
Allowing clients to feel emotions rather than block
them
Using the Ways to Describe Emotions from the
Emotion Regulation Module
Talking through each one, allowing for examples
Using guided imagery during the sessions to
experience emotions through to the end
9. Generalize and Strengthen Skills
Members can teach skills each week
Group chain analyses in which one member
describes a situation and other members offer
suggestions for skills use
Cope ahead plans
Preparing for emotions ahead of time and having skills ready
to use
10. Building a life worth living
Using skills to determine what they would like to
work on
Setting a goal
Breaking goals into manageable steps
Tracking goals
Following through on goals
Rewarding self for completing tasks
Being able to problem solve barriers
11. Transitioning out of therapy
Developing support systems outside therapist
Using Interpersonal Effectiveness Skills to create new
friendships or rekindle old ones
Developing activities outside attending therapy
How else could they use the time? What would they rather be
doing?
Using Pleasant Events Schedule to find more to do
Beginning to trust self and own decisions
Don’t need a therapist to work through every problem
Developing self-sufficiency in solving day to day dilemmas
12. New rules for graduate group
Attendance is flexible – come when you want
Can discontinue the group at any time
Can return at any time for “booster” sessions
Diary cards are optional, but each person must keep
a goal tracking sheet
Each person must commit to working on a goal
If no goal, cannot be in group
May need several weeks to determine goal
Focus of group remains skills based
Not a therapy group, any problems presented are to help
decide which skills to use
13. New rules for graduate group
Cannot be actively engaging in self-harming
behaviors
Cannot actively be using drugs/alcohol
Cannot have been in the hospital in the last three
months
Has to have successfully completed all four modules
of the DBT skills group
14. New rules for graduate group
Facilitators take less active role
Facilitators are there as consultants
Facilitators may help keep group on track, but group members
are responsible for decisions about group activities
Clients are encouraged to “act as the expert”
On the skills and mindfulness
On their own needs, wants, desires and hopes
15. Structure of Group
Mindfulness Activity
Led by group member
Skills Review
Skill taught by group member
Client choice
Work on goals/goal worksheets
One member presents chain analysis and receives feedback
Emotional experiencing
Discussing aspects of different emotions
Group wrap up
Weekly commitments (What do you agree to work on?)
Closing mindfulness activity
Led by group member
16. Worksheets and Homework
All worksheets and directions for creating and
developing goals can be found on the client website
at:
http://www.jcmh.org/DBT/Graduate/graduate.cfm
