Dialectic Behavior

Therapy
Lindsay Popilskis, Ms.Ed.
 Dialectic Behavior Therapy
Zen/Buddhism Cognitive Behavioral
Mindfulness techniques Therapy
Acceptance Change
 Dialectical Behavioral Therapy (DBT) is a type of cognitive-behavioral
therapy developed by Marsha Linehan, Ph.D that also encompasses
Eastern mindfulness and meditative practices.

 Designed to directly target psychotherapy patients who had a history

of suicidal thoughts and behaviors, who self-injured, and/or who had
extreme difficulty in managing their emotions.
 CBT
DBT
 CBT therapists:
– aim to solve emotional & behavioral difficulties through a goal-oriented,
systematic approach.
– help students/clients/patients understand how their thoughts & beliefs impact
their behaviors & vice-versa.

 DBT therapists also:

– promote the idea that change is constant and inevitable
– help clients achieve self-acceptance to bring about positive changes
– believe that with ample validation, patients are more likely to cooperate and
less likely to suffer distress at the idea of change
– confirm that clients’ actions "make sense" within the context of their personal
experiences without necessarily agreeing that those are the best approach
to solving the problem or dealing with life
 DBT is based upon the following
assumptions:
 Because of biological factors and/or unhealthy
environments in childhood, the person has developed
an inability to regulate emotional responses.
 Emotional arousal in these students/patients increases
very quickly, peaks at a high level, and takes a long
time to return to “normal” or baseline level.
 Self-destructive behaviors are efforts at coping with
intense and negative emotions, and no other effective
means of coping has been learned.
 Overview of DBT Skills

4 Basic Modules for Individual and

Group Therapy:
1. Mindfulness

2. Interpersonal Effectiveness

3. Emotion Regulation

4. Distress Tolerance
 1) Mindfulness
 Refers to the quality of:
– Attention
– Awareness
– Presence that one brings to every day life
 Reaction to Event:
– Observe  Describe  Participate
 Mindfulness (cont.)
Observing/Describing
 Experience without reacting to the experience
– Focus on the "what", not the "good" or the "bad", the "terrible" or the
"wonderful", the "should" or the "should not.“
– Unglue opinions from the facts, from the who, what, when and where.
 See others' actions and expressions.
– Stay away from "fair" and "unfair," "right" and "wrong,"
"should" and "should not."
 Mindfulness Techniques
for Students
Specific Example: "No one likes me," “My teacher hates me,” “I am going to fail this
exam.”
– Goal of School Psychologist: Have students describe the event and put their
feelings about the event into words to help them figure out whether their
thoughts /feelings actually fit the situation.
– To Do This: Help Students to Identify if they:
 Have any physical symptoms - sweaty hands,  butterflies in their stomach,
etc.?  
 What are their thoughts and feelings?: “What are you thinking about this
exam?” “How do you feel about this exam?”   “Are these thoughts actually
connected to this exam? “  “Are your feelings actually connected to the
outcome of this exam? Remember that you don't know the outcome yet!”
– Describing those thoughts and feelings helps students to realize their
thoughts are real. But, they are not ‘the event’ and those feelings do not
necessarily explain or predict events in their lives.
 
 Mindfulness Techniques
for Students (cont.)

General Example for Skills Training:

-“Today pick one experience that you have - walking your dog
after school, watching a TV show, etc.  Observe the experience,
without judging or evaluating it. Describe what you are doing or
seeing.  What are you hearing or touching?”
- “Do you feel something? Give words to your feelings. Keep them
free of judgments. Are your thoughts and feelings about the
experience actually separate from the experience itself?”
- Have students keep a journal for a day or several days, recording
their experiences and what they observe. They should also
observe their feelings and describe them on paper. If they feel
comfortable, they could share their journal, or parts of it, with the
group.
 Mindfulness (cont.) –
Participate
 Students allow themselves to get involved in the
moment and enter into experiences.
 Do just what is needed in each situation – don’t go
overboard.
– Meet the needs of the current situation- not the situation
student wishes to be in.
 If other actions, or thoughts, or strong feelings
distract them, let go of distractions and go
back to what they were doing-- again and
again and again.
– Let go of vengeance, useless anger, and
righteousness that hurts the student and doesn't
work or is counterproductive. 
 2) Interpersonal
Effectiveness
Interpersonal response patterns taught in DBT skills training are
very similar to those taught in many assertiveness and
interpersonal problem-solving classes. They include effective
strategies for:
 asking for what one needs
 balancing priorities (students’ needs) with others’
demands (others’ needs)
 saying no when appropriate and being taken
seriously
 coping with interpersonal conflict
 effectively maintaining & improving relationships
Interpersonal Effectiveness Skills
Guidelines for Maintaining a Relationship
(taught & then practiced in a group & for
homework)
 Be Gentle
 Act Interested
 Validate
 Easy Manner
 3) Emotion Regulation
 Teaching students to:
– Identify and label emotions (mindfulness –
observe/describe) as well as realize that emotions
communicate and influence others (e.g., facial
expressions).
– Use emotions to organize and motivate actions
 Emotions can be self-validating (e.g. “If student attends
extra help and attains a better grade on her next test, she
now feels successful & his/her confidence is increased
because she knows how to help herself. )
– Identify obstacles to changing emotions (e.g.,
environment; sibling issues)
– Increase positive emotional events
 Methods for Increasing Positive Emotions
 BUILD POSITIVE EXPERIENCES
– Short Term:
 Do pleasant things that are possible now.
 Increase pleasant events that prompt positive emotions (e.g., sports)
– Long Term
– Work towards goals: ACCUMULATE POSITIVES
– List small steps towards goals
– Take the first step!!!

 ATTEND TO RELATIONSHIPS
– Repair old relationships
– Work on current relationships
– Reach out for new relationships

 AVOID AVOIDING
Avoid giving up

 BE MINDFUL OF POSITIVE EXPERIENCES

– FOCUS attention on positive events that happen
– REFOCUS when mind wanders to the negative
 4) Distress Tolerance
 Distress tolerance behaviors are
used for:
– Accepting life as it is in the
moment
– Tolerating and surviving crises

 Distress Tolerance helps

students to feel better, and as
they feel better and productive,
their self esteem rises.
 Distress Tolerance
Distraction, Self-soothing
 Activities
 Contributing
 Comparisons
 Emotions
 Pushing Away
 Thoughts
 Sensations
 Distress Tolerance
Distraction, Self-soothing
 Imagery
 Meaning
 Prayer
 Relaxation
 One thing at a time
 Vacation
 Encouragement
 References
 American Psychiatric Association. (2001). Practice
guideline for the treatment of students with borderline
personality disorder. American Journal of
Psychiatry, 158(Suppl. 10), 152.
 American Psychological Association. (1998). Update on
empirically validated therapies: II. The Clinical
Psychologist , 51, 3 16
 Bagge, C., Stepp, S., & Trull, T. J. (2005). Borderline
personality disorder features and utilization of treatment
over two years. Journal of Personality Disorders , 19,
420439.
 Blais, M. A. (2005, March). SOS-10: Update on a brief
mental health outcome measure . Paper presented at the
annual convention of the Society for Personality
Assessment, Chicago.
 Blais, M., Lenderking, W., Baer, L., deLorell, A., Peets,
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 Deisinger, J. A., Cassisi, J. Paris J. (2002) Chronic
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 Linehan, M. M. (1993a). Cognitive behavioral therapy of
borderline personality disorder . New York: Guilford
Press.
 References (cont).
 Linehan, M. M. (1993b). Skills training manual for treating borderline personality
disorder . New York: Guilford Press.
 Linehan, M. M., Armstrong, H., Suarez, A., Allmon, D., & Heard, H. (1991). Cognitive-
behavioral treatment of chronically parasuicidal borderline students. Archives of
General Psychiatry, 48, 10601064.
 Linehan, M. M., Schmidt, H., Dimeff, L. A., Craft, J. C., Kanter, J., & Comtois, K. A.
(1999). Dialectical behavior therapy for students with borderline personality disorder
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 Perseius K.I., Öjehagen A., Ekdahl S., et al. (2003) Treatment of suicidal and deliberate
self-harming students with borderline personality disorder using dialectical
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 Stone M.H. (1993) Long-term outcome in personality disorders. British Journal of
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 Thomsen S., Soares J., Nolan P., et al. (1999) Feelings of professional fulfillment and
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Questions?