DBT Slides

Overview

• Chain Analysis of self-harming behaviours
• Behavioural Analysis of self harming behaviours
• Vulnerability Factors
• Immediate Precipitating Events
• Dysfunctional Links:
  • Skills deficits
  • Problematic emotions
  • Dysfunctional cognitions
• Consequences:
  • Reinforcers of dysfunctional behaviours
  • Failures to reinforce more functional behaviours:
• Dialectical Behaviour Therapy:
• Primary Treatment Target
  • Behaviours to decrease
  • Behaviours to increase
• Secondary Targets
  • Therapy-interfering
  • Quality of Life-interfering
• DBT Summary Points

Chain Analysis of self-harming behaviours

Behavioural Analysis Of Self-Harming Behaviours

Vulnerability factors

• Lives alone, reduced contact wife / children.
• ISOLATION.
• Easy access to alcohol / prescribed medication..
• Unstructured time alone (temporary loss of employment).
• Loss of contact with colleagues.
• Poor sleep.
• Post-traumatic memories (images, dreams).
• Distress & hyper arousal
• Distress intolerance.
• Risk factors for suicidal behaviour

Immediate Precipitating Events

• Mood cycling & cognitive dys-regulation (mind racing).
• Feelings of abandonment.
• Anger to self; Guilt, self-blame, self-invalidation.
• Feelings of hopelessness.

Dysfunctional Links:

Skills deficits:

• poor ability to access support / communicate needs
• Difficulty regulating emotions / tolerating distress.
• poor self / behavioural management.

Problematic emotions:

• Guilt, self-blame, anger to self, agitated distress.

Dysfunctional cognitions:

• "I've lost everything / I'm losing it".
• "My life is shit".
• "Family would be better off without me".
• "It's my fault.. I could have prevented it".
• "My life is going down the tubes".
• "Eventually, I'll be alone"
• "Everything I have contact with falls apart".

Consequences:

Reinforcers of dysfunctional behaviours:

• Relief of distress, reduced arousal, mind clearing.
• Manages to switch off for a while.
• Punishment - feels this is deserved
• Validates negative core schemas.

Failures to reinforce more functional behaviours:

• No immediate alleviation of distress.
• Doesn't feel deserving of more rewarding alternatives.
• Wife won't speak to him if he has been drinking.
• Contact with children not easily arranged.
• Difficulty approaching old friends - "They won't understand".

DIALECTICAL BEHAVIOUR THERAPY

Primary Treatment Targets

Secondary Targets

Therapy-interfering:

• Active-passivity . Active problem solving.
• Erratic attendance.
• Ambivalent motivation.
• Self-management skills.
• Dissociative tendencies . Mindfulness.
• Unremitting crises.
• Alcohol use.
• (?)Any therapy-interfering behaviours of therapist.

Quality of Life-interfering:

• Alcohol use . Emotion regulation.
• Depressive behaviours . Distress tolerance.
• Panic attacks .
• Dissociation.
• Post-Traumatic symptoms.
• Forensic.

DBT Summary Points

• Stability, Safety, Skills.
• Validate Trauma -"radically accept".
• No direct focus on Trauma memories.
• "Here and now"
• Focus on minutia / in-session behaviour.
• Structured, thorough, long-term.