DIALECTICAL

BEHAVIOR
THERAPY
Shervin T.
 Dialectical Behavior Therapy
(DBT)

Dialectical behavior therapy is a broad

based cognitive behavior therapy that
has been specifically designed for clients
with Borderline Personality Disorder.
DBT conceptualizes a biosocial theory of
borderline personality disorder with a
skills deficit and problem solving model.
 DBT Organization of Deficits

Emotional Dysregulation: Affective lability,

problems with anger
Interpersonal Dysregulation: chaotic
relationships, fears of abandonment
Self Dysregulation: identity disturbance/
difficulties sense of self/ sense of emptiness
Behavioral Dysregulation: parasuicidal behavior
impulsive behavior
Cognitive Dysregulation: dissociation responses/
paranoid ideation
 What is Dialectics?
Dialectics is a cooperative exercise
between two people with opposing views.
Instead of battling it out until one view is
taken to be the right one, the aim of
dialectics is for both parties to search for
an answer that satisfies the problem from
both points of view.
Its about finding the Both/And not the
And/Or
 Biosocial Model

Biological Principals
Linehan's theory is based on emotional
dysregulation which is produced by an
emotional vulnerability and maladaptive
and inadequate emotional modulation
strategies.
 Biosocial Model

Emotional Invalidating
Vulnerability Environment

Pervasive Emotional
Dysregulation
 Biological Principals cont
A person who is emotionally vulnerable is
someone whose automatic nervous system
reacts excessively to relatively low levels of
stress and takes longer to return to normal levels
of arousal once the stressor has been removed.

Emotion dysregulation is seen as a result in the

transaction between the biological disposition
and the environment.
 Environmental Principles
Invalidating Environment refers essentially to
the situation where personal experiences and
responses of the growing child are
invalidated by care givers in their life.
The childs personal communications are not
accepted as an accurate indication of her
true feelings.
The invalidating environment contributes to
emotion dysregulation by failing to teach the
child to label and moderate arousal, to
tolerate distress, or trust her own emotion
responses as valid interpretations of events.
Biological Principles cont

Emotion Vulnerability

+
Maladaptive, inadequate emotion regulation
strategies

EMOTIONAL DYSREGULATION
Components of DBT
1:1
SESSIONS

TELEPHONE
OTHER
SUPPORT
PROFESSIONALS
9am-9pm

DBT

SKILLS TEAM
TRAINING MEETING
 Skills Training in DBT
There are 4 skills taught in DBT skills training:

Mindfulness
Interpersonal effectiveness
Distress tolerance
Emotion regulation
 Skills Training in DBT
Skills training has two primary goals:

1) Communicate information about particular

coping strategies to clients
2) Elicit from clients rules and strategies for
effective coping that they have learned in the
particular situation they encounter
 Mindfulness Skills
Mindfulness is central for DBT

It is the first skill taught and listed on the diary card

Mindfulness skills are taught at the beginning of each
module
The skills are a psychological and behavioral version
of Eastern meditation that has been drawn from ZEN.
Mindfulness DBT looks at three primary states of mind
Mindfulness Skills cont

Wise mind

Emotional mind Reasonable mind

 Mindfulness Skills cont.

What skills How skills

Observe Non- judgmental

Describe One mindfully
Participate Effectively
Interpersonal Effectiveness Skills
DBT Interpersonal Effectiveness skills are similar
to those skills taught in assertiveness training
and interpersonal problem solving classes.
The skills taught assist group members in:
ASKING WHAT ONE NEEDS TO SAY NO TO;
COPING WITH CONFLICTS.
The term effectiveness in DBT means
obtaining changes that one wants,
maintaining the relationship and maintaining
your self respect.
 Emotion Regulation Skills
The first step in emotional regulation is learning to
identify emotions. To do this clients have to learn to
observe and describe:

1) The event prompting the emotion

2) The interpretation of the event that prompted the
emotion
3) The phenomenological experience (including
physical sensations)
4) The behavior expressing emotion
5) The after effects of the emotion on others types
of functioning
 Emotion Regulation Skills cont

Skills covered:
identify obstacles to changing emotions
reducing vulnerability to Emotional Mind
increasing positive emotional events
increasing mindfulness to current emotions
taking the opposite action
applying distress tolerance techniques
 Distress Tolerance Skills
The distress tolerance behaviors targeted in DBT skills
training are concerned with tolerating and surviving
crisis and with accepting life as it is in that moment

Four sets of skills are taught;

1) Distraction
2) Self soothing
3) Improve the moment
4) Thinking of pros and cons
 Phone Coaching

The aim of telephone coaching is to help clients

refocus and use skills

Problem solve
Highlight shame
Validate
Use radical acceptance