DBT IN GROUP THERAPY

HEATHER VENTURA-WITCHER, M.S.

 COGNITIVE THEORY

• Perceptions and/or thoughts influence emotional and behavioral reactions

• Faulty information processing → distorted thinking → psychopathology
• Identify automatic thoughts
• Altering thinking patterns to better reflect reality

Beck, 1993; McLeod, 2019

COGNITIVE THEORY

Thoughts Feelings
create create
feelings behaviors

Behavior
reinforces
thoughts

Beck, 1993; McLeod, 2019

COGNITIVE THEORY

• Cognitive therapy
• Problem-solving therapy
• Dialectical behavior therapy
• Rational-emotive behavior therapy
• Cognitive processing therapy
• Cognitive-behavioral analysis

Guadiano, 2019
DISTORTED BELIEFS

• All-or-nothing thinking
• Overgeneralization
• Disqualifying the positive
• Mind-reading
• Fortune telling
• Catastrophizing
• Minimizing
• Emotional reasoning.

Beck, 1993; McLeod, 2019

THIRD WAVE CBT

• Minimizes/excludes disputing cognitive distortions

• Relies more on acceptance-based strategies
• Places heavier emphasis on changing/controlling behaviors
• Often times addresses avoidance patterns

Guadiano, 2019
DIALECTICAL BEHAVIORAL THERAPY

• Originally developed to address chronic suicidal ideation and self-harm behaviors

• First evidence-based treatment for Borderline Personality Disorder
• Emphasizes over-/under-control of emotions
• Focuses on changing behaviors
• Can be effective in treating disorders of emotion dysregulation

Linehan, 2014
DIALECTICS

• 2 definitions:
• Part of the fundamental nature of reality
• Philosophical basis of DBT

• Component of persuasive dialog in relationships

• Strategies used to create change

Linehan, 2014
DIALECTICS

• 3 primary characteristics:
• Stresses interrelatedness in reality
• Focuses on individual parts unless otherwise indicated

• Reality is not static

• Composed of opposing forces
• Therapist’s job is to help clients synthesize

• Nature of reality is constantly changing

• Content/structure is not always present in reality

Linehan, 2014
EMOTION MODEL

• Emotional responses involve the interaction of:

• Vulnerability to external cues
• Internal events that act as cues
• Interpretation of cues
• Behavioral patterns of response
• Verbal and nonverbal responses
• Any after-effects (i.e. secondary emotions)

Linehan, 2014
EMOTION MODEL
Emotion Dysregulation
• Excess of negative experiences
• Inability to regulate arousal
• Inability to ignore emotional cues
• Cognitive distortions
• Impulse control problems
• Possibility of dissociation
Emotion Regulation
• Effective impulse control
• Ability to behave effectively
• Not mood-dependent
• Ability to self-soothe
• Distract when strong emotions
are present
Linehan, 2014
BIOSOCIAL THEORY

Inaccurate/
extreme
expression

Heightened
emotional
arousal BPD Invalidation

Linehan, 2014; Lis et al., 2007

BIOLOGICAL FACTORS

• Intense reactivity of the limbic system

• Variation in processing serotonin
• Smaller hippocampus and amygdala
• Slow glucose metabolism
• Less activity in the prefrontal cortex

• *These factors + negative learning experiences = an increased risk for BPD

Linehan, 2014; Lis et al., 2007

SOCIAL FACTORS

• An invalidating environment
• Emotions act as a rapid communication system
• Invalidation shows that the message was not received
• Behaviors escalate as a result
• An inability to model appropriate expressions/emotions
• Reinforcement for emotional arousal
• Poor fit between child temperament and parenting style of caregiver

Linehan, 2014
DBT MODULES

• Mindfulness
• Emotion Regulation Skills
• Interpersonal Effectiveness Skills
• Distress Tolerance Skills

Linehan, 2014
MINDFULNESS Wise Mind

Emotion
Mind Reasonable
Mind

Linehan, 2014
MINDFULNESS

What Skills How Skills

•Observe •Nonjudgmentally
•Describe •One-mindfully
•Participate •Effectively

Linehan, 2014
EMOTION REGULATION

Radha, 2020
EMOTION REGULATION: CHECK THE FACTS

Event Thoughts Emotions

Event Emotion Thoughts

Linehan, 2014
EMOTION REGULATION: CHECK THE FACTS

• What is the emotion I want to change?

• What prompted my emotion?
• What are my thoughts, assumptions, and interpretations about what happened?
• Am I assuming a threat is present?
• Does my emotion/reaction fit the facts?
• Is there really a catastrophe?

Linehan, 2014
EMOTION REGULATION: OPPOSITE ACTION

• Identify the emotion you want to change

• Check the facts first
• Identify the urges that are present with the emotion
• Identify opposite actions
• Engage in the opposite action
• Repeat until your emotion changes

Linehan, 2014
EMOTION REGULATION: PROBLEM SOLVING

• Figure out/describe the problem

• Check the facts
• Identify the goal(s)
• Brainstorm multiple solutions
• Choose the best fitting solution
• Implement the solution
• Evaluate the results
• Repeat as needed until the problem is fixed

Linehan, 2014
INTERPERSONAL EFFECTIVENESS: DEAR MAN

• Describe the situation

• Express your feelings/opinions
• Assert yourself
• “Reinforce” the person ahead of time

• stay Mindful

• Appear confident
• Negotiate

Linehan, 2014
INTERPERSONAL EFFECTIVENESS: GIVE

• Gentle
• act Interested

• Validate
• use an Easy manner

Linehan, 2014
INTERPERSONAL EFFECTIVENESS: FAST

• be Fair

• no Apologies

• Stick to values
• be Truthful

Linehan, 2014
DISTRESS TOLERANCE: STOP

• Stop (do NOT just react out of impulse)

• Take a step back from the situation
• Observe internal and external experiences
• Proceed mindfully

Linehan, 2014
DISTRESS TOLERANCE: PROS AND CONS

• Used to help make a decision between 2 options

• Complete a pros and cons for habitual urges/behavior
• Complete a pros and cons BEFORE a crisis occurs
• When in crisis, review your pros and cons

Linehan, 2014
DISTRESS TOLERANCE: TIP(P)

• Tip the temperature

• Hot or cold

• Intense exercise
• Paced breathing
• Diaphragmatic breathing
• Breathe out more slowly than breathing in

• Paired muscle relaxation

Linehan, 2014
DISTRESS TOLERANCE: SENSORY SELF-SOOTHING

• Use physical sensation as a distraction from a crisis

• 5 senses exercises:
• Name 5 things you can see
• Name 4 things you can feel
• Name 3 things you can hear
• Name 2 things you can smell
• What is one thing you can taste?

Linehan, 2014
DISTRESS TOLERANCE: RADICAL ACCEPTANCE

• Completely accepting reality

• Life isn’t going to go the way we want it too
• Rejecting reality causes more distress and does NOT lead to change
• Everything is temporary

Linehan, 2014
REFERENCES
• Beck, A. T. (1993). Cognitive therapy: Past, present, and future. Journal of Consulting Clinical Psychology
• Gaudiano, B. A. (2013). Cognitive-behavioral therapies: Achievements and challenges. Evidence Based
Mental Health, 11(1), 5-7.
• McLeod, S. (2019). Cognitive behavioral therapy. Retrieved from simplypsychology.org/cognitive-
therapy.html
• Linehan, M. M. (2014). DBT skills training manual (2nd ed.). New York, NY: Guilford Press.
• Lis, E., Greenfield, B., Henry, M., Guilé, J. M., & Dougherty, G. (2007). Neuroimaging and genetics of
borderline personality disorder: A review. Review of Psychiatric Neuroscience, 32(3), 162-173.
• Radha, C. (2020). The Junto wheel: Why and how we use it. Retrieved from
thejuntoinstitute.com/blog/the-junto-emotion-wheel-shy-and-how-we-use-it