DBT Mindfulness Training Guide

DBT Training Study Guide

• Mindfulness is a core component of Dialectical Behavior Therapy (DBT), focusing on awareness and intentionality in thoughts and actions. It helps individuals recognize distractions and return their focus to the present moment.

Structure of Mindfulness Practice

• Hook: Start with a personal story related to the mindfulness practice to engage participants.
• Relatability: Highlight how the story connects to feelings of dysregulation or frustration, making it relatable.
• Effective Conclusion: Ensure the story ends with a positive outcome, demonstrating the effectiveness of the skill being taught.

Mindfulness Practice Example

• An example of mindfulness practice can involve grounding oneself when feeling overwhelmed.
• Participants should identify their goals for the session and reflect on what they want to achieve.

Key Concepts in Mindfulness

• Awareness: Mindfulness is about recognizing when attention drifts and consciously bringing it back.
• Monkey Mind: This metaphor describes the restless nature of thoughts, emphasizing the importance of training the mind to focus intentionally.

Understanding Dysregulation

• Emotional Dysregulation: Characterized by intense emotional fluctuations, often misdiagnosed as bipolar disorder. It involves rapidly changing feelings, indicating emotional lability.
• Interpersonal Dysregulation: Difficulties in relationships, including fear of abandonment and chaotic attachments.
• Self-Dysregulation: Identity disturbances and feelings of emptiness, often observable in children and adolescents.
• Behavioral Dysregulation: Out-of-control behaviors such as self-harm or substance use, often used as avoidance strategies for emotional distress.
• Cognitive Dysregulation: Distorted thinking patterns, including black-and-white thinking and paranoid interpretations of neutral stimuli.

DBT's Approach

• DBT combines validation with change strategies, ensuring individuals feel understood before introducing skills for change.

DBT Study Guide - Key Concepts

• DBT Skills: Dialectical Behavior Therapy (DBT) emphasizes the importance of teaching skills while helping students tolerate their emotions.

DBT for Adolescents and Children

• Parent Involvement: DBT for adolescents includes parent coaching to address the home environment's influence on a child's behavior.
• Adaptation for Younger Children: Skills are simplified for younger children, focusing more on caregiver training than on the children themselves.
• Core Assumptions in DBT—Best Efforts: Patients are doing the best they can given their circumstances, and there is always room for improvement.
• Hope and Improvement: Instilling hope is crucial for effective treatment, leading to significant improvements in mental health.
• Fallibility in Therapy: Therapists must maintain humility and recognize they may not have the full picture for effective treatment.

Key Components of DBT for Children

• Parent Involvement: DBT for children includes a significant parent component for treatment success.
• Target Hierarchy: DBT focuses first on life-threatening behaviors (self-harm, suicidal ideation), then on treatment or school-interfering behaviors, and therapeutic goals.

DBT Training - Part 2 Notes

• Chain Analysis: A method to understand the sequence of events leading to a behavior, identifying prompting events, thoughts, emotions, and urges.
• Steps in Chain Analysis: Identify the behavior, determine the prompting event, explore thoughts and emotions, engage in role play to understand the child's perspective and feelings, and assess consequences.
• Example Case (Sarah's Behavior): Illustrates a practical application of chain analysis where Sarah cussed at her teacher.

DBT for Children

• Biosocial Theory: Explains behavior through the interaction of biological and environmental influences; both nature and nurture play a role.
• Individual Therapy: Sessions are adapted for children to teach skills without using the term "skills" to avoid negative associations.
• Goals in DBT for Children: Focus on the child's goals rather than solely on the therapist's or school's goals.
• Teaching Strategies: Use relatable examples to explain concepts like high sensitivity and emotional reactivity, engage parents in understanding children's needs and validating feelings.

Tools and Techniques

• Diary Cards: Simplified tools for children, often using emojis to gauge emotions.
• Dragon Chain Analysis: Helps children understand the connection between thoughts, emotions, and behaviors.
• Emotional Wave: Emotions peak and subside, helping children understand that emotions are temporary.
• STOP Skill: Stands for stop, take a step back, observe, and proceed mindfully (consider consequences).
• States of Mind: Emotion Mind (impulsive actions), Reasonable Mind (logic), Wise Mind (balance of emotion and reason).
• Mindfulness in DBT: Focuses on recognizing emotions and behaviors consciously, attuned to the present moment without judgment.
• Skill Building: Encourages full engagement in activities.

Non-Judgmental Practice and Distress Tolerance

• Non-Judgmental Stance: Helps children to describe situations factually, promoting emotional regulation and communication.
• Distress Tolerance Module: The objective is to get through difficult moments without making the situation worse.
• Key Skills: Willingness vs. Willfulness, Self-Soothing, Skillful Distraction, Radical Acceptance.

Application – Emotional Regulation Skills

• Application: Encouraging patients to identify behaviors in a way that aligns with their reality.
• Emotional Regulation Goals: Transitions from distress tolerance to emotion regulation, where individuals can manage their emotions.
• Techniques: Surfing the Wave, Opposite Action
• Interpersonal Effectiveness: Balancing personal needs with maintaining healthy relationships using the DEAR skill (describing, expressing, asking, rewarding).
• Lifestyle Factors: Emphasize physical health, positive experiences, and avoiding substances to promote greater emotional well-being.