DBT Training - OCDE 10/8 Study Guide PDF

DBT Training - OCDE 10/8 Dr. Faria Kamal, Ph.D. FSD Members Present: Tanya Gustin, Tina Maldando, Jessica Pappas **Study Guide for DBT Mindfulness Practice** **Overview of Mindfulness in DBT** - Mindfulness is a core component of Dialectical Behavior Thera...

DBT Training - OCDE 10/8 Dr. Faria Kamal, Ph.D. FSD Members Present: Tanya Gustin, Tina Maldando, Jessica Pappas **Study Guide for DBT Mindfulness Practice** **Overview of Mindfulness in DBT** - 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** 1. **Hook**: Begin with a personal story related to the mindfulness practice to engage participants. 2. **Relatability**: Highlight how the story connects to feelings of dysregulation or frustration, making it relatable for participants. 3. **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. **Observations Post-Practice** - After mindfulness practice, participants should share observations about their thoughts, feelings, and urges. This helps in recognizing patterns and understanding emotional responses. **Understanding Dysregulation** - **Emotional Dysregulation**: Characterized by intense emotional fluctuations, often misdiagnosed as bipolar disorder. It involves feelings that can change rapidly, 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 that individuals feel understood before introducing skills for change. **Conclusion** - The guide emphasizes the importance of mindfulness in DBT, providing a structured approach to practice and the significance of recognizing and addressing various forms of dysregulation in individuals. **DBT Study Guide** **Key Concepts** - **DBT Skills**: Dialectical Behavior Therapy (DBT) emphasizes the importance of teaching skills while also helping students tolerate their emotions. It's crucial not to solely rely on skills to avoid feelings, as this can lead to emotional numbness and maladaptive coping strategies. - **Acceptance and Change**: A foundational dialectic in DBT is the balance between acceptance and change. This means recognizing the validity of a student's feelings while also encouraging growth and improvement. - **Validation**: Validating emotions is essential, especially when students are distressed. This involves acknowledging their feelings without endorsing ineffective behaviors. **Important Strategies** - **Managing Dysregulation**: When students exhibit high arousal or dysregulated behaviors, start with validation of their emotions before attempting to implement change. This helps lower their emotional intensity and fosters collaboration. - **Addressing "I Don't Know" Responses**: When students frequently respond with "I don't know," assess the underlying reasons. This could indicate a lack of knowledge, a desire for solitude, or fear of consequences. **DBT Components** 1. **DBT Skills Group**: A structured group setting where students learn and practice DBT skills over an extended period (typically 6 months to a year). 2. **Individual Therapy**: Weekly sessions focused on increasing motivation and commitment to personal goals. 3. **Phone Coaching**: Provides real-time support for students to practice skills in their daily lives. This is a brief interaction aimed at reinforcing skills rather than functioning as therapy. 4. **Consultation Teams**: Support for therapists to prevent burnout and ensure effective treatment delivery. **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 in students is crucial, as effective treatment can lead to significant improvements in their mental health. - **Fallibility in Therapy**: Therapists must maintain humility and recognize that they may not have the full picture, which is vital for effective treatment. Key Components of DBT for Children ​ Parent Involvement: DBT for children includes a significant parent component, which is essential for the treatment's success 1. Caregivers are treated as primary patients, emphasizing their role in the therapeutic process 2. ​ Target Hierarchy: DBT has a unique target hierarchy, focusing first on life-threatening behaviors (self-harm, suicidal ideation) 3. The second target addresses treatment or school interfering behaviors, and the third encompasses all other therapeutic goals 4. Treatment Structure ​ Skills Training and Psychoeducation: Skills training is often conducted in both group and individual settings to ensure comprehension 5. Psychoeducation focuses on emotions and is adapted for children's understanding 6.  ​ Commitment to Treatment: Commitment from parents is crucial before starting DBT 7. This pre-commitment helps avoid future challenges during treatment 8. Understanding Emotional Sensitivity ​ Super Sensors: Children in DBT are often referred to as "super sensors," indicating their heightened emotional sensitivity 9. They react strongly to minor stimuli, which can lead to intense emotional responses 10. ​ Double Gravity Effect: Super sensors experience a "double gravity effect," where they hold both stressors and their emotional reactions, making their experiences uniquely challenging 11. Psychoeducation for Parents ​ Iceberg Metaphor: The iceberg metaphor illustrates that only a small portion of a child's emotional experience is visible, emphasizing the importance of understanding their internal struggles 12. ​ Highlighting Strengths: It's essential to communicate the advantages of emotional sensitivity, such as enhanced empathy and creativity, to both children and parents 13. Behavioral Analysis ​ Core Problem Analysis: This analysis helps identify the function of behaviors in children, allowing for tailored interventions 14. Understanding the meaning assigned to behaviors is crucial for effective treatment 15. ​ Chain Analysis: This involves examining specific incidents to understand the links between behaviors and their underlying causes 16. It is essential to differentiate between various functions of behaviors to provide appropriate interventions 17. Conclusion  ​ The training emphasizes the importance of understanding children's unique emotional experiences and the necessity of involving parents in the therapeutic process to foster effective treatment outcomes. DBT Training - Part 2 Notes Functional Analysis of Behavior ​ Chain Analysis: A method to understand the sequence of events leading to a behavior. It involves identifying the prompting event, thoughts, emotions, and urges that contribute to the behavior. ○​ Example: Cursing in the classroom can be analyzed by identifying the prompting event (e.g., teacher asking to sit quietly) 18. Steps in Chain Analysis ​ Identify the Behavior: Start with the behavior in question (e.g., cursing). ​ Determine the Prompting Event: Identify what triggered the behavior (e.g., teacher's instruction) 19. ​ Explore Thoughts and Emotions: Discuss what the individual was thinking and feeling at each step leading to the behavior 20. ​ Role Play: Engage in role play to better understand the child's perspective and feelings 21. Example Case: Sarah's Behavior ​ Behavior: Cursed at the teacher. ​ Prompting Event: Teacher asked her to sit down 19. ​ Thoughts: Felt thirsty and annoyed by peers 22. ​ Emotions: High levels of annoyance and anger. Consequences of Behavior ​ Assess the consequences of the behavior on the individual and their environment. For instance, Sarah felt embarrassed after cursing 23. DBT for Children ​ Biosocial Theory: Explains behavior through the interaction of biological factors and environmental influences. It emphasizes that both nature and nurture play a role in shaping behavior 24. ​ Individual Therapy: Sessions are adapted for children, focusing on teaching skills without using the term "skills" to avoid negative associations 25. Goals in DBT for Children ​ Focus on the child's goals (e.g., feeling less embarrassed, making friends) rather than solely on the therapist's or school's goals 26. Teaching Strategies ​ Use relatable examples to explain concepts, such as high sensitivity and emotional reactivity through storytelling 27. ​ Engage parents in understanding their child's needs and the importance of validating their feelings 28. Conclusion of Training Session ​ Emphasize the importance of understanding the function of behaviors and the need for effective interventions tailored to individual children's experiences and needs 29. **Understanding Emotions in Children through DBT** **Key Concepts** - **Emotional Awareness**: Helping children identify their feelings is crucial for emotional regulation. Using tools like *emotion cards* and *emotion wheels* aids in this process. - **Individualization**: Tailoring emotional identification tools to children's interests, such as using familiar characters (e.g., Cocomelon) or memes (e.g., Drake), makes the process relatable and effective. **Tools and Techniques** - **Diary Cards**: These are simplified for children, often using emojis to gauge emotions instead of complex metrics used for adults. - **Dragon Chain Analysis**: This activity helps children understand the connection between thoughts, emotions, and behaviors through a fun, engaging format. Dragon Chaining **DBT Skills for Children** 1. **Emotion Wave**: Emotions are likened to waves, emphasizing that feelings peak and eventually subside. Teaching children that no feeling is permanent helps them manage intense emotions. 2. **STOP Skill**: This acronym stands for: - **S**top: Freeze and do nothing. - **T**ake a step back: Reflect on the situation. - **O**bserve: Notice internal and external cues. - **P**roceed mindfully: Act with awareness and consider the consequences. **States of Mind** - **Emotion Mind**: Represents feelings and urges, often leading to impulsive actions. - **Reasonable Mind**: Focuses on facts and logic, devoid of emotions. - **Wise Mind**: A balance of both emotion and reason, allowing for informed decision-making. **Mindfulness in DBT** - Mindfulness is the foundational skill in DBT, enabling children to recognize their emotions and behaviors consciously. It involves paying attention to the present moment without judgment. **Skill Building** - **Participate Skill**: Encourages full engagement in activities, even when they seem unappealing, to enhance enjoyment and effectiveness. - **Nonjudgmental Stance**: Teaching children to describe situations factually rather than judgmentally helps in emotional regulation and communication. **Conclusion** The integration of these concepts and skills in DBT provides children with the tools they need to understand and manage their emotions effectively, fostering better emotional regulation and interpersonal relationships. **Key Concepts in Non-Judgmental Practice and Distress Tolerance** **Non-Judgmental Practice** - **Importance**: Practicing non-judgmental skills is crucial for therapists and patients, especially in high-stress situations. - **Challenges**: It’s difficult to remain non-judgmental, particularly when emotions are high. This practice helps therapists understand the challenges faced by their patients. **Distress Tolerance Module** - **Objective**: Distress tolerance is not about feeling better but about getting through difficult moments without making the situation worse. - **Key Skills**: - **Willingness vs. Willfulness**: Willingness involves accepting reality, while willfulness focuses on resisting it. - **Self-Soothing**: Utilizing the five senses (sight, smell, taste, touch, sound) to calm oneself. - **Skillful Distraction**: Time-limited distractions can help manage distress without leading to avoidance. **Radical Acceptance** - **Definition**: Accepting reality as it is, which can be particularly challenging for adults. - **Application**: Encouraging patients to identify behaviors they would exhibit if they accepted their reality. **Emotion Regulation Skills** - **Goal**: Transition from distress tolerance to emotion regulation, where individuals can manage their emotions effectively. - **Techniques**: - **Surfing the Wave**: Understanding that emotions are temporary and learning to ride the emotional waves without being overwhelmed. - **Opposite Action**: Acting contrary to emotional urges to change feelings (e.g., getting out of bed when feeling sad). **Interpersonal Effectiveness** - **Goals**: Balancing getting what you want with maintaining healthy relationships. - **DEAR Skill**: A method for effective communication that includes describing the situation, expressing feelings, asking for what you want, and rewarding the other person. **Lifestyle Factors in Emotional Health** - **Physical Health**: Importance of attending to physical health, nutrition, sleep, and avoiding mood-altering substances. - **Positive Experiences**: Intentionally scheduling positive activities to counterbalance negative experiences. This summary captures the essential skills and concepts discussed in the audio, focusing on non-judgmental practice, distress tolerance, emotion regulation, interpersonal effectiveness, and lifestyle factors that contribute to emotional health.