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DBT and Recovery

DBT and Recovery. Michelle Rollins, MA, LPC, CACIII Jennifer Leeson, MSW, LCSW. Objectives. Explain basic tenets of DBT Discuss fundamental components of recovery Discuss 4-step process of hope Discuss what helps and hinders in the recovery process. Dialectical Behavior Therapy.

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DBT and Recovery

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  1. DBT and Recovery Michelle Rollins, MA, LPC, CACIII Jennifer Leeson, MSW, LCSW

  2. Objectives • Explain basic tenets of DBT • Discuss fundamental components of recovery • Discuss 4-step process of hope • Discuss what helps and hinders in the recovery process

  3. Dialectical Behavior Therapy

  4. What is DBT? • Developed at the University of Washington by Marsha Linehan, Ph.D. • Empirically-supported “modified” cognitive behavioral treatment for borderline personality disorder • Particular efficacy in consumers with chronic suicidal or self-harming behaviors • Provides tools and strategies to improve quality of life, facilitate change, manage crises, and eliminate dysfunctional behaviors

  5. Research on DBT • Originally validated in two RCTs comparing DBT to TAU in BPD and BPD + SA • DBT patients vs TAU patients • Less likely to drop out of treatment • Fewer/less medically severe self-harm behaviors • Fewer/shorter inpatient hospitalizations • Greater scores of global and social adjustment

  6. Research on DBT • Other empirical studies comparing DBT to TAU • Decreased suicidal ideation • Decreased depression, hopelessness, anger • Greater treatment retention

  7. Biosocial theory of BPD • Emotion dysregulation • Biological disposition + environmental context • Emotional vulnerability • High sensitivity/intense response to stimuli • Slow return to baseline after emotional arousal

  8. Modes of delivery in DBT • Outpatient individual psychotherapy • Outpatient group skills training • Telephone consultation • Case consultation for therapists • Ancillary treatment

  9. Skills modules in DBT • Core Mindfulness • Goal: to develop a lifestyle of participating with awareness • Identity disturbance; feelings of emptiness • Interpersonal Effectiveness • Goal: to apply specific skills in interpersonal encounters to obtain objectives by asking or saying no, maintain the relationship, maintain self-respect, analyze the situation and determine goals • Unstable relationships; efforts to avoid loss

  10. Skills modules in DBT • Emotion Regulation • Goal: to apply specific skills to identify, label, and regulate emotions within a context of self-validation and non-judgment • Affective instability; problems with anger • Distress Tolerance • Goal: to apply specific skills to tolerate and survive crises and to accept oneself and the current situation in a nonjudgmental fashion • Impulsivity; self-harm behaviors

  11. Recovery

  12. What is recovery? • MHCD definition of recovery: An ongoing process of self-directed healing and transformation (adopted from Pricilla Ridgeway)

  13. Fundamental components • Self-direction • Determining own path of recovery • Individualized/person-centered • Multiple paths to recovery based on individual strengths • Empowerment • Authority to participate in decisions

  14. Fundamental components • Strength based • Valuing/building on talents, coping abilities, etc. • Peer support • Encouragement, sense of belonging • Respect • Eliminating stigma, self-acceptance

  15. Fundamental components • Responsibility • Personal responsibility to promote self wellness • Holistic • Mind, body, spirit, community • Non-linear • Growth, setbacks, learning from experience

  16. Fundamental components • Hope • Catalyst of the recovery process

  17. Four step process to hope • Empathize with reality of despair • Establish legitimacy of need to ask for extensive help • Identify meaningful, attainable measures of successful progress • Emphasize a hopeful vision of pride and dignity

  18. What helps in recovery? • Belief that recovery is possible • Positive expectations • Caring attitude • Being treated with respect • Well trained staff • Fostering self-empowerment

  19. What hinders recovery? • Staff who are burned out • Mistrust, paternalism, superiority • Coercion • Not understanding consumers’ experiences

  20. Wrap-up Questions and Feedback

  21. Contact information-DBT • Michelle Rollins • michelle.rollins@mhcd.org • 303-504-1054 • Jennifer Leeson • jennifer.leeson@mhcd.org • 303-504-1067

  22. Contact information-recovery • Roy Starks (specific recovery information, measurement/outcomes) • roy.starks@mhcd.org • 303-504-1721 • Jay Flynn (general recovery questions, training) • jay.flynn@mhcd.org • 303-504-1035

  23. DBT Resources • Behavioral Tech Website: http://behavioraltech.org/ • Dimeff, L.A. & Koerner, K. Eds. (2007). Dialectical Behavior Therapy in Clinical Practice: Applications across Disorders and Settings. New York: Guilford Press. • Linehan, M.M. (1993).Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press. • Linehan, M. M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford Press. • Miller, A.; Rathus, J.H., & Linehan, M.M. (2006). Dialectical Behavior Therapy with Suicidal Adolescents. New York: Guilford Press.

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