DBT Assumptions, Agreements and a Nonjudgmental Stance
What is DBT: Introduce DBT as a treatment model, including the different functions and modes of achieving these functions. Explain DBT targets (what behaviors are targeted in treatment) and the order they are dealt with, including suicidal thoughts and behaviors, treatment interfering behaviors, etc. Describe the biosocial theory for emotion dysregulation, and how to talk about this with patients.
Briefly, this states that people have vulnerabilities to experiencing dysregulaton that can be prompted by events in peoples’ lives, emotions involve sensations that are useful to observe and name, they come with urges, emotions serve specific functions, and that this all makes sense given evolution.
DBT Principles: DBT centers around the concept of dialectics – what is it, how it relates to dysregulation, how to use it in treatment – and the main dialectic is to balance acceptance and change. Dialectics will be defined as a concept as well as some examples of dialectical dilemmas and how to think about a dialectical synthesis. Talk about the 6 levels of validation and practice providing validation. Understanding behavioral principles, like conditioning, reinforcement, and extinction are paramount to DBT being done effectively. Behavioral principles should guide interactions with patients and how the milieu thinks about and deals with patients’ behaviors – those that are wanted and unwanted. Skills coaching is the manner by which staff help patients get through difficult moments and learn to use and generalize skills. Teach how do to skills coaching correctly. Diary cards and behavioral chain analyses are tools used in DBT to track and understand behavior, and determine where to intervene with problem solving. Finally DBT strategies for acceptance and change will be taught, including a review of dialectical dilemmas and validation as well as new ones such as irreverent communication, problem solving, and consultation to the client and consultation to the environment.
DBT Skills: 1) Mindfulness is often called the core DBT skill. Will talk about how DBT defines mindfulness (how and what it is, non-judgmental stance, not clinging, in the present), how to teach this to patients, and the ways it is woven throughout the whole treatment. Practice mindfulness (and will do from this point forward). 2) Patients benefiting from DBT experience moments when they are so emotionally dysregulated they engage in unhelpful or harmful behaviors to try to decrease the intensity of their dysregulation. Distress tolerance skills are aimed at getting through these moments without turning to the unhelpful or harmful behaviors. 3) Review the specific emotion regulation skills. These skills are aimed at helping people manage their day to day emotions. They focus on understanding emotions, reducing vulnerability to heightened emotions, and decreasing unwanted emotions or the intensity of them. 4) Teach the interpersonal effectiveness skills group, which is DBT’s version of communication skills. In a nutshell, these skills are aimed at maintaining self-respect while respecting the relationships one has and wants to keep.
The target audience for this activity are physicians, nurses, psychologists, social workers and counselors.
Define what a nonjudgmental stance is and how to practice and illustrate it.
Identify DBT assumptions and apply them.
Define and evaluate DBT agreements.
Dr. Andrea Gottlieb is a psychologist and the DBT Project Coordinator for the Sheppard Pratt Health System. She graduated from the University of Denver’s Clinical Child Psychology PhD Program with a focus on depression and nonsuicidal self-injury in adolescents. Her research has specifically focused on understanding what leads to an increase in depression during adolescence as well as factors that contribute to a teenager being at greater risk for engaging in nonsuicidal self-injury. Dr. Gottlieb completed her psychology internship and psychology postdoctoral training at McLean Hospital/Harvard Medical School, where she primarily worked in McLean’s Behavioral Health Partial for Adults and was the co-director of the program’s psychology externship during the 2015-2016 academic year. While there, she also trained at McLean’s 3East DBT program for adolescents and OCD-Institute. Some other prior work experiences of Dr. Gottlieb’s include managing a large research study assessing deep brain stimulation for treatment resistant depression at Emory University as well as teaching undergraduate courses in psychology at The University of Denver and Skidmore College. Now working at the Sheppard Pratt Health System, Dr. Gottlieb oversees the integration of DBT by teaching DBT to staff, working directly with units to design and implement DBT programming, and she maintains a small private practice at Sheppard Pratt doing comprehensive DBT.
Sheppard Pratt holds the standard that its continuing medical education programs should be free of commercial bias and conflict of interest. In accord with Sheppard Pratt's Disclosure Policy, as well as standards of the Accreditation Council for Continuing Medical Education (ACCME) and the American Medical Association (AMA), all planners, reviewers and speakers have been asked to disclose any relationship he /she or their spouse has with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients, during the past 12 months. All planners, reviewers and speakers have also been asked to disclose any payments accepted for this lecture from any entity besides Sheppard Pratt Health System, and if there will be discussion of any products, services or off-label uses of product(s) during this presentation.
Andrea Gottlieb, Ph.D. reports having no financial relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. She will not discuss medications, off-label uses or services used to treat patients in this presentation.
Event Planners/Reviewers Disclosures: The following event planners and/or reviewers are reported as having no financial interest, arrangement or affiliation with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients, during the past 12 months: Ellen Mongan, M.D., Caroline Cahn, LCSW-C, Tom Flis, LCPC, Faith Dickerson, Ph.D., Robert Roca, M.D., Drew Pate, M.D., Briana Riemer, M.D. Ernestine Crosby, APRN, Darby Subotich, RN, MSN, Rick Wallace, RN, MSN, Jacqueline Williams-Porter, RN, MBA, Jennifer Tornabene, and Bonnie Katz.
Physician Statement: Sheppard Pratt Health System is accredited by The Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CME activity. Sheppard Pratt Health System designates this live activity for a maximum of 2.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Nurse Statement: Sheppard Pratt Health System is an approved provider of continuing nursing education by Maryland Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CME activity. This activity is approved for 2.0 contact hours for nurses.
Psychologist Statement: Sheppard Pratt Health System is authorized by the State Board of Examiners of Psychologists as a sponsor of continuing education. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CME activity. Sheppard Pratt Health System designates this educational activity for a maximum of 2.0 CEU hours for Psychologists. Psychologists should claim credit commensurate with the extent of their participation in the activity.
Social Worker Statement: Sheppard Pratt Health System is authorized by the Board of Social Work Examiners of Maryland to offer continuing education for Social Workers. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CME activity. This activity is approved for 2.0 CEU contact hours in Category 1 credits for Social Workers.
Counselor Statement: Sheppard Pratt Health System has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 5098. Programs that do not qualify for NBCC credit are clearly identified. Sheppard Pratt Health System is solely responsible for all aspects of the program. This activity is approved for 2.0 clock hours for National Certified Counselors.
- 2.00 AMA PRA Category 1 Credit™
- 2.00 Category I credits for Social Workers
- 2.00 Psychologists
- 2.00 Participation