DBT : No t F e a ring Yo ur Mo st Diffic ult Pa tie nts DR. MARI - - PowerPoint PPT Presentation
DBT : No t F e a ring Yo ur Mo st Diffic ult Pa tie nts DR. MARI O E L I A ADJUNCT PROF E SSOR, DE PART ME NT OF F AMI L Y ME DI CI NE Ob je c tive s I ntro duc e the c o nc e pt o f dia le c tic a l b e ha vio r the
O E L I A ADJUNCT PROF E SSOR, DE PART ME NT OF F AMI L Y ME DI CI NE
I
ntro duc e the c o nc e pt o f dia le c tic a l b e ha vio r the ra py (DBT )
Pro vide the b a sic fra me wo rk o f inc o rpo ra ting DBT
into pra c tic e s
Pro vide re so urc e s fo r fa mily physic ia ns to b e c o me
pro fic ie nt in DBT
F
a c ulty: Dr. Ma rio E lia
Re la tio nships with c o mme rc ia l inte re sts Gra nts/ Re se a rc h Suppo rt: no ne Spe a ke rs Bure a u/ Ho no ra ria : no ne Co nsulting F
e e s: Onta rio MD (Pe e r L e a de r), T e lus He a lth (Physic ia n a dviso r fo r Ra re Dise a se s Da shb o a rd), Ce ntre fo r E ffe c tive Pra c tic e (Po ve rty T
Othe r: no ne
F ive o r mo re o f the fo llo wing to b e pre se nt fo r a sig nific a nt pe rio d o f time :
F ra ntic e ffo rts to a vo id re a l o r ima g ine d
A pa tte rn o f unsta b le a nd inte nse inte rpe rso na l re la tio nships c ha ra c te rize d b y a lte rna ting b e twe e n e xtre me s o f a nd
I de ntity disturb a nc e : ma rke dly a nd pe rsiste ntly unsta b le
in a t le a st two a re a s tha t a re po te ntia lly se lf-da ma g ing (e .g ., spe nding , pro misc uo us se x, e a ting diso rde rs, sub sta nc e a b use , re c kle ss driving , b ing e e a ting ).
Re c urre nt , g e sture s, o r thre a ts, o r
Affe c tive insta b ility due to a (e .g ., inte nse e piso dic dyspho ria , irrita b ility, o r a nxie ty usua lly la sting a fe w ho urs a nd o nly ra re ly mo re tha n a fe w da ys)
Chro nic fe e ling s o f
I na ppro pria te , inte nse o r diffic ulty c o ntro lling a ng e r (e .g ., fre q ue nt displa ys o f te mpe r, c o nsta nt a ng e r, re c urre nt physic a l fig hts).
T ra nsie nt, stre ss-re la te d pa ra no id ide a tio n o r se ve re disso c ia tive sympto ms
abandonment idealization devaluation self-image or sense of self impulsivity suicidal behaviour s, self-mutilating behaviour mar ked r eactivity of mood emptiness anger
De c re a se
L
ife thre a te ning (se lf ha rm, c risis surviva l)
T
he ra py inte rfe ring (no t sha ring info rmatio n, missing a ppo intme nts, into xic a tio n, b o unda ry vio la tio ns)
Qua lity o f life (inc re a se se lf e ste e m, se lf wo rth, ho using , re la tio nships,
wo rk) I nc re a se behavioural skills:
‐
Core mindfulness
‐
Interpersonal effectiveness
‐
Emotion regulation
‐
Distress tolerance
‐
Self‐management
Review diary card Check in on other aspects of treatment Set agenda according to target hierarchy Identify a specific instance of a target relevant problem behaviour (topography,
frequency, intensity and duration)
Do a behavioural chain analysis Perform a solution analysis Rehearse some new behaviour, plan generalization and ask for commitment to it,
troubleshoot obstacles
Notify of session ending, plan for next session, wind down