Learning Objectives By the end of this session, participants - - PowerPoint PPT Presentation

DialecticalBehavioralTherapy(DBT) SkillsinPsychotherapywithPediatric Populations

PhaedraPascoe,MD June5th,2019 CPAA/AIMSCenterTrainingProgram

LearningObjectives

Bytheendofthissession,participantsshouldbe ableto:

• Describethestructuralcomponentsoffullfidelity

DBTprogramandfourgroupsofskillsutilizedin DBT

• Identifyclinicalsituationswhereitwouldbe

usefultoutilizediarycardsand/orchainanalysis asatherapeutictechnique

• Explaintopatientsandtheirfamilieshowto

utilizeDBTskillTIPPduringperiodsofintense emotions

OverviewofPresentation

• GeneraloverviewofDBT

– Theoreticalbasis – DBTinadolescents – FourgroupsofskillsutilizedinDBT – FourcomponentsoffullfidelityDBT

• TherapeutictechniquesutilizedinDBT

– Diarycards – Chainanalysis

• DistresstoleranceskillTIPP
• Resources

GeneralOverviewofDBT

CoreFeaturesofDBT Behaviorism Mindfulness Dialecticalphilosophy

GeneralOverviewofDBT

UseofDBTinadolescents

GeneralOverviewofDBT

FourgroupsofskillsofDBT

Mindfulness Distress tolerance Emotion regulation Interpersonal effectiveness Middlepath

GeneralOverviewofDBT

1.IndividualTherapy 3.Telephone Consultation 2.SkillsGroup 4.Therapist ConsultationTeam *Ancillary Treatments*

FourcomponentsoffullfidelityDBT

TherapeutictechniquesutilizedinDBT: DiaryCards

DiarycardsusedinDBT

TherapeutictechniquesutilizedinDBT: DiaryCards

DiarycardsusedinDBT

TherapeutictechniquesutilizedinDBT: DiaryCards

Diarycardsinothertherapeuticframeworks Introducingdiarycards Clinicalutilityofdiarycards Thingstomonitor:

Emotions Thoughtsandurges Maladaptivebehaviors:Selfharm,bingingpurging, substanceuse,stealing Adaptivebehaviors:Exercise,extracurricularactivities, socialengagement,schoolattendance,copingskills

Problemsolvingsurroundingdiarycards

TherapeutictechniquesutilizedinDBT: Chains

• Whentouseofchains:Afterpatientengages

intargetbehavior

• Functionsofchains:

– Tounderstandfunctionofbehaviors – Identifyfactorsreinforcingbehaviors – Helppatientidentifythoughtsandfeelings associatedwithbehaviors – Identifyalternativebehaviorsandskills

TherapeutictechniquesutilizedinDBT: Chains

TherapeutictechniquesutilizedinDBT: Chains

• Tired
• Hungry
• Ill
• Earlier

eventsin theday ParentsaidI couldn’tgo tofriends house Anger (7/10) Tightchest, fists, increased HR “Ineverget myway” “There’sno pointtrying”

• Runaway

from house

• Punch

wall Punched wall

• Anger

decreased (3/10)

• Peopleleft

mealone

• Hurthand
• Hadtopay

for damanges

• NoTVx1

wk

TherapeutictechniquesutilizedinDBT: Chains

• Tired
• Hungry
• Ill
• Earlier

eventsin theday ParentsaidI couldn’tgo tofriends house “Ineverget myway” “There’sno pointtrying”

• Runaway

from house

• Punch

wall Punched wall

• Anger

decreased (3/10)

• Hurthand
• Hadtopay

for damanges

• NoTVx1

wk Anger (7/10) Tightchest, fists, increased HR

DistressToleranceSkill:TIPP

• TippingtheTemperature

– MammalianDiveReflex – https://www.youtube.com/watch?v=JkhGeHLzHJ8

• Intenseaerobicexercise
• Pacedbreathing
• Pairedmusclerelaxation

DistressToleranceSkill:STOP

• Stop
• Takeastepback
• Observethesituation
• Proceedmindfully

Resources:

Books

Resources:

Diarycardexamples:

• http://www.cbmdbt.com/images/Diary_Card.pdf
• https://www.dbtselfhelp.com/html/diary_card_5.html

Progressivemusclerelaxation:

• https://www.anxietycanada.com/sites/default/files/MuscleRelaxation.pdf

Apps:

• Breath2relax:Free,includesinstructionsandpracticeexercises

EfficacyofDBT:

• McCauley,E.,Berk,M.S.,Asarnow,J.,Adrian,M.,Cohen,J.,Korslund,K,

Avina,C.,Hughes,J.,Harned,M.,Gallop,R.,Linehan,M.,Efficacyof DialecticalBehaviorTherapyforAdolescentsatHighRiskforSuicide:A RandomizedClinicalTrial.2018,JAMAPsychiatry,777– 785

QUESTIONS? THANK YOU!

Pleasefeelfreetocontactmewithanyquestions.Myemailis: phaedra.pascoe@seattlechildrens.org