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Lecture 8

Lecture 8 PSYC36.docx

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University of Toronto Scarborough
Amanda U.

November 6, 2012: Dialectical behavior therapy 1 Marsha Linehan was the creator of DBT, she had borderline personality herself. DBT was target for BPD initially, but I had expanded. She admitted that she had very severe BPD, she killed to kill herself repeatedly. The truth that she had made and championed. The article, “Expert on Mental Health Illness Reveals Her Own Fight.” Literally the only therapy that works with people with borderline personality disorder, for extreme emotion deregulation. What is Borderline Personality Disorder?  Extreme thinking (black and white thinking)  Mood instability  Instable identity o One day you want to be a doctor, one day you want to be a doctor o One day you are dropping school, one day school is all you think about  Sometimes mild ______  They have really chaotic relationship with other people o They have extreme ups and downs o They are obsessed with someone and then they might hate them o Very hard to be maintained in romantic relationships  BPD often hurt themselves – this is the primary marker o Cut themselves, put their hair out o Suicidal tendencies o A lot of them die from BPD  Mostly women its true, but think about the stereotypical images of Emo  Cognitive deregulation, emotional deregulation, interpersonal deregulation  They might be unpredictable  It might be hard to have a therapeutic relationship with --- this is a major problem o Therapists couldn’t get a grasp, couldn’t make boundaries Dialectical behavior therapy  Marsha Linehan  Treating woman with suicidality and self-harm (borderline personality disorder)  Was using CBT, and was effective for suicide and depression, and was trying to use it on women with BPD but it just wasn’t working  People were often refused at some clinics Start of DBT These are three things that Marsha noticed in her treatments: 1. Time constraints  1 hour a week wasn’t enough 2. Therapy interfering behaviors were reinforced  Hugging the therapist  Screaming and yelling 1. “my thoughts aren’t irrational what are you saying” 2. the screaming and yelling was being reinforced because the CBT therapists were held hostage they were 3. The focus on change in CBT is invalidating  It was so focused on changing their thoughts and cognitions and pateints with BPD weren’t responding well. They were insensitive to social cues, and they tend to react very strongly. November 6, 2012: Dialectical behavior therapy 2 1.) Time constraints DBT was derived from CBT and so she kept something and added to it  Individual therapy  one hour a week  Group therapy  Different group leaders  Two hours a week  Commitment for 1 year  With adults  Generally it takes about a year for people to get better  For teenagers, its about 6 months  Consultation group  DBT therapists attend a consultation group  Its for therapists because they too burn out  They might begin to dread the patient coming in  It can be very difficult  The prof had a patient who gave her negative comments every time she picked him up from the waiting room  It made her uncomfortable  She would ignore it because she didn’t want to give attention  Until the last day of the therapy  What would you have done?  Humor it  Ask why would you say that in a nonjudgmental way  He actually wanted to be the powerful one in the waiting room  She thought it was an attention thing so she ignored it but she was powerful in the therapy so he had to feel powerful, like a man in the waiting room  The patient: o He was severe BPD patient o He screamed at her, he was loud  People would come thinking that he might have been assaulting her 2.) Reinforcement & punishment the therapist has to be very careful in what they do and say, for it could reward, motivate or punish the patient’s behavior. its to fix those ____ behaviors  Radical behaviorism  Thought, feeling, is a behavior and everything that be operantly conditioned or reinforced  You come into the room and you make a comment about how I look like and let’s see if we can trigger or change how we can trigger or extinguish the behavior Two things that we can do to change the behavior:  Diary Card  Track: emotion, thoughts, action, healthy behavior  Its like a daily kind of drafting to help pin point what goes on during the day  Chain analyses  It’s a _______________________________________________  Example: a kid from her therapy sessions that has BPD and often wants to dye his hair purple, or get a tattoo, or a get a piercing when mother says no, he throws and tantrum or goes and cuts himself and then mother gives to what he had asked November 6, 2012: Dialectical behavior therapy 3 Make a She request says Frustratio “I hate Goes Cuts Feels Shows Mom to Mom no n/Anger you!” upstairs arm relief Mom gives in  When they cut themselves, they get a neurological release and they actually feel better  When BPD it makes them ashamed, they ask why they do it to themselves, but it makes sense, they do feel better  This could also be for emotion deregulation  Therapists might suggest things that might break the chain  Suggestions: o Start right when the mother says no  Ask him is he bored,  Find out the trigger???  Figure it out o Take the knives out of the house o Reinforcing the cutting – so she shouldn’t be giving in to the request after he cuts himself  This is the major problem o For the kid:  How to soothe the frustration and anger  The kid would ask about 5 times aggressively 3.) Change is invalidating DBT consists of two things: 1. radical acceptance 2. mindfulness Balance a lot of the things in the chain reaction with validation and acceptance --- this has a calming effect and its like the piss and vinegar out of the conversation What is validation?  Validation  Validation communicates to another person that his or her feelings, thoughts, and actions make sense and are understandable to you in a particular situation.  Its communicating that you understand their feelings and why they are doing it  Its like empathy?  It may not be what you might do, but you could try to understand the intensity of that feeling  Self-validation involves perceiving your own feelings, thoughts, and actions as accurate and acceptable in a particular situation.  You got really mad, and then you feel stupid for being mad  But that’s not really validating  Tell yourself, its ok to have this emotion and try to move on  People with BPD have trouble identifying their emotions  The validation video: It shows, although a lot of that was flattery, why validation is important in therapy. It helps moves the wheels and keeps people motivated November 6, 2012: Dialectical behavior therapy 4 Biosocial Theory ** this is an etiological theory – people with BPD have a genetic predisposition t
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