Boderline personality disorder

2. Introduction of DBT
• DBT is a type of talking therapy which was
originally developed by an American
psychologist named Marsha linehan in 1993.
• It is based on cognitive behavioral therapy
(CBT) .
• CBT tries to identify and change negative
thinking patterns and pushes for positive
behavioral changes.

3. What does’ dialectics’ means ?
• ‘’dialectics” means try to balance seemingly
contradictory position .for example ,in DBT
you will work with your therapist to find a
good balance between :
1. Acceptance –acceptance yourself as you are.
2. Change - making positive changes in yourself

4. Dialectical behavioral therapy
Definition :
DBT is a broad based cognitive behavior
treatment originally developed for chronically
suicidal /individual diagnosed with BPD .

5. CBT VS DBT
CBT
• Wrong thinking
• Therapeutic relationship
needed to do work
• Collaborative stance with
willing client
• change
DBT
• Dialectical thinking
• Therapeutic relationship is
essential
• Working with commitment
and therapy interfering
behavior
• Radical acceptance

6. Goal of DBT skill training
• To help the individuals change behavior
,emotional thinking ,and interpersonal pattern
associated with problem in living,

11. Symptoms of Borderline personality
disorder
Behavioral symptoms:
• Antisocial behavior
• Compulsive behavior
• Hostility
• Impulsivity
• Irritability
• Self- distructive behavior
• Social isolation
• Self-harm

12. Mood:
• anger
• Anxiety
• Guilt
• Lonlinesss
• Loss of interest or pleasure in activity
• Mood swings or sadness

13. Psychological :
• Depression
• Distorted self image
• Fear
• Grandiosity
Common:
• Risky behavior
• Thought of suicide

16. acceptance change

17. Learning how to control your
mind/attention so it does not control
you.
MINDFULNESS

18. Getting through the moment
without making matters worse.
DISTRESS
TOLERANCE

19. Not about changing or controlling our
emotions- instead is about changing our
reactions to emotions
EMOTION
REGULATION

20. Interpersonal Effectiveness
• Describe
• Express
• Assert
• Reinforce
• Mindfully
• Appear confident
• Negotiate
• Gentle
• Interested
• Validate
• Easy manner
• Fair
• Apologies (no undue)
• Stick to values
• Truthful

21. Organizing DBT skill training
1. Form a team.
2.select skill training members of your team .
• Skill training can be conducted by psychotherapist counselors,
case manager ,social workers, milieu staff, and psychiatric
nurse.
• Skill training also can be conducted by any one trained in the
principal of skill training.
• They need to know and be able to use basic behavior
technique such as (behavior analysis, solution analysis,
management, exposure procedure and basis of skill building.
• DBT treatment strategies such as(dialectical strategies
,validation and problem solving strategies reciprocal
communication strategies consultation to the patients and
environmental strategies.

22. 3 .select skill modules and specific skill to teach.
• Orientation +mindfulness module 2 week
• Interpersonal effectiveness module 6 week
• Orientation +mindfulness module 2 week
• Emotional regulation module 6week
• Orientation +mindfulness module 2 week
• Distress tolerance module 6 week
(24 week ,6 month )

24. • A standard DBT ,skill training is conducted in
group of 6-8 ( 10 at the most) participant, plus
2group leader ,once a week for 2.5 hr.
participant one full cycle of core skill through
all the module in 6 month ,in a one year
treatment programme participant then repeat
the cycle for a total of 12 months.

25. Cont…
4.plan a skill training curriculum
• Decide how many total weeks your skill training programme will last and
how many long each session will be , it also depend on whether do or do
not have mental disorder and severity of mental disorder.
• Goal of treatment is (stabilization ,treatment ,skill building).
• Decide which skill you definitely want to teach ,and content of skill should
be based on the research data for the disorder/problem you re addressing
it will guide you.
• Decide which handout and worksheets you want to use don’t use them
without reviewing.

26. 5.Decide on :
• Individual vs group skill training
• Open vs closed group
• Heterogonous vs homogenous groups
6. 6.clarify the role of skill trainers ,individual therapist ,case
managers, nurses and line staff and pharmacotherapist in
a skill training program

28. commitment in dialectical behavior
therapy
• Patient agreement:
Stay in therapy for the specified time period
Attend scheduled therapy sessions Work
toward reducing suicidal behaviors as a goal of
therapy Work on problems that arise that
interfere with the progress of therapy
Participate in skills training for the specified
period.

30. Cont..
Therapist agreement :
Make every reasonable effort to conduct
competent and effective therapy Obey
standard ethical and professional guidelines
Be available to the patient for weekly therapy
sessions and provide needed therapy back- up
Maintain confidentiality Obtain consent when
needed.

32. Components of DBT
Individual sessions
• Individual sessions typically last for 45–60 minutes and
occur weekly. The past week is reviewed using ‘diary
cards’ that the patient has filled in.
• There is a recommended structure to sessions that
follows a hierarchy of topics. Life-threatening behaviors
should be discussed and dealt with first.
• Then come therapy-interfering behaviors, quality-of-
life- interfering behaviors and attention to skills.

33. Skill training:
• Skills training is conducted in a weekly group,
which typically lasts for 2 or 2½ hours..
• The room may be arranged like a classroom.
• The book also contains hand-outs for patients,
which may be freely copied for the purpose.
• Groups may include group exercises and role-
play, and homework is suggested.
• The content is divided into four modules, each of
which is usually taught in blocks lasting a few
weeks. Three modules are on topics – emotional
regulation, distress tolerance and interpersonal
effectiveness .

34. Out of hour telephone contact:
• Patients within a DBT programme may telephone their
individual therapist between session.
• The contact should be mainly about coaching the patient in
the appropriate use of the skills that have been learned.
• Typically a DBT telephone call is brief – perhaps 5 or 10
minutes – and should not in general be used as an extra
therapy session.
• It is mainly to try to help the patient avoid self-harm or
sometimes to sustain or repair the therapeutic relationship.
• The patient is banned from contacting the therapist for 24
hours after an act of self-harm.
• The hours during which telephone contact is available are
agreed between the therapist and the patient.

35. The consultation group
• The fourth essential component of DBT does
not involve the patient directly.
• DBT is a team treatment and the consultation
group is where the team – the individual
therapists and skills trainers – meet to review
the programme and their practice.

37. authors Subject/setting design Adherence to
standard DBT
Outcomes and
comments
Jame winmills et
.al(2011)
25
adolescents(84%)
female ,M age=15
yr )with a history
of persistent self
harm; community
out patient
treatment among
teen in UK.
This pre-post
treatment study
examined an
adopted one year
DBT programme
for teen in a
looked after care
system
participant
assessed at pre-
and post
treatment
Mode of
treatment
included weekly
2 hr DBT skills
group ,telephone
consultation,out
reach,consultatio
n team and
weekly individual
session no
individual DBT
Paired t –test
:significant
reduction in
depression,
hopelessness
score and
lowered
frequency of self
harm. no
significant
changes in
automatic
thought

40. bibliography