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

Learning � Objectives � By � the � end � of � this � session, � participants � should � be � Dialectical � Behavioral � Therapy � (DBT) � able � to: Skills � in � Psychotherapy � with � Pediatric � • Describe � the � structural � components � of � full � fidelity � Populations DBT � program � and � four � groups � of � skills � utilized � in � DBT • Identify � clinical � situations � where � it � would � be � Phaedra � Pascoe, � MD useful � to � utilize � diary � cards � and � / � or � chain � analysis � June � 5 th , � 2019 as � a � therapeutic � technique � • Explain � to � patients � and � their � families � how � to � CPAA � / � AIMS � Center � Training � Program utilize � DBT � skill � TIPP � during � periods � of � intense � emotions Overview � of � Presentation General � Overview � of � DBT • General � overview � of � DBT Core � Features � of � DBT – Theoretical � basis – DBT � in � adolescents � � Behaviorism � – Four � groups � of � skills � utilized � in � DBT � Mindfulness – Four � components � of � full � fidelity � DBT • Therapeutic � techniques � utilized � in � DBT � Dialectical � philosophy – Diary � cards – Chain � analysis • Distress � tolerance � skill � TIPP • Resources

General � Overview � of � DBT General � Overview � of � DBT Use � of � DBT � in � adolescents Four � groups � of � skills � of � DBT Distress � Emotion � Interpersonal � tolerance regulation effectiveness Middle � path Mindfulness Therapeutic � techniques � utilized � in � DBT: � General � Overview � of � DBT Diary � Cards Diary � cards � used � in � DBT Four � components � of � full � fidelity � DBT 1. � Individual � Therapy 2. � Skills � Group 3. � Telephone 4. � Therapist � Consultation Consultation � Team *Ancillary Treatments*

Therapeutic � techniques � utilized � in � DBT: � Therapeutic � techniques � utilized � in � DBT: � Diary � Cards Diary � Cards Diary � cards � in � other � therapeutic � frameworks Diary � cards � used � in � DBT � Introducing � diary � cards � Clinical � utility � of � diary � cards � Things � to � monitor: � Emotions � Thoughts � and � urges � Maladaptive � behaviors: � Self � harm, � binging � purging, � substance � use, � stealing � Adaptive � behaviors: � Exercise, � extracurricular � activities, � social � engagement, � school � attendance, � coping � skills � Problem � solving � surrounding � diary � cards Therapeutic � techniques � utilized � in � DBT: � Therapeutic � techniques � utilized � in � DBT: � Chains Chains • When � to � use � of � chains: � After � patient � engages � in � target � behavior • Functions � of � chains: � – To � understand � function � of � behaviors – Identify � factors � reinforcing � behaviors – Help � patient � identify � thoughts � and � feelings � associated � with � behaviors – Identify � alternative � behaviors � and � skills

Therapeutic � techniques � utilized � in � DBT: � Therapeutic � techniques � utilized � in � DBT: � Chains Chains • • Tired Tired • • Hungry Hungry Anger Anger • • Ill Ill (7/10) “I � never � get � “I � never � get � (7/10) Parent � said � I � Parent � said � I � • • Earlier � • Earlier � Tight � chest, � • my � way” Run � away � my � way” Run � away � Tight � chest, � couldn’t � go � couldn’t � go � events � in � events � in � fists, � “There’s � no � from � “There’s � no � from � fists, � to � friends � to � friends � the � day the � day increased � point � trying” house point � trying” house increased � house house • HR • Punch � Punch � HR wall wall • • Hurt � hand Hurt � hand Punched � Punched � • • Had � to � pay � Had � to � pay � • wall • wall Anger � Anger � for � for � decreased � decreased � damanges damanges (3/10) (3/10) • • No � TV � x � 1 � No � TV � x � 1 � • People � left � wk wk me � alone Distress � Tolerance � Skill: � TIPP Distress � Tolerance � Skill: � STOP • T ipping � the � Temperature � • S top – Mammalian � Dive � Reflex • T ake � a � step � back – https://www.youtube.com/watch?v=JkhGeHLzHJ8 • O bserve � the � situation • I ntense � aerobic � exercise • P roceed � mindfully • P aced � breathing • P aired � muscle � relaxation

Resources: Resources: Books Diary � card � examples: • http://www.cbm � dbt.com/images/Diary_Card.pdf • https://www.dbtselfhelp.com/html/diary_card_5.html Progressive � muscle � relaxation: • https://www.anxietycanada.com/sites/default/files/MuscleRelaxation.pdf Apps: • Breath2relax : � Free, � includes � instructions � and � practice � exercises Efficacy � of � DBT: • McCauley, � E., � Berk, � M.S., � Asarnow, � J., � Adrian, � M., � Cohen, � J., � Korslund, � K, � Avina, � C., � Hughes, � J., � Harned, � M., � Gallop, � R., � Linehan, � M., � Efficacy � of � Dialectical � Behavior � Therapy � for � Adolescents � at � High � Risk � for � Suicide: � A � Randomized � Clinical � Trial. � 2018, � JAMA � Psychiatry, � 777 � – 785 QUESTIONS? THANK YOU! � Please � feel � free � to � contact � me � with � any � questions. � My � email � is: � phaedra.pascoe@seattlechildrens.org