Therapy

Dialectical behavior therapy is a synthesis of cognitive behavioral therapy and Eastern meditative practices created by Dr Marsha Linehan in the early 1990’s. The framework of DBT is based around a core mindfulness foundation of learning to observe our emotions, describe our emotions, and participate in our experiences in the moment. The four other skills training components of DBT are emotional regulation, distress tolerance, interpersonal effectiveness, and reality acceptance. This article details the foundations for emotional regulation skills training.

The three goals of emotional regulation skills training are to understand your emotions, reduce emotional vulnerability, and decrease emotional suffering. In congruence with each goal are skill building exercises that help in achieving the goal.

To understand emotions, we first analyze myths about emotions. We debate ideas like there is a right and wrong way to feel in a given situation. This idea is a myth about emotions that would lead to judging our feelings not giving us space to fully understand our emotional experience. The next part of the skill training consists of learning to describe emotions mindfully in a six step process: looking at words to describe a emotion, look at prompting events for the emotion, interpretations that promote the feeling, how we experience the feeling, how we express the feeling behaviorally, and the aftereffects of the feeling. This six step process is very detailed and helps to slow down and evaluate an emotional experience in a mindful way so that we learn fully about our own emotional system. Finally, we understand what emotions do for us, validating the need for emotions in the first place. Emotions are shown to help us communicate to others, organize and motivate action, and assist in self-validation.

In order to learn to reduce emotional vulnerability, we must understand and avoid emotional mind (the state of mind in which we act out of pure emotion versus using emotions and logic to make our decisions- -this is the state of mind where we would get angry and act out versus thinking that we know we are angry and why and then deciding what action will serve us and our goals)
The first skill set to help reduce emotional vulnerability is an acronym “PLEASE MASTER” to reinforce the need to build mastery in our lives. For PL- the skill is to treat physical illness exemplifying the need to take care of our physical health as there is a connection between mind, body, and spirit. It also advocates taking medication as prescribed. E- Stands for balanced eating, which describes the need for self care and awareness of our physical needs in emotional wellbeing. A- Avoid mood-altering drugs, which details the need to refrain from taking non-prescribed drugs and alcohol to help with emotional stability. Many people who take an antidepressant do not understand that drinking alcohol invalidates the effectiveness of their antidepressant medication. S- stands for balanced sleep further validating the benefits of regular (similar time each night), adequate (6-8 hours) sleep in emotional regulation. E- represents getting exercise, this helps to reinforce the mental health benefits of endorphins released in exercise. The last component of this skill is to build MASTERy stressing the need to do things every day that help us feel confident and competent.

Workshop Overview: Dialectical behavioral therapy (DBT) is a branch of cognitive behavioral therapy developed by Marsha Linehan over 30 years ago to help people manage difficult emotions. DBT combines individual therapy sessions with group skills training to increase a client’s self-awareness and capability to tolerate distress, manage. Dialectical behavior therapy emphasizes learning to bear pain skillfully. Distress tolerance skills constitute a natural development from mindfulness skills. They have to do with the ability to accept, in a non-evaluative and nonjudgmental fashion, both oneself and the current situation. Jonathan Tarbox, Doreen Granpeesheh, in Evidence-Based Treatment for Children with Autism, 2014. Behavioral Skills Training. Behavioral Skills Training (BST) is a treatment package consisting of multiple treatment components that has been proven to be effective for training a wide variety of skills, simple and complex, in people in a wide variety of populations, including children and adults.

In the goal of reducing vulnerability to negative emotions, there are steps to increasing positive emotions. This skill emphasizes the need to build positive experiences by looking at our short term and long term options. For experiencing joy in the short term, we need to do pleasant things now by integrating activities we enjoy every day. Through this practice, we create a life worth living. In the long term, we can make changes that will improve the quality of our lives like attending to relationships, “avoid avoiding”, and accumulating positives. Then we want to be mindful of positive experiences, meaning if we are doing what we love stay present mentally with the experiences. Be unmindful of worries by not thinking of when the positive experience will end, not contemplating deserving the positive or fearing what may be expected of you after having something positive.

Dialectical behavior therapy in a nutshell

The last component of the skill set is letting go of emotional suffering. There are two parts to the skill; letting go and taking opposite action. Letting go of emotional suffering through mindfulness to the current emotion emphasizes emotional awareness and the ability to externalize the experience to learn from it. This skill also points out that the best way to get rid of negative emotions is to let them go. Letting go and pushing away are not the same thing. Fighting emotions normally leads to them staying longer, whereas just letting go is from more of a non attachment premise. The final step is learning to respect our emotions as they hold valuable information for us.

Finally, my favorite part of the emotional regulation training is taking opposite action. I describe this skill by telling someone who is depressed to tell me how they would advise someone who wanted to become depressed to get depressed. I ask them to give me details, and they usually start like this…I would tell them to lie in bed, close the blinds, turn off the phone, sleep all day, etc. Then I tell them to learn the skill, they just do the exact opposite to the depressed actions and make themselves follow through. To take opposite action, if your depression tells you to stay in bed- get up. If the depression tells you to turn off the phone, reach out to someone. (I know that I personalize the depression here, but it often helps to externalize the “enemy” to change it.)

Overall the emotional regulation skills of DBT help you to learn to understand your emotions more fully, take care of yourself in ways to reduce emotional intensity, and empower your actions through awareness and steps for change. These skills give you power over your emotions. If you would like to learn more about DBT, please attend the NASW GA annual conference on Saturday October 27th and sign up for the DBT workshop in the evening. If you have questions about DBT or want to use it in an individual or group setting, don’t hesitate to contact Tara Arnold, PhD, LCSW at 404-964-6629.

- By Tara Arnold, Ph.D., LCSW

Dialectical Behavior Therapy was developed by Marsha Linehan and colleagues specifically to treat problems associated with emotion dysregulation. Comprehensive DBT deviates from traditional psychotherapy interventions in a variety of ways. First, outpatient DBT is a comprehensive program that includes five different functions. Dialectical Behavioral Therapy (DBT) was developed by Marsha Linehan in the 1990s as a treatment for adults with borderline personality disorder. It includes facets of cognitive behavior therapy, skills training, mindfulness meditation, behaviorism, and dialectics, and is structured to help clients gain insight and skills to manage their thoughts, emotions, and behaviors.

By Zainab Fazal, M.ADS, BCBA

bSci21 Contributing Writer

On June 22, 2015, I received a phone call from a staff at a local residential home serving adults with developmental disabilities. With a lot of excitement, she asked if I watched NBC Dateline the night before. Before I could answer, in even more excitement, she said, “that guy did that strategy you were talking about in class!”

Let me give you a little insight into what she was talking about. She was referring to the segment on NBC Dateline called “My kid would never do that: gun safety”, and the guy was Dr. Raymond Miltenberger.You can check out the segment here.

If you teach anyone, anything, behavior analysis has a secret to share with you. It’s the strategy the staff was talking about – Behavior Skills Training (BST). It is a method to teach students, staff, parents, and anyone else you are teaching a new skill. Dr. Miltenberger defines BST as “a procedure consisting of instruction, modeling, behavioral rehearsal, and feedback that is used to teach new behaviors or skills” (2004, p. 558). And that’s exactly what it is, a 4-step teaching strategy that works!

BST teaches a person what to do — that is, what behaviors to engage in under a particular circumstance.It allows for practice within the program so that the person can become fluent with the skills.It is an effective train-the-trainer procedure. And perhaps most importantly, can be individualized to each person. Sounds pretty good, doesn’t it?

Let’s break down each of the steps:

Instruction – Provide a description of the skill, its importance or rationale, and when and when not to use the skill. Repeat this step as necessary.

Modeling – Show your participant how to perform the skill. In-vivo modeling is recommended.

Rehearsal – Practice, practice, and practice! Allow the participant opportunities to practice the skill. Recent research suggests that participants should be able to practice in-situ. The trainer should record data on correct and incorrect responding during this step.

Feedback – The trainer should provide positive praise for correct responding and some form of corrective feedback for incorrect responses.

Some requirements before you can implement a BST program include: the person receiving the training must have the pre-requisite skills required for the behaviors you are teaching, the skill must include a chain of behaviors (a number of skills), and you must be able to role-play or video model the skills.

In a Registered Behavior Technician training course I was providing, I used BST to teach various skills to participants. Any skill I was teaching that met the afore-mentioned requirements I taught using BST. Based on the feedback forms from eight cohorts, participants reported that they enjoyed and learned the most when they got to practice the skills being taught, and got immediate feedback.

Here’s an example of how it was used in the training. The skill was implementing preference assessments with clients.

Instructions were provided on why preference assessments are done, when and with whom to do them, how to use the data sheet, the materials required, and how to complete the assessment.

I modeled completing a preference assessment, using one of the course participants as my “client.”

Participants paired up and practiced administering the preference assessment with their colleagues.Participants were able to practice the skill as each preference assessment included 30 trials!

I went to each group and provided feedback on what each person was doing correctly and incorrectly.

What have been your experiences with Behavior Skills Training? Let us know in the comments below. Also, be sure to subscribe to bSci21 via email to receive the latest articles directly to your inbox!

Overviewdialectical Behavioral Training Jobs

Recommended Readings:

Johnson, B.M., Miltenberger, R.G., Egemo-Helm, K., Jostad, C. J., Flessner, C., & Gatheridge, B. (2005). Evaluation of behavioural skills training for teaching abduction-prevention skills to young children. Journal of Applied Behavior Analysis, 38, 67-78.

Classroom posters clipart

Training Courses Dialectical Behavior Therapy

Miles, N.I., & Wilder, D.A. (2009). The effects of behavioral skills trainingon caregiver implementation of guided compliance. Journal of Applied Behavior Analysis, 42(2), 405-410.

Miltenberger, R. (2004). Behaviour Modification: principals and procedure (3rd ed.) Belmont, CA. Wadsworth Publishing.

Miltenberger, R.G., Flessner, C., Batheridge, B., Johnson, B., Satterlund, M., & Egemo, K. (2004). Evaluation of behavioural skills training procedures to prevent gun play in children. Journal of Applied Behavior Analysis, 37, 513-516.

Overviewdialectical Behavioral Training Certification

Steward, K.K., Carr, J.E., & LeBlanc, L.A. (2007). Evaluation of family-implemented behavioural skills training for teaching social skills to a child with asperger’s disorder. Clinical Case Studies, 6, 252-262.

Dialectical Behavior Therapy In A Nutshell

Zainab Fazal, M.ADS, BCBA, began her career in the developmental disabilities field in 2002, and has dedicated her clinical work and research in the area of Applied Behaviour Analysis (ABA). She has worked for many years in assessing and developing comprehensive programs plans for children, youth, and adults with Autism Spectrum Disorders (ASD), learning disabilities, other developmental disabilities, behavioural challenges and mental health issues. Her recent work includes training front-line staff and teachers to use ABA in therapeutic and school settings, and has successfully trained individuals for the Registered Behaviour Technician credential with the Behaviour Analyst Certification Board. She is also an adjunct professor at Seneca College teaching ABA courses in the Behavioural Sciences program. Zainab is the founder and director of Phoenix Behaviour Services, a private practice in Toronto, Canada. You can follow her on twitter @Phoenix_ABA and reach her at [email protected]

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