DBT : No t F e a ring Yo ur Mo st Diffic ult Pa tie nts DR. MARI - PowerPoint PPT Presentation

DBT : No t F e a ring Yo ur Mo st Diffic ult Pa tie nts DR. MARI O E L I A ADJUNCT PROF E SSOR, DE PART ME NT OF F AMI L Y ME DI CI NE

Ob je c tive s  I ntro duc e the c o nc e pt o f dia le c tic a l b e ha vio r the ra py (DBT )  Pro vide the b a sic fra me wo rk o f inc o rpo ra ting DBT into pra c tic e s  Pro vide re so urc e s fo r fa mily physic ia ns to b e c o me pro fic ie nt in DBT

Disc lo sure  F a c ulty: Dr. Ma rio E lia  Re la tio nships with c o mme rc ia l inte re sts  Gra nts/ Re se a rc h Suppo rt: no ne  Spe a ke rs Bure a u/ Ho no ra ria : no ne  Co nsulting F e e s: Onta rio MD (Pe e r L e a de r), T e lus He a lth (Physic ia n a dviso r fo r Ra re Dise a se s Da shb o a rd), Ce ntre fo r E ffe c tive Pra c tic e (Po ve rty T o o l)  Othe r: no ne

Be fo re we b e g in….

Bo rde rline Pe rso na lity Diso rde r F ive o r mo re o f the fo llo wing to b e pre se nt fo r a sig nific a nt pe rio d o f time : abandonment  F ra ntic e ffo rts to a vo id re a l o r ima g ine d  A pa tte rn o f unsta b le a nd inte nse inte rpe rso na l re la tio nships c ha ra c te rize d b y a lte rna ting b e twe e n idealization devaluation e xtre me s o f a nd self-image or sense of self  I de ntity disturb a nc e : ma rke dly a nd pe rsiste ntly unsta b le impulsivity  in a t le a st two a re a s tha t a re po te ntia lly se lf-da ma g ing (e .g ., spe nding , pro misc uo us se x, e a ting diso rde rs, sub sta nc e a b use , re c kle ss driving , b ing e e a ting ). self-mutilating behaviour suicidal behaviour s,  Re c urre nt , g e sture s, o r thre a ts, o r mar ked r eactivity of mood  Affe c tive insta b ility due to a (e .g ., inte nse e piso dic dyspho ria , irrita b ility, o r a nxie ty usua lly la sting a fe w ho urs a nd o nly ra re ly mo re tha n a fe w da ys) emptiness  Chro nic fe e ling s o f anger  I na ppro pria te , inte nse o r diffic ulty c o ntro lling a ng e r (e .g ., fre q ue nt displa ys o f te mpe r, c o nsta nt a ng e r, re c urre nt physic a l fig hts).  T ra nsie nt, stre ss-re la te d pa ra no id ide a tio n o r se ve re disso c ia tive sympto ms

Bo rde rline Pe rso na lity Diso rde r “ Borderline individuals are the psychological equivalent of third-degree- burn patients. They simply have, so to speak, no emotional skin. Even the slightest touch or movement can create immense suffering. ” --Marsha Linehan

Wha t is DBT ? - Hie ra rc hy De c re a se  L ife thre a te ning (se lf ha rm, c risis surviva l)  T he ra py inte rfe ring (no t sha ring info rmatio n, missing a ppo intme nts, into xic a tio n, b o unda ry vio la tio ns)  Qua lity o f life (inc re a se se lf e ste e m, se lf wo rth, ho using , re la tio nships, wo rk) nc re a se behavioural skills: I Core mindfulness ‐ Interpersonal effectiveness ‐ Emotion regulation ‐ Distress tolerance ‐ Self‐management ‐

Se ssio n Struc ture  Review diary card  Check in on other aspects of treatment  Set agenda according to target hierarchy  Identify a specific instance of a target relevant problem behaviour (topography, frequency, intensity and duration)  Do a behavioural chain analysis  Perform a solution analysis  Rehearse some new behaviour, plan generalization and ask for commitment to it, troubleshoot obstacles  Notify of session ending, plan for next session, wind down