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Bullying and the What is Dialectical Behavior Therapy (DBT)? Emotional Mind: Teaching DBT Skills • Another premise is clients need validating environments in which they are taught to regulate emotions, deal with to Foster Resiliency interpersonal conflicts, tolerate distress, and find balance in the lives. • The goal of DBT is to teach healthy coping skills to help clients manage intense emotions without the use of self- Kimberly L. Mason, Ph.D., LPC-S, NCC destructive behavior, with the ideal result being LCA Conference improved relationships. September 27, 2016 Objectives Biology and Emotion Regulation Understand DBT and Bullying Goodness of Fit Learn the Foundation of DBT Develop a Bullying Prevention Model Based on DBT Core Skills Cultivate DBT Strategies to help youth accept their feelings and to use thinking to change feelings What is Dialectical Behavior Therapy (DBT)? Biology, the Amygdala, and Emotion Regulation • DBT is a cognitive-behavioral approach that emphasizes • Functional magnetic resonance imaging (fMRI) studies in the psychosocial aspects of treatment. BPD show increased amygdala activity to specific types of stimuli. • Premise of DBT is that individuals struggle to tolerate and – “unresolved” life events, emotional faces, positive and regulate strong emotional states. negative emotional pictures, and emotionally-triggering • Emotional dysregulation (affective instability) is caused by: scripts. 1. heightened emotional responsivity • DBT targets amygdala hyperactivity • high sensitivity to emotional stimuli and heightened emotional – part of the disturbed neural circuitry underlying emotional intensity dysregulation. 2. difficulties in effortful modulation of negative affect. (Goodman et al., 2014) 1 DBT and Bullying: Goodness of Fit DBT and Bullying: Goodness of Fit • Adverse childhood experiences in combination with Given that DBT has been shown biological vulnerabilities and heightened emotional and behavioral dysregulation are thought to be effective in treating emotional relevant in the etiology of bullying, BPD, depression, regulation, DBT-ST can help youth anxiety, and self-harm (Linehan, 1993). reduce emotional dysregulation and • Research indicated in children under 12 who were reactivity by addressing deficits in bullied, there is an increased risk of developing poor emotion regulation, distress tolerance, mood and impulse control, unstable and intense personal relationships, and severe difficulty trusting and interpersonal relationships so the actions or motives of others (Wolke et al., 2012). bullying may decline. DBT and Bullying: Goodness of Fit Foundation of DBT Emotions can facilitate or impede youths’ peer relationships • Dialectics • Behaviorism • Youth who engage in bullying have lower competence Paradigms • Mindfulness in managing their emotions, being empathetic, solving • Wholeness and Interrelatedness problems, and/or evaluating the consequences of their Dialectical • Polarity actions. Principles • Continuous Change • Victims of bullying experience fear, isolation, anxiety, • Reducing dysfunctional behaviors anger, hurt, and embarrassment. They have increase • Increasing skillful behaviors in health concerns and withdraw activities they once Purpose • Building a life worth living enjoyed. DBT and Bullying: Goodness of Fit Foundation of DBT Dialectical View Opposites can co-exist • Current research shows that DBT has been shown effective in treating transdiagnostic disorders. • A life worth living has positive and negative • Emerging evidence suggests that DBT skills training (DBT-ST) aspects reduces problems with emotions. • Find ways to accept • DBT-ST has been shown to reduce emotion dysregulation, BOTH sides of a increase skills use, and reduce anxiety severity for individuals situation and find a who met criteria for BPD, depression, anxiety, eating synthesis that does not disorders, self-harm, and suicidal ideation. negate the reality of either. (Harley, Sprich, Safren, Jacobo, & Fava, 2008; Linehan, 1993; 1994; Neacsiu, Rizvi, & Linehan, 2010; Neacsiu et al, 2014; Soler et al., 2009; Safer, Robinson, & Jo, 2010) 2 Foundation of DBT Balanced Thinking Teen Dialectics Examples • There is no absolute truth; everyone has something to • Avoids all or none and accepts “both” offer. • Acceptance and hope • I am doing the best I can and I can do better. – (Parents often feel that if they accept they give up hope; this dialectic needs to be re-enforced so they do not become • I am tough and I am gentle. I may not have caused all of hopeless) my problems, and I’m responsible for working on them. • Independence and assistance • A life worth living has happiness, sadness, anger, and • Choices and limits calm, and all of these things are valuable and necessary. • Giving in and choosing priorities • Firmness and gentleness Obstacles to Dialectical Thinking Balanced Language • All Or Nothing: If you’re not perfect, you’re a total Help kids use less extreme loser. or absolute words • Disqualifying the Positive: The good stuff doesn’t • Minimize use of always, the possibility of hope count because the rest of your life is a miserable pile never, everyone, nobody, of crap. you make me • Jumping to Conclusions: You suddenly become a • Use “I feel…” statements, anger, disappointment, psychic mind reader and know exactly what everyone instead of “You are…” and frustration really thinks. statements. • Emotional Reasoning: You start thinking emotions • Instead of saying: “Everyone are facts. I feel like she hates me, so she does. always treats me unfairly,” say “Sometimes I am treated fairly AND at other times I am treated unfairly.” The Central Dialectic in DBT Creating Balance • As a counselor, you balance understanding your clients’ behavior in the context of their life AND helping them to learn skills to manage their behaviors better. – An emphasis either on acceptance or on change is usually ineffective Problem Solving • Validation means the acceptance that someone is Mindfulness Cognitive Behavioral doing the best he/she can in the context of his/her life Radical Acceptance Goals and Contingencies is as true for parents as for the adolescent. Turning the Mind • Validation communicates empathy and acceptance Validation and serves to de-escalate emotional situations . 3 Social Conformity Experiment Behaviorism Paradigm Creating Balance A Bullying Prevention Model Based on DBT Core Skills It is important to remember, and to remind your Mindfulness clients, that behaviors have been learned; they Interpersonal Distress can be unlearned and new behaviors can be Effectiveness DBT Tolerance learned to replace them. Emotional Regulation DBT Balances Skills Acquisition: teaching new behaviors Mindfulness VS. Validating and Reinforcing existing adaptive Focusing Skills behaviors 4
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