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7/17/19
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HOW TO RUN A DBT SKILLS CLASS
AND
MINDFULNESS SKILLS
Clara Doctolero, PsyDEi Resources, LLC and Seattle Psych Studio, LLCclara@seattlepsychstudio.com
DBT SeminarJuly 23, 2019
DBT STAGES
Pre-treatment – motivational interviewing, commitment
Stage 1: Suicidal behaviors, therapy-interfering behaviors, major quality of life interfering behaviors, skills deficits; one-year commitment
Stage 2: Not actively engaged in suicidal behaviors, are able to work in therapy, and have adequate stability and resources, willingness to engage in exposure exercises; various time commitment to therapy
Stage 3: Increasing self-respect and achieving individual goals
OVERVIEW
1. What you need for a DBT Skills CLASS
2. Orienting new clients to Class
3. Guidelines for Skills Class
4. SKILLS: Mindfulness
5. SKILLS: States of Mind
6. SKILLS: “What”
7. SKILLS: “How”
For educational use only
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SKILLS TRAINING: WHAT YOU NEED FOR A STANDARD DBT GROUP
1. Clients with individual therapists
2. Binders with DBT worksheets and handouts
3. Group is typically 2.5 hours for adults and 2 hours for adolescents
4. Leader• Begins the group with a mindfulness exercise• Conducts homework review• Flows from person to person• Teaches new skills
SKILLS TRAINING: WHAT YOU NEED FOR A STANDARD DBT CLASS
4. Co-leader
• Assist leader with timing of the group•Mediates tension that arise between client and leader by providing a synthesis to the issue• Pays attention to the needs of each individual• Acts as a tutor by offering examples and/or different way of looking/teaching the skill• Sends homework reminders
For educational use only
5. Both Leader/Co-leader
•Maintains a dialectical perspective•On the same consultation team•Are not individual therapists while conducting group
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SKILLS CLASS CULTURE
Based on behaviorism• Environmental change •Modeling• (Selling)• Rehearsal• Reinforcement
ORIENTING A NEW CLASS MEMBER
Member has an individual DBT therapist
Time commitment to treatment/skills class
Review the skills training treatment targets and individual goals
Guidelines for Skills training (see next slides)• 4-miss rule
• No SI talk
• Group rules per the group e.g., no cell phones, stickers
Validate the client
Diary card
Skills exam
For educational use only
SKILLFUL BEHAVIOR REPLACES PROBLEM BEHAVIOR
FOR EDUCATIONAL USE ONLY
Behavior to Increase Behavior to Decrease
Mindfulness Skills ü Identity confusionü Emptinessü Cognitive distortions
Emotion Regulation Skills ü Labile affectü Anger
Interpersonal Effectiveness Skills ü Chaosü Fear of abandonment
Distress Tolerance Skills ü NSSIü Impulsive bxü Suicidality
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GUIDELINES FOR SKILLS TRAINING
1. Participants who drop out of skills training are not out of skills training.The only way out is to miss four scheduled sessions of skills training in a row.
2. Participants who join the skills training group support each other and: Keep names of other participants and information obtained during sessions confidential. Come to each group session on time and stay until the end. Make every effort to practice skills between sessions. Validate each other, avoid judging each other, and assume the best about each other. Give helpful, noncritical feedback when asked. Are willing to accept help from a person they ask or call for help.
For educational use only
GUIDELINES FOR SKILLS TRAINING
3. Participants who join the skills training group: Call ahead of time if they are going to be late or miss a session.
4. Participants do not tempt others to engage in problem behaviors and: Do not come to sessions under the influence of drugs or alcohol. If drugs or alcohol have already been used, come to sessions acting and appearing clean
and sober. Do not discuss, inside or outside sessions, current or past problem behaviors that could be
contagious to others.
For educational use only
GUIDELINES FOR SKILLS TRAINING
5. Participants do not form confidential relationships with each other outside of skills training sessions and:
Do not start a sexual or a private relationship that cannot be discussed in group.
Are not partners in risky behaviors, crime, or drug use.
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STANDARD CORE DBT SKILLS TRAINING SCHEDULE: 6 MONTHS
Interpersonal Effectiveness – 5 weeks
CoreMindfulness – 2 weeks
Emotion Regulation –
7 weeks
Core Mindfulness – 2 weeks
Distress Tolerance –
6 weeks
Core Mindfulness – 2 weeks
For educational use only
SKILLS GROUP SCHEDULE
5 minutes – mindfulness
5 minutes – observations of mindfulness
45 minutes – homework review
5-10 minute Break
45 hour – new material
5 minutes – closing observations
Mindfulness bell
Group leaders
DBT handouts and homework assignment(s)
For educational use only
TEACHING SKILLS GROUP
üKnow your audience- Teens vs. friends and family vs. adults
üDon’t fear technology- youtube; iphone apps; audio recordings
üModeling and self-disclosure- Doing the homework/homework challenges
üBe an active co-leader
üObserving judgments
üSell it
üRealistic expectations
For educational use only
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QUESTIONS?
MINDFULNESS
Mindfulness means paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.
Jon Kabat-Zinn,
Wherever You Go, There You Are
WHY BOTHER?
To reduce suffering and increasing happiness and experience reality as it is
Being in control of your mind
Developing a lifestyle of participating with awareness
Reduce pain, tension, and stress
Increase joy and happiness
Decrease psychological distress and increased sense of well-being
For educational use only
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OVERVIEW OF THE MINDFULNESS MODULE
1. States of Mind
2. “What“ and “How“ skills
For educational use only
STATES OF MIND
For educational use only
EMOTION MIND
When emotions are in control, they influence your thinking and behavior, and facts are amplified or distorted to fit emotions
Benefits: exciting, passionate, creative, motivation for relationships, mothers running through fires, passion for beliefs and causes, etc
Problems: Impulsive behavior, short-term and long-term consequences
Mood-dependent behavior
For educational use only
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REASONABLE MIND
“Rational,” thinking, “logical” mind
Detached and organized
Plans and evaluates
Less values
Benefits: Build homes, roads, following instructions, science
Problems: Affects relationships, don’t follow values, don’t listen to your “gut”
For educational use only
WISE MIND
Goal of therapy
Everyone has wise mind
The integration of emotion and reason
Peace, centered, strong, wise
The part of each person that can know and experience the truth
The calm that follows the storm
Finding wise mind consistently can take a lot of practice
For educational use only
LEADING MINDFULNESS PRACTICE
Tell a story, present a problem, or describe a situation that hits a universal theme, to get the attention and interest of participants
Relate the story to yourself to highlight the importance of the skill or exercise being taught
Make it clear, “this is an exercise that helps you get into wise mind” and explain how
Get in a “wide-awake” posture (e.g., keeping both feet on the floor and sitting in a posture that is likely to stay alert and comfortable)
Tell participants exactly what to do
Instruct what to do if they get distracted
Signal the start and end of the practice
Invite participants to share and comment on their experience
Give corrective feedback and troubleshoot
For educational use only
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LEADING MINDFULNESS PRACTICETell a story, present a problem, or describe a situation that hits a universal theme, to get the attention and interest of participants
Relate the story to yourself to highlight the importance of the skill or exercise being taught
Make it clear, “this is an exercise that helps you get into wise mind” and explain how
Get in a “wide-awake” posture (e.g., keeping both feet on the floor and sitting in a posture that is likely to stay alert and comfortable)
Tell participants exactly what to do
Instruct what to do if they get distracted
Signal the start and end of the practice
Invite participants to share and comment on their experience
Give corrective feedback and troubleshoot
For educational use only
WISE MIND PRACTICE
Stone flake on the lake
Walking down the spiral stairs
Breathing “Wise” in, “Mind” out
Asking Wise Mind a question
…another DBT skill like pace breathing
For educational use only
WHAT AND HOW SKILLS
“What” skills1. Observe2. Describe3. Participate
“How” skills1. Non-judgmental2. One-mindfully3. Effectiveness
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“WHAT” SKILLS (WHAT TO DO TO PRACTICE MINDFULNESS)
Observe
Describe
Participate
For educational use only
“WHAT” SKILLS:
OBSERVE
Learning how to just notice what you’re observing without adding anything to it.
Pay attention to what comes to you through your sensations.
The idea is to do it without a name or hang on to it.
For educational use only
“WHAT” SKILLS:
DESCRIBE
The hardest skill for people to learn (and therapists).
This is when you put words on the experience - describe what you observe not what you infer.
The key is knowing what you added.
Use the facts.
For educational use only
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DESCRIBE WITH JUSTTHE FACTS
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“WHAT” SKILLS:
PARTICIPATE
Throwing yourself into the present moment
Go with the flow
Fully present; like driving stick shift car
For educational use only
“HOW” SKILLS (HOW TO BE MINDFUL)
Non-judgmentally: focus on the facts, accepting the reality of each moment, recognize the difference of opinions/thoughts/emotions
One-Mindfully: Doing one thing at a time. When distracted, let go of the distraction and come back to the experience
Effectively: Focus on what works (rather than what is “fair,” “right,” or “should be.” Being skillful to meet the situation you’re in. Let go of ineffective anger, revenge, righteousness, etc.)
For educational use only
MINDFULNESS HOMEWORK EXAMPLES
States of mind - observe and describe each state of mind with three examples during the week
Pros/cons of practicing mindfulness
Wise mind practice
Mindfulness calendar
Practice observe, describe, and/or participate
Nonjudgmental stance
For educational use only
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PRACTICE FOR YOU AND OTHERS
Encourage each client to practice
Validate the difficulty of these skills
Come up with your own examples especially with your own strengths and weaknesses
For educational use only
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