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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