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BASICS & BEYOND
Contact Information
@Kirbyreutter
Kirby Reutter
@kirbyreutter
Dr. Kirby Reutter
WWW drkirbyreutter.com
Brief History of Dialectics
Socrates
Socratic Method
Hegel
1. Thesis
2. Antithesis
3. Synthesis
Karl Marx
Communism
Marsha Linehan
DBT
Marsha Linehan
Bio-Social Model
Nature
• Temperament • Sex / Gender
Nurture INVALIDATION!
TRANSACTION
Invalidating Families
1. “Disorganized” Family
2. “Perfect” Family
3. “Normal” Family
Emotional Vulnerability
1. More negative emotions
2. More sensitive to triggers
3. Higher intensity of emotions
4. Slower return to baseline
5 Deficits
1. Lack of awareness
2. Polarized thinking
3. Poor emotional control
4. Maladaptive coping
5. Deficient people skills
5 Skill Sets
1. Mindfulness
2. Dialectical Thinking
3. Emotion Regulation
4. Distress Tolerance
5. Interpersonal Effectiveness
Clients: 4 Options
• Solve the problem
• Feel better about the problem
• Tolerate the problem
• Stay miserable
DBT
CBT DBT
CognitiveComponents
BehavioralComponents
Mindfulness Distress Tolerance
Dialectical Thinking
EmotionRegulation
Interpersonal Effectiveness
AND
AcceptanceSkills
ChangeSkills
Mindfulness Emotion Regulation
Distress Tolerance
Interpersonal Effectiveness
Dialectical Thinking
Acceptance vs. Change
Radical Genuineness
• Cheerleading
• Self-Disclosure
• Clinical “Irreverence”
• Functional Validation
Lynch, T. R., Morse, J. Q., Mendelson, T., & Robins, C. J. (2003).
Dialectical behavior therapy for depressed older adults: A randomized
pilot study. The American Journal of Geriatric Psychiatry, 11(1), 33-45.
Research Says:
Azizi, A., Borjali, A., & Golzari, M. (2010). The effectiveness of emotion
regulation training and cognitive therapy on the emotional and
addictional problems of substance abusers. Iranian Journal of
Psychiatry, 5(2), 60.
Research Says:
Steil, R., Dyer, A., Priebe, K., Kleindienst, N., & Bohus, M. (2011).
Dialectical behavior therapy for posttraumatic stress disorder related to
childhood sexual abuse: a pilot study of an intensive residential
treatment program. Journal of traumatic stress, 24(1), 102-106.
Research Says:
Goldstein, T. R., Axelson, D. A., Birmaher, B., & Brent, D. A. (2007).
Dialectical behavior therapy for adolescents with bipolar disorder: a 1-
year open trial. Journal of the American Academy of Child & Adolescent
Psychiatry, 46(7), 820-830.
Research Says:
Marco, J. H., García-Palacios, A., & Botella, C. (2013). Dialectical
behavioural therapy for oppositional defiant disorder in adolescents: A
case series. Psicothema, 25(2).
Research Says:
Ahovan, M., Balali, S., Shargh, N. A., & Doostian, Y. (2016). Efficacy of
Dialectical Behavior Therapy on Clinical Signs and Emotion Regulation
in Patients with Obsessive-Compulsive Disorder. Mediterranean Journal of
Social Sciences, 7(4), 412.
Research Says:
Mindfulness“Know Thyself”
Mindlessness
Examples:
1. Reactivity
2. Dissociation
3. Automaticity
4. Multi-Tasking
Mindfulness
Definition:
1. Paying attention AWARENESS
2. On purpose
3. In the present
4. Without judging ACCEPTANCE
Mindfulness
Mindfulness = Awareness + Acceptance
Core MindfulnessWHAT Skills HOW Skills
1. OBSERVE
• Non-Verbal
ONE - MINDFULLY
• Awareness
2. DESCRIBE
• Verbal
NON - JUDGMENTALLY
• Acceptance
3. PARTICIPATE
• Experiential
EFFECTIVELY
• Action
Applied Mindfulness
1. Observe One-Mindfully Awareness
2. Describe Non-Judgmentally Acceptance
3. Participate Effectively Action
Three Categories
• Physical Experiences
• Internal Experiences
• External Experiences
Expanding
Awareness
Physical Experiences
1. Breathing
2. Muscles
3. Movements
4. Senses
5. Sensations
Inner Experiences
1. Urges
2. Thoughts
3. Feelings
4. Memories
5. Triggers
Stream of Consciousness• Imagine that your mind is a river.• The following “boats” are floating down this river:
o Urgeso Feelings o Thoughtso Memories
• Imagine sitting on the grass, observing the boats.• Describe each boat as it floats by.• Try not to jump on the boats!
Other Experiences
1. Ordinary Activities
2. Guided Imagery
3. Pleasant Events
4. Unpleasant Events
5. Spiritual Experiences
Distress Tolerance
“The Mess of Stress”“The Rigors of Triggers”
“The Bane of Pain”
Distress Tolerance
Definitions:
• “Surviving the moment without making it worse.”
• “Turning unbearable pain into bearable pain.”
Applied Mindfulness
1. Observe One-Mindfully Awareness
2. Describe Non-Judgmentally Acceptance
3. Participate Effectively Action
Distress ToleranceGoals:
• Replace impulsive behaviors
• Replace self-harm behaviors
• Replace substance behaviors
• Replace suicidal behaviors
• Reduce crisis orientation
Distress Tolerance
Categories:
1. Coping Mindsets
2. Coping Postures
3. Coping Skills
Radical Acceptance
Definition:
“See something as it is - no more and no less.”
Three Scenarios
1. PAST: Events that can’t be changed
2. PRESENT: Events that can’t be changed
3. PRESENT: Events that can be changed
“When we are no longer able to change a situation,
we are challenged to change ourselves.”
Viktor Frankl
"Life is difficult. This is a great truth, one of the greatest truths. It is a
great truth because once we truly see this truth, we transcend it. Once we
truly know that life is difficult - once we truly understand and accept it -
then life is no longer (as) difficult. Because once it is accepted, the fact
that life is difficult no longer matters."
M. Scott Peck
Why Accept Reality?
• Pain cannot be avoided
• Rejecting reality turns pain into suffering
• Denying reality does not change reality
• Changing reality requires accepting reality
• Accepting may increase sadness at first, but then leads to peace and freedom
• “The path out of hell is through misery”
Radical Acceptance
Non-AcceptanceExamples:
• Lying
• Denial
• Excuses
• Blaming
• Distraction
• Avoidance
• Any defense mechanism!
Radical Acceptance
When to use:
1. Try to problem-solve
2. Try to reframe
3. RADICALLY ACCEPT
Every Day Acceptance
• Deal with minor issues before become major issues
• Good practice for Radical Acceptance
• Sometimes more difficult than Radical Acceptance!
Half Smile
You can’t control the waves
but you can learn to surf.
Emotion Regulation“Dealing with Feeling”
Emotion RegulationGoals:
1. Identify / label emotions2. Understand purpose of emotions3. Increase emotional stability
Applied Mindfulness
1. Observe One-Mindfully Awareness
2. Describe Non-Judgmentally Acceptance
3. Participate Effectively Action
Purpose of Emotions
1. CommunicateSELF
2. Motivate OTHERS
3. Influence
Trigger Emotion
ProblemUrge
Tips for Acting Opposite
• Behavior
• Posture
• Body Chemistry
• Imagery
• Words
Trigger Emotion Problem Urge
Dialectical Thinking “How to Tinker with the Thinker”
Dialectical Thinking
The ability to:
1. To see things from different perspectives
2. To think in the middle (not the extremes)
3. To be flexible (not rigid) in your thinking
4. To change how you think based on new information
Applied Mindfulness
1. Observe One-Mindfully Awareness
2. Describe Non-Judgmentally Acceptance
3. Participate Effectively Action
Candy Bowl Analogy
CBT 101
Reality 101
Whatनs in your TEA?Thoughts
Emotions Actions
Mindfulness of Thoughts
• Learn to vocalize your thoughts out loud
• Say your thoughts really really fast
• Say your thoughts really really slow (one syllable / breath)
• Say your thoughts using different voices
• Provide a radio commentary on your thoughts.
• Sing your thoughts as dramatically as possible
Interpersonal Effectiveness
“How to win friends and influence people”
Interpersonal Effectiveness
Definition:
“How to get most of your wants and needs met most of the time.”
Interpersonal Effectiveness
Goals:
1. Meet wants and needs
2. Balance acceptance & change
3. Build positive relationships
4. End destructive relationships
Applied Mindfulness
1. Observe One-Mindfully Awareness
2. Describe Non-Judgmentally Acceptance
3. Participate Effectively Action
How to Negotiate
• Compromise
• Turn the tables
• Take partial responsibility
• Offer to be part of solution
• Use connect talk – NOT control talk
• Use principle-orientation vs. position orientation
• Think dialectically (win-win NOT win-lose)
Advanced Mindfulness
“Know Thyself Even More”
Expanding Awareness
From Mindfulness to Insight:
• Mindfulness: Awareness of one thing at a time
• Insight: Awareness of how multiple things are related
Mindfulness Insight
Mindfulness of Physical Experiences
Mindfulness of Internal Experiences
+ Mindfulness of External Experiences________________________________________
INSIGHT
Summary of DBT
A Awareness
A Acceptance
A Action
BALANCE
The End. Go Home.
