Foundations of DBT:
- The Bio-Social Theory and its role in treatment
- What are dialectics?
- Trauma is invalidating / Invalidation is traumatizing
- Why DBT has moved beyond personality disorders
- Acceptance v. change – the overarching dialectic
DBT, Trauma, and the Brain
- Healthy Brain v Traumatized Brain
- Malleability, plasticity, and post-traumatic growth
- How DBT interventions impact neurobiology
- Fight, flight, freeze as it relates to trauma survival
Integrating Trauma-Informed Care into DBT Core Skills
- How to sequence DBT in a trauma-informed manner
- The role of dialectics in trauma recovery
- Application of DBT to other trauma-related symptoms and disorders
- Integration of DBT with other trauma-focused modalities
Dialectical Thinking
- Common thinking errors among traumatized clients
- Teaching clients to find the “both/and” in their lives
- The role of dialectics in trauma recovery
- Skills: DBT House; TEA – Thoughts, Emotions, Actions; TOM – Thoughts, Opposite, Middle; Cognitive Defusion; Socratic Questioning
Mindfulness: Reactivity v. Dissociation
- How trauma forces awareness to the extremes
- Replace dissociation and hypervigilance with mindful tools
- Mindfulness skills to combat flashbacks and insomnia
- Skills: 3 A’s – Awareness, acceptance, action; RAIN Dance; Mindfulness Action Plan; Somatic Awareness
Distress Tolerance: Overreaction v. Paralysis
- Radical acceptance through the lens of trauma
- Coping with triggers, nightmares, and intrusive thoughts
- Finding meaning in suffering
- Increasing willingness to try new behavior
- Skills: Diary cards; chain analysis, DBT House
Emotion Regulation: Impulsivity v. Paralyzing Worry
- How traumatic experiences escalate the frequency, severity, and intensity of emotions
- Common emotional myths caused by trauma
- Distinguish between feelings and “action urges”
- Replace reactivity with problem-solving
- Skills: “Act opposite”, SEEDS - Symptoms, Eating, Exercise, Drugs, Sleep
Interpersonal Effectiveness: Over-Reliance v. Burning Bridges
- Trauma’s effect on attachments and relational styles
- Assertiveness, boundaries, and coping with conflict
- Decrease social isolation and mistrust of others
- Skills: DEAR Adult: Assert, appreciate, apologize; Escaping the drama cycle; Appearing confident; Dealing with crisis
Develop a Trauma-Informed Treatment Program
- Skills groups and skills coaching
- Levels of validation
- Adherence v. adaptation
- Priorities and stages of treatment
Clinical Considerations
- Crisis intervention for suicidality, self-injury
- Co-morbidities: Personality disorders, substance abuse
- Diversity and multicultural factors
- Limitations of the research and potential risks