DBT EXAM REVIEW QUESTIONS & ANSWERS
What is DBT? - Answer -• Dialectical Behavioural Therapy is a broad array of cognitive
and beavioural therapy strategies for dysregulation which are common in persons who
struggle with BPD or who have multiple mood dx or who have not been able to
participate effectively in CBT.
Principle driven not protocol driven therapy*
What three techniques and strategies does DBT include? - Answer -Cognitive and
Behavioural techniques- it is very particular work
-Acceptance Based Strategies - patients have to be able to accept the reality of their
situation, commitment work is important because a lot of people don't want to admit the
fact that they are struggling, as a clinician you have to accept the previous coping skills
(even maladaptive ones), you have to be able to communicate that you acknowledge
what they were doing before was working for them
-dialectics
How is DBT a team based approach? - Answer -• a skills coach, 2-3 people running a
skills group, 1 person who see those people individually, and then the team would meet
and support each other (ideal world with requires funding) however that is often not the
case (in a situation where money is tight there might just be one person who sees them
all)
What is included in standart DBT? - Answer -• Individual Therapy - 1 X a week 1hr
• Group Skills Training - 1X a week 2.5hrs
• Therapist Consultation Team - 1X a week 1.5hours* works just like a skills group
• Phone Coaching- when you say "I can always take your call" no one calls, when you
don't have time to take calls everyone calls
What is the struggle for clinicians? - Answer -when you have a dysregulated client
comes in and has a lot going on that they want to talk about but you are trying to teach
them a skills it can become a disjointed situation, its challenging not to get lost in the
story telling and ignore what you are trying to teach them. You have to decide how to
navigate with your client what you want to do. You need to find a balance between
teaching the skill and not disclosing too much, and the client needs to learn how to not
disclose too much
Who is DBT for? - Answer -• DBT is for hard to treat patients who are typically
diagnosed with Borderline Personality Disorder (BPD).
• These patients use a tremendous amount of resources within the mental health
system and typically do very poorly in standard CBT models of care. They tend to drop
out precisely because of the nature of their illness.
,• Everyone can learn DBT skills, it is a treatment for severe and persistent emotional
and behavioural difficulties such as; suicidal, personality disorders, affective disorders,
substance abuse, eating disorders, self-injury
what BPD treatment is offered in DBT? - Answer -- Trauma Program
- Substance Abuse Treatment
- Individual Therapy
- Mood and Anxiety
What does DBT offer? - Answer -• Ways to manage multiple high risk behaviours
• Distance stages of treatment
• A system for managing obstacles for treatment delivery
AKA (Therapy interfering behaviours) (the small things, ex. Not brushing your teeth,
being late)
• Behavioral Rehearsal: purpose is for clients to use the skills in real life
• A focus on emotion as core target: difference between CBT and DBT, we are actively
engaging with emotion
• Comprehensive Skills training
• Strategies to reduce dropout/increase commitment: focus on self- care, ask if clients
are putting in more or less effort than you
• Built in support for clinicians: you have a whole team that is supporting you
Evidence of DBT? - Answer -• DBT is the gold standard treatment for patients with BPD
• Lower frequency and severity of suicide /self-injury
• Lower psychiatric hospitalization days*
• Lower substance use*
• Lower anger: better range of being able to manage their emotions
• Higher retention in therapy*
• Higher social adjustment, can be more cost effective
What other complex and emotionally driven illnesses does DBT effectively treat? -
Answer -• Depression
• Bi-polar Disorder
• Post traumatic stress disorder
• Eating Disorders
What is the DBT approach to treatment? - Answer -• Based on behavioral theory,
cognitive theory and mindfulness practice
• A 'stages of treatment' model with hierarchies of treatment at each stage
• Problem solving
• Behavioral analysis
• Insight strategies/cognitive restructuring
• Didactics
• Contingency Management
• Behavioral Rehearsal
• Exposure therapy
, What are four sections in adult DBT? - Answer -Mindfulness: being aware of the
present moment without judgement
Emotion Regulation: understanding and reducing vulnerability to emotions, changing
unwanted emotions, eg. Acting opposite
Distress Tolerance: getting through crisis situations without making things worse and
accepting reality as it is, reality acceptance is one of the hardest things people do
(recognizing that unfair or unjust things happen to us all the time, doesn't mean we
deserved it, means it is on our lap and we have to deal with it, the idea that you have to
live with something you don't want to can be extremely distressing).
Interpersonal Effectiveness: getting interpersonal objectives met, maintaining
relationships, and increasing self-respect in relationships
What is the difference between DBT and CBT? - Answer -• CBT - Focus on changing
dysfunctional cognitions to regulate/change emotions
• DBT - Focus on emotion, behavior and cognition
How does DBT look deeper? - Answer -Symptoms -> Core problem: Emotion
Regulation System (DBT looks into the core problem)
What is BPD? - Answer -• A pervasive pattern of instability of interpersonal
relationships, self-image, and affects, and marked impulsivity, beginning by early
adulthood and present in a variety of contexts as indicated by five or more of the
following:
• Should know this for the exam
1. Frantic efforts to avoid real or imagined abandonment. *
2. A pattern of unstable and intense interpersonal relationships characterized by
alternating between extremes of idealizations and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging such as spending,
sex, substance abuse, reckless driving, binge eating.*
5. Recurrent (ex. Multiple 5+ hospital admissions) suicidal behavior, gestures, or threats
or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood for example intense episodic
dysphoria, irritability, or anxiety usually lasing a few hours and only rarely more than a
few days).
7. Chronic feelings of emptiness.
• Inappropriate, intense anger or difficulty controlling anger for example frequent
displays of temper, constant anger, recurrent physical fights.
• Women tend to be diagnosed with BPD more often because they vocalize more where
men tend to end up undiagnosed and in the legal system.
• Transient, stress related paranoid ideation or severe dissociative symptoms.
What is dysregulation/ emotion regulation for adults and youth? - Answer -• Painful
emotional experiences
What is DBT? - Answer -• Dialectical Behavioural Therapy is a broad array of cognitive
and beavioural therapy strategies for dysregulation which are common in persons who
struggle with BPD or who have multiple mood dx or who have not been able to
participate effectively in CBT.
Principle driven not protocol driven therapy*
What three techniques and strategies does DBT include? - Answer -Cognitive and
Behavioural techniques- it is very particular work
-Acceptance Based Strategies - patients have to be able to accept the reality of their
situation, commitment work is important because a lot of people don't want to admit the
fact that they are struggling, as a clinician you have to accept the previous coping skills
(even maladaptive ones), you have to be able to communicate that you acknowledge
what they were doing before was working for them
-dialectics
How is DBT a team based approach? - Answer -• a skills coach, 2-3 people running a
skills group, 1 person who see those people individually, and then the team would meet
and support each other (ideal world with requires funding) however that is often not the
case (in a situation where money is tight there might just be one person who sees them
all)
What is included in standart DBT? - Answer -• Individual Therapy - 1 X a week 1hr
• Group Skills Training - 1X a week 2.5hrs
• Therapist Consultation Team - 1X a week 1.5hours* works just like a skills group
• Phone Coaching- when you say "I can always take your call" no one calls, when you
don't have time to take calls everyone calls
What is the struggle for clinicians? - Answer -when you have a dysregulated client
comes in and has a lot going on that they want to talk about but you are trying to teach
them a skills it can become a disjointed situation, its challenging not to get lost in the
story telling and ignore what you are trying to teach them. You have to decide how to
navigate with your client what you want to do. You need to find a balance between
teaching the skill and not disclosing too much, and the client needs to learn how to not
disclose too much
Who is DBT for? - Answer -• DBT is for hard to treat patients who are typically
diagnosed with Borderline Personality Disorder (BPD).
• These patients use a tremendous amount of resources within the mental health
system and typically do very poorly in standard CBT models of care. They tend to drop
out precisely because of the nature of their illness.
,• Everyone can learn DBT skills, it is a treatment for severe and persistent emotional
and behavioural difficulties such as; suicidal, personality disorders, affective disorders,
substance abuse, eating disorders, self-injury
what BPD treatment is offered in DBT? - Answer -- Trauma Program
- Substance Abuse Treatment
- Individual Therapy
- Mood and Anxiety
What does DBT offer? - Answer -• Ways to manage multiple high risk behaviours
• Distance stages of treatment
• A system for managing obstacles for treatment delivery
AKA (Therapy interfering behaviours) (the small things, ex. Not brushing your teeth,
being late)
• Behavioral Rehearsal: purpose is for clients to use the skills in real life
• A focus on emotion as core target: difference between CBT and DBT, we are actively
engaging with emotion
• Comprehensive Skills training
• Strategies to reduce dropout/increase commitment: focus on self- care, ask if clients
are putting in more or less effort than you
• Built in support for clinicians: you have a whole team that is supporting you
Evidence of DBT? - Answer -• DBT is the gold standard treatment for patients with BPD
• Lower frequency and severity of suicide /self-injury
• Lower psychiatric hospitalization days*
• Lower substance use*
• Lower anger: better range of being able to manage their emotions
• Higher retention in therapy*
• Higher social adjustment, can be more cost effective
What other complex and emotionally driven illnesses does DBT effectively treat? -
Answer -• Depression
• Bi-polar Disorder
• Post traumatic stress disorder
• Eating Disorders
What is the DBT approach to treatment? - Answer -• Based on behavioral theory,
cognitive theory and mindfulness practice
• A 'stages of treatment' model with hierarchies of treatment at each stage
• Problem solving
• Behavioral analysis
• Insight strategies/cognitive restructuring
• Didactics
• Contingency Management
• Behavioral Rehearsal
• Exposure therapy
, What are four sections in adult DBT? - Answer -Mindfulness: being aware of the
present moment without judgement
Emotion Regulation: understanding and reducing vulnerability to emotions, changing
unwanted emotions, eg. Acting opposite
Distress Tolerance: getting through crisis situations without making things worse and
accepting reality as it is, reality acceptance is one of the hardest things people do
(recognizing that unfair or unjust things happen to us all the time, doesn't mean we
deserved it, means it is on our lap and we have to deal with it, the idea that you have to
live with something you don't want to can be extremely distressing).
Interpersonal Effectiveness: getting interpersonal objectives met, maintaining
relationships, and increasing self-respect in relationships
What is the difference between DBT and CBT? - Answer -• CBT - Focus on changing
dysfunctional cognitions to regulate/change emotions
• DBT - Focus on emotion, behavior and cognition
How does DBT look deeper? - Answer -Symptoms -> Core problem: Emotion
Regulation System (DBT looks into the core problem)
What is BPD? - Answer -• A pervasive pattern of instability of interpersonal
relationships, self-image, and affects, and marked impulsivity, beginning by early
adulthood and present in a variety of contexts as indicated by five or more of the
following:
• Should know this for the exam
1. Frantic efforts to avoid real or imagined abandonment. *
2. A pattern of unstable and intense interpersonal relationships characterized by
alternating between extremes of idealizations and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging such as spending,
sex, substance abuse, reckless driving, binge eating.*
5. Recurrent (ex. Multiple 5+ hospital admissions) suicidal behavior, gestures, or threats
or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood for example intense episodic
dysphoria, irritability, or anxiety usually lasing a few hours and only rarely more than a
few days).
7. Chronic feelings of emptiness.
• Inappropriate, intense anger or difficulty controlling anger for example frequent
displays of temper, constant anger, recurrent physical fights.
• Women tend to be diagnosed with BPD more often because they vocalize more where
men tend to end up undiagnosed and in the legal system.
• Transient, stress related paranoid ideation or severe dissociative symptoms.
What is dysregulation/ emotion regulation for adults and youth? - Answer -• Painful
emotional experiences
