DBT LBC Certification Study Guide.Final Exam Test 2026\2027.
According to Linehan, BPD clients possess 6 behavioral patterns. These are:
emotional vulnerability, self invalidation, unrelenting crisis, inhibited grieving, active passivity, and apparent competence
Linehan's criteria for BPD is most similar to
Millon
What % of BPD client's engage in self-injurious behaviors?
70-75%
Kreitman introduced this term meaning nonfatal, intentional self injurious behavior resulting in actual tissue
damage, illness, or risk of death; or 2) ingestion of any drugs or substance not prescribed or in excess to the
prescription with intent to cause harm or death. This term includes both SI gestures and self injurious behaviors
with little or not intent to cause death.
parasuicide
4 differences between CBT and DBT:
1) Emphasis on acceptance and validation of behavior as it is in the moment
2) Emphasis on TIBs
3) Emphasis on the therapeutic relationship
4) Focus on dialectical processes
The term "dialectics" as applied to behavioral therapy has come to imply 2 contexts of usage:
1) fundamental nature of reality and persuasive dialogue and relationship.
2) Treatment approach or strategies used by the therapist to effect change.
Dialectics as a worldview has 3 traits:
1) interrelatedness and wholeness
2) Principles of Polarity (within dysfunction there is function, wise mind, finding value in one's pt of view, looking for the
function within the present moment)
3) Thesis, Antithesis, Synthesis: Principles of Continuous Change
Borderline splitting is defined as
tendency to get stuck in either the thesis or the antithesis, unable to move to a synthesis. Either/or thinking
The environment- person system is comprised of the:
environmental sub-system (social support, life change, suicidal, suicidal consequences) demographic factors (age, sex, and
race), and behavioral subsystem ( cognitive, over motor, and physiological affective system)
Grostein proposed bpd is a disorder of
self regulation
characteristics of emotional vulnerability includes :
high sensitivity to emotional stimuli, emotional intensity, slow return to emotional baseline.
emotional regulation requires 2 paradoxical strategies
1) the individual must learn to experience and label the discreet emotions
2) the individual must learn to reduce emotionally relevant stimuli that serve either to reactivate and augment ongoing
negative emotions or to set off secondary dysfunctional emotional responses.
inhibition of emotions can lead to
1) neglect of the problem situation causing the emotions
2) increase in emotional avoidance (emotion phobic)
3) research is unknown on the outcome of emotion inhibition over the long term
,DBT LBC Certification Study Guide.Final Exam Test 2026\2027.
Poorness of fit results (Chess and Thomas)
when there is discrepancies and dissonances between environmental opportunities and demands and the capacities and
characteristics of the child. In these instances , distorted environment and maladaptive functions results.
Per Linehan, an invalidating enivorment:
is one in which communication of private experiences is met by erratic, inappropriate, and extreme responses.
Invalidation has 2 primary traits
1) it tells the person that they are wrong 2) it attributes her experiences to socially unacceptable characteristics or
personality traits
consequences of invalidating environments
1) emotional labeling is not learned, 2) distress intolerance and unrealistic goals/ expectations are instilled, 3) extreme
behavioral displays are used to get needs met, 4) lack of trust of one's own emotional and cognitive interpretations are
instilled
what are the 3 types of invalidating family systems
1) perfect family
2) chaotic family
3) typical family
This family type struggles with multiple issues within the family system, needs of the child are ignored and
invalidated, there is volatile responses, etc
Chaotic Family
This family type cannot tolerate the negative emotions of the child. This can be due to high work demands, self-
centeredness, intolerance of negative emotions, and naive fears of spoiling the child. This family system has
sympathy for their child but unknowingly can invalidate by offering over simplified solutions to their child, ie pray
about it
perfect family
This family system exists within the western cultures and supports the idea of cognitive control with focus on
achievement above all else. Self-control is move important.
Typical family system
Active Passivity is similar to _____ focused coping; ie the tendency to respond to stressful events with efforts to
reduce the negative emotional reaction by distracting or seeking comfort from others.
Emotion
What factors contribute to apparent competency:
1) person's competence is variable and conditional
2) person struggles with ability to be vulnerable with others
3) person's reaction to interpersonal relationships; ie the difference in behavior of the person in a therapeutic relationship
versus other outside relationships
The core strategies of dbt are:
problem solving (change) and validation (acceptance)
There are 2 types of validation strategies (ie core strategies):
1) wisdom within the client's maladaptive behaviors based on the client's historical context
2) the therapist belief in the client's ability to build a LWL
Problem solving strategies (core strategies) include:
,DBT LBC Certification Study Guide.Final Exam Test 2026\2027.
1) BCAs
2) Solutions Analysis
3) Orientation to the treatment solution
4) Eliciting commitment from the client
5) Application of the treatment
The BCA includes the 4 following questions (BCA being a problem-solving strategies which is a Core strategy)
1) Does the individual have the ability to engage in a more adaptive response? (if not incorporate skills)
2) What are the reinforcing contingencies? (contingency management)
3) If adaptive responses are present, is their application inhibited by client's fear or guilt? Is the client emotion phobic?
(exposure therapy)
4) if adaptive responses are present, is their application inhibited by client's faulty belief's or beliefs? (cognitive
modification)
What are the two communication styles in DBT?
irreverent and reciprocal
What are the 4 modes of DBT treatment?
individual therapy, dbt consult team, dbt phone consultation, dbt skill class
How many DBT assumptions are there?
8
What are the DBT assumptions?
1) People are doing the best they can
2) People want to do better
3) People need to try harder and be more motivated to change
4) Clients cannot fail treatment
5) Therapist treating BPD must seek support
6) We did not cause all of our problems but we have to solve them anyways
7. The lives of SI clients are unbearable as they are being lived currently
8. Client must learn new behaviors in all relevant contexts
"Unwavering centeredness" is defined as
believing in oneself, in therapy, and in oneself. It is the calmness in the storm.
"Compassionate flexibility" is defined as
Ability to adapt to changes within the therapeutic relationship as needed. This includes admitting mistakes, observing and
extending limits as needed.
The balance "unwavering centeredness" and "compassionate flexibility" requires
the therapist observe limits and conditions while being flexible in response to changing, adapting, etc.
"Nurturing" includes:
teaching, coaching, assisting, strengthening, and aiding the patient
"Benevolent demanding" includes:
therapist recognition of the client's on strengths and capability , reinforcement of their adaptive responses, and not taking
care of them
The dialectical position to take with benevolent demanding and nurturing is:
Pushing the client forward while supporting them.
, DBT LBC Certification Study Guide.Final Exam Test 2026\2027.
Patient agreements include:
1) 1 year commitment to DBT
2) 4 missed shows in a row
3) Attendance agreement
4) SI agreement
5) TIB agreement
6) Skill training agreement
7) Research and payment agreement
Therapist agreements include:
1) Every reasonable effort agreement
2) Ethical agreement
3) Personal contact agreement
4) Respect for the client agreement
5) Confidentiality Agreement
6_ Consultation agreement
There is no absolute truth and when polarities exist the goal is to search for the synthesis rather than the truth.
Dialectical Agreement
Therapists do no serve as intermediaries for their patients with other professionals, including other members of
the treatment team.
Consultation to the client
Consistencies with other members of the treatment team are not expected and each member of the team does not
have to teach the same thing nor agree on proper rules of the therapy.
Consistency Agreement
The case conceptualization group agrees that therapists are to observe their own limits nor judge others limits.
Observing Limits Agreement
Therapist agree to search for a nonpejorative interpretation of clients behaviors
phenomenological empathy agreement
Explicit agreement that all therapist are jerks.
Fallibility agreement
There are 5 subcategories of SI-related behaviors which are targeted in DBT:
1) SI Crisis behaviors
2) Parasuicidal acts (nonfatal, intentional self-injurious behaviors)
3) SI ideation and communications
4) SI- related experiences and beliefs (idea it is a problem-solving technique)
5) SI- related affect
Reducing Parasuicidal acts is important because:
1) best predictor of subsequent SI
2) damages to the body
3) actions based on the intent to harm oneself are incompatible with therapy
4) It is hard to express care for a client if you do not address self-harm
There are 3 categories of client TIBs:
According to Linehan, BPD clients possess 6 behavioral patterns. These are:
emotional vulnerability, self invalidation, unrelenting crisis, inhibited grieving, active passivity, and apparent competence
Linehan's criteria for BPD is most similar to
Millon
What % of BPD client's engage in self-injurious behaviors?
70-75%
Kreitman introduced this term meaning nonfatal, intentional self injurious behavior resulting in actual tissue
damage, illness, or risk of death; or 2) ingestion of any drugs or substance not prescribed or in excess to the
prescription with intent to cause harm or death. This term includes both SI gestures and self injurious behaviors
with little or not intent to cause death.
parasuicide
4 differences between CBT and DBT:
1) Emphasis on acceptance and validation of behavior as it is in the moment
2) Emphasis on TIBs
3) Emphasis on the therapeutic relationship
4) Focus on dialectical processes
The term "dialectics" as applied to behavioral therapy has come to imply 2 contexts of usage:
1) fundamental nature of reality and persuasive dialogue and relationship.
2) Treatment approach or strategies used by the therapist to effect change.
Dialectics as a worldview has 3 traits:
1) interrelatedness and wholeness
2) Principles of Polarity (within dysfunction there is function, wise mind, finding value in one's pt of view, looking for the
function within the present moment)
3) Thesis, Antithesis, Synthesis: Principles of Continuous Change
Borderline splitting is defined as
tendency to get stuck in either the thesis or the antithesis, unable to move to a synthesis. Either/or thinking
The environment- person system is comprised of the:
environmental sub-system (social support, life change, suicidal, suicidal consequences) demographic factors (age, sex, and
race), and behavioral subsystem ( cognitive, over motor, and physiological affective system)
Grostein proposed bpd is a disorder of
self regulation
characteristics of emotional vulnerability includes :
high sensitivity to emotional stimuli, emotional intensity, slow return to emotional baseline.
emotional regulation requires 2 paradoxical strategies
1) the individual must learn to experience and label the discreet emotions
2) the individual must learn to reduce emotionally relevant stimuli that serve either to reactivate and augment ongoing
negative emotions or to set off secondary dysfunctional emotional responses.
inhibition of emotions can lead to
1) neglect of the problem situation causing the emotions
2) increase in emotional avoidance (emotion phobic)
3) research is unknown on the outcome of emotion inhibition over the long term
,DBT LBC Certification Study Guide.Final Exam Test 2026\2027.
Poorness of fit results (Chess and Thomas)
when there is discrepancies and dissonances between environmental opportunities and demands and the capacities and
characteristics of the child. In these instances , distorted environment and maladaptive functions results.
Per Linehan, an invalidating enivorment:
is one in which communication of private experiences is met by erratic, inappropriate, and extreme responses.
Invalidation has 2 primary traits
1) it tells the person that they are wrong 2) it attributes her experiences to socially unacceptable characteristics or
personality traits
consequences of invalidating environments
1) emotional labeling is not learned, 2) distress intolerance and unrealistic goals/ expectations are instilled, 3) extreme
behavioral displays are used to get needs met, 4) lack of trust of one's own emotional and cognitive interpretations are
instilled
what are the 3 types of invalidating family systems
1) perfect family
2) chaotic family
3) typical family
This family type struggles with multiple issues within the family system, needs of the child are ignored and
invalidated, there is volatile responses, etc
Chaotic Family
This family type cannot tolerate the negative emotions of the child. This can be due to high work demands, self-
centeredness, intolerance of negative emotions, and naive fears of spoiling the child. This family system has
sympathy for their child but unknowingly can invalidate by offering over simplified solutions to their child, ie pray
about it
perfect family
This family system exists within the western cultures and supports the idea of cognitive control with focus on
achievement above all else. Self-control is move important.
Typical family system
Active Passivity is similar to _____ focused coping; ie the tendency to respond to stressful events with efforts to
reduce the negative emotional reaction by distracting or seeking comfort from others.
Emotion
What factors contribute to apparent competency:
1) person's competence is variable and conditional
2) person struggles with ability to be vulnerable with others
3) person's reaction to interpersonal relationships; ie the difference in behavior of the person in a therapeutic relationship
versus other outside relationships
The core strategies of dbt are:
problem solving (change) and validation (acceptance)
There are 2 types of validation strategies (ie core strategies):
1) wisdom within the client's maladaptive behaviors based on the client's historical context
2) the therapist belief in the client's ability to build a LWL
Problem solving strategies (core strategies) include:
,DBT LBC Certification Study Guide.Final Exam Test 2026\2027.
1) BCAs
2) Solutions Analysis
3) Orientation to the treatment solution
4) Eliciting commitment from the client
5) Application of the treatment
The BCA includes the 4 following questions (BCA being a problem-solving strategies which is a Core strategy)
1) Does the individual have the ability to engage in a more adaptive response? (if not incorporate skills)
2) What are the reinforcing contingencies? (contingency management)
3) If adaptive responses are present, is their application inhibited by client's fear or guilt? Is the client emotion phobic?
(exposure therapy)
4) if adaptive responses are present, is their application inhibited by client's faulty belief's or beliefs? (cognitive
modification)
What are the two communication styles in DBT?
irreverent and reciprocal
What are the 4 modes of DBT treatment?
individual therapy, dbt consult team, dbt phone consultation, dbt skill class
How many DBT assumptions are there?
8
What are the DBT assumptions?
1) People are doing the best they can
2) People want to do better
3) People need to try harder and be more motivated to change
4) Clients cannot fail treatment
5) Therapist treating BPD must seek support
6) We did not cause all of our problems but we have to solve them anyways
7. The lives of SI clients are unbearable as they are being lived currently
8. Client must learn new behaviors in all relevant contexts
"Unwavering centeredness" is defined as
believing in oneself, in therapy, and in oneself. It is the calmness in the storm.
"Compassionate flexibility" is defined as
Ability to adapt to changes within the therapeutic relationship as needed. This includes admitting mistakes, observing and
extending limits as needed.
The balance "unwavering centeredness" and "compassionate flexibility" requires
the therapist observe limits and conditions while being flexible in response to changing, adapting, etc.
"Nurturing" includes:
teaching, coaching, assisting, strengthening, and aiding the patient
"Benevolent demanding" includes:
therapist recognition of the client's on strengths and capability , reinforcement of their adaptive responses, and not taking
care of them
The dialectical position to take with benevolent demanding and nurturing is:
Pushing the client forward while supporting them.
, DBT LBC Certification Study Guide.Final Exam Test 2026\2027.
Patient agreements include:
1) 1 year commitment to DBT
2) 4 missed shows in a row
3) Attendance agreement
4) SI agreement
5) TIB agreement
6) Skill training agreement
7) Research and payment agreement
Therapist agreements include:
1) Every reasonable effort agreement
2) Ethical agreement
3) Personal contact agreement
4) Respect for the client agreement
5) Confidentiality Agreement
6_ Consultation agreement
There is no absolute truth and when polarities exist the goal is to search for the synthesis rather than the truth.
Dialectical Agreement
Therapists do no serve as intermediaries for their patients with other professionals, including other members of
the treatment team.
Consultation to the client
Consistencies with other members of the treatment team are not expected and each member of the team does not
have to teach the same thing nor agree on proper rules of the therapy.
Consistency Agreement
The case conceptualization group agrees that therapists are to observe their own limits nor judge others limits.
Observing Limits Agreement
Therapist agree to search for a nonpejorative interpretation of clients behaviors
phenomenological empathy agreement
Explicit agreement that all therapist are jerks.
Fallibility agreement
There are 5 subcategories of SI-related behaviors which are targeted in DBT:
1) SI Crisis behaviors
2) Parasuicidal acts (nonfatal, intentional self-injurious behaviors)
3) SI ideation and communications
4) SI- related experiences and beliefs (idea it is a problem-solving technique)
5) SI- related affect
Reducing Parasuicidal acts is important because:
1) best predictor of subsequent SI
2) damages to the body
3) actions based on the intent to harm oneself are incompatible with therapy
4) It is hard to express care for a client if you do not address self-harm
There are 3 categories of client TIBs:
