DBT EXAM QUESTIONS & ANSWERS
What is an environmental intervention? What are the three reasons to justify it? -
Answer -- intervention strategies used when an issue is so important and/or the patient's
ability to intervene on her own behalf is so limited that intervention by the therapist is
necessary - therapist intervenes only when the harm to the pt of not intervening
outweighs the harm of intervening on her behalf - when the therapist does a direct or
unilateral intervention, it is done at the lowest level possible and the pt should be
informed of the intervention before it takes place to give consent unless of course it is
an emergency (suicide, serious self-injury, or violence to others)
1. The outcome is essential
2. The pt clearly does not have the power or the capability to produce the outcome
3. The environment has high power relative to the pt, and the therapist needs to step in
and equalize the power distribution
What are the three types of biological vulnerability to emotions? - Answer -· High
sensitivity to emotional stimuli
· High extremity of emotional responding
· Slow return to baseline
What are the three main characteristics of an invalidation environment? - Answer -·
Indiscriminate rejection of expression of a person's internal experiences
· Intermittent reinforcement of escalation of emotional responses
Oversimplification of problem solving
1. What is the primary hierarchy of targets in Stage 1?
2. For the top two targets, list three sub-targets? - Answer -1. Decreasing suicidal/ life
threatening behaviors; Decreasing therapy-interfering behaviors; Decreasing quality of
life interfering behaviors; Increasing behavioral skills
2. Decreasing Suicidal/Life Threatening Behaviors subtargets = (i) suicide crisis
behaviors (ii) NSSI (iii) frequency and intensity of suicidal ideation and communications;
Decreasing Therapy Interfering Behaviors subtargets = (i) behaviors of the patient,
behaviors that interfere with receiving therapy (non-collaborative, non-compliance, non-
attending behaviors), (ii) behaviors of the patient, behaviors that interfere with other
patients, (iii) behaviors of the patient, behaviors that burnout the therapist (behaviors
that push the therapist's limits, behaviors reducing the therapist's motivation to treat (iv)
behavior of the therapist, behaviors that unbalance therapy (extreme acceptance or
change, extreme flexibility or rigidity, extreme nurturing or withholding, extreme
vulnerability or irreverence), (v) behavior of the therapist, disrespectful behaviors
What is the primary question to ask in doing a dialectical assessment? - Answer -What
is being left out?
, What are DEAR MAN skills used for? - Answer -they are within interpersonal
effectiveness skills and they are objectives effectiveness skills which help us to be as
effective as possible in achieving our objectives or goals
What does DEAR MAN stand for? - Answer -Describe the situation
Express clearly
Assert wishes
Reinforce
(stay) Mindful
Appear confident
Negotiate
What are the three pairs of the six secondary targets? - Answer -1. Emotional
Vulnerability and Self-Invalidation
2. Unrelenting Crises and Inhibited Grieving (Trauma & Experiential Avoidance)
3. Apparent Competence and Active Passivity (Help Seeking - Communication)
What are the Stages of Disorder (I to IV) in DBT in terms of the problem and goal for
each? - Answer -Stage I. Severe Behavioral Dyscontrol with GOAL Stability and
behavioral control
Stage II. Quiet desperation with GOAL non-anguished emotional experiencing
Stage III. Problems in living/less severe disorders with GOAL ordinary
happiness/unhappiness
Stage IV. Incompleteness with GOAL freedom and capacity for joy
Give an example of a clinical situation in which your client (family) is having problems
with other professionals and an example of strategies you could do, which are:
(a) pure consultation to patient
(b) pure environmental intervention
(c) one strategy in between - Answer -EXAMPLE: patient is experiencing non-life
threatening negative side effects of new psychotropic medication (a) pure consultation
to the patient = Corollary 5: teach the patient to act as her own agent in obtaining
appropriate care - rather than calling and arranging medical consult, I would instruct/
coach her to seek out and make the appointment herself
EXAMPLE: patient's car breaks down on way to appointment in dangerous
neighborhood in the middle of winter (b) pure environmental intervention = intervene
when it is the humane thing to do and will cause no harm - I would go pick up the
patient for session
EXAMPLE: discuss picking patient up from car breakdown with skills therapist, skills
therapist shares that the patient has disclosed not making bill payments and electricity
cut off the week before (c) one strategy in between = help the skills therapist find
resources for their patient regarding energy share
What is active passivity? - Answer -tendency to approach problems passively and
helplessly, rather than actively and determinedly, as well as corresponding tendency
What is an environmental intervention? What are the three reasons to justify it? -
Answer -- intervention strategies used when an issue is so important and/or the patient's
ability to intervene on her own behalf is so limited that intervention by the therapist is
necessary - therapist intervenes only when the harm to the pt of not intervening
outweighs the harm of intervening on her behalf - when the therapist does a direct or
unilateral intervention, it is done at the lowest level possible and the pt should be
informed of the intervention before it takes place to give consent unless of course it is
an emergency (suicide, serious self-injury, or violence to others)
1. The outcome is essential
2. The pt clearly does not have the power or the capability to produce the outcome
3. The environment has high power relative to the pt, and the therapist needs to step in
and equalize the power distribution
What are the three types of biological vulnerability to emotions? - Answer -· High
sensitivity to emotional stimuli
· High extremity of emotional responding
· Slow return to baseline
What are the three main characteristics of an invalidation environment? - Answer -·
Indiscriminate rejection of expression of a person's internal experiences
· Intermittent reinforcement of escalation of emotional responses
Oversimplification of problem solving
1. What is the primary hierarchy of targets in Stage 1?
2. For the top two targets, list three sub-targets? - Answer -1. Decreasing suicidal/ life
threatening behaviors; Decreasing therapy-interfering behaviors; Decreasing quality of
life interfering behaviors; Increasing behavioral skills
2. Decreasing Suicidal/Life Threatening Behaviors subtargets = (i) suicide crisis
behaviors (ii) NSSI (iii) frequency and intensity of suicidal ideation and communications;
Decreasing Therapy Interfering Behaviors subtargets = (i) behaviors of the patient,
behaviors that interfere with receiving therapy (non-collaborative, non-compliance, non-
attending behaviors), (ii) behaviors of the patient, behaviors that interfere with other
patients, (iii) behaviors of the patient, behaviors that burnout the therapist (behaviors
that push the therapist's limits, behaviors reducing the therapist's motivation to treat (iv)
behavior of the therapist, behaviors that unbalance therapy (extreme acceptance or
change, extreme flexibility or rigidity, extreme nurturing or withholding, extreme
vulnerability or irreverence), (v) behavior of the therapist, disrespectful behaviors
What is the primary question to ask in doing a dialectical assessment? - Answer -What
is being left out?
, What are DEAR MAN skills used for? - Answer -they are within interpersonal
effectiveness skills and they are objectives effectiveness skills which help us to be as
effective as possible in achieving our objectives or goals
What does DEAR MAN stand for? - Answer -Describe the situation
Express clearly
Assert wishes
Reinforce
(stay) Mindful
Appear confident
Negotiate
What are the three pairs of the six secondary targets? - Answer -1. Emotional
Vulnerability and Self-Invalidation
2. Unrelenting Crises and Inhibited Grieving (Trauma & Experiential Avoidance)
3. Apparent Competence and Active Passivity (Help Seeking - Communication)
What are the Stages of Disorder (I to IV) in DBT in terms of the problem and goal for
each? - Answer -Stage I. Severe Behavioral Dyscontrol with GOAL Stability and
behavioral control
Stage II. Quiet desperation with GOAL non-anguished emotional experiencing
Stage III. Problems in living/less severe disorders with GOAL ordinary
happiness/unhappiness
Stage IV. Incompleteness with GOAL freedom and capacity for joy
Give an example of a clinical situation in which your client (family) is having problems
with other professionals and an example of strategies you could do, which are:
(a) pure consultation to patient
(b) pure environmental intervention
(c) one strategy in between - Answer -EXAMPLE: patient is experiencing non-life
threatening negative side effects of new psychotropic medication (a) pure consultation
to the patient = Corollary 5: teach the patient to act as her own agent in obtaining
appropriate care - rather than calling and arranging medical consult, I would instruct/
coach her to seek out and make the appointment herself
EXAMPLE: patient's car breaks down on way to appointment in dangerous
neighborhood in the middle of winter (b) pure environmental intervention = intervene
when it is the humane thing to do and will cause no harm - I would go pick up the
patient for session
EXAMPLE: discuss picking patient up from car breakdown with skills therapist, skills
therapist shares that the patient has disclosed not making bill payments and electricity
cut off the week before (c) one strategy in between = help the skills therapist find
resources for their patient regarding energy share
What is active passivity? - Answer -tendency to approach problems passively and
helplessly, rather than actively and determinedly, as well as corresponding tendency
