Potomac Behavioral Solutions — DIALECTICAL BEHAVIORAL THERAPY (DBT) (2023)

Potomac Behavioral Solutions — DIALECTICAL BEHAVIORAL THERAPY (DBT) (1)


DBT is an evidence based treatment designed to help manage impulsive behaviors, emotional responses, and self-destructive urges. DBT was originally developed by Marsha Linehan, Ph.D., ABPP,as a comprehensive cognitive-behavioral treatment.

Empirical research has shown that DBT can also help address a variety of other concerns including eating disorders, anxiety disorders, and mood disorders. DBT skills can help you manage stress and live a healthier, more meaningful life.

DBT focuses on the acquisition of 4 critical skill sets: Mindfulness, Distress Tolerance, Emotion regulation, and
Interpersonal effectiveness.

Our DBT team is intensively trained by the Linehan Institute/Behavioral Tech.

> Learn more about comprehensive DBT programs

ADULT DBT

The program requires a minimum commitment of 24 weeks. Medication management and Nutrition Services are available for individuals with additional needs.

DBT CLASS SCHEDULE

Stage 1 & 2 Adult:

Mondays, 12:00pm-2:00pm
Wednesdays, 5:30pm-7:30pm
Thursdays, 5:00pm-7:00pm
Fridays, 1:00 pm- 3:00 pm

Stage 3/REACH:

Thursday 6-7 pm (every other week)

For more info on Adult DBT, please contact us.

DBT - PROLONGED EXPOSURE FOR PTSD

Credit: https://www.ptsd.va.gov/appvid/video/index.asp

PROLONGED EXPOSURE (PE) THERAPY promotes new learning that helps to reduce anxiety and fear in people experiencing trauma related symptoms as well as post-traumatic stress disorder (PTSD). This evidence-based treatment allows you to gain new perspectives on your trauma while building on the foundation of skills learned in stage one DBT. Although each case will vary, the usual amount of time needed to complete the program is 3-4 months, with a 90-minute session weekly in addition to access to phone coaching and commitment to completing homework.

Prolonged exposure (PE) was originally developed by Edna Foa, Ph.D for the treatment of PTSD. The name Prolonged Exposure reflects the fact that the treatment program emerged from the long tradition of exposure therapy for anxiety disorders in which clients are helped to confront safe but anxiety-evoking situations in order to overcome their excessive fear. To date, treatments such as PE that use exposure therapy have received the most research support for their effectiveness in treating PTSD and have been designated by expert consensus as a first-line treatment for PTSD. The strong effectiveness of exposure therapy has been demonstrated in a wide range of persons who have experienced trauma and have symptoms related to that trauma which are impeding progress toward goals in their lives.

At Potomac Behavioral Solutions, we have therapists who have been intensively trained and who receive continuous supervision in the administering of this treatment. We require that those embarking on DBT-PE have successfully completed the 6-month DBT program, be free from self-harm and suicide attempts for at least the past 2 months, and willingness to complete exposure homework.

DBT FOR SUBSTANCE ABUSE DISORDERS

Dialectical abstinence is the core model of DBT-SUB. The foundation of this treatment is the dilemma between total abstinence and harm reduction.

Comprehensive DBT has ample research (Harned et al., 2008; Linehan et al., 1999; Linehan, et al. 2002; van den Bosch, et al. 2002) to support its effectiveness with substance used disorders. The treatment incorporates additional skills, self management strategies, and drug replacement methods.

Comprehensive DBT is effective for individuals with multiple co-occuring disorders such as self-injury, suicidality, eating disorders, mood or anxiety disorders, etc. Our DBT programming focuses on outpatient treatment and sees acute detox and hospitalization as, at times, interfering with building a long term.

DBT-SUD TREATMENT program (12-MONTH)

A 12-month commitment is required to enroll in the DBT-SUB program.

The program commitments include:

  • Individual therapy (at least once weekly)

    • Addressing higher-order primary targets (e.g., therapy interfering behavior, suicidal behavior, etc.)

  • Skills class (once weekly)

  • Phone coaching (24/7)

  • Family therapy (required for adolescents)

  • Replacement medications (when indicated)

  • Urinalysis (three times weekly)

Participants also commit to:

  • Stopping all illegal substances

  • Stopping all distribution of drugs to others

  • Appear sober when at the office

FAMILY CONNECTIONS PROGRAM

Family Connections™ is a free 12-week course that meets weekly to provide education, skills training, and support for people who are in a relationship with someone who has BPD.

Focusing on issues that are specific to BPD, it is hosted in a community setting and led by trained group leaders who are usually family members of relatives with BPD. Dr. Alan Fruzzetti and Dr. Perry Hoffman developed the course based on their research as well as their significant professional expertise in counseling people with BPD and their loved ones. Family Connections provides: current information and research on BPD and on family functioning; individual coping skills based on Dialectical Behavior Therapy (DBT); family skills; and group support that builds an ongoing network for family members.

COURSE CONTENT

• Research-based program typically taught as 12-week course

• Education & Research on BPD

• Skills training for families based onDialectical Behavior Therapy

• Skills training for families based on

Dialectical Behavior Therapy

• Relationship Mindfulness

• Effective Communication

• Validation

• Development of a support network

COURSE DETAILS

When: Tuesday 5:00-6:30 PM, co-led by Allie Gasbarro, Julianna Twigg

Cost: FREE!

Commitment: The research demonstrating effectiveness of this program is based on a 12-week commitment. We HIGHLY encourage attending all 12 weeks.

How to Register: Email us atInfo@pbshealthcare.com

DBT FOR FAMILY & FRIENDS

To enroll in F & F you must first complete the Family Connections Program.

Friends & Family™ is a 12-week course that meets weekly to teach more advanced theoretical concepts of Dialectical Behavior Therapy (DBT) and skill application techniques to friends and family members of individuals in a DBT program.

COURSE CONTENT

  • Intro (Guidelines/Assumptions) & Review the BioSocial Model of DBT

  • Mindfulness Skills: Three States of Mind, What & How

  • Validation & Problem Solving: Core Acceptance & Change Skills - why do we stay mindful of judgments?

  • Primary Target Behavior: Functions, Response from Family & Skills

  • Secondary Target Behaviors: Biological & Social Consequences

  • Understand the functional relationship: thinking, feeling & acting

  • Distress Tolerance Skills for Family & Friends

  • Review & Role Play: Limit Setting, Observing Limits & Acceptance

  • Relationship Mindfulness: Skills for Family & Friends

  • Emotion Regulation: Sensitivity, Reactivity & Slow Return to Baseline: Now What? Skills!

  • Interpersonal Effectiveness: DEARMAN, GIVE & FAST (role play)

  • Basics of Behaviorism: Don’t Shoot the Dog!

COURSE DETAILS

When: Tuesday 5:00-6:30 PM, led by Andrea Deal, LPC

Cost: FREE!

Commitment: We HIGHLY encourage attending all 12 weeks.

How to register: Email us at info@pbshealthcare.com

COMPREHENSIVE DBT FOR COMPLEX EATING DISORDERS

Comprehensive DBT for an eating disorder can be effective when:

  • Traditional evidence-based treatment for the eating disorder (i.e., CBT-E) has not yielded desired results

  • Emotion dysregulation is central to the eating disorder symptoms

  • Significant co-morbidities such as substance use, mood disorders, self-harm, or suicidality impacts standard treatment

  • There is a history of significant therapy interfering behavior(s)

TREATMENT PROGRAM

Our comprehensive program includes the components listed below.

DBT FOR CHILDREN (DBT-C)

Potomac Behavioral Solutions — DIALECTICAL BEHAVIORAL THERAPY (DBT) (4)

DBT-C is a 30-week treatment program that focuses on skill development for parents of kids (typically under age 14) who are emotionally sensitive and reactive. DBT-C focuses on changing the environment to meet the needs of the child. For this reason, the family is seen as the “patient,” not the child. Learn more from Behavioral Tech about DBT-C.

Emotionally vulnerable children can exhibit behavioral and emotional dysregulation including:

  • Hyper-reactivity

  • Severe temper outbursts

  • Irritability

  • Difficulty with change and transitions

  • Easily bored

  • Avoidance of effort toward completing tasks

  • Rapidly shifting attention

  • Hyperactivity

  • Impulsivity

  • Sensory sensitivity (e.g., touch, smell, hearing, taste)

  • Severe interpersonal problems with friends or family

  • Difficulty maintaining hygiene

  • Black and white (extreme) thinking styles

  • Suicidal thoughts, comments, or behaviors

Of course, there are also many benefits of emotional sensitivity including empathy, creativity, pattern recognition, and strong positive emotions.

These "super sensor" kids need parents who are "super parents"! DBT-C focuses on helping parents become more effective parents which therefore prevents kids from serious adolescent and adult ineffective behavior (e.g., substance use, truancy, interpersonal conflicts, etc.)

GOALS OF DBT-C

  • Create a change ready environment

  • Recognize and understand emotion

  • Better control behavior

  • Learn ways to effectively cope with problems

  • Learn how to problem-solve difficulties

TREATMENT MODES

  • Individual therapy

  • Skills training

  • Phone consultation (required for parents, optional for kids)

TREATMENT PROGRAM STRUCTURE (30-WEEK)

DBT-C is structured with 90 minute sessions

  1. Pre-commitment to the DBT-C model with parents (Sessions 1-11)

    • Biosocial model and goals

    • Orientation and commitment

    • Change ready environment

  2. Individual skills review with child (20 mins), parent training (30 mins), and family skills training (40 mins) (12-30 weeks):

    • Session 12-20: Education on emotions, skills training;

    • Session 20-30: Individual therapy with child focusing on behavioral targets, parent training, skills training with family

PARENT TRAINING SKILLS CLASS

This class is for parents of children 12 years and under who are currently in the DBT-C program at PBS. DBT-C helps parents/adult caretakers become the agents of change for children who are emotionally reactive and sensitive. The Parent Training Skills Class is an ancillary service to outpatient DBT-C.

Goals of the class

  • Create a change ready environment

  • Recognize and understand emotion

  • Manage and support behavioral dysregulation

  • Learn ways to effectively cope with problems

  • Learn how to problem-solve difficulties

Class details

WHEN: Saturdays, 2:30PM - 3:30PM

LOCATION: Potomac Behavioral Solutions, Group Room B

LEADERS: Joanna Marino, PhD

If you are interested in learning more about Child DBT services, please contact us.

Parents may also attend our free Family Connections and Friends and Families series! Scroll to Adult Treatment Programs for more info.

ADOLESCENT & FAMILY DBT

Our Adolescent DBT Program is based on the "DBT Skills Manual for Adolescents" by Rathus and Miller (2015).

TREATMENT PROGRAM (24-WEEKS)

Our 24-week comprehensive program is delivered in a "multi-family" format and includes the several components listed below.

If you are interested in learning more about Adolescent DBT services, please contact us.

Multifamily Skills Classes

Stage 1 & 2:

Mondays, 5:45pm-7:45pm
Tuesdays, 5:30pm-7:30pm
Wednesdays, 5:30pm-7:30pm
Saturdays, 11:30am-1:30pm

Stage 3/Teen REACH:

Wednesday 5:30-6:45pm

SUICIDE & SELF-INJURY

A dialectical approach aims to achieve a synthesis among seemingly opposite positions. A core "dialectical dilemma" in DBT is the need to combine acceptance and change.

DBT teaches us that hospitalization is avoided whenever possible. DBT is very similar to a rehabilitative model. It suggests it is most effective to keep individuals in their stressful environments and help them cope with life as it is.

Individuals are not less likely to attempt suicide if they are hospitalized.

In the DBT Program at Potomac Behavioral Solutions, acute hospitalization is extremely rare (i.e., < 5 participant/year) even for individuals who experience Target 1 Behaviors such as suicidal ideation and self-harm.

To date, there is no empirical data to suggest that acute inpatient hospitalization is effective in reducing suicide risk, even for individuals considered "high risk."

IS DBT COST EFFECTIVE?

YES! BehavioralTech.org consolidated the following research:

Accumulating evidence indicates that DBT reduces the cost of treatment. For example, the American Psychiatric Association (1998) estimated that DBT decreased costs by 56% – when comparing the treatment year with the year prior to treatment – in a community-based program. In particular, reductions were evident by decreased face-to-face emergency services contact (80%), hospital days (77%), partial hospitalizations (76%), and crises bed days (56%). The decrease in hospital costs (~$26,000 per client) far outweighed the outpatient services cost increase (~$6,500 per client).

Read more

WHAT DO I NEED TO KNOW IF I REFER SOMEONE FOR COMPREHENSIVE DBT?

"CONSULTATION-TO-THE-PATIENT"

According to Linehan (1993), the consultation-to-the-patient approach is "quite different from, and sometimes diametrically opposite to, the behaviors expected of mental health professionals." Unlike the traditional medical model, "the role of the therapist is to consult with the patient about how to manage other people, rather than to consult with others about how to manage or treat the patient" (Linehan, 1993, p. 411). "The consultation-to-the-patient approach is designed to make sure that if the individual [patient] is not the expert on herself now, she becomes the expert" (Linehan, 1993, p. 422). In other words, DBT providers do not intervene or solve problems for the patient. Because of this approach, our Providers do not speak to family members or other treatment providers without the individual patient being present for or leading the conversation.

PAUSING TREATMENT WITH OTHER THERAPISTS

  • Because of the intensive nature of DBT (i.e., individual therapy, skills class, phone coaching, etc.)and consultation-to-the-patient approach,we STRONGLY suggest individuals in this treatment "press pause" with their other therapists. DBT aims to aid individuals in using DBT skills to manage all of their environment which can be difficult when a participant has multiple individual therapists.

PHONE COACHING IN DBT

Individuals who participate in Comprehensive DBT may call their individual therapist in order to get help applying and generalizing skills they learn in skills training to their everyday life.

There are three main purposes of phone coaching:

  • Replace behaviors that could lead to self-injurious acts or suicidal gestures.

  • Get feedback and suggestions while practicing your skills.

  • Relationship repair with your therapist.

PHONE COACHING IS NOT:

  • A suicide hotline.

  • Therapy over the phone (eg. extra individual therapy sessions discussing abstract concerns).

  • A way to soothe yourself when you feel bored or lonely, or have no one to talk to.

24-HOUR RULE:

  • Your DBT therapist will not allow any phone contact during the 24-hours after you have last engaged in self harm. If you are in need of imminent medical care, go to your nearest emergency department or call 911.

HOSPITALIZATION

In DBT, inpatient hospitalization is avoided whenever possible! Our goal is to help participants cope with life as it is, even if it becomes very stressful. In a crisis, DBT says "Now is the time to learn new behavior," instead of temporarily avoiding the stressors by being hospitalized.

Linehan, M.M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford.

To request a consultation or inquire about treatment options, please contact us below. Please allow 24 hours for a response to your inquiry.

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