About the Event

Cognitive Behavior Institute is excited to welcome Emily Wharton, PsyD, for a live interactive webinar on: Flexibly and Responsively Providing Dialectical Behavior Therapy

Dates/Times:
June 8th, 2023 11:00am-5:00pm EST
June 9th, 2023 11:00am-5:00pm EST
June 15th, 2023 11:00am-5:00pm EST
June 16th, 2023 11:00am-5:00pm EST
Location: online via Zoom
Cost: $99.99
Level: Intermediate
Credit Hours: 18 total CEs including: 17 clinical and 1 suicide prevention credits


Description:
Dialectical Behavior Therapy (DBT) was originally created to treat adults with Borderline Personality Disorder (BPD) and suicidal behaviors (Mehlum, 2021). The creation of DBT was ground-breaking in providing a highly effective approach for previously stigmatized presentations. DBT is a cognitive behavioral treatment that incorporates dialectics of acceptance and change, behavioral conceptualization, and concrete skills in mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. DBT has been shown to be highly effective in reducing symptoms such as suicidal and self-harm behaviors and improving quality of life for adolescents and adults struggling with BPD (Gillespie et al., 2022).

The full adherent treatment model of DBT, called “Comprehensive DBT” consists of four components: weekly skills group (2 to 2.5 hours long, with modules consisting of Mindfulness, Emotion Regulation, Interpersonal Effectiveness, and Distress Tolerance), weekly individual therapy, 24/7 in vivo phone coaching, consultation team (attended by all DBT therapists) (O’Hayer, 2021). However, many patients do not have access to comprehensive DBT programs, and many clinicians are unable to provide every component of the model (Valentine et al., 2020). Thus, many clinics offer standalone DBT skills groups, and many providers offer DBT-informed individual psychotherapy.

Since DBT became the “gold standard” treatment for BPD, self-harm, and suicidal behaviors, numerous studies have emerged regarding the effectiveness of DBT for other disorders as well. Emerging studies have found strong outcomes in using DBT for substance use disorders (Warner & Murphy, 2022), Posttraumatic Stress Disorder and complex trauma (Bohus et al., 2020), and eating disorders (Brown et al., 2020). Researchers have developed cultural adaptations of DBT to more effectively support communities of color and marginalized groups that were not sufficiently represented in earlier DBT studies (Haft et al., 2022). DBT practitioners and critics have examined ways to challenge problematic aspects of DBT interventions and have suggested ways to hold an anti-racist DBT stance, such as ideas presented in the article, “You Didn’t Cause Racism, and You Have to Solve it Anyways”: Antiracist Adaptations to Dialectical Behavior Therapy for White Therapists (Pierson et al., 2022).

Given these multicultural, diagnostic, and practical considerations, flexibility and responsiveness are key in providing effective, individualized DBT. While some DBT trainings often focus on only the fully adherent, BPD-specific application of DBT, this training will teach the core DBT interventions and discuss how to provide DBT flexibly with responsiveness to different presentations and cultural populations. Experiential exercises, case examples, and multimedia will be used to provide applied, practical, clinical learning. An overview of the history, theory, and model of DBT will be presented, alongside discussions of diverse applications of DBT for different diagnostic presentations, populations, and settings. DBT-based conceptualization of behavior and symptoms will be discussed, and skills from each skills module (Mindfulness, Emotion Regulation, Interpersonal Effectiveness, and Distress Tolerance) will be presented and practiced. The primary focus of this training is on how to provide DBT in a flexible, responsive, and individualized manner, while maintaining fidelity to DBT core principles and practices.

Agenda:

Day 1:
11am-11:50 Lecture: Origins and Underlying theory of DBT

• Historical context of the emergence of DBT for BPD

• Marsha Linehan, Ph.D. on acceptance-oriented therapies and change-oriented therapies
• Dialectics as core principle of DBT
• Live reflection and discussion on change and acceptance dialectic

11:50am-12:00pm Break

12:00pm-1:00pm: Lecture and Discussion: Comprehensive Model of DBT 

• Individual therapy, skills group, therapist consultation, phone coaching
• Brief overview of four modules: Mindfulness, Emotion Regulation, Distress Tolerance, Interpersonal Effectiveness

• Case example
• What’s possible when “full-model DBT” is not accessible for client/therapist?
• Incorporating DBT into trauma-focused work (CPT, PE) vs. DBT-PTSD
• DBT integration with Acceptance and Commitment Therapy

1:00pm-2:00pm: Lunch

2:00pm-3:00pm: Lecture and Discussion: Diverse Applications of DBT 

• Biopsychosocial model of BPD and how DBT targets each “deficit”
• How the biopsychosocial model of invalidation is applied to other presentations and populations (SUD, PTSD, ED, cultural groups, DBT for adolescents)
• Racism, discrimination, system invalidation, racial trauma
• Basic assumptions of DBT and challenges: practicing cultural humility
• Case study and group discussion

3pm-3:10pm: Break

3:10pm-4:20: Lecture/Practice: Function of Behaviors and Conducting Chain Analysis 

• Functional analysis of “target-behavior”
• Chain analysis: validating, curious approach rather than punishing
• Building insight into vulnerability factors, prompting event, emotions/thoughts/behaviors, short-term/long-term consequences
• Using a chain for oneself to understand function and consequences of our own behaviors
• Breakout rooms: Chain Analysis practice

4:20-4:30pm: Break

4:30-5pm: Day 1 Review, Questions, Homework 

Day 2:
11:00-11:15: Day 1 and Homework Review 

• Questions and reflections from previous day
• Homework review

11:15am-11:45: Solution Analysis and Contextual Use of DBT Skills 

• Completing a Solution Analysis
• How each core skill address part of chain:

11:45-11:50 Break

11:50-1:00: The Why, How, and What of Mindfulness 

• Buddhist origins
• The WHY: Goal of accessing Wise Mind (observer self, self-as-context in ACT)
• Mindfulness as awareness, not “tool” for productivity or way to “relax”/get rid
• Presenting Wise Mind
• Breakout room practice
• How to incorporate mindfulness practice into DBT group/individual therapy

1:00-2:00: Lunch

2:00-3:00: Distress Tolerance Part I: Crisis Survival Skills 

• Creating effective, realistic suicide (or other crisis) safety plans
• Distress Thermometer: Skills to use when you’re at a 7-10
• Presenting window of tolerance, distress tolerance, challenge zone vs. overwhelm zone
• Review Core Crisis Survival Skills
• Developing your own Distress Tolerance toolkit

3:00-3:15: Break

3:15-4:20: Distress Tolerance Part II: Reality Acceptance Skills 

• Common traps/myths of Radical Acceptance
• Experiential practice
• Reality Acceptance Skills practice: Practice Willing Hands and Turning the Mind
• Radical Acceptance and Trauma and Racism

4:20-4:30: Break

4:30-5:00: Day 2 Review, Questions, Homework

Day 3:
11:00-11:15: Day 2 and Homework Review 

• Questions and reflections from previous day
• Homework review

11:15am-12:00: Emotion Regulation: Function of Emotions and Skills 

• How to discuss function of each emotion
• Reducing Vulnerability to Emotion Mind

• ABC Please Skills
• Behavioral Activation
• Coping Ahead: consider unique application to different presentations

12:00-12:10: Break

12:10-1:00 Values and Problem-Solving 

• Incorporating Values work: creating a vivid picture of A Life Worth Living
• Group intervention demonstration: Values and Willingness, Two Sides of a Coin
• Clarifying values and problem-solving at distress of 1-6 level

1:00-2:00 Lunch

2:00-3:00: Interpersonal Effectiveness Part I 

• Why interpersonal effectiveness is so tricky: barriers, myths, others’ responses
• Balance between aggressive, passive: assertive
• How patterns of invalidation lead to escalated response: breaking the cycle
• Clarifying priority: Objective, Relationship, Self-respect
• The crowd favorite: DEARMAN
• FAST skill

3:00-3:10: Break

3:10-4:20: Interpersonal Effectiveness Part II 

• Cultural considerations
• GIVE skill
• Five levels of Validation (for us as therapists and patients to practice)

4:20-4:30: Break

4:30-5:00: Day 3 Review, Questions, Homework 

Day 4:
11:00-11:15: Day 3 and Homework Review

• Questions and reflections from previous day
• Homework review

11:15am-11:45: Individual Therapy: Using a Diary Card 

• Tracking target behaviors, daily mood, skills use
• Help client identify patterns of how behaviors and skills affect mood
• Use as impetus for chain analysis/identifying skills to incorporate into session

11:45am-11:50am: Break

11:50-1:00: The DBT Targets Hierarchy 

• Life-threatening, therapy-interfering, quality-of-life interfering behaviors
• Radical genuineness
• Therapist-interfering behaviors
• Using Target Hierarchy for case consultation
• Running a DBT Case Consultation team

1:00-2:00: Lunch

2:00pm-3:00pm: DBT for Specific Presentations 

• PTSD and complex trauma
• Substance Use Disorders
• Eating Disorders
• Mixed messages about controlling internal experience (for anxiety, depression)

3:00-3:15: Break

3:15pm-4:20pm: Individual DBT-Informed Therapy and Case Conceptualizing

• Bringing in skills as individual therapist, as needed vs. set timing
• What a Dialectical Behavior Therapy (DBT) Session looks like
• Determining stage of treatment

• Six dialectical dilemmas
• Cultural context, using Bronfenbrenner’s Ecological Model, systemic invalidation

4:20-4:30: Break

4:30-5:00: Reflection and Wrap-up 

• Next Steps, DBT Certification process, DBT Group Consultation
• Resources, ongoing support and DBT Community
• Answering questions/case-specific needs
• Group reflection

Learning Objectives:

1. Participants will describe the core tenets, principles, and underlying theory of Dialectical Behavior Therapy (DBT).
2. Participants will explain how the DBT model fits the presentation of Borderline Personality Disorder.
3. Participants will illustrate how to incorporate cultural humility and responsiveness into DBT.
4. Participants will demonstrate chain analyses and solution analyses.
5. Participants will demonstrate how to present Wise Mind concept
6. Participants will define distress tolerance and its purpose.
7. Participants will explain core crisis survival skills
8. Participants will demonstrate how to incorporate distress tolerance skills into safety planning.
9. Participants will give examples of the interaction between radical acceptance and racism/bigotry.
10. Participants will explain function of emotions and role of emotion regulation.
11. Participants will explain how to incorporate values work into therapy.
12. Participants will demonstrate how to create a Cope Ahead Plan.
13. Participants will give examples of cultural considerations for teaching interpersonal effectiveness skills.
14. Participants will identify target behaviors and how to incorporate them on a diary card.
15. Participants will distinguish the three levels of treatment targets and how to prioritize them.
16. Participants will list strategies for managing potential suicidality or self-harm in a client.
17. Participants will demonstrate how to case conceptualize through a DBT frame.
18. Participants will explain the applicability of DBT to specific presentations, such as PTSD, SUD, and eating disorders.

Instructor Bio:

  Dr. Emily Wharton is a Clinical Psychologist at the Palo Alto Veterans Affairs, within Addiction Treatment Services. Dr. Wharton provides evidence-based treatment in Substance Use Disorders, Posttraumatic Stress Disorder, anxiety disorders, OCD, depression, and co-occurring disorders. Dr. Wharton provides training and supervision to Stanford medical students, residents, practicum students, postdoctoral fellows, and psychology interns. Dr. Wharton also serves as the Member-At-Large Director for the San Francisco Bay Area Chapter of the Association for Contextual Behavioral Sciences. Dr. Wharton has given lectures and trainings for the Palo Alto VA, Stanford University, and the Association for Contextual and Behavioral Science on topics such as Dialectical Behavior Therapy, Acceptance and Commitment Therapy, PTSD Assessment, Cognitive Processing Therapy, Emotionally Focused Therapy for Couples, Group Trauma-Focused CBT, Motivational Interviewing, trauma, guilt, and moral injury. Dr. Wharton has also provided Mindfulness and Self-Care workshops for Seneca Center and the Association for Contextual and Behavioral Science. Dr. Wharton has published papers and book chapters on ACT for PTSD, ACT for moral injury, mindfulness practices for anxiety disorders, and group trauma-focused CBT for parents of preterm infants.

http://dremilywharton.com/
https://www.psychologytoday.com/us/therapists/emil...


Course bibliography:
Bohus, M., Kleindienst, N., Hahn, C., Müller-Engelmann, M., Ludäscher, P., Steil, R., Fydrich, T., Kuehner, C., Resick, P. A., Stiglmayr, C., Schmahl, C., & Priebe, K. (2020). Dialectical Behavior Therapy for Posttraumatic Stress Disorder (DBT-PTSD) Compared With Cognitive Processing Therapy (CPT) in Complex Presentations of PTSD in Women Survivors of Childhood Abuse: A Randomized Clinical Trial. JAMA Psychiatry, 77(12), 1235–1245.

Brown, T. A., Wisniewski, L., & Anderson, L. K. (2020). Dialectical Behavior Therapy for Eating Disorders: State of the Research and New Directions. Eating Disorders, 28(2), 97–100.

Gillespie, C., Murphy, M., & Joyce, M. (2022). Dialectical Behavior Therapy for Individuals With Borderline Personality Disorder: A Systematic Review of Outcomes After One Year of Follow-Up. Journal of Personality Disorders, 36(4), 431–454.

Haft, S. L., O’Grady, S. M., Shaller, E. A. L., & Liu, N. H. (2022). Cultural adaptations of dialectical behavior therapy: A systematic review. Journal of Consulting and Clinical Psychology.

O’Hayer, C. V. (2021). Building a Life Worth Living During a Pandemic and Beyond: Adaptations of Comprehensive DBT to COVID-19. Cognitive and Behavioral Practice, 28(4), 588–596.

Pierson, A. M., Arunagiri, V., & Bond, D. M. (2022). “You Didn’t Cause Racism, and You Have to Solve it Anyways”: Antiracist Adaptations to Dialectical Behavior Therapy for White Therapists. Cognitive and Behavioral Practice, 29(4), 796–815.

Valentine, S. E., Smith, A. M., & Stewart, K. (2020). Chapter 15—A review of the empirical evidence for DBT skills training as a stand-alone intervention. In J. Bedics (Ed.), The Handbook of Dialectical Behavior Therapy (pp. 325–358). Academic Press.

Warner, N., & Murphy, M. (2022). Dialectical behaviour therapy skills training for individuals with substance use disorder: A systematic review. Drug and Alcohol Review, 41(2), 501–516.


Approvals:

Cognitive Behavior Institute, #1771, is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 06/30/2022-06/30/2025. Social workers completing this course receive 18 total credits including 17 clinical continuing education credits.

Cognitive Behavior Institute, LLC is recognized by the New York State Education Department's State Board for Psychology as an approved provider of continuing education for licensed psychologists #PSY-0098 and the State Board for Social Work as an approved provider of continuing education for licensed social workers #SW-0646 and the State Board for Mental Health Practitioners as an approved provider of continuing education for licensed mental health counselors #MHC-0216.

Cognitive Behavior Institute has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7117. Programs that do not qualify for NBCC credit are clearly identified. Cognitive Behavior Institute is solely responsible for all aspects of the programs.

Cognitive Behavior Institute is approved by the American Psychological Association to sponsor continuing education for psychologists. Cognitive Behavior Institute maintains responsibility for content of this program. Social workers, marriage and family therapists, and professional counselors in Pennsylvania can receive continuing education from providers approved by the American Psychological Association. Since CBI is approved by the American Psychological Association to sponsor continuing education, licensed social workers, licensed marriage and family therapists, and licensed professional counselors in Pennsylvania will be able to fulfill their continuing education requirements by attending CBI continuing education programs. For professionals outside the state of Pennsylvania, you must confirm with your specific State Board that APA approved CE's are accepted towards your licensure requirements. The Association of Social Work Boards (ASWB) has a process for approving individual programs or providers for continuing education through their Approved Continuing Education (ACE) program. ACE approved providers and individual courses approved by ASWB are not accepted by every state and regulatory board for continuing education credits for social workers. Every US state other than New York accepts ACE approval for social workers in some capacity: New Jersey only accepts individually approved courses for social workers, rather than courses from approved providers. The West Virginia board requires board approval for live courses, but accepts ASWB ACE approval for other courses for social workers. For more information, please see https://www.aswb.org/ace/ace-jurisdiction-map/. Whether or not boards accept ASWB ACE approved continuing education for other professionals such as licensed professional counselors or licensed marriage and family therapists varies by jurisdiction. To determine if a course can be accepted by your licensing board, please review your board’s regulations or contact them. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit.

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