a dbt homework assignments

a dbt homework assignments

Effective Strategies for Designing and Implementing DBT Homework Assignments

1. Introduction to Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) is an evidence-based treatment package developed by Marsha Linehan and colleagues in the 1980s for individuals diagnosed with borderline personality disorder (BPD) who are chronically suicidal and engage in impulsive, self-destructive behaviors. DBT synthesizes behavior therapy, cognitive therapy, and mindfulness within a dialectical philosophical viewpoint. In this model, the therapist is responsible for acceptance of the client as she is and for changing her unacceptable behaviors. Consistent with a behavioral perspective, DBT is founded on the idea that all behaviors, thoughts, and emotions serve an adaptive function, regardless of their appropriateness or effectiveness.

Initially, DBT was composed of four modes: individual therapy, family therapy, skills training, and crisis phone coaching. The most recent definitive formulation of DBT, published in 2015, refined the focus, stance, and targets of standard, programmatic DBT. In its current form, standard DBT is composed of three modes: Individual DBT involves a weekly hour-long individual therapy session. Skills Training is conducted over the course of one hour once a week for a period of 24 weeks.

Therapists adhere closely to a manual and use handouts that are specifically crafted to facilitate the addition of DBT techniques and strategies to the repertoire of individuals with BPD. These manuals align with the structure and content of the book Skills Training Manual for Treating Borderline Personality Disorder, which is written by Marsha Linehan and updated in 2015. Telephone Consultation is provided between sessions to address both the challenges and victories experienced by patients as they implement DBT skills outside of the treatment room.

DBT is an evidence-based treatment package that has been shown to be effective in enhancing emotion regulation, distress tolerance, mindful awareness, interpersonal effectiveness, and targeting BPD symptoms.

2. The Importance of Homework Assignments in DBT

Dialectical Behavior Therapy (DBT) individual therapy includes weekly homework assignments to support the generalization of skills. The current paper is a review of evidence from clinical expertise, consulting call results, filed fidelity ratings, and research that provides strategies for effective assignment review, identification of avoidant clients, and elaborating on client difficulties in completing assignments. These strategies are valuable for new DBT therapists and indispensable for those already participating in a comprehensive consultation team.

While skills are taught within the context of individual therapy, outside practice through homework is necessary for skills to become functioning responses. Indeed, Linehan et al. found that participants who practiced skills frequently as homework had a greater increase in distress tolerance skills from the beginning to the end of the module than did participants who did not practice skills. These changes in skill use, both in type and amount, were related to improved treatment success. Specifically, homework practice of distress tolerance and emotion regulation skills was particularly effective in decreasing the frequency of suicidal self-injury events. The importance of practice over understanding is underscored by the ability of many clients who have not received in-depth DBT to describe the skills but remain in crisis when emotions are triggered in daily life. In DBT, therapists understand their role in teaching these skills, and clients understand that practice takes time and motivation to get tangible results.

3. Key Components of Effective DBT Homework Assignments

It’s essential to first decide whether an assignment is necessary. The decision about homework should be based on the overarching goal of enhancing client capacity. More often than not, this means that if a client can complete DBT homework assignments in session, without having to take something home with them, this is ideal. Part of the essence of being a therapist in dialectical behavior therapy involves: 1) allowing the client to lean on the expertise of the therapist; 2) letting the therapist be part of a therapeutic relationship that involves the complexities of the back-and-forth between client and therapist; and 3) giving the client a rewarding experience in being part of a relationship that involves changing, growing, and learning. By being mindful of the dialectic, the therapist can make the best decision about what, if any, assignment is necessary for that particular client at that given moment.

Although the practice of designing and implementing effective DBT homework assignments has not been widely researched, it has arguably been the single most frequently offered real-world question to our expert trainers regarding client implementation of the evidence-supported practice of DBT in community settings. Researchers have implied that the level of client’s acting consistency in completing DBT homework assignments is one of the few processes emerging as reliable mediators for producing better outcomes in the intervention. And clients have noted on numerous occasions in our individual and group therapy settings that their success in decreasing their struggles with problematic behaviors have been directly tied to their completing the assignments.

4. Strategies for Designing and Implementing DBT Homework Assignments

We have presented several creative ideas for the goal-setting sessions that are part of the DBT program, each of which has advantages and disadvantages. However, in any case, the critical personnel focus is on designing and implementing a session that both elicits the clients’ needs and desires and empowers the client to problem-solve. These client-centered strategies are most relevant to the first goal-setting session, which precedes the first weekly presentation of DBT material.

We have presented several creative ideas for this first goal-setting assignment, which represents the 7 days that clients have before the slide-room session, and for the question and answer sessions in which clients present their efforts. In addition, before clients present the first week’s homework, ask them to write a list of all their coping skills on separate slips of paper. During the presentation, ask everyone else to make a list of what skills they thought were used. Then ask the client to verify which skills were used in the situation.

5. Case Studies and Practical Examples

One of the most effective ways to increase therapist competency in DBT is to engage in role-play scenarios and review case studies during consultation team meetings. During individual consultation, therapists are able to review specific strategies and coach clients to implement them. This can greatly increase the likelihood of successful skills acquisition. This chapter includes a number of case studies that demonstrate how varying homework assignments can be matched to the same client based on symptom presentation. Many of the case examples demonstrate specific encouraging responses that can be utilized by therapists, point out potential roadblocks to completing the assignment, and demonstrate how to overcome those roadblocks.

There are three areas implicated in an imbalance in a person’s biosocial theory which are vulnerability, self-control, and invalidation. There can be variations in the amount a person has of each of these areas. These variations influence a person’s ability to effectively regulate their emotions in either direction of emotion. There are cognitive, behavioral, and emotional symptoms caused by a person’s inability to regulate their emotions. There are three factors that need to occur for a pervasive pattern of instability across various moods and a person’s relationships. There are dialectical dilemmas that cause invalidating environments to lessen or increase the capability of someone to balance empathy. Therapists are ultimately left to construct a treatment oriented in the commonly reported phenomena of patients who show symptoms of BPD.