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LearningObjectives DBTDistressToleranceSkills Afterthistraining,participantsshouldbeable to: DeterminewhentouseDBT’sDistress AnnaHink,MSW,LICSW Toleranceskillswithyourpatients ClinicianTrainer ListtheDistressToleranceskills UWAIMSCenter IntegratetheuseofDistressToleranceskills intoyourpractice 2 CaseExample:DS WhatIsACrisis? KeyComplaints Aseriousproblemthat Thereispressuretosolve 54y/oHispanicwoman,liveswith “There’snothingIcandowhenI’m can’tbesolvedrightnow theproblem,anditis husband,somecollege inpain;I’marguingwithmy husbandallthetime;I’mworried difficulttostoptrying aboutcancerreturning” Crisis OUD.Stoppedopioidsx1week. BuprenorphineͲNaloxone24Ͳ8mg Longstandinganxiety&depressive qd Emotionsarehigh,sothe It’sshortͲterm symptoms: VenlafaxineXR275mgqd problemisdistressing Ifitishappeningallthetime, BaselinePHQͲ9=10(mild) Highemotionsgenerally itisnotacrisis.Itisyourlife! BaselineGADͲ7=15(moderate) makethingsworse 3 4 CanYouSolveTheCrisis? WhoAreDistressToleranceSkillsFor? Stickwithit Patients Clinicians IfYes… Don’ttakeyoureyeofftheball facemanystressors facemanystressors Dowhatittakes! Painflares Largecaseloads Frustrationswithmedicalcare Difficultandsickpatients Intenseemotions Hearingmanytraumaticstories IfNo STOPtryingtosolveit Familyconflicts Inabilitytohelptheirpatients Tryingtosolvetheunsolvablecanmakeit Housingissues Lackoftimeorresourcestohelp Moneyissues theirpatients (ornotright worseorsendemotionsthroughtheroof with FocusonDistressTolerance skills Drugsandalcohol Frustratinginteractions now)… DTskillsare Dangerousneighborhoods socialservices designedjustfor Longwaitsforsocialservices Unhelpfulrulesorregulations anunsolvedcrisis Paperwork 5 6 PurposeofDistressToleranceSkills Yellingat someone Helpyousurvivethecrisisbynotmakingthe Givingupon Usingdrugsor situationworse life alcohol Notintendedtomakeyoufeelbetter(though Waysto sometimesyoumight) Worsen aCrisis Complainingso “Retail Ifskillspreventthecrisisfromgettingworse, muchfolks therapy”with don’twantto moneyyou butyoudonotfeelbetterͲ don’tstop! talktoyou can’taffordto spend – Anescalatedcrisismaymakeyoufeelworse Eatingtoo muchortoo little 7 8 BenefitsofDistressToleranceSkills DBTDistressTolerance:The4Steps Learntosurvivea crisiswithout makingitworse Step1: Step3: Step4: Step2: Choose FollowͲup, Becomemore Behavioral MakethePitch Strategy& Evaluateand Assessment Determine ProblemSolve confidentand Homework capableof navigatingfuture crises 9 10 Step1:BehavioralAssessment Step1:BehavioralAssessment AskThreeQuestions: RevisitingCaseExampleͲ DS 1. Whattriggersthedistress? 1. Triggers –Bebehavioral(i.e.,talkingwithafamilymember, ൞ Intensebackpainflaresforhours thinkingathought) ൞ Tendstooverdothingswhenfeelingbetter 2.Howdidthepatientrespondtodistress? 2. Response –Bebehavioral(i.e.,yelled/startedafight,stayedin ൞ Bedbound ൞ isolatesself bedallday) ൞ Doesnoteatorhydrate ൞ yellsathusband –Listenforhelpfulanddestructivebehaviors 3. WhatMadeitWorse 3.Howdidtheirresponsemakethingsworse? ൞ “IfeelsoguiltyafterIyellatmyhusband.He’s –Fromthepatient’sperspective(notyoursasthe justtryingtohelp” provider)! 11 12 DBTDT:The4Steps Step2:MakethePitch Explaintheconceptofdistresstolerance –“Theseareskillstohelpyouwith(1.triggers). You’vetoldmeyoutendto(2.response).” Step3: Step4: Step1: Step2: Choose Behavioral Strategy& FollowͲup, Explainthegoalofdistresstoleranceskills Assessment MakethePitch Determine Evaluateand –“Thegoalistonotmakethingsworse.Thisis Homework ProblemSolve verydifferentthan‘feelingbetter.’” –“DTskillshelpyoubringdownyouremotionsso youthinkmoreclearly.” –“You’vetoldmethingsareworsewhenyou(3. whatmadeitworse).” 13 14 Step2:MakethePitch DBTDT:The4Steps RevisitingCaseExampleͲ DS “Theseareskillstohelpyouwiththeintensepain flaresyouexperience.You’vetoldmeyoutendtoneed tostayinbedformanyhours,noteatordrinkwater, Step3: Step4: isolateyourselffromyourfamily,andyellatyour Step1: Step2: Choose husband. Behavioral Strategy& FollowͲup, Assessment MakethePitch Determine Evaluateand Homework ProblemSolve Thegoalistonotmakethingsworse.Thisisvery differentthan‘feelingbetter.’DTskillshelpyoubring downyouremotionssoyouthinkmoreclearly.You’ve toldmethingsareworsewhenyouyellatyour husband.” 15 16
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