Dialectical Behavior Therapy (DBT) is a cognitive-behavioral treatment originally designed for people diagnosed with borderline personality disorder. Its effectiveness in modulating extreme emotions and reducing negative behaviors makes in an attractive treatment for a variety of populations, including people injuries. DBT delivers treatment through multiple treatment modalities which include individual therapy, skills training, coaching in crisis, structuring the environment and consultation teams for providers.
Individual Therapy
In DBT individual therapy includes multiple components, many of which will require modification for a person with a brain injury. The therapist must be sensitive to a need for repetition, the individuals ability to understand key concepts and skills and the need to modify and simplify the language used. Progress in therapy may proceed slowly to ensure the client understands and is committed to the process.
Skills Training
Group skills training should be structured and taught as outlined in the "Skills Training Manual for Treating Borderline Personality Disorder" developed by Marsha Linehan (1993). The focus of any curriculum adaptations is an emphasis on increased repetition and tactile, visual and hearing modalities. In addition, consideration should be given to training family and support personnel so that skills usage can be reinforced outside of the group setting.
Coaching in Crisis
Coaching in crisis should follow the protocols as described in Linehan's Cognitive-Behavioral Treatment of Disorder (1993), which include providing clients with instruction and support in utilizing DBT skills in times of crisis. Individuals with brain injury may require proactive phone-in times. In addition, it may be helpful to design individual relapse prevention plans and to use service providers and family members to assist in coaching.
Structuring the Environment
Individuals with brain injury frequently have multiple providers involved in their treatment, such as residential providers, day programs, job coaches, and case workers. A structured environment is particularly necessary to provide the repetition and reinforcement this population requires to learn new skills and behaviors. In a complex environment with multiple treatment modalities the individual therapist is likely the best person to assume a role as consultant to the team. The purpose of this consultation is to structure the environment to support DBT principles and may include support, education and training and clinical leadership.
Consultation Team
Consultation team should be structured consistent with DBT principles. Two primary functions of DBT consultation teams are to enhance the skills of team members and to assist treatment providers in remaining adherent to the treatment. In order to accomplish those goals, consideration should be given to structuring teams to include all service providers involved in the treatment of clients with brain injuries.
Tags: with brain, with brain injury, Behavior Therapy, Borderline Personality, Borderline Personality Disorder,