DBT
DBT services
Dialectical Behavioural Therapy is an evidence-based treatment developed by Dr. Marsha Linehan for Borderline Personality Disorder (BPD) as well as other diagnoses and symptoms such as anxiety, mood disorders, substance use, eating disorders, suicidal thoughts, self-harm, trauma, etc. Participating in a comprehensive DBT program is shown to have a positive impact on the above mentioned and other common difficulties. It is critical to be sure that your DBT therapist is truly qualified to practice DBT. When DBT is not done as designed, the results may be inadequate and cause the person to lose hope in treatment. Therefore, getting the best outcomes possible from DBT requires a comprehensively trained DBT therapist who provides treatment that adheres to the DBT model.
We are the only centre in Montreal to offer comprehensive DBT therapy. We are also the only centre in Quebec with a DBT Linehan Board of Certification™ Certified Program and Clinicians.
Comprehensive DBT includes
Depending on the need of the individual as well as the agreement between the individual and the therapist,
DBT either be carried out in a group and/or individually.
DBT either be carried out in a group and/or individually.
How do you choose a DBT therapist/program?
Here are some questions to help ensure that you are choosing the right DBT therapist for you:
- Have you completed a DBT Foundational Training?
- Are you currently a member of a DBT consultation team?
- Are you supervised by an experienced DBT therapist?
- How often do you attend DBT trainings?
- Do you teach DBT skills classes weekly?
- Do you practice Behavior Chain Analysis?
- Are you familiar with the main sets of DBT strategies (CBT, validation, dialectics)?
- Do you provide phone coaching?
- Do you use Diary Cards?
- Are you an DBT-Linehan Board of Certification, Certified Clinician™ or do you have one on your consultation team?
We hope this provides you with a guideline of what to expect from a properly trained DBT therapist. At Greyzone we strive to provide DBT treatment of the highest quality standard.
DBT for Children
DBT-C is Dialectical Behavioural Therapy that has been modified to address the treatment needs and developmental levels of children. DBT-C aims to help parents work with their child in learning helpful coping skills. DBT-C is a relatively new treatment program for children, but it is an effective option. Through DBT-C, children learn DBT coping skills so they can handle strong emotions and enjoy their time with friends, family and all the things that make them smile.
DBT-C has been modified to suit the developmental levels of children ages 6 to 12. Older children and young adults might consider regular DBT treatment to address challenges with emotion regulation and harmful behaviour patterns.
When Should Parents Consider DBT-C for Their Child?
You might be wondering if your child would benefit from DBT-C treatment, or if they will naturally outgrow outbursts. Although not every tantrum is a sign of a deeper issue, children who are irritable or angry most days of the week may benefit from receiving treatment as soon as possible. DBT-C might help prevent mental health conditions, like anxiety and depression, down the road.
DBT-C can be an effective treatment for pre-adolescent children with the following:
- High emotional sensitivity: A child who reacts immediately and intensely to an emotional trigger may have high emotional sensitivity. A child with high emotional sensitivity may experience long-lasting reactions, and find it challenging to process emotions due to extreme arousal.
- Corresponding impulsive behaviour: In response to emotional sensitivity, a child might display frequent anger outbursts involving either verbal or physical aggression, or self-injurious behaviours.
Other signs of high emotional sensitivity in children include:
- Easily bored
- Does not like change
- Shifts attention rapidly
- Hyperactive
- Acts impulsively
- Sensory sensitivity
- Black and white thinking
- Interpersonal difficulties
- Low tolerance for delayed gratification
Children with high emotional sensitivity may have been diagnosed with one of the following disorders:
- Disruptive mood dysregulation disorder (DMDD): DMDD is a diagnosis given to children who experience frequent outbursts and tantrums, or who are angry and irritable almost every day. With DMDD, severe outbursts usually occur several times a week. DMDD is a relatively new diagnosis, and a clinical trial found that DBT-C may be an effective treatment for this disorder.
- ADHD: Many children have a lot of energy and could be inattentive, but sometimes hyperactivity and impulsive behaviours are a sign of ADHD, especially if symptoms negatively affect school, home life and relationships. A child may be diagnosed with ADHD if he/she has trouble focusing and following instructions, are easily distracted and have trouble staying seated in school. DBT-C might help children learn ways to cope with ADHD symptoms.
Other diagnoses, such as depression or an anxiety disorder, can also lead to symptoms of high emotional sensitivity. It’s worth noting that children with high emotional sensitivity often also experience enhanced positive emotions, increased creativity and greater empathy. Also, if your child displays any of the above behaviours, whether because of a mood disorder or other diagnosis, that does not mean something is wrong with him/her. DBT-C can help your child learn techniques to cope with high emotional sensitivity in a way that is beneficial to his/her wellbeing and relationships.
4 Core Modules of DBT-C
What to Expect?
Depending on the need of the individual as well as the agreement between the individual and the therapist, DBT either be carried out in a group and/or individually.
There are two main components of DBT-C – individual therapy and parents skills training.
- Individual Therapy for the Child: Individual therapy sessions focus on teaching the child about his/her emotions and why they matter. During DBT-C sessions, a child will work with a therapist to develop and build DBT coping skills. Together, the child and therapist will discuss goals and address issues as they arise. Therapists will target destructive behaviours.
- Parent Skills Training: Children do not possess the ability to fully take advantage of DBT skills alone, and they require the support of their parents to reap the most long-term benefits from DBT-C treatment. The parent component of DBT-C trains parents to take on the role of their child’s therapist once treatment ends. This continuous support is critical to helping a child stay on track with DBT coping skills. Parents do not have to worry – they will learn everything they need to know throughout their child’s treatment. For example, parents will learn how to model skills, how to create a validating environment and how to help their child practise DBT skills every day. The parent component of DBT-C also aims to improve the relationship between the child and parent.
How Are Parents Part of DBT-C?
As mentioned above, parents play an essential role in their child’s treatment. In a study, parents report learning DBT skills helps their ability to help their child use skills, and it also helps them regulate their own emotions. Caregivers also say that it helps to validate a child’s feelings before practicing skills.
Caregivers will learn about dialectics, behaviour modification and validation techniques. The DBT-C therapist and parents will cover topics such as:
- Principles of dialectics: Parents and the therapist will discuss how there is no absolute truth and opposites can both be true.
- Creating a validating environment: Parents will learn the importance of actively listening to the child and accepting their thoughts and feelings as meaningful or justifiable. They will also learn how to observe and reflect feelings back without judgment.
- Behaviour change techniques: Parents will learn ways to influence their child’s behaviour and how to reinforce behaviours effectively.
- Reinforcement: Parents will learn how to reinforce DBT skills and adaptive behaviours. They will also learn how to practice reinforced skills with the child daily.
- Punishment: Parents will learn the difference between effective and ineffective punishment, and the best ways of handling their child.
DBT for Post-Traumatic Stress Disorders
DBT-PTSD is tailored to provide adherent, comprehensive DBT while treating Posttraumatic Stress Disorder. For clients beginning the program who want to treat PTSD as soon as possible, we offer DBT and Prolonged Exposure, following modifications by Dr. Melanie Harned, a DBT expert and researcher trained under Dr. Marsha Linehan.
DBT-PTSD is for those who have co-occurring diagnoses of PTSD, which develops in response to having experienced or witnessed one or more traumatic events, and other concerns such as depression, anxiety, substance-use, chronic pain, insomnia, or behaviors that are life threatening or quality of life interfering.
Our therapists will assess your history and current symptoms at intake to determine your diagnosis and whether DBT-PTSD is a good fit for you.
Build a life worth living, without PTSD.
What to expect?
- Weekly individual therapy before engaging in PTSD treatment.
- Once engaged in PTSD treatment, two weekly individual therapy session (50 minutes per session).
- Once weekly group DBT skills training.
DBT for Eating Disorders
Not all eating disorder clients are appropriate for comprehensive DBT, and comprehensive DBT is not appropriate for all clients with an eating disorder. DBT should be considered with clients for whom standard, evidence-based treatments have not helped, for clients who have a co-morbid diagnosis, or for when emotion regulation issues are central to a client’s illness.
- Anorexia nervosa
- Bulimia nervosa
- Binge eating disorder
- ARFID (Avoidant/Restrictive Food Intake Disorder)
- Emotional eating
- Body Image concerns
- Other eating issues
Depending on individual needs, the goals of this treatment are to:
- Working on nutritional restoration
- Weight restoration
- Extinction of eating disorder behaviors
- Learning how to notice and more effectively manage emotional responses to food and body image
Our therapists will assess your history and current symptoms at intake to determine your diagnosis and whether DBT for eating disorders is a good fit for you.
What to expect?
Weekly individual DBT therapy.
Once weekly group DBT skills training.
Nutritionist services as needed
DBT for Substance Use Disorders
DBT-SUD is a modification of standard DBT developed by Dr. Linda Dimeff. It is for individuals who have co-occurring mental health and substance dependency concerns. Participants strive for dialectical abstinence, being 100 percent clean and sober, using a harm reduction model.
DBT-SUD helps clients to:
- Become more aware of urges to drink or use and tolerate or reduce them
- Increase motivation to stop abusing alcohol or drugs; manage aversive emotions such as anxiety, depression, and anger without alcohol or drugs
- Structure the environment to support substance-free living
Individual therapy and as needed phone coaching are provided by clinicians trained in DBT
Radically Open DBT
This new therapy is a breakthrough, transdiagnostic approach (developed by Dr. Thomas Lynch) that helps clients with extremely difficult-to-treat overcontrol (OC) disorders such as anorexia nervosa, chronic depression, and obsessive-compulsive disorder (OCD).
RO DBT treatment involves both individual treatment sessions and skills training classes, and centers around five overcontrol themes: inhibited and disingenuous emotional expression; hyper-detailed focused and overly cautious behavior; rigid and rule-governed behavior; aloof and distant style of relating; as well as high social comparison and envy/bitterness.
Psychological health or well-being in RO DBT is thought to involve three core interrelated traits:
- Receptivity and Openness to new experience and disconfirming feedback in order to learn.
- Flexible-control in order to adapt to changing environmental conditions.
- Intimacy and social-connectedness (with at least one other person) based on premises that species survival required capacities to form long-lasting bonds and work in groups.
Radical Openness is the core philosophical principle and core skill in RO DBT. Radical Openness is a way of behaving, but it is also a state of mind informed by the core idea that emotional well-being involves the overlap of the above three traits: openness, flexibility, and social connectedness. As a state of mind, Radical Openness involves actively seeking our personal unknown in order to learn from an ever-changing environment. Radical Openness also enhances relationships because it models humility and the willingness to learn from what the world has to offer.
What to expect?
- Weekly group therapy sessions are led by a trained RO-DBT therapist in which people learn skills from the different modules. At the end of each session, members are assigned homework, such as practicing mindfulness skills. Participants of the group are generally encouraged to share their experiences, worries and feelings, ultimately providing mutual support (1.5 hours for 12 weeks).
- Individual weekly sessions emphasize problem-solving behaviours and help the person stay motivated in learning and applying different skills they have learned throughout sessions (50 minutes).
Support for Families
Our parent groups are meant to support parents who have children with emotion dysregulation, and who may engage in risky behaviours, self-harm, and/or have suicidal thoughts. Our 10-week parent group helps parents learn about Borderline Personality Disorder and other disorders that involve emotional dysregulation, Dialectical Behavior Therapy (DBT), and effective ways to support their teen or young adult children.