DBT Intensive Part 4: Mindfulness, Conceptualization, and Diverse DBT Applications

This workshop is Part 4 of a 5-Part Series on DBT theory, skills, and practice. It is recommended to attend all five parts to receive the full DBT training, however you may attend a portion of the series if you are unable to attend all parts.

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. The primary focus of this training series is on how to provide DBT in a flexible, responsive, and individualized manner, while maintaining fidelity to DBT core principles and practices.

The focus of Part 4 is on the mindfulness module, DBT case conceptualization, and diverse applications of DBT to a range of presentations. Participants will experientially practice mindfulness and discuss how to present the role of mindfulness within DBT. DBT case conceptualization frameworks and the Bronfenbrenner’s Ecological Model will be presented to conceptualize complex DBT cases. An overview of how DBT is used for Posttraumatic Stress Disorder, Eating Disorders, and Substance Use Disorders will be provided, as well as the integration of DBT and Acceptance and Commitment Therapy.