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NAME OF PRESENTATION - UNC School of Social...
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What's New in DBT?October 20, 2014
University of North Carolina at Chapel Hill
School of Social Work Clinical Lecture Series
Meggan Moorhead, Ed.D.
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Why Keep On?Schmahl (2014) and Gunderson (2012) show that while BPD symptoms decrease, long term follow up:
50% GAF scores under 61,
53% unemployed or in school,
36% on disability, social isolation pervades.
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Areas of Study
• Emotions
• Interventions
• Mindfulness
• Populations
• TADBiT
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Emotions• Evolutionary function of 9 emotions
• Higher level of baseline arousal
• Schmahl et al. Review 2014
• New work in emotion regulation
– Fineran, 2014
– Gratz et al.
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Mechanisms of Emotional Processing Fineran, 2014
• Higher baseline of arousal, BPD, PTSD, BED
• Shame, guilt, disgust, fear
• High neg leads to dissociation
• Sees social rejection where it is not
• Disturbed Processing-----------ineffective responses
• Tension, dissociation, maladaptive coping
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Schmahl, 2014• Review of over 108 studies
• Emotion Regulation includes social assumptions, neural mechanisms, action tendencies
1. Higher arousal at baseline
2. Most aversive: shame, guilt, disgust, fear
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Schmahl cont.3. Experience of high negative can
lead to dissociation
4. No genetic findings
5. Amygdala 13% smaller, hypocampus 11% smaller, cingulate gyri smaller
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Gratz et al., 2013• High threat in response to
perceived social rejection (which is:– The need to belong, for self respect,
perceived control, meaningful existence
– BPD = greater threat, lack of effective strategies including labeling of emotion, hard to sustain goal directed beh under stress
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Conclusions• Further Emphasis in DBT Skills Training in
Observing and Describing of emotions (everyday)
• Adding the practice of belonging to Participate, along with VITALS
• Tonglen breathing for each of the above four needs
• Interpersonal Effectiveness, under pressure (ask for time, practice distress tolerance)
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Conclusions• Continue graduate groups
• Continue Yearly Retreat
• Continue training in treatment of trauma, SE, SP, PE
• Continue referring to System Centered Therapy
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New Interventions• Banawan: DBT App DBT Diary Card• Credentialling in DBT • Rizvi: Treatment protocol for shame• Linehan: New Skills Training Manual
– TIP– Cope Ahead – Acting in accordance with values
• Lynch: Radically Open DBT• Harned, Korslund and Linehan: adding PE to
stage one DBT
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Research on Mindfulness• Lutz et al., 2014 prefrontal and in amygdala
• Bruhl, A. S. et al., 2014 amygdala, prefrontal and insula
• Chavos et al. BPD who practiced had increase in key brain areas and decrease in impulsivity, emotion irregularity and relationship instability
• Hill, 2014 Mindfulness 6x a day increased emotion regulation (teens)
• Dynamic Functional Connectivity mid-200’s
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New Populations• Substance Abuse (SA) • Binge Eating Disorder (BED)• Adolescents• Forensic• Children ages 5-14 • Depressed Elderly• Treatment Resistant Depression• Anorexia Nervosa • Emotional Inhibition • Over Control
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Developments in TADBiT• Change in leadership• New Website with DBT
therapists• Adult (women and co-ed)• Adolescent• Middle Schoolers• University
• Eating Disorder• Couples• Family Members• Transgender• Graduate Groups• Skills Training for Tx
• Needs– Forensic– Elderly
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Cited studiesFineran, V. (2014). Multimodal emotion perception in Borderline Personality
Disorder. Dissertations and Theses, 2014-Present. Paper 205
Gratz, KL; Dixon-Gordon, KL; Breetz, A & M. Tull (2013). A Laboratory-based examination of responses to social rejection in borderline personality disorder: The mediating role of emotion dysregulation. Journal of Personality Disorders, 27, No. 2, pp. 157-171.
Gunderson, JG, Keuroghlian AS, McGlashan TH, et al. (2014). Interactions of borderline personality disorder and mood disorders over 10 years. The Journal of clinical psychiatry, 75: 829-834.
Schmahl, C. et al. (2014). Mechanisms of disturbed emotion processing and social interaction in borderline personality disorder: state of knowledge and research agenda of the German Clinical Research Unit, Borderline Personality Disorder and Emotion Dysregulation, 2014, 1:12.