Dialectical Behavior Therapy Chat Transcript with Scott Spradlin, M.A., author

Tasumi: 

why did you decide to write your book?

Patty:

If anyone has a Question for our speaker, please put a "?" next to your name and when it is your turn I will call on you. Go ahead Tasumi

Scott Spradlin:

I decided to write the book after Matt McKay and Pat Fanning asked me to.  They were looking for someone to write a New Harbinger book addressing emotions from a DBT framework.

Guest:

?

Scott Spradlin:

I was glad to do it since I am a very sincere believer in DBT and want more people to hear about it and have access to it's ideas.

Tasumi: 

?

Patty:

Guest your question please.

Guest:

Can you in a nutshell tell us about emotions from a DBT framework? I haven't read the book yet.

Scott Spradlin:

Let me try.  Here goes.

DBT looks at emotions as a full-system response, that is made of biological action tendencies and urges, hormones, changes in brain chemistry. From there we look at emotion as making people ready for action, they motivate us to do things.

Robinongo:

?

Scott Spradlin:

Emotion is seen as having several important functions such as giving you information and communicating with others. Emotions are problematic for persons who have a biological thermostat that is at a higher set point, so they experience their emotions much more strongly and quickly than others.  Without certain skills emotions can take over, rather than serve the person that feels them.  Sorry for going beyond the nutshell.

Patty:

Tasumi

Guest:

Thank you SS :-)

Tasumi: 

How young can a person be and have bpd traits? 

Scott Spradlin:

The youngest I know of are usually around 14. I'm not knowledgeable about what current research would say. So this is based on my clinical experiences.

Patty:

Robinongo your question

Robinongo:

What can we do to advocate DBT so that it becomes more available?

Scott Spradlin:

Robin, great question.  This is important.  I think what we can do is exactly what this website is doing, plus write articles for local papers, or ask our religious and social services leaders to provide a space for workshops or education on DBT.  I consider a part of my practice to be advocating for DBT, and BPD's generally, but as you can imagine, it's easy for me to be suspected of conflicted interest since this is how I earn a living.

Guest:

LOL!

Scott Spradlin:

Finally, speak to your medical professionals since they're health gate-keepers. Offer to get them brochures from NIMH or here for their office so they will know more and know what the research is saying about DBT's effectiveness.

Patty:

I have a ? What specific skills should bpds use when we are experiencing emotional crisis and feel we cannot cope?

Tasumi: 

great question patty :)

Scott Spradlin:

Since we're talking about DBT, I would say what is called Distress Tolerance. These are the crisis survival skills of DBT.  They are designed to help one survive by learning to tolerate emotional pain in a skillful manner. There is a whole set of skills within distress tolerance such as distraction techniques, soothing oneself, prayer, sensations and so on. These don't solve life's major problems, but they help one begin to clear the floor so that one can get on to the "deeper" stuff.

Guest:

?

Patty:

Guest. TY SS

Guest:

Such as 12 step stuff SS?

Scott Spradlin:

I have found with one client, especially, that much of what is done in 12 step work is compatible with DBT. 

Guest:

yes...ty

Patty:

Does anyone have any questions for our speaker tonight?

Robinongo:

?

Patty:

Robinongo

Robinongo:

Why is DBT used mostly in an outpatient setting?

Scott Spradlin:

Mostly because the aim of DBT is to help persons live their lives as normally as possible. Life in the hospital is not normal living.  The skills must be learned and generalized in the client's natural environment, and that can't be done when one is hospitalized.  You can learn how to live effectively in the hospital, but once you're discharged you will need skills for living at home. 

One more thing.

Patty:

?

Scott Spradlin:

There are some hospitals that are integrating DBT skills training on their units, which can have people learn skills they otherwise wouldn't if they were left in their rooms, or to process groups, rather than skills-based training. 

Patty:

I have read that the biggest reason for bpd suicide is not depression but impulse control. How specifically can DBT help in that area? 

Robinongo:

?

Scott Spradlin:

The impulsive behaviors that you're talking about usually come on the tail of severe emotional dysregulation--that emotionally stormy experience, the hurricane as some of my clients call it.  Many acts of self injury have a function of soothing, distracting or otherwise regulating these powerful emotions.

DBT looks at these impulsive behaviors as attempts to problem-solve that have limited effectiveness and often potentially life-threatening, if not life-ending results.

DBT targets providing skills for BPD folks that do what the impulsive behaviors do only without the disastrous outcomes.  And there are many strategies that both nurture the client's change to embrace skills and to hold client's accountable to skills practice on a weekly basis, and there is also phone contact w/DBT therapists between the weekly sessions.  I hope that's not too much.

Guest:

Volcanoes here :-) LOL!

Patty:

Robinongo, your question please.

Scott Spradlin:

I'll have to share that with my clients!

Robinongo:

My daughter does not need to be hospitalized, she is safe.  But she does not function well at home.  It makes sense that DBT skills can be learned and utilized in any setting. 

Patty:

Is that a question or comment?

Robinongo:

It was a comment.

Patty:

Ok. Any more questions? I have one

If we do not have access to DBT skills training, can we learn it ourselves from the books?

Scott Spradlin:

Patty, I think one can benefit from learning some.  I can't say this is something that has been looked at empirically, there is not data to support this, and I think it's important to note this.

One thing that is clear, the best thing to do get, is to get full DBT with individual therapy, skills training and phone consult.  I know that's hard to come by in some places.  Just using my book, for example is not the same as getting actual DBT.  You are only getting a taste of it, or it can work as adjunctive support to work in therapy underway.  But, we all have to do the best we can with what resources we have.

Patty:

I have another ?

Scott Spradlin:

ok. 

Patty:

What other mental health disorders does the DBT help with?

Robinongo:

?

Scott Spradlin:

Right now research shows that it works with BPD concurrently diagnosed with substance abuse, and Dr. Linda Dimeff will be published soon in her hard work in this area.

Guest:

?

Scott Spradlin:

Also, DBT has been adapted for Binge Eating Disorder that seems to work, and perhaps with bulimia, too.  However, not likely with anorexia.

I have used adaptations of DBT for an anger management program, impulse control disorder, NOS, and the mindfulness and emotion regulation for adults with ADD.

Patty:

Robinongo, your question please.

Robinongo:

Have there been any studies using brain mapping to diagnose bpd?

Scott Spradlin:

Robin, that's a great question that I don't have an answer to.  To my knowledge, brain scans are not standard diagnostic tools in determining disorders.  Tomography scans are helpful in showing brain differences between groups that indicates important differences in biology that may account for the variances of the emotional thermostats. 

Patty:

Guest, your question please.

Robinongo:

ty

Guest:

1) are you referring to dual diagnosis? and 2) if an absent parent is obviously untreated BPD, but I have raised the child in a healthy setting who has BP with BPD traits, what are the chances of it developing into full blown BPD? IMO, environment plays a role in dictating one's outcome despite the genetic influence...but there are some things that are so genetic as my son does identical things though not knowing his father

Scott Spradlin:

Guest, this is a complexity we face in this field.  I think dialectics are helpful in thinking about the interrelatedness of parts and whole of the picture of any one person's life.  Genetics can influence behavior, and behaviors can influence one brain chemistry.  People have reciprocal influences on one another, and are interdependent, so who really knows the "details." We have broadstroke theories. 

Patty:

I have a ?

Guest:

ty

Patty:

What are the major points you try to make in your book? What would we expect to find in your book?

Kristy:

?

Scott Spradlin:

You can expect to find educational materials explaining how emotions are good for us, and how our diets, exercise, thinking patterns and relationships make a great difference in how we can develop emotional resilience.  There are also very practical DBT-derived skills based on sound behavioral strategies that are easy to learn and practice for immediate use.  I hope one finds the message of hope. 

Patty:

Kristy your question please.

Kristy:

What is the success rate for the program?

Normally, does everyone improve?

Crazgrl:

?

Scott Spradlin:

Kristy, the success rates vary from one program to another.  I don't have any articles hand with me, but work by Linehan, Heard, Dimeff, Miller and a number of others has shown consistently better rates of progress in DBT compared to other psychotherapies, or what is called treatment as usual (TAU).

Kristy:

I know it is working for me

Scott Spradlin:

The improvements where DBT has been shown to be superior to other therapies are great reductions in number of acts of self-harm, suicide attempts and days in hospitals. 

Patty:

CraZgrl your question please.

Crazgrl:

I apologize if this was already asked since I came late but how does DBT view using psych meds?

Patty:

Good question.

Scott Spradlin:

CraZ, DBT of course sees a role for medications, as long as the medications prescribed are targeting specific symptoms of mood disorders or in some cases, psychosis.  Research data is clear about one thing, medication alone does not effectively treat BPD.  Meds can help reduce impulsivity and alleviate other symptoms, which of course can aid any treatment since it can clear away some clutter, making room for learning and skills generaliz...

I hope that answered your question.

Patty:

oh ok. I have a ?

Crazgrl:

Yes thank you

Patty:

I have heard rumors that DBT is not helpful with bpds who have this disorder severely. What are your comments about this?

Kristy:

?

Scott Spradlin:

DBT is helpful for what i think of as severe, and I think that the growing body of research data would support this.  DBT was designed for BPD women who are chronically suicidal.  These are often considered the worse cases, and this is why DBT has engendered so much hope for so many BPD's and their therapists.  I think this is a rumor, and I have heard naysayers in different clinics, but they don't have other options that are effective a

Patty:

Kristy, your question please.

Kristy:

Is there a problem if your a Bpd and you dissociate and are not aware of hurting yourself? Can I still be kicked out of the program? When it happens in your sleep.

Kristy:

?

Scott Spradlin:

Kristy, whether or not you get "kicked out" of the program you're in now, is a matter of agreement between you and those running that program.  I have to say, hurting yourself in dissociated states is a problem, but as we say in DBT problems are problems to be solved.

Patty:

I have another ? Does DBT in fact change the chemistry in your brain, improving the brain disorder?

Scott Spradlin:

Since there has been data showing brain changes in occurring during social interactions and general psychotherapy then I would say we can safely generalize from that to say yes.  Also, practicing new skills (e.g., DBT skills, French, musical instrument, exercise) affect brain structure and chemistry.  So DBT targets and teaches people how to create experiences and environments that increase positive emotions for this very reason.

I hope that answered the question.  Are there any others?  If not, perhaps this could be a good ending point?

Patty:

oooh ok. There are only a few minutes remaining in this conference.

Robinongo:

Thank you so much.

Patty:

Scott, is there anything you would like to say?

Scott Spradlin:

Ok.  Let's live those out mindfully.

Kristy:

Thank you

Crazgrl:

thank you

Patty:

Thanks very much for being here!!! Is there anything further?

Scott Spradlin:

I would like to say to you Patty, keep up the good work you're doing here with this site.  I think you're doing a great work that is important to a lot of people.  I would also like to say to anyone with BPD, have hope.  You can have a life worth living, and one full of beauty.  You are not your diagnosis, and if you are in a DBT program, do as my one time Dialectical Behavior Therapy skills mentor, Alice Rose always said, "practice, practice, practice. 

Patty:

Thanks very much.

Scott Spradlin:

It's been a pleasure. I hope we might do it again some time. 

Kristy:

Thank you so much

Patty:

Yes, I learned a lot. Thanks again Scott.

Robinongo:

TY, Patti and SS

Patty:

Goodnight everyone.