Index

ABC PLEASE (acronym),

78, 95–97

Acceptance, as focus of DBT,

69–72, 101. See also Radical acceptance

ACCEPTS (acronym)

. See Distraction (ACCEPTS)

Access, to specialized therapies for BPD,

xiv, 11, 12, 127

Action steps, and patient goals in DBT,

46

Action urges, and emotion regulation skills,

88, 89–91, 93, 94

Active stance, of clinician,

38, 51

Adolescents, clinical staging model for,

13, 17, 21

Affective instability, and medication options,

113

After effects, and emotion regulation,

88

Agenda setting,

75–76, 133. See also Goals

Alcoholics Anonymous,

65

American Psychiatric Association,

109

Anger

. See also Emotions

in case illustration of GPM,

131–138

emotion regulation and,

88, 89

symptom-targeted medication options for,

113

Anorexia,

108, 109

Antidepressants,

114

Antipsychotics,

113, 114, 115

Anxiety disorders,

109. See also Social anxiety

Apologies, and interpersonal effectiveness skills,

100

Apps, and diary cards,

76

Assertion, and interpersonal effectiveness skills,

98

Assessment

. See also Diagnosis

of risk for suicide,

59

stepped care models and,

24, 25

Assumptions, of clinicians and patients in DBT,

38, 39

Australia

brief intervention clinics for personality disorders,

27

guidelines for medications used in management of BPD,

108–109

Autobiography,

119, 146–147

Behavior(s)

. See also Impulsivity; Self-harm

connections between emotions and,

48, 50

DBT and treatment-interfering,

75

discussion of BPD diagnosis with patient and,

43

emotion regulation and,

88

lack of progress in DBT and,

44

Benchmarks, for improvement in GPM and DBT,

44

Benzodiazepines,

111

Biosocial model, of BPD,

5–7, 128

Bipolar disorder,

18–19, 108, 109

Body posture, and opposite actions to emotions,

94

Bonus skills, in DBT,

78, 100–102

Borderline personality disorder (BPD)

. See also Behavior(s); Comorbidity; Dialectical behavior therapy (DBT); Diagnosis; Emotion(s); Good psychiatric management (GPM); Interpersonal relationships; Patients; Pharmacotherapy; Psychoeducation; Stepped care models

core features of effective treatments for,

xiii–xiv

emotional dysregulation and biosocial model of,

5–7, 128

interpersonal coherence model of,

2, 3

myths about,

36, 37

secondary and primary comorbidities of,

108, 109

stepped care models for,

12–28

stigma and patients with,

11, 36–37

Brief treatment, and stepped care models,

12, 17

Buprenorphine,

113

Case illustrations

of goal setting and working with anger in GPM,

131–138

of GPM management follow-up after DBT,

138–143

of medication management in GPM,

143–147

of psychoeducation in primary care setting,

125–130

Case management

as active approach in DBT and GPM,

50–51

stepped-care models and,

18, 20, 22, 23

Chain analysis

in case illustration,

135

connections between behaviors and emotions,

48, 49, 50, 150

interpersonal events and,

118

self-harm and,

52

Change, as focus of DBT,

69–72

Check the facts, as emotion regulation skill,

78, 92–95, 96

Clinical staging models,

13, 14, 17, 18–19, 20–21

Clinician(s)

burnout of and hospitalization of patient,

64

medication management and,

115

splitting and communication between,

65–66

stance of in GPM and DBT,

35–41, 150–151

treatment agreement and,

155

Clonidine,

113

Clozapine,

19, 20

Cochrane review,

108–109

Cognitive-Behavioral Treatment of Borderline Personality Disorder (Linehan 1993),

69

Cognitive and perceptual disturbances, and symptom-targeted medication,

113

Cold packs, and TIPP skill,

80

Collaboration

involvement of family in GPM,

117

monitoring of medications and,

115

Communication, and therapeutic alliance,

38. See also Intersession contact

Comorbidity, of BPD with other disorders

GPM and treatment of,

105–108, 109, 114

hospitalization during crisis and,

64

Comparisons, and distraction skills,

82

Confidence

clinician stance and,

39–40

interpersonal effectiveness skills and,

98

Connected state, in BPD,

2, 3

Consistency, and involvement of family in GPM,

117

Consultation to the patient approach,

66–67

Continuing education, and training in GPM,

152, 163

Contributing, and distraction skills,

81–82

“Cope ahead” plan, and emotion regulation,

97

Cost savings

evidence-based treatment of patients with BPD and,

29

whole of service stepped-care approach and,

27

Crisis, and crisis plans

. See also Safety plan

clinician support during,

65–67

example of,

157–158

helping patients through,

57–61

hospitalization and,

63–64

intersession contact and,

61–63, 151

involvement of family in GPM and,

117

treatment agreements and,

155

DBT Skills Training Manual, Second Edition (Linehan 2015),

69, 76–77, 82, 95

DEAR MAN (acronym),

78, 98–99

Depressive disorders, comorbidity of with BPD,

108, 109, 127

Descriptions

interpersonal effectiveness skills and,

98

mindfulness and,

84

Devil’s advocate, and commitment strategies in DBT,

73

DHA (docosahexaenoic acid),

113, 114

Diagnosis

. See also Assessment

discussion of with patient,

41–43

GPM and,

4, 26

Dialectic, definition of concept,

6

Dialectical behavior therapy (DBT)

acceptance and change as focus of,

69–72

case illustration of GPM follow-up after,

138–143

clinician stance and,

35–41, 150–151

clinician support during crisis,

65–67

commitment strategies and,

72–75

comparison of outcomes of GPM to, xv diary cards and agenda setting in,

75–76

as effective treatment for BPD, viii family involvement in,

117–118

getting started in treatment,

41–47

group component of,

51–53, 151

helping patients through crisis,

57–61

hospitalization and,

63–64

integration of with GPM,

xvi, 7, 28–29

intersession contact and,

61–63, 151

limits of access to,

11

medication management and,

114

overview of,

5–7, 149–152

self-harm and impulsive behaviors,

150

session structure and,

47–48

stepped care models and,

xv, 22

top 10 skills in,

76–102

Diary cards,

47, 75–76, 133–135, 159–161

Disgust, and emotion regulation,

91

Distraction (ACCEPTS),

78, 81–83

Distress, and therapeutic alliance,

39

Distress tolerance skills

in case illustrations,

130, 136, 137

crisis plan and,

59, 158

DBT and development of skills,

52, 77–83

Dive reflex,

79–80

Documentation, of crisis situations,

60

Door in the face, and commitment strategies in DBT,

73

Dropout rate, and stepped-care approach,

17

DSM-5 (American Psychiatric Association 2013),

41–42

Duration, of treatment in DBT and GPM,

43–45

Early intervention, clinical staging model for,

13, 17, 18–19, 20–21

Easy manner, and interpersonal effectiveness skills,

99

Effectiveness, and “how” skills,

86

Emergency room, and case illustrations,

127, 131

Emergency services, and intersession contact,

62

Emotion(s), and emotional intensity

. See also Anger; Emotion regulation skills

ABC PLEASE and accumulation of positive,

95–96

in case illustration,

127

connections between behavior and,

48, 50

discussion of BPD diagnosis with patient,

42

as explanatory model of BPD in DBT,

5–7

functions, precipitants, physical sensations, thoughts, and action urges of common,

89–91

involvement of family in GPM and,

117

mindfulness of current,

78, 101–102

validation in DBT and,

71

Emotion mind,

87

Emotion regulation skills,

78, 82, 87–97

Empathy, and clinician stance,

36–38

Enter the paradox, and commitment strategies in DBT,

73

Environment, influence of on BPD,

42

Envy, and emotion regulation,

90

Evidence-based treatments, for BPD

reversal of stigma associated with diagnosis of BPD and,

11

stepped-care models and,

22

Exercise, and TIPP skill,

80

Exposure treatment, and hospitalization,

64

Expression, and interpersonal effectiveness skills,

98

Extended care, and stepped care models,

12, 17

Extending, and commitment strategies in DBT,

74

Facial expressions, and opposite actions to emotions,

94

Fairness, and interpersonal effectiveness skills,

99

Family

clinical staging model for early intervention and,

20

involvement of in GPM,

116–118

Family Connections program,

117–118

FAST (acronym),

78, 99–100

Fear, and emotion regulation,

89

Fight-or-flight response, and TIPP skills,

79, 80

Fluoxetine,

111

Follow-up, case illustration of GPM after standard DBT,

138–143

Foot in the door, and commitment strategies in DBT,

72–73

Freedom to choose, and commitment strategies in DBT,

73, 141

Frequency, of treatment in DBT and GPM,

43–45

Function, focus on in GPM,

119–120

Functional validation,

71–72

Gentleness, and interpersonal effectiveness skills,

99

GIVE (acronym),

78, 99

Goals

. See also Agenda setting

case illustration of GPM and setting of,

131–138, 146

focus on function in GPM and,

119–120

identification of and start of treatment in DBT and GPM,

45–46

of 10-session variant of GPM,

26

Good psychiatric management (GPM)

access to care and,

xiv–xv

autobiography and,

119

case illustrations of,

125–147

clinician stance and,

35–41, 150–151

clinician support during crisis,

65–67

comparison of outcomes of DBT to,

xv

function as focus of,

119–120

getting started in treatment,

41–47

helping patient through crisis,

57–61

hospitalization and,

63–64

integration of with DBT,

xvi, 7, 28–29

intercession contact and,

61–63, 151

interpersonal dynamics as focus of,

118–119

involvement of significant others in,

116–118

overview of,

1–4, 149–152

patient participation in groups and,

51–53, 151

safety plans and,

60

self-harm and impulsive behaviors,

150

session structure and,

47–48

stepped-care models and,

xv, 22, 23, 24, 25, 26

timelines for improvement,

105, 106–107

training in,

152, 163

treatment of comorbidities,

105, 108

Group therapy

involvement of GPM and DBT patients in,

51–53, 151

stepped-care models and,

22

Guidelines

for addressing comorbidities of BPD,

109

for family involvement in GPM,

117

for medication management of BPD,

110–111

Guilt, and emotion regulation,

90

Gunderson Personality Disorders Institute,

163

“Half-smiling,” and opposite actions to emotion,

94, 95

Harvard Medical School Continuing Medical Education,

152, 163

Homework,

48. See also Diary cards

“How” skills, and mindfulness,

78, 84–86

HYPE (Helping Young People Early),

18

Improvement, GPM and timelines for,

105, 106–107

Impulsivity

. See also Behavior(s)

symptom-targeted medication options and,

113

view of as coping mechanism in both DBT and GPM,

150

Intercession contact, and crisis situations,

61–63, 151, 155

Interest

interpersonal effectiveness skills and,

99

validation and,

70

Internet, and resources for training in GPM,

163

Interpersonal coherence model, of BPD,

3

Interpersonal effectiveness skills,

78, 97–100

Interpersonal relationships

. See also Family; Social network

DBT skills and,

78

focus on dynamics of in GPM,

118–119

GPM and sources of distress,

7

hospitalization and strain in clinician-patient,

64

involvement of significant others in GPM,

116–118

10-session GPM and,

25

unstable as characteristic of BPD,

6

Interpersonal sensitivity, and discussion of BPD diagnosis with patient,

43

Interpretations, and emotion regulation skills,

88, 92

Invalidation

. See also Validation

clinician stance and,

150

emotional intensity and exposure to,

5, 6, 42

“how” skills and history of,

86

Irreverence, and clinician stance,

41

Jealousy, and emotion regulation,

91

Joy, and emotion regulation,

91

Judgmental statements, and “how” skills,

85–86

Learning skills, and DBT,

7

Lemon out of lemons, and commitment strategies in DBT,

74–75

Life worth living, as patient goal in GPM and DBT,

45, 46, 120, 150. See also Quality of life

Limit setting, and involvement of family in GPM,

117

Lorazepam,

144, 145

Mastery, and emotion regulation skills,

96–97

McLean Hospital, and Gunderson Personality Disorders Institute,

163

Medications

. See Pharmacotherapy

Mental health literacy, and stepped-care model,

18, 22

Mentalization-based treatment (MBT),

xiii, 22

Methylphenidate,

113

Mind, identification of states of in DBT,

87

Mindfulness, and DBT skills,

78, 83–87, 98, 101–102

“Mind reading” thoughts/feelings/urges, and validation in DBT,

70

Missed sessions

treatment contracts and,

44, 155

treatment-interfering behavior in DBT and,

75

Mood stabilizers,

113, 114, 115

Motivational interviewing,

72

Narcotics Anonymous,

65

National Education Alliance for Borderline Personality Disorder,

118

National Institute for Health and Care Excellence,

108

Negotiation, and interpersonal effectiveness skills,

98

Nonjudgmentally, and “how” skills,

84–85

Objectives, and interpersonal effectiveness skills,

99

Observation

emotion regulation skills and,

78, 87–88

mindfulness skills and,

83–84

Obsessive-compulsive disorder,

109

Omega-3 fatty acids,

113, 114

One-mindfully, and “how” skills,

86

Opposite actions, and emotion regulation skills,

78, 92–95, 96, 136

Paced breathing, and emotion regulation skills,

80, 81, 95, 143

Panic disorder,

109

Participation, and mindfulness,

84

Patients

brief care model and increase in number of,

17

tips on helping to learn and apply distress tolerance skills,

82–83

treatment agreement and,

155

Personality disorders, and whole of service stepped-care approach,

27. See also Borderline personality disorder

Personal self-disclosure, and clinician stance,

40

Pharmacotherapy

. See also Antidepressants; Antipsychotics; Selective serotonin reuptake inhibitors

case illustration of,

143–147

clinical-staging model for BPD and,

18, 20

GPM and approach to management of,

108–115

hospitalization and,

64

Phase-specific psychosocial intervention,

18

Physical sensations, and emotion regulation,

88, 89–91

Physiological arousal, and TIPP skills,

79

PLEASE (acronym)

. See ABC PLEASE

Polarization, acceptance and change in DBT and,

72

Polypharmacy,

108, 111, 115

Posttraumatic stress disorder (PTSD),

64, 108, 109

Primary care, case illustration of psychoeducation in,

125–130

Primary emotions,

88

Problem-solving

in case illustration,

136

“check the facts” as emotion regulation skill and,

78, 92–95, 96

radical acceptance and,

100

stepped-care models and,

20, 21, 22

Prognosis, and discussion of treatment with patient,

43

Progressive muscle relaxation,

79, 80–81, 143

Project Air Strategy for Personality Disorders,

27

Prompting events, and emotion regulation,

88, 89–91

Pros and cons, and commitment strategies in DBT,

73, 74

Psychoeducation

in case illustrations,

125–130, 131, 143, 145

diagnosis and,

42

for family,

116

as important element of DBT and GPM,

4, 7

integration of DBT and GPM,

28

medication management and,

110, 114

stepped-care models and,

18, 20, 21, 22, 24, 25

symptom improvement in patients with BPD and,

149–150

therapeutic alliance and,

38

Psychotherapy, and clinical-staging model for BPD,

18, 20

Pushing away, and distraction skills,

82

Quality of life

. See also Life worth living

diary cards and,

76

as goal of treatment in DBT,

7

Quetiapine,

144, 145

Radical acceptance,

78, 100–101, 136

Reasonable or rational mind,

87

Referrals, as option in case illustration,

127, 128

Reflection, and validation in DBT,

70

Reinforcement, and interpersonal effectiveness skills,

98

Relapses, and clinical-staging model for BPD,

18, 20

Risk, and risk factors

for mood disorders and BPD,

20

for suicide,

59, 129

Sadness, and emotion regulation,

89–91

Safety plan, GPM and development of,

60, 141. See also Crisis

Schema-focused therapy,

xiii

Secondary emotions,

88, 100

Selective serotonin reuptake inhibitors (SSRIs),

111, 112, 113, 114, 115, 126, 128, 145

Self

BPD and unstable sense of,

5–6

DBT skills groups and,

146

GPM and drafting of autobiography,

119

Self-disclosure, and clinician stance,

40–41, 151

Self-harm

in case illustration,

126, 127, 130

diary cards and,

76

patient care during crisis and,

57–61

view of as coping mechanism in DBT and GPM,

150

Self-help, and clinical-staging model for BPD,

18

Self-soothing, and coping with distress,

111

Sensations, and distraction skills,

82

Session structure, in DBT and GPM,

47–48. See also Intercession contact

Shame, and emotion regulation,

90

Silence, and active stance of clinician,

51

Skills groups, and DBT,

52–53

Social anxiety,

109, 144, 145

Social network, development of as goal in GPM,

45, 142. See also Interpersonal relationships

Splitting

case illustration of medication management and,

146

communication between clinicians and,

65–66

Step-down, of intensive treatment in stepped care model,

23

Stepped care models

brief versus extended care,

12, 13, 17

clinical staging model and,

13–14, 17, 18–19, 20–21

evidence-based care at different clinical stages,

21–24

integration of DBT and GPM,

xvi, 7, 28–29

summary of,

13–16

ten-session GPM and,

24, 25, 26

whole of service approach and,

27–28

Stigma, and patients with BPD,

11, 36–37

STOP (acronym),

78, 79

Stress, and stressors

focus of session following crisis,

60

hospitalization for situational,

63

therapeutic alliance and,

39

Substance use, and substance use disorders

comorbidity of with BPD,

108, 109

hospitalization and,

64

Suicide, and suicidal ideation

assessment of risk for in case illustration,

129

diary cards and,

76

hospitalization and,

64

patient care during crisis and,

57–61

treatment agreements and,

155

whole of service stepped-care approach and,

27

Supervision

in case illustration,

136–137, 138

clinician support during crisis and,

65

Support groups, for family,

116

Supportive therapy, and stepped-care models,

21, 22, 23

Symptom-targeted approach, to pharmacological management of patients with BPD,

109, 113

Tapering

of intensive treatment in stepped care models,

23

of medications for patients with BPD,

111

Target behaviors,

48

Telephone calls, and intersession contact,

61

Temperature, and TIPP skills,

79

10-session variant of GPM,

15, 24, 25, 26

Termination, of therapy in DBT,

44–45

Therapeutic alliance

case management and,

50

clinician stance and building of,

38–40

as “corrective experience” for patient with BPD,

4

GPM and medication management,

109–110, 112, 115

myths about BPD and,

36

Thoughts

distraction skills and,

82

emotion regulation and,

89–91

TIPP (acronym),

78, 79–81

Training, online resources for GPM,

152, 163

Transcranial magnetic stimulation,

113

Transference, and case management,

50

Transference-focused psychotherapy,

xiii

Treatment contracts

development of in GPM and DBT,

46–47, 151

example of,

155

termination rules in standard DBT and,

44

Treatment-interfering behavior, and DBT,

75, 76

Truthfulness, and interpersonal effectiveness skills,

100

Validation

. See also Invalidation

acceptance and change as focus of DBT and,

70–72

in case illustration,

137

clinician stance in both DBT and GPM,

151

interpersonal effectiveness skills and,

99

involvement of family in GPM and,

116, 117

therapeutic alliance and,

38–39

Values

in case illustration,

146

cross-cultural list of common,

153–154

identification of DBT goals and,

46

interpersonal effectiveness skills and,

100

Vulnerability, and emotion regulation,

88

“What” skills,

78, 83–84

Whole of service stepped-care approach,

16, 27–28

“Willing hands,” and opposite actions to emotions,

94, 95

“Willingness,” contrast between “willfulness” and,

86

Wise mind, and DBT skills,

78, 87, 141, 142

Withdrawal, and medication management,

111