Principles of Exposure in Stage 1 and Stage 2 DBT© (August 2024)

Training Description

In the treatment manual for Dialectical Behavior Therapy (DBT), Marsha Linehan (1993) described Dialectical Behavior Therapy as an exposure-based treatment.  Conceptually, people who have high emotion sensitivity and emotional intensity learn to avoid emotion.  In DBT patients, the behaviors that are targeted in treatment (life threatening, therapy interfering and quality of life interfering behaviors) are often the avoidance behaviors of uncomfortable emotions.  Providing DBT requires that the therapist identifies cues for emotional avoidance and exposes patients to those cues while blocking avoidance behaviors.  Harned (2014) has developed exposure based DBT-PE (prolonged exposure) to target symptoms of PTSD in Stage 2 of DBT.  However, in order to transition from Stage 1 to Stage 2, patients often need exposure-based interventions to decrease life threatening and extreme quality of life interfering behaviors, make progress towards lives worth living and develop skills for emotional experiencing. 

Exposure based principles are used in several ways in DBT.  First, because shame is an emotion that drives many of the behaviors targeted in DBT, coming to therapy, completing a diary card, participating in behavioral chain analyses and solution analyses are exposure to shame. Exposure is used to address in-session dysfunctional behaviors.  Second, once assessment is completed and controlling variables for problem behaviors are determined, the DBT individual psychotherapist may need to do informal exposure to an emotion link or a vulnerability factor that leads to a problem behavior. Third, in DBT Stage 1, patients are asked to collaboratively define, with their therapists, their Life Worth Living Goals (LWLG’s).  The targets and interventions in DBT are focused on moving clients towards these LWLG’s.  Many DBT patients want to reach their LWLG’s but have patterns of avoiding engaging in behaviors that would move them to their goals.  Informal exposure principles are used as one approach to achieving LWLG’s.  DBT therapists help patients to develop an exposure lifestyle which is one in which people actively engage in meaningful behaviors even when emotion (fear, shame, guilt) would interfere.  Finally, exposure principles are used in the DBT consultation team to address emotion intensity and/or avoidance in the therapists providing DBT. 

This course will describe the principles of exposure used in Stage 1 DBT.  There will be demonstrations and practices in conducting in-session exposure, exposure as a solution for problem behaviors, exposure for experiential avoidance and conducting exposure with colleagues on the DBT consultation team.  The final session will focus on the principles of exposure used in Stage 2 DBT for PTSD.  It is designed for clinicians who are currently providing DBT individual psychotherapy.

This training will not teach an overview or the basic principles of DBT.

This training will use PowerPoints, handouts, examples, practices/breakouts and homework to learn and generalize concepts in DBT. 

Training Objectives:

Following this training, participants will be able to:                                                                          

• Lead mindfulness practices related to exposure;

• Explain the rationale for exposure;

• Demonstrate orienting skills for exposure;

• Conduct in-session exposure for emotional avoidance;

• Assess avoidance behaviors in clients;

• Conduct imaginal exposure for solutions to problem behaviors;

• Determine behavioral homework for exposure practices;

• Describe the FREE skill for creating an exposure lifestyle;

• Construct a hierarchy for exposures to experiential avoidance;

• Conduct exposure on a member of their consultation team;

• Define when a patient is ready to move to Stage 2 DBT (PTSD treatment);

• Describe the structure of a DBT-PE session;

• Explain the importance of process in DBT-PE;

• Describe the steps that are taken in Stage 2 when a patient returns to Stage 1 behaviors.

Training Prerequisites:

This course is designed for clinicians who have been trained and are actively practicing DBT.  This course will not teach the basics of DBT. 

Continuing Education:

This course is 14.5 hours. 100% participation is required to receive any credit. No partial credit will be given for any reason.  In order to document participation in this live online course, each participant will be provided their own invitation to attend each session.  At the conclusion of the course, each participant will be required to complete an Attestation that they attended 100% of each training session. 

Addiction Professionals

Application in process.

Social Workers

Application in process.

Counselors

Application in process.

Psychologists

Treatment Implementation Collaborative, LLC (TIC) is approved by the American Psychological Association to sponsor continuing education for psychologists. TIC maintains responsibility for this program and its content.

APA credit will be provided upon completion of the course. 100% participation is required in order to receive any credit. No partial credit will be given. 14.5 APA hours.

Tuition and Registration:

Regular rate: $450 (USD) per person.

Early payment rate: $405 (USD) per person. To qualify for the early payment rate, tuition must be received in full by June 7, 2024. 

Group rate: $405 (USD) per person. To qualify for the group rate, tuition must be received in full, for 2+  individuals, in one payment. Please include list of all participant names and email addresses with your registration. Use coupon code: "GroupEx24" at checkout. 

If you need to pay by check, please complete our INVOICE REQUEST.

Refunds and cancellations:

If you need to substitute a colleague to take your place or cancel a registration, please contact TIC at cbest@ticllc.org no later than August 9, 2024. We will refund your registration fees, minus $50 (USD) – we understand that life happens when you are making other plans and we want to be accommodating. No substitutions or refunds will be made after August 9, 2024.

For a complete description of this training, please view thPrintable Course Brochurere