Discussion 3

Discussion 3

Discussion 3

  1. Discuss the practice guidelines and assumptions for DBT among patients with the following disorders: psychiatric disorders (general), obsessive-compulsive disorders, eating disorders, and posttraumatic stress disorder. 

Dialectical Behavioral Therapy (DBT) assumptions refer to beliefs that therapists applying DBT must accredit to treat clients effectively. Therapists practice DBT therapy with assumptions about patients, which are not usually justified (Ward-Ciesielski et al., 2020). The assumptions are guidelines that create a basis that enable DBT therapists to make decisions. They create a context for planning and facilitating treatment.


DBT practice guidelines for general psychiatric disorders recommend using the following evidence-based treatments mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. The assumptions for patients with psychiatric disorders, in general, are that they are doing the best they can, and they wish to become better (Ward-Ciesielski et al., 2020). Psychiatric patients need to change for the better, put more effort, and have greater motivation to transform. Besides, psychiatric patients may not have initiated all their problems, but they have to address them in any case.

Practice guidelines for DBT in obsessive-compulsive disorder (OCD) recommend using four basic skills: interpersonal efficiency skills, mindfulness skills, distress tolerance skills, and emotional regulation, to curb the degree of emotional disteress and sustain an emotional balance (Swales & Dunkley, 2020). DBT assumes that emotional regulation skills help patients with OCD control obsession and fear-related anxiety. Patients will recognize that anxiety reduces with time, and they do not have to submit to the compulsion.

DBT guidelines on patients with eating disorders recommend applying DBT skills to teach clients new strategies to handle distressing thoughts and emotions associated with eating. The assumption about clients with eating disorders is that patients are doing the best they can to cope, and if they are not coping well, they need to do better (Ward-Ciesielski et al., 2020). For patients with posttraumatic stress disorder (PTSD), DBT practice guidelines recommend the use of Mindfulness to equip patients with strategies of grounding and enable them to stay in the present moment (Bohus et al., 2020). They also recommend using emotion regulation and distress tolerance skills to help PTSD patients manage the distress they feel as a response to intrusive thoughts. DBT assumptions about patients with PTSD is that they must learn new behaviors to cope with the associated distress in all relevant aspects and cannot fail in therapy (Bohus et al., 2020).

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  1. What are some limitations, complications, or contraindications to CBT?

CBT entails challenging maladaptive thoughts and behaviors to cause a change in a patient’s emotional distress. It has an assumption that thoughts, emotions, and behaviors are interconnected, and any of the three elements can cause distress (Wheeler, 2020). Limitations in using CBT include challenges in managing patients with comorbid severe personality disorders like antisocial personality disorders and abnormally low intelligence levels (Gautam et al., 2020). Special training and expertise are needed in managing clients with these conditions. In addition, it is often difficult to manage clients with severe depression, psychosis, and suicidality with CBT alone (Gautam et al., 2020). Therefore, pharmacotherapy and other therapies should be considered before CBT.

CBT is not recommended for patients with complex mental health conditions or learning difficulties due to its structured nature. Patients with minimal intellectual functioning fail to benefit from CBT fully. CBT approaches should be modified in particular groups, such as young children and older adults, to ensure it is provided in a developmentally suitable and culturally competent way (Gautam et al., 2020).


Bohus, M., Kleindienst, N., Hahn, C., Müller-Engelmann, M., Ludäscher, P., Steil, R., … & Priebe, K. (2020). Dialectical behavior therapy for posttraumatic stress disorder (DBT-PTSD) compared with cognitive processing therapy (CPT) in complex presentations of PTSD in women survivors of childhood abuse: a randomized clinical trial. JAMA psychiatry77(12), 1235-1245. https://doi.org/10.1001/jamapsychiatry.2020.2148

Gautam, M., Tripathi, A., Deshmukh, D., & Gaur, M. (2020). Cognitive Behavioral Therapy for Depression. Indian journal of psychiatry62(Suppl 2), S223–S229. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_772_19

Swales, M., & Dunkley, C. (2020). Principles of skills assessment in dialectical behavior therapy. Cognitive and Behavioral Practice27(1), 18-29. https://doi.org/10.1016/j.cbpra.2019.05.001

Ward-Ciesielski, E. F., Limowski, A. R., & Krychiw, J. K. (2020). History and overview of dialectical behavior therapy. In the Handbook of Dialectical Behavior Therapy (pp. 3-30). Academic Press. https://doi.org/10.1016/B978-0-12-816384-9.00001-4

Wheeler, K. (2020). Psychotherapy for the advanced practice psychiatric nurse (3rd ed.). Springer Publishing Company.


emotional intensity and maintain emotional balance in times of crisis through training four basic skills, namely,

mindfulness skills, interpersonal efficiency skills, emotion regulation, and distress tolerance skills

1.Use ONLY S. Journals! The journals must be peer review. Please use “Google Scholar”

  1. Please use only APA 7th ed. The pages number must be listed in the reference for this book. This paper will be check for plagiarism in com
  2. I would like you to use the textbook along with other journal articles or books, etc. and cite them. Journal article must be peer reviewed- google scholar.


Sadock, B. J., Sadock, V. A., & Pedro, R. (2018). Kaplan and Sadock’s comprehensive textbook of psychiatry (2 volume set) (10th ed.). Lippincott Williams & Wilkins.

Wheeler, K. (2020). Psychotherapy for the advanced practice psychiatric nurse (3rd ed.). Springer Publishing Company.



  1. Discuss the practice guidelines and assumptions for DBT among patients with the following disorders: psychiatric disorders (general), obsessive-compulsive disorders, eating disorders, and posttraumatic stress disorder.
  2. See diagram of the cognitive triad below.  What causes mental illness according to the cognitive theory?

*I have to possess a question after the response to continue the discussion.



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