This training addresses adaptations to standard DBT designed to fill the gaps in practice between the treatment and service needs of people with co-occuring mental and substance use disorders.

Individuals with co-occurring substance use disorders (SUDs) and mental disorders (i.e., co-occurring disorders or CODs) are in great need for effective treatment. SAMHSA (2020, p. ix) states, “People with SUDs are more likely than those without SUDs to have co-occurring mental disorders. Addiction counselors encounter clients with CODs as a rule, not an exception.” SAMHSA (2020, p. ix) goes on to state, “Serious gaps exist between the treatment and service needs of people with CODs and the actual care they receive. Many factors contribute to the gap, such as lack of awareness about and training in CODs by addiction counselors, as well as workforce factors like labor shortages and professional burnout.”

Dialectical Behavior Therapy for individuals with substance use disorders (DBT-SUD) has a growing evidence base as an efficacious treatment and can serve to fill the gaps in training in the treatment of individuals with CODs. It is a treatment that explicitly targets reducing provider burnout. DBT-SUD involves a set of strategies that can readily be learned by trained DBT providers. Further, DBT-SUD can be incorporated into existing SUD treatment structures and systems.

This course can be provided onsite or remotely (online). The modules can be customized to the schedule of our clients, or it can be offered over 2 contiguous days. If the course is offered as a spaced modularized offering each module is 90-minutes, while a contiguous offering would have each module as 75-minute segments with additional segments to begin and close each day. Quizzes are included in each module, and are repeated as a final knowledge test at the end of the program.

This course provides in-depth training in Dialectical Behavior Therapy for individuals with substance use disorders (DBT-SUD). Orienting to what DBT-SUD is and how it differs from standard DBT will be addressed. The DBT-SUD treatment model, targets, and strategies are taught. The training will review how to teach skills specific to DBT-SUD. Additionally, the course will review how to apply standard DBT strategies including skills training, chain analysis and stylistic strategies to substance use behaviors. Clinical examples are used to illustrate procedures. Participants will learn key teaching points for the DBT-SUD skills. Video and demonstrations of interventions are incorporated.

A DBT team leader is crucial to the success of any program. Team leaders must combine skills in leadership, organizational negotiation, and enhanced clinical acumen to effectively lead their team. This training course is the only training specifically designed for DBT Team leaders. As such, it requires that participants must currently be a member of a DBT team applying comprehensive DBT. It assumes that all participants are comprehensively trained in DBT (Intensive or Foundational training). It is also suitable for those aspiring to develop the skills to take on the role of a DBT team leader.

The training will use multiple instructional methods, including lecture, demonstrations, practice exercises, and small group feedback to achieve its aims. Topics addressed include developing relevant leadership skills and shaping adherence in multiple modes of DBT. The training will also build on specific consultation questions submitted by participants.

This live remote instructor-led training will be delivered via video conference embedded in a learning management system (LMS) for a total of 13 instructor-led hours. This course has been developed by Prof. Michaela Swales and Dr. Christine Dunkley, who look forward to working with participants to pass on the skills that they have learned in how to lead an effective DBT team.

The ability to effectively assess and manage suicide risk is a critical skillset for those in mental health professions. Responding to suicide risk is often stressful, especially if a provider is underprepared. This workshop is intended to help mental health professionals prepare themselves to effectively assess and respond to suicide risk. Participants will become familiar with chronic and acute risk factors for suicide, protective factors for suicide, and how to formulate an overall level of suicide risk based on these factors. In addition, participants will learn when to screen for suicide risk and how to talk with individuals who may be suicidal to assess and manage risk. The workshop includes specific steps for crisis management.

In addition, participants will be oriented to evidence-based treatments for suicidal behaviors. While the ability to predict suicidal behavior has not statistically improved over many decades, evidence supporting interventions for suicidal behaviors continues to grow. The workshop will be presented in light of the current state of the science.

This 2-day workshop includes 8 training segments with introductory and summary sessions at the beginning and end of each day for a total of 12 training hours. Methods of instruction include lecture, clinical case illustrations, demonstration of strategies, discussion, and participant practice.

The workshop is intended for mental health professionals. Requirements for this workshop include the education or licensure requirements necessary to engage in mental health services provided to persons at risk for suicide. It may also be pertinent to students who are under supervision. The content addressed can serve as a supplement for persons who have completed DBT Intensive Training, however comprehensive training in DBT is not required. For those who are not trained in an evidence-based treatment for suicide, please note that the content of the workshop is limited to the tasks of suicide risk assessment and management and does not cover ongoing treatment or treatment planning with persons at risk for suicide. Those who are interested in developing skills for ongoing treatment of persons at risk for suicide or treatment planning should consider pursuing DBT Intensive Training or another evidence-based treatment for suicidal behavior.

Comprehensive Training in Dialectical Behavior Therapy (DBT) is an extended program of study intended to provide the equivalent of Dialectical Behavior Therapy Intensive Training for teams in circumstances that require an alternative training structure. As is the case for Intensive Training, DBT Comprehensive Training is intended for teams that are invested in learning DBT to a high standard in order to better implement the treatment in their settings. DBT is a treatment that requires an ongoing consultation team, therefore DBT Comprehensive Training is designed for treatment teams, not individual practitioners intending to practice alone. A DBT team is a group of mental health professionals who meets at least weekly, either in person or via video-conference, to assist each other in applying DBT in their practice setting. Participants can either apply as teams or become part of a team that will be developed in Phase 1 with the expectation that the developing teams will be well-established by Phase 2. Participants should clarify their level of commitment prior to applying for the course, as it requires an ongoing time commitment to study and practice the treatment. All persons attending are expected to actively provide DBT to patients during the course. Ideally, all participants should work with at least 2 patients with BPD or 1 patient and lead or co-lead a DBT skills training class.

The comprehensive training is conducted in four phases over 18 months It includes 89 hours of instructional time and educational activities.

Phase 1 Orientation, Team Formation & Self-study

6 months

Teams embark upon 20 weeks of team formation and self-study. The self-study focuses on readings and discussions based on Dr. Marsha Linehan’s books outlining the treatment and the DBT skills. This phase consists of three components

1. An orientation to the DBT Comprehensive Training Program via videoconference.
2. Five meetings with your team and the assigned mentor to facilitate your orientation to the program and your team development.
3. Twenty sets of readings and discussions with your team (without the assigned mentor).

Phase 2 Foundational Training

10 half-day sessions (2 weeks) over video conference

These sessions rely on lectures, treatment demonstrations, and small group exercises to teach and apply DBT theory and strategies in-depth. They are designed to model basic elements of the treatment in an experiential way and to foster team development. Just as DBT requires clients to make a full commitment to treatment and to attend all sessions, the Foundational training requires full, willing, and committed participation. It is expected that everyone will be on-time and present for all sessions. Given this precious opportunity for all participants in the program to spend time together we work hard to make the best use of this valuable time. Please keep in mind that homework assignments will be required between sessions. Some of these involve work with your team. Please arrange your time to stay as focused as possible during these 2 weeks of training.

Phase 3 Implementation

6 months

In this phase participants consolidate and apply what they have learned with the help of practice assignments. Teams design and begin to implement their own DBT programs or to integrate DBT into an ongoing treatment setting. Monthly meetings occur with mentors to help facilitate the process.

Phase 4 Practice Improvement & Sustainability

1 week; In-person

This week builds on the work teams have accomplished during the implementation phase of the training. Each team receives consultation on their work from the trainers, specifically focused on the team’s program development and functioning. In addition, each team chooses a clinical case for consultation.Consultation sessions are observed by all participants to create a shared learning experience. In addition, advanced topics are taught to enhance clinical skill and improve DBT programs.

3 months

These 3 months focus on consolidating knowledge and laying the foundation for long-term sustainability of DBT programs. It includes 2 additional meetings between teams and their mentors, and 2 additional half-day sessions with the full training team and other trainees.

This comprehensive training in Dialectical Behavior Therapy (DBT) is an extended program of study intended to meet the standards of Dialectical Behavior Therapy Intensive Training in an extensive 2-year program that builds on the Intensive Training with learning communities and applied activities intended to foster sustainable implementation of DBT. It also includes comprehensive training in DBT skills; providing the tools necessary for patients to acquire, strengthen, and generalize DBT skills.

Since its initial development in the 1980s, DBT has been shown to be effective for an array of problems related to emotion dysregulation. We know severe emotion regulation difficulties result in persons facing multiple problems across many areas of life and that these problems manifest in a variety of ways. The principles of DBT were specifically designed for cases which often present therapists with novel challenges. One of the benefits of a principle-based treatment is that it can be versatile enough to accommodate the specific situations, cultures, and contexts of the persons it serves. DBT has been studied and implemented in multiple countries across the globe.

DBT Intensive Training is a comprehensive team-based program of study designed to provide teams with the knowledge and skills necessary to provide DBT. It focuses on both the establishment of comprehensive DBT programs and the clinical skills necessary to provide the treatment to persons with complex mental health problems. Intensive Training in DBT includes content specific to risk assessment, management, and treatment of suicidal behaviors. While standard DBT Intensive Training includes 60 instructional hours, this program provides 160 hours of instructional time and additional learning activities that count for a total of 240 hours. As is the case for Intensive Training, DBT Extended Study is intended for teams that are invested in learning DBT to a high standard in order to better implement the treatment in their settings. DBT is a treatment that requires an ongoing consultation team; therefore, this program is designed for treatment teams, not individual practitioners intending to practice alone. A DBT team is a group of mental health professionals that meets at least weekly, either in person or via video-conference, to assist each other in applying DBT in their practice settings. Participants can either apply as teams or become part of a team that will be developed in the preparatory phase of the training. The expectation is that all participants will be committed to their teams and the training program by the end of the preparatory phase. Participants should clarify their level of commitment prior to applying for the course, as it requires an ongoing time commitment to study, practicing the treatment, and working closely with others. All persons attending are expected to actively provide DBT to patients during the course. Ideally, all participants should work with at least 2 patients with high-risk behaviors or 1 patient and lead or co-lead a DBT skills training class.

DBT Extended Study is designed to guide teams to accomplish four phases of DBT program implementation.

Phase 1 Deciding to adopt DBT

a. Preparation

Phase 2 Acquiring knowledge and skills

a. Key Concepts

b. Structure of DBT

c. Core Strategies and Procedures

d. DBT Skills Training

e. Special Strategies and Protocols

Phase 3 Implementing DBT

a. Implementation

Phase 4 Practice Improvement & Sustainability

a. Practice Improvement

b. Sustainability

In Phase 1 of the course teams coalesce and prepare for training. This process may begin for some teams years in advance of formal training. Other teams will still be in the early stages of formation when formal training begins. Still others may need assistance with forming teams, and the trainers will consult with this process, including help with matching participants to form virtual teams that meet over remote platforms. This phase is conducted remotely via video-conference.

In Phase 2, lectures, demonstrations of treatment, and small group exercises are used to teach DBT theory and strategies in-depth. The course is designed to model basic elements of the treatment in an experiential way and to foster team development. Just as DBT requires clients to make a full commitment to treatment and to attend all sessions, the training requires full, willing, and committed participation. It is expected that everyone will be on-time and present for all sessions. Given this precious opportunity, for all participants in the program to spend time together, we work hard to make the best use of this valuable time. All didactic sessions in Phase 2 are followed by learning communities to allow for discussion of key concepts, and practice applying what is learned. Quizzes are interspersed throughout Phase 2. Please keep in mind that additional homework assignments may be required between sessions, and some of these involve work with your team. Please arrange your time to allow for completion of the extra work, and to stay as focused as possible during the training. Estimates of the time needed to complete each module are listed in the module descriptions that follow. This phase is conducted remotely via video-conference.

The function of Phase 3 is for participants to consolidate and apply what they have learned with the help of practice assignments that are intended to guide the implementation process. This involves a series of tasks in the service of implementing DBT programs and clinical work. Participants work in their teams to establish (or modify) their DBT programs in line with fidelity to the evidence-based models of DBT. It is expected that all participant will be actively providing DBT to patients at this time. Teams are provided a timeline for designing and implementing their own DBT programs or integrating DBT into an ongoing treatment setting. Meeting with mentors during this phase are conducted remotely via video-conference.

In Phase 4, each team receives focused consultation from the trainers that is observed by all participants, and each consultation is followed by a discussion among the full group of participants. While the team has an opportunity to have its specific questions addressed by DBT experts, it is expected that the observation and discussion among the whole group will result in sharpening the assessment and intervention skills of all participants, and that vicarious learning will occur that will generalize across teams and programs. Consultations are based on program and team development documents and a case formulation that is prepared by each team. Trainers use the information from these documents, a knowledge exam, and the consultations that have occurred to date to assess the needs of trainees and weave advanced topics into the discussions of the consultations. The final module

engages teams in a series of exercises designed to solidify their learning and to strategize ways to keep their learning vibrant over time. The first segment of this phase (8. Practice Improvement) is conducted onsite with all persons present. The final segment (9. Sustainability) is conducted over video-conference.

The full program is designed to run approximately 2 years. A complete list of the training modules is included later in this document.