Regulate Emotion. Maximize Potential.

The Skills System is a DBT™-informed emotion regulation skills training curriculum consisting of nine core skills and three System Tools that help people be effective at all levels of emotion. The original version, The Skills System Instructor’s Guide: An Emotion Regulation Skills Curriculum for All Learning Abilities, was written in 2011. The updated edition, The Emotion Regulation Skills System: A DBT™-informed Approach was published by Guilford Press in 2016.

Individuals who experience learning/developmental, and mental health challenges often experience difficulty regulating emotions. There are few evidence-based, and psychologically-based treatments for individuals with co-occurring cognitive and mental health issues. The Skills System is a simplified, user-friendly model that is taught to youths and/or adults with diverse learning profiles. This treatment tool has been used in a myriad of inpatient, outpatient, residential, vocational, school, outreach, and corrections settings in the US and abroad.
Individuals may need supports that help them avoid engaging in destructive behaviors, as well as, needing a vehicle and road map to be able to manage and build a quality of life. In Skills System groups/individual training, the participants learn skills to help them stop demonstrating life threatening/destructive behavior. They gain tools for solving problems, expressing themselves, getting things that they need, and managing relationships with themselves and other people.

Individuals have to be able to deal effectively with:

  • Family members
  • Community access
  • Staff relationship
  • Coordinating support plans
  • Work
  • Friendships
  • Dating and intimacy

Emotion regulation skills training can help people get what they need AND stay on-track.

The Skills System is often used as a treatment tool or plug-in within more comprehensive therapeutic models (e.g. DBT, trauma-informed treatment etc); it plays well with others! In more naturalistic or clinically-eclectic settings, the Skills System can function as a primary treatment model. In both of these scenarios, the Skills System helps create a common language and emotion regulation tool kit that equips treatment providers and collateral supports (e.g. staff, family members) to help participants develop core self-management capacities.

Learning Formats for Participants: The Emotion Regulation Skills System book provides practitioners with materials to run therapy groups with individuals who experience learning challenges. These groups are a billable services through most health insurances. The Skills System teaching strategies can be adapted for individual/1:1 skills training, as well. It may be optimal to expose participants to both group skills training and individual therapy to enhance generalization. The participant having access to Skills System skills coaches in the living environments can also improve the integration of new, adaptive behaviors.

Practitioners/Teams: Just as learning formats for clients are tailor-able to meet the needs of diverse participants, there are alternative options for agencies, skills group leaders and skills coaches. All Skills System at JRI implementations are customized, accommodating the goals and resources of the individual/group to maximize skills acquisition, fidelity, and sustainability. For example, individuals/teams may want to dabble in the Skills System materials with the intention of adding a few strategies to their existing bags-of-tricks; other practitioners/teams may choose to fully integrate the model.

When practitioners/teams are contemplating learning the Skills System, it is important to be clear about the realities of treating individuals with long-standing behavioral health and learning challenges. As our pilot data highlights, exposure to a comprehensive treatment model over an extended period of time may be necessary to facilitate significant improvements in emotion/self-regulation functioning. Additionally, support providers likely need to have competency in the Skills System model versus a casual understanding of the concepts. When skills group leaders and skills coaches are fluent in the Skills System model, they are able to customize learning experiences for youths and adult who have complex behavioral health and learning challenges.

Collateral support people, such as staff, teachers, or family members, can learn the Skills System and can function as in-vivo skills coaching in the participant’s natural environment. A Certificate of Specialized Proficiency: Skills Coach is available through the Skills System (see Certificates). Having information about emotion regulation strategies allows the support person to help the individual manage emotions, versus suppress or avoid them. Ineffective supports can exacerbate behavioral dysregulation, resulting in transactions involving co-dysregulation versus co-regulation between people. This type of common language not only facilitates the generalization of emotion regulation strategies, it may also serve to improve attunement in relationships.

When collateral support providers understand the Skills System, they have tools to help them engage in self-regulation strategies. The experience of supporting an individual with complex behavioral health issues can evoke emotional escalation for both the client and the support person. The Skills System can be a helpful framework for collateral support providers to use, not only to help clients directly, but indirectly through using Skills System strategies, potentially minimizing extraneous conflict that can add to volatile situations.

A comprehensive implementation of the Skills System involves developing a Train-the-Trainer (TtT) team that develops the competency to:

  • Lead Skills System groups
  • Integrate the model into individual therapy
  • Train staff as in-vivo skills coaches
  • Anchor the language into programs to facilitate sustainability
Refer to the Skills System Training Options Packet for more details.
The DBT skills concepts were created for individuals who experienced high levels of emotional, cognitive, and behavioral dysregulation. Unfortunately, the Standard DBT skills curricula are not accessible for people with significant learning challenges. Cognitive load demands are too high to allow for learning, free recall, and generalization in the natural environment. Most specifically:

  • Language was too complex
  • Divided into four modules – Difficult to integrate concepts
  • Hundreds of discreet skills
  • No mechanism for people to know what skill to use when
  • No system for linking skills; no connective tissue; lily pads vs. chains
  • No structure that differentiated skills you use at low/high levels of emotion

Skills System Adaptation of DBT:

The goal in creating the Skills System was to use a DBT-based framework that helped people experience a dialectical synthesis (the ability to be in pain AND be effective at the same time) versus polarization during emotional, cognitive, behavioral, relationship, and self-processes in complex life contexts.

Simultaneously, the framework had to be accessible for (1) Individuals diagnosed with moderate/mild ID (who often have limited reading abilities and impaired executive functioning) and (2) simple enough for collateral support providers to learn given the limited time/resources that are often available for training. Both of these groups had to be able to learn essential concepts, be able to recall them under-pressure, assemble adequate skills chains to manage the span of a dysregulation emotion, and generalize these capacities into diverse, real-life contexts.

The De-construction and Re-construction Process:

This process involved de-constructing essential DBT processes, re-labeling, and reorganizing the concepts in a way that (1) provided effective emotions regulation strategies in the re-constructed form and (2) minimized extraneous cognitive load demands. The work of James Gross, PhD (editor of the Emotion Regulation Handbook, 2007, 2014) was integrated to ensure that all aspects of emotion regulation processes were addressed in the Skills System model; Dr. Gross also reviewed and endorsed the Skills System prior to the publication of this model. The work of Sweller (Cognitive Load Theory, 1988, 2010) guided the design of both the Skills System model and teaching strategies.

The Skills System Design

  • Framework breaks complex tasks into component parts – Task Analysis
  • Integrates mindfulness strategies and goal directed thinking that lead the individual to execute goal-directed actions
  • Provides clear, strategic steps (micro-transitions) to create adaptive chains of behavior
  • The tools have to be flexible enough to be able to adapt to internal and external changes in the moment
  • The skills and the “system” function as cognitive scaffolding to help navigation (being present & effective) across the spans of emotions
Approximately one third of adults with intellectual and developmental disabilities have emotion dysregulation and challenging behaviors (CBs). Although research has not yet confirmed that existing treatments adequately reduce CBs in this population, dialectical behavior therapy (DBT) holds promise, as it has been shown to effectively reduce CBs in other emotionally dysregulated populations. This longitudinal single-group pilot study examined whether individuals with impaired intellectual functioning would show reductions in CBs while receiving standard DBT individual therapy used in conjunction with the Skills System (DBT-SS), a DBT emotion regulation skills curriculum adapted for individuals with cognitive impairment. Forty adults with developmental disabilities (most of whom also had intellectual disabilities) and CBs, including histories of aggression, self-injury, sexual offending, or other CBs, participated in this study. Changes in their behaviors were monitored over 4 years while in DBT-SS. Large reductions in CBs were observed during the 4 years. These findings suggest that modified DBT holds promise for effectively treating individuals with intellectual and developmental disabilities.

Download the PDF below to see the full pilot study.

Download Pilot Data PDF

Announcements

Messages from Julie F. Brown, PhD, developer of the Skills System

An Innovative Approach to Delivery of the Skills System to People with Developmental Disabilities in Northern Ontario

Tina Benevides, Ph.D. and Stephen White, M.A., C. Psych., from Hands The
FamilyHelpNetwork.ca and North Community Network of Specialized Care in Northern Ontario wrote this article for the NADD Bulletin.  Tina will have a poster about this project at NADD and Stephen will be presenting in the Pre-Conference on Wednesday with me addressing Enhancing Emotion Regulation Skills of individuals with ID.

Learn More

 Jump in With Both Feet!

It has come to my attention that many newcomers to the Skills System and those who have been using the model for years are continuing to utilize the 2011 self-published text (The Skills System Instructor’s Guide: An Emotion Regulation Skills Curriculum for All Learning Abilities). I would recommend everyone invest in the 2016 Guilford Press version (The Emotion Regulation Skills system: A DBT-Informed Approach). While the core elements remained the same in the update, there are a few sub-skill changes that clarify Skills System mechanisms. The new text providers a clearer theoretical framework and …

Learn More

A New Article! Free Download!

This article, recently published in the Journal of Mental Health Research in Intellectual Disabilities is entitled Exploring Perspectives of Individuals with Intellectual Disabilities and Histories of Challenging Behaviors about Family Relationships: An Emergent Topic in a Grounded Theory Focus Group Study. This is a unique piece of research because it explores the complex topic of family relationships from the perspective of individuals who are diagnosed with an intellectual disability that have one/more co-occurring mental illnesses and histories of challenging behaviors.

Learn More

New Instant Best Seller!

The Emotion Regulation Skills System for the Cognitively Challenged Client: A DBT™-Informed Approach (Brown, 2016) was recently deemed a Guilford Press Instant Best Seller. Click the link below to go to Guilford Press to get your copy. Thank you all for purchasing the revised version of the Skills System!

Learn More

Creating Virtual Classrooms for Skills System Learning

Teams doing Skills System implementations will have the opportunity to use JRI’s Learning Management System (LMS). The LMS creates virtual classrooms that support training and consultation efforts. Each agency’s LMS site is customized to maximize progress towards team and individual goals! Every core team member can download Skills System materials, read teaching materials online, upload assignments, and share insights on the Forum with the trainer and team members. Additionally, data is generated to help the trainer and team leaders adjust strategies to optimize participation. There are no fees for utilizing the LMS.

Check out the New Blog Posts by Dr. Susan Vaught & Deborah Jackson, LICSW

Dr. Vaught added a post entitled The Competency Vacuum that addresses the difficulties associated with treating individuals with complex mental health and learning challenges. Deborah Jackson’s post discusses using the Skills System with forensic populations.

Blog

Test Center

The Test Center is back! If you would like to begin to work towards earning Certificates of Specialized Proficiency, please email me and I will send you an application to get started. Once you send in the application materials, I will send you a code for the two exams.

Test Center

LinkedIn

Follow Dr. Julie Brown on LinkedIn or email her at jbrown@jri.org for more information about the Skills System.

LinkedIn

The Emotion Regulation Skills System for the Cognitively Challenged Client: A DBT™-Informed Approach (2016) by Julie F. Brown, PhD, is available through Guildford Press and Amazon. This book provides a comprehensive presentation of the Skills System curriculum materials, and allows the purchaser to download an additional 150 pages of supplementary handouts. The Skills System is a highly effective treatment tool that has been used successfully in a multitude of settings with a myriad of individuals who have diverse behavioral and learning profiles.

Available at Guilford Press

Affiliates