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 curricula are designed to be used in therapy group settings. Practitioners who earn a Certificate of Special Proficiency: Skills Group Leader will need to have an independent license to practice in a clinical discipline. It is a billable service through health insurances that pay for group therapy. The teaching format can be adapted for individuals’ skills training. Ideally, an individual learns skills in a group setting, and the concepts are also integrated and reinforced in individual therapy by an individual therapist who is well-versed in the model.
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

Pre-Conference at NADD

There will be a 3-hour Pre-Conference at NADD on November 2, 2016 on the topic of Emotion Regulation Skills. I will be the chairperson of this session and will present about the Skills System. Stephen White, M.A.,C.Psych. will share an innovative Skills System group model that he is using to reach adults across northern Canada who live in remote areas. Kim Shontz, MSW will discuss integrating the Skills System with crisis prevention models. Join us in Niagara Falls!

Skills System Book

The new Skills System book is out! I hope folks like it! There have been a few typos found that are going to be corrected by Guilford Press at the reprint. If you have noticed a mistake or would like us to review any wording of specific phrases to increase clarity, please email me those points. Thanks!

amazon

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.

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 Amazon

Available at Guilford Press

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