by Samantha Hellberg, MA*, Jennifer Kirby PhD*, Tiffany Hopkins, PhD**
*University of North Carolina at Chapel Hill
**University of North Carolina, School of Medicine
Let’s be real: graduate school can be tough. Students are tasked with juggling countless roles and responsibilities, all while working to develop their professional identity as researchers and clinicians (McElhinney 2008). Many clinical psychology trainees understandably experience challenges and chronic stress in this process (Pakenham & Stafford-Brown, 2012), which, in turn, can negatively impact well-being and performance. Perhaps unsurprisingly, emerging data suggests the tools we offer as clinicians may help mitigate these adverse effects, and enhance trainees’ professional and personal experiences (Pakenham 2017).
While data is limited, our personal experience- and that of our peers and colleagues- suggests Dialectical Behavior Therapy (DBT) skills may lend themselves well to common struggles faced by trainees. For example, a survey of our clinical program suggested many students struggled to identify and prioritize their goals effectively. In line with broader data on graduate student well-being, many have reported challenges balancing work and personal demands, managing chronic stress and high personal expectations, advocating for their needs and asking for help, setting boundaries (particularly with those in positions of power, e.g., supervisors, mentors), and building social and professional support networks. In this series, we will explore how these challenges inherent to graduate school training can be understood through a DBT lens and addressed through specific skills. We hope this series will offer clinical trainees a starting place to consider how they can practice what they teach to enhance their effectiveness and well-being.
First, let us consider the relevance of the biosocial theory, the theoretical foundation for DBT, to clinical science training (Crowell et al., 2009). In short, this model proposes biological vulnerabilities (e.g., affective reactivity) and environmental stressors (e.g., invalidation) interact to confer risk for emotion dysregulation. Emotion regulatory difficulties then, in turn, can lead to significant behavioral, cognitive, and interpersonal challenges.
This theory informs our conceptualization of mechanisms of risk and resilience in clinical science training. Individuals bring an array of pre-existing personal vulnerabilities and strengths into graduate school. Common vulnerabilities may include, for example, a biological predisposition towards anxiety, prior mental health difficulties, perfectionistic tendencies, or difficulties with time management and organization. Graduate training provides many opportunities for stress, such as: limited (or absent) financial resources, intense workloads, a lack of personal time, problematic environmental reinforcers, and power dynamics. Notably, these environmental stressors disproportionately affect individuals with identities underrepresented in academia, who may also encounter discrimination, microaggressions, and other identity-related stressors. Taken together, clinical science training environments can provide a unique context, where trainees’ pre-existing vulnerabilities and considerable stress exposure interact to facilitate significant difficulties with emotions, goal-setting, relationships, self-esteem, etc.
Fortunately, DBT may provide trainees with a menu of skills to help decrease their vulnerabilities and mitigate the impact of environmental stressors. Mindfulness skills serve as the foundation for all DBT strategies as they strengthen our ability to notice what is happening in the here-and-now, in a nonjudgmental way. We build on mindfulness with distress tolerance skills, which help us survive crises without making them worse, and emotion regulation skills, which can help reduce our vulnerabilities and allow us to work effectively with our emotions. Finally, we layer on interpersonal effectiveness skills, which are vital for working well with others, getting our needs met, building healthy relationships, and maintaining our sense of self-respect in the process.
In our next article, we will discuss how mindfulness skills can be used to increase awareness of your goals, values, and experiences during clinical science training, and in turn, allow you to use your DBT Skills Toolkit to help survive (and perhaps, even thrive) as a trainee.
As preparation, we offer a home practice assignment for students and trainees: over the next few weeks, you might try to tune in to your “highs and lows” in training- when are you most at peace, productive, or meeting your goals? When are you more likely to struggle, feel down, anxious, or stuck? It can help to take notes on the thoughts, emotions, behaviors, and circumstances you notice. These observations are the first step towards change, and will be useful to draw on in our skills discussions to come.
We hope you will join us again for next article: Accessing and acting on wise mind in clinical science training.
Have a question about how DBT skills may be used to address common challenges clinical science trainees face? We’d be glad to feature it in this series. Email shellberg@unc.edu with ideas, comments, or questions.
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References
Jergensen, K. (2018). Practice what you preach: An exploration of DBT therapists personal skill utilization in burnout prevention. Clinical Social Work Journal, 46(3), 187-199.
Team, S., Angell, C., Eales, S., & Brannelly, P. A Pilot Study to Improve Emotional Well-being of Early Career Midwives: A Modified Dialectical Behavioural Therapy Skills Training Group Intervention.
Pistorello, J., Fruzzetti, A. E., MacLane, C., Gallop, R., & Iverson, K. M. (2012). Dialectical behavior therapy (DBT) applied to college students: a randomized clinical trial. Journal of consulting and clinical psychology, 80(6), 982.
Harrington, K. (2018). Harness the power of groups to beat the’PhD blues’. Nature, 559(7712), 143-145.
Pakenham, K. I., & Stafford‐Brown, J. (2012). Stress in clinical psychology trainees: Current research status and future directions. Australian Psychologist, 47(3), 147-155.
Fischer, B. A., & Zigmond, M. J. (1998). Survival skills for graduate school and beyond. New directions for higher education, 1998(101), 29-40.
Austin, A. E. (2002). Preparing the next generation of faculty: Graduate school as socialization to the academic career. The journal of higher education, 73(1), 94-122.
McElhinney, R. (2008). Professional identity development: A grounded theory study of clinical psychology trainees.
Wise, E. H., Hersh, M. A., & Gibson, C. M. (2012). Ethics, self-care and well-being for psychologists: Reenvisioning the stress-distress continuum. Professional Psychology: Research and Practice, 43(5), 487.
Stafford‐Brown, J., & Pakenham, K. I. (2012). The effectiveness of an ACT informed intervention for managing stress and improving therapist qualities in clinical psychology trainees. Journal of clinical psychology, 68(6), 592-513.
Pakenham, K. I. (2017). Training in acceptance and commitment therapy fosters self‐care in clinical psychology trainees. Clinical Psychologist, 21(3), 186-194.
Crowell, S. E., Beauchaine, T. P., & Linehan, M. M. (2009). A biosocial developmental model of borderline personality: Elaborating and extending linehan’s theory. Psychological bulletin, 135(3), 495.
Linehan, M. (2014). DBT Skills training manual. Guilford Publications.
Linehan, M. M. (2018). Cognitive-behavioral treatment of borderline personality disorder. Guilford Publications.
Disclaimer: The views and opinions expressed in this newsletter are those of the authors alone and do not necessarily reflect the official policy or position of the Psychological Clinical Science Accreditation System (PCSAS).