Dr. Shireen Rizvi is a leading expert in Dialectical Behavior Therapy (DBT) and the treatment of Borderline Personality Disorder. She received her PhD in clinical psychology from the University of Washington, where she trained directly under Marsha Linehan, the originator of DBT, and has spent more than 25 years immersed in the research, clinical practice, and training of the model. She currently serves as Director of Psychology Training and Director of DBT Services and Research at Montefiore Einstein in New York City, and is co-author of Real Skills, Real Life, a practical guide to DBT skills for everyday use. In this episode, Dr. Rizvi offers a comprehensive introduction to DBT as a treatment for BPD — from its philosophical roots in dialectics, through the biosocial model of emotion dysregulation, to the full structure of the treatment: individual therapy, skills training, between-session coaching, and therapist consultation. She walks clinicians through the target hierarchy, diary card, and chain analysis, and unpacks each of the four skill modules — mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness — with concrete clinical examples. She also addresses when DBT is most indicated, how it has shaped the broader BPD treatment landscape, and what clinicians without full DBT training can meaningfully borrow from the model.

Learning Objectives

After completing this educational activity, participants should be able to:

• Describe the DBT biosocial model and explain how the transaction between biological emotional vulnerability and an invalidating environment gives rise to pervasive emotion dysregulation in borderline personality disorder.
• Identify the four modes of comprehensive DBT and explain how the treatment target hierarchy structures the individual therapy session.
• Summarize the four DBT skills modules — mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness — and describe how the diary card and chain analysis link skills training to individual therapy.
• Apply core DBT-informed strategies — including validation and the model's compassionate core assumptions — to clinical work with patients who have borderline personality disorder.

Topics Covered in This Interview

• The dialectical philosophy and what it means for treatment
• How DBT fits within the broader landscape of BPD treatments
• The biosocial model: biology, invalidating environments, and pervasive emotion dysregulation
• How DBT’s etiological model differs from other BPD treatment frameworks
• Emotion dysregulation as DBT’s core treatment target
• Balancing acceptance and validation with change strategies in session
• The four modes of comprehensive DBT: individual therapy, skills training, between-session coaching, and therapist consultation
• The treatment target hierarchy and how it structures sessions
• The four DBT skill modules: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness
• DBT acronyms as mnemonic tools: the DEAR MAN interpersonal skill in depth
• The role of group therapy in DBT
• The diary card and chain analysis: tracking and intervening on target behaviors
• Who is DBT for — and when might another model be preferable?
• Common misconceptions about DBT
• What clinicians without full DBT training can borrow from the model
• DBT’s broader impact on the BPD treatment field
• Recommended resources for further learning

Interview Transcript

Abigail Rasol: Hi everyone, and welcome back to the Carlat Psychotherapy Podcast, where we explore different evidence-based practices to better expose you to the wide range of modalities available. Today we’re continuing with episode three of our Borderline Personality Disorder series. In our first episode, Dr. Kenneth Levy gave us an integrative overview of the five major evidence-based treatments for BPD and introduced the concept of the “alphabet divide” — the tendency for clinicians to align with a single treatment model without awareness of the others. Episode two explored Transference-Focused Psychotherapy with Dr. Frank Yeomans. Today we turn to Dialectical Behavior Therapy, and I’m delighted to be joined by Dr. Shireen Rizvi.

Dr. Rizvi is a leading expert in DBT and the treatment of BPD. She received her PhD in clinical psychology from the University of Washington, where she trained directly under Marsha Linehan, the developer of Dialectical Behavior Therapy. For the past 25 years, Dr. Rizvi has been deeply involved in the research, clinical practice, and training of DBT. She’s published and presented widely on DBT, BPD, and cognitive behavioral therapies, and her research has been supported by organizations including the National Institute of Mental Health and the American Foundation for Suicide Prevention. She currently serves as Director of Psychology Training and Director of DBT Services and Research at Montefiore Einstein in New York City, and is co-author of Real Skills, Real Life, which translates DBT skills into practical tools for everyday life.

Abigail Rasol: Thank you so much for joining us, Dr. Rizvi.

Shireen Rizvi, PhD: Thank you so much for having me.

The Meaning of Dialectics

Abigail Rasol: To start off, I’d like to give listeners a broad orientation to Dialectical Behavior Therapy. Could you begin by explaining the word “dialectics” — what that means, and how that philosophy frames the treatment overall?

Shireen Rizvi, PhD: It’s important to recognize that DBT is a form of CBT — it grows out of that tradition. What it adds is this notion of dialectics: a philosophy that everything in the world is interrelated, that tension and polarization are inevitable, and that in order to be effective in our lives, we have to learn how to navigate that tension. Usually that means looking for the truth in both sides of a polarization and searching for a synthesis.

In DBT, the primary dialectic is between acceptance and change. Acceptance means receiving your life, your relationships, your problems exactly as they are. Change means recognizing that you don’t want things to stay this way. We’re constantly working to find the synthesis — what is important to accept, what can we change, and what can we actively do to move toward a life that is closer to your goals?

Abigail Rasol: That’s really interesting. I’m curious what it is about the nature of BPD specifically that makes this focus on the dialectic so crucial in its treatment.

Shireen Rizvi, PhD: From a behavioral point of view — which is DBT’s framework — we think about borderline personality disorder as existing on a continuum, and people with BPD are very similar to the rest of us, except that the problems they experience, and the behaviors those problems produce, are more intense. If we look at it that way, I actually agree that we could all benefit from dialectical thinking, from learning to navigate the tension between acceptance and change, from recognizing that polarity is inevitable. That’s one reason so many clinicians are attracted to DBT — they realize it is useful in their own lives, not just in the treatment room.

Conceptualizing BPD through the Biosocial Model

Abigail Rasol: DBT has its own distinct theory of how BPD develops — the biosocial model. Could you walk us through that framework and explain how it shapes your understanding of the disorder?

Shireen Rizvi, PhD: The first piece of the biosocial model is the premise that the core of BPD, from this framework, is pervasive emotion dysregulation. So when we talk about the biosocial model, we’re actually describing not necessarily how BPD develops per se, but how pervasive emotion dysregulation develops.

The biosocial model posits that this dysregulation develops as a result of a transaction between two things: biology and a social environment — specifically, what we call the invalidating environment. The biology piece is the presumption that some people are born with, or very early in childhood develop, a sensitivity to experiencing emotions more intensely and with a slower return to baseline. On the other side is an invalidating environment, one in which the person’s emotional experiences are pervasively, chronically invalidated, negated, or dismissed.

The key piece — which also speaks to the dialectical nature of things being interrelated — is that these two sides transact with each other. If you are somebody born more sensitive to emotional experience, you are likely exerting pressure on your environment from a very early age, and that pressure is more likely to elicit invalidation. The more invalidation you receive, the more sensitive you become, and the more extreme your reactions. That transaction goes back and forth, heightening both sides, until a person develops pervasive emotion dysregulation. They learn that the only way to get attention is to have a very extreme reaction; they learn to self-invalidate because they’re so used to receiving invalidation; they learn to shut down to avoid being invalidated further. All of the patterns that go on to become BPD symptoms are a result of that transaction over time.

Emotional Dysregulation as the Core of BPD

Abigail Rasol: So would you say that the emotional dysregulation arising from the biosocial transaction is the core dysfunction that DBT is targeting?

Shireen Rizvi, PhD: Yes, and this is something that sets DBT apart from the other theoretical models and treatments. The premise of DBT is that emotion dysregulation is the core of the disorder, and all of the other symptoms and characteristics associated with BPD are either a result of emotion dysregulation or a way of managing it.

Balancing Acceptance and Change

Abigail Rasol: I’d like to dive into the treatment itself. You’ve described it as built on two seemingly paradoxical principles — acceptance and change. How do you hold both of those simultaneously in session?

Shireen Rizvi, PhD: As a clinician delivering DBT, we are holding a lot of things in mind at the same time. We are striving to understand multiple perspectives — to really see how it is that a person is behaving and feeling the way they are. And we are implementing the acceptance side of the dialectic primarily through validation.

Validation is a key strategy in DBT — it’s the strategy meant to embody acceptance. It communicates: it makes sense that you feel the way you feel. It makes sense that you self-harm because self-harm is the only thing that helps you feel better in the moment. It makes sense that you are shut down in session with me because in the past, whenever you’ve expressed emotion, you’ve been punished. So we do a lot of validation to accept the person exactly as they are in this moment.

“It makes sense that you’re shut down in session, because other people have punished you for emotional expression.” That’s the acceptance. “And this isn’t working for us in our session. I can’t help you if you’re shut down, so we have to find a way for you to be able to express yourself.” That’s the change. As a DBT therapist, you’re navigating those two and always looking for the synthesis — sometimes acknowledging both sides simultaneously. “Self-harm works for you, and we need to get it to stop.” That is a dialectical statement in and of itself.

The Four Modes of DBT

Abigail Rasol: What do some of those change strategies look like in practice? If you were to give us a brief overview of the DBT manual and how it provides the roadmap for the treatment, what are the main components?

Shireen Rizvi, PhD: The manual is the 1993 book by Linehan, Cognitive-Behavioral Treatment of Borderline Personality Disorder. It is hundreds of pages, very dense — and practically perfect in the sense that it really does include everything. We say DBT has four modes of treatment, meaning four components that, when you’re doing DBT by the book, you deliver all four.

The first mode is individual therapy — weekly, one-on-one sessions, but conducted in a very particular way. The second mode is skills training, usually delivered in a group format, weekly, structured much like a class. The third is between-session coaching (originally called phone coaching) — support available to patients in the moments they most need it, which are almost always outside the therapy hour. The fourth mode is the therapist consultation team: a weekly meeting among clinicians delivering DBT. This is a distinctive feature of the model — no other major BPD treatment requires a built-in peer consultation structure as a core mode of the therapy. The goal is to enhance therapist skill, maintain adherence to the model, and provide the clinician with the same kind of support — validation and problem-solving — that we ask therapists to provide to their patients.

The Target Hierarchy

Abigail Rasol: You mentioned that individual therapy in DBT is conducted in a very particular way. What defines a DBT session — what does it actually look like in the room?

Shireen Rizvi, PhD: One of the core principles of individual therapy is the target hierarchy — it’s the roadmap for how you spend session time, and in DBT you must attend to it.

At the top of the hierarchy are life-threatening behaviors: suicidal behavior (attempts, ambivalent attempts, planning), non-suicidal self-injury, and homicidal urges or actions. The mantra is: first, save life. If any life-threatening behavior has occurred in the past week, it receives the highest priority in the session.

Second are therapy-interfering behaviors: any behaviors by the patient or the therapist that interfere with the delivery of the treatment — a patient coming late, being intoxicated, not attending skills group; a therapist being late or inattentive.

Third are quality-of-life interfering behaviors: essentially everything else — substance use, impulsive behavior, interpersonal difficulties, trouble holding employment. This is usually what patients come in wanting to address, and there is often a point of tension when the therapist must redirect.

For example, a patient comes in and says, “I harmed myself last week, but it’s done. I don’t want to talk about it — I want to talk about this fight with my friend.” The DBT therapist has to hold the hierarchy. She might say: “I want to talk about your fight with your friend — that matters to me too. The only way we’ll have sufficient time for that is if you’re not harming yourself and you’re engaged in treatment.” We’re setting contingencies: the life-threatening behavior has to be addressed first in order for us to eventually get to the quality-of-life problems.

Skills Training in DBT

Abigail Rasol: You’ve touched on the skill-building piece of DBT throughout. What skills in particular are you building, and how does that work in practice?

Shireen Rizvi, PhD: This stems directly from the biosocial model. As a result of that transaction between biology and invalidation, people never learned effective, skillful ways of managing emotions, being interpersonally effective, tolerating distress, or accepting things as they are. So DBT operates on a skills deficit model: what people need to do to improve is learn skills they either never acquired or never had reinforced.

Skills training has a curriculum — like teaching a class. In standard DBT for adults, it takes about six months of weekly sessions to move through all the basic skills. There are four categories.

Mindfulness skills are considered core to everything else — learning to be aware and awake to the present moment. They form the foundation on which the other modules are built.

Emotion regulation skills teach people how to identify what they’re feeling, understand the components of an emotional experience, intervene at different points in that experience to change its trajectory, and reduce their overall vulnerability to intense emotions.

Distress tolerance skills teach people how to survive a crisis without making the situation worse — recognizing that we can’t avoid all stress, and that we need strategies for when it arrives.

Interpersonal effectiveness skills teach people how to ask for what they want, maintain relationships, say no effectively, and protect their self-respect in interactions with others.

Simultaneously, the individual therapist is aware of what the patient is learning in group and looks for opportunities in session to say: “Instead of reaching for that razor blade, what skill could you have used? What got in the way of using it?” We’re actively working to replace ineffective behaviors with skillful ones.

The Role of Group Therapy in DBT

Abigail Rasol: Group therapy is a feature that distinguishes DBT from some of the other BPD treatments we’ve covered. What role does the group format play, beyond simply a delivery mechanism for the skills curriculum?

Shireen Rizvi, PhD: I do think there is an experience of validation that happens in a group — a recognition that I’m not alone in this, that other people are struggling with the same problems. And there’s real learning that happens between group members. When I teach a skill like DEAR MAN and everybody shares their practice, others can say ‘what if you tweaked it this way?’ — there becomes this idea that we’re all invested in each other learning the skill. That sense of shared effort and mutual support is something the group format uniquely provides.

DBT Acronyms as Mnemonic Tools

Abigail Rasol: You mentioned DEAR MAN — a phrase that probably doesn’t mean much to our listeners yet. DBT uses a lot of acronyms. What are they for, and what does DEAR MAN stand for?

Shireen Rizvi, PhD: Acronyms in DBT are simply mnemonic devices — they help people remember the steps of a skill. We don’t need to attach too strongly to them.

DEAR MAN is the interpersonal effectiveness skill for asking for something in a way that increases the likelihood the other person will give it to you, or for saying no to something in a way the other person will accept. The acronym spells out seven steps:

D – Describe: State the situation in objective terms, just the facts, no interpretations or judgments.

E – Express: Share how you feel or think about the situation.

A – Assert: Directly ask for what you want, or say no clearly. This is often the hardest step.

R – Reinforce: Explain why giving you what you’re asking for will benefit the other person, too — offer a reward ahead of time.

M – Mindful: Stay focused on your goal. If the other person deflects or attacks, acknowledge it briefly and return to what you’re asking for.

A – Appear confident: Act as though you deserve to get what you’re asking for, even if you don’t feel it.

N – Negotiate: If you’re not getting what you want, be willing to give a little to get a little. Keep at it.

To give a concrete example: a patient who lives with her mother wanted to address a recurring problem — her mother was letting the dog go through the trash, creating a mess and reinforcing the dog’s bad behavior. She was also mindful that her mother does a great deal for her and she didn’t want to come in aggressively.

Using DEAR MAN, she described the behavior in just the facts: the dog goes through the garbage each night and leaves a mess on the floor. She expressed how she felt: she worried they were teaching the dog bad habits and didn’t like having to clean up. She asserted what she wanted: can we put the garbage away at night so he can’t get into it? She reinforced her ask by noting that less mess in the house would benefit both of them and that she’d be easier to live with. And then she stayed mindful, appearing confident, and was ready to negotiate if her mother pushed back or redirected the conversation.

Abigail Rasol: It sounds like it gives patients a very structured way to navigate what would otherwise be emotionally charged and overwhelming situations.

Shireen Rizvi, PhD: Exactly.

Teaching Mindfulness Skills

Abigail Rasol: I’d like to explore the other three skill modules in a bit more depth. Could you give us an example from each? Starting with mindfulness — how does DBT approach teaching it?

Shireen Rizvi, PhD: Mindfulness in DBT is not about teaching meditation. It’s seven concrete skills for practicing being more mindful in your life. We teach the skill of observe: just notice, at the level of sensation, what is happening in this moment — your breath, the sounds in the room, the sensation of your body on the chair. And we teach participate: how do you throw yourself fully into whatever you’re doing, letting go of self-consciousness, becoming one with this moment — whether that moment is something you love or something you’d rather avoid. These are just a few examples of how we make mindfulness concrete and learnable.

Emotion Regulation and Distress Tolerance

Abigail Rasol: How about emotion regulation and distress tolerance? What does each look like in practice?

Shireen Rizvi, PhD: There are many skills in the emotion regulation module. One of my favorites is opposite action, which is designed to change the emotion you’re experiencing.

The idea is that every emotion has an action urge — an urge to behave in a particular way — and that if we act in a way that is inconsistent with that urge, we can change our emotional experience. When we feel anger, our urge is often to lash out. If we act on that urge, the anger tends to persist. Opposite action means identifying the urge, identifying its opposite — instead of lashing out, gently avoiding, or being kind — and then acting on that opposite urge, repeatedly, until the original emotion subsides.

The distress tolerance module is divided into two categories. The first is the crisis survival skills: how to get through a crisis without doing anything to make the situation worse. The second is the reality acceptance, or radical acceptance, skills — the practice of accepting your life exactly as it is at this moment. We have specific strategies for how to do that.

Bridging Skills Work and Individual Therapy

Abigail Rasol: So you’re moving through these modules in a fairly linear way in the skills group, while in individual sessions the client is bringing whatever has happened that week. How does the therapist bridge those two?

Shireen Rizvi, PhD: Exactly right, and the key tool for that bridge is the diary card.

The Diary Card

Shireen Rizvi, PhD: The diary card — which can be a paper form, an app, a spreadsheet — is where we ask people to self-monitor daily on a number of variables that map directly onto the target hierarchy. Daily ratings of suicidal ideation on a zero-to-five scale; urges to self-harm and whether they acted on them; whether they took their medications; whether they used substances; the intensity of different emotions.

In an ideal session, the person arrives with the diary card completed for the last seven days. The therapist reviews it with the patient in the first few minutes: “I see that most days your suicide ideation was a one or two, but on Thursday it was a four. I also see you had urges to self-harm but no self-harm actions — which is significant. You drank on this day.” You’re building a picture of the week.

That picture, combined with what you observe in the room, tells you where things fall in the target hierarchy for today’s session. The diary card tells you whether there are life-threatening behaviors to address. Your experience with this patient tells you whether there’s therapy-interfering behavior to address — including if they didn’t complete the diary card. All the pieces come together into an agenda for the session.

Chain Analysis: Mapping It Out

Abigail Rasol: Once you’ve identified the top target for the session — say, the day the suicide ideation reached a four — what does the assessment actually look like?

Shireen Rizvi, PhD: Our primary assessment tool is chain analysis: a moment-by-moment account of what led up to the target behavior, what the behavior was, and what the consequences were — all in order to identify different points where we might have intervened differently.

I might say: “The day your ideation hit a four, you hadn’t slept well, so you woke up tired and irritable. Then your mom criticized you for being out the night before. Then you got to class and received a poor grade. At what point did suicidal thinking start to emerge, and what did it look like?” We’re filling in the chain link by link, figuring out where we could have intervened — a different skill, a different response — to prevent the ideation from reaching that intensity.

Abigail Rasol: That sounds genuinely useful for both the therapist and the patient in building a shared map of what happened and why.

Shireen Rizvi, PhD: I’m a big advocate of structure. It keeps you on track — not just for the session, but for the person’s larger goals in life. And when you’re working with patients who have a great deal of suicidal behavior, self-harm, or instability, you need that hierarchy and that goal to keep you focused on what matters most.

What Clinicians Without Full DBT Training Can Borrow

Abigail Rasol: Becoming a DBT-certified clinician requires extensive training. For therapists who haven’t pursued that, what can they meaningfully take from DBT and apply in their work with BPD patients?

Shireen Rizvi, PhD: I’m fully in favor of people taking elements of DBT if that would be helpful. What I want to be very clear about is that clinicians should not present themselves as doing DBT when they’re only borrowing a piece here or there. I’ve had so many patients come to me and say ‘I did DBT and it didn’t work,’ and when you ask them what they actually received, it was not the treatment as designed. So: borrow elements, and be transparent about what you’re doing.

With that said — what I think most therapists benefit from most immediately is learning the skills themselves. Whenever I train clinicians, there is never a moment where someone says, ‘this isn’t useful for me.’ The skills are universally helpful. If therapists learn them, they will begin to see how these skills might benefit their patients and find opportunities to introduce them organically in session.

The other thing clinicians can adopt from DBT is the set of core assumptions we ask DBT therapists to hold: the patient is doing the best they can; the patient wants to improve; the patient may not have caused all of their problems, but they are the ones who have to solve them. These assumptions function almost as therapy for the therapist — they’re designed to cultivate a compassionate, nonjudgmental stance toward patients who are often, frankly, quite difficult to treat. Given the significant stigma that still surrounds BPD, that compassionate lens is not just helpful — it’s essential.

Further Learning

Abigail Rasol: As we close, I’d love for you to share a few resource recommendations for clinicians who want to learn more about DBT. We’ll include links in the episode description.

Shireen Rizvi, PhD: The most recent book I’ve co-authored with Jesse Finkelstein is designed as a user-friendly, practical guide to DBT skills — it includes illustrations and specific strategies for how to learn and practice them. For the foundational texts, there are of course the Linehan manuals: the 1993 Cognitive-Behavioral Treatment of Borderline Personality Disorder and the DBT Skills Training Manual. A couple of books by other DBT experts that some people find more accessible are Doing Dialectical Behavior Therapy by Kelly Koerner and DBT Principles in Action by Charlie Swenson.

For training, there are a number of organizations that offer one-day and multi-day workshops in DBT. I encourage people to seek those out if they’re interested — and to recognize that DBT is complex. You’re not going to learn it in a week or an hour. This is a lifelong practice, and that’s precisely why the consultation team exists. I’m always striving to improve my own practice, every week, with every patient.

Abigail Rasol: I think that’s a wonderful note to close on. We’ve covered a great deal of ground today — from the philosophical foundations of DBT, through the biosocial model and its implications for treatment, to the practical structure of the therapy: the target hierarchy, the diary card, chain analysis, and the four skill modules. We’ve also heard Dr. Rizvi’s perspective on what any clinician can borrow from DBT, and why the compassionate, nonjudgmental stance at the heart of the model matters so much when working with this population. Thank you so much, Dr. Rizvi.

Shireen Rizvi, PhD: Thank you — it was a real pleasure.

Abigail Rasol: And thank you to our listeners for tuning in. In our next episode we’ll be exploring Mentalization-Based Treatment with Dr. Carla Sharp.

References

American Psychiatric Association. (2024). Practice Guideline for the Treatment of Patients With Borderline Personality Disorder. American Psychiatric Association Publishing.

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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), 495–510.

Koerner, K. (2012). Doing Dialectical Behavior Therapy: A Practical Guide. Guilford Press.

Linehan, M. M. (1987). Dialectical behavior therapy for borderline personality disorder: Theory and method. Bulletin of the Menninger Clinic, 51(3), 261–276.

Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford Press.

Linehan, M. M. (2015). DBT Skills Training Manual (2nd ed.). Guilford Press.

Linehan, M. M. (2015). DBT Skills Training Handouts and Worksheets (2nd ed.). Guilford Press.

Linehan, M. M., Armstrong, H. E., Suarez, A., Allmon, D., & Heard, H. L. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48(12), 1060–1064.

Linehan, M. M., Comtois, K. A., Murray, A. M., et al. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy versus therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63(7), 757–766.

Linehan, M. M., Korslund, K. E., Harned, M. S., et al. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: A randomized clinical tria and component analysisl. JAMA Psychiatry, 72(5), 475–482.

Lynch, T. R., Trost, W. T., Salsman, N., & Linehan, M. M. (2007). Dialectical behavior therapy for borderline personality disorder. Annual Review of Clinical Psychology, 3, 181–205.

Rizvi, S. L., & Finkelstein, J. (2025). Real Skills for Real Life: A DBT Guide to Navigating Stress, Emotions, and Relationships. Guilford Press

Rizvi, S. L (2019). Chain Analysis in Dialectical Behavior Therapy. Guilford Press  

Swenson, C. R. (2016). DBT Principles in Action: Acceptance, Change, and Dialectics. Guilford Press.

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The Carlat CME Institute is accredited by the ACCME to provide continuing medical education for physicians. Carlat CME Institute maintains responsibility for this program and its content. Carlat CME Institute designates this enduring material educational activity for a maximum of one quarter (.50) AMA PRA Category 1 Credits^TM. Physicians or psychologists should claim credit commensurate only with the extent of their participation in the activity. This activity is available for CME credit for a defined period based on the date of publication, in accordance with accreditation requirements. The post-test must be completed prior to the expiration date; after that time, CME credit will no longer be available.