Skills Training Group Research Articles

The Liebowitz Social Anxiety Scale (LSAS): Psychometric Properties of the Amharic Version in Ethiopian University Student Sample

The Liebowitz Social Anxiety Scale (LSAS) assesses the fear and avoidance associated with social anxiety and has been validated in several languages. The present study describes the adaptation and psychometric evaluation of the Amharic version of the LSAS in Ethiopian university student samples. Two studies were carried out. In the first study, 429 participants completed a survey, including demographic information, and the Amharic version of the LSAS. In the second study, 32 participants completed a survey comprising demographic information and the Amharic version of the LSAS. The participants were recruited using a convenience sampling method. The findings suggest a two-factor solution (CFI = 0.92, TLI = 0.92, and RMSEA = 0.06) consistent with the original factor structure and excellent reliability coefficient. Finally, the Amharic version of the LSAS can demonstrate good sensitivity to treatments (solution-focused and social skills training groups) in a nonclinical sample of university students in Ethiopia. Taken together, the present findings indicate that the LSAS is a suitable psychometric measure to assess social anxiety in Ethiopia.

Group-based DBT skills training modules are linked to independent and additive improvements in emotion regulation in a heterogeneous outpatient sample

Objective: Dialectical Behavior Therapy (DBT) was initially developed to treat symptoms of Borderline Personality Disorder (BPD), but has also been shown to improve symptoms of several other mental health conditions. Emotion regulation difficulties comprise a key target of DBT as well as a common challenge for individuals with depression, anxiety, PTSD, and other conditions. The current study investigated the impact of a DBT skills-training group on emotion regulation, and whether improvement in specific facets of emotion regulation would be linked to training in specific modules. Method: One hundred and thirty-six patients diagnosed with heterogeneous mental health conditions participated in the study. Patients were enrolled in the group on a rolling basis, and emotion regulation was assessed at the beginning and end of every six- to eight-week module. Results: Mixed model analysis revealed that each DBT skills-training module (i.e., mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation) was associated with improvements in emotion regulation (all Bonferroni corrected ps < .003). Conclusions: These findings add to the growing literature on the applicability of DBT skills-training to heterogeneous psychological conditions, particularly when patients’ challenges reflect underlying difficulties with emotion regulation.

Practicing Procedural Skills Is More Effective Than Basic Psychomotor Training in Knee Arthroscopy: A Randomized Study.

Background:Simulator-assisted arthroscopy education traditionally consists of initial training of basic psychomotor skills before advancing to more complex procedural tasks.Purpose:To explore and compare the effects of basic psychomotor skills training versus procedural skills training on novice surgeons’ subsequent simulated knee arthroscopy performance.Study Design:Controlled laboratory study.Methods:Overall, 22 novice orthopaedic surgeons and 11 experienced arthroscopic surgeons participated in this study, conducted from September 2015 to January 2017. Novices received a standardized introductory lesson on knee arthroscopy before being randomized into a basic skills training group or a procedural skills training group. Each group performed 2 sessions on a computer-assisted knee arthroscopy simulator: The basic skills training group completed 1 session consisting of basic psychomotor skills modules and 1 session of procedural modules (diagnostic knee arthroscopy and meniscal resection), whereas the procedural skills training group completed 2 sessions of procedural modules. Performance of the novices was compared with that of the experienced surgeons to explore evidence of validity for the basic psychomotor training skills modules and the procedural modules. The effect of prior basic psychomotor skills training and procedural skills training was explored by comparing pre- and posttraining performances of the randomized groups using a mixed-effects regression model.Results:Validity evidence was found for the procedural modules, as test results were reliable and experienced surgeons significantly outperformed novices. We found no evidence of validity for the basic psychomotor skills modules, as test scores were unreliable and there was no difference in performance between the experienced surgeons and novices. We found no statistical effect of basic psychomotor skills training as compared with no training (P = .49). We found a statistically significant effect of prior procedural skills training (P < .001) and a significantly larger effect of procedural skills training as compared with basic psychomotor skills training (P = .019).Conclusion:Procedural skills training was significantly more effective than basic psychomotor skills training regarding improved performance in diagnostic knee arthroscopy and meniscal resection on a knee arthroscopy simulator. Furthermore, the basic psychomotor skills modules lacked validity evidence.Clinical Relevance:On the basis of these results, we suggest that future competency-based curricula focus their training on full knee arthroscopy procedures. This could improve future education programs.

Adapted dialectical behaviour therapy skills group service evaluation

Purpose The purpose of this paper is to determine the effectiveness of an adapted dialectical behaviour therapy (DBT) treatment programme for individuals with an intellectual disability, via completion of a service evaluation. Design/methodology/approach Outcome measurements were competed at pre-, post- and 12 months follow-up, and the effectiveness of the intervention was assessed using a Friedman analysis. Findings Findings demonstrated that the treatment group showed significant differences in their “psychological distress” scores, but no significant differences were found in their “psychological well-being”, “anxiety” or “quality of life” (WHO-QOL) scores over time. Originality/value Overall, the current study adds to the small but growing literature that supports using the skills training group part of DBT as a stand-alone psychological intervention when working with people with an intellectual disability.

A Systematic Review of Studies on Social Skills Development for Adolescents with Autism Spectrum Disorders

Aim and Significance: The systematic literature review is developed as an investigation of existing and recommended evidence based social skills and strategies to adopt in improving adolescents with ASD social skills. The systematic review was developed based on the understanding that a majority of the studies have focused on children below 11 years social skills. The need to analsye and establish the age specific social skills and strategies required informed the review development. This ystematic review evaluates the available published studies on group-based social skills interventions in the United States and the realm of Canada to improve the social skills among adolescents with ASD Methods: The systematic review developed an online search for peer reviewed articles published on the Medline, PsycINFO, Psychoarticle, Psychology and behaviour and Web of Science, through a PubMed-NCBI, an EBSCO and the Ovid databases. Key words and phrases were used to search for relevant literature. Once results were obtained, an inclusion and exclusion criteria was applied to narrow down the studies to applicable and most relevant studies. Results and Discussion: Three categories of social skills interventions have been identified to be effective in improving social and communication skills. They are (i) the use of the PEERS, (ii) social skills training group and (iii) group skills training. The recommendation for future research should focus on comparing protocols of various social skills training in clinical settings of the real-world.

Effect of group problem-solving skills training on the severity of aggression in patients with bipolar I disorder

Introduction: Psychological interventions can help prevent patients’ problems by increasing insight. Aim: This study was aimed to determine the effect of problem-solving skills training on the severity of aggression in patients with bipolar I disorder. Material and methods: In this randomized controlled trial, we enrolled 60 patients with bipolar I disorder admitted to Ibn Sina Psychiatric Hospital in Mashhad during 2018. The patients were assigned to the two groups of intervention (n = 30) and control (n = 30). In addition to pharmacological therapy, the intervention group attended six 45-minute problem-solving group training sessions, while the control group received medication alone. The data collection instrument was the Buss and Perry aggression questionnaire (BPAQ), which was filled out before and a month after the intervention. Results and discussion: In the pre-intervention phase, there was no significant difference in the mean score of aggression between the problem-solving skills training and control groups (119 ± 5.6 vs. 120.5 ± 8.5; P = 0.222); while, the total score of aggression after the intervention was significantly different between two groups (86.9 ± 5.5 vs. 120.2 ± 5.8; P &lt;0.001). Conclusions: Problem-solving skills training can reduce the severity of aggression in patients with bipolar disorder. It is recommended that these skills used in individual and family care for patients with bipolar I disorder.

Dialectical behaviour therapy skills group including stigma management: a pilot with sexual and gender minority veterans

AbstractAs a principle-driven treatment, dialectical behaviour therapy (DBT) offers concepts and strategies that can be flexibly applied to address unique types of invalidation, such as stigma experienced by marginalized groups. A pilot DBT skills training group that included material on using skills to dialectically manage the effects of stigma was conducted with four sexual and gender minority (SGM) veterans. The group included standard DBT skills along with explicitly teaching about stigma commonly faced by SGM individuals and ways to apply DBT skills to the experiences of stigma. This pilot group was conducted to determine the acceptability of such a group as well as its effects on symptoms (depression, emotion regulation), use of DBT skills in daily living, and the psychological burden of stigma-related experiences. The group was well-received by participants; outcomes suggest promising trends in reducing psychological distress and increasing use of DBT skills to cope. Implications for clinical practice using a dialectical approach to stigma management and future directions are provided.Key learning aims(1)Readers will learn about how dialectical behaviour therapy can be used to help sexual and gender minority clients effectively manage the effects of minority stress.(2)Readers will learn how taking a dialectical perspective on managing minority stress can be effective.(3)Readers will learn how delivering dialectical behaviour therapy in a manner contextualized within the clients’ experience can be effective in managing mental health symptoms.

Culturally Informed Interventions for Military, Veteran and Emergency Service Personnel: The Importance of Group Structure, Lived Experience Facilitators, and Recovery-Oriented Content

There is little available research on what constitutes a culturally informed program to treat mental health conditions among military, veteran, and emergency services personnel. The current study presents the qualitative participant evaluations of a modified group Skills Training in Affective and Interpersonal Regulation (STAIR) program. Participants were grouped with either lived-experience facilitators or non-lived-experience clinicians for the program, and 93 textual responses to a series of qualitative questions were analyzed. The findings suggest strong support for the postulated three primary components of a culturally informed program: a group structure; facilitation by peers with lived experience; and functional, skills-based, and recovery-oriented content.

Effect of Simulation Evacuation Training Improvement Activity through Wheelchair Skill Training

Purpose The purpose of this study was to determine the effect of simulation evacuation training improvement activity through wheelchair skill training. Methods The study included 40 patients with early stroke who were randomly allocated to a wheelchair skill training group (Experimental group, n=20) and a general exercise group (Control group, n=20). Both groups performed the exercise 3 times a week for 3 weeks. Outcomes were assessed using Wheelchair Skills Test Skills Performance (WSTSP), Wheelchair Skills Test Skills Safety (WSTSS) and Wheelchair Propulsion Velocity (WPV). Results After 3 weeks of training, both groups showed significantly improved WSTSP, WSTSS and WPV (p<.01 in both groups). However, the WSTSP, WSTSS and WPV in the experimental group were very significantly better than in the control group (p<.01). Conclusion These findings indicate that wheelchair skill training may be effective at improving wheelchair skill ability and wheelchair propulsion velocity in stroke patients who cannot walk independently. Therefore, short-term wheelchair skill training could be useful for patient safety in simulated evacuation situations. Key words: Locomotion ㆍ Patient safety ㆍ Stroke ㆍ Wheelchairs

The Effect of Teaching Methods (Lecturing, Reading, Cooperative Learning, and Skill Training) and the Level of Intelligence on the Outcomes of Learning Arabic in High School/تأثير طرق التعليم (المحاضرة و القراءة و التعليم التعاوني و تدريب المهارة) ومستوى

This study aims Knowing the Interaction between teaching methodology and intelligence on learning achievement in Arabic at MAPK MAN 1 Surakarta year lesson 2019/2020. This research applied quantitative. Conducted at MAPK MAN 1 Surakarta from january-february 2020. While the sample is class XI PK. The approach used in this study is a quantitative approach using experimental methods. collection techniques using Observation, Test and Documentation. Analysis techniques using the normality test, homogeneity test, and hypothesis testing. The conclusion of this reasearch is the influence of teaching method (Lecture, Recitation, and Grup in Work, Skill Training) and the level of Intellegence on Arabic learning Achievement in MAPK MAN 1 Surakarta. There were significant differences in Arabic learning using the lecture and recitation methods and students taught using group work methods and skills training. from the calculated r value greater than r table, namely rh = 0.49 0.44 = rt, There was a difference in the learning to students with low IQ or students in 1` lower IQ group. the calculated r value greater than the table, namely: rh = 0.78 0.44 = rt, The method of teaching group work and skills training can significantly improve students' learning in the experimental class when compared to the control group. This can be seen from the difference in the average value achieved by the two groups where the experimental group is greater than the control group, namely: 96 94.

Arts-Based Compassion Skills Training (ABCST): Channelling Compassion Focused Therapy Through Visual Arts for Australia's Indigenous Peoples.

The last 20 years have seen the development of a new form of therapy, compassion focused therapy (CFT). Although CFT has a growing evidence base, there have been few studies of CFT outside of an Anglo-European cultural context. In this paper, we ask: Might a CFT-based approach be of value for Indigenous Australians? If so, what kind of cultural adaptations might be needed? We report the findings from a pilot study of an arts-based compassion skills training (ABCST) group, in which usual CFT group processes were significantly adapted to meet the needs of Indigenous Australians. At face value, CFT appeared to be a promising approach to enhancing the social and emotional wellbeing of Australia’s Indigenous peoples. However, despite initial consultations with Indigenous health professionals, the first attempts to offer a more conventional group-based CFT to Indigenous clients were largely unsuccessful. Following a review and advice from two Indigenous clients, we combined elements of CFT with visual arts to develop a new approach, “arts-based compassion skills training” (ABCST). This paper reports an evaluation of this pilot ABCST group. The group had 6 × 4 h sessions of ABCST, facilitated by two psychologists (1 Indigenous, 1 non-Indigenous) and two artists (1 Indigenous, 1 non-Indigenous). There were 10 participants, who attended between 2 and 6 sessions: five were clients, five were health professionals. Between 1 and 3 months later, six of the participants (2 clients, 4 health professionals) were interviewed. Qualitative analysis of interview data identified that two key processes—creating a positive group atmosphere and channeling compassion skills training through the medium of visual arts—led to four positive outcomes for participants: planting the seeds of new understandings, embodying the skills of compassion, strengthening relationships with others, and evolving a more self-compassionate relationship. We suggest that the preliminary results are sufficiently encouraging to warrant further development of ABCST in Indigenous communities.

Preventive Treatment on Sexual Abuse Survivor with Mental Retardation

The existence of limitations for children with mental retardation causes an inability to protect themselves so that they often become victims of sexual harassment. Preventive efforts are something that needs to be improved for prevention, considering the worse risks to children. The importance of an effort to prevent sexual abuse of children with mental retardation in connection with the lack of knowledge about sexual abuse and the inability of children to face the dangers that threaten themselves. From the results of research conducted in the United States in 1994, nearly 90% of children with mental retardation disorders had experienced sexual abuse, as many as 49% had experienced sexual abuse more than ten times. The high incidence of sexual abuse experienced by children with mental retardation is due to various factors, namely the condition of children's limitations, lack of supervision and protection of children by parents and the environment. Efforts that can be made are increasing knowledge about sexual abuse and self-protection skills through the Behavioral Skills Training Group Program, where children are trained to recognize threatening objects and situations (sexual abuse). Increasing knowledge about sexual abuse and providing training (self-protection skills) is a significant primary preventive measure to reduce the risk of sexual abuse in children with mental retardation.

Balint groups and narrative medicine compared to a control condition in promoting students\u2019 empathy

BackgroundThe perceived importance of clinical empathy may decline among students during medical training. Several interventions have been shown to be effective in promoting or preserving medical students’ empathic abilities, such as empathy skills training or Balint groups. Although narrative medicine training shares some features with these interventions, no randomized study to date examined the efficacy of narrative medicine training. This study aimed to assess the effects of Balint groups and narrative medicine training on clinical empathy measured by the self-rated Jefferson’s School Empathy Scale - Medical Student (JSPE-MS©) among fourth-year medical students.MethodsStudents who gave their consent to participate were randomly allocated in equal proportion to Balint groups, narrative medicine training or to the control group. Participants in the intervention groups received either seven sessions of 1.5-h Balint groups or a 2-h lecture and five sessions of 1.5-h narrative medicine training from October 2015 to December 2015. The main outcome was the change in JSPE-MS© score from baseline to one week after the last session.ResultsData from 362 out of 392 participants were analyzed: 117 in the control group, 125 in the Balint group and 120 in the narrative medicine group. The change in JSPE-MS© score from baseline to follow-up was significantly higher in the Balint group than in the control group [mean (SD): 0.27 (8.00) vs. -2,36 (11.41), t = 2.086, P = 0.038]. The change in JSPE-MS© score in the narrative medicine group [mean (SD): − 0.57 (8.76)] did not significantly differ from the changes in the control group (t = 1.355, P = 0.18) or the Balint group (t = 0.784, P = 0.43). Adjusting for participants’ characteristics at baseline, Balint groups remained associated with better outcomes compared to the control group (β = 2.673, P = 0.030).ConclusionsBalint groups may promote clinical empathy to some extent among medical students, at least in the short run.

Real world implementation of a group-based memory rehabilitation program into stroke services: A knowledge translation evaluation

ABSTRACT Background Support for memory difficulties remains a significant unmet need for survivors of stroke. Memory skills group training of compensatory strategies can be effective for improving everyday memory function. However, access to these services remains limited. Objectives We aimed to evaluate the fidelity, acceptability, and effectiveness of implementing an evidence-based memory group in real-world clinical settings, to establish a potentially scalable implementation model. Methods The program was facilitated at one acute and one community-based rehabilitation health service. Three clinical neuropsychologists received comprehensive training in facilitating the program. Implementation followed the Knowledge to Action framework, and implementation outcome measures included fidelity monitoring of adherence and competence, as well as clinician and participant reports of acceptability. The clinical effectiveness outcome was attainment of memory-specific goals using Goal Attainment Scaling at post-intervention and six-week follow-up. Results The training process resulted in full adherence to the program content and demonstration of all essential clinical competencies. The program was acceptable and enjoyable for the clinicians and participants (n= 19, 63% male, 73% ischemic stroke). Participants demonstrated high levels of goal attainment (>80% at follow-up), comparable in magnitude to previous controlled trials. Conclusions The stroke memory skills program has the potential to be implemented successfully in real-world clinical settings using the Knowledge to Action framework, incorporating comprehensive clinician training.

CALMA, a Mobile Health Application, as an Accessory to Therapy for Reduction of Suicidal and Non-Suicidal Self-Injured Behaviors: A Pilot Cluster Randomized Controlled Trial

The present study was aim to evaluate the acceptability and preliminary effectiveness of a mobile-health application, CALMA, based on dialectical behavioral therapy skills. CALMA was proposed as an adjunct to therapy for the reduction of non-suicidal and suicidal self-injury behaviors. A parallel design was used to compare the intervention group (DBT + CALMA) and the comparison group (DBT). Patients were randomized based on their groups following a randomized cluster design. After treatment, patients completed a follow-up assessment four weeks later. Each cluster was represented by a different DBT Skills Training Group offered weekly at FORO Foundation for Mental Health. Six DBT Skills Training groups were randomized to the intervention or comparison group. Twenty-one individuals met inclusion criteria and eighteen were included in the analysis. Acceptability was measured with the User Experience Questionnaire short version (UEQ-s) and preliminary efficacy with the Self-injurious thoughts and behaviors interview (SITBI). CALMA shows good acceptability to be used as an adjunct to therapy specific to the reduction of suicidal and non-suicidal self-directed violence. Evidence for preliminary efficacy included a high probability of decreased in more behaviors evaluated with the SITBI pre- and post-intervention for the group that received CALMA as compared to the comparison group. Our study provides initial evidence for the effectiveness and acceptability of CALMA. Future studies scaling up this intervention in a larger number of participants are necessary. CALMA may be especially useful in low and middle-income Latin American countries to improve access to evidence-based interventions openly available in Spanish and free to download. Highlights CALMA is a DBT-based app aimed to reduce non-suicidal and suicidal self-directed violence. The app showed good acceptability by users A high probability of decrease in suicidal ideation, suicidal plan, suicidal gesture, thoughts about NSSI and NSSI pre- and post-intervention was observed

The influence of common polygenic risk and gene sets on social skills group training response in autism spectrum disorder

Social skills group training (SSGT) is a frequently used behavioral intervention in autism spectrum disorder (ASD), but the effects are moderate and heterogeneous. Here, we analyzed the effect of polygenic risk score (PRS) and common variants in gene sets on the intervention outcome. Participants from the largest randomized clinical trial of SSGT in ASD to date were selected (N = 188, 99 from SSGT, 89 from standard care) to calculate association between the outcomes in the SSGT trial and PRSs for ASD, attention-deficit hyperactivity disorder (ADHD), and educational attainment. In addition, specific gene sets were selected to evaluate their role on intervention outcomes. Among all participants in the trial, higher PRS for ADHD was associated with significant improvement in the outcome measure, the parental-rated Social Responsiveness Scale. The significant association was due to better outcomes in the standard care group for individuals with higher PRS for ADHD (post-intervention: β = −4.747, P = 0.0129; follow-up: β = −5.309, P = 0.0083). However, when contrasting the SSGT and standard care group, an inferior outcome in the SSGT group was associated with higher ADHD PRS at follow-up (β = 6.67, P = 0.016). Five gene sets within the synaptic category showed a nominal association with reduced response to interventions. We provide preliminary evidence that genetic liability calculated from common variants could influence the intervention outcomes. In the future, larger cohorts should be used to investigate how genetic contribution affects individual response to ASD interventions.

The Impact of Social Distancing on People with Borderline Personality Disorder: The Views of Dialectical Behavioural Therapists

Dialectical Behavioural Therapy (DBT) is an evidence-based treatment for borderline personality disorder and other problems associated with emotional dysregulation. It has traditionally been deployed as a face-to-face programme comprised of attendance at group skills training, individual therapy and phone coaching. Social distancing measures arising from the COVID-19 pandemic led to a cessation of therapeutic programmes in many places. This survey of DBT clinicians in a regional State mental health service in Australia explored the impact of the cessation of DBT programmes in the region and obstacles to engaging with people via online platforms. Clinicians have been able to engage in DBT informed care, but it was perceived that many people have experienced a clinical deterioration or have increased their use of crisis services, which is entirely appropriate, as group skills programmes have ceased. Movement to online platforms of delivery poses problems, as some people do not have the access to internet or privacy in their home environments to engage in online therapy. Ideally, clinicians need to be supported through education, supervision and coaching in the use of telehealth interventions. Social distancing requirements has enabled an opportunity to carefully consider how programmes can be adapted to enable the extension of these programmes to those who have traditionally been unable to access them.

The Design, Implementation, and Acceptability of a Telehealth Comprehensive Recovery Service for People With Complex Psychosis Living in NYC During the COVID-19 Crisis.

IntroductionThe COVID-19 crisis and subsequent stay-at-home orders have produced unprecedented challenges to the dissemination of recovery oriented behavioral health services (RS) that support the treatment of those with complex psychosis (CP).This population has typically been managed with in-person pharmacotherapy and/or RS, with the goals of relieving symptoms, improving life satisfaction and increasing community engagement. COVID-19 related social distancing measures have required rapid shifts in care management, while easing of telehealth regulations has allowed for flexibility to approach RS differently. It is essential to learn from the RS telemedicine implementation experience, so that RSs can maintain care for this vulnerable and needy population.MethodThis paper describes the successful telehealth conversion of a NYC-based, university affiliated RS that serves adults with severe mental illnesses (SMI; n = 64). Results focus on the telehealth acceptance rates of the subset of participants with CP (n = 23).ResultsThe RS continued providing services including intake, care coordination, group psychotherapies, skills training groups, individual skills coaching, and vocational/educational supports. The telehealth conversion rates of the CP subsample indicated that 90% of CP patients accepted telehealth sessions and maintained their specific treatment plans in the virtual format. Mean comparisons between session attendance and cancellations/no-shows during the six-week period before and after telehealth conversion showed no significant differences in service utilization.DiscussionRSs play an essential role in the treatment of CP and telehealth may prove to be a viable format of care delivery even after the COVID-19 crisis subsides. The multiple factors in the inner and outer treatment setting that contributed to successful conversion to telehealth will be considered along with the challenges that clinicians and patients encountered.

Feasibility trial of the dialectical behavior therapy skills training group as add-on treatment for adults with attention-deficit/hyperactivity disorder.

Our aim was to explore the feasibility, and efficacy of a Dialectical Behavior Therapy Skill Training Group (DBT-ST) as an add-on treatment for adult attention-deficit/hyperactivity disorder (ADHD) in Latin America. Adults with ADHD (n = 31) with stable medication treatment for ADHD and residual symptoms (ASRS > 20) were randomly assigned to DBT-ST (n = 16) or treatment as usual (TaU; n = 15) for 12 weeks. Feasibility was accessed by attendance and completion rates at 12 weeks. Efficacy outcomes were measured with the ASRS, and performed at 0, 6, 12, and 16 weeks. The DBT-ST protocol had 81.25% completion rate, with a mean attendance of 87.25% of the sessions. No significant interactions between group and time were detected for outcome measures. The DBT-ST was feasible as add-on treatment for adult patients with ADHD in Latin America. Replicating previous findings, DBT-ST has shown no significantly higher improvement in ADHD symptoms in comparison with TaU. Registered at the Clinical Trials database (NCT03326427).

Adaptations de la thérapie comportementale dialectique ambulatoire en période de pandémie COVID-19 et conséquences du confinement sur des patients souffrant d’un état-limite

BackgroundThe COVID-19 pandemic impacted the accessibility of psychotherapy for particularly vulnerable patients during the period of confinement in the French-speaking part of Switzerland. We had to adapt our usual therapeutic programs. We illustrate this approach in an outpatient program of dialectical behavioral therapy for patients with borderline personality disorder. Each week the individual therapies took place by videoconference or phone. The skills training group was held individually by videoconference or phone and was supported by an online skills training program. Patients filled out their diary cards online. Intersession contact with the therapist remained available as usual and we could organize team consultation. The aim of this study is to describe how a sample of our patients experienced the period of confinement. MethodWe compared the experiences of seven patients suffering from borderline personality disorder during two periods: eight weeks prior to confinement, and during the eight weeks of confinement. We analyzed their daily diary cards (n=426) and their weekly frequency of problem behaviors (n=69). We performed multilevel analyses to take into account the hierarchical structure of the data and the autocorrelation of observations. ResultsThe seven patients were predominantly female (85.7 %) and had an average age of 35.1 (11.5) years. Measurements prior to the start of the pandemic indicated on average severe depression (Beck Depression Inventory, m=30.9 [10.0]) and marked hopelessness (Beck Hopelessness Scale, m=15.0 [5.0]). Analysis of the daily diary cards indicated that the confinement period significantly predicted a decrease in feelings of shame or guilt, fear and tension. At the same time, however, there was an increase in distress. Weekly monitoring of problem behaviors showed a decrease in binge-eating behaviors and a trend towards a decrease in alcohol consumption during confinement. ConclusionsDespite the small number of patients included, two types of repeated measurements indicated convergent results, with some improvements during confinement: a decrease of the feelings of fear, shame or guilt, and tension, and a decrease of the frequency of binge-eating behaviors. The decreased pace of daily social and professional life may explain these improvements. The diminution of the above-mentioned feelings as triggers for addictive and compulsive behaviors may also account for the improvements regarding binge-eating. However, they also experienced an increased distress that may reflect the loneliness experienced during this period. The pre-pandemic development of computerized tools that were already familiar to patients greatly facilitated the necessary adaptations to maintain an intensive therapeutic setting during the confinement. This may partly explain why these patients were able to adjust the challenges of this period.