Standard Dialectical Behavior Therapy Research Articles

Borderline Bireylerde Kendine Zarar Verme Davranışı ve İntihar Girişimine Yönelik Psikolojik Müdahaleler: Sistematik Derleme

Self-harm behaviour and suicide attempts are considered maladaptive coping mechanisms by individuals with a diagnosis of borderline personality disorder (BPD). Numerous studies have demonstrated that individuals with BPD are at a heightened risk for self-harm behaviour and suicide. Therefore, there is a need for intervention efforts aimed at reducing self-harm and suicide attempts in this population by promoting more functional coping strategies. No systematic review has been conducted to explore the effectiveness of such interventions. A systematic review was performed to identify randomized controlled trials of interventions to reduce self-harm and suicide attempts among individuals with BPD, published between 2012 and 2022. PsycARTICLES, PubMed, Web of Science, Science Direct, and Taylor & Francis databases were examined in the review. A total of 6,760 studies were initially screened, only 13 were selected for review based on the inclusion and exclusion criteria. The results indicated that the standard dialectical behaviour therapy protocol, with the addition of psychological intervention components such as skills training, exposure and acceptance, statistically significantly increased recovery. Statistically significant results have been obtained from various psychotherapeutic intervention groups such as schema therapy, cognitive behavioural therapy and emotion regulation therapy However, it was noted that existing protocols might be inadequate in preventing relapse and addressing potential negative outcomes such as premature termination of therapy.

Efficacy of Dialectical Behavior Therapy in the Treatment of Borderline Personality Disorder: A Systematic Review of Randomized Controlled Trials.

Objective: Borderline personality disorder (BPD) is a serious public health problem. Dialectical Behavior Therapy (DBT) is a program that has provided encouraging results for its treatment. However, scientific evidence about its efficacy is scarce. Therefore, we aimed to describe the scientific production on the components of the DBT program and its therapeutic efficacy in the treatment of people with BPD. Method : A systematic review with relevant keywords was conducted based on studies available in Scopus, Web of Science, and PubMed until June 2023, including studies in English, research on therapeutic intervention, studies with a randomized controlled trial (RCT) design that included people with the diagnosis of BPD. Results: We found 18 RCTs, most of which supported the effectiveness of DBT for BPD. There were a total of 1,755 participants in these studies, most of whom were women. These studies looked for treating self-injurious behaviors, suicidal thoughts or ideations, number of visits to emergency services, and frequency of hospital admissions. Most studies revealed that both short-term DBT and standard DBT improved suicidality in BPD patients with small or moderate effect sizes, lasting up to 24 months after the treatment period. Furthermore, these studies showed that DBT can significantly improve general psychopathology and depressive symptoms in patients with BPD. Improvement of compliance, impulsivity, mood instability, as well as reduction in hospitalization rate are other findings observed in the trials following DBT. Conclusion: Although DBT shows efficacy in the treatment of BPD, heterogeneity in the methodologies employed is highlighted. Therefore, it is necessary to design studies from a homogeneous theoretical and methodological framework.

Sexual identity and race/ethnicity as predictors of treatment outcome and retention in dialectical behavior therapy.

There is inconclusive evidence regarding sexual identity and race/ethnicity differences in outcomes in evidence-based psychological treatments. Although dialectical behavior therapy (DBT) is well-studied, little is known about the extent to which its efficacy generalizes to sexual minority and racial/ethnic minority people. This study examined sexual identity, race/ethnicity, and their interaction as predictors of treatment outcome and retention in DBT. Data were from five clinical trials conducted in research and community settings with a variety of adult populations (N = 269) engaged in standard DBT, augmented DBT, or DBT components. Longitudinal mixed-effects models evaluated sexual identity and racial/ethnic differences in clinical outcomes (suicide attempts, nonsuicidal self-injury [NSSI], global functioning, psychiatric hospitalizations) and retention. Sexual identity, race/ethnicity, and their interaction did not predict the average severity or the rate of change in any clinical outcome over time. Sexual minority identity was associated with decreased risk of treatment dropout (OR = .44, p < .001). However, this effect was moderated by race/ethnicity, such that non-Hispanic White sexual minority participants had the lowest rates of dropout. Exploratory analyses suggested potential differences related to NSSI for certain sexual and racial/ethnic minority subgroups. Findings suggest no significant differences in DBT treatment outcomes when comparing between sexual minority and heterosexual individuals and between non-Hispanic White and racial/ethnic minority individuals. Sexual minority identity interacted with race/ethnicity to predict dropout, such that non-Hispanic sexual minority people were more likely to complete DBT compared to sexual minority people of color and heterosexual individuals. Further research is needed to clarify potential subgroup and intersectional differences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Development and Evaluation of a Pragmatic Measure of Adherence to Dialectical Behavior Therapy: The DBT Adherence Checklist for Individual Therapy.

This paper presents two studies conducted to develop and evaluate a new pragmatic measure of therapist adherence to Dialectical Behavior Therapy (DBT): the DBT Adherence Checklist for Individual Therapy (DBT AC-I). Study 1 used item response analysis to select items from the gold standard DBT Adherence Coding Scale (DBT ACS) using archival data from 1271 DBT sessions. Items were then iteratively refined based on feedback from 33 target end-users to ensure relevance, usability, and understandability. Study 2 examined the psychometric properties of the DBT AC-I as a therapist self-report and observer-rated measure in 100 sessions from 50 therapist-client dyads, while also evaluating predictors of therapist accuracy in self-rated adherence. When used as a therapist self-report measure, concordance between therapist and observer ratings was at least moderate (AC1 ≥ 0.41) for all DBT AC-I items but overall concordance (ICC = 0.09) as well as convergent (r = 0.05) and criterion validity (AUC = 0.54) with the DBT ACS were poor. Higher therapist accuracy was predicted by greater DBT knowledge and adherence as well as more severe client suicidal ideation. When used by trained observers, the DBT AC-I had excellent interrater reliability (ICC = 0.93), convergent validity (r = 0.90), and criterion validity (AUC = 0.94). While therapists' self-rated adherence on the DBT AC-I should not be assumed to reflect their actual adherence, some therapists may self-rate accurately. The DBT AC-I offers an effective and relatively efficient method of evaluating adherence to DBT when used by trained observers.

Broad strokes or fine points: Are dialectical behavior therapy modules associated with general or domain-specific changes?

Dialectical behavior therapy (DBT) has demonstrated effectiveness for a range of emotional difficulties, and DBT skills training groups may be necessary to produce symptom change. However, it is unclear how skills training groups influence outcomes. Specifically, is participation in DBT skills modules associated with general effects (i.e., changes in multiple domains) or domain-specific effects (i.e., changes in the conceptually relevant domain)? Participants recruited from a university training clinic (n = 87; 75.9% diagnosed with borderline personality disorder) participated in standard DBT for 6 months. We conducted hierarchical linear mixed models to test whether self-reported changes in emotion regulation, interpersonal problems, and distress tolerance were associated with the specific DBT module intended to target that outcome. In 3 models, we regressed end-of-module ratings of each of our measures of interest on (a) premodule ratings of each measure of interest, (b) time, and (c) dummy-coded module completed. Although all modules were associated with similar reductions in emotion dysregulation, the Emotion Regulation module was associated with the greatest improvements in both interpersonal problems and distress tolerance. In contrast, the first skills module completed was unrelated to changes in any of these domains. These results suggest that Emotion Regulation skills are associated with improvements in patient symptoms across relevant domains and offer potential directions for optimizing the delivery of DBT. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Gender- and Sexuality-Minoritised Adolescents in DBT: A Reflexive Thematic Analysis of Minority-Specific Treatment Targets and Experience.

Gender- and sexuality-minoritised (GSM) adolescents are at increased risk of self-harm and suicidal behaviours compared to their cisgender and heterosexual peers. This increased risk is thought to be explained in part by exposure to stigma and societal oppression. Dialectical Behaviour Therapy (DBT) is an evidence-based intervention for self-harm and suicidal behaviour that may have advantages for supporting GSM young people in distress. No study has yet sought to understand what GSM-associated difficulties may be important to consider in DBT for adolescents, or the experiences of GSM young people in a standard DBT programme. Therefore, this study aimed to understand the experiences of GSM young people in DBT and what difficulties and dilemmas associated with their gender and sexuality diversity were thought by them to be important to target in DBT. Qualitative interviews were conducted with 14 GSM young people in a comprehensive DBT programme and were analysed using Reflexive Thematic Analysis. The analysis was supported by two further GSM young people who had finished DBT. The findings were split into three overarching themes (Identity, Impact of Others, and Space for Sexual and Gender Identity in DBT), each with themes within. The identity-based theme included "identity confusion and acceptance"; the relationship-based themes included "cis-Heterosexism" and "community connectedness"; and the space within DBT themes included "negotiating focus and targeting in DBT" and "creating safety in DBT". Findings are discussed in relation to implications and recommendations for therapists working with GSM young people within and outside of DBT.

Application of Dialectical Behaviour Therapy in treating common psychiatric disorders: study protocol for a scoping review

IntroductionDialectical behaviour therapy (DBT) is a well-known intervention for treating borderline personality disorder, and has been increasingly adapted for other disorders. Standard DBT consists of four treatment modes, delivered over...

Dialectical Behavior Therapy Skills Training With Music Therapy Interventions for Adults With Serious Mental Illness: A Quasi-Experimental Nonequivalent Control-Group Pilot Study.

Dialectical behavior therapy (DBT) improves emotion regulation by building skills in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. The purpose of this pilot study was to compare a DBT skills group with a combined DBT skills and music therapy (MT) group on participant outcomes of attendance, participation, skill practice, and skill knowledge, as well as determine feasibility of study procedures. We used a quasi-experimental nonequivalent control-group design with all groups co-led by a psychologist and a music therapist. Clinicians facilitated twice weekly 45-min groups in 12-week cycles for a total of eight groups over 2 years. The groups alternated DBT-only and DBT+MT; participant data were analyzed for their first cycle attended. The DBT-only group followed a standard DBT skills training format, whereas the DBT+MT group included music therapy interventions as group exercises. Participants (N = 26) were adults with serious mental illness referred to the inpatient psychosocial rehabilitation group (PSR) at a state psychiatric hospital. Participants completed a demographic form, diary cards, and exit interview; clinicians recorded attendance and session participation. Participants in the DBT+MT condition had significantly higher participation levels, slightly higher average attendance, submitted more diary cards, and included more feeling statements than the DBT-only condition. Although interpretations should be approached with caution, the pilot study intervention shows promise. Overall, this study could be implemented as intended under close monitoring, with minor modifications to assist with recruitment and data collection. Modifications, clinical implications, and recommendations for future research are discussed.

Impact of Dialectical Behavior Therapy Prolonged Exposure protocol on trauma-related symptoms in Egyptian women with Borderline Personality Disorder

IntroductionAlthough around 50% of individuals with borderline personality disorder (BPD) suffer from trauma-related disorders, literature lacks a specific treatment for these serious co-occurring problems. Dialectical Behavior Therapy Prolonged Exposure (DBT PE) is a recent protocol developed by Melanie Harned, integrating (PE) into standard (DBT). The protocol has showed promising results in treating comorbid PTSD in BPD patients. The current study, however, was the first trial to apply DBT PE protocol in Egypt.ObjectivesTo investigate the efficacy of (DBT PE) protocol in reducing trauma-related symptoms (psychological trauma symptoms and trauma-related cognitions) among Egyptian women with BPD.MethodsSixteen women diagnosed with BPD and trauma-related symptoms, were recruited from “DBT clinic”, a private outpatient clinic in Alexandria, Egypt and randomly divided into equivalent (Therapeutic &amp; Control) groups. The therapeutic group received DBT PE protocol while the control group received Treatment as usual (TAU). Participants were assessed pre and post-intervention using: The short version of the Borderline Symptom list, The Trauma Symptom Checklist-40, and The Posttraumatic Cognitions Inventory. The therapeutic group started treatment with standard comprehensive DBT concurrently with DBT PE protocol (14 individual sessions, 120 minutes/ week), according to readiness criteria suggested by the treatment developer.ResultsPatients who received DBT PE protocol showed significantly lower degrees of psychological trauma symptoms and trauma-related cognitions compared to patients in control group.ConclusionsDespite being applied for the first time in Egypt, DBT PE protocol proved to be an effective intervention in reducing trauma-related symptoms in a sample of Egyptian BPD patients without any need to modify the original protocol.DisclosureNo significant relationships.

The effect of dialectical behavior therapy on anger and aggressive behavior: A systematic review with meta-analysis

Dysregulated anger, and its common behavioral urge, aggression, pose substantial costs to public health and society. Though some studies have shown DBT to be efficacious in treating aggression and anger dyscontrol, the overall effects of DBT on these outcomes are unknown. To address this limitation, a systematic review with meta-analysis was conducted on 34 studies (N = 2536) published in PsycINFO and PubMed between January 1994 and February 2022 assessing the effect of DBT on anger and/or aggression. Included studies were empirical research articles published in a peer-reviewed journal and assessed the delivery of DBT on quantitative outcome measures of anger or aggression. Included studies delivered the standard outpatient DBT program or DBT adapted for the population and treatment setting, though all studies included the core components of DBT. Risk of publication bias was assessed. Results demonstrated that DBT significantly reduced anger (Hedge's G = −0.21, 95% CI [-0.32, −0.11]) independent of study design and participant variables, though longer treatment duration was associated with greater reductions in anger. There was also a non-significant trend for DBT in reducing aggression (Hedge's G = −0.10, 95% CI [-0.21, 0.00]). Findings from this study suggest that DBT demonstrates efficacy in reducing dysregulated anger transdiagnostically.

Effectiveness of a brief dialectical behavior therapy intensive-outpatient community health program.

Standard dialectical behavior therapy (DBT), with its 12-month format, has a documented record of efficacy. While emerging evidence is supportive of DBT adaptations in community mental health settings and brief, intensive formats, many of these studies are limited by sample size of its DBT group, by omission of program completion rates and specific data from program noncompleters, and by focusing solely on symptom-focused measures-which inadvertently omits observing gains associated with well-being. We used a nonexperimental design to assess client outcomes on pathology-focused and positive-psychology measures in a brief DBT intensive-outpatient Community Mental Health Center in the midwestern United States for program graduates and program dropouts who completed at least two surveys (n = 77). This is the shortest average program length (M = 19.01 days) known for a DBT program. Scores on measures of depression (d = 0.41), anxiety (d = 0.5), stress (d = 0.5), and difficulties in emotion regulation (d = 0.51) all decreased from entrance to exit. Scores on measures of mindfulness (d = 0.43), Snyder's hope (d = 0.51), and integrative hope (d = 0.41) increased from entrance to exit. These results provide evidence that pathology decreases and measures associated with well-being increase in this brief, intensive-outpatient community health DBT program. This study provides support for future investigations of brief, intensive community health programs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Individuals who report having benefitted from dialectical behaviour therapy (DBT): a qualitative exploration of processes and experiences at long-term follow-up

BackgroundQualitative research in the area of DBT is limited, particularly at follow-up. The current study explored the follow-up experiences of individuals who previously received a diagnosis of borderline personality disorder and self-report having benefitted from DBT at the time of treatment.MethodsIndividuals who completed 12 months of standard DBT and were a minimum of two years post-completion were recruited. Individual semi-structured interviews were completed with a total of twelve participants.ResultsA thematic analysis generated three main themes which indicated that participants found DBT had a positive impact on their lives in the years after the programme and enabled further development; gave them control over their lives and the ability to manage setbacks and difficult situations; and contributed to healthier and more meaningful relationships with others.ConclusionsThe findings of this study indicated that DBT contributed positively to the participants’ lives and helped advance their recovery in the years after the programme.Despite the positive impact of DBT, participants required further support in the years following the intervention. Clinical and research implications of these findings are discussed.

Effects of dialectical behaviour therapy on reducing self-harming behaviours and negative emotions in patients with borderline personality disorder: A meta-analysis.

Dialectical behaviour therapy(DBT) has been widely used for borderline personality disorder(BPD). Existing studies are limited to behaviours such as self-harm, and the results for reducing self-harm were controversial. Few have systematically evaluated the effect of DBT on self-harming behaviours and negative emotions. This study aims to evaluate the effects of DBT on self-harming behaviours and negative emotions in patients with BPD. RCTs on DBT for BPD were searched from PubMed, Embase, etc., and the results were performed by RevMan 5.3. The meta-analysis demonstrated that DBT reduced self-harming behaviours, and alleviated depression, but had a negligible effect on suicidal ideation and anger. One subgroup revealed that standard DBT improved depression significantly, but DBT skills training improved poorly. Another subgroup revealed that there was a significant reduction in depression among patients receiving DBT for 4months to 14months, but not at 4months. Findings indicate that DBT can reduce self-harming behaviours and improve depression, but effects on suicidal ideation and anger are insignificant. Subgroup analysis suggests that standard DBT and DBT-ST lasting beyond 4months benefits on BPD. Given the quality and quantity restrictions of RCTs, more high-quality RCTs need to verify these effects.

Compliant patients with borderline personality disorder non-responsive to one-year dialectical behavior therapy: Outcomes of a second year

There is a lack of information in the literature on patients with borderline personality disorder (BPD) who do not respond sufficiently to the standard one-year dialectical behavior therapy (DBT). In this naturalistic, observational study, we compared 43 patients completing and responding to one year of DBT (m = 34.5 years, 83.7% women; first-year responders, R1) with 12 patients (m = 34.4 years, 91.7% women) with BPD who completed but did not respond clinically to the standard one-year DBT (first-year non-responders, NR1). We also followed the NR1's progress in treatment during a second consecutive year of DBT. Despite a lack of difference in clinical characteristics at baseline, progress of R1 and NR1 patients differed substantially and significantly during the first year of DBT. Over two years, the NR1 patients significantly improved on all outcome measures. However, most of the changes became significant only after 18 months of therapy. The proportion of NR1 patients attaining a Global Assessment of Functioning score > 60 after their second year of treatment was close to that of R1 patients (58.3% and 62.8%, respectively). Despite improvements in BPD symptomatology and an increased use of DBT skills, rates of reliable clinical change indicated that these NR1 patients remained vulnerable to depression and emotion regulation difficulties.

Adapting dialectical behavior therapy in Mandarin-speaking Chinese patients with borderline personality disorder: An open pilot trial in Taiwan.

Dialectical behavior therapy (DBT) is the most commonly used treatment for patients suffering from borderline personality disorder (BPD). However, data on its applications in Asian countries remain lacking. This pilot study aims to evaluate the feasibility and effectiveness of applying Mandarin-translated DBT among suicidal Chinese patients with BPD in Taiwan. An open-label trial design was implemented for the 1-year standard DBT model. Patients from a psychiatric outpatient department in a general hospital in Taiwan with a history of ≥2 episodes of suicidal behavior within the previous year and who scored >40 on the Borderline Symptom List were invited to participate in this trial. Outcomes of suicidal behaviors, severity of BPD and depression symptoms, suicidal ideation, hopelessness, and quality of life were assessed at the beginning of the treatment and every 3months until 12 months. Eighteen patients participated, three of whom (16.7%) dropped out. Significant improvements were found in the frequency and severity of suicidal behaviors and ideations, depressive symptoms, and BPD symptoms beginning as early as the third month after initiating DBT. This pilot study found that DBT may be an effective and feasible intervention for Mandarin-speaking individuals with a recent history of suicidal behaviors with BPD. Future randomized controlled trials with comparison groups are needed to further determine the efficacy of DBT on this population.

Predictors of Dropout in a Cohort of People Undergoing Treatment for Borderline Personality Disorder in a Public Community Mental Health Service: A Time-to-Event Analysis

Background: Dialectical Behaviour Therapy (DBT) is an effective evidence based treatment for Borderline Personality Disorder (BPD). However, irrespective of the success of the treatment, a dropout rate of approximately 30%-40% is regarded as the norm. In this analysis we aimed to investigate whether early predictors of dropout can be identified from baseline data. Methods: Between 2014 and 2017, data was collected from 196 participants at multiple timepoints as part of a coordinated multisite study of standard DBT treatment for community based service users being treated for BPD in Ireland. Dropout was strictly defined as per the standard DBT programme four-miss rule. For this analysis data were censored at 48 weeks and risk factors for dropout were identified using a Cox proportional hazards model that adjusted for age and gender. Engagement with phone coaching in the first month was examined as a time dependant covariate. Outcomes: Of the 196 participants, 12 (6%) were censored and 9 (4%) removed leaving 187 for analysis of whom, 109 (58%) completed and 66 (32%) dropped out. Results from univariable Cox proportional hazard regressions found off-label use of anti-psychotic medication was associated with an increased risk of drop-out, while full time employment status, receipt of disability support and engagement with phone coaching in the first month were associated with a reduced risk of dropout. Entering these variables in a multivariable Cox proportional hazard regression found off-label use of anti-psychotic medication (adjusted HR 2·69, 95% CI 1·50 - 4·83; p=0·001); full time employment status (adjusted HR 0.23, 95% CI 0.07-0.77; p=0.02) and disability (adjusted HR 0.20, 95% CI 0.05-0.85; p=0.03) remained significant predictors. Interpretation: Awareness of employment status and off-label prescription of anti-psychotic medication at baseline as significant risk factors for dropout may provide clinicians with valuable insight when starting treatment and could potentially inform treatment approach. Funding Information: This work, as part of the The National DBT Project, was funded by the Irish Health Service Executive (HSE) and the National Office for Suicide Prevention (NOSP). The fund is administered via the National Suicide Research Foundation (NSRF). Declaration of Interests: We declare no competing interests. Ethics Approval Statement: All procedures were reviewed and approved by the following research ethics committees: Clinical Research Ethics Committee of the Cork University Teaching Hospitals, Galway Clinical Research Ethics Committee, HSE Mid Western Regional Hospital Research Ethics Committee, HSE North East Area Research Ethics Committee, HSE South East Area Research Ethics Committee, Linn Dara & Beechpark Ethics Committee; Naas General Hospital Ethics Committee; Saint John of God Hospitaller Ministries Research Ethics Committee and Sligo General Hospital Research Ethics Committee.

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.

Dialectical behavior therapy in the Asia-Pacific Rim region.

Borderline personality disorder (BPD) contributes to suicide-related morbidity and mortality and requires more intensive psychotherapeutic resources due to its high mental health service usage. Accessibility to an evidence-based treatment program is a cornerstone to support patients with BPD and part of broader suicide prevention efforts as well as improving their quality of life. In this article, the authors aim to discuss and review available dialectical behavior therapy (DBT) and DBT-informed services of selected countries in the Asia-Pacific Rim, namely Singapore, Malaysia, and Mexico. We contacted providers of different services and gathered information on the process of setting up the service and adapting the treatment, in addition to reviewing the available literature published in the countries. To date, there have been a pair of DBT-informed services in Singapore, four in Malaysia, and several in Mexico with a few of them offering standard DBT. Different efforts have been put in place to increase the accessibility to training and also the number of DBT practitioners. Important considerations during the process of setting up new services include the use of domestic examples and local language that are contextually appropriate for the local community. Selected challenges faced in common include shortage of workforce, affordability of training programs, and the need for language adaptation with or without translation. Further long-term evaluation of locally adapted DBT-informed mental health services will help to elucidate the effectiveness and efficacy of the program which will potentially serve as a guide for other resource-scarce regions.

Pilot Test of a DBT-Based Parenting Intervention for Parents of Youth With Recent Self-Harm

Improving family functioning is a critical treatment target for youth at risk for suicide. The present study focused on the development and pilot testing of a brief, parent-only, Dialectical Behavior Therapy (DBT)-based intervention with N = 10 sets of parents of youth with a suicide attempt or nonsuicidal self-injury within the past 3 months. Youth received treatment as usual; however, they did not receive any treatment as part of the study. Results showed that parents who received the intervention reported reductions in parent self-reported depressive symptoms, emotion dysregulation, caregiver strain, psychiatric symptom distress and interpersonal sensitivity, from baseline to 6-month follow-up. Youth also showed decreases in total self-harm from baseline to 6-month follow-up. These results provide support for further testing of the DBT-based parenting intervention, both as a stand-alone treatment and as an adjunct to enhance the effectiveness of standard DBT for adolescents. This article provides a detailed description of the parenting protocol, as well as a case example.

Störungsspezifische Psychotherapie der Borderline-Persönlichkeitsstörung

BackgroundSeveral disorder-specific psychotherapy methods have been developed for the treatment of borderline personality disorder (BPD). For this reason people with BPD are no longer regarded as untreatable. To date, dialectical behavior therapy (DBT) according to Linehan and the mentalization-based treatment (MBT) according to Fonagy have been most intensively studied.ObjectiveThe current evidence for DBT and MBT is surveyed. In addition, adaptations of the standard DBT and MBT treatments for specific patient groups are outlined along with findings from evaluation studies.Material and methodsThe current evidence from randomized controlled trials of DBT and MBT in BPD patients is summarized based on the current Cochrane review. In addition, some relevant studies are highlighted, which showed essential new developments in this field.ResultsIn meta-analyses both DBT and MBT showed clear effects for many levels of expression of symptoms, especially BPD severity, suicidality and self-harm behavior. Several adaptations of both are now available, especially for a variety of comorbid disorders as well as adolescents and relatives of people with BPD.ConclusionThe current evidence supports the use of disorder-specific methods, such as DBT and MBT for treatment of BPD, while the study situation for other methods is still scarce. Evidence is emerging that adolescents with BPD or severe BPD symptoms can also benefit from early interventions.