Therapist Consultation Research Articles

Novel Neural Network Models for Predicting Mental Health Outcomes in the U.S. Youth Population

Anxiety and depression are two of the most pressing mental health issues, particularly among young adults. Given the success of neural networks for predictive modeling, we developed novel neural network models for classifying anxiety and depression using Substance Abuse and Mental Health Services Administration’s Mental Health Client- Level Data (SAMHSA MH-CLD) on 382,174 young adults (15 to 24 years old). The SAMHSA MH-CLD included mental health and general background data collected in 2020 for individuals reporting to state-accredited hospital service centers across the United States. The neural networks were trained on 10% randomized k-folds of the dataset and tested on the remaining 90% for each fold. We found that neural network models predicted anxiety and depression with high accuracy (91.5% to 94.2% accuracy, 8.4% to 3.1% loss), outperforming conventional statistical models. Additionally, for all tested variable sets, our neural network model outperformed expectations for the average therapist consultation (46% to 50% accuracy), as reported previously. For the optimal neural network model with the highest accuracy, the variables most correlated with anxiety and depression were age, education, gender, race, employment, marital status, and stressor events, not accounting for redundant and minimally correlated variables. The effectiveness of our neural network model indicates that it can be implemented alongside therapists in clinical environments to improve psychiatric diagnosis among young adults.

Консультация терапевтом стоматологического пациента с поражением слизистой оболочки полости рта. Когда, зачем, о чем?

Oral mucosal pathology is a significant problem in stomatology due to the complexity of a differential diagnosis and often requires the systemic therapy of it. Therefore, it is not uncommon for patients with diseases of the oral mucosa to be referred to a therapeutic physician to find the etiological factor of oral mucosa disease and to choose the systemic therapy. However, the purpose of the consultation and the capacity of the therapist’s physician in such situations may be interpreted differently by stomatologists and therapists. There is an example of the patient with lichen planus. The main tasks of the therapist consultation in this case are: to provide a general clinical examination of the possible somatic manifestations of the lichen planus autoimmune process, to evaluate the therapy to exclude possible influence some of the medication to the lesion of oral mucosal or progression lichen planus, to assess the general condition of the patient in order to select the treatment regimens using systemic corticosteroids and risk factors for the development of side effects of this therapy.

EVALUATION OF THE THERAPEUTIC ALLIANCE IN PATIENTS WITH ADHESIVES CAPSULITIS AND MYOFASCIAL PAIN SYNDROME AFTER PHYSICAL THERAPY

Abstract. The purpose of the study: to investigate the therapeutic alliance that is formed during physical therapy based on therapeutic exercises and ischemic compression in patients with adhesive capsulitis of the shoulder joint and myofascial pain syndrome in the thoracic region.
 Materials and methods. 20 patients participated in the study. None of the patients had a history of intra-articular corticosteroid injections prior to the orthopedic physician's consultation, while 7 (35%) patients received the injection after the physician's consultation prior to physical therapy. Physical therapy began after an examination and consultation with an orthopedic traumatologist. Patients received a physical therapist's consultation, during which they were given information about the specifics of performing therapeutic exercises and ischemic compression of trigger points at home through instruction, demonstration, and trial performance. The patient also received an information booklet. Later, exercises and ischemic compression were performed at home independently. The complex of therapeutic exercises included pendulum exercises and stretching exercises, which were aimed at the shoulder joint and did not aim to move the scapulothoracic joint. Planned counseling of patients by a physical therapist also took place at the beginning of the 2nd and 3rd week of therapy, and the final one at the end of the 3rd week. At all consultations, in addition to providing and clarifying information about physical therapy, information was also received from the patient about the presence of questions, thoughts and feelings related to physical therapy to prevent the existence of unanswered questions and unexpressed thoughts.
 Goniometry of the shoulder joint and assessment of pain on a numerical scale at trigger points (when applying pressure of 2.5 kg×cm-2) were used before the intervention and after three weeks of physical therapy. The first assessment of the therapeutic alliance was conducted after three weeks of physical therapy, and the second 1.5 months after the first questionnaire.
 Results. In the course of physical therapy, the indicators of movement amplitudes improved and pain in trigger points decreased statistically. The first assessment of the therapeutic alliance established that the Mе (25%; 75%) indicators of the goal domain were 16 (15; 17) points, the task domain was 15 (14; 17) points, the relationship domain was 16 (15; 17) points, and re-evaluation did not establish changes in key indicators in the distant period. The goals domain scores decreased slightly, while the task and relationship domains increased slightly. Statistical differences were established only in the eighth (in favor of the first questionnaire), ninth and twelfth points of the questionnaire (in favor of the second questionnaire).
 Conclusions. Physical therapy, which consisted of a series of consultations and independent performance of therapeutic exercises and ischemic compression, had a positive effect on the range of motion in the shoulder joint and pain in trigger points. During the three-week participation in the physical therapy program, a therapeutic alliance was formed, which the patients rated at the level of 47 (46; 48) points, and the remote assessment did not establish its changes over time.

The Effectiveness of 6 versus 12 Months of Dialectical Behavior Therapy for Borderline Personality Disorder: A Noninferiority Randomized Clinical Trial

Introduction: Evidence-based psychotherapies for borderline personality disorder (BPD) are lengthy, posing a barrier to their access. Brief psychotherapy may achieve comparable outcomes to long-term psychotherapy for BPD. Evidence is needed regarding the comparative effectiveness of short- versus long-term psychotherapy for BPD. Objective: The aim was to determine if 6 months of Dialectical Behavior Therapy (DBT) is noninferior to 12 months of DBT in terms of clinical effectiveness. Methods: This two-arm, single-blinded, randomized controlled noninferiority trial with suicidal or self-harming patients with BPD was conducted at two sites in Canada. Participants (N = 240, M (SD)_age = 28.27 (8.62), 79% females) were randomized to receive either 6 (DBT-6) or 12 months (DBT-12) of comprehensive DBT. Masked assessors obtained measures of clinical effectiveness at baseline and every 3 months, ending at month 24. DBT-6 and DBT-12 were outpatient treatments consisting of weekly individual therapy sessions, weekly DBT skills training group sessions, telephone consultation as needed, and weekly therapist consultation team meetings. Results: The noninferiority hypothesis was supported for the primary outcome, total self-harm (6 months: margin = −1.94, M_diff [95% CI] = 0.16 [−0.14, 0.46]; 12 months: margin = −1.47, M_diff [95% CI] = 0.04 [−0.17, 0.23]; 24 months: margin = −1.25, M_diff [95% CI] = 0.12 [−0.02, 0.36]). Results also supported noninferiority of DBT-6 for general psychopathology and coping skills at 24 months. Furthermore, DBT-6 participants showed more rapid reductions in BPD symptoms and general psychopathology. There were no between-group differences in dropout rates. Conclusions: The noninferiority of a briefer yet comprehensive treatment for BPD has potential to reduce barriers to treatment access.

“You Didn’t Cause Racism, and You Have to Solve it Anyways”: Antiracist Adaptations to Dialectical Behavior Therapy for White Therapists

There are currently no published studies that investigate or discuss the cultural responsiveness of Dialectical Behavior Therapy (DBT) to the needs of Black/African-American clients. In addition, no published scholarly works offer guidance to therapists on how to practice antiracism within the context of delivering evidence-based treatment. Methods for developing a culturally responsive antiracist treatment are discussed within a dialectical framework and from the perspective of critical race psychology. We propose that an antiracist adaptation to DBT is needed to correct for context minimization errors in the DBT model that create an invisibility of racism. Recommendations are made for an additional DBT Therapist Agreement that encourages labeling and targeting therapist treatment-interfering racist behavior. An additional Therapist Consultation Agreement is also proposed to guide therapist antiracist advocacy and functional validation for Black/African-American clients. The DBT technology is used in conjunction with other multicultural theoretical models to recommend strategies for developing White DBT therapists’ antiracist competencies. Future directions for developing critical race psychological research are discussed.

A Functional Approach to the Assessment and Treatment of Non-Suicidal Self-Injury in Veterans: A Dialectical Behavior Therapy–Informed Perspective

Given that non-suicidal self-injury (NSSI) is related to increased odds of suicidal ideation and suicide attempts, treating NSSI in veterans is a key treatment priority to help reduce suicide risk and increase quality of life. Treating NSSI can be difficult for clinicians and training in addressing NSSI can enhance therapist empathy and decrease negative attitudes. The current paper describes prevalence of and risk factors for NSSI in veterans and presents a Dialectical Behavior Therapy (DBT)-informed approach for arriving at a functional understanding of NSSI in order to inform assessment and treatment. This DBT-informed approach is demonstrated with two case examples of veteran clients. While in many circumstances treatment of NSSI may be most effective in the context of full model DBT (i.e., individual therapy, group skills training, phone coaching, and therapist consultation team), many aspects of the functional approach discussed herein are not specific to DBT and could therefore be integrated into behavioral analyses and case formulations conducted within non-DBT therapeutic approaches.

A Glimpse into the "Black Box": Which Elements of Consultation in an EBP are Associated with Client Symptom Change and Therapist Fidelity?

Background: Consultation is an implementation strategy that improves delivery and clinical outcomes for Cognitive Processing Therapy (CPT), an evidence-based practice (EBP) for posttraumatic stress disorder (PTSD). However, little is known about the specific components of consultation that influence the fidelity of treatment delivery or clinical outcomes. Methods: The current study examined whether specific activities performed during CPT consultation meetings were associated with better fidelity to the CPT protocol among 60 newly trained therapists or improved clinical outcomes among 135 clients treated by these therapists. Consultation activities that fall under three broad categories (discussion of the application of CPT to individual cases, review/feedback on fidelity, and technical difficulties) were measured by consultant checklists for each consultation session. Treatment fidelity (adherence to the protocol and competence of delivery) was rated by trained observers for a random sample of therapists' CPT sessions following consultation. The self-reported PTSD Checklist-IV assessed PTSD symptom change. Results: Multilevel regression analyses indicated that higher therapist consultation attendance predicted a greater decrease in their clients' PTSD symptoms and that attendance was not associated with observer-rated treatment fidelity. Discussion of the application of specific CPT strategies was the only consultation activity that was significantly associated with greater improvement in PTSD symptoms. Lastly, no consultation activities were significantly associated with treatment fidelity. Conclusions: Our findings suggest that specific consultation strategies such as emphasizing the discussion of the application of specific CPT strategies to individual cases during consultation meetings may be effective in improving the clinical outcomes of CPT.

The utility of emergency department physical therapy and case management consultation in reducing hospital admissions.

BackgroundA significant number of patients who present to the emergency department (ED) following a fall or with other injuries require evaluation by a physical therapist. Traditionally, once emergent conditions are excluded in the ED, these patients are admitted to the hospital for evaluation by a physical therapist to determine whether they should be transferred to a sub‐acute rehabilitation facility, discharged, require services at home, or require further inpatient care. Case management is typically used in conjunction with a physical therapist to determine eligibility for recommended services and to aid in placement.ObjectiveTo evaluate the benefit of using ED‐based physical therapist and case management services in lieu of routine hospital admission.MethodsRetrospective, observational study of consecutive patients presenting to an urban, tertiary care academic medical center ED between December 1, 2017, and November 30, 2018, who had a physical therapist consult placed in the ED. We additionally evaluated which of these patients were placed into ED observation for physical therapist consultation, how many required case management, and ED disposition: discharged home from the ED or ED observation with or without services, placed in a rehabilitation facility, or admitted to the hospital.ResultsDuring the 12‐month study period, 1296 patients (2.4% of the total seen in the ED) were assessed by a physical therapist. The mean age was 75.5 ± 15.2 and 832 (64.2%) were female. Case management was involved in 91.8% of these cases. The final patient disposition was as follows: admission 24.3% (95% CI = 22.1–26.7%), home discharge with or without services 47.8% (95% CI = 45.1–50.5%), rehabilitation (rehab) setting 27.9% (95% CI = 25.6%–30.4). The median (interquartile range) time in observation was 13.1 (6.0–20.3), 9.9 (1.8–15.8), and 18.4 (14.1–24.8) hours for patients admitted, discharged home, or sent to rehabilitation (P < 0.001). Among the 979 patients discharged home or sent to rehabilitation, 17 (1.7%) returned to the ED within 72 hours and were ultimately admitted.ConclusionGiven that the standard of care would otherwise be an admission to the hospital for 1 day or more for all patients requiring physical therapist consultation, an ED‐based physical therapy and case management system serves as a viable method to substantially decrease hospital admissions and potentially reduce resource use, length of hospital stay, and cost both to patients and the health care system.

Effects of Low-Dose Therapist-Led Self-Exercise Education on the Management of Chronic Low Back Pain: Protocol for a Community-Based, Randomized, 6-Month Parallel-Group Study.

Introduction Chronic low back pain (CLBP), defined as low back pain persisting for at least 3 months, leads to limitations in the activities of daily living and decreased quality of life. Individualized self-exercise education could be a preferable treatment option, especially in community-dwelling people with CLBP. Previous studies, however, did not directly compare the effects of therapist-led self-exercise education and material-only education, and there are only a few studies investigating the effects of low-dose (comprising a few sessions) self-exercise education on CLBP. We present a protocol of community-based, randomized study to evaluate the effects of low-dose (comprising a few sessions), therapist-led self-exercise education on CLBP. Methods Forty-eight participants with CLBP (men and women, aged 40-74 years) will be allocated to therapeutic self-exercise education programs, either a therapist-led group (2-week therapist's consultation and material use) or material-only group (material use only), in a randomized controlled trial. Pain intensity (NRS, numeric rating scale), pain disability (RDQ, Roland-Morris disability questionnaire), pain self-efficacy (PSEQ, pain self-efficacy questionnaire), and quality of life score (EQ-5D, European quality of life-5 dimensions) will be measured at baseline and at 4, 12, and 24 weeks. We will apply a repeated-measures design with mixed-effect models to estimate group differences from the baseline. Ethics/Trial registration number: The protocol was approved by the Ethics Committees of the Osaka Center for Cancer and Cardiovascular Disease Prevention and Osaka University. The trial registration number is registered on the University Hospital Medical Information Network (UMIN000024537).

Dialectical Behavior Therapy in the Treatment of Borderline Personality Disorder

DBT is the first and the most studied CBT approach in the treatment of BPD. It is a modular manualized treatment program developed for suicidal women most of who were noticed to meet the criteria for borderline personality disorder. The theory behind DBT is called the biosocial theory. The theory suggests that biological factors such as being born with an emotionally vulnerable temperament and social or environmental factors play roles in the development of BPD. DBT attend to the balance of acceptance-based and change-based strategies. This is the “teeter-totter” on which the therapist rests. DBT consists of five modes of treatment, which are the individual therapy, skills training, telephone consultation, therapist consultation team and ancillary treatments. If we think CBT as a technology of change based on the techniques of field of learning, DBT is more like balancing change with acceptance. On the other hand, cognitive modification program applied in DBT is driven from CBT. DBT can be applied to various settings and populations successfully. The main advantage of DBT is its low drop-out rates. Even though more research should be conducted on its generalizability, it proved itself as one of the successful treatments since it has been widely used by therapists with different treatment approaches.

Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide

Suicide is a leading cause of death among 10- to 24-year-old individuals in the United States; evidence on effective treatment for adolescents who engage in suicidal and self-harm behaviors is limited. To evaluate the efficacy of dialectical behavior therapy (DBT) compared with individual and group supportive therapy (IGST) for reducing suicide attempts, nonsuicidal self-injury, and overall self-harm among high-risk youths. This randomized clinical trial was conducted from January 1, 2012, through August 31, 2014, at 4 academic medical centers. A total of 173 participants (pool of 195; 22 withdrew or were excluded) 12 to 18 years of age with a prior lifetime suicide attempt (≥3 prior self-harm episodes, suicidal ideation, or emotional dysregulation) were studied. Adaptive randomization balanced participants across conditions within sites based on age, number of prior suicide attempts, and psychotropic medication use. Participants were followed up for 1 year. Study participants were randomly assigned to DBT or IGST. Treatment duration was 6 months. Both groups had weekly individual and group psychotherapy, therapist consultation meetings, and parent contact as needed. A priori planned outcomes were suicide attempts, nonsuicidal self-injury, and total self-harm assessed using the Suicide Attempt Self-Injury Interview. A total of 173 adolescents (163 [94.8%] female and 97 [56.4%] white; mean [SD] age, 14.89 [1.47] years) were studied. Significant advantages were found for DBT on all primary outcomes after treatment: suicide attempts (65 [90.3%] of 72 receiving DBT vs 51 [78.9%] of 65 receiving IGST with no suicide attempts; odds ratio [OR], 0.30; 95% CI, 0.10-0.91), nonsuicidal self-injury (41 [56.9%] of 72 receiving DBT vs 26 [40.0%] of 65 receiving IGST with no self-injury; OR, 0.32; 95% CI, 0.13-0.70), and self-harm (39 [54.2%] of 72 receiving DBT vs 24 [36.9%] of 65 receiving IGST with no self-harm; OR, 0.33; 95% CI, 0.14-0.78). Rates of self-harm decreased through 1-year follow-up. The advantage of DBT decreased, with no statistically significant between-group differences from 6 to 12 months (OR, 0.65; 95% CI, 0.12-3.36; P = .61). Treatment completion rates were higher for DBT (75.6%) than for IGST (55.2%), but pattern-mixture models indicated that this difference did not informatively affect outcomes. The results of this trial support the efficacy of DBT for reducing self-harm and suicide attempts in highly suicidal self-harming adolescents. On the basis of the criteria of 2 independent trials supporting efficacy, results support DBT as the first well-established, empirically supported treatment for decreasing repeated suicide attempts and self-harm in youths. ClinicalTrials.gov Identifier: NCT01528020.

Dialectical behavior therapy skills training: Paving the way to healthy relationships

Dialectical behavior therapy (DBT) is a comprehensive multiple mode cognitive-behavioral treatment. It includes weekly individual therapy, weekly group skills training, and as-needed phone coaching along with therapist consultation team meetings. DBT skills training is a central component of DBT effectiveness. Skills training programs have been reported to be effective in different populations, such as health care professionals, caregivers of the elderly, and college students. Skills training has also been effective to treat individuals with a range of mental disorders. The overall objective of the workshop is to describe a set of behavioral, cognitive and dialectical skills which can facilitate the development and maintenance of healthy relationships. Participants will be able to apply the principles of dialects, validation and behavioral analysis to their thoughts and actions; be able to develop effective communication; and find a kernel of truth in other people’s views. The skills presented are important for individuals with or without a diagnosis of mental disorder, and they can be helpful in any relationship. There are three skill sets: dialectics, validation, and behavior change strategies. Taken together, the skills focus on balancing our own priorities with the demands of others in interpersonal relationships. During the ninety-minute interactive workshop, skills will be presented alongside individual and small group exercises given by one presenter. The language of the workshop will be English, however questions can be asked in French, Spanish or Portuguese and will be answered in English.

Video Game Rehabilitation for Outpatient Stroke (VIGoROUS): protocol for a multi-center comparative effectiveness trial of in-home gamified constraint-induced movement therapy for rehabilitation of chronic upper extremity hemiparesis

BackgroundConstraint-Induced Movement therapy (CI therapy) is shown to reduce disability, increase use of the more affected arm/hand, and promote brain plasticity for individuals with upper extremity hemiparesis post-stroke. Randomized controlled trials consistently demonstrate that CI therapy is superior to other rehabilitation paradigms, yet it is available to only a small minority of the estimated 1.2 million chronic stroke survivors with upper extremity disability. The current study aims to establish the comparative effectiveness of a novel, patient-centered approach to rehabilitation utilizing newly developed, inexpensive, and commercially available gaming technology to disseminate CI therapy to underserved individuals. Video game delivery of CI therapy will be compared against traditional clinic-based CI therapy and standard upper extremity rehabilitation. Additionally, individual factors that differentially influence response to one treatment versus another will be examined.MethodsThis protocol outlines a multi-site, randomized controlled trial with parallel group design. Two hundred twenty four adults with chronic hemiparesis post-stroke will be recruited at four sites. Participants are randomized to one of four study groups: (1) traditional clinic-based CI therapy, (2) therapist-as-consultant video game CI therapy, (3) therapist-as-consultant video game CI therapy with additional therapist contact via telerehabilitation/video consultation, and (4) standard upper extremity rehabilitation. After 6-month follow-up, individuals assigned to the standard upper extremity rehabilitation condition crossover to stand-alone video game CI therapy preceded by a therapist consultation. All interventions are delivered over a period of three weeks. Primary outcome measures include motor improvement as measured by the Wolf Motor Function Test (WMFT), quality of arm use for daily activities as measured by Motor Activity Log (MAL), and quality of life as measured by the Quality of Life in Neurological Disorders (NeuroQOL).DiscussionThis multi-site RCT is designed to determine comparative effectiveness of in-home technology-based delivery of CI therapy versus standard upper extremity rehabilitation and in-clinic CI therapy. The study design also enables evaluation of the effect of therapist contact time on treatment outcomes within a therapist-as-consultant model of gaming and technology-based rehabilitation.Trial registrationClinicaltrials.gov, NCT02631850.

Dialectical behavior therapy as treatment for borderline personality disorder.

Dialectical behavior therapy (DBT) is a structured outpatient treatment developed by Dr Marsha Linehan for the treatment of borderline personality disorder (BPD). Dialectical behavior therapy is based on cognitive-behavioral principles and is currently the only empirically supported treatment for BPD. Randomized controlled trials have shown the efficacy of DBT not only in BPD but also in other psychiatric disorders, such as substance use disorders, mood disorders, posttraumatic stress disorder, and eating disorders. Traditional DBT is structured into 4 components, including skills training group, individual psychotherapy, telephone consultation, and therapist consultation team. These components work together to teach behavioral skills that target common symptoms of BPD, including an unstable sense of self, chaotic relationships, fear of abandonment, emotional lability, and impulsivity such as self-injurious behaviors. The skills include mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. Given the often comorbid psychiatric symptoms with BPD in patients participating in DBT, psychopharmacologic interventions are oftentimes considered appropriate adjunctive care. This article aims to outline the basic principles of DBT as well as comment on the role of pharmacotherapy as adjunctive treatment for the symptoms of BPD.

IOM REPORT ON PSYCHOSOCIAL INTERVENTIONS: COMMENTARY FROM A DBT PERSPECTIVE.

IOM REPORT ON PSYCHOSOCIAL INTERVENTIONS: COMMENTARY FROM A DBT PERSPECTIVE.

Dialectical behavior therapy for adolescent binge eating, purging, suicidal behavior, and non-suicidal self-injury: a pilot study.

There are few published randomized controlled trials examining treatment for symptoms of bulimia nervosa (BN) in adolescents. Additionally, many adolescents presenting for treatment for BN symptoms endorse co-occurring mood disturbances, suicidality, and nonsuicidal self-injury (NSSI), and may not meet full Diagnostic and Statistical Manual-IV-Text Revision (DSM-IV-TR) diagnostic criteria for BN. In addition to the limited number of randomized controlled trials, published treatment studies of BN symptoms in adolescence do not specifically address the multiple comorbid symptoms that these adolescents often report. The purpose of this pilot study was to examine the feasibility and effectiveness of an outpatient dialectical behavior therapy (DBT) program for adolescents with symptoms of BN, suicide attempts, and NSSI. Ten eligible participants enrolled in the study; 3 dropped within 4 weeks of initiating treatment. In addition to binge eating and suicidal behavior, participants also endorsed a number of other comorbid mood disorders and substance abuse. Seven participants completed 6 months of treatment and 6-month follow-up assessments. Treatment included access to a crisis management system, individual therapy, skills training, and a therapist consultation team. At posttreatment, participants had significantly reduced self-harm; (Cohen's d = 1.35), frequency of objective binge episodes (Cohen's d = .46), frequency of purging (Cohen's d = .66), and Global Eating Disorder Examination scores (Cohen's d = .64). At follow-up, 6 participants were abstinent of NSSI; 3 participants were abstinent from binge eating. At follow-up, treatment gains were maintained and enhanced. Results indicate that it is feasible to address multiple forms of psychopathology during the treatment of BN symptoms in this age-group.

Compliance to Dbt Skills Training Among a Sample of Egyptian Female Patients with Borderline Personality Disorder

Introduction Dialectical Behavior Therapy (DBT) is a comprehensive psychosocial treatment developed by Marsha Linehan and originally designed for persons meeting criteria for Borderline Personality Disorder (BPD). DBT contains four treatment modes that are deigned to address core problems of BPD. The four modes of treatment include individual therapy, skills training group, phone consultation and therapist consultation meeting. The skills training group is organized as 120-150 minutes group, weekly, for 6 months. Four modules are taught across the six months period which are core mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. Although psychotherapeutic interventions are always the first line of treatment for BPD in most guidelines but adherence to therapy have been always a major problem. Objectives Assessment of patient's compliance to DBT skills training group. Aim The aim of the current study was to estimate drop out rate in the first Egyptian DBT skills training group over one year. Methods Fifteen female patients diagnosed with BPD were recruited to DBT skills training over one year. Drop out rates were calculated based on the rule of being out of therapy if the patient misses four consecutive sessions for no obvious reason. Results Three patients only out of 15 dropped out of treatment (20%). Twelve patients could complete the full six month DBT skills training or are still currently engaged in treatment. Conclusion Although this was the first time to teach DBT skills in Arabic, DBT skills training group among Egyptian female patients with BPD had a high compliance rates.

The Course and Evolution of Dialectical Behavior Therapy.

Dialectical behavior therapy was originally developed from early efforts to apply standard behavior therapy to treat individuals who were highly suicidal. Its development was a trial and error effort driven primarily from clinical experience. Dialectical behavior therapy is a modular and hierarchical treatment consisting of a combination of individual psychotherapy, group skills, training, telephone coaching, and a therapist consultation team. The inherent modularity and hierarchical structure of DBT has allowed for relative ease in adapting and applying the treatment to other populations and settings. New skills have been developed and/or modified due to clinical need and/or advancement in research such as treatment outcomes or mechanisms. There has been an effort to implement DBT skills as a standalone treatment. More research is needed to assess how DBT skills work and for whom. As DBT broadens its reach, the treatment will continue to grow and adapt to meet demands of an evolving clinical landscape.

Benign Paroxysmal Positional Vertigo in the Acute Hospital Setting

Introduction: Dizziness is a common and nonspecific complaint leading to a growing number of emergency department visits and hospital admissions following trauma associated with a fall. Otovestibular conditions constitute a significant proportion of dizziness cases. Common treatable peripheral vestibular disorders, including benign paroxysmal positional vertigo (BPPV), that may go unrecognized may be diagnosed using inexpensive bedside tests. Case Description: Two patients were consulted to have a vestibular rehabilitation therapy evaluation performed by physical therapy in the acute care department as both subjectively described BPPV. The first patient was treated using conventional techniques and application of evidence-based guidelines for BPPV intervention. However, orthopedic/pain limitations restricted traditional examination techniques for the second patient allowing consideration of a novel approach to carrying out the examination. Discussion: The first patient was treated successfully for BPPV remission using emerging clinical practice guidelines. The clinical evaluation of the second patient was nonsignificant; however, the presentation illustrates how traditional vestibular assessment techniques can be modified in a novel way in the acute care setting based on recent biophysical scientific evidence. Conclusion: This case study found that evidence-based practice guidelines as well as application of a biophysical scientific knowledge base can be applied into the acute care vestibular rehabilitation examination using primarily different configurations of a hospital bed only. Positive outcomes hold the unique potential of physical therapist consultation services throughout acute and inpatient environments, as well as setting a clinical precedent for future patients presenting with previously unrecognized BPPV.

An overview of dialectical behavior therapy for professional psychologists.

Dialectical Behavior Therapy (DBT) is a comprehensive psychosocial treatment originally designed for individuals meeting criteria for borderline personality disorder (BPD). The purpose of this article is to provide an overview of the principles and techniques of DBT for BPD, summarize current research, and discuss the implications for psychologists who wish to implement DBT. The four modes in DBT (individual therapy, skills training, as-needed consultation between sessions, and therapist consultation meetings) are reviewed. The three overarching theories that guide and help organize DBT treatment (biosocial theory, behavioral theory, and dialectical philosophy) are also summarized. DBT has been the subject of much research and has been adapted for different settings, disorders, and populations, including substance abuse and BPD, eating disorders, treatment-resistant depression, ADHD, and forensic settings. This research is critically reviewed. Finally, we examine the implications and applications for practicing psychologists who seek training in DBT and work in independent practice.