Use Of Dialectical Behavior Therapy Research Articles

Dialectical behaviour therapy skills training: A feasibility study with active duty military

LAY SUMMARYThis study looked at the use of dialectical behaviour therapy (DBT) skills group training with military personnel. DBT skills group training teaches coping skills to manage emotions; it has been well researched and used effectively with civilians and Veterans, but less is known about its use with military personnel. The General Mental Health (GMH) clinic receives a large volume of referrals for military personnel who have difficulty with coping skills and managing emotions. On the basis of previous research, a modified DBT skills group therapy program was developed for the clinic to offer an efficient, effective treatment program for these clients in this busy clinic. Military personnel may be a particularly good fit for this type of group-based treatment because they are familiar with working in small group settings. This treatment can also allow for a timelier return to work, minimizing interruptions to military deployments and operations. Study results showed that program participants had lower levels of depression and a greater ability to manage emotions and cope more effectively after the program. Treatment gains were largely maintained at six-month follow-up. This research suggests that DBT skills group training may be an effective treatment for military personnel.

Exploring skill utilization as a mechanism of dialectical behavioral therapy among adults with eating disorders in a partial hospitalization program

Research supports the use of dialectical behavior therapy (DBT) for patients with eating disorders (EDs). The DBT skills deficit model suggests that individuals engage in maladaptive behaviors to reduce or avoid strong emotions due to lack of knowledge or mastery of more effective methods to regulate distress. A primary component of DBT is teaching patients skills to cope with emotional dysregulation. Building upon previous research, this study examined whether change in DBT skills use frequency mediated the relationship between emotion dysregulation and ED symptoms across ED diagnoses, in a sample of treatment-seeking adults with EDs ( N = 454). Variables were measured at treatment admit, one-month post-admission, and discharge. Bootstrapped mediation analyses were used and biased-corrected 95% confidence intervals (CIs) were computed. Increases in DBT skills use mediated the association between emotion dysregulation and ED psychopathology (95% CI [−.0022, −.0002]), but not change in binge eating (95% CI [−.0034, .0001]) or self-induced vomiting (95% CI [−.0032, .0006]). The index of moderated mediation for all outcomes indicated the simple mediation model did not significantly differ as a function of diagnosis type. Results provide support for the DBT skills deficit model in an ED sample and suggest that DBT improves ED psychopathology by increasing frequency of using effective coping skills.

A Narrative Review on Dialectical Behavior Therapy for Patients with Depressive Difficulties

Background: Dialectical behavior therapy (DBT) is a type of cognitive behavioral therapy (CBT) that was earlier intended to treat only patients with borderline personality disorder (BPD), but researchers have found DBT to treat several psychological disorders, including depression. Aim: The article aims to review the clinical shreds of evidence regarding the use of DBT to treat depression. Methods: PubMed literature search was done by applying the year filter range, 2010 to 2021. Another filter applied was “Randomized controlled trial”, so that the strength of evidence could be enhanced. The keywords used were “Dialectical Behavior Therapy” AND “Depression”. Results: 33 articles were found, out of which only 20 relevant articles were reviewed. DBT was found to alleviate depressive symptoms associated with different psychological disorders like bipolar disorder and BPD but the number of studies that validated the aforementioned were less than those studies which showed that DBT had no significant effect on the patients with depressive difficulties. The long-term effect of DBT for treating depression is under suspect, as studies showed that DBT got ineffective during the follow-ups. Conclusion: DBT shows benefits in depression, but further studies are still required to validate this concretely as DBT did not show a significant effect when compared to its control counterparts. There is much need for future studies which can evaluate the long-term efficacy of DBT in depression, which is another challenging area because follow-up data did not favor DBT.

An Open Trial Examining Dialectical Behavior Therapy Skills and Behavioral Weight Loss for Adults With Emotional Eating and Overweight/Obesity

Third-wave cognitive behavioral interventions for weight loss have shown promise. However, sparse data exists on the use of dialectical behavior therapy for weight loss. Adapted dialectical behavior therapy skills programs may be especially well suited for adults who engage in emotional eating and are seeking weight loss. Dialectical behavior therapy is skills-based, shares theoretical links to emotional eating, and is effective in treating binge eating. The current study examined the feasibility, acceptability, and preliminary efficacy of Live FREE: FReedom from Emotional Eating, a 16-session group-based intervention. A total of 87 individuals expressed interest in the program, and 39 adults with overweight/obesity (BMI ≥25) and elevated self-reported emotional eating were enrolled. Live FREE targeted emotional eating in the initial sessions 1–9, and sessions 10–16 focused primarily on behavioral weight loss skills while continuing to reinforce emotion regulation training. Assessments were administered at baseline, posttreatment, and 6-month follow up. Enrolled participants were primarily female (97.4%) and Caucasian (91.7%). Treatment retention was strong with participants attending an average of 14.3 sessions and 89.7% of participants completing the intervention. On average, participants lost 3.00 kg at posttreatment, which was maintained at follow-up. Intent-to-treat analyses showed improvements in key outcome variables (self-reported emotional eating, BMI, emotion regulation) over the course of the intervention. Combining dialectical behavior therapy skills with conventional behavioral weight loss techniques may be an effective intervention for adults with overweight/obesity who report elevated emotional eating.

How to Treat Childhood Sexual Abuse Related PTSD Accompanied by Risky Sexual Behavior: A Case Study on the Use of Dialectical Behavior Therapy for Posttraumatic Stress Disorder (DBT-PTSD)

Childhood and adolescent sexual abuse (CSA) is a traumatic experience associated with a variety of short- and long-term negative consequences. Theoretical models assume that an abuse related and learned distorted image of sexuality might lead CSA survivors to feel obligated to provide sex or engage in unwanted sexual practices in order to gain affection or prevent abandonment. Dialectical behavioral therapy for posttraumatic stress disorder (DBT-PTSD) is tailored to people with PTSD and comorbid emotion regulation deficits. This case study presents the results of an outpatient DBT-PTSD treatment of an adult patient with posttraumatic stress disorder following sexual and physical abuse. DBT-PTSD was used to treat the patient’s complex psychopathological problems and to decrease her risky sexual behavior, which manifested itself in highly dangerous sexual practices with her partner. The treatment took place over a period of 18 months, with a total of 72 sessions. At the end of the treatment, the patient no longer met criteria for PTSD as indicated by large reductions in the assessments used. Furthermore, she managed to distance herself from risky sexual practices and to remain in a satisfying relationship.

Applying Dialectical Behavior Therapy to Self‐Harm in College‐Age Men: A Case Study

Researchers suggest an increase in self‐harm among men. Specifically, college‐age men appear to be at risk for self‐harming behaviors, and counselors often overlook these behaviors in treatment. In this article, the authors describe the issue of self‐harm and illustrate the use of dialectical behavior therapy (DBT; Linehan, ) with male college students. The authors use a case study to illustrate the use of a modified form of DBT with a male college student who self‐harmed. Limitations of this approach and implications for college counselors are also addressed.

A pilot study to explore the adaptation of a Dialectical Behaviour Therapy pathway for use with adults with intellectual disabilities within a community service

There is a lack of evidence to support the use of Dialectical Behaviour Therapy (DBT) for people with intellectual disabilities (ID) living in the community with no history of forensic involvement. This study evaluates a DBT pilot programme for those with ID within a community setting. Four participants took part over a period of six months. The research focuses on ways in which a DBT programme can be adapted for this population and discusses the suitability of outcome measures used to evaluate the intervention (Cognitive and Affective Mindfulness Scale-Revised, Difficulties in Emotional Regulation Scale and Health of the Nation Outcome Scales for People with Learning Disabilities). All four participants completed the pilot programme. Results were not found to be significant. However, there is evidence of small improvement on the HoNOS-LD measure. The findings support the need for larger scale studies and outcome measures appropriate for use for those with ID.

The "What" and "Hows" of Mindfulness: Using DBT's Mindfulness Skills to Reduce Test Anxiety

Background: Many studies have shown the positive effects of extended mindfulness interventions on anxiety reduction in several different populations; however, few have yet to examine the effects of mindfulness interventions on test anxiety in a college student population.Aim: This study assesses the effects of overall test anxiety reduction through the use of Dialectical Behavior Therapy's (DBT's) mindfulness skills over an eight-week period among college students.Methods: Participants included 16 college students that were trained in mindfulness, which included an eight-week mindfulness training using DBT's "What" and "How" skills of the mindfulness module. Participants were assessed on text anxiety, general anxiety, and mindfulness at the beginning, mid-way point, and end of the study. A weekly schedule of mindfulness practices was given to participants to complete on their own at home.Results: Participants showed significant within-group reductions in test anxiety from the start of the study (Mean = 56, SD = 11.47) to the end of the study (Mean = 37.56, SD = 9.98).Conclusions: It is likely a mindfulness intervention that specifically teaches the “What” and “How” skills of DBT can help students reduce not only test anxiety, but overall anxiety, as well as increase individual levels of mindfulness based on the self-reported mindfulness questionnaire. Further research is needed to more definitively assess these results matched against a wait-list control group.

Adapting dialectical behaviour therapy for binge eating disorder: A pilot study

Historically, binge eating disorder has not been treated within the Forth Valley Eating Disorder Service; these patients are often referred directly to weight management services, which can result in poor outcomes. The use of dialectical behaviour therapy for patients with binge eating disorder has developed recently and, as part of the Eating Disorder Service in Forth Valley, an adapted dialectical behaviour therapy treatment programme has been piloted prior to patients progressing on to the weight management service, to find out if an adapted dialectical behaviour therapy group can help patients with binge eating disorder reduce bingeing behaviour and improve quality of life.

Dialectical Behaviour Therapy [DBT] with People with Intellectual Disabilities: A Systematic Review and Narrative Analysis

There is mixed evidence regarding the effectiveness of psychological therapies for people with intellectual and developmental disorders. Although systematic reviews have supported the use of dialectical behaviour therapy with people with borderline personality disorder, there are no comparable reviews regarding DBT with people with intellectual and development disabilities. Studies were identified using a systematic approach and were selected if they reported an intervention that included a DBT skills group and then assessed using the Evaluative Method for Determining Evidence Based Practice. Seven studies reported adaptations and outcomes of DBT for people with intellectual and development disabilities, four of which delivered full DBT programmes with three describing DBT skills groups. All studies were appraised with regard to methodological quality and the adaptations and results examined. The findings indicate that DBT and DBT skills groups can be adapted for people with intellectual and development disabilities, but further high-quality research is needed to make conclusions about efficacy and effectiveness.

Psychosocial interventions following self-harm in adults: a systematic review and meta-analysis

Self-harm (intentional acts of non-fatal self-poisoning or self-injury) is common, particularly in young adults aged 15-35 years, often repeated, and strongly associated with suicide. Effective aftercare of individuals who self-harm is therefore important. We have undertaken a Cochrane systematic review and meta-analysis of the effectiveness of psychosocial interventions for self-harm in adults. We searched five electronic databases (CCDANCTR-Studies and References, CENTRAL, MEDLINE, Embase, and PsycINFO) between Jan 1, 1998, and April 29, 2015, for randomised controlled trials of psychosocial interventions for adults after a recent (within 6 months) episode of self-harm. Most interventions were assessed in single trials. We report results for interventions for which at least three randomised controlled trials comparing interventions with treatment as usual have been published and hence might contribute to clinical guidance. The primary outcome was repetition of self-harm at the conclusion of treatment and at 6, 12, and 24 months' follow-up analysed, when available, with the intention-to-treat method; if this was not possible, we analysed with all available case data. We identified 29 non-overlapping randomised controlled trials with three independent trials of the same intervention. Cognitive-behavioural-based psychotherapy (CBT; comprising cognitive-behavioural and problem-solving therapy) was associated with fewer participants repeating self-harm at 6 months' (odds ratio 0·54, 95% CI 0·34-0·85; 12 trials; n=1317) and at 12 months' follow-up (0·80, 0·65-0·98; ten trials; n=2232). There were also significant improvements in the secondary outcomes of depression, hopelessness, suicidal ideation, and problem solving. Patients receiving dialectical behaviour therapy (in three trials) were not less likely to repeat self-harm compared with those provided with treatment as usual at 6 months (odds ratio [OR] 0·59, 95% CI 0·16-2·15; n=267, three trials) or at 12 months (0·36, 0·05-2·47; n=172, two trials). However, the secondary endpoint of frequency of self-harm was associated with a significant reduction with use of dialectical behaviour therapy (mean difference -18·82, 95% CI -36·68 to -0·95). Four trials each of case management (OR 0·78, 95% CI 0·47-1·30; n=1608) and sending regular postcards (OR 0·87, 95% CI 0·62-1·23; n=3277) did not reduce repetition of self-harm. CBT seems to be effective in patients after self-harm. Dialectical behaviour therapy did not reduce the proportion of patients repeating self-harm but did reduce the frequency of self-harm. However, aside from CBT, there were few trials of other promising interventions, precluding firm conclusions as to their effectiveness. National Institute for Health Research.

Outpatient Dialectical Behavior Therapy for Adolescents Engaged in Deliberate Self-Harm: Conceptual and Methodological Considerations.

The current review examines conceptual and methodological issues related to the use of dialectical behavior therapy for adolescents (DBT-A) in treating youth who engage in deliberate self-harm. A comprehensive review of the literature identified six studies appropriate for the review. Results indicated several inconsistencies and limitations across studies including the mixing of various forms of self-harm; variations in diagnostic inclusion/exclusion criteria, insufficient use of standardized self-harm outcome measures, variable lengths and intensity of provided treatment, and inadequate attention paid to DBT adherence. Each of these areas is reviewed along with a discussion of ways to improve the quality of future research.

It Takes a Borderline Village

It Takes a Borderline Village

Evidence-based practice in group work with incarcerated youth

As a result of the Youth Criminal Justice Act's increased focus on restorative justice, treatment, rehabilitation, and reintegration of youth, many more juvenile offenders require mental health services while resident in youth detention facilities [Youth Criminal Justice Act (2002, c.1). Ottawa: Department of Justice Canada. Retrieved September 19, 2008 from http://laws.justice.gc.ca/en/Y-1.5]. Several common characteristics such as violence, aggression, and other antisocial behaviors, associated with criminal behavior, have been identified among male and female offenders. Dialectical behavior therapy, originally developed by Linehan [Linehan, M. M., 1993a. Cognitive–behavioural treatment of borderline personality disorder. New York: Guildford Press] for chronically parasuicidal women diagnosed with borderline personality disorder, has been successfully modified for use with other populations, including violent and impulse-oriented male and female adolescents residing in correctional facilities. The intent of this article is to encourage the wider use of dialectical behavior therapy (DBT) with young offenders. It includes an extensive review of the evidence-base to date and describes some of the creative modifications that have been made to standard DBT program format to meet the particular needs of various groups in both Canada and the United States. In keeping with the movement toward more evidence-based practice, the authors argue that DBT is a promising approach in group work with incarcerated adolescents and should be more widely used.

Psychological treatment of self‐injury among adolescents

Self-injury is a dangerous and pervasive behavior problem among adolescents. Clinical trials testing the effectiveness of psychological treatments for this behavior problem among adolescents are lacking; however, several treatments have shown promise, such as those focused on teaching emotion regulation, distress tolerance, and interpersonal skills. The authors provide a case illustration of the use of dialectical behavior therapy, which is one of the most promising treatments for adolescent self-injury. They then discuss several important considerations in the treatment of self-injury, such as the use of strategies to increase treatment participation and the assessment of self-injury and related target behaviors over the course of treatment to determine its effectiveness and to manage risk of self-injury.

Use of Dialectical Behavior Therapy in Borderline Personality Disorder: A View From Residency

The authors describe the use of dialectical behavior therapy (DBT) in treating borderline personality disorder during psychiatry residency, and assess the status of DBT education within psychiatry residencies in the United States. The authors present a patient with borderline personality disorder treated by a resident using DBT, along with perspectives from the resident's supervisors. Additionally, self-report surveys inquiring about the attitudes and experiences of residency directors and PGY-4 residents regarding DBT were sent to program directors with available e-mail addresses on FREIDA online. The DBT method employed by the resident had to be modified to fit the constraints of a residency program. The patient in therapy had a tumultuous course, ultimately resulting in the discontinuation of treatment. Survey results suggested an underemphasis on the education and use of DBT during residency, though the strength of this conclusion is limited by the small proportion of surveys returned. Achieving the efficacy of DBT-based treatment of borderline personality disorder reported in the literature in the setting of a residency program is challenging. Greater exposure to DBT during residency may increase residents' skills in using the technique and the likelihood that they will use it after residency.

Managing the ‘unmanageable’: Training staff in the use of dialectical behaviour therapy for borderline personality disorder

Ninety-four staff from a regionally based mental health service and associated health and human services completed a two-day workshop introducing dialectical behaviour therapy, with a smaller number also undertaking advanced training. Survey and focus group data were collected on participants’ demographics, attitudes, knowledge and experience of working with persons with this disorder, prior to and at one-month and six-months following completion of the introductory workshops. Quantitative and qualitative findings indicated that involvement in the training program was a positive experience for the majority of participants, with knowledge regarding detection and treatment and staff attitudes toward consumers being improved following exposure to the principles and practice of dialectial behaviour therapy. Discourse analysis of the focus group interview data pre- and post-training indicated a significant shift in the meanings staff associate with borderline personality disorder, with a pervasive therapeutic pessimism being displaced by more optimistic understandings and outlooks. Improved therapeutic outlook is likely to have positive implications for staff engagement with service users with borderline personality disorder. While this article proCvides a brief overview of the findings of the survey, the main purpose is to reporNt the findings of the focus group interviews.

Preliminary Outcomes on the Use of Dialectical Behavior Therapy to Reduce Hospitalization Among Adolescents in Residential Care

ABSTRACT Dialectical behavior therapy (DBT), a form of cognitive-behavioral therapy, has been shown in clinical trials to be an effective treatment for clients who suffer from borderline personality disorder or borderline-type behaviors. Although originally developed as an outpatient model, DBT is increasingly being applied in other settings. This article describes the use of DBT in a residential treatment facility for adolescent girls. Analyses of the time periods before and after the implementation of DBT indicate that DBT was effective in achieving a significant reduction in both premature terminations due to suicidality, and in the number of days clients spent in psychiatric hospitals due to self-injurious behaviors. Overall, DBT has proven to be extremely useful in the treatment of chronically suicidal adolescents placed into residential care.

Recurrent Suicide Attempts, Self-Mutilation, and Binge/Purge Behavior: A Case Report

The last decade has seen an explosive growth in the use of dialectical behavior therapy (DBT) for the treatment of borderline personality disorder (BPD). This combined individual and group therapy blends elements of learning theory, cognitive-behavioral therapy, self-psychology, and Zen Buddhism in a coherent, teachable, replicable fashion to achieve significantly lower rates of self-injurious behavior among patients with BPD. Moreover, it has increased interest among clinicians in treating this often-challenging group of patients. The following is a case report of a chronically suicidal woman treated using the DBT model in multiple settings (outpatient, partial hospital, and group home). Case material is presented along with sufficient explanation to allow readers unfamiliar with DBT to follow the formulation and interventions. Rather than being written by multiple authors, this report summarizes the experience of one clinician in presenting her clinical work to a group of nationally recognized senior DBT clinicians at the University of Washington in Seattle,* where this form of treatment originated.

Dialectical behavior therapy for binge eating disorder.

This study evaluated the use of dialectical behavior therapy (DBT) adapted for binge eating disorder (BED). Women with BED (N = 44) were randomly assigned to group DBT or to a wait-list control condition and were administered the Eating Disorder Examination in addition to measures of weight, mood, and affect regulation at baseline and posttreatment. Treated women evidenced significant improvement on measures of binge eating and eating pathology compared with controls, and 89% of the women receiving DBT had stopped binge eating by the end of treatment. Abstinence rates were reduced to 56% at the 6-month follow-up. Overall, the findings on the measures of weight, mood, and affect regulation were not significant. These results support further research into DBT as a treatment for BED.