1,720,978 research outputs found
Dialectical behavior therapy for pervasive emotion dysregulation: Theoretical and practical underpinnings
No full textDialectical behavior therapy for borderline personality disorder
No full textSince the introduction of Linehan's treatment manuals in 1993, dialectical behavior therapy (DBT) has been widely disseminated throughout multiple therapeutic settings and applied to a variety of diagnoses. The enthusiasm with which it was embraced by clinicians early on led some to question whether DBT's popularity was outstripping its empirical foundation. Most of the specific concerns raised regarding DBT's early empirical base have been meaningfully addressed in subsequent randomized controlled trials. This review provides a brief introduction to DBT, followed by a critical appraisal of empirical support for the treatment and a discussion of current research trends
The dialectical behavior therapy ways of coping checklist: development and psychometric properties
No full textSkills training is a crucial mode of treatment in dialectical behavioral therapy (DBT; Linehan, 1993b), yet a psychometrically sound measure of DBT skills use does not exist. We adapted the Revised Ways of Coping Checklist (RWCCL; Vitaliano, Russo, Carr, Maiuro, & Becker, 1985) to create the DBT Ways of Coping Checklist (DBT-WCCL). Using factor analysis procedures, two subscales emerged: one assessing coping via DBT skills, the DBT Skills Subscale (DSS), and one assessing coping via dysfunctional means, the Dysfunctional Coping Subscale (DCS). Principal component, internal consistency, test-retest reliability, and content validity analyses suggested that the scale has good to excellent psychometric properties. In addition, the DSS successfully discriminated patients who received skills training during 4 months of treatment from patients who did not. Moderators of skills use are also discussed. The DBT-WCCL appears to be a promising new measure of DBT skills use
A Treatment Mechanism for Emotion Dysregulation Across Mood and Anxiety Disorders
Full text linkThesis (Ph.D.)--University of Washington, 2012Dialectical Behavior Therapy (DBT; Linehan, 1993a) has been consistently shown to successfully improve indices of emotion regulation in a variety of client populations (e.g., Bohus et al., 2004; Lynch et al., 2007; Feigenbaum et al., 2011). Furthermore, evidence suggests that use of DBT skills is a mechanism of change for emotion dysregulation in Borderline Personality Disorder (BPD; Neacsiu, Rizvi, & Linehan, 2010). Thus, DBT may offer a mechanism of treatment for emotion dysregulation. In this paper, evidence supporting emotion dysregulation as a transdiagnostic mechanism of disorder is presented. A theoretical model that accounts for the effectiveness of DBT skills training, a component of DBT, at reducing emotion dysregulation across disorders is proposed. In addition, the transdiagnostic effectiveness of DBT skills training to change emotion dysregulation is assessed via a randomized controlled trial. Forty-four men and women who met criteria for at least one mood or anxiety disorder and who reported high emotion dysregulation were included in the study. Participants were randomly assigned to DBT skills training or an Activities Based Support Group, designed to control for nonspecific factors. The randomization algorithm matched participants on gender, primary disorder and reported use of medication. Both treatment conditions were administered in a group format and lasted for 16 weeks, two hours per week. Enrolled participants were assessed before treatment started, at the middle of the treatment, at the end of treatment and at a 2-month follow up. Analyses using hierarchical linear modeling supported that DBT skills training was superior to the support group in increasing skills use and in reducing emotion dysregulation, general distress, shame, anger suppression and anxiety. Both treatments performed similarly in reducing depression, disgust and anger expression. Furthermore, use of DBT skills mediated all of the changes seen between conditions. Findings are discussed in the context of the current treatment literature
Outcome and predictors of functional impairment in suicidal women with BPD receiving Dialectical Behavior Therapy
Full text linkThesis (Master's)--University of Washington, 2014Individuals diagnosed with BPD are more likely to be more functionally impaired, or experience difficulty finding and maintaining satisfying employment, housing, or relationships. The theory underlying Dialectical Behavior Therapy (DBT) proposes that emotion dysregulation is the core feature of Borderline Personality Disorder (BPD) and lacking skills to regulate emotions drives many of the maladaptive behaviors associated with BPD. While various aspects of functioning have been examined in individuals diagnosed with BPD, possible mechanisms have not been explored. Participants (n=99) were drawn from a single-blind, randomized controlled trial component analysis of DBT. Participants were women diagnosed of borderline personality disorder who had at least two episodes of suicide attempts and/or non-suicidal self-injury (NSSI) in the last 5 years, an episode in the 8 weeks prior to screening, and a suicide attempt in the past year. Results indicate that DBT improve functioning. Emotion dysregulation and skills use assessed from the previous period predicted functional outcomes. Implications of the findings are discussed
The Role of Executive Functioning in the Treatment of Borderline Personality Disorder
No full textThesis (Ph.D.)--University of Washington, 2014Borderline Personality Disorder (BPD) is characterized as a problem of emotion regulation and impulsivity that becomes increasingly problematic over time due to deficits in problem solving. Problem solving incorporates the executive functions, such as planning, organization, cognitive flexibility, decision making, and inhibitory control. Despite their assumed importance in psychotherapy, the executive functions are seldom examined in treatment research. The present study examines three forms of executive functioning (figural fluency, verbal fluency, and inhibition) for their role in the treatment of BPD. This study is based on data previously collected in a one year randomized control trial (Linehan et al., 2006) which compared dialectical behavior therapy (DBT) to a community treatment by experts (CTBE) for its effectiveness in treating BPD. Participants included 101 women with recent suicidal and self-injurious behaviors who met DSM-IV criteria for a diagnosis of BPD. First, this study tested whether any of the three aforementioned forms of executive functioning (figural fluency, verbal fluency, and inhibition) served as predictors of three important post-treatment therapy outcomes: reductions in depression, suicide attempts (SA), and non-suicidal self injury (NSSI). This study also tested a second hypothesis as to whether these three forms of executive functioning moderate the relationship between the treatment condition (DBT vs CTBE) and the outcomes (depression, SA, NSSI). In a third hypothesis, it was predicted that treatment condition (DBT vs CTBE) could enhance executive functioning. The results for all three of these hypotheses were primarily null findings, with some minor exceptions in the second hypothesis. These exceptions were that while none of the executive functions (figural fluency, verbal fluency, and inhibition) demonstrated consistent moderation across all the outcome measures, they did each show evidence for moderating the treatment on at least one outcome each (depression, SA, or NSSI). Limitations of the study are discussed, particularly emphasizing the possibility for increased Type I and II errors from running many analyses on a moderately sized sample. Though the hypotheses were largely unsupported, these findings remain encouraging as they may suggest that both of these treatments positively benefit therapy clients regardless of their pre-existing executive functioning abilities
Internet-Delivered Dialectical Behavior Therapy Skills Training for Suicidal and Heavy Drinkers
No full textThesis (Ph.D.)--University of Washington, 2018Internet-Delivered Dialectical Behavior Therapy Skills Training for Suicidal and Heavy Drinkers Chelsey Rochelle Wilks A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy University of Washington 2018 Reading Committee: Marsha M. Linehan, Chair Mary Larimer Kevin King Program Authorized to Offer Degree: Clinical Psychology ©Copyright 2018 Chelsey Rochelle Wilks University of Washington Abstract Internet-Delivered Dialectical Behavior Therapy Skills Training for Suicidal and Heavy Drinkers Chelsey Rochelle Wilks Chair of the Supervisory Committee Professor Marsha M. Linehan Department of Psychology Alcohol use is considered to be a significant risk factor among those who die by suicide, especially among those who drink to regulate their emotions. Unfortunately, there is a dearth of treatment outcome research for individuals presenting with both suicide ideation and problem drinking. Moreover, treatments that target this population must be maximally effective and widely disseminable. The application of technology has been increasingly utilized as an efficacious and acceptable way to rapidly disseminate evidence-base treatment. However, these methods are used infrequently for individuals deemed too high risk for Internet-delivered treatment. Dialectical Behavior Therapy (DBT) skills training is an effective intervention for behaviors associated with emotion dysregulation including addictive and suicidal behaviors. DBT skills use has been identified as the active ingredient for treatment effectiveness; thus, a skills training intervention delivered via the Internet has the capacity to be a potent and efficient method of treatment delivery. This project sought to evaluate the usability, feasibility, acceptability, and preliminary efficacy of an Internet-delivered DBT skills training intervention compared to a waitlist control. Participants (N = 59) were randomized to receive the treatment immediately or after an 8-week waiting period. Primary outcomes were suicide ideation, alcohol use, and emotion dysregulation and secondary outcomes were reasons for living, alcohol related consequences, DBT skills use, and depression. Participants on average saw a significant reduction in all primary and secondary outcomes over the four-month study period. Individuals who were randomized to receive iDBT-ST first had faster reductions in suicide ideation and alcohol consumption. These preliminary results suggest that iDBT-ST may be a viable and accessible resource for high-risk and underserved populations
Relationships between Dialectical Behavior Therapy, psychiatric emergency room visits, and suicide attempts: A secondary analysis
No full textThesis (Master's)--University of Washington, 2016-12Previous research has demonstrated a strong relationship between inpatient psychiatric hospitalization and subsequent death by suicide, and recent research suggests that this correlation may extend to include psychiatric emergency room (ER) visits as well. Additionally, although Dialectical Behavior Therapy (DBT) minimally employs the use of these forms of crisis management, this intervention characteristic and its impact on DBT’s effectiveness have gone unstudied. Thus we performed secondary analyses in the context of a large DBT RCT (n = 101) to explore the relationships between DBT, psychiatric ER visits utilized during the treatment year, and suicide attempts that occurred during the year of follow-up assessment. Using the SASII to assess suicide attempts, the SBQ to measure suicide ideation, and the THI to assess ER visits, negative binomial GLM analyses demonstrated that (1) pre-treatment psychiatric ER visits predicted treatment-year ER visits (2) only treatment-year ER visits predicted suicide attempts during follow-up and (3) treatment condition dropped to non-significance in predicting follow-up suicides when treatment-year ER visits were included in the model. This study provides evidence that, in this population and treatment context, pre-existing clinical severity is unlikely to explain the relationship between psychiatric ER utilization and subsequent suicide. Implications of the findings are discussed
Computerized Trans-Diagnostic Dialectical Behavior Therapy Skills Training for Emotion Dysregulation
No full textThesis (Ph.D.)--University of Washington, 2015Over the last several decades, research in clinical psychology has generated many different treatments targeting many different mental disorders. Yet many individuals with mental health problems do not receive evidence based treatments (EBTs) fitting their clinical profile (Kessler, Merikangas, & Wang, 2007; Shafran et al., 2009; Stobie, Taylor, Quigley, Ewing, & Salkovskis, 2007). Two important obstacles to this goal are: (1) the current symptom-based classification system for mental health disorders, and (2) the dearth of cost-effective treatment dissemination mechanisms. Following an increase in understanding psychopathology driven by behavioral studies and cognitive neuroscience, the field has witnessed the emergence of trans-diagnostic treatments targeting general dysfunctional processes and mechanisms of change common across disorders. Large-scale treatment dissemination remains a grand challenge for the field (Biederman, Newcorn, & Sprich, 1991; Regier, Narrow, Kuhl, & Kupter, 2009). Common barriers include the high cost of face-to-face treatment, mental health stigma, and inaccessibility due to geographical locations (Biederman et al., 1991; Conway, Compton, Stinson, & Grant, 2006). Computerized psychotherapy treatments can enable large-scale dissemination of EBTs and several have been found efficacious in depression and anxiety disorders (Cartreine, Ahren, & Locke, 2010; Marks, Cavanagh, & Gega, 2007; Marks, Kenwright, McDonough, Whittaker, & Mataix-Cols, 2004; Proudfoot et al., 2003; D. Richards & Richardson, 2012). This project builds on both a theoretical model proposing emotion dysregulation as a trans-diagnostic mechanism of disorder and on supporting evidence that DBT skills training can be an effective treatment for decreasing emotion dysregulation trans-diagnostically (Neacsiu, 2012; Neacsiu, Eberle, Kramer, Weismann, & Linehan, 2014). This project unfolded in two phases. In Phase 1 of this project we developed and tested feasibility and in Phase 2 we evaluated a computerized trans-diagnostic DBT skills training intervention targeting individuals with difficulties regulating their emotion who met diagnostic criteria for mood and anxiety disorders. Seven men and women who met criteria for at least one mood or anxiety disorder and who reported high emotion dysregulation were included in Phase 1 of the study. They went through the computerized intervention by coming to our research laboratory and then they provided qualitative and quantitative feedback on different components of the intervention and their experience during a post-session interview with a research assistant. Phase 1 participants were assessed before treatment started at the middle of treatment and at the end of treatment. Participants reported reductions in emotion dysregulation, anxiety, depression as well as increases in mindfulness and use of skillful behavior. Phase 1 participants found the intervention acceptable and usable. Qualitative feedback from Phase 1 participants was utilized to modify the intervention by improving its usability and acceptability resulting in the intervention evaluated in Phase 2. Twenty five men and women participated in Phase 2 of the intervention meeting similar inclusion criteria to Phase 1 (reported high emotion dysregulation and met criteria for at least one mood or anxiety disorder). Participants went through the intervention online in their own environment. Participants were assessed before treatment started, at the middle of treatment, at the end of treatment and at two months follow-up. Participants reported reductions in emotion dysregulation, anxiety, depression, general distress as well as increases in mindfulness and use of skillful behavior. Results were compared to findings from a historical control study that recruited a similar clinical population (high in emotion dysregulation and meeting diagnostic criteria for a mood and/or anxiety disorder) and taught DBT skills in a face-to-face format. Findings and future directions are discussed in the context of the current treatment literature. Comparison to historical control study revealed post-treatment effect sizes comparable at a descriptive level with the effect sizes of face-to-face therapy. Future work includes using the iDBT intervention as an add on to individual therapy, expanding the intervention to different clinical groups, expanding the intervention to include all DBT skills, as well as using the intervention within a stepped care model
Brief Interventions for Suicidal Individuals Not Engaged in Treatment
No full textThesis (Ph.D.)--University of Washington, 2015Non-treatment engaged individuals experiencing suicidal thoughts have been largely overlooked in the intervention literature, despite reviews suggesting that the majority of individuals who die by suicide were not in treatment immediately prior to their death. These individuals clearly represent a group in need of additional empirical attention. An intervention has been developed with these individuals in mind and involves a brief, one-time intervention wherein participants are presented with a selection of emotion regulation and distress tolerance skills from the dialectical behavior therapy (DBT) skills training curriculum (Ward-Ciesielski, 2013). This DBT brief suicide intervention (DBT-BSI) has been shown to have promise as an intervention to reduce suicidal ideation, but has yet to be rigorously tested with a control condition. The aims of the present study were 1) to compare evaluate the safety of the DBT-BSI relative to a relaxation training (RT) control condition for adults not engaged in mental health treatment with respect to potential adverse events on participants, 2) to assess the feasibility of the research methodology, and 3) to preliminarily estimate the immediate and long-term degree of change and variability of response to DBT-BSI relative to RT on the primary outcomes of suicidal ideation, emotion dysregulation, and skills use as well as a number of secondary outcomes (e.g., depression, anxiety). The study was a randomized controlled trial of two one-session interventions and three follow-up interviews over three months conducted from 2012-2013. Participants were randomly assigned to one of the two conditions and outcome assessors were blind to study condition assignment. Suicidal ideation, depression severity, and anxiety severity all significantly improved during the follow-up period; however, there were no significant differences between conditions and skills use and emotion dysregulation did not significantly change over time for either condition. The implications of these findings are discussed
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