Dialectical behaviour therapy skills training compared to standard group therapy in borderline personality disorder: A 3-month randomised controlled clinical trial
ABSTRACT Dialectical behaviour therapy (DBT) has proven to be an effective treatment in borderline personality disorder (BPD). However, the effectiveness in BPD of DBT skills training (DBT-ST) alone is not known. This study aimed at comparing the efficacy of DBT-ST and standard group therapy (SGT) for outpatients with BPD. Sixty patients meeting the DSM-IV diagnostic criteria for BPD, as assessed by two semi-structured diagnostic interviews, were included in a 3-month, single-blind randomised controlled trial. A total of 13 weekly group psychotherapy sessions of 120 min of either SGT or DBT-ST were conducted. Assessments were carried out every 2 weeks by two blinded evaluators. Observer-rater, self-report scales and behavioural reports were used as outcome measures. DBT-ST was associated with lower dropout rates, 34.5% compared to 63.4% with SGT. It was superior to SGT in improving several mood and emotion areas, such as: depression, anxiety, irritability, anger and affect instability. A reduction in general psychiatric symptoms was also observed. Three-months weekly DBT-ST proved useful. This therapy was associated with greater clinical improvements and lower dropout rates than SGT. DBT-ST seems to play a role in the overall improvement of BPD seen with standard DBT intervention. It allows straightforward implementation in a wide range of mental health settings and provides the additional advantage that it is cost effective.
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ABSTRACT: http://www.elsevier.es/en-revista-revista-psiquiatria-salud-mental-286-resumen-effectiveness-of-an-integrated-treatment-90381002 Introducción: En los últimos 25 años varios estudios han mostrado la eficacia de diversas intervenciones psicológicas para los trastornos graves de la personalidad. Sin embargo, la generalización de estos resultados positivos desde entornos con larga tradición investigadora a condiciones de practica habitual ha sido cuestionada, reclamándose la replicación en estudios pragmáticos. Métodos: Este estudio pragmático compara las hospitalizaciones y las visitas a urgencias antes y durante un programa terapéutico de 6 meses para trastornos graves de la personalidad y 36 meses después del inicio. El programa terapéutico, que integra varias intervenciones específicas en un encuadre coherente, se realizó en un entorno de práctica habitual. Se incluyeron 51 pacientes evaluados de acuerdo a criterios DSM-IV por medio de la versión española de la Entrevista Clínica Estructurada para trastornos de la personalidad (SCID II). Resultados: Las características clínicas evidenciaron un grupo de pacientes muy graves, de los que el 78,4% cumplía criterios de trastorno límite de la personalidad. El porcentaje de pacientes hospitalizados y que visitaron urgencias así como el número de días de hospitalización y de visitas a urgencias se redujo significativamente durante el tratamiento y esta mejoría se mantuvo en el tiempo. Conclusiones: Un tratamiento integrado para trastornos graves de la personalidad puede ser efectivo para reducir las re-admisiones o las estancias hospitalarias prolongadas cuando es implementado por clínicos en condiciones de práctica habitual.
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ABSTRACT: Dialectical Behavioral Therapy (DBT) is an evidence-based program aimed at decreasing impulsive and self-harming behaviors. One part of this treatment is a skills training group, in which participants learn specific techniques to manage behaviors, interact with others and learn how to tolerate painful emotions. During this part of treatment, the focus is primarily on skills acquisition, but may not necessarily provide the chance to strengthen the skills or generalize the skills into day-to-day problems. One possibility to address this issue is to implement a DBT graduate group, in which clients can continue to develop the skills they have learned. This article presents a pilot study for a DBT graduate group in which 11 clients created specific target goals and then used the skills to work toward these goals, overcome barriers and experience emotions related to life problems. Results from this study indicate an improvement in mood based on decreases in depression scores on the Patient Health Questionnaire (PHQ-9), reports of achievements of target goals and positive and successful transitions out of therapy. While more information is needed about DBT aftercare programs, this article suggests components of a possible graduate group curriculum to help clients continue with the positive momentum gained from the skills training groups.Social Work in Mental Health 03/2013; 11(2):141-153. DOI:10.1080/15332985.2012.755145
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ABSTRACT: Introduction: Over the past 25 years, several studies have shown the efficacy of a number of psychological interventions for severe personality disorders. However, the generalizability of these positive results from long tradition research settings to more ordinary ones has been questioned, requiring a need for replication in pragmatic studies. Method: This pragmatic study compares hospitalizations and emergency room visits before and during a six-month therapeutic program for severe personality disorders and 36 months after starting it. The therapeutic program, which integrates several specific interventions within a coherent framework, was carried out in an ordinary clinical setting. Fifty-one patients evaluated according DSM-IV criteria by using the Spanish version of the Structured Clinical Interview for personality disorders (SCID II) were included. Results: The clinical characteristics showed a group of severely disturbed patients, of which 78.4% met criteria for borderline personality disorder. The percentage of patients hospitalized and visiting the emergency room as well as the number of days of hospitalization and emergency room visits was significantly reduced during the treatment and this improvement was maintained throughout. Conclusions: An integrated treatment for severe personality disorders could be effective in preventing reliance on readmissions or prolonged hospital stays when it is implemented by clinicians in ordinary clinical settings.