Dialectical behavior therapy skill use as a mediator and outcome of treatment for borderline personality disorder

University of Washington, Behavioral Research and Therapy Clinics, Department of Clinical Psychology, Seattle, 98195-1525, USA.
Behaviour Research and Therapy (Impact Factor: 3.85). 09/2010; 48(9):832-9. DOI: 10.1016/j.brat.2010.05.017
Source: PubMed


A central component of Dialectical Behavior Therapy (DBT) is the teaching of specific behavioral skills with the aim of helping individuals with Borderline Personality Disorder (BPD) replace maladaptive behaviors with skillful behavior. Although existing evidence indirectly supports this proposed mechanism of action, no study to date has directly tested it. Therefore, we examined the skills use of 108 women with BPD participating in one of three randomized control trials throughout one year of treatment and four months of follow-up. Using a hierarchical linear modeling approach we found that although all participants reported using some DBT skills before treatment started, participants treated with DBT reported using three times more skills at the end of treatment than participants treated with a control treatment. Significant mediation effects also indicated that DBT skills use fully mediated the decrease in suicide attempts and depression and the increase in control of anger over time. DBT skills use also partially mediated the decrease of nonsuicidal self-injury over time. Anger suppression and expression were not mediated. This study is the first to clearly support the skills deficit model for BPD by indicating that increasing skills use is a mechanism of change for suicidal behavior, depression, and anger control.


Available from: Marsha M Linehan, Feb 25, 2014
    • "DBT-WCCL (Neacsiu, Rizvi, Vitaliano, et al., 2010). The DBT-WCCL comprises 38 items, each assessing the frequency of skill use over the past month and is rated on a 0 (never use) to 3 (always use) Likert-type scale. "
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    ABSTRACT: Objective: Dialectical behavior therapy (DBT) was developed for treatment of borderline personality disorder (BPD), and adapted forms of DBT are currently used to treat bipolar disorder, eating disorders, anxiety, and depression. This study was designed to validate the Dialectical Behavior Therapy Ways of Coping Checklist (DBT-WCCL) DBT Skills subscale (DSS) for use in a diagnostically heterogeneous sample. Method: We used naturalistic data from 228 patients receiving treatment at a partial hospital program to assess psychometric properties of the DBT-WCCL DSS. We assessed interitem correlations, internal consistency, factor structure, construct validity and sensitivity to change. Results: Internal consistency, construct validity, and sensitivity to change were good. The measure displayed good convergent and discriminant validity. Factor analysis results were consistent with previous research indicating a 1-factor solution for this subscale. Conclusions: Psychometric properties were similar to the original BPD sample, indicating that this measure can be used as an assessment tool for DBT skill use in a diverse psychiatric population.
    Journal of Clinical Psychology 09/2015; DOI:10.1002/jclp.22226 · 2.12 Impact Factor
    • "In line with the aforementioned definition, emotional processing involves a variety of aspects, such as down-regulating the intensity of emotion , the construction of new meaning related to emotion, and emotional transformation aimed at changing emotion with emotion (Greenberg, 2002; Greenberg & Pascual-Leone, 2006). So far, treatment research has mostly focused on down-regulating the intensity of emotion, (e.g., McMain et al., 2013; Neacsiu, Rizvi & Linehan, 2010). No research on PDs has focused on the transformation process perspective, studying how emotion changes emotion in the therapy hour, and how such a process is linked with in-session interaction and outcome. "
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    ABSTRACT: It is important to understand the change processes involved in psychotherapies for patients with personality disorders (PDs). One patient process that promises to be useful in relation to the outcome of psychotherapy is emotional processing. In the present process-outcome analysis, we examine this question by using a sequential model of emotional processing and by additionally taking into account a therapist's appropriate responsiveness to a patient's presentation in clarification-oriented psychotherapy (COP), a humanistic-experiential form of therapy. The present study involved 39 patients with a range of PDs undergoing COP. Session 25 was assessed as part of the working phase of each therapy by external raters in terms of emotional processing using the Classification of Affective-Meaning States (CAMS) and in terms of the overall quality of therapist-patient interaction using the Process-Content-Relationship Scale (BIBS). Treatment outcome was assessed pre- and post-therapy using the Global Severity Index (GSI) of the SCL-90-R and the BDI. Results indicate that the good outcome cases showed more self-compassion, more rejecting anger, and a higher quality of therapist-patient interaction compared to poorer outcome cases. For good outcome cases, emotional processing predicted 18% of symptom change at the end of treatment, which was not found for poor outcome cases. These results are discussed within the framework of an integrative understanding of emotional processing as an underlying mechanism of change in COP, and perhaps in other effective therapy approaches for PDs.
    Journal of personality disorders 06/2015; DOI:10.1521/pedi_2015_29_204 · 3.08 Impact Factor
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    • "One of four treatment components in DBT is skills training that covers four modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. DBT skills are shown to be a critical part of increasing the use of effective and skillful behaviors in clinical populations (Neacsiu, Rizvi, & Linehan, 2010; Stepp, Epler, Jahng, & Trull, 2008). DBT treatment as well as skills training are often modified to address the needs of populations that DBT has been adapted to, such as children (Perepletchikova , Ansell, & Axelrod, 2012), adolescents (Miller, Rathus, & Linehan, 2007), and those with eating disorders (Safer, Robinson, & Jo, 2010). "
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    ABSTRACT: There are currently no empirically supported interventions to target parenting among mothers who have Borderline Personality Disorder (BPD). The current study uses Consensus Qualitative Research (CQR) methodology to: I) learn about mothers' experiences of parenting with BPD, and II) identify treatment modifications to Dialectical Behavior Therapy (DBT) as suggested by mothers with BPD who are currently engaged in DBT skills training. Twenty-three mothers were recruited from intensive outpatient and partial hospitalization programs that teach DBT skills. A total of 9 focus groups that met one time were conducted asking women a series of questions regarding their experiences of parenting with BPD and how they would modify DBT to address parenting issues. Using the CQR approach, we coded domains and categories that were discussed by mothers in the focus groups. Coding revealed that mothers with BPD wished parenting was integrated more in their current DBT skills groups. In addition, one of the most prominent themes to emerge was that parenting is particularly stressful to mothers with BPD and is associated with guilt, uncertainty, and worry. Finally, mothers offered many ideas for how to integrate parenting-focused interventions into DBT. The CQR method revealed gaps in current treatment for mothers with BPD and provided useful ideas for how to modify DBT to target parenting and integrate these modifications into other approaches for treating mothers with BPD.
    Journal of Psychotherapy Integration 06/2015; 25(2). DOI:10.1037/a0038877
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