Dialectical behavior therapy skills 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

ABSTRACT 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.

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Available from: Marsha M Linehan, Feb 25, 2014
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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
    • "reported test– retest reliability coefficients on the SCL-90-R individual scales ranging from 0.68 to 0.83 over the course of 10 weeks among a psychiatric outpatient sample. DBT ways of coping checklist (DBT:WCCL) (Neacsiu et al. 2010 "
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    ABSTRACT: Background Dialectical behaviour therapy (DBT) is a multi-modal psychological therapy with established efficacy in treating borderline personality disorder (BPD). Younger adults represent a group more likely to drop out of treatment than their older counterparts and treatments specifically targeted at this younger cohort may be advantageous.The current study We describe an evaluation of a DBT programme in a mental health centre for younger adults 18–25 years who met criteria for BPD (n=11).Methodology We used a simple pre/post-test design, measuring BPD symptoms, general mental health symptoms, and coping skills using self-report questionnaires at the beginning of DBT and again following the delivery of 22 weeks of DBT.Findings Statistically significant reductions were found in BPD symptoms and several mental health symptoms alongside an increase in DBT skills use. Dropout was 31% at 22 weeks of treatment. Methodological weaknesses and avenues for future research are discussed.
    Irish journal of psychological medicine 01/2015; -1:1-7. DOI:10.1017/ipm.2014.69
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    • "In addition to functional differences in amygdala activity, some (Driessen et al., 2000; Tebartz van Elst et al., 2003) but not all (Goldstein et al., 2009; Rusch et al., 2003) structural MRI studies report significantly smaller amygdala volumes in BPD patients compared with HCs, with discrepant findings possibly due to posttraumatic stress disorder (PTSD) comorbidity (de-Almeida et al., 2012). Dialectical Behavior Therapy (DBT) emphasizes the role of emotion regulation (Bohus et al., 2004; Linehan et al., 1991) and targets the acquisition of skills and techniques to encourage cognitive control over maladaptive behavioral patterns (Neacsiu et al., 2010). It has achieved widespread proliferation due to its robust empirical basis and exportability and is included as a component of the APA Practice Guideline for the treatment of BPD. "
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    ABSTRACT: Objective: Siever and Davis' (1991) psychobiological framework of borderline personality disorder (BPD) identifies affective instability (AI) as a core dimension characterized by prolonged and intense emotional reactivity. Recently, deficient amygdala habituation, defined as a change in response to repeated relative to novel unpleasant pictures within a session, has emerged as a biological correlate of AI in BPD. Dialectical behavior therapy (DBT), an evidence-based treatment, targets AI by teaching emotion-regulation skills. This study tested the hypothesis that BPD patients would exhibit decreased amygdala activation and improved habituation, as well as improved emotion regulation with standard 12-month DBT. Methods: Event-related fMRI was obtained pre- and post-12-months of standard-DBT in unmedicated BPD patients. Healthy controls (HCs) were studied as a benchmark for normal amygdala activity and change over time (n = 11 per diagnostic-group). During each scan, participants viewed an intermixed series of unpleasant, neutral and pleasant pictures presented twice (novel, repeat). Change in emotion regulation was measured with the Difficulty in Emotion Regulation (DERS) scale. Results: fMRI results showed the predicted Group × Time interaction: compared with HCs, BPD patients exhibited decreased amygdala activation with treatment. This post-treatment amygdala reduction in BPD was observed for all three pictures types, but particularly marked in the left hemisphere and during repeated-emotional pictures. Emotion regulation measured with the DERS significantly improved with DBT in BPD patients. Improved amygdala habituation to repeated-unpleasant pictures in patients was associated with improved overall emotional regulation measured by the DERS (total score and emotion regulation strategy use subscale). Conclusion: These findings have promising treatment implications and support the notion that DBT targets amygdala hyperactivity-part of the disturbed neural circuitry underlying emotional dysregulation in BPD. Future work includes examining how DBT-induced amygdala changes interact with frontal-lobe regions implicated in emotion regulation.
    Journal of Psychiatric Research 10/2014; 57(1). DOI:10.1016/j.jpsychires.2014.06.020 · 3.96 Impact Factor
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