Book

DBT skills training Manuale

Authors:
  • University of Pavia IT

Abstract

The Book is the Italian Edition of M-M: Linehan DBT skills training manual pp.900
... Duyguları tanımanın, düzenlenmenin ve farkındalığın kendine zarar verme davranışı için koruyucu ve önleyici olduğu (Greenberg, 2010;Linehan, 2014) ve bireylerin iyi oluşuna önemli bir katkı sunduğu bilinmektedir (Coughlan vd., 2017). O halde ergenlerin işlevsel olmayan duygu düzenleme stratejileri kullanımını azaltmak onları kendine zarar verme davranışlarından koruyabileceğimiz anlamına gelmektedir. ...
... Duygu odaklı terapinin teorik olarak kendine zarar vermeyi önlediği düşüncesi deneysel olarak da desteklenmektedir (Bentley vd., 2017;Kimball, 2009;Lee Bracken vd., 2008). Fakat duygu odaklı terapinin tek başına kendine zarar vermede etkisinin sınırlı olduğu bu yüzden ergenlerin kendine zarar vermesini önlemede en umut verici yaklaşımlardan biri olarak kabul gören diyalektik davranışçı terapi yaklaşımı (Koerner, 2012;Linehan, 2014;Nock vd., 2007;Robins & Chapman, 2004) ile birlikte kullanıldığında etkisinin artacağı belirtilmektedir (Gratz & Gunderson, 2006;Gratz & Roemer, 2008;Muehlenkamp vd., 2010). ...
... Diyalektik Davranışçı Terapi danışanların zorlayıcı duyguları tolere etmelerine ve kabul etmelerine yardımcı olmanın dışında (Linehan, 2014); katılımcılara davranışları yönetmek, başkalarıyla etkileşim kurmak ve acı veren duygulara nasıl tahammül edeceklerini öğrenmeleri için özel teknikler öğretir (Robins & Chapman, 2004). Çünkü bireyler genellikle olumsuz yaşam olaylarının ardından olumsuz ruh halinin kalıcı olacağına inanırlar (Leahy, 2002), bu inançla yüzleşmekten kaçınır ve kronik şekilde olumsuz duygu durumunu engellemeye/bastırmaya çalışırlar (Marissen vd., 2010;Neacsiu vd., 2014). ...
Article
Kendine zarar verme ergenlik döneminde en sık görülen risk faktörleri arasında yer aldığı ve kendine zarar vermenin duyguları işlevsel olarak düzenleyememe ile yakından ilişkili olduğu bilinmektedir. Bu çalışmanın amacı; duygu düzenleme psiko-eğitim programının ergenlerde kendine zarar verme davranışı ve duygu düzenleme stratejileri üzerindeki etkililiğini sınamaktır. Bu araştırma 2X2'lik (deney ve kontrol x ön test-son test) yarı deneysel modele dayalıdır. Bu araştırma 2021-2022 eğitim öğretim yılında Şanlıurfa ilinde bir meslek lisesinde okuyan 204 öğrenci ile yapılmıştır. Bu çalışmada Ergenler İçin Duygu Düzenleme Ölçeği ve Kendine Zarar Verme Envanteri kullanılmıştır. Çalışmaya 12'si deney 12'si kontrol grubunda olmak üzere toplam 24 kişi katılmıştır. Deney ve kontrol grubunun ön test ölçümleri alındıktan sonra deney grubu üyelerine araştırmacılar tarafından geliştirilen, duygu odaklı terapi ve diyalektik davranışçı terapi temelli sekiz oturumluk Duygu Düzenleme Psiko-eğitim programı uygulanmıştır. Kontrol grubuna herhangi bir işlem yapılmamıştır. Duygu Düzenleme Psikoeğitim programı tamamlandıktan bir hafta sonra deney ve kontrol grubunun son test ölçümleri yapılmıştır. Psiko-eğitim programının etkililiği karışık desenler için çift yönlü ANOVA ile test edilmiştir. Analizler sonucunda uygulanan psiko-eğitim programına katılan deney grubunun kendine zarar verme ve içsel işlevsel olmayan duygu düzenleme puan ortalamalarının kontrol grubuna göre manidar düzeyde azaldığı görülmüştür. Elde edilen bulgular Duygu Düzenleme Psiko-eğitim programının kendine zarar verme ve içsel işlevsel olmayan duygu düzenleme stratejileri üzerinde etkili olduğunu ortaya koymaktadır.
... Such a stance (i.e., avoidance) is not perceived as realistic in DBT. Therefore, DBT focuses on regulating emotions that may lead to undesirable consequences rather than avoiding or ridding them (Linehan, 2015). Emotion regulation skills have a critical role in daily life as they help the individual to recognize, make sense of, and react to the emotions of both oneself and the people around the person (Bozkurt Yükçü & Demircioglu, 2017). ...
... However, this does not mean that anger cannot be controlled (Mazza, Dexter-Mazza, Miller, Rathus, & Murphy, 2016). Both the human body and brain are involved in the process of experiencing emotions (Linehan, 2015). In other words, anger has more than one component. ...
... DBT therapists believe that accepting reality, what is beyond one's control, and changing what one can change to overcome an issue are critical in the therapy process (Hollenbaugh & Lewis, 2018). The theoretical foundation of DBT is based on the biosocial and dialectical (i.e., integration of opposites) theory of psychological dysfunction (Linehan, 2015). The biosocial theory posits that pervasive emotion dysregulation and maladaptive behaviors occur as a result of two interacting elements: invalidating environment and biological sensitivity (Hollenbaugh & Lenz, 2018). ...
Article
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Adolescence brings about many changes that are observed biologically, psychologically, and socially. This period is viewed as challenging in many cultures and can be a time when adolescents have difficulty controlling their emotions. Researchers focusing on the emotional state of adolescence emphasized that uncontrollable anger negatively affects' adolescent mental health and social relationships. In this systematic review article, studies using Dialectical Behavior Therapy (DBT) or DBT-informed studies assessing anger among adolescents have been examined. Characteristics as well as findings of these studies have been discussed. In general, DBT is a promising psychotherapy approach in increasing adolescent anger management; however, more methodologically rigorous experimental and meta-analysis studies are warranted.
... Studies on DBT skills training (DBT-ST) in BPD have evaluated the effectiveness of training four skill modules: mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance [50]. Those studies show that standard DBT (including all treatment modes) and DBT-ST mode alone are both effective in reducing selfinjurious behavior, suicide attempts, and depression and anxiety [12,48,71]. ...
... Mindfulness and compassion-based interventions have been associated with increased positive affect, improved quality of life and pro-social behavior [4,18,20,24,28,38,59]. Some mindfulness practices, such as loving-kindness (LK) and self-compassion (SC), are part of a set of DBT skills named "other perspectives on mindfulness" [50]. LK and SC, along with mindfulness, have proven useful to alleviate suffering and promote well-being ( [26,33]; [53,57]). ...
... LK and SC, along with mindfulness, have proven useful to alleviate suffering and promote well-being ( [26,33]; [53,57]). Nevertheless, most DBT skills training programs [10,25,50] focus on the "core mindfulness skills", which teach participants how to practice mindfulness. Since LK and SC are not considered "core" skills, they are often left out of these programs as explicit teaching skills, even though some authors have suggested that they can be woven into the teaching of the "core" mindfulness skills [50]. ...
Article
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Background Long-term follow-up studies in patients with borderline personality disorder (BPD) consistently show persistent impairment in psychosocial adjustment, although symptoms tend to decrease over time. Consequently, it might be better to deemphasize symptom-oriented interventions and instead promote interventions that incorporate patient perspectives on recovery. In this study we aimed to examine the feasibility and acceptability of a novel intervention (dialectical behavioral therapy combined with positive psychology and contextual-based skills) in the clinical treatment of long-lasting BPD difficulties. Methods This was a qualitative study. We developed an initial 8-week group intervention for long-lasting BPD. Upon completion of the 8-week program, the participants were asked to participate in a group discussion to provide feedback. Based on that feedback, the intervention protocol was modified and then offered to a second group of patients, who also provided feedback. The protocol was revised again and administered to a third group. A total of 32 patients participated in the group interventions; of these, 20 provided feedback in the qualitative study. The main outcome measure was acceptability. Results The following overarching themes emerged from the group interviews: helpful, unhelpful and neutral practices; internal/external barriers; facilitators; and effects. Participants reported difficulties in imagining an optimal future and self-compassion. By contrast, positive skills were associated with an increase in positive emotions. The main internal barrier was facing difficult emotions. The main external barriers were language-related issues. The group format was perceived as a facilitator to success. Dropout rates, which were assessed as an additional measure of acceptability, decreased substantially in each successive group, from 60 to 40% and finally 20%. Conclusions The intervention was feasible to implement in the clinical setting and participants rated the final set of skills highly. Most of the skills were considered useful. Participant feedback was invaluable to improve the intervention, as evidenced by the large increase in the retention rate from 40 to 80%. Randomized clinical trials are needed to test the efficacy of this intervention in promoting well-being in participants with long-lasting BPD.
... Dialectical behavior therapy (DBT) is a comprehensive treatment that targets these behaviors, helping BPD patients increase behavioral control and build a life worth living [32]. In addition to receiving individual therapy and telephone coaching, patients participate in a skills training group where they learn a wide range of skills grouped into four modules: emotion regulation, mindfulness, interpersonal effectiveness, and distress tolerance (DT) [31]. In recent years, the use of skills has been suggested as a key mechanism of change in DBT; for example, more frequent use of skills is associated with less frequent self-harm and dropout [6,38,51]. ...
... It has been suggested that DT represents an individual's ability to handle uncomfortable emotion states and sensations [53]. In DBT, DT is defined in a more precise way as the ability to accept (tolerate) distress when it is unavoidable and to handle emotional crises in an effective way [31]. BPD pathology has been reported to be associated with low DT and difficulties in emotion regulation [21]. ...
... The aim of the present study was to evaluate the psychometric properties of the SE-DT, assessing a person's perceived ability to handle distress caused by emotional crises. The SE-DT focuses on the use of effective behaviors (skills), as opposed to dysfunctional behaviors with negative consequences (such as self-harm) or which one regrets [31]. It is designed to facilitate the investigation of DT skills' specific contributions to treatment effect and dropout in, for example, standalone skills training groups and skills training in full-scale DBT programs. ...
Article
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Background Skills training is believed to be essential in dialectical behavior therapy (DBT) and is also offered as a standalone intervention. There is a need to better understand each skills module’s separate contribution to treatment outcomes. Several assessment instruments are available, but none of them provides specific information about patients’ perceived ability to use skills promoting distress tolerance. The aim of the present study was to develop and evaluate the psychometric properties of a Swedish adaptation of the General Self-Efficacy scale (GSE) for skills use in distress tolerance – the Self-Efficacy in Distress Tolerance scale (SE-DT). Methods Cross-sectional and longitudinal data were gathered in a non-clinical (NC) community sample (n = 407) and a clinical psychiatric (CP) sample (n = 46). Participants in the NC sample were asked to complete a set of 19 self-report instruments, including the SE-DT, and 45 participants repeated the assessment after 2 weeks. The patients in the CP sample filled out a subset of eight instruments; twenty patients repeated the assessment after completing a treatment intervention including mindfulness skills and distress tolerance skills or emotion regulation skills. Results The analyses showed that the SE-DT is unidimensional with high internal consistency (Cronbach’s alpha = .92) and good test-retest reliability (intraclass correlation = .74). The SE-DT also showed good convergent and divergent validity, demonstrating positive correlations with general self-efficacy and self-compassion, and negative correlations with difficulties in emotion regulation, psychiatric symptoms, and borderline symptoms. The SE-DT showed sensitivity to change, when pre- and post-treatment assessments were compared (Cohen’s d = 0.82). Discussion This is preliminary evidence that the SE-DT has adequate to good psychometric properties, supporting the use of a total sum score. The results indicate that the SE-DT can adequately measure the construct of self-efficacy with regard to dealing with distress and emotional crises. The instrument enables continued investigation of standalone skills training and the specific contribution of distress tolerance skills to treatment outcomes in DBT. Further studies are needed to investigate whether these results are valid in other populations. In addition, the field would benefit from a common definition of distress tolerance.
... Jane, a 32-year-old female presented for treatment for anxiety, depression and mood disturbance (5 th ed.; DSM-5; American Psychiatric Association, 2013) and in need of feeling more connected to her baby and her life. The use of creative techniques including mindfulness, distress tolerance activity, emotion regulation, and interpersonal skills (Linehan, 2015(Linehan, , 2016 were implemented. The use of these skills can be added to the repertoire of practice of a mental health counselor working with clients with PMADs. ...
... The relationship between counselor and client begins with the primary validation of the individual's present experience and existence. It is critical that the counselor accepts the client and communicates this by taking the client's responses seriously without discounting or trivializing them (Linehan, 1993(Linehan, , 1995(Linehan, , 2015(Linehan, , 2016. This involves hearing the experience of the client and evoking a level of understanding of the emotions in light of the history and overall context of the situation. ...
... DBT is a complex treatment process that includes specific protocoled treatment and long-term commitment for individuals typically diagnosed with borderline personality disorder. One element of the DBT model is the implementation of DBT skills modules that include teaching mindfulness, interpersonal effectiveness, distress tolerance and emotional regulation (Linehan, 1993(Linehan, , 1995(Linehan, , 2015(Linehan, , 2016. When working with individuals diagnosed with PMADs, these DBT modules can be utilized in whole or in part based upon the treatment needs of clients. ...
Article
Perinatal Mood and Anxiety Disorders (PMADs) is a serious condition impacting up to 21 percent of woman after the birth of a child (Byrnes, 2018). Jane, a 32-year-old female presented for treatment for anxiety, depression and mood disturbance (5th ed.; DSM-5; American Psychiatric Association, 2013) and in need of feeling more connected to her baby and her life. The use of creative techniques including mindfulness, distress tolerance activity, emotion regulation, and interpersonal skills (Linehan, 2015, 2016) were implemented. The use of these skills can be added to the repertoire of practice of a mental health counselor working with clients with PMADs.
... Linehan's biosocial model of severe emotion dysregulation provides a theoretical context for the relationship between emotion, suicidal thoughts/behaviors, and ED behaviors. This model posits that vulnerability factors (e.g., emotional reactivity and temperament) transact with negative environmental/social interactions (i.e., emotional invalidation-patterns of rejection or dismissal of another's emotions) to confer risk for difficulties regulating emotions (Linehan, 2014). Oftentimes, unskillful efforts to inhibit emotional expressions result in maladaptive escape behaviors such as suicide attempts (Crowell et al., 2009;Linehan, 2014) and ED behaviors (Linehan & Chen, 2005). ...
... This model posits that vulnerability factors (e.g., emotional reactivity and temperament) transact with negative environmental/social interactions (i.e., emotional invalidation-patterns of rejection or dismissal of another's emotions) to confer risk for difficulties regulating emotions (Linehan, 2014). Oftentimes, unskillful efforts to inhibit emotional expressions result in maladaptive escape behaviors such as suicide attempts (Crowell et al., 2009;Linehan, 2014) and ED behaviors (Linehan & Chen, 2005). Work stemming from theoretical models for suicide (Anestis et al., 2011) and EDs (Rieger et al., 2010) propound that social/interpersonal processes (e.g., negative evaluation, perceived burdensomeness, and thwarted belongingness) are associated with experiences of negative emotions and when coupled with difficulties in regulating emotions, are associated with suicidal desire and EDs (see Anestis et al., 2011;Rieger et al., 2010). ...
... Extant literature has shown greater subjective emotional reactivity among individuals with a history of suicidality as well as in patients with EDs (Nock et al., 2008). Emotional reactivity has been theorized to confer risk for emotion regulation difficulties (Linehan, 2014), and thus may also influence emotion dysregulation and suicidality in individuals with EDs. ...
Article
Introduction: Emotional processes play a role in both suicide risk and eating disorders (EDs), which are often comorbid. However, limited research has explored how emotional processes relate to suicide risk in EDs and the prognostic value of suicide risk for ED treatment. Thus, the current study examined associations between emotion dysregulation and reactivity with suicide risk in patients with EDs, and determined if suicide risk predicts ED treatment outcomes. Methods: Participants (n = 201) were adults in an ED partial hospitalization program who completed measures at admission, 1-month post-admission, and discharge. Results: When controlling for depressive symptoms, limited access to adaptive emotion regulation strategies, difficulties engaging in goal-oriented behaviors, and engaging in impulsive behavior when experiencing negative emotions (i.e., emotion dysregulation) were associated with suicide attempt frequency. Depressive symptoms were associated with suicide risk severity, while emotion dysregulation and reactivity were not. Importantly, patients with elevated suicide risk at admission improved comparably to other risk categories across treatment, despite presenting with greater ED symptoms at admission. Conclusion: Emotion dysregulation and depression are salient factors when examining suicide risk in patients with EDs. Suicide risk and attempt history may not negatively impact ED treatment outcomes when using emotion-focused treatment.
... The two main derivations of CBT that authors have been shown to prefer for mobile app development are DBT and ACT. DBT was first developed for borderline patients and is mostly focused on integrating CBT principles with acceptance, mindfulness practices, and skills training to address emotional dysregulation and self-harming behaviors and to develop more cognitive and emotional flexibility [41][42][43]. ACT, too, is an upgraded form of CBT that focuses on mindfulness and acceptance practices to enhance psychological flexibility, and it focuses on personal values and their pursuit [44]. ...
... Moreover, it is often related to suicidal behavior and self-harm. Among the many different treatments that have been developed for this disorder, DBT is one of the most empirically supported for its effectiveness [42,43]. ...
Article
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Background: Mental health care has been enriched with the progressive use of technology during the last ten years, in particular after the COVID-19 pandemic. Mobile applications (apps) and smartphones have become the most widespread access point for many people who look for self-help in the psychological domain. Objective: We focused on a systematic review of mobile apps for mental health, focusing on the blending of apps with psychotherapy contexts, with a specific focus on emotional dysregulation. Methods: A comprehensive literature search (January 2017 to August 2022) in PubMed, PsycInfo, Web of Science, and the Cochrane Library was conducted. Abstracts were included if they described mental health mobile apps targeting emotional dysregulation and their use during ongoing psychological or psychotherapy treatment for adults and adolescents. Results: In total, 397 abstracts were identified; of these, 19 publications describing apps targeting borderline personality disorder, depression, anxiety, suicidal behaviors, and post-traumatic stress disorders met the inclusion criteria. Conclusions: App-enhanced psychotherapy might be a winning combination in many scenarios, but at the same time, many issues must still be faced in this yet emerging scientific field. In conclusion, we tried to put together some major guidelines for mental health mobile app development in the context of psychological treatments.
... Con base en la figura 1, las intervenciones de contención emocional implicaron el uso de estrategias conductuales específicas para la regulación emocional, tales como la respiración profunda, cambiar la temperatura corporal o distraerse con los cinco sentidos (Linehan 1993;2015), las mismas que se adaptaron a las particularidades tanto del paciente como del contexto en el que se encontraba. Por otro lado, cuando se detectaba una preocupación a la cual era posible hacerle frente, se orientó hacia la solución de problemas (Linehan, 2015), enfocándose en la reducción de los déficits en las habilidades necesarias para el afrontamiento eficaz de la problemática. ...
... Con base en la figura 1, las intervenciones de contención emocional implicaron el uso de estrategias conductuales específicas para la regulación emocional, tales como la respiración profunda, cambiar la temperatura corporal o distraerse con los cinco sentidos (Linehan 1993;2015), las mismas que se adaptaron a las particularidades tanto del paciente como del contexto en el que se encontraba. Por otro lado, cuando se detectaba una preocupación a la cual era posible hacerle frente, se orientó hacia la solución de problemas (Linehan, 2015), enfocándose en la reducción de los déficits en las habilidades necesarias para el afrontamiento eficaz de la problemática. Al tiempo que se entrenaba al usuario en el uso de dichas habilidades, el psicólogo hacía énfasis en validar la emoción y el malestar que el solicitante mostraba. ...
Article
Full-text available
Ante la pandemia por la COVID-19, surgió una necesidad imperante de adecuar la práctica clínica a distancia para la atención a la salud mental. Conformar un modelo accesible, de pronta respuesta y que mantuviera la cercanía con el consultante resultó un objetivo fundamental durante la emergencia sanitaria. Por esta razón, un grupo de profesionales de la salud mental de diversas partes del mundo desarrollaron una plataforma digital con el fin de atender las necesidades psicológicas de la población a raíz de la pandemia. Como parte de los servicios disponibles de dicha plataforma, se habilitó un chat de asistencia en el cual se brindó contención emocional, orientación sobre los módulos que la conforman y referencia a servicios de atención especializada en caso de ser necesario. En el presente trabajo se informan las principales afectaciones psicológicas identificadas (estrés, ansiedad y riesgo de suicidio) en la muestra atendida a través de este servicio, además se documenta la experiencia de un grupo de psicólogos que atendieron el chat durante los meses críticos de la pandemia en México.
... Dialectical Behavior Therapy (DBT) uses cognitive and behavioral tools to change problem behaviors and thoughts and teach clients the skills needed to improve their lives and relationships. Linehan (2014) indicated that Dialectical Behavior Therapy is a comprehensive treatment, and its aims are as follows: ...
... Dialectical Behavior Therapy success factors: Linehan (2014) stated that for DBT to be effective in treating workplace bullying, we use the following : ...
Chapter
There are growing studies on quality-of-life interventions. And the studies conducted on the effectiveness of quality of life interventions in European and American countries were large-scale, and they included different samples of normal individuals who suffer from physical, mental, and psychological diseases. In the Arab countries, studies of quality of life interventions were less comprehensive for specific types of individuals, especially patients. In general, most of these studies used the experimental and quasi-experimental quantitative methodology. However, we still need to use the mixed research methodology further to expand the study of the interventions' effectiveness.
... 4 DBT was originally developed by Linehan and colleagues as a treatment for patients with BPD. 5 The overall goal of DBT skills training is to help create a life worth living. 6 DBT skills training teaches mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills to help reduce suffering and increase quality of life. 6 DBT has been well researched and exam ined in numerous randomized controlled trials (RCTs). ...
... 6 DBT skills training teaches mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills to help reduce suffering and increase quality of life. 6 DBT has been well researched and exam ined in numerous randomized controlled trials (RCTs). 7 Systematic literature reviews of DBT skills training as a stand-alone treatment provide preliminary evidence of its utility in addressing a range of mental health issues, including psychosocial functioning, mood, eating, and other mental health disorders (e.g., ADHD). ...
Article
LAY SUMMARY This 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 6-month follow-up. This research suggests that DBT skills group training may be an effective treatment for military personnel.
... Emotion dysregulation mediated the relationship between yoga experience and depression, anxiety, or stress for both long-term and intermittent practitioners. This finding is consistent with clinical theoretical orientations that emphasize emotional regulation skills (i.e., Dialectical Behavior Therapy; Linehan, 2014) and emotional processing (i.e., Emotion-Focused Therapy; Greenberg, 2017) for improving mental health. Our finding is also consistent with other studies. ...
Article
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Previous research has identified numerous physical, psychological, and spiritual benefits associated with the practice of yoga. Indeed, yoga has been linked with improved quality of life, reduced stress, and numerous markers of psychological well-being. In the current research, a cross-sectional design was used to examine whether the psychological benefits associated with yoga only apply to long-term practitioners or whether more “casual,” intermittent yoga experience could produce positive outcomes. An American population of long-term practitioners (n = 129), intermittent practitioners (n = 161), and non-practitioners (n = 164) completed online self-report measures of emotional regulation, trait mindfulness, self-compassion, interoceptive awareness, and spiritual intelligence variables. The results indicated that long-term (LT) practitioners scored higher than intermittent experience (IE) practitioners on measures of mindfulness (MLT = 137.3; MIE = 127.6), interoceptive awareness (MLT = 3.4; MIE = 3.1), self-compassion (MLT = 3.4; MIE = 3.1), and spiritual intelligence (MLT = 63.5; MIE = 55.5; all p-value < 0.05). Intermittent practitioners scored higher than no-experience (NE) group on interoceptive awareness (MIE = 3.1; MNE = 2.7) and spiritual intelligence (MIE = 55.5; MNE = 46.6; both p-value < 0.05). Contrary to our hypotheses, yoga experience had no effect on depression, anxiety, or stress levels. Separate mediation analyses demonstrated that interoceptive awareness, spiritual intelligence, mindfulness, and self-compassion each mediated the relationship between yoga experience and emotion dysregulation. Furthermore, emotion dysregulation mediated the relationship between yoga experience and depression, anxiety, and stress. Taken together, the results of this study suggest that long-term practitioners experience more benefits compared to intermittent and non-practitioners, and that the mechanisms underlying these benefits are multi-faceted.
... A person experiencing emotional difficulties often struggles to act decisively, and a low level of assertive behavior can amplify the problem. Theories of assertiveness can be understood as a relational style that treads a middle ground between passive and aggressive (Linehan, 2014). Someone with a passive style will easily give in to requests and follow decisions or actions that they may not approve of from their environment, in other words someone with a passive style will prioritize and please others. ...
Article
Menurut Mansour Fakih, konsep gender dipahami sebagai sifat yang melekat pada laki-laki dan perempuan yang dikonstruksi secara sosial dan budaya. Misalnya, wanita dikenal lemah, cantik, dan emosional. Sedangkan laki-laki sering dianggap kuat, perkasa, dan rasional. Sedangkan tenaga teknis operasional identik dengan jenis kelamin tertentu. Tidak hanya terkait gender, para pekerja teknis operasional juga seringkali dituntut untuk bekerja di luar ruangan dalam berbagai kondisi cuaca dimana mereka harus memiliki kondisi fisik yang prima, dan bagi pekerja perempuan, teknis operasional bukanlah pekerjaan yang tepat. Untuk keperluan penelitian ini, perempuan pekerja teknis operasional di Telkom Akses Jakarta Utara diamati menggunakan kerangka teori sudut pandang Sandra Harding dan Julia T Wood yang menyatakan bahwa tidak semua perempuan memiliki sudut pandang yang sama. Selain isu gender, ditegaskan bahwa kondisi ekonomi, ras, dan orientasi seksual merupakan identitas budaya tambahan yang dapat membawa seseorang ke tengah-tengah masyarakat atau bahkan mengisolasi mereka dari lingkungannya. Melalui analisis ini, fenomena peran perempuan dalam pekerjaan teknis operasional tidak hanya menjadi pelengkap tetapi juga memiliki peran penting dalam sebuah perusahaan.
... It cognizes individuals with four significant compounds of skills with a view to manage massive emotions, and innervate coping skills. These skills are distress tolerance skills, mindfulness, emotional regulation and interpersonal effectiveness (Linehan, 2014). Dialectical therapy (DBT) is not lately innovative therapy; however, in 1993, Marsha Linehan developed it to help women chronically suicidal and meet criteria for borderline personality disorder. ...
... Further, attitudinal qualities of mindfulness are the foundation of which mindfulness practice is built on [128]. These attitudinal qualities include curiosity, openness, patience, kindness, empathy, taking a nonevaluative stance towards stimuli, non-attachment (allowing thoughts, feelings, and sensations to come and go without striving towards or away from experiences), nonreactivity to inner experiences, and gratitude [128][129][130]. Although mindfulness-based interventions have been shown to improve self-control skills in adolescents [131,132], few studies focus on specific qualities of mindfulness-such as acceptance, loving-kindness, and compassion [124]. ...
Article
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Background: Adolescence is a critical developmental period for mentalization and emotion regulation skills. Studies show that during this time, adolescents may experience greater vulnerability to challenges of mental and emotional well-being. Studies also show that self-skills, such as mentalization, self-compassion, and self-control are independently associated with feelings of global self-worth or psychological well-being. To date, no known studies have explored interconnected relations among these self-skills, despite significant overlaps in the social-biological development of these skills. Aims: To investigate interconnected relations among psychological well-being, mentalization, self-compassion and self-control. Gender differences in these relations are explored. Method: As part of a larger, longitudinal study of adolescent well-being, this cross-sectional study drew on a variety of self-report measures, investigating relations among adolescents’ self-reports of psychological well-being, emotion recognition, self-control, and self-compassion. Participants consisted of 88 girls and 57 boys, mean age 13.38. Results: Main results showed associations among emotion recognition, self-control and self-compassion and feelings of global self-worth. Specifically, results showed that understanding negative emotions in others relates to lower levels of self-compassion and feelings of self-worth. Further, adolescents who report low levels of self-control reported uncompassionate self-responding and lower levels of self-worth. Gender differences and implications for further research and adolescent social-emotional interventions are discussed.
... Self-soothing behaviors provide distressed individuals with a sense of calmness or pleasure and are promoted in EBTs (eg, BA [57] and Dialectical Behavior Therapy [62,63]). In quest 3, users are instructed to engage in self-soothing whenever they ruminate and are automatically prompted to do so every time rumination is logged. ...
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Background: Depression is a common mental health condition that poses a significant public health burden. Effective treatments for depression exist; however, access to evidence-based care remains limited. Mobile health (mHealth) apps offer an avenue for improving access. However, few mHealth apps are informed by evidence-based treatments and even fewer are empirically evaluated before dissemination. To address this gap, we developed RuminAid, an mHealth app that uses evidence-based treatment components to reduce depression by targeting a single key depressogenic process-rumination.
... Module 2 is focused on aiding participants to develop or enhance their emotional identification and regulation skills, which may help participants effectively process their past experiences. Skills include mindfulness (e.g., nonjudgmental observation), cognitive restructuring (e.g., check the facts), and distress tolerance (i.e., Temperature, Intense exercise, Paced breathing, Paired muscle relaxation) adopted from Dialectical Behavior Therapy (DBT; Linehan, 2014). Modules 3 and 4 are the imaginal and in vivo exposure modules. ...
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Background Adversity is prevalent among people with psychotic disorders, especially those within the first 5 years of a psychotic disorder, called early phase psychosis. Although adversity can lead to many negative outcomes (e.g., posttraumatic stress symptoms), very few treatments for adversity-related sequelae have been tested with individuals with psychotic disorders, and even fewer studies have specifically tested interventions for people in early phase psychosis. Furthermore, people who misuse substances are commonly excluded from adversity treatment trials, which is problematic given that individuals with early phase psychosis have high rates of substance misuse. For the first time, this trial will examine the outcomes of an adapted 15-session prolonged exposure protocol (i.e., PE+) to observe whether reductions in adversity-related psychopathology occurs among people with early phase psychosis and comorbid substance misuse. Methods This study will use a multiple-baseline design with randomization of participants to treatment start time. Participants will complete baseline appointments prior to therapy, engage in assessments between each of the five therapy modules, and complete a series of follow-up appointments 2 months after the completion of therapy. Primary hypothesized outcomes include clinically significant reductions in (1) negative psychotic symptoms measured using the Positive and Negative Syndrome Scale, (2) adversity-related sequelae measured using the Trauma Symptom Checklist-40, and (3) substance use frequency and overall risk score measured with the Alcohol, Smoking, and Substance Involvement Screening Test. We also anticipate that clinically significant reductions in hopelessness and experiential avoidance, measured with the Beck Hopelessness Scale and Brief Experiential Avoidance Questionnaire, the theorized mechanisms of change of PE+, will also be observed. A secondary outcome is a hypothesized improvement in functioning, measured using the Clinical Global Impression and Social and Occupational Functioning Assessment scales. Discussion The results of this treatment trial will contribute to the advancement of treatment research for individuals in early phase psychosis who have current substance misuse and a history of adversity, and the findings may provide evidence supporting the use of hopelessness and experiential avoidance as mechanisms of change for this treatment. Clinical trial registration Clinicaltrials.gov , NCT04546178; registered August 28, 2020, https://clinicaltrials.gov/ct2/show/NCT04546178?term=NCT04546178&draw=2&rank=1 .
... In light of the results, however, some reflections can be raised. With regards to the population of women suffering from obesity, the results suggest that they might benefit from cognitive-behavioral therapies focusing more on emotional regulation such as Marsha Linhean's DBT, especially for "suffering tolerance" and "crisis survival" skills [27]. With regards to men with obesity, who have different characteristics and specific needs, a programme that increases interoceptive awareness, such as Mindfulness-Based Therapy, and the Mindful Eating module, might be more indicated [28]. ...
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Relatively little research has examined sex differences among people affected by obesity. The aim of this study is to assess the relationship between negative emotions and eating behaviors, taking into account the role of biological sex. The final sample consists of 200 candidates for bariatric surgery, 62 males (31%) and 138 females (69%), aged from 18 to 60 years (M = 40.71; SD = 11.30). Participants were screened with the Binge Scale Questionnaire (BSQ) and individually evaluated with the Eating Disorder Inventory (EDI) and the Profile of Mood States (POMS). Correlations were calculated by splitting the sample by sex. Analyses of the relationship between negative emotions and eating behavior showed a large number of correlations in the sample of women and few correlations in men. The differences between women and men with obesity suggest the need for a different theoretical construct that explains the differentiated mechanisms of functioning and lays the foundations for specific therapeutic paths.
... In DBT, the therapist and patient address substance use within the framework of a self-harming behavior. Therapy targets learning to identify, manage, and tolerate uncomfortable feelings and emotions without resorting to substance use [41]. ...
Chapter
The prevalence of substance use disorders is relatively high among physicians (Oreskovich et al., Am J Addict 24(1):30–8, 2015). Various factors are believed to contribute to this phenomenon, including the intense demands and stress of the job, access to highly potent medications, personality factors, and tendency to self-medicate and/or avoid seeking help. Substance use disorders among physicians can lead to practice impairment, putting patient safety at risk, and can also contribute to significant physical and mental health consequences for the physician (Merlo et al., UpToDate, Wolters Kluwer, 2019). They are associated with both physician burnout and suicidal ideation (Oreskovich et al., Arch Surg 147(2):168–74, 2012). Thus, substance use, and substance use disorders, can be viewed as both consequences of and contributors to physician distress, making the topic a key challenge to physician well-being. However, it is important to recognize that recovery is both possible and likely for physicians who take advantage of existing resources, such as state physician health programs (also known as impaired practitioner monitoring programs) (McLellan et al., BMJ 337:a2038, 2008; DuPont et al., J Subst Abuse Treat 36(2):159–71, 2009).KeywordsSubstance use disorderRecoveryPhysician Health ProgramAddictionImpaired physician
... One example of a well-studied therapy is based on dialectical principles (Dialectical Behaviour Therapy; DBT). The traditional model consists of group and individual therapy, with access to phone coaching as needed, often for at least 12 months duration [13]. Recent studies have evaluated the effectiveness of brief therapy [12,14,15] or skills group only adaptations [16][17][18][19] with good outcomes in reducing the emotional and behavioural dysregulation in acute phase of illness (e.g. ...
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Objective We developed and piloted a novel art-based online skills program led by a peer mental health professional with lived experience of complex mental health, including Borderline Personality Disorder (BPD). Key challenges of living with BPD and emotion dysregulation were addressed through artmaking informed by a dialectical framework and skills, to evaluate acceptability and efficacy. Method A structured, manualised 2-hour weekly arts-based skills program was piloted for people with BPD over 18 weeks. Evaluation included both quantitative and qualitative measures at commencement and completion. Results Thirty-eight participants enrolled in the program (89.5% identified she/her pronouns, average age 33.6 years), and 31 completed (82% retention). Multilevel modelling analysis of the primary outcome variable Difficulties in Emotion Regulation Scale (DERS) demonstrated a large improvement over time (effect size Cohen’s d = 1.77). Qualitative thematic analysis found participants had improved capacity to regulate emotions and tolerate distress, improved connection with others, enhanced understanding of the self, and higher hope for living well. We found that artmaking facilitated processes and helped the expression of difficult emotions, symbolise challenging relationships, and facilitate greater self-understanding. Participants reported high levels of satisfaction, and 77.4% reported that the program had increased wellbeing. Conclusion This novel artmaking program for emotion dysregulation and BPD was acceptable and potentially effective. Peer facilitation using arts-based skills is a modality of therapy for further investigation.
... DBT aims to change behavior and to enforce the ability to tolerate difficult or painful feelings through a focus on skills in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills. 19 Furthermore, DBT builds on a bio-social theory accounting for biological vulnerabilities along with environmental adversities as the core aetiologic factors that contribute to the development of BPD. According to this, temperamental factors (such as a heightened emotional sensitivity to external stimuli, intense reactions, and slow return to the emotional equilibrium) along with childhood adversities (such as emotional, physical, or sexual abuse, chronic invalidation, or neglect) promote a pronounced emotional dysregulation. ...
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Current evidence suggests that individuals with borderline personality disorder (BPD) are likely to benefit from specialized, or BPD-specific, treatments. Dialectical behavior therapy (DBT) and mentalization-based treatment (MBT) are currently the most intensively researched BPD treatments. Reviewing the current research, this paper highlights similarities and differences between the two treatments, and discusses possible ways they could complement each other. As the effectiveness of specialized treatments for BPD in general has been determined with some certainty, research now tends towards individualized approaches, identifying predictors of optimal treatment response. However, it is still to be settled who might profit from a combination of or sequential treatment with DBT and MBT.
... In her work with clients diagnosed with borderline personality disorder, Marsha Linehan espoused the importance of validation in early therapy sessions (14). Linehan (15,16) submits that validation of the client requires the therapist to communicate acceptance and demonstrate that the client's expressions are worthy of attention, taking care not to discount or disparage. Linehan (16) likens her definition of validation to Rogers' (17,18) "unconditional positive regard" in the therapy relationship. ...
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Purpose To validate an individual's feelings or behaviour is to sanction their thoughts or actions as worthy of social acceptance and support. In contrast, rejection of the individual's communicated experience indicates a denial of social acceptance, representing a potential survival threat. Pain-invalidation, though ill-defined, appears to be a fundamental component of psychosocial stress for people with chronic pain. As such, the aim of this paper was to define pain-validation and outline its importance for those with chronic pain. Methods The pain-validation construct was defined using themes inherent in the narratives of those with chronic pain, as identified in a previously published systematic search and thematic analysis, together with examination of additional literature on pain-validation in the clinical context. Results We present a construct definition, proposing that pain-validation must necessarily include: (i) belief that the pain experience is true for the individual, (ii) acceptability of the individual's expressions of pain, and (iii) communication of belief and acceptability to the individual experiencing pain. Further, we outline the importance of pain-validation as a protective factor and means of reducing many of the psychosocial stresses of chronic pain; for example, by indicating social support for pain-coping, buffering negative emotions, and re-enforcing unity and shared identity. Implications The role of pain-validation in the current era of pain management intervention is discussed. Adhering to interventions that involve cognitive and behavioural change is often difficult. Acknowledging and validating the acceptability of the patient's pain experience in the early stages of pain management may, therefore, be a key component of intervention that encourages compliance to the treatment plan and achieving therapeutic goals.
... Salovey et al (1999) primarily interpret coping as a response to emotions. However, the concept of coping has developed within mental healthcare provision to involve a set of cognitive and affective responses to stress and adversity (Linehan, 2015). Lazarus (1999: 160) describes coping as an individual's attempt to restore 'integrity' or self-mastery and 'verve' or energy, thereby regaining a sense of wholeness and internal consistency, and very much links the three concepts of stress, emotion and coping as three parts of a whole relationship. ...
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A look at the theoretical development of coping as a phenomenon and its development to concepts of infant resilience.
... Suicidal ideations might be thus transformed into saying "yes" to life and integrated on the existentialist basis into the positive vision of one's life. Such efforts are being elaborated first of all within Logotherapy, Dialectical Behavior Therapy, and Cognitive Behavioral Therapies (see, e.g., Linehan, 2015;Bakhiyi et al., 2016). ...
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Introduction Meaning is an important psychological resource both in situations of accomplishment and in situations of ongoing adversity and psychological crisis. Meaning in life underlies the reasons for staying alive both in everyday and in critical circumstances, fulfilling a buffering function with respect to life adversities. Aim The aim of the present study was to reveal the role of both meaningfulness, including specific sources of meaning and reasons for living, and meaninglessness (alienation) in patients suffering from profound crisis situations with or without suicidal intentions and behavior. Methods The sample included 148 patients (all Caucasian) who were referred to a crisis center in Moscow, Russia. Seventy-seven patients (54 females, mean age 32.00 ± 11.98 years) reported a current crisis situation in their life but denied suicidal thoughts or behavior. Twenty-nine patients (21 females, mean age 31.55 ± 13.76 years) reported suicidal ideations but denied suicidal attempts or self-harming behavior. Forty-two patients (31 females, mean age 30.64 ± 11.38 years) had episodes of suicidal attempts or self-harming behavior accompanied by suicidal intentions. There were no significant gender or age differences between groups. Participants completed a number of measures of different aspects of meaning and meaninglessness, well-being, ill-being and psychological resources. For some patients ( N = 74), a clinical checklist was completed by their doctors assessing 28 various characteristics associated with the patient’s clinical status. Results and discussion Meaningfulness and reasons for living were more helpful in distinguishing between reactions to profound crisis situations (suicidal intentions versus non-suicidal behavior) than were measures of well-being, ill-being, meaning crisis or personality resources. In both suicidal and non-suicidal crisis patients meaningfulness predicted more positive reasons for living. The relationship between meaningfulness and most reasons for living remained significant after controlling for clinically appraised suicidal “readiness,” acute stress and lack of social support. Self-transcendence was the major specific source of meaning predicting higher reasons for living after adjusting for general meaningfulness. Conclusion The data cast some light on the psychological meaning of suicide. It follows that prevention efforts are to be focused not on eliminating the factors “pushing” one to suicidal behavior, but rather on supporting inner strengths conducive of a positive decision, to be , through enhancing meaningfulness and reasons for living.
... In DBT, the treatment environment is structured according to clients' levels of disorder, that is, the complexity of each case. 4 The standard treatment takes 1 year, and comprises four treatment modes aimed at fulfilling five main functions, as in table 1, which is modified from Koerner. 5 Individual psychotherapy Individual psychotherapy involves mutual verbal commitment to DBT, including jointly organising a hierarchy of treatment targets with clients. These are behaviours requiring change (to increase or decrease) and other client goals. ...
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Introduction: Dialectical behaviour therapy (DBT) is a well-known intervention for treating borderline personality disorder, and has been increasingly adapted for other disorders. Standard DBT consists of four treatment modes, delivered over a year. Adaptations to DBT include changes to modes of delivery, treatment length, and skills modules taught to clients, or incorporating interventions from other evidence-based therapies. There is a need to synthesise existing evidence on DBT so that stakeholders-clinicians, researchers and policymakers-can understand how it has been provided for various psychiatric conditions, and whether it has been effective. Methods and analysis: This study proposes a scoping review conducted according to Arksey and O'Malley's (2005) procedures, to map and summarise the literature on DBT interventions for treating a range of psychiatric concerns. Electronic databases (ie, the Cochrane Central Register of Controlled Trials, PubMed, PsycINFO, SCOPUS, EBSCOhost and ProQuest Dissertations and Theses), conference proceedings and the US National Institutes of Health Ongoing Trial Register will be searched for intervention studies that involve a control or comparison group, and that report quantitative data on pre/post-measures for psychiatric symptom severity. The initial search was conducted on 18 September 2020, and data charting has not commenced. An update will be performed in September 2022, pending this protocol's publication. Data charting will collect individual studies' characteristics, methodology and reported findings. Outcomes will be reported by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for Scoping Reviews. Ethics and dissemination: No ethical approval is required for this study. The goal of dissemination is to keep DBT stakeholders abreast on latest updates in clinical applications of DBT. Findings from this research are intended to inform a more specific topic of study (eg, a meta-analysis), to further aid in the development of DBT interventions for psychiatric populations. Registration details: The study protocol was pre-registered with the Open Science Framework on 24 August 2021 (https://osf.io/vx6gw).
Article
Individuals with emotional dysregulation often struggle with assertiveness and interpersonal problem‐solving for a variety of reasons. Adolescence reflects a developmental period with well‐characterized changes in social processes that can be disrupted by affective psychopathology. In these situations, the expected challenges associated with typical adolescence can be amplified by inhibiting emotions, like anxiety and shame. Symptoms of common adolescent anxiety and mood disorders, such as social anxiety, generalized anxiety, obsessive‐compulsive disorder (OCD), and major depressive disorder, frequently exacerbate teens’ experiences of these dysregulated emotions, which in turn increase anxiety and mood symptoms. Such emotional disturbances present barriers to many important developmental tasks of adolescence. These include skillfully navigating social relationships, developing a sense of autonomy, and learning how to express and assert one's independence, while simultaneously asking for help when needed. Dialectical behavior therapy for adolescents (DBT‐A; Miller, Rathus, & Linehan, 2007; Linehan, 2015) is an empirically supported treatment developed for emotionally dysregulated youth with multiple, serious psychiatric problems, including suicidality. The treatment explicitly teaches skills to address these common challenges, while structuring the environment to support effective behaviors and ensure skills generalization across environments.
Article
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.
Preprint
Psychological studies on obesity have focused on finding common characteristics in the population of people with obesity, such as personality traits. In contrast, in the field of medicine, individual differences are shown, for example in terms of metabolic phenotypes. This article proposes a clinical and theoretical observation about the role of life events in the development of obesity. Patients affected by obesity actually report differentiated life and weight control histories. The proposal is to distinguish these types of patients into two psychological phenotypes at the initial assessment, because surgical and post-surgical outcomes may differ. While from a mental health point of view, identifying these elements may be an indicator to direct the patient to an appropriate and targeted psychological treatments.
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The introduction chapter describes the scope and purpose of this book and summarizes key topics regarding online therapy. We explain that the book addresses most of the main approaches and schools of psychotherapy that are prevalent in the therapeutic field nowadays. Thus, in addition to exploring how each of them adjust to online therapy, we also have created a collection of the most practiced therapeutic approaches nowadays. Beyond the theories, we describe why flexibility and creativity are among the main factors that contribute to the success of online therapy. Also discussed briefly are skills and training required for the successful provision of online therapy. The introduction also presents the current research about online therapeutic alliance, elements influencing the therapeutic alliance such as the setting and rupture and repair, and the outcome of online therapy. We show that there is enough evidence that online therapy is beneficial no less than in-person. We address the question whether it is suitable for everyone, and summarize how the factors that unify all psychodynamic approaches can be applied online.
Preprint
Psychological studies on obesity have focused on finding common traits in the population of people with obesity, such as personality traits. In contrast, in the field of medicine, it is pointed out that individuals with obesity can be very different from each other, e.g. in terms of their metabolic profile, which gives rise to different phenotypes. This article proposes a clinical and theoretical observation of the role of life events in the development of obesity. Obesity patients indeed report differentiated life and weight control histories. The proposal is to distinguish these types of patients into two psychological phenotypes at initial assessment, as surgical and post-surgical outcomes may differ. While from a mental health point of view, identifying these elements may be an indicator to send the patient to effective and targeted psychological treatments.
Article
Background: Depressive symptoms are common in patients seeking medication treatment for opioid use disorder (MOUD treatment) and decrease quality of life but have been inconsistently related to opioid treatment outcomes. Here, we explore whether depressive symptoms may only be related to adverse treatment outcomes among individuals reporting high opioid use-related coping motives (i.e., use of opioids to change affective states) and high trait impulsivity, two common treatment targets. Methods: Patients seeking MOUD treatment (N = 118) completed several questionnaires within two weeks of their treatment intake. Treatment outcomes (opioid-positive urine screens and days retained in treatment) were extracted from treatment records. Moderation analyses controlling for demographic characteristics and main effects were conducted to explore interaction effects between depressive symptoms and two distinct moderators. Results: Depressive symptoms were only related to opioid use during early treatment among patients reporting high opioid use-related coping motives (B = 2.67, p =.004) and patients reporting high trait impulsivity (B = 2.01, p =.039). Further, depressive symptoms were only inversely related to days retained among individuals with high opioid use-related coping motives (B = -10.12, p =.003). Conclusions: Individuals presenting to treatment with opioid-related coping motives and/or impulsivity in the context of depressive symptoms may confer unique risk for adverse treatment outcomes. Clinicians may wish to consider these additive risk factors when developing their treatment plan.
Article
Background: Borderline personality disorder (BPD) is increasingly diagnosed in perinatal and infant settings, and research suggests that as well as an escalation of BPD symptoms in this period, these symptoms may also be detrimental to infant development. Providing tailored treatments during the postnatal period may help women and prevent an intergenerational cycle of emotional and interpersonal symptoms in infants. Mother–infant dialectical behavior therapy (MI-DBT) has produced promising, yet inconsistent, improvements on quantitative scales of maternal mental health and the mother–infant relationship. The qualitative evaluation may provide complementary information. Aims: This study aimed to explore the subjective experiences of women who had completed MI-DBT. Material and Methods: Thematic analysis of semistructured interviews conducted on 13 women undertaking MI-DBT before, post, and 12 months after MI-DBT were analyzed for themes. Results: Five major themes were identified. Overall, the women expressed that their emotional literacy and regulation improved after MI-DBT, subsequently addressing key risks and challenges such as uncertainty around their child's cues, and low self-esteem, and potentially improving the women's mentalization capability. Discussion and Conclusions: This study consolidates previous research on maternal BPD, and provides qualitative evidence of the benefits of MI-DBT for mothers as both individuals and as parents with likely flow-on effects for infants. Lived experience input for future adaptations was a valuable gain.
Thesis
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As clinicians, we find ourselves in the role of helping others and collectively we have the systemic power to help improve the health and well-being of our communities through our clinical work and the inherited admonition to ‘do no harm.’ This help includes the support of life-changing and potentially life altering experiences that have the potential to change an individual’s worldview (Brook, 2017; Harris, 2018). Individually and as a society, we are moving forward into a new health and wellness paradigm never seen in human history (Johnson & Armour, 2018). At this time, there is a deeper understanding within the clinical community that we must rise to meet the needs of our clients. The new vision of clinical work is a more comprehensive view that includes the practice of a global psychotherapy that supports indigenous beliefs and practices honoring the emic ‘voices’ of indigenous knowledge of self, well-being, and spirituality while considering clinically proven methods of understanding behavior and health. The purpose of this compendium is to explore the intersection between spiritual and mental health experiences, to bring light to how the two are often confused by healthcare providers, and to provide clinicians with alternative models for treatment. This compendium supports competent clinical psychotherapy treatment that imparts the spiritual/religious/transpersonal (S/R/T) beliefs and practices of clients (Barnett, 2016). Therefore, understanding a client’s symptoms (e.g., cultural, spiritual, or religious) is important to developing competence in the delivery of effective and ethical clinical care (Barnett, 2016; Frisby, 2018; Hodge, 2018). Spiritual emergence (SE) and spiritual emergency SE(y) are categorized throughout this compendium under the broad term’s spiritual, religious, and transpersonal (S/R/T) experiences. In some cases, reference to spiritual emergence (e.g., SE) or spiritual emergency SE(y) will be used to specify a particular type of experience, and other times spiritual, religious, or transpersonal (i.e., S/R/T) will be used to define broader categories of spiritual emergence.
Article
Objective: Adjunctive mobile health (mHealth) technologies offer promise for improving treatment response to enhanced cognitive-behavior therapy (CBT-E) among individuals with binge-spectrum eating disorders, but research on the key "active" components of these technologies has been very limited. The present study will use a full factorial design to (1) evaluate the optimal combination of complexity of two commonly used mHealth components (i.e., self-monitoring and microinterventions) alongside CBT-E and (2) test whether the optimal complexity level of these interventions is moderated by baseline self-regulation. Secondary aims of the present study include evaluating target engagement associated with each level of these intervention components and quantifying the component interaction effects (i.e., partially additive, fully additive, or synergistic effects). Method: Two hundred and sixty-four participants with binge-spectrum eating disorders will be randomized to six treatment conditions determined by the combination of self-monitoring condition (i.e., standard self-monitoring or skills monitoring) and microinterventions condition (i.e., no microinterventions, automated microinterventions, or just-in-time adaptive interventions) as an augmentation to 16 sessions of CBT-E. Treatment outcomes will be measured using the Eating Disorder Examination and compared by treatment condition using multilevel models. Results: Results will clarify the "active" components in mHealth interventions for binge eating. Discussion: The present study will provide critical insight into the efficacy of commonly used digital intervention components (i.e., skills monitoring and microinterventions) alongside CBT-E. Furthermore, results of this study may inform personalization of digital intervention intensity based on patient profiles of self-regulation. Public significance: This study will examine the relative effectiveness of commonly used components of application-based interventions as an augmentation to cognitive-behavioral therapy for binge eating. Findings from this study will inform the development of an optimized digital intervention for individuals with binge eating.
Article
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While dialectical behavior therapy (DBT) appears effective for some psychiatric conditions commonly associated with alexithymia, it is unclear whether DBT improves difficulties experienced by alexithymic individuals. This review investigated the current evidence on the effectiveness of DBT-based interventions in improving alexithymia. A qualitative synthesis of studies that investigated the efficacy of DBT on self-reported alexithymia was performed, identifying eligible studies using EBSCO/Essentials, Google Scholar, PubMed, Web of Science, and PsychINFO databases. Eight studies were identified. Overall, the results were inconclusive due to the heterogeneity of the studies but suggest that DBT-based interventions may be associated with self-reported decreases in alexithymia and increases in the ability to identify emotional states. The literature is limited by significant methodological problems, such as the low number of controlled trials, small samples, and high variability between DBT programs, which increases the risk of bias across study outcomes. More research is needed to reach conclusions regarding the effectiveness of DBT in improving alexithymia. Future studies should conduct randomized controlled trial designs (primarily with active treatment control conditions), greater standardization of DBT-based interventions, and a more in-depth examination of the level of participant involvement in long-term DBT-based interventions may help to understand whether DBT improves alexithymia difficulties.
Article
Background: Suicide is a leading cause of death for adolescents in the United States. Widespread implementation of evidence-based practices for this population remains challenging due to resource shortages and system barriers. Dialectical Behavior Therapy for Adolescents (DBT-A) has robust research support, with positive clinical outcomes when implemented with fidelity. At the same time, implementation requires individual therapy with trained clinicians, a resource which may not be available at the level required in some communities. The current study uses theoretical frameworks from adult implementations of Dialectical Behavior Therapy (DBT) where treatment was provided in a DBT Skills Training format without weekly individual therapy to examine skills training for adolescent clients with suicidal behaviors and is the first published study regarding feasibility of skills training for this population. Methods: Adolescents and their families were offered DBT Skills Training while on the waitlist for DBT-A. Of the 125 families referred, 48 chose DBT Skills Training and 77 opted to wait for DBT-A, creating a natural quasi-experimental design useful in exploring differences between DBT-Skills Training and DBT-A. Results: There were no significant differences between the two groups at baseline. Rates of treatment completion were similar between the two groups. Conclusions: Results from the current study demonstrate similar rates of treatment drop-out and treatment completion between DBT Skills Training and DBT-A, suggesting DBT Skills Training without individual therapy for adolescents is feasible and warrants additional research.
Article
Narcissistic personality disorder (NPD) and the manic and hypomanic episodes found in the bipolar disorders are characterized by grandiosity. It is possible that this shared grandiosity is a “homologous structure” or reflects a superficial similarity between two disparate conditions. It is, however, possible that NPD and the bipolar disorders are more closely related than implied by their segregation into the separate superordinate categories of personality disorders and mood disorders. Whereas narcissism is considered to be a life‐course, stable trait and the bipolar disorders are characterized by episodes of mania and depression, there is considerable research indicating that narcissism may be linked to mood instability (including depression) and bipolar disorder may have a pervasive personality component (i.e., hypomanic personality). Utilizing dimensional models of psychopathology, the current review examined the evidence linking narcissism and the bipolar disorders and suggests that considerable overlap may exist in the domains associated with reward‐seeking, harm avoidance, and social functioning.
Chapter
Seventeen years have passed since the arrival of third wave behavior therapy was officially declared, and now the field of behavior therapy is said to have progressed beyond the third wave behavior therapy movement into a new era of process-based cognitive behavioral therapy (CBT). From this historical perspective, this chapter is going to evaluate the contributions that the third wave behavior therapy movement has brought to the field of behavior therapy, including its additive advantages in philosophy, theory, and practice. To do so, we will first present our account of what third wave behavior therapy is, and the characteristics of this historical movement. Subsequently, we will outline changes that this movement has brought to the field of behavior therapy during early 1990s and into the mid-2010s. Finally, we are going to present the incremental advantages of third wave behavior therapies in theory and practice.
Article
Individuals with personality disorders (PDs) have a decreased life expectancy compared with the general population in part due to physical illnesses. Many hypotheses have been suggested to explain those physical illnesses such as hormone imbalance, medication, lack of physical activity, and unhealthy diet. However, little is known about the relation between lifestyle and PDs. The purpose of this scoping review is to regroup the available information on this topic. We searched the literature up to February 2021 using four databases and found 21 articles analyzing the relation between lifestyle and PDs in observational studies including 153,081 participants from diverse populations going from general population to adults in psychiatric care. Most studies used measures of lifestyle as control variables or did not use lifestyle variables at all. Moreover, the instruments used to measure lifestyle variables lacked precision at best. Two studies demonstrated a relation between early malnutrition and further development of PDs, but those results may be influenced by confounding variables and cannot indicate a clear link between nutrition and personality disorder. The lack of solid evidence we observed is surprising, considering the multiple benefits individuals with PDs could get from a healthy lifestyle. More studies are needed to thoroughly analyze the impact of lifestyle on PDs and vice versa.
Chapter
Denial of disordered eating (i.e., the tendency to conceal behaviors which reflect symptoms of an eating disorder) can be conscious or unconscious, ranging from lack of insight to deliberate refusal to disclose. Accordingly, denial of disordered eating may stem from various motivations such as a defense of self, shame and stigmatization, and/or fear of intervention. Denial of disordered eating is important to study and understand because it is associated with a variety of maladaptive consequences, including interpersonal conflict, suicidality, and further disordered eating. Denial of disordered eating also poses unique challenges to the assessment and treatment of eating disorders, which will be discussed within this chapter along with directions for future research.
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