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Preliminary Data on an Acceptance-Based Emotion Regulation Group Intervention for Deliberate Self-Harm Among Women With Borderline Personality Disorder
Abstract
Borderline personality disorder (BPD) and deliberate self-harm are clinically important conditions for which additional economically and clinically feasible interventions are needed. Literature on both the emotion regulating and experientially avoidant function of self-harm and the role of emotional dysfunction in BPD provided the rationale for developing a group intervention targeting emotion dysregulation among self-harming women with BPD. This study provides preliminary data on the efficacy of this new, 14-week, emotion regulation group intervention, designed to teach self-harming women with BPD more adaptive ways of responding to their emotions so as to reduce the frequency of their self-harm behavior. Participants were matched on level of emotion dysregulation and lifetime frequency of self-harm and randomly assigned to receive this group in addition to their current outpatient therapy (N = 12), or to continue with their current outpatient therapy alone for 14 weeks (N = 10). Results indicate that the group intervention had positive effects on self-harm, emotion dysregulation, experiential avoidance, and BPD-specific symptoms, as well as symptoms of depression, anxiety, and stress. Participants in the group treatment condition evidenced significant changes over time on all measures, and reached normative levels of functioning on most. While these preliminary results are promising, the study's limitations require their replication in a larger-scale randomized controlled trial.
... Borderline personality disorder (BPD) is characterized by extreme emotional, behavioral, interpersonal, and cognitive dysregulation, with emotion dysregulation at its core (Fruzzetti et al., 2005;Gunderson et al., 2018;Linehan, 1993). Individuals with BPD often report significant interpersonal problems (Bagge et al., 2004;Herr et al., 2013), suicidal ideation (SI), and non-suicidal self-injury (NSSI) (Gratz & Gunderson, 2006;Linehan & Heard, 1999). These impairing behaviors have consistently been linked to dysregulated emotion and often result in a struggle to meet social role obligations and academic and occupational achievements (Gunderson et al., 2018). ...
... Studies with adults consistently show that emotion dysregulation contributes to the development and maintenance of common BPD symptoms such as NSSI and SI (Gratz & Gunderson, 2006;Linehan & Heard, 1999), unstable relationships (Herr et al., 2013), and impulsivity (Krause-Utz et al., 2019). Likewise, emotion dysregulation has been shown to be related to negative interpersonal outcomes and poorer family functioning in adolescents (Fruzzetti & Shenk, 2008;Shenk & Fruzzetti, 2011 and higher rates of behavioral, cognitive, and physiological impairment (Chapman, 2019;Gratz et al., 2016) in adults with BPD. ...
... Consideration of the present findings alongside Kaplan et al. (2016) and Moran et al. (2018) suggest several avenues for future research to add nuance to our understanding of the relationship between childhood abuse, emotional dysregulation, and BPD in adolescents. There is a breadth of previous research indicating that emotion dysregulation and BPD-related problems -including self-injurious and suicidal behaviors -are experiences that influence one another in reciprocal ways (e.g., Fruzzetti et al., 2005;Gratz & Gunderson, 2006;Herr et al., 2013). Kaplan et al. (2016) and Moran et al. (2018) highlight that exposure to childhood abuse has a significant effect on BPD-related problems, especially SI and NSSI, and suggests that abuse exposure may influence the transactions among these behaviors. ...
... Emotion regulation therapy, such as ERGT (Gratz & Gunderson, 2006) and its adapted version for adolescents, ERITA Bjureberg et al., 2018), is an acceptance-based behavioral therapy that draws from DBT and Acceptance and Commitment Therapy (ACT; Hayes et al., 1999) to specifically target NSSI. It views NSSI as an attempt to control or avoid certain emotions, and it emphasizes control of behavior in the presence of emotional distress rather than control of emotions (Gratz & Gunderson, 2006). ...
... Emotion regulation therapy, such as ERGT (Gratz & Gunderson, 2006) and its adapted version for adolescents, ERITA Bjureberg et al., 2018), is an acceptance-based behavioral therapy that draws from DBT and Acceptance and Commitment Therapy (ACT; Hayes et al., 1999) to specifically target NSSI. It views NSSI as an attempt to control or avoid certain emotions, and it emphasizes control of behavior in the presence of emotional distress rather than control of emotions (Gratz & Gunderson, 2006). Consistent with DBT, principles include increasing awareness, understanding, and acceptance of emotions, as well as improving one's ability to metabolize emotions in a healthy way by altering behavioral responses to emotions rather than eliminating, avoiding, or controlling emotions themselves. ...
... Consistent with DBT, principles include increasing awareness, understanding, and acceptance of emotions, as well as improving one's ability to metabolize emotions in a healthy way by altering behavioral responses to emotions rather than eliminating, avoiding, or controlling emotions themselves. Consistent with ACT principles, treatment also includes increasing the willingness to experience difficult emotions as they arise and emphasizing the pursuit of meaningful activities and goal-directed behavior in light of emotions (Gratz & Gunderson, 2006). In the context of NSSI, emotion regulation therapy highlights the paradoxical effect of emotional avoidance: when emotional distress occurs and is perceived as intolerable, NSSI short-circuits the emotional distress in the moment but reinforces the perception that difficult emotions are intolerable and, therefore, must be avoided or controlled. ...
Internationally, at least 1 in 5 adolescents and 1 in 16 children ages 12 and under report having engaged in nonsuicidal self-injury (NSSI) at some point in their life. Common methods of NSSI include self-cutting, burning, biting, hitting, carving (words or symbols into skin), and severely scratching. The reasons for self-injury vary from person to person and often change over time, but individuals self-injure most frequently to regulate or manage their emotions. There are several risk factors for engaging in NSSI. This chapter begins with a discussion about the variability of prevalence rates of NSSI among children and adolescents as well as a detailed review of common risk factors for engaging in the behavior. It then focuses on screening for NSSI and offers a step-by-step approach to completing a brief, yet thorough, risk assessment of self-injury, with special focus on the therapist’s role in wound care and assessment. This chapter ends with an overview of common treatment approaches for addressing NSSI and their evidence base. Here, modalities that target emotion dysregulation and those that target differential reinforcement of alternative behaviors as the mechanisms of change are delineated, and a brief discussion of digital interventions for NSSI and considerations for treatment choice are offered.KeywordsNonsuicidal self-injurySelf-harmNSSIPediatricsAdolescentsRisk assessmentSelf-injury assessmentSuicide preventionEvidence-based treatment
... Furthermore, research has indicated that group-based emotion regulation therapy is a practical treatment option for both physical and psychiatric conditions (Smyth & Arigo, 2009). Such conditions include, but are not limited to, autism (Hartmann et al., 2019), deliberate self-harm (Gratz & Gunderson, 2006), breast cancer (Cameron, Booth, Schlatter, Ziginskas, & Harman, 2007), and bipolar I disorder (Painter et al., 2019), among others. ...
... As Gratz and Gunderson put it, an important goal for research in the eld of emotion regulation therapy should be to "examine potential mechanisms of change". They see such efforts as analogous to identifying "the active ingredients of this treatment" (Gratz & Gunderson, 2006). The current study is an effort aimed at improving our understanding of the mechanisms by which acceptance-based emotion regulation interventions affect the thought processes of the participants of such sessions. ...
... Theoretical Framework Gratz and Gunderson (2006) conceptualize emotion regulation to include four main dimensions. Based on their de nition and the results of their research emotion regulation involves: (1) awareness, understanding, and acceptance of emotions; (b) ability to engage in goal-directed behaviors, and inhibit impulsive behaviors, when experiencing negative emotions; (c) exible use of situationally appropriate strategies to modulate the intensity and/or duration of emotional responses, rather than to eliminate emotions entirely; and (d) willingness to experience negative emotions as part of pursuing meaningful activities in life. ...
Background
Type 2 diabetes is a severe, chronic illness that necessitates lifelong care. Research suggests that individuals with enhanced emotional and psychological skills, typically experience greater success in managing and mitigating the adverse physical and psychological ramifications of the condition. Among the psychological approaches that have demonstrated efficacy in assisting diabetic patients is acceptance-based emotion regulation. The present study aims to enhance our understanding of the ways in which acceptance-based emotion regulation therapy can benefit individuals with diabetes. The study builds on Gratz and Gunderson's emotion regulation model, expanding upon its concepts and application to the diabetic population.
Method
A series of in-depth interviews were conducted with patients diagnosed with type 2 diabetes who had undergone acceptance-based emotion regulation therapy. The treatment program encompassed 14 two-hour therapy sessions.
Results
The findings of this study provide a comprehensive account of the strategies employed by informed patients to regulate their emotions effectively.
Conclusion
Qualitative research examining the subjective experiences of patients undergoing therapy can equip therapists with valuable insights to enhance the quality of care provided.
... In a previous study (Adrian et al., 2019), adolescents with greater emotion regulation difficulties had better treatment effect of a treatment that targets emotion regulation difficulties (i.e., dialectical behavior therapy for adolescents [DBT-A]) compared to a treatment with another focus (i.e., individual and group supportive therapy [IGST]). In addition, greater emotion regulation difficulties were found to predict better treatment response (i.e., less borderline personality disorder [BPD] symptoms) to a brief emotion regulation group therapy (ERGT; Gratz & Gunderson, 2006); the treatment that IERITA was developed from, among adult women with BPD and NSSI (Gratz et al., 2014). However, emotion regulation difficulties did not predict change in the outcome of NSSI during ERGT (Gratz et al., 2014;Sahlin et al., 2019). ...
... IERITA is a 12-week acceptance-based emotion regulation behavioral therapy developed from the face-to-face manuals of emotion regulation individual therapy for adolescents (Bjureberg et al., 2017), ERGT (Gratz & Gunderson, 2006) and DBT-A (Miller et al., 2007), with the goal of decreasing NSSI by targeting emotion regulation difficulties. Across 11 weekly modules, adolescents receive interventions targeting emotional awareness and acceptance, impulse control, self-validation, identifying and engaging in valued directions, TREATMENT MODERATORS AND PREDICTORS OF IERITA -3 of 10 and non-avoidant emotion regulation skills. ...
Background
Despite the wide‐ranging negative consequences of nonsuicidal self‐injury (NSSI), there are few evidence‐based treatments for NSSI among adolescents and little is known about what treatments that work best for whom. The objective of this study was to investigate moderators (i.e., for whom a specific treatment works) and predictors (i.e., factors associated with treatment outcome independent of treatment type) of treatment outcome in a randomized clinical trial comparing internet‐delivered emotion regulation individual therapy for adolescents (IERITA) plus treatment as usual (TAU) to TAU alone.
Methods
Adolescents ( N = 166; mean [SD] age = 15.0 [1.2] years) with NSSI disorder were randomized to IERITA plus TAU ( n = 84) or TAU‐only ( n = 82). Adolescent emotion regulation difficulties, suicidality, NSSI frequency, depressive symptoms, sleep difficulties, global functioning, and age, and parental invalidation, were measured pre‐treatment and investigated as moderators and predictors of treatment outcome (i.e., NSSI frequency during treatment and for 4 weeks post‐treatment). A zero‐inflated negative binomial generalized linear mixed effects regression model was used to estimate the rate of NSSI change as a function of both treatment condition and moderator/predictor.
Results
No significant moderators of treatment outcome were found. Parental invalidation was a significant predictor of treatment outcome regardless of treatment condition, such that high levels of parental invalidation pre‐treatment were associated with a less favorable NSSI frequency.
Conclusions
We did not find evidence of a differential treatment effect as a function of any of the examined client factors. Future research should investigate moderation in larger samples and with sufficient statistical power to detect moderation effects of smaller magnitude. Results suggest that parental invalidation may have a negative impact on treatment response and highlight the importance of further investigating parental invalidation in the context of NSSI treatments.
... Research has shown that emotional dysregulation can have negative effects on an individual's health and well-being. While emotional dysregulation, which negatively affects the mental health of individuals, is defined as a part of the clinical picture in anxiety and mood disorders (Campbell-Sills & Barlow, 2007;Gibb et al, 2001;Hankin, 2005;Maciejewski & Mazure, 2006) as well as generalized anxiety disorder (Mennin, Heimberg, Turk, & Fresco, 2002), posttraumatic stress disorder (Cloitre, 1998), substance abuse (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996), dissociative symptoms (Briere, 2010), self-harming behavior (Gratz & Gunderson, 2006, Gratz & Chapman, 2007, eating disorders (Sim & Zeman 2006;Whiteside et al. , 2007) and borderline personality disorder (Gratz & Gunderson, 2006;Linehan, 1993). ...
... Research has shown that emotional dysregulation can have negative effects on an individual's health and well-being. While emotional dysregulation, which negatively affects the mental health of individuals, is defined as a part of the clinical picture in anxiety and mood disorders (Campbell-Sills & Barlow, 2007;Gibb et al, 2001;Hankin, 2005;Maciejewski & Mazure, 2006) as well as generalized anxiety disorder (Mennin, Heimberg, Turk, & Fresco, 2002), posttraumatic stress disorder (Cloitre, 1998), substance abuse (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996), dissociative symptoms (Briere, 2010), self-harming behavior (Gratz & Gunderson, 2006, Gratz & Chapman, 2007, eating disorders (Sim & Zeman 2006;Whiteside et al. , 2007) and borderline personality disorder (Gratz & Gunderson, 2006;Linehan, 1993). ...
It can be said that the main goal of psychotherapy approaches is to change dysfunctional attitudes and behaviors. The therapeutic effectiveness of psychotherapy methods that lead to change, in other words, the establishment of a causal relationship between the change in the target behavior, symptom or disorder and the intervention is examined through effectiveness studies. Emotion regulation processes play an important role in the development of many psychopathologies. The aim of this study is to examine the effect of the art therapy program on reducing the emotion regulation difficulties of individuals and to compare it with the effect of the same practices on reducing the emotion regulation difficulties of individuals participating in art therapy training, which is carried out in an experiential way. In the study, art therapy program was applied to the first experimental group and art therapy training was applied to the second experimental group. Psychology undergraduate and psychology graduate students participated in the study. Individuals who scored high on the Difficulties in Emotion Regulation Scale and volunteered were assigned to the first experimental group (11) and the second experimental group (11) by random sampling method. The program was applied to both experimental groups once a week for a total of ten sessions, each session lasting 180 minutes. The same program developed by the program coordinator was applied to both groups. Wilcoxon Signed Rank Test was used to compare the groups within each other. As a result, it was found that the emotion regulation difficulties of the individuals who participated in the art therapy program decreased, and the difference between the mean pre-test and post-test scores of the individuals who participated in the art therapy training program was not significant at the .05 level. From this point of view, treatment motivation is an important issue for art therapy as in other treatment methods. It can be stated that being ready for change and taking steps towards recovery is an important factor in emotion regulation.
... DBT has showed promising results as a transdiagnostic treatment for depression and anxiety [31,32], and has also been tested in randomised controlled trials for adolescents [27,33]. Another example is Emotion Regulation Group Therapy (ERGT [34]) which is based on DBT and Acceptance and Commitment Therapy (ACT [35]) and was developed for BPD and selfharm. Positive results for ERGT have been observed in treatment studies [26,36], with increased emotion regulation skills and overall quality of life, and reduced selfharm, symptoms of BPD and depression [37]. ...
... The skills training was developed by the first and last author informed by evidence-based CBT treatments with emotion regulation as a core component, such as DBT [30], Emotion Regulation Group Therapy [34], Acceptance and Commitment Therapy [53], Unified Protocol [23], and from clinical experiences of treating adolescents in CAP. ...
Background
Emotion regulation difficulties underlie several psychiatric conditions, and treatments that focus on improving emotion regulation can have an effect on a broad range of symptoms. However, participants’ in-depth experiences of participating in emotion regulation treatments have not been much studied. In this qualitative study, we investigated participants’ experiences of a joint emotion regulation group skills training in a child and adolescent psychiatric outpatient setting.
Methods
Twenty-one participants (10 adolescents and 11 parents) were interviewed about their experiences after they had participated in a seven-session transdiagnostic emotion regulation skills training for adolescents and parents. The aim of the skills training was to decrease emotion regulation difficulties, increase emotional awareness, reduce psychiatric symptoms, and enhance quality of life. The skills training consisted of psychoeducation about emotions and skills for regulating emotions. The interviews were transcribed and analysed using reflexive thematic analysis.
Results
The analysis resulted in three overarching themes: Parent – Child processes, Individual processes, and Group processes. The result showed that participants considered an improved parent-child relationship to be the main outcome. Increased knowledge, emotion regulation skills and behavioural change were conceptualised as both mechanisms of change and outcomes. The group format, and the fact that parents and adolescents participated together, were seen as facilitators. Furthermore, the participants experienced targeting emotions in skills training as meaningful and helpful.
Conclusion
The results highlight the potential benefits of providing emotion regulation skills training for adolescents and parents together in a group format to improve the parent-child relationship and enable the opportunity to learn skills.
... Emotion Regulation Group Therapy Similar to DBT, emotion regulation group therapy (ERGT; Gratz & Gunderson, 2006) is predicated on theories suggesting that self-injurious behaviors arise from emotion dysregulation (Linehan, 1993). Drawing from DBT and acceptance and commitment therapy, ERGT teaches emotion regulation and acceptance skills and calls attention to themes such as emotional avoidance leading to paradoxical consequences, emotional acceptance leading to emotion regulation, and the importance of behavioral control rather than emotional control. ...
... RCTs suggest that ERGT leads to significantly larger reductions in NSSI frequency than treatment as usual, which are maintained and even improved upon posttreatment (Gratz et al., 2012(Gratz et al., , 2014Gratz & Gunderson, 2006). These findings also implicate emotion regulation as a mechanism of change in ERGT. ...
Deliberate self-harm (DSH) technically refers to a broad category of self-injurious behavior that includes both suicidal and non-suicidal forms (see Table 1). Non-suicidal self-injury (NSSI) involves intentionally inflicting damage onto one’s own body without the intent to die. In contrast, in suicidal self-injurious behavior, the intent to die is present (i.e., attempted or completed suicide). DSH, however, is most often equated with NSSI (rather than suicidal self-injury), which will be the focus of the present entry.
... The ability to regulate emotions influences stress and mental health at all ages (De France and Hollenstein, 2019), as well as the quality of life (Manju and Basavarajappa, 2017). Emotional regulation problems are associated with the development of various mental disorders (Gratz and Gunderson, 2006;Berking and Wupperman, 2012), such as depression (Hong et al., 2019), anxiety (O'Toole et al., 2019), borderline personality disorder, substance and social media abuse (White-Gosselin and Poulin, 2022), etc. ...
... Participants also completed the Difficulties in Emotion Regulation Scale (DERS) (Gratz and Roemer, 2004). This scale is one of the most widely used self-reported tools to assess emotion regulation strategies, especially in clinical practice (Gratz and Gunderson, 2006). It assesses difficulties in regulating emotions using 36 items and includes six subscales: non-acceptance of one's emotional response, difficulty in adopting goal-oriented behaviors in a negative emotional context, lack of emotional awareness, difficulty in identifying one's own emotions, difficulty in controlling oneself in a negative emotional context (impulsivity), difficulty implementing emotion regulation strategies in a negative emotional context (Gross, 2014). ...
Introduction
The emerging adult stage of life is a time of many positive changes, as well as stress and uncertainty. Certain psychological characteristics - such as emotional regulation, attachment style, or assertiveness – could help these adults thrive and maintain positive mental health. This study aimed to explore the influence of these variables on the well-being of emerging adults.
Methods
The sample included 360 French emerging adults, with a mean age of 21.3 years. Well-being was assessed with the Mental Health Continuum, emotional regulation with the Emotional Regulation Difficulties Scale, assertiveness with the Assertiveness Scale, and attachment styles with the Relationship Scales Questionnaire.
Results
Results showed that judgment toward one’s own emotional experience and shyness (as part of assertiveness) predicted emerging adults’ well-being. This study also highlighted the role of substance use and experiences of violence on emerging adults’ emotional regulation and well-being.
Discussion
Results support the importance of in-person and distance education and prevention to support emerging adults’ well-being, especially in higher education institutions and in times of the COVID pandemic.
... Evidence-based treatments developed specifically for NSSI generally include those that target emotion regulation or differential reinforcement of alternative behaviors as mechanisms of change. Examples include Emotion Regulation Group Therapy (Gratz & Gunderson, 2006), Emotion Regulation Individual Therapy for Adolescents (Bjureberg et al., 2023), the Cutting Down Program (Kaess et al., 2020), the Treatment for Self-Injurious Behaviors (Andover et al., 2015), and a variety of digital interventions (Kruzan & Whitlock, 2023). Importantly, no treatments for NSSI include the visual examination of wounds. ...
Beneficence and nonmaleficence are key ethical principles toward which psychotherapists consistently strive. When patients engage in nonsuicidal self-injury (NSSI) during the course of psychotherapy, therapists may feel responsible for visually assessing the severity of the NSSI wound in order to benefit their patients and keep them from harm. However, there are no guidelines for conducting these visual assessments, and there is no research exploring their effects on patients. This article considers the ethical implications of visually examining NSSI wounds; discusses psychotherapist scope of practice and competence; draws attention to relevant ethical standards; underscores risk management, liability, and standard of care; and addresses the risk of suicide or accidental death resulting from NSSI. It also provides ethical guidance for conducting effective verbal assessments of NSSI wounds and offers suggestions for navigating complex clinical situations, such as when patients routinely and spontaneously show their therapists their wounds and how psychotherapists should handle assessments and interventions related to NSSI scars. It ends with implications for training and therapeutic practice.
... Emotion dysregulation is a key mechanism target in multiple transdiagnostic therapies. For example, acceptance-based emotion regulation group therapy targets emotion dysregulation and has shown to reducing self-injury, BPD symptomatology, and suicidal ideation (Gratz & Gunderson, 2006). Emotion regulation therapy has also shown to be efficacious for distress disorders like generalized anxiety disorder and Major Depressive Disorder (MDD; Renna et al., 2017). ...
Emotion dysregulation is a transdiagnostic phenomenon. In evidence-based treatments for disorders involving emotion dysregulation, there are still many who do not achieve clinically significant gains. The primary goal of the present study was to examine the effect of personality on treatment outcomes in individuals experiencing symptoms of emotion dysregulation. Participants were involved in a randomized control trial, where they participated in one of two group therapy programs, dialectical behavioural therapy or positive psychotherapy (PPT). Hierarchical regressions were performed to examine the main effects and interactive effects predicting change in emotion dysregulation, depression, and anxiety across the course of treatment. Split group analyses were conducted to examine the main effects of personality on treatment outcomes, differentiated by treatment group. None of the individual personality traits reached a level of significance to predict treatment outcomes after controlling for baseline symptom severity. However, large effect sizes were observed suggesting personality may have moderated specific treatment effects within the individual types of treatment. For participants undergoing dialectical behaviour therapy, higher conscientiousness and higher neuroticism predicted improved depressive symptoms. Conversely, for participants undergoing PPT, lower neuroticism and lower conscientiousness predicted improved emotion dysregulation. Extraversion predicted better outcomes across both groups. Results suggest that certain treatment types could be more beneficial for people with certain personality profiles.
... In other words, when a person has experienced effective communication in his or her family and has not felt threatened by the lack of parental support, the person has the potential to grow and flourish even in situations that face the challenges and problems of life, because this person has a higher resilience and consequently better adjustment. As Gratz and Gunderson (2006) say, family and social interactions foster resilience in stressful situations and enhance activity and response to social situations and more adjustment in those situations. Furthermore, the mediating role of resilience in the relationship between the sense of security and adjustment is explained. ...
Objective: One of the signs of people's mental health is the ability to adapt to different life conditions. This study aims to explore how parent-child interaction, sense of security, entitlement schema and adjustment are related, and how resilience mediates these relationships. Methods: The participants are 250 female high school students from Rudsar city, who were selected by convenience sampling from 5 schools in the academic year 2023-2022. The data were collected online using the following instruments: the Parent-Child Relationship Assessment Questionnaire (PCRS), the Sense of Security in Family System Questionnaire (SIFS), the Young Schema Questionnaire (YSQ), the California Social Adjustment Questionnaire (CSAQ) and the Resilience Scale (SQRS). The data analysis was performed using Pearson correlation coefficient test and structural equation modeling with LISREL-8.8 and SPSS-22 software. Results: The results showed that the data has a good fit with the proposed research model. The results showed that parent-child interaction, sense of security and entitlement schema have a direct and significant impact on the adjustment of female students. Moreover, there was an indirect and significant impact of parent-child interaction, sense of security and entitlement schema on the adjustment of students through the mediating role of resilience (p > 0.05). Conclusion: The results suggest that the type of parent-child interaction, sense of security and the schemas created can influence the individual's adjustment with the environment, and resilience plays a mediating role in this process. Therefore, paying attention to these variables is recommended to parents, counselors, psychologist and experts in the field of education.
... A total of 14 weekly sessions were carried out with all groups. The number of sessions was determined based on previous studies with BPD patients [34] and the characteristics of the AT sessions [15]. The sessions with the control group consisted of group psychotherapy based on the usual PSHP (Partial Specific Hospitalization Programme) cognitive behavioural therapy [35] for people diagnosed with BPD. ...
Adventure Therapy (AT) is a therapeutic intervention utilizing the natural environment and adventure activities as tools for psychotherapeutic interventions. It has been demonstrated to be appropriate for the intervention of patients with borderline personality disorder (BPD). This study aims to evaluate the response to AT treatment compared with the response to treatment as usual (TAU), based on cognitive behavioural therapy, in the short and long term, assessing clinical, psychosocial, and functional outcomes; quality of life; and physical health levels. This study extends the sample of and is a follow-up to a pilot study published in 2021, with a sample of 30 patients in the AT group and 10 in the control group. It does not allow us to affirm that AT provides better outcomes than TAU, as the positive effects observed immediately after therapy seem to be attenuated in the long term. Therefore, the effectiveness of long-term psychotherapy did not show differences between AT and TAU therapies in the treatment of BPD patients. However, the effects of intangibles observed during therapy by professionals and patients were not reflected in the measurements collected. Therefore, we believe it is necessary to increase the programme duration, complement treatment with a specific physical health programme, assess results with more specific instruments, and/or move towards a qualitative methodology to measure perceived changes in clinical improvement. New studies are needed to evaluate the results of the proposed changes.
... A range of cognitive behavioral interventions include elements designed to directly target emotion regulation. A handful of interventions focus almost exclusively on emotion regulation, including as in emotion regulation therapy for generalized anxiety (Mennin et al., 2005(Mennin et al., , 2015, an acceptance-based emotion regulation group therapy for BPD and self-injury (Gratz & Gunderson, 2006), and an emotion regulation skills training designed as a supplement to traditional cognitive behavioral therapy (Berking et al., 2013). Other interventions identify emotion regulation as one target within a more comprehensive treatment, such as in the case of DBT for BPD (Linehan, 1993), the unified protocol for emotional disorders (a cognitive-behaviorally based treatment for broadly defined conditions [e.g., anxiety, depression] that may share one or more transdiagnostic features, such as emotional disturbance; Barlow et al., 2010), acceptance-based behavioral therapy for generalized anxiety disorder (Roemer et al., 2008), and skills training in affect and interpersonal regulation treatment that is a prelude for prolonged exposure (Cloitre et al., 2002). ...
... Lower abilities in these areas of emotion regulation has been framed as a core deficiency in various clinical groups (Aldao, Nolen-Hoeksema, & Schweizer, 2010;Barlow, Allen, & Choate, 2016;Linehan, 1993;Sloan et al., 2017) and has received increased focus as a unifying function in diverse psychopathologies. This line of research has advanced as new evidence-based treatments have become available (Barlow et al., 2016;Gratz & Gunderson, 2006). Of note, a substantial amount of previous work describing deficits in emotion regulation as important markers of psychopathology trace these deficits back to adverse or traumatic experiences early in the child's development (e.g., Barlow et al., 2016;Linehan, 1993). ...
... Notably, and consistent with other coping and emotion regulation strategies common among individuals with BPD pathology (which often have paradoxical consequences, e.g., avoidance, reassurance-seeking, venting, self-injury; see Chapman et al., 2011;Dixon-Gordon et al., 2018;Gratz & Gunderson, 2006;Gunderson, 1996), one strategy that may be used by individuals with BPD pathology to offset the social isolation and resultant distress associated with social distancing interventions during a pandemic -posting on or viewing social media -may paradoxically increase distress and feelings of isolation and social disconnection (e.g., Cho et al., 2023;Ooi et al., 2020). Indeed, evidence suggests that social media use increased during the COVID-19 pandemic (Bailey et al., 2022;Marciano et al., 2022), likely in an effort to both stay informed about the pandemic and maintain social connections in the absence of face-to-face interactions. ...
This study examined the prospective relations of baseline borderline personality disorder (BPD) symptoms to later coping- and health-related outcomes during the early stages of the COVID-19 pandemic, as well as the moderating role of social media addiction in these relations. A U.S. nationwide community sample of 377 adults completed a prospective online study, including an initial assessment completed between March 27 and April 5, 2020 and a follow-up assessment one-month later. Baseline BPD symptoms were uniquely positively associated with maladaptive emotion regulation strategies, past-month substance use, thwarted belongingness, and health anxiety at one-month follow-up. BPD symptoms were also found to be positively associated with substance use and thwarted belongingness only among participants with high levels of social media addiction. Results suggest that individuals with BPD pathology may be particularly vulnerable to adverse coping- and health-related outcomes during a pandemic, and highlight the potential downsides of excessive social media use in the context of a global health crisis.
... Furthermore, a greater tendency to use acceptance has been found to be associated with lower thwarted belongingness, perceived burdensomeness, and suicide ideation, which are all associated with suicide attempts (Baer et al., 2022). Similarly, preliminary results of an acceptance-based emotion regulation group intervention for NSSI found that it reduced NSSI and emotion dysregulation (Gratz and Gunderson, 2006). However, there is little information on how and if these strategies are naturalistically employed by those who have histories of self-harm. ...
Background
Self-injurious behaviors have a high prevalence in emerging adulthood. People who engage in self-injury report more emotion regulation difficulties than their peers without self-injury. However, there is little research on how use of emotion regulation strategies varies over brief periods among emerging adults with differing self-harm histories. The current study examined variability in cognitive emotion regulation strategies between emerging adults with no self-harm, previous suicide attempts, or non-suicidal self-injury (NSSI).
Methods
Forty-one racially and ethnically diverse participants, ages 18–27, completed measures of cognitive emotion regulation once daily for one week.
Results
Data collected from 5 of these days were analyzed due to missing data on days 6 and 7. Growth curve analyses revealed differences in trajectories of rumination, acceptance, and catastrophizing, depending on self-harm histories. Specifically, participants with previous NSSI displayed increases in rumination, acceptance, and catastrophizing over time, compared to peers with a previous suicide attempt.
Limitations
The study design was limited by lack of assessment of self-harm during the daily diary, a limited assessment period of only one week, and distal time period of group classification.
Conclusions
These findings suggest that while emerging adults with NSSI histories use more emotion regulation strategies, they may need assistance in selecting when and how to use specific strategies.
... Although NSSI can be di cult to treat, it does respond to intervention (e.g., Turner et al., 2014). Several manualized interventions have demonstrated success at decreasing rates of NSSI in adults, including dialectical behavior therapy (DBT; Linehan, 1993), manual-assisted cognitive therapy (MACT; Tyrer et al., 2003), and emotion regulation group therapy (ERGT; Gratz et al., 2006). However, research on NSSI interventions often focuses on individuals with BPD symptoms or diagnoses (Turner et al., 2014), though not every person who self-injures has a personality disorder. ...
This chapter elaborates on the prevalence of nonsuicidal self-injury (NSSI) among adults. NSSI severity can be characterized in different ways, including increased versatility, increased frequency, need for medical attention due to the physical harm caused by NSSI, or self-reported subjective severity. Moreover, NSSI commonly co-occurs with other psychiatric disorders. According to NSSI research focused on adult samples, the functions of NSSI primarily reduce unwanted negative emotions, which is similar to other age groups. The chapter clarifies how critical it is to recognize that NSSI is not limited to the youth so prevention and intervention must be accessible to people of all ages.
... The non-judgmental items of the FFMQ refer predominantly to responding to internal emotions and thoughts with acceptance rather than criticism. This approach towards thoughts and emotions, rather than "controlling" or "criticizing" emotions, has been identified as an important component of emotional regulation (Gratz and Gunderson 2006;Velotti et al. 2015). While changes on the measure of emotional regulation (DERS-18) did not reach statistical significance, the qualitative data suggested the development of important skills in emotional regulation. ...
People with Huntington’s disease (HD) face difficult emotional and practical challenges throughout their illness, including in the pre-symptomatic stage. There are, however, extremely limited psychosocial interventions adapted to or researched for HD. We adapted and piloted an 8-week mindfulness-based stress reduction (MBSR) program in people with pre-symptomatic HD to determine if the program (i) was feasible and acceptable to participants, (ii) resulted in increased mindfulness understanding and skills, and (iii) led to improved psychological adjustment. Quantitative measures of mindfulness, emotion regulation, mood, and quality of life were administered pre and post the MBSR program and at 3-month follow-up. Measures of mindfulness practice and session clarity were administered weekly. Qualitative participant feedback was collected with a post-program interview conducted by independent clinicians. Seven participants completed the 8-week course. The program’s feasibility and acceptability was supported by excellent retention and participation rates and acceptable rates of home practice completion. In addition, qualitative feedback indicated participant satisfaction with the program structure and content. Two core mindfulness skills (observing and non-judgment) showed significant improvement from pre- to post-assessment. Participant qualitative feedback indicated increased confidence and capacity to use mindfulness techniques, particularly in emotionally challenging situations. Participant questionnaire data showed good psychological adjustment at baseline, which did not change after treatment. Psychological benefits of the program identified in qualitative data included fewer ruminations about HD, reduced isolation and stigma, and being seen by others as calmer. These findings justify expansion of the program to determine its efficacy in a larger, controlled study.
... The term NSSI refers to self-destructive behaviors carried out by individuals who by definition are not intending to take their lives, using methods such as scratching, burning, or cutting skin, headbanging, and related behaviors. Multiple researchers have formulated NSSI as arising from difficulty regulating emotion (Chapman, Gratz & Brown, 2006;Gratz & Gunderson, 2006;Linehan, 1993;Linehan, Bohus & Lynch, 2007) and experiential avoidance (Gratz, 2003). Self-harm formulations are broader and can include behaviors encompassed by NSSI definitions while also considering acts that could result in suicide, such as jumping in front of a moving vehicle or self-poisoning (Hawton, Rodham, Evans & Weatherall, 2002; National Institute for Health and Clinical Excellence [NICE, 2004[NICE, , 2011[NICE, , 2013). ...
Both self-harm and suicidal behaviors have been targeted through school-based prevention programs, many of which have been developed in the United States. The aims of this systematic review were to assess effects of school-based prevention programs on suicide and self-harm and to evaluate whether they are fit to the exporting culture. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our inclusion criteria, structured according to population/problem, intervention, control/comparison, outome, were: children and youth up to 19 years of age, school-based programs at universal, selective or indicated levels compared with teaching as usual or with other programs, and outcomes of suicide or self-harm measured at least 10 weeks after intervention. Studies without a control group or using non-behavioral outcomes were excluded. A comprehensive and systematic literature search was conducted from the 1990s to March 2022. Risk for bias was assessed with checklists adapted from the Cochrane Risk of Bias (ROB) tool. A total of 1,801 abstracts were retrieved. Five studies fulfilled our inclusion criteria, but one had high risk for bias. Confidence in the evidence for effect was assessed with Grading of Recommendations Assessment, Development and Evaluation (GRADE). Studies included in this review were evaluated with respect to applicability in the context of international export. Only two school-based programs demonstrated efficacy in preventing suicidal behaviors. Although implementation of evidence-based interventions is a crucial next step, further replication with simultaneous attention to dissemination and implementation issues are called for. Funding and registration: conducted on assignment by the Swedish government. The protocol is available at the SBU website in Swedish.
... Both males and females would benefit from treatments targeting the improvement of ER and emotional acceptance (Barlow et al., 2017;Elliott et al., 2004;Greenberg et al., 2019;Timulak & Koegh, 2022). An acceptance-based behavioural program called Emotion Regulation Group Therapy (ERGT) has been developed for self-harm and emotion dysregulation by Gratz and Gunderson (2006). It involves psychoeducation and emotion management along three axesthe paradoxical effects of emotional avoidance, the consequences of emotional acceptance, and the importance of controlling one's behaviour. ...
Over recent years, non-suicidal self-injury (NSSI) has been associated with emotion dysregulation. However, only a few quantitative studies have empirically investigated differences in emotion dysregulation among people who self-harm, while none have explored gender differences in this regard. Thus, this research study aimed to further examine the association between NSSI and emotion regulation deficits and strategies in young adults. A total of 201 participants (mean age = 21.82 years) were recruited from different support groups dedicated to NSSI and from health care centres and were divided into two groups: a control group (CG, n = 100, mean age = 21.92 years, comprised of 30% males) and an NSSI group (NSSIG, n = 101, mean age = 21.72 years, comprised of 16% males). All participants completed the Deliberate Self-Harm Inventory, the Difficulties in Emotion Regulation Scale, and the Emotion Regulation Questionnaire. The results showed that compared to the CG participants, those from the NSSIG had increased emotion regulation deficits, higher expressive suppression scores, and lower cognitive re-evaluation scores. Within the NSSIG, females had higher impulse control difficulties and limited access to emotion regulation strategies, while males had higher expressive suppression scores. Factors associated with NSSI also differed by gender. These results indicate the necessity to take gender into account when planning treatment, since treatment protocols must be adapted to the specific emotion regulation difficulties concerned.
... Both males and females would benefit from treatments targeting the improvement of ER and emotional acceptance (Barlow et al., 2017;Elliott et al., 2004;Greenberg et al., 2019;Timulak & Koegh, 2022). An acceptance-based behavioural program called Emotion Regulation Group Therapy (ERGT) has been developed for self-harm and emotion dysregulation by Gratz and Gunderson (2006). It involves psychoeducation and emotion management along three axesthe paradoxical effects of emotional avoidance, the consequences of emotional acceptance, and the importance of controlling one's behaviour. ...
Over recent years, non-suicidal self-injury (NSSI) has been associated with emotion dysregulation. However, only a few quantitative studies have empirically investigated differences in emotion dysregulation among people who self-harm, while none have explored gender differences in this regard. Thus, this research study aimed to further examine the association between NSSI and emotion regulation deficits and strategies in young adults. A total of 201 participants (mean age = 21.82 years) were recruited from different support groups dedicated to NSSI and from health care centres and were divided into two groups: a control group (CG, n = 100, mean age = 21.92 years, comprised of 30% males) and an NSSI group (NSSIG, n = 101, mean age = 21.72 years, comprised of 16% males). All participants completed the Deliberate Self-Harm Inventory, the Difficulties in Emotion Regulation Scale, and the Emotion Regulation Questionnaire. The results showed that compared to the CG participants, those from the NSSIG had increased emotion regulation deficits, higher expressive suppression scores, and lower cognitive re-evaluation scores. Within the NSSIG, females had higher impulse control difficulties and limited access to emotion regulation strategies, while males had higher expressive suppression scores. Factors associated with NSSI also differed by gender. These results indicate the necessity to take gender into account when planning treatment, since treatment protocols must be adapted to the specific emotion regulation difficulties concerned.
... Performance also revealed significant correlation. [27] opined that parents in inferior occupations earned lower incomes and often had to work longer hours to earn more for their families. Therefore they were often left with less time to spend with their family members and getting more involved in their children's educational activities. ...
Following the normative-descriptive type of research using a semi-census survey, this study gathered
information on the profile of school-going children of Baguingey Elementary School. It also utilized document
scanning and analyses of grade reports to describe the academic performance of school children. Based on findings
of the study, the study formulated an Assistance Program for the school children and their families. Findings of the
study revealed that majority of the school children spoke Ayangan, who were enrolled from grades 1 to 6, and
affiliated with Union Espiritista and Born Again. The parents of the learners were in their middle adulthood. The
mothers were younger than their fathers and they had big number of children to look after their needs. Most had
nuclear families and followed the patrilocal type of residence, a big majority of the heads of families either finished
elementary or no schooling completed. The study concluded that the Ayangan children were in need of assistance to
be able to finish their education as gleaned from the profile. Government, NGOs and private sponsored – projects
were seen as vital in enhancing their opportunities in life. Since about 97% are Ayangan, the integration of
indigenous peoples’ education also helped in preserving, protecting and promoting relevant indigenous knowledge,
systems and practices to sustain cultural life. Today’s generation of Ayangan learners at Baguingey Elementary
School exhibited opportunities to grow or enhance themselves through education. They were good academically and
could exhibit greater chances to succeed but much needed educational support was called for, including economic
support for their families. The proposed infrastructure projects like paving and widening of roads, school building
construction, livelihood trainings for mothers and feeding program were seen as important activities since they were
need-based and rights-based in as far as the approach of community-based programs and projects were concerned.
... 42 Research indicates that value-based change can even help with hard-to-treat disorders such as BPD, where value-based work improves symptoms associated with hopelessness, BPD symptomatology, psychological flexibility and emotional issues. 43,44 Values, then, motivate action and help individuals find meaning in their lives and actions, but are these values different from, or do they need to be differentiated from, philosophical engagements with values and ethics? Philosophy has a long history of emphasizing values to orient human decision-making and behavior. ...
Ancient therapeutic practices have influenced the development of cognitive behavioral therapy (CBT) theories such as Albert Ellis's rational emotive behavior therapy and Aaron Beck's cognitive therapy. By drawing inspiration from Socratic questioning, the importance of philosophy in evidence‐based practices in human mental health can be acknowledged. Stoicism has also informed CBT, notably its emphasis on establishing psychological distance from emotions. Cognition and emotion are two aspects of mental processes, and irrational demands are processed through rational deliberation. Using mental imaging techniques and acceptance strategies (to accept oneself and the world as imperfect), avoiding catastrophic interpretations and acknowledging emotions are also included among such practices.
Methods
We will explore the use of values across CBT, acceptance and commitment therapy (ACT), and radically open dialectical behavioral therapy (RO DBT) to clarify their use of values.
Results
In this framework, values are conceptualized as life‐orienting principles and are now widely used across CBTs, such as acceptance and commitment therapy and radically open dialectical behavioral therapy. In recent years, the development of CBT has involved a renewed relationship with philosophy through the use of values, interest in dialectics and development of self‐questioning practices reminiscent of classical Socratic principles. This movement from applied clinical psychology toward philosophical skills has also encouraged the recent emergence of philosophical health considerations. The opposition between psychological and philosophical health can be questioned, and the fundamental issue of philosophical skills implemented in psychiatric treatment (and not solely as practices of enhancement for the sane) needs to be considered.
... We also removed one pilot study (Morton, Snowdon, Gopold, & Guymer, 2012), because their intervention was not delivered as a full course treatment, but rather as a brief-adjunct intervention, only meant to be provided as an addition to a current treatment (i.e. Gratz et al., 2006). This resulted in a total of 43 studies (n = 3273), including eleven conditions (psychotherapies and control conditions) that were used for the statistical analyses. ...
A broad range of psychotherapies have been proposed and evaluated in the treatment of borderline personality disorder (BPD), but the question which specific type of psychotherapy is most effective remains unanswered. In this study, two network meta-analyses (NMAs) were conducted investigating the comparative effectiveness of psychotherapies on (1) BPD severity and (2) suicidal behaviour (combined rate). Study drop-out was included as a secondary outcome. Six databases were searched until 21 January 2022, including RCTs on the efficacy of any psychotherapy in adults (⩾18 years) with a diagnosis of (sub)clinical BPD. Data were extracted using a predefined table format. PROSPERO ID:CRD42020175411. In our study, a total of 43 studies (N = 3273) were included. We found significant differences between several active comparisons in the treatment of (sub)clinical BPD, however, these findings were based on very few trials and should therefore be interpreted with caution. Some therapies were more efficacious compared to GT or TAU. Furthermore, some treatments more than halved the risk of attempted suicide and committed suicide (combined rate), reporting RRs around 0.5 or lower, however, these RRs were not statistically significantly better compared to other therapies or to TAU. Study drop-out significantly differed between some treatments. In conclusion, no single treatment seems to be the best choice to treat people with BPD compared to other treatments. Nevertheless, psychotherapies for BPD are perceived as first-line treatments, and should therefore be investigated further on their long-term effectiveness, preferably in head-to-head trials. DBT was the best connected treatment, providing solid evidence of its effectiveness.
... (Wolff et al., 2019). In spite of intervention and treatment programs for NSSI targeting for emotion dysregulation (e.g., Gratz & Gunderson, 2006), there is no empirical evidence on the role of culture in the association between emotion dysregulation and NSSI. Focusing on emotion dysregulation for individuals struggling with NSSI from other cultural backgrounds may inadvertently impose different cultural values (such as emotion expression) and may further impede their treatment progress. ...
The purpose of the present study is to examine the mediating role of emotion dysregulation in the association between family relational problems and nonsuicidal self-injury (NSSI) in a sample of American and Taiwanese college students. The current study also tested whether this mediation model was moderated by culture. A total of 723 college students (324 Americans, 399 Taiwanese) completed questionnaires assessing family relational problems, emotion dysregulation and NSSI. Results revealed that emotion dysregulation partially mediated the association between family relational problems and NSSI and this indirect effect was moderated by culture, such that the association between family relational problems and emotion dysregulation was stronger for U.S. than Taiwanese college students. The findings contribute to our understanding of the role of culture in crucial factors for NSSI and highlight the necessity of considering cultural context in prevention and intervention programs for NSSI.
... Emotion regulation was defined as the process of initiating, preserving, modifying or alteration to incidence, severity or continuity of one's inner feelings and the emotions engaged with social, psychological and physical procedures in accomplishing individual's goals [6]. In other words, cognitive emotion regulation strategies refer on how people think after having a negative experience or traumatic event [7]. ...
Introduction: The present study has aimed to predict the psychological hardiness and emotion regulation strategies based on components of meaning of life, in adults of Tehran city. Materials and Methods: The study was conducted using Correlation Method. 384 subjects were chosen from 22 regions of Tehran city from 1395 to 1396, by clustered sampling, and participated in the study. The data were collected through ‘’meaning in life” questionnaire-MLQ-(Steger et al, 2006), “cognitive-emotional regulation” questionnaire (CERQ), and “Ahwaz Hardiness Inventory” (AHI). And the resultant data were analyzed step by step by correlation scales and regression analysis, using version 18th of SPSS software. Results: According to the results, the presence of meaning subscale, has negative and significant correlation with other-blame and catastrophizing, and has positive and significant correlation with putting into perspective, positive refocusing, positive reappraisal, and planning. Regression analysis results suggested that 28% of variations in positive refocusing, 29% of variations in planning, 33% of variations in positive reappraisal, 22% of variations in putting into perspective, 4% of variations in catastrophizing, and 8% of variations in other-blame, are predictable through the presence of meaning subscale. Also, presence of meaning subscale, had positive and significant correlation with psychological hardiness(r=0.66), and 43% of variations in psychological hardiness was predictable by presence of meaning subscale. Conclusion: The present study results showed that presence of meaning component, had role in predicting psychological hardiness and emotion regulation strategies.
... Emotion regulation and specifically the fostering of flexible use of different emotion-regulation strategies are important topics in the treatment of mental health disorders and more specifically in psychotherapy research. This is made evident by the large number of publications that focus on the topic of emotion regulation [34][35][36][37]. Interestingly, emotion regulation has been discussed as a transdiagnostic factor related to psychopathology and the treatment of mental health disorders [34,[38][39][40]. ...
Background:
Only 11%-40% of those with a mental disorder in Germany receive treatment. In many cases, face-to-face psychotherapy is not available because of limited resources, such as an insufficient number of therapists in the area. New approaches to improve the German health care system are needed to counter chronification. Web-based interventions have been shown to be effective as stand-alone and add-on treatments to routine practice. Interventions designed for a wide range of mental disorders such as transdiagnostic interventions are needed to make treatment for mental disorders more accessible and thus shorten waiting times and mitigate the chronification of mental health problems. In general, interventions can be differentiated as having either a capitalization (CAP) focus-thus drawing on already existing strengths-or a compensation (COMP) focus-trying to compensate for deficits. Up to now, the effectiveness of transdiagnostic web-based interventions with either a CAP or a COMP focus has not yet been evaluated.
Objective:
This study is the first to examine the effectiveness of two transdiagnostic web-based interventions: (1) the activation of resilience and drawing on existing strengths (CAP: Res-Up!) and (2) the improvement of emotion regulation (COMP: REMOTION), compared with care as usual (CAU) in routine outpatient psychotherapy.
Methods:
Adults with at least 1 mental health disorder will be recruited at 4 outpatient centers in Germany. Participants will then be randomized equally into 1 of the 2 intervention groups Res-Up! (CAP) and REMOTION (COMP) or into the control group (CAU). Assessments will be made at baseline (T0), at 6 weeks after treatment start (T1), and at 12 weeks after treatment start (T2). A primary outcome will be symptom severity (Brief Symptom Inventory-18). Secondary outcomes will focus on emotion regulation and resilience.
Results:
Participant recruitment and data collection started in April 2020 and were ongoing as of July 2022. We expect participants to benefit more from the interventions than from the CAU control on the dimensions of symptom severity, resilience, and emotion regulation. Furthermore, we expect to find possible differences between CAP and COMP. The results of the study are expected in 2023.
Conclusions:
This randomized controlled trial will compare CAU with the transdiagnostic web-based interventions Res-Up! and REMOTION, and will thus inform future studies concerning the effectiveness of transdiagnostic web-based interventions in routine outpatient psychotherapy.
Trial registration:
ClinicalTrials.gov NCT04352010; https://clinicaltrials.gov/ct2/show/NCT04352010.
International registered report identifier (irrid):
DERR1-10.2196/41413.
Аннотация: материалы и методы: в работе использованы материалы исследования, проводившегося в г. Москва в сентябре-июне 2020 года. Для изучения особенностей самоповреждающего поведения подростков была выбрана шкала причин самопрвеждающего поведения (Польская Н.А., 2014). Для изучения особенностей партнерских отношений подростков: диагностика эмоциональных барьеров в меж-личностном общении (Бойко В.В., 1996), опросник привязанности к близким людям (Сабельникова Н.В., Каширский Д.В., 2015), дифференциальный опросник переживания одиночества (Осин Е.Н., Леонтьев Д.А., 2013), семантический дифференциал «характеристи-ка отношений» (Осгуд Ч.Е., 1957), личностный семантический дифференциал «характе-ристика себя в отношениях», «характеристика партнера в отношениях» (Бажин Е.Ф., Эткинд А.М., 1983). Результаты. Выявленная структура партнерских отношений у подростков с самоповреждающим поведением комплексна и в некоторой степени противоречива. Смо самоповреждающее поведение направлено скорее на снижение собственной тревоги и над стремлением контро-лировать свои чувства, что дает возможность оценивать себя как более спокойного. Когда партнер проявляет активность и эмоциональность, снижается интенсивность самоповреждений и увеличивается нежелание эмоциональной близости. Но если отношения становятся более удовлетворительными, пвышается риск самоповреждающего поведения за счет увеличения значимости его стратегий, и повышается избегание в привязанности. Когда же отношения оцниваются как «тяжелые», проявляется еще большая тревожность в привязанности, как «хаотичные» – усугубляется самоповреждающее поведение для улучшения самоконтроля. Заключение. На основе эмпирического исследования определены особенности выстраивания подростками взаимодействия с другими людьми: привязанность и эмоциональные барьеры, и проводится исследование восприятия отношений, а также собственной роли и роли партнера в них в качестве социального фактора самоповреждающего поведения. Было доказано, что у подростков с самоповреждающим поведением восприятие партнерских отношений отличается от подростков без самоповреждающего поведения, обобщены и систематизированы выводы по специфике самоповреждающего поведения, которые могут быть использованы в коррекционной работе с группой подростков. Полученные данные имеют ценность как теоретической базы, так как подчеркивают важность изучения партнерских отношений подростков как важной части общей структуры этого жизненного периода, так и для практической работы, так как подчеркивают важность уделения внимания этой сфере жизни в индивидуальной или групповой работе с подростками, которые столкнулись с самоповреждающим поведением, а также работу над коррекцией стиля привязанности.
Abstract: materials and methods: the paper used materials from a study conducted in Moscow in September-June 2020. To study the characteristics of self-harmful behavior of adolescents, a scale of causes of self-harmful behavior was chosen (Polskaya N.A., 2014). To study the characteristics of adolescent partnerships: diagnosis of emotional barriers in interpersonal communication (Boiko V.V., 1996), attachment questionnaire for close people (Sabelnikova N.V., Kashirsky D.V., 2015), differential questionnaire for experiencing loneliness (Osin E.N., Leontyev D.A., 2013), semantic differential «characteristics of relationships» (Osgood P.E., 1957), personal semantic differential «characteristics of oneself in a relationship», «characteristics of a partner in a relationship» (Bazhin E. F., Etkind A.M., 1983). Results. The identified structure of partnerships in adolescents with self-harmful behavior is complex and somewhat contradictory. Self-harmful behavior is more likely aimed at reducing one’s own anxiety and the desire to control one’s feelings, which makes it possible to evaluate oneself as calmer. When a partner is active and emotional, the intensity of self-harm decreases and the reluctance of emotional intimacy increases. But as the relationship becomes more satisfying, the risk of self-injurious behavior increases due to the increased importance of its strategies, and avoidance in attachment increases. When the relationship is assessed as «difficult», even greater anxiety in attachment appears, as «chaotic» – self-harmful behavior is aggravated to improve self-control. Conclusion. Based on empirical research, the features of how adolescents build interactions with other people are identified: attachment and emotional barriers, and a study is conducted of the perception of relationships, as well as one’s own role and the role of a partner in them as a social factor of self-harmful behavior. It has been proven that adolescents with self-harmful behavior have a different perception of partner relationships from adolescents without self-harmful behavior; conclusions on the specifics of self-harmful behavior that can be used in correctional work with a group of adolescents have been summarized and systematized. The data obtained are valuable as a theoretical basis, as they emphasize the importance of studying adolescents’ partnerships as an important part of the general structure of this life period, and for practical work, since they emphasize the importance of paying attention to this area of life in individual or group work with adolescents who are faced with with self-harming behavior, as well as working on correcting attachment style.
The American Psychological Association Advisory Steering Committee for Development of Clinical Practice Guidelines created a working group to consider the feasibility of, and appropriate methods for, developing an APA clinical practice guideline for interventions that address a transdiagnostic change process, rather than a categorical disorder. Specifically, the working group was asked to determine whether development of a clinical practice guideline focused on emotion regulation was worth pursuing at this time, given the state of the scientific literature, feasibility, and considerations of clinical need and utility.
The working group identified a set of goals for a clinical practice guideline based on the idea that if a guideline could mostly achieve these goals, it would be an advance for the field and worth the investment to try to develop a clinical practice guideline based on a transdiagnostic change process or principle.
Goals:
1) Inform providers, patients and their families, payers and other stakeholders about what the empirical data indicate regarding the efficacy of treatments targeting emotion regulation
2) Enhance clinical utility of a clinical practice guideline so we learn more than typical guidelines tell us about:
● What works, for whom, and under what circumstances
● What is known about widely-used treatments for which there is not rigorous evidence concerning efficacy
● What is known about change processes or principles underlying the effects of efficacious treatments
After careful consideration of the opportunities and challenges likely to arise in developing a clinical practice guideline on emotion regulation, the working group recommends developing and publishing three review protocols that would lead to a clinical practice guideline with three components:
Review 1. Systematic review of the efficacy data leading to recommendations, following the current best practices to reduce bias (and acknowledgement of biases not addressed with this approach). This would include the Population, Intervention, Comparator, Outcomes, Timing, and Setting (PICOTS) questions to assess applicability based on current best practices, and would include the usual review of literature on harms, patient preferences, etc.
Note: Only in unusual cases when there is a good reason a priori to think that a given subgroup will have a unique response to a treatment will subgroup analyses, cohort or other studies (that don’t meet best practices to reduce bias) be included. In these cases, careful attention to likely confounds and differences in the analytic approach will need to be considered if these studies are used to guide recommendations.
Review 2. Summary of current knowledge (with appropriate caveats about the quality of evidence) for select treatments that were not included in Review 1, when the treatments are both widely used and studies meet stringent, pre-specified inclusion and exclusion criteria.
Review 3. Summary of current knowledge (with appropriate caveats about the quality of evidence) for literature on change processes or principles based on systematic inclusion and exclusion criteria to determine (observational) studies that rigorously try to account for confounding.
This report outlines the working group’s process, rationale for a guideline on emotion regulation, review of challenges likely to arise when developing a guideline of this nature and how recognition of these challenges guided the current proposal. Next the proposal and rationale for the three reviews are discussed, along with consideration of how to manage scope and why the working group believes developing this guideline would be very challenging, but ultimately feasible. We close with recommendations for future research in the hopes that the available literature will one day better match the urgent clinical needs.
Emotion Regulation and Parenting provides a state-of-the-art account of research conducted on emotion regulation in parenting. After describing the conceptual foundations of parenthood and emotion regulation, the book reviews the influence of parents' emotion regulation on parenting, how and to what extent emotion regulation influences child development, cross-cultural perspectives on emotion regulation, and highlights current and future directions. Drawing on contributions from renowned experts from all over the world, chapters cover the most important topics at the intersection of parenting and emotion regulation. Essentials are explored, as well as current, topical, and controversial issues, pointing both to what is known and what requires further research. This title is part of the Flip it Open Programme and may also be available Open Access. Check our website Cambridge Core for details.
Learning Objectives: After participating in this CME activity, the psychiatrist should be better able to
• Outline the risk factors involved with opioid accessibility in patients receiving treatment for cancer.
• Identify factors to address in order to mitigate risk for opioid misuse during cancer care.
Abstract
Most patients with advanced cancer receive treatment for related pain. Opioid accessibility, however, is a risk factor for misuse, which can present care challenges and quality-of-life concerns. There is a lack of consistent universal screening prior to initiation of opioid prescribing. One crucial issue in treating this population is adequately identifying and mitigating risk factors driving opioid misuse. Drawing on theory and research from addiction science, psychology, palliative care, and oncology, the presented conceptual framework suggests that risk factors for opioid misuse during cancer care can be stratified into historical, current, malleable, and unmalleable factors. The framework identifies necessary factors to address in order to mitigate risk for opioid misuse during cancer care, and offers key directions for future research.
Background
There is considerable evidence of the burden of care encountered by informal caregivers of persons with severe and enduring mental health conditions in low- and middle-income countries. Previous studies have highlighted the need to support these informal caregivers as key players in the care of these patients. To date, limited evidence exists on the extent and types of strategies for supporting these informal caregivers in low- and middle-income countries.
Objective
This scoping review aims to identify and describe the extent and type of evidence on the existing strategies for alleviating the burden of care among informal caregivers of persons with severe and enduring mental health conditions in low- and middle-income countries.
Methods
A systematic literature search was completed following the Joanna Briggs Institute methodology for scoping reviews. The participants, concept, and context framework was used to guide the search for literature sources across 5 databases: PubMed, MEDLINE, CINAHL, and PsycINFO for published literature and ProQuest for unpublished literature. This review included studies that reported on strategies for alleviating the burden of care among informal caregivers of persons with severe and enduring mental health conditions, with a focus on studies that evaluated or recommended caregiver interventions and support strategies in low- and middle-income countries. The search was limited to studies conducted between 2001 and 2021, and only papers written in English were considered for inclusion. Using the Covidence software (Veritas Health Innovation), 2 reviewers independently screened the papers, applied the inclusion and exclusion criteria, and met biweekly to discuss and resolve conflicts. The relevant studies and reported outcomes were summarized, organized, and analyzed descriptively using numeric summary analysis and deductive content analysis.
Results
Of the 18,342 studies identified, 44 (0.24%) met the inclusion criteria. The included studies were from 16 low- and middle-income countries in Asia, Africa, Europe, and South and North America. Most studies (21/44, 48%) were randomized controlled trials conducted in Asian countries. The identified strategies were grouped into 2 categories: implemented and recommended intervention strategies. Identified strategies included community-based interventions, psychoeducation interventions, support groups, cognitive behavioral therapy, spirituality-based interventions, and smartphone-based interventions. In addition, mindfulness and empowerment, collaborative interventions, standard care, financial and social support, counseling, occupation-based interventions, policy and legislature, and access to mental health care were identified. Psychoeducation and support group interventions were identified as common strategies for alleviating the burden of care among informal caregivers of persons with severe and enduring mental health conditions.
Conclusions
This review provides evidence on the types of implemented and recommended strategies for alleviating the burden of care among informal caregivers in low- and middle-income countries. Although psychoeducational interventions were the most preferred strategy for alleviating burden, their benefits were short-lived when compared with peer-led support groups.
International Registered Report Identifier (IRRID)
RR2-10.2196/44268
Importance:
Nonsuicidal self-injury is prevalent in adolescence and associated with adverse clinical outcomes. Effective interventions that are brief, transportable, and scalable are lacking.
Objective:
To test the hypotheses that an internet-delivered emotion regulation individual therapy for adolescents delivered adjunctive to treatment as usual is superior to treatment as usual only in reducing nonsuicidal self-injury and that improvements in emotion regulation mediate these treatment effects.
Design, setting, and participants:
This 3-site, single-masked, randomized superiority trial enrolled participants from November 20, 2017, to April 9, 2020. Eligible participants were aged between 13 and 17 years and met diagnostic criteria for nonsuicidal self-injury disorder; they were enrolled as a mixed cohort of consecutive patients and volunteers. Parents participated in parallel to their children. The primary end point was at 1 month after treatment. Participants were followed up at 3 months posttreatment. Data collection ended in January 2021.
Interventions:
Twelve weeks of therapist-guided, internet-delivered emotion regulation individual therapy delivered adjunctive to treatment as usual vs treatment as usual only.
Main outcomes and measures:
Primary outcome was the youth version of the Deliberate Self-harm Inventory, both self-reported by participants prior to treatment, once every week during treatment, and for 4 weeks posttreatment, and clinician-rated by masked assessors prior to treatment and at 1 and 3 months posttreatment.
Results:
A total of 166 adolescents (mean [SD] age, 15.0 [1.2] years; 154 [92.8%] female) were randomized to internet-delivered emotion regulation therapy plus treatment as usual (84 participants) or treatment as usual only (82 participants). The experimental intervention was superior to the control condition in reducing clinician-rated nonsuicidal self-injury (82% vs 47% reduction; incidence rate ratio, 0.34; 95% CI, 0.20-0.57) from pretreatment to 1-month posttreatment. These results were maintained at 3-month posttreatment. Improvements in emotion dysregulation mediated improvements in self-injury during treatment.
Conclusions and relevance:
In this randomized clinical trial, a 12-week, therapist-guided, internet-delivered emotion regulation therapy delivered adjunctive to treatment as usual was efficacious in reducing self-injury, and mediation analysis supported the theorized role of emotion regulation as the mechanism of change in this treatment. This treatment may increase availability of evidence-based psychological treatments for adolescents with nonsuicidal self-injury.
Trial registration:
ClinicalTrials.gov Identifier: NCT03353961.
Background:
The defective self model of nonsuicidal self-injury (NSSI) theorizes that individuals who are highly self-critical are more likely to choose NSSI to regulate emotions. This model indirectly suggests that individuals who engage in NSSI may experience more self-conscious emotions in response to negative social feedback, increasing risk for near-term NSSI. This study examined (1) whether individuals with a history of NSSI (vs. without) display greater self-conscious and negative emotional reactions to daily social stressors, and more problematic features of these daily social stressors, and (2) whether greater-than-usual negative emotional reactions and social stressor features predict NSSI urges and behaviors in daily life.
Methods:
Participants were 134 female college students with recent, recurrent NSSI (n = 77) or no NSSI history (n = 57). Participants completed baseline measures of socioemotional functioning and a two-week daily diary protocol.
Results:
The NSSI (vs. no NSSI) group reported significantly greater self-conscious and negative emotional reactions to daily social stressors, and social stressors characterized by greater dysfunction. In the NSSI group, experiencing social stressors characterized by greater distress than one's average during the daily diary period was associated with same-day NSSI urges and behavior, greater confusion than one's average predicted same-day NSSI urges, and greater conflict than one's average predicted same-day NSSI behavior. Greater self-conscious and negative emotional reactions to these stressors than one's average predicted same-day NSSI urges and behavior.
Limitations:
Limitations include reliance on self-report, a once-daily assessment, and lack of generalizability to other samples.
Conclusions:
Interpersonal conflict and increased self-conscious emotions pose vulnerability for NSSI. Prevention and intervention efforts would benefit from including a focus on interpersonal functioning.
Otizm Spektrum Bozukluğu (OSB), sosyal-duygusal etkileşimde ve iletişimde bozulma, sınırlı kısıtlı ve tekrarlayıcı davranışlarla karakterize nörogelişimsel bir bozukluktur. Belirtiler erken çocukluk çağından itibaren başlamakta ve günlük işlevleri olumsuz etkilemektedir. Bu süreç, aile ve özellikle bakım verici için rollerini yerine getirmede çeşitli güçlükler oluşturur. Bakım verici konumda bulunan annenin stres düzeyi artmakta, sosyal izolasyon ve depresyon gibi çeşitli belirtiler görülebilmektedir. Bu nedenle anneler, gelişimsel ihtiyaçları farklılık gösteren çocuklarının gereksinimlerini dengelemekte zorlanmakta, duygusal destek sağlama ve uyumsal başa çıkma becerileri konusunda yeterli rol model olamamaktadır. Bu bağlamda, OSB tanılı bireylerin ailelerinin yaşadıkları stres, bakım yükü ve bununla ilişkili yaşanan duygusal zorluklar, stresle başa çıkmada yaşanan güçlükler ve olumsuz duygular göz önüne alınarak bu makalede; OSB tanılı çocukları olan ebeveynler için bir psikoeğitim programı model önerisi sunuldu. Hazırlanan psikoeğitim programı; Bütüncül Psikoterapi kapsamında, diyalektik davranışçı terapi ve duygu odaklı terapi eğitimi ve Psikodrama eğitimine dayanmaktadır. Literatürde OSB tanılı çocukların ebeveynlerinin yaşadığı güçlüklere yönelik çalışmalar olmasına karşın, bu ailelerin yaşadığı sorunları çözümlemeye yönelik girişimsel çalışmalara ihtiyaç olduğu görüldü. Bu amaçla, Duygu Düzenleme Psikoeğitim Programı, ruh sağlığı uzmanları için girişimsel bir çalışma modeli olarak sunuldu.
Nonsuicidal self-injury (NSSI) is prevalent and concerning among adolescents and adults. Although prior meta-analytic work has considered the efficacy of individual psychotherapy for reducing NSSI, the efficacy of group psychotherapy remains unclear. We conducted a systematic meta-analysis of group psychotherapy studies with NSSI measures. We identified a total of eight studies, including published articles (n = 6) or dissertations (n = 2) with 10 total effect sizes for group interventions. Overall, random-effects meta-analysis suggests that group psychotherapies have a significant small effect on NSSI. However, when corrected for publication bias, the effect is no longer significant. This meta-analysis cautiously suggests that group psychotherapies, which are cost-effective and efficient, hold promise for attenuating NSSI. The field would benefit from further study and treatment refinement, including consideration of what works for whom.
Eine komorbide Erkrankung von Persönlichkeitsstörung und Abhängigkeit ist häufig. Klinisch sind diese Patienten psychisch instabiler und impulsiver als solche mit nur einer der beiden Diagnosen. Therapieabbrüche sind häufiger und Abstinenzphasen der Betroffenen kürzer. Die Behandlung dieser Betroffenen erfordert daher besondere Behandlungskonzepte. Dieses Kapitel gibt ein Überblick über den aktuellen Stand des Wissens in diesem Segment. Grundlage dieses Textes sind eine Literaturrecherche zu Neurologie, und zur Therapie dieser Dualdiagnose. Im Fokus steht die Vorstellung von sowohl neurobiologischer Grundlagen als auch Behandlungsansätze, die speziell für diese Patienten evaluiert wurden. Als Basis dienen Cochrane-Collaboration-Reviews und ergänzende aktuelle Literatursuchen nach kontrolliert randomisierten Studien.
Background:
Quality of care and access to effective interventions have been widely criticised as limited for people diagnosed with 'personality disorder' or who have comparable needs (described in some recent papers as "Complex Emotional Needs" (CEN). It is important to identify effective interventions and the optimal context and mode of delivery for people with CEN. We aimed to investigate the effectiveness of psychosocial interventions delivered in community and outpatient settings in treating symptoms associated with 'personality disorder', and the moderating effects of treatment-related variables.
Methods:
We systematically searched MEDLINE, EMBASE, PsycINFO, CINAHL, HMIC, ASSIA for articles published in English, from inception to November 23, 2020. We included randomized controlled trials examining interventions provided in community or outpatient settings for CEN. The primary outcome was 'personality disorder' symptoms, while secondary outcomes included anxiety symptoms, depressive symptoms, and global psychiatric symptoms. Random-effects meta-analysis was conducted for each outcome, and meta-regression analysis was performed to assess the moderating effects of treatment characteristics. The quality of the studies and the degree of publication bias was assessed.
Results:
We included 54 trials (n = 3716 participants) in the meta-analysis. We found a large effect size (g = 0.78, 95% CI: 0.56 to 1.01, p < 0.0001) favoring interventions for 'borderline personality disorder' (BPD) symptoms over Treatment as Usual or Waitlist (TAU/WL), and the efficacy was maintained at follow-up (g = 1.01, 95% CI: 0.37 to 1.65, p = 0.002). Interventions effectively reduced anxiety symptoms (g = 0.58, 95% CI: 0.21 to 0.95, p = 0.002), depressive symptoms (g = 0.57, 95% CI: 0.32 to 0.83, p < 0.0001), and global psychiatric symptoms (g = 0.50, 95% CI: 0.35 to 0.66, p < 0.0001) compared to TAU/WL. The intervention types were equally effective in treating all symptom categories assessed. Treatment duration and treatment intensity did not moderate the effectiveness of the interventions for any outcome.
Conclusions:
People with a 'personality disorder' diagnosis benefited from psychological and psychosocial interventions delivered in community or outpatient settings, with all therapeutic approaches showing similar effectiveness. Mental health services should provide people with CEN with specialised treatments in accordance with the availability and the patients' preferences.
The Lightbulb Service, a brief intervention, provided the opportunity for people who screened into the Offender Personality Disorder (OPD) pathway to access a therapeutic service to increase insight and experience a positive change in their wellbeing. The Service Evaluation used qualitative methods to explore the benefits of this intervention whilst recognising its limitations. Specificall, themes around being listened to; someone interested in them and their story, and improved connection to other professionals were just some of the discoveries made. It provided us with hope that brief interventions within a personality disorder service can make real and positive change for someone, who otherwise would not have accessed help.
Self-reported reasons for suicide attempts and nonsuicidal self-injury were examined using the Parasuicide History Interview within a sample of chronically suicidal women meeting criteria for borderline personality disorder (N = 75). Overall, reasons given for suicide attempts differed from reasons for nonsuicidal self-injury. Nonsuicidal acts were more often reported as intended to express anger. punish oneself. generate normal feelings. and distract oneself. whereas suicide attempts were more often reported as intended to make others better off. Almost all participants reported that both types of parasuicide were intended to relieve negative emotions. It is likely that suicidal and nonsuicidal parasuicide have multiple intents and functions.
The present study describes the development of a short, general measure of experiential avoidance, based on a specific theoretical approach to this process. A theoretically driven iterative exploratory analysis using structural equation modeling on data from a clinical sample yielded a single factor comprising 9 items, A fully confirmatory factor analysis upheld this same 9-item factor in an independent clinical sample. The operational characteristics of the Acceptance and Action Questionnaire (AAO) were then examined in 8 additional samples. All totaled, over 2,400
The present study describes the development of a short, general measure of experiential avoidance, based on a specific theoretical approach to this process. A theoretically driven iterative exploratory analysis using structural equation modeling on data from a clinical sample yielded a single factor comprising 9 items. A fully confirmatory factor analysis upheld this same 9-item factor in an independent clinical sample. The operational characteristics of the Acceptance and Action Questionnaire (AAQ) were then examined in 8 additional samples. All totaled, over 2,400 participants were studied. As expected, higher levels of experiential avoidance were associated with higher levels of general psychopathology, depression, anxiety, a variety of specific fears, trauma, and a lower quality of life. The AAQ related to more specific measures of avoidant coping and to self-deceptive positivity, but the relation to psychopathology could not be fully accounted for by these alternative measures. The data provide some initial support for the model of experiential avoidance based on Relational Frame Theory that is incorporated into Acceptance and Commitment Therapy, and provides researchers with a preliminary measure for use in population-based studies on experiential avoidance.
The factor structure, reliability, and validity of the Depression Anxiety Stress Scales (DASS; S. H. Lovibond & P. F. Lovibond, 1995) and the 21-item short form of these measures (DASS–21 ) were examined in nonclinical volunteers (
n = 49) and patients with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) diagnoses of panic disorder (
n = 67), obsessive-compulsive disorder (
n = 54), social phobia (
n = 74), specific phobia (
n = 17), and major depressive disorder (
n = 46). This study replicates previous findings indicating that the DASS distinguishes well between features of depression, physical arousal, and psychological tension and agitation and extends these observations to the DASS–21. In addition, the internal consistency and concurrent validity of the DASS and DASS–21 were in the acceptable to excellent ranges. Mean scores for the various groups were similar to those in previous research, and in the expected direction. The implications of these findings are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Syndromal classification is a well-developed diagnostic system but has failed to deliver on its promise of the identification of functional pathological processes. Functional analysis is tightly connected to treatment but has failed to develop testable, replicable classification systems. Functional diagnostic dimensions are suggested as a way to develop the functional classification approach, and experiential avoidance is described as 1 such dimension. A wide range of research is reviewed showing that many forms of psychopathology can be conceptualized as unhealthy efforts to escape and avoid emotions, thoughts, memories, and other private experiences. It is argued that experiential avoidance, as a functional diagnostic dimension, has the potential to integrate the efforts and findings of researchers from a wide variety of theoretical paradigms, research interests, and clinical domains and to lead to testable new approaches to the analysis and treatment of behavioral disorders. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Given the clinical importance of deliberate self-harm and the need for further research informing the treatment and prevention of this behavior, a review of the extant literature on the risk factors for and functions of self-harm is needed. In this article, I review empirical and theoretical literature on the following potential risk factors for self-harm: childhood sexual and physical abuse, neglect, childhood separation and loss, security of attachment to caregivers, and emotional reactivity and intensity. Literature on the emotion regulating function of self-harm behavior is also reviewed. Future research is needed on the interaction of individual and environmental risk factors in the development of self-harm, as well as on the experi-entially avoidant function of this behavior.
Behavioral activation (BA), as a stand-alone treatment for depression, began as a behavior therapy treatment condition in a component analysis study of the Beck, Rush, Shaw, and Emery version of cognitive therapy. BA attempts to help depressed people reengage in their lives through focused activation strategies. These strategies counter patterns of avoidance, withdrawal, and inactivity that may exacerbate depressive episodes by generating additional secondary problems in individuals' lives. BA is designed to help individuals approach and access sources of positive reinforcement in their lives, which can serve a natural antidepressant function. Our purpose in this article is to describe BA and the history of its development.
Given recent attention to emotion regulation as a potentially unifying function of diverse symptom
presentations, there is a need for comprehensive measures that adequately assess difficulties in emotion
regulation among adults. This paper (a) proposes an integrative conceptualization of emotion
regulation as involving not just the modulation of emotional arousal, but also the awareness, understanding,
and acceptance of emotions, and the ability to act in desired ways regardless of emotional
state; and (b) begins to explore the factor structure and psychometric properties of a new measure, the
Difficulties in Emotion Regulation Scale (DERS). Two samples of undergraduate students completed
questionnaire packets. Preliminary findings suggest that the DERS has high internal consistency, good
test–retest reliability, and adequate construct and predictive validity.
At least 1 in 600 adults wound themselves sufficiently to need hospital treatment. More men than women do it, although more women receive psychological treatment. Many have a history of sexual or physical abuse. Self-wounding differs from other self-harm in being aimed neither at mutilation nor at death. Self-wounding coerces others and relieves personal distress. Repeated self-wounding is one criterion of borderline personality disorder but we prefer to consider it an 'addictive' behaviour rather than an expression of a wider disorder. Psychological management may need to be augmented by drug or social treatment. Carers, including professional carers, usually need help to contain the turbulence that self-wounding produces.
A randomized clinical trial was conducted to evaluate the effectiveness of a cognitive-behavioral therapy, ie, dialectical behavior therapy, for the treatment of chronically parasuicidal women who met criteria for borderline personality disorder. The treatment lasted 1 year, with assessment every 4 months. The control condition was "treatment as usual" in the community. At most assessment points and during the entire year, the subjects who received dialectical behavior therapy had fewer incidences of parasuicide and less medically severe parasuicides, were more likely to stay in individual therapy, and had fewer inpatient psychiatric days. There were no between-group differences on measures of depression, hopelessness, suicide ideation, or reasons for living although scores on all four measures decreased throughout the year.
In 1984, Jacobson, Follette, and Revenstorf defined clinically significant change as the extent to which therapy moves someone outside the range of the dysfunctional population or within the range of the functional population. In the present article, ways of operationalizing this definition are described, and examples are used to show how clients can be categorized on the basis of this definition. A reliable change index (RC) is also proposed to determine whether the magnitude of change for a given client is statistically reliable. The inclusion of the RC leads to a twofold criterion for clinically significant change.
Contemporary interest in emotion regulation promises to advance important new views of emotional development as well as offering applications to developmental psychopathology, but these potential contributions are contingent on developmentalists' attention to some basic definitional issues. This essay offers a perspective on these issues by considering how emotion regulation should be defined, the various components of the management of emotion, how emotion regulation strategies fit into the dynamics of social interaction, and how individual differences in emotion regulation should be conceptualized and measured. In the end, it seems clear that emotion regulation is a conceptual rubric for a remarkable range of developmental processes, each of which may have its own catalysts and control processes. Likewise, individual differences in emotion regulation skills likely have multifaceted origins and are also related in complex ways to the person's emotional goals and the immediate demands of the situation. Assessment approaches that focus on the dynamics of emotion are well suited to elucidating these complex developmental and individual differences. In sum, a challenging research agenda awaits those who enter this promising field of study.
The purpose of this study was to provide an experimental test of the theory of change put forth by A. T. Beck, A. J. Rush, B. F. Shaw, and G. Emery (1979) to explain the efficacy of cognitive-behavioral therapy (CT) for depression. The comparison involved randomly assigning 150 outpatients with major depression to a treatment focused exclusively on the behavioral activation (BA) component of CT, a treatment that included both BA and the teaching of skills to modify automatic thoughts (AT), but excluding the components of CT focused on core schema, or the full CT treatment. Four experienced cognitive therapists conducted all treatments. Despite excellent adherence to treatment protocols by the therapists, a clear bias favoring CT, and the competent performance of CT, there was no evidence that the complete treatment produced better outcomes, at either the termination of acute treatment or the 6-month follow-up, than either component treatment. Furthermore, both BA and AT treatments were just as effective as CT at altering negative thinking as well as dysfunctional attributional styles. Finally, attributional style was highly predictive of both short- and long-term outcomes in the BA condition, but not in the CT condition.
Self-mutilation, examined in samples of the general population, clinical groups, and self-identified self-mutilators, was reported by 4% of the general and 21% of the clinical sample, and was equally prevalent among males and females. Results suggest that such behavior is used to decrease dissociation, emotional distress, and posttraumatic symptoms. Childhood sexual abuse was associated with self-mutilation in both clinical and nonclinical samples.
Self-reported reasons for suicide attempts and nonsuicidal self-injury were examined using the Parasuicide History Interview within a sample of chronically suicidal women meeting criteria for borderline personality disorder (N = 75). Overall, reasons given for suicide attempts differed from reasons for nonsuicidal self-injury. Nonsuicidal acts were more often reported as intended to express anger, punish oneself, generate normal feelings, and distract oneself, whereas suicide attempts were more often reported as intended to make others better off. Almost all participants reported that both types of parasuicide were intended to relieve negative emotions. It is likely that suicidal and nonsuicidal parasuicide have multiple intents and functions.
Given recent attention to emotion regulation as a potentially unifying function of diverse symptom presentations, there is a need for comprehensive measures that adequately assess difficulties in emotion regulation among adults. This paper (a) proposes an integrative conceptualization of emotion regulation as involving not just the modulation of emotional arousal, but also the awareness, understanding, and acceptance of emotions, and the ability to act in desired ways regardless of emotional state; and (b) begins to explore the factor structure and psychometric properties of a new measure, the Difficulties in Emotion Regulation Scale (DERS). Two samples of undergraduate students completed questionnaire packets. Preliminary findings suggest that the DERS has high internal consistency, good test–retest reliability, and adequate construct and predictive validity.
Given the clinical importance of deliberate self-harm and the need for further research informing the treatment and prevention of this behavior, a review of the extant literature on the risk factors for and functions of self-harm is needed. In this article, I review empirical and theoretical literature on the following potential risk factors for self-harm: childhood sexual and physical abuse, neglect, childhood separation and loss, security of attachment to caregivers, and emotional reactivity and intensity. Literature on the emotion regulating function of self-harm behavior is also reviewed. Future research is needed on the interaction of individual and environmental risk factors in the development of self-harm, as well as on the experientially avoidant function of this behavior.
A randomized, controlled trial was conducted on 110 subjects who scored positive on the Diagnostic Interview for Borderlines to assess the merits of an experimental, time-limited group treatment for borderline personality disorder (BPD) in comparison with the control condition, individual dynamic psychotherapy. Seventy-nine subjects received treatment. Analyses at 12- and 24-month follow-ups on 84% of the treated subjects (N = 66), demonstrated no statistically significant differences in outcome on the major dependent variables. Outpatient referrals to the study complied with the treatments at twice the rate of inpatient referrals. The total study cohort showed significant improvements on all major outcomes at follow-up. The cost effectiveness of the group approach, in tandem with its potential for application in a range of community services by multidisciplinary practitioners, speaks to the promise of this treatment as an innovative service approach for BPD.
An ACT Approach Chapter 1. What is Acceptance and Commitment Therapy? Steven C. Hayes, Kirk D. Strosahl, Kara Bunting, Michael Twohig, and Kelly G. Wilson Chapter 2. An ACT Primer: Core Therapy Processes, Intervention Strategies, and Therapist Competencies. Kirk D. Strosahl, Steven C. Hayes, Kelly G. Wilson and Elizabeth V. Gifford Chapter 3. ACT Case Formulation. Steven C. Hayes, Kirk D. Strosahl, Jayson Luoma, Alethea A. Smith, and Kelly G. Wilson ACT with Behavior Problems Chapter 4. ACT with Affective Disorders. Robert D. Zettle Chapter 5. ACT with Anxiety Disorders. Susan M. Orsillo, Lizabeth Roemer, Jennifer Block-Lerner, Chad LeJeune, and James D. Herbert Chapter 6. ACT with Posttraumatic Stress Disorder. Alethea A. Smith and Victoria M. Follette Chapter 7. ACT for Substance Abuse and Dependence. Kelly G. Wilson and Michelle R. Byrd Chapter 8. ACT with the Seriously Mentally Ill. Patricia Bach Chapter 9. ACT with the Multi-Problem Patient. Kirk D. Strosahl ACT with Special Populations, Settings, and Methods Chapter 10. ACT with Children, Adolescents, and their Parents. Amy R. Murrell, Lisa W. Coyne, & Kelly G. Wilson Chapter 11. ACT for Stress. Frank Bond. Chapter 12. ACT in Medical Settings. Patricia Robinson, Jennifer Gregg, JoAnne Dahl, & Tobias Lundgren Chapter 13. ACT with Chronic Pain Patients. Patricia Robinson, Rikard K. Wicksell, Gunnar L. Olsson Chapter 14. ACT in Group Format. Robyn D. Walser and Jacqueline Pistorello
The Diagnostic Interview for Borderlines (DIB) was revised to sharpen its ability to discriminate between clinically diagnosed borderline patients and patients with other types of Axis II clinical diagnoses. The discriminant power of both the revised DIB (DIB-R) and the DIB itself was then tested in a sample of 237 inpatients and outpatients given an Axis II diagnosis by their therapists. The DIB-R was administered blind to clinical diagnosis, while a DIB score was independently derived from DIB-R and other data using a predetermined scoring algorithm. At a cutoff of 8, the DIB-R had a sensitivity of .82, a specificity of .80, a positive predictive power of .74, and a negative predictive power of .87. Overall, these conditional probabilities compare favorably to those obtained for the DIB at its standard cutoff of 7: sensitivity = .97, specificity = .27, positive predictive power = .47, and negative predictive power = .93. They also compare favorably with those obtained in studies that used semistructured or self-report instruments based on DSM-III or DSM-III-R criteria for BPD.
Self-mutilation is a disturbing and puzzling behavior encountered in patients with borderline personality disorder. Detailed descriptions from five patients with recent self-mutilation experiences are offered to illustrate the sequential development of symptoms leading to and immediately following self-mutilation. The authors speculate about the implications of the phenomenology of these states concerning psychodynamic and biological underpinnings, possible therapeutic approaches, and future research questions.
Discusses the nature and treatment of repetitive self-mutilation. Three types of self-mutilation have been documented: major; stereotypic; and superficial/moderate, the most prevalent type. Most repetitive self-mutilators treated are females in their 20s, about 66% of whom report childhood sexual and/or physical abuse. Medications used to treat the disorder include fluoxetine and clomipramine. Psychotherapy rarely goes smoothly, and countertransference issues must be dealt with. Treatment typically goes on for years and involves multiple therapists. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Reviews the book,
Emotion-focused therapy: Coaching clients to work through their feelings by Leslie S. Greenberg (see record
2002-00066-000). This book was written for both novice therapists who have had little experience working with emotions in treatment, as well as for experienced therapists looking to systematize their understanding of how emotional change works. The book is divided into four parts. Part I examines the nature and function of emotions. Part II examines the first part of emotional coaching--arriving at emotion. Part III examines the second part of emotional coaching--leaving emotion. Finally, Part IV examines the application of emotion-focused therapy to the problems of living, in the context of individuals, couples therapy, and parenting. This book offers a wealth of therapeutic techniques and theoretical principles about the process of change. As such, it is an important and natural companion to seminal works in cognitive behaviour therapy and interpersonal therapy. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Part I of the book focuses on the scope of the problem of self-mutilation. This entails reviewing the forms of SMB [self-mutilative behavior] that have been reported in the literature. . . . In addition, reviewing the scope of self-mutilation requires a look at the incidence of the behavior as it has been reported in a number of Western countries.
In Part II of the book, self-mutilation is discussed as it occurs in different clinical populations. In this section, we also examine SMB as it occurs in different types of client groups, including borderline personalities, psychotics, and retarded and autistic individuals. In this section, emphasis is placed on the determinants of the behavior that are specific to a particular client group.
In the third and final section of the book, the focus is on treatment. Here we review some of the therapeutic techniques that have been used by others, and we present a number of our own. We also identify clinical strategies or responses that we believe are likely to be especially counterproductive. In this treatment section, the focus is on four types on interventions: cognitive-behavioral, psychoanalytic, family therapy, and group treatment. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Describes a new program that evaluates the effects of marital therapy on the marital problems associated with depression, as well as on the depressive symptoms themselves. It is hoped that marital therapy will facilitate both recovery from depression and the long-term maintenance of the positive changes, especially when it is conducted concurrently with cognitive behavior therapy (CBT) for the depressed spouse alone. The treatment model used for working with couples is a social learning or behavior marital therapy model with recent modifications designed to deal more effectively with cognitive and affective components of relationships. CBT includes many techniques for modifying dysfunctional cognitions, including behavioral experiments that are designed to test specific beliefs held by the depressed client. The use of CBT as a vehicle for overcoming excessive dependency and powerlessness and for enhancing social support is discussed. It is concluded that the treatment of depression is moving in an interpersonal direction because depression seems to keep recurring, and impairments in intimate relationships seem to be one of the main factors associated with recurrence. (45 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Deliberate self-harm has recently begun to receive more systematic attention from clinical researchers.
However, there remains a general lack of consensus as to how to define and measure this important
clinical construct. There is still no standardized, empirically validated measure of deliberate selfharm,
making it more difficult for research in this area to advance. The present paper provides an
integrative, conceptual definition of deliberate self-harm as well as preliminary psychometric data on a
newly developed measure of self-harm, the Deliberate Self-Harm Inventory (DSHI). One hundred and
fifty participants from undergraduate psychology courses completed research packets consisting of the
DSHI and other measures, and 93 of these participants completed the DSHI again after an interval of
2–4 weeks (M D3:3 weeks). Preliminary findings indicate that the DSHI has high internal consistency;
adequate construct, convergent, and discriminant validity; and adequate test-retest reliability.
The effects of acceptance versus suppression of emotion were examined in 60 patients with panic disorder. Prior to undergoing a 15-minute 5.5% carbon dioxide challenge, participants were randomly assigned to 1 of 3 conditions: a 10-minute audiotape describing 1 of 2 emotion-regulation strategies (acceptance or suppression) or a neutral narrative (control group). The acceptance group was significantly less anxious and less avoidant than the suppression or control groups in terms of subjective anxiety and willingness to participate in a second challenge, but not in terms of self-report panic symptoms or physiological measures. No differences were found between suppression and control groups on any measures. Use of suppression was related to more subjective anxiety during the challenge, and use of acceptance was related to more willingness to participate in a second challenge. The results suggest that acceptance may be a useful intervention for reducing subjective anxiety and avoidance in patients with panic disorder.
Dialectical behavior therapy (DBT) can be considered a well-established treatment for borderline personality disorder (BPD) as evidenced by seven well-controlled randomized clinical trials across four independent research teams. The primary purpose of this article is to address a variety of potential mechanisms of change that may be associated with those aspects of DBT that are unique to the treatment and its theoretical underpinnings. Based on the biosocial theory of BPD, many of these mechanisms can be distilled down to the following process: the reduction of ineffective action tendencies linked with dysregulated emotions. Specifically we address the following interventions and associated mechanisms of change: mindfulness, validation, targeting and chain analysis, and dialectics. Patient change in BPD is conceptualized primarily as helping the patient to engage in functional, life-enhancing behavior, even when intense emotions are present. Ultimately, our goal was to provide guidance for theoretically and empirically grounded research on the mechanisms of change in DBT.
This handbook offers therapists an approach to helping clients live in harmony with head and heart. Leslie Greenberg proposes that, rather than controlling or avoiding emotions, clients can learn from their own bodily reactions and begin to act sensibly on them. Expressing emotion in ways that are appropriate to context is a highly complex skill. Offering clinical wisdom, practical guidance and case illustration, the volume presents an empirically-supported model of training clients to attain emotional wisdom.
The Diagnostic Interview for Personality Disorders (DIPD) is a semistructured interview of 252 questions that encompasses all 11 Axis II disorders described in the DSM-III. Its interrater reliability was assessed using a sample of 43 patients and its test-retest reliability was assessed using a separate sample of 54 patients. Adequate kappas were obtained in both situations for all disorders except schizoid personality disorder, which was never diagnosed. Interrater coefficients ranged from .52 to 1.0, with nine in the excellent range (κ > .75). Test-retest coefficients ranged from .46 to .85, with four in the excellent range. These results compara very favorably to those achieved using the other two Axis II interviews that have appeared in the literature, the Structured Interview for the DSM-III Personality Disorders (SIDP) and the Personality Disorder Examination (PDE).
The psychometric properties of the Depression Anxiety Stress Scales (DASS) were evaluated in a normal sample of N = 717 who were also administered the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). The DASS was shown to possess satisfactory psychometric properties, and the factor structure was substantiated both by exploratory and confirmatory factor analysis. In comparison to the BDI and BAI, the DASS scales showed greater separation in factor loadings. The DASS Anxiety scale correlated 0.81 with the BAI, and the DASS Depression scale correlated 0.74 with the BDI. Factor analyses suggested that the BDI differs from the DASS Depression scale primarily in that the BDI includes items such as weight loss, insomnia, somatic preoccupation and irritability, which fail to discriminate between depression and other affective states. The factor structure of the combined BDI and BAI items was virtually identical to that reported by Beck for a sample of diagnosed depressed and anxious patients, supporting the view that these clinical states are more severe expressions of the same states that may be discerned in normals. Implications of the results for the conceptualisation of depression, anxiety and tension/stress are considered, and the utility of the DASS scales in discriminating between these constructs is discussed.
Clinical conceptualizations of emotion that stress its disruptive influences and functional models of emotion that emphasize its adaptive aspects can be integrated into a developmental psychopathology framework. Under certain conditions, emotion regulation may develop dysregulatory aspects that can become a characteristic of an individual's coping style. This style may then jeopardize or impair functioning and become associated with symptomatic, disordered functioning. Emotional development provides a critical vantage point from which to study the development of symptomatology and psychopathology, particularly given the prevalence of emotional symptoms in various forms of psychopathology. Dimensions of emotionality that can be used to characterize dysregulation include access to the range of emotions, flexible modulation of intensity, duration, and transitions between emotions, acquisition and use of cultural display rules, and the ability to reflect on the complexity and value of one's own emotions in a self-supporting manner. Developmental psychopathology provides a framework within which to examine how emotions are regulatory, how their regulation changes over time, and under what conditions an adaptive emotion process can develop into a pattern of dysregulation that then becomes, or sustains, some symptoms of mental disorders. Such research requires samples that include children with and without risk or presence of particular mental health problems, paradigms that allow the examination of dimensions of emotionality in context and provide multiple assessments that include observations of children's reactions beyond what they themselves can report, and analyses that extend beyond simple global aggregates such as positive and negative emotion. We believe that it is particularly important to study children and their families in situations that challenge their emotional adaptation. The developmental tasks of emotional life evolve in exchanges between the child and the world of events and relationships. The emotional conditions of early childhood appear to be very important in optimizing or interfering with how the child's emotionality regulates his or her interpersonal and intrapsychic functioning and how the child learns to regulate emotion. The experiences that accrue around emotional events influence the stable aspects of the developing personality and become trait-like aspects of the person (Malatesta & Wilson, 1988). Dysregulation occurs when an emotional reaction loses breadth and flexibility. If a dysregulatory pattern becomes stabilized and part of the emotional repertoire, it is likely that this pattern is a symptom and supports other symptoms. When development and adaptation are compromised, the dysregulation has evolved into a form of psychopathology. The line between normative variations and clinical conditions is not clearly drawn.(ABSTRACT TRUNCATED AT 400 WORDS)
This paper describes a model of group cognitive-behavioral therapy (CBT) for women with posttraumatic stress disorder (PTSD) and substance use disorder (SUD). The need for specialized treatment derives from the high incidence of these comorbid disorders among women as well as from their particular clinical presentation and treatment needs. The treatment educates patients about the two disorders, promotes self-control skills to manage overwhelming affects, teaches functional behaviors that may have deteriorated as a result of the disorders, and provides relapse prevention training. The program draws on educational principles to make it accessible for this population: visual aids, education for the patient role, teaching for generalization, emphasis on structured treatment, testing of acquired knowledge of CBT, affectively engaging themes and materials, and memory enhancement devices.
The psychometric properties of the Depression Anxiety Stress Scales (DASS) were evaluated in two studies using large clinical samples (N = 437 and N = 241). In Study 1, the three scales comprising the DASS were shown to have excellent internal consistency and temporal stability. An exploratory factor analysis (principal components extraction with varimax rotation) yielded a solution that was highly consistent with the factor structure previously found in nonclinical samples. Between-groups comparisons indicated that the DASS distinguished various anxiety and mood disorder groups in the predicted direction. In Study 2, the conceptual and empirical latent structure of the DASS was upheld by findings from confirmatory factor analysis. Correlations between the DASS and other questionnaire and clinical rating measures of anxiety, depression, and negative affect demonstrated the convergent and discriminant validity of the scales. In addition to supporting the psychometric properties of the DASS in clinical anxiety and mood disorders samples, the results are discussed in the context of current conceptualizations of the distinctive and overlapping features of anxiety and depression.
The evidence suggests that personality traits are hierarchically organized with more specific or lower-order traits combining to form more generalized higher-order traits. Agreement exists across studies regarding the lower-order traits that delineate personality disorder but not the higher-order traits. This study seeks to identify the higher-order structure of personality disorder by examining the phenotypic and genetic structures underlying lower-order traits.
Eighteen lower-order traits were assessed using the Dimensional Assessment of Personality Disorder-Basic Questionnaire in samples of 656 personality disordered patients, 939 general population subjects, and a volunteer sample of 686 twin pairs.
Principal components analysis yielded 4 components, labeled Emotional Dysregulation, Dissocial Behavior, Inhibitedness, and Compulsivity, that were similar across the 3 samples. Multivariate genetic analyses also yielded 4 genetic and environmental factors that were remarkably similar to the phenotypic factors. Analysis of the residual heritability of the lower-order traits when the effects of the higher-order factors were removed revealed a substantial residual heritable component for 12 of the 18 traits.
The results support the following conclusions. First, the stable structure of traits across clinical and nonclinical samples is consistent with dimensional representations of personality disorders. Second, the higher-order traits of personality disorder strongly resemble dimensions of normal personality. This implies that a dimensional classification should be compatible with normative personality. Third, the residual heritability of the lower-order traits suggests that the personality phenotypes are based on a large number of specific genetic components.
The treatment of deliberate self-harm (parasuicide) remains limited in efficacy. Despite a range of psychosocial, educational and pharmacological interventions only one approach, dialectical behaviour therapy, a form of cognitive-behaviour therapy (CBT), has been shown to reduce repeat episodes, but this is lengthy and intensive and difficult to extrapolate to busy clinical practice. We investigated the effectiveness of a new manual-based treatment varying from bibliotherapy (six self-help booklets) alone to six sessions of cognitive therapy linked to the booklets, which contained elements of dialectical behaviour therapy.
Thirty-four patients, aged between 16 and 50, seen after an episode of deliberate self-harm, with personality disturbance within the flamboyant cluster and a previous parasuicide episode within the past 12 months, were randomly assigned to treatment with manual-assisted cognitive-behaviour therapy (MACT N = 18) or treatment as usual (TAU N = 16). Assessment of clinical symptoms and social function were made at baseline and repeated by an independent assessor masked to treatment allocation at 6 months. The number and rate of all parasuicide attempts, time to next episode and costs of care were also determined.
Thirty-two patients (18 MACT; 14 TAU) were seen at follow-up and 10 patients in each group (56% MACT and 71% TAU) had a suicidal act during the 6 months. The rate of suicidal acts per month was lower with MACT (median 0.17/month MACT; 0.37/month TAU; P = 0.11) and self-rated depressive symptoms also improved (P = 0.03). The treatment involved a mean of 2.7 sessions and the observed average cost of care was 46% less with MACT (P = 0.22).
Although limited by the small sample, the results of this pilot study suggest that this new form of cognitive-behaviour therapy is promising in its efficacy and feasible in clinical practice.
This study compared the effectiveness of psychoanalytically oriented partial hospitalization with standard psychiatric care for patients with borderline personality disorder.
Thirty-eight patients with borderline personality disorder, diagnosed according to standardized criteria, were allocated either to a partially hospitalized group or to a standard psychiatric care (control) group in a randomized controlled design. Treatment, which included individual and group psychoanalytic psychotherapy, was for a maximum of 18 months. Outcome measures included the frequency of suicide attempts and acts of self-harm, the number and duration of inpatient admissions, the use of psychotropic medication, and self-report measures of depression, anxiety, general symptom distress, interpersonal function, and social adjustment. Data analysis used repeated measures analysis of covariance and nonparametric tests of trend.
Patients who were partially hospitalized showed a statistically significant decrease on all measures in contrast to the control group, which showed limited change or deterioration over the same period. An improvement in depressive symptoms, a decrease in suicidal and self-mutilatory acts, reduced inpatient days, and better social and interpersonal function began at 6 months and continued until the end of treatment at 18 months.
Psychoanalytically oriented partial hospitalization is superior to standard psychiatric care for patients with borderline personality disorder. Replication is needed with larger groups, but these results suggest that partial hospitalization may offer an alternative to inpatient treatment.
The aim of this study was to determine whether the substantial gains made by patients with borderline personality disorder following completion of a psychoanalytically oriented partial hospitalization program, in comparison to patients treated with standard psychiatric care, were maintained over an 18-month follow-up period.
Forty-four patients who participated in the original study were assessed every 3 months after completion of the treatment phase. Outcome measures included frequency of suicide attempts and acts of self-harm, number and duration of inpatient admissions, service utilization, and self-reported measures of depression, anxiety, general symptom distress, interpersonal functioning, and social adjustment.
Patients who completed the partial hospitalization program not only maintained their substantial gains but also showed a statistically significant continued improvement on most measures in contrast to the patients treated with standard psychiatric care, who showed only limited change during the same period.
The superiority of psychoanalytically oriented partial hospitalization over standard psychiatric treatment found in a previous randomized, controlled trial was maintained over an 18-month follow-up period. Continued improvement in social and interpersonal functioning suggests that longer-term changes were stimulated.
To compare group therapy with routine care in adolescents who had deliberately harmed themselves on at least two occasions within a year.
Single-blind pilot study with two randomized parallel groups that took place in Manchester, England. Sixty-three adolescents aged 12 through 16 years were randomly assigned to group therapy and routine care or routine care alone. Outcome data on suicide attempts were obtained without knowledge of treatment allocation on all randomized cases (62/63 by direct interview) on average 29 weeks later. The primary outcomes were depression and suicidal behavior.
In intention-to-treat analyses, adolescents who had group therapy were less likely to be "repeaters" at the end of the study (i.e., to have repeated deliberate self-harm on two or more further occasions) than adolescents who had routine care (2/32 versus 10/31; odds ratio 6.3), but the confidence intervals for this ratio were wide (95% confidence interval 1.4 to 28.7). They were also less likely to use routine care, had better school attendance, and had a lower rate of behavioral disorder than adolescents given routine care alone. The interventions did not differ, however, in their effects on depression or global outcome.
Group therapy shows promise as a treatment for adolescents who repeatedly harm themselves, but larger studies are required to assess more accurately the efficacy of this intervention.