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This dissertation explores the comorbidity of posttraumatic stress disorder (PTSD) and personality disorders (PD), particularly in the context of treatment outcomes. Traumatic experiences, especially during childhood, can have profound effects on mental health and are implicated in conditions such as PTSD and PD. PTSD is characterized by intrusive memories, emotional numbing, and heightened arousal, while PD involves enduring patterns of maladaptive behavior and cognition. These disorders are often comorbid, with the presence of PD potentially complicating the treatment of PTSD. The dissertation comprises a series of studies aimed at understanding whether combining trauma-focused therapy for PTSD with interventions specifically targeting PD can improve treatment outcomes. It was hypothesized that simultaneous treatment would result in better outcomes, including reduced PTSD and PD symptoms, improved functional ability, and enhanced quality of life. The first study examined whether adding group schema therapy (GST) to imagery rescripting (ImRs) for individuals with PTSD and cluster C personality disorders (CPD) would be more effective than ImRs alone. The second study compared eye movement desensitization and reprocessing (EMDR) with and without concurrent dialectical behavior therapy (DBT) in treating PTSD with comorbid borderline personality disorder (BPD). Contrary to expectations, the findings revealed that concurrent treatments did not outperform trauma-focused treatments alone on any of the outcomes. Large reductions in symptoms were observed in all treatment groups. In fact, EMDR dropout rates were even higher in the EMDR+DBT group compared to EMDR only, although this was not the case for ImRs+GST, compared to ImRs only. Furthermore, reductions in PD symptoms were large and similar across all groups, raising the suggestion that trauma-focused therapy may be effective in treating PD. The dissertation also investigated predictors of treatment attendance, driven

The purpose of this transcendental phenomenological study was to describe experiences of dialectical behavior therapy for special education teachers at a large, suburban school district in the Southeast United States. The theory guiding this study was Bandura's social cognitive theory (SCT), as it explains how new behaviors are learned and acquired. The central research question was: What are special education teachers' experiences of dialectical behavior therapy at a suburban school district in the Southeast United States? This qualitative design utilizes a phenomenological method. The sample included 12 special education teachers in behavior classrooms receiving dialectical behavior therapy. The setting was a large, suburban, public school district in the Southeast United States including elementary, middle, and high schools. Data collection utilized surveys, interviews, and artifacts analyzed using epoché, phenomenological reduction, and textural/structural descriptions. Resulting themes include: a) DBT and mindfulness skills support the improvement of student behaviors, b) certain coping skills are viewed as more valuable than others, and c) teachers view the coping skills as personally beneficial and empowering. The results of this study support findings from similar studies conducted within other settings regarding DBT and mindfulness.

Bakgrund: Komplexiteten i vård och behandling av personer med substansbrukssyndrom (SUD) är omfattande. Dialektisk beteendeterapi (DBT) syftade initialt till att minska självskadandebeteende hos personer med borderline personlighetssyndrom (BPD) men har på senare år anpassats till andra typer av problem som exempelvis SUD. I Sverige har kommuner och regioner i dagsläget ett delat ansvar i att tillgodose vård och behandling för personer med SUD vilket kan försämra kvaliteten på vård och behandling. Ett nytt förslag att Regionen ska äga huvudmannaskapet ligger idag hos regeringen där en kompetensökning kommer att krävas inom regional verksamhet rörande behandling vid SUD. Som ett led i den kompetensökningen blir syftet med denna examensuppsats att undersöka DBT-terapeuters erfarenheter rörande DBT vid SUD. Metod: Sju DBT-terapeuter rekryterades till studien. Deltagarna intervjuades digitalt med hjälp av en semistrukturerad intervjuguide. Som metod användes reflexiv tematisk analys. Resultat: Upplägg av behandlingen varierade mellan de olika verksamheterna. Viktigt för patientgruppen med SUD var noggrann kartläggning initialt i behandling. Alla DBT-terapeuter var eniga i att DBT var effektiv för patienter med bristande känsloreglering och impulskontroll. Utmaningar att bedriva behandlingen var omgivande faktorer och grupprocesser som kunde ta fokus från behandlingen. Alla DBT-terapeuter var eniga i att det behövdes ett helhetstänk i behandling vid SUD. Samtliga DBT-terapeuter upplevde DBT som hjälpsamt för patientgruppen och majoriteten såg en minskning av återfall och användande av substanser. Slutsats: Författarna drar slutsatsen att DBT och DBT-skill training (DBT-ST) kan vara en bra metod för patienter med SUD. Ett skifte i huvudmannaskap blir viktigt för en mer patientsäker vård. Vidare forskning rekommenderas dock. Nyckelord: Substansbrukssyndrom, Dialektiskt beteendeterapi, erfarenheter, behandling.

OBJECTIVE: Borderline personality disorder (BPD) is characterized by instability in emotions, relationships, and behaviors, such as self-injury and suicidal behavior. Dialectical Behavioral Therapy (DBT) is an established intervention for BPD, but there are long waiting times for treatment. This study aimed to explore if a brief internet-delivered DBT skills training program with minimal therapist support is acceptable, that it can be administered, useful, and does not do harm for patients with BPD. METHODS: Acceptability was measured through data on recruitment and attrition, utilization of the intervention, reported impulses to drop out, and through ratings on self-injury and suicidality. Participants were interviewed about their experiences of the intervention; analyzed with content analysis. RESULTS: Twenty patients on the waiting list for treatment at a DBT-clinic were invited and nine female patients (age 19-37 years) volunteered. The participants completed a large part of the intervention, which did not appear harmful since ratings of suicidal and self-harming behavior were similar before and after the intervention. In the interviews, participants stated that they had gained new knowledge and skills to manage situations, e.g. to stop and think before acting. Some even reported decreased levels of self-injury. The time spent on patient contact was short, and some patients reported difficulties to practice on their own and requested more support. CONCLUSIONS: The intervention seems to be acceptable. Future studies should investigate in what ways some BPD patients are more susceptible to internet-delivered skills training than others, and if this intervention could be delivered within a stepped-care model.

Evidence-based psychological interventions for adults with attention deficit hyperactivity disorder (ADHD) are seldom available in clinical settings. Medication is often offered as the sole treatment, with non-optimal effects for a majority of patients. The objective was to compare internet-based cognitive behavioral therapy (iCBT) to an active control treatment of internet-based applied relaxation training (iART), and to treatment as usual only (TAU) in adult outpatients with ADHD. One hundred and four patients, of which 67 % used ADHD medication, were randomized to 12 weeks of iCBT (n = 36), iART (n = 37), or TAU (n = 31). Primary outcome was change in the Adult ADHD Self Report Scale (ASRS) up to 3 (FU3) and 12 months (FU12) after treatment. ASRS improved more for iCBT (p < .01; Cohen's d = 0.42 at post-treatment and 0.67 at FU3) and iART (p < .01; Cohen's d = 0.57 at post-treatment and 0.66 at FU3) than for TAU. The effects sustained over 12 months for iCBT (p < .001) and iART (p < .001). No significant difference was found when comparing iCBT to iART (p = .53). Treatment responders reached 25 % for both treatments, which was superior to the 3 % responders in TAU (p < .05). iCBT and iART could both be promising add-ons to medication and increase availability to psychological treatment with sustained symptom reductions after one year.

PurposeAdults with bulimia nervosa (BN) and co-occurring emotional dysregulation and multiple impulsive behaviors are less responsive to existing interventions. Initial data suggest that the combination of Dialectical Behavior Therapy (DBT) and a mood stabilizer, lamotrigine, significantly reduces symptoms of affective and behavioral dysregulation in these patients. Identifying candidate neurobiological mechanisms of change for this novel treatment combination may help guide future randomized controlled trials and inform new and targeted treatment development. Here, we examined neurocognitive and symptom changes in a female patient with BN and severe affective and behavioral dysregulation who received DBT and lamotrigine.MethodsGo/no-go task performance data and resting-state functional MRI scans were acquired before the initiation of lamotrigine (after 6 weeks in an intensive DBT program), and again after reaching and maintaining a stable dose of lamotrigine. The patient completed a battery of symptom measures biweekly for 18 weeks over the course of treatment.ResultsAfter lamotrigine initiation, the patient made fewer errors on a response inhibition task and showed increased and new connectivity within frontoparietal and frontolimbic networks involved in behavioral and affective control. Accompanying this symptom improvement, the patient reported marked reductions in bulimic symptoms, behavioral dysregulation, and reactivity to negative affect, along with increases in DBT skills use.ConclusionImproved response inhibition and cognitive control network connectivity should be further investigated as neurocognitive mechanisms of change with combined DBT and lamotrigine for eating disorders. Longitudinal, controlled trials integrating neuroimaging and symptom measures are needed to fully evaluate the effects of this treatment.Level of evidenceIV: Evidence obtained from multiple time series with or without the intervention, such as case studies.

Perceived Criticism is a transdiagnostic construct that captures the patients’ perception of criticism. PC seems to be a reliable predictor of negative clinical outcomes concerning recurrence of symptoms or relapse in a broad range of stress-related psychiatric disorders and is thought to be related to underlying stress-related psychobiological vulnerabilities. Dialectical Behavior Therapy (DBT) is a treatment targeting these stress-related psychobiological vulnerabilities. In this pilot study we focus on the possible change in Perceived Criticism due to a (residential) DBT network training. This study follows a pre-post design where PC is recorded in 33 patients (mean age 25 years) and 61 relatives during 8 group sessions of a DBT network training, as part of a residential DBT program. The degree of perceived criticism is systematically assessed using the Perceived Criticism Measure, a two item self-report questionnaire that assesses mutual (perceived) criticism from patients and network members. Overall scores of the perceived criticism measure decrease significantly for both patients and relatives after following the DBT network training. More specific, item scores of both patients and relatives concerning how critical they are towards the other and how critical they thought the other was of them also decreased significantly after following the DBT network training. Findings suggest that a DBT network training as part of a residential DBT program may be instrumental in decreasing levels of perceived criticism. We recommend further exploration of Perceived Criticism as a possible moderator in effect size studies in randomized controlled clinical trials on DBT and in more fundamental research on the putative mechanisms of behavioural change such as improved perspective taking, and the evaluation of social cues.

Current evidence suggests that individuals with borderline personality disorder (BPD) are likely to benefit from specialized, or BPD-specific, treatments. Dialectical behavior therapy (DBT) and mentalization-based treatment (MBT) are currently the most intensively researched BPD treatments. Reviewing the current research, this paper highlights similarities and differences between the two treatments, and discusses possible ways they could complement each other. As the effectiveness of specialized treatments for BPD in general has been determined with some certainty, research now tends towards individualized approaches, identifying predictors of optimal treatment response. However, it is still to be settled who might profit from a combination of or sequential treatment with DBT and MBT.

BackgroundLong-term follow-up studies in patients with borderline personality disorder (BPD) consistently show persistent impairment in psychosocial adjustment, although symptoms tend to decrease over time. Consequently, it might be better to deemphasize symptom-oriented interventions and instead promote interventions that incorporate patient perspectives on recovery. In this study we aimed to examine the feasibility and acceptability of a novel intervention (dialectical behavioral therapy combined with positive psychology and contextual-based skills) in the clinical treatment of long-lasting BPD difficulties. MethodsThis was a qualitative study. We developed an initial 8-week group intervention for long-lasting BPD. Upon completion of the 8-week program, the participants were asked to participate in a group discussion to provide feedback. Based on that feedback, the intervention protocol was modified and then offered to a second group of patients, who also provided feedback. The protocol was revised again and administered to a third group. A total of 32 patients participated in the group interventions; of these, 20 provided feedback in the qualitative study. The main outcome measure was acceptability. ResultsThe following overarching themes emerged from the group interviews: helpful, unhelpful and neutral practices; internal/external barriers; facilitators; and effects. Participants reported difficulties in imagining an optimal future and self-compassion. By contrast, positive skills were associated with an increase in positive emotions. The main internal barrier was facing difficult emotions. The main external barriers were language-related issues. The group format was perceived as a facilitator to success. Dropout rates, which were assessed as an additional measure of acceptability, decreased substantially in each successive group, from 60 to 40% and finally 20%. ConclusionsThe intervention was feasible to implement in the clinical setting and participants rated

BackgroundEating disorders have serious psychological and physical consequences. Current evidence-based treatments for adolescents with eating disorders have modest effects, underscoring the need to improve current treatment approaches. Cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT) have been proposed as alternative treatment options, with burgeoning research in this area. This review aims to summarize and critically analyze the current literature on the feasibility, acceptability, effectiveness, and efficacy of CBT and DBT for adolescent eating disorders, and then proposes areas of future research.MethodsPsycINFO and PubMed were searched using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify studies examining the feasibility, acceptability, effectiveness and/or efficacy of CBT or DBT for adolescent eating disorders.ResultsEligible studies (N = 50; CBT: n = 40, DBT: n = 10) indicated that both treatments are reasonably feasible, acceptable, and possibly effective for adolescent eating disorders across diagnoses and levels of care, though efficacy trials are lacking.ConclusionsCBT and DBT demonstrate promise as alternatives to family-based approaches for adolescent eating disorders. Adequately powered trials to establish the effectiveness and efficacy of CBT and DBT are needed, particularly ones that compare these treatments against other leading approaches. Despite high rates of relapse and likelihood for severe and enduring illness, there is a dearth of evidence-based treatment options for adolescents with eating disorders. Potentially viable but less well-studied treatments for adolescents with eating disorders include cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT). This systematic review of CBT and DBT for adolescent eating disorders focuses on feasibility (i.e., how easy it was to implement the treatment), acceptability (i.e., how well the intervention was received

With the number of drug overdoses ever increasing, it has become more apparent that other forms of therapy need to explored in the treatment of substance use. By taking the unique needs of substance use recovery into consideration, the country will be better able to help those seeking treatment. The combined use of dance/movement therapy and dialectical behavior therapy were considered in this literature review, as both have been effective in substance use recovery but have not been used together. Through a discussion of the effectiveness of dialectical behavior therapy and an analysis of dance/movement therapy literature, it has been found that dance/movement therapists have already included dialectical behavior therapy skills in their work, despite not labelling it as such. A number of recurring themes regarding ways to make dance/movement therapy more effective and challenges of working with substance use were also considered. From this analysis, it is believed that combining dance/movement therapy and dialectical behavior therapy is possible and may even be effective when working in substance use recovery.

Mindfulness based approaches as well as alternative forms of treatment have widely been introduced into the partial hospitalization setting. While the inclusion of art therapy allows individuals to engaged with a tactile experience, DBT and mindfulness informs the individual of concrete skills and coping strategies to be directly applied in the creative space. There has been ample research conducted on the use of DBT in a partial hospital setting, however there is a lack of research on the inclusion of DBT informed art therapy in the same setting. However, small scale phenomenological research has been conducted on the effectiveness of DBT informed art therapy. These studies provide a unique glimpse into the usefulness of integrating both approaches to promote skill acquisition and generalization, practice and role play of skills in a safe therapeutic environment, and authentic self - expression. In addition, empirical research has been conducted on the usefulness of mindfulness and meditation in managing emotions and mental states. These studies suggest that learning to consciously and mindfully control ones breath during meditation, is instrumental in the mastery of both mind and emotions. To contribute to the growing research conducted on DBT informed art therapy, this writer has developed a four group art therapy and DBT skills protocol specific for the partial hospital setting. The group notes, participation, and success seen during their 10-day treatment suggests there are benefits to be explored in the combination of DBT and art therapy in partial hospitalization treatment.

Little is known about how adolescents with attention deficit/hyperactivity disorder (ADHD) experience participating in group therapy, an important factor to consider when developing treatment methods for this age group. This study aimed to explore how adolescents with ADHD experience participating in a structured skills training group program based on dialectical behavioral therapy. Semi-structured interviews were conducted with 20 adolescents (15-18 years of age) with ADHD after participating in a structured skills training group. The interviews were transcribed verbatim and qualitative content analysis were used to analyze the text. The participants emphasized the value of meeting other adolescents with ADHD and the opportunity to exchange experiences, strategies and tips. Participating in the group treatment made the adolescents realize that they were not alone, and feelings of togetherness and an increased acceptance of themselves were described. The participants associated the treatment with elevated knowledge and understanding, for example, about ADHD, their own functioning and helpful strategies. They also described emotional and behavioral changes, such as higher self-esteem, fewer inter-personal conflicts and improved concentration. Activating and experiential exercises were considered important elements of the treatment, and the participants expressed a need for a variation of exercises, as well as more time for practicing skills, discussions and breaks. The results indicate that the group format add an extra value to the treatment and that the use of an active approach throughout the treatment is of importance for this group of patients.

In addition to suicidal behaviors, men with borderline personality disorder (BPD) often display antisocial behavior that could impair contacts with mental health services. While research has established effective treatments for women with BPD, this is not yet the case for men. The authors evaluated 12 months of dialectical behavior therapy (DBT) for 30 men with BPD and antisocial behavior, using a within-group design with repeated measurements. The authors found moderate to strong, statistically significant pre-to posttreatment reductions of several dysfunctional behaviors, including self-harm, verbal and physical aggression, and criminal offending (rate ratios 0.17-0.39). Symptoms of BPD and depression were also substantially decreased. The dropout rate was 30%, and completing participants reported high satisfaction with treatment and maintained their improvements at 1-year follow-up. The authors conclude that DBT could be an effective treatment alternative for men with BPD and antisocial behavior, and it merits future studies with more rigorous design.

Given the high rates of comorbidity between eating disorders (EDs) and substance use disorders (SUDs), it is important to develop effective treatment approaches for individuals with both an ED and SUD (ED-SUD). To date, there is limited information guiding the concurrent treatment of these disorders. To build on existing research, the present study compared adult patients with ED-SUD (n = 36) to patients with ED-only (n = 62) in terms of demographics, psychiatric comorbidity, and self-reported eating disorder and related psychopathology. Results indicated that ED-SUD patients had a higher number of psychiatric comorbidities, were more likely to be prescribed mood stabilizers, and were more sensitive to reward. They also reported greater difficulty with emotion regulation, including more difficulty engaging in goal-directed activity, higher impulsivity, and more limited access to emotion regulation strategies. These differences highlight the importance of targeting emotion dysregulation for ED-SUD, and provide evidence for the importance of integrated, transdiagnostic treatment to simultaneously address the SUD, ED, and other psychiatric comorbidities. Implications for tailoring treatment are discussed with a focus on Dialectical Behavior Therapy (DBT).

BACKGROUND: Several quantitative studies support the effectiveness of the Dialectical Behavior Therapy (DBT) psychosocial skills training group component for adolescents with impulse-control disorder and/or emotional dysregulation. However, qualitative research to assess this psychotherapeutic tool in the adolescent population is sparse. This study aims to examine the subjective experience of adolescents with behavioral issues who have completed DBT skills training group, as well as using this experience to extract hypotheses regarding its usefulness which can then be verified at a later time by means of quantitative instruments. METHODS: We developed a qualitative study by using focus groups with adolescents (N=20) whose diagnosis includes symptoms such as behavior disorder, impulse-control disorder and/or emotional dysregulation, and good informants, who have completed DBT skills training. Three focus groups were created. RESULTS: The subjective experience of adolescents who have completed a DBT skills training group is collected in four main categories: experience of illness, motivation for therapy, experience of therapy and results of the therapy. CONCLUSIONS: Adolescents with behavioral problems assess their participation in the DBT skills training group positively, even recommending its usefulness to healthy population. Beyond learning skills, they emphasize the intrapsychic changes (as improvement in reflective activity) that they objectify after the group experience.

Emotion regulation deficits are associated with eating disorder (ED) symptoms, regardless of eating disorder diagnosis. Thus, recent treatment approaches for EDs, such as dialectical behavior therapy (DBT), have focused on teaching patients skills to better regulate emotions. The present study examined changes in emotion regulation among adult patients with EDs during DBT-oriented partial hospital treatment, and at follow-up (M[SD] = 309.58[144.59] days from discharge). Exploratory analyses examined associations between changes in emotion regulation and ED symptoms. Patients with anorexia nervosa, restricting (AN-R, n = 77), and binge-eating/purging subtype (AN-BP, n = 46), or bulimia nervosa (BN, n = 118) completed the Difficulties in Emotion Regulation Scale (DERS) at admission, discharge, and follow-up. Patients with BN demonstrated significant improvements across all facets of emotion dysregulation from admission to discharge and maintained improvements at follow-up. Although patients with AN-BP demonstrated statistically significant improvements on overall emotion regulation, impulsivity, and acceptance, awareness, and clarity of emotions, from admission to discharge, these improvements were not significant at follow-up. Patients with AN-R demonstrated statistically significant improvements on overall emotion dysregulation from treatment admission to discharge. Changes in emotion regulation were moderately correlated with changes in ED symptoms over time. Results support different trajectories of emotion regulation symptom change in DBT-oriented partial hospital treatment across ED diagnoses, with patients with BN demonstrating the most consistent significant improvements.

Objective: Group Experience Therapy (GET; Visintini et al., 2019) is a structured treatment for patients with Borderline Personality Disorder (BPD) features. The study aimed at evaluating GET effectiveness in a longitudinal, single-blind, two-arm parallel design, comparing GET with Dialectical Behavior Therapy (DBT; Linehan, 1993, 2014). The individual variability was expected to be consistent. Methods: The sample was comprised of 95 outpatients, assigned to groups with the minimisation procedure and assessed every three months. Treatments were delivered by 28 therapists at the San Raffaele Scientific Institute, Milan, Italy. Hierarchical Linear Models with random effects were used; supplementary analyses were repeated for the completers’ subsample (N = 53). Results: Suicidality, self-harm, emotional and behavioral dysregulation decreased in both groups after one year. Strategies to regulate intense emotions and mindfulness skills improved better in GET for the completers. Unconditional growth models indicated that subjects differed in the elevation and in the rate of change. Discussion: GET and DBT reached comparable outcomes on target variables over one year. Group setting or the intensity of treatment could be hypothesized as GET-specific therapeutic mechanisms.

My thesis concerns observations made while incorporating mindfulness-oriented art therapy experientials into hour-long, didactic DBT skills-training groups at a residential partial program serving dually-diagnosed adults. For the thesis, I adapted two exercises from Clark’s DBT-Informed Art Therapy. My research method was arts-based grounded theory, referencing Corbin’s grounded theory and Wadeson and Allen’s thinking on the use of art for professional processing. My data took the form of a journal, word clouds, poems, and small artworks I iteratively created to deepen my learnings. My experientials highlighted areas of confusion regarding mindfulness that I attempted to address. Through the process, I became profoundly aware of art-making’s potential to evoke shame in patients. This turned my attention to relational trauma and its enduring impact on patients with addiction disorders. I saw that the work that I was doing in groups was providing a safe, contained space for patients to gently re-experience shame. The art moments, including their ability to evoke shame, were an opportunity for corrective emotional experiences. Because of their acuity, some patients benefitted from the structure of DBT and its focus on managing dysfunctional behaviors. Patients who were better stabilized and regulated had the added potential to benefit from approaches that considered maladaptive schemas. I concluded that both DBT and aspects of schema therapy could be incorporated into the setting, with benefits to many patients, as long as the overarching framework of attachment trauma was kept in the practitioner’s mind.

Die Posttraumatische Belastungsstörung (PTBS) nach sexueller Gewalt in der Kindheit geht häufig mit komorbiden Symptomen einher. Kognitiv-behaviorale Therapien haben sich als effektiv in der Behandlung der PTBS erwiesen. Die Datenlage zur PTBS nach sexueller Gewalt in der Kindheit ist jedoch gering. In der vorliegenden Dissertation wurden Fragestellungen zur Diagnostik und Therapie der PTBS nach sexueller Gewalt verfolgt. In Schrift 1 werden die Ergebnisse einer ambulanten Assessmentstudie präsentiert, in der 28 Patientinnen wiederholt zum intrusiven Wiederleben befragt wurden. Mit durchschnittlich 75 Intrusionen und 24 Flashbacks pro Woche fand sich eine hohe Symptombelastung. Die Schriften 2, 3 und 4 beziehen sich auf eine randomisiert-kontrollierte Studie. Patientinnen (N=74) wurden randomsiert einer 12-wöchigen stationären DBT-PTBS oder einer treatment-as-usual Warteliste zugewiesen. Die Ergebnisse, die in Schrift 2 beschrieben sind, zeigen eine signifikante Reduktion der posttraumatischen Symptomatik mit einer großen Zwischengruppen-Effektstärke (g=1.35). In Schrift 3 wird dargestellt, dass die Effekte auf die posttraumatische Symptomatik in Bezug auf mehrere traumatische Ereignisse geringer sind als die Effekte in Bezug auf das am stärksten belastende Ereignis. Schrift 4 beinhaltet Ergebnisse zu der Inanspruchnahme psychiatrisch-psychotherapeutischer Behandlung und den assoziierten Kosten. Im Jahr vor der DBT-PTBS fanden sich im Mittel jährliche Pro-Kopf-Kosten von 18100 € und 57 stationäre Tage. Im Jahr nach der DBT-PTBS waren die Inanspruchnahme mit durchschnittlich 14 Tagen und die mittleren Kosten von 7233 € deutlich geringer. Zusammengefasst sprechen die Ergebnisse für eine hohe Effektivität der DBT-PTBS. Zudem scheint die DBT-PTBS mit einer Reduktion stationärer Tage und entsprechender Kosten einherzugehen. Die Ergebnisse zur Diagnostik deuten darauf hin, dass ein Teil der Symptomatik mit dem üblichen diagnostischen Vorgehen nicht erfasst wird., Posttraumatic stress disorder (PTSD) with co-occurring severe psychopathology is a frequent sequel of childhood sexual abuse (CSA). Cognitive-behavioral therapy has been shown to be efficacious in treating PTSD, but there is only limited data regarding patients with PTSD related to CSA. This dissertation focused on both the assessment and the treatment of PTSD related to CSA. Paper 1 presents data from an ambulatory assessment study. Patients (N=28) were provided with electronic diaries for repeated real-time assessment of intrusions and flashbacks. They reported an average of 75 intrusions and 24 flashbacks during the week of assessment. Papers 2, 3, and 4 present data from a randomized controlled trial. Patients (N=74) were randomized to either a 12-week residential DBT-PTSD program or a treatment-as-usual wait list. The results for primary and secondary outcomes are shown in Paper 2. Data revealed a significant reduction of posttraumatic symptoms with a large between-group effect size (g=1.35). Paper 3 provides results on the impact of the definition of the index trauma. When the index trauma included multiple traumas, PTSD severity scores were significantly higher, and improvements from pre- to post-treatment were significantly lower, compared to when the index trauma was defined as the worst trauma. Paper 4 presents data on the utilization of mental health care. The mean total costs were 18000 € per patient during the year before and 7233 € during the year after DBT-PTSD. The significant cost reduction was due to large reductions in inpatient treatment days (on average 57 days before and 14 days after DBT-PTSD). To sum up, the findings show clear evidence for the efficacy of the DBT-PTSD program. Data further indicate that DBT-PTSD might contribute to reducing the mental health care costs. Also, the results suggest that the currently applied methods of assessing PTSD in patients with severe symptoms might miss aspects of clinically relevant symptomatology.

Manifested symptoms can cause agony within an individual with borderline personality disorder. However, by integrating dialectical behavioral therapy and schema focused therapy, these theories can help the individual feel more at ease. In this group manual, individuals diagnosed with borderline personality disorder will participate in an 12 week group therapy for 2 hours. The group members will explore new approaches to cope with their established symptoms by focusing on the four core beliefs in dialectical behavior therapy, and schema modes in schema focused therapy. The goal of this group therapy is for the group members to consider themselves in the healthy adult mode, develop adequate coping mechanisms, decrease life-threatening behaviors, and improve quality of life. With these results, future researchers will have an alternative and effective approach to working with individuals with borderline personality disorder. Further research is needed to find the effectiveness of the integration of dialectical behavior therapy and schema focused therapy in individual therapy sessions.

Children in care are a complicated and vulnerable population. Youth who live in the care of the State often present with behaviours that are challenging to manage and which leave those around them struggling, whether they are caregivers or peers. Behaviour such as shown by these youth, is commonly thought to be an expression of emotional dysregulation or an attempt to regulate emotions. Dialectical Behavioural Therapy (DBT) is a therapy designed to support clients with extreme emotional dysregulation whose behaviour can be similar to what is observed in youth in care. DBT skills groups as a standalone intervention have been shown to support youth with emotional dysregulation and the resulting behavioural difficulties. The aim of the current research is to understand the experiences of New Zealand youth in care participating in a DBT based skills group. The research uses three case studies to explore each participant’s engagement with the activities and skills individually throughout the eight sessions. This will be done using in-group observations, what they thought and felt about the group and whether staff working with the young people identified any behavioural changes. Preliminary results demonstrated positive engagement with the skills, noted positive change from those working with the young people, as well as positive reports of behavioural change and increased understanding from the participants themselves.

Mindfulness trainings, which tend to include daily home meditation practice, have been found to improve in- and pre-service teachers well-being, but findings indicate that participants struggle to complete the recommended home meditation practice. A mindfulness training based on Dialectical Behavior Therapy (DBT) skills may be a more feasible training format for teachers because the home practice is informal and easily integrated into daily life. DBT skills are also discrete and easy-to-understand and directly relate to the intrapersonal and interpersonal challenges teachers face. Although DBT skills-based trainings have been used with non-clinical populations, to date no study has been identified exploring the use of DBT skills training with teachers generally or pre-service teachers specifically. This dissertation reports the findings of a study of a DBT skills-based training with pre-service teachers to improve their mindfulness and well-being. This study spanned 81 days and used a multiple-baseline single-case experimental design with longitudinal daily diary data from 11 participants. Qualitative homework data, facilitator reflections, and post-training interviews with four participants provided supplementary qualitative data. Quantitative findings indicate that the DBT skills training resulted in higher levels of mindfulness and positive affect the evening after participants attended trainings and continued elevated positive affect the following evening. The study did not find phase effects of training. Qualitative evidence shows that participants used DBT skills in a variety of personal and professional settings to address negative emotions or deal with difficult situations. According to interviews and homework data, the skills presented were easy to understand and apply. The discussion includes limitations of the study and implications for future research.

Third Wave Cognitive Behavioural therapies have received much attention in the practice community recently. However, little has been done to understand how these therapies relate and diverge. Despite the varying theoretical models contributing to the Third Wave movement and their supposed varying therapeutic elements, studies have suggested that outcomes do not differ across these therapeutic approaches. This finding leaves room for the notion that shared or ‘common’ factors may be operating across these approaches. Exploration into common elements between these approaches is useful for identifying areas of overlap or uniqueness, shared processes of change, and perhaps components that may be particularly efficacious. Goldfried argued the best way to identify the commonalities among diverse therapeutic approaches is to compare them by their principles of change, or change processes (Goldfried, 1980). Research has investigated change processes for many approaches, including those of the Behaviour and Cognitive tradition. However, such extensive investigations have not been applied to the Third Wave approaches. Further, a lack of quality comparisons across these approaches, even at the more specific level of therapeutic strategies, represents a gap in the field. The present research first identified a set of strategies (84 items) within three Third Wave approaches: Dialectical Behaviour Therapy, Acceptance and Commitment Therapy and Mindfulness Based Cognitive Therapy. Strategies are sorted according to similarity in a card-sorting task, by two participant samples, a non-therapist sample (N=32) and a therapist sample (N=35). Sorting data were analysed using multidimensional scaling (MDS) to produce three three-dimensional models, representing each sample and a combined sample. The therapist sample was judged to represent the underlying relationships between strategies best. Three dimensions were identified that classified strategies according to their internal or exter

BackgroundAlthough Dialectical Behaviour Therapy (DBT) is an evidence-based psychosocial treatment for borderline personality disorder (BPD), the demand for it exceeds available resources. The commonly researched 12-month version of DBT is lengthy; this can pose a barrier to its adoption in many health care settings. Further, there are no data on the optimal length of psychotherapy for BPD. The aim of this study is to examine the clinical and cost-effectiveness of 6 versus 12 months of DBT for chronically suicidal individuals with BPD. A second aim of this study is to determine which patients are as likely to benefit from shorter treatment as from longer treatment.Methods/designPowered for non-inferiority testing, this two-site single-blind trial involves the random assignment of 240 patients diagnosed with BPD to 6 or 12 months of standard DBT. The primary outcome is the frequency of suicidal or non-suicidal self-injurious episodes. Secondary outcomes include healthcare utilization, psychiatric and emotional symptoms, general and social functioning, and health status. Cost-effectiveness outcomes will include the cost of providing each treatment as well as health care and societal costs (e.g., missed work days and lost productivity). Assessments are scheduled at pretreatment and at 3-month intervals until 24 months.DiscussionThis is the first study to directly examine the dose-effect of psychotherapy for chronically suicidal individuals diagnosed with BPD. Examining both clinical and cost effectiveness in 6 versus 12 months of DBT will produce answers to the question of how much treatment is good enough. Information from this study will help to guide decisions about the allocation of scarce treatment resources and recommendations about the benefits of briefer treatment.Trial registrationNCT02387736 . Registered February 20, 2015.

Thesis (Ph. D.)--University of Rochester. Margaret Warner Graduate School of Education and Human Development, 2016., Despite the general notion that psychodynamic modalities are incongruent with cognitive behavior therapy, the author has been successfully using components of Intensive Short-Term Dynamic Psychotherapy (ISTDP) together with Dialectical Behavior Therapy (DBT) in the treatment of personality disorders. While both ISTDP and DBT have garnered empirical support for their utility with various personality disorders, their use together in the same treatment regimen is unprecedented. Taken together, ISTDP and DBT appear to suggest an integrative therapy approach, and concomitant theoretical principles, for use with the majority of clients with a personality disorder. This study is a preliminary step in elucidating viable theoretical and pragmatic principles for treating individuals with personality disorders derived from the ISTDP-DBT therapy integration. Using a qualitative, theory-building methodology, the therapy integration was vetted with ten experts; three with expertise in ISTDP, three with expertise in DBT, and four with expertise in psychotherapy integration in general. The feedback of these experts was obtained through in-depth individual interviews, which were used to produce an initial formulation of the ISTDP-DBT therapy integration in preparation for future study on the effectiveness of the therapy integration in actual work with clients.

Problems with emotion regulation are common in people who seek help from health care professionals working with problems featuring psychological factors. Two such patient groups, chronic pain patients and patients with severe anxiety, are of interest in this dissertation. Effectively regulating and increasing functional emotion regulation in these patients is often challenging for clinicians, and effective strategies are needed. One treatment that greatly emphasizes the importance of functional emotion regulation is dialectical behavior therapy (DBT). DBT has a strong empirical basis in other patients with severe problems with emotion regulation, raising the question of whether the treatment and its more specific components (e.g., validation, which means communicating understanding and acceptance) could be effec-tive in the groups of patients of interest here. Accordingly, the overall aim of this dissertation was to expand our knowledge of how to use functional emotion-regulation strategies from DBT to regulate emotions in patients with chronic pain or treatment-resistant anxiety disorders. Study I examined whether brief training was enough to increase validation in partners of people with chronic pain, and whether this was associated with better-regulated emotion in the people with chronic pain. Study II explored patient perceptions of validation and invalidation by the physician in a clinical chronic pain context. Lastly, study III investi-gated whether a more extensive treatment intervention inspired by DBT was feasible and effective in patients suffering from treatment-resistant anxiety disorders. The findings indicate that emotion-regulation strategies from DBT can be effective in regulating emotions in these patients. The dissertation also illus-trates some of the difficulties in doing this, providing important information for future work, such as suggestions for modifications that might further increase positive outcomes.

Bipolar disorder is difficult to capture in a single animal model, so far proving impossible. Models have evaluated the neurobiological, genetic, pharmacological and behavioral aspects, both in seclusion and in various combinations, but have yet to prove construct or face validity or led to highly effective treatment models. One area where animal models are having success is when animal models shape behavioral treatment. Third wave behavioral therapies and Applied Behavior Analysis (ABA) have shown decreased relapse and re-hospitalization at 1 year follow up, increased medication compliance and increased family support. Cognitive Behavior Therapy (CBT), Dialectal Behavior Therapy (DBT) and Family Focused Treatment (FFT) that include problem solving, family education and self-management have shown success across setting such as school, home and community, especially when used as part of the overall treatment package with medication. While a single model is unable to encompass all areas of need for a disorder as complex as bipolar disorder, continued research should allow for new treatment models to emerge.Keywords: Bipolar disorder, animal models, cognitive behavior therapy, dialectical behavior therapy, applied behavior analysis, family focused therapy

BackgroundHomeless female ex-offenders (homeless female offenders) exiting jail and prison are at a critical juncture during reentry and transitioning into the community setting.ObjectiveThe purpose of the study was to compare the effect of a dialectical behavioral therapy-case management (DBT-CM) program with a health promotion (HP) program on achieving drug and alcohol abstinence among female parolees/probationers residing in the community.MethodsWe conducted a multicenter parallel randomized controlled trial with 130 female parolees/probationers (aged 19-64 years) residing in the community randomly assigned to either DBT-CM (n = 65) or HP (n = 65). The trial was conducted in four community-based partner sites in Los Angeles and Pomona, California, from February 2015 to November 2016. Treatment assignment was carried out using a computer-based urn randomization program. The primary outcome was drug and alcohol use abstinence at 6-month follow up.ResultsAnalysis was based on data from 116 participants with complete outcome data. Multivariable logistic regression revealed that the DBT-CM program remained an independent positive predictor of decrease in drug use among the DBT-CM participants at 6 months (p = .01) as compared with the HP program participants. Being non-White (p < .05) and having higher depressive symptom scores (p < .05) were associated with lower odds of drug use abstinence (i.e., increased the odds of drug use) at 6 months.DiscussionDBT-CM increased drug and alcohol abstinence at 6-month follow-up, compared to an HP program.

Schema therapy (ST) and dialectical behavior therapy (DBT) have both shown to be effective treatment methods especially for borderline personality disorder. Both, ST and DBT, have their roots in cognitive behavioral therapy and aim at helping patient to deal with emotional dysregulation. However, there are major differences in the terminology, explanatory models and techniques used in the both methods. This article gives an overview of the major therapeutic techniques used in ST and DBT with respect to emotion regulation and systematically puts them in the context of James Gross' process model of emotion regulation. Similarities and differences of the two methods are highlighted and illustrated with a case example. A core difference of the two approaches is that DBT directly focusses on the acquisition of emotion regulation skills, whereas ST does seldom address emotion regulation directly. All DBT-modules (mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness) are intended to improve emotion regulation skills and patients are encouraged to train these skills on a regular basis. DBT assumes that improved skills and skills use will result in better emotion regulation. In ST problems in emotion regulation are seen as a consequence of adverse early experiences (e.g., lack of safe attachment, childhood abuse or emotional neglect). These negative experiences have led to unprocessed psychological traumas and fear of emotions and result in attempts to avoid emotions and dysfunctional meta-cognitive schemas about the meaning of emotions. ST assumes that when these underlying problems are addressed, emotion regulation improves. Major ST techniques for trauma processing, emotional avoidance and dysregulation are limited reparenting, empathic confrontation and experiential techniques like chair dialogs and imagery rescripting.

Die vorliegende kumulative Promotion umfasst drei veröffentlichte Publikationen, die im Rahmen der Berliner Borderline Versorgungsstudie (BBV-Studie) durchgeführt wurden. In Studie 1 wurde die effectiveness der ambulanten Dialektisch-Behavioralen Therapie (DBT) an N = 47 Patienten mit einer Borderline Persönlichkeitsstörung (BPS), die das DBT-Behandlungsjahr vollständig durchlaufen haben, untersucht. Im Prä-Post-Vergleich zeigten sich für die untersuchten Symptombereiche signifikante Veränderungen und die Effektstärken lagen überwiegend im mittleren Bereich. 77% der Patienten erfüllten nach einem Jahr DBT nicht mehr die diagnostischen Kriterien für eine BPS. In Studie 2 wurden die Krankheitskosten von N = 55 BPS-Patienten in dem Jahr vor der ambulanten DBT umfassend aus einer gesellschaftlichen Perspektive erhoben. Die durchschnittlichen Kosten lagen bei €26.882 (SD = €32.275). Davon gingen mit €17.976 (SD = €23.867) etwa 66% auf die direkten, mit €8.906 (SD = €15.518) knapp 34% auf die indirekten Kosten zurück. In Studie 3 wurden für die N = 47 DBT- compleater die Krankheitskosten im Jahr vor der Therapie mit denen während des DBT-Behandlungsjahres und mit denen während des ersten Katamnesejahres (N = 33) verglichen. Die durchschnittlichen Krankheitskosten lagen im Jahr vor der DBT bei €28.026 (SD = €33.081), während des DBT-Jahres bei €18.758 (SD = €19.450) und sanken innerhalb des Katamnesejahres weiter auf €14.750 (SD = €18.592). Die deutlichsten Kostenreduktionen zeigten sich im stationären Bereich. Hingegen konnten die indirekten Kosten kaum gesenkt werden. Insgesamt weist die vorliegende Promotion darauf hin, dass die ambulante DBT auch unter Versorgungsbedingungen in Berlin wirksam ist. Zudem besitzt die BPS auch in Deutschland eine hohe gesellschaftliche Relevanz. Die Krankheitskosten können deutlich gesenkt werden, wenn BPS-Patienten in einem DBT-Netzwerk behandelt werden. Hieraus ergeben sich erste Hinweise auf die Effizienz der ambulanten DBT., This thesis includes three publications that were conducted as part of a Berlin wide treatment study (“Berliner Borderline Versorgungsstudie“). In study 1, we examined the effectiveness of dialectical behavior therapy (DBT) for borderline personality disorder (BPD) under the routine health care situation in Berlin. N = 47 patients completed the one-year treatment and provided data. Our findings demonstrate significant improvements on all measures with medium effect sizes. Moreover, at the end of the first treatment year, 77% of the patients no longer met the criteria for a BPD diagnosis. In Study 2, BPD-related cost-of-illness 12 months prior to outpatient DBT was assessed in a sample of N = 55 BPD-patients from a societal perspective. Total cost-of-illness was €26882 (SD = €32275) per patient. €17976 (SD = €23867; 66%) were direct costs and €8906 (SD = €15518; 34%) were calculated as indirect costs. In study 3, societal cost-of-illness of the N = 47 DBT completers was calculated for 12 months prior to DBT and further investigated during DBT-treatment year and during the following year. Total mean annual cost-of-illness was €28026 (SD = €33081) during pre-treatment, €18758 (SD = €19450) during the DBT treatment year and €14750 (SD = €18592) during the follow-up year for the N = 33 patients who participated in the final assessment. Cost savings were mainly due to marked reductions of inpatient treatment costs, while indirect costs barely decreased. In sum, the present thesis shows that outpatient DBT under routine mental health care conditions in Berlin leads to positive results. Furthermore, mean annual cost-of-illness of German BPD-patients exceed those of many other mental disorders meaning that BPD poses a high economic burden. Importantly, treatment of BPD patients with an outpatient DBT program is associated with substantial overall cost savings. Correspondingly, outpatient DBT has the potential to be an efficient treatment.

Dialectical Behavior Therapy (DBT) is a treatment developed for patients with borderline personality disorder diagnosis (BPD). DBT combines behavior therapy with reality acceptance principles derived from Zen and dialectical philosophy. DBT is a multi-modal treatment with 4 components: individual therapy, skills training, phone consultation and consultation team for therapists. Today, there are several randomized controlled clinical trials proving enough evidence as to consider that DBT is an empirically based treatment for BPD. DBT has also been adapted for the treatment of other clinical populations characterized by emotional dysregulation. The skills training component of the therapy has begin to be used as a standalone treatmentent and evidence in regard to its efficacy is still growing. In this article we resume the principles and structure of DBT and review its clinical applications and empirical data., La Terapia Dialéctica Conductual (TDC) es un tratamiento desarrollado para pacientes con Trastorno Límite de la Personalidad (TLP). En la TDC se combinan técnicas de terapia de la conducta con principios de aceptación de la realidad derivados del Zen y de la filosofía dialéctica. La TDC es una terapia multi-modal que incluye 4 componentes: terapia individual, entrenamiento grupal en habilidades, soporte telefónico y un grupo de consulta para los terapeutas. Como lo demuestran distintos ensayos clínicos controlados y aleatorizados, la TDC es hoy en día el único tratamiento para el TLP que ha sido suficientemente investigado como para considerarse basado en la evidencia. La TDC también ha sido adaptada para el tratamiento de otras patologías vinculadas a la disregulación emocional, lo que ha contribuido a ampliar su aplicación a otras poblaciones clínicas. En este sentido, el entrenamiento en habilidades también se aplica como componente único de tratamiento, acumulando cada vez más evidencia en relación a su eficacia. En el presente artículo se exponen los principios básicos de la terapia y se realiza una revisión de sus aplicaciones clínicas y así como de la evidencia empírica disponible hasta el momento.

__Abstract__ Background: Borderline Personality Disorder (BPD) is a serious psychiatric condition associated with substantial mortality, burden and public health costs. DBT is the treatment model with the largest number of published research articles showing effectiveness. However, some patients are not sufficiently engaged in outpatient treatment while presenting severe parasuicidal behavior, making hospitalization necessary. The Center for Personality Disorders Jelgersma developed an intensive 12-week inpatient DBT program that (i) rapidly reduces core borderline symptoms like suicidal behavior, (ii) minimizes the negative effects of an inpatient setting, and (iii) enhances compliance with outpatient treatment. We evaluate the (cost-) effectiveness of this experimental program.Methods/design: Seventy patients, aged 18 to 45 years with a primary diagnosis of BPD, showing a chronic pattern of parasuicidal gestures and/or reporting high degrees of severity of other borderline symptoms, are randomly allocated to the control and intervention groups. Subjects in the control group receive standard outpatient DBT, provided in one of three regular mental health settings in GGZ Rivierduinen. Subjects in the intervention group receive 12 weeks of intensified inpatient DBT plus six months of standard DBT, provided in the Center for Personality Disorders Jelgersma. The primary outcome is the number of suicide attempts/self-harming acts. Secondary outcomes are severity of other borderline complaints, quality of life, general psychopathological symptoms and health care utilization and productivity costs. Data are gathered using a prospective, two (group: intervention and control) by five (time of measurement) repeated measures factorial design.Participants will complete three-monthly outcome assessments in the course of therapy: at baseline, and 12, 24, 36 and 52 weeks after the start of the treatment. The period of recruitment started in March 2012 and the study will end in Dec

This essay is about families with an adolecent with self-injuried behaviour and what kind of support they can get. This essay is based on several therapist's view. These therapists works with the method dialectical behavior therapy. Dialectical behavior therapy (DBT) is a method that has gained good results with patients that have self-injury behavior. This essay is based on a qualitative study made on four semi-structured interviews. The study shows that relatives to children with self-injury can get support from the DBT-methods relativeprogram “Familyconnection”. The therapists consider the method as a good one and research shows that the DBT-method has a good effect on the relatives health.

Syftet med uppsatsen var att utvärdera dialektisk beteendeterapi för ungdomar, en behandling som initialt utvecklats för en äldre patientgrupp. Inledningsvis jämfördes patienternas (N = 33, ålder = 13-17) skattningar innan behandlingen, gällande psykiatrisk problematik, anknytningsdimensioner samt temperaments- och karaktärsfaktorer, mot normgrupper. För en mindre grupp (N = 10) undersöktes därefter förändringar efter behandlingen genom beräknande av statistisk och klinisk signifikans. Resultatet visade att patientgruppen skilde sig från normgruppen på flertalet psykiatriska variabler. En skillnad uppvisades mellan instrumenten SCL-90 och SDQ; överlag skilde sig patientgruppen mer från normgruppen på SCL-90. Stor skillnad uppvisades även mellan patientgruppen och normgruppen gällande samtliga anknytningsdimensioner (ASQ), samt flera temperaments- och karaktärsfaktorer (TCI). Ett flertal statistiskt signifikanta förbättringar uppmättes efter behandlingen, bland annat gällande grad av depression, ångest och självskadebeteende. Patienterna uppvisade dessutom signifikant högre grad av tillit, lägre grad av distans och bifallsbehov samt högre grad av self-directedness. Även klinisk signifikans uppmättes, exempelvis uppfyllde 90 % av patienterna kriterierna för kliniskt signifikant förbättring på Globalt svårighetsindex (SCL-90) och 55 % på Totala svårigheter (SDQ). Trots att metoden begränsar uppsatsens slutsatser gällande förändring hos patientgruppen i stort, tyder resultatet på att förändringar efter DBT-behandling kan göra sig gällande för såväl psykiatrisk problematik som anknytningsdimensioner och karaktärsdrag., The purpose of the paper was to evaluate a Dialectical Behavior Therapy (DBT) treatment for adolescents, a treatment that was originally developed for older patient groups. First patients (N = 33, age = 13-17) were compared with norm groups on current psychiatric problems, attachment dimensions (ASQ) and temperament and character factors (TCI). The adolescent patient group differed in most of these domains. In addition a difference was demonstrated between the instruments SCL-90 and SDQ; the patients differed more on the SCL -90. Changes after treatment were studied for a smaller group (N = 10) by calculating statistical and clinical significance. Several statistically significant improvements were found including current levels of depression, anxiety and deliberate self-harm. In addition patients demonstrated significantly higher levels of confidence, lower degree of discomfort with closeness and need for approval and higher level of self-directedness. In regard to clinically significant improvements 90% of the patients met these criteria on Global severity index (SCL -90) and 55% on Total difficulties (SDQ). In conclusion these results indicate changes after DBT treatment on psychiatric problems as well as attachment dimensions and character factors. Due to the limitations of the study the results should be interpreted with caution and further research is warranted to establish DBT as a standard treatment for adolescents.

Borderline Personality Disorder (BPD) is a psychiatric condition associated with severe functional impairments in areas including emotion regulation, impulse control and the maintenance of stable and balanced self-views as well as interpersonal relationships. Dialectical Behavior Therapy (DBT) is a comprehensive cognitive-behavioral treatment program that has been shown effective in reducing suicidal behaviors in patients diagnosed with BPD. Nevertheless, the scarceness of studies examining treatment effects on long term aspects of the borderline personality, such as self-views, calls for further exploration. The present paper sought to examine the experiences of five former patients diagnosed with BPD who completed a DBT- program, in regard to relationships with therapists and changes in self-views. A subsidiary aim of the study was to identify factors that in participants’ experience had contributed to such changes. The results indicate that at post-treatment, participants experienced significant positive changes in self-views as well as in interpersonal functioning. Factors reported as contributing to change were motivation, relationships in and outside of treatment as well as skills acquired in DBT. A well-established theoretical approach to the development and maintaining of self-views, self- verification theory, is applied to discuss the processes by which change has occured.

Purpose: Describe the Suquamish cultural influences on defining living a life worthwhile and to describe the compatibility of a culturally modified Dialectical Behavior Therapy (DBT) with a Native American community's culture and context. Background: Native Americans experience serious psychological distress, suicide, and substance abuse at higher rates than other racial groups. Studies using DBT found a significant decrease in parasuicidal risk behavior and substance abuse. However, research has not demonstrated that DBT is efficacious or compatible within the Native American culture. Specific Aims: 1) Describe the Native American cultural influences on defining living a life worthwhile. 2) Describe the compatibility between Healthy and Whole, a culturally modified DBT intervention with Native American culture. Methodology: Critical ethnographic study with in-depth interviews (13) and participant observations (10 months) was conducted. Sample was tribal members and clinicians exposed to the Healthy and Whole and tribal members who are identified as knowledgeable regarding tribal tradition. Analyses included semantic domain, taxonomic, and theme analysis for aim1 and compared DBT curriculum to results of aim 1 to accomplish aim 2.Findings: An intergenerational cycle of relational trauma was initiated by structural cultural genocide with systematic abuse and neglect of Native Americans especially children. Relational trauma of abuse and neglect is the source of a variety of maladaptive behaviors. These maladaptive behaviors lead to relational trauma in the next generation. A dual process of maintaining and revitalizing Suquamish cultural values coupled with skills taught in a culturally modified DBT intervention, Healthy and Whole, help Suquamish members live more worthwhile lives and recover from intrapersonal trauma. Implications: Healthy and Whole is a community approach to healing from relational trauma. Healthy and Whole approach to DBT may help other indigenous

Les personnes souffrant d’un trouble de la personnalité borderline (TPL) représentent une proportion importante de la clientèle hospitalisée en psychiatrie et de la clientèle ambulatoire. Elles consomment jusqu’à 40 % des ressources en santé mentale. La thérapie comportementale dialectique (TCD) est l’une des thérapies les mieux validées dans les écrits scientifiques pour traiter cette clientèle. Malheureusement, son déploiement au Québec demeure assez limité, entre autres à cause d’un manque de ressources pour offrir la thérapie individuelle et les appels téléphoniques d’urgence. Même si l’approche globale, telle que préconisée initialement, est peu accessible, plusieurs départements de psychiatrie proposent des groupes d’entraînement aux compétences aux personnes souffrant de TPL. Cet article vise à dresser un bref portrait de ce qu’est la TCD, de rendre compte des études sur les groupes TCD et de quelques adaptations existantes. L’auteure présentera le modèle appliqué dans deux milieux psychiatriques québécois, le Centre de santé et de services sociaux du Sud de Lanaudière et le pavillon Albert-Prévost, ainsi que les adaptations prévues dans le cadre du plan d’action en santé mentale., Patients suffering from borderline personality disorder (BPD) represent a substantial proportion of hospitalized and outpatient patients in psychiatry. They use up to 40% of mental health resources. Dialectical behavioral therapy (DBT) is one of the best studied treatment for this population. Unfortunately, its deployment in Quebec remains quite limited partly because resources are lacking to provide individual therapy and a response to emergency calls. Although the complete package, as originally studied, is not widely available, several psychiatric departments offer skills training groups for patients with BPD. This article aims to provide a brief overview of the DBT model, review studies on DBT groups and some existing adaptations to the original model. The author will also present the model used in two psychiatric settings, the Centre de Santé et Services Sociaux du Sud de Lanaudière and Pavilion Albert-Prévost, as well as the adaptations in the context of transfers to community health settings.

The current literature on nonsuicidal self-injury among male adolescents is lacking in amount and level of understanding in comparison to females. The purpose of this study is to determine the gender differences in treatment outcomes for adolescents with nonsuicidal self-injury in a Dialectical Behavior Therapy outpatient program. A total of 65 adolescent males and females from ages 12-18 who successfully graduated from the program were available for this study. Results show that the overall group of male and female patients reported a significant improvement in their levels of distress from baseline to post-treatment. Quantitative analyses conducted between male and female patients showed no significant differences in the number of treatment days, age, number of inpatient admissions during the program, number of previous psychiatric hospitalizations, and levels of overall distress at baseline and post-treatment. A case study analysis showed that typical male patient graduates included in the case study largely differed from the typical female patient graduates on some key demographic information. These included sexual orientation, history of abuse, history of abandonment, academic functioning, family history of mental illness, and history of inpatient psychiatric hospitalizations. Lastly, post-treatment outcomes show that none of the males indicated any psychiatric hospitalizations or outpatient treatment after being discharged from the program in comparison to 15.4% and 84.6% of females who reported post-treatment psychiatric hospitalization and outpatient treatment, respectively. The current study was able to provide preliminary support for the application of DBT for the adolescent male population. DBT is a powerful treatment approach that is able to successfully target both the male and the female adolescent population with NSSI. Future research should focus on the influence of group dynamics among patients in the program and gender differences in help-seeking b

SammanfattningLångvarig smärta orsakar stort lidande för individen och belastar samhället ekonomiskt. Syftet med denna uppsats var att undersöka om en exponering in vivo-behandling inspirerad av Dialektisk beteendeterapi (DBT) för människor med långvarig ländryggssmärta var görbar samt om behandlingen gav effekt på smärtrelaterad problematik. Designen var en single case experimental design vilket är en beprövad design för att testa nya terapimetoder. Studien bestod av sex deltagare, alla med hög grad av smärtrelaterade katastroftankar, något som litteraturen visat predicera sämre behandlingsutfall. Behandlingen var DBT-inspirerad och indelad i tre faser; en första valideringsfas, en andra färdighetsfas och en tredje exponeringsfas. Fem av sex deltagare fick förbättringar på alla de primära utfallsmått, tre av sex deltagare fick förbättringar på samtliga primära- och sekundära utfallsmått. Framtida replikationer är motiverade., Chronic pain causes great suffering for the individual and burden society economically. The aim of this study was to examine whether an exposure in vivo treatment inspired by Dialectical Behavior Therapy (DBT) for people with chronic low back pain was feasible and whether the treatment had effect on pain-related problems. The design was a single case experimental design, which is a widely used design to test new therapy methods. The study consisted of six participants, all with high levels of pain catastrophizing, something that in the literature been linked to poor treatment outcomes. The treatment was inspired by DBT and divided into three phases: an initial validation phase, a second phase for skills training and a third exposure phase. The results were promising: five out of six participants had improved in all primary outcome measures. Three out of six participants had improvements in all primary and secondary outcome measures. Future replications are warranted.

The aim of this intervention study was to investigate possible effects of dialectical behavior therapy skills training (DBT-ST) for staffs at a residential treatment center for patients with serious mental illness. Eighteen staffs divided in two groups were assessed before and after participation in DBT-ST. The intervention lasted one year for each group. Mean number of self-injuries each month were calculated for patients (N = 64) at the center receiving DBT during the baseline, intervention, and post-intervention years. Staff participation in DBT-ST was associated with increases in self-reported mindfulness and improvements in the work environment. The number of staffs who reported frequent violent incidents at work decreased from 39% to 11%. A significant and large reduction (r = -.63) was found in the number of self-injuries among patients following DBT-ST for the first group of staffs. The study demonstrates that important aspects of mindfulness probably can be learned by staffs without engaging in meditation-based programs. Further, the results suggest the hypothesis that promoting increased mindfulness among staffs can contribute to a reduction of self-harm and violence among patients. The findings are discussed with reference to a cognitive declarative-procedural-reflective model of therapist skill development (Bennett-Levy, 2006).

Objectives This work compares the efficacy of four treatment models for Borderline Personality Disorder (BPD) that have been tested in empirical research. The models considered are Mentalization- Based treatment (MBT) by Bateman and Fonagy, Transference-Focused Psychotherapy (TFP) by Clarkin, Yeomans and Kernberg, Dialectical Behaviour Therapy (DBT) by Linehan, and Schema-Focused Therapy (SFT) by Young. For all four models, a specific treatment manual is available that allows reliable trials on efficacy to be carried out. Methods A critical review of literature from 1991 to date has been conducted, reviewing all published empirical studies on the efficacy of the four models. Pubmed and Psychinfo databases were searched using as keywords the terms “Mentalization-Based Treatment”, “Transference-Focused Psychotherapy”, “Dialectical Behaviour Therapy” and “Schema-Focused Therapy”. The efficacy of treatments was compared considering three different parameters: dysregulation, mentalization, and duration/stability of changes. Results The review of literature identified 5 studies on MBT, 7 on TFP, 20 on DBT and its modified forms, and 7 on SFT. The four models showed efficacy in reducing self-mutilating, suicidal, and parasuicidal behaviours. TFP is the most effective treatment in reducing anger and impulsivity, while DBT was effective in treating eating behaviour disorders, one of the symptoms of severe dysregulation. Considering substance abuse, data are unclear. As for mentalization, only TFP demonstrated efficacy in increasing the level of reflective functioning. The changes obtained with treatments showed long-term stability for MBT, TFP, and DBT, while further follow-up studies are required for SFT. Conclusions All four models can be considered effective in treating BPD (or, at least, some aspects) with a level of efficacy that varies depending on the parameter considered. According to criteria of the American Psychiatric Association 5 for empirically-validated treatm

In the past decade the push for utilization of evidence-based practice (EBP) in mental health has increased dramatically. Due to managed healthcare, lowered spending on state and federal mental health budgets, and requirements by funding agencies such as Medicaid, it is imperative that mental health clinicians (MHCs) be trained in and utilize EBPs to improve funding and ensure continuity of best practice in clinical interventions with clients. Minimal research exists on MHCs and their knowledge and use of EBPs. The present study examined MHCs' perceptions, knowledge, training, and utilization of EBPs, with a specific focus on Dialectical Behavior Therapy (DBT). To date, it is the most prominent and effective EBP for treating Borderline Personality Disorder (BPD) and associated parasuicidal and suicidal behaviors. Current research supports its effectiveness in treating a myriad of other commonly treated disorders. The exploratory study provides insight into MHCs level of interest in receiving more EBP awareness and DBT training. Results indicate that though clinicians have received training in EBP and DBT, most of that training has been encouraged through career settings. Age of the clinician, years in practice, and type of training background are predictors of level of education, knowledge and training. Results show the majority of clinicians are interested in EBP, aware of the impact EBP can have on treatment effects, and report desire to have more training in EBPs and DBT specifically. These results could provide a necessary bridge between disciplines to allow clinicians, irrespective of training, to provide the most clinically effective treatments to clients.

Background and aims: Chronic pain patients often present with a host of psychological and somatic problems and are unable to work despite receiving traditional pain management. For example, it is common that patients with persistent pain also suffer from a variety of anxiety and depressive symptoms. Indeed, the regulation of emotions may be one important factor that is associated with the development of persistent pain. Dialectical behavior therapy, a form of cognitive-behavioral therapy, focuses on emotion regulation and has successfully addressed other complex problems. The objective of this case study was to test the feasibility of developing and applying a dialectical behavior therapy approach to chronic pain. Methods: Feasibility study of n=1. A 52-year-old adult suffering musculoskeletal pain, work disability, depression, and mood swings was offered therapy. She had not worked at her occupation for 10 years. An intervention was developed based on dialectical behavior therapy that included goal setting, validation, behavioral experiments and interoceptive exposure. Goals were developed with the client, based on her own values, and these were to: increase participation in previously enjoyable activities, not only reduce but also accept that some pain may remain, and, express and regulate emotions. Validation (understanding the patient’s situation) and psychoeducation were used to analyze the problem with the patient in focus. Function was approached by monitoring activities and conducting dialectical behavioral experiments where the patient systematically approached activities she no longer participated in (exposure). Emotional regulation followed a training program developed in dialectical behavior therapy designed to have people experience, express, and manage a variety of positive and negative emotions. In order to address the patient’s complaint that she avoided her own feelings as well as the pain, interoceptive exposure was introduced. After establishing c

För att undersöka vad medveten närvaro kan betyda i dialektisk beteendeterapi (DBT) meningskoncentrerades nio intervjuer. Medveten närvaro hade en positiv betydelse för samtliga deltagare. Det centrala för deltagarna var färdigheterna observera och en sak i taget. Färdigheterna hjälpte patienterna att stanna upp i ett negativt händelseförlopp. Behandlarna menade att medveten närvaro hjälpte vid stressrelaterade situationer. Samtliga deltagare underströk betydelsen av färdighetsträningen i grupp och praktiska övningar. Det fanns ett tydligt behov av att förenkla teorin kring medveten närvaro i DBT samt att medveten närvaro behövde få ett större utrymme. Om medveten närvaro kan hjälpa patienter i DBT att stanna upp i ett destruktivt händelseförlopp så är det en verkan av stor betydelse för patienterna såväl som för anhöriga och sjukvården.

The outcomes of Behavior Therapy have been significant in the last decades; we have at our disposal empirically validated treatments for many mental disorders. However, effective treatment programs for some other psychological problems are still scarce. Personality disorders are among the most difficult problems to treat from any psychotherapeutic perspective, including Behavior Therapy. Because of this, some researchers have devoted their work to study personality disorders and develop specific interventions. These researchers have designed new approaches and techniques that have contributed not only to improve the treatment of personality disorders, but also to enrich Behavior Therapy, given that those approaches could be used effectively in the treatment of personality disorders and in the treatment of other disorders as well. One of the most active research groups in the study and treatment of personality disorders is Dr. Marsha Linehan's team at the University of Washington in United States of America. This group has designed and validated Dialectal Behavior Therapy, a program for the treatment of borderline personality disorder, one of the most complex and challenging psychological problems. The aim of this work is to offer a general view of Dialectical Behavior Therapy, highlighting the innovative aspects of the program that have contributed to improve the strategies that Behavior Therapy offers., La Terapia de Conducta ha avanzado de farma significativa en las últimas décadas. Disponemos de frotamientos empíricamente validados para el tratamiento de un número importante de trastornos mentales. Sin embargo, existen todavía problemas psicológicos para los que los programas de tratamiento eficaces son todavía escasos. Los trastornos de la personalidad se podrían incluir entre los trastornos más difíciles de abordar desde cualquier perspectiva terapéutica, incluyendo la Terapia de Conducta. Debido a ello, desde hace años algunos investigadores se han preocupado por estudiar estos trastornos y por desarrollar intervenciones especificas para los mismos. En esa labor han desarrollado nuevos enfoques y técnicas que han contribuido no sólo a la mejora en el abordaje de estos trastornos, sino también al enriquecimiento de la Terapia de Conducta, de modo que estas intervenciones se pueden aplicar al tratamiento de los trastornos de la personalidad y de otros trastornos mentales. Uno de los grupos más activos en el tratamiento de los trastornos de la personalidad ha sido el equipo de la Dra. Marsha Linehon en la Universidad de Washington, en Estados Unidos. Este grupo ha diseñado y validado un programa de tratamiento denominado Terapia dialéctico-comportamental dirigida al abordaje de uno de los trastornos más Complejos que nos encontramos en la práCtiCO clínica diaria, el trastorno límite de la personalidad. El objetivo de este artículo es ofrecer una visión general de este programa de tratamiento enfatizando los aspectos novedosos que han significado una contribución importante o la mejora de las estrategias que lo Terapia de Conducta nos ofrece.