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• Describes the paradigms that inform the delivery of dialectical behavior therapy. • Provides overview of critical research on dialectical behavior therapy. • Suggests avenues for future research on dialectical behavior therapy. The first randomized clinical trial of dialectical behavior therapy (DBT) for women with borderline personality disorder was published in 1991. Over the past 30 years, research on DBT has proliferated along with interest by clinicians and the public. In this State of the Science review, we provide a brief description of the treatment paradigm and its conceptual and theoretical underpinnings. We also briefly review the research conducted to date on DBT across populations and settings, the vast majority of which demonstrates that it is effective at treating the behaviors that it targets. We also argue that, although DBT has been established as a "gold-standard" treatment for certain populations and behaviors, there is much more research needed to answer critical questions and improve its efficacy. [ABSTRACT FROM AUTHOR]

Borderline personality disorder (BPD) is a severe mental illness, with high rates of co-morbid depression and suicidality. Despite the importance of optimizing treatment in BPD, little is known about how neural processes relate to individual treatment response. This study examines how baseline regional brain blood oxygen level dependent (BOLD) activation during a functional magnetic resonance imaging (fMRI) task of emotion regulation is related to treatment response following a six-month randomized clinical trial of Dialectical Behavior Therapy (DBT) or Selective Serotonin Reuptake Inhibitor (SSRI) treatment. Unmedicated females with BPD (N = 37), with recent suicidal behavior or self-injury, underwent an fMRI task in which negative personal memories were presented and they were asked to distance (i.e., downregulate their emotional response) or immerse (i.e., experience emotions freely). Patients were then randomized to DBT (N = 16) or SSRI (N = 21) treatment, with baseline and post-treatment depression and BPD severity assessed. BOLD activity in prefrontal cortex, anterior cingulate, and insula was associated with distancing. Baseline BOLD during distancing in dorsolateral, ventrolateral, and orbital prefrontal cortex (dlPFC, vlPFC, OFC) differentially predicted depression response across treatment groups, with higher activity predicting better response in the SSRI group, and lower activity predicting better response in the DBT group. All female samples. Findings indicate that greater prefrontal engagement during emotion regulation may predict more antidepressant benefit from SSRIs, whereas lower engagement may predict better response to DBT. These results suggest different mechanisms of action for SSRI and DBT treatment, and this may allow fMRI to guide individualized treatment selection. • Borderline personality disorder (BPD) is associated with high rates of depression. • Neural processes may offer insight into predicting antidepressant response. • Prefrontal engagement differentially predicted response to SSRI and DBT treatment. • Examining prefrontal activity may allow for more individualized treatment in BPD. [ABSTRACT FROM AUTHOR]

• Clients with Borderline Personality Disorder exhibit a complex array of presenting problems. • Identifying a client's "core problem" brings precision and clarity to Dialectical Behavior Therapy case formulation. • Treating the core problem leads to reductions in high-priority target behaviors and increases in quality of life. In her later years of teaching and training, Linehan (personal communication) spoke of an assessment construct that she referred to as a client's "core problem." In this paper, we trace the historical roots of this concept, review and clarify its current operationalization, anticipate common therapist questions and challenges to identifying a client's core problem, and provide a case example to illustrate its utility for Dialectical Behavior Therapy (DBT) case formulation and treatment planning. We propose that conceptualizing a client's core problem holds great promise for enhancing the therapist's effective and efficient delivery of DBT. [ABSTRACT FROM AUTHOR]

Youth mental health is a major public health concern. Adolescents experiencing mental health crises are increasingly presenting to high-intensity settings such as inpatient and partial hospitalization programs. These services offer a multimodal approach involving medication management, cognitive-behavioral therapy (CBT), and dialectical behavior therapy (DBT).1 Treating these distressed youth in intense settings is challenging due to their high acuity, limited lengths of stay, and frequent lack of resources. However, CBT/DBT are typically evaluated in outpatient settings, leaving clinicians in high-intensity programs to adapt models with limited guidance.2 While traditional CBT/DBT interventions are not new or unfamiliar, and various literature reviews report their effectiveness, few reports offer specific guidance and practical tips for implementing these procedures.1-6 This Clinical Perspectives article highlights the necessary adaptations of traditional CBT/DBT for these intense settings in which high acuity, shorter stays, limited resource allocation, and a lack of staff involvement/training are limiting factors. [ABSTRACT FROM AUTHOR]

To evaluate rates of remission, recovery, relapse, and recurrence in suicidal youth who participated in a clinical trial comparing Dialectical Behavior Therapy (DBT) and Individual and Group Supportive Therapy (IGST). Participants were 173 youth, aged 12 to 18 years, with repetitive self-harm (including at least 1 prior suicide attempt [SA]) and elevated suicidal ideation (SI). Participants received 6 months of DBT or IGST and were followed for 6 months post-treatment. The sample was 95% female, 56.4% White, and 27.49% Latina. Remission was defined as absence of SA or nonsuicidal self-injury (NSSI) across one 3-month interval; recovery was defined across 2 or more consecutive intervals. Relapse and recurrence were defined as SA or NSSI following remission or recovery. Cross-tabulation with χ2 was used for between-group contrasts. Over 70% of the sample reported remission of SA at each treatment and follow-up interval. There were significantly higher rates of remission and recovery and lower rates of relapse and recurrence for SA in DBT than for IGST. Across treatments and time points, SA had higher remission and recovery rates and lower relapse and recurrence rates than NSSI. There were no significant differences in NSSI remission between conditions; however, participants receiving DBT had significantly higher NSSI recovery rates than those receiving IGST for the 3- to 9-month, 3- to 12-month, and 6- to 12-month intervals. Results showed higher percentages of SA remission and recovery for DBT as compared to IGST. NSSI was less likely to remit than SA. This study examined rates of remission, recovery, relapse, and recurrence of suicide attempts (SA) and nonsuicidal self-injury (NSSI) among the participants in the CARES Study, a randomized clinical trial of 6 months of Dialectical Behavior Therapy or Individual and Group Supportive Therapy. 173 youth aged 12 to 18 years participated in the study and were followed for 6 months post treatment. Over 70% of the sample reported remission of SA at each treatment and follow-up interval. There were significantly higher rates of remission and recovery and lower rates of relapse and recurrence for SA among participants who received Dialectical Behavioral Therapy. Across both treatments, remission and recovery rates were lower and relapse and recurrence rates were higher for NSSI than for SA. These results underscore the value of Dialectical Behavioral Therapy as a first line treatment for youth at high risk for suicide. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. Collaborative Adolescent Research on Emotions and Suicide (CARES); https://www.clinicaltrials.gov/ ; NCT01528020. [ABSTRACT FROM AUTHOR]

• Youth living with chronic medical conditions and their families face several challenges. • Traditional CBT approaches may feel inaccessible or unhelpful for pediatric patients and their families who face illness-related challenges. • Dialectical behavior therapy balances both change and acceptance-based strategies and may be helpful for pediatric patients, families, and medical providers. Youth living with chronic medical conditions and their families face several challenges (e.g., adjustment to a new diagnosis, ongoing daily condition management, coping with potential long-term consequences of illness). Traditional CBT approaches emphasize collaborative problem-solving with a core focus on change. At times, these approaches may feel inaccessible or unhelpful for pediatric patients and their families who are facing illness-related challenges that they cannot change or control. Dialectical behavior therapy integrates CBT-based change interventions with acceptance-based strategies to normalize challenging thoughts and emotions and help individuals feel validated. Medical providers working with pediatric patients and families can also benefit from a DBT-based conceptualization and approach to improve patient/family-provider relationships. This article summarizes the current evidence base for and justifies the use of adaptations of DBT for patients with medical illness. Further, through clinical case examples, it illustrates the use of DBT skills and concepts in improving outcomes for pediatric patients and their families. [ABSTRACT FROM AUTHOR]

Suicidal ideation is a substantial clinical challenge in treatment-resistant depression (TRD). Recent work demonstrated promising antidepressant effects in TRD patients with no or mild suicidal ideation using a specific protocol termed intermittent theta burst stimulation (iTBS). Here, we examined the clinical effects of accelerated schedules of iTBS and continuous TBS (cTBS) in patients with moderate to severe suicidal ideation. Patients with TRD and moderate to severe suicidal ideation (n = 44) were randomly assigned to receive accelerated iTBS or cTBS treatment. Treatments were delivered in 10 daily TBS sessions (1800 pulses/session) for 5 consecutive days (total of 90,000 pulses). Neuronavigation was employed to target accelerated iTBS and cTBS to the left and right dorsolateral prefrontal cortex (DLPFC), respectively. Clinical outcomes were evaluated in a 4-week follow-up period. Accelerated cTBS was superior to iTBS in the management of suicidal ideation (p week 1 =.027) and anxiety symptoms (p week 1 =.01). Accelerated iTBS and cTBS were comparable in antidepressant effects (p <.001; accelerated cTBS: mean change at weeks 1, 3, 5 = 49.55%, 54.99%, 53.11%; accelerated iTBS: mean change at weeks 1, 3, 5 = 44.52%, 48.04%, 51.74%). No serious adverse events occurred during the trial. One patient withdrew due to hypomania. The most common adverse event was discomfort at the treatment site (22.73% in both groups). These findings provide the first evidence that accelerated schedules of left DLPFC iTBS and right DLPFC cTBS are comparably effective in managing antidepressant symptoms and indicate that right DLPFC cTBS is potentially superior in reducing suicidal ideation and anxiety symptoms. [ABSTRACT FROM AUTHOR]

Suicidal thoughts and behaviors (STBs) are common among adolescent girls and increase risk for suicide death. Emotion regulation difficulties are linked with STBs, particularly in response to targeted social rejection. However, neural correlates of this link have not been investigated and may identify novel targets for interventions. Here, we examined neural correlates of emotion regulation before and after an experimentally delivered targeted social rejection in adolescent girls with STBs and girls without STBs (i.e., control participants). Girls (N = 138; age range, 9–15 years; mean [SD] age = 11.6 [1.79] years) completed a functional neuroimaging emotion regulation task. In the middle of the task, participants were socially rejected by an unfamiliar confederate whom the participants had elected to meet. Participants also completed a multimethod STB assessment. Before rejection, girls with a history of STBs, compared with control participants, showed greater activation in the right superior frontal gyrus when passively viewing negative stimuli, and girls with suicidal behavior (SB) versus those without SB showed less activation in the right frontal pole during emotion regulation attempts. Following the rejection, girls with STBs, compared with control participants, showed greater activation in the right inferior frontal gyrus during emotion regulation. Before social rejection, girls with SB versus without SB may not activate brain regions implicated in emotion regulation, suggesting a vulnerability to poor regulation at their baseline emotional state. After social rejection, girls with any history of STBs showed altered activation in a brain region strongly associated with inhibition and emotion regulation success, possibly reflecting increased effort at inhibiting emotional responses during regulation following stress exposure. [ABSTRACT FROM AUTHOR]

Emotion dysregulation (ED), the difficulty in modulating which emotions are felt, and when and how they are expressed or experienced, has been implicated in an array of psychological disorders. Despite potentially different manifestations depending on the disorder, this symptom is emerging as a transdiagnostic construct that can and should be targeted early, given the associations with various maladaptive behaviors as early as childhood and adolescence. As such, our goal was to investigate the psychotherapeutic interventions used to address ED and gauge their effectiveness, safety, and potential mechanisms across various populations. This umbrella systematic review, pre-registered under PROSPERO (registration: CRD42023411452), consolidates evidence from systematic reviews and meta-analyses on psychotherapeutic interventions targeting ED, in accordance with PRISMA guidelines. Our synthesis of quantitative and qualitative evidence from 21 systematic reviews (including 11 meta-analyses) points—with moderate overall risk of bias—to the effectiveness of Dialectical Behavior Therapy and Cognitive Behavioral Therapy in reducing ED in a wide range of adult transdiagnostic psychiatric patients and healthy participants. Similar results have emerged in other less extensively researched methods as well. However, results on adolescents and children are sparse, highlighting the need for additional research to tailor these interventions to the unique challenges of ED in younger populations with diverse externalizing and internalizing disorders. These demonstrated transdiagnostic advantages of psychotherapy for ED underscore the potential for specifically designed interventions that address this issue directly, particularly for high-risk individuals. In these individuals, early interventions targeting transdiagnostic core dimensions may mitigate the emergence of full-blown disorders. Future research on the mediating factors, the durability of intervention effects, and the exploration of understudied interventions and populations may enhance prevention and treatment efficiency, enhancing the quality of life for those affected by varied manifestations of ED. [ABSTRACT FROM AUTHOR]

• Escuela de Madres y Padres is an 8-session DBT skills-based program adapted for Latinx caregivers of school-aged children. • Participation was associated with decreased general perceived stress among caregivers. • Participation was associated with increased emotion regulation among caregivers. Latinx caregivers of school-aged children are faced with unique stressors. These stressors include racism, immigration status, and limited resources in schools. Despite an abundance of evidence-based programs for parents and caregivers, many were not developed by or with members of the intended demographic or with specific attention to racial and linguistic identities and social context. This study was a pilot-trial aimed to evaluate the feasibility and effectiveness of Escuela de Madres y Padres (EMP; "School for Mothers and Fathers"), a program based on Dialectical Behavior Therapy (DBT) skills adapted in a community context by Latinx community leaders who are recognized for their expertise in culturally responsive practices to support Latinx caregivers. EMP integrates DBT skills with a strength-based approach and decolonizing lens to highlight and promote the resiliencies and capacities of Latinx parents of school-aged students. Participation in EMP was associated with high satisfaction among participants, significantly decreased perceived stress among caregivers, significantly increased mindfulness in parenting, significantly increased emotion regulation among caregivers, and significantly decreased child behavioral difficulties. This study indicates that EMP holds promise as a culturally relevant program that could improve the well-being of Latinx caregivers. [ABSTRACT FROM AUTHOR]

Establishing effective treatments for youth at risk of suicide is one of the most pressing and important tasks within child and adolescent psychiatry. Self-harm, which includes suicide attempt (SA), nonsuicidal self-injury (NSSI), and nonsuicidal self-poisoning, is one of the strongest predictors of suicide.1 Youth who engage in self-harm or experience mental health crisis are becoming more and more common, at increasingly younger ages, and so confidence in treatments to successfully reduce self-harm and prevent relapse and recurrence is crucial.2 However, the evidence base for such treatments is severely lacking despite some progress in the field.3-5 Dialectical behavior therapy (DBT) is the most established treatment option, but even so, the evidence comes from just a handful of studies and primarily focuses on the ability of DBT to reduce the repetition of self-harm. Whether DBT is successful in supporting young people along their recovery journey and is equally effective at treating different forms of self-harm are yet to be properly explored. [ABSTRACT FROM AUTHOR]

Suicide is the second leading cause of death among adolescents, and rates of suicidal thoughts and behaviors (STBs) are climbing.1 Promising interventions such as dialectical behavior therapy (DBT) are available to treat suicidal youth, and new approaches may facilitate greater intervention engagement, adherence, and effectiveness.2 Digital tools (eg, personal smartphones) are a particularly promising avenue and could enhance existing, evidence-based interventions by providing new opportunities for assessment and intervention between sessions. [ABSTRACT FROM AUTHOR]

Chronic pain affects nearly 20% of the U.S. population. It is a leading cause of disability globally and is associated with a heightened risk for suicide. The role of the central nervous system in the perception and maintenance of chronic pain has recently been accepted, but specific brain circuitries involved have yet to be mapped across pain types in a large-scale study. We used data from the UK Biobank (N = 21,968) to investigate brain structural alterations in individuals reporting chronic pain compared with pain-free control participants and their mediating effect on history of suicide attempt. Chronic pain and, more notably, chronic multisite pain was associated with, on average, lower surface area throughout the cortex after adjusting for demographic, clinical, and neuropsychiatric confounds. Only participants with abdominal pain showed lower subcortical volumes, including the amygdala and brainstem, and lower cerebellum volumes. Participants with chronic headaches showed a widespread thicker cortex compared with control participants. Mediation analyses revealed that precuneus thickness mediated the relationship of chronic multisite pain and history of suicide attempt. Mediating effects were also identified specific to localized pain, with the strongest effect being amygdala volume in individuals with chronic abdominal pain. Results support a widespread effect of chronic pain on brain structure and distinct brain structures underlying chronic musculoskeletal pain, visceral pain, and headaches. Mediation effects of regions in the extended ventromedial prefrontal cortex subsystem suggest that exacerbated negative internal states, negative self-referencing, and impairments in future planning may underlie suicidal behaviors in individuals with chronic pain. [ABSTRACT FROM AUTHOR]

There is limited literature on stress management interventions targeting Indian medical undergraduates. With this background, the study aimed to evaluate the feasibility and effectiveness of stress management intervention on perceived stress, coping and burnout amongst first-year medical undergraduates. It was a quasi-experimental study assessing the effect of "Comprehensive Stress Management Skill Training Program". This intervention emphasized on self-awareness of early warning signs of stress, adopting a healthy lifestyle, developing assertiveness at work, maintaining work–life balance. The stress reduction techniques mainly consisted of deep breathing exercises, progressive muscular relaxation and visualization. It was delivered by a team of a psychiatrist and a nurse to hundred first year medical undergraduate students. Medical Students Stressor Questionnaire, Brief COPE Questionnaire and Maslach Burnout Inventory–Student Survey were applied for assessment of perceived stress, burn out, and coping, respectively, at baseline, finish of one and three months of intervention. Significant improvement was noted in academic stress, interpersonal-related stress, teaching learning–related stress, and total stress scores, emotional exhaustion, and emotion-focused coping at the end of the three months of intervention. Positive feedback about the intervention was given by majority of the students. Stress management intervention was found to be feasible and effective in improving stress, coping, and emotional exhaustion in first year medical students. [ABSTRACT FROM AUTHOR]

Partial hospitalization programs (PHPs) are designed to help stabilize patients with acute mental health problems and are considered more cost-effective than inpatient care for patients who do not require 24-hour monitoring. Many PHPs treat transdiagnostic adolescents to reduce suicidality, self-harm, and other high-risk behaviors; however, the effectiveness of such programs is unknown. We aimed to review the existing evidence for the effects of PHPs on adolescent mental health symptoms and functioning. We retrieved peer-reviewed evaluations of PHPs treating adolescents with a range of disorders that reported quantitative clinical outcomes. We followed PRISMA guidelines for systematic reviews and included studies published since 2000. Fifteen studies of 10 PHPs in North America, Europe, Asia, and Australia met inclusion criteria, 5 of which used comparison groups. Most participants were White and female with depressive disorders. All studies found improvements in adolescents' functioning and mental health from admission to discharge; however, only 1 study tested PHP relative to other levels of care, and only 1 study included follow-up data. Dialectical behavior therapy (DBT) may be an effective theoretical orientation for PHP settings, but evidence is limited. Evidence for effectiveness of PHPs relative to other models is limited. Currently available research suggests that many high-risk transdiagnostic adolescents tend to improve during PHP treatment; however, controlled studies with follow-up data are needed to determine whether partial hospitalization is effective and, if so, how effective, and whether treatment gains persist after discharge. [ABSTRACT FROM AUTHOR]

Posttraumatic stress disorder (PTSD) is often associated with female sexual dysfunctions (FSD). However, little is known about the impact of therapies for PTSD on FSD according to DSM-5 criteria. To examine if sexual functioning diagnosed according to DSM-5 criteria improves after treatment for PTSD in women with a PTSD diagnosis after interpersonal child abuse. FSD according to DSM-5 criteria were assessed with the structured clinical interview SISEX in N = 152 female participants (mean age = 36.5 years) of a large randomized controlled trial three months into treatment and after 15 months of receiving either dialectical behavior therapy for PTSD or cognitive processing therapy. Number of fulfilled FSD criteria and diagnostic status were compared from pre-to post-treatment using Poisson and negative binomial regression analyses and the McNemar test. The effect of treatment type on reduction of FSD symptoms and the association between reduction in PTSD symptoms and reduction in FSD symptoms were assessed. From pre-to post-treatment, the number of fulfilled criteria for each FSD decreased (Incident rate ratios between 0.60 and 0.71, p between <. 001 and <0.05). Less women met criteria for genito-pelvic pain/penetration disorder at post-treatment compared to pre-treatment (11.8 % vs. 6.6 %, p <.05). No difference was found between treatments in reduction of FSD symptoms. Reduction of PTSD symptoms was associated with greater decrease in FSD symptoms. Our results suggest a positive association between effective PTSD treatments and improvements in sexual functioning of women with PTSD after child abuse. • Posttraumatic Stress Disorder (PTSD) is associated with Female Sexual Dysfunctions (FSD). • After trauma focused therapies fewer symptoms of FSD were present than to before treatment. • Greater reductions in PTSD symptoms were associated with greater reductions in FSD symptoms. [ABSTRACT FROM AUTHOR]

• Overview of development of Sage for borderline personality disorder (BPD) • Sage is a conjoint therapy for people with BPD and significant others (SOs) • Sage targets BPD, relationship functioning, and SO mental health. • Sage has three phases: safety, communication/emotion regulation, and beliefs. • Sage may optimize, expedite, and expand access to intervention for BPD and SOs. Borderline personality disorder (BPD) is associated with several destructive behaviors, including suicide and nonsuicidal self-injury. The devastating effects of BPD impact individuals with BPD, their relationships, and the mental health of significant others (SOs), which research suggests may be suboptimal. Few BPD interventions incorporate SOs into treatment, despite research suggesting that both emotion dysregulation and relationship dysfunction contribute to the maintenance of BPD. Incorporating SOs into treatment presents an opportunity to optimize BPD outcomes, while dismantling emotional and relational factors that maintain BPD and improving SO mental health. This paper describes the development of Sage, a 12-session conjoint psychotherapy intervention delivered to individuals with BPD who engage in suicidal and nonsuicidal self-injurious behavior, or have suicidal ideation, and their SOs. It is designed to simultaneously target BPD pathology, relationship functioning, and SO mental health. Sage is a time-limited cognitive-behavioral intervention that is primarily informed by cognitive-behavioral conjoint therapy for posttraumatic stress disorder (Monson & Fredman, 2012) and dialectical behavior therapy (Linehan, 1993, 2015). This paper describes the development of the intervention, including key skills taught, logistical issues that were encountered in its delivery, and relevant solutions. Future directions in the development and testing of Sage are described. [ABSTRACT FROM AUTHOR]

• We meta-analyzed immune-related biomarkers in suicidal behavior. • Suicidal behavior in depression and other psychiatric disorders is associated with increased blood CRP and IL-6. • Recent suicidal behavior is associated with further elevated blood CRP levels. • Inflammatory biomarkers are promising state-dependent markers for suicidal behavior. Biomarkers that can differentiate between psychiatric disorders with and without suicidal behavior history from each other and from healthy volunteers may explain part of the pathogenesis of suicidal behavior. We conducted the hitherto largest meta-analysis comparing immune biomarkers between subjects with and without suicide attempt history or death by suicide. The study protocol was registered with PROSPERO, CRD42020212841. Standardized mean differences (SMD) were pooled with random-effects models. Heterogeneity between studies was assessed with the I 2-statistic and publication bias was evaluated by the Egger test and funnel plots. Data were based on 36 studies including 2679 persons with suicidal behaviors and 6839 comparison subjects, and four immune-related biomarkers (CRP, IL-6, TNF-α and IL-1β). Suicidal behavior was associated with higher CRP blood levels compared with: healthy controls (SMD [95%CI] = 1.42[0.85–1.98]); patients with depression alone (SMD [95%CI] = 1.23[0.20–2.26]); and patients with any psychiatric disorders (SMD [95%CI] = 0.39[0.22–0.55]). IL-6 blood level was higher in patients with suicidal behaviors compared with healthy controls (SMD [95%CI] = 1.13[0.45–1.82]) and when compared with psychiatric patients without suicidal behaviors (SMD [95%CI] = 0.22 [0.11–0.33]). Meta-regression and subgroup analyses revealed that increased CRP in suicidal behavior is primarily driven by recent suicidal behavior. These results implicate the immune system and inflammatory response in suicidal behavior independent of a relationship to major psychiatric disorders, and that these biological measures are predominantly state-dependent markers. Future studies are needed to determine the cause-and-effect relationship of these immune system biomarkers with suicidal behavior, and their potential predictive properties. [ABSTRACT FROM AUTHOR]

• The COVID-19 pandemic led to DBT via telehealth being widely adopted. • Clinicians' attitudes toward DBT via telehealth are cautiously optimistic. • Clinicians outlined three main areas of stress associated with DBT via telehealth. • Clinicians outlined pandemic-related changes to their self-care strategies. • Clinicians provided recommendations for providing DBT via telehealth. The COVID-19 pandemic has created a burden on healthcare systems and increased demand for mental healthcare at a time when in-person services are limited. Many programs offering dialectical behavior therapy (DBT) for complex clients have pivoted to telehealth in order to increase access to critical mental healthcare. There is, however, limited research on the provision of telehealth treatment for clients with complex psychopathology more broadly, or the telehealth implementation of DBT more specifically. The aim of this study was to examine the use of telehealth services and related clinician attitudes and experiences in the context of DBT. We examined the degree of telehealth platform adoption among DBT clinicians, as well as changes in stress and self-care strategies. A supplemental aim was to gather clinicians' recommendations for providing DBT via telehealth. Participants included N = 99 DBT practitioners (79.8% female; 20.2% male). Qualitative and quantitative methods were used for data analysis. Findings show that telehealth DBT has been widely adopted among DBT clinicians, and that clinicians' attitudes to telehealth DBT are cautiously optimistic. Participants described three main areas of stress associated with DBT via telehealth provision, as well as lost and novel self-care strategies. [ABSTRACT FROM AUTHOR]

• The efficacy of a stand-alone DBT-ST intervention for SUD impulsivity was tested. • 29 patients with AUD and other SUDs were treated with a 3-month DBT-ST program. • The study included an untreated SUD control group (N = 29) and a HC group (N = 29). • The DBT-ST showed significant therapeutic effects on emotion-based forms of impulsivity. • Distress tolerance, mindfulness and emotion regulation were mechanisms of change. Impulsivity is considered a core feature of substance use disorders (SUDs), including personological (i.e., negative urgency, positive urgency, lack of premeditation) and neuropsychological (i.e., cognitive and motor disinhibition, impulsive choice) dimensions. Dialectical Behavior Therapy Skills Training (DBT-ST) as a stand-alone treatment is an effective intervention for alcohol use disorder (AUD) and other SUDs. However, there are no studies that have investigated changes in impulsivity levels during a DBT-ST program, especially testing the therapeutic effects of DBT skills. Twenty-nine patients with AUD and other SUDs were admitted to a 3-month DBT-ST program. Self-report (i.e., UPPS-P) and computerized neuropsychological (i.e., Attentional Network test; Go/No-Go task; Iowa Gambling Task) measures of impulsivity were administered at the beginning and end of the DBT-ST. Distress tolerance (DTS), mindfulness (MAAS, FFMQ) and emotion regulation (DERS) were also assessed pre- and post-intervention. The study included two age- and gender-matched control groups: (a) untreated patients with SUDs (N = 29); (b) healthy controls (HCs) (N = 29). Twenty-four (82.7%) patients concluded the DBT-ST program. Emotion-based forms of impulsivity significantly improved during the program. At the end of treatment, impulsivity levels were significantly lower than those of untreated patients with SUDs and they were not significantly different from HCs. Cognitive disinhibition significantly decreased during the treatment. The improvement in impulsivity was explained by pre- posttreatment changes in distress tolerance, mindfulness and emotion regulation. Motor disinhibition did not improve during the treatment. These findings supported the initial efficacy of the DBT-ST program for addressing different features of impulsivity among individuals with AUD and other SUDs. Future follow-up studies should demonstrate the role of impulsivity domains in long-term relapse prevention. [ABSTRACT FROM AUTHOR]

Dialectical Behavior Therapy (DBT) is one of the primary psychosocial treatments for reducing suicidal behaviors and improving psychosocial outcomes among patients with borderline personality disorder (BPD) and has been shown to reduce BPD symptoms when delivered in a Veteran Affairs medical center setting. Despite evidence of similar rates of BPD in both men and women, the vast majority of treatment outcome research in BPD has focused on women. We sought to characterize sex differences in symptom trajectories among Veterans participating in a comprehensive DBT program. We found that Veteran men and women who entered the DBT program were diagnostically and demographically similar. Participants exhibited reductions in BPD symptoms and improvements in emotion regulation over the course of treatment. Moreover, Veteran men reported BPD symptom reductions that were not statistically inferior to those of Veteran women and exhibited a sharper reduction in these symptoms. This research provides support for the use of DBT as a psychosocial treatment for Veteran men with BPD symptoms. [Display omitted] [ABSTRACT FROM AUTHOR]

Youth in communities of color are disproportionately affected by the current mental health crisis, as highlighted in the recent Declaration of National Emergency by the American Academy of Child and Adolescent Psychiatry (AACAP), the American Academy of Pediatrics (AAP), and the Children's Hospital Association (CHA).1 The structural racism that Black youth encounter is a social determinant of health that contributes to inequitable access to evidence-based mental health services. Black youth in the United States experience inequities in financial hardships, access to educational resources, and the undue burden of the coronavirus disease 2019 (COVID-19) pandemic, further exacerbating an already outsized mental health burden.2 [ABSTRACT FROM AUTHOR]

Quantitative benefit-risk assessment (qBRA) is a structured process to evaluate the benefit-risk balance of treatment options to support decision making. The ISPOR qBRA Task Force was recently established to provide recommendations for the design, conduct, and reporting of qBRA. This report presents a hypothetical case study illustrating how to apply the Task Force's recommendations toward a qBRA to inform the benefit-risk assessment of brodalumab at the time of initial marketing approval. The qBRA evaluated 2 dosing regimens of brodalumab (210 mg or 140 mg twice weekly) compared with weight-based dosing of ustekinumab and placebo. We followed the 5 steps recommended by the Task Force. Attributes included treatment response (≥75% improvement in Psoriasis Area and Severity Index), suicidal ideation and behavior, and infections. Performance data were drawn from pivotal clinical trials of brodalumab. The qBRA used multicriteria decision analysis and preference weights from a hypothetical discrete choice experiment. Sensitivity analyses examined the robustness of benefit-risk ranking to uncertainty in clinical effect and preference estimates, consideration of a subgroup (nail psoriasis), and the maintenance phase of treatment (52 weeks instead of 12). Results from this hypothetical qBRA suggest that brodalumab 210 mg had a more favorable benefit-risk profile compared with ustekinumab and placebo. Ranking of brodalumab compared with ustekinumab was dependent on brodalumab's dose. Sensitivity analyses demonstrated robustness of benefit-risk ranking to uncertainty in clinical effect and preference estimates, as well as choice of attributes and length of follow-up. This case study demonstrates how to implement the ISPOR Task Force's good practice recommendations on qBRA. • Illustration of recommendations from the ISPOR Task Force on emerging good practices in quantitative benefit-risk assessment. • Case study of quantitative benefit-risk assessment for psoriasis comparing 2 doses of brodalumab, weight-based ustekinumab, and placebo. Multicriteria decision analysis utilized hypothetical patient preference weights and clinical trial results available at the time of initial marketing authorization of brodalumab in 2017. [ABSTRACT FROM AUTHOR]

• Non-suicidal self-injury (NSSI) can present in a variety of ways. • Treating NSSI is critical given its relation to increased odds of suicide. • Understanding the function of NSSI can inform treatment strategies. Given that non-suicidal self-injury (NSSI) is related to increased odds of suicidal ideation and suicide attempts, treating NSSI in veterans is a key treatment priority to help reduce suicide risk and increase quality of life. Treating NSSI can be difficult for clinicians and training in addressing NSSI can enhance therapist empathy and decrease negative attitudes. The current paper describes prevalence of and risk factors for NSSI in veterans and presents a Dialectical Behavior Therapy (DBT)-informed approach for arriving at a functional understanding of NSSI in order to inform assessment and treatment. This DBT-informed approach is demonstrated with two case examples of veteran clients. While in many circumstances treatment of NSSI may be most effective in the context of full model DBT (i.e., individual therapy, group skills training, phone coaching, and therapist consultation team), many aspects of the functional approach discussed herein are not specific to DBT and could therefore be integrated into behavioral analyses and case formulations conducted within non-DBT therapeutic approaches. [ABSTRACT FROM AUTHOR]

Aggressive behavior has long been a focal point of inquiry within behavioral therapies. However, there is a lack of comprehensive reviews synthesizing the efficacy of third-wave behavioral therapies in managing aggression. This study addresses this gap through a systematic review, examining the effectiveness of third-generation behavioral therapies—Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), Functional Analytical Psychotherapy (FAP), and Behavioral Activation (BA)—in managing aggressive behavior among adults. Out of 38 articles selected for full reading, only six met the criteria for inclusion in this synthesis: three employing Acceptance and Commitment Therapy (ACT) as an intervention strategy and three employing Dialectical Behavior Therapy (DBT). Merely three of these studies were RCTs. Overall, these interventions exhibited a notable reduction in aggressive behavior during the treatment phase but failed to maintain this improvement during follow-up assessments. This review contextualizes its findings in relation to existing systematic reviews and employs the Quality Assessment Tool for Quantitative Studies to gauge the level of evidence. The collective evidence underscores the need for additional research employing diverse intervention strategies, with the objective of establishing more robust and enduring treatments for aggressive behavior. • Both DBT and ACT demonstrated significant reductions of aggressive behaviors during treatment, but not during follow-up. • Studies reviewed with a quality assessment tool were generally of moderate to weak quality, with methodological limitations. • There is a need for more rigorous research, including randomized controlled trials and works focusing on long-term outcomes. [ABSTRACT FROM AUTHOR]

Overweight and obesity affect >40% of adolescents. Family-based behavioral treatment (FBT) is the most efficacious behavioral treatment for weight management among youth and consists of nutrition and physical activity education, behavior change skills, and parent skills training. However, the efficacy of FBT decreases for youth as they get older. Increased emotional lability and limited emotion regulation skills may contribute to the reduced efficacy of FBT for adolescents. To date, there are no treatments for overweight or obesity specifically adapted for the needs of adolescents. We developed a treatment that integrates components from Dialectical Behavior Therapy and Emotion Focused Therapy with FBT (FBT+ER or FBT-ER) to address the specific needs of adolescents. The current study randomized 166 adolescents (BMI = 32.8; 14.3 years; 57% female; 32% Hispanic, 50% Non-Hispanic White, 18% Non-Hispanic and Non-White) and one of their parents (BMI = 32.9; 45.3 years; 85% female; 27% Hispanic, 57% Non-Hispanic White, 16% Non-Hispanic and Non-White) to 6 months of either standard FBT or FBT+ at 2 sites. Assessments were conducted at baseline, mid-treatment (month 3), post-treatment (month 6), 6-month follow-up (month 12) and 12-month follow-up (month 18). Primary outcomes are adolescent weight (BMIz/%BMIp95), emotion regulation skills, and emotional eating behaviors. Given the public health concern of adolescent obesity, FBT+ could prove extremely useful to provide more targeted and effective intervention for adolescents with overweight or obesity. # NCT03674944 [ABSTRACT FROM AUTHOR]

Long-term follow-up studies have shown that the symptoms of borderline personality disorder (BPD) tend to remit over time. However, many patients present long lasting symptoms (LLS), including low mood, emptiness, and persistent impairment in psychosocial adjustment. Given the high rate of LLS in BPD patients, new treatment strategies are needed. We conducted a randomized clinical trial (RCT) to evaluate the efficacy of a novel intervention that combines self-compassion and contextual-based skills for patients with persistent symptoms. Sixty BPD individuals with LLS who had received dialectical behavior therapy skills training (DBT-ST) in the previous six months were recruited and randomized to receive the experimental intervention or treatment as usual (TAU) for 12 weeks. All participants were evaluated pre- and post-intervention and at 3-months follow-up. The primary outcome measure was self-reported well-being. Other clinical variables were also evaluated, including depressive symptoms, BPD symptoms, functionality, self-compassion, and self-criticism. Participants in the experimental arm showed a significant increase in indicators of well-being (e.g., happiness and quality of life) and a significant decrease in depressive symptoms. These results were sustained—and even continued to improve—at the three-month follow-up. No significant changes were observed in BPD severity, self-criticism, or self-compassion. More RCTs are needed to test the efficacy of new interventions targeting this population with persistent symptoms, not only to reduce symptoms but also to promote well-being and personal recovery. • BPD tends to remit over time, but many patients experience persistent functional impairment. • Given the growing numbers of patients with long-lasting symptoms, new strategies are needed. • Contextual-compassion training for BPD with persistent symptoms significantly improved well-being. • Treatment should target clinical remission as well as well-being and personal recovery. [ABSTRACT FROM AUTHOR]

Third wave interventions have demonstrated efficacy as a treatment option to promote wellbeing in adolescents. Evidence of their effectiveness for chronic mental health disorders remains unclear. The PubMed, PsycINFO, ProQuest, Embase, and CINAHL databases were searched from inception until March 2024 for five established interventions: acceptance and commitment therapy (ACT), compassion focused therapy, dialectical behaviour therapy (DBT), mindfulness-based cognitive therapy, and mindfulness-based stress reduction (MBSR). Risk of bias was assessed (QualSyst tool), and standardized mean group differences (Hedges' g) with associated p -values, 95% confidence intervals, and prediction intervals calculated. Three randomized controlled trials and 10 single-group designs, all assessing DBT and representing 700 adolescents (most with subthreshold or full syndrome borderline personality disorder), were included. All studies were of sound methodological quality. DBT was associated with large and significant reductions in mental health symptoms (depression, anxiety, emotional regulation, suicidal ideation, self-harm, and BPD symptoms; g range = 0.69 to 1.05) – although individual variability in treatment response was noted. Symptom improvements were maintained at follow-up (g range = 0.70 to 1.71), although based on limited data. Neither DBT intensity nor duration significantly moderated treatment effects. DBT is the most assessed intervention for adolescents with severe emotional or behavioral problems. Additional controlled studies with diverse samples are needed to confirm the unique effects of DBT relative to other promising third wave interventions. Protocol registration: Open Science Framework [ https://osf.io/fgd2j/ ]. • An up-to-date review of third-wave therapies for adolescents in clinical settings. • Only 13 dialectical behavior therapy studies met inclusion criteria. • Evidence confirms the benefits of dialectical behavior therapy for this cohort. • Individual variation to treatment response warrants further examination. • Future research should also attend to quality considerations. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to define a cardinal symptom burden measure based on items from the Uterine Fibroid Symptom and Quality of Life questionnaire for use as a clinical trial endpoint.Methods: Exploratory factor analysis was computed to assess the Uterine Fibroid Symptom and Quality of Life symptom severity scale factor structure, using phase 2 data. Pooled blinded data from phase 3 studies were used for the confirmatory factor analysis and the psychometric evaluation of the new measure. Exit interviews in 30 patients from phase 3 studies provided additional qualitative evidence. A meaningful change threshold was determined using anchor-based analyses supported by patient feedback in the exit interviews.Results: Three factors emerged from the exploratory factor analysis. Factor 1, called the bleeding and pelvic discomfort (BPD) scale, consists of cardinal symptoms, measuring menstrual distress owing to heavy bleeding, passing blood clots, and feeling tightness or pressure in pelvic area. Patients generally understood the items in the scale and the recall period as intended. The BPD scale had good item performance and internal consistency reliability, strong item-to-total correlations, good item discrimination, known-groups validity, and ability to detect change. A 20-point change on the BPD scale was determined as the clinically meaningful change threshold.Conclusions: The BPD scale assesses symptom burden owing to bleeding, passing blood clots, and pelvic pressure. The subscale is based on a subset of items selected to measure the cardinal symptoms of uterine fibroids in a clinical trial setting. The responder threshold evaluates whether patients experience a meaningful treatment benefit over the on-treatment period. [ABSTRACT FROM AUTHOR]

• Methods for developing culturally responsive treatment are discussed within a dialectical framework and from the perspective of critical race psychology. • We propose that an antiracist adaptation to DBT is needed to correct for context minimization errors in the DBT model that create an invisibility of racism. • Recommendations include defining antiracism as a competency domain in therapeutic practice, and amendments and modifications to DBT therapist agreements and tools for treating Black/African-American clients. There are currently no published studies that investigate or discuss the cultural responsiveness of Dialectical Behavior Therapy (DBT) to the needs of Black/African-American clients. In addition, no published scholarly works offer guidance to therapists on how to practice antiracism within the context of delivering evidence-based treatment. Methods for developing a culturally responsive antiracist treatment are discussed within a dialectical framework and from the perspective of critical race psychology. We propose that an antiracist adaptation to DBT is needed to correct for context minimization errors in the DBT model that create an invisibility of racism. Recommendations are made for an additional DBT Therapist Agreement that encourages labeling and targeting therapist treatment-interfering racist behavior. An additional Therapist Consultation Agreement is also proposed to guide therapist antiracist advocacy and functional validation for Black/African-American clients. The DBT technology is used in conjunction with other multicultural theoretical models to recommend strategies for developing White DBT therapists' antiracist competencies. Future directions for developing critical race psychological research are discussed. [ABSTRACT FROM AUTHOR]

Objective: Implicit biases within school systems contribute to racist school cultures and policies. Black and Hispanic students are more likely to be over-policed in schools and to be penalized, especially by White teachers. Dialectical behavior therapy (DBT) skills can be taught to educators to support antiracist efforts in schools.Method: A virtual 2-day Train-the-Trainer antiracism workshop incorporating DBT skills was delivered to South Texas educators. DBT skills were integrated as life skills in antiracism situational role play, small group discussions, and meta-cognitive activities. Participants also received books on antiracism and an educators' toolkit to DBT and antiracism. Descriptive analysis described results from the workshop application, pre/post-workshop survey, and 6-month follow-up survey.Results: Twelve educators completed the workshop application, with 10 educators reporting no history of antiracism trainings at their schools. Nine educators attended the workshop. Workshop feedback was overwhelmingly positive. A pre/post-workshop survey demonstrated growth in both teaching and use of all measured DBT skills and antiracism attitudes. Confidence in teaching and using DBT skills and changes in antiracism attitudes were sustained 6 months later. Five educators reported leading an antiracism initiative in their schools since the attendance of the workshop.Conclusion: A DBT-centered Train-the-Trainer antiracism workshop instilled confidence in educators to lead antiracism efforts, which resulted in the initiation of several initiatives in South Texas schools. Training educators, including teachers, counselors, and administrators, encouraged systemic antiracist change in school systems. The virtual training format may facilitate accessibility to educators who lack access to trainings; however, it may also add difficulty in building community among participants. [ABSTRACT FROM AUTHOR]

Objective/background: Many studies have reported associations between disturbing dream occurrence and internalizing symptoms in adults, but the extent to which such associations also characterize adolescents remains unknown. The main goal of the present longitudinal study was to evaluate the strength and stability of the associations between disturbing dream frequency, suicidal ideation, and internalizing symptoms from ages 13 to 18.Methods: Participants (N = 434) drawn from two longitudinal birth cohort studies on child development in the province of Quebec, Canada, completed annual self-reports of disturbing dream frequency, suicidal ideation, and levels of depression and anxiety.Results: Two separate cross-lagged panel models for symptoms of depression and anxiety were conducted with both models showing similar results. In early adolescence, high levels of and higher change in disturbing dream frequency were associated with increased odds of reporting later suicidal ideation, whereas in mid to late adolescence, increased odds of reporting suicidal ideation at age 17 was associated with increased disturbing dream frequency at age 18. Across adolescence, increased levels of depression and anxiety were associated with increased odds of reporting later suicidal ideation and increased disturbing dream frequency.Conclusions: These findings support previous literature suggesting that disturbing dream frequency, depression, and anxiety, are risk factors for suicidal ideation throughout adolescence. The present longitudinal study allows for a refinement of our conceptualization of disturbing dream and their relation to suicide and internalizing symptoms throughout adolescence and suggests that the collection of information on disturbing dream and internalizing symptoms during early adolescence may help screen adolescents for suicide risk. [ABSTRACT FROM AUTHOR]

Objective: To examine trajectories of treatment response in suicidal youth who participated in a randomized controlled trial comparing dialectical behavior therapy (DBT) and individual and group supportive therapy.Method: Using latent class analysis across both treatment conditions, secondary analyses were conducted of data from a multisite randomized controlled trial comprising 173 youths ages 12-18 with repetitive self-harm (SH) (including ≥1 lifetime suicide attempts) and elevated suicidal ideation (SI). The sample was 95% female, 56.4% White, and 27.49% Latina. Participants received 6 months of DBT or individual and group supportive therapy and 6 months of follow-up. Primary outcomes were SH and SI.Results: Of the sample, 63% and 74% were members of latent classes that showed improvement in SI and SH, respectively; 13% were total nonresponders, with no improvement in SI or SH. SH nonresponse emerged at the midpoint of treatment (3 months), with nonresponders showing a sharp increase in SH over the remainder of treatment and follow-up. Youth receiving DBT were significantly more likely to be an SH responder vs nonresponder than youths in individual and group supportive therapy (ꭓ21 = 6.53, p = .01). An optimal threshold cut point using multivariate predictors of total nonresponse (White, externalizing symptoms, total SH, and SI) predicted total nonresponders to DBT with 100% accuracy.Conclusion: This is the first study to identify trajectories of both SI and SH response to treatment in a sample of adolescents at risk of suicide. Results may inform personalized treatment approaches.Clinical Trial Registration Information: Collaborative Adolescent Research on Emotions and Suicide (CARES); https://www.Clinicaltrials: gov/; NCT01528020. [ABSTRACT FROM AUTHOR]

• The role of dichotomous thinking in client problem presentations is highlighted. • Dialectical thinking is described in detail. • Observing thinking and thoughts is typically a first step. • How perspective-taking is enhanced by dialectical thinking. • How dialectical thinking helps to depolarize conflict. Dialectical thinking is a set of attention and thinking strategies, or approaches, to reducing automatic negative thinking, dichotomous thinking, polarizing, and concomitant negative emotions, emotion dysregulation, and impulsive and other problematic behaviors. Examples of dichotomous and/or polarized thinking are provided along with descriptions of how dialectical thinking can be used in therapy to create more acceptance, less reactivity, and improved problem solving. [ABSTRACT FROM AUTHOR]

• Intensive outpatient program (IOP) can be an effective alternative to inpatient hospitalization for patients in crisis. • We observed clinically and statistically significant reductions in anxiety, depression, and suicidality in a majority of our sample. • Evidence-based psychosocial approaches, such as CBT and DBT, can be successfully adapted to naturalistic and community-based settings. • Flexible treatment protocols can produce similar therapeutic effects to those obtained in randomized controlled trials of structured protocols. Anxiety and depression are highly prevalent and disabling mental health disorders, with comorbidity often posing as a barrier to successful treatment outcomes, thus creating a need for more intensive treatment options. Outpatient clinicians are more likely to refer patients with severe symptoms of anxiety and depression to inpatient hospitalizations rather than partial hospital programs (PHPs) or intensive outpatient programs (IOPs), despite evidence that inpatient hospitalization is associated with high costs and other risks following discharge. The present study reviews two case studies of patients who received cognitive-behavioral therapy/dialectical behavior therapy (CBT/DBT)-based IOP treatment in a private New York clinic. We evaluated treatment outcomes for 73 adult patients (50.7% female) with a mean age of 29.10 years (SD = 10.30). At intake, patients averaged 2.15 diagnoses (SD = 0.94, range = 4) and the majority (80.8%) were prescribed psychotropic medication. Treatment was structured and individually tailored, with patients receiving an average of 21.77 hours (SD = 15.06) of psychotherapy over 12.63 treatment sessions (SD = 9.76), across 12.21 days (SD = 9.61). We observed a clinically and statistically significant change in symptoms of anxiety (t = 6.24, p <.001), depression (t = 5.55, p <.001), and suicidality (t = 2.32, p <.05) over the course of the IOP. After completing treatment, 68.1% of participants tapered down to once-weekly treatment. The present study highlights the clinical utility of an IOP and suggests that this approach can be effective for adult patients presenting with severe symptoms of anxiety and/or depression. [ABSTRACT FROM AUTHOR]

Third-wave cognitive behavioral interventions for weight loss have shown promise. However, sparse data exists on the use of dialectical behavior therapy for weight loss. Adapted dialectical behavior therapy skills programs may be especially well suited for adults who engage in emotional eating and are seeking weight loss. Dialectical behavior therapy is skills-based, shares theoretical links to emotional eating, and is effective in treating binge eating. The current study examined the feasibility, acceptability, and preliminary efficacy of Live FREE: FReedom from Emotional Eating, a 16-session group-based intervention. A total of 87 individuals expressed interest in the program, and 39 adults with overweight/obesity (BMI ≥25) and elevated self-reported emotional eating were enrolled. Live FREE targeted emotional eating in the initial sessions 1-9, and sessions 10-16 focused primarily on behavioral weight loss skills while continuing to reinforce emotion regulation training. Assessments were administered at baseline, posttreatment, and 6-month follow up. Enrolled participants were primarily female (97.4%) and Caucasian (91.7%). Treatment retention was strong with participants attending an average of 14.3 sessions and 89.7% of participants completing the intervention. On average, participants lost 3.00 kg at posttreatment, which was maintained at follow-up. Intent-to-treat analyses showed improvements in key outcome variables (self-reported emotional eating, BMI, emotion regulation) over the course of the intervention. Combining dialectical behavior therapy skills with conventional behavioral weight loss techniques may be an effective intervention for adults with overweight/obesity who report elevated emotional eating. [ABSTRACT FROM AUTHOR]

Only 50% of the patients with Borderline Personality Disorder (BPD) respond to psychotherapies, such as Dialectical Behavioral Therapy (DBT), this might be increased by identifying baseline predictors of clinical change. We use machine learning to detect clinical features that could predict improvement/worsening for severity and impulsivity of BPD after DBT skills training group. To predict illness severity, we analyzed data from 125 patients with BPD divided into 17 DBT psychotherapy groups, and for impulsiveness we analyzed 89 patients distributed into 12 DBT groups. All patients were evaluated at baseline using widely self-report tests; ∼70% of the sample were randomly selected and two machine learning models (lasso and Random forest [ Rf ]) were trained using 10-fold cross-validation and compared to predict the post-treatment response. Models' generalization was assessed in ∼30% of the remaining sample. Relevant variables for DBT (i.e. the mindfulness ability "non-judging", or "non-planning" impulsiveness) measured at baseline, were robust predictors of clinical change after six months of weekly DBT sessions. Using 10-fold cross-validation, the Rf model had significantly lower prediction error than lasso for the BPD severity variable, Mean Absolute Error (MAE) lasso - Rf = 1.55 (95% CI, 0.63–2.48) as well as for impulsivity, MAE lasso - Rf = 1.97 (95% CI, 0.57–3.35). According to Rf and the permutations method, 34/613 significant predictors for severity and 17/613 for impulsivity were identified. Using machine learning to identify the most important variables before starting DBT could be fundamental for personalized treatment and disease prognosis. • Random forest [ Rf ] and lasso identified the most important clinical variables that predicted symptom severity after DBT group. • The predictive precision of the Rf learner was significantly better than lasso during cross-validation training. • Relevant predictors were "non-judging" ability, related to mindfulness practice, or "non-planning" impulsivity. [ABSTRACT FROM AUTHOR]

Dialectical Behaviour Therapy (DBT) is an evidence-based treatment for borderline personality disorder (BPD), with findings demonstrating improvements in various BPD features and related behaviours, such as nonsuicidal self-injury (NSSI). Theory and research suggest that reductions in emotion dysregulation and interpersonal dysfunction could account for at least some of the reduction in NSSI observed during the course of DBT. The current research investigated: 1) the trajectory of changes in emotion dysregulation, interpersonal dysfunction, and NSSI over the course of DBT, and 2) whether changes in emotion dysregulation mediate the relationship between changes in interpersonal dysfunction and changes in NSSI over treatment. One hundred and twenty individuals with BPD enrolled in a multi-site randomized-clinical trial were assessed at five timepoints over 12 months of standard DBT. Results indicated that interpersonal dysfunction and NSSI decreased over the course of DBT. Emotion dysregulation decreased in a quadratic manner such that most of the gains in emotion dysregulation occurred in earlier phases of DBT. Although changes in interpersonal dysfunction predicted changes in emotion dysregulation, changes in emotion dysregulation did not mediate the relationship between changes in interpersonal dysfunction and changes in NSSI. • Non-suicidal self-injury and interpersonal dysfunction decrease during standard DBT. • Improvement in emotion dysregulation occurs in earlier phases of standard DBT. • Changes in interpersonal dysfunction predict changes in emotion dysregulation. [ABSTRACT FROM AUTHOR]

Transdiagnostic approaches offers a paradigm shift in managing psychiatric disorders. Emotion regulation difficulties are a transdiagnostic prevalent across various mood and personality disorders. Dialectical Behavioural Therapy Skills Training (DBT-ST), initially designed as part of treatment for borderline personality disorder, targets emotion regulation and has shown promise in diverse psychiatric conditions. In lower middle-income countries with resource-constrained settings, online delivery of evidence-based interventions holds potential to bridge treatment gaps. This study assesses the feasibility and acceptability of online group DBT skills training for individuals with depression or anxiety disorders in India. Mental health professionals practising in India referred twenty-four eligible participants currently not engaged in psychotherapy. Of these, 18 initiated the 8-week virtual group DBT-ST program, with 12 completing it (66 % female, 18-35 years of age, 5 on concurrent medication). They provided feedback on therapy content's usefulness. Baseline, post-intervention, and one-month follow-up assessments measured changes in emotion regulation difficulties, depression, and anxiety symptoms. Treatment retained 66.7 % of participants, all participants found the intervention beneficial. Repeated measures ANOVA indicates significant reductions in self-reported difficulties in emotion regulation, depression, and anxiety symptoms post-intervention. These findings highlight the promise of transdiagnostic interventions like DBT-ST that merit further evaluations using RCTs with larger sample sizes. [ABSTRACT FROM AUTHOR]

This study investigates the use of neurocognitive data collected via functional near infrared spectroscopy (fNIRS) for the development of predictive algorithms related to client Dialectical Behavior Therapy (DBT) skill use in Digital Counseling Environments (DCEs). Specifically, the aim of this study is to examine the utility of using neurocognitive data in combination with a machine learning algorithm to predict client selection of strategies in a virtual environment. Participants were recruited from a rural school located in the United States (n = 50). Student participants engaged in one of three DBT skill development conditions: time-delay-control, face-to-face, and virtual reality-based. Neurocognitive responses in the form of ratios of oxygenated and deoxygenated blood in neural tissue (hemodynamic response) were collected during the learning phase within each condition. The data was then used to train and develop a model to predict the success of client selection of DBT strategies when presented with the opportunity in an assessment phase. The average predictive accuracy of the resultant algorithm was ∼83%. Results also illustrated the potential to capture changes in cognition via hemodynamic response as they occur during DBT skill development in near real-time (∼300 ms). Findings from this study illustrate that the use of neurocognitive data in DCEs may be used to successfully predict client outcomes and increase the quality and reliability of counselor assessments of client progress, aid in the development of artificially intelligent counselors, and improve counselors use of client-based analytics in face-to-face and digital counseling environments. • Classification of neurocognitive data allows prediction of client outcomes by measuring fluctuations in cognition. • Describes neurocognitive data sources for development of predictive digital counseling platforms. • Hemodynamic responses help to understand levels of client attention and engagement in real-time. [ABSTRACT FROM AUTHOR]

Opioid misuse is hypothesized to compromise the ability to regulate negative emotions, as manifested through visceral and peripheral physiological signals. However, neurophysiological impairment of top-down cognitive emotion regulation in opioid misuse has not previously been shown. Patients with chronic pain who had been taking opioids for 90 days or longer (N = 149; female, n = 98) underwent a negative emotion regulation task with electroencephalography. Participants were instructed to view or reappraise negative images presented for 3 seconds. Using a validated cutoff score on the Current Opioid Misuse Measure, participants were classified as exhibiting aberrant drug-related behavior consistent with opioid misuse (MISUSE+) or as being low risk for opioid misuse (MISUSE−). Participants reported their craving in response to negative emotions over the past week. We observed a group × condition interaction (p =.003) such that the MISUSE− group decreased the late positive potential of the electroencephalography during reappraisal, whereas the MISUSE+ group showed increased late positive potential during reappraisal. This deficit in negative emotion regulation remained significant after controlling for an array of potential confounding variables, including opioid dose, pain, and depression. Heightened late positive potential during reappraisal was associated with more severe opioid craving. Opioid misuse may occasion top-down deficits in emotional regulation that begin as early as 400 ms after presentation of negative stimuli. It remains unknown whether emotion dysregulation is the cause, correlate, or consequence of opioid misuse. Nonetheless, targeting emotion dysregulation in opioid misuse with reappraisal-focused interventions may represent an important treatment approach. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to conduct a systematic review of cost-utility studies of internet-based and face-to-face cognitive behavioral therapy (CBT) for depression from childhood to adulthood and to examine their reporting and methodological quality.Methods: A structured search for cost-utility studies concerning CBT for depression was performed in 7 comprehensive databases from their inception to July 2020. Two reviewers independently screened the literature, abstracted data, and assessed quality using the Consolidated Health Economic Evaluation Reporting Standards and Quality of Health Economic Studies checklists. The primary outcome was the incremental cost-effectiveness ratio (ICER) across all studies. To make a relevant comparison of the ICERs across the identified studies, cost data were inflated to the year 2020 and converted into US dollars.Results: Thirty-eight studies were included in this review, of which 26 studies (68%) were deemed of high methodological quality and 12 studies (32%) of fair quality. Despite differences in study designs and settings, the conclusions of most included studies for adult depression were general agreement; they showed that face-to-face CBT monotherapy or combination therapy compared with antidepressants and usual care for adult depression were cost-effective from the societal, health system, or payer perspective (ICER -$241 212.4/quality-adjusted life-year [QALY] to $33 032.47/QALY, time horizon 12-60 months). Internet-based CBT regardless of guided or unguided also has a significant cost-effectiveness advantage (ICER -$37 717.52/QALY to $73 841.34/QALY, time horizon 3-36 months). In addition, CBT was cost-effective in preventing depression (ICER -$23 932.07/QALY to $26 092.02/QALY, time horizon 9-60 months). Nevertheless, the evidence for the cost-effectiveness of CBT for children and adolescents was still ambiguous.Conclusions: Fair or high-quality evidence showed that CBT monotherapy or combination therapy for adult depression was cost-effective; whether CBT-related therapy was cost-effective for children and adolescents depression remains inconclusive. [ABSTRACT FROM AUTHOR]

• First review to evaluate brief specific psychotherapies interventions (SPI) specifically designed for NSSI in adolescents. • SPI should include psychotherapeutic components from or adapted cognitive behavioral and dialectical behavior Therapy, and psychoeducation. • The interventions specifically developed for adolescents with NSSI agree applying individual and brief treatments manualized (8–19 sessions). • Only 13 studies have evaluated the effectiveness of 6 different SPI. • In general, all interventions are demonstrative of the general effectiveness, but CDP and T-SIB therapies presented more effect for decreases in NSSI behaviors. Non-suicidal self-injury (NSSI) is a clinically significant behavior with high relevance and prevalence, especially affecting approximately 17–18% of the adolescent population worldwide. The aim of this study is to perform a systematic review to evaluate the effectiveness of the available Specific Psychotherapeutic Interventions (SPI) focused on the reduction of NSSI behaviors. A systematic review was performed analyzing PsychINFO, MEDLINE, Web of Science, PubMed and Cochrane CentralRegister of Controlled Trials to identify studies of interest from January 2010 to December 2020. According to PRISMA guidelines, only 13 studies were included in the review. Six SPI were found to specifically and significantly reduce NSSI in adolescents: Developmental Group Psychotherapy (DGP), Therapeutic Assessment (TA), Cutting Down Program (CDP), Emotional Regulation Individual Therapy for Adolescents (ERITA), Treatment for Self-Injurious Behaviors (T-SIB) and Intensive Contextual Treatment (ICT). Furthermore, relevant improvements in anxiety and depression symptoms were observed. The results of this review demonstrate the effectiveness of these interventions, mainly the CPD and T-SIB, which are the only SPI that have been studied using Randomized Controlled Trial (RCT). Considering the clinical relevance and associated functional impairment of NSSI, more research is needed to replicate the results and to increase knowledge about SPIs. [ABSTRACT FROM AUTHOR]

Despite ample evidence for Dialectical Behavior Therapy (DBT) as an effective treatment for borderline personality disorder (BPD), close examination of the trajectory of change in BPD symptoms over the course of DBT is lacking. There also remain questions regarding the directionality of changes in different domains of BPD symptoms, such as improvements in dysfunctional behaviors and thoughts/feelings. In order to provide more fine-grained information about the treatment process in DBT, the current study aimed to (a) examine the trajectories of change of BPD-associated negative thoughts/feelings and behaviors, and positive behaviors, and (b) test the temporal relationship between changes in negative behaviors and thoughts/feelings. The study involved 55 adult clients attending a 6-month outpatient DBT program for BPD who completed assessments of BPD symptoms every four sessions. Growth curve models suggested that clients experienced a faster rate of decrease in negative behaviors during the initial phase of treatment, whereas steady rates of improvement were found for negative thoughts/feelings and positive behaviors, respectively, throughout treatment. Further, a random-intercept cross-lagged panel model found that the within-person fluctuations in negative behaviors preceded the within-person changes in negative thoughts/feelings at a subsequent time point during the later phase of treatment, whereas within-person fluctuations in thoughts/feelings were followed by changes in negative behaviors at the beginning and end of the treatment. These results highlighted the complexity of patterns and processes of change in BPD symptomatology during the course of DBT. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the mediating effects of working hours, sleep duration, and depressive mood on the association between shift work and the risk of suicidal ideation in Korean workers.Methods: Data from 33,047 workers were obtained from the nationwide cross-sectional Korea National Health and Nutrition Examination Surveys conducted in 2007-2018. Healthy workers without depressive disorders and chronic medical illnesses were included in the current study. Shift work patterns, sleep duration, working hours, depressive mood, and suicidal ideation were assessed using self-reported questionnaires. Multivariate logistic regressions were used to examine the association between shift work and the risk of suicidal ideation. Additionally, mediating studies were conducted to identify the roles of working hours and sleep durations on the association.Results: Compared with daytime workers, shift workers had 1.33 times greater risk of suicidal ideation (OR = 1.33, 95% Cl = 1.17-1.52, p < 0.001). Specifically, among shift work patterns, fixed-night shift, 24-h rotating shift and irregular rotating shift were associated with the risk of suicidal ideation when compared with daytime workers (irregular rotating shift: OR = 1.92, 95% Cl = 1.29-2.86, p = 0.001; fixed-night shift: OR = 1.75, 95% Cl = 1.32-2.31, p < 0.001; 24-h rotating shift: OR = 1.58, 95% Cl = 1.06-2.36, p = 0.024). In the mediating study, working hours, sleep duration and depressive mood significantly mediated the relationship between shift work and suicidal ideation (direct effect: β = 0.019, p = 0.001; indirect effect: β = 0.004, p = 0.031; total effect: β = 0.023, p < 0.001).Conclusion: This study revealed that shift workers had a greater risk of suicidal ideation. The patterns significantly associated with suicidal ideation were irregular rotating, fixed-night, and 24-h rotating shifts. The pathway analysis revealed serial mediating effects of working hours, sleep duration, and depressive mood on the association between shift work and suicidal ideation. [ABSTRACT FROM AUTHOR]

• Improving family functioning is a critical target of interventions for youth with self-harm (SH). • We developed a brief, DBT-based, parent-only intervention for parents of youth with recent SH. • The intervention was feasible and acceptable, and reductions in parent depression, emotion dysregulation and caregiver strain were observed. • Decreases in youth SH were also observed. • Results support further testing of the intervention. • A description of the treatment and case examples are provided. Improving family functioning is a critical treatment target for youth at risk for suicide. The present study focused on the development and pilot testing of a brief, parent-only, Dialectical Behavior Therapy (DBT)-based intervention with N = 10 sets of parents of youth with a suicide attempt or nonsuicidal self-injury within the past 3 months. Youth received treatment as usual; however, they did not receive any treatment as part of the study. Results showed that parents who received the intervention reported reductions in parent self-reported depressive symptoms, emotion dysregulation, caregiver strain, psychiatric symptom distress and interpersonal sensitivity, from baseline to 6-month follow-up. Youth also showed decreases in total self-harm from baseline to 6-month follow-up. These results provide support for further testing of the DBT-based parenting intervention, both as a stand-alone treatment and as an adjunct to enhance the effectiveness of standard DBT for adolescents. This article provides a detailed description of the parenting protocol, as well as a case example. [ABSTRACT FROM AUTHOR]

Background: Psychological therapies may play an important role in the treatment of bipolar disorders. Several meta-analyses that examine the effectiveness of psychotherapies for patients with bipolar disorder include conclusions about the impact upon bipolar depression. However, these tend not to consider differences in depression outcome depending upon whether the therapy primarily targets acute depression, nor severity of baseline depression. This may affect the conclusions drawn about the effectiveness of these therapies for acute bipolar depression treatment.Objectives: This meta-analysis explored the effectiveness of psychological therapies in reducing bipolar depression, in particular examining whether: (1) the effect of therapy is greater when baseline depressive symptoms are more severe, and (2) the effect of therapy is greater when the primary focus of the therapy is the treatment of acute bipolar depression?Data Sources: A systematic search was conducted using the following electronic databases; Cochrane Controlled Register of Trials (1996), MEDLINE (1966 onwards), EMBASE (1980 onwards), PsycINFO (1974 onwards), Scopus, Web of Science and Clinical Trials Registries (listed at:https://www.hhs.gov/ohrp/international/clinical-trial-registries/index.html).Eligibility Criteria: Eligible studies were randomized controlled trials evaluating a psychological intervention for adults diagnosed with Bipolar I or II disorder. The comparators were usual care, wait-list, placebo, active treatment control. Post-treatment depression status was required to be measured continuously using a validated self- or observer- report measure, or categorically by a validated diagnostic instrument or clinical diagnosis by a suitably qualified person.Data Extraction and Synthesis: Titles and abstracts were screened, followed by full texts. Two reviewers conducted each stage until agreement was reached, and both independently extracted study information. Means, standard deviations (SDs) and number of participants were retrieved from articles and used to perform a meta-analysis. The primary outcome was depressive symptom score.Results: The database search identified 6388 studies. After removing the duplicates, 3298 studies remained, of which, 28 studies were included in the qualitative review and 22 in the meta-analysis. Effect sizes range from -1.99 [-2.50, -1.49] to 0.89 [-0.12, 1.90]. There was low quality evidence of a significant effect on symptoms of depression for cognitive behavioral therapy and dialectical behavior therapy. Trials of psychoeducation, mindfulness-based therapy, family therapy and interpersonal and social rhythm therapy showed no evidence of any effect on depression. We found no significant relationship between baseline depression score and depression outcome post-treatment when we controlled for therapy type and comparator. The result also showed that the effect sizes for studies targeting acute depression to be tightly clustered around a small overall effect size.Conclusions: Some psychological therapies may reduce acute bipolar depression although this conclusion should be viewed with caution given the low quality of evidence. More research using similar therapy types and comparators is needed to better understand the relationship between depression status at baseline and outcome. [ABSTRACT FROM AUTHOR]

Background: Recently, a small literature has emerged suggesting that repetitive transcranial magnetic stimulation (rTMS) may offer benefit for MDD even in BPD patients, perhaps by enhancing cognitive control, and/or disrupting excessive 'non-reward' activity in right orbitofrontal regions. This study aimed primarily to assess the therapeutic effects of dorsomedial prefrontal cortex (DMPFC)-rTMS against MDD symptoms in BPD patients, and secondarily to assess whether the therapeutic effects ensued via mechanisms of reduced impulsivity and core BPD pathology on clinical scales (BIS-11, ZAN-BPD) or of reduced alpha- and theta-band activity on EEG recordings of right orbitofrontal cortex..Methods: In a crossover-design trial, 20 BPD patients with MDD underwent 2 × 30 session/15 day blocks of either active-then-sham or sham-then-active bilateral 20 Hz DMPFC-rTMS.Results: Sixteen out of 20 patients completed treatment. A significant (p = 0.00764) crossover effect was detected, with overall reductions in HamD17 score from 23.1±SD3.1 to 10.75±SD5.8. Nine out of 16 (56.3%) treatment completers achieved response (>50% improvement) and 6/16 (37.5%) achieved remission (HamD≤7), maintained at 1 month followup. BIS-11 scores remained unchanged, and ZAN-BPD scores improved similarly in both groups with no significant crossover effect. Change in low-band power over right orbitofrontal regions correlated with clinical improvement.Limitations: This was a crossover study with a small sample size. A randomized controlled trial with larger sample size will be needed to establish the efficacy more definitively.Conclusions: The results suggest efficacy for DMPFC-rTMS in treating MDD in BPD, and provide a foundation for a larger future trial. [ABSTRACT FROM AUTHOR]

The psychological trauma associated with events resulting in traumatic brain injury (TBI) is an important and frequently overlooked factor that may impede brain recovery and worsen mental health following TBI. Indeed, individuals with comorbid posttraumatic stress disorder (PTSD) and TBI have significantly poorer clinical outcomes than individuals with a sole diagnosis. Emotion dysregulation is a common factor leading to poor cognitive and affective outcomes following TBI. Here, we synthesize how acute postinjury molecular processes stemming from either physical or emotional trauma may adversely impact circuitry subserving emotion regulation and ultimately yield long-term system-level functional and structural changes that are common to TBI and PTSD. In the immediate aftermath of traumatic injury, glucocorticoids stimulate excess glutamatergic activity, particularly in prefrontal cortex-subcortical circuitry implicated in emotion regulation. In human neuroimaging work, assessing this same circuitry well after the acute injury, TBI and PTSD show similar impacts on prefrontal and subcortical connectivity and activation. These neural profiles indicate that emotion regulation may be a useful target for treatment and early intervention to prevent the adverse sequelae of TBI. Ultimately, the success of future TBI and PTSD early interventions depends on the fields' ability to address both the physical and emotional impact of physical injury. [ABSTRACT FROM AUTHOR]

• Emotion regulation (ER) deficits are an underlying mechanism in many disorders. • We examined DBT as a transdiagnostic treatment for common mental health disorders. • 12 RCTs of DBT for mental health disorders, and no comorbid personality disorder, were included. • DBT led to ER improvements and significant effects for depression, eating disorders and anxiety. • DBT shows potential as a transdiagnostic treatment for common mental health disorders. [ABSTRACT FROM AUTHOR]