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Abraham JG, Thomas N, Shenoy DS, Padickaparambil DS. Feasibility and acceptability of an online group dialectical behavioural therapy skills training in a Transdiagnostic group with Anxiety and Depression. Psychiatry Res 2024; 339:116016. [PMID: 38908264 DOI: 10.1016/j.psychres.2024.116016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 06/06/2024] [Accepted: 06/08/2024] [Indexed: 06/24/2024]
Abstract
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.
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Affiliation(s)
- Joshin George Abraham
- Clinical Psychologist/Lecturer Department of Psychiatry, Father Muller Medical College, Mangalore, Karnataka, India
| | - Nitha Thomas
- Clinical Psychologist (Previously Assistant Professor, Department of Clinical Psychology, Manipal Academy of Higher Education), Mangalore, Karnataka, India.
| | - Dr Sonia Shenoy
- Associate Professor Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Dr Sebastian Padickaparambil
- Additional Professor Department of Clinical Psychology, Manipal Academy of Higher Education, Manipal, Karnataka, India
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2
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Durpoix A, Lachaux E, Weiner L, Weibel S. Transdiagnostic skills training group of dialectical behavior therapy: a long-term naturalistic study. Borderline Personal Disord Emot Dysregul 2023; 10:37. [PMID: 38124187 PMCID: PMC10734074 DOI: 10.1186/s40479-023-00243-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Dialectical Behavior Therapy (DBT) has assembled a large body of evidence for the treatment of emotional dysregulation in borderline personality disorder (BPD), but also in other disorders characterized by emotional dysregulation (e.g., bipolar disorder (BD) and ADHD). Standalone skills learning groups address the problem of limited resources in several clinical settings. Furthermore, transdiagnostic skills groups facilitate the recruitment and decrease the scattering of resources in psychiatric settings. However, few studies have focused on the pertinence of transdiagnostic standalone skills groups in naturalistic settings as well as their long-term outcomes. The goal of this study is to assess the impact of participation in a transdiagnostic DBT skills group one year after its completion. METHOD Transdiagnostic DBT skills training groups were provided for BPD, BD and ADHD patients in a University Psychiatric Department (Strasbourg, France), between 2019 and 2020. They consisted of 16 group sessions of 2.5 h and 3 individual sessions. At 1-year follow-up, ad-hoc questionnaires were proposed to all participants to assess the perceived impacts, the changes in symptomatology, and the maintenance of skills learned. RESULT 22 of the 31 participants were interviewed at the one-year post-group session (64% BPD, 41% ADHD and 27% BD). 73% participants estimated that group impact was important or very important, 64% stated using the skills learned often or very often, mainly emotion regulation skills. An improvement in emotional instability, substance use, impulsivity and suicidal thoughts was reported by respectively 100%, 91%, 86% and 85% of participants. Quality of life improved according to 90% participants. All patients reported an improvement in suicidality during the post-group year, especially in suicide attempts. Psychotropic medication decreased in 59% of participants. DISCUSSION Our one-year naturalistic study suggests that transdiagnostic DBT skills training groups are promising for the treatment of emotional dysregulation in people with BPD, BD and/or ADHD. The observational design and the lack of control group are the main limitations. Randomized controlled studies are required to confirm the long-term efficacy of transdiagnostic skills learning groups in naturalistic settings.
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Affiliation(s)
- Amaury Durpoix
- Psychiatry, Mental Health and Addictology Department, University Hospitals of Strasbourg, 1 place de l'Hôpital, Strasbourg, 67000, France.
- Faculty of Medicine, Strasbourg University, Strasbourg, 67000, France.
| | - Enzo Lachaux
- Psychiatry, Mental Health and Addictology Department, University Hospitals of Strasbourg, 1 place de l'Hôpital, Strasbourg, 67000, France
- Faculty of Psychology, Strasbourg University, Strasbourg, 67000, France
| | - Luisa Weiner
- Psychiatry, Mental Health and Addictology Department, University Hospitals of Strasbourg, 1 place de l'Hôpital, Strasbourg, 67000, France
- Faculty of Psychology, Strasbourg University, Strasbourg, 67000, France
- Laboratoire de Psychologie des Cognitions, Strasbourg University, Strasbourg, 67000, France
| | - Sébastien Weibel
- Psychiatry, Mental Health and Addictology Department, University Hospitals of Strasbourg, 1 place de l'Hôpital, Strasbourg, 67000, France
- Inserm u1114, Strasbourg, 67000, France
- Faculty of Medicine, Strasbourg University, Strasbourg, 67000, France
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Taliercio JR, Wigod T, Shen J, Yang L, Davino S, Servidio E, McGinn LK, Miller AL. Coping with Transitions: A Promising Intensive Outpatient DBT Program for Emerging Adults and Their Families. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2023:1-9. [PMID: 37363718 PMCID: PMC10193327 DOI: 10.1007/s10879-023-09583-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/28/2023]
Abstract
Emerging adulthood is a period of significant exploration, transformation, variability, and growth. Simultaneously, this developmental period presents unique challenges as emerging adults work to achieve developmental milestones including self-identity formation, the establishment of long-term intimate relationships, career advancement, and independence from parents. For those who are vulnerable, this period is also marked by the development of significant mental health problems and associated impairment, which prevents individuals from successfully reaching these developmental milestones. To address the various challenges unique to this developmental period, we created and implemented a multifaceted DBT treatment protocol to specifically address emotional dysregulation within emerging adults. The current study presents an evaluation of a novel, intensive, outpatient DBT program called System for Adult Growth and Emergence-Foundations (SAGE-F). We aim to first introduce the SAGE-F treatment protocol, and then to assess both its short and long-term therapeutic value. Participants enrolled in SAGE-F were administered a testing battery assessing symptom severity, functioning capacities, and coping strategies at intake, upon completion of the program 6-weeks later, and at 3-month follow-up. It was found participants who completed SAGE-F reported significant reductions in depression and anxiety symptoms, as well as non-suicidal self-injurious behaviors. Simultaneously, participants also reported improvements in their daily functioning and coping capacities. Follow-up assessments indicated therapeutic progress remained.
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Affiliation(s)
- Joseph R. Taliercio
- Cognitive and Behavioral Consultants, 1 North Broadway, Suite 704, White Plains, NY 10601 USA
| | - Talia Wigod
- Cognitive and Behavioral Consultants, 1 North Broadway, Suite 704, White Plains, NY 10601 USA
| | - Joy Shen
- Cognitive and Behavioral Consultants, 1 North Broadway, Suite 704, White Plains, NY 10601 USA
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY USA
| | | | - Suzanne Davino
- White Cedar Cognitive and Behavioral Health, Ridgefield, CT USA
| | - Elaina Servidio
- Cognitive and Behavioral Consultants, 1 North Broadway, Suite 704, White Plains, NY 10601 USA
| | - Lata K. McGinn
- Cognitive and Behavioral Consultants, 1 North Broadway, Suite 704, White Plains, NY 10601 USA
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY USA
- Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY USA
| | - Alec L. Miller
- Cognitive and Behavioral Consultants, 1 North Broadway, Suite 704, White Plains, NY 10601 USA
- Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY USA
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4
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Cheavens JS, Whitted WM. Hope therapy. Curr Opin Psychol 2023; 49:101509. [PMID: 36495712 DOI: 10.1016/j.copsyc.2022.101509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
Research over the past three decades has established that hope is related to positive outcomes. Hope therapy was originally developed to optimize successful goals pursuits by increasing hopeful thought. Here, we briefly review the current state of hope therapy research and offer directions for future investigations. We note that hope therapy has been adapted to be delivered in different formats, by providers from various professional backgrounds, and to participants presenting with a variety of chronic health conditions. We suggest there is a need to reach a consensus about what characterizes hope therapy. Further, we note the need for well-designed trials to test potential mechanisms of change. We believe that these future directions will result in a more efficacious hope therapy that can be widely disseminated.
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Ritschel LA, Cassiello-Robbins C. Hope and depression and personality disorders. Curr Opin Psychol 2023; 49:101507. [PMID: 36459930 DOI: 10.1016/j.copsyc.2022.101507] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
Abstract
Hope is a positive psychology construct that comprises goals, agency thinking, and pathways thinking and has been associated with psychological and physical well-being. This paper summarizes recent findings regarding the relationship between hope and depressive symptoms as well as hope and personality disorders and traits. Studies have shown that hope is inversely associated with negative affect when examined cross-sectionally, although the relationship between hope and depression is more complex longitudinally. Little is known about hope as it pertains to personality disorders, though more recent studies have examined the relationship between hope and personality traits such as neuroticism and extraversion; results from those studies are mixed, leaving a wide gap in the literature for future exploration.
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Affiliation(s)
- Lorie A Ritschel
- Triangle Area Psychology Clinic, 5726 Fayetteville Road, Suite 101, Durham, NC 27713, USA; University of North Carolina School of Medicine, Department of Psychiatry, Campus Box 7160, Chapel Hill, NC 27599-7160, USA.
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6
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CBT/DBT-Informed Intensive Outpatient Treatment for Anxiety and Depression: A Naturalistic Treatment Outcomes Study. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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7
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Childs AW, Connors EH. A Roadmap for Measurement-based Care Implementation in Intensive Outpatient Treatment Settings for Children and Adolescents. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2022; 7:419-438. [PMID: 36687381 PMCID: PMC9856214 DOI: 10.1080/23794925.2021.1975518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Measurement-based care (MBC), the routine collection and use of patient-reported data to monitor progress and tailor treatment, has been predominantly studied in adult treatment settings. Although growing evidence supports MBC effectiveness with youth in outpatient settings and university training clinics, there is a substantial dearth of findings about successful implementation of MBC in "real world" youth treatment settings, particularly intensive settings offering group-based treatment. The current manuscript provides a foundational model of MBC implementation for "real world" intensive outpatient programs (IOP) for youth using the organizational framework of the Consolidated Framework for Implementation Research (CFIR). We also illustrate MBC implementation within a hospital-based adolescent psychiatric IOP, including enhancements to the foundational model and timely discussion of adjustments necessitated by the COVID-19 pandemic and transition to telehealth. Given the promising transdiagnostic and transtheoretical applicability of MBC, coupled with the MBC mandate for Joint Commission accredited health-care systems, IOP programs are well-positioned to adopt, implement and sustain MBC with careful attention to a phased, multilevel implementation approach.
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Affiliation(s)
- Amber W. Childs
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA;,Yale New Haven Psychiatric Hospital, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Elizabeth H. Connors
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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8
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Van Swearingen KM, Lothes JE. Symptom reduction in DBT-informed partial hospital, intensive outpatient, and step-down programs: Mindfulness matters. Psychother Res 2021; 32:640-651. [PMID: 34806559 DOI: 10.1080/10503307.2021.2001602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Preliminary evidence suggests the efficacy of Dialectical Behavior Therapy (DBT) to reduce clinical symptoms in Partial Hospital (PH) programs. However, less is known about DBT in Intensive Outpatient (IOP) programs, or in PH to IOP step-down models. The current study examined changes in depression, anxiety, stress, hopelessness, and mindfulness skills acquisition, from intake and discharge data of clients at a southeastern behavioral health clinic in the United States. The sample included 146 clients, 65.75% female (ages M = 33.88, SD = 12.34), who attended either a DBT-PH, -IOP, or -PH to IOP step-down program. Participants completed the Depression, Anxiety, Stress Scale (DASS-21), Beck Hopelessness Scale (BHS), and Five Facets of Mindfulness Questionnaire Short Form (FFMQ-SF). Depression, anxiety, and hopelessness decreased from intake to discharge in the PH program, while all symptoms decreased in the IOP and step-down programs. Mindfulness total scores, and most subscales, increased in each program. Mindfulness skills acquisition predicted decreases in depression and stress in the IOP group, and decreases in depression and hopelessness in the step-down group. Overall, clinical symptoms and mindfulness skills acquisition improved over the course of the DBT-PH and-IOP programs.
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Affiliation(s)
| | - John E Lothes
- College of Health & Human Services, University of North Carolina, Wilmington, NC, USA
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9
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Chugani CD, Murphy CE, Talis J, Miller E, McAneny C, Condosta D, Kamnikar J, Wehrer E, Mazza JJ. Implementing Dialectical Behavior Therapy Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A) in a Low-Income School. SCHOOL MENTAL HEALTH 2021; 14:391-401. [PMID: 34377215 PMCID: PMC8339697 DOI: 10.1007/s12310-021-09472-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 12/30/2022]
Abstract
Adolescents living in low-income areas often have high need for mental health supports due to experiences of poverty and trauma, coupled with limited access and availability of such supports. This study investigated the implementation of a socio-emotional learning curriculum titled, “Dialectical Behavior Therapy Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A),” which was integrated into health classes in a low-income high school. While preliminary evidence suggests that DBT STEPS-A can be effective in reducing mental health symptoms in high school students, this study is the first to explore the program’s acceptability, appropriateness, and feasibility when implemented in a low-income school. The implementation presented here also diverged from recommended training protocols due to time and cost limitations. Quantitative and qualitative data were collected from 29 school stakeholders prior to implementation and from 23 school stakeholders post-implementation. Our results indicate that DBT STEPS-A is acceptable and feasible for teachers involved in offering the program and that more work is needed to address appropriateness of the content for racially and socio-economically diverse students, ease of implementing lessons, and support for teachers using DBT STEPS-A skills outside of class. We conclude with a discussion of key implementation challenges and solutions generated.
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Affiliation(s)
- Carla D Chugani
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Courtney E Murphy
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Janine Talis
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Elizabeth Miller
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | | | | | | | | | - James J Mazza
- University of Washington College of Education, Seattle, WA USA
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10
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Lothes JE, McCool MW, Mochrie KD, Guendner E, St John J. Applying adherent DBT Principles to treatment in a partial hospital setting: An analysis over 5-years of outcomes from intake to discharge. J Clin Psychol 2021; 77:2431-2441. [PMID: 34061985 DOI: 10.1002/jclp.23188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/04/2021] [Accepted: 05/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES A small number of studies to date have examined Partial Hospital (PH) that utilize a Dialectical Behavior Therapy (DBT) model. Preliminary findings suggest DBT PH programs can be effective in various symptom reduction. METHODS This study examined clinically relevant outcomes and included a heterogeneous clinical sample over a five-year period. Specifically, the present study assessed pre-post data to examine changes in symptoms of depression, anxiety, hopelessness, and overall degree of suffering from intake to discharge in a DBT PH. RESULTS Findings showed symptom reduction from intake to discharge for depression, anxiety, hopelessness, and suffering for all 5 years. This DBT PH program was successful at reducing various symptoms in a sample of psychiatric patients. CONCLUSION Clinicians might consider the advantages of placing patients in PH programs versus an inpatient stay or consider utilizing DBT-informed PH programs after an inpatient hospitalization as a form of step-down care.
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Affiliation(s)
- John E Lothes
- University of North Carolina Wilmington, Wilmington, North Carolina, USA.,Delta Behavioral Health, Wilmington, North Carolina, USA
| | - Matison W McCool
- University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Kirk D Mochrie
- Triangle Area Psychology Clinic, Durham, North Carolina, USA
| | - Eric Guendner
- University of North Carolina Wilmington, Wilmington, North Carolina, USA.,Delta Behavioral Health, Wilmington, North Carolina, USA
| | - Jane St John
- Delta Behavioral Health, Wilmington, North Carolina, USA
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11
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Puspitasari AJ, Heredia D, Coombes BJ, Geske JR, Gentry MT, Moore WR, Sawchuk CN, Schak KM. Feasibility and Initial Outcomes of a Group-Based Teletherapy Psychiatric Day Program for Adults With Serious Mental Illness: Open, Nonrandomized Trial in the Context of COVID-19. JMIR Ment Health 2021; 8:e25542. [PMID: 33651706 PMCID: PMC7954114 DOI: 10.2196/25542] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In the context of the COVID-19 pandemic, many behavioral health services have transitioned to teletherapy to continue delivering care for patients with mental illness. Studies that evaluate the outcome of this rapid teletherapy adoption and implementation are pertinent. OBJECTIVE This single-arm, nonrandomized pilot study aimed to assess the feasibility and initial patient-level outcomes of a psychiatric transitional day program that switched from an in-person group to a video teletherapy group during the COVID-19 pandemic. METHODS Patients with transdiagnostic conditions who were at risk of psychiatric hospitalization were referred to the Adult Transitions Program (ATP) at a large academic medical center in the United States. ATP was a 3-week intensive outpatient program that implemented group teletherapy guided by cognitive and behavioral principles delivered daily for 3 hours per day. Feasibility was assessed via retention, attendance rate, and rate of securing aftercare appointments prior to ATP discharge. Patients completed standardized patient-reported outcome measures at admission and discharge to assess the effectiveness of the program for improving quality of mental health, depression, anxiety, and suicide risk. RESULTS Patients (N=76) started the program between March and August of 2020. Feasibility was established, with 70 of the 76 patients (92%) completing the program and a mean attendance of 14.43 days (SD 1.22); also, 71 patients (95%) scheduled at least one behavioral health aftercare service prior to ATP discharge. All patient-level reported outcomes demonstrated significant improvements in depression (95% CI -3.6 to -6.2; Cohen d=0.77; P<.001), anxiety (95% CI -3.0 to -4.9; Cohen d=0.74; P<.001), overall suicide risk (95% CI -0.5 to -0.1; Cohen d=0.41; P=.02), wish to live (95% CI 0.3 to 1.0; Cohen d=0.39; P<.001), wish to die (95% CI -0.2 to -1.4; Cohen d=0.52; P=.01), and overall mental health (95% CI 1.5 to 4.5; Cohen d=0.39; P<.001) from admission to discharge. CONCLUSIONS Rapid adoption and implementation of a group-based teletherapy day program for adults at risk of psychiatric hospitalization appeared to be feasible and effective. Patients demonstrated high completion and attendance rates and reported significant improvements in psychosocial outcomes. Larger trials should be conducted to further evaluate the efficacy and effectiveness of the program through randomized controlled trials.
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Affiliation(s)
- Ajeng J Puspitasari
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Dagoberto Heredia
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Brandon J Coombes
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Jennifer R Geske
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Melanie T Gentry
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Wendy R Moore
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Craig N Sawchuk
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Kathryn M Schak
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
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Heath N, Midkiff MF, Gerhart J, Turow RG. Group-based DBT skills training modules are linked to independent and additive improvements in emotion regulation in a heterogeneous outpatient sample. Psychother Res 2021; 31:1001-1011. [PMID: 33539233 DOI: 10.1080/10503307.2021.1878306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Objective: Dialectical Behavior Therapy (DBT) was initially developed to treat symptoms of Borderline Personality Disorder (BPD), but has also been shown to improve symptoms of several other mental health conditions. Emotion regulation difficulties comprise a key target of DBT as well as a common challenge for individuals with depression, anxiety, PTSD, and other conditions. The current study investigated the impact of a DBT skills-training group on emotion regulation, and whether improvement in specific facets of emotion regulation would be linked to training in specific modules.Method: One hundred and thirty-six patients diagnosed with heterogeneous mental health conditions participated in the study. Patients were enrolled in the group on a rolling basis, and emotion regulation was assessed at the beginning and end of every six- to eight-week module.Results: Mixed model analysis revealed that each DBT skills-training module (i.e., mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation) was associated with improvements in emotion regulation (all Bonferroni corrected ps < .003).Conclusions: These findings add to the growing literature on the applicability of DBT skills-training to heterogeneous psychological conditions, particularly when patients' challenges reflect underlying difficulties with emotion regulation.
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Affiliation(s)
- Nicole Heath
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Melanie F Midkiff
- Department of Psychology, Central Michigan University, Mt. Pleasant, MI, USA
| | - James Gerhart
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.,Department of Psychology, Central Michigan University, Mt. Pleasant, MI, USA
| | - Rachel Goldsmith Turow
- Department of Psychology, Seattle University, Seattle, WA, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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13
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Mochrie KD, Lothes Ii J, Guender E, St John J. DBT-informed treatment in a partial hospital and intensive outpatient program: the role of step-down care. ACTA ACUST UNITED AC 2020; 23:461. [PMID: 33024726 PMCID: PMC7513610 DOI: 10.4081/ripppo.2020.461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/21/2020] [Indexed: 11/22/2022]
Abstract
Few studies to date have examined Partial Hospital (PH) and Intensive Outpatient (IOP) programs that utilize a Dialectical Behavior Therapy (DBT)-informed model. Preliminary findings suggest that DBT-informed PH programs are effective in reducing clinical symptoms; however, less is known about IOP programs as well as step-down care models. The present study utilized clinically relevant outcome indices and included a heterogeneous clinical sample. Specifically, the present study assessed pre-post data to examine changes in symptoms of depression, anxiety, hopelessness, and overall degree of suffering from intake to discharge in DBT-informed PH and IOP programs as well as a step-down condition (PH to IOP). Participants included 205 adults (ages M = 35.28, SD = 12.49). The sample was predominantly female (N = 139, 67.8%) and Caucasian (N = 181, 88.3%). The sample was divided into three distinct groups: PH program patients, PH to IOP program step-down patients, and IOP patients. Findings indicated significant symptom reduction from intake to discharge for all three conditions. There were no significant differences in mean change scores in symptom reduction between the three groups. Severity of depression symptoms at intake predicted program placement. However, type of program did not predict significant changes in symptoms from intake to discharge. This DBT-informed PH and IOP program was successful at reducing various psychiatric symptoms in the sample. Clinicians might consider the advantages of placing patients with higher symptoms of depression into PH programs with the intention of transitioning to step-down care through IOP programs that utilize DBT.
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14
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Chugani CD, Fuhrman B, Abebe KZ, Talis J, Miller E, Coulter RWS. Wellness and resilience for college and beyond: protocol for a quasi-experimental pilot study investigating a dialectical behaviour therapy skill-infused college course. BMJ Open 2020; 10:e036833. [PMID: 32565475 PMCID: PMC7311003 DOI: 10.1136/bmjopen-2020-036833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION College students' mental health problems and suicidal behaviour are serious, persistent and prevalent public health issues. With the need for mental health support greatly exceeding the availability of on-campus treatment, a recent trend on college campuses is to offer courses designed to teach students strategies for developing mental health or resilience. While these courses are exceptionally popular among students, a paucity of research investigates the health outcomes associated with participation. The purpose of this study is to investigate the acceptability, appropriateness, feasibility and preliminary effectiveness of a college course grounded in skills from dialectical behaviour therapy (DBT) titled, 'Wellness and Resilience for College and Beyond'. METHODS AND ANALYSIS During the spring and fall 2020 semesters, the course will be offered on five campuses in Southwestern Pennsylvania and West Virginia. The course consists of 15 weekly 2.5-hour lessons, weekly homework assignments and a final examination with content drawn from DBT, acceptance and commitment therapy and positive psychology. Undergraduate students aged 18-24 will self-select into the course and control subjects receiving 'university as usual' will be recruited to serve as a comparison group. Students who receive the course will complete measures of course acceptability, appropriateness and feasibility. All study participants will complete measures of adaptive coping skills use, emotion dysregulation and suicidality. ETHICS AND DISSEMINATION All of the study procedures were approved as an exempt protocol for evaluation of educational curricula by the University of Pittsburgh Human Research Protections Office (HRPO); the study was approved as a research study by the institutional review board (IRB) of the fifth study site. The University of Pittsburgh HRPO served as the IRB of record for all except one study site, which required standard IRB review. Data from this study will be disseminated via conference presentations, peer-reviewed publications and via our online stakeholder learning collaborative. TRIAL REGISTRATION NUMBER NCT04338256.
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Affiliation(s)
- Carla D Chugani
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Barbara Fuhrman
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Kaleab Z Abebe
- School of Medicine, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Janine Talis
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Elizabeth Miller
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Robert W S Coulter
- School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
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Morris MR, Feldpausch NI, Inga Eshelman MG, Bohle-Frankel BU. Recovering in Place: Creating Campus Models of Care for the High-Risk College Student. Curr Psychiatry Rep 2019; 21:111. [PMID: 31630268 DOI: 10.1007/s11920-019-1101-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Over the last decade, the number and severity of mental health problems among college students has continued to rise. Universities are struggling to dedicate enough resources to meet the mental health needs of students. In this article, we review on-campus innovative programs designed to promote recovery in high-risk college students. RECENT FINDINGS Colleges respond in a variety of ways to students on campus with serious mental health problems, from encouraging or requiring students to take a leave of absence, to creating treatment programs and reducing course loads to treat in place. On-campus programs that address the needs of high-risk students can include post-hospitalization programs, intensive outpatient groups, and specialized treatment for diverse populations such as athletes. Some universities are developing unique programs that enable high-risk college students to recover on campus. More research is needed to determine how best to deliver this care.
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Affiliation(s)
- Marcia R Morris
- Department of Psychiatry, University of Florida College of Medicine, Student Health Care Center Psychiatry at the Counseling and Wellness Center, The University of Florida, 3190 Radio Road, Gainesville, FL, 32611, USA.
| | | | - Melissa G Inga Eshelman
- Department of Psychiatry, Dell Medical School, Counseling and Mental Health Center, The University of Texas at Austin, Austin, TX, USA
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Intensive Outpatient Treatment of Depression in a Spinocerebellar Ataxia Type 1 Patient. Case Rep Psychiatry 2019; 2019:9186797. [PMID: 30886755 PMCID: PMC6388339 DOI: 10.1155/2019/9186797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 11/17/2022] Open
Abstract
Objective Spinocerebellar ataxia type 1 (SCA1) is but one subtype of spinocerebellar ataxia (SCA), each of which can possibly be considered a separate neurological condition (N. Whaley, S. Fujioka, Z. K. Wszolek, 2011). SCA is hereditary, progressive, and degenerative. SCA1 symptoms initially include coordination problems and ataxia. SCA1 can also include speech and swallowing difficulties, spasticity, ophthalmoplegia, cognitive difficulties, and even sensory neuropathy, dystonia, atrophy, and fasciculations. Literature has established that depressive symptoms can be exhibited with spinocerebellar ataxia patients regardless of type (T. Schmitz-Hübsch, 2011). While a higher risk for depression occurs with more severe SCA disease, successful treatment to mitigate symptoms has been documented (N. Okamoto, M. Ogawa, Y. Murata, et al., 2010). In this case a SCA1 patient with advanced neurological disease was enrolled in a psychiatric intensive outpatient (IOP) treatment program in the midwestern United States to address his comorbid depressive symptoms. This treatment option allowed a less restrictive environment while providing a more structured therapeutic setting and social support for the patient, much more so than that which is typically offered in a traditional outpatient setting. Case Report A patient with relatively advanced SCA1 successfully participated in a psychiatric IOP program or depressive symptoms and benefitted from the program's structure and additional psychosocial support. Conclusion Awareness among physicians, particularly psychiatrists and neurologists, regarding IOP programs as a treatment option for comorbid depression in the clinical setting of progressive SCA or other neurological conditions can be beneficial to patients requiring an increased level of psychiatric treatment.
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Mochrie KD, Lothes J, Quickel EJW, John J, Carter C. From the hospital to the clinic: The impact of mindfulness on symptom reduction in a DBT partial hospital program. J Clin Psychol 2019; 75:1169-1178. [DOI: 10.1002/jclp.22774] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 01/20/2019] [Accepted: 03/03/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Kirk D. Mochrie
- Department of PsychologyEast Carolina UniversityGreenville North Carolina
| | - John Lothes
- College of Health and Human ServicesUniversity of North Carolina WilmingtonWilmington North Carolina
| | | | - Jane John
- PsychologyDelta Behavioral HealthWilmington North Carolina
| | - Carlie Carter
- College of Health and Human ServicesUniversity of North Carolina WilmingtonWilmington North Carolina
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The Development and Feasibility Outcomes of a Youth Suicide Prevention Intensive Outpatient Program. J Adolesc Health 2019; 64:362-369. [PMID: 30502117 DOI: 10.1016/j.jadohealth.2018.09.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/24/2018] [Accepted: 09/12/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Suicide is a leading cause of death in adolescents worldwide. There is an absence of effective and low cost treatment strategies for this growing public health problem. Current practice consists of brief hospitalization of acutely suicidal youth, but many get inadequate follow-up treatment. There are few alternatives to individual outpatient services offered at too low an intensity for an acutely distressed population. This paper describes the development, feasibility, acceptability, and preliminary clinical outcomes of an intensive outpatient program (IOP) for suicidal adolescents over a two-year period. METHOD 364 eligible adolescents (12-18 years) who had a worsening of suicidal ideation or a suicide attempt were enrolled in an IOP and attended at least 1 group session. Depressive symptoms and suicidality were assessed at baseline and discharge from the program and at one and six month follow-up. RESULTS The majority of patients completed the IOP (81.0%; average of nine sessions). Over 95% of teens and parents responded that they were mostly or very satisfied with the IOP. The condition of patients improved at the time of discharge on depressive symptoms and suicidal ideation and behavior. 286 of the 364 youth (78.6%) completed the six-month follow-up. In total, 8.7% and 27.3% of the 286 respondents reported a suicide attempt and event, respectively, within six months of discharge from the IOP. CONCLUSIONS While limited by the lack of a control group, our findings suggest that an IOP for adolescents with suicidality is acceptable and feasible as either a step-down from or an alternative to inpatient treatment.
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Beidel DC, Frueh BC, Neer SM, Lejuez CW. The efficacy of Trauma Management Therapy: A controlled pilot investigation of a three-week intensive outpatient program for combat-related PTSD. J Anxiety Disord 2017; 50:23-32. [PMID: 28545005 DOI: 10.1016/j.janxdis.2017.05.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 04/25/2017] [Accepted: 05/03/2017] [Indexed: 11/16/2022]
Abstract
Despite the 8-18.5% of returning Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF) and Operation New Dawn (OND) veterans who are suffering from posttraumatic stress disorder (PTSD), few receive empirically supported treatments. Among those that do, the dropout rate is high and more than 50% retain their diagnosis after treatment. This study evaluated the efficacy of Trauma Management Therapy (TMT), delivered in a 3-week intensive outpatient (IOP) format. TMT combines virtual-reality augmented individual exposure therapy with a group intervention to address social isolation, anger, and depression. One hundred twelve (112) OIF/OEF/OND veterans and active duty personnel participated. Assessment included measures of PTSD, sleep, depression, anger, guilt, and social isolation, administered at post-treatment, 3-month, and 6-month follow-up. The effect size for TMT delivered in an IOP format was 2.06, with 65.9% no longer meeting diagnostic criteria for PTSD. There were similar positive effects in other domains and treatment gains were maintained at 6-month follow-up. The results are discussed regarding the need for efficacious, multi-component interventions that can be delivered safely and rapidly, and the potential of this approach towards that end.
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Affiliation(s)
- Deborah C Beidel
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL 32816, United States.
| | - B Christopher Frueh
- Department of Psychology, University of Hawaii at Hilo, 200 W. Kawili St., Hilo, HI, United States.
| | - Sandra M Neer
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL 32816, United States.
| | - Carl W Lejuez
- Department of Psychology, Kansas University, Strong Hall, Room 200, Lawrence, KS 66045, United States.
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Hou J, Song B, Chen ACN, Sun C, Zhou J, Zhu H, Beauchaine TP. Review on Neural Correlates of Emotion Regulation and Music: Implications for Emotion Dysregulation. Front Psychol 2017; 8:501. [PMID: 28421017 PMCID: PMC5376620 DOI: 10.3389/fpsyg.2017.00501] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 03/16/2017] [Indexed: 12/15/2022] Open
Abstract
Previous studies have examined the neural correlates of emotion regulation and the neural changes that are evoked by music exposure. However, the link between music and emotion regulation is poorly understood. The objectives of this review are to (1) synthesize what is known about the neural correlates of emotion regulation and music-evoked emotions, and (2) consider the possibility of therapeutic effects of music on emotion dysregulation. Music-evoked emotions can modulate activities in both cortical and subcortical systems, and across cortical-subcortical networks. Functions within these networks are integral to generation and regulation of emotions. Since dysfunction in these networks are observed in numerous psychiatric disorders, a better understanding of neural correlates of music exposure may lead to more systematic and effective use of music therapy in emotion dysregulation.
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Affiliation(s)
- Jiancheng Hou
- Center for Educational Neuroscience, School of Psychology and Cognitive Science, East China Normal UniversityShanghai, China.,Department of Radiology, School of Medicine and Public Health, University of Wisconsin-MadisonMadison, WI, USA
| | - Bei Song
- Center for Educational Neuroscience, School of Psychology and Cognitive Science, East China Normal UniversityShanghai, China.,Music Conservatory of HarbinHarbin, China
| | - Andrew C N Chen
- Center for Higher Brain Functions and Institute for Brain Disorders, Capital Medical UniversityBeijing, China
| | - Changan Sun
- School of Education and Public Administration, Suzhou University of Science and TechnologySuzhou, China
| | - Jiaxian Zhou
- Center for Educational Neuroscience, School of Psychology and Cognitive Science, East China Normal UniversityShanghai, China
| | - Haidong Zhu
- Department of Psychology, Shihezi UniversityShihezi, China
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The impact of a specialized inpatient and day patient group programme on clinical outcome in older adolescents and young adults with mental illness. Ir J Psychol Med 2017; 34:39-44. [PMID: 30115168 DOI: 10.1017/ipm.2016.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction Effective transition from child and adolescent mental health services (CAMHS) to adult services is one of the main challenges currently facing child psychiatry today The Young Adult 1Programme (YAP) based at St. Patrick's University Hospital Dublin, is a group based day programme especially designed to meet the needs of younger people aged 18-25 and support them through this difficult period. Aims To examine the effectiveness of participation in YAP for young adults with mental illness. To determine whether participation in particular aspects of the programme prove more beneficial and what factors might be associated with outcome. METHOD All patients enrolled in YAP between 1 September 2011 and 31 August 2012 were included in the study. Each patient was assessed using the Health of the Nation Outcome Scales (HONOS) and Global Assessment of Functioning (GAF) rating scale before beginning the programme and after discharge in order to evaluate improvement. The frequency of attendance at individual group sessions was recorded. Patient and illness variables were also recorded, for example demographics, diagnosis. RESULTS A total of 101 service users were in enrolled in YAP during this 12-month period. Eight service users could not be used for analysis, as they did not have a complete data set, mostly due to failure to attend for discharge HONOS/GAF ratings Using a paired sample t-test, there is a significant reduction in HONOS: Mean df=1.3, s.d.=1.09 (95% CI=1.08-1.53), p<0.001 Using a paired sample t-test, there is a significant increase in GAF: Mean df=9.25, s.d.=7.69 (95% CI=7.66-10.83), p<0.001 Improvements in HONOS and GAF scores are significantly correlated with better attendance at the programme (p<0.04, <0.00 respectively). CONCLUSION More attendance at YAP sessions correlates with better improvement in both HONOS and GAF rating scores.
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Tamez J, Du YB, Shah AA. Management of Treatment-Resistant Depression in Intensive Outpatient Programs. Psychiatr Ann 2016. [DOI: 10.3928/00485713-20160218-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Webb CA, Beard C, Kertz SJ, Hsu KJ, Björgvinsson T. Differential role of CBT skills, DBT skills and psychological flexibility in predicting depressive versus anxiety symptom improvement. Behav Res Ther 2016; 81:12-20. [PMID: 27057997 DOI: 10.1016/j.brat.2016.03.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 03/24/2016] [Accepted: 03/27/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Studies have reported associations between cognitive behavioral therapy (CBT) skill use and symptom improvement in depressed outpatient samples. However, little is known regarding the temporal relationship between different subsets of therapeutic skills and symptom change among relatively severely depressed patients receiving treatment in psychiatric hospital settings. METHOD Adult patients with major depression (N = 173) receiving combined psychotherapeutic and pharmacological treatment at a psychiatric hospital completed repeated assessments of traditional CBT skills, DBT skills and psychological flexibility, as well as depressive and anxiety symptoms. RESULTS Results indicated that only use of behavioral activation (BA) strategies significantly predicted depressive symptom improvement in this sample; whereas DBT skills and psychological flexibility predicted anxiety symptom change. In addition, a baseline symptom severity X BA strategies interaction emerged indicating that those patients with higher pretreatment depression severity exhibited the strongest association between use of BA strategies and depressive symptom improvement. CONCLUSIONS Findings suggest the importance of emphasizing the acquisition and regular use of BA strategies with severely depressed patients in short-term psychiatric settings. In contrast, an emphasis on the development of DBT skills and the cultivation of psychological flexibility may prove beneficial for the amelioration of anxiety symptoms.
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Affiliation(s)
- Christian A Webb
- Department of Psychiatry, Harvard Medical School and Center for Depression, Anxiety and Stress Research, McLean Hospital.
| | - Courtney Beard
- Behavioral Health Partial Program, McLean Hospital, Harvard Medical School, 115 Mill Street, Belmont, MA 02478, USA
| | - Sarah J Kertz
- Department of Psychology, Southern Illinois University, Carbondale, IL, USA
| | - Kean J Hsu
- Behavioral Health Partial Program, McLean Hospital, Harvard Medical School, 115 Mill Street, Belmont, MA 02478, USA
| | - Thröstur Björgvinsson
- Behavioral Health Partial Program, McLean Hospital, Harvard Medical School, 115 Mill Street, Belmont, MA 02478, USA
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McMahon K, Herr NR, Zerubavel N, Hoertel N, Neacsiu AD. Psychotherapeutic Treatment of Bipolar Depression. Psychiatr Clin North Am 2016; 39:35-56. [PMID: 26876317 DOI: 10.1016/j.psc.2015.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The gold standard for treating bipolar depression is based on the combination of mood stabilizers and psychotherapy. Therefore, the authors present evidence-based models and promising approaches for psychotherapy for bipolar depression. Cognitive-behavioral therapy, family focused therapy, interpersonal and social rhythm therapy, mindfulness-based cognitive therapy, and dialectical behavior therapy are discussed. Behavioral activation, the cognitive behavioral analysis system of psychotherapy, and the unified protocol as promising future directions are presented. This review informs medical providers of the most appropriate referral guidelines for psychotherapy for bipolar depression. The authors conclude with a decision tree delineating optimal referrals to each psychotherapy approach.
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Affiliation(s)
- Kibby McMahon
- Cognitive-Behavioral Research and Treatment Program, Department of Psychology and Neuroscience, Duke University Medical Center, Duke University, 3026, 2213 Elba Street, Room 123, Durham, NC 27710, USA
| | - Nathaniel R Herr
- Department of Psychology, American University, 4400 Massachusetts Avenue Northwest, Washington, DC 20016, USA
| | - Noga Zerubavel
- Cognitive-Behavioral Research and Treatment Program, Department of Psychiatry and Behavioral Science, Duke University Medical Center, 3026, 2213 Elba Street, Room 123, Durham, NC 27710, USA
| | - Nicolas Hoertel
- Department of Psychiatry, Corentin Celton Hospital, Assistance Publique-Hôpitaux de Paris (APHP), 4 parvis Corentin Celton, Issy-les-Moulineaux 92130, France; INSERM UMR 894, Psychiatry and Neurosciences Center, 2 ter rue d'Alésia, Paris 75014, France; PRES Sorbonne Paris Cité, Paris Descartes University, 12 Rue de l'École de Médecine, Paris 75006, France
| | - Andrada D Neacsiu
- Cognitive-Behavioral Research and Treatment Program, Department of Psychiatry and Behavioral Science, Duke University Medical Center, 3026, 2213 Elba Street, Room 123, Durham, NC 27710, USA.
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Hall HG, Beattie J, Lau R, East C, Anne Biro M. Mindfulness and perinatal mental health: A systematic review. Women Birth 2016; 29:62-71. [DOI: 10.1016/j.wombi.2015.08.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/07/2015] [Accepted: 08/12/2015] [Indexed: 10/23/2022]
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Stein AT, Hearon BA, Beard C, Hsu KJ, Björgvinsson T. Properties of the Dialectical Behavior Therapy Ways of Coping Checklist in a Diagnostically Diverse Partial Hospital Sample. J Clin Psychol 2015; 72:49-57. [PMID: 26390145 DOI: 10.1002/jclp.22226] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Dialectical behavior therapy (DBT) was developed for treatment of borderline personality disorder (BPD), and adapted forms of DBT are currently used to treat bipolar disorder, eating disorders, anxiety, and depression. This study was designed to validate the Dialectical Behavior Therapy Ways of Coping Checklist (DBT-WCCL) DBT Skills subscale (DSS) for use in a diagnostically heterogeneous sample. METHOD We used naturalistic data from 228 patients receiving treatment at a partial hospital program to assess psychometric properties of the DBT-WCCL DSS. We assessed interitem correlations, internal consistency, factor structure, construct validity and sensitivity to change. RESULTS Internal consistency, construct validity, and sensitivity to change were good. The measure displayed good convergent and discriminant validity. Factor analysis results were consistent with previous research indicating a 1-factor solution for this subscale. CONCLUSIONS Psychometric properties were similar to the original BPD sample, indicating that this measure can be used as an assessment tool for DBT skill use in a diverse psychiatric population.
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Panepinto AR, Uschold CC, Olandese M, Linn BK. Beyond Borderline Personality Disorder: Dialectical Behavior Therapy in a College Counseling Center. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2015. [DOI: 10.1080/87568225.2015.1045782] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Johnston JAY, O'Gara JSX, Koman SL, Baker CW, Anderson DA. A pilot study of maudsley family therapy with group dialectical behavior therapy skills training in an intensive outpatient program for adolescent eating disorders. J Clin Psychol 2015; 71:527-43. [PMID: 25867492 DOI: 10.1002/jclp.22176] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The goal of this study was to provide pilot clinical data on the effectiveness of an intensive outpatient treatment model for adolescent eating disorders that combines Maudsley-based family therapy and group dialectical behavior therapy skills training. METHOD Measures of physical and psychological status were gathered upon admission, discharge, and at 3 follow-up intervals. RESULTS Adolescents who completed the program gained a significant amount of weight and experienced a significant decrease in eating disorder psychopathology. At the 1-year follow-up, 64% of adolescents were weight restored and menstruating normally. Measures of eating disorder psychopathology continued to improve up to a year after treatment. CONCLUSIONS This pilot, multimodal program warrants further investigation and may be an effective intermediate level of care treatment option for adolescent eating disorders.
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Jomphe J. [Dialectical behavior therapy : a review of studies on skills training groups and applications in psychiatric settings]. SANTE MENTALE AU QUEBEC 2014; 38:83-109. [PMID: 24719004 DOI: 10.7202/1023991ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Julie Jomphe
- Centre de santé et de servicessociaux du Sud de Lanaudière; Hôpital du Sacré-Coeur de Montréal
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Herschell AD, Lindhiem OJ, Kogan JN, Celedonia KL, Stein BD. Evaluation of an implementation initiative for embedding Dialectical Behavior Therapy in community settings. EVALUATION AND PROGRAM PLANNING 2014; 43:55-63. [PMID: 24333657 PMCID: PMC3946614 DOI: 10.1016/j.evalprogplan.2013.10.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 10/28/2013] [Accepted: 10/30/2013] [Indexed: 05/13/2023]
Abstract
We examined the effectiveness of Dialectical Behavior Therapy (DBT) training in community-based agencies. Data were gathered at four time points over a 2-year period from front-line mental health therapists (N=64) from 10 community-based agencies that participated in a DBT implementation initiative. We examined change on therapist attitudes toward consumers with Borderline Personality Disorder (BPD), confidence in the effectiveness of DBT, and use of DBT model components. All measures were self-report. Participating in DBT training was associated with positive changes over time, including improved therapist attitudes toward consumers with BPD, improved confidence in the effectiveness of DBT, and increased use of DBT components. Therapists who had the lowest baseline scores on the study outcomes had the greatest self-reported positive change in outcomes over time. Moreover, there were notable positive correlations in therapist characteristics; therapists who had the lowest baseline attitudes toward individuals with BPD, confidence in the effectiveness of DBT, or who were least likely to use DBT modes and components were the therapists who had the greatest reported increase over time in each respective area. DBT training with ongoing support resulted in changes not commonly observed in standard training approaches typically used in community settings. It is encouraging to observe positive outcomes in therapist self-reported skill, perceived self-efficacy and DBT component use, all of which are important to evidence-based treatment (EBT) implementation. Our results underscore the importance to recognize and target therapist diversity of learning levels, experience, and expertise in EBT implementation.
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Affiliation(s)
- Amy D Herschell
- Western Psychiatric Institute & Clinic, University of Pittsburgh School of Medicine, 3811 O' Hara Street, Pittsburgh, PA 15213, United States.
| | - Oliver J Lindhiem
- Western Psychiatric Institute & Clinic, University of Pittsburgh School of Medicine, 3811 O' Hara Street, Pittsburgh, PA 15213, United States
| | - Jane N Kogan
- Western Psychiatric Institute & Clinic, University of Pittsburgh School of Medicine, 3811 O' Hara Street, Pittsburgh, PA 15213, United States; Community Care Behavioral Health Organization, 112 Washington Boulevard, Pittsburgh, PA 15219, United States
| | - Karen L Celedonia
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, United States
| | - Bradley D Stein
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, United States
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Bistricky SL. Mill and mental phenomena: critical contributions to a science of cognition. Behav Sci (Basel) 2013; 3:217-231. [PMID: 25379235 PMCID: PMC4217623 DOI: 10.3390/bs3020217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 04/16/2013] [Accepted: 04/18/2013] [Indexed: 11/16/2022] Open
Abstract
Attempts to define cognition preceded John Stuart Mill's life and continue to this day. John Stuart Mill envisioned a science of mental phenomena informed by associationism, empirical introspection, and neurophysiology, and he advanced specific ideas that still influence modern conceptions of cognition. The present article briefly reviews Mill's personal history and the times in which he lived, and it traces the evolution of ideas that have run through him to contemporary cognitive concepts. The article also highlights contemporary problems in defining cognition and supports specific criteria regarding what constitutes cognition.
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Affiliation(s)
- Steven L Bistricky
- Department of Clinical Health and Applied Sciences, University of Houston-Clear Lake, 2700 Bay Area Boulevard, Houston, TX 77058, USA
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