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Wucherpfennig F, Eggert P. [Effects of Dialectical Behavior Therapy (DBT) Skills Training on Depression and Anxiety Disorders - A Pilot Study under Routine Care Conditions]. Psychother Psychosom Med Psychol 2024; 74:286-294. [PMID: 38641333 DOI: 10.1055/a-2294-2330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
OBJECTIVE Skills training as an integral part of dialectical behavioral therapy (DBT) is highly effective in the treatment of borderline personality disorder. Research interest is increasingly focused on the transdiagnostic effects of the skills training on depression and anxiety disorders. The present study examined the extent to which the findings of high-quality randomized controlled studies can be transferred to everyday treatment under routine care conditions. METHODS N=26 patients without personality disorders were treated in a day clinic over a period of eight weeks. In the control group, 11 patients received routine care treatment and in the experimental group 15 patients additionally received weekly skills training. Symptom distress, as well as emotion regulation and mindfulness were assessed longitudinally at three time points. Multilevel analyzes were used to examine whether there was an additive effect of the skills training. RESULTS The experimental group was superior to the control group in all endpoints. The effect sizes were comparable to those from experimental research. Improvements in mindfulness were significantly correlated with reductions in symptom distress. DISCUSSION The findings fit into previous research efforts and complement them with a naturalistic research perspective. The advantages and disadvantages of an experimental and naturalistic research perspective are discussed, and relevant limitations of the present study are highlighted. CONCLUSION Skills training is an established, flexible, modular therapy program that is ideal for improving the adaptability of patients with different psychological diagnoses.
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Durpoix A, Rolling J, Coutelle R, Lalanne L. Psychotherapies in opioid use disorder: toward a step-care model. J Neural Transm (Vienna) 2024; 131:437-452. [PMID: 37987829 PMCID: PMC11055728 DOI: 10.1007/s00702-023-02720-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023]
Abstract
Opioid use disorder (OUD) is characterized by a lack of control in opioid use, resulting in psychological distress and deficits in interpersonal and social functioning. OUD is often associated with psychiatric comorbidities that increase the severity of the disorder. The consequences of OUD are dramatic in terms of increased morbi-mortality. Specific medications and psychotherapies are essential tools not only in the treatment of OUD but also in the prevention of suicide and overdoses. In our review, we assess the different types of psychotherapies (counseling, motivational interviewing, contingency management, cognitive-behavioral therapy, and dialectical-behavior therapy) that are delivered to opioid users, either associated or un-associated with OUD medications and/or medications for psychiatric disabilities. We describe the application of these therapies first to adult opioid users and then to adolescents. This work led us to propose a stepped-care model of psychotherapies for OUD which provided information to assist clinicians in decision-making regarding the selection of psychotherapeutic strategies according to patients' OUD severity.
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Affiliation(s)
- Amaury Durpoix
- Addictology Department, Strasbourg University Hospital, 1, place de l'Hôpital, 67091, Strasbourg, France
- Strasbourg University, Faculty of Medicine, Strasbourg, France
| | - Julie Rolling
- Psychiatry, Mental Health and Addictology Department, Strasbourg University Hospital, Strasbourg, France
- Regional Center for Psychotrauma Great East, Strasbourg, France
- Centre National de la Recherche Scientifique Unité Propre de Recherche 3212 (CNRS UPR 3212), Institute for Cellular and Integrative Neurosciences (INCI), Strasbourg, France
| | - Romain Coutelle
- Psychiatry, Mental Health and Addictology Department, Strasbourg University Hospital, Strasbourg, France
- INSERM U1114, Cognitive Neuropsychology, and Pathophysiology of Schizophrenia, Strasbourg, France
| | - Laurence Lalanne
- Addictology Department, Strasbourg University Hospital, 1, place de l'Hôpital, 67091, Strasbourg, France.
- INSERM U1114, Cognitive Neuropsychology, and Pathophysiology of Schizophrenia, Strasbourg, France.
- Strasbourg University, Faculty of Medicine, Strasbourg, France.
- Fédération de Médecine translationnelle de Strasbourg, Strasbourg, France.
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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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Martin S. Using values in cognitive and behavioral therapy: A bridge back to philosophy. J Eval Clin Pract 2023; 29:1189-1195. [PMID: 37226577 DOI: 10.1111/jep.13872] [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: 03/21/2023] [Revised: 05/09/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023]
Abstract
Ancient therapeutic practices have influenced the development of cognitive behavioral therapy (CBT) theories such as Albert Ellis's rational emotive behavior therapy and Aaron Beck's cognitive therapy. By drawing inspiration from Socratic questioning, the importance of philosophy in evidence-based practices in human mental health can be acknowledged. Stoicism has also informed CBT, notably its emphasis on establishing psychological distance from emotions. Cognition and emotion are two aspects of mental processes, and irrational demands are processed through rational deliberation. Using mental imaging techniques and acceptance strategies (to accept oneself and the world as imperfect), avoiding catastrophic interpretations and acknowledging emotions are also included among such practices. METHODS: We will explore the use of values across CBT, acceptance and commitment therapy (ACT), and radically open dialectical behavioral therapy (RO DBT) to clarify their use of values. RESULTS: In this framework, values are conceptualized as life-orienting principles and are now widely used across CBTs, such as acceptance and commitment therapy and radically open dialectical behavioral therapy. In recent years, the development of CBT has involved a renewed relationship with philosophy through the use of values, interest in dialectics and development of self-questioning practices reminiscent of classical Socratic principles. This movement from applied clinical psychology toward philosophical skills has also encouraged the recent emergence of philosophical health considerations. The opposition between psychological and philosophical health can be questioned, and the fundamental issue of philosophical skills implemented in psychiatric treatment (and not solely as practices of enhancement for the sane) needs to be considered.
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Affiliation(s)
- Sylvia Martin
- Center for Research and Bioethics, Uppsala University, Uppsala, Sweden
- Clinical Psychologist specialized in CBT, Psycho-TCCE Private Practice, Nîmes, France
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Penner-Goeke L, Belows M, Kristjanson A, Andrade BF, Cameron EE, Giuliano R, Katz LY, Kelly LE, Letourneau N, Mota N, Reynolds K, Zalewski M, Pharazyn A, Roos LE. Protocol for a randomized control trial of the Building Regulation in Dual Generations Program (BRIDGE): preventing the intergenerational transmission of mental illness in at-risk preschool children. Trials 2023; 24:597. [PMID: 37726821 PMCID: PMC10507827 DOI: 10.1186/s13063-023-07591-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/16/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Since the onset of the COVID-19 pandemic, the worldwide prevalence of maternal depression has risen sharply; it is now estimated that one quarter of mothers experience clinically significant depression symptoms. Exposure to maternal depression during early childhood increases the risk for the development of childhood mental illness (MI) in offspring, with altered parenting practices mediating the association between maternal depression and child outcomes. Dual-generation interventions, which aim to simultaneously treat parent and child mental health, show promise for improving outcomes for mothers with depression and their young children. The Building Regulation in Dual Generations (BRIDGE) program combines Dialectical Behavior Therapy (DBT) and parenting skills training to concurrently treat maternal depression and improve parenting practices. In pilot within-group studies, BRIDGE has led to large reductions in maternal depression and child MI symptoms. The aim of the current study is to evaluate the efficacy of BRIDGE in reducing maternal depression and child MI symptoms (primary outcomes) as well as parenting stress and harsh parenting (secondary outcomes). METHODS A three-armed randomized control trial with equal group sizes will be conducted to compare the efficacy of (1) BRIDGE (DBT + parenting skills), (2) DBT skills training, and (3) services-as-usual. Participants (n = 180) will be mothers of 3- to 5-year-old children who report elevated depression symptoms. Those randomized to BRIDGE or DBT skills training will complete a 16-week group therapy intervention. Assessments will be administered at pre-intervention(T1) post-intervention (T2), and 6-month follow-up (T3). DISCUSSION Dual-generation programs offer an innovative approach to prevent the intergenerational transmission of mental illness. The current study will add to the evidence base for BRIDGE by comparing it to a stand-alone mental health intervention and a services-as-usual group. These comparisons will provide valuable information on the relative efficacy of including parenting support in a mental health intervention for parents. The results will contribute to our understanding of how maternal depression affects children's development and how intervening at both a mental health and parenting level may affect child and family outcomes. TRIAL REGISTRATION Name of registry: Clinical Trials Protocol Registration and Results System; trial registration number: NCT05959538; date of registry: July 24, 2023; available: https://classic. CLINICALTRIALS gov/ct2/show/NCT05959538.
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Affiliation(s)
| | | | | | - Brendan F Andrade
- McCain Centre for Child Youth and Family Mental Health, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | | | | | - Lauren E Kelly
- Depts of Pharmacology and Therapeutics, Community Health Sciences, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | | | | | | | | | | | - Leslie E Roos
- University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
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Zarubin VC, Gupta T, Mittal VA. History of trauma is a critical treatment target for individuals at clinical high-risk for psychosis. Front Psychiatry 2023; 13:1102464. [PMID: 36683986 PMCID: PMC9846262 DOI: 10.3389/fpsyt.2022.1102464] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
People meeting criteria for a clinical high-risk (CHR) for psychosis syndrome frequently represent a heterogeneous, help-seeking, and dynamic population. Among the numerous symptoms and risk factors for psychosis, exposure to trauma stands out as both highly prevalent and poorly understood. Indeed, while up to 80% of individuals meeting criteria for a CHR syndrome report trauma histories, there is currently limited research dedicated to this specific area. This is particularly problematic as trauma is tied to risk for conversion, leads to a range of clinical issues, and contributes to disability and poor quality of life. Fortunately, recent research in the general population has led to a significant evolution in the way trauma is assessed and understood, and further, some studies have indicated that targeted trauma interventions in formal psychotic disorders are highly effective. However, direct adoption is challenging as the CHR syndrome holds a number of unique concerns (e.g., clinical heterogeneity, developmental trauma), and characteristically, involves a developing pediatric or young adult population that also comes with specific considerations (e.g., living with caregivers, transitionary period in roles). In this "perspective" we frame the issues around understanding trauma in CHR individuals, discuss viable treatments and unique considerations, and provide suggestions for future steps in developing and incorporating trauma-focused interventions in this population.
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Affiliation(s)
- Vanessa C. Zarubin
- Department of Psychology, Northwestern University, Evanston, IL, United States
- Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Chicago, IL, United States
| | - Tina Gupta
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University, Evanston, IL, United States
- Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Chicago, IL, United States
- Department of Psychiatry, Northwestern University, Chicago, IL, United States
- Medical Social Sciences, Northwestern University, Chicago, IL, United States
- Institute for Policy Research (IPR), Northwestern University, Chicago, IL, United States
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