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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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2
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van Leeuwen H, Sinnaeve R, Witteveen U, Van Daele T, Ossewaarde L, Egger JIM, van den Bosch LMC. Reviewing the availability, efficacy and clinical utility of Telepsychology in dialectical behavior therapy (Tele-DBT). Borderline Personal Disord Emot Dysregul 2021; 8:26. [PMID: 34717772 PMCID: PMC8556811 DOI: 10.1186/s40479-021-00165-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 09/14/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Telepsychology is increasingly being implemented in mental health care. We conducted a scoping review on the best available research evidence regarding availability, efficacy and clinical utility of telepsychology in DBT. The review was performed using PRISMA-ScR guidelines. Our aim was to help DBT-therapists make empirically supported decisions about the use of telepsychology during and after the current pandemic and to anticipate the changing digital needs of patients and clinicians. METHODS A search was conducted in PubMed, Embase, PsycARTICLES and Web of Science. Search terms for telepsychology were included and combined with search terms that relate to DBT. RESULTS Our search and selection procedures resulted in 41 articles containing information on phone consultation, smartphone applications, internet delivered skills training, videoconferencing, virtual reality and computer- or video-assisted interventions in DBT. CONCLUSIONS The majority of research about telepsychology in DBT has focused on the treatment mode of between-session contact. However, more trials using sophisticated empirical methodologies are needed. Quantitative data on the efficacy and utility of online and blended alternatives to standard (i.e. face-to-face) individual therapy, skills training and therapist consultation team were scarce. The studies that we found were designed to evaluate feasibility and usability. A permanent shift to videoconferencing or online training is therefore not warranted as long as face-to-face is an option. In all, there is an urgent need to compare standard DBT to online or blended DBT. Smartphone apps and virtual reality (VR) are experienced as an acceptable facilitator in access and implantation of DBT skills. In addition, we have to move forward on telepsychology applications by consulting our patients, younger peers and experts in adjacent fields if we want DBT to remain effective and relevant in the digital age.
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Affiliation(s)
- Hanneke van Leeuwen
- Vincent van Gogh Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Stationsweg 46, 5803, AC, Venray, the Netherlands. .,Cognition and Behaviour, Donders Institute for Brain, Radboud University, Nijmegen, the Netherlands. .,Dialexis, Training institute for Dialectical Behavior Therapy, Nijmegen, The Netherlands.
| | - Roland Sinnaeve
- Dialexis, Training institute for Dialectical Behavior Therapy, Nijmegen, The Netherlands.,UPC KU Leuven, Kortenberg, Belgium.,Department of Neurosciences, Mind Body Research, KU Leuven, Leuven, Belgium
| | - Ursula Witteveen
- Dialexis, Training institute for Dialectical Behavior Therapy, Nijmegen, The Netherlands.,GGNet for Psychiatry, Apeldoorn, the Netherlands.,Dutch Centre for treatment in DBT (NB-DBT), Harderwijk, the Netherlands
| | - Tom Van Daele
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Lindsey Ossewaarde
- Centre for Anxiety and Obsessive-Compulsive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands
| | - Jos I M Egger
- Vincent van Gogh Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Stationsweg 46, 5803, AC, Venray, the Netherlands.,Cognition and Behaviour, Donders Institute for Brain, Radboud University, Nijmegen, the Netherlands.,Stevig Specialized and Forensic Care for People with Intellectual Disabilities, Dichterbij, Oostrum, The Netherlands
| | - Louisa M C van den Bosch
- Dialexis, Training institute for Dialectical Behavior Therapy, Nijmegen, The Netherlands.,Dutch Centre for treatment in DBT (NB-DBT), Harderwijk, the Netherlands
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Edwards ER, Kober H, Rinne GR, Griffin SA, Axelrod S, Cooney EB. Skills-homework completion and phone coaching as predictors of therapeutic change and outcomes in completers of a DBT intensive outpatient programme. Psychol Psychother 2021; 94:504-522. [PMID: 33774902 DOI: 10.1111/papt.12325] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 01/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Dialectical behaviour therapy (DBT) emphasizes generalization of skills to the patient's real-world context as a primary mechanism of change in treatment. To promote generalization, DBT includes weekly skills-focused homework assignments and as-needed phone coaching. Despite this central function of generalization in DBT, research on these treatment components is limited. The current study addresses this research gap by assessing the association of homework and phone coaching to DBT treatment outcomes. DESIGN A longitudinal study design explored the extent to which (a) completion of skills homework and (b) frequency of phone coaching were associated with therapeutic changes and treatment outcomes in a DBT intensive outpatient programme (DBT-IOP). METHOD Medical records and diary cards of 56 patients who had completed a four-month treatment cycle of DBT-IOP were reviewed and coded for proportion of skills homework completed, frequency of phone coaching calls, and reported urges for and engagement in suicide, non-suicidal self-injury, illicit or non-prescribed substance use, and alcohol use behaviours. RESULTS Completion of skills homework and frequency of phone coaching were significantly associated with (a) reduced urges for suicide, non-suicidal self-injury, illicit or non-prescribed substance use, and alcohol use from the beginning to end of treatment and (b) a lower likelihood of engaging in any of these behaviours during the final month of treatment. CONCLUSIONS Results suggest that within a DBT programme modified for an intensive outpatient setting, skills homework and phone coaching may enhance therapeutic change and outcomes in target behaviours. These generalization methods appear to be important ingredients of DBT effectiveness. PRACTITIONER POINTS In dialectical behaviour therapy (DBT), therapeutic skills homework and phone coaching are specifically designed to promote generalization of skills from the therapeutic context to the patient's real-world contexts. In a DBT intensive outpatient programme, patient engagement with therapeutic homework and phone coaching were associated with favourable therapeutic change and outcomes in target urges and behaviours. Clinicians may consider a patient's lack of homework completion and/or phone coaching to be early warning signs of poor therapeutic progress within dialectical behaviour therapy.
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Affiliation(s)
- Emily R Edwards
- Yale University School of Medicine, New Haven, Connecticut, USA.,James J. Peters VA Medical Center, VISN 2 MIRECC, Bronx, New York, USA
| | - Hedy Kober
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gabrielle R Rinne
- Yale University School of Medicine, New Haven, Connecticut, USA.,Yale University, New Haven, Connecticut, USA
| | | | - Seth Axelrod
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Emily B Cooney
- Yale University School of Medicine, New Haven, Connecticut, USA
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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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Landes SJ, Rodriguez AL, Smith BN, Matthieu MM, Trent LR, Kemp J, Thompson C. Barriers, facilitators, and benefits of implementation of dialectical behavior therapy in routine care: results from a national program evaluation survey in the Veterans Health Administration. Transl Behav Med 2018; 7:832-844. [PMID: 28168608 DOI: 10.1007/s13142-017-0465-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
National implementation of evidence-based psychotherapies (EBPs) in the Veterans Health Administration (VHA) provides important lessons on the barriers and facilitators to implementation in a large healthcare system. Little is known about barriers and facilitators to the implementation of a complex EBP for emotional and behavioral dysregulation-dialectical behavioral therapy (DBT). The purpose of this study was to understand VHA clinicians' experiences with barriers, facilitators, and benefits from implementing DBT into routine care. This national program evaluation survey measured site characteristics of VHA sites (N = 59) that had implemented DBT. DBT was most often implemented in general mental health outpatient clinics. While 42% of sites offered all four modes of DBT, skills group was the most frequently implemented mode. Fifty-nine percent of sites offered phone coaching in any form, yet only 11% of those offered it all the time. Providers were often provided little to no time to support implementation of DBT. Barriers that were difficult to overcome were related to phone coaching outside of business hours. Facilitators to implementation included staff interest and expertise. Perceived benefits included increased hope and functioning for clients, greater self-efficacy and compassion for providers, and ability to treat unique symptoms for clinics. There was considerable variability in the capacity to address implementation barriers among sites implementing DBT in VHA routine care. Mental health policy makers should note the barriers and facilitators reported here, with specific attention to phone coaching barriers.
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Affiliation(s)
- Sara J Landes
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA. .,University of Arkansas for Medical Sciences, 4301 W. Markham St., #755, Little Rock, AR, 72205, USA. .,Central Arkansas VA Health Care System, VISN 16 South Central Mental Illness Research Education and Clinical Center (MIRECC), NW, Washington, DC, USA.
| | - Allison L Rodriguez
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA
| | - Brandy N Smith
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA
| | - Monica M Matthieu
- Central Arkansas VA Health Care System, 2200 Fort Roots Drive, Building 58, North Little Rock, AR, 72114, USA.,College for Public Health and Social Justice, School of Social Work, Saint Louis University, Tegeler Hall, Suite 300, 3550 Lindell Blvd., Saint Louis, MO, 63103, USA
| | - Lindsay R Trent
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road Suite 3217, Stanford, 94305-5719, USA
| | - Janet Kemp
- VISN 2 Center of Excellence for Suicide Prevention, NW, Washington, DC, USA
| | - Caitlin Thompson
- Office for Suicide Prevention, Mental Health Service, US Department of Veterans Affairs, NW, Washington, DC, 20420, USA
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Clinical Observations About the Potential Benefits and Pitfalls of Between-Session Contacts with Borderline Patients. Harv Rev Psychiatry 2016; 24:e8-e14. [PMID: 27603746 DOI: 10.1097/hrp.0000000000000129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Borderline Personality Disorder (BPD) has a reputation for being a challenging disorder to treat due to the nature of the illness. With the development of evidence-based treatments, therapists are becoming more skilled at successfully helping this cohort of patients. A common factor associated with all validated treatments for BPD is the active involvement of therapists. For example, DBT is one treatment where therapists are expected to be available to patients for coaching outside of sessions. However, understanding the benefits and pitfalls associated with therapists' accessibility in between sessions is relevant to any treatment with intersession contact. In this article, three benefits of intersession contact are described: to generalize the use of skills, to improve understanding of the patient's needs, and to facilitate an alliance. This article also addresses the pitfalls of therapists being so accessible to patients. Both the benefits and pitfalls of intersession contact are illustrated using case vignettes. Assessing the function served by a patient's contact in between sessions is an important way to determine whether such contact is a productive part of treatment. Recommendations are provided to avoid detrimental outcomes for both the therapist (therapist burnout) and the patient.
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Ben-Porath DD. Orienting Clients to Telephone Coaching in Dialectical Behavior Therapy. COGNITIVE AND BEHAVIORAL PRACTICE 2015. [DOI: 10.1016/j.cbpra.2014.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Engle E, Gadischkie S, Roy N, Nunziato D. Dialectical Behavior Therapy for a College Population: Applications at Sarah Lawrence College and Beyond. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2013. [DOI: 10.1080/87568225.2013.739014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Serafini K, LaPaglia D, Steinfeld M. Article Commentary: Calling for Help? Considering Function and Meaning when Patients Drunk-Dial Psychotherapists. Subst Abuse 2013; 7:131-7. [PMID: 24023519 PMCID: PMC3762714 DOI: 10.4137/sart.s12423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Drunk-dialing is a term documented in both popular culture and academic literatures to describe a behavior in which a person contacts another individual by phone while intoxicated. In our collective clinical experience we have found that clients drunk-dial their clinicians too, particularly while in substance use treatment, and yet there is a noticeable absence of research on the topic to guide clinical decision-making within a process-based understanding of these events. As the parameters within which psychotherapy takes place become increasingly technologized, a literature base to document clients’ idiosyncratic use of technology will become increasingly necessary and useful. We provide a brief review of the existing research on drunk-dialing and conclude with specific questions to guide future research and practice.
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Affiliation(s)
- Kelly Serafini
- Yale University School of Medicine, Department of Psychiatry, New Haven, Connecticut, United States
| | - Donna LaPaglia
- Yale University School of Medicine, Department of Psychiatry, New Haven, Connecticut, United States
| | - Matthew Steinfeld
- Yale University School of Medicine, Department of Psychiatry, New Haven, Connecticut, United States
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Limbrunner HM, Ben-Porath DD, Wisniewski L. DBT Telephone Skills Coaching With Eating Disordered Clients: Who Calls, for What Reasons, and for How Long? COGNITIVE AND BEHAVIORAL PRACTICE 2011. [DOI: 10.1016/j.cbpra.2010.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Steinberg JA, Steinberg SJ, Miller AL. Orienting Adolescents and Families to DBT Telephone Consultation: Principles, Procedures, and Pitfalls. COGNITIVE AND BEHAVIORAL PRACTICE 2011. [DOI: 10.1016/j.cbpra.2009.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Koons CR. The Role of the Team in Managing Telephone Consultation in Dialectical Behavior Therapy: Three Case Examples. COGNITIVE AND BEHAVIORAL PRACTICE 2011. [DOI: 10.1016/j.cbpra.2009.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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