Dialectical Behavior Therapy Skills Training With Music Therapy Interventions for Adults With Serious Mental Illness: A Quasi-Experimental Nonequivalent Control-Group Pilot Study

Dialectical behavior therapy (DBT) improves emotion regulation by building skills in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. The purpose of this pilot study was to compare a DBT skills group with a combined DBT skills and music therapy (MT) group on participant outcomes of attendance, participation, skill practice, and skill knowledge, as well as determine feasibility of study procedures. We used a quasi-experimental nonequivalent control-group design with all groups co-led by a psychologist and a music therapist. Clinicians facilitated twice weekly 45-min groups in 12-week cycles for a total of eight groups over 2 years. The groups alternated DBT-only and DBT+MT; participant data were analyzed for their first cycle attended. The DBT-only group followed a standard DBT skills training format, whereas the DBT+MT group included music therapy interventions as group exercises. Participants (N = 26) were adults with serious mental illness referred to the inpatient psychosocial rehabilitation group (PSR) at a state psychiatric hospital. Participants completed a demographic form, diary cards, and exit interview; clinicians recorded attendance and session participation. Participants in the DBT+MT condition had significantly higher participation levels, slightly higher average attendance, submitted more diary cards, and included more feeling statements than the DBT-only condition. Although interpretations should be approached with caution, the pilot study intervention shows promise. Overall, this study could be implemented as intended under close monitoring, with minor modifications to assist with recruitment and data collection. Modifications, clinical implications, and recommendations for future research are discussed.

The Most Commonly Used Instruments in Research on Functioning in Schizophrenia

Abstract. A comprehensive assessment of functioning in schizophrenia is essential to plan appropriate interventions for helping individuals with this health condition. The International Classification of Functioning, Disability and Health (ICF) offers a theoretical framework for assessing functioning and disability. Our aim was to identify the most frequently used measurement instruments reported in studies on functioning in schizophrenia, to conduct a content comparison with respect to the ICF, and to compare the categories extracted from these instruments with those covered by the Brief ICF-Core Set for schizophrenia. A structured literature search of studies on functioning in schizophrenia was conducted using Medline, CINAHL, and PsycINFO. The items of the top 20 measurement instruments were then linked to the ICF classification system. The most commonly used instruments were neuropsychological tests (i.e., Wisconsin Card Sorting Test and Trail Making Test) and measures of clinical symptoms (i.e., PANSS) and general functioning (i.e., GAF). The linking process resulted in 45 ICF categories (25 from Body functions, 1 from Body structures, 14 from Activities and Participation, and 5 from the Environmental factors component). Most of the top 20 instruments are not specifically designed for patients with schizophrenia or for assessing functioning, but rather are general standardized tests widely used to measure a broad range of outcome variables in several health conditions. Our results suggest a lack of an internationally accepted, commonly used, specific and comprehensive gold standard to assess functioning in individuals with schizophrenia.

Web-based intervention to improve quality of life in late stage bipolar disorder (ORBIT): randomised controlled trial protocol

BACKGROUND

The primary objective of this randomised controlled trial (RCT) is to establish the effectiveness of a novel online quality of life (QoL) intervention tailored for people with late stage (≥ 10 episodes) bipolar disorder (BD) compared with psychoeducation. Relative to early stage individuals, this late stage group may not benefit as much from existing psychosocial treatments. The intervention is a guided self-help, mindfulness based intervention (MBI) developed in consultation with consumers, designed specifically for web-based delivery, with email coaching support.

METHODS/DESIGN

This international RCT will involve a comparison of the effectiveness and cost-effectiveness of two 5-week adjunctive online self-management interventions: Mindfulness for Bipolar 2.0 and an active control (Psychoeducation for Bipolar). A total of 300 participants will be recruited primarily via social media channels. Main inclusion criteria are: a diagnosis of BD (confirmed via a phone-administered structured diagnostic interview), no current mood episode, history of 10 or more mood episodes, no current psychotic features or active suicidality, under the care of a medical practitioner. Block randomisation will be used for allocation to the interventions, and participants will retain access to the program for 6 months. Evaluations will be conducted at pre- and post- treatment, and at 3- and 6- months follow-up. The primary outcome measure will be the Brief Quality of Life in Bipolar Disorder Scale (Brief QoL.BD), collected immediately post-intervention at 5 weeks (T1). Secondary measures include BD-related symptoms (mania, depression, anxiety, stress), time to first relapse, functioning, sleep quality, social rhythm stability and resource use. Measurements will be collected online and via telephone assessments at baseline (T0), 5 weeks (T1), three months (T2) and six months (T3). Candidate moderators (diagnosis, anxiety or substance comorbidities, demographics and current treatments) will be investigated as will putative therapeutic mechanisms including mindfulness, emotion regulation and self-compassion. A cost-effectiveness analysis will be conducted. Acceptability and any unwanted events (including adverse treatment reactions) will be documented and explored.

DISCUSSION

This definitive trial will test the effectiveness and cost-effectiveness of a novel QoL focused, mindfulness based, online guided self-help intervention for late stage BD, and investigate its putative mechanisms of therapeutic action.

TRIAL REGISTRATION

ClinicalTrials.gov : NCT03197974 . Registered 23 June 2017.

Psychosocial roots of paranoid ideation: The role of childhood experiences, social comparison, submission, and shame

BACKGROUND

Social experiences have a significant impact on cognitive functioning and appraisals of social interactions. Specifically, recalls of antipathy from parents, submissiveness, and bullying during childhood can have a significant influence on paranoid ideation later in life.

METHOD

Multiple hierarchical regression analysis was performed on a sample of 91 patients diagnosed with paranoid schizophrenia in remission and active phase, their first-degree relatives (n = 32) and unaffected controls (n = 64).

OBJECTIVES

Exploring the impact of distal (events from childhood) and proximal factors (current cognitive, emotional, and behavioural aspects of social functioning) in the frequency, degree of conviction, and distress resulting from paranoid ideation in the participants from 4 samples.

RESULTS

Proximal and distal factors (shame, submissive behaviour, negative social comparison, antipathy from father) predicted several aspects of paranoid ideation. Those variables had a differential impact in affected patients and healthy controls.

DISCUSSION

Finding suggests different variables being involved in paranoid ideation, and the specificities of patients with paranoid schizophrenia should be considered in the development of more effective psychotherapeutic interventions.