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Dhar A, Hay P, Meade T. Social and Occupational Functioning in Individuals With BPD: A Systematic Review. J Pers Disord 2023; 37:691-723. [PMID: 38038659 DOI: 10.1521/pedi.2023.37.6.691] [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] [Indexed: 12/02/2023]
Abstract
This systematic review aimed to explore social and occupational functioning levels in individuals with BPD and whether this varies according to symptomatic status, age, or gender. A multi-database search was conducted for articles, and of the 1164 records identified, 19 were included in this review. Of the 15 studies reporting on social functioning, 13 indicated significant levels of impairment, and of the 14 studies reporting on global functioning, all indicated significant impairment across both clinical and in-remission populations. Occupational functioning was primarily assessed as either a part of global functioning or by subscales within social functioning, highlighting a lack of use of dedicated measures for its assessment. This systematic review found that individuals with BPD experience a range of significant impairments in functioning persisting across the lifespan. Further studies are warranted to explore levels of functional impairment across all functional domains and factors associated with continual functional impairment in this population.
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Affiliation(s)
- Abhijatya Dhar
- School of Psychology, Western Sydney University, NSW, Australia
| | - Phillipa Hay
- School of Medicine, Western Sydney University, NSW, Australia
- Translational Health Research Institute, Western Sydney University, NSW, Australia
| | - Tanya Meade
- School of Psychology, Western Sydney University, NSW, Australia
- Translational Health Research Institute, Western Sydney University, NSW, Australia
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Lenz AS, Conte GD, Douglas C, Crenshaw A, Dobbs C, Stogner E, Williford V. A pre‐experimental evaluation of treatment gains associated with a DBT‐A partial hospitalization program. JOURNAL OF COUNSELING AND DEVELOPMENT 2021. [DOI: 10.1002/jcad.12416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A. Stephen Lenz
- Texas A&M University‐San Antonio, One University Way San Antonio Texas 78224 USA
| | - Garry Del Conte
- Daybreak Treatment Center 2262 South Germantown Road Germantown Tennessee 38138 USA
| | - Cameron Douglas
- The University of Mississippi 101 Guyton Hall University Mississippi 38677 USA
| | - Ayanna Crenshaw
- The University of Mississippi 101 Guyton Hall University Mississippi 38677 USA
| | - Christin Dobbs
- The University of Mississippi 101 Guyton Hall University Mississippi 38677 USA
| | - Emily Stogner
- The University of Mississippi 101 Guyton Hall University Mississippi 38677 USA
| | - Victoria Williford
- The University of Mississippi 101 Guyton Hall University Mississippi 38677 USA
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Dalal F. CBF: Cognitive Behavioral Fallacies. PSYCHOANALYTIC INQUIRY 2021. [DOI: 10.1080/07351690.2021.1983399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Price AL, Mahler HIM, Hopwood CJ. Construction and Validation of a Self-report Subjective Emptiness Scale. Assessment 2020; 29:397-409. [PMID: 33291950 DOI: 10.1177/1073191120968275] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Subjective emptiness is a psychiatric symptom that is primarily assessed and studied as a criterion of borderline personality disorder, even though research suggests that it may have clinical importance beyond that diagnosis. The aim of this series of studies was to develop and validate a standalone self-report measure of subjective emptiness. A systematic, multistep approach to identifying test content was used to generate 88 items that were then trimmed to 53 via ratings of interviews with patients and experts. This preliminary scale was administered to a sample of 544 university students, and a trimmed version was given to two samples oversampled for clinical problems (n = 1,067; n = 1,016). A five-item measure fit a unidimensional model well and had satisfactory internal consistency across these samples. External validity analyses suggested that emptiness, as measured by the Subjective Emptiness Scale, is strongly related to a number of clinical constructs, particularly in the internalizing domain, indicating that emptiness is an important construct to consider in its own right, independent of its presence in the borderline criterion set.
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Affiliation(s)
- Adrian L Price
- California State University San Marcos, San Marcos, CA, USA
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Rabeyron T. Psy Wars : le tsunami cognitivocomportemental en Grande-Bretagne. PSYCHO-ONCOLOGIE 2020. [DOI: 10.3166/pson-2020-0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cet article propose une analyse critique de l’évolution des prises en charge psychothérapiques en Grande-Bretagne à partir des réflexions de Farhad Dalal (2019) dans un ouvrage intitulé CBT: the Cognitive Behavioural Tsunami. Après avoir souligné les affinités idéologiques qui associent néolibéralisme et thérapies cognitivocomportementales (TCC), nous décrivons la manière dont ces dernières ont construit un mythe de leurs origines reposant sur l’idée, mensongère et démentie par la recherche empirique, de leur supposée meilleure efficacité par rapport aux autres approches. Ce discours idéologique s’inscrit plus largement dans le contexte actuel des PsyWars du développement de la psychiatrie biologique ayant mené aux évolutions contemporaines du DSM. Nous décrivons ensuite la mise en place de l’Increasing Access to Psychological Therapies (IAPT) en Grande-Bretagne, un large programme censé améliorer les prises en charge psychothérapiques à partir d’une libéralisation de ce secteur, National institute for health and care Excellence. Ce programme s’appuie sur les recommandations du NICE qui a favorisé l’utilisation quasi exclusive des TCC. Après avoir présenté comment un patient est suivi grâce à l’IAPT, nous soulignons les dérives et les échecs de ce système. Nous proposons ensuite une synthèse des principales formes de corruptions scientifiques associées aux TCC en prenant pour exemple deux études publiées dans ce champ. Ces dérives rendent intelligible l’écart observé actuellement entre les résultats empiriques des recherches en ce domaine et le manque d’efficacité des TCC dans la prise en charge effective des patients. L’ensemble de ces éléments, qui découlent des dérives idéologiques et scientifiques de certains tenants des TCC, apparaissent essentiels à connaître afin de ne pas reproduire en France les mêmes erreurs que la Grande-Bretagne dans la mise en place des futures politiques de santé publique concernant les psychothérapies.
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Toms G, Williams L, Rycroft-Malone J, Swales M, Feigenbaum J. The development and theoretical application of an implementation framework for dialectical behaviour therapy: a critical literature review. Borderline Personal Disord Emot Dysregul 2019; 6:2. [PMID: 30805193 PMCID: PMC6373034 DOI: 10.1186/s40479-019-0102-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dialectical behaviour therapy (DBT) is a third wave behaviour therapy combining behaviour based components with elements of mindfulness. Although DBT effectiveness has been explored, relatively little attention has been given to its implementation. Frameworks are often the basis for gathering information about implementation and can also direct how the implementation of an intervention is conducted. Using existing implementation frameworks, this critical literature review scoped the DBT implementation literature to develop and refine a bespoke DBT implementation framework. METHOD AND RESULTS The initial framework was developed by consolidating existing implementation frameworks and published guidance on DBT implementation. The critical literature review retrieved papers from Medline, CINAHL, PsycInfo, PubMed, and the reference lists of included papers. Framework elements were used as codes which were applied to the literature and guided the synthesis. Findings from the synthesis refined the framework.The critical literature review retrieved 60 papers but only 14 of these explicitly focused on implementation. The DBT implementation framework captured all the execution barriers and facilitators described in the literature. However, the evidence synthesis led to a more parsimonious framework as some elements (e.g., research and published guidance) were seldom discussed in DBT implementation. CONCLUSION To our knowledge this is the first published review exploring DBT implementation. The literature synthesis suggests some tentative recommendations which warrant further exploration. For instance, if DBT implementation is not pre-planned, having someone in the organisation who champions DBT can be advantageous. However, as the literature is limited and has methodological limitations, further prospective studies of DBT implementation are needed.
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Affiliation(s)
- Gill Toms
- Gill Toms, School of Healthcare Sciences, Bangor University, Fron Heulog, Bangor, Gwynedd LL57 2EF UK
| | - Lynne Williams
- Gill Toms, School of Healthcare Sciences, Bangor University, Fron Heulog, Bangor, Gwynedd LL57 2EF UK
| | - Jo Rycroft-Malone
- Gill Toms, School of Healthcare Sciences, Bangor University, Fron Heulog, Bangor, Gwynedd LL57 2EF UK
| | - Michaela Swales
- North Wales Clinical Psychology Programme, School of Psychology, Brigantia Building, Bangor University, Bangor, Gwynedd LL57 2DG UK
| | - Janet Feigenbaum
- Research Department of Clinical, Education and Health Psychology, University College London, Gower Street, London, WC1E 6BT UK
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Reavey P, Brown S, Kanyeredzi A, McGrath L, Tucker I. Agents and spectres: Life-space on a medium secure forensic psychiatric unit. Soc Sci Med 2019; 220:273-282. [DOI: 10.1016/j.socscimed.2018.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/25/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
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Abstract
There is encouraging evidence that some patients with personality disorder are treatable. Psychotherapeutic interventions show promise, although interpretation of the literature is problematic: the number of patients in most trials is small, outcome measures are questionable, follow-up is limited, and treatments are multifaceted, complex interventions in which the effective components are unclear. The evidence base can be assessed according to efficacy and generalisability, and when both are taken into account the best verification is for psychodynamic therapy. However, there is inadequate evidence to make specific recommendations for any particular therapy.
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Rivera M, Darke JL. Integrating Empirically Supported Therapies for Treating Personality Disorders: A Synthesis of Psychodynamic and Cognitive-Behavioral Group Treatments. Int J Group Psychother 2015; 62:500-29. [DOI: 10.1521/ijgp.2012.62.4.500] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Callahan KL, Price JL, Hilsenroth MJ. A Review of Interpersonal-Psychodynamic Group Psychotherapy Outcomes for Adult Survivors of Childhood Sexual Abuse. Int J Group Psychother 2015; 54:491-519. [PMID: 15388403 DOI: 10.1521/ijgp.54.4.491.42770] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This article discusses the use of interpersonal-psychodynamic group treatments for survivors of childhood sexual abuse. Empirically based interpersonal-psychodynamic group outcome studies are reviewed according to efficacy and effectiveness models of treatment outcome research. To facilitate the evaluation and comparison of clinically significant change across studies, effect size indicators were calculated when descriptive data were reported. Findings suggest that interpersonal-psychodynamic group therapy is an effective treatment approach for many survivors of childhood sexual abuse. Implications for future research are considered.
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Panos PT, Jackson JW, Hasan O, Panos A. Meta-Analysis and Systematic Review Assessing the Efficacy of Dialectical Behavior Therapy (DBT). RESEARCH ON SOCIAL WORK PRACTICE 2014; 24:213-223. [PMID: 30853773 PMCID: PMC6405261 DOI: 10.1177/1049731513503047] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The objective was to quantitatively and qualitatively examine the efficacy of DBT (e.g., decreasing life-threatening suicidal and parasuicidal acts, attrition, and depression) explicitly with borderline personality disorder (BPD) and using conservative assumptions and criteria, across treatment providers and settings. METHOD Five randomized controlled trials (RCTs) were identified in a systematic search that examined the efficacy of DBT in reducing suicide attempts, parasuicidal behavior, attrition during treatment, or symptoms of depression, in adult patients with BPD. RESULTS Combining effect measures for suicide and parasuicidal behavior (five studies total) revealed a net benefit in favor of DBT (pooled Hedges' g -0.622). DBT was only marginally better than treatment as usual (TAU) in reducing attrition during treatment in five RCTs (pooled risk difference -0.168). DBT was not significantly different from TAU in reducing depression symptoms in three RCTs (pooled Hedges' g -0.896). DISCUSSION DBT demonstrates efficacy in stabilizing and controlling self-destructive behavior and improving patient compliance.
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Zapolski TCB, Guller L, Smith GT. Construct validation theory applied to the study of personality dysfunction. J Pers 2013; 80:1507-31. [PMID: 22321263 DOI: 10.1111/j.1467-6494.2012.00772.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors review theory validation and construct validation principles as related to the study of personality dysfunction. Historically, personality disorders have been understood to be syndromes of heterogeneous symptoms. The authors argue that the syndrome approach to description results in diagnoses of unclear meaning and constrained validity. The alternative approach of describing personality dysfunction in terms of homogeneous dimensions of functioning avoids the problems of the syndromal approach and has been shown to provide more valid description and diagnosis. The authors further argue that description based on homogeneous dimensions of personality function/dysfunction is more useful because it provides direct connections to validated treatments.
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Affiliation(s)
- Tamika C B Zapolski
- Department of Psychology, University of Kentucky, Lexington,KY40506-0044, USA. tamika.zapolski@gmail
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Hazlett EA, Zhang J, New AS, Zelmanova Y, Goldstein KE, Haznedar MM, Meyerson D, Goodman M, Siever LJ, Chu KW. Potentiated amygdala response to repeated emotional pictures in borderline personality disorder. Biol Psychiatry 2012; 72:448-56. [PMID: 22560044 PMCID: PMC3415575 DOI: 10.1016/j.biopsych.2012.03.027] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 03/19/2012] [Accepted: 03/25/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is characterized by an inability to regulate emotional responses. The amygdala is important in learning about the valence (goodness and badness) of stimuli and functions abnormally in BPD. METHODS Event-related functional magnetic resonance imaging (MRI) was employed in three groups: unmedicated BPD (n = 33) and schizotypal personality disorder (n = 28) participants and healthy control subjects (n = 32) during a task involving an intermixed series of unpleasant, neutral, and pleasant pictures each presented twice within their respective trial block/run. The amygdala was hand-traced on each participant's structural MRI scan and co-registered to their MRI scan. Amygdala responses were examined with a mixed-model multivariate analysis of variance. RESULTS Compared with both control groups, BPD patients showed greater amygdala activation, particularly to the repeated emotional but not neutral pictures, and a prolonged return to baseline for the overall blood oxygen level-dependent response averaged across all pictures. Despite amygdala overactivation, BPD patients showed blunted self-report ratings of emotional but not neutral pictures. Fewer dissociative symptoms in both patient groups were associated with greater amygdala activation to repeated unpleasant pictures. CONCLUSIONS The increased amygdala response to the repeated emotional pictures observed in BPD was not observed in schizotypal patients, suggesting diagnostic specificity. This BPD-related abnormality is consistent with the well-documented clinical feature of high sensitivity to emotional stimuli with unusually strong and long-lasting reactions. The finding of a mismatch between physiological and self-report measures of emotion reactivity in BPD patients suggests they may benefit from treatments targeting emotion recognition.
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Affiliation(s)
- Erin A. Hazlett
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA,VISN 3 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA,Address correspondence to: Erin A. Hazlett, Ph.D., Mental Illness Research, Education, and Clinical Center, J.J.P. VA Medical Center, 130 West Kingsbridge Road, Rm 6A-45, Bronx, NY 10468, Phone: 718.584.9000 x3701, FAX: 718.364.3576,
| | - Jing Zhang
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - Antonia S. New
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA,VISN 3 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Yuliya Zelmanova
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - Kim E. Goldstein
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - M. Mehmet Haznedar
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA,VISN 3 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - David Meyerson
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - Marianne Goodman
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA,VISN 3 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Larry J. Siever
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA,VISN 3 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - King-Wai Chu
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
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Abstract
BACKGROUND Dialectical behaviour therapy (DBT) is the first empirically validated treatment for chronically suicidal patients diagnosed with borderline personality disorder (BPD). Numerous randomised clinical trials conducted with adults with BPD have demonstrated that DBT is effective in reducing suicidal and non-suicidal self-injurious (NSSI) behaviours. Other research on the use of DBT for adults has shown that the treatment is effective in reducing a variety of problem behaviours in a range of therapeutic settings. In the last decade, a number of studies have evaluated DBT as a promising treatment for adolescents with different psychological disorders and behaviours, including borderline personality disorder (BPD), eating disorders, externalising disorders, and suicidal and NSSI behaviours. This article reviews the literature on the use of DBT with adolescents. RESULTS Overall findings indicate some empirical support for the conclusion that DBT is a promising treatment for adolescents with BPD symptomatology, suicidal ideation and comorbid depression, bipolar disorder, disordered eating behaviours and aggressive and impulsive behaviours. Adolescents in these studies were also hospitalised less frequently when treated with DBT. Moreover, studies conducted with these populations suggest that DBT may be adapted for use in outpatient, inpatient, community, and residential treatment settings. CONCLUSIONS The authors conclude that DBT may be effective in treating adolescents with additional disorders and dysfunctional behaviours not yet examined. Data from soon to be completed randomised controlled trials need to be published.
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Affiliation(s)
- Sameena Groves
- Montefiore Medical Center, Child Outpatient Psychiatry, 3340 Bainbridge Avenue, Bronx, New York 10467, USA. E-mail:
| | | | - Wies van den Bosch
- Psychiatric Hospital Pro Persona, Psychology Department, Arnhem, Netherlands
| | - Alec Miller
- Montefiore Medical Center, Child Outpatient Psychiatry, 3340 Bainbridge Avenue, Bronx, New York 10467, USA. E-mail:
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Neacsiu AD, Ward-Ciesielski EF, Linehan MM. Emerging Approaches to Counseling Intervention. COUNSELING PSYCHOLOGIST 2012. [DOI: 10.1177/0011000011421023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Dialectical Behavior Therapy (DBT) is a comprehensive, multimodal cognitive behavioral treatment originally developed for individuals who met criteria for borderline personality disorder (BPD) who displayed suicidal tendencies. DBT is based on behavioral theory but also includes principles of acceptance, mindfulness, and validation. Since its development, DBT has been adapted to various populations and has been successfully used in a wide array of settings. This article presents the approaches used in DBT with a particular emphasis on (a) the philosophy and assumptions on which the treatment is based, (b) the major theoretical constructs and the DBT conceptualization of the client, (c) the intervention and specific techniques used, (d) research supporting the theory and treatment, and (e) the integration of diversity, culture, and social justice.
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Cavanaugh MM, Solomon P, Gelles RJ. The Dialectical Psychoeducational Workshop (DPEW): the conceptual framework and curriculum for a preventative intervention for males at risk for IPV. Violence Against Women 2011; 17:970-89. [PMID: 21757433 DOI: 10.1177/1077801211414266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Current programs aimed at reducing intimate partner violence (IPV) have demonstrated little effect on at-risk males, who may potentially engage in acts of IPV. Dialectical behavior therapy (DBT) provides the conceptual and empirical foundation for the dialectical psychoeducational workshop (DPEW). The DPEW offers a targeted preventative intervention for individuals potentially at risk for IPV. This article offers the rationale and theoretical basis for a specialized preventative approach to IPV and delineates a brief psychoeducational program that may stimulate further research and provide an alternate preventative intervention strategy in an area in need of innovative programs.
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Affiliation(s)
- Mary M Cavanaugh
- Lois J. and Samuel V. Silberman School of Social Work at Hunter College, New York 10035, USA.
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Feigenbaum JD, Fonagy P, Pilling S, Jones A, Wildgoose A, Bebbington PE. A real-world study of the effectiveness of DBT in the UK National Health Service. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2011; 51:121-41. [PMID: 22574799 DOI: 10.1111/j.2044-8260.2011.02017.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Janet D Feigenbaum
- Research Department of Clinical, Educational, and Health Psychology, University College London, UK.
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Preface: the current status of cognitive behavioral therapy for psychiatric disorders. Psychiatr Clin North Am 2010; 33:xiii-xix. [PMID: 20599128 DOI: 10.1016/j.psc.2010.04.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Feigenbaum J. Self-harm – The solution not the problem: The Dialectical Behaviour Therapy Model. PSYCHOANALYTIC PSYCHOTHERAPY 2010. [DOI: 10.1080/02668731003707873] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Carter GL, Willcox CH, Lewin TJ, Conrad AM, Bendit N. Hunter DBT project: randomized controlled trial of dialectical behaviour therapy in women with borderline personality disorder. Aust N Z J Psychiatry 2010; 44:162-73. [PMID: 20113305 DOI: 10.3109/00048670903393621] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Deliberate self-harm (DSH), general hospital admission and psychiatric hospital admission are common in women meeting criteria for borderline personality disorder (BPD). Dialectical behaviour therapy (DBT) has been reported to be effective in reducing DSH and hospitalization. METHOD A randomized controlled trial of 73 female subjects meeting criteria for BPD was carried out with intention-to-treat analyses and per-protocol analyses. The intervention was DBT and the control condition was treatment as usual plus waiting list for DBT (TAU+WL), with outcomes measured after 6 months. Primary outcomes were differences in proportions and event rates of: any DSH; general hospital admission for DSH and any psychiatric admission; and mean difference in length of stay for any hospitalization. Secondary outcomes were disability and quality of life measures. RESULTS Both groups showed a reduction in DSH and hospitalizations, but there were no significant differences in DSH, hospital admissions or length of stay in hospital between groups. Disability (days spent in bed) and quality of life (Physical, Psychological and Environmental domains) were significantly improved for the DBT group. CONCLUSION DBT produced non-significant reductions in DSH and hospitalization when compared to the TAU+WL control, due in part to the lower than expected rates of hospitalization in the control condition. Nevertheless, DBT showed significant benefits for the secondary outcomes of improved disability and quality of life scores, a clinically useful result that is also in keeping with the theoretical constructs of the benefits of DBT.
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Affiliation(s)
- Gregory L Carter
- Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia.
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Abstract
A proposal made for DSM-IV was to include a means with which to provide a dimensional profile of a patient in terms of the diagnostic categories. However, a suggestion of the DSM-V Research Planning Conference on personality disorders was to develop a more fundamental revision through an integration of alternative dimensional models of personality disorder and general personality structure. A purpose of the current article is to provide this proposal. Also discussed is a primary concern with respect to the implementation of any such dimensional model: clinical utility. Discussed in particular are concerns regarding feasibility and treatment implications.
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Affiliation(s)
- Thomas A Widiger
- Department of Psychology, University of Kentucky, 106-B Kastle Hall, Lexington, KY 40506-0044, USA.
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Hodgetts A, Wright J, Gough A. Clients with borderline personality disorder: Exploring their experiences of dialectical behaviour therapy. COUNSELLING & PSYCHOTHERAPY RESEARCH 2007. [DOI: 10.1080/14733140701575036] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ivanovski B, Malhi GS. The psychological and neurophysiological concomitants of mindfulness forms of meditation. Acta Neuropsychiatr 2007; 19:76-91. [PMID: 26952819 DOI: 10.1111/j.1601-5215.2007.00175.x] [Citation(s) in RCA: 163] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To provide a comprehensive review and evaluation of the psychological and neurophysiological literature pertaining to mindfulness meditation. METHODS A search for papers in English was undertaken using PsycINFO (from 1804 onward), MedLine (from 1966 onward) and the Cochrane Library with the following search terms: Vipassana, Mindfulness, Meditation, Zen, Insight, EEG, ERP, fMRI, neuroimaging and intervention. In addition, retrieved papers and reports known to the authors were also reviewed for additional relevant literature. RESULTS Mindfulness-based therapeutic interventions appear to be effective in the treatment of depression, anxiety, psychosis, borderline personality disorder and suicidal/self-harm behaviour. Mindfulness meditation per se is effective in reducing substance use and recidivism rates in incarcerated populations but has not been specifically investigated in populations with psychiatric disorders. Electroencephalography research suggests increased alpha, theta and beta activity in frontal and posterior regions, some gamma band effects, with theta activity strongly related to level of experience of meditation; however, these findings have not been consistent. The few neuroimaging studies that have been conducted suggest volumetric and functional change in key brain regions. CONCLUSIONS Preliminary findings from treatment outcome studies provide support for the application of mindfulness-based interventions in the treatment of affective, anxiety and personality disorders. However, direct evidence for the effectiveness of mindfulness meditation per se in the treatment of psychiatric disorders is needed. Current neurophysiological and imaging research findings have identified neural changes in association with meditation and provide a potentially promising avenue for future research.
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Affiliation(s)
| | - Gin S Malhi
- 3Academic Discipline of Psychological Medicine, Northern Clinical School, University of Sydney
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Kröger C, Kosfelder J. Eine Meta-Analyse zur Wirksamkeit der Dialektisch Behavioralen Therapie bei Borderline-Persönlichkeitsstörungen. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2007. [DOI: 10.1026/1616-3443.36.1.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Die Dialektisch Behaviorale Therapie (DBT) gilt inzwischen als empirisch bewährte Behandlungsform für die Borderline-Persönlichkeitsstörung im ambulanten wie stationären Setting. Fragestellung: Wie groß ist die durchschnittliche Wirksamkeit in den bisherigen Studien? Gibt es Hinweise auf eine differenzielle Effektivität? Unterscheidet sich die Wirksamkeit im ursprünglich ambulanten Konzept von der stationären Adaptation? Methode: Eine Literaturrecherche erbringt zehn Primärstudien, die in die Meta-Analyse eingehen. Berechnet werden neben summarischen Effektstärken (ES) über alle Maße spezifische ES für die Bereiche Impulsivität, Soziale Anpassung und allgemeine Symptombelastung. Ergebnisse: Die globale Wirksamkeit der DBT liegt bei ES = 0,62. Verbesserungen der Sozialen Anpassung fallen mit einer ES von 1,09 noch höher aus. Zwischen ambulantem und stationärem Setting ergaben sich keine Unterschiede. Schlussfolgerungen: DBT kann als wirksames Behandlungsverfahren gelten. Notwendig erscheinen weitere kontrollierte Studien besonders im stationären Bereich.
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Paris J. Recent advances in the treatment of borderline personality disorder. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2005; 50:435-41. [PMID: 16127960 DOI: 10.1177/070674370505000802] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine recent research on the treatment of borderline personality disorder (BPD). METHOD A narrative review of all recent controlled trials of therapy for patients with BPD. RESULTS Various psychotherapeutic and psychopharmacological methods can be used to reduce impulsivity and dysphoric mood in this disorder. CONCLUSION There is strong support for well-structured forms of psychotherapy, but evidence for pharmacotherapy in BPD is mixed. Treatment can usually be carried out in an outpatient setting.
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Affiliation(s)
- Joel Paris
- Department of Psychiatry, McGill University, Montreal, Quebec.
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Useda JD, Duberstein PR, Conner KR, Conwell Y. Personality and attempted suicide in depressed adults 50 years of age and older: a facet level analysis. Compr Psychiatry 2004; 45:353-61. [PMID: 15332198 DOI: 10.1016/j.comppsych.2004.06.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We examined the contribution of personality traits to attempted suicide, the number of suicidal attempts, and suicidal ideation in a sample of depressed inpatients. Personality was assessed via the Revised NEO Personality Inventory (NEO-PI-R). Bivariate analyses showed that suicide attempters were more self-conscious, self-effacing, impulsive, and vulnerable to stress, and less warm, gregarious, and inclined to experience positive emotions. Multivariate regression analyses controlling for age, gender, severity of depression, and psychiatric comorbidity showed that patients with a lifetime history of attempted suicide were less inclined to experience positive emotions and be more self-effacing. Patients with more severe suicidal ideation were less warm and more self-effacing. Results indicated that specific personality traits confer risk for suicidal behaviors in middle age and older adults. Interventions tailored to specific personality profiles in this high-risk group should be developed, and their efficacy examined.
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Affiliation(s)
- J David Useda
- Laboratory of Personality and Development, Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester Medical Center, NY 14642, USA
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Huffman JC, Stern TA, Harley RM, Lundy NA. The use of DBT skills in the treatment of difficult patients in the General Hospital. PSYCHOSOMATICS 2003; 44:421-9. [PMID: 12954919 DOI: 10.1176/appi.psy.44.5.421] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jeff C Huffman
- Psychiatry Consultation Service, Massachusetts General Hospital, Boston, MA 02114, USA.
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Abstract
The confusion of personality disorders with Axis I disorders can be traced in part to inadequacies of assessment instruments and diagnostic criterion sets. However, it also reflects the absence of adequate conceptualization. If Axis I continues to include early onset, chronic impairments that characterize everyday functioning, then there is unlikely to be a clear or meaningful distinction. Inherent and unique to personality disorders is that they concern a person's sense of self and identity. They are disorders of everyday functioning. Personality disorders have an early onset, characterize everyday functioning, and relate closely to personality functioning evident within the general population; Axis I disorders, in contrast, have an onset throughout adult life, are episodic, and are readily distinguishable from normal personality functioning.
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Affiliation(s)
- Thomas A Widiger
- Department of Psychology, University of Kentucky, Lexington, 40506-0044, USA.
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Baer RA. Mindfulness training as a clinical intervention: A conceptual and empirical review. ACTA ACUST UNITED AC 2003. [DOI: 10.1093/clipsy.bpg015] [Citation(s) in RCA: 1445] [Impact Index Per Article: 68.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Pieters G, Vermote R. In-patient treatment of borderline personality disorder: convergences and divergences between a psychoanalytical and a cognitive-behavioral approach. Acta Neuropsychiatr 2002; 14:81-4. [PMID: 26983970 DOI: 10.1034/j.1601-5215.2002.140206.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
For more than 20 years, patients with borderline personality disorder have been treated as in-patients in the UC St-Jozef in Kortenberg, Belgium. The majority of these patients were treated in a psychoanalytical or a behavior therapy ward. During these years, the treatment programs of these wards were gradually adjusted to the challenges provided by these patients. In this paper, we will describe the process of change that both wards have experienced. We will highlight similarities and differences between the approaches that are the result of an evolution over years. In both approaches, there is a strong emphasis on training and support for staff. While the psychoanalytical ward uses a group approach, the behavior therapy ward evolves towards a more individualized treatment.
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Integrated behavioral treatment of comorbid OCD, PTSD, and borderline personality disorder: A case report. COGNITIVE AND BEHAVIORAL PRACTICE 2002. [DOI: 10.1016/s1077-7229(02)80004-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Interest in dialectical behavior therapy (DBT) as a treatment for personality disorders has increased dramatically in recent years. Although originally designed for the outpatient treatment of suicidal individuals with borderline personality disorder (BPD), DBT has been applied to many more diverse populations including comorbid substance dependence and BPD, inpatient treatment for BPD, as well as antisocial behaviors in juveniles and adults. This paper provides a brief overview of DBT, presents and evaluates the most recent literature on the application of DBT to the treatment of personality disorders, and highlights some of the current controversies surrounding the use of DBT.
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Affiliation(s)
- S L Rizvi
- Department of Psychology, Behavioral Research and Therapy Clinics, University of Washington, Seattle, WA 98195-1525, USA.
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Robins CJ. Expanding applications of dialectical behavior therapy: Prospects and pitfalls. COGNITIVE AND BEHAVIORAL PRACTICE 2000. [DOI: 10.1016/s1077-7229(00)80060-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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