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Tobiassen AH, Sundal T, Stänicke E, Folmo EJ. The cultural change narrative as a core component of therapeutic change. Front Psychiatry 2023; 14:1149984. [PMID: 37867772 PMCID: PMC10587421 DOI: 10.3389/fpsyt.2023.1149984] [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: 01/23/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Research indicates a similar effect of Mentalization-based treatment (MBT) and Dialectical behavior therapy (DBT) for borderline personality disorder (BPD). However, there is a paucity in studies investigating the change narrative received from and developed in these treatments. The aim of the present study is to investigate similarities and differences in the change narratives provided by MBT and DBT, and how these narratives reflect the rationale, explanations, and procedures of the provided treatment. Methods The study is a qualitative analysis of seven interviews conducted by the authors. Three of the participants had received MBT, and four of the participants had received DBT. This study presents an Interpretative Phenomenological Analysis (IPA) of the change narratives received in two specialized treatments for BPD. Results The main findings from the IPA were that the change narratives described by the participants reflected the treatment they received. The DBT participants highlighted explicit learning of tools and techniques, with predictable and safe therapists. In contrast, the MBT participants emphasized a long-lasting process of exploring to create procedural learning with therapists who followed their lead. Discussion The participants' stories of change shed light on how a change narrative was developed, and therefore how the rationale, explanations and procedures were conveyed differently by MBT and DBT.
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Affiliation(s)
| | | | - Erik Stänicke
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
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2
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Ohlis A, Bjureberg J, Ojala O, Kerj E, Hallek C, Fruzzetti AE, Hellner C. Experiences of dialectical behaviour therapy for adolescents: A qualitative analysis. Psychol Psychother 2023; 96:410-425. [PMID: 36756991 DOI: 10.1111/papt.12447] [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: 05/03/2022] [Revised: 12/14/2022] [Accepted: 01/22/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVES To explore how former patients in dialectical behaviour therapy for adolescents (DBT-A) experience their treatment, and specifically if there were aspects of the treatment that they retrospectively identify as particularly meaningful, helpful or unhelpful. DESIGN From a larger sample of 75 former DBT-A patients 19 were selected for a qualitative semi-structured interview study. METHODS Young adults (N = 19; 18 females, one male), who as adolescents had been enrolled in DBT-A due to self-harming behaviours and features of borderline personality disorder, were interviewed up to 8 years (median 6.0; min 1.3; max 8.2) after end of treatment, at mean age 23 years (SD 2.5). Reflexive thematic analysis was implemented. RESULTS Six key themes were revealed; (1) The need to be seen, listened to and believed in, (2) the importance of teamwork between patient and therapist, (3) the value of group and structure, (4) therapy as lifesaving and life-changing, (5) the risks of feeling misplaced and (6) the risks of abrupt endings. CONCLUSION A trusting relationship with the therapist promoted commitment and motivation for treatment. This relationship was facilitated by the therapist showing explicit care and belief in the patient's own competence in changing their destructive behaviours. Meeting peers in group skill training offered a salient form of validation and was reported to be of particular value. The format of meeting peers and the importance of the dialectical therapeutic stance need to be studied further. Not all youth experienced DBT-A as suitable and the need for sufficient treatment dose was emphasized.
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Affiliation(s)
- Anna Ohlis
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Johan Bjureberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Department of Psychology, Stanford University, Stanford, California, USA
| | - Olivia Ojala
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Emme Kerj
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Camilla Hallek
- DBT-unit, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Alan E Fruzzetti
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Clara Hellner
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Francis JL, Sawyer A, Roberts R, Yelland C, Drioli-Phillips P, Sved Williams AE. Mothers with borderline personality disorders' experiences of mother-infant dialectical behavior therapy. J Clin Psychol 2022; 79:1245-1260. [PMID: 36515397 DOI: 10.1002/jclp.23465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/09/2022] [Accepted: 11/20/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is increasingly diagnosed in perinatal and infant settings, and research suggests that as well as an escalation of BPD symptoms in this period, these symptoms may also be detrimental to infant development. Providing tailored treatments during the postnatal period may help women and prevent an intergenerational cycle of emotional and interpersonal symptoms in infants. Mother-infant dialectical behavior therapy (MI-DBT) has produced promising, yet inconsistent, improvements on quantitative scales of maternal mental health and the mother-infant relationship. The qualitative evaluation may provide complementary information. AIMS This study aimed to explore the subjective experiences of women who had completed MI-DBT. MATERIAL AND METHODS Thematic analysis of semistructured interviews conducted on 13 women undertaking MI-DBT before, post, and 12 months after MI-DBT were analyzed for themes. RESULTS Five major themes were identified. Overall, the women expressed that their emotional literacy and regulation improved after MI-DBT, subsequently addressing key risks and challenges such as uncertainty around their child's cues, and low self-esteem, and potentially improving the women's mentalization capability. DISCUSSION AND CONCLUSIONS This study consolidates previous research on maternal BPD, and provides qualitative evidence of the benefits of MI-DBT for mothers as both individuals and as parents with likely flow-on effects for infants. Lived experience input for future adaptations was a valuable gain.
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Affiliation(s)
- Jaimee L Francis
- Department of psychology, University of Adelaide, Adelaide, Australia.,Novita Children' Service, St Marys, Australia
| | - Alyssa Sawyer
- Department of psychology, University of Adelaide, Adelaide, Australia
| | - Rachel Roberts
- Department of psychology, University of Adelaide, Adelaide, Australia
| | - Chris Yelland
- Perinatal and Infant Mental Health, Womens and Childrens Health Network, North Adelaide, Australia
| | | | - Anne E Sved Williams
- Perinatal and Infant Mental Health, Womens and Childrens Health Network, North Adelaide, Australia.,Department of Psychiatry, University of Adelaide, Adelaide, Australia
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4
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Tilley JL, Molina L, Luo X, Natarajan A, Casolaro L, Gonzalez A, Mahaffey B. Dialectical behaviour therapy (DBT) for high-risk transgender and gender diverse (TGD) youth: A qualitative study of youth and mental health providers' perspectives on intervention relevance. Psychol Psychother 2022; 95:1056-1070. [PMID: 36054170 PMCID: PMC10332383 DOI: 10.1111/papt.12418] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Despite the significant mental health challenges and unique treatment needs of transgender and gender diverse (TGD) youth, research on the acceptability of evidence-based treatments for these youth is limited. To address this gap, the current study explored the perceived relevance of dialectical behaviour therapy (DBT) for high-risk TGD youth. METHODS Qualitative data were collected from six focus group discussions with a purposive sample of 21 TGD youth aged 18-25 years old who endorsed a history of depression, suicidality or self-harm and individual interviews with 10 mental health treatment providers with prior DBT and TGD client experience. The data were analysed inductively using thematic content analysis. RESULTS The results highlighted the perceived relevance of DBT in targeting chronic and acute stressors, some of which are unique to TGD youth such as issues related to gender dysphoria, hormone-related treatment and gender identity. Possible areas for treatment modifications including the adaptation of body awareness exercises and physiological-related coping techniques for youth experiencing gender dysphoria, and the reinforcement of self-care skills, were identified. While interpersonal effectiveness skills were acknowledged as important, treatment providers highlighted a need to prioritize safety over the practice of these skills. This is because TGD youth often experience more hostile and prejudiced interpersonal experiences than their cisgender peers. CONCLUSION The study's findings shed light on previously unexplored perspectives of TGD youth and treatment providers on the perceived relevance of DBT and provide treatment providers and implementation researchers with some critical issues to consider when working with high-risk TGD youth.
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Affiliation(s)
- Jacqueline L. Tilley
- Psychological and Child & Human Development Area Group, National Institute of Education, Nanyang Technological University
| | - Lucero Molina
- Mind-Body Clinical Research Center, Department of Psychiatry and Behavioral Health, Stony Brook University
| | - Xiaochen Luo
- Department of Counseling Psychology, Santa Clara University
| | - Aaradhana Natarajan
- Mind-Body Clinical Research Center, Department of Psychiatry and Behavioral Health, Stony Brook University
| | - Leslye Casolaro
- Mind-Body Clinical Research Center, Department of Psychiatry and Behavioral Health, Stony Brook University
| | - Adam Gonzalez
- Mind-Body Clinical Research Center, Department of Psychiatry and Behavioral Health, Stony Brook University
| | - Brittain Mahaffey
- Mind-Body Clinical Research Center, Department of Psychiatry and Behavioral Health, Stony Brook University
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5
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Barnicot K, Redknap C, Coath F, Hommel J, Couldrey L, Crawford M. Patient experiences of therapy for borderline personality disorder: Commonalities and differences between dialectical behaviour therapy and mentalization-based therapy and relation to outcomes. Psychol Psychother 2022; 95:212-233. [PMID: 34459086 DOI: 10.1111/papt.12362] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/02/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Dialectical behaviour therapy (DBT) and mentalization-based therapy (MBT) are widely used evidence-based psychological treatments for borderline personality disorder (BPD). The study aimed to establish evidence on common and unique, and helpful and unhelpful, treatment processes. DESIGN Mixed-methods. METHODS In-depth qualitative interview data on patient experiences during treatment were combined with quantitative outcome measures in 73 patients diagnosed with a personality disorder and receiving DBT or MBT. RESULTS Across both DBT and MBT, accounts of learning not to react impulsively, learning to question one's thoughts and assumptions, learning to communicate more effectively, and exposure to painful emotions that may previously have been avoided were each associated with less baseline-adjusted self-harm at the end of treatment. Difficulties in interacting with other group members were more likely to be described by patients receiving MBT than DBT, whilst difficulties in the therapeutic relationship were equally common. Both of these types of difficult experience were associated with higher baseline-adjusted levels of BPD traits and emotional dysregulation, at the end of the 12-month study period. CONCLUSIONS The findings identify novel evidence of common therapeutic processes across DBT and MBT that may help to reduce self-harm. The findings also highlight the potential iatrogenic effect of difficulties in the alliance with therapists or with other group members. This underscores the importance of listening to patients' voices about what they are finding difficult during therapy and working to address these relational challenges, so that the patient is able to progress and make best use of the treatment. PRACTITIONER POINTS Regardless of whether dialectical behaviour therapy or mentalization based therapy is used, helping service-users to learn not to react impulsively, to question their thoughts and assumptions, and to communicate more effectively, may be beneficial for reducing self-harm. Across both types of therapy, exposure to painful emotions is a difficult experience for service-users, but may also be beneficial for reducing self-harm, if carefully managed. Whilst service-users' experiences across both types of therapy have much in common, accounts of mentalization based therapy stand out in more often describing both helpful and unhelpful experiences of interactions with therapy group members. Service-users across both types of therapy report the benefits of learning intrapersonal mentalization skills, whilst recipients of mentalization based therapy uniquely extend this to learning interpersonal mentalization. Ruptures in the therapeutic alliance, and distressing interactions with group members, may be iatrogenic and must be carefully managed.
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Affiliation(s)
- Kirsten Barnicot
- Division of Psychiatry, Imperial College London, UK.,Health Services Research & Management, City University of London, UK
| | - Caio Redknap
- Division of Psychiatry, Imperial College London, UK
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6
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Gillespie C, Murphy M, Kells M, Flynn D. Individuals who report having benefitted from dialectical behaviour therapy (DBT): a qualitative exploration of processes and experiences at long-term follow-up. Borderline Personal Disord Emot Dysregul 2022; 9:8. [PMID: 35227318 PMCID: PMC8885141 DOI: 10.1186/s40479-022-00179-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/27/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Qualitative research in the area of DBT is limited, particularly at follow-up. The current study explored the follow-up experiences of individuals who previously received a diagnosis of borderline personality disorder and self-report having benefitted from DBT at the time of treatment. METHODS Individuals who completed 12 months of standard DBT and were a minimum of two years post-completion were recruited. Individual semi-structured interviews were completed with a total of twelve participants. RESULTS A thematic analysis generated three main themes which indicated that participants found DBT had a positive impact on their lives in the years after the programme and enabled further development; gave them control over their lives and the ability to manage setbacks and difficult situations; and contributed to healthier and more meaningful relationships with others. CONCLUSIONS The findings of this study indicated that DBT contributed positively to the participants' lives and helped advance their recovery in the years after the programme. Despite the positive impact of DBT, participants required further support in the years following the intervention. Clinical and research implications of these findings are discussed.
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Affiliation(s)
- Conall Gillespie
- School of Applied Psychology, University College Cork, Cork, Ireland.
| | - Mike Murphy
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Mary Kells
- Mental Health Services, Cork Kerry Community Healthcare, Health Service Executive, Cork, Ireland
| | - Daniel Flynn
- Mental Health Services, Cork Kerry Community Healthcare, Health Service Executive, Cork, Ireland
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Bock MM, Graf T, Woeber V, Kothgassner OD, Buerger A, Plener PL. Radical Acceptance of Reality: Putting DBT®-A Skill Groups Online During the COVID-19 Pandemic: A Qualitative Study. Front Psychiatry 2022; 13:617941. [PMID: 35546945 PMCID: PMC9082632 DOI: 10.3389/fpsyt.2022.617941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/23/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Emotion dysregulation is a common challenge pertaining to numerous psychiatric disorders in adolescence and is associated with increased morbidity and mortality. Dialectical Behavior Therapy for Adolescents (DBT®-A) has been shown to be an effective treatment, especially in the reduction of self-harm and suicidality. Measures in relation to the COVID-19 pandemic set strict limits on physical contacts with patients. In order to continuously provide evidence-based specialized care to patients suffering from emotion dysregulation, we offered two online DBT®-A skill groups in a video-group-call format. OBJECTIVE We aimed at assessing our online DBT®-A skills groups, collect according up- and downsides, and form a basis for advancement of this form of treatment provision. Also, the impact of the COVID-19 pandemic on patients was assessed. METHODS A physical DBT®-A skill group was switched to a video-group-call format and a second group was initiated de novo online. After five sessions, patients engaged in structured group discussions to reflect experiences. Discussion content was analyzed via Inductive Category Formation within the Framework of Qualitative Content Analysis. RESULTS Patients unanimously found the COVID-19 pandemic challenging, but also reported differentially on its impact. Downsides were balanced by subjective "gains" in time and a perceived reduction in stress. Technical problems of the online format were discussed, but did not limit the positive experience of still receiving treatment. Patients of both online DBT®-A skill groups valued the offer, felt connected, and reported benefits from the treatment. The transition group additionally discussed changes in structure and content of the group sessions after the switch to online meetings and reflected differential functions of the group. DISCUSSION Although the sample size is small, and conclusions are drawn from Inductive Qualitative Content Analysis, the presented results are of interest. In our investigation, video-group-calls were both safe and beneficial for patients. This alternative to physical meetings is not only interesting for further waves of the current pandemic but also for service provision in remote areas with limited access to specialized care. Further research is needed to challenge and refine our results and to explore extensions to "basic" video-group-calls, such as "break-out sessions," blended therapy, or real-time supervision within an online session.
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Affiliation(s)
- Mercedes M Bock
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.,Psychosocial Services, Vienna, Austria
| | - Theres Graf
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Verena Woeber
- Department of Clinical Psychology and Psychotherapy, Wiener Gesundheitsverbund, University Clinic AKH, Vienna, Austria.,Department of Child and Adolescent Psychiatry, Wiener Gesundheitsverbund, University Clinic AKH, Vienna, Austria
| | - Oswald D Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Arne Buerger
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Würzburg, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.,Department of Child- and Adolescent Psychiatry and Psychotherapy, Medical University of Ulm, Ulm, Germany
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8
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Hestbæk E, Hasselby-Andersen M, Juul S, Beier N, Simonsen S. Mentalizing the patient-Patient experiences with short-term mentalization-based therapy for borderline personality disorder: A qualitative study. Front Psychiatry 2022; 13:1088872. [PMID: 36620679 PMCID: PMC9815536 DOI: 10.3389/fpsyt.2022.1088872] [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: 11/03/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Mentalization-based therapy (MBT) is an evidence-supported psychotherapy approach for borderline personality disorder (BPD) that has been implemented in mental health services worldwide. Originally, MBT was developed as an 18-months program for BPD. However, a short-term (5 months) MBT program has been developed. Research into patient experiences with long-term MBT for BPD is scarce, and no studies have investigated patient experience with short-term MBT for BPD. OBJECTIVE The objective of this study was to explore patient experience with short-term MBT for BPD in the Danish mental health services. METHODS Semi-structured qualitative interviews were conducted with 12 outpatients diagnosed with BPD, who attended short-term MBT for 5 months. The interviews were verbatim transcribed and analyzed using thematic analysis with double coding. RESULTS The analysis resulted in four subordinate themes: (1) Treatment duration - too short or appropriately short?, (2) The group as a "safe space," (3) Bad experiences impacted treatment negatively, and (4) My life has changed for the better. CONCLUSION The results suggest that most of the patients were overall satisfied with short-term MBT, which they experienced as having a positive impact on their lives. However, a subgroup of patients wanted more therapy. This study highlighted the strengths and limitations of short-term MBT for BPD as experienced by the patients, and points to barriers in developing service-user informed short-term treatment options for BPD.
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Affiliation(s)
- Emilie Hestbæk
- Stolpegaard Psychotherapy Centre, Mental Health Services, Gentofte, Denmark
| | - Mathilde Hasselby-Andersen
- Stolpegaard Psychotherapy Centre, Mental Health Services, Gentofte, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Sophie Juul
- Stolpegaard Psychotherapy Centre, Mental Health Services, Gentofte, Denmark.,Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Nynne Beier
- Stolpegaard Psychotherapy Centre, Mental Health Services, Gentofte, Denmark
| | - Sebastian Simonsen
- Stolpegaard Psychotherapy Centre, Mental Health Services, Gentofte, Denmark
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Schaich A, Braakmann D, Rogg M, Meine C, Ambrosch J, Assmann N, Borgwardt S, Schweiger U, Fassbinder E. How do patients with borderline personality disorder experience Distress Tolerance Skills in the context of dialectical behavioral therapy?-A qualitative study. PLoS One 2021; 16:e0252403. [PMID: 34129606 PMCID: PMC8205175 DOI: 10.1371/journal.pone.0252403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 05/16/2021] [Indexed: 11/19/2022] Open
Abstract
Distress Tolerance Skills (DTS) are an important component of Dialectical Behavioral Therapy (DBT), a therapy method frequently used for treating patients with Borderline Personality Disorder (BPD). However, little is known about how DTS-training is experienced by individuals with BPD. The aim of this study was to explore BPD patients’ experiences with receiving DTS-training. Qualitative data were collected through semi-structured interviews with 24 individuals (87.5% females) with a primary diagnosis of BPD who received DTS-training in the context of 18 months of DBT treatment. Interview data were analyzed following the procedures of qualitative content analysis. Participants reported various effects of DTS including an immediate reduction of tension. Patients perceived DTS as a tool to cope with difficult interpersonal situations and emergencies and stated that this helped them to feel stable, safe and self-confident. Patients reported difficulties during the initial engagement, the learning process and the application of DTS as well as various facilitating factors. Implications of the findings for further research and for optimizing DTS-training in clinical practice are discussed.
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Affiliation(s)
- Anja Schaich
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
- * E-mail:
| | - Diana Braakmann
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Mirco Rogg
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Clara Meine
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Julia Ambrosch
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Nele Assmann
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Ulrich Schweiger
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Eva Fassbinder
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
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10
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Prajapati R, Liebling H. Accessing Mental Health Services: a Systematic Review and Meta-ethnography of the Experiences of South Asian Service Users in the UK. J Racial Ethn Health Disparities 2021; 9:598-619. [PMID: 33686621 PMCID: PMC8897382 DOI: 10.1007/s40615-021-00993-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/03/2021] [Accepted: 02/07/2021] [Indexed: 12/13/2022]
Abstract
Background Despite calls to address ethnic inequalities to accessing mental health services in the UK, governmental initiatives have had limited impact. Studies indicate that South Asian communities underutilise mental health services. Previous reviews have identified cultural and institutional factors that may influence service use, but these are mostly narrative and limited in their scope. Method A systematic literature search resulted in fifteen studies exploring the experiences of seeking help and barriers to accessing and using services from the perspective of British South Asian service users. Findings Qualitative data was synthesised through meta-ethnography, and three themes emerged: Distanced from Services, Dilemma of Trust and Threat to Cultural Identity. South Asian service users were positioned at a distance from being able to access services and stuck in a dilemma of mistrusting White and Asian professionals. They constructed their cultural identity through a set of important values which were neglected by mental health services. Service users, therefore, appeared to engage in an ongoing evaluation of the potential benefits of accessing services against the risks of threat to their personal and cultural identities. The findings are discussed in relation to Eurocentric models of care and community engagement approaches. Conclusion The review argues that institutional racism and cultural dissonance marginalise South Asian service users from access to quality and effective mental healthcare. It is recommended that services acknowledge the impact of alienation and powerlessness and advance their practices to establish trust and cultural safety for South Asian service users in the UK.
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Affiliation(s)
- Riddhi Prajapati
- Faculty of Health and Life Sciences, Coventry University, Priory Street, Coventry, CV1 5FB UK
| | - Helen Liebling
- Faculty of Health and Life Sciences, Coventry University, Priory Street, Coventry, CV1 5FB UK
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11
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Lakeman R, Emeleus M. The process of recovery and change in a dialectical behaviour therapy programme for youth. Int J Ment Health Nurs 2020; 29:1092-1100. [PMID: 32535985 DOI: 10.1111/inm.12749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/10/2020] [Accepted: 05/15/2020] [Indexed: 01/08/2023]
Abstract
Dialectical behaviour therapy (DBT) is an effective treatment for borderline personality disorder and suicidal behaviour. However, it is a complex programme involving individual therapy, participation in skills training groups, and phone coaching aimed at improving emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness. Little is known about what elements contribute to its effectiveness, or the characteristics of those who complete the programme and achieve recovery. In this study, six participants in a dialectical behaviour therapy programme for youth were interviewed at three time points over their recovery journey. The transcribed narratives were analysed using inductive methods, and the core processes related to recovery were elucidated and described: 'Becoming a cheerleader for DBT' and 'Learning the language of DBT and consolidation of skills'. Indicators of recovery included having a sound working alliance with the primary therapist and others involved in the programme and noticing meaningful improvements in problem areas which they attributed to particular skills and improved capacity to regulate emotions. The rich narrative description provided by participants might inspire some to remain engaged in a dialectical behavioural therapy programme or clinicians to consider promoting a positive view of the prognosis for borderline personality disorder.
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Affiliation(s)
| | - Mary Emeleus
- Queensland Health, Brisbane, Queensland, Australia
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12
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Dialectical Behaviour Therapy for Emotion Regulation Difficulties: A Systematic Review. BEHAVIOUR CHANGE 2019. [DOI: 10.1017/bec.2019.9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AbstractWhile dialectical behaviour therapy (DBT) appears efficacious in reducing suicidal and self-harming behaviour, it is unclear whether DBT reduces emotion regulation (ER) difficulties, a purported mechanism of change of treatment. This review aims to investigate and evaluate the current evidence to understand the effectiveness of DBT in improving ER difficulties. A qualitative synthesis of studies investigating the effectiveness of DBT on self-reported ER difficulties as measured by the Difficulties in Emotion Regulation Scale (DERS) was performed, identifying eligible studies using PsycINFO, PubMed, MEDLINE and EMBASE databases. Fourteen studies were identified. Current evidence indicates that DBT does not show consistent benefits relative to existing psychological treatments in improving ER difficulties. The literature is compromised by significant methodological limitations increasing risk of bias across study outcomes. Furthermore, high variability across DBT programs and a lack of investigation regarding adherence and participant engagement within interventions was observed. Further research is needed in order to conclude regarding the effectiveness of DBT in improving ER difficulties. Consistent use of active treatment conditions, greater standardisation of DBT-based interventions, in addition to further examination of participant engagement level in DBT-based interventions in the long term may assist understanding as to whether DBT improves ER difficulties.
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Kverme B, Natvik E, Veseth M, Moltu C. Moving Toward Connectedness - A Qualitative Study of Recovery Processes for People With Borderline Personality Disorder. Front Psychol 2019; 10:430. [PMID: 30873097 PMCID: PMC6403141 DOI: 10.3389/fpsyg.2019.00430] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/12/2019] [Indexed: 11/29/2022] Open
Abstract
Borderline personality disorder (BPD) is a mental health disorder estimated to affect 1–2% of the general population. As a group, people with BPD endure a high degree of suffering, often leading to suicide attempts, self-harm, and suicide. Comparatively few studies explore the first person perspective of the person suffering from any mental health disorder. This might be especially problematic for people diagnosed with BPD, as this particular diagnosis is followed by stigma potentially making help seeking harder and helping relationships more vulnerable. We interviewed 12 female participants recently diagnosed with BPD in-depth about their experiences with recovery and treatment, and used a stepwise reflective approach to rigorously analyze the data. Results show an overarching theme of working toward connectedness, with four constituent sub-themes. We discuss the findings with regard to empirical work, recovery and autonomy, and the risk of epistemic injustice that people with BPD risk facing.
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Affiliation(s)
- Britt Kverme
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
| | - Eli Natvik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - Marius Veseth
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Christian Moltu
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway.,Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
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Browne C, Brown G, Smith IC. Adapting dialectical behaviour therapy in forensic learning disability services: A grounded theory informed study of "what works". JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:792-805. [PMID: 30687987 DOI: 10.1111/jar.12569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 12/18/2018] [Accepted: 01/06/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Emerging evidence indicates effectiveness of dialectical behaviour therapy (DBT) for people with intellectual disabilities (PWID) in forensic settings; however, little is known about "what works" facilitating engagement and change. METHODS Eleven interviews were conducted with nine service users across two secure inpatient services. Grounded theory was used to develop a model of perceived engagement and change. RESULTS The model provides insights into how change occurs during DBT delivered in forensic settings. DBT constitutes a challenging journey, yet provides the motivation and means to address individual's intra-/interpersonal aggression and progress towards release. Participants experienced engaging with DBT as difficult and coercive, moving from compliance and avoidance to acceptance and change. Key factors included participants' motivation, beliefs about safety and ability to change, and interactions with staff. CONCLUSION Recommendations are made for increasing intrinsic motivation, reducing perceived coercion and distress, and for future research to address potential aversive elements and enhance effectiveness.
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Affiliation(s)
- Claire Browne
- Clinical Psychology Programme, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Gill Brown
- Clinical Psychology Programme, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Ian C Smith
- Clinical Psychology Programme, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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