Interpersonal outcome of cognitive behavioral treatment for chronically suicidal borderline patients

Linehan, Marsha M.; Tutek, Darren A.; Heard, Heidi L.; Armstrong, Hubert E.

doi:10.1176/ajp.151.12.1771

Cited by 387 publications

(35 citation statements)

References 22 publications

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“…Our results provide additional support that DBT has the capacity to improve functioning over time (Bohus et al, 2004; Linehan, Schmidt, Dimeff, Craft, Kanter, & Comtois, 1999; Linehan, Tutek, Heard, & Armstrong, 1994). GAS, GSA, and IIP showed quadratic relationships, indicating accelerated improvement that plateaued once treatment ended (e.g.…”

Section: Discussionsupporting

confidence: 62%

“…Gunderson et al, 2011; Skodal et al, 2002; Skodal et al, 2005; Stepp et al, 2012), and in the context of clinical trials (e.g. Bateman & Fonagy, 2008; Bohus et al, 2004; Linehan, Tutek, Heard, & Armstrong, 1994; Linehan, et al; 1999; McMain et al, 2012; Nadort et al, 2009), predictors of functioning have yet to be explored. Accordingly, we tested three principal hypotheses and one exploratory hypothesis: (1) functional outcomes will improve during the course of a treatment outcome study of DBT for suicidal women who meet criteria for BPD, (2) improvements in emotion dysregulation will be related to improved functioning, (3) increased skills use will be related to improved functioning, and (4) we will examine the possible bi-directionality of both emotion dysregulation and skills use on functional impairment.…”

Section: Introductionmentioning

confidence: 99%

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Dialectical behavior therapy and domains of functioning over two years

Wilks

Korslund

Harned

et al. 2016

Behaviour Research and Therapy

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Individuals diagnosed with borderline personality disorder (BPD) tend to have a significant degree of functional impairment across a range of social and occupational spheres including difficulty finding and maintaining satisfying employment, housing, or relationships. Understanding what factors are associated with functional impairment will enable treatment providers to move those diagnosed with BPD beyond symptomatic recovery and toward a life worth living. This paper investigated the trajectories and predictors of functional outcomes for suicidal women with BPD (N=99) during a treatment outcome study of Dialectical Behavior Therapy (DBT). Results revealed that participants had statistical and clinical improvements in functioning. Individuals with high emotion dysregulation displayed poorer psychosocial functioning at the subsequent assessment period and slower rates of change, which was also seen in reverse for one psychosocial functioning variable. Skills use was not related to individual trajectories in functioning. This study highlights the relationship of emotion dysregulation to functioning within a sample of suicidal women with BPD as well as the importance researching multiple domains in functioning.

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Section: Discussionsupporting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Dialectical behavior therapy and domains of functioning over two years

Wilks

Korslund

Harned

et al. 2016

Behaviour Research and Therapy

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“…Our results validate evaluations from the US, which were able to prove a reduction of suicidal and non-suicidal self-injurious behavior under the treatment with DBT in comparison to controls. This applies to both female adults and adolescents diagnosed with BPD symptoms [6,7,25]. In a 10-year prospective follow-up study on adult patients with BPD by Zanarini et al [26], 50% of patients recovered from borderline personality disorder which was defined as a remission of symptoms as well as social and vocational functioning during the previous two years.…”

Section: Discussionmentioning

confidence: 99%

Dialectical Behavioral Therapy for Adolescents (DBT-A): a clinical Trial for Patients with suicidal and self-injurious Behavior and Borderline Symptoms with a one-year Follow-up

Fleischhaker

Böhme

Sixt

et al. 2011

Child Adolesc Psychiatry Ment Health

201

131

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BackgroundTo date, there are no empirically validated treatments of good quality for adolescents showing suicidality and non-suicidal self-injurious behavior. Risk factors for suicide are impulsive and non-suicidal self-injurious behavior, depression, conduct disorders and child abuse. Behind this background, we tested the main hypothesis of our study; that Dialectical Behavioral Therapy for Adolescents is an effective treatment for these patients.MethodsDialectical Behavioral Therapy (DBT) has been developed by Marsha Linehan - especially for the outpatient treatment of chronically non-suicidal patients diagnosed with borderline personality disorder. The modified version of DBT for Adolescents (DBT-A) from Rathus & Miller has been adapted for a 16-24 week outpatient treatment in the German-speaking area by our group. The efficacy of treatment was measured by a pre-/post- comparison and a one-year follow-up with the aid of standardized instruments (SCL-90-R, CBCL, YSR, ILC, CGI).ResultsIn the pilot study, 12 adolescents were treated. At the beginning of therapy, 83% of patients fulfilled five or more DSM-IV criteria for borderline personality disorder. From the beginning of therapy to one year after its end, the mean value of these diagnostic criteria decreased significantly from 5.8 to 2.75. 75% of patients were kept in therapy. For the behavioral domains according to the SCL-90-R and YSR, we have found effect sizes between 0.54 and 2.14.During treatment, non-suicidal self-injurious behavior reduced significantly. Before the start of therapy, 8 of 12 patients had attempted suicide at least once. There were neither suicidal attempts during treatment with DBT-A nor at the one-year follow-up.ConclusionsThe promising results suggest that the interventions were well accepted by the patients and their families, and were associated with improvement in multiple domains including suicidality, non-suicidal self-injurious behavior, emotion dysregulation and depression from the beginning of therapy to the one-year follow-up.

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“…DBT [45] is an evidenced-based intervention with demonstrated efficacy for adults with borderline personality disorder [46], and has been adapted for adolescents with suicidality [47]. A primary focus of DBT is emotional dysregulation and, given the extreme emotional dysregulation experienced by youth with PBD [48,49], DBT has been applied to the treatment of adolescents with PBD to improve this feature of the disorder.…”

Section: Interventions With Support In Non-randomized Trialsmentioning

confidence: 99%

Psychosocial intervention for pediatric bipolar disorder: current and future directions

Weinstein¹,

West

Pavuluri

2013

Expert Review of Neurotherapeutics

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Summary Pediatric bipolar disorder (PBD) affects approximately two percent of the population and disrupts mood regulation, psychosocial functioning, and quality of life among affected youth and families. Given the significant psychosocial impairment and poor long-term prognosis associated with PBD, psychosocial intervention is considered to be an essential component of a multi-modal treatment approach. This relatively young field of research has witnessed significant growth in the evidence base for psychosocial treatments targeting youth in the past decade, particularly family-based interventions grounded in a biopsychosocial framework. This article reviews existing empirically-supported interventions for children and adolescents with PBD. Common elements of successful interventions are identified, and future research directions to address current limitations in the field and advance understanding of treatment for PBD are discussed.

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Interpersonal outcome of cognitive behavioral treatment for chronically suicidal borderline patients

Abstract: These results suggest that dialectical behavior therapy is a promising psychosocial intervention for improving interpersonal functioning among severely dysfunctional patients with borderline personality disorder.

Cited by 387 publications

References 22 publications

Dialectical behavior therapy and domains of functioning over two years

Dialectical behavior therapy and domains of functioning over two years

Dialectical Behavioral Therapy for Adolescents (DBT-A): a clinical Trial for Patients with suicidal and self-injurious Behavior and Borderline Symptoms with a one-year Follow-up

Psychosocial intervention for pediatric bipolar disorder: current and future directions

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