Adolescent Characteristics that Predict Success of Mindfulness Therapy to Reduce Self-Harm and Suicidality

Adolescent Characteristics that Predict Success of Mindfulness Therapy to Reduce Self-Harm and Suicidality

 

By John M. de Castro, Ph.D.

 

The pain of depression is quite unimaginable to those who have not suffered it,  and it kills in many instances because its anguish can no longer be borne.
The prevention of many suicides will continue to be hindered until there is a general awareness of the nature of this pain.” – William Styron

 

Around 43,000 people take their own lives each year in the US. Someone dies from suicide every 12.3 minutes. Worldwide over 800,000 people die by suicide every year. (Suicide Awareness Voices of Education). It is much more prevalent with males who account for 79% of suicides. The problem is far worse than these statistics suggest as it has been estimated that for every completed suicide there were 12 unsuccessful attempts. In other words, about a half a million people in the U.S. attempt suicide each year. Yet compared with other life-threatening conditions there has been scant research on how to identify potential suicide attempters, intervene, and reduce suicidality.

 

Mindfulness training has been shown to reduce suicidality. Dialectical Behavior Therapy (DBT) is a mindfulness-based therapy targeted at changing the problem behaviors including self-injury and suicide. Behavior change is accomplished through focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors. In DBT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness. It is important to identify the characteristics of adolescents who are most likely to benefit from DBT for the reduction of suicide.

 

In today’s Research News article “Predictors and moderators of recurring self‐harm in adolescents participating in a comparative treatment trial of psychological interventions.” (See summary below or view the full text of the study at: https://onlinelibrary.wiley.com/doi/full/10.1111/jcpp.13099), Adrian and colleagues recruited adolescents with previous lifetime suicide attempt, repetitive self‐harm in the past 12 weeks, borderline personality disorder (BPD) characteristics, and clinically significant suicidal ideation. They were randomly assigned to receive 6-months of either Dialectical Behavior Therapy (DBT) or individual/group supportive therapy. They were measured before and after treatment and at the midpoint of treatment for suicide attempts, non-suicidal self-injuries, self-harm, prior self-harm severity, externalizing symptoms, other psychiatric disorders, substance abuse, PTSD symptoms, borderline personality disorder (BPD) symptoms, adolescent-parent conflict, and emotional dysregulation. In addition, their parents were measured for emotional distress and adolescent-parent conflict.

 

They found that non-white adolescents had a greater response to treatment than white adolescents in the reduction in suicide ideation. The adolescent’s pre-treatment history also affected the response to treatment with adolescents with greater levels of family conflict, more extensive self‐harm histories, and more externalizing problems having a greater reduction in self-harm. They also found that Dialectical Behavior Therapy (DBT) was more effective for adolescents who were high in emotional dysregulation and whose parents had greater psychopathology and emotional dysregulation.

 

These results are interesting and suggest that certain adolescents are more responsive to treatment than others. Non-white (particularly Latino) youths, adolescents with greater levels of family conflict, more extensive self‐harm histories, more externalizing problems, higher in emotional dysregulation and whose parents had greater psychopathology and emotional dysregulation had more positive changes produced by therapy. These factors may be used to triage which youths would be most likely to benefit from different therapies and thus may potentiate therapeutic benefits.

 

Suicide is a major problem for adolescents and self-harm, self-injury, suicide ideation, and suicide attempts are all indicators of potential lethal outcomes. So, treatment is extremely important. Dialectical Behavior Therapy (DBT) appears to be effective but it is particularly effective for certain youths. Knowing this can help target and refine therapy to improve therapeutic effectiveness in reducing suicides in adolescents.

 

So, reduce suicidality in certain adolescents with mindfulness.

 

“Being curious about your suicidal thoughts is another part of mindful observation. If you have the thought, “I should kill myself,” how does it affect the thought’s meaning to then tell yourself, “Hmm, I wonder why I just had the thought that I should kill myself?” – Stacey Freedenthal

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Molly Adrian, Elizabeth McCauley, Michele S. Berk, Joan R. Asarnow, Kathryn Korslund, Claudia Avina, Robert Gallop, Marsha M. Linehan. Predictors and moderators of recurring self‐harm in adolescents participating in a comparative treatment trial of psychological interventions. Journal of Child Psychology and Psychiatry, 30 July 2019, 60(10), 1123-1132, https://doi.org/10.1111/jcpp.13099

 

Key points

  • Adolescent prior self‐harm, externalizing problems, and reported family conflict were significant predictors of change in self‐harm, NSSI, and suicidal ideation, where adolescents with higher family conflict and less severe self‐harm history produced on average more reduction in SH from baseline to post‐treatment.
  • DBT produced better rate of improvement compared to IGST for adolescents who were emotionally dysregulation and whose parents had higher baseline emotion dysregulation and psychopathology.
  • Clinicians could consider either IGST or DBT for adolescents with self‐harm histories whose parents are well regulated and do not have impairing psychopathology. Adolescents with emotional dysregulation and parents with psychopathology and emotion dysregulation may benefit more from DBT than IGST.

Abstract

Background

In primary analyses, dialectical behavior therapy (DBT) was associated with greater reduction in self‐harm during treatment than individual/group supportive therapy (IGST). The objective of this paper was to examine predictors and moderators of treatment outcomes for suicidal adolescents who participated in a randomized controlled trial evaluating DBT and IGST.

Methods

Adolescents (N = 173) were included in the intent‐to‐treat sample and randomized to receive 6 months of DBT or IGST. Potential baseline predictors and moderators were identified within four categories: demographics, severity markers, parental psychopathology, and psychosocial variables. Primary outcomes were suicide attempts (SA) and nonsuicidal self‐injury evaluated at baseline, midtreatment (3 months), and end of treatment (6 months) via the Suicide Attempt and Self‐Injury Interview (Psychological Assessment, 18, 2006, 303). For each moderator or predictor, a generalized linear mixed model was conducted to examine main and interactive effects of treatment and the candidate variable on outcomes.

Results

Adolescents with higher family conflict, more extensive self‐harm histories, and more externalizing problems produced on average more reduction on SH frequency from baseline to post‐treatment. Adolescents meeting BPD diagnosis were more likely to have high SH frequency at post‐treatment. Analyses indicated significant moderation effects for emotion dysregulation on NSSI and SH. DBT was associated with better rates of improvement compared to IGST for adolescents with higher baseline emotion dysregulation and those whose parents reported greater psychopathology and emotion dysregulation. A significant moderation effect for ethnicity on SA over the treatment period was observed, where DBT produced better rate of improvement compared to IGST for Hispanic/Latino individuals.

Conclusions

These findings may help to inform salient treatment targets and guide treatment planning. Adolescents that have high levels of family conflict, externalizing problems, and increased level of severity markers demonstrated the most change in self‐harm behaviors over the course of treatment and benefitted from both treatment interventions. Those with higher levels of emotion dysregulation and parent psychopathology may benefit more from the DBT.

https://onlinelibrary.wiley.com/doi/full/10.1111/jcpp.13099

 

Brain Activity Predicts the Effectiveness of Dialectical Behavior Therapy for Borderline Personality Disorder

Brain Activity Predicts the Effectiveness of Dialectical Behavior Therapy for Borderline Personality Disorder

 

By John M. de Castro, Ph.D.

 

“Dialectical behavior therapy (DBT). . . is a type of psychotherapy, sometimes called “talk therapy,” used to treat borderline personality disorder (BPD). DBT is a form of cognitive behavioral therapy (CBT).” – Kristalyn Salters-Pedneault

 

Borderline Personality Disorder (BPD) is a very serious mental illness that is estimated to affect 1.6% of the U.S. population. It involves unstable moods, behavior, and relationships, problems with regulating emotions and thoughts, impulsive and reckless behavior, and unstable relationships. BPD is associated with high rates of co-occurring depression, anxiety disorders, substance abuse, eating disorders, self-harm, suicidal behaviors, and completed suicides. Needless to say, it is widespread and debilitating.

 

One of the few treatments that appears to be effective for Borderline Personality Disorder (BPD) is Dialectical Behavior Therapy (DBT). It is targeted at changing the problem behaviors characteristic of BPD including self-injury. Behavior change is accomplished through focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors. In DBT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness.

 

The nervous system is a dynamic entity, constantly changing and adapting to the environment. It will change size, activity, and connectivity in response to experience. These changes in the brain are called neuroplasticity. It is unknown how Dialectical Behavior Therapy may interact with brain systems to improve the responsiveness of Borderline Personality Disorder (BPD) to Dialectical Behavior Therapy (DBT).

 

In today’s Research News article “Individualized treatment response prediction of dialectical behavior therapy for borderline personality disorder using multimodal magnetic resonance imaging.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6749487/), Schmitgen and colleagues recruited female patients suffering from Borderline Personality Disorder (BPD) who were treated with a 12-week program of Dialectical Behavior Therapy (DBT). They were classified into patients who had significantly benefited from treatment (responders) and those who did not (non-responders). Prior to the therapy the participants underwent functional Magnetic Resonance Imaging (fMRI) of their brains while performing cognitive reappraisal, sensory distraction and cognitive distraction tasks. They were also measured for BPD symptom severity, emotion regulation, dissociative experiences, anxiety, depression, and working memory.

 

They found that before treatment responders had significantly higher levels of borderline symptoms and borderline severity and higher anxiety levels than non-responders. They also found that activation of the amygdala and parahippocampus areas during a cognitive reappraisal task, along with borderline personality disorder severity and the gray matter volume of the amygdala produced the best predictors of responders vs. non-responders.

 

It appears that Dialectical Behavior Therapy (DBT) for Borderline Personality Disorder (BPD) works best with patients who have the most severe symptoms and whose amygdala and parahippocampus areas are largest and respond most to a cognitive reappraisal task. These areas are associated with the brain systems underlying emotion regulation. Hence, the results suggest that particularly severe borderline patients whose brains respond best to emotional stimuli are the best responders to DBT. This suggests that the patients whose brains are best able to regulate emotions respond best to DBT.

 

Hence, brain activity predicts the effectiveness of Dialectical Behavior Therapy (DBT) for Borderline Personality Disorder (BPD).

 

“one thing that has really helped in my recovery process, I would say dialectical behavior therapy. I eat, sleep and breathe DBT. I can give you a damn good crash course in mindfulness, which is a core concept in DBT. I can teach you about self-validation. I can spoon-feed you lessons and lessons on interpersonal effectiveness. DBT has truly been a gift to me.” – Borderline Beauty

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Schmitgen, M. M., Niedtfeld, I., Schmitt, R., Mancke, F., Winter, D., Schmahl, C., & Herpertz, S. C. (2019). Individualized treatment response prediction of dialectical behavior therapy for borderline personality disorder using multimodal magnetic resonance imaging. Brain and behavior, 9(9), e01384. doi:10.1002/brb3.1384

 

Abstract

Introduction

Individualized treatment prediction is crucial for the development and selection of personalized psychiatric interventions. Here, we use random forest classification via pretreatment clinical and demographical (CD), functional, and structural magnetic resonance imaging (MRI) data from patients with borderline personality disorder (BPD) to predict individual treatment response.

Methods

Before dialectical behavior therapy (DBT), 31 female patients underwent functional (three different emotion regulation tasks) and structural MRI. DBT response was predicted using CD and MRI data in previously identified anatomical regions, which have been reported to be multimodally affected in BPD.

Results

Amygdala and parahippocampus activation during a cognitive reappraisal task (in contrasts displaying neural activation for emotional challenge and for regulation), along with severity measures of BPD psychopathology and gray matter volume of the amygdala, provided best predictive power with neuronal hyperractivities in nonresponders. All models, except one model using CD data solely, achieved significantly better accuracy (>70.25%) than a simple all‐respond model, with sensitivity and specificity of >0.7 and >0.7, as well as positive and negative likelihood ratios of >2.74 and <0.36 each. Surprisingly, a model combining all data modalities only reached rank five of seven. Among the functional tasks, only the activation elicited by a cognitive reappraisal paradigm yielded sufficient predictive power to enter the final models.

Conclusion

This proof of principle study shows that it is possible to achieve good predictions of psychotherapy outcome to find the most valid predictors among numerous variables via using a random forest classification approach.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6749487/

 

Reduce Suicide with Mindfulness

Reduce Suicide with Mindfulness

 

By John M. de Castro, Ph.D.

 

The pain of depression is quite unimaginable to those who have not suffered it, and it kills in many instances because its anguish can no longer be borne.
The prevention of many suicides will continue to be hindered until there is a general awareness of the nature of this pain.” – William Styron

 

After cancer and heart disease, suicide accounts for more years of life lost than any other cause. Around 43,000 people take their own lives each year in the US. Someone dies from suicide every 12.3 minutes. Worldwide over 800,000 people die by suicide every year. (Suicide Awareness Voices of Education). It is much more prevalent with males who account for 79% of suicides. The problem is far worse than these statistics suggest as it has been estimated that for every completed suicide there were 12 unsuccessful attempts. In other words, about a half a million people in the U.S. attempt suicide each year. Yet compared with other life-threatening conditions there has been scant research on how to identify potential suicide attempters, intervene, and reduce suicidality.

 

Mindfulness training has been shown to reduce suicidality. Dialectical Behavior Therapy (DBT) is a mindfulness-based therapy targeted at changing the problem behaviors including self-injury and suicide. Behavior change is accomplished through focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors. In DBT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness. Hence it makes sense to further study the ability of DBT to reduce suicides in adolescents.

 

In today’s Research News article “Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide: A Randomized Clinical Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584278/), McCauley and colleagues recruited adolescents (12-18 years of age) with at least one suicide attempt, elevated suicide ideation, a history of self-harm, and symptoms of Borderline Personality Disorder (BPD). They were randomly assigned to receive 6 months of individualized group therapy either of Dialectical Behavior Therapy (DBT) or individual and group non-directive supportive therapy. They were measured before, midway and after treatment and 3 and 6 months later for suicides, suicide ideation, self-harm, mood, anxiety, psychosis, eating disorders, Borderline Personality Disorder (BPD), substance abuse, and externalizing symptoms.

 

They found that in comparison to individual and group non-directive supportive therapy, the participants in Dialectical Behavior Therapy (DBT) attended more sessions, remained in treatment longer, and had higher completing rates. Importantly, after treatment, the group receiving Dialectical Behavior Therapy (DBT) had significantly fewer suicide attempts, less self-harm, and significantly higher rates of clinical change.

 

These are important results that suggests that Dialectical Behavior Therapy (DBT) is an effective treatment for adolescents with a history of suicide attempts and self-harm. Since compliance and completion rates were high, it suggests that the treatment was acceptable to the youths. The fact that DBT was compared to another therapy is important as it demonstrates that participant expectancy effects or placebo effects cannot account for the findings. They are also important as they suggest that DBT may help save adolescent lives in a very vulnerable population or at the very least help to relieve their suffering.

 

So, reduce suicide with mindfulness.

 

“In general, the practice of mindfulness involves observing your thoughts without buying into them. You label your thoughts as just that – thoughts. Not necessarily truth. Not necessarily a call to action. If you have the thought, “I should kill myself,” you can then observe, “I just had the thought that I should kill myself.” – Stephanie Freedenthal

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

McCauley, E., Berk, M. S., Asarnow, J. R., Adrian, M., Cohen, J., Korslund, K., … Linehan, M. M. (2018). Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide: A Randomized Clinical Trial. JAMA psychiatry, 75(8), 777–785. doi:10.1001/jamapsychiatry.2018.1109

 

Key Points

Question

Is dialectical behavior therapy more effective than individual and group supportive therapy in reducing suicide attempts and nonsuicidal self-injury in suicidal adolescents?

Findings

This multisite randomized clinical trial of 173 adolescents indicated a significant advantage for dialectical behavior therapy compared with individual and group supportive therapy for reducing repeat suicide attempts, nonsuicidal self-injury, and total self-harm after treatment. Although the dialectical behavior therapy advantage weakened over time, secondary analyses indicated that youths receiving dialectical behavior therapy were more likely to respond to treatment, indexed by the absence of any self-harm, after treatment and at 12-month follow-up.

Meaning

Dialectical behavior therapy is effective for reducing repeat suicide attempts among highly suicidal adolescents, underscoring the value of dialectical behavior therapy in suicide prevention initiatives.

Abstract

Importance

Suicide is a leading cause of death among 10- to 24-year-old individuals in the United States; evidence on effective treatment for adolescents who engage in suicidal and self-harm behaviors is limited.

Objective

To evaluate the efficacy of dialectical behavior therapy (DBT) compared with individual and group supportive therapy (IGST) for reducing suicide attempts, nonsuicidal self-injury, and overall self-harm among high-risk youths.

Design, Setting, and Participants

This randomized clinical trial was conducted from January 1, 2012, through August 31, 2014, at 4 academic medical centers. A total of 173 participants (pool of 195; 22 withdrew or were excluded) 12 to 18 years of age with a prior lifetime suicide attempt (≥3 prior self-harm episodes, suicidal ideation, or emotional dysregulation) were studied. Adaptive randomization balanced participants across conditions within sites based on age, number of prior suicide attempts, and psychotropic medication use. Participants were followed up for 1 year.

Interventions

Study participants were randomly assigned to DBT or IGST. Treatment duration was 6 months. Both groups had weekly individual and group psychotherapy, therapist consultation meetings, and parent contact as needed.

Main Outcomes and Measures

A priori planned outcomes were suicide attempts, nonsuicidal self-injury, and total self-harm assessed using the Suicide Attempt Self-Injury Interview.

Results

A total of 173 adolescents (163 [94.8%] female and 97 [56.4%] white; mean [SD] age, 14.89 [1.47] years) were studied. Significant advantages were found for DBT on all primary outcomes after treatment: suicide attempts (65 [90.3%] of 72 receiving DBT vs 51 [78.9%] of 65 receiving IGST with no suicide attempts; odds ratio [OR], 0.30; 95% CI, 0.10-0.91), nonsuicidal self-injury (41 [56.9%] of 72 receiving DBT vs 26 [40.0%] of 65 receiving IGST with no self-injury; OR, 0.32; 95% CI, 0.13-0.70), and self-harm (39 [54.2%] of 72 receiving DBT vs 24 [36.9%] of 65 receiving IGST with no self-harm; OR, 0.33; 95% CI, 0.14-0.78). Rates of self-harm decreased through 1-year follow-up. The advantage of DBT decreased, with no statistically significant between-group differences from 6 to 12 months (OR, 0.65; 95% CI, 0.12-3.36; P = .61). Treatment completion rates were higher for DBT (75.6%) than for IGST (55.2%), but pattern-mixture models indicated that this difference did not informatively affect outcomes.

Conclusions and Relevance

The results of this trial support the efficacy of DBT for reducing self-harm and suicide attempts in highly suicidal self-harming adolescents. On the basis of the criteria of 2 independent trials supporting efficacy, results support DBT as the first well-established, empirically supported treatment for decreasing repeated suicide attempts and self-harm in youths.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584278/Importance

 

Improve Bulimia and Binge Eating Disorder with Mindfulness

Improve Bulimia and Binge Eating Disorder with Mindfulness

 

By John M. de Castro, Ph.D.

 

“mindfulness techniques. . . . can prevent destructive behaviors such as not eating, purging, or eating until uncomfortably full. If individuals take a step back and focus on the present moment and their feelings, they will be able to transform impulsive eating habits into healthy thoughts and behaviors.” – Eating Disorders Recovery

 

Around 30 million people in the United States of all ages and genders suffer from an eating disorder; either anorexia nervosa, bulimia, or binge eating disorder. 95% of those who have eating disorders are between the ages of 12 and 26. Eating disorders are not just troubling psychological problems, they can be deadly, having the highest mortality rate of any mental illness. Binge eating disorder involves eating a large amount of food within a short time-period while experiencing a sense of loss of control over eating. Bulimia involves binge-eating and also involves purging (e.g., self-induced vomiting, compensatory exercise).

 

Eating disorders can be difficult to treat because eating is necessary and cannot be simply stopped as in smoking cessation or abstaining from drugs or alcohol. One must learn to eat appropriately not stop. So, it is important to find methods that can help prevent and treat eating disorders. Contemplative practices, mindfulness, and mindful eating have shown promise for treating eating disorders. Acceptance and Commitment Therapy (ACT) is a mindfulness-based therapy that has also been shown to alter eating behavior. Dialectical Behavior Therapy (DBT) produces behavior change by focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors. In DBT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness. Mindfulness and acceptance-based treatments in general produce change by targeting acceptance, mindfulness, psychological flexibility, cognitive diffusion/distancing, and emotion regulation.

 

Scientific studies of the application of mindfulness and acceptance-based treatments for eating disorders has been accumulating. So, it makes sense to step back and take a look at what has been learned. In today’s Research News article “Mechanisms and moderators in mindfulness- and acceptance-based treatments for binge eating spectrum disorders: A systematic review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6570825/), Barney and colleagues review, summarize, and perform a meta-analysis of the published scientific research on the effectiveness of mindfulness and acceptance based therapies for the treatment of bulimia and binge eating disorder. They identified 39 studies, 7 utilizing ACT, 22 DBT, and 10 mindfulness-based interventions.

 

They report that the published research studies found that Acceptance and Commitment Therapy (ACT) produced significant improvements in bulimia and binge eating disorder and it appears that ACT has its effects by improving psychological flexibility. They also report that Dialectical Behavior Therapy (DBT) similarly produced significant improvements in bulimia and binge eating disorder and it appears that DBT has its effects by improving emotion regulation. Finally, they report that mindfulness-based interventions also produced significant improvements in bulimia and binge eating disorder and it appears that these therapies have their effects by improving mindfulness and awareness skills.

 

Hence, the published scientific research clearly establishes that mindfulness and acceptance-based therapies are safe and effective for the treatment of bulimia and binge eating disorder. It appears that the different therapies may work through different processes in having their effects on eating disorders. The authors conclude that there is a need to study factors that may moderate the effects of these mindfulness and acceptance-based therapies on eating disorders.

 

So, Improve Bulimia and Binge Eating Disorder with Mindfulness.

 

“Studies in mindfulness techniques has shown that participants practising mindfulness enjoyed significant reductions in weight and shape concern, dietary restraint, thin-ideal internalisation, eating disorder symptoms and psychosocial impairment.” – Janette Grant

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Barney, J. L., Murray, H. B., Manasse, S. M., Dochat, C., & Juarascio, A. S. (2019). Mechanisms and moderators in mindfulness- and acceptance-based treatments for binge eating spectrum disorders: A systematic review. European eating disorders review : the journal of the Eating Disorders Association, 27(4), 352–380. doi:10.1002/erv.2673

 

Highlights:

  • Analyses of mechanisms of action and moderators of treatment outcome in MABTs for BN and BED are crucial for enhancing the efficiency of treatment development and dissemination.
  • Research to date supports improvements in theoretically consistent mechanisms of action from pre- to post-treatment when using MABTs for BN and BED, however conclusions relevant to whether these changes are occurring as theorized are limited by the use of substandard mediation methods, inconsistent measurement tools across studies, and infrequent use of mid-treatment assessment points.
  • Recommendations for enhancing future research on mechanisms of action and moderators of treatment outcome are discussed.

Abstract

Objective:

Increasing evidence suggests that mindfulness- and acceptance-based psychotherapies (MABTs) for bulimia nervosa (BN) and binge-eating disorder (BED) may be efficacious however little is known about their active treatment components or for whom they may be most effective.

Methods:

We systematically identified clinical trials testing MABTs for BN or BED through PsychINFO and Google Scholar. Publications were categorized according to analyses of mechanisms of action and moderators of treatment outcome.

Results:

Thirty-nine publications met inclusion criteria. Twenty-seven included analyses of therapeutic mechanisms and five examined moderators of treatment outcome. Changes were largely consistent with hypothesized mechanisms of MABTs, but substandard mediation analyses, inconsistent measurement tools, and infrequent use of mid-treatment assessment points limited our ability to make strong inferences.

Discussion:

Analyses of mechanisms of action and moderators of outcome in MABTs for BN and BED appear promising but use of more sophisticated statistical analyses and adequate replication are necessary.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6570825/

 

Mindfulness Therapies May Be Cost-Effective for the Treatment of Mental Illness

Mindfulness Therapies May Be Cost-Effective for the Treatment of Mental Illness

 

By John M. de Castro, Ph.D.

 

“[Mindfulness] is a cost-saving alternative to treatment as usual over the trial duration from both a healthcare and a societal perspective for patients with a diagnosis of depression, anxiety or stress and adjustment disorders.” – Sanjib Saha

 

There has developed a large volume of research findings supporting the effectiveness of mindfulness training for the treatment of mental illnesses. Effectiveness has been documented for a wide variety of psychological disorders including anxiety, depression, stress responses, obsessive-compulsive disorder, eating disorders, addictions, and major mental illnesses. But there is little understanding of the cost-effectiveness of these mindfulness trainings. So, it is important take a serious look at the costs of implementing these therapies in comparison to the healthcare savings produced and/or the costs of other treatments of similar effectiveness.

 

In today’s Research News article “Are acceptance and mindfulness-based interventions ‘value for money’? Evidence from a systematic literature review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588093/), Duarte and colleagues review and summarize the published studies of the cost-effectiveness of acceptance and mindfulness-based interventions. The following acceptance and mindfulness-based interventions were identified:  Mindfulness Based Cognitive Therapy (MBCT), Mindfulness-Based Stress Reduction (MBSR) , Dialectical Behavior Therapy (DBT),  Acceptance and Commitment Therapy (ACT), mindfulness‐based relapse prevention (MBRP), and other mindfulness meditation and mindfulness training. They identified 10 published studies.

 

They reported that the published studies found mixed results depending on the type of economic analysis and the comparator condition. In general, they report that acceptance and mindfulness-based interventions are mildly cost-effective for the treatment of depression, emotional unstable personality disorder, and general mental health conditions. It is clear, however, that this issue needs to be further studied.

 

In an age of high healthcare costs, it is important to perform economic analyses of treatments. Before widespread implementation of a treatment it is important to know that the costs of implementing the treatments are less than the healthcare savings produced. Various acceptance and mindfulness-based interventions can be expensive to implement and the savings produced hard to evaluate. So, the analysis has produced ambiguous results. One way to improve the cost-effectiveness of acceptance and mindfulness-based interventions is to implement the therapies online or with smartphone technologies. This markedly reduces the costs while maintaining effectiveness.

 

So, mindfulness therapies may be cost-effective for the treatment of mental illness.

 

“MBSR reduced costs to society by $724 per year in comparison to usual care, and reduced healthcare costs to payers by $982; it also increased participants’ quality-adjusted life years.” – Patricia Herman

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Duarte, R., Lloyd, A., Kotas, E., Andronis, L., & White, R. (2019). Are acceptance and mindfulness-based interventions ‘value for money’? Evidence from a systematic literature review. The British journal of clinical psychology, 58(2), 187–210. doi:10.1111/bjc.12208

 

Abstract

Objectives

Acceptance and mindfulness‐based interventions (A/MBIs) are recommended for people with mental health conditions. Although there is a growing evidence base supporting the effectiveness of different A/MBIs for mental health conditions, the economic case for these interventions has not been fully explored. The aim of this systematic review was to identify and appraise all available economic evidence of A/MBIs for the management of mental health conditions.

Methods

Eight electronic bibliographic databases (MEDLINE, MEDLINE In‐Process & Other Non‐Indexed Citations, EMBASE, Web of Science, NHS Economic Evaluation Database (EED), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA) database, and EconLit) were searched for relevant economic evaluations published from each database’s inception date until November 2017. Study selection, quality assessment, and data extraction were carried out according to published guidelines.

Results

Ten relevant economic evaluations presented in 11 papers were identified. Seven of the included studies were full economic evaluations (i.e., costs and effects assessed), and three studies were partial economic evaluations (i.e., only costs were considered in the analysis). The A/MBIs that had been subjected to economic evaluation were acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), mindfulness‐based cognitive therapy (MBCT), and mindfulness‐based stress reduction (MBSR). In terms of clinical presentations, the evaluation of cost‐effectiveness of A/MBIs has been more focused on depression and emotional unstable personality disorder with three and four economic evaluations, respectively. Three out of seven full economic evaluations observed that A/MBIs were cost‐effective for the management of mental health conditions. Nevertheless, the heterogeneity of included populations, interventions, and economic evaluation study types limits the extent to which firm conclusions can currently be made.

Conclusion

This first substantive review of economic evaluations of A/MBIs indicates that more research is needed before firm conclusions can be reached on the cost‐effectiveness of A/MBIs for mental health conditions.

Practitioner points

The findings of the review provide information that may be relevant to mental health service commissioners and decision‐makers as all economic evidence available on acceptance and mindfulness‐based interventions for mental health conditions is summarized.

Evidence relating to the cost‐effectiveness and cost‐saving potential of acceptance and mindfulness‐based interventions is focused mainly on depression and emotional unstable personality disorder to date.

Heterogeneity in the specific forms of acceptance and mindfulness‐based interventions may limit generalizability of the findings.

The number of health economic evaluations relating to acceptance and mindfulness‐based interventions remains relatively small. Further research in this area is required.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588093/

 

Improve PTSD Symptoms Related to Childhood Sexual Abuse with Mindfulness

Improve PTSD Symptoms Related to Childhood Sexual Abuse with Mindfulness

 

By John M. de Castro, Ph.D.

 

DBT-PTSD significantly reduced the women’s PTSD symptoms, including depression and anxiety. In addition, the women’s PTSD symptoms were still improving six weeks after they completed the treatment, suggesting that they may have learned skills during the study that helped them continue to recover from PTSD after the treatment ended.” – Matthew Tull

 

Childhood sexual abuse is a horrific crime. The trauma created in the victim changes them forever. It changes the trusting innocence of childhood to a confused, guilt ridden, frightening, and traumatized existence. It not only produces short-term trauma which includes both psychological and physical injury, it has long-term consequences. It damages the victim’s self-esteem and creates difficulties entering into intimate relationship in adulthood. It can create post-traumatic stress disorder (PTSD) complete with painful flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about the event. Victims often experience depression and sometimes become suicidal. It is a heinous crime that haunts the victims for the rest of their lives.

 

Unfortunately, childhood sexual abuse is shockingly common. It is estimated that 20% of girls and 10% of boys have experienced childhood sexual abuse and half of these were forcefully assaulted. Children between the ages of 7 and 13 are the most vulnerable but abuse is also prevalent in adolescence with 16% of children between 14 to 17 having been sexually victimized. Compounding the problem disclosure of sexual abuse is often delayed; children often avoid telling because they are either afraid of a negative reaction from their parents or of being harmed by the abuser. As such, they often delay disclosure until adulthood. This makes it unlikely that they’ll seek help and instead suffer in silence.

 

Mindfulness training has been shown to be effective in treating victims of trauma and PTSD.

Dialectical Behavior Therapy (DBT) focuses on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors. In DBT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness. So, it would make sense to explore the effectiveness of DBT for the treatment of adult survivors of childhood sexual abuse.

 

In today’s Research News article “Dialectical behaviour therapy for posttraumatic stress disorder related to childhood sexual abuse: a pilot study in an outpatient treatment setting.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774406/ ), Steil and colleagues recruited adult healthy women who had experienced childhood sexual abuse and were diagnosed with post-traumatic stress disorder (PTSD). They treated them with Dialectical Behavior Therapy (DBT) in a group for 90 minutes, once a week for 24 weeks. They were measured before and after treatment and 6 weeks later for frequency and intensity of PTSD symptoms, personality disorders, borderline symptoms, depression, and dissociative symptoms.

 

They found that the average duration of the PTSD symptoms prior to treatment was 14.5 years. 81% of the patients completed treatment. Following treatment, the women had significant reductions in PTSD symptoms including fewer intrusions, less avoidances, and hyperarousal episodes with large effect sizes. Treatment also produced large significant reductions in borderline symptoms, depression, and dissociative symptoms. These effects were still present and significant at the 6-week follow-up measurement.

 

The results suggest that Dialectical Behavior Therapy (DBT) is a safe, lasting, and effective treatment for PTSD symptoms resulting from childhood sexual abuse. But this was a pilot study without a control group. It relied upon before and after treatment comparisons. As such, there are many potential confounding factors. But the results are so positive and beneficial that a large randomized controlled clinical trial is warranted.

 

So, improve PTSD symptoms related to childhood sexual abuse with mindfulness.

 

“Mindfulness has been shown to be an effective stress reduction practices in general, but there may be other ways it works for people with PTSD as well. Recent research suggests that mindfulness may help to mitigate the relationship between maladaptive thinking and posttraumatic distress.” – Matthew Tull

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Regina Steil, Clara Dittmann, Meike Müller-Engelmann, Anne Dyer, Anne-Marie Maasch, Kathlen Priebe. Dialectical behaviour therapy for posttraumatic stress disorder related to childhood sexual abuse: a pilot study in an outpatient treatment setting. Eur J Psychotraumatol. 2018; 9(1): 1423832. Published online 2018 Jan 19. doi: 10.1080/20008198.2018.1423832

 

ABSTRACT

Background: Dialectical behaviour therapy for posttraumatic stress disorder (DBT-PTSD), which is tailored to treat adults with PTSD and co-occurring emotion regulation difficulties, has already demonstrated its efficacy, acceptance and safety in an inpatient treatment setting. It combines elements of DBT with trauma-focused cognitive behavioural interventions.

Objective: To investigate the feasibility, acceptance and safety of DBT-PTSD in an outpatient treatment setting by therapists who were novice to the treatment, we treated 21 female patients suffering from PTSD following childhood sexual abuse (CSA) plus difficulties in emotion regulation in an uncontrolled clinical trial.

Method: The Clinician Administered PTSD Symptom Scale (CAPS), the Davidson Trauma Scale (DTS), the Borderline Section of the International Personality Disorder Examination (IPDE) and the Borderline Symptom List (BSL-23) were used as primary outcomes. For secondary outcomes, depression and dissociation were assessed. Assessments were administered at pretreatment, post-treatment and six-week follow-up.

Results: Improvement was significant for PTSD as well as for borderline personality symptomatology, with large pretreatment to follow-up effect sizes for completers based on the CAPS (Cohens d = 1.30), DTS (d = 1.50), IPDE (d = 1.60) and BSL-23 (d = 1.20).

Conclusion: The outcome suggests that outpatient DBT-PTSD can safely be used to reduce PTSD symptoms and comorbid psychopathology in adults who have experienced CSA.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774406/

 

Reduce Anxiety and Depression with Mindfulness

Reduce Anxiety and Depression with Mindfulness

 

By John M. de Castro, Ph.D.

 

Being unwilling to experience negative thoughts, feelings, or sensations is often the first link in a mental chain that can lead to automatic, habitual, and critical patterns of mind becoming re-established. By accepting unpleasant experiences, we can shift our attention to opening up to them. Thus, “I should be strong enough” shifts to “Ah, fear is here,” or “Judgment is present.”—Zindel Segal,

 

Meditation training has been shown to improve health and well-being. It has also been found to be effective for a large array of medical and psychiatric conditions, either stand-alone or in combination with more traditional therapies. Meditation practice has been found to improve the regulation of emotions and reduce difficult emotional states such as anxiety and depression.

 

A characterizing feature of anxiety disorders is recurring thoughts, such as impending disaster, that they may realize are unreasonable, but are unable to shake. Indeed, Mindfulness practices have been shown to be quite effective in relieving anxiety. Anxiety often co-occurs with depression and mindfulness training is also effective for treating depression. Anxiety disorders and depression have generally been treated with drugs. But there are considerable side effects and these drugs are often abused. So, there is a need to develop alternative treatments. Since mindfulness- based treatments are relatively new, it makes sense to step back and summarize what is known regarding the effectiveness of mindfulness training for anxiety disorders and for depression.

 

In today’s Research News article “Mindfulness-Based Interventions for Anxiety and Depression. The Psychiatric clinics of North America.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5679245/ ), Hofmann and Gomez review and summarize the published research literature on the effectiveness of mindfulness training for the relief of anxiety and depression.

 

They report that randomized controlled trials found that Mindfulness-Based interventions including the Mindfulness-Based Stress Reduction (MBSR), the Mindfulness-Based Cognitive Therapy (MBCT), Dialectical Behavior Therapy, and Acceptance and Commitment Therapy treatment programs were “moderately-to-largely effective at reducing anxiety and depression symptom severity among individuals with a broad range of medical and psychiatric conditions.” They also report that these programs are effective whether provided in person or over the internet. They are consistently more effective than health education, relaxation training, and supportive psychotherapy, but equivalently effective as Cognitive Behavioral Therapy (CBT).

 

Hence, accumulating controlled research has built a strong case for the use of Mindfulness-Based Interventions for the treatment of anxiety and depression. Since, these treatments are generally safe and effective with little if any side effects, they would appear to be preferable to pharmacological treatments.

 

So, reduce anxiety and depression with mindfulness.

 

“Mindfulness keeps us focused on the present, and helps us meet challenges head on while we appreciate all our senses absorb. On the contrary, focus on the future contributes to anxiety, while perseveration on the past feeds depression. Far too often when we look to the future, we ask ourselves, “What if,” and the answer we give ourselves is often a prediction of a negative result.” – Vincent Fitzgerald

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Hofmann, S. G., & Gómez, A. F. (2017). Mindfulness-Based Interventions for Anxiety and Depression. The Psychiatric clinics of North America, 40(4), 739-749.

 

Key Points

  • Research on mindfulness-based interventions (MBIs) for anxiety and depression has increased exponentially in the past decade. The most common include Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT).
  • MBIs have demonstrated efficacy in reducing anxiety and depression symptom severity in a broad range of treatment-seeking individuals.
  • MBIs consistently outperform non-evidence-based treatments and active control conditions, such as health education, relaxation training, and supportive psychotherapy.
  • MBIs also perform comparably to cognitive-behavioral therapy (CBT). The treatment principles of MBIs for anxiety and depression are compatible with those of standard CBT.

Synopsis

This article reviews the ways in which cognitive and behavioral treatments for depression and anxiety have been advanced by the application of mindfulness practices. Research on mindfulness-based interventions (MBIs) has increased exponentially in the past decade. The most common include Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT). MBIs have demonstrated efficacy in reducing anxiety and depression symptom severity in a broad range of treatment-seeking individuals. MBIs consistently outperform non-evidence-based treatments and active control conditions, such as health education, relaxation training, and supportive psychotherapy. MBIs also perform comparably to cognitive-behavioral therapy (CBT). The treatment principles of MBIs for anxiety and depression are compatible with those of standard CBT.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5679245/

 

Decrease Suicide Ideation with Skills Learned in Dialectical Behavior Therapy

Decrease Suicide Ideation with Skills Learned in Dialectical Behavior Therapy

 

By John M. de Castro, Ph.D.

 

“DBT provided me with a rubric for figuring out what was causing my anxiety, anger or sadness, and new options for how to behave in light of it. Once a week, for the last two-and-a-half years, I’ve attended a DBT group and learned a set of skills that have been nothing short of transformative.” – Will Lippincott

 

Borderline Personality Disorder (BPD) is a very serious mental illness that is estimated to affect 1.6% of the U.S. population. It involves unstable moods, behavior, and relationships, problems with regulating emotions and thoughts, impulsive and reckless behavior, and unstable relationships. BPD is associated with high rates of co-occurring depression, anxiety disorders, substance abuse, eating disorders, self-harm, suicidal behaviors, and completed suicides. Needless to say, it is widespread and debilitating.

 

One of the few treatments that appears to be effective for Borderline Personality Disorder (BPD) is Dialectical Behavior Therapy (DBT). It is targeted at changing the problem behaviors characteristic of BPD including self-injury. Behavior change is accomplished through focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors. In DBT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness. How important it is for the patients to be successful in the development and employment of these skills is unknown.

 

In today’s Research News article “Suicidal Ideation and Skill Use During In-patient Dialectical Behavior Therapy for Borderline Personality Disorder. A Diary Card Study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5920639/ ), Probst and colleagues recruited patients diagnosed with Borderline Personality Disorder (BPD) and provided them with a 5-week program of Dialectical Behavior Therapy (DBT). The patients completed diary entries after each treatment day with ratings of their levels of suicide ideation and their use of the five core skills of DBT.

 

They found that the patients used skills and found them useful on 80% of treatment days. They found that the patients who had successful skill use on most days had greater reductions in suicide ideation than less successful patients. In addition, on days where skill use was successful there were lower levels of suicide ideation. Hence, successful employment of the five core skills of DBT appears to be very important for progress in therapy.

 

During the course of therapy, the BPD patient is encouraged to practice and use the five core skills; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness. If they are successful in using these skills, suicidal thoughts appear to diminish. This emphasizes the importance of stressing skill development and use during Dialectical Behavior Therapy (DBT) treatment for Borderline Personality Disorder (BPD) as it can influence the effectiveness of treatment.

 

So, decrease suicide ideation with skills learned in Dialectical Behavior Therapy.

 

“A variety of dialectical behavioral therapy (DBT) interventions can reduce suicidal behavior in women with borderline personality disorder (BPD), but skills training is a “necessary component” of any intervention.” – Megan Brooks

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

Probst, T., Decker, V., Kießling, E., Meyer, S., Bofinger, C., Niklewski, G., Mühlberger, A., … Pieh, C. (2018). Suicidal Ideation and Skill Use During In-patient Dialectical Behavior Therapy for Borderline Personality Disorder. A Diary Card Study. Frontiers in psychiatry, 9, 152. doi:10.3389/fpsyt.2018.00152

 

Abstract

Associations between suicidal ideation and skill use were investigated during in-patient dialectical behavior therapy (DBT) for borderline personality disorder (BPD). Participants were N = 44 patients with BPD undergoing a 5-week in-patient DBT program in a psychiatric clinic. They filled in a diary card each treatment day resulting in 1,334 skill use ratings and 1,364 suicidal ideation ratings. Treatment days were categorized as days with successful skill use (using skills and perceiving them as effective), days with no skill use, days with unsuccessful skill use (using skills but perceiving them as ineffective). Multilevel models were performed to account for the nested data structure. The results showed that suicidal ideation improved more for patients who applied skills successfully more often during treatment (p < 0.05). Moreover, suicidal ideation was lower on treatment days with successful skill use compared to treatment days with no skill use and compared to treatment days with unsuccessful skill use (p < 0.05). When treatment days with no skill use were compared to treatment days with unsuccessful skill use, suicidal ideation was higher on treatment days with unsuccessful skill use (p < 0.05). To conclude, using skills successfully on as many treatment days as possible is associated with lower suicidal ideation

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5920639/

 

Improve Borderline Personality Disorder with Dialectical Behavior Therapy Mindfulness

Improve Borderline Personality Disorder with Dialectical Behavior Therapy Mindfulness

 

By John M. de Castro, Ph.D.

 

“People with borderline personality disorder can be challenging to treat, because of the nature of the disorder. They are difficult to keep in therapy, frequently fail to respond to our therapeutic efforts and make considerable demands on the emotional resources of the therapist, particular when suicidal behaviors are prominent. Dialectical Behavior Therapy is an innovative method of treatment that has been developed specifically to treat this difficult group of patients in a way which is optimistic and which preserves the morale of the therapist.” – Psych Central

 

Borderline Personality Disorder (BPD) is a very serious mental illness that is estimated to affect 1.6% of the U.S. population. It involves unstable moods, behavior, and relationships, problems with regulating emotions and thoughts, impulsive and reckless behavior, and unstable relationships. BPD is associated with high rates of co-occurring depression, anxiety disorders, substance abuse, eating disorders, self-harm, suicidal behaviors, and completed suicides. Needless to say, it is widespread and debilitating.

 

One of the few treatments that appears to be effective for Borderline Personality Disorder (BPD) is Dialectical Behavior Therapy (DBT). It is targeted at changing the problem behaviors characteristic of BPD including self-injury. Behavior change is accomplished through focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors. In DBT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness. Although the effectiveness of DBT for BPR is well established the most effective and cost effective means of delivering DBT has not been established.

 

In today’s Research News article “Effectiveness of step-down versus outpatient dialectical behaviour therapy for patients with severe levels of borderline personality disorder: a pragmatic randomized controlled trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040072/ ), Sinnaeve and colleagues examine the effectiveness of DBT provided either as a Step-down DBT program or delivered on an out-patient basis. The Step-down DBT program consisted of 3 months of therapy as an inpatient and then 6 months as an outpatient. Outpatient DBT was delivered for 12 months completely on an outpatient basis. They recruited adult (18–45 years of age) patients with severe Borderline Personality Disorder (BPD) and randomly assigned them to either the step-down or outpatient program of Dialectical Behavior Therapy (DBT). They were measured at baseline and at 3, 6, 9, and 12 months of treatment for psychiatric symptoms, borderline personality disorder, suicidal thoughts, quality of life, and costs of therapy delivery.

 

They found that both programs were effective and produced significant decreases in the severity of Borderline Personality Disorder (BPD). But, the step-down program was far more effective in retaining participants with 95% of the participants who started the program completing it as opposed to only 45% of the out-patient participants completing the program. In addition, the step-down program patients had significant reductions in suicidal intentions and improvements in quality of life while the out-patient participants did not. Hence the step-down delivery of DBT was found to be significantly more effective than the outpatient DBT,

 

On the other hand, the step-down program was far more expensive to deliver; €19,899 per patient versus €12,472. To further investigate this the costs per Quality Adjusted Life Year (QALY) for both programs were calculated. QALY measures how much benefit (increase in quality of life) is produced per unit of cost. This analysis suggested that the step-down program was not as cost effective as the outpatient program. So, it would appear that although a step-down program is more effective it may not be as cost effective as a more traditional outpatient program. Regardless, Dialectical Behavior Therapy (DBT) was an effective treatment for severe Borderline Personality Disorder (BPD) regardless of delivery method.

 

So, improve borderline personality disorder with dialectical behavior therapy produced mindfulness.

 

“DBT was the first psychotherapy shown to be effective in treating BPD in controlled clinical trials, the most rigorous type of clinical research.“ – Kristalyn Salters

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Sinnaeve, R., van den Bosch, L. M. C., Hakkaart-van Roijen, L., & Vansteelandt, K. (2018). Effectiveness of step-down versus outpatient dialectical behaviour therapy for patients with severe levels of borderline personality disorder: a pragmatic randomized controlled trial. Borderline Personality Disorder and Emotion Dysregulation, 5, 12. http://doi.org/10.1186/s40479-018-0089-5

 

Abstract

Background

Step-down dialectical behaviour therapy (DBT) is a treatment consisting of 3 months of residential DBT plus 6 months of outpatient DBT. The program was specifically developed for people suffering from severe borderline personality disorder (BPD). The present study examines the effectiveness and cost-effectiveness of step-down DBT compared to 12 months of regular, outpatient DBT.

Methods

Eighty-four participants reporting high levels of BPD-symptoms (mean age 26 years, 95% female) were randomly assigned to step-down versus standard DBT. Measurements were conducted at baseline and after 3, 6, 9 and 12 months. The Lifetime Parasuicide Count and BPD Severity Index (BPDSI) were used to assess suicidal behaviour, non-suicidal self-injury (NSSI) and borderline severity. Costs per Quality Adjusted Life Year (QALY) were calculated using data from the EQ-5D-3L and the Treatment Inventory Cost in Psychiatric Patients (TIC-P).

Results

In step-down DBT, 95% of patients started the program, compared to 45% of patients in outpatient DBT. The probability of suicidal behaviour did not change significantly over 12 months. The probability of NSSI decreased significantly in step-down DBT, but not in outpatient DBT. BPDSI decreased significantly in both groups, with the improvement leveling off at the end of treatment. While step-down DBT was more effective in increasing quality of life, it also cost significantly more. The extra costs per gained QALY exceeded the €80,000 threshold that is considered acceptable for severely ill patients in the Netherlands.

Conclusions

A pragmatic randomized controlled trial in the Netherlands showed that 9 months of step-down DBT is an effective treatment for people suffering from severe levels of BPD. However, step-down DBT is not more effective than 12 months of outpatient DBT, nor is it more cost-effective. These findings should be considered tentative because of high noncompliance with the treatment assignment in outpatient DBT. Furthermore, the long-term effectiveness of step-down DBT, and moderators of treatment response, remain to be evaluated.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040072/

 

Reduce Self-Harming in Adolescents with Mindfulness

Reduce Self-Harming in Adolescents with Mindfulness

 

By John M. de Castro, Ph.D.

 

“In order to end self-harm, one needs to change one’s whole relationship with oneself, and how one sees oneself. A good starting point is with one’s thoughts. Mindfulness keeps one fully grounded in the present … in the presence of the action of the present moment. Mindfulness helps one to observe and note thoughts, positive or negative, without feeling the need to act upon them.” – Ian Ellis-Jones

 

Self-injury is a disturbing phenomenon occurring worldwide, especially in developed countries, such as the U.S. and those in western Europe. Approximately two million cases are reported annually in the U.S. Each year, 1 in 5 females and 1 in 7 males engage in self-injury usually starting in the teen years. Frequently, untreated depression and other mental health challenges create an environment of despair that leads people to cope with these challenges in unhealthy ways. Nearly 50 percent of those who engage in self-injury have been sexually abused. Borderline Personality Disorder (BPD) is a very serious mental illness that is estimated to affect 1.6% of the U.S. population. It involves unstable moods, behavior, and relationships, problems with regulating emotions and thoughts, impulsive and reckless behavior, and unstable relationships. About ¾ of BPD patients engage in self-injurious behaviors.

 

One of the few treatments that appears to be effective for Borderline Personality Disorder (BPD) is Dialectical Behavior Therapy (DBT). It is targeted at changing the problem behaviors characteristic of BPD including self-injury. Behavior change is accomplished through focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors. In DBT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness. DBT reduces self-injurious behaviors in BPD patients.

 

In today’s Research News article “Cost-effectiveness of dialectical behaviour therapy vs. enhanced usual care in the treatment of adolescents with self-harm.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928596/ ), Haga and colleagues recruited adolescents who had repeatedly harmed themselves and randomly assigned then to receive 19 once a week 1 hour sessions of either Dialectical Behavior Therapy (DBT) or enhanced usual care. Enhanced usual care consisted of a combination of psychotherapy and cognitive behavioral therapy tailored to treat suicidality and self-harm. They were measured before and after treatment and 1 year later for self-harm episodes and global functioning. The costs of treatment were also estimated.

 

They found that at the end of treatment the adolescents who received Dialectical Behavior Therapy (DBT) had significantly fewer self-harm episodes and lower levels of suicide ideation and depression than those who received enhanced usual care. Importantly, a year later, the group that received DBT still had significantly fewer self-harm episodes. In addition, DBT did not cost more than the enhanced usual care program to implement.

 

These results are important and suggest that Dialectical Behavior Therapy (DBT) is an effective and cost-effective treatment for adolescents who harm themselves. This is particularly important as self-harm is often a predictor of eventual suicide. The reduction in suicidal ideation in these adolescents is an indication of this. Hence, DBT can reduce self-harm behaviors and reduce the suffering of these troubled adolescents.

 

So, reduce self-harming in adolescents with mindfulness.

 

dialectical behavior therapy, or DBT, for treatment of children and adolescents. DBT, regarded as one of the few treatments that has shown success in combating self-injury behaviors, combines Buddhism’s mindfulness with cognitive behavior therapy in a program that teaches coping and communication skills.” – Paradigm Malibu

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Haga, E., Aas, E., Grøholt, B., Tørmoen, A. J., & Mehlum, L. (2018). Cost-effectiveness of dialectical behaviour therapy vs. enhanced usual care in the treatment of adolescents with self-harm. Child and Adolescent Psychiatry and Mental Health, 12, 22. http://doi.org/10.1186/s13034-018-0227-2

 

Abstract

Background

Studies have shown that dialectical behaviour therapy (DBT) is effective in reducing self-harm in adults and adolescents.

Aims

To evaluate the cost-effectiveness of DBT for adolescents (DBT-A) compared to enhanced usual care (EUC).

Methods

In a randomised study, 77 adolescents with repeated self-harm were allocated to 19 weeks of outpatient treatment, either DBT-A (n = 39) or EUC (n = 38). Cost-effective analyses, including estimation of incremental cost-effectiveness ratios, were conducted with self-harm and global functioning (CGAS) as health outcomes.

Results

Using self-harm as effect outcome measure, the probability of DBT being cost-effective compared to EUC increased with increasing willingness to pay up to a ceiling of 99.5% (threshold of € 1400), while with CGAS as effect outcome measure, this ceiling was 94.9% (threshold of € 1600).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928596/