Borderline Personality Disorder

Improve the Psychological Well-Being of Sexual Minorities (LBGQ) with Mindfulness

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Improve the Psychological Well-Being of Sexual Minorities (LBGQ) with Mindfulness

 

By John M. de Castro, Ph.D.

 

“It is revolutionary for any trans person to choose to be seen and visible in a world that tells us we should not exist.” —Laverne Cox

 

Around 43,000 people take their own lives each year in the US. 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. Indeed, suicide is the second leading cause of death in adolescents. Suicidality and self-injury are particularly problematic in sexual minorities (LBGTQ).

 

One of the few treatments that appears to be Dialectical Behavior Therapy (DBT). It is targeted at changing the problem behaviors characteristic 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 has been found to reduce suicidality. There is thus a need to study the effectiveness of DBT for the mental health of sexual minority adolescents.

 

In today’s Research News article “Dialectical behavior therapy for adolescents (DBT-A): Outcomes among sexual minorities at high risk for suicide.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9233065/ ) Poon and colleagues recruited heterosexual and sexual minority (LGBQ) adolescents (13-18 years of age). They received and 18-week program of Dialectical Behavior Therapy (DBT). They completed online measures before and after treatment of emotion regulation, anxiety, depression, coping, and borderline symptoms.

 

They found that after treatment the adolescents had significant decreases in depression, borderline symptoms, and dysfunctional coping and significant increases in emotion regulation and use of coping skills. There were no significant differences between the improvements seen with the sexual minority and heterosexual adolescents.

 

Hence, Dialectical Behavior Therapy (DBT) Produces significant improvements in the psychological well-being of sexual minority adolescents and is as effective as it is in heterosexual adolescents. Although not measured these improvements would predict a decrease in suicidality.

 

“Shame creates lies about how men should think and act, and when men don’t fulfill those roles, they have additional shame.” ― Liz Plank

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Twitter @MindfulResearch

 

Study Summary

 

Poon J, Galione JN, Grocott LR, Horowitz KJ, Kudinova AY, Kim KL. Dialectical behavior therapy for adolescents (DBT-A): Outcomes among sexual minorities at high risk for suicide. Suicide Life Threat Behav. 2022 Jun;52(3):383-391. doi: 10.1111/sltb.12828. Epub 2022 Jan 12. PMID: 35019159; PMCID: PMC9233065.

 

Abstract

The alarming rates and pervasiveness of suicidal and self-destructive behaviors (e.g., non-suicidal self-injury) among young sexual minorities represent a major public health concern. We set out to examine whether an empirically driven treatment for suicide and self-harm, dialectical behavior therapy for adolescents (DBT-A), provides benefits for adolescents who identify as gay, lesbian, bisexual, or questioning (LGBQ). LGBQ adolescents (n = 16) were compared with non-LGBQ peers (n = 23). Psychological measures were collected before and after participation in a comprehensive DBT-A program. LGBQ participants demonstrated significant improvements in emotion regulation, depression, borderline symptoms, and coping strategies; changes were comparable to their heterosexual peers.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9233065/

 

Improve Borderline Personality Disorder with Mindfulness

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Improve Borderline Personality Disorder with Mindfulness

 

By John M. de Castro, Ph.D.

 

“DBT . . . is considered one of the best treatments for [Borderline Personality Disorder] in terms of documented success rates. . . [Borderline Personality Disorder] is effective in reducing psychiatric hospitalization, substance use, and suicidal behavior. . .  self-injurious behaviors, and the severity of borderline symptoms.” – 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. 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. The research regarding the effectiveness of DBT reduces for BPD patients has been accumulating. So, it makes sense to step back and summarize what has been learned.

 

In today’s Research News article “Psychological therapies for people with borderline personality disorder.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199382/ ) Storebø and colleagues review and summarize the published randomized controlled trials on the effectiveness of Dialectical Behavior Therapy (DBT). for the treatment of Borderline Personality Disorder (BPD). They found 25 randomized controlled trials.

 

They report that the published research found that Dialectical Behavior Therapy (DBT) compared to treatment as usual, wait-list controls, and no-treatment produced significantly greater reductions in Borderline Personality Disorder (BPD) severity, self-harm, anger, impulsivity, dissociation, psychotic-like symptoms, and emotional instability and significantly greater increases in psychological functioning. There were no significant differences in adverse events between DBT and controls.

 

The published research clearly demonstrates that Dialectical Behavior Therapy (DBT) is a safe and effective treatment for Borderline Personality Disorder (BPD).

 

“‘Dialectical’ means trying to understand how two things that seem opposite could both be true. For example, accepting yourself and changing your behaviour might feel contradictory. But DBT teaches that it’s possible for you to achieve both these goals together.” – Mind

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Twitter @MindfulResearch

 

Study Summary

 

Storebø, O. J., Stoffers-Winterling, J. M., Völlm, B. A., Kongerslev, M. T., Mattivi, J. T., Jørgensen, M. S., Faltinsen, E., Todorovac, A., Sales, C. P., Callesen, H. E., Lieb, K., & Simonsen, E. (2020). Psychological therapies for people with borderline personality disorder. The Cochrane database of systematic reviews, 5(5), CD012955. https://doi.org/10.1002/14651858.CD012955.pub2

 

Abstract

Background

Over the decades, a variety of psychological interventions for borderline personality disorder (BPD) have been developed. This review updates and replaces an earlier review (Stoffers‐Winterling 2012).

Objectives

To assess the beneficial and harmful effects of psychological therapies for people with BPD.

Search methods

In March 2019, we searched CENTRAL, MEDLINE, Embase, 14 other databases and four trials registers. We contacted researchers working in the field to ask for additional data from published and unpublished trials, and handsearched relevant journals. We did not restrict the search by year of publication, language or type of publication.

Selection criteria

Randomised controlled trials comparing different psychotherapeutic interventions with treatment‐as‐usual (TAU; which included various kinds of psychotherapy), waiting list, no treatment or active treatments in samples of all ages, in any setting, with a formal diagnosis of BPD. The primary outcomes were BPD symptom severity, self‐harm, suicide‐related outcomes, and psychosocial functioning. There were 11 secondary outcomes, including individual BPD symptoms, as well as attrition and adverse effects.

Data collection and analysis

At least two review authors independently selected trials, extracted data, assessed risk of bias using Cochrane’s ‘Risk of bias’ tool and assessed the certainty of the evidence using the GRADE approach. We performed data analysis using Review Manager 5 and quantified the statistical reliability of the data using Trial Sequential Analysis.

Main results

We included 75 randomised controlled trials (4507 participants), predominantly involving females with mean ages ranging from 14.8 to 45.7 years. More than 16 different kinds of psychotherapy were included, mostly dialectical behaviour therapy (DBT) and mentalisation‐based treatment (MBT). The comparator interventions included treatment‐as‐usual (TAU), waiting list, and other active treatments. Treatment duration ranged from one to 36 months.

Psychotherapy versus TAU

Psychotherapy reduced BPD symptom severity, compared to TAU; standardised mean difference (SMD) −0.52, 95% confidence interval (CI) −0.70 to −0.33; 22 trials, 1244 participants; moderate‐quality evidence. This corresponds to a mean difference (MD) of −3.6 (95% CI −4.4 to −2.08) on the Zanarini Rating Scale for BPD (range 0 to 36), a clinically relevant reduction in BPD symptom severity (minimal clinical relevant difference (MIREDIF) on this scale is −3.0 points).

Psychotherapy may be more effective at reducing self‐harm compared to TAU (SMD −0.32, 95% CI −0.49 to −0.14; 13 trials, 616 participants; low‐quality evidence), corresponding to a MD of −0.82 (95% CI −1.25 to 0.35) on the Deliberate Self‐Harm Inventory Scale (range 0 to 34). The MIREDIF of −1.25 points was not reached.

Suicide‐related outcomes improved compared to TAU (SMD −0.34, 95% CI −0.57 to −0.11; 13 trials, 666 participants; low‐quality evidence), corresponding to a MD of −0.11 (95% CI −0.19 to −0.034) on the Suicidal Attempt Self Injury Interview. The MIREDIF of −0.17 points was not reached.

Compared to TAU, psychotherapy may result in an improvement in psychosocial functioning (SMD −0.45, 95% CI −0.68 to −0.22; 22 trials, 1314 participants; low‐quality evidence), corresponding to a MD of −2.8 (95% CI −4.25 to −1.38), on the Global Assessment of Functioning Scale (range 0 to 100). The MIREDIF of −4.0 points was not reached.

Our additional Trial Sequential Analysis on all primary outcomes reaching significance found that the required information size was reached in all cases.

A subgroup analysis comparing the different types of psychotherapy compared to TAU showed no clear evidence of a difference for BPD severity and psychosocial functioning.

Psychotherapy may reduce depressive symptoms compared to TAU but the evidence is very uncertain (SMD −0.39, 95% CI −0.61 to −0.17; 22 trials, 1568 participants; very low‐quality evidence), corresponding to a MD of −2.45 points on the Hamilton Depression Scale (range 0 to 50). The MIREDIF of −3.0 points was not reached.

BPD‐specific psychotherapy did not reduce attrition compared with TAU. Adverse effects were unclear due to too few data.

Psychotherapy versus waiting list or no treatment

Greater improvements in BPD symptom severity (SMD −0.49, 95% CI −0.93 to −0.05; 3 trials, 161 participants), psychosocial functioning (SMD −0.56, 95% CI −1.01 to −0.11; 5 trials, 219 participants), and depression (SMD −1.28, 95% CI −2.21 to −0.34, 6 trials, 239 participants) were observed in participants receiving psychotherapy versus waiting list or no treatment (all low‐quality evidence). No evidence of a difference was found for self‐harm and suicide‐related outcomes.

Individual treatment approaches

DBT and MBT have the highest numbers of primary trials, with DBT as subject of one‐third of all included trials, followed by MBT with seven RCTs.

Compared to TAU, DBT was more effective at reducing BPD severity (SMD −0.60, 95% CI −1.05 to −0.14; 3 trials, 149 participants), self‐harm (SMD −0.28, 95% CI −0.48 to −0.07; 7 trials, 376 participants) and improving psychosocial functioning (SMD −0.36, 95% CI −0.69 to −0.03; 6 trials, 225 participants). MBT appears to be more effective than TAU at reducing self‐harm (RR 0.62, 95% CI 0.49 to 0.80; 3 trials, 252 participants), suicidality (RR 0.10, 95% CI 0.04, 0.30, 3 trials, 218 participants) and depression (SMD −0.58, 95% CI −1.22 to 0.05, 4 trials, 333 participants). All findings are based on low‐quality evidence. For secondary outcomes see review text.

Authors’ conclusions

Our assessments showed beneficial effects on all primary outcomes in favour of BPD‐tailored psychotherapy compared with TAU. However, only the outcome of BPD severity reached the MIREDIF‐defined cut‐off for a clinically meaningful improvement. Subgroup analyses found no evidence of a difference in effect estimates between the different types of therapies (compared to TAU) .

The pooled analysis of psychotherapy versus waiting list or no treatment found significant improvement on BPD severity, psychosocial functioning and depression at end of treatment, but these findings were based on low‐quality evidence, and the true magnitude of these effects is uncertain. No clear evidence of difference was found for self‐harm and suicide‐related outcomes.

However, compared to TAU, we observed effects in favour of DBT for BPD severity, self‐harm and psychosocial functioning and, for MBT, on self‐harm and suicidality at end of treatment, but these were all based on low‐quality evidence. Therefore, we are unsure whether these effects would alter with the addition of more data.

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Plain language summary

Psychological therapies for people with borderline personality disorder

Background

People affected by borderline personality disorder (BPD) often have difficulties with controlling their impulses and emotions. They may have a poor self‐image, experience rapid changes in mood, harm themselves and find it hard to engage in harmonious interpersonal relationships. Different types of psychological treatments (‘talking treatments’) have been developed to help people with BPD. The effects of these treatments must be investigated to decide how well they work and if they can be harmful.

Objective

This review summarises what we currently know about the effect of psychotherapy in people with BPD.

Methods

We compared the effects of psychological treatments on people affected by BPD who did not receive treatment or who continued their usual treatment, were on a waiting list or received active treatment.

Findings

We searched for relevant research articles, and found 75 trials (4507 participants, mostly female, mean age ranging from 14.8 to 45.7 years). The trials examined a wide variety of psychological treatments (over 16 different types). They were mostly conducted in outpatient settings, and lasted between one and 36 months. Dialectical behaviour Therapy (DBT) and Mentalisation‐Based Treatment (MBT) were the therapies most studied.

Psychotherapy compared with usual treatment

Psychotherapy reduced the severity of BPD symptoms and suicidality and may reduce self‐harm and depression whilst also improving psychological functioning compared to usual treatment. DBT may be better than usual treatment at reducing BPD severity, self‐harm and improving psychosocial functioning. Similarly, MBT appears to be more effective than usual treatment at reducing self‐harm, suicidality and depression. However, these findings were all based on low‐quality evidence and therefore we are uncertain whether or not these results would change if we added more trials. Most trials did not report adverse effects, and those that did, found no obvious unwanted reactions following psychological treatment. The majority of trials (64 out of 75) were funded by grants from universities, authorities or research foundations. Four trials reported that no funding was received. For the remaining trials (7), funding was not specified.

Psychotherapy versus waiting list or no treatment

Psychotherapy was more effective than waiting list at improving BPD symptoms, psychosocial functioning, and depression, but there was no clear difference between psychotherapy, and waiting list for outcomes of self‐harm, and suicide‐related outcomes.

Conclusions

In general, psychotherapy may be more effective than usual treatment in reducing BPD symptom severity, self‐harm, suicide‐related outcomes and depression, whilst also improving psychosocial functioning. However, only the decrease in BPD symptom severity was found to be at a clinically important level. DBT appears to be better at reducing BPD severity, self‐harm, and improving psychosocial functioning compared to usual treatment and MBT appears more effective than usual treatment at reducing self‐harm and suicidality. However, we are still uncertain about these findings as the quality of the evidence is low.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199382/

 

Reduce Self-Harm in Patients with Borderline Personality Disorder with Mindfulness

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Reduce Self-Harm in Patients with Borderline Personality Disorder with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Dialectical Behavior Therapy group skills training was associated with a reduction in non-suicidal self-injury in patients with Borderline Personality Disorder.” – Gary Rothbard

 

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 “Cessation of Deliberate Self-Harm Behavior in Patients With Borderline Personality Traits Treated With Outpatient Dialectical Behavior Therapy.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7952764/ ) Westad and colleagues recruited adults with subthreshold Borderline Personality Disorder (BPD) and provided them with 1 hour individual therapy and 2.5 hours of group skills training per week for 8 weeks of Dialectical Behavior Therapy (DBT). Prior to treatment they were assessed for personality and clinical symptoms. Before and after treatment they were measured for self-harm and suicidal behaviors, depression, hopelessness, personality disorders, quality of life, general health, and psychological, social, and occupational functioning.

 

They found that over the first year following therapy 94% of the patients ceased self-harm behaviors in an average of 16 weeks. Compared to baseline, following treatment the patients had significant increases in quality of life and functioning and significant decreases in depression, hopelessness, and personality disorders. A comparison of patients who reduced self-harm behaviors quickly to those who took longer for the reduction did not reveal any significant differences.

 

In the present study there wasn’t a control condition. So, alternative confounding interpretations are present. But the findings replicate previous controlled work that Dialectical Behavior Therapy (DBT) produces significant improvement in Borderline Personality Disorder and reductions in self-harm behaviors. So, the results of the present study are likely to due to DBT alone. The findings expand knowledge in that they demonstrate the effectiveness of DBT for patients who are subthreshold for BPD.

 

Dialectical Behavior Therapy (DBT) is one of very few treatments that are effective for Borderline Personality Disorder (BPD). But DBT is a complex therapy that includes mindfulness and other significant components. So, it is unclear which components or combination of components are necessary and sufficient for the clinical benefits.

 

So, reduce self-harm in patients with borderline personality disorder with mindfulness.

 

“DBT might provide an effective treatment for severe self-harm in institutional settings.” – Gail Skillington

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Yngvill Ane Stokke Westad, Kristen Hagen, Egil Jonsbu, Stian Solem. Cessation of Deliberate Self-Harm Behavior in Patients With Borderline Personality Traits Treated With Outpatient Dialectical Behavior Therapy, Front Psychol. 2021; 12: 578230. Published online 2021 Feb 26. doi: 0.3389/fpsyg.2021.578230

 

Abstract

The first aim of the study was to identify when deliberate self-harm (DSH) behavior ceased in patients with borderline symptoms undergoing dialectical behavioral treatment (DBT). The second aim was to compare patients who ceased their self-harm behavior early or late in the course of treatment, with regard to demographics, comorbidity, and symptom severity. The study used a naturalistic design and included 75 treatment completers at an outpatient DBT clinic. Of these 75 patients, 46 presented with self-harming behavior at pre-treatment. These 46 participants where split into two groups, based on median amount of time before ceasing self-harm behavior, termed early (up to 8 weeks) and late (8+ weeks) responders. Treatment duration varied from 16 to 160 weeks. Patients were assessed pre- and post-treatment using measures of depression, hopelessness, personality traits, quality of life, and global assessment of symptoms and functioning. The majority (93.5%) ceased their self-harming within the first year, and the average number of weeks was 15.5 (SD = 17.8). Twenty-five percent of patients ceased their DSH behavior during the first week of treatment. For the remaining patients, the cessation of DSH continued gradually across a 1 year period. We found no differences between early and late responders with respect to demographics, comorbidity, symptom severity, or treatment outcome. None of the patients committed suicide. The findings indicate that self-harming behavior decreases gradually across the first year after starting DBT.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7952764/

 

Spirituality is Associated with Improved Psychological Well-Being in Patients with Persistent Mental Illness

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Spirituality is Associated with Improved Psychological Well-Being in Patients with Persistent Mental Illness

 

By John M. de Castro, Ph.D.

 

“No cure that fails to engage our spirit can make us well.” – Victor Frankl

 

Religion and spirituality have been promulgated as solutions to the challenges of life both in a transcendent sense and in a practical sense. What evidence is there that these claims are in fact true? The transcendent claims are untestable with the scientific method. But the practical claims are amenable to scientific analysis. There have been a number of studies of the influence of religiosity and spirituality on the physical and psychological well-being of practitioners mostly showing positive benefits, with spirituality encouraging personal growth and mental health. But there is still a need to investigate the relationships of spirituality with psychological well-being in patients with persistent mental illness.

 

In today’s Research News article “Spirituality and Employment in Recovery from Severe and Persistent Mental Illness and Psychological Well-Being.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827133/ ) Saiz and colleagues recruited adult patients with persistent mental illness who were in a program to prepare them for employment. The disorders included psychoses, schizophrenia, personality disorders, and mood disorders. The patients completed questionnaires measuring stage of recovery, hope, self-determination, psychological well-being, including self-acceptance, positive relationships, autonomy, environmental mastery, personal growth and purpose in life subscales, employment, work motivation including of satisfaction, integration into the work environment, social acceptance, social performance, job skills, self-esteem, perception of family support and job assertiveness subscales, spiritual experiences and spiritual well-being.

 

They report that the higher the levels of spirituality and work motivation, the higher the levels of psychological well-being and recovery. When spirituality and work motivation were used together as predictors of recovery only spirituality was significantly related. Similarly, when spirituality and work motivation were used together as predictors of psychological well-being only spirituality was significantly related. Hence, when work motivation is considered, only spirituality is significantly related to psychological well-being and recovery.

 

These findings for patients with persistent mental illness make sense as spirituality has been found in the past with other groups to be associated with psychological well-being and better mental health. The findings, though, are correlational and as such causation cannot be determined. Only that spirituality is associated with to psychological well-being and recovery can be ascertained. But this association is potentially important and suggests that the promotion of spirituality may be beneficial for patients with persistent mental illness, helping them recover better and be psychologically healthier. This remains for future research.

 

So, spirituality is associated with improved psychological well-being in patients with persistent mental illness.

 

“many people with mental illness desire the incorporation of spirituality in their recovery process/treatment.” – Jan-Stella Metheany

 

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Saiz, J., Galilea, M., Molina, A. J., Salazar, M., Barsotti, T. J., Chopra, D., & Mills, P. J. (2021). Spirituality and Employment in Recovery from Severe and Persistent Mental Illness and Psychological Well-Being. Healthcare (Basel, Switzerland), 9(1), 57. https://doi.org/10.3390/healthcare9010057

 

Abstract

People diagnosed with severe and persistent mental illness (SPMI) face multiple vulnerabilities, including when seeking employment. Among SPMI patients, studies show that a stronger sense of spirituality can help to reduce psychotic symptoms, increase social integration, reduce the risk of suicide attempts and promote adherence to psychiatric treatment. This study examined how the variables spirituality and employment affect the recovery process and psychological well-being of people with SPMI who attend employment recovery services. The sample consisted of 64 women and men diagnosed with an SPMI. The assessment instruments included the Recovery Assessment Scale, Ryff Psychological Well-Being Scale, Work Motivation Questionnaire, Daily Spiritual Experience Scale, and Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being (FACIT-Sp12). Hierarchical regression analyses were performed to compare three different models for each dependent variable (recovery and psychological well-being). The findings showed that job skills predicted psychological well-being and recovery. When spiritual variables were included in the model, job skills dropped out and the dimension meaning/peace of the FACIT-Sp12 emerged as the only significant predictor variable. Integrating spirituality into recovery programs for people with SPMI may be a helpful complement to facilitate the recovery process and improve psychological well-being.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827133/

 

Improve Borderline Personality Disorder with Mindfulness

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Improve Borderline Personality Disorder with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness meditation training may help individuals with BPD be more effective in applying healthy coping skills in the midst of emotional pain. Mindfulness skills allow you to get just a little bit of space to be able to notice the emotion and be more strategic in terms of how you will act in the face of the emotion.” – 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 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 not known if Dialectical Behavior Therapy (DBT) is effective for a subset of patients with Borderline Personality Disorder (BPD) who are not suicidal or self-harming. In today’s Research News article “Dialectical behaviour therapy skills reconsidered: applying skills training to emotionally dysregulated individuals who do not engage in suicidal and self-harming behaviours.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6993331/), Kells and colleagues recruited patients with Borderline Personality Disorder (BPD) who had never attempted suicide or engaged in any self-harming and who had high levels of emotional dysregulation. They received a 24-week Dialectical Behavior Therapy (DBT) program that met once a week for 2.5 hours. They were measured before, during, and after treatment and 6 months later for emotion regulation, mindfulness, and DBT skills.

 

There was a 49% drop-out rate. They found that for those that completed the program at each time point during and after treatment including the 6-month follow-up there were significant reductions in dysfunctional coping and increases in emotion regulation, mindfulness, and DBT skills. The effects were quite large with changes of 22% to 50% from baseline.

 

The study has a number of interpretive problems as there wasn’t a control condition. Previous controlled research, however, has demonstrated that Dialectical Behavior Therapy (DBT) is effective for the treatment of Borderline Personality Disorder (BPD). So. the present results were probably due to the treatment and not a confounding influence. The drop-out rate in this study was very high. BPD is a very difficult condition to treat and high drop-out rates are common. Hence it is reasonable to conclude that the present study successfully demonstrated that DBT is an effective treatment for BPD in patients without a history of suicide attempts or self-harming behaviors.

 

These findings suggest that Dialectical Behavior Therapy (DBT) affects a core symptom of Borderline Personality Disorder (BPD), an inability to cope with and regulate emotions. The patients improved markedly in their ability to regulate their emotions and cope with them. It is possible that the observed improvements in mindfulness may have been responsible for the improvements as mindfulness has been shown repeatedly to improve emotion regulation and coping behavior. It remains for future research to investigate this idea.

 

So, improve Borderline Personality Disorder with mindfulness.

 

“Strong emotions disrupt a person’s ability to think and to be mindful. This is true for all of us. An inability to think can lead to even stronger and more dysregulated emotions. This is of particular concern in people with BPD, who often experience strong and difficult to control emotions.” = Blaise Aguirre

 

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

 

Kells, M., Joyce, M., Flynn, D., Spillane, A., & Hayes, A. (2020). Dialectical behaviour therapy skills reconsidered: applying skills training to emotionally dysregulated individuals who do not engage in suicidal and self-harming behaviours. Borderline personality disorder and emotion dysregulation, 7, 3. https://doi.org/10.1186/s40479-020-0119-y

 

Abstract

Background

Dialectical behaviour therapy (DBT) is an evidence-based intervention for borderline personality disorder (BPD) but is an intensive treatment with significant health service costs. Access to DBT can sometimes be restricted due to limited resources. Positive results have been reported for the use of DBT skills training (DBT-ST), one of the four modes of standard DBT, in the treatment of individuals with BPD who self-harm. This study evaluates DBT-ST for a subgroup of individuals attending community mental health services who may have a diagnosis of BPD (or emerging BPD traits) but who are not actively self-harming.

Methods

Participants in this study were 100 adults attending community mental health services with a diagnosis of BPD, emerging BPD traits or emotion dysregulation who were not actively self-harming. The majority of participants were female (71%), aged 25–34 years (32%), single (48%) and unemployed (34%). Participants partook in a 24-week DBT-ST intervention delivered by DBT therapists. Outcome measures included the Difficulties in Emotion Regulation Scale (DERS), the DBT Ways of Coping Checklist (DBT-WCCL) and the Five Facet Mindfulness Questionnaire (FFMQ). Measures were administered at pre-intervention, at the end of each skills module, and at post-intervention.

Results

Significant reductions in emotion dysregulation (DERS) and dysfunctional coping (DBT-WCCL) scores were reported from pre- to post-intervention (p < .001). A significant increase in mindfulness scores (FFMQ) and DBT skill use (DBT-WCCL) was also observed (p < .001). However, the drop-out rate was high (49% at post-intervention).

Discussion

The results of this uncontrolled study suggest that a standalone 24-week DBT-ST intervention may have a beneficial impact in terms of a reduction in emotion dysregulation and dysfunctional coping, and an increase in mindfulness and DBT skills use in patients with BPD/ emerging BPD traits who are not currently engaging in self-harm. Adequately powered randomised controlled trials are required to determine treatment efficacy in comparison to standard DBT for this population.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6993331/

 

Improve Borderline Personality Disorder with Dual Diagnosis with Mindfulness

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Improve Borderline Personality Disorder with Dual Diagnosis with Mindfulness

 

By John M. de Castro, Ph.D.

 

“The pain, emotional instability and impulsive behavior of borderline personality disorder place these individuals at risk of drug or alcohol abuse.” – Foundation Recovery

 

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 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.

 

Borderline Personality Disorder (BPD) frequently occurs with other problems, particularly drug and alcohol abuse. This dual diagnosis increases the issues presenting with the patient. It is therefore important to establish if Dialectical Behavior Therapy (DBT) is effective in the dual diagnosis patients. In today’s Research News article “Does an adapted Dialectical Behaviour Therapy skills training programme result in positive outcomes for participants with a dual diagnosis? A mixed methods study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6694661/?report=classic), Flynn and colleagues examine the effectiveness of Dialectical Behavior Therapy (DBT) skills training for patients with dual diagnosis.

 

They recruited patients diagnosed with Borderline Personality Disorder (BPD) and substance abuse (primarily alcohol abuse). The patients were treated with a 48-week program of skills training adapted from Dialectical Behavior Therapy (DBT); mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness. They were measured before and after treatment and 6 months later for mindfulness, emotion regulation, coping behavior, and the frequency and severity of substance abuse. At the end of the program they were interviewed regarding their experiences with the program.

 

They found that compared with baseline, at the end of the program there were significant increases in mindfulness and Dialectical Behavior Therapy (DBT) skills use and significant reductions in dysfunctional coping behavior and emotional dysregulation that were maintained at the 6-month follow-up. Substance abuse was also significantly reduced after treatment. There was still a reduced use at the 6-month follow-up but it was no longer statistically significant. In the interviews the patients reported that the program improved their self-assurance and confidence, but there was a need for continued care after the end of the program.

 

These results are important as Borderline Personality Disorder (BPD) is extremely difficult to treat and when it is combined with substance abuse it is even more difficult to treat. It is very encouraging that training in Dialectical Behavior Therapy (DBT) skills of mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness is effective in improving emotion regulation and coping behavior and reducing substance abuse in BPD patients with dual diagnosis. This suggests that this skills training may be an acceptable and effective treatment for patients with both BPD and substance abuse.

 

So, improve borderline personality disorder with dual diagnosis with mindfulness.

 

“[Dialectical Behavior Therapy] DBT is reported to reduce suicidal behavior, non-suicidal self-injurious behavior, other impulsive behaviors strongly linked with borderline personality disorder, and significantly reduce psychiatric hospitalization (relapse), self-injury, and depression among adolescents and adults.” – Burning Tree

 

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

 

Flynn, D., Joyce, M., Spillane, A., Wrigley, C., Corcoran, P., Hayes, A., … Mooney, B. (2019). Does an adapted Dialectical Behaviour Therapy skills training programme result in positive outcomes for participants with a dual diagnosis? A mixed methods study. Addiction science & clinical practice, 14(1), 28. doi:10.1186/s13722-019-0156-2

 

Abstract

Background

Treating severe emotional dysregulation and co-occurring substance misuse is challenging. Dialectical behaviour therapy (DBT) is a comprehensive and evidence-based treatment for borderline personality disorder (BPD). It has been hypothesised that the skills training, which is a facet of the full DBT programme, might be effective for people with severe emotional dysregulation and other co-occurring conditions, but who do not meet the criteria for BPD. However, there is limited research on standalone DBT skills training for people with substance misuse and emotional dysregulation.

Methods

A mixed methods study employing an explanatory sequential design was conducted where participants with a dual diagnosis (n = 64) were recruited from a community-based public addiction treatment service in Ireland between March 2015 and January 2018. DBT therapists screened potential participants against the study eligibility criteria. Quantitative self-report measures examining emotion regulation, mindfulness, adaptive and maladaptive coping responses including substance misuse, and qualitative feedback from participants were collected. Quantitative data were summarised by their mean and standard deviation and multilevel linear mixed effects models were used to estimate the mean change from baseline to post-intervention and the 6-month follow-up period. Thematic analysis was used to analyse the qualitative data.

Results

Quantitative results indicated reductions in binge drinking and use of Class A, B and C drug use from pre-intervention (T1) to the 6-month follow-up (T3). Additionally, significant improvements were noted for mindfulness practice and DBT skills use from T1 to T3 (p < 0.001). There were also significant reductions in dysfunctional coping and emotional dysregulation from T1 to T3 (p < 0.001). Significant differences were identified from pre to post intervention in reported substance use, p = 0.002. However, there were no significant differences between pre-intervention and 6-month follow up reports of substance use or at post-intervention to 6 month follow up. Qualitative findings indicated three superordinate themes in relation to participants’ experiences of a DBT skills training programme, adapted from standard DBT: (1) new lease of life; (2) need for continued formal aftercare and (3) programme improvements. Participants described reductions in substance misuse, while having increased confidence to use the DBT skills they had learned in the programme to deal with difficult emotions and life stressors.

Conclusions

This DBT skills training programme, adapted from standard DBT, showed positive results for participants and appears effective in treating people with co-occurring disorders. Qualitative results of this mixed methods study corroborate the quantitative results indicating that the experiences of participants have been positive. The study indicates that a DBT skills programme may provide a useful therapeutic approach to managing co-occurring symptoms.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6694661/?report=classic

 

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

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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

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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

 

Decrease Suicide Ideation with Skills Learned in Dialectical Behavior Therapy

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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

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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/