Improve Refractory Depression with Mindfulness

Improve Refractory Depression with Mindfulness

 

By John M. de Castro, Ph.D.

 

Mindfulness and other meditations, particularly combined with cognitive therapy, work just as well for anxiety or depression as the medications do, but they don’t have those side effects,” – Daniel Goleman

 

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. Depression can be difficult to treat and is usually treated with anti-depressive medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients do not respond to treatment. This is called refractory depression.

 

Mindfulness training has been shown to be an effective treatment for depression and its recurrence and even in the cases where drugs failDialectical Behavior Therapy (DBT)  is a mindfulness-based therapeutic technique that 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. DBT has been shown to be effective in treating depression. So, it makes sense, then, to study the effectiveness of Dialectical Behavior Therapy (DBT) for refractory depression.

 

In today’s Research News article “Refractory depression – mechanisms and efficacy of radically open dialectical behaviour therapy (RefraMED): findings of a randomised trial on benefits and harms.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282863/ ) Lynch and colleagues recruited adults with refractory major depressive disorder and randomly assigned them to either treatment as usual or to receive 29 weekly 1 hour sessions of Dialectical Behavior Therapy (DBT). They were measured before and after treatment and 5 months and 11 months later for depressive symptoms, psychosocial functioning, suicidal ideation, psychological inflexibility, emotional coping, and social support.

 

They found that compared to baseline both groups continuously improved with reduced depressive symptoms, but the group that received Dialectical Behavior Therapy (DBT) demonstrated significantly greater reductions but they were only statistically significant immediately after treatment but not at the 5 and 11 month follow ups. Also remission rates were higher in the DBT group. In addition, the DBT group had significantly greater psychological flexibility, emotional coping after treatment and all follow-up measurements.

 

These are interesting results that suggest that Dialectical Behavior Therapy (DBT) is an effective treatment for refractory major depressive disorder. In other words, it helps the patients who are not helped by any other treatments; the most difficult to treat patients. The fact that the relief of depressive symptoms is not significantly different from the treatment as usual group at the 5 and 11-month follow ups suggests that booster session may be necessary. But it should be recognized that the patients were markedly improved relative to their baselines. It was just that the treatment as usual group improved as well. So, the DBT produced a large and sustained reduction in depression in these refractory patients.

 

So, improve refractory depression with mindfulness.

 

Meditation helped me realize that the misery I feel is temporary. It sucks, but if I can wade my way through it, I know I’ll probably have a better day tomorrow.” – Stacey Neglia

 

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

 

Lynch, T. R., Hempel, R. J., Whalley, B., Byford, S., Chamba, R., Clarke, P., Clarke, S., Kingdon, D. G., O’Mahen, H., Remington, B., Rushbrook, S. C., Shearer, J., Stanton, M., Swales, M., Watkins, A., & Russell, I. T. (2020). Refractory depression – mechanisms and efficacy of radically open dialectical behaviour therapy (RefraMED): findings of a randomised trial on benefits and harms. The British journal of psychiatry : the journal of mental science, 216(4), 204–212. https://doi.org/10.1192/bjp.2019.53

 

Abstract

Background

Individuals with depression often do not respond to medication or psychotherapy. Radically open dialectical behaviour therapy (RO DBT) is a new treatment targeting overcontrolled personality, common in refractory depression.

Aims

To compare RO DBT plus treatment as usual (TAU) for refractory depression with TAU alone (trial registration: ISRCTN 85784627).

Method

RO DBT comprised 29 therapy sessions and 27 skills classes over 6 months. Our completed randomised trial evaluated RO DBT for refractory depression over 18 months in three British secondary care centres. Of 250 adult participants, we randomised 162 (65%) to RO DBT. The primary outcome was the Hamilton Rating Scale for Depression (HRSD), assessed masked and analysed by treatment allocated.

Results

After 7 months, immediately following therapy, RO DBT had significantly reduced depressive symptoms by 5.40 points on the HRSD relative to TAU (95% CI 0.94–9.85). After 12 months (primary end-point), the difference of 2.15 points on the HRSD in favour of RO DBT was not significant (95% CI –2.28 to 6.59); nor was that of 1.69 points on the HRSD at 18 months (95% CI –2.84 to 6.22). Throughout RO DBT participants reported significantly better psychological flexibility and emotional coping than controls. However, they reported eight possible serious adverse reactions compared with none in the control group.

Conclusions

The RO DBT group reported significantly lower HRSD scores than the control group after 7 months, but not thereafter. The imbalance in serious adverse reactions was probably because of the controls’ limited opportunities to report these.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282863/

 

Improve the Health and Well-Being of Patients with Functional Dyspepsia with Mindfulness

Improve the Health and Well-Being of Patients with Functional Dyspepsia with Mindfulness

 

By John M. de Castro, Ph.D.

 

“mindfulness-based cognitive therapy reduces symptoms of functional dyspepsia and increases quality of life of the patients.” – Sobhan Pur Nik Dast

 

Functional Dyspepsia involves abdominal pain. Bloating, and nausea without a clear physical cause. It is often accompanied with anxiety. It is one of the most common digestive problems and affects 10% to 20% of the population. There is no cure. The symptoms are most frequently treated with over-the-counter medications such as antacids or anti-gas medications or even antidepressants. Stress is known to exacerbate dyspepsia. So, lifestyle changes are often recommended to reduce stress.

 

Mindfulness trainings have been shown to improve the physiological and psychological responses to stress and to reduce anxiety. They have also been shown to improve other digestive disorders such as irritable bowel syndrome (IBS). So, it is reasonable to investigate whether mindfulness training might be effective for functional dyspepsia.  Dialectical Behavior Therapy (DBT) is a mindfulness-based therapy that 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. It is not known if functional dyspepsia can be effectively treated with DBT.

 

In today’s Research News article “Comparison of dialectical behavior therapy and anti-anxiety medication on anxiety and digestive symptoms in patients with functional dyspepsia.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554546/ ) Tavakoli and colleagues recruited adults diagnosed with functional dyspepsia and continued them on antacid medication (pantoprazole ) and randomly assigned them to one of three groups, receiving either 8 weekly 2.5 hour sessions of Dialectical Behavior Therapy (DBT), an antianxiety medication (sertraline), or no further treatment. They were measured before and after treatment for dyspepsia symptom severity and anxiety.

 

They found that after treatment the group that received Dialectical Behavior Therapy (DBT) had the greatest significant reduction is dyspepsia symptom severity with the anti-anxiety medication group second and no significant improvement in the no-treatment group. They also found that after treatment the group that received anti-anxiety medication had the greatest significant reduction is dyspepsia symptom severity with the DBT group second and no significant improvement in the no-treatment group.

 

These are interesting results that suggest that Dialectical Behavior Therapy (DBT) is effective for the treatment of the symptoms of functional dyspepsia including anxiety. But anti-anxiety medication is better at reducing anxiety levels. Since the mindfulness training of DBT does not require drugs with significant side effects, it would appear to be the preferred treatment for functional dyspepsia.

 

The mechanism by which DBT improves functional dyspepsia were not studied. Functional dyspepsia, however, is thought to be produced or exacerbated by stress. Mindfulness training is known to reduce the physiological and psychological responses to stress. So, it is likely that DBT reduces stress effects thereby improving functional dyspepsia.

 

So, improve the health and well-being of patients with functional dyspepsia with mindfulness.

 

Meditation works at all levels to aid the digestive process, making it one of the most effective natural remedies for indigestion.” – Beeja

 

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

 

Tavakoli, T., Hoseini, M., Tabatabaee, T., Rostami, Z., Mollaei, H., Bahrami, A., Ayati, S., & Bijari, B. (2020). Comparison of dialectical behavior therapy and anti-anxiety medication on anxiety and digestive symptoms in patients with functional dyspepsia. Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences, 25, 59. https://doi.org/10.4103/jrms.JRMS_673_19

 

Abstract

Background:

Functional dyspepsia is a common chronic digestive disorder. The purpose of this study was to compare the effectiveness of dialectical behavior therapy and anti-anxiety medication in patients with functional dyspepsia.

Materials and Methods:

The present study was a randomized, controlled clinical trial with sixty patients who were suffering from functional dyspepsia that identified by the ROME III criteria. Patients were divided into three groups by using pre- and posttest design, including Group A (dialectal treatment and pantoprazole), Group B (anxiolytic drug treatment and pantoprazole), and Group C (no intervention, only pantoprazole were used). The Beck Anxiety Inventory and the patient assessment of Gastrointestinal Symptom Severity Index Questionnaire were completed by the patients after receiving the written consent. Finally, the data were analyzed using the Statistical Package for the Social Sciences software version 20.

Results:

There was a significant improvement in the severity of dyspepsia after intervention in all three groups. The greatest decrease in the severity of functional dyspepsia was observed in the dialectical behavioral therapy group as compared to the other groups (Group A: −15.4 ± 6.61, Group B: −3.85 ± 2.77, and Group C: −7.8 ± 4.02; P = 0.001). Furthermore, the Beck Anxiety Inventory scores were statistically significantly improved in all three groups (Group A: −5.75 ± 2.53, Group B: −7.3 ± 3.19, and Group C: −2.60 ± 1.5; P = 0.001). There was a positive correlation between the change in dyspepsia score and change in anxiety score across different intervention groups (r = 0.55; P < 0.001).

Conclusion:

Dialectical behavioral therapy can be effective in reducing anxiety and improving the dyspepsia symptoms in patients with functional dyspepsia compared to anti-anxiety medication or conventional therapy. Therefore, communication between the physicians and psychologists and psychiatrists can have positive effects on the treatment of these patients.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554546/

 

Improve Adherence to Treatment and Self-Care of Coronary Heart Disease Patients with Mindfulness

Improve Adherence to Treatment and Self-Care of Coronary Heart Disease Patients with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Not only can meditation improve how your heart functions, but a regular practice can enhance your outlook on life and motivate you to maintain many heart-healthy behaviors, like following a proper diet, getting adequate sleep, and keeping up regular exercise,” – Dr. John Denninger

 

Cardiovascular disease is the number one killer. A myriad of treatments has been developed including a variety of surgical procedures and medications. In addition, lifestyle changes have proved to be effective including quitting smoking, weight reduction, improved diet, physical activity, and reducing stresses. Unfortunately, for a variety of reasons, 60% of cardiovascular disease patients decline engaging in these lifestyle changes, making these patients at high risk for another attack.

 

Contemplative practices have been shown to be safe and effective alternative treatments for cardiovascular disease. Practices such as meditation, tai chi, and yoga, have been shown to be helpful for heart health and to reduce the physiological and psychological responses to stress. They have also been shown to be effective in maintaining cardiovascular health and the treatment of cardiovascular diseaseDialectical Behavior Therapy (DBT)  is a mindfulness-based therapeutic technique that 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.

 

It makes sense, then, to study the effectiveness of Dialectical Behavior Therapy (DBT) for the treatment of patients with Coronary Heart Disease. In today’s Research News article “The effectiveness of dialectical behavior therapy on adherence to treatment and self-caring behavior in patients with coronary heart disease.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073803/) Tavakoli and colleagues recruited patients with coronary heart disease. They continued to receive treatment as usual and were randomly assigned to receive either no additional treatment or an 8 weekly 2-hour session of Dialectical Behavior Therapy (DBT). They were measured before and after training for medication adherence and self-care for coronary heart disease.

 

They found that in comparison to baseline and the control group that the patients who received Dialectical Behavior Therapy (DBT) had significantly improved medication adherence and self-care for coronary heart disease. These effects of DBT would predict favorable outcomes. After DBT the patients take their medication more reliably and they better maintain and manage their own care and have greater confidence in their ability to care for themselves. These improvements to the patients’ behavior should lead to better recovery from coronary heart disease and better overall health.

 

So, improve adherence to treatment and self-care of coronary heart disease patients with mindfulness.

 

this practice may be clinically useful in the secondary prevention of cardiovascular disease [the prevention of further heart or stroke events for people who already have the condition].” – Heart Matters

 

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

 

Tavakoli, F., Kazemi-Zahrani, H., & Sadeghi, M. (2019). The effectiveness of dialectical behavior therapy on adherence to treatment and self-caring behavior in patients with coronary heart disease. ARYA atherosclerosis, 15(6), 281–287. https://doi.org/10.22122/arya.v15i6.1733

 

Abstract

BACKGROUND

The aim of this study was to investigate the effectiveness of dialectical behavior therapy (DBT) on adherence to treatment and self-caring behavior in patients with coronary heart disease (CHD).

METHODS

This was an experimental study based on control and experimental groups with pre-test and post-test. 32 male and female patients with CHD having at least high school diploma, referring to Isfahan cardiovascular research institute, Isfahan, Iran, were selected and placed randomly in two groups of control and experimental. Pre-test stage was done for both two groups by 8-item Morisky Medication Adherence Scale (MMAS-8) and Self-Care of Coronary Heart Disease Inventory (SC-CHDI). The experimental group was placed under the intervention of DBT for 8 sessions of 2 hours (once a week). Afterwards, the post-test was done for both groups.

RESULTS

It was shown by analyzing results from t-test that adherence to treatment and self-care behavior significantly increased in experimental group comparing to control group [(1.81 ± 0.75 vs. 5.19 ± 1.22, P < 0.001) and (72.50 ± 4.38 vs. 55.50 ± 7.42, P < 0.001), respectively]. Also results showed that self-caring and adherence to treatment significantly increased after being adjusted for baseline measurement (P < 0.001). The findings showed that DBT had effect on adherence to treatment and self-caring behavior of patients with CHD.

CONCLUSION

On the basis of results, it could be said that DBT intervention can have positive impact on adherence to treatment and self-caring behavior of patients with CHD.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073803/

Lower Suicide Risk in College Students with Mindfulness

Lower Suicide Risk in College Students with Mindfulness

 

By John M. de Castro, Ph.D.

 

Zhongyong thinking still plays an important role in regulating mental distress and maintaining subjective well-being among contemporary Chinese young adults.” – Xeuling Yang

 

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. 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 suicidalityDialectical 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.

 

Zhong‐Yong thinking emphasizes pursuing the middle ground and never going to extremes and is characterized by acting appropriately and flexibly under different situations. It would seem to be compatible with the kinds of training occurring in Dialectical Behavior Therapy (DBT) and would tend to be an antidote for suicidal thinking. Although it would seem reasonable combining Zhong‐Yong thinking with DBT would improve its effectiveness in lowering the risk of suicide, there have been no systematic studies.

 

In today’s Research News article “Effectiveness of Zhong-Yong thinking based dialectical behavior therapy group skills training versus supportive group therapy for lowering suicidal risks in Chinese young adults: A randomized controlled trial with a 6-month follow-up.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303376/) Yang and colleagues recruited high suicide risk college students and randomly assigned them to either a wait-list control condition or to receive a 2-hour once a week for 12 weeks program of either Dialectical Behavior Therapy (DBT) modified for inclusion of Zhong‐Yong thinking or a supportive group therapy program based upon interpersonal psychology focusing on emotional regulation and interpersonal effectiveness. They were measured before and after training and 6 months later for suicide behaviors and ideation, hopelessness, psychological distress, and psychopathological symptoms.

 

They found that in comparison to baseline and the wait-list control group, the groups that received either treatment has significant reductions in suicide behaviors and ideation, hopelessness, psychological distress, and psychopathological symptoms. But at the 6-month follow up the treatment groups differed with the Zhong-Yong thinking based Dialectical Behavior Therapy (DBT) group producing significantly greater improvements of obsessive compulsive, anxiety, hostility, phobic, and psychotic symptoms in comparison to supportive group therapy.

 

The results are promising that Zhong-Yong thinking based Dialectical Behavior Therapy (DBT) can reduce suicidality and risk factors for suicide in college students and maintain the benefits for 6 months after the end of active treatment. Although supportive therapy was equally beneficial on the short-term, it was less effective on the long-term. So, Zhong-Yong thinking based DBT would appear to be the superior treatment. It would be important in future research to compare Zhong-Yong thinking based DBT to traditional DBT to determine if the addition of training in Zhong-Yong thinking increases the benefits.

 

So, lower suicide risk in college students with mindfulness.

 

those who scored high on the Zhongyong Thinking Scale had substantially lower scores on anxiety and depressive symptoms, and had higher scores on self-esteem and life satisfaction.” – Xeuling Yang

 

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

 

Yang, X., Liu, D., Wang, Y., Chen, Y., Chen, W., Yang, C., Zhang, P., Ding, S., & Zhang, X. (2020). Effectiveness of Zhong-Yong thinking based dialectical behavior therapy group skills training versus supportive group therapy for lowering suicidal risks in Chinese young adults: A randomized controlled trial with a 6-month follow-up. Brain and behavior, 10(6), e01621. https://doi.org/10.1002/brb3.1621

 

Abstract

Background

Dialectical behavior therapy (DBT) is a first‐line treatment for the prevention of suicide. Zhong‐Yong thinking could be viewed as a Chinese way of dialectical thinking, has long been a culturally dictating thinking style in China. To enhance cultural adaptability, we integrated Zhong‐Yong thinking into DBT group skills training and examined its efficacy in suicidal prevention compared with a supportive group therapy and a wait‐list group in high‐risk suicidal Chinese college students.

Methods

A total of 97 suicidal participants were randomized to either Zhong‐Yong thinking based DBT group skills training (DBTZYT, n = 33), or supportive group therapy (SGT; n = 32), or wait‐list group (WL; n = 32). DBTZYT was a 12‐week program based on Zhong‐Yong thinking instead of dialectical thinking, coaching participants mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. Supportive group therapy was a 12‐week program aiming at improving interpersonal effectiveness and emotion regulation skills. Outcome measures were assessed at pre‐ and post‐treatment and 6‐month follow‐up.

Results

At post‐treatment measures, the levels of suicidal ideation, hopelessness, psychache symptoms, and general psychopathology had significantly decreased in both intervention groups; at the 6‐month follow‐up measures, the intervention effects were better maintained in the DBTZYT group rather than in the SGT group. Specifically, DBTZYT was more effective in relieving participants’ long‐term obsessive‐compulsive, anxiety, hostility, phobic, psychotic, and additional symptoms.

Conclusions

Zhong‐Yong thinking not only could integrate with DBT skills training in Chinese young adult population, but also has special strength in enhancing DBT’s efficacy.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303376/

 

Control Binge Eating Disorder with Mindfulness

Control Binge Eating Disorder with Mindfulness

 

By John M. de Castro, Ph.D.

 

Psychotherapy approaches, including DBT, have been shown to be effective in helping a person with binge eating disorder overcome abnormal eating behaviors.” – Jacquelyn Ekern

 

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.

 

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 disordersAcceptance and Commitment Therapy (ACT) is a mindfulness-based therapy that has also been shown to alter eating behaviorDialectical 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.

 

In today’s Research News article “Dialectical behavior therapy adapted for binge eating compared to cognitive behavior therapy in obese adults with binge eating disorder: a controlled study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7285554/), Lammers and colleagues  recruited obese (BMI>30) adults who were diagnosed with binge eating disorder and engaged in emotional eating. They were randomly assigned to receive once a week for 20 weeks of either 3.75 hours of Cognitive Behavioral Therapy (CBT) or 2 hours of Dialectical Behavior Therapy (DBT). They were measured before and after treatment and 6 months later for eating disorders, emotion regulation, general psychopathology, depression, and body size.

 

They found that both groups had reduced eating disorder psychopathology after treatment and 6 months later with the Cognitive Behavioral Therapy (CBT) group having better outcomes with 65% of the patients shifting from dysfunctional to functional at follow-up as compared to 46% for the Dialectical Behavior Therapy (DBT) group.

 

These results were contrary to the researchers’ expectation that Dialectical Behavior Therapy (DBT) would be more efficacious than Cognitive Behavioral Therapy (CBT). One possible explanation for the superiority of CBT was that it contained a greater amount of therapeutic contact hours, 3.75 hours per week, than DBT, 2 hours per week. But the results clearly show that both treatments were effective in treating binge eating disorder in obese patients with emotional eating.

 

So, control binge eating disorder with mindfulness.

 

Integrating mindfulness techniques in binge eating disorder treatment has been shown to reduce binge eating, improve nutritional outcomes, improve weight management, as well as enhance diabetes management.” – Jacquelyn Ekern

 

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

 

Lammers, M. W., Vroling, M. S., Crosby, R. D., & van Strien, T. (2020). Dialectical behavior therapy adapted for binge eating compared to cognitive behavior therapy in obese adults with binge eating disorder: a controlled study. Journal of Eating Disorders, 8, 27. https://doi.org/10.1186/s40337-020-00299-z

 

Abstract

Background

Current guidelines recommend cognitive behavior therapy (CBT) as the treatment of choice for binge eating disorder (BED). Although CBT is quite effective, a substantial number of patients do not reach abstinence from binge eating. To tackle this problem, various theoretical conceptualizations and treatment models have been proposed. Dialectical behavior therapy (DBT), focusing on emotion regulation, is one such model. Preliminary evidence comparing DBT adapted for BED (DBT-BED) to CBT is promising but the available data do not favor one treatment over the other. The aim of this study is to evaluate outcome of DBT-BED, compared to a more intensive eating disorders-focused form of cognitive behavior therapy (CBT+), in individuals with BED who are overweight and engage in emotional eating.

Methods

Seventy-four obese patients with BED who reported above average levels of emotional eating were quasi-randomly allocated to one of two manualized 20-session group treatments: DBT-BED (n = 41) or CBT+ (n = 33). Intention-to-treat outcome was examined at post-treatment and at 6-month follow-up using general or generalized linear models with multiple imputation.

Results

Overall, greater improvements were observed in CBT+. Differences in number of objective binge eating episodes at end of treatment, and eating disorder psychopathology (EDE-Q Global score) and self-esteem (EDI-3 Low Self-Esteem) at follow-up reached statistical significance with medium effect sizes (Cohen’s d between .46 and .59). Of the patients in the DBT group, 69.9% reached clinically significant change at end of the treatment vs 65.0% at follow-up. Although higher, this was not significantly different from the patients in the CBT+ group (52.9% vs 45.8%).

Conclusions

The results of this study show that CBT+ produces better outcomes than the less intensive DBT-BED on several measures. Yet, regardless of the dose-difference, the data suggest that DBT-BED and CBT+ lead to comparable levels of clinically meaningful change in global eating disorder psychopathology. Future recommendations include the need for dose-matched comparisons in a sufficiently powered randomized controlled trial, and the need to determine mediators and moderators of treatment outcome.

Plain English summary

Binge eating disorder (BED) is mostly treated with cognitive behavior therapy (CBT). The treatment focusses on reducing efforts to diet. Yet, a substantial number of patients still suffer from binge eating after this treatment. We suggest that patients with BED are better served with a treatment that helps them cope with negative emotions in a healthier way. Dialectical behavior therapy for BED (DBT-BED) is one such treatment. To test this, we compared outcomes of DBT-BED to the intensive CBT program that is common in our treatment center. We did so, in individuals with BED who might especially benefit from DBT-BED: those who are overweight and eat in response to emotions. Greater improvements were observed in the CBT group regarding the number of objective binge eating episodes at the end of treatment, and regarding global eating disorder psychopathology and self-esteem 6 months after treatment. Yet, patients in the CBT group received more therapy hours than in the DBT-BED group, which may have advantaged the CBT treatment. Concurrently, in both groups a comparable percentage of patients showed clinically meaningful changes in global eating disorder psychopathology. In conclusion, our results overall support the intensive CBT program over DBT-BED. Yet, given the fact that DBT-BED is less time-consuming (so cheaper) and presents similar percentages of meaningful change in global eating disorder psychopathology, it is worthwhile to further test the effects of DBT-BED in future studies.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7285554/

 

Improve Borderline Personality Disorder with Mindfulness

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

 

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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/

 

Reduce the Risk of Suicide in Adolescents with Mindfulness

Reduce the Risk of Suicide in Adolescents with Mindfulness

 

By John M. de Castro, Ph.D.

 

results support DBT as the first well-established, empirically supported treatment for decreasing repeated suicide attempts and self-harm in youths.” — Christina Vogt

 

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. 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.

 

Adolescence can be a difficult time, fraught with challenges. During this time the child transitions to young adulthood; including the development of intellectual, psychological, physical, and social abilities and characteristics. There are so many changes occurring during this time that the adolescent can feel overwhelmed and unable to cope with all that is required. This can produce despair leading to suicide. Indeed, suicide is the second leading cause of death in adolescents.

 

Mindfulness training for children and adolescents has been shown to have very positive effects. These include academic, cognitive, psychological, and social domains. Mindfulness training has been shown to improve emotion regulation and to benefit the psychological and emotional health of adolescents. Importantly, mindfulness training with children and adolescents appears to improve the self-conceptimprove attentional ability and reduce stress. This suggests that mindfulness practices may be effective in reducing the risk of suicide in adolescents. Indeed, 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 review the published research studies examining the effectiveness of DBT for the reduction of the risk of suicide in adolescents.

 

In today’s Research News article “Recent advances in understanding and managing self-harm in adolescents.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6816451/), Clarke and colleagues review and summarize the published research studies on the use of various therapeutic techniques including Dialectical Behavior Therapy (DBT) for the reduction of the risk of suicide in adolescents. They report that the published research supports the ability of mindfulness-based interventions, especially DBT for the reduction of self-injurious behaviors in adolescents with a high risk of suicide. It appears that the most important components for the effectiveness of DBT are “family involvement, emotion regulation skills, communication skills, and problem-solving skills.” As a result, they deem DBT as “the first and only “well-established” treatment for suicidal and [self-injurious]  adolescents.”

 

So, reduce the risk of suicide in adolescents with mindfulness.

 

One RCT of DBT with adolescents has been conducted in Norway demonstrating greater reductions in self-harm behaviors than enhanced usual care at 19 week and one year follow-up.” Michele Berk

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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Study Summary

 

Clarke, S., Allerhand, L. A., & Berk, M. S. (2019). Recent advances in understanding and managing self-harm in adolescents. F1000Research, 8, F1000 Faculty Rev-1794. doi:10.12688/f1000research.19868.1

 

Abstract

Adolescent suicide is a serious public health problem, and non-suicidal self-injury (NSSI) is both highly comorbid with suicidality among adolescents and a significant predictor of suicide attempts (SAs) in adolescents. We will clarify extant definitions related to suicidality and NSSI and the important similarities and differences between these constructs. We will also review several significant risk factors for suicidality, evidence-based and evidence-informed safety management strategies, and evidence-based treatment for adolescent self-harming behaviors. Currently, dialectical behavior therapy (DBT) for adolescents is the first and only treatment meeting the threshold of a well-established treatment for self-harming adolescents at high risk for suicide. Areas in need of future study include processes underlying the association between NSSI and SAs, clarification of warning signs and risk factors that are both sensitive and specific enough to accurately predict who is at imminent risk for suicide, and further efforts to sustain the effects of DBT post-treatment. DBT is a time- and labor-intensive treatment that requires extensive training for therapists and a significant time commitment for families (generally 6 months). It will therefore be helpful to assess whether other less-intensive treatment options can be established as evidence-based treatment for suicidal adolescents.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6816451/

 

Improve Borderline Personality Disorder with Dual Diagnosis with Mindfulness

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

 

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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

 

Improve Bipolar Disorder with a Mindfulness-Based Therapy (Dialectical Behavioral Therapy, DBT)

Improve Bipolar Disorder with a Mindfulness-Based Therapy (Dialectical Behavioral Therapy, DBT)

 

By John M. de Castro, Ph.D.

 

“The skills training and treatment model of DBT is applicable to people living with a range of mental health conditions. Practicing mindfulness helps people with and without mental health conditions to improve well-being, attention to the present moment, and increasing positive emotional experiences while decreasing negative emotions and distress. This is why people with depression, bipolar, anxiety, eating disorders, and other mental health conditions may benefit from mindfulness practice and the other skills that form dialectical behavior therapy.” – Jeremy Schwartz

 

Bipolar Disorder, also known as Manic Depressive Disorder, is a mood disorder characterized by alternating states of extreme depression, relative normalcy, and extreme euphoria (mania). The symptoms of depression and mania are so severe that the individual is debilitated and unable to conduct their normal daily lives. The depression is so severe that suicide occurs in about 1% of cases of Bipolar Disorder. There are great individual differences in Bipolar Disorder. The extreme mood swings can last for a few days to months and can occur only once or reoccur frequently.

 

Bipolar Disorder affects about 1% of the population throughout the world at any time. But about 3% to 10% of the population may experience it sometime during their lives. It is usually treated with drugs. But these medications are not always effective and can have difficult side effects. Hence, there is a great need for alternative treatments. Mindfulness practices and treatments have been shown to be effective for major mental disorders, including depression and anxiety disorders and to improve the regulation of emotions.

 

Dialectical Behavior Therapy (DBT) is a mindfulness-based therapy targeted at changing the problem behaviors. 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. So, it makes sense to further study the ability of DBT to treat the symptoms of Bipolar Disorder.

 

In today’s Research News article “Effectiveness of Dialectical Behavioral Therapy on Executive Function, Emotional Control and Severity of Symptoms in Patients with Bipolar I Disorder.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6796294/), Zagar and colleagues recruited patients with Bipolar Disorder Type 1, aged 20-45 years, and were randomly assigned to receive either Dialectical Behavior Therapy (DBT) or no additional treatment. All participants maintained their prescribed drug regimen. DBT was delivered in 12 weekly, 1.5 hour sessions. They were measured before and after treatment and 3 months later for mania, depression, emotional control, and cognitive executive function.

 

They found that the group receiving Dialectical Behavior Therapy (DBT) had significant reductions in mania and depressed mood following the treatment. These results suggest that DBT is a safe and effective treatment for Bipolar Disorder when provided in addition to drug therapy. No 3-month follow-up measures were reported. Hence, it is not known whether these improvements are lasting. Further research is warranted.

 

So, improve Bipolar Disorder with a mindfulness-based therapy (Dialectical Behavioral Therapy, DBT).

 

DBT helps people learn and implement four skills to create what they determine to be a life worth living: mindfulness, the ability to tolerate distress, the ability to regulate emotions, and healthy communication skills.” – Robin Flanigan

 

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

 

Zargar, F., Haghshenas, N., Rajabi, F., & Tarrahi, M. J. (2019). Effectiveness of Dialectical Behavioral Therapy on Executive Function, Emotional Control and Severity of Symptoms in Patients with Bipolar I Disorder. Advanced biomedical research, 8, 59. doi:10.4103/abr.abr_42_19

 

Abstract

Background:

Bipolar disorder is a disabling illness characterized by recurrent episodes of mania, hypomania, and depression. The dialectical behaviour therapy (DBT) is basically designed to help regulate excitement, tolerance of discomfort, mindfulness and interpersonal relationships. This study aimed to determine the effectiveness of DBT on executive function, emotional control and symptom relief in patients with type 1 bipolar disorder.

Materials and Methods:

This clinical trial was conducted on 50 patients with type 1 bipolar disorder. These patients were divided into two 25 populated groups of controls and intervention. The control group did not receive any other alternative therapy apart from routine medications, but in the intervention group, in addition to routine medications, DBT treatment was also done as complementary therapy in 12 sessions based on Dick’s protocol. Then, Mania severity, emotional control and their executive functions were evaluated before and after the intervention and compared in two groups.

Results:

After the intervention, the scores of mania and depression mood with the mean of 2.12 ± 3.09 and 31.08 ± 8.98 respectively in intervention group were significantly lower than control group with the mean of 4.24 ± 4.11 and 39.92 ± 9.05 respectively (P < 0.05). Depression and executive function of the patients had no significant difference between the two groups in the post-intervention period and had a modest and non-significant change.

Conclusion:

DBT has been effective in decreasing the intensity of mania, but, it cannot be used to reduce the emotional instability and impulsivity of these patients along with drug therapy although it has improved the executive functions and depression of the patients.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6796294/

 

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