Research In

Recent research in DBT indicates that it is effective in the treatment of multi-disordered clients. Linehan et al. (1991) completed the first randomized controlled trial for chronically suicidal females who met criteria for borderline personality disorder in an outpatient clinic and compared DBT with community-based 'treatment as usual' (TAU) after 12 months of treatment. The subjects who were in the DBT condition demonstrated statistically significant reductions in suicidal and non-suicidal self-injurious behaviours during the treatment year, fewer inpatient hospitalization days and improvement on global and social adjustment. Retention in treatment was greater for the subjects in the DBT condition at the conclusion of the study (83 % versus 47 %). Dialectical behaviour therapy subjects also demonstrated significant improvements in reducing anger. All subjects improved over time on depression, hopelessness and suicide ideation (Linehan etal, 1994). Koons etal. (2001) conducted a six months study at an outpatient women's clinic for the Veteran's Administration in Durham, NC. The Koons et al. study was six months in duration as opposed to the Linehan et al. (1991) study, which was one year in duration. The participants in the Koons et al. study met criteria for BPD but recent non-suicidal self-injurious behaviour was not controlled. Participants in the DBT protocol had a statistically significant reduction in suicidal ideation, hopelessness, depression and anger compared with TAU at six months.

In response to criticism that the original research on DBT did not control for level of expertise by the TAU condition, Linehan et al (2006) conducted a study testing DBT versus treatment in the community by therapists identified by their peers as being expert clinicians in nonbehavioural treatments. The community treatment by experts condition (CTBE) provided supervision and consultation comparable to the DBT therapists. The DBT condition was again associated with better outcomes than the control condition (CTBE).

DBT clients were 50% less likely to engage in suicide attempts, had a significant decrease in hospitalization, and medical interventions across suicidal behaviours and non-suicidal self-injurious behaviours. DBT clients were less likely to drop out of treatment.

Since the original Linehan et al. (1991) research, studies have been carried out on modifications of DBT. Linehan et al. (1999) adapted DBT for women who met criteria for BPD and for substance abuse. The original comprehensive DBT programme was modified to include drug replacement therapy when necessary. Urinalyses were conducted at each therapy session. The treatment targets were modified to treat substance abuse specific difficulties, such as problems with attaching to the therapy and the therapists. Case-management strategies were developed to target substance abuse related problems (financial, housing, etc). In addition, the skills training group was split into two components: a one-on-one skills coaching (homework review) group and the teaching group. Self-report and urinalysis data demonstrated that the DBT clients had a statistically significant reduction in illicit drug use compared to the TAU and an increase in global and social functioning at follow-up. As in earlier studies, the clients in the DBT condition had a higher retention in treatment.

Miller, Rathus & Linehan (2006) have adapted DBT for adolescents and have pilot data comparing DBT to TAU for adolescents. Unlike earlier studies with adults, 22% of the population studied included males. The population was adolescent so clients were not required to meet criteria for BPD, however each client did meet three or more criteria for BPD. The programme was modified for 12 weeks of individual psychotherapy with twice-weekly meetings. The skills training group was completed as a multi-family group with parents/caregivers in attendance. The pilot data for the programme suggests differences in inpatient hospitalizations. The retention of clients in the DBT programme was also higher than those in the TAU (DBT 62 % versus TAU 13 %).

One of the questions that is prevalent for treatments that are developed in clinic labs is whether or not they can be applied to other mental health settings. Currently, there are on-going outcome studies being conducted in mental health systems. There is some preliminary evidence that DBT can be learned and applied in public community mental health settings. Hawkins & Singha (1998) evaluated 109 clinicians who were trained in DBT in as part of a community mental health initiative. The clinicians were tested for conceptual knowledge and mastery. The study showed that prior education and training in behaviour therapy did not affect ability to learn and even master DBT content. Another community mental health initiation, the Mental Health Center of Greater Manchester, New Hampshire, implemented DBT successfully and received the American Psychiatric Association Gold Achievement Award in the category of a small community-based programme. The program used an integrated DBT programme which demonstrated clinical changes for clients and cost savings for the system (Psychiatric Services, 1998). These studies indicate that DBT can generalize from academic and research settings into community mental health settings.

There have been two studies that have examined the efficacy of DBT skills training group with no individual DBT psychotherapy. Telch et al. (2000) used DBT for binge-eating disorders. The content of the skills training group was modified and chain analyses were conducted in the group. The number of binge-eating episodes and the days when binging occurred decreased. The DBT condition also reported lower scores on measures of weight and eating concerns. In another study Lynch et al. (2003) examined DBT group skills and scheduled telephone coaching sessions and antidepressant medication. The group targets were modified to treat elderly depression. At a six-month follow-up, 73 % of medication plus DBT patients were in remission compared with 38 % of the medication patients, a significant difference. The DBT clients showed significant differences in maladaptive Pleasing Others (a targeted behaviour).

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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