ABSTRACT
The present study was aim to evaluate the acceptability and preliminary effectiveness of a mobile-health application, CALMA, based on dialectical behavioral therapy skills. CALMA was proposed as an adjunct to therapy for the reduction of non-suicidal and suicidal self-injury behaviors. A parallel design was used to compare the intervention group (DBT + CALMA) and the comparison group (DBT). Patients were randomized based on their groups following a randomized cluster design. After treatment, patients completed a follow-up assessment four weeks later. Each cluster was represented by a different DBT Skills Training Group offered weekly at FORO Foundation for Mental Health. Six DBT Skills Training groups were randomized to the intervention or comparison group. Twenty-one individuals met inclusion criteria and eighteen were included in the analysis. Acceptability was measured with the User Experience Questionnaire short version (UEQ-s) and preliminary efficacy with the Self-injurious thoughts and behaviors interview (SITBI). CALMA shows good acceptability to be used as an adjunct to therapy specific to the reduction of suicidal and non-suicidal self-directed violence. Evidence for preliminary efficacy included a high probability of decreased in more behaviors evaluated with the SITBI pre- and post-intervention for the group that received CALMA as compared to the comparison group. Our study provides initial evidence for the effectiveness and acceptability of CALMA. Future studies scaling up this intervention in a larger number of participants are necessary. CALMA may be especially useful in low and middle-income Latin American countries to improve access to evidence-based interventions openly available in Spanish and free to download.HighlightsCALMA is a DBT-based app aimed to reduce non-suicidal and suicidal self-directed violence.The app showed good acceptability by usersA high probability of decrease in suicidal ideation, suicidal plan, suicidal gesture, thoughts about NSSI and NSSI pre- and post-intervention was observed.
Subject(s)
Mobile Applications , Self-Injurious Behavior , Telemedicine , Humans , Self-Injurious Behavior/prevention & control , Self-Injurious Behavior/psychology , Suicidal Ideation , Suicide, Attempted/psychologyABSTRACT
INTRODUCTION: Many patients with bipolar disorder (BD) spend around 10 years without a diagnosis and appropriate treatment. The difficulty in distinguishing bipolar from unipolar depression, the prevalence of depressive symptoms along the course of BD and patients' bias in recalling their hypomanic symptoms are some of the factors that contribute to this problem. OBJECTIVE: This study compares the efficiency of several screening instruments for BD detection in a group of patients (n=63) with mood disorders, or cluster B personality disorders. METHOD: The diagnoses were made with structured interviews: Mini International Neuropsychiatric Interview (MINI) and Structured Clinical Diagnostic Interview for axis II (SCID-II). The patients completed the Mood Disorder Questionnaire (MDQ) and Bipolar Spectrum Disorder Scale (BSDS) and were assessed with the Bipolar Index-BI and Ghaemi-Goodwin Bipolar Spectrum Criteria. Sensitivity, specifcity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were estimated for each instrument, along with Chi2 and T-tests. Statistical analyses were conducted using the SPSS-v16. RESULTS: The BI had the best global performance with 88% specificity and 0.90 of sensitivity. The MDQ-H had the highest specificity and the MDQ-6 the highest sensitivity. However, when combining the MDQ with Ghaemi's criteria, an ostensible augment was obtained in sensitivity while maintaining good predictive values. CONCLUSIONS: The joint assessment of mania symptoms and typical evolving course symptoms in BD increased the probability of BD detection in this clinical sample.
Subject(s)
Bipolar Disorder/diagnosis , Psychiatric Status Rating Scales , Adult , Female , Humans , Male , Psychiatric Status Rating Scales/statistics & numerical data , Sensitivity and SpecificityABSTRACT
Clinical work with patient suffering complex or multiple problems represents one of the biggest challenges for mental health professionals. The third wave of cognitive behavioral therapies emphasizes the context and function of psychological events more so than their validity, frequency, or form, while incorporating processes of acceptance and mindfulness. The current work aims to provide a description of one type of these therapies, Dialectical Behavioral Therapy (DBT), which was developed by Dr. Marsha M. Linehan. In the 80's DBT's efficacy was investigated among women diagnosed with borderline personality disorder, while later extending the model to be used for other disorders. Specifically, the orientation of DBT, the central dialectic component between acceptance and change, validation procedures, and changes are explained. Moreover, the biosocial theory of the etiology and maintenance of behavioral problems are considered. Lastly, the targeted problems specific to when they occurred and their components for treatment are explained in stages.
ABSTRACT
Clinical work with patient suffering complex or multiple problems represents one of the biggest challenges for mental health professionals. The third wave of cognitive behavioral therapies emphasizes the context and function of psychological events more so than their validity, frequency, or form, while incorporating processes of acceptance and mindfulness. The current work aims to provide a description of one type of these therapies, Dialectical Behavioral Therapy (DBT), which was developed by Dr. Marsha M. Linehan. In the 80's DBT's efficacy was investigated among women diagnosed with borderline personality disorder, while later extending the model to be used for other disorders. Specifically, the orientation of DBT, the central dialectic component between acceptance and change, validation procedures, and changes are explained. Moreover, the biosocial theory of the etiology and maintenance of behavioral problems are considered. Lastly, the targeted problems specific to when they occurred and their components for treatment are explained in stages.
Subject(s)
Behavior Therapy , Mental Disorders/therapy , Humans , Severity of Illness IndexABSTRACT
INTRODUCTION: Several lines of evidence have well established a relationship between Bipolar Disorder and Cluster B Personality Disorders. The study compares mood spectrum and temperamental symptoms, personality traits and clinical characteristics among outpatients (n = 63) diagnosed with major depression (MD), bipolar disorder (BD), cluster B personality disorders (PD-B) and comorbidity of BD + PD-B. METHOD: The diagnosis was determined with structured interviews (MINI and SCID II) and symptom assessments with evaluation and diagnostic instruments (MOODS-SR, BI, TEMPS-A and IPDE). Differences between groups were explored with post hoc analysis and analysis of variance. RESULTS: Patients with BD+PD-B comorbidity presented an earlier onset and more severity in suicide attempts, hospitalizations and self-harm behaviors. They showed more characteristics of cyclothymic and irritable temperament and more cluster A and B personality traits, than patients with BD only. PD-B patients obtained intermediate scores in manic like symptoms: higher than patients with depression and lower than patients with bipolar disorder. However, the Bipolarity Index clearly distinguished patients with BD or with comorbidity (BD+PD-B) from the other diagnostic groups (PD-B and MD). CONCLUSIONS: BD+PD-B comorbidity presents a more severe type of emotional dysregulation compared to the other diagnostic groups, including BD and PD-B alone. Assessing temperament, personality traits, emotional dysregulation in mania and depression, self-harm and hospitalizations severity and age onset could facilitate differential diagnosis and enhance effectiveness of treatments for BD, PD-B and their comorbidity.
Subject(s)
Bipolar Disorder/complications , Depressive Disorder, Major/complications , Mood Disorders/complications , Personality Disorders/complications , Bipolar Disorder/diagnosis , Depressive Disorder, Major/diagnosis , Humans , Mood Disorders/diagnosis , Personality Disorders/diagnosis , Severity of Illness Index , Surveys and QuestionnairesABSTRACT
Introducción: Varias líneas de evidencia han establecido una relación entre el Trastorno Bipolar y los Trastornos de la Personalidad del grupo B. El estudio compara los síntomas del espectro del ánimo, temperamentales, de personalidad y características clínicas entre pacientes ambulatorios (n=63) diagnosticados con Depresión Mayor (DM), Trastorno Bipolar (TB), Trastornos de la Personalidad del grupo B (TP-B) o comorbilidad de TB+TP-B. Metodología: El diagnóstico se realizó con entrevistas estructuradas (MINI y SCID II), las evaluaciones con instrumentos de evaluación y diagnóstico (MOODS-SR, BI, TEMPSA y IPDE). Se analizaron diferencias entre grupos con análisis de varianza y análisis post hoc. Resultados: Los pacientes con comorbilidad TB+TP-B presentaron una aparición más temprana y mayor severidad en síntomas, intentos de suicidio, internaciones y autolesiones. Mostraron más características de temperamento ciclotímico e irritable y más rasgos de la personalidad del grupo Ay B que los pacientes con TB únicamente. Los pacientes TP-B obtuvieron puntajes intermedios en síntomas maníacos: mayor que pacientes con depresión y menor que pacientes con trastorno bipolar. Sin embargo, el Índice de Bipolaridad claramente distinguió a pacientes con TB solamente o comorbilidad (TB+TP-B) de los otros grupos de diagnóstico (TP-B y DM).Conclusiones: La comorbilidad TB+TP-B presenta un tipo de desregulación emocional más severa que los demás grupos, incluyendo al TB y el TP-B por sí solos. Evaluar el temperamento afectivo, rasgos de personalidad, desregulación emocional en la manía y depresión, gravedad de autolesiones, internaciones y edad de inicio, facilitaría el diagnóstico diferencial y la eficacia de tratamientos para TB,TP-B y comorbilidad (AU)
Introduction: Several lines of evidence have well established a relationship between Bipolar Disorder and Cluster B Personality Disorders. The study compares mood spectrum and temperamental symptoms, personality traits and clinical characteristics among outpatients (n = 63) diagnosed with major depression (MD), bipolar disorder (BD), cluster B personality disorders (PD-B) and comorbidity of BD+ PD-B. Method: The diagnosis was determined with structured interviews (MINI and SCID II) and symptom assessments with evaluation and diagnostic instruments (MOODS-SR, BI, TEMPS-A and IPDE). Differences between groups were explored with post hoc analysis and analysis of variance. Results: Patients with BD+PD-B comorbidity presented an earlier onset and more severity in suicide attempts, hospitalizations and self-harm behaviors. They showed more characteristics of cyclothymic and irritable temperament and more cluster A and B personality traits, than patients with BD only. PD-B patients obtained intermediate scores in manic like symptoms: higher than patients with depression and lower than patients with bipolar disorder. However, the Bipolarity Index clearly distinguished patients with BD or with comorbidity (BD+PD-B) from the other diagnostic groups (PD-B and MD).Conclusions: BD+PD-B comorbidity presents a more severe type of emotional dysregulation compared to the other diagnostic groups, including BD and PD-B alone. Assessing temperament, personality traits, emotional dysregulation in mania and depression, self-harm and hospitalizations severity and age onset could facilitate differential diagnosis and enhance effectiveness of treatments for BD, PD-B and their comorbidity (AU)
Subject(s)
Humans , Bipolar Disorder/psychology , Personality Disorders/psychology , Affective Disorders, Psychotic/psychology , Comorbidity , Affective Symptoms/psychology , Borderline Personality Disorder/psychologyABSTRACT
The present study evaluates a standardized group intervention for individuals with a family relative diagnosed with Borderline Personality Disorder (BPD) or suffering from severe emotional disregulation, impulsive behavior, and interpersonal conflict, as reported by the participants of the study. This study is a preliminary exploratory step toward a future efficacy study. The intervention is based on Dialectical Behavioral Therapy and is structured as a 12-week program that introduces participants to psychoeducation, therapeutic strategies and training skills. An analysis of the degree of caretaker burden and psychological distress among participants was conducted in two phases: before and after the 12-week program. In the first phase, descriptive statistics present a sample of family relatives (n = 42) with a high degree of caretaker burden and intense psychological distress. There were significantly higher rates of burden, distress, and family conflict among the subjects whose family relatives had previous suicide attempts and hospitalizations. Subjects who completed the intervention experienced a reduction in level of burden, psychological distress and somatic symptoms. The findings are useful for designing group interventions for relatives of individuals with borderline personality disorder, and efficacy studies to evaluate them. More is discussed on the psychological factors to be considered for experimental research in this population.
Subject(s)
Borderline Personality Disorder/therapy , Family , Psychotherapy, Group , HumansABSTRACT
This article presents a Protocol for Suicidal Clients in mental health practice. These protocols in medicine should promote a practice based on evidence and the experts consensus. It discusses the advantages and disadvantages of this procedures, promoting its use. The reasons include research, training, efficacy, evidence based practices, stress reduction and better performance of the mental health professionals. Based on Dialectical Behavioral Therapy, this protocol has been designed and used in a program with severly disturb clients. This article also discusses the advantages and disadvantages of the No Harm Contracts versus its replacement for Treatment Agreements or Compromises.
Subject(s)
Clinical Protocols , Suicide Prevention , Clinical Medicine , Humans , ImaginationABSTRACT
Introducción: La comunicación telefónica es un medio efectivo para el tratamiento de los pacientes, cualquiera que sea el grado de complejidad de su padecimiento. Objetivo: Revisar la literatura sobre la consulta telefónica en el tratamiento psicológico y psiquiátrico. Método: Revisión de la literatura. Desarrollo: Se revisa el material y se compara con la terapia dialéctico- conductual. Se presenta una guía para que el terapeuta tenga práctica en la realización de preguntas y comentarios. Conclusión: El uso por parte de los profesionales de determinadas tecnologías implica una instancia de refl exión que lo acompañe. Es importante que los terapeutas reciban el entrenamiento suficiente en el manejo de la asistencia telefónica y estén preparados para dar este tipo de apoyo. Se espera contar con una mayor cantidad de estudios que investiguen esta línea de acción.
Introduction: Phone consultation is an effective way for the treatment of patients with problems of any level of complexity. Objective: To review the literature on phone consultation during psychological and psychiatric treatment. Methodology: Revision of the topic and its comparison with DBT. Development of a question-and-answer protocol for therapists. Conclusion: The use of certain technologies by professionals implies also to refl ect on them. It is important for therapists to get an effective training in phone consultation and to be prepared for providing this kind of support. Further studies are expected about this topic.
ABSTRACT
Evidence suggests that while clinical practitioners generally value scientific validity, most clinical practices are supported by personal experience and belief. On the other hand, the Empirically Supported Therapies are rejected by most therapists who consider them inflexible and poorly adapted to each particular case. Larry Beutler et al, have developed a method based on scientific evidence called Systematic Treatment Selection (STS), that guides the clinician in the decisions about which are the most appropriate type of interventions for each particular patient. Fundación Aiglé and Centro Privado de Psicoterapias have developed a validation program with a local sample of three hundred patients. The following article will present the principal concepts of STS, as well as the steps and preliminary results of the validation program in Argentina.
Subject(s)
Evidence-Based Medicine/methods , Mental Disorders/therapy , Mental Health Services/organization & administration , Psychotherapy/methods , Adult , Argentina , Continuity of Patient Care , Humans , Middle Aged , Reproducibility of ResultsABSTRACT
Evidence suggests that while clinical practitioners generally value scientific validity, most clinical practices are supported by personal experience and belief. On the other hand, the Empirically Supported Therapies are rejected by most therapists who consider them inflexible and poorly adapted to each particular case. Larry Beutler et al, have developed a method based on scientific evidence called Systematic Treatment Selection (STS), that guides the clinician in the decisions about which are the most appropriate type of interventions for each particular patient. Fundación Aiglé and Centro Privado de Psicoterapias have developed a validation program with a local sample of three hundred patients. The following article will present the principal concepts of STS, as well as the steps and preliminary results of the validation program in Argentina.
ABSTRACT
Evidence suggests that while clinical practitioners generally value scientific validity, most clinical practices are supported by personal experience and belief. On the other hand, the Empirically Supported Therapies are rejected by most therapists who consider them inflexible and poorly adapted to each particular case. Larry Beutler et al, have developed a method based on scientific evidence called Systematic Treatment Selection (STS), that guides the clinician in the decisions about which are the most appropriate type of interventions for each particular patient. Fundación Aiglé and Centro Privado de Psicoterapias have developed a validation program with a local sample of three hundred patients. The following article will present the principal concepts of STS, as well as the steps and preliminary results of the validation program in Argentina.
ABSTRACT
This present paper reviews the current theories about the borderline personality disorder and their relations with their families and significant others. The biosocial theory states that the relationship between emotional vulnerability and the interactions with family relations seems to explain the problems with DLP clients. This disorder is defined then as an interaction disease. Relatives and significant others usually have symptoms, beliefs, and emotions produced by this interaction. A list of general strategies for the assistance of these clients and their families is introduced: The transformation of the complaint into a problem, the psycho education, the reduction of expressed emotions, the acceptance and the training in different abilities. At the end, the experience with psycho education approach workshops is commented, as well as the use of a psycho educational manual.
Subject(s)
Borderline Personality Disorder/psychology , Family/psychology , HumansABSTRACT
This present paper reviews the current theories about the borderline personality disorder and their relations with their families and significant others. The biosocial theory states that the relationship between emotional vulnerability and the interactions with family relations seems to explain the problems with DLP clients. This disorder is defined then as an interaction disease. Relatives and significant others usually have symptoms, beliefs, and emotions produced by this interaction. A list of general strategies for the assistance of these clients and their families is introduced: The transformation of the complaint into a problem, the psycho education, the reduction of expressed emotions, the acceptance and the training in different abilities. At the end, the experience with psycho education approach workshops is commented, as well as the use of a psycho educational manual.
ABSTRACT
This present paper reviews the current theories about the borderline personality disorder and their relations with their families and significant others. The biosocial theory states that the relationship between emotional vulnerability and the interactions with family relations seems to explain the problems with DLP clients. This disorder is defined then as an interaction disease. Relatives and significant others usually have symptoms, beliefs, and emotions produced by this interaction. A list of general strategies for the assistance of these clients and their families is introduced: The transformation of the complaint into a problem, the psycho education, the reduction of expressed emotions, the acceptance and the training in different abilities. At the end, the experience with psycho education approach workshops is commented, as well as the use of a psycho educational manual.
ABSTRACT
The aim of this research is try to expose and to debate the groupal psychotherapy experience of homosexual males older than 65 years, in Buenos Aires. The starting point for this work is based on that homogeneous groups are effective in some contexts, what is demonstrated by the results at the beginning and at the end of the samples of the BSI and SAS, although this data are not, like it was supposed, commonly linked with the selected biographical antecedents (abuse of power, bereavements during the last military dictatorships, bereavements as result of the AIDS epidemic and the difficulties in the economic survival).
Subject(s)
Aging/physiology , Homosexuality, Male/psychology , Psychotherapy, Group/methods , Aged , Humans , Male , Quality of LifeABSTRACT
El propósito de este trabajo es exponer y debatir la experiencia grupal de psicoterapia con varones homosexuales mayores de 65 años en Buenos Aires. Las hipótesis centrales que lo articulan se constituyen desde dos perspectivas, una estadística y otra de análisis narrativo. Se parte del presupuesto que los grupos homogéneos son eficaces en algunos contextos, lo que queda demostrado en los resultados de las tomas de inicio y al final del BDI y SAS; aunque dichos datos no se encuentran, como se suponía, consistentemente vinculados con los antecedentes históricos (abuso de poder, duelos durante las últimas dictaduras militares, duelos por la epidemia de SIDA y las dificultadesen la supervivencia económica). Por otro lado se ha evidenciado que las Narrativas Gay y Lesbianas descriptas y validadas en la bibliografía contemporánea anglosajona son asumidas por este grupo. Por último, se discute el constructo de la atribución melodramática que está relacionado con la homofobia, y las vinculaciones de esta con el carácter patologizante de los tratamientos psicoterapéuticos anteriores.(AU)
Subject(s)
Humans , Aged , Homosexuality/psychology , Psychotherapy, Group , Aging/psychologyABSTRACT
El propósito de este trabajo es exponer y debatir la experiencia grupal de psicoterapia con varones homosexuales mayores de 65 años en Buenos Aires. Las hipótesis centrales que lo articulan se constituyen desde dos perspectivas, una estadística y otra de análisis narrativo. Se parte del presupuesto que los grupos homogéneos son eficaces en algunos contextos, lo que queda demostrado en los resultados de las tomas de inicio y al final del BDI y SAS; aunque dichos datos no se encuentran, como se suponía, consistentemente vinculados con los antecedentes históricos (abuso de poder, duelos durante las últimas dictaduras militares, duelos por la epidemia de SIDA y las dificultadesen la supervivencia económica). Por otro lado se ha evidenciado que las Narrativas Gay y Lesbianas descriptas y validadas en la bibliografía contemporánea anglosajona son asumidas por este grupo. Por último, se discute el constructo de la atribución melodramática que está relacionado con la homofobia, y las vinculaciones de esta con el carácter patologizante de los tratamientos psicoterapéuticos anteriores.
Subject(s)
Humans , Aged , Homosexuality , Psychotherapy, Group , AgingABSTRACT
The aim of this research is try to expose and to debate the groupal psychotherapy experience of homosexual males older than 65 years, in Buenos Aires. The starting point for this work is based on that homogeneous groups are effective in some contexts, what is demonstrated by the results at the beginning and at the end of the samples of the BSI and SAS, although this data are not, like it was supposed, commonly linked with the selected biographical antecedents (abuse of power, bereavements during the last military dictatorships, bereavements as result of the AIDS epidemic and the difficulties in the economic survival).
ABSTRACT
The aim of this research is try to expose and to debate the groupal psychotherapy experience of homosexual males older than 65 years, in Buenos Aires. The starting point for this work is based on that homogeneous groups are effective in some contexts, what is demonstrated by the results at the beginning and at the end of the samples of the BSI and SAS, although this data are not, like it was supposed, commonly linked with the selected biographical antecedents (abuse of power, bereavements during the last military dictatorships, bereavements as result of the AIDS epidemic and the difficulties in the economic survival).
