Dialectical behavior therapy: is outpatient group psychotherapy an effective alternative to individual psychotherapy?: Preliminary conclusions.

OBJECTIVES: This study evaluates a 12-month-duration adapted outpatient group dialectical behavior therapy (DBT) program for patients with a borderline personality disorder in an unselected, comorbid population. If the results of this approach are comparable with the outcome rates of a standard DBT program, the group approach can have several advantages over individual treatment. One advantage is the possibility of treating more patients per therapist. METHOD: A pre-post design was used to measure the effectiveness of an outpatient group DBT. Data from the Beck Depression Inventory II, the Symptom Checklist 90-Revised, the State-Trait Anger Inventory, the State and Trait Anxiety Inventory, of 34 female patients (mean age, 32.65 years) were collected before and after a treatment period of 1 year. RESULTS: Overall, a significant reduction (P < .05) of depressive symptoms, suicidal thoughts, anxiety, and anger was experienced by the patients. CONCLUSIONS: This study is a first attempt in showing that DBT in an outpatient group setting can be effective in reducing psychiatric complaints and therefore has several advantages, such as the opportunity to treat more patients at once.

Prenatal stress and mixed-handedness.

Atypical lateralization, as indicated by mixed-handedness, has been related to diverse psychopathologies. Maternal prenatal stress has recently been associated with mixed-handedness in the offspring. In the present study, this relationship was investigated further in a prospective, methodologically comprehensive manner. Stress levels were determined three times during pregnancy by means of questionnaires and measurements of cortisol levels. The handedness of 110 6-y-old children (48 boys) was determined by independent observers. Mixed handedness was defined as using the opposite hand for one or more of the tested activities. Logistic regression analysis showed that more maternal daily hassles in late pregnancy and maternal mixed-handedness increased the chance of mixed-handedness in the offspring. In contrast, more pregnancy-related fear in late pregnancy and a longer duration of gestation were associated with a smaller chance of being mixed-handed. Prenatal stress measured during the first two periods of pregnancy or determined by cortisol was not related to mixed-handedness in the offspring. In conclusion, reported and physiologic measures of prenatal stress in a moderately stressed pregnant population were only partly related to offspring mixed-handedness.

Does maternal prenatal stress adversely affect the child's learning and memory at age six?

Prenatal maternal stress has been shown to affect postnatal development in animals and humans. In animals, the morphology and function of the offspring's hippocampus is negatively affected by prenatal maternal stress. The present study prospectively investigated the influence of prenatal maternal stress on learning and memory of 112 children (50 boys, 62 girls, Age: M=6.7 years, SD=8.4 months), with the Test of Memory and Learning (TOMAL). Maternal stress levels were determined three times during pregnancy by self-report questionnaires. Furthermore, maternal saliva cortisol samples were used as a measure of hypothalamus-pituitary-adrenal axis functioning. Results of hierarchical multivariate regression analyses showed that maternal life events measured during the first part of pregnancy were negatively associated with the child's attention/concentration index, while controlling for overall IQ, gender, and postnatal stress. No associations were found between prenatal maternal cortisol and the offspring's learning and memory.

Prenatal stress and children's cortisol reaction to the first day of school.

Maternal prenatal stress has been found to be related to over-activity and/or dysregulation of the HPA-system in the offspring. These effects are more readily apparent in response to novel situations. The aim of the present report was to examine whether pregnancy stress predicted HPA-axis reactions of children to the first day of school after the summer break. Children of mothers with more prenatal stress were compared to those of mothers with less stress. Habituation was studied by comparisons between the first school day and a second school day a week later. Finally, cortisol levels at school were compared to those of a weekend day. The participants were 29 mother-child pairs (20 girls and nine boys, mean age 5.31 years, SD = 0.50). The children's cortisol levels were determined in saliva. Multilevel analysis (hierarchical linear modelling) was used to analyze the data. Both prenatal cortisol and pregnancy anxiety were related to the children's cortisol levels as a reaction to the first school day. Children whose mothers had higher levels of morning cortisol during pregnancy, and more fear of bearing a handicapped child showed higher levels of cortisol on school days. In addition, the circadian rhythm of cortisol on school days appeared to have a steeper slope as compared to that of the circadian curve on a weekend day.

The effects of prenatal stress on temperament and problem behavior of 27-month-old toddlers.

AIM: To examine, in a prospective study, the influence of prenatal stress on infant temperament and problem behavior. METHOD: Self-report data on stress and anxiety, and levels of cortisol in saliva were collected from nulli-parous women during pregnancy. Temperament of the child was measured at 27 months by parent report on the Infant Characteristics Questionnaire. Behavior of the child was assessed by direct observation during the administration of the Bayley Scales of Development 2-30, and by parent report on the Child Behavior Checklist 2-3. RESULTS: Complete data were available for 103 healthy toddlers. Logistic regression analyses were performed and results were adjusted for possible prenatal, perinatal and postnatal confounders. Perceived stress during pregnancy was a predictor of lower levels of restless/disruptive temperament (OR=0.77), more total behavioral problems (OR=1.17), and more externalizing behavioral problems (OR=1.12) in 2-year-olds. Fear of bearing a handicapped child was a predictor of higher levels of restless/disruptive temperament (OR=1.39) and more attention regulation problems in toddlers (OR=1.46). CONCLUSIONS: Increased levels of maternal prenatal stress appear to be associated with temperamental and behavioral problems in toddlers.

Maternal prenatal stress and 4-6 year old children's salivary cortisol concentrations pre- and post-vaccination.

In this study influences of maternal prenatal stress on the cortisol reactions of children to a vaccination were determined. Prenatal stress at around 16 weeks of gestation was measured through questionnaires and a cortisol day curve. Cortisol reactions were determined preceding and following the vaccination. A total of 24 children (age between 3.11 and 5.9 years, mean age 4.9 years) and their mothers participated in this study. Multilevel analysis (hierarchical linear modelling) was used to analyze the data. Children of mothers who had higher concentrations of morning cortisol during pregnancy had higher concentrations of cortisol as compared to children of mothers who had lower concentrations of morning cortisol. Furthermore, more daily hassles and a higher level of fear of bearing a handicapped child during pregnancy were associated with higher concentrations of cortisol in the children.