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1.
Suicide Life Threat Behav ; 54(2): 338-348, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38265111

ABSTRACT

INTRODUCTION: Borderline personality disorder (BPD) is a disorder of pervasive emotion dysregulation associated with high rates of self-injurious thoughts and behaviors (SITB). Understanding specific emotion states in relation to SITB is important for effective intervention. METHODS: The current study examined whether, and how, the specific emotion of shame contributes to suicide ideation and urges to engage in non-suicidal self-injury (NSSI) both directly, and indirectly via anger, among individuals with BPD. Participants (N = 100) were enrolled in a 6-month comprehensive dialectical behavior therapy (DBT) program and provided daily ratings of shame, anger, suicide ideation, and urges for NSSI. RESULTS: We found that higher daily ratings of shame and anger were directly associated with higher same-day ratings of both suicidal ideation and urges for NSSI. Furthermore, anger partially mediated the relationships between shame and both suicidal ideation and urges for NSSI. CONCLUSION: These findings highlight shame and anger as potential antecedents of SITB among individuals with BPD. Clinical approaches, such as DBT, that include personalized, ongoing, clinical assessment of these specific affective states may be particularly important for treatment of SITB.


Subject(s)
Borderline Personality Disorder , Dialectical Behavior Therapy , Self-Injurious Behavior , Humans , Suicidal Ideation , Borderline Personality Disorder/therapy , Borderline Personality Disorder/psychology , Treatment Outcome , Self-Injurious Behavior/therapy , Self-Injurious Behavior/psychology , Anger , Shame , Behavior Therapy
2.
Behav Res Ther ; 171: 104427, 2023 12.
Article in English | MEDLINE | ID: mdl-37980875

ABSTRACT

Research and clinical experience highlight the variability of suicidal ideation (SI) within and between individuals. Although the idiographic emotional contexts in which SI occurs may offer explanations for its dynamic nature, most statistical methods focus on nomothetic patterns, making it difficult to advance our understanding of SI. Furthermore, the gap between nomothetic methods and a need for idiographic understanding of SI poses challenges to translating empirical knowledge into individualized clinical treatment. Group iterative multiple model estimation (GIMME) is a method that may bridge the idiographic-nomothetic divide by analyzing temporal relationships among a network of variables at both group- and individual-levels. This study explored the feasibility and clinical utility of GIMME applied to examine the relationships between various emotions and SI among individuals with borderline personality disorder who underwent Dialectical Behavior Therapy. We present graphic outputs that emerged throughout treatment and discuss how they could aid clinical assessment and case formulation (ClinicalTrials.gov Identifier: NCT03123198.).


Subject(s)
Borderline Personality Disorder , Dialectical Behavior Therapy , Humans , Suicidal Ideation , Borderline Personality Disorder/psychology , Emotions
3.
Int J Eat Disord ; 56(5): 885-887, 2023 05.
Article in English | MEDLINE | ID: mdl-37057346

ABSTRACT

Schleider et al. (2023, International Journal of Eating Disorders) provide an overview and compelling rationale for incorporating single-session interventions (SSIs) into the eating disorder field. As intervention researchers working with complex mental health problems, including suicide risk, we agree that there is much to be gained by developing and deploying SSIs on a broader scale and for historically difficult-to-treat problems. In this commentary, we describe some additional strengths of the SSI approach and highlight their potential in the use of stepped care models of treatment. Ultimately, determining who could benefit from a low dose of treatment and for whom longer treatment is warranted could pave the way for addressing the current mental health burden.


Subject(s)
Feeding and Eating Disorders , Mental Health , Humans
4.
Assessment ; 30(7): 2223-2233, 2023 10.
Article in English | MEDLINE | ID: mdl-36604797

ABSTRACT

Although ecological momentary assessment (EMA) provides an opportunity for the examination of intervention mechanisms in real time, there are few validated tools to assess key treatment mechanisms in EMA studies. Our focus in this study is a potentially critical treatment mechanism, improvement in self-efficacy for managing negative emotions. We examined the psychometric properties of the Patient-Reported Outcomes Measurement Information System (PROMIS) self-efficacy for managing negative emotions scale measured via EMA. Participants (n = 145 college students) in a clinical trial of Dialectical Behavior Therapy skills completed four daily EMAs for 6 weeks (13,153 total responses). Results indicated (a) excellent internal consistency and good factor structure, (b) sufficient variability at both the between- and the within-persons levels, and (c) strong construct and predictive validity. This study supports the validity of an EMA measure of self-efficacy for managing negative emotions that can be used in real time, both in intervention studies and in observational research.


Subject(s)
Ecological Momentary Assessment , Self Efficacy , Humans , Students/psychology , Psychometrics , Emotions
5.
Psychother Res ; 33(4): 455-467, 2023 04.
Article in English | MEDLINE | ID: mdl-36305345

ABSTRACT

OBJECTIVE: Prior studies of Dialectical Behavior Therapy (DBT) for borderline personality disorder (BPD) have yielded heterogeneous findings on what factors differentiate individuals with or without sufficient treatment response, highlighting the need for further research. METHOD: We investigated a sample of 105 individuals with BPD receiving a 6-month course of DBT. Participants were categorized as sufficient or insufficient responders using clinical and statistical change indices (based on emotion dysregulation, BPD symptom severity, utilization of DBT skills, and functional impairment). Sociodemographic, clinical severity, and treatment process factors were tested as potential predictors of treatment response using a machine learning approach (LASSO regression). RESULTS: Two cross-validated LASSO regression models predicted treatment response (AUCs > .75). They suggested that higher homework completion rate, retention in treatment, and greater baseline severity were the most important predictors of DBT treatment response indicated by BPD symptom severity and utilization of DBT skills. Favorable effects of some aspects of therapeutic alliance during initial sessions were also found. CONCLUSIONS: Future research may benefit from consolidating the criteria of treatment response, identifying clinically relevant variables, and testing the generalizability of findings to enhance knowledge of insufficient treatment response in DBT for BPD.


Subject(s)
Borderline Personality Disorder , Dialectical Behavior Therapy , Therapeutic Alliance , Humans , Borderline Personality Disorder/therapy
6.
Perspect Psychol Sci ; 18(2): 445-460, 2023 03.
Article in English | MEDLINE | ID: mdl-36054911

ABSTRACT

Despite recognition that borderline personality disorder (BPD) is one of the most stigmatized psychological disorders, destigmatization efforts have thus far focused on the views and actions of clinicians and the general public, neglecting the critical role that psychological science plays in perpetuating or mitigating stigma. This article was catalyzed by recent concerns about how research and editorial processes propagate stigma and thereby fail people with BPD and the scientists who study BPD. We provide a brief overview of the BPD diagnosis and its history. We then review how BPD has been stigmatized in psychological science, the gendered nature of BPD stigma, and the consequences of this stigmatization. Finally, we offer specific recommendations for researchers, reviewers, and editors who wish to use science to advance our understanding of BPD without perpetuating pejorative views of the disorder. These recommendations constitute a call to action to use psychological science in the service of the public good.


Subject(s)
Borderline Personality Disorder , Humans , Borderline Personality Disorder/diagnosis , Borderline Personality Disorder/psychology , Social Stigma , Stereotyping
7.
J Psychiatr Res ; 154: 242-251, 2022 10.
Article in English | MEDLINE | ID: mdl-35961180

ABSTRACT

INTRODUCTION: Despite the pressing need for primary care-based suicide prevention initiatives and growing acknowledgement of recruitment difficulties and Institutional Review Board (IRB) challenges in suicide research, we are aware of no illustrative examples describing how IRB decisions in the design of a primary care trial can compound recruitment challenges. METHODS: The CDC-funded trial (NCT02986113) of Men and Providers Preventing Suicide aimed to examine the effects of a tailored computer program encourage men with suicidal thoughts (n = 304, ages 35-64) to discuss suicide with a primary care clinician and accept treatment. Before a visit, participants viewed MAPS or a non-tailored control video. Post-visit, both arms were offered telephone collaborative care, as mandated by the institutional review board (IRB). We previously showed that exposure to MAPs led to improvements in communication about suicide in a primary care visit. In this paper, we report data on the study's primary outcome, suicide preparatory behaviors. RESULTS: After screening nearly 4100 men, 48 enrolled. Recruitment challenges, which were exacerabted by an IRB mandate narrowing post-intervention patient management differences between trial arms, limited detection of the effects of MAPS on suicide preparatory behaviors. CONCLUSIONS: While primary care settings are key sites for suicide prevention trials, issues such as recruitment difficulties and overly restrictive IRB requirements may limit their utility. Methodological innovation to improve recruitment and ethical guidance to inform IRB decision-making are needed.


Subject(s)
Suicide Prevention , Adult , Ethics Committees, Research , Humans , Male , Middle Aged , Primary Health Care , Research Design , Suicidal Ideation
8.
Behav Ther ; 53(3): 401-413, 2022 05.
Article in English | MEDLINE | ID: mdl-35473645

ABSTRACT

Despite ample evidence for Dialectical Behavior Therapy (DBT) as an effective treatment for borderline personality disorder (BPD), close examination of the trajectory of change in BPD symptoms over the course of DBT is lacking. There also remain questions regarding the directionality of changes in different domains of BPD symptoms, such as improvements in dysfunctional behaviors and thoughts/feelings. In order to provide more fine-grained information about the treatment process in DBT, the current study aimed to (a) examine the trajectories of change of BPD-associated negative thoughts/feelings and behaviors, and positive behaviors, and (b) test the temporal relationship between changes in negative behaviors and thoughts/feelings. The study involved 55 adult clients attending a 6-month outpatient DBT program for BPD who completed assessments of BPD symptoms every four sessions. Growth curve models suggested that clients experienced a faster rate of decrease in negative behaviors during the initial phase of treatment, whereas steady rates of improvement were found for negative thoughts/feelings and positive behaviors, respectively, throughout treatment. Further, a random-intercept cross-lagged panel model found that the within-person fluctuations in negative behaviors preceded the within-person changes in negative thoughts/feelings at a subsequent time point during the later phase of treatment, whereas within-person fluctuations in thoughts/feelings were followed by changes in negative behaviors at the beginning and end of the treatment. These results highlighted the complexity of patterns and processes of change in BPD symptomatology during the course of DBT.


Subject(s)
Borderline Personality Disorder , Dialectical Behavior Therapy , Adult , Behavior Therapy/methods , Borderline Personality Disorder/therapy , Dialectical Behavior Therapy/methods , Emotions , Humans , Treatment Outcome
9.
Psychotherapy (Chic) ; 59(2): 163-167, 2022 06.
Article in English | MEDLINE | ID: mdl-35025564

ABSTRACT

Dialectical behavior therapy (DBT) is an empirically supported behavioral treatment for individuals with borderline personality disorder who frequently exhibit life-threatening behavior, such as suicide attempts, nonsuicidal self-injury urges and actions, and suicidal ideation. We provide an overview of the theoretical framework by which DBT conceptualizes these life-threatening behaviors and the principles by which safety planning measures are implemented and maintained throughout treatment. The importance of orienting clients to treatment and obtaining their commitment to decrease life-threatening behavior is reviewed. Relevant strategies associated with risk management and assessment, such as the diary card, chain analysis, solution analysis, phone coaching, and consultation team, are described. The overview concludes with a case example to illustrate the application of these techniques with a DBT client with a long-standing history of engaging in life-threatening behaviors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Subject(s)
Borderline Personality Disorder , Dialectical Behavior Therapy , Self-Injurious Behavior , Behavior Therapy/methods , Borderline Personality Disorder/therapy , Dialectical Behavior Therapy/methods , Humans , Risk Management , Self-Injurious Behavior/therapy , Suicidal Ideation , Suicide, Attempted/prevention & control , Treatment Outcome
10.
Behav Res Ther ; 149: 104015, 2022 02.
Article in English | MEDLINE | ID: mdl-34958980

ABSTRACT

This randomized clinical trial aimed to determine feasibility, acceptability, and initial efficacy of brief Dialectical Behavior Therapy (DBT) skills videos in reducing psychological distress among college students during the COVID-19 pandemic. Over six weeks, 153 undergraduates at a large, public American university completed pre-assessment, intervention, and post-assessment periods. During the intervention, participants were randomized to receive animated DBT skills videos for 14 successive days (n = 99) or continue assessment (n = 54). All participants received 4x daily ecological momentary assessments on affect, self-efficacy of managing emotions, and unbearableness of emotions. The study was feasible and the intervention was acceptable, as demonstrated by moderate to high compliance rates and video ratings. There were significant pre-post video reductions in negative affect and increases in positive affect. There was a significant time × condition interaction on unbearableness of emotions; control participants rated their emotions as more unbearable in the last four vs. first two weeks, whereas the intervention participants did not rate their emotions as any more unbearable. Main effects of condition on negative affect and self-efficacy were not significant. DBT skills videos may help college students avoid worsening mental health. This brief, highly scalable intervention could extend the reach of mental health treatment.


Subject(s)
COVID-19 , Mental Health , Humans , Pandemics , SARS-CoV-2 , Students
11.
J Soc Clin Psychol ; 41(5): 491-516, 2022 Oct.
Article in English | MEDLINE | ID: mdl-38031633

ABSTRACT

Introduction: The prediction of affective experiences, also known as affective forecasting, is an integral component of individuals' decision-making processes. Yet, research consistently demonstrates that affective forecasts (AF) and recollections (AR) are generally inaccurate. Recent research has demonstrated distinct patterns of AF/R bias related to psychopathology. The present study examined the relationship between AF/R and features of Borderline Personality Disorder (BPD), anxiety, and depression using Valentine's Day as the target event. Methods: Undergraduate students (N=263; 33% white; 63% female; Mage=19.08) predicted their affective states a week before, and then reported their actual affective states on Valentine's Day and the two days after, and recalled Valentine's Day affect two days later. Results: Results indicate that higher BPD symptomatology predicted a significant overestimation of negative affect (B=.17, p=.02), even after controlling for anxiety and depression. Additionally, individuals' levels of depressive, anxious, and BPD symptomatology were significant predictors of AF of positive affect when entered into regression analyses separately, however when entered together, only depressive symptoms remained significant. Specifically, higher depressive symptoms predicted a significant underestimation of positive affect (B=-.21, p=.01). Discussion: Results were in line with prior research indicating that unique patterns of AF biases are associated with symptoms of psychopathology. However, results failed to support prior research linking AR biases to symptoms of psychopathology. Implications for future studies of affective biases and psychopathology more generally are discussed.

13.
Emerg Adulthood ; 10(2): 473-490, 2022 Apr.
Article in English | MEDLINE | ID: mdl-38603124

ABSTRACT

Initial research has indicated that college students have experienced numerous stressors as a result of the pandemic. The current investigation enrolled the largest and most diverse sample of college students to date (N = 4714) from universities in New York (NY) and New Jersey (NJ), the epicenter of the North American pandemic in Spring 2020. We described the impact on the psychological, academic, and financial health of college students who were initially most affected and examined racial/ethnic group differences. Results indicated that students' mental health was severely affected and that students of color were disproportionately affected by academic, financial, and COVID-related stressors. Worry about COVID-19 infection, stressful living conditions, lower grades, and loneliness emerged as correlates of deteriorating mental health. COVID-19's mental health impact on college students is alarming and highlights the need for public health interventions at the university level.

14.
Cogn Behav Pract ; 28(4): 573-587, 2021 Nov.
Article in English | MEDLINE | ID: mdl-34629837

ABSTRACT

Given the severity and suicide risk of patients typically treated by Dialectical Behavior Therapy (DBT) and the absence of guidelines regarding delivery of DBT via telehealth, it is crucial that the DBT treatment community gather and rapidly disseminate information about effective strategies for delivering DBT via telehealth. The current study surveyed DBT providers (N = 200) to understand challenges and lessons learned as they transitioned to conducting DBT via telehealth during the COVID-19 pandemic. Open-ended responses to challenges and lessons-learned were coded. Most frequently noted challenges were Therapy-Interfering Behaviors and elements related to the provision of Individual Therapy and Skills Training Group. The majority of providers offered advice for implementing group skills training, avoiding or overcoming therapist burnout, and emphasized continued adherence to treatment principles, even in the context of this new treatment modality. Overall, this qualitative study marks a starting point on identifying best practices delivering DBT via telehealth for which it is anticipated that clinical recommendations in this area will evolve, informed by clinician, researcher, and consumer input.

15.
J Ment Health ; 30(5): 578-584, 2021 Oct.
Article in English | MEDLINE | ID: mdl-31647364

ABSTRACT

BACKGROUND: Research suggests that a major barrier to mental health treatment is not knowing where to go for services, yet little is known about the specific steps people take to find treatment. AIMS: To (1) understand the process people would undertake if they decided they needed mental health treatment and (2) examine how well the process that current non-treatment-seeking individuals describe matches that used by individuals currently in treatment. METHODS: Adults recruited online via Amazon's Mechanical Turk (N = 669) answered questions about finding a mental health provider. Participants who had (N = 167) and had not (N = 502) seen a mental health provider in the past month were compared. RESULTS: Both groups indicated they would rely on Internet searches and recommendations of family, friends and physicians to find mental health providers. The order in which participants indicated they would use each step was similar across groups as was participants' confidence these steps would help them find a provider. Differences emerged in the factors each group indicated were important to their selection of a provider. CONCLUSIONS: Results can inform mental health providers and policy makers regarding the importance of clear and informative online mental health information, including thorough information about appropriate mental health providers.


Subject(s)
Information Seeking Behavior , Internet , Mental Health Services , Mental Health , Adult , Friends , Humans , Policy , United States
16.
Suicide Life Threat Behav ; 51(3): 429-445, 2021 06.
Article in English | MEDLINE | ID: mdl-32969037

ABSTRACT

OBJECTIVE: Dialectical behavior therapy (DBT) targets suicidal behavior and non-suicidal self-injury (NSSI) as well as urges/ideation to engage in these behaviors. However, it remains unclear which specific suicidal ideation (SI) and NSSI ideation domains (i.e., frequency, worst intensity, average intensity, perceived likelihood of future ideation, and duration of ideation), if any, are impacted, and whether specific emotions moderate these effects. METHOD: 73 individuals with borderline personality disorder (BPD), enrolled in six months of DBT, completed interviews of suicide and NSSI ideation and self-report measures of specific emotions at baseline, mid-treatment, and post-treatment. RESULTS: Generalized estimation equations revealed that all domains of suicidal ideation decreased over the course of DBT, but for NSSI domains, only ideation intensity decreased. Higher levels of shame/guilt predicted less, and higher fear predicted more, reduction in SI and NSSI ideation frequency. Higher shame/guilt also predicted more reduction in worst SI intensity. Higher sadness predicted greater reductions in SI intensity and duration, but less reductions in the perceived likelihood of future NSSI ideation. CONCLUSIONS: These findings suggest that DBT effectively reduces several facets of SI, but more work is required to target NSSI ideation. Results also suggest that targeting shame/guilt may be important to reducing SI and NSSI ideation.


Subject(s)
Dialectical Behavior Therapy , Self-Injurious Behavior , Suicide , Emotions , Humans , Self-Injurious Behavior/therapy , Suicidal Ideation
17.
Behav Ther ; 51(6): 946-957, 2020 11.
Article in English | MEDLINE | ID: mdl-33051036

ABSTRACT

Evidence-based borderline personality disorder (BPD) treatments such as dialectical behavior therapy (DBT) emphasize the acquisition and use of strategies to down regulate negative emotion. However, little research examines whether specific emotions change during DBT. Further, it is unclear if BPD-relevant comorbidities that involve heightened emotion-namely, depression, anxiety disorders, and posttraumatic stress disorder (PTSD)-moderate these outcomes. This study investigated which specific emotions (hostility/anger, fear, shame/guilt, and sadness) decrease during DBT, and whether comorbid depression, anxiety disorders, and PTSD moderate these outcomes. Individuals with BPD (N = 101) completed 6 months of standard DBT and provided measurements of specific emotions at every session and at pre-, mid-, and posttreatment. Generalized estimating equations revealed moderate effect-sized reductions in anger at major assessment time points. Anxiety disorders and PTSD moderated the effect of time on fear, shame, and guilt. PTSD also moderated the effect of time on sadness. For all moderating effects, individuals with the comorbidity exhibited greater reductions than those without. These findings corroborate that DBT reduces several specific emotions, and comorbid PTSD and anxiety disorders may facilitate this effect for fear, shame/guilt, and sadness (clinical trial registration number = NCT03123198).


Subject(s)
Anxiety Disorders , Borderline Personality Disorder , Dialectical Behavior Therapy , Emotions , Stress Disorders, Post-Traumatic , Anxiety/therapy , Anxiety Disorders/therapy , Behavior Therapy , Borderline Personality Disorder/therapy , Depression/therapy , Humans , Stress Disorders, Post-Traumatic/therapy
18.
Personal Disord ; 10(5): 468-472, 2019 09.
Article in English | MEDLINE | ID: mdl-31144840

ABSTRACT

Borderline personality disorder (BPD) is a diagnosis characterized by intense and labile emotion; dialectical behavior therapy, a common treatment for BPD, aims to reduce the intensity and lability of clients' emotion through multiple methods, some of which occur in the therapy session, with the expectation that changes will generalize to the rest of clients' lives. However, little research has examined how BPD clients' affect presents and varies in session or whether affect in session reflects patients' patterns of affect outside of treatment. This study had 2 aims: (a) to explore changes in clients' positive and negative affect in therapy, and (b) to assess if the severity of client psychopathology relates to affect in treatment. Positive and negative affect ratings were collected from clients (N = 73) at the start and end of every individual therapy session (total sessions = 1,474). Hierarchical linear modeling and linear regression were used to examine patterns of affect and assess the relationship between affect and severity. Results indicated that positive affect increased while negative affect decreased between the start and end of sessions, with the same pattern of change in presession affect from week to week. In addition, increased BPD severity was associated with lower presession positive affect ratings and higher negative affect ratings. Further exploration is needed to assess which dialectical behavior therapy treatment processes contribute to changes in in-session affect and how in-session affect relates to treatment outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Subject(s)
Affect , Affective Symptoms/therapy , Borderline Personality Disorder/therapy , Dialectical Behavior Therapy , Emotional Regulation/physiology , Outcome and Process Assessment, Health Care , Adolescent , Adult , Affect/physiology , Affective Symptoms/etiology , Affective Symptoms/physiopathology , Borderline Personality Disorder/complications , Borderline Personality Disorder/physiopathology , Female , Humans , Male , Middle Aged , Severity of Illness Index , Young Adult
19.
J Dual Diagn ; 15(1): 67-73, 2019.
Article in English | MEDLINE | ID: mdl-30646819

ABSTRACT

Objective: Almost all individuals in methadone treatment for opioid dependence smoke cigarettes, and half of people in methadone treatment have an opioid relapse within six months. Dialectical behavior therapy (DBT) skills training has shown promise for addressing substance use and a variety of health behaviors and conditions; however, it has never been evaluated for smoking cessation in any population. The objective of this study was to field test a DBT skills training-based intervention for tobacco dependence and opioid relapse prevention (DBT-Quit) among people in methadone treatment. Methods: We recruited seven individuals in methadone treatment to participate in a field test of DBT-Quit. Participants attended 12 weekly 90-minute DBT skills training groups, focusing on mindfulness, emotion regulation, and distress tolerance skills. Participants received nicotine patches for eight weeks and completed assessments at baseline, 6 weeks (mid-treatment), and 12 weeks (post-treatment). Results: All but one participant (86%, n = 6) attended at least 50% of intervention sessions. Participants were "very" or "mostly" satisfied with the intervention. At 12 weeks, all but one (86%, n = 6) had made a quit attempt, and one (14%) had seven-day point prevalence abstinence. Participants were smoke-free for 24 hours (14%, n = 1), 7 to 14 days (43%, n = 3), and 30 to 59 days (29%, n = 2). Participants smoked significantly fewer cigarettes per day at 6 weeks and 12 weeks as compared to baseline. No participants used illicit drugs. As compared to baseline, at follow-up there were no significant differences in difficulties with emotion regulation, distress tolerance, or mindfulness. Conclusions: A DBT skills training-based intervention for individuals who smoke and have an opioid use disorder is feasible and acceptable in methadone treatment and may help this population prevent drug relapse, attempt to quit smoking, experience smoke-free days, and cut down on their smoking. More research is needed to determine the optimal structure and components of a DBT skills-based intervention for drug relapse prevention and smoking cessation. Further, a randomized controlled trial of DBT-Quit is needed to determine the efficacy of DBT skills training for smoking cessation and drug relapse prevention in this population.


Subject(s)
Dialectical Behavior Therapy , Methadone/therapeutic use , Opioid-Related Disorders/therapy , Tobacco Use Cessation/methods , Tobacco Use Disorder/therapy , Adult , Female , Humans , Middle Aged , Opioid-Related Disorders/complications , Secondary Prevention , Tobacco Use Disorder/complications , Treatment Outcome , Young Adult
20.
Cogn Behav Ther ; 47(5): 383-396, 2018 09.
Article in English | MEDLINE | ID: mdl-29468940

ABSTRACT

Telephone coaching is a treatment mode in Dialectical Behavior Therapy (DBT) that is designed to help clients generalize skills, prevent suicidal behaviors, and repair therapeutic ruptures. To date, phone coaching has received scant empirical investigation. The aims of this study were to (1) describe patterns in frequency of telephone calls and text messaging in DBT and (2) investigate whether demographic factors, baseline severity, suicidal behaviors, and therapeutic alliance are associated with phone and text frequency. Participants were 51 adults (35 treatment completers) with borderline personality disorder (BPD) in a six-month comprehensive DBT treatment program. Phone coaching frequency was documented by therapist weekly session notes. The average number of contacts per month was 2.55 (SD = 4.49). Four of the 35 treatment completers comprised 56% of the contacts. Having a recent history of suicidal behaviors, degree of severity at baseline, or the strength of the therapeutic alliance was not associated with phone coaching use. However, lower income was significantly associated with a higher frequency of phone coaching use. These preliminary results can help clinicians and administrators make informed decisions on how to better provide phone coaching and clarify the degree of effort involved in providing this service to clients with BPD.


Subject(s)
Borderline Personality Disorder/therapy , Dialectical Behavior Therapy/methods , Remote Consultation/methods , Adult , Borderline Personality Disorder/psychology , Female , Humans , Male , Telephone , Text Messaging , Treatment Outcome , Young Adult
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