The Experts below are selected from a list of 1917 Experts worldwide ranked by ideXlab platform
Marsha M Linehan - One of the best experts on this subject based on the ideXlab platform.
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Dialectical Behavior Therapy for suicidal self harming youth emotion regulation mechanisms and mediators
Journal of the American Academy of Child and Adolescent Psychiatry, 2021Co-Authors: Joan Rosenbaum Asarnow, Michele S Berk, Kathryn E Korslund, Robert Gallop, Claudia Avina, Jamie D Bedics, Molly Adrian, Judith A Cohen, Jennifer L Hughes, Marsha M LinehanAbstract:Objective This study evaluated mechanisms, mediation, and secondary/exploratory outcomes in our randomized controlled trial evaluating Dialectical Behavior Therapy (DBT) compared to individual and group supportive Therapy (IGST). We expand on previously reported results indicating a DBT advantage at posttreatment on planned suicide/self-harm outcomes, and greater self-harm remission (absence of self-harm, post hoc exploratory outcome) during active-treatment and follow-up periods. Method This was a multi-site randomized trial of 173 adolescents with prior suicide attempts, self-harm, and suicidal ideation. Randomization was to 6 months of DBT or IGST, with outcomes monitored through 12 months. Youth emotion regulation was the primary mechanistic outcome. Results Compared to IGST, greater improvements in youth emotion regulation were found in DBT through the treatment-period [t(498) = 2.36, p = .019] and 12-month study period (t(498) = 2.93, p = .004). Their parents reported using more DBT skills: posttreatment t(497) = 4.12, p Conclusion Results support the significance of emotion regulation as a treatment target for reducing self-harm, and indicate a DBT advantage on substance misuse, externalizing Behavior, and self-harm-remission, with 49.3% of youths in DBT achieving self-harm remission during follow-up. Clinical trial registration information Collaborative Adolescent Research on Emotions and Suicide; https://www.clinicaltrials.gov/ ; NCT01528020
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predictors of adoption and reach following Dialectical Behavior Therapy intensive training
Community Mental Health Journal, 2019Co-Authors: Maria V Navarroharo, Kathryn E Korslund, Melanie S Harned, Anthony P Dubose, Tianying Chen, Andre Ivanoff, Marsha M LinehanAbstract:Dialectical Behavior Therapy (DBT) is an evidence-based treatment for borderline personality disorder. The DBT Intensive Training™ is widely used to train community clinicians to deliver DBT, but little is known about its effectiveness. This study prospectively evaluated predictors of adoption and reach of DBT among 52 community teams (212 clinicians) after DBT Intensive Training™. Pre-post training questionnaires were completed by trainees and a follow-up survey by team leaders approximately 8 months later. Overall, 75% of teams adopted all DBT modes and delivered DBT to an average of 118 clients. Lower training and program needs, fewer bachelor’s-level clinicians, and greater prior DBT experience predicted adoption of more DBT modes. More prior DBT experience, smaller team size, more negative team functioning, and staff with lower job satisfaction, growth, efficacy, and influence predicted greater DBT reach. DBT Intensive Training™ appears effective in promoting DBT adoption and reach in routine clinical practice settings.
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Dialectical Behavior Therapy and domains of functioning over two years
Behaviour Research and Therapy, 2016Co-Authors: Chelsey R Wilks, Kathryn E Korslund, Melanie S Harned, Marsha M LinehanAbstract:Individuals diagnosed with borderline personality disorder (BPD) tend to have a significant degree of functional impairment across a range of social and occupational spheres including difficulty finding and maintaining satisfying employment, housing, or relationships. Understanding what factors are associated with functional impairment will enable treatment providers to move those diagnosed with BPD beyond symptomatic recovery and toward a life worth living. This paper investigated the trajectories and predictors of functional outcomes for suicidal women with BPD (N = 99) during a treatment outcome study of Dialectical Behavior Therapy (DBT). Results revealed that participants had statistical and clinical improvements in functioning. Individuals with high emotion dysregulation displayed poorer psychosocial functioning at the subsequent assessment period and slower rates of change, which was also seen in reverse for one psychosocial functioning variable. Skills use was not related to individual trajectories in functioning. This study highlights the relationship of emotion dysregulation to functioning within a sample of suicidal women with BPD as well as the importance researching multiple domains in functioning.
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the course and evolution of Dialectical Behavior Therapy
American Journal of Psychotherapy, 2015Co-Authors: Marsha M Linehan, Chelsey R WilksAbstract:Dialectical Behavior Therapy was originally developed from early efforts to apply standard Behavior Therapy to treat individuals who were highly suicidal. Its development was a trial and error effort driven primarily from clinical experience. Dialectical Behavior Therapy is a modular and hierarchical treatment consisting of a combination of individual psychoTherapy, group skills, training, telephone coaching, and a therapist consultation team. The inherent modularity and hierarchical structure of DBT has allowed for relative ease in adapting and applying the treatment to other populations and settings. New skills have been developed and/or modified due to clinical need and/or advancement in research such as treatment outcomes or mechanisms. There has been an effort to implement DBT skills as a standalone treatment. More research is needed to assess how DBT skills work and for whom. As DBT broadens its reach, the treatment will continue to grow and adapt to meet demands of an evolving clinical landscape.
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adapting Dialectical Behavior Therapy for outpatient adult anorexia nervosa a pilot study
International Journal of Eating Disorders, 2015Co-Authors: Eunice Y Chen, Marsha M Linehan, Martin Bohus, Kay Segal, Jessica Weissman, Thomas A Zeffiro, Robert Gallop, Thomas R LynchAbstract:Objective: Anorexia Nervosa (AN) is associated with excessive self-control. This iterative case series describes the augmentation of Dialectical Behavior Therapy (DBT) for outpatient adult AN with skills addressing emotional and Behavioral overcontrol. An overly controlled style is theorized to develop from the transaction between an individual with heightened threat sensitivity and reduced reward sensitivity, interacting with an environment reinforcing overcontrol and punishing imperfection. Method: Case Series 1 utilized standard DBT, resulting in retention of 5/6 patients and a body mass index (BMI) effect size increase of d 52 0.5 from pre- to post-treatment. Case series 2, using standard DBT augmented with skills addressing overcontrol, resulted in retention of 8/9 patients with an effect size increase in BMI at posttreatment that was maintained at 6and 12-months follow-up (d 52 1.12, d 52 0.87, and d 52 1.12). Discussion: Findings suggest that skills training targeting rigidity and increasing openness and social connectedness warrant further study of this model and treatment for AN.
Shelley Mcmain - One of the best experts on this subject based on the ideXlab platform.
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alliance rupture and repair in early sessions of Dialectical Behavior Therapy the case of rachel
Journal of Clinical Psychology, 2021Co-Authors: Shelley Mcmain, Tali Boritz, Sonya Varma, Christianne MacaulayAbstract:Emotional and interpersonal instability are core features of borderline personality disorder (BPD) and can pose a challenge for the therapeutic relationship. In Dialectical Behavior Therapy (DBT) for BPD, ruptures in the therapeutic alliance are considered through a Behavioral lens that examines the client's relational learning history, the function and context of the rupture, as well as the patterns of emotional processing difficulties that underlie interpersonal conflict. In this article, we use the case of Rachel to illustrate how alliance-focused approach can be integrated with DBT case formulation to enhance treatment planning and the successful negotiation of alliance ruptures.
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alliance rupture and resolution in Dialectical Behavior Therapy for borderline personality disorder
Journal of Personality Disorders, 2018Co-Authors: Shelley Mcmain, Tali Boritz, Ryan Barnhart, Catherine F EubanksAbstract:The aim of this exploratory study was to investigate alliance rupture and resolution processes in the early sessions of a sample of clients who underwent 1 year of standard Dialectical Behavior Therapy (DBT) for borderline personality disorder (BPD). Participants were three recovered and three unrecovered clients drawn from the DBT arm of a randomized controlled trial that compared the clinical and cost-effectiveness of DBT and general psychiatric management. Alliance rupture and resolution processes were coded using the observer-based Rupture Resolution Rating Scale. Unrecovered clients evidenced a higher frequency of withdrawal ruptures than recovered clients. Withdrawal ruptures tended to persist for unrecovered clients despite the degree of resolution in the prior session, unlike for recovered clients, for whom the probability of withdrawal ruptures decreased as the degree of resolution increased. This study suggests that alliance rupture and resolution processes in early treatment differ between recovered and unrecovered clients in DBT for BPD.
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a randomized trial of Dialectical Behavior Therapy versus general psychiatric management for borderline personality disorder
American Journal of Psychiatry, 2009Co-Authors: Shelley Mcmain, Paul S Links, William H Gnam, Tim Guimond, Robert J Cardish, Lorne Korman, David L StreinerAbstract:Objective: The authors sought to evaluate the clinical efficacy of Dialectical Behavior Therapy compared with general psychiatric management, including a combination of psychodynamically informed Therapy and symptom-targeted medication management derived from specific recommendations in APA guidelines for borderline personality disorder. Method: This was a single-blind trial in which 180 patients diagnosed with borderline personality disorder who had at least two suicidal or nonsuicidal self-injurious episodes in the past 5 years were randomly assigned to receive 1 year of Dialectical Behavior Therapy or general psychiatric management. The primary outcome measures, assessed at baseline and every 4 months over the treatment period, were frequency and severity of suicidal and nonsuicidal self-harm episodes. Results: Both groups showed improvement on the majority of clinical outcome measures after 1 year of treatment, including significant reductions in the frequency and severity of suicidal and nonsuicidal ...
Tali Boritz - One of the best experts on this subject based on the ideXlab platform.
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alliance rupture and repair in early sessions of Dialectical Behavior Therapy the case of rachel
Journal of Clinical Psychology, 2021Co-Authors: Shelley Mcmain, Tali Boritz, Sonya Varma, Christianne MacaulayAbstract:Emotional and interpersonal instability are core features of borderline personality disorder (BPD) and can pose a challenge for the therapeutic relationship. In Dialectical Behavior Therapy (DBT) for BPD, ruptures in the therapeutic alliance are considered through a Behavioral lens that examines the client's relational learning history, the function and context of the rupture, as well as the patterns of emotional processing difficulties that underlie interpersonal conflict. In this article, we use the case of Rachel to illustrate how alliance-focused approach can be integrated with DBT case formulation to enhance treatment planning and the successful negotiation of alliance ruptures.
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alliance rupture and resolution in Dialectical Behavior Therapy for borderline personality disorder
Journal of Personality Disorders, 2018Co-Authors: Shelley Mcmain, Tali Boritz, Ryan Barnhart, Catherine F EubanksAbstract:The aim of this exploratory study was to investigate alliance rupture and resolution processes in the early sessions of a sample of clients who underwent 1 year of standard Dialectical Behavior Therapy (DBT) for borderline personality disorder (BPD). Participants were three recovered and three unrecovered clients drawn from the DBT arm of a randomized controlled trial that compared the clinical and cost-effectiveness of DBT and general psychiatric management. Alliance rupture and resolution processes were coded using the observer-based Rupture Resolution Rating Scale. Unrecovered clients evidenced a higher frequency of withdrawal ruptures than recovered clients. Withdrawal ruptures tended to persist for unrecovered clients despite the degree of resolution in the prior session, unlike for recovered clients, for whom the probability of withdrawal ruptures decreased as the degree of resolution increased. This study suggests that alliance rupture and resolution processes in early treatment differ between recovered and unrecovered clients in DBT for BPD.
Katherine Anne Comtois - One of the best experts on this subject based on the ideXlab platform.
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Dialectical Behavior Therapy is effective for the treatment of suicidal Behavior a meta analysis
Behavior Therapy, 2019Co-Authors: Christopher R Decou, Katherine Anne Comtois, Sara J LandesAbstract:Dialectical Behavior Therapy (DBT) prioritizes suicidal Behavior and other self-directed violence as the primary treatment targets, and has been demonstrated to reduce self-directed violence in clinical trials. This paper synthesizes findings from controlled trials that assessed self-directed violence and suicidality, including suicide attempts, non-suicidal self-injury (NSSI), suicidal ideation, and accessing psychiatric crisis services. Eighteen controlled trials of DBT were identified. Random effects meta-analyses demonstrated that DBT reduced self-directed violence (d = -.324, 95% CI = -.471 to -.176), and reduced frequency of psychiatric crisis services (d = -.379, 95% CI = -.581 to -.176). There was not a significant pooled effect of DBT with regard to suicidal ideation (d = -.229, 95% CI = -.473 to .016). Our findings may reflect the prioritization of Behavior over thoughts within DBT, and offer implications for clinical practice and future research concerning the implementation of DBT for acute suicidality.
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Dialectical Behavior Therapy as a precursor to ptsd treatment for suicidal and or self injuring women with borderline personality disorder
Journal of Traumatic Stress, 2010Co-Authors: Melanie S Harned, Katherine Anne Comtois, Safia C Jackson, Marsha M LinehanAbstract:This study examined the efficacy of Dialectical Behavior Therapy (DBT) in reducing Behaviors commonly used as exclusion criteria for posttraumatic stress disorder (PTSD) treatment. The sample included 51 suicidal and/or self-injuring women with borderline personality disorder (BPD), 26 (51%) of whom met criteria for PTSD. BPD clients with and without PTSD were equally likely to eliminate the exclusionary Behaviors during 1 year of DBT. By posttreatment, 50-68% of the BPD clients with PTSD would have been suitable candidates for PTSD treatment. Borderline personality disorder clients with PTSD who began treatment with a greater number of recent suicide attempts and more severe PTSD were significantly less likely to become eligible for PTSD treatment.
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two year randomized controlled trial and follow up of Dialectical Behavior Therapy vs Therapy by experts for suicidal Behaviors and borderline personality disorder
Archives of General Psychiatry, 2006Co-Authors: Marsha M Linehan, Kathryn E Korslund, Robert Gallop, Katherine Anne Comtois, Milton Z Brown, Angela Murray, Heidi L Heard, Darren A Tutek, Sarah K Reynolds, Noam LindenboimAbstract:CONTEXT: Dialectical Behavior Therapy (DBT) is a treatment for suicidal Behavior and borderline personality disorder with well-documented efficacy. OBJECTIVE: To evaluate the hypothesis that unique aspects of DBT are more efficacious compared with treatment offered by non-Behavioral psychoTherapy experts. DESIGN: One-year randomized controlled trial, plus 1 year of posttreatment follow-up. SETTING: University outpatient clinic and community practice. PARTICIPANTS: One hundred one clinically referred women with recent suicidal and self-injurious Behaviors meeting DSM-IV criteria, matched to condition on age, suicide attempt history, negative prognostic indication, and number of lifetime intentional self-injuries and psychiatric hospitalizations. INTERVENTION: One year of DBT or 1 year of community treatment by experts (developed to maximize internal validity by controlling for therapist sex, availability, expertise, allegiance, training and experience, consultation availability, and institutional prestige). MAIN OUTCOME MEASURES: Trimester assessments of suicidal Behaviors, emergency services use, and general psychological functioning. Measures were selected based on previous outcome studies of DBT. Outcome variables were evaluated by blinded assessors. RESULTS: Dialectical Behavior Therapy was associated with better outcomes in the intent-to-treat analysis than community treatment by experts in most target areas during the 2-year treatment and follow-up period. Subjects receiving DBT were half as likely to make a suicide attempt (hazard ratio, 2.66; P = .005), required less hospitalization for suicide ideation (F(1,92) = 7.3; P = .004), and had lower medical risk (F(1,50) = 3.2; P = .04) across all suicide attempts and self-injurious acts combined. Subjects receiving DBT were less likely to drop out of treatment (hazard ratio, 3.2; P < .001) and had fewer psychiatric hospitalizations (F(1,92) = 6.0; P = .007) and psychiatric emergency department visits (F(1,92) = 2.9; P = .04). CONCLUSIONS: Our findings replicate those of previous studies of DBT and suggest that the effectiveness of DBT cannot reasonably be attributed to general factors associated with expert psychoTherapy. Dialectical Behavior Therapy appears to be uniquely effective in reducing suicide attempts.
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two year randomized controlled trial and follow up of Dialectical Behavior Therapy vs Therapy by experts for suicidal Behaviors and borderline personality disorder
Archives of General Psychiatry, 2006Co-Authors: Marsha M Linehan, Kathryn E Korslund, Robert Gallop, Katherine Anne Comtois, Milton Z Brown, Angela Murray, Heidi L Heard, Darren A Tutek, Sarah K Reynolds, Noam LindenboimAbstract:Context Dialectical Behavior Therapy (DBT) is a treatment for suicidal Behavior and borderline personality disorder with well-documented efficacy. Objective To evaluate the hypothesis that unique aspects of DBT are more efficacious compared with treatment offered by non–Behavioral psychoTherapy experts. Design One-year randomized controlled trial, plus 1 year of posttreatment follow-up. Setting University outpatient clinic and community practice. Participants One hundred one clinically referred women with recent suicidal and self-injurious Behaviors meeting DSM-IV criteria, matched to condition on age, suicide attempt history, negative prognostic indication, and number of lifetime intentional self-injuries and psychiatric hospitalizations. Intervention One year of DBT or 1 year of community treatment by experts (developed to maximize internal validity by controlling for therapist sex, availability, expertise, allegiance, training and experience, consultation availability, and institutional prestige). Main Outcome Measures Trimester assessments of suicidal Behaviors, emergency services use, and general psychological functioning. Measures were selected based on previous outcome studies of DBT. Outcome variables were evaluated by blinded assessors. Results Dialectical Behavior Therapy was associated with better outcomes in the intent-to-treat analysis than community treatment by experts in most target areas during the 2-year treatment and follow-up period. Subjects receiving DBT were half as likely to make a suicide attempt (hazard ratio, 2.66; P = .005), required less hospitalization for suicide ideation (F 1,92 =7.3; P = .004), and had lower medical risk (F 1,50 =3.2; P = .04) across all suicide attempts and self-injurious acts combined. Subjects receiving DBT were less likely to drop out of treatment (hazard ratio, 3.2; P 1,92 =6.0; P = .007) and psychiatric emergency department visits (F 1,92 =2.9; P = .04). Conclusions Our findings replicate those of previous studies of DBT and suggest that the effectiveness of DBT cannot reasonably be attributed to general factors associated with expert psychoTherapy. Dialectical Behavior Therapy appears to be uniquely effective in reducing suicide attempts.
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Dialectical Behavior Therapy for patients with borderline personality disorder and drug dependence
American Journal on Addictions, 1999Co-Authors: Marsha M Linehan, Linda A Dimeff, Henry Schmidt, Christopher J Craft, Jonathan W Kanter, Katherine Anne ComtoisAbstract:A randomized clinical trial was conducted to evaluate whether Dialectical Behavior Therapy (DBT), an effective cognitive-Behavioral treatment for suicidal individuals with borderline personality disorder (BPD), would also be effective for drug-dependent women with BPD when compared with treatment-as-usual (TAU) in the community. Subjects were randomly assigned to either DBT or TAU for a year of treatment. Subjects were assessed at 4, 8, and 12 months, and at a 16-month follow-up. Subjects assigned to DBT had significantly greater reductions in drug abuse measured both by structured interviews and urinalyses throughout the treatment year and at follow-up than did subjects assigned to TAU. DBT also maintained subjects in treatment better than did TAU, and subjects assigned to DBT had significantly greater gains in global and social adjustment at follow-up than did those assigned to TAU. DBT has been shown to be more effective than treatment-as-usual in treating drug abuse in this study, providing more support for DBT as an effective treatment for severely dysfunctional BPD patients across a range of presenting problems.
Robert Gallop - One of the best experts on this subject based on the ideXlab platform.
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Dialectical Behavior Therapy for suicidal self harming youth emotion regulation mechanisms and mediators
Journal of the American Academy of Child and Adolescent Psychiatry, 2021Co-Authors: Joan Rosenbaum Asarnow, Michele S Berk, Kathryn E Korslund, Robert Gallop, Claudia Avina, Jamie D Bedics, Molly Adrian, Judith A Cohen, Jennifer L Hughes, Marsha M LinehanAbstract:Objective This study evaluated mechanisms, mediation, and secondary/exploratory outcomes in our randomized controlled trial evaluating Dialectical Behavior Therapy (DBT) compared to individual and group supportive Therapy (IGST). We expand on previously reported results indicating a DBT advantage at posttreatment on planned suicide/self-harm outcomes, and greater self-harm remission (absence of self-harm, post hoc exploratory outcome) during active-treatment and follow-up periods. Method This was a multi-site randomized trial of 173 adolescents with prior suicide attempts, self-harm, and suicidal ideation. Randomization was to 6 months of DBT or IGST, with outcomes monitored through 12 months. Youth emotion regulation was the primary mechanistic outcome. Results Compared to IGST, greater improvements in youth emotion regulation were found in DBT through the treatment-period [t(498) = 2.36, p = .019] and 12-month study period (t(498) = 2.93, p = .004). Their parents reported using more DBT skills: posttreatment t(497) = 4.12, p Conclusion Results support the significance of emotion regulation as a treatment target for reducing self-harm, and indicate a DBT advantage on substance misuse, externalizing Behavior, and self-harm-remission, with 49.3% of youths in DBT achieving self-harm remission during follow-up. Clinical trial registration information Collaborative Adolescent Research on Emotions and Suicide; https://www.clinicaltrials.gov/ ; NCT01528020
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adapting Dialectical Behavior Therapy for outpatient adult anorexia nervosa a pilot study
International Journal of Eating Disorders, 2015Co-Authors: Eunice Y Chen, Marsha M Linehan, Martin Bohus, Kay Segal, Jessica Weissman, Thomas A Zeffiro, Robert Gallop, Thomas R LynchAbstract:Objective: Anorexia Nervosa (AN) is associated with excessive self-control. This iterative case series describes the augmentation of Dialectical Behavior Therapy (DBT) for outpatient adult AN with skills addressing emotional and Behavioral overcontrol. An overly controlled style is theorized to develop from the transaction between an individual with heightened threat sensitivity and reduced reward sensitivity, interacting with an environment reinforcing overcontrol and punishing imperfection. Method: Case Series 1 utilized standard DBT, resulting in retention of 5/6 patients and a body mass index (BMI) effect size increase of d 52 0.5 from pre- to post-treatment. Case series 2, using standard DBT augmented with skills addressing overcontrol, resulted in retention of 8/9 patients with an effect size increase in BMI at posttreatment that was maintained at 6and 12-months follow-up (d 52 1.12, d 52 0.87, and d 52 1.12). Discussion: Findings suggest that skills training targeting rigidity and increasing openness and social connectedness warrant further study of this model and treatment for AN.
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Dialectical Behavior Therapy dbt applied to college students a randomized clinical trial
Journal of Consulting and Clinical Psychology, 2012Co-Authors: Jacqueline Pistorello, Robert Gallop, Alan E. Fruzzetti, Chelsea Maclane, Katherine M IversonAbstract:Objective: College counseling centers (CCCs) are increasingly being called upon to treat highly distressed students with complex clinical presentations. This study compared the effectiveness of Dialectical Behavior Therapy (DBT) for suicidal college students with an optimized control condition and analyzed baseline global functioning as a moderator. Method: The intent-to-treat (ITT) sample included 63 college students between the ages of 18 and 25 years who were suicidal at baseline, reported at least 1 lifetime nonsuicidal self-injurious (NSSI) act or suicide attempt, and met 3 or more borderline personality disorder (BPD) diagnostic criteria. Participants were randomly assigned to DBT (n = 31) or an optimized treatment-as-usual (O-TAU) control condition (n = 32). Treatment was provided by trainees, supervised by experts in both treatments. Both treatments lasted 7-12 months and included both individual and group components. Assessments were conducted at pretreatment, 3 months, 6 months, 9 months, 12 months, and 18 months (follow-up). Results: Mixed effects analyses (ITT sample) revealed that DBT, compared with the control condition, showed significantly greater decreases in suicidality, depression, number of NSSI events (if participant had self-injured), BPD criteria, and psychotropic medication use and significantly greater improvements in social adjustment. Most of these treatment effects were observed at follow-up. No treatment differences were found for treatment dropout. Moderation analyses showed that DBT was particularly effective for suicidal students who were lower functioning at pretreatment. Conclusions: DBT is an effective treatment for suicidal, multiproblem college students. Future research should examine the implementation of DBT in CCCs in a stepped care approach. (PsycINFO Database Record (c) 2012 APA, all rights reserved). Language: en
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two year randomized controlled trial and follow up of Dialectical Behavior Therapy vs Therapy by experts for suicidal Behaviors and borderline personality disorder
Archives of General Psychiatry, 2006Co-Authors: Marsha M Linehan, Kathryn E Korslund, Robert Gallop, Katherine Anne Comtois, Milton Z Brown, Angela Murray, Heidi L Heard, Darren A Tutek, Sarah K Reynolds, Noam LindenboimAbstract:CONTEXT: Dialectical Behavior Therapy (DBT) is a treatment for suicidal Behavior and borderline personality disorder with well-documented efficacy. OBJECTIVE: To evaluate the hypothesis that unique aspects of DBT are more efficacious compared with treatment offered by non-Behavioral psychoTherapy experts. DESIGN: One-year randomized controlled trial, plus 1 year of posttreatment follow-up. SETTING: University outpatient clinic and community practice. PARTICIPANTS: One hundred one clinically referred women with recent suicidal and self-injurious Behaviors meeting DSM-IV criteria, matched to condition on age, suicide attempt history, negative prognostic indication, and number of lifetime intentional self-injuries and psychiatric hospitalizations. INTERVENTION: One year of DBT or 1 year of community treatment by experts (developed to maximize internal validity by controlling for therapist sex, availability, expertise, allegiance, training and experience, consultation availability, and institutional prestige). MAIN OUTCOME MEASURES: Trimester assessments of suicidal Behaviors, emergency services use, and general psychological functioning. Measures were selected based on previous outcome studies of DBT. Outcome variables were evaluated by blinded assessors. RESULTS: Dialectical Behavior Therapy was associated with better outcomes in the intent-to-treat analysis than community treatment by experts in most target areas during the 2-year treatment and follow-up period. Subjects receiving DBT were half as likely to make a suicide attempt (hazard ratio, 2.66; P = .005), required less hospitalization for suicide ideation (F(1,92) = 7.3; P = .004), and had lower medical risk (F(1,50) = 3.2; P = .04) across all suicide attempts and self-injurious acts combined. Subjects receiving DBT were less likely to drop out of treatment (hazard ratio, 3.2; P < .001) and had fewer psychiatric hospitalizations (F(1,92) = 6.0; P = .007) and psychiatric emergency department visits (F(1,92) = 2.9; P = .04). CONCLUSIONS: Our findings replicate those of previous studies of DBT and suggest that the effectiveness of DBT cannot reasonably be attributed to general factors associated with expert psychoTherapy. Dialectical Behavior Therapy appears to be uniquely effective in reducing suicide attempts.
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two year randomized controlled trial and follow up of Dialectical Behavior Therapy vs Therapy by experts for suicidal Behaviors and borderline personality disorder
Archives of General Psychiatry, 2006Co-Authors: Marsha M Linehan, Kathryn E Korslund, Robert Gallop, Katherine Anne Comtois, Milton Z Brown, Angela Murray, Heidi L Heard, Darren A Tutek, Sarah K Reynolds, Noam LindenboimAbstract:Context Dialectical Behavior Therapy (DBT) is a treatment for suicidal Behavior and borderline personality disorder with well-documented efficacy. Objective To evaluate the hypothesis that unique aspects of DBT are more efficacious compared with treatment offered by non–Behavioral psychoTherapy experts. Design One-year randomized controlled trial, plus 1 year of posttreatment follow-up. Setting University outpatient clinic and community practice. Participants One hundred one clinically referred women with recent suicidal and self-injurious Behaviors meeting DSM-IV criteria, matched to condition on age, suicide attempt history, negative prognostic indication, and number of lifetime intentional self-injuries and psychiatric hospitalizations. Intervention One year of DBT or 1 year of community treatment by experts (developed to maximize internal validity by controlling for therapist sex, availability, expertise, allegiance, training and experience, consultation availability, and institutional prestige). Main Outcome Measures Trimester assessments of suicidal Behaviors, emergency services use, and general psychological functioning. Measures were selected based on previous outcome studies of DBT. Outcome variables were evaluated by blinded assessors. Results Dialectical Behavior Therapy was associated with better outcomes in the intent-to-treat analysis than community treatment by experts in most target areas during the 2-year treatment and follow-up period. Subjects receiving DBT were half as likely to make a suicide attempt (hazard ratio, 2.66; P = .005), required less hospitalization for suicide ideation (F 1,92 =7.3; P = .004), and had lower medical risk (F 1,50 =3.2; P = .04) across all suicide attempts and self-injurious acts combined. Subjects receiving DBT were less likely to drop out of treatment (hazard ratio, 3.2; P 1,92 =6.0; P = .007) and psychiatric emergency department visits (F 1,92 =2.9; P = .04). Conclusions Our findings replicate those of previous studies of DBT and suggest that the effectiveness of DBT cannot reasonably be attributed to general factors associated with expert psychoTherapy. Dialectical Behavior Therapy appears to be uniquely effective in reducing suicide attempts.