Dialectical behaviour therapy (DBT) for forensic psychiatric patients: An Italian pilot study

Abstract

Background Several previous randomised controlled trials of dialectical behaviour therapy (DBT) since Linehan's original have shown that it has an advantage over standard care or other psychological treatments, but focus is usually on suicide‐related behaviours, and little is known about its effect with offender‐patients. Aims To evaluate DBT with a group of offender‐patients in the Italian high intensity therapeutic facilities—the Residenze per l'Esecuzione delle Misure di Sicurezza (REMS), established under the Italian Law 81/2014. Methods Twenty‐one male forensic psychiatric in‐patients with borderline personality disorder were enrolled and randomly assigned to 12 months of standard DBT together with all the usual REMS treatments (n = 10) or usual REMS treatments alone (n = 11). All participants completed the same pretreatment and posttreatment assessments, including the Barratt Impulsiveness Scale (BIS‐11), Difficulties in Emotion Regulation Scale (DERS), and Toronto Alexithymia Scale 20 (TAS‐20). Results Men receiving DBT showed a significantly greater reduction in motor impulsiveness, as measured by the BIS‐11, and emotional regulation, as reflected by the DERS total score, than the controls. There were no significant differences between groups in alexithymia scores. Conclusions Italy has innovative forensic psychiatric facilities with a new recovery–rehabilitation approach, but the ambitious goals behind these cannot be achieved by pharmacology alone. For the first time in clinical forensic settings in Italy, there has been limited access to DBT. This small pilot study suggests this is likely to help ameliorate traits associated with violent and antisocial behaviours, so a full‐scale randomised controlled trial should follow.

Feasibility, Acceptability and Preliminary Efficacy of Dialectical Behavior Therapy for Autistic Adults without Intellectual Disability: A Mixed Methods Study

“…Hence the lack of significant improvement on the GAFS-8 in our study might be explained by the fact that alexithymia was not the main target of our intervention (Cameron et al, 2014 ). Alexithymia has rarely been measured in DBT protocols (Bianchini et al, 2019 ; Holmqvist Larsson et al, 2020 ), and it is still unknown whether and how it changes in other clinical populations during the course of DBT.…”

Vulnerabilities of High-Security Forensic Psychiatry Residences in Italy during the COVID-19 pandemic: a qualitative survey and a proposal for recovery and prevention

“…The use of an evidence-based approach is strategic since this can allow the most reliable and effective assessment and treatment procedures to be adopted, particularly during emergency situations like the present one. Despite some preliminary effectiveness studies have been conducted in the Italian context (e.g., Bianchini et al 2019), more research and clinical work should be done to evaluate and adapt the psycho-rehabilitative programs to our context, since the attention given by forensic psychiatry professionals to evidence-based literature is still limited. The lack of evidence-based programs makes the REMS high-risk settings during the COVID-19 pandemic, as the spread of controversial information on the pandemic might have a strong impact on the inpatients' distress and increase the risk for violent acts (Campbell 2020).…”

A pilot randomized controlled trial of dialectical behavior therapy (DBT) for reducing craving and achieving cessation in patients with marijuana use disorder: feasibility, acceptability, and appropriateness

“…It also intervenes in low quality of life situations, reduces drug-seeking behavior, and helps patients function adaptively by accepting unpleasant emotions such as craving. 9,10,14 Research literature shows the efficacy and effectiveness of DBT in various comorbid problems and diseases such as suicide, 16 forensic psychiatric patients, 17 and irritable bowel syndrome. 18 Nevertheless, studies have reported contradictory results for the effectiveness of implementing DBT in various SUD populations.…”