Outcomes of dialectical behavior therapy administered by an interdisciplinary team

Robinson, Shannon K.; Lang, Jacob; Hernández, Alexandra; Holz, Tracey; Cameron, Megan; Brannon, Beth

doi:10.1016/j.apnu.2018.02.009

Cited by 16 publications

(13 citation statements)

References 16 publications

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“…Accordingly, it was not possible to assess the sensitivity to change of the BSL-23 severity grades or to empirically evaluate the clinically important question regarding the extent the BSL-23 severity classes are useful in guiding clinical decisions, such as the initiation of treatment or the choice between treatment options. However, the original version of the BSL-23 has shown that it is highly sensitive to change, both in the original validation study [21] and in subsequent treatment studies (e.g., [42]). Because of the very high correlation of the BSL-23 severity classification and the original version of the BSL-23 (rho = 0.97 to 0.98 in the samples investigated in our study), it seems likely that the BSL-23 severity classes will show sensitivity to change in treatment studies.…”

Section: Discussionmentioning

confidence: 99%

A proposed severity classification of borderline symptoms using the borderline symptom list (BSL-23)

Kleindienst

Jungkunz

Bohus

2020

bord personal disord emot dysregul

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Background: The Borderline Symptom List (BSL-23) is a well-established self-rating instrument to assess the severity of borderline typical psychopathology. However, a classification of severity levels for the BSL-23 is missing. Methods: Data from 1.090 adults were used to develop a severity classification for the Borderline Symptom List (BSL-23). The severity grading was based on the distribution of the BSL-23 in 241 individuals with a diagnosis of BPD. Data from three independent samples were used to validate the previously defined severity grades. These validation samples included a group of treatment seeking patients with a diagnosis of BPD (n = 317), a sample of individuals with mental illnesses other than BPD (n = 176), and a healthy control sample (n = 356). The severity grades were validated from comparisons with established assessment instruments such as the International Personality Disorders Examination, the Structured Clinical Interview for DSM-IV, the global severity index of the Symptom Checklist (GSI, SCL-90), the Global Assessment of Functioning (GAF), and the Beck Depression Inventory (BDI-II). Results: Six grades of symptom severity were defined for the BSL-23 mean score: none or low: 0-0.3; mild: 0.3-0.7; moderate: 0.7-1.7; high: 1.7-2.7; very high: 2.7-3.5; and extremely high: 3.5-4. These grades received consistent empirical support from the independent instruments and samples. For instance, individuals with a severity grade of none or low were virtually free from diagnostic BPD-criteria, had a GSI below the normative population, and a high level of global functioning corresponding to few or no symptoms. Severity grades indicating high to extremely high levels of BPD symptoms were observed at a much higher rate in treatment-seeking patients (70.0%) than in clinical controls (17.6%) and healthy controls (0.0%). The BSL-23 score that best separated treatment-seeking BPD patients and clinical controls was 1.50, whereas the clearest discrimination of BPD patients and healthy controls was found at a score of 0.64. Conclusions: The grades of BPD-specific symptom severity derived from the distribution of the BSL-23 scores received consistent empirical validation from established assessments for psychopathology. Future studies should expand this validation by including additional instruments e.g., to assess self-esteem, loneliness, connectedness, and quality of life.

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Section: Discussionmentioning

confidence: 99%

A proposed severity classification of borderline symptoms using the borderline symptom list (BSL-23)

Kleindienst

Jungkunz

Bohus

2020

bord personal disord emot dysregul

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“…For some of the outcomes, differences were no longer significant at follow-up compared to post-treatment. Non-randomised experiments, observational studies, quasi experiment, and natural experiment with pre-post comparison ( n = 15) [ 45 – 59 ] Sample size: < 20 ( n = 2); 20–100 ( n = 13). Date: 2000–2009 ( n = 7); 2010–2019 ( n = 8).…”

Section: Resultsmentioning

confidence: 99%

Current state of the evidence on community treatments for people with complex emotional needs: a scoping review

Ledden

Rains²,

Schlief³

et al. 2022

BMC Psychiatry

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Background Improving the quality of care in community settings for people with ‘Complex Emotional Needs’ (CEN—our preferred working term for services for people with a “personality disorder” diagnosis or comparable needs) is recognised internationally as a priority. Plans to improve care should be rooted as far as possible in evidence. We aimed to take stock of the current state of such evidence, and identify significant gaps through a scoping review of published investigations of outcomes of community-based psychosocial interventions designed for CEN. Methods We conducted a scoping review with systematic searches. We searched six bibliographic databases, including forward and backward citation searching, and reference searching of relevant systematic reviews. We included studies using quantitative methods to test for effects on any clinical, social, and functioning outcomes from community-based interventions for people with CEN. The final search was conducted in November 2020. Results We included 226 papers in all (210 studies). Little relevant literature was published before 2000. Since then, publications per year and sample sizes have gradually increased, but most studies are relatively small, including many pilot or uncontrolled studies. Most studies focus on symptom and self-harm outcomes of various forms of specialist psychotherapy: most result in outcomes better than from inactive controls and similar to other specialist psychotherapies. We found large evidence gaps. Adaptation and testing of therapies for significant groups (e.g. people with comorbid psychosis, bipolar disorder, post-traumatic stress disorder, or substance misuse; older and younger groups; parents) have for the most part only reached a feasibility testing stage. We found little evidence regarding interventions to improve social aspects of people’s lives, peer support, or ways of designing effective services. Conclusions Compared with other longer term mental health problems that significantly impair functioning, the evidence base on how to provide high quality care for people with CEN is very limited. There is good evidence that people with CEN can be helped when specialist therapies are available and when they are able to engage with them. However, a much more methodologically robust and substantial literature addressing a much wider range of research questions is urgently needed to optimise treatment and support across this group.

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“…Accordingly, it was not possible to assess the sensitivity to change of the BSL-23 severity grades or to empirically evaluate the clinically important question regarding the extent the BSL-23 severity classes are useful in guiding clinical decisions, such as the initiation of treatment or the choice between treatment options. However, the original version of the BSL-23 has shown that it is highly sensitive to change, both in the original validation study [22] and in subsequent treatment studies [e.g., 43]. Because of the very high correlation of the BSL-23 severity classes and the original version of the BSL-23 (rho=0.97 to 0.98), it seems likely that the BSL-23 severity classes will show sensitivity to change in treatment studies.…”

Section: Resultsmentioning

confidence: 99%

A Proposed Severity Classification of Borderline Symptoms Using the Borderline Symptom List (BSL-23)

Kleindienst¹,

Jungkunz

Bohus

2020

Preprint

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Background The Borderline Symptom List (BSL-23) is a well-established self-rating instrument to assess the severity of borderline typical psychopathology. However, a classification of severity levels for the BSL-23 is missing. Methods Data from 1.090 adults were used to develop a severity classification for the Borderline Symptom List (BSL-23). The severity grading was based on the distribution of the BSL-23 in 241 individuals with a diagnosis of BPD. Data from three independent samples were used to validate the previously defined severity grades. These validation samples included a group of treatment seeking patients with a diagnosis of BPD (n=317), a sample of individuals with mental illnesses other than BPD (n=176), and a healthy control sample (n=356). The severity grades were validated from comparisons with established assessment instruments such as the International Personality Disorders Examination, the Structured Clinical Interview for DSM-IV, the global severity index of the Symptom Checklist (GSI, SCL-90), the Global Assessment of Functioning (GAF), and the Beck Depression Inventory (BDI-II).Results Six grades of symptom severity were defined for the BSL-23 mean score: none or low: 0-0.3; mild: 0.3-0.7; moderate: 0.7-1.7; high: 1.7-2.7; very high: 2.7-3.5; and extremely high: 3.5-4. These grades received consistent empirical support from the independent instruments and samples. For instance, individuals with a severity grade of none or low were virtually free from diagnostic BPD-criteria, had a GSI below the normative population, and a high level of global functioning corresponding to few or no symptoms. Severity grades indicating high to extremely high levels of BPD symptoms were observed at a much higher rate in treatment-seeking patients (70.0%) than in clinical controls (17.6%) and healthy controls (0.0%). The BSL-23 score that best separated treatment-seeking BPD patients and clinical controls was 1.50, whereas the clearest discrimination of BPD patients and healthy controls was found at a score of 0.64.Conclusions The grades of BPD-specific symptom severity derived from the distribution of the BSL-23 scores received consistent empirical validation from established assessments for psychopathology. Future studies should expand this validation by including additional instruments e.g., to assess self-esteem, loneliness, connectedness, and quality of life.

show abstract

Outcomes of dialectical behavior therapy administered by an interdisciplinary team

Cited by 16 publications

References 16 publications

A proposed severity classification of borderline symptoms using the borderline symptom list (BSL-23)

A proposed severity classification of borderline symptoms using the borderline symptom list (BSL-23)

Current state of the evidence on community treatments for people with complex emotional needs: a scoping review

A Proposed Severity Classification of Borderline Symptoms Using the Borderline Symptom List (BSL-23)

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