Two-Year Randomized Controlled Trial and Follow-up of Dialectical Behavior Therapy vs Therapy by Experts for Suicidal Behaviors and Borderline Personality Disorder

Linehan, Marsha M.; Comtois, Katherine Anne; Murray, Angela M.; Brown, Milton Z.; Gallop, Robert; Heard, Heidi L.; Korslund, Kathryn E.; Tutek, Darren A.; Reynolds, Stephen A.; Lindenboim, Noam

doi:10.1001/archpsyc.63.7.757

Cited by 1,671 publications

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“…Therapies which directly target experiential avoidance, such as accep-tance and commitment therapy (ACT), or DBT (which also addresses cognitive dissonance, as noted above [80]), may be useful in augment-ing treatment for patients with PNESs [87].…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies on implicit cognition have conceptualized such discrepancies from within a cognitive dissonance theory perspective [78], suggesting that aversive dissonance-related discomfort increases when implicit and explicit beliefs diverge [79]. The application of cognitive dissonance theory to PNESs may, therefore, suggest that nonepileptic seizures function to reduce cognitive dissonance, and targeting this dissonance (e.g., using strategies from dialectical behavior therapy (DBT; [80])), is an avenue for future research and treatment approaches in populations with PNESs.…”

Section: Experiential Avoidancementioning

confidence: 99%

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Anxiety and avoidance in psychogenic nonepileptic seizures: The role of implicit and explicit anxiety

Dimaro

Dawson

Roberts

et al. 2014

Epilepsy & Behavior

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This study examined implicit and explicit anxiety in individuals with epilepsy and psychogenic nonepileptic seizures (PNESs) and explored whether these constructs were related to experiential avoidance and seizure frequency. Based on recent psychological models of PNESs, it was hypothesized that nonepileptic seizures would be associated with implicit and explicit anxiety and experiential avoidance. Explicit anxiety was measured by the State-Trait Anxiety Inventory; implicit anxiety was measured by an Implicit Relational Assessment Procedure; and experiential avoidance was measured with the Multidimensional Experiential Avoidance Questionnaire. Although both groups with epilepsy and PNESs scored similarly on implicit measures of anxiety, significant implicit-explicit anxiety discrepancies were only identified in patients with PNESs (p b .001). In the group with PNESs (but not in the group with epilepsy), explicit anxiety correlated with experiential avoidance (r = .63, p b .01) and frequency of seizures (r = .67, p b .01); implicit anxiety correlated with frequency of seizures only (r =.56,p b .01). Our findings demonstrate the role of implicit anxiety in PNESs and provide addi-tional support for the contribution of explicit anxiety and experiential avoidance to this disorder.

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Section: Discussionmentioning

confidence: 99%

Section: Experiential Avoidancementioning

confidence: 99%

Anxiety and avoidance in psychogenic nonepileptic seizures: The role of implicit and explicit anxiety

Dimaro

Dawson

Roberts

et al. 2014

Epilepsy & Behavior

View full text Add to dashboard Cite

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“…When the completion of the study was threatened by the high rate of attrition, the researchers responded by using intensive case managers to maintain contact with clients through a community phone-mail account, and by calling client's friends, family, clergy, probation officers, and other mental health providers when contact was lost. Another example of treatment engagement is evident in Linehan's DBT (Linehan, 1993), which has been found to be an effective treatment for reducing suicide related-behavior in individuals with borderline personality disorder in multiple studies (Linehan et al, 1999;Linehan et al, 2006). In DBT, suicide-related behavior is conceptualized as maladaptive problem-solving.…”

Section: Cognitive Behavioral Therapy (Cbt) To Reduce Suicidal Behaviormentioning

confidence: 99%

Integrating Motivational Interviewing and Self-Determination Theory With Cognitive Behavioral Therapy to Prevent Suicide

Britton

Patrick

Wenzel

et al. 2011

Cognitive and Behavioral Practice

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Cognitive Behavioral Therapy (CBT) has been found to be effective in preventing suicide-related behavior. However, it is often difficult to engage patients who are at-risk in treatment. Motivational Interviewing (MI) has been shown to increase treatment engagement and improve treatment outcomes when it is used to complement other treatments. As a general theory of human motivation that is consistent with MI, Self-Determination Theory (SDT) provides a framework for understanding how MI may be added to CBT to increase treatment engagement and effectiveness. In this paper, we use SDT to explain how MI may complement CBT to reduce suicide-related behavior, provide a case example of using MI with a suicidal patient before CBT-based treatment, and explore future directions for research.In the United States, over 300,000 people died by suicide between 1995 and 2005, making suicide a major public health concern (Centers for Disease Control and Prevention, 2008). Although an estimated 90% of individuals who die from suicide suffer from one or more mental disorders, up to 65% never receive psychological or psychiatric treatment (Cavanagh, Carson, Sharpe, & Lawrie, 2003). Psychosocial interventions such as Cognitive Behavioral Therapy are effective in reducing suicide-related behaviors (CBT; Tarrier, Taylor, & Gooding, 2008); thus, it is important to use theoretically and empirically supported methods to ensure that at-risk clients receive effective mental health treatment. Motivational Interviewing (MI;Miller & Rollnick, 2002) has been shown to increase treatment engagement and improve treatment outcomes when it is used to complement other treatments (Hettema, Steele, & Miller, 2005). However, MI is a clinical approach that currently lacks an underlying theory to explain the mechanisms by which it functions. As a general theory of human motivation that is consistent with the underlying principles of MI, Self-Determination Theory (SDT; Deci & Ryan, 2002) provides a framework for understanding the manner in which MI can be integrated with CBT to increase treatment Correspondence concerning this article should be addressed to Peter C. Britton, Ph.D., Center of Excellence, Department of Veteran Affairs Medical Center, 14424. peter.britton@va.gov. U.S. Department of Veterans AffairsPublic Access Author manuscript Cogn Behav Pract. Author manuscript; available in PMC 2016 October 19. Cognitive Behavioral Therapy (CBT) to Reduce Suicidal BehaviorIn a recent meta-analysis of 28 randomized controlled trials (RCTs), CBT was found to reduce suicide-related behavior (i.e., death by suicide, suicide attempts, suicide intent and/or plans, and ideation) in the 3 months following treatment (Tarrier et al., 2008). The primary cognitive behavioral interventions that were represented in the study included Dialectical Behavioral Therapy (DBT), problem-solving therapy, and Cognitive Therapy (CT). Although the findings were promising, a review of the major studies suggested that attrition was a common problem. For example, in Brown's ...

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“…A RCT of schema-focused therapy among patients with borderline personality disorder also reported positive outcomes with regard to the number of episodes of DSH (Giesen-Bloo et al, 2006). To date, dialectical behavioural therapy is the only CBT intervention studied in more than one RCT, and has consistently been found to reduce self-injury in (female) patients with borderline personality disorder (Linehan et al, 2006). Furthermore, a recent RCT showed that DSH patients who received CBT in addition to usual care had signifi cantly greater reductions in DSH, suicidal cognitions, symptoms of depression and anxiety and signifi cantly greater improvements in self-esteem and problem-solving ability than controls (Slee et al, 2008a).…”

Section: Introductionmentioning

confidence: 99%

Emotion regulation as mediator of treatment outcome in therapy for deliberate self‐harm

Slee

Spinhoven

Garnefski

et al. 2008

Clin Psychology and Psychoth

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This study presents the outcomes of mediator analyses as part of a randomized controlled trial of Cognitive-Behavioural Therapy (CBT) for young people who engage in deliberate self-harm (DSH). The study involved 90 people, aged 15-35 years, who were randomly assigned to CBT in addition to treatment as usual or to treatment as usual only. The fi ndings showed that changes in DSH were partially mediated by changes in emotion-regulation diffi culties, particularly diffi culties with impulse control and goal-directed behaviours. In addition, the potential mediating role of symptoms of depression, anxiety and suicidal cognitions was examined. Although the CBT intervention signifi cantly reduced depression, anxiety and suicidal cognitions, these measures of symptom severity did not play a mediating role. These fi ndings suggest that interventions for DSH should not primarily focus on mental disorders associated with DSH, but should be DSH-specifi c and should target specifi c emotion-regulation diffi culties.

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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

Abstract: 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.

Cited by 1,671 publications

References 56 publications

Anxiety and avoidance in psychogenic nonepileptic seizures: The role of implicit and explicit anxiety

Anxiety and avoidance in psychogenic nonepileptic seizures: The role of implicit and explicit anxiety

Integrating Motivational Interviewing and Self-Determination Theory With Cognitive Behavioral Therapy to Prevent Suicide

Emotion regulation as mediator of treatment outcome in therapy for deliberate self‐harm

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