Dialectical Behavior Therapy

SUMMARY

This chapter provides an overview of Dialectical Behavior Therapy (DBT), an evidence-based outpatient treatment developed for suicidal women with borderline personality disorder (BPD), and since adapted for other settings and populations. The chapter introduces the biosocial theory of the etiology of BPD and how DBT addresses each aspect of the disorder. It further describes the theoretical foundations of DBT in behaviorism, Zen and dialectics. The reader learns about DBT structures of treatment and what client behaviors are targeted in each stage of treatment. Finally, the chapter uses a clinical case example to illustrate how a therapist would get started with a new client using DBT.     

A specific therapeutic approach to suicide risk in borderline clients

One of the most difficult clinical challenges facing social workers today is suicidal behavior in clients with borderline personality disorder. This article reviews the various types of suicidal behavior exhibited by these clients, including self-destructive behavior and overt suicide attempts. Management of these behaviors is essential if treatment is to be successful. Frameworks are offered for understanding and managing both kinds of behavior.     

Kernberg Versus Kohut: A (Case) Study in Contrasts

In this paper, the main concepts of Otto Kernberg and Heinz Kohut—two theorists who have greatly influenced clinical social work practice with severely disturbed patients—are presented, and then compared by using a case from the practice of the author. The case illustrates the value of utilizing some of the treatment principles put forward by Kernberg and Kohut without becoming too wedded to either of the overall treatment approaches they have formulated. Some aspects of the manner in which the practitioner determines when the treatment approach needs to be modified—to avoid the pitfalls of either being too wedded to an approach or too eclectic—are discussed as well.     

Coping and Regulating Emotions: A Pilot Study of a Modified Dialectical Behavior Therapy Group Delivered in a College Counseling Service

Abstract

Objective: To analyze the efficacy of a pilot program, aimed at treating college students with borderline personality disorder (BPD) using short-term, modified group dialectical behavior therapy at an Australian college counseling service (CCS). Participants: Seventeen enrolled college students aged between 18 and 28 (76.5% female), with a diagnosis of BPD completed the program between November 2009 and November 2010. Methods: Participants attended 8 2-hour group therapy sessions, held at the CCS during semester. Participants were assessed for levels of depression, anxiety, BPD traits, and coping strategies, at commencement and completion of the program. Results: There was a reduction in symptoms of depression and BPD traits, and an increase in adaptive coping skills, including problem solving, and constructive self-talk. There was no reduction in anxiety. Conclusions: The findings indicate promise for short-term treatment of college students with BPD. Implications and limitations are discussed, with emphasis on replication with a control group.     

An Integrated Approach to Managing Change

Complex systems often involve a huge number of variables whose interdependence must be taken into account. This makes the adoption of an integrated approach essential for the proper management of a wide range of aspects related to human life, from social matters to the environment. In particular, this paper takes into consideration three different experiences in which the use of an integrated approach represented the most effective response for managing the evolving realities we took into consideration. We focused on the issue of land management, with particular attention to the problem of monoculture in Brazil. Then we analyzed the attempted cooperation between the States of the Aral Sea area for efficient water management of the basin and, finally, we dealt with the matter of energy efficiency and how the production of home integrated systems could lead to a better rationalization of energy consumption in the near future.      

Peer Substance Use Associated With the Co-occurrence of Borderline Personality Disorder Features and Drug Use Problems in College Students

Abstract

Objective: To determine if the substance use patterns of one's close friends and romantic partners would be a significant contributor to the co-occurrence of borderline personality disorder (BPD) features and drug use problems above and beyond impulsivity and negative emotionality. Participants: Participants were 2,202 undergraduates who attended a large southeastern university between 2003 and 2006. Methods: All subjects completed measures assessing the presence of BPD symptoms, drug use problems, general personality traits, and the proportion of their friends and partners who had used illicit drugs within the past 12 months. Results: The illicit drug use patterns of one's friends and romantic partners was a significant contributor to the co-occurrence of BPD features and drug use problems even when controlling for levels of impulsivity and negative emotionality. Conclusions: These findings suggest possible additional avenues for treatment focusing on helping students with BPD and drug use problems modify their social group.     

Fostering Validating Responses in Families

SUMMARY

Families and family interactions can play a role in the development (vs. prevention), maintenance (or remediation), and treatment of borderline personality disorder (BPD); and, having a family member with BPD can have a significant impact on family functioning. This paper reviews a transactional model for the development and maintenance of BPD, with implications for treatment, particularly from the perspective of dialectical behavior therapy (DBT). The paper also describes a subset of DBT interventions specifically developed for work with couples and families to turn the destructive “inaccurate expression/invalidation cycle” into the constructive “accurate expression/validation cycle,” which is illustrated by a case example.     

Family Systemic Approaches for Borderline Personality Disorder in Acute Adult Mental Health Care Settings

This thematic literature review explores the contribution of family/systemic approaches in the treatment and care of people with borderline personality disorder (BPD) in acute adult mental health care settings. It recognises the importance of early childhood trauma, family dynamics, and relationships in the aetiology of BPD and outlines key benefits and constraints of a family systems approach. The article discusses institutional, cultural, and power structures that influence the diagnosis and treatment process for adult clients with BPD and the value of relational ethics in guiding or mediating care between the family, healthcare system, and community.     

An mHealth Approach to Extend a Brief Intervention for Adolescent Alcohol Use and Suicidal Behavior: Qualitative Analyses of Adolescent and Parent Feedback

Abstract

Mobile health (mHealth) tools that supplement inpatient psychiatric care can maintain and enhance intervention effects following hospitalization. Adolescents hospitalized following a suicidal event represent a vulnerable population who could greatly benefit from such an mHealth intervention. In specific, suicidal adolescents who drink alcohol are in need of robust interventions that address the bidirectional relationship between alcohol use and suicidal thoughts and behaviors, because it puts them at especially high risk for suicide upon discharge. The purpose of this study was to conduct qualitative interviews to gather feedback to improve a brief alcohol intervention provided to suicidal adolescents during psychiatric hospitalization, and to develop a mHealth tool to extend care after discharge. Participants, eight adolescents and their parents, identified the need for a smartphone application to deliver intervention content to adolescents and parents during the posthospitalization period. Adolescents sought support in meeting alcohol- and mood-related goals, while parents desired general resources as well as tips for conversations with their adolescent about mood and alcohol use.     

Emotional Dysregulation: The Key to a Treatment Approach for Violent Mentally Ill Individuals

Prior research has suggested that psychopathy, substance abuse, and the presence of a personality disorder increase an individual's risk for violence toward others. Substantial clinical literature has established emotional dysregulation as a risk marker for violence toward self. It is hypothesized that emotional dysregulation may be an important component in a constellation of risk markers for violence toward others and may interact with psychopathy and substance abuse in individuals with personality disorders to enhance risk for violence. If these hypothesized relationships exist, it suggests that the development of an intervention approach which directly targets these factors may hold promise. A potential intervention approach based on dialectical behavioral therapy, with case illustrations, is provided.     

Pilot study of a personality-based approach to assessing eating disorder and Obsessive Compulsive Disorder symptom risk in college men and women

Abstract

Objective: To conduct a pilot test of the validity of using empirically derived personality types to characterize eating disorder (ED) risk in college students and resolve discrepancies regarding the role of perfectionism and obsessive-compulsive disorder (OCD) symptoms.

Participants: Man and woman undergraduate students (N?=?169) at a small, private university. Data were collected from February to May 2016 and 2018. Methods: Participants completed self-report measures of personality (perfectionism, impulsivity, and effortful control) and psychopathology (EDs, OCD). Results: Our analyses replicated three validated personality types: overcontrolled, undercontrolled, and resilient. Analysis of variances demonstrated perfectionism, ED, and OCD symptoms were significantly elevated in the overcontrolled subtype. There was no interaction by sex. Conclusions: These findings suggest that personality types may be useful for classifying ED risk and OCD symptoms in college students across sexes. Further study and relevance to prevention and intervention efforts to reduce the burden of EDs on college campuses will be discussed.     

An Approach to Coordinated Teaching of Growth and Behavior in Class and Field

This study of the validity of admissions predictions made by the full-time faculty of a school of social work showed some capacity of the faculty to predict classroom performance, but no ability to predict field performance. Interjudge reliability for the group was low, with an overall reliability coefficient of .47. Nearly half the faculty could significantly predict classroom performance, however, there was a strong tendency toward negative correlation between admissions ratings and field performance, particularly by field instruction faculty. The pooled judgments of three faculty raters were shown not to have any significant advantage over average individual judgments in validity terms.     

Suicidal Ideation and Comorbid Disorders in Adolescents and Young Adults Diagnosed with Asperger's Syndrome: A Population at Risk

ABSTRACT

The purpose of this study was to examine the level of suicidal ideation and comorbid disorders (major depressive disorder, generalized anxiety disorder) among adolescents and young adults with diagnosed Asperger's syndrome (AS). A cross-sectional study using a self-administrated mail questionnaire and a Web-based questionnaire were used. Two samples were selected for this study. The first sample used snowball sampling, starting with parents of adolescents and young adults with diagnosed AS who participated in a qualitative study conducted in 2002. The second sample consisted of a volunteer sample of parents who visited Web sites for parents and individuals with diagnosed autism spectrum disorder. The sample included 10 adolescents and young adults with diagnosed AS. Fifty percent of the sample had a clinically significant level of suicidal ideation, 20% met criteria for a diagnosis of major depressive disorder, and 30% met criteria for generalized anxiety disorder.     

A Mixed-Methods Approach to Refining and Measuring the Construct of Positive Risk-Taking in Adolescence

Adolescence is a peak period for risk-taking, but research has largely overlooked positive manifestations of adolescent risk-taking due to ambiguity regarding operationalization and measurement of positive risk-taking. We address this limitation using a mixed-methods approach. We elicited free responses from contemporary college students (N = 74, M_age = 20.1 years) describing a time they took a risk. Qualitative analysis informed the construction of a self-report positive risk-taking scale, which was administered to a population-based sample of adolescents (N = 1,249, M_age = 16 years) for quantitative validation and examination of associations with normative and impulsive personality. Sensation seeking predicted negative and positive risk-taking, whereas extraversion and openness were predominantly related to positive risk-taking. Results provide promising evidence for a valid measure of adolescents' engagement in positive risks.     

The Effect of Support Expectations on Prenatal Attachment: An Evidence-Based Approach for Intervention in an Adolescent Population

This study was designed to determine the significant variables predicting prenatal attachment in an adolescent population. Scientifically supported knowledge of the factors enhancing attachment plays a crucial role in assisting social workers and other health care professionals to accurately assess and intervene to decrease pregnancy risks. Previous prenatal attachment studies demonstrated conflicting findings due to problems from using different theoretical frameworks and research methodologies. In order to ensure consistency, this study infused an attachment theory perspective. Bowlby’s attachment theory, Levitt’s support expectations model, and research from prenatal relationship studies were integrated. The social survey sampled 129 minority status pregnant adolescents attending public school. Measurements included the Prenatal Attachment Inventory (PAI) and the Support Expectations Index (SEI). Regression analyses revealed that support expectation was a powerful predictor of prenatal attachment with pregnancy planning and less stress adding importantly to explain over 33% of the variance. Support expectation was a greater predictor of prenatal attachment than the actual support available. Findings also supported the construct of prenatal attachment as the initial stage of development of the life cycle. Janis B. Feldman is an Assistant Professor, University, of Texas-Pan American.     

Comparing the effectiveness of behavioral interventions in adults with co-occurring tobacco and substance use disorders: a systematic review of literature

ABSTRACT

This systematic literature review compares the e?ectiveness of various behavioral interventions delivered to persons with co-occurring tobacco and substance use disorders. It examines ?ndings of six randomized trials and three secondary analyses from randomized trials. Based on the ?ndings of this literature review, support is given to the following: (1) The consequences of tobacco use and smoking are deadly, costly, and can have an inhibitory e?ect on the progress of people in substance abuse treatment, (2) tobacco cessation options are a preventive intervention that can be easily incorporated into a treatment facility’s standard of practice and should be made available within the context of all substance abuse treatment facilities, and (3) concurrently treating tobacco use disorder and substance use disorder(s) is an e?ort that will help meet the social work profession’s Grand Challenge to ‘Close the Health Gap.’     

Conflict-Oriented Cognitive Behavioral Therapy (CO-CBT): An Integrative Approach to the Treatment of Bulimia Nervosa Patients

The paper describes an integrative approach to the treatment of Bulimia Nervosa that combines Cognitive Behavioral Treatment (CBT) with short-term dynamic treatment, called conflict-oriented cognitive behavioral treatment (CO-CBT). The need to develop an integrative model emerges from the lack of focus on the underlying emotional dynamics in the traditional CBT approach. This article provides a brief literature review of CBT and short-term dynamic therapy as applied to Bulimia Nervosa patients. It describes the CO-CBT treatment model, followed by clinical examples, and a discussion of the importance of incorporating this additional dimension in order to most successfully treat Bulimia Nervosa.

Internet-Based Instruction as an Innovative Approach to Managing Prerequisite Curriculum Content in a Graduate Social Work Program

SUMMARY

Students admitted to graduate social work programs possess varying levels of understanding of prerequisite curriculum content. Compounding this situation is that social work educators teaching at the foundation level are now required to provide an expanded array of curriculum content in their courses. This article conceptualizes an Internet-Based orientation course as a unique tool for preparing students with prerequisite curriculum content necessary for successful integration and mastery of a graduate curriculum. Several steps are presented in the design and development of the course: obtaining support and approval, identifying and collecting data, designing and developing course components, and implementing and evaluating the course. Although course development occurs within a social work education setting, findings from this Internet-Based orientation course are applicable to other educational and human service settings.     

An Ecological Approach to Understanding Peer Victimization in South Korea

This article analyzes the common and serious problem of peer victimization in South Korean (hereafter referred to as Korean) schools using Bronfenbrenner's ecological model. We conceptualize peer victimization within Korean culture, then identify and examine risk factors that operate simultaneously within and between five system levels: the micro-, meso-, exo-, macro-, and chrono-systems. Theories that explain relationships between the risk factors and peer victimization also are discussed. Finally, we draw implications from our ecological analysis for assessing, preventing, and treating peer victimization in Korean schools.     

An Approach to Community Outreach Practice in the 21st Century

ABSTRACT

This article presents the findings of a study about knowledge, attitudes and beliefs about AIDS held by older Hispanic adults. Members of the convenience sample provided responses that identify concerns about effective practice in outeach and information provision to older adults with regard to risky sexual practices. Intervention to prevent the spread of HIV/AIDS among older adults needs to be culturally competent and to be attuned to social practices, traditions, community concerns, and generational perspectives with regard to serious health problems related to sexual behavior. The sample composition was primarily Hispanic (97.4%); Catholic, (92.1%) and female (84.2%) with a mean age of 73.7 years. Approximately 28.2% of those surveyed stated that they felt that AIDS was an important problem for older adults. The majority, (76.3%) were aware of locations where health information and services were available if AIDS were a problem. Even though the majority indicated knowledge that AIDS is spread through sexual intercourse, more than one third, (36.8%) thought that sexually active adults 55 and over never use condoms. A discussion of the implications for disease prevention programs and community practice is presented emphasizing the importance of empowerment strategies in health promotion programs and the strengthening of multidisciplinary collaborative efforts to effect positive community health changes.