Future Directions for Dialectical Behaviour Therapy

2018 ◽  
pp. 1004-1016
Author(s):  
Michaela A. Swales
Keyword(s):  
Clinical Practice ◽  
Clinical Outcomes ◽  
Behaviour Therapy ◽  
Research Strategies ◽  
Future Directions ◽  
Dialectical Behaviour Therapy ◽  
General Psychiatry ◽  
Implementation Aspects ◽  
Treatment Mechanisms

The Oxford Handbook of DBT has reviewed and considered theoretical, structural, clinical, and implementation aspects of DBT, comprehensively detailing its journey in research and clinical practice since the landmark, yet small, RCT published in Archives of General Psychiatry over 25 years ago (Linehan et al, 1991).. This closing chapter reflects on the treatment’s achievements since that first trial and considers future directions in relation to theory, clinical outcomes, adaptations, and implementation in practice. Building on initial demonstrations of efficacy to deliver any intervention effectively at scale, reaching all those who may benefit, requires changes in dissemination, implementation and research strategies. Targeting research on treatment mechanisms that drive change may usefully inform this agenda. This chapter explores these issues and concludes by discussing challenges within the wider psychotherapy field and their implications for DBT.

Manual-assisted cognitive-behaviour therapy (MACT): a randomized controlled trial of a brief intervention with bibliotherapy in the treatment of recurrent deliberate self-harm

1999 ◽  
Vol 29 (1) ◽  
pp. 19-25 ◽  
Author(s):  
K. EVANS ◽  
P. TYRER ◽  
J. CATALAN ◽  
U. SCHMIDT ◽  
K. DAVIDSON ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cognitive Behaviour Therapy ◽  
Controlled Trial ◽  
Small Sample ◽  
Cost Of Care ◽  
Behaviour Therapy ◽  
Deliberate Self Harm ◽  
Dialectical Behaviour Therapy ◽  
Cognitive Behaviour ◽  
Self Harm

Background. The treatment of deliberate self-harm (parasuicide) remains limited in efficacy. Despite a range of psychosocial, educational and pharmacological interventions only one approach, dialectical behaviour therapy, a form of cognitive-behaviour therapy (CBT), has been shown to reduce repeat episodes, but this is lengthy and intensive and difficult to extrapolate to busy clinical practice. We investigated the effectiveness of a new manual-based treatment varying from bibliotherapy (six self-help booklets) alone to six sessions of cognitive therapy linked to the booklets, which contained elements of dialectical behaviour therapy.Methods. Thirty-four patients, aged between 16 and 50, seen after an episode of deliberate self-harm, with personality disturbance within the flamboyant cluster and a previous parasuicide episode within the past 12 months, were randomly assigned to treatment with manual-assisted cognitive-behaviour therapy (MACT N=18) or treatment as usual (TAU N=16). Assessment of clinical symptoms and social function were made at baseline and repeated by an independent assessor masked to treatment allocation at 6 months. The number and rate of all parasuicide attempts, time to next episode and costs of care were also determined.Results. Thirty-two patients (18 MACT; 14 TAU) were seen at follow-up and 10 patients in each group (56% MACT and 71% TAU) had a suicidal act during the 6 months. The rate of suicidal acts per month was lower with MACT (median 0·17/month MACT; 0·37/month TAU; P=0·11) and self-rated depressive symptoms also improved (P=0·03). The treatment involved a mean of 2·7 sessions and the observed average cost of care was 46% less with MACT (P=0·22).Conclusions. Although limited by the small sample, the results of this pilot study suggest that this new form of cognitive-behaviour therapy is promising in its efficacy and feasible in clinical practice.

The Oxford Handbook of Dialectical Behaviour Therapy

2017 ◽  
Keyword(s):  
College Counseling ◽  
Clinical Settings ◽  
Post Traumatic Stress ◽  
Behaviour Therapy ◽  
Future Directions ◽  
Dialectical Behaviour Therapy ◽  
Biosocial Theory ◽  
Post Traumatic ◽  
International Systems ◽  
College Counseling Centers

This handbook examines theoretical, structural, clinical and implementation aspects of dialectical behaviour therapy (DBT) for a variety of disorders such as borderline personality disorder (BPD), suicidal behaviour in the context of BPD, substance use disorders, cognitive disabilities, eating disorders, and post-traumatic stress disorder (PTSD). The volume considers the dialectical dilemmas of implementation with respect to DBT in both national and international systems, its adaptations in routine clinical settings, and its behavioural foundations. It also discusses evidence-based training in DBT, validation principles and practices in DBT, the biosocial theory of BPD, the structure of DBT programs, and the efficacy of DBT in college counseling centers. Finally, the book reflects on the achievements of DBT since the first treatment trial and considers challenges and future directions for DBT in terms of its theoretical underpinnings, clinical outcomes, adaptations and implementation in practice.

scholarly journals Dialectical behaviour therapy v. mentalisation-based therapy for borderline personality disorder

2018 ◽  
Vol 49 (12) ◽  
pp. 2060-2068 ◽  
Author(s):  
Kirsten Barnicot ◽  
Mike Crawford
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Clinical Outcomes ◽  
Emotional Regulation ◽  
Experimental Studies ◽  
Borderline Personality ◽  
Emotional Dysregulation ◽  
Behaviour Therapy ◽  
Dialectical Behaviour Therapy ◽  
Self Harm

AbstractBackgroundDialectical behaviour therapy (DBT) and mentalisation-based therapy (MBT) are both widely used evidence-based treatments for borderline personality disorder (BPD), yet a head-to-head comparison of outcomes has never been conducted. The present study therefore aimed to compare the clinical outcomes of DBT v. MBT in patients with BPD.MethodsA non-randomised comparison of clinical outcomes in N = 90 patients with BPD receiving either DBT or MBT over a 12-month period.ResultsAfter adjusting for potentially confounding differences between participants, participants receiving DBT reported a significantly steeper decline over time in incidents of self-harm (adjusted IRR = 0.93, 95% CI 0.87–0.99, p = 0.02) and in emotional dysregulation (adjusted β = −1.94, 95% CI −3.37 to −0.51, p < 0.01) than participants receiving MBT. Differences in treatment dropout and use of crisis services were no longer significant after adjusting for confounding, and there were no significant differences in BPD symptoms or interpersonal problems.ConclusionsWithin this sample of people using specialist personality disorder treatment services, reductions in self-harm and improvements in emotional regulation at 12 months were greater amongst those receiving DBT than amongst those receiving MBT. Experimental studies assessing outcomes beyond 12 months are needed to examine whether these findings represent differences in the clinical effectiveness of these therapies.

DBT with Adolescents

2018 ◽  
pp. 546-572 ◽  
Author(s):  
Jill H. Rathus ◽  
Alec L. Miller ◽  
Lauren Bonavitacola
Keyword(s):  
Outcome Research ◽  
Treatment Strategies ◽  
Behaviour Therapy ◽  
Future Directions ◽  
Dialectical Behaviour Therapy ◽  
Skills Group ◽  
Telephone Coaching ◽  
Group Family

Alec Miller and Jill Rathus adapted Dialectical Behaviour Therapy (DBT) for adolescents with suicidal behaviours, multiple disorders, and complex presentations using Marsha Linehan’s original DBT for adults. This chapter outlines this adaptation, provides discussion of the original components and strategies and how they apply to adolescents, and describes the modifications for adolescents and their caregivers. It describes DBT treatment stages and targets, as well as treatment strategies specific to adolescents. It outlines the modes of treatment, including the multi-family skills group, family sessions, parenting sessions, and telephone coaching for parents. Further, it describes the additional skills that were added and/or adapted, including the new skills module, Walking the Middle Path. It includes a case study that highlights the conceptualization, interventions, and outcomes of a typical adolescent’s progress through DBT. Lastly, it summarizes the outcome research of DBT-A and suggests future directions for adolescent DBT.

Meeting the Best Practice for Hearing Aid Verification in Children: Challenges and Future Directions

2019 ◽  
Vol 28 (4) ◽  
pp. 877-894
Author(s):  
Nur Azyani Amri ◽  
Tian Kar Quar ◽  
Foong Yen Chong
Keyword(s):  
Clinical Practice ◽  
Hearing Aids ◽  
Best Practice ◽  
Hearing Aid ◽  
Evidence Based ◽  
Future Directions ◽  
Major Barrier ◽  
Klang Valley ◽  
Age Range ◽  
Fitting Hearing Aids

Purpose This study examined the current pediatric amplification practice with an emphasis on hearing aid verification using probe microphone measurement (PMM), among audiologists in Klang Valley, Malaysia. Frequency of practice, access to PMM system, practiced protocols, barriers, and perception toward the benefits of PMM were identified through a survey. Method A questionnaire was distributed to and filled in by the audiologists who provided pediatric amplification service in Klang Valley, Malaysia. One hundred eight ( N = 108) audiologists, composed of 90.3% women and 9.7% men (age range: 23–48 years), participated in the survey. Results PMM was not a clinical routine practiced by a majority of the audiologists, despite its recognition as the best clinical practice that should be incorporated into protocols for fitting hearing aids in children. Variations in practice existed warranting further steps to improve the current practice for children with hearing impairment. The lack of access to PMM equipment was 1 major barrier for the audiologists to practice real-ear verification. Practitioners' characteristics such as time constraints, low confidence, and knowledge levels were also identified as barriers that impede the uptake of the evidence-based practice. Conclusions The implementation of PMM in clinical practice remains a challenge to the audiology profession. A knowledge-transfer approach that takes into consideration the barriers and involves effective collaboration or engagement between the knowledge providers and potential stakeholders is required to promote the clinical application of evidence-based best practice.

Translating Principles of Speech Science to Clinical Practice: Current and Future Trends in Craniofacial Disorders

2008 ◽  
Vol 18 (1) ◽  
pp. 31-40 ◽  
Author(s):  
David J. Zajac
Keyword(s):  
Clinical Practice ◽  
Speech Intelligibility ◽  
Current Practice ◽  
Computer Assisted ◽  
Behavioral Management ◽  
Single Word ◽  
Future Directions ◽  
Speech Science ◽  
The Impact ◽  
Opinion Article

Abstract The purpose of this opinion article is to review the impact of the principles and technology of speech science on clinical practice in the area of craniofacial disorders. Current practice relative to (a) speech aerodynamic assessment, (b) computer-assisted single-word speech intelligibility testing, and (c) behavioral management of hypernasal resonance are reviewed. Future directions and/or refinement of each area are also identified. It is suggested that both challenging and rewarding times are in store for clinical researchers in craniofacial disorders.

Dialectical Behaviour Therapy Skills Training Groups for Common Mental Health Disorders: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Chantal P Delaquis ◽  
Kayla M. Joyce ◽  
Maureen Zalewski ◽  
Laurence Katz ◽  
Julia Sulymka ◽  
...  
Keyword(s):  
Mental Health ◽  
Emotion Regulation ◽  
Meta Analysis ◽  
Skills Training ◽  
Mental Health Disorders ◽  
Behaviour Therapy ◽  
Dialectical Behaviour Therapy ◽  
Transdiagnostic Treatment ◽  
Training Groups ◽  
Health Disorders

Context: Emotion regulation deficits are increasingly recognized as an underlying mechanism of many disorders. Dialectical behaviour therapy (DBT) holds potential as a transdiagnostic treatment for disorders with underlying emotion regulation deficits.Objective: Systematically review the evidence for DBT skills training groups as a transdiagnostic treatment for common mental health disorders via meta-analysis. Study Selection: Randomized control trials (RCTs) of DBT skills training groups for adults with common mental health disorders, and no comorbid personality disorder, were included. Data Synthesis: Twelve RCTs met inclusion criteria (N = 425 participants). DBT had a moderate-to-large effect on symptom reduction (g = 0.79, 95% CI [0.52, 1.06], p &lt; .0001). Improvements in emotion regulation yielded a small-to-moderate effect (g = 0.48, 95% CI [0.22, 0.74], p &lt; .01). Results showed significant effects of DBT on depression (g = 0.50, 95% CI [0.25, 0.75], p = .002), eating disorders (g = 0.83, 95% CI [0.49, 1.17], p = .001) and anxiety (g = 0.45, 95% CI [0.08, 0.83], p = .03).Conclusions: Findings suggest DBT is an effective treatment for common mental health disorders and may be considered as a promising transdiagnostic therapy.

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