scholarly journals Emotion regulation group therapy for deliberate self-harm: a multi-site evaluation in routine care using an uncontrolled open trial design

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e016220 ◽  
Author(s):  
Hanna Sahlin ◽  
Johan Bjureberg ◽  
Kim L Gratz ◽  
Matthew T Tull ◽  
Erik Hedman ◽  
...  
Keyword(s):  
Emotion Dysregulation ◽  
Trial Design ◽  
Primary Outcome ◽  
Borderline Personality ◽  
Post Treatment ◽  
Deliberate Self Harm ◽  
Site Evaluation ◽  
Self Harm ◽  
Secondary Outcomes

ObjectiveEmotion regulation group therapy (ERGT) has shown promising results in several efficacy trials. However, it has not been evaluated outside a research setting. In order to increase the availability of empirically supported treatments for individuals with borderline personality disorder and deliberate self-harm, an evaluation of ERGT in routine clinical care was conducted with therapists of different professional backgrounds who had received brief intensive training in ERGT prior to trial onset.DesignMulti-site evaluation, using an uncontrolled open trial design with assessments at pretreatment, post-treatment and 6-month follow-up.Setting14 adult outpatient psychiatric clinics across Sweden.ParticipantsNinety-five women (mean age=25.1 years) with borderline personality disorder (both threshold and subthreshold) and repeated self-harm were enrolled in the study. Ninety-three per cent of participants completed the post-treatment assessment and 88% completed the follow-up assessment.Primary and secondary outcome measuresPrimary outcome was self-harm frequency as measured with the Deliberate Self-Harm Inventory. Secondary outcomes included self-harm versatility, emotion dysregulation, other self-destructive behaviours, depression, anxiety, stress symptoms and interpersonal and vocational difficulties.InterventionERGT is an adjunctive, 14-week, acceptance-based behavioural group treatment that directly targets both self-harm and its proposed underlying mechanism of emotion dysregulation.ResultsAt post-treatment, intent-to-treat analyses revealed a significant improvement associated with a moderate effect size on the primary outcome of self-harm frequency (51%, reduction; Cohen’s d=0.52, p<0.001) as well as significant improvements in the secondary outcomes of self-harm versatility, emotion dysregulation, other self-destructive behaviours and general psychiatric symptomatology. These results were either maintained or further improved on at 6-month follow-up.ConclusionsERGT appears to be a feasible, transportable and useful treatment for deliberate self-harm and other self-destructive behaviours, emotion dysregulation and psychiatric symptoms when delivered by clinicians in the community.Trial registration numberNCT01986257; results.

Randomized controlled trial and uncontrolled 9-month follow-up of an adjunctive emotion regulation group therapy for deliberate self-harm among women with borderline personality disorder

2013 ◽  
Vol 44 (10) ◽  
pp. 2099-2112 ◽  
Author(s):  
K. L. Gratz ◽  
M. T. Tull ◽  
R. Levy
Keyword(s):  
Emotion Dysregulation ◽  
Controlled Trial ◽  
Borderline Personality ◽  
Post Treatment ◽  
Randomized Controlled ◽  
Self Harm ◽  
Treatment Gains ◽  
Destructive Behaviors

BackgroundDespite the clinical importance of deliberate self-harm (DSH; also referred to as non-suicidal self-injury) within borderline personality disorder (BPD), empirically supported treatments for this behavior among individuals with BPD are difficult to implement in many clinical settings. To address this limitation, a 14-week, adjunctive emotion regulation group therapy (ERGT) for DSH among women with BPD was developed. The current study examined the efficacy of this ERGT in a randomized controlled trial (RCT) and the durability of treatment gains over a 9-month uncontrolled follow-up period.MethodFemale out-patients with BPD and recent recurrent DSH were randomly assigned to receive this ERGT in addition to their ongoing out-patient therapy immediately (n = 31) or after 14 weeks (n = 30). Measures of DSH and other self-destructive behaviors, psychiatric symptoms, adaptive functioning and the proposed mechanisms of change (emotion dysregulation/avoidance) were administered pre- and post-treatment or -waitlist (to assess treatment efficacy), and 3 and 9 months post-treatment (to assess durability of treatment gains).ResultsIntent-to-treat (ITT) analyses (n = 61) revealed significant effects of this ERGT on DSH and other self-destructive behaviors, emotion dysregulation, BPD symptoms, depression and stress symptoms, and quality of life. Analyses of all participants who began ERGT (across treatment and waitlist conditions; n = 51) revealed significant improvements from pre- to post-treatment on all outcomes, additional significant improvements from post-treatment to 9-month follow-up for DSH, emotion dysregulation/avoidance, BPD symptoms and quality of life, and no significant changes from post-treatment to 9-month follow-up on the other measures.ConclusionsThe results support the efficacy of this ERGT and the durability of treatment gains.

The effect of referral for brief intervention for alcohol misuse on repetition of deliberate self-harm: an exploratory randomized controlled trial

2010 ◽  
Vol 40 (11) ◽  
pp. 1821-1828 ◽  
Author(s):  
M. J. Crawford ◽  
E. Csipke ◽  
A. Brown ◽  
S. Reid ◽  
K. Nilsen ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Health Information ◽  
Brief Intervention ◽  
Primary Outcome ◽  
Alcohol Misuse ◽  
Controlled Trial ◽  
Information Leaflet ◽  
Deliberate Self Harm ◽  
Self Harm ◽  
Secondary Outcomes

BackgroundReferral for brief intervention among people who misuse alcohol is reported to be effective but its impact among those who present to services following deliberate self-harm (DSH) has not been examined.MethodConsecutive patients who presented to an Emergency Department (ED) following an episode of DSH were screened for alcohol misuse. Those found to be misusing alcohol were randomly assigned to brief intervention plus a health information leaflet or to a health information leaflet alone. The primary outcome was whether the patient reattended an ED following a further episode of DSH during the subsequent 6 months. Secondary outcomes were alcohol consumption, mental health and satisfaction with care measured 3 and 6 months after randomization.ResultsOne hundred and three people took part in the study. Follow-up data on our primary outcome were obtained for all subjects and on 63% for secondary outcomes. Half those referred for brief intervention received it. Repetition of DSH was strongly associated with baseline alcohol consumption, but not influenced by treatment allocation. There was a non-significant trend towards the number of units of alcohol consumed per drinking day being lower among those randomized to brief intervention.ConclusionsReferral for brief intervention for alcohol misuse following an episode of DSH may not influence the likelihood of repetition of self-harm. Longer-term interventions may be needed to help people who deliberately harm themselves and have evidence of concurrent alcohol misuse.

THE TREATMENT OF DELIBERATE SELF-HARM IN BORDERLINE PERSONALITY DISORDER USING DIALECTICAL BEHAVIOUR THERAPY: A PILOT STUDY IN A HIGH SECURITY HOSPITAL

2001 ◽  
Vol 29 (1) ◽  
pp. 85-92 ◽  
Author(s):  
Gail Low ◽  
David Jones ◽  
Conor Duggan ◽  
Mick Power ◽  
Andrew MacLeod
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Suicide Ideation ◽  
Borderline Personality ◽  
Institutional Setting ◽  
Behaviour Therapy ◽  
Deliberate Self Harm ◽  
Dialectical Behaviour Therapy ◽  
Self Harm

Deliberate self-harm (DSH) presents a significant health problem, especially as treatments have not been particularly successful in reducing repetition. Dialectical behaviour therapy (DBT; Linehan, 1993) is one approach that has reported some success in reducing self-harm rates in borderline personality disorder patients, who self-harm frequently, though it remains largely untested outside its original setting. The present study aimed to assess the effectiveness of DBT in self-harming women in an institutional setting in the United Kingdom where self-harm is common. Female patients at Rampton Hospital who were displaying self-harming behaviour and met criteria for borderline personality disorder (N = 10) participated in the full one-year treatment package of DBT. Patients were assessed on self-harm rates and on a number of psychological variables, pre-, during- and post-therapy, including a 6-month follow-up. There was a significant reduction in DSH during therapy, which was maintained at 6-month follow-up. This was paralleled by a reduction in dissociative experiences and an increase in survival and coping beliefs, alongside improvements in depression, suicide ideation, and impulsiveness. The findings are preliminary but the results suggest that DBT might provide an effective treatment for severe self-harm in institutional settings, and also highlight some of the psychological mechanisms that might mediate these improvements in self-harming behaviour.

Emotion Regulation as a Mechanism of Change in an Acceptance-Based Emotion Regulation Group Therapy for Deliberate Self-Harm Among Women With Borderline Personality Pathology

2012 ◽  
Vol 26 (4) ◽  
pp. 365-380 ◽  
Author(s):  
Kim L. Gratz ◽  
Roy Levy ◽  
Matthew T. Tull
Keyword(s):  
Emotion Regulation ◽  
Group Therapy ◽  
Emotion Dysregulation ◽  
Clinical Importance ◽  
Underlying Mechanism ◽  
Borderline Personality ◽  
Deliberate Self Harm ◽  
Mediating Role ◽  
Empirically Supported ◽  
Self Harm

Despite the clinical importance of deliberate self-harm (DSH) within borderline personality disorder (BPD), there are few empirically supported treatments for this behavior among individuals with BPD; and those that do exist are difficult to implement in many clinical settings. Thus, Gratz and colleagues developed an adjunctive emotion regulation group therapy (ERGT) for women with BPD that directly targets both DSH and its proposed underlying mechanism of emotion dysregulation. Although previous studies support the use of this ERGT in reducing DSH, no studies have examined emotion regulation as a mechanism of change in this treatment. Therefore, this study examined the mediating role of changes in emotion dysregulation in DSH improvement across two separate trials of this ERGT. As hypothesized, changes in emotion dysregulation mediated the observed reductions in DSH frequency. Results provide support for the theoretical model underlying this ERGT and highlight the importance of targeting emotion dysregulation in treatments for DSH.

Rumination in Borderline Personality Disorder: Meta-Analysis

2018 ◽  
Author(s):  
Mara J. Richman ◽  
Zsolt Unoka ◽  
Robert Dudas ◽  
Zsolt Demetrovics
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Emotion Dysregulation ◽  
Meta Analysis ◽  
Borderline Personality ◽  
Therapeutic Interventions ◽  
Sample Type ◽  
Moderator Variables ◽  
Analytic Review ◽  
Self Harm

Borderline personality disorder (BPD) is characterized by deficits in emotion regulation and affective liability. Of this domain, ruminative behaviors have been considered a core feature of emotion dysregulation difficulties. Despite this, inconsistencies have existed in the literature regarding which rumination type is most prominent in those with BPD symptoms. Moreover, no meta-analytic review has been performed to date on rumination in BPD. Taking this into consideration, a meta-analysis was performed to assess how BPD symptoms correlate with rumination, while also considering clinical moderator variables (i.e., BPD symptom domain, co-morbidities, GAF score) and demographic moderator variables (i.e., age, gender, sample type, and education level). Analysis of correlation across rumination domains for the entire sample revealed a medium overall correlation between BPD symptoms and rumination. When assessing types of rumination, the largest correlation was among pain rumination followed by anger, depressive, and anxious rumination. Among BPD symptom domain, affective instability had the strongest correlation with increased rumination, followed by unstable relationships, identity disturbance, and self-harm/ impulsivity, respectively. Demographic variables showed no significance. Clinical implications are considered and further therapeutic interventions are discussed in the context of rumination.

scholarly journals Repetition of deliberate self-harm and subsequent suicide risk: Long-term follow-up study of 11 583 patients

2004 ◽  
Vol 185 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Daniel Louis Zahl ◽  
Keith Hawton
Keyword(s):  
Relative Risk ◽  
Suicide Risk ◽  
Single Episode ◽  
Deliberate Self Harm ◽  
Young Females ◽  
Follow Up Study ◽  
Increased Risk ◽  
Self Harm

BackgroundRepetition of deliberate self-harm (DSH) is a risk factor for suicide. Little information is available on the risk for specific groups of people who deliberately harm themselves repeatedly.AimsTo investigate the long-term risk of suicide associated with repetition of DSH by gender, age and frequency of repetition.MethodA mortality follow-up study to the year 2000 was conducted on 11583 people who presented to the general hospital in Oxford between 1978 and 1997. Repetition of DSH was determined from reported episodes prior to the index episode and episodes presenting to the same hospital during the follow-up period. Deaths were identified through national registers.ResultsThirty-nine percent of patients repeated the DSH. They were at greater relative risk of suicide than the single-episode DSH group (2.24; 95% CI 1.77–2.84). The relative risk of suicide in the repeated DSH group compared with the single-episode DSH group was greater in females (3.5; 95% C11.3–2.4) than males (1.8; 95% C1 2.3–5.3) and was inversely related to age (up to 54 years). Suicide risk increased further with multiple repeat episodes of DSH in females.ConclusionsRepetition of DSH is associated with an increased risk of suicide in males and females. Repetition may be a better indicator of risk in females, especially young females.

Efficacy of intravitreal conbercept injection in the treatment of retinopathy of prematurity

2018 ◽  
Vol 103 (4) ◽  
pp. 494-498 ◽  
Author(s):  
Yichen Bai ◽  
Huanjie Nie ◽  
Shiyu Wei ◽  
Xiaohe Lu ◽  
Xiaoyun Ke ◽  
...  
Keyword(s):  
Retinopathy Of Prematurity ◽  
Laser Photocoagulation ◽  
Primary Outcome ◽  
Safety And Efficacy ◽  
Postmenstrual Age ◽  
Zone Ii ◽  
The Mean ◽  
Secondary Outcomes ◽  
Number Of Injections

BackgroundTo evaluate the safety and efficacy of intravitreal conbercept (IVC) injection in the treatment of retinopathy of prematurity (ROP).MethodsPatients with ROP who underwent IVC injection in Zhujiang Hospital from June 2015 to July 2016 were studied retrospectively. The primary outcome was defined as the regression of plus disease. The secondary outcomes were defined as the presence of recurrence, number of injections and the final regression of disease.ResultsA total of 48 eyes of 24 patients with ROP were included. Among them, 9 eyes of 5 patients had zone I ROP, 35 eyes of 18 patients had zone II ROP and 4 eyes of 2 patients had aggressive posterior ROP. The mean gestational age was 28.5±1.6 weeks, the mean birth weight was 1209.6±228.6 g, the mean postmenstrual age of first injection was 34.2±1.9 weeks and the mean follow-up period was 31.0±4.7 weeks. Forty of 48 eyes (83.3%) received IVC only once, and the regression of plus disease occurred at an average of 3.5±1.5 weeks after the first injection of conbercept. For eight recurrent eyes (16.7%), four eyes received a second IVC and the remaining four eyes received laser photocoagulation, and the regression of plus disease occurred in 3 weeks. No lens opacity, vitreous haemorrhage, entophthalmia or retinal detachment was observed during follow-up.ConclusionIVC injection is an effective treatment for ROP.

scholarly journals A Virtual Reality-Based Self-Help Intervention for Dealing with the Psychological Distress Associated with the COVID-19 Lockdown: An Effectiveness Study with a Two-Week Follow-Up

2021 ◽  
Vol 18 (15) ◽  
pp. 8188
Author(s):  
Giuseppe Riva ◽  
Luca Bernardelli ◽  
Gianluca Castelnuovo ◽  
Daniele Di Lernia ◽  
Cosimo Tuena ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Psychological Distress ◽  
Outcome Measures ◽  
Perceived Stress ◽  
Social Connectedness ◽  
Primary Outcome ◽  
Post Intervention ◽  
Stress Levels ◽  
Secondary Outcomes

The aim of this study is to investigate the effectiveness of a novel self-administered at-home daily virtual reality (VR)-based intervention (COVID Feel Good) for reducing the psychological burden experienced during the COVID-19 lockdown in Italy. A total of 40 individuals who had experienced at least two months of strict social distancing measures followed COVID Feel Good between June and July 2020 for one week. Primary outcome measures were depression, anxiety, and stress symptoms, perceived stress levels, and hopelessness. Secondary outcomes were the experienced social connectedness and the level of fear experienced during the COVID-19 pandemic. Linear mixed-effects models were fitted to evaluate the effectiveness of the intervention. Additionally, we also performed a clinical change analysis on primary outcome measures. As concerning primary outcome measures, participants exhibited improvements from baseline to post-intervention for depression levels, stress levels, general distress, and perceived stress (all p < 0.05) but not for the perceived hopelessness (p = 0.110). Results for the secondary outcomes indicated an increase in social connectedness from T0 to T1 (p = 0.033) but not a significant reduction in the perceived fear of coronavirus (p = 0.412). Among these study variables, these significant improvements were maintained from post-intervention to the 2-week follow-up (p > 0.05). Results indicated that the intervention was associated with good clinical outcomes, low-to-no risks for the treatment, and no adverse effects or risks. Globally, evidence suggests a beneficial effect of the proposed protocol and its current availability in 12 different languages makes COVID Feel Good a free choice for helping individuals worldwide to cope with the psychological distress associated with the COVID-19 crisis, although large scale trials are needed to evaluate its efficacy.

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