He Waka Eke Noa at Korowai Manaaki: A Process Evaluation of a Dialectical Behaviour Therapy-informed skills programme for young people in a secure youth justice residence

<p>Dialectical Behaviour Therapy (DBT) aims to help people live a life worth living. It has increasingly been developed and adapted to address a range of mental health symptoms across different ages, cognitive abilities and environmental contexts; however, its popularity in implementation has outpaced empirical research. The current study was a Process Evaluation which assessed professionals’ perspectives about a DBT-informed skills group called He Waka Eke Noa operating at Korowai Manaaki – a youth justice secure residence in New Zealand (NZ). The study involved 11 interviews with professionals across two organisations involved in facilitating He Waka Eke Noa and/or supporting the young people who participated. Thematic analysis was used to analyse the interviews and three overarching themes were identified. The first theme, ‘Factors influencing practical effectiveness’, explored areas which professionals highlighted as having a significant impact on how He Waka Eke Noa worked and had three subthemes: ‘Generalisability’, ‘Cultural Responsivity’, and ‘Criminal Justice Environment’. The second theme, ‘Theoretical application of DBT to young people in NZ’ investigated the compatibility of DBT with young people in secure youth justice residences in NZ. The final theme, ‘Motivation’, considered the role that motivation played in engagement and continuation of treatment for people involved in He Waka Eke Noa. The findings from this study shed light on how the group was operating and highlighted the importance of the relationship between facilitators and young people. It identified the challenges He Waka Eke Noa faced including the difficulty of balancing a risk-reduction approach with creating a therapeutic environment. Further developments are considered that would assist He Waka Eke Noa in maximising its effectiveness through increasing resources and ensuring diversity amongst the clinicians (e.g., increasing cultural diversity). The thesis concludes with recommendations for the future direction of operation, for example, rolling out DBT-informed skills groups in other residences and the community; and potential research avenues.</p>

He Waka Eke Noa at Korowai Manaaki: A Process Evaluation of a Dialectical Behaviour Therapy-informed skills programme for young people in a secure youth justice residence

<p>Dialectical Behaviour Therapy (DBT) aims to help people live a life worth living. It has increasingly been developed and adapted to address a range of mental health symptoms across different ages, cognitive abilities and environmental contexts; however, its popularity in implementation has outpaced empirical research. The current study was a Process Evaluation which assessed professionals’ perspectives about a DBT-informed skills group called He Waka Eke Noa operating at Korowai Manaaki – a youth justice secure residence in New Zealand (NZ). The study involved 11 interviews with professionals across two organisations involved in facilitating He Waka Eke Noa and/or supporting the young people who participated. Thematic analysis was used to analyse the interviews and three overarching themes were identified. The first theme, ‘Factors influencing practical effectiveness’, explored areas which professionals highlighted as having a significant impact on how He Waka Eke Noa worked and had three subthemes: ‘Generalisability’, ‘Cultural Responsivity’, and ‘Criminal Justice Environment’. The second theme, ‘Theoretical application of DBT to young people in NZ’ investigated the compatibility of DBT with young people in secure youth justice residences in NZ. The final theme, ‘Motivation’, considered the role that motivation played in engagement and continuation of treatment for people involved in He Waka Eke Noa. The findings from this study shed light on how the group was operating and highlighted the importance of the relationship between facilitators and young people. It identified the challenges He Waka Eke Noa faced including the difficulty of balancing a risk-reduction approach with creating a therapeutic environment. Further developments are considered that would assist He Waka Eke Noa in maximising its effectiveness through increasing resources and ensuring diversity amongst the clinicians (e.g., increasing cultural diversity). The thesis concludes with recommendations for the future direction of operation, for example, rolling out DBT-informed skills groups in other residences and the community; and potential research avenues.</p>

Dialectical behaviour therapy ‘Skills for Living’ for young people leaving care: A qualitative exploration of participants’ experiences

It is acknowledged that care leavers experience an accelerated transition into adulthood, despite often having complex psychosocial needs with limited support networks. The ‘Skills for Living’ programme was designed to improve the psychological wellbeing of care leavers and offers an adapted Dialectical Behaviour Therapy skills group as its primary intervention. This paper provides a qualitative evaluation of the programme. Semi-structured interviews were undertaken with 10 participants, and the data were analysed using thematic analysis ( Braun & Clarke, 2006 ). Four key themes emerged: ‘Initial Apprehension and Reluctance to Participate’, ‘Connection, Understanding and Validation’, ‘Confidence with Social Skills’, and ‘Emotional Acceptance and Self-Soothing’. Clinical implications and recommendations are discussed.

BORDERLINE PERSONALITY TRAITS AND CYBER-VICTIMISATION -A SINGLE CASE STUDY.

Dialectical behaviour therapy is a form of cognitive behaviour therapy that applies principles of learning to elicit the reasons and the strengthening factors behind maladaptive behaviours and alternate them with more healthy and helpful skills. The present study aims to assess the efcacy of brief dialectical behaviour therapy for borderline personality traits with cyber-victimisation. As a single experimental design, 20 years aged young female, diagnosed with borderline personality traits along with cyber-victimisation was taken up for the study. Borderline traits and cyber-victimisation were targeted maladaptive behaviours. The intervention was given for the duration of 8 weeks, during which DBT in a brief format consisting of mindfulness skills, emotion regulation skills, interpersonal effectiveness skills and distress tolerance skills was given. The sessions were based on weekly basis with each being 60 minutes session. Follow after a month revealed greater reduction in the targeted maladaptive behaviours. The study reveals that brief DBT is effective in reducing borderline personality traits and cyber-victimisation.

A pilot study of dialectical behaviour therapy skills training for autistic adults

Background: Autism spectrum disorder (ASD) is a common and lifelong neurodevelopmental disorder with the hallmark features of social impairment and restricted and repetitive patterns of behaviour. Individuals with ASD often experience co-occurring mental health difficulties, some of which may obfuscate the ASD features themselves. Although there is a high need for mental health services for autistic adults, there are surprisingly few evidence-based treatments (EBTs) available; moreover, many mental health practitioners who are well-trained in EBTs shy away from treating autistic individuals due to lack of training in ASD. Aims: The aim of the current study was to evaluate the feasibility and acceptability of dialectical behaviour therapy skills training (DBT-ST) in a sample of autistic adults without intellectual disability. Method: Sixteen adults with ASD were recruited from a treatment waiting list to enrol in this study, which included 24 weeks of DBT-ST delivered in a group setting. Feasibility and acceptability were assessed using retention and attendance data and a participant satisfaction questionnaire. Results: Retention (81.3%) and attendance data (mean 87.5%) provided support for the feasibility of this intervention. Overall satisfaction ratings were high (mean 4.5 out of 5), and participants reported that they felt that DBT-ST would probably be helpful for others with ASD (mean 4.5 out of 5). Conclusions: The study findings provide preliminary evidence of (1) the feasibility of providing DBT-ST for autistic adults in community-based clinics, and (2) the perceived benefit of DBT-ST for this under-served population. Recommended modifications to the standard DBT-ST materials are discussed.

Radically open dialectical behaviour therapy adapted for adolescents: a case series

Background Overcontrol is a transdiagnostic cluster of traits associated with excessive psychological, behavioural and social inhibitory control. It is associated with psychiatric diagnoses of depression, restrictive eating disorders and/or obsessive-compulsive personality disorder. Radically Open Dialectical Behaviour Therapy is a transdiagnostic treatment for maladaptive overcontrol. This case series evaluates an adolescent adaption (RO-A) for a transdiagnostic group of adolescents identified as overcontrolled. Methods Twenty-eight adolescents were consecutively referred for RO-A from two different National and Specialist Child and Adolescent Mental Health Services between June 2017 and February 2020. Baseline self-report measures assessed overcontrol characteristics, relationship and attachment quality and mental health symptoms of depression and eating disorders, which were repeated at discharge. Results Adolescents in this case series reported high rates of depression (78.6%), self-harm (64.3%) and eating disorders (78.6%). Most (85.7%) had two or more mental health diagnoses and all had previous mental health treatments before starting RO-A. The mean number of RO-A sessions attended was 18 group-based skills classes and 21 individual sessions over a mean period of 34 weeks. Significant improvements with medium and large effect sizes were reported in cognitive flexibility (d = 1.63), risk aversion (d = 1.17), increased reward processing (d = .79) and reduced suppression of emotional expression (d = .72). Adolescents also reported feeling less socially withdrawn (d = .97), more connected to others (d = 1.03), as well as more confident (d = 1.10) and comfortable (d = .85) in attachment relationships. Symptoms of depression (d = .71), eating disorders (d = 1.06) and rates of self-harm (V = .39) also significantly improved. Exploratory correlation analyses suggest improvements in overcontrol are moderately to strongly correlated with improvements in symptoms of depression and eating disorders. Conclusions This case series provides preliminary data that RO-A may be an effective new treatment for adolescents with overcontrol and moderate to severe mental health disorders like depression and eating disorders. RO-A led to improved management of overcontrol, improved relationship quality and reduced mental health symptoms. Further evaluation is indicated by this case series, particularly for underweight young people with eating disorders. More rigorous testing of the model is required as conclusions are only tentative due to the small sample size and methodological limitations.