BackgroundTransdiagnostic clinical emotional dysregulation is a key component of psychopathology and offers an avenue to address multiple disorders with one transdiagnostic treatment. In the current study, we pilot a one-time intervention... more
BackgroundTransdiagnostic clinical emotional dysregulation is a key component of psychopathology and offers an avenue to address multiple disorders with one transdiagnostic treatment. In the current study, we pilot a one-time intervention that combines cognitive restructuring (CR) with repetitive transcranial magnetic stimulation (rTMS), targeted using functional magnetic resonance imaging (fMRI).MethodsThirty-seven clinical adults with high emotional dysregulation were enrolled in this randomized, double-blind, placebo-controlled trial. fMRI was collected as participants were reminded of lifetime stressors and asked to downregulate their distress using CR tactics. fMRI BOLD data were analyzed to identify the cluster of voxels within the left dorsolateral prefrontal cortex (dlPFC) with the highest activation when participants attempted to downregulate, versus passively remember, distressing memories. Participants underwent active or sham rTMS (10 Hz) over the target while practicing...
Research Interests:
Research Interests:
Dialectical Behavior Therapy (DBT) is effective at treating disorders of emotion dysregulation. However, it is unclear which mechanisms contribute to these effects. The aim of this study was to characterize the within-person associations... more
Dialectical Behavior Therapy (DBT) is effective at treating disorders of emotion dysregulation. However, it is unclear which mechanisms contribute to these effects. The aim of this study was to characterize the within-person associations of two theoretically relevant mechanisms of change, skill use and skill effectiveness, with anxiety, stress, and depression. Participants (n = 19, Mage = 31.8, 68% female) with a primary anxiety or depressive disorder completed daily reports (N = 1344) of DBT skill use, perceived effectiveness, anxiety, stress, and depression during a 16-session DBT skills training group. DBT skill use increased across treatment, p < .01, but effectiveness did not, p = .64. Within persons, participants used more skills on days with greater stress and anxiety, p < .01, which predicted next-day decreases in stress and anxiety, p = .03. On days when participants reported higher effectiveness, they used more skills than their personal average when experiencing mor...
Research Interests:
Research Interests:
Introduction: Emotional dysregulation constitutes a serious public health problem in need of novel transdiagnostic treatments. Objective: To this aim, we developed and tested a one-time intervention that integrates behavioral skills... more
Introduction: Emotional dysregulation constitutes a serious public health problem in need of novel transdiagnostic treatments. Objective: To this aim, we developed and tested a one-time intervention that integrates behavioral skills training with concurrent repetitive transcranial magnetic stimulation (rTMS). Methods: Forty-six adults who met criteria for at least one DSM-5 disorder and self-reported low use of cognitive restructuring (CR) were enrolled in a randomized, double-blind, sham-controlled trial that used a between-subjects design. Participants were taught CR and underwent active rTMS applied at 10 Hz over the right (n = 17) or left (n = 14) dorsolateral prefrontal cortex (dlPFC) or sham rTMS (n = 15) while practicing reframing and emotional distancing in response to autobiographical stressors. Results: Those who received active left or active right as opposed to sham rTMS exhibited enhanced regulation (ds = 0.21–0.62) as measured by psychophysiological indices during the ...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
This chapter examines modifications to and implementation of the skills training mode of dialectical behaviour therapy (DBT). Skills training in DBT is often modified, and the implementation of these adaptations is often inconsistent with... more
This chapter examines modifications to and implementation of the skills training mode of dialectical behaviour therapy (DBT). Skills training in DBT is often modified, and the implementation of these adaptations is often inconsistent with the evidence-base for DBT. This chapter provides guidance for adapting skills training for implementation in community-based settings. It reviews theoretical underpinnings of DBT skills training, the content and general structure of skills training, and empirical support for adaptations of skills training. It discusses how the broad principles that guide DBT—Zen, behaviour therapy, and dialectical philosophy—are applied in skills training group. It then discusses practical considerations, including recommendations for starting a new group and making research-informed decisions when modifying skills training in community-based settings. Finally, it includes case examples and a decision tree that contains specific recommendations for which DBT skills...
We examined in two independent samples whether: (1) difficulties with emotion regulation predict suicide ideation and (2) depressed adults with a history of attempting suicide report and exhibit more emotion dysregulation compared to... more
We examined in two independent samples whether: (1) difficulties with emotion regulation predict suicide ideation and (2) depressed adults with a history of attempting suicide report and exhibit more emotion dysregulation compared to healthy and depressed controls. Difficulties with emotional clarity and relationship status were significant predictors of suicide ideation (Study 1). In Study 2, when compared to controls, depressed attempters reported significantly more difficulties with emotional clarity and emotional impulsivity. Attempters had significantly more difficulty than controls returning to heart rate baseline following a stressful task. Problems with emotions are therefore differentially connected to suicidal behaviors.
Research Interests:
Contemporary treatments assume that the inability to downregulate negative emotional arousal is a key problem in the development and maintenance of psychopathology and that lack of effective regulation efforts and a preference to use... more
Contemporary treatments assume that the inability to downregulate negative emotional arousal is a key problem in the development and maintenance of psychopathology and that lack of effective regulation efforts and a preference to use maladaptive regulation strategies is a primary mechanism. Though ubiquitous, there is limited empirical evidence to support this assumption. Therefore, the aim of the current study was to examine whether self-reported emotion dysregulation equated to difficulties reducing emotional arousal during a behavioral task and to primary use of maladaptive strategies to manage negative emotions. 44 anxious and depressed adults with high emotion dysregulation induced negative distress using autobiographic memory recall. After induction, participants were instructed to downregulate but were not provided any specific instructions in strategies to use. Self-reported emotional arousal was assessed before and after induction and after regulation. Qualitative descripti...
Research Interests:
The standard clinical technique for using repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder (MDD) is associated with limited efficacy to date. Such limited efficacy may be due to reliance on scalp-based... more
The standard clinical technique for using repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder (MDD) is associated with limited efficacy to date. Such limited efficacy may be due to reliance on scalp-based targeting rather than state-of-the-science methods which incorporate fMRI-guided neuronavigation based on a specific model of neurocircuit dysfunction. In this review, we examine such a specific model drawn from regulatory focus theory, which postulates two brain/behavior systems, the promotion and prevention systems, underlying goal pursuit. Individual differences in these systems have been shown to predict vulnerability to MDD as well as to comorbid generalized anxiety disorder (GAD). Activation of an individual's promotion or prevention goals via priming leads to motivational and affective responses modulated by the individual's appraisal of their progress in attaining the goal. In addition, priming promotion vs. prevention goals induces dis...
Research Interests:
The standard clinical technique for using repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder (MDD) is associated with limited efficacy to date. Such limited efficacy may be due to reliance on scalp-based... more
The standard clinical technique for using repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder (MDD) is associated with limited efficacy to date. Such limited efficacy may be due to reliance on scalp-based targeting rather than state-of-the-science methods which incorporate fMRI-guided neuronavigation based on a specific model of neurocircuit dysfunction. In this review, we examine such a specific model drawn from regulatory focus theory, which postulates two brain/behavior systems, the promotion and prevention systems, underlying goal pursuit. Individual differences in these systems have been shown to predict vulnerability to MDD as well as to comorbid generalized anxiety disorder (GAD). Activation of an individual's promotion or prevention goals via priming leads to motivational and affective responses modulated by the individual's appraisal of their progress in attaining the goal. In addition, priming promotion vs. prevention goals induces dis...
Research Interests:
Zusammenfassung. Ziel dieser Arbeit war die Erprobung und Validierung einer deutschen Version der Dialectical Behavior Therapy Ways of Coping Checklist (DBT-WCCL, Neacsiu, Rizui, Vitaliano, Lynch & Linehan, 2010 ), einem Fragebogen zur... more
Zusammenfassung. Ziel dieser Arbeit war die Erprobung und Validierung einer deutschen Version der Dialectical Behavior Therapy Ways of Coping Checklist (DBT-WCCL, Neacsiu, Rizui, Vitaliano, Lynch & Linehan, 2010 ), einem Fragebogen zur Erhebung der Häufigkeit der Nutzung von Skills, wie sie im Rahmen der Dialektisch-Behavioralen Therapie (DBT) vermittelt werden. Hierzu bearbeiteten 150 Patientinnen mit Borderline Persönlichkeitsstörung eine deutschsprachige Übersetzung, sowie Fragebögen zur Symptomschwere. Weitere 40 Patientinnen füllten die DBT-WCCL im Rahmen einer stationären DBT zu 5 Messzeitpunkten aus. Die drei Faktoren der Originalversion ließen sich replizieren. Weiterführende Analysen zeigten gute interne Konsistenzen und Retest-Reliabilitäten. Erwartungsgemäße Zunahmen auf der Subskala zur Erfassung von Skillsanwendung während der stationären DBT sowie erwartungsgemäße Zusammenhänge der DBT-WCCL mit der Skills- und DBT-Erfahrung geben erste Hinweise auf die Validität des Ve...
Research Interests:
Research Interests:
Dialectical behavior therapy (DBT) is an empirically supported treatment for suicidal individuals. However, DBT consists of multiple components, including individual therapy, skills training, telephone coaching, and a therapist... more
Dialectical behavior therapy (DBT) is an empirically supported treatment for suicidal individuals. However, DBT consists of multiple components, including individual therapy, skills training, telephone coaching, and a therapist consultation team, and little is known about which components are needed to achieve positive outcomes. To evaluate the importance of the skills training component of DBT by comparing skills training plus case management (DBT-S), DBT individual therapy plus activities group (DBT-I), and standard DBT which includes skills training and individual therapy. We performed a single-blind randomized clinical trial from April 24, 2004, through January 26, 2010, involving 1 year of treatment and 1 year of follow-up. Participants included 99 women (mean age, 30.3 years; 69 [71%] white) with borderline personality disorder who had at least 2 suicide attempts and/or nonsuicidal self-injury (NSSI) acts in the last 5 years, an NSSI act or suicide attempt in the 8 weeks befor...
Research Interests:
This study examined the relation between identity disturbance and emotion dysregulation in a cross-diagnostic sample. We assessed whether these constructs are related and relevant beyond borderline personality disorder (BPD). We recruited... more
This study examined the relation between identity disturbance and emotion dysregulation in a cross-diagnostic sample. We assessed whether these constructs are related and relevant beyond borderline personality disorder (BPD). We recruited 127 participants who completed measures assessing identity disturbance, emotion dysregulation, anxiety, and depression. The sample included primarily depressed adults meeting criteria for multiple diagnoses as well as psychiatrically healthy participants. Identity disturbance was significantly higher among psychiatric participants with and without BPD compared to healthy controls. Emotion dysregulation was a significant predictor of identity disturbance, even when controlling for BPD diagnosis, depression, and anxiety. In particular, clarity in emotional situations and problems using emotion regulation strategies were most closely related to identity disturbance. The results of this study suggest that future research should examine identity disturb...
Research Interests: Psychology, Clinical Psychology, Cognitive Science, Anxiety Disorders, Borderline Personality Disorder, and 13 moreAdolescent, Emotions, Humans, Female, Male, Regression Analysis, Young Adult, Depressive Disorder, Middle Aged, Adult, Identity Crisis, Southeastern United States, and Case Control Studies
Difficulties with emotions are common across mood and anxiety disorders. Dialectical behavior therapy skills training (DBT-ST) reduces emotion dysregulation in borderline personality disorder (BPD). Preliminary evidence suggests that use... more
Difficulties with emotions are common across mood and anxiety disorders. Dialectical behavior therapy skills training (DBT-ST) reduces emotion dysregulation in borderline personality disorder (BPD). Preliminary evidence suggests that use of DBT skills mediates changes seen in BPD treatments. Therefore, we assessed DBT-ST as a stand-alone, transdiagnostic treatment for emotion dysregulation and DBT skills use as a mediator of outcome. Forty-four anxious and/or depressed, non-BPD adults with high emotion dysregulation were randomized to 16 weeks of either DBT-ST or an activities-based support group (ASG). Participants completed measures of emotion dysregulation, DBT skills use, and psychopathology every 2 months through 2 months posttreatment. Longitudinal analyses indicated that DBT-ST was superior to ASG in decreasing emotion dysregulation (d = 1.86), increasing skills use (d = 1.02), and decreasing anxiety (d = 1.37) but not depression (d = 0.73). Skills use mediated these differential changes. Participants found DBT-ST acceptable. Thirty-two percent of DBT-ST and 59% of ASG participants dropped treatment. Fifty-nine percent of DBT-ST and 50% of ASG participants complied with the research protocol of avoiding ancillary psychotherapy and/or medication changes. In summary, DBT-ST is a promising treatment for emotion dysregulation for depressed and anxious transdiagnostic adults, although more assessment of feasibility is needed.
Research Interests:
Dialectical Behavior Therapy (DBT) is a comprehensive, multimodal cognitive behavioral treatment originally developed for individuals who met criteria for borderline personality disorder (BPD) who displayed suicidal tendencies. DBT is... more
Dialectical Behavior Therapy (DBT) is a comprehensive, multimodal cognitive behavioral treatment originally developed for individuals who met criteria for borderline personality disorder (BPD) who displayed suicidal tendencies. DBT is based on behavioral theory but also includes principles of acceptance, mindfulness, and validation. Since its development, DBT has been adapted to various populations and has been successfully used in a wide array of settings. This article presents the approaches used in DBT with a particular emphasis on (a) the philosophy and assumptions on which the treatment is based, (b) the major theoretical constructs and the DBT conceptualization of the client, (c) the intervention and specific techniques used, (d) research supporting the theory and treatment, and (e) the integration of diversity, culture, and social justice.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests: Psychology, Anger, Depression, Borderline Personality Disorder, Suicide, and 15 moreLinear models, Self Efficacy, Humans, Business and Management, Female, Cognitive Therapy, Skill, Awareness, Major Depression, Adult, Dialectical Behavior Therapy, Mechanism of action, Suicide Attempt, Hierarchical Linear Model, and Behaviour Therapy
Research Interests: Psychology, Emotion, Community-Based Mental Health Services, Borderline Personality Disorder, Suicide, and 13 moreTreatment Outcome, Adolescent, Emotions, Humans, Business and Management, Female, Cognitive Therapy, Young Adult, Follow-up studies, Middle Aged, Questionnaires, Adult, and Behaviour Therapy
Previous studies have demonstrated abnormalities in emotion recognition within individuals diagnosed with borderline personality disorder (BPD). However, it is yet unknown how much these abnormalities can be attributed to emotional states... more
Previous studies have demonstrated abnormalities in emotion recognition within individuals diagnosed with borderline personality disorder (BPD). However, it is yet unknown how much these abnormalities can be attributed to emotional states or affect. Therefore, the current study aimed to investigate the independent effects of BPD, positive affect, and negative affect on emotion recognition sensitivity. We recruited a mixed, transdiagnostic community sample of 118 adults diagnosed with either a personality disorder, only an affective disorder, or without psychopathology. Participants completed self-report assessments of positive and negative affect and two behavioral assessments of emotion recognition sensitivity. We found that both positive and negative affect predict lower overall emotion recognition sensitivity in both tasks, beyond the effect of BPD. We did not find a significant, independent effect of the diagnosis of BPD. Additionally, we found that the diagnosis of BPD moderate...